James Powell

• MD, FRCS(C), FAADEP
• Professor at University of Calgary

Osteoarthritis (OA) is a painful and debilitating disease which has no cure and there are no treatments which can predictably stop/reverse its progression. Treating this disease is particularly difficult since the articular cartilage lacks intrinsic repair capacity even though mesenchymal stem cells (MSCs) are present in the joint environment and h...

Osteoarthritis (OA) is a painful and debilitating disease which has no cure and there are no treatments which can predictably stop/reverse its progression. Treating this disease is particularly difficult since the articular cartilage lacks intrinsic repair capacity even though mesenchymal stem cells (MSCs) are present in the joint environment and h...

Osteoarthritis (OA) is a painful and debilitating disease which has no cure and there are no treatments which can predictably stop/reverse its progression. Treating this disease is particularly difficult since the articular cartilage lacks intrinsic repair capacity even though mesenchymal stem cells (MSCs) are present in the joint environment and h...

Aims: This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection. Methods: This is a retrospective population-based cohort study using prospectively colle...

Objective To determine the relationship between patients' preoperative readiness for total knee arthroplasty (TKA) and surgical outcome at 1 year post‐TKA. Methods This prospective cohort study recruited patients with knee osteoarthritis (OA) who were ≥30 years and were referred for TKA at 2 hip/knee surgery centers in Alberta, Canada. Those who u...

Background There has been increasing recognition of local and systemic adverse events associated with the release of metal ions and nanoparticles from hip arthroplasty components. Adverse local tissue reactions to metal ion debris can include periprosthetic solid and cystic masses known as pseudotumors. These masses can result in pain, swelling, ex...

The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset (≤90 d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to...

Aims Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of...

Introduction The aim of this study was to compare functional outcomes and perioperative complications between patients on a selective serotonin reuptake inhibitor (SSRI) and those who are not on a SSRI preoperatively at the time of total joint arthroplasty (TJA). Methods A retrospective study was performed on 28,386 patients who received a primary...

This chapter presents a case scenario of a 22‐year‐old female patient who is reporting progressive pain in her right hip over the last six months. The development of new techniques in pelvic osteotomies for hip dysplasia and subsequently the introduction of the concept of femoroacetabular impingement (FAI) have led to an increase in both open and a...

This chapter presents a case scenario of a 70‐year‐old patient with a total hip arthroplasty (THA) performed eight years ago presents with pain in his hip for the last four months. He had unremarkable postoperative recovery and was asymptomatic for the last eight years. Although majority of the patients with THA have a high satisfaction rate, betwe...

Aim How reduced femoral neck anteversion alters the distribution of pressure and contact area in Hip Resurfacing Arthroplasty (HRA) remains unclear. The purpose of this study was to quantitatively describe the biomechanical implication of different femoral neck version angles on HRA using a finite element analysis. Materials and methods A total of...

First, the authors question our selection of the exposure measure ‐ patients’ pre‐operative expectations for total knee arthroplasty (TKA) surgery. In brief, we assessed TKA expectations using the HSS TKA Expectations Questionnaire2. For each of 17 TKA outcomes, participants are asked, “How important are these expectations in the treatment of your...

Proponents of the Sub-Vastus (SV) approach in primary Total Knee Arthroplasty (TKA) claim superior extensor mechanism function which results in earlier recovery after surgery. We performed a meta-analysis of randomized controlled trials comparing the SV and standard Medial Parapatellar (MPP) approaches in primary TKAs. The study was performed using...

Objective To assess the relationship between patients’ expectations for total knee arthroplasty (TKA) and satisfaction with surgical outcome. Methods This prospective cohort study recruited patients with knee osteoarthritis (OA) ages ≥30 years who were referred for TKA at 2 hip/knee surgery centers in Alberta, Canada. Those who received primary, u...

Synovitis is common in osteoarthritis (OA) patients and is associated with pain and disease progression. We have previously demonstrated that chemokine C-C motif chemokine 22 (CCL22) induces chondrocyte apoptosis in vitro, however, the effects of CCL22 on the synovium remain unknown. Therefore, our goal was to investigate the effect of CCL22 on fib...

Aims: Dislocation is the most common indication for further surgery following total hip arthroplasty (THA) when undertaken in patients with a femoral neck fracture. This study aimed to assess the complication rates of THA with dual mobility components (THA-DMC) following a femoral neck fracture and to compare outcomes between THA-DMC, conventional...

Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it...

Background: Patients with bilateral end-stage hip or knee arthritis want to know if it is safe to have bilateral surgery under a single anesthetic, to restore their quality of life as quickly as possible. The purpose of this study was to assess if there is an increase in the rate of postoperative medical adverse events, length of stay (LOS), blood...

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are reliable surgical options to treat pain and disability resulting from degenerative conditions around the hip and knee. Obesity is a modifiable risk factor that contributes to significant morbidity. The purpose of this study was to retrospectively compare outcomes in pri...

Background: The aim of this prospective cohort study was to determine the effect of preoperative mental health status on functional outcome 1 year after total hip arthroplasty (THA). Methods: Data were collected for 677 patients from a randomized controlled trial in Alberta who received primary THA between April 2005 and June 2006 (sex, age, bod...

Background: Allogeneic blood transfusion has been linked with an increase in the risk of surgical site infections (SSIs) through the mechanism of immunomodulation. However, no studies to date have investigated the direct relationship between blood conserving strategies including antifibrinolytics and wound complications after total hip arthroplast...

Objectives: The aim of this study was to investigate femoral head perfusion following cadaveric hip resurfacing using the posterior approach. Methods: This cadaveric study involved injecting Higgins India ink into the common iliac arteries and evaluating the distribution of ink in the resurfaced heads using the modified Spalteholz technique. The...

Background: To assess using a retrospective case control study, whether patients undergoing primary, elective total hip or knee arthroplasty who receive blood transfusion have a higher rate of post-operative infection compared to those who do not. Materials and Methods: Data on elective primary total hip or knee arthroplasty patients, including pat...

Background The synovial membrane adjacent to the articular cartilage is home to synovial mesenchymal progenitor cell (sMPC) populations that have the ability to undergo chondrogenesis. While it has been hypothesized that multiple subtypes of stem and progenitor cells exist in vivo, there is little evidence supporting this hypothesis in human tissue...

Dissociation of the polyethylene liner from the acetabular shell is a rare but catastrophic complication of total hip arthroplasty (THA). There have been reports of polyethylene liner dissociation (PLD) as well as ceramic liner dissociation (CLD) in the literature. Amongst the commonly used implants, liner dissociation has been reported with the Pi...

Background: Testing of whole blood or serum metal ion levels has become an important part of assessing and monitoring the performance of metal-on-metal bearings, both in hip resurfacing arthroplasty and in total hip replacement. The aim of this study was to determine the concordance between 2 laboratories testing cobalt and chromium ion levels in...

Background Inflammation is associated with the onset and progression of osteoarthritis in multiple joints. It is well known that mechanical properties differ between different joints, however, it remains unknown if the inflammatory process is similar/distinct in patients with hip vs. knee OA. Without complete understanding of the role of any specif...

Metal-On-Metal hip resurfacing technique is becoming widely accepted as a viable alternative to other forms of total hip replacements. The technique has many proven benefits in terms of ease of the surgical operation, operation outcome and subsequent revisions. However, recent reports suggest that there is an effect caused by the different femoral...

Background Lactobacillus spp. are uncommon pathogens in immunocompetent hosts, and even rarer causes of prosthetic device infections. Case presentation A case of chronic hip prosthetic joint infection (PJI) caused by L. animalis is described. This occurred 5 years after a transient bacteremia with the same organism. Whole genome sequencing of both...

The aim of this prospective cohort study was to determine what factors affected the improving of 1-year post-operative WOMAC scores in patients who had undergone total hip arthroplasty (THA). The study group comprised of 677 patients who received primary total hip arthroplasty between April 1, 2005 and June 30, 2006 from a randomised controlled tri...

Aims: We aimed to assess the comparability of data in joint replacement registries and identify ways of improving the comparisons between registries and the overall monitoring of joint replacement surgery. Materials and methods: We conducted a review of registries that are full members of the International Society of Arthroplasty Registries with...

There is limited knowledge regarding the anatomic relationships and functional anatomy of the Obturator Externus muscle (OE). It is described as a muscle which originates from the external bony margin of the obturator foramen with a cylindrical tendon which passes like a sling under the femoral neck and inserts in the trochanteric fossa. The primar...

We report the clinical and radiological outcome of subcapital osteotomy of the femoral neck in the management of symptomatic femoroacetabular impingement (FAI) resulting from a healed slipped capital femoral epiphysis (SCFE). We believe this is only the second such study in the literature. We studied eight patients (eight hips) with symptomatic FAI...

The aim of the current study was to evaluate the innervation of the acetabular labrum in the various zones and to understand its potential role in nociception and proprioception in hips with labral pathology. A total of twenty hip labrums were tagged and excised intraoperatively from patients undergoing a total hip replacement. After preparation, t...

The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels in...

The purpose of this study was twofold: first, to determine whether the five-year results of hip resurfacing arthroplasty (HRA) in Canada justified the continued use of HRA; and second, to identify whether greater refinement of patient selection was warranted. This was a retrospective cohort study that involved a review of 2773 HRAs performed betwee...

To develop a rapid and reliable method, using an octopole reaction system (ORS) ICP-MS, capable of monitoring trace levels of Co and Cr in whole blood samples from hip arthroplasty patients with metal-on-metal prostheses. Whole blood is diluted 10-fold with an alkaline diluent and analyzed using an Agilent 7500 CE ORS-ICP-MS. Limit of quantificatio...

Total Hip Arthroplasty is undoubtedly one of the most successful innovations of the last millennium. The vast majority of recipients have a good clinical outcome and a significant improvement in quality of life. Unfortunately a minority can have ongoing pain for a multitude of reasons. The aim of this chapter is to provide an evidence based approac...

The aim of the study was to assess the use of the centre-edge (CE) angle in the assessment of pincer femoro-acetabular impingement (FAI) for reliability and predictability in the diagnosis. Between 2004 and 2008, 55 patients underwent surgical treatment for FAI. A control group of 30 was identified among patients attending the emergency department...

Seven patients with symptomatic osteochondritic lesions of the femoral head are presented. All were male with a mean age of 26 years (16 – 33 years). Two distinct morphologic appearances of the hip joint could be identified. Five patients presented with a coxa valga deformity, four of whom had signs of epiphyseal dysplasia. There were 2 patients wh...

Surgical dislocation of the hip in the treatment of acetabular fractures allows the femoral head to be safely displaced from the acetabulum. This permits full intra-articular acetabular and femoral inspection for the evaluation and potential treatment of cartilage lesions of the labrum and femoral head, reduction of the fracture under direct vision...

Fracture of the neck of the femur after resurfacing arthroplasty usually leads to failure and conversion to a total hip replacement. We describe an intracapsular fracture of the femoral neck sustained after hip resurfacing which was treated by cannulated screws, resulting in union and retention of the resurfacing implant. The result at follow-up th...

Background: Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for bicondylar tibial plateau fractures; however, surgical morbidity, especially soft-tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive met...

Objective: To compare the rate of Acute Respiratory Distress Syndrome (ARDS) in multiply injured patients with femoral shaft fractures, treated with intramedullary femoral nails inserted with or without reaming. Design: Prospective, randomized, multicenter, clinical trial. Setting: Seven Level 1 trauma centers. Patients: Three hundred fiftee...

Acute intramedullary stabilization of femoral shaft fractures in multiply injured patients is controversial. Intravasation of medullary fat during canal pressurization has been suspected to trigger adult respiratory distress syndrome. The goal of the present study was to evaluate the effect, on the lungs, of a filter placed into the ipsilateral com...

The relative infrequency and complexity of acetabular fractures provide a challenge for trauma surgeons. In young patients, the management may be complicated by other injuries. The aim of treatment is to maintain a stable congruent joint. Although there is a role for non-operative treatment the hip joint tolerates instability and incongruity poorly...

To determine the incidence and severity of tibial malrotation following reamed intramedullary nail fixation as measured by computerized tomography and to determine the repeatability of computed tomography measurement in the assessment of rotational malreduction. Prospective cohort. Level 1 trauma center. Twenty-five consecutive patients with 25 tib...

Non-unions of acetabulum are rare. Seven cases of acetabular non-unions are reported in this retrospective study. Five out of our seven patients had either transverse or associated transverse with posterior wall fractures. All patients had surgical stabilisation of their index fractures. A diagnosis of non-union was made at an average of 5.8 months...

Background: Intramedullary nailing of the femur without reaming of the medullary canal has been advocated as a method to reduce marrow embolization to the lungs and the rate of infection after open fractures. The use of nailing without reaming, however, has been associated with lower rates of fracture-healing. The purpose of this prospective study...

This study evaluated the ability of the orthopaedic surgeon to radiographically assess bone density in the wrist with sufficient accuracy to determine which patients require treatment for osteoporosis. Thirty-eight patients with unilateral distal radius fractures, 30 of whom were female, were included in this study. The mean age was 55 years (range...

We randomised prospectively 44 patients with fractures of the shaft of the humerus to open reduction and internal fixation by either an intramedullary nail (IMN) or a dynamic compression plate (DCP). Patients were followed up for a minimum of six months. There were no significant differences in the function of the shoulder and elbow, as determined...

We randomised prospectively 44 patients with fractures of the shaft of the humerus to open reduction and internal fixation by either an intramedullary nail (IMN) or a dynamic compression plate (DCP). Patients were followed up for a minimum of six months. There were no significant differences in the function of the shoulder and elbow, as determined...

The purpose of our study was to assess the effect of comorbidity and duration of nonunion on the general health status and joint-specific outcome of a group of patients treated for nonunion of the humeral shaft. We identified 25 consecutive patients with nonunion of the humeral shaft, all treated with compression plating and bone grafting. Twenty-o...

This article outlines our experience with a new technique using a radiolucent fracture support for intramedullary nailing procedures. The support is used primarily for nailing of acute tibial shaft fractures and for insertion of femoral nails in a retrograde fashion without a fracture table.

This article outlines our experience with a new technique using a radiolucent fracture support for intramedullary nailing procedures. The support is used primarily for nailing of acute tibial shaft fractures and for insertion of femoral nails in a retrograde fashion without a fracture table.

A marked discrepancy exists in the reported mortality rates in patients with open pelvic fractures, ranging from 4.8% to 50%. A retrospective review of patients with open pelvic fractures was performed at three centers. Thirty-nine patients with open pelvic fractures were identified; the average age was 32. The average injury-severity score was 29...

Segmental subtrochanteric fractures have been associated with high rates of malunion, nonunion, and implant failure. Although the use of second generation intramedullary nails with proximal interlocking in the femoral head has been advocated for these fractures, shaft fractures at the tip of short second generation intramedullary rod nails in clini...

This study compares the relative strengths of iliosacral lag screws and transiliac bars in the fixation of vertically unstable pelvic injuries with sacral fractures. A vertical sacral fracture was artificially induced by vertical loading in eight pelvises from cadavers, which were then fixed with two 6.5 mm iliosacral lag screws or two 6.4 mm trans...

Unlabelled: A retrospective series of 99 femoral shaft fractures treated by small diameter (10 and 11 mm) and large diameter (> 11 mm) closed section femoral nails from November 1989 to September 1993 was analyzed. No significant differences in the parameters of bony union and time to full weight bearing were seen between the two groups nor were t...

The choice of which decision to use for open reduction and internal fixation of complex acetabulum fractures depends on several variables. We report on 26 patients in whom a lateral extension of the ilioinguinal incision was used to achieve fracture reduction and stabilization. The lateral extension allowed visualization of the lateral ilium, in so...

This study tested different methods of internal fixation of a symphyseal disruption, in comparison with the mechanics of the intact pelvis. Unembalmed cadaveric pelves were tested in simulated bilateral stance in a servohydraulic materials-testing machine. Motion of the superior and inferior pubic symphysis, and at two levels of the posterior sacro...

Control of rotation after intramedullary fixation of the humeral shaft has been observed to vary clinically. Two of the newer intramedullary nails specifically designed for the humerus were tested. Transverse and spiral fractures were created in 35 fresh-frozen cadaveric humeri. The constructs were tested in a materials testing system to evaluate i...

Ten fresh frozen specimens of a hemipelvis, including the hip joint, capsule and proximal femur, from elderly cadavers were used to evaluate three methods of internal fixation of isolated posterior column osteotomies. Intact and reconstructed specimens were tested at 30 degrees and 60 degrees of hip flexion in a specially designed joint simulator....

The findings of this study emphasize the importance of distraction in obtaining and maintaining reduction in upper thoracic fractures that are unstable and collapsing into kyphosis. It also shows that a Luque rectangle construct cannot fulfill this function adequately in this type of fracture. Thirty-four consecutive cases of surgically treated upp...

Although iliosacral lag screws are an established technique for fixation of sacroiliac joint dislocation and sacral fractures, there is a paucity of data on the relative strength of fixation of screws in the sacral ala and body. The purpose of this study was to quantify and compare the extraction strength of cancellous screws in the sacral ala and...

In the last 100 fractures of the acetabulum surgically treated in our institution, cerclage wires have been used as a reduction tool in 14 patients. In each case the fracture pattern affected both columns, and nine of them were approached through a single ilioinguinal exposure. To evaluate our initial experience with the method, these patients were...

The cases of 60 patients with 63 open femoral fractures treated by primary reamed intramedullary nailing were retrospectively reviewed. Twenty-two were classified as Type I open fractures, 26 as Type II and 15 as Type III open fractures by Gustilo's classification. All fractures were treated by wound debridement followed by immediate reamed intrame...

Double-level noncontiguous spinal injury is a more common occurrence than generally appreciated. A large number of these patients have neurological injury. Because these injuries occur in patients who meet the criteria for categorization as multiple trauma patients, we feel that a complete radiographic survey of the spine must be accomplished in th...

In a retrospective review of 231 patients who were referred to Princess Margaret Hospital because of a soft-tissue sarcoma in an extremity, 100 patients were identified who had no metastases when they were first seen and who had been treated by local resection and adjuvant radiation therapy. Complete data were collected for each patient for the fol...