The Watson Extraction System for removal of well-fixed femoral stems: A retrospective review of 10 cases.

Background: Revision of well-fixed cementless femoral stems is a challenging and time-consuming aspect of revision hip arthroplasty. The Watson Extraction System (WES) is a novel, size-specific 3-D fabricated instrument that mimics the outer geometry of the implanted femoral stem. The device acts to cut circumferentially around the stem as it is impacted into place, effectively disrupting the bone-implant interface.

Case Report of Successful Bilateral Total Knee Arthroplasty: 46 Years and Still Going.

Case: A 63-year-old woman with 46-year-old bilateral cemented total knee arthroplasty (TKA) presented to our clinic for routine evaluation. She was diagnosed with idiopathic juvenile arthritis at the age of 17. Radiographically she had well-fixed implants bilaterally without bone-cement lucency.

The Microbiome of Osteoarthritic Hip and Knee Joints: A Prospective Multicenter Investigation.

Background: Recent advances in high-throughput DNA sequencing technologies have made it possible to characterize the microbial profile in anatomical sites previously assumed to be sterile. We used this approach to explore the microbial composition within joints of osteoarthritic patients.

Methods: This prospective multicenter study recruited 113 patients undergoing hip or knee arthroplasty between 2017 and 2019.

Total Hip Arthroplasty With Subtrochanteric Osteotomy for Developmental Hip Dysplasia: A Long-term Follow-up Study.

Background: Total hip arthroplasty (THA) for developmental hip dysplasia (DDH) often requires a subtrochanteric shortening derotational osteotomy (SDO) to limit leg lengthening, mitigate risk of peripheral nerve palsy, and reduce excessive femoral anteversion. Few studies exist detailing long-term clinical outcomes and survivorship. The aim of this study is to analyze the long-term outcomes and survivorship of an SDO-THA cohort.

An Enhanced Understanding of Culture-Negative Periprosthetic Joint Infection with Next-Generation Sequencing: A Multicenter Study.

Background: The challenges of culture-negative periprosthetic joint infection (PJI) have led to the emergence of molecular methods of pathogen identification, including next-generation sequencing (NGS). While its increased sensitivity compared with traditional culture techniques is well documented, it is not fully known which organisms could be expected to be detected with use of NGS. The aim of this study was to describe the NGS profile of culture-negative PJI.

Efficacy and Durability of Opioid Restrictive State Legislation Two Years After Implementation for Total Knee Arthroplasty.

Background: To curtail the U.S. opioid crisis, many states have instituted regulations that mandate time and/or dosage limits for opioid prescriptions.

The Double-Cup Construct: A Novel Treatment Strategy for the Management of Paprosky IIIA and IIIB Acetabular Defects.

Background: Treatment of massive acetabular bone loss in revision total hip arthroplasty is complex, and various treatment strategies have been described. We describe a novel technique of using a Trabecular Metal Revision Shell as a buttress augment creating a "double-cup" construct rather than the use of custom triflanges or cup-cage constructs for Paprosky types IIIA and IIIB acetabular defects.

Methods: We retrospectively reviewed 20 double-cup cases at a mean of 2.

Computer navigation and distal femoral reconstruction in the oncologic patient.

Objectives: As adjuvant treatments for musculoskeletal malignancies improve expectations of preserved function increase. We questioned whether computer navigation for distal femoral reconstruction would improve outcomes.

Methods: Twenty oncology patients were reviewed after distal femoral reconstruction using navigation.

Biomechanical analysis of impending femoral neck fractures: the role of percutaneous cement augmentation for osteolytic lesions.

Background: Management of impending pathologic femoral neck fractures includes internal fixation, arthroplasty and megaprostheses. The study aim was to determine the augmentative effect of cement injection for minimally invasive treatment of femoral neck lesions.

Methods: Twenty-seven cadaveric femora received a simulated osteolytic lesion previously shown to decrease the femur's failure load by 50%.

Hip resurfacing arthroplasty in severely obese patients.

We conducted a study of outcomes of modern hip resurfacing arthroplasty (HRA) in severely obese patients. Patients who had undergone HRA and been followed for a minimum of 2 years were divided into 2 groups, those with body mass index under 35 (control, 366 hips) and those with body mass index of 35 or above (study, 63 hips). At mean follow-up of 41 months, there was no significant difference between the groups with respect to postoperative Harris Hip Scores, complication rates, and need for revision.

Diagnosis and indications for treatment of unicompartmental arthritis.

Unicompartmental knee arthroplasty (UKA) is a reliable operation for isolated unicompartmental arthritis. A comprehensive understanding of the limitations of UKA is crucial for success in the young patient. Obesity may impact implant longevity; however, acceptable results can be achieved with precise component implantation and careful patient selection.

Biomechanical model of a high risk impending pathologic fracture of the femur: lesion creation based on clinically implemented scoring systems.

Background: Multiple classifications combine objective and subjective measures to predict fracture risk through a metastatic lesion. In our literature review, no studies have attempted to validate this predicted fracture risk from a biomechanical perspective. The study goal was to evaluate proximal femur strength after creating osteolytic defects.

Results of revision total hip arthroplasty with modular, titanium-tapered femoral stems in severe proximal metaphyseal and diaphyseal bone loss.

Evidence supporting modular, tapered stems for severe proximal metaphyseal and diaphyseal bone loss is limited. We report our clinical experience with its use for severely deficient femurs. Of 211 revision total hip arthroplasties (THAs), 18 tapered, modular titanium stems were implanted in Paprosky type III and IV femurs.

Biology, classification, and management of recurrent myxofibrosarcoma 21 years after resection.

Soft-tissue sarcomas (STSs) are a heterogenous group of rare malignancies that have significant lifelong implications. Accepted management options include limb-sparing surgical resection and adjuvant radiation therapy. Here we present the case of a myxoid malignant fibrous histiocytoma, now termed a myxofibrosarcoma, which recurred 21 years after primary surgical resection.

Advances in segmental endoprosthetic reconstruction for extremity tumors: a review of contemporary designs and techniques.

Background: Improved understanding and advances in treatment regimens have led to increased longevity among patients diagnosed with extremity soft tissue sarcomas. Limb salvage techniques and implants have improved and continue to evolve to accommodate the increasing demands and survival of these patients.

Methods: The current report is a review of the literature for recent advancements in techniques, implant design, and outcomes in the field of limb salvage therapy using segmental megaprostheses for the treatment of extremity sarcomas.

Initial experience of the Journey-Deuce bicompartmental knee prosthesis: a review of 36 cases.

We evaluated the effectiveness of a novel bicompartmental knee arthroplasty prosthesis for the treatment of degenerative disease affecting the medial and patellofemoral compartments. The study included 36 knees in 32 patients with a mean follow-up of 21 months. The mean Knee Society functional survey and Western Ontario McMaster Osteoarthritic Index Survey scores were 65.

Femoral component incarceration at the distal slot.

Femoral components with distal coronal slots were introduced to decrease the stiffness mismatch of the femoral diaphysis and stem. We present 2 cases in which the stem of an S-ROM (DePuy, Warsaw, Ind) endoprosthesis was incarcerated in the diaphysis of the femur by bone growth through the distal slot. In both cases, this finding was discovered intraoperatively, following multiple unsuccessful attempts at stem extraction.

Purse-string capsule repair to reduce proximal femoral arthroplasty dislocation for tumor--a novel technique with results.

Hip joint dislocation is the most common complication after proximal femoral arthroplasty with a large endoprosthesis. Average dislocation rates are around 15%. In an attempt to decrease dislocations after proximal femoral arthroplasty for tumor resections, we devised a novel closure of the hip capsule.