Objective

Compare the safety and effectiveness of different anesthetic technique used in the simultaneous bilateral total knee arthroplasty (BTKA).

Introduction. Survival after contemporary solid organ transplant (SOT) is increasing, and demand for total hip arthroplasty (THA) among SOT recipients is rising accordingly. The purpose of this study is to compare the perioperative outcomes and short-term implant- and patient-survivorship of contemporary THA following the most common types of SOT. Methods. Among SOT recipients, 119 primary THAs (92 patients, 39% female) were performed at a single institution from 2000–2020 and were retrospectively reviewed at a mean follow-up of 3.6yrs. Revisions, conversion to THA and multiple organs transplanted were excluded. The most common SOT was renal (39%), followed by lung (34%), liver (18%) and heart (8%). Demographics, peri-operative outcomes, 90-day re-admissions, re-operations and mortality were compared between SOT groups using chi-squared, Fisher's exact, Wilcoxon tests and Cox proportional hazard ratios. Results. Renal (median: 52yrs, 25–75%ile: 45.1–58.1) and heart transplant patients (55.4, 53.8–68.8) presented for THA at younger ages than liver (62.8, 50.0–67.6) and lung patients (63.1, 55.4–69.0; p<0.001). However, renal patients had the longest duration between SOT and THA (8.2yrs, 2.8–13.7; p=0.002), followed by liver (5.0, 1.2–11.4), heart (4.2, 2.4–9.6) and lung (2.6, 1.3–5.5). LOS was 3.0 days (p=0.31), 16% were discharged to a facility (p=0.87), and 9.4% required transfusion (p=0.43). Eighteen patients required re-admission within 90days (15%; p=0.44), and four underwent revision at 1-yr (3.4%; p=0.42). Mortality was 4.3% at 1yr (95% CI: 1.6–10.9) and 23.1% at 3yrs (95% CI: 15.0–32.9). When adjusted for age, ASA class, and duration from SOT to THA, lung transplant had higher mortality relative to kidney (RR 4.28, 95% CI: 1.79–11.26; p<0.001) and liver (RR 5.84, 95% CI: 1.95–25.29; p<0.001). Conclusion. SOT patients are a medically complex group with substantial requirements for facility placement, transfusions and re-admissions after THA. Short-term implant survivorship is acceptable, but THA in SOT patients is not without mortality risk, especially among lung transplant recipients

Three-dimensional (3D) printing has become more frequently used in surgical specialties in recent years. Orthopaedic surgery is particularly well-suited to 3D printing applications, and thus has seen a variety of uses for this technology. These uses include pre-operative planning, patient-specific instrumentation (PSI), and patient-specific implant production. As with any new technology, it is important to assess the clinical impact, if any, of three-dimensional printing. The purpose of this review was to answer the following questions: . What are the current clinical uses of 3D printing in orthopaedic surgery?. Does the use of 3D printing have an effect on peri-operative outcomes?. Four electronic databases (Embase, MEDLINE, PubMed, Web of Science) were searched for Articles discussing clinical applications of 3D printing in orthopaedics up to November 13, 2018. Titles, abstracts, and full texts were screened in duplicate and data was abstracted. Descriptive analysis was performed for all studies. A meta-analysis was performed among eligible studies to compare estimated blood loss (EBL), operative time, and fluoroscopy use between 3D printing cases and controls. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria for non-randomized studies and the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs). This review was prospectively registered on PROSPERO (Registration ID: CRD42018099144). One-hundred and eight studies were included, published between 2012 and 2018. A total of 2328 patients were included in these studies, and 1558 patients were treated using 3D printing technology. The mean age of patients, where reported, was 47 years old (range 3 to 90). Three-dimensional printing was most commonly reported in trauma (N = 41) and oncology (N = 22). Pre-operative planning was the most common use of 3D printing (N = 63), followed by final implants (N = 32) and PSI (N = 22). Titanium was the most commonly used 3D printing material (16 studies, 27.1%). A wide range of costs were reported for 3D printing applications, ranging from “less than $10” to $20,000. The mean MINORS score for non-randomized studies was 8.3/16 for non-comparative studies (N = 78), and 17.7/24 for non-randomized comparative studies (N = 19). Among RCTs, the most commonly identified sources of bias were for performance and detection biases. Three-dimensional printing resulted in a statistically significant decrease in mean operative time (−15.6 mins, p < .00001), mean EBL (−35.9 mL, p<.00001), and mean fluoroscopy shots (−3.5 shots, p < .00001) in 3D printing patients compared to controls. The uses of 3D printing in orthopaedic surgery are growing rapidly, with its use being most common in trauma and oncology. Pre-operative planning is the most common use of 3D printing in orthopaedics. The use of 3D printing significantly reduces EBL, operative time, and fluoroscopy use compared to controls. Future research is needed to confirm and clarify the magnitude of these effects

To examine the relationship between obesity (BMI> 30) and the incidence of peri-operative complications, outcome of surgery and return to work in patients undergoing elective less invasive posterior lumbar inter-body fusion of the lumbar spine for low back pain and leg pain (“LI-PLIF”). 15 patients with BMI> 30 who underwent (“LI-PLIF”) were identified by reviewing the clinical notes and the pre-operative admission sheet from April 2005- to March 2007. All had suffered chronic low back pain for a minimum of 2 years that had proven unresponsive to conservative treatment. All patients underwent pre- and postoperative evaluations for Oswestry Disability Index (ODI), short-form 36 (SF-36), and visual analogue scores (VAS). Minimum follow-up was for 12 months. Blood loss was dependent on BMI, number of levels, and surgical time. Post operative complication was more in the morbidly obese group than the in the obese. 10 patients (66.6%) returned to their normal pre-operative employment within the 12 months of the index procedure. There was a significant improvement in the ODI and in the VAS for back pain. Length of hospital stay was a mean of 3.3 days. Although surgery is technically more demanding our experience with less invasive posterior inter-body fusion has shown less incidence of post operative complication, less intra-operative blood loss and short in-patient hospital stay. We conclude that a high BMI should not be a contraindication to surgery in patients with degenerative low back pain. Ethics approval: None: Audit Interest Statement None

The June 2014 Hip & Pelvis Roundup³⁶⁰ looks at: Modular femoral necks: early signs are not good; is corrosion to blame for modular neck failures; metal-on-metal is not quite a closed book; no excess failures in fixation of displaced femoral neck fractures; noise no problem in hip replacement; heterotopic ossification after hip arthroscopy: are NSAIDs the answer?; thrombotic and bleeding events surprisingly low in total joint replacement; and the elephant in the room: complications and surgical volume.