Bilateral Total Knee Arthroplasty and In-Hospital Opioid Dispension: A Population-Based Study.

Background: There is paucity of data regarding opioid dispension in patients undergoing bilateral total knee arthroplasty (BTKA). Our aim is to compare in-hospital opioid dispension between BTKA and unilateral TKA (UTKA) and to identify other factors associated with opioid dispension in the BTKA and UTKA cohorts.

Methods: Patients receiving elective TKA from 2006 to 2016 were retrospectively extracted from the Premier Healthcare Database.

Characterization of laboratory and real driving emissions of individual Euro 6 light-duty vehicles - Fresh particles and secondary aerosol formation.

Emissions from passenger cars are one of major sources that deteriorate urban air quality. This study presents characterization of real-drive emissions from three Euro 6 emission level passenger cars (two gasoline and one diesel) in terms of fresh particles and secondary aerosol formation. The gasoline vehicles were also characterized by chassis dynamometer studies.

Same-Day Surgery Does Not Increase the Manipulation Under Anesthesia and Reoperation Rates for Stiffness Following Bilateral Total Knee Arthroplasty.

Background: There is a paucity of data on the incidence of stiffness and need for subsequent manipulation under anesthesia (MUA) and reoperation following same-day bilateral total knee arthroplasty (BTKA). We compared the rates of at least 1 MUA, bilateral knee involvement, single and multiple MUA rates, and stiffness-related reoperation rates between patients undergoing same-day, same-admission staged, and staged within 1 year BTKA in a tertiary institution.

Methods: We analyzed institutional data for 3175 same-day (group A), 153 same-admission staged (group B), and 1226 staged within 1 year BTKA patients (group C) from 1998 to 2009.

Superior knee flexor strength at 2 years with all-inside short-graft anterior cruciate ligament reconstruction vs a conventional hamstring technique.

Purpose: To compare the "all-inside technique" for anterior cruciate ligament (ACL) reconstruction using a short, quadrupled semitendinosus tendon (ST4) autograft and suspensory cortical fixation on both the femoral and tibial side vs the "conventional technique" using a semitendinosus/gracilis (ST/G) autograft fixed with a suspensory device on the femoral side and with an interference screw on the tibial side, in terms of clinical and functional outcomes.

Methods: A total of 90 patients were enrolled, randomised into two groups, and prospectively followed. Group A comprised 45 patients treated with the all-inside technique and Group B included 45 patients treated with the conventional ACL technique (55 males, 35 females; mean age 28.

A study on the CO and NO emissions performance of Euro 6 diesel vehicles under various chassis dynamometer and on-road conditions including latest regulatory provisions.

The current study presents a detailed analysis of the gaseous emissions, focusing on CO and NO, of diesel vehicles under several operating conditions. An assessment is also made on the impact and effectiveness of the Real Driving Emissions (RDE) test, which is mandatory by the European Union (EU) type approval regulation for passenger cars since September 2017. The method followed comprises emissions measurement tests on three Euro 6 diesel vehicles, under laboratory and various on-road operation conditions.

Surgical approach does not affect deep infection rate after primary total hip arthroplasty.

Background: There is a concern for higher rates of wound complications and a potentially increased periprosthetic joint infection (PJI) risk after total hip arthroplasty (THA) with the direct anterior approach (DAA) compared to the posterolateral approach (PLA). Our purpose was to compare PJI risk after THA with the DAA or the PLA and to identify risk factors for PJI after primary THA.

Methods: Clinical characteristics of patients treated in our institution with primary DAA or PLA THA between 1/2010 and 12/2015 were retrospectively reviewed.

Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty.

Background: Effective blood management strategies are a major determinant of successful outcomes after one-stage bilateral total knee arthroplasty (BTKA). Proper patient selection with preoperative optimization and intra- and postoperative interventions can reduce transfusion risk and associated morbidity in these patients.

Questions/purposes: The purpose of this study was to evaluate intraoperative blood management modalities based on three keystone questions: (1) What is the role of the anesthesiologist?, (2) Which are the surgeon-dependent strategies?, and (3) Is there any place for pharmacologic interventions?

Methods: We searched the established electronic literature database MEDLINE.

Does blood transfusion type affect complication and length of stay following same-day bilateral total knee arthroplasty?

Same-day Bilateral Total Knee Arthroplasty (BTKA) safety is still controversial. The aim of this study was to examine the association of blood transfusion type (pure autologous, pure allogeneic, and combined) with complication and prolonged length of stay (PLOS) following same-day BTKA. 649 consecutive patients were retrospectively identified over a two-year period.

Rate and Risk Factors for Periprosthetic Joint Infection Among 36,494 Primary Total Hip Arthroplasties.

Background: As periprosthetic joint infections (PJIs) can have tremendous health and socioeconomic implications, recognizing patients at risk before surgery is of great importance. Therefore, we sought to determine the rate of and risk factors for deep PJI in patients undergoing primary total hip arthroplasty (THA).

Methods: Clinical characteristics of patients treated with primary THA between January 1999 and December 2013 were retrospectively reviewed.

Infection risk assessment in patients undergoing primary total knee arthroplasty.

Purpose: To determine the incidence and to identify potential risk factors for in-hospital and late infections, as well as for deep periprosthetic joint infection (PJI) following TKA.

Methods: We identified 17,959 patients treated with primary TKA between 2000 and 2009. We recorded patient demographics, comorbidities and in-hospital complications.

Experimental assessment of the potential to decrease diesel NO emissions beyond minimum requirements for Euro 6 Real Drive Emissions (RDE) compliance.

The objective of this study was to test the potential for NO emissions improvements on a typical Euro 6 diesel vehicle, following modifications to its emissions control system, under Real Drive Emissions (RDE) testing conditions. A commercially available car was selected and was first measured in its original configuration according to RDE on the road and an initial conformity factor (CF) of 5.4 was determined.

Perioperative Morbidity of Same-Day and Staged Bilateral Total Hip Arthroplasty.

Background: Management strategies for bilateral hip degenerative disease include same-day or staged bilateral total hip arthroplasty (THA), but information on outcomes remains sparse. We sought to describe in-hospital complications and blood transfusion rates after same-day and staged bilateral THAs at different time intervals and to assess risk factors for these events.

Methods: We retrospectively reviewed administrative data for 3785 patients treated with same-day bilateral (n = 1946; group A) and staged bilateral THA within (1) 0-3 months apart (n = 328; group B); (2) 3-6 months apart (n = 703; group C); and (3) 6-12 months apart (n = 808; group D), between 1999 and 2014.

Implant retention after acute and hematogenous periprosthetic hip and knee infections: Whom, when and how?

Periprosthetic joint infections (PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement (I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state.

Periprosthetic Infection Recurrence After 2-Stage Exchange Arthroplasty: Failure or Fate?

Background: Two-stage exchange arthroplasty remains the preferred method for treating a chronic periprosthetic joint infection (PJI) in North America. However, infection recurrence may occur. Previously, recurrent infections have been classified as persistent (same isolated pathogen) or new (different pathogen identified).

Same-Day Surgery Does Not Increase Deep Infection Risk in Bilateral Total Hip Arthroplasty Patients.

Background: Patients with bilateral hip disease may undergo same-day or staged bilateral total hip arthroplasty (THA). Our purpose was to compare the odds and identify risk factors for deep periprosthetic joint infection (PJI) among patients undergoing same-day vs staged bilateral THA (within 1 year or more than 1 year apart).

Methods: Administrative data for patients subjected to same-day and staged bilateral THA between January 1999 and December 2013 were retrieved.

Multiple Irrigation and Debridements for Periprosthetic Joint Infections: Facing a Necessity or Just Prolonging the Inevitable?

Irrigation and debridement (I&D) may be a viable option in selected cases of periprosthetic joint infections (PJI). Our aim was to investigate the role of multiple I&Ds. Among 141 patients with PJI treated with I&D in our institution, 19 were subjected to additional procedures.

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties.

Background: Fretting and corrosion at head-neck junctions of total hip arthroplasties (THAs) have been associated with adverse local tissue reactions in patients with both metal-on-polyethylene (MoP) and metal-on-metal (MoM) prostheses. Femoral head size contributes to the severity of fretting and corrosion in large-diameter MoM THAs, but its impact on such damage in MoP THAs remains unknown.

Questions/purposes: (1) Is femoral head size associated with increased fretting or corrosion at the head-neck junction in MoP total hips? (2) Is duration of implantation associated with increased fretting or corrosion?

Methods: The severity of fretting/corrosion on surfaces of head tapers and stem trunnions was visually examined in 154 MoP THAs retrieved as part of 3282 revision surgeries performed at our institution between January 1, 2007, and December 31, 2013.

Patient, Surgery, and Hospital Related Risk Factors for Surgical Site Infections following Total Hip Arthroplasty.

Surgical site infections (SSI) following total hip arthroplasty (THA) have a significantly adverse impact on patient outcomes and pose a great challenge to the treating surgeon. Therefore, timely recognition of those patients at risk for this complication is very important, as it allows for adopting measures to reduce this risk. This review discusses literature reported risk factors for SSI after THA.

Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome.

Purpose: Our purpose was to identify the success rate and factors predicting outcome of irrigation and debridement (I&D) in patients with deep periprosthetic joint infection (PJI) of the hip.

Methods: We retrospectively reviewed clinical characteristics of patients with deep PJI after primary/revision total hip arthroplasty (THA) between January 2000 and May 2013 treated with I&D. Implant retention was the outcome of interest.

Periprosthetic knee infections treated with irrigation and debridement: outcomes and preoperative predictive factors.

The role of irrigation and debridement (I&D) in the treatment of periprosthetic joint infections (PJI) of the knee remains controversial. Our purpose was to identify the success rate and factors determining outcome of I&D in those patients. Clinical characteristics of 78 patients with PJI of the knee treated with I&D were retrospectively reviewed.

Dual mobility cups in total hip arthroplasty.

Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France.

Management and outcome of diaphyseal aseptic non-unions of the lower limb: a systematic review.

Objectives: To review current treatments utilising biological enhancement modalities and their efficacy for the management of lower limb long bone aseptic non-unions.

Materials & Methods: A systematic review of English articles using PubMed Medline; Ovid Medline; Embase; and the Cochrane Library was performed, supplemented by a manual search of bibliographies.

Results: Thirteen manuscripts met the inclusion criteria reporting on 428 patients.

Effect of vertebroplasty on the compressive strength of vertebral bodies.

Background Context: Percutaneous vertebroplasty has been used successfully for many years in the treatment of painful compressive vertebral fractures due to osteoporosis.

Purpose: To compare the effect of vertebroplasty on the compressive strength of unfractured vertebral bodies.

Study Design: Biomechanical study on cadaveric thoracic vertebrae.

Advances made in the treatment of thoracolumbar fractures: current trends and future directions.

Thoracolumbar fractures are common injuries after blunt trauma and are accompanied with significant morbidity, including neurologic deficit. Parallel to the evolution of initial management during the past few years, efforts have been concentrated on determining clear indications for surgical treatment, as there is no agreement over superiority of conservative or operative treatment. Various classification systems have been used for identifying those injuries requiring surgical intervention.