Revision Total Knee Arthroplasty (TKA) is becoming increasingly prevalent as the number of TKA procedures grow in a younger, higher-demand population. Factors associated with patients requiring multiple revision TKAs are not yet well understood. The purpose of this study is to investigate the epidemiology of re-revision TKA, and identify risk factors that are associated with failure of re-revision TKA. A retrospective analysis was performed on 358 patients who underwent revision TKA at a single institution between 1/2012 and 12/2013. Patients who underwent revision knee arthroplasty two or more times were included. Patients were excluded if their indication for the first revision was periprosthetic joint infection (PJI). Patient demographics, surgical indications, revision details, and available follow-up information were collected. Re-revision failure was defined as the need for any additional operative intervention. A logistic regression analysis was performed to assess for significant predictors of re-revision failure.Introduction
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The epidemiology of re-revision total hip arthroplasty (THA) is not well understood. The purpose of this study is to investigate the epidemiology of re-revision THA, and identify risk factors that are associated with failure of re-revision THA. A retrospective analysis was performed on 288 patients who underwent revision THA at a single institution between 1/2012 and 12/2013. Patients who underwent revision hip arthroplasty two or more times were included. Patients were excluded if their indication for their first revision was due to periprosthetic joint infection (PJI). Patient demographics, surgical indications, revision details, and available follow-up information were collected through the electronic medical record. Re-revision failure was defined as the need for any additional return to the operating room, regardless of indication. A logistic regression analysis was performed to assess for significant predictors of re-revision failure.Introduction
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Non-hinged constrained condylar components (CCK) may be used for primary TKA in presence of severe deformity, fixed contractures and ligamentous laxity. Several authors have recommended use of stem extensions to accompany CCK type of components. However, use of stem extensions in primary TKA, not only invades the medullary canal, but may also be associated with increased surgical time, implant cost, and thigh or leg pain. The purpose of this study was to assess the short-term outcomes of primary CCK knees without stem extensions and to compare this to a control group of standard posterior stabilized (PS) knees, otherwise using the same implant design. We retrospectively reviewed the clinical and radiographic data on 503 consecutive TKA's performed by 2 arthroplasty surgeons at the same institution between 2008–2010. Surgical technique, implant type, bone-cement and cementation technique was similar. The only difference between groups was the use of CCK polyethylene insert in one group and a PS insert in the other. Knee society scores (KSS) were used to determine pain, function and ROM. Radiographic evaluation was done using the knee society's criteria to determine implant fixation. Failure was defined as revision for any reason. Statistical analyses were performed using SPSS software.Introduction:
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Acetabular component position is an important determinant of stability, wear and impingement following total hip arthroplasty (THA). Its optimum position and size in direct anterior approach (DAA) THA has not been clearly described in previous studies. Our aim was to study the evolution of the same with reference to stability and impingement as a part of a single surgeon's learning curve. Clinical and radiographic records of first 300 consecutive DAA THAs performed by a single surgeon from April 2009 to April 2011 were reviewed from a prospective database at a single center. Radiographic analysis was done by two observers to determine acetabular inclination and anteversion on 6 week postoperative standing radiographs. Native femoral head size, measured on preoperative radiographs after adjusting for magnification, was used to calculate the native acetabular cup size. The study population was divided into three groups; Group A– 1st 100 DAA THA cases, Group B – 2nd 100 and Group C – 3rd 100 corresponding to the use of intraoperative anterior stability assessment (Group B and C) and change in the cup size strategy (Group C). The incidence of instability and psoas impingement (PI) –related groin pain at 2 year follow-up was determined for the three groups. Statistical analysis was done to see if there were differences in these clinical and radiographic outcome measures in the three groups.Introduction
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Direct anterior approach (DAA) total hip arthroplasty (THA) has been reported to be a muscle sparing approach. The purpose of this study was to compare gait patterns over time between patients undergoing THA via DAA and posterior approach (PA). 22 patients with unilateral primary hip osteoarthritis were prospectively enrolled and gait analysis was performed prior to, at 6 months and 1 year following THA via DAA and PA. All PA THA's were performed by a single surgeon from January 2008 to February 2009; all DAA THA's were performed by the same surgeon at the same institution from January 2010 to May 2011 with similar design of uncemented acetabular, femoral components and bearing surfaces. Reflective markers were placed on the lower extremity and motion data collected using six infrared cameras (Qtrac, Qualysis). Ground reaction forces were recorded with a multicomponent force plate (Kistler). A repeated-measures ANOVA was used to compare changes in gait parameters over time. Harris Hip Score was used to quantify pain and function.Introduction:
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Severe bone loss creates a challenge for fixation in femoral revision. The goal of the study was to assess reproducibility of fixation and clinical outcomes of femoral revision with bone loss using a modular, fluted, tapered distally fixing stem. 92 consecutive patients (96 hips) underwent hip revision surgery using the same design of a modular, fluted, tapered titanium stem between 1998 and 2005. Fourteen patients with 16 hips died before a 2-year follow-up. Eighty hips were followed for an average of 11.3 years (range of 8 to 13.5 years). Bone loss was classified as per Paprosky's classification, osseointegration assessed according to a modified system of Engh et al, and Harris Hip Score was used to document pain and function. Serial radiographs were reviewed by an independent observer to assess subsidence, osseointegration and bony reconstitution.Introduction:
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The purpose of this study was to determine the efficacy of a multi-modal blood conservation protocol that involved pre–operative autologous blood donations (2 units) in conjunction with erythropoietin supplementation as well as intra-operative conservation modalities. A retrospective chart review of 90 patients with simultaneous bilateral total knee arthroplasty done between 2006–2009 by one of the 3 senior authors was performed. Patients donated two units of blood 4 weeks prior to surgery and also received erythropoietin injections (40,000 units: 3 weeks, 2 weeks and 1 week prior to surgery). Intra- operative blood management included use of pneumatic tourniquet, re-infusion drains, local epinephrine injections and fibrin spray. Post-operatively, autologous transfusions were provided based on symptoms. Pre-donation blood levels, peri-operative hemoglobin and hematocrit levels along with transfusion records were assessed.Introduction
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Acetabular cup orientation is an important element of Total Hip arthroplasty (THA). The purpose of this retrospective case-control study was to compare variability of acetabular cup placement between THA performed via Direct Anterior Approach (DAA) with fluoroscopy in supine position and posterior approach (PA) in lateral position without use of fluoroscopy. Radiographic and clinical records of THAs performed by a single, high volume arthroplasty surgeon at one institution were reviewed. Patients with similar design of uncemented acetabular cup, femoral component and bearing surface were included to form two groups. PA group consisted of 300 THAs performed from May 2006 to June 2009. DAA group consisted of 300 THAs performed from Oct 2009 to Oct 2011 excluding first 100 cases to eliminate the influence of learning curve. Radiographic analysis was done by two independent blinded observers to determine cup inclination and anteversion (Liaw et al) on standardized, 6 week postoperative, standing anteroposterior pelvic radiographs using Picture Archiving and Communication System software (PACS).INTRODUCTION
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Patellar mobilisation methods used during total knee arthroplasty (TKA) have been debated in the literature, with some proponents of minimally invasive TKA suggesting that laterally retracting, rather than everting the patella may be beneficial. It was our hypothesis that by using randomised, prospective, blinded study methods, there would be no significant difference in clinical outcome measures based solely on eversion of the patella during total knee arthroplasty. After an Introduction
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Cadaveric studies have reported damage to the direct head of rectus femoris and tensor fascia lata muscles with direct anterior approach(DAA) and to the abductors, external rotators with posterior approach(PA). The aim of this prospective study was to evaluate differences in hip muscle strength recovery between DAA and posterior approach (PA) THA. Patients with unilateral hip osteoarthritis undergoing THA at a single institution from January 2011 to October 2011 were enrolled. All DAA THA's were performed by one surgeon, and all PA THA's were performed by another surgeon with similar design of components, pain management and rehabilitation protocols. Hip muscle strength was measured with a handheld dynamometer in all planes by a single observer preoperatively, at 6 weeks, 3 months and 6 months. Functional recovery was assessed with the motor component of Functional Independence Measure, UCLA activity score, Harris hip score, SF-12 score.INTRODUCTION
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Osteoarthritis (OA) of the hip and the knee has been found to affect sexual activity. Few retrospective studies have investigated the role of total hip replacement on sexual function. We designed a prospective study to evaluate the influence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) on the physical and psychological aspects of sexuality of patients. Between April 2009 and April 2011, patients under 70 years of age scheduled for primary THA or TKA for OA were invited to anonymously participate in this study. All patients were recruited from the practices of 2 arthroplasty surgeons (at the same institution) by mailing the 2 questionnaires, 2 pre-paid self-addressed envelopes and a cover letter. Patients were instructed to mail back the pre-operative questionnaire prior to surgery and the post- operative questionnaire 6 months after surgery. Enrolled patients were also contacted after 1 year of surgery to fill a similar questionnaire. Responses were identified only by a unique code number on the questionnaire.INTRODUCTION
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Although Total Knee Arthroplasty (TKA) has been shown to correct abnormal frontal plane knee biomechanics, little is known about this effect beyond 6 months. The purpose of this study was to compare sequentially the knee adduction moment during level-walking before and after TKA in varus knees. We hypothesized that adduction moment would diminish after TKA proportionate to the tibio-femoral realignment in degrees. Fifteen patients (17 TKA's) with varus knees were prospectively enrolled and gait analysis performed prior to, 6 months and 1 year following TKA. Reflective markers were placed on the lower extremity and motion data collected using six infrared cameras (Qtrac, Qualysis). Ground reaction forces were recorded with a multicomponent force plate (Kistler). A repeated-measures ANOVA was used to compare changes in the peak adduction moment and peak dynamic varus angle over time.Introduction
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Fixation remains a challenge in Revision TKR. Irregular and cavitary bone loss may precludeproper metaphyseal cementation and pressurization. Metaphyseal sleeves have been proposed to improve theinherent rotational stability of the implant bone interface. The goal of this study was to assess the effect of the use of metaphyseal sleeves on the quality of the cement fixation achieved. Fifty consecutive revision TKRs for AORI type 2 and 3 bone loss between January 2005 through January 2008 with average 2 years follow up were assessed retrospectively. Twelve patients were excluded for inadequate follow up. Nineteen patients with 26 cemented metaphyseal sleeves (15 tibiae and 11 femora) formed group 1 and 19 patients with 36 revision components (without metaphyseal sleeves) served as control (group 2). Patients were assessed clinically with knee society scores (KSS) and radiographically by quality of metaphyseal cement mantle and radiolucent lines(RLL). Groups were matched for pre-op bone loss and length of follow-up.Introduction
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Studies have documented encouraging results with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss. However, radiographic signs of osseointegration and patterns of reconstitution have not been previously categorized. 64 consecutive hips with index femoral revision using a particular stem of this design formed the study cohort. Serial radiographs were retrospectively reviewed by an independent observer. Bone loss was determined by Paprosky's classification. Osseointegration was assessed by a slight modification of the criteria of Engh et al. Femoral restoration was classified according to Kolstad et al. Pain and function was documented using Harris Hip Score (HHS).Introduction
Materials and Methods
It is not uncommon to encounter patients with atypical hip or lower extremity pain, ill-defined clinico-radiological features and concomitant hip and lumbar spine arthritis. It has been hypothesized that an anaesthetic hip arthrogram can help identify the source of pain in these cases. The purpose of this study is to analyze our experience with this technique in order to verify its accuracy. We undertook a retrospective analysis of 204 patients who underwent a hip anesthetic-steroid arthrogram for diagnostic purposes matching our inclusion criteria. Patient charts were scrutinized carefully for outcomes of arthrogram and treatment. Harris Hip Score was used to quantify outcome.Introduction
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