Pain and Opioid use Following Total Knee Arthroplasty: Psycho-Social Factors are More Predictive Than Pharmacogenomics.

Background: This prospective, observational study was designed to assess the phenotype variation of the genes associated with pain and opioid use following total knee arthroplasty (TKA) in comparison to psycho-social elements.

Methods: Preoperative demographic data and Patient-Reported Outcomes Measurement Information System-43 scores were obtained on 305 elective TKA patients. Patient visual analog scale pain scores and opioid use were extracted from the hospital record.

Liposomal bupivacaine interscalene blocks demonstrate a greater proportion of total shoulder arthroplasty patients with clinically tolerable pain: a retrospective quality improvement study of 491 patients.

Objective: To evaluate the effects of liposomal bupivacaine use for interscalene blocks on postoperative analgesia in total shoulder arthroplasty patients.

Methods: De-identified total or reverse total shoulder arthroplasty patients between 2018 and 2021 were analyzed. Patients were grouped into single shot interscalene block with liposomal bupivacaine (LB) with plain bupivacaine, other block (OB) with other local anesthetics (mepivacaine, ropivacaine, or plain bupivacaine), or no block (NB).

Predicting chronic postsurgical pain: current evidence and a novel program to develop predictive biomarker signatures.

Chronic pain affects more than 50 million Americans. Treatments remain inadequate, in large part, because the pathophysiological mechanisms underlying the development of chronic pain remain poorly understood. Pain biomarkers could potentially identify and measure biological pathways and phenotypical expressions that are altered by pain, provide insight into biological treatment targets, and help identify at-risk patients who might benefit from early intervention.

Multi-Site Observational Study to Assess Biomarkers for Susceptibility or Resilience to Chronic Pain: The Acute to Chronic Pain Signatures (A2CPS) Study Protocol.

Chronic pain has become a global health problem contributing to years lived with disability and reduced quality of life. Advances in the clinical management of chronic pain have been limited due to incomplete understanding of the multiple risk factors and molecular mechanisms that contribute to the development of chronic pain. The Acute to Chronic Pain Signatures (A2CPS) Program aims to characterize the predictive nature of biomarkers (brain imaging, high-throughput molecular screening techniques, or "omics," quantitative sensory testing, patient-reported outcome assessments and functional assessments) to identify individuals who will develop chronic pain following surgical intervention.

Radiographically Silent Loosening of the Acetabular Component in Hip Arthroplasty.

Polyethylene wear and subsequent osteolysis are major obstacles to the long-term success of total hip arthroplasty (THA). We conducted a study to determine the incidence of loose acetabular components that did not show frank signs of loosening on either plain radiography or computed tomography (CT), or radiographically silent loosening (RSL). In this retrospective study, we evaluated patients who underwent revision THA and were evaluated with plain radiography and CT between 2000 and 2012.

What do we know about taper corrosion in total hip arthroplasty?

Mechanically assisted crevice corrosion (MACC) at metal/metal modular junctions in which at least one of the components is fabricated from cobalt-chromium alloy, has reemerged as a potential clinically significant complication in total hip arthroplasty. The clinical manifestation of MACC may include the development of an adverse local tissue reaction (ALTR), similar to what has been described in association with metal-on-metal bearing total hip and resurfacing arthroplasty. The clinical presentation of MACC-associated ALTRs may include pain and possibly late recurrent dislocations.

Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual-taper stem with a cobalt-chromium modular neck.

Background: Femoral stems with dual-taper modularity were introduced to allow additional options for hip-center restoration independent of femoral fixation in total hip arthroplasty. Despite the increasing availability and use of these femoral stems, concerns exist about potential complications arising from the modular neck-body junction.

Methods: This was a multicenter retrospective case series of twelve hips (eleven patients) with adverse local tissue reactions secondary to corrosion at the modular neck-body junction.

A randomized trial of epidural analgesia followed by continuous femoral analgesia compared with oral opioid analgesia on short- and long-term functional recovery after total knee replacement.

Objective: The purpose of this study was to compare continuous femoral nerve analgesia to oral opioid analgesics after discontinuation of epidural analgesia following total knee replacement.

Design: Randomized prospective controlled parallel group trial. Setting.

Limitations of imageless computer-assisted navigation for total hip arthroplasty.

We prospectively evaluated acetabular cup placement in total hip arthroplasty with an imageless computer navigation system or using conventional manual technique. The achieved cup orientation in the manual group had substantially larger variances and greater placement error than the navigation cases. The use of navigation was abandoned in 3 cases because of excessive pelvic tilt and unreliable registration of the pelvis.

Validation of a computer navigation system and a CT method for determination of the orientation of implanted acetabular cup in total hip arthroplasty: a cadaver study.

Background: Successful hip reconstruction to restore the normal hip biomechanics requires precise placement of implants. Computer assisted navigation in total hip arthroplasty has been proposed to have the potential to help achieve a high accuracy in implant placement. The goal of the study was to evaluate the accuracy of an imageless computer navigation system on cadavers and to validate a non-invasive computed tomography method for post-operative determination of acetabular cup orientation.

Computer-assisted total hip navigation.

Accurate implant placement in total hip replacement is important in avoiding dislocation, impingement, and edge-loading throughout the patient's postoperative functional range of motion. Current implants and bearing surfaces now provide the potential for prolonged longevity of the reconstruction, which can be compromised by malposition of the components outside of designated "safe zones." Computer-assisted hip navigation offers the potential for more accurate placement of hip components and control of leg length and offset.

Computed tomographic follow-up evaluation of operative intervention for periacetabular lysis.

Computed tomography (CT) accurately evaluates periacetabular lytic lesions. The purpose of this study is to determine the fate of osteolytic lesions after treatment with liner exchange and bone grafting. Fifteen patients who had undergone liner exchange with grafting for progressive lytic lesions, as demonstrated by preoperative CT scans, were identified.

Total hip arthroplasty with the porous-coated anatomic hip prosthesis: results at 11 to 18 years.

The authors had previously reported good results with apparent fixation of a series of porous-coated anatomic hips at 2 to 4 years. In a larger series of 133 hips with porous-coated anatomic uncemented components, 91 hips in 82 patients were available for a follow-up of 11 years or greater. Although 3.

Computer assisted navigation in total knee arthroplasty: improved coronal alignment.

The use of a computer navigation system is intended to optimize implant positioning. This study compares prospectively followed total knee arthroplasty (TKA) done with imageless computer-assisted navigation with a cohort of TKA done with manual instruments. Primary TKAs were performed on 147 knees, with 78 in the manual group and 69 in the navigated group.

Total hip arthroplasty through a minimal posterior approach using imageless computer-assisted hip navigation.

With decreased exposure in a minimal posterior hip incision, navigation with computer assistance provides an alternative method to accurately place the components. This study compares the results of a series of 82 navigated total hips to a retrospective cohort of 50 hips done with conventional instruments. The surgical incision split the gluteus maximus but did not extend distally into the fascia.

Preoperative risks and outcomes of hip and knee arthroplasty in the Veterans Health Administration.

The relationship between patient characteristics and outcomes of total joint arthroplasty (TJA) was examined in a population of veterans treated in VA hospitals. Outcomes included 30-day mortality and morbidity, postoperative length of stay, and readmission caused by surgical complications. A larger proportion of women then men were functionally impaired before surgery in both the hip (22% vs.

Comparison of two home care protocols for total joint replacement.

Objectives: To examine the effect of a more-efficient home care protocol to manage total joint replacement (TJR) patients after surgery.

Design: A randomized trial of two home care protocols for TJR management.

Setting: A hospital-affiliated home healthcare agency in a large midwestern city.

A prospective, randomized study of preoperative autologous donation for hip replacement surgery.

Background: Preoperative autologous blood donation is commonly performed to meet potential perioperative transfusion needs and is a common practice prior to total hip arthroplasty. Using standardized transfusion guidelines, we prospectively analyzed the effectiveness of preoperative autologous donation as a method for decreasing allogeneic transfusion among patients undergoing unilateral primary total hip replacement who were eligible to donate autologous blood.

Methods: Patients who were scheduled for primary total hip replacement surgery and who had a preoperative baseline hemoglobin level >or=120 g/L were randomized either to donate two units of blood (autologous donors) or not to donate any blood (nondonors).

Linezolid treatment for osteomyelitis due to vancomycin-resistant Enterococcus faecium.

The incidence of nosocomial infections caused by vancomycin-resistant enterococci has risen substantially during the past 15 years. We report the use of linezolid for the successful treatment of hip prosthesis infection associated with osteomyelitis due to vancomycin-resistant Enterococcus faecium.

Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty.

Background: Acetabular osteolysis is a major problem affecting long-term survival of total hip prostheses. Since lytic lesions may be asymptomatic until extensive bone loss has occurred, early detection of lytic lesions is important. The purposes of this study were to determine the efficacy and potential role of high-resolution helical (or spiral) computed tomography with metal-artifact minimization in the early detection of osteolysis of the pelvis and to use the method to determine if there was a relationship between the extent of osteolysis and the amount of polyethylene wear.

Effect of initiation chemistry on the fracture toughness, fatigue strength, and residual monomer content of a novel high-viscosity, two-solution acrylic bone cement.

Porous-free, two-solution bone cements have been developed in our laboratory as an alternative to commercial powder/liquid formulations. Each pair of solutions consist of poly(methyl methacrylate) (PMMA) powder dissolved in methyl methacrylate (MMA) monomer, with benzoyl peroxide (BPO) added to one solution as the initiator and N,N-dimethyl-p-toluidine (DMPT) added to the other as the activator. When mixed, the solutions polymerize via a free radical reaction, which is governed by the concentrations of initiator and activator and their molar stoichiometry.

Short-term results of the M2a-taper metal-on-metal articulation.

A polyethylene-free, metal-on-metal acetabular system (M2a-taper [Biomet, Inc., Warsaw, IN]) was designed in an effort to improve total hip arthroplasty (THA) longevity. Minimum 2-year follow-up results involving 72 polyethylene liner THAs and 78 metal liner THAs from a multicenter, randomized, controlled, investigational device exemption study are reported.

Efficacy of preoperative autologous blood donation: analysis of blood loss and transfusion practice in total hip replacement.

Study Objective: To determine the frequency of allogeneic transfusion for total hip replacement (THR) surgery and to examine the efficacy of preoperative autologous blood donation (PABD) under specified, standardized blood transfusion guidelines.

Design: Prospective, nonrandomized study.

Setting: University medical center.

A theoretical and experimental analysis of polymerization shrinkage of bone cement: A potential major source of porosity.

A theoretical basis for understanding polymerization shrinkage of bone cement is presented based on density changes in converting monomer to polymer. Also, an experimental method, based on dilatometry and the Archimedes' principle is presented for highly precise and accurate measurement of unconstrained volumetric shrinkage of bone cement. Furthermore, a theoretical and experimental analysis of polymerization shrinkage in a constrained deformational state is presented to demonstrate that porosity can develop due to shrinkage.