Revision total hip arthroplasty with a modular cementless femoral stem.

We retrospectively reviewed 123 patients who underwent cementless THA with modular femoral stem designs for revision THA or conversion of failed ORIF and found 75 patients available for analysis. The Harris Hip Score (HHS) improved from 52 ± 14 to 86 ± 11 (P < 0.001). The femoral stem was re-revised in eight patients (11%). The mean time to re-revision was 1.1years (0.13-2.54). Reasons for re-revision included infection (n = 5, 7%), aseptic loosening (n = 2, 3%) and significant pain (n = 1, 1%). There were no failures of the modular junctions. PC stems had an increased rate of intraoperative fractures (PC 28% vs. STS 9%, P = 0.04). Modular cementless femoral stems provide acceptable mid-term results in revision THA.

Addition of a suture anchor for coracoclavicular fixation to a superior locking plate improves stability of type IIB distal clavicle fractures.

PURPOSE: The purpose of this study was to determine the effect of coracoclavicular (CC) fixation on biomechanical stability in type IIB distal clavicle fractures fixed with plate and screws. METHODS: Twelve fresh-frozen matched cadaveric specimens were used to create type IIB distal clavicle fractures. Dual-energy x-ray absorptiometry (DEXA) scans ensured similar bone quality. Group 1 (6 specimens) was stabilized with a superior precontoured distal clavicle locking plate and supplemental suture anchor CC fixation. Group 2 (6 specimens) followed the same construct without CC fixation. Each specimen was cyclically loaded in the coronal plane at 40 to 80 N for 17,500 cycles. Load-to-failure testing was performed on the specimens that did not fail cyclic loading. Outcome measures included mode of failure and the number of cycles or load required to create 10 mm of displacement in the construct. RESULTS: All specimens (12 of 12) completed cyclic testing without failure and underwent load-to-failure testing. Group 1 specimens failed at a mean of 808.5 N (range, 635.4 to 952.3 N), whereas group 2 specimens failed at a mean of 401.3 N (range, 283.6 to 656.0 N) (P = .005). Group 1 specimens failed by anchor pullout without coracoid fracture (4 of 6) and distal clavicle fracture fragment fragmentation (1 of 6); one specimen did not fail at the maximal load the materials testing machine was capable of exerting (1,000 N). Group 2 specimens failed by distal clavicle fracture fragment fragmentation (3 of 6) and acromioclavicular (AC) joint displacement (1 of 6); 2 specimens did not fail at the maximal load of the materials testing machine. CONCLUSIONS: During cyclic loading, type IIB distal clavicle fractures with and without CC fixation remain stable. CC fixation adds stability to type IIB distal clavicle fractures fixed with plate and screws when loaded to failure. CLINICAL RELEVANCE: CC fixation for distal clavicle fractures is a useful adjunct to plate-and-screw fixation to augment stability of the fracture.

Successful intraoperative retrieval of dislocated femoral trial head during total hip arthroplasty.

Since the advent of modular hip prostheses in the early 1970s, dissociation of the femoral trial head and migration into the deep tissue space of the pelvis are rarely reported complications of total hip arthroplasty. Several case reports have described this complication, but the actual incidence is unknown and likely underreported. Two cases are presented here using a new technique to retrieve a trial femoral head from within the pelvis without use of an extensile approach, laparoscopic retrieval, or secondary incisions.

The prevalence of radiographic criteria of femoral acetabular impingement in patients undergoing hip arthroplasty surgery.

BACKGROUND: Pistol grip deformity of the proximal femur has been reported as a potential cause of hip pain and early-onset arthritis. The exact incidence of patients with osteoarthritis resulting from femoral acetabular impingement (FAI) is unknown. The purpose of this study was to explore the relationship between radiographic markers of FAI in patients undergoing hip arthroplasty. METHODS: We retrospectively reviewed the radiographs of patients undergoing hip arthroplasty by a single surgeon over a 2-year period. The patients were divided by age, those younger than 65 years and (group A) and those 65 years and older (group B). The radiographs were evaluated for morphology consistent with FAI including an α angle >55°, crossover sign, coxa profunda, acetabular protrusio, and ischial spine sign. Three independent reviewers evaluated all the radiographs. The incidence of CAM, Pincer, and mixed deformities were compared between the 2 groups. RESULTS: A total of 255 patients with 258 hip arthroplasties were included in this analysis. Group A was found to have a greater number of patients with CAM morphology. Linear regression analysis revealed that the α angle was greater in younger patients. CONCLUSION: Patients undergoing hip arthroplasty exhibit a high incidence of radiographic abnormalities consistent with FAI. The CAM-type morphology occurs more frequently in younger patients with advanced arthritis requiring hip arthroplasty. This morphology is thought to cause a delaminating injury to the cartilage of the acetabulum. This study supports the notion that CAM-type morphology is a risk factor for early development of degenerative arthritis of the hip.

Relevant anatomic landmarks and measurements for biceps tenodesis.

BACKGROUND: Biceps tenodesis around the pectoralis major insertion may alter resting tension on the biceps, leading to unfavorable clinical outcomes. HYPOTHESIS: The anatomic relationship between the musculotendinous junction (MTJ) of the biceps and the pectoralis major tendon will provide guidelines for anatomic location to perform biceps tenodesis with the goal of re-establishing biceps tension. STUDY DESIGN: Descriptive laboratory study. METHODS: Cadaveric dissections were performed that reflected the pectoralis major tendon and exposed the long head of the biceps tendon (LHBT). Calipers were used to measure the longitudinal width of the pectoralis major tendon at the humerus, 2 cm away from the humerus, and at its proximal expansion on the humerus. The distance from the proximal extent of the pectoralis major tendon footprint to the beginning of the MTJ of the biceps and the length of the MTJ of the biceps were recorded. The location of the distal end of the MTJ of the biceps relevant to the inferior border of the pectoralis major tendon was calculated. RESULTS: The average longitudinal width of the pectoralis major tendon at its humeral insertion was 76.8 mm, the width 2 cm away from the humerus averaged 37.3 mm, and the proximal expansion averaged 13.3 mm. The MTJ of the biceps began an average of 32.4 mm distal from the proximal aspect of the pectoralis major footprint and extended for an average of 78.1 mm. The MTJ of the LHBT was calculated to extend 3.3 cm distal to the inferior border of the pectoralis major footprint. CONCLUSION: The MTJ of the biceps begins further proximal than may be appreciated intraoperatively. Knowledge of the anatomic relationships between the LHBT, its MTJ, and the pectoralis major tendon provides helpful guidelines for the biceps tenodesis site. The final resting spot of the most distal aspect of the MTJ of the LHBT after tenodesis should be approximately 3 cm distal to the inferior edge of the pectoralis major tendon footprint on the humerus.