Jeremy M. Gililland

Perioperative Closure-related Complication Rates and Cost Analysis of Barbed Suture for Closure in TKA

BackgroundThe use of barbed suture for surgical closure has been associated with lower operative times, equivalent wound complication rate, and comparable cosmesis scores in the plastic surgery literature. Similar studies would help determine whether this technology is associated with low complication rates and reduced operating times for orthopaedic closures.Questions/purposesWe compared a running barbed suture with an interrupted standard suture technique for layered closure in primary TKA to determine if the barbed suture would be associated with (1) shorter estimated closure times; (2) lower cost; and (3) similar closure-related perioperative complication rates.MethodsWe retrospectively compared two-layered closure techniques in primary TKA with either barbed or knotted sutures. The barbed group consisted of 104 primary TKAs closed with running barbed suture. The standard group consisted of 87 primary TKAs closed with interrupted suture. Cost analysis was based on cost of suture and operating room time. Clinical records were assessed for closure-related complications within the 6-week perioperative period.ResultsAverage estimated closure time was 2.3 minutes shorter with the use of barbed suture. The total closure cost was similar between the groups. The closure-related perioperative complication rates were similar between the groups.ConclusionsBarbed suture is associated with a slightly shorter estimated closure time, although this small difference is of questionable clinical importance. With similar overall cost and no difference in perioperative complications in primary TKA, this closure methodology has led to more widespread use at our institution.Level of EvidenceLevel III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence‐based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA).

Center Edge Angle Measurement for Hip Preservation Surgery: Technique and Caveats

Anterior and lateral center edge angles have traditionally been used to determine acetabular coverage, and thereby strongly influence the decision to perform acetabular reorientation versus osteochondroplasty in patients with dysplasia and/or femoroacetabular impingement. We propose templating the center of the contained articular femoral head in aspherical hips to provide reliable assessment of acetabular coverage. Digital radiographs of 30 patients with various combinations of femoral and acetabular morphologies were evaluated using 2 methods to identify the anterior center edge angle and lateral center edge angle. The control method used an estimated femoral head center for angle apex. The study technique determined the center of the femoral head by templating the congruent aspect of the femoral head contained by the acetabulum while ignoring the increasing lateral and anterior radius associated with cam deformities. Four readers measured lateral center edge angles on anteroposterior radiographs and anterior center edge angles on false-profile radiographs. Two reads were performed by each reader using both the estimated and the templated methods for a total of 4 reads. Interobserver reliability using the proposed method compared to the standard was much improved for anterior center edge angles (intraclass correlation coefficient of 0.76 vs 0.55) as well as with lateral center edge angles (ICC of 0.80 vs 0.42). Decreased correlation was most commonly associated with abnormal sourcil morphology, posterior wall deficiency combined with calcified labra, and os acetabuli. Including the anterolateral cam deformity in identifying the center of the femoral head for measuring center edge angles leads to an underestimation of acetabular coverage, which may negatively affect hip preservation surgical decision making.

Neer Award 2006: Biomechanical assessment of inferior tuberosity placement during hemiarthroplasty for four-part proximal humeral fractures.

Tuberosity malpositioning commonly occurs and is associated with a decline in clinical function after prosthetic shoulder reconstruction for proximal humeral fractures. This study assesses the biomechanical effects of inferior tuberosity position on glenohumeral joint forces and humeral head position at multiple positions. Eight fresh-frozen cadaveric shoulders were tested. Hemiarthroplasty was performed with preservation of anatomic tuberosity height and with 10 mm and 20 mm of inferior tuberosity displacement. The rotator cuff, deltoid, pectoralis major, and latissimus dorsi muscles were statically loaded. Contact forces and humeral head position were recorded within a functional range of motion. Glenohumeral joint forces shifted significantly superiorly (P < .05) at 30 degrees of abduction after both 10 mm and 20 mm of tuberosity displacement. At 60 degrees of glenohumeral abduction, glenohumeral joint forces remained significantly altered after tuberosity displacement of 10 mm and 20 mm compared with the intact height (P < .005). This study demonstrates that, during hemiarthroplasty performed for proximal humeral fractures, malpositioning the tuberosities inferiorly results in significant superior glenohumeral joint force displacement. These findings suggest that the mechanical advantage of the shoulder abductor muscles is compromised with inferior tuberosity malpositioning and may help to explain inferior functional results seen in these patients.

Clinical and radiographic results of 184 consecutive revision total knee arthroplasties placed with modular cementless stems.

Clinical and radiographic outcomes of 184 consecutive revision total knee arthroplasties (TKAs) placed with cemented components and press-fit fluted cementless stems were reviewed at average follow-up of 49 months. Revision was performed for septic failure in 53 of 184 knees, periprosthetic fracture in 10 of 184 knees, and aseptic failure in 121 of 184 knees. The press-fit cementless stems were placed to tightly contact the endosteum of the metadiaphyseal area of the femur and tibia. No knees were re-revised for aseptic loosening. There were 15 failures (15/184, 8.2%): 13 were septic failures, 9 of which were recurrence of sepsis and 4 of which were new cases of sepsis. Average Knee Society knee score improved from 134.6 to 167.8 (P < .05). Revision TKA with modular cementless stems provided excellent fixation with no revisions for aseptic loosening. Re-revision for sepsis was the dominant failure mechanism with an overall rate of 7%. Given the increasing prevalence of revision TKA, sepsis prevention strategies should receive increased attention.

Barbed Versus Standard Sutures for Closure in Total Knee Arthroplasty: A Multicenter Prospective Randomized Trial

Barbed suture has been associated with improved closure efficiency and safety in TKA in prior studies. We performed a multicenter randomized controlled trial to determine the efficiency and safety of this technology in TKA. We prospectively randomized 411 patients undergoing primary TKA to either barbed running (n=191) or knotted interrupted suture closure (n=203). Closure time was measured intra-operatively. Cost analysis was based on suture and OR time costs. Closure time was shorter with barbed suture (9.8 vs. 14.5 min, p<0.001). Total closure cost was less with barbed suture (

Biomechanical Analysis of Acetabular Revision Constructs: Is Pelvic Discontinuity Best Treated With Bicolumnar or Traditional Unicolumnar Fixation?

324 vs.

Clinical & Radiographic Outcomes of Cemented vs. Diaphyseal Engaging Cementless Stems in Aseptic Revision TKA

419, p<0.001). Early complications and outcomes were similar between groups. The use of barbed suture in TKA is associated with shorter closure time, lower cost and similar outcomes and complications when compared with standard sutures.

Subcapital correction osteotomy for malunited slipped capital femoral epiphysis.

Pelvic discontinuity in revision total hip arthroplasty presents problems with component fixation and union. A construct was proposed based on bicolumnar fixation for transverse acetabular fractures. Each of 3 reconstructions was performed on 6 composite hemipelvises: (1) a cup-cage construct, (2) a posterior column plate construct, and (3) a bicolumnar construct (no. 2 plus an antegrade 4.5-mm anterior column screw). Bone-cup interface motions were measured, whereas cyclical loads were applied in both walking and descending stair simulations. The bicolumnar construct provided the most stable construct. Descending stair mode yielded more significant differences between constructs. The bicolumnar construct provided improved component stability. Placing an antegrade anterior column screw through a posterior approach is a novel method of providing anterior column support in this setting.

Higher Frequency of Reoperation With a New Bicruciate-retaining Total Knee Arthroplasty

Modular revision systems have become standard in revision TKAs. However, the type of stem fixation remains controversial. The purpose of this study is to compare the incidence of failure between cemented and diaphyseal engaging cementless stems in aseptic revision TKAs. We performed a multicenter retrospective review of 82 revision TKAs performed for aseptic failure. Follow-up averaged 76 and 121 months for the cemented and cementless groups respectively. Re-revision and radiographic failure rates for both femoral and tibial stems were similar between groups. We found similar improvements in knee society scores between the groups. At midterm follow-up, we found no difference in failure rates between the groups. Both types of stem appear to provide reliable fixation and are viable options in revision TKAs.