Is There a Benefit to Modularity in 'Simpler' Femoral Revisions?

Background: Modular revision femoral components allow the surgeon to make more precise intraoperative adjustments in anteversion and sizing, which may afford lower dislocation rates and improved osseointegration, but may not offer distinct advantages when compared with less expensive monoblock revision stems.

Questions/purposes: We compared modular and monoblock femoral components for revision of Paprosky Type I to IIIA femoral defects to determine (1) survivorship of the stems; and (2) complications denoted as intraoperative fracture, dislocation, or failure of osseointegration.

Methods: Between 2004 and 2010, participating surgeons at three centers revised 416 total hip arthroplasties (THAs) with Paprosky Type I to IIIA femoral defects.

Risk assessment tools used to predict outcomes of total hip and total knee arthroplasty.

This article reviews recently proposed clinical tools for predicting risks and outcomes in total hip arthroplasty and total knee arthroplasty patients. Additionally, we share the Massachusetts General Hospital experience with using the Risk Assessment and Prediction Tool to predict the need for an extended care facility after total joint arthroplasty.

Does the Risk Assessment and Prediction Tool predict discharge disposition after joint replacement?

Background: Payers of health services and policymakers place a major focus on cost containment in health care. Studies have shown that early planning of discharge is essential in reducing length of stay and achieving financial benefit; tools that can help predict discharge disposition would therefore be of use. The Risk Assessment and Prediction Tool (RAPT) is a preoperative survey constructed to predict discharge disposition after total joint arthroplasty (TJA).

In vivo and ex vivo measurement of polyethylene wear in total hip arthroplasty: comparison of measurements using a CT algorithm, a coordinate-measuring machine, and a micrometer.

Background: Determination of the amount of wear in a polyethylene liner following total hip arthroplasty (THA) is important for both the clinical care of individual patients and the development of new types of liners.

Patients And Methods: We measured in vivo wear of the polyethylene liner using computed tomography (CT) (obtained in the course of regular clinical care) and compared it to coordinate-measuring machine (CMM) readings. Also, changes in liner thickness of the same retrieved polyethylene liner were measured using a micrometer, and were compared to CT and CMM measurements.

Economic benefit to society at large of total knee arthroplasty in younger patients: a Markov analysis.

Background: To our knowledge, the economic implications of total knee arthroplasty to society at large have not been assessed with specific consideration of the young working population with osteoarthritis of the knee. The goal of the present study was to use a Markov analysis to estimate the overall average cost to society--in terms of medical expenses and lost wages--of delaying early total knee arthroplasty in favor of nonoperative treatment for end-stage knee osteoarthritis in a hypothetical fifty-year-old patient.

Methods: A Markov state-transition decision model was constructed to compare the overall average cost over thirty years of total knee arthroplasty with the average thirty-year cost of nonoperative treatment for a fifty-year-old patient with end-stage osteoarthritis.

Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?

Acetabular cup positioning is a critical factor in determining adverse clinical outcomes in THA. This evaluation was performed to determine if morbid obesity (BMI ≥35kg/m(2)) is a contributing risk factor to cup malpositioning. Two groups of patients were obtained from a local arthroplasty registry and match-controlled for gender, age, and diagnosis (n=211 morbidly obese; n=211 normal).