Long-term follow-up of an uncemented proximally hydroxyapatite-coated femoral stem in total hip arthroplasty.

Aims: The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in total hip arthroplasty (THA) at a minimum follow-up of 20 years. Methods: We reviewed the results of 165 THAs using the Omnifit HA system in 138 patients, performed between August 1993 and December 1999. The mean age of the patients at the time of surgery was 46 years (20 to 77). Avascular necrosis was the most common indication for THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (20 to 31). At 20 and 25 years, 113 THAs in 91 patients and 63 THAs in 55 patients were available for review, respectively, while others died or were lost to follow-up. Kaplan-Meier analysis was performed to evaluate the survival of the stem. Radiographs were reviewed regularly, and the stability of the stem was evaluated using the Engh classification. Results: A total of seven stems (4.2%) were revised during the study period: one for aseptic loosening, three for periprosthetic fracture, two for infection, and one for recurrent dislocation. At 20 years, survival with revision of the stem for any indication and for aseptic loosening as the endpoint was 96.0% (95% confidence interval (CI) 92.6 to 99.5) and 98.4% (95% CI 96.2 to 100), respectively. At 25 years, the corresponding rates of survival were 94.5% (95% CI 89.9 to 99.3) and 98.1% (95% CI 95.7 to 99.6), respectively. There was radiological evidence of stable bony fixation in 86 stems (76.1%) and evidence of loosening in four (3.5%) at 20 years. All patients with radiological evidence of loosening were asymptomatic. Conclusion: The Omnifit HA femoral stem offered promising long-term survival into the third decade.

The effect of the surgical helmet system on intraoperative contamination in arthroplasty surgery.

Aims: The surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI. Methods: There were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed. Results: The leakage intensity increased with exposure duration and frequency of glove exchanges in all groups. When SHS was used and GGI was not sealed (H+S-), the leakage intensity via GGI had the fastest increase, consistently higher than other groups (H+S+, H-S+ and H-S-) after 30 minutes (p < 0.05) and when there were more than four instances of glove exchange (p < 0.05). Additionally, the leakage was strongly correlated with the duration of exposure (rs = 0.8379; p < 0.050) and the frequency of glove exchange (rs = 0.8198; p < 0.050) in H+S-. The correlations with duration and frequency turned weak when SHS was not used (H-) or GGI was sealed off (S+). Conclusion: Due to personal protection, SHS is recommended in arthroplasties. Meanwhile, it is strongly recommended to seal the GGI of the inner gloves and exchange the outer gloves hourly to reduce the risk of contamination from SHS.

Prediction of Total Knee Arthroplasty Sizes with Demographics, including Hand and Foot Sizes.

Anticipating implant sizes before total knee arthroplasty (TKA) allows the surgical team to streamline operations and prepare for potential difficulties. This study aims to determine the correlation and derive a regression model for predicting TKA sizes using patient-specific demographics without using radiographs. We reviewed the demographics, including hand and foot sizes, of 1,339 primary TKAs. To allow for comparison across different TKA designs, we converted the femur and tibia sizes into their anteroposterior (AP) and mediolateral (ML) dimensions. Stepwise multivariate regressions were performed to analyze the data. Regarding the femur component, the patient's foot, gender, height, hand circumference, body mass index, and age was the significant demographic factors in the regression analysis (R-square 0.541, p < 0.05). For the tibia component, the significant factors in the regression analysis were the patient's foot size, gender, height, hand circumference, and age (R-square 0.608, p < 0.05). The patient's foot size had the highest correlation coefficient for both femur (0.670) and tibia (0.697) implant sizes (p < 0.05). We accurately predicted the femur component size exactly, within one and two sizes in 49.5, 94.2, and 99.9% of cases, respectively. Regarding the tibia, the prediction was exact, within one and two sizes in 53.0, 96.0, and 100% of cases, respectively. The regression model, utilizing patient-specific characteristics, such as foot size and hand circumference, accurately predicted TKA femur and tibia sizes within one component size. This provides a more efficient alternative for preoperative planning.

Does Barbed Suture Lower Cost and Improve Outcome in Total Knee Arthroplasty? A Randomized Controlled Trial.

BACKGROUND: Wound closure is key to prevent infection, facilitate immediate rehabilitation, and improve efficiency of total knee arthroplasty (TKA). Continuous knotless suturing with barbed suture can potentially save time and distribute tension more evenly. However, its role in TKA in terms of cost-effectiveness and wound complications is not clear. This study aims at comparing barbed and traditional sutures' wound closure time and cost in primary TKA. METHODS: One hundred nine knees were randomized into either barbed or traditional group. Synthetic absorbable sutures (Vicryl, Ethicon Inc) and bidirectional barbed sutures (Stratafix, Ethicon Inc) were used. Arthrotomy and subcutaneous wound closure time, wound complications, and rehabilitation parameters in terms of range of motion and Knee Society Score were compared. Patients were followed up to 3 months. RESULTS: Traditional sutures had significantly more positive leak tests (10 vs 2, P value <.05) and wound complications (11 vs 2, P value <.05). No differences in range of motion and Knee Society Score were noted. Arthrotomy and subcutaneous closure time were significantly shorter with barbed sutures (arthrotomy 325 seconds vs 491 seconds; subcutaneous 306 seconds vs 381 seconds, P value <.05). Concerning cost of suture material and operation time, barbed suture on average saved USD 48.7 per TKA in our local institute. CONCLUSION: Bidirectional barbed suture improves the cost-effectiveness of TKA through reducing wound closure time and wound complications.