Autologous bone has been the gold standard for grafting material in foot and ankle arthrodesis. While autograft use has been effective, the harvest procedure does present risks to the patient including readmission, infection, and persistent graft harvest site pain. Previous studies have examined graft harvest site pain, but most have focused on the iliac crest and none have long term follow-up. The purpose of this study was to examine long-term (7–10 year) harvest site pain in subjects undergoing autograft harvest from multiple sites for hindfoot and/or ankle arthrodesis. Sixty (60) subjects underwent hindfoot or ankle arthrodesis supplemented with autograft as part of the control arm of a prospective, randomized trial. The mean subject age was 59.4 years (range, 24.7–76.8) and mean body mass index was 30.6 kg/m2 (range, 22.0–44.0). There were 29 males and 31 female subjects. Subjects had the tibiotalar (37.9%), subtalar (24.1%), talonavicular (10.3%), subtalar/talonavicular (5.1%), or subtalar/calcaneocuboid/talonavicular (22.4%) joints arthrodesed. Autograft was harvested from either the proximal tibia (51.7%), iliac crest (17.2%), calcaneous (15.5%), distal tibia (6.8%), or other location (8.6%). Graft harvest site pain was evaluated using a 100-point visual analog score (VAS), with clinically significant pain being any score greater than 20. Subjects were followed a mean of 9.0 years (range, 7.8–10.5). The percentage of subjects who reported clinically significant pain was 35.7%, 21.4%, 18.2%, 10.5%, 8.9%, and 5.2% at 2, 6, 12, 24, 52 weeks, and final follow-up (7.8–10.5 years), respectively. The mean VAS autograft harvest site pain at final follow-up was 4.4 (range, 0.0–97.0), with 37.9% of subjects reporting at least some pain. For three subjects (5%) with clinically significant pain (VAS >20) at final follow-up, two had proximal tibial harvest sites and one had an iliac crest harvest site. There was no correlation between graft volume and harvest site pain. This study is the first to examine long-term pain following autologous bone graft harvest for hindfoot and/or ankle arthrodesis. Over a third of patients reported having some pain at an average follow-up of nine years, with 5% experiencing clinically significant pain. The results of this study suggest that harvesting autograft bone carries a risk of persistent, long-term pain regardless of the volume of graft that is harvested. This potential for persistent pain should be considered when informing patients of procedure risks and when deciding to use autograft or a bone graft substitute material.
The National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man (NJR) monitors the performance of primary total hip arthroplasty (THA) implants and summarizes usage and outcomes for specific hip systems. The objectives of this study were to 1) determine if survivorship for the PROCOTYL® L acetabular cup, a hemispherical press-fit cup coated with hydroxyapatite and a metal on XLPE articulation, is significantly different from all other cementless cups in the NJR and 2) to analyze patient reported outcomes measures (PROMs) at a minimum five year follow-up for the subject cup. The database of the NJR was searched for demographic information and survivorship data for all THAs performed with the PROCOTYL® L cup (metal on XLPE) and all other cementless cups. Survivorship data for both groups was adjusted to exclude metal on metal bearings and compared for all revisions and acetabular revisions only. The Cox Proportional Hazards model for the revision risk ratio of the subject cup to all cementless cups was also calculated. Patients with the subject cup implanted for at least five years were mailed a PROMs program questionnaire consisting of the Oxford Hip, EQ-5D, and EQ VAS scores. No pre-operative PROMs scores were collected.Introduction
Methods
Recently there have been case reports of component fractures and elevated metal ion levels potentially resulting from the use of cobalt-chrome modular necks in total hip arthroplasty. One potential cause that has been suggested is fretting corrosion caused by micromotion at the taper junction between the modular neck and the femoral stem. The objective of the current study was to investigate the effects of various impaction and loading methods on micromotion at the modular neck-femoral stem interface in a total hip replacement system. A femoral stem was potted using dental acrylic and displacement transducers were inserted to measure micromotion in the modular neck pocket (Figure 1a). An 8° varus, long, cobalt-chrome, modular neck and 28 mm XXL cobalt-chrome femoral head were inserted in the femoral stem using various assembly techniques (a) hand assembly, (b) impaction loads: 2, 3, 4, 6, 16.4 kN and (c) INTRODUCTION
METHODS
Total hip replacement (THR) is one of the most successful orthopedic surgeries performed today. Long term success of THR has been well established, but there remains significant room to improve early outcomes (e.g. pain, length of hospital stay, readmissions). The surgical technique is a key variable affecting these early outcomes. The objective of the current study was to evaluate outcomes for over 1,000 consecutive THRs using the supercapsular percutaneously-assisted total hip (SuperPath) approach. Between September 2008 and April 2015, one surgeon performed 1,074 consecutive primary THRs using the SuperPath surgical technique. All THRs were performed without local anesthesia, patient controlled analgesia (PCA), or postoperative hip precautions. Surgical outcomes including operative time, blood loss, incision length, length of stay (LOS), and complications were collected as part of this IRB approved study. Harris Hip Scores (HHS) and UCLA scores were obtained preoperatively and at 6 and 12 months postoperatively.Introduction
Patients and Methods
Total hip replacement is increasingly being conducted in younger and more active patients, so surgeons often use bearing surfaces with improved wear characteristics, such as ceramic on ceramic. The primary objective of this study was to determine if survivorship for a BIOLOX® delta ceramic on delta ceramic couple used with the PROCOTYL® L acetabular cup is significantly different from all other cementless cups in a large arthroplasty registry. The secondary objective of this study was to analyze patient reported outcomes measures (PROMs) of the subject cup with a minimum five year follow-up. Patient demographics and survivorship data was collected from the National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man (NJR) database for all total hip replacements performed with the PROCOTYL® L cup used in combination with a delta-on-delta articulation, as well as for all other cementless cups. Survivorship data was compared for all revisions and cup revisions only and data was adjusted to exclude metal on metal articulations. The hazard ratio of the subject system to all cementless cups was also calculated with the Cox Proportional Hazards model. Patients with the subject components implanted for a minimum of five years completed Oxford Hip, EQ-5D, and EQ VAS score questionnaires.Objectives
Methods
Total knee replacement (TKR) implant designs and materials have been shown to have a significant impact on tibial insert wear. A medial-pivot (MP) design theoretically should generate less wear due to a large contact area in the medial compartment and lower contact stresses. Synovial fluid aspiration studies have confirmed that a first generation MP TKR system (ADVANCE®, MicroPort Orthopedics Inc., Arlington, TN, USA) generates less wear debris than is seen with other implant designs articulating against conventional polyethylene (CP). The objective of this study was to evaluate the Introduction
Objectives
The supercapsular percutaneously-assisted total hip (SuperPath) replacement surgical technique was developed as a hybrid of the supercapsular (SuperCap) and percutaneously-assisted total hip (PATH) approaches. The technique does not require any muscle release and preserves the external rotators with the objectives of reducing hospital length of stay, increasing the percentage of subjects discharged home, and decreasing complications (e.g. dislocation). The purpose of this study was to evaluate these perioperative outcomes associated with a large consecutive cohort of prospectively followed subjects. Four hundred eighty-six (486) consecutive total hip replacements (THRs) were performed using the SuperPath technique in 469 subjects between April 29, 2010 and December 31, 2013 and prospectively followed. Perioperative outcomes including length of stay, discharge status, skin-to-skin surgical time, estimated blood loss, transfusions, and complications were collected. Subjects were also evaluated using Harris Hip Scores (HHS), UCLA Activity Scores, range of motion, and Numeric Rating Scale (NRS-11) Scores.Introduction
Patients and Methods
Quadriceps performance following total knee arthroplasty (TKA) is a critical factor in patient satisfaction that can be significantly affected by implant design (Greene, 2008). The objective of this study was to compare quadriceps efficiency (QE) following TKA with a medial-pivot system (EVOLUTION®, MicroPort Orthopedics Inc., Arlington, TN, USA) to non-implanted control measurements. Five cadaveric leg specimens with no prior surgeries, deformities, or disease were obtained. Each was placed in a custom closed chain device and loaded to simulate a heel-up squat from full-extension to deep flexion (approximately 115°) and back to full extension. Quadriceps force (FQ) and ground reaction force (FZ) were measured, and the ratio of the two was calculated as the quadriceps load factor (QLF). QFLs are inversely related to QE, with higher QFLs representing reduced efficiency. Each specimen was then implanted with a medial-pivot implant by a board certified orthopedic surgeon and force measurements were repeated. Mean pre- (represents control values) and post-implantation QFLs were compared to determine any differences in QE throughout the range of motion.Introduction
Methods
