Seminars in Arthroplasty RSS feed: Current Issue. Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice. 2009 Issues/Topics February Current Concepts in Hip and Knee Replacement A. Seth Greenwald May Current Concepts in Shoulder Replacement A. Seth Greenwald August Disorders and Treatment of the Patellofemoral Joint David Hungerford December TBD http://www.semarthroplasty.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Seminars in Arthroplasty1045-4527211March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.semarthroplasty.com/article/PIIS104545271000012X/abstract?rss=yesMasthead10.1053/S1045-4527(10)00012-XSeminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-5IFCIFChttp://www.semarthroplasty.com/article/PIIS1045452710000131/abstract?rss=yesEditorial Board10.1053/S1045-4527(10)00013-1Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-5iihttp://www.semarthroplasty.com/article/PIIS1045452710000155/abstract?rss=yesContents10.1053/S1045-4527(10)00015-5Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-5iiiiihttp://www.semarthroplasty.com/article/PIIS1045452710000143/abstract?rss=yesIssue Topics10.1053/S1045-4527(10)00014-3Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-5ivivhttp://www.semarthroplasty.com/article/PIIS1045452710000088/abstract?rss=yesI would like to welcome the journal readership to the first of 3 companion issues of Seminars in Arthroplasty dedicated to selected papers presented at the Spring 2009 Current Concepts in Joint Replacement meeting held in Las Vegas, Nevada. The papers provide commentaries from thought leaders with recognized expertise in orthopedic joint reconstruction.IntroductionA. Seth Greenwald10.1053/j.sart.2010.02.001Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-511http://www.semarthroplasty.com/article/PIIS1045452709001047/abstract?rss=yesOsteonecrosis is a debilitating disease that affects patients with a varying degree of severity. Treatment for severe progression of the disease often includes total hip arthroplasty or resurfacing procedures. In a younger patient population, the preservation of the femoral head is desirable in cases where the integrity of the femoral head can be preserved. The indication for various femoral head preservation techniques differs based on the stage of the disease. Three femoral head preserving techniques will be discussed, including core decompression, percutaneous drilling, and nonvascularized bone grafting.Osteonecrosis of the Femoral Head: Femoral Head Sparing TreatmentsAaron J. Johnson, Harpal S. Khanuja, Michael A. Mont10.1053/j.sart.2009.12.018Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-524http://www.semarthroplasty.com/article/PIIS1045452709000911/abstract?rss=yesMuch controversy surrounds decision-making regarding hip arthroplasty for the treatment of acute displaced femoral neck fractures. These controversies include the decision on when prosthetic replacement is appropriate; when an attempt at open reduction and internal fixation is appropriate; which type of prosthesis to chose: monopolar, bipolar, or total hip arthroplasty; and the method of prosthetic fixation, cemented or uncemented. Generally, younger patients are treated with anatomic reduction and internal fixation, and older patients are treated with arthroplasty. Implant decisions regarding hemiarthroplasty or total hip arthroplasty, and component fixation strategy are based on activity and bone quality. Attention to detail is important to minimize complications, notably, dislocation.Femoral Neck Fractures: In the Bucket or on Top of the Neck?George J. Haidukewych10.1053/j.sart.2009.12.008Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-558http://www.semarthroplasty.com/article/PIIS1045452709000996/abstract?rss=yesPeriprosthetic femur fractures are complex problems. Its incidence is reported to be increasing with the increasing number of total hip replacements. Treatment recommendations are based upon the fracture location and implant fixation stability. Despite improvements in fixation and surgical techniques, clinical outcome remains suboptimal. This review focuses on the discussion of periprosthetic femur fractures around a total hip replacement.Periprosthetic Femur Fractures: Current Concepts and ManagementGuillaume D. Dumont, Jacob R. Zide, Michael H. Huo10.1053/j.sart.2009.12.013Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-5913http://www.semarthroplasty.com/article/PIIS1045452709001096/abstract?rss=yesThis study developed evidence-based quality indicators to measure key aspects of care than can be targeted to decrease variations in complication rates following total joint replacement. There were 101 candidate indicators of quality identified in the 6 domains of preoperative processes of care; intraoperative processes; postoperative processes; implant selection and the use of new technology; privileging of hospitals and surgeons; and outcomes and comorbidity assessment. A total of 68 of the 101 indicators were rated as valid with statistical agreement.. This project provides tools to measure and improve quality of care for patients undergoing total joint replacement.Development of Quality-of-Care Indicators for Patients Undergoing Total Hip or Total Knee ReplacementNelson F. SooHoo, Jay R. Lieberman, Eugene Farng, Samuel Park, Sushma Jain, Clifford Y. Ko10.1053/j.sart.2009.12.023Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-51418http://www.semarthroplasty.com/article/PIIS1045452709000881/abstract?rss=yesMetal-on-metal (MOM) bearings with large head diameter are commonly used for total hip arthroplasty (THA). They provide low wear and a reduced risk of dislocation. Since 2001, we have done 1327 primary THAs using this bearing surface. Using revision as an endpoint, survivorship is 94% at 8 years. Of the 17 revisions (1.3%), none have been for dislocation. Five patients (0.3%) have shown evidence of a local reaction to the MOM bearing which contributed to their failure and ultimate revision. All 5 presented with elevated inflammatory indexes and had a purulent-appearing joint effusion at revision. Two showed a necrotic periarticular tissue mass (pseudotumor). The presumed diagnosis of infection and the delay in diagnosis of reaction to the MOM with pathology complicated management.Metal-on-Metal Total Hip Arthroplasty Adverse Local Tissue ReactionCharles A. Engh, Henry Ho, Charles A. Engh, William G. Hamilton, Kevin B. Fricka10.1053/j.sart.2009.12.005Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-51923http://www.semarthroplasty.com/article/PIIS1045452709001059/abstract?rss=yesHistorically, ceramic-on-ceramic bearings have had an excellent global clinical track record, with only very rare reports of audible squeaking. Recently, however, this squeaking phenomenon has been reported with increasing frequency, and in particular with the most commonly used design in North America that being a titanium metal-backed ceramic insert with an elevated titanium rim. The definitive etiologic background of this new problem remains elusive and will most certainly be multifactorial. Issues of particulate debris, joint fluid lubrication, and even femoral component design and metallurgy may all play an important causative role. It is critical, however, to understand and identify the issues surrounding any noted bearing-related complication and to understand the related factors, rather than simplistically vilifying an entire bearing class, as is so often done. Squeaking ceramic-on-ceramic bearings is a classic example of this issue. To move forward the science of alternate bearings in total hip arthroplasty, we have to look at all the issues involved with any given bearing, not minimizing any complication, while at the same time not simplifying the issues to the point where we no longer apply critical thinking to the published data and simply abandon an entire bearing class at the first sign of any reported concern.Ceramic-On-Ceramic Bearings: For the Hard of Hearing and Living Alone—AffirmsKristoff Corten, Steven J. MacDonald10.1053/j.sart.2009.12.019Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-52426http://www.semarthroplasty.com/article/PIIS1045452710000064/abstract?rss=yesThe objective of this study is to review the use of ceramic in hip arthroplasty. Ceramic-on-ceramic bearing in total hip arthroplasty has excellent wear resistance and the previous risk of fracture has been reduced because of improved manufacturing processes. It is rarely associated with osteolysis, but squeaking can be an inconvenient complication. However, it occurs rarely, and does not usually cause any functional deficit. The etiology of squeaking is still unknown, but by controlling the surgical and implant factors, the risk can be reduced. Ceramic-on-ceramic bearings are recommended for use in the general public, and should not be restricted to certain groups only on the basis of hearing ability and domestic arrangement.Ceramic-on-Ceramic: For the Hard of Hearing and Living Alone—OpposesEric Yeung, Paul Thornton-Bott, William L. Walter10.1053/j.sart.2010.01.005Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-52732http://www.semarthroplasty.com/article/PIIS104545270900087X/abstract?rss=yesAlthough surface replacement arthroplasty (SRA) of the hip remains intuitively appealing and aggressively marketed, the data suggest that short-term and intermediate results of surface replacement are not as good as conventional total hip replacement. Significantly worse results are observed in specific age and gender categories. In addition, there are clear limitations to biomechanical aspects of SRA, such as offset and limb length restoration. SRA continues to be an evolving aspect of hip replacement technique, and should remain an investigational procedure confined to specialized centers.The Optimal Metal-Metal Arthroplasty Is Not a Surface Replacement—AffirmsJohn M. Cuckler10.1053/j.sart.2009.12.004Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-53335http://www.semarthroplasty.com/article/PIIS1045452710000052/abstract?rss=yesA hip resurfacing arthroplasty has all the characteristics of an optimized metal on metal bearing: low surface roughness, head sphericity, low clearance, high carbon alloy metallurgy, and a larger diameter. Both wear simulation in the laboratory and clinical experience demonstrate that large diameter metal bearings with optimized clearance have the potential for low metal ion wear production. In addition, hip resurfacing can maintain normal hip mechanics. Hip resurfacing is the only metal bearing option that allows femoral bone conservation. There are situations where the femoral head bone is not sufficiently healthy or mechanically sound to warrant preservation. However, when the goal is bone conservation, and a metal bearing is indicated, there is no substitute in today's technology for a hip resurfacing.The Optimal Metal-Metal Arthroplasty Is Not a Surface Replacement—OpposesThomas P. Vail10.1053/j.sart.2010.01.004Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-53638http://www.semarthroplasty.com/article/PIIS1045452709001060/abstract?rss=yesHip resurfacing arthroplasty is a highly successful procedure when used to treat patients with osteoarthritis who have failed nonoperative treatment methods. Successful outcomes require appropriate patient selection criteria, along with a sufficiently experienced surgeon to appropriately carry out the procedure. The combination of appropriate selection criteria and operative techniques with a goal of decreasing postoperative complications to provide the most successful outcomes will be discussed.Femoral Head Resurfacing: Appropriate Patient SelectionAaron J. Johnson, Michael G. Zywiel, Qais Naziri, Michael A. Mont10.1053/j.sart.2009.12.020Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-53941http://www.semarthroplasty.com/article/PIIS1045452709000960/abstract?rss=yesIn the last century, an open fracture of the lower extremity would result in amputation and/or death until Joseph Lister described the antiseptic principle. The prepared mind must understand Lister to reduce infection. Lister described washing hands and reducing bacterial counts in the operating room (OR) through clean air techniques. Lister washed his hands, instruments, wounds, bandages, and sprayed carbolic acid to reduce bacteria. Evidence-based medicine supports simple measures, such as limiting OR traffic and personnel, wearing gowns and gloves, and carefully preparing the operative site. Charnley enforced the principles of Lister with laminar flow. OR efficiency and the use of antibiotic cement prevent infection. Data support preoperative antibiotics as the most important factor in reducing infection. Protocols for decolonization reduce infection. The prepared mind focuses on reducing the bacterial count in the OR and uses the host's ability to fight off infection.Minimizing Infection Risk: Fortune Favors the Prepared MindKeith Berend, Adolph V. Lombardi10.1053/j.sart.2009.12.010Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-54244http://www.semarthroplasty.com/article/PIIS1045452710000040/abstract?rss=yesThe purpose of this paper is to: (1) define the concept of a dual mobility acetabular component; (2) present the clinical issue that a dual mobility cup seeks to address; and (3) review the clinical and laboratory data available on dual mobility acetabular components.Dual Mobility for Chronic Instability: Solution OptionS. David Stulberg10.1053/j.sart.2010.01.003Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-54547http://www.semarthroplasty.com/article/PIIS1045452709000856/abstract?rss=yesThere are many options in revision total hip arthroplasty with cases of proximal femoral bone loss (Paprosky Type IIB and Type IV femurs). The gold standard has been the use of extensively coated stems with a track record of 90%-95% survivorship at 10 years following revision surgery. Modular tapered stems can address problems that were somewhat problematic with extensively coated stems. Specifically, it is an option in the revision situation where distal diaphyseal fixation is less than 4 cm, in cases of large femoral canals, and in cases with stability concerns (ie, retention of acetabular components).The Revision Femur: A Potpourri of Options—Proximal Bone Loss: Distal Modular FixationJohn J. Callaghan, Steve S. Liu, Christopher W. Wells10.1053/j.sart.2009.12.002Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-54850http://www.semarthroplasty.com/article/PIIS1045452709001084/abstract?rss=yesDespite remarkable advances in the field of revision surgery during the last decades, the reconstruction in patients with massive femoral bone loss is still challenging. Proximal femoral replacement (megaprosthesis) and the use of an allograft-prosthesis composite are 2 valuable options for managing severe proximal femoral bone loss conditions. Although an allograft-prosthesis composite has several advantages, such as a potential restoration of proximal femoral bone mass and providing a site for soft-tissue attachment, a proximal femoral replacement has the benefit of being more readily available, technically less demanding, and more expeditious to implant than allograft-prosthesis composite. The outcome of megaprosthesis in non-neoplastic condition is dependent on several different issues, including patient selection, appropriate preoperative planning and templating, proper surgical techniques, and good postoperative care. We believe that proximal femoral replacement is a viable option for reconstruction of elderly and sedentary patients with severe femoral bone deficiency.Massive Femoral Bone Loss: Solutions of Last ResortJavad Parvizi, S.M. Javad Mortazavi10.1053/j.sart.2009.12.022Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-55156http://www.semarthroplasty.com/article/PIIS1045452709000893/abstract?rss=yesTreatment of massive contained acetabular defects is challenging. The current generation of reconstruction cages in combination with either morcellized or structural allograft bone has given promising results. However, a significant proportion will fail due to lack of biological fixation of the cage, resulting in fatigue fracture. This study examines the early results of a new technique of combining a cage with a shell of Trabecular Metal (Zimmer, Warsaw, IN), because this material has the potential to enhance biological fixation. Fourteen patients with major acetabular defects underwent revision total hip arthroplasty with a Cup-Cage construct. Clinical and radiographic outcomes were determined at minimum 2-year follow-up. Complications, reoperations, and functional status (overall satisfaction, pain, limp, and use of gait-aids) were assessed. Radiographs were analyzed for evidence of implant migration, new radiolucent lines, and bone graft resorption. Mean follow-up was 27 months (range: 1-39), excluding 1 death in less than 1 year after surgery. Outcomes were 82% excellent or good, 12% fair, and 6% poor. Average pre- and postoperative Western Ontario MacMaster scores were 64 and 33 points, respectively. Oxford hip scores were an average of 45 preoperative and 28 postoperative. Short-form-36 averaged 351 preoperative and 601 postoperative. Radiographically, all the implants were stable and none had migrated.Massive Acetabular Bone Loss: The Cup-Cage SolutionCatherine F. Kellett, Allan E. Gross, David Backstein, Oleg Safir10.1053/j.sart.2009.12.006Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-55761http://www.semarthroplasty.com/article/PIIS1045452709000984/abstract?rss=yesDr Hungerford: I have selected a few cases for discussion by the panel, Drs Hugh Cameron, Cliff Colwell, Thomas Vail, Adolph Lombardi, and Mark Froimson. The radiograph in A, B is from a 44-year-old man, who presented in 1984. He reports that he fell at his job at Bethlehem Steel 6 months earlier and since has experienced increasing hip pain and progressive shortening of his leg. He has analgised his hip pain with a pint of whiskey every night. He really was not the typical kind of alcoholic, as he had not missed any work, although he certainly had an alcohol problem. So I would just like some comments from the panel as to how they would approach this case, and what they might consider doing, particularly considering the time that he presented in 1984.What Would You Do? Challenges in Hip SurgeryDavid S. Hungerford, Hugh U. Cameron, Clifford W. Colwell, Mark I. Froimson, Adolph V. Lombardi, Thomas P. Vail10.1053/j.sart.2009.12.012Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-56269http://www.semarthroplasty.com/article/PIIS104545271000009X/abstract?rss=yesIn the September 2009 issue of Seminars in Arthroplasty, pages 172 and 178, Wayne B. Leadbetter, MD, was omitted from the author lines in revision of these articles. The correct author lines are “Peter M. Bonutti, MD,* Uma I. Maduekwe, MD,† Michael G. Zywiel, MD,† Wayne B. Leadbetter, MD,† and Michael A. Mont, MD†” and “Michael A. Mont, MD,* Mario John, MD,† Wayne B. Leadbetter,* MD, Mike S. McGrath, MD,* Peter A. Bonutti, MD,‡ and Michael G. Zywiel, MD*,” respectively.Erratum10.1053/j.sart.2010.02.002Seminars in Arthroplasty 21, 1 (2010)2010-03-01Seminars in Arthroplasty2010-03-01211S1045-4527(10)X0002-57070