Liver Disease Increases the Risk of Postoperative Complications in Patients Undergoing Aseptic Revision Total Hip and Knee Arthroplasty.

Background: Due to the multiorgan effects of liver disease, surgical patients with liver disease have an increased risk of perioperative complications. With revision total hip and knee arthroplasty surgeries increasing, it is important to determine the effects of liver disease in this patient population. The purpose of this study was to evaluate the impact of underlying liver disease on postoperative outcomes following revision total joint arthroplasty (TJA).

Multimodal conservative management of arthrofibrosis after total knee arthroplasty compared to manipulation under anesthesia: a feasibility study with retrospective cohort comparison.

Background: The ideal treatment of early-stage arthrofibrosis after total knee arthroplasty is unclear. The purpose of this study was to determine the treatment effect, including variability, and feasibility of a multimodal physical therapy program as compared to manipulation under anesthesia.

Methods: This was a prospective feasibility study with a retrospective cohort comparison.

Patients Achieving 90°/45°/0° Intraoperative Stability Do Not Require Hip Precautions Following Posterior Approach Total Hip Arthroplasty: A Prospective Randomized Study.

Background: Hip precautions are traditionally employed after posterior total hip arthroplasty (THA). The primary purpose was to investigate the necessity of hip precautions after posterior approach THA. We hypothesized that eliminating precautions in patients that achieved appropriate intraoperative stability would not increase the dislocation rate.

Recurrent Hemarthrosis Secondary to Erosive Patellofemoral Arthritis Treated with Arthroplasty: A Report of 3 Cases.

Case: Three patients presented with recurrent hemarthrosis secondary to erosive patellofemoral arthritis. Recurrent hemarthrosis from the eroded patellofemoral subchondral bone has not been well described. Each patient presented with symptoms secondary to painful effusions that were identified by aspiration.

A Smartwatch Paired With A Mobile Application Provides Postoperative Self-Directed Rehabilitation Without Compromising Total Knee Arthroplasty Outcomes: A Randomized Controlled Trial.

Background: Self-directed rehabilitation (SDR) after total knee arthroplasty (TKA) has not been traditionally recommended. The purpose of this study was to determine if there was an impact on postoperative outcomes with the use of an SDR program after primary TKA.

Methods: In this prospective, randomized, multicenter, controlled trial, we paired a smartwatch with a mobile application, providing an SDR program after TKA.

Giardia lamblia Reactive Arthritis Mimicking Acute Periprosthetic Knee Infection: A Case Report.

Case: A healthy 49-year-old man with a well-functioning total knee replacement developed a painful swollen knee. The erythrocyte sedimentation rate was 12 mm/hour, and C-reactive protein was 20.3 mg/L.

The Utility of Obtaining a Complete Blood Count After Total Knee Arthroplasty in the Era of Tranexamic Acid.

Questioning the routine use of postoperative laboratory tests is a strategy to combat rising health care costs. The goal of this study was to determine the utility and cost of routine postoperative complete blood count (CBC) testing after primary total knee arthroplasty (TKA) in the era of tranexamic acid (TXA). This retrospective chart review identified patients who underwent primary TKA performed by a single surgeon at a single private institution during a 2-year period.

The Risk of Acute Infection Following Intra-articular Corticosteroid Injection Into a Pre-existing Total Knee Arthroplasty.

Background: No previous studies have investigated the risk of infection following intra-articular corticosteroid injection (IACI) into a pre-existing total knee arthroplasty (TKA). The aim of this study is to determine the risk of acute infection following IACI into a pre-existing TKA.

Methods: A retrospective chart review identified all patients at a single institution between October 2009 and May 2015 that had an ipsilateral knee injection subsequent to a TKA.

Arthrofibrosis Associated With Total Knee Arthroplasty.

Background: Arthrofibrosis is a debilitating postoperative complication of total knee arthroplasty (TKA). It is one of the leading causes of hospital readmission and a predominant reason for TKA failure. The prevalence of arthrofibrosis will increase as the annual incidence of TKA in the United States rises into the millions.

Global health and orthopaedic surgery-A call for international morbidity and mortality conferences.

Introduction: There is a large discrepancy between supply and demand of surgical services in developing countries. This inequality holds true in orthopaedic surgery and the delivery of musculoskeletal care. Intertwined amongst the decision to perform surgical procedures in the developing world are the ethics of doing so - just because one is capable of performing a procedure, should it be done?

Presentation Of Case: A 31 year-old female with end-stage joint destruction underwent a left total hip replacement by a foreign orthopaedic team in Tanzania.

The inter-observer and intra-observer reliability of the Paprosky femoral bone loss classification system.

The Paprosky classification provides a straightforward algorithm for defining bone loss and directing treatment for femoral revision. The purpose of this study was to test the inter-observer and intra-observer reliability of this system. Four arthroplasty surgeons reviewed radiographs of 205 consecutive femoral revisions.

Hip resurfacing and conventional THA: comparison of acetabular bone stock removal, leg length, and offset.

The purpose of this study was to compare total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA) with regard to the amount of acetabular bone stock removed and the ability to restore leg length and offset. Anteroposterior pelvis radiographs of 153 consecutive THAs and 84 consecutive HRAs were compared. Excluded patients were those with prior hip surgery, those in which a best-fit circle could not be adequately matched to the femoral head, and those with preoperative radiographic findings that precluded consideration for HRA (ie, disease severity, deformity, leg-length discrepancy).

Prevalence, risk factors, and management of proximal femoral remodeling in revision hip arthroplasty.

The prevalence of, risk factors, and management of proximal femoral remodeling in revision total hip arthroplasty is unknown. Therefore, we reviewed the files of 200 consecutive femoral revision arthroplasties to study this phenomenon. Remodeling was considered present if a properly sized diaphyseal-engaging acrylic template had appropriate distal canal fill but lied within 2mm of the proximal lateral endosteal cortex (definition 1) or completely outside the femoral canal (definition 2) on anteroposterior femoral radiographs.

Long-term survivorship and failure modes of unicompartmental knee arthroplasty.

Background: In a previously reported series of 51 patients with 62 cemented, fixed-bearing unicompartmental knee arthroplasties, we reported a 10-year, 98% survival rate with an average knee score of 92 points. The survivorship and modes of failure past 10 years are incompletely understood.

Questions/purposes: At 15-year followup we sought to determine (1) the overall durability and survivorship of this design; (2) modes of failure; and (3) the progression of arthritis in the nonresurfaced compartments.

Patient perception of physician reimbursement in elective total hip and knee arthroplasty.

The purpose of this study was to evaluate patient perception of orthopedic surgeon reimbursement for total hip (THA) and knee (TKA) arthroplasty. A total of 1120 consecutive patients were asked what they believed a surgeon should be paid for performing THA and TKA. Patients were then asked to estimate what Medicare actually reimbursed for each of these procedures.

Protrusio acetabuli and total hip arthroplasty in patients with Marfan syndrome.

Our goals were (1) to quantify protrusio acetabuli in patients with Marfan syndrome who underwent total hip arthroplasty and (2) to identify clinical results and complications associated with total hip arthroplasty in those patients. We reviewed the preoperative radiographs of the 29 patients (38 hips) in our study and analyzed the related patient operative reports, postoperative records, and self-administered questionnaires (mean follow-up, 116 ± 102 months). The mean preoperative center-edge angle of Wiberg was 50.

Early aseptic loosening with a precoated low-profile tibial component: a case series.

Between March 2007 and December 2008, we performed 529 consecutive total knee arthroplasties in 460 patients with the Zimmer (Warsaw, IN) NexGen MIS Tibial Component using a minimally invasive approach. Eight knees in 8 patients (1.5%) were revised for early aseptic loosening of the tibial component despite normal initial postoperative radiographs.

Protrusio acetabuli in Marfan syndrome: age-related prevalence and associated hip function.

Background: Protrusio acetabuli is known to occur in patients with Marfan syndrome, but its prevalence, its effects on hip function, and its possible association with the subsequent development of degenerative hip disease have not been studied in a large population. Nevertheless, some clinicians have recommended prophylactic hip surgery for preadolescents with Marfan syndrome and protrusio acetabuli.

Methods: We performed a cross-sectional study of 173 patients (346 hips) with Marfan syndrome who were interviewed and examined for calculation of the Iowa hip score.

Structural and mechanical alterations in spastic skeletal muscle.

Spasticity, a neurological problem secondary to an upper motor neuron lesion, has a significant effect on skeletal muscle. The upper motor neuron lesions may be secondary to a cerebral vascular accident, head injury, spinal cord injury, or degenerative diseases such as multiple sclerosis, or perinatal brain injuries such as cerebral palsy. Functional ability in these patients can be severely compromised but the basic mechanisms underlying these deficits are not clearly understood.

Characterization of the symptoms associated with dural ectasia in the Marfan patient.

Dural ectasia, an expansion of the dural sac surrounding the spinal cord, is one of the most common orthopedic manifestations of Marfan syndrome. The purpose of the present study was to characterize the clinical symptoms associated with dural ectasia in patients with Marfan syndrome and to understand the effects of symptomatic dural ectasia on the overall health of affected patients. Twenty-two volunteers aged 9-55 years with Marfan syndrome, and dural ectasia diagnosed by MRI or CT, filled out a "symptoms" questionnaire and completed an SF-36 health survey.

Total knee arthroplasty in obese patients: a comparison with a matched control group.

Thirty knees in 27 obese patients were matched to 30 knees in 27 nonobese patients, with both cohorts followed for a mean of approximately 15 years. Nine of 30 obese knees were revised, whereas 3 of 30 nonobese knees were revised, with Knee Society objective scores being higher in the nonobese group. There were more polyethylene insert revisions in the nonobese group, which may have been accounted for by a trend of higher activity levels in this group.

The outcome of total knee arthroplasty in obese patients.

Background: Evidence linking increased body weight to osteoarthritis of the knee and the high prevalence of obesity underscore the importance of defining the outcome of total knee arthroplasty in obese patients. The purpose of this study was to compare the clinical and radiographic results of total knee arthroplasties performed in obese patients with those of total knee arthroplasties performed in nonobese patients.

Methods: Clinical and radiographic data on seventy-eight total knee arthroplasties in sixty-eight obese patients were compared with data on a matched group of nonobese patients.