Intraoperative Challenges of the Kinematic Knee.

Total knee arthroplasty (TKA) is a widely accepted surgical procedure for managing end-stage knee osteoarthritis. Among the various TKA techniques, kinematic alignment has gained increasing popularity as it can potentially restore a more natural joint function. However, despite its theoretical advantages, kinematic total knee replacement presents several operative challenges that necessitate a thorough understanding and analysis of patient-specific anatomy during surgical planning and execution.

Five to Ten-Year Results of the Birmingham Hip Resurfacing Implant in the U.S.: A Single Institution's Experience.

Background: International surgeon series and registry data have demonstrated positive outcomes and long-term survival of the Birmingham Hip Resurfacing (BHR) implant. We report the 5 to 10-year results from a single center in the U.S.

High Rate of Failure After Revision of a Constrained Liner.

Background: The purpose of this study was to examine the outcomes of repeat revision after failure of a constrained liner.

Methods: We reviewed 1212 consecutive revisions and identified 74 (6%) revisions of a failed constrained liner in 46 patients with a mean age of 65 years. The most common reasons for revision of a constrained liner were recurrent instability (64.

Acetabular Focal Chondral Lesions Are Not Associated With Worse Outcomes After Periacetabular Osteotomy: A Matched Group Analyses.

Background: The purpose of this study was to assess the outcomes of patients who underwent combined hip arthroscopy and periacetabular osteotomy with acetabular focal chondral defects and compare these outcomes with a group of patients without focal chondral defects.

Methods: A retrospective review looking at patients who underwent hip arthroscopy and/or periacetabular osteotomy was performed. Minimum 2-year follow-up, Tönnis grade 0-1, and a Beck chondromalacia stages 4-5 were included.

Do Mortality and Complication Rates Differ Between Periprosthetic and Native Hip Fractures?

Background: Epidemiological estimates indicate a rising incidence of periprosthetic hip fractures. While native hip fractures are known to be a highly morbid condition, a significant body of research has led to improved outcomes and decreased complications following these injuries. Comparatively, little research has evaluated the relative morbidity and mortality of periprosthetic hip fractures.

Revision Total Hip Arthroplasty With a Monoblock Splined Tapered Grit-Blasted Titanium Stem.

Background: In revision total hip arthroplasty (THA), proximal femoral bone loss creates a challenge of achieving adequate stem fixation. The purpose of this study was to examine the outcomes of a monoblock, splined, tapered femoral stem in revision THA.

Methods: Outcomes of revision THA using a nonmodular, splined, tapered femoral stem from a single surgeon were reviewed.

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.

Femoroacetabular Impingement and Pelvic Incidence: Radiographic Comparison to an Asymptomatic Control.

Purpose: To investigate whether pelvic incidence (PI) in patients with symptomatic femoroacetabular impingement was different from that in a normal population.

Methods: Retrospective analysis of 30 consecutive female and 30 consecutive male patients with computed tomography scans who underwent hip arthroscopy for FAI. PI was measured using scout lateral radiographs.

Return to Golf After Lumbar Fusion.

Background: Spinal fusion surgery is being increasingly performed, yet few studies have focused on return to recreational sports after lumbar fusion and none have specifically analyzed return to golf.

Hypothesis: Most golfers successfully return to sport after lumbar fusion surgery.

Study Design: Case series.

A Novel Complication of the Dall-Miles Cable Grip System Mimicking Recurrent Synovial Chondromatosis: A Case Report and Review of the Literature.

Case: A 25-year-old man with synovial chondromatosis of the hip was treated with a synovectomy through a transtrochanteric approach; the repair was made with use of a Dall-Miles cable. Approximately 13 years later, the patient returned with a massive bursal reaction and a cyst containing "rice bodies." Although the physical examination and imaging were suggestive of recurrent synovial chondromatosis, the bursal reaction actually represented a novel complication of the Dall-Miles system.

Does Hip Arthroscopy Affect the Outcomes of a Subsequent Total Hip Arthroplasty?

Background: Hip arthroscopy utilization is on the rise in the United States. Thus, determining the impact of prior hip arthroscopy on subsequent total hip arthroplasty (THA) is important to understand.

Methods: A retrospective review of a high-volume orthopedic surgery practice's billing database yielded 42 hip arthroscopies that underwent subsequent THA.

Techniques and Results for Open Hip Preservation.

While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is the most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation.

Prevalence of Cam Morphology in Females with Femoroacetabular Impingement.

Cam and pincer are two common morphologies responsible for femoroacetabular impingement (FAI). Previous literature has reported that cam deformity is predominantly a male morphology, while being significantly less common in females. Cam morphology is commonly assessed with the alpha angle, measured on radiographs.

Radiographic Comparison of Anterior Acetabular Rim Morphology Between Pincer Femoroacetabular Impingement and Control.

Purpose: To define and compare 3 new parameters (anterior rim angle [ARA], anterior wall angle [AWA], and anterior margin ratio [AMR]), in addition to the lateral center-edge angle of Wiberg and the Tönnis angle, for measuring pincer-type femoroacetabular impingement (FAI) in an asymptomatic versus symptomatic FAI population.

Methods: We reviewed anteroposterior pelvis radiographs of patients verified to have no hip complaints between December 2009 and December 2011. We also reviewed anteroposterior pelvis radiographs of patients who underwent a rim-trimming procedure for pincer FAI between December 2010 and December 2011.

An Analysis of Risk Factors for Short-Term Complication Rates and Increased Length of Stay Following Unicompartmental Knee Arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) is an increasingly popular procedure, with excellent long-term outcomes. However, there are only a limited number of reports reporting its short-term morbidity and mortality.

Questions/purposes: We sought to analyze the reported 30-day morbidity, mortality, and risk factors for complications and prolonged length of stay (>4 days) following UKA.

Does Neuraxial Anesthesia Decrease Transfusion Rates Following Total Hip Arthroplasty?

Perioperative transfusions increase complications and cost following THA. Current series evaluating neuraxial anesthesia and blood loss following THA are small and utilize heterogeneous populations. Using the NSQIP database we compared transfusion rates following THA with neuraxial and general anesthesia.

Bilateral extensor mechanism disruption after total knee arthroplasty in two morbidly obese patients.

Disruption of the extensor mechanism as a result of patellar tendon or quadriceps tendon rupture is an uncommon but devastating complication after total knee arthroplasty. Treating a disrupted extensor mechanism can be challenging, particularly in patients who are morbidly obese, due to an increased risk of postoperative complications. Therefore, despite the debilitating nature of extensor mechanism disruption, many community surgeons do not feel comfortable pursuing more complex cases like revision total knee arthroplasty with extensor mechanism allograft on morbidly obese patients, and consequently many of these patients are referred to tertiary-care centers for reconstruction secondary to the complexity of this patient cohort.

The False-Profile View May Be Used to Identify Cam Morphology.

Purpose: To identify the accuracy of measuring the alpha angle on the false-profile, anteroposterior (AP), and 90° Dunn lateral views of the hip as compared with computed tomography (CT) scan findings.

Methods: Forty patients were needed to have power greater than 80%. Forty-five consecutive patients undergoing hip arthroscopy were retrospectively reviewed with preoperative radial oblique CT reformatted scans and plain radiographs.

Do Complication Rates Differ by Gender After Metal-on-metal Hip Resurfacing Arthroplasty? A Systematic Review.

Background: Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender.

Questions/purposes: This systematic review aimed to: (1) compare the rate of adverse local tissue reaction (ALTR); (2) dislocation; (3) aseptic loosening; and (4) revision between men and women undergoing primary MoM hip resurfacing arthroplasty (HRA).

Operative treatment of femoroacetabular impingement.

Femoroacetabular impingement is a common pathologic disorder of the hip that causes pain and has been implicated in the development of early osteoarthritis in young adults. This disorder includes 2 different subtypes: cam impingement and pincer impingement. When nonsurgical treatment methods fail, surgical options are indicated.

An analysis of references used for the Orthopaedic In-Training Examination: what are their levels of evidence and journal impact factors?

Background: Although the references recommended for the Orthopaedic In-Training Examination (OITE) have been evaluated in certain subspecialty domains, suggested reference level of evidence (LOE), impact factor, and citation age have not been evaluated comprehensively to our knowledge.

Questions/purposes: We present an analysis of all references cited in the OITE recommended readings for each test question including the duration of time between their initial publication and their use in the OITE, which we defined as citation age, LOE, and the impact factor of the journals referenced.

Methods: We evaluated all references for the 2010 to 2012 OITE administrations (three examinations; 825 questions total).

Resident involvement does not influence complication after total hip arthroplasty: an analysis of 13,109 cases.

Our study aimed to determine the impact of resident involvement on the 30-day postoperative complication rates following primary total hip arthroplasty (THA). Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, 13,109 primary THAs were identified, of which 3462 (26.4%) had resident involvement.