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Background: Modular fluted tapered (MFT) femoral components are frequently utilized in aseptic revision total hip arthroplasties (THAs). However, long-term follow-up has been limited. The purpose of this study was to update our prior series at long-term follow-up, with specific emphasis on implant survivorship, radiographic results, and complications in a large cohort of aseptic revision THAs using MFT stems., Methods: We retrospectively identified 515 aseptic femoral revisions performed with 2 MFT stem designs in the total joint registry of a single tertiary care academic institution from 1999 to 2013. Serial radiographs were reviewed for subsidence of >5 mm. The mean follow-up (and standard deviation) was 10 ± 5 years (range, 2 to 21 years). A competing risk model accounting for death was utilized., Results: The 15-year cumulative incidence of any revision was 12%. There were 57 revisions, 27 of which involved revision of the fluted tapered component (FTC). Dislocation (n = 19), periprosthetic joint infection (n = 15), and aseptic loosening of the FTC (n = 11) were the most common reasons for revision. The 15-year cumulative incidence of any reoperation was 16%. The 15-year cumulative incidences were 6% for any FTC revision and 2% for FTC revision for aseptic loosening. Stem subsidence of >5 mm occurred in 2% of unrevised cases, and all but 1 stem was stable at the most recent follow-up., Conclusions: This large series of MFT stems used in aseptic revision THAs had a 2% incidence of subsequent revision of the FTC for aseptic loosening at 15 years. Dislocation and infection were the most common reasons for any revision., Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: Dr. Daniel J. Berry was funded by grants from the National Institutes of Health (R01AR73147, R01HL147155) and NIAMS (P30AR76312). The Andrew A. and Mary S. Sugg Professorship in Orthopedic Research made the research possible through its philanthropic support of Dr. Matthew P. Abdel. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/I81 )., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Highly porous metal tibial metaphyseal cones (TMCs) are commonly utilized in revision total knee arthroplasty (TKA) to address bone loss and obtain biologic fixation. Mid-term (5 to 10 year) studies have previously demonstrated excellent survivorship and high rates of osseointegration, but longer-term studies are lacking. We aimed to assess long-term (≥ 10 year) implant survivorship, complications, and clinical and radiographic outcomes after revision TKA with TMCs., Methods: Between 2004 and 2011, 228 revision TKAs utilizing porous tantalum TMCs with stemmed tibial components were performed at a single institution and were retrospectively reviewed. The mean age at revision was 65 years, the mean body mass index was 33, and 52% were women. Implant survivorship, complications, and clinical and radiographic outcomes were assessed. The mean follow-up was 6.3 years., Results: The 10-year survivorship free of aseptic loosening leading to TMC removal was 97%, free of any TMC removal was 88%, free of any re-revision was 66%, and free of any reoperation was 58%. The most common indications for re-revision were periprosthetic joint infection, instability, and aseptic femoral component loosening. The 10-year nonoperative complication rate was 24%. The mean Knee Society scores increased from 38 preoperatively to 69 at 10 years. There were 8 knees that had evidence of partial, progressive tibial radiolucencies at 10 years., Conclusions: Porous tantalum TMCs demonstrated persistently durable longer-term survivorship with a low rate of implant removal. The rare implant removals for component loosening or instability were offset by those required for periprosthetic joint infection, which accounted for 80% of cone removals. Porous tantalum TMCs provide an extremely reliable tool to address tibial bone loss and achieve durable long-term fixation in revision TKA., Level of Evidence: IV., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Few studies have described the outcomes following conversion of failed hemiarthroplasties to total hip arthroplasty (THA) and the impact of mortality when estimating implant survivorship. The aims of this study were to evaluate the following: (1) the risks and predictors of complications, dislocations, reoperations, and revisions and (2) the extent of competing risk of death when evaluating outcomes in patients converted from hemiarthroplasty to THA., Methods: The study comprised 389 patients treated with conversion THA following hemiarthroplasty for femoral neck fractures between 1985 and 2014. Revision rates were calculated using both the Kaplan-Meier method and cumulative incidence accounting for death as a competing risk. Risk factors were evaluated using Cox regression models., Results: During an average 9.3 years of follow-up, there were 122 complications, 34 dislocations, 69 reoperations, and 51 revisions. Conversion for periprosthetic fractures was associated with a higher risk of reoperations (hazard ratio 4.30, 95% confidence interval 1.94-9.52). Increasing age was a risk factor for reoperations (hazard ratio 1.32, 95% confidence interval 1.10-1.59). No decrease in the rate of complications, dislocations, reoperations, or revisions was observed over the entire 30 years of the study either when evaluating year of surgery as a continuous variable or when comparing specific calendar year intervals (1985-1989, 1990-1999, 2000-2009, 2010-2014) (P > .05). Compared to the cumulative incidence accounting for the competing risk of death, the Kaplan-Meier method overestimated the risk of revision by 7% at 15 years and 10% at 20 years., Conclusion: Conversion from hemiarthroplasty to THA remains at high risk for subsequent complications. The cumulative incidence estimate provides a more accurate estimate of revision risk., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: There is limited information on the complications and costs of conversion THA after hemiarthroplasty for femoral neck fractures. Previous studies have found that patients undergoing conversion THA experience higher risk complications, but it has been difficult to quantify the risk because of small sample sizes and a lack of comparison groups. Therefore, we compared the complications of patients undergoing conversion THA with strictly matched patients undergoing primary and revision THA., Questions/purposes: (1) What are the risks of complications, dislocations, reoperations, revisions and periprosthetic fractures after conversion THA compared with primary and revision THA and how has this effect changed over time? (2) What are the length of hospital stay and hospital costs for conversion THA, primary THA, and revision THA?, Methods: Using a longitudinally maintained total joint registry, we identified 389 patients who were treated with conversion THA after hemiarthroplasty for femoral neck fractures between 1985 and 2014. The conversion THA cohort was 1:2 matched on age, sex, and year of surgery to 778 patients undergoing primary THA and 778 patients undergoing revision THA. The proportion of patients having at least 5-year followup was 73% in those who underwent conversion THA, 77% in those who underwent primary THA, and 76% in those who underwent revision THA. We observed a significant calendar year effect, and therefore, compared the three groups across two separate time periods: 1985 to 1999 and 2000 to 2014. We ascertained complications, dislocations, reoperations, revisions and periprosthetic fractures from the total joint registry. Cost analysis was performed using a bottom-up, microcosting methodology for procedures between 2003 and 2014., Results: Patients who converted to THA between 1985 and 1999 had a higher risk of complications (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.7-3.1; p < 0.001), dislocations (HR, 2.3; 95% CI, 1.3-4.2; p = 0.007), reoperations (HR, 1.7; 95% CI, 1.2-2.5, p = 0.005), and periprosthetic fractures (HR, 3.8; 95% CI, 2.2-6.6; p < 0.001) compared with primary THA. However, conversion THAs during the 1985 to 1999 time period had a lower risk of reoperations (HR, 0.7; 95% CI, 0.5-1.0; p = 0.037), revisions (HR, 0.6; 95% CI, 0.5-0.9; p = 0.014), and periprosthetic fractures (HR, 0.6; 95% CI, 0.4-0.9; p = 0.007) compared with revision THA. The risk differences across the three groups were more pronounced after 2000, particularly when comparing conversion THA patients with revision THA. Conversion THA patients had a higher risk of reoperations (HR, 1.9; 95% CI, 1.0-3.4; p = 0.041) and periprosthetic fractures (HR, 1.7; 95% CI, 1.0-2.9; p = 0.036) compared with revision THA, but there were no differences in the complication risk (HR, 1.4; 95% CI, 0.9-2.1; p = 0.120), dislocations (HR, 1.5; 95% CI, 0.7-3.2; p = 0.274), and revisions (HR, 1.4; 95% CI, 0.7-3.0; p = 0.373). Length of stay for conversion THA was longer than primary THA (4.7 versus 4.0 days; p = 0.012), but there was no difference compared with revision THA (4.7 versus 4.5 days; p = 0.484). Similarly, total inpatient costs for conversion THA were higher than primary THA (USD 22,662 versus USD 18,694; p < 0.001), but there was no difference compared with revision THA (USD 22,662 versus USD 22,071; p = 0.564)., Conclusions: Over the 30 years of the study, conversion THA has remained a higher risk procedure in terms of reoperation compared with primary THA, and over time, it also has become higher risk compared with revision THA. Surgeons should approach conversion THA as a challenging procedure, and patients undergoing this procedure should be counseled about the elevated risks. Furthermore, hospitals should seek appropriate reimbursement for these cases., Level of Evidence: Level III, therapeutic study.

Introduction: We determined mortality rates after intraoperative and postoperative periprosthetic femur fractures in primary and revision total hip arthroplasty (THA)., Methods: The study population comprised 522 intraoperative and 480 postoperative femur fractures in 26,250 primary THA patients and 590 intraoperative and 224 postoperative femur fractures in 4,532 revision THA patients. The risk of death was examined using Cox regression models., Results: In primary THA, intraoperative periprosthetic femur fractures were not associated with excess risk of death (hazard ratio, 1.03; 95% confidence interval, 0.86 to 1.22). The risk of death was slightly elevated among primary THA patients with postoperative femur fractures (hazard ratio, 1.19; 95% confidence interval, 1.08 to 1.43), but the excess risk was only confined to patients with comorbid orthopaedic conditions. In revision THA, neither intraoperative nor postoperative periprosthetic femur fractures were associated with excess risk of death., Conclusion: Periprosthetic femur fractures are not associated with excess mortality among primary osteoarthritis patients., Level of Evidence: Level III.

Within reverse total shoulder arthroplasty (RSA), prior studies have suggested that smaller glenosphere diameters may result in higher rates of scapular notching and polyethylene wear, while lateralized glenospheres may allow for better range of motion (ROM); however, supportive data remains limited. Therefore, the purpose of this study was to report the outcomes of a prospective randomized clinical trial comparing 4 different glenosphere configurations based on diameter and lateral offset. Between 2016 and 2020, 113 primary RSAs with a diagnosis of either rotator cuff tear arthropathy (n = 48, 42%), irreparable rotator cuff tears (n = 22, 19%), or primary glenohumeral osteoarthritis with subluxation or glenoid bone loss (n = 43, 38%) were enrolled into a blinded prospective randomized clinical trial. The mean age of the patients included in the study was 73 ± 7 (range, 50-89) years, and 58 (51.3%) were males. All procedures were performed by two surgeons utilizing the ReUnion RSA system (Stryker, Mahwah, NJ, USA). Patients were randomized into four possible groups based on the diameter and lateral offset of the glenosphere implanted: 36 mm diameter with 2 mm (n = 34, 30.1%) or 6 mm (n = 28, 24.8%) of lateralization and 40 mm diameter with 2 mm (n = 29, 25.7%) or 6 mm (n = 22, 19.5%) of lateralization. Outcomes collected included pain, active ROM, strength, satisfaction, patient-reported outcome measures (PROMs), complications, reoperations, and revisions. PROMs included the Oxford Shoulder Score, the American Shoulder and Elbow Surgeons, and the quick Disabilities of the Arm, Shoulder and Hand questionnaire. All patients were followed for a minimum of 2 years. With the numbers available, glenosphere diameter and lateralization resulted in no differences in pain, ROM, strength, satisfaction, and PROMs at 1 year, 2 years, or final follow-up (All P >.05). However, all 3 complications (10.7% vs. 0% vs. 0% vs. 0%; P =.025) and 2 revision surgeries (7.1% vs. 0% vs. 0% vs. 0%; P =.103) occurred in males, with the 36 + 6 cohort. Using this particular RSA design, implantation of glenospheres with 36 mm or 40 mm of diameter and 2 mm or 6 mm of sphere lateralization did not translate into significant differences when primary RSA was performed in shoulders with rotator cuff tear arthropathy, irreparable cuff tears, or primary glenohumeral osteoarthritis. However, all observed complications occurred in males with the smallest diameter and lateralized glenosphere. [ABSTRACT FROM AUTHOR]

Background: Nonagenarians (90-99 years) have experienced the fastest percent growth in primary total knee arthroplasty (TKA) utilization recently. However, there are limited data on the results of the procedure in this population. The goals of this study are to determine the mortality rate, implant survivorship, clinical outcomes, and complications of primary TKAs in nonagenarians.Methods: Our institutional total joint registry was used to identify 105 nonagenarians who underwent 119 primary cemented TKAs for osteoarthritis between 1997 and 2017. Mean age was 92 years, with 58% being female. Mortality, revision, and reoperation were assessed using cumulative incidence with death as a competing risk and Cox regression methods. Clinical outcomes were assessed using Knee Society Scores. A posterior-stabilized design was used in 88%. Mean follow-up was 4 years.Results: The mortality rates were 0%, 2%, 9%, and 47% at 90 days, 1 year, 2 years, and 5 years, respectively. The 5-year cumulative incidences of any revision and reoperation were 0% and 3%, respectively. The reoperations included 2 internal fixations for periprosthetic fracture and 1 hardware removal. The mean Knee Society Score improved significantly from 34 preoperatively to 80 at 5 years (P < .001). The 5-year cumulative incidence of any nonmortality complication was 66%. The most common complications were urinary tract infections and retention (8%) in the early postoperative period, and acquired idiopathic stiffness (10%) later.Conclusion: Nonagenarians undergoing primary TKA had low mortality rates at 90 days (0%) and 1 year (2%) with substantial functional improvements. The cumulative incidences of revision and reoperation were low at 5 years.Level Of Evidence: Level IV, retrospective cohort. [ABSTRACT FROM AUTHOR]

Background: Long-term mortality after primary THA is lower than in the general population, but it is unknown whether this is also true after revision THA.Questions/purposes: We examined (1) long-term mortality according to reasons for revision after revision THA, and (2) relative mortality trends by age at surgery, years since surgery, and calendar year of surgery.Methods: This retrospective study included 5417 revision THAs performed in 4532 patients at a tertiary center between 1969 and 2011. Revision THAs were grouped by surgical indication in three categories: periprosthetic joint infections (938; 17%); fractures (646; 12%); and loosening, bearing wear, or dislocation (3833; 71%). Patients were followed up until death or December 31, 2016. The observed number of deaths in the revision THA cohort was compared with the expected number of deaths using standardized mortality ratios (SMRs) and Poisson regression models. The expected number of deaths was calculated assuming that the study cohort had the same calendar year, age, and sex-specific mortality rates as the United States general population.Results: The overall age- and sex-adjusted mortality was slightly higher than the general population mortality (SMR, 1.09; 95% CI, 1.05-1.13; p < 0.001). There were significant differences across the three surgical indication subgroups. Compared with the general population mortality, patients who underwent revision THA for infection (SMR, 1.35; 95% CI, 1.24-1.48; p < 0.001) and fractures (SMR, 1.23; 95% CI, 1.11-1.37; p < 0.001) had significantly increased risk of death. Patients who underwent revision THA for aseptic loosening, wear, or dislocation had a mortality risk similar to that of the general population (SMR, 1.01; 95% CI, 0.96-1.06; p = 0.647). The relative mortality risk was highest in younger patients and declined with increasing age at surgery. Although the relative mortality risk among patients with aseptic indications was lower than that of the general population during the first year of surgery, the risk increased with time and got worse than that of the general population after approximately 8 to 10 years after surgery. Relative mortality risk improved with time after revision THA for aseptic loosening, wear, or dislocation.Conclusions: Shifting mortality patterns several years after surgery and the excess mortality after revision THA for periprosthetic joint infections and fractures reinforce the need for long-term followup, not only for implant survival but overall health of patients having THA.Level Of Evidence: Level III, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Modular fluted tapered stems have become the most commonly employed category of femoral component in revision hip arthroplasty in North America as a result of favorable early results and simplicity of use. Despite wide adoption, the majority of published data are limited to relatively small series with modest follow-up. The goal of the current study was to determine the success rate and factors associated with success, failure, and complications of the use of modular fluted tapered stems in aseptic revision total hip arthroplasties (THAs) in a large patient cohort.Methods: We identified 519 aseptic femoral revisions during which a modular fluted tapered stem was utilized. Clinical outcomes, Kaplan-Meier survivorship, radiographic outcomes, and complications were assessed. The mean age at revision arthroplasty was 70 years, the mean body mass index (BMI) was 29 kg/m, and the mean duration of follow-up was 4.5 years (range, 2 to 14 years).Results: The mean Harris hip score (HHS) improved significantly from 51 points preoperatively to 76 points at 2 years (p < 0.001). This improvement was maintained at the last follow-up evaluation (mean HHS = 75 points). At the time of the most recent follow-up, 16 femoral revisions had been performed: 6 because of aseptic loosening, 4 because of infection, 3 because of instability, 2 because of periprosthetic fracture, and 1 because of stem fracture. The 10-year survivorship was 96% with revision for any reason as the end point and 90% with any reoperation as the end point. Of the patients who were alive and had not undergone revision at the time of final follow-up, 12 had stem subsidence but all but 1 of these stems had stabilized after subsiding. Postoperative complications were noted in 12% of the cases. Repeat revision due to femoral component loosening was not correlated with the preoperative bone-loss category or patient demographic factors.Conclusions: In this large series, femoral revision with a modular fluted tapered stem provided a high rate of osseointegration and sustained improvement in clinical scores at the time of the last follow-up. There was also a high rate of successful implant fixation across all categories of preoperative bone loss and an acceptable rate of complications.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of revision surgery after thumb trapeziometacarpal joint arthroplasty and to present the expected results of future surgical treatment. Methods: We reviewed the patient database at our medical center and found 654 procedures performed between 1988 and 2000 for the treatment of thumb basal joint arthritis. From the database we found that revision arthroplasties were performed on 15 patients with 17 arthroplasties in the treatment of mechanical pain related to instability or bone impingement. Referred patients with primary surgery performed elsewhere and patients with neurogenic pain were reviewed but not included as a primary focus of this study. The revision surgical procedures included soft-tissue interposition alone or soft-tissue interposition with ligament reconstruction for mechanical symptoms and neurolysis of peripheral nerves for associated neurogenic pain. The assessment included preoperative and postoperative patient chart review, measurement of pinch and grip strengths, radiographic assessment, and patient contact to provide complete medical information including any further medical or surgical treatment. Results: Based on a grading system previously used to evaluate thumb revision surgery, objective good (or satisfactory) results were found in 13 of 17 revision procedures. The method of soft-tissue revision (resection with soft-tissue interposition or resection with ligament reconstruction) did not influence the outcome of good versus fair or poor results. Persistent failures (2 fair, 2 poor) resulted from both soft-tissue interposition alone and revision with ligament support arthroplasties. Revision arthroplasty with soft-tissue procedures for mechanical pain provided predictably good results unless a nerve injury occurred at the time of the revision surgery. Conclusions: Failure of primary thumb trapeziometacarpal arthroplasty can be salvaged by a second surgery with ligament reconstruction procedures combined with soft-tissue interposition and provides satisfactory patient outcomes in more than 75% of cases studied. Type of study/level of evidence: Therapeutic, Level IV. [Copyright &y& Elsevier]