Devoted to disseminating new and important orthopaedic knowledge,Clinical Orthopaedics and Related Research (CORR) is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons. CORR brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. Learn more about CORR.
Abstract Long-term results of periacetabular osteotomy for advanced-stage osteoarthritis secondary to developmental dysplasia of the
hip are reportedly unsatisfactory compared with results for early-stage osteoarthritis. Other preoperative information that
can be used to determine indications for periacetabular osteotomy is therefore important to avoid performing osteotomy in
young patients with advanced-stage osteoarthritis who would not likely achieve substantial benefit. We retrospectively reviewed
47 patients (49 hips) with advanced-stage osteoarthritis who underwent rotational acetabular osteotomy (RAO) using preoperative
congruency in abduction. The minimum postoperative followup was 8 years (mean, 12.3 years; range, 8–20 years) and mean age
at surgery was 43.1 years (range, 30–59 years). At followup, osteoarthritic stage was improved in 12 hips, unchanged in 24
hips, and had progressed in 13 hips. Preoperative joint congruency in abduction was good in 13 hips, poor in 32 hips, and
narrowed in four hips. Patients with better congruency in abduction had better results. We believe osteoarthritis with good
congruency in abduction preoperatively remains a good indication for RAO even in advanced stages of disease.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0443-9
Authors
Kunihiko Okano, Nagasaki University Department of Orthopaedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Hiroshi Enomoto, Nagasaki University Department of Orthopaedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Makoto Osaki, Nagasaki University Department of Orthopaedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Hiroyuki Shindo, Nagasaki University Department of Orthopaedic Surgery, Graduate School of Biomedical Science 1-7-1 Sakamoto Nagasaki 852-8501 Japan
Abstract Many shoulder and elbow abstracts presented at the American Academy of Orthopaedic Surgeons (AAOS) annual meeting are cited
in the orthopaedic literature or are used to guide orthopaedic practice, but not all of these abstracts are submitted, survive
peer review, or eventually are published. Presuming unpublished works have not been scientifically confirmed, one could question
whether it is academically responsible to cite abstracts presented at the AAOS before they are peer-reviewed and published.
To partly address this issue we determined the peer-reviewed publication rate for 558 abstracts (233 papers and 325 posters)
presented at the shoulder and elbow sessions of the AAOS from 1999 to 2004. In April 2007, we searched the computerized database
MEDLINE® and PubMed® for published articles based on these abstracts. We examined the published articles to assess publication rate, time to publication,
change in contents, change in authors, and change in conclusions of abstracts. The overall publication rate in peer-reviewed
journals was 58% (321 of 558), similar to other orthopaedic meetings and medical disciplines. We believe it is unacceptable
to cite shoulder and elbow abstracts submitted to the AAOS because only slightly more than ½ (58%) of them are authenticated
scientifically.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0474-2
Authors
Philip M. DeMola, Mercy Suburban Hospital Department of General Surgery Norristown PA USA
Derek L. Hill, Pennsylvania Hospital 3B Orthopaedics 800 Spruce Street, 8th Floor Preston Philadelphia PA 19107 USA
Kenneth Rogers, Pennsylvania Hospital 3B Orthopaedics 800 Spruce Street, 8th Floor Preston Philadelphia PA 19107 USA
Joseph A. Abboud, Pennsylvania Hospital 3B Orthopaedics 800 Spruce Street, 8th Floor Preston Philadelphia PA 19107 USA
Abstract In this study, we developed a complete description of the morphology of the proximal femur. Then, using this framework, we
(1) determined normal population means, standard deviations, and ranges; (2) established differences among subpopulations;
and (3) showed correlations among the various measurements. To accomplish these objectives, we analyzed 375 adult femurs.
Specimens were digitally photographed in standardized positions, measurements being obtained using ImageJ software. Three
parameters of the head-neck relationship were assessed. Translation was examined through four raw offset measurements (anterior,
posterior, superior, inferior) used to calculate anterior-posterior and superior-inferior ratios. Rotation was investigated
through anteroposterior (AP) and lateral physeal angles. Concavity was examined using alpha, beta, gamma, and delta angles.
Two parameters of the neck-shaft relationship were assessed, neck version and angle of inclination. Average anterior-posterior
and superior-inferior ratios were 1.14 and 0.90. Average AP and lateral physeal angles were 74.33° and 81.83°, respectively.
Averages for alpha, beta, gamma, and delta angles were 45.61°, 41.85°, 53.46°, and 42.95°, respectively. Average neck version
and angle of inclination were 9.73° and 129.23°, respectively. Differences existed between males and females and between those
younger and older than 50 years. Correlations were observed between translation and concavity, and translation and the neck-shaft
relationships.
Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0473-3
Authors
Paul A. Toogood, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center Department of Orthopaedics 2423 Overlook Road, Apartment 7 Cleveland Heights OH 44106 USA
Anthony Skalak, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center Department of Orthopaedics 11100 Euclid Ave. Cleveland OH 44106 USA
Daniel R. Cooperman, Case Western Reserve University School of Medicine and University Hospitals Case Medical Center Department of Orthopaedics 11100 Euclid Ave. Cleveland OH 44106 USA
Abstract One of the assumed benefits of mobile bearings is the reduction of UHMWPE wear. However, to date, such benefit has not been
categorically proven. To test the hypothesis that rotating platform total knee arthroplasty would have less wear than a fixed-bearing
of the same design, this in vitro study compared the wear and kinematics (which influence wear) of one type of mobile with
fixed-bearing tibial components of otherwise identical design. We tested four fixed bearing (FB) and four rotating platforms
(RP) on force control knee simulators using identical ISO standard force inputs and simulated soft tissue restraint for 6
million walking cycles. The internal/external rotations peaked just before toe off, reaching an average maximum of 7° internal
(tibial rotation) in the RP, 1.5 times that of the FB, which peaked at approximately 4.5° internally. Two of the RP specimens
showed infrequent and mostly temporary dislocations of the UHMWPE insert. The wear rate for the FB averaged 8.14 ± 2.63 mg/million
cycles and the RP averaged 6.78 ± 1.74 mg/million cycles. Both were very low wear rates compared with most other implants
tested similarly in the same laboratory. We concluded polyethylene wear was similar for both designs.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0463-5
Authors
Hani Haider, University of Nebraska Medical Center Department of Orthopaedic Surgery and Rehabilitation 985360 Nebraska Medical Center–Scott Technology Center Omaha NE 68198-1080 USA
Kevin Garvin, University of Nebraska Medical Center Department of Orthopaedic Surgery and Rehabilitation 981080 Nebraska Medical Center Omaha NE 68198-1080 USA
Abstract From August 1999 to February 2006, 11 patients with cervicothoracic lesions (eight males, three females; age range, 17–77 years)
were surgically treated using the trans-upper-sternal approach. Combined cervicothoracic incision and upper sternotomy facilitated
exposure for tumor resection, partial or subtotal removal of the involved vertebrae, and spinal cord decompression. The spinal
column then was stabilized. Neurologic status was assessed using the Frankel classification. Followup for a minimum of 10 months
(mean, 31 months; range, 10–56 months) revealed one patient had a chyle leak (50 mL) 1 day after surgery, which resolved after
2 days of drainage. One patient had a transient vocal cord paresis, which recovered within 3 months of surgery. All the patients
had improved neurologic function. No nonunions or instrument-related complications developed. Stability of the vertebral column
was maintained during followup in all patients. The trans-upper-sternal approach can provide excellent exposure for reconstruction
of the cervicothoracic junction. Special care must be taken to avoid injury to the recurrent laryngeal nerve and the thoracic
duct.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0469-z
Authors
Yi-Lin Liu, Sichuan University Department of Orthopedic Surgery, West China Hospital No. 37 GuoXue Road Chengdu Sichuan 610041 China
Ying-Jie Hao, Zhengzhou University Department of Orthopedic Surgery, the First Affiliated Hospital Zhengzhou China
Tao Li, Sichuan University Department of Orthopedic Surgery, West China Hospital No. 37 GuoXue Road Chengdu Sichuan 610041 China
Yue-Ming Song, Sichuan University Department of Orthopedic Surgery, West China Hospital No. 37 GuoXue Road Chengdu Sichuan 610041 China
Li-Min Wang, Zhengzhou University Department of Orthopedic Surgery, the First Affiliated Hospital Zhengzhou China
Abstract Precise pre- and postoperative anatomic measurements are necessary to plan, perform, and evaluate total knee arthroplasty
(TKA). We evaluated the relationship between radiographic and navigation alignment measurements, identified sources of error
in radiographic and navigated alignment assessment, and determined the differences between desired and clinically accepted
alignment. Fifty-eight computer-assisted TKAs were performed and limb alignment measurements were recorded both pre- and postoperatively
with standard radiographs and with an intraoperative navigation system. Intraoperative navigation produced consistent navigation-generated
alignment results that were within 1° of the desired alignment. The difference between preoperative radiographic and navigation
measurements varied by as much as 12° and the difference between postoperative radiographic and navigation measurements varied
by as much as 8°. This discrepancy depended on the degree of limb deformity. Postoperative radiographic measurements have
inherent limitations. Navigation can generate precise, accurate, and reproducible alignment measurements. This technology
can function as an effective tool for assessing pre- and postoperative limb alignment and relating intraoperative alignment
measurements to clinical and functional outcomes.
Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0427-9
Authors
Mark A. Yaffe, Northwestern University Feinberg School of Medicine Chicago IL USA
Samuel S. Koo, Northwestern University Feinberg School of Medicine Chicago IL USA
S. David Stulberg, Northwestern University Feinberg School of Medicine Chicago IL USA
ABJS/C.T. Brighton Workshop on Musculoskeletal Trauma in Developing Countries: Editorial Comment
Content Type Journal Article
Category Symposium: ABJS/C.T. Brighton Workshop on Trauma in Developing Countries
DOI 10.1007/s11999-008-0411-4
Authors
David A. Spiegel, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine Division of Orthopaedic Surgery 2nd Floor Wood Bldg, 34th Street and Civic Center Blvd Philadelphia PA 19104 USA
Abstract Recent studies question an effect of gender on outcome of primary TKA. We questioned whether the results of revision TKA were
affected by gender. We separated 67 revision TKAs by gender and preoperative diagnosis into four groups (arthrofibrosis, infection,
instability, and wear and loosening). Each revision TKA was individually matched by age and gender to two primary TKAs. Postoperative
Knee Society pain and function scores after revision TKA were lower than for primary TKA for both females and males. However,
postoperative Knee Society pain and function scores were similar in males and females. Postoperative pain and function scores
were lower for all revision groups compared with primary TKA, except for pain and function scores after revision for instability.
Postoperative pain and function scores were higher for instability and wear or loosening than for arthrofibrosis. Our data
suggest the results of revision TKA are affected by preoperative diagnosis but not gender.
Level of Evidence: Level III, retrospective matched cohort study. See Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0451-9
Authors
Stephanie Y. Pun, University of California Department of Orthopaedic Surgery 500 Parnassus Avenue (MU 320_W) San Francisco CA 94143 USA
Michael D. Ries, University of California Department of Orthopaedic Surgery 500 Parnassus Avenue (MU 320_W) San Francisco CA 94143 USA
Abstract Over years of practice, many beliefs and practices become entrenched as tried and tested, and we subconsciously believe they
are based on scientific evidence. We identified nine such beliefs by interviewing orthopaedic surgeons in which studies (or
lack thereof) apparently do not support such practices. These are: changing the scalpel blade after the skin incision to limit
contamination; bending the patient’s knee when applying a thigh tourniquet; bed rest for treatment of deep vein thrombosis;
antibiotics in irrigation solution; routine use of hip precautions; routine use of antibiotics for the duration of wound drains;
routine removal of hardware in children; correlation between operative time and infection; and not changing dressings on the
floor before scrubbing. A survey of 186 practicing orthopaedic surgeons in academic and community settings was performed to
assess their routine practice patterns. We present the results of the survey along with an in-depth literature review of these
topics. Most surgeon practices are based on a combination of knowledge gained during training, reading the literature, and
personal experience. The results of this survey hopefully will raise the awareness of the selected literature for common practices.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0458-2
Authors
Nirmal C. Tejwani, NYU Hospital for Joint Diseases Department of Orthopaedics 550 First Avenue, NBV 21W 37 New York NY 10016 USA
Igor Immerman, NYU Hospital for Joint Diseases Department of Orthopaedics 550 First Avenue, NBV 21W 37 New York NY 10016 USA
Abstract There is currently no German version of the Oxford hip score. Therefore we sought to cross-culturally adapt and validate the
Oxford hip score for use with German-speaking patients (OHS-D) with osteoarthritis of the hip using a forward-backward translation
procedure. We then assessed the new score in 105 consecutive patients (mean age, 63.4 years; 48 women) undergoing THA. We
specifically determined: the number of fully completed questionnaires, reliability, concurrent validity by correlation with
the WOMAC, Harris hip score, and SF-12, and distribution of floor and ceiling effects. We received 96.6% fully completed questionnaires.
An intraclass correlation coefficient of 0.90 and Cronbach’s alpha of 0.87 suggested the OHS-D was reliable. Correlation coefficients
between the OHS-D and the WOMAC total score, pain subscale, stiffness subscale, and physical function subscale were 0.82,
0.70, 0.68, and 0.82, respectively. OHS-D correlated with the Harris hip score (r = 0.63) and the physical component scale
of the SF-12 (r = 0.58). We observed no ceiling or floor effects. The OHS-D appeared a reliable and valid measurement tool
for assessing pain and disability with German-speaking patients with hip osteoarthritis.
Level of Evidence: Level I, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0457-3
Authors
Florian D. Naal, Schulthess Clinic Department of Orthopedic Surgery Lengghalde 2 8008 Zurich Switzerland
Marc Sieverding, Schulthess Clinic Department of Orthopedic Surgery Lengghalde 2 8008 Zurich Switzerland
Franco M. Impellizzeri, Schulthess Clinic Department of Research and Development Zurich Switzerland
Fabian von Knoch, Schulthess Clinic Department of Orthopedic Surgery Lengghalde 2 8008 Zurich Switzerland
Anne F. Mannion, Schulthess Clinic Department of Research and Development Zurich Switzerland
Michael Leunig, Schulthess Clinic Department of Orthopedic Surgery Lengghalde 2 8008 Zurich Switzerland
Abstract The management of the patellar articular surface at the time of primary total knee arthroplasty (TKA) is controversial. We
used expected-value decision analysis to determine whether the patella should be resurfaced in TKA, and also whether secondary
resurfacing on an unresurfaced patella is worthwhile. Outcome probabilities and utility values were derived from randomized
controlled trials only. A decision tree was constructed and fold-back analysis was performed to ascertain the best treatment
path. Sensitivity analyses were performed to determine the effect on decision-making of varying outcome probabilities and
utilities. Our model showed patellar resurfacing is the best management strategy for the patella at the time of primary TKA.
This decision is robust to changes in the specific data: the best path would remain the same as long as the incidence of persistent
anterior knee pain (AKP) with resurfacing remains less than 29% (current mean, 12%) or the incidence of AKP after nonresurfacing
falls below 12% (current mean, 26%). Delayed (ie, secondary) patellar resurfacing for ongoing patellar pain provides inferior
results for the majority of patients.
Level of Evidence: Level II, decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0420-3
Authors
Naeder Helmy, University of Zurich, Uniklinik Balgrist Department of Orthopaedics Zurich Switzerland
Carolyn Anglin, University of Calgary Centre for Bioengineering Research & Education, and Department of Civil Engineering Calgary AB Canada
Nelson V. Greidanus, University of British Columbia Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre 910 West 10th Avenue, Third Floor Vancouver BC Canada V5Z 4E1
Bassam A. Masri, University of British Columbia Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre 910 West 10th Avenue, Third Floor Vancouver BC Canada V5Z 4E1
Abstract We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments
in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the
fracture to the tibial plafond was 11 mm. All fractures healed and the average time to union was 14 weeks. Six patients (19%)
reported occasional local disturbance over the medial malleolus. There were two cases of postoperative superficial infections
and evidence of delayed wound healing. Using the American Orthopaedic Foot and Ankle Society ankle score, the average functional
score was 87.3 points (of 100 total possible points). Our results show the polyaxial locking plates, which offer more fixation
versatility, may be a reasonable treatment option for distal tibia fractures with very short metaphyseal segments.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0459-1
Authors
Hong Gao, Jiaotong University Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital 600 Yishan Road Shanghai 200233 People’s Republic of China
Chang-Qing Zhang, Jiaotong University Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital 600 Yishan Road Shanghai 200233 People’s Republic of China
Cong-Feng Luo, Jiaotong University Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital 600 Yishan Road Shanghai 200233 People’s Republic of China
Zu-Bin Zhou, Jiaotong University Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital 600 Yishan Road Shanghai 200233 People’s Republic of China
Bing-Fang Zeng, Jiaotong University Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital 600 Yishan Road Shanghai 200233 People’s Republic of China
Abstract There is debate about whether distinct designs of femoral components for men and women are needed based on morphologic and
size differences between genders. We asked whether anthropomorphic differences exist between the distal femoral dimensions
in women and men. We measured the distal femora of 100 women and 100 men intraoperatively after preparation for prosthetic
implantation. The measured dimensions included the anteroposterior height from the posterior edge of the medial femoral condyle
to the flush anterior cut, the mediolateral width at the transepicondylar axis, the anterior and posterior edges of the anterior
chamfer, and the medial and lateral trochlear flanges. These measurements were compared between genders using independent-samples
t test. The aspect ratio (a measure of the shape of the distal femur), the ratio between the anteroposterior and mediolateral
dimensions, was calculated for men and women to determine whether there is a shape difference between genders. The mean aspect
ratio was larger for women than for men (0.84 [range, 0.57–1.03] versus 0.81 [range, 0.066–1.34], respectively). The standard
deviation and range of each measurement of size and morphology suggest variability not only between genders but also within
genders. Whether the aspect ratios and variations will reflect clinically important differences in outcomes after TKA with
available prostheses will require additional study.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0415-0
Authors
Jess H. Lonner, Pennsylvania Hospital Booth Bartolozzi Balderston Orthopaedics 800 Spruce Street Philadelphia PA 19107 USA
Jeff G. Jasko, Pennsylvania Hospital Booth Bartolozzi Balderston Orthopaedics 800 Spruce Street Philadelphia PA 19107 USA
Beverly S. Thomas, Pennsylvania Hospital Booth Bartolozzi Balderston Orthopaedics 800 Spruce Street Philadelphia PA 19107 USA
Abstract Recent modifications in total knee prosthesis design theoretically better accommodate the anatomy of the female femur and
thereby have the theoretical potential to improve clinical results in TKA by more accurately restoring femoral posterior condylar
offset, reducing femoral notching, reducing femoral component flexion, and reducing component overhang. First, we radiographically
evaluated whether a contemporary unisex prosthesis would accommodate female anatomy equally as well as male anatomy. Next,
we radiographically evaluated female knees in which a gender-specific prosthesis was used. Pre- and postoperative radiographs
of 122 knees (42 female unisex, 41 male unisex, 39 female gender-specific) were reviewed. In the unisex groups, there were
no differences in femoral notching or femoral component flexion. Posterior femoral offset increased in both groups. However,
femoral component overhang was worse in female knees (17%) than in male knees (0%). In the gender-specific female group, the
incidence of component overhang was similar to that in the unisex female group. Unisex femoral components of this specific
design do not equally match the native anatomy male and female knees. In some women, a compromise was required in sizing.
Content Type Journal Article
Category Symposium: Papers Presented at the Annual Meetings of the Knee Society
DOI 10.1007/s11999-008-0454-6
Authors
Henry D. Clarke, Mayo Clinic Arizona Department of Orthopedic Surgery 5777 East Mayo Boulevard Phoenix AZ 85054 USA
Joseph G. Hentz, Mayo Clinic Arizona Section of Biostatistics Phoenix AZ USA
Abstract It generally is accepted that fractures of the tibia located in the proximal and distal thirds tend to angulate more than
midshaft fractures when treated with intramedullary nails. We therefore compared the angular deformities and final shortening
of 434 closed fractures located in the middle third of the tibia treated with a functional brace with those in fractures in
the proximal and distal thirds treated in the same manner. Ninety-seven percent in the middle third healed with 8° or less
angulation in the mediolateral plane, which was a higher percentage than we had experienced in distal and proximal third fractures
treated with this method. Nonunions occurred in four (0.9%) fractures. We found correlations between initial shortening, final
shortening, initial displacement, final displacement, and time to brace with initial angulation and final angulation in the
mediolateral and anteroposterior planes. The overall mean final shortening of the fractures located in the middle third was
4.3 mm. These experiences suggest satisfactory results can be obtained in most instances using a functional brace for management
of closed fractures of the middle third of the tibia.
Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0438-6
Authors
Augusto Sarmiento, University of Miami School of Medicine 13-27 Department of Orthopaedics and Rehabilitation PO Box 016960 Miami FL 33101 USA
Loren L. Latta, University of Miami School of Medicine 13-27 Department of Orthopaedics and Rehabilitation PO Box 016960 Miami FL 33101 USA
Abstract Patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) typically are young and active, which might
affect functional ratings or failure rates after resurfacing arthroplasty. We therefore evaluated 24 patients (32 hips; mean
age, 44.2 years) after hip resurfacing performed for osteoarthritis secondary to DDH. We used the Harris hip score (HHS),
the University of California, Los Angeles (UCLA) activity scale, and a sports and activity questionnaire. A radiographic analysis
also was performed. We followed patients a minimum of 28 months (mean, 43 months; range 28–60 months). The HHS improved from
a mean of 54.7 to 97.3 and UCLA activity levels increased from a mean of 5.3 to 8.6. All patients returned to sports activity
at a mean of 11 weeks after surface replacement. There were no major differences in preoperative and postoperative participation
in the most common sports and activities. Two of the 32 replacements (6%) failed. We detected femoral radiolucencies in 10
of the remaining 30 hips. Despite satisfactory outcomes in clinical scores, return to sports, and hip biomechanics, the failure
rate of 6% was disappointing. Additional followup is important to assess if failure rates increase in these young, active
patients.
Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Content Type Journal Article
Category Original Article
DOI 10.1007/s11999-008-0456-4
Authors
Florian D. Naal, Schulthess Clinic Department of Orthopaedic Surgery Lengghalde 2 8008 Zurich Switzerland
Matthias Schmied, Schulthess Clinic Department of Orthopaedic Surgery Lengghalde 2 8008 Zurich Switzerland
Urs Munzinger, Schulthess Clinic Department of Orthopaedic Surgery Lengghalde 2 8008 Zurich Switzerland
Michael Leunig, Schulthess Clinic Department of Orthopaedic Surgery Lengghalde 2 8008 Zurich Switzerland
Otmar Hersche, Schulthess Clinic Department of Orthopaedic Surgery Lengghalde 2 8008 Zurich Switzerland
Devoted to disseminating new and important orthopaedic knowledge,Clinical Orthopaedics and Related Research (CORR) is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons. CORR brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. 
