Heather J. Grant

Are hip resurfacing arthroplasties meeting the needs of our patients? A 2-year follow-up study.

Hip resurfacing arthroplasty (HRA) is a treatment of end-stage hip arthritis in young patients with excellent bone stock. One hundred four consecutive HRAs (Depuy ASR, Warsaw, Ind) were performed with 36-Item Short Form Health Survey (SF-36), Western Ontario and McMaster University Osteoarthritis Index, Harris Hip Scores, and University of California, Los Angeles activity ratings obtained preoperatively, at 6 months, and at 1 and 2 years postoperatively. Four patients required conversion to total hip arthroplasty. All patients showed significant improvements in their activity, pain, stiffness, and function postoperatively. Patients with lower SF-36 mental component scores (MCSs) improved their MCS compared with those of the general population, as well as improving their pain and physical functioning scores. These findings demonstrate reliable improvements in standard quality of life measures in patients undergoing HRA, including those with low preoperative SF-36 MCS.

Shared Morphology of Slipped Capital Femoral Epiphysis and Femoroacetabular Impingement in Early-onset Arthritis

A subclinical form of slipped capital femoral epiphysis (SCFE) can lead to subtle morphologic abnormalities, such as cam-type femoroacetabular impingement (FAI). Femoroacetabular impingement is a mechanical hip abnormality that typically affects young populations and leads to hip pain and premature osteoarthritis. Imaging is critical to diagnosis, whether by radiograph, magnetic resonance imaging, or computed tomography. The authors investigated the use of imaging to detect characteristics of subclinical SCFE and cam-type FAI in patients undergoing hip resurfacing. They retrospectively assessed computed tomography scans of 81 hips from 75 patients. Measurements were taken of the proximal femur and included the alpha angle, head-neck tilt, and anterior offset taken in both the conventional oblique axial plane and the radial plane. The cohort consisted of 68 men and 13 women with an average age of 52 years. Ninety percent of hips on the oblique axial view and 95% of hips on the radial view were found to have pathologically increased alpha angles. Negative correlations were found between the alpha angle and head-neck tilt and positive correlations between head-neck tilt and anterior offset ratio. Sixty percent and 68% of hips in the oblique axial and radial planes, respectively, were abnormal for the alpha angle, head-neck tilt, and anterior offset ratio, strongly suggesting SCFE morphology. This studys results show similarity in morphology between cam-type FAI and SCFE, known precursors to osteoarthritis, in an early arthritic patient population.

Osteocartilaginous transfer of the proximal part of the fibula for osseous overgrowth in children with congenital or acquired tibial amputation: surgical technique and results.

BACKGROUND Osseous overgrowth is a common problem in children after tibial transcortical amputation. We present the results of forty-seven children (fifty tibiae) treated for tibial osseous overgrowth with an autologous osteocartilaginous cap from the proximal part of the ipsilateral fibula. METHODS We reviewed the records of all patients who underwent amputation at a single pediatric hospital from 1990 to 2011. All patients who had been followed for a minimum of two years after undergoing osteocartilaginous capping with the proximal part of the ipsilateral fibula to treat established tibial overgrowth were included. Patients with acquired and congenital amputations were compared. RESULTS Fifty tibiae in forty-seven patients met our inclusion criteria. There were thirty-one acquired and nineteen congenital amputations. The mean age at surgery was 7.6 years (range, 2.1 to 15.6 years), and the mean duration of follow-up was 7.2 years (range, 2.2 to 15.4 years). Five tibiae (10%) in four patients had recurrence of the overgrowth at a mean of 5.4 years (range, 2.8 to 7.6 years) after the osteocartilaginous transfer. There was no significant difference in the results between children with an acquired amputation and those with a congenital amputation. CONCLUSIONS At a mean of 7.2 years after autologous osteocartilaginous capping with the proximal part of the fibula, 90% of the limbs had not had recurrent overgrowth. This is a safe and effective treatment of long-bone overgrowth following either congenital or acquired amputation in children.

Ten-Year Mortality and Revision After Total Knee Arthroplasty in Morbidly Obese Patients

BACKGROUND Although morbid obesity has been associated with early surgical complications after total knee arthroplasty (TKA), evidence of long-term outcomes is limited. We conducted a population-based study to determine the association between morbid obesity and 10-year survival and revision surgery in patients undergoing primary TKA. METHODS A cohort study of 9817 patients aged 18-60 years treated with primary TKA from April 1, 2002 to March 31, 2007 was conducted using Ontario administrative health-care databases of universal health-care coverage. Patients were followed up for 10 years after TKA. Risk ratios (RRs) of mortality and TKA revision surgery in patients with body mass index > 45 kg/m2 (morbidly obese patients) compared with body mass index ≤45 kg/m2 (nonmorbidly obese) were estimated adjusting for age, sex, socioeconomic status, and comorbidities. RESULTS About 10.2% (1001) of the cohort was morbidly obese. Morbidly obese patients were more likely to be female than nonmorbidly obese patients (82.5% vs 63.7%, P < .001) but otherwise similar in characteristics. Morbidly obese patients had higher 10-year risk of death than nonmorbidly obese patients (adjusted RR 1.50, 95% confidence interval 1.22-1.85). About 8.5% (832) of the patients had at least 1 revision procedure in the 10 years after TKA; revision rates did not differ by obesity (adjusted RR 1.09, 95% confidence interval 0.88-1.34). CONCLUSION Morbidly obese patients ≤60 years had a 50% higher 10-year risk of death but no difference in the risk of revision surgery. Results of this population-based study inform evidence-based perioperative counseling of morbidly obese patients considering TKA.