Effect of sleeved ceramic femoral heads on titanium ion release.

INTRODUCTION: Metal ion release from wear and corrosion at the femoral head-stem taper junction can evoke local adverse reactions to metal debris (ARMD). In a specific large-diameter head (LDH) total hip arthroplasty (THA) system, ceramic femoral heads of 44 to 48 mm are available with a titanium (Ti) adaptor sleeve, while heads of 36- to 40-mm come without sleeves. The hypothesis of this study is that the Ti adaptor sleeve with LDH ceramic-on-ceramic (CoC) bearings will not cause wear or corrosion at the taper junction and, thus, will not generate high whole blood Ti ion levels. METHODS: We compared whole blood Ti levels at minimum 1-year follow-up in 27 patients with unilateral primary LDH CoC THA with head sizes ranging from 36 to 48 mm using a Ti stem and acetabular component. RESULTS: Although Ti ion levels in patients with 36- to 40-mm head diameters without Ti sleeve were found to be statistically significantly higher (2.3 µg/l: 1.6-3.1, SD 0.44) compared to those with a Ti sleeve (1.9 µg/l: 1.6-2.2, SD 0.19) (p = 0.020), the found difference has no clinical importance. No patients presented clinical signs of ARMD, and the clinical results in both groups were similar. CONCLUSIONS: LDH CoC THA Ti levels were low and probably related to unavoidable passive corrosion of implant surfaces. Measurement of Ti in subjects with ceramic LDH, with or without Ti adaptor sleeve, did not disclose undirected signs of trunnionosis.

Familial Transmission of emm12 Group A Streptococcus.

Incidence and severity of invasive group A Streptococcus infections are of increasing concern in France and worldwide. The risk for secondary infection of close contacts is known but rarely described. We report a case of intrafamilial and life-threatening transmission of emm12 group A Streptococcus.

Can patients return to high-impact physical activities after hip resurfacing? A prospective study.

PURPOSE: Although the resumption of low-impact sports activities is compatible with total hip arthroplasty (THA), participation in high-impact sports seems problematic, and there is no consensus as to whether it is advisable. The purpose of this article is to evaluate the quality and possibility of resuming high-impact physical activities after hip resurfacing. MATERIALS: The study was performed in an on-going, single-surgeon, prospective series of 215 resurfacing arthroplasties (RSA). Mean follow-up was 44.1 months (range, 39.1-54.5). Clinical evaluation included the Postel-Merle d'Aubigné (PMA) score, the Oxford hip score, the Harris hip score (HHS), Devane score, and UCLA activity score. A specific questionnaire analysing sports activities was administered to each patient to assess the number and level of physical activities performed (both before the operation and at final follow-up). RESULTS: In the series of 202 consecutive patients (215 RSA), 50 patients (55 RSA) engaged regularly in at least one high-impact activity before their operation and the onset of pain, 102 patients practised at least one intermediate-impact activity, and the 50 remaining patients undertook only low-impact activities. Harris hip score increased from 44.8 (range, 23-68) before the operation to 97.8 (range, 85-100) at the last follow-up. Mean time to sports resumption after surgery was 14.6 weeks (range, 7-29). The resumption rate was 98 % for sports of any impact level and 82 % for high-impact activities. No osteolysis or implant loosening was observed at follow-up. No revision was performed. CONCLUSION: In 2012, no consensus recommendations yet exist for the resumption of sports activities after RSA. Existing recommendations concern only conventional THA. We believe that RSA allows younger and more active patients to resume physical and sports activities without restriction. The rate of return to sports after RSA appears to be excellent and unequalled by conventional hip prostheses. High-impact sports seem to be compatible with hip resurfacing, although no long-term studies have analysed the impact of these activities on wear and/or aseptic loosening.