Incidence of Neuraxial Abnormalities Is Approximately 8% Among Patients With Adolescent Idiopathic Scoliosis: A Meta-analysis.

BACKGROUND: Several studies have sought to address the role of routine preoperative MRI in patients with adolescent idiopathic scoliosis (AIS) undergoing deformity correction. Despite similar results regarding the prevalence of neuraxial anomalies detected on MRI, published conclusions conflict and give opposing recommendations. Lack of consensus has led to important variations in use of MRI before spinal surgery for patients with AIS. QUESTIONS/PURPOSES: This systematic review and meta-analysis of studies about patients with AIS evaluated (1) the overall proportion of neuraxial abnormalities; (2) the patient factors and curve characteristics that may be associated with abnormalities; and (3) the proportion of patients who underwent neurosurgical intervention before scoliosis surgery and the kinds of neuraxial lesions that were identified. METHODS: We performed a search of four electronic databases (PubMed, EMBASE, CINAHL Plus, and SCOPUS) utilizing search terms related to routine MRI and AIS, yielding 206 articles. Studies included had at least 20 participants, patients with ages 11 to 21 years, and a Methodological Index for Non-Randomized Studies (MINORS) study quality score of 8 and 16 points for noncomparative and comparative studies, respectively. Non-English manuscripts, animal studies, and those that did not include patients with AIS solely were excluded. Eighteen articles with 4746 patients were included for analysis of the overall proportion of neuraxial abnormalities, 12 articles with 3028 patients for analysis by sex, eight articles with 1603 patients for right main thoracic curve, eight articles with 665 patients for a left main thoracic curve, and 13 articles with 3063 patients and 230 (7.5%) abnormalities for number of neurosurgical interventions before scoliosis correction. The mean MINORS score for studies included was 14 (range, 10-20). Each study was analyzed for the proportion of patients identified with neuraxial abnormalities and associations with specific demographics. We determined the proportion of patients who underwent surgical interventions before scoliosis surgery as well as the types of neuraxial lesions identified. The articles were assessed for heterogeneity and publication bias. Because all groups were determined to be heterogeneous, a random-effects model was used for each group in this meta-analysis; with this analysis, an overlap of 95% confidence intervals suggests no difference at the p < 0.05 level, but this analytic approach does not provide p values. RESULTS: The pooled proportion of neuraxial abnormalities detected on MRI was 8% (95% confidence interval [CI], 6%-12%). With the numbers available, we found no difference in the proportion of male and female patients with neuraxial abnormalities (18% [95% CI, 11%-29%] versus 9% [95% CI, 6%-12%], respectively). Likewise, there was no difference in the proportion of pooled neuraxial abnormalities in right and left curves (9% [95% CI, 6%-14%] versus 15% [95% CI, 5%-35%], respectively). In the subset of abnormalities analyzed for number of neurosurgical interventions before scoliosis correction, the pooled proportion showed that 33% (95% CI, 24%-43%) underwent neurosurgical intervention before deformity correction. The most common abnormalities of the 367 found on MRI were syringomyelia in 127 patients (35%), Arnold-Chiari Type 1 malformation with syrinx in 103 patients (28%), and isolated Arnold-Chiari Type 1 malformation in 91 patients (25%). CONCLUSIONS: The proportion of patients with AIS who have neuraxial abnormalities is high (8%) and a large number undergo surgical intervention before scoliosis reconstruction. We did not find any particular demographic variables that indicated an increased risk of abnormality. Clinicians should consider advanced imaging before surgical intervention in the treatment of a patient with an idiopathic diagnosis. Preventable variables need to be identified by future studies to establish a better working treatment protocol for these patients. LEVEL OF EVIDENCE: Level III, diagnostic study.

Ultrasound-Guided Calcium Debridement of the Shoulder Joint: A Case Series.

OBJECTIVE: Our purpose was to assess the outcomes of those who underwent an ultrasound-guided debridement of the deposits. Specifically, we analyzed: (1) function; (2) pain; (3) activity level; (4) patient satisfaction; and (5) complications. MATERIALS AND METHODS: A review of patients who underwent an ultrasound-guided debridement of calcific deposits about their shoulder joint between 2005 and 2015 was performed. Our final cohort consisted of 38 patients with a mean age of 53 years (range, 35 to 62 years)-11 men and 27 women-and a mean follow up of 32 months (range, 12 to 53 months). Functional outcomes, activity level, and pain level were assessed using the Disabilities of Arm, Shoulder, and Hand (DASH) scale, the University of Southern California (UCLA) activity scale, and the Visual Analog Scale (VAS). Additionally, patients were asked if they were satisfied with the outcomes of their procedure. All medical records were assessed for potential complications from this procedure. RESULTS: Excellent outcomes were achieved. The mean DASH score improved from 21 to 10 points (p=0.0001). Additionally, mean UCLA score increased from 2 to 7 points (p=0.0001). Furthermore, the mean reported VAS improved from 8 to 1.6 (p=0.0001). Ninety-seven percent of patients reported being satisfied. There were no reported complications in our cohort. CONCLUSION: We found that this procedure can result in effective pain relief and prevent or delay the need for more invasive procedures. Future studies should evaluate the role of calcium deposit size in the outcomes of those who undergo debridement.

No Decrease in Knee Survivorship or Outcomes Scores for Patients With HIV Infection Who Undergo TKA.

BACKGROUND: HIV is prevalent worldwide and numerous patients with this diagnosis ultimately may become candidates for TKA. Although some studies have suggested that complications are more common in patients with HIV who undergo TKA, these studies largely were done before the contemporary era of HIV management; moreover, it is unclear whether patients with HIV achieve lower patient-reported outcome scores or inferior implant survivorship. QUESTIONS/PURPOSES: We asked whether there were any differences in the outcomes of patients with HIV without hemophilia who undergo TKA compared with a matched control cohort in terms of: (1) patient-reported outcomes; (2) implant survivorship; and (3) complication rates. METHODS: Forty-five patients with HIV who had undergone 50 TKAs at three institutions with a minimum followup of 4 years between 2005 and 2011 were identified. An additional three patients were lost to followup before the fourth-year annual visit. All patients with HIV underwent thorough preoperative optimization with their primary care physician and infectious disease specialist. There were 31 men and 14 women with a mean age of 57 years and mean followup of 6 years (range, 4-10 years). These patients were compared with a matched cohort of 135 patients (one-to-three ratio) who did not have HIV and who had undergone a primary TKA by the same surgeons during this same period using the same implant. Matching criteria included patient age (within 2 years), BMI (within 2 kg/m2), surgeon performing TKA, followup (within 6 months), minimum followup of 4 years, sex ratio, and primary diagnosis (degenerative joint disease versus osteonecrosis). Approximately 10% of patients in the matching group had not returned for followup after their sixth annual visit. Outcomes evaluated included The Knee Society objective and function scores, University of California, Los Angeles (UCLA) activity scores, overall implant survivorship (free of revision) using Kaplan-Meier analysis, and complications. With the numbers available, there were no differences in preoperative Knee Society score or UCLA activity scores among the cohorts. RESULTS: With the numbers available, there were no differences in the mean Knee Society objective scores between patients with HIV (89 ± 11 points) and the matching cohort (91 ± 14 points) (95% CI, -7 to 3; p = 0.38). There were no differences among the Knee Society functional component as well (88 ± 12 points versus 90 ± 13 points; 95% CI, -6 to 2; p = 0.36) at latest followup. Similarly, there were no differences with the numbers available in the UCLA activity scores (6 ± 5 points [range, 4-7] versus 6 ± 7 points [range, 4-8]; p = 0.87) between the cohorts. With the numbers available, Kaplan-Meier analysis showed no significant difference in the overall implant survivorships between patients with HIV (98%; 95% CI, 94%-99%) compared with the matching group (99%; 95% CI, 98%-100%; p = 0.89). Postoperative complications were also comparable between the two groups. CONCLUSIONS: With the numbers available, we found that patients with HIV had no differences in clinical scores and implant survivorship compared with patients without the disease at mid-term followup. We believe practitioners should not be reluctant to perform TKA on this patient population. However, we believe the preoperative optimization process is crucial to achieving good outcomes and minimizing the risk of complications. Future comparative studies should have longer followup and a larger sample size with greater power to determine if there are differences in complications and implant survivorship. LEVEL OF EVIDENCE: Level III, therapeutic study.

A Systematic Review of Tennis Elbow Surgery: Open Versus Arthroscopic Versus Percutaneous Release of the Common Extensor Origin.

PURPOSE: To compare complications, function, pain, and patient satisfaction after conventional open, percutaneous, or arthroscopic release of the extensor origin for the treatment of lateral epicondylitis. METHODS: A thorough review of 4 databases-PubMed, EBSCOhost, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus, and Scopus-was performed to identify all studies that addressed surgical management of lateral epicondylitis. We included (1) studies published between 2000 and 2015 and (2) studies with clearly defined surgical techniques. We excluded (1) non-English-language manuscripts, (2) isolated case reports, (3) studies with fewer than 10 subjects, (4) animal studies, (5) studies with additional adjunctive procedures aside from release of the extensor origin, (6) clinical or systematic review manuscripts, (7) studies with a follow-up period of 6 months or less, and (8) studies in which less than 80% of patients completed follow-up. Each study was analyzed for complication rates, functional outcomes, pain, and patient satisfaction. RESULTS: Thirty reports were identified that included 848 open, 578 arthroscopic, and 178 percutaneous releases. Patients within each release group had a similar age (46 years vs 46 years vs 48 years; P = .9 and P = .4, respectively), whereas there was a longer follow-up time in patients who underwent surgery by an open technique (49.4 months vs 42.6 months vs 23 months, P < .001). There were no differences in complication rates among these techniques (3.8% vs 2.9% vs 3.9%; P = .5 and P = .9, respectively). However, open techniques were correlated with higher surgical-site infection rates than arthroscopic techniques (0.7% vs 0%, P = .04). Mean Disabilities of the Arm, Shoulder and Hand scores were substantially better with both open and arthroscopic techniques than with percutaneous release (19.9 points vs 21.3 points vs 29 points, P < .001). In addition, there was less pain reported in the arthroscopic and percutaneous release groups as opposed to their open counterparts (1.9 points vs 1.4 points vs 1.3 points, P < .0001). There were no differences among the techniques in patient satisfaction rate (93.7% vs 89% vs 88%; P = .08 and P = .07, respectively). CONCLUSIONS: Functional outcomes of open and arthroscopic releases may be superior to those of percutaneous release. In addition, patients may report less pain with arthroscopic and percutaneous techniques. Although the risk of complications is similar regardless of technique, patients may be counseled that their risk of infectious complications may be slightly higher with open releases. However, it is important to note that this statistical difference may not necessarily portend noticeable clinical differences. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV evidence.

Sexual Activity After Total Hip Arthroplasty: A Systematic Review of the Outcomes.

BACKGROUND: Total hip arthroplasty (THA) may have a marked positive impact on sexual activity. However, it is unclear how important regaining sexual activity is for patients undergoing THA or whether surgeons are aware of such concerns. The purpose of this systematic review was to evaluate the literature on the effect of THA on sexual activity before and after the procedure and to assess patient and surgeon perspectives. METHODS: A search of 4 electronic databases yielded 10 reports between 1970 and 2015. Nine evaluated the effects of THA on sexual activity in 1694 patients who had a mean age of 57 years (range 17-98 years). Two studies evaluated the perspective of 337 surgeons. Metrics evaluated included differences in patient and surgeon perspectives, improvements in sexual activity, and differences in outcomes between men and women. RESULTS: Seventy-six percent of patients identified hip arthritis as the primary cause of sexual problems with pain and stiffness being the most common complaints. Post THA, 44% of patients reported improvements in sexual satisfaction while 27% reported increased intercourse frequency. Patients returned to sexual activity at a mean 4-month post-THA. Eighty-six percent of surgeons rarely or never discuss sexual activity with their patients, and 61% believed that patients can resume sexual activity 1-month post-THA with many agreeing that certain positions were safer. CONCLUSION: The outcomes of this systematic review suggest that THA is associated with improved sexual activities and is an important topic for patients. However, surgeons may spend less time than is desired by the patients on this subject pre- and post-THA.

Does Hepatitis C Affect the Clinical and Patient-Reported Outcomes of Primary Total Hip Arthroplasty at Midterm Follow-Up?

BACKGROUND: It is estimated that 3%-6% of orthopedic patients, many of whom may undergo lower extremity total joint arthroplasty, are infected with hepatitis C. The purpose of this study was to assess the outcomes of patients with hepatitis C who undergo total hip arthroplasty (THA) in comparison with a matched control cohort in terms of (1) patient-reported outcomes, (2) implant survivorship, and (3) complications. METHODS: Fifty-four hips in 49 hepatitis C-infected patients who underwent a primary THA between 2002 and 2011 were reviewed. This included 10 women and 39 men who had a mean age of 57 years and a mean 6.5-year follow-up. These patients were matched to 163 THAs (148 patients) who did not have this disease and underwent a THA during the same period. We compared implant survivorship, complication rates, Harris hip scores, and University of California, Los Angeles, activity scores. Radiographs were evaluated for loosening, fracture, malalignment, and osteolysis. RESULTS: The implant survivorship in the hepatitis C-infected patients and comparison group was 96.2% and 98.7%, respectively. The risk of revision surgery in the hepatitis C cohort was 3-fold higher than the comparison group; however, this difference was not significant (P = .26). The hepatitis C-infected cohort had a higher risk of surgical complications (odds ratio = 6.5; P = .034). There were no differences in postoperative Harris hip scores or University of California, Los Angeles, activity scores between the cohorts. CONCLUSION: Hepatitis C patients can achieve good implant survivorship and clinical outcomes after THA. However, these patients may be at an increased risk for surgical complications and revision rate.

Medical Missions in the Middle East: An Orthopaedic Surgeon's Experience of a Series of Lower Extremity Cases.

Orthopaedic trauma accounts for a great deal of disability worldwide. There are many impoverished nations affected by war wherein victims suffer blast injuries associated with mines, missiles, high-powered gunshots, and bombings. One way to address this is through international medical missions sponsored by industrialized nations. It is imperative that practitioners have a basic understanding of the type of injuries that may be encountered in these nations impacted by war and conflict. Therefore, we described a small number of various lower extremity injuries seen by one orthopaedic surgeon during his volunteer medical mission to Jordan. Frequently, these injuries did result in the loss of a limb and/or function as the patients were treated without appropriate instrumentation or facilities in a suboptimal environment. Treatment was frequently delayed, and many of the surgeons involved lacked optimal training. It is our hope that this case series will lead to studies which may give guidance regarding how to best treat these complex injuries with optimal outcomes and minimal complications.

An Anterior Inferior Iliac Spine Avulsion Fracture in a 14-Year Old Boy on Human Growth Hormone.

We present the case of a young man with an anterior inferior iliac spine (AIIS) avulsion fracture who was taking human growth hormone (HGH) at the time his injury was diagnosed. He presented with chronic hip pain and no traumatic event. Physical exam revealed symptoms of hip impingement. Upon imaging, he was diagnosed with an AIIS avulsion fracture and underwent surgical repair. He returned to full activity six months post-operatively. At 18-months post-operatively, he was pain-free and performing all activities without difficulty. The role of HGH in his injury or recovery is not well understood and must be studied with large database studies.

Low Ankle Sprains: A Current Review of Diagnosis and Treatment.

LLow ankle sprains are common injuries in young athletes. Hence, it is imperative that low ankle sprains are diagnosed and treated quickly and effectively. We reviewed the: (1) anatomy; (2) imaging; (3) physical exam findings; and (4) treatment modalities regarding these injuries. Plain radiographs are standard of care and routine MRI is not recommended for suspected sprains. However, physical exam findings often may guide management decisions. The majority of patients diagnosed with low ankle sprains are treated with a one- to two-week immobilization period with physical therapy focused on peroneal proprioception and strength. If a prolonged non-operative course fails, or there is gross instability upon physical exam (grade III sprain), surgical reconstruction may be considered and may lead to excellent outcomes. When low ankle sprains do occur, the great majority may be treated non-operatively. In the event that conservative modalities fail, surgical reconstruction may be considered with an open modified Brostrom reconstruction as the current standard of care.

A Partial Posterior Bundle Ulnar Collateral Ligament Tear in a 10-year old Boy.

Medial-sided elbow pain is becoming more common among pediatric overhead sport athletes. One potential cause of this is a partial or complete tear of the ulnar collateral ligament (UCL). Because the growth plate remains open in many of these athletes, the most common injury experienced is an avulsion at the medial epicondyle. However, although rare, there is a potential to tear the UCL, with the most common tears occurring at the anterior bundle. However, tears to the posterior bundle are quite rare in pediatric patients. We aim to describe the case of a 10-year old boy who was diagnosed with a partial posterior bundle UCL tear and was successfully treated by cessation of throwing activities and physical therapy. He was able to return to baseball 10 months after his diagnosis.

Midterm Outcomes Following Total Knee Arthroplasty in Lupus Patients.

BACKGROUND: An increasing number of patients with systemic lupus erythematosus (SLE) are undergoing total knee arthroplasty (TKA), but there are few studies detailing their outcomes. The purpose of this study was to evaluate TKA cohort of patients who had SLE compared with a matched cohort who did not have this disease by analyzing (1) implant survivorship, (2) functional outcomes, (3) complication rates, (4) health-related quality of life, and (5) patient-perceived activity level. METHODS: A retrospective review of all patients who underwent TKA and had an International Classification of Diseases, Ninth Revision, code diagnosis for SLE was performed at 3 high-volume institutions. A total of 31 patients (34 arthroplasties) were identified, and they were compared with a matched cohort (1:3) who did not have SLE and had undergone a primary TKA during this same time period. RESULTS: After a mean 6-year follow-up (range, 2-10 years), both cohorts had similar implant survivorship (91% vs 99%). In addition, each cohort had similar complication rates (odds ratio = 1.9, 0.99-13). Functional outcomes were similar as measured by Knee Society Scores objective (90 vs 91 points) and functional (89 vs 90 points). There were no differences in Short Form-36 physical (47 vs 49 points) or mental components (51 vs 53 points). University of California Los Angeles activity scores were similar as well (5.1 vs 5.9 points). CONCLUSIONS: Our study demonstrated comparable excellent clinical and patient-reported outcomes of TKA in patients with or without SLE. Prospective studies are necessary to evaluate these outcomes at longer follow-up.

Traumatic Diastasis of the Pubic Symphysis-A Review of Fixation Method Outcomes.

Traumatic pubic symphysis diastases (PSD) are life-threatening injuries that often require operative fixation. The purpose of this review is to evaluate the outcomes of patients following various operative fixation techniques of these particular pelvic ring injuries. Specifically, we will analyze the role of: (1) surgical approach; (2) implant failure; and (3) fixation methods in treating traumatic PSD. They are typically fixed using the Pfannestiel approach, but a midline approach may be used in cases where this is not ideal. These fractures often have implant failure; however, studies have shown this does not impact clinical outcomes. Currently, the gold standard of fixation is multiple-hole plate fixation. There are a number of other surgical fixation methods such as two-hole plating or percutaneous fixation that may be considered as well. Future studies should focus on the long-term outcomes and efficacy of these new innovative techniques for fixation of traumatic PSD.

What Is the Efficacy of Repeat Manipulations Under Anesthesia to Treat Stiffness Following Primary Total Knee Arthroplasty?

BACKGROUND: Manipulation under anesthesia (MUA) can help post-total knee arthroplasty (TKA) patients who have knee stiffness regain range-of-motion. However, despite undergoing MUA, patients may have persistent knee stiffness. Often, this persistent knee stiffness is treated with a repeat MUA. Therefore, the purpose of this study was to evaluate repeat MUAs by assessing: (1) demographic characteristics, (2) range-of-motion, (3) clinical outcomes, and (4) rate of revision surgery in post-TKA patients with persistent knee stiffness who either underwent a single MUA or repeat MUAs. MATERIALS AND METHODS: One-hundred-and-sixty-seven post-TKA who had undergone an MUA between 2005 and 2011 at two institutions were reviewed. Patients were stratified into those who had a single-MUA (138 knees) and those who had a repeat MUA (29 knees). The mean follow-up period was 63 months (range, 36 to 90 months). The incidence of repeat MUA within this cohort was determined. Demographics and ROM were compared using Student t-test and Chi-square as appropriate. Functional outcomes were assessed using Knee Society scores (KSS) and compared between the two cohorts. RESULTS: Among the 167 patients who underwent a MUA, 29 (17%) required repeat manipulations. The repeat MUA cohort was younger and more likely to have osteonecrosis as the underlying cause of knee disease. For the repeat MUA cohort, 17 patients (59%) had achieved satisfactory mean gains in ROM after their repeat MUAs. These patients had also achieved excellent mean Knee Society objective and functional scores. However, another seven knees (24%) had further persistent knee stiffness requiring arthrolysis of adhesions and five patients (17%) had undergone revision of the polyethylene spacer or patellar component to improve range-of-motion. CONCLUSION: In this study, the majority of patients who had undergone a repeat MUA were able to achieve improvements in flexion range-of-motion and functional outcomes. However, the remaining patients required more invasive procedure to treat persistent knee stiffness. In patients who have persistent knee stiffness after MUAs, a repeat MUA may be helpful to increase range-of-motion and function.

Total Shoulder Arthroplasty Demographics, Incidence, and Complications-A Nationwide Inpatient Sample Database Study.

INTRODUCTION: Total shoulder arthroplasty (TSA) has become a popular and successful surgery to treat advanced glenohumeral arthritis, rotator cuff arthropathy, and proximal humerus fractures. Historical data is available investigating the epidemiology of total shoulder arthroplasty with regard to patient characteristics, outcomes, and complications; however, there is a lack of studies investigating the most recent and up to date national trends related to shoulder replacement. The purpose of this study was to evaluate changes in the annual incidence, various demographics, and complications of TSA in America. MATERIALS AND METHODS: The Nationwide Inpatient Sample (NIS) was assessed to identify all patients who were admitted for TSA in the United States between 1998 and 2010. National trends in patient demographics, incidence, and length-of-stay (LOS) were analyzed for correlations. The impacts of contributing factors to each outcome were assessed using adjusted multivariable regression analysis. These were used to calculate odds ratios of cohort demographics and their association with complications and LOS. RESULTS: Admissions for TSA have risen (8,041 to 39,072 admissions). The majority of the cohort consisted of Caucasian men between the ages of 64 and 79 years. The incidence rate of complications has remained consistent. Female gender, age > 80 years, and higher Deyo Comorbidity scores were risk factors for higher complications. The LOS has decreased (2.96 to 2.21 days) during the study time period. Female gender, African-American race, Medicaid insurance, and higher Deyo Comorbidity scores were associated with longer stays. DISCUSSION: Our study demonstrates a rapid increase in incidence rates of TSAs within the 13-year period in the United States. An increased risk of complications was noted with older age, female gender, and increased Deyo score. CONCLUSION: Our findings may help health care providers identify ways to better manage this procedure and select patients.

Ochronosis as Etiology of Requiring Total Knee Arthroplasty-A Case Series.

Alkaptonuria is a rare hereditary metabolic disorder that leads to the accumulation of homogentisic acid accumulation and weakens the collagen, creating fissuring and articular cartilage degeneration. Therefore, we are reporting a multicenter case series of three patients (four arthroplasties) who presented with signs and symptoms of ochronotic arthropathy-and eventually underwent total knee arthroplasty (TKA)-and provide a review of the current literature on total joint arthroplasty in ochronotic osteoarthritis. Each patient achieved excellent Knee Society Scores (KSS) after at least a five-year follow-up-regardless of receiving cemented or cementless prostheses-and suffered no complications. There have been a number of case reports published on patients who had TKA and were found to have a diagnosis of ochronosis. We believe that surgery for symptomatic patients who are surgical candidates for TKA should not be delayed for concerns of complications. However, future studies should compare outcomes to those who undergo TKA without ochronotic arthropathy.

Is the use of thin, highly cross-linked polyethylene liners safe in total hip arthroplasty?

PURPOSE: Due to the high number of total hip arthroplasties (THA) revised due to instability, the use of large femoral heads to reduce instability is justifiable. It is critical to determine whether or not large femoral heads used in conjunction with thin polyethylene liners lead to increased wear rates, which can lead to osteolysis. Therefore, by using validated wear-analysis software, we evaluated linear wear rates in a consecutive cohort of patients who underwent primary THA with thin polyethylene liners. METHODS: All patients were selected from a consecutive, prospectively collected database of 241 THAs performed at a single institution by two fellowship-trained joint-reconstruction surgeons between July 2007 and June 2011. These patients were 1:1 matched to a cohort of patients who had conventional-thickness polyethylene liners. RESULTS: No significant differences were observed between linear wear rates of thin or conventional-thickness liners. The Kaplan-Meier survivorship for both cohorts was 100 %, and no cases of polyethylene fracture were observed in either cohort. CONCLUSIONS: Our results suggest that according to a mean follow-up of 4 years, the use of thin liners in THA is promising. Longer follow-up is required to assess whether these outcomes are observed later.

A Current Review of Mechanical Compression and Its Role in Venous Thromboembolic Prophylaxis in Total Knee and Total Hip Arthroplasty.

Interest in mechanical compression for venous thromboembolic disease prophylaxis has increased over the last several years because of concerns related to bleeding complications associated with chemoprophylaxis. However, the research evaluating compression is clearly not definitive. Therefore, this review aims to: (1) summarize methods of compression; (2) compare AAOS, ACCP, and SCIP guidelines; and (3) make recommendations regarding usage. Below-the-knee devices have demonstrated the most efficacy with multiple guidelines recommending usage. Efficacy and compliance may be improved with the use of mobile devices.

Early Outcomes of Titanium-Based Highly-Porous Acetabular Components in Revision Total Hip Arthroplasty.

Titanium-based highly-porous metal cups have been introduced as a relatively new alternative for enhanced acetabular fixation during revision THA; limited number of studies have evaluated its outcomes. We aimed to assess the clinical, functional, and patient-reported outcomes following the use of new generation highly-porous titanium acetabular implants in the revision setting. Seventy-one revisions were (1:1) matched to a conventional porous-coated cohort and were followed-up clinically and radiographically for at least 2-years. Non-significant differences in overall aseptic-survivorship were found across all types of acetabular defects comparing both cohorts (P=0.3). The overall HHS, UCLA, and SF-36 scores were similar between both cohorts. It remains to be seen if the great potential for enhanced osseointegration translates into improved long-term survivorship compared to conventional-porous devices.

Long-Term Survivorship and Clinical Outcomes Following Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is one of the most successful commonly performed orthopedic procedures; as such, the purpose was to assess the long-term outcomes and survivorship of primary TKAs with a dual-radius prosthesis. We evaluated 125-patients (145-knees), with a mean age of 63 years (37-90 years) for a mean 11-year follow-up (10-13 years). Outcomes were assessed with KSS, UCLA, SF-36, satisfaction scores, and aseptic survivorship analysis. At 10-year follow-up, the UCLA (6-points), KSS objective (84-points) and functional (73-points), SF-36 physical (41-points) and mental (51-points), and patient satisfaction (14-points) scores were reported to be good to excellent. The 10-year Kaplan-Meier survivorship rate was 99%; one TKA demonstrated radiographic loosening. At a minimum 10-year follow-up, this device demonstrated satisfactory outcomes and outstanding aseptic-survivorship rates.

Readmission Rates in Patients Who Underwent Total Hip Arthroplasty.

Readmission rates remain a concern following total hip arthroplasty (THA). This study: 1) evaluated 30-day, 90-day, and total readmission rates after THAs; 2) assessed causes of readmission; 3) determined differences in demographic factors between those who were and were not readmitted; and 4) compared readmission rates to other large-scale studies. We retrospectively reviewed 232 primary THAs (224 patients) using the same prosthesis at 7 institutions. This included 79 men and 145 women who had a mean age of 69 years (range, 44 to 88). Descriptive analyses were used to evaluate readmission, and rates were compared with those from large cohort studies. There were 11 unplanned readmissions (4.7%) in 10 patients during the first 90 days post-discharge. Seven (3%) readmissions were due to surgical and 4 (1.7%) were due to medical reasons. Surgical causes were found in 70% of early (0 to 30 days) readmissions but none of late (60 to 90 days) readmissions. No differences existed in mean age, gender, and body mass index between readmitted patients and the remainder of the population. We observed lower readmission rates when compared with large cohort studies. The positive performance of the prosthesis may have contributed to the lower readmission rates.