Prospective Noninvasive Hemoglobin Monitoring in the Outpatient Total Joint Arthroplasty Setting.

Background: Total joint arthroplasty (TJA) is increasingly being performed as an outpatient (i.e., same-day discharge) procedure.

Is Periacetabular Osteotomy With Hip Arthroscopy Superior to Periacetabular Osteotomy Alone? A Systematic Review and Meta-Analysis.

Introduction: There remains ongoing controversy regarding the optimal treatment strategy of hip dysplasia, with some advocating for the addition of hip arthroscopy to periacetabular osteotomy (PAO) to address concomitant labral tears. The purpose of this systematic review was to compare the clinical outcomes, complications, and joint preservation of PAO and PAO with hip arthroscopy.

Methods: A literature search was done, and studies were included if they reported outcomes of PAO with concomitant hip arthroscopy, PAO with staged hip arthroscopy, or compared outcomes of PAO alone versus PAO with hip arthroscopy.

The Impact of Leg Length and Offset Change on Dislocation Risk Following Primary Total Hip Arthroplasty.

Background: Soft tissue management in total hip arthroplasty includes appropriate restoration and/or alteration of leg length (LL) and offset to re-establish natural hip biomechanics. The purpose of this study was to evaluate the effect of LL and offset-derived variables in a multivariable survival model for dislocation.

Methods: Clinical, surgical, and radiographic data was retrospectively acquired for 12,582 patients undergoing primary total hip arthroplasty at a single institution from 1998 to 2018.

Development and implementation of a roadmap for improving quality of care in prearthritic hip disease: A journey over 20 years.

The understanding and treatment of prearthritic hip disease has evolved remarkably over the past 20 years. The principal investigator and the multicenter Academic Network of Conservational Hip Outcomes Research (ANCHOR) group have had a key role in improving the quality of care for these patients suffering from the three most common prearthritic conditions: femoroacetabular impingement, developmental dysplasia of the hip, and residual Legg-Calve-Perthes Disease. We aim to demonstrate that based on the six quality of care dimensions as defined by Donabedian, our 20-year academic journey has markedly improved the quality of care for young patients with prearthritic hip disease.

Identifying Critical Evidence Gaps in Wound Closure and Incision Management After Total Knee Arthroplasty: Delphi Panel Insights.

Background: Effective surgical wound management in total knee arthroplasty (TKA) is crucial for optimal healing and patient outcomes. Despite surgical advances, managing wounds to prevent complications remains challenging. This study aimed to identify and address evidence gaps in TKA wound management, including preoperative optimization, intraoperative options, and postoperative complication avoidance.

No Revisions Attributable to Wear of Highly Cross-Linked Polyethylene Liners: A Long-Term Follow-Up Study.

Background: There is a paucity of data beyond 15 years on the survivorship of total hip arthroplasty since the introduction of highly cross-linked polyethylene (HXLPE) liners. Our aim was to evaluate implant survivorship, liner wear rates, and clinical outcomes after primary total hip arthroplasty using HXLPE liners implanted between 1999 and 2002.

Methods: Between 1999 and 2002, 690 primary total hip arthroplasties utilizing 28-mm femoral heads and HXLPE liners of a single design were identified using our institutional total joint registry.

Peri-Operative Management of Periacetabular Osteotomy: A Report of Current Practices from the Anchor Group, Supporting Literature, and Areas for Future Investigation.

Background: Periacetabular osteotomy (PAO) is a well-established surgical treatment for hip dysplasia, but very few studies report the impact of peri-operative management strategies on early pain and function. The purpose of this study is to describe peri-operative management variability among a group of experienced surgeons and review the literature supporting these practice patterns.

Methods: We surveyed 16 surgeons that perform PAO to document various aspects of peri-operative management at four stages: pre-operative, intra-operative, post-operative in the hospital, and at discharge.

Total knee replacement with an accelerometer-based, hand-held navigation system improves knee alignment: reliable in all patients.

Background: Achieving adequate alignment has traditionally been an important goal in total knee arthroplasty to achieve long-term implant survival. While accelerometer-based hand-held navigation systems (ABN) has been introduced as a way to achieve alignment, there is a limited body of evidence on its accuracy, especially in patients under 65 years with differing etiologies for knee arthritis. This study aimed to assess the precision of a specific ABN system in restoring the mechanical axis and report surgical variables and complications, with particular attention to younger patients.

Osteochondral Allograft Transplantation for the Treatment of an Acetabular Defect: A Case Report.

Case: A 20-year-old woman presented with a unipolar, 1.8 × 1.8-cm osteochondral defect of the left acetabulum.

A Randomized Clinical Trial of Direct Anterior Versus Mini-Posterior Total Hip Arthroplasty: Small, Early Functional Differences Did Not Lead to Meaningful Clinical Differences at 7.5 Years.

Background: Our previously reported randomized clinical trial of direct anterior approach (DAA) versus mini-posterior approach (MPA) total hip arthroplasty showed slightly faster initial recovery for patients who had a DAA and no differences in complications or clinical or radiographic outcomes beyond 8 weeks. The aims of the current study were to determine if early advantages of DAA led to meaningful clinical differences beyond 5 years and to identify differences in midterm complications.

Methods: Of the 101 original patients, 93 were eligible for follow-up at a mean of 7.

Diaphyseal Impaction Grafting Combined with Metaphyseal Cones: Outcomes in 88 Revision Total Knee Arthroplasties.

Background: Metaphyseal cones with cemented stems can be successfully utilized in most revision total knee arthroplasties (TKAs). However, if the diaphysis has been previously violated, fixation of the cemented stem, which is important for cone ingrowth and construct survival, can be compromised. The initial results of our novel technique combining diaphyseal impaction bone-grafting with a metaphyseal cone were promising but required additional study.

Incidence, treatment, and outcomes of modern dual-mobility intraprosthetic dissociations.

Aims: Dual-mobility (DM) components are increasingly used to prevent and treat dislocation after total hip arthroplasty (THA). Intraprosthetic dissociation (IPD) is a rare complication of DM that is believed to have decreased with contemporary implants. This study aimed to report incidence, treatment, and outcomes of contemporary DM IPD.

Modular fluted tapered stems in two-stage reimplantation of previously infected total hip arthroplasties.

Aims: Uncemented implants are now commonly used at reimplantation of a two-stage revision total hip arthoplasty (THA) following periprosthetic joint infection (PJI). However, there is a paucity of data on the performance of the most commonly used uncemented femoral implants - modular fluted tapered (MFT) femoral components - in this setting. This study evaluated implant survival, radiological results, and clinical outcomes in a large cohort of reimplantation THAs using MFT components.

Contemporary Aseptic Revision Total Hip Arthroplasty in Patients ≤50 Years of Age: Results of >500 Cases.

Background: There has been a paucity of long-term outcomes data on aseptic revision total hip arthroplasties (THAs) in the young adult population. The purpose of this study was to evaluate implant survivorship, complications, and clinical outcomes in a large cohort of contemporary aseptic revision THAs in patients ≤50 years of age at the time of the surgical procedure.

Methods: We identified 545 aseptic revision THAs performed at a single academic institution from 2000 to 2020 in patients who were 18 to 50 years of age.

The Femur-First Technique for Oxford Medial Unicompartmental Knee Arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) is a reliable procedure to treat medial compartment knee osteoarthritis (OA). The reported survivorship of UKA has varied in the literature. In part, the higher failure rates of UKA seen in registries could be related to the caseload and experience of the reporting surgeon.

Femoral Coronal Malalignment is Associated With Failure in Mobile-Bearing Medial Unicompartmental Knee Arthroplasty.

Background: Femur-first (FF) technique for mobile-bearing medial unicompartmental knee arthroplasty (UKA) has been described as an alternative to tibia-first (TF) technique. The aim of this study was to compare the radiographic results in UKAs using FF or TF techniques and their influence on failure rates.

Methods: We retrospectively reviewed 288 UKAs with a minimum 2-year follow-up.

Highly Porous Acetabular Cup and Augment Constructs in Complex Revision Total Hip Arthroplasty: What Predicts 10-Year Implant Survivorship?

Background: Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship.

The Frank Stinchfield Award: Assembly and Dissociation Forces Differ Between Commonly Used Dual Mobility Implants: A Biomechanical Study.

Background: Intraprosthetic dissociation (IPD) is a complication unique to dual mobility (DM) implants where the outer polyethylene head dissociates from the inner femoral head. Increasing reports of IPD at the time of closed reduction of large head DM dislocations prompted this biomechanical study evaluating the assembly and dissociation forces of DM heads.

Methods: We tested 17 polyethylene DM heads from 5 vendors.

Primary Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Published Clinical Outcomes at Minimum 5-Year Follow-up.

Background: Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and failure rates are high in some studies, limiting understanding of the role and utility of hip arthroscopy in this patient cohort.

Purpose: To provide an up-to-date, evidence-based review of the clinical outcomes of primary hip arthroscopy in patients with frank or borderline hip dysplasia at ≥5-year follow-up and report the failure rate and progression to total hip arthroplasty in this cohort.

Study Design: Systematic review; Level of evidence, 4.

International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty.

Background: This modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures.

Methods: An international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty).

A New Arthroscopic Classification for Chondrolabral Disease in Patients Undergoing Surgery for Developmental Dysplasia of the Hip.

Background: Current classification systems for intra-articular pathology intraoperatively have been described for patients with femoroacetabular impingement rather than dysplasia.

Purpose: To (1) describe intra-articular findings in dysplastic hips undergoing combined hip arthroscopy and periacetabular osteotomy (PAO); (2) propose a new chondrolabral classification system for dysplastic hips based on these findings; and (3) correlate patient-reported outcome measures (PROM) with the newly proposed classification.

Study Design: Case series; Level of evidence, 4.

International Delphi Study on Wound Closure and Dressing Management in Joint Arthroplasty: Part 1: Total Knee Arthroplasty.

Background: The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA).

Methods: The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review.

Making the cut: a technical note and literature review of Bernese periacetabular osteotomy techniques with special attention to ischial osteotomy initiation and completion with an inside to anterior curved osteotomy.

Periacetabular osteotomy includes a fluoroscopy-guided ischial cut without direct visualization. Previously described techniques include a mediolateral ischial cortex cut, which is associated with the risk of injuring nearby nerves. Another drawback of that technique is the difficulty connecting an ischial cortex cut with a retroacetabular cut due to orthogonal nature of the osteotomy.