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1. Outcomes of Unicompartmental Knee Arthroplasty Stratified by Body Mass Index

Author

Peter M. Bonutti, Michael G. Zywiel, Harpal S. Khanuja, Maria S. Goddard, Michael A. Mont, and Aaron J. Johnson

Subjects
Male, musculoskeletal diseases, medicine.medical_specialty, Knee Joint, medicine.medical_treatment, Radiography, Total knee arthroplasty, Osteoarthritis, Body Mass Index, Risk Factors, Outcome Assessment, Health Care, medicine, Humans, Orthopedics and Sports Medicine, In patient, Obesity, Arthroplasty, Replacement, Knee, Unicompartmental knee arthroplasty, Aged, Retrospective Studies, Aged, 80 and over, business.industry, nutritional and metabolic diseases, Middle Aged, Osteoarthritis, Knee, musculoskeletal system, medicine.disease, Surgery, Treatment Outcome, Female, Periprosthetic Fractures, Knee Prosthesis, business, human activities, Body mass index, Follow-Up Studies
Abstract

Patients who have high body mass indices can have disabling medial compartment knee osteoarthritis, which might benefit from unicompartmental knee arthroplasty (UKA). The purpose of this study was to compare clinical and radiographic outcomes of UKAs in patients with body mass indices (BMIs) greater and less than 35 kg/m 2 . Thirty-four patients (40 knees) had BMIs of 35 kg/m 2 or greater, whereas the remaining 33 patients (40 knees) had BMIs below 35 kg/m 2 , with 2-year minimum follow-up. In the high-BMI group, 5 knees were revised to total knee arthroplasty, compared with none in the lower BMI group. Knee Society scores were lower in the surviving high-BMI knees. All surviving components were radiographically stable. The results suggest that UKA should be approached with caution in patients who have high BMIs.

Published
2011
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2. Cementless Femoral Fixation in Total Hip Arthroplasty

Author

Harpal S. Khanuja, Maria S. Goddard, Jeffrey J. Vakil, and Michael A. Mont

Subjects
musculoskeletal diseases, medicine.medical_specialty, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Dentistry, Femoral fixation, Initial fixation, Prosthesis Design, Osseointegration, medicine, Humans, Prosthesis design, Orthopedics and Sports Medicine, Femur, business.industry, Bone Cements, General Medicine, equipment and supplies, musculoskeletal system, Arthroplasty, Surgery, surgical procedures, operative, Thigh pain, Hip Prosthesis, business, Total hip arthroplasty
Abstract

A number of cementless femoral stems are associated with excellent long-term survivorship. Cementless designs differ from one another in terms of geometry and the means of obtaining initial fixation. Strict classification of stem designs is important in order to compare results among series. Loosening and thigh pain are less prevalent with modern stem designs. Stress-shielding is present in most cases, even with newer stem designs.

Published
2011
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3. Osteonecrosis of the knee

Author

Maria S. Goddard and Harpal S. Khanuja

Subjects
musculoskeletal diseases, medicine.medical_specialty, business.industry, Cartilage, medicine.medical_treatment, Total knee replacement, Total knee arthroplasty, Avascular necrosis, General Medicine, Disease, medicine.disease, Surgery, medicine.anatomical_structure, medicine, Core decompression, business, Unicompartmental knee arthroplasty
Abstract

The pathogenesis of osteonecrosis of the knee remains largely unexplained. MRI has become the mainstay of diagnosis and screening, especially for lesions in the early stages of the disease. Treatment encompasses nonoperative and operative interventions. With regard to the latter, recent studies have shown that the role of biologic substitutes is evolving, core decompression continues to be a successful option for patients with early osteonecrosis, and total knee arthroplasty provides the best outcomes for patients with advanced osteonecrosis. In addition, unicompartmental knee arthroplasty for selected patients has produced good results, and several case studies have indicated promising outcomes with the use of tissue-engineered cartilage, although additional experience with long-term data is needed before this option becomes part of the general armamentarium. In this review, we provide an update on the pathophysiology and treatment of osteonecrosis of the knee based on the recent literature.

Published
2009
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4. Total Hip and Knee Arthroplasty in Patients With Hereditary Multiple Exostoses

Author

Harpal S. Khanuja, Addisu Mesfin, Maria S. Goddard, and Yetsa A. Tuakli-Wosornu

Subjects
Male, musculoskeletal diseases, medicine.medical_specialty, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Hereditary multiple exostoses, Radiography, Metaphysis, Prosthesis Design, Prosthesis Fitting, Deformity, Humans, Medicine, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, Valgus deformity, biology, business.industry, Middle Aged, musculoskeletal system, medicine.disease, biology.organism_classification, Arthroplasty, Surgery, Joint Deformities, Acquired, Valgus, medicine.anatomical_structure, Hip Prosthesis, medicine.symptom, Ankle, Knee Prosthesis, business, Exostoses, Multiple Hereditary
Abstract

To the authors’ knowledge, few reports have been published in the English literature of using total knee arthroplasty and total hip arthroplasty for the treatment of hereditary multiple exostoses. This article describes 2 patients with hereditary multiple exostoses, 1 treated with total hip arthroplasty and 1 treated with total knee arthroplasty. Bony deformities make arthroplasty uniquely challenging in patients undergoing total hip or knee arthroplasty. An expanded metaphysis of the proximal femur, coxa valga deformity, and the presence of hardware from previous reconstructive surgeries can make total hip arthroplasty technically difficult. Substantial bony deformity of the distal femur, valgus deformity of the knee, and sizing issues that necessitate custom implants can make total knee arthroplasty difficult. The most common bony deformities in hereditary multiple exostoses are short stature, limb-length discrepancy, valgus deformity at the knee and ankle, and asymmetry of the pectoral and pelvic girdles. Most reported surgical treatments for patients with hereditary multiple exostoses focus on the pediatric population or the management of malignant transformation of exostoses. Studies that specifically address the conditions associated with knee deformities focus on extra-articular deformity correction rather than arthroplasty. When arthroplasty is necessary in this patient population, an understanding of the commonly occurring deformities can help with preoperative planning and surgical management. All painful lesions must be evaluated for malignant transformation. Bone scans can be useful during workup. All specimens should be sent for pathologic evaluation. Such patients are challenging because of the distorted hip anatomy and valgus knee deformity. The current 2 cases illustrate specific challenges that can be anticipated and underscore key principles for arthroplasty in the management of hereditary multiple exostoses.

Published
2012
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5. Nonoperative Treatment of Knee Arthritis

Author

Maria S. Goddard, Stephen R. Thompson, Harpal S. Khanuja, Michael A. Mont, and Marc W. Hungerford

Subjects
Knee arthritis, medicine.medical_specialty, business.industry, medicine, business, medicine.disease, Surgery, Nonoperative treatment
Published
2012
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6. Contributors

Author

Aryeh M. Abeles, Paolo Aglietti, Azhar A. Ali, Annunziato Amendola, Allen F. Anderson, Christian Noel Anderson, Jason D. Archibald, Elizabeth Arendt, Jean-Noël Argenson, Amy F. Austin, Bernard R. Bach, David Backstein, Geoffrey S. Baer, Sarvottam Bajaj, Andrea Baldini, Mark A. Baldwin, Sue Barber-Westin, Joseph Barker, Christopher P. Beauchamp, Martin Bédard, Keith R. Berend, Richard A. Berger, Thomas Bernasek, Daniel J. Berry, Jack M. Bert, Kevin F. Bonner, Adam C. Brekke, Karen K. Briggs, Claire L. Brockett, Michael K. Brooks, James A. Browne, Brandon J. Bryant, Jarett S. Burak, Alissa Burge, Charles Bush-Joseph, Asokumar Buvanendran, John Callaghan, Tom R. Carter, Eli Chen, Anikar Chhabra, Constance R. Chu, Randy Clark, Henry D. Clarke, David E. Cohen, Brian J. Cole, Thomas M. Coon, John H. Currier, Fred D. Cushner, Diane L. Dahm, Timothy A. Damron, Joseph P. DeAngelis, Bridget M. Deasy, David DeJour, Craig J. Della Valle, A. Lee Dellon, Guillaume Demey, Douglas A. Dennis, Ezra Deutsch, Ian D. Dickey, David R. Diduch, Mark E. Easley, Kostas Economopoulos, Gerard A. Engh, Gregory C. Fanelli, Jack Farr, Christopher M. Farrell, Thomas K. Fehring, Julian Feller, Jonathan T. Finnoff, John Fisher, Wolfgang Fitz, Clare K. Fitzpatrick, John P. Fletcher, John M. Flynn, Andrew G. Franks, Richard J. Friedman, Nicole A. Friel, Freddie H. Fu, John P. Fulkerson, Robert Kyle Fullick, Theodore J. Ganley, Donald S. Garbuz, Burhan Gharaibeh, Thomas J. Gill, Maria S. Goddard, Andreas Gomoll, Carlos Gonzalez, Christopher R. Gooding, Robert C. Grumet, F. Winston Gwathmey, Steve Haas, Mahmoud Hafez, George J. Haidukewych, Christopher A. Hajnik, Arlen D. Hanssen, Christopher D. Harner, Joseph M. Hart, William L. Healy, Peter F. Heeckt, Sarah E. Henry, Benton E. Heyworth, Richard Y. Hinton, Aaron A. Hofmann, Siegfried Hofmann, Ginger E. Holt, Terese T. Horlocker, Stephen M. Howell, Johnny Huard, Catherine Hui, Christophe Hulet, Maury L. Hull, Marc W. Hungerford, Anthony F. Infante, John N. Insall, David J. Jacofsky, James G. Jarvis, Louise Jennings, Charles E. Johnston, V. Karthik Jonna, Thomas Keller, Donna R. Kesselman, Craig Kessler, Saurabh Khakharia, Harpal S. Khanuja, Raymond H. Kim, Sung Jae Kim, Yair D. Kissin, Kevin Klingele, Mininder S. Kocher, Richard D. Komistek, Gabrielle P. Konin, Sandra L. Kopp, Nathan Kopydlowski, Dennis Kramer, Christopher M. Kuenze, Paul F. Lachiewicz, Jason E. Lang, Joshua R. Langford, Robert F. LaPrade, Peter J. Laz, Matthew Leidl, James M. Leone, Filip Leszko, David Levi, Gabriel Levi, Randall J. Lewis, Martin Lind, Eric M. Lindvall, David R. Lionberger, Frank A. Liporace, Martin Logan, Adolph V. Lombardi, William J. Long, Jess H. Lonner, Sébastien Lustig, Steven Lyons, Travis G. Maak, Jeffrey A. Macalena, Samuel D. Madoff, Shinichi Maeno, Robert A. Magnussen, Suzanne A. Maher, Mohamed R. Mahfouz, Sabine Mai, Patrick G. Marinello, J. Bohannon Mason, Bassam A. Masri, Henry Masur, Kevin R. Math, Richard C. Mather, Kenneth B. Mathis, Shuichi Matsuda, Jeremy McCandless, Kristen E. McClure, R. Michael Meneghini, Mark Miller, Douglas Mintz, Michael A. Mont, Claude T. Moorman, Michael J. Morris, William B. Morrison, Kenneth R. Morse, John Kyle P. Mueller, Thomas Muellner, David Murray, Volker Musahl, Michael D. Neel, Joshua Nelson, Michael P. Nett, Philippe Neyret, Philip C. Noble, Frank R. Noyes, Mary I. O’Connor, Matthew E. Oetgen, Mark W. Pagnano, Christopher J. Palestro, Sebastien Parratte, Brian S. Parsley, Nilesh Patil, Henrik B. Pedersen, Lars Peterson, Michael H. Pillinger, Leo Pinczewski, William R. Post, Sridhar R. Rachala, Craig S. Radnay, Adam J. Rana, R. Lor Randall, Robert S. Reiffel, Michael D. Ries, Samuel P. Robinson, Scott A. Rodeo, William G. Rodkey, Jose Rodriquez, Gregory J. Roehrig, Aaron G. Rosenberg, Pamela B. Rosenthal, Paul J. Rullkoetter, Paulo R.F. Saggin, Lucy Salmon, Roy Sanders, Robert C. Schenck, Oliver S. Schindler, Verena M. Schreiber, Richard D. Scott, Susan Craig Scott, W. Norman Scott, Giles R. Scuderi, Ari D. Seidenstein, Jon K. Sekiya, Elvire Servien, Erik P. Severson, Nicholas A. Sgaglione, Adrija Sharma, Seth L. Sherman, Michael S. Shin, Werner E. Siebert, Rafael J. Sierra, C. Van Sikes, David L. Skaggs, Gideon P. Smith, Gary E. Solomon, Kurt P. Spindler, Andrew I. Spitzer, Bryan D. Springer, J. Richard Steadman, Kelly Stets, Anna L. Stevens, James B. Stiehl, Eric J. Strauss, Michael Stuart, S. David Stulberg, Eric Tannenbaum, Dean C. Taylor, Kimberly Templeton, Stephen R. Thompson, Thomas Thornhill, Gehron Treme, Alfred J. Tria, Kimberly A. Turman, Hans K. Uhthoff, Anthony S. Unger, Thomas Parker Vail, Douglas W. Van Citters, Geoffrey S. Van Thiel, Haris S. Vasiliadis, Vincent J. Vigorita, Kelly G. Vince, Bruno Violante, James E. Voos, Shail Vyas, Daniel M. Walz, David Warwick, Nicholas P. Webber, Jennifer Weiss, Kurt R. Weiss, Barbara N. Weissman, Leo A. Whiteside, Thomas L. Wickiewicz, Bryan S. Williams, Riley J. Williams, Yi-Meng Yen, Hong Zhang, Sumesh M. Zingde, and Adam C. Zoga

Published
2012
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7. Chronic Expanding Hematoma of the Lateral Thigh and Massive Bony Destruction After a Failed Total Hip Arthroplasty

Author

Harpal S. Khanuja, Jeffrey J. Vakil, Maria S. Goddard, and Edward F. McCarthy

Subjects
medicine.medical_specialty, Osteolysis, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Total hip replacement, Thigh, Hematoma, Ischium, medicine, Humans, Orthopedics and Sports Medicine, business.industry, Middle Aged, medicine.disease, Arthroplasty, Prosthesis Failure, Surgery, medicine.anatomical_structure, Chronic Disease, Female, business, Bony destruction, Total hip arthroplasty
Abstract

Pseudotumors have been described around both stable and failed total hip arthroplasties. The causes are varied and include polyethylene debris and masses associated with metal-on-metal bearings. We present a patient with a massive tumor of the thigh that grossly and pathologically was associated with recurrent bleeding and extensive bony destruction. The characteristics of this tumor most resemble those of a chronic expanding hematoma. To our knowledge, this has not previously been reported in association with a total hip arthroplasty.

Published
2011
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