The Journal of arthroplasty
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Case Reports
Successful fixation of an intertrochanteric fracture after hip resurfacing arthroplasty using cannulated screws.
We report a case of successful treatment of a high, stable intertrochanteric fracture (type 1) in a 59-year-old man. He sustained the injury 8 years after the resurfacing procedure. ⋯ We have shown that fixation with cannulated screws may be an acceptable option for treatment of high trochanteric fractures where a stable anatomical reduction can be obtained. We have also included a review of the literature for other reported surgical treatment options of this complication.
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Between February 1987 and October 2008, we performed 102 total hip arthroplasties (THAs) after failed internal fixation of a prior hip fracture. There were 39 intertrochanteric fractures and 63 femoral neck fractures. Etiology of failure included 35 cases of osteonecrosis, 32 cases of arthritis, 25 cases of early failure of fixation, and 10 cases of nonunion. ⋯ These included 5 patients who had dislocations (4.9%), 4 periprosthetic fractures (3.9%), 2 hematomas (2.0%), and 1 infection (1%). Of these 102 THAs, 50 were available for at least 2 years of follow-up (mean, 3.2 years). At a minimum 2-year follow-up, THA after failed internal fixation of hip fracture in these patients was clinically successful with an elevated risk of periprosthetic fracture and dislocation.
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This study aims to assess the accuracy of metal ion analysis in the diagnosis of adverse reaction to metal debris (ARMD) in patients with metal-on-metal hip arthroplasties by comparing the cobalt and chromium levels in 57 patients (62 hips) to findings on metal artifact reduction magnetic resonance imaging (MRI). An ARMD was detected using MRI in 18 (29%) of the hips. Forty patients had cobalt levels less than 7 μg/L, and 33 had chromium levels less than 7 μg/L, but 8 of these had an ARMD on MRI and only minimal symptoms (Oxford Hip Score ≥ 44/48). The incidence of ARMD was significantly higher when chromium concentration was above 7 μg/L (P = .02), but normal metal ion levels can be misleading and metal artifact reduction MRI imaging is advised in all patients.
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Total knee arthroplasty can be challenging in Jehovah's Witnesses, as these patients do not accept blood transfusions. We reported our experiences with a special blood management protocol for these patients who underwent total knee arthroplasty. There were 124 self-reported Jehovah's Witnesses who had a mean age of 64 years and who underwent total knee arthroplasties between 1998 and 2009. ⋯ Implant survivorship, with revision for aseptic component failure as an end point, was 98%. At the final follow-up, mean Knee Society objective and function score improved to 91 and 81 points, respectively. The authors believe that this blood management protocol was responsible for performing safe and transfusion-free total knee arthroplasties that can ultimately lead to excellent outcomes.
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We studied the frequency and patient risk factors for postoperative periprosthetic fractures after primary total hip arthroplasty (THA). With a mean follow-up of 6.3 years, 305 postoperative periprosthetic fractures occurred in 14,065 primary THAs. In multivariable-adjusted Cox regression analyses, female gender (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.17-1.88), Deyo-Charlson comorbidity score of 2 (HR, 1.74 for score of 2; 95% CI, 1.25-2.43) or 3 or higher (HR, 1.71; 95% CI, 1.26-2.32), and American Society of Anesthesiologist class of 2 (HR, 1.84; 95% CI, 0.90-3.76) or 3 (HR, 2.45; 95% CI, 1.18-5.1) or 4 or higher (HR, 2.68; 95% CI, 0.70-10.28) were significantly associated with higher risk/hazard, and cemented implant, with lower hazard (HR, 0.68; 95% CI, 0.54-0.87) of postoperative periprosthetic fractures. Interventions targeted at optimizing comorbidity management may decrease postoperative fractures after THA.