Long-term outcomes of acetabular impaction grafting with cemented cups and trabecular metal for revision hip arthroplasty: a follow-up study.

Introduction: Revision hip arthroplasty in the presence of complex acetabular deficiencies is challenging. Cement, allograft, reconstruction rings and porous trabecular metal now provide versatile options for acetabular fixation and restoration of acetabular offset. We compare acetabular impaction bone grafting (AIBG) and trabecular metal (TM) cups at long-term follow-up.

A modified Delphi consensus statement on patellar instability: part I.

Aims: The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach.

Methods: A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability.

A modified Delphi consensus statement on patellar instability: part II.

Aims: The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process.

Methods: This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area.

A standardised communication tool reduces radiation exposure associated with intraoperative fluoroscopy.

Background: The widespread use of intraoperative fluoroscopy in orthopaedic procedures has revolutionised surgical practice. However, there are risks associated with using ionising radiation. Efforts to reduce radiation exposure include low-dose imaging protocols and lead protective equipment.

Subsidence of monoblock and modular titanium fluted tapered stems in revision hip arthroplasty: A retrospective multicentre comparison study.

Background: Tapered, fluted, titanium (TFT) stems have shown good clinical outcomes in revision total hip arthroplasty (rTHA), however concerns exist regarding early subsidence. This study compares subsidence between a modern monoblock 3-degree and a modular 2-degree TFT stem in rTHA.

Methods: A retrospective, international multicentre comparative study was conducted including 64 rTHA in 63 patients.

Weight-bearing Allowed Following Internal Fixation of Ankle Fractures, a Systematic Literature Review and Meta-Analysis.

Background: Postoperative management regimes vary following open reduction and internal fixation of unstable ankle fractures. Traditional postoperative nonweightbearing cast immobilization may prevent loss of fixation and protect the soft tissue envelope but may also be associated with poorer functional outcomes. This systematic review and meta-analysis aimed to compare the complication rate and functional outcomes of early weightbearing (EWB) vs late weightbearing (LWB) following open reduction and internal fixation of ankle fractures.

Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

Background: Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres.

Short-term outcomes of total knee arthroplasty performed with and without a tourniquet.

Introduction: Not using a tourniquet could improve early postoperative pain, range of motion (ROM), length of stay (LOS), and thromboembolic risk in patients undergoing total knee arthroplasty (TKA). Our aim was to compare these factors, intraoperative blood loss, and gender-related outcomes in patients undergoing primary TKA with or without a tourniquet.

Methods: We performed a retrospective cohort study of 97 patients undergoing TKA with or without tourniquet from 2018 to 2020.

A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations.

Background: Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations.

Methods: We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar.

Incidence and Risk Factors for the Development of Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) in Total Joint Arthroplasty Patients.

Background: Acute colonic pseudo-obstruction (Ogilvie syndrome [OS]) is a rare but devastating condition that can develop in orthopaedic patients postoperatively. The objective of this study was to identify the risk factors for developing OS after total hip arthroplasty (THA) or total knee arthroplasty (TKA) and to compare the outcomes between patients who did and did not develop OS postoperatively.

Methods: This was a retrospective review using the National Inpatient Sample, a national database incorporating inpatient hospitalization information.

Single 3° tapered fluted femoral stems demonstrate low subsidence at mid-term follow-up in severe bony deficiency.

Background: Tapered femoral stems have become popular in revision total hip arthroplasty (rTHA). Increasing the distal taper angle may mitigate subsidence. This study reports osseointegration of a new 3 degree distal taper revision stem at minimum 4 years post-operatively.

404 Porous titanium revision shells permit early weight-bearing and rapid rehabilitation in revision hip surgery.

An aging population and younger primary arthroplasty candidates have led to increased demand for acetabular bone deficient revision hip surgery. Seventy consecutive revision arthroplasty porous titanium shells prior to December 2011 were reviewed. We sought to determine evidence of implant instability in a cohort of patients that are mobilised early.

Self-Directed Oral Vitamin D Supplementation in Professional Ballet Dancers: A Randomized Controlled Trial Pilot Study.

Inadequate levels of vitamin D may lead to poor performance in professional dancers. Therefore, dietary supplementation may be essential in this population. This longitudinal pilot study to a randomized controlled trial assessed dancer compliance with self-directed oral vitamin D supplementation.

The Role of One-Stage Exchange for Prosthetic Joint Infection.

Purpose Of Review: In an era of increasing numbers of hip and knee replacements, strategies to manage prosthetic joint infection (PJI) that are effective at infection control with good patient-reported outcomes and cost containment for health systems are needed. Interest in single-stage exchange for PJI is rising and we assess evidence from the last 5 years related to this treatment strategy.

Recent Findings: Only five series for total knee replacement and ten series for total hip replacement have been reported in the last five years.

Prevention of Dislocation After Total Hip Arthroplasty.

Background: Prevention of dislocation after primary total hip arthroplasty (THA) begins with patient preoperative assessment and planning.

Methods: We performed a literature search to assess historical perspectives and current strategies to prevent dislocation after primary THA. The search yielded 3458 articles, and 154 articles are presented.

The onset of fretting at the head-stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions.

Mechanically assisted crevice corrosion (MACC) is a mechanism for trunnion damage in total hip arthroplasties (THAs). Retrieval studies have shown reduced MACC-related damage for ceramic heads compared with cobalt-chromium (CoCr) heads. We propose that ceramic heads demonstrate fretting at higher cyclic compressive loads than CoCr heads on titanium alloy trunnions in a simulated corrosion model.

Dual-Mobility vs Fixed-Bearing Total Hip Arthroplasty in Patients Under 55 Years of Age: A Single-Institution, Matched-Cohort Analysis.

Background: Prosthetic dislocation of total hip arthroplasty (THA) is a common cause for revision surgery. Dual-mobility (DM) bearings were introduced to mitigate complications; however, their performance in younger patients is unknown. This study compared results of patients <55 years of age with DM vs fixed-bearing (FB) primary THA.

Early experience with dual mobility acetabular systems featuring highly cross-linked polyethylene liners for primary hip arthroplasty in patients under fifty five years of age: an international multi-centre preliminary study.

Purpose: To evaluate early performance of contemporary dual mobility acetabular systems with second generation annealed highly cross-linked polyethylene for primary hip arthroplasty of patients under 55 years of age.

Methods: A prospective observational five years study across five centers in Europe and the USA of 321 patients with a mean age of 48.1 years was performed.

A comparison of acetabular impaction grafting and trabecular metal for revision arthroplasty.

Background: Acetabular defect reconstruction in revision hip arthroplasty may be achieved with acetabular impaction bone grafting (AIBG) or porous trabecular metal (TM) implantation. We sought to compare clinical and radiological outcomes of both methods at a single institution.

Methods: 36 patients that were revised using AIBG and 17 patients that were revised with TM were retrospectively reviewed from local joint registry data.

The Oswestry Spinal Risk Index (OSRI): an external validation study.

Purpose: The Oswestry Spinal Risk Index (OSRI) was recently reported as an adjunct in the management of metastatic spinal disease. Based on the tumour type and a general condition score, survivorship is predicted. We aimed to externally validate this new score.

An assessment of the readability and quality of elective orthopaedic information on the Internet.

This study assessed the readability and quality of websites related to; total hip replacement, total knee replacement and anterior cruciate ligament reconstruction using validated instruments. 225 websites were analyzed from Google, Yahoo and Bing. Readability was assessed using the Flesch Reading Ease Score and Flesch-Kincaid grade level.

A mountain among molehills: removing an impinging large femoral neck osteochondroma in a man with hereditary multiple exostoses.

A 31-year-old man with a history of hereditary multiple exostoses (HME) presented with persistent right groin pain and reduced hip range of movement. Examination demonstrated a positive FADIR (flexion, adduction and internal rotation) test suggesting femoroacetabular impingement (FAI). Investigations showed multiple sessile osteochondromata of the right femur with a dominant anterolateral femoral neck osteochondroma causing flexion block.

RhBMP-2 use in lumbar fusion surgery is associated with transient immediate post-operative leg pain.

Purpose: Supra-physiological rhBMP loads during spinal fusion may trigger local inflammation and post-operative radiculitis. MRI is an effective tool to detect nerve root compression in severe post-operative leg pain. The aim of this study was to determine if recombinant bone morphogenic protein 2 (rhBMP-2) is associated with immediate post-operative leg pain without evidence of root compression using MRI.