No abstract

We describe the case of a 57-year-old female who underwent bilateral ceramic-on-polyethylene total hip arthroplasties performed in 2015. She presented to us in 2018 with headaches, fatigue, and right hip pain 5 months after an atraumatic right polyethylene liner failure for which she did not seek treatment. She was found to have imaging consistent with an adverse local tissue reaction and massive pseudotumor formation. During revision surgery, fracture of the acetabular liner was noted, with ceramic head wear through the titanium cup. In the months after her debridement and prosthesis revision, the patient continued to complain of systemic symptoms including weakness, fatigue, headaches, and vision problems. Serum titanium levels were found to be 100 times higher than normal. This case serves as a rarely reported example of titanium toxicity and titanium pseudotumor formation in the setting of polyethylene failure.

Purpose Use of dual mobility (DM) articulations can reduce the risk of instability in both primary and revision total hip arthroplasty (THA). Knowledge regarding the impact of this design on patient-reported outcome measures (PROMs) is limited. This study aims to compare clinical outcomes between DM and fixed bearing (FB) prostheses following primary THA. Materials and Methods All patients who underwent primary THA between 2011-2021 were reviewed retrospectively. Patients were separated into three cohorts: FB vs monoblock-D vs modular-DM. An evaluation of PROMs including HOOS, JR, and FJS-12, as well as discharge-disposition, 90-day readmissions, and revisions rates was performed. Propensity-score matching was performed to limit significant demographic differences, while ANOVA and chi-squared test were used for comparison of outcomes. Results Of the 15,184 patients identified, 14,652 patients (96.5%) had a FB, 185 patients (1.2%) had a monoblock-DM, and 347 patients (2.3%) had a modular-DM prosthesis. After propensity-score matching, a total of 447 patients were matched comparison. There was no statistical difference in the 90-day readmission ( P =0.584), revision rate ( P =0.265), and 90-day readmission ( P =0.365) and revision rate due to dislocation ( P =0.365) between the cohorts. Discharge disposition was also non-significant ( P =0.124). There was no statistical difference in FJS-12 scores at 3-months ( P =0.820), 1-year ( P =0.982), and 2-years ( P =0.608) between the groups. Conclusion DM bearings yield PROMs similar to those of FB implants in patients undergoing primary THA. Although DM implants are utilized more often in patients at higher-risk for instability, we suggest that similar patient satisfaction may be attained while achieving similar dislocation rates.

WHEREAS, when members of the public seek to visit individuals in custody, public health is imperiled by the person-to-person spread ofCOVID-19, which would be devastating to the health, safety and security of the individuals who live in, work in, and visit Department of Correction facilities; and WHEREAS, the risk of community spread throughout New York City impacts the life and health of the public and public health is imperiled by the person-to-person spread of COVID-19; and WHEREAS, the reduction of opportunities for the person-to-person transmission of COVID-19 in meetings and other gatherings is necessary to combat the spread of this disease; and;

Periprosthetic fractures about the hip and knee are challenging injuries to treat for the orthopaedic surgeon. The preexisting femoral implant and poor bone quality provide for difficulties in achieving stable fixation. We present a surgical technique and clinical series of 5 patients describing the use and outcomes of a 3.5 screw with a "double washer" technique to achieve bicortical fixation around a femoral prosthesis.

No abstract

No abstract

Open humeral shaft fractures comprise approximately 2% of all fractures of the humerus. Nearly 20% of open humeral shaft fractures will develop deep infection, increasing the risk of nonunion regardless of treatment method. Recalcitrant septic nonunion of the humeral shaft is a complex and challenging problem. Operative treatment should aim to eradicate infection, address bony defects, and establish a stable construct that affords early motion. We describe the case of a 38-year-old male with a recalcitrant humeral shaft septic nonunion following fixation of an open humeral shaft fracture. Management of the infection consisted of periodic surgical debridement and IV antibiotics, resulting in a 10 cm segmental defect. Definitive fixation was achieved using the combination of an antegrade intramedullary nail, intercalary femoral shaft allograft, compression plating, and autologous bone graft. In addition to achieving bony union, the patient regained his pre-injury ROM and function, which was clinically sustained at 2-year follow-up.