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.
Introduction
Inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) are the most common surgical implants in the field of men's health. Infected or defective implants can be removed or replaced. The “drain and retain” strategy has been described as generally safe when prosthetic reservoirs are not easily retrieved. However, case reports of complications related to retained balloons have been described including erosion into the bowel and bladder, intraperitoneal migration and vascular compression. Here we describe two rare cases of reservoir-induced small bowel obstruction (SBO) from IPP and AUS reservoirs.
Objective
Describe two rare cases of retained IPP and AUS reservoirs causing SBO.
Methods
Single institutional retrospective case series.
Results
Case 1: 75 year old male who underwent IPP placement in 2001. Due to device malfunction, IPP cylinders were removed and replaced with 2-piece device in 2017, and the reservoir was “drained and retained.” The patient presented 4 years later with abdominal pain, nausea/vomiting, and right lower quadrant (RLQ) feculent cutaneous drainage. CT scan showed SBO with a transition within the terminal ileum due and an endoluminal foreign body in the cecum (consistent with the retained reservoir) (Figure 1A). Additionally, a contained bowel perforation with entero-cutaneous fistula tract to the skin was identified. Diagnostic laparoscopy revealed a thickened terminal ileum, walled-off perforation in the RLQ (Figure 1B) thought to be due to reservoir entry into the bowel, and a fistula to the right abdominal wall. The bowel was resected, thorough investigation including right-sided colonoscopy was unable to identify the reservoir, and primary anastomosis was performed. Follow up CT scan 3 days later showed passage of reservoir, presumably in the patient's bowel movements. Case 2: 81 year old male with a history of AUS placement in 2016. The device was removed for infection 5 years later. The reservoir was “drained and retained” given difficult access and no sign of reservoir infection. One month later, he presented with abdominal distention, nausea and vomiting. A CT scan revealed dilated loops of small bowel with an abrupt transition point in the RLQ adjacent to the retained reservoir (Figure 1C). Exploratory laparotomy showed SBO with the reservoir and tubing embedded into the small bowel wall (Figure 1D). The foreign bodies were successfully retrieved and the affected bowel was resected and repaired with a primary anastomosis.
Conclusions
These two cases of SBO due to IPP and AUS reservoirs show a potential danger of the “drain and retain” strategy, especially when reservoirs are placed intraperitoneal. These cases may be helpful to inform patient counseling on the rare risks of implant revision surgery. Innovative means of reservoir retrieval at explantation are needed to mitigate these risks.
Disclosure
No
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