Short-term to midterm results of hip resurfacing arthroplasty suggest various contraindications, in particular the female sex. This study evaluates survivorship and clinical outcomes of a large patient cohort to determine whether sex itself has a detrimental effect on the results of hip resurfacing. We compared the clinical and survivorship results of men and women from a series of 1107 resurfaced hips in 923 patients (681 males and 242 females). Women saw greater positive changes in walking, function, and the mental component of the Short Form-12. There was no difference in complication rates between men and women. Although the revision rate was higher in the women's group, the effect of sex disappeared when adjusted for component size and surgical technique. These data suggest that there is no appreciable effect of sex on implant survivorship and that women may be excellent candidates for resurfacing with proper surgical technique. This is a level III, retrospective comparative study.

BACKGROUND: Implant-related impingement has been reported following metal-on-metal hip resurfacing, and reactive osseous patterns associated with implant-bone impingement have been identified. The purpose of this study was to determine the prevalence and clinical implications of radiographic signs of femoral neck-acetabular cup impingement following metal-on-metal hip resurfacing. METHODS: Serial anteroposterior and lateral radiographs made five to 12.9 years postoperatively were available for ninety-one of the first 100 metal-on-metal hip resurfacing procedures (in eighty-nine patients) performed by the senior author. These radiographs were reviewed by a single independent observer, who was blinded to the clinical results. Radiographic signs of impingement were assessed and were correlated with clinical outcomes. RESULTS: Twenty hips (in eighteen patients) had at least one of two reactive osseous signs: a solitary exostosis (six hips, 7%) and an erosive "divot-type" deformity (twenty hips, 22%). Each radiographic sign occurred predominantly at the superior aspect of the femoral neck just distal to the femoral component. None of the patients with such an impingement sign reported any symptoms or discomfort during examination of the range of hip motion. These patients had a greater mean postoperative University of California Los Angeles activity score and a greater mean range of hip motion than the patients without an impingement sign. Based on the numbers available, there was no association between component size, abduction angle and anteversion angle of the socket, femoral stem-femoral shaft angle, or femoral component-femoral neck ratio and the occurrence of repetitive impingement signs on radiographs. CONCLUSIONS: The reactive osseous features identified in this study should facilitate the radiographic assessment of impingement in other patients following hip resurfacing arthroplasty. Longer-term follow-up is needed to determine whether radiographic signs of impingement are of prognostic consequence.

BACKGROUND: There was a need for information about the long-term performance of the modern generation of hip resurfacing implants. A retrospective review of the first 100 hips that had implantation of one resurfacing design and had been followed for a minimum of ten years was performed. METHODS: Between 1996 and 1998, 100 CONSERVE PLUS hip resurfacing devices were implanted by a single surgeon in eighty-nine patients. The mean age of the patients was 49.1 years, and fifty-nine patients were male. Primary osteoarthritis was the etiology for sixty-four hips. All patients were assessed clinically and radiographically. RESULTS: The mean duration of follow-up was 11.7 years (range, 10.8 to 12.9 years). Two patients were lost to follow-up, and five patients died of causes unrelated to the surgery. Eleven hips had conversion to total hip arthroplasty because of loosening of the femoral component (eight), a femoral neck fracture (one), recurrent subluxation (one), and late infection (one). The Kaplan-Meier survivorship was 88.5% at ten years. None of the resurfacing arthroplasties failed in the twenty-eight hips that had a femoral component of >46 mm and no femoral head cystic or necrotic defects of >1 cm. Five hips had narrowing of the femoral neck, three had radiolucent zones interpreted as osteolysis, and twenty had signs of neck-socket impingement. Five hips had radiolucencies around the metaphyseal stem (two partial and three complete) that had been stable for 7.8 to 10.2 years. The mean scores on the University of California at Los Angeles (UCLA) system at the time of the latest follow-up were 9.5 points for pain, 9.3 points for walking, 8.9 points for function, and 6.8 points for activity; the mean scores on the physical and mental components of the Short Form-12 (SF-12) were 47.3 and 50.5 points, respectively; and the mean Harris hip score was 90 points. CONCLUSIONS: The results of the present series constitute a reference point to which subsequent series should be compared. These ten-year results in a group of young patients are satisfactory, and the low rate of osteolysis is encouraging, but longer follow-up is required for comparison with conventional total hip arthroplasty.

The theoretical advantage of using thinner acetabular components in hip resurfacing has not yet been clinically verified. Our purpose was to test the hypothesis of bone conservation and assess the effects of using a thinner acetabular component on hip biomechanics and clinical outcome. We compared the bone conservation, biomechanical results, and functional outcomes between hips in 35 patients who received bilateral metal-on-metal resurfacing arthroplasties with acetabular components of 5 mm thickness on one side and 3.5 mm thickness on the other. Acetabular abduction angle and acetabular anteversion were measured using Ein-Bild-Röentgen-Analysis software. Medial acetabular wall thickness and position of the hip center of rotation were measured using Image J software. The change in position of the hip center of rotation was minimal and did not reach significance. Thin-shelled components showed greater bone conservation on the acetabular side measured by an increase in the medial acetabular wall thickness. Bone conservation on the femoral side was achieved as well with thin shells. Range of motion, pain scores, and complication rates were comparable. No appreciable difference was found in bone-cup radiographic appearance between the two types of components. These data suggest that patients can experience good clinical outcomes for resurfacing with either thin or thick-shelled acetabular components. However, thin-shelled components preserve acetabular bone stock and allow the use of a larger femoral component. The use of thinner acetabular components is an improvement in bone conservation for a hip resurfacing design.

Mental health problems disproportionately affect women, particularly during childbearing years. We sought to estimate the prevalence of antepartum mental health problems and determine potential risk factors in a representative USA population. We examined data on 3,051 pregnant women from 11 panels of the 1996-2006 Medical Expenditure Panel Survey. Poor antepartum mental health was defined by self report of mental health conditions or symptoms or a mental health rating of "fair" or "poor." Multivariate regression analyses modeled the odds of poor antepartum mental health; 7.8% of women reported poor antepartum mental health. A history of mental health problems increased the odds of poor antepartum mental health by a factor of 8.45 (95% CI, 6.01-11.88). Multivariate analyses were stratified by history of mental health problems. Significant factors among both groups included never being married and self-reported fair/poor health status. This study identifies key risk factors associated with antepartum mental health problems in a nationally representative sample of pregnant women. Women with low social support, in poor health, or with a history of poor mental health are at an increased risk of having antepartum mental health problems. Understanding these risk factors is critical to improve the long-term health of women and their children.

PURPOSE: To determine if caring for a child with cancer or a brain tumor affects parental health and mental health and if and to what extent stress mediates the relationship between case status and parental quality of life. METHODS: In person interviewer-assisted surveys were administered to 74 case dyads (children diagnosed with cancer or a brain tumor and their parents) and 129 control dyads (children without health problems and their parents from a community sample) to assess health-related quality of life and perceived levels of stress. RESULTS: Parents of children with cancer or a brain tumor had significantly worse health-related quality of life, including worse overall mental health. Overall physical health was no different between cases and controls. Staged multivariate analysis revealed that worse health-related quality of life is completely mediated by perceived stress in these parents. CONCLUSIONS: The experience of caring for a child with cancer is not in itself related to poor quality of life, but is related to an increased level of stress that may adversely impact parental mental health and quality of life.

Range of motion after total hip arthroplasty is becoming an important topic as today's patients present at a younger age and are more active. An effective study design to carry out comparisons of clinical performance between two implants should eliminate patient-related extraneous variables (e.g., age, gender, activity level, among others). The aim of the present study was to compare the range of motion results achieved postoperatively between metalon-metal hip resurfacing (HR) and conventional total hip arthroplasty (THA) in a cohort of bilateral patients implanted with both designs. Thirty-five patients who had undergone bilateral surgery with one hip receiving an HR device and the contralateral hip receiving a THA were retrospectively selected. Sixty-nine percent of the patients were male, and at the time of implantation of the resurfacing device the mean age of the patients was 53 years. The mean follow-up time was 88 months for the hips treated with HR and 96 months for the hips that received a THA. We found no difference in any of the range of motion measurements between HR and THA even after separating the cohort into two groups based on the femoral head size of the THA (femoral heads under 40 mm and femoral heads greater or equal to 40 mm). Our investigation showed that, for most patients, prosthetic design is unlikely to be a limiting factor of range of motion after surgery provided that the positioning of the acetabular component is adequate.

The walls of conduit arteries undergo cyclic stretching from the periodic fluctuation of arterial pressure. Atherosclerotic lesions have been shown to localize to regions of excessive stretching of the arterial wall. We employed a displacement encoding with stimulated echoes (DENSE) sequence to image the motion of the common carotid artery wall and map the two-dimensional (2D) circumferential strain. The sequence utilizes a fully-balanced steady-state free-precession (SSFP) readout with 0.60 mm in-plane resolution. Preliminary results in volunteers at 1.5T (N = 4) and 3.0T (N = 17) are compared to measurements of the lumen circumference from cine images. The agreement between the two independent measurements at both field strengths (P < or = 0.001) supports the use of DENSE as a means to map the pulsatile strain in the carotid artery wall.