While automated impaction can provide a more standardized process for femoral canal preparation, little is known regarding its effect on femoral component sizing and position. The purpose of our ...study was to directly compare femoral component canal fill ratio (CFR) and coronal alignment between primary total hip arthroplasty (THA) procedures performed with automated impaction versus manual mallet impaction.
A retrospective analysis was performed on 184 patients who underwent primary THA by a single arthroplasty surgeon between 2017 and 2021 with a modern cementless femoral component using either the direct anterior or posterolateral approach. The final cohort was divided into 2 groups based on impaction technique during broaching: automated (N = 122) or manual (N = 62). A propensity score match was used to match for age, body mass index, sex, high versus standard offset stem, and preoperative femoral bone quality. Radiographic review was performed to measure intramedullary prosthetic CFR and coronal alignment.
The automated cohort trended toward the use of a larger stem (5.67 versus 4.82, P = .006) and had a larger CFR at all 4 levels within the proximal femur (P = .004). The automated cohort had a more valgus and reliable coronal alignment (−0.57 (SD 1.50) versus −0.03 (SD 2.17) degrees, P = .03) and significantly shorter operative time (mean 78 versus 90 minutes, P < .001). There were no intraoperative or postoperative periprosthetic fractures in either cohort.
Automated impaction in primary THA is a safe technique for femoral preparation, which resulted in improved stem coronal alignment, optimized canal fill within the proximal femur, and reduced operative times.
Highly cross-linked polyethylene (HXLPE) has improved polyethylene (PE) wear rates while decreasing osteolysis and aseptic loosening. However, concerns exist regarding the risk of mechanical failure ...with thin HXLPE liners in total hip arthroplasty (THA). Our purpose was to evaluate long-term outcomes and PE wear rates in primary THAs pairing large femoral heads with small acetabular components and thin HXLPE liners. We retrospectively reviewed 29 patients who underwent 33 primary THAs using large femoral heads (32 or 36 mm) with small acetabular components (48 or 50 mm) and thin HXLPE liners (3.9 or 5.9 mm) at minimum 10-year follow-up. PE liner wear was measured using a validated radiographic technique. Mean age was 66 years, 97% of the patients were women, and mean body mass index was 26.3 kg/m
. Thirty hips (90.9%) had ceramic femoral heads, and 13 hips (39%) had 36-mm femoral heads with 3.9-mm HXLPE liners. All cases used a neutral PE design. Mean linear wear rate and volumetric wear rate were 0.04 mm/year and 39.6 mm
/year, respectively, at mean 10.9-year follow-up. There were no instances of liner fracture, liner dissociation, or revision. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) was 92.1. In the largest long-term study of primary THAs using large femoral heads with small acetabular components and thin HXLPE liners, we found low linear and volumetric wear rates and no cases of liner mechanical failures. Thin HXLPE liners are a safe and viable option for THA surgeons.
. 2024;47(2):118-122..
Same calendar day discharge (SCDD) following total joint arthroplasty is desirable for patients and surgeons alike. The aim of this study was to compare the success rate of SCDD in an ambulatory ...surgical center (ASC) versus hospital setting.
A retrospective analysis was performed on 510 patients who underwent primary hip and knee total joint arthroplasty over a 2-year period. The final cohort was divided into 2 groups based on location of surgery: ASC (N = 255) or hospital (N = 255). Groups were matched for age, sex, body mass index, American Society of Anesthesiologists score, and Charleston Comorbidity Index. Successes of SCDD, reasons for failure of SCDD, length of stay (LOS), and 90-day readmission and complication rates were recorded.
All SCDD failures were from the hospital setting (36 65.6% total knee arthroplasty TKA and 19 34.5% total hip arthroplasty THA). There were no failures from the ASC. The main causes of failed SCDD in both THA and TKA included failed physical therapy and urinary retention. Regarding THA, the ASC group had a significantly shorter total LOS (6.8 4.4 to 11.6 versus 12.8 4.7 to 58.0 hours, P < .001). Similarly, TKA patients had a shorter LOS in the ASC (6.9 4.6 to 12.9 versus 16.9 6.1 to 57.0, P < .001). Total 90-day readmission rates were higher in the ASC group (2.75% versus 0%), where all but 1 patient underwent TKA. Similarly, complication rates were higher in the ASC group (8.2% versus 2.75%), where all but 1 patient underwent TKA.
TJA performed in the ASC, compared to the hospital setting, allowed for reduced LOS and improved success of SCDD.
Salvage conversion hip arthroplasty is a viable solution to restore function and reduce pain after failed intertrochanteric hip fracture fixation. Our primary objective was to assess early outcomes ...achieved with primary cementless metaphyseal-engaging femoral stems for conversion hip arthroplasty compared with revision diaphyseal-engaging stems. This was a retrospective review of 70 patients with failed intertrochanteric hip fractures subsequently managed with conversion total hip arthroplasty or hemiarthroplasty. Thirty-five patients who underwent conversion using a primary cementless stem were compared with 35 patients who underwent conversion using a revision stem. The groups were similar regarding sex, body mass index, American Society of Anesthesiologists classification, preoperative diagnosis, and implants removed. Clinical and radiographic outcomes and complications were compared over a mean follow-up of 6 years. The primary stem cohort had a shorter mean hospital stay (3.03 vs 4.34 days,
=.028). There were no significant differences between the primary and revision cohorts regarding mean time to conversion (2.26 vs 1.75 years,
=.671), operative time (127 vs 131 minutes,
=.611), incidence of discharge to home (54.3% vs 37.1%,
=.23), postoperative complications (5.71% vs 5.71%,
=1.0), reoperations (5.71% vs 11.4%,
=.669), leg length discrepancy (5.33 vs 7.38 mm,
=.210), subsidence (20.0% vs 23.3%,
=.981), and Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (78.6 vs 81.9,
=.723). We report comparable outcomes of conversion hip arthroplasty with the use of primary cementless and revision stems. Current primary cementless femoral stems may be considered for conversion hip arthroplasty for failed intertrochanteric fracture fixation.
. 2024;47(1):e6-e12..
Introduction
This study documented the incidence of incidental findings from preoperative computerized‐tomography (CT) scans obtained for robotic‐arm‐assisted total joint arthroplasty (TJA) and its ...effect on patient management.
Methods
A retrospective review was conducted for patients who underwent robotic‐arm assisted primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from 2016 to 2020. All patients obtained preoperative CT scans which were formally read by fellowship‐trained musculoskeletal radiologists. CT's were flagged with incidental findings and those requiring physician follow‐up were identified as significant.
Results
A total of 1519 patients (mean age, 66 years ±9; 849 females) were evaluated. Seventy‐three (4.81%) patients had incidental CT scan findings, and 25 (1.65%) patients had significant incidental findings. Four patients required additional imaging and two patients required intervention.
Conclusion
This study found a 4.81% incidence of incidental findings from preoperative CT scans for robotic‐arm‐assisted THA and TKA. Of these findings, less than 2% required physician follow‐up and less than 1% required intervention. With the increasing popularity of robotic‐arm assisted total joint arthroplasty, it is important to consider the necessity of detection and management of associated incidental findings from preoperative CT scans.
This study documents the incidental findings on preoperative CT scans for robotic‐arm‐assisted THA and TKA. Of these findings, less than 2% required physician follow‐up and less than 1% required intervention. With the increasing popularity of robotic‐arm‐assisted total joint arthroplasty, it is important to consider the necessity of detection and management of associated incidental findings on preoperative CT scans.
Background:
While many studies have examined the impact of comorbidities on the success of same calendar day discharge (SCDD) in total joint arthroplasty (TJA), literature surrounding the impact of ...social determinants is lacking.
Purpose:
We sought to investigate the relationship between various social determinants and success of SCDD after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Methods:
We conducted a retrospective review of 1160 THA and 1813 TKA performed at a single academic institution between November 2020 and August 2022. Social factors including substance use, occupation, marital status, income, and participation in physical exercise were included. In addition, aspects of discharge planning were reviewed such as living situation and transportation details.
Results:
Overall, 952 (32%) patients had successful SCDD, whereas 2021 (68%) patients were discharged on postoperative day 1 (POD1) or greater. Successful SCDD patients were more likely to have health care (4.8% vs 2.5%) and active (5.4% vs 4.6%) rather than sedentary occupations, be married (79.6% vs 67.4%), have access to transportation (95.6% vs 92.9%), live in a higher median income area ($64,044 16,183 vs $61,572 14,594), and exercise weekly (62.6% vs 23.9%). Interestingly, the successful patients had more stories in their homes (1.62 0.56 vs 1.43 0.53), more stairs to enter their homes (5.19 5.22 vs 4.60 5.24), lived farther from the hospital (43.3 138.0 vs 32.0 75.9 miles), and a higher prevalence of alcohol use (60.7% vs 44.7%) and tobacco use (19.3% vs 17.3%).
Conclusion:
These findings may help arthroplasty surgeons to better understand the social factors that contribute to successful SCDD in TJA patients, ultimately aiding in patient selection and preoperative counseling.
Background:
Total joint arthroplasty (TJA) performed in the ambulatory surgical center (ASC) has been shown to be safe and cost-effective for an expanding cohort of patients. As criteria for TJA in ...the ASC become less restrictive, data guiding the efficient use of ASC resources are crucial.
Purpose:
We sought to identify factors associated with length of stay in the recovery room after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed in the ASC.
Methods:
We conducted a retrospective review of 411 patients who underwent primary THA or TKA at our institution’s ASC between November 2020 and March 2022. We collected patient demographics, perioperative factors, success of same-day discharge (SDD), and length of time in the recovery room.
Results:
Of 411 patients, 100% had successful SDD. The average length of time spent in recovery was 207 minutes (SD: 73.9 minutes). Predictors of longer time in recovery were increased age, male sex, and operative start time before 9:59 am. Body mass index, preoperative opioid use, Charlson Comorbidity Index, type of surgery (THA vs TKA), urinary retention risk, and type of anesthesia (spinal vs general) were not significant predictors of length of time in the recovery room.
Conclusion:
In this retrospective study, factors associated with increased length of time in the recovery room included older age, male sex, and operative start time before 9:59 am. Such factors may guide surgeons in determining the optimal order of cases for each day at the ASC, but further prospective studies should seek to confirm these observations.
Background:
Selective genicular artery embolization (GAE) has shown promise as a minimally invasive treatment option for persistent symptomatic recurrent effusions (REs) following total knee ...arthroplasty (TKA).
Purpose:
We sought to investigate the radiographic and clinical success of GAE for RE after TKA.
Methods:
We performed a retrospective review of prospectively collected data on primary and revision TKA patients with RE, both hemorrhagic and non-hemorrhagic, who underwent GAE between 2019 and 2021 with a minimum of 6-month follow-up. All embolization procedures were performed by a single interventional radiologist. Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores were collected prior to GAE and at 1, 3, and 6 months post-procedure. Recurrence of effusion following GAE was assessed at 6 months using ultrasound.
Results:
Seventeen patients, 10 female and 7 male, with 18 TKAs and a mean (SD) age of 63.1 (8.6) years were included. We saw a mean (SD) of 36.1 (24.4) and 3.3 (3.0) point improvement in WOMAC and VAS scores, respectively. In addition, 14 of the 18 TKAs (77.8%) seen at final follow-up had complete resolution of effusion confirmed by ultrasound.
Conclusion:
Our retrospective review found that a majority of patients showed significant clinical improvement and resolution of effusion following GAE. These findings suggest that GAE may be an effective minimally invasive treatment option for RE following TKA and should be further investigated.
Category:
Ankle Arthritis; Ankle
Introduction/Purpose:
Polyethylene (PE) wear particles have been shown to be a contributing factor of osteolysis and aseptic loosening. The use of highly cross-linked ...polyethylene (HXLPE) liners has been proven to reduce wear rates in hip and knee arthroplasty. To date, no clinical study has investigated the in vivo wear rates of HXLPE in total ankle arthroplasty (TAA). Therefore, the purpose of our study was to evaluate mid- and long-term outcomes and HXLPE wear rates in primary TAA.
Methods:
We retrospectively identified 49 patients who underwent primary TAA with HXLPE liners at a minimum of 5-year follow up. The average age was 65 years, 57.1% female, and average body mass index was 28.7 kg/m2. Polyethylene wear rates at final follow up were assessed using anteroposterior ankle radiographs and a validated computer assisted software. In addition, overall implant survivorship and complications were recorded.
Results:
The average polyethylene linear wear rate was 0.073 mm/year (SD, +/- 0.027) at mean 7.6 year (range, 5.1 to 12.2) follow up. Further analysis of patients with greater than 10 year follow up (n=8) demonstrated a linear wear rate of 0.06 mm/year (SD, +/- 0.02) at mean 11.1 year (range, 10.0 to 12.2). There were no instances of linear fracture or dissociation. Survivorship was 98.0% with 1 patient requiring removal of hardware and revision TAA secondary to failure of distal tibial osteotomy which was performed at index procedure. The rate of reoperation was 12.2% (n=6) with the most common indication being symptomatic ankle impingement treated with peri-implant cyst excision, exostectomy, and debridement (n=4).
Conclusion:
Highly crosslinked polyethylene liners in primary TAA demonstrated low in vivo wear rates and no cases of liner mechanical failures. In addition, our cohort demonstrated low complication and reoperation rates and exceptional survivorship at mid to long-term follow up. Therefore, the use of HXLPE liners is a viable option for surgeons performing TAA.
IntroductionThe canal-to-calcar isthmus (CC) ratio has been previously correlated with proximal femur osteology, but its relationship with bone density is not well established. Our purpose was to ...assess the relationship between femoral bone density, measured on opportunistic quantitative CT in Hounsfield units (HU), and CC ratio.MethodsA total of 148 THA patients were included. The CC ratio was measured on anteroposterior hip radiographs. Using perioperative CT scans, a 1 cm diameter area was identified on a single mid-coronal slice in the medial calcar just proximal to the intertrochanteric ridge. The mean HU was calculated in this region to represent calcar bone density.ResultsTwenty-four percent (n = 35) of patients were classified as Dorr A (average CC ratio 0.47 0.45; 0.48), 67% (n = 96) as Dorr B (0.62 0.55; 0.68), and 11% (n = 17) as Dorr C (0.78 0.77; 0.80). There was a significant difference between Dorr A and Dorr C femurs (769 (144) vs. 588 (154) HU) as well as between B and C femurs (718 (166) vs. 588 (154) HU). The CC ratio was correlated with calcar bone density on CT (-0.370).ConclusionCC ratio is correlated with bone density determined by HU measurements on an opportunistic quantitative computed tomography scan, and bone density HU values were able to accurately differentiate bone density in Dorr A and B from Dorr C femurs. These findings suggest that the CC ratio is a reliable measurement to predict bone density in Dorr C femurs. Therefore, arthroplasty surgeons can confidently use the Dorr classification for patients with Dorr C femurs when preoperatively planning for THA.
