Bilateral Total Hip and Knee Arthroplasties: Average 10-Year Follow-Up.

Background: The present study investigates the clinical and radiographic outcomes in patients with all 4 major lower extremity joints replaced.

Methods: A retrospective review of our institution's database identified 125 patients in whom both hips and both knees were replaced. The mean time between the first and last arthroplasty was 6.

ACL Damage and Deficiency is Associated with More Severe Preoperative Deformity, Lower Range of Motion at the Time of TKA.

Background: ACL status varies in the arthritic knee during TKA.

Questions/purposes: The purpose of this study was to examine clinical features and intraoperative findings associated with stages of ACL degeneration.

Methods: Coronal deformity, ROM, intra-articular degenerative patterns, and ligament releases were assessed for 1656 knees during TKA.

Midterm Results of the Vanguard SSK Revision Total Knee Arthroplasty System.

Revision total knee arthroplasty (TKA) is becoming increasingly common as the population ages and the number of existing primary TKAs continues to increase. Revision TKA systems use a greater range of component modularity than primary TKA systems, including stems, augments, and varying levels of constraint. The purpose of this study was to retrospectively review the authors' institution's use of one specific revision knee implant system and its midterm results.

Ten-Year Outcome Comparison of the Anatomical Graduated Component and Vanguard Total Knee Arthroplasty Systems.

Unlabelled: The development of a new total knee system as a successor prosthesis in total knee arthroplasty (TKA) requires clinical outcome improvement. 10,843 TKAs were performed of which 9169 utilized the Anatomical Graduated Component (AGC) and 1674 utilized the Vanguard prosthesis (both Biomet, Warsaw, IN). Survival rates at ten years postoperatively for the AGC and Vanguard were 98.

The Surgeon's Role in Relative Success of PCL-Retaining and PCL-Substituting Total Knee Arthroplasty.

Background: The orthopedic literature has not shown a universal and replicated difference, outside of flexion, in clinical results between posterior cruciate ligament retention and posterior cruciate ligament substitution in total knee arthroplasty.

Questions/purposes: This study was performed to compare the restoration of flexion and knee function in a large series of cruciate-retaining and cruciate-substituting total knee arthroplasties (TKRs). In addition, we aimed to study how other variables, such as those unique to each surgeon, may have affected the results.

"Thicker" polyethylene bearings are associated with higher failure rates in primary total knee arthroplasty.

"Thin" modular polyethylene bearings have previously been associated with failure from wear. This study examined the influence of polyethylene thickness on survivorship in primary total knee arthroplasty (TKA). Do "thinner" or "thicker" bearings fail more? Six thousand seventy primary TKAs with a single implant design were reviewed.

High preoperative range of motion is a significant risk factor for dislocation in primary total hip arthroplasty.

Dislocation after total hip arthroplasty (THA) is multifactorial and is dependent on surgical, implant, and patient factors. We hypothesized that high preoperative hip range of motion is an important variable contributing to instability after THA. We retrospectively reviewed 3379 THAs performed during a 21-year period.

Hybrid total knee arthroplasty: 13-year survivorship of AGC total knee systems with average 7 years followup.

A retrospective study of 201 anatomic graduated component total knee arthroplasties implanted with hybrid fixation at the authors' center was performed in response to conflicting data in the literature concerning the benefits of a hybrid method. Selection for hybrid fixation was nonrandomized and based on femoral component fit. Survivorship analysis was performed, and rates of radiolucent lines surrounding the femoral component and occurrence of osteolysis were noted.

Early failure of unicompartmental knee arthroplasty leading to revision.

The most common previously reported modes of failure of unicompartmental knee arthroplasty (UKA) in the first and second decades are polyethylene wear, progression of arthritis, and component loosening. The purpose of this study is to describe an early mechanism of failure of the medial UKA. Thirty-two consecutive revisions from UKA to total knee arthroplasty were retrospectively reviewed.

Extended femoral osteotomy and proximally coated prosthesis for hip revision.

Extended trochanteric osteotomy facilitates femoral reconstruction in revision total hip arthroplasty. This study examined the outcome of extended trochanteric osteotomy combined with a proximally porous-coated calcar replacement prosthesis during revision total hip arthroplasty. Forty-five cases were reviewed with an osteotomy union rate of 98%.

Clinical results of isolated tibial component revisions with femoral component retention.

The purpose of this study is to report the outcome for a consecutive series of isolated nonmodular tibial component revisions. A consecutive series of 6548 total knee arthroplasties (6024 metal backed; 524 all-polyethylene) were performed with nonmodular tibial components of which 54 knees (0.82%) (22 metal backed; 32 all-polyethylene) underwent isolated tibial component revision with femoral component retention.

The effect of stuffing the patellofemoral compartment on the outcome of total knee arthroplasty.

Background: The effect of so-called stuffing of the patellofemoral compartment at the time of total knee arthroplasty (that is, increasing the anterior patellar displacement, the anteroposterior femoral size, or the combined anteroposterior patellofemoral size) has not been well studied. The purpose of the present study was to evaluate the effect of stuffing the patellofemoral compartment on the outcome of primary total knee arthroplasty.

Methods: A retrospective review of 1100 primary total knee arthroplasties that had been performed in 1997 and 1998 was conducted.

Manipulation after total knee arthroplasty.

Background: Following total knee arthroplasty, some patients who fail to achieve >90 degrees of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty.

Methods: One hundred and thirteen knees in ninety patients underwent manipulation for postoperative flexion of < or =90 degrees at a mean of ten weeks after surgery.

Total knee arthroplasty effectiveness in patients 55 years old and younger: osteoarthritis vs. rheumatoid arthritis.

In the past, total knee arthroplasty, although very successful, was only indicated for an elderly population. Recently though, several papers have been published confirming that total knee arthroplasty is effective in younger patients. This paper supports the results of those papers.

A clinical comparison of patellar tracking using the transepicondylar axis and the posterior condylar axis.

Two different methods for femoral component rotation in total knee arthroplasty (TKA) were compared with regard to the need for lateral retinacular release and 3-year follow-up knee society scores of both patellofemoral function and 3-year radiographs of the patella. The posterior condylar axis was used in 1322 consecutive primary TKAs, and the transepicondylar axis (TEA) was used in 1059 consecutive primary TKA. A significant decrease in lateral retinacular release was observed from 56.

Lateral patellar contact after total knee arthroplasty: an analysis of the effects on postoperative pain and outcome.

Although medialization of the patellar component during primary total knee arthroplasty (TKA) has been advocated for biomechanical reasons, this can lead to lateral patellar contact with the femoral component. Using blinded radiographic evaluations, we evaluated 980 consecutive primary TKAs performed from 1997 to 1998. The prevalence of lateral patellar contact in this series was found to be 46.

The effect of the Insall-Salvati ratio on outcome after total knee arthroplasty.

The effect of total knee arthroplasty (TKA) on the Insall-Salvati ratio (ISR) and the effect of the ISR on the outcome of TKA have not been clearly established. A retrospective review of 1055 primary TKAs performed in 1997 to 1998 was performed. Radiographic measurements were made preoperatively and postoperatively, and the ISR was calculated.

Polyethylene sterilization and production affects wear in total hip arthroplasties.

Production and package sterilization techniques for the polyethylene used in acetabular components for total hip arthroplasties are known to affect wear. We considered three combinations of techniques: sterilization by radiation in inert gas with isostatically molded polyethylene, in inert gas and ram-extruded polyethylene, and in air with extruded polyethylene. The intent of this study was to confirm that molded polyethylene and polyethylene radiated in inert environments reduce wear rates in vivo, to determine the combination of methods with the least wear, and to determine how much variance in wear is attributable to these methods.

The cemented all-polyethylene acetabular cup: factors affecting survival with emphasis on the integrated polyethylene spacer: an analysis of the effect of cement spacers, cement mantle thickness, and acetabular angle on the survival of total hip arthroplasty.

Four hundred seven primary total hip arthroplasties were performed using a cemented, direct compression molded all-polyethylene acetabular component. Based on a double-blinded randomization schedule, one group received acetabular cups with cement spacers made from polyethylene integrated into the cup, whereas the other group received the same acetabular cups with the polyethylene spacers removed. Patients were followed up for an average of 6.

The effect of femoral notching during total knee arthroplasty on the prevalence of postoperative femoral fractures and on clinical outcome.

Background: The treatment of a supracondylar femoral fracture following total knee arthroplasty is complicated by the presence of the prosthetic components. Anterior femoral notching during arthroplasty has been implicated as a contributing risk factor for femoral fracture. We retrospectively reviewed the effect of anterior femoral notching on the subsequent occurrence of a periprosthetic supracondylar fracture of the distal aspect of the femur and the outcomes of primary total knee arthroplasty in such patients.

Long-term followup of posterior-cruciate-retaining TKR in patients with rheumatoid arthritis.

A consecutive series of 220 primary posterior-cruciate ligament-retaining total knee replacements were done in 148 patients with rheumatoid arthritis. From this group, 212 total knee replacements (141 patients) were followed up for an average of 10 years. Average knee scores at 5, 10, 15, and 20 years after operation improved to 86, 83, 88, and 89, respectively, and average function scores improved to 70, 72, 64, and 88, respectively.

Tibial component failure mechanisms in total knee arthroplasty.

The purpose of this study was to examine the failure mechanisms and factors associated with failure of a nonmodular metal backed cemented tibial component. Out of 3152 total knee replacements done for osteoarthritis, 41 tibial components had been revised (1.3%).

Total knee arthroplasty in patients with angular varus or valgus deformities of > or = 20 degrees.

Of 8,014 surgeries between January 1986 and August 2000, 82 primary total knee arthroplasties (TKAs) were performed on 75 patients with severe preoperative varus or valgus deformity of greater than or equal to 20 degrees with a minimum 2-year follow-up time and a posterior cruciate retaining prosthesis. This study was designed to determine whether these patients (group A) could be as successful, using a Knee Society score (KSS) and alignment, as a matched control group (group B). There was no statistical difference in knee score, alignment, or revision.