Both mobile bearing and fixed bearing unicompartmental knee arthroplasty (UKA) have demonstrated clinical success. However, much debate persists about the superiority of a single design. Currently most clinical data is based on high volume centers data, however to reduce bias, we undertook a through review of retrospective national joint registries. In this study, we aim to investigate UKA implant utilization and survivorship between 2000 and 2018. Ten annual joint registry reports of various nations were reviewed. Due to the variable statistical methods of reporting implant use and survivorship we focused on three registries: Australia (AOANJRR), New Zealand (NZJR), United Kingdom (NJR) for uniformity. We evaluated UKA usage, survivorship, utilization and revision rates for each implant. Implant survivorship was reported in the registries and was compared within nations due to variation in statistical reporting.Introduction
Methods
The direct anterior approach (DAA) and the posterior approach (PA) are 2 common total hip arthroplasty (THA) exposures. This prospective study quantitatively compared changes in periarticular muscle volume after DAA and PA THA. Nineteen patients undergoing THA were recruited from the practices of 3 fellowship-trained hip surgeons. Each surgeon performed a single approach, DAA or PA. Enrolled patients underwent a preoperative MRI of the affected hip and two subsequent postoperative MRIs, averaging 9.6 and 24.3 weeks after surgery. Clinical evaluations were done by Harris Hip Score at each follow-up interval.Introduction
Materials
Robotic-assisted total knee arthroplasty (TKA) was introduced to improve limb alignment, component positioning, and soft-tissue balance, yet the effect of adoption of this technology has not been established. This study was designed to evaluate whether robotic-assisted TKA leads to improved patient reported outcome measures (PROMs) and patient satisfaction as compared to conventional TKA at 3 and 12 months. This IRB-approved single-surgeon retrospective cohort analysis of prospectively collected data compared 113 conventional TKA patients with 145 imageless robotic-assisted TKA patients (Navio™ Surgical System, Smith&Nephew®, Memphis TN). Basic demographic information, intraoperative and postoperative data, and PROMs (SF-P, SF-M, WOMAC pain, WOMAC stiffness, WOMAC Physical Function, KSS) were collected and recorded preoperatively, at 3 months, and at 12 months following surgery. Range of motion (ROM), blood loss, surgical duration, and complication rates between groups were also collected. Continuous measures such as mean difference in PROMs and ROM were compared using unpaired t-tests. Categorical measures such as the percentage of patients with complications were compared using chi-square analysis.Introduction
Methods
The success of total knee arthroplasty (TKA) necessitates precise osteotomies and soft tissue balancing to realign the lower extremity to a neutral mechanical axis. While technological advances have facilitated precise osteotomies, soft tissue balancing has traditionally relied mostly on surgeons’ subjective and variable tactile feedback. As soft tissue imbalance accounts for 35% of early TKA revisions in North America, we aimed to compare outcomes when TKA was balanced free-hand versus a sensor-guided balancing device (VERASENSE, OrthoSensor, Inc (Dania, FL)). In a randomized-controlled fashion, patients underwent primary TKA soft tissue balancing either free-hand or with VERASENSE (Orthosensor Inc, Dania FL) at our institution beginning January 2018. With VERASENSE, soft-tissue balancing is considered when the pressure difference between the medial and lateral knee compartments was less than 15 pounds. Data regarding patient-reported outcomes, knee range of motion (ROM), pain level, opioid consumption, inpatient ambulation distance, length of stay (LOS), and incidence of arthrofibrosis was collected and analyzed in a two-year minimum follow-up and target patient goal of 120 patients.Introduction
Methods
Dislocation remains among the most common complications
of, and reasons for, revision of both primary and revision total
hip replacements (THR). Hence, there is great interest in maximising
stability to prevent this complication. Head size has been recognised
to have a strong influence on the risk of dislocation post-operatively.
As femoral head size increases, stability is augmented, secondary
to an increase in impingement-free range of movement. Larger head
sizes also greatly increase the ‘jump distance’ required for the
head to dislocate in an appropriately positioned cup. Level-one
studies support the use of larger diameter heads as they decrease
the risk of dislocation following primary and revision THR. Highly cross-linked
polyethylene has allowed us to increase femoral head size, without
a marked increase in wear. However, the thin polyethylene liners
necessary to accommodate larger heads may increase the risk of liner
fracture and larger heads have also been implicated in causing soft-tissue
impingement resulting in groin pain. Larger diameter heads also
impart larger forces on the femoral trunnion, which may contribute
to corrosion, metal release, and adverse local tissue reactions.
Alternative large bearings including large ceramic heads and dual
mobility bearings may mitigate some of these risks, and several
of these devices have been used with clinical success. Cite this article:
Two-stage exchange remains the gold standard
for treatment of peri-prosthetic joint infection after total hip replacement
(THR). In the first stage, all components and associated cement
if present are removed, an aggressive debridement is undertaken
including a complete synovectomy, and an antibiotic-loaded cement
spacer is put in place. Patients are then treated with six weeks
of parenteral antibiotics, followed by an ‘antibiotic free period’
to help ensure the infection has been eradicated. If the clinical
evaluation and serum inflammatory markers suggest the infection
has resolved, then the second stage can be completed, which involves
removal of the cement spacer, repeat debridement, and placement
of a new THR. Cite this article:
Large ceramic femoral heads offer several advantages
that are potentially advantageous to patients undergoing both primary
and revision total hip replacement. Many high-quality studies have
demonstrated the benefit of large femoral heads in reducing post-operative instability.
Ceramic femoral heads may also offer an advantage in reducing polyethylene wear
that has been reported Cite this article: Bone Joint J 2013;95-B, Supple A:63–6.
