Revision Total Hip Arthroplasty: Evaluating the Utility of the Geriatric Nutritional Risk Index as a Risk Stratification Tool.

Background: This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a measure of malnutrition risk, and 30-day postoperative complications following revision total hip arthroplasty (rTHA). Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients ≥65 who underwent aseptic rTHA between 2015 and 2021. The final study population (n = 7119) was divided into 3 groups based on preoperative GNRI: normal/reference (GNRI >98) (n = 4342), moderate malnutrition (92 ≤ GNRI ≤98) (n = 1367), and severe malnutrition (GNRI <92) (n = 1410). Multivariate logistic regression analysis was conducted to investigate the association between preoperative GNRI and 30-day postoperative complications. Results: After controlling for significant covariates, the risk of experiencing any postoperative complications was significantly higher with both moderate (odds ratio [OR] 2.08, P < .001) and severe malnutrition (OR 8.79, P < .001). Specifically, moderate malnutrition was independently and significantly associated with deep vein thrombosis (OR 1.01, P = .044), blood transfusions (OR 1.78, P < .001), nonhome discharge (OR 1.83, P < .001), readmission (OR 1.27, P = .035), length of stay >2 days (OR 1.98, P < .001), and periprosthetic fracture (OR 1.54, P = .020). Severe malnutrition was independently and significantly associated with sepsis (OR 3.67, P < .001), septic shock (OR 3.75, P = .002), pneumonia (OR 2.73, P < .001), urinary tract infection (OR 2.04, P = .002), deep vein thrombosis (OR 1.01, P = .001), pulmonary embolism (OR 2.47, P = .019), acute renal failure (OR 8.44, P = .011), blood transfusions (OR 2.78, P < .001), surgical site infection (OR 2.59, P < .001), nonhome discharge (OR 3.36, P < .001), readmission (OR 1.69, P < .001), unplanned reoperation (OR 1.97, P < .001), length of stay >2 days (OR 5.41, P < .001), periprosthetic fractures (OR 1.61, P = .015), and mortality (OR 2.63, P < .001). Conclusions: Malnutrition has strong predictive value for short-term postoperative complications and has potential as an adjunctive risk stratification tool for geriatric patients undergoing rTHA.

History and design considerations for arthroplasty around the wrist.

The history and evolution of both soft tissue and implant arthroplasty about the wrist are discussed, including carpometacarpal, radiocarpal, and distal radioulnar joints. Technical considerations for arthroplasty are reviewed, including factors affecting implant osseointegration, implant articulation/constraint, and management of complications.

The cup fulcrum: a technical tip to improve femoral exposure in total hip arthroplasty.

An unobstructed view of the proximal femur is a necessity in total hip arthroplasty for proper femoral preparation and to minimize the risk of femoral fractures and damage to the proximal soft tissues. A novel leverage technique is described that uses a trial head and liner to improve femoral visualization for the posterolateral approach. The cup fulcrum technique may minimize the risk of component malposition and damage, femoral fractures, and wound complications. Because there is no additional instrumentation or cost associated with this technique, it should prove useful for all surgeons who perform total hip arthroplasty through the posterolateral approach.

Radiographic and biomechanical support for fibular plating of the agility total ankle.

Syndesmosis nonunion with the Agility total ankle system has been associated with adverse radiographic findings such as radiolucency and migration. We analyzed radiographs and biomechanical data to determine whether the addition of a fibular plate was associated with improved findings related to syndesmosis union compared with results when two syndesmosis screws alone were used. Radiographs for 40 consecutive ankles with the Agility total ankle system with two syndesmosis screws were compared with radiographs for the subsequent 40 consecutive total ankle replacements with an added fibular plate. When all ankles were considered, syndesmosis nonconsolidation at 6-10 weeks was associated significantly with nonunion at 5-7 months. Syndesmosis nonconsolidation at 6-10 weeks in ankles with screws alone was significantly higher than in ankles with plates. The radiolucency rate at 5-7 months also was significantly higher in ankles with screws alone than in ankles with plates. In the biomechanical evaluation using full tibia and fibula sawbones, maximum compression force within the syndesmosis was measured using the ISCAN sensor (TekScan). The addition of the fibular plate allowed significantly higher compression than the use of screws alone.

Joint contact characteristics in agility total ankle arthroplasty.

High component contact pressures in total joint prostheses can lead to particle wear debris and prosthesis loosening. The contact pressures in the Agility total ankle prosthesis have not been investigated. In the current study, a cadaveric model was used to evaluate contact characteristics (average contact area, contact pressure, and contact peak pressures) for the Agility total ankle system. Ten cadaveric specimens were implanted with the Agility total ankle and axially loaded to 700 N. The average contact pressure of the system was 5.6 MPa with mean peak pressures of 21.2 MPa. In a separate phase of the study, contact characteristics with applied loads for each of the six component sizes showed a significant effect of component size on contact characteristics. When physiologic ankle forces are considered for normal patient activity, peak pressures observed in the current study may exceed recommended contact pressures (10 MPa) and the compressive yield point (13-22 MPa) for polyethylene. A heavy patient with a small ankle would not be expected to have a good outcome based on the current contact pressures data, whereas a heavy patient with a larger ankle might be a better candidate for surgery.