The Journal of arthroplasty
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Comparative Study
Does a collar improve the immediate stability of uncemented femoral hip stems in total hip arthroplasty? A bilateral comparative cadaver study.
The aim of this study was to compare the immediate stability of collared vs collarless uncemented femoral stems in total hip arthroplasty. A bilateral comparative study of 20 cadavers (40 hips: 20 collarless, 20 collared) was performed. Forces in the vertical and horizontal planes required to initiate subsidence of femoral stem and subsequent femoral fracture were measured. ⋯ Fracture occurred at a significantly higher force for collared stems (P = .005). Collared uncemented stems have significantly greater immediate stability than collarless. They are able to withstand greater vertical and horizontal forces before the initiation of subsidence and subsequent fracture.
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Total hip arthroplasty (THA) longevity is the primary concern in young patients. Metal-on-metal articulations were reintroduced to reduce polyethylene particle-induced osteolysis and improve survivorship; to date, based on issued reports, this strategy appears to have been successful. In this study, the authors investigated metal-on-metal articulation survivorship and osteolysis incidence in young patients (19-50 years old at index operations) and retrospectively reviewed cementless metal-on-metal THAs in 70 patients (78 hips) with a mean follow-up of 12.4 years. ⋯ Mean Harris hip score improved from 51 to 95 points at final follow-up. The findings of this study indicate that outcomes of cementless THA with a metal-on-metal bearing in young patients are satisfactory. However, longer-term studies in larger cohorts are required to determine whether metal-on-metal articulations are really a favorable option in young patients.
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Lateral hip pain is a common problem in middle-aged women. This pain is usually attributed to trochanteric bursitis and treated as such. ⋯ Six patients (7%) in the original study cohort of 89 patients were lost to follow-up, but of the remaining patients, 65 of 72, or 90%, were pain-free or had minimal pain (P < .00001). Surgical reconstruction of detached gluteal tendons causing chronic lateral hip pain addresses the problem directly and reliably relieves the symptoms of so-called "trochanteric bursitis."
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Iliopsoas impingement is a known cause of pain after total hip arthroplasty. The author reports on a patient with iliopsoas impingement due to prominence of the anterior aspect of her acetabular hip arthroplasty component successfully treated with revision to an anatomically designed acetabular implant. Use of such an anatomically designed acetabular implant may prove to be beneficial in selected patients with iliopsoas impingement.
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Case Reports
A custom coupling device of total knee and ipsilateral total hip arthroplasties after distal femoral fracture.
The treatment of periprosthetic femoral fractures around long-stemmed hip implants is an orthopedic challenge, which may be complicated by the presence or need for a total knee arthroplasty. Treatment of this fracture when the proximal implant is well fixed and a distal implant is required poses ongoing challenges. Traditional plating and allograft struts have produced variable results, particularly in osteoporotic bone, where incidence of nonunion is greater. Thus, we report a custom interlocking device, which couples the stem of the fixed proximal implant to a new stemmed total knee prosthesis, resulting in the expedited restoration of functionality and fracture union.