OCTOBER 2009 VOLUME XXXVIII NUMBER 10 pISSN:1078-4519 eISSN:1934-3418

E-PUBLISHING

156	Differences Between Neurosurgeons and Orthopedic Surgeons in Classifying Cervical Dislocation Injuries and Making Assessment and Treatment Decisions: A Multicenter Reliability Study Paul M. Arnold, MD, FACS, Darrel S. Brodke, MD, Y. Raja Rampersaud, MD, James S. Harrop, MD, Andrew T. Dailey, MD, Christopher I. Shaffrey, MD, Jonathan N. Grauer, MD, Marcel F. S. Dvorak, MD, Christopher M. Bono, MD, Jared T. Wilsey, PhD, Joon Y. Lee, MD, Ahmad Nassr, MD, and Alexander R. Vaccaro, MD; the Spine Trauma Study Group Dr. Arnold is Professor of Neurosurgery, and Director, Spinal Cord Injury Center, University of Kansas Medical Center, Kansas City, Kansas. Variability exists in the management of cervical spinal injuries. The goal of this study was to assess the effect of training specialty (orthopedic surgery vs neurosurgery) on management of cervical dislocations. Twenty-nine spine surgeons reviewed 10 cases of cervical dislocation injuries. For each of the 10 cases, the surgeons evaluated 3 clinical scenarios, which included a neurologically intact patient, a patient with an incomplete spinal cord injury (SCI), and a patient with complete SCI. Surgeons determined whether a unilateral or bilateral facet dislocation was present and whether pretreatment magnetic resonance imaging (MRI) or immediate closed reduction was indicated. Management decisions were re-assessed after review of MRIs. While spine surgeons may agree on what they see on MRI and how they classify certain cervical injuries irrespective of training, significant differences of opinion continue to exist regarding the therapeutic implications of this information, specifically, whether to order a pretreatment MRI and how to manage the injury. Am J Orthop. 2009;38(10):E156-E161.
162	Traumatic Thoracic Spondyloptosis Without Neurologic Deficit, and Treatment With in Situ Fusion Alex Gitelman, MD, Mathew J. Most, MD, and Mark Stephen, MD Dr. Gitelman is Spine Surgery Fellow, University of California Los Angeles Comprehensive Spine Center, Santa Monica, California. Abstract not available. Introduction provided instead. Thoracic spinal fracture-disassociation (traumatic spondyloptosis) is a rare injury caused by high-energy forces. This injury most often leaves the patient with a severe neurologic deficit. Complete paraplegia is estimated to result in up to 80% of cases.1 In this article, we report the case of a patient who presented with a complete traumatic thoracic spondyloptosis but no neurologic deficits. He was treated surgically, with posterior instrumented spinal fusion in situ. Given the patient’s spinal canal preservation and overall spinal alignment, reduction was not attempted. The postoperative course was complicated only by a wound infection, at 14 months, when already there was clinical and radiographic evidence of solid fusion. The infection was treated successfully with irrigation and débridement, implant removal, and intravenous (IV) antibiotics. At most recent (30-month) follow-up, the patient was neurologically intact and independently ambulating. Informed consent for publication of this case report and the radiographic images was obtained from the patient. Am J Orthop. 2009;38(10):E162-E165.
166	Spondylodiscitis After Vertebral Fracture in the Thoracic Spine Ali Nourbakhsh, MD, and Kim J. Garges, MD Dr. Nourbakhsh is Research Fellow, Division of Spine Surgery, Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas. Abstract not available. Introduction provided instead. Pyogenic spinal infections can be regarded as a spectrum of diseases and represent 2% to 4% of all cases of osteomyelitis.1,2 Most are categorized as either spondylodiscitis or pyogenic osteomyelitis. Pure discitis has been challenged as an entity because there is evidence of spondylodiscitis in all cases with a pure radiographic diagnosis of discitis on magnetic resonance imaging (MRI).3,4 Although granulomatous infections can begin as spondylitis,5 pure pyogenic spondylitis has never been reported with certainty.6 Spondylodiscitis, which consists of an inflammatory process involving the disc and adjacent vertebrae,2,7 may occur spontaneously or after spinal surgery (usually lumbar discectomy). It has been proved that intervertebral disc-space infections and vertebral osteomyelitis are the same disease at different stages,6,8 so the outlines of treatment are the same. Patients with diabetes and lung or systemic infections, patients undergoing dialysis or transplantations, and patients with depressed immune systems are more commonly affected.9 All previous case reports of spondylodiscitis after vertebral fracture involved the thoracolumbar and lumbar spine.10-15 In this article, we describe the first case of spondylodiscitis after vertebral fracture in the thoracic spine. The authors have obtained the patient’s written informed consent for print and electronic publication of the case report. Am J Orthop. 2009;38(10):E166-E169.

497	National Joint Replacement Registry Jess H. Lonner, MD Dr. Lonner, this journal’s Associate Editor for Adult Reconstruction, is Director, Knee Replacement Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania. Abstract not available. Am J Orthop. 2009;38(10):497-498.
500	Why Do We Need a National Joint Replacement Registry in the United States? Fabian von Knoch, MD, and Henrik Malchau, MD, PhD Dr. von Knoch is Arthroplasty Fellow, Massachusetts General Hospital, Boston, Massachusetts. The continually increasing number of total hip arthroplasties (THAs) being performed, in conjunction with the rapid growth in new surgical techniques and implants related to THA, warrants ongoing and objective monitoring of results. National joint replacement registries have become powerful surveillance systems for monitoring contemporary THAs and improving outcomes. Despite the compelling evidence of their benefits, such a registry has yet to be established in the United States. In this article, we provide a rationale for implementing a national joint replacement registry in the United States. Am J Orthop. 2009;38(10):500-503.
507	A Technique to Facilitate Everting the Patella in Stiff or Obese Knees in Total Knee Arthroplasty Hans-Philipp Springorum, MD, and Richard D. Scott, MD Dr. Springorum is Consultant, Department of Orthopaedic Surgery, University of Cologne, Köln, Germany, and International Fellow, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts. In many techniques for total knee arthroplasty, eversion of the patella is necessary. In stiff or obese knees, eversion is often difficult to perform. With the patella-holding clamp (used to cement the patellar component), it is possible to keep the patella in an everted position while the knee is being flexed. Am J Orthop. 2009;38(10):507-508.
509	Acetabular Component Revision in Total Hip Arthroplasty. Part I: Cementless Shells Paul S. Issack, MD, PhD, Markku Nousiainen, MS, MD, FRCS(C), Burak Beksac, MD, David L. Helfet, MD, Thomas P. Sculco, MD, and Robert L. Buly, MD Dr. Issack is Fellow, Orthopaedic Trauma and Adult Reconstructive Surgery, Hospital for Special Surgery, New York, New York. Magnitude and location of acetabular bone defects dictate the type of reconstruction required. For the majority of reconstructions, a porous-coated hemispheric shell secured to host bone with multiple screws is the implant of choice. This reconstruction is feasible provided at least 50% of the implant contacts host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. An uncemented cup can be placed at a “high hip center.” Alternatively, the acetabular cavity can be progressively reamed to accommodate extra-large cups. Oblong cups, which take advantage of the oval-shaped cavity resulting from many failed acetabular components, can also be used. The success of these cementless techniques depends on the degree and location of bone loss and on the presence of pelvic discontinuity. Am J Orthop. 2009;38(10):509-514.
519	Effect of Bone Cement Viscosity and Set Time on Mantle Area in Total Knee Arthroplasty Michael Kopec, BS, Joseph C. Milbrandt, PhD, Nick Kohut, BS, Brian Kern, MD, and D. Gordon Allan, MD, FRCS(C) Mr. Kopec was a medical student, Division of Orthopaedics and Rehabilitation, Southern Illinois University School of Medicine, Springfield, Illinois. To assess the impact of bone cement viscosity on total knee arthroplasty, we compared 1 high-viscosity and 2 medium-viscosity cements with respect to mantle area and zone-specific intrusion depths into the tibial plateau. We analyzed postoperative radiographs to determine penetration area and depth in 72 consecutive patients (79 knees) in whom DePuy II (n = 11), Endurance (n = 34), or Simplex-P (n = 34) cement was used. Penetration into the tibial plateau (anteroposterior zones 1-4) was significantly reduced with use of the high-viscosity DePuy II cement but did not differ significantly between the 2 medium-viscosity cements, Endurance and Simplex-P. Surgical and tourniquet times were significantly decreased with the quicker setting DePuy II cement. Given these findings, additional studies are warranted to assess the long-term impact of the lower intrusion depths found with DePuy II cement. Such differences in cement penetration could jeopardize long-term fixation and lead to higher long-term device failure rates. Am J Orthop. 2009;38(10):519-522.
523	Closed Reduction of a Dislocated Total Hip Arthroplasty With a Constrained Acetabular Component Robert J. Gaines, MD, and Mitchell Hardenbrook, MD Dr. Gaines is Lieutenant Commander, Medical Corps, United States Navy, and Resident, Department of Orthopedic Surgery, Bone and Joint/Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia. Abstract not available. Am J Orthop. 2009;38(10):523-525.
526	Clinical Use of Porous Tantalum in Complex Primary Total Knee Arthroplasty Neil P. Sheth, MD, and Jess H. Lonner, MD Dr. Sheth is Resident, Department of Orthopedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania. Abstract not available. Am J Orthop. 2009;38(10):526-530.
531	Total Hip Arthroplasty in Slipped Capital Femoral Epiphysis: A Novel Technique to Remove Embedded Knowles Pins Anand Karmegam, MS, Manish Agarwal, MS, FRCS, FRCS(Orth), Aravind Desai, MS, MRCS, MSc, MCh, and Martyn Porter, FRCS(Ed), FRCS(Orth) Mr. Karmegam is Clinical Research Fellow, Wrightington Hospital, Wigan, United Kingdom. The Knowles pin has been well recognized in fixing slipped capital femoral epiphysis. When these pins are left in place for a long period, it is very difficult to remove them during total hip arthroplasty, because the pins have fluted threads, which are oversized in the end and allow bone growth in the previously threaded slots. We present a simple and novel technique to remove Knowles pins so that both unnecessary trauma to the lateral femoral cortex and operating time is reduced significantly. Am J Orthop. 2009;38(10):531-532.

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