Arthroplasty Cases Research Articles

Survival of unconstrained ceramic wrist joint implants

Introduction Survival of implants is an important indicator of improvement in the patient's quality of life. In foreign literature, the issue of implant survival finds special attention.The aim of the work was to evaluate the efficacy and survival of an unconstrained ceramic wrist joint endoprosthesis.Materials and methods We analysed 83 cases of total wrist arthroplasty with an unconstrained ceramic implant at long-term follow-up. At the Novosibirsk RSITO, total wrist arthroplasty was performed in 81 patients with severe changes in the wrist joint from 2011 to 2021. Two patients underwent arthroplasty on two joints. A retrospective uncontrolled cohort study was conducted which divided the hospitalized patients into three groups according to the etiological cause of the disease. Radiological methods were used to control the state of the implant (radiography in two projections and CT-scans of the wrist joint). For binary indicators, the number, rates and 95 % confidence interval of frequencies were calculated according to the Wilson formula in the groups. Comparison was carried out by Fisher's exact two-sided test. The p-error was corrected using the Benjamini – Hochberg method. Kaplan – Meier curves were constructed for survival analysis. The groups were compared using a generalized chi-square test.Results Each case of repeated surgical intervention was evaluated from the standpoint of selected groups. Depending on the time elapsed from surgery to revision, we calculated the time frame for overall and group survival of the components of the wrist joint endoprosthesis. The causes and scope of surgical revision are presented.Discussion There are no data on the survival of unconstrained ceramic wrist joint implants in the foreign literature. Graphic images according to a proposal for the division of the orthopaedic postoperative period are presented. Conclusions 1. Intermediate conclusions in regard to total arthroplasty with an unconstrained ceramic endoprosthesis of the wrist joint inspire optimism in obtaining a stable positive effect of motion range lost due to the degenerative process in the wrist joint. 2. An 11-year follow-up period demonstrates that the survival rate of an unconstrained ceramic wrist endoprosthesis is 88 %.

The Megaendoprosthesis in Revision Arthroplasty - a Cost-revenue Analysis in the aG-DRG System.

Megaendoprosthesis offer a viable treatment in complex revision arthroplasty cases with good functional outcome. In the context of a neoplastic indication, the diagnosis-related group (DRG) I95A is usually assigned with a relative weight of 4.906 (2021). In contrast, in revision arthroplasty, the appropriate DRG is assigned, depending on the joint replacement. The additional costs compared to the invoiced DRG are to be compensated by agreeing on hospital-specific individual fees. These complex revision arthroplasties set high technical and operative demands and are mainly performed in specialised departments. We conducted a cost-benefit analysis of the use of the megaendoprosthesis in revision cases in a specialised orthopaedic clinic, as a single centre study. The question we sought to answer was: Is cost recovery possible in the modified German DRG system (aG-DRG)?A retrospective single centre analysis of treatment costs was performed. From 2018 to 2020, 113 patients treated with a megaendoprosthesis reconstruction in a referral centre due to extensive bone loss after aseptic or septic revision of a hip or knee prosthesis were included in the study. Relevant case-related cost drivers of the aG-DRG matrix (including staff and material costs of the operating theatre area and the ward) were taken into account. The actual costs were determined according to the specifications of the calculation manual published by the German institute for the remuneration system in hospitals (InEK). For each case, the contribution margin was calculated by relating the hospital's internal costs to the corresponding cost pool of the aG-DRG matrix.According to the DRG system 2021, 17 different DRGs were used for billing - in 70% based on a patient clinical complexity level (PCCL) ≥4. Compared with the InEK calculation, there is a deficit of -2,901€ per case in the examined parameters. The costs of physicians show a shortfall in both the operating theatre and on the ward. Implant costs, which were supposed to be compensated by hospital-specific additional charges, show a hospital-specific shortage of -2,181€. When analysing the risk factors for cost recovery, only these showed a significant difference.Implantation of the megaendoprosthesis in revision arthroplasty is often the last option to preserve limb function. At present, despite a high degree of specialisation and process optimisation, this treatment cannot be provided cost-effectively even in tertiary care. The politically desired specialised department structure requires sufficient reimbursement for complex cases. The economic outcome of each treatment case is often unpredictable, however the surgeon is confronted with these cases and is expected to treat them. The high standard deviation indicates large differences in the cost/revenue situation of each individual case. Our results show for the first time a realistic cost analysis for megaprosthesis in revision arthroplasty and underline the importance of an adequate hospital-specific charge, individually agreed by the funding units. The calculation should include not only the implant costs, but also the increased staff costs (increased, complex planning effort, quality management, surgery time, etc.).

How have the Volume and Backlog of Total Shoulder Arthroplasty Cases Changed during the COVID-19 Pandemic?

BACKGROUND As COVID-19 rapidly propagated, many institutions were forced to respond with suspension in all elective surgical procedures, including primary and revision Total Shoulder Arthroplasty (TSA). In 2021, the Centers of Medicare & Medicaid Services (CMS) removed primary and revision TSA from the Inpatient-Only-List (IPO). These rapid changes created uncertainty surrounding the potential backlog of patients that healthcare systems could face. The purpose of this study is to observe the change in volume as well as proportion of TSA performed in the outpatient setting. METHODS Patients who underwent primary and revision elective TSA from January 2018 to April 2021 were identified using the Pearldiver database. Descriptive analysis was utilized to report the monthly changes in elective TSA volume and the proportion of the volume performed in the outpatient setting. A linear forecast analysis using historical data was utilized to determine the expected volume and proportion of TSA cases performed on an outpatient basis during the pandemic period. This was compared to the observed case volume and setting. RESULTS Within 3 months following suspension, the total volume had returned to expected for both primary and revision TSA. Those performed in the outpatient setting significantly increased throughout the pandemic, with the largest peak following January 2020. By April 2021, four months after the CMS removal of TSA from the IPO list, the backlog of primary TSA volume had decreased by 30.8% with respect that in December 2020. For revision TSA, the backlog was entirely overcome by April 2021 as there was an observed decrease of 131% with respect that in December 2020. CONCLUSION The backlog for both primary and revision TSA from the beginning of the pandemic has decreased. The observed decrease did not seem to start until January 2021 following CMS’ removal of TSA from the IPO list. Therefore, the reduction in the backlog may be associated with the increased utilization of outpatient primary and revision TSA.

Impact of a Dedicated Orthopaedic Trauma Room on Elective Arthroplasty Case Volume.

To examine the effects of implementing a dedicated orthopaedic trauma room (DOTR) on elective arthroplasty volume. Retrospective cohort study. Level I academic trauma center. A retrospective analysis was performed for two 3-year intervals before and after DOTR introduction on January 20, 2013, at a Level I trauma center. Surgeons were included if they performed elective primary total hip arthroplasty (THA), total knee arthroplasty (TKA), total shoulder arthroplasty (TSA), or reverse total shoulder arthroplasty (RTSA) regularly from 2010 to 2015. Change in elective arthroplasty volume after the implementation of a DOTR. A total of 2339 cases were performed by surgeons A-E, with an average of 303.3 cases per year pre-DOTR and an average of 476.3 cases per year post-DOTR. On average, within our institution, there were 75.79 per 10,000 cases/year in Michigan pre-DOTR and 104.2 per 10,000 cases/year in Michigan post-DOTR. Surgeons A-E averaged 173.0 more cases per year and increased their average proportion of elective arthroplasty case volume in Michigan. There was a statistically significant market share increase of 9.8 per 10,000 cases/year in Michigan, at our hospital in the post-DOTR periods ( P = 0.039) (CI [0.5442, 19.21], SE = 4.523). This market share increase of 9.8 cases/10,000 cases was the yearly increase in market share that our average surgeons saw after the DOTR implementation, this took into account the observed annual increase in arthroplasty volume statewide during those years. Implementation of a DOTR was associated with increases in the total number, annual mean, and annual proportion of elective arthroplasty cases performed in Michigan for both elective surgeons and the institution as a whole. These findings reveal a benefit of DOTR implementation to elective arthroplasty surgeons and health systems on a larger scale, in the form of increased arthroplasty case volume.

Patient-related Risk Factors Associated with Poorer Outcomes Following Total Ankle Arthroplasty: A Scoping Review of 101552 Cases

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty and ankle arthrodesis are both first line options for end stage arthritis. Both have good outcomes in terms of patient reported outcome measures, complications, and revision rate. Despite efforts to determine a superior option, results are inconsistent. It may be better to take a patient-specific approach in deciding which procedure to use based on risk factors such as BMI, age, and co-morbidities. This scoping review aims to identify and summarise all literature on total ankle arthroplasty and risk factors to guide a patient-specific decision making process, helping clinicians refine selection criteria and identify patients who are likely to respond well to the procedure. Methods: A scoping review was performed using the Preferred Reporting Items for Systematic Reviews an Meta-Analyses (PRISMA) guidelines. Computer based literature searching was performed in PubMed, Embase, Cochrane trials and ISI Web of science. Two reviewers independently performed title/abstract and full text screening according to pre-determined selection criteria. English-language original research studies reporting patient related factors associated with a poorer outcome following total ankle arthroplasty were included. Outcomes were defined as patient reported outcome measures (PROMs), peri-operative complications and failure. Results: A total of 94 studies reporting 101,552 cases of total ankle arthroplasty in 101,177 patients were included. The most common patient-related risk factor associated with poorer outcomes were younger age (21 studies), rheumatoid arthritis (17 studies) and diabetes (16 studies). Of the studies using multivariate regression specifically, the most frequently described risk factors were younger age (12 studies), rheumatoid arthritis (8 studies) and diabetes (8 studies). Conclusion: When controlling for cofounding factors, the most commonly reported risk factors are younger age, rheumatoid arthritis and co-morbidities such as diabetes and smoking. These patient-related risk factors reported may be used to facilitate the refinement of patient selection criteria for total ankle arthroplasty and inform patient expectations.

The Use of Iodophor-Impregnated Drapes in Patients With Iodine-Related Allergies: A Case Series and Review of the Literature.

The use of iodophor-impregnated adhesive drapes have become almost universally incorporated into standard practice of arthroplasty draping technique. Iodine-related allergies in patients planned for joint replacement present a challenge in terms of the best course of action to minimize complications and optimize outcomes. This is a retrospective case series of patients that received an iodophor-impregnated drape as part of draping for a total hip or knee arthroplasty at a single orthopaedic-specific hospital with documented iodine-related allergies. From 2015 to 2023, 9816 total hip arthroplasty and total knee arthroplasty cases were reviewed, and 135 were documented to have an iodine-related allergy for a prevalence of 1.38%. Intraoperative and postoperative records were reviewed to screen for an allergic reaction or wound healing issues that may have been related to an adverse reaction to the use of the iodophor-impregnated drape. Of the 135 patients, 43 had iodine listed as an allergy, 85 had shellfish, 20 had iodinated contrast media, and 3 had povidone iodine. Sixteen patients had a cluster of iodine-related allergies. There were no intraoperative reports of an allergic reaction to this drape. There were four superficial wound problems, none of which were documented to relate to an allergic dermatitis reaction, and none required further surgery. Patients reporting iodine-related allergies were present in 1.38% of patients undergoing hip or knee arthroplasty in our series. We encountered no allergic reactions or adverse outcomes that could be attributed to the use of iodiphor impregnated drapes in these patients.

Prevalence and Risk Factors for Missed Short-term Follow-up After Primary Total Shoulder Arthroplasty.

The importance of consistent postoperative follow-up has been established for collecting patient-reported outcomes and surveilling for potential complications. Despite this, the prevalence of and risk factors for missed short-term follow-up after elective shoulder arthroplasty remain limited. A retrospective review of consecutive primary anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty cases with a minimum of 12-month follow-up performed by a single, fellowship-trained shoulder surgeon was undertaken from January 2015 to December 2021. Demographic patient and surgical data, including age, sex, marital status, self-identified race, body mass index, American Society of Anesthesiologists score, age-adjusted Charlson Comorbidity Index, prior ipsilateral shoulder surgery and/or contralateral arthroplasty, distance from home to clinic, smoking status, and hospital length of stay, were collected. The follow-up at 1 week, 6 weeks, 6 months, 12 months, and 24 months and beyond was determined. Patient-related and surgical predictors for missing the 12-month and 24-month follow-up were identified. There were 295 cases included (168 aTSA and 127 reverse total shoulder arthroplasty), of whom 199 (67%) were women. Of the total cases, 261 (86%) were eligible for 24-month follow-up. Patients undergoing aTSA, those of younger age, those of male sex, and those who missed their 6-week and 6-month follow-up were significantly more likely to miss the 12-month follow-up visit. Following multivariable analysis, a missed 6-month follow-up (OR 10.10, 95% CI 5.32 to 19.16, P < 0.001) was associated with 12-month visit nonattendance, and increasing age (per year) (OR 0.96, 95% CI 0.93 to 0.99, P = 0.011) was associated with improved 12-month follow-up. Not having a surgical complication within 6 months postoperatively, not undergoing ipsilateral revision arthroplasty, and missing the 1-week and 12-month follow-up were significantly associated with missing the 24-month follow-up. After multivariable analysis, missing the 1-week (OR 3.07, 95% CI 1.12 to 8.41, P = 0.029) and 12-month (OR 3.84, 95% CI 2.11 to 6.99, P < 0.001) follow-ups was associated with missing the 24-month visit, whereas having a postoperative complication was associated with increased attendance at 24 months (OR 0.38, 95% CI 0.14 to 0.99, P = 0.047). Strategies for preventing missed short-term follow-up should be focused on ensuring that patients undergoing TSA attend the 6-month and 12-month visit, particularly among younger patients and those with an uneventful postoperative course.

Impact of COVID-19 on inpatient anatomic, reverse and hemi shoulder arthroplasty case volume in the United States

BackgroundDespite known surgical volume reductions in 2020 during the height of the COVID-19 pandemic, no studies have quantified the impact of the pandemic on the number of inpatient anatomic total shoulder arthroplasty (aTSA), reverse total shoulder arthroplasty (rTSA) and hemiarthroplasty cases. The purpose of this study is to analyze the impact of COVID-19 on aTSA, rTSA and hemiarthroplasty case volumes in the United States. MethodsThe Premier Health-care Database was used to identify adults undergoing primary inpatient aTSA, rTSA and hemiarthroplasty from January 2017 to December 2020. Patients undergoing revision total shoulder arthroplasty surgery were excluded. The monthly case volume variance in 2020 was calculated by subtracting the 2017-2019 monthly mean from each respective monthly mean in 2020. Differences in patient and hospital characteristics between subgroups were analyzed using analysis of variance for continuous variables and chi-squared for categorical variables. All statistical analysis was done using STATA (version 17BE; StataCorp LLC, College Station, TX, USA). ResultsA total of 127,496 cases were identified using the Premier Healthcare Database from January 2017 to December 2020. Anatomic TSA accounted for 30.67% of all cases, rTSA represented 63.55%, and hemiarthroplasty accounted for 5.78%. A precipitous decline in cases was observed in March and April of 2020, with aTSA declining by 97%, rTSA declining by 83% and hemiarthroplasty declining by 77% from their prepandemic monthly averages. Cases rebounded in May and peaked by June (rTSA and hemiarthroplasty) or July (aTSA). Cases slightly declined in August, rebounded in September, and declined again at the end of the year. The average length of stay in 2020 was slightly longer for aTSA (1.87 to 2.12 days, P < .0001) and hemiarthroplasty (2.08 to 2.49 days, P = .0021), but slightly shorter for rTSA (1.92 to 1.64 days, P < .0001). We estimated that a total of 29,951 cases were performed in 2020, representing a 7.8% decrease compared with the average from 2017 through 2019, with roughly 2564 patients either delayed or unable to undergo arthroplasty in 2020. ConclusionBased on data from the Premier database, COVID-19 had a negative impact on the case volume of inpatient shoulder replacement (aTSA, rTSA and hemiarthroplasty) surgery in the United States. By the end of 2020, rTSA cases had returned to its monthly average in the years preceding the pandemic, while aTSA and hemiarthroplasty recovered to roughly 75% of their prepandemic case volumes.

Unplanned Emergency Department Visits Following Revision Total Joint Arthroplasty: Incidences, Risk Factors, and Mortalities

BackgroundThe incidence of unplanned emergency department (ED) visits following revision total joint arthroplasty is an indicator of the quality of postoperative care. The aim of this study was to investigate the incidences, timings, and characteristics of ED visits within 90 days after revision total joint arthroplasty. MethodsA retrospective review of 457 consecutive cases, including 254 revision total hip arthroplasty (rTHA) and 203 revision total knee arthroplasty (rTKA) cases, was conducted. Data regarding patient demographics, timings of the ED encounter, chief complaints, readmissions, and diagnoses indicating reoperation were analyzed. ResultsThe results showed that 41 patients who had rTHA (16.1%) and 14 patients who had rTKA (6.9%) returned to the ED within 90 days postoperatively. The incidence of ED visits was significantly higher in the rTHA group than in the rTKA group (P = .003). The most common surgery-related complications were dislocation among rTHA patients and wound conditions among rTKA patients. Apart from elevated calculated comorbidity scores, peptic ulcer in rTHA patients and cerebral vascular events and chronic obstructive pulmonary disease in rTKA patients might increase chances of unplanned ED visits. Patients who had ED visits showed significantly higher mortality rates than the others in both rTHA and rTKA cohorts (P = .050 and P = .008, respectively). ConclusionsThe ED visits within 90 days are more common after rTHA than after rTKA. Patients in both ED visit groups after rTHA and rTKA demonstrated worse survival. Efforts should be made to improve quality of care to prevent ED visits.

Hypersensitivity to metals in metal-on-metal hip arthroplasty: a prospective study of one hundred and thirty five lymphocyte transformation tests

BackgroundMetal allergy remains a controversial topic in the orthopaedic community. It is not known if or to what degree metal sensitivity contributes to inflammatory soft tissue failures, unexplained residual pain, or clinical complications after total joint replacement with metal prostheses.MethodsWe investigated the efficacy of the lymphocyte transformation test (LTT) in predicting adverse outcomes in patients after receiving a metal joint replacement. Our study cohort consists of 135 metal-on-metal hip resurfacing arthroplasty cases performed between 2013 and 2015. All study patients had an LTT preoperatively. We retrospectively analyzed clinical outcomes and failures for our cohort.ResultsThere was no difference in LTT reactivity between men and women. Of the 135 patients tested, 46 (34.1% of cohort) tested positive to at least one of the materials comprising their implant, and 78 patients (57.8%) had at least one reactive score to any component of the LTT. After a minimum follow-up of two years, we did not observe an allergic response to the implant in any patients. There were no failures requiring revision. We observed a 2.2% rate of moderate residual pain; no patients with residual pain tested positive for metal sensitivity. When patients with moderate-high LTT reactivity (30.4% of cohort) were compared to the remainder of the study group, there was no difference in HHS or UCLA activity score. There was no correlation between blood metal ion levels and LTT reactivity.ConclusionWe were unable to prove any predictive value of the LTT. We failed to identify hypersensitivity to metals in patients with metal-on-metal hip resurfacing arthroplasty.

Facebook Data Analytics: An Orthopedic Arthroplasty Case Study and Guide for Physicians.

Social media is increasingly used for health queries and subspecialist selection, but physicians receive little training in its use. This case study describes use of the free data tool Facebook Audience Insights to understand population demographics relevant to an orthopedic practice. Facebook Audience Insights was used to compare demographics and activity patterns of two patient samples typical of total joint arthroplasty (TJA)-young TJA (ages 55-64 years) and Medicare TJA (age ≥65 years)-in May 2020. Creation of a professional Facebook page is described accompanied by the demonstration of Audience Insights to analyze regional user patterns. A local sample of Facebook users was then compared with a single orthopedic practice's Facebook traffic. Facebook use is common among patients undergoing TJA, and the proportion of self-identified women increases with age (young TJA, 53% women; Medicare TJA, 63% women). Women are more interactive Facebook users across all age ranges, with more frequent comments, "Liked" pages, and advertisement clicks. Analysis of a local Facebook population revealed a lower proportion of TJA-aged patients than the national cohort; however, TJA-aged patients represented 38% of the practice's Facebook page traffic, with a predominance of visitors being women (26% women, 12% men). Facebook demonstrates a high prevalence of users in the typical age range for TJA. Those users were common on an orthopedic practice Facebook page, suggesting social media may be an effective medium for engaging patients. [Orthopedics. 2024;47(2):e79-e84.].

Long-term clinical outcomes of the Biomet M2a-38: a retrospective review of 335 total hip arthroplasty cases

BackgroundAt the turn of the century, over one-third of total hip arthroplasties comprised metal-on-metal bearings. As this patient population and their implants age, it is crucial to understand associated late failure modes and expected long-term functional outcomes. We report the long-term results of a large metal-on-metal uncemented total hip arthroplasty system with unique design characteristics compared to others that have been reported with high failure rates.MethodsWe retrospectively analyze our prospective clinical database to determine overall implant survivorship and functional outcomes. Further, we compare these results to the clinical outcomes reported in orthopedic registries and in other published studies with similar metal-on-metal total hip arthroplasty cohorts.ResultsImplant survivorship at 10 years was 99.1% and continued to 97.6% survivorship at 20 years. Implant survivorship at 20 years did not vary significantly between sexes (Male: 98.3%, Female: 97.2%; log-rank p-value = 0.46). Mean whole blood cobalt levels were 2.6 µg/L in unilateral cases, 5.3 µg/L in bilateral patients, and 3.4 µg/L for the combined cohort. Average blood chromium levels were 1.4 µg/L in unilateral patients, 2.9 µg/L in bilateral patients, and 1.8 µg/L for group combined. We observed a 0.9% rate of failure due trunnion corrosion at a mean of 13.1 years postoperatively (10.6–15.6 years) but had no bearing wear failures.ConclusionsOur 20-year implant survivorship of 97.6% with the M2a-38 bearing surpassed registry benchmarks for THA. This large-bearing (38 mm), full hemisphere coverage metal-on-metal system had no bearing wear failures, one failure of instability, one failure of fixation, and three trunnion failures, perhaps suggesting an optimum balance between stability of the joint and the trunnion.

Clinical characteristics and long-term outcomes of septic arthritis of the native hip joint: a 20-year retrospective review.

The primary purpose of this retrospective case series was to describe the prevalence and outcomes of single-stage hip arthroplasty in patients who were previously treated for septic arthritis of the native hip at our institution over a 20-year period. This study also examined rates of persistent or recurrent infection, reoperation, and mortality for septic arthritis of the native hip. Adult patients treated for septic arthritis of the native hip at our institution from 1995 to 2015 were retrospectively identified. Exclusion criteria included age <18 years, missing or incomplete medical records, treatment at an outside institution, and prior surgery of the hip. 97 patients were included in this study. 3 patients (3.1%) who were previously treated for septic arthritis of the native hip underwent single-stage hip arthroplasty an average of 40 ± 25 months from the date of infection. 3 of the 18 (16.7%) patients who were treated with resection arthroplasty underwent second-stage joint reconstruction. There were no cases of periprosthetic joint infection (PJI). 1 patient who underwent single-stage arthroplasty experienced implant-induced metallosis, necessitating removal of the implant. There were no other cases of revision arthroplasty. The prevalence of single-stage hip arthroplasty in patients with a history of septic arthritis of the native hip joint was 3.1%, which is higher than the prevalence of hip arthroplasty in the United States general population, suggesting that a history of septic arthritis may increase the risk of requiring hip arthroplasty. In the small number of patients who went on to receive a hip replacement, there were no reported cases of PJI. This study suggests that hip arthroplasty is a viable option for patients with symptomatic osteoarthritis and a history of septic arthritis of their hip.

Impact of Zweymüller Stem Modification on Clinical and Radiological Outcomes

Background. According to the analysis of large arthroplasty registers we have noted the increase in the use of non-cemented implants, because the latter shows the same results of implant survival as well as cemented implants. On the other hand, they can affect the quality of the bone around the implant in different ways. These components differ in shape, length, and surface properties. According to the analysis of the arthroplasty register of the Vreden National Medical Research Center of Traumatology and Orthopedics, a significant decrease of the Alloclassic femoral stem using can be noted. In parallel the use of its SL-PLUS MIA modification has increased significantly.&#x0D; Aims of the study: 1) to determine the influence of changes in the design of the Zweymller-type femoral stem on midterm and long-term outcomes and its survival; 2) to identify the characteristics of adaptive remodeling of periprosthetic bone tissue around these femoral stems; 3) to determine risk factors for aseptic loosening of these femoral stems.&#x0D; Methods. 492 cases of hip arthroplasty using the Alloclassic and SL-PLUS MIA femoral stems were observed, with an average follow-up 78.6 months. The patients were divided into 2 groups according to the type of femoral stem. The assessment the hip articulation condition was carried out using the HHS and OHS. The intensity of the pain syndrome was assessed by VAS, and the level of patients satisfaction. The dynamic analysis of X-rays was also performed visually.&#x0D; Results. A significant improvement in clinical and functional results was observed according to the HHS and OHS in both groups of patients, regardless of the type of femoral stem. Analysis of X-rays over time showed differences in the behavior of these two femoral component models. The radiolucent lines around the femoral stem are absent in SL-PLUS MIA group, in Alloclassic stem group radiolucent lines are present even at a minimal period (12 months). We also found that a tight fit of Zweymller femoral stems in the distal shaft is a risk factor for severe stress-shielding syndrome, especially in the funnel channels. But ceteris paribus, a distal tight fit of SL-PLUS MIA stems despite similar geometry of the distal part does not lead to such frequent manifestation of severe stress shielding.&#x0D; Conclusion. The change in Zweymller stem design from Alloclassic to SL-PLUS MIA improved the nature of adaptive remodeling in the periprosthetic area of the femur. It may improve the long-term results of primary hip arthroplasty, but these differences require closer observation.

Improvements in networking processes for hip or knee revision arthroplasty: a silver lining of the COVID-19 pandemic.

Improvements in outcomes following hip and knee revision arthroplasties have been demonstrated following the introduction of specialised orthopaedic services in the form of 'hub and spoke' networking models. In light of the COVID-19 pandemic, these networks have undergone some inevitable adaptations. We investigated the impact of recent adaptations on the performance of our regional revision arthroplasty network. A retrospective review of all referrals that were discussed at our regional revision arthroplasty meeting, over 2 separate phases, was undertaken. Phase 1 included data between March 2018 and April 2019, representing an interval prior to COVID-19 pandemic. Phase-2 included data between September 2020 and March 2021 (during COVID-19 pandemic). Data were collected from East Midland South Orthopaedic Network (EMSSON) database and included data relating to indication and time to revision surgery, surgeon's proposal plan, network proposal plan, and executed definitive plan. We compared and analysed network performance between 2 phases. In phase 1, 99 cases were discussed in EMSSON meetings, equating to 35.7% of the region's revision arthroplasty volume, according to the National Joint Registry (NJR) records. Plan alterations were recommended in 48/99 cases (48.5%), of which 41/48 (85.4%) were adhered to. Phase 2 included 98 discussed cases, equating to 81.6% of the region's revision arthroplasty volume. Plan alterations were recommended in 20/98 cases (20.4%), all of which were adhered to (100%). Adherence to recommended adaptations showed significant improvement (p < 0.03). Based upon our observations, a greater volume and proportion of revision arthroplasty cases are now being discussed. Adherence to MDT recommendations has significantly improved following the described adaptations. The number of recommended adaptations to management plans have decreased, indicating an educational value of the network.Overall, these findings demonstrate a trend towards NHS England's target of 100% of revision arthroplasty cases undergoing MDT discussion.

Serum Procalcitonin Guide in a Case of Proteus mirabilis Prosthetic Joint Infection

Infection is a dreaded complication in patients who have underwent arthroplasty and often very challenging to treat. It accounts for lesser than 1% of arthroplasty cases and although low in occurrence, requires appropriate investigations and management to successfully treat the condition. This case demonstrates a case of a rare microorganism with unusual antibiotic susceptibility causing a prosthetic joint infection and the use of serum procalcitonin level as guide in management of the patient.

Revision of failed reverse total shoulder arthroplasty with reverse: short-term clinical outcomes

The prevalence of failed reverse total shoulder arthroplasty (rTSA) is increasing. This can often present a challenging clinical situation with substantial bone loss and limited reconstruction options. This study reports a single tertiary referral center's experience with revision of failed rTSA managed with revision rTSA of bone-interfacing components. Following institutional review board approval, all revision shoulder arthroplasty cases performed at a single institution between 2012 and 2020 were reviewed. Cases in which rTSA was revised to a new rTSA construct with revision of at least one bone-interfacing implant (humeral stem and/or baseplate) with a minimum two-year follow-up were identified. Characteristics of revision cases-including indications, bony stock, revised components, and use of bone graft-were collected. All patients were contacted for patient-reported outcome measures at a minimum of two-years following surgery. In addition, the incidence and indication for any reoperation following revision were determined. Thirty-three patients with an average age of 66 years (range: 46-82) 19 (58%; 19/33) being female met inclusion criteria and had a mean follow-up of 4.2 years (range: 2-8). The most common indication for revision rTSA included humeral component loosening (33%; 11/33), baseplate loosening (27%; 9/33), and instability (21%; 7/33). Pre-revision infectious workup demonstrated no cases of periprosthetic shoulder infection. Thirteen cases had massive bone loss-five treated with humeral allograft prosthetic composite, five with glenoid bone grafting, and three with custom glenoid implant. In total, 10 cases (30%; 10/33) required re-operation at mean of 13 months (range: 1-44) for instability (4), humeral loosening (2), infection (1), baseplate loosening (1), or periprosthetic fracture (1). The re-operation rate for patients with revised baseplates only, humerus only, or combined was 23% (3/13), 28% (5/18), and 27% (3/11), respectively. Overall, VAS pain improved from 6.5 preoperatively to 2.0 (p<0.001) and the ASES score improved from 30.7 to 67.5 (p<0.001). However, postoperative SANE score averaged only 51.2% (range: 2-100). This study demonstrates that failed rTSA can be salvaged with a revision rTSA. However, patient expectations for functional improvements should be tempered and a high re-operation rate should be expected.

Anterior and posterior hip osteoarthritis: prevalence and potential value of CT compared to radiographs.

To determine the added value of computed tomography (CT) to identify severe hip osteoarthritis (OA). A retrospective query of all cases of hip or knee arthroplasty planning CTs between January 2018 and March 2022 was performed. Age, sex, and symptoms were collected from the medical record. CTs were evaluated for the degree of osteoarthritis and classified using an adapted Kellgren-Lawrence (KL) grading system in the anterior, posterior, superior, and superomedial hip. Frontal hip or pelvis radiographs within 1 year of the CT were also graded. There were 265 eligible hips in 178 subjects, age 66 ± 11 (range 31-93) years, with 85/178 (48%) males and 93/178 (52%) females, and 127/265 (48%) right and 138/265 (52%) left hips. The posterior hip joint was the most common location for grade 2/3 OA (20%), followed by superior hip joint (14%). Anterior or posterior grade 2/3 OA occurred concurrently with superior or superomedial grade 2/3 OA in 32/68 (47%) of hips. Grade 2/3 OA was detected on CT more commonly than on XR both in the superior (14 vs 8.6%, P = 0.0016) and superomedial (8.7 vs 4.8%, P = 0.016) hip joint. Of the 71 symptomatic hips, 22 (31%) hips demonstrated either anterior and/or posterior grade 2/3 OA on CT, and 9 (9/22, 41%) of these hips had superior or superomedial grade 0/1 OA. CT may be warranted when the patient has pain suggestive of osteoarthritis not detected on radiographs.

DEPRIVATION, COMPLEXITY, AND MORTALITY IN KNEE ARTHROPLASTY

AbstractIntroductionKnee replacement surgery can greatly improve pain, disability, quality of life and ability to work. Socioeconomic deprivation is associated with multiple poor health outcomes, partly due to reduced access to services, including surgery. We investigated whether deprivation was associated with characteristics at presentation, and outcomes following knee arthroplasty.MethodologyWe linked data from 2358 knee arthroplasty cases with the Index of Multiple Deprivation, and mortality data after mean 7.6 years follow up. A locally developed scoring system was used prospectively to categorise case complexity.ResultsMost patients were from more affluent areas. Deprivation was associated with younger age, and increasing case complexity. There was a significant association between case complexity and mortality, while an independent association between deprivation and mortality could not be confirmed.ConclusionHealth inequalities may impact presentations and outcomes in knee arthroplasty. Patients from areas of socioeconomic deprivation present more complex cases, which may be a result of associated comorbidity and delayed presentation due to impaired access. As knee arthroplasty can improve disability and ability to work, its availability in deprived areas can play a role in the alleviation of health inequality.

Mapping the course to recovery: a prospective study on the anatomic distribution of early postoperative pain after total knee arthroplasty

IntroductionEarly postoperative pain following total knee arthroplasty significantly impacts outcomes and patient satisfaction. However, the characteristics and sources of early pain after total knee arthroplasty remain unclear. Therefore, the purpose of this study was to determine the anatomic distribution and course of postoperative pain in the acute and subacute period following total knee arthroplasty.MethodsA prospective observational study of primary, elective unilateral total knee arthroplasty cases was conducted at our academic tertiary care medical center from January 2021 to September 2021. Preoperative variables were extracted from institutional electronic medical records. Postoperatively, patients utilized a knee pain map to identify the two locations with the most significant pain and rated it using the visual analog scale (VAS). The data were collected on day 0, at 2 weeks, 2 months, and 6 months after operation.ResultsThis study included 112 patients, with 6% of patients having no pain at postoperative day 0, 22% at 2 weeks, 46% at 2 months, and 86% at 6 months after operation. In those who reported pain, the VAS score (mean ± standard deviation) was 5.8 ± 2.4 on postoperative day 0 and decreased at each follow-up time point (5.4 ± 2.3 at 2 weeks, 3.9 ± 2.2 at 2 months, and 3.8 ± 2.7 at 6 months). The majority of patients were able to identify distinct loci of pain. The most common early pain loci were patellae, thigh, and medial joint line, and this distribution dissipated by 6 months.ConclusionAt 2 postoperative weeks, pain was primarily at the medial joint, and at 6 months postoperatively, pain was more likely to be at the lateral joint. No relationship was found between pain at six months and pain scores or location at postoperative day 0 or 2 weeks. Understanding the distribution and progression of knee pain following total knee arthroplasty may benefit patient education and targeted interventions.Level of EvidenceLevel II, prospective observational study