ABSTRACT
CASE: We review the case of a 44-year-old man with Camurati-Engelmann disease, who presented with chronic right hip pain that did not improve following intra-articular hip injections. He was functionally debilitated because of the worsening pain. Routine radiographs demonstrated severe right hip osteoarthritis and severe diaphyseal sclerosis of the femur. To address the narrowed medullary cavity, appropriate reaming of the diaphysis and broaching to fill the metaphysis were performed. The patient underwent an uncemented total hip arthroplasty that resulted in an excellent recovery with no complications. CONCLUSION: Uncemented total hip arthroplasty serves as a good option for patients with hip osteoarthritis secondary to Camurati-Engelmann disease. Anticipation of potential operative challenges is the key to avoiding complications and achieving an optimal, durable outcome.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Camurati-Engelmann Syndrome , Adult , Camurati-Engelmann Syndrome/complications , Camurati-Engelmann Syndrome/diagnostic imaging , Camurati-Engelmann Syndrome/surgery , Humans , Male , Osteoarthritis, Hip/diagnostic imaging , Osteoarthritis, Hip/etiology , Osteoarthritis, Hip/surgery , Pelvic Bones/diagnostic imaging , Pelvic Bones/surgeryABSTRACT
BACKGROUND: A large component of the cost of revision total hip arthroplasty (THA) is the cost of the implants. We examined the pricing of revision THA implants to determine the possible savings of different pricing models. METHODS: From our institutional database, all revision THAs done from 9/1/2013 to 8/31/2014 were identified. The cost of the implants was analyzed as a percentage of the total cost of the hospitalization and compared to direct to hospital and fixed implant pricing models. RESULTS: Of 153 revision THAs analyzed, the cost of implants amounted to 36% of the total hospital cost. The direct to hospital cost and fixed implant pricing models would reduce the cost of an all-component revision to $4395 (saving $8962 per case) and $5000 (saving $8357 per case). CONCLUSION: Both fixed implant pricing and the direct to hospital pricing models would result in a decrease in revision implant costs.
Subject(s)
Arthroplasty, Replacement, Hip/economics , Hip Prosthesis/economics , Reoperation/economics , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/instrumentation , Databases, Factual , Female , Hospital Costs , Humans , Joints , Male , Middle Aged , Prosthesis Design , Reoperation/instrumentationABSTRACT
CASE: A twenty-five-year-old man presented with recurrent episodes of hemoptysis requiring hospitalization and interventional embolization. Instrumentation that had been implanted ten years previously for anterior spinal correction and fusion to treat adolescent idiopathic scoliosis adjoined the medial border of the right lung. The instrumentation eroded the lung during respiration, which prompted the formation of adhesions and fibrosis. Because of the risk of additional hemoptysis events, we performed revision thoracotomy, removal of the spinal instrumentation, and partial lobectomy. CONCLUSION: This rare and serious complication underscores the importance of meticulous surgical technique to ensure proper implant placement and of vigilant monitoring for late iatrogenic injury.
