Cemented femoral stem fixation through the anterior approach has fewer early complications than cementless fixation.

Aims: To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless complications?

Methods: A consecutive series of 341 patients (360 hips) receiving the DA approach between 2016 and 2018 were reviewed. There were 203 cementless stems and 157 cemented stems. Mean age was 75 years (70 to 86) in the cementless group and 76 years (52 to 94) in the cemented group, with 239 (70%) females in the whole series.

The AAHKS Clinical Research Award: No Evidence for Superior Patient-Reported Outcome Scores After Total Hip Arthroplasty With the Direct Anterior Approach at 1.5 Months Postoperatively, and Through a 5-Year Follow-Up.

Background: The direct anterior approach to total hip arthroplasty (THA) may result in superior early postoperative patient-reported outcome measures (PROMs). This study compared PROMs between THA patients treated with the direct anterior or posterolateral approach between 1.5 months and 5 years, using literature-derived patient acceptable symptom state (PASS) and minimal clinically important improvement (MCII) thresholds.

Modern Day Bicruciate-Retaining Total Knee Arthroplasty: A Short-Term Review of 146 Knees.

Background: Bicruciate retaining (BCR) implants were first proposed in the 1960s with the polycentric knee. Given the technical difficulty of implanting these devices, and the mixed results at the time, the BCR concept had stalled, until recently. This study seeks to provide a short-term review of the BCR implant design, describe patient-reported outcomes, and discuss key aspects to ensure successful implantation of the modern-day BCR implant design.

Eight Hundred Twenty-Five Medial Mobile-Bearing Unicompartmental Knee Arthroplasties: The First 10-Year US Multi-Center Survival Analysis.

Background: FDA approval for the Oxford phase III device was approved for use in the United States in 2004. This study seeks to provide the first long-term, large patient sample size, Oxford phase III multi-site survivorship study in the United States, investigating patient reported outcomes of pain and function, while also providing an in-depth analysis of causes for revision, and finally addressing recent advancements that can help aid the unicompartmental knee arthroplasty (UKA) process and further improve partial knee survivorship.

Methods: Between July 2004 and December 2006, 5 surgeons from around the United States performed medial UKA through the minimally invasive surgical approach, on 825 knees in 695 patients.

Twenty-Five-Years and Greater, Results After Nonmodular Cemented Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) has been shown to be very successful with long-term follow-ups. But there are no reports showing prosthesis survival at 25-30 years. Here, we report the outcomes for 25-30 years using the Anatomic Graduated Component (Biomet, Warsaw, IN) TKA and elucidate the etiology and cause of failure of the components.

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA.

Background: Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction. There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks.

Questions/purposes: (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA? (2) Do patients treated with liposomal bupivacaine-based PAI experience fewer opioid-related adverse events compared with patients treated with morphine-based spinal anesthesia or ropivacaine-based PAI in controlling postoperative pain after TKA?

Methods: This multicenter, blind trial randomized 119 patients undergoing TKA with spinal anesthesia to receive spinal anesthesia plus periarticular injection with liposomal bupivacaine (40 patients), spinal anesthesia with bupivacaine plus intrathecal morphine (41 patients) but no liposomal bupivacaine injection, or spinal anesthesia with bupivacaine (38 patients) and no liposomal bupivacaine injection.

Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors.

Background: It has been reported that pain-related outcomes after total knee arthroplasty (TKA) may vary with different analgesic techniques and with patient demographics. The purposes of this study were to compare local infiltration of regular bupivacaine (periarticular infiltration [PAI] group) vs liposomal bupivacaine (LBUP group) and to examine the effect of patient characteristics on postoperative pain after TKA.

Methods: The study sample included 665 consecutive TKA cases performed between December 2011 and August 2013.

How Do Demographic, Surgical, Patient, and Cultural Factors Affect Pain Control After Unicompartmental Knee Arthroplasty? A Multivariable Regression Analysis.

Background: Controlling pain after unicompartmental knee arthroplasty (UKA) is essential for improving patient satisfaction, minimizing complications, and early rehabilitation. There is little literature available evaluating the effect of both treatment and patient characteristics on in-hospital pain after UKA. The purpose of this study was to examine the effect of patient and treatment characteristics on in-hospital pain after UKA.

Femoral Nerve Block Versus Long-Acting Wound Infiltration in Total Knee Arthroplasty.

Multimodal wound infiltration analgesic techniques have attracted growing interest for applications in total knee arthroplasty (TKA). A benefit of using wound infiltration instead of femoral nerve block (FNB) in a multimodal pain control regimen is the limitation of muscle strength impairment to the surgical area, which will focus the pain control effort and may provide the opportunity for easier rehabilitation and earlier discharge from the hospital. The current study directly compares patients undergoing TKA who are given a continuous FNB with those who were administered an injection of liposomal bupivacaine infiltration.

Comparison of Local Infiltration Analgesia to Bupivacaine Wound Infiltration as Part of a Multimodal Pain Program in Total Hip Replacement.

Insufficient control of pain after total hip arthroplasty (THA) can delay rehabilitation and adversely affect long-term surgical outcomes. The current study directly compares 36 THA patients who were given a routine wound infiltration (RWI group) with 36 patients who were administered an injection of liposomal bupivacaine infiltration (LBUP group). Average visual analog scale pain scores were significantly higher for RWI patients (2.

A Comparison of 2 Tibial Inserts of Different Constraint for Cruciate-Retaining Primary Total Knee Arthroplasty: An Additional Tool for Balancing the Posterior Cruciate Ligament.

Background: Frequently, a normal posterior-cruciate ligament (PCL) is removed at the surgeon's discretion, converting the normal 4-ligament knee to a 2-ligament knee, thus eliminating the need to balance all 4 ligaments. The development of modular tibial components has led to the availability of differing polyethylene inserts that permit adjustment to the flexion gap independent of the extension gap, permitting PCL balancing not previously available. The purpose of this study is to analyze a specific cruciate-retaining (CR) prosthesis which has 2 polyethylene inserts intended for CR knee use.

Liposomal Bupivacaine: A Comparative Study of More Than 1000 Total Joint Arthroplasty Cases.

Pain after total joint arthroplasty (TJA) can be severe and difficult to control. A single-dose local analgesic delivers bupivacaine in a liposomal time-release platform. In 2248 consecutive patients with hip and knee arthroplasty, half (Pre) were treated using a well-established multimodal analgesia, including periarticular injection (PAI), and half had the PAI substituted for a liposomal bupivacaine injection technique (Post).

Improving patient outcomes through advanced pain management techniques in total hip and knee arthroplasty.

Pain following orthopedic surgery is common and often suboptimally managed, with many patients reporting acute moderate to severe pain following surgery. Opioids are often used to manage this pain, yet this can result in significant side effects and complications, including constipation, nausea, vomiting, respiratory distress, and other central nervous system issues. Multimodal therapy that includes surgical site infiltration with extended release local anesthetic has been seen as a new way to minimize this pain for patients, which can result in improved quality of life and shorter length of hospital stay.

Defining new directions for more effective management of surgical pain in the United States: highlights of the inaugural Surgical Pain Congress™.

Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes.

The short and "shorter" of it: >1750 tapered titanium stems at 6- to 88-month follow-up.

Introduction: Femoral fixation in THA can be achieved with different design rationales. Our hypothesis was that two short titanium flat-tapered stems would demonstrate similar stability.

Methods: Between May 2005 and May 2012, 849 short (135-170mm), titanium flat stems ("Short") were used in THA.

Increased anteversion of press-fit femoral stems compared with anatomic femur.

Background: With contemporary canal-filling press-fit stems, there is no adjustability of stem position in the canal and therefore the canal anatomy determines stem version. Stem version will affect head/neck impingement, polyethylene wear from edge loading, and hip stability, but despite this, the postoperative version of a canal-filling press-fit stem is unclear.

Questions/purposes: Is there a difference between the version of the nonoperated femur and the final version of a canal-filling press-fit femoral component? Could a difference create an alignment problem for the hip replacement?

Methods: Sixty-four hips were studied with fluoroscopy and 46 nonarthritic and 41 arthritic hips were studied with MRI.

Men versus women: does size matter in total knee arthroplasty?

Unlabelled: The role played by femoral component sizing in the clinical outcome of primary TKA is currently debated. Oversizing the femur in patients with smaller knees could lead to overstuffing the knee capsule with resulting pain and reduced range of motion. We asked whether the distribution of femoral component sizes differed between genders and whether the availability of additional sizes benefited genders differently and led to a measurable improvement in knee flexion and Knee Society scores or pain.

Unicompartmental knee arthroplasty with the oxford prosthesis in patients with medial compartment arthritis.

Background: The mobile-bearing feature of the Oxford unicompartmental knee replacement has the potential to optimize polyethylene wear, thereby leading to longer-term function of the implant. The function of the bearing requires intact soft tissues, with the ligaments being balanced throughout the range of motion intraoperatively through bone resection only. Final limb alignment is determined by the restored soft-tissue tension.

Preoperative and postoperative limb alignment after Oxford unicompartmental knee arthroplasty.

From a series of 64 sequential Oxford (Biomet Orthopedics, Inc, Warsaw, phase 3 implants, two study groups were selected: 23 knees with unilateral surgery and a normal opposite side, and 21 knees with bilateral simultaneous surgery. Standing 3-foot radiographs were taken pre- and postoperatively to assess the femorotibial angle and the location of the mechanical axis of the limb in relation to the knee. Results in the unilateral group showed an average postoperative femorotibial angle of 4.

Metal-on-metal total hip arthroplasty with large heads may prevent early dislocation.

Unlabelled: Postoperative dislocation is one of the major causes of morbidity and failure of total hip arthroplasty. We reviewed 327 patients (377 hips) retrospectively with varying diagnoses and indications but all of whom received large-diameter metal-on-metal prostheses. Two surgical approaches were used: the anterolateral abductor splitting (342 procedures) and a mini-incision posterior approach (35 procedures).

Unicompartmental mobile-bearing knee arthroplasty.

Two diferent mobile-bearing unicompartmental knee replacement designs have been available since the late 1970s. The primary difference between these two designs is that one has a constrained bearing in a track and the other has a freely moving bearing. Both implants are currently indicated for the treatment of patients with medial unicompartmental osteoarthritis and are available for use in the United States.

A comparison of highly instrumented and minimally instrumented unicompartmental knee prostheses.

In this study, two specific implants are compared: the Oxford prosthesis, which uses a highly instrumented technique and was placed through a traditional arthrotomy; and the Repicci prosthesis, which uses a minimally instrumented technique and was placed with a minimally invasive surgical approach. The study looked specifically at limb alignment, because achieving appropriate alignment is correlated with the best long-term implant function and achieving alignment is a function of the implant instrumentation. The rationale of more instrumentation for a surgical technique is to add precision and reproducibility; less instrumentation requires less surgical exposure and therefore is more minimally invasive.

Proximal ingrowth components.

The advantage of using a proximal ingrowth hip revision component is restoring physiologic load to the revision femur. Although first generation components had limited survivorship and diminished clinical outcomes, subsequent designs have proven much better with rates of aseptic loosening of 2% to 5%, and good clinical scores. Titanium is the favored substrate metal for these components because of its bone affinity and low modulus of elasticity.

Clinical and radiographic analysis of the Mallory-Head femoral component in revision total hip arthroplasty. A minimum 8.8-year and average eleven-year follow-up study.

Background: Although many designs of cementless femoral stems are available for revision hip arthroplasty, there is no consensus about which design features are required to achieve an optimal clinical outcome and maximum preservation of bone. The purpose of this study was to report the clinical and radiographic results for a specific design.

Methods: A selected series of 107 revision total hip arthroplasties with use of the Mallory-Head calcar-replacement prosthesis was reviewed with clinical and radiographic evaluation.