Comparing Trabecular Metal Versus Fiber Mesh Cementless Acetabular Components: A Single-Center Study of 6,563 Hips.

Background: Trabecular metal is being increasingly used in primary total hip arthroplasty (THA). This study compared medium-term (< 15 years) outcomes of fiber mesh titanium and trabecular metal acetabular components.

Methods: This study included 6,563 patients who underwent primary THA with either fiber mesh titanium or trabecular metal-backed acetabular components.

A Scoping Review of 'Smart' Dressings for Diagnosing Surgical Site Infection: A Focus on Arthroplasty.

Early diagnosis and treatment of surgical wound infection can be challenging. This is especially relevant in the management of periprosthetic joint infection: early detection is key to success and reducing morbidity, mortality and resource use. 'Smart' dressings have been developed to detect parameters suggestive of infection.

Is there an increased revision rate due to early tibial component loosening with a modern total knee arthroplasty design? A retrospective analysis from a large volume arthroplasty centre.

Background: The Attune TKR was introduced in 2011 as a successor to its predicate design The PFC Sigma. However, following reports of early failures, there are ongoing concerns related to increased loosening rates. Given the concerns, this study aimed to compare revision rates of the Attune implant to an established predicate, and other implant designs used in a high-volume arthroplasty center.

Cementless TKA use as an alternative to cemented TKA in high BMI patients: A systematic review and meta-analysis.

Purpose: Obesity is prevalent, with nearly one-third of the world's population being classified as obese. In patients with high body mass index (BMI)/body mass undergoing total knee arthroplasty (TKA), there is an increase in strain placed on the implant fixation interfaces. As such, component fixation is a potential concern when performing TKA in the obese patient.

Postoperative Continuous Passive Motion Does Not Improve the Range of Movement Achieved After Manipulation Under Anesthetic for Stiffness in Total Knee Replacement.

Background: Stiffness is a common complication following total knee arthroplasty. Manipulation under anesthesia (MUA) is an intervention that can potentially improve range of motion (ROM). Continuous passive motion (CPM) therapy has been utilized to enhance post-MUA ROM, but its effectiveness remains debated.

Lower Risk of Revision With 32- and 36-Millimeter Femoral Heads Compared With 28-mm Heads in Primary Total Hip Arthroplasty: A Comparative Single-Center Study (10,104 Hips).

Background: We aimed to compare the clinical outcomes of different head sizes (28-, 32-, and 36- millimeter) in primary total hip arthroplasty (THA) at mean 6 years follow-up (range, 1 to 17.5 years).

Methods: This was a retrospective consecutive study of primary THA at our institution (2003 to 2019).

Return to driving post upper or lower extremity orthopaedic surgical procedures: a scoping review of current published literature.

Patients undergoing planned or unplanned orthopaedic procedures involving their upper or lower extremity can prevent them from safe and timely return to driving, where they commonly ask, 'Doctor, when can I drive?' Driving recommendations after such procedures are varied. The current evidence available is based on a heterogenous data set with varying degrees of sample size and markedly differing study designs. This instructional review article provides a scoping overview of studies looking at return to driving after upper or lower extremity surgery in both trauma and elective settings and, where possible, to provide clinical recommendations for return to driving.

"Wearable Sensors to Guide Remote Rehabilitation Following Knee Arthroplasty Surgery".

Background: Total knee arthroplasty requires effective rehabilitation to achieve optimal results, but institutions often rely on unsupervised home exercises due to cost constraints. Wearable sensors have become increasingly popular as a potential method of monitoring patients remotely to ensure efficacy and compliance. This review assesses the current evidence for their use in remotely monitored rehabilitation following knee arthroplasty.

Articular spacers in two-stage revision arthroplasty for prosthetic joint infection of the hip and the knee.

Use of articular antibiotic-eluting cement spacers during two-stage revision arthroplasty for prosthetic joint infection (PJI) is a long-established and proven adjunctive technique during first-stage surgery. Articular spacers come in many forms, either static or dynamic. The authors present an instructional review of current evidence regarding their use.

The Effect of Perioperative Biologic Disease-Modifying Anti-Rheumatic Drugs on the Risk of Postoperative Complications: Surgical Site Infection, Delayed Wound Healing, and Disease Flares Following Orthopaedic Surgical Procedures.

Background: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are effective in treating inflammatory diseases and have been increasingly utilized over the past decade. Patients who receive bDMARDs have been shown to be at an increased risk for surgical site infection following surgical procedures. The severe consequences of infection following orthopaedic surgery have led to the practice of withholding bDMARDs perioperatively; however, there has been no definitive evidence showing a clear benefit of withholding the use of bDMARDs, and in doing so, patients may be at an increased risk for higher disease activity.

Doctor when can I drive? A systematic review and meta-analysis of return to driving after total hip arthroplasty.

Background/objective: Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons' recommendations range between 4-8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact.

How Accurate is the Use of Contralateral Implant Size as a Template in Bilateral Hemiarthroplasty?

Purpose: Accurately predicting implant size for hemiarthroplasties offers an important contribution to theatre efficiency and patients' intraoperative care. However, pre-operative sizing using templating of implants in hip fracture patients requiring a hemiarthroplasty is often difficult due to non-standard radiographs, absence of a calibration marker, poor marker placement, variable patient position, and in many institutions a lack of templating facilities. In patients who have previously undergone a hemiarthroplasty on the contralateral side, surgeons can use the contralateral implant size for pre-operative planning purposes.

A novel mechanical inclinometer device to measure acetabular cup inclination in total hip arthroplasty.

It is well recognised that acetabular cup orientation influences patient function and implant survival post-THR. Reliable intra-operative determination of cup orientation remains a challenge. We describe the design and testing of a novel mechanical inclinometer to measure intra-operative acetabular cup inclination.

Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature.

Introduction: The angle of acetabular (cup) radiographic inclination is an important measurement in total hip arthroplasty (THA) procedures. Abnormal radiographic inclination is associated with dislocation, edge loading and higher failure rates. Consistently achieving a satisfactory radiographic inclination remains a challenge.

Changing Device Regulations in the European Union: Impact on Research, Innovation and Clinical Practice.

Background: Up until 2017, medical devices were placed on the European Union's (EU) single market in accordance with either Medical Device Directive 93/42/EEC for general medical devices or Medical Device Directive 90/385/EEC for active implantable devices. However, some devices that complied with these directives still failed catastrophically. In the orthopaedic device field, these failures were most pronounced in metal-on-metal hip devices causing severe patient morbidity with increased need for revision surgery which had unpredictable outcomes.

Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion: A Single-Blinded Randomized Controlled Trial.

Background: FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation.

Methods: Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts.

A calcar collar is protective against early periprosthetic femoral fracture around cementless femoral components in primary total hip arthroplasty: a registry study with biomechanical validation.

Aims: The aim of this study was to estimate the 90-day risk of revision for periprosthetic femoral fracture associated with design features of cementless femoral stems, and to investigate the effect of a collar on this risk using a biomechanical model.

Materials And Methods: A total of 337 647 primary total hip arthroplasties (THAs) from the United Kingdom National Joint Registry (NJR) were included in a multivariable survival and regression analysis to identify the adjusted hazard of revision for periprosthetic fracture following primary THA using a cementless stem. The effect of a collar in cementless THA on this risk was evaluated in an model using paired fresh frozen cadaveric femora.

Posterior Bearing Overhang Following Medial and Lateral Mobile Bearing Unicompartmental Knee Replacements.

This study explores the extent of bearing overhang following mobile bearing Oxford unicompartmental knee replacement (OUKR) (Oxford Phase 3, Zimmer Biomet). The Oxford components are designed to be fully congruent, however knee movements involve femoral rollback, which may result in bearing overhang at the posterior margin of the tibial implant, with potential implications for; pain, wear, and dislocation. Movement is known to be greater, and therefore posterior overhang more likely to occur, with; lateral compared to medial implants, anterior cruciate ligament (ACL) deficiency (ACLD) compared to ACL intact (ALCI), and at extremes of movement.

Proof-of-concept prototype drill-guide for use in medial patello-femoral ligament (MPFL) reconstruction surgery.

For surgical reconstruction of the medial patello-femoral ligament (MPFL) a variety of techniques are used for fixation of the graft to the medial border of the patella. The bone bridge or V-shaped tunnel technique utilises two tunnels drilled from the medial aspect of the patella that converge centrally creating a tunnel through which the graft is threaded. This technique has advantages: it avoids hardware (bone anchors) and their associated complications, creates a broad attachment of the ligament approximating normal anatomy and the tunnel does not breach the lateral cortex of the patella reducing the risk of patella fracture.

Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty Part I: A survey of current practice in the UK.

Background: The management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. In part 1 of this two-part series, we present an overview of current practice regarding the management of the IPFP in elective TKA among surgeons in the UK.

Methods: A web-based survey was offered to 269 delegates of the BASK 2017 annual conference.

Preservation vs. resection of the infrapatellar fat pad during total knee arthroplasty part II: A systematic review of published evidence.

Background: The management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. In part 2 of this two part series the authors aimed to investigate if resection of the IPFP affects clinical outcomes.

Methods: A systematic search of CENTRAL Cochrane library, Medline, Embase and Web-of-science databases for the past 10 years was performed.

Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery.

Background and purpose - Simulation is an adjunct to surgical education. However, nothing can accurately simulate fluoroscopic procedures in orthopedic trauma. Current options for training with fluoroscopy are either intraoperative, which risks radiation, or use of expensive and unrealistic virtual reality simulators.