This study aims to identify recent trends in discharge disposition following bilateral total knee arthroplasty (TKA) as well as factors that predispose patients to enter inpatient rehabilitation facilities (IRF) or skilled nursing facilities (SNF) versus home-rehabilitation (HR). The goal was to identify risk factors that predispose prolonged hospital stays and identify changes in management over time that may be responsible for decreased length of stay (LOS) and a HR program. A retrospective cohort study design was used to collect and analyze clinical and demographic data for 404 consecutive bilateral primary total knee arthroplasty (TKA) procedures. Patients who underwent elective primary bilateral total knee arthroplasty from 2011 to 2016 were identified from hospital records at a single institution. Clinical and demographic data including sex, age, and disposition were analyzedBACKGROUND
METHODS
Stiffness after total knee arthroplasty (TKA) has been reported to occur due to component malpositioning and/or oversizing, improper femoral component (FC) flexion and tibial component (TC) slope, tight extension gap, inaccurate joint line placement, deficient posterior osteophyte resection, heterotopic ossification (HO), poor patellofemoral joint reconstruction, poor posterior condylar offset restoration, and/or posterior cruciate ligament (PCL) under-resection or retraction. However, the importance of these potential factors for stiffness are not well documented in the medical literature. The aim of this study was therefore to evaluate specific radiographic parameters in patients who had stiffness after primary TKA. An IRB-approved retrospective chart review was performed to identify patients that were revised due to stiffness after TKA. We defined stiffness as 15º or more of flexion contraction, less than 75º of flexion or a range of motion (ROM) of 90º with the chief complaint of limited ROM and pain. Patients with history of previous revisions and/or ORIF, infection, or isolated polyethylene exchange were excluded. Patients with a minimum of 1 year radiographic follow-up were included. Radiographic measurements were performed as described by the Knee Society TKA Roentgenographic Evaluation System (KSRES). Two blinded observers performed all measurements. Descriptive data is reported as mean (range). Inter-observer correlations were reported using Intraclass correlations coefficient (ICC).Introduction
Material and Methods
The incidence of periprosthetic fractures is increasing as the population ages. Wound complications and surgical site infections following surgery to treat periprosthetic fractures are a major source of patient morbidity and health care burden. This study evaluates the efficacy of closed-incision negative-pressure wound therapy (ciNPT) in decreasing wound complications and surgical site infections (SSIs) after periprosthetic fracture surgery about the hip and knee. An IRB-approved retrospective quality improvement analysis of sixty-five consecutive periprosthetic fracture surgeries performed by four surgeons at a single institution in a fifteen-year period was performed. ciNPT was selectively used on patients in the last 20 months of the study period. Rates of wound complications, surgical site infections, and reoperation were compared with those of a sterile antimicrobial dressing (AMD).Introduction
Methods
A stiff total knee arthroplasty (TKA) is an uncommon but disabling problem because it causes pain and limited function. Revision surgery has been reported as a satisfactory treatment option for stiffness with modest benefits. The aim of this study was to evaluate the results of revision surgery for the treatment of stiffness after TKA. We defined stiffness as 15 degrees or more of flexion contracture or less than 75º of flexion or a range of motion of 90º or less presenting with a chief complain of limited range of motion and pain. We evaluated the results of forty-two revisions performed by one of four orthopedic surgeons due to stiffness after TKA. Patients with history of infection or isolated polyethylene insert exchange were excluded.Introduction
Methods
Iliopsoas impingement is a well described cause of groin pain after direct anterior total hip arthroplasty (THA). We proposed to evaluate the incidence, natural history and response to treatment of iliopsoas impingement after direct anterior total hip arthroplasty. A retrospective chart review of 725 consecutive patients who underwent anterior approach total hip arthroplasty between 2009 and 2014 was conducted. All surgeries were performed by one of two surgeons. Patients were included if they underwent primary anterior approach THA and had a minimum of 2 years of follow up. Patients who had a posterior approach, revision surgery or had less than 2 years of follow up were excluded. Iliopsoas impingement was identified if patients reported groin pain at greater than 6 weeks of postoperative follow up and in association with pain with resisted seated hip flexion. The natural history and response to treatment was recorded for patients identified as having iliopsoas impingement.Introduction
Methods
Total hip arthroplasty (THA) is a common operation. Different operative approaches have specific benefits and compromises. Soft tissue injury occurs in total hip arthroplasty. This prospective study objectively measured muscle volume changes after direct anterior and posterior approach surgeries. Patients undergoing Direct Anterior Approach (DAA) and Posterior Approach (PA) THA were prospectively evaluated. 3 orthopaedic surgeons performed all surgeries. Muscle volumes of all major muscles around the hip were objectively measured using preoperative and 2 different postoperative follow-up MRIs. 2 independent measurers performed all radiographic volume measurements. Repeated-measures ANOVA was used to compare mean muscle volume changes over time. Student's t-test was used to compare muscle volumes between groups at specific time intervals.Introduction
Methods
Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may come have significant learning curves. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual THA during the learning curve. Three types of THAs were compared in this retrospective cohort: 1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior, FA) done by a posterior surgeon learning the anterior approach, 2) the first 100 robotic assisted posterior THAs done by a surgeon learning robotic assisted surgery (robotic posterior, RP) and 3) the last 100 manual posterior THAs done by each surgeon (total 200 THAs) prior to adoption of novel techniques (manual posterior, MP). Component position was measured on plain radiographs. Radiographic measurements were done by two blinded observers. The percentage of hips within the surgeons' target zone (inclination 30°–50°, anteversion 10°–30°) was calculated, along with the percentage within the safe zone of Lewinnek (inclination 30°–50°; anteversion 5°–25°) and Callanan (inclination 30°–45°; anteversion 5°–25°). Relative risk and absolute risk reduction were calculated. Variances (square of the SDs) were used to describe the variability of cup position.Background
Methods
Posterior referencing (PR) total knee arthroplasty (TKA) aims to restore posterior condylar offset. When a symmetric femoral implant is externally rotated (ER) to the posterior condylar axis, it is impossible to anatomically restore the offset of both condyles. PR jigs variously reference medially, laterally, or centrally. The distal femoral cutting jigs typically reference off the more distal medial condyle, causing distal and posterior resection discrepancies. We used sawbones to elucidate differences between commonly used PR cutting jigs with regards to posterior offset restoration. Using 32 identical sawbones, we performed distal and posterior femoral resections using cutting guides from 8 widely available TKA systems. 6 systems used a central-referencing strategy, 1 system used a lateral-referencing strategy, and 1 system used a medial-referencing strategy with implants of asymmetric thickness. Distal femoral valgus resection was set at 5 degrees for all specimens. Rotation was set at 3 degrees for 2 sawbones and 5 degrees for 2 sawbones with each system. We measured the thickness of all bone resections, and compared those values to known implant thickness.Background
Materials/Methods
Computer-assisted navigation is an established tool in hip and knee arthroplasty. This technology was introduced with the goals of greater precision in bone preparation and implant placement, potentially leading to improved clinical outcomes. Various navigation protocols exist, many of which require placement of temporary percutaneous pins in the operative field. Risks of pin placement have not been described. We conducted a retrospective review of 352 consecutive patients undergoing elective hip and knee surgery using computer-assisted navigation between January 2013 and December 2015, all with a minimum follow-up of 90 days. Navigation pins were placed using a standardized protocol into the iliac crest for hip arthroplasty or into the femoral and tibial diaphysis for knee arthroplasty. Postoperatively, all patients were allowed to weight bear as tolerated. Patient records were reviewed for operative details and clinical outcomes. Outcome measures included any pin site complications including direct neurovascular damage, fracture through a pin site, and pin site infection.Introduction
Methods
