Prior investigations have suggested that physician-related factors may contribute to differential use of TKA among women and ethnic minorities. We sought to evaluate the effect of surgeon bias on recommendations for TKA.
The John Charnley Award: Highly Crosslinked Polyethylene in Total Hip Arthroplasty Decreases Long-term Wear: A Double-blind Randomized Trial
The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use.
The 2014 Frank Stinchfield Award: The ‘Landing Zone’ for Wear and Stability in Total Hip Arthroplasty Is Smaller Than We Thought: A Computational Analysis
Positioning of total hip bearings involves tradeoffs, because cup orientations most favorable in terms of stability are not necessarily ideal in terms of reduction of contact stress and wear potential. Previous studies and models have not addressed these potentially competing considerations for optimal total hip arthroplasty (THA) function.
The Otto Aufranc Award: Modifiable versus Nonmodifiable Risk Factors for Infection After Hip Arthroplasty
Periprosthetic joint infections (PJIs) are associated with increased morbidity and cost. It would be important to identify any modifiable patient- and surgical-related factors that could be modified before surgery to decrease the risk of PJI.
Highly crosslinked polyethylene (XLPE) is believed to demonstrate better wear resistance than conventional polyethylene (CPE) in total hip arthroplasty.
A relatively high percentage of monoblock metal-on-metal total hip arthroplasties (THAs) undergo early revision. Revision of these THAs poses challenges unique to this implant type. The early complications after these revisions remain unreported as do the clinical and demographic factors associated with these complications.
What Are the Predictors and Prevalence of Pseudotumor and Elevated Metal Ions After Large-diameter Metal-on-metal THA?
Soft tissue masses, or “pseudotumors,” around metal-on-metal total hip arthroplasty (MoM THA) have been reported frequently; however, their prevalence remains unknown. Several risk factors, including elevated metal ion levels, have been associated with the presence of pseudotumor, although this remains controversial.
There is a general perception that adverse local tissue reactions in metal-on-metal hip arthroplasties are caused by wear, but the degree to which this is the case remains controversial.
Do Serologic and Synovial Tests Help Diagnose Infection in Revision Hip Arthroplasty With Metal-on-metal Bearings or Corrosion?
The diagnosis of periprosthetic joint infection (PJI) in patients with failed metal-on-metal (MoM) bearings and corrosion reactions in hip arthroplasties can be particularly difficult, because the clinical presentation of adverse local tissue reactions may mimic that of PJI, because it can also occur concurrently with PJI, and because common laboratory tests used to diagnose PJI may be elevated in patients with MoM THAs.
Use of large-diameter metal-on-metal (MoM) articulations in THA increased, at least in part, because of the possibility of achieving improved joint stability and excellent wear characteristics in vitro. However, there have been subsequent concerning reports with adverse reactions to metal debris (ARMD), pseudotumors, and systemic complications related to metal ions.
Continued Good Results With Modular Trabecular Metal Augments for Acetabular Defects in Hip Arthroplasty at 7 to 11 Years
Reconstruction of large acetabular defects remains a substantial challenge in hip arthroplasty. There remains a paucity of data on the long-term results of acetabular trabecular metal augments.
Although the introduction of ultraporous metals in the forms of acetabular components and augments has increased the orthopaedic surgeon’s ability to reconstruct severely compromised acetabuli, there remain some that cannot be managed readily using cups, augments, or cages. In such situations, allograft-prosthetic composites or custom acetabular components may be called for. However, few studies have reported on the results of these components.
Porous Metal Acetabular Components Have a Low Rate of Mechanical Failure in THA After Operatively Treated Acetabular Fracture
Total hip arthroplasty (THA) for the treatment of posttraumatic osteoarthritis (OA) after acetabular fracture has been associated with a high likelihood of aseptic loosening, instability, and infection. Porous metal components may help to address the issue of loosening, but there are few data on the use of porous metal acetabular components for posttraumatic OA after acetabular fracture.
Uncemented stems have been used in THA for well over two decades, but there are relatively few studies reporting on the results after 20 years.
Femoral revision using fully coated femoral components offers distinct advantages in patients with notable bone loss. With the increasing concerns being raised about the problems of stem modularity, the results and complications of revision arthroplasty using devices with limited modularity are important.
Modular Tapered Implants for Severe Femoral Bone Loss in THA: Reliable Osseointegration but Frequent Complications
Modular tapered stems have been suggested as the optimal implants for patients with severe femoral bone loss (Paprosky Type IIIB and IV) undergoing revision total hip arthroplasty (THA); however, there are few data describing survivorship and hip scores associated with this treatment.
Systematic Review of Literature of Cemented Femoral Components: What Is the Durability at Minimum 20 Years Followup?
Cemented femoral total hip arthroplasty may be one of the most successful surgical interventions of all time. However, although results are very encouraging over the early to mid-term followup, relatively few studies have analyzed the durability of these implants beyond 20 years followup. To evaluate the performance of contemporary implants, it is important to understand how previous implants perform at 20 or more years of followup; one way to do this is to aggregate the available data in the form of a systematic review.
To determine the importance of MRI abnormalities in metal-on-metal (MoM) bearings, it is important to understand the baseline features of this diagnostic tool in conventional metal-on-polyethylene (MoP) bearings.
Does HIV Infection Increase the Risk of Perioperative Complications After THA? A Nationwide Database Study
Recent studies have shown successful midterm outcomes after total hip arthroplasty (THA) in patients with human immunodeficiency virus (HIV). However, little data exist on the epidemiology, risk of perioperative complications, and length of stay in patients with HIV receiving THA.
Preoperative Erythropoietin Alpha Reduces Postoperative Transfusions in THA and TKA but May Not Be Cost-effective
Preoperative erythropoietin alpha (EPO) has been shown to be effective at reducing postoperative blood transfusions in total hip arthroplasty (THA) and total knee arthroplasty (TKA); however, treatment with EPO is associated with additional costs, and it is not known whether these costs can be justified when weighed against the transfusion reductions achieved in patients who receive the drug.
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). The RAPT was developed and tested on a population of Australian patients undergoing joint replacement, but its validity in other populations is unknown. A low RAPT score is reported to indicate a high risk of needing any form of inpatient rehabilitation after TJA, including short-term nursing facilities.
Femoroacetabular Impingement Negates the Acetabular Labral Seal During Pivoting Maneuvers but Not Gait
Experimental disruption of the labrum has been shown to compromise its sealing function and alter cartilage lubrication. However, it is not known whether pathological changes to the labrum secondary to femoroacetabular impingement (FAI) have a similar impact on labral function.
Preservation of the Rectus Femoris Origin During Periacetabular Osteotomy Does Not Compromise Acetabular Reorientation
The early recovery period after periacetabular osteotomy (PAO) can be limited by pain and activity restrictions. Modifications of the Bernese PAO, including sparing the rectus tendon and discontinuing routine arthrotomy, may accelerate early postoperative recovery compared with the standard approach.
What Factors Predict Improvements in Outcomes Scores and Reoperations After the Bernese Periacetabular Osteotomy?
The Bernese periacetabular osteotomy (PAO) has entered its fourth decade and is frequently used for corrective osteotomy in patients with acetabular dysplasia. Although our capacity to preserve the joint after corrective osteotomy is excellent, gaining a better understanding on how well patients function after this surgery is important as well.
Direct Anterior versus Miniposterior THA With the Same Advanced Perioperative Protocols: Surprising Early Clinical Results
Although some surgeons strongly advocate for one approach over the other, there are few data directly comparing the direct anterior approach with a miniposterior approach for total hip arthroplasty (THA).
Do Sex and BMI Predict or Does Stem Design Prevent Muscle Damage in Anterior Supine Minimally Invasive THA?
Cadaveric and clinical studies have suggested that, despite being touted as muscle-sparing, the direct anterior approach is still associated with muscle damage, particularly to the tensor fascia lata (TFL). Patient body mass index (BMI) and/or sex may also influence this parameter.
Validation of Porcine Knee as a Sex-specific Model to Study Human Anterior Cruciate Ligament Disorders
Animal models have long been considered an important modality for studying ACL injuries. However, to our knowledge, the value of these preclinical models to study sex-related phenomena associated with ACL injury and recovery has not been evaluated.
Conversion of Stemmed Hemi- or Total to Reverse Total Shoulder Arthroplasty: Advantages of a Modular Stem Design
If revision of a failed anatomic hemiarthroplasty or total shoulder arthroplasty is uncertain to preserve or restore satisfactory rotator cuff function, conversion to a reverse total shoulder arthroplasty has become the preferred treatment, at least for elderly patients. However, revision of a well-fixed humeral stem has the potential risk of loss of humeral bone stock, nerve injury, periprosthetic fracture, and malunion or nonunion of a humeral osteotomy with later humeral component loosening.
Preoperative Deltoid Size and Fatty Infiltration of the Deltoid and Rotator Cuff Correlate to Outcomes After Reverse Total Shoulder Arthroplasty
Reverse total shoulder arthroplasty (RTSA) allows the deltoid to substitute for the nonfunctioning rotator cuff. To date, it is unknown whether preoperative deltoid and rotator cuff parameters correlate with clinical outcomes.
Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty
Shoulder arthroplasty provides reliable pain relief and restoration of function. However, the effects of fatty infiltration and atrophy in the supraspinatus and infraspinatus muscles on functional outcomes are not well understood.
Some patients opt to undergo conversion to a THA for continued pain or progression of hip arthritis after periacetabular osteotomy. Whether patients are at greater risk for postoperative complications, revision THA, poor clinical outcomes, or compromised radiographic results after periacetabular osteotomy is debatable.
There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions.
Is Intralesional Treatment of Giant Cell Tumor of the Distal Radius Comparable to Resection With Respect to Local Control and Functional Outcome?
A giant cell tumor is a benign locally aggressive tumor commonly seen in the distal radius with reported recurrence rates higher than tumors at other sites. The dilemma for the treating surgeon is deciding whether intralesional treatment is adequate compared with resection of the primary tumor for oncologic and functional outcomes. More information would be helpful to guide shared decision-making.
Do Previsit Expectations Correlate With Satisfaction of New Patients Presenting for Evaluation With an Orthopaedic Surgical Practice?
Patient satisfaction is associated with increased compliance, improved treatment outcomes, and decreased risk of litigation. Factors such as patient understanding and psychological well-being are recognized influences on satisfaction. Less is known about the relationship between previsit expectations and satisfaction.
Postural Orthostatic Tachycardia Syndrome (POTS): Association with Ehlers-Danlos Syndrome and Orthopaedic Considerations
Postural orthostatic tachycardia syndrome (POTS) is the most common of several types of dysautonomia, characterized by dysfunction of the autonomic nervous system manifesting with symptoms of orthostatic intolerance with or without associated orthostatic hypotension and excessive autonomic excitation. Given the numerous presenting musculoskeletal symptoms of POTS and its known associations with other clinical entities like Ehlers-Danlos syndrome, POTS constitutes an unusual treatment challenge of which the orthopaedic surgeon and other related healthcare providers should be aware.
Publication of a manuscript does not end an author’s responsibilities. Reasons to contact an author after publication include clarification, access to raw data, and collaboration. However, legitimate questions have been raised regarding whether these responsibilities generally are being met by corresponding authors of biomedical publications.
Locally Aggressive Fibrous Dysplasia Mimicking Malignancy: A Report of Four Cases and Review of the Literature
Fibrous dysplasia is a benign fibroosseous bone tumor that accounts for 5% to 10% of benign bone tumors. It can present as monostotic fibrous dysplasia (70% to 80%), polyostotic fibrous dysplasia (20% to 30%), McCune-Albright syndrome (2% to 3%), or Mazabraud’s syndrome in rare cases. Bone lesions in fibrous dysplasia arise in the medullary canal and usually are confined to the bone. Cortical destruction and extension into soft tissue usually indicates malignant transformation or secondary aneurysmal bone cyst formation. Locally aggressive fibrous dysplasia with cortical destruction and extension into soft tissue in the absence of these two possibilities is extremely rare. It is important for the treating physician to distinguish this entity from more aggressive or malignant tumors to avoid overtreating the patient for a benign condition or inattention to a malignant tumor.