Search

Background Polyethylene liner dissociation is an uncommon complication of hip replacement. Dissociation has been associated with particular acetabular component designs. This study reviewed acetabular liner dissociations in a specific modular cup with a Morse taper locking mechanism that has not been previously reported. Methods The senior author performed 655 primary total hip arthroplasties with one particular design of acetabular component using Class A polyethylene liners and metal head articulation. Cases with revision surgery performed for acetabular liner dissociation were reviewed. Results Seven of 655 patients with this cup underwent revision surgery for a dissociated liner. Liner dissociation occurred at a mean of 73 months postoperatively. Patients presented with new-onset hip pain or squeaking, 4 of which developed symptoms acutely. Two patients treated with polyethylene liner exchange into the same cup required a second revision surgery for recurrent dissociation. Conclusion Polyethylene liner dissociation is an infrequent but possible complication associated with modular acetabular components using a Morse taper locking. Providers should be vigilant with long-term follow-up of patients with this acetabular system for patient complaints of catching or squeaking. Patients treated for liner dissociation should not have a new liner placed into the same acetabular shell given the risk for further dissociation.

Objective: The authors hypothesized that implementation of a department-wide opioid prescribing program would reduce opioid tablets and morphine milligram equivalents (MMEs) prescribed as well as prescription refills. Design: A retrospective study was conducted to determine the effects of a department wide opioid prescribing policy. Setting: A university teaching hospital Orthopaedic Surgery Department. Patients, participants: All prescriptions written by members of our department were reviewed for 3 months before and 3 months after program implementation. There were 1,445 patients in the pre-intervention and 1,209 patients in the postintervention cohort. Two thousand two hundred forty-six total prescriptions written during the pre-intervention period and 1,530 written during the post-intervention period of the study. Interventions: A departmental opioid prescribing policy was introduced through several department teaching sessions. The policy included recommendations on numbers of tablets per procedures and patient education about the dangers of narcotic medications. Main outcome measure(s): The primary study outcome measures were the number of opioid tablets prescribed, the number of MMEs prescribed, and the number of prescription refills. Results: The mean number of tablets per prescription decreased from 47.2 (95% confidence interval (CI): 46.4-47.9) tablets in the pre-intervention cohort to 39.2 (95% CI: 38.1-40.4) tablets in the post-intervention cohort (p < 0.0001). Likewise, the mean MME per prescription decreased from 354 (95% CI: 344-364) in the pre-intervention cohort to 265 (95% CI: 249-281) in the post-intervention cohort (p < 0.0001). A refill prescription was provided 949 times in the pre-intervention group and 404 times in the post-intervention group. Prior to the introduction of prescription guidelines, the average number of prescriptions was 1.76 per patient (95% CI: 1.71-1.81). This fell to 1.34 prescriptions per patient (95% CI: 1.31-1.38) after policy institution. Noncompliance with policy was not related to provider, service, or procedure size. Conclusions: Implementation of a departmental policy can successfully reduce the number of opioid tablets and MMEs prescribed per procedure. Policies also decrease the number of refill prescriptions per procedure. Standardization of prescription practices is effective in improving opioid prescription stewardship. Level of evidence: Level III, retrospective cohort study.

Slipped capital femoral epiphysis (SCFE) is a commonly encountered hip disorder. The goal of this study was to describe the incidence of missed contra-lateral SCFE as well as to identify risk factors. The authors hypothesized that contralateral slips are more often missed in patients with severe involvement of the treated side. After institutional review board approval was obtained, a retrospective chart review was performed of all pediatric patients who were treated for sequential and bilateral SCFE at a single institution during an 18-year period. Medical records were reviewed for demographic features and attending surgeon. Radiographs were reviewed for skeletal maturity, Klein's line, and severity of the treated slip. All radiographs were reviewed by 3 pediatric orthopedists. Contralateral SCFE was deemed present when consensus was achieved. Comparisons were made with Fisher's exact test, and P P =.0065). A contralateral slip was more likely to be present in patients who had a positive finding for Klein's line ( P Orthopedics . 2020;43(2):e114–e118.]

Total joint arthroplasty (TJA) remains one of the most common and successful procedures performed in the United States. Improving outcomes, decreasing complications, and minimizing costs have been increasingly emphasized with the shift to alternative payment models. Rapid recovery clinical pathways have led to decreased hospital length of stay, decreased readmissions, increased patient satisfaction, and decreased costs. The preoperative pathway is critical to the success of rapid recovery after total joint arthroplasty. This pathway involves the proper selection of patients suitable for rapid recovery, optimization of modifiable risk factors, and preoperative education. Successful participation in rapid recovery protocols involves a multidisciplinary approach and is critical to the success of total joint arthroplasty.

This study aimed to evaluate patient education materials that are focused on total hip arthroplasty (THA) and total knee arthroplasty (TKA) using health literacy best practices and plain language principles as frameworks. Readability assessments were conducted on a sample of nine patient education documents that are commonly given to THA and TKA surgery patients. Mean readability scores were compared across the sample. The mean readability grade level for the nine arthroplasty educational documents analyzed in this study was 11th grade (10.5). The mean readability ranged from 9th to 12th grade. The documents in this study were written at levels that exceed recommendations by health literacy experts. Health literacy best practices and plain language principles were suggested to reduce the demands on patients so that the documents are easier to understand. Incorporating health literacy best practices into patient education materials for THA and TKA can contribute to improved communication with patients that is necessary for patient understanding and satisfaction. (Journal of Surgical Orthopaedic Advances 27(1):72-76, 2018).