Use of screws and cement in primary TKA with up to 20 years follow-up.

The purpose of this study was to investigate screws and cement for large tibial bone defects during primary TKA. Of 14,686 consecutive primary TKAs performed between December 1988 and February 2010, 256 received screws and cement for tibial defects. Cox regression was used for the analysis.

Concerns of an itinerant surgeon: results of a Guatemalan surgical aid trip.

Over the past decade the popularity of foreign medical aid has increased and gained notoriety. Operation Walk is a philanthropic organization dedicated to improving the ambulatory potential of patients in developing countries by providing free surgical treatment for patients who otherwise lack access to care of debilitating bone and joint conditions. During Operation Walk Mooresville's 2013 trip to Guatemala 40 patients prospectively completed a Likert Scale style survey.

Meeting increased demand for total knee replacement and follow-up: determining optimal follow-up.

The strain on clinic and surgeon resources resulting from a rise in demand for total knee replacement (TKR) requires reconsideration of when and how often patients need to be seen for follow-up. Surgeons will otherwise require increased paramedical staff or need to limit the number of TKRs they undertake. We reviewed the outcome data of 16 414 primary TKRs undertaken at our centre to determine the time to re-operation for any reason and for specific failure mechanisms.

The role of the posterior cruciate ligament in total knee replacement.

Objectives: The purpose of this study was to examine the effect of posterior cruciate ligament (PCL) retention, PCL recession, and PCL excision during cruciate-retaining total knee replacement.

Methods: A total of 3018 anatomic graduated component total knee replacements were examined; 1846 of these retained the PCL, 455 PCLs were partially recessed, and in 717 the PCL was completely excised from the back of the tibia.

Results: Clinical scores between PCL groups favored excision for flexion (p < 0.

Preoperative malalignment increases risk of failure after total knee arthroplasty.

Background: Implant survival after total knee arthroplasty has historically been dependent on postoperative knee alignment, although failure may occur when alignment is correct. Preoperative knee alignment has not been thoroughly evaluated as a possible risk factor for implant failure after arthroplasty. The purpose of this study was to analyze the effect of preoperative knee alignment on implant survival after total knee arthroplasty.

Evaluation and management of complications of the extensor mechanism.

Extensor mechanism and patellofemoral joint complications occur infrequently following total knee arthroplasty but represent a high percentage of clinically significant problems. Accurately diagnosing and identifying specific complications of the underlying etiology are the keys to successful treatment. Patellofemoral joint complications may be broadly categorized into implant-related problems, tendinous and patellar bone integrity issues, and soft-tissue imbalance or instability of the patellofemoral joint.

Heterotopic bone formation following resurfacing total hip arthroplasty.

Heterotopic bone (HO), a rare association with total hip arthroplasty (THA), has recently been shown to be more of a problem with resurfacing hip arthroplasty (RHA). It has been speculated to be the result of greater soft tissue dissection required for this procedure. HO most commonly develops in males and patients with bilateral disease.

Pain relief and functional improvement remain 20 years after knee arthroplasty.

Background: TKA provides demonstrable pain relief and improved health-related quality of life. Yet, a decline in physical function may occur over the long term despite the absence of implant-related problems.

Questions/purposes: (1) Does pain relief diminish over 20 years after TKA? (2) Does function decline over 20 years in terms of Knee Society function, knee, and walking scores? And (3) what is the patient-reported activity level at most recent followup?

Patients And Methods: We retrospectively identified 1471 patients with 1757 primary cruciate-retaining TKAs implanted between 1975 and 1989 and identified 128 living patients (8.

Low incidence of groin pain and early failure with large metal articulation total hip arthroplasty.

Background: Large-diameter metal-on-metal articulations reportedly improve stability and wear in THAs. However, some reports suggest some patients have unexplained hip and early failures with these implants. Thus, the potential benefits may be offset by these concerns.

The effect of alignment and BMI on failure of total knee replacement.

Background: The purpose of this study was to determine the effect of tibiofemoral alignment, femoral and tibial component alignment, and body-mass index (BMI) on implant survival following total knee replacement.

Methods: We retrospectively reviewed 6070 knees in 3992 patients with a minimum of two years of follow-up. Each knee was classified on the basis of postoperative alignment (overall tibiofemoral alignment and alignment of the tibial and the femoral component in the coronal plane).

Intramedullary vs extramedullary femoral alignment guides: a 15-year follow-up of survivorship.

The influence of intramedullary (IM) and extramedullary (EM) femoral cutting guides on survivorship of total knee arthroplasty was studied in 6726 total knee arthroplasty guided by either an IM (4993 knees) or EM (1733 knees) system. Fifteen-year survivorship of the 2 cohorts showed no statistically significant difference (EM 97.9% vs IM 98.

Does high tibial osteotomy affect the success or survival of a total knee replacement?

Background: Whether a previous high tibial osteotomy (HTO) influences the long-term function or survival of a total knee arthroplasty (TKA) is controversial.

Questions/purposes: We compared long-term functional scores and survival of bilateral TKAs in patients who had a previous HTO in one of the knees.

Patients And Methods: From 1980 to 1995, we performed 5043 primary TKAs; 39 of these patients had bilateral TKAs at an average of 8.

Metal backing significantly decreases tibial strains in a medial unicompartmental knee arthroplasty model.

Clinical success of unicompartmental knee arthroplasty (UKA) is on the rise and is dependent on multiple patient, implant, and surgical factors. Tibial subsidence has been clinically reported as a cause of failure in UKA with an all-polyethylene tibial design in the absence of metal backing, yet the role of metal backing UKA tibial components on tibial loading is not fully understood. In this study, composite tibiae were implanted with medial all-polyethylene fixed-bearing or metal-backed UKA tibial components and a 1.

Acetabular UHMWPE survival and wear changes with different manufacturing techniques.

Background: Polyethylene wear may be affected by the type of polyethylene resin, manufacturing technique, degree of thermal stabilization, and sterilization technique.

Questions/purposes: We therefore compared femoral head penetration into the PE and cup survival using the same cup system with different PE resins, manufacturing, and sterilization techniques.

Methods: Our study group consisted of 1912 THAs performed using the same uncemented cup and identical 28-mm cobalt-chrome heads.

"Thicker" polyethylene bearings are associated with higher failure rates in primary total knee arthroplasty.

"Thin" modular polyethylene bearings have previously been associated with failure from wear. This study examined the influence of polyethylene thickness on survivorship in primary total knee arthroplasty (TKA). Do "thinner" or "thicker" bearings fail more? Six thousand seventy primary TKAs with a single implant design were reviewed.

A comparison in proximal tibial strain between metal-backed and all-polyethylene anatomic graduated component total knee arthroplasty tibial components.

Loading in total knee arthroplasty (TKA) is multifactorial and dependent on alignment, ligament balance, patient, and implant factors. Abnormal loading has been linked to clinical failure; however, the respective contribution of each factor to failure is not well known. This study defined the effect of metal backing on loading patterns in the proximal tibia.

High preoperative range of motion is a significant risk factor for dislocation in primary total hip arthroplasty.

Dislocation after total hip arthroplasty (THA) is multifactorial and is dependent on surgical, implant, and patient factors. We hypothesized that high preoperative hip range of motion is an important variable contributing to instability after THA. We retrospectively reviewed 3379 THAs performed during a 21-year period.

Outcome of infected total joint replacement.

Numerous protocols are used to treat an infected total joint arthroplasty. We evaluated survival outcomes of patients with infected total joint arthroplasties over 35 years to determine if one treatment is more effective than others.Of 17,561 total joint arthroplasties performed at our facility, 116 (0.

High survival of uncemented proximally porous-coated titanium alloy femoral stems in osteoporotic bone.

Unlabelled: Because the initial fixation of an uncemented stem may be compromised in patients with osteoporotic bone (Class C, Dorr et al.), many surgeons prefer a cemented stem in this setting. We therefore determined the survival of an uncemented, proximally porous-coated, straight-stemmed, titanium alloy femoral component in patients with Class C bone when compared with Class A and B bone.

Total knee arthroplasty with 4.4 mm of tibial polyethylene an update.

Three hundred eighty-seven one-piece, 8-mm tibial components were implanted in 313 patients. All tibial prostheses were manufactured with 4.4 mm of polyethylene.

Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates.

The study aims to delineate the deep infection rates and infection risk factors for primary total knee and total hip arthroplasty patients. A retrospective review was conducted on 6108 patients from 1991 to 2004. The deep infection cases were compared to the noninfected cohort whereby infection risk factors were identified.

Effects of coronal plane conformity on tibial loading in TKA: a comparison of AGC© flat versus conforming articulations.

Conforming articulations potentially decrease polyethylene contact stresses in total knee arthroplasty (TKA); however, less is known about the effect of coronal geometry on tibial loading and clinical failure. This study examined the relationship between coronal plane geometry and loading patterns in the proximal tibia. Composite tibiae were implanted with modular, metal-backed tibial trays and were compressively loaded with conforming and nonconforming ultra-high molecular weight polyethylene (UHMWPE) tibial bearings and comparable femoral components.

Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double-blind, placebo-controlled study.

We investigated the hypothesis that a posterior capsular injection of ropivacaine would improve pain and accelerate functional recovery after total knee arthroplasty in a randomized, double-blind, placebo-controlled study design. Sixty-six patients received a standardized multimodal anesthesia protocol that included a femoral nerve block. Twenty milliliters of either saline (control) or ropivacaine (study group) was injected into the posterior capsule.

Twenty-year survivorship of cementless anatomic graduated component total knee arthroplasty.

There is a renewed interest in cementless total knee arthroplasty (TKA) due to improved biomaterials, desire for decreased surgical times and the potential increased longevity. Seventy-three cementless TKAs (AGC, Biomet, Warsaw, Ind) were performed from 1984 to 1986. All components were implanted without cement and without screws and obtained minimum 10 years of follow-up.