Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p < .001). The results of the present study have demonstrated the superiority of the distal chevron osteotomy over the modified McBride procedure for mild to moderate deformity. For patients with moderate deformity, the McBride group had a greater risk of hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus.

Efficacy of Debridement for Early Periprosthetic Joint Infection after Hip Arthroplasty.

PURPOSE: In early prosthetic joint infection after hip arthroplasty, debridement with prosthesis retention may be performed for implant salvage, but the reported success rates are highly variable. Hence we reviewed the outcome of radical debridement and retention of prosthesis using established diagnostic criteria and surgical procedures in relation to significant variables including clinical characteristics, pathogenicity, and antibiotic treatment. MATERIALS AND METHODS: We retrospectively reviewed 20 patients (11 men and 9 women) with early prosthetic joint infection after unilateral hip arthroplasty, treated by radical debridement with retention of prosthesis from January 2000 to May 2011. Average follow-up period was 55 months (12-178 months). The outcome was evaluated and analyzed based on recurrence of infection and clinical (Harris hip score) and radiological criteria. RESULTS: Pathogens were isolated from 11 hips (methicillin-resistant Staphylococcus aureus [MRSA] in three, methicillin-resistant Staphylococcus epidermidis [MRSE] in two, methicillin-sensitive Staphylococcus aureus [MSSA] in one, Acinetobacter baumannii in two, Enterococcus faecalis in two patients, and Enterococcus, Citrobacter species in one). The mean duration of antibiotic administration was 43.5 days. Recurrence of infection was not observed in any case. Average Harris hip score was 91 points at the last follow-up. Revision surgery was not required for any reason including implant failure. Dislocation occurred in two hips after debridement and was treated conservatively. CONCLUSION: Radical debridement with prosthesis retention is an effective procedure for early prosthetic joint infection after hip arthroplasty in carefully selected patients and with early diagnosis.

Characterization of progression of pelvic osteolysis after cementless total hip arthroplasty: computed tomographic study.

A retrospective analysis of 63 primary total hip arthroplasty cases was done using repeated computed tomography scans to evaluate the pelvic osteolytic lesions in early stage. The progression rate of osteolysis of hips with small osteolytic volume less than 766.97 mm(3) in initial CT was 85.82 mm(3)/year, and that of hips with osteolysis more than 766.97 mm(3) was 456.3 mm(3)/year (P < 0.001). Younger patients less than 52 years old with good Harris Hip Scores (more than 80) frequently showed much faster progression in volume of osteolytic lesions. The rate of osteolysis was accelerated when the amount of osteolysis reached a certain threshold volume in active young patients in a cascade manner even in early stage.

Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.

BACKGROUND: There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties. METHODS: On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases. RESULTS: Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1). CONCLUSIONS: An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.