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  Subjects -> BIOLOGY (Total: 3190 journals)
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BIOTECHNOLOGY (244 journals)                  1 2 | Last

Showing 1 - 200 of 244 Journals sorted alphabetically
3 Biotech     Open Access   (Followers: 8)
Advanced Biomedical Research     Open Access  
Advances in Bioscience and Biotechnology     Open Access   (Followers: 17)
Advances in Genetic Engineering & Biotechnology     Hybrid Journal   (Followers: 9)
Advances in Regenerative Medicine     Open Access   (Followers: 3)
African Journal of Biotechnology     Open Access   (Followers: 6)
Algal Research     Partially Free   (Followers: 11)
American Journal of Biochemistry and Biotechnology     Open Access   (Followers: 69)
American Journal of Bioinformatics Research     Open Access   (Followers: 7)
American Journal of Polymer Science     Open Access   (Followers: 33)
Amylase     Open Access  
Anadolu University Journal of Science and Technology : C Life Sciences and Biotechnology     Open Access  
Animal Biotechnology     Hybrid Journal   (Followers: 8)
Annales des Sciences Agronomiques     Full-text available via subscription  
Applied Biochemistry and Biotechnology     Hybrid Journal   (Followers: 45)
Applied Biosafety     Hybrid Journal  
Applied Food Biotechnology     Open Access   (Followers: 3)
Applied Microbiology and Biotechnology     Hybrid Journal   (Followers: 67)
Applied Mycology and Biotechnology     Full-text available via subscription   (Followers: 4)
Arthroplasty Today     Open Access   (Followers: 1)
Artificial Cells, Nanomedicine and Biotechnology     Hybrid Journal   (Followers: 1)
Asia Pacific Biotech News     Hybrid Journal   (Followers: 2)
Asian Journal of Biotechnology     Open Access   (Followers: 9)
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: 5)
Beitr?ge zur Tabakforschung International/Contributions to Tobacco Research     Open Access   (Followers: 3)
Bio-Algorithms and Med-Systems     Hybrid Journal   (Followers: 2)
Bio-Research     Full-text available via subscription   (Followers: 4)
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   (Followers: 1)
Biofuels     Hybrid Journal   (Followers: 11)
Biofuels Engineering     Open Access   (Followers: 1)
Biological & Pharmaceutical Bulletin     Full-text available via subscription   (Followers: 4)
Biological Cybernetics     Hybrid Journal   (Followers: 10)
Biomarkers and Genomic Medicine     Open Access   (Followers: 3)
Biomaterials Research     Open Access   (Followers: 4)
BioMed Research International     Open Access   (Followers: 4)
Biomédica     Open Access  
Biomedical and Biotechnology Research Journal     Open Access  
Biomedical Engineering Research     Open Access   (Followers: 6)
Biomedical Glasses     Open Access  
Biomedical Reports     Full-text available via subscription  
BioMedicine     Open Access  
Biomedika     Open Access  
Bioprinting     Hybrid Journal   (Followers: 1)
Bioresource Technology Reports     Hybrid Journal   (Followers: 1)
Bioscience, Biotechnology, and Biochemistry     Hybrid Journal   (Followers: 21)
Biosensors Journal     Open Access  
Biosimilars     Open Access   (Followers: 1)
Biosurface and Biotribology     Open Access  
Biotechnic and Histochemistry     Hybrid Journal   (Followers: 1)
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: 8)
Biotechnology & Biotechnological Equipment     Open Access   (Followers: 4)
Biotechnology Advances     Hybrid Journal   (Followers: 34)
Biotechnology and Applied Biochemistry     Hybrid Journal   (Followers: 44)
Biotechnology and Bioengineering     Hybrid Journal   (Followers: 160)
Biotechnology and Bioprocess Engineering     Hybrid Journal   (Followers: 6)
Biotechnology and Genetic Engineering Reviews     Hybrid Journal   (Followers: 13)
Biotechnology and Health Sciences     Open Access   (Followers: 1)
Biotechnology and Molecular Biology Reviews     Open Access   (Followers: 2)
Biotechnology Annual Review     Full-text available via subscription   (Followers: 5)
Biotechnology for Biofuels     Open Access   (Followers: 10)
Biotechnology Frontier     Open Access   (Followers: 2)
Biotechnology Journal     Hybrid Journal   (Followers: 17)
Biotechnology Law Report     Hybrid Journal   (Followers: 4)
Biotechnology Letters     Hybrid Journal   (Followers: 34)
Biotechnology Progress     Hybrid Journal   (Followers: 41)
Biotechnology Reports     Open Access  
Biotechnology Research International     Open Access   (Followers: 1)
Biotechnology Techniques     Hybrid Journal   (Followers: 10)
Biotecnología Aplicada     Open Access  
Bioteknologi (Biotechnological Studies)     Open Access  
BIOTIK : Jurnal Ilmiah Biologi Teknologi dan Kependidikan     Open Access  
Biotribology     Hybrid Journal   (Followers: 1)
BMC Biotechnology     Open Access   (Followers: 17)
Cell Biology and Development     Open Access  
Chinese Journal of Agricultural Biotechnology     Full-text available via subscription   (Followers: 4)
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)
Copernican Letters     Open Access   (Followers: 1)
Critical Reviews in Biotechnology     Hybrid Journal   (Followers: 20)
Crop Breeding and Applied Biotechnology     Open Access   (Followers: 3)
Current Bionanotechnology     Hybrid Journal  
Current Biotechnology     Hybrid Journal   (Followers: 4)
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: 13)
Current Trends in Biotechnology and Chemical Research     Open Access   (Followers: 3)
Current trends in Biotechnology and Pharmacy     Open Access   (Followers: 8)
DNA and RNA Nanotechnology     Open Access  
EBioMedicine     Open Access  
Electronic Journal of Biotechnology     Open Access  
Entomologia Generalis     Full-text available via subscription   (Followers: 1)
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: 9)
Food Science and Biotechnology     Hybrid Journal   (Followers: 8)
Frontiers in Bioengineering and Biotechnology     Open Access   (Followers: 6)
Frontiers in Systems Biology     Open Access   (Followers: 2)
Fungal Biology and Biotechnology     Open Access   (Followers: 2)
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  
Horticultural Biotechnology Research     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)
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: 2)
Indonesian Journal of Biotechnology     Open Access   (Followers: 1)
Indonesian Journal of Medicine     Open Access  
Industrial Biotechnology     Hybrid Journal   (Followers: 18)
International Biomechanics     Open Access  
International Journal of Bioinformatics Research and Applications     Hybrid Journal   (Followers: 14)
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: 4)
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)
JMIR Biomedical Engineering     Open Access  
Journal of Biometrics & Biostatistics     Open Access   (Followers: 3)
Journal of Bioterrorism & Biodefense     Open Access   (Followers: 6)
Journal of Petroleum & Environmental Biotechnology     Open Access   (Followers: 1)
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: 4)
Journal of Applied Biomedicine     Open Access   (Followers: 2)
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 BioScience and Biotechnology     Open Access  
Journal of Biosecurity Biosafety and Biodefense Law     Hybrid Journal   (Followers: 3)
Journal of Biotechnology     Hybrid Journal   (Followers: 63)
Journal of Biotechnology and Strategic Health Research     Open Access   (Followers: 1)
Journal of Chemical and Biological Interfaces     Full-text available via subscription   (Followers: 1)
Journal of Chemical Technology & Biotechnology     Hybrid Journal   (Followers: 9)
Journal of Chitin and Chitosan Science     Full-text available via subscription   (Followers: 1)
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: 3)
Journal of Ecobiotechnology     Open Access  
Journal of Essential Oil Research     Hybrid Journal   (Followers: 2)
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: 18)
Journal of Integrative Bioinformatics     Open Access  
Journal of Medical Imaging and Health Informatics     Full-text available via subscription  
Journal of Molecular Biology and Biotechnology     Open Access  
Journal of Molecular Microbiology and Biotechnology     Full-text available via subscription   (Followers: 13)
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: 1)
Journal of Organic and Biomolecular Simulations     Open Access  
Journal of Plant Biochemistry and Biotechnology     Hybrid Journal   (Followers: 4)
Journal of Science and Applications : Biomedicine     Open Access  
Journal of the Mechanical Behavior of Biomedical Materials     Hybrid Journal   (Followers: 13)
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: 4)
Meat Technology     Open Access  
Messenger     Full-text available via subscription  
Metabolic Engineering Communications     Open Access   (Followers: 4)
Metalloproteinases In Medicine     Open Access  
Microbial Biotechnology     Open Access   (Followers: 10)
MicroMedicine     Open Access   (Followers: 3)
Molecular and Cellular Biomedical Sciences     Open Access   (Followers: 1)
Molecular Biotechnology     Hybrid Journal   (Followers: 13)
Molecular Genetics and Metabolism Reports     Open Access   (Followers: 3)
Nanobiomedicine     Open Access  
Nanobiotechnology     Hybrid Journal   (Followers: 2)

        1 2 | Last

Journal Cover
Arthroplasty Today
Journal Prestige (SJR): 0.243
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2352-3441
Published by Elsevier Homepage  [3155 journals]
  • A case of bilateral hip mechanically assisted crevice corrosion after
           staged total hip arthroplasty

    • Abstract: Publication date: Available online 20 June 2018Source: Arthroplasty TodayAuthor(s): Carl L. Herndon, Roshan P. Shah, H. John Cooper, Jeffrey A. Geller Mechanically assisted crevice corrosion (MACC), also known as trunnionosis, and adverse local tissue reaction (ALTR) are entities that can lead to pain and necessitate revision in total hip arthroplasty (THA). We present a case of a 75-year-old female who received a bilateral staged primary THA with metal on cross-linked polyethylene implants and had subsequent bilateral revisions for MACC and ALTR. In both instances, she presented with anterior thigh pain, weakness, and difficulty ambulating, and she was revised to ceramic on cross-linked polyethylene implants. This case may suggest a biologic predisposition or systemic immunogenic reaction to metal debris in some patients with ALTR or represent an implant-specific complication. To our knowledge, this is the first case reported of a patient having bilateral MACC from staged THA performed by 2 different surgeons using the same brand implant.
       
  • Fracture of the insert cone of a polyethylene liner in a failed
           posterior-stabilized, rotating-platform total knee arthroplasty

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Marc R. Angerame, Jason M. Jennings, Douglas A. Dennis Failures unique to posterior cruciate-substituting total knee prostheses rarely include polyethylene post fractures but have been described. We report a case involving a fracture of the distal insert cone of a rotating-platform (RP) polyethylene liner in a primary total knee arthroplasty. This case highlights a 67-year-old male presenting with new-onset knee pain and recurrent effusions with osteolysis 11 years following placement of a posterior-stabilized, RP total knee arthroplasty. At the time of revision surgery, the polyethylene insert cone was found to be fractured just below the junction between cone and the body of the insert. Liner exchange, synovectomy, and osteolytic-defect curettage and cement packing were performed. One year following revision surgery, the patient is without pain and has returned to function without limitations. Clinicians must be aware of this possible failure with RP prostheses in the setting of pain with a stable knee, recurrent aseptic effusions, and osteolysis.
       
  • Are reinfusion drains safe to use with periarticular liposomal
           bupivacaine' An analysis of systemic bupivacaine toxicity

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Marc R. Angerame, Gavin P. Hart, Susan M. Odum, Bryan D. Springer BackgroundIntraoperative periarticular injection (PAI) with local anesthetic is an important component of multimodal pain control in total joint arthroplasty (TJA). A potential risk of this practice is serum anesthetic toxicity resulting from the autotransfusion of blood collected from a reinfusion drain. The purpose of this study is to evaluate the levels of bupivacaine in blood collected in an autotransfusion system after use of a PAI in TJA.MethodsIn this prospective study, each TJA patient had an identical PAI consisting of 20 cc of liposomal bupivacaine, 30 cc of 0.25% bupivacaine with epinephrine, and 10 cc of normal saline. An autologous reinfusion drain was utilized in all patients. At 2 and 5 hours postoperatively, blood was collected from the autotransfusion canister and sent to the laboratory to quantify bupivacaine levels. The sums of these levels were compared to the lowest reported serum bupivacaine dose associated with toxicity (1.1 mg/kg).ResultsEleven unilateral TJA patients were enrolled (6 total knee arthroplasties, 5 total hip arthroplasties). The average 2-hour serum bupivacaine level was 2.9 μg (range 0.8-5.6) while the average 5-hour serum bupivacaine level was 4.5 μg (range 0.4-10.0). The average sum of the 2-hour and 5-hour serum bupivacaine level was 5.6 μg (range 0.8-13.6). Each of the 11 patient samples were well below their minimum serum bupivacaine dose toxicity.ConclusionsUse of a reinfusion drain after PAI with liposomal bupivacaine in TJA appears safe, as bupivacaine levels in the autotransfused blood remains well below the reported minimum serum toxic dose.Level of EvidenceIV.
       
  • Do illness rating systems predict discharge location, length of stay, and
           cost after total hip arthroplasty'

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Sarah E. Rudasill, Jonathan R. Dattilo, Jiabin Liu, Charles L. Nelson, Atul F. Kamath BackgroundAs procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients.MethodsA retrospective analysis of patients undergoing elective primary or revision THA was conducted at a single institution. Multivariable regressions were utilized to assess the significant predictive factors for lengths of stay, total costs, and discharge to skilled nursing facilities (SNFs), rehabilitation centers, and home. Controls included demographic factors, insurance coverage, and the type of procedure.ResultsASA scores ≥3 are the only significant predictors of discharge to SNFs (odds ratio [OR] = 1.69, confidence interval [CI] = 1.04-2.74) and home (OR = 0.57, CI = 0.34-0.98). Medicaid coverage (OR = 2.61, CI = 1.37-4.96) and African-American race (OR = 2.60, CI = 1.59-4.25) were additional significant predictors of discharge to SNF. SOI scores are the only significant predictors of length of stay (β = 1.36 days, CI = 0.53-2.19) and total cost for an episode (β = $6,234, CI = $3577-$8891). MP scores possess limited predictive power over lengths of stay only.ConclusionsThese findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.
       
  • Association of rapidly destructive osteoarthritis of the hip with
           intra-articular steroid injections

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Shane R. Hess, Robert S. O'Connell, Christopher P. Bednarz, Andrew C. Waligora, Gregory J. Golladay, William A. Jiranek BackgroundTo assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections.MethodsCoding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne's classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy). Demographic information, health characteristics, and number of injections were collected and analyzed as other potential explanatory variables. Patient outcome assessed by need for total hip arthroplasty (THA) after injection was also recorded.ResultsOne hundred twenty-nine injection events met the inclusion criteria in a total of 109 patients. From this sample, 23 cases of RDOA were confirmed representing a 21% incidence of RDOA. Twenty-one of the patients (91%) with RDOA had a THA at a median time of 10.2 months (interquartile range: 6.5-11.2) compared with 27 (31%) of those without RDOA at a median time of 24.9 months (interquartile range: 15.3-65.3). Older patients, patients with more severe osteoarthritis, and patients who identified themselves as white were more likely to have a diagnosis of RDOA (P = .008; P = .040; P = .009, respectively).ConclusionsThe potential for RDOA and faster progression to THA raises questions about the use of intra-articular steroid injections for hip osteoarthritis and should be discussed with patients. Additional studies are needed to define a true relationship.
       
  • The effect of constraint on post damage in total knee arthroplasty:
           posterior stabilized vs posterior stabilized constrained inserts

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Circular hexapod external fixation for periprosthetic tibial fracture

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Michael J. Assayag, Noam Bor, Guy Rubin, S. Robert Rozbruch A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided. Using a web-based software program, a gradual reduction in all planes was achieved. Adequate fixation, stability, reduction, and quick healing were obtained in the 2 cases, with minimal complications. The patients returned to their activity level a few months after external fixation removal.
       
  • External fixator immobilization after extensor mechanism reconstruction in
           total knee arthroplasty

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Colin D. Canham, Christopher Walsh, Stephen J. Incavo Extensor mechanism disruption after total knee arthroplasty is a complicated problem that typically requires surgical reconstruction. After extensor mechanism failure, reconstruction is typically indicated to restore active knee extension and provide a stable limb for ambulation. Immobilization of the knee in extension is vital in the initial postoperative period after extensor mechanism reconstruction. We describe a series of 4 patients who underwent extensor mechanism reconstruction followed by external fixator application to maintain the knee extended in the initial postoperative period. Our results have been favorable. However, close follow-up is important to monitor for the development of pin site infections.
       
  • Rapid destructive osteoarthritis of the hip after intra-articular steroid
           injection

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Late total hip arthroplasty dislocation due to yoga

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Murillo Adrados, Luke A. Myhre, Lee E. Rubin Yoga has become a popular form of exercise, recreation, and meditation for adults in the United States. As the popularity of both yoga and the incidence of hip replacements have both coincidentally increased over the last 2 decades, we imagine that the number of total hip replacement patients partaking in the practice of yoga has also increased. There are no clear guidelines available for yoga practice following hip replacement. To date, there have been no published reports of prosthetic hip dislocations during yoga. We present 2 cases of late total hip dislocations during yoga and provide a review of the available orthopaedic literature and our recommendations on patient restrictions and education with respect to practicing yoga after a hip replacement.
       
  • A novel use of a tibial cone in a proximal femoral replacement

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Early aseptic loosening of the Tritanium primary acetabular component with
           screw fixation

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Abundant heterotopic bone formation following use of rhBMP-2 in the
           treatment of acetabular bone defects during revision hip arthroplasty

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Lyme periprosthetic joint infection in total knee arthroplasty

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Two pegs are better than one: rare mode of femoral component failure in
           unicompartmental arthroplasty requiring revision to total knee
           arthroplasty

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Ryan Stancil, Nathan Summers, Douglas Van Citters, Adam Sassoon Femoral component fracture is a rare complication in unicompartmental knee arthroplasty, especially in cemented prostheses. We present a 75-year-old man who presented with a fractured single-peg Vanguard component 9 years postoperatively. He was revised to a total knee arthroplasty with an excellent functional outcome at 1 year. The components were additionally examined at an outside biomechanical engineering laboratory. Theories as to the cause of the component fracture include aseptic loosening due to a thin anterior cement mantle and the single-peg Oxford design.
       
  • Short-term safety and effectiveness of a second-generation motion-guided
           total knee system

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Adam I. Harris, Tianyi David Luo, Jason E. Lang, Branko Kopjar BackgroundModern 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.MethodsA 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.ResultsAt 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.ConclusionsIn 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.
       
  • Tibial tray fracture in a modern prosthesis with retrieval analysis

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(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.
       
  • Proximal tibiofibular osteoarthritis presenting as pain after total knee
           arthroplasty treated successfully with fusion of the proximal
           tibial-fibular joint

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Kavin Sundaram, Christian M. Klare, Wayne E. Moschetti Total knee arthroplasty (TKA) is a common treatment option for end-stage osteoarthritis of the tibiofemoral and patellafemoral joints. Diagnosis and treatment of the painful TKA can pose a significant challenge. In this report, we present the unusual case of a patient 12 years after total knee replacement presenting with isolated proximal tibial-fibular osteoarthritis as a cause of lateral knee pain. Proximal tibiofibular osteoarthritis is not typically on the differential diagnosis for a painful TKA but can be a rare cause of lateral knee pain. Proximal tibiofibular fusion may provide relief of pain and restoration of function.
       
  • In the zone

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Brian J. McGrory
       
  • Proximal tibial resorption in a modern total knee prosthesis

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Justin T. Deen, Terry B. Clay, Dane A. Iams, MaryBeth Horodyski, Hari K. Parvataneni BackgroundIn 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.MethodsFour 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.ResultsAfter 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.ConclusionsOur 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.
       
  • Early femoral condyle insufficiency fractures after total knee
           arthroplasty: treatment with delayed surgery and femoral component
           revision

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): George L. Vestermark, Susan M. Odum, Bryan D. Springer BackgroundPeriprosthetic fracture following total knee arthroplasty (TKA) is usually associated with a traumatic event and typically treated with fracture fixation techniques. However, we report on a series of patients with early atraumatic condyle fractures that occurred as a result of insufficiency of the unloaded preoperative femoral condyle treated with delayed reconstruction.MethodsWe retrospectively reviewed a series of 7 patients who sustained femoral condyle fractures following TKA and evaluated risk factors for insufficiency.ResultsThere were 6 females and 1 male with an average age of 65.5 (range, 63-75) years and an average body mass index of 29.4 (range, 27-32). Fracture occurred on average 24.9 days from the index surgery and secondary to a low energy mechanism. Five patients had valgus alignment (mean, 15.2°) preoperatively and sustained fracture of the unloaded medial femoral condyle. Two patients had varus alignment (mean, 7.0°) preoperatively and both fractured the unloaded lateral condyle. One patient underwent early intervention requiring distal femoral replacement secondary to femoral bone loss. The remaining 6 patients underwent delayed surgery for an average of 6 weeks to allow for fracture healing followed by femoral component revision. At last follow-up (average, 48.5 months), 1 patient required a tibial component revision; however, no revision of the femoral component was required.ConclusionsEarly femoral condyle insufficiency fractures following TKA may be a risk in females with poor bone quality and preoperative valgus alignment. Delayed surgery and femoral component revision is a treatment strategy that prevented the need for other tertiary reconstruction.
       
  • Single-dose lidocaine spinal anesthesia in hip and knee arthroplasty

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Nicholas B. Frisch, Brian Darrith, Dane C. Hansen, Adrienne Wells, Sheila Sanders, Richard A. Berger BackgroundWith the increasing interest in fast recovery and outpatient joint arthroplasty, short-acting local anesthetic agents and minimal narcotic use are preferred. Lidocaine is a fast-onset, short-duration local anesthetic that has been used for many years in spinal anesthesia. However, lidocaine spinal anesthesia has been reported to have a risk of transient neurologic symptoms (TNSs). The purpose of this study is to determine the safety and efficacy of single-dose lidocaine spinal anesthesia in the setting of outpatient joint arthroplasty.MethodsWe performed a prospective study on 50 patients who received lidocaine spinal anesthesia in the setting of outpatient hip and knee arthroplasty. All patients received a single-shot spinal injection, with 2% isobaric lidocaine along with titrated propofol sedation. We evaluated demographic data, length of motor blockage, time to ambulation, time to discharge readiness, patient-reported symptoms of TNS.ResultsOf the 50 patients studied, 11 had total hip arthroplasty, 33 total knee arthroplasty, 5 unicompartmental knee arthroplasty, and 1 underwent isolated polyethylene liner exchange in a total knee arthroplasty. The average total duration of motor blockade was 2.89 hours (range 1.73-5.17, standard deviation 0.65). Average time from postanesthesia care unit to return of motor function was 0.58 hours (range 0-1.5, standard deviation 0.48). None of the patients reported TNS.ConclusionsIsobaric lidocaine spinal anesthesia appears to be a safe and effective regimen for outpatient hip and knee arthroplasty. All patients were discharged on the day of surgery with isobaric lidocaine spinal injection. There were no reports of TNSs.
       
  • Accessibility and content of individualized adult reconstructive hip and
           knee/musculoskeletal oncology fellowship web sites

    • Abstract: Publication date: June 2018Source: Arthroplasty Today, Volume 4, Issue 2Author(s): Bradley L. Young, Colin K. Cantrell, Joshua C. Patt, Brent A. Ponce BackgroundAccessible, adequate online information is important to fellowship applicants. Program web sites can affect which programs applicants apply to, subsequently altering interview costs incurred by both parties and ultimately impacting rank lists. Web site analyses have been performed for all orthopaedic subspecialties other than those involved in the combined adult reconstruction and musculoskeletal (MSK) oncology fellowship match.MethodsA complete list of active programs was obtained from the official adult reconstruction and MSK oncology society web sites. Web site accessibility was assessed using a structured Google search. Accessible web sites were evaluated based on 21 previously reported content criteria.ResultsSeventy-four adult reconstruction programs and 11 MSK oncology programs were listed on the official society web sites. Web sites were identified and accessible for 58 (78%) adult reconstruction and 9 (82%) MSK oncology fellowship programs. No web site contained all content criteria and more than half of both adult reconstruction and MSK oncology web sites failed to include 12 of the 21 criteria.ConclusionsSeveral programs participating in the combined Adult Reconstructive Hip and Knee/Musculoskeletal Oncology Fellowship Match did not have accessible web sites. Of the web sites that were accessible, none contained comprehensive information and the majority lacked information that has been previously identified as being important to perspective applicants.
       
  • Total knee replacement in patients with osteoarthritis and concomitant
           inveterate patellar dislocation

    • Abstract: Publication date: Available online 28 May 2018Source: Arthroplasty TodayAuthor(s): P. David Figueroa, C. Alan Garín, B. Francisco Figueroa The inveterate patellar dislocation is an uncommon entity. The most frequent findings correspond to a misaligned valgus associated with lateral patellar dislocation. When severe knee osteoarthritis is present, total knee arthroplasty is an option, whether it is associated or not with realignment of the extensor apparatus. We present a review of published literature on correction of inveterate patellar dislocation associated with knee arthritis and our surgical technique with a case of inveterate patellar dislocation associated with tricompartmental knee osteoarthritis, in which a total knee arthroplasty was performed associated with proximal and distal realignment of the extensor apparatus. Total knee arthroplasty is a useful procedure in knee osteoarthritis associated with inveterate patellar dislocation, which can be associated with techniques on the extensor apparatus to achieve an adequate patellar alignment.
       
  • What are the incidence and risk factors of in-hospital mortality after
           venous thromboembolism events in total hip and knee arthroplasty
           patients'

    • Abstract: Publication date: Available online 26 May 2018Source: Arthroplasty TodayAuthor(s): Alisina Shahi, Thomas L. Bradbury, George N. Guild, Usama Hassan Saleh, Elie Ghanem, Ali Oliashirazi BackgroundPulmonary embolism and deep vein thrombosis, together referred to as venous thromboembolism (VTE), are serious and potentially preventable complications after total hip arthroplasty and total knee arthroplasty. The aim of this study was to investigate the incidence of mortality after VTE events and assess the risk factors that are associated with it.MethodsThe Nationwide Inpatient Sample was used to estimate the total number of total hip arthroplasty, total knee arthroplasty, VTE events, and mortality using the International Classification of Diseases, Ninth Revision procedure codes from 2003 to 2012. Patients' demographics, Elixhauser, and Charlson comorbidity indices were used to identify the risk factors associated with in-hospital VTEs and mortality.ResultsA total of 1,805,621 THAs and TKAs were included. The overall rate of VTE was 0.93%. The in-hospital mortality rate among patients with VTEs was 7.1% vs 0.30% in patients without VTEs (P-value < .0001). The risk factors for mortality after VTE events in descending order were as follows: hypercoagulable state (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 3.6-5.8), metastatic cancer (OR: 5.2, 95% CI: 3.3-5.6), myocardial infarction (OR: 4.2, 95% CI: 2.3-4.7), peripheral vascular disease (OR: 3.6, 95% CI: 3.2-4.0), cardiac arrhythmias (OR: 3.2, 95% CI: 1.6-4.3), advanced age (OR: 3.1, 95% CI: 2.3-3.7), electrolyte disorders (OR: 3.1, 95% CI: 2.2-3.6), pulmonary circulation disorders (OR: 2.9, 95% CI: 2.6-3.3), depression (OR: 2.8, 95% CI: 1.6-3.4), complicated diabetes (OR: 2.7, 95% CI: 2.1-3.2), weight loss (OR: 2.6, 95% CI: 2.2-3.3), renal failure (OR: 2.6, 95% CI: 1.7-3.5), chronic pulmonary disease (OR: 2.5, 95% CI: 1.3-3.1), valvular disease (OR: 2.4, 95% CI: 1.8-2.7), liver disease (OR: 1.7, 95% CI: 1.2-1.9), and obesity (OR: 1.6, 95% CI: 1.5-1.9).ConclusionsIn-hospital VTE has a significant in-hospital mortality rate. Several of the identified risk factors in this study are modifiable preoperatively. We strongly urge the orthopaedic community to be cognizant of these risk factors and emphasize on optimizing patients' comorbidities before an elective arthroplasty.
       
  • Catastrophic failure of tripolar constrained liners due to backside wear:
           a novel failure mode

    • Abstract: Publication date: Available online 18 May 2018Source: Arthroplasty TodayAuthor(s): Christopher W. Jones, Michael-Alexander Malahias, Elexis Baral, Timothy Wright, Thomas P. Sculco, Peter K. Sculco Constrained acetabular liners have been developed for patients who are at high risk for dislocation or who are undergoing revision surgery for recurrent dislocations. We report on 2 cases of failure of tripolar constrained liners due to severe backside polyethylene wear after dissociation of the outer polyethylene liner without dislocation, a mode of failure not previously reported. The backside of the inserts suffered severe polyethylene deformation, wear, and scratching due to dissociation from the locking mechanism. In patients with tripolar constrained liners, radiographic evidence of eccentric wear should be considered as possible occult dissociation of the polyethylene liner within the shell. Conversion to a modular dual mobility liner appears to be a viable solution in this setting.
       
  • Fracture of an S-ROM stem at the sleeve-stem junction

    • Abstract: Publication date: Available online 10 May 2018Source: Arthroplasty TodayAuthor(s): Kilian Rueckl, Friedrich Boettner, Ulrich Bechler, Elexis C. Baral, Timothy M. Wright, Peter K. Sculco Fracture of a well-ingrown femoral component is a rare and often challenging complication. Modular junctions and sleeve interfaces have been identified as one potential point of weakness with corrosion and fretting being contributing factors to ultimate femoral component fracture. Stem fractures at the sleeve interface were reported occasionally for the proximal ingrowth modular Emperion System (Smith and Nephew, Memphis, TN). However, this failure mechanism has been reported infrequently, often associated with corrosion at the modular junction, for the similarly designed S-ROM system (DePuy Orthopedics Inc., Warsaw, IN). We present the case of a 52-year-old patient, with a body weight of 84 kg (185 lbs) and a body mass index of 30.6 kg/m2, who suffered a fatigue fracture of a 14 × 09 × 130 mm S-ROM stem 42 months after implantation. The present study presents the results of the surface analysis, discusses possible failure mechanisms, provides treatment guidelines, and a review of the literature revealing 15 cases of failure at the level of the stem-sleeve junction. In particular, modifiable risk factors for potential stem failure, including stem diameter, stem offset, and the resulting cantilever bending forces on the proximal sleeve-stem junction, are discussed in detail.
       
  • Total knee arthroplasty in patients with multiple hereditary exostoses

    • Abstract: Publication date: Available online 7 May 2018Source: Arthroplasty TodayAuthor(s): Samuel A. Fernandez-Perez, Julio A. Rodriguez, David Beaton-Comulada, Roberto G. Colon-Miranda, Antonio H. Soler-Salas, Antonio Otero-Lopez We present a case report of a patient with severe valgus deformity of the right knee due to multiple hereditary exostoses (MHEs) treated with total knee arthroplasty (TKA). The surgical management of MHE affecting the knee encompasses exostoses resection, joint deformity rectification, and limb-length discrepancy alignment. On rare occasions, distraction osteogenesis and TKA have been used to correct valgus deformities of the knee. TKA in MHE patients with knee involvement has only been described in 6 cases. Several considerations, such as extensive knowledge of frequently occurring skeletal aberrations, are required to successfully correct the deformities associated with MHE via TKA. This report describes a case of severe valgus knee deformity with a rotational component in MHE managed with TKA, the surgical technique, and future recommendations.
       
  • Total hip arthroplasty and femoral nail lengthening for hip dysplasia and
           limb-length discrepancy

    • Abstract: Publication date: Available online 3 May 2018Source: Arthroplasty TodayAuthor(s): Elizabeth Harkin, S. Robert Rozbruch, Tomas Liskutin, William Hopkinson, Mitchell Bernstein The application of distraction osteogenesis through the use of magnet-operated, remote-controlled intramedullary lengthening continues to provide new opportunities for accurate limb equalization. While limb-length discrepancy and deformity can be addressed by total hip arthroplasty alone, the magnitude of correction is limited by the soft-tissue envelope and complications such as sciatic nerve palsy. This 3-patient case series presents the combination of staged ipsilateral total hip arthroplasty and retrograde intramedullary femoral nail lengthening for the correction of both deformity and limb-length discrepancy. Our results report leg-length equalization, independent ambulation without assistive devices, and excellent bone and functional outcomes without complications, demonstrating that this combined technique can be used to achieve targeted lengthening and deformity correction.
       
  • Acetabular wedge augments for uncontained tibial plateau defects in
           revision total knee arthroplasty

    • Abstract: Publication date: Available online 30 April 2018Source: Arthroplasty TodayAuthor(s): Jeffrey B. Stambough, Jacob A. Haynes, Robert L. Barrack, Ryan M. Nunley Tibial bone loss is a common scenario encountered during revision total knee arthroplasty. Reconstructive options depend on the amount and location of bone loss, but few good solutions exist to address large, uncontained tibial defects where cortical support is lost in the metadiaphyseal region. We describe a novel technique using acetabular augments to buttress a revision tibial component and recreate a hemiplateau during tibial revision total knee arthroplasty. In selected scenarios, this construct can create a biomechanically friendlier surface onto which to support the tibial tray and a less expensive option when compared to traditional stacked augments or cones.Level of EvidenceIV–Case series.
       
  • Catastrophic failure of a dual mobility bearing in a revision total hip
           arthroplasty

    • Abstract: Publication date: Available online 22 April 2018Source: Arthroplasty TodayAuthor(s): Brett G. Brazier, Ethan R. Wren, Michael J. Blackmer, Dominic V. Marino, Jason M. Cochran The following case demonstrates an example of a catastrophic failure of a dual mobility (DM) bearing used in the setting of a revision total hip arthroplasty for an acetabular component with an excessive abduction angle. Currently, in the literature, it has been demonstrated that DM bearings have decreased polyethylene wear at abduction angles up to 65°; however, this has only been shown in in vitro studies. To our knowledge, there have been no reports of in vivo DM bearings that have demonstrated these same results. In this case, a DM bearing was used in a revision surgery with a retained acetabular component that had an abduction angle of approximately 70°-75° which ultimately led to catastrophic polyethylene failure.
       
  • Antibiotic cement spacer for isolated medial wall acetabular deficiency in
           the setting of infected hip arthroplasty

    • Abstract: Publication date: Available online 23 March 2018Source: Arthroplasty TodayAuthor(s): Kevin S. Weiss, Kyle V. McGivern, Juan C. Suarez, Jesus M. Villa, Preetesh D. Patel Periprosthetic joint infections remain challenging for orthopaedic surgeons. These are typically treated with 2-stage revision with an antibiotic spacer and arthroplasty reimplantation after infection eradication. We report a novel technique to create an antibiotic cement spacer construct in the setting of significant acetabular medial wall destruction due to osteolysis and infection. The medial wall of the acetabulum was reconstructed using antibiotic cement with 2 screws acting as a rebar. An acetabular liner was then cemented into place forming a cement construct similar to a reconstruction cage in function. This technique created a firm acetabular construct that allowed for the placement of a stable articulating spacer. The spacer allowed for infection eradication and was successfully converted into a revision total hip arthroplasty.
       
  • Preoperative optimization for vascular involvement complicating revision
           total hip arthroplasty

    • Abstract: Publication date: Available online 21 March 2018Source: Arthroplasty TodayAuthor(s): Daniel Asemota, Brandon Passano, James E. Feng, David Novikov, Afshin A. Anoushiravani, Ran Schwarzkopf Vascular complications in revision total hip arthroplasty may occur in cases where the components of the hip implant migrate through the acetabular wall, through the iliopectineal line of the pelvis, and into the pelvic cavity. This migration may lead to substantial intrapelvic vascular compromise, drastically increasing the surgical complexity and potential risk for morbidity and mortality in these surgical cases. Here, we present a case of a 78-year-old woman with significant acetabular protrusio, which resulted in intraoperative compromise of the external iliac artery with rapid extravasation. As a result of prudent preoperative planning, interdisciplinary collaboration, and precautionary measures, significant patient morbidity and mortality was averted.Level of EvidenceLevel V, Case Report.
       
  • Superior rim fracture of a vitamin E-infused highly cross-linked
           polyethylene (HXLPE) liner leading to total hip arthroplasty revision

    • Abstract: Publication date: Available online 21 March 2018Source: Arthroplasty TodayAuthor(s): Brett G. Brazier, J. Wesley Mesko This case report looks at the failure of a vitamin E-infused highly cross-linked polyethylene acetabular liner that fractured at the superior rim of the locking mechanism. This calls to question whether there is a problem with the vitamin E-infused product or a flaw in the design of the liner or possibly a combination of the 2. Although there has been discussion of a possible minimum rim polyethylene thickness, there has not been a minimum thickness established. In addition, in the case of offset liners, indentations which are a part of a locking mechanism can cause the minimum rim dimension to be much less than the specified nominal thickness. This case serves as an interesting observation and contributes to the discussion of rim liner polyethylene thickness and minimum rim thickness.
       
  • Tranexamic acid increases early perioperative functional outcomes after
           total knee arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Matthew J. Grosso, David P. Trofa, Jonathan R. Danoff, Thomas R. Hickernell, Taylor Murtaugh, Akshay Lakra, Jeffrey A. Geller BackgroundThe 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).MethodsWe 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.ResultsTXA 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.ConclusionsIt 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.
       
  • A nonsurgical protocol for management of postarthroplasty wound drainage

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Antibiotic impregnated total femur spacers: a technical tip

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Biarticular total femur spacer for massive femoral bone loss: the mobile
           solution for a big problem

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Renal failure after placement of an articulating, antibiotic impregnated
           polymethylmethacrlyate hip spacer

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Intraoperative femoral head dislodgement during total hip arthroplasty: a
           report of four cases

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Intraoperative bladder perforation during primary total hip arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • The direct anterior approach for acetabular augmentation in primary total
           hip arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Muscle activation pattern during gait and stair activities following total
           hip arthroplasty with a direct anterior approach: a comprehensive case
           study

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Periprosthetic fungal infection of a hip caused by Trichosporon
           inkin

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Diagnosis of Streptococcus canis periprosthetic joint infection: the
           utility of next-generation sequencing

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Early failure with massive metallosis and posteromedial wear following
           atraumatic anterior cruciate ligament rupture after medial
           unicompartmental knee arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Enoxaparin-induced skin necrosis at injection site after total knee
           arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Tapered modular fluted titanium stems for femoral fixation in revision
           total knee arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(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.
       
  • Surgical hexing can curse outcomes

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Brian J. McGrory, Jessica Taylor
       
  • Corrigendum to “Delayed diagnosis of catastrophic ceramic liner failure
           with resultant pelvic discontinuity and massive metallosis” [ARTD 3
           (2017) 77–82]

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Benjamin A. Winston, Ryland P. Kagan, Thomas W. Huff
       
  • Response to letter to the editor on “Early intraprosthetic dislocation
           in dual-mobility implants: a systematic review”

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Ivan De Martino, Rocco D'Apolito, Bradford S. Waddell, Alexander S. McLawhorn, Peter K. Sculco, Thomas P. Sculco
       
  • Letter to the editor on “Early intraprosthetic dislocation in
           dual-mobility implants: a systematic review”

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Domenico Tigani, Jean Louis Prudhon, Luca Amendola, Thierry Aslanian
       
  • Can an arthroplasty risk score predict bundled care events after total
           joint arthroplasty'

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Blair S. Ashley, Paul Maxwell Courtney, Daniel J. Gittings, Jenna A. Bernstein, Gwo Chin Lee, Eric L. Hume, Atul F. Kamath BackgroundThe 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).MethodsWe 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.ResultsARS 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).ConclusionsImplementation 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.
       
  • Correlation between Single Assessment Numerical Evaluation score and
           Lysholm score in primary total knee arthroplasty patients

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Ted Sueyoshi, Gen Emoto, Toru Yato BackgroundThere 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.MethodsForty-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.ResultsThere 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 r2 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%.ConclusionsThe 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.
       
  • Continuing versus discontinuing antiplatelet drugs, vasodilators, and/or
           cerebral ameliorators on perioperative total blood loss in total knee
           arthroplasty without pneumatic tourniquet

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Sachiyuki Tsukada, Motohiro Wakui BackgroundAlthough 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.MethodsWe 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.ResultsThere 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).ConclusionsNo 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.
       
  • A prospective, randomized, comparative study of intravenous alone and
           combined intravenous and intraarticular administration of tranexamic acid
           in primary total knee replacement

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Paolo Adravanti, Eleonora Di Salvo, Giuseppe Calafiore, Sebastiano Vasta, Aldo Ampollini, Michele Attilio Rosa BackgroundStudies 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).MethodsA 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.ResultsThe 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.ConclusionsThis 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.
       
  • A computer-assisted, tibia-first technique for improved femoral component
           rotation in total knee arthroplasty

    • Abstract: Publication date: March 2018Source: Arthroplasty Today, Volume 4, Issue 1Author(s): Chong Meng Lee, Malkit K. Dhillon, Mohd Amin Sulaiman BackgroundThe 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.MethodsWe 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.ResultsSagittal 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.ConclusionsThese 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.
       
  • Radiographic assessment and clinical outcomes after total knee
           arthroplasty using an accelerometer-based portable navigation device

    • Abstract: Publication date: Available online 12 February 2018Source: Arthroplasty TodayAuthor(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.
       
  • Primary lower limb joint replacement and tranexamic acid: an observational
           cohort study

    • Abstract: Publication date: Available online 1 February 2018Source: Arthroplasty TodayAuthor(s): Llion Davies, Kylie Bainton, Robyn Milne, Peter Lewis BackgroundThis work aimed to evaluate the efficacy and safety of routine tranexamic acid (TXA) use in elective orthopaedic lower limb joint replacement surgery.MethodsThis 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.ResultsOf 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 
       
 
 
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