Vitamin D deficiency is common in patients undergoing total hip (THA) or total knee arthroplasty (TKA) which may affect prosthesis survival and 90-day readmission rates. The purpose of this study was to assess whether preoperative Vitamin D deficiency or insufficiency have an influence on revision, readmission, and complication rates following THA and TKA. We hypothesized that low Vitamin D levels in patients undergoing THA and TKA have a negative effect on revision rates. Patients who underwent primary THA or TKA in a 2-year period university hospital were identified and stratified into 3 groups based on preoperative 25-hydroxyvitamin D serum levels: normal levels of 30 ng/ml or greater, (2) deficient levels of 20–29.9 ng/ml, and (3) insufficient levels of less than 20 ng/ml. Patient demographics and postoperative course were collected from the electronic medical record.Introduction
Methods
The number of complex revision total hip arthroplasties (THA) is predicted to rise. The identification of acetabular bone defects prior to revision THA has important implications on technique and complexity of acetabular reconstruction. Paprosky et al. proposed a classification system including 3 main types with up to 3 subtypes focused on the integrity of the superior rim of the acetabulum and medial wall. However, the classification system is complex and its reliability has been questioned. The purpose of this study was to evaluate the effectiveness of different radiologic imaging modalities (plain radiographs, 2-D CT, 3-D CT reconstructions) in classifying acetabular defects in revision hip arthroplasty cases and their value of at different levels of orthopaedic training. Patients treated with revision total hip arthroplasty for acetabular bone defects between 2002–2012 were identified and 22 cases selected that had plain radiographs, 2-D CT and 3-D reconstructions available. Bone defects were classified independently by two fellowship-trained adult reconstruction surgeons. Representative sections were chosen and compiled into a timed presentation. Thirty-five residents from PGY-1 to PGY-5 and 4 attending orthopaedic surgeons were recruited for this study and received a 15-minute introduction to the classification system. Chi square analysis was utilized to examine the influence of image modality and level of training on the correct classification of acetabular bone loss using the Paprosky classification system with alpha=0.05.Introduction
Methods
Unicompartmental knee arthroplasty (UKA) has seen renewed interest in recent years and is a viable option for patients with limited degenerative disease of the knee as an alternative to total knee arthroplasty. However, the minimally invasive UKA procedure is challenging, and accurate component alignment is vital to long-term survival. Robotic-assisted UKA allows for greater accuracy of component placement and dynamic intraoperative ligament balancing which may improve clinical patient outcomes. The purpose of this study was to analyse the clinical outcomes in a large, consecutive cohort of patients that underwent robotic-assisted UKA at a single institution with a minimum follow-up of 2 years. The study hypothesis was that robotic-assisted UKA improves patient outcomes by decreasing the rate of revision in comparison to conventional UKA. A search of the institutional joint registry was performed to identify patients that underwent robotic-assisted UKA beginning in August 2008. The patients' electronic medical record was analysed for surgical indication, age at surgery, body mass index (BMI), and American Society of Anesthesiology Physical Status Classification System (ASA). Patient comorbidities were evaluated using the Charlson comorbidity index. Length of surgery and length of hospitalisation were assessed and clinical outcomes were evaluated using the Oxford Knee Score. In addition to postoperative follow-up assessments in clinic, patients without recent follow-up were contacted by telephone to capture the overall revision rate and time to revision.Introduction
Materials and methods
Unicompartmental knee arthroplasty (UKA) has seen renewed interest in recent years due to improved surgical techniques and prosthetic design, and the desire for minimally invasive surgery. For patients with limited degenerative disease, UKA offers a viable alternative to total knee arthroplasty. Historically, the outcomes of lateral compartment UKA have been inferior to medial compartment UKA, with suboptimal patient satisfaction and increased revision rates. Robotic-assisted UKA has been shown to improve precision and accuracy of component placement, which may improve outcomes of lateral UKA. The purpose of this study was to compare the outcome of robotic-assisted UKA to conventional UKA for degenerative disease of the lateral compartment. The hypothesis of the study was that robotic-assisted lateral UKA results in superior outcomes compared to conventional UKA. A search of the institution's joint registry was conducted to identify patients who underwent UKA for limited degenerative disease of the lateral knee compartment. A total of 130 lateral UKAs were identified that were performed between 2004 and 2012. The mean age of the patients was 63.1 years (range, 20 to 88); patients had a mean BMI of 29.9 (range, 18 to 48). The medical records of all patients were reviewed and assessed for the type of surgical procedure used (robotic-assisted versus conventional), length of hospital stay, Oxford knee score, and occurrence of revision surgery.Introduction
Materials and methods
