Breast cancer screening motivation and behaviours of women aged over 75 years.

OBJECTIVE: In Australia, breast screening is offered free every two years to women aged 50-74 years. Women aged ≥75 are eligible to receive a free mammogram but do not receive an invitation. This study aimed to explore the motivations and behaviours of women living in Australia aged ≥75 years regarding ongoing breast cancer screening given the public health guidance. METHODS: Sixty women aged ≥75 were recruited from metropolitan, regional, and rural areas across Australia to participate in a descriptive qualitative study. Semi-structured interviews were used to seek reflection on women's experience of screening, any advice they had received about screening beyond 75, their understanding of the value of screening and their intention to participate in the future. Thematic analysis of transcripts led to the development of themes. RESULTS: Themes resulting from the study included: reasons to continue and discontinue screening, importance of inclusivity in the health system and availability of information. Regular screeners overwhelmingly wished to continue screening and had strong beliefs in the benefits of screening. Women received limited information about the benefits or harms of screening beyond age 75 and very few had discussed screening with their Primary Healthcare Provider. No longer receiving an invitation to attend screening impacted many women's decision-making. CONCLUSION: More information via structured discussion with health professionals is required to inform women about the risks and benefits of ongoing screening. No longer being invited to attend screening left many women feeling confused and for some this led to feelings of discrimination.

Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review.

BACKGROUND: This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available. METHODS: All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners). The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken. RESULTS: A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making. CONCLUSION: The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.

Use of a Novel Reverse Hip Replacement System to Address Dislocation and Instability.

While total hip arthroplasty (THA) is an enormously successful treatment for patients with end-stage degenerative arthritis of the hip, and surgeons have optimized existing hip implants and techniques, dislocation and instability persist as a leading cause of failure. Given the tremendous success of reverse total shoulder arthroplasty in enhancing the stability of shoulder reconstruction by reversing the anatomic seating of the ball and socket components, one manufacturer (Hip Innovation Technology, LLC, Woodstock, Georgia) has developed a novel Reverse Hip Replacement System (Reverse HRS) to address the need for greater stability in reconstruction of the arthritic hip joint. Rather than the traditional anatomic components that replace the head of the femur with a spherical ball and the acetabulum with a socket with polyethylene liner mounted into the pelvis, the Reverse HRS features a cup with polyethylene liner attached to the femoral stem and a spherical metal head attached to a central trunnion inside of the porous-coated acetabular shell fixed into the pelvis. This design provides dramatically enhanced stability and improved range of motion. This article reviews relevant published literature, including results from a Canadian clinical trial and case reports from a multicenter American clinical trial monitored by the U.S. Food and Drug Administration. It also describes the components and surgical technique of reverse THA.

Impact of Proximal Tibial Varus Anatomy on Survivorship After Medial Unicondylar Knee Arthroplasty.

BACKGROUND: Precise indications for medial unicondylar knee arthroplasty (UKA) continue to be defined. It is unclear if patients who have proximal tibia vara should be considered candidates for UKA. The purpose of this study was to evaluate the impact of proximal tibial varus alignment on outcomes after UKA. METHODS: A retrospective review identified 2,416 patients (3,029 knees) who underwent mobile-bearing medial UKA with 2-year minimum follow-up or revision. Preoperative radiographs were evaluated, and medial proximal tibial angle (mPTA) was measured. Patients were grouped into two groups as follows: mPTA <80 degrees and mPTA ≥80 degrees. Analyses were performed on the impact of mPTA on clinical outcomes, all-cause revisions, and tibial failures. RESULTS: At a mean follow-up of 5 years (range, 0.5 years to 12.8 years), there was not a statistically significant difference in clinical outcomes nor increased risk for all-cause revision or tibial failure in patients who had an mPTA <80°. Mean mPTA in patients who had tibial failures was 82.5° and not significantly different than those who did not have a tibial failure (82.9°) (P = .289). Tibial failure rate in knees with an mPTA <80° was 2.2% and not significantly different than knees with an mPTA ≥80° at 1.4% (P = .211). The all-cause revision rate in knees with an mPTA <80° was 5.8% and was not significantly different than knees with an mPTA ≥80° at 4.9% (P = .492). CONCLUSION: Patients who have tibia vara are not at increased risk for tibial related or all-cause failure in medial UKA. This data may allow surgeons to increase their indications for medial UKA.

Custom Triflange Acetabular Components For Catastrophic Bone Loss: Minimum 5-Year Results.

INTRODUCTION: Custom acetabular components are an increasingly utilized reconstructive option in total hip arthroplasty for catastrophic bone loss and acetabular failure. The purpose of this study was to determine the survivorship of such components for reconstruction due to catastrophic bone loss at a minimum 5-year follow-up. METHODS: From August 2003 to July 2016, 64 patients (66 hips) underwent acetabular reconstruction with custom triflange components. All hips were classified as Paprosky 3B or 3C. Harris hip scores were analyzed. Overall survivorship was determined by survival analysis. RESULTS: Seventeen patients (18 hips) died prior to returning for 5-year follow-up. One presumed living patient was lost to contact, yielding a cohort of 46 patients (47 hips) who had minimum 5-year follow-up. The mean age was 65 years (range, 46 to 85), mean body mass index was 29.4 (range, 18 to 45), and 72% were women. Mean follow-up was 8 years (range, 5 to 16). There were 3 revisions of the triflange device (6.4%) due to infection. Survivorship to end point of triflange removal for any reason was 94.1% (95% confidence interval: ±3.4%) at a mean of 16 years. In the overall series (n = 66), there were 9 (13.6%) additional reoperations as follows: 5 incision and debridements, one open reduction internal fixation, two stem revisions for periprosthetic femoral fracture, and one head revision. Harris hip scores improved significantly from a mean of 41 points preoperatively to 64 points postoperatively. CONCLUSIONS: Custom acetabular triflange components represent a highly effective tool in a surgeon's armamentarium. These devices are extremely helpful in managing catastrophic bone loss and have a good mean 16-year survival.

Minimum 25-Year Results of a Tapered Titanium Porous Plasma Spray Coated Femoral Component.

BACKGROUND: Previous studies have reported excellent results with tapered, titanium, porous plasma-sprayed components in patients undergoing uncemented primary total hip arthroplasty (THA). The purpose of this study was to examine survival and clinical results at a minimum 25-year follow-up. METHODS: We reviewed all patients who underwent primary THA at our center through 1995 with a specific femoral component that was essentially unchanged since its 1984 introduction, except porous coating was continued circumferentially in 1987, a hydroxyapatite-coated option was offered in 1988, and an offset option was added in 1999. There were 332 patients (396 THA) who had a minimum 25-year follow-up (range, 25 to 37). Mean age at surgery was 48 years (range, 21 to 70 years). Mean follow-up in nonfailed patients was 29 years (range, 25 to 37 years). RESULTS: There were 31 femoral revisions (7.8%): 9 infections, 3 failures of ingrowth, 5 aseptic loosening, 8 osteolysis well-fixed, 2 periprosthetic fractures, 2 polyethylene wear with trochanteric avulsion, 1 component breakage, and 1 malalignment well-fixed. Kaplan-Meier survival with the endpoint of all-cause stem revision was 94.8% (95% confidence interval: ±0.9%) at 37 years, and with the endpoint of aseptic loosening/failure of ingrowth was 98.7% (95% confidence interval: ±0.5) at 37 years. Harris hip scores improved significantly from 43 preoperatively to 76 most recently. CONCLUSION: This tapered, titanium, porous plasma spray-coated femoral component continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.

Tough Questions in Total Hip and Total Knee Arthroplasty.

Some of today's tough questions surrounding hip and knee arthroplasty involve modifiable risks, bilateral staging, physiotherapy, postoperative activity, venous thromboembolism and infection prophylaxis, pain management, and outpatient settings. The available literature is reviewed to provide answers to difficult questions facing the orthopaedic surgeon. Preoperative questions focus on patient selection, medical optimization, and appropriateness for outpatient surgery. Modifiable risk factors for undergoing lower extremity arthroplasty include obesity, smoking, and diabetic control. Guidelines are presented to advise which patients are suitable candidates to undergo the procedure in an outpatient setting. Perioperative questions arise regarding the use of first-generation cephalosporins for prophylaxis, topical vancomycin powder, tranexamic acid, negative-pressure dressings, local intra-articular injections, and optimal timing of staged bilateral procedures. Postoperative questions are often raised about the necessity of formal postoperative physical therapy, when can patients resume driving after arthroplasty, should patients return to high-level sporting activity, and how long should patients be advised to take antibiotic prophylaxis for dental procedures.

Survivorship of a Metal-on-Metal Total Hip Implant With Modular Titanium Adapter.

BACKGROUND: Use of metal-on-metal (MoM) articulations in total hip arthroplasty (THA) has sharply declined due to high failure rates from metal-related complications. Although certain MoM designs have demonstrated only 46% survival, not all MoM designs have performed the same. The purpose of this study is to evaluate mid-term to long-term survival of a specific MoM implant with a modular titanium taper adapter. METHODS: A retrospective review was performed on all patients who underwent primary THA at our center with the M2a-Magnum system (Zimmer Biomet, Warsaw, IN). Of 829 patients (956 hips) identified, 754 patients (869 hips) met inclusion criteria of signed research consent, minimum 2-year follow-up, and/or any revision surgery. RESULTS: Mean follow-up was 11.0 years (range 2-16; ±3.5). Mean cup angle of inclination was 42.8° (range 24°-70°, ±6.3°), with 88.0% reconstructed within the 40° ± 10° safe zone. There were 64 revisions (7.36%): 7 (0.81%) septic and 57 (6.56%) aseptic. Of those, 32 (3.68%) were adverse reactions to metal debris. Kaplan-Meier survival free of revision for all causes was 88.6% at 16 years (95% confidence interval 86.8-90.4). Univariate analysis of risk factors for all-cause, aseptic, and adverse reaction to metal debris revision found no relationship with female gender, age ≥65 years, body mass index >30 kg/m2, higher activity level, or inclination angle outlier. CONCLUSION: The results of this study demonstrate a more favorable mid-term to long-term survivorship with this specific MoM implant compared to other designs. Although our institution no longer performs MoM THA, further investigation into differences in MoM implant designs is warranted.

Mid-Term Survival of Total Hip Arthroplasty in Patients Younger Than 55-year-old.

BACKGROUND: Survivorship of total hip arthroplasty (THA) in younger patients is concerning given the inverse relationship between age and lifetime risk for revision. The purpose of this study is to determine if risk of revision has improved for patients aged 55 years or younger who undergo primary THA using modern polyethylene liners. METHODS: A retrospective review identified 2,461 consented patients (2,814 hips) with minimum 2-year follow-up who underwent primary THA at our institution between September 2007 and August 2014 using components from a single manufacturer (Zimmer Biomet), all with vitamin E-infused highly crosslinked polyethylene acetabular inserts. There were 561 patients (643 THA; 23%) aged 55 or younger and 1,900 (2,171 THA; 77%) older than 55. RESULTS: Mean follow-up was 5.0 years for both groups. There were more male patients in the younger (55%) than older (41%) group. Body mass index (BMI) was higher in younger patients independent of gender. Improvement in Harris hip score (HHS) was similar between groups. Kaplan-Meier survival to endpoint of all cause revision was similar between groups at 12 years (P = .8808) with 97.5% (95% CI: ±0.7%) for younger versus 97.1% (95% CI: ±0.6%) for older patients. Most frequent reason for revision overall was periprosthetic femoral fracture (21; 0.75%); univariate analysis revealed risk factors were female gender (P = .28) and age ≥65 years (P = .012). CONCLUSION: Use of modern polyethylene, such as vitamin E-stabilized highly cross-linked, liners during THA may improve survivorship in younger patients undergoing THA. Younger patients undergoing primary THA with highly cross-linked polyethylene liners had no increased rate of revision at mid-term follow-up.

Interval Between Staged Bilateral Total Knee Arthroplasties Does Not Affect Early Medical or Surgical Complications.

BACKGROUND: The purpose of this study is to evaluate early postoperative surgical and medical complications in patients undergoing staged bilateral total knee arthroplasty (TKA) and determine if the interval to the second stage influences the risk of complications. METHODS: A retrospective review was performed from 2016 through 2018 of all staged bilateral primary TKA procedures, yielding a cohort of 1005 patients (2010 TKAs). Four groups were created based on the timing of the second stage: 3 to 6 weeks, 7 to 12 weeks, 13 to 24 weeks, and >24 weeks. Clinical data compared between groups included demographics, knee range of motion, University of California, Los Angeles (UCLA) activity score, Knee Society pain score, Knee Society clinical score, and Knee Society functional score. Postoperative complications within 90 days were evaluated, with complications after the second knee being the primary outcome. RESULTS: The mean follow-up after second stage was 10.7 months (range, 3 to 37 months). No significant differences were found between groups in the range of motion, Knee Society pain, Knee Society clinical score, Knee Society functional score, or University of California Los Angeles activity score in either the first or second knee. After the first knee surgery, medical complications were highest in the >24-week group. After the second knee, there were no significant difference in manipulation (P = .9), wound complications (P = .7), venous thromboembolism (P = .8), or other medical complications (P = 1) based on the interval duration. CONCLUSION: The interval between staged TKA did not affect early medical or surgical complications after the second stage. Early clinical and function results were not different based on timing of the second surgery.

Mid-Term Clinical Outcomes and Survivorship of a Second-Generation Modular Revision Knee System.

INTRODUCTION: Revision knee systems have adapted to the challenges of revision knee arthroplasty with offset stems, augments, cones, and various levels of constraint. The purpose of this study is to review the mid-term outcomes of a second-generation modular knee revision system. MATERIALS AND METHODS: A retrospective review was conducted from 2011 through 2014 on all patients who underwent knee arthroplasty with the Vanguard® 360 revision knee system (Zimmer Biomet, Warsaw, Indiana). Patients were included in the study if they were eligible for five-year minimum follow up and had signed a general research consent. The initial query revealed 253 patients (267 knees) that met inclusion criteria. Complications assessed were manipulation under anesthesia (MUA) and revision of any component. Statistical analysis using paired t-test was performed to evaluate changes in clinical outcomes and Kaplan-Meier survival analysis. RESULTS: Mean follow up was 6.6 years. The Vanguard® 360 knee system was used in four (1.5%) primary total knee arthroplasties (TKAs), 66 (24.7%) second-stage reimplantation TKAs after infection, and 197 (73.8%) aseptic revisions. There were significant improvements in knee range of motion and Knee Society Scores (all p<0.05). Manipulations under anesthesia were performed in 17 knees (6.4%). A total of 41 knees (15.4%) failed for any cause and required re-revision surgery. Of these, 11 (4.1%) failed due to aseptic loosening. Kaplan-Meier analysis revealed overall survival to endpoint of aseptic loosening to be 96.4% (95% CI: ±1.2%) at five years and 95.2% (95% CI: ±1.4%) at 9.5 years. When comparing survivorship in patients who underwent initial revision for aseptic indications compared with those whose underwent revision for second-stage reimplantation after infection, Kaplan-Meier survival to endpoint of revision for any cause at 9.5 years was higher for patients with aseptic than septic indication for TKA (87.0% [95% CI: ±2.4%] vs. 75.3% [95% CI: ±5.4%], p=0.0156). CONCLUSION: The findings of this study demonstrate greater than 95% aseptic survivorship with the use of the Vanguard® revision knee system at mid-term follow up.

Low complication rates in outpatient total knee arthroplasty.

PURPOSE: The primary purpose of this study is to report the incidence of complications associated with outpatient total knee arthroplasty (TKA). Secondarily, 2-year minimum outcomes are reported. METHODS: Between 2013 and 2016, 928 patients underwent 1143 outpatient TKAs with the Vanguard Complete Knee System (Zimmer Biomet, Warsaw, IN). Patients were selected for outpatient surgery if they were medically optimized without a failing organ system and had sufficient support at home. Overnight stays, medical complications and early perioperative complications were assessed in this entire cohort. Two-year minimum follow-up was available on 793 patients (978 knees). Patient records were analyzed for outcome measures and revisions. RESULTS: In 124 procedures, the patient stayed overnight for 23-h observation. Thirty-seven (3.2%) were for convenience reasons and 87 (7.6%) for medical observation. Heart disease and chronic obstructive pulmonary disease were associated with increased risk of overnight stay. Excluding manipulations, reoperation within 90 days occurred in eight (0.7%) knees. Patients with 2-year minimum follow-up had significant improvements in ROM, Knee Society Clinical, Functional and Pain scores (p < 0.005). Nine (0.8%) patients required revision. Manipulations were performed on 118 (10.3%) patients. The overall deep infection rate was 0.17% (2/1143). CONCLUSIONS: Outpatient TKA is safe for a large proportion of patients. Certain medical co-morbidities increase the risk of overnight stay. Patients had significant improvement in ROM and outcome scores with low revision rate. LEVEL OF EVIDENCE: III.

Metal-on-Metal Total Hip Revisions: Pearls and Pitfalls.

BACKGROUND: At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. METHODS: This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. RESULTS: Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. CONCLUSION: Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.

The Feasibility of Outpatient Revision Total Knee Arthroplasty in Selected Case Scenarios.

BACKGROUND: As total knee arthroplasty (TKA) continues moving to the outpatient arena, the demand for revision surgery will subsequently increase which draws into question the feasibility for some revision scenarios as an outpatient. The purpose of this study is to report on the safety of outpatient revision knee arthroplasty. METHODS: From June 2013 through December 2018, 102 patients (106 knees) underwent revision knee arthroplasty at a free-standing ambulatory surgery center. Mean patient age was 58.0 years, and 43% of patients were male. Procedures included the following: 45 cases of unicompartmental arthroplasty to TKA, 54 TKA revisions, and 52 cases involved a full exchange of components. RESULTS: Ninety-three patients (88%) were discharged the same day without incident, none required transfer to acute facility, and 13 required overnight stay with 4 of these for convenience and 9 for medical reasons. There were no major complications within the first 48 hours postoperative. One patient required readmission for treatment of ileus 11 days postoperative. There were no other readmissions, no subsequent surgeries, and no deaths within 90 days. One or more major comorbidities were present in 66 patients. CONCLUSION: Outpatient revision knee arthroplasty was found to be safe in carefully selected patients and case scenarios. Presence of medical comorbidities was not associated with risk of complications. The paradigm changes of patient education, medical optimization, and a multimodal program to mitigate the risk of blood loss and reduce need for narcotics facilitates performing some revision arthroplasties safely in an outpatient setting.

Higher Activity Level Following Total Knee Arthroplasty Is Not Deleterious to Mid-Term Implant Survivorship.

BACKGROUND: The impact of a patient's activity level following total knee arthroplasty (TKA) remains controversial, with some surgeons concerned about increased polyethylene wear, aseptic loosening, and revisions. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after TKA. METHODS: A retrospective review identified 1611 patients (2038 knees) that underwent TKA with 5-year minimum follow-up. Patients were divided in 2 groups based on their University of California Los Angeles (UCLA) activity level: low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥6). Outcomes included range of motion, Knee Society scores, complications, and reoperations. Parametric survival analysis was performed to evaluate the significance of activity level on survivorship while controlling for age, gender, preoperative pain, Knee Society clinical scores, Knee Society functional scores, and body mass index (BMI). RESULTS: Mean follow-up was 11.4 years (range 5.1-15.9). The LA group had significantly more female patients, were older, had higher BMI, and had lower functional scores preoperatively (all with P < .001). The HA group had significantly higher improvements in Knee Society scores (P < .001) and pain postoperatively (P < .001). Revisions were performed in 4% of the LA group and 1.7% knees of the HA group (P = .003). After controlling for age, gender, preoperative pain, Knee Society clinical scores, Knee Society functional scores, and BMI, a higher postoperative activity level remained a significant factor for improved survivorship with an odds ratio of 2.4 (95% confidence interval 1.2-4.7, P = .011). The all-cause 12-year survivorship was 98% for the HA group and 95.3% for the LA group (P = .003). The aseptic 12-year survivorship was 98.4% for the HA group and 96.3% for the LA group (P = .02). CONCLUSION: Highly active patients had increased survivorship at 5-year minimum follow-up compared to lower activity patients after TKA. Patient activity level after TKA may not need to be limited with modern implants.

Mid-Term Survivorship of a Novel Constrained Acetabular Device.

BACKGROUND: Recurrent instability after total hip arthroplasty is a difficult complication. In certain cases, a constrained acetabular device is needed to address these issues. The purpose of this study is to report the midterm outcomes and survivorship of a single novel constrained liner device. METHODS: A retrospective review as performed on all procedures (except first stage exchange for infection) in which a Freedom Constrained (Zimmer Biomet, Warsaw, IN) liner was used between December 2003 and November 2016. Patients with 2-year minimum follow-up or failure were included, yielding a cohort of 177 patients. Procedures were 130 aseptic revisions, 40 reimplantations following infection eradication, and 7 complex primaries. The constrained mechanism was implanted in 46 hips (26%) to treat active instability and 131 hips (74%) for increased risk of instability and intraoperative instability. Patients had on average 3.4 previous surgeries. RESULTS: With an average 7.1-year follow-up, 11 hips dislocated (6.2%), and 13 hips (7.3%) were revised for acetabular aseptic loosening, resulting in an overall constrained aseptic or mechanical failure rate of 13.6%. Nineteen hips (10.7%) failed from infection with 58% of these having had a previous infection. Patients with active instability had significantly higher failure for dislocation than patients who were at risk (15.2% vs 3%, P = .01). All-cause survival rate at 7 years was 74.8%, aseptic survival was 83.6%, and survival for instability was 91.8%. CONCLUSION: Revision for instability remains challenging as many patients have had numerous previous surgeries and at-risk anatomy. Constrained inserts are one option to manage instability, but a high rate of recurrence can still occur.

Long-Term Outcomes of a Modular System in Revision Total Knee Arthroplasty.

INTRODUCTION: With the growing demand for total knee arthroplasty (TKA), the burden of revision surgery will continue to rise. Revision knee arthroplasty has historically had worse survivorship than primary knee arthroplasty. The purpose of this study is to review the 10-year outcomes and survivorship of a modular revision knee system. MATERIALS AND METHODS: A retrospective review was conducted on 109 patients (117 knees) who underwent a revision knee arthroplasty with the Vanguard® Super Stabilized Knee (SSK) Revision System (Zimmer Biomet; Warsaw, Indiana) who were eligible for 10-year minimum follow up. Clinical and radiographic data was obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter. RESULTS: With an average follow up of 10.7 years (range, 2.3 to 14.1 years), the SSK revision system exhibited a notable improvement in both clinical and functional outcomes. Average knee range of motion improvement was 4.2 degrees (SD ±18). Manipulations under anesthesia were performed in six knees (5%). Re-revisions occurred in 27 knees (23%). Ten of the re-revisions were for aseptic loosening (37%), eight for periprosthetic infection (30%), five for instability (19%), and the remainder for other aseptic causes. Mean time to failure was 4.6 years (range, 1 to 9.1 years). The 10-year all-cause survival was 77% (95% confidence interval [CI], 73 to 81%). The 10-year aseptic survival was 83% (95% CI, 79 to 87%). CONCLUSION: The findings of this study show an 83% 10-year aseptic survivorship with the Vanguard® SSK knee revision system. These results are comparable to long-term follow up of other revision knee systems.

Isolated RingLoc Polyethylene Liner Revision for Treatment of Liner Wear.

Polyethylene wear and osteolysis has long been an issue with the survivorship of total hip arthroplasty. The purpose of this study was to assess the survivorship after isolated liner exchange with the use of the RingLoc acetabular cup. A query of our practice registry revealed 106 patients (112 hips) with a single cementless titanium plasma sprayed acetabular component (RingLoc, Zimmer Biomet, Warsaw, IN), who underwent acetabular liner exchange for treatment of polyethylene wear between January 2001 and March 2015. Eighty patients (85 hips) met inclusion criteria. Clinical outcomes were assessed with the Harris hip score and radiographic evaluation was performed. The mean follow-up after liner exchange was 6 years (range, 2-15.7 years). Harris hip scores improved from 70.9 (range, 28-100) preoperatively to 79 (range, 29-100) at most recent evaluation (p < 0.001). Subsequent surgery was required in 11 patients (11 hips, 13%). Components were revised in 7 hips (8.2%). One acetabular revision was performed for aseptic loosening and four for instability (4.7%). One metal-polyethylene sandwich liner was revised for metal hypersensitivity. One patient underwent two-staged exchange for infection. In our early to mid-term experience with the RingLoc acetabular cup, isolated liner exchange for treatment of polyethylene wear yielded 98.8% acetabular survival for aseptic loosening at up to 15 years. (Journal of Surgical Orthopaedic Advances 29(2):59-64, 2020).

Partial 2-Stage Exchange for Infected Total Hip Arthroplasty: An Updated Report.

BACKGROUND: Management of an infected total hip arthroplasty (THA) is challenging. The eradication of infection as well as complications of component removal must all be considered. This study is an update on previous reports of treating periprosthetic infection of the hip with a partial 2-stage exchange with retention of the femoral component. METHODS: A retrospective review of our practice's arthroplasty registry from 2000 to 2018 revealed 41 hips with 2-year minimum follow-up that were treated with a 2-stage partial exchange for an infected THA. All first-stage procedures allowed an articulating construct with 1 of 3 variations: cemented constrained liner (13 hips), StageOne Hip Cement Spacer Mold (14 hips), or an antibiotic polymethylmethacrylate head molded from a bulb syringe (14 hips). Of 41 cases, 34 were culture positive, with 3 cases having methicillin-resistant Staphylococcus. RESULTS: Mean follow-up was 5.5 years (range, 1.5-18.5 years). The second-stage reimplantation was accomplished in 39 of the 41 hips (95%) at a mean interval of 9.2 weeks (range, 5-9 weeks). Two patients underwent repeat radical debridement with removal of all components before reimplantation for persistent clinical evidence of infection. Thirty-three of the 41 hips (81%) were infection free at most recent follow-up. The mean postoperative Harris hip score at most recent evaluation was 63.6 (range, 24-100). CONCLUSION: Eradication of periprosthetic joint infections, while minimizing patient morbidity, continues to be a challenge. Partial 2-stage exchange may be considered in cases where removal of a well-fixed femoral component may result in significant bony destruction.

Activity Level Does Not Affect Survivorship of Unicondylar Knee Arthroplasty at 5-Year Minimum Follow-Up.

BACKGROUND: Patients are often cautioned against a high level of activity after knee arthroplasty. The purpose of this study was to report on implant survivorship and outcomes of high-activity patients compared with low-activity patients after unicondylar knee arthroplasty (UKA). METHODS: We identified 487 patients (576 knees) who underwent UKA with the Oxford mobile bearing knee (Zimmer Biomet, Warsaw, IN) with a 5-year minimum follow-up. Patients were divided into 2 groups: low activity (LA) (University of California Los Angeles ≤6) and high activity (HA) (University of California Los Angeles ≥7). Preoperative and postoperative range of motion, Knee Society scores, complications, and reoperations were evaluated. RESULTS: Mean follow-up was 9 years (range, 4 to 13.1). The HA group had significantly more male patients, were younger, and had higher knee society clinical scores and knee society functional scores preoperatively. The HA group had significantly higher improvements in Knee Society scores and pain postoperatively. Revisions were performed in 8.4% of the LA group and 6.2% of the HA group (P = .43). At our mean of 9-year follow-up, there was 94.0% survival for the HA group and 92.1% for the LA group (P = .6085). CONCLUSIONS: Highly active patients had no increased risk of revision after UKA with the Oxford mobile bearing knee at 5-year minimum follow-up.