Fewer Dislocations After Total Hip Arthroplasty With Robotic Assistance or Fluoroscopic Guidance.

Background: Computer navigation and robotic assistance may reduce total hip arthroplasty (THA) dislocations by improving the accuracy and precision of component positioning. We investigated dislocation rates for THAs using conventional techniques, robotic assistance, and computer navigation, while controlling for surgical approach, dual mobility (DM) use, and fluoroscopic guidance.

Methods: We reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation.

Functional knee apparatus for the evaluation of ligamentous tensions on contact loads.

Background: Soft tissue balancing is integral in providing stability following total knee arthroplasty (TKA). Although intraoperative contact load sensors are providing insights into the effects of soft tissue balancing, there is still a lack of understanding of the relationship between the knee's ligamentous tensions and joint surface contact loads. This study reports on the development of a multifunctional testing apparatus that can quantify the effects of ligamentous tension on joint contact loads in a controlled repeatable environment.

Technology Applications for Arthroplasty: Moving the Field Forward?

Total joint arthroplasty (TJA) is one of the most performed and successful surgeries in the United States for advanced degenerative and inflammatory arthritis with most patients reporting excellent outcomes. However, a large number of patients are still dissatisfied following TJA. To improve outcomes, new technologies such as patient-specific instrumentation and custom implants; smart implant trials; radiologic, computer, and portable accelerometer-based navigation systems; and robotics have been developed.

Relationship between surgical balancing and outcome measures in total knees.

Background: The purpose of the study was to investigate the accuracy of balancing which could be achieved at total knee surgery and its relation to functional outcomes.

Methods: During surgery, the forces on the medial and lateral plateaus were measured at 10-15 degrees flexion in 101 patients, using an instrumented tibial trial, with equal forces being targeted. Of the initial 101 cases, 71 cases completed all follow-up visits to 1 year.

Tramadol in Knee Osteoarthritis: Does Preoperative Use Affect Patient-Reported Outcomes After Total Knee Arthroplasty?

Background: The 2013 American Academy of Orthopedic Surgeons evidence-based guidelines recommend against the use of preoperative narcotics in the management of symptomatic osteoarthritic knees; however, the guidelines strongly recommend tramadol in this patient population. To our knowledge, no study to date has evaluated outcomes in patients who use tramadol exclusively as compared with narcotics naive patients.

Methods: This is a retrospective study of prospectively collected data for patients who underwent unilateral primary total knee arthroplasty between January 2017 and March 2018.

Payer type does not impact patient-reported outcomes after primary total knee arthroplasty.

Background: There is a paucity of literature assessing whether payer type has an impact on postoperative patient-reported outcomes (PROs) after total knee arthroplasty (TKA). The aim of this study was to comparatively evaluate TKA PROs among patients with commercial and Medicare insurance.

Methods: We conducted a single-center, retrospective review of patients operated between January 2017 and March 2018.

Relationship Between Ligament Forces and Contact Forces in Balancing at Total Knee Surgery.

Background: Spacer blocks, tensors, or instrumented tibial trials are current methods of balancing the knee during surgery but there are no current techniques for measuring ligament forces. Our goal was to study the relationship between the collateral ligament forces and the condylar contact forces to determine whether there was equivalence.

Methods: A test rig was constructed modeling an artificial knee joint with collateral ligaments.

Laxity and contact forces of total knee designed for anatomic motion: A cadaveric study.

Background: Total knee designs that attempt to reproduce more physiological knee kinematics are gaining attention given their possible improvement in functional outcomes. This study examined if a total knee designed for anatomic motion, where the soft tissue balancing was intended to replicate anatomical tibiofemoral contact forces, can more closely reproduce the laxity of the native knee.

Methods: In an ex-vivo setting, the laxity envelope of the knees from nine lower extremity specimens was measured using a rig that reproduced surgical conditions.

Contact forces in the tibiofemoral joint from soft tissue tensions: Implications to soft tissue balancing in total knee arthroplasty.

Proper tension of the knee's soft tissue envelope is important during total knee arthroplasty; incorrect tensioning potentially leads to joint stiffness or instability. The latter remains an important trigger for revision surgery. The use of sensors quantifying the intra-articular loads, allows surgeons to assess the ligament tension at the time of surgery.

Rigid Patient Positioning is Unreliable in Total Hip Arthroplasty.

Background: To our knowledge, no study has assessed the ability of rigid patient positioning devices to afford arthroplasty surgeons with ideal acetabular orientation throughout surgery. The purpose of this study is to use robotic arm-assisted computer navigation to assess the reliability of pelvic position in total hip arthroplasty performed on patients positioned with rigid positioning devices.

Methods: A prospective cohort of 100 hips (94 patients) underwent robotic-guided total hip arthroplasty in the lateral decubitus position from the posterior approach, 77 stabilized by universal lateral positioner, and 23 by peg board.

Accuracy of Balancing at Total Knee Surgery Using an Instrumented Tibial Trial.

Background: Balancing is an important part of a total knee procedure, and in recent years, more emphasis has been given to quantifying the process.

Methods: During 101 total knee surgeries, initial bone cuts were made using navigation. Lateral and medial contact forces were determined throughout flexion using an instrumented tibial trial.

Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty.

The geometry of the intercondylar box plays a significant role in the development of patellar clunk syndrome. We reviewed the incidence of patella clunk at mid-to-long-term follow-up of a rotating high-flex versus fixed bearing posterior stabilized TKA design. 188-mobile and 223-fixed bearing TKAs were reviewed for complications, incidence of patellar clunk, treatment, recurrence rates, range of motion, and patient satisfaction.

Effects of surgical variables in balancing of total knee replacements using an instrumented tibial trial.

Background: In total knee surgery, typically the bone cuts are made first to produce the correct overall alignment. This is followed by balancing, often using spacer blocks to obtain equal parallel gaps in flexion and extension. Recently an electronically instrumented tibial trial has been introduced, which measures lateral and medial contact forces.

Identification of the landmark registration safe zones during total knee arthroplasty using an imageless navigation system.

Incorrect registration during computer assisted total knee arthroplasty (CA-TKA) leads to malposition of implants. Our aim was to evaluate the tolerable error in anatomic landmark registration. We incorrectly registered the femoral epicondyles, femoral and tibial centers, as well as the malleoli and documented the change in angulation or rotation.

Computer-assisted surgery patterns of ligamentous deformity of the knee: a clinical and cadaveric study.

Knee malalignment during total knee arthroplasty (TKA) is commonly classified as either varus or valgus on the basis of a standing anteroposterior radiograph. Computer-assisted surgery (CAS) navigation TKA provides precise dynamic evaluation of knee alignment throughout the full range of motion (FROM). The goal of this study was to classify patterns of CAS-generated knee deformity curves that match specific soft tissue contracture combinations.

Total hip arthroplasty in above-knee amputees: a case report.

There are previous case reports in the literature that describe total knee and total hip arthroplasty (THA) in below-knee amputees, but we could find no case reports on above-knee amputees (AKAs) who have severe osteoarthritis of the hip. We present a case involving an AKA who developed severe osteoarthritis of the ipsilateral hip. Out patient underwent THA with a satisfactory postoperative outcome.

Effect of a perioperative intra-articular injection on pain control and early range of motion following bilateral TKA.

Pain control after total knee arthroplasty (TKA) is integral in the immediate postoperative period for early rehabilitation. Numerous different methods of postoperative analgesia are available, but each has its own risk of adverse side effects. This study was performed to prospectively evaluate the benefits of an intra-articular analgesic injection in patients undergoing bilateral TKA.

Massive wear and metallosis of an Acetabular Cup System presenting as pseudodislocation.

In primary and revision total hip arthroplasty (THA), the acetabular component continues to pose greater challenges than the femoral component. Numerous factors lead to polyethylene wear, which subsequently affects primary THA survival. Progressive polyethylene wear is associated with the occurrence of osteolysis, especially overlying the acetabulum, which can lead to component loosening and subsequent revision.

"Floating total knee": ipsilateral periprosthetic fractures of the distal femur and proximal tibia after total knee arthroplasty.

Unlabelled: Currently, there are more than 300000 primary total knee arthroplasty (TKA) performed annually in the United States. It is estimated that 0.3% to 2.

Musculoskeletal complications associated with lysosomal storage disorders: Gaucher disease and Hurler-Scheie syndrome (mucopolysaccharidosis type I).

Purpose Of Review: Enzyme therapy for lysosomal storage disorders directed at correcting the underlying cause of disease represents the most significant recent advance in patient management. This review focuses on two disease groups: glycosphingolipidoses and mucopolysaccharidoses. Specifically, Gaucher disease and Hurler-Scheie syndrome have been selected as the prototypical disorder for each respective class.

A simple method for construction of an articulating antibiotic-loaded cement spacer.

A 2-stage exchange protocol has been used widely in North America for management of infected total hip arthroplasties. Many surgeons choose to use an antibiotic-loaded cement spacer in the interval before reimplantation of the final prosthesis. We propose a simple technique for the construction of an articulating antibiotic-loaded spacer for use as part of 2-stage exchange protocol for the treatment of infected total hip arthroplasties.