Brief Communication

Abstract: A brief technique to place a cement plug on top of a polyethylene is presented. This technique has helped the authors obtain better cement mantles when they are plugging the canal in total hip replacement. Key words: femoral intramedullary plug, cemented hip arthroplasty, technique, biomechanical studies, hip replacement. Currently, more than 200,000 hemiarthroplasties and total hip replacements are performed every year in the United States First-generation cementing techniques consisted of hand mixing of the cement and finger packing of the cement into the femoral canal. Modern (secondgeneration) cementing techniques consist of pressurized insertion of the cement, centrifugation or vacuum mixing, and plugging of the intramedullary canal. These changes decrease the porosity of th

Osteonecrosis of the femoral head

Abstract New cases of osteonecrosis of the femoral head in the Unite

Quality of Life and Cost-Effectiveness 1 Year After Total Hip Arthroplasty

Abstract: Quality of life index (Quality Of Well-Being [QWB]) was used to calculate the costs per quality of well year (QWY) in total hip arthroplasty (THA) and compare it to other interventions. Ninety-eight primary and/or revision THA were reviewed. Patients had minimum 1-year follow-up. Quality of life index was used to calculate the costs per QWY in primary and revision THA. Preoperative QWB for primary THA was 0.52 ± 0.06 SD; revision was 0.53 ± 0.07 SD. The QWB change at 1 year for primary THA was 0.08 ± 0.13 SD; revision THA was 0.06 ± 0.14 SD. Calculated costs per QWY were $5572 for primary procedures and$10 775 for revision procedures. Cost-effectiveness of THA compares favorably with other surgical and medical interventions such as epilepsy ablation surgery and gastric bypass surgery. Keywords: costeffectiveness, quality of life, primary hip arthroplasty, revision hip arthroplasty. © 2011 Elsevier Inc. All rights reserved. Health care expenditures will hit the 2. Surgeons performing total hip arthroplasty, especially primary hip surgery, have had the deepest cuts. The reimbursement for a primary arthroplasty today is 39% less than what it was in 1991. The current reimbursement for revision hip arthroplasty is only 5% more than the reimbursement for primary hip arthroplasty Cost-utility ratios allow an investigator to calculate the relative cost-effectiveness of health care interventions In previous work, our group has reported on the quality of life immediately after knee arthroplasty and the dollar value of a QWY obtained by a total knee arthroplasty Methods Patient Selection Two hundred seventy-six (276) consecutive hip procedures were performed. Sixty-five hemiarthroplasty procedures were excluded; 32 patients (64 procedures

Technique for a composite femoral intramedullary plug in cemented hip arthroplasty

A brief technique to place a cement plug on top of a polyethylene is presented. This technique has helped the authors obtain better cement mantles when they are plugging the canal in total hip replacement

The increasing financial burden of knee revision surgery in the United States

The popularity of total knee arthroplasty combined with the aging US population indicates a dramatic increase in revision TKA procedures. Our objective was to project revision surgery costs in the United States, and to estimate the financial burden for hospitals historically under-reimbursed for these complex surgical procedures. Inflation adjusted charge data derived from a series of knee revision surgeries performed by a single surgeon practice (CJL) (n = 100) were applied to population projections of the number of revision surgeries expected for the Medicare population from 2005-2030. The average charge of TKA revision surgery was 73,696 dollars, (Cost was 36,848 dollars) with substantially higher costs for patients undergoing surgery because of deep joint infection, patients receiving a three component exchange, and patients receiving hinged or constrained condylar knee implants. The number of revision procedures is expected to increase from 37,544 in 2005 to 56,918 in 2030. Projected hospital costs for these procedures may exceed 2 billion dollars by 2030. The number of revision knee surgeries may increase by 66% in the next 25 years. Reimbursement rates will not cover hospital costs for this procedure despite recent increases in Medicare payments for revision arthroplasty. Economic analysis study, level III. See the Guidelines for Authors for a complete description of levels of evidence

Bone and tissue allograft use by orthopaedic surgeons

The purpose of our study was to determine the involvement of orthopaedic surgeons in the process of acquiring allografts they transplant. A questionnaire regarding allograft acquisition and use was directed to 340 hospitals. In approximately 85% of the institutions, nonorthopaedic personnel selected and acquired the allografts. In most, those responsible for providing surgeons with allografts had little or no knowledge of the practices of tissue banking and allograft transplantation biology. In about 15% of the hospitals, the surgeon was involved in the selection of the source of allografts. It is imperative that orthopaedic surgeons who transplant bone and tissue allografts become actively involved in determining the source and processing of tissue transplants they place in their patients