Which functional assessments predict long-term wear after total hip arthroplasty?

BACKGROUND: There is a paucity of literature concerning functional assessment at long-term followup of THAs in general and in young patients specifically. Functional data may be useful in determining differences in the performance of various implants and surgical techniques in THA. QUESTIONS/PURPOSES: The purposes of this study were to evaluate a group of young patients who were still active 10 years after THA to determine (1) which functional tests and (2) which patient-reported outcome assessments predicted long-term THA function, as measured by acetabular UHMWPE wear, and (3) whether medical comorbidities influenced patient performance on activity tests and patient outcome questionnaires. METHODS: Fifty patients (58 hips) 50 years and younger at the time of THA were followed clinically and radiographically for a minimum of 10 years. All patients wore step activity monitors for up to 21 days, performed 6-minute walk (6-MW) tests, and every patient had minimum 10-year radiographs and sequential radiographs evaluated for wear using edge detection techniques. Mean age and BMI at surgery were 39 years and 29 kg/m(2), respectively. RESULTS: Patients who walked more as determined by step activity monitor (average daily steps) had more linear acetabular UHMWPE wear per year and more volumetric wear per year. The 6-MW, University of California Los Angeles (UCLA), and Tegner Lysholm scores did not correlate with acetabular wear. Mean 6-MW distance was 335 m and pedometer data averaged 1.56 million steps per year. Average UCLA and Tegner Lysholm scores were 6 and 3, respectively. Mean linear wear rate was 0.266 mm/year; mean volumetric wear rate was 82.6 mm(3)/year. The number of comorbid medical conditions had a detrimental effect on our activity parameters and outcomes questionnaires, but the relationships were not statistically significant. CONCLUSIONS: Of functional tools measured, only pedometer data correlated with THA polyethylene wear. Obtaining pedometer data should be considered when trying to distinguish differences in various hip arthroplasty designs and techniques over the long term.

Cementless total hip arthroplasty in patients fifty years of age or younger: a minimum ten-year follow-up.

BACKGROUND: The durability of total hip arthroplasty in younger patients has been reported to be less than that in older patients. The purpose of this study was to evaluate the results of cementless total hip arthroplasty performed in a consecutive series of patients fifty years of age or younger who were followed for a minimum of ten years. METHODS: We prospectively followed 100 consecutive patients (115 hips) who were fifty years of age or younger when they were treated with primary cementless total hip arthroplasty with use of a second-generation, extensively porous-coated femoral stem and a cementless acetabular component. The patients were followed for a minimum of ten years, and the results were compared with our patients in the same age group who had total hip arthroplasty with cement. Evaluation included the need for revision, activity questionnaires, six-minute walks, activity level monitoring with an accelerometer, and radiographic evaluation for evidence of loosening, wear, and osteolysis. RESULTS: Seventy-three patients (eighty-two hips) were available for follow-up at ten years (mean, twelve years). Seventeen patients (twenty-three hips) had died, and ten patients (ten hips) were lost to follow-up. The average age at the time of surgery was 40.1 years. Three femoral stems were revised for periprosthetic fracture. No acetabular shell or femoral stem was revised for loosening, and none were loose on radiographs made at the time of a minimum ten-year follow-up. This compares favorably with the cemented cohort, which had poorer survivorship of the implant with regard to revision for aseptic loosening and radiographic loosening. Reoperation for any reason was similar between the two cohorts at ten years, primarily because of the relatively large numbers of revisions for polyethylene wear in the cementless group. CONCLUSIONS: Cementless total hip arthroplasty with use of a second-generation, extensively porous-coated stem demonstrated durable fixation in an active, younger population at a minimum follow-up of ten years and had better survivorship with respect to fixation compared with our previously reported cemented cohort.

The use of traction in the treatment of severe spinal deformity.

STUDY DESIGN: Multicenter, retrospective, nonrandomized comparison group study of patients with severe scoliosis and kyphosis treated after 1995 with halo-gravity traction and without halo-gravity traction before definitive fusion. OBJECTIVE: Compare surgical correction of severe spine deformity with preoperative halo traction and without preoperative traction. SUMMARY OF BACKGROUND DATA: Prior studies have demonstrated that halo traction is a safe, well-tolerated method of applying gradual, sustained traction to maximize operative correction in patients with severe idiopathic scoliosis (IS) and kyphosis. However, these studies lack a comparison control group and study only a relatively small number of patients with IS. METHODS: Fifty-three patients with severe scoliosis or kyphosis were studied using hospital records, standing preoperative, traction, postoperative, and final radiographs. Thirty were treated with traction and 23 were treated without traction. Patients within each group were analyzed based on demographics, diagnosis, perioperative, and radiographic data. In addition, patients were evaluated based on diagnosis, specifically whether patients had adolescent idiopathic scoliosis. RESULTS: Within the entire study population, there was no statistically significant difference in main coronal curve correction (62% vs. 59%), operative time, blood loss, and total complication rate (27% vs. 52%). However, the nontraction group underwent vertebral column resection more often (30% vs. 3%, P = 0.015). The traction group had a statistically significant increase in average hospital stay (36 vs. 14 days) (P = 0.011). Analysis of the 23 patients with adolescent idiopathic scoliosis also showed no statistically significant differences in curve correction, blood loss, or complications. CONCLUSION: Our study shows that patients with halo traction less frequently had a vertebral body resection, but achieved comparable deformity correction.

Subperiosteal chondromyxoid fibroma: a report of two cases.

Chondromyxoid fibroma is a rare cartilage tumor that represents less than 1% of all bone tumors. When in a long bone, it is usually an intramedullary lesion that is eccentrically located in the metaphyseal region. Chondromyxoid fibroma may also have unusual presentations. These include intracortical lesions and subperiosteal lesions. There have been 14 reported cases of intracortical chondromyxoid fibroma, but there have been only four reports of subperiosteal lesions. A subperiosteal location, therefore, is extremely rare for a chondromyxoid fibroma. We present two new cases of subperiosteal chondromyxoid fibroma. Given its rarity, chondromyxoid fibroma is often not in the differential diagnosis of a painful, subperiosteal scalloped lesion in a long bone. Other entities such as periosteal chondroma, periosteal myxoma, subperiosteal ganglion cyst, or subperiosteal osteoid osteoma are more likely to be considered. Our cases illustrates that subperiosteal chondromyxoid fibroma, although rare, should be included in the differential diagnosis of a painful, radiographically inactive lytic lesion on the surface of a long bone.