No Decrease in Early Survivorship of Dual Mobility Implants in Primary Total Hip Arthroplasty.

Background: Dual mobility (DM) implants in primary total hip arthroplasty (THA) have gained recent popularity; however, safety concerns persist. The purpose of this study was twofold: 1) assess trends in DM implant adoption; and 2) evaluate the impact of modular DM implants on dislocation and all-cause revision rates at short-term follow-up.

Methods: This retrospective study identified patients in our institutional arthroplasty database who underwent primary posterior approach THA for degenerative conditions from November 2013 to December 2020.

Initiation of Bisphosphonates Prior to Total Joint Arthroplasty Does Not Lower Periprosthetic Fracture Risk.

Background: Many patients are diagnosed with osteoporosis shortly prior to scheduling total joint arthroplasty (TJA). The purpose of this study was to determine if initiation of bisphosphonates prior to TJA decreased the risks of periprosthetic fractures (PPFx).

Methods: A national database was used to identify all patients diagnosed with osteoporosis prior to primary TJA.

Intra-Articular Corticosteroid Injections Into a Preexisting Total Knee Arthroplasty are Associated With Increased Risk of Periprosthetic Joint Infection and Revision.

Background: This study aims to determine the risks of periprosthetic joint infection (PJI) and revision associated with injecting a preexisting total knee arthroplasty (TKA) with intra-articular corticosteroids (IACSs).

Methods: The PearlDiver database was used to identify patients who underwent elective, primary TKA between 2015 and 2019. Patients who received IACS injections into the ipsilateral knee within 1 year after their primary TKA were matched 2:1 on age, gender, and Charlson comorbidity index and compared to a no-injection control group.

Metallosis in Total Hip Arthroplasty.

» Metallosis is a rare but significant complication that can occur after total hip arthroplasty (THA) for a variety of reasons but most commonly in patients with metal-on-metal implants.» It is characterized by the visible staining, necrosis, and fibrosis of the periprosthetic soft tissues, along with the variable presence of aseptic cysts and solid soft tissue masses called pseudotumors secondary to the corrosion and deposition of metal debris.» Metallosis can present with a spectrum of complications ranging from pain and inflammation to more severe symptoms such as osteolysis, soft tissue damage, and pseudotumor formation.

Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty.

Background: Instability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure.

Preoperative Depression Is Associated With Increased Short-term Complications But Equivalent Long-term Outcomes in Total Knee Arthroplasty.

Concomitant depression negatively impacts outcomes following total knee arthroplasty (TKA). Patient-Reported Outcomes Measurement Information System (PROMIS) surveys are validated measures that quantify depression, pain, and physical function. We hypothesized that higher preoperative PROMIS-depression scores would be associated with inferior outcomes following TKA.

Higher Complication Rate in COVID-19 Recovered Patients Undergoing Primary Total Joint Arthroplasty.

Background: There is limited data reviewing complication risks associated with total joint arthroplasty (TJA) after recovering from COVID-19. This study evaluated complications within 90 days of TJA in patients who had a COVID-19 diagnosis at varying intervals prior to surgery versus a non-COVID-19 cohort.

Methods: A large national database was used to identify patients diagnosed with COVID-19 in the six months prior to total hip arthroplasty (THA) or total knee arthroplasty.

Revision total knee arthroplasty for arthrofibrosis improves range of motion.

Purpose: Arthrofibrosis after primary total knee arthroplasty (TKA) is a significant contributor to patient dissatisfaction. While treatment algorithms involve early physical therapy and manipulation under anaesthesia (MUA), some patients ultimately require revision TKA. It is unclear whether revision TKA can consistently improve these patient's range of motion (ROM).

Impact of Antibiotic-Impregnated Spacer Design in the Treatment of Periprosthetic Hip Infection.

Background: Although 2-stage exchange arthroplasty, consisting of temporary insertion of an antibiotic-impregnated cement spacer (AICS), is considered the standard of care for chronic periprosthetic joint infection (PJI) in total hip arthroplasty (THA), a consensus on the AICS design has not yet been established. Ceramic-on-polyethylene AICSs (Poly-AICS) are theorized to cause less pain and better function than cement-on-bone AICS (CemB-AICS) but use non-antibiotic-impregnated components that may harbor bacteria. This study evaluates the impact of spacer design on infection-free survivorship following THA reimplantation as well as pain and function during the interim AICS stage.

High-Dose Vitamin D Supplementation Can Correct Hypovitaminosis D Prior to Total Knee Arthroplasty.

Background: Vitamin D deficiency in the perioperative surgical period is associated with inferior surgical outcomes. There are no established preoperative supplementation regimens in the orthopedic literature. The purpose of this study is to compare the efficacy between 2 different supplementation regimens of vitamin D prior to total knee arthroplasty.

National Decline in Knee Fusions Performed for Salvage of Chronic Periprosthetic Total Knee Infections.

The primary purpose of this study was to study and compare rates of two salvage operations for patients with chronically infected total knee arthroplasties: (1) knee arthrodesis and (2) above knee amputation (AKA). An analysis was performed comparing the inpatient hospital characteristics and complications between the two procedures. Secondarily, we presented rates of all surgically treated periprosthetic total knee infections over a 6-year period.

Activity Recommendations After Total Hip and Total Knee Arthroplasty.

»: A formal unsupervised activity program should be recommended to all patients recovering from total knee arthroplasty (TKA) and total hip arthroplasty (THA).

»: In a subset of all patients undergoing TKA or THA, studies have found that an unsupervised activity program may be as efficacious as supervised physical therapy (PT) after surgery. Certain patients with inadequate independent function may continue to benefit from supervised PT.

Nationwide Analysis of Lower Extremity Periprosthetic Fractures.

Background: Although the annual incidence of primary total joint arthroplasty is increasing, trends in the annual incidence of periprosthetic fractures have not been established. This study aimed to define the annual incidence of periprosthetic fractures in the United States.

Methods: Inpatient admission data for 60,887 surgically treated lower extremity periprosthetic fractures between 2006 and 2015 were obtained from the National Inpatient Sample database.

Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty.

Given a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of "tobacco use disorder.

Determining and Achieving Target Limb Length and Offset in Total Hip Arthroplasty Using Intraoperative Digital Radiography.

Background: Achieving appropriate limb length and offset in total hip arthroplasty (THA) is challenging. Target limb length and offset may not always mean equal radiographic measurements bilaterally. The goal of this study is to introduce a method for determining as well as achieving target limb length and offset using digital radiographic measurements.

Smoking and Total Hip Arthroplasty: Increased Inpatient Complications, Costs, and Length of Stay.

Background: Smoking is a potentially modifiable risk factor that may impact the overall outcomes of total hip arthroplasty (THA). In an era of bundled payments for THA, the purpose of this study was to evaluate, on a national level, the inpatient complications and additional costs of smokers undergoing THA.

Methods: The Nationwide Inpatient Sample was used to identify all primary elective THAs performed in the United States in 2014.

Increasing Burden of Total Hip Arthroplasty Revisions in Patients Between 45 and 64 Years of Age.

Background: This study provides a comprehensive analysis of total hip arthroplasty (THA) revisions in the U.S. from 2007 to 2013.

Digital Radiography in Total Hip Arthroplasty: Technique and Radiographic Results.

Background: Obtaining the ideal acetabular cup position in total hip arthroplasty remains a challenge. Advancements in digital radiography and image analysis software allow the assessment of the cup position during the surgical procedure. This study describes a validated technique for evaluating cup position during total hip arthroplasty using digital radiography.

Nationwide Analysis of Femoral Neck Fractures in Elderly Patients: A Receding Tide.

Background: Geriatric femoral neck fractures are associated with substantial morbidity and medical cost. We evaluated the incidence and management trends of femoral neck fractures in recent years in the U.S.

The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries.

Background: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability.

Hypothesis: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury.

Study Design: Controlled laboratory study.

Increasing Use of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures in Elderly Patients.

This study described surgical treatment patterns for proximal humerus fractures among elderly patients, focusing on reverse total shoulder arthroplasty (TSA), and evaluated how the type of fixation affects inpatient factors (cost, length of stay), transfusion rates, and patient disposition (home vs skilled nursing facility). With Nationwide Inpatient Sample data from 2011 to 2013, the authors identified patients 65 years and older who had proximal humerus fractures and divided them into 3 groups: (1) open reduction and internal fixation (ORIF); (2) hemiarthroplasty; and (3) reverse TSA. From 2011 to 2013, 38,729 surgically treated proximal humerus fractures were identified.

Identifying Hidden Zones of the Far Posterior Cartilage of the Femoral Condyles Not Visible During Knee Arthroscopy.

Objective: The purpose of this study was to compare standard knee arthroscopic and MRI findings and measurements for visualization of the femoral condyle articular cartilage. The hypothesis was that certain posterior cartilage defects identified with MRI may not be accessible with routine arthroscopy.

Materials And Methods: Six cadaveric knees were examined by routine arthroscopy through standard inferomedial and inferolateral portals.

Primary total elbow arthroplasty for distal humeral fractures in elderly patients: a nationwide analysis.

Background: Displaced intra-articular distal humeral fractures are a challenging injury in elderly patients. High rates of complications have led to the increasing use of total elbow arthroplasty (TEA) for primary treatment. This study presents US nationwide trends in primary TEA for distal humeral fractures in elderly patients (65 years and older) from 2002 to 2012.

National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients: A Focus on Bearing Surface Usage From 2009 to 2012.

Background: The ideal bearing surface for primary total hip arthroplasty (THA) in young patients remains a debate. Data on recent national trends are lacking. The purpose of this study is to provide an analysis on the national epidemiologic trends of bearing surface usage in patients aged ≤30 years undergoing THA from 2009 through 2012.