Jeffrey A. Geller

Predicting need for allogeneic transfusion after total knee arthroplasty.

Total knee arthroplasty (TKA) can lead to substantial blood loss. To avoid the high costs of autologous blood predonation programs and efficiently allocate limited blood resources, we sought to identify preoperative and intraoperative factors associated with allogeneic blood transfusion (AllTx) after primary TKA and, subsequently, develop a model to predict patients who will require AllTx. We analyzed 31 independent variables in 644 primary unilateral TKAs without autologous blood predonation for requirement of AllTx. Seventy-one procedures (11.0%) required AllTx. Age, comorbid anemia, preoperative hemoglobin concentration, and surgical time were significant predictors for requiring AllTx. When applied to an independent cohort, our model for predicting the need for AllTx after TKA was 90% sensitive and 52.5% specific.

Effect of Femoral Offset on Pain and Function After Total Hip Arthroplasty

The effects of altering patients femoral offset (FO) during total hip arthroplasty on postoperative pain and function have not been well described. This study compared clinical outcomes as assessed by the Short Form 12 Health Survey and Western Ontario and McMaster University Osteoarthritis Index between patients who had their FOs restored to varying degrees (compared to the contralateral normal hip [CL]). We retrospectively measured postoperative FOs on standard anteroposterior pelvis radiographs and compared to the CL. Patients were categorized into one of 3 groups: decreased offset (< -5 mm compared to CL), normal offset (between -5 and +5 mm), and increased offset (> +5 mm). The decreased offset group exhibited Western Ontario and McMaster University Osteoarthritis Index Physical Function scores that were less than those of the normal offset and increased offset groups (72.03, 82.23, and 79.51, respectively [P = .019]). In conclusion, reducing a patients native FO led to inferior functional outcome scores.

Unicompartmental Knee Arthroplasty Relieves Pain and Improves Function More Than Total Knee Arthroplasty

This study compared outcomes as assessed by 12-item Short-Form Health Survey (SF-12) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) between patients who underwent unicompartmental (UKA) and patients who underwent total knee (TKA) arthroplasty. We prospectively collected preoperative demographic and SF-12 and WOMAC data on 128 TKAs and 70 UKAs. Postoperatively, SF-12 and WOMAC outcomes were recorded during annual follow-up visits. At baseline, patients who underwent UKA had a higher Charlson Comorbidity Index than patients who underwent TKA; otherwise, preoperative characteristics were similar. At a mean follow-up of 3.0 years for UKA and 2.9 years for TKA, patients who underwent UKA reported higher SF-12 physical component and mental component scores and WOMAC pain/stiffness/physical function scores (confirmed with multivariate analysis). Furthermore, patients who underwent UKA had significantly larger improvements in both SF-12 outcomes and WOMAC pain and physical function scores from baseline than did patients who underwent TKA.

The effect of fixation technique on the stiffness of comminuted Vancouver B1 periprosthetic femur fractures.

The purpose of this study was to evaluate the stiffness of 3 different constructs for the fixation of comminuted Vancouver B1 periprosthetic femoral shaft fractures: a single lateral locking plate, a single lateral locking plate plus an anterior strut allograft, and a lateral locking plate plus an anterior locking plate. The axial stiffness, lateral bending stiffness, and torsional stiffness of 10 synthetic periprosthetic femur fracture models were tested. Differences in stiffness between constructs were determined with a 1-way repeated-measures analysis of variance. Fixation technique was found to have a significant effect for all loading modalities (P < .0001). A lateral locked plate plus an anterior locked plate was significantly stiffer than the allograft that in turn was significantly stiffer than the single plate (P < .0001).

Does ipsilateral knee pain improve after hip arthroplasty

BackgroundIntraarticular hip disease is commonly acknowledged as a cause of ipsilateral knee pain. However, this is based primarily on observational rather than high-quality evidence-based studies, and it is unclear whether ipsilateral knee pain improves when hip disease has been treated.Questions/purposesWe asked whether (1) hip disease was associated with preoperative ipsilateral knee pain and (2) ipsilateral knee pain would improve after hip arthroplasty.Patients and MethodsWe retrospectively assessed knee pain in 255 patients who underwent hip arthroplasties between 2006 and 2008. The WOMAC pain score of each joint was the primary outcome measure, which was obtained prospectively before surgery and at 3 months and 1 year postoperatively. Of the 255 patients, 245 (96%) had followup data obtained at 3 months or 1 year.ResultsPreoperatively, ipsilateral knee pain was observed more frequently than contralateral knee pain (55% versus 18%). Preoperative ipsilateral knee pain scores were worse than contralateral knee pain scores (mean, 80 versus 95). Ipsilateral knee pain improved at 3 months and 1 year. When compared with the scores for contralateral knee pain at 3 months (95) and 1 year (96), there were no differences between knees.ConclusionsOur observations suggest hip disease is associated with ipsilateral knee pain and that it improves after hip arthroplasty. This should be considered during preoperative evaluation for patients with hip and knee pain.Level of Evidence Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

The Accuracy and Reliability of Preoperative Templating for Metal-on-Metal Hip Resurfacing

The purposes of this study were to evaluate the accuracy and reliability of preoperative templating on conventional radiographs (CRs) for metal-on-metal hip resurfacing and to determine the factors affecting the accuracy. Four observers templated 80 CRs on 2 separate occasions in a blinded fashion. Eight independent variables were evaluated to investigate their effect on the accuracy of templating. The overall accuracy of templating within one size of the actual component was 80.6% for the femoral component and 98.5% for the acetabular component. Overall, the intraobserver and interobserver reliability was fair to substantial (κ = 0.22-0.61). Using multiple regression analysis, surgical time was the only factor that affected the accuracy of predicting the size of the acetabular component (P = .019). We conclude that CR templating for metal-on-metal hip resurfacing is a useful method for preoperative planning of the sizes of the respective implants and that surgeon experience does play a significant role in the accuracy of predicting component size during templating.

Does a high-flexion design affect early outcome of medial unicondylar knee arthroplasty? Clinical comparison at 2 years.

Recently, implant companies have sought to target a more active segment of the population with high-flex implants. Our aim was to compare a successful medial UKA implant with its newer high-flex version. Sixty-one patients (nonflex, 33; high-flex [HF], 28) were prospectively followed after medial UKA with a minimum of 2-year follow-up. Patients were evaluated using Short Form 12, Western Ontario and McMaster Osteoarthritis (WOMAC), Knee Society Scores, and range of motion (ROM). The HF group exhibited significantly higher WOMAC Physical Function scores at 3-month follow-up and higher WOMAC Pain and SF-12 Mental Component scores at 2-year follow-up; all other comparisons were not statistically different, including ROM. The HF cohort had significantly higher improvements in Knee Society Function and Knee score at 1- and 2-year follow-up, respectively; all other comparisons yielded no significant differences in mean improvement from baseline, including ROM or survivorship.

Predicting Femoral Head Diameter and Lesser Trochanter to Center of Femoral Head Distance: A Novel Method of Templating Hip Hemiarthroplasty

Lesser-trochanter-to-center-of-femoral-head-distance (LTCHD) is commonly used in hip reconstruction. Demographic and radiographic variables were analyzed to predict the LTCHD and femoral head size (FHS). Two hundred twenty six patients after hip arthroplasty and 136 patients after hip hemiarthroplasty (HA) were retrospectively reviewed. Five variables significantly affected the LTCHD and four affected the FHS. For LTCHD, it was relative neck length (RNL), gender, height, race, age and weight. For FHS it was gender, height, age and race. The average predicted LTCHD was within 2.86 mm, and the FHS was 1.63 ± 1.10mm of the intra-operative measurements. By using our regression formulas the LTCHD and FHS can be calculated preoperatively to help improve precision in leg length and offset reconstruction.

Simultaneous ipsilateral knee arthroscopy and unicondylar knee arthroplasty is effective for bicompartmental symptoms

BACKGROUNDnPatients with unicompartmental radiographic arthritis but bicompartmental symptoms pose a clinical challenge. Some surgeons may perceive it as a contraindication for unicondylar knee arthroplasty (UKA). We investigated patient outcomes 2 years after simultaneous ipsilateral arthroscopy and UKA as compared to a similar group of patients who had total knee replacement (TKA) for a similar clinical presentation.nnnMETHODSnWe identified 9 patients with simultaneous ipsilateral arthroscopy and UKA between 2004 and 2013, and 12 clinically similar patients treated with TKA.nnnRESULTSnAt 1- and 2-years, SF-12 physical scores were significantly improved in the UKA-scope group than in the TKA group (47.2 vs 40.3, pxa0=xa00.042; 48.3 vs 32.6, pxa0=xa00.026). WOMAC pain score, WOMAC stiffness score, WOMAC function and KSFS were significantly improved in the UKA-scope group at 2 years as compared to the TKA group (98.7 vs 63.8, pxa0=xa00.030), (90.1 vs 43.8, pxa0=xa00.013), (92.3 vs 55.2, pxa0=xa00.027 and (92.3 vs 55.2, pxa0=xa00.027), respectively). Change in score from baseline for KSFS, SF-12 physical and WOMAC stiffness were significantly improved in the UKA-scope group at 2 years compared to TKA, (28.3 vs -5, pxa0=xa00.041), (13.6 vs 3.0, pxa0=xa00.026), (52.6 vs -6.3, pxa0=xa00.025), respectively.nnnCONCLUSIONnThis study shows that patients with isolated compartment radiographic disease but with bicompartmental symptoms can benefit from UKA and simultaneous arthroscopy. Further, TKA for isolated compartment radiographic disease in this limited series had poorer outcomes. We obtain MRI selectively when physical exam and radiographic findings suggest isolated arthritic disease in patients with bicompartmental symptoms.