Intra-Articular Hyaluronic Acid Injections Less Than 6 Months Before Total Hip Arthroplasty: Is It Safe? A Retrospective Cohort Study in 565 Patients.

BACKGROUND: Intra-articular hyaluronic acid (IAHA) can be injected into an osteoarthritic hip joint to reduce pain and to improve functionality. Several studies report IAHA to be safe, with minor adverse effects that normally disappear spontaneously within a week. However, intra-articular corticosteroids prior to total hip arthroplasty (THA) have been associated with increased infection rates. This association has never been investigated for IAHA and THA. We aimed to assess the influence of IAHA on the outcome of THA, with an emphasis on periprosthetic joint infection (PJI). METHODS: At a mean follow-up of 52 months (±18), we compared complication rates, including superficial and deep PJIs, of THA in patients who received an IAHA injection ≤6 months prior to surgery (injection group) with that of patients undergoing THA without any previous injection in the ipsilateral hip (control group). One hundred thirteen patients (118 hips) could be retrospectively included in the injection group, and 452 patients (495 hips) in the control group. RESULTS: No differences in baseline characteristics nor risk factors for PJI between the 2 groups were found. The clinical outcomes in terms of VAS pain scores (1.4 vs 1.7 points, P = .11), modified Harris Hip Scores (77 vs 75 points, P = .09), and Hip disability and Osteoarthritis Outcome Scores (79 vs 76 points, P = .24) did not differ between the injection group and the control group. Also, complications in terms of persistent wound leakage (0% vs 1.2%, P = .60), thromboembolic events (0% vs 0.6%, P = 1.00), periprosthetic fractures (1.7% vs 1.2%, P = .65), and dislocations (0% vs 0.4%, P = 1.00) did not differ. However, in the injection group there was a higher rate of PJIs (4% vs 0%, P < .001) and postoperative wound infections (9% vs 3%, P = .01), compared to the control group. CONCLUSION: Our findings suggest that IAHA performed 6 months or less prior to THA may pose a risk for increased rates of PJI. We recommend refraining from performing THA within 6 months after IAHA administration.

Comparison of surgical treatments for mucous cysts of the distal interphalangeal joint.

Mucous cysts of the interphalangeal joints are common. Several surgical techniques have been described, but none has proven to be superior. We compared three techniques that entail complete removal of the cyst together with the concomitant osteophytes. In group A wound closure was obtained by full thickness skin graft, in group B by primary closure and in group C by a local skin graft. Sixty-four patients with 70 cysts were reviewed. An overall recurrence rate of 8.6% was observed. Forty-five of the studied patients received a full thickness skin graft (4 out of 45 recurred), 23 were closed primarily (2 out of 23 recurred) and 2 by a local skin graft (no recurrences). Full thickness skin graft showed no significant higher recurrence compared to primary closure. Full thickness skin graft showed no significant higher pain or satisfaction compared to primary closure. Patients with a recurrent cyst were less satisfied and had more pain than those without recurrences.

Outcome of custom-made IMP femoral components of total hip arthroplasty: a follow-up of 15 to 22 years.

A total of 1659 primary THAs using a cemented custom-made intra-operative manufactured prosthesis (IMP)-stem were studied. The end point for survival was defined as revision of the stem for any reason. Revision arthroplasty was performed in 49 cases. The IMP-stems had a revision free 20-year survival rate of 95.5%. Revisions were performed mainly because of aseptic loosening. There were no drawbacks like increased infection risk due to the prolonged surgical time needed for the intra-operative production of the stem. These data provide evidence that the cemented IMP-stem is able to provide good long-term results.

Long-term outcome of elbow resurfacing.

BACKGROUND: The purpose of this study is to review the long term results the Kudo and instrumented Bone Preserving elbow prostheses. The instrumented Bone Preserving prosthesis is the successor of the Kudo prosthesis, and both of these are nonconstrained elbow resurfacing prostheses. METHODS: Fifty-five nonconstrained elbow prosthesis were implanted in 51 patients. Patients were evaluated with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm Shoulder and Hand score. Revision or the necessity of revision was regarded as failure of the prosthesis. RESULTS: Twenty-one prostheses (of which 3 instrumented Bone Preserving prostheses) were revised or needed revision, yielding a revision rate of 15.1% after 5 years and 36.5% after 10. The major reasons for revision were loosening in 10 cases and instability in 5. Eleven of the nonrevised patients died of unrelated causes, having little or no subjective problems until the time of death. There was no statistical difference between Kudo and instrument Bone Preserving implant survival. Most nonrevised patients were satisfied, according to the Visual Analog Scale for satisfaction. The median MEPS indicated fair to good results. CONCLUSION: When comparing our results to those of other elbow prosthesis we must conclude that our revision rate is high, however, the outcome of the nonrevised patients is good. This study shows that the results of the Kudo prosthesis, which have been reported twice before by our department, have clearly deteriorated after an average follow-up of 174 months (the last study had an average follow-up of 58 months).

Pinnacle revision cup in acetabular surgery results at 2 to 5 years.

Uncemented revision cups are widely used in revision hip arthroplasty; they have shown good results. We report the the short term outcome with the cementless Pinnacle revision cup. All acetabular revisions using a Pinnacle revision cup between January 2007 and March 2010 were included. In March 2012, clinical scores were determined and the latest radiographs were assessed. Revision and radiographic signs of loosening were reported as failure of the cup. Ths study included 117 patients (118 revision cups) with a follow-up between two and five years. Five cups failed (4%). The median modified Harris Hip Score was 64 (range : 18-91). Survival rates of the Pinnacle revision cup are good in the short term follow-up. This implant appears as a safe and reliable solution for small to moderate acetabular defects.

Two-stage revision of an infected total hip arthroplasty: a follow-up of 136 patients.

BACKGROUND AND PURPOSE: Periprosthetic infection of a total hip arthroplasty (THA) is commonly treated with a two-stage revision procedure. After resection of the infected THA and placement of a cement spacer loaded with antibiotics, a THA is inserted at a second procedure to restore hip function and mobility. Revision surgery carries a significant risk of complications. This study focuses on hip function, rate of complications and reinfection after two-stage revision surgery for an infected THA. PATIENTS AND METHODS: From January 1996 to April 2010, 136 patients underwent revision surgery after removal of an infected THA. Follow-up ranged from 2 years to more than 15 years. Hip function was evaluated using the modified Harris Hip Score (mHHS) and the Hip disability and Osteoarthritis Outcome Score (HOOS). Visual Analogue Scale (VAS) measured pain. Annual follow-up included radiographs of the affected hip and blood sampling for inflammatory parameters. RESULTS: After revision surgery, average mHHS was 63% and average HOOS was 54%. VAS pain averaged 26.8 on a 100-point scale and 40% of patients had no pain. Prosthesis-related complications unrelated to sepsis occurred in 32%. Most common were periprosthetic fractures, leg length discrepancy and dislocation. Reinfection occurred in 13% of these patients and Coagulase Negative Staphylococcus (CNS) was isolated in 67%. CONCLUSION: Two-stage evision surgery is an accepted treatment for infected THAs. However, complications are common and hip function afterwards is modest. As previous studies have shown, CNS is an important microorganism in reinfection.