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A retrospective case-control study was conducted to evaluate 1-year total knee arthroplasty (TKA) outcomes among preoperative stiff knees, range of motion (ROM) 80° or less, compared with nonstiff preoperative knees, ROM 100° or greater. A total of 134 stiff knee cases were compared with a matched cohort of 134 non-stiff knee controls. Knee Society Score and Oxford Knee Score change scores from baseline to 1 year were similar between the groups. Stiff knees experienced a significantly greater mean improvement in ROM from baseline to 1 year (30.8° ± 18.8°) as compared with nonstiff knees (1.1° ± 12.8°) (P < .0001). Although ultimate ROM of a TKA can be restricted secondary to preoperative stiffness, improvements in outcomes and ROM are not affected. We conclude that progression of stiffness should not in and of itself lead to earlier intervention of TKA in most cases., (Copyright © 2012 Elsevier Inc. All rights reserved.)

A 42-item survey was developed and administered to determine patient perception of and satisfaction with total hip arthroplasty (THA) vs total knee arthroplasty (TKA). A total of 153 patients who had both primary THA and TKA for osteoarthritis with 1-year follow-up were identified. Survey response rate was 72%. Patients were more satisfied with THA meeting expectations for improvement in function and quality of life (P < .05), whereas pain relief expectations were equivalent. Most patients (70.9%) reported that TKA required more physiotherapy. One-year Oxford score and improvement in Oxford score from preoperative to 1 year were superior for THAs (P = .000). Despite equivalent pain relief, THAs trend toward higher satisfaction compared with TKAs. THA is more likely to "feel normal" with greater improvement in Oxford score. Recovery from TKA requires more physiotherapy and a longer time to achieve a satisfactory recovery status. Patients should be counseled accordingly., (Copyright © 2012 Elsevier Inc. All rights reserved.)

We analyzed the reproducibility and reliability of computer templating in primary uncemented total hip arthroplasties as compared to standard onlay templating techniques with hardcopy radiographs from a digital source. Digital templating showed good intraobserver and interoberserver reliability with intraclass correlation coefficient values greater than 0.7. Using computer templating, prediction of sizing to within 1 size was 85% accurate for femoral stem sizing and 80% accurate for acetabular sizing. Using onlay templating, prediction of sizing to within 1 size was 85% accurate for femoral sizing and 60% accurate for acetabular sizing. We conclude that the introduction of digital templating has significant benefits in preoperative planning for total hip arthroplasty over onlay templating., (Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.)

Introduction: Historically, cemented total hip arthroplasty (THA) femoral stems inserted in varus have yielded poor clinical results. Few studies to date have addressed the question of the effects of varus alignment on cementless stems. We conducted a retrospective review of 125 uncemented THA femoral stems implanted by a single surgeon from 1994 to 1999., Methods: We conducted a retrospective radiographic review of 125 cementless primary THA femoral stems implanted by a single surgeon who used the Watson-Jones approach; we identified 16 stems implanted in varus, defined as >or= 5 degrees and thus analyzed the effect of varus alignment on functional outcome. We matched varus stems to a cohort of 16 nonvarus cementless stems and measured radiographic signs of loosening and subsidence, defined as > 2 mm., Results: At 4 years postsurgery, there was no significant difference in range of motion or in Harris Hip Score (p > 0.5), and no cases showed evidence of radiographic loosening or subsidence (p = 0.226)., Conclusions: Study results suggest there is no consequence of varus femoral alignment in the cementless stems. Although it is not recommended to implant stems in varus, there were no apparent radiographic or clinical consequences observed at up to 4 years postoperative in this small case series.

Failed open reduction internal fixation (ORIF) of the proximal femur can render patients severely disabled. This study analyzed the short-term functional results and complications of total hip arthroplasty (THA) for complications of ORIF after hip fracture. A retrospective arthroplasty database review identified 36 patients treated with a THA for complications of ORIF of the hip. These patients were matched to a cohort of 36 patients who underwent primary unilateral THA for osteoarthritis. Study results indicate that THA for failed ORIF of the hip is a successful procedure despite concerns of increased intraoperative difficulty and risk of fracture.

Retrospective review of 1216 primary total knee arthroplasties (TKAs) to evaluate incidence and predictors of arthrofibrosis, defined as flexion less than 90 degrees 1 year post-TKA. Incidence of stiffness post-TKA was 3.7% (45/1216). A matched case-control study was then conducted to identify predictive factors for this outcome. Preoperative flexion and intraoperative flexion were predictive of ultimate postoperative flexion (P = .001 and P = .039, respectively). There was no correlation between postoperative stiffness and specific medical comorbidities, including diabetes. Preoperative and postoperative relative decreased patellar height and stiffness postoperative were significantly correlated (P = .001). Although stiffness post-TKA is multifactorial, careful attention to surgical exposure, restoring gap kinematics, minimizing surgical trauma to the patellar ligament/extensor mechanism, appropriate implant selection, and physiotherapy combined with a well-motivated patient may all serve to reduce the incidence of stiffness post-TKA.

Multiple specialized exposures have been described for revision total hip arthroplasty. In this article, we report on a series of 7 patients who underwent major isolated acetabular revision surgery through a modified iliofemoral approach. The use of this approach was deemed desirable because of the individual pathology present in each case, particularly major acetabular bone loss (Paprosky 2C/3B). However, successful reconstruction was achieved in all cases with the most frequent complication being meralgia paresthetica., (Copyright 2003, Elsevier Science (USA). All rights reserved.)

A Tensor/Balancer device (Stryker Howmedica Osteonics, Allendale, NJ) was used to restore optimal stability and alignment during 83 consecutive total knee arthroplasties with a minimum of 6-week clinical and radiographic follow-up. The surgical technique is described. Mean flexion-extension symmetry was restored to within 1 degrees. Mean femoral rotation required to achieve symmetry in flexion differed between varus (4.38 degrees ) and valgus (6.0 degrees ) knees. Of 83 knees, 7 had >3 mm of subjective laxity during component trialing and were associated with a preoperative deformity of >15 degrees; 19 knees required femoral rotation of >6 degrees and were associated with greater preoperative malalignment. Postoperative knee alignment, range of motion, Knee Society score, and lateral release rate were similar between the 2 groups. The use of a Tensor/Balancer device in total knee arthroplasty can achieve outcomes comparable to existing techniques with potential for improved technical accuracy.

A retrospective review of 31 patients who developed acute colonic pseudo-obstruction (ACPO) after total joint arthroplasty was undertaken to determine predisposing factors related to, and outcomes following, therapeutic intervention. Comparison with all patients who underwent total joint arthroplasty revealed an overall 1.2% incidence of ACPO. There was a higher incidence of ACPO in patients undergoing sequential bilateral total knee arthroplasty (3.4%) compared with unilateral total knee arthroplasty (0.3%) and a higher incidence in patients undergoing revision total hip arthroplasty (5.6%) compared with primary total hip arthroplasty (1.4%). Additional risk factors for developing ACPO included slow postoperative mobilization and male gender. No association was found with respect to body mass index, age, comorbidity, anesthetic type, international normalized ratio level, or postoperative analgesia. There were no deaths, and 2 patients required operative intervention. The remaining cases of ACPO resolved with nonsurgical treatment. In all cases, there was a prolonged length of hospitalization (mean, 13.2 days) compared with all other arthroplasties performed at our institution (mean, 7.5 days).

We encountered a case of apparent progressive femoral osteolysis around a well-fixed cementless implant in a young patient. At the time of revision arthroplasty, massive hemorrhaging occurred during exposure and attempted femoral component extraction. Urgent packing of the exposed endosteum with polymethyl methacrylate controlled the bone bleeding. Emergent angiography confirmed an arteriovenous malformation with extensive proximal diaphyseal involvement directly at the site of osteolysis. This arteriovenous malformation was treated successfully with selective arterial embolization and second-stage resection. In retrospect, the index arthroplasty operative note indicated an excessive amount of blood loss, and prerevision radiographs showed osteolysis with uncharacteristic vascular markings. The presence of an osteolytic lesion in total hip arthroplasty should not be assumed to be attributed to polyethylene granuloma, and any atypical radiographic features should prompt further preoperative investigations.

A small-frame Hoffman external fixation bar instrumented with strain gauges to quantify bending and torsional forces was applied to 4 patients with a displaced metaphyseal fracture of the distal radius. Measurements were taken during surgery as well as at 1, 3, and 6 weeks after surgery during activities of daily living and hand therapy mobilization. Radiographs also were taken before and after reduction and at each subsequent visit. Force decay occurred after reduction of the fracture, averaging only 26% of the initial distraction forces by 5 minutes. These forces plateaued and did not significantly change over the subsequent 40-minute observation period. There was no correlation between carpal height index and the forces measured in the external fixator. Significant changes in external fixator forces were measured during activities of daily living and hand therapy mobilization, but these returned to baseline after the activities were performed. The most provocative activities studied were twisting a doorknob and lifting heavy objects. These activities should be performed with caution by patients with unstable distal radial fractures.

A retrospective review of the medical records and radiographs of 32 consecutive patients, totaling 52 extremities with chevron osteotomies for hallux valgus, was conducted to compare K wire fixation with absorbable (poly-p-dioxanone) pin fixation. Each group comprised 21 feet, with a mean clinical follow-up of 35.6 months (25.6-50.5 months) in the K wire group and 23.1 months (13.7-28.8 months) in the absorbable pin group. Demographics as well as final clinical follow-up scores (hallux-metatarsophalangeal-interphalangeal scale and visual analogue scores) were similar in both groups. Postoperative hallux valgus and intermetatarsal angles were similar in both groups. No complications, such as osteolysis for inflammatory sinus formation, occurred in the absorbable pin group. Two patients in the K wire group had a malunited osteotomy and two patients had a retained K wire at final follow-up. Our experience suggests that poly-p-dioxanone pins are at least as effective as K wires, and the previous reports of inflammatory sinus formation and osteolysis are not a significant concern in the fixation of chevron osteotomies for hallux valgus.

The relationship of measurements of the intercanthal width (en-en), the biocular width (ex-ex) and both eye fissures (ex-en), constituting the orbital protrusion index ex-ex x 100 (en-en) + (en-ex, r) + (en-ex, l) was used to analyze preoperative morphological developments in the orbits of 23 patients with Treacher Collins syndrome. The index permitted distinction between mildly and severely defective orbits, based on the degree of defective measurements and variations in relative sagittal positions. Optimal index values (mean, 94.0) were seen in 11 subjects with a slightly different sagittal level between the inner and outer commissures of the eye fissures, which created slightly protruding but still normal soft-tissue relief. The eye fissures in seven patients were moderately reduced in length. Orbits with higher indices (mean 98.1) (12 subjects) showed less differences in level between the two commissures of the eye fissures, producing a flattening in the surface relief. Eye fissure length was markedly subnormal in all patients.