Revision Of Femoral Component Research Articles

Periprocedural clinical outcomes of revision hip arthroplasty: a multi-centric comparison of current strategies based on the NSQIP.

Recent projections suggest a substantial rise in demand for revision total hip arthroplasties, emphasizing the need for optimized perioperative care. Various revision techniques, such as isolated acetabular or femoral component revisions and total replacements, have garnered attention. Further research is needed to establish the most effective strategies for improving clinical outcomes. This retrospective analysis utilized data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File from 2016 to 2021. The study aimed to compare clinical characteristics and 30-day outcomes among patients undergoing combined acetabular and femoral (A + F) revision, acetabulum-only (A) revision, and femoral side-only (F) revision surgeries. The analysis of 18,888 patients revealed crucial differences in preoperative and postoperative outcomes among various revision strategies. Specifically, there were notable variations in patient demographics, comorbidities, and emergency procedures. Postoperative data showed distinct rates of mortality, complications, and readmissions across the groups. Notably, femoral component revisions were associated with increased risks of mortality, transfusion, and urinary tract infections, underscoring the need for careful evaluation and consideration when opting for this revision approach. The study's significance lies in its extensive patient cohort and multifaceted evaluation of revision strategies. Although consensus is lacking on single-component revisions, targeting the acetabulum component appears relatively safer. Continued research and individualized evaluations are crucial for refining revision strategies and optimizing outcomes in THA revisions.

Analysis of Postoperative Complication and Revision Rates and Mid- to Long-Term Implant Survival in Primary Short-Stem Total Hip Arthroplasty.

Background/Objectives: Short-stem prostheses were introduced as an alternative to conventional straight-stem prostheses. Despite their benefits, including minimally invasive approaches, soft-tissue- and bone-sparing implantation, and physiological load transfer to the metaphysis, data on postoperative complication and revision rates as well as on implant survival are scarce. Methods: A retrospective analysis of 1327 patients who underwent primary total hip arthroplasty (THA) using the Metha® short stem between 2006 and 2023 was conducted. Complication and revision rates were analysed for the intraoperative, direct postoperative, and follow-up episodes. Implant survival was analysed with the endpoint of all-cause stem revision. Results: Intraoperative complications were observed in 3.77% of the cases and included 44 hairline cracks and 6 fractures. In 15 cases (30.0%), conversion to a straight-stem or revision implant was necessary. The direct postoperative complication rate was 2.44%, and 11 revision procedures were performed during inpatient stay (0.84%). Mean follow-up was 7 years (range 1-17). During follow-up, femoral component revision was performed in 60 cases. Aseptic loosening and stem subsidence accounted for a combined percentage of 80% of all indications. Implant survival rate was 95.66% after 5 years, 95.58% after 10 years, and 95.50% after 15 years. Conclusions: Our study provides a comprehensive analysis of postoperative complication and revision rates in a large sample undergoing primary short-stem THA. Postoperative complication rates were favourable, and the long-term implant survival rates were comparable to conventional straight-stem prostheses. Therefore, short-stem THA may be considered an alternative for younger patients.

Revision total hip arthroplasty using a modular fluted, tapered revision femoral component and interlocking screws in Vancouver B3 periprosthetic fractures with insufficient bone at the isthmus.

Revision total hip arthroplasty in patients with Vancouver type B3 fractures with Paprosky type IIIA, IIIB, and IV femoral defects are difficult to treat. One option for Paprovsky type IIIB and IV defects involves modular cementless, tapered, revision femoral components in conjunction with distal interlocking screws. The aim of this study was to analyze the rate of reoperations and complications and union of the fracture, subsidence of the stem, mortality, and the clinical outcomes in these patients. A total of 46 femoral components in patients with Vancouver B3 fractures (23 with Paprosky type IIIA, 19 with type IIIB, and four with type IV defects) in 46 patients were revised with a transfemoral approach using a modular, tapered, cementless revision Revitan curved femoral component with distal cone-in-cone fixation and prospectively followed for a mean of 48.8 months (SD 23.9; 24 to 112). The mean age of the patients was 80.4 years (66 to 100). Additional distal interlocking was also used in 23 fractures in which distal cone-in-cone fixation in the isthmus was < 3 cm. One patient (2.2%) died during the first postoperative year. After six months, 43 patients (93.5%) had osseous, and three had fibrous consolidation of the fracture and the bony flap, 42 (91.3%) had bony ingrowth and four had stable fibrous fixation of the stem. No patient had radiolucency around the interlocking screws and no screw broke. One patient had non-progressive subsidence and two had a dislocation. The mean Harris Hip Score increased from of 57.8 points (SD 7.9) three months postoperatively to 76.1 points (SD 10.7) 24 months postoperatively. The 2° tapered, fluted revision femoral component with distal cone-in-cone-fixation, combined with additional distal interlocking in patients with bony deficiency at the isthmus, led to reproducibly good results in patients with a Vancouver B3 fracture and Paprosky type IIIA, IIIB, and IV defects with regard to union of the fracture, subsidence or loosening of the stem, and clinical outcomes.

Durability of Primary Total Hip Arthroplasty With Cementless Stems Without a Collar in Elderly Patients Age 75 Years and Over

BackgroundCementless femoral fixation in total hip arthroplasty (THA) has increased in prevalence worldwide. However, cementless fixation in elderly patients is controversial due to the risks of periprosthetic fracture and aseptic loosening. This study evaluated outcomes in patients undergoing primary THA utilizing a cementless stem without a collar, comparing those less than 75 years to those older than 75 years. MethodsBetween 2011 and 2021, there were 2,605 cementless THAs performed by 4 surgeons utilizing a highly porous metal fixation surface without a collar and consistent clinical protocols. There were 469 patients who had an age ≥ 75 years. Revision rates, intraoperative fractures, and 90-day mortality were compared between cohorts. In the ≥ 75 year age group, there were more women, more American Society of Anesthesiologists physical status classification III or IV, a lower body mass index, and more kidney disease, osteoporosis, and thyroid disease (P ≤ .002). ResultsAll-cause revision rates trended lower for the ≥75 year age group compared to < 75 year (1.9 versus 3.5%, P = .082) at 20-months of follow-up. Moreover, there was no difference in all-cause femoral component revisions comparing ≥ 75 to < 75 year age groups (1.5 versus 2.2%, P = .375), with only 3 of 10 femoral revisions due to aseptic loosening being in the ≥ 75 year age group. Intraoperative fracture (0.2 versus 0.5%, P = .701) and 90-day mortality (0.2 versus 0.1%, P = .460) did not differ between ≥ 75 and < 75 year age groups. ConclusionsOlder patients had comparable revision rates compared to younger patients using cementless femoral fixation without a collar. Furthermore, there was no difference in 90-day mortality or intraoperative fracture rates. Study findings provide evidence for the safety and durability of cementless THA using collarless femoral stems in elderly patients ≥ 75 years of age. Level of EvidenceIII.

Periprosthetic Osteolysis (PPOL) Following Total Knee Arthroplasty (TKA) Treated with Hybrid Semiconstrained Prosthetic Revision: A Case Report

Periprosthetic Osteolysis (PPOL) is a significant complication following total knee arthroplasty (TKR), often leading to the need for surgical revisions. The precise etiology of aseptic loosening and PPOL remains unclear, but it is a growing problem due to an aging population and increased demand for TKR implants. A 70-year-old female presented with left knee pain following a fall. She had previously undergone left and right TKR due to osteoarthritis. X-rays revealed a dislodged femoral prosthesis component and bone lysis, indicating PPOL. The patient had poor bone quality and was at risk for further complications. Due to insurance limitations, a hybrid revision technique was chosen, preserving the tibial component and enhancing the femoral aspect with a new augmented implant. Periprosthetic osteolysis is complex, and treatment options can be limited by financial constraints, such as insurance coverage. In this case, the decision to perform an isolated femoral component revision was made to reduce costs, with close follow-up and rehabilitation planned to prevent complications. Hybrid revision requires careful monitoring. PPOL restoration necessitates immediate action and rehabilitation to promote optimal joint function. This case highlights the importance of balancing medical judgment and financial constraints, and the potential for hybrid revision in specific cases. It also emphasizes the need for a harmonious relationship between healthcare professionals and healthcare management for patient safety and satisfaction. Keywords: Complication; Hybrid revision; Periprosthetic osteolysis; Total knee arthroplasty.

A Three-dimensional Comparison of Pre- and Post-component Position in a Series of Off-label Robotic-assisted Revision Total Knee Arthroplasties

BackgroundThe application of robotic-assisted arthroplasty in revision knee scenarios continues to evolve. This study compares the pre- and post-revision implant positions in series of revision total knee arthroplasties (TKA) using a robotic arm system. MethodsTwenty-five consecutive off-label robotic-assisted revision TKA were performed. After virtual revision femoral and tibial components were positioned to achieve “balanced” medial and lateral flexion and extension gaps, the existing primary implants (PI) were removed, and bone cuts were executed with the robotic arm system. Preoperative coronal, sagittal, and axial position of the PI was compared to the final planned positions of the robotic revision implants (RRI) for each subject. A repeated measures ANOVA using the absolute difference in millimeters and degrees between the PI and RRI orientation was completed. ResultsIntra-operatively, the virtual gaps were balanced within the planning software followed by successful execution of the plan. There was a statistically significant difference between posterior condylar offset and tibial component positioning for RRI compared to PI. There was no difference between the distal femoral component values between PI and RRI. ConclusionsThe sagittal alignment of the revision implants, specifically the femoral posterior condylar offset and tibial component slope, are statistically significant considerations for a stable revision TKA with off-label use of a robotic-arm system. Other potential benefits may include appropriate implant sizing which can affect the resultant ligamentous tension important for a functional revision TKA. Future research and software iterations will be needed to determine the overall accuracy and utility of robotic-assisted revision TKA.

The “Inside-Out” Anterior Osteotomy of the Proximal Femur via the Direct Anterior Approach in Revision Hip Arthroplasty

Osteotomy techniques used for wide exposure during femoral component revision include the extended trochanteric osteotomy and its modifications. We describe an anterior proximal femur osteotomy technique starting from the inside of the femoral canal at the bone-implant interface and heading outward. The technique is used in conjunction with the extended direct anterior approach and allows direct access to and visualization of the anterior, medial, and lateral bone-implant interfaces. This technique is most useful for the removal of collared, fully hydroxyapatite-coated double-tapered femoral stems, in which bone-implant interfaces need to be accessed for removal of a well-osseointegrated hip arthroplasty implant.

Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty

BackgroundInstability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure. MethodsThis was a retrospective study of patients undergoing revision TKA for instability from 2015 to 2019. Patients with prior revisions were excluded. 42 patients undergoing isolated polyethylene LE without an increase in constraint were compared with 48 patients undergoing full component revision revision (FCR) of both tibial and femoral components. The primary outcome was differences in rerevision for instability. Noninstability reoperations, 90-day readmissions, and lengths-of-stay were also compared. ResultsLEs had a 10.1% higher rerevision for instability rate that approached statistical significance (LE 14.3% versus FCR 4.2%, P = .092). Additionally, FCR had a 4.2% rate of aseptic loosening and a 4.2% rate of periprosthetic-joint-infection, whereas LE had none (P = .181). FCR also had a longer length-of-stay (FCR 3.0 ± 1.3 versus LE: 1.8 ± 0.9 days, P < .001). No differences were found in 90-day readmissions (LE 7.1% versus FCR 4.2%, P = .661). ConclusionAll component revision may have a higher success rate than isolated LE in addressing instability but is associated with higher rates of surgical complications. With appropriate patient selection and risk-benefit discussion, isolated LE may be a reasonable surgical option for TKA instability with a lower complication profile and length-of-stay.

Image-free handheld robotic-assisted technology improved the accuracy of implant positioning compared to conventional instrumentation in patients undergoing simultaneous bilateral total knee arthroplasty, without additional benefits in improvement of clinical outcomes

PurposeThe purpose of this study was to compare the clinical and radiological outcomes in patients who underwent simultaneous bilateral total knee arthroplasty (SB-TKA) using either robotic-assisted TKA (RA-TKA) or conventional TKA (C-TKA).MethodsIncluded were the patients who underwent SB-TKA between January 2018 and January 2020 and had a minimum follow-up of 2 years. Of 151 patients included, 117 patients were operated using an image-free handheld robotic sculpting system (RA-TKA group) and 34 patients operated using conventional instrumentation (C-TKA group). The key outcomes noted were multiple patient-reported outcomes (PROs), adverse events, and radiological outcomes. Two investigators independently measured the radiological outcomes on pre- and post-operative radiographs in coronal plane (medial proximal tibial angle [MPTA] and anatomic lateral distal femoral angle [aLDFA]) and sagittal plane (posterior tibial slope [PTS] and posterior condylar offset [PCO]). The chi-square test was used to examine categorical variables. Student’s t test was used to analyze the continuous variables.ResultsPatients in both groups were similar in baseline characteristics (gender, body mass index, incidence of comorbidities, and length of hospital stay) except that RA-TKA group patients younger (66.7 ± 8.9 vs 70.4 ± 10.5, P = 0.037) than C-TKA group. The operative time was longer in RA-TKA group as compared to C-TKA (189.3 ± 37.1 vs 175.0 ± 28.2, P = 0.040). The final PROs at each were similar between the two groups (P > 0.05). The values of PROs at final follow-up in RA-TKA compared to C-TKA were VAS pain (0.4 ± 0.9 vs 0.4 ± 0.5), KOOS-JR (89.3 ± 5.8 vs 87.1 ± 5.3), and physical (55.9 ± 2.8 vs 55.4 ± 3.2), mental (61.1 ± 4.4 vs 60.2 ± 4.7) component of VR-12 scores, and KSS satisfaction (37.5 ± 1.1 vs 37.1 ± 2.2) (all P > 0.50 or non-significant [n.s.]). While one patient in RA-TKA required revision of femoral component for peri-prosthetic fracture, none of the patient in conventional group were revised (0.85% vs 0%, P = n.s.). The proportion of patients with outliers in RA-TKA group was lower for aLDFA (2.6% vs 22.1%, P < 0.01) and PTS (0% vs 35%, P < 0.01).ConclusionThis comparative study in patients undergoing SB-TKA found reduction of outliers in femoral and tibial implant positioning with RA-TKA as compared to C-TKA. There were no differences in both groups for pain, function, and satisfaction at a minimum of 2 years of follow-up.Level of evidenceIII Therapeutic Study.

Patologická ložiska a zlomeniny proximálního femuru

PURPOSE OF THE STUDY The aim of the study was to determine the incidence of primary malignancies metastasizing to the area of the proximal femur, to evaluate the localization of the lesions and fractures, to compare the results of the selected surgical therapy, survival time of the patients and postoperative complications. MATERIAL AND METHODS We retrospectively evaluated the group of patients operated on from 2012 to 2021. The study included 45 patients (24 women and 21 men) with a pathological lesion or a pathological fracture in the area of the proximal femur. The average age was 67 years (38-90). There were 30 (67%) cases of pathological fracture and 15 (33%) cases of pathological lesions in the cohort. In each patient, the perioperative biopsy or resected sample was sent for histological examination. The type of primary malignancy with the localization of lesions and fractures was assessed. Furthermore, we evaluated the outcomes of the surgical method chosen and its complications. We monitored the patients' functional score using the Karnofsky performance status and survival interval. RESULTS The most common primary malignancy was multiple myeloma in 10 cases (22%), followed by seven cases (16%) of breast and lung cancer and 6 cases (13%) of clear cell renal cell carcinoma. Internal fixation was used in 15 cases (33%). Tumor resection with hip joint replacement was performed in 29 patients (64%). One patient was treated with percutaneous femoroplasty. Out of a total of 45 patients, 10 patients (22%) survived for less than three months. The survival rate of more than one year was observed in 21 patients (47%). A total of seven complications occurred in six patients (15%). Fewer complications occurred in the group of patients with a pathological fracture compared to the group with an impending fracture. DISCUSSION Pathological lesions in the bone or an already existing pathological fracture are signs of advanced cancer. Better outcomes are reported in patients who underwent prophylactic surgery, which was, however, not confirmed by our study. The incidence of individual primary malignancies, the postoperative complications and the patient survival corresponded to the statistical data reported by the other authors. CONCLUSIONS In patients with a pathological lesion of the proximal femur, operative treatment will increase the quality of life, either when choosing osteosynthesis or joint replacement, while prophylactic treatment is usually associated with a better prognosis. As a less invasive procedure with lower blood loss, osteosynthesis is indicated for palliative therapy in patients with a limited expected survival time or in patients with a prognosis of healing of the lesion. Reconstruction of the joint with an arthroplasty is indicated in patients with a better prognosis or in cases excluding safe osteosynthesis. Our study confirmed good outcomes with the use of an uncemented revision femoral component. Key words: metastasis, osteolysis, pathological fracture, proximal femur.

Mark-Up Trends in Contemporary Medicare Primary and Revision Total Joint Arthroplasty

BackgroundUnderstanding mark-up ratios (MRs), the ratio between a healthcare institution’s submitted charge and the Medicare payment received, for high-volume orthopaedic procedures is imperative to inform policy about price transparency and reducing surprise billing. This analysis examined the MRs for primary and revision total hip and knee arthroplasty (THA and TKA) services to Medicare beneficiaries between 2013 and 2019 across healthcare settings and geographic regions. MethodsA large dataset was queried for all THA and TKA procedures performed by orthopaedic surgeons between 2013 and 2019, using Healthcare Common Procedure Coding System (HCPCS) codes for the most frequently used services. Yearly MRs, service counts, average submitted charges, average allowed payments, and average Medicare payments were analyzed. Trends in MRs were assessed. We evaluated 9 THA HCPCS codes, averaging 159,297 procedures a year provided by a mean of 5,330 surgeons. We evaluated 6 TKA HCPCS codes, averaging 290,244 procedures a year provided by a mean of 7,308 surgeons. ResultsFor knee arthroplasty procedures, a decrease was noted for HCPCS code 27438 (patellar arthroplasty with prosthesis) over the study period (8.30 to 6.62; P = .016) and HCPCS code 27447 (TKA) had the highest median (interquartile range [IQR]) MR (4.73 [3.64 to 6.30]). For revision knee procedures, the highest median (IQR) MR was for HCPCS code 27488 (removal of knee prosthesis; 6.12 [3.83-8.22]). While no trends were noted for both primary and revision hip arthroplasty, median (IQR) MRs in 2019 for primary hip procedures ranged from 3.83 (hemiarthroplasty) to 5.06 (conversion of previous hip surgery to THA) and HCPCS code 27130 (total hip arthroplasty) had a median (IQR) MR of 4.66 (3.58-6.44). For revision hip procedures, MRs ranged from 3.79 (open treatment of femoral fracture or prosthetic arthroplasty) to 6.10 (revision of THA femoral component). Wisconsin had the highest median MR by state (>9) for primary knee, revision knee, and primary hip procedures. ConclusionThe MRs for primary and revision THA and TKA procedures were strikingly high, as compared to nonorthopaedic procedures. These findings represent high levels of excess charges billed, which may pose serious financial burdens to patients and must be taken into consideration in future policy discussions to avoid price inflation.

Minimum 25-Year Results of a Tapered Titanium Porous Plasma Spray Coated Femoral Component

BackgroundPrevious studies have reported excellent results with tapered, titanium, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at a minimum 25-year follow-up. MethodsWe reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component that was essentially unchanged since its 1984 introduction, except porous coating was continued circumferentially in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999. There were 332 patients (396 THA) who had a minimum 25-year follow-up (range, 25 to 37). Mean age at surgery was 48 years (range, 21 to 70 years). Mean follow-up in nonfailed patients was 29 years (range, 25 to 37 years). ResultsThere were 31 femoral revisions (7.8%): 9 infections, 3 failures of ingrowth, 5 aseptic loosening, 8 osteolysis well-fixed, 2 periprosthetic fractures, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with the endpoint of all-cause stem revision was 94.8% (95% confidence interval: ±0.9%) at 37 years, and with the endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% confidence interval: ±0.5) at 37 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently. ConclusionThis tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.

Forte ceramic-on-delta ceramic cementless total hip arthroplasty: an 8- to 15-year follow-up study.

Forte ceramic head on delta ceramic liner articulation showed satisfactory midterm results without ceramic-related complication. We aimed to investigate the clinical and radiological outcomes of cementless total hip arthroplasty (THA) with forte ceramic head on delta ceramic liner articulation. Overall, 107 patients (57 men, 50 women; 138 hips) who underwent cementless THA with forte ceramic head on delta ceramic liner articulation were enrolled. The mean follow-up duration was 11.6years. For the clinical assessments, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), presence of thigh pain, and presence of squeaking were evaluated. Radiographs were assessed to search for osteolysis, stem subsidence, loosening of implants. Kaplan-Meier survival curves were evaluated. The mean HHS and WOMAC improved from 57.1 and 28.1 preoperatively to 81.4 and 13.1 at the final follow-up, respectively. Nine revisions (6.5%) were performed; 5 hips for stem loosening, 1 hip for ceramic liner fracture, 2 hips for periprosthetic fracture, and 1 hip for progressive osteolysis around cup and stem. Thirty-two patients (37 hips) complained squeaking, in which 4 cases (2.9%) were identified as ceramic-related noises. After a mean follow-up period of 11.6years, 91% (95% CI 87.8-94.2) were free from revision of both femoral and acetabular components due to any reason. Cementless THA with forte ceramic-on-delta ceramic articulation showed acceptable clinical and radiological results. Serial surveillance of these patients should be performed due to the possibility of cerami- related complications such as squeaking, osteolysis, and ceramic liner fracture.

USE OF CEMENTED FEMORAL COMPONENT FOR REVISION IN PERIPROSTHETIC FEMORAL FRACTURES (PFF) IN THE ELDERLY

PFFs are an increasing burden presenting to the acute trauma services. The purpose of this study is to show that cemented revision for Vancouver B2/B3 PFFs is a safe option in the geriatric population, allows early pain-free weight bearing and comparable to a control-group of uncemented stems with regard to return to theatre and revision surgery.A retrospective review was conducted of all PFFs treated in a Level 1 trauma centre from 2015-2020. Follow up x-rays and clinical course through electronic chart was reviewed for 78 cemented revisions and 49 uncemented revisions for PFF. Primary endpoints were all cause revision and return to theatre for any reason. Secondary endpoints recorded mobility status and all-cause mortality.In the cemented group there were 73 Vancouver B2, 5 Vancouver B3 PFF; the mean age was 79.7 years and mean radiological follow-up of 11.9 months. In the cementless group there were 32 Vancouver B2 and 17 Vancouver B3 PFFs; with all 49 patients undergoing distally bearing uncemented revision, the mean age was 72.7 years and mean radiological follow-up of 21.3 months.Patients treated with a cemented prosthesis had significantly higher ASA score (2.94 -v- 2.43, p&lt;0.001). The primary endpoints showed that there was no significant difference in all cause revision 3/78 and 5/49 p=0.077, or return to theatre 13/78 -v- 12/49 p=0.142.Secondary endpoints revealed no significant difference in in-hospital mortality. The cementless group were more likely to be mobilising without any aid at latest follow-up 35/49 -v- 24/78 p&lt;0.001.The use of cemented revision femoral component in the setting of PFFs is one option in the algorithm for management of unstable PFFs according to the Vancouver classification. Evidence from this case-control study, shows that the all-cause revision and return to theatre for any cause was comparable in both groups.

A new method of distal blocking of intramedullary implants

Aim to assess the capabilities of the developed method and device for distal blocking of intramedullary implants.&#x0D; Material and methods. An experimental study on the tibia models was performed in the settings of the Department of Traumatology and orthopedics of the Voronezh State Medical University. The main group included 10 models on which the blocking was done using the developed method. In the control group (10 models) the "free hand" method was used. The study evaluated the following parameters: the duration of blocking, the time of X-ray exposure, the number of blocking attempts.&#x0D; Results. In the main group, the duration of distal blocking procedure was significantly shorter than in the control group (T-criterion = -36.0; p 0.05). The time of X-ray exposure in the main group was also less than in the control group (T-test = -30.2, p 0.05). The number of blocking attempts in the control group was higher than in the main group (U-criterion = 20, p = 0.02). In the main group, all screws were inserted at the first attempt. In the control group, drilling holes past the pin holes was noted.&#x0D; Conclusion. The developed method and the device for its implementation are universal. They can be used with most intramedullary pins and revision femoral components of a hip endoprosthesis, both cannulated and non-cannulated.

The Impact of the COVID-19 Pandemic on Orthopaedic Knee Procedures: A National Multicentered Analysis.

The coronavirus disease 2019 (COVID-19) pandemic strained the United States healthcare system, and associated policies resulted in the postponement or cancellation of many elective surgeries. While most orthopaedic surgeons are aware of how the pandemic affected their patients' care, broader national trends in the operative treatment of orthopaedic knee pathology are poorly characterized. Therefore, the purpose of this study was to identify trends in orthopaedic knee procedures during the COVID-19 pandemic. The TriNetX database was queried for orthopaedic knee procedures performed from March 2018 to May 2021. Procedures were classified as arthroplasty (total knee arthroplasty (TKA), revision total knee arthroplasty) or non-arthroplasty (tendon or ligament repair, fracture fixation). Procedural volume per healthcare organization was determined over five seasons from March 2020 to May 2021 and compared to overlapping pre-pandemic periods from March 2018 to May 2019. Descriptive analysis was performed, and comparisons were made using a Student's T-test. Compared to the pre-pandemic period, there were significant decreases in primary TKA (p=0.016), femoral or entire tibial component revision TKA (p=0.005), and open treatment of femoral shaft fractures (p=0.007) in spring 2020. Procedural volume returned to baseline in summer 2020 through winter 2021. In spring 2021, primary TKA (p=0.017) and one component revision TKA (p=0.003) increased compared to the pre-pandemic period. The greatest decrease in knee procedures occurred early in the pandemic. Rates of these procedures have since rebounded, with some exceeding pre-pandemic levels. Hospitals are now better able to accommodate orthopaedic surgical volume while continuing to care for patients with COVID-19.

The Impact of Exchanging Cerclage Fixation after Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty for Periprosthetic Joint Infection

BackgroundAn extended trochanteric osteotomy (ETO) is a powerful tool for femoral component revision. There is limited evidence that directly supports its use in the setting of a periprosthetic joint infection (PJI). Cerclage fixation raises the theoretical concern for persistent infection. MethodsOur institutional database included 76 ETOs for revision hip arthroplasty between January 1, 2008 and December 31, 2019. The cohort was divided based on indication for femoral component revision: PJI versus aseptic revision. The PJI group was subdivided based on second-stage exchange versus retention of initial cerclage fixation. Operative time, estimated blood loss, complications, and rate of repeat revision surgery were evaluated. ResultsForty-nine patients (64%) underwent revision for PJI and 27 patients (36%) underwent aseptic revision. There was no significant difference in operative times (P = .082), postoperative complications (P = .258), or rate of repeat revision surgery (P = .322) between groups. Of the 49 patients in the PJI group, 40 (82%) retained cerclage fixation while 9 (18%) had cerclage exchange. Cerclage exchange did not significantly impact operative time (P = .758), blood loss (P = .498), rate of repeat revision surgery (P = .302), or postoperative complications (P = .253) including infection (P = .639). ConclusionAn ETO remains a powerful tool for femoral component removal, even in the presence of a PJI. A multi-institutional investigation would be required to validate observed trends toward better infection control with cerclage exchange. Cerclage exchange did not appear to increase operative time, blood loss, or postoperative complication rates.

Revision Distal Femoral Replacement for Patello-Femoral Maltracking: A Surgical Technique.

The use of the distal femoral replacement (DFR) has grown in recent years. Historically, this procedure was reserved for malignancy and complex revision cases with relative success. In recent years, complex reconstruction cases have had relative success. DFR has been associated with a range of complications including anterior knee pain, patellar instability, limitations in knee motion, and rotational instability that are sequelae of altered patello-femoral mechanics. Thus, subsequent dysfunction may require revision. To our knowledge, no surgical technique to correct DFR patello-femoral maltracking has been demonstrated in current literature. We present a surgical technique for DFR patello-femoral maltracking corrected surgically with femoral component revision and femoral stem retention.

A Retrospective Review of Relative Value Units in Revision Total Knee Arthroplasty: A Dichotomy Between Surgical Complexity and Reimbursement.

Revision total knee arthroplasties (TKA) are costly, time-intensive, and technically demanding procedures. There are concerns regarding the valuation of Current Procedural Terminology (CPT) codes and the assigned relative value units (RVU) as a potential disincentive to perform revision TKAs. This study evaluated the labor and time investment for each component-specific revision and assessed the disparities between procedural value billed and reimbursement. A retrospective review of 154 primary and revision TKA cases were thoroughly vetted using operative notes and internal billing data. Revision TKAs were stratified by single femoral component, single tibial component, polyethylene liner only, all-component, and spacer placement for prosthetic infection. Operative time, RVUs billed, total charges, deductions, and reimbursements were recorded. Mann-Whitney U tests compared final reimbursement per minute and per RVU between revision and primary TKAs. There were 28 primary TKAs, 11 femoral component revisions, 25 tibial component revisions, 25 liner exchanges, 37 all-component revisions, and 28 spacer placements. Revisions involving the tibial component, all-components, and placement of spacers were reimbursed less dollars per minute than primary TKAs (P < .05). Controlling for RVUs, liner exchanges and all-component revisions had fewer dollars per RVU than primary TKAs (P < .05). As revision complexity increases, physicians face less reimbursement per minute and per RVU. With reductions set by CMS and private insurers, revisions may be financially unfavorable and lead to restrictions and access to care problems. Our data supports the need for reevaluating RVU allocation amongst revision procedures with potential updates to the CPT coding system.

Risk factors for implant failure of custom-made acetabular implants in patients with Paprosky III acetabular bone loss and combined pelvic discontinuity.

Severe acetabular bone loss in revision total hip arthroplasty (RTHA), both with or without pelvic discontinuity, remains a great challenge in orthopaedic surgery. The aim of this study was to evaluate risk factors for failure of custom-made acetabular implants in RTHA. Seventy patients with severe acetabular bone loss (Paprosky Type III) and pelvic discontinuity, who required RTHA, were included in our study. All prostheses were constructed based on a thin-layer computed-tomography (CT) scan of the pelvis. The treatment was considered unsuccessful in the event of periprosthetic joint infection (PJI) or aseptic loosening (AL) with need for explantation of the custom-made acetabular implant. The average follow-up was 41.9 ± 34.8 months (range 1.5-120). Implant survival at last follow-up was 75.7% (53 of 70). Explantation was necessary in 17 cases (15 PJI; 2 AL). Previous PJI as reason for RTHA (p= 0.025; OR 3.56 (95% CI: 1.14; 11.21)), additional revision of femoral components (p= 0.003; OR 8.4 (95% CI: 1.75; 40.42)), rheumatoid disease (p= 0.039; OR 3.43 (95% CI: 1.01; 11.40)), elevated preoperative CRP > 15.2 mg/l (p= 0.015; AUC: 0.7) and preoperative haemoglobin < 10.05 (p= 0.022; AUC: 0.69) were statistically significant risk factors associated with treatment failure. Age and BMI were not statistically significant contributing to implant failure. Risk factors for treatment failure were a previous PJI, additional revision of femoral component, rheumatoid disease, elevated preoperative CRP and low preoperative haemoglobin. Awareness of these risk factors will help to improve future treatment standards.