A Cost Analysis of Surgical Approach in Total Hip Arthroplasty.

Background: With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-posterior (P) and direct anterior (DA).

Materials And Methods: A total of 233 THAs (134 P and 99 DA) performed by two fellowship-trained arthroplasty surgeons from 2017 to 2022 were reviewed.

Total Hip Revision with a Custom Acetabular Component and Femoral Allograft-Prosthetic Composite as Salvage for Failed Unstable Megaprosthesis in an Adolescent Patient: A Case Report at 19-Year Follow-up Duration.

Case: A 13-year-old girl presented after a right proximal femur replacement after proximal femoral resection for treatment of an Ewing sarcoma. She presented after multiple episodes of recurrent instability with her hip endoprosthesis chronically dislocated. Her hip was revised to a custom, constrained metal-on-metal acetabular component with a small iliac flange.

What is the Effect of Posterior Osteophytes on Flexion and Extension Gaps in Total Knee Arthroplasty? A Cadaveric Study.

Background: Posterior compartment knee osteophytes may pose a challenge in achieving soft-tissue balance during total knee arthroplasty (TKA). Obtaining symmetry of flexion and extension gaps involves balance of both bony and soft-tissue structures. We hypothesize that space-occupying posteromedial femoral osteophytes affect soft-tissue balance.

Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?

Background: Laboratory studies are routinely obtained preoperatively and postoperatively for total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study evaluates the necessity of routine, perioperative laboratory tests and identifies risk factors for laboratory-associated interventions.

Methods: This retrospective review evaluated 967 consecutive patients scheduled for primary, unilateral TKAs (n = 593) or THAs (n = 374) over an 18-month period at a single institution.

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained recent popularity, with 1 purported benefit being access to intraoperative fluoroscopy. However, there are limited data demonstrating improved component position with the use of intraoperative fluoroscopy. The aim of this study is to compare radiographic implant positioning on 2 consecutive cohorts of patients undergoing DAA THA performed by 1 surgeon either utilizing intraoperative fluoroscopy or not.

Management of Bone Defects in Revision Total Knee Arthroplasty with Use of a Stepped, Porous-Coated Metaphyseal Sleeve.

Background: Revision total knee arthroplasty is a costly operation associated with many challenges including bone loss in the distal end of the femur and proximal end of the tibia. Reconstruction of bone defects remains a difficult problem that may require more extensive reconstruction techniques to restore mechanical stability and ensure long-term fixation. Use of porous-coated metaphyseal sleeves is a modern technique to address bone deficiency in revision total knee arthroplasty.

Total Knee Arthroplasty Kinematics.

Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA.

Does the Method of Sterile Glove-Opening Influence Back Table Contamination? A Fluorescent Particle Study.

Background: Surgical site infections (SSI) may result from inadvertent intraoperative contamination events. This study investigated the method of opening surgical gloves onto the operative field (OF) and potential contamination rates.

Methods: Twenty surgical glove packets were coated with a commercially available fluorescent particle powder.

What Is the Value of Component Loosening Assessment of a Preoperatively Obtained Bone Scan Prior to Revision Total Knee Arthroplasty?

Background: Bone scintigraphy (BS) is frequently ordered to investigate cause of failure following total knee arthroplasty (TKA). Its correlation of component loosening with intraoperative findings (IFs) at the time of revision TKA (rTKA) has not been well studied. This study investigated correlations between the preoperatively obtained radiologist report (RR) of BS, preoperatively documented surgeon prediction (SP) of component loosening, and operative reports documenting IFs.

A retrospective analysis of the merits and challenges associated with simultaneous bilateral THA using the direct anterior approach.

Introduction: 15%-20% of patients presenting for total hip arthroplasty (THA) have bilateral disease. While simultaneous bilateral THA is of interest to patients and surgeons, debate persists regarding its merits. The majority of previous reports on simultaneous bilateral THA involve patients in the lateral decubitus position, which require repositioning, prepping and draping, and exposure of a fresh wound to pressure and manipulation for the contralateral THA.

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay.

Introduction: Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States, representing a health-care cost of US$9 to 20 billion. Hip fracture incidence is projected to increase dramatically. Hospitals must modify clinical models to accommodate this growing burden.

Incidence of heterotopic ossification in direct anterior vs posterior approach to total hip arthroplasty: a retrospective radiographic review.

Purpose: To investigate the prevalence of heterotopic ossification following direct anterior approach total hip arthroplasty compared to posterior approach, performed by a single surgeon at one institution

Methods: All primary THAs performed by the senior author (JEL) over a 70-month period were reviewed, including 235 DAA and 120 posterior THAs. Brooker's system was used to grade HO at a minimum of six months follow-up.

Results: Patients undergoing DAA were less likely to develop clinically significant HO compared to posterior THA (p = 0.