Cases reported "Osteoarthritis, Hip"

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1/28. Intrahepatic hemorrhage after use of low-molecular-weight heparin for total hip arthroplasty.

    Low-molecular-weight heparin (LMWH) has become a popular agent for prophylaxis against deep vein thrombosis and thromboembolic disease after total joint arthroplasty. LMWH allows for consistent dosing in postoperative patients without the need for laboratory monitoring. hemorrhage is an uncommon but documented adverse reaction when using LMWH; however, intrahepatic hemorrhage has not been previously reported in conjunction with LMWH therapy. We report the case of a woman who suffered intrahepatic hemorrhage presenting with acute abdominal pain and vomiting after the use of enoxaparin for total hip arthroplasty.
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ranking = 1
keywords = operative
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2/28. Total hip arthroplasty after failed intertrochanteric valgus osteotomy for advanced osteoarthrosis.

    Thirty hips that had undergone conversion total hip arthroplasty because of failed intertrochanteric valgus osteotomy for advanced osteoarthrosis were analyzed clinically and radiographically for more than 2 years. The average followup after total hip arthroplasty was 7 years (range, 2-18 years). The average age of the patients at the time of valgus osteotomy was 42 years (range, 30-63 years). The average age of the patients at the time of conversion total hip arthroplasty was 57 years (range, 43-76 years), and the average period between valgus osteotomy and conversion was 14 years (range, 3-24 years). Perioperative complications in conversion total hip arthroplasties were minimal, and intramedullary reaming was performed easily. Of the 30 conversion total hip arthroplasties, 12 cemented and 18 cementless components were used, respectively. Kaplan-Meier's survival analysis indicated that survivorship of cemented stems was significantly higher than that of conventional cementless stems. Cemented stems are preferable for conversion total hip arthroplasty after failed femoral valgus osteotomy.
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ranking = 1
keywords = operative
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3/28. indomethacin-induced postoperative psychosis.

    indomethacin is used commonly for the prevention of postoperatively heterotopic ossification. There have been 3 reports in the pharmacologic literature of indomethacin-induced psychosis. We describe a case of indomethacin-induced psychosis in a patient in whom indomethacin was used for the prevention of postoperative heterotopic ossification after bilateral uncemented total hip replacements.
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ranking = 6
keywords = operative
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4/28. Femoral bone regeneration subsequent to impaction grafting during hip revision: histologic analysis of a human biopsy specimen.

    Cemented revision with impaction grafting shows encouraging early clinical results; postoperative biopsy specimens taken from the proximal femur in humans have demonstrated viable trabecular and cortical bone. Human radiographic studies also illustrate density changes within the proximal femur, consistent with remodeling of bone-graft. In an animal experiment, bone incorporation was shown in the proximal femur, but graft lysis was reported around the distal portion of the implant. We report on a patient who sustained a traumatic femoral fracture at the level of the tip of the femoral component 27 months after revision with impaction grafting and a collarless polished taper stem. At the time of open reduction and internal fixation of the fracture, we obtained circumferential biopsy specimens from the fracture site. Three distinct zones could be identified histologically: i) an inner zone consisting of bone-cement, fibrous tissue, and partially necrotic trabeculae with evidence of bone remodeling; ii) a middle zone consisting of viable trabecular bone and probable neocortex formation with fewer particles of bone-cement; and iii) an outer zone with viable cortex. Fibrous tissue was present around some of the incorporating bone-graft fragments, but no continuous fibrous membrane was present. Cement particles were identified, but no polyethylene debris was found by light microscopy. biopsy specimens from the distal aspect of the prosthesis may not reflect changes seen proximally, but based on the available tissue, this case illustrated histological evidence of bone-graft remodeling after impaction grafting. These results are consistent with our expectations based on radiographic findings and clinical results.
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ranking = 1
keywords = operative
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5/28. Rotational acetabular osteotomy for severely dysplastic acetabulum.

    The operative procedures chosen for arthrosis with severe acetabular dysplasia vary among orthopaedic surgeons. We operated on 250 hips using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa [8]. In this report, we describe the technique of RAO and the results of this procedure in patients with severely dysplastic hips. Among the 250 hips, there were 6 which were classified as Severin group V. In those hips, the CE angle was less than 0 degrees, and the femoral head showed superolateral subluxation. After acetabular osteotomy with straight and curved osteotomes, smooth inferolateral rotation could be done in all cases. At the latest follow-up symptoms were improved remarkably, especially pain. Radiographically, adequate coverage of the femoral head was achieved and joint congruence improved in all 6 hips.
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ranking = 1
keywords = operative
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6/28. Dealing with post-traumatic arthrosis of the hip.

    The conversion of the arthritic post-traumatic hip may be more similar to revision surgery than routine primary hip replacement. Careful preoperative planning and templating is essential. Soft-tissue balance to produce stability is challenging, and patients may need bracing with a THR orthosis postoperatively to assure soft-tissue healing and stability. Acetabular bone stock may be significantly compromised, and the preoperative identification of bone stock deficiencies may not always be possible. The surgeon should be prepared with adequate allograft, acetabular reconstruction rings, and alternative procedures such as fusion or resection arthroplasty in these challenging cases.
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ranking = 3
keywords = operative
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7/28. sciatic nerve palsy after cementless total hip arthroplasty. Treatment by modular neck and calcar shortening: a case report.

    This is a case report of sciatic nerve palsy after total hip arthroplasty. Although the patient's symptoms became worse postoperatively, full recovery occurred after shortening of the calcar and femoral neck length. For acute sciatic nerve palsy patients with worsening of symptoms in the postoperative course in spite of hip and knee flexion, reexposure for early recognition of the sciatic nerve condition and reoperation by shortening the femoral neck may be an option.
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ranking = 2
keywords = operative
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8/28. Avascular necrosis of the femoral head after surgery for lumbar spinal stenosis.

    STUDY DESIGN: Case report. OBJECTIVE: To report a previously undescribed complication of lumbar spinal surgery under prolonged hypotensive anesthesia. BACKGROUND DATA: Avascular necrosis of bone most commonly affects the femoral head. The etiology of the condition is understood in only 75% of cases. There have been no prior reports of this condition following lumbar spine surgery carried out under hypotensive anesthetic. methods: Notes review, clinical examination, plain radiographs, and magnetic resonance imaging diagnosed three patients who developed avascular necrosis of the femoral heads (five joints in total) after surgery for lumbar spinal stenosis. All three were treated with total hip replacement (five joints), and the diagnosis of avascular necrosis was confirmed in two by histopathological examination. RESULTS: All three patients have recovered full mobility following hip replacement surgery. None had any residual symptoms of lumbar spinal stenosis or hip disease, and none of them had shown any clinical evidence of avascular necrosis in any other bone. CONCLUSIONS: The development of avascular necrosis of the femoral heads following surgery for spinal stenosis may be due to hypotensive anesthesia, prone positioning on a Montreal mattress, or a combination of the two. Careful intraoperative positioning may reduce the risk of this occurring after spinal surgery. However, close postoperative surveillance and a high index of suspicion of worsening hip pathology in patients who appear to mobilize poorly after lumbar spinal surgery may be the only method of early detection and treatment for this condition.
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ranking = 2
keywords = operative
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9/28. Non-operative management of a peri-prosthetic subcapital fracture after metal-on-metal Birmingham hip resurfacing.

    We describe a patient who sustained a peri-prosthetic fracture of the femoral neck two weeks after undergoing a resurfacing procedure for osteoarthritis of the hip. The fracture was minimally displaced and a satisfactory outcome was obtained following conservative treatment.
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ranking = 4
keywords = operative
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10/28. Plasmacup--special design. Aspects of the dysplastic acetabulum.

    In japan, the main reason for osteoarthritis of the hip joint is caused by dysplastic deformities. The implantation technique of cementless press-fit cup with multi-screw fixation and acetabular bone graft to reconstruct the true acetabular center is described. In addition, special design aspects of the BiCONTACT-N stem were optimized for these patients. Between January 1997 and December 1999, 29 patients (33 hips) received a BiCONTACT-N/Plasmacup-M total hip replacement. There were 28 women and one man. Average age at the time of THA of 64 (range 51-76) years. Average time of follow-up was 41 (range 25-59) months. According to the Crowe classification, 18 hips where classified as type 1 (less than 50% subluxation of the femoral head from the acetabulum), nine type 2 (50-75% subluxation), five type 3 (75-100% subluxation), and one type 4 (complete dislocation). At time of follow-up, there was no loosening of the acetabular implant or collapse of the acetabular bone graft. In the radiographic examination, 80% of the femoral implants showed spot welds in the transitional zone of the coated and uncoated area, and 96% sclerotic lines in the coated area. At the uncoated surface, radiolucent lines were seen in 12% and a cortical hypertrophy in 24%. No stress shielding could be observed. Stem subsidence was measured with an average value of 0.32 (range 0-1.6) mm. No patient complained about thigh pain, and no intraoperative complications were observed. postoperative complications were two anterior dislocations due to cup malposition and excessive lumbar hypnosis. Three deep-venous thromboses where found with venography and treated with warfarin therapy. The limited experience indicates that BiCONTACT-N stem design in combination with the Plasmacup multihole implant is appropriate for the treatment of dysplastic hip deformities in Japanese patients. However, a long-term follow-up study is needed.
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ranking = 2
keywords = operative
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