The Journal of arthroplasty
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This study assessed the results of 90 one-component revisions for failed hip resurfacing due to adverse reaction to metal wear debris (76 acetabular, 14 femoral). Patients with a femoral head size 40-45 mm (n=33) received a two-piece titanium meshed shell with a cross-linked polyethylene liner and patients with femoral head size 46-54 mm (n=43) received metal-on-metal components. Patients with femoral head size>45 mm who wished a metal-polyethylene bearing received a dual mobility femoral prosthesis. ⋯ Three failures required re-revision; there was one deep infection. There were no dislocations. One-component revision is a reasonable alternative to revision to total hip arthroplasty.
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The following study is a review of 3 different treatment methods for treating comminuted distal periprosthetic femur fractures in 23 patients over the age of 70 (average age 80, range 70-90). Reconstruction techniques included 7 allograft prosthesis composite (APC), 9 revision systems (RSA), and 7 distal femur endoprosthesis (DFR). ⋯ No significant difference was found in the 6-week or 6-month Knee Society Scores. Our preliminary results demonstrate that in experienced hands, distal femur endoprosthesis should be considered in patients with advanced age and poor bone quality who require early mobilization.
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Corrosion at the modular neck-stem taper junction has become an increasingly important topic as several reports have identified this couple as a possible source for early failure with findings similar to failed metal-on-metal hip arthroplasties. Recently, two different modular stem systems from a single manufacturer were voluntarily recalled due to concerns of failure of the modular taper junction. ⋯ We further reviewed the literature to evaluate whether this is a manufacturer-specific defect or indicative of a broader trend. Recent studies appear to implicate the basic design of the neck-stem taper junction, rather than a single manufacturer, which is at high risk for fretting and corrosion.
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It is not clear whether indicating TKA-surgery is advisable in depressed patients. A prospective cohort of 716 patients undergoing TKA was designed. SF36, KSS, WOMAC and VAS plus 2 satisfaction questions were evaluated. ⋯ Depressed patients obtained great improvement from preoperative at one-year follow-up and even greater than non-depressed patients in some domains. Moreover, satisfaction was similar. Therefore, TKA can be recommended to depressed patients.
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We assessed the association of cerebrovascular disease preoperatively with patient-reported outcomes (PROs) of moderate-severe activity limitation and moderate-severe pain at 2- and 5-years after primary total knee arthroplasty (TKA) using multivariable-adjusted logistic regression; 7139 primary and 4234 revision TKAs were included. Compared to the patients without cerebrovascular disease, those with cerebrovascular disease had a higher odds ratio (OR) of moderate-severe limitation at 2 years and 5 years, 1.32 (95% confidence interval [CI]: 1.02, 1.72; P = .04) and 1.83 (95% CI: 1.32, 2.55; P < .001), respectively. ⋯ In conclusion, we found that cerebrovascular disease is independently associated with pain and function outcomes after primary TKA. This should be taken into consideration when discussing expected outcomes of TKA with patients.