Survivorship of Modern Cementless Total Knee Arthroplasty: Analysis From the Canadian Joint Replacement Registry.

Background: Cementless total knee arthroplasty (TKA) is rising in popularity. The literature supporting its use over cemented TKA remains sparse. Using the Canadian Joint Replacement Registry (CJRR), we sought to investigate cementless versus cemented fixation in modern primary TKA and (1) determine whether there is an overall difference in revision by fixation, (2) perform a subanalysis of the most-commonly used cementless TKA brand in Canada, and (3) identify the reasons for revision.

Survivorship and Outcomes of 2-Stage Revision for Infected Total Hip Arthroplasty at a Mean of 7-Year Follow-Up.

Background: Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following total hip arthroplasty (THA). The objectives of the study were to (1) determine the minimum 2-year infection-free survivorship of 2-stage revision THA, (2) determine the causative organisms for repeat 2-stage revision THA, and (3) characterize the results of failed 2-stage revisions and evaluate patient-reported outcome measures (PROMs).

Methods: A retrospective chart review was completed for patients who underwent 2-stage revision THA for PJI.

Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution.

Background: Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution.

Minimum 2-Year Outcomes of a Modern Monoblock Titanium Fluted Tapered Revision Stem for Complex Primary and Revision Total Hip Arthroplasty.

Background: Modular titanium fluted tapered (TFT) stems have demonstrated excellent clinical success for femoral revision total hip arthroplasty (THA) surgery. This study reports the short-term outcomes of a novel modern monoblock TFT stem used for revision and complex primary THA with a minimum of 2 years of follow-up.

Methods: We identified 126 patients who received a single monoblock TFT stem: 26 patients for complex THA (failed fracture fixation) and 100 patients for revision THA.

Predictors of Undergoing Revision Within 5 Years of Total Knee Arthroplasty: A Population-Based Study.

Background: The objective of this study was to identify the rate and risk factors for revision total knee arthroplasty (TKA) within the first 5 years postoperative. Our secondary objective was to identify the rate of additional surgical procedures and death.

Methods: We conducted a retrospective cohort study among patients in Ontario, Canada who underwent an elective, primary TKA between April 1, 2007, and March 31, 2014, for osteoarthritis.

Minimum 5-Year Clinical Outcomes and Survivorship for a Single Revision Total Knee Arthroplasty System Using Hybrid Fixation and Press-Fit Stems.

Background: Hybrid fixation, utilizing diaphyseal press-fit stems and cement fixation in the tibial and femoral metaphyseal areas, has long been a strategy for revision total knee arthroplasty (rTKA). The purpose of this study was to evaluate the clinical outcomes and survivorships of hybrid fixation using a single rTKA revision system with a minimum of 5 years follow-up.

Methods: We reviewed our prospectively collected database to identify 281 patients who underwent rTKA using a single revision system with hybrid fixation and press-fit stems between July 2006 and August 2016.

No Difference in Subsidence Between Modern Monoblock and Modular Titanium Fluted Tapered Femoral Stems.

Background: Subsidence remains a concern when utilizing tapered fluted titanium (TFT) femoral stems and may lead to leg length discrepancy, impingement, instability, and failure to obtain osseointegration. This study aims to compare stem subsidence across 3 modern TFT stems. Our secondary aim was to investigate the influence of bicortical contact or "scratch fit" on subsidence, as well as the role of intraoperative imaging in maximizing bicortical contact and preventing stem subsidence.

Minimum 2-Year Outcomes of a Novel 3D-printed Fully Porous Titanium Acetabular Shell in Revision Total Hip Arthroplasty.

Background: Fully porous acetabular shells are an appealing choice for patients with extensive acetabular defects undergoing revision total hip arthroplasty (rTHA). This study reports on the early outcomes of a novel 3-D printed fully porous titanium acetabular shell in revision acetabular reconstruction.

Methods: A multicenter retrospective study of patients who received a fully porous titanium acetabular shell for rTHA with a minimum of 2 years of follow-up was conducted.

The Prevalence and Outcomes of Unexpected Positive Intraoperative Cultures in Presumed Aseptic Revision Knee Arthroplasty.

Background: The prevalence and outcomes of unexpected positive intraoperative cultures (UPC) in presumed aseptic revision total knee arthroplasty (TKA) are unclear. The purpose of this study was to determine the prevalence of UPC and infection-free implant survival in this patient population. Secondly, we aimed to compare the infection-free implant survival between cohorts based on number of UPCs and antibiotic treatment.

Cement Mantle Quality and Stem Alignment in Cemented Collarless Polished Tapered Stems Implanted via the Direct Anterior and Direct Lateral Approaches: A Single Institution Experience.

Background: The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA).

Methods: A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness.

Survivorship of Metaphyseal Cones and Sleeves in Revision Total Knee Arthroplasty.

Background: Bone loss remains an anticipated challenge in revision total knee arthroplasty (rTKA). Recent efforts to enhance rTKA fixation and stability have focused on metaphyseal implants, namely cones and sleeves. We sought to compare cone and sleeve implant survivorship in rTKA.

A Ten-Year Radiostereometric Analysis of Polyethylene Wear Between Oxidized Zirconium and Cobalt Chrome Articulations in Total Hip Arthroplasty.

Background: Oxidized zirconium (OxZi) femoral heads combine the decreased abrasive properties of ceramics with the toughness of metal alloys to lower wear and increase the durability of total hip arthroplasty. The purpose of this study was to compare the 10-year polyethylene wear rates between OxZi/XLPE and cobalt chrome (CoCr)/XLPE articulations.

Methods: A radiostereometric analysis (RSA) was performed on two cohorts of 23 patients who underwent total hip arthroplasty using either OxZi/XLPE or CoCr/XLPE at a minimum of 10-year follow-up.

Comparison of long-term kinematics and wear of total knee arthroplasty implant designs.

We sought to evaluate wear and kinematics in well-established implants of posterior stabilized (PS) and cruciate retaining (CR) designs. Ninety-one knees implanted for at least five years were examined. The implants were Genesis II PS (Smith & Nephew, Memphis, TN), Sigma PS (DePuy Synthes, Warsaw, IN), or Sigma CR.

Minimum ten-year follow-up of a randomized trial comparing acetabular component fixation of two porous in-growth surfaces using radiosteriometric analysis.

Aims: To compare the in vivo long-term fixation achieved by two acetabular components with different porous ingrowth surfaces using radiostereometric analysis (RSA).

Methods: This was a minimum ten-year follow-up of a prospective randomized trial of 62 hips with two different porous ingrowth acetabular components. RSA exams had previously been acquired through two years of follow-up.

Contact kinematics of patient-specific instrumentation versus conventional instrumentation for total knee arthroplasty.

Background: The goal was to evaluate the joint contact kinematics of total knee arthroplasties implanted using patient-specific instrumentation (PSI) compared to conventional instrumentation (CI). We hypothesized that use of PSI would not significantly alter contact kinematics.

Methods: The study was a prospective randomized controlled trial, with equal allocation of fifty patients to PSI and CI groups.

Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems.

Introduction: Corrosion at the head-neck interface of modular components in total hip arthroplasty (THA) has been reported as a cause of failure of modern total hip replacement implants. While this method of failure has been well described, it remains poorly understood. The purpose of this study is to review the three most commonly used uncemented femoral stems at our institution over the last fifteen years and to correlate any established risk factors with rates of revision, particularly corrosion.

Midterm Results of a Contemporary, Porous-Coated Acetabular System in Patients Undergoing Primary Total Hip Replacement for Degenerative Hip Disease: A Prospective, Multicenter Study.

Background: A contemporary, porous-coated acetabular implant designed for uncemented insertion was introduced in Europe and Australia in 2007. A similar previous acetabular system was found in several studies at 10 to 15-year follow-up to demonstrate accelerated polyethylene wear, osteolysis, and early failure. The current study was conducted to determine the midterm safety and effectiveness of this contemporary acetabular system using highly crosslinked polyethylene and ceramic liners at 5-year follow-up.

Clinical Outcomes and Midterm Survivorship of an Uncemented Primary Total Hip Arthroplasty System.

Background: The rise in total hip arthroplasty (THA) has led to a concomitant increase in revision THAs. Tracking implant performance therefore remains a significant element of scientific inquiry to garner and maintain public trust in this procedure. There are few available reports of outcomes of a single manufacturer's total hip system outside registry data.

Indications, Survivorship, and Clinical Outcomes of a Rotating Hinge Total Knee and Distal Femoral Arthroplasty System.

Background: Rotating hinge knee prostheses (with or without distal femoral replacement) are indicated in cases of unreconstructible bony or soft tissue compromise. Despite their versatility, these implants have demonstrated high rates of mechanical failure. We aimed to review clinical outcomes of a novel hinged knee arthroplasty system.

Minimum 15-Year Results of a Dual-Offset Uncemented Femoral Stem in Total Hip Arthroplasty.

Background: The aim of the present study is to assess the long-term clinical and radiological outcomes of a proximal porous-coated, dual-offset, tapered titanium alloy uncemented stem at a minimum of 15 years of follow-up.

Methods: We reviewed 210 total hip arthroplasties (in 193 patients) performed between 1996 and 1999 and followed prospectively in our database who received the Synergy stem. We report a Kaplan-Meier survival analysis as well as the Harris Hip Score, the Western Ontario and McMaster University Arthritis Index, and the Short Form Health Survey-12 scores.

Revision Rates and Functional Outcomes Among Severely, Morbidly, and Super-Obese Patients Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Obesity has been associated with a greater burden of symptomatic knee osteoarthritis. There is some evidence that patients with a very high body mass index (BMI) may have a higher risk of complications and poor outcomes following total knee replacement compared with non-obese patients or obese patients with a lower BMI. We hypothesized that increasing degrees of obesity would be associated with deteriorating outcomes for patients following total knee replacement.

Revision Rates and Functional Outcome Scores for Severely, Morbidly, and Super-Obese Patients Undergoing Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Background: We performed a systematic review and meta-analysis of the literature to quantify the impact of patients with severe obesity (body mass index [BMI] > 35 kg/m), those with morbid obesity (BMI > 40 kg/m), and those with super-obesity (BMI > 50 kg/m) on revision rates and outcome scores after primary total hip arthroplasty compared with non-obese patients (BMI < 25 kg/m).

Methods: Four electronic databases were reviewed (AMED, Embase, Ovid Healthstar, and MEDLINE) from their inception to August 2016. The search strategy used combined and/or truncated keywords, including hip replacement or arthroplasty and obesity, BMI, or any synonym of the latter in the title, abstract, or manuscript text.