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Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_2 | Pages 107 - 107
1 Jan 2016
Kindsfater K Sherman C Bureau C
Full Access

Introduction

Revision TKA can be a difficult and complex procedure. Bone quality is commonly compromised and stem fixation is required in many cases to provide stability of the prosthetic construct. However, utilization of diaphyseal engaging stems adds complexity to the case and can present technical challenges to the surgeon. Press fit metaphyseal sleeves can provide stable fixation of the construct without the need for stems and allows for biologic ingrowth of the prosthesis. Metaphyseal sleeves simplify the revision procedure by avoiding the need to prepare the diaphysis for stems, alleviating the need for offset stems and decreasing the risk of intra-operative complications. The ability to obtain biologic fixation in the young patient is also appealing. This study reports on the author's mid-term experience with this novel technique.

Methods

Between May 2007 and June 2009 the author performed 17 revisions TKA that utilized press-fit metaphyseal sleeves without stems on either the tibial side of the joint, the femoral side of the joint or both. Twenty six sleeves were implanted altogether (13 tibial, 13 femoral). Patients were limited to touch down weight bearing for 6 weeks post-operatively. The patients were followed prospectively with clinical and radiographic follow-up at routine intervals.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 226 - 226
1 Mar 2013
Kindsfater K Sherman C Bureau C Tescula J
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Introduction

Modern acetabular shells have many liner options from which the surgeon can choose to most appropriately reconstruct the arthritic hip. Lateralised liners are one option that is available to the surgeon and these liners have potential benefits over “standard” polyethylene liners. Benefits include decreased Von Mises stresses which may lead to decreased polyethylene wear, lateralisation of the femur away from the pelvis which can decrease impingement / increase ROM and having the ability to use larger femoral heads in a smaller shell improving stability of the THA. Despite these benefits, lateralised liners are not routinely used by surgeons as there is concern over lateralisation of the centre of rotation of the hip with increased joint reaction forces, unsupported polyethylene that could lead to liner failure, and a slightly increased torque moment to the shell which could lead to micromotion and failure of the shell to obtain bony ingrowth. This study reports on 5-year minimum clinical and radiographic F/U of a prospective series of lateralised, moderately crosslinked polyethylene liners.

Methods

102 consecutive patients who were to have a THA with a polyethylene liner were enrolled prospectively in an acetabular shell study. Two patients that had standard thickness liners were excluded from this analysis. The remaining 100 patients all had +4 lateralised liners of the same construct (Marathon polyethylene / Pinnacle Cup, DePuy, Warsaw, Indiana). All surgeries were performed by the same surgeon via a posterior approach. A neutral or 10 degree face changing liner was chosen based on shell position and stability of the THA construct. Patient data including the Harris Hip Score (HHS), WOMAC and ROM was collected at 3, 6 and 12 months and yearly thereafter. Radiographs were obtained at each visit.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXV | Pages 113 - 113
1 Jun 2012
Kindsfater K Terefenko C Bureau C Sherman C
Full Access

Introduction

Metal on metal hip bearings (MoM) are under scrutiny. Short and mid-term complications attributed to metal wear debris have been reported. Distinctions between MoM prostheses exist. Thus, generalizing findings from one design to another is questionable. This study reports minimum 5 yr. Pinnacle™ modular MoM results.

Methods

Between September 2001 and October 2004, 95 consecutive MoM THAs were performed by one surgeon in a prospective cohort design. Mean age was 53 yrs (range 34-70); 57 were male. Mean BMI was 29 (range 20-46). OA was noted in 87 patients. Head size was 28mm in 3 and 36mm in 92. Surgical approach was postero-lateral in all patients. Harris Hip Score (HHS), WOMAC, ROM and radiographs were evaluated preoperatively, at 6-months, and yearly thereafter.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 454 - 454
1 Nov 2011
Dennis D Johnson D Kindsfater K Kim R
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Introduction: Obtaining accurate anatomic and mechanical alignment in total knee arthroplasty (TKA) is correlated with improved long-term results. Whether computer-assisted total knee arthroplasty (CAS-TKA) more reliably produces a neutral mechanical and anatomic alignment and improves functional outcomes over traditional total knee arthroplasty (T-TKA) remains debatable. This report evaluates the results of CAS-TKA vs. T-TKA in a series of patients who underwent bilateral TKA performed at the same surgical operation.

Methods: Sequential bilateral TKA were performed on 36 patients utilizing CAS-TKA in one knee and T-TKA in the contralateral knee by two high volume, fellowship trained surgeons. A review and statistical analysis of prospectively collected data was performed after a mean follow-up of 2.2 years.

Results: Knee Society Scores (KSS) improved from 42.9 to 96.3 in the CASTKA group vs. 46.0 to 94.8 in the T-TKA group. Range of motion (ROM) improved from 116.8° to 126.9° in the CAS-TKA group vs. 118.3° to 125.4° in the T-TKA group.

With numbers available, there were no differences between the groups with regard to change in KSS (p=0.38), ROM (p=0.42), mean postoperative anatomic alignment (5.78° vs. 5.50°, p=0.37), femoral angle (5.56° vs. 5.61°, p=0.84), or tibial angle (89.89° vs.

89.69°, p=0.46). There was a non-significant trend towards fewer outliers in the CASTKA group with respect to anatomic alignment (2.8% vs. 13.9%, p=0.09) and tibial angle (0% vs. 5.6%, p=0.46).

Conclusion: There is not an apparent benefit to the use of CAS-TKA with regards to KSS, ROM, or alignment in the hands of high-volume, fellowship-trained total joint specialists. The clinical relevance of the non-sig-nificant trend towards fewer outliers in the CAS-TKA group is unknown at the current follow-up interval. These results may not preclude the benefits of CAS-TKA in lower-volume or less experienced TKA surgeons.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 405 - 406
1 Nov 2011
Kindsfater K Dennis D Politi J
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Introduction: Although use of modular femoral components in revision hip arthroplasty is widely accepted, many still question the need for modular versatility in primary THA. The purpose of our study was to examine in a large cohort the percentage of hips in which femoral component version was changed to optimize stability or avoid prosthetic impingement of the THA construct. We hypothesized that the percentage of hips needing version change in routine primary THA would be low.

Methods: This prospective study analyzed 1000 consecutive primary THAs using a modular S-ROM (DePuy) stem performed by 3 surgeons at 3 institutions all via a posterior approach. Mean patient age at surgery was 57.5 years; 51.6% were male. The difference in version between the femoral sleeve placed anatomically and the femoral stem was recorded intra-operatively.

Results: Femoral component version was changed in 47.9% of hips. Logistic regression analysis showed no correlation between the likelihood of changing stem version and patient age (p=0.87), gender (p=0.23), diagnosis (p=0.54), or surgeon (p=0.27). 10 hips (1%) experienced early dislocation (within 3 months post-op). With the numbers available, there was a slight trend of lower dislocation rate in hips where stem version was changed (0.6%) versus those in which it was not (1.5%, p=0.16, chi squared).

Conclusion: The incidence of femoral version change in routine primary THA was much higher than expected. It was difficult to predict the need to alter version based on clinical variables including diagnosis. Thus, we conclude it may be advantageous to routinely use a stem that allows variable version as it is not possible to pre-operatively determine when changing version will be required. In addition, we surmise our low dislocation rate compared to historical controls of THA performed using a posterior approach was aided by the ability to adjust version in almost half of our patients.