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Access Statistics 2012 | July-June | Issue 1


Original Research-Adult Reconstruction
Kevin T Hug BS, Robert A Henderson MD, Benjamin J Hansen MD, Samuel S Wellman MD, Thomas P Vail MD, Michael P Bolognesi MD

Polished Cobalt-Chrome vs Titanium Tibial Trays in Total Knee Replacement (a Comparison using the PFC Sigma System)

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:5-11]


Fixed-bearing total knee arthroplasty components can cause wear debris due to fretting micromotion between the polyethylene insert and the metal tibial tray, possibly leading to osteolysis and implant failure. This study compared the effects of either a highly polished cobalt-chrome (CoCr) or titanium tibial tray in patients receiving the PFC. Sigma® posterior stabilized knee system with a moderately cross-linked polyethylene insert. One hundred five patients with titanium tibial trays and 70 patients with CoCr tibial trays were prospectively enrolled at the time of follow-up of at least 4 years from surgery. There were two revisions with implant removal in each group. On blinded radiographic review, osteolysis was observed in three of 105 knees in the titanium group and three of 70 knees in the CoCr group. Radiolucent lines were categorized in accordance with the Knee Society roentgenographic evaluation system. In the titanium group 18% showed no radiolucent lines, 65% scored four or less (nonconcerning), and 17% scored between five and nine (requires observation for progression). In the CoCr group 24% showed no radiolucencies, 61% scored four or less, and 14% scored between five and nine. None of the knees in either group scored greater than 10 (possible or impending failure). Knee society scores and radiographic alignment were statistically similar between groups. These results suggest that there may not be a difference in clinical or radiographic midterm outcome between titanium and CoCr tibial trays in total knee arthroplasty.

Keywords:TKA, Cobalt-chrome, Titanium, Osteolysis, Radiolucency.

How to Cite article: Hug KT, Henderson RA, Hansen BJ, Wellman SS, Vail TP, Bolognesi MP. Polished Cobalt-Chrome vs Titanium Tibial Trays in Total Knee Replacement (A Comparison using the PFC Sigma System). The Duke Orthop J 2012;2(1):5-11.


Special Interest

Special Interest Articles

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:xxiii-l]

“In the spring of 1964 while a first year orthopaedic resident at Duke the rumor floated that my next rotation would be in Gastonia at the North Carolina Orthopaedic Hospital (NCOH). I had misgivings and questioned Dr Goldner about the assignment. He said it was a great opportunity; that Dr Miller was an excellent teacher and if I showed interest and was capable I would have a good surgical experience


Original Research-Sports Medicine
Ankur M Manvar BS, Sheetal M Bhalani MD, Grant E Garrigues MD, Nancy M Major MD

Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:44-49]


Objective: To improve the magnetic resonance imaging (MRI) and magnetic resonance arthrogram (MRA) interpretation of a ‘meniscoid-type’ superior labrum vs a superior labral tear by evaluation of a simple sign.

Materials and methods: Retrospective analysis of our institution's shoulder MRIs and MRAs yielded 144 patients thought to have a superior labral tear. Fifty-five patients had arthroscopy. Analysis of the orthopaedic database for superior labral repair surgeries performed in the same time frame yielded seven additional patients without prospective MRI/MRA diagnosis of superior labral tear.

Results: Two of 17 (11.8%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy. Both cases failed to have extension of high signal intensity behind the biceps anchor to the most posterior oblique coronal image. Nine of 38 (23.7%) patients thought to have superior labral tears by MRI or MRA were found to have no labral pathology at arthroscopy, but a meniscoidtype superior labrum. Four of seven patients known to have superior labral tears by arthroscopy but incorrectly diagnosed as meniscoid-type superior labrum on MRI or MRA, were retrospectively found to have extension of high signal intensity in the superior labrum to the most posterior image.

Conclusion:Signal abnormality that continues through the remainder of the superior labrum posterior to the biceps anchor indicates a superior labral tear. Absence of this sign in the setting of more anterior high signal under the labrum may indicate a meniscoid variant.

Keywords:Superior labral tears, Meniscoid-insertion superior labrum, Superior sublabral recess.

How to Cite article:Manvar AM, Bhalani SM, Garrigues GE, Major NM. Distinguishing Superior Labral Tears from Normal Meniscoid Insertions with Magnetic Resonance Imaging. The Duke Orthop J 2012;2(1):44-49.


Original Research-Foot and Ankle
Karl M Schweitzer Jr MD, Samuel B Adams Jr MD, Nicholas A Viens MD, Robin M Queen PhD, Mark E Easley MD, James K DeOrio MD, James A Nunley II MD

Early Prospective Results of the Salto-Talaris Total Ankle Prosthesis

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:23-34]


Background:Several fixed-bearing total ankle arthroplasty (TAA) systems are available in the United States (US). We report on the early clinical results of the largest known US cohort of patients who received a Salto-Talaris total ankle replacement for end-stage ankle arthritis.

Methods: We prospectively followed 67 TAA patients with a minimum clinical follow-up of 2 years. Patients completed standardized assessments, including visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot score, short form (36) health survey (SF-36), and the short musculoskeletal function assessment (SMFA), along with physical examination, functional assessment, and radiographic evaluation, preoperatively and yearly thereafter through most recent follow-up.

Results: Implant survival was 96% using metallic component revision, removal, or impending failure as endpoints, with a mean follow-up of 2.81 years. Three patients developed aseptic loosening, all involving the tibial component. Of these, one underwent revision to another fixed-bearing TAA system, one patient is awaiting revision surgery, and the other patient has remained minimally symptomatic and fully functional without additional surgery. Forty-five patients underwent at least one additional procedure at the time of their index surgery. The most common concurrent procedure performed was a deltoid ligament release (n = 21), followed by removal of previous hardware (n = 16) and gastrocnemius recession (n = 11). Eight patients underwent additional surgery following their index TAA, most commonly debridement for medial and/or lateral impingement (n = 4). Patients demonstrated significant improvement in VAS, AOFAS hindfoot, several SF-36 subscales, SMFA, and functional scores at most recent follow-up (p < 0.001).

Conclusion:Early clinical results indicate that the Salto-Talaris fixed-bearing TAA system can provide significant improvement in pain, quality of life, and standard functional measures in patients suffering from end-stage ankle arthritis. The majority of patients underwent at least one concurrent procedure, most commonly to address varus hindfoot deformity, hardware removal, or equinus contracture.

Keywords:Salto-Talaris, Total ankle replacement, Total ankle arthroplasty, Fixed-bearing, Clinical outcome.

How to Cite article:Schweitzer Jr KM, Adams Jr SB, Viens NA, Queen RM, Easley ME, DeOrio JK, Nunley II JA. Early Prospective Results of the Salto-Talaris Total Ankle Prosthesis. The Duke Orthop J 2012;2(1):23-34.


Review Article-Spine
Richard J Nasca MD

Osteolysis in Lumbar Interbody Fusions: The Role of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:50-54]


Osteolysis may occur following lumbar interbody fusion procedures in which recombinant human bone morphogenetic protein-2, more commonly known as rhBMP-2, is used. The actual incidence of this process is unknown. Osteolysis results from an osteoclastic, rather than an osteoblastic response to rhBMP-2 and its carrier on trabecular vertebral bone, early in the sequence of bone graft healing. This osteoclastic response may represent an idiosyncratic reaction in those affected. The patient usually does well in the immediate postoperative period with resolution of their preoperative complaints of axial and radicular pain. However, at 4 to 12 weeks following the index surgery, the patient experiences a recurrence of severe back and radicular pain corresponding to the dermatomal level(s) operated upon. Laboratory studies including erythrocyte sedimentation rate, C reactive protein, and cultures are negative for infection. Imaging studies show areas of bone destruction and cyst formation containing fluid. In the majority of postoperative patients with osteolysis, there is an osteoblastic healing response with symptom resolution. Supportive, nonoperative care is usually effective in managing the patient.

Keywords:Osteolysis, Bone resorption, rhBMP-2, Interbody fusion, Radiculitis.

How to Cite article:Nasca RJ. Osteolysis in Lumbar Interbody Fusions: The Role of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2). The Duke Orthop J 2012;2(1):50-54.


Case Series-Sports Medicine
Nathan T Morrell MD, Deana M Mercer MD, Moheb S Moneim MD

Reconstruction of Chronic Distal Biceps Tendon Rupture using Fascia Lata Autograft

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:55-59]


Introduction: Distal biceps tendon ruptures are a rare injury and surgical reconstruction is typically recommended for chronic ruptures. There is no consensus regarding the most appropriate reconstruction technique. We present our experience with fascia lata autograft reconstructions of chronic distal biceps tendon ruptures using a modified single incision technique and distal fixation with suture anchors.

Materials and methods: We retrospectively reviewed the outcome of 12 male patients with chronic distal biceps tendon ruptures who had reconstruction using a fascia lata autograft through a single anterior approach. The age ranged from 29 to 62 years. The average delay to surgery was 26.5 weeks (range 6-68 weeks). A modified single anterior incision was utilized for all patients. Fascia lata autograft was attached distally to the bicipital tuberosity using suture anchors. Tension was set with the elbow in 50° of flexion. The average follow-up was 14.5 months (range 1.5-66 months). All patients were treated by the senior author (MSM).

Results: Eleven patients (92%) reported subjective improvement in elbow flexion and supination strength, as well as painless range of motion. The average elbow flexion/ extension arc was 126° (5° flexion to 131° flexion) and the average supination/pronation arc was 167 degrees (87° pronation to 80° supination). Five patients underwent isokinetic flexion strength testing which revealed a restoration of 86% of strength when compared to the uninvolved side. Four patients underwent supination isokinetic strength testing which revealed a restoration of 87% of strength when compared to uninvolved side. Four patients reported numbness in the superficial radial nerve distribution that recovered within 12 months. There were no cases of heterotopic ossification or graft rupture. There was one case of wound dehiscence at the elbow that required local flap coverage and went on to heal uneventfully. Aside from a small muscle bulge at the donor site, there were no donor site complications.

Conclusion:To our knowledge, this is the largest case series of patients undergoing distal biceps tendon reconstruction using fascia lata autograft. Our study has demonstrated a low complication rate with functional results similar to those reported in the literature utilizing a similar technique. We conclude that this technique offers a surgical treatment alternative that yields satisfactory functional outcomes with a low risk of complication.

Keywords:Distal biceps, Reconstruction, Fascia lata, Suture anchor.

How to Cite article:Morrell NT, Mercer DM, Moneim MS. Reconstruction of Chronic Distal Biceps Tendon Rupture using Fascia Lata Autograft. The Duke Orthop J 2012;2(1):55-59.


Case Report-Adult Reconstruction
Jordan F Schaeffer MD, David E Attarian MD, Samuel S Wellman MD

Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:66-69]


Recent literature shows an association between long-term bisphosphonate therapy and low-energy fractures of the subtrochanteric femur. It is thought that the pharmacology of bisphosphonates and stress characteristics of the subtrochanteric femur predispose patients on long-term therapy to fracture. There are few reports in the literature of bisphosphonate- associated periprosthetic fractures with the characteristic fracture pattern. We report a case in a patient with a 10- year history of sustained bisphosphonate use. The patient is a 79-year-old female that developed new thigh pain 9 years following a cemented total hip arthroplasty. Radiographs revealed lateral cortical thickening and a transverse periprosthetic stress fracture of the lateral femoral cortex at the level of the distal stem. This fracture appears consistent with a bisphosphonate-associated insufficiency fracture, demonstrating that this pattern is not isolated to nonarthroplasty patients.

Keywords:Bisphosphonate, Femur fracture, Periprosthetic fracture, Insufficiency fracture.

How to Cite article:Schaeffer JF, Attarian DE, Wellman SS. Periprosthetic Femoral Insufficiency Fracture in a Patient on Long-term Bisphosphonate Therapy. The Duke Orthop J 2012;2(1):66-69.


Original Research-Sports Medicine
VJ Sabesan MD, DM Pedrotty MD, JR Urbaniak MD, G Gahreeb MD, JM Aldridge III MD

Free Vascularized Fibular Grafting Preserves Athletic Activity Level in Patients with Osteonecrosis

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:40-43]


Background:Athletic patients with osteonecrosis of the femoral head have few desirable therapeutic options that preserve athletic ability. A total hip arthroplasty for this young and active patient population would be catastrophic for patients’ chances of returning to vigorous athletic endeavors. Therefore, other therapeutic alternatives must be considered prior to enlisting this patient population for a total hip arthroplasty.

Materials and methods: We retrospectively evaluated 15 patients (19 hips) who presented at an average age of 28.5 years (12-46) and stages 2 (6/19), 3 (2/19), 4 (9/19) and 5 (2/ 19) of osteonecrosis of the femoral head (ONFG). All patients were participating in strenuous athletic activity and were treated with free vascularized fibular autografting (FVFG) to the femoral head.

Results: Postoperative evaluation of pain symptoms and functional activity showed improvements in all patients. The average follow-up time was 8 years. Harris hip scores significantly increased from an average preoperative score of 72.5 to an average postoperative score of 94. Seventy-five percent of patients were able to return to their sport after recovery and all patients reported being satisfied with the procedure and would repeat their decision to have surgery. Three patients’ hips were converted to arthroplasty at 3, 11 and 17 years post-FVFG.

Conclusion:Our results demonstrate FVFG as a successful treatment in athletes with osteonecrosis of the femoral head. This procedure has the potential to reduce pain, increase activity and allow most to return to their sport, an achievement often not possible with other treatment options.

Keywords:Free vascularized fibula, Athletes, Osteonecrosis.

How to Cite article:Sabesan VJ, Pedrotty DM, Urbaniak JR, Gahreeb G, Aldridge III JM. Free Vascularized Fibular Grafting Preserves Athletic Activity Level in Patients with Osteonecrosis. The Duke Orthop J 2012;2(1):40-43.


Original Research-Hand and Upper Extremity
Gary M Lourie MD, R Glenn Gaston MD, Allan E Peljovich MD, Jason J Marshall MD, Lee Patterson MD

Anomalous Thenar Musculature Associated with Aberrant Median Nerve Motor Branch Take-off: An Anatomic and Clinical Study

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:18-22]


Introduction: Iatrogenic laceration of the median nerve motor branch during carpal tunnel release is a devastating complication that has been reported with both open and endoscopic techniques. The purpose of this study is to highlight a previously underreported relationship between an aberrant course of the median nerve motor branch and an anomalous thenar muscle that places the motor branch at high risk.

Materials and methods:This was a two part study. The first part was a retrospective review of over 500 cases of carpal tunnel release over a 7 year period. There were 530 carpal tunnel releases performed and 20/530 cases were found to have a characteristic anomalous thenar muscle associated with a consistent aberrant course of the motor branch of the median nerve. Part two was an anatomic study in which 42 cadaveric wrists were dissected to determine median nerve branching patterns, dimensions of the transverse carpal ligament, and thenar musculature dimensions

Results: Twenty patients (3.8%) in the clinical arm were found to have anomalous musculature. In each case, the characteristics of the muscle were similar; the muscle was triangular in shape, was distal to the FPB, and had minimal fascial covering. In 100% of the cases the motor branch was found to be more anterior/central or ulnar in its take-off. In the anatomic study, two hands (5%) had aberrant musculature extending distal to the transverse carpal ligament (TCL). Both were associated with an anterior/central or ulnar median motor branch take-off with recurrent course. Larger thenar musculature dimensions and anomalous thenar muscle were associated with more anterior and ulnar motor branch take-off.

Conclusion: There appears to be a high association between anomalous thenar musculature and an aberrant course of the motor branch of the median nerve placing it a greater potential risk for iatrogenic injury.

Keywords: Carpal tunnel, Thenar muscle, Median nerve.

How to Cite article:Lourie GM, Gaston RG, Peljovich AE, Marshall JJ, Patterson L. Anomalous Thenar Musculature Associated with Aberrant Median Nerve Motor Branch Take-off: An Anatomic and Clinical Study. The Duke Orthop J 2012;2(1):18-22.


Original Research-Adult Reconstruction
Michael E Berend MD, Merrill A Ritter MD, John B Meding MD, Peter Davis BA

Twenty-one Years Clinical Experience of 461 Femoral Revision Total Hip Arthroplasties with a Calcar Replacement Prosthesis

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:1-4]


Outcomes following femoral reconstruction during revision total hip arthroplasty (THA) may be influenced by femoral deformity, fixation interface and implant type. The purpose of this study was to determine the long-term clinical and radiographic outcomes of a series of 461 femoral reconstructions with a calcar replacement prosthesis performed over a 21-year period. Multivariate analysis was performed based on age, femoral Paprosky class, implant length, modularity and mode of failure. Mean follow-up was 5.6 years. There were 18 stem revisions for an overall stem survivorship of 96.3%. Infection (n = 13) and dislocation (n = 2) were the most common indications for revision. Two stems were revised for aseptic loosening for an aseptic failure rate of 0.4%. Increased femoral deformities had higher revision rates due to all failure modes (p < 0.006). Overall complication rate was 13.4%, most commonly instability, infection and periprosthetic fracture, but most often did not lead to stem revision. We conclude that an uncemented bowed calcar replacement prosthesis has excellent clinical results in a wide range of femoral deformities, and most complications are unrelated to the femoral implant. All implants in this study have FDA approval.

Keywords:Revision total hip arthroplasty, Calcar replacement.

How to Cite article: Berend ME, Ritter MA, Meding JB, Davis P. Twenty-one years Clinical Experience of 461 Femoral Revision Total Hip Arthroplasties with a Calcar Replacement Prosthesis. The Duke Orthop J 2012;2(1):1-4.


Case Series-Sports Medicine
Tyler S Watters MD, Adam M Kaufman MD, John M Solic MD, Sandra S Stinnett DrPH, Steven A Olson MD

Combined Arthroscopic and Mini-Open Treatment of CAM-Type Femoroacetabular Impingement

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:60-65]


Purpose: Osteochondroplasty of the femoral head-neck junction can improve hip pain and function in patients with femoroacetabular impingement. We report our initial series of patients undergoing surgical treatment for symptomatic CAM type femoroacetabular impingement using a combined arthroscopic and mini-open approach.

Materials and methods: A retrospective chart review of 20 consecutive patients was performed. Seventeen patients had adequate follow-up for inclusion. Preoperative clinical and radiographic characteristics as well as intraoperative findings were obtained from patient records. Postoperative Harris Hip scores and VAS pain scores were recorded at final follow-up.

Results:At an average of 27.8 months (range 12-48 months), the mean Harris Hip score improved from 64.7 preoperatively to 86.8 (p < 0.001). The mean VAS pain score improved from 4.80 to 1.53 (p = 0.001). Two patients (11.7%) underwent total hip arthroplasty at an average of 15 months postoperatively. Fourteen patients (82%) stated they would have the procedure again. There were no significant complications.

Conclusion:Surgical treatment of CAM type femoroacetabular impingement using a combined arthroscopic and mini-open anterior hip approach has a low complication rate and improves functional and pain scores at short-term follow-up.

Keywords:Femoroacetabular impingement, Mini-open, Arthroscopic, CAM.

How to Cite article:Watters TS, Kaufman AM, Solic JM, Stinnett SS, Olson SA. Combined Arthroscopic and Mini-Open Treatment of CAM-Type Femoroacetabular Impingement. The Duke Orthop J 2012;2(1):60-65.


Original Research-Spine
Wyzscx Merfil Patacxil MS, Daniel Kyle Palmer BS, David Rios BS, Serkan Inceoglu PhD, Paul Allen Williams MS, Wayne K Cheng MD

Screw Orientation and Foam Density Interaction in Pullout of Anterior Lumbar Interbody Fusion Plates

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:35-39]


Introduction:Previous studies demonstrated increases in single screw pullout strength with increases in material density. Recent anterior cervical interbody fusion plate pullout studies utilizing a polyurethane foam block model have shown that alterations in screw insertion angle from straight-in are not associated with an increase in pullout strength. The purpose of this study is to characterize the pullout strength of an anterior lumber interbody fusion (ALIF) plate when installed at various screw angles in different simulated bone densities.

Materials and methods:Ninety ALIF plate pullout tests were performed using three common screw insertion angles in polyurethane (PU) foam blocks of three densities: 0.08 g/cm3, 0.16 g/cm3 and 0.24 g/cm3, simulating severely, mildly and nonosteoporotic cancellous bone, respectively. Plates were pulled out axially at 1 mm/min and pullout strength and stiffness compared.

Results:Doubling foam density yielded 2.6-fold and 3.0-fold increases (p < 0.05) in mean pullout strength and stiffness, respectively. Tripling foam density yielded 4.5-fold and 5.3-fold increases (p < 0.05) in mean pullout strength and stiffness, respectively. Screw angle placement contributed relatively less to pullout strength and stiffness compared to PU foam density.

Conclusion: In our model, ALIF plate pullout strength and stiffness appear to be more associated with increased foam block density than screw trajectory. Vertebral bone density should be a strong consideration in preoperative planning for ALIF with plating. Screw trajectory should be based on vascular anatomy and screw placement safety, rather than the classic lateral-to-medial trajectory.

Keywords: ALIF, Biomechanical, Polyurethane foam, Pullout strength, Screw angle, Spine.

How to Cite article:Patacxil WM, Palmer DK, Rios D, Inceoglu S, Williams PA, Cheng WK. Screw Orientation and Foam Density Interaction in Pullout of Anterior Lumbar Interbody Fusion Plates. The Duke Orthop J 2012;2(1):35-39.


Original Research-Adult Reconstruction
Apostolos Dimitroulias MD, Jeff Hodrick MD, Rusty Brand MD, Nicholas Viens MD, David E Attarian MD, Thomas P Vail MD, Michael P Bolognesi MD

Total Hip Arthroplasty after Vascularized Fibular Grafting

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:12-17]


Background: Vascularized fibular grafting has been reported as a successful joint preserving surgery for patients with femoral head osteonecrosis. Few reports exist regarding the outcomes associated with total hip arthroplasty after failed vascularized fibular grafting. This study aims to highlight the early results and complications associated with this procedure.

Materials and methods: We retrospectively reviewed charts and radiographs of 30 patients (38 hips) who underwent conversion of prior vascularized fibular grafting to an uncemented total hip arthroplasty utilizing modern bearings (highly cross-linked polyethylene-on-metal or metal-on-metal). Mean follow-up was 41 months. A control group of 15 osteonecrosis patients (19 hips) was used who had a history of total hip arthroplasty without previous surgery. Outcome measures used were perioperative complications, clinical and radiological findings.

Results: The prior vascularized fibular grafting group had longer surgical times and more perioperative complications (calcar fracture and persistent wound drainage requiring early reoperation). In the prior vascularized fibular grafting group there were two cases requiring revision for aseptic loosening (one femoral and one acetabular component) and three cases of asymptomatic radiographic loosening (two femoral and one acetabular component). Furthermore, three patients reported symptoms of trochanteric bursitis. None of the above complications were seen in the control group. There was one dislocation in each group; and both were treated successfully with closed reduction. There was no significant difference between the two groups in the final postoperative Harris Hip Score (HHS).

Conclusion: Despite an increased complication rate, comparable clinical outcomes can be expected after conversion of vascularized fibular grafting to total hip arthroplasty.

Keywords:Arthroplasty, Hip joint, Preservation.

How to Cite article: Dimitroulias A, Hodrick J, Brand R, Viens N, Attarian DE Vail TP, Bolognesi MP. Total Hip Arthroplasty after Vascularized Fibular Grafting. The Duke Orthop J 2012; 2(1):12-17.


Chairman’s Corner
James A Nunley II

From the Chairman’s Corner

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:xxi-xxii]

Last year as Duke Orthopaedics successfully navigated a difficult first year as a new department, little did any of us know how good our second year would be. In late July, Duke Orthopaedics finally moved into our new orthopaedic institute located within Research Triangle Park


The Resident’s Corner

Class of 2012 Chief Resident Autobiographies

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:]



The Duke Orthopaedic Journal

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:]


Stephanie W Mayer, Karl M Schweitzer Jr, Jonathan C Riboh

Letter from the Editors

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:xix]

It is our pleasure to have served as the Co-Editors of the 2012 Edition of the Duke Orthopaedic Journal. After a successful inaugural issue, we were challenged to continue to raise the bar for the sophomore publication. The Duke University Department of Orthopaedic Surgery has again seen a successful year with the opening of the Page Road clinic building and expansion into Raleigh, repeat ranking at #6 in orthopaedic surgery in US News and World Report, and multiple national and international recognitions of our faculty for clinical expertise and research. It is a large task to justly represent all that is happening at our world-class institution, and we are grateful to each of the contributing authors for submitting their work to represent the current state of Duke Orthopaedics. Each year we hope to grow both in our personal experience with editing and improve upon past issues of a successful journal. We also hope to increase the size of the audience which comes to look forward to the publication.


Faculty Advisor’s
Selene G Parekh

2012 Faculty Advisor’s Corner

[Year:2012] [Month:July-June] [Volumn:2 ] [Number:1] [Pages:69] [Pages No:xx]

The 2011-2012 academic year has been exciting for Duke Orthopadics. We have continued to build on the tradition and success of Duke, highlighted by our first year as a Department,