Juan C. Suarez

Why Do Revision Knee Arthroplasties Fail

This study identified the mechanisms of failure and the variables associated with failure after revision knee arthroplasty. Five hundred sixty-six index revision knee arthroplasties were studied. Of index revisions, 12.0% failed at an average of 40.1 months. Predominant revision failure modes included infection (46%), aseptic loosening (19%), and instability (13%). Only 4.3% of knees revised for aseptic loosening required rerevision as compared to 21% of knees revised for infection. Revision knee arthroplasty was more likely to fail in younger patients and in those who underwent polyethylene exchanges. Mechanisms of failure for revision arthroplasties are different than for primary knee arthroplasties. Revisions for infection are 4 times more likely to fail than revisions for aseptic loosening. The survivorship for the entire cohort, with revision for any reason as an end point, was 82% at 12 years.

Accuracy of Fluoroscopic Guided Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty

Acetabular component malposition contributes to increased complications and early revision. Supine positioning during direct anterior approach (DAA) THA facilitates the use of fluoroscopy to improve component positioning. This study evaluated the accuracy of acetabular component orientation using intraoperative fluoroscopy in DAA THA. A total of 780 surgeries by two surgeons were retrospectively reviewed over a 3-year period. Ranges for abduction (30°-50°) and version (5°-250) were employed. Overall, 92% fell within the targeted abduction range, 93% fell within the targeted anteversion range, and 88% met both criteria. The accuracy of component positioning for combined abduction and anteversion improved yearly (79.2%, 2011; 90.9%, 2012; and 95.6%, 2013). Fluoroscopy in DAA THA is a useful tool to improve acetabular component orientation, though a learning curve exists with its interpretation.

One-stage versus two-stage exchange.

Liaison: Paul Lichstein MD, MSLeaders: Thorsten Gehrke MD (International), Adolph Lombardi MD, FACS (US), Carlo RomanoMD (International), Ian Stockley MB, ChB, MD, FRCS (International)Delegates: George Babis MD, Jerzy Bialecki MD, La´szlo´ Bucsi MD, Xu Cai MD, Li Cao MD, Briande Beaubien MD, Johannes Erhardt MD, Stuart Goodman MD, PhD, FRCSC, FACS, FBSE,William Jiranek MD, Peter Keogh, David Lewallen MD, MS, Paul Manner MD, WojciechMarczynski MD, J. Bohannon Mason MD, Kevin Mulhall MB, MCh, FRCSI, Wayne PaproskyMD, Preetesh Patel MD, Francisco Piccaluga MD, Gregory Polkowski MD, Luis Pulido MD, IanStockley MBBS, ChB, FRCS, Juan Suarez MD, Fritz Thorey MD, Rashid Tikhilov MD, JobDiego Velazquez MD, Heinz Winkler MD

Incidence of Heterotopic Ossification in Direct Anterior Total Hip Arthroplasty: A Retrospective Radiographic Review

Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6 months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip.

One-stage vs two-stage exchange.

Liaison: Paul Lichstein MD, MSLeaders: Thorsten Gehrke MD (International), Adolph Lombardi MD, FACS (US),Carlo Romano MD (International), Ian Stockley MB, ChB, MD, FRCS (International)Delegates: GeorgeBabisMD,JerzyBialeckiMD,LaszloBucsiMD,XuCaiMD,LiCaoMD,BriandeBeaubienMD,Johannes Erhardt MD, Stuart Goodman MD, PhD, FRCSC, FACS, FBSE, William Jiranek MD,PeterKeoghFRCSI,DavidLewallenMD,MS,PaulMannerMD,WojciechMarczynskiMD,J.BohannonMasonMD,Kevin Mulhall MB, MCh, FRCSI, Wayne Paprosky MD, Preetesh Patel MD, Francisco Piccaluga MD,Gregory Polkowski MD, Luis Pulido MD, Ian Stockley MBBS, ChB, FRCS, Juan Suarez MD, Fritz Thorey MD,Rashid Tikhilov MD, Job Diego Velazquez MD, Heinz Winkler MD

Fluoroscopic Imaging of Acetabular Cup Position During THA Through a Direct Anterior Approach

Mobile image intensifiers are more readily used to assess acetabular cup placement when performing a total hip arthroplasty through a direct anterior approach. However, patient positioning affects pelvic tilt and rotation, which in turn requires proper C-arm fluoroscopy adjustments for image interpretation. The authors provide insight into the interpretation of acetabular cup positioning based on the fluoroscopic images obtained to ensure appropriate cup positioning using the direct anterior approach for total hip arthroplasty.

Comprehensive approach to the evaluation of groin pain

&NA; Groin pain is often related to hip pathology. As a result, groin pain is a clinical complaint encountered by orthopaedic surgeons. Approximately one in four persons will develop symptomatic hip arthritis before age 85 years. Groin injuries account for approximately 1 in 20 athletic injuries, and groin pain accounts for 1 in 10 patient visits to sports medicine centers. Many athletes with chronic groin pain have multiple coexisting pathologies spanning several disciplines. In treating these patients, the orthopaedic surgeon must consider both musculoskeletal groin disorders and nonorthopaedic conditions that can present as groin pain. A comprehensive history and physical examination can guide the evaluation of groin pain.

Prospective, Randomized Trial to Evaluate Efficacy of a Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty

Total knee arthroplasty (TKA) can be associated with substantial blood loss, leading to increased morbidity and transfusion rates. The study objective was to evaluate routine use of a thrombin-based topical hemostatic matrix in reducing blood loss and transfusion requirements in primary TKA. 108 patients were enrolled in a prospective, randomized, single-center trial. Patients receiving the hemostatic agent demonstrated a lower mean calculated blood loss (1325.2±464.8mL vs. control, 1509.3±432.8mL; P=0.02), drain output (415.6±202.0mL vs. control, 579.9±306.7mL; P=0.008), and length of stay (3.3±0.8days vs. control, 3.7±1.1days; P=0.03), without a statistically significant difference in mean hemoglobin loss or transfusion requirements. The clinical utility of this hemostatic agent to reduce transfusions after uncomplicated, primary TKA continues to remain unclear.

Prospective, Randomized Trial to Evaluate Efficacy of a Bipolar Sealer in Direct Anterior Approach Total Hip Arthroplasty

Total hip arthroplasty can be associated with substantial blood loss requiring allogenic transfusions. Intraoperative blood loss patterns in DAA differ from other approaches. This study evaluated the hemostatic efficacy of a bipolar sealer in DAA THA on surgical blood loss and transfusion requirements. 118 patients were enrolled in this prospective, randomized, double-blinded trial. Primary outcome measure was transfusion rate, while secondary measures included calculated blood loss. A lower transfusion rate was found in the treatment group (3.5 % vs 16.4%, P=.03). There were differences in Hemoglobin-drop (P=.04), calculated blood loss (P=.02), and hidden blood loss (P=.02), favoring the treatment group. The use of a bipolar sealer decreased intraoperative blood loss and transfusion requirements in the study population.

Removal of Trabecular Metal Osteonecrosis Intervention Implant and Conversion to Primary Total Hip Arthroplasty

Core decompression and placement of the Trabecular Metal Osteonecrosis Intervention Implant have shown to be initially successful in treating early osteonecrosis. When treatment fails, however, patients often undergo primary total hip arthroplasty (THA) requiring removal of a previously inserted trabecular metal implant. We describe a technical tip for removal of a well-ingrown trabecular metal screw. A metal-cutting trephine placed over the screw allows for removal in an efficient manner while minimizing additional dissection and bone loss during conversion to THA.