The Journal of arthroplasty
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Comparative Study
Femoral revision in hip resurfacing compared with large-bearing metal-on-metal hip arthroplasty.
It has been suggested that revision of the femoral component of hip resurfacing after femoral failure would be straightforward and have an outcome comparable to primary total hip arthroplasty (THA). We have compared the outcome of femoral side-only revision resurfacings to the results of primary modular large-bearing metal-on-metal THA. Fourteen consecutive patients underwent revision surgery of the failed femoral component, to a cemented tapered stem (CPT, Zimmer, Warsaw, Indiana) with a large modular metal head (Smith and Nephew Orthopaedics Ltd, Memphis, Tennessee, or Adept, Finsbury Orthopaedics, Surrey, England). ⋯ At a mean follow-up of 49 months (range, 30-60 months), clinical outcome measured using the Oxford and Harris Hip Scores showed no significant difference (P = .11, P = .45, respectively). Operative time and blood loss were comparable for both groups. We conclude that revision of the failed femoral resurfacing component gives excellent results.
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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.