Is total hip arthroplasty after hip arthrodesis as good as primary arthroplasty?

BACKGROUND: Conversion of hip arthrodesis to a THA reportedly provides a reasonable solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with a hip fusion. Patients generally are satisfied with conversion despite the fact that range of mobility, muscle strength, leg-length discrepancy (LLD), persistence of limp, and need for assistive walking aids generally are worse than those for conventional primary THA. QUESTIONS/PURPOSES: We compared THA after hip arthrodesis and primary THA to determine whether these procedures would be associated with similar functional scores, maintenance of scores with time, complications and failures, survivorship of the arthroplasty, and patient satisfaction. PATIENTS AND METHODS: We retrospectively matched 48 patients undergoing conversion of a fused hip to a THA between January 1980 and January 2000, with 50 patients receiving a primary THA during the same period. We prospectively followed all patients between January 2000 and January 2010. The changes in function and pain after THA were compared between the two cohorts using the Harris hip score (HHS) and the Rosser Index Matrix (RIM). The Oxford hip score (OHS) and the SF-36 also were used to assess quality of life (QOL) during followup. Complications were collected and survivorship of the THA was evaluated. Patient satisfaction was assessed using the Robertsson and Dunbar questionnaire. The minimum followup was 10 years (mean, 17 years; range, 10-29 years). RESULTS: At last followup, hip function and health-related QOL were similar for patients having conversion of hip arthrodesis to THA and for patients having a routine THA. Scores diminished overall in the two groups between 2000 and 2010, but without a difference for the HHS, RIM QOL, and OHS in the study cohort. The rate of complications, THA survival, and patient satisfaction were similar in both groups. CONCLUSIONS: Conversion of hip arthrodesis to a THA provides substantial improvement of hip function and health-related QOL, with an acceptable rate of complications, good expectancy of survival for the arthroplasty, and high level of patient satisfaction comparable to those of primary THA. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Tantalum is a good bone graft substitute in tibial tubercle advancement.

BACKGROUND: Porous tantalum is reportedly a good substitute for structural bone graft in several applications. So far, its use has not been reported in tibial tuberosity anteriorization (TTA) for treatment of isolated degenerative chondral lesions of the patellofemoral joint. QUESTIONS/PURPOSES: We asked whether the use of this material would produce similar standardized functional scores, pain (VAS), fusion rates, complications, and patient satisfaction to those for bone graft. PATIENTS AND METHODS: We performed a randomized, controlled trial in 101 patients (108 knees) scheduled for TTA comparing a porous tantalum implant (57 knees) with an autologous local tibial bone graft (51 knees). The minimum followup was 5 years (mean, 6.2 years; range, 5-8 years). RESULTS: At the last followup, clinical scores, fusion rates, and maintenance of the anteriorization either were better or similar for the TTA using the tantalum implant depending on the respective parameter. The operative technique was easier and shorter with the tantalum device. Complication and failure rates were greater using bone graft. Patient satisfaction was greater using the tantalum implant. CONCLUSIONS: Porous tantalum provided a reasonable alternative to bone graft in TTA. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

[Osteointegration of porous tantalum stems implanted in avascular necrosis of the hip]. / Osteointegración de vástagos de tantalio poroso implantados en necrosis avasculares de la cadera.

Efficacy of osteointegration of tantalum porous systems has been demonstrated through animal experimentation. However, there is a lack of studies that evaluate osteointegration of implants retrieved after a period of implantation in humans. For this study, eight rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty three months. Observation during this study has confirmed effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. Bone in growth however, proved to be of a slower and less intense degree than that resulting within animal species during first months after implantation. Nevertheless, the results obtained in the quantitative evaluation of this process proved to be similar to those results achieved by other authors in previous experimental studies.

Incidencia de lesiones traumáticas de miembro superior en pacientes pediátricos: Hospital Universitario de Coro Dr. Alfredo Van Grieken / Incidence of traumatic injuries of upper limb in pediatric patients: Hospital Universitario de Coro

Establecer las causas e incidencia de lesiones traumáticas de miembro superior, en pacientes pediátricos ingresados en el Hospital "Dr. Alfredo Van Grieken", de la ciudad de Coro, durante el período comprendido entre abril 02 - abril 03 y establecer recomendaciones basadas en las conclusiones de este trabajo, dirigidas a pediatras, padres, maestros y otros. Se presenta una revisión retrospectiva de 44 pacientes pediátricos ingresados en el Hospital Universitario "Dr. Alfredo Van Grieken" con diadnóstico de lesiones traumáticas de miembros superiores, durante el período abril 2001 a abril 2002. Los pacientes fueron niños en edades comprendidas entre 6 años a 8 años 11 meses y del sexo masculinos. El diagnóstico más frecuente fue las fracturas en un 65 por ciento. Estos ocurrieron en el hogar en un 52,25 por ciento, mientras se encontraban jugando en un 77,27 por ciento, y para el momento de la lesión se encontraban solos en un 72,71 por ciento, recibiendo en su mayoría tratamiento quirúrgico en 68,18 por ciento, sin secuelas posterior a tratamiento en un 65,90 por ciento.