Dual Mobility in Total Hip Arthroplasty: Biomechanics, Indications and Complications-Current Concepts.

Dual-mobility (DM) articulations are increasingly utilized to prevent or manage hip instability after total hip arthroplasty (THA). DM cups offer enhanced stability due to the dual articulation resulting in larger jump distance and greater range of motion before impingement. Improvement in design features and biomaterials has contributed to increased interest in dual-mobility articulations due to lower risk of complications compared to their historic rates.

Dual-Mobility Articulations in Femoral Neck Fractures: A Systematic Review of the Literature and Meta-analysis of the Outcomes.

Introduction: Femoral neck fractures have been traditionally managed with hemiarthroplasty (HA) or conventional total hip arthroplasty (CTHA). There has been recent interest in using dual-mobility components (DMC) in total hip arthroplasty for patients with femoral neck fractures to provide increased stability and decrease the need for future revision.

Methods: We conducted a systematic review of the literature reporting on the use of DMC in the management of femoral neck fractures in geriatric patients.

Isolated Acetabuloplasty and Labral Repair for Combined-Type Femoroacetabular Impingement: Are We Doing Too Much?

Purpose: To evaluate patient outcomes after isolated arthroscopic volumetric acetabular osteoplasty and labral repair for the treatment of patients with combined femoroacetabular impingement (FAI) lesions.

Methods: A review of a prospectively collected registry identified 86 patients (106 hips) with an average age of 38.1 years (range, 17-59 years) with combined-type FAI that underwent isolated acetabular osteoplasty and labral repair.

Clinical and Biomechanical Evaluation of an All-Arthroscopic Suprapectoral Biceps Tenodesis.

Background: Pathology of the long head of the biceps (LHB) is a well-recognized cause of shoulder pain in the adult population and can be managed surgically with tenotomy or tenodesis.

Purpose: To compare the biomechanical strength of an all-arthroscopic biceps tenodesis technique that places the LHB distal to the bicipital groove in the suprapectoral region with a more traditional mini-open subpectoral tenodesis. This study also evaluates the clinical outcomes of patients who underwent biceps tenodesis using the all-arthroscopic technique.

Symptomatic flexion instability in posterior stabilized primary total knee arthroplasty.

Flexion instability in posterior-stabilized total knee arthroplasty is a relatively uncommon but distinct problem that is often underdiagnosed and may require surgical management. This retrospective study evaluated the authors' management strategy and assessed the results of revision surgery. The authors identified 19 knees that underwent revision for isolated flexion instability after primary posterior-stabilized total knee arthroplasty.

Time and Cost of Diagnosis for Symptomatic Femoroacetabular Impingement.

Background: Femoroacetabular impingement (FAI) and labral tears are common causes of hip pain that are often not promptly or properly diagnosed. To our knowledge, no reports have defined the time and cost of diagnosis of labral tears associated with FAI.

Hypothesis: Patients with labral tears associated with FAI undergo extraneous diagnostic testing and pain and incur a significant amount of health care costs before they receive appropriate surgical management for their pathology.

Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach?

Background: Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy.

Questions/purposes: We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement.

Methods: In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and go (TUG) test, motor component of the Functional Independence Measure™ (M-FIM™), UCLA activity score, Harris hip score, and patient-maintained subjective milestone diary and general health outcome using SF-12 scores.

All-arthroscopic iliotibial band autograft harvesting and labral reconstruction technique.

The labrum is essential for stability, movement, and prevention of arthritis in the hip. In cases of labral damage where repair of a labral tear is not possible, reconstruction can be a useful alternative. Several different autografts have been used, including the iliotibial band (ITB), the ligamentum teres capitis, and the gracilis tendon.

Radiographic results of an accelerometer-based, handheld surgical navigation system for the tibial resection in total knee arthroplasty.

In total knee arthroplasty (TKA), intramedullary and extramedullary tibial alignment guides are not proven to be highly accurate in obtaining alignment perpendicular to the mechanical axis in the coronal plane. The objective of this study was to determine the accuracy of an accelerometer-based, handheld surgical navigation system in obtaining a postoperative tibial component alignment within 2° of the intraoperative goal in both the coronal and sagittal planes. A total of 151 TKAs were performed by 2 surgeons using a handheld surgical navigation system to perform the tibial resection.

Primary hip arthroplasty with 28-mm Metasul articulation.

This follow-up study reports on 69 patients at mean 13 years with total hip arthroplasty using 28-mm Metasul (Zimmer, Winterthur, Switzerland) metal-on-metal articulation. These results are not transferable to large-diameter head metal-on-metal articulations. Four new revisions, 3 for disassociation of the liner and 1 for mechanical loosening of the acetabulum, occurred since the previous report of mean 7.

A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty.

Background: The intraoperative estimation of the anteversion of the femoral component of a total hip arthroplasty is generally made by the surgeon's visual assessment of the stem position relative to the condylar plane of the femur. Although the generally accepted range of intended anteversion is between 10 degrees and 20 degrees, we suspected that achieving this range of anteversion consistently during cementless implantation of the femoral component was more difficult than previously thought.

Methods: We prospectively evaluated the accuracy of femoral component anteversion in 109 consecutive total hip arthroplasties (ninety-nine patients), in which we implanted the femoral component without cement.

Precision surgery.

Accurate component placement in joint replacement cannot be overemphasized; despite many re-engineering efforts over the past 3 decades, failure rates at 10 years for total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain constant. Intraoperative decisions with joint replacement have been facilitated with manual instrumentation and are affected by the surgeon's intuition, instinct, and experience. Current technology allows the development and use of high-tech instrumentation, which, irrespective of surgeon-dependent variables, gives intraoperative quantitative information on which precise placement of hip and knee components can be done.