Excellent 20-Year Results of Total Hip Arthroplasty With Highly Cross-Linked Polyethylene on Cobalt-Chromium Femoral Heads in Patients ≤50 Years.

Background: Highly cross-linked polyethylene (HXLPE) acetabular bearing surfaces have appeared to offer excellent wear resistance, low incidence of wear-related osteolysis, and high implant survivorship at 10-year to 15-year follow-up. However, concerns over potential performance deterioration at longer-term follow-up remain - particularly in younger patients - and outcome data into the third decade have not been available.

Methods: We retrospectively assessed 62 patients (68 hips) who underwent primary total hip arthroplasty (THA) at age ≤50 years with a single manufacturer's cementless components, remelted HXLPE liner, and small diameter (26 and 28 millimeter) cobalt-chromium (CoCr) femoral heads at minimum 18-year follow-up.

Gluteus Maximus Transfer for Hip Abductor Deficiency.

Hip abductor deficiency resulting from gluteus medius and minimus pathology is increasingly recognized as a generator of lateral-sided hip pain. In the setting of a failed gluteus medius repair or in patients with irreparable tears, transfer of the anterior portion of the gluteus maximus muscle can be performed to treat gluteal abductor deficiency. The classic description of the gluteus maximus transfer technique relies solely on bone tunnel fixation.

Mean 16-Year Results of Total Hip Arthroplasty With Alumina Ceramic Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years or Less.

Background: Highly cross-linked polyethylene (HXLPE) is a widely used bearing surface in total hip arthroplasty (THA); long-term results in young patients are limited. We previously demonstrated excellent results in HXPLE on cobalt-chrome femoral heads at 15-year mean follow-up. The purpose of the present study was to investigate polyethylene wear rates, implant survivorships, wear-related revisions, and patient-reported outcomes (PROs) in a young patient cohort who had alumina ceramic on HXPLE coupling at an average 16-year follow-up.

Enhanced Recovery After Primary Total Hip and Knee Arthroplasty: A Systematic Review.

Background: Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical procedure. This study aimed to systematically review the effect of ERAS after primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay, total procedure-related morbidity, and readmission.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with guidance from the Cochrane Handbook for Systematic Reviews of Interventions.

The flipped third fragment in femoral shaft fractures: A reason for open reduction?

Objectives: First introduced by Kuntscher in the 1940s, closed intramedullary nailing of femoral shaft fractures has become the standard of care, with reported union rates up to 99% in some series. However, fractures with large intercalary segments, which are present in 10-34% of femoral shaft fractures, present unique challenges. In particular, how to treat flipped intercalary segments has remained controversial, with some advocating open reduction of these fractures.

Preoperative Risk Factor Screening Protocols in Total Joint Arthroplasty: A Systematic Review.

Background: Preoperative optimization protocols targeting potentially modifiable risk factors could prove beneficial in reducing the rate of complications in lower extremity total joint arthroplasty (LE-TJA). We aimed to summarize the evidence on preoperative screening protocols targeting modifiable risk factors to assess their effect on postoperative outcomes following primary LE-TJA.

Methods: A literature search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in August 2019.

Does Adherence to Preoperative Surgical Selection Criteria Reduce the Rate of Prosthetic Joint Infection in Primary and Revision Total Knee Arthroplasties?

Background: There has been recent increased focus on the importance of modifiable risk factors that can affect the risk of potentially avoidable complications such as prosthetic joint infection (PJI). We aimed to assess the relationship between adherence to a preoperative optimization protocol at our institution and its influence on the rate of PJI after primary and revision total knee arthroplasty (TKA).

Methods: A single-institution, retrospective study was conducted on all elective primary and revision TKAs performed over a 2-year period.

Insurance status is associated with treatment allocation and outcomes after subarachnoid hemorrhage.

Objective: Subarachnoid hemorrhage (SAH) is a particularly devastating type of stroke which is responsible for one third of all stroke-related years of potential life lost before age 65. Surgical treatment has been shown to decrease both morbidity and mortality after subarachnoid hemorrhage. We hypothesized that payer status other than private insurance is associated with lower allocation to surgical treatment for patients with SAH and worse outcomes.