A Cone Stacked on a Cone Within a Cone: A Technique for Reconstructing Proximal Third Tibial Shaft Fractures During Revision Total Knee Arthroplasty.

Bone loss in revision total knee arthroplasty is an increasing challenge, especially as younger active patients undergo primary procedures. Treatment options for severe tibial bone loss include cement, allograft, metal augments, metaphyseal cones, sleeves, and megaprostheses. Novel combinations of these have enabled complex limb salvage without resorting to megaprostheses or amputation.

Prior Femoral Canal Instrumentation Is a Major Risk Factor for Fixation Failure After Distal Femoral Replacement.

Background: Distal femoral replacement (DFR) is a salvage option for massive femoral bone loss and is often performed in revision total knee arthroplasty (rTKA) that have undergone multiple prior procedures. This study aimed to report on a large cohort of DFRs performed at a tertiary referral institution regarding survivorship and risk factors for aseptic loosening, specifically the impact of a previously instrumented femoral canal.

Methods: Between 2016 and 2021, 105 patients undergoing rTKA to DFR with a minimum 2-year follow-up were identified.

Fracture of the Femoral Broach Locking Mechanism and Surgical Technique to Retrieve the Broach.

The current case series reports on 4 cases of intraoperative fracture of the femoral broach locking mechanism during total hip arthroplasty and subsequent entrapment of the broach. Three of the cases were performed via the direct anterior approach and 1 was performed with the posterolateral approach. Two femoral broach locking mechanisms fractured with the use of a power broaching device and 2 occurred when using the calcar planar.

Excellent early outcomes following lateral robotic-assisted unicompartmental knee arthroplasty.

Introduction: Lateral unicompartmental knee arthroplasty (UKA) has historically shown mixed results and there is limited contemporary literature on lateral robotic-assisted UKA (RA-UKA) outcomes. This study aimed to evaluate the short-term survivorship, clinical, and radiographic outcomes of lateral RA-UKA.

Methods: A retrospective review identified 138 lateral RA-UKAs performed from 2016 to 2022 at a single institution, with a study population of 58% women, a mean BMI of 27 kg/m, and a mean age of 62 years.

Contemporary Outcomes of Proximal Femoral Replacement as a Salvage Treatment in Nononcologic Severe Bone Loss.

Background: Severe proximal femoral bone loss remains a challenging problem in revision total hip arthroplasty (rTHA). Proximal femoral replacements (PFRs) are salvage options for severe bone loss in complex rTHA. The purpose of this study was to describe the survivorship and clinical outcomes of PFR for nononcologic indications.

Low rates of dislocation and reoperation following robotic-assisted total hip arthroplasty for femoral neck fracture.

Introduction: Total hip arthroplasty (THA) is widely used for active, elderly patients with femoral neck fractures (FNF). Compared to THA for osteoarthritis, THA for FNF is associated with a higher incidence of dislocation and reoperation. Robotic assistance may improve component positioning and leg-length restoration in THA, but its use in FNF has not been described.

Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively.

Background: Tobacco use is a well-documented modifiable risk factor for perioperative complications.

Aim: To determine the tobacco abstinence rates of patients who made cessation efforts prior to a total joint arthroplasty (TJA) procedure.

Methods: A retrospective evaluation was performed on 88 self-reported tobacco users who underwent TJA between 2014-2022 and had tobacco cessation dates within 3 mo of surgery.

Risk Factors for Early Readmission and Reoperation After Outpatient Total Hip Arthroplasty.

Outpatient total hip arthroplasty (THA) is a safe option for select patients. The purpose of this study was to analyze a national database and understand risk factors that lead to unplanned early readmission and reoperation after outpatient THA. The National Surgical Quality Improvement Program database was used to collect outpatient THAs performed from 2013 to 2020.

Assessing the Diagnostic Accuracy of Next-Generation Sequencing in Patients With Antibiotic Spacers Before Reimplantation.

Use of molecular sequencing modalities in periprosthetic joint infection diagnosis and organism identification has gained popularity recently. To date, there is no diagnostic test that reliably predicts infection eradication in patients with antibiotic spacers. The purpose of this study was to compare the diagnostic accuracy of next-generation sequencing (NGS), culture, the Musculoskeletal Infection Society (MSIS) criteria, and the criteria by Parvizi et al in patients with antibiotic spacers.

Transitioning to Outpatient Shoulder Arthroplasty: Safety, Efficiency, and Cost in a Diverse Payer Mix.

Outpatient shoulder arthroplasty presents potential clinical benefits but also risk without perioperative optimization. Length of stay depends largely on surgeon preferences, and a large single-surgeon cohort may provide insight into optimal strategies and costs for outpatient shoulder arthroplasty. A single-surgeon cohort of 472 anatomic and reverse shoulder arthroplasties performed between 2017 and 2020 was retrospectively reviewed.

The characteristics of opioid use in patients with proximal humerus fractures.

Background: Orthopaedic surgeons prescribe more opioid narcotics than any other surgical specialty. Proximal humerus fractures (PHF) often occur in the high-risk elderly population. The opioid epidemic has led to public policy aimed at reductions in opioid prescription.

Epidemiology of Sports-Related Clavicle Fractures in the United States: Injuries From 2015 to 2019.

Background: Clavicle fractures are common orthopaedic injuries that frequently occur during sports and recreational activity.

Purpose: To (1) determine the incidence rate of sports-related clavicle fractures among patients evaluated in emergency departments in the United States over a 5-year period, (2) determine the most common sports and risks associated with clavicle fractures, and (3) update the literature by comparing past and present injury trends.

Study Design: Descriptive epidemiology study.

Total Hip Arthroplasty in Morbidly Obese: Does a Strict Body Mass Index Cutoff Yield Meaningful Change?

Purpose: The number of obese patients seeking total hip arthroplasty (THA) continues to expand despite body mass index (BMI) cutoffs. We sought to determine the outcomes of THA in the morbidly obese patient, and hypothesized they would have comparable outcomes to two cohorts of obese, and normal weight patients.

Materials And Methods: THA performed on morbidly obese patients (BMI >40 kg/m) at a single academic center from 2010 until 2020 were retrospectively reviewed.

Serology and Comorbidities in Patients With Fracture Nonunion: A Multicenter Evaluation of 640 Patients.

Introduction: This multicenter cohort study investigated the association of serology and comorbid conditions with septic and aseptic nonunion.

Methods: From January 1, 2011, to December 31, 2017, consecutive individuals surgically treated for nonunion were identified from seven centers. Nonunion-type, comorbid conditions and serology were assessed.

Ulnar Resection Length: A Risk Factor for Nonunion in Ulnar Shortening Osteotomy.

Background: Nonunion rates following ulnar shortening osteotomy (USO) are reported up to 18% with few known risk factors. While resection length is variable in practice, little is known about the prognostic implications on healing. The purpose of this study was to evaluate whether longer resection lengths increased the odds of nonunion.

Fracture Severity Based on Neer Classification Does Not Predict Short-term Complications Following Reverse Shoulder Arthroplasty.

Proximal humerus fractures (PHF) are common in elderly and osteoporotic patients, and these fractures are often described using the Neer classification. As reverse shoulder arthroplasty (RSA) for PHF becomes more common, it is helpful to identify the utility of Neer classification in predicting postoperative outcomes for patients undergoing RSA. The medical records of patients undergoing primary RSA for PHF at a single academic institution from 2013-2019 were identified using medical billing codes.

Histologic grading correlates with inflammatory biomarkers in tibialis posterior tendon dysfunction.

Background: It has been theorized that tibialis posterior tendon dysfunction (TPTD) is a degenerative process unrelated to inflammation. The purpose of this study was to determine if inflammatory cytokines, matrix metalloproteases (MMPs), and glutamate were elevated in diseased tibialis posterior tendons (TPTs).

Methods: Matched diseased TPT, TPT insertion, and flexor digitorum longus (FDL) samples were collected from 21 patients.

Cutibacterium Positive Cultures in Total Hip Arthroplasty: Contaminant or Pathogen?

Background: Cutibacterium spp. is an emerging pathogen in total hip arthroplasty (THA) that is not well evaluated in the literature. This study reported on the presentation and management of THA complicated by positive intraoperative Cutibacterium cultures.

Patient Factors Associated With Increased Risk for Complications After the Latarjet Procedure.

Background: The open Latarjet has become the most common method of addressing significant glenoid bone loss in patients with recurrent glenohumeral instability.

Purpose: To describe national trends in Latarjet procedures and risk factors for complications associated with this procedure.

Study Design: Cohort study; Level of evidence, 3.

Effect of commonly used lavage solutions on the polymerization of bone cement.

Introduction: Little is known about the impact irrigation solutions have on the material properties of cement used in hip and knee arthroplasty. We sought to compare the effect of three commonly used lavage solutions on cement polymerization.

Methods: Ten groups were used for cure and mechanical testing: two cement controls, and eight cement groups mixed with test solutions.

Heterotopic Ossification Prophylaxis Following Operative Fixation of Acetabular Fractures: A Systematic Review.

Introduction: Heterotopic ossification (HO) is a well-recognized complication following operative fixation of acetabular fractures with a range of severity and clinical consequences. The purpose of this review was to: (1) report the incidence of heterotopic ossification (HO) formation following operative fixation of acetabular fractures; (2) determine the effectiveness of prophylactic treatments for HO; and (3) assess the radiographic severity of HO with and without prophylactic treatment.

Materials And Methods: A literature search for peer-reviewed articles was conducted utilizing a variety of research databases.

Patterns and Predictors of Weight Change Before and After Total Hip Arthroplasty in Class 2 and 3 Obese Patients.

Background: This study aimed to better understand body mass index (BMI) change patterns and factors associated with BMI change before and after total hip arthroplasty (THA) in Class 2 and 3 obese patients, and assess if preoperative or postoperative BMI change affects postoperative clinical outcomes.

Methods: We retrospectively reviewed World Health Organization Class 2 and 3 obese patients (BMI > 35.0 at surgery) who underwent THA at a tertiary medical center from 2010 to 2020.

An ACS-NSQIP Analysis of Unicompartmental Knee Arthroplasty Trends from 2013 to 2018.

Unicompartmental knee arthroplasty (UKA) volume has increased with advances in implant design, perioperative protocols, and patient selection. This study analyzed national trends of UKA from 2013 to 2018 and the relationship between patient demographics and postoperative outcomes. Data on UKA (CPT 27446) from 2013 to 2018 was collected from the National Surgical Quality Improvement Program (NSQIP).