Leg-length discrepancy in revision total hip arthroplasty : computer-assisted navigation improves the discrepancy when compared with manual techniques.

Aims: Leg-length discrepancy (LLD) following total hip arthroplasty (THA) is a source of patient dissatisfaction and morbidity. The objectives of this study were to characterize LLD following revision THA (rTHA) and evaluate the difference in LLD between navigated and non-navigated rTHA.

Methods: This retrospective cohort study included 202 patients treated with rTHA performed between 2017 and 2021.

Not so Fast! Feasibility and Safety of Outpatient Revision Total Knee Arthroplasty.

Background: As a result of a successful transition of primary total knee arthroplasty (TKA) to an outpatient procedure, there is interest from payers to see a similar shift for revision total knee arthroplasty (rTKA) surgery. This study aimed to evaluate (1) the number of patients meeting discharge criteria within 24 hours following revision total knee arthroplasty (rTKA); (2) the proportion of patients meeting these criteria after isolated polyethylene exchange (PE) ± patellar revision compared to any other component revision; and 3) factors contributing to successful outpatient status after rTKA.

Methods: We reviewed 3,150 rTKA procedures between 2017 and 2023.

Cement Mantle Screws in Periprosthetic Hip Fracture Fixation Near Well-Fixed Femoral Stems May Not Impact Short-Term Femoral Stem Survivorship.

Background: Vancouver Type-B1 and C periprosthetic hip fractures have traditionally been treated using single- or double-plate fixation constructs. Concern exists regarding screws within the cement mantle due to the theoretical risk of cement fracture and eventual prosthetic loosening. The aim of this study was to assess femoral stem survivorship in patients with Vancouver Type-B1 or C fractures around a well-fixed cemented femoral component who were treated with a plate construct and screws into the cement mantle.

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.

Extended Trochanteric Osteotomy Increases the Risk of Tapered Splined Stem Subsidence in Revision Total Hip Arthroplasty.

Introduction: In the United States, tapered splined titanium stems (TSTSs) are the most frequently used femoral stem design in revision total hip arthroplasty. Despite encouraging and favorable results with TSTS, complications including femoral stem subsidence persist and subsidence >5 mm has been associated with implant failures and the need for aseptic rerevision surgery. We sought to investigate whether an extended trochanteric osteotomy (ETO) at the time of TSTS insertion increased mean subsidence and whether the amount of cortical contact was associated with subsidence, failure, and revision.

Can artificial intelligence generate scientific discussion that passes peer review for publication in a high-impact orthopaedic journal?

Background: There is huge interest in the use of artificial intelligence (AI) in the production and assessment of academic material; however, the role of AI remains unclear.

Aim: The purpose of this study was to perform a reviewer-blinded assessment of the quality of scientific discussion generated by an advanced AI language model (ChatGPT-4, Open AI) and determine whether this could be recommended for high-impact journal publication.

Methods: The introduction, methods and results sections of a recently published article from a high-impact journal were input into a current AI model.

Acute Arthrotomy Dehiscence After Primary Total Knee Arthroplasty: Depth of Injury Impacts Outcome.

Background: Arthrotomy dehiscence is a challenging complication following total knee arthroplasty (TKA). As early mobilization and fast-track rehabilitation protocols become increasingly popular, arthrotomy dehiscence incidence will likely increase. This study aimed to evaluate the clinical outcomes of acute, traumatic arthrotomy dehiscence, with and without superficial skin involvement, following primary TKA.

Polymer-Based Cerclage Cables Are Equivalent to Stainless Steel Cables in Management of Peri-Isthmic Periprosthetic Femoral Fractures: A Biomechanical Comparison.

Background: Periprosthetic femoral fractures (PPFs) following total hip arthroplasty (THA) are challenging complications, and as THA is increasingly performed in younger, more active populations, the incidence of PPFs is expected to rise. Treatment often requires tapered titanium stems to provide axial and rotational stability, and cerclage fixation is commonly used. Traditional metallic cerclage cables are effective, but carry risks such as fretting, corrosion, and intraoperative injury.

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.

Repeat Revision Total Knee Arthroplasty Has Significantly Lower Survivorship Compared to First-Time Revisions.

Background: Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. Compared to first-time rTKA, re-rTKA presents additional challenges, including further compromised soft tissues and bone loss, abundant scar tissue, stemmed revision implants, and metaphyseal fixation. The goal of this study was to compare the survivorship and clinical outcomes of aseptic first-time rTKAs and re-rTKAs.

A Comprehensive Approach to Stiffness in Total Knee Arthroplasty.

This article is a summary of a symposium on knee stiffness in primary and revision total knee arthroplasties presented at the 2024 American Association of Hip and Knee Surgeons annual meeting. The purpose of this article was to provide an overview of the genetics of arthrofibrosis, preoperative and perioperative risk factors associated with arthrofibrosis, ways to optimize modifiable risk factors, and early and late treatment options for stiffness and when it fails to improve with initial interventions. LEVEL OF EVIDENCE: V.

Piriformis preservation in total hip arthroplasty: do we have a new concept? An update on anatomy, function and clinical outcomes.

The piriformis muscle (PM) is important for posture and preventing falls. It is a key landmark for hip surgery. The PM function is reported to be increasingly important for improving total hip arthroplasty (THA) outcomes and reducing complications.

Arthrofibrosis Severity in Knees With Failed Total Knee Arthroplasties Differs With Magnetic Resonance Imaging Synovial Classification.

Background: Treatment of stiffness following total knee arthroplasty (TKA) is complicated by a lack of a specific diagnosis for arthrofibrosis. Magnetic resonance imaging (MRI) provides a noninvasive means to generate and evaluate clinically diagnostic images of deep structures within the knee. The purpose of this study was to assess how the severity and location of arthrofibrosis observed on MRI relate to MRI synovial classifications and range of motion in primary TKA patients undergoing revision surgery.

Beyond Coronal Plane Alignment of the Knee: Similarity and Variability of Extension Knee Balance Across Coronal Plane Alignment of the Knee Phenotypes.

Background: The Coronal Plane Alignment of the Knee (CPAK) classification has been proposed to guide the alignment strategy in total knee arthroplasty (TKA). However, the classification does not take into account the variability of the soft-tissue envelope unique to each knee. The purpose of our study was to determine the variability and similarity of extension balance across each CPAK phenotype.

Simulated Partial and Complete Resection of the Posterior Cruciate Ligament in Medially Conforming Total Knee Arthroplasty Causes a Graded Reduction in Femoral Rollback and Increase in Posterior Tibial Sag: A Computational Study.

Background: Medially conforming (MC) total knee arthroplasty (TKA) has seen increased clinical utilization. This design allows for either retention or resection of the posterior cruciate ligament (PCL); however, the impact of the PCL on femoral rollback and posterior tibial sag is unknown. Therefore, we developed a computational model to quantify how the PCL affects femoral rollback and posterior sag in MC-TKA.

Complete and Selective Resection of the Posterior Cruciate Ligament Reduces Contact Forces Asymmetrically in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study.

Background: Assessing intraoperative ligament balance in the posterior cruciate ligament (PCL)-retaining total knee arthroplasty (TKA) can be achieved by quantifying tibio-femoral contact forces. Ligament balancing may involve selectively releasing PCL fibers; however, the effects of the extent and location of PCL release on compartmental contact forces are not well understood. To investigate these effects, we developed a computational model to quantify changes in medial and lateral contact forces resulting from targeted PCL fiber release.

Stratified Comparison of Short-Term Perioperative Outcomes in Direct Anterior Versus Posterolateral Primary Total Hip Arthroplasty: A Retrospective Review.

It is unclear what influence patient sex and body mass index (BMI) have on perioperative outcomes following total hip arthroplasty (THA), especially regarding anterior versus posterolateral approaches. : We sought to compare perioperative outcomes of primary THA via direct anterior (DAA) versus posterolateral (PLA) approaches, stratified by patient sex and BMI. : A retrospective review at a single institution identified 8258 patients 18 to 80 years old who underwent primary THA via DAA or PLA for osteoarthritis between February 2019 and April 2022.

A Novel Radiographic Methodology to Measure Knee Adduction Moment Using Routine Biplane Radiographs: Initial Results of 20 Patients.

Background: Compromised function is a common reason for patient dissatisfaction after total knee arthroplasty. However, objectively evaluating function often requires costly, time-consuming, and highly specialized data collection and analysis in a dedicated motion analysis laboratory. To overcome this practical barrier, we developed a radiographic-based method to quantify knee joint moments in routine clinical care and to explore the relationship between knee moments in the sagittal plane and the Knee Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR).

Closed-Incision Negative Pressure Wound Therapy Improves Outcomes in Obese Aseptic Revision Total Hip and Knee Arthroplasty.

Background: The burden of revision total joint arthroplasty (rTJA) is increasing. Revision procedures are associated with an increased risk of perioperative complications. Obese patients undergoing rTJA may have a higher risk of wound complications due to their soft-tissue envelope.

Not so Fast! Feasibility and Safety of Outpatient Revision Total Hip Arthroplasty.

Background: As total hip arthroplasty (THA) transitions to the outpatient setting, so will some revision procedures. However, revisions are more complex and have greater impact physiologic stress on the patient. Therefore, the purposes of this study were to: (1) evaluate the number of patients discharged within 24 hours following revision; (2) compare the proportion of patients discharged following ball/liner exchange versus any component revision; and (3) determine the factors leading to successful discharge within 24 hours following revision THA (rTHA).

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.

The Impact of Contemporary Glucagon-like Peptide-1 Receptor Agonists on the Onset, Severity, and Conversion to Arthroplasty in Hip and Knee Osteoarthritis.

Background: The growing popularity of glucagon-like peptide-1 receptor agonists (GLP-1-RAs) for weight loss could significantly impact joint preservation and arthroplasty. While this will in part be driven by the association between obesity, osteoarthritis (OA), and total joint arthroplasty (TJA), recent evidence also indicates that GLP-1-RAs may have direct joint-protective, anti-inflammatory effects.

Purpose: To evaluate the association between GLP-1-RA use and the onset and progression of hip and knee OA in an obese population.

Finite Element Model of Patient-Specific Flanged Acetabular Components Highlights Biomechanical Effects of Bone Density and Cortical Shell Thickness.

Patient-specific flanged acetabular components are utilized to treat failed total hip arthroplasties with severe acetabular defects. We previously developed and published a finite element model that investigated the impact of hip joint center lateralization on construct biomechanics during gait conditions. This model consisted of a patient-specific implant designed to address a superior-medial defect created in a standard pelvic geometry.

Comparison and Validation of Methods for Restoring Neck Length in Hip Arthroplasty That Can Be Applied for Femoral Neck Fracture.

Restoring leg length during total hip arthroplasty (THA) for femoral neck fracture is challenging due to the lack of an intact femoral neck on the fractured side. Thus, templating methods typically use size of the intact contralateral hip to estimate length. Common reference points include the distance from the lesser trochanter to the center of the femoral head (LTC) and femoral head diameter (FHD).

Glucagon-Like Peptide-1 Receptor Agonists Decrease Medical and Surgical Complications in Morbidly Obese Patients Undergoing Primary TKA.

Background: Weight optimization methods in morbidly obese patients with a body mass index (BMI) of ≥40 kg/m 2 undergoing total knee arthroplasty (TKA) have shown mixed results. The purpose of this study was to evaluate the effect of perioperative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients with a BMI of ≥40 kg/m 2 undergoing primary TKA.

Methods: Using an administrative claims database, patients with morbid obesity undergoing primary TKA were stratified into GLP-1 RA use for 3 months before and after the surgical procedure (treatment group) and GLP-1 RA non-use (control group), and were matched on the basis of patient age, gender, diagnosis of type-2 diabetes mellitus, and Charlson Comorbidity Index (CCI).