Aging of Population – Baby Boomers, Millennials, Generation X. Burden of TJR in USA – Estimated ∼ 4 million US adults currently live with TKR (4.2% of the population aged 50 or older) – Females (4.8%); Males (3.4%). Prevalence increased with increasing age. Estimated lifetime risk of primary TKR – 7.0% for males, 9.5% for females. Changes in Resident Education – Resident Work Hour Restrictions. Changes in Fellowship Education – Presumed shortage of fellowship trained
Aims. Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons. Methods. Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration. Results. Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female
Aims. Pelvic incidence (PI) is a position-independent spinopelvic parameter traditionally used by spinal surgeons to determine spinal alignment. Its relevance to the
The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years’ follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined.Aims
Methods
There is growing interest in the peri-operative management of patients with indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, type 2 diabetes mellitus, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian
Background. Orthopaedic surgeons are exposed to high levels of noise when performing common surgical procedures. Noise induced hearing loss (NIHL) has been demonstrated amongst senior orthopaedic staff. The objective of this study was to investigate the prevalence of hearing loss amongst
Aims. Total hip arthroplasty (THA) using the direct anterior approach (DAA) is undertaken with the patient in the supine position, creating an opportunity to replace both hips under one anaesthetic. Few studies have reported simultaneous bilateral DAA-THA. The aim of this study was to characterize a cohort of patients selected for this technique by a single, high-volume
Periprosthetic joint infections (PJIs) centers are garnering the attention of different
Aims. Total knee arthroplasty (TKA) is a common and safe orthopaedic procedure. Zimmer Biomet's NexGen is the second most popular brand of implant used in the UK. The primary cause of revision after the first year is aseptic loosening. We present our experience of using this implant, with significant concerns around its performance with regards early aseptic loosening of the tibial component. Methods. A retrospective, single-surgeon review was carried out of all of the NexGen Legacy Posterior Stabilized (LPS) TKAs performed in this institute. The specific model used for the index procedures was the NexGen Complete Knee System (Legacy Knee-Posterior Stabilized LPS-Flex Articular Surface, LPS-Flex Femoral Component Option, and Stemmed Nonaugmentable Tibial Component Option). Results. Between 2013 and 2016, 352 NexGen TKAs were carried out on 331 patients. A total of 62 TKAs have been revised to date, giving an all-cause revision rate of 17.6% at a minimum of five years. Three of these revisions were due to infection. Overall, 59 of the revisions were performed for aseptic loosening (16.7%) of the tibial component. The tibial component was removed intraoperatively without instrumentation due to significant tibial debonding between the implant-cement interface. Conclusion. While overall, we believe that early aseptic loosening is multi-factorial in nature, the significantly high aseptic revision rate, as seen by an experienced fellowship-trained
Aims. Perthes’ disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths. Methods. All patients treated for PD in our institution between January 2013 and June 2020 were reviewed retrospectively. Patients with unilateral PD, LLD of ≥ 5 mm, and long-leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD), and subtrochanteric femoral length were compared between PD side and the unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis. Results. Overall, 79 patients were included, of whom 21 underwent contralateral epiphysiodesis for leg length correction. In the complete cohort, the mean LLD was 1.8 cm (95% confidence interval (CI) 1.5 to 2.0), mean ATD difference was 1.8 cm (95% CI -2.1 to -1.9), and mean subtrochanteric difference was -0.2 cm (95% CI -0.4 to 0.1). In the epiphysiodesis group, the mean LLD before epiphysiodesis was 2.7 cm (95% CI 1.3 to 3.4) and 1.3 cm (95% CI -0.5 to 3.8) at skeletal maturity. In the nonepiphysiodesis group the mean LLD was 2.0 cm (95% CI 0.5 to 5.1; p = 0.016). The subtrochanteric region on the PD side was significantly longer at skeletal maturity in the epiphysiodesis group compared to the nonepiphysiodesis group (-1.0 cm (95% CI -2.4 to 0.6) vs 0.1 cm (95% CI -1.0 to 2.1); p < 0.001). Conclusion. This study demonstrates that LLD after PD originates from the proximal segment only. In patients who had contralateral epiphysiodesis to balance leg length, this is achieved by creating a difference in subtrochanteric length.
Introduction. Hip fractures are a common pathology treated by Orthopaedic surgeons. The Comprehensive Care for Joint Replacement (CJR) model utilizes risk stratification to set target prices for these patients undergoing hemiarthroplasty or total hip arthroplasty (THA). We hypothesized that sub-specialty
Abstract. Aim. To study and compare the rise of Inflammatory markers post TKR operated by Medial parapatellar approach with tourniquet (MP) and by Subvastus approach used without tourniquet. (SV). Materials and Methods. 100 patients were operated for a TKR by two experienced
Despite considerable legacy issues, Girdlestone's Resection Arthroplasty (GRA) remains a valuable tool in the armoury of the
The trend towards more minimal access has led to a series of instruments being developed to enable adequate access for Direct Anterior Approach (DAA) for hip arthroplasty. These include longer levers, hooks attached to the operating table and a series of special attachments to the operating table to position the leg and apply traction where necessary. The forces applied in this way may be transmitted locally, damaging muscle used as a fulcrum, or the knee and ankle joints when torque has to be applied to the femur through a boot. The
Periprosthetic joint infection is a serious complication of primary total hip replacement (THR) with significant associated morbidity. In acute infection, Debridement, Antibiotics and Implant Retention (DAIR) may be considered. Current national guidelines recommend a DAIR should be performed by “an experienced arthroplasty surgeon┕ but do not specify the need for this to be a revision arthroplasty surgeon. We investigated outcomes in our NHS Trust of DAIR procedures performed by revision and non-revision
Climbers and mountaineers will present to
Total Hip Arthroplasty (THA) and Hip Hemiarthroplasties (HA) are successful, cost-effective procedures that improve quality of life. Dislocation is a well recognised complication with a significant health and economic burden. We aim to establish the current management practices across the United Kingdom (UK) for Prosthetic Hip Dislocations (PHD). Our definition of a PHD includes; THA, HA and revision THA. This national study builds on our regional pilot study and records one of the largest datasets of Prosthetic Hip Dislocation management within the UK. A trainee-led collaborative; the North West Orthopaedic Research Collaborative (NWORC). Conducted a retrospective audit, registered as Quality Improvement (QI) projects, collected data from 38 hospital trusts across the UK. Data was collected on patient-related factors, inpatient management, and outpatient follow up of each PHD episode between January and July 2019. Primary outcome measured definitive management, in the form of revision surgery or the consideration for this through a referral pathway. A total of 673 (THA 504, Revision THA 141, HA 28) patients were included with a total of 740 dislocation episodes. Mean age was 75.6 years with female to male ratio 2:1. The majority of PHDs were a result of a low energy mechanism (98.7%) and presented over 6 months post index procedure (80.5%). Over half (53.8%) attended with a first or second time dislocation. Only 29.9% patients received onward revision referral; whereas 70.1% followed diverse management patterns, including local non-arthroplasty and primary
There is a surge of patients on the waiting-list for primary total hip replacement (THR), due to unprecedented reduction of elective activity caused by COVID-19. A higher incidence of femoral head collapse (FC) and acetabular erosion (AE) leading to increase in pain and instability as well as requirement of more complex surgery and potentially higher risk to patients was noted in this period. Rapidly progressive Arthritis (RPA) of the hip is a known entity often described as progression of joint space narrowing greater than 2mm over one year time period. The study aims to identify any potential relationship between waiting time and establishment of femoral head collapse and/ or acetabular erosion. A retrospective review of
Retained polymethylmethacrylate (PMMA) debris in surgical instrument trays is a rare, but disquieting situation for the
The National Health Service produces over 500,000 tonnes of waste and 25 mega tonnes of CO2 annually. Operating room waste is segregated into different streams which are recycled, disposed of in landfill sites, or undergo costly and energy-intensive incineration processes. By assessing the quantity and recyclability of waste from primary hip and knee arthroplasty cases, we aim to identify strategies to reduce the carbon footprint of arthroplasty surgery. Data was collected prospectively at a tertiary orthopaedic hospital, in the theatres of six
Aims. Traditionally, acetabular component insertion during total hip arthroplasty (THA) is visually assisted in the posterior approach and fluoroscopically assisted in the anterior approach. The present study examined the accuracy of a new surgeon during anterior (NSA) and posterior (NSP) THA using robotic arm-assisted technology compared to two experienced surgeons using traditional methods. Methods. Prospectively collected data was reviewed for 120 patients at two institutions. Data were collected on the first 30 anterior approach and the first 30 posterior approach surgeries performed by a newly graduated
Increased femoral head size reduces the rate of dislocation after total hip arthroplasty (THA). With the introduction of highly crosslinked polyethylene (HXLPE) liners in THA there has been a trend towards using larger size femoral heads in relatively smaller cup sizes, theoretically increasing the risk of liner fracture, wear, or aseptic loosening. Short to medium follow-up studies have not demonstrated a negative effect of using thinner HXLPE liners. However, there is concern that these thinner liners may prematurely fail in the long-term, especially in those with thinner liners. The aim of this study was to evaluate the long-term survival and revision rates of HXLPE liners in primary THA, as well as the effect of liner thickness on these outcomes. We hypothesized that there would be no significant differences between the different liner thicknesses. We performed a retrospective database analysis from a single center of all primary total hip replacements using HXLPE liners from 2010 and earlier, including all femoral head sizes. All procedures were performed by fellowship trained
The decision to undertake total hip replacement (THA) in a child is complex and daunting. This is augmented by the paucity of data on potential quality of life (QoL) improvement and functional outcomes. Therefore, the aim of this study was to ascertain whether outcomes after surgery are influenced by the nature of the primary diagnosis. This was a prospective, consecutive cohort study of patients under the age of 18 years undergoing THA by a single
Tourniquet use in total knee arthroplasty (TKA) remains a subject of considerable debate. A recent study questioned the need for tourniquets based on associated risks. However, the study omitted analysis of crucial tourniquet-related parameters which have been demonstrated in numerous studies to be associated with safe tourniquet use and reduction of adverse events. The current utilization and preferences of tourniquet use in Canada remain unknown. Our primary aim was to determine the current practices, patterns of use, and opinions of tourniquet use in TKA among members of the Canadian Arthroplasty Society (CAS). Additionally, we sought to determine the need for updated best practice guidelines to inform optimal tourniquet use and to identify areas requiring further research. A self-administered survey was emailed to members of the CAS in October 2021(six-week period). The response rate was 57% (91/161). Skip logic branching was used to administer a maximum of 59 questions related to tourniquet use, beliefs, and practices. All respondents were staff surgeons and 88% were arthroplasty fellowship trained. Sixty-five percent have been in practice for ≥11 years and only 16% for 50 TKA/year, 59% have an academic practice, and >67% prefer cemented TKA. Sixty-six percent currently use tourniquets, 25% no longer do but previously did, and 9% never used tourniquets. For those not using tourniquets, the most common reasons are potential harm/risks and publications/conferences. Among current users, 48% use in all cases and an additional 37% use in 76-99% of cases. The top reason for use was improved visualization/bloodless field (88%), followed by performing a cemented TKA, used in training, and faster operative times. The main patient factor influencing selective tourniquet use was peripheral vascular disease and main surgical factors were operative duration and cementless TKA. The most frequent adverse events reported were bruising/pinching under the tourniquet and short-term pain, which majority believed were related to improper tourniquet use (prolonged time, high-pressures, poor cuff fit), yet only 8% use contoured tourniquets and 32% don't use limb protection. Despite substantial evidence in literature that tourniquet safety and probability of harm are affected by tourniquet time and pressure, only 83% and 72% of respondents believe reducing tourniquet time and pressure respectively reduce the probability of harm. In addition, no surgeon utilizes personalized limb occlusion pressure which has been demonstrated to substantially reduce tourniquet pressure while being safe and effective. Furthermore, 62% always use fixed pressure and 37% will modify the pressure based on patient parameters, most often systolic blood pressure and limb size. Almost all (88%) were interested in new evidence-based guidelines regarding these parameters. Tourniquet use in TKA remains prevalent among
Abstract. Objectives. Obesity is prevalent with nearly one third of the world's population being classified as obese. Total knee arthroplasty (TKA) is an effective treatment option for high BMI patients achieving similar outcomes to non-obese patients. However, increased rates of aseptic loosening in patients with a high BMI have been reported. In patients with high BMI/body mass there is an increase in strain placed on the implant fixation interfaces. As such component fixation is a potential concern when performing TKA in the obese patient. To address this concern the use of extended tibial stems in cemented implants or cementless fixation have been advocated. Extend tibial stems are thought to improve implant stability reducing the micromotion between interfaces and consequently the risk of aseptic loosening. Cementless implants, once biologic fixation is achieved, effectively integrate into bone eliminating an interface. This retrospective study compared the use of extended tibial stems and cementless implants to conventional cemented implants in high BMI patients. Methods. From a prospectively maintained database of 3239 primary Attune TKA (Depuy, Warsaw, Indiana), obese patients (body mass index (BMI) >30 kg/m²) were retrospectively reviewed. Two groups of patients 1) using a tibial stem extension [n=162] and 2) cementless fixation [n=163] were compared to 3) a control group (n=1426) with a standard tibial stem cemented implant. All operations were performed by or under the direct supervision of specialist
Aim. Whether laminar airflow (LAF) in the operating room (OR) is effective for decreasing periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant yet controversial issue. This study investigated the association between operating room ventilation systems and the risk of PJI in TJA patients. Method. We performed a retrospective observational study on consecutive patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) from January 2013-September 2017 in two surgical facilities within a single institution, with a minimum 1-year follow-up. All procedures were performed by five board-certified
Obesity is an epidemic across both the developed
and developing nations that is possibly the most important current
public health factor affecting the morbidity and mortality of the global
population. Obese patients have the potential to pose several challenges
for
Over 62,000 total hip arthroplasty (THA) cases are performed each year in Canada, with an estimated annual healthcare system cost of $1.4 billion and resulting in 4 billion tonnes of waste annually (6,600 tonnes per day). The aims of this study were 1) Assess satisfaction of current/standard set-up amongst different stakeholders. 2) Assess energy, economic and waste cost of current set up and apply lean methodology to improve efficiency 3. Design and test SLIM setup based on lean principles and its ability to be safely implemented into everyday practice. A Needs Assessment Survey was circulated to OR nursing staff to assess the need for change in the current THA OR setup at an academic tertiary referral hospital. Through feedback, surgeon input, and careful analysis of current instrumentation, the “SLIM setup” was created. Standard instrument tray numbers for elective THA were reduced from 9 to 3 trays. Eighty patients were then randomised to either the standard or SLIM setup. Four staff
Introduction. Legg-Calvé-Perthes disease (LCPD) often results in femoral head deformity and leg length discrepancy (LLD). Objective of this study was to analyse femoral morphology in LCPD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalisation on proximal and subtrochanteric femoral lengths. Materials and Methods. All patients treated for LCPD in our institution between January 2013 and June 2020 were retrospectively reviewed. Patients with unilateral LCPD, LLD of ≥5mm and long leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD) and subtrochanteric femoral length were compared between LCPD side and unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis. Results. 79 patients were included, 21/79 underwent contralateral epiphysiodesis for leg length correction. In the complete cohort the average LLD was 1.8cm (95% CI 1.5 – 2.0), average ATD difference was 1.8cm (95% CI −2.1 – −1.9) and average subtrochanteric difference was −0.2cm (95% CI −0.4 – 0.1). In the epiphysiodesis group the average LLD before epiphysiodesis was 2.7 (1.3 – 3.4) cm and 1.3 (−0.5 – 3.8) cm at skeletal maturity. In the non-epiphysiodesis group the average LLD was 2.0 (0.5 – 5.1), p=0.016. The subtrochanteric region on the LCPD side was significantly longer at skeletal maturity in the epiphysiodesis group compared to the non-epiphysiodesis group: −1.0 (−2.4 – 0.6) versus 0.1 (−1.0 – 2.1), p<0.001. Conclusions. This study concludes that LLD after LCPD originates from the proximal segment only. In patients who had had a contralateral epiphysiodesis, the subtrochanteric femoral region was significantly longer on the LCPD side. These anatomical changes need to be considered by paediatric surgeons when advising leg length equalisation procedures, and by
Aims. Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications. Methods. A multi-institutional retrospective study of all consecutive total hip arthroplasty (THA) and revision total hip arthroplasty (rTHA) patients who received the monolithic TFTS was conducted. Surgery was performed by eight fellowship-trained
Purpose:. To examine the feasibility of surgical outcome measures for a children's orthopaedic surgeon when compared with other specialties. Methods & Results:. Details of procedure codes for 2726 inpatient episodes were used to examine the distribution of procedures and the breadth of diagnoses dealt with by a variety of orthopaedic sub-specialists. The author's practice included 199 surgical cases and was compared with two
The anterior approach is now an accepted approach for total hip arthroplasty. First described over a century ago, its popularity has grown significantly in the last decade with the advent of a reproducible technique on an orthopaedic table. Potential advantages include quicker recovery times, less post-operative pain, improved hip biomechanics, and more accurate cup position. While both femoral exposure and learning curve are often cited as potential drawbacks, a large percentage of US surgeons now utilise this teachable approach. The adoption of this approach has facilitated the development of new tools to assist the
Background. Total hip arthroplasty (THA) has been and continues to be the gold standard for treatment of end-stage osteoarthritis. With each year, implant characteristics are evolving to increase patient-reported outcomes and decrease complications. Purpose: to report minimum 2-year outcomes and complications in patients who underwent robotic-arm assisted THA using Corin versus Stryker-type implants. Methods. Data were prospectively collected on patients who underwent THA with Corin-type implants (both cup and stem) and THA using Stryker implants between June 2011 and July 2016. A 1:1 propensity match was performed using the following 5 covariates: age, body mass index, gender, Charlson score and smoking status. Surgical outcomes were assessed at minimum 2-year follow-up using the Forgotten Joint Score (FJS), Harris Hip Score (HHS), Veterans RAND 12-item physical and mental health survey, Short Form 12 physical and mental health survey, Visual Analog Score (VAS), and patient satisfaction. The exclusion criteria were previous hip condition/surgery, workers compensation, or were unwilling. Results. Of the eligible 774 cases, 645 patients (83.3%) had minimum 2-year follow-up and met inclusion and exclusion criteria. Of the 645 patients, 323 had Corin implants, and 155 had Stryker implants. The 1:1 propensity match successfully yielded 290 patients (145 per implant group) which had a minimum 2-year follow-up at a mean 38.3 months (range, 24.1–65.3 months). Average age was 59.9 (range, 34.92–79.89 Stryker group, 30.65–75.92 Corin group) for each group and average BMI were 30.0 (range, 19.05–49.33) kg/m. 2. for the Stryker group and 29.77 (range, 20.15–55.37) kg/m. 2. for the Corin group. FJS (P=0.0388) and patient satisfaction (P=0.0019) were significantly higher in the Stryker implant group than the Corin implant group. There were nine cases of postoperative thigh numbness or paresthesias, three cases of wound infection, and one case of nonunion in the Corin-implant group. There were four cases of postoperative thigh numbness or parasthesias and six cases of wound infection in the Stryker-implant group. Conclusion. At minimum 2-year follow-up, patients who had undergone THA with Stryker-type implants had significantly higher FJS and satisfaction and a trend toward decreased complications than patients with Corin-type implants. These results can help guide decision making for surgical instrumentation by
Introduction. Recent literature has sought to quantify pre-operative work associated with total joint arthroplasty. These studies have utilized surveys or self-reported time logs to estimate the Pre-op Optimization Work (POW) completed by the surgical team. The purpose of this study was to objectively quantify POW associated with total hip arthroplasty (THA) using electronic medical record (EMR) activity audit logs. Methods. Retrospective analysis of EMR activity for 4
Background. In recent years, the use of modern cementless implants in total knee arthroplasty has been increasing in popularity. These implants take advantage of new technologies such as additive manufacturing and potentially provide a promising alternative to cemented implant designs. The purpose of this study was to compare implant migration and tibiofemoral contact kinematics of a cementless primary total knee arthroplasty (TKA) implanted using either a gap balancing (GB) or measured resection (MR) surgical technique. Methods. Thirty-nine patients undergoing unilateral TKA were recruited and assigned based on surgeon referral to an
In the USA, 34.9% of adults are currently obese (BMI > 30). Growth in total knee arthroplasty (TKA) is outpacing growth in total hip arthroplasty (THA) largely due to a differential utilization of TKA in overweight patients in the USA. In a recent study, 54.5% of patients reporting to arthroplasty clinics in the USA were obese. From 2006–2010, 61.2% of primary unilateral TKA patients in the USA ACS-NSQIP database were obese.
Background. Highly porous acetabular components are widely used in revision hip surgery. The purpose of this study is to compare the mid-term survivorship, clinical and radiological outcomes of a hemispherical cup (Stryker Tritanium Revision component) and a peripherally expanded cup (Zimmer TM modular component) in revision hip surgery. Methods. Between 2010 and 2017, 30 patients underwent revision hip replacement using a hemispherical cup and 54 patients using a peripherally expanded cup. The surgery was carried out by two
Clinical cases will be presented to a panel of experienced
Aims. The aim of this study was to determine the general postoperative opioid consumption and rate of appropriate disposal of excess opioid prescriptions in patients undergoing primary unilateral total knee arthroplasty (TKA). Patients and Methods. In total, 112 patients undergoing surgery with one of eight
Introduction. Total hip arthroplasty (THA) is a highly successful procedure achieving excellent clinical outcomes beyond 10 years post-surgery. With exception of periprosthetic infection, dislocation is the most common cause of failure in THA. A novel reverse total hip (RTH) replacement has been developed to address dislocation through reversal of the typical THA articulation in which a femoral cup and acetabular ball interlock at the extremes of motion to enhance mechanical stability in all planes. The purpose of this study was to assess the safety and efficacy of this novel RTH in a series of 22 patients and to monitor implant fixation using radiostereometric analysis (RSA). Methods. Twenty two patients with end-stage osteoarthritis of the hip were enrolled between 2017 and 2019 at a single center. All surgeries were performed by a group of four high-volume fellowship-trained
Aim. The incidence of early periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is between 1 and 2 percent. In our department approximately 700 primary THAs and TKAs are performed annually. In 2015 and 2016 the incidence of early PJIs was nearly 3%. The aim of this study was to see if it was possible to reduce the incidence of infection by employing a bundle of measures by involving staff from all aspects of patient flow and addressing preventing measures in every step of the patients´ course throughout the hospital. Method. The
Purpose. South African
Introduction. t is accepted dogma in total knee arthroplasty (TKA) that resecting the posterior cruciate ligament (PCL) increases the flexion space by approximately 4mm, which significantly affects intra-operative decisions and surgical techniques. Unfortunately, this doctrine is based on historical cadaveric studies of limited size. This study purpose was to more accurately determine the effect of PCL resection on the tibiofemoral flexion gap dimension in vivo in a large sample. Methods. Tibiofemoral joint space measurements were made during 127 standardized TKAs by two
Background. The purpose of this study was to assess the overall clinical and radiographic outcomes of unicompartmental knee arthroplasty (UKA) in the 2–10 year postoperative period. The secondary goal was to compare outcomes between fixed- (FB) and mobile-bearing (MB) implant designs. Methods. We performed a retrospective analysis of 237 consecutive primary medial UKAs from a single academic center. All cases were performed by high-volume fellowship-trained
Background. Cementless Total Knee Arthroplasty has been developed to reduce the incidence of failure secondary to aseptic loosening, osteolysis and stress-induced osteopenia, especially in younger and more active patients. However, failures are still more common compared to cemented components, especially those involving the tibia. It is hypothesized that this is caused by incomplete contact between the tibial tray and the underlying bony surface due to: (i) inadequate flatness of the tibial osteotomy, or (ii) failure of implantation to spread the area of contact over the exposed cancellous surface. In the present study we compare the contact area developed during implantation of a cementless tray as a function of the initial flatness of the tibial osteotomy. Method. Eight
Introduction. The practice of overlapping surgery has been increasing in the delivery of orthopaedic care, aiming to provide efficient, high-quality care. However, there have been concerns about the safety of this practice. The purpose of this study is to examine safety and efficacy of a model of partially overlapping surgery that we termed “the swing room” in practice in primary hip and knee arthroplasty. Methods. A retrospective review of prospectively collected data using an administrative database was carried out on patients who underwent primary unilateral total hip and total knee arthroplasty from 2006 to 2017 at two sites of one academic center staffed by four
Minimally invasive total knee arthroplasty is purported to have a number of patient benefits: reduced post-operative pain, earlier mobilisation, and shorter in-patient stay. However, previous literature has identified the existence of a learning curve that may render the procedure unsuitable for low-volume
Total knee arthroplasty (TKA) is a common orthopaedic procedure with over 1,500 done in 2016 in Ireland alone. 96% of all TKAs are due to pain in the knee associated with osteoarthritis. According to the UK National Joint Registry (NJR), there is a 0.47%, 1.81%, 2.63% and 4.34% probability risk of undergoing a revision TKA within one, three, five and ten years respectively post-index surgery. A variety of reasons for failure of TKA have been described in the literature including infection, aseptic loosening, pain, instability, implant wear, mal-alignment, osteolysis, dislocation, peri-prosthetic fracture and implant fracture. The NexGen Posterior Stabilised Fixed has NJR revision rates of 0.44%, 1.61% and 2.54% at years one, three and five respectively. A retrospective review was carried out of 350 NexGen TKAs that were performed directly by, or under the supervision of, a fellowship trained
Introduction. The purpose of this study is to compare total and rate of caloric energy expenditure between conventional and robotic-arm assisted total knee arthroplasty (TKA) between a high volume “veteran” surgeon (HV) and a lower volume, less experienced surgeon (LV). Methods. Two specialized
The use of a tourniquet during total knee arthroplasty (TKA) is controversial. Return to function and pain are believed to be affected by the use of a tourniquet. The hypothesis of this study was that use of a tourniquet (T) would delay postoperative functional recovery and increase pain as compared to no tourniquet use (NT). 200 patients were recruited for this prospective, double-blinded, randomized controlled trial. All surgeries were performed by one of two fellowship trained