The Journal of arthroplasty
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We describe a case of successful revision total hip arthroplasty for a Vancouver type B3 periprosthetic femoral fracture with extensive bone stock deficiency and osteoporotic diaphyseal bone. The femur was reconstructed with an allograft-cemented stem composite using a telescoping technique and a drainage hole for surplus cement. This procedure facilitated stable stem fixation to the host femur without cement interference and bony fusion between the allograft and host bone, as revealed by bone scintigraphy. This technique provides a surgical option for a severe periprosthetic femoral fracture in which the femoral diaphyseal bone is too osteoporotic to support the fixation of an allograft-cementless stem composite.
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We describe a case of a well-functioning total knee arthroplasty acutely infected with Clostridium septicum. This is the first reported infection of a prosthetic joint with this organism. ⋯ This organism is highly associated with gastrointestinal malignancy, and appropriate investigation should be carried out when it is discovered. The importance of full anaerobic bacterial identification by the microbiology laboratory is underscored by this case.
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Large-diameter metal-on-metal hip arthroplasties have incited renewed interest because of the advantages of decreased wear and increased stability. These new designs have not had significant long-term or midterm performance results, and we are reporting the case of pseudotumor in a patient with a painful metal-on-metal hip arthroplasty.
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This systematic review compared 2 treatments for hip disease in active young patients: modern metal-on-metal total hip resurfacing and standard total hip arthroplasty. We conducted a literature search to identify relevant randomized and clinical controlled trials and included 968 patients from 4 trials in our analysis. ⋯ Hip function scores were similar between the 2 groups, but the resurfacing group showed higher activity levels. These results have provided insufficient evidence to determine whether modern metal-on-metal total hip resurfacing offers clinical advantages over standard total hip arthroplasty.
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We assessed whether higher body mass index (BMI) is associated with higher risk of moderate-severe knee pain 2 and 5 years after primary or revision total knee arthroplasty (TKA). We adjusted for sex, age, comorbidity, operative diagnosis, and implant fixation in multivariable logistic regression. ⋯ Similarly, BMI was not associated with moderate-severe pain at 5-year primary TKA and at 2-year and 5-year revision TKA follow-up. Lack of association of higher BMI with poor pain outcomes post-TKA implies that TKA should not be denied to obese patients for fear of suboptimal outcomes.