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Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_12 | Pages 11 - 11
23 Jun 2023
Lombardi AV Alexander JS Berend KR Houserman DJ Adams JB Crawford DA
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Previous studies have reported excellent results with tapered, titanium alloy, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at minimum 25-year follow-up.

We reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component, the Mallory-Head Porous (MHP; Zimmer Biomet, Warsaw, IN). This device, marketed in the U.S. until December 2021, was essentially unchanged since its 1984 introduction, except the porous coating was continued circumferentially along the lateral aspect in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999 after the study period. Three hundred thirty-two patients (396 THA) had a minimum of 25-year follow-up. Mean age at surgery was 47.6 years (range, 21–70 years).

Mean follow-up in non-failed patients was 28.7 years (range, 25 to 37 years). There were 31 femoral revisions (7.8%): 9 infection, 3 failure of ingrowth, 5 aseptic loosening, 8 osteolysis revised well-fixed, 2 periprosthetic fracture, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with endpoint of stem revision for all causes was 94.8% (95% CI: ±0.9%) at 36.7 years, and survival with endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% CI: ±0.5) at 36.7 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently.

This tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 14 - 14
1 Oct 2019
Lombardi AV Crawford DA Morris MJ Adams JB Berend KR
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Background

Thigh pain following a well-fixed total hip arthroplasty (THA) remains problematic and a source of patient dissatisfaction. The purpose of this study is to evaluate if the development of distal femoral cortical hypertrophy (DFCH) is associated with chronic postoperative thigh pain after THA with a short stem implant.

Methods

All patients who underwent an uncomplicated primary THA via a direct anterior approach with the short stem Taperloc Microplasty® (Zimmer Biomet, Warsaw, IN) implant between 2011 and 2015 were mailed a pain drawing questionnaire. Radiographs were reviewed at 1-year minimum to determine cortical thickness change from immediate post-op. Thigh pain was compared to DFCH as well as patient demographics and femoral stem size. 293 patients were included in the study


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 37 - 37
1 Oct 2019
Berend KR Crawford DA Adams JB Morris MJ Lombardi AV
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Background

Recurrent instability and dislocation after total hip arthroplasty are difficult complications. In certain cases, a constrained acetabular device can address these issues. The purpose of this study is to report the midterm outcomes and survivorship of a single constrained liner device.

Methods

A retrospective review as performed on all procedures (except first stage exchange for infection) in which a Freedom® Constrained (Zimmer Biomet, Warsaw, IN) liner was used between December 2003 to November 2016. Patients with 2-year minimum follow-up or failure were included, yielding a cohort of 177 patients. Procedures were 130 revisions, 40 reimplantations following infection eradication, and 7 complex primaries. The constrained mechanism was implanted in 46 hips (26%) to treat active instability and 131 hips (74%) for increased risk of instability or intraoperative instability. Patients had on average 3.4 previous surgeries.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 63 - 63
1 Oct 2019
Berend KR Crawford DA Adams JB Lombardi AV
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Introduction

Patients are often cautioned against a high level of activity following knee arthroplasty. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after TKA.

Methods

We identified 1611 patients (2038 knees) who underwent TKA with 5-year minimum follow-up. Patients were divided in two groups: Low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥ 6). Pre-and postoperative ROM, Knee Society scores, complications and reoperations were evaluated.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_12 | Pages 35 - 35
1 Oct 2018
Lombardi AV Berend KR Adams JB Mallory NT
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Introduction

Modern implant systems offer a variety of options to address the posterior cruciate ligament (PCL) and afford stability in primary total knee arthroplasty (TKA). One system has three bearing options for cruciate retaining (CR) TKA: standard CR bearing (CR-S) with 3° posterior slope and no posterior lip; CR lipped bearing (CR-L) with no slope and small posterior lip, and deep-dished anterior stabilized bearing (CR-AS) with large anterior build-up to compensates for deficient or lax PCL. We previously reported on 1940 patients (2449 CR-TKA) at early follow-up comparing these three CR bearings and found CR-AS bearings had greater improvement in ROM and lower rate of manipulation despite their use in patients with greater preoperative deformity and lower ROM. The purpose of this study was to review a broader series by a single surgeon-designer with minimum 2-year follow-up to determine if there were differences between bearing types in terms of clinical outcomes and survival.

Methods

From 2003 to 2014, 3348 patients (4500 knees) underwent primary CR-TKA and were available for review with minimum 2-year follow-up. An algorithmic approach to constraint was employed, choosing the least amount necessary to afford stability. Bearings used were 3883 CR-S (86%), 256 CR-L (6%), and 361 CR-AS (8%). CR-S bearings were used in patients with less preoperative tibiofemoral deformity (p=0.0316), less flexion contracture (p<0.0001), and better ROM (p<0.0001), but more mediolateral instability (p<0.0001) than CR-AS bearings.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 68 - 68
1 Oct 2018
Lombardi AV Berend KR Morris MJ Crawford DA Adams JB
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Total hip arthroplasty (THA) continues moving to the outpatient arena, and may be feasible for some conversion and revision scenarios. Controversy surrounds appropriate patient selection. The purpose of this study is to report complications associated with outpatient revision and conversion THA, and to determine if comorbidities are associated with complications or overnight stay.

From June 2013 through March 2018, 43 patients (44 hips) underwent conversion (n=9) or revision (n=35) THA at a free-standing ambulatory surgery center. Mean patient age was 58.4 years, and 52% of patients were male. Conversion procedures were failed fracture fixation with retained hardware and all involved both femoral and acetabular replacement. Revision procedures involved head only in one, head and liner in 20, cup and head in 8, stem only in one, stem and liner in 4, and full revision in one.

Forty-one (93%) were discharged same day without incident, none required transfer to acute facility, and 3 required overnight stay with 2 of these for convenience and only one for a medical reason, urinary retention. Three patients with early superficial infection, including 2 diagnosed by positive intraoperative cultures, were successfully treated with oral antibiotics. There were no major complications, readmissions, or subsequent surgeries within 90 days. One or more major comorbidities were present in 15 patients (34%) including 1 valvular disease, 7 arrhythmia, 2 thromboembolism history, 3 obstructive sleep apnea, 3 chronic obstructive pulmonary disease, 2 asthma, 4 frequent urination, and 1 renal disease. The single patient who stayed overnight for a medical reason had no major medical comorbidities.

Outpatient arthroplasty, including revision THA in some scenarios, is safe for many patients. Presence of medical comorbidities was not associated with risk of complications. The paradigm change of patient education, medical optimization, and a multimodal program to mitigate risk of blood loss and reduce need for narcotics facilitates performing arthroplasty safely in an outpatient setting.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 3 - 10
1 Oct 2016
Hamilton TW Pandit HG Lombardi AV Adams JB Oosthuizen CR Clavé A Dodd CAF Berend KR Murray DW

Aims

An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre.

Patients and Methods

Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature.


The Bone & Joint Journal
Vol. 98-B, Issue 10_Supple_B | Pages 28 - 33
1 Oct 2016
Lum ZC Lombardi AV Hurst JM Morris MJ Adams JB Berend KR

Aims

Since redesign of the Oxford phase III mobile-bearing unicompartmental knee arthroplasty (UKA) femoral component to a twin-peg design, there has not been a direct comparison to total knee arthroplasty (TKA). Thus, we explored differences between the two cohorts.

Patients and Methods

A total of 168 patients (201 knees) underwent medial UKA with the Oxford Partial Knee Twin-Peg. These patients were compared with a randomly selected group of 177 patients (189 knees) with primary Vanguard TKA. Patient demographics, Knee Society (KS) scores and range of movement (ROM) were compared between the two cohorts. Additionally, revision, re-operation and manipulation under anaesthesia rates were analysed.