Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 2015
Surgical hip dislocation is a reliable approach for treatment of femoral head fractures.
Femoral head fractures are rare injuries; incongruency and instability are indications for surgical intervention. Anterior, posterior, and transtrochanteric surgical approaches have been proposed, but the exposure is limited with classical approaches. Surgical hip dislocation allows for a 360° view of the head and may facilitate a reduction in selected head fractures, but to our knowledge, few studies have reported on the results with this technique. We therefore report on the (1) quality of fracture reduction; (2) modified Harris hip score at a minimum of 2 years (mean, 6 years, range, 26-122 months); and (3) frequency of complications, including avascular necrosis (AVN), arthritis development, and heterotopic ossification, in a case series of patients with femoral head fractures treated with this approach. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · Dec 2015
Comparative StudyTHA revisions using impaction allografting with mesh is durable for medial but not lateral acetabular defects.
Most acetabular revisions are managed with cementless hemispherical or elliptical metal implants relying on bone ingrowth. Nonetheless, loss of acetabular bone stock and inability to achieve secure component fixation represent challenges in the setting of revision total hip arthroplasty. Impaction bone grafting (IBG) using allograft represents one option for treatment of this problem. However, cup migration and bone graft resorption are limitations when IBG is used for large segmental defects, and the precise role of IBG as well as the use of mesh (and the kinds of defects for which mesh does not work well) in this setting remains unknown. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Dec 2015
Comparative StudyPosterior glenoid wear in total shoulder arthroplasty: eccentric anterior reaming is superior to posterior augment.
Uncorrected glenoid retroversion during total shoulder arthroplasty may lead to an increased likelihood of glenoid prosthetic loosening. Augmented glenoid components seek to correct retroversion to address posterior glenoid bone loss, but few biomechanical studies have evaluated their performance. ⋯ Angle-backed components may introduce shear stress and potentially compromise stability. Additional in vitro and comparative long-term clinical followup studies are needed to further evaluate this component design.
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Clin. Orthop. Relat. Res. · Dec 2015
Risk calculators predict failures of knee and hip arthroplasties: findings from a large health maintenance organization.
Considering the cost and risk associated with revision Total knee arthroplasty (TKAs) and Total hip arthroplasty (THAs), steps to prevent these operations will help patients and reduce healthcare costs. Revision risk calculators for patients may reduce revision surgery by supporting clinical decision-making at the point of care. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Dec 2015
An increased iliocapsularis-to-rectus-femoris ratio is suggestive for instability in borderline hips.
The iliocapsularis muscle is an anterior hip structure that appears to function as a stabilizer in normal hips. Previous studies have shown that the iliocapsularis is hypertrophied in developmental dysplasia of the hip (DDH). An easy MR-based measurement of the ratio of the size of the iliocapsularis to that of adjacent anatomical structures such as the rectus femoris muscle might be helpful in everyday clinical use. ⋯ Level III, prognostic study.