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Multidisciplinary approach to revision of failed total hip arthroplasty with significant pelvic discontinuity and intrapelvic protrusio of the femoral and acetabular components

Schwarzkopf, R.; Alwatar, B.; Martin, E.; Testa, N.
A case of severe hip pain and limb shortening due to intrapelvic migration of the acetabular cup and protrusion of the femur component is reported in a 55-year-old female [New York, USA]. She presented to the clinic with a complaint of right hip pain which started intermittently a few months before visiting the clinic, but has increased and become debilitating in the past three weeks. The pain was accompanied by lateral thigh paresthesia and weakness. On examination, the right lower extremity appears shorter with decreased light touch sensation on posterolateral aspect of thigh. The patient was unable to raise leg and the range of motion of the hip was limited due to pain. X-ray of the right hip and femur presented a comminuted fracture of the acetabulum and iliac bone with central dislocation of the femoral head into the hemipelvis and migration of the acetabular cup into the pelvis, with breakage and displacement of proximal cerclage wires. Computed tomography angiog! raphy/pyelography, arteriogram and intravenous pyelogram showed the above findings without any internal haemorrhage or further pathology. A two-stage revision repair was planned. At the time of reimplantation, continuity of the acetabulum was verified. And a large uncontained acetabular defect was noted including the entire anterior wall, anterior column, and medial wall. A large superior defect was noted as well. Wire mesh was used to contain the defect which was filled with morselized allograft. A Burch-Schneider cage was placed over the graft. And a constrained polyethylene liner was cemented into the cage. The proximal femur had a small greater trochanteric fragment that was not united. The top three inches of the proximal femur had a defect involving over a third of its circumference, extending below the isthmus, with poor bone quality. This bone was resected and modular Mega-Prosthesis was cemented into the remaining femur. The trochanteric fragment was reattached to ! the prosthesis. At follow-up, the patient was doing well, scar was wel l healed and patient was able to ambulate with a walker
GlobalHealth:20093068627
ISSN: 1562-9023
CID: 98785

Long-term radiographic evaluation of Trilock press-fit acetabular components in primary total hip arthroplasty [Case Report]

Levine, Brett; Weisz, Russell; Kubiak, Erik; Testa, N Noel
A retrospective radiographic evaluation of 39 acetabulae reconstructed with Trilock press-fit components (Depuy, Warsaw, IN) without use of supplementary fixation was performed. The following radiographic criteria were evaluated: change in component inclination angle, migration, osteolytic areas, and radiolucent lines. Acetabular components were considered loose when there was migration greater than four millimeters, change in abduction angle greater than four degrees, or a concentric radiolucent line greater than two millimeters. The average length of follow-up was 12.6 years. Six of the 39 (15.4%) total hip arthroplasties were considered loose. Two (5.1%) of these were revised and four (10.4%) were asymptomatic at the time of latest follow-up. Significant areas of osteolysis were found in 15 hips (38.5%). We conclude that the Trilock acetabular component provides adequate fixation and satisfactory long-term results
PMID: 16022224
ISSN: 0018-5647
CID: 58719

Lessons learned from the activation of a disaster plan: 9/11

Wolinsky, Philip R; Tejwani, Nirmal C; Testa, N Noel; Zuckerman, Joseph D
PMID: 12954850
ISSN: 0021-9355
CID: 44539

Effect of posterior cut angle on tibial component loading

Bai B; Baez J; Testa N; Kummer FJ
Although clinical studies have shown that posterior cut angle affects tibial component stability, biomechanical studies are lacking. Fifteen Sawbones tibiae were divided into 5 groups and prepared with 0 degrees , 3 degrees, 6 degrees, 9 degrees, and -5 degrees tibial surface cuts, and a tibial component was implanted with cement. Using a standard and then a highly congruent polyethylene insert, the knee was loaded at 0 degrees and 30 degrees of flexion. There were statistically significant increases in anterior micromotion of the standard polyethylene component for each increase in posterior slope cut angle, which increased for the highly congruent polyethylene component. The anterior slope cut (-5 degrees) led to significant posterior micromotion of the tibial polyethylene component. Increased posterior slope cut angle significantly decreased tibial anterior compressive strains and significantly increased tibial posterior compressive strains. The highly congruent insert significantly increased this posterior strain. The results indicate that cutting the articular surface of the tibia at a 0 degrees or 3 degrees posterior slope provides the greatest tibial component stability
PMID: 11061453
ISSN: 0883-5403
CID: 65809

Aspergillus infection of total knee arthroplasty presenting as a popliteal cyst. Case report and review of the literature [Case Report]

Austin KS; Testa NN; Luntz RK; Greene JB; Smiles S
Fungal infections have only rarely been reported to occur in patients having undergone total knee arthroplasty. This case report documents the first known case of Aspergillus fumigatus as the offending organism. Its initial presentation as a popliteal cyst further reinforces the known association of popliteal cysts and intra-articular knee pathology
PMID: 1402949
ISSN: 0883-5403
CID: 13462

Heterotopic ossification after direct lateral approach and transtrochanteric approach to the hip

Testa NN; Mazur KU
The incidence of heterotopic ossification after total hip replacement using the direct lateral approach is compared to the incidence using the transtrochanteric approach. All the initial ectopic ossification occurred by six months following the implant with noncemented fixation. The direct lateral approach adds slightly to the incidence of ectopic ossification as compared to the transtrochanteric approach. Heterotopic ossification of minimal grade did not interfere with any of the planar motions of the hip, whereas severe ectopic ossification disabled the hip in several planes of motion and restricted it significantly in the others. The more severe form of ectopic bone was more common after the transtrochanteric approach to the hip, while the lighter form developed more often following the direct lateral approach
PMID: 3141882
ISSN: 0094-6591
CID: 10949

Peroneal nerve compression secondary to posterior osteophyte [Editorial]

Sherman, O; Testa, N N; Klein, M J
A 45-year-old man was treated for peroneal nerve compression secondary to an osteophyte in the posterior compartment of the knee. Surgical excision led to complete resolution of symptoms.
PMID: 24831603
ISSN: 0147-7447
CID: 3568492

Stress fracture of the hip as a complication of total knee replacement. Case report [Case Report]

Lesniewski, P J; Testa, N N
PMID: 7056791
ISSN: 0021-9355
CID: 576852

THE DISRUPTIONS OF THE KNEE AND ANKLE

TESTA, NN
ISI:A1982NE78400015
ISSN: 0013-6654
CID: 40445

An unusual cause of knee locking: a case report [Case Report]

Testa NN; Williams LA; Klein MJ
Intra-articular tumors of the knee joint causing intermittent locking are extremely rare. A 39-year-old woman with the complaint of joint locking had a pedunculated intra-articular mass and nodular synovitis
PMID: 729238
ISSN: 0009-921x
CID: 47579