Hemiarthroplasty for Femoral Neck Fractures: Does Surgeon Subspecialty Affect Perioperative Outcomes?

Objectives: To determine if surgeon subspecialty training affects perioperative outcomes for displaced femoral neck fractures treated with hemiarthroplasty.

Design: Retrospective comparative study.

Setting: One health system with 2 hospitals (Level I and Level III trauma centers).

Efficacy of multimodal perioperative analgesia protocol with periarticular medication injection in total knee arthroplasty: a randomized, double-blinded study.

Pain control is necessary for successful rehabilitation and outcome after total knee arthroplasty. Our goal was to compare the clinical efficacy of periarticular injections consisting of a long-acting local anesthetic (ropivacaine) and epinephrine with and without combinations of an α2-adrenergic agonist (clonidine) and/or a nonsteroidal anti-inflammatory agent (ketorolac). In a double-blinded controlled study, we randomized 160 patients undergoing total knee arthroplasty to receive 1 of 4 intraoperative periarticular injections: Group A, ropivacaine, epinephrine, ketorolac, and clonidine; Group B, ropivacaine, epinephrine, and ketorolac; Group C, ropivacaine, epinephrine, and clonidine; Group D (control), ropivacaine and epinephrine.

Use of tranexamic acid results in decreased blood loss and decreased transfusions in patients undergoing staged bilateral total knee arthroplasty.

Background: Tranexamic acid (TXA) is an antifibrinolytic that reduces blood loss and transfusion rates in total joint arthroplasty. Blood loss and allogenic transfusion rates have not been well studied in patients receiving TXA and undergoing bilateral staged total knee arthroplasty (TKA). The purpose was to evaluate the effect of TXA on blood loss, hemoglobin (Hb) changes, and transfusion in patients undergoing staged bilateral TKA.

Medial UKA: favorable mid-term results in middle-aged patients.

In middle-aged patients with knee arthritis, surgical treatment options include arthroscopic procedures, osteotomies, and unicompartmental and total knee arthroplasty. Unicompartmental knee osteoarthrosis is particularly challenging and controversial in such patients. From December 2001 through October 2005, we treated 32 consecutive middle-aged patients (46 to 59 years old) with 40 medial unicompartmental knee arthroplasties.

Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone.

Cementless femoral fixation has become widely accepted in modern total hip arthroplasty. Treating patients who have a stovepipe-shaped femur (Dorr type C) with cementless implants has traditionally been challenging. We treated 53 consecutive patients (60 hips) who had type C bone with identical tapered, proximally coated implants and postoperative weight bearing as tolerated.

All-polyethylene tibial components in obese patients are associated with low failure at midterm followup.

Background: In the United States, the obese population has increased markedly over the last four decades, and this trend continues. High patient weight places additional stress on TKA components, which may lead to increased polyethylene wear, osteolysis, radiolucencies, and clinical failure. Metal-backed tibial components and all-polyethylene tibial components in the general population have comparable osteolysis and failure, but it is unclear whether these components yield similar osteolysis and failure in obese patients.

When can I drive?: brake response times after contemporary total knee arthroplasty.

Background: After right total knee arthroplasty (TKA), patients are usually eager to return to driving. Previous studies suggest 6 weeks postsurgery is a safe time. However, recent advances in surgical technique, pain management, and rehabilitation have theoretically improved recovery after TKA.

Role of navigation in total hip arthroplasty.

Current uses of computed tomography-based and imageless navigation systems for total hip arthroplasty include proper placement of the acetabular component, measurement of limb-length changes, enablement of minimally invasive surgery, and proper placement of components for hip resurfacing procedures. This article provides an overview of the rationale for computer-assisted surgery in total hip arthroplasty and hip resurfacing. The experience of the senior author (M.