Effect of Posterior Osteophytes on Total Knee Arthroplasty Coronal Soft Tissue Balance: Do They Matter?

Background: Achieving coronal plane balance in total knee arthroplasty (TKA) is of paramount importance. There is concern that obtaining balancing before removal of posterior osteophytes may lead to asymmetrical extension balance once removed. We hypothesized that there is a particular posterior osteophyte size and location that does not result in significant change in coronal gap balancing.

Complex Total Hip Arthroplasty in a Patient with Klippel-Trénaunay Syndrome: A Case Report.

Case: Klippel-Trénaunay syndrome (KTS) carries manifestations including skeletal dysplasia and prominent vascular malformations. This report details a case of hip dysplasia in the setting of KTS treated with total hip arthroplasty (THA) requiring preoperative embolization, intraoperative angiography for placement of an iliac artery occlusive balloon, and modular hip arthroplasty components for femoral and acetabular dysplasia. Perioperatively, the patient rehabilitated well and was walking painlessly and unassisted at 3 and 12 months postoperatively.

Appropriate Use Criteria for the Nonarthroplasty Treatment of Knee Osteoarthritis in Veterans.

While patients without knee instability use more nonarthroplasty treatments over a longer period prior to total knee arthroplasty, patients with less severe knee osteoarthritis are at risk of receiving interventions judged to be rarely appropriate.

No Difference in Conventional Polyethylene Wear Between Yttria-stabilized Zirconia and Cobalt-chromium-molybdenum Femoral Heads at 10 Years.

Background: Concerns have arisen regarding deterioration of wear properties of yttria-stabilized zirconia (YSZ) femoral head on conventional polyethylene (PE) bearings due to YSZ phase transformation.

Questions/purposes: The purpose of this study was to determine if there is a difference in long-term PE wear properties between YSZ and cobalt-chromium-molybdenum (Co-Cr-Mo) femoral heads.

Methods: Ten-year radiographic wear assessment was performed on a cohort of patients enrolled in a prospective randomized clinical trial comparing total hip arthroplasty with YSZ or Co-Cr-Mo femoral heads on conventional, non-cross-linked PE.

Premature Consolidation with Resultant Implant Failure Using PRECICE Femoral Nail Lengthening: A Case Report.

Case: Posttraumatic limb-length discrepancies secondary to femoral malunion can be treated with a variety of external or internal lengthening systems. The PRECICE nail is an intramedullary device featuring an external remote control to activate a magnetically driven internal distraction mechanism. While this intramedullary system avoids the soft-tissue complications common to external lengthening, it has unique mechanisms of failure that are difficult to diagnose and that require a systematic approach.

Periprosthetic joint infection in patients with inflammatory joint disease: a review of risk factors and current approaches to diagnosis and management.

Background: Prevention, early identification, and effective management of periprosthetic joint infection (PJI) in patients with inflammatory joint disease (IJD) present unique challenges for physicians. Discontinuing disease-modifying anti-rheumatoid drugs (DMARDs) perioperatively may reduce immunosuppression and infection risk at the expense of increasing disease flares. Interpreting traditional diagnostic markers of PJI can be difficult due to disease-related inflammation.

Clostridium difficile colitis in patients undergoing lower-extremity arthroplasty: rare infection with major impact.

Background: The prevalence of Clostridium difficile colitis is reportedly increasing in surgical patients and can negatively impact their outcome. However, as yet there are no clear estimates of the C difficile infection colitis rate and its consequences among patients undergoing total joint arthroplasty (TJA).

Questions/purposes: We asked: (1) What is the rate of C difficile colitis in TJA patients? (2) What are the risk factors of C difficile colitis in these patients? And (3) what is the effect of C difficile colitis on length of stay, in-hospital mortality, and estimated total charges?

Methods: Using ICD-9-CM diagnosis and procedure codes, we queried the Nationwide Inpatient Sample database for patients undergoing TJA for the years 2002 to 2010.

Hip resurfacing is less painful at 24 hours than hip replacement.

This article quantifies pain differences in the immediate postoperative period between patients undergoing total hip arthroplasty (THA) and metal-on-metal hip resurfacing (MoMHR). Patients less than 65 years old indicated for either a primary MoMHR or THA were screened for consent. A total of 51 patients completed the study.

Factors affecting response rates to mailed preoperative surveys among arthroplasty patients.

Aim: To identify factors that affect patient response rates to preoperative functional surveys in hip and knee arthroplasty patients.

Methods: From May 2008 to March 2009, 247 patients were scheduled more than 4 wk in advance for hip or knee arthroplasty by one of two participating surgeons at our center. A personalized questionnaire comprised of the Short Form 12 (SF-12) and Western Ontario and McMaster Universities (WOMAC) Index was mailed to patients at random time points ranging from 7 to 101 d prior to surgery.

Early adverse results with bicompartmental knee arthroplasty: a prospective cohort comparison to total knee arthroplasty.

This prospective cohort study compares functional outcomes of bicompartmental knee arthroplasty (BKA) and total knee arthroplasty (TKA) in patients with osteoarthritis (OA) of the patellofemoral and medial compartments. Eligibility criteria included bicompartmental OA with less than grade 2 OA in the lateral compartment and intact cruciate ligaments. Fifty-six patients met eligibility criteria (21 BKA, 33 TKA).

The effect of fixation technique on the stiffness of comminuted Vancouver B1 periprosthetic femur fractures.

The purpose of this study was to evaluate the stiffness of 3 different constructs for the fixation of comminuted Vancouver B1 periprosthetic femoral shaft fractures: a single lateral locking plate, a single lateral locking plate plus an anterior strut allograft, and a lateral locking plate plus an anterior locking plate. The axial stiffness, lateral bending stiffness, and torsional stiffness of 10 synthetic periprosthetic femur fracture models were tested. Differences in stiffness between constructs were determined with a 1-way repeated-measures analysis of variance.

Predicting short-term outcome of primary total hip arthroplasty:a prospective multivariate regression analysis of 12 independent factors.

The purpose of this study was to investigate factors affecting the short-term outcome of primary total hip arthroplasty (THA) and develop a multivariate regression equation to predict the short-term outcome of primary THA. Prospectively collected data for 101 primary THAs performed at a single institution were used in this study. Twelve independent variables were analyzed via correlation and multivariate regression analyses.

Tip-apex distance of intramedullary devices as a predictor of cut-out failure in the treatment of peritrochanteric elderly hip fractures.

A tip-apex distance (TAD) of greater than 25 mm has been shown to be an accurate predictor of lag screw cut-out when sliding hip screws (SHS) are used to treat peritrochanteric (PT) hip fractures. The purpose of this study was to determine which factors, including TAD, correlated with successful clinical outcomes of PT hip fractures surgically treated with intramedullary (IM) devices. A total of 192 patients were included in this retrospective study.