Ivan De Martino

Dual mobility cups in total hip arthroplasty.

Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature.

Corrosion and Fretting of a Modular Hip System: A Retrieval Analysis of 60 Rejuvenate Stems

Femoral stems with dual-taper modularity were introduced to allow independent control of length, offset, and version. Corrosion and fretting related to micromotion at the neck-stem junction are thought to stimulate an adverse local tissue reaction (ALTR). Analysis of 60 consecutively retrieved modular-neck stem implants (Rejuvenate, Stryker) revised primarily for ALTR was done to determine the variables influencing corrosion and fretting patterns at the neck-stem interface. Taper damage evaluation was performed with stereomicrocopic analysis with two observers. Evidence of fretting and corrosion was seen at the neck-stem taper in all implants, including three implants revised for periprosthetic fractures within four weeks of the index surgery indicating that this process starts early. Femoral stems paired with the long overall neck lengths had significantly higher corrosion scores. Correlation of the corrosion severity at particular locations with the length of implantation suggests that the neck-stem junction experiences cyclic cantilever bending in vivo. The positive correlation between the length of implantation and fretting/corrosion scores bodes poorly for patients who still have this implant. Scanning electron microscopy on a subset of specimens was also performed to evaluate the black corrosion material. We strongly urge frequent follow-up exams for every patient with this particular modular hip stem.

Social media for patients: benefits and drawbacks

Purpose of reviewSocial media is increasingly utilized by patients to educate themselves on a disease process and to find hospital, physicians, and physician networks most capable of treating their condition. However, little is known about quality of the content of the multiple online platforms patients have to communicate with other potential patients and their potential benefits and drawbacks.Recent findingsPatients are not passive consumers of health information anymore but are playing an active role in the delivery of health services through an online environment. The control and the regulation of the sources of information are very difficult. The overall quality of the information was poor. Bad or misleading information can be detrimental for patients as well as influence their confidence on physicians and their mutual relationship.SummaryOrthopedic surgeons and hospital networks must be aware of these online patient portals as they provide important feedback on the patient opinion and experience that can have a major impact on future patient volume, patient opinion, and perceived quality of care.

Total Knee Arthroplasty Using Cementless Porous Tantalum Monoblock Tibial Component: A Minimum 10-Year Follow-Up

BACKGROUND Cementless fixation in total knee arthroplasty (TKA) was introduced to improve the longevity of implants but has yet to be widely adopted because of reports of higher failure rates in some series. The cementless tantalum monoblock tibial component, in contrast, has shown successful short-term results, but long-term survivorship with this design is still lacking. The purpose of this study was to investigate the minimum 10-year clinical and radiographic results of the cementless tantalum monoblock tibial component in primary TKA. METHODS From March 2002 to March 2005, 33 patients (33 knees) underwent primary TKA with a cementless tantalum monoblock tibial component. All patients were followed clinically and radiographically for a minimum of 10 years (mean 11.5 years, range 10-13 years). No patients were lost to follow-up. The underlying diagnosis that led to the primary TKA was primary osteoarthritis in 31 knees and post-traumatic osteoarthritis in 2 knees. RESULTS None of the components was revised. At a minimum 10-year follow-up, the survivorship with reoperation for any reason as end point was 96.9%. With tibial component revision for aseptic loosening or osteolysis as the end point survivorship was 100%. There was no radiographic evidence of tibial component loosening, subsidence, osteolysis, or migration at the time of the latest follow-up. The mean Knee Society knee scores improved from 56 points preoperatively to 93 points at the last clinical visit. CONCLUSION The porous tantalum tibial monoblock component demonstrated excellent clinical and radiographic outcomes with no component revisions for aseptic loosening at a minimum follow-up of 10 years.

Early intraprosthetic dislocation in dual-mobility implants: a systematic review

Background Dual mobility implants are subject to a specific implant-related complication, intraprosthetic dislocation (IPD), in which the polyethylene liner dissociates from the femoral head. For older generation designs, IPD was attributable to late polyethylene wear and subsequent failure of the head capture mechanism. However, early IPDs have been reportedly affecting contemporary designs. Methods A systematic review of the literature according to the preferred reporting items for systematic reviews and meta-analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, Embase, and Google Scholar was conducted for English articles between January 1974 and August 2016 using various combinations of the keywords “intraprosthetic dislocation,” “dual mobility,” “dual-mobility,” “tripolar,” “double mobility,” “double-mobility,” “hip,” “cup,” “socket,” and “dislocation.” Results In all, 16 articles met our inclusion criteria. Fourteen were case reports and 2 were retrospective case series. These included a total of 19 total hip arthroplasties, which were divided into 2 groups: studies dealing with early IPD after attempted closed reduction and those dealing with early IPD with no history of previous attempted closed reduction. Early IPD was reported in 15 patients after a mean follow-up of 3.2 months (2.9 SD) in the first group and in 4 patients after a mean follow-up of 15.1 months (9.9 SD) in the second group. Conclusions Based on the current data, most cases have been preceded by an attempted closed reduction in the setting of outer, large articulation dislocation, perhaps indicating an iatrogenic etiology for early IPD. Recognition of this possible failure mode is essential to its prevention and treatment.

Social media and your practice: navigating the surgeon-patient relationship

Utilization of social media both in the private and professional arenas has grown rapidly in the last decade. The rise of social media use within health care can be viewed as the Internet-based corollary of the patient-centered care movement, in which patient perspectives and values are central to the delivery of quality care. For orthopedic surgeons and their practices, general-purpose online social networks, such as Facebook and Twitter, are convenient platforms for marketing, providing patient education and generating referrals. Virtual health communities are used less frequently by orthopedic surgeons but provide forums for patient engagement and active surgeon-to-patient communication via blogs and ask-the-doctor platforms. This commentary reviews the current state of social media use in orthopedic practice, with particular emphasis on managing the extension of the surgeon-patient relationship online, including the unique practice risks social media poses, such as privacy concerns, potential liability, and time consumption.

Social media: physicians-to-physicians education and communication

Purpose of reviewPhysician to physician communication is essential for the transfer of ideas, surgical experience, and education. Social networks and online video educational contents have grown exponentially in recent years changing the interaction among physicians.Recent findingsSocial media platforms can improve physician-to-physician communication mostly through video education and social networking. There are several online video platforms for orthopedic surgery with educational content on diagnosis, treatment, outcomes, and surgical technique. Social networking instead is mostly centered on sharing of data, discussion of confidential topics, and job seeking. Quality of educational contents and data confidentiality represent the major drawbacks of these platforms.SummaryOrthopedic surgeons must be aware that the quality of the videos should be better controlled and regulated to avoid inaccurate information that may have a significant impact especially on trainees that are more prone to use this type of resources. Sharing of data and discussion of confidential topics should be extremely secure according the HIPAA regulations in order to protect patients’ confidentiality.

The future of social media in orthopedic surgery

In 2015, 84% of adults used the Internet on a regular basis and 80% of these user references online sources for health-related information [1, 2]. There has been a corresponding growth in online social networking and social media outlets, in the form of websites, online social networks, and mobile applications [3]. These social media platforms have expanded to become vital networks for patients and physicians to communicate with each other, among each other, and learn from each other’s experiences. With an estimated 6.5 million health-related search engine queries per day [4], we believe that the contemporary practicing physician must be aware of these social media outlets and ideally have a deeper understanding and utilization that will allow for the improvement of patient care, patient and physician education, and increases in practice outreach, scope, and volume. As previously discussed, social media grew with the development of Web 2.0 which allowed for a more dynamic interaction between the user and the web. Web 2.0 allowed for the Internet user to create content in the form of personal blogs, to post messages in online discussion boards, and to create online profiles, and eventually online social networks. Going forward, practicing orthopedic surgeons, physician groups, and hospital networks have a decision, either control social media outlets or be controlled by them. Current social media platforms such as Facebook, Twitter, YouTube, and Instagram offer far-reaching online social networks that will grow in usage over the next few years. These social media outlets will continue to be a platform for physicians to improve practice visibility with each application potentially serving its own function. Facebook will provide an online social network for the practice. YouTube will provide preoperative, perioperative, and postoperative video instructions. Instagram will serve as a way to share patient photos and progress and provide helpful information during the recovery process. The benefit of increasing physician-specific online content is that patient education and the surgeon-patient engagement can potentially occur remotely. Social media will evolve into a form of telemedicine where patients will be guided through the preoperative, perioperative, and postoperative period with a digital assistant or orthopedic avatar. Patients will be able to post their results on a physician-controlled or hospitalcontrolled health care network. Radiographic and clinical performance can then be tracked remotely and patients will have the choice to follow up in the physician office or remotely from home. It is likely than in the next 5 years, telemedicine and remote follow-up will be a common practice for standard follow-up of the orthopedic patient. In addition, the additional online content in the form of patient education forms, online videos, physical therapy exercises, and motivation milestones will allow the patient to have more digital contact with the physician office without an increase in overall face-to-face time. Increased patient engagement without an increase in physician involvement allows for potentially more costeffective care delivery. In the era of bundles payments, any technology that continues to provide a high level of patient This article is part of the Topical Collection on Social Media and Orthopedics

Optimizing Intraoperative Blood Management for One-Stage Bilateral Total Knee Arthroplasty

BackgroundEffective blood management strategies are a major determinant of successful outcomes after one-stage bilateral total knee arthroplasty (BTKA). Proper patient selection with preoperative optimization and intra- and postoperative interventions can reduce transfusion risk and associated morbidity in these patients.Questions/PurposesThe purpose of this study was to evaluate intraoperative blood management modalities based on three keystone questions: (1) What is the role of the anesthesiologist?, (2) Which are the surgeon-dependent strategies?, and (3) Is there any place for pharmacologic interventions?MethodsWe searched the established electronic literature database MEDLINE. After critical appraisal, 94 studies were deemed eligible from which to draw documented evidence.ResultsA number of blood-conserving methods are currently implemented in patients undergoing one-stage BTKA. Among them, regional anesthesia, tourniquet use, and tourniquet deflation after wound closure, femoral canal sparing or femoral canal plugging, avoidance of drains, and tranexamic acid use were the intraoperative strategies with documented efficacy in blood conservation.ConclusionCombined proper intraoperative anesthesiologic, surgical, and pharmacologic interventions reduce blood loss and need for transfusion in BTKA patients. However, contemporary relevant literature is lacking evidence-based guidelines.

The Swimmer’s Shoulder: Multi-directional Instability

Purpose of ReviewSwimmer’s shoulder is the term used to describe the problem of shoulder pain in swimmers. Originally described as supraspinatus tendon impingement under the coracoacromial arch, it is now understood that several different pathologies can cause shoulder pain in competitive swimmers, including subacromial impingement syndrome, overuse and subsequent muscle fatigue, scapular dyskinesis, and laxity and instability.Recent FindingsSwimmers may develop increased shoulder laxity over time due to repetitive use. Such excessive laxity can decrease passive shoulder stability and lead to rotator cuff muscle overload, fatigue, and subsequent injury in order to properly control the translation of the humeral head. Generalized laxity can be present up to 62% of swimmers, while a moderate degree of multi-directional instability can be present in the majority. Laxity in swimmers can be due to a combination of underlying inherent anatomical factors as well as from repetitive overhead activity.SummaryThe role of excessive laxity and muscle imbalance are crucial in the swimmer’s shoulder and should be well understood since they are the primary target of the training and rehabilitation program.