Introduction

Enhanced Recovery After Surgery (ERAS) is a multi-disciplinary approach for establishing procedure–specific, evidence-based perioperative protocols to optimize patient outcomes. ERAS evidence is predominantly for non-orthopaedic procedures. We review the impact of ERAS protocol implementation on total joint arthroplasty (TJA) outcomes at our institution.

Introduction: Less invasive surgical technique in THA is expected to minimize soft tissue damage and expedite rehabilitation. Due to this, it is now in widespread use in elective THA. The large geriatric patient population suffering a fractured neck of femur thereby would also benefit of this technique. Aim of this study was to evaluate if this technique is feasible in the non-elective setting of geriatric patients and if there are benefits regarding clinical and social outcome.

Patients and Methods: Study setup is a prospective randomized trial with a positive Ethical Committee vote. Included were patients under legal care of a third party. Inclusion criteria were the indication for bipolar hip arthroplasty including grade ASA 4; exclusion criteria included neoplastic disease and rheumatoid arthritis. Setting is a large university hospital. After biometrical evaluation, each arm was set as 30 patients. Primary end point was the modified Barthel index. 48 patients were female. Mean age for female patients was 85.5, for male 82.9 years. There was no detectable difference in the groups regarding age, sex and BMI. As a less invasive approach, the well described „Direct Anterior Approach-DAA”(modified Smith-Petersen approach) was chosen. In the other arm the Watson-Jones approach was used. The ABG II stem with a bipolar UHR head (Stryker) were used in both groups. To minimize the learning curve, 10 cadaver- and 15 clinical procedures were performed with the DAA approach before the study. The pre- and postoperative regimen was identical in both arms. The modified Barthel index and other clinical parameter were determined preoperatively and at 4 postoperative intervals up to 40 days.

Results: There were no statistical differences between both groups for intra- and postoperative complications. The mean theatre time was 4.8 minutes longer for the DAA group, in the first 10 patients this difference was measured with 16 minutes. The Barthel Index was only statistically different at 40 days, at this time the DAA patients had reached their preoperative mobility level whilst the conventional approach patients (with a pre-operative level of 42.5) were measured with 25 points. The hemoglobin levels on day 5 and 16 were significantly different with a higher Hb for the DAA group. All other parameters showed no significant difference.

Conclusion: The DAA approach has a clear learning curve. Once this has passed, the theatre time is only slightly longer. There is a detectable benefit regarding early rehabilitation and a slight but significantly reduced blood loss.

There has been a longstanding need for a structural biomaterial that can serve as a bone graft substitute or implant construct and is effective for fixation by bone ingrowth. A porous tantalum material was developed to address these issues. The purpose of this paper and presnetation is to describe the properties and 2 to 5 year clinical results of porous tantalum in various reconstructive orthopaedic procedures.

Porous tantalum has been used to manufacture primary and revision acetabular cups, acetabular augments, tibial and patella implants, patellar augments, structural devices for the treatment of osteonecrosis, and spinal fusion implants. Clinical follow-up includes: 2–5 year clinical and radiographic evaluation of: 414 monoblock cups in primary THA, 36 monoblock cups and 587 revision hemispheres used in revision THR, 16 hips revised with acetabular augments and revision hemispheres; 2 to 4 years for 101 tibial implants used in primary TKR and 69 patellas used in cementless TKR; 2–4 years for 11 patellar augments in salvage TKR, 1–5 years for 53 revision TKRs using knee spacers; 1–4 years for 91 osteone-crosis hip implants; and for 15 cervical fusion cases.

This innovative tantalum implant material with trabecular architecture possesses advantages in stiffness, friction coefficient, porosity, rate and extent of tissue ingrowth, and versatility in manufacturing of structural devices. It has been clinically validated in numerous and diverse reconstructive procedures.

Press-fit acetabular reconstructions have become the standard THA; however, controversies remain. The purpose of this study was to critically evaluate serial radiographs for initial cup stability, i.e. gaps and signs of periacetabular interface changes for a porous tantalum monoblock socket.

A multicenter study evaluating 574 primary THRs (542 patients) performed by 9 surgeons at 7 hospitals, all with a monoblock cup without screws. Analyses included clinical outcomes and detailed 2-year minimum radiographic evaluation by one independent observer (mean follow-up, 33 months).

Complications included 9 intra-operative acetabular fractures. Among the 123 cases excluded from radiographic evaluations: deceased (19), lost-to-follow-up (8), 7 early revisions (recurrent dislocations (6) and one trauma-related loosening), and sepsis (3). Patient demographics (414 hips): mean age 65 years (19–93); 58 percent females. Baseline radiographs revealed 113 zones in 85 hips (21 percent) with acetabular gaps; 36 in zone I, 72 in zone II, and 5 in zone III. Of these radiolucencies, 57 zones were 1 mm or less and 56 zones ranged from 2 to 5 mm. At last follow-up, 64 hips (75 percent) had complete gap fill-in, including 100 percent of gaps greater than 3 mm.

There were no socket migrations, no evidence of lysis, no revisions for loosening, and no complete periacetabular interface radiolucencies. The fill-in of preexisting OA cysts and gaps is attributed to adequate initial stability and osteointegration into the porous tantalum. These results suggest that a monoblock cup without screws is an attractive option in THA.