Proximal tibial replacement in revision knee arthroplasty for non-oncologic indications.

Proximal tibial metaphyseal bone loss compromises the alignment and fixation of components during revision total knee arthroplasty. In massive, segmental defects with loss of collateral ligamentous support and lack of bone to support the use of prosthetic augments or metaphyseal cones or sleeves, a hinged proximal tibial replacement or a so-called megaprosthesis should be available. While proximal tibial replacement is the reconstructive method of choice in the setting of bone tumor resection, applications in non-oncologic joint arthroplasty are rare and may offer an opportunity for limb salvage in dire clinical scenarios with massive proximal tibial bone loss. This report reviews 6 cases of proximal tibial replacement

Revision total knee arthroplasty outcomes in solid organ transplant Patients, a matched cohort study of aseptic and infected revisions

Background: Previous studies have demonstrated that solid organ transplant (SOT) patients undergoing primary total knee arthroplasty (TKA) are at an increased risk of postoperative complications. The purpose of this study is to utilize a large, national database to investigate revision TKA (rTKA) outcomes in SOT patients. Methods: This was a retrospective review utilizing the Nationwide Readmissions Database (NRD) and ICD-9 codes to identify patients who underwent rTKA from 2010-2014 with a history of at least one SOT. Propensity-score-matching (PSM) was used to compare rTKA outcomes in SOT patients compared to matched patients without SOT. Results: A total of 303,867 rTKAs, with 464 of those being performed in SOT patients, were included in the study. Of these, 71,903 and 182 were performed for PJI in non-SOT and SOT patients, respectively. rTKA was performed most frequently in kidney transplant patients (53.0%) followed by liver transplant patients (34.3%). For non-PJI patients, SOT patients had a higher 90-day readmission rate than matched non-SOT rTKA patients (23.2% vs 12.6%, p = 0.006). However, there were no differences in 90-day readmission rates for specific rTKA complications, subsequent revision rTKA, or mortality. Among patients undergoing rTKA for PJI, there was no difference in overall 90-day readmission rate, readmission for specific rTKA complications, subsequent revision rTKA, or mortality. Conclusions: While the increased medical comorbidities associated with SOT place patients at increased risk for complications following rTKA, it appears that SOT alone does not do so when patients are matched based on overall medical comorbidity

Low Prevalence of Hip and Knee Arthritis in Active Marathon Runners.

BACKGROUND: Existing evidence on whether marathon running contributes to hip and knee arthritis is inconclusive. Our aim was to describe hip and knee health in active marathon runners, including the prevalence of pain, arthritis, and arthroplasty, and associated risk factors. METHODS: A hip and knee health survey was distributed internationally to marathon runners. Active marathoners who completed ≥5 marathons and were currently running a minimum of 10 miles per week were included (n = 675). Questions assessed pain, personal and family history of arthritis, surgical history, running volume, personal record time, and current running status. Multivariable analyses identified risk factors for pain and arthritis. Arthritis prevalence in U.S. marathoners was compared with National Center for Health Statistics prevalence estimates for a matched group of the U.S. RESULTS: Marathoners (n = 675) with a mean age of 48 years (range, 18 to 79 years) ran a mean distance of 36 miles weekly (range, 10 to 150 miles weekly) over a mean time of 19 years (range, 3 to 60 years) and completed a mean of 76 marathons (range, 5 to 1,016 marathons). Hip or knee pain was reported by 47%, and arthritis was reported by 8.9% of marathoners. Arthritis prevalence was 8.8% for the subgroup of U.S. marathoners, significantly lower (p \u3c 0.001) than the prevalence in the matched U.S. population (17.9%) and in subgroups stratified by age, sex, body mass index (BMI), and physical activity level (p \u3c 0.001). Seven marathoners continued to run following hip or knee arthroplasty. Age and family and surgical history were independent risk factors for arthritis. There was no significant risk associated with running duration, intensity, mileage, or the number of marathons completed (p \u3e 0.05). CONCLUSIONS: Age, family history, and surgical history independently predicted an increased risk for hip and knee arthritis in active marathoners, although there was no correlation with running history. In our cohort, the arthritis rate of active marathoners was below that of the general U.S. POPULATION: Longitudinal follow-up is needed to determine the effects of marathon running on developing future hip and knee arthritis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence

sj-docx-2-hss-10.1177_15563316231208977 – Supplemental material for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center

Supplemental material, sj-docx-2-hss-10.1177_15563316231208977 for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center by Matthew J. Schultz, Hope S. Thalody, Rex W. Lutz, Quincy T. Cheesman, Alvin C. Ong, Zachary D. Post and Danielle Y. Ponzio in HSS Journal®</p

sj-docx-8-hss-10.1177_15563316231208977 – Supplemental material for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center

Supplemental material, sj-docx-8-hss-10.1177_15563316231208977 for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center by Matthew J. Schultz, Hope S. Thalody, Rex W. Lutz, Quincy T. Cheesman, Alvin C. Ong, Zachary D. Post and Danielle Y. Ponzio in HSS Journal®</p

sj-docx-4-hss-10.1177_15563316231208977 – Supplemental material for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center

Supplemental material, sj-docx-4-hss-10.1177_15563316231208977 for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center by Matthew J. Schultz, Hope S. Thalody, Rex W. Lutz, Quincy T. Cheesman, Alvin C. Ong, Zachary D. Post and Danielle Y. Ponzio in HSS Journal®</p

sj-docx-5-hss-10.1177_15563316231208977 – Supplemental material for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center

Supplemental material, sj-docx-5-hss-10.1177_15563316231208977 for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center by Matthew J. Schultz, Hope S. Thalody, Rex W. Lutz, Quincy T. Cheesman, Alvin C. Ong, Zachary D. Post and Danielle Y. Ponzio in HSS Journal®</p

sj-docx-10-hss-10.1177_15563316231208977 – Supplemental material for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center

Supplemental material, sj-docx-10-hss-10.1177_15563316231208977 for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center by Matthew J. Schultz, Hope S. Thalody, Rex W. Lutz, Quincy T. Cheesman, Alvin C. Ong, Zachary D. Post and Danielle Y. Ponzio in HSS Journal®</p

sj-docx-9-hss-10.1177_15563316231208977 – Supplemental material for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center

Supplemental material, sj-docx-9-hss-10.1177_15563316231208977 for Older Age, Male Sex, and Early Start Time Lengthen the Recovery Room Stay Following Total Joint Arthroplasty in an Ambulatory Surgical Center by Matthew J. Schultz, Hope S. Thalody, Rex W. Lutz, Quincy T. Cheesman, Alvin C. Ong, Zachary D. Post and Danielle Y. Ponzio in HSS Journal®</p