Journal of Arthroplasty

INTRODUCTION: Instability is a leading cause of early failure following total knee arthroplasty. Enabling technologies can improve accuracy, but their clinical value remains undetermined. The purpose of this study was to determine the value of achieving a balanced knee joint at the time of TKA. METHODS: A Markov model was developed to determine the value from reduced revisions and improved outcomes associated with TKA joint balance. Patients were modelled for the first 5 years following TKA...

BACKGROUND: Instability remains a devastating complication following total hip arthroplasty (THA). Here we describe a mini-posterior approach with a monoblock dual-mobility implant without "traditional posterior hip precautions" yielding excellent results. METHODS: There were 580 consecutive hips in 575 patients who underwent THA utilizing a monoblock dual-mobility implant and a mini-posterior approach. With this technique, the acetabular component positioning does not rely on tradition intra-operative radiographic abduction and anteversion goals, but rather uses patient-specific anatomic landmarks (anterior acetabular rim and, when visible, the transverse acetabular ligament) to set cup position; stability is assessed with a significant, dynamic intra-operative test of range of motion...

BACKGROUND: The treatment of Vancouver B periprosthetic proximal femur fractures (PPFF) is complex due to the overlap between arthroplasty and orthopaedic trauma techniques. Our purpose was to assess the effects of fracture type, treatment difference, and surgeon training on the risk of reoperation in Vancouver B PPFF. METHODS: A collaborative research consortium of eleven centers retrospectively reviewed PPFFs from 2014 to 2019 to determine the effects of variations in surgeon expertise, fracture type, and treatment on surgical reoperation...

INTRODUCTION: Due to increasing volume of total hip arthroplasties, periprosthetic femoral fractures have become a common complication with increased revision burden and perioperative morbidity. The objective of this study was to evaluate the fixation stability of Vancouver B2 fractures treated with two techniques. METHODS: A common B2 fracture was created by reviewing 30 type B2 cases. The fracture was then reproduced in 7 pairs of cadaveric femora. The specimens were divided into two groups...

BACKGROUND: Patients who have obesity seldom lose weight after total knee arthroplasty (TKA). The Look AHEAD trial randomized patients with type 2 diabetes who had overweight or obesity to a 10-year intensive lifestyle intervention (ILI) or diabetes support and education (DSE). METHODS: Of the total 5,145 participants enrolled who had a median 14-year follow-up, a subset of 4,624 met inclusion criteria. The ILI aimed at achieving and maintaining a 7% weight loss and included weekly counseling the first 6 months, with decreasing frequency thereafter...

BACKGROUND: Many risk factors have been described for periprosthetic femur fracture (PPFFx) following total hip arthroplasty (THA), yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to develop a high-dimensional, patient-specific risk-stratification nomogram that allows dynamic risk modification based on operative decisions. METHODS: We evaluated 16,696 primary non-oncologic THAs performed between 1998 and 2018. During mean 6-year follow-up, 558 patients (3...

BACKGROUND: Ideal goals for alignment and balance in total knee arthroplasty (TKA) remain controversial. We aimed to compare initial alignment and balance using mechanical alignment (MA) and kinematic alignment (KA) techniques, and to analyze the percentage of knees that could achieve balance using limited adjustments to component position. METHODS: Prospective data on 331 primary robotic TKAs (115 MA and 216 KA) were analyzed. Medial and lateral virtual gaps were recorded in both flexion and extension...

BACKGROUND: Diagnosing periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) remains challenging despite recent advancements in testing and evolving criteria over the last decade. Moreover, the effects of antibiotic use on diagnostic markers are not fully understood. Thus, this study sought to determine the influence of antibiotic use within 48 hours before knee aspiration on synovial and serum laboratory values for suspected late PJI. METHODS: Patients who underwent a TKA and subsequent knee arthrocentesis for PJI workup at least six weeks after their index arthroplasty were reviewed across a single healthcare system from 2013 to 2020...

INTRODUCTION: Cementless fixation is gaining popularity for primary total knee arthroplasties (TKAs). The prior 5-year results of our randomized clinical trial (RCT) that included 3 different tibial designs found minimal differences. The purpose of the current study was to investigate the 10-year results in the same cohort. METHODS: Between 2003 to 2006, 389 primary TKAs were randomized: traditional modular cemented tibia (135); hybrid (cemented baseplate with uncemented pegs) monoblock tibia (128); and cementless monoblock tibia (126)...

BACKGROUND: Patient-reported outcome measures (PROMs) are often lower following conversion total hip arthroplasty (cTHA) compared to matched primary THA controls. However, the minimal clinically important differences (MCIDs) for any PROMs have yet to be analyzed for cTHA. This study aimed to 1) Determine if patients undergoing cTHA achieve primary THA-specific 1-year PROM MCIDs at comparable rates to matched controls undergoing primary THA and 2) Establish 1-year MCID values for specific PROMs following cTHA...

INTRODUCTION: The American Joint Replacement Registry (AJRR) is a powerful tool for the study of revision total knee arthroplasty (rTKA). The AJRR utilizes International Classification of Diseases-10 (ICD-10-CM) codes for recording surgical diagnoses. However, the validity of this methodology is unknown. The purpose of this study was to determine the accuracy of ICD-10-CM codes, as used by AJRR, in classifying rTKA diagnoses. METHODS: There were 988 rTKAs performed from 2015 to 2021 identified in our institutional total joint registry (TJR)...

BACKGROUND: Concerns remain that thinner highly crosslinked polyethylene (HXLPE) liners in modern total hip arthroplasty (THA) may lead to premature liner-related failures or revision. The aim of this study was to evaluate the effect of liner-thickness on survival and revision rates of HXLPE in primary THA after more than 10 years. METHODS: We retrospectively identified 2,565 primary THA using HXLPE with a mean follow-up of 13 years (range, 11 to 19). Patients were grouped for each millimeter (mm) of polyethylene thickness...

BACKGROUND: High impact chronic pain (HICP) is not typically measured following orthopaedic surgeries, but has a substantial negative impact on post-operative quality of life. This analysis determined which Patient-Reported Outcome Measurement Information System (PROMIS) measures accurately estimate HICP status following total joint arthroplasty (TJA). METHODS: This was a secondary analysis of a hip and knee TJA cohort. HICP status was determined by two items from the Graded Chronic Pain Scale-Revised...

BACKGROUND: Despite a growing understanding of spinopelvic biomechanics in total hip arthroplasty (THA), there is no validated approach for executing patient-specific acetabular component positioning. The purpose of this study was to (1) validate quantitative, patient-specific acetabular "safe zone" component positioning from spinopelvic parameters and (2) characterize differences between quantitative patient-specific acetabular targets and qualitative hip-spine classification targets...

BACKGROUND: This study evaluated the ability to achieve the targeted soft-tissue balance in terms of medio-lateral (ML) laxity and gap values when using a computer-assisted orthopedic surgery (CAOS) system featuring an intraarticular, force-controlled distractor and assessed learning curves associated with the adoption of this technology. METHODS: The first 273 cases using this technology were reported without any exclusions comparing 1) final ML laxity and 2) final average gap to their pre-defined targets...

INTRODUCTION: Spinal anesthesia is increasingly used in complex patient populations including revision total hip arthroplasties (THAs). This study aimed to investigate the pain control, length of stay (LOS), and complications associated with spinal versus general anesthesia in a large institutional series of revision THAs. METHODS: We retrospectively identified 4,767 revision THAs (4,533 patients) from 2001 to 2016 using our institutional total joint registry. Of these cases, 86% had general and 14% had spinal anesthesia...

BACKGROUND: Instrumented Posterior Lumbar Spinal Fusion (IPLSF) has been demonstrated to contribute to instability following Total Hip Arthroplasty (THA). It is unclear whether a supine Direct Anterior (DA) approach reduces the risk of instability. METHODS: A retrospective review of 1,773 patients who underwent THA through either a DA approach or a posterior approach at our institution over a 7-year period. Radiographic and chart review were then used to identify our primary group of interest comprised of 111 patients with previous IPLSF...

BACKGROUND: Cementless stem designs with proximal metaphyseal fixation aim to achieve better load distribution, reduce stress shielding, and improve primary stability. The purpose of this prospective, randomized controlled trial was to evaluate the 2-year migration and clinical outcomes of two cementless femoral stems. METHODS: A total of 60 participants undergoing primary total hip arthroplasty for any cause were randomly allocated to receiving either a proximally coated, short blade stem or a quadrangular-taper stem with a reinforced proximal body...

BACKGROUND: The interspace between the popliteal artery and capsule of the posterior knee (iPACK) block and the genicular nerve block (GNB) are motor-sparing nerve blocks used for knee pain relief. We compared the analgesic efficacies of ultrasound-guided iPACK block and GNB when combined with continuous adductor canal block after total knee arthroplasty. METHODS: In this randomized control study, 132 total knee arthroplasty patients were assigned to the iPACK, GNB, and iPACK+GNB groups...

BACKGROUND: There is an increasing body of evidence that suggests racial and ethnic disparities exist in medical care. In the field of anesthesiology, few studies have investigated the association of race and ethnicity with the provision of regional anesthesia for patients undergoing total knee arthroplasty. This analysis queried a large national surgical database to determine whether there were racial or ethnic differences in the administration of peripheral nerve blocks for patients undergoing total knee arthroplasty...