Head-neck taper corrosion in hip arthroplasty

Modularity at the head-neck junction of the femoral component in THA became popular as a design feature with advantages of decreasing implant inventory and allowing adjustment of leg length, offset, and soft tissue balancing through different head options. The introduction of a new modular interface to femoral stems that were previously monoblock, or nonmodular, comes with the potential for corrosion at the taper junction through mechanically assisted crevice corrosion. The incidence of revision hip arthroplasty is on the rise and along with improved wear properties of polyethylene and ceramic, use of larger femoral head sizes is becoming increasingly popular. Taper corrosion appears to be related to all of its geometric parameters, material combinations, and femoral head size. This review article discusses the pathogenesis, risk factors, clinical assessment, and management of taper corrosion at the head-neck junction.S. Hussenbocus, D. Kosuge, L. B. Solomon, D. W. Howie, and R. H. Oskoue

Is internal fixation alone advantageous in selected B2 periprosthetic fractures?

BACKGROUND: Revision surgery is currently the recommended treatment for Vancouver B2 femoral periprosthetic fractures, but isolated open reduction and internal fixation (ORIF) might be an effective treatment for these fractures around cemented collarless polished tapered (CCPT) stems, as these stems can re-engage in the cement mantle, regaining stability following internal fixation. The aim of this study was to determine the operative risks, post-operative complications, and radiographic and functional outcomes in two cohorts of Vancouver B2 femoral fractures around CCPT stems treated either by ORIF alone or revision surgery. METHODS: The results of 12 patients with B2 periprosthetic fractures around a CCPT stems treated by ORIF alone (median follow-up 67 months) were compared with those of nine patients with a similar fracture treated by revision surgery (median follow-up 59 months). RESULTS: All fractures treated by ORIF alone healed and all stems restabilized and remained stable within their original cement mantle. These patients had significantly shorter overall operating room times (P = 0.002), surgical times (P = 0.002) and required fewer units of blood transfusion (P = 0.008) than patients in the revision cohort. In the ORIF cohort, one patient had two dislocations. In the revision cohort, one patient had delayed wound healing, a second patient had delayed wound healing and two dislocations, and a third patient had two dislocations. CONCLUSION: Although further studies with larger numbers are required, treatment of these fractures with ORIF alone may be a viable alternative to revision surgery as it reduces the operative risks involved.Lucian B. Solomon, Saleem M. Hussenbocus, Tania A. Carbone, Stuart A. Callary, and Donald W. Howi

Spontaneous spinal epidural hematoma: a case report and literature review

Abstract not availableSaleem M. Hussenbocus, Martin J. Wilby, Chris Cain, and David Hal

Unusual outcomes of neck of femur fractures: from acetabulisation of the femur to ankylosis of the femoral head

Purpose: The aim of the study was to investigate the possible outcomes of intracapsular femoral neck fractures managed non-operatively or with a simple form of internal fixation. Methods: We reviewed 30 fractures and their post mortem reports from the Galler collection, a modern pathology reference series. Results: Ourinvestigationrevealedunusualappearancesofthehipfollowingfemoralneckfracturesthat are not usually seen in modern orthopaedic practice, including previously undescribed acetabularisation of the femur and ankyloses of ununited femoral heads. Conclusion: Appreciation of these appearances and an understanding of how these fractures may progress are important in the current diagnosis and management of delayed presentations, neglected or inadequately fixed subcapital fractures of the femoral neck