Salto Talaris Fixed-Bearing Total Ankle Arthroplasty: Long-Term Results at a Mean of 10.7 Years.

Background: Total ankle arthroplasty (TAA) has become increasingly popular in the treatment for end-stage ankle arthritis in recent decades. However, there is limited evidence regarding the long-term clinical outcomes and complication rates of modern TAA implants. Methods: This study presents a follow-up on a previous cohort involving 78 patients (81 ankles) who underwent Salto Talaris fixed-bearing TAA to treat end-stage arthritis, with a mean postoperative follow-up of 5.2 years. The aim of this follow-up study was to assess the radiographic (33 patients, 35 ankles) and clinical (48 patients, 50 ankles) results from the original cohort at a mean of 10.7 years (range, 7.8-14 years). Results: At a mean of 10.7 years, the Kaplan-Meier estimated survivorship was 84.2% (95% CI, 71.9%-98.6%). For the patients reviewed, we did not find any change in patient-reported outcomes between an average 5- and 11-year follow-up. Measured total range of motion and plantarflexion did not change between 1 and 11 years, but dorsiflexion was measured as decreasing by an average of 4 degrees (P < .02). Conclusion: In this longer-term follow-up of a limited cohort, we found that Salto Talaris fixed-bearing TAA demonstrated good long-term survival with relatively low rates of revision or other complications. Patient-reported outcome and range of motion measures revealed good stability. Level of Evidence: Level III, therapeutic.

Five-Strand Hamstring Grafts are Biomechanically Comparable to Four-Strand Grafts and Offer Greater Diameter for Anterior Cruciate Ligament Reconstruction.

Purpose: The purpose of this study was to compare the biomechanics of 4-strand and 5-strand hamstring constructs for anterior cruciate ligament grafts. Methods: Thirty-six human cadaveric hamstring grafts were tested in 3 different conditions: (1) graft femoral fixation complex, (2) graft femoral and tibial fixation (GFTF) complex using a human model, and (3) GFTF complex using a porcine model. Grafts were tested on a tensile testing machine. Four-stranded grafts served as the control group, and 5-stranded grafts served as the experimental group. Cyclic elongation, ultimate load to failure, stiffness, and diameter of the grafts were analyzed. Results: Average 4-strand graft diameter was 7.96 mm compared to 9.32 mm for the 5-strand graft (P = .00017). Average stiffness of grafts ≥8 mm was 105.04 N/mm compared to 85.05 N/mm for grafts <8 mm (P = .04988). There was a positive correlation between graft diameter and stiffness (13.4 N/mm per every 1 mm increase in diameter, r 2 value of 13.1%, and F-significance of 0.02778). There were no significant differences in terms of ultimate load to failure, cyclic elongation, or stiffness between the experimental groups. Conclusion: Five-strand hamstring grafts offer greater diameter and are biomechanically comparable to 4-strand equivalents at time 0. Grafts >8 mm offer significantly greater stiffness compared to grafts sized <8 mm. There is a weak positive correlation between graft diameter and stiffness. Clinical Relevance: A potential drawback to hamstring grafts is their variability in size. Five-strand hamstring grafts provide increased diameter in comparison to 4-strand equivalents and might be used when quadrupled graft diameter is <8 mm.

Biomechanical Comparison of Meniscal Allograft Root Fixation Techniques: Anterograde Interference Bone Plug Fixation Yields Favorable Results Compared to Transosseous Suture Fixation Alone.

Purpose: To compare the biomechanical properties of 2 different fixation techniques (interference bone plug fixation vs transosseous suture fixation) of the posterior horn of the medial meniscus using a porcine model. Methods: Twenty-six matched pairs of fresh-frozen juvenile domestic porcine knees were used in this study. Specimens were randomly distributed among 3 groups: (1) native meniscus groups, (2) interference fixation, and (3) transosseous suture fixation. In each group, the posterior segments of the tested medial menisci were gripped with the freeze clamps and fixed to the tensile testing machine. Samples were preconditioned, followed by cyclic tension-relaxation for 1000 cycles between 10 and 30 N at 0.5 Hz and finally pulled to failure at a rate of 0.55 mm/s. The cyclic elongation, stiffness to failure, mode, and ultimate load to failure were recorded. Results: There was no significant difference in ultimate load to failure between the interference fixation (169.71 ± 71.98 N) and transosseous suture fixation (222.73 ± 72.40 N) groups (P = .118), both were significantly less than that of the native meniscus (405.46 ± 95.62) (P < .001). Interference fixation displayed cyclic elongation (1.04 ± 0.71 mm) and stiffness (69.10 ± 25.8 N/mm) that were not significantly different from the native meniscus tissue (0.78 ± 0.53 mm and 83.1 ±26.28 N/mm) (P = .359 and P = .224), in comparison to transosseous suture fixation, which did show increased cyclic elongation (1.85 ± 1.44 mm) (P = .047) and decreased stiffness (34.72 ± 10.2 N/mm) (P < .001). Conclusion: Interference fixation of the posterior horn of the medial meniscus has superior cyclic elongation and stiffness when compared to transosseous suture fixation. Interference fixation and the native meniscus model have a similar stiffness and cyclic elongation. Clinical Relevance: The significance of our study is that using interference fixation for meniscal allograft transplantation has the potential to reduce short term surgical failures as well as long term complication rates.

A Unique Complication of Femoral Broach Fracture and Incarceration During Total Hip Arthroplasty.

In recent years, total hip arthroplasty via the direct anterior approach has been gaining popularity. It offers potential early advantages for less pain and quicker return of hip function; however, compared to other surgical approaches, it is associated with a more difficult femoral reconstruction. Inadequate femoral exposure during the direct anterior approach can result in suboptimal press fit, implant malalignment, and intraoperative fracture. This case report presents a unique complication of femoral broach failure and describes a simple technical solution that is feasible, cost-effective, and safe.

Negative Online Ratings of Joint Replacement Surgeons: An Analysis of 6,402 Reviews.

BACKGROUND: With the expanding accessibility of online health-care information, patients frequently report visiting physician rating websites before choosing a surgeon. As such, it is important to analyze patients' perception of arthroplasty surgeons as reflected on physician rating websites. METHODS: A total of 6402 online reviews of arthroplasty surgeons were extracted for analysis. Each review rated less than 5 on a 5-point scale was deemed a "negative" review and was subsequently assigned to an appropriate category. Reviews were stratified by practice type, years in practice, gender, and low (<3) vs high (> 3) ratings. RESULTS: A total of 6402 reviews comprising 315 physicians were included in the analysis. The average rating for all surgeons was 4.35. The average rating for physicians in private practice was 4.3, compared to 4.5 for those in an academic setting. The average rating for physicians in practice for 1-10 years was 4.46, compared to 4.03 for those with >10 years of experience (P < .001). The most common factors contributing to negative reviews were bedside manner, wait time, poor outcome, and surgeon proficiency. Surgeon-dependent factors were more commonly associated with lower rated reviews (P < .001). CONCLUSIONS: Arthroplasty surgeons typically receive high online ratings, with a mean of 4.35 on a 5-point scale. Physicians in academic practice received higher ratings than those in private practice, and physicians who have been in practice for 1-10 years received higher ratings than those with more than 10 years in practice. The most common factors contributing to negative reviews are surgeon-dependent, including bedside manner, poor outcome, and surgeon proficiency.

Bilateral Knee Dislocations Treated with Acute, Single-Stage Multiligament Reconstructions.

Bilateral knee dislocations are exceedingly rare in orthopaedics. Managing these injuries presents a difficult task given their high complication rate and guarded prognosis. We report the case of a 21-year-old male who presented to our institution with bilateral knee dislocations sustained in a motor vehicle collision. The patient subsequently underwent multiligament knee reconstruction surgeries for each knee at one and three weeks following the initial injury. At one-year follow-up, the patient has achieved a successful outcome and has returned to regular activities which include hiking and exercising at the gym.

A Rare Case of Periprosthetic Joint Infection Caused by a Periodontal Pathogen, Slackia exigua: A Case Report.

CASE: A 72-year-old woman with a history of right total hip arthroplasty and subsequent revision 18 years ago developed right hip periprosthetic joint infection with significant bone destruction caused by Slackia exigua. She underwent a dental cavity filling without prophylactic antibiotics before presentation that may have contributed to development of the infection. The patient required total hip revision and prolonged antibiotic therapy to eradicate the bacteria. CONCLUSION: This case is an example that certain high-risk patients undergoing invasive dental procedures are at risk of developing prosthetic joint infection.

Single-Stage Bilateral Total Hip Arthroplasty in an Ambulatory Surgical Center: A Report of Three Cases.

In recent years, there has been increased interest in transitioning total joint arthroplasty procedures from inpatient settings to ambulatory surgical centers to decrease costs and eliminate the need for hospital stays. In addition, simultaneous bilateral total hip arthroplasty (THA) has been found to be favorable in certain patient populations when compared with staged bilateral THA. In this study, we report the results of a series of three patients who underwent single-stage bilateral THA in a free-standing ambulatory surgical center with excellent short-term outcomes and no 90-day complications.

Premature spinal fusion after insertion of magnetically controlled growing rods for treatment of early-onset scoliosis: illustrative case.

BACKGROUND: Magnetically controlled growing rod (MCGR) systems have gained attention for their use in the treatment of early-onset scoliosis. Although traditional growing rods require frequent operations to lengthen the construct, MCGR allows for fewer open procedures and more frequent distractions by externally controlling rod elongation. Despite its appealing advantages, MCGR is not without limitations. OBSERVATIONS: The authors describe a case of premature spinal autofusion before growing rod removal and termination of rod distraction. LESSONS: This case highlights the limitations of MCGR systems, including length of use, body habitus restrictions, and risk of autofusion.

Personalized Fiber-Reinforcement Networks for Meniscus Reconstruction.

The menisci are fibrocartilaginous tissues that are crucial to the load-sharing and stability of the knee, and when injured, these properties are compromised. Meniscus replacement scaffolds have utilized the circumferential alignment of fibers to recapitulate the microstructure of the native meniscus; however, specific consideration of size, shape, and morphology has been largely overlooked. The purpose of this study was to personalize the fiber-reinforcement network of a meniscus reconstruction scaffold. Human cadaveric menisci were measured for a host of tissue (length, width) and subtissue (regional widths, root locations) properties, which all showed considerable variability between donors. Next, the asymmetrical fiber network was optimized to minimize the error between the dimensions of measured menisci and predicted fiber networks, providing a 51.0% decrease (p = 0.0091) in root-mean-square (RMS) error. Finally, a separate set of human cadaveric knees was obtained, and donor-specific fiber-reinforced scaffolds were fabricated. Under cyclic loading for load-distribution analysis, in situ implantation of personalized scaffolds following total meniscectomy restored contact area (253.0 mm2 to 488.9 mm2, p = 0.0060) and decreased contact stress (1.96 MPa to 1.03 MPa, p = 0.0025) to near-native values (597.4 mm2 and 0.83 MPa). Clinical use of personalized meniscus devices that restore physiologic contact stress distributions may prevent the development of post-traumatic osteoarthritis following meniscal injury.

Biomechanical characterization of a novel collagen-hyaluronan infused 3D-printed polymeric device for partial meniscus replacement.

The menisci transmit load by increasing the contact area and decreasing peak contact stresses on the articular surfaces. Meniscal lesions are among the most common orthopedic injuries, and resulting meniscectomies are associated with adverse polycaprolactone contact mechanics changes and, ultimately, an increased likelihood of osteoarthritis. Meniscus scaffolds were fabricated by 3D-printing a network of circumferential and radial filaments of resorbable polymer (poly(desaminotyrosyl-tyrosine dodecyl ester dodecanoate)) and infused with collagen-hyaluronan. The scaffold demonstrated an instantaneous compressive modulus (1.66 ± 0.44 MPa) comparable to native meniscus (1.52 ± 0.59 MPa). The scaffold aggregate modulus (1.33 ± 0.51 MPa) was within 2% of the native value (1.31 ± 0.36 MPa). In tension, the scaffold displayed a comparable stiffness to native tissue (127.6-97.1 N/mm) and an ultimate load of 33% of the native value. Suture pull-out load of scaffolds (83.1 ± 10.0 N) was within 10% of native values (91.5 ± 15.4 N). Contact stress analysis demonstrated the scaffold reduced peak contact stress by 60-67% and increased contact area by 38%, relative to partial meniscectomy. This is the first meniscal scaffold to match both the axial compressive properties and the circumferential tensile stiffness of the native meniscus. The improvement of joint contact mechanics, relative to partial meniscectomy alone, motivates further investigation using a large animal model. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2457-2465, 2019.

Partial Meniscus Replacement with a Collagen-Hyaluronan Infused Three-Dimensional Printed Polymeric Scaffold.

IMPACT STATEMENT: The only FDA-approved partial meniscus scaffold, the Collagen Meniscus Implant (CMI), is not approved for reimbursement by government and only reimbursable by certain private insurers. Scaffolds with improved mechanical properties and greater efficacy are needed. A previous study (Ghodbane, et al. DOI: 10.1002/jbm.b.34331) demonstrated the ability of our novel acellular, off-the shelf scaffold to restore knee biomechanics following partial meniscectomy, which could potentially decrease the risk of osteoarthritis following partial meniscectomy, providing the motivation for this study. This article presents a first-in-animal feasibility study.

Tissue-Engineered Total Meniscus Replacement With a Fiber-Reinforced Scaffold in a 2-Year Ovine Model.

BACKGROUND: Meniscus injuries and associated meniscectomies cause patients long-term pain and discomfort and can lead to joint deterioration. PURPOSE: To evaluate a collagen-hyaluronan sponge reinforced with synthetic resorbable polymer fiber for total meniscus reconstruction in a long-term ovine model. STUDY DESIGN: Controlled laboratory study. METHODS: Eleven skeletally mature sheep were implanted with the total meniscus scaffold. At 2 years, explants were evaluated biologically (radial/circumferential histology, immunofluorescence) and mechanically (compression, tension), and articular surfaces were examined for damage. RESULTS: The fiber-reinforced scaffold induced formation of functional neomeniscus tissue that was intact in 8 of 11 animals. The implant was remodeled into organized circumferentially aligned collagen bundles to resist meniscus hoop stresses. Moreover, type II collagen and proteoglycan deposition near the inner margin suggested a direct response to compressive stresses and confirmed fibrocartilage formation. Cartilage damage was observed, but end-stage (severe) joint deterioration associated with meniscectomy was avoided, even with limitations regarding the ovine surgical procedure and postoperative care. CONCLUSION: A fiber-reinforced total meniscus replacement device induces formation of functional neomeniscus tissue that has the potential to prevent catastrophic joint deterioration associated with meniscectomy. CLINICAL RELEVANCE: An off-the-shelf meniscus device that can be remodeled into functional tissue and thus prevent or delay the onset of osteoarthritis could address a widespread clinical need after meniscus injury.

Interference Screw Versus Suture Endobutton Fixation of a Fiber-Reinforced Meniscus Replacement Device in a Human Cadaveric Knee Model.

BACKGROUND: Meniscal lesions represent one of the most common intra-articular knee injuries. Meniscus replacement devices are needed to restore load distribution and knee stability after meniscectomy. Fixation of these devices is crucial to the generation of hoop stresses and the distribution of loads in the joint. PURPOSE: To evaluate 2 different fixation techniques (suture endobutton and interference screw) for implantation of a novel meniscus device. STUDY DESIGN: Controlled laboratory study. METHODS: In 7 human cadaveric knees (aged 17-61 years), 1 anterior and 2 potential posterior tunnel locations were investigated, and both fixation techniques were tested in each tunnel. The native meniscus roots, devices fixed with a suture endobutton, and devices fixed with an interference screw were gripped with cryoclamps, and tibias were drilled and loaded into a custom jig. Samples were preloaded, preconditioned, loaded for 500 cycles (50-150 N), and tested in tension until failure. RESULTS: For all 3 tunnels, suture fixation resulted in greater elongation (54.1%-150.7% greater; P < .05) during cyclic loading than interference screw fixation, which approximated the native roots. Both fixation techniques displayed ultimate tensile loads in the same range as native roots. However, stiffness of the suture fixation groups (36.5-41.6 N/mm) was only 28% to 37% of that of the interference screw fixation groups (98.7-131.6 N/mm), which had values approaching those of the native roots (anterior: 175.4 ± 24.2 N/mm; posterior: 157.6 ± 22.9 N/mm). CONCLUSION: Interference screw fixation was found to be superior to suture fixation with regard to elongation and stiffness, a finding that should be considered in the design and implantation of novel meniscus replacement devices. CLINICAL RELEVANCE: With the emergence of various devices for total meniscus replacement, the establishment of fixation strategies is crucial for the generation of tensile hoop stresses and the efficacy of these approaches.

* The Ovine Model for Meniscus Tissue Engineering: Considerations of Anatomy, Function, Implantation, and Evaluation.

Meniscus injuries represent one of the most-common intra-articular knee injuries. The current treatment options include meniscectomy and allograft transplantation, both with poor long-term outcomes. Therefore, there is a need for regenerative techniques to restore meniscal function. To preclinically test scaffolds for meniscus replacement, large animal models need to be established and standardized. This review establishes the anatomical and compositional similarities between human and sheep menisci and provides guidance for implantation and evaluation of such devices. The ovine meniscus represents a scaled-down version of the human meniscus, with only slight structural differences that can be addressed during device fabrication. Implantation protocols in sheep remain a challenge, as the meniscus cannot be visualized with the arthroscopic-assisted procedures commonly performed in human patients. Thus, we recommend the appropriate implantation protocols for meniscus visualization, ligamentous restoration, and surgical fixation of both total and partial meniscus replacement devices. Last, due to the lack of standardization in evaluation techniques, we recommend a comprehensive battery of tests to evaluate the efficacy of meniscus replacement implants. We recommend other investigators utilize these surgical and testing techniques to establish the ovine model as the gold standard for preclinical evaluation of meniscus replacement devices.

Correlation of the Caprini Score and Venous Thromboembolism Incidence Following Primary Total Joint Arthroplasty-Results of a Single-Institution Protocol.

BACKGROUND: Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis, is a serious complication after total joint arthroplasty (TJA). Risk assessment models are increasingly used to provide patient-specific risk stratification. A recently implemented protocol mandates calculation of a Caprini Score for all surgical patients at our institution. We investigated the accuracy of the Caprini Score in predicting VTE events following TJA. METHODS: A retrospective review of patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) over a 1-year time period was performed. The 90-day postoperative incidence of emergency department evaluations, hospital readmissions, medical complications, need for revision surgery, and symptomatic VTE was recorded. "Preoperative" Caprini Scores routinely recorded per protocol and calculated during review ("Calculated") were compared and assessed for relationship with VTE events. A "VTEstimator" Score was calculated for each patient. RESULTS: Three hundred seventy-six arthroplasties (151 TKA and 225 THA) meeting inclusion criteria were identified. Ten patients (2.5%) had symptomatic VTE postoperatively, with 3 pulmonary embolism (0.8%) and 7 deep vein thrombosis (1.8%). Eight VTE (5.3%) occurred following TKA and 2 (0.9%) occurred following THA. For each surgical characteristic evaluated, no significant difference was observed between mean Preoperative or Calculated Caprini Scores for patients with and without VTE (P > .05). Additionally, the distribution of VTEstimator Scores for patients with and without VTE was not significantly different (P = .93). CONCLUSION: The Caprini risk assessment model does not appear to provide clinically useful risk stratification for TJA patients. Alternative risk stratification protocols may provide assistance in balancing safety and efficacy of thromboprophylaxis.

[Comparative analyses of reference values used in Polish medical diagnostic laboratories for selected biochemical investigations]. / Analiza porównawcza wartosci referencyjnych stosowanych w polskich medycznych laboratoriach diagnostycznych dla wybranych parametrów biochemicznych.

UNLABELLED: The establishment of reference values comparative ranges for each laboratory test result does not meet expectations. THE AIM OF THE STUDY was to make a comparative analysis of the reference values (RV) used in medical diagnostic laboratories (MLD) in Poland for concentrations in serum or plasma biochemical parameters (potassium, calcium, creatinine, and glucose) in adults. MATERIAL AND METHODS: The data source was the information sent to the Centre for Quality Assessment in Laboratory Medicine by MLD participating in programs interlaboratory surveys. RESULTS: Studies have shown that there is a great diversity of reference values for the analyzed biochemical parameters used in MLD. The study also demonstrated the use by MLD various units of measurement systems (SI and weight-volume). CONCLUSION: A large variation of the reference values in the parameters significantly hinders the interpretation of laboratory results by physician.