The incidence of femur fracture around total hip arthroplasties continues to increase at substantial cost to society. These fractures are frequently associated with a loose femoral component. Consequently, we sought to test whether femoral component loosening predisposes to periprosthetic femoral fracture. Because many periprosthetic femoral fractures are spiral in nature, we evaluated the torsional characteristics of the implanted femur in which the only design variable was instability of the femoral component. We used synthetic (polyurethane) (n = 15) and paired cadaveric femora (n = 10) with specimens divided into two groups: well-fixed and loose cemented stems. Each specimen was tested mechanically in internal rotation until failure. For the synthetic specimens, torque to failure was reduced by 38%, whereas stiffness was decreased 54% for the loose group compared with the well-fixed group. For the cadaveric specimens, torque to failure was reduced by 58%, whereas stiffness decreased 70% for the loose group compared with the wellfixed group. Fracture patterns were similar between synthetic and cadaveric femora with a proximal spiral pattern in loose specimens and more distal fracture patterns with well-fixed stems. Based on our data, patients with loosened femoral components are at risk for fracture at a substantially lower torque than those with well-fixed components.
Preservation of the menisci is increasingly emphasized in orthopedic care of the knee. Techniques are rapidly emerging that allow easier accomplishment of this goal. In particular, the development of all-inside arthroscopic meniscal repair devices has facilitated more ready repair. A number of laboratory and clinical studies have examined these devices and comparisons with more traditional techniques have been made. Numerous reports of potential complications from these new technologies have also been described in the literature. This review covers the current options for treatment of meniscal repair, laboratory and clinical data, and also potential complications.
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