Background

Cementless femoral fixation in total hip arthroplasty (THA) continues to rise worldwide, accompanied by the increasing abandonment of cemented femoral fixation. Cementless fixation is known to contribute to higher rates of post-operative complications and reoperations. New data is available from the Centers for Medicare and Medicaid Services (CMS) regarding total costs of care from the Bundled Payment for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) initiatives.

Introduction

Cementless acetabular fixation in total hip replacement (THA) is reliable and has been the fixation method of choice in the United States for decades. While revision for failure of osseointegration or early loosening is relatively rare, recurrent dislocation remains a leading cause of early revision. Novel acetabular implants and those offered by smaller companies often lack constrained or dual mobility liners, which may result in revision of well-fixed, well-positioned cups in cases of recurrent dislocation.

The purpose of this study was to compare outcomes of THA with three different acetabular cups with differing fixation surfaces. One hydroxyapatite (HA)-coated cup (Trident, Stryker, Kalamazoo, MI, USA) offered dual mobility or constrained liner options. The other cups were a novel highly porous cup (Restoris PST, Stryker, Kalamazoo, MI, USA), and a Calcium Phosphate (CaP)-coated cup (Trinity, Corin, Cirincester, UK), neither of which offered dual mobility or constrained options at the time of investigation. Endpoints of interest were: clinical and radiographic outcomes including evidence of osseointegration, overall reoperations, reoperations for acetabular fixation failure, and reoperations to address dislocation in which a well-positioned shell was revised due to the lack of dual mobility or constrained options.

Introduction and Aims: The purpose of this study was to determine if celecoxib would improve the conservative treatment of plantar fasciitis.

Method: Twenty-nine patients with plantar fasciitis were given a night splint, viscoelastic heel cups and a home heel cord stretching program. Thirteen of the patients were given celecoxib 200mg a day for one month and 16 were given a placebo for one month. After their initial visit, patients were followed at one, two and six months.

Results: Twenty-eight patients improved, and one patient’s symptoms were subjectively worse at the end of the six months. Pain scores improved 5.79 points for the celecoxib group and 4.59 for the placebo group. Disability scores improved 5.03 points and 3.44 respectively. The celecoxib group had greater reductions in both pain and disability than the placebo group.

Conclusion: Although, our study was limited by the small sample size, our results indicate that plantar fasciitis can be treated effectively by non-surgical methods and that the use of an anti-inflammatory early in the course of plantar fasciitis may have some beneficial effects in improvement of symptoms.

We examined 36 consecutive patients with closed tibial plateau fractures under anaesthesia and by diagnostic and operative arthroscopy before treating them by closed or open reduction and internal fixation. Following the principle of Hohl (1967) (Fig. 1) there were 9 minimally displaced fractures (type I), 6 with local depression (type II), 13 with split depression (type III), 7 with total condylar depression (type IV), and one bicondylar comminuted upper tibial fracture (type V). Seventeen (47%) of knees were found to have associated meniscal injuries which required surgical treatment; five repairs and 12 partial meniscectomies. Neither the type of plateau fracture nor the presence or absence of ligament injury correlated with meniscal tear. There were no intraoperative or postoperative complications from arthroscopy.