Global practice variation of suppressive antimicrobial treatment for prosthetic joint infections: A cross-sectional survey study.

Objectives: To identify global differences in the use of suppressive antimicrobial therapy (SAT) in the management of prosthetic joint infection (PJI).

Methods: An online survey was designed to investigate clinician's approach to SAT for PJI, including indications, preferred antimicrobial drugs, dosing, treatment duration and follow-up. The survey was distributed to members of four international (bone and joint) infection societies and study groups.

Estimation of two-year hospital costs of hip and knee periprosthetic joint infection treatments using activity-based costing.

Aims: Our aim was to estimate the total costs of all hospitalizations for treating periprosthetic joint infection (PJI) by main management strategy within 24 months post-diagnosis using activity-based costing. Additionally, we investigated the influence of individual PJI treatment pathways on hospital costs within the first 24 months.

Methods: Using admission and procedure data from a prospective observational cohort in Australia and New Zealand, Australian Refined Diagnosis Related Groups were assigned to each admitted patient episode of care for activity-based costing estimates of 273 hip PJI patients and 377 knee PJI patients.

Access to shoulder arthroplasty in Australia: A balance of regulation, surveillance, and monitored efficacy to maximize patient outcome and optimum care.

Prosthetic arthroplasty has emerged as a major contributor to the management of shoulder disorders. This paper outlines the situation in Australia regarding the process by which shoulder replacement devices are made available. Although entry of joint replacement devices to the Australian market is relatively unrestricted, they must be first approved by the Therapeutic Goods Administration-based on safety and efficacy-to be legally used.

What is the Long-term Wear of a 5-Mrad Highly Crosslinked Polyethylene Liner? A 14-year RSA Study.

Background: Lower doses of irradiation (≤ 5 Mrad) during the manufacture of highly crosslinked polyethylene acetabular liners may result in less crosslinking and an increased wear rate. Radiostereometric analysis (RSA) studies have found that wear of more highly irradiated highly crosslinked polyethylene liners (7 to 10 Mrad) decreases at longer-term follow-up compared with earlier reports of the same cohorts. Although wear of 5-Mrad irradiated liners appears to increase at midterm follow-up, it is unclear whether that remains true at longer follow-up.

Large articulations do not increase wear rates of thin second-generation highly cross-linked polyethylene liners at ten years.

Aims: Radiostereometric analysis (RSA) is the most accurate radiological method to measure in vivo wear of highly cross-linked polyethylene (XLPE) acetabular components. We have previously reported very low wear rates for a sequentially irradiated and annealed X3 XLPE liner (Stryker Orthopaedics, USA) when used in conjunction with a 32 mm femoral heads at ten-year follow-up. Only two studies have reported the long-term wear rate of X3 liners used in conjunction with larger heads using plain radiographs which have poor sensitivity.

The International Initiative to Measure Perceived Risk in Arthroplasty: The Results From a Multinational Survey.

Background: There is an inherent moral imperative to avoid complications from arthroplasty. Doing so at ideal cost is also associated with surgeon reputation, and, increasingly in health care delivery systems that measure and competitively score outcomes, reimbursement to the surgeons and their hospitals. As a result, patients who are perceived to be in higher risk comorbidity groups, such as the obese and diabetics, as well as those challenged by socioeconomic factors may face barriers to access elective arthroplasty.

Perception of Perioperative Risk for Arthroplasty Patients: A Poll of Australian Orthopedic Surgeons.

Background: There is growing interest in the perioperative management of patients who have indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, poorly controlled diabetes, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients who have modifiable risk factors.

Insights and trends review: the role of three-dimensional technology in upper extremity surgery.

The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy.

A senescence stress secretome is a hallmark of therapy-related myeloid neoplasm stromal tissue occurring soon after cytotoxic exposure.

Therapy-related myeloid neoplasm (tMN) is considered a direct consequence of DNA damage in hematopoietic stem cells. Despite increasing recognition that altered stroma can also drive leukemogenesis, the functional biology of the tMN microenvironment remains unknown. We performed multiomic (transcriptome, DNA damage response, cytokine secretome and functional profiling) characterization of bone marrow stromal cells from tMN patients.

Outcomes analysis of anterior and lateral approach for open repair of hip abductor tendons.

Background: Gluteal tendons tears are increasingly being recognised as a cause of recalcitrant trochanteric pain, but there is a paucity of robust studies analysing the type of tears, results and predictors of outcome.

Methods: Patients with gluteal tendon tears resistant to conservative treatment who underwent isolated open repair (IR) or total hip arthroplasty and concomitant repair (THA+repair) with a minimum 1-year follow-up were retrospectively assessed separately. Type of tear, surgical approach, and fixation methods were registered.

Total shoulder replacement stems in osteoarthritis-short, long, or reverse? An analysis of the impact of crosslinked polyethylene.

Background: The 2021 Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) report indicated that total shoulder replacement using both midhead (TMH) length humeral components and reverse arthroplasty (RTSA) had a lower revision rate than stemmed humeral components in anatomic total shoulder arthroplasty (aTSA)-for all prosthesis types and diagnoses. However, there are many factors that affect the outcome of total shoulder replacement, including stem length and polarity, polyethylene type, and glenoid fixation (cemented vs. cementless).

Predictors of Treatment Success After Periprosthetic Joint Infection: 24-Month Follow up From a Multicenter Prospective Observational Cohort Study of 653 Patients.

Background: Periprosthetic joint infection (PJI) is a devastating condition and there is a lack of evidence to guide its management. We hypothesized that treatment success is independently associated with modifiable variables in surgical and antibiotic management.

Methods: The is a prospective, observational study at 27 hospitals across Australia and New Zealand.

Lisfranc Sprain with Second Metatarsal Base Adaptive Stress Response in High-Level Athletes: Case Series and Novel Perspective on a Distinct Entity of Chronic Low-Energy Lisfranc Injury.

Lisfranc injury is increasingly being recognised in the high-performance athletic cohort, particularly in contact sports. In this cohort, there is a pattern of low-energy Lisfranc injury which combines magnetic resonance findings of both ligamentous sprain and adaptive bone stress response that infers a longer timeframe of stress than the duration of symptoms would suggest. This has not been previously described, and the authors believe that this is an unrecognized subset of midfoot sprain in the context of sustained stress to the midfoot.

Primary Total Knee Arthroplasty Revised for Instability: A Detailed Registry Analysis.

Background: Instability after total knee arthroplasty is a common but poorly understood complication.

Methods: Data from a large national registry was used to study patient and prosthesis characteristics of 2605 total knee arthroplasty revisions for instability. The cumulative percent revision was calculated using Kaplan-Meier estimates, and Cox proportional models used to compare revision rates.

Medial soft-tissue complex of the knee: Current concepts, controversies, and future directions of the forgotten unit.

The medial side of the knee is comprised of ligaments, myotendinous and meniscal structures that work as a unit to stabilize the joint. The superficial medial collateral ligament is its core structure. Still, all elements of the medial side have load-sharing relationships, leading to a cascade of events in the scenario of insufficiency of any of them.

Highly Crosslinked Polyethylene Liners Have Negligible Wear at 10 Years: A Radiostereometric Analysis Study.

Background: The introduction of crosslinked ultra-high molecular weight polyethylene (XLPE) acetabular liners has been very successful, with decreased wear and reduction in the rates of revision hip arthroplasties. XLPE is the preferred articulation for most surgeons; however, there are concerns about the long-term performance of XLPE liners created with different manufacturing processes, which may lead to time-dependent failure, including accelerated wear, after several years.

Questions/purposes: (1) What is the amount and rate of wear during the first 10 years using radiostereometric analysis (RSA) measurements of patients who had THAs that included a second-generation XLPE bearing? (2) Does the rate of wear change after 5 years in situ?

Methods: This is a brief follow-up of a previous RSA study.

Low percentage of surgeons meet the minimum recommended unicompartmental knee arthroplasty usage thresholds: Analysis of 3037 Surgeons from Three National Joint Registries.

Purpose: The reported usage of UKA is around 10% in the UK, Australian and New Zealand joint registries. However, some authors recommend that a higher UKA usage of 20%, or a minimum 12 UKA cases per year, would reduce revision rates. The purpose of this study was to analyze the percentage of surgeons performing the recommended thresholds in these 3 registries.

Acetabular screws do not improve early revision rates in primary total hip arthroplasty. An instrumented registry analysis.

Background: Initial stability of uncemented acetabular components in total hip arthroplasty (THA) is important for osseointegration and potentially enhanced by screw fixation. We used Australian Orthopaedic Association National Joint Replacement Registry data to determine whether screw usage influences uncemented acetabular component survival.

Methods: Primary THA with uncemented acetabular components performed for osteoarthritis from 1999 to 2018 was included.

A rare case of isolated traumatic avulsion of the pes anserinus tendon.

Complete rupture of the conjoint pes anserinus tendon is rare, and isolated rupture without injury to associated structures has not been previously reported in the literature. A case of complete isolated rupture of the pes anserinus tendon is described in a young, healthy male. The non-specific nature of the presentation and rarity of the condition makes diagnosis from history and examination alone challenging.

Does Knee Prosthesis Survivorship Improve When Implant Designs Change? Findings from the Australian Orthopaedic Association National Joint Replacement Registry.

Background: TKA generally has excellent long-term survivorship. When a new knee system supersedes a previous model, increased survivorship, improved functional performance, or both may be expected, because key areas of design modification are often targeted to address wear, stability, and the patellofemoral articulation. However, not all design changes are beneficial, and to our knowledge, knee arthroplasty has not been systematically evaluated in the context of design changes that occur during the development of new knee arthroplasty systems.

Porous metal wedge augments to address glenoid retroversion in anatomic shoulder arthroplasty: midterm update.

Background: Wedge-shaped porous metal augments were used to address bone deficiency in shoulder arthroplasty as part of a hybrid combination of high-density polyethylene, polymethyl methacrylate bone cement, and porous metal implant. This article presents an ongoing review of the use of the generically designed augments in the shoulder to address glenoid retroversion as part of anatomic total shoulder arthroplasty (aTSA).

Materials: Seventy-five shoulders in 66 patients (23 women and 43 men, aged 42-85 years) with Walch grade B2 or C glenoids underwent porous metal glenoid augment (PMGA) insertion as part of aTSA.

Catastrophic failure of biconcave unicompartmental polyethylene bearings.

Background: A biconcave polyethylene (PE) bearing was developed for mobile-bearing unicompartmental knee arthroplasties (UKA) to reduce PE dislocation.

Methods: A modification of the BalanSys Unicompartmental knee system with a biconcave PE and convex tibial component was used in 32 prostheses in 28 patients. Clinical outcomes and five cases of PE fracture are reported and extensively analyzed ex vivo.