Impact of dental clearance on total joint arthroplasty: A systematic review.

Many orthopedic surgeons require that their patients obtain dental clearance before elective total joint arthroplasty (TJA). However, there is no consensus substantiating the practice. To this end, a systematic review on the prevalence of dental pathology in TJA patients, risk factors for failing dental screening, and impact of dental evaluations was performed.

Clinical Results of Direct Anterior Approach THA with Minimal Fluoroscopic Exposure Optimization Techniques.

Purpose: To determine if low-level intraoperative fluoroscopy usage is associated with increased complications during an initial series for an experienced surgeon transitioning to direct anterior approach (DAA) for total hip arthroplasty (THA).

Materials And Methods: Subjects who underwent DAA were eligible for analysis. Inclusion criteria included the first 50 subjects who underwent DA hip arthroplasty by a single surgeon (January 2013 to December 2014).

Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use.

Background: Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation from a single-blind trial. In the present study, we used double-blind methodology to compare motor cortex tDCS and prefrontal cortex tDCS to both sham and active-control (active electrodes over non-pain modulating brain areas) tDCS.

Complications of hip and knee joint replacement in solid-organ transplant patients.

This study investigated complication rates for 68 solid-organ transplant patients who had undergone 94 primary hip or knee joint replacements at a single institution from 1995 to 2008. There was a deep infection rate of 6.8% in the transplant patients compared to a 1.

The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions.

Study Objective: To determine whether an automated intermittent bolus technique provides enhanced analgesia compared with a continuous infusion for femoral nerve block.

Design: Prospective, single-blinded, randomized controlled trial (ClinicalTrials.gov Identifier: NCT01226927).

Detection of mammaglobin mRNA in peripheral blood is associated with high grade breast cancer: interim results of a prospective cohort study.

Background: We sought to examine the detection rate of cancer cells in peripheral blood (PBL) and in bone marrow (BM) using an established 7-gene marker panel and evaluated whether there were any definable associations of any individual gene with traditional predictors of prognosis.

Methods: Patients with T1-T3 primary breast cancer were enrolled into a prospective, multi-institutional cohort study. In this interim analysis 215 PBL and 177 BM samples were analyzed by multimarker, real-time RT-PCR analysis designed to detect circulating and disseminated breast cancer cells.

Failure analysis of composite femoral components for hip arthroplasty.

In this research, a numerical method was developed for predicting the progressive failure of thick laminated composite femoral components. A three-dimensional (3-D) global/ 3-D local technique was developed to capture the overall structural response of this system, while also enabling the 3-D ply-level stress state to be determined efficiently and accurately. Different failure criteria and material degradation models were incorporated in the method, giving it the flexibility to model a wide range of materials and structures.

Progressive failure analysis of laminated composite femoral prostheses for total hip arthroplasty.

In this research program, a numerical method was developed to predict the progressive failure of a thick laminated composite femoral component for total hip arthroplasty. A 3-D global/local technique was used to capture the overall structural response of this system while also enabling the 3-D ply level stress state to be determined efficiently and accurately. Different failure criteria and different material degradation models were incorporated as individual subroutines in the numerical method, giving it the flexibility to model a wide range of materials and structures.

Mechanical stability of polyethylene liners cemented into acetabular shells.

Revision of well-fixed, metal-backed acetabular components for dislocation or polyethylene failure requires consideration of removing the entire construct or replacing the polyethylene liner only. For non-modular or first-generation modular components with poor locking mechanisms, one option is to cement undersized liners into well-fixed shells. The purpose of this study was to measure the stability of undersized liners cemented into metal acetabular shells and compare the results with those of modular components.

Noncompliance in the inpatient administration of enoxaparin in conjunction with epidural or spinal anesthesia.

Deep venous thrombosis is 1 of the most common postoperative complications resulting in significant mortality and morbidity in patients undergoing total hip and total knee arthroplasty. Research has shown that the effectiveness and safety of low-molecular-weight heparins depend on the timeliness of their administration, particularly when used in conjunction with spinal or epidural anesthesia, both of which are effective and safe treatment modalities for knee and hip arthroplasty. The focus of this study was to examine the compliance with current protocols in the administration of enoxaparin (Lovenox) to patients who had undergone total joint arthroplasty.

Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity.

Background: Distinction between uncomplicated infective fasciitis and early necrotizing fasciitis can be extremely difficult without operation, yet the management and prognosis of both conditions depend greatly on early recognition and assessment of the extent of involvement.

Study Design: This was a prospective review of the utility of magnetic resonance imaging (MRI) in nine patients with suspected infective or necrotizing fasciitis treated at an academic medical center or a Veterans Administration hospital.

Results: Magnetic resonance imaging documented fascial inflammation, characterized by low intensity on T1-weighted images and high intensity on T2-weighted images, in all nine patients.

Effects of acetabular abduction on cup wear rates in total hip arthroplasty.

This study was designed to determine the effect of acetabular abduction on the polyethylene wear rates of the acetabular component. The hypothesis of this study is that acetabular placement, in particular abduction, effects contact forces and therefore polyethylene wear. A total of 364 total hip arthroplasties that were performed between 1974 and 1976 were included in this study.

Is duplex venous surveillance worthwhile after arthroplasty?

Deep venous thrombosis (DVT) complicates 60% of knee and 80% of hip arthroplasties performed without prophylactic therapy. Routine postoperative duplex ultrasound surveillance has been proposed for the detection of venous thrombosis following arthroplasty. In order to determine whether surveillance represents an effective strategy to detect postoperative DVT when prophylaxis is used, surveillance duplex exams obtained after primary or revision hip or knee arthroplasty were analyzed using decision analysis techniques.

Long-term compressive property durability of carbon fibre-reinforced polyetheretherketone composite in physiological saline.

In total hip arthroplasty, concerns such as corrosion and stress shielding associated with stiff metallic femoral components have led to the development of low stiffness advanced fibre-reinforced polymer (FRP) composite femoral components. Carbon fibre-reinforced polyetheretherketone (CF/PEEK) composite material is now one of the primary material systems being considered for composite hip stem development. As a hip stem, a composite material must be able to support a complex state of stress in the in vivo environment without failure.

Long-term durability of the interface in FRP composites after exposure to simulated physiologic saline environments.

Fiber/matrix interfacial bond strength significantly influences the mechanical behavior of fiber-reinforced polymer (FRP) composites. Interfacial bond strength durability is therefore particularly important in the development of FRP composites for implant applications where diffused moisture may potentially weaken the material over time. In this study, the long-term durability of interfacial bonding in carbon fiber/380 grade polyetheretherketone (C/PEEK) and carbon fiber/polysulfone (C/PSF) composites was investigated after exposure to hygrothermal environments.