Cobalt toxicity from third-body wear following revision of fractured ceramic-on-ceramic hip bearings with a metal articulation : the fractured ceramic syndrome.

Aims: Ceramic-on-ceramic (CoC) articulations in total hip arthroplasty (THA) have the advantage of low wear but the unique risk of fracture. After revision for CoC-bearing fracture, third-body ceramic particles can lead to massive wear of cobalt-chrome (CoCr) bearings, causing extremely elevated blood cobalt. We present a multicentre series of five cases where patients sustained fractures of ceramic liners, were revised using a CoCr articulation, and rapidly developed severe cobalt toxicity.

Total hip arthroplasty in patients with angular proximal femoral deformities.

Aims: An angular proximal femoral deformity, in association with osteoarthritis (OA) of the hip, considerably increases the technical complexity of primary total hip arthroplasty (THA). The aims of this study were to determine the long-term implant survival, the risk factors for failure, complications, and clinical outcomes of contemporary primary THA in this difficult group of patients.

Methods: Our institutional total joint registry was used to identify 119 primary THAs performed in 108 patients with an angular proximal femoral deformity, between January 1997 and September 2017.

Long-Term Risk of Heart Failure in Total Joint Arthroplasty: A Population-Based Cohort Study.

Background: Previous case reports raised concerns about the cardiovascular effects of metal particles and ions produced by mechanical wear and corrosion of total joint arthroplasty (TJA) implants. We compared the long-term risk of heart failure in a cohort of individuals who had TJA and in a general population comparison cohort.

Methods: This was a population-based, retrospective cohort study of 7,182 TJA subjects who first had total hip arthroplasty (THA) or total knee arthroplasty surgeries between 1990 and 2020 and 7,407 age-, sex-, and calendar year-matched non-TJA subjects.

The Rise of Medicare Advantage is Impacting the Fidelity of Traditional Medicare Claims Data: Implications for Reporting of Long-Term Total Knee Arthroplasty Survivorship.

Background: Traditional Medicare (TM) claims data are widely used by researchers and registries to report survivorship following total knee arthroplasty (TKA). The purpose of the present study was to investigate whether the mass exodus of patients from TM to Medicare Advantage (MA) has compromised the fidelity of TM data.

Methods: We identified 11,717 Medicare-eligible patients (15,282 knees) who had undergone primary TKA from 2000 to 2020 at a single institution.

Acetabular Revision With Dual-Mobility Bearing Reduces Redislocation in Unstable Total Hip Arthroplasty.

Background: The redislocation rate for revision total hip arthroplasty (R-THA) done for instability ranges from 21 to 39%. Large femoral heads, constrained liners (CL), or dual-mobility (DM) implants are used to address this issue. This study assessed cumulative redislocation and re-revision rates after R-THA was performed for instability and identified associated risk factors for failure.

Primary Total Hip Arthroplasty in Patients Less Than 30 Years of Age: Durable, but Not Free of Complications.

Background: Primary total hip arthroplasty (THA) in young patients presents surgical challenges due to preoperative conditions and the likelihood of an active postoperative lifestyle. This study assessed mid-term (mean 7.5 years) survivorship and risk factors for revisions and reoperations in patients aged ≤30 undergoing primary THA.

Brain tissue metal concentrations and Alzheimer's disease neuropathology in total joint arthroplasty patients versus controls.

We examined whether total joint arthroplasty (TJA) is associated with increased metal accumulation in the brain and histopathologic changes of Alzheimer's disease. We measured ultra-trace metal concentrations (aluminum, chromium, cobalt, manganese, molybdenum, nickel, titanium, and vanadium) on postmortem frozen tissues of the occipital lobe of 177 subjects (89 non-TJA and 88 TJA) using a triple-quadrupole inductively coupled plasma mass spectrometry and correlated elemental concentrations to the degree of Alzheimer's disease neuropathic change (ADNC). To effectively assess the relationship between TJA and brain metal concentrations, subjects with and without TJA were matched for baseline clinical characteristics and showed no difference in postmortem Alzheimer's disease neuropathic change.

Retaining a Well-fixed Cone During Revision Total Knee Arthroplasty: Surgical Technique and Outcomes.

Unlabelled: Metaphyseal cones are frequently used in revision total knee arthroplasties (TKAs). However, during subsequent aseptic re-revisions, removing a well-fixed cone can be difficult. One innovative option is to retain the well-fixed cone and cement a new, stemmed revision component through the retained cone, yet minimal data exist on this technique.

Data-Driven Approach to Development of a Risk Score for Periprosthetic Joint Infections in Total Joint Arthroplasty Using Electronic Health Records.

Background: Periprosthetic joint infection (PJI) is an uncommon, but serious complication in total joint arthroplasty. Personalized risk prediction and risk factor management may allow better preoperative assessment and improved outcomes. We evaluated different data-driven approaches to develop surgery-specific PJI prediction models using large-scale data from the electronic health records (EHRs).

Obesity and Primary Total Knee Arthroplasty: The Absolute Versus Relative Risk of Periprosthetic Joint Infection at 15 Years.

Background: When indicating patients for primary total knee arthroplasty (TKA), surgeons and patients must understand the absolute and relative risks of periprosthetic joint infection (PJI) to make an informed decision. We sought to evaluate the long-term risk of PJI following primary TKA stratified by body mass index (BMI) and PJI-related risk factors.

Methods: We identified 25,160 primary TKAs performed from 2000 to 2021 at a single institution.

Why Are Contemporary Primary Ceramic-on-Highly Crosslinked Polyethylene Total Hip Arthroplasties Failing? An Analysis of Over 5,500 Cases.

Background: Ceramic-on-highly crosslinked polyethylene (HXLPE) has become the most common bearing surface utilized in primary total hip arthroplasty (THA). The purpose of this study was to determine the implant survivorship and clinical outcomes of THAs with ceramic-on-HXLPE in a large single-institutional series.

Methods: We identified 5,536 primary THAs performed from 2007 to 2017 using a ceramic-on-HXLPE bearing through our total joint registry.

What Is the Incidence of and Outcomes After Debridement, Antibiotics, and Implant Retention (DAIR) for the Treatment of Periprosthetic Joint Infections in the AJRR Population?

Background: Debridement, antibiotics, and implant retention (DAIR) is used to manage acute periprosthetic joint infections (PJIs) after total joint arthroplasty (TJA). Given the uncertain success of single or multiple DAIR attempts and possible long-term deleterious effects this treatment can create when trying to treat persistent infection, it is important to understand the frequency with which surgeons in the United States are attempting multiple debridements for PJI and whether those procedures are achieving the desired goal.

Question/purposes: In the context of the American Joint Replacement Registry (AJRR), we asked: (1) What proportion of patients who undergo DAIR have only one DAIR, and what percentage of those patients have more than one? (2) Of the patients who undergo one or more DAIR procedures, what is the proportion who progress to additional surgical procedures? (3) What is the cumulative incidence of medical or surgical endpoints related to infection on the affected leg (other than additional DAIR procedures)?

Methods: DAIR procedures to treat PJI, defined by ICD-9/10 and CPT (Current Procedural Technology) codes, reported to the AJRR from 2012 to 2020 were merged with Centers for Medicare and Medicaid Services (CMS) data from 2012 to 2020 to determine the incidence of patients aged 65 and older who underwent additional PJI-related procedures on the same joint.

Diaphyseal Impaction Grafting Combined with Metaphyseal Cones: Outcomes in 88 Revision Total Knee Arthroplasties.

Background: Metaphyseal cones with cemented stems can be successfully utilized in most revision total knee arthroplasties (TKAs). However, if the diaphysis has been previously violated, fixation of the cemented stem, which is important for cone ingrowth and construct survival, can be compromised. The initial results of our novel technique combining diaphyseal impaction bone-grafting with a metaphyseal cone were promising but required additional study.

Porous Tantalum Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty: Excellent 10-Year Survivorship.

Background: Highly porous metal tibial metaphyseal cones (TMCs) are commonly utilized in revision total knee arthroplasty (TKA) to address bone loss and obtain biologic fixation. Mid-term (5 to 10 year) studies have previously demonstrated excellent survivorship and high rates of osseointegration, but longer-term studies are lacking. We aimed to assess long-term (≥ 10 year) implant survivorship, complications, and clinical and radiographic outcomes after revision TKA with TMCs.

Highly Porous Acetabular Cup and Augment Constructs in Complex Revision Total Hip Arthroplasty: What Predicts 10-Year Implant Survivorship?

Background: Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship.

Cemented dual-mobility constructs in uncemented revision acetabular components.

Aims: Dislocation remains a leading cause of failure following revision total hip arthroplasty (THA). While dual-mobility (DM) bearings have been shown to mitigate this risk, options are limited when retaining or implanting an uncemented shell without modular DM options. In these circumstances, a monoblock DM cup, designed for cementing, can be cemented into an uncemented acetabular shell.

Obesity and Primary Total Hip Arthroplasty: The Absolute versus Relative Risk of Periprosthetic Joint Infection at 15 Years.

Background: To make an informed decision about total hip arthroplasty (THA), surgeons and patients need to understand the absolute and relative risks of periprosthetic joint infection (PJI). We sought to evaluate the long-term risk of PJI following primary THA stratified by body mass index (BMI) and PJI-related risk factors.

Methods: We identified 21,550 primary THAs performed from 2000 to 2021 at a single institution.

Is the Rise of Medicare Advantage Impacting the Fidelity of Traditional Medicare Claims Data? Implications for Reporting of Long-Term Total Hip Arthroplasty Survivorship.

Background: Arthroplasty registries often use traditional Medicare (TM) claims data to report long-term total hip arthroplasty (THA) survivorship. The purpose of this study was to determine whether the large number of patients leaving TM for Medicare Advantage (MA) has compromised the fidelity of TM data.

Methods: We identified 10,962 THAs in 9,333 Medicare-eligible patients who underwent primary THA from 2000 to 2020 at a single institution.

Total Hip Arthroplasty Following Operative Fixation of Acetabular Fracture: A Contemporary Series.

Background: Total hip arthroplasty (THA) is the operation of choice for salvage of post-traumatic arthritis following acetabular fracture. While high failure rates have been reported for these procedures, existing literature reports mainly on historical implant designs and techniques. We aimed to describe implant survivorships, complications, radiographic results, and clinical outcomes of contemporary THA following prior open reduction internal fixation (ORIF) of an acetabular fracture.

Long-term outcome of total hip arthroplasty in patients with multiple hereditary exostosis.

Background: Multiple hereditary exostosis (MHE) is a rare autosomal dominant disorder characterized by multiple osteochondromas. There is a paucity of literature concerning total hip arthroplasty (THA) in patients with MHE. The aim of this study is to report long-term outcomes of THA in patients with MHE.

Midterm outcomes of total hip arthroplasty after internal hemipelvectomy and iliofemoral arthrodesis.

Background And Objectives: Recent studies have reported acceptable outcomes after arthrodesis takedown and conversion to total hip arthroplasty (THA); however, there are no reports on outcomes after oncologic resection, which are inherently complex and may portend poorer outcomes. The purpose of this study was to examine the surgical and functional outcomes of patients who underwent prior hemipelvectomy for tumor resection and were later converted to THA.

Methods: All patients who had prior iliofemoral arthrodesis after oncologic resection that were later converted to THA at a single institution were examined.

Whole Blood Metal Levels in the Setting of an Oncologic Endoprosthesis: Is There Cause for Concern?

Background: Massive modular endoprostheses have become a primary means of reconstruction after oncologic resection of a lower extremity tumor. These implants are commonly made with cobalt-chromium alloys that can undergo wear and corrosion, releasing cobalt and chromium ions into the surrounding tissue and blood. However, there are few studies about the blood metal levels in these patients.

Correlation of Blood Metal Concentrations with Cognitive Scores and Neuroimaging Findings in Patients with Total Joint Arthroplasty.

Total joint arthroplasty (TJA) implants are composed of metals, ceramics, and/or polyethylene. Studies suggest that the debris released from metal implants may possess neurotoxic properties with reports of neuropsychiatric symptoms and memory deficits, which could be relevant to Alzheimer's disease and related dementias. This exploratory study examined the cross-sectional correlation of blood metal concentrations with cognitive performance and neuroimaging findings in a convenience sample of 113 TJA patients with history of elevated blood metal concentrations of either titanium, cobalt and/or chromium.