Immunoglobulin A Nephropathy in a Patient With Bilateral Metal-on-Metal Hip Arthroplasty.

Immunoglobulin A (IgA) nephropathy in the presence of a metal-on-metal (MoM) hip arthroplasty is a rare condition that requires close monitoring. A 61-year-old male with bilateral hip osteoarthritis underwent resurfacing hip arthroplasty with MoM articulating surfaces. Prior to his four-year postoperative visit, the patient was diagnosed with IgA nephropathy.

Acute Periprosthetic Hip Fractures With Short, Uncemented Femoral Stems.

Background: Uncemented femoral stems in hip arthroplasty have shown excellent long-term results, and several systematic studies indicate satisfactory performance of short stems. However, biomechanical and finite element analysis studies have suggested that shorter stems allow greater micromotion, producing greater strain at the implant-bone interface, which potentially increases the risk for periprosthetic fracture (PPF). We sought to assess this risk within our unit.

Cobalt ions induce a cellular senescence secretory phenotype in human synovial fibroblast-like cells that may be an early event in the development of adverse local tissue reactions to hip implants.

Objectives: Total hip arthroplasty is a successful procedure for treating advanced osteoarthritis (OA). Metal bearing surfaces remain one of the most widely implanted prosthesis, however approximately 10% of patients develop adverse local tissue reactions (ALTRs), namely lymphocytic predominant soft tissue reaction with or without necrosis and osteolysis resulting in high revision rates. The mechanism(s) for these reactions remains unclear although T lymphocyte mediated type IV hypersensitivity to cobalt (Co) and chromium (Cr) ions have been described.

Inter-segment coordination amplitude and variability during gait in patients with knee osteoarthritis and asymptomatic adults.

Background: Inter-segment coordination examines the timing and coupling of multiple body segments and provides a complex understanding of how the neuromuscular system controls the body. Research is required to examine if inter-segment coordination during gait differs between individuals with different knee osteoarthritis (OA) severities and asymptomatic adults.

Research Question: Do inter-segment coordination amplitude and between-trial variability during gait differ between individuals with varying levels of knee OA severity and asymptomatic adults?

Methods: This observational, cross-sectional study included participants with mild/moderate knee OA (n = 38), severe knee OA (n = 24), and asymptomatic adults (n = 51).

Indication for total knee arthroplasty based on preoperative functional score: Are we operating earlier?

Background: The number of total knee arthroplasty (TKA) procedures performed annually is increasing for reasons not fully explained by population growth and increasing rates of obesity. The purpose of this study was to determine the role of patient functional status as an indication for surgery and to determine if patients are undergoing surgery with a higher level of preoperative function than in the past.

Methods: A systematic review and meta-analysis of the MEDLINE, Embase and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Outcomes of Ceramic-On-Ceramic Bearing Total Hip Arthroplasty: A Minimum 10-Year Follow-Up Study.

Background: Although the fourth generation of ceramics has demonstrated excellent clinical results 5 to 6 years postoperatively, concerns over ceramic fracture and squeaking persist and longer-term follow-up (minimum 10 years) studies are warranted. Our study aimed to evaluate the minimum 10-year clinical outcomes and bearing-specific complications of ceramic-on-ceramic (CoC) total hip arthroplasties.

Methods: We retrospectively evaluated all patients who underwent primary delta CoC total hip arthroplasty in our institution between January 2004 and February 2013.

Osteosarcoma Around a Ceramic-on-Ceramic Total Hip Arthroplasty.

Sarcoma arising at the site of a total hip arthroplasty (THA) is uncommon. We present a case report of a patient diagnosed with an osteosarcoma around a ceramic-on-ceramic THA and a narrative literature review of sarcomas around THA. A search of PubMed MEDLINE was performed from inception.

Long-Term Survivorship of Cemented and Uncemented Polyethylene Liner Exchange.

Background: Revision surgery is usually required for complications associated with total hip arthroplasty (THA). Significant morbidity can be associated with revision THA and thus some may only revise the liner of the original metal back component if it is found to be well fixed. We compare the long-term survivorship of cemented and uncemented head-liner THA exchange surgeries and possible causes.

Long-Term Outcome of Small Head Metal-On-Metal Total Hip Arthroplasty: A 15-to-22 Year Follow-Up.

Background: The Metasul articular interface was a second-generation metal-on-metal (MoM) total hip arthroplasty (THA) that was introduced as a promising interface with improved manufacturing technology, better clearances, and enhanced metal hardness. In December 2001, the manufacturer recalled these implants due to the failure of cup osseointegration.

Methods: Between 1997 and 2004, 168 consecutive primary Metasul THAs were performed in 144 patients.

The Influence of Lateral and Posterior Total Hip Arthroplasty Approaches on Muscle Activation and Joint Mechanics During Gait.

Background: Lateral and posterior total hip arthroplasty (THA) approaches disrupt muscle function, which could impact gait. The objectives of this study were to compare muscle activation and joint mechanics during gait, and isometric strength between participants after lateral and posterior THA approaches and healthy adults.

Methods: Participants 1 year post-THA from either lateral (n = 21) or posterior (n = 21) approaches, and healthy adults (n = 21) ambulated at self-selected speeds.

No Difference in Major Complication and Readmission Rates Following Simultaneous Bilateral vs Unilateral Total Hip Arthroplasty.

Background: Simultaneous bilateral total hip arthroplasty (THA) is an attractive option for patients with osteoarthritis as it requires a single anesthetic and hospitalization. Nonetheless, serious concerns remain over the perioperative safety and rate of hospital readmission. The purpose of the present study was to compare the rate of 30-day major complications and hospital readmissions between patients undergoing simultaneous bilateral vs unilateral THA using the National Surgical Quality Improvement Program database.

Hospital Discharge within 2 Days Following Total Hip or Knee Arthroplasty Does Not Increase Major-Complication and Readmission Rates.

Background: The rising costs of total knee arthroplasty (TKA) and total hip arthroplasty (THA) have resulted in a substantial economic burden on the U.S. health-care system.

Navigated vs Conventional Total Knee Arthroplasty: Is There a Difference in the Rate of Respiratory Complications and Transfusions?

Background: Proponents of navigation in total knee arthroplasty (TKA) report lower rates of systemic embolization and perioperative bleeding compared to conventional TKA given that breeching the intramedullary canal is not required.

Methods: We queried the National Surgical Quality Improvement Program to compare perioperative respiratory complications and transfusions between navigated and conventional TKA. We identified 2008 patients who underwent navigated TKA.

Major Complications and Transfusion Rates After Hemiarthroplasty and Total Hip Arthroplasty for Femoral Neck Fractures.

Background: Postoperative complications and perioperative transfusions are common after hemiarthroplasty or total hip arthroplasty (THA) and can lead to increased morbidity and mortality.

Methods: The National Surgical Quality Improvement Program Database was queried to compare 30-day major complications and perioperative transfusions after femoral neck fractures.

Results: A total of 4058 patients were included in the study: 3192 were treated with hemiarthroplasty and 866 with THA.

Favorable Results of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem at a Minimum 4-Year Follow-Up.

Background: Shorter femoral stems have been increasingly used in total hip arthroplasty. However, there are few clinical studies evaluating the outcomes of these stems and comparing them to their regular-sized counterparts.

Methods: Our study provides radiologic and functional outcomes at 5-year mean follow-up of 131 cementless Tri-Lock Bone Preservation Stems, a short tapered stem with a proximal porous coating.

Simultaneous Bilateral Versus Unilateral Total Knee Arthroplasty: A Comparison of 30-Day Readmission Rates and Major Complications.

We queried the National Surgical Quality Improvement Program to compare the rate of 30-day readmissions and major complications between simultaneous bilateral and unilateral total knee arthroplasty (TKA). We identified 1771 patients who underwent simultaneous (same-day) bilateral TKA and matched them to a control group of 6790 patients who underwent unilateral TKA. The simultaneous bilateral TKA patients had longer surgery, were more commonly performed under general anesthesia, had a higher rate of postoperative transfusion, and a greater proportion of patients discharged to rehabilitation facilities.

Comparison of US and Canadian Perioperative Outcomes and Hospital Efficiency After Total Hip and Knee Arthroplasty.

Importance: The combination of an aging population, growing number of medical interventions, and surging economic burden of health care has renewed interest in reevaluating and exploring new health care models.

Objectives: To compare the performance of the US and Canadian health care systems by assessing major complications following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to measure the efficiency of both health care models by comparing the postoperative length of stay.

Design, Setting, And Participants: With patients grouped according to the country where they underwent surgery, we queried the National Surgical Quality Improvement Program database to identify 55,335 Canadian and US patients who underwent primary elective THA or TKA between January 1, 2011, and December 31, 2012.

Perioperative Complications and Length of Stay After Revision Total Hip and Knee Arthroplasties: An Analysis of the NSQIP Database.

Goals of this study were (1) to determine the 30-day complications after aseptic revision hip arthroplasty (RHA) and aseptic revision knee arthroplasty (RKA) and (2) to identify patient-related risk factors predicting major complications and prolonged hospital stay beyond 7 days. The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients with RHA (n=2643) or RKA (n=2425) from 2011 to 2012. The 30-day mortality rates for RHA and RKA were 1.

Midterm Outcomes of the Recently FDA Approved Ceramic on Ceramic Bearing in Total Hip Arthroplasty Patients Under 65 Years of Age.

The present study aimed to evaluate the mid-term results of the fourth generation of ceramic on ceramic (CC) bearing. Demographics, surgical technique, complications, clinical and radiologic outcomes were analyzed in a series of 133 consecutive CC total hip arthroplasties (THAs) with a newest generation CC bearings to determine if these provide safe and well performing bearings. At the last follow-up, there were no cases of ceramic fracture or chipping and no revision surgery necessary for bearing related complication.

Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.

Background: The aim of this study was to analyze NSQIP (National Surgical Quality Improvement Program) data to better understand the incidence, risk factors, and thirty-day complication rates associated with transfusions in primary total hip and knee arthroplasty.

Methods: We identified 9362 total hip and 13,662 total knee arthroplasty procedures from the database and separated those in which any red blood-cell transfusion was performed within seventy-two hours after surgery from those with no transfusion. Patient demographics, comorbidities, preoperative laboratory values, intraoperative variables, and postoperative complications were compared between patients who received a transfusion and those who did not.

Clinically significant corrosion at the head-neck taper interface in total hip arthroplasty: a systematic review and case series.

Corrosion of the head-neck junction of the femoral component in total hip arthroplasty has been associated with symptomatic adverse local tissue reactions, trunion fracture and elevated serum metal ions. An analysis of risk factors and treatment strategies for corrosion at this interface is lacking in the literature. We therefore performed a systematic review of AAOS proceedings, MEDLINE and EMBASE databases, and included our own case series.