Assessing Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty Using Sensor Technology.

Background: The purpose of our study was to assess the accuracy of a commercially available wearable sensor in replicating pelvic tilt movement in both the sitting and standing position in patients before total hip arthroplasty.

Methods: This prospective study evaluated patients undergoing a primary unilateral total hip arthroplasty by a single surgeon. Patients were excluded if they had a body mass index (BMI) greater than 40 kg/m.

Head-to-Head Comparison of Kinematic Alignment Versus Mechanical Alignment for Total Knee Arthroplasty.

Background: Seeing as there are many alignment strategies for total knee arthroplasty (TKA), we need to determine differences between them in a rigorous scientific way. Therefore, we sought to compare perioperative and postoperative functional outcomes in patients undergoing TKA for varus osteoarthritis with a mechanical alignment target vs a kinematic alignment target, both executed with the same implant and same technological guidance.

Methods: One hundred consecutive patients who underwent TKA using a mechanical alignment technique were 1:1 matched to 100 patients who underwent TKA using a kinematic alignment (KA) technique, using the same implant and robotic technology.

The journey to preventing dislocation after total hip arthroplasty : how did we get here?

Dislocation following total hip arthroplasty (THA) is a well-known and potentially devastating complication. Clinicians have used many strategies in attempts to prevent dislocation since the introduction of THA. While the importance of postoperative care cannot be ignored, particular emphasis has been placed on preoperative planning in the prevention of dislocation.

Mental Health in Patients Undergoing Orthopaedic Surgery: Diagnosis, Management, and Outcomes.

»: Mental health and psychosocial factors play a critical role in clinical outcomes in orthopaedic surgery.

»: The biopsychosocial model of disease defines health as a product of physiology, psychology, and social factors and, traditionally, has not been as emphasized in the care of musculoskeletal disease.

»: Improvement in postoperative outcomes and patient satisfaction is incumbent upon the screening, recognition, assessment, and possible referral of patients with high-risk psychosocial factors both before and after the surgical procedure.

2021 Otto Aufranc Award: A simple Hip-Spine Classification for total hip arthroplasty : validation and a large multicentre series.

Aims: Patients with spinal pathology who undergo total hip arthroplasty (THA) have an increased risk of dislocation and revision. The aim of this study was to determine if the use of the Hip-Spine Classification system in these patients would result in a decreased rate of postoperative dislocation in patients with spinal pathology.

Methods: This prospective, multicentre study evaluated 3,777 consecutive patients undergoing THA by three surgeons, between January 2014 and December 2019.

An Overview of Telehealth in Total Joint Arthroplasty.

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits.

Applying the Hip-Spine Relationship: What X-Rays and Measurements Are Important?

Understanding spinopelvic motion and the dynamic relationship of the hip, spine, and pelvis is essential in decreasing the risk of instability after total hip arthroplasty. The hip-spine relationship is complex, and a detailed analysis of each patient's spinopelvic mobility is warranted to help guide safe acetabular component positioning. Through the use of a standing anteroposterior pelvis X-ray, lateral spinopelvic radiographs in the standing and seated position, and advanced functional imaging, key spinopelvic parameters can be obtained.

High Offset Stems Are Protective of Dislocation in High-Risk Total Hip Arthroplasty.

Background: Spinal stiffness has been shown to increase risk of dislocation due to impingement and instability. Increasing anteversion of the acetabular component has been suggested to prevent dislocation, but little has been discussed in terms of femoral or global offset restoration. The purpose of this study is to quantify dislocation rates after primary THA using standard versus high-offset femoral components and to determine how differences in offset affect impingement-free range of motion in a stiff spine cohort using a novel impingement model.

Does Prosthetic or Bony Impingement Occur More Often in Total Hip Arthroplasty: A Dynamic Preoperative Analysis.

Background: Impingement is a leading cause for instability resulting in revision total hip arthroplasty (THA). Impingement can be prosthetic, bony, or soft tissue. The purpose of this study is to investigate, using a virtual simulation, whether bony or prosthetic impingement presents first in well-positioned THAs.

Abductor Deficiency-Induced Recurrent Instability After Total Hip Arthroplasty.

» Operative intervention for deficient hip abductor muscles may require muscle transfer or the use of synthetic materials, possibly with biologic augmentation, to help stabilize the hip joint and prevent further dislocation following total hip arthroplasty (THA). » Direct repair of the abductor mechanism onto the greater trochanter can be used in patients who present with instability <15 months following primary THA. » Augmentation of soft tissue with acellular dermal allografts can be considered for patients with abductor avulsion that requires posterior capsular reconstruction.

Synthetic Biphasic Scaffolds versus Microfracture for Articular Cartilage Defects of the Knee: A Retrospective Comparative Study.

Objective: The purpose of this study was to compare the results of a biphasic synthetic scaffold (TruFit, Smith & Nephew) to microfracture for the treatment of knee cartilage defects and identify patient- and lesion-specific factors that influence outcomes.

Design: Prospectively collected data from 132 patients (mean age, 41.8 years; 69% male) with isolated chondral or osteochondral femoral defects treated with biphasic synthetic scaffolds ( = 66) or microfracture ( = 66) were reviewed.

Does femoral morphology and stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered titanium stems?

Introduction: Stem subsidence and thigh pain can cause significant patient dissatisfaction after cementless THA. The purpose of this study was to examine the effect of proximal-femoral morphology and stem alignment on clinical outcomes using a double-tapered, cementless titanium femoral component.

Methods: We retrospectively reviewed 281 consecutive, primary THAs from 2012 to 2014 with a mean follow-up of 4 years.

Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair?

Background: Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have been widely accepted because of their superior biomechanical properties when compared with arthroscopic single-row repair. Concerns regarding repair overtensioning with medial-row knot tying have led to increased interest in knotless repair techniques; however, there is a paucity of clinical data to guide the choice of technique.

Hypothesis: Arthroscopic TOE repair techniques using knotless medial-row fixation will demonstrate lower retear rates and greater improvements in the Constant score relative to conventional knot-tying TOE techniques.

Control Strategies for Infection Prevention in Total Joint Arthroplasty.

Despite the development of newer preventative measures, the rate of infection continues to be approximately 1% for patients undergoing total joint arthroplasty (TJA). The extent of the infection can range from a mild superficial infection to a more serious periprosthetic joint infection (PJI). PJIs not only play a significant role in the clinical well-being of the TJA patient population, but also have substantial economic implications on the health care system.

Trends and Demographics in the Utilization of Total Wrist Arthroplasty.

Background: Health disparities exist among many patient populations, with race, payer status, hospital size and access to teaching versus non-teaching hospitals potentially affecting whether certain patients have access to the benefits of total wrist arthroplasty (TWA).

Methods: The National Inpatient Sample Database (NIS) was queried from 2001 to 2013 for TWA using the ICD-9 code 81.73.

Peer-to-Peer Collaboration Adds Value for Surgical Colleagues.

Background: Peer-to-peer advisory among colleagues in orthopedic surgery is commonplace in academic medical centers. In the private practice setting, however, it becomes more difficult for surgeons to discuss complex cases among peers.

Purpose/questions: We sought to study the effect of peer-to-peer mentorship on surgeons' decision-making and on patient care across academic and private adult joint reconstruction practices via the use of group secured messages.

The effect of wound dressings on infection following total joint arthroplasty.

Background: The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA.

Methods: MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA.

Respiratory Synchronized Versus Intermittent Pneumatic Compression in Prevention of Venous Thromboembolism After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted.

Irrigation and Debridement for Early Periprosthetic Knee Infection: Is It Effective?

Background: Irrigation and debridement (I&D) is performed for early management of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Symptom reporting is a subjective measure and may miss direct management of PJI. Utilizing an objective time interval from index procedure to I&D may better inform treatment decisions.

Strategies for reducing implant costs in the revision total knee arthroplasty episode of care.

Background: Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models.

Methods: Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014.

Hospital Consumer Assessment of Healthcare Providers and Systems Scores Do Not Predict Outcomes After Total Hip Arthroplasty.

Background: With the establishment of the Hospital Value-Based Purchasing program, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score has been incorporated into the calculation of the total performance score, which determines redistribution of up to 2% of Medicare payments. This study aims to assess whether the HCAHPS score correlates with validated outcome measures after total hip arthroplasty.

Methods: Data from 63 patients who underwent a total hip arthroplasty and completed both an HCAHPS score and patient-reported outcome measures (PROMs) at our institution during the study period from January 1, 2015 to September 2016 were analyzed.

Three-Dimensional Templating for Acetabular Component Alignment During Total Hip Arthroplasty.

Appropriate placement of the acetabular cup is an important determinant of implant stability and longevity. Malposition of acetabular cups negatively influences prosthesis survival and leads to an increased dislocation rate. The objective of the study was to determine the role of 3-dimensional templating in obtaining accurate acetabular component placement in total hip arthroplasty.

Private Bundles: The Nuances of Contracting and Managing Total Joint Arthroplasty Episodes.

In recent years, bundled payment reimbursement models have been used to address the unsustainable rising cost of healthcare. Centers for Medicare and Medicaid Services initiatives, such as Bundled Payment for Care Improvement Program, have already demonstrated their ability to create financial and performance accountability in the public sector. More recently, these value-based models have been introduced among private payers to increase coordination, quality, and efficiency.