Marital Status, Race, Insurance Type, and Socioeconomic Status-Assessment of Social Predictors for Outcomes After Total Knee Arthroplasty.

Background: The purpose of this study was to investigate the effect of various social determinants of health on outcomes and dispositions after total knee arthroplasty (TKA).

Methods: A retrospective review was conducted on 14,462 consecutive TKA procedures between 2013 and 2021 at a multicenter hospital system. Data abstraction was done by inquiry to the Michigan Arthroplasty Registry Collaborative Quality Initiative.

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty: An Analysis of Neighborhood Deprivation Indices.

Background: Social determinants of health (SDOH) are important factors in the delivery of orthopaedic care. The purpose of this study was to investigate the relationship between outcomes following total knee arthroplasty (TKA) and both the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI).

Methods: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was utilized to identify TKA cases for inclusion.

Non-ischaemic cardiomyopathy associated with elevated serum cobalt and accelerated wear of a metal-on-metal hip resurfacing.

A man in his late 30s developed non-ischaemic cardiomyopathy due to systemic cobalt toxicity associated with accelerated bearing surface wear from metal-on-metal hip resurfacing implanted in the previous 6 years. Following revision arthroplasty, the patient regained baseline cardiac function. Cobalt-induced cardiomyopathy is a grave condition that deserves early consideration due to potentially irreversible morbidity.

Echocardiographic Changes in the Context of Metal-on-Metal Versus Nonmetal-on-Metal Total Hip Arthroplasty.

Background: The purpose of this study is to determine if there is a difference in echocardiographic results between patients with metal-on-metal (MoM) vs non-MoM total hip arthroplasty (THA) and to determine if a correlation exists between serum metal levels and echocardiographic outcomes.

Methods: Seventy-five patients with the same modular THA enrolled in this prospective cohort study, and 49 had MoM bearings. All patients had serum cobalt, chromium, and titanium levels drawn at 2 study visits with a transthoracic echocardiogram at the second visit.

Incidence of Pseudotumors in a Dual Modular Stem Construct With and Without Metal-on-Metal Bearing Surface.

Background: The purpose of this study was to compare the incidence of pseudotumors in metal-on-metal (MoM) titanium modular neck hip arthroplasties to non-MoM modular neck hip arthroplasties. A secondary goal was to determine whether a correlation exists between elevated metal concentrations and pseudotumor incidence.

Methods: The data were collected and evaluated from 49 MoM joints and 26 non-MoM joints between the years 2012 and 2017.

Comparison of Harris Hip Scores and Revision Rates in Metal-on-Metal Versus Non-Metal-on-Metal Total Hip Arthroplasty.

Introduction: This study compares functional outcome scores and revision rates between metal-on-metal (MoM) and non-MoM total hip arthroplasty patients.

Methods: A cohort of 75 patients who underwent implantation of the same dual modular hip arthroplasty between the years of 2004 and 2010 was enrolled. Patients were subsequently evaluated in 2015 to 2017 for joint revision history and functionality, as measured by the Harris hip score (HHS).

Dual-taper modular hip implant: Investigation of 3-dimensional surface scans for component contact, shape, and fit.

Background: The etiology of wear particle generation and subsequent corrosion in modular total hip arthroplasty implants likely begins with mechanical fretting. The purpose of this study was to determine geometric features of the male and female taper surfaces that drive stability within the neck-stem junction.

Methods: Eighteen modular hip components received 3-dimensional surface scans to examine the neck-stem taper junction using an optical scanner.

Hemispherical and minimally invasive total hip reamers: a biomechanical analysis of use and design.

Background: The purpose of this study was to determine the accuracy of used and new reamer systems for both hemispherical and minimally invasive (MIS) acetabular reamers.

Methods: New and used hemispherical and MIS acetabular reamers were tested on a computer numerical control machine to ream holes in special machinable wax blocks. Each reamer was tested 3 times in sizes 48 mm through 55 mm.

The stability of dual-taper modular hip implants: a biomechanical analysis examining the effect of impact location on component stability.

Background: The purpose of this study was to investigate the stability of dual-taper modular implants following impaction forces delivered at varying locations as measured by the distraction forces required to disassemble the components.

Methods: Distraction of the head-neck and neck-stem (NS) tapers of dual-taper modular implants with 0°, 8°, and 15° neck angles were measured utilizing a custom-made distraction fixture attached to a servohydraulic materials test machine. Distraction was measured after hand pressing the components as well as following a simulated firm hammer blow impaction.

Ultrasound findings in asymptomatic patients with modular metal on metal total hip arthroplasty.

Objective: The use of metal-on-metal and modular total hip arthroplasty is associated with potentially serious local and systemic complications. The primary aim of this study was to identify the prevalence of a pseudotumor in asymptomatic patients with a particular metal-on-metal hip prosthesis after a minimum follow-up of 5 years using ultrasound evaluation. A secondary purpose was to identify associations between the presence of pseudotumor and serum metal ion levels following implantation.

Heterotopic Ossification Prophylaxis After Total Hip Arthroplasty: Randomized Trial of 400 vs 700 cGy.

Background: Heterotopic ossification (HO) is a known complication following total hip arthroplasty. Radiation is an effective prophylaxis, but an optimal protocol has yet to be determined. We performed a randomized, double-blinded clinical trial in high-risk patients to determine the efficacy of 400 vs 700 cGy doses of radiation.

Effect of Body Mass Index on Blood Transfusion in Total Hip and Knee Arthroplasty.

Perioperative blood management remains a challenge during total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to systematically examine the relationship between body mass index (BMI) and perioperative blood transfusion during THA and TKA while attempting to resolve conflicting results in previously published studies. The authors retrospectively evaluated 2399 patients, 896 of whom underwent THA and 1503 of whom underwent TKA.

The Effect of Impact Location on Force Transmission to the Modular Junctions of Dual-Taper Modular Hip Implants.

Background: The purpose of this study was to investigate the effect that off-axis impaction has on stability of dual-taper modular implants as measured by forces delivered to and transmitted through the head-neck and neck-stem tapers, respectively.

Methods: One hundred forty-four impact tests were performed using 6 different directions: one on-axis and five 10° off-axes. Four different simulations were performed measuring the head-neck only and 3 different neck angulations: 0°, 8°, and 15°.

Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial.

Background: Tranexamic acid (TXA) reduces perioperative blood loss in total hip arthroplasty (THA).

Methods: In our randomized control trial, 139 patients were enrolled and received 2 g of either topical or intravenous (IV) TXA. Preoperative and postoperative protocols were standardized.

Intraoperative Periprosthetic Femur Fracture: A Biomechanical Analysis of Cerclage Fixation.

Intraoperative periprosthetic femur fracture is a known complication of total hip arthroplasty (THA) and a variety of cerclage systems are available to manage these fractures. The purpose of this study was to examine the in situ biomechanical response of cerclage systems for fixation of periprosthetic femur fractures that occur during cementless THA. We compared cobalt chrome (CoCr) cables, synthetic cables, monofilament wires and hose clamps under axial compressive and torsional loading.

Rivaroxaban Versus Enoxaparin for Venous Thromboembolism Prophylaxis after Hip and Knee Arthroplasty.

The oral Factor Xa inhibitor rivaroxaban (Xarelto) has been the pharmacologic agent used for venous thromboembolism (VTE) prophylaxis after primary hip and knee arthroplasty (THA/TKA) at our institution since February 2012. The purpose of our study was to compare rates of VTE and major bleeding between rivaroxaban and our previous protocol of enoxaparin after THA/TKA. A retrospective cohort study was performed including 2406 consecutive patients at our institution between 1/1/11 and 9/30/13.

Predictors and complications of blood transfusion in total hip and knee arthroplasty.

Perioperative patient optimization can minimize the need for blood transfusions in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to determine predictors and complications of transfusions. This retrospective review analyzed 1795 patients who underwent primary THA and TKA at our institution between January 2011 and December 2012.

Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis.

Modular neck femoral stems have a higher-than-anticipated rate of failure in registry results, but large single-center cohort studies are lacking. This is a retrospective cohort of 152 hips implanted with a single titanium stem with a modular titanium neck, presenting clinical, radiographic, and metal ion results at a mean 4.5-year follow-up.

A prospective double-blind placebo controlled trial of topical tranexamic acid in total knee arthroplasty.

Tranexamic acid (TNA) reduces postoperative blood loss in general and obstetrical surgery but there is limited orthopaedic literature regarding its use in the topical setting. To study the effect of topical TNA after primary total knee arthroplasty (TKA), 101 patients were randomized to topical administration of 2.0g TNA in 75mL of normal saline (50 patients) or placebo (51 patients).

In vivo oxide-induced stress corrosion cracking of Ti-6Al-4V in a neck-stem modular taper: Emergent behavior in a new mechanism of in vivo corrosion.

In vivo modular taper corrosion in orthopedic total joint replacements has been documented to occur for head-neck tapers, modular-body tapers, and neck-stem tapers. While the fretting corrosion mechanism by which this corrosion occurs has been described in the literature, this report shows new and as yet unreported mechanisms at play. A retrieved Ti-6Al-4V/Ti-6Al-4V neck-stem taper interface, implanted for 6 years is subjected to failure analysis to document taper corrosion processes that lead to oxide driven crack formation on the medial side of the taper.

Joint and long-bone gunshot injuries.

Gunshot wounds remain a major clinical problem, with the number of nonfatal gunshot wounds reported as 60,000 to 80,000 per year in the United States. Bone or joint injuries comprise a major portion of gunshot wound injuries. It is paramount for orthopaedic surgeons to be thorough in their treatment of patients with these injuries.