"Intra-operative assessment of leg length discrepancy with anterior approach total hip replacement: a comparison between standard table, position table with and without intra-operative radiographs".

Purpose: Post-operative LLD is a major concern after THA. The anterior approach on a standard table allows surgeons for a direct control of the leg length. Intra-operative radiography (IR) helps in assessment of hip biomechanics and anatomic parameters.

Prevalence of anemia and association with outcome in joint arthroplasty - is there a difference between primary and revision cases?

Purpose: Anemia has been shown to be a modifiable pre-operative, patient factor associated with outcome following arthroplasty. The aims of this retrospective study were to (1) ascertain the prevalence of preoperative anemia in patients undergoing primary and revision hip and knee arthroplasty at a tertiary referral center and (2) to test the association with outcome and whether it differs between primary and revision cases.

Methods: All hip and knee primary and revision arthroplasties performed at a Canadian academic, tertiary-care, arthroplasty center between 2012 and 2017 were included in this study.

Impact of Anesthetic Choice on Time to Discharge for Same-Day Discharge Joints.

Background: As total joint arthroplasty programs continue to move towards same-day discharge (SDD), time to discharge is an increasingly important performance indicator. The primary objective of this study was to determine the impact of the choice of anesthetic on the time to discharge after SDD primary hip and knee arthroplasty.

Methods: A retrospective chart review was conducted within our SDD arthroplasty program, with 261 patients identified for analysis.

The direct anterior approach is safe and shortens hospital length of stay following hemiarthroplasty for neck of femur fracture.

Objective: To investigate the safety of using the anterior approach (AA), compared to the lateral approach (LA), in hemiarthroplasty for the treatment of displaced neck of femur fractures.

Design: Retrospective case-control match cohort study.

Setting: Level 1 trauma center.

Accuracy of digital templating in uncemented primary total hip arthroplasty: which factors are associated with accuracy of preoperative planning?

Background: Preoperative planning is a fundamental step for successful total hip arthroplasty (THA). Studies have highlighted the accuracy of preoperative digital templating for estimating acetabular cup and stem size. Stem design such as single-wedge metadiaphyseal (Type 1 stem) versus mid-short stem (microplasty) and surgical approach (anterior, direct lateral or posterior) have not been well investigated as predictors of THA templating accuracy.

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

Background: Short cementless femoral stems may allow for easier insertion with less dissection. The use of short stems with the anterior approach (AA) may be associated with a considerable perioperative fracture risk. Our aim was to evaluate whether patient-specific femoral and pelvic morphology and surgical technique, influence the perioperative fracture risk.

The SLIM Study: Economic, Energy, and Waste Savings Through Lowering of Instrumentation Mass in Total Hip Arthroplasty.

Background: Nearly 700,000 total hip arthroplasties (THAs) are annually performed in North America, costing the healthcare system >$15 billion and creating over 5 million tons of waste. This study aims to (1) assess satisfaction of current THA setup; (2) determine economic cost, energy cost, and waste cost of current setup and apply lean methodology to improve efficiency; and (3) design and test "Savings through Lowering of Instrumentation Mass (SLIM) setup" based on lean principles and its ability to be safely implemented into practice.

Methods: A Needs Assessment Survey was performed.

Outcomes of Total Hip Arthroplasty After Acetabular Open Reduction and Internal Fixation in the Elderly-Acute vs Delayed Total Hip Arthroplasty.

Background: Optimum management for the elderly acetabular fracture remains undefined. Open reduction and internal fixation (ORIF) in this population does not allow early weight-bearing and has an increased risk of failure. This study aimed to define outcomes of total hip arthroplasty (THA) in the setting of an acetabular fracture and compared delayed THA after acetabular ORIF (ORIF delayed THA) and acute fixation and THA (ORIF acute THA).

Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches.

Background: The most effective surgical approach to total hip replacement (THR) remains controversial. Most studies that have compared approaches have reported only short-term outcome data. It is therefore unclear in the literature if a particular surgical approach offers long-term advantages.

Ten-Year Experience With the Anterior Approach to Total Hip Arthroplasty at a Tertiary Care Center.

Background: The anterior approach (AA) to total hip arthroplasty (THA) has advantages for patients and healthcare providers. However, some studies have reported high rates of adverse events when introducing AA-THA. This was not consistent with our center's experience, where 4 senior surgeons safely introduced AA-THA into practice.

Is There a Role for Preclosure Dilute Betadine Irrigation in the Prevention of Postoperative Infection Following Total Joint Arthroplasty?

Background: Conflicting evidence exists surrounding the use of preclosure irrigation solutions in primary total joint arthroplasty (TJA). We aimed to determine the role of dilute betadine lavage in preventing early infection after primary TJA.

Methods: We retrospectively reviewed primary TJAs between 2010 and 2018.

Natural history of lateral femoral cutaneous nerve neuropraxia after anterior approach total hip arthroplasty.

Aim:: The aim of this study was to examine the natural history of lateral femoral cutaneous nerve (LFCN) neuropraxia in a previously reported cohort of individuals after direct anterior approach (DAA).

Methods:: 99 patients (107 hips) with LFCN neuropraxia were identified, out of which 82 patients (87 hips) (83.1%) completed functional outcomes questionnaires at mean follow-up of 5.

2018 Frank Stinchfield Award: Spinopelvic Hypermobility Is Associated With an Inferior Outcome After THA: Examining the Effect of Spinal Arthrodesis.

Background: Many patients undergo both THA and spinal arthrodesis, and those patients may not fare as well as those who undergo one procedure but not the other. The mechanisms of how spinal arthrodesis affects patient function after THA remain unclear.

Questions/purposes: The aims of our study were to (1) determine how patient-reported outcome measures (PROMs), including the Oxford hip score as well as dislocations and complications compare after THA between patients with and without spinal arthrodesis; (2) characterize sagittal pelvic changes in these patients that occur when moving between different functional positions and test for differences between patients with and without spinal arthrodesis; and (3) assess whether differences in sagittal pelvic dynamics are associated with PROMs, complications, and dislocations after THA.

Metal on Metal Hip Resurfacing in Patients 45 Years of Age and Younger at Minimum 5-Year Follow-Up.

Background: Metal on metal hip resurfacing (MoM-HR) is an alternative to total hip arthroplasty in young and active patients. The purpose was to determine the survivorship of MoM-HR procedures performed in patients aged 45 years and younger assessing patient-reported outcome measures (PROMs) at minimum 5-year follow-up.

Methods: All 217 patients equal to or younger than 45 years of age at the time of surgical intervention presenting to our center with MoM-HR between May 2002 and May 2011 were prospectively followed.

A Single-Center Experience With a Titanium Modular Neck Total Hip Arthroplasty.

Background: Added modular junction has been associated with implant-related failures. We report our experience with a titanium-titanium modular neck-stem interface to assess complications, possible clinical factors influencing use of neck modularity, and whether modularity reduced the incidence of dislocation.

Methods: A total of 809 total hip arthroplasties completed between 2005 and 2012 from a prospectively collected database were reviewed.

What Do Reported Learning Curves Mean for Orthopaedic Surgeons?

Practicing orthopaedic surgeons must assess the effects of the learning curve on patient safety and surgical outcomes if a new implant, technique, or approach is being considered; however, it remains unclear how learning curves reported in the literature should be interpreted and to what extent their results can be generalized. Learning curve reports from other surgical specialties and from orthopaedic surgery can be analyzed to identify the strengths and weaknesses of learning curve reporting. Single-surgeon series and registry data can be analyzed to understand learning challenges and to develop a personalized learning plan.

Do patients with a failed metal-on-metal hip implant with a pseudotumor present differences in their peripheral blood lymphocyte subpopulations?

Background: Early adverse tissue reactions around metal-on-metal (MoM) hip replacements, especially pseudotumors, are a major concern. Because the causes and pathomechanisms of these pseudotumors remain largely unknown, clinical monitoring of patients with MoM bearings is challenging.

Questions/purposes: The purpose of this study was to compare the lymphocyte subpopulations in peripheral blood from patients with a failed MoM hip implant with and without a pseudotumor and patients with a well-functioning MoM hip implant without a pseudotumor.

Primary total knee arthroplasty twenty years after distal femoral cement augmentation of a giant cell tumor.

We present a case of knee reconstruction 20 years after treatment of a giant cell tumor (GCT) with curettage and cementation. There is currently an ongoing debate whether cement or allograft bone is the preferred material for filling the void after GCT curettage. In this case we were able to readily implant a primary total knee replacement without disturbing the existing well-interdigitated large cement bolus and did not require any stems or augments for the reconstruction.

Clinical results of the conserve plus metal on metal hip resurfacing: an independent series.

The purpose of the present study was to report the clinical and radiographic results of an independent series of the Conserve Plus hip resurfacing. Five hundred forty-eight consecutive hip resurfacings were performed using the Conserve Plus prosthesis in 458 patients (350 males) with a mean age of 48.3 years (range 19 to 66).

Proximal femoral arthroplasty in patients undergoing revision hip arthroplasty.

Bone loss represents one of the greatest challenges in revision joint surgery. A retrospective review was conducted of both radiographic and clinical outcomes of eleven patients who underwent revision arthroplasty using a long extensively porous coated cylindrical femoral component. All patients' femurs presented with severe proximal femoral bone loss (Paprosky class IIIB and IV).

Repeated early failure of a newly designed hinged knee system.

We report a case of acute and recurrent accelerated wear of the polyethylene bushings of the hinge mechanism in the Zimmer Segmental Knee System. This resulted in an unacceptable recurvatum deformity leading to multiple revision knee operations, which was unexpected in a modern design hinged knee system. A custom modification of the original design was used to prevent further recurvatum deformity.