The Journal of arthroplasty
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Review Case Reports
Insufficiency subchondral fracture of the femoral head: report of 4 cases and review of the literature.
Insufficiency subchondral fractures are nontraumatic flattened lesions in the superolateral area of the femoral head, occurring in healthy adults. These lesions were recently described and are an infrequent cause of acute hip pain. ⋯ The etiology and the natural history of these rare lesions remain to be elucidated. These lesions should be differentiated from osteonecrosis and transient osteoporosis, because treatment and prognosis may differ.
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This study evaluated the mortality after total knee and hip arthroplasties by a single surgeon in a medium-volume university referral practice. For 610 knee arthroplasties, the in-hospital mortality rate was 0.16%, and overall, 2 patients (0.33%) died within the first 90 days. ⋯ For 1,108 total hip arthroplasties, the early in-hospital mortality rate was 0.18%, and overall 5 patients (0.45%) died within the first 90 days. For the entire group of arthroplasties, the overall mortality at 1 year and 2 years was significantly less (both P <.05) than the number of expected deaths in the general population.
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Unicompartmental knee arthroplasty is now being used more commonly to treat single compartment disease of knee, with very encouraging results. We report on a rare case of common peroneal nerve palsy; 8 years after lateral unicompartmental knee arthroplasty. This palsy was caused by pressure on the common peroneal nerve, due to posterior migration of tibial component.
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Prosthetic replacement arthroplasty for glenohumeral arthritis is a well-developed and well-described technique with good and excellent results. The surgeon is faced with many decisions to make, however, regarding choice of implant, implant fixation, soft tissue management, and options for glenoid resurfacing. In general, when the precise cause of the arthritic condition is identified, the choices become more straightforward. ⋯ Acute, nonreducible fractures of the proximal humerus are treated best with a humeral head replacement. Post-traumatic arthropathy of the shoulder joint is treated with arthroplasty, and the decision to resurface the glenoid should take into account the age of the patient and the wear and concentricity of the glenoid. Many options exist for the choice of an implant; biomechanical and anatomic studies suggest that a better technical result can be achieved with a third-generation implant design that has the ability to recreate accurately the proximal anatomy of the humerus.
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This study compared the effects of hydroxyapatite (HA) coating and biphasic HA/tricalcium-phosphate (HA/TCP) coating on the osseointegration of grit-blasted titanium-alloy implants. Each coated implant was compared with uncoated grit-blasted implants as well. The implants were press-fit into the medullary canal of rabbit femora, and their osseointegration was evaluated 3 to 24 weeks after surgery. ⋯ The coated implants had significantly (P<.05) greater interfacial shear strength than the uncoated implants (HA, 4.1 +/- 0.4 MPa; HA/TCP, 4.8 +/- 0.5 MPa; uncoated, 2.6 +/- 0.2 MPa, 12 weeks). There was no difference between HA and HA/TCP coating in regard to new bone growth or interfacial shear strength. These data show a comparable enhancement effect of HA and HA/TCP coatings on the osseointegration of titanium-alloy implants.