Acetabular Component Positioning in Primary THA via an Anterior, Posterolateral, or Posterolateral-navigated Surgical Technique

The purpose of this study was to compare the acetabular component alignment in patients undergoing primary total hip arthroplasty (THA) via 3 surgical techniques: direct anterior using intraoperative fluoroscopy, posterolateral using an external alignment guide (posterolateral conventional), and posterolateral using computer navigation (posterolateral navigated). Two surgeons performed the direct, anterior THAs; 2 surgeons performed the posterolateral-conventional THAs; and 1 surgeon performed the posterolateral-navigated THAs. The most recent 110 THAs performed using each approach were reviewed, and Einsel-Bild-Roentgen analysis software was used to measure the acetabular component abduction and anteversion. One-way analysis of variance showed the anterior cohort to have a more horizontal alignment of the acetabular component (P,.001); 90.9% of the acetabular components in the posterolateral-navigated cohort were within 40°610° and 15°610° for both acetabular abduction and anteversion, respectively, vs 70% in the posterolateral-conventional (P,.001), and 68.2% in the anterior cohort (P,.001). The anterior technique using intraoperative fluoroscopy does not improve acetabular positioning compared with the conventional, posterolateral technique

Authorship Trends in 30 Years of the Journal of Arthroplasty.

Background While various studies have investigated trends in characteristics of authors in other medical literature, no study has examined these characteristics in the field of arthroplasty. Methods A database was created of all articles published in The Journal of Arthroplasty in 1986, 1990, 1995, 2000, 2005, 2010, and 2015. Degree(s) of authors, number of authors, number of references, and region of institution were recorded. Results A total of 1343 original articles were assessed over the study period. There was a significant increase in the number of authors per publication from 3.45 in 1986 to 4.98 in 2015 (P \u3c .001) and number of references per article from 17.36 to 29.76 (P \u3c .001). There was a significant increase in proportion of first authors with a bachelor\u27s degree (P = .001), MD/PhD (P \u3c .001), and MD/MBA (P = .016), with a significant decrease in first authors with an MD degree only (P \u3c .001). There was a significant increase in number of last authors with an MD/PhD (P = .001) and MD/MBA (P = .003). There has been a significant growth in papers from outside North America (P = .007), with a decrease in articles from the UK/Ireland (P = .003) and an increase in contributions from the Far East (P \u3c .001). Conclusion Trends of authorship characteristics in the arthroplasty literature largely mirror those seen in other medical literature including increased number of authors per article over time, changes in author qualifications, and increased contributions from international author groups

Perioperative Complications and Impact of Operation Time on Revision Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) is a common and effective treatment of knee osteoarthritis. As more TKAs are performed, there will be more subsequent revisions and failures. In multiple studies, operation length was shown to be a risk factor for postoperative infection and venous thromboembolism. Thus, it is important to understand the association between length of operation time and the risk of these various postoperative complications following revision TKA. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent unilateral revision TKAs between 2007 and 2014 were identified and sorted into three different cohorts- below standard operation length (BSOL), standard operation length (SOL), and above standard operation length (ASOL). SOL was defined as between 40-100 minutes. Univariate and multivariate analyses were used to evaluate the incidence of multiple 30-day adverse outcomes after revision TKA with statistical significance as p\u3c.05. Results: Patients that were BSOL were more likely to develop a deep surgical site infection (OR 3.3; CI 1.2-9.0; p=0.017) compared to SOL. Patients that were ASOL were more likely to develop a pulmonary embolism (OR 2.5; CI 1.1-6.1; p=0.038), but less likely to develop an organ/space infection (OR 0.5; CI 0.4-0.7; p\u3c0.001) or sepsis (OR 0.5; CI 0.3-0.6; p\u3e0.001) compared to patients with SOL. Conclusion: Relative to patients with SOL, those with BSOL or ASOL have a greater likelihood of developing certain postoperative complications. However, there were also certain decreased risks associated with ASOL, particularly infection. Orthopedic surgeons should keep in consideration the implication of operation time as a risk factor for postoperative outcomes. Keywords: revision, knee, arthroplasty, operation length, postoperativ

Catastrophic failure of tripolar constrained liners due to backside wear: a novel failure mode

Constrained acetabular liners have been developed for patients who are at high risk for dislocation or who are undergoing revision surgery for recurrent dislocations. We report on 2 cases of failure of tripolar constrained liners due to severe backside polyethylene wear after dissociation of the outer polyethylene liner without dislocation, a mode of failure not previously reported. The backside of the inserts suffered severe polyethylene deformation, wear, and scratching due to dissociation from the locking mechanism. In patients with tripolar constrained liners, radiographic evidence of eccentric wear should be considered as possible occult dissociation of the polyethylene liner within the shell. Conversion to a modular dual mobility liner appears to be a viable solution in this setting. Keywords: Revision total hip arthroplasty, Dislocation, Tripolar constrained liner, Modular dual mobilit

Posterior Femoral Single Limb Osteotomy for the Removal of Well-Fixed Modular Femoral Neck Components

Modular neck femoral components were introduced to optimize femoral neck anteversion, leg length, offset, and stability in total hip arthroplasty. However, concerns have been raised in recent years regarding early failure of these implants due to corrosion, pseudotumor, as well as fracture of the modular neck. Removing modular neck femoral implants is challenging as removal of the modular femoral neck leaves a proximally coated femoral stem level with the proximal bone of the femoral neck. We describe a posterior femoral single limb osteotomy  (posterior cut of an extended trochanteric osteotomy) for the removal of a modular neck femoral component