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BIOTECHNOLOGY (227 journals)                  1 2 | Last

Showing 1 - 200 of 227 Journals sorted alphabetically
3 Biotech     Open Access   (Followers: 7)
Advances in Bioscience and Biotechnology     Open Access   (Followers: 14)
Advances in Genetic Engineering & Biotechnology     Hybrid Journal   (Followers: 7)
African Journal of Biotechnology     Open Access   (Followers: 6)
Algal Research     Partially Free   (Followers: 9)
American Journal of Biochemistry and Biotechnology     Open Access   (Followers: 68)
American Journal of Bioinformatics Research     Open Access   (Followers: 8)
American Journal of Polymer Science     Open Access   (Followers: 29)
Animal Biotechnology     Hybrid Journal   (Followers: 9)
Annales des Sciences Agronomiques     Full-text available via subscription  
Applied Biochemistry and Biotechnology     Hybrid Journal   (Followers: 42)
Applied Bioenergy     Open Access  
Applied Biosafety     Hybrid Journal  
Applied Microbiology and Biotechnology     Hybrid Journal   (Followers: 62)
Applied Mycology and Biotechnology     Full-text available via subscription   (Followers: 5)
Arthroplasty Today     Open Access   (Followers: 1)
Artificial Cells, Nanomedicine and Biotechnology     Hybrid Journal   (Followers: 2)
Asia Pacific Biotech News     Hybrid Journal   (Followers: 2)
Asian Journal of Biotechnology     Open Access   (Followers: 8)
Asian Pacific Journal of Tropical Biomedicine     Open Access   (Followers: 2)
Australasian Biotechnology     Full-text available via subscription   (Followers: 1)
Banat's Journal of Biotechnology     Open Access  
BBR : Biochemistry and Biotechnology Reports     Open Access   (Followers: 4)
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 1)
Bio-Research     Full-text available via subscription   (Followers: 2)
Bioactive Materials     Open Access   (Followers: 1)
Biocatalysis and Agricultural Biotechnology     Hybrid Journal   (Followers: 4)
Biocybernetics and Biological Engineering     Full-text available via subscription   (Followers: 5)
Bioethics UPdate     Hybrid Journal  
Biofuels     Hybrid Journal   (Followers: 11)
Biofuels Engineering     Open Access   (Followers: 1)
Biological & Pharmaceutical Bulletin     Full-text available via subscription   (Followers: 5)
Biological Cybernetics     Hybrid Journal   (Followers: 10)
Biomarkers and Genomic Medicine     Open Access   (Followers: 5)
Biomarkers in Drug Development     Partially Free   (Followers: 1)
Biomaterials Research     Open Access   (Followers: 4)
BioMed Research International     Open Access   (Followers: 6)
Biomédica     Open Access  
Biomedical Engineering Research     Open Access   (Followers: 7)
Biomedical glasses     Open Access  
Biomedical Reports     Full-text available via subscription  
BioMedicine     Open Access  
Bioprinting     Hybrid Journal  
Bioresource Technology Reports     Hybrid Journal  
Bioscience, Biotechnology, and Biochemistry     Hybrid Journal   (Followers: 22)
Biosimilars     Open Access   (Followers: 1)
Biosurface and Biotribology     Open Access  
Biotechnic and Histochemistry     Hybrid Journal   (Followers: 2)
BioTechniques : The International Journal of Life Science Methods     Full-text available via subscription   (Followers: 28)
Biotechnologia Acta     Open Access   (Followers: 1)
Biotechnologie, Agronomie, Société et Environnement     Open Access   (Followers: 2)
Biotechnology     Open Access   (Followers: 6)
Biotechnology & Biotechnological Equipment     Open Access   (Followers: 5)
Biotechnology Advances     Hybrid Journal   (Followers: 33)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 159)
Biotechnology and Bioprocess Engineering     Hybrid Journal   (Followers: 6)
Biotechnology and Genetic Engineering Reviews     Hybrid Journal   (Followers: 14)
Biotechnology and Health Sciences     Open Access   (Followers: 1)
Biotechnology and Molecular Biology Reviews     Open Access   (Followers: 1)
Biotechnology Annual Review     Full-text available via subscription   (Followers: 7)
Biotechnology for Biofuels     Open Access   (Followers: 10)
Biotechnology Frontier     Open Access   (Followers: 2)
Biotechnology Journal     Hybrid Journal   (Followers: 15)
Biotechnology Law Report     Hybrid Journal   (Followers: 4)
Biotechnology Letters     Hybrid Journal   (Followers: 33)
Biotechnology Progress     Hybrid Journal   (Followers: 39)
Biotechnology Reports     Open Access  
Biotechnology Research International     Open Access   (Followers: 2)
Biotechnology Techniques     Hybrid Journal   (Followers: 10)
Biotecnología Aplicada     Open Access  
Biotribology     Hybrid Journal  
BMC Biotechnology     Open Access   (Followers: 15)
Chinese Journal of Agricultural Biotechnology     Full-text available via subscription   (Followers: 3)
Communications in Mathematical Biology and Neuroscience     Open Access  
Computational and Structural Biotechnology Journal     Open Access   (Followers: 2)
Computer Methods and Programs in Biomedicine     Hybrid Journal   (Followers: 8)
Contributions to Tobacco Research     Open Access   (Followers: 3)
Copernican Letters     Open Access   (Followers: 1)
Critical Reviews in Biotechnology     Hybrid Journal   (Followers: 20)
Crop Breeding and Applied Biotechnology     Open Access   (Followers: 4)
Current Bionanotechnology     Hybrid Journal  
Current Biotechnology     Hybrid Journal   (Followers: 3)
Current Opinion in Biomedical Engineering     Hybrid Journal   (Followers: 1)
Current Opinion in Biotechnology     Hybrid Journal   (Followers: 55)
Current Pharmaceutical Biotechnology     Hybrid Journal   (Followers: 9)
Current Research in Bioinformatics     Open Access   (Followers: 14)
Current trends in Biotechnology and Pharmacy     Open Access   (Followers: 9)
EBioMedicine     Open Access  
Electronic Journal of Biotechnology     Open Access   (Followers: 1)
Entomologia Generalis     Full-text available via subscription  
Environmental Science : Processes & Impacts     Full-text available via subscription   (Followers: 4)
Experimental Biology and Medicine     Hybrid Journal   (Followers: 3)
Folia Medica Indonesiana     Open Access  
Food Bioscience     Hybrid Journal  
Food Biotechnology     Hybrid Journal   (Followers: 12)
Food Science and Biotechnology     Hybrid Journal   (Followers: 9)
Frontiers in Bioengineering and Biotechnology     Open Access   (Followers: 6)
Frontiers in Systems Biology     Open Access   (Followers: 2)
Fungal Biology and Biotechnology     Open Access   (Followers: 1)
GM Crops and Food: Biotechnology in Agriculture and the Food Chain     Full-text available via subscription   (Followers: 1)
GSTF Journal of BioSciences     Open Access  
HAYATI Journal of Biosciences     Open Access  
Horticulture, Environment, and Biotechnology     Hybrid Journal   (Followers: 11)
IEEE Transactions on Molecular, Biological and Multi-Scale Communications     Hybrid Journal   (Followers: 1)
IET Nanobiotechnology     Hybrid Journal   (Followers: 2)
IIOAB Letters     Open Access  
IN VIVO     Full-text available via subscription   (Followers: 4)
Indian Journal of Biotechnology (IJBT)     Open Access   (Followers: 2)
Indonesia Journal of Biomedical Science     Open Access   (Followers: 1)
Indonesian Journal of Biotechnology     Open Access   (Followers: 1)
Industrial Biotechnology     Hybrid Journal   (Followers: 18)
International Biomechanics     Open Access  
International Journal of Bioinformatics Research and Applications     Hybrid Journal   (Followers: 15)
International Journal of Biomechatronics and Biomedical Robotics     Hybrid Journal   (Followers: 4)
International Journal of Biomedical Research     Open Access   (Followers: 2)
International Journal of Biotechnology     Hybrid Journal   (Followers: 5)
International Journal of Biotechnology and Molecular Biology Research     Open Access   (Followers: 2)
International Journal of Biotechnology for Wellness Industries     Partially Free   (Followers: 1)
International Journal of Environment, Agriculture and Biotechnology     Open Access   (Followers: 5)
International Journal of Functional Informatics and Personalised Medicine     Hybrid Journal   (Followers: 4)
International Journal of Medicine and Biomedical Research     Open Access   (Followers: 1)
International Journal of Nanotechnology and Molecular Computation     Full-text available via subscription   (Followers: 3)
International Journal of Radiation Biology     Hybrid Journal   (Followers: 4)
Iranian Journal of Biotechnology     Open Access  
ISABB Journal of Biotechnology and Bioinformatics     Open Access  
Italian Journal of Food Science     Open Access   (Followers: 1)
Journal of Biometrics & Biostatistics     Open Access   (Followers: 3)
Journal of Bioterrorism & Biodefense     Open Access   (Followers: 6)
Journal of Petroleum & Environmental Biotechnology     Open Access   (Followers: 2)
Journal of Advanced Therapies and Medical Innovation Sciences     Open Access  
Journal of Advances in Biotechnology     Open Access   (Followers: 5)
Journal Of Agrobiotechnology     Open Access  
Journal of Analytical & Bioanalytical Techniques     Open Access   (Followers: 7)
Journal of Animal Science and Biotechnology     Open Access   (Followers: 6)
Journal of Applied Biomedicine     Open Access   (Followers: 3)
Journal of Applied Biotechnology     Open Access   (Followers: 2)
Journal of Applied Biotechnology Reports     Open Access   (Followers: 2)
Journal of Applied Mathematics & Bioinformatics     Open Access   (Followers: 5)
Journal of Biologically Active Products from Nature     Hybrid Journal   (Followers: 1)
Journal of Biomaterials and Nanobiotechnology     Open Access   (Followers: 6)
Journal of Biomedical Photonics & Engineering     Open Access  
Journal of Biomedical Practitioners     Open Access  
Journal of Bioprocess Engineering and Biorefinery     Full-text available via subscription  
Journal of Bioprocessing & Biotechniques     Open Access  
Journal of Biosecurity, Biosafety and Biodefense Law     Hybrid Journal   (Followers: 3)
Journal of Biotechnology     Hybrid Journal   (Followers: 68)
Journal of Chemical and Biological Interfaces     Full-text available via subscription   (Followers: 1)
Journal of Chemical Technology & Biotechnology     Hybrid Journal   (Followers: 10)
Journal of Chitin and Chitosan Science     Full-text available via subscription  
Journal of Colloid Science and Biotechnology     Full-text available via subscription  
Journal of Commercial Biotechnology     Full-text available via subscription   (Followers: 6)
Journal of Crop Science and Biotechnology     Hybrid Journal   (Followers: 7)
Journal of Essential Oil Research     Hybrid Journal   (Followers: 3)
Journal of Experimental Biology     Full-text available via subscription   (Followers: 25)
Journal of Genetic Engineering and Biotechnology     Open Access   (Followers: 5)
Journal of Ginseng Research     Open Access  
Journal of Industrial Microbiology and Biotechnology     Hybrid Journal   (Followers: 16)
Journal of Integrative Bioinformatics     Open Access  
Journal of International Biotechnology Law     Hybrid Journal   (Followers: 3)
Journal of Medical Imaging and Health Informatics     Full-text available via subscription  
Journal of Molecular Microbiology and Biotechnology     Full-text available via subscription   (Followers: 14)
Journal of Nano Education     Full-text available via subscription  
Journal of Nanobiotechnology     Open Access   (Followers: 4)
Journal of Nanofluids     Full-text available via subscription   (Followers: 2)
Journal of Organic and Biomolecular Simulations     Open Access  
Journal of Plant Biochemistry and Biotechnology     Hybrid Journal   (Followers: 6)
Journal of Science and Applications : Biomedicine     Open Access  
Journal of the Mechanical Behavior of Biomedical Materials     Hybrid Journal   (Followers: 11)
Journal of Trace Elements in Medicine and Biology     Hybrid Journal   (Followers: 1)
Journal of Tropical Microbiology and Biotechnology     Full-text available via subscription  
Journal of Yeast and Fungal Research     Open Access   (Followers: 1)
Marine Biotechnology     Hybrid Journal   (Followers: 5)
Messenger     Full-text available via subscription  
Metabolic Engineering Communications     Open Access   (Followers: 4)
Metalloproteinases In Medicine     Open Access  
Microalgae Biotechnology     Open Access   (Followers: 2)
Microbial Biotechnology     Open Access   (Followers: 9)
MicroMedicine     Open Access   (Followers: 3)
Molecular and Cellular Biomedical Sciences     Open Access  
Molecular Biotechnology     Hybrid Journal   (Followers: 16)
Molecular Genetics and Metabolism Reports     Open Access   (Followers: 3)
Nanobiomedicine     Open Access  
Nanobiotechnology     Hybrid Journal   (Followers: 3)
Nanomaterials and Nanotechnology     Open Access  
Nanomaterials and Tissue Regeneration     Open Access  
Nanomedicine and Nanobiology     Full-text available via subscription  
Nanomedicine Research Journal     Open Access  
Nanotechnology Reviews     Hybrid Journal   (Followers: 5)
Nature Biotechnology     Full-text available via subscription   (Followers: 520)
Network Modeling and Analysis in Health Informatics and Bioinformatics     Hybrid Journal   (Followers: 3)
New Biotechnology     Hybrid Journal   (Followers: 4)
Nigerian Journal of Biotechnology     Open Access  
Nova Biotechnologica et Chimica     Open Access  
NPG Asia Materials     Open Access  
npj Biofilms and Microbiomes     Open Access  
OA Biotechnology     Open Access  
Plant Biotechnology Journal     Open Access   (Followers: 10)
Plant Biotechnology Reports     Hybrid Journal   (Followers: 4)
Preparative Biochemistry and Biotechnology     Hybrid Journal   (Followers: 4)

        1 2 | Last

Journal Cover Arthroplasty Today
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  This is an Open Access Journal Open Access journal
   ISSN (Online) 2352-3441
   Published by Elsevier Homepage  [3177 journals]
  • Surgical hexing can curse outcomes

    • Authors: Brian J. McGrory; Jessica Taylor
      Pages: 1 - 2
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Brian J. McGrory, Jessica Taylor

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.07.004
  • Tapered modular fluted titanium stems for femoral fixation in revision
           total knee arthroplasty

    • Authors: Jeffrey B. Stambough; J. Bohannon Mason; Aldo M. Riesgo; Thomas K. Fehring
      Pages: 3 - 9
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Jeffrey B. Stambough, J. Bohannon Mason, Aldo M. Riesgo, Thomas K. Fehring
      Consensus regarding femoral stem fixation options in revision total knee arthroplasty remains controversial. Tapered, modular, fluted titanium (TMFT) stems have an excellent track record in total hip arthroplasty for their ability to provide axial and rotational stability in situations of compromised host bone. We present 3 successfully treated cases in which the Food & Drug Administration granted permission to use custom TMFT stems in situations of failed femoral fixation in multiple revised knees. These stems hold promise to achieve stable fixation in revision total knee arthroplasty where host metadiaphyseal bone is deficient. Implant manufactures should consider dedicating future resources to create adapters that can link existing successful TMFT stems currently used in hip arthroplasty to revision total knee components when host bone is severely compromised.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.03.006
  • Enoxaparin-induced skin necrosis at injection site after total knee

    • Authors: Max Haffner; Nasser Heyrani; John P. Meehan; Mauro Giordani
      Pages: 10 - 14
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Max Haffner, Nasser Heyrani, John P. Meehan, Mauro Giordani
      Enoxaparin is a widely used low-molecular-weight heparin for perioperative thromboembolic prophylaxis. Enoxaparin-induced skin necrosis in the setting of arthroplasty has been rarely reported in the literature with varying outcomes and management decisions. Our patient developed skin necrosis at his injection site and thrombocytopenia 10 days following left total knee arthroplasty surgery and after receiving subcutaneous Lovenox injections postoperatively. The patient was started on an alternative anticoagulation based on a high suspicion for heparin-induced thrombocytopenia and the wound was monitored without surgical debridement. Our case highlights the key clinical management decisions when facing this potentially life-threatening adverse reaction.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.09.006
  • Early failure with massive metallosis and posteromedial wear following
           atraumatic anterior cruciate ligament rupture after medial
           unicompartmental knee arthroplasty

    • Authors: Ashok Rajgopal; Inayat Panda; Vipin C. Tyagi
      Pages: 15 - 19
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Ashok Rajgopal, Inayat Panda, Vipin C. Tyagi
      Severe metallosis following medial unicompartmental knee arthroplasty (UKA) is relatively rare. It is usually due to long-standing wear of the polyethylene component, resulting in frictional wear between the femoral and tibial metallic components. Biomechanical and cadaveric studies have shown the effects of anterior cruciate ligament (ACL) transection following medial UKA. We describe a case of a 58-year-old male who developed attritional rupture of the ACL 16 months following medial UKA leading on to early accelerated failure over the next 8 months. The patient underwent revision to total knee arthroplasty with good outcome. The clinical effect of spontaneous ACL transection on medial UKA causing abnormal posteromedial wear of polyethylene component and tibial tray, massive metallosis, and worsening of mechanical axis can be demonstrated in this case report.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.09.007
  • Diagnosis of Streptococcus canis periprosthetic joint infection: the
           utility of next-generation sequencing

    • Authors: Majd Tarabichi; Abtin Alvand; Noam Shohat; Karan Goswami; Javad Parvizi
      Pages: 20 - 23
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Majd Tarabichi, Abtin Alvand, Noam Shohat, Karan Goswami, Javad Parvizi
      A 62-year-old man who had undergone a primary knee arthroplasty 3 years earlier, presented to the emergency department with an infected prosthesis. He underwent prosthesis resection. All cultures failed to identify the infecting organism. Analysis of the intraoperative samples by next-generation sequencing revealed Streptococcus canis (an organism that resides in the oral cavity of dogs). It was later discovered that the patient had sustained a dog scratch injury several days earlier. The patient reports that his dog had licked the scratch. Treatment was delivered based on the sensitivity of S. canis, and the patient has since undergone reimplantation arthroplasty.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.08.005
  • Periprosthetic fungal infection of a hip caused by Trichosporon inkin

    • Authors: Federico José Burgo; Diego Edmundo Mengelle; Agustín Abraham; Guillermina Kremer; Carlos María Autorino
      Pages: 24 - 26
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Federico José Burgo, Diego Edmundo Mengelle, Agustín Abraham, Guillermina Kremer, Carlos María Autorino
      An immunocompromised patient with a history of multiple hip implant revisions extended courses of empiric antibiotic treatment, and a retained metallic rod in the femoral medullary canal was transferred for diagnostic studies and treatment. A high suspicion of fungal infection and utilization of extended and specific fungal cultures were the diagnostic keys for infection with Trichosporon inkin. The treatment consisted in a debridement surgery with the use of a functional spacer with cement supplemented with voriconazole and vancomycin plus a 6-month systemic treatment with voriconazole. After 2 years of follow-up, the patient is free of symptoms.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.05.005
  • Muscle activation pattern during gait and stair activities following total
           hip arthroplasty with a direct anterior approach: a comprehensive case

    • Authors: Swati Chopra; Michael Taunton; Kenton Kaufman
      Pages: 27 - 32
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Swati Chopra, Michael Taunton, Kenton Kaufman
      Muscle activation following total hip arthroplasty with a direct anterior approach has not previously been reported in the literature. This case report details the electromyography outcome of a 60-year-old male patient with unilateral direct anterior approach-total hip arthroplasty during walking and stair activities. Outcome reports the continuation of altered muscle activation 12 months postoperatively, even with a good clinical outcome.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.06.006
  • The direct anterior approach for acetabular augmentation in primary total
           hip arthroplasty

    • Authors: Erin Honcharuk; Stephen Kayiaros; Lee E. Rubin
      Pages: 33 - 39
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Erin Honcharuk, Stephen Kayiaros, Lee E. Rubin
      Addressing acetabular bone defects can be difficult and depends on the amount of bone loss. Augments, either with bone or highly porous metals, are options that still allow the use of a hemispherical cup. Almost all previous research and publication on acetabular augments have focused on revision hip arthroplasty utilizing either a modified lateral or a posterolateral surgical approach. We describe 3 cases of augmenting acetabular bone defects through a direct anterior approach for primary total hip arthroplasty. We achieved proper cup placement, alignment, and augment incorporation while reconstructing complex acetabular deficiencies. All patients had complete pain relief and a satisfactory clinical outcome with stable radiographs at follow-up. With appropriate training, acetabular augmentation can be performed safely and efficiently with excellent clinical results through this approach.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.03.007
  • Intraoperative bladder perforation during primary total hip arthroplasty

    • Authors: Andrew Konopitski; Anthony Boniello; Patrick Wang; Mitesh Shah; Andrew Old; Kevin Gingrich
      Pages: 40 - 43
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Andrew Konopitski, Anthony Boniello, Patrick Wang, Mitesh Shah, Andrew Old, Kevin Gingrich
      We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality. Management of bladder injury, should it occur, includes bladder decompression with a Foley catheter, antibiotic administration, hemodynamic monitoring, and urology consult with close follow-up. This case reinforces the importance of urologic preoperative evaluation for anatomic variations of the bladder. In such cases, intraoperative Foley catheters to prevent distension may reduce the risk of perforation.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.03.008
  • Intraoperative femoral head dislodgement during total hip arthroplasty: a
           report of four cases

    • Authors: Ahmed Siddiqi; Carl T. Talmo; James V. Bono
      Pages: 44 - 50
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Ahmed Siddiqi, Carl T. Talmo, James V. Bono
      Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.08.002
  • Renal failure after placement of an articulating, antibiotic impregnated
           polymethylmethacrlyate hip spacer

    • Authors: Robert P. Runner; Amanda Mener; Thomas L. Bradbury
      Pages: 51 - 57
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Robert P. Runner, Amanda Mener, Thomas L. Bradbury
      A 58-year-old male presented with native joint septic arthritis of the hip and osteomyelitis. After treatment with an articulating antibiotic spacer, he developed acute renal failure requiring dialysis. He continued to have elevated serum tobramycin levels exclusively from the antibiotic spacer elution as no intravenous tobramycin was used. Subsequent explantation was required to correct his renal failure. Although renal failure after antibiotic impregnated cement placement is rare, the risk of this potential complication should be considered preoperatively and in the postoperative management of these patients.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.02.005
  • Biarticular total femur spacer for massive femoral bone loss: the mobile
           solution for a big problem

    • Authors: Pablo Sanz-Ruiz; Jose Antonio Calvo-Haro; Manuel Villanueva-Martinez; Jose Antonio Matas-Diez; Javier Vaquero-Martín
      Pages: 58 - 64
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Pablo Sanz-Ruiz, Jose Antonio Calvo-Haro, Manuel Villanueva-Martinez, Jose Antonio Matas-Diez, Javier Vaquero-Martín
      Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cement-coated tumor prostheses for preparing the spacer. In most cases, the knee joint must be sacrificed. We describe a novel technique for preparing a biarticular total femur spacer with the help of a trochanteric nail coated with antibiotic loaded cement, allowing mobility of the hip and knee joints and assisted partial loading until second step surgery. This technique is helpful to maintain the length of the leg, prevent soft tissue contracture, and help eradicate the infection preserving the patient comfort and autonomy while waiting to receive total femoral replacement.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.02.007
  • Antibiotic impregnated total femur spacers: a technical tip

    • Authors: Colin D. Canham; Christopher P. Walsh; Stephen J. Incavo
      Pages: 65 - 70
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Colin D. Canham, Christopher P. Walsh, Stephen J. Incavo
      Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers. Custom total femoral spacers are useful in the management of infected femoral megaprostheses and cases with ipsilateral injected hip and knee arthroplasties and severe femoral bone loss.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.06.001
  • A nonsurgical protocol for management of postarthroplasty wound drainage

    • Authors: Michael S. Reich; Kace A. Ezzet
      Pages: 71 - 73
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Michael S. Reich, Kace A. Ezzet
      Persistent wound drainage after total joint arthroplasty can potentiate periprosthetic joint infection. Although current recommendations are to treat persistent wound drainage with surgical debridement, we believe nonoperative treatment may be successful in selected patients. We performed a retrospective analysis of 25 persistently draining hip and knee arthroplasty wounds treated with a protocol consisting of a combination of surgical site aspiration, closure of open wound edges, cessation of anticoagulants, activity modification, and antibiotics (in select patients). Wound drainage ceased in 24 of 25 wounds treated with this protocol. One patient who continued to drain for 3 more days was successfully treated with surgical debridement and evacuation of hematoma. No patient developed infection. We believe this protocol can be successful in many arthroplasty patients.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.03.009
  • Tranexamic acid increases early perioperative functional outcomes after
           total knee arthroplasty

    • Authors: Matthew J. Grosso; David P. Trofa; Jonathan R. Danoff; Thomas R. Hickernell; Taylor Murtaugh; Akshay Lakra; Jeffrey A. Geller
      Pages: 74 - 77
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Matthew J. Grosso, David P. Trofa, Jonathan R. Danoff, Thomas R. Hickernell, Taylor Murtaugh, Akshay Lakra, Jeffrey A. Geller
      Background The purpose of this study was to investigate the influence of tranexamic acid (TXA) on functional outcomes in the immediate postoperative period after total knee arthroplasty (TKA). We hypothesized that the known benefits of TXA would confer measurable clinical improvements in physical therapy (PT) performance, decrease pain, and decrease hospital length of stay (LOS). Methods We retrospectively analyzed 560 TKA patients, including 280 consecutive patients whose surgery was performed before the initiation of a standardized TXA protocol and the first 280 patients who received TXA after protocol initiation. Outcome measurements included postoperative changes in hemoglobin and hematocrit, LOS, pain scores, destination of discharge, and steps ambulated with PT over 5 sessions. Results TXA administration resulted in less overall drops in hemoglobin (P < .001) and hematocrit levels (P < .001). Moreover, patients administered TXA ambulated more than their counterparts during every PT session, which was statistically significant during the second (P = .010), third (P = .011), and fourth (P = .024) sessions. On average, the TXA cohort ambulated 20% more per PT session than patients who did not receive TXA (P < .001). TXA administration did not influence pain levels during PT, hospital LOS, or discharge destination in this investigation. Conclusions It is well known that TXA reduces postoperative anemia, but this study also demonstrates that it confers early perioperative functional benefits for TKA patients. Potential mechanisms for this benefit include reduced rates of postoperative anemia and reduced rates of hemarthroses.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.05.009
  • A computer-assisted, tibia-first technique for improved femoral component
           rotation in total knee arthroplasty

    • Authors: Chong Meng Lee; Malkit K. Dhillon; Mohd Amin Sulaiman
      Pages: 78 - 84
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Chong Meng Lee, Malkit K. Dhillon, Mohd Amin Sulaiman
      Background The use of navigation for total knee arthroplasty (TKA) improves limb alignment in the coronal and sagittal planes. However, similar improvements in femoral and tibial component rotation have not yet been realized using currently available systems. Methods We developed a modified navigated TKA technique in which femoral rotation was set using the resected tibial plane as the reference with the aim of achieving a rectangular flexion gap. Limb alignment was assessed in a cohort of 30 knees using the navigation system. Post-operative limb alignment was measured using long-leg standing radiographs. Computed tomography was used to determine post-operative component orientation. Results Sagittal alignment data improved from a mean of 7.8° varus (pre-operative) to 0.0° (post-operative), assessed by intra-operative navigation. Post-operative hip-knee-ankle axis alignment was 0.9° valgus (mean; standard deviation [SD] 1.7°). Mean femoral component rotation was 0.5° internally rotated (SD 2.6°), relative to the surgical transepicondylar axis. Mean tibial component rotation was 0.9° externally rotated (SD 5.5°). No soft tissue releases were performed. Conclusions These results confirm that the desired femoral rotation, set using a tibia-first approach with the resected tibial plane as the reference, can be achieved without compromising overall limb alignment. Femoral component rotation was within a narrow range, with a moderate improvement in achieving more consistent tibial component rotation compared with other techniques. This technique may prove to be useful for surgeons wishing to employ a tibia-first philosophy for TKA while maximizing the benefits associated with computer-assisted navigation.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.06.007
  • A prospective, randomized, comparative study of intravenous alone and
           combined intravenous and intraarticular administration of tranexamic acid
           in primary total knee replacement

    • Authors: Paolo Adravanti; Eleonora Di Salvo; Giuseppe Calafiore; Sebastiano Vasta; Aldo Ampollini; Michele Attilio Rosa
      Pages: 85 - 88
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Paolo Adravanti, Eleonora Di Salvo, Giuseppe Calafiore, Sebastiano Vasta, Aldo Ampollini, Michele Attilio Rosa
      Background Studies on the use of tranexamic acid (TXA) to improve clinical outcomes after joint arthroplasty have reported contrasting results between intravenous (IV) TXA alone and combined IV and intraarticular (IA) administration. We compared the effectiveness of the 2 methods in providing higher postoperative hemoglobin (Hb) levels in patients undergoing primary total knee arthroplasty (TKA). Methods A total of 100 TKA patients were randomly assigned to receive either IV TXA alone (group 1) or combined IV and topical IA TXA (group 2). Hb and hematocrit levels were measured before and after surgery. The amount of drained blood and transfused blood for the 2 groups was compared. Results The Hb level was significantly higher at postoperative day 4, together with a positive, albeit not significant, trend toward less postoperative blood loss in the group that received combined IV and IA TXA. No postoperative infections or deep venous thrombosis events occurred. Conclusions This study reinforces evidence that, as compared to IV TXA alone, combined IV and IA administration of TXA has a synergic effect, leading to higher postoperative Hb levels without influencing drug safety in TKA patients.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.08.004
  • Continuing versus discontinuing antiplatelet drugs, vasodilators, and/or
           cerebral ameliorators on perioperative total blood loss in total knee
           arthroplasty without pneumatic tourniquet

    • Authors: Sachiyuki Tsukada; Motohiro Wakui
      Pages: 89 - 93
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Sachiyuki Tsukada, Motohiro Wakui
      Background Although studies have supported the utility of perioperative continuation of antiplatelet drugs, vasodilators, and cerebral ameliorators in most procedures, no study compared total volume of blood loss after total knee arthroplasty (TKA) in patients continuing and discontinuing these drugs. Methods We retrospectively reviewed 266 consecutive patients undergoing TKA, and included 67 patients (25.2%) taking antiplatelet drugs, vasodilators, or cerebral ameliorators in this study. All TKAs were performed without a pneumatic tourniquet. The primary outcome was perioperative total blood loss calculated from blood volume and change in hemoglobin. As subgroup analysis, we compared perioperative total blood loss in patients taking antiplatelet drugs. Results There was no significant difference between the continuing group (n = 38) and discontinuing group (n = 29) in terms of the perioperative total blood loss (1025 ± 364 vs 1151 ± 327 mL, respectively; mean difference 126 mL; 95% confidence interval −45 to 298 mL; P = .15). No major bleeding or thrombotic events occurred in either group until postoperative 3-month follow-up. In patients taking antiplatelet drugs (n = 51), no significant difference was observed in the total blood loss between the continuing group (n = 30) and discontinuing group (n = 21) (1056 ± 287 vs 1151 ± 305 mL, respectively; mean difference 95 mL; 95% confidence interval −75 to 264 mL; P = .27). Conclusions No significant differences in terms of perioperative total blood loss were observed between patients continuing and discontinuing study drugs. Continuing these drugs may be preferable in the perioperative period of TKA.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.07.002
  • The ratio of patient body mass index to age: a cost-effective implant
           selection guideline for total knee arthroplasty

    • Authors: Feroz A. Osmani; Nicholas Bolz; Khalid Odeh; Craig Bearison; Ran Schwarzkopf; Richard Iorio
      Pages: 94 - 98
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Feroz A. Osmani, Nicholas Bolz, Khalid Odeh, Craig Bearison, Ran Schwarzkopf, Richard Iorio
      Background We sought to develop an objective implant selection guideline based on the ratio of patient body mass index (BMI) to age in order to select implants preoperatively and reduce cost while maintaining quality. The BMI-to-age ratio can be used to distinguish patient demand and select those patients who may benefit from newer technology and higher cost implants and those who would do well with standard-demand implants. Methods A retrospective analysis investigated the types of implants received by patients undergoing total knee arthroplasty from January 2012 to August 2014. Patients with a BMI-to-age ratio >0.60 were categorized as high demand and were eligible for either a high-demand implant or a standard-demand implant. Patients with a BMI-to-age ratio ≤0.60 were recognized as standard demand and would be eligible for only standard-demand implants. The actual implant received was identified and compared with the implant as predicted by the BMI-to-age ratio and potential cost savings were identified. Results A total of 1507 operative knees were identified. The high-demand implant carries a 31% greater cost than that of a standard-demand implant. Thirty-eight of 1084 high-demand implants were placed in standard-demand knees. An additional 1.1% cost was realized with 38 standard-demand knees receiving high-demand implants and 28.6% if high-demand knees had been used in all standard-demand patients. Conclusions Limiting the use of high-demand implants to high-functional-demand patients based on the BMI-to-age ratio may guide the surgeon's choice in optimizing implant selection while providing value-based purchasing criteria to the selection of total knee arthroplasty implants.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.08.001
  • Correlation between Single Assessment Numerical Evaluation score and
           Lysholm score in primary total knee arthroplasty patients

    • Authors: Ted Sueyoshi; Gen Emoto; Toru Yato
      Pages: 99 - 102
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Ted Sueyoshi, Gen Emoto, Toru Yato
      Background There are numerous subjective rating scales available to evaluate outcomes of total knee arthroplasty (TKA). Single Assessment Numerical Evaluation (SANE) score was developed to reduce the burden of patients or clinicians to evaluate patients' status by asking patients to simply rate the current status of their injured body part on a scale of 0-100. The purpose of this study is to investigate the correlation between SANE score and Lysholm score in patients who underwent primary TKA. Methods Forty-nine patients who underwent primary TKA participated. Patients who underwent bilateral TKA or revision TKA were excluded from this study. They were asked to respond to SANE and Lysholm scores. Regression analysis was used to evaluate the correlation between 2 scores. Bilateral isometric quadriceps strength and limb symmetry index were also measured and recorded. Results There were a total of 49 patients in the study. The mean age of the subjects was 73.04 ± 6.63 years. The mean height and body weight were 153.37 ± 8.81 cm and 55.51 ± 8.61 kg, respectively. The mean scores for SNAE and Lysholm scores were 66.08 ± 16.77 and 71.0 ± 17.55, respectively. Pearson r correlation coefficient between SANE and Lysholm scores was 0.38 (P = .003). Regression analysis showed statistically significant correlation between 2 scores with r 2 of 0.15 (P = .005). The average time from surgery was 16.02 weeks. The mean isometric quadriceps strength was 26.76 ± 11.30 kgf for the involved knee and 40.58 ± 11.55 kgf for the non-involved knee. The limb symmetry index was 66.10% ± 21.51%. Conclusions The results of the investigation showed that there was a statistically significant, however relatively weak, correlation between SANE score and Lysholm score. SANE score may serve as an alternative method to assess TKA patients' subjective post-operative outcomes to Lysholm score.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.09.004
  • Can an arthroplasty risk score predict bundled care events after total
           joint arthroplasty'

    • Authors: Blair S. Ashley; Paul Maxwell Courtney; Daniel J. Gittings; Jenna A. Bernstein; Gwo Chin Lee; Eric L. Hume; Atul F. Kamath
      Pages: 103 - 106
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Blair S. Ashley, Paul Maxwell Courtney, Daniel J. Gittings, Jenna A. Bernstein, Gwo Chin Lee, Eric L. Hume, Atul F. Kamath
      Background The validated Arthroplasty Risk Score (ARS) predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS), discharge disposition, and episode-of-care cost (EOCC). Methods We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation. Results ARS implementation was associated with fewer patients going to a skilled nursing or rehabilitation facility after discharge (63% vs 74%, P = .002). There was no difference in LOS, EOCC, readmission rates, or complications. While the adoption of the ARS did not change the mean EOCC, ARS >3 was predictive of high EOCC outlier (odds ratio 2.65, 95% confidence interval 1.40-5.01, P = .003). Increased ARS correlated with increased EOCC (P = .003). Conclusions Implementation of the ARS was associated with increased disposition to home. It was predictive of high EOCC and should be considered in risk adjustment variables in alternative payment models.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.07.005
  • Is a shortened length of stay and increased rate of discharge to home
           associated with a low readmission rate and cost-effectiveness after
           primary total knee arthroplasty'

    • Authors: Steven J. Barad; Stephen M. Howell; Joyce Tom
      Pages: 107 - 112
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Steven J. Barad, Stephen M. Howell, Joyce Tom
      Background It is controversial whether shortening the average length of hospital stay and increasing discharge from a rehabilitation facility to home with either health care or outpatient physical therapy is safe and cost-effective. Methods We computed the average length of hospital stay; the rate of discharge to a rehabilitation facility, home with health care, or home with outpatient physical therapy; the all-cause readmission rate within 30 days of discharge per year; and cost savings for 2328 consecutive patients treated with a unilateral primary total knee replacement between 2009 and 2014. Results The average length of hospital stay per year shortened from 2.0 to 1.3 days (P < .0001); the rate of discharge per year to a rehabilitation facility decreased from 41% to 1% and increased from 9% to 53% to home with outpatient physical therapy (P < .0001); and the rate of readmission within 30 days per year did not change (P = .38). The cost savings averaged $3245 per patient. Conclusions A shorter length of hospital stay and an increased rate of discharge to home was not associated with an increased rate of readmission within 30 days and was cost-effective. Level of Evidence Level IV, Therapeutic study

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2015.08.003
  • Physical therapists collect different outcome measures after total joint
           arthroplasty as compared to most orthopaedic surgeons: a New England study

    • Authors: Allicia Imada; Nathaniel Nelms; David Halsey; Michael Blankstein
      Pages: 113 - 117
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Allicia Imada, Nathaniel Nelms, David Halsey, Michael Blankstein
      Background Following total knee and hip arthroplasty, patient progress can be assessed with patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collecting several measures, including Patient Reported Outcome Measure Information System Global, Knee Injury and Osteoarthritis Outcome Score Jr, and Hip Injury and Osteoarthritis Outcome Score Jr. This study aimed to assess the current and anticipated use of PROMs and PBOMs by New England physical therapists. Methods An online survey was conducted in July and August of 2015 asking physical therapists in New England to rate their current and anticipated future use of PROMs and PBOMs in terms of clinical decision making associated with the treatment and care of patients after total hip and knee replacement. Results There were 122 responses. The most often used and recommended PROMS were the Numeric Pain Rating Scale (99.2% and 97.5%, respectively) and Lower Extremity Function Scale (76.2% and 77.0%). There was significant variability in the use of different PBOMs, but the most often used and recommended were the Timed Up and Go (93.4% and 85.2%) and the Single Leg Balance Test (90.2% and 87.7%). Conclusions This study suggests that orthopaedic surgeons and physical therapists use different PROMs and PBOMs for postoperative assessment of total joint patients and highlights the need for more collaboration and consistency between these disciplines.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.08.003
  • Don't forget the hip! Hip arthritis masquerading as knee pain

    • Authors: Florian F. Dibra; Hernan A. Prieto; Chancellor F. Gray; Hari K. Parvataneni
      Pages: 118 - 124
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Florian F. Dibra, Hernan A. Prieto, Chancellor F. Gray, Hari K. Parvataneni
      Background Hip osteoarthritis typically manifests with groin or thigh pain. Other atypical pain patterns, including knee pain, have been described. Except for 2 case reports, there is no literature on this subject. Methods From our institutional database, between 2011 and 2016, we identified 21 patients who were referred for treatment of knee pain but ultimately diagnosed with hip pathology as the cause of their pain. This group was evaluated for duration of symptoms prior to diagnosis, previous interventions, presence of walking aids, and symptom resolution after treatment of the hip pathology. Results Fifteen of the 21 patients were referred from musculoskeletal providers (12 from orthopaedic surgeons). Prior to diagnosis of the hip etiology, 16 patients were reduced to major assistive devices including wheelchairs. Twelve of 21 patients had undergone surgical knee interventions, including total knee arthroplasty, with minimal to no relief of their pain. Seventeen of 21 referred patients underwent total hip arthroplasty at our institution. Fourteen patients had complete resolution of knee pain after total hip arthroplasty. Conclusions Although knee pain referred from hip disease may be considered a basic and common knowledge, it continues to be an overlooked phenomenon. Most of the cases were misdiagnosed by musculoskeletal providers including orthopaedic surgeons and this highlights the need for continued education and awareness of this clinical scenario.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.06.008
  • The effect of wound dressings on infection following total joint

    • Authors: Kevin K. Chen; Ameer M. Elbuluk; Jonathan M. Vigdorchik; William J. Long; Ran Schwarzkopf
      Pages: 125 - 129
      Abstract: Publication date: March 2018
      Source:Arthroplasty Today, Volume 4, Issue 1
      Author(s): Kevin K. Chen, Ameer M. Elbuluk, Jonathan M. Vigdorchik, William J. Long, Ran Schwarzkopf
      Background The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA. Methods MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA. All studies comparing Hydrofibre dressings to Standard dressings or Absorbent dressings were included in this meta-analysis. Studies looking at TJA secondary to trauma were excluded. Two individuals independently extracted data, and study results were divided based on type of treatment. The primary outcome was to compare the infection rate of Hydrofibre dressings to that of both Standard Dressings and Absorbent dressings. Results Of a total of 3721 participants, 1483 were treated with Standard dressings (non-impregnated gauze), 1911 with Hydrofibre dressings, and 327 with Absorbent dressings. The risk ratio for infection comparing Standard with Hydrofibre was 4.16 (95% confidence interval, 1.71-10.16) as compared to 2.60 (95% confidence interval, 0.66-10.27) when comparing Absorbent with Hydrofibre dressings. Conclusions Our analysis suggests that Hydrofibre dressings may be significantly better than Standard and Absorbent dressings with respect to reducing infection. However, given the observed heterogeneity and small number of studies included, more comparative studies are needed to definitively recommend superiority among dressings following TJA. Level of Evidence Level 1.

      PubDate: 2018-03-07T20:41:49Z
      DOI: 10.1016/j.artd.2017.03.002
  • Short-term safety and effectiveness of a second-generation motion-guided
           total knee system

    • Authors: Adam I. Harris; Tianyi David Luo; Jason E. Lang; Branko Kopjar
      Abstract: Publication date: Available online 16 February 2018
      Source:Arthroplasty Today
      Author(s): Adam I. Harris, Tianyi David Luo, Jason E. Lang, Branko Kopjar
      Background Modern knee prostheses are designed to more closely replicate normal knee kinematics. The JOURNEY II Bi-Cruciate Stabilized Total Knee System (Smith & Nephew Inc., Memphis, TN) is a second-generation motion-guided knee system that demonstrates axial rotation patterns during flexion, which resemble those of the normal knee. The aim of this study was to assess the short-term safety and effectiveness of this system in standard clinical practice. Methods A total of 186 subjects (209 primary total knee arthroplasties [TKAs]) were enrolled at 12 U.S. sites. Subjects were operated on between December 2011 and October 2013 and followed for 24 months. Radiographic, clinical, and patient-reported outcome data were collected at 6-, 12-, and 24-month postoperatively. Results At 24-month follow-up, the average objective Knee Society Score was 96.20 (standard deviation [SD] = 6.63), the average satisfaction score was 35.22 (SD = 6.63), the average expectation score was 10.91 (SD = 3.16), and the average functional activities score was 81.49 (SD = 14.65). On a 0-10 scale, pain level for walking was 0.79 (SD = 1.51) and 1.50 (SD = 1.97) for climbing stairs or inclines. The cumulative incidence of reoperation at 2-year follow-up was 1.48% (95% confidence interval [CI] 0.48%-4.52%). Ten TKAs in 7 patients were treated with closed manipulations for stiffness. Iliotibial band syndrome was reported in 2 TKAs. Two deep infections occurred, 1 requiring reoperation. No dislocations occurred in the study cohort. Conclusions In short-term follow-up, the JOURNEY II Bi-Cruciate Stabilized Guided Motion Total Knee System appears to be a safe and effective device for TKA.

      PubDate: 2018-02-16T20:41:19Z
      DOI: 10.1016/j.artd.2017.11.007
  • Rapid destructive osteoarthritis of the hip after intra-articular steroid

    • Authors: Anurag Tiwari; Yugal Karkhur; James A. Keeney; Ajay Aggarwal
      Abstract: Publication date: Available online 15 February 2018
      Source:Arthroplasty Today
      Author(s): Anurag Tiwari, Yugal Karkhur, James A. Keeney, Ajay Aggarwal
      Rapid destructive osteoarthritis of the hip is a separate entity different from the usual osteoarthritis. It is usually seen in elderly women, and the characteristic feature is the rapid progression within 6 to 12 months to complete destruction of the joint. The exact etiology is not known. We present a rare case of rapid destructive osteoarthritis of the hip in a 62-year-old woman who developed it within 2 months of intra-articular steroid injection, which was managed well with uncemented total hip arthroplasty. Through this report, we emphasize the possibility of the disastrous complication of injection, which should be informed to the patient before any intra-articular injection.

      PubDate: 2018-02-16T20:41:19Z
      DOI: 10.1016/j.artd.2018.01.002
  • Postoperative prophylactic antibiotics in total joint arthroplasty

    • Authors: Adolph J. Yates
      Abstract: Publication date: Available online 14 February 2018
      Source:Arthroplasty Today
      Author(s): Adolph J. Yates
      The Center for Disease Control and Prevention recently released their 2017 Guideline for the Prevention of Surgical Site Infection. One of their recommendations is the ordering of a single dose of preoperative prophylactic antibiotics with no subsequent postoperative dosing; this recommendation includes perioperative antibiotics for patients undergoing total joint arthroplasty. At this time, the American Association of Hip and Knee Surgeons (AAHKS) does not agree with this recommendation vis-a-vis total joint arthroplasty because it contradicts current international standards of care with limited evidence and study. AAHKS still recommends postoperative antibiotics and recommends further research. Both the Board of Counselors and Board of Specialty Societies of the American Academy of Orthopaedic Surgeons have endorsed this AAHKS recommendation through an advisory opinion; the American Academy of Orthopaedic Surgeons Board of Directors adopted that advisory opinion in June 2017. A 2017 Foundation for Arthroplasty Research and Education prospective, randomized study is being undertaken to provide level I evidence for or against single-dose vs 24-hour antibiotic prophylaxis in primary total knee arthroplasty.

      PubDate: 2018-02-16T20:41:19Z
      DOI: 10.1016/j.artd.2018.01.003
  • Radiographic assessment and clinical outcomes after total knee
           arthroplasty using an accelerometer-based portable navigation device

    • Authors: Hiroaki Shoji; Atsushi Teramoto; Tomoyuki Suzuki; Yohei Okada; Kota Watanabe; Toshihiko Yamashita
      Abstract: Publication date: Available online 12 February 2018
      Source:Arthroplasty Today
      Author(s): Hiroaki Shoji, Atsushi Teramoto, Tomoyuki Suzuki, Yohei Okada, Kota Watanabe, Toshihiko Yamashita
      It has been reported that an accelerometer-based portable navigation device can achieve accurate bone cuts, but there have been few studies of clinical outcomes after total knee arthroplasty (TKA) using such a device. The aim of this study was to evaluate lower limb alignment and clinical outcomes after TKA using an accelerometer-based portable navigation device. Thirty-five patients (40 knees) underwent primary TKAs using an accelerometer-based portable navigation device. Postoperative radiographic assessments included the hip-knee-ankle angle, femoral component angle (FCA), and tibial component angle (TCA) in the coronal plane and the sagittal FCA and sagittal TCA in the sagittal plane. Clinical outcomes were evaluated by the Japanese Orthopedic Association score for osteoarthritic knees, Japanese Knee Osteoarthritis Measure, and the New Knee Society Score. The frequency of outliers (>3 degrees) was 10% for the hip-knee-ankle angle, 8% for FCA, 0% for TCA, 19% for sagittal FCA, and 9% for sagittal TCA. The Japanese Orthopedic Association score and Japanese Knee Osteoarthritis Measure were significantly improved postoperatively. The postoperative New Knee Society Score was 67.2% for symptoms, 50.3% for satisfaction, 58.6% for expectation, and 44.1% for function. TKA using an accelerometer-based portable navigation device achieved good results for both lower limb alignment and clinical outcomes.

      PubDate: 2018-02-16T20:41:19Z
      DOI: 10.1016/j.artd.2017.11.012
  • Tibial tray fracture in a modern prosthesis with retrieval analysis

    • Authors: John J. Callaghan; David E. DeMik; Nicholas A. Bedard; Andrew N. Odland; William M. Kane; Steven M. Kurtz
      Abstract: Publication date: Available online 10 February 2018
      Source:Arthroplasty Today
      Author(s): John J. Callaghan, David E. DeMik, Nicholas A. Bedard, Andrew N. Odland, William M. Kane, Steven M. Kurtz
      Fracture of the tibial tray is a rarely observed complication of total knee arthroplasty (TKA), predominately in implants placed greater than a decade ago. This case highlights a case of baseplate fracture in a contemporary prosthesis. The patient presented 1 year after TKA with medial knee pain consistent with pes bursitis. The implant-cement-bone construct was intact and she was managed with corticosteroids. She had persistent pain, acutely developed new varus deformity, and presented with a tibial tray fracture. Retrieval analysis suggested fatigue fracture as the likely mechanism. At time of revision, necrotic bone was found at the medial plateau, which likely caused cantilever bending relative to the well-supported portion of the tray and resultant failure. The patient continues to do well 5 years after revision TKA.

      PubDate: 2018-02-16T20:41:19Z
      DOI: 10.1016/j.artd.2017.12.005
  • A novel use of a tibial cone in a proximal femoral replacement

    • Authors: Hilary Koech; Joshua M. Lawrenz; Daniel R. Mesko; Robert M. Molloy
      Abstract: Publication date: Available online 1 February 2018
      Source:Arthroplasty Today
      Author(s): Hilary Koech, Joshua M. Lawrenz, Daniel R. Mesko, Robert M. Molloy
      Revision total hip arthroplasty in the setting of severe femoral bone loss can be challenging, with salvage options often limited to modular tapered stems, allograft prosthetic composites, and megaprostheses. This case highlights a 79-year-old woman with 2 years of thigh pain who is 8 years status post a revision proximal femoral allograft prosthetic composite reconstruction. Radiographs demonstrated significant stem subsidence into the femoral condyle. In an attempt to avoid a total femoral replacement and spare her functioning native knee, a tibial cone was used in conjunction with a proximal femoral replacement to structurally fill the flaring femoral canal and serve as a stable pedestal for the megaprosthesis body and provide the potential for biologic ingrowth. At 12-month follow-up, she ambulates with a cane, and radiographs reveal stable implant position.

      PubDate: 2018-02-06T16:15:37Z
      DOI: 10.1016/j.artd.2017.12.006
  • Primary lower limb joint replacement and tranexamic acid: an observational
           cohort study

    • Authors: Llion Davies; Kylie Bainton; Robyn Milne; Peter Lewis
      Abstract: Publication date: Available online 1 February 2018
      Source:Arthroplasty Today
      Author(s): Llion Davies, Kylie Bainton, Robyn Milne, Peter Lewis
      Background This work aimed to evaluate the efficacy and safety of routine tranexamic acid (TXA) use in elective orthopaedic lower limb joint replacement surgery. Methods This retrospective cohort study included all primary hip or knee replacement procedures by a single surgeon over a 6-year period. TXA was introduced during the study period as part of an enhanced recovery after surgery strategy. Results Of the 673 procedures, 446 cases (66.3%) received TXA. The median length of stay was 5 days (2-69) and 6 days (3-28) for the TXA and control groups, respectively (P < .001). Blood transfusion was required for 28 (6.3%) of the TXA cases versus 40 (17.6%) controls (P < .001). Complication rates were similar irrespective of TXA status. At multivariate analysis, TXA was significantly and independently associated with fewer blood transfusions (hazard ratio 0.309, 95% confidence interval: 0.168-0.568, P < .001), with a number needed to treat of 9 cases. TXA use was estimated to save between £67.89 and £155.90 per case. Conclusions Routine prophylactic TXA administration for elective primary hip and knee replacement reduces the likelihood of postoperative transfusion with a number needed to treat of 9. Cost savings may be as high as £155.90 per case, and no safety concerns were noted.

      PubDate: 2018-02-06T16:15:37Z
      DOI: 10.1016/j.artd.2017.12.001
  • Low rates of renal injury in total joint arthroplasty patients without
           pre-existing renal disease

    • Authors: Jessica M. Hooper; Benjamin S. Kester; Ran Schwarzkopf
      Abstract: Publication date: Available online 1 February 2018
      Source:Arthroplasty Today
      Author(s): Jessica M. Hooper, Benjamin S. Kester, Ran Schwarzkopf
      Acute kidney injury is a reported complication of total joint arthroplasty (TJA), with potentially severe long-term complications. Our study aimed to identify the rate of perioperative renal injury in patients without pre-existing renal dysfunction who undergo TJA. Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified a mean annual rate of perioperative renal injury of 0.172% between 2009 and 2015. Factors most strongly associated with perioperative renal injury are age of 70 years or older, current smoking, history of diabetes mellitus, history of hypertension, and American Society of Anesthesiologists class of 3 or greater. There was no significant increase in the rate of renal injury from year to year. In patients without pre-existing renal disease, perioperative rates of acute kidney injury remain low in patients undergoing TJA.

      PubDate: 2018-02-06T16:15:37Z
      DOI: 10.1016/j.artd.2017.12.007
  • Corrigendum to “Delayed diagnosis of catastrophic ceramic liner failure
           with resultant pelvic discontinuity and massive metallosis” [ARTD 3
           (2017) 77–82]

    • Authors: Benjamin A. Winston; Ryland P. Kagan; Thomas W. Huff
      Abstract: Publication date: Available online 20 January 2018
      Source:Arthroplasty Today
      Author(s): Benjamin A. Winston, Ryland P. Kagan, Thomas W. Huff

      PubDate: 2018-01-26T17:18:18Z
      DOI: 10.1016/j.artd.2018.01.001
  • Lyme periprosthetic joint infection in total knee arthroplasty

    • Authors: Murillo Adrados; Daniel Howard Wiznia; Marjorie Golden; Richard Pelker
      Abstract: Publication date: Available online 19 January 2018
      Source:Arthroplasty Today
      Author(s): Murillo Adrados, Daniel Howard Wiznia, Marjorie Golden, Richard Pelker
      Lyme arthritis, caused by the spirochete Borrelia burgdorferi sensu stricto, is a common tick-borne illness in New England and the upper Midwest. Most often, the disease affects the knee and has typically been reported as a cause of native joint infection. There has been only 1 case of Lyme periprosthetic joint infection (associated with a total knee arthroplasty) reported in the literature, and to our knowledge, no other reported cases of Lyme periprosthetic joint infections exist. In this article, we report on 2 patients diagnosed with prosthetic joint infections who were subsequently found to have Lyme prosthetic joint infections, with B burgdorferi as the infectious organism. We discuss the medical and surgical management of these patients.

      PubDate: 2018-01-26T17:18:18Z
      DOI: 10.1016/j.artd.2017.12.003
  • Abundant heterotopic bone formation following use of rhBMP-2 in the
           treatment of acetabular bone defects during revision hip arthroplasty

    • Authors: Alexander Arzeno; Tim Wang; James I. Huddleston
      Abstract: Publication date: Available online 12 January 2018
      Source:Arthroplasty Today
      Author(s): Alexander Arzeno, Tim Wang, James I. Huddleston
      Revision hip arthroplasty in the setting of periacetabular bone loss presents a significant challenge, as options for restoring bone loss are limited. Recombinant human bone morphogenetic protein-2 may offer a solution by promoting bone growth to restore bone stock before implant reimplantation. Here we present a case of a patient with a periprosthetic acetabulum fracture, resulting in pelvic discontinuity as the result of significant periacetabular bone loss. Using a staged approach, periacetabular bone stock was nearly entirely reconstituted using recombinant BMPs and allograft, which resulted in stable fixation, but with abundant heterotopic bone formation. Recombinant BMP-2 offers a useful tool for restoring bone stock in complex hip arthroplasty revision cases with periacetabular bone loss; however, caution must be used as overabundant bone growth as heterotopic ossification may result.

      PubDate: 2018-01-15T17:25:04Z
      DOI: 10.1016/j.artd.2017.12.004
  • Early aseptic loosening of the Tritanium primary acetabular component with
           screw fixation

    • Authors: William J. Long; Samir Nayyar; Kevin K. Chen; David Novikov; Roy I. Davidovitch; Jonathan M. Vigdorchik
      Abstract: Publication date: Available online 2 January 2018
      Source:Arthroplasty Today
      Author(s): William J. Long, Samir Nayyar, Kevin K. Chen, David Novikov, Roy I. Davidovitch, Jonathan M. Vigdorchik
      Ultraporous acetabular components were developed to improve osseointegration and fit for increased longevity and better outcomes after total hip arthroplasty. There is a paucity of literature detailing this acetabular component’s clinical performance, with even less detailing those with screw fixation. We identify 5 patients at our institution who underwent revision total hip arthroplasty for early aseptic acetabular cup loosening of an ultraporous acetabular component known as the Tritanium primary cup with secondary screw fixation. They all presented with groin and hip pain after index surgery and underwent follow-up radiographic examination consistent with component loosening requiring revision surgery. This case series reports on the risk of early acetabular cup loosening and its associated clinical presentation, workup, and surgical management in patients with the Tritanium primary cup augmented with screws.

      PubDate: 2018-01-03T22:05:09Z
      DOI: 10.1016/j.artd.2017.11.009
  • Empiric treatment is less costly than Staphylococcus aureus screening and
           decolonization in total joint arthroplasty patients

    • Authors: Jacob Stirton; Joseph Scott Herron; Sumon Nandi
      Abstract: Publication date: Available online 30 December 2017
      Source:Arthroplasty Today
      Author(s): Jacob Stirton, Joseph Scott Herron, Sumon Nandi
      The aim of our study was to compare the cost of preoperative empiric mupirocin treatment of all total joint arthroplasty patients with a standard Staphylococcus aureus screening and decolonization protocol. The cost of empiric mupirocin treatment is $24.65 per patient, whereas the cost of a standard S. aureus screening and decolonization protocol is $60.32 per patient. Given that more than 1,051,000 total joint arthroplasties are performed annually, the cost savings with empiric treatment is nearly $40 million per year. Empiric treatment allows for more efficient workflow, minimizes potential for clerical error, eliminates risk of undertreatment, and has not been shown to increase antibiotic resistance.

      PubDate: 2018-01-03T22:05:09Z
      DOI: 10.1016/j.artd.2017.11.011
  • Corrosion and adverse tissue reaction after modular unipolar hip

    • Authors: Brian F. Moore; Paul F. Lachiewicz
      Pages: 207 - 210
      Abstract: Publication date: December 2017
      Source:Arthroplasty Today, Volume 3, Issue 4
      Author(s): Brian F. Moore, Paul F. Lachiewicz
      Modern unipolar hip hemiarthroplasty, commonly used for displaced femoral neck fracture, is now modular, with both a variable length cobalt-chromium adapter-sleeve and large femoral head. Patients with these modular components may develop symptomatic trunnion corrosion, with elevated serum metal levels. We report the case of an 82-year-old woman, 5.5 years after a modular unipolar hip hemiarthroplasty, who presented with a 4-month history of hip pain and limp. Evaluation showed elevated serum cobalt and chromium levels and an acetabular cyst. At revision, fluid, tissue, and gross inspection were consistent with trunnion corrosion. The hip was revised with a ceramic head and dual mobility acetabular component, with a good result at 1 year. The designs of commercially available, modern unipolar hip hemiarthroplasty prostheses are reviewed.

      PubDate: 2017-11-30T13:37:04Z
      DOI: 10.1016/j.artd.2017.01.002
  • Corrosion and adverse local tissue reaction after total hip arthroplasty
           with a modular titanium alloy femoral neck

    • Authors: Colin D. Canham; Pavel I. Muradov; Jordan B. Simpson; Stephen J. Incavo
      Pages: 211 - 214
      Abstract: Publication date: December 2017
      Source:Arthroplasty Today, Volume 3, Issue 4
      Author(s): Colin D. Canham, Pavel I. Muradov, Jordan B. Simpson, Stephen J. Incavo
      This report describes a case of mechanically assisted crevice corrosion and secondary adverse local tissue reaction in a patient following a total hip arthroplasty, utilizing a modular neck (bi-modular) femoral component. Radiographic evaluation demonstrated a well-positioned, stable, cementless arthroplasty. Upon further evaluation, the patient had elevated serum cobalt and chromium levels, and magnetic resonance imaging demonstrated a periprosthetic pseudotumor. Corrosion of both the neck-stem and head-neck junctions was suspected. At the time of surgery, the neck-body junction was pristine; however, the head-neck junction of the implant demonstrated severe corrosive wear, a problem that has been reported only once previously with this particular bi-modular implant. This serves as a reminder that any modular junction may be susceptible to corrosion and not all bi-modular designs behave similarly.

      PubDate: 2017-11-30T13:37:04Z
      DOI: 10.1016/j.artd.2017.03.003
  • Response to letter to the editor on “Early intraprosthetic dislocation
           in dual-mobility implants: a systematic review”

    • Authors: Ivan De Martino; Rocco D'Apolito; Bradford S. Waddell; Alexander S. McLawhorn; Peter K. Sculco; Thomas P. Sculco
      Pages: 197 - 202
      Abstract: Publication date: Available online 13 December 2017
      Source:Arthroplasty Today
      Author(s): Ivan De Martino, Rocco D'Apolito, Bradford S. Waddell, Alexander S. McLawhorn, Peter K. Sculco, Thomas P. Sculco

      PubDate: 2017-12-22T12:48:23Z
      DOI: 10.1016/j.artd.2016.12.002
  • Intramuscular hemangioma after total hip arthroplasty: an iatrogenic

    • Authors: Ali H. Sobh; Lane Brown; Drew D. Moore
      Abstract: Publication date: Available online 21 December 2017
      Source:Arthroplasty Today
      Author(s): Ali H. Sobh, Lane Brown, Drew D. Moore
      Soft-tissue hemangioma is a common benign tumor that can develop cutaneously, subcutaneously, or intramuscularly. Hemangioma formation within a muscular compartment is most often developmental in etiology; however, some cases are known to occur after blunt trauma to the soft tissues. To our knowledge, no cases of hemangioma formation after joint arthroplasty have been reported. We present a case of intramuscular hemangioma development within the hip abductor musculature after total hip arthroplasty via an anterolateral approach. Aside from developing congenitally or posttraumatically, hemangiomas may form after surgical dissection and must be considered as a source of anomalous swelling after surgery.

      PubDate: 2017-12-22T12:48:23Z
      DOI: 10.1016/j.artd.2017.11.010
  • Fracture risk of tapered modular revision stems: a failure analysis

    • Authors: Kilian Rueckl; Peter K. Sculco; Jonathan Berliner; Michael B. Cross; Chelsea Koch; Friedrich Boettner
      Abstract: Publication date: Available online 21 December 2017
      Source:Arthroplasty Today
      Author(s): Kilian Rueckl, Peter K. Sculco, Jonathan Berliner, Michael B. Cross, Chelsea Koch, Friedrich Boettner
      Fractures of well-ingrown femoral components are a rare and often challenging complication after revision total hip arthroplasty. Prior series have documented catastrophic failure at the modular junction of revision femoral components. However, to the authors' knowledge, there has been only 1 report of a mid-stem fracture of a modular tapered revision stem. The present article reports 2 cases of fatigue fractures (14 months and 10 years after implantation) of a tapered modular revision stem. It presents the results of the fracture surface analysis, discusses the etiology of failure, and presents the authors' recommendations on how to best avoid this complication.

      PubDate: 2017-12-22T12:48:23Z
      DOI: 10.1016/j.artd.2017.11.002
  • Letter to the editor on “Early intraprosthetic dislocation in
           dual-mobility implants: a systematic review”

    • Authors: Domenico Tigani; Jean Louis Prudhon; Luca Amendola; Thierry Aslanian
      Abstract: Publication date: Available online 13 December 2017
      Source:Arthroplasty Today
      Author(s): Domenico Tigani, Jean Louis Prudhon, Luca Amendola, Thierry Aslanian

      PubDate: 2017-12-22T12:48:23Z
      DOI: 10.1016/j.artd.2017.11.004
  • Shoelace capsular and external rotators closure techniques in posterior
           (southern) approach to hip joint

    • Authors: Kazuha Kizaki; Fumiharu Yamashita; Noboru Funakoshi; Soshi Uchida
      Abstract: Publication date: Available online 8 December 2017
      Source:Arthroplasty Today
      Author(s): Kazuha Kizaki, Fumiharu Yamashita, Noboru Funakoshi, Soshi Uchida
      The possible increased risk of dislocation with a posterior approach for femoral hemiarthroplasty is attributed to disruption of the posterior soft-tissue structures, including the posterior capsular ligament structure and short external rotators of the hip. In this surgical technical note, we demonstrate the surgical technique for shoelace suturing of the external rotators and the capsule with use of ULTRATAPE. After prosthesis stem insertion, shoelace suturing using ULTRATAPE was performed between the great trochanter and the external rotators for preventing the external rotators from tearing. Also, ULTRATAPE was sewed alternately on the split capsule like shoe lacing, and it was laced up from proximal to distal in line with the split as shoelaces tied down. The shoelace suturing technique using ULTRATAPE after a posterior approach to the hip joint, possibly lowers risks of tearing hip capsular ligament and external rotators and stabilizes the posterior wall.

      PubDate: 2017-12-11T12:21:47Z
      DOI: 10.1016/j.artd.2017.11.003
  • Alternative technique for knee manipulation under anesthesia

    • Authors: Kelli S. Baum; Tianyi D. Luo; Shea Comadoll; Anthony Marois; Maxwell Langfitt; John Shields
      Abstract: Publication date: Available online 6 December 2017
      Source:Arthroplasty Today
      Author(s): Kelli S. Baum, Tianyi D. Luo, Shea Comadoll, Anthony Marois, Maxwell Langfitt, John Shields
      Total knee arthroplasty is a successful surgery for the majority of patients with osteoarthrosis of the knee. Approximately 5% of patients undergoing total knee arthroplasty experience loss of motion or arthrofibrosis. Manipulation under anesthesia (MUA) is generally indicated for patients who do not achieve >90° of flexion by 6-12 weeks postoperatively. Complications from MUA are rare but can be devastating. We describe a novel technique for MUA with no reported major complications in our review of 78 patients. The average flexion improved from 80.0 (±3.8) before manipulation to 115.4 (±2.1) after manipulation. There were no major complications including fracture or extensor mechanism injury.

      PubDate: 2017-12-11T12:21:47Z
      DOI: 10.1016/j.artd.2017.07.006
  • The effect of constraint on post damage in total knee arthroplasty:
           posterior stabilized vs posterior stabilized constrained inserts

    • Authors: Joseph Konopka; Lydia Weitzler; Daniel Westrich; Timothy M. Wright; Geoffrey H. Westrich
      Abstract: Publication date: Available online 6 December 2017
      Source:Arthroplasty Today
      Author(s): Joseph Konopka, Lydia Weitzler, Daniel Westrich, Timothy M. Wright, Geoffrey H. Westrich
      Posterior stabilized constrained (PSC) inserts are intended to provide greater varus-valgus and rotational constraint than conventional PS inserts. We determined whether the added constraint resulted in more damage to the post in PSC compared to PS inserts. Retrieved PSC inserts were matched to retrieved PS inserts from the same manufacturer according to patient age, body mass index, and length of implantation. Surface damage was visually assessed, and 3-D surface deviation from pristine was measured. Damage scores for the PSC posts were significantly greater than those of the PS posts. Surface deviation was significantly greater in the posterior and medial post regions of the PSC inserts. Based on short-term follow-up, our results suggest that added constraint is accompanied by greater polyethylene surface damage.

      PubDate: 2017-12-11T12:21:47Z
      DOI: 10.1016/j.artd.2017.11.001
  • Proximal tibial resorption in a modern total knee prosthesis

    • Authors: Justin T. Deen; Terry B. Clay; Dane A. Iams; MaryBeth Horodysky; Hari K. Parvataneni
      Abstract: Publication date: Available online 6 December 2017
      Source:Arthroplasty Today
      Author(s): Justin T. Deen, Terry B. Clay, Dane A. Iams, MaryBeth Horodysky, Hari K. Parvataneni
      Background In an effort to minimize backside polyethylene wear and osteolysis associated with titanium tibial baseplates, many manufacturers have transitioned to cobalt chromium alloys. Recent literature has implicated thicker cobalt chromium designs as a potential source of increased stress shielding and resorption. We report the incidence of proximal tibial bone resorption in a large consecutive series of patients undergoing total knee arthroplasty, with a modern total knee design. Methods Four hundred thirty-two consecutive primary total knee arthroplasties, performed by 2 fellowship-trained arthroplasty surgeons were identified over a 24-month period. In addition to review of the medical records, analysis of preoperative and postoperative radiographs was performed. Utilizing a novel classification system, the severity of resorption was quantified and correlated with patient and implant characteristics. Results After exclusions, 339 knees were evaluated in 292 patients. Mean follow-up was 13.2 months (range 6-41). Resorption was present in 119 knees (35.1%). Average time to diagnosis of bone loss was 6.9 months (range 2-32) postoperatively. There was a statistically significant difference between resorption and nonresorption groups with regards to gender and preoperative alignment. Most cases were classified as Grade 1. During the study period, 2 patients required revision for aseptic tibial loosening. Conclusions Our findings suggest that proximal tibial resorption is common with this particular implant, particularly in men and patients with preoperative varus deformity. Although this typically occurs relatively early in postoperative period and in most cases appears to remodel and stabilize, its ultimate clinical significance and effect on implant survivorship remains unclear.

      PubDate: 2017-12-11T12:21:47Z
      DOI: 10.1016/j.artd.2017.10.005
  • Note from the editor

    • Authors: Brian J. McGrory
      Abstract: Publication date: Available online 16 November 2017
      Source:Arthroplasty Today
      Author(s): Brian J. McGrory

      PubDate: 2017-11-20T05:29:21Z
      DOI: 10.1016/j.artd.2017.09.002
  • Update regarding opportunities for orthopaedic surgeons to contribute to
           postmarket surveillance of potential safety issues for orthopaedic medical
           devices marketed in the United States

    • Authors: Vincent J. Devlin
      Abstract: Publication date: Available online 16 October 2017
      Source:Arthroplasty Today
      Author(s): Vincent J. Devlin

      PubDate: 2017-10-22T14:51:54Z
      DOI: 10.1016/j.artd.2017.09.003
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