The Journal of arthroplasty
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One hundred twenty-two consecutive minimally invasive Oxford phase 3 medial unicompartmental knee arthroplasties in 109 patients were evaluated for postoperative limb alignment and the influence of factors such as preoperative limb alignment, age, body mass index, sex, insert thickness, and surgeon's experience. The mean mechanical preoperative hip-knee-ankle (HKA) angle of 172.2° ± 3.1° improved to 177.1° ± 2.9° postoperatively. ⋯ Only preoperative HKA angle was predictive of postoperative HKA angle. Although most of the limbs had acceptable limb alignment after unicompartmental knee arthroplasty, limbs with more severe preoperative varus deformity had a tendency to remain in excessive varus, and limbs with lesser preoperative varus deformity had a greater tendency to go into valgus postoperatively.
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Randomized Controlled Trial
Benefits of prolonged postoperative cyclooxygenase-2 inhibitor administration on total knee arthroplasty recovery: a double-blind, placebo-controlled study.
A double-blind, placebo-controlled study of a selective cyclooxygenase (COX)-2 inhibitor administered in 107 patients for 6 weeks after total knee arthroplasty was done to determine any benefits. All patients received celecoxib preoperatively and during hospitalization. At hospital discharge, patients were randomized to receive celecoxib or placebo for 6 weeks. ⋯ The celecoxib group used fewer narcotics and had significantly better visual analog scale scores, knee flexion, Knee Society Score scores, Oxford Knee Score scores, and Short-Form 12 physical composite scores than the placebo group. Knee flexion remained significantly improved through 1 year. These results demonstrate that patients who took celecoxib for 6 weeks after total knee arthroplasty had a less painful and more rapid recovery.
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Case Reports
Failure of larger-diameter metal-on-metal total hip arthroplasty resulting from anterior iliopsoas impingement.
Anterior iliopsoas impingement is a recognized cause of persistent groin pain after total hip arthroplasty. We report 3 patients with failed total hip arthroplasties resulting from anterior iliopsoas and capsular impingement secondary to a metal femoral ball with a diameter larger than the native femoral head. ⋯ Resolution of symptoms occurred in all patients after revision surgery. To our knowledge, this is the first report of this potential failure mechanism with these large-diameter implant designs and should be considered in the appropriate clinical scenario.
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There are currently few published studies examining the use of locking compression plates for the treatment of periprosthetic femoral fractures. Fifteen total hip or knee arthroplasty patients with 16 Vancouver type B1 and C fractures with an average age of 76 years were fixed and followed clinically and radiographically for 2 years. Fourteen patients achieved radiographic union by 6 months, and 13 patients were ambulatory by 6 months. ⋯ In summary, locking plates offer a viable treatment option for these difficult fractures. We advocate a minimum of 10 cortices of fixation (with unicortical or bicortical screws and cable combinations) above and below the fracture. Bone grafting should be used if the soft tissue envelope is violated with extensive dissection, and cortical struts should be considered in cases of failed hardware and revision fixation.
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Case Reports
Catastrophic failure of a metal-on-metal total hip arthroplasty secondary to metal inlay dissociation.
Metal-on-metal bearing surfaces in total hip arthroplasty have been recently shown to have acceptable survivorship properties (J Bone Joint Surg Am. 2006;88:1183; J Bone Joint Surg Am. 2006;88:1173), and they have certain advantages and disadvantages when compared to conventional metal-on-polyethylene bearing surfaces. Like traditional metal-on-polyethylene bearings, these metal-on-metal implants may also suffer from catastrophic failure. This case report represents an unusual situation in a 57-year-old man in which dissociation of a metal inlay in a metal-on-metal total hip arthroplasty resulted in articulation of the inferior aspect of the inlay with the femoral neck, leading to femoral neck notching, extensive periprosthetic soft tissue metallosis, osteolysis, and subsequent prosthetic catastrophic failure.