Difference In Revision Rates Research Articles

P92. Compared to multi rod (≥3) constructs, interbody fusion does not reduce the rate of rod failure at 2-year minimum follow-up

<h3>BACKGROUND CONTEXT</h3> Pseudarthrosis with distal mechanical failure is a common complication after long constructs in adult spinal deformity (ASD). Multiple strategies have been proposed to improve fusion rates and reduce the rate of rod fracture, including the use of interbody fusion (IBF) and multi-rod (≥3) techniques. Whether rod fracture rates are lower with the utilization of IBF versus multi-rod constructs remains unknown. <h3>PURPOSE</h3> To assess for any difference in rod fracture rate between constructs with IBF and multiple rods up to 2 years postoperatively. <h3>STUDY DESIGN/SETTING</h3> Retrospective Cohort. <h3>PATIENT SAMPLE</h3> ASD patients undergoing fusion of ≥6 levels to ilium and a minimum follow-up of 24 months. <h3>OUTCOME MEASURES</h3> Rate of postoperative rod fracture. <h3>METHODS</h3> ASD patients undergoing fusion of ≥6 levels to ilium and a minimum follow-up of 24 months were included. Patients with a history of prior fusion to L4 or below, and those with neuromuscular disease, inflammatory arthritis, or skeletal dysplasia were excluded. Patients were grouped by construct types: 2 rods w/ IBF (IBF) and w/o IBF (2R) and ≥3 rods w/o IBF (3R). Demographics, perioperative and radiographic data, and evidence of rod fracture were collected. ANOVA, chi-square and Fisher exact tests were used to compare across construct types. <h3>RESULTS</h3> Seventy-one patients were included, with mean age 65.0 years (±8.5) and BMI 26.7 kg/m2 (±5.4). In total, 20 patients had 2R constructs, 12 had IBF, and 39 had 3R. There were no significant differences in sagittal or coronal parameters at baseline or 2 years, or in OR time, EBL, or number of levels fused across groups. There were 76.1% of patients with posterior column osteotomy (2R 75.0%, IBF 50.0%, 3R 84.6%; p=0.063) and 9.9% had 3 column osteotomy. There were 12 total rod fractures (15.2%) with no significant difference between groups (2R 25.0%, IBF 16.7%, 3R 12.8%; p=0.423) and no differences in revision rate for rod fracture. <h3>CONCLUSIONS</h3> Compared to multi-rod techniques, the addition of IBF does not reduce the rate of rod fracture at two years after long constructs for ASD. These findings suggest that increasing the rigidity of the construct with the addition of a third rod may be sufficient to prevent rod fractures while IBF may provide no additional benefit at 2 years follow-up. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

How Large a Study Is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis.

How Large a Study Is Needed to Detect TKA Revision Rate Reductions Attributable to Robotic or Navigated Technologies? A Simulation-based Power Analysis.

Instrumentation Techniques to Prevent Proximal Junctional Kyphosis and Proximal Junctional Failure in Adult Spinal Deformity Correction: A Systematic Review of Clinical Studies.

Study Design:Systematic review.Objectives:To summarize the results of clinical studies investigating spinal instrumentation techniques aiming to reduce the postoperative incidence of proximal junctional kyphosis (PJK) and/or failure (PJF) in adult spinal deformity (ASD) patients.Methods:EMBASE and Medline® were searched for articles dating from January 2000 onward. Data was extracted by 2 independent authors and methodological quality was assessed using ROBINS-I.Results:18 retrospective- and prospective cohort studies with a severe or critical risk of bias were included. Different techniques were applied at the upper instrumented vertebra (UIV): tethers in various configurations, 2-level prophylactic vertebroplasty (2-PVP), transverse process hooks (TPH), flexible rods (FR), sublaminar tapes (ST) and multilevel stabilization screws (MLSS). Compared to a pedicle screw (PS) group, significant differences in PJK incidence were found using tethers in various configurations (18% versus 45%, P = 0.001, 15% versus 38%, P = 0.045), 2-PVP (24% vs 36%, P = 0.020), TPH (0% vs. 30%, P = 0.023) and FR (15% versus 38%, P = 0.045). Differences in revision rates for PJK were found in studies concerning tethers (4% versus 18%, P = 0.002), 2-PVP (0% vs 13%, P = 0.031) and TPH (0% vs 7%, P = n.a.).Conclusion:Although the studies are of low quality, the most frequently studied techniques, namely 2-PVP as anterior reinforcement and (tensioned) tethers or TPH as posterior semi-rigid fixation, show promising results. To provide a reliable comparison, more controlled studies need to be performed, including the use of clinical outcome measures and a uniform definition of PJF.

Arthroscopic distal clavicle excision is associated with fewer postoperative complications than open.

BackgroundThe rate of complications of open compared to arthroscopic distal clavicle excision remain poorly studied. Therefore, the purpose of this investigation was to (1) Identify most recent national trends in the usage of open vs. arthroscopic approaches for distal clavicle excision (DCE) from 2007 to 2017; (2) to identify and compare the complication rates for both approaches, and to identify patient-specific risk factors for complications; (3) to identify and compare the revision rate for both approaches; and (4) to identify and compare the reimbursement of each approach.MethodsThe PearlDiver database was reviewed for patients undergoing DCE from 2007 to 2017. Patients were stratified into 2 cohorts: those undergoing arthroscopic DCE (n = 8933) and those undergoing open DCE (n = 2295). The rate of postoperative complications within 90 days was calculated and compared. The revision rate and reimbursement of the arthroscopic and open approach were compared. Statistical analysis included chi-square testing to compare the rates of postoperative complications and multivariate logistic regression analysis to identify risk factors for complications within 90 days. Results were considered significant at P < .05.ResultsThe percentage of DCEs performed arthroscopically has significantly increased from 53.9% in 2007 to 69.8% in 2016, with a concomitant decrease in the use of open DCE from 46.1% in 2007 to 30.2% in 2016. The open approach was associated with significantly more postoperative complications, including a significantly greater incidence of surgical site infection (1.9% vs. 0.3%; P < .001), wound disruption (0.3% vs. 0.1%; P < .001), hematoma (0.9% vs. 0.2%; P = .001), and transfusion (0.6% vs. 0.1%; P < .001), than arthroscopic DCE. Several risk factors, including open approach, diabetes, heart disease, tobacco use, chronic kidney disease, and female gender, were identified as independent risk factors for complications after DCE. There was no significant difference in revision rate between open and arthroscopic approaches (P = .126). The reimbursement of open and arthroscopic DCE procedures were comparable, with median reimbursements of $5408 and $5,447, respectively (P = .853).ConclusionBoth arthroscopic and open DCE techniques were found to have similar reimbursement amounts, with a low rate of complications, although the open technique had a higher rate of early complications such as surgical site infection. Over the study period, there was an increase in the utilization of arthroscopic DCE, while the incidence of the open technique remained constant.

Minimally invasive posterior lumbar surgery in the morbidly obese, obese and non-obese populations: A single institution retrospective review

BackgroundThere is a paucity of information regarding outcomes in minimally invasive surgical (MIS) approaches to posterior lumbar surgery in morbidly obese patients. We seek to determine if there are differences in operative variables and early complication rates in morbidly obese patients undergoing MIS posterior lumbar surgery compared to obese and non-obese patients. MethodsA single institution retrospective review of patients undergoing MIS posterior lumbar surgery (decompression and/or fusion) between 2013 and 2016 was performed. Morbidly obese patients (BMI ≥ 40) were compared to obese (BMI 30–39.9) and non-obese (BMI < 30) cohorts. Postoperative complication rates and perioperative variables including estimated blood loss, operative time, and outcome measures including length of stay (LOS), in-hospital complications, readmission, and disposition were assessed. Results47 morbidly obese, 135 obese and 224 non-obese patients underwent posterior MIS instrumented fusion. 59 morbidly obese, 182 obese and 314 non-obese patients underwent posterior MIS decompression. The morbidly obese group experienced a greater rate of deep vein thrombosis and had an increased hospital LOS (p < 0.05). Morbidly obese patients who underwent MIS decompression experienced increased postoperative complications (p < 0.01), and increased LOS (p < 0.0001) compared to obese and non-obese patients. There were no differences in revision rates, readmissions, and other complications including surgical site infection. Morbid obesity was an independent predictor of overall complications and increased LOS on multivariate analysis. ConclusionMorbidly obese patients undergoing posterior MIS fusion had a higher rate of complications and increased LOS. While weight loss should be encouraged, complication rates remains acceptably low in morbidly obese patients and MIS posterior lumbar surgery should still be offered.

A Comparison of Revision Rates for Dislocation and Aseptic Causes Between Dual Mobility and Large Femoral Head Bearings in Primary Total Hip Arthroplasty With Subanalysis by Acetabular Component Size: An Analysis of 106,163 Primary Total Hip Arthroplasties

BackgroundDual mobility (DM) and large femoral head bearings (≥36 mm) both decrease the risk of dislocation in total hip arthroplasty (THA). There is limited comparable data in primary THA. This study compared the revision rates for dislocation and aseptic causes between DM and large femoral heads and subanalyzed by acetabular component size. MethodsData from the Australian Orthopedic Association National Joint Replacement Registry were analyzed for patients undergoing primary THA for osteoarthritis from January 2008 (the year of first recorded DM use) to December 2019. All DM and large femoral head bearings were identified. The primary outcome measure was the cumulative percent revision (CPR) for dislocation and for all aseptic causes. The results were adjusted by age, sex, and femoral fixation. A subanalysis was performed stratifying acetabular component diameter <58 m and ≥58 mm. ResultsThere were 4942 DM and 101,221 large femoral head bearings recorded. There was no difference in the CPR for dislocation (HR = 0.69 (95% CI 0.42, 1.13), P = .138) or aseptic causes (HR = 0.91 (95% CI 0.70, 1.18), P = .457). When stratified by acetabular component size, DM reduced the CPR for dislocation in acetabular component diameter <58 mm (HR = 0.55 (95% CI 0.30, 1.00), P = .049). There was no difference for diameter ≥58 mm. There was no difference in aseptic revision when stratified by acetabular component diameter. ConclusionThere is no difference in revision rates for dislocation or aseptic causes between DM and large femoral heads in primary THA. When stratified by acetabular component size, DM reduces dislocation for acetabular component diameter <58 mm. Level of EvidenceLevel III.

Vitamin E-enriched polyethylene bearings are not inferior to Arcom bearings in primary total knee arthroplasty at medium-term follow-up.

The release of wear particles can be responsible for periprosthetic osteolysis, which can in turn, lead to aseptic loosening. Vitamin E-infused polyethylene (HXLPE Vit-E) has been shown, in vitro, to be more resistant to wear than conventional polyethylene (UHMWPE) by its crosslinking (HXLPE) and its higher resistance to oxidation. After reading a case report of a fracture of a vitamin E-enriched HXLPE bearing, the aim of this retrospective study was to evaluate fracture risk and clinical inferiority or not of vitamin-E HXLPE compared to conventional polyethylene in total knee arthroplasty (TKA). Three hundred and forty-nine patients (403 TKAs) were contacted, to find out whether they had undergone revision surgery for any reason after a mean (SD) of 7 (1.5) years. Follow-up control radiographs were analyzed for periprosthetic radiolucent lines (RLL) and loosening. Two different Patient Reported Outcome Measurements Scores (PROMS), KOOS and FJS-12, were utilized to assess the daily functionality and identify potential problems. No statistically significant difference in revision rate, occurrence of aseptic loosening or RLL nor outcome as measured with PROMS was observed. No bearing fractures or clinical inferiority was observed for vitamin E-enriched HXLPE at medium-term follow-up (7years) compared to conventional Arcom polyethylene. Level III, therapeutic study.

The effect of antibiotic-loaded bone cement on risk of revision following hip and knee arthroplasty.

This study aimed to compare the effect of antibiotic-loaded bone cement (ALBC) versus plain bone cement (PBC) on revision rates for periprosthetic joint infection (PJI) and all-cause revisions following primary elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). MEDLINE, Embase, Web of Science, and Cochrane databases were systematically searched for studies comparing ALBC versus PBC, reporting on revision rates for PJI or all-cause revision following primary elective THA or TKA. A random-effects meta-analysis was performed. The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID CRD42018107691). Nine studies and one registry report were identified, enabling the inclusion of 371,977 THA and 671,246 TKA. Pooled analysis for THA demonstrated ALBC was protective against revision for PJI compared with PBC (relative risk (RR) 0.66, 95% confidence interval (CI) 0.56 to 0.77; p < 0.001), however, no differences were seen for all-cause revision rate (RR 0.62, 95% CI 0.35 to 1.09; p = 0.100). For TKA, there were no significant differences in revision rates for PJI or all causes between ALBC and PBC (RR 0.92, 95% CI 0.59 to 1.45; p = 0.730, and RR 0.73, 95% CI 0.53 to 1.02; p = 0.060, respectively). ALBC demonstrated a protective effect against revision for PJI compared with PBC in THA with no difference in all-cause revisions. No differences in revision rates for PJI and all-cause revision between ALBC and PBC for TKA were observed. Cite this article: Bone Joint J 2021;103-B(1):7-15.

Hip Arthroplasty After Hip Arthroscopy: Are Short-term Outcomes Affected? A Systematic Review

To systematically review the published literature regarding intraoperative measures, patient reported outcomes, and complications of THA in patients with or without a history of prior hip arthroscopy. PubMed and Cochrane Library databases were searched for all publications regarding patients who had undergone a THA after a prior ipsilateral hip arthroscopy. Included studies were comparative in nature and included post-operative outcome measures. Excluded studies were opinion articles, review articles, cadaveric studies, case reports, or technique articles. Patient demographics, surgical outcomes, complications, and patient reported outcome measures (PROMs) were recorded. Eight studies were included in this systematic review. These included 305 hips with a THA following a prior hip arthroscopy, with 502 matched control hips. Mean time for conversion from prior hip arthroscopy was 23 months and mean follow-up was 35.9 vs 36.1, for the prior arthroscopy and control groups respectively. No significant differences were found regarding intra-operative measures and PROMs. There was no difference in rate of revisions at latest follow-up. However, there was a trend towards higher rates of dislocations and infections in the prior hip arthroscopy group. The short-term patient-reported outcomes of patients who underwent total hip arthroplasty with a prior history of an ipsilateral hip arthroscopy are comparable to those of patients undergoing primary THA. Although a conclusion could not be made regarding differences in complication rates between patients with a history of prior arthroscopy and patients undergoing primary THA it is still imperative to consider the possible implications of a prior hip procedure on postoperative stability and infection rates. In summary, hip arthroplasty following a prior hip arthroscopy is a safe procedure with comparable short-term outcomes to primary arthroplasty

Anterior Cervical Corpectomy and Fusion for Degenerative and Traumatic Spine Disorders, Single-Center Experience of a Case Series of 119 Patients.

BACKGROUNDAnterior cervical corpectomy and fusion (ACCF) is a treatment option for several cervical pathologies. Various graft materials such as autografts, titanium mesh cages (TMC), or poly-ether-ether-ketone (PEEK) cages are used. Additional posterior fixation (PF) to provide extra support and improve stability is sometimes performed initially, or later as supplementary treatment.OBJECTIVETo describe our retrospective study of 119 consecutive cases of ACCF with synthetic grafts, in 3 cohorts of cervical spondylotic myelopathy (CSM), infectious and neoplastic processes, and trauma, with special focus on need for supplementary PF.METHODSA total of 135 adult patients treated with ACCF between January 2005 and January 2018 were identified. Patients lost to follow-up were excluded, and 119 remaining patients were included for retrospective clinical and radiological assessment.RESULTSSynthetic grafts were used in 116 (97%) cases. Only 9 (8%) ACCF cases required later supplementary PF, where 7 (78%) cases were multilevel. There was a statistically significant difference in revision rate with PF for single-level compared to multilevel ACCFs (P = .001). Revision rates with PF were 2%, 29%, and 7% in CSM, infectious and neoplastic processes, and trauma cohorts, respectively.CONCLUSIONThe results indicate that ACCF is a safe and effective treatment for degenerative and traumatic cervical spine disorders, with low complication and revision rates. Single-level ACCF can be performed without additional PF. Multilevel ACCF (n > 2) and pathologies affecting bone quality seem to be risk factors for material subsidence and instability. In these cases, additional PF should be considered.

Type V superior labral anterior-posterior tears results in lower rates of return to play.

The purpose of this study was to evaluate the rate of return to play (RTP) in patients who underwent Type V superior labrum anterior-posterior (SLAP) repair compared to patients who underwent isolated Bankart repair in the setting of traumatic anterior shoulder instability. A retrospective review of patients who underwent arthroscopic Bankart repair and SLAP repair by a single surgeon between 2012 and 2017 was performed. Additionally, these were pair-matched in a 1:2 ratio for age, sex, sport and level of pre-operative play, with those undergoing isolated arthroscopic Bankart repair alone as a control group. RTP, level of RTP and the timing of RTP were assessed. The study included a total of 96 patients, with 32 in the study group and 64 in the control group, and a mean follow-up of 59months. Overall, there was no significant difference in the overall rate of return to play (26/32 (81.3%) vs 56/64 (87.5%), n.s), but there was a significantly higher rate of RTP at the same/higher level in the control group (14/32 (43.6%) vs 43/64 (67.2%), p = 0.0463). There was no significant difference in timing of RTP between the groups (n.s). There was no significant difference in recurrent instability (6/32 (18.8%) vs 5/64 (7.8%), n.s) but there was a significant difference in revision rates (5/32 (15.6%) vs. 2/64 (3.1%), p = 0.0392) between the Type V SLAP repair group and the control group. Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of RTP when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. However, those who underwent Type V SLAP repair reported significantly lower rates of RTP at the same or higher level compared to the control group. III.

Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients. A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction. Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45-4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55-3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43-2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61-4.03, p = 0.35). Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.

Modern total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis

The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.

Cemented vs. cementless fixation in primary total knee arthroplasty: a systematic review and meta-analysis.

Over 100,000 total knee replacements (TKRs) are carried out in the UK annually, with cemented fixation accounting for approximately 95% of all primary TKRs. In Australia, 68.1% of all primary TKRs use cemented fixation, and only 10.9% use cementless fixation. However, there has been a renewed interest in cementless fixation as a result of improvements in implant design and manufacturing technology.This meta-analysis aimed to compare the outcomes of cemented and cementless fixation in primary TKR. Outcome measures included the revision rate and patient-reported functional scores.MEDLINE and EMBASE were searched from the earliest available date to November 2018 for randomized controlled trials of primary TKAs comparing cemented versus cementless fixation outcomes.Six studies met our inclusion criteria and were analysed. A total of 755 knees were included; 356 knees underwent cemented fixation, 399 underwent cementless fixation. They were followed up for an average of 8.4 years (range: 2.0 to 16.6).This study found no significant difference in revision rates and knee function in cemented versus cementless TKR at up to 16.6-year follow-up.Cite this article: EFORT Open Rev 2020;5:793-798. DOI: 10.1302/2058-5241.5.200030

General surgery involvement with ventriculoperitoneal shunt insertions reduces revision rates

BackgroundVentriculoperitoneal shunts (VPS) are placed for a variety of etiologies. It is common for general surgery to assist with insertion of the distal portion in the peritoneum. ObjectiveTo determine if there is a difference in revision rates in patients undergoing VPS placement with general surgery as well as those undergoing laparoscopic insertion. MethodsA retrospective review of all consecutive patients undergoing VPS placements was performed in a three-year period (2017−2019). Those that underwent placement with general surgery were compared to those without general surgery. Additionally, patients undergoing distal placement via mini-laparotomy versus laparoscopy were compared. Multivariable logistic regression was used to examine risk factors for distal VPS failure. Results331 patients were included. 202 (61.0 %) underwent VPS placement with general surgery. 121 (36.6 %) patients underwent insertion via laparoscopic technique. General surgery involvement reduced operative times, decreased length of stay, and lowered overall revision rates with distal revision rates being most significant (1.5 % vs 8.5 %; p = 0.0034). Patients undergoing VPS placement via laparoscopic technique had decreased operative time, length of stay, in-hospital complications and revision rates, with significant decrease in shunt infection (1.7 % vs 7.1 %; p = 0.0366). A history of prior shunt or abdominal surgery (OR 3.826; p = 0.0282) and lack of general surgery involvement (OR 20.98; p = 0.0314) are independent risk factors for distal shunt revision in our cohort. ConclusionThe use of general surgeons in VPS insertion can be of benefit by decreasing operative time, length of stay, total revisions, and distal revision rates. Further prospective studies are warranted to determine true benefit.

A systematic review and meta-analysis of survivorship and wear rates of metal and ceramic heads articulating with polyethylene liners in total hip arthroplasty.

The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally accepted that this is due to a lower polyethylene wear rate. We used evidence synthesis to compare survivorship, polyethylene wear rates and metal ion levels for metal-on-polyethylene (MoP) and ceramic-on-polyethylene (CoP) bearings. If wear rates are not dissimilar in vivo this difference in revision rate may have another cause. Modular junctions are a potential source of corrosion and it is postulated that this may result in higher revision rates. We performed a systematic review and meta-analysis comparing the survivorship of MoP and CoP bearings. Odds ratio (95% CI) of revision was calculated. Mean difference (MD) and 95% confidence intervals (CI) were used to compare secondary outcomes of polyethylene wear and metal ion levels. Meta-analysis was performed with a Mantel-Haenszel Random-Effects Model. 6 randomised controlled trials were included. There was no statistically significant difference between MoP and CoP revision rate (OR 1.04; 95% CI, 0.37-2.90, I2 = 0%, p = 0.94), linear bearing wear (MD 0.00 mm; 95% CI, -0.05 -0.05, I2 = 98%, p = 0.90), nor volumetric bearing wear (MD 33.57 mm3; 95% CI, -215.56-282.70, I2 = 98%, p = 0.79). No studies evaluated metal ion levels. We found no evidence of a difference in revision rates nor linear and volumetric wear between MoP and CoP bearings in the randomised controlled trials currently available. Our study therefore does not advocate the additional cost associated with the use of ceramic heads in combination with polyethylene bearings in order to minimise revision rates. This contrasts the findings of in vitro studies and the major joint registries.

Are Oxinium Femoral Heads Superior to Alternative Bearing Surface Materials? A Systematic Review

AbstractOxidized zirconium (OxZr) femoral heads were developed to emulate the superior wear and scratch properties of ceramics while eliminating their unwanted tendency for brittle fracturing. Studies using OxZr have demonstrated reduced linear and volumetric wear of polyethylene (PE) liners when compared with cobalt chrome, ceramic, and steel femoral heads. The purpose of this systematic review was to determine the difference in revision rates, radiologically determined linear wear rates, and patient-reported outcomes among OxZr and alternative bearing materials. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols, a systematic review of published literature through April 24, 2018 was conducted. Among the 862 cases included at a mean weighted follow-up of 4.78 years, the revision THA rate and patient-reported outcomes were similar among OxZr and alternative bearing materials. One of the five studies demonstrated significantly lower linear wear rates in the OxZr group when paired with ultrahigh molecular-weight PE (OxZr 0.03 mm/y vs. stainless-steel 0.11 mm/y; p &lt; 0.001) and when paired with highly-crosslinked PE (OxZr 0.02 mm/y vs. stainless-steel 0.04 mm/y; p &lt; 0.001). The remaining four studies found no difference in linear wear rates. OxZr demonstrated similar outcome to that of modern-day ceramic and metal femoral heads for short- and mid-term revision surgery rates and patient-reported outcomes. Longer term studies are needed to evaluate if any long-term wear advantages are seen with the use of OxZr femoral heads and if the use of OxZr is cost effective compared with ceramic or metal alternatives. The level of evidence of the study is level II, systematic review.

Patient-Reported Outcome Measures and Radiological Outcomes in Mobile-Bearing Total Ankle Arthroplasty With Varus or Valgus Deformity.

There is increasing evidence that varus deformity does not negatively affect total ankle arthroplasty (TAA) outcomes, but there is a sparsity of evidence for valgus deformity. We present our outcomes using a mobile-bearing prosthesis for neutral, varus, and valgus ankles. This is a retrospective cohort study of consecutive cases identified from a local joint registry. In total, 230 cases were classified based on preoperative radiographs as neutral (152 cases), varus greater than 10 degrees (60 cases), or valgus greater than 10 degrees (18 cases). Tibiotalar angle was again measured postoperatively and at final follow-up (mean follow-up of 55.9 months). A total of 164 cases had adequate patient-reported outcome measures data (Foot and Ankle Outcome Score, Short Form-36 [SF-36] scores, and patient satisfaction) for analysis (mean follow-up of 61.6 months). The groups were similar for body mass index and length of follow-up, but neutral ankles were younger (P = .021). Baseline scores were equal except SF-36 physical health, with valgus ankles scoring lowest (P = .045). Valgus ankles had better postoperative pain (P = .025) and function (P = .012) than neutral. Pre- to postoperative change did not reach statistical significance except physical health, in which valgus performed best (P = .039). Mean final angle for all groups was less than 5 degrees. There was no significant difference in revision rates. Our study is consistent with previous evidence that varus deformity does not affect outcome in TAA. In addition, in our cohort, outcomes were satisfactory with valgus alignment. Postoperative coronal radiological alignment was affected by preoperative deformity but within acceptable limits. Coronal plane deformity did not negatively affect radiological or clinical outcomes in TAA. Level III, retrospective comparative study.

An Update on Cementless Femoral Fixation in Total Hip Arthroplasty.

➤ Cementless stems can be categorized using the updated classification system.➤ Short stems were designed as an alternative to conventional stems with the advantage of bone preservation, and they have grown in popularity with promising results; however, long-term outcomes are lacking.➤ Hydroxyapatite coating appears to have no advantage with respect to stem loosening.➤ The literature has shown no difference in revision rates between modular and nonmodular stems; however, with the advantages of equalizing limb lengths and offset come the drawbacks of corrosion and junctional fatigue failure of modular implants.➤ There is increasing use of cementless stems, including in octogenarians, with promising outcomes compared with cemented stems; however, there is a higher risk of periprosthetic fractures with cementless fixation, particularly in elderly female patients.

Early surgical complications of total hip arthroplasty related to surgical approach.

Total hip arthroplasty (THA) can be performed through a number of surgical approaches. The aim was to compare the incidence of early surgical complications in THA related to approach. A retrospective review of prospectively recorded data extracted from St. Vincent's Melbourne Arthroplasty Registry was performed between January 2006 and December 2016. Surgical approach was identified: lateral, posterior, anterior and superior. Primary outcome measure was return to theatre (RTT) for any cause within 1 year. Age, comorbidity, body mass index and femoral fixation were assessed for potential confounding. Secondary outcomes were RTT for revision procedure and for specific complications: intra or post-operative fracture, dislocation/instability, aseptic loosening and prosthetic joint injection (PJI). Variables were assessed for their association with outcome using unadjusted and adjusted quantile median regression for continuous outcomes and Cox proportional hazards regression for binary time-to-event outcomes. There were a total of 2906 consecutive THA's recorded, 1413 lateral, 1188 posterior, 233 anterior and 72 superior. A total of 140 cases (4.5%) required RTT within 1 year. No approach was associated with RTT on unadjusted analyses or multivariate modelling. There was no association between approach and revision, PJI or periprosthetic fracture. The posterior approach was associated with 2.90 times the rate of dislocation relative to the lateral (P = 0.005). There was no difference in the RTT rate between surgical approaches for THA. There was no difference in revision rates, PJI or periprosthetic fracture. The posterior approach was associated with a higher rate of dislocation relative to the lateral, but not the anterior.