Introduction

Perioperative optimization efforts have improved outcomes following primary total knee arthroplasty (TKA). However, morbidly obese patients continue to have increased rates of complications. The purpose of this study was to assess if rates of early complications after TKA have similarly improved for both morbidly obese and non-morbidly obese patients.

Introduction

There have been significant advancements in postoperative care following total hip arthroplasty (THA) over the past decade and it is essential to quantify the impact of efforts made to better optimize patients and improve postoperative care. The purpose of this study was to assess trends in discharge destination, length of stay (LOS), and readmissions following primary THA.

Introduction

In 2015, the healthcare system transitioned from International Classification of Diseases, Ninth Revision (ICD-9) coding to the Tenth Revision (ICD-10). Given that administrative claims are used for quality initiatives, risk adjustment models and clinical research, we sought to determine the effect of new, more detailed coding on the incidence of complications following primary total knee arthroplasty (TKA).

Purpose

Obesity has previously been demonstrated to be an independent risk factor for increased complications following total hip (THA) and total knee arthroplasty (TKA). The purpose of this study was to compare the effects of obesity and BMI to determine whether the magnitude of the effect was similar for both procedures.

Purpose: To our knowledge, there are no 35 year follow-up studies of the Charnley total hip arthroplasty in the United States. The purpose of the study was to evaluate the results of a single surgeon series of primary Charnley total hip arthroplasties performed with cement at a minimum 35 year follow-up interval.

Method: Between July 1970 and April 1972, the senior author performed 330 Charnley total hip replacements with cement using a hand-packing cement technique. At minimum 35 years post-operatively, 13 patients (16 hips) were alive, with 1 patient (1 hip) lost to follow-up. Living patients were evaluated clinically with a standard terminology questionnaire, and WOMAC. Radiographic evaluation included loosening, lysis, and need for reoperation.

Results: After a minimum 35 year follow-up, only 25 (8%) acetabular components and 10 (3%) femoral components revised for aseptic loosening. For the 16 hips in living patients, 7 acetabular components (44%) and 2 femoral component (12%) were revised for aseptic loosening. Overall, 87% of the original prosthesis remains intact at the time of final follow-up, or at the time of the patient’s death. The average linear wear rate for all patients with minimum 10 year radiographic follow-up was 0.09 mm/year.

Conclusion: Our follow-up study at a minimum 35 years following Charnley total hip arthroplasty with cement demonstrates the remarkable durability of the procedure. As demonstrated in this study, the long term challenge has been revisions associated with bearing surface wear. This study should provide a benchmark for comparison to follow-up studies of other procedures and devices as they reach this interval of follow-up.

Purpose: The original AML prosthesis was fully coated and later the manufacturer switched it to 5/8ths coating. The second generation Prodigy femoral component was developed to return to full coating of the prosthesis and to provide a medial relief to decrease bone stress shielding. The purpose of this study was to evaluate the minimum ten year results using this device and to compare the results to the same surgeon’s results at 10 years using a first generation proximally coated device.

Method: 100 consecutive primary total hip replacements were performed by a single surgeon in 86 patients using the Prodigy (DePuy, Warsaw, Indiana) femoral component between 1994 and 1997. The components were mated with 80 HGI and 20 Duraloc acetabular components. Patients were evaluated with WOMAC ratings, need for revision and radiographic loosening. The same parameters had been evaluated at minimum 10-year follow-up for the same surgeon’s initial 100 consecutive PCA (Stryker, New Jersey) primary THR’s and were compared to the present series.

Results: At minimum 10 year follow-up, 71 patients with 83 hips were living. The average clinical follow-up for the living patients was 11 years (range 10 to 12 years) and the average radiographic follow-up was 9.2 years for this group (range 7–12 years). No femoral component was revised for loosening and all femoral components were bone ingrown on radiographs. 7 acetabular components required a liner exchange or revision for polyethylene wear. This compares favorably to the same surgeon’s 10 year results with the PCA where 6 femoral components were revised for wear or loosening and an additional 2 were radiographically loose.

Conclusion: The Prodigy femoral component demonstrated excellent durability at 10 years. With the newer cementless stems with a wide variety of sizes, femoral loosening is rarely a clinical problem.

Purpose: Few reports are available at minimum 15 year follow-up of cemented modular cruciate retaining TKA, especially where all polyethylene patella components were utilized. This paper addresses the questions “What is the durability of cemented modular cruciate retaining TKA with all polyethylene patella components at 15 years?” and “Did modular tibial trays demonstrate their utility in terms of the potential for less costly and less complex revisions?”

Method: 101 Press Fit Condylar TKA’s were performed consecutively over a 27 month interval and followed prospectively for a minimum of 15 years. The average age at surgery was 72 years. Clinical Knee Society scores, need for revision, radiographic evidence of loosening, and osteolysis were recorded. All patients were recalled at 5 year intervals.

Results: At minimum 15 year follow-up, 34 patients with 45 knees were living and 40 patients with 54 knees were deceased (one patient [2 knees] was lost to follow-up). 81% of living patients had 15 year radiographs. 6 knees were revised (all related to wear and osteolysis). Average Knee Society clinical scores only deteroriated from 92 points to 89 points between 10 and 15 years.

Conclusion: This cemented modular CR TKA performed well at 15 years with only 6% of knees requiring revision. All revisions occurred after 10 years and were related to wear and osteolysis. 2/3 of the revisions could be salvaged without tibial component revision in this closely followed series. Hopefully these results can be improved with better wear-resistant designs and better quality polyethylene. Especially into the second decade, patients with modular tibial tray TKA constructs should be closely followed to optimize their utility allowing less costly and less complex revisions in cases with polyethylene wear.