Early outcomes of a modern cemented total knee arthroplasty : is tibial loosening a concern?

Aims: Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design.

Which Nonsurgical Treatments Do Patients Believe Are Most Effective for Hip and Knee Arthritis?

Background: The purpose of this study was to determine which nonsurgical treatments patients believe are most effective for managing pain secondary to hip and knee arthritis.

Methods: Five hundred sixty-five consecutive patients were administered an anonymous questionnaire developed in consultation with a center with expertise in survey design. Statistical analyses included Student t-test, Fisher Exact, Wilcoxon Rank-Sum test, and generalized cost-effectiveness analysis.

Randomized Trial of Static and Articulating Spacers for Treatment of the Infected Total Hip Arthroplasty.

Background: The purpose of this randomized clinical trial is to compare perioperative and postoperative variables between static and articulating spacers for the treatment of chronic periprosthetic joint infection (PJI) complicating total hip arthroplasty (THA).

Methods: Fifty-two patients undergoing resection arthroplasty as part of a 2-stage exchange for PJI at 3 centers were randomized to either a static (n = 23) or articulating spacer (n = 29). The primary endpoint was operative time of the second-stage reimplantation and power analysis determined that 22 patients per cohort were necessary to detect a 20-minute difference.

The Optimal Dosing Regimen for Tranexamic Acid in Revision Total Hip Arthroplasty: A Multicenter Randomized Clinical Trial.

Background: The purpose of this multicenter, randomized trial was to determine the optimal dosing regimen of tranexamic acid (TXA) to minimize perioperative blood loss in revision total hip arthroplasty.

Methods: Six centers prospectively randomized 175 patients to 1 of 4 regimens: (1) 1-g intravenous (IV) TXA prior to incision (the single-dose IV group), (2) 1-g IV TXA prior to incision followed by 1-g IV TXA after arthrotomy wound closure (the double-dose IV group), (3) a combination of 1-g IV TXA prior to incision and 1-g intraoperative topical TXA (the combined IV and topical group), or (4) 3 doses totaling 1,950-mg oral TXA (the multidose oral group). Randomization was based on revision subgroups to ensure equivalent group distribution.

Saline lavage after a "dry tap".

Aims: In patients with a "dry" aspiration during the investigation of prosthetic joint infection (PJI), saline lavage is commonly used to obtain a sample for analysis. The aim of this study was to investigate prospectively the impact of saline lavage on synovial fluid analysis in revision arthroplasty.

Methods: Patients undergoing revision hip (THA) or knee arthroplasty (TKA) for any septic or aseptic indication were enrolled.

A Randomized Trial of Static and Articulating Spacers for the Treatment of Infection Following Total Knee Arthroplasty.

Background: There is no consensus whether the interim antibiotic spacer utilized in the 2-stage exchange arthroplasty should immobilize the joint or allow for motion. The purpose of this multicenter, randomized clinical trial was to compare static and articulating spacers as part of the 2-stage exchange arthroplasty for the treatment of chronic periprosthetic joint infection complicating total knee arthroplasty as defined with use of Musculoskeletal Infection Society criteria.

Methods: Sixty-eight patients undergoing 2-stage exchange arthroplasty were randomized to either a static (32 patients) or an articulating (36 patients) spacer.

Education Increases Disposal of Unused Opioids After Total Joint Arthroplasty: A Cluster-Randomized Controlled Trial.

Background: Unused opioid pills are a danger to patients and their loved ones as they may be diverted for abuse or misuse. The purpose of this study was to determine the baseline rate of proper disposal of unused opioids among patients undergoing total joint arthroplasty and to determine how education impacts disposal rates.

Methods: In this study, 563 patients undergoing primary total joint arthroplasty (183 patients undergoing total hip arthroplasty, 293 patients undergoing total knee arthroplasty, and 87 patients undergoing unicompartmental knee arthroplasty) were cluster-randomized to groups that received no education, educational pamphlets, or educational pamphlets plus text messages.

Does Femoral Morphology Predict the Risk of Periprosthetic Fracture After Cementless Total Hip Arthroplasty?

Background: Periprosthetic femur fracture remains a leading mode of early failure following cementless total hip arthroplasty (THA). The purpose of this study is to determine if a specific femoral morphology is associated with an increased risk of acute, periprosthetic fracture after cementless THA.

Methods: An institutional arthroplasty registry was used to identify 32 primary, cementless THAs revised for acute, postoperative periprosthetic fracture ("fracture" cohort) within 3 months of the index procedure.

Cemented Versus Cementless Total Knee Arthroplasty of the Same Modern Design: A Prospective, Randomized Trial.

Background: Highly porous surfaces promoting biologic fixation have renewed interest in cementless total knee arthroplasty (TKA), but the potential for failed biologic fixation remains. The purpose of this study was to compare the clinical outcomes of cemented and cementless versions of the same TKA design at an average of 2 years postoperatively.

Methods: This was an institutional review board-approved, prospective, randomized controlled trial of patients from 18 to 75 years of age who were undergoing a primary TKA.

Patient Attitudes Toward Resident and Fellow Participation in Orthopedic Surgery.

Background: Residents' and fellows' participation in orthopedic surgery is a potential source of anxiety and concern for patients. The purpose of this study was to determine patients' attitudes toward trainee involvement in orthopedic surgery, surgeons as educators, and disclosure of trainee involvement.

Methods: Three hundred two consecutive patients with preoperative and postoperative appointments at three arthroplasty practices in academic medical centers were surveyed with an anonymous, self-administered questionnaire.

External Validity of a New Prediction Model for Patient Satisfaction After Total Knee Arthroplasty.

Background: The ability to identify patients at risk of dissatisfaction after total knee arthroplasty (TKA) remains elusive. This study's purpose was to determine the external validity of a recently published prediction model for patient satisfaction (PMPS) with the hypothesis that it would achieve similar predictive success in our study sample.

Methods: A 10-question PMPS statistically derived from 5 patient-reported outcome questionnaires was tested for external validity in this prospective cohort investigation.

High Failure at a Minimum 5-Year Follow-Up in Primary Total Hip Arthroplasty Using a Modular Femoral Trunnion.

Background: Modular femoral trunnions enable the surgeon to independently adjust offset, leg length, and anteversion in total hip arthroplasty (THA). However, modularity may result in an increased risk of fretting and corrosion along with a higher risk of implant dissociation or fracture. The purpose of this study is to evaluate mid-term survivorship of THAs using a cementless modular system.

Non-neurological outcomes of anterior and posterolateral approaches in the surgical treatment of thoracic disc disease: a retrospective study.

Background: Symptomatic thoracic disc herniation (TDH) is rare, and for those patients that fail conservative treatment, two main categories of surgical approaches exist-anterior and posterolateral. In many cases either approach would be considered equally appropriate. Recommendations in support of either anterior or posterolateral approaches are currently based on case series and expert opinion.

Incidence and risk factors of wound complications in long segment instrumented thoracolumbar spinal fusions: a retrospective study.

Background: This is a retrospective analysis of prospectively collected data. Our objective was to determine the incidence and assess the risk factors associated with surgical site wound complications in long segment (7+ vertebrae) instrumented thoracolumbar fusions. Surgical site complications lead to patient morbidity, increased financial burden, and further medical intervention.

Functional gait analysis in a spinal contusion rat model.

Evaluating functional performance of spinal cord injury (SCI) rat models is essential for the development of novel treatments and breakthroughs. However, due to the variety of functional analysis methods available - each with its own strengths and weaknesses - it can be challenging to choose the most appropriate functional analysis test for the animal model. Therefore, we analyzed the strengths and weaknesses of five methods in order to determine which test is not only accurate and easily reproducible, but also relatively inexpensive so that it can be adopted universally.