Cemented Versus Cementless Primary Total Knee Arthroplasty in Obese Patients: A Systematic Review.

Total knee arthroplasty (TKA) in obese patients (body mass index [BMI] > 30) is associated with increased complications. There is a renewed interest in cementless fixation in obese patients. However, the ideal method of TKA fixation in obese patients remains unclear.

Rapid Return to Braking After Anterior and Posterior Approach Total Hip Arthroplasty.

Background: Little is known about the effect of surgical approach on return to braking after total hip arthroplasty (THA), and few studies have investigated braking after THA with modern surgical techniques and rehabilitation protocols.

Methods: In a prospective comparative design, we enrolled 65 patients who received right-sided primary THA at our institution from April 2018 through March 2020, 34 with a direct anterior approach (DAA) and 31 with a posterior approach (PA). Braking tests measuring brake reaction time (BRT) and brake pedal depression (BPD) were administered to patients preoperatively and at 1, 2, and 4 weeks postoperatively using a realistic driving simulator.

Running Following Hip Arthroplasty: A Systematic Review.

With improved implants and younger patients undergoing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA), there are increased expectations to return to high-impact activities. Recommendations regarding return to running following hip arthroplasty remain unclear. A search of the PubMed database was conducted, and all publications referencing running following THA or HRA published between January 1, 2000, and September 1, 2020, were included in the systematic review.

Alignment in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty: The Limb Has a Leg Up on the Component.

Background: To assess how implant alignment affects unicompartmental knee arthroplasty (UKA) outcome, we compared tibial component alignment of well-functioning UKAs against 2 groups of failed UKAs, revised for progression of lateral compartment arthritis ("Progression") and aseptic loosening ("Loosening").

Methods: We identified 37 revisions for Progression and 61 revisions for Loosening from our prospective institutional database of 3351 medial fixed-bearing UKAs performed since 2000. Revision cohorts were matched on age, gender, body mass index, and postoperative range of motion with "Successful" unrevised UKAs with minimum 10-year follow-up and Knee Society Score ≥70.

Unicompartmental Knee Arthroplasty: More Conversions, Fewer Complications Than Proximal Tibial Osteotomy in a Young Population.

Background: Patients with isolated medial compartment osteoarthritis requiring surgical intervention generally have two surgical options: unicompartmental knee arthroplasty (UKA) and proximal tibial osteotomy (PTO). Outcomes of reoperation rates and survivorship are important for counseling patients on treatment options.

Methods: A retrospective, comparative cohort study was performed for a consecutive series of patients in the Military Health System who underwent either UKA or PTO between 2003 and 2018.

Bilateral Fractures of Anatomic Medullary Locking Hip Arthroplasty Stems in a Single Patient: A Case Report.

Introduction: Stem fracture is a rare complication of total hip arthroplasty (THA) using fully porous-coated femoral stems. Bilateral fractures in a single patient have not been previously reported.

Case Report: A 48-year-old female underwent bilateral staged primary THA with fully porous-coated anatomic medullary locking femoral prostheses.

The Impact of Coronal Alignment on Revision in Medial Fixed-Bearing Unicompartmental Knee Arthroplasty.

Background: To better define the optimal alignment target for medial fixed-bearing unicompartmental knee arthroplasty (UKA), this study compares the postoperative mechanical alignment of well-functioning UKAs against 2 groups of failed UKAs, including revisions for progression of lateral compartment osteoarthritis ("Progression") and revisions for aseptic loosening or subsidence ("Loosening").

Methods: From our prospective institutional database of 3351 medial fixed-bearing UKAs performed since 2000, we identified 37 UKAs revised for Progression and 61 UKAs revised for Loosening. Each of these revision cohorts was matched based on age at surgery, gender, body mass index, and postoperative range of motion with unrevised UKAs that had at least 10 years of follow-up and a Knee Society Score of 70 or greater without subtracting points for alignment ("Success" groups).

Low Revision Rates at 10 years for Metal on Metal Hip Implants in a Military Population.

Introduction: Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort.

Materials And Methods: We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012.

Elimination of Preoperative Flexion Contracture as a Contraindication for Unicompartmental Knee Arthroplasty.

Introduction: Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) for the management of unicondylar osteoarthritis. Historical contraindications limit patients' eligibility for UKA. However, recent reports have suggested that some contraindications may not be absolute.

Is Outpatient Unicompartmental Knee Arthroplasty Safe to Perform at an Ambulatory Surgery Center? A Comparative Study of Early Post-Operative Complications.

Background: Unicompartmental knee arthroplasty (UKA) lends itself to the outpatient surgical setting. Prior literature has established a low rate of readmission and post-operative complications when performed in a hospital outpatient setting (HOP). To our knowledge, there have been no studies comparing complications of UKA performed at an ambulatory surgery center (ASC) and those in a HOP.

Biomechanical Stability of a Stand-Alone Interbody Spacer in Two-Level and Hybrid Cervical Fusion Constructs.

Study Design: In vitro human cadaveric biomechanical analysis.

Objective: To evaluate the segmental stability of a stand-alone spacer (SAS) device compared with the traditional anterior cervical plate (ACP) construct in the setting of a 2-level cervical fusion construct or as a hybrid construct adjacent to a previous 1-level ACP construct.

Methods: Twelve human cadaveric cervical spines (C2-T1) were nondestructively tested with a custom 6-degree-of-freedom spine simulator under axial rotation (AR), flexion-extension (FE), and lateral bending (LB) at 1.

Comparison of Wound Complications and Deep Infections With Direct Anterior and Posterior Approaches in Obese Hip Arthroplasty Patients.

Background: The purpose of this study was to compare the posterior approach (PA) with the direct anterior approach (DAA) among obese and nonobese total hip arthroplasty patients to determine if obese DAA patients have a higher risk of infection or wound complications compared with obese PA patients.

Methods: We retrospectively evaluated 4651 primary total hip cases performed via anterior approach or PA between 2009 and 2015. Patients were divided into 4 study groups based on approach and body mass index (BMI): (1) DAA <35 kg/m, (2) DAA ≥35 kg/m, (3) PA <35 kg/m, and (4) PA ≥35 kg/m.

Pelvic Floor Reconstruction Utilizing a Residual Hamstring Rotational Flap Following Traumatically Induced Subtotal Hemipelvectomy in a Combat Blast Casualty: A Case Report.

Objective: There are several options for soft tissue coverage following external hemipelvectomy; however, in cases of war-related blast trauma, standard flaps are not always available as a result of the extensive soft tissue damage.

Methods: We detail a novel closure technique following a subtotal hemipelvectomy with exposed abdominal viscera using a residual hamstring myofascial cutaneous flap.

Results: This flap allowed for fascial tissue to fill the pelvic defect and provided excellent soft tissue coverage for future prosthetic wear.

Persistent axial neck pain after cervical disc arthroplasty: a radiographic analysis.

Background Context: There is very little literature examining optimal radiographic parameters for placement of cervical disc arthroplasty (CDA), nor is there substantial evidence evaluating the relationship between persistent postoperative neck pain and radiographic outcomes.

Purpose: We set out to perform a single-center evaluation of the radiographic outcomes, including associated complications, of CDA.

Design: This is a retrospective review.

Outcomes of war related femoral neck fractures.

Introduction: In the civilian trauma literature, femoral neck fractures in young adults are considered an orthopedic 'urgency'. To our knowledge, there have been no studies looking at the outcomes of these injuries in the combat setting. The purpose of this study is to determine the outcomes of war related femoral neck fractures; the rates avascular necrosis associated with these injuries as well as the effect time to fixation has on the development of avascular necrosis.

Outcomes following cervical disc arthroplasty: a retrospective review.

Cervical disc arthroplasty has emerged as a viable technique for the treatment of cervical radiculopathy and myelopathy, with the proposed benefit of maintenance of segmental range of motion. There are relatively few, non-industry sponsored studies examining the outcomes and complications of cervical disc arthroplasty. Therefore, we set out to perform a single center evaluation of the outcomes and complications of cervical disc arthroplasty.

Outcomes of single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion.

Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications.

Outcomes following cervical disc arthroplasty in an active duty military population.

Symptomatic cervical radiculopathy is a common problem in the active duty military population and can cause significant disability leading to limited duty status and loss of operational readiness and strength. Based on their increasing experience with cervical disc arthroplasty (CDA) in this unique patient population, the authors set out to further evaluate the outcomes and complications of CDA in active duty military patients. A retrospective review of a single military tertiary medical center was performed between August 2008 and August 2012 and the clinical outcomes of patients who underwent cervical disc arthroplasty were evaluated.

Occult femoral neck fracture associated with vitamin D deficiency diagnosed by MRI: case report.

Hip fractures in the young are exceedingly rare and are usually seen in instances of high energy trauma or metabolically altered bone states. In this case report, we present an occult femoral neck fracture, diagnosed by magnetic resonance imaging, in an otherwise healthy, young, active duty male patient with an isolated vitamin D deficiency treated using cannulated percutaneous screws.