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The northern approach for total hip arthroplasty: Surgical technique and a single surgeon prospective case series [Meeting Abstract]
Snir, N; Alvarado, C; Thompson, S; Meere, P
Introduction: The Northern approach is a muscle sparing surgical approach to the hip that allows accurate placement of components while avoiding intraoperative dislocation. This technique minimises the known risk of DVT and leg swelling associated with dislocation, allowing for a rapid recovery when compared to the standard posterior approach. Method: To date there have been 208 consecutive total hip replacements done with Northern approach by a single surgeon. All cases were primary total hip replacements. Post operatively they were managed with standard hip precautions for 3 weeks followed by allowing increased flexion to 120 degrees and hip circumduction exercises. Average follow up was 12 months (range 1-24). Patients were followed for satisfaction, complications, postoperative rehabilitation and leg swelling. Leg swelling was monitored by measuring thigh circumference. Results: The outcomes were measured using a patient satisfaction survey with 97% having good to excellent results. There was no increase in complications rates. Intraoperative 3 (1.5%) patients needed cerclage wire around the neck due to a non-displaced intraoperative fracture. Postoperative one patient underwent revision surgery due to fracture-dislocation after falling and one patient had a single anterior dislocation. Wound complications or sepsis was not observed. Two patients had U.S confirmed DVT with one progressing to PE. The average limb lengthening was less than 3mm. The Average length of hospital stay was 3.5 days and the average recovery time was 2.6 weeks to ambulation without an assistive device. Conclusion: The Northern approach for total hip arthroplasty is safe and allows faster recovery when compared to the conventional posterior approach. The long term advantages and the possibility of decreased rates of DVT will continue to be investigated as more patients are enrolled and monitored for longer periods of time
EMBASE:71960232
ISSN: 1120-7000
CID: 1720512
Effect of a perioperative intra-articular injection on pain control and early range of motion following bilateral TKA
Fajardo, Marc; Collins, Jason; Landa, Joshua; Adler, Edward; Meere, Patrick; Di Cesare, Paul E
Pain control after total knee arthroplasty (TKA) is integral in the immediate postoperative period for early rehabilitation. Numerous different methods of postoperative analgesia are available, but each has its own risk of adverse side effects. This study was performed to prospectively evaluate the benefits of an intra-articular analgesic injection in patients undergoing bilateral TKA.Thirty consecutive patients undergoing bilateral TKA were enrolled in this prospective, randomized, controlled study. Each patient was randomized to receive (1) a perioperative intra-articular mixture of morphine, bupivacaine with epinephrine, and ketorolac in 1 knee, and (2) injectable sterile saline in the contralateral knee. Each patient acted as his or her own internal control. The pharmacologically injected knee had statistically significantly less pain immediately postoperatively when compared to the control knee and displayed significantly increased range of motion within the first week of rehabilitation.The use of an intraoperative intra-articular injection with the above drug combination significantly reduces patient pain and increases postoperative mobility with no apparent risks following bilateral TKA
PMID: 21598890
ISSN: 1938-2367
CID: 134721
Total hip arthroplasty in above-knee amputees: a case report [Case Report]
Sathappan, Sathappan S; Wee, James; Ginat, Daniel; Teicher, Mathew; Meere, Patrick; Di Cesare, Paul E
There are previous case reports in the literature that describe total knee and total hip arthroplasty (THA) in below-knee amputees, but we could find no case reports on above-knee amputees (AKAs) who have severe osteoarthritis of the hip. We present a case involving an AKA who developed severe osteoarthritis of the ipsilateral hip. Out patient underwent THA with a satisfactory postoperative outcome. Technical considerations for AKAs undergoing THA are also reviewed.
PMID: 21720599
ISSN: 1078-4519
CID: 212712
Massive wear and metallosis of an Acetabular Cup System presenting as pseudodislocation [Case Report]
Sathappan, Sathappan S; Wee, James; Ginat, Daniel; Meere, Patrick
In primary and revision total hip arthroplasty (THA), the acetabular component continues to pose greater challenges than the femoral component. Numerous factors lead to polyethylene wear, which subsequently affects primary THA survival. Progressive polyethylene wear is associated with the occurrence of osteolysis, especially overlying the acetabulum, which can lead to component loosening and subsequent revision. Polyethylene failure usually manifests as massive liner wear up to the metal shell, fracture of the liner, or a combination of both. There is often a small amount of metallosis associated with this pathology. To our knowledge, massive wear of the acetabular metal shell, however, has not previously been reported in the literature. This article describes a case of massive wear through a polyethylene liner and the acetabular metal shell of an Acetabular Cup System (DePuy, Leeds, United Kingdom) that presented as an apparent dislocation 13 years following the index operation. The pseudodislocation was intraoperatively found to be penetration of the femoral head through the acetabular shell. The acetabular component was consequently revised to a larger cementless cup. The femoral component was mechanically stable and required no revision. Patients with long-standing Acetabular Cup System THA may experience acetabular metal shell wear-through phenomena presenting as a pseudodislocation, and this possibility should be taken into consideration during preoperative planning
PMID: 19634809
ISSN: 1938-2367
CID: 101288
"Floating total knee": ipsilateral periprosthetic fractures of the distal femur and proximal tibia after total knee arthroplasty [Case Report]
Jeong, Gerard K; Pettrone, Sarah K; Liporace, Frank A; Meere, Patrick A
Currently, there are more than 300000 primary total knee arthroplasty (TKA) performed annually in the United States. It is estimated that 0.3% to 2.5% of these patients will sustain a periprosthetic fracture in association with a TKA [Haidukewych GJ, Jacofsky DJ, Hanssen AD. Treatment of periprosthetic fractures around a total knee arthroplasty. J Knee Surg 2003;16:111]. The first report of a periprosthetic fracture involving a TKA occurred in 1977 [Callaghan JJ. Periprosthetic fractures of the acetabulum during and following total hip arthroplasty. Instr Course Lect 1998;47:231]. The majority of periprosthetic fractures associated with a TKA are distal femoral fractures [Berry D. Epidemiology: hip and knee. In: Callaghan J, Duncan C, editors. Periprosthetic fractures after major joint replacement. Philadelphia: WB Saunders; 1999. p. 183]. Periprosthetic tibial fractures are rare and usually involve the medial tibial plateau in the presence of a loose component [Rand JA, Coventry MB. Stress fractures after total knee arthroplasty. J Bone Joint Surg Am 1980;62:226, Hanssen AD, Stuart MJ]. Treatment of periprosthetic tibial fractures. Clin Orthop 2000; p. 91]. The following case report describes the management of simultaneous ipsilateral distal femoral and proximal tibial periprosthetic fractures associated with a TKA. The patient was informed that data concerning the case would be submitted for publication. To our knowledge, this 'floating total knee' injury has not been previously reported
PMID: 16446199
ISSN: 0883-5403
CID: 64646
Musculoskeletal complications associated with lysosomal storage disorders: Gaucher disease and Hurler-Scheie syndrome (mucopolysaccharidosis type I) [Review, Tutorial]
Pastores, Gregory M; Meere, Patrick A
PURPOSE OF REVIEW: Enzyme therapy for lysosomal storage disorders directed at correcting the underlying cause of disease represents the most significant recent advance in patient management. This review focuses on two disease groups: glycosphingolipidoses and mucopolysaccharidoses. Specifically, Gaucher disease and Hurler-Scheie syndrome have been selected as the prototypical disorder for each respective class. RECENT FINDINGS: Musculoskeletal complications are encountered in several of the lysosomal storage disorders and often represent a major source of extraneurologic morbidity, particularly in the subacute or chronic variants. Enzyme therapy has led to improvements in physical and functional well-being. However, bone involvement remains a recalcitrant feature, especially among patients with established disease before institution of therapy. SUMMARY: Early diagnosis and appropriate timely intervention are critical in achieving the best therapeutic results. A better understanding of the fundamental mechanisms of bone pathology may enable the identification of complementary approaches (eg, the use of bisphosphonates for severe osteopenia) for optimized outcomes. Symptomatic care and rigorous physical and occupational therapy remain critical components of a comprehensive management approach
PMID: 15604908
ISSN: 1040-8711
CID: 50284
A simple method for construction of an articulating antibiotic-loaded cement spacer
Shin, Steven S; Della Valle, Craig J; Ong, Bernard C; Meere, Patrick A
A 2-stage exchange protocol has been used widely in North America for management of infected total hip arthroplasties. Many surgeons choose to use an antibiotic-loaded cement spacer in the interval before reimplantation of the final prosthesis. We propose a simple technique for the construction of an articulating antibiotic-loaded spacer for use as part of 2-stage exchange protocol for the treatment of infected total hip arthroplasties
PMID: 12216036
ISSN: 0883-5403
CID: 56390