Incisional squamous cell carcinoma after total knee arthroplasty.

With the rising number of total knee arthroplasties being performed annually, the number of complications associated with this procedure will also continue to rise. The most common reasons for revision include infection, instability, and aseptic loosening. Fortunately, wound complications are rare, and in this case report, we describe the development of a well-differentiated squamous cell carcinoma, keratoacanthomatous type, within the surgical incision of a total knee arthroplasty several months after the index procedure.

Computed tomography confirmation of component rotation in nanosensor-balanced total knee arthroplasty.

Balanced gaps and proper rotation are felt to be essential for optimum range of motion, stability, and patellar tracking in total knee arthroplasty. The purpose of this study is to assess, using computed tomography, the rotation of femoral and tibial components in fresh-frozen human cadaver knees that have been balanced using nanosensor trials while also observing how this rotation affects measured compartment loads and requirement for ligament balancing adjustment. We found that minor degrees of rotational malalignment of the femur and tibia were common using standard instrumentation and measured resection technique.

Inflammatory demyelinating polyneuropathy after total hip arthroplasty.

Inflammatory demyelinating polyneuropathy is a rare but devastating condition. Guillain-Barré syndrome is the most common cause with acute inflammatory demyelinating polyneuropathy being the most common subtype that follows a monophasic course and does not recur. Chronic inflammatory demyelinating polyneuropathy occurs when symptoms persist for greater than 8 weeks.

Safety and side-effect profile of intrathecal morphine in a diverse patient population undergoing total knee and hip arthroplasty.

Intrathecal morphine (ITM) can be useful for postoperative analgesia following lower extremity joint arthroplasty, but concerns exist regarding potential dose-related side effects. In this study, we examined the safety and efficacy of ITM in patients undergoing lower extremity joint arthroplasty. We hypothesized that there would be (1) direct relationship between dosing and side effects, and (2) an inverse relationship between ITM dosing and 24-hour postoperative opioid requirement.

Association of rapidly destructive osteoarthritis of the hip with intra-articular steroid injections.

Background: To assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections.

Methods: Coding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne's classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy).

Initial Stability of Cemented vs Cementless Tibial Components Under Cyclic Load.

Background: Cement fixation of total knee components remains the gold standard despite resurgence in cementless fixation with the goal of long-term durable fixation. Initial stability is paramount to achieve bony ingrowth of cementless components.

Methods: Twelve cemented and cementless tibial baseplates were implanted into sawbones and tested using a physiological medial-lateral load distribution for 10,000 cycles to represent 8 weeks of in vivo function.

Minimally invasive surgical technique for tethered surgical drains.

A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible.

The Effect of Prophylactic Cerclage Wires in Primary Total Hip Arthroplasty: A Biomechanical Study.

Background: Despite literature to support the use of various cerclage techniques to address intraoperative femoral fractures in total hip arthroplasty, there are limited data to support prophylactic cerclage wiring of the femur during cementless implant placement. This study aims to evaluate the effect of prophylactic calcar cerclage wires on the biomechanical parameters required to produce periprosthetic femoral fractures and on the morphology of these fracture patterns in stable cementless femoral implants.

Methods: Ten pairs of matched fresh frozen cadaveric femurs were implanted with anatomic tapered cementless implants with or without the addition of 2 monofilament calcar wires.

Surgical Treatment of Prosthetic Joint Infections of the Hip and Knee: Changing Paradigms?

Prosthetic joint infection (PJI) of the hip and knee remains one of the most common and feared arthroplasty complications. The impact and cost of PJI is significant, both to the patient and to the health care system. Recent reports of results of different treatment strategies have led many surgeons to modify their approach to management of PJI.