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Arthroplasty Today

Jim Lesko, Kirk Kindsfater
No abstract text is available yet for this article.
September 2018: Arthroplasty Today
David S Egilman, Joan E Steffen, Ella A Fassler, Kevin J Reardon
No abstract text is available yet for this article.
September 2018: Arthroplasty Today
Tyler A Luthringer, Ameer M Elbuluk, Omar A Behery, Zlatan Cizmic, Ajit J Deshmukh
Background: Failed internal fixation of intertrochanteric (IT) hip fractures presents a significant challenge in the elderly, osteoporotic population. Conversion total hip arthroplasty (cTHA) and hemiarthroplasty (cHA) are both accepted salvage operations for failed IT fracture fixation, though limited clinical data exist regarding the optimal treatment between these procedures. Methods: A systematic review of 3 databases (PubMed, Cochrane, and Embase) was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
September 2018: Arthroplasty Today
Kirk Kindsfater, Jim Lesko
Background: Total hip arthroplasty (THA) requires components that meet a variety of patient factors and needs. This investigation evaluated survivorship of the PINNACLE Acetabular Cup System in primary total hip arthroplasty at 5-10 years. Methods: In total, 1592 hips (1473 subjects) were enrolled in a multi-center, non-comparative, open-label study of the PINNACLE system: N  = 896 metal-on-polyethylene (MOP), N  = 667 metal-on-metal (MOM), N  = 27 ceramic-on-polyethylene, and N  = 2 unknown articulation...
September 2018: Arthroplasty Today
Nicholas B Frisch, Jonathan R Lynch, Robin Pourzal, Richard F Banglmaier, Craig D Silverton
Background: The etiology of wear particle generation and subsequent corrosion in modular total hip arthroplasty implants likely begins with mechanical fretting. The purpose of this study was to determine geometric features of the male and female taper surfaces that drive stability within the neck-stem junction. Methods: Eighteen modular hip components received 3-dimensional surface scans to examine the neck-stem taper junction using an optical scanner. The normal distance between the surfaces of the neck taper as seated in the stem slot was measured and produced a color map of the contact proximity...
September 2018: Arthroplasty Today
Sen Wang, Yonggang Zhou, Haiyang Ma, Yinqiao Du, Shang Piao, Wenming Wu
Background: Total hip athroplasty (THA) in Crowe IV developmental dysplasia of the hip (DDH) presents many challenges for surgeons with regard to acetabular and femoral deformities. The purposes of this study are to (1) report the mid-term results of THA with subtrochanteric transverse osteotomy using S-ROM prosthesis and ceramic-on-ceramic (COC) surface for Crowe type IV DDH; and (2) compare the wear performance between COC and metal-on-polyethylene (MOP) bearing couple. Methods: Eighty Crowe IV DDH patients (103 hips) treated with cementless THA were retrospectively reviewed...
September 2018: Arthroplasty Today
Vineet Tyagi, Coridon Huez, Shasta Henderson, Adam Lukasiewicz, Elizabeth Gardner, Lee Rubin, Lawrence Weis
Background: Arthrofibrosis after total knee arthroplasty (TKA) is a common complication, potentially occurring in up to 25% of patients, and may be treated during the early recovery period by manipulation under anesthesia (MUA). The majority of preoperative factors that predispose patients to postoperative stiffness are patient specific and not modifiable. The United States Veteran Affairs is a particularly challenging group given a higher baseline rate of medical comorbidities and opioid dependence than the general population...
September 2018: Arthroplasty Today
David Shau, Neeta Shenvi, Kirk Easley, Melissa Smith, George Guild
Background: Medicaid payer status has been shown to affect resource utilization across multiple medical specialties. There is no large database assessment of Medicaid and resource utilization in primary total knee arthroplasty (TKA), which this study sets out to achieve. Methods: The Nationwide Readmissions Database was used to identify patients who underwent TKA in 2013 and corresponding "Medicaid" or "non-Medicaid" payer statuses. Demographics, 15 individual comorbidities, readmission rates, length of stay, and direct cost were evaluated...
September 2018: Arthroplasty Today
John-Paul Whittaker, Kimberly A Dwyer, James Howard, Verdonna Huey, James Lesko, Ryan M Nunley, Peter Verdonk
Background: This study provides an example for evaluating learning curve when introducing a new knee system. Methods: Thirty-five investigators across 22 sites prospectively implanted 843 subjects with currently available products (group A). Seventy-seven investigators across 48 sites prospectively implanted 2330 subjects with the ATTUNE Knee System; in which the first 10 subjects for each surgeon were the learning curve cases (group B, N = 611), and the later subjects were designated as group C (N = 1719)...
September 2018: Arthroplasty Today
Alisina Shahi, Thomas L Bradbury, George N Guild, Usama Hassan Saleh, Elie Ghanem, Ali Oliashirazi
Background: Pulmonary embolism and deep vein thrombosis, together referred to as venous thromboembolism (VTE), are serious and potentially preventable complications after total hip arthroplasty and total knee arthroplasty. The aim of this study was to investigate the incidence of mortality after VTE events and assess the risk factors that are associated with it. Methods: The Nationwide Inpatient Sample was used to estimate the total number of total hip arthroplasty, total knee arthroplasty, VTE events, and mortality using the International Classification of Diseases, Ninth Revision procedure codes from 2003 to 2012...
September 2018: Arthroplasty Today
Joshua S Bingham, Christopher G Salib, Kyle Labban, Zachary Morrison, Mark J Spangehl
Background: Periprosthetic joint infections (PJIs) are devastating complications. Excessive anticoagulation with warfarin is an independent risk factor for PJIs. The use of a dedicated anticoagulation clinic to improve warfarin management has not been proven. Methods: Between 2006 and 2014, we identified 92 patients who were placed on postoperative warfarin, and later developed PJI. These patients were compared to 313 patients who underwent total joint arthroplasty placed on warfarin without developing PJI...
September 2018: Arthroplasty Today
Orchideh Abar, Nader Toossi, Norman Johanson
Background: Acute kidney injury (AKI) is a serious complication after major surgery, which may lead to increased morbidity and mortality. The aim of this study was to identify cost and determinants of AKI after total joint arthroplasty. Methods: A retrospective case-controlled study was conducted with 1719 primary elective total hip or knee replacements performed from January 2004 through September 2015 at an urban teaching hospital. Patients who developed AKI were matched in a 1:3 ratio with those in a control group who did not develop AKI based on age, sex, race, operated joint, and comorbidities including hypertension and diabetes...
September 2018: Arthroplasty Today
Llion Davies, Kylie Bainton, Robyn Milne, Peter Lewis
Background: This work aimed to evaluate the efficacy and safety of routine tranexamic acid (TXA) use in elective orthopaedic lower limb joint replacement surgery. Methods: This retrospective cohort study included all primary hip or knee replacement procedures by a single surgeon over a 6-year period. TXA was introduced during the study period as part of an enhanced recovery after surgery strategy. Results: Of the 673 procedures, 446 cases (66...
September 2018: Arthroplasty Today
Samuel A Fernandez-Perez, Julio A Rodriguez, David Beaton-Comulada, Roberto G Colon-Miranda, Antonio H Soler-Salas, Antonio Otero-Lopez
We present a case report of a patient with severe valgus deformity of the right knee due to multiple hereditary exostoses (MHEs) treated with total knee arthroplasty (TKA). The surgical management of MHE affecting the knee encompasses exostoses resection, joint deformity rectification, and limb-length discrepancy alignment. On rare occasions, distraction osteogenesis and TKA have been used to correct valgus deformities of the knee. TKA in MHE patients with knee involvement has only been described in 6 cases...
September 2018: Arthroplasty Today
Jacob Stirton, Joseph Scott Herron, Sumon Nandi
The aim of our study was to compare the cost of preoperative empiric mupirocin treatment of all total joint arthroplasty patients with a standard Staphylococcus aureus screening and decolonization protocol. The cost of empiric mupirocin treatment is $24.65 per patient, whereas the cost of a standard S. aureus screening and decolonization protocol is $60.32 per patient. Given that more than 1,051,000 total joint arthroplasties are performed annually, the cost savings with empiric treatment is nearly $40 million per year...
September 2018: Arthroplasty Today
Hiroaki Shoji, Atsushi Teramoto, Tomoyuki Suzuki, Yohei Okada, Kota Watanabe, Toshihiko Yamashita
It has been reported that an accelerometer-based portable navigation device can achieve accurate bone cuts, but there have been few studies of clinical outcomes after total knee arthroplasty (TKA) using such a device. The aim of this study was to evaluate lower limb alignment and clinical outcomes after TKA using an accelerometer-based portable navigation device. Thirty-five patients (40 knees) underwent primary TKAs using an accelerometer-based portable navigation device. Postoperative radiographic assessments included the hip-knee-ankle angle, femoral component angle (FCA), and tibial component angle (TCA) in the coronal plane and the sagittal FCA and sagittal TCA in the sagittal plane...
September 2018: Arthroplasty Today
Jeffrey B Stambough, Jacob A Haynes, Robert L Barrack, Ryan M Nunley
Tibial bone loss is a common scenario encountered during revision total knee arthroplasty. Reconstructive options depend on the amount and location of bone loss, but few good solutions exist to address large, uncontained tibial defects where cortical support is lost in the metadiaphyseal region. We describe a novel technique using acetabular augments to buttress a revision tibial component and recreate a hemiplateau during tibial revision total knee arthroplasty. In selected scenarios, this construct can create a biomechanically friendlier surface onto which to support the tibial tray and a less expensive option when compared to traditional stacked augments or cones...
September 2018: Arthroplasty Today
Kazuha Kizaki, Fumiharu Yamashita, Noboru Funakoshi, Soshi Uchida
The possible increased risk of dislocation with a posterior approach for femoral hemiarthroplasty is attributed to disruption of the posterior soft-tissue structures, including the posterior capsular ligament structure and short external rotators of the hip. In this surgical technical note, we demonstrate the surgical technique for shoelace suturing of the external rotators and the capsule with use of ULTRATAPE. After prosthesis stem insertion, shoelace suturing using ULTRATAPE was performed between the great trochanter and the external rotators for preventing the external rotators from tearing...
September 2018: Arthroplasty Today
Bernd Fink
Modular revision stems are very common in hip arthroplasty, but junction fracture remains a known failure mechanism. A review of the literature with description of cases with junction breakage of modular revision stems showed that in all 24 analyzed cases, there was a common finding: the combination of an effective osteointegration of the distal component and missing medial bone support of the proximal component. The result was a bending stress point of the stem construction in the region of the junction. A technique using the combination of short distal component and longer proximal components may alter this stress pattern, allow proximal implant support, and reduce the risk of junction fracture...
September 2018: Arthroplasty Today
Kilian Rueckl, Peter K Sculco, Jonathan Berliner, Michael B Cross, Chelsea Koch, Friedrich Boettner
Fractures of well-ingrown femoral components are a rare and often challenging complication after revision total hip arthroplasty. Prior series have documented catastrophic failure at the modular junction of revision femoral components. However, to the authors' knowledge, there has been only 1 report of a mid-stem fracture of a modular tapered revision stem. The present article reports 2 cases of fatigue fractures (14 months and 10 years after implantation) of a tapered modular revision stem. It presents the results of the fracture surface analysis, discusses the etiology of failure, and presents the authors' recommendations on how to best avoid this complication...
September 2018: Arthroplasty Today
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