Survivorship and Functional Outcomes After Complex Primary Total Knee Arthroplasty With Contemporary Rotating-Hinge Implants.

Initial fixed-bearing hinge designs for primary total knee arthroplasty (TKA) had high rates of aseptic loosening. There are limited data on contemporary rotating-hinge implants. : We sought to determine survivorship and functional outcomes of contemporary rotating-hinge implants used in primary TKA.

Cementless Versus Cemented Total Knee Arthroplasty of the Same Design: Shorter Operative Times and Minimal Differences in Early Outcomes.

Modern primary cementless total knee arthroplasty (TKA) is increasingly popular, but there is limited evidence on its benefits, early complications, and failures. : We sought to evaluate operative time, early survivorship, and outcomes of cementless versus cemented TKA of the same design. : As part of this single-center, multisurgeon, retrospective cohort study, we reviewed 598 primary, unilateral TKAs (170 cementless, 428 cemented) of the same design from 2016 to 2018.

Preoperative Cannabis Use Did Not Increase Opioid Utilization After Primary Total Knee Arthroplasty in a Propensity Score-Matched Model.

Recreational and medicinal cannabis use is becoming increasingly popular, but there are little data on its effect on postoperative pain and opioid consumption after primary total knee arthroplasty (TKA). : We sought to evaluate the relationship between self-reported preoperative cannabis use and postoperative opioid consumption and post-discharge opioid prescriptions following elective primary TKA. : We identified all patients who underwent unilateral, primary TKA for a diagnosis of osteoarthritis at a single institution between February 1, 2019, and April 30, 2021, and subdivided them into current cannabis users and non-users based on self-reported data.

High Rates of Early Septic Failure, but Low Rates of Aseptic Loosening After Revision Total Knee Arthroplasty With Contemporary Rotating-Hinge Prostheses.

Background: The purpose of this study was to determine implant survivorship and functional outcomes for revision total knee arthroplasty (rTKA) with contemporary rotating-hinge knee implants.

Methods: A retrospective review identified 115 rTKAs using contemporary rotating-hinge implants from 2014 to 2018 for the treatment of instability (34, 30%), reimplantation after periprosthetic joint infection (PJI) (33, 29%), aseptic loosening (25, 22%), arthrofibrosis (14, 12%), periprosthetic fracture (4, 3%), osteolysis (4, 3%), and femoral component fracture (1, 1%). There were 70 women (61%), and the mean age was 67 years (range, 27 to 94).

Characterizing the Magnitude and Risk Factors of Functional and Anatomic Limb Lengthening in Patients Undergoing Revision Total Knee Arthroplasty.

Background: In revision total knee arthroplasty (TKA), there is little information on the magnitude of potential limb lengthening, risk factors for lengthening, or its impact on patient-reported outcome measures. We aimed to quantify limb length alteration during revision TKA and assess risk factors for lengthening.

Methods: We identified 150 patients over a 3-year period who underwent revision TKA and had preoperative and postoperative EOS hip-to-ankle standing radiographs.

The Efficacy and Safety of Tranexamic Acid in Total Hip and Knee Arthroplasty: A Literature Review.

Historically, total hip arthroplasty (THA) and total knee arthroplasty (TKA) have been associated with significant perioperative blood loss and a relatively high rate of allogeneic blood transfusions. However, in recent years, tranexamic acid (TXA), a competitive inhibitor of tissue plasminogen activator, inhibiting fibrinolysis of existing thrombi, has substantially decreased the need for blood transfusion in THA and TKA. Various administration strategies have been studied, but there remains a lack of consensus on an optimal route and dosing regimen, with intravenous and topical regimens being widely used.

Total Hip Arthroplasty After Proximal Femoral Nailing: Preoperative Preparation and Intraoperative Surgical Techniques.

The combination of an aging population and increased utilization of total hip arthroplasty (THA) is leading to a higher incidence of conversion THA, defined as conversion from previous hip fracture surgery to THA. Conversion THA is a more technically challenging, time-consuming, and costly procedure compared to primary THA and frequently involve more medically complex patients. Thus, the aim of this review is to provide a rubric for surgeons to use when preparing for a conversion THA.

Total Hip Arthroplasty: An Update on Navigation, Robotics, and Contemporary Advancements.

While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates.

How Much Protection Does a Collar Provide? Assessing Risk of Early Periprosthetic Femur Fractures Following Total Hip Arthroplasty in Elderly Patients.

Background: Periprosthetic fractures (PPFs) account for approximately 25% of early revisions following total hip arthroplasty (THA). Cemented femoral fixation is associated with a lower-risk of PPF, and collared-cementless stems may reduce the risk as well. The objective of this study was to compare early-PPF rates between cemented, collared-cementless, and non-collared cementless stems in elderly patients.

Patients Undergoing Primary, Cementless TKA had Similar Pain, Opioid Utilization, and Functional Outcomes Compared to Matched Patients With Cemented Fixation.

Background: Despite renewed interest in cementless fixation of total knee implants, many surgeons have anecdotal concerns about slower recovery and higher early pain scores. We sought to analyze 90-day opioid utilizations, inhospital pain scores, and patient-reported outcome measures (PROMs) in patients undergoing primary cemented versus cementless total knee arthroplasty (TKA).

Methods: We retrospectively identified a cohort of opioid naïve patients undergoing primary TKA for osteoarthritis.

Outcomes After Revision Total Knee Arthroplasty From a Specific, Now-Recalled Implant System.

Background: A specific total knee arthroplasty (TKA) implant system was recently recalled for high incidence of early polymeric wear and osteolysis. We analyzed the early outcomes of aseptic revision with these implants.

Methods: We identified 202 aseptic revision TKAs of this implant system performed at a single institution between 2010 and 2020.

No Difference in the Rate of Periprosthetic Joint Infection in Patients Undergoing the Posterolateral Compared to the Direct Anterior Approach.

Background: There remains inconsistent data about the association of surgical approach and periprosthetic joint infection (PJI). We sought to evaluate the risk of reoperation for superficial infection and PJI after primary total hip arthroplasty (THA) in a multivariate model.

Methods: We reviewed 16,500 primary THAs, collecting data on surgical approach and all reoperations within 1 year for superficial infection (n = 36) or PJI (n = 70).

Mid-term survivorship of primary total knee arthroplasty with a specific implant.

The purpose of this study was to assess mid-term survivorship following primary total knee arthroplasty (TKA) with Optetrak Logic components and identify the most common revision indications at a single institution. We identified a retrospective cohort of 7,941 Optetrak primary TKAs performed from January 2010 to December 2018. We reviewed the intraoperative findings of 369 TKAs that required revision TKA from January 2010 to December 2021 and the details of the revision implants used.

Preoperative cannabis use does not increase opioid utilization following primary total hip arthroplasty in a propensity matched analysis.

Purpose: The recreational and medical use of cannabis is being legalized worldwide. Its use has been linked to an increased risk of developing opioid use disorders. As opioids continue to be prescribed after total hip arthroplasty (THA), the influence that preoperative cannabis use may have on postoperative opioid consumption remains unknown.

Total Joint Arthroplasty in Patients With Atrial Septal Defects: What Are the 90-Day Complications?

Background: Congenital heart defects, such as atrial septal defects (ASDs) and patent foramen ovale (PFO), may increase the risk of embolic events in total hip or knee arthroplasty (THA/TKA). The objective of this study was to determine the 90-day incidence of intraoperative and postoperative embolic events and all other complications in patients with a known ASD/PFO who underwent primary hip and knee arthroplasty.

Methods: This is a retrospective review of 160 patients with ASD/PFO undergoing 196 primary arthroplasties (94 THAs, 102 TKAs) at a single institution.

Contemporary Use of Trochanteric Plates in Periprosthetic Femur Fractures: A Displaced Trochanter Will Not Be Tamed.

Background: The objective of this study was to evaluate the reoperation and complication rate following trochanteric plate fixation of greater trochanter (GT) periprosthetic femur fractures associated with total hip arthroplasty and to identify risk factors for subsequent reoperation, nonunion, and hardware failure (plate/cable breakage or migration).

Methods: Between 2010 and 2020, 44 patients who had 44 periprosthetic greater trochanter fractures at mean follow up of 2 years were retrospectively reviewed. Initial injury radiographs as well as immediate and final follow-up radiographs were evaluated.

Liquid Phase 3D Printing: How This New Technology Can Help Bring 3D Printing to the Operating Room.

Purpose Of Review: The purpose of this review is to discuss the state of technology in liquid phase three-dimensional (3D) metal printing, how this has affected the field of orthopedic surgery, and changes that we can expect in the future with the rise of this printing technology. We will also discuss how liquid phase metal printing can possibly bring three-dimensional printing to the operating room.

Recent Findings: The use of liquid phase 3D metal printing may become commonplace for manufacturing orthopedic implants and devices.

Avoiding Femoral Canal Instrumentation in Computer-Assisted Total Knee Arthroplasty With Contemporary Blood Management Had Minimal Differences in Blood Loss and Transfusion Rates Compared to Conventional Techniques.

Background: Computer-assisted surgery that does not utilize femoral canal instrumentation is theorized to have less blood loss. However, there is a paucity of data on this, particularly in the era of tranexamic acid use. We sought to analyze the association of computer navigation with total calculated blood loss and transfusion rate in patients undergoing primary total knee arthroplasty (TKA).

Superselective embolization in posttraumatic high-flow priapism.

We present a case of a 24 year old man who presented with high flow priapism. Priapism is defined as an erection lasting four or more hours, either after or unrelated to sexual stimulation. Priapism can be categorized into low-flow, stuttering, and high-flow types, each with unique mechanisms and treatments.