Subsidence of a Single-Taper Femoral Stem in Primary Total Hip Arthroplasty: Characterization, Associated Factors, and Sequelae.

Background: We characterized subsidence of an uncemented single-taper femoral stem in primary total hip arthroplasty (THA), determined factors associated with subsidence, and evaluated the impact of subsidence on outcome.

Methods: This retrospective study included 502 primary THAs performed using a single-taper stem in Dorr type-A and type-B femora between 2014 and 2018. Subsidence was measured based on distance from the greater trochanter to stem shoulder on calibrated X-rays.

Irregular porous titanium enhances implant stability and bone ingrowth in an intra-articular ovine model.

Two commercially available porous coatings, Gription and Porocoat, were compared for the first time in a challenging intra-articular, weight-bearing, ovine model. Gription has evolved from Porocoat and has higher porosity, coefficient of friction, and microtextured topography, which are expected to enhance bone ingrowth. Cylindrical implants were press-fit into the weight-bearing regions of ovine femoral condyles and bone ingrowth and fixation strength evaluated 4, 8, and 16 weeks postoperatively.

Outcomes of Bulk Fresh Osteochondral Allografts for Cartilage Restoration in the Knee.

Background: Symptomatic osteochondral defects of the knee in young patients can cause substantial disability and predispose to osteoarthritis. Fresh osteochondral allografts (FOCAs) are a treatment option for such defects. With our institution having one of the longest-running FOCA programs, we investigated the long-term outcomes of bulk FOCA in the knee, focusing on graft survivorship, function, complications, and reoperation.

Return to Paralympic Rowing After Partial Joint Transplantation: A Case Report.

Case: A 24-year-old competitive rower suffered a severe road injury to the medial aspect of his knee. He was referred to us for a partial joint transplantation consisting of a medial tibiofemoral fresh osteochondral allograft (FOCA), medial collateral ligament, meniscal allograft, and osteotomy. Two years after reconstruction, the patient won a bronze medal in the Summer Paralympics.

Periacetabular Osteotomy and Femoral Head Allograft for Hip Dysplasia and Femoral Head Cyst: A Case Report.

Case: A 34-year-old woman with developmental dysplasia of the hip (DDH) presented with chronic left hip pain related to a femoral head cyst. The patient strongly preferred a joint-preserving option. Periacetabular osteotomy (PAO) has shown reliable options for managing DDH, and femoral head fresh osteochondral allograft (FOCA) can be performed for cysts.

Midterm Outcomes After Reconstruction of Superolateral Acetabular Defects Using Flying Buttress Porous Tantalum Augments During Revision Total Hip Arthroplasty.

Background: Porous tantalum augments are versatile tools in reconstructing complex acetabular defects during revision total hip arthroplasty (THA). This study examines the clinical and radiographic outcomes of porous tantalum augments placed in the type I (flying buttress) configuration at two to 17-year follow-up in the largest cohort to-date in the literature.

Methods: We retrospectively analyzed 59 consecutive revision THAs involving the use of flying buttress augments between 2003 and 2018.

Biomechanical optimization of the far cortical locking technique for early healing of distal femur fractures.

This finite element study optimized far cortical locking (FCL) technology for early callus formation in distal femur fracture fixation with a 9-hole plate using FCL screws proximal to, and standard locking screws distal to, the fracture. Analyses were done for 120 possible FCL screw configurations by varying FCL screw distribution and number. A hip joint force of 700 N (i.

Does Trochanteric Osteotomy Length Affect the Amount of Proximal Trochanteric Migration During Revision Total Hip Arthroplasty?

Background: Nonunion and proximal trochanteric migration is a known complication of trochanteric osteotomy. This study examines the effect of osteotomy length on proximal greater trochanter (GT) migration.

Methods: We analyzed 113 modified trochanteric slide osteotomies and 73 extended trochanteric osteotomies performed between 2008 and 2016.

Long-Term Results of Treating Large Posttraumatic Tibial Plateau Lesions with Fresh Osteochondral Allograft Transplantation.

Background: The use of fresh osteochondral allograft (FOCA) transplantation is a treatment option for large posttraumatic tibial osteochondral defects in young, high-demand patients. We aimed to assess the long-term outcomes of this procedure and factors impacting graft survivorship.

Methods: Evaluated were patients with a posttraumatic tibial plateau defect of >3 cm in diameter and >1 cm in depth who were treated with use of a FOCA, with or without a realignment osteotomy, before September 2007.

Patient and Caregiver Understanding of Prognosis After Hip Fracture.

Background: Hip fracture (HF) is common and requires communication between patient, family, surgeons, and hospitalists. Patient and family understanding of the seriousness of HF is unclear.

Methods: We interviewed older patients (age > 65 years) hospitalized with HF at two Canadian academic hospitals, or their surrogate decision-makers (SDMs).

Revision Total Knee Arthroplasty for the Management of Periprosthetic Fractures.

Periprosthetic fractures after total knee arthroplasty (TKA) can present reconstructive challenges. Not only is the procedure technically complex, but patients with these fractures may have multiple comorbidities, making them prone to postoperative complications. Early mobilization is particularly beneficial in patients with multiple comorbidities.

The focally constrained liner is a reasonable option for revision of unstable total hip arthroplasty.

Purpose: Revision surgery for a patient with previous recurrent dislocations or abductor muscle dysfunction has been considered to be a complication-prone procedure regardless of the type of constrained implant used. We investigated the survivorship of a focally constrained acetabular liner used for revision total hip arthroplasty in patients with abductor insufficiency or previous recurrent dislocations.

Methods: We retrospectively reviewed 98 patients in whom a focally constrained acetabular liner was used to treat abductor insufficiency or previous recurrent dislocations.

The Use of a Supra-Acetabular Antibiotic-Loaded Cement Shelf to Improve Hip Stability in First-Stage Infected Total Hip Arthroplasty.

Background: Antibiotic-loaded cement spacers in first-stage revision total hip arthroplasty (THA) for managing infection are associated with high dislocation and fracture rates. The aim of this study was to report the use of an antibiotic-loaded cemented supra-acetabular roof augmentation to reinforce hip stability after cement spacer insertion for first-stage total hip revision in the treatment of infected THA.

Methods: We retrospectively reviewed a consecutive series of 50 THAs involving 47 patients with an infected hip requiring staged revisions of THA.

Biomechanical comparison of the human cadaveric pelvis with a fourth generation composite model.

The use of cadavers for orthopaedic biomechanics research is well established, but presents difficulties to researchers in terms of cost, biosafety, availability, and ease of use. High fidelity composite models of human bone have been developed for use in biomechanical studies. While several studies have utilized composite models of the human pelvis for testing orthopaedic reconstruction techniques, few biomechanical comparisons of the properties of cadaveric and composite pelves exist.

Arthroplasty for Pertrochanteric Hip Fractures.

The mainstay of treatment of pertrochanteric fractures is internal fixation using a sliding hip screw or a cephalomedullary device. However, in patients with ipsilateral hip osteoarthritis or avascular necrosis of the femoral head, or inflammatory arthritis, arthroplasty should be considered as the primary treatment modality to reduce the likelihood of a secondary procedure. Unstable fracture patterns with concomitant poor bone quality represent a challenge for internal fixation, with high rates of lag screw cut-out and hardware failure.

Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial.

Purpose: Several studies have failed to show significant benefits of closed suction drainage (CSD) in routine primary total hip arthroplasty (THA). However, blood loss, haematoma formation and wound complications are generally much greater in revision THA as compared to primary THA. The purpose of this study was to determine if CSD is beneficial for revision THA patients.

The results of two-stage revision TKA using Ceftazidime-Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections.

Purpose: This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA).

Methods: A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39-87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin.

Complications following conversion of a hip hemiarthroplasty to a total hip arthroplasty.

Purpose: Conversion of hip hemiarthroplasty to total hip arthroplasty (CTHA) is a complication-prone procedure with high dislocation rates and early component loosening. The purpose of this study was to evaluate the complications of CTHA performed using contemporary implants.

Methods: Forty-six patients who had CTHA were retrospectively matched to a control group of 46 patients who had a first-time THA revision.

Arthroplasty for unstable pertrochanteric hip fractures may offer a lower re-operation rate as compared to cephalomedullary nailing.

Purpose: Cephalomedullary (CM) nailing is widely used for the treatment of pertrochanteric hip fractures. Fixation failures with CM nailing tend to occur in unstable fracture patterns often necessitating revision surgery. The purpose of this study was to compare the complications and clinical outcomes of primary arthroplasty to CM nailing for the treatment of unstable pertrochanteric hip fractures.

Periprosthetic supracondylar femoral fractures following knee arthroplasty: a biomechanical comparison of four methods of fixation.

Purpose: The aim of this study was to determine the biomechanical properties of four fixation options for periprosthetic supracondylar femoral fractures.

Methods: Fourth-generation composite femurs were implanted with a posterior-stabilizing femoral component of total knee arthroplasty. All femurs were osteotomized to produce a AO/OTA 33-A3 fracture pattern and four different constructs were tested: (1) non-locking plate; (2) polyaxial locking plate; (3) intramedullary fibular strut allograft with polyaxial locking plate; (4) retrograde intramedullary nail.

Risk Factors for Subsidence of a Modular Tapered Femoral Stem Used for Revision Total Hip Arthroplasty.

The purpose of this study was to determine the incidence, and the clinical and radiographic risk factors for significant subsidence of a cementless, modular tapered revision femoral stem. Femoral stem subsidence of at least 10 mm or subsidence requiring revision was considered significant subsidence. Ninety-seven patients (99 hips) were included with minimum radiographic follow-up of one year (mean 34 months; range, 12-91 months).

Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes.

In North America, two-stage revision arthroplasty is the treatment of choice for chronic periprosthetic infection of the hip and knee. Controversy exists regarding the diagnosis of persistent infection, cement spacer design, and duration of antibiotic therapy. Erythrocyte sedimentation rate and C-reactive protein tests have no clear cutoff values for detecting infection before reimplantation of hardware, and aspiration for microbial culture can yield false-negative results.

External fixation versus open reduction with plate fixation for distal radius fractures: a meta-analysis of randomised controlled trials.

Background: Both external fixation and open reduction with internal fixation (ORIF) using plates have been recommended for treatment of distal radius fractures. We conducted a systematic review and meta-analysis of randomised controlled trials comparing external fixation to ORIF.

Methods: MEDLINE, EMBASE, and COCHRANE databases were searched from inception to January 2011 for all trials involving use of external fixation and ORIF for distal radius fractures.

Changes in femoral cortical porosity after reaming and intramedullary canal preparation in a canine model.

This study examined changes in femoral cortical porosity resulting from femoral canal preparation during cemented total hip arthroplasty (THA). Twenty-four canines were randomly assigned to 3 groups: (1) reaming only, (2) cementing without pressurization, and (3) cementing with pressurization. Femoral cortical porosity was measured from histologic samples of the femurs at 7 positions.

A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures.

Background: The gamma nail has an option to statically lock its lag screw (static mode) or to allow its lag screw to move within the nail to compress the intertrochanteric fracture (dynamic mode). The purpose of this study was to compare the biomechanical stiffness of static and dynamic lag screw modes for a cephalomedullary nail used to fix an unstable peritrochanteric fracture.

Methods: Unstable four-part peritrochanteric fractures were created in 30 synthetic femurs and fixed with Long Gamma 3 Nails.