Discrepancy of Trial Rasp and Femoral Stem Relative Position Within the Femoral Canal of a Coated Tapered System: An Intraoperative, Intrapatient Controlled Study.

BACKGROUND: For a successful total hip arthroplasty, the final position of the trial rasp should be adopted by the femoral stem to achieve correct positioning. This study aimed to characterize the discrepancy of the stem and rasp position in vivo of a widely used dual-tapered straight stem with rectangular cross section that is known to have an oversized stem with respect to the rasp. METHODS: The distances between the tip of the greater trochanter and the shoulder of the implant and rasp were measured on 39 intraoperatively acquired fluoroscopic image pairs. Leg-length discrepancy was also measured clinically before and after surgery. RESULTS: A paired t-test showed a significant average protrusion of the femoral stem with respect to the final rasp position of 2.63 mm (standard deviation = 2.3 mm, P < .001), while 88% of the cases had no leg-length discrepancy after surgery. The quantified stem protrusion was statistically significant but did not reach clinical relevance and was easily mitigated in our study. CONCLUSIONS: The quantified stem protrusion appears to be clinically manageable, as only 2 cases required attenuation of stem positioning: in one case by the use of a femoral head with a shorter neck and in the other case by rerasping the femoral bed. Neither case was associated with the most extreme differences in position of the stem with respect to the final rasp. In addition, the used stem shows good overall outcomes in other studies. It appears that factors other than stem and rasp position play a critical role to the surgeon and for total hip arthroplasty success.

Intra-articular versus periarticular acromioclavicular joint injection: a multicenter, prospective, randomized, controlled trial.

PURPOSE: The purpose of this randomized study was to compare the clinical efficacy of intra-articular versus periarticular acromioclavicular joint injections. METHODS: In this multicenter, prospective, randomized, controlled trial, 101 patients (106 shoulders) with symptomatic acromioclavicular joints were treated with an injection and were randomly assigned to either the intra-articular group or the periarticular group. To ensure accurate needle placement either intra-articularly or in a periarticular manner, the needle was placed under ultrasound guidance. Baseline values including the Constant-Murley score, pain assessment with a visual analog scale for pain under local pressure and pain at night, and the crossover arm test were investigated in 7 different centers immediately before treatment. Follow-up examinations were scheduled after 1 hour, 1 week, and 3 weeks. RESULTS: All patients completed the study. Overall, a highly significant clinical improvement in all tested variables and in both groups was observed over time (P < .0001) beginning with 1 hour after treatment and lasting for the entire follow-up period of 3 weeks. The difference between the 2 groups was not significant except regarding the crossover arm test (P < .016). CONCLUSIONS: With both injection techniques, a highly significant clinical advantage for the patient can be achieved. The difference between the 2 treatments was not significant except for more pain reduction according to the crossover arm test after intra-articular injection at 3 weeks' follow-up. LEVEL OF EVIDENCE: Level II, multicenter, randomized, prospective, controlled trial.

Follow-up of a modular rotating hinge knee system in salvage revision total knee arthroplasty.

We evaluated the clinical and radiographic outcomes of salvage knee revisions using a modern-generation, modular, rotating hinge total knee prosthesis in 24 cases with a minimum follow-up of 36 months (mean, 56 months). Indications for revision included aseptic loosening, combined with bone loss and gross collateral ligament instability in all cases. Patients were evaluated clinically and radiographically (Knee Society scores). Knee Society scores improved from 25 preoperatively to 91 postoperatively, and function scores improved from 35 to 85. No loosening of implants was observed. Nonprogressive radiolucent lines were identified around 2 tibial components. One patient required a revision due to patellofemoral subluxation.

Two-stage cementless revision of late total hip arthroplasty infection using a premanufactured spacer.

We observed 44 patients with 2-stage revisions for septic hip prostheses. We used a uniform protocol consisting of the implantation of a preformed spacer (interval 12-26 weeks), specific systemic antibiotic therapies, and cementless total hip arthroplasty at time of reimplantation. The minimum follow-up was 36 months (mean, 67 months; range, 36-120 months). During the spacer period, we observed 4 dislocations and 2 fractures leading to a resection arthroplasty interval before reimplantation in 5 cases. In one patient, reinfection was diagnosed 12 months after reimplantation. The Harris hip score increased from a preoperative mean of 39 to 90 at a mean follow-up of 67 months after reimplantation.