Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty.

Background: Frailty can predict adverse outcomes for multiple medical conditions and surgeries but is not well studied in total hip arthroplasty (THA). We evaluate the association between Hospital Frailty Risk Score and postoperative events and costs after primary THA.

Methods: Using the National Readmissions Database, we identified primary THA patients for osteoarthritis, osteonecrosis, or hip fracture from January to November 2017.

Use of Cementless Metaphyseal Fixation in Revision Total Knee Arthroplasty in the United States.

Background: Fixation options for revision total knee arthroplasty (rTKA) have expanded and now include cementless metaphyseal fixation. The utilization rates of these implants in the United States are not well known. The purpose of this study was to analyze trends in cementless metaphyseal fixation for rTKA within the American Joint Replacement Registry (AJRR).

Isolated tibial insert exchange in revision total knee arthroplasty : reliable and durable for wear; less so for instability, insert fracture/dissociation, or stiffness.

Aims: This study aimed to determine outcomes of isolated tibial insert exchange (ITIE) during revision total knee arthroplasty (TKA).

Methods: From 1985 to 2016, 270 ITIEs were performed at one institution for instability (55%, n = 148), polyethylene wear (39%, n = 105), insert fracture/dissociation (5%, n = 14), or stiffness (1%, n = 3). Patients with component loosening, implant malposition, infection, and extensor mechanism problems were excluded.

Total Femur Antibiotic Spacers: Effective Salvage for Complex Periprosthetic Joint Infections.

Background: A simultaneous periprosthetic joint infection (PJI) of an ipsilateral hip and knee arthroplasty is a challenging complication of lower extremity reconstructive surgery. We evaluated the use of total femur antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers in the staged treatment of such limb-threatening PJIs.

Methods: Thirteen patients were treated with a total femur antibiotic spacer.

Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation.

Introduction: Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA.

Direct Anterior Approach Total Hip Arthroplasty Is Not Associated with Increased Infection Rates: A Systematic Review and Meta-Analysis.

Background: The direct anterior approach (DAA) for primary total hip arthroplasty (THA) has recently increased in popularity. Recent evidence has raised concerns about whether use of the DAA is associated with increased rates of superficial and deep infection. The aim of this study was to systematically assess the literature and comparatively evaluate the rate of superficial and deep infection following primary THA using the DAA and non-direct anterior (non-DAA) approaches.

Intermediate to Long-Term Follow-up of Cementing Liners into Well-Fixed Acetabular Components.

Background: The cementation of a new liner into a well-fixed acetabular component is common during revision total hip arthroplasty (THA) for many indications, but most commonly for lack of a modern, compatible, highly cross-linked polyethylene (HXLPE) liner. However, little is known about the intermediate-term to long-term durability of this strategy. The purpose of this study was to evaluate the implant survivorship, risk of complications, clinical outcomes, and radiographic results of cementing a new HXLPE liner into a well-fixed acetabular component.

Excellent two-year survivorship of 3D-printed metaphyseal cones in revision total knee arthroplasty.

Aims: Metaphyseal fixation during revision total knee arthroplasty (TKA) is important, but potentially difficult when using historical designs of cone. Material and manufacturing innovations have improved the size and shape of the cones which are available, and simplified the required bone preparation. In a large series, we assessed the implant survivorship, radiological results, and clinical outcomes of new porous 3D-printed titanium metaphyseal cones featuring a reamer-based system.

Are Postoperative Hip Precautions Necessary After Primary Total Hip Arthroplasty Using a Posterior Approach? Preliminary Results of a Prospective Randomized Trial.

Background: It is unclear whether posterior hip precautions after primary total hip arthroplasty (THA) reduce the incidence of early postoperative dislocation.

Methods: We performed a prospective randomized study to evaluate the effect of hip precautions on incidence of early dislocation after primary THA using a posterior approach. Between January 2016 and April 2019, 587 patients (594 hips) were consented and randomized into restricted or unrestricted groups.

Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications.

Background: Although some prior work supports the safety of same-day arthroplasty performed in a hospital, concerns remain when these procedures are performed in a free-standing ambulatory surgery center. The purpose of this study is to compare 90-day complication rates between matched cohorts that underwent inpatient vs outpatient arthroplasty at an ambulatory surgery center.

Methods: A single-surgeon cohort of 243 consecutive patients who underwent outpatient arthroplasty was matched with 243 inpatients who had the same procedure.

Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center?

Background: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines.

Methods: One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014.

Short-term Complications After Revision Hip Arthroplasty for Prosthetic Joint Infection Are Increased Relative to Noninfectious Revisions.

Background: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is associated with significant morbidity and cost. The purpose of this study was to determine how rates of perioperative complications, operative duration, and postoperative length of stay (LOS) in patients undergoing revision THA for PJI compare to primary THA and to revision THA for non-PJI.

Methods: We used the National Surgical Quality Improvement Program registry from 2005 to 2015 to identify all patients who underwent primary and revision THA.

Adverse Local Tissue Reaction After a Metal-on-Metal Total Hip Prosthesis Without Elevated Serum Metal Ion Levels.

In the 1990s, metal-on-metal (MoM) bearings were reintroduced in total hip arthroplasty (THA), having the proposed advantages of decreased wear and improved stability. However, catastrophic adverse local tissue reaction (ALTR) secondary to metal debris from both the bearing surface and the head-neck junction is a well-recognized complication. The measurement of metal ion levels in the serum is often a first-line test to identify failure of a MoM bearing.

Same-Day Discharge Compared with Inpatient Hospitalization Following Hip and Knee Arthroplasty.

Background: Discharge from the hospital on the day of (same-day) hip and knee arthroplasties has become more common; however, to our knowledge, few studies have compared morbidity between same-day and inpatient surgical procedures. The aims of this study were to compare matched cohorts of patients who underwent same-day and inpatient hip or knee arthroplasty in terms of postoperative complications and 30-day readmission rates.

Methods: Patients who underwent primary elective total hip arthroplasty, total knee arthroplasty, or unicompartmental knee arthroplasty from 2005 to 2014 were identified from the National Surgical Quality Improvement Program registry.

A classification-based approach to the patella in revision total knee arthroplasty.

Background: There is a paucity of data to guide management of the patella in revision total knee arthroplasty (RTKA). The purpose of this study was to review our experience with patellar management in RTKA.

Methods: We retrospectively reviewed 422 consecutive RTKAs at a minimum of 2 years (mean, 42 months).

Analysis of Player Statistics in Major League Baseball Players Before and After Achilles Tendon Repair.

Background: No currently available literature evaluates the effect of Achilles tendon repair on professional baseball players in the Major League Baseball (MLB).

Questions/purposes: The purpose of this study was to determine the impact of Achilles tendon rupture and repair on MLB players in terms of return to play and batting/fielding performance metrics.

Methods: Achilles tendon rupture data were retrospectively collected using information from the MLB disabled list, injury reports, MLB game summaries, player profiles, and publicly available news articles.

Sepsis Within 30 Days of Geriatric Hip Fracture Surgery.

Background: Sepsis after hip fracture typically develops from one of the 3 potential infectious sources: urinary tract infection (UTI), pneumonia, and surgical site infection (SSI). The purpose of this investigation is to determine (1) the proportion of cases of sepsis that arises from each of these potential infectious sources; (2) baseline risk factors for developing each of the potential infectious sources; and (3) baseline risk factors for developing sepsis.

Methods: The National Surgical Quality Improvement Program database was searched for geriatric patients (aged >65 years) who underwent surgery for hip fracture during 2005-2013.

Medial Gastrocnemius Flap in the Course of Treatment for an Infection at the Site of a Total Knee Arthroplasty.

Introduction: The pedicled medial gastrocnemius flap provides a robust coverage option for most soft-tissue deficiencies over the distal anterior aspect of the knee encountered in the setting of an infection after total knee arthroplasty.

Step 1 Patient Positioning: Position the patient supine with an ipsilateral sterile thigh tourniquet to allow room for harvest of a split-thickness skin graft as needed.

Step 2 Revision Arthroplasty For Infection: Perform the arthroplasty to address the underlying deep infection (e.

A Prospective Randomized Trial of Mini-Incision Posterior and 2-Incision Total Hip Arthroplasty: Minimum 5-Year Follow-Up.

Background: We previously described the results of a randomized controlled trial of mini-posterior vs 2-incision total hip arthroplasty and were unable to demonstrate significant differences in early outcomes. As less-invasive anterior approaches remain popular, the purpose of this report was to re-examine the outcomes at a minimum 5-year follow-up.

Methods: Seventy-two patients undergoing primary total hip arthroplasty were randomized to a mini-posterior or 2-incision approach.

Perceived Leg-Length Discrepancy After Primary Total Knee Arthroplasty: Does Knee Alignment Play a Role?

Leg length discrepancy (LLD) is common after total knee arthroplasty (TKA) although its incidence has not been well documented. The purpose of this study was to determine the incidence of perceived LLD before and after primary total knee arthroplasty as well as to determine the correlation between mechanical axis of the knee and perceived LLD. The incidence and time frame of resolution of postoperative LLD was also assessed.

A cost comparison of unicompartmental and total knee arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) in appropriately selected patients. There is a paucity of data comparing hospital resource utilization and costs for UKA versus TKA.

Methods: We retrospectively reviewed 128 patients who underwent UKA or TKA for osteoarthritis by a single surgeon in the 2011 Fiscal Year.

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

Background: Soft tissue defects after TKA are a potentially devastating complication. Medial gastrocnemius flaps occasionally are used to provide soft tissue coverage, most commonly with a periprosthetic joint infection.

Questions/purposes: We asked: (1) What were the rates of persistent or recurrent infection, implant survivorship, flap-related complications, and reoperation for patients who underwent medial gastrocnemius flap reconstruction for soft tissue coverage after TKA? (2) What were the Knee Society clinical and functional scores for patients who underwent medial gastrocnemius flap reconstruction for soft tissue defects after TKA? (3) What were the risk factors for failure of medial gastrocnemius flap reconstruction after TKA, with failure defined as recurrent or new periprosthetic joint infection or inability to reimplant the TKA prosthesis?

Methods: Between 2003 and 2011, four surgeons at one institution performed 31 medial gastrocnemius flaps for soft tissue coverage over an infected TKA.

Is Tommy John Surgery Performed More Frequently in Major League Baseball Pitchers From Warm Weather Areas?

Background: Medial ulnar collateral ligament (UCL) reconstruction is a common procedure performed on Major League Baseball (MLB) pitchers with symptomatic UCL insufficiency, frequently due to overuse. Warm weather climates afford youth pitchers the opportunity to throw year-round, potentially placing them at risk for overuse elbow injuries.

Purpose/hypothesis: To determine whether the proportion of MLB pitchers who underwent medial UCL reconstruction and who pitched competitive youth baseball in warm weather areas is higher than those from cold weather areas.