High Survivorship of Hybrid Fixation Technique in Aseptic Condylar Revision Total Knee Arthroplasty with Minimal Metaphyseal Bone Loss: 5-10 Year Clinical Outcomes.

The aim of this study was to evaluate the outcomes of hybrid fixation technique in aseptic condylar revision total knee arthroplasty (rTKA). A retrospective consecutive study of patients with minimal metaphyseal bone loss who underwent aseptic rTKA with press-fit cementless femoral stems and short cemented tibial stems. Primary outcome measure was mechanical failure.

Risk of complications with prolonged operative time in morbidly obese patients undergoing elective total knee arthroplasty.

Background: Patients with a high body-mass index (BMI) are at increased risk for significant complications after total knee arthroplasty (TKA). We explored whether operative time is a modifiable risk factor for infectious and thromboembolic complications.

Methods: A retrospective observational cohort study of the ACS-NSQIP registry, including all patients who underwent primary TKA (2015-2018), and were morbidly obese (BMI 40 kg/m or greater) was performed.

The Use of Rifampin in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Comparative Studies.

Background: Periprosthetic joint infection (PJI) is a devastating complication of total joint arthroplasty (TJA). Rifampin is an antibiotic with the ability to penetrate bacterial biofilms, and thus has been considered as a potentially important adjunct in the prevention and treatment of PJI. The aim of this systematic review is to evaluate and summarize the use of rifampin in TJA, particularly in the context of PJI.

Surgery-related predictors of kneeling ability following total knee arthroplasty: a systematic review and meta-analysis.

Purpose: Kneeling ability is among the poorest outcomes following total knee arthroplasty (TKA). The purpose of this meta-analysis was to: (1) quantify kneeling ability after TKA; (2) identify surgical approaches and prosthesis designs that improve kneeling ability following TKA; and (3) quantify the effectiveness of these approaches.

Methods: We performed a systematic review in accordance with the PRISMA guidelines of multiple medical databases.

Patient gender does not influence referral to an orthopaedic surgeon by advanced practice orthopaedic providers: a prospective observational study in Canada.

Background: The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider.

Prevalence of Persistent Pain of the Neuropathic Subtype after Total Hip or Knee Arthroplasty.

This study aimed to (1) estimate the point prevalence of persistent postoperative pain (PPP) identified using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) after unilateral primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from a registry of total joint arthroplasty (TJA) patients in Ontario, (2) estimate the effect of PPP on function, (3) estimate the prevalence of neuropathic pain (NP) features among patients with persistent pain, (4) determine participant characteristics in order to estimate the potential predictors of NP classification among individuals with persistent pain after TJA, (5) estimate the extent to which the estimates of prevalence depended on the measure used (i.e., S-LANSS vs.

Medical Cannabis for Chronic Noncancer Pain: A Systematic Review of Health Care Recommendations.

Purpose: Medical cannabis for patients with chronic noncancer pain (CNCP) has been the focus of numerous health care recommendations. We conducted a systematic review to identify and summarize the currently available evidence-based recommendations.

Methods: We searched MEDLINE, EMBASE, PsycINFO, the Cochrane database of systematic reviews, and websites for clinical guidelines and recommendations.

Ten years on: increased metal ion levels in a cohort of patients who underwent uncemented metal-on-polyethylene total hip arthroplasty.

Aims: We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice.

Methods: Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed.

Extensor mechanism reconstruction "Tubeplasty" in total knee arthroplasty with previous patellectomy: Surgical technique and clinical outcomes.

Purpose: to evaluate our consecutive series of tubeplasty and extensor mechanism reconstruction during knee arthroplasty in patients with previous patellectomy.

Methods: we describe our surgical technique and present a retrospective consecutive series of 4 patients with a minimum 6 months follow-up. Knee society score (KSS), clinical and radiographic outcomes were collected at final follow up.

Retrospective multicentre matched cohort study comparing safety and efficacy outcomes of intermittent-infusion versus continuous-infusion vancomycin.

Background: Patients with good renal function receiving intermittent-infusion vancomycin (IIV) may require total daily doses ≥4 g to achieve trough concentrations of 15-20 mg/L, increasing the risk of vancomycin-associated nephrotoxicity. Continuous-infusion vancomycin (CIV) may be associated with a lower risk of vancomycin-associated nephrotoxicity compared with IIV, but studies comparing safety of both dosing strategies are lacking.

Objectives: To compare the risk of nephrotoxicity with CIV versus IIV when target concentration ranges were the same with both dosing modalities.

Lithium for Fracture Treatment (LiFT): a double-blind randomised control trial protocol.

Introduction: Fracture healing can fail in up to 10% of cases despite appropriate treatment. While lithium has been the standard treatment for bipolar disorder, it may also have a significant impact to increase bone healing in patients with long bone fractures. To translate this knowledge into clinical practice, a randomised clinical trial (RCT) is proposed.

myHip&Knee: Improving Patient Engagement and Self-Management Through Mobile Technology.

Given the increasing volume of hip and knee replacement surgery with reduced hospital stays and resources, we explored technology to address gaps in patient care and enhance self-management. The team at the Holland Orthopaedic and Arthritic Centre of Sunnybrook Health Sciences Centre, which performs a high volume of joint replacement surgery, partnered with patients and a health technology company to create a mobile app: myHip&Knee. The results to date demonstrate that the app improves patient experience and reduces follow-up calls to surgeons' offices, ultimately reducing demand on healthcare resources.

Outcomes for cemented dual mobility cup to treat recurrent instability; A UK case series.

Objectives: Recurrent dislocation of Total Hip Replacement (THR) is often multifactorial and remains a significant surgical challenge with a significant risk of further instability. Dual Mobility Cups (DMC) have been used widely with good long term results in France with few studies in the British literature, especially assessing their use for recurrent instability. We set out to assess whether recurrent instability can be successfully treated solely with revision of acetabular component to a dual mobility cup.

Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work.

Objectives: The objectives of this study were to (1) examine the overall recovery and satisfaction following an expedited rotator cuff (RC) decompression or repair at 3-6 months and (2) explore group differences (repair vs. decompression) in demographics, clinical, disability, and psychosocial factors.

Methods: This was a prospective longitudinal study of injured workers whose surgery was expedited.

Short-term Outcomes of Arthroscopic Debridement and Selected Acromioplasty of Bursal- vs Articular-Sided Partial-Thickness Rotator Cuff Tears of Less Than 50.

Background: While it is believed that good results can be achieved by arthroscopic debridement of partial-thickness tears (PTTs) of <50% tendon thickness, few studies have directly compared the treatment of articular- versus bursal-sided PTTs of <50%.

Purpose: To compare the postoperative outcomes of patients with articular- versus bursal-sided PTTs of <50% tendon thickness that were treated with arthroscopic debridement and selective acromioplasty (for type II or III acromions).

Study Design: Cohort study; Level of evidence, 3.

Abnormal Pain Response After a Compensable Shoulder Injury.

Background: The role of psychosocial factors has been established in patients with shoulder abnormalities. However, the prevalence of exaggerated pain behaviors and their association with the characteristics of injured workers have not been well studied.

Purpose: To examine the prevalence of abnormal pain responses (APRs) in workers with active workers' compensation claims for a shoulder injury and to examine the differences between workers with APRs versus workers without APRs.

Evaluation of an advanced-practice physiotherapist in triaging patients with lumbar spine pain: surgeon-physiotherapist level of agreement and patient satisfaction.

Background: Surgery for lumbar spine pain is indicated for specific etiologies. Given the majority of individuals referred to spine surgeons are not surgical candidates, care delivery is inefficient, with consultations being of limited value for most. Using specially trained physiotherapists in triage is a human resource strategy that may optimize surgeons' time and the patient experience.

The coach program - a "joint" approach to patient education and support.

Hospital lengths of stay for orthopaedic procedures are declining internationally. Discharge home from hospital following total joint replacement surgery can be stressful due to pain and physical restrictions. Thus, many patients report experiencing increased anxiety and feeling a sudden withdrawal of support from their medical team.

Association between Neuropathic Pain and Reported Disability after Total Knee Arthroplasty.

Purpose: To determine whether reporting neuropathic pain (NP) at an average of 5 years after total knee arthroplasty (TKA) was related to patient age, sex, preoperative comorbidity, arthritis self-efficacy, or disability before surgery and at 1 year after surgery. The estimate of NP prevalence and cross-sectional group differences were explored at 5 years after surgery.

Methods: A subsample of participants in a formal research study was contacted via mail approximately 5 years after undergoing surgery and were sent four questionnaires: the Western Ontario and McMaster Universities Osteoarthritis Index, the Patient Health Questionnaire, the Self-Administered Leeds Assessment of Neuropathic Signs and Symptoms (S-LANSS), and a satisfaction questionnaire.

Current Controversies of Alignment in Total Knee Replacements.

Total knee replacement is an increasingly popular operation for end stage knee arthritis. In the majority it alleviates pain and improves function. However up to 20% of patients remain dissatisfied, even with well-aligned and secure implants.

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Background: Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation.

Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy.

Background: There is limited information on the validity of magnetic resonance imaging (MRI) in detection of biceps disease. The purpose of this study was to examine the measurement properties of noncontrasted MRI in diagnosis of biceps disease using arthroscopic surgery as the "gold standard."

Materials And Methods: Prospectively collected surgical data of patients with impingement syndrome or rotator cuff tear, with biceps disease (study group) or without biceps disease (control group), were reviewed.