Clinical Outcomes and Survivorship of Hybrid Total Hip Arthroplasty Performed Through the Anterior Approach.

INTRODUCTION: There is growing evidence that cemented femoral stems have lower complication rates in the elderly due to lower rates of periprosthetic fracture. The main objective of this study was to analyze the survival rate of a hybrid total hip arthroplasty (THA) construct utilizing a taper-slip femoral stem implanted through the anterior approach (AA). Secondary outcome measures were the complication rate, the rate of aseptic loosening, coronal plane alignment of the stem, and the grade of the cement mantle. METHODS: Patients who underwent AA hybrid THA from 2013 to 2020 were included. Indications for a cemented stem were age over 70 or patients with poor bone quality. Descriptive statistics were calculated for patient characteristics. Serial radiographs were reviewed for component alignment and for evidence of implant loosening. The survival of the femoral stem was recorded, with failure defined as femoral stem revision for any reason or radiographic evidence of implant loosening. RESULTS: A total of 473 hybrid THA in 426 patients were identified, with a mean age of 76 years. Mean follow-up was 38 months. Femoral stem survival was 99.2%. There were no cases of aseptic loosening of the femoral component. Mean coronal stem alignment was 0.2 degrees varus, and all were within 5 degrees of neutral. Cement mantle grade was either A or B in 94% of cases. CONCLUSION: AA hybrid THA is an excellent option in elderly patients, or patients with poor bone quality, with a femoral stem survival rate of 99.2% and a 0% rate of aseptic loosening.

Ultrasound-Guided Adductor Canal Block Versus Intraoperative Transarticular Saphenous Nerve Block: A Retrospective Analysis.

BACKGROUND: The ultrasound-guided adductor canal block (High-ACB) is an effective option for pain control in total knee arthroplasty (TKA), but its use can add substantial cost and preparatory time to a TKA procedure. An intraoperative adductor canal block (Low-ACB) performed by the operative surgeon has been described as an alternative. The hypothesis of this study is that the Low-ACB would achieve noninferior pain control and opioid utilization postoperatively when compared to the High-ACB. METHODS: This is a retrospective study of a prospectively maintained database comparing the High-ACB vs the Low-ACB. The primary outcome measure was morphine milligram equivalents consumed. Secondary outcome measures included Visual Analog Scale pain scores, postoperative outcomes (Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, knee range of motion), length of stay, postoperative speed of mobilization, and complications related to the type of block. RESULTS: There were 139 patients in the study. There was lower opioid use in the first 24 hours in the Low-ACB compared to the High-ACB group respectively (26.3 vs 30, P = .29) but this did not reach statistical significance. There was a statistically significant difference in Visual Analog Scale score on postoperative day 1 in the Low-ACB vs High-ACB groups respectively (4.6 vs 3.7, P = .02) but this did not reach the level of clinical significance. There was no statistical difference in the Patient-Reported Outcome Measurement Information System, Knee Injury and Osteoarthritis Outcome Score, or postoperative range of motion. There were no block-related complications in either group. CONCLUSION: The Low-ACB is a safe, effective, and cost-saving alternative to the traditional High-ACB for pain control in TKA.

Tobacco Smoking Independently Predicts Lower Patient-Reported Outcomes: New Insights on a Forgotten Epidemic.

BACKGROUND: Although smoking is a well-accepted risk factor for surgical complications, the effect of smoking on patient-reported outcomes (PROs) has not been previously investigated. Prompted by an increasingly value-conscious healthcare environment, the purpose of this study is to investigate the association between smoking and PROs in total joint arthroplasty (TJA). METHODS: A retrospective review of 713 primary total hip and knee replacements was performed. Two cohorts were compared: (1) current smokers and (2) previous/never smokers at the time of TJA. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-12 Physical Composite Summary (SF-12 PCS) and Short Form-12 Mental Composite Summary were assessed preoperatively and again at 6 and 12 months postoperatively. The primary outcomes were the net changes and absolute outcome scores at final follow-up. Postoperative patient satisfaction was also assessed as a secondary outcome. Linear mixed-effects regression analysis was performed. RESULTS: There were significant demographic and preoperative health disparities as measured by PROs among smokers. After adjusting for baseline differences, smokers achieved significantly lower improvements in WOMAC (P = .002) and SF-12 PCS (P = .03) compared to nonsmokers. For each unit increase in packs per day smoked, the WOMAC scores increased (worsened) by 7.7 points (P = .003) and SF-12 PCS decreased by 4.8 points (P = .001). At final follow up, nonsmokers had significantly better absolute scores for all outcomes (except for mental health) and were more likely to be satisfied with surgery (89% vs 82%, P = .052). CONCLUSION: Tobacco smoking is an independent predictor for lower PROs after TJA and this relationship is dose-dependent. The negative impact of smoking does not appear to be related to impaired psychological health. As we transition to value-based care delivery models, this study provides further evidence that smoking cessation should be strongly recommended as a modifiable risk factor before embarking on elective TJA. Studies are still needed to define the optimal window for smoking cessation.

Revisiting Cemented Femoral Fixation in Hip Arthroplasty.

➤: The primary means of femoral fixation in North America is cementless, and its use is increasing worldwide, despite registry data and recent studies showing a higher risk of periprosthetic fracture and early revision in elderly patients managed with such fixation than in those who have cemented femoral fixation. ➤: Cemented femoral stems have excellent long-term outcomes and a continued role, particularly in elderly patients. ➤: Contrary to historical concerns, recent studies have not shown an increased risk of death with cemented femoral fixation. ➤: The choice of femoral fixation method should be determined by the patient's age, comorbidities, and bone quality. ➤: We recommend considering cemented femoral fixation in patients who are >70 years old (particularly women), in those with Dorr type-C bone or a history of osteoporosis or fragility fractures, or when intraoperative broach stability cannot be obtained.

Upper extremity deep venous thromboembolism following arthroscopic labral repair of the shoulder and biceps tenodesis: a case report.

STUDY DESIGN: Case Report. BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is a rare complication following arthroscopic shoulder surgery. However, it is possible that a patient with an UEDVT will present to physical therapy as the first service to interact with the patient following surgery. As a result, proper screening in the physical therapy setting is essential. CASE DESCRIPTION: The purpose of this report is to present the case of a 37 year-old male who developed an upper extremity deep vein thrombosis (UEDVT) following arthroscopic glenohumeral labral repair and arthroscopically assisted biceps tenodesis. This patient presented with disproportionate pain and swelling of his involved upper extremity at his initial evaluation in physical therapy (8 days post-operatively), which raised the index of suspicion for an UEDVT. OUTCOME: The patient was referred to the emergency department for immediate diagnostic testing and treatment. A Doppler scan provided a definitive diagnosis of UEDVT. Following successful medical treatment with anti-coagulant therapy, the patient went on to complete an otherwise uneventful course of rehabilitation. DISCUSSION: UEDVT events following arthroscopy are rare, and are often attributed to a systemic secondary stimulus. UEDVT following shoulder arthroscopy is a complication that occurs in the orthopaedic setting, but may present primarily to the physical therapist, and as such requires awareness of its clinical presentation and treatment. Care of UEDVT requires a systems-based approach when considering clinical manifestation, best treatment, and future research.

In vitro evaluation of the anti-bacterial effect of two preparations of platelet rich plasma compared with cefazolin and whole blood.

PURPOSE: This study investigates the antibacterial properties of two different platelet-rich plasma (PRP) platelet concentration preparations (PRPLP and PRPHP) through a time-kill assay. METHODS: Two different PRP preparations - a single spin process yielding lower white blood cells and platelet concentration (PRPLP) and one yielding high platelet and white blood cell concentration (PRPHP) - were obtained from 2 individuals. PRPLP, PRPHP, phosphate buffered saline (PBS), whole blood and Cefazolin were added to experimental reaction tubes, each containing a single bacterial inoculum of Staphylococcus aureus (S. aureus), Staphylococcus epidermidis (S. epi), methicillin-resistant Staphylococcus aureus (MRSA) or Propionibacterium acnes (P. acnes). Two dilutions (1:1,000, and 1:10,000) were plated in duplicate tubes, along with positive (blood and PBS) and negative (Cefazolin) controls and assessed at five time points (0, 1, 4, 8 and 24 hours). RESULTS: After centrifugation, platelet count of PRPLP was 386 ± 65.5 × 103/?L and PRPHP was 867 ± 234.4 × 103/?L. Both PRP products showed a significant decrease (p<0.05) in bacterial growth at 8 hours compared to whole blood. CONCLUSION: The application of PRPLP and PRPHP showed a significant decrease in bacterial growth after 8 hours for S. aureus, S. epi, MRSA and P. acnes compared to the whole blood control group. S.epi, MRSA, and P. acnes also showed a significant decrease in bacterial growth after 24 hours. Despite differences in platelet concentration and WBC concentration, no difference in antibacterial activity was seen between the two preparations.