How often is the office visit needed? Predicting total knee arthroplasty revision risk using pain/function scores.

Background: Most patients have favorable outcomes after primary total knee arthroplasty (TKA). Well-validated methods to predict the risk of poor outcomes have not been developed or implemented. Several patients have annual clinic visits despite well-funcitoning TKA, as a routine practice, to detect early failure requiring revision surgery.

Retreatment after percutaneous nephrolithotomy in the computed tomographic era: long-term follow-up.

Objective: To examine the long-term retreatment rates and explore prognostic factors after percutaneous nephrolithotomy (PCNL) in the computed tomographic era.

Methods: Consecutive patients who underwent PCNL with a standardized technique attempting complete fragment detection and clearance by a single surgeon between September 2000 and June 2004 were identified. Through medical record, review details of procedures and outcomes were collected.

Efficacy of revision surgery for the dislocating total hip arthroplasty: report from a large community registry.

Background: Historically, achieving stability for the unstable total hip arthroplasty (THA) with revision surgery has been achieved inconsistently. Most of what we know about this topic comes from reports of high-volume surgeons' results; the degree to which these results are achieved in the community is largely unknown, but insofar as most joint replacements are done by community surgeons, the issue is important.

Questions/purposes: We used a community joint registry to determine: (1) the frequency of repeat revision after surgery to treat the unstable THA; (2) what surgical approaches to this problem are in common use in the community now; (3) are there differences in repeat revision frequency that vary by approach used; and (4) has the frequency of repeat revision decreased over time as surgical technique and implant options have evolved?

Methods: We reviewed 6801 primary THAs performed in our community joint registry over the last 20 years.

Improved survival of uncemented versus cemented femoral stems in patients aged < 70 years in a community total joint registry.

Background: Aseptic loosening of the femoral stem remains a significant reason for revision in total hip arthroplasty (THA). Although stem fixation methods have changed over time, there is relatively little evidence supporting cemented or uncemented stems as more durable constructs.

Questions/purposes: We examined whether there was a difference in survival to revision between cemented and uncemented THA stems (1) for any reason; (2) for aseptic loosening or loosening related to wear/osteolysis; (3) based on patient age groupings (as a proxy for patient activity level); and (4) based on procedural timeframe groupings between cemented and uncemented stems.

Aggregate Interview Method of ranking orthopedic applicants predicts future performance.

This article evaluates and describes a process of ranking orthopedic applicants using what the authors term the Aggregate Interview Method. The authors hypothesized that higher-ranking applicants using this method at their institution would perform better than those ranked lower using multiple measures of resident performance. A retrospective review of 115 orthopedic residents was performed at the authors' institution.

Cumulative revision rate is higher in metal-on-metal THA than metal-on-polyethylene THA: analysis of survival in a community registry.

Background: Metal-on-metal (MOM) THA bearing technology has focused on improving the arc of motion and stability and minimizing wear compared with traditional metal-on-polyethylene (MOP) bearing couples. It is unclear whether this more costly technology adds value in terms of improved implant survival.

Questions/purposes: This study evaluated Kaplan-Meier survival, revisions for dislocation, and cost of MOM THA compared with metal-on-cross-linked polyethylene (MOXP) THA in a community joint registry, with subset analysis of the recalled Depuy ASR™ implant.

Midterm outcomes in patients with cam femoroacetabular impingement treated arthroscopically.

Purpose: The purpose of this study was to evaluate the midterm outcomes of patients with cam-type femoroacetabular impingement treated arthroscopically.

Methods: Outcomes were measured with the Nonarthritic Hip Score (NAHS), visual analog scale pain scores, and satisfaction levels preoperatively; at 6 weeks and 3, 6, 12, and 24 months postoperatively; and at final follow-up. Two hundred one procedures were available for final assessment with a minimum follow-up of 36 months (mean, 46 months).

Revision surgery for patellofemoral problems: should we always resurface?

Background: Routine patellar resurfacing performed at the time of knee arthroplasty is controversial, with some evidence of utility in both TKA (tricompartmental) and bicompartmental knee arthroplasty. However, whether one approach results in better implant survival remains unclear.

Questions/purposes: We asked whether (1) routine patellar resurfacing in TKAs resulted in lower cumulative revision rates compared to bicompartmental knee arthroplasties, (2) patella-friendly implants resulted in lower cumulative revision rates than earlier designs, and (3) bicompartmental knee arthroplasties revised to TKAs had higher cumulative revision rates than primary TKAs.

Emergency surgical salvage for severe intracranial aneurysm rupture during endovascular coiling procedures not amenable to additional coiling.

Background: We report the management and outcomes of six patients who underwent emergency surgical intervention in the setting of severe intraprocedural rupture during endovascular treatment of an intracranial aneurysm not amenable to additional coiling.

Methods: From July 1997 through December 2010, our neurovascular service treated 1613 patients with coil embolization. During this time, we encountered six patients who suffered severe intraprocedural aneurysm rupture, defined by contrast extravasation during the coiling procedure, in whom additional attempted coiling failed to stop the ongoing extravasation.

Do "premium" joint implants add value?: analysis of high cost joint implants in a community registry.

Background: Numerous joint implant options of varying cost are available to the surgeon, but it is unclear whether more costly implants add value in terms of function or longevity.

Questions/purposes: We evaluated registry survival of higher-cost "premium" knee and hip components compared to lower-priced standard components.

Methods: Premium TKA components were defined as mobile-bearing designs, high-flexion designs, oxidized-zirconium designs, those including moderately crosslinked polyethylene inserts, or some combination.

Can this prosthesis be saved?: implant salvage attempts in infected primary TKA.

Background: Open débridement with polyethylene liner exchange (ODPE) remains a relatively low morbidity option in acute infection of total knee arthroplasty (TKA), but concerns regarding control of infection exist. We sought to identify factors that would predict control of infection after ODPE.

Methods: We identified 44 patients (44 knees) with culture-positive periprosthetic infection who underwent ODPE.

High prevalence of gouty arthritis among the Hmong population in Minnesota.

Objective: The prevalence of gout is on the rise worldwide, especially among newly industrialized populations. We evaluated the prevalence of gout in the recently established Hmong of Minneapolis/St. Paul (MSP) compared with that in non-Hmong populations.

Do men outperform women during orthopaedic residency training?

Background: Orthopaedic surgery residency has one of the lowest percentages of women (13.1%) of all primary surgical specialties. There are many possible reasons for this, including bias during the selection process.

Do porous tantalum implants help preserve bone?: evaluation of tibial bone density surrounding tantalum tibial implants in TKA.

Background: TKA with conventional metal-backed tibial implants subjects the tibial metaphysis to stress shielding, with resultant loss of bone density.

Questions/purposes: We hypothesized tibial bone mineral density in patients with porous tantalum (trabecular metal) tibial baseplates would (1) more closely parallel tibial bone mineral density in the nonoperative control limb and (2) be better maintained than in conventional historical controls.

Patients And Methods: We prospectively followed 41 patients (35 men, six women) 60 years of age or younger undergoing TKA with uncemented trabecular metal tibial components.