Optimizing PROM Implementation in Orthopedic Clinics for Longitudinal Outcome Monitoring: Lessons from a Multisite Study.

Background: Systematic patient-reported outcome measure (PROM) collection is challenging for clinics, particularly when patients are not in the office. The Arthritis care through Shared Knowledge (ASK) study deployed multimodal approaches to collect PROMs using a clinical microsystem framework.

Conceptual Model: Informed by the clinical microsystem model, the authors coached 12 orthopedic practices to implement shared processes to support best practices for PROM collection and use.

Liposomal Bupivacaine vs Plain Bupivacaine in Periarticular Injection for Control of Pain and Early Motion in Total Knee Arthroplasty: A Randomized, Prospective Study.

Background: The use of multimodal pain regimens has been shown to be an effective technique for the treatment of postoperative pain after total knee arthroplasty. Periarticular injections, of both short-acting and long-acting anesthetics, have emerged as an additional method of providing significant improvement in postoperative pain relief. The purpose of this study is to compare the efficacy of periarticular injection using long-acting vs short-acting preparations.

Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head.

Background: Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF.

Dose-Associated Changes in Gait Parameters in Response to Exercise Programs after Total Knee Arthroplasty: Secondary Analysis of Two Randomized Studies.

Background: Rehabilitation plays an important role to improve the outcomes of total knee arthroplasty (TKA). Evidence about the appropriate dose of exercise to recover gait dysfunction after TKA is limited. We posed the research question: In patients during the post-acute stage after TKA, is increased dose of exercise associated with larger improvements in gait parameters such as step length and single support time?

Methods: This was a secondary analysis from two randomized studies on exercise after TKA to investigate dose-dependence of gait parameters in response to exercise.

Contribution of hip abductor strength to physical function in patients with total knee arthroplasty.

Background: Investigating modifiable factors that contribute to functional limitations in patients with total knee arthroplasty (TKA) may guide changes in rehabilitation protocols and improve functional outcomes. Whereas quadriceps muscle weakness has been demonstrated to contribute to functional limitations in TKA, the role of hip abductor weakness has not received attention.

Objective: The purpose of this study was to determine whether hip abductor strength (force-generating capacity) contributes to physical function beyond what can be explained by quadriceps muscle strength in patients after a TKA.

A balance exercise program appears to improve function for patients with total knee arthroplasty: a randomized clinical trial.

Background: Patients with total knee arthroplasty (TKA) have impaired balance and movement control. Exercise interventions have not targeted these impairments in this population.

Objectives: The purposes of this study were: (1) to determine the feasibility of applying a balance exercise program in patients with TKA, (2) to investigate whether a functional training (FT) program supplemented with a balance exercise program (FT+B program) could improve physical function compared with an FT program alone in a small group of individuals with TKA, and (3) to test the methods and calculate sample size for a future randomized trial with a larger study sample.

Patient and family-centered collaborative care: an orthopaedic model.

Despite both longstanding and recent interest in patient-centered care, there are few published models or methods for defining and implementing patient-centered care in the office and hospital setting through a full cycle of care from the patient's perspective. We describe patient- and family-centered collaborative care as a low-technology, systems-based solution to many current problems and suggest ways to provide safe, effective, timely, and efficient health care. We presumed such a patient- and family-centered collaborative care model would provide high quality health care.

Functional pelvic orientation measured from lateral standing and sitting radiographs.

We prospectively obtained preoperative and 3-month postoperative lateral pelvic radiographs in the standing and sitting positions from 84 patients who underwent total hip arthroplasty. We measured pelvic orientation (flexion extension) using the anterior pelvic plane as defined by the anterior superior iliac spines and pubic tubercles as references. There was a trend towards upright pelvic alignment when standing, with a mean anterior pelvic plane angle of 1.

Accuracy of pelvic flexion measurements from lateral radiographs.

Variations in pelvic orientation affect preoperative planning decisions, intraoperative navigation, and postoperative measurements. By providing the means to measure pelvic flexion at low cost and reporting pelvic flexion using the standard reference system, a lateral radiograph technique based on the pubic tubercles and anterior superior iliac spines may be useful for studying functional pelvic orientation and functional alignment and for improving accuracy of postoperative measurement. We evaluated the accuracy of this method by synthesizing 50 lateral pelvic radiographs.

Measurements of acetabular cup position and pelvic spatial orientation after total hip arthroplasty using computed tomography/radiography matching.

This study presents a clinical validation of postoperative measurements of acetabular cup alignment following total hip arthroplasty (THA). The methodology was based on concurrent anatomic three-dimensional (3D) measurements of both the acetabular cup alignment and pelvic orientation, using an original CT/X-ray matching algorithm named Xalign. The subjects were 19 patients who had undergone bilateral THA using CT-based surgical navigation.

Less invasive total hip arthroplasty using navigational tools.

Although traditional total hip arthroplasty offers good visualization of bony landmarks and allows for the accurate orientation and fixation of implants, these benefits are achieved at the expense of extensive soft-tissue dissection and can result in postoperative complications and a delayed return to full function. To address these disadvantages, navigational tools were coupled with a mini-incision technique that allowed accurate bone preparation and orientation of the implant components without direct visualization of the bony landmarks. Additionally, image-guided systems provide three-dimensional information before and during surgery, making it possible to know, in real time, the orientation of implants and to visualize the full bony anatomy.

Mini-incision technique for total hip arthroplasty with navigation.

This prospective study compares a mini-incision technique and traditional posterior approach for total hip arthroplasty (THA). Thirty-three patients who had undergone a mini-incision THA were matched by diagnosis, gender, average age, and preoperative Harris Hip Score (HHS) to 33 patients who had undergone THA using the traditional posterior approach. The average length of the incision for group 1 was 11.

Comparison of a mechanical acetabular alignment guide with computer placement of the socket.

We hypothesized that use of mechanical acetabular guides for intraoperative alignment leads to variations between the actual and desired implant orientation. Acetabular implant orientation using only the mechanical guide was studied in 78 patients (82 hips) undergoing primary total hip arthroplasty. A computer-assisted navigation system was used to measure alignment and to monitor the orientation of the pelvis during surgery.