Cemented Fixation in Arthroplasty for Hip Fractures Does Not Increase Cardiopulmonary Complications: A Secondary Analysis of the HIP ATTACK Trial.

Background: Cemented fixation in arthroplasty to treat hip fractures is now widely recommended, but it is not universally used. Some surgeons may feel that the risk of bone cement implantation syndrome and its cardiopulmonary sequalae are too high, in part, because the evidence provides little detail on postoperative myocardial injury and other medical complications after cement use.

Questions/purposes: We aimed to use data from the HIP ATTACK trial (an RCT in which patients with a hip fracture were randomized to accelerated time to surgery versus normal timing of surgery) for a secondary analysis to answer the following questions on arthroplasty for patients with hip fractures: (1) Are patients who undergo cemented hip arthroplasty for hip fractures more likely to experience cardiopulmonary events than patients who undergo uncemented hip arthroplasty? (2) Are patients who undergo cemented hip arthroplasty for hip fractures more likely to experience myocardial injury, identified by elevated troponin levels, than patients who undergo uncemented hip arthroplasty?

Methods: We performed a post hoc analysis of the HIP ATTACK trial for a subset of patients who were treated with THA or hemiarthroplasty for a femoral neck fracture because the trial collected postoperative troponin levels to allow us to identify myocardial injury.

Postoperative knee pain, satisfaction, and revision after total knee arthroplasty with and without primary patella resurfacing.

Background: Patella resurfacing during total knee arthroplasty (TKA) remains controversial. We performed a large cohort study to assess pain, function, and revision risk between patients with and without primary patella resurfacing.

Method: We identified 10,846 primary TKAs in 2005-2024.

Outcomes of Long-Term Antibiotic Therapy for Prosthetic Joint Infection: A Cohort Study in a Canadian High-Volume Arthroplasty Center.

Background: Long-term antibiotic therapy (LAT) can be used to prevent relapse of prosthetic joint infection. Evidence on best practices for LAT is limited and conflicting. We aimed to assess total hip or knee arthroplasty revision for prosthetic joint infection for patients on LAT.

Primary Total Knee Arthroplasty in Patients with BMI of ≥50 kg/m 2: A Cohort Study with Long-Term Follow-up.

Background: The obesity epidemic has given rise to an orthopaedic patient subgroup with a body mass index (BMI) of ≥50 kg/m 2 . Without sound evidential guidance, arthroplasty surgeons and anesthesiologists do not know whether they can push the limits of the surgical feasibility of total knee arthroplasty (TKA) without risks of harm.

Methods: In a retrospective cohort study of patients who had undergone primary TKA for degenerative arthritis at our academic center (n = 10,389; 6,821 women, 4,070 men, and 38 unknown), we compared the outcomes between patients with a BMI of ≥50 kg/m 2 (n = 627) and patients in other weight classes.

Multi-center experience with outpatient total hip arthroplasty via a standard posterolateral approach.

Background: This study sought to evaluate the safety, efficacy, and resource utilization of a pilot outpatient surgery program for total hip arthroplasty compared to traditional inpatient total hip arthroplasty performed via the posterolateral approach.

Methods: A cohort of 68 patients from two sites were enrolled in a regional pilot project for outpatient total hip arthroplasty (THA) and matched 1:1 against a cohort of patients undergoing routine inpatient THA. Data was extracted retrospectively from patient and hospital charts including adverse events (AE), readmission within 90 days, emergency room (ER) visits, patient calls, patient-reported outcome measures, length of stay, and multiple surgical variables.

Randomized controlled trial comparing traditional versus enhanced-fixation designs of a novel cemented total knee arthroplasty tibial component.

Aims: A novel enhanced cement fixation (EF) tibial implant with deeper cement pockets and a more roughened bonding surface was released to market for an existing total knee arthroplasty (TKA) system.This randomized controlled trial assessed fixation of the both the EF (ATTUNE S+) and standard (Std; ATTUNE S) using radiostereometric analysis.

Methods: Overall, 50 subjects were randomized (21 EF-TKA and 23 Std-TKA in the final analysis), and had follow-up visits at six weeks, and six, 12, and 24 months to assess migration of the tibial component.

Comparison of two hydroxyapatite-coated femoral components: a randomized clinical trial using radiostereometric analysis.

Aims: The primary aim of this trial was to compare the subsidence of two similar hydroxyapatite-coated titanium femoral components from different manufacturers. Secondary aims were to compare rotational migration (anteversion/retroversion and varus/valgus tilt) and patient-reported outcome measures between both femoral components.

Methods: Patients were randomized to receive one of the two femoral components (Avenir or Corail) during their primary total hip arthroplasty between August 2018 and September 2020.

Radiostereometric analysis and clinical outcomes of a novel reverse total hip system at two years.

Aims: Instability is a common cause of failure after total hip arthroplasty. A novel reverse total hip has been developed, with a femoral cup and acetabular ball, creating enhanced mechanical stability. The purpose of this study was to assess the implant fixation using radiostereometric analysis (RSA), and the clinical safety and efficacy of this novel design.

Modes of failure of hip hemiarthroplasty for femoral neck fracture.

Background: Hemiarthroplasty is a common treatment for displaced femoral neck fractures, but limited Canadian data are available about hemiarthroplasty failure. We evaluated the frequency and predictors of hemiarthroplasty failure in Manitoba.

Methods: In this retrospective multicentre province-wide study, billing and joint registry databases showed 4693 patients who had hemiarthroplasty for treatment of femoral neck fracture in Manitoba over an 11-year period (2005-2015), including 155 hips with subsequent reoperations (open or closed) for treatment of hemiarthroplasty failure.

Survivorship of constrained polyethylene inserts in primary total knee replacements.

Background: Varus-valgus constrained (VVC) inserts are used in primary total knee arthroplasty (TKA) when stability cannot be achieved with a traditional insert. Concern has been raised regarding premature loosening and failure of these primary TKAs due to the increased load transfer through the prosthesis. This study seeks to assess the survival, clinical outcomes and radiographic assessment of VVC total knee inserts used in a single primary TKA system without diaphyseal stem extensions.

Guided-motion hinged knee replacement prosthesis: early survival rate and postoperative patient function and satisfaction.

Background: Literature on the survival rates and function of hinged total knee replacement (HTKR) prostheses is scarce, and to our knowledge there is not yet any published literature on the Legion HK Hinge Knee Replacement prosthesis (Smith & Nephew) with guided-motion articulation. The objective of this study was to establish the early survival rate of this modern HTKR at a single institution and to investigate postoperative patient function and satisfaction.

Methods: This retrospective study included patients who received the Legion HTKR prosthesis with guided-motion inserts as a primary or revision implant between October 11 and March 2016 at a tertiary care centre in Manitoba, Canada.

Midterm Results of a Contemporary, Porous-Coated Acetabular System in Patients Undergoing Primary Total Hip Replacement for Degenerative Hip Disease: A Prospective, Multicenter Study.

Background: A contemporary, porous-coated acetabular implant designed for uncemented insertion was introduced in Europe and Australia in 2007. A similar previous acetabular system was found in several studies at 10 to 15-year follow-up to demonstrate accelerated polyethylene wear, osteolysis, and early failure. The current study was conducted to determine the midterm safety and effectiveness of this contemporary acetabular system using highly crosslinked polyethylene and ceramic liners at 5-year follow-up.

Does oxidized zirconium make a difference? Midterm cohort survivorship of symmetric posterior condyle posterior-stabilized total knee arthroplasty.

Background: A novel symmetric posterior condylar design and option of a femoral component with an outer zirconium oxide layer were introduced to a successful asymmetric condylar total knee arthroplasty system in 2005. Given the paucity of information on this modified design, we performed a study to determine its early to midterm survivorship and performance.

Methods: Patients who received the Genesis II Symmetric Posterior Condyle or Legion Primary total knee (cobalt–chromium [CoCr] or oxidized zirconium–niobium [OxZr]) (Smith & Nephew) implanted at the study centre between March 2007 and December 2013 were enrolled into a prospective database.

Clinical and radiographic outcomes of a hybrid fixation revision total knee arthroplasty system at short to mid-term follow-up.

Background: Despite the extensive study of primary arthroplasty, revision surgery is rarely discussed due to the reduced frequency and variability between patients. A new revision knee system was introduced to build off the geometry of a successful knee replacement system. This study seeks to assess the survival, clinical outcomes and radiographic assessment of this revision system at the early to mid-term.

Retrieval Analysis of Large-Head Modular Metal-on-Metal Hip Replacements of a Single Design.

Background: There are limited publications examining modular metal-on-metal (MoM) total hip implants in which a comprehensive analysis of retrieved components is performed. This study examines 24 retrieved modular MoM implants from a single manufacturer and compares retrieval analytics; bearing surface damage, wear, and modular taper corrosion against patient, surgical and implant characteristics to elucidate significant associations.

Methods: Clinical, patient, and surgical data were collected including age, body mass index, blood metal ion levels, and cup inclination.

Damage Assessment of Retrieved Birmingham Monoblock Cups: Is Conversion to Dual-Mobility Head a Viable Revision Option?

Background: A novel revision technique for failed hip resurfacings involves retention of the acetabular cup, if well-fixed, which is mated to dual-mobility (DM) prosthesis in a traditional hip replacement configuration. It is unknown whether existing damage on the retained cup will result in unacceptable wear of the DM prosthesis.

Methods: Thirty retrieved Birmingham (Smith & Nephew) monoblock cups were visually scored for damage features and area of coverage.

The biochemical characteristics of wear testing lubricants affect polyethylene wear in orthopaedic pin-on-disc testing.

Lubricant protein concentration is known to affect crosslinked polyethylene wear in in vitro testing; however, the biochemical nature of these lubricants may also have a significant effect on wear and dictate its clinical relevance. A modified approach to pin-on-disc testing was implemented to explore the effect of four biochemically different lubricants on the wear of two types of crosslinked polyethylene materials (XLK™ and Marathon™; DePuy Synthes, Warsaw, IN, USA). XLK was associated with higher wear rates than Marathon.

Wear of a sequentially annealed polyethylene acetabular liner.

Background And Purpose: We previously reported on a randomized controlled trial (RCT) that examined the effect of adding tobramycin to bone cement after femoral stem migration. The present study examined femoral head penetration into both conventional and highly crosslinked polyethylene acetabular liners in the same group of RCT patients, with a minimum of 5 years of postoperative follow-up.

Patients And Methods: Linear penetration of the femoral head into an X3 (Stryker) crosslinked polyethylene (XLPE) liner was measured in 18 patients (19 hips) using radiostereometric analysis (RSA).

Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements.

Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.

The effect of patient positioning on the precision of model-based radiostereometric analysis.

A repeatable method for in vivo and in vitro measurement of polyethylene wear in total knee replacement (TKA) is needed. This research examines the model-based radiostereometric analysis' (MBRSA) in vitro precision under different patient-radiograph orientations and flexion angles of the knee using a TKA phantom. Anterior-posterior and medial-lateral imaging orientations showed the highest precision; better than 0.

Biochemical analyses of human osteoarthritic and periprosthetic synovial fluid.

Biochemical analyses were performed on osteoarthritic and periprosthetic synovial fluid in order to propose changes to lubricant specifications currently outlined in orthopaedic wear testing standards. Osteoarthritic and periprosthetic synovial fluid samples were obtained from the hip and knee joints of 40 patients. The samples in each group were analysed and compared in order to identify differences between the protein concentration, constituent fractions, osmolality, thermal stability and the hyaluronic acid concentration and molecular weight distribution of osteoarthritic and periprosthetic synovial fluid.

Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements.

The present study investigates the performance of ceramic-on-ceramic total hip replacements by combining a retrieval analysis with a survivorship analysis to elucidate mechanisms that led to clinical failure. Semiquantitative surface damage assessment, contact profilometry, contour measurements, and scanning electron microscopy were performed to characterize the types and quantify the extent of surface damage on the retrieved ceramic components. The implantation period was positively correlated with both damage scores of the femoral heads (R = 0.