bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing Blood Loss after Total Hip Arthroplasty: A Prospective Randomised Controlled Trial to Evaluate the Efficacy of Temporarily Clamping Drains
Authors: Clifton R. , Norrish A.R. , Howell F.R. 
Published: January 2018

The purpose of the study is to primarily answer the question as to whether temporarily clamping the drain for one hour after total hip replacement reduces blood loss. Many surgeons use this technique, as it is perceived that it creates a tamponade effect in the closed wound, promoting clotting and thereby reducing blood loss. There are no studies to support this practice after hip replacement. We have designed and conducted a randomised controlled trial. Fifty-six patients undergoing total hip replacement had drains placed in their wounds. They were randomised into two groups: half had their drain temporarily clamped for one hour and then the drain opened. The other half had the drain opened immediately after wound closure. The primary outcome measure was volume of drainage at 24 hours and the secondary outcome measures were transfusion requirements and postoperative haemoglobin reduction. No differences were seen between controlled groups for the volume of drainage (413±152 mL vs. 378±141 mL, standard deviation, SD; p=0.38), the transfusion requirement (8/28 in each group received 2 units of packed red cells), or the postoperative haemoglobin drop (not transfused: 3.1±1.3 vs. 3.6±1.5 g/dL, SD, p=0.29; and transfused 2 units: 0.8±1.4 vs. 1.4±1.2 g/dL, SD, p=0.38). The data from this trial suggests that the practice of clamping drains does not give a beneficial effect in terms of reduced blood loss. This is the first trial of its kind to explore this question in total hip replacement surgery.
Knitted Outer Gloves in Primary Hip and Knee Arthroplasty
Authors: Tanner J. , Wraighte P. , Howard P. 
Published: January 2018

A randomised trial was carried out to determine the rate of perforation to inner gloves when comparing latex with knitted gloves during hip and knee arthroplasty. Members of the surgical team were randomised to wear either two pairs of latex gloves (standard double gloving) or a knitted glove on top of a latex glove. In addition, participants completed a visual analogue assessment of their overall satisfaction with the gloves. A total of 406 inner gloves were tested for perforations over a four-month period: 23% of inner gloves were perforated when latex outer gloves were used and 6% of inner gloves were perforated when knitted outer gloves were used. In total, there were 64 perforations to the inner gloves; only one of these perforations was detected by the glove wearer. Wearing knitted outer gloves during hip and knee arthroplasty statistically significantly reduces the risk of perforation to inner latex gloves (p<0.0001).
Greater Trochanteric Pain after Total Hip Arthroplasty: The Incidence, Clinical Outcome and Associated Factors
Authors: Sayed-Noor A.S. , Sjödén G.O. 
Published: January 2018

We evaluated any residual pain around the hip joint 11 to 23 months post-surgery in 172 consecutive patients who underwent total hip arthroplasty (THA) for primary or secondary osteoarthritis during 2002 at Sundsvall Hospital, Sweden. Patients with suspected greater trochanteric pain (GTP) were matched with controls from the same cohort. The two groups were assessed with the Western Ontario and McMaster Universities Arthrosis Index (WOMAC) and were examined for localised tenderness over the trochanteric area by algometer. The pre- and postoperative radiographs including femoral offset were evaluated. We found that 21 patients (12%) had GTP with a male to female ratio of 1:6. The WOMAC index revealed a reduction in the clinical outcome in this group. An associated factor of significance was postoperative uncorrected lengthening of the operated limb equal to or more than one centimetre. We found no correlation between the prevalence of GTP and body weight or length, femoral offset or size of the prosthetic components used.
Total Hip Replacement Using Hemi-Circumferential Interposition Acetabuloplasty for Acetabular Deficiency in Post-Perthes Deformities: Technique and Long-Term Results
Authors: Haverkamp D. , Eijer H. , Marti R.K. 
Published: January 2018

We describe a technique of hemi-circumferential interposition grafting that allows placement of the cup in the anatomical position of the original acetabulum in the rare cases of post-Perthes or Perthes-like deformities of the femoral head combined with a steep and shallow acetabulum. This technique was performed on 10 hips (9 patients, with an average age of 56 years). One revision was performed for septic loosening after 2.1 years; however, the graft was well integrated and provided sufficient support for the revision cup. All the others had a good clinical and radiological result after an average of 11.4 years with an average Harris Hip Score of 97. The authors have found this an easy-to-use method, which can give an excellent, long-lasting result. It also provides important bone stock for possible subsequent revisions.
The Quality of Web-Based Information on Hip Resurfacing Arthroplasty: A Cross-Sectional Survey
Authors: Kwong Y. , Kwong F.N. , Costa M.L. 
Published: January 2018

The Internet has become an important source of information for patients. Websites offering medical information are not subject to peer-review. The aim of this study was to evaluate the quality of information available on the web regarding hip resurfacing arthroplasty. The search term ‘hip resurfacing’ was entered into five commonly used general search engines. The 20 highest-ranked websites from each engine were reviewed, after eliminating duplicate and non-relevant sites. Each site was then given a quality score (maximum of 20) according to predefined general and specific criteria. Our search identified 40 unique websites. Commercial websites were the most common (n=17). Quality scores ranged from 8 to 18, indicating that the quality of information on the web varied widely. The mean score for all sites was 11.7, SD 2.6, and only four websites scored >15. Fifteen sites did not mention the disadvantages or complications specific to hip resurfacing. The quality of information on the Internet regarding hip resurfacing is variable. Only four sites out of 40 were deemed to be of high quality. Orthopaedic surgeons need to be aware of these limitations, and take the lead in educating and counselling their patients.
Early Clinical Experience with a Metaphyseal Loading Implant: Why have a Stem?
Authors: Kulkarni M. , Wylde V. , Aspros D. , Learmonth I.D. 
Published: January 2018

This is a prospective cohort study of patients undergoing total hip replacement using an uncemented, proximally coated stem with a short tapered distal stem. Patients with a minimum of 24 months of clinical and radiological follow-up were included in this study. There were 18 males and 34 females. Average age at surgery was 40 years. The diagnoses included developmental dysplasia of the hip in 20 patients, osteoarthritis in 15, avascular necrosis of the femoral head in nine, and inflammatory arthritis in three. Average follow-up was 46 months (range 25–78). There was no evidence of subsidence of any stem at the final follow-up. Interface buttressing was observed in 52 patients on the AP view and in 32 on the lateral view. This was seen in Gruen zones 1, 7, 8 and 14. Heterotopic ossification was seen in 15 patients. Distal cortical hypertrophy was seen in three patients. Three patients had one episode of dislocation and two patients had superficial wound infection. None of the hips has been revised and there was no radiological evidence of aseptic loosening. The high percentage of patients exhibiting condensation of the bone and interface buttressing at the lower reaches of the metaphysis suggest the objective of proximal loading is being achieved. We believe that early stability and durable biological fixation can be achieved by this cementless implant, in which the stem is designed to avoid any contact with the diaphyseal cortex.
The Safety of Hip Injection with Corticosteroid in the Diagnosis and Treatment of Osteoarthritis
Authors: Karuppiah S.V. , Gibson P. 
Published: January 2018

Introduction Injection of steroid and local anaesthetic into hip and knee joints has been a recommended treatment for osteoarthritic pain for decades. There have been recent studies showing a higher incidence of infection leading to early revision of joint prostheses in patients who have had corticosteroid injections prior to joint replacement surgery. Objective The aim of our study was to determine if there is any risk of infection in patients undergoing total hip arthroplasty (THA) after a hip joint injection. Patients and Methods A retrospective search was conducted using the hospital computer database to identify patients who underwent hip injection and subsequent THA between 2000 and 2004. The study included a review all case notes to specifically identify prosthetic infection or early joint replacement surgery. Results One hundred and twenty-eight patients had hip joint injections and subsequently underwent successful total hip replacement. In this study there was no evidence of associated risk of prosthetic infection or early revision of total hip arthroplasty after hip joint injection with corticosteroids (average time of follow-up 3.2 years). Conclusions Hip injection is safe provided a strict aseptic protocol is maintained. The time period of pain relief with hip injection is limited (average 2 months). For diagnostic purposes injections with local anaesthetic only is recommended. A large randomised control study would probably further substantiate these findings.
Separation of the Apex Hole Eliminator Screw in Four Failed Hybrid Total hip Arthroplasties
Authors: Comba F. , Buttaro M.A. , Piccaluga F. 
Published: January 2018

Advancement or separation of the apex hole eliminator screw in uncemented Duraloc 100 cups (DePuy®, Warsaw, Indiana, USA) has been recently reported as a radiographic finding without clinical effects. We report four patients with a separation of the apex hole eliminator screw in Duraloc 300 uncemented cups and aseptic failures of a hybrid total hip arthroplasty (acetabular osteolysis and femoral stem loosening). Revision surgery was performed when disabling pain and radiographic signs of loose components were present. Although difficult to determine, a relationship between the screw migration and the failure could have existed in these cases. Migration of the screw might not only be interpreted as a radiographic, clinically irrelevant finding. Its presence should alert the orthopaedic surgeon that the prosthesis is exposed to high intraarticular fluid pressures.
The Role of Alpha1-Antitrypsin in Total Hip Replacement: A Pilot Study
Authors: Dixon S. , Wood J. , Beetham R. , Abou-Shameh M. , Bannister G. 
Published: January 2018

Background Lungs exposed to particulate debris may be damaged by proteolytic enzymes during phagocytosis. Damage is worse if patients are deficient in a1-antitrypsin (A1AT), which helps neutralise these enzymes. We investigated the possibility that A1AT deficiency contributes to aseptic loosening following total hip replacement (THR) when wear particles are phagocytosed. Method A1AT level and phenotype were measured in patients attending for revision THR within 15 years of implantation. Periprosthetic lysis was graded from radiographs by three hip surgeons with an interest in revision, blinded to history and A1AT results. Patients were grouped according to presence of high or low levels of lysis radiologically Mean A1AT levels were calculated for the two groups. Results 17 patients were recruited, mean age 69.5, mean interval between surgery and onset of pain 8.3 years (2–12). Two were heterozygotes for the less active S form of A1AT and therefore mildly deficient. Time to onset of pain in both was 12 years. Radiographs were available for 12 patients. Combining the results for all reviewers the probability of a difference in the level of A1AT between the high and low lysis groups reached statistical significance (p=0.008). For all reviewers, the mean A1AT level in their high lysis group was raised and greater than that of their low lysis group. Both A1AT-deficient patients were classified as high lysis by all reviewers. Conclusions The incidence of A1AT deficiency is only marginally higher in this group than in the general population therefore A1AT deficiency is unlikely to be a common cause of failure of hip replacements. Elevated levels of A1AT in the presence of lysis suggest that A1AT may play a role in the aetiology of aseptic loosening. A1AT-deficient patients may be at increased risk of osteolysis. Further work is needed to evaluate this and to assess vulnerability of A1AT-deficient patients to lysis.
Femoral Stem Tip Orientation and Surgical Approach in Total Hip Arthroplasty
Authors: Vaughan P.D. , Singh P.J. , Teare R. , Kucheria R. , Singer G.C. 
Published: January 2018

Introduction A posterior entry point, a neutral tip position and neutral stem alignment are recommended to avoid a thin cement mantle and ensure an optimal outcome in total hip arthroplasty (THA). Our aim was to highlight any influence of surgical approach in obtaining an optimal stem orientation. Methods We examined the post-operative, digitised radiographs of 100 (50 each group) polished, tapered Exeter THA, inserted via the antero-lateral or posterior approaches. Stem tip position was assessed in both coronal and sagittal planes and stem alignment was assessed in the coronal plane. Results: There was a significant difference between the two approaches in the sagittal stem tip position only (p=0.01). Discussion Our results illustrate that a neutral stem tip position in THA is significantly more difficult to obtain with an antero-lateral approach, when compared to the posterior approach. A posterior approach to the hip avoids the cuff of glutei that can lever the proximal stem anteriorly causing an anterior entry point and a posterior stem tip position. We also illustrate how the anatomy of the proximal femur in the sagittal plane makes a neutral stem alignment difficult to achieve with either approach.
Antibiotic Distribution in a Bone Cement Spacer Model
Authors: Shiramizu K. , Lovric V. , Leung A.M.D. , Walsh W.R. 
Published: January 2018

Purpose To mix high dose antibiotic powder to the bone cement more easily, Hanssen et al reported mixing the antibiotics with the cement during its liquid phase but made no comments about the relevance of cement viscosity and antibiotic distribution. The purpose of this study was to investigate the effect of the cement mixing technique and cement viscosity on the antibiotics distribution in a cement spacer model. Methods Thirty cylindrical models from three groups were examined. Group A was made by mixing the antibiotics with medium viscosity cement prior to adding the liquid monomer (traditional technique). Group B was made by mixing the antibiotics with medium viscosity cement during its liquid phase (Hanssen's technique). Group C was made by traditional technique with low viscosity cement. In all groups 2 g of tetracycline was used. Three 0.1 mm thick cross sections from each spacer model were examined under the fluorescent microscope. The fluorescent spots of tetracycline were calculated automatically in pixels. To evaluate the distribution of the antibiotics in the spacer model, we selected the cross section with the highest number of pixels and the one with the lowest number of pixels from each of the three cross sections and calculated the difference between them. The distribution disequilibrium was compared between group A and B, A and C. Results No significant difference was observed in either comparison. Conclusion The Hanssen's mixing technique can be used when using high dose antibiotics, and either medium or low viscosity cement could be used in terms of antibiotic distribution.
Hip Sonography: 20 Years Experience and Results
Authors: Graf R. 
Published: January 2018

Hip sonography in the “Graf technique” is an important tool to detect early DDH cases and dysplastic hips in the German speaking countries, although hip sonography is still controversially discussed in the English speaking countries. The reason may be different techniques with different classification and outcome. Exact anatomical identification, measurement technique, typing, difference between instability and elasticity with a reproducible “standard plane” is absolutely necessary to make hip ultrasound (US) comparable and reliable. US screening had reduced open reductions in Germany to 1:4000, in Austria to 0.23 per thousand. Because of the early screening and earlier less aggressive treatment, the overall costs could be reduced by 1/3 in comparison to the pre-ultrasound area. US screening seems to prevent many, but not all operations and can be recommended as an important tool for prevention.
Total hip arthroplasty in hemodialysis and renal transplant patients
Authors: García-Ramiro S. , Cofán F. , Esteban P.L. , Riba J. , Gallart X. , Oppenheimer F. , Campistol J.M. , Suso S. 
Published: January 2018

Osteoarticular complications are common in patients with chronic renal failure and they often require implantation of a hip arthroplasty (total or partial) due to osteoarthritis, femoral neck fracture or ischemic necrosis of multifactor aetiology. Between 1992 and 2005 we operated on eighteen patients (23 hips) with chronic renal failure who were receiving renal replacement therapy (ten haemodialysis and eight renal transplants), and in each case either a total or partial hip arthroplasty was implanted. This group comprised nine women and nine men, with a mean age of 56 years (range: 30–83). Five cases were bilateral. The clinical diagnoses were necrosis (fourteen cases), femoral neck fracture (five cases) and osteoarthritis (three cases). The main early complications were haemorrhage in seventeen cases (74%) and infection in six cases (33%) (two urinary infections and four of the surgical wound). The late complications involved eight cases (35%) of prosthetic loosening (five aseptic and three septic). The surgery-related mortality rate was 17% (three cases). Prosthetic hip surgery in patients receiving renal replacement therapy is associated with high morbidity and mortality, thus highlighting the importance of careful patient selection.
Cement venogram: As a Result of high Femoral Cement Pressurisation. A Report of 3 Cases
Authors: Miller D. , Frost A. , Choksey A. , Perkins R. 
Published: January 2018

Current femoral cementing techniques for total hip arthroplasty (THA) have improved over recent years. High pressurisation is achieved using a cement gun with a proximal seal and a cement restrictor, maximising the microinterlock at the bone cement interface. However, there are concerns regarding over pressurisation of the femoral canal resulting in an increased risk of cardiorespiratory collapse secondary to embolic phenomena. We report on three cases over a one year period of cement within a vein (cement venogram) on a post-operative radiograph following THA. We feel that the cement venogram is an important indicator of high pressurisation and that its incidence may be on the increase with improved cementing techniques.
Complication of an Insufficiency Fracture of the Acetabulum
Authors: Angles F. , Coscujuela A. , Tramunt C. , Panisello M. Gonzalez , Portabella F. 
Published: January 2018

An 83-year-old woman presented to the emergency department with a history of pain in the left hip of gradual onset over several days. There was no history of trauma and the X rays showed degenerative changes in the hip joint but no apparent fracture. She was sent home after being given reassurance, analgesics and a cane. Three weeks later she returned unable to mobilise after falling while getting out of bed and injuring the left hip. On this occasion the X-rays showed an acetabular fracture with femoral head protrusio. A CT scan confirmed the diagnosis and also demonstrated the absence of a haematoma in the surrounding soft tissues. The latter is characteristic of insufficiency fractures. Orthopaedic surgeons require a high index of suspicion for insufficiency fractures of the pelvis, femoral head and femoral neck in elderly osteoporotic patients who complain of hip pain without any history of trauma.
Role of Hip Arthrodesis in Current Practice: Long Term Results following Conversion to Total hip Arthroplasty
Authors: Sirikonda S.P. , Beardmore S.P. , Hodgkinson J.P. 
Published: January 2018

Background Hip arthrodesis was once considered as a preferred treatment option in young people with hip arthritis. The purpose of this retrospective study was to evaluate the long term outcome following conversion of hip arthrodesis to arthroplasty The main indications for conversion were back pain and ipsilateral muscular or knee pain. Methods Sixty-eight procedures in 67 patients performed between 1963 and 2000 at Wrightington Hospital were evaluated. Results The mean age at the time of hip arthrodesis was 16.7 years (3 to 39 years). The mean age at the time of conversion was 48.7 years (24 to 74 years). The Merle d'Aubigné score improved from a mean of 8.81 pre-operatively to 13.6 at the latest follow-up. Complications included DVT (3 patients), transient foot drop (1 patient), and hepatitis following blood transfusion (1 patient). Seven patients required further revision surgery following conversion. Conclusions Arthrodesis remains a sensible and safe treatment option maintaining independent mobility without multiple operations or significant bone loss for 20–30 years which subsequently can be successfully converted to an arthroplasty.
Femoral Revision with Impaction Allografting and an Uncemented Femoral Component
Authors: Nickelsen T.N. , Erenbjerg M. , Retpen J.B. , Solgaard S. 
Published: January 2018

A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric®, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral component revision for aseptic loosening was performed on 100 hips. In 14 cases (14%) an intraoperative fracture occurred and 7 patients (7%) had other postoperative complications. Seventeen patients (17%) required further revision, 10 because of aseptic loosening. Of 50 surviving patients with retained implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone and implant survival.