Hip and Knee Arthroplasty Outcomes for Nonagenarian Patients.

Introduction: Studies have previously reported higher complication rates in elective total joint arthroplasty (TJA) for nonagenarians compared with younger cohorts. The purpose of this study was to assess whether nonagenarians were still at increased risk of complications and hospital readmissions by answering three questions: (1) Do nonagenarians have an increased risk of medical complications after TJA compared with octogenarians and septuagenarians? (2) Do nonagenarians have an increased risk of surgical complications after TJA compared with octogenarians and septuagenarians? (3) Do nonagenarians have an increased risk of hospital readmission after TJA compared with octogenarians and septuagenarians?

Methods: A total of 174 patients undergoing primary TJA between 2010 and 2017 were included; 58 nonagenarians (older than 90 years) were matched with 58 octogenarians (age 80 to 84 years) and 58 septuagenarians (age 70 to 74). Groups were matched by sex, diagnosis, surgeon, surgical joint, and year of surgery.

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA.

Background: Tranexamic acid (TXA) is often used to prevent excessive blood loss during bilateral TKA. Although it diminishes blood loss, TXA may have a potentially elevated thrombogenic risk with extra, unnecessary doses of TXA in this high-risk population. To date, the most efficacious dosing protocol in this setting has not yet been ascertained.

Lower Extremity Total Joint Arthroplasty Has Minimal Effect on Golf Handicap.

Although the vast majority of arthroplasty surgeons allow patients to return to participation in golf following total knee arthroplasty (TKA) and total hip arthroplasty (THA), there is relatively little published data regarding how TKA or THA affects a patient's golfing ability. The purpose of this study was to determine how golfers' handicaps change following TKA and THA. We mailed a questionnaire to patients who had underwent primary TKA or THA at our institution and asked whether they played golf and for their golf handicap information network (GHIN) number.

Aspirin used for venous thromboembolism prophylaxis in total hip arthroplasty decreases heterotopic ossification.

Background: Heterotopic ossification (HO) is a known complication of total hip arthroplasty (THA) that can lead to persistent pain, stiffness, nerve impingement, and instability. Aspirin (ASA) has become an increasingly popular method of venous thromboembolism (VTE) prophylaxis, given its availability, ease of use, and relative safety. Although indomethacin has been commonly used for HO prophylaxis, we wanted to determine whether ASA, given the similar mechanism of action, may be effective in reducing the risk of HO in routine unilateral, primary THA when already being used for VTE prophylaxis.

Standardized Opioid Prescription Protocol Reduces Opioid Consumption After Total Joint Arthroplasty.

Unlabelled: Previous studies demonstrate routine overprescription of pain medications after total joint arthroplasty (TJA). A standardized reduced opioid prescription protocol for TJA was initiated at our institution, which we hypothesized would lead to a reduction in opioid consumption compared with patients who had surgery before initiation of the new protocol.

Methods: We evaluated 97 consecutive opioid-naive patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) using a standardized opioid prescription protocol (standardized group).

Chronic Systemic Metal Ion Toxicity from Wear on a Revised Cobalt-chromium Trunnion.

Introduction: Metal toxicity secondary to corrosion and wear has been reviewed in the arthroplasty literature with evidence supporting dermatologic, neurologic, and cardiac involvement. This is the first report of a novel case with the occurrence of systemic pathology with only mildly elevated serum cobalt (Co) and chromium (Cr) levels due to trunnion wear in a metal-on-polyethylene articulation.

Case Report: A 45-year-old female who had undergone a revision total hip arthroplasty developed concerning dermatologic, neurologic, and cardiac symptoms.

Outcomes of Salvage Arthrodesis and Arthroplasty for Failed Osteochondral Allograft Transplantation of the Ankle.

Background: Osteochondral allograft (OCA) transplantation is a useful treatment for posttraumatic ankle arthritis in young patients, but failure rates are high and reoperations are not uncommon. The aim of this study was to evaluate the outcomes of failed ankle OCA transplantation converted to ankle arthrodesis (AA) or total ankle arthroplasty (TAA).

Methods: We evaluated 24 patients who underwent salvage procedures (13 AA and 11 TAA) after primary failed ankle OCA transplantation.

Oral Opioids Are Overprescribed in the Opiate-Naive Patient Undergoing Total Joint Arthroplasty.

Introduction: The opioid epidemic in the United States continues to escalate and contribute to potentially preventable deaths. Because many opioid addictions begin with prescription medication, focus on limiting exposure and decreasing availability are essential. This study identifies the average number of opioid pills consumed following primary total knee and hip arthroplasty (TKA and THA) at our institution in opiate-naive patients to provide an estimate of medication required.

One Dose of Intravenous Tranexamic Acid Is Equivalent to Two Doses in Total Hip and Knee Arthroplasty.

Background: Tranexamic acid (TXA) helps to prevent excessive blood loss during total hip arthroplasty (THA) and total knee arthroplasty (TKA), but the most efficacious dosing protocol has not been ascertained. The purpose of this study was to identify whether 1 dose of intravenous TXA is equivalent to 2 doses for reducing blood loss and transfusion rates following THA and TKA without an increase in complications.

Methods: We identified 1,736 patients who underwent THA (592 who did not receive TXA, 454 who received 1 dose of TXA, and 690 who received 2 doses) and 2,042 patients who underwent TKA (744 who did not receive TXA, 499 who received 1 dose, and 799 who received 2 doses) from 2012 to 2016.

Carbon Dioxide Exposure Resulting From Hood Protective Equipment Used in Joint Arthroplasty Surgery.

Background: To protect both the surgeon and patient during procedures, hooded protection shields are used during joint arthroplasty procedures. Headache, malaise, and dizziness, consistent with increased carbon dioxide (CO) exposure, have been anecdotally reported by surgeons using hoods. We hypothesized that increased CO concentrations were causing reported symptoms.

Accuracy of A Handheld Accelerometer-Based Navigation System for Femoral and Tibial Resection in Total Knee Arthroplasty.

Restoration of mechanical axis in total knee arthroplasty (TKA) is correlated with improved implant survivorship. We assessed the accuracy and required surgical time using a hand-held accelerometer-based navigation system for TKA. Data collected on 53 patients included assembly, resection, and tourniquet times.

Ceramic liner fracture and impingement in total hip arthroplasty.

Background: Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added.

Questions/purposes: How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims?

Methods: With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking.

Accuracy of a hand-held surgical navigation system for tibial resection in total knee arthroplasty.

Background: Accuracy of total knee arthroplasty (TKA) implant placement and overall limb are important goals of TKA technique.

Methods: The accuracy and ease of use of an accelerometer-based hand-held navigation system for tibial resection during TKA was examined in 90 patients. Preoperative goals for sagittal alignment, navigation system assembly time, resection time, and tourniquet time were evaluated.

A comparison of standard and high-flexion knees: are we getting what we expected?

Some patients have been less than satisfied with flexion after total knee arthroplasty (TKA). As early designs provided limited flexion, companies have developed high-flexion designs. We conducted a study to compare flexion between 2 standard and 3 high-flexion designs and to compare clinical and radiographic postoperative flexion.

Outcome and range of motion using a high-flexion cruciate-retaining TKA.

Increased knee flexion after total knee arthroplasty (TKA) may contribute to patients' increased satisfaction and more active lifestyles. This study evaluated a TKA component designed for high flexion (more than 125°). The design features an anatomic sagittal femoral radius with short, flared femoral condyles to allow for femoral rollback.

Thrombosis incidence in unilateral vs. simultaneous bilateral total knee arthroplasty with compression device prophylaxis.

This study compares the incidence of venous thromboembolic event (VTE) in 55 patients (110 knees) undergoing simultaneous bilateral TKA with 287 patients (287 knees) undergoing unilateral TKA using a mobile compression device as monotherapy prophylaxis in both groups. All patients were clinically evaluated 3months after surgery with symptomatic confirmed VTE as an endpoint. Deep venous thrombosis (DVT) was documented by duplex ultrasound and pulmonary embolism (PE) was documented by spiral CT.

Measured flexion following total knee arthroplasty.

Postoperative flexion is an important factor in the outcome of total knee arthroplasty. Although normal activities of daily living require a minimum of 105° to 110° of flexion, patients from non-Western cultures often engage in activities such as kneeling and squatting that require higher flexion. The desire to achieve greater flexion serves as the driving force for prosthetic modifications, including high-flexion designs.

A randomized controlled trial of intraarticular ropivacaine for pain management immediately following total knee arthroplasty.

Total knee arthroplasty (TKA) is a commonly performed procedure for the treatment of end-stage arthritis of the knee. Pain control following TKA is difficult to manage in some patients. We examined the use of a postoperative intraarticular injection of 100 mL of 0.

Incidence of 'squeaking' after ceramic-on-ceramic total hip arthroplasty.

Unlabelled: The incidence of hip "squeak" associated with ceramic-on-ceramic bearings has been variably reported, ranging from 0.7% to 20.9%.

Early dislocation rate in ceramic-on-ceramic total hip arthroplasty.

Wear debris from metal-on-polyethylene articulation in conventional total hip arthroplasty (THA) may limit THA longevity. Bearing surfaces made of modern ceramic material, with high wear resistance and low fracture risk, have the potential to extend the longevity of THA and make the procedure more suitable for young, active patients. Concerns regarding a ceramic-on-ceramic bearing surface have included potential for a higher incidence of dislocation caused by limited modular neck length and liner options.

The use of reinfusion drains after total knee arthroplasty in patients treated with low molecular weight heparin for thromboembolic prophylaxis.

The effect of closed-suction drainage with red-cell reinfusion on patients receiving low molecular weight heparin (LMWH) prophylaxis after total knee arthroplasty (TKA) has not been previously studied. Therefore, our goals were to determine the effect of reinfusion drains and LMWH on allogeneic transfusions and wound complications after TKA by comparing patients treated with and without drains. Overall, transfusion rates were lower in the drain group (40% vs 15%, P=.

Portable compression device and low-molecular-weight heparin compared with low-molecular-weight heparin for thromboprophylaxis after total joint arthroplasty.

This preliminary prospective study to determine the rate of deep venous thrombosis (DVT) examined 277 patients undergoing total knee or total hip arthroplasty (TKA or THA) who were randomized to use a portable, continuous enhanced circulation therapy (CECT) compression device and low-molecular-weight heparin (LMWH) or to receive LMWH alone. Patients were screened for DVT using duplex ultrasound at hospital discharge and followed clinically for 3 months. In TKA, 5 DVTs (6.

Extensor mechanism function in single-radius vs multiradius femoral components for total knee arthroplasty.

The early outcomes of 2 newer-generation posterior cruciate ligament-retaining fixed-bearing total knee arthroplasty (TKA) implant designs were assessed to determine if a single sagittal radius femoral design has an advantage in obtaining earlier knee range of motion and function when compared with a contemporary multiradius femoral design. Total knee arthroplasty patients were prospectively randomized to receive either a single sagittal radius femoral design (n=50) or a multiradius femoral design (n=50). Knee extensor mechanism function after TKA with either a single sagittal radius or multiradius implant was comparable in contemporary posterior cruciate ligament-retaining TKA designs.

The efficacy of a single daily dose of enoxaparin for deep vein thrombosis prophylaxis following total knee arthroplasty.

Deep vein thrombosis (DVT) is a major risk following total knee arthroplasty (TKA). This prospective outcomes study evaluates the efficacy of enoxaparin 40 mg once daily for 7 days after TKA, by documenting symptomatic and asymptomatic outcomes using bilateral lower extremity duplex ultrasound upon hospital discharge and on postoperative day 21 (+/-2). In 60 extremities, duplex ultrasound demonstrated a DVT prevalence of 16.