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The Problem With Fragile Results
C.A. Krueger,M.A. Mont,D.J. Backstein,J.B. Mason,M.J. Taunton,J.J. Callaghan
doi : 10.1016/j.arth.2021.04.018
EDITORIAL| VOLUME 36, ISSUE 6, P1847-1848, JUNE 01, 2021
Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project—Phase II Outcomes
Cody C. Wyles,Matthew P. Abdel,Adam W. Amundson,Michael J. Taunton,Kevin I. Perry,Hugh M. Smith
doi : 10.1016/j.arth.2020.12.054
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 6, P1849-1856, JUNE 01, 2021
Our institution previously initiated a perioperative surgical home initiative to improve quality and efficiency across the hospital arc of care of primary total knee arthroplasty and total hip arthroplasty patients. Phase II of this project aimed to (1) expand the perioperative surgical home to include revision total hip arthroplasties and total knee arthroplasties, hip preservation procedures, and reconstructions after oncologic resections; (2) expand the project to include the preoperative phase; and (3) further refine the perioperative surgical home goals accomplished in phase I.
Minimizing Surgical Instrument Burden Increases Operating Room Efficiency and Reduces Perioperative Costs in Total Joint Arthroplasty
Jess H. Lonner,Graham S. Goh,Kathryn Sommer,...Eric A. Levicoff,Joseph V. Vernace,Robert P. Good
doi : 10.1016/j.arth.2021.01.041
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 6, P1857-1863, JUNE 01, 2021
Optimizing surgical trays to improve operating room efficiency and reduce costs in instrument processing is an under-appreciated strategy for cost containment. This study aimed to assess the economic impact of instrument tray optimization in total joint arthroplasty.
Total Hip and Knee Arthroplasties Are Highly Cost-Effective Procedures: The Importance of Duration of Follow-Up
Ross A. Wilson,David P. Gwynne-Jones,Trudy A. Sullivan,J. Haxby Abbott
doi : 10.1016/j.arth.2021.01.038
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 6, P1864-1872.E10, JUNE 01, 2021
Total hip and knee arthroplasties (THA/TKA) are clinically effective but high cost procedures. The aim of this study is to perform a cost-effectiveness analysis of THA and TKA in the New Zealand (NZ) healthcare system.
Which Socioeconomic Factors Affect Outcomes Following Total Hip and Knee Arthroplasty?
Emanuele Chisari,Michael Yayac,Matthew Sherman,Elie Kozaily,P. Maxwell Courtney
doi : 10.1016/j.arth.2021.01.077
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 6, P1873-1878, JUNE 01, 2021
Studies have shown that lower socioeconomic status may result in adverse outcomes following total hip (THA) and total knee arthroplasty (TKA). The optimal method of defining socioeconomic status, however, continues to be debated. The purpose of this study is to determine which socioeconomic variables are associated with poor outcomes following THA and TKA.
Modified Kerboul Angle Predicts Outcome of Core Decompression With or Without Additional Cell Therapy
Krit Boontanapibul,James I. Huddleston III,Derek F. Amanatullah,William J. Maloney,Stuart B. Goodman
doi : 10.1016/j.arth.2021.01.075
JOINT PRESERVATION & NON ARTHROPLASTY| VOLUME 36, ISSUE 6, P1879-1886, JUNE 01, 2021
Core decompression is the most common procedure for early-stage osteonecrosis of the femoral head (ONFH). This study investigated outcomes of core decompression with/without bone marrow aspirate concentrate (BMAC), based on the Kerboul combined necrotic angles using magnetic resonance imaging.
Online Crowdsourcing to Explore Public Perceptions of Robotic-Assisted Orthopedic Surgery
Nicholas R. Pagani,Michael A. Moverman,Richard N. Puzzitiello,Mariano E. Menendez,C. Lowry Barnes,Joseph J. Kavolus
doi : 10.1016/j.arth.2021.02.027
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 6, P1887-1894.E3, JUNE 01, 2021
The clinical benefits of robotic-assisted technology in total joint arthroplasty are unclear, but its use is increasing. This study employed online crowdsourcing to explore public perceptions and beliefs regarding robotic-assisted orthopedic surgery.
Frailty, Race/Ethnicity, Functional Status, and Adverse Outcomes After Total Hip/Knee Arthroplasty: A Moderation Analysis
Charlie Dharmasukrit,Sut Yee Shirley Chan,Richard L. Applegate II,Daniel J. Tancredi,Theresa A. Harvath,Jill G. Joseph
doi : 10.1016/j.arth.2021.01.033
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 6, P1895-1903, JUNE 01, 2021
Although frailty has been shown to be associated with adverse outcomes in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), prior studies have not examined how race/ethnicity might moderate these associations. We aimed to assess race/ethnicity as a potential moderator of the associations of frailty and functional status with arthroplasty outcomes.
Pre-Operative Urodynamic Assessment Has Poor Predictive Value for Developing Post-Operative Urinary Retention
Robert Pivec,C. Baylor Wickes,Matthew S. Austin
doi : 10.1016/j.arth.2021.01.056
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 6, P1904-1907, JUNE 01, 2021
Post-operative urinary retention (POUR) following primary total joint arthroplasty (TJA) has a reported prevalence up to 35%. Risk factors for POUR have included surrogate markers such as the presence or absence of urologic disease. Pre-operative dynamic measurement with post-void residual volumes (PVR) has not been investigated as a tool for assessing POUR risk.
Postoperative Outcomes Following Total Hip and Knee Arthroplasty in Patients with Pain Catastrophizing, Anxiety, or Depression
Thomas J. Wood,Aaron M. Gazendam,Conrad B. KabaliHamilton Arthroplasty Group
doi : 10.1016/j.arth.2021.02.018
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 6, P1908-1914, JUNE 01, 2021
The relationship among pain catastrophizing, emotional disorders, and total joint arthroplasty (TJA) outcomes is an emerging area of study. The purpose of this study is to examine the association of these factors with 1-year postoperative pain and functional outcomes.
Early Emergency Department Visits Following Primary Hip and Knee Arthroplasty
Scott A. Muffly,Qiang An,Nicholas A. Bedard,Timothy S. Brown,Jesse E. Otero
doi : 10.1016/j.arth.2021.01.058
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 6, P1915-1920, JUNE 01, 2021
Postoperative emergency department (ED) utilization remains an understudied aspect of total joint arthroplasty (TJA). The purpose of this study is to characterize 30-day ED visits following TJA.
Risk of Gastrointestinal Bleeding With Extended Use of Nonsteroidal Anti-Inflammatory Drug Analgesia After Joint Arthroplasty
Andrew N. Fleischman,William T. Li,Andrew J. Luzzi,Eric S. Schwenk,William A. Arnold,Javad Parvizi
doi : 10.1016/j.arth.2021.02.015
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 6, P1921-1925.E1, JUNE 01, 2021
Chronic nonsteroidal anti-inflammatory drug (NSAID) use is associated with gastrointestinal bleeding via inhibition of endogenous mucosal protection and platelet aggregation. This study aimed to determine whether extended NSAIDs after joint arthroplasty is associated with increased risk of gastrointestinal bleeding.
A Case-Control Comparison of Single-Stage Bilateral vs Unilateral Medial Unicompartmental Knee Arthroplasty
Arnaud Clavé,Fabien Ros,Hoël Letissier,Xavier Flecher,Jean-Noël Argenson,Frédéric Dubrana
doi : 10.1016/j.arth.2021.01.030
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1926-1932, JUNE 01, 2021
We aimed to compare postoperative pain, functional recovery, and patient satisfaction among patients receiving one-stage medial bilateral or medial unilateral UKA (unicompartmental knee arthroplasty). Our main hypothesis was that during the first 72 postoperative hours, patients who underwent medial bilateral UKA did not consume more analgesics than those who underwent medial unilateral UKA.
TKA is More Durable Than UKA for Morbidly Obese Patients: A Two-Year Minimum Follow-Up Study
R. Tyler Ellis,John F. Nettrour,James A. Keeney
doi : 10.1016/j.arth.2020.12.039
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1933-1941, JUNE 01, 2021
Unicompartmental knee arthroplasty (UKA) indications have expanded during the past two decades to include some morbidly obese patients (body mass index (BMI) > 40 kg/m2). Few published studies have compared UKA and total knee arthroplasty (TKA) in this unique patient subgroup with conflicting observations.
Can Met Expectations Moderate the Relationship Between Pain/Function and Satisfaction in Total Knee Arthroplasty?
Joseph S. Munn,Sharon E. Culliton,Dianne M. Bryant,Steven J. MacDonald,Bert M. Chesworth
doi : 10.1016/j.arth.2021.01.028
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1942-1946, JUNE 01, 2021
Approximately 20% of patients are dissatisfied with their total knee arthroplasty (TKA) at 1-year post-surgery. Met expectations have been found by some to significantly predict satisfaction. The role of met expectations in determining patient satisfaction has not been exhaustively explored. The primary aim of this study is to evaluate if met expectations moderate the relationship between pain and function variables and satisfaction.
Typical Pain Patterns in Unhappy Patients After Total Knee Arthroplasty
Dominic T. Mathis,Antonia Hauser,Edna Iordache,Felix Amsler,Michael T. Hirschmann
doi : 10.1016/j.arth.2021.01.040
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1947-1957, JUNE 01, 2021
The primary aim of this study is to assess characteristics of pain in patients with ongoing pain after total knee arthroplasty (TKA). The secondary aim of this study is to identify specific pain patterns and link these to underlying pathologies.
Functional Outcomes and Health-Related Quality of Life Before and After Primary Total Knee Replacement for Patients From Diverse Geographic Regions
Minji K. Lee,James M. Naessens,David T. Eton,Thomas J. O’Byrne,Mark A. Nyman
doi : 10.1016/j.arth.2021.01.043
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1958-1965, JUNE 01, 2021
The purpose of this study was to investigate whether patient-reported knee function and health status before and after primary total knee replacement (TKR) at an academic medical center differs among patients from diverse geographic regions.
Factors Associated With the Risk of Developing Moderate to Severe Acute Postoperative Pain After Primary Total Knee Arthroplasty: Results From the PAIN OUT Registry
Jaume Garc?a-L?pez,Mauricio Polanco-Garc?a,Antonio Montes
doi : 10.1016/j.arth.2021.02.005
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1966-1973, JUNE 01, 2021
Total knee arthroplasty (TKA) is one of the most common procedures in orthopedic surgery and not always matches with patient’s expectations of pain relief and function improvement. The aim of this study was to assess risk factors for developing moderate to severe acute postoperative pain (APOP) after TKA using the PAIN OUT questionnaire.
Change in Body Mass Index after Simultaneous Bilateral Total Knee Arthroplasty: Risk Factors and Its Influence on Functional Outcomes
Yong Zhi Khow,Graham S. Goh,Jerry Yongqiang Chen,Ngai Nung Lo,Seng Jin Yeo,Ming Han Lincoln Liow
doi : 10.1016/j.arth.2021.01.059
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1974-1979, JUNE 01, 2021
Previous studies evaluating weight changes following total knee arthroplasty (TKA) were performed on heterogenous cohorts. However, no study has evaluated weight changes in a cohort of simultaneous-bilateral TKA (SB-TKA) patients. This study aimed to evaluate the prevalence of patients who lost or gained weight, determine if postoperative weight change influences functional outcome, and identify predictors of weight change after SB-TKA.
Adductor Canal Blocks Reduce Inpatient Opioid Consumption While Maintaining Noninferior Pain Control and Functional Outcomes After Total Knee Arthroplasty
James E. Feng,Chibuokem P. Ikwuazom,Uchenna O. Umeh,William Macaulay,William J. Long,Ran Schwarzkopf
doi : 10.1016/j.arth.2021.01.065
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1980-1986, JUNE 01, 2021
The use of perioperative adductor canal blocks (PABs) continues to be a highly debated topic for total knee arthroplasty (TKA). Here, we evaluate the effect of PABs on immediate postoperative subjective pain scores, opioid consumption, and objective functional outcomes.
The Association Between Cement Viscosity and Revision Risk After Primary Total Knee Arthroplasty
Ronald W.B. Wyatt,Richard N. Chang,Kathryn E. Royse,Elizabeth W. Paxton,Robert S. Namba,Heather A. Prentice
doi : 10.1016/j.arth.2021.01.052
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1987-1994, JUNE 01, 2021
Recent case series have reported early failure with the use of high-viscosity cement (HVC) in total knee arthroplasty (TKA). We evaluated revision risk after TKA with HVC compared with medium-viscosity cement (MVC) in a large cohort.
High-Viscosity Versus a Lower-Viscosity Cement Penetration at Dough Phase In Vivo in Primary Total Knee Arthroplasty
Michael G. Rizzo,Anya T. Hall,Justin T. Downing,Raymond P. Robinson
doi : 10.1016/j.arth.2021.02.010
PRIMARY KNEE| VOLUME 36, ISSUE 6, P1995-1999, JUNE 01, 2021
Previous studies have shown that the depth of cement penetration and the presence of radiolucent lines (RLLs) correspond with the risk of aseptic loosening in total knee arthroplasty, while others have found a correlation between the viscosity of the cement and the depth of cement penetration. We compared cement marketed as high-viscosity cement (HVC) with one marketed by the same manufacturer as low-viscosity cement (LVC). We hypothesized that no significant difference would be found in depth of penetration or presence of RLLs between the two cohorts.
Tibial Component Migration After Total Knee Arthroplasty With High-Viscosity Bone Cement
Elise K. Laende,C. Glen Richardson,Alexander R. Meldrum,Michael J. Dunbar
doi : 10.1016/j.arth.2021.01.081
PRIMARY KNEE| VOLUME 36, ISSUE 6, P2000-2005, JUNE 01, 2021
High-viscosity (HV) bone cements have been formulated to offer potentially advantageous handling characteristics. However, alteration in the handling characteristics could influence implant fixation and survival. The primary objective of this study was to use radiostereometric analysis after total knee arthroplasty to assess the migration of the Triathlon tibial component fixed with HV cement (Simplex HV).
Effectiveness of Periarticular Injection After Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture in Elderly Patients: A Double Blinded Randomized, Controlled Study
Ong-art Phruetthiphat,Attaporn Lawanprasert,Saradej Khuangsirikul,Danai Heebtamai,Thanainit Chotanaphuti
doi : 10.1016/j.arth.2021.01.017
PRIMARY HIP| VOLUME 36, ISSUE 6, P2006-2011, JUNE 01, 2021
Bipolar hemiarthroplasty is a standard treatment for displaced femoral neck fracture in elderly with a normal acetabulum. Several studies have shown controversial results regarding postoperative visual analogue scale, opioid consumption, and the effectiveness of periarticular injection in hip arthroplasty. The purpose of this study is going to identify the effectiveness of periarticular injection after bipolar hemiarthroplasty compared with the patients treated with conventional pain control.
Minimum Five-Year Outcomes of Hip Resurfacing: Propensity-Score Matched Against Total Hip Arthroplasty Control Groups
Benjamin G. Domb,Rishika Bheem,Peter F. Monahan,Mitchell B. Meghpara,Ajay C. Lall,Jacob Shapira
doi : 10.1016/j.arth.2021.01.042
PRIMARY HIP| VOLUME 36, ISSUE 6, P2012-2015, JUNE 01, 2021
The aim of this study is to evaluate clinical outcomes of patients undergoing Birmingham hip resurfacing (BHR) with a minimum 5-year follow-up and compare these outcomes to 2 matched control groups of patients undergoing either direct anterior approach (DAA) or posterior approach (PA) total hip arthroplasty (THA).
Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty?
Patawut Bovonratwet,Tony S. Shen,Wasif Islam,Peter K. Sculco,Douglas E. Padgett,Edwin P. Su
doi : 10.1016/j.arth.2021.01.023
PRIMARY HIP| VOLUME 36, ISSUE 6, P2016-2023, JUNE 01, 2021
Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data.
Patient Factors That Matter in Predicting Hip Arthroplasty Outcomes: A Machine-Learning Approach
Jhase Sniderman,Roland B. Stark,Carolyn E. Schwartz,Hajra Imam,Joel A. Finkelstein,Markku T. Nousiainen
doi : 10.1016/j.arth.2020.12.038
PRIMARY HIP| VOLUME 36, ISSUE 6, P2024-2032, JUNE 01, 2021
Despite the success of total hip arthroplasty (THA), approximately 10%-15% of patients will be dissatisfied with their outcome. Identifying patients at risk of not achieving meaningful gains postoperatively is critical to pre-surgical counseling and clinical decision support. Machine learning has shown promise in creating predictive models. This study used a machine-learning model to identify patient-specific variables that predict the postoperative functional outcome in THA.
Preoperative Corticosteroid Injections Demonstrate a Temporal and Dose-Dependent Relationship with the Rate of Postoperative Infection Following Total Hip Arthroplasty
Enrico M. Forlenza,Robert A. Burnett,Avinaash Korrapati BS,JaeWon Yang,Brian Forsythe,Craig J. Della Valle
doi : 10.1016/j.arth.2021.01.076
PRIMARY HIP| VOLUME 36, ISSUE 6, P2033-2037.E1, JUNE 01, 2021
Corticosteroid injections (CSI) are commonly used for the treatment of osteoarthritis of the hip. There is concern, however, that these injections may increase the risk of postoperative infection if a subsequent total hip arthroplasty (THA) is performed. The purpose of the present investigation is to determine the relationship between CSI and the risk of periprosthetic joint infection (PJI) and surgical site infections (SSIs) following THA.
Direct Anterior Approach to the Hip Does Not Increase the Risk for Subsequent Periprosthetic Joint Infection
Noam Shohat,Karan Goswami,Samuel Clarkson,D’Andrew Gursay,Timothy L. Tan,Javad Parvizi
doi : 10.1016/j.arth.2021.02.016
PRIMARY HIP| VOLUME 36, ISSUE 6, P2038-2043, JUNE 01, 2021
Recent studies suggest an increased risk for periprosthetic joint infection (PJI) utilizing the direct anterior (DA) approach to the hip. The purpose of this study was to investigate whether such an increased risk does indeed exist on a large cohort of patients, operated by experienced surgeons and taking into account various confounders.
Perioperative Mortality and Periprosthetic Fracture: A Single-Center Experience of 857 Uncemented Hemiarthroplasties for Displaced Femoral Neck Fractures
Evelyn P. Murphy,Christopher Fenelon,Ahmed I. Akoud,Stephen R. Kearns,Fintan J. Shannon,Colin G. Murphy
doi : 10.1016/j.arth.2021.01.055
PRIMARY HIP| VOLUME 36, ISSUE 6, P2044-2048, JUNE 01, 2021
Uncemented hemiarthroplasty (UHA) for displaced femoral neck fracture (FNF) is favored by some surgeons because of the reduced rate of perioperative mortality and operative time. However higher rates of intraoperative and postoperative periprosthetic fractures (PPFs) have been reported. The aim of the study was to review day-0, day-1, day-2, day-30, and one-year mortality as well as intraoperative and postoperative PPF after UHA for displaced FNF and compare this with cemented hemiarthroplasties (CHAs) performed. Secondary objectives were to assess whether femoral stem geometry and alignment were associated with PPF in UHA.
Risks and Complications After Arthroplasty for Pathological or Impending Pathological Fracture of the Hip
Venkat Boddapati,Michael B. Held,Matthew Levitsky,Ryan S. Charette,Alexander L. Neuwirth,Jeffrey A. Geller
doi : 10.1016/j.arth.2021.02.004
PRIMARY HIP| VOLUME 36, ISSUE 6, P2049-2054.E5, JUNE 01, 2021
Treatment options for metastatic osseous lesions of the proximal femur include hemiarthroplasty (HA) or total hip arthroplasty (THA) depending on lesion characteristics and patient demographics. Studies assessing short-term outcomes after HA/THA in this patient population are limited. Therefore, the purpose of this present study was to identify short-term rates of morbidity and mortality after HA/THA for pathological proximal femur fractures, as well as readmission and reoperation rates and reasons.
The Effects of Rasp Oversize on the Clinical and Radiographic Outcomes of Total Hip Arthroplasty With a Collared Satin-Finished Composite Beam Cemented Stem
Yoshichika Hashimoto,Wataru Ando,Takashi Sakai,Masaki Takao,Hidetoshi Hamada,Nobuhiko Sugano
doi : 10.1016/j.arth.2021.01.044
PRIMARY HIP| VOLUME 36, ISSUE 6, P2055-2061, JUNE 01, 2021
This study aimed to compare the clinical and radiographic outcomes of using two different oversized rasps in total hip arthroplasty (THA) with a composite beam cemented stem (DCM-J).
Discontinuation of Intraoperative Liposomal Bupivacaine in Primary THA Does Not Clinically Change Postoperative Subjective Pain, Opioid Consumption, or Objective Functional Status
James E. Feng,Chibuokem P. Ikwuazom,James D. Slover,William Macaulay,Ran Schwarzkopf,William J. Long
doi : 10.1016/j.arth.2021.01.064
PRIMARY HIP| VOLUME 36, ISSUE 6, P2062-2067, JUNE 01, 2021
There is debate regarding the benefit of liposomal bupivacaine (LB) as part of a periarticular injection (PAI) in total hip arthroplasty (THA). Here, we evaluate the effect of discontinuing intraoperative LB PAI on immediate postoperative subjective pain, opioid consumption, and objective functional outcomes.
Non-Inferiority of Aspirin for Venous Thromboembolism Prophylaxis After Hip Arthroplasty in a Statewide Registry
Stefano R. Muscatelli,Huiyong Zheng,Richard E. Hughes,Mark E. Cowen,Brian R. Hallstrom
doi : 10.1016/j.arth.2021.01.025
PRIMARY HIP| VOLUME 36, ISSUE 6, P2068-2075.E2, JUNE 01, 2021
Uncertainty remains surrounding the use of aspirin as a sole chemoprophylactic agent to reduce the risk of venous thromboembolism (deep vein thrombosis or pulmonary embolism) and bleeding after primary total hip arthroplasty.
Radiographic Evaluation of Proximal Femoral Nutrient Arteries After Total Hip Arthroplasty With a Short Femoral Stem
Malynda S. Wynn,Christopher N. Carender,Emily Solsrud,Charles R. Clark,Jesse E. Otero,Timothy S. Brown
doi : 10.1016/j.arth.2021.02.003
PRIMARY HIP| VOLUME 36, ISSUE 6, P2076-2079, JUNE 01, 2021
The use of less invasive approaches and broach only press-fit femoral stems in total hip arthroplasty (THA) may increase the risk for periprosthetic fracture. Proximal femoral nutrient arteries (FNAs) can be mistaken for fractures after THA. Description of FNAs in relation to THA implants is important to better distinguish between FNAs and periprosthetic fractures. The purpose of this study was to evaluate the frequency, location, and morphology of FNAs visible on radiographs after primary THA with a broach-only stem design.
Safe Upper Limits of Serum Cobalt and Chromium Levels for a Metal-on-Metal Total Hip Bearing: A 10-Year Follow-Up Study
Maarten C. Koper,Brechtje Hesseling,Wim E. Tuinebreijer,Hans van der Linden,Nina M.C. Mathijssen
doi : 10.1016/j.arth.2021.01.027
PRIMARY HIP| VOLUME 36, ISSUE 6, P2080-2086, JUNE 01, 2021
Long-term survival of metal-on-metal (MoM) prostheses and the development of adverse reaction to metal debris (ARMD) around these bearings are still unclear. Serum levels of cobalt (Co) and chromium (Cr) are used as a screening tool to anticipate failure in MoM bearings and detect ARMD.
Long-Term Outcomes of 496 Anatomical Cementless Modular Femoral Stems: Eleven to Twenty Years of Follow-Up
David Manuel Ferre?o M?rquez,Cristina Dauder Gallego,F?tima NGole Bebea Zamorano,Victoria Sebasti?n Pérez,Jorge Montejo Sancho,Javier Mart?nez Mart?n
doi : 10.1016/j.arth.2021.01.057
PRIMARY HIP| VOLUME 36, ISSUE 6, P2087-2099, JUNE 01, 2021
The aim of the study is to assess the long-term outcomes of this specific stem (anatomical cementless modular stem ESOP), to review the survivorship, complication rate, and radiographic and clinical outcomes.
Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty
Kwong-Yin Chung,Kin-Wing Cheung,Chi-Ho Fan,Wai-Chin Poon,Kwok-Hing Chiu,Kevin Ki-Wai Ho
doi : 10.1016/j.arth.2021.01.024
PRIMARY HIP| VOLUME 36, ISSUE 6, P2100-2104, JUNE 01, 2021
Total hip arthroplasty with ceramic-on-ceramic articulation aims to decrease wear, osteolysis, and aseptic loosening. A metal-backed ceramic liner was developed to reduce the risk of liner fracture. However, a significant number of cases of mal-seating of the metal-backed ceramic liner were observed in the 2000s, and there were concerns about their outcome. This review aims to investigate the long-term performance of the mal-seated ceramic liner.
Long-Term Clinical and Radiographic Results of an Ultra-Short Metaphyseal-Fitting Non-Anatomic Cementless Stem in Patients with Femoral Neck Fracture
Young-Hoo Kim,Young-Soo Jang
doi : 10.1016/j.arth.2021.01.029
PRIMARY HIP| VOLUME 36, ISSUE 6, P2105-2109, JUNE 01, 2021
The purpose of this study is to determine the clinical and radiographic outcomes, mortality rate, complication rate, and revision rate of this ultra-short non-anatomic cementless femoral stem in elderly patients with a femoral neck fracture.
Crohn’s Disease is Associated with Longer In-Hospital Lengths of Stay and Higher Rates of Complications and Costs after Primary Total Hip Arthroplasty
Lucas C. Voyvodic,Nabil Z. Khan,Aaron W. Lam,Andrew R. Horn,Michael A. Mont,Afshin E. Razi
doi : 10.1016/j.arth.2021.02.002
PRIMARY HIP| VOLUME 36, ISSUE 6, P2110-2115, JUNE 01, 2021
As the incidence and prevalence of Crohn’s disease continues to change worldwide, rates within North America have been increasing. The objective of this study was to evaluate whether patients who have Crohn’s disease undergoing primary total hip arthroplasties have worse outcomes compared with matched cohorts. Specifically, we evaluated 1) medical complications, 2) in-hospital lengths of stay (LOS), and 3) costs of care.
Utility and Prognostic Ability of a Diagnostic Injection Before Revision Total Knee Arthroplasty
Kevin A. Sonn,Evan R. Deckard,Abdul R. Aasar,Lily K. Wolf,R. Michael Meneghini
doi : 10.1016/j.arth.2020.12.056
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 6, P2116-2120, JUNE 01, 2021
Diagnostic injections are commonly utilized in the workup of painful total knee arthroplasties (TKA), particularly when the diagnosis remains unclear. However, current literature provides limited evidence regarding the utility and prognostic capability of anesthetic injections in this scenario. This study sought to establish the role of diagnostic injections in predicting successful revision TKA.
Revision Total Knee Arthroplasty Using an Uncemented Metaphyseal Sleeve, Rotating Hinge Prosthesis: A Case Series of 99 Patients
Karan Panesar,Louay Al-Mouazzen,Luthfun Nessa,Sam C. Jonas,Sanjeev Agarwal,Rhidian Morgan-Jones
doi : 10.1016/j.arth.2020.12.047
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 6, P2121-2125, JUNE 01, 2021
Hinge knee replacement is a salvage procedure with historically high failure and complication rates. We aim to analyze the use of an uncemented metaphyseal sleeve revision knee replacement in our unit—a third-generation rotating hinge knee prosthesis. This is the largest reported series of this implant with longest follow up.
Patellar Tracking in Revision Total Knee Arthroplasty: Does Retaining a Patella From a Different Implant System Matter?
David Yeroushalmi,Stephen Zak,Mohamad Sharan,Jenna A. Bernstein,Ran Schwarzkopf,Joshua C. Rozell
doi : 10.1016/j.arth.2021.01.082
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 6, P2126-2130, JUNE 01, 2021
Patellar maltracking is a potential surgical complication following total knee arthroplasty (TKA) and can result in anterior knee pain, recurrent patellar dislocation, and damage to the medial patellar soft tissue stabilizers. Data remain unclear as to whether the patellar button should be revised during a revision TKA (rTKA) if changing the component implant system. Our study examines whether retaining the original patellar button during an rTKA using a different implant system affects patellar tracking.
Septic Revision Total Knee Arthroplasty Is Associated With Significantly Higher Mortality Than Aseptic Revisions: Long-Term Single-Center Study (1254 Patients)
Hosam E. Matar,Benjamin V. Bloch,Susan E. Snape,Peter J. James
doi : 10.1016/j.arth.2021.01.068
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 6, P2131-2136, JUNE 01, 2021
The aim of this study is to examine the differences in long-term mortality rates between septic and aseptic revision total knee arthroplasty (rTKA) in a single specialist center over 17-year period.
The Utility of Frozen Section Histology in Diagnosing Periprosthetic Joint Infection in Revision Total Joint Arthroplasty
McKayla E. Kelly,Shreeya R. Bahethi,Mary E. King,Benjamin C. Elstner,Justin J. Turcotte,Paul J. King
doi : 10.1016/j.arth.2020.12.051
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2137-2143, JUNE 01, 2021
Surgeons utilize a combination of preoperative tests and intraoperative findings to diagnose periprosthetic joint infection (PJI); however, there is currently no reliable diagnostic marker that can be used in isolation. The purpose of our study is to evaluate the utility of frozen section histology in diagnosis of PJI.
Alpha-Defensin Is Not Superior to Traditional Diagnostic Methods for Detection of Periprosthetic Joint Infection in Total Hip Arthroplasty and Total Knee Arthroplasty Patients
Lindsay T. Kleeman-Forsthuber,Douglas A. Dennis,Anna C. Brady,Aviva K. Pollet,Roseann M. Johnson,Jason M. Jennings
doi : 10.1016/j.arth.2021.01.036
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2144-2149, JUNE 01, 2021
Synovial fluid alpha-defensin (AD) may improve diagnostic accuracy of periprosthetic joint infection (PJI) following total knee (TKA) and hip (THA) arthroplasty but is only available as send-out test. This study evaluated laboratory result accuracy between send-out test vs hospital labs and if AD made a difference in treatment plan.
What is the Clinical Utility of Synovial Alpha Defensin Testing of Antibiotic Spacers Before Reimplantation?
Christopher N. Carender,David E. DeMik,Jesse E. Otero,Nicolas O. Noiseux,Timothy S. Brown,Nicholas A. Bedard
doi : 10.1016/j.arth.2021.02.001
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2150-2157, JUNE 01, 2021
The purpose of this study was to evaluate the diagnostic performance of standalone alpha defensin (AD) testing of antibiotic spacers during two stage exchange and to determine if the addition of AD testing to other commonly used laboratory tests improves the ability to detect persistent infection in an antibiotic spacer.
Analysis of Culture Positive First and Second Stage Procedures in Periprosthetic Knee and Hip Joint Infections
Bernhard J.H. Frank,Alexander Aichmair,Sebastian Simon,Gilbert M. Schwarz,Martin Dominkus,Jochen G. Hofstaetter
doi : 10.1016/j.arth.2021.01.074
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2158-2164, JUNE 01, 2021
A positive microbiological result at reimplantation may lead to a failed 2-stage revision arthroplasty in the treatment of periprosthetic joint infections. Little is known about changes in microbiological spectrum and resistance pattern between culture positive first and second stage procedures in revision knee and hip arthroplasty.
Management of Large Segmental Bone Defects at the Knee With Intramedullary Stabilized Antibiotic Spacers During Two-Stage Treatment of Endoprosthetic Joint Infection
Joseph A. Ippolito,Jennifer E. Thomson,Steven M. Rivero,Kathleen S. Beebe,Francis R. Patterson,Joseph Benevenia
doi : 10.1016/j.arth.2021.01.026
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2165-2170, JUNE 01, 2021
Following debridement of infected prostheses that require reconstruction with an endoprosthetic replacement (EPR), instability related to segmental residual bone defects present a challenge in management with 2-stage reimplantation.
Randomized Trial of Static and Articulating Spacers for Treatment of the Infected Total Hip Arthroplasty
Cindy R. Nahhas,Peter N. Chalmers,Javad Parvizi,Chris N. Culvern,Mario Moric,Craig J. Della Valle
doi : 10.1016/j.arth.2021.01.031
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2171-2177, JUNE 01, 2021
The purpose of this randomized clinical trial is to compare perioperative and postoperative variables between static and articulating spacers for the treatment of chronic periprosthetic joint infection (PJI) complicating total hip arthroplasty (THA).
High Rates of Spacer Fracture in the Setting of Extended Trochanteric Osteotomy With a Specific Thin-Core Articulating Antibiotic Hip Spacer
Alex J. Lancaster,Victor R. Carlson,Christopher E. Pelt,Lucas A. Anderson,Christopher L. Peters,Jeremy M. Gililland
doi : 10.1016/j.arth.2021.01.086
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 6, P2178-2183, JUNE 01, 2021
Two-stage revision remains the standard of care for prosthetic joint infection after total hip arthroplasty. However, there are substantial complications associated with articulating antibiotic hip spacers. Handmade and molded spacers have been shown to have higher rates of spacer fracture than antibiotic-coated prostheses (ACPs). The aim of this study is to review outcomes with an implant that is often categorized as an ACP spacer, the Zimmer-Biomet StageOne Select Femoral Spacer (ZBSO).
The Effect of Functional Pelvic Tilt on the Three-Dimensional Acetabular Cup Orientation in Total Hip Arthroplasty Dislocations
Thom E. Snijders,Tom P.C. Schl?sser,Nathanael D. Heckmann,Harry Weinans,Arthur de Gast,Lawrence D. Dorr
doi : 10.1016/j.arth.2020.12.055
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 6, P2184-2188.E1, JUNE 01, 2021
Anterior and posterior pelvic tilt appears to play a role in total hip arthroplasty (THA) stability. When changing from the standing to the sitting position, the pelvis typically rotates posteriorly while the hips flex and this affects the femoro-acetabular positions. This case-control study compares changes in 3-D acetabular cup orientation during functional pelvic tilt between posterior THA dislocations vs stable THAs.
Periprosthetic Atypical Femoral Fractures Exist: A Retrospective Study at a Single Institution. Prevalence on 115 Periprosthetic Femoral Fractures Around a Primary Hip Stem
Nicola Mondanelli,Andrea Facchini,Elisa Troiano,Francesco Muratori,Vanna Bottai,Stefano Giannotti
doi : 10.1016/j.arth.2021.01.066
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 6, P2189-2196, JUNE 01, 2021
Some periprosthetic femoral fractures (PFFs) present history and radiographic aspect consistent with an atypical femoral fracture (AFF), fulfilling the criteria for AFF except that PFFs by themselves are excluded from the diagnosis of AFFs. The aim of this study is to evaluate in a single institution series of PFFs if any of them could be considered a periprosthetic atypical femoral fracture (PAFF), and their prevalence.
Deep Learning Artificial Intelligence Model for Assessment of Hip Dislocation Risk Following Primary Total Hip Arthroplasty From Postoperative Radiographs
Pouria Rouzrokh,Taghi Ramazanian,Cody C. Wyles,Hilal Maradit Kremers,David G. Lewallen,Bradley J. Erickson
doi : 10.1016/j.arth.2021.02.028
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 6, P2197-2203.E3, JUNE 01, 2021
Dislocation is a common complication following total hip arthroplasty (THA), and accounts for a high percentage of subsequent revisions. The purpose of this study is to illustrate the potential of a convolutional neural network model to assess the risk of hip dislocation based on postoperative anteroposterior pelvis radiographs.
Accuracy of a New Digital Templating Method for Total Hip Arthroplasty Using Picture Archiving and Communication System (PACS) and iPhone Technology: Comparison With Acetate Templating on Digital Radiography
Anuwat Pongkunakorn,Chayanut Aksornthung,Nithipat Sritumpinit
doi : 10.1016/j.arth.2021.01.019
BASIC SCIENCE| VOLUME 36, ISSUE 6, P2204-2210, JUNE 01, 2021
Preoperative templating for total hip arthroplasty (THA) on digital radiography can be achieved using templating software or hybrid methods (acetate templates overlaid on digital images). No studies have examined templating with a mobile phone. We evaluated the accuracy and reproducibility of a new digital templating method using the picture archiving and communication system (PACS) and iPhone, compared with the hybrid method for cementless THA.
The Fragility of Statistically Significant Findings From Randomized Controlled Trials in Hip and Knee Arthroplasty
Seper Ekhtiari,Aaron M. Gazendam,Nicholas W. Nucci,Colin C. Kruse,Mohit Bhandari
doi : 10.1016/j.arth.2020.12.015
MISCELLANEOUS| VOLUME 36, ISSUE 6, P2211-2218.E1, JUNE 01, 2021
The Fragility Index (FI) is a method for evaluating the robustness of statistically significant findings from randomized controlled trials (RCTs) beyond the P value in trials with dichotomous outcomes. The FI is defined as the number of patients in one arm of a trial that would have to have a different outcome to change the results of the trial from statistically significant to nonsignificant. This review assessed the FI in arthroplasty RCTs.
Quantifying the Level of Evidence of Podium Presentations at the American Association of Hip and Knee Surgeons From 2015 to 2019
Aaron M. Gazendam,Nicholas W. Nucci,Seper Ekhtiari,Brent A. Lanting,Steven J. MacDonald,Thomas J. Wood
doi : 10.1016/j.arth.2021.01.083
MISCELLANEOUS| VOLUME 36, ISSUE 6, P2219-2222, JUNE 01, 2021
The American Association of Hip and Knee Surgeons (AAHKS) Annual Scientific Meeting is a leading forum for the presentation and dissemination of research regarding the management of hip and knee pathology making research presented at these meetings a representation of the current literature in the field. The purpose of this study was to quantify the level of evidence of podium presentations presented at the AAHKS annual meeting from 2015 to 2019.
The Emergence of Collaboration in the Education of Fellows and Residents during COVID-19
Wayne E. Moschetti,Benjamin M. Frye,Jeremy M. Gililland,Andrew J. Braziel,Vivek M. Shah
doi : 10.1016/j.arth.2021.02.019
MISCELLANEOUS| VOLUME 36, ISSUE 6, P2223-2226, JUNE 01, 2021
COVID-19 has created a void in surgical education. Given social distancing and postponed surgeries, unique educational opportunities have arisen. Attendings from 10 adult reconstruction fellowships led a multi-institution web-based weekly collaborative, the Arthroplasty Consortium (AC), developed to educate trainees through complex arthroplasty case-based discussions.
Simultaneous Bilateral Total Knee Arthroplasty Is Associated With Shorter Length of Stay but Increased Mortality Compared With Staged Bilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Navnit S. Makaram,Simon B. Roberts,Gavin J. Macpherson
doi : 10.1016/j.arth.2021.01.045
SYSTEMATIC REVIEW & META-ANALYSIS| VOLUME 36, ISSUE 6, P2227-2238, JUNE 01, 2021
Primary total knee arthroplasty (TKA) is associated with high patient satisfaction. However, controversy remains regarding the safety and efficacy of conducting simultaneous bilateral (simBTKA) versus staged bilateral TKA (staBTKA). The objective of this systematic review and meta-analysis was to evaluate the current evidence for simBTKA versus staBTKA and compare clinical outcomes including mortality, complications and length of stay (LOS).
Total Hip Arthroplasty in Patients With Postpolio Residual Paralysis: A Systematic Review
Gaurav K. Upadhyaya,Mohit K. Patralekh,Vijay K. Jain,Deepak Gautam,Raju Vaishya,Rajesh Malhotra
doi : 10.1016/j.arth.2021.01.046
SYSTEMATIC REVIEW & META-ANALYSIS| VOLUME 36, ISSUE 6, P2239-2247, JUNE 01, 2021
Patients with postpolio residual paralysis can develop disabling hip arthritis in paralytic as well as a nonparalytic limb, warranting total hip arthroplasty (THA). Limited literature is available on the results of THA among these patients in the form of small series or case reports. We have undertaken a systematic review to evaluate the clinical outcome of THA in patients with poliomyelitis with hip pathologies.
Letter to the Editor on “Crohn’s Disease Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Complications and Costs Following Primary Total Hip Arthroplasty”
Xiaofei Li
doi : 10.1016/j.arth.2021.03.013
LETTER TO THE EDITOR| VOLUME 36, ISSUE 6, E59, JUNE 01, 2021
no abstract
Response to Letter to the Editor on “Crohn’s Disease Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Complications and Costs Following Primary Total Hip Arthroplasty”
Lucas C. Voyvodic,Nabil Z. Khan,Aaron W. Lam,Andrew R. Horn,Michael A. Mont,Afshin E. Razi
doi : 10.1016/j.arth.2021.03.015
LETTER TO THE EDITOR| VOLUME 36, ISSUE 6, E60-E61, JUNE 01, 2021
no abstract
Conflict of Interest
doi : 10.1016/S0883-5403(21)00357-0
MISCELLANEOUS| VOLUME 36, ISSUE 6, P2248, JUNE 01, 2021
no abstract
Ed board
doi : 10.1016/S0883-5403(21)00354-5
EDITORIAL BOARD| VOLUME 36, ISSUE 6, PA1, JUNE 01, 2021
no abstract
Masthead
doi : 10.1016/S0883-5403(21)00355-7
MISCELLANEOUS| VOLUME 36, ISSUE 6, PA2, JUNE 01, 2021
no abstract
Table of Contents
doi : 10.1016/S0883-5403(21)00356-9
CONTENTS LIST| VOLUME 36, ISSUE 6, PA10, JUNE 01, 2021
no abstract
