The impact of prior ACL reconstruction on total knee arthroplasty outcomes: a retrospective matched cohort study.

Introduction: Discrepant data exists regarding the outcomes following total knee arthroplasty (TKA) with a prior anterior cruciate reconstruction (ACLR). The purpose of our study was to compare surgical and medical outcomes in the patients with prior ACLR undergoing TKAs compared to a matched control group of the patients who had undergone TKAs without prior ACLR. We hypothesized that the patients with prior ACLR would have inferior clinical outcomes.

Total Hip Arthroplasty in Nonagenarians - A National In-Patient Sample-Based Study of Perioperative Complications.

Background: Nonagenarians are a rapidly expanding population in the United States. These patients are met with increasing rates of hip arthritis, necessitating the need for total hip arthroplasty (THA). However, there is currently limited information on hospitalization information and perioperative complications in this population.

Standardized total knee arthroplasty pathway improves outcomes in minority patients.

Objectives: Inferior total knee arthroplasty (TKA) outcomes are reported in minority populations. Standardized TKA pathways improve outcomes but have not been studied extensively in minority populations. This study evaluated the impact of TKA pathway standardization at an urban teaching hospital that predominantly treats minority patients.

Complications of primary total hip arthroplasty in human immunodeficiency virus-positive patients with femoral head osteonecrosis.

Background: Femoral head osteonecrosis (FHON) is a well-recognised complication in patients with human immunodeficiency virus (HIV) infection. Total hip arthroplasty (THA) is a reliable solution to FHON and has provided functional improvement and pain relief in these patients. Higher complication rates, in particular infections, have been reported in the series of THAs done in the HIV-positive patients.

Sources of contamination in the operating room: A fluorescent particle powder study.

This study utilized fluorescent particle powder to investigate 2 potential sources of sterile field contamination in the operating room (OR): forced-air warming blankets and OR light manipulation. In part 1, sterile draping for knee replacement surgery was performed on a mannequin in a sterile OR, comparing field contamination with the forced-air warming on versus off during draping. In part 2, OR lights coated with fluorescent powder were manipulated over a sterile field.

Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty.

Venous thromboembolic disease (VTED) is a major cause of morbidity and mortality after total knee arthroplasty (TKA). Current VTED prophylaxis protocols consist of early mobilization, mechanical compression devices, and pharmacologic agents. Venous phasic flow-regulated below-knee devices are generally favored, but the optimal duration and method of mechanical prophylaxis is unknown.

Stem geometry changes initial femoral fixation stability of a revised press-fit hip prosthesis: A finite element study.

Background: Stable femoral fixation during uncemented total hip arthroplasty is critical to allow for subsequent osseointegration of the prosthesis. Varying stem designs provide surgeons with multiple options to gain femoral fixation.

Objective: The purpose of this study was to compare the initial fixation stability of cylindrical and tapered stem implants using two different underreaming techniques (press-fit conditions) for revision total hip arthroplasty (THA).

Tapered vs Cylindrical Stem Fixation in a Model of Femoral Bone Deficiency in Revision Total Hip Arthroplasty.

Background: Distal fixation achieved with a tapered stem design has demonstrated favorable clinical results in revision total hip arthroplasty in the setting of severe bone defects. However, stem subsidence is common with this stem design.

Purpose: The purpose of this study is to compare the initial fixation stability of a tapered stem design to a fully porous-coated cylindrical stem design in a model of severe femoral bone deficiency.

New anticoagulants for thromboprophylaxis after total knee arthroplasty.

Total knee arthroplasty (TKA) is one of the most common orthopedic procedures in the United States. The number of TKAs is expected to rise significantly over the next 2 decades. One of the most common complications after TKA is venous thromboembolism (VTE), which is potentially fatal.

Apixaban and rivaroxaban decrease deep venous thrombosis but not other complications after total hip and total knee arthroplasty.

Apixaban and rivaroxaban are oral direct factor Xa (FXa) inhibitors used for VTE prevention after total hip (THA) and total knee arthroplasty (TKA). A meta-analysis of level I studies comparing rivaroxaban 10 mg daily or apixaban 2.5 mg twice daily to enoxaparin for the prevention of VTE after THA or TKA was performed analyzing efficacy and safety outcomes.

The efficacy and safety of rivaroxaban for venous thromboembolism prophylaxis after total hip and total knee arthroplasty.

Venous thromboembolism (VTE) is a common complication after total hip and total knee arthroplasty. Currently used methods of VTE prophylaxis after these procedures have important limitations, including parenteral administration, and unpredictable plasma levels requiring frequent monitoring and dose adjustment leading to decreased patient compliance with recommended guidelines. New oral anticoagulants have been demonstrated in clinical trials to be equally efficacious to enoxaparin and allow for fixed dosing without the need for monitoring.

Preoperative flexion does not influence postoperative flexion after rotating-platform total knee arthroplasty.

Purpose: Preoperative range of motion (ROM) has been regarded as one of the most important factors in predicting postoperative ROM following total knee arthroplasty (TKA). Mobile-bearing TKA designs have been suggested to possibly improve the knee kinematics compared to fixed-bearing designs. The purpose of this study was to examine the difference in postoperative flexion as a function of preoperative flexion in a consecutive series of TKAs done using a posterior-stabilized rotating-platform prosthesis.

Thromboembolic prophylaxis in orthopedic surgery using dabigatran: an oral direct thrombin inhibitor.

Dabigatran etexilate is a direct thrombin inhibitor that has been in clinical use for the prevention and treatment of venous and arterial thrombosis. Dabigatran allows for oral administration, has a rapid onset of action and has a predictable anticoagulant effect. Studies in healthy volunteers and in patients undergoing orthopedic surgery indicate that dabigatran has a predictable pharmacokinetic profile, allowing for a fixed-dose regimen without the need for coagulation monitoring.

Total hip arthroplasty in the ankylosed hip.

Altered biomechanics secondary to hip ankylosis often result in degeneration of the lumbar spine, ipsilateral knee, and contralateral hip and knee. Symptoms in these joints may be reduced with conversion total hip arthroplasty (THA) of the ankylosed hip. THA in the ankylosed hip is a technically challenging procedure, and the overall clinical outcome is generally less satisfactory than routine THA performed for osteoarthritis and other etiologies.

New oral anticoagulants in venous thromboembolism prophylaxis in orthopaedic patients: are they really better?

Prophylaxis against venous thromboembolism (VTE) is considered standard of care. Appropriate chemoprophylaxis for VTE has been mandated by the United States government agencies and consumer groups. However, controversies exist regarding the most clinically relevant and safe chemoprophylaxis protocols in patients undergoing joint replacement surgery.

Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, double-blind, non-inferiority trial.

This trial compared the efficacy and safety of oral dabigatran, a direct thrombin inhibitor, versus subcutaneous enoxaparin for extended thromboprophylaxis in patients undergoing total hip arthroplasty. A total of 2,055 patients were randomised to 28-35 days treatment with oral dabigatran, 220 mg once-daily, starting with a half-dose 1-4 hours after surgery, or subcutaneous enoxaparin 40 mg once-daily, starting the evening before surgery. The primary efficacy outcome was a composite of total venous thromboembolism [VTE] (venographic or symptomatic) and death from all-causes.

The eighth American college of chest physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies.

Venous thromboembolism (VTE) is the most common potentially preventable form of hospital-related mortality. It presents as a major healthcare burden, affecting both medical and surgical patients. The prevention of VTE has been identified as one of the most important in-hospital safety practices in the US.

Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: a review.

Background: Prophylaxis against venous thromboembolism (VTE) is routinely administered during the hospital stay in at-risk surgical and medical patients. However, in high-risk groups, the risk of deep-vein thrombosis or pulmonary embolism may persist for several weeks after discharge. The standard duration of thromboprophylaxis (6-14 days) may not provide adequate protection against such events.

Revision total hip arthroplasty using the Zweymuller femoral stem.

Background: A variety of femoral stem designs have been reported to be successful in revision total hip arthroplasty without consensus as to optimal design. We evaluated the clinical and radiographic outcomes in a consecutive series of femoral revisions using a wedge-shape, tapered-stem design at medium and long-term follow-up.

Materials And Methods: We performed a retrospective review of clinical and radiographic outcomes of twenty-eight consecutive femoral revisions arthroplasties, which were done using the Zweymuller femoral stem.

A randomized evaluation of betrixaban, an oral factor Xa inhibitor, for prevention of thromboembolic events after total knee replacement (EXPERT).

Betrixaban is an oral direct inhibitor of factor Xa (FXa) being developed for the prevention of venous thromboembolism (VTE). Its antithrombotic effects had not been previously tested in patients. This exploratory clinical trial in the US and Canada randomized 215 patients undergoing elective total knee replacement (TKR) in a 2:2:1 ratio to receive post-operative betrixaban 15 mg or 40 mg p.