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Arthroplasty Today

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https://www.readbyqxmd.com/read/29896563/early-femoral-condyle-insufficiency-fractures-after-total-knee-arthroplasty-treatment-with-delayed-surgery-and-femoral-component-revision
#1
George L Vestermark, Susan M Odum, Bryan D Springer
Background: Periprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction. Methods: We retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896562/proximal-tibial-resorption-in-a-modern-total-knee-prosthesis
#2
Justin T Deen, Terry B Clay, Dane A Iams, MaryBeth Horodyski, Hari K Parvataneni
Background: In an effort to minimize backside polyethylene wear and osteolysis associated with titanium tibial baseplates, many manufacturers have transitioned to cobalt chromium alloys. Recent literature has implicated thicker cobalt chromium designs as a potential source of increased stress shielding and resorption. We report the incidence of proximal tibial bone resorption in a large consecutive series of patients undergoing total knee arthroplasty, with a modern total knee design...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896561/short-term-safety-and-effectiveness-of-a-second-generation-motion-guided-total-knee-system
#3
Adam I Harris, Tianyi David Luo, Jason E Lang, Branko Kopjar
Background: Modern knee prostheses are designed to more closely replicate normal knee kinematics. The JOURNEY II Bi-Cruciate Stabilized Total Knee System (Smith & Nephew Inc., Memphis, TN) is a second-generation motion-guided knee system that demonstrates axial rotation patterns during flexion, which resemble those of the normal knee. The aim of this study was to assess the short-term safety and effectiveness of this system in standard clinical practice. Methods: A total of 186 subjects (209 primary total knee arthroplasties [TKAs]) were enrolled at 12 U...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896560/single-dose-lidocaine-spinal-anesthesia-in-hip-and-knee-arthroplasty
#4
Nicholas B Frisch, Brian Darrith, Dane C Hansen, Adrienne Wells, Sheila Sanders, Richard A Berger
Background: With the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896559/accessibility-and-content-of-individualized-adult-reconstructive-hip-and-knee-musculoskeletal-oncology-fellowship-web-sites
#5
Bradley L Young, Colin K Cantrell, Joshua C Patt, Brent A Ponce
Background: Accessible, adequate online information is important to fellowship applicants. Program web sites can affect which programs applicants apply to, subsequently altering interview costs incurred by both parties and ultimately impacting rank lists. Web site analyses have been performed for all orthopaedic subspecialties other than those involved in the combined adult reconstruction and musculoskeletal (MSK) oncology fellowship match. Methods: A complete list of active programs was obtained from the official adult reconstruction and MSK oncology society web sites...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896558/are-reinfusion-drains-safe-to-use-with-periarticular-liposomal-bupivacaine-an-analysis-of-systemic-bupivacaine-toxicity
#6
Marc R Angerame, Gavin P Hart, Susan M Odum, Bryan D Springer
Background: Intraoperative periarticular injection (PAI) with local anesthetic is an important component of multimodal pain control in total joint arthroplasty (TJA). A potential risk of this practice is serum anesthetic toxicity resulting from the autotransfusion of blood collected from a reinfusion drain. The purpose of this study is to evaluate the levels of bupivacaine in blood collected in an autotransfusion system after use of a PAI in TJA. Methods: In this prospective study, each TJA patient had an identical PAI consisting of 20 cc of liposomal bupivacaine, 30 cc of 0...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896557/arthroplasty-care-redesign-related-to-the-comprehensive-care-for-joint-replacement-model-results-at-a-tertiary-academic-medical-center
#7
Chancellor F Gray, Hernan A Prieto, Andrew T Duncan, Hari K Parvataneni
Background: Total joint arthroplasty (TJA) remains the highest expenditure in the Centers for Medicare and Medicaid Services (CMS) budget. One model to control cost is the Comprehensive Care for Joint Replacement (CJR) model. There has been no published literature to date examining the efficacy of CJR on value-based outcomes. The purpose of this study was to determine the efficacy and sustainability of a multidisciplinary care redesign for total joint arthroplasty under the CJR paradigm at an academic tertiary care center...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896556/are-patients-being-evaluated-for-periprosthetic-joint-infection-prior-to-referral-to-a-tertiary-care-center
#8
Matthew W Tetreault, Kenneth A Estrera, Erdan Kayupov, Caroline Brander, Craig J Della Valle
Background: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines. Methods: One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896555/do-illness-rating-systems-predict-discharge-location-length-of-stay-and-cost-after-total-hip-arthroplasty
#9
Sarah E Rudasill, Jonathan R Dattilo, Jiabin Liu, Charles L Nelson, Atul F Kamath
Background: As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896554/association-of-rapidly-destructive-osteoarthritis-of-the-hip-with-intra-articular-steroid-injections
#10
Shane R Hess, Robert S O'Connell, Christopher P Bednarz, Andrew C Waligora, Gregory J Golladay, William A Jiranek
Background: To assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections. Methods: Coding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne's classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy)...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896553/the-effect-of-constraint-on-post-damage-in-total-knee-arthroplasty-posterior-stabilized-vs-posterior-stabilized-constrained-inserts
#11
Joseph Konopka, Lydia Weitzler, Daniel Westrich, Timothy M Wright, Geoffrey H Westrich
Posterior stabilized constrained (PSC) inserts are intended to provide greater varus-valgus and rotational constraint than conventional PS inserts. We determined whether the added constraint resulted in more damage to the post in PSC compared to PS inserts. Retrieved PSC inserts were matched to retrieved PS inserts from the same manufacturer according to patient age, body mass index, and length of implantation. Surface damage was visually assessed, and 3-D surface deviation from pristine was measured. Damage scores for the PSC posts were significantly greater than those of the PS posts...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896552/circular-hexapod-external-fixation-for-periprosthetic-tibial-fracture
#12
Michael J Assayag, Noam Bor, Guy Rubin, S Robert Rozbruch
A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided. Using a web-based software program, a gradual reduction in all planes was achieved...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896551/external-fixator-immobilization-after-extensor-mechanism-reconstruction-in-total-knee-arthroplasty
#13
Colin D Canham, Christopher Walsh, Stephen J Incavo
Extensor mechanism disruption after total knee arthroplasty is a complicated problem that typically requires surgical reconstruction. After extensor mechanism failure, reconstruction is typically indicated to restore active knee extension and provide a stable limb for ambulation. Immobilization of the knee in extension is vital in the initial postoperative period after extensor mechanism reconstruction. We describe a series of 4 patients who underwent extensor mechanism reconstruction followed by external fixator application to maintain the knee extended in the initial postoperative period...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896550/rapid-destructive-osteoarthritis-of-the-hip-after-intra-articular-steroid-injection
#14
Anurag Tiwari, Yugal Karkhur, James A Keeney, Ajay Aggarwal
Rapid destructive osteoarthritis of the hip is a separate entity different from the usual osteoarthritis. It is usually seen in elderly women, and the characteristic feature is the rapid progression within 6 to 12 months to complete destruction of the joint. The exact etiology is not known. We present a rare case of rapid destructive osteoarthritis of the hip in a 62-year-old woman who developed it within 2 months of intra-articular steroid injection, which was managed well with uncemented total hip arthroplasty...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896549/late-total-hip-arthroplasty-dislocation-due-to-yoga
#15
Murillo Adrados, Luke A Myhre, Lee E Rubin
Yoga has become a popular form of exercise, recreation, and meditation for adults in the United States. As the popularity of both yoga and the incidence of hip replacements have both coincidentally increased over the last 2 decades, we imagine that the number of total hip replacement patients partaking in the practice of yoga has also increased. There are no clear guidelines available for yoga practice following hip replacement. To date, there have been no published reports of prosthetic hip dislocations during yoga...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896548/a-novel-use-of-a-tibial-cone-in-a-proximal-femoral-replacement
#16
Hilary Koech, Joshua M Lawrenz, Daniel R Mesko, Robert M Molloy
Revision total hip arthroplasty in the setting of severe femoral bone loss can be challenging, with salvage options often limited to modular tapered stems, allograft prosthetic composites, and megaprostheses. This case highlights a 79-year-old woman with 2 years of thigh pain who is 8 years status post a revision proximal femoral allograft prosthetic composite reconstruction. Radiographs demonstrated significant stem subsidence into the femoral condyle. In an attempt to avoid a total femoral replacement and spare her functioning native knee, a tibial cone was used in conjunction with a proximal femoral replacement to structurally fill the flaring femoral canal and serve as a stable pedestal for the megaprosthesis body and provide the potential for biologic ingrowth...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896547/early-aseptic-loosening-of-the-tritanium-primary-acetabular-component-with-screw-fixation
#17
William J Long, Samir Nayyar, Kevin K Chen, David Novikov, Roy I Davidovitch, Jonathan M Vigdorchik
Ultraporous acetabular components were developed to improve osseointegration and fit for increased longevity and better outcomes after total hip arthroplasty. There is a paucity of literature detailing this acetabular component's clinical performance, with even less detailing those with screw fixation. We identify 5 patients at our institution who underwent revision total hip arthroplasty for early aseptic acetabular cup loosening of an ultraporous acetabular component known as the Tritanium primary cup with secondary screw fixation...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896546/abundant-heterotopic-bone-formation-following-use-of-rhbmp-2-in-the-treatment-of-acetabular-bone-defects-during-revision-hip-arthroplasty
#18
Alexander Arzeno, Tim Wang, James I Huddleston
Revision hip arthroplasty in the setting of periacetabular bone loss presents a significant challenge, as options for restoring bone loss are limited. Recombinant human bone morphogenetic protein-2 may offer a solution by promoting bone growth to restore bone stock before implant reimplantation. Here we present a case of a patient with a periprosthetic acetabulum fracture, resulting in pelvic discontinuity as the result of significant periacetabular bone loss. Using a staged approach, periacetabular bone stock was nearly entirely reconstituted using recombinant BMPs and allograft, which resulted in stable fixation, but with abundant heterotopic bone formation...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896545/lyme-periprosthetic-joint-infection-in-total-knee-arthroplasty
#19
Murillo Adrados, Daniel Howard Wiznia, Marjorie Golden, Richard Pelker
Lyme arthritis, caused by the spirochete Borrelia burgdorferi sensu stricto, is a common tick-borne illness in New England and the upper Midwest. Most often, the disease affects the knee and has typically been reported as a cause of native joint infection. There has been only 1 case of Lyme periprosthetic joint infection (associated with a total knee arthroplasty) reported in the literature, and to our knowledge, no other reported cases of Lyme periprosthetic joint infections exist. In this article, we report on 2 patients diagnosed with prosthetic joint infections who were subsequently found to have Lyme prosthetic joint infections, with B burgdorferi as the infectious organism...
June 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29896544/two-pegs-are-better-than-one-rare-mode-of-femoral-component-failure-in-unicompartmental-arthroplasty-requiring-revision-to-total-knee-arthroplasty
#20
Ryan Stancil, Nathan Summers, Douglas Van Citters, Adam Sassoon
Femoral component fracture is a rare complication in unicompartmental knee arthroplasty, especially in cemented prostheses. We present a 75-year-old man who presented with a fractured single-peg Vanguard component 9 years postoperatively. He was revised to a total knee arthroplasty with an excellent functional outcome at 1 year. The components were additionally examined at an outside biomechanical engineering laboratory. Theories as to the cause of the component fracture include aseptic loosening due to a thin anterior cement mantle and the single-peg Oxford design...
June 2018: Arthroplasty Today
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