Erratum to 'Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty With Ceramic Head' [Arthroplasty Today 6 (2020) 612-616].

[This corrects the article DOI: 10.1016/j.artd.2020.03.009.].

Favorable Radiographic and Early Postoperative Results with the Inguinal Crease Direct Anterior Total Hip Arthroplasty.

We report the results, scar appearance, and patient satisfaction of a direct anterior approach total hip arthroplasty performed through an oblique inguinal incision. Patients were separated into direct anterior THA (n = 29) or an oblique inguinal incision anterior approach (n = 41). Clinical and radiographic data was compared, scar appearance was assessed by the Vancouver Scar Scale (VSS), and satisfaction was assessed by a simple questionnaire. Harris Hip Scores significantly improved in each group (1.8×10-8) and improved similarly between groups (p ≥ 0.35). The VSS score was lower in the inguinal incision versus the standard incision group (0.68 [range 0-3] vs. 1.56 [range 0-4], p = 0.015). Scar satisfaction was higher in the inguinal incision group with 87% compared to only 32% in the standard approach. The inguinal incision approach was safe, offered similar postoperative results, and resulted in improved patient scar satisfaction compared to the standard anterior approach by using an incision that more closely resembled normal anatomy. (Journal of Surgical Orthopaedic Advances 31(1):056-060, 2022).

Case Report: Bullous Lung Disease Following COVID-19.

More than 87% of patients report the persistence of at least one symptom after recovery from the Coronavirus disease 2019 (COVID-19). Dyspnea is one of the most frequently reported symptoms following severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) infection with persistent chest radiological abnormalities up to 3 months after symptom onset. These radiological abnormalities are variable and most commonly include ground-glass opacities, reticulations, mosaic attenuation, parenchymal bands, interlobular septal thickening, bronchiectasis, and fibrotic-like changes. However, in this case report, we describe findings of bullous lung disease as a complication of SARS CoV-2 infection. As the pandemic continues, there is a need to understand the multiple respiratory manifestations of post-acute sequelae of COVID-19. We, therefore, present this case to add to the current body of literature describing pulmonary disease as a consequence of SARS CoV-2 infection.

A Case of Hemothorax as Manifestation of Thoracic Endometrial Syndrome.

Thoracic endometriosis is a rare progression of a mostly benign disease of ectopic endometrial activity involving the pleura and lung. This is a case of a young female who presented with progressive shortness of breath and was found to have significant anemia. Further investigations showed a massive right-sided pleural effusion and ascites. Subsequent thoracentesis and pelvic diagnostic laparoscopy showed a hemorrhagic pleural effusion and ascites, along with dense pelvic adhesions. Pathology was consistent with endometriosis. Patient improved on leuprolide acetate and norethindrone. This case illustrates an important consideration in the differential of a reproductive-age female with new onset shortness of breath and anemia.

Spontaneous intercostal artery bleeding in a patient with alcohol-induced liver cirrhosis.

Spontaneous intercostal artery bleeding is a rare disease seen in cirrhosis and can present with hemodynamically significant blood loss anemia, hypotension, and shock. Transcatheter arterial embolization is an effective treatment for severe cases.

Pulmonary Hyalinizing Granuloma: A Rare Cause of a Benign Lung Mass.

Pulmonary hyalinizing granuloma (PHG) is a rare, benign lung disease of unknown etiology. It usually manifests as solitary and sometimes as multiple pulmonary nodules. It may have irregular margins, cavitation, or calcifications mimicking metastasis or primary lung neoplasm. It should be considered in the differential diagnosis of pulmonary nodules or masses. In this report, we present an unusual case of incidental slow-growing lung mass in a patient with 30 pack-year smoking history, construction-based occupation. The pleural-based calcified nodule in the left upper lobe gradually increased in size over ten years without any hilar or mediastinal lymphadenopathy. For an accurate diagnosis, PET-scan and histopathological analysis through wedge resection by video-assisted thoracoscopic surgery (VATS) were done. The biopsy findings were consistent with pulmonary hyalinizing granuloma, a rare benign cause of lung mass with an excellent long-term prognosis.

Disseminated Mycobacterium abscessus infection and native valve endocarditis.

Mycobacterium abscessus is a rapidly growing mycobacterium. It rarely causes disseminated infection or endocarditis. A 55-year-old male with a history of hepatitis C, liver cirrhosis, intravenous drug use (last use was four years ago), and chronic back pain presented with a three-week history of a right calf nodular lesion. He did not have a fever, chills, rash, dyspnea, or cough. Laboratory data showed mild leukocytosis. Computed tomography of the chest revealed bilateral cavitating nodules. Skin biopsy, sputum, and blood cultures grew Mycobacterium abscessus. Therapy with meropenem, tigecycline, and amikacin was initiated. He was re-admitted with worsening lower back pain. A lumbar magnetic resonance imaging showed destructive changes of L4 and L5 vertebral bodies concerning for osteomyelitis. Blood culture and bone biopsy grew Mycobacterium abscessus again. An echocardiogram was performed due to persistent bacteremia, which revealed large vegetation on the tricuspid valve and small vegetation on the mitral valve. Therapy was changed to eight weeks of amikacin, with cefoxitin and imipenem for twelve months based on drug susceptibility. Treatment of disseminated Mycobacterium abscessus is challenging due to antibiotic resistance. Typically, multidrug therapy is warranted with at least three active drugs. In severe valvular endocarditis, valve replacement may be required.

A case of secondary tension pneumothorax in COVID-19 pneumonia in a patient with no prior history of lung disease.

Complications that arise in patients with severe COVID-19 pneumonia are acute respiratory distress syndrome, often leading to mechanical ventilation, shock requiring vasopressors, acute kidney injury, stroke, thromboembolic phenomena, and myocardial injury. To date, there are four cases of tension pneumothorax in patients with COVID-19, published in literature. We present a 33-year-old man with no prior history of lung disease who was admitted to our hospital on account of hypoxic respiratory failure secondary to COVID-19 pneumonia. During his hospitalization, he developed sudden onset of chest pain which worsened with coughing. A chest X-ray showed a right-sided pneumothorax with left-sided mediastinal shift. He required placement of chest tubes with eventual resolution of the pneumothorax several days later. This case highlights the need for clinical recognition, consideration of differential diagnoses, prompt evaluation, appropriate imaging, and management of this severe life-threatening unusual complication of COVID-19 pneumonia.

Adverse Reaction to Zirconia in a Modern Total Hip Arthroplasty with Ceramic Head.

Hypersensitivity reactions to zirconia (ZrO2) or similar ceramics is highly unusual. Owing to the stable oxide formed between the base metal and oxygen, ceramics are considered relatively biologically inert. We report the case of an otherwise healthy 50-year-old woman with a 5-year history of progressively worsening right hip pain who underwent a ceramic-on-polyethylene total hip replacement and subsequently developed hypersensitivity reaction. After metal allergy testing showed her to be highly reactive to zirconium, the femoral head was revised to a custom titanium implant and her symptoms resolved.

Paraganglioma of the middle mediastinum.

A 60-year-old female was evaluated for significant weight loss, nausea, vomiting, and dysphagia. A computed tomography (CT) of the chest showed a 3 cm mass in the middle mediastinum. CT scan of the abdomen and pelvis revealed no abnormality. Positron emission tomography (PET) of the whole body revealed tracer uptake in the pre-carinal nodal mass. There were no other suspicious foci of tracer uptake. Mediastinoscopy and biopsy revealed a well-differentiated low-grade neuroendocrine tumor. She underwent sternotomy, and after careful mobilization of the great vessels, the middle mediastinal mass was successfully resected. Final pathology revealed a paraganglioma with no morphological signs to suggest malignancy. The right lower paratracheal lymph node did not show any tumor cells. She did well postoperatively.

Dislocation of the Hip: A Review of Types, Causes, and Treatment.

BACKGROUND: Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip replacement. METHODS: In this review, the types, causes, and treatment modalities of hip dislocation are discussed and illustrated, with particular emphasis on the assessment, treatment, and complications of dislocations following total hip replacement. RESULTS: Hip dislocations are commonly classified according to the direction of dislocation of the femoral head, either anterior or posterior, and are treated with specific techniques for reduction. Generally, closed reduction is the initial treatment method, usually occurring in the emergency room. Bigelow first described closed treatment of a dislocated hip in 1870, and since then many reduction techniques have been proposed. Each method has unique advantages and disadvantages. Anterior hip dislocation is commonly reduced by inline traction and external rotation, with an assistant pushing on the femoral head or pulling the femur laterally to assist reduction. Posterior hip dislocations are the most common type and are reduced by placing longitudinal traction with internal rotation on the hip. CONCLUSION: Patients with hip dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. Timely evaluation and treatment, including recognizing the potential complications, are necessary to offer the best outcome for the patient.