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Several management strategies have been described to treat intraoperative calcar fractures during total hip arthroplasty (THA), including retaining the primary implant and utilizing cerclage cables (CCs) or switching the implant to one that bypasses the fracture and achieves diaphyseal fixation. However, the radiographic and clinical outcomes of these differing strategies have never been described and compared. We retrospectively identified 50 patients who sustained an intraoperative calcar fracture out of 9,129 primary total hip arthroplasties (0.55%) performed by one of three surgeons between 2008 and 2022. Each of the three surgeons consistently employed a distinct strategy for the management of these fractures: retention of the primary metaphyseal-engaging implant and placement of CCs; exchange to a modular, tapered-fluted stem (MTF); or exchange to a fully-coated, diaphyseal-engaging stem (FC). Stem subsidence was then evaluated on standing anteroposterior pelvis radiographs at three months and one year postoperatively. Postoperative medical and surgical complication rates were evaluated. A total of fifteen patients were treated with CC, 15 with MTF, and 20 with FC. At three-month follow-up, mean stem subsidence was 0.43 ± 0.08 mm, 1.47 ± 0.36 mm, and 0.68 ± 0.39 mm for CC, MTF, and FC cohorts, respectively (P =.323). At one-year, mean stem subsidence was 0.70 ± 0.08 mm, 1.74 ± 0.69 mm, and 1.88 ± 0.90 mm for the CC, MTF, and FC cohorts, respectively (P =.485). Medical complications included 2 venous thromboembolic events (4%) within 90 days of surgery. There were 6 reoperations (12%); 3 (6%) for acute periprosthetic joint infection (all within the FC cohort); 2 (4%) for postoperative periprosthetic fractures (one fracture distal to the stem in the FC cohort and one fracture at the level of the stem in the MTF cohort), and 1 (2%) closed reduction for instability (within the CC cohort). The three described methods of managing intraoperative nondisplaced calcar fractures demonstrated little radiographic stem subsidence; however, the risk of reoperation was much higher than expected. [ABSTRACT FROM AUTHOR]

Lateral unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated lateral compartment osteoarthritis. However, due to the rarity of the procedure, long-term outcomes and survivorship are poorly understood. We report the clinical and radiographic outcomes after lateral UKA. We retrospectively reviewed a consecutive series of patients who underwent lateral UKA by a single fellowship-trained arthroplasty surgeon from 2001 to 2021 with a minimum 2 year follow up. There were 161 knees in 153 patients (average age 69 years) that met inclusion criteria, with a mean follow up of 10.0 years (range 0.05 to 22.2). All patients underwent the procedure via a minimally invasive lateral parapatellar approach with a fixed-bearing implant. Patient demographics, complications, radiographic findings, patient-reported outcomes, and the need for revision surgery were evaluated. Survivorship was defined with the end point as revision of components. There were 8 patients (5.0%) who underwent conversion to total knee arthroplasty for lateral UKA implant failure or progression of arthritis. There were 3 patients (1.9%) who underwent ipsilateral medial UKA due to medial compartment arthritis progression with preserved mechanical alignment and patellofemoral joint. There were 8 additional procedures that did not require implant changes, including 5 irrigation and debridements for acute periprosthetic joint infection (3.1%), 2 wound closures for dehiscence (1.3%), and one loose body removal (0.6%). Lateral UKA showed a survivorship rate of 98.0% at 5 years, 96.0% at 10 years, and 94.5% at 15 years. When including patients who underwent additional surgery for the progression of arthritis, survivorship was 97.4% at 5 years, 95.4% at 10 years, and 91.3% at 15 years. Lateral UKA should be seen as a durable treatment option for isolated lateral compartment osteoarthritis. [ABSTRACT FROM AUTHOR]

Synovial fluid analysis is an essential tool in diagnosing periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). However, concern exists that aspiration may introduce infection into a noninfected joint. Therefore, the purpose of this study was to evaluate the incidence of iatrogenic PJI following diagnostic knee aspiration done within 6 months of the primary TKA. Between 2017 and 2021, the senior surgeon performed over 4,000 primary TKAs and aspirated 155 knees in 137 patients for whom there was a suspicion for PJI within 6 months of their primary TKA. There were 22 knees diagnosed as infected from the initial aspiration and therefore were excluded from the study. The remaining 133 aspirates in 115 patients who were negative for infection were followed for 6 months for signs and symptoms of PJI to elucidate whether aspiration introduced infection into an initially noninfected joint. There were 70 of 133 knees (52.6%) aspirated between 0 and 6 weeks after index TKA, 40 of 133 (30.1%) between 6 weeks and 3 months, and 23 of 133 (17.3%) between 3 and 6 months. At final follow-up, none of the 133 initially noninfected knees exhibited evidence of subsequent iatrogenic PJI or had subsequent surgery for infection. While joint aspiration is a procedure with inherent risks, this study shows that the rate of iatrogenic PJI is extremely low (0%). Therefore, if infection is suspected, the surgeon should consider joint aspiration, even in the initial postoperative period, as the risk for introducing infection is far outweighed by the risk of missing an infection. [ABSTRACT FROM AUTHOR]

Background: Progressive arthritis in the unresurfaced compartments of the knee is one failure mode after partial knee arthroplasty (PKA). While progressive arthritis after PKA is typically treated with revision to TKA (rTKA), staged bicompartmental knee arthroplasty (sBiKA) -the addition of another PKA - is an alternative. This study compared outcomes of sBiKA and rTKA for progressive arthritis after PKA.Methods: A retrospective comparative study of non-consecutive cases at four institutions were performed in patients with an intact PKA, without loosening or wear, who underwent sBiKA (n = 27) or rTKA (n = 30), for progressive osteoarthritis. Outcomes studied were new Knee Society Function and Objective Scores (KSSF, KSSO), KOOS, Jr., ROM, operative times, length of stay, complication rates and the need for reoperations.Results: Mean time to conversion was 7.4 ± 6 years for sBiKA and 9.7 ± 8 for rTKA, P = .178. Patient demographics and pre-operative outcomes were similar among cohorts. At an average of 5.7 ± 3 (sBiKA) and 3.2 ± 2 years (rTKA), KOOS, Jr. significantly improved, P < .001, by an equivalent amount. Post-operative KSSO and KSSF were significantly higher in the sBiKA cohort, respectively, (90.4 ± 10 vs 72.1 ± 20, P < .001) and (80.3 ± 18 vs 67.1 ± 19, P = .011). sBiKA patients had significantly greater improvement in KSSO (30.7 ± 33 vs 5.2 ± 18, P = .003). One sBiKA patient underwent reoperation for continued pain.Conclusion: SBiKA has equivalent survivorship, but greater improvement in functional outcomes as rTKA at short to midterm follow-up. Given the shorter operative times and length of stay, sBiKA is a safe and cost-effective alternative to rTKA for progressive osteoarthritis following PKA. Nevertheless, further follow-up is necessary to determine whether sBiKA is a durable option. [ABSTRACT FROM AUTHOR]

Background: Tibial component loosening is one of the most common modes of failure in contemporary total knee arthroplasty (TKA). Limited literature is available on the outcomes of isolated tibial revision with retention of the cruciate retaining (CR) femoral component. The purpose of this study was to determine the results of isolated tibial revisions in CR TKA.Methods: We identified 135 patients who underwent an isolated tibial revision after a primary CR TKA from our institutional registry between January 2007 and January 2017. The mean time between the primary and revision was 2.9 years (range 0.1-15.4). Revision with a press-fit stem was performed in 79 patients and 56 patients were revised with a fully cemented stem. Patients were evaluated at a minimum of two years using Knee Society Score, Knee Injury and Osteoarthritis Score for Joint Replacement, and radiography. Implant survivorship was determined using Kaplan-Meier survival analysis.Results: At a mean follow-up of 5.1 years, there were six (4.4%) repeat revisions: three for periprosthetic infection (2.2%), two for instability (1.5%), and one for a fractured tibial stem (0.7%). The mean Knee Society Score and Knee Injury and Osteoarthritis Score for Joint Replacement increased from 51.6 and 56.1 preoperatively to 90.1 and 89.7 after surgery (P < .001). Survivorship free of repeat revision for any cause was 93.3% at 5 years, and aseptic revision survivorship was 95.8% at 5 years. No implants were radiographically loose.Conclusion: In patients with isolated tibial loosening and a well-fixed and well-positioned CR femoral component, isolated tibial revision provides excellent early to midterm implant survivorship and clinical outcomes with a low risk of instability and recurrent tibial loosening. [ABSTRACT FROM AUTHOR]

Background: Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) in isolated unicompartmental disease; however, mid-term to long-term results in young patients are unknown. The purpose of this study is to determine the mid-term outcomes of fixed-bearing medial UKA in patients less than 55 years of age.Methods: Seventy-seven fixed-bearing medial UKAs in patients less than 55 years of age (mean 49.9, range 38-55) from a previously published report were retrospectively reviewed at a mean follow-up of 11.2 years (range 4.1-19.2).Results: Eleven knees were converted to TKA (14.3%) at 0.7-13.8 years postoperatively. The indications for revision included 7 for unexplained pain (9.1%), 2 for grade 4 arthritic progression (1 isolated lateral and 1 lateral and patellofemoral compartments; 2.6%), 1 for polyethylene wear (1.3%), and 1 for femoral component loosening (1.3%). Predicted survivorship free from component revision was 90.4% (95% confidence interval 86.9-93.9) at 10 years and 75.1% (95% confidence interval 66.2-84.0) at 19 years. The mean Knee Society Score improved from a mean of 51.9-88.6 points (P < .001). Of the 52 knees with 4-year minimum radiographs, 3 (5.8%) developed isolated grade 4 patellofemoral arthritis that was asymptomatic, and no knees had evidence of component loosening or osteolysis.Conclusion: Fixed-bearing medial UKA is a durable option for young patients with unicompartmental arthritis, with good clinical outcomes at mid-term follow-up. Unexplained pain was the most common reason for revision to TKA. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to compare open reduction and internal fixation (ORIF) to distal femoral replacement (DFR) for treatment of displaced periprosthetic distal femur fractures.Methods: We identified 72 patients with minimum 2-year follow-up following a displaced periprosthetic distal femur fracture: 50 were treated with ORIF and 22 with DFR. Outcomes were assessed with multivariate regression analysis and include Knee Society Scores (KSS), infection rates, revision incidence, and mortality.Results: Patients treated with DFR had a higher Charlson comorbidity index (5.2 vs 3.8; P = .006). The mean postoperative KSS were similar between groups, but the Knee Society Functional Scores were higher in the ORIF group (P = .01). Six ORIF patients (12%) and 3 DFR patients (14%) underwent a revision surgery (P = .1). In the ORIF group, 3 revisions were associated with periprosthetic infection, and 3 revisions occurred for aseptic nonunion. In the DFR group, 1 infection was treated with irrigation and debridement, and 2 cases of patellar maltracking resulted in 1 liner exchange with soft tissue release and 1 femoral revision for malrotation. More patients in the ORIF group required repeat revisions, with twice as many total revisions (P < .001). Six ORIF patients and 7 DFR patients died within 2 years (P = .26).Conclusion: The Knee Society Functional Score favored ORIF, but the total incidence of revision was higher in the ORIF cohort. Given the high mortality and the substantial risk of reoperation in both groups, additional studies are needed regarding the prevention of and optimal treatment for patients with periprosthetic distal femur fractures. [ABSTRACT FROM AUTHOR]

Background: Previous reports on the outcomes of isolated head and liner exchange in revision total hip arthroplasty have found high rates of instability after these surgeries. Most reports have studied constructs using ≤28 mm femoral heads. The purpose of this study was to determine if modern techniques with the use of larger head sizes can improve the rate of instability after head and liner exchange.Methods: We identified 138 hips in 132 patients who underwent isolated head and liner exchange for polyethylene wear/osteolysis (57%), acute infection (27%), metallosis (13%), or other (2%). All patients underwent revision with either 32 (23%), 36 (62%), or 40 (15%) mm diameter heads. Cross-linked polyethylene was used in all revisions. Lipped and/or offset liners were used in 104 (75%) hips. Average follow-up was 3.5 (1.0-9.1) years. Statistical analyses were performed with significance set at P < .05.Results: Revision-free survivorship for any cause was 94.6% and for aseptic causes was 98.2% at 5 years. 11 (8%) hips experienced a complication with 7 (5%) hips requiring additional revision surgery. After revision, 4 (3%) hips experienced dislocation, 5 (4%) hips experienced infection, and 1 (1%) hip was revised for trunnionosis. No demographic or surgical factors significantly affected outcomes.Conclusion: Our study shows that isolated head and liner exchange using large femoral heads and modern liners provides for better stability than previous reports. The most common complication was infection. We did not identify specific patient, surgical, or implant factors that reduced the risk of instability or other complication. [ABSTRACT FROM AUTHOR]

Background: Patients between 45 and 54 years old will be the fastest-growing cohort seeking total knee arthroplasty (TKA) over the next 15 years. The purpose of this investigation is to determine the clinical outcomes of TKA in patients less than 50 years old at a minimum of 10 years. We hypothesized that this patient population would have a high rate of survivorship that is similar to that of older patients.Methods: We reviewed 298 consecutive TKAs on 242 patients at a minimum of 10 years postoperatively. Twenty patients died and 30 TKAs were lost to follow-up leaving 248 TKAs in 202 patients (91 male, 111 female) with a mean age of 45.7 years (range, 26-49) at the time of surgery. Patient-reported outcomes, survivorship, causes of reoperation, and initial postoperative radiographic parameters were collected.Results: At a mean of 13.0 years, there were 9 revisions for tibial loosening (3.6%), 8 for deep infection (3.2%), 7 for polyethylene wear (2.8%), and 3 for failed ingrowth of a cementless femoral component (1.2%). Kaplan-Meier analysis demonstrated 92.0% survivorship with failures defined as aseptic component revision and 83.9% survivorship for all-cause reoperation at 13 years. Patients with tibial alignment of 4° or more of varus or 10° or more of posterior slope were found to have increased rate of failure.Conclusion: While overall durability was good in this young patient population, tibial fixation and deep infection were relatively common causes of failure. In addition, increased tibial varus and slope were found to increase the rate of failure. Furthermore, the nearly 3% risk of revision for wear suggests that the use of more wear-resistant bearing surfaces may reduce the risk of failure in this patient population. [ABSTRACT FROM AUTHOR]

Background: Rapid-pathway outpatient (OTJA) and one-night inpatient (ITJA) arthroplasty require close follow-up by the surgeon. We quantify and characterize the total perioperative touches required in the first 7 days, and compare OTJA and ITJA patients.Methods: We reviewed 103 consecutive primary total joint arthroplasty (TJA) patients from April 2014 without exclusion; all patients were discharged either within 5 hours or the morning after surgery. All telephone and office visits during the first 7 days following surgery were studied. Specialized outpatient TJA education was included. We measured the frequency, duration, and subject matter of phone calls. Simple Poisson regression analysis and t-tests were used to determine significance.Results: None of the 103 rapid pathway patients were lost to follow-up. Average age was 61.2 years (range 26.9-83.0), with 49 females (47.6%), 78 total knee arthroplasties, average Charlson Comorbidity Index score of 2.1, and average body mass index of 29.5 kg/m2. There were 253 touches required, averaging 2.5/patient. One hundred sixty were outgoing phone calls by the surgical team and 93 were incoming calls from patients. The average duration of each call was 4.74 minutes (SD 3.7). The entire group required 19 hours and 35 minutes of telephone contact. After including specialized education time, this cohort required 83.1 hours of clinical time, or 48.4 minutes per patient.Conclusion: Postoperative care after rapid pathway TJA requires a significant burden of resources, shifted from the hospital to the surgeon. We found that both rapid pathway groups require similar work by the surgeon's team. This additional work should be considered by policymakers. [ABSTRACT FROM AUTHOR]

Background: Hip and knee arthroplasties length of stay continues to shorten after advances in perioperative and intraoperative management, as well as financial incentives. Some authors have demonstrated good results with outpatient arthroplasty, but safety and general feasibility of such procedures remain unclear. Our hypothesis is that outpatient arthroplasty would demonstrate higher readmission and complication rates than inpatient arthroplasty.Methods: We performed a systematic review of all publications on outpatient arthroplasty between January 1, 2000 and June 1, 2016. Included publications had to demonstrate a specific outpatient protocol and have reported perioperative complications and unplanned readmissions. Patient demographics, surgical variables, and protocol details were recorded in addition to complications, readmission, and reoperation.Results: Ten manuscripts accounting for 1009 patients demonstrated that 955 (94.7%) were discharged the same day as planned, with the majority of failures to discharge being secondary to pain, hypotension, and nausea. There were no deaths and only 1 major complication. Only 20 patients (1.98%) required reoperation and 20 (1.98%) had readmission or visited the emergency room within 90 days of their operation. In the 2 series recording patient outcomes, 80% and 96% of patients reported that they would choose to undergo outpatient arthroplasty again.Conclusion: For carefully selected patients with experienced surgeons in major centers, outpatient arthroplasty may be a safe and effective procedure. Although our data is promising, further study is required to better elucidate the differences between inpatient and outpatient arthroplasty outcomes. [ABSTRACT FROM AUTHOR]

Background: As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols.Methods: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014. Demographic variables, medical comorbidities, and 30-day complication, readmission, and reoperation rates were compared between outpatient and traditional inpatient procedures. A multivariate logistic regression analysis was then performed to identify independent risk factors of poor short-term outcomes.Results: Of the total 169,406 patients who underwent TJA, 1220 were outpatient (0.7%). The outpatient and inpatient groups had an overall complication rate of 8% and 16%, respectively. Patients aged more than 70 years, those with malnutrition, cardiac history, smoking history, or diabetes mellitus are at higher risk for readmission and complications after THA and TKA (all P < .05). Surprisingly, outpatient TJA alone did not increase the risk of readmission (OR 0.652, 95% CI 0.243-1.746, P = .395) or reoperation (OR 1.168, 95% CI 0.374-3.651, P = .789), and was a negative independent risk factor for complications (OR 0.459, 95% CI 0.371-0.567, P < .001).Conclusion: With the resources available in a hospital setting, outpatient TJA may be a safe option, but only in select, healthier patients. Care should be taken to extrapolate these results to an outpatient facility, where complications may be more difficult to manage. [ABSTRACT FROM AUTHOR]

Background: Patients commonly report difficulty kneeling after total knee arthroplasty (TKA). The purpose of this study was to retrospectively assess patients' ability to kneel after TKA and to prospectively determine whether patients with reported difficulty can be taught to kneel.Methods: Attempts were made to reach 307 consecutive TKAs in 255 adult patients who were 18-24 months after surgery. Patients were surveyed for their ability to kneel. Those who reported difficulty kneeling were offered participation in a kneeling protocol. At the conclusion of the protocol, participants were surveyed again for their ability to kneel.Results: Of the 307 consecutive TKAs, 288 knees (94%) answered the survey. Of them, 196 knees (68%) could kneel with minor or no difficulty without any specific training. And 77 knees (27%) reported at least some difficulty kneeling and were eligible for participation in the protocol. Pain or discomfort was the most commonly reported reason for difficulty kneeling. Of these 77 knees, 43 knees (56%) participated. Thirty-six knees (84%) completed all or most of the protocol. All patients who completed all or most of the protocol were then able to kneel, and none reported significant difficulty kneeling. On average, participants improved 1.4 levels.Conclusion: In this cohort, 68% of knees could kneel after TKA without any specific training. Of those who had at least some difficulty kneeling, all who participated were able to kneel after a simple kneeling protocol, although 44% of eligible patients did not participate. This study suggests that kneeling should be included in postoperative TKA rehabilitation. [ABSTRACT FROM AUTHOR]

We reviewed 27 patients who underwent revision for an adverse local tissue reaction (ALTR) secondary to corrosion at the head-neck junction with MoP bearings. Serum cobalt and chromium levels were elevated in all cases, with a mean cobalt of 11.2 ppb and chromium of 2.2 ppb. Patients underwent modular bearing exchange, including a ceramic head with a titanium sleeve in 23 of 27 cases with only one recurrence of ALTR in one of the four patients not treated with a ceramic head. The diagnosis of ALTR secondary to corrosion is associated with cobalt levels of >1 ppb with cobalt levels elevated above chromium. Retention of a well-fixed stem and modular exchange to a ceramic head leads to resolution of symptoms and decreases in metal levels. [ABSTRACT FROM AUTHOR]

Background: Early wound healing complications and persistent drainage are associated with an increased risk of infection following knee arthroplasty. However, the scenario in which a patient sustains an acute, traumatic wound dehiscence has not been investigated. The purpose of this study is to determine the outcomes of an acute traumatic wound dehiscence following arthroplasty treated with an urgent irrigation and debridement and primary wound closure.Methods: Using a single institution's arthroplasty registry, patients sustaining an acute, traumatic wound dehiscence within 30 days of undergoing a primary knee arthroplasty were identified. Patients experiencing chronic wound drainage without injury or a history of prior infection were excluded. Patients were followed for the occurrence of complications and clinical outcomes using the Knee Society Score.Results: From 2006 to 2016, 14 of 25,819 eligible patients (0.05%) were identified as having a traumatic wound dehiscence. The mean time from arthroplasty to wound dehiscence was 9.3 days. All but one patient was treated operatively within 24 hours of dehiscence. Postoperative antibiotics were administered for a mean of 21 days. At a mean of 6.5 years, 6 patients were considered failures (43%) including 2 deep infections, 3 revisions for instability, and 1 patient with a Knee Society Score <60 points.Conclusion: Despite emergent incision and drainage and wound closure, patients experiencing an acute traumatic wound dehiscence following knee arthroplasty subsequently exhibit high rates of reoperation for instability, periprosthetic infection, and clinical failure. Further work is required to better understand the optimal modes of treatment for this complication. [ABSTRACT FROM AUTHOR]

Abstract: Air travel and total joint arthroplasty (TJA) are both risk factors for venous thromboembolism (VTE). Patients are counseled against flying after surgery, however the basis for this recommendation has not been investigated and may be unfounded. A retrospective cohort of 1465 consecutive TJA patients was divided into a study population of 220 patients (15.0%) who flew home at a mean of 2.9days after surgery (range, 1–10days) and a control population of 1245 patients (85.0%) who did not fly. We found no differences in the rate of deep vein thrombosis, pulmonary embolism, or overall VTE between the groups, and incidence of all events was low in both groups and comparable with published data. Allowing air travel after TJA appears to be a safe practice. [Copyright &y& Elsevier]

Eighty-five fixed bearing medial unicompartmental arthroplasties were performed in 42 men and 33 women with a mean age of 49 years (range, thirty-three to fifty-five years old) at the time of surgery. At a mean of 4.0 years (range two to twelve years), the mean pre-operative Knee Society score improved from 49 to 95.1 points (P<0.0001) and the mean UCLA activity score was 7.5 (range 5 to 9). Three knees underwent revision to a total knee arthroplasty; two for arthritic progression in the lateral compartment and one for pain. At the time of final follow-up, two knees (2.4%) demonstrated progressive Grade 4 arthritis of the patellofemoral compartment but were asymptomatic. There was no radiographic evidence of loosening, osteolysis, or premature polyethylene wear. Estimated survivorship was 96.5% at 10 years. UKA offered excellent early outcomes in this cohort of younger, active patients. [ABSTRACT FROM AUTHOR]

Abstract: Eighty-five fixed bearing medial unicompartmental arthroplasties were performed in 42 men and 33 women with a mean age of 49years (range, thirty-three to fifty-five years old) at the time of surgery. At a mean of 4.0years (range two to twelve years), the mean pre-operative Knee Society score improved from 49 to 95.1 points (P<0.0001) and the mean UCLA activity score was 7.5 (range 5 to 9). Three knees underwent revision to a total knee arthroplasty; two for arthritic progression in the lateral compartment and one for pain. At the time of final follow-up, two knees (2.4%) demonstrated progressive Grade 4 arthritis of the patellofemoral compartment but were asymptomatic. There was no radiographic evidence of loosening, osteolysis, or premature polyethylene wear. Estimated survivorship was 96.5% at 10years. UKA offered excellent early outcomes in this cohort of younger, active patients. [Copyright &y& Elsevier]

Abstract: The risk factors for and results of operatively treated peri-prosthetic femoral fractures sustained within 90 days following primary THA were evaluated. 5,313 consecutive THAs were reviewed and 32 (0.60%) fractures were identified which included 9 Ag, 2 B1, 18 B2, 1 B3, and 2 Ag/B2 fractures. 19 (61%) patients sustained 23 complications including 9 greater trochanter non-unions, 2 femoral shaft non-unions, 3 patients with Brooker III HO, and 2 deep infections. 7 patients (23%) required a second operative procedure and one patient required a third. Peri-prosthetic fractures were associated with advancing age, female gender, developmental hip dysplasia, and cementless metaphyseal engaging components, particularly flat wedge tapers. Overall, operative treatment of acute peri-prosthetic fractures is associated with a high rate of complications (61%) and re-operation (23%). [Copyright &y& Elsevier]

Abstract: Few studies have evaluated the results of revision of well-fixed components for stiffness, and some authors have recommended against this intervention based on poor reported results. Thirty-five consecutive patients underwent revision of both femoral and tibial components for stiffness. At a mean of 54.5 months (range, 25-134), the mean arc of motion improved by 44.5° from a preoperative mean of 53.6° to a postoperative mean of 98.1° (P < .0001). The arc of motion improved by more than 30° in 75% (24/32) of patients evaluated at a minimum of 2 years. Seventeen (49%) of the 35 patients required a further intervention for stiffness or sustained a complication. These results suggest that revision total knee arthroplasty for stiffness can be performed with a reasonable expectation of improvement, although the risk of complications and additional operative procedures is substantial. [ABSTRACT FROM AUTHOR]

Abstract: We evaluated the performance of a contemporary cementless acetabular component at a minimum of 5 years postoperatively. One hundred eighty-seven consecutive acetabular component revisions were performed using a hemispherical porous-coated component. Patients were followed prospectively with radiographs and Harris hip scores. Twenty patients died, leaving 158 patients (166 hips) available for follow-up at a mean of 91 months. No patients were lost. Eleven acetabular components (7%) required repeated revision, including 4 (2%) for aseptic loosening. Seven of the 145 unrevised acetabular components with radiographic follow-up (5%) were loose. The results of acetabular revision with this contemporary acetabular component were good but inferior to those of earlier-generation implants. This difference is likely multifactorial. [Copyright &y& Elsevier]

Abstract: The goal of this study is to evaluate the efficacy of using an extended trochanteric osteotomy (ETO) as part of a 2-stage exchange procedure for prosthetic hip infections. Twenty-three consecutive infected total hip arthroplasties in which an ETO was used as part of a 2-stage exchange procedure were retrospectively reviewed. An ETO was used when the femoral component could not be extracted using standard techniques. Clinical and radiographic parameters were evaluated at an average of 49 months of follow-up. Postoperatively, 20 of 23 (87%) patients had resolution of their infection, with healing of the ETO in 22 of 23 patients at a mean of 11.5 weeks. Preoperative modified D''Aubigne and Postel score means of 2.4 for pain and 2.6 for walking ability significantly improved (P < .001) to 5.3 and 4.9. Use of an ETO as part of a 2-stage exchange arthroplasty can be performed safely and effectively in appropriately selected cases. [Copyright &y& Elsevier]

Abstract: Periprosthetic femur fractures after total hip arthroplasty are a growing concern as their prevalence is expected to rise. A retrospective review was performed of all patients undergoing revision total hip arthroplasty with an extended trochanteric osteotomy (ETO) for treatment of a Vancouver B2/B3 fracture at our institution. Fourteen patients were identified having a minimum of 2-year follow-up. Clinical and radiographic evaluation was performed for all patients. At a mean 44.5 months of follow-up, mean modified D''Aubigne and Postel scores were 8.6. In all cases the ETO and fracture healed with radiographic evidence of osseointegration of the femoral component. Use of an ETO for the treatment of periprosthetic femur fractures provides excellent exposure, facilitates component implantation, and is compatible with fracture healing and good short-term clinical results. [Copyright &y& Elsevier]

Abstract: One hundred five consecutive painful knee arthroplasties were evaluated by a single surgeon for the presence of infection using a uniform protocol that included an erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), perioperative aspiration with synovial fluid white blood cell (WBC) count and differential, intraoperative frozen section analysis, and culture. A synovial fluid WBC count of greater than 3000 was the most precise test with a sensitivity of 100%, specificity of 98%, and accuracy of 99%. The preoperative use of an ESR and CRP proved to be an excellent screening modality with only one infection identified with both values being normal. A rational approach to perioperative testing for sepsis includes a screening ESR and CRP, and if elevated, aspiration with synovial fluid WBC count or an intraoperative frozen section. [Copyright &y& Elsevier]

Abstract: Fifty-five consecutive revision total hip arthroplasties (THAs) in 51 patients in which a constrained acetabular liner was used (Duraloc Constrained Liner, DePuy, Warsaw, Ind) were reviewed. In these revisions, 41 constrained liners were placed for recurrent instability and 14 for inadequate stability at the time of revision THA. The mean age of the cohort was 62 years, and 38 of the hips were in female patients (69%). At a minimum of 2 years, 9 of the 55 hips (16%) dislocated. Of these 9 dislocations, 8 occurred in patients who had undergone revision to a constrained liner for recurrent instability without femoral or acetabular component revision. Revision THA for recurrent instability by placing a constrained liner without optimizing other aspects of the reconstruction leads to a high rate of recurrent failure. [Copyright &y& Elsevier]

Abstract: Fifty consecutive patients were enrolled in this prospective study. This was 37% of the 135 patients undergoing primary total knee arthroplasty (TKA) by one surgeon. The average patient age was 68 years (50-79 years). A comprehensive perioperative management pathway was developed and was implemented, which combined regional anesthesia with a minimally invasive, TKA technique in which the only incision in the capsule and extensor mechanism is a capsular incision from the joint line to the superior pole of the patella. Postoperatively, patients received oral analgesia. After specific discharge criteria were met, 48 patients (96%) chose to go home the day of surgery. No intraoperative complications occurred. There were 3 readmissions, none related to early discharge: gastrointestinal bleed at 8 days, superficial irrigation and debridement at 21 days, and a closed manipulation at 9 weeks. This study demonstrates that, in these selected patients, outpatient TKA was safe with no short-term readmission or complications related to early discharge. This comprehensive pathway may make it possible for this minimally invasive TKA to be done as an outpatient in specialized surgicenters in the future. [Copyright &y& Elsevier]