Femoral Component Revision of Total Hip Arthroplasty.

Modern primary total hip arthroplasty (THA) is among the most successful operations in medicine. It has been a consistently effective treatment for end-stage osteoarthritis of the hip. With the increasing number of primary THA procedures being performed and the decreasing age of patients undergoing the procedure, there is an inevitable associated increase in revision burden for arthroplasty surgeons. Revision THA is most often indicated for instability, aseptic loosening, osteolysis, infection, periprosthetic fracture, component malposition, and catastrophic implant failure. Understanding the etiology of THA failure is essential for guiding clinical decision making. Femoral component revision presents a complex challenge to the arthroplasty surgeon because of modern implant design as well as bone loss in the proximal femur. Thorough patient evaluation, defect classification, and well-executed surgical reconstruction based on comprehensive preoperative planning may determine the postoperative results. Knowledge of various reconstructive options and the indications for each is necessary to achieve a successful outcome. This article highlights the most common indications for revision after THA and offers recommendations for how to approach revision of the femoral component. Specifically, the authors review preoperative assessment, common classification systems for femoral deficiency, techniques for component extraction, and modalities of femoral component fixation. [Orthopedics. 2016; 39(6):e1129-e1139.]

The role of prehabilitation with a telerehabilitation system prior to total knee arthroplasty.

Background: The purpose of the current study was to evaluate the usage of prehabilitation on a telehealth platform prior to total knee arthroplasty (TKA) and its impact on short-term outcomes. Specifically, the study examined whether patients participating in a prehabilitation program impacted length of stay (LOS) and discharge disposition. Methods: A total of 476 consecutive patients who underwent TKA at three institutions were included. The average age of the 476 patients was 65.1 years (range, 35 and 93 years). There was a total of 114 patients who utilized the novel prehabilitation program that provided exercises, nutritional advice, education regarding home safety and reducing medical risks, and pain management skills prior to surgery. A group of 362 patients who did not utilize the program formed the control cohort. The outcomes evaluated were LOS and discharge disposition to home, home with health aide (HHA), or skilled nursing facility (SNF). Results: The average LOS in the prehabilitation group was significantly shorter than in the control group (2.0 vs. 2.7 days, P\u3c0.001). Additionally, prehabilitation patients had more favorable discharge disposition status in comparison to the control group. In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group (P\u3c0.001). Also, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%, P\u3c0.0001). Conclusions: Prehabilitation preceding TKA in the current study showed early benefits in LOS and discharge disposition. This study will help expand the current literature and educate orthopaedic surgeons on a novel technology. To truly appreciate the role of telerehabilitation in the setting of TKA, further investigation is needed to investigate long-term outcomes, cost analysis, and patient and clinician satisfaction