Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2009
Multicenter Study Comparative StudyResurfacing arthroplasty for patients with osteonecrosis.
The suitability of third-generation metal-on-metal hip resurfacing products for patients with a primary diagnosis of osteonecrosis has been debated. The preservation of femoral head bone stock for femoral prosthetic support is essential for the long-term stability of implants. A modern hip resurfacing system was implanted in 1148 hips as part of a United States multicenter investigational device exemption study. ⋯ Survival rates were not significantly different (95.9% and 95.8% at 24 months for osteoarthritis and osteonecrosis respectively, p = 0.46). Resurfacing arthroplasty for patients with osteonecrosis appears to be a reasonable alternative, taking into consideration implant size, patient gender, and size of femoral deficiency. Further characterization is needed to identify those specific patients with osteonecrosis for whom resurfacing arthroplasty would be appropriate.
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In recent years, metal-on-metal hip resurfacing has become an increasingly popular treatment for patients needing hip arthroplasty. Important factors to consider for a successful outcome include proper patient selection and surgical technique, including approach, component positioning, and cementing technique. This review will serve as guide to both those who are learning the technique of hip resurfacing and to more experienced surgeons.
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While much literature has focused on the management of osteonecrosis of the femoral head, far less information is available regarding the treatment and outcomes of this disease in the proximal humerus. To a great extent, management of humeral head osteonecrosis has been inferred from studies involving the femoral head. ⋯ Regardless of the underlying etiology, the common pathway involves disruption of the arterial inflow or the venous outflow of the bone, with resultant osseous cell death. The general treatment strategies for humeral head osteonecrosis include nonoperative modalities for symptomatic early disease, with surgical intervention reserved for more advanced disease or those with recalcitrant pain.
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Clavicle fractures remain one of the more common fractures encountered in the orthopaedic office. Nonoperative management remains the standard of care in most cases. ⋯ When operative reduction and fixation is indicated, there are numerous techniques to aid the surgeon patient care. This article reviews the midshaft clavicle fracture and discusses recent outcome studies on patients with fracture shortening and approaches to operative management.
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Bull NYU Hosp Jt Dis · Jan 2009
ReviewResurfacing versus conventional total hip arthroplasty - review of comparative clinical and basic science studies.
Although standard total hip arthroplasties have a long and successful history as the standard of care for advanced, symptomatic osteoarthritis, there is increasing patient demand and surgeon interest in femoral bone conserving resurfacing alternatives. The purpose of this study was to assess the state of the research that directly compares the outcomes of conventional total hip arthroplasty procedures with the current generation of metal-on-metal resurfacing hip arthroplasties. ⋯ While there is still much debate and room for additional research on this topic, multiple midterm clinical results suggest that resurfacing hip arthroplasty represents a safe, effective alternative to conventional total hip arthroplasty, especially for younger, active patients.