James F. Wenz

Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes.

Compared with patients with total hip arthroplasty (THA) via a direct lateral approach, patients treated with THA via a mini-incision approach had significantly earlier ambulation, less transfer assistance, and more favorable discharge dispositions; they also had decreased transfusion requirements and better functional recovery with early physical therapy. This procedure achieved accurate and reproducible implantation, regardless of patient habitus.

Postoperative fever after total knee arthroplasty: the role of cytokines.

Febrile temperatures commonly are seen after total knee arthroplasty, but their source and importance are unclear. The goal of the current study was to determine whether such fevers are part of the normal physiologic response to surgery mediated by inflammatory cytokines. In 20 patients who had total knee arthroplasty, serum and wound drain fluid samples were collected preoperatively and at 1, 6, 24, and 48 hours postoperatively; oral temperatures were measured postoperatively every 4 hours for 3 days. Concentrations of interleukin 1β, interleukin 6, and tumor necrosis factor α in the samples were measured via enzyme-linked immunosorbent assays and compared in patients who did and did not have fevers develop (≥38.5° C). Gender, age, operative time, amount of blood loss or drain output, anesthesia type, drop in hematocrit, and transfusion administration were not associated with fever. Significant increases were seen postoperatively in drain fluid concentrations of interleukin 1β and interleukin 6 and in serum concentrations of interleukin 6. Patients who were febrile had significantly higher drain and serum interleukin 6 concentrations than patients who were afebrile. These findings suggest that fevers seen after total knee arthroplasty are at least partly the result of surgical site inflammation and subsequent local and systemic release of the endogenous pyrogen interleukin 6.

Brief postoperative delirium in hip fracture patients affects functional outcome at three months.

It is unclear how brief postoperative delirium (DEL) affects functional outcomes. In this study, we sought to determine if patients with brief postoperative DEL (<6-wk duration) have different living situations when compared with non-DEL patients after hip fracture repair. In a prospective study, patients admitted to the geriatric hip fracture service were assessed every postoperative day for the presence of DEL using the confusion assessment method (CAM) score. Patients were reassessed at 6 wk and 3 mo postoperatively for CAM score, current living situation, and activities of daily living. Group comparisons were tested after dividing patients into two groups: DEL (DEL; [+] CAM at any time during the postoperative period while in the hospital); no-DEL (no DEL; [−] CAM throughout the postoperative period while in the hospital). The study included 92 patients of whom 26 (28%) were CAM (+) after surgery. At 6 wk follow-up, n = 81; at 3 mo follow-up, n = 76. Eight patients died during the study. At 6 wk and 3 mo, a larger percentage of DEL patients were not living with a family member (27% versus 8% patients not living with a family member at 3 mo follow-up in DEL and no-DEL, respectively). There was no difference in activities of daily living by 3 mo. We conclude that brief postoperative DEL lasting <6 wk is a determining factor for poor long-term functional outcome after hip fracture repair, because it significantly impacts the ability to live independently.

In-Hospital Outcome and Resource Use in Hip Arthroplasty: Influence of Body Mass

To determine the influence of body mass index (BMI) on perioperative morbidity, functional recovery, and hospital use, the records of 207 patients who underwent primary total hip arthroplasty were reviewed and patients were grouped according to BMI. Transfusion requirements, operative complications, functional recovery, and assistance needed for transfers from supine to sit, sit to stand, and bed to chair positions were analyzed at the first physical therapy. Compared with others, morbidly obese patients (BMI > or = 40 kg/m2) had significantly longer mean operative time and higher mean intraoperative blood loss (P<.05), a trend toward more complications, but no significant difference in functional recovery and hospital use.

Pigmented villonodular synovitis : Keys to early diagnosis

Pigmented villonodular synovitis is a synovial proliferative disorder that remains a diagnostic difficulty. Many clues in the history, physical examination, and radiographic studies can aid in the diagnosis. A patient in the third or fourth decade of life often will present with vague monoarticular complaints. Symptoms include intermittent, extreme deep pain localized to the hip, occasionally relieved by position. Decreased active and passive range of motion may be found. Small erosions in the head of the femur and acetabulum may occur early in the course of the disease. Magnetic resonance imaging is the imaging modality of choice and will show the characteristic findings of a joint effusion, synovial proliferation, and bulging of the hip. The synovial lining has a low signal on T1-and T2-weighted images, secondary to hemosiderin deposition. Pigmented villonodular synovitis should be included in the differential diagnosis of young patients with unexplained hip pain.

The economic impact of medical complications in geriatric patients with hip fracture.

The records of 510 elderly patients with hip fractures admitted to our institution between January 1995 and December 2000 were retrospectively reviewed to determine the incidence and type of developed medical complications and their economic implications. Of those 510 patients, 217 (43%) developed at least 1 medical complication, most frequently electrolyte imbalance (11%), urinary tract infection (10%), respiratory failure (10%), and delirium (9%). Patients who developed medical complications had significantly longer mean hospital stays (10 days) and higher mean hospital costs (

Hip Fracture Service—an Interdisciplinary Model of Care

16,203) than patients without such complications (5 days and

Treatment of osteoarthritic cartilage lesions with osteochondral autograft transplantation.

10,284, respectively) (P<.001).

Evaluating the quality of Internet-derived information on plantar fasciitis.

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Surgical treatment options for cartilage defects within the knee.

Twenty-two osteochondral autograft transplantations were performed on two types of knees: those with isolated (group 1) and multiple (group 2) degenerative cartilage lesions. At minimum 24-month follow-up, group 1 had significantly better pain relief and function than group 2 based on the Western Ontario and McMaster Universities Osteoarthritis Index and pain scores (10-point visual analog scale). Osteochondral autograft transplantation may be effective in treating knees with isolated degenerative cartilage lesions but appears contraindicated in those with multiple lesions.