Stacked Cone Constructs for the Treatment of Extensive Tibial Bone Loss in Revision Total Knee Arthroplasty: A Series of 22 Patients.

Background: Highly porous metaphyseal cones have emerged as a promising fixation strategy to address extensive proximal tibial bone loss in the multiply revised knee. Despite a paucity of literature regarding stacked cone constructs, they have gained popularity. This study reports on the early outcomes of stacked tibial cone constructs that are used during revision total knee arthroplasty (TKA).

A "1.5-Stage" Spacer Construct Using Revision Components for the Management of Periprosthetic Joint Infection of the Knee.

Background: The two-stage surgical protocols used for the treatment of periprosthetic joint infection following total knee arthroplasty are associated with marked patient morbidity. As such, alternatives, such as durable "1.5-stage" spacer constructs, have gained popularity.

Cemented Constrained Liners Used as an Articulating Hip Spacer for the Treatment of Chronic Prosthetic Joint Infection.

Background: Two-stage exchange arthroplasty remains the gold standard for treating chronic hip periprosthetic joint infections. However, controversy remains regarding the optimal spacer type, particularly among patients with increased dislocation risk. This study reports on the outcomes of articulating hip spacers utilizing a single constrained-liner design.

Fracture of the Proximal Body of a Modern Cementless Modular Fluted Tapered Stem.

Previous reports have described failures of modular fluted tapered femoral stems secondary to fatigue failure at the modular junction. However, the present study is the first reported case of modular fluted tapered femoral component failure involving atraumatic fracture of the proximal body following revision total hip arthroplasty. The failure occurred in a 52-year-old female with a history of postmenopausal osteoporosis on bisphosphonates who sustained an atraumatic fracture of the proximal body of a modular revision femoral stem.

Trabecular Metal Augments During Complex Primary Total Hip Arthroplasty.

Background: Trabecular metal augments (TMAs) have been extensively used in revision total hip arthroplasty (THA) to address acetabular bone defects. However, limited data exists regarding TMA utilization during primary THA. This study aims to assess the clinical and radiographic outcomes of TMAs used during primary THA.

An Updated Estimate of Total Hip and Total Knee Arthroplasty Inpatient Case Volume During the 2020 COVID-19 Pandemic in the United States.

Background: Inpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) practices were dramatically affected in the United States in 2020 as elective surgeries were paused in response to the COVID-19 pandemic. This study sought to provide an updated estimate of inpatient total joint arthroplasty (TJA) case volumes in the United States in 2020.

Methods: A retrospective cohort study was performed by identifying all adult patients who underwent primary, elective TJA from January 1st, 2017 to December 31st, 2020, using the National Inpatient Sample.

Metal artifact reduction sequence-MRI abnormalities in asymptomatic patients with dual-mobility hip prostheses.

Aims: Modular dual-mobility (DM) articulations are increasingly used during total hip arthroplasty (THA). However, concerns remain regarding the metal liner modularity. This study aims to correlate metal artifact reduction sequence (MARS)-MRI abnormalities with serum metal ion levels in patients with DM articulations.

Robotic-Assisted Total Knee Arthroplasty in Obese Patients.

Background: Robotic-assisted systems have gained popularity in total knee arthroplasty (TKA). The purpose of this study was to evaluate operative characteristics and radiographic outcomes of obese patients undergoing robotic-assisted TKA.

Methods: A retrospective review of consecutive cases performed by a single surgeon was performed from January 1, 2016, to January 31, 2022.

Postoperative Complications Associated with Non-Steroidal Anti-Inflammatory Combinations Used Status-Post Total Hip and Knee Arthroplasty.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in multimodal pain control following total joint arthroplasty (TJA). However, few studies have assessed the complications associated with the combinations of NSAIDs in this population despite the known risks associated with this class of medications. The Premier Healthcare Database was queried to identify adults who underwent primary total hip or knee arthroplasty from 2005-2014.

Limited Durability of Extensor Mechanism Reconstruction Following Total Knee Arthroplasty: Mesh and Allograft Show Equivalent Outcomes at Five-Year Follow-Up.

Background: Extensor mechanism disruption is a challenging complication following total knee arthroplasty. The purpose of this study was to compare outcomes between patients who received mesh versus allograft extensor mechanism reconstruction.

Methods: All patients who underwent extensor mechanism reconstruction at a single institution were screened.

Refining the Role of Routine Synovial Alpha-Defensin in Periprosthetic Joint Infection Following Total Knee Arthroplasty: An Analysis of Limitations.

Background: The utility of the synovial alpha-defensin test in diagnosing periprosthetic joint infections (PJIs) remains controversial. This study aimed to examine the diagnostic utility of this test.

Methods: A retrospective review was conducted to identify adults evaluated for PJI following total knee arthroplasty at a single institution.

Factors Associated With Failure Following Proximal Femoral Replacement for Salvage Hip Surgery for Nononcologic Indications.

Background: Proximal femoral replacement (PFR) is used when extensive proximal femoral bone loss is encountered during revision total hip arthroplasty. However, further data on 5-to-10-year survivorship and predictors of failure are needed. Our aim was to assess the survivorship of contemporary PFRs used for nononcologic indications and determine factors associated with failure.

Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates.

Background: This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19.

Methods: A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not.

A double-blinded, placebo-controlled, randomized study to evaluate the efficacy of perioperative dextromethorphan compared to placebo for the treatment of postoperative pain: a study protocol.

Background: Pain management is a critical component of comprehensive postsurgical care, as it influences patient safety and outcomes, and inadequate control has been associated with the development of chronic pain syndromes. Despite recent improvements, the management of postoperative pain following total knee arthroplasty (TKA) remains a challenge. The use of opioid-sparing, multimodal analgesic regimens has broad support, but there is a paucity of high-quality evidence regarding optimal postoperative protocols and novel approaches are needed.

Peripheral Nerve Block Utilization is Associated With Decreased Postoperative Opioid Consumption and Shorter Length of Stay Following Total Knee Arthroplasty.

Background: This study aims to examine differences in postoperative complications and opioid consumption associated with perioperative peripheral nerve block (PNB) utilization during primary total knee arthroplasty (TKA).

Methods: The Premier Healthcare Database was queried for adult patients who underwent primary, elective TKA from 2015 to 2020. Patients who received a femoral or adductor canal PNB were compared to patients who did not.

Drill Bone with Both Hands: Plunge Depth and Accuracy with 4 Bracing Positions.

Unlabelled: Bone drilling is a critical skill honed during orthopaedic surgical education. How a bone drill is held and operated (bracing position) may influence drilling performance.

Methods: A prospective study with randomized crossover was conducted to assess the effect of 4 bracing positions on orthopaedic surgical trainee performance in a simulated bone drilling task.

Aspirin for Venous Thromboembolic Prophylaxis Following Total Hip and Total Knee Arthroplasty: An Analysis of Safety and Efficacy Accounting for Surgeon Selection Bias.

Background: Aspirin may be effective at preventing venous thromboembolism following total knee arthroplasty (TKA) or total hip arthroplasty (THA). Current evidence is limited by bias as many surgeons who use aspirin prescribe for high-risk patients alternative chemoprophylactic agents. Therefore, this study aimed to evaluate the risk of pulmonary embolism (PE) and deep vein thrombosis (DVT) in patients who received aspirin and warfarin while accounting for surgeon selection bias.

The Persistent Effects of the COVID-19 Pandemic on Total Joint Arthroplasty Changes in Practice Patterns in the United States From 2020 to 2021.

Background: The SARS-CoV-2 (COVID-19) pandemic has dramatically disrupted orthopaedic surgery practice patterns. This study aimed to examine differences between patients who underwent total joint arthroplasty (TJA) before the pandemic compared to 2020 and 2021.

Methods: A retrospective cohort study was performed on all patients who underwent elective inpatient TJA from January 2017 to December 2021 using a national large database.

Does Prednisone Dose Affect Rates of Periprosthetic Joint Infection Following Primary Total Hip and Total Knee Arthroplasty?

Background: Prednisone use is associated with higher rates of periprosthetic joint infection (PJI) following total joint arthroplasty (TJA). However, the relationship between prednisone dosage and infection risk is ill-defined. Therefore, this study aimed to assess the relationship between prednisone dosage and rates of PJI following TJA.

Influence of donor age and comorbidities on transduced human adipose-derived stem cell in vitro osteogenic potential.

Human adipose-derived mesenchymal stem cells (ASCs) transduced with a lentiviral vector system to express bone morphogenetic protein 2 (LV-BMP-2) have been shown to reliably heal bone defects in animal models. However, the influence of donor characteristics such as age, sex, race, and medical co-morbidities on ASC yield, growth and bone regenerative capacity, while critical to the successful clinical translation of stem cell-based therapies, are not well understood. Human ASCs isolated from the infrapatellar fat pads in 122 ASC donors were evaluated for cell growth characteristics; 44 underwent additional analyses to evaluate in vitro osteogenic potential, with and without LV-BMP-2 transduction.

Tranexamic Acid and Prothrombotic Complications Following Total Hip and Total Knee Arthroplasty: A Population-Wide Safety Analysis Accounting for Surgeon Selection Bias.

Background: Tranexamic acid (TXA) utilization during total joint arthroplasty (TJA) has become ubiquitous. However, concerns remain regarding the risk of thrombotic complications. The goal of this study was to examine the risk of prothrombotic complications in patients who received TXA during total knee (TKA) and total hip arthroplasty (THA).

Monomicrobial Joint Infection by Leclercia adecarboxylata in an Immunocompetent Patient After Knee Arthroscopy: A Case Report.

Case: A 54-year-old immunocompetent man presented to the office with severe right knee pain and swelling 27 days after knee arthroscopy. Additional diagnostics identified a monomicrobial infection of the right knee joint by the bacterium Leclercia adecarboxylata, which was later confirmed by repeated aspiration of the joint and culture of the aspirated fluid.

Conclusion: This case report details a postoperative monomicrobial infection with L.

Systematic Review and Meta-Analysis of Intrawound Vancomycin in Total Hip and Total Knee Arthroplasty: A Continued Call for a Prospective Randomized Trial.

Background: Periprosthetic joint injection (PJI) is a rare, but life-altering complication of total joint arthroplasty (TJA). Though intrawound vancomycin powder (IVP) has been studied in other orthopedic subspecialties, its efficacy and safety in TJA has not been established.

Methods: PubMed and MEDLINE databases were used to identify studies utilizing IVP in primary and revision total hip (THA) and knee arthroplasty (TKA).

Elective Inpatient Total Joint Arthroplasty Case Volume in the United States in 2020: Effects of the COVID-19 Pandemic.

Background: Despite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no study has fully quantified the impact of the pandemic on the number of elective inpatient total hip (THA) and total knee arthroplasty (TKA) cases. The purpose of the present study was to analyze THA and TKA case volumes in the United States during the COVID-19 pandemic.

Methods: The Premier Healthcare Database was utilized to identify adults undergoing primary elective THA or TKA from January 2017 to December 2020.

Modern Proximal Femoral Replacement in Revision Total Hip Arthroplasty for Nononcologic Indications.

Background: Advances in surgical technique and prosthesis design have expanded the non-neoplastic indications for proximal femoral replacement (PFR) to include fracture nonunion, periprosthetic fracture, and severe bone loss in the setting of revision total hip arthroplasty (THA). The purpose of this study is to assess outcomes of PFRs used for nononcologic indications.

Methods: A single-institution, retrospective, cohort survey study was conducted between August 2015-February 2020 of consecutive patients undergoing PFR for nononcologic indications in revision THA.