Zachary D. Post

The effect of stem design on the prevalence of squeaking following ceramic-on-ceramic bearing total hip arthroplasty.

BACKGROUND The ceramic-on-ceramic bearing for total hip arthroplasty has an extremely low wear rate and demonstrates minimal inflammatory response in comparison with other bearing choices. However, acoustic emissions such as squeaking and clicking are being reported as annoying complications related to its use. The cause or causes of this phenomenon have not been determined. The purpose of the present study was to evaluate the possibility that design aspects of the femoral component may be a contributing factor to the etiology of squeaking associated with the ceramic-on-ceramic bearing total hip arthroplasty. METHODS We retrospectively reviewed 266 consecutive patients (304 hips) who had undergone total hip arthroplasty with use of ceramic-on-ceramic bearings. The first 131 consecutive patients (152 hips) (Group 1) received a hydroxyapatite-coated stem composed of titanium-aluminum-vanadium alloy with a C-taper neck geometry and robust midsection with an anteroposterior diameter of 13 mm. The second 135 consecutive patients (152 hips) (Group 2) also received a hydroxyapatite-coated stem, but in that group the stem was composed of titanium-molybdenum-zirconium-iron alloy, with a V-40 neck geometry and a midsection with an anteroposterior thickness of only 10 mm. All 304 hips received the same cup, composed of titanium-aluminum-vanadium alloy. Demographic characteristics, such as age, sex, height, weight, and body mass index, were similar in both groups. Data regarding the presence of squeaking were obtained prospectively. Patients who were seen for clinical follow-up either expressed the squeaking phenomenon themselves or were asked about it by the physician. Patients who were not seen at a recent clinical follow-up visit were contacted by telephone and were asked specifically about squeaking that might be associated with the hip replacement. Only patients with confirmed squeaking noise were included in the present study. Postoperative radiographs, the Short Form-36 health survey, the Harris hip score, and office or telephone interviews of the patient were used to determine the overall outcome of the procedure. RESULTS The prevalence of squeaking was seven times higher for patients who received the titanium-molybdenum-zirconium-iron-alloy stem (twenty-seven patients, twenty-eight hips [18.4%]) than in those who received the titanium-aluminum-vanadium-alloy stem (three patients, four hips [2.6%]); this difference was significant (p < 0.0001). CONCLUSIONS Our study suggests that different stem alloys, stem geometries, or neck geometries can have an impact on the frequency of squeaking following a ceramic-on-ceramic total hip arthroplasty.

Outpatient Surgery as a Means of Cost Reduction in Total Hip Arthroplasty: A Case-Control Study

BackgroundThe current healthcare market coupled with expedited recovery and improvements in analgesia have led to the development of total hip arthroplasty being performed as an outpatient procedure in selected patients.Questions/PurposesThe purpose of this study is to compare outcomes and cost-effectiveness of traditional inpatient THA with outpatient hip replacement at the same facility.Patients and MethodsThis observational, case-control study was conducted from 2008 to 2011. One hundred nineteen patients underwent outpatient THA through a direct anterior approach. These cases were all performed by a single surgeon. Outpatient cases were then compared to inpatient hospital controls performed by the same surgeon at the inpatient hospital facility.ResultsComplications, length of stay, demographic data, and overall costs were compared between groups. There was no difference in complications or estimated blood loss between groups. Most notably, the average overall cost in the outpatient setting was significantly lower than inpatient,

Distal Femoral Arthroplasty for the Treatment of Periprosthetic Fractures After Total Knee Arthroplasty

24,529 versus

Direct anterior approach for total hip arthroplasty: indications, technique, and results.

31,327 (p = 0.0001).ConclusionsThis study demonstrates that appropriately selected patients can undergo THA in an outpatient setting with no increase in complications and at a substantial savings to the healthcare system.

Mobile-Bearing Total Knee Arthroplasty Better Than a Fixed-Bearing?

Periprosthetic fractures after total knee arthroplasty present substantial challenge if associated with poor bone stock, fracture comminution, and loose or damaged components. Revision total knee arthroplasty with distal femoral arthroplasty is often necessary in these injuries. We reviewed 20 patients (22 knees) with a mean age of 69.5 years who underwent revision with distal femoral arthroplasty fracture. Patients were followed for an average of 58.6 months. At the latest follow-up, the mean Knee Society knee and functional score were 82.8 and 40, and the Short Form 36 mean physical functioning and mental functioning scores were 55.8 and 65.6, respectively. There were 10 postoperative complications with 5 patients requiring additional surgery. Distal femoral arthroplasty seems to be a viable option for complex periprosthetic femoral fractures after total knee arthroplasty. However, considering the relatively high rate of complications, this procedure should be reserved for patients where alternative treatments are not possible.

A Prospective Evaluation of 2 Different Pain Management Protocols for Total Hip Arthroplasty

The direct anterior approach (DAA) to the hip was initially described in the 19th century and has been used sporadically for total hip arthroplasty (THA). In the past decade, enthusiasm for the approach has been renewed because of increased demand for minimally invasive techniques. New surgical instruments and tables designed specifically for use with the DAA for THA have made the approach more accessible to surgeons. Some authors claim that this approach results in less muscle damage and pain as well as rapid recovery, although limited data exist to support these claims. The DAA may be comparable to other THA approaches, but there is no evidence to date that shows improved long-term outcomes for patients. The steep learning curve and complications unique to this approach (fractures and nerve damage) have been well described. However, the incidence of these complications decreases with greater surgeon experience. A question of keen interest to hip surgeons and patients is whether the DAA results in improved early outcomes and long-term results comparable to those of other approaches for THA.

Fibrosis in Hepatitis C Patients Predicts Complications After Elective Total Joint Arthroplasty

The purported advantages of mobile-bearing knee include increased survivorship and restoration of more natural knee kinematics compared to a standard fixed-bearing design. To evaluate these claims, an extensive review of the available literature was undertaken. We compared survivorship and clinical function, including patient preference. We found no difference in survivorship at 12 to 23 years. Kinematic profiles of both designs did not differ significantly: rotation, flexion, and extension were comparable. Studies evaluating both designs in the same patient showed no difference in range of motion, knee preference, knee scores, and survivorship at midterm follow-up. Both designs were capable of producing excellent long-term results and clinical outcomes if properly implanted. The available evidence does not point to the superiority of one design over another in survivorship and clinical function.

Extensor Mechanism Reconstruction with Achilles Tendon Allograft in TKA: Results of an Abbreviate Rehabilitation Protocol

Pain management after total hip arthroplasty has improved dramatically in the past decade. However, most protocols use opioid medications for pain control. In the current study, 100 patients were prospectively selected to receive a traditional narcotic-based patient-controlled analgesia protocol or a nonnarcotic oral protocol for pain management after primary total hip arthroplasty. Therapy programs were similar for both groups. Postoperatively, patients were followed daily for opioid use, medication adverse effects, pain control, and overall satisfaction. The nonnarcotic oral group showed lower mean pain scores during the first 24 hours after surgery. The satisfaction rate was high in both groups. Both protocols provided adequate pain control after total hip arthroplasty; the nonnarcotic pain management protocol resulted in significantly decreased opioid consumption and fewer adverse effects.

Patients with atrial fibrillation undergoing total joint arthroplasty increase hospital burden.

Effects of Hepatitis C on total hip (THA) and total knee arthroplasty (TKA) outcomes are poorly understood. Seventy-two hepatitis C patients underwent 77 primary THA or TKA and were retrospectively identified, stratified by fibrosis and thrombocytopenia and compared to matched controls. Overall, Hepatitis C and control patients had similar outcomes. After TKA, fibrotic hepatitis C patients demonstrated a greater average hemoglobin drop than non-fibrotic hepatitis C patients (4.9 versus 3.8, P=0.023), greater deep infection rate (21% versus 0%, P=0.047), and rate of cellulitis (21% versus 0%, P=0.047). Thrombocytopenia showed a trend toward greater infections. Prior to fibrosis, Hepatitis C patients appear to be at no increased risk of complication after joint arthroplasty. Evaluation of fibrosis may predict poor outcome in Hepatitis C patients.

Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes

Various treatment alternatives address extensor mechanism failure after total knee arthroplasty. We present the results of a protocol utilizing Achilles tendon allograft followed by an abbreviated immobilization program to treat extensor mechanism disruptions after TKA in 29 knees (27 patients). Failed reconstruction was defined as mechanical allograft failure requiring re-intervention, extension lag >30°, recurrent falls, regression to a lower ambulatory status, and revision due to infection. With mean follow-up of 3.5 years, seventeen cases (58.6%) had satisfactory results, eleven cases (37.9%) were considered failures, and one case was lost to follow-up. Among failures, eight (27.5%) underwent reoperation with four (13.8%) due to late infections. Our observational data suggest that 1) a shortened immobilization protocol yields less favorable results than expected, and 2) continuous monitoring of patients who had allograft reconstruction for possible development of late infection is recommended.