Acetabular Distraction: Promising 5-Year Outcomes for the Treatment of Chronic Pelvic Discontinuity.

Background: Severe acetabular bone loss encountered during revision total hip arthroplasty (THA) poses a clinical challenge. In cases involving pelvic discontinuity, where the ilium is separated superiorly from the inferior ischiopubic segment through the acetabulum, acetabular distraction may be used to restore the biomechanics of the hemipelvis. This technique allows for correct sizing of the acetabulum, and the subsequent peripheral distraction and medial compression at the discontinuity provide initial mechanical stability and biological fixation as bone in growth occurs.

Evaluation and Management of Acetabular Bone Loss in Revision Total Hip Arthroplasty: A 10-year Update.

Acetabular bone loss continues to be one of the most complex and challenging scenarios facing the orthopaedic surgeon. Preoperative planning and classification systems essentially have remained the same, with the Paprosky classification still being the most commonly used. Careful radiological assessment with well-defined criteria can accurately diagnose acetabular bone loss patterns with an associated chronic pelvic discontinuity before surgery.

Acetabular Distraction Technique: A Multicenter Study With a Minimum 2-Year Radiographic Follow-Up.

Background: Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity.

Systematic Exposure in Revision Total Hip Arthroplasty: The Posterior Approach.

As indications for total hip arthroplasty (THA) continue to expand, and patients continue to live longer with more active lifestyles, the incidence of revision THA is expected to rise. General orthopaedic surgeons are now beginning to consider doing revision THA surgery because of the increased revision burden being experienced nationwide. While classical approaches to the hip can be used for simple revisions, extensile exposure techniques in conjunction with selective soft-tissue releases are often required for adequate visualization for more complex revision cases.

The Dome Technique for Managing Massive Anterosuperior Medial Acetabular Bone Loss in Revision Total Hip Arthroplasty: Short-Term Outcomes.

Purpose: The dome technique is a technique used in performance of revision total hip arthroplasty (THA) involving intraoperative joining of two porous metal acetabular augments to fill a massive anterosuperior medial acetabular bone defect. While excellent outcomes were achieved using this surgical technique in a series of three cases, short-term results have not been reported. We hypothesized that excellent short-term clinical and patient reported outcomes could be achieved with use of the dome technique.

Radiographic measurement of leg-length change in the nonoperative leg during total hip arthroplasty: a potential indicator of imaging error?

Background: Anteroposterior (AP) pelvic radiographs are subject to errors that may cause measurement inaccuracy in total hip arthroplasty (THA). Such errors may be detected by measuring pre- to postoperative leg-length changes in the nonoperative leg, which experiences no physical changes during THA.

Methods: From AP pelvic radiographs, we measured pre- to postoperative leg-length changes (LLC) in the nonoperative legs of 67 patients who underwent primary THA using the trans-ischial line method.

Computer Navigation for Revision Total Hip Arthroplasty Reduces Dislocation Rates.

Purpose: Computer navigation in total hip arthroplasty (THA) offers potential for more accurate placement of acetabular components, avoiding impingement, edge loading, and dislocation, all of which can necessitate revision THA (rTHA). Therefore, the use of computer navigation may be particularly beneficial in patients undergoing rTHA. The purpose of this study was to determine if the use of computer-assisted hip navigation reduces the rate of dislocation in patients undergoing rTHA.

Management of Severe Acetabular Bone Loss With Chronic Pelvic Discontinuity in Revision Total Hip Arthroplasty.

Acetabular bone loss continues to be a challenging clinical problem faced by the revision total hip arthroplasty surgeons. The presence of a chronic pelvic discontinuity further complicates this clinical entity. Several surgical techniques have been described for the management of severe acetabular bone loss with an associated chronic pelvic discontinuity, with increasing enthusiasm for noncemented reconstruction.

The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium.

Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review.

Early outcomes of a modern cemented total knee arthroplasty : is tibial loosening a concern?

Aims: Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design.

Soft-Tissue Balancing in Total Hip Arthroplasty.

»: Appropriate total hip arthroplasty (THA) reconstruction must simultaneously address component position, restoration of biomechanics, and soft-tissue balance.

»: Preoperative planning for complex THA cases should include radiographic templating, a detailed case plan that contains backup implant options, and a thorough understanding of the patient's preoperative examination.

»: Using a systematic approach to soft-tissue balancing in THA enhances the ability to intraoperatively execute the preoperative plan.

The Dome Technique, an Option for Massive Anterosuperior Medial Acetabular Bone Loss: A Retrospective Case Series.

Background: Acetabular bone loss in revision total hip arthroplasty can be very challenging even for fellowship-trained surgeons. Although it is uncommon, massive anterosuperior medial defects may be encountered, but treatment options have been limited and better ones are needed.

Questions/purposes: The primary purpose of this case series is to describe a novel surgical treatment, which we call the dome technique, that can be used to address these challenging defects.

Medium term clinical outcomes of tibial cones in revision knee arthroplasty.

Introduction: Trabecular metal cones are a relatively new option for reconstruction of major bone defects during revision total knee arthroplasty (TKA). The purpose of the present study was to retrospectively assess medium-term results for tibial cones in revision TKA with a severe proximal tibial bone defect. We hypothesized that revision TKA patients with bone defects treated with trabecular metal cones have excellent medium-term clinical and radiological results.

Adverse Local Tissue Reaction due to Mechanically Assisted Crevice Corrosion Presenting as Late Instability Following Metal-on-Polyethylene Total Hip Arthroplasty.

Background: Mechanically assisted crevice corrosion (MACC) at modular junctions can cause a spectrum of adverse local tissue reactions (ALTRs) in patients who have undergone total hip arthroplasty (THA). The purpose of this study is to describe the presentation, treatments, and related complications of a cohort of patients presenting with late instability following metal-on-polyethylene THA due to underlying MACC and ALTR.

Methods: This multicenter retrospective case series presents 17 patients (12 women, mean age 62.

Acetabular Distraction Technique for Severe Acetabular Bone Loss and Chronic Pelvic Discontinuity: An Advanced Course.

Acetabular bone loss, and specifically when it is associated with a chronic pelvic discontinuity, presents a difficult clinical challenge at the time of revision total hip arthroplasty. Most centers have advocated the use of noncemented constructs in an effort to achieve biologic fixation. The authors prefer noncemented fixation with use of the acetabular distraction technique in conjunction with modular porous metal augments for the treatment of severe acetabular bone loss and an associated chronic pelvic discontinuity.

Outcomes of Isolated Head and Liner Exchange Using Large Femoral Heads and Modern Liners in Revision Total Hip Arthroplasty.

Background: Previous reports on the outcomes of isolated head and liner exchange in revision total hip arthroplasty have found high rates of instability after these surgeries. Most reports have studied constructs using ≤28 mm femoral heads. The purpose of this study was to determine if modern techniques with the use of larger head sizes can improve the rate of instability after head and liner exchange.

Midlevel Providers in Orthopaedic Surgery: The Patient's Perspective.

Background: Midlevel providers (i.e. physician assistants [PAs] and nurse practitioners [NPs]) are being integrated into systems of care due to the exponentially increasing demand for orthopaedic care.

Painful Hip Arthroplasty: What Should We Find? Diagnostic Approach and Results.

Introduction: Identifying the source of pain is paramount for determining appropriate treatment and ensuring successful outcome in terms of management and relief of pain. The difficulty is that each surgeon has his or her own way of seeing the problem, and there is no consensus for the evaluation of these patients. The study hypothesis was that it is possible to find the cause of the pain in most cases.

Computer-assisted navigation as a diagnostic tool in revision total hip arthroplasty: A case report.

Revision total hip arthroplasty is a costly procedure accounting for approximately 14% of all hip arthroplasties. Compounding the cost considerations is the potential for serious injury to the patient when removing existing components. Such injury can result in not only increased morbidity but also dramatically increased costs.

Evaluation and Treatment of Patients With Acetabular Osteolysis After Total Hip Arthroplasty.

As the demand for total hip arthroplasty (THA) continues to increase, the burden of revision THA is also expected to increase. Although the quality of polyethylene has improved markedly, osteolysis continues to be a risk for older designs and younger, active patients. Although progressive but typically asymptomatic in early stages, osteolysis can result in component failure and complicate revision surgery.

Evaluation of Tilt-correction of Anteversion on Anteroposterior Pelvic Radiographs in Total Hip Arthroplasty.

Despite inaccuracies due to artifact and variations in patient positioning, anteroposterior (AP) radiographs remain the clinical standard for post-operative evaluation of component placement following total hip arthroplasty (THA). However, cup position, specifically anteversion, can be significantly affected by variations in patient positioning on an X-ray. A major cause of such artifact is unaccounted for pelvic tilt.