Supracondylar femoral fracture following total knee arthroplasty.

Twenty-nine supracondylar femoral fractures above total knee arthroplasty were studied retrospectively. Group 1 consisted of 5 nondisplaced fractures managed with closed treatment, yielding 5 satisfactory results. Group 2 consisted of 9 displaced fractures managed with closed treatment. There were no satisfactory results in Group 2; there were 8 malunions and 2 knees requiring revision. Group 3 consisted of 15 displaced fractures managed with open reduction and internal fixation. There were 10 satisfactory results in Group 3; there were 2 malunions and 3 knees requiring revision or repeat fixation. On the basis of these results, closed treatment for nondisplaced fractures is recommended. If displacement exists, early open reduction and internal fixation yields the greatest chance for a satisfactory result, though it has a significant complication rate.

Prospective serial technetium diphosphonate and indium-111 white blood cell labeled imaging in primary uncemented total hip arthroplasty.

Although technetium diphosphonate (TcMP) and Indium-111 white blood cell labeled (Ind-WBC) imaging are reported useful in identifying aseptic and septic loosening in cemented hip arthroplasty, their usefulness has not been identified in uncemented porous coated hip arthroplasty. We attempted to define the natural history of TcMP and Ind-WBC imaging in primary P.C.A. uncemented total hip arthroplasty. Twenty-five hips in 21 patients were scanned immediately postoperatively, at 3 months, 6 months, 12 months, 18 months, and 24 months after surgery with both TcMP and Ind-WBC tracers. Clinical and radiographic follow-up were also obtained at each interval. Intensity and distribution of tracer activity were recorded as well as the time when stabilization occurred around the acetabulum, femoral porous surface areas, and femoral stem tip. Acetabular cup and femoral porous surface areas stabilized in the first year on both TcMP and Ind-WBC imaging. Focal femoral hip activity continued at 24 months in 72% of TcMP and 24% of Ind-WBC images. TcMP and Ind-WBC images used to assess uncemented total hip arthroplasty should not be over interpreted. Although persistent intense activity after one year around the acetabulum and porous surface femoral areas should be considered abnormal for both TcMP and Ind-WBC scans, femoral tip activity is present in the majority of patients, with or without thigh pain, at 24 months on TcMP scans. Tip activity can also persist at 24 months on Ind-WBC images and should be interpreted in conjunction with TcMP images.

Evaluation of the learning curve associated with uncemented primary porous-coated anatomic total hip arthroplasty.

The results of the first and second groups of 50 consecutive primary, uncemented porous-coated anatomic arthroplasties were analyzed to evaluate the learning curve associated with the procedure. Femoral fit, acetabular cup angle, femoral fracture rate, minimum two-year clinical hip ratings, and clinical symptoms were compared between the two groups. Significant improvement in achieving better femoral canal filling with the prosthesis and lower acetabular cup angle placements was documented in the second 50 cases. Although a definite learning curve in mastering the technique of uncemented total hip arthroplasty was observed, thigh pain rate and clinical ratings were not improved after two years.

Assessing the results of hip replacement. A comparison of five different rating systems.

One hundred hips in patients who had had primary uncemented replacements were followed up for one or two years, and assessed by five different methods. All produced different results. The Hospital for Special Surgery rating produced the most optimistic assessment and the Merle d'Aubigné rating the most pessimistic. The functional class of the patients, as defined by Charnley in 1979, significantly affected the ratings, and these should clearly be included in all rating systems. Moreover, if systems are to be compared, they should all use descriptive words, such as limp or pain, in precisely the same way.

Nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral component.

Ipsilateral femur fractures in patients who have had cemented total hip arthroplasty is an infrequent and hazardous complication. Operative treatment has been specifically recommended for type II fractures (those extending from the proximal portion of the femur shaft to beyond the distal tip of the prosthesis) because of the predictably unsatisfactory results with nonoperative treatment. The authors report the successful nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral component. They recommend nonoperative treatment for minimally displaced type II femoral shaft fractures around uncemented porous-coated prostheses.

The uncemented porous-coated anatomic total hip prosthesis. Two-year results of a prospective consecutive series.

Fifty uncemented porous-coated total hip prostheses were implanted in forty-seven patients whose mean age was fifty-eight years. Clinical hip-rating scores, as described by Harris, were determined and anteroposterior and frog-leg lateral radiographs were made preoperatively, shortly postoperatively, and at three months, six months, one year, and two years postoperatively. The mean hip-rating score was 92 points (range, (range, 74 to 100 points) at one year and 92 points (range, 69 to 100 points) at two years. The thigh was slightly painful in nine patients (18 per cent) at one year and in eight (16 per cent) at two years. Fourteen hips (28 per cent) (in thirteen patients) caused a moderate or severe limp two years postoperatively; however, this complication appears to have been related more to the direct lateral approach that was used than to the prosthesis. Six (13 per cent) of the patients walked with a cane at one year and five (11 per cent) still required a cane at two years. Serial radiographic evaluations revealed that, between the first and second postoperative years, a progressive radiodense femoral line developed in twenty hips (41 per cent); a progressive acetabular line, in four hips (8 per cent); and progressive femoral sclerosis, in twelve hips (24 per cent). There was progressive loosening of beads from twelve (24 per cent) of the femoral components and from nine (18 per cent) of the acetabular components. The position of one acetabular and one femoral component changed. Two femoral shafts fractured, one intraoperatively and one fourteen months postoperatively. We concluded that the clinical results were encouraging in these patients at the end of two years. We are concerned, however, about the progressive radiodense lines, sclerosis, and loosening of beads as well as the slight, but persistent, pain in the thigh in eight patients.