Bilateral Total Knee Arthroplasties in a Patient with Bilateral Below-Knee Amputations and Osseointegration Limb Replacements: A Case Report.

CASE: A 38-year-old man with congenital pain insensitivity underwent bilateral below-knee amputations. After his subsequent bilateral osseointegration (OI) limb replacements, he rapidly developed severe bilateral knee arthritis and varus deformity. In lieu of performing bilateral above-knee amputations, he underwent bilateral staged total knee arthroplasties (TKA) with excellent clinical and radiographic evaluation at 1-year follow-up. CONCLUSION: To address both the limited bone stock and OI implant stem location, TKA after OI limb replacement in congenital pain insensitivity patients can be successfully achieved with a nonkeeled cementless tibial component and augmentation with a tibial cone.

Evaluating femoral graft placement using three-dimensional magnetic resonance imaging in the reconstruction of the anterior cruciate ligament via independent or transtibial drilling techniques: a retrospective cohort study.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction is a common surgical procedure, yet failure still largely occurs due to nonanatomically positioned grafts. The purpose of this study was to retrospectively evaluate patients with torn ACLs before and after reconstruction via 3D MRI and thereby assess the accuracy of graft position on the femoral condyle. METHODS: Forty-one patients with unilateral ACL tears were recruited. Each patient underwent 3D MRI of both knees before and after surgery. The location of the reconstructed femoral footprint relative to the patient's native footprint was compared. RESULTS: Native ACL anatomical location of the native ACL had a significant impact on graft position. Native ACLs that were previously more anterior yielded grafts that were more posterior (3.70 ± 1.22 mm, P = 0.00018), and native ACL that were previously more proximal yielded grafts that were more distal (3.25 ± 1.09 mm, P = 0.0042). Surgeons using an independent drilling method positioned 76.2% posteriorly relative to the native location, with a mean 0.1 ± 2.8 mm proximal (P = 0.8362) and 1.8 ± 3.0 mm posterior (P = 0.0165). Surgeons using a transtibial method positioned 75% proximal relative to the native location, with a mean 2.2 ± 3.0 mm proximal (P = 0.0042) and 0.2 ± 2.6 mm posterior (P = 0.8007). These two techniques showed a significant difference in magnitude in the distal-proximal axis (P = 0.0332). CONCLUSION: The femoral footprint position differed between the native and reconstructed ACLs, suggesting that ACL reconstructions are not accurate. Rather, they are converging to a normative reference point that is neither anatomical nor isometric.

Titanium-Dioxide-Nanoparticle-Embedded Polyelectrolyte Multilayer as an Osteoconductive and Antimicrobial Surface Coating.

Bioactive surface coatings have retained the attention of researchers and physicians due to their versatility and range of applications in orthopedics, particularly in infection prevention. Antibacterial metal nanoparticles (mNPs) are a promising therapeutic, with vast application opportunities on orthopedic implants. The current research aimed to construct a polyelectrolyte multilayer on a highly porous titanium implant using alternating thin film coatings of chitosan and alginate via the layer-by-layer (LbL) self-assembly technique, along with the incorporation of silver nanoparticles (AgNPs) or titanium dioxide nanoparticles (TiO2NPs), for antibacterial and osteoconductive activity. These mNPs were characterized for their physicochemical properties using quartz crystal microgravimetry with a dissipation system, nanoparticle tracking analysis, scanning electron microscopy, and atomic force microscopy. Their cytotoxicity and osteogenic differentiation capabilities were assessed using AlamarBlue and alkaline phosphatase (ALP) activity assays, respectively. The antibiofilm efficacy of the mNPs was tested against Staphylococcus aureus. The LbL polyelectrolyte coating was successfully applied to the porous titanium substrate. A dose-dependent relationship between nanoparticle concentration and ALP as well as antibacterial effects was observed. TiO2NP samples were also less cytotoxic than their AgNP counterparts, although similarly antimicrobial. Together, these data serve as a proof-of-concept for a novel coating approach for orthopedic implants with antimicrobial and osteoconductive properties.

Ceramic-on-Ceramic Total Hip Arthroplasty: I Can Hear You.

Background: Squeaking is a known complication of ceramic-on-ceramic (CoC) total hip arthroplasty (THA), yet there is a lack of studies specifically quantifying its loudness. The aims of this study were: (1) to determine the incidence of squeaking in CoC THAs at long-term follow-up; (2) to identify risk factors; and (3) to quantify the loudness of the squeaking. Methods: A specifically designed prospective questionnaire was used to determine the prevalence, characteristics, and loudness of squeaking in 130 (110 patients) primary THAs with fourth-generation CoC bearings at a mean follow-up of 10.5 years. The loudness of the squeaking was determined by the decibel (dB) scale from the Centers for Disease Control and Prevention. Results: Overall, 28% of the CoC hips experienced squeaking. The mean onset was 5.7 years postoperatively, with 39% of the cases having their onset more than 5 years after their THA. Patients with a lower body mass index were more likely to report squeaking (P = .009). The mean loudness of the squeak was 35 dB (range, 10-70 dB) and was loud in 36% of the hips. Patients who developed squeaking early postoperatively had louder squeaking than those with a later onset (P = .007). The loudness of the squeaking sound progressed in 25% of the cases, and these hips had louder squeaking (P = .04). Conclusions: Squeaking after CoC THA is not uncommon, can be relatively loud, and increases over time. This needs to be considered in young patients that are candidates for CoC THAs.

Using citizen science data to assess the population genetic structure of the common yellowjacket wasp, Vespula vulgaris.

Monitoring insect genetic diversity and population structure has never been more important to manage the biodiversity crisis. Citizen science has become an increasingly popular tool to gather ecological data affordably across a wide range of spatial and temporal scales. To date, most insect-related citizen science initiatives have focused on occurrence and abundance data. Here, we show that poorly preserved insect samples collected by citizen scientists can yield population genetic information, providing new insights into population connectivity, genetic diversity and dispersal behaviour of little-studied insects. We analysed social wasps collected by participants of the Big Wasp Survey, a citizen science project that aims to map the diversity and distributions of vespine wasps in the UK. Although Vespula vulgaris is a notorious invasive species around the world, it remains poorly studied in its native range. We used these data to assess the population genetic structure of the common yellowjacket V. vulgaris at different spatial scales. We found a single, panmictic population across the UK with little evidence of population genetic structuring; the only possible limit to gene flow is the Irish sea, resulting in significant differentiation between the Northern Ireland and mainland UK populations. Our results suggest that queens disperse considerable distances from their natal nests to found new nests, resulting in high rates of gene flow and thus little differentiation across the landscape. Citizen science data has made it feasible to perform this study, and we hope that it will encourage future projects to adopt similar practices in insect population monitoring.

Local tissue concentrations of cefazolin during total joint arthroplasty: a systematic review.

BACKGROUND: Periprosthetic joint infections (PJI) following joint arthroplasty are now the leading cause of reoperation and are associated with serious morbidity to the patient, often requiring several staged operations and a prolonged course of parenteral antibiotics. Prophylactic administration of intravenous antibiotics before skin incision is arguably the most important measure to prevent PJI; however, the dose effectiveness of cefazolin in target tissue is not well known. We aimed to identify parameters affecting local tissue concentration (LTC) of cefazolin. METHODS: We performed a literature search using the following keywords: "orthopaedics," "orthopedic," "arthroplasty" and "cefazolin." We included studies that measured LTC of cefazolin from samples obtained during either a total knee or total hip arthroplasty. RESULTS: Of the 332 records screened, we included 10 studies that described LTC of cefazolin. The included studies evaluated dosing (n = 7), procedure type (n = 3), body mass index (n = 1) and tourniquet utilization (n = 1). CONCLUSION: Few studies have measured LTC levels of antibiotics (or levels of cefazolin) to validate current recommendations for antibiotic prophylaxis in orthopedic surgery. With infection as the leading reason for early reoperation or revision surgery, the parameters affecting LTC during orthopedic procedures need to be further assessed.

Revision Distal Femoral Replacement Using Custom-made Stem and Cone to Augment Proximal Fixation.

Achieving bone fixation during megaprosthesis revision presents a formidable challenge in view of the substantial bone loss. We report treatment of a failed revision distal femoral replacement in an active 36-year-old male mechanic remotely treated for osteosarcoma. A custom stem and cone were manufactured to augment fixation and preserve bone stock within a short segment of the remaining proximal femur. The patient returned to regular function without the need for assistive devices. Follow-up imaging demonstrated stable implant fixation at 1-year follow-up. While cones and sleeves have vastly improved fixation in revision knee arthroplasty, a custom-made cone for the proximal femur was used to augment fixation of a revision megaprosthesis and obviate the use of a total femoral replacement.

Five- to 12-Year Outcomes of a Short, Tapered, Highly Porous, Proximally Coated Cementless Femoral Stem.

BACKGROUND: Short cementless stems in total hip arthroplasty have gained increasing popularity, yet on-going studies of many of these implants are lacking. The aim of this study was to evaluate the minimum 5 year clinical and radiological results of a short, highly porous, single-tapered-wedge cementless femoral implant. METHODS: A retrospective study of 281 hips in 256 patients who had a minimum 5-year follow-up and underwent primary total hip arthroplasty between 2010 and 2016 were evaluated. Clinical and radiological results, complications, and the presence of postoperative thigh pain were evaluated. RESULTS: The mean follow-up was 8 years (range, 5 to 12 years). Clinically, patients had significant improvement in the average patient-related outcome scores postoperatively (Harris hip score: pre 47 versus post 95, University of California Los Angeles activity scale: pre 4 versus post 6, Western Ontario and McMaster Universities Arthritis Index: pre 51 versus post 3, Short Form (SF)-12 physical component summary : pre 32 versus post 52, Short Form-12 mental component summary: pre 49 versus post 55 (P < .001)). Radiographic signs of ingrowth were present in all hips. There were three patients (1.1%) who developed transient thigh pain postoperatively, all of which resolved with nonoperative management. CONCLUSION: This study provides the longest follow-up of this short, highly porous, single-tapered-wedge cementless femoral stem in the literature. This short, single-wedge stem with its highly porous coating demonstrated reproducible bone ingrowth in all patients and significant functional improvement with a very low rate of transient thigh pain.

A Short Course of Celecoxib Prevents Heterotopic Ossification Following Cementless Total Hip Arthroplasty.

Heterotopic ossification (HO) is a common complication after total hip arthroplasty (THA) and can result in pain and loss of motion of the hip. This is the first study in the literature to determine if a short course of Celecoxib is effective in the prevention of HO in patients undergoing cementless THA. In this retrospective study of prospectively collected data, consecutive patients undergoing a primary cementless THA were reviewed at a 2-year follow-up. The Control group consisted of 104 hips that did not receive Celecoxib (Control group), while the 208 hips in the Celecoxib group received 100 mg twice daily for 10 days. Radiographs, patient-recorded outcome measures and range of motion (ROM) were evaluated. Overall, there was a significantly decreased incidence of HO in the Celecoxib group (18.7%) than in the Control group (31.7%) (p = 0.01). The odds that a patient developed HO using Celecoxib were 0.4965 times the odds that a patient developed HO without treatment. Clinically, the Celecoxib group demonstrated significantly greater improvement in their mean WOMAC stiffness (0.35 vs. 0.17, p = 0.02) and physical function scores (3.26 vs. 1.83, p = 0.03) compared to those in the Control group, but there was no difference in the ROM between the two groups. This study is the first to demonstrate that the lowest dose of Celecoxib for a short course of only 10 days is a simple and effective prophylactic treatment option that can significantly reduce the incidence of HO following cementless THA.

Episode-of-care costs of total hip arthroplasty: day surgery versus same-day admission.

BACKGROUND: Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways. METHODS: We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020. Patient demographic and clinical data were recorded, as were preoperative diagnosis, type of anesthesia, type of implant used, surgical time and estimated blood loss. We determined direct and indirect costs from time of arrival at the presurgical unit to hospital discharge. We determined the EOCCs using an ABC method. RESULTS: The study included 50 patients who underwent THA (25 DS, 25 SDA). The mean length of stay in the SDA group was 45.1 (standard deviation [SD] 21.4) hours. Differences were observed between the 2 groups in mean age, mean Charlson Comorbidity Index score, surgical technique and mean surgical time (p ≤ 0.001). The mean total EOCC for SDA THA was $10 911 (SD $706.12, range $9944.07-$12 871.95), compared to $9672 (SD $546.55, range $8838.30-$11 058.07) for DS THA, a difference of 11.4%, mostly attributable to hospital resources such as laboratory tests, radiologic studies and cost of the surgical admission. CONCLUSION: Day surgery THA is cost-effective in selected patient populations. With the savings identified in this study, every 10 additional DS THA procedures would save sufficient resources to perform an additional THA operation.

Capsular Repair Counteracts the Risk of Dislocation in Hemiarthroplasty Conversion to Total Hip Arthroplasty.

This study investigated whether decreasing the femoral head size, in addition to performing a posterior capsular closure and short external rotator repair, influences the historical rate of dislocation after conversion of a failed hemiarthroplasty (HA) to a total hip arthroplasty (THA) through a posterior approach. We reviewed 15 patients from our prospective arthroplasty database who underwent a conversion from an HA to a THA with closure of the posterior capsule, had downsizing of the femoral head, and had at least a 2-year follow-up. Patients were clinically observed to determine whether their hip dislocated postoperatively or required re-revision. Radiographs were evaluated to assess for known risk factors for dislocation, including component position and restoration of hip biomechanics. The femoral head size was downsized from a mean of 45 mm (range, 42-57 mm) preoperatively to a mean of 32 mm (range, 28-36 mm) postoperatively (P<.001). Femoral heads sized 36, 32, and 28 mm were used in the revision of 4, 5, and 6 hips, respectively. At the mean 84-month follow-up (range, 24-156 months), there were no dislocations. Attention to surgical technique and closing the posterior capsule can decrease the historically high dislocation rate associated with converting an HA to a total hip replacement using the posterolateral approach. Despite substantial reduction in size of the prosthetic femoral head, there were no postoperative dislocations with closure of the posterior capsule. Downsizing the femoral head during revision THA should be avoided; however, if not feasible, closure of the posterior capsule can offset the otherwise increased risk of dislocation. [Orthopedics. 2023;46(3):175-179.].

Augmented Reality in Arthroplasty: An Overview of Clinical Applications, Benefits, and Limitations.

Augmented reality (AR) is a natural extension of computer-assisted surgery whereby a computer-generated image is superimposed on the surgeon's field of vision to assist in the planning and execution of the procedure. This emerging technology shows great potential in the field of arthroplasty, improving efficiency, limb alignment, and implant position. AR has shown the capacity to build on computer navigation systems while providing more elaborate information in a streamlined workflow to the user. This review investigates the current uses of AR in the field of arthroplasty and discusses outcomes, limitations, and potential future directions.

Revision Hip Arthroplasty in a Jehovah's Witness with Pelvic Discontinuity: A Case Report.

CASE: A 68-year-old Jehovah's Witness (JW) presented with pelvic discontinuity 9 years after right total hip arthroplasty. Her pelvis was previously irradiated for cervical cancer. Meticulous hemostasis, blood conserving strategies, and a prophylactic arterial balloon catheter were used to mitigate bleeding. She underwent an uneventful revision total hip arthroplasty with excellent functional recovery and radiographic evaluation at 1 year postoperatively. CONCLUSION: Pelvic discontinuity in a JW with irradiated bone makes for a challenging revision arthroplasty with high bleeding risk. Preoperative coordination with anesthesia and blood loss mitigation strategies can lead to successful surgical outcomes in cases of high-risk surgery among JW patients.

Reliability of Anatomic Bony Landmark Localization of the ACL Femoral Footprint Using 3D MRI.

BACKGROUND: Nonanatomic placement of anterior cruciate ligament (ACL) grafts is a leading cause of ACL graft failure. Three-dimensional (3D) magnetic resonance imaging (MRI) femoral footprint localization could enhance planning for an ACL graft's position. PURPOSE: To determine the intra- and interobserver reliability of measurements of the ACL femoral footprint position and size obtained from 3D MRI scans. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 41 patients with complete ACL tears were recruited between November 2014 and May 2016. Preoperatively, a coronal-oblique proton-density fast spin echo 3D acquisition of the contralateral uninjured knee was obtained along the plane of the ACL using a 1.5T MRI scanner. ACL footprint parameters were obtained independently by 2 musculoskeletal radiologists (observers A and B). The distal and anterior positions of the center of the footprint were measured relative to the apex of the deep cartilage at the posteromedial aspect of the lateral femoral condyle, and the surface area of the ACL femoral footprint was approximated from multiplanar reformatted images. After 1 month, the measurements were repeated. Intraclass correlation coefficients (ICCs) were calculated to assess for intra- and interobserver reliability. Bland-Altman plots were produced to screen for potential systematic bias in measurement and to calculate limits of agreement. RESULTS: The ICCs for intraobserver reliability of the ACL femoral distal and anterior footprint coordinates were 0.75 and 0.78, respectively, for observer A. For observer B, they were 0.75 and 0.74, respectively. The ICCs for interobserver reliability were 0.75 and 0.85 for the distal and anterior coordinates, respectively. Bland-Altman plots demonstrated no significant systematic bias. For surface area measurements, the intraobserver ICCs were 0.37 and 0.62 for observers A and B, respectively. The interobserver reliability was 0.60. Observer B consistently measured the footprints as slightly larger versus observer A (1.19 ± 0.27 vs 1 ± 0.22 cm2, respectively; P < .001). CONCLUSION: Locating the center of the anatomic footprint of the ACL with 3D MRI showed substantial intra- and interobserver agreement. Interobserver agreement for the femoral footprint surface area was fair to moderate.

Marital Relationship and Quality of Life in Couples Following Hip Replacement Surgery.

For the majority of patients with osteoarthritis, total hip (THA) arthroplasty results in a significant reduction in pain, emotional distress, and disability and a significant improvement in their quality of life. Little is known about how these recovery-related changes impact the spouse or the marital relationship. METHODS: Twenty-nine couples whose spouse underwent a THA (29 THA) participated in a semi-structured retrospective interview designed for this study. They were each asked to recall the level of pain before and after surgery and to provide a numerical rating score for questions pertaining to the level of disability in seven different activities of daily living. Couples were also asked to list in order of importance the five ways in which the surgery affected their overall quality of life. RESULTS: The spouses estimated their partner's pain, both pre- and postoperatively, to be significantly higher level than the patient's perception. The spouses perceived a greater improvement in family/home responsibilities, recreation and social activities, and in their occupation than that noted by the partner. After the arthroplasty, the spouses indicated that their lives had improved with respect to doing more activities/leisure (72%), because their partner had less suffering (59%), they had more independence/less caregiving (55%), it improved their marital relationship (52%), they had a better social/family life (28%), and they were able to travel (28%). CONCLUSIONS: This study indicates that THA result in a significant improvement in quality of life not only for the patients, but also for their spouses.

Restoration of Hip Biomechanics after a Hemiarthroplasty for a Femoral Neck Fracture-Who Does It Better?

INTRODUCTION: The restoration of the preoperative biomechanics of the hip, in particular leg length and femoral offset, are critical in restoring normal function and diminishing the risk of dislocation following hip arthroplasty. This study compares the consistency of arthroplasty and non-arthroplasty orthopedic surgeons in restoring the normal biomechanics of the hip when performing a hemiarthroplasty for the treatment of a femoral neck fracture. METHODS: We retrospectively reviewed the preoperative and postoperative digital radiographs of 175 hips that had a modular hemiarthroplasty for the treatment of a displaced femoral neck fracture at a Level 1 academic hospital. Fifty-two hips were treated by one of the three fellowship-trained arthroplasty surgeons (Group A), and 123 were treated by one of the nine non-arthroplasty fellowship-trained orthopedic surgeons (Group B). RESULTS: Patients in Group A were more likely to have their femoral offset restored to normal than patients in Group B, both with respect to under correcting the offset (p = 0.031) and overcorrecting the offset (p = 0.010). Overall, there was no difference in restoration of leg lengths between the two groups (p = 0.869). CONCLUSIONS: Following a hemiarthroplasty for a displaced femoral neck fracture, the normal biomechanics of the hip are more likely to be restored by an arthroplasty-trained surgeon than by a non-arthroplasty-trained surgeon. Identifying the inconsistency of non-arthroplasty surgeons and, to a lesser degree, arthroplasty surgeons in restoring hip biomechanics is important for sensitizing surgeons to rectify this in the future with appropriate templating and femoral implant selection.

Trends in Morbidity, Mortality, and Cost of Hospitalizations Associated With Infectious Disease Sequelae of the Opioid Epidemic.

BACKGROUND: Increases in fatal drug poisonings and hepatitis C infections associated with the opioid epidemic are relatively well defined, because passive surveillance systems for these conditions exist. Less described is the association between the opioid epidemic and skin, soft-tissue, and venous infections (SSTVIs), endocarditis, sepsis, and osteomyelitis. METHODS: Michigan hospitalizations between 2016 and 2018 that included an International Classification of Diseases, Tenth Revision, Clinical Modification, code indicating substance use were examined for codes indicative of infectious conditions associated with injecting drugs. Trends in these hospitalizations were examined, as were demographic characteristics, discharge disposition, payer, and cost data. RESULTS: Among hospitalized patients with a substance use diagnosis code, endocarditis, osteomyelitis, sepsis, and SSTVI hospitalizations increased by 33%, 35%, 24%, and 12%, respectively between 2016 and 2018. During this time frame, 1257 patients died or were discharged to hospice. All SSTVI hospitalizations resulted in >$1.3 billion in healthcare costs. Public insurance accounted for more than two-thirds of all hospitalization costs. CONCLUSIONS: This study describes a method for performing surveillance for infection-related sequelae of injection drug use. Endocarditis, osteomyelitis, sepsis, and SSTVI hospitalizations have increased year over year between 2016 and 2018. These hospitalizations result in significant morbidity, mortality, and healthcare costs and should be a focus of future surveillance and prevention efforts.

Long-Term Survivorship of Total Hip Arthroplasty with Highly Cross-Linked Polyethylene for Osteonecrosis.

BACKGROUND: Osteonecrosis of the hip is the underlying etiology for 3% to 12% of total hip arthroplasties (THAs). Compared with patients who undergo THA because of osteoarthritis, those who do so because of osteonecrosis typically are younger, have a greater number of underlying diagnoses, and have inferior clinical outcomes and implant survivorship. The purpose of this study was to compare the long-term implant survivorship (median follow-up, 10 years), functional outcomes, and radiographic results of contemporary THAs with a highly cross-linked polyethylene (HXLPE) liner between patients with osteonecrosis and those with osteoarthritis. METHODS: All patients who underwent primary THA with an HXLPE liner from 1999 to 2007 were identified from our institutional total joint registry. Patients with a primary diagnosis of osteonecrosis were matched 1:1, on the basis of age, sex, and body mass index (BMI), to patients with a diagnosis of osteoarthritis. This resulted in 461 hips in 413 patients with osteonecrosis matched to 461 hips in 427 patients with osteoarthritis (mean age, 59 years; 47% female; and mean BMI, 29 kg/m). Long-term implant survivorship, patient-reported outcomes, and radiographic findings were compared. In addition, a subgroup analysis of the osteonecrosis group was performed to see whether certain underlying etiologies portended poor outcomes. The median follow-up was 10 years. RESULTS: The 15-year cumulative rates of revision were 6.6% and 4.5% in the osteonecrosis and osteoarthritis groups, respectively (hazard ratio [HR] = 1.8, p = 0.09). The 15-year cumulative rates of any reoperation were 10.5% and 6.4% in the osteonecrosis and osteoarthritis groups, respectively (HR = 2.2, p = 0.008). There were no radiographic signs of component loosening or osteolysis in the entire cohort. Despite a lower median preoperative Harris hip score (HHS) for patients with osteonecrosis, both groups had marked improvements in their scores, which were similar at all time points after surgery. The cumulative rate of reoperations at 15 years was 0% for hips with radiation-induced osteonecrosis, 6.3% for those with alcohol-induced osteonecrosis, 9.0% for those with posttraumatic osteonecrosis, 12.1% for those with steroid-induced osteonecrosis, and 25% for those with idiopathic osteonecrosis. CONCLUSIONS: Contemporary THA with an HXLPE liner offers excellent long-term implant survivorship and functional outcomes for patients with osteonecrosis; however, the risk of a reoperation is higher when compared with patients with osteoarthritis. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.