2/9/2024 0 Comments Normal hip replacement xray![]() However, what if the opposite was true? That people with hip pain often have clean x-rays and that people with evidence of arthritis on their hip x-rays often have no hip pain? First, people with hip pain must have a high likelihood of having arthritis on their hip x-rays, and conversely, people with no hip pain should mostly have clean hip x-rays. Take for example the many hip pain patients that I see in the office who have had a hip replacement, based only on an x-ray and cursory exam.įor us physicians to rely on hip x-rays to make big clinical decisions like hip replacement surgery, a few things need to be true. Remarkably, despite all that we know about the disconnect between what we see in images and pain, many orthopedic surgeries are still launched based on imaging findings. By submitting the form you agree that you've read and consent to our Privacy Policy. We do not sell, or share your information to third party vendors. Hence, one bad association between a meniscus tear seen on MRI that has been there for years and sudden knee pain leads to a cascading series of bad decisions that cause patient harm. We also know through multiple randomized controlled trials that any surgery to remove the torn part of the meniscus doesn’t work better than physical therapy or a placebo procedure! (3-7) Finally, we know that this surgery (partial meniscectomy) increases the likelihood of the patient developing knee arthritis (8). Hence, the fact that a meniscus tear was seen after the knee began to hurt is a red herring and usually not the cause of the knee pain. Meaning they are ubiquitous in middle-aged and older people who don’t have knee pain. They are about as important as the wrinkles on your face. ![]() Why is this a scam? Because the research on degenerative meniscus tears is crystal clear and has been for some time (1,2). A part of the meniscus is then removed with an arthroscopic procedure, but the knee pain often persists. An MRI shows a meniscus tear and after a cursory exam, surgery is recommended. This one usually begins with a middle-aged patient who feels sudden knee pain when exercising. One of the biggest medical scams of the twentieth century that’s still ongoing is a knee MRI that shows a meniscus tear. Despite this, many invasive surgeries are launched solely based on an x-ray or MRI result and a cursory 2-minute exam in the office. We’ve known for a long time that images like x-rays and MRIs are really bad at predicting who has pain and who doesn’t. This is going out of fashion due to the added complication of osteolysis.Credit: Shutterstock Pain and Imaging 101 The large prosthetic head can be removed and a smaller one attached to the femoral stem and an acetabular cup prosthesis is inserted. The prosthesis may be a bipolar hemiarthroplasty, which can be converted to a total hip arthroplasty in the future. Cemented hemiarthroplasty have fewer prosthesis-related complications when compared to an uncemented hip prosthesis despite similar rates of mortality 4. ![]() Many organizations worldwide recommend the cemented technique as standard 2,3. When cemented, a plastic medullary cavity plug may be used to stop the inferior migration of the cement. The femoral stem is inserted similarly to total hip arthroplasty and can be cemented or non-cemented. Posterior (Moore, Southern, and true posterior)Īnterior (direct anterior, Smith-Peterson) Hemiarthroplasty is generally performed via one of the following approaches 4: In younger or more active patients, outcomes are better with total hip arthroplasty 1. As the procedure is quicker and far less morbid than internal fixation, hemiarthroplasty is also routinely used in older, less active and co-morbid patients who would not be good surgical candidates for total arthroplasty. Hemiarthroplasty is indicated for the surgical treatment of subcapital neck fractures that are displaced and at high risk of femoral head avascular necrosis, ( Garden III and IV fractures) if treated with DHS internal fixation 1. ![]()
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