Internet-Based Exercise Therapy Using Algorithms for Conservative Treatment of Anterior Knee Pain: A Pragmatic Randomized Controlled Trial.

Background: Conservative treatment remains the first-line option, and there is significant medical evidence showing that home-based exercise therapy for the treatment of common causes of knee pain is effective. SimpleTherapy created an online platform that delivers Internet-based exercise therapy for common causes of knee pain. The system is driven by an algorithm that can process the user's feedback to provide an adaptive exercise regimen.

Percutaneous external fixator pins with bactericidal micron-thin sol-gel films for the prevention of pin tract infection.

Risk of infection is considerable in open fractures, especially when fracture fixation devices are used to stabilize the fractured bones. Overall deep infection rates of 16.2% have been reported.

Ceramic-on-ceramic total hip arthroplasty in patients younger than 55 years.

Purpose: To review the outcomes of 65 patients younger than 55 years who underwent uncemented total hip arthroplasty (THA) using third-generation ceramic-on-ceramic prostheses.

Methods: Medical records of 30 men and 35 women (80 hips) aged 18 to 55 (mean, 39) years who underwent uncemented THA using third-generation ceramic-onceramic prostheses by a single surgeon were reviewed. 61 THAs used the Reflection cup with the Synergy stem (n=49), Spectron stem (n=7), or Anthology stem (n=5), and 19 THAs used the Trident cup with the Secur-Fit stem.

Saline-coupled bipolar sealing in simultaneous bilateral total knee arthroplasty.

Background: The efficacy of saline-coupled bipolar sealing devices in joint arthroplasty is uncertain, and the utility in simultaneous bilateral total knee arthroplasty (TKA) has not been reported.

Methods: This study compares the use of bipolar sealing and conventional electrocautery in 71 consecutive patients. The experimental and control groups were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin.

Bactericidal micron-thin sol-gel films prevent pin tract and periprosthetic infection.

Orthopedic injuries constitute the majority of wounds sustained by U.S. soldiers in recent conflicts.

Periprosthetic fractures around loose femoral components.

The development of periprosthetic fractures around loose femoral components can be a devastating event for patients who have undergone total hip arthroplasty (THA). As indications for THA expand in an aging population and to use in younger patients, these fractures are increasing in incidence. This review covers the epidemiology, risk factors, prevention, and clinical management of periprosthetic femoral fractures.

FDG PET for diagnosing infection in hip and knee prostheses: prospective study in 221 prostheses and subgroup comparison with combined (111)In-labeled leukocyte/(99m)Tc-sulfur colloid bone marrow imaging in 88 prostheses.

Purpose: This study aims to assess and compare the value of FDG PET with combined In-labeled leukocyte/Tc-sulfur colloid bone marrow (WBC/BM) imaging for diagnosing infection in hip and knee prostheses.

Methods: In this prospective study, patients with painful hip or knee arthroplasty, who were scheduled to undergo clinical and diagnostic evaluation for prosthesis revision, were included. They have been studied by using FDG PET and WBC/BM scan.

Outcomes of long tapered hydroxyapatite-coated stems in revision total hip arthroplasty.

The purpose of this study was to evaluate the outcome of femoral component revisions using a long tapered HA coated femoral revision stem. Between 2001 and 2008, 55 femoral component revisions were performed using this stem. Forty-one patients were available for follow up evaluation at average of 59 months.

Cement technique for reducing post-operative bursitis after trochanteric fixation.

Post-operative trochanteric bursitis is a known complication secondary to the surgical approach in total hip arthroplasty. This phenomenon may be partially attributable to repetitive microtrauma generated when soft tissues rub against implanted hardware. Significant rates of post-operative trochanteric bursitis have been observed following procedures in which a trochanteric fixation device, such as a bolt-washer mechanism or a cable-grip/claw system, is used to secure the trochanteric fragment after trochanteric osteotomy.

Managing massive bone loss after infected total knee arthroplasty with a custom-made spacer.

Periprosthetic infection is an increasingly prevalent and challenging problem in joint reconstruction. We present a technical report of a custom spacer for management of an infected total knee arthroplasty (TKA) and concomitant severe bone loss. The spacer was designed to provide sufficient leg length, soft tissue tension, and limb stability in preparation for ultimate limb reconstruction.

Steinman pin technique for the removal of well-fixed femoral stems.

Femoral stems with the capacity for exuberant bony in-growth, such as hydroxyapatite- or porous-coated stems, pose a challenge in the revision setting if extraction is required. The goal of minimal bone loss is crucial. We present an adjunct technique for the removal of well-fixed femoral stems with the use of Steinman pins.

Current concepts in diagnosis and management of periprosthetic infection.

Infection remains a devastating complication of total joint arthroplasty. There have been many significant advances to help identify and reduce the risks of infection over the years. However, when an infection occurs, the management can be complex.

Bipolar sealing in revision total hip arthroplasty for infection: efficacy and cost analysis.

Saline-coupled bipolar sealing has shown mixed results in primary arthroplasty. However, this technology has not been studied in infected revision total hip arthroplasty (THA), where morbidity is higher and conventional methods of blood management, such as cell salvage, often cannot be used. This case-matched study of 76 consecutive revision THA for infection included an experimental bipolar sealing group and a control group of conventional electrocautery.

Retrieval analysis of squeaking alumina ceramic-on-ceramic bearings.

This multicentre study analysed 12 alumina ceramic-on-ceramic components retrieved from squeaking total hip replacements after a mean of 23 months in situ (11 to 61). The rates and patterns of wear seen in these squeaking hips were compared with those seen in matched controls using retrieval data from 33 'silent' hip replacements with similar ceramic bearings. All 12 bearings showed evidence characteristic of edge-loading wear.

Prophylactic decompression and bone grafting for small asymptomatic osteonecrotic lesions of the femoral head.

Core decompression and grafting has been shown to relieve pain and possibly prevent disease progression in patients with symptomatic osteonecrosis (ON) of the hip. However, there is a lack of evidence regarding the management of the asymptomatic hip with femoral head ON. The purpose of this study was to evaluate the outcome of core decompression in the asymptomatic hip with ON.

Prospective results of uncemented tantalum monoblock tibia in total knee arthroplasty: minimum 5-year follow-up in patients younger than 55 years.

A significant increase in younger patients undergoing total knee arthroplasty raises the theoretical concern for revision secondary to micromotion and fixation failure with cemented components. We prospectively studied 100 consecutive tantalum monoblock uncemented tibial components and 312 concurrent cemented controls. Patients younger than 55 years with adequate bone stock were enrolled.

Autologous blood reinfusion in patients undergoing bilateral total hip arthroplasty.

Purpose: To compare the rate and unit of allogeneic blood transfusion in one-stage bilateral total hip arthroplasty (THA) in patients with and without autologous blood reinfusion.

Methods: Records of a consecutive series of 43 men and 33 women aged 25 to 83 (mean, 55) years who underwent one-stage sequential bilateral THA by a single surgeon were reviewed. Their risks of cardiopulmonary complications were minimal.

Porous tantalum patellar components in revision total knee arthroplasty minimum 5-year follow-up.

Revision total knee arthroplasty can be complicated by severe patellar bone loss, precluding the use of standard cemented patellar components. This study evaluated the midterm outcomes of porous tantalum (PT) patellar components. Twenty-three PT components were used in 6 men and 17 women (average age, 62 years).

Comparison of surgical outcomes and implant wear between ceramic-ceramic and ceramic-polyethylene articulations in total hip arthroplasty.

The results of a prospective multicenter trial comparing 357 hips randomized to total hip arthroplasty with either ceramic-ceramic or ceramic-polyethylene couplings are presented. No statistically significant difference in clinical outcomes scores between the ceramic-ceramic and ceramic-polyethylene groups was observed at any time interval. The mean linear rate was statistically lower (P < .

Impaction bone grafting with proximal and distal femoral arthroplasty.

Capacious diaphyses and poor bone stock in revision arthroplasty can lead to fracture and poor component fixation. Impaction bone grafting can be performed in salvage reconstructions in cases with extensive circumferential bone loss. We present a consecutive series of patients who underwent proximal or distal femoral reconstructions in combination with impaction bone grafting.

Seven-year results of a tapered, titanium, hydroxyapatite-coated cementless femoral stem in primary total hip arthroplasty.

Background: Aseptic loosening of cemented hip prostheses is recognized as a long-term problem, and especially in males and younger patients. Much energy has been focused on developing new prostheses that are designed for cementless fixation. We evaluated the performance of and periprosthetic bone response to a tapered, titanium, hydroxyapatite (HA)-coated femoral hip prosthesis at a minimum of 7 years of follow-up after treatment with primary total hip arthroplasty.

Limb salvage after infected knee arthroplasty with bone loss and extensor mechanism deficiency using a modular segmental replacement system.

Multiple total knee arthroplasty revisions pose significant surgical challenges, such as bone loss and soft tissue compromise. For patients with bone loss and extensor mechanism insufficiency after total knee arthroplasty, arthrodesis is a treatment option for the avoidance of amputation. However, arthrodesis is both difficult to achieve in situations with massive bone loss and potentially undesirable due to the dramatic shortening that follows.