Tibial Baseplate Microstructure Governs High Cycle Fatigue Fracture In Vivo.

Previous studies report rare occurrences of tibial baseplate fractures following primary total knee arthroplasty (TKA). However, at a microstructural scale, it remains unclear how fatigue models developed in vitro apply to fractures in vivo. In this study, we asked: (1) do any clinical factors differentiate fracture patients from a broader revision sample; and (2) in vivo, how does microstructure influence fatigue crack propagation? We identified three fractured tibial baseplates from an institutional review board exempt implant retrieval program.

Dynamic Ultrasound Assessment for Diagnosis of Pseudo-Patellar Clunk Syndrome: A Case Report.

Patellar clunk syndrome (PCS) is a complication of total knee arthroplasty (TKA) leading to audible and palpable clunking of the patellofemoral joint as the knee is extended out of deep flexion. While historically a clinical diagnosis, some cases require further workup and imaging. Here, we demonstrated the utility of dynamic ultrasound assessment for a patient with clunking after TKA and identified a variant of PCS that is not well described in the literature.

Titanium-Titanium Junctions in the Knee Corrode, Generating Damage Similar to the Hip.

Background: Previous studies identified corrosion between the modular tibial components of total knee arthroplasty devices. However, gaps persist. Compared to the hip, damage modes that occur within taper junctions in the knee remain poorly understood.

Retrieval Analysis of Titanium Nitride Coatings for Orthopaedic Implants.

Background: The first generation of titanium nitride (TiN) coatings for orthopaedic implants was clinically introduced in the 1990s because of their promising biocompatibility, wear resistance, and corrosion resistance. This study evaluated the in vivo performance of early TiN-coated knee and hip implants, focusing on the bearing surfaces and mechanisms of in vivo damage.

Methods: There were 13 TiN-coated implants (5 knee and 8 hip) retrieved from 8 patients as part of a multi-institutional implant retrieval program.

Publication Rates of Poster and Podium Presentations at the American Association of Hip and Knee Surgeons Annual Meetings 2016 to 2019.

Background: The objective of this study was to provide the poster and podium publication rates from the 2016 to 2019 American Association of Hip and Knee Surgeons (AAHKS) annual meetings and assess the quality of presentations ultimately published during this time.

Methods: Posters and podiums from 2016 to 2019 were located through the AAHKS e-poster and meeting archives. Titles were queried on Google, Google Scholar, and PubMed.

Femoral Head Penetration Rates and Oxidation of Highly Cross-Linked Polyethylene Hip Liners Implanted More Than 10 Years.

Background: Highly cross-linked polyethylene (HXLPE) was introduced to improve wear in total hip arthroplasty, with manufacturers implementing different thermal treatments to reduce oxidation. It is important to understand how long-term time in vivo affects the wear of these materials. The purpose of this study was to investigate the wear and oxidative performance of first-generation HXLPE hip inserts implanted for greater than 10 years and compare annealed and remelted HXLPE formulations.

Comparison of Early Postoperative Step and Stair Counts With the Direct Anterior Approach Versus the Posterior Approach for Total Hip Arthroplasty.

Background: The purpose of this study was to evaluate the impact of direct anterior approach (DAA) or posterior approach (PA) on step and stair counts after total hip arthroplasty using a remotely monitored mobile application with a smartwatch while controlling for baseline characteristics.

Methods: This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform. The primary outcomes were step and stair counts and changes from baseline through one year.

Evaluating ChatGPT's Capabilities on Orthopedic Training Examinations: An Analysis of New Image Processing Features.

Introduction The efficacy of integrating artificial intelligence (AI) models like ChatGPT into the medical field, specifically orthopedic surgery, has yet to be fully determined. The most recent adaptation of ChatGPT that has yet to be explored is its image analysis capabilities. This study assesses ChatGPT's performance in answering Orthopedic In-Training Examination (OITE) questions, including those that require image analysis.

Are Corrosion and Material Loss a Threat for Titanium-Titanium Tapers in Total Hip Arthroplasty Modular Acetabular Components?

Background: Extensive research has reported on fretting corrosion and material loss for a variety of metal taper interfaces in orthopedic devices. For modular acetabular shell-liner constructs, the interfaces studied thus far have consisted of mixed-metal pairings, and the risk of fretting corrosion and material loss for the all-titanium (Ti) shell-liner taper junction in one ceramic-on-ceramic (COC) design remains poorly understood. We asked: do Ti shell-liner taper interfaces in COC total hip arthroplasty devices show in vivo evidence of (1) fretting and/or corrosion, and (2) quantifiable potential material loss?

Methods: We examined 22 shell-liner pairs and 22 single liners from retrieved COC components.

Evaluation of weight loss counsel for Osteoarthritis patients: A cross-sectional analysis of NHANES 2011-2018.

Objective: Though health care providers (HCPs) know the importance of weight loss counsel for Osteoarthritis (OA), little is known about how frequently it is practiced and even less of its effectiveness. Thus, we analyzed the prevalence and effectiveness of weight counsel receipt in overweight/obese OA patients.

Design: Using 2011-2018 National Health and Nutrition Examination Survey data, we cross-sectionally analyzed overweight/obese patients in the United States to determine the prevalence of receipt of HCP weight counsel in those with OA and among other variables.

Analyzing the Quality and Readability of Online Hyaluronic Acid Knee Injection Resources.

Introduction: We analyzed the quality of information about Hyaluronic acid (HA) knee injections for osteoarthritis using DISCERN, a tool that grades the quality of websites. We also analyzed readability with Flesch-Kincaid grade reading levels (FKGRL).

Methods: Lists of the top ten included sites from Google searches about HA injections were evaluated using DISCERN to determine their quality.

Short-Term Surface Damage Mechanisms of Retrieved Highly Cross-Linked Polyethylene Patellar Components.

Background: Previous retrieval studies of patellar components for total knee arthroplasty focused on historical designs and polyethylene materials that are no longer clinically relevant. Therefore, this study aimed to compare revision reasons and surface damage mechanisms of conventional, gamma inert sterilized polyethylene and highly cross-linked polyethylene (HXLPE) patellar components in contemporary designs from a single manufacturer.

Methods: A total of 114 gamma inert and 76 HXLPE patellar components were gathered in a multicenter orthopaedic implant retrieval program.

The Use of Computerized Tomography Scans in Elective Knee and Hip Arthroplasty-What Do They Tell Us and at What Risk?

The average background radiation exposure in the United States has nearly doubled over the previous quarter century, with almost all the increase derived from medical imaging. Nearly 2% of all cancers in the United States may be attributable to radiation from computerized tomography (CT) scans. Given the nondiagnostic nature of CT scans that are used in elective knee and hip arthroplasty today, special consideration should be given to the inherent risk of radiation exposure with routine use of this technology.

The Influence of Orthopedic Journals in Knee Arthritis Treatment Research: Evaluation Using Relative Citation Ratio.

Introduction The iCite database, developed by the National Institute of Health (NIH), utilizes a bibliometric known as the relative citation ratio (RCR) to gauge scholarly impact. The goal of this study was to use the RCR to evaluate the influence of orthopedic journals in regard to knee arthritis treatment literature, as no such studies exist to date. Materials and methods The 100 highest RCR-rated articles published between 2007 and 2017 were obtained in the following categories: physical therapy (PT), viscosupplementation (VS), nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injection (CSI), results of total knee arthroplasty (TKA), platelet-rich plasma (PRP), and meniscectomy (MS).

Femoral Condyle Insufficiency Fracture After Total Knee Arthroplasty Using a Stemless Femoral Component With a Midlevel Constraint Articular Surface.

Midlevel constraint prostheses have provided increased varus/valgus and rotational stability for patients with severe deformity or ligamentous instability undergoing total knee arthroplasty (TKA). Here we present a series of 5 patients, 2 in detail, who underwent a primary TKA with a midlevel constraint articular surface and a primary femoral component without stem extension who all suffered isolated medial femoral condyle insufficiency fractures. All 5 TKAs were performed in females with both preoperative valgus deformity and flexion contractures.

Do New Hospital Price Transparency Regulations Reflect Value in Arthroplasty?

Introduction: In an attempt to improve price transparency, the Centers for Medicare & Medicaid Services (CMS) now requires hospitals to post clear, accessible pricing data for common procedures. We aimed to determine how many top orthopaedic hospitals are compliant with the new regulation and whether there was any correlation between hospital charges and outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: The hospital websites of the top 101 orthopaedic hospitals per the US News & World Report 2020-2021 were explored to assess compliance with the price transparency requirement.

Hospital Charges Are Not Associated With Episode-of-Care Costs or Complications After Total Joint Arthroplasty.

Background: The Centers for Medicare and Medicaid Services (CMS) now requires hospitals to publish charges for commonly performed procedures. This study aimed to evaluate compliance with the price transparency mandate and to determine if there is a correlation between hospital charges and episode-of-care claims costs and outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: We identified a consecutive series of 2476 Medicare patients who underwent primary THA or TKA from 2018 to 2019 at one of 18 hospitals.

Patient Satisfaction with Orthopedic Telemedicine Health Visits During the COVID-19 Pandemic.

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Success of Various Marketing Strategies for a New-to-the-Area Orthopedic Practice.

Background Competition for patients among orthopaedic private practices, multi-specialty groups, and hospital systems continues to persist. An effective marketing campaign is essential for a practice to succeed in this competitive environment. The purpose of this study was to investigate the cost-effectiveness and efficacy of each marketing campaign and the influence of patient demographics on efficacy.

Distal Femoral Replacement and Periprosthetic Joint Infection After Non-Oncological Reconstruction: A Retrospective Analysis.

Background: Distal femoral replacement (DFR) is commonly used to manage massive bone loss around the knee arising from aseptic loosening, periprosthetic joint infection (PJI), and distal femoral fractures. A number of studies report the outcome of DFR with considerable variation in long-term survivorship. This study investigated the outcome of DFR for patients with aseptic failures, fractures, and PJI.

Differences in Patient and Physician Perceptions of Urgency for Musculoskeletal Conditions During the COVID-19 Pandemic.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic limited musculoskeletal care to urgent or "nonelective" office visits and procedures. No guidelines exist to inform patients or physicians what meets these criteria. The purpose of this multi-institutional study was to describe the differences in perceptions of urgency for musculoskeletal complaints between patients and providers during the COVID-19 pandemic.

Patient Perception of Physician Attire in the Outpatient Setting During the COVID-19 Pandemic.

Introduction: In response to the SARS-CoV-2 pandemic, physician attire has evolved to incorporate personal protective equipment (PPE). Although PPE is mandated for all healthcare workers, variability exists in choice and availability. The purpose of this study was to determine patient perception of physician attire during the COVID-19 pandemic in an outpatient setting.

2021 John N. Insall Award: Aspirin is effective in preventing propagation of infrapopliteal deep venous thrombosis following total knee arthroplasty.

Aims: The optimal management of an infrapopliteal deep venous thrombosis (IDVT) following total knee arthroplasty (TKA) remains unknown. The risk of DVT propagation and symptom progression must be balanced against potential haemorrhagic complications associated with administration of anticoagulation therapy. The current study reports on a cohort of patients diagnosed with IDVT following TKA who were treated with aspirin, followed closely for development of symptoms, and scanned with ultrasound to determine resolution of IDVT.