Discharge to a Skilled Nursing Facility After Hip Fracture Results in Higher Rates of Periprosthetic Joint Infection.

Background: Femoral neck fractures (FNFs) in elderly patients are associated with major morbidity and mortality. The influence of postoperative discharge location on recovery and outcomes after arthroplasty for hip fractures is not well understood.

Methods: A multisite retrospective cohort from 9 academic centers identified patients who had FNF treated with hemiarthroplasty or total hip arthroplasty between 2010 and 2019.

Early Radiographic and Clinical Outcomes of an Additive-Manufactured Acetabular Component.

Background: Additive manufacturing has recently gained popularity and is widely adopted in the orthopaedic industry. However, there is a paucity of literature on the radiographic and clinical outcomes of these relatively novel components. The aim of this study was to assess the 2-year clinical and radiographic outcomes of a specific additive-manufactured acetabular component in primary total hip arthroplasty.

The Empty Ischial Fossa Sign: A Visual Representation of Relative Inadequate Anteversion in the Posteriorly Tilted Pelvis.

Background: Instability is a known complication following total hip arthroplasty (THA) and is influenced by spinopelvic alignment. Radiographic markers have been investigated to optimize the acetabular cup position. This study evaluated if the empty ischial fossa (EIF) sign and the position of the trans-teardrop line were predictive of postoperative instability.

Early Radiographic Fit and Fill Analysis of a New Metaphyseal-Filling Triple Taper Stem Designed Using a Large Computed Tomography Scan Database.

Background: Numerous cementless stems are available to maximize implant stability, fit, and survivorship in total hip arthroplasty. Recently, a new metaphyseal-filling triple-taper collared stem was designed using femoral morphology data obtained from over 1300 computed tomography scans. The purpose of this study was to evaluate the radiographic fit and fill of this new stem in the coronal and sagittal dimensions.

A Novel Method to Calculate Functional Pelvic Tilt Using a Standing Anteroposterior Pelvis Radiograph.

Background: Functional patient-specific acetabular component positioning is important in total hip arthroplasty. We preoperatively evaluate the pelvic tilt (PT) on standing anteroposterior (AP) pelvis radiographs using a novel measurement and then recreate this intraoperatively using imaging. The purpose of this study was to determine if there is a linear correlation between this novel measurement and the actual PT.

Displaced Versus Nondisplaced Femoral Neck Fractures: Is Arthroplasty the Answer for Both?

Background: Traditionally, nondisplaced geriatric femoral neck fractures (FNFs) have undergone operative fixation, while displaced geriatric FNFs have undergone hip arthroplasty. The purpose of this study was to evaluate differences between outcomes in patients with nondisplaced (Garden I and II) fractures and displaced (Garden III and IV) fractures that were treated with arthroplasty.

Methods: This was a retrospective review of patients who had a minimum of 1 year follow-up from nine academic medical centers who underwent arthroplasty for FNFs between 2010 and 2020.

Outcomes are Compromised When Revising Patellofemoral Arthroplasties for Patellar Component Failures.

Background: Outcomes of patellofemoral arthroplasty (PFA) to total knee arthroplasty (TKA) conversion are reported to be similar to primary cases. The purpose of this study was to determine whether the cause for conversion from PFA to TKA correlated to outcomes when compared to a matched cohort.

Methods: A retrospective chart review was performed to identify aseptic PFA to TKA conversions between 2000 and 2021.

Accelerometer-Based Navigation in Primary Total Knee Arthroplasty Leads to Improved Alignment but No Change in Patient-Reported Outcomes.

Background: Computer and accelerometer-based navigation (ABN) tools have demonstrated improved mechanical alignment in primary total knee arthroplasty (TKA). ABN, in particular, is attractive due to avoidance of pins and trackers. Prior literature has yet to demonstrate an associated improvement in functional outcomes using ABN compared to conventional instrumentation (CONV).

Conservatively Treated Symptomatic Rotator Cuff Tendinopathy May Progress to a Tear.

Purpose: To determine the likelihood of, and risk factors for, progression of rotator cuff tendinopathy to tear on magnetic resonance imaging (MRI) in patients treated conservatively for minimum 1 year.

Methods: Patients in the Veterans Health Administration (VHA) Corporate Data Warehouse with a diagnosis of rotator cuff injury and sequential MRI of the same shoulder at least 1 year apart were identified. Presenting MRIs were reviewed to select patients with tendinopathy, while excluding those with a normal appearing cuff, tear, or prior repair.

Symptomatic Rotator Cuff Tear Progression: Conservatively Treated Full- and Partial-Thickness Tears Continue to Progress.

Purpose: To determine the likelihood of and risk factors for tear progression among patients with a symptomatic partial or full-thickness rotator cuff tears (RCTs) who return with continued shoulder pain and obtain subsequent magnetic resonance imaging (MRI) and to identify various patient factors and MRI findings associated with rotator cuff tear progression.

Methods: We performed a retrospective review of MRI studies from Veteran's Affair patients with conservatively treated partial- or full-thickness rotator cuff tears. Patient characteristics and demographics were obtained via chart review.

Occupational Hazards to the Joint Replacement Surgeon: Radiation Exposure.

Background: Intraoperative fluoroscopy is an essential tool to assist orthopedic surgeons in accurately and safely implanting hardware. In arthroplasty cases, its use is on the rise with the increasing popularity of the direct anterior (DA) approach for THA. However, exposure of ionizing radiation poses a potential health risk to surgeons.

Anterior-Based Approaches to Total Hip Arthroplasty: Beyond the Learning Curve.

Background: Anterior-based approaches for total hip arthroplasty (THA) have gained popularity over the last decade. At our institution, anterior-based approaches are preferentially utilized, including both anterior-based muscle-sparing (ABMS) and direct anterior (DA) for primary THA. As there are higher complication rates during the transition to an anterior approach, we compared the outcomes and complications between ABMS and DA approaches beyond the learning curve.

Neocortex Formation in a Tapered Wedge Stem is Not Indicative of Complications or Worse Outcomes.

Background: The formation of sclerotic bone, a neocortex, distally surrounding total hip arthroplasty (THA) stems may commonly be seen on radiographs around proximally porous coated stems but can be confused with loosening. The goal of this study was to determine the prevalence of the neocortex finding and whether it associated with worse outcomes after THA.

Methods: A retrospective review of 825 patients with a single tapered wedge stem was performed.

Managing Hip-Spine Concepts in the Direct Anterior Approach With Use of Fluoroscopy.

Background: The spinopelvic relationship in regard to total hip arthroplasty has become a topic of increasing interest in recent years. Hip arthritis and a stiff lumbar spine create a situation where the spinopelvic junction has decreased mobility, which in turn increases the risk of instability after total hip arthroplasty as the femoral acetabular joint must undergo increased motion. Regardless of the approach, surgeons should be aware of the risk of instability in patients with a stiff spinopelvic junction and the necessary modifications to component positioning to avoid postoperative instability.

Conjoint tendon release for persistent anterior shoulder pain following reverse total shoulder arthroplasty.

Background: Persistent anterior shoulder pain is an under-reported complication after reverse total shoulder arthroplasty (RTSA). The purpose of this study was to determine the effectiveness of open conjoint tendon release in patients with anterior shoulder pain due to conjoint tendinitis after RTSA.

Methods: Open conjoint tendon release was performed by the senior author from June 2014 to November 2018 in patients with persistent anterior shoulder pain after RTSA.