Sean S. Rajaee

National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients : A Focus on Bearing Surface Usage

The purpose of this study was to present national trends in primary total hip arthroplasty (THA) and bearing surface usage for patients 30 years and younger. Using the Healthcare-Cost-and-Utilization-Project Nationwide Inpatient Sample for the years 2006 to 2009, 8919 primary THA discharges (4454 coded by bearing surface) were identified in patients 30 years and younger. The most commonly used bearing surface was metal-on-metal (MoM), representing 37.6% of cases, followed by ceramic-on-ceramic (CoC) (24.6%), metal-on-polyethylene (MoP) (22.1%) and ceramic-on-polyethylene (15.7%). From 2006 to 2009, the percentage of THAs that used hard-on-hard bearing surfaces decreased (MoM: 42.9%-29.4%; CoC: 34.0%-19.7%).This decrease in hard-on-hard bearing surface usage presents a challenge for surgeons treating young patients to find other acceptable durable bearings that do not have the potential problems associated with MoM or CoC.

Primary total elbow arthroplasty for distal humeral fractures in elderly patients: a nationwide analysis.

BACKGROUND Displaced intra-articular distal humeral fractures are a challenging injury in elderly patients. High rates of complications have led to the increasing use of total elbow arthroplasty (TEA) for primary treatment. This study presents US nationwide trends in primary TEA for distal humeral fractures in elderly patients (65 years and older) from 2002 to 2012. We hypothesized that there was an increase in the rate of TEA utilization. METHODS Data were obtained from the Nationwide Inpatient Sample for the years 2002 to 2012. All inpatients 65 years and older with distal humeral fractures were identified and were divided into 2 subgroups based on the operation they received: (1) TEA and (2) open reduction-internal fixation (ORIF). RESULTS Between 2002 and 2012, the annual frequency of TEA for elderly patients with distal humeral fractures increased 2.6-fold, with 147 patients in 2002 and 385 in 2012. In 2012, TEA was performed in 13% of operatively treated distal humeral fractures compared with only 5.1% in 2002 (P < .05). Mean hospital charges increased significantly for both the ORIF and TEA groups from 2002 to 2012. The average hospital charge for TEA in 2012 was

The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

85,365, which was

Increasing Use of Reverse Total Shoulder Arthroplasty for Proximal Humerus Fractures in Elderly Patients

16,358 higher than that for patients who underwent ORIF (P < .05). CONCLUSION The national rate of primary TEA for the acute management of distal humeral fractures in elderly patients has increased significantly over the past 10 years. Given the significant complexity, long-term restrictions, and risks associated with TEA, this increasing trend should be analyzed closely.

Inflammatory pseudotumor after ceramic-on-ceramic total hip arthroplasty

Background: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. Hypothesis: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury. Study Design: Controlled laboratory study. Methods: Twelve human cadaveric knees were subject to static forces applied to the tibia including an anterior-directed force as well as varus, valgus, and internal and external rotation moments to quantify laxity at 0°, 30°, 60°, and 90° of flexion. The following ligament conditions were tested on each specimen: (1) ACL intact/MCL intact, (2) ACL deficient/MCL intact, (3) ACL deficient/partial MCL injury, and (4) ACLR/partial MCL injury. To quantify the effect of muscle loads, the quadriceps, semimembranosus, biceps femoris, sartorius (SR), ST, and G muscles were subjected to static loads. The loads on the G, ST, and SR could be added or removed during various test conditions. For each ligament condition, the responses to loading and unloading the G/ST and SR were determined. Three-dimensional positional data of the tibia relative to the femur were recorded to determine tibiofemoral rotations and translations. Results: ACLR restored anterior stability regardless of whether static muscle loads were applied. There was no significant increase in valgus motion after ACL transection. However, when a partial MCL tear was added to the ACL injury, there was a 30% increase in valgus rotation (P < .05). ACLR restored valgus stability toward that of the intact state when the G/ST muscles were loaded. A load on the SR muscle without a load on the G/ST muscles restored 19% of valgus rotation; however, it was still significantly less stable than the intact state. Conclusion: After ACLR in knees with a concurrent partial MCL injury, the absence of loading on the G/ST did not significantly alter anterior stability. Simulated G/ST harvest did lead to increased valgus motion. These results may have important clinical implications and warrant further investigation to better outline the role of the medial hamstrings, particularly among patients with a concomitant ACL and MCL injury. Clinical Relevance: A concurrent ACL and MCL injury is a commonly encountered clinical problem. Knowledge regarding the implications of hamstring autograft harvest techniques on joint kinematics may help guide management decisions.

Digital Radiography in Total Hip Arthroplasty: Technique and Radiographic Results

This study described surgical treatment patterns for proximal humerus fractures among elderly patients, focusing on reverse total shoulder arthroplasty (TSA), and evaluated how the type of fixation affects inpatient factors (cost, length of stay), transfusion rates, and patient disposition (home vs skilled nursing facility). With Nationwide Inpatient Sample data from 2011 to 2013, the authors identified patients 65 years and older who had proximal humerus fractures and divided them into 3 groups: (1) open reduction and internal fixation (ORIF); (2) hemiarthroplasty; and (3) reverse TSA. From 2011 to 2013, 38,729 surgically treated proximal humerus fractures were identified. The rate of reverse TSA increased 1.8-fold during this time, from 13% of operative cases in 2011 to 24% of operative cases in 2013 (P<.001). At the same time, the rates of hemiarthroplasty and ORIF decreased (hemiarthroplasty, from 28% to 21%; ORIF, from 59% to 55%). Although reverse TSA accounted for 32.2% of arthroplasty procedures for proximal humerus fractures in 2011, this value was 53.3% in 2013 (P<.001). In 2013, mean total hospital cost for reverse TSA was

Effect of Hamstring Harvest in the Setting of ACL and MCL Concurrent Injury

24,154, which was significantly higher than that for ORIF (

Nationwide trends in total shoulder arthroplasty and hemiarthroplasty for osteoarthritis.

16,269) or hemiarthroplasty (

National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients: A Focus on Bearing Surface Usage From 2009 to 2012

19,175) (P<.001). In a multivariable model, patients undergoing reverse TSA were less likely than those undergoing hemiarthroplasty to be discharged to a skilled nursing facility (odds ratio, 0.75; P=.027). The national rate of reverse TSA nearly doubled from 2011 to 2013. As of 2013, reverse TSA replaced hemiarthroplasty as the most commonly performed arthroplasty procedure for proximal humerus fractures for patients 65 years and older. Patients undergoing reverse TSA were more likely than those undergoing hemiarthroplasty to be discharged home. [Orthopedics. 2017; 40(6):e982-e989.].

A transgluteal approach—Back to the future

We present a unique case of a symptomatic adverse local tissue reaction in a patient with a ceramic-on-ceramic total hip bearing surface. To our knowledge, this pathological finding has not yet been described in a ceramic-on-ceramic articulation without a cobalt-chromium alloy trunnion or modular neck component as a source of metal wear. We conclude that despite its mechanical mostly benign wear characteristics, ceramic wear debris is not entirely inert and may lead to the development of adverse local tissue reaction.