Obesity is a known risk factor for hip osteoarthritis. The aim of this study was to compare the incidence of obesity in Australians undergoing hip replacements (HR) for osteoarthritis to the general population. A cohort study was conducted comparing data from the Australian Bureau of Statistics and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 2017-18. Body mass index (BMI) data for patients undergoing primary total hip replacement and resurfacing for osteoarthritis were obtained from the AOANJRR. The distribution of HR patients by BMI category was compared to the general population, in
The study of spinopelvic anatomy and movement has received great interest as these characteristics influence the biomechanical behavior (and outcome) following hip arthroplasty. However, to-date there is little knowledge of what “normal” is and how this varies with
The influence of patient
Arthroscopic hip procedures have increased dramatically over the last decade as equipment and techniques have improved. Patients who require hip arthroscopy for femoroacetabular impingement on occasion require surgery on the contralateral hip. Previous studies have found that younger
Total hip arthroplasty (THA) has high rates of patient satisfaction; however patient expectations for recreational and sporting activities are not always met. Our study aimed to identify preoperative factors that predict whether patient expectations for sporting or recreational activity are met 12 months following THA. Patient reported outcome measures (PROMs) were collected prospectively from 2015-2018 at one private hospital in Sydney.
Seniors make up 16.9 percent of the Canadian population. Furthermore, the number of Canadians who are 65 years or older is increasing at an average rate of 20 percent every 5 years. In 2017, Sing etal reported that there is an increasing number of patients undergoing degenerative scoliosis surgery with the largest increase attributed to patients
Introduction. From 2004 to 2015, elective lumbar fusions increased by 62% in the US. The largest increases were for among
Total knee replacement (TKA) is one of the most successful procedures in orthopaedic surgery. Although originally limited to more elderly and less active individuals, the inclusion criteria for TKA have changed, with ever younger, more active and heavier patients receiving TKA. This broadening of indications coincided with the widespread adoption of modular cemented and cementless TKA systems in the 1980's, and soon thereafter wear debris related osteolysis and associated prosthetic loosening became major modes of failure for TKA implants of all designs. Initially, tibial components were cemented all polyethylene monoblock constructs. Subsequent long-term follow-up studies of some of these implant designs have demonstrated excellent durability in survivorship studies out to twenty years. While aseptic loosening of these all polyethylene tibial components was a leading cause of failure in these implants, major polyethylene wear-related osteolysis around well-fixed implants was rarely (if ever) observed. Cemented metal-backed nonmodular tibial components were first introduced to allow for improved tibial load distribution and protection of the underlying (often osteoporotic) bone. Eventually, modularity between the polyethylene tibial component and the metal-backed tray was introduced in the mid-80s mainly to facilitate screw fixation for cementless implants. These designs also provided intraoperative versatility by allowing interchange of various polyethylene thicknesses, and also aided the addition of stems and wedges. Modular vs. All Polyethylene Tibial Components in Primary TKA: Kremers et al. reviewed 10,601 adult (>18 years) patients with 14,524 condylar type primary TKA procedures performed at our institution between 1/1/1988 and 12/31/2005 and examined factors effecting outcome. The mean
Management of the pathologic long-head biceps tendon remains controversial. Biceps tenotomy is a simple intervention but may result in visible deformity and subjective cramping. Comparatively, biceps tenodesis is technically challenging, and has increased operative times, and a more prolonged recovery. The purpose of this study was to determine the incidence of popeye deformity following biceps tenotomy versus tenodesis, identify predictors for developing a deformity, and compare subjective and objective outcomes between those that have one and those that do not. Data for this study were collected as part of a randomized clinical trial comparing tenodesis versus tenotomy in the treatment of lesions of the long head of biceps tendon. Patients 18 years of
Young, active patients with end-stage medial osteoarthritis (OA) secondary to anterior cruciate ligament (ACL) deficiency present a treatment challenge for surgeons. Current surgical treatment options include high tibial osteotomy (HTO) with or without ACL reconstruction, unicompartmental knee arthroplasty (UKA) with ACL reconstruction, and total knee arthroplasty (TKA). A recent systematic review reported a much higher rate of complications in HTO combined with ACL reconstruction than with UKA-ACL (21.1% vs 2.8%), while survivorship between the two procedures was similar. UKA offers several advantages over TKA, namely faster recovery, lower blood loss, lower rate of postoperative complications, better range of motion, and better knee kinematics. However, UKA has classically been contraindicated in the presence of ACL deficiency due to reported concerns over increased incidence aseptic loosening tibia. However, as a majority of patients presenting with this pathology are young and active, concerns about implant longevity with TKRA and loss of bone stock have arisen. As a result, several authors have described combining ACL reconstruction with medial UKA to decrease the tibiofemoral translation-related stress on the tibial component, thereby decreasing aseptic loosening-related failures. The purpose of this study was to compare the functional outcomes and survivorship of combined medial UKA and ACL reconstruction (UKA-ACL) with those of a matched TKA cohort. We hypothesized that UKA-ACL patients would have better functional outcomes than TKA patients while maintaining similar survivorship. Material and Methods. We conducted a case-control study establishing UKA-ACL as the study group and TKA as the control group by a single senior surgeon between October 2005 and January 2015. We excluded patients who were over the
INTRODUCTION. Patients less than 60 years old have been reported to have a higher risk of revision following total hip arthroplasty (THA) than older patient cohorts, possibly to due higher activity, a higher incidence of deformity and greater probability of prior surgery. Ceramic-on-ceramic bearing surfaces have been proposed for use in young and active individuals due to their low wear, low risk of adverse biologic reaction, and long-term survivorship. We assessed the clinical results and long-term survivorship of uncemented ceramic-on-ceramic THA in a young patient population. METHODS. For the six year period from May 1999 to March 2005, 278 hip replacements in 244 patients less than 60 yeas of
The use of Patient Reported Outcome Measures (PROMS) has been critical to the success of total joint arthroplasty (TJA). They have made possible the evaluations of new implants, materials and surgical techniques that have been essential to the development of these technologies. PROMS have had a major impact on the decisions that surgeons make regarding treatment and care of patients. However, there are serious limitations of PROMS. They are useless in the first few weeks after surgery. They provide very little objective functional information to which health care providers can respond in the early, critical post-operative period. PROMS do not objectively measure specific outcome measures (e.g. ROM, distance walked). PROMS are also cumbersome and time consuming to use. Joint specific surface sensors are emerging to allow objective measurements of specific functional outcomes of knee surgery. This allows an examination of the factors that might affect these functional outcomes. The purpose of this study was to examine the relationship of
Introduction. Cardiac events have been found to occur with increased frequency in total joint arthroplasty (TJA) patients >65 y/o without known coronary artery disease (CAD). Avoidance of readmissions for cardiac events is paramount with bundled payment programs. It has been thought that many of these patients may have undiagnosed CAD because of sedentary life styles brought on by chronic osteoarthritis. The purpose of this study is to assess with Coronary Computed Tomographic Angiography (CCTA) the prevalence and severity of CAD in patients >65 y/o for elective TJA. Methods. 126 elective patients that were part of a total hip and knee bundled payment program were referred for cardiac evaluation with CCTA if they were >65 but <70 y/o with a history of heart disease or 2 risk factors or were >70 y/o. CCTA was acquired on all patients unless they had a history of a severe allergic reaction to contrast, GFR <50 ml/min., the presence of atrial fibrillation, or declined the test. All images were evaluated by an experienced reader. Arterial narrowing of 70% diameter or greater was classified as significant CAD. Intermediate lesions <70% were reclassified as significant if CT-FFR (Functional flow reserve) was < or = 0.80. Results. Excluding the 12 patients with known CAD who had stents or coronary artery bypass graft (CABG), the remaining 114 patients were classified into three groups. 34/114 (29.8%) had no CAD (Group A). 75/114 (65.8%) had (Group B). 5/114 (4.4%) had > or = 70% stenosis. Group C included one patient who had <70% stenosis but had CT-FFR <80%. Of 17 patients with known CAD with >70% or heart CT-FFR <80%, or prior stents/CABG, one patient was predicted to be high risk of a cardiac event because of a complex plaque with an ulcer, history of suppressed paroxysmal atrial fibrillation, and withdrawal from apixaban. He was nurse navigated throughout his hospital course and post discharge only to be recalled to the hospital to be rescued with cardiac stenting. Conclusion. Patients >65 y/o having TJA without a cardiac history were found to have a 4.4% prevalence of significant CAD. When added to the patients with known CAD, the overall prevalence was 13.5%. One patient had complex plaque predictive of a cardiac event. As the US population
Purpose. Due to the
Lubricin is a proteoglycan that is a boundary lubricant in synovial joints and both a surface and collagen inter-fascicular lubricant in ligaments. The purpose of this study was to characterise the mRNA levels for lubricin in the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) in
Purpose. To identify the modes of failure after total knee arthroplasty (TKA) in patients ≤ 55 years of
Objectives. This study examines variations in knee arthroplasty patient reported outcome measures according to patient
Hip resurfacing has been proposed as an alternative to traditional total hip replacement in young, active patients. Metal-on-metal resurfacing devices were introduced in the 1990's, and a number of them reached the international market. The promise of bone preservation, more normal loading, greater activity, and easier revision led many surgeons to begin implanting these devices. Over time, lessons have been learned regarding patient selection, implant selection, and surgical technique. Several devices have been withdrawn from the market, and many surgeons have abandoned the procedure. We continue to perform this procedure in substantial numbers, approximately 350 per year. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following FDA approval in 2006, we studied the safety and effectiveness of one hip resurfacing device at our US institution in a large, single-surgeon series. We report our early to mid–term results in 476 patients who were under the
Posterolateral spinal fusion using autograft in adult rabbits has been reported by many groups using the Boden model.
Two big problems exist with the all polyethylene cemented tibial component; the polyethylene and the cement. The polyethylene is too weak and flexible to bear high tibial load, so it deforms and loosens. The interface stresses are too high when two flexible structures are poorly bonded and heavily loaded. Modularity between the polyethylene tibial component and the metal-backed tray was introduced in the mid-80's for versatility and to facilitate screw fixation for cementless implants. These designs allow exchange of various polyethylene thicknesses, and aids the addition of stems and wedges. Other advantages include the reduction of inventory, and the potential for isolated tibial polyethylene exchanges as a simpler revision procedure. Several studies have documented the high failure rate of isolated polyethylene exchange procedures, because technical problems related to the original components are left uncorrected. However, revision for wear is the simplest revision ever! Since the late 1980's the phenomena of polyethylene wear and osteolysis have been observed much more frequently when compared with earlier eras. The reasons for this increased prevalence of synovitis, progressive osteolysis, and severe polyethylene wear remain unclear. There is some association with the widespread use of both cementless and cemented modular tibial designs. Improved polyethylene attachment is the answer even if a screw, a wire, or a pin is needed. Do not abandon the modular tibia.