Correlation of magnetic resonance arthrography with revision hip arthroscopy.

BACKGROUND: Arthroscopic approaches for the diagnosis and treatment of hip disorders are well established; however, there are limited data regarding revision hip arthroscopy. There have been several studies evaluating the findings of MR arthrography with primary hip arthroscopy, but to our knowledge, no study has evaluated the diagnostic value of MR arthrography before revision hip arthroscopy. QUESTIONS/PURPOSES: We obtained sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MR arthrography to detect labral lesions, chondral lesions and loose bodies before revision hip arthroscopy. METHODS: We performed a single-surgeon, retrospective review of 70 revision hip arthroscopies (62 patients) and assessed the association between MR arthrography findings and intraoperative findings. There were 43 females and 19 males with a mean age of 36 years (range, 17-59 years). Radiographic interpretation was performed by one of four fellowship-trained musculoskeletal radiologists at three institutions, who had at least 5 years of experience. Radiographic findings were compared with surgical findings by one of the authors for calculation of sensitivity, specificity, PPV, and NPV. RESULTS: The sensitivity, specificity, PPV, and NPV of MR arthrography for detecting labral tears were 82%, 70%, 94%, and 39%, respectively. The sensitivity, specificity, PPV, and NPV of MR arthrography for detecting chondral damage were 65%, 90%, 94%, and 50%, respectively. The sensitivity, specificity, PPV, and NPV of MR arthrography for detecting loose bodies were 33%, 100%, 100%, and 88%, respectively. CONCLUSIONS: Our study showed the utility of MR arthrography to assist in the diagnosis and treatment of patients with ongoing or recurrent symptoms who have had prior hip arthroscopy. Our data show that MR arthrography is superior at ruling in, rather than ruling out, labral lesions, chondral lesions, and loose bodies, as there were studies interpreted as normal which in fact showed disorders.

Technical pearls for hip arthroscopy in the management of synovial chondromatosis.

Synovial chondromatosis of the hip is often underdiagnosed. A high index of suspicion and good quality imaging studies are therefore essential. A wide array of long and curved instrumentation is needed at surgery. Efficient use of time and an organized surgical approach are critical to decrease joint distraction time and potential complications. A successful outcome, with pain relief and return of joint function and range of motion, is predicated on incremental follow-up.

Blood, bugs, and motion - what do we really know in regard to total joint arthroplasty?

In total joint arthroplasty, it is often necessary to formulate decisions that are not clearly evidence-based. This review presents some current controversial topics in total joint arthroplasty, including preoperative autologous blood donation versus erythropoietin (EPO) usage, preoperative screening and treatment for methicillin resistant Staphylococcus aureus (MRSA), and the use of continuous passive motion (CPM) following total knee arthroplasty, providing an evidence-based guide for the treating orthopaedic surgeon. Our review shows that preoperative autologous blood donation is over utilized, with EPO being under utilized. Surgeons are encouraged to develop patient-specific strategies, which have been shown to decrease transfusion rates, reduce wasted autologous blood, and increase EPO use. Definitive conclusions regarding MRSA screening for orthopaedic patients cannot be drawn; but due to the significant cost and morbidity associated with a postoperative MRSA infection, we believe a screen and treat protocol should be considered for all patients being admitted to the hospital for elective or emergent surgery. Short-term (3 to 5 days) inpatient use of CPM is recommended at this time. It is low-cost, has minimal risk, and may be a factor in decreasing the length of stay, potentially leading to significant cost savings. However, no long-term benefits of CPM use have been established.

Failure of proximal femoral locking compression plate: a case series.

OBJECTIVES: The treatment of fractures of the proximal femur has evolved significantly over recent years. The most recent advance is the proximal femoral locking compression plate (PF-LCP; Synthes, West Chester, PA). We present seven failures of the PF-LCP in an attempt to elicit reasons for the failures so that these pitfalls can be avoided in the future. DESIGN: Retrospective chart review. SETTING: Level I trauma centers, tertiary referral hospitals. PATIENTS/PARTICIPANTS: Ten patients at five institutions. INTERVENTION: Open reduction and internal fixation with a PF-LCP. MAIN OUTCOME MEASUREMENTS: Failure mode, time until failure, need for further surgery, bony union, or conversion to arthroplasty. RESULTS: Of the seven cases, two were acute peritrochanteric fractures, one was a periprosthetic fracture at the site of a prior hip fusion, one was an early failure of a compression hip screw, and three were nonunions. The failure mode was implant fracture in four cases and loss of fixation in three cases resulting from varus collapse and implant cutout. Five of seven failures were within the first 3 weeks (average, 12.4 days). The average time to failure for all cases was 37.9 days (range, 5-175 days). The average patient age was 56.7 years (range, 36-72 years). CONCLUSION: Biomechanical studies have shown the PF-LCP to be stronger or equivalent to other fixation methods for fractures of the femoral neck and subtrochanteric femur fractures. The seven failures in our cases may be partially the result of patient factors as well as technical factors; however, there appears to be a high rate of failure even when surgery is performed by experienced and fellowship-trained traumatologists.

Obturator dislocation of total hip arthroplasty--a case report.

This study consists of a single case report of a patient who had an irreducible obturator dislocation of a total hip arthroplasty after a motor vehicle accident, not previously described in the English literature. In particular, the focus will be on offering an educated opinion on the risk factors for dislocation and difficulties encountered with this type of dislocation. The aim is to offer valuable insight based on the operative experience with this patient and to supplement the literature with the management of such a complication following total hip arthroplasty.

High-altitude illness and muscle physiology.

High-altitude illness is a growing concern in sports medicine that affects persons shortly after they have climbed to a new high-altitude level to which their body is not acclimatized. With the increasing popularity of extreme sports, such as high-altitude mountaineering, skiing, and snowboarding, the incidence of complications arising from sports activities at high altitudes is increasing. High-altitude pulmonary edema and high-altitude cerebral edema are potentially fatal conditions. The study of high-altitude muscle physiology has broad ramifications in creating training programs for elite endurance athletes. A thorough understanding of the pathophysiology, presentation, treatment, and prevention of high-altitude illness is necessary for the treatment of these patients.