Comparison of survival between cemented vs cementless unicompartimental knee arthroplasty: a case control study with propensity score matching.

INTRODUCTION: The first results of cementless prosthesis were rather disappointing. However recent progress in methods of cementless fixation of prosthesis should lead to better results in terms of survival of these prostheses. The main objective is to compare the survival rate at last follow-up of UKA with cemented tibial or cementless. HYPOTHESIS: We hypothesize that UKAs with uncemented tibial implants have better survival compared to UKAs with cemented tibial implants. MATERIAL AND METHODS: This single center case-control study included 94 medial UKA with a cemented tibial component that were paired by propensity score matching to 94 medial UKA with a uncemented tibial component. The main evaluation criterion was the comparison of the survivorship of the UKA between a cemented tibial implant and those with a cementless tibial implant in terms of all-cause revision surgery at last follow-up. The secondary endpoints were the analysis of the causes of failure. RESULTS: The mean final follow-up was 6.1years (2.3). The overall survival rate in our serie of medial UKA was 92.4% [88.7%-96.3%] at five years. The overall survival rate in cemented group was and 91.5% [86.0%-97.3%] at five years and at 93.2% [88.1%-98.7%] at five years, in the uncemented group. No differences significant were observed in the two groups (p.value = 0.6). Only the tibial preoperative deformity was a risk factor of failure (HR: 1.11 [1.02, 1.20], value = 0.02). DISCUSSION: The use of a cemented or a cementless tibial component in a medial UKA did not influence the survival rate. LEVEL OF EVIDENCE: III; case control study.

Wettability-Oriented Laser Microgrooving Process on Cemented Carbide Surface.

Surface micro-texture has been shown to enhance wettability and reduce wear on cutting tools. However, there is limited research on how laser parameters impact the dimensional accuracy of surface texture and its wettability. This study focuses on producing arrayed groove textures on WC/Co cemented carbide surfaces using Nd: YAG laser, evaluating the effect of the laser parameters on surface topography and texture accuracy through microscopic observation and simulation. The results indicate that, with laser parameters such as a number of passes less than 5, approximately 16 W power, scanning speed of 100-150 mm/s, and pulse frequency of 30 kHz, the error between the groove width and laser spot diameter was 4.7%. Additionally, the study explores the impact of the groove texture on surface wettability using the solid droplet method and XPS analysis. Comparative experiments reveal that increased surface roughness enhanced oleophobicity, with surfaces exhibiting high texture accuracy and integrity showing improved oleophobic and spreading properties. Thus, the precise regulation of laser processes is crucial for maintaining surface texture integrity and enhancing surface wettability.

Cementless TKA use as an alternative to cemented TKA in high BMI patients: A systematic review and meta-analysis.

Purpose: Obesity is prevalent, with nearly one-third of the world's population being classified as obese. In patients with high body mass index (BMI)/body mass undergoing total knee arthroplasty (TKA), there is an increase in strain placed on the implant fixation interfaces. As such, component fixation is a potential concern when performing TKA in the obese patient. To address the growing concerns around the longevity of implant fixation, some have advocated cementless over cemented fixation. However, there is no clear consensus on whether a cementless fixation has more favourable outcomes. The aim of this paper was to present a systematic review and meta-analysis of the existing evidence to establish if cementless TKA has a lower rate of aseptic loosening in high BMI patients when compared to cemented TKA procedures. Methods: A systematic review was performed, and the following databases Medical Literature Analysis and Retrieval System Online (1946 to date), PubMed (1966 to date) and Excerpta Medica Database (1974 to date) were searched. All studies comparing cementless to cemented TKA in patients with BMI > 30 were considered. Meta-analysis compared aseptic loosening and all-cause revision between cemented and uncemented implant use in BMI > 30 patients. Results: The search returned 91 articles in total; after duplicates were removed, the yield was 44 studies. Of the remaining studies that were assessed, three studies met the inclusion criteria for meta-analysis. The pooled odds ratio for all-cause revisions was 0.17 (95%, 0.08-0.36) in favour of uncemented implants (p < 0.01). The pooled odds ratio for aseptic loosening was 0.15 (95% confidence interval, 0.02-0.90) in favour of uncemented implants (p = 0.04). Conclusions: Meta-analysis demonstrated a significant decrease in all-cause revisions and revisions for aseptic loosening when using uncemented fixation in high BMI patients when compared to the use of cemented implants. Level of Evidence: The level of evidence is 1 for our systematic review.

Comprehensive evaluation of risk factors for aseptic loosening in cemented total knee arthroplasty: A systematic review and meta-analysis.

Purpose: Aseptic loosening is the most common cause for revisions after total knee arthroplasty (TKA). Despite many studies exploring various risk factors associated with aseptic loosening, findings often present inconsistencies. To address this, we conducted a thorough review of the literature to identify and analyse these risk factors in cemented TKA. Additionally, we performed a meta-analysis to reconcile the divergent conclusions observed across studies. Methods: We searched PubMed, Web of Science and Embase from 1996 up to 2024 and evaluated the quality of the included literature. Seventy-four studies were included to assess the association of BMI, diabetes, high physical activity (HPA), osteoporosis, rheumatoid arthritis (RA), cement material and implant design. Twenty-nine studies were used to calculate relative risk and CIs (using the random effects theory) and study heterogeneity for six different risk factors (BMI, diabetes, HPA level, cement material, polyethylene and implant design). Results: Patients with diabetes are eight times more likely to experience aseptic loosening compared to those without diabetes (RR = 9.18, 95% CI: 1.80-46.77, p < 0.01). The use of tibial stem extension or highly crosslinked polyethylene can help reduce the incidence of aseptic loosening. However, we did not identify BMI, HPA, osteoporosis, RA, the use of high-viscosity cement and the utilization of mobile-bearing designs as risk factors for aseptic loosening post-cemented TKA. Conclusions: Patients with diabetes undergoing TKA should be counselled regarding their potential increased risk of aseptic loosening. The use of tibial stem extensions and HXLPE can mitigate the incidence of aseptic loosening in cemented TKA. However, given a limited number of studies were included in the meta-analysis, we believe that higher-level studies are necessary to clearly identify other risk factors. Level of Evidence: Level III.

Experimental study on the mechanical characteristics of weakly cemented mudstone under different loading rates.

With the gradual shift of coal mining to the western coal mining region of China, floor heave in weakly cemented mudstone roadways has become an issue affecting the safety and efficiency of coal mine production. Additionally, different mining rates can lead to fluctuating support stresses on the roof and floor of weakly cemented mudstone roadways. Therefore, obtaining a comprehensive understanding of the mechanical properties of weakly cemented mudstone at different loading rates is conducive to improving the issue of floor heave in such roadways and provides a theoretical basis for further study. In this context, a series of uniaxial mechanical tests with concurrent acoustic emission monitoring were conducted on specimens of weakly cemented mudstone under various loading rates (0.005, 0.01, 0.05, and 0.1 mm/s). The stress‒strain and acoustic emission response curves were obtained to effectively characterize the strength, deformation, damage, macroscale instability, and crack propagation characteristics of the mudstone under the influence of loading rate effects. The research results support the following findings: (1) With increasing loading rate, the peak strength and elastic modulus of weakly cemented mudstone significantly increase, while the peak axial strain and peak radial deformation significantly decrease. (2) With increasing loading rate, the stress required to trigger the expansion of weakly cemented mudstone gradually increases, and a significant power-law relationship arises between the strain of the mudstone at the start of expansion and the loading rate. (3) With increasing loading rate, the acoustic emission ringing count of weakly cemented mudstone increases: The failure of weakly cemented mudstone changes from small-range progressive failure to sudden failure, and the failure mode transitions from shear failure to tensile‒shear composite failure. (4) The studied mudstone damage variables increase with increasing loading rate, following an approximate exponential function. The conclusions obtained in this work can provide a theoretical basis for the evolution mechanism and control of floor heave in deep roadway mining.

Periprosthetic Fractures: A Rising Tide of Hip Arthroplasty Failure Noted in the American Joint Replacement Registry and the Preventative Role of Cemented Stems.

BACKGROUND: This investigation examined cemented femoral component use in total hip arthroplasty (THA) and its impact on the incidence of periprosthetic fractures (PPFx), a common failure mode in THA. The study leverages data from the American Joint Replacement Registry (AJRR) to assess trends in cemented femoral component usage over time, its association with PPFx rates, and compares the survivorship and 90-day complication rates between cemented and cementless femoral component THAs. METHODS: Primary THAs, captured in the AJRR, in patients aged 65 years and older from 2012 to 2021 were analyzed. Variables considered included age, sex, race, region, teaching status, year, Charlson comorbidity index, and institution bed size. Analysis compared fixation types for THA on all-cause linked revision and PPFx. Logistic regression models analyzed the odds ratios for all-cause linked revision and PPFx for any follow-up time as well as for 90-day revision. The models were adjusted for the listed variables. RESULTS: During the study period, the rate of cement utilization as a percentage of primary THAs performed and reported to the AJRR increased from 4.4 to 8.3%. The rate of THA failure from PPFx increased from 11.4 to 33.3%. When both fixation groups were compared in the univariate analysis, there was a statistically significant difference in all demographic variables (P < .001). To account for this, multivariable logistic regression models were applied. In our models, cemented stems showed a 54.4% (odds ratio: 0.456; 95% confidence interval: 0.347 to 0.599; P < .0001) and 65.8% (odds ratio: 0.342; 95% confidence interval: 0.237 to 0.493; P < .0001) lower risk of PPFx linked and PPFx early linked revision, respectively. CONCLUSIONS: Periprosthetic fractures are becoming a leading failure mode for THAs in the AJRR. Given cemented fixation's relative resistance to this failure mode compared to cementless fixation, we should consider increasing the utilization of this technique.

Franklin's "Cemented Tomb": The Jamme Report of 1928 Revisited.

Few details are known about the fate of the Franklin Expedition after it departed England in 1845. What we do know is derived from the archaeological record, Inuit testimony and brief communications written in 1847 and 1848 from the Expedition. During the 1860s, Charles Francis Hall went to the Arctic in search of survivors, papers, and relics. During Hall's second expedition, two Inuit testimonies emerged which reported unusual site(s) on the Westcoast of King William Island which were reputedly build by the Expedition. Hall believed these sites were either a burial site or a cemented document vault(s). The first testimony, recorded by Hall himself, was obtained from a Pelly Bay Inuk, Su-pung-er, in 1866. The second, was collected from Pelly Bay Inuit by members of Hall's support team, including Peter Bayne, in Hall's absence in 1868. Eventually, the second testimony was sold to the Canadian Government in the form of a report written by George Jamme after Bayne's death in 1928. Until now, only extracts of the Jamme Report have been available. This paper describes the background to the Jamme report and presents it in its entirety along with critiques so that scholars in the future may have this tool.

Factors that influence surgical decision-making for geriatric displaced femoral neck fractures: Bullet Health Analysis (BHA) I : Worldwide Orthopaedic Research Collaboration: Leveraging Big Data (WORLD) I.

PURPOSE: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury. METHODS: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website. Collaboratively developed standardized polls, based on the best available evidence and a comprehensive, peer-reviewed, evidence-based item list, were used to capture surgeons' treatment preferences worldwide. Subsequent analyses explored preferences within subspecialties and practice settings. Multivariable regression analysis identified associations between subspecialty, practice type, the likelihood of choosing THA, and the preferred femoral fixation method. RESULTS: Our study encompassed 2595 respondents from 76 countries. Notably, 51.5% of participants (n = 1328; 51.5%, 95% CI 49.6-53.4%) leaned towards THA and 44.9% for HA, while 3.6% favoured surgical fixation. Respondents affiliated with academic institutions and large non-university-affiliated hospitals were 1.74 times more likely to favour THA, and arthroplasty specialists exhibited a 1.77-fold preference for THA. There was a 19-fold variation for cemented femoral fixation between the United Kingdom (UK) and USA with the UK favouring cemented fixation. CONCLUSION: Our study reveals a significant shift towards THA preference for managing geriatric femoral neck fractures, influenced by subspecialty and practice settings. We also observed a pronounced predominance of cement fixation in specific geographic locations. These findings highlight the evolving fracture management landscape, emphasizing the need for standardization and comprehensive understanding across diverse healthcare settings.

Proximal cementation of a collarless polished tapered hip stem: biomechanical analysis using a validated finite element model.

Total hip replacement (THR) with cemented stem is a common procedure for patients with hip osteoarthritis. When primary THR fails, removal of the cement is problematic and poses challenges during revision surgeries. The possibility of proximal partial cementing of the hip stem was explored to mitigate the problem. 3D finite element analysis was performed to investigate the feasibility of reduced cement length for effective implant fixation and load transmission. Three levels of cement reduction (40 mm, 80 mm, and 100 mm) in the femoral stem were evaluated. All models were assigned loadings of peak forces acting on the femur during walking and stair climbing. The experimental and predicted max/min principal bone strains were fitted into regression models and showed good correlations. FE results indicated stress increment in the femoral bone, stem, and cement due to cement reduction. A notable increase of bone stress was observed with large cement reduction of 80-100 mm, particularly in Gruen zones 3 and 5 during walking and Gruen zones 3 and 6 during stair climbing. The increase of cement stresses could be limited to 11% with a cement reduction of 40 mm. The findings suggested that a 40-mm cement reduction in hip stem fixation was desirable to avoid unwanted complications after cemented THR.

Dynamic response and deformation failure microscopic characteristics of cyclic impact-cemented tailing backfill.

Frequent blasting disruptions can lead to cumulative damage within the cemented tailing backfill (CTB), increasing the risks associated with mining operations and reducing the recovery rate of the pillar. To address this issue, the Split Hopkinson Pressure Bar (SHPB) was utilized to conduct cyclic impact tests on CTB containing various cement tailing ratios (CTR) at different curing ages. The tests analyzed the stress-strain curve law, dynamic compressive strength (DCS), dynamic strength increase factor (DIF), absorption energy, and deformation failure characteristics of CTB under different impact velocities. Additionally, nuclear magnetic resonance (NMR) and scanning electron microscopy (SEM) were employed to investigate the internal pore structural properties of CTB. The research findings indicate that (1) Average strain rate exhibits a linear relationship with the DCS and impact velocity. A lower number of impacts occurred at higher impact velocities and shorter curing age. The number of impacts was drastically reduced when the impact velocity surpassed 3 m/s. As the CTR increased, the number of impacts also increased. When the number of impacts increased, the elastic modulus, dynamic impact strength, and peak strain initially increased before ultimately decreasing. (2) Under the cyclic impact load, the shear failure and axial splitting failure were the main failure modes of CTB. Increasing the CTR may be a more effective strategy for reducing the degree of CTB fragmentation compared to prolonging the curing age. When the impact velocity is lower than 3 m/s, CTB can withstand multiple impacts and maintain high levels of integrity. When the DIF of the first shock is below 1.5, the CTB demonstrates a capability to withstand more than four shocks. If the DIF exceeds 2, the CTB can only endure a single shock. (3) NMR and SEM observations revealed that CTB itself contains more pores. A dense network structure will grow inside CTB as the curing age and CTR are increased, reducing the porosity. The pore size observed in the samples also support that increasing CTR may be a more effective strategy. Our findings contribute to a better understanding of the kinetic response of CTB in deep mines under frequent blasting disruption and offer a valuable reference point for future research in this area.

Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre.

BACKGROUND: Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making. METHODS: This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant. RESULTS: 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions. CONCLUSIONS: PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.

Analysis of physical characteristics and mechanism of retarder to stratified cemented backfill.

The stratified structural plane caused by stratified backfill will reduce the strength of backfill, and the introduction of retarder will make up for the defect. Three retarders, sodium tripoly-phosphate, citric acid and sucrose, were introduced. After determining the optimal dosage of retarder, they were added into the filling slurry with a ratio of lime to sand of 1:6 and a mass concentration of 75%. Based on the hydration reaction mechanism and damage mechanics theory of cement, the setting time test and uniaxial compressive strength test were carried out. With the help of scanning electron microscopy and X-ray diffraction, the influence mechanism of retarder on the physical characteristics of stratified cemented filling was investigated.The main research contents and achievements are as follows:. The results showed that the three retarding agents can delay the setting time of the cement filling slurry, and the retarding effect is sucrose > citric acid > sodium tripolyphosphate. The addition of retarder can improve the uniaxial compressive strength and integrity of stratified consolidated backfill, and the best filling interval time (FIT) is 12 h. Appropriate addition of retarder will increase the amount of cement hydration products, make the structure of hydration products more dense, reduce the formation of stratified structural plane, and help to improve the strength of stratified cemented backfill.

Impact of fixation method on femoral bone loss: a retrospective evaluation of stem loosening in first-time revision total hip arthroplasty among two hundred and fifty five patients.

PURPOSE: Implant loosening represent the most common indication for stem revision in hip revision arthroplasty. This study compares femoral bone loss and the risk of initial revisions between cemented and uncemented loosened primary stems, investigating the impact of fixation method at primary implantation on femoral bone defects. METHODS: This retrospective study reviewed 255 patients who underwent their first revision for stem loosening from 2010 to 2022, receiving either cemented or uncemented stem implants. Femoral bone loss was preoperatively measured using the Paprosky classification through radiographic evaluations. Kaplan-Meier analysis estimated the survival probability of the original stem, and the hazard ratio assessed the relative risk of revision for uncemented versus cemented stems in the first postoperative year and the following two to ten years. RESULTS: Cemented stems showed a higher prevalence of significant bone loss (type 3b and 4 defects: 32.39% vs. 2.72%, p < .001) compared to uncemented stems, which more commonly had type 1 and 2 defects (82.07% vs. 47.89%, p < .001). In our analysis of revision cases, primary uncemented stems demonstrated a 20% lower incidence of stem loosening in the first year post-implantation compared to cemented stems (HR 0.8; 95%-CI 0.3-2.0). However, the incidence in uncemented stems increased by 20% during the subsequent years two to ten (HR 1.2; 95%-CI 0.7-1.8). Septic loosening was more common in cemented stems (28.17% vs. 10.87% in uncemented stems, p = .001). Kaplan-Meier analysis indicated a modestly longer revision-free period for cemented stems within the first ten years post-implantation (p < .022). CONCLUSION: During first-time revision, cemented stems show significantly larger femoral bone defects than uncemented stems. Septic stem loosening occurred 17.30% more in cemented stems.

Research on Slurry Flowability and Mechanical Properties of Cemented Paste Backfill: Effects of Cement-to-Tailings Mass Ratio and Mass Concentration.

The flowability and mechanical properties are increasingly crucial in the filling process of deep metal mines with mining depths exceeding 1000 m. The rheological properties of filling slurry in the pipeline were analyzed through rheological tests, L-tube self-flow tests, and semi-industrial loop tests. The results revealed that with an increase in the cement-to-tailings mass ratio (c/t ratio) and mass concentration, the slurry exhibited a higher flow resistance and decreased stowing gradient. During slurry transportation, the pressure loss in the straight pipe was positively correlated with the slurry flow rate, c/t ratio, and mass concentration. A uniaxial compressive strength (UCS) test was conducted to analyze the mechanical properties of the cemented paste backfill containing BMC (CCPB) in both standard and deep-underground curing environments. The UCS of the CCPB showed an increasing trend with the rise in curing age, mass concentration, and the c/t ratio. The comprehensive analysis concluded that when the c/t ratio is 1:4, and the mass concentration is approximately 74%, and parameters such as the slump, bleeding rate, and flowability of the filling slurry meet the criteria for conveying and goaf filling, resulting in a high-strength filling body.

Cemented Versus Uncemented Hemiarthroplasty for Displaced Intracapsular Neck of Femur Fractures in the Elderly: Outcomes and Costings.

Background: Hemiarthroplasty (HA) is a common form of treatment for displaced neck of femur fractures. There is ongoing debate as to whether cemented or uncemented HA is a more superior treatment modality. The aim of this study was to compare the outcomes between patients that underwent cemented HA to uncemented HA. Secondarily, we analysed the costs associated of each treatment option. Methods: This was a retrospective study conducted at a busy district general hospital. The study included 335 patients that were treated with either a cemented or uncemented HA for a displaced neck of femur fracture between January 2017 and December 2018. Data collected included age, sex, American Society of Anesthesiologist (ASA) score, treatment modality, length of stay (LOS) and general costs. Results: 197 (58.8%) of the cohort underwent cemented HA and 138 (41.2%) underwent uncemented HA. Mean age for the cemented cohort was 84.7 years and 85.9 years in the uncemented group (p = 0.31). There was no significant differences between the groups with regard to mean LOS and discharge disposition (p = 0.44). There were no significant difference in 30-day and 1-year mortality between the two groups (p = 0.2). We did find a statistically significant difference in the costings between the two procedures, with cemented HAs costing £66 more than uncemented HAs (p < 0.001). Conclusion: We found that both cemented and uncemented HAs produced comparable results. We found a statistically significant reduction in operative time and costs associated with uncemented HA. Uncemented HA implants may be considered where a shorter operation duration is essential.

Minimum 15-Year Survival of a Biconvex Inlay Patellar Component in Primary Total Knee Arthroplasty: An Analysis of 2,530 Total Knee Arthroplasties From a Single Institution.

BACKGROUND: Routine patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. To our knowledge, there are no studies reporting the long-term performance of a cemented biconvex all-polyethylene inlay component implanted at the time of primary TKA. The purpose of this study was to examine the 15-year survivorship and long-term clinical outcomes of this biconvex inlay patella used at our institution. METHODS: We retrospectively reviewed our prospectively collected institutional database and identified 2,530 patients who underwent cemented TKA with a single prosthetic design (from 1996 to 2007) where the patella was resurfaced using this cemented biconvex inlay patella. The mean age at surgery was 68 years (range, 29 to 93). The mean body mass index was 33.0 (range, 16.4 to 76.3), with 61.9% women. At the time of analysis, the mean time from surgery was 20.4 years (range, 15 to 26). We used Kaplan-Meier analysis to calculate survivorship at 15 years. We analyzed clinical outcomes using 3 patient-reported outcome measures collected prospectively. RESULTS: The 15-year survivorship with revision surgery for all causes as the end point was 97.1% (95% confidence interval 96.1 to 98.1%). The 15-year survivorship with revision surgery for a patella-related complication as the end point was 99.7% (95% confidence interval 99.4 to 1.0). At the final follow-up, patients showed significant improvement in scores for the Knee Society Clinical Rating System (P < .001), Western Ontario and McMaster University Osteoarthritis Index (P < .001), and Veterans Rand 12-Item Health Survey physical component (P < .001). CONCLUSIONS: Routine patellar resurfacing using a biconvex inlay patellar component has excellent survivorship and a low rate of complications at 15 years post-TKA.

Cemented vs cementless stems for revision arthroplasties due to Vancouver B2 periprosthetic hip fracture.

PURPOSE: According to Vancouver classification, B2 type fractures are most often treated with removal of the loose stem and implantation of a long stem that bypasses the fracture site. However, there is a controversy about the stem fixation that should be used: cemented or cementless. Hence, this study aims to compare cemented and cementless stems in prosthetic revision due to Vancouver B2 (VB2) periprosthetic hip fracture. METHODS: A retrospective study was done including all the patients treated with stem exchange due to VB2 periprosthetic hip fracture in a tertiary hospital between 2015 and 2022. Patients were divided into two groups according to the stem fixation used: cemented or cementless. Functional outcomes, hospital stay, surgical time, complication rate, and mortality were compared between the two groups of patients. RESULTS: Of the 30 included patients, 13 (43.4%) were treated with cementless stems and 17 (56.7%) with cemented stems. There were no statistically significant differences in age, gender, anesthesia risk scale (ASA) or functional capacity prior to the intervention. Patients treated with cementless stems had a higher complication and reintervention rate than those treated with cemented stems: 62 and 45% versus 34 and 6% (p = 0.035; p = 0.010), respectively. Furthermore, in the group of cementless stems a higher proportion of non-union was found (53.8% vs. 17.6%; p = 0.037). Also, the hospital stay (33 vs. 24 days; p = 0.037) and the time to full weight-bearing (21 days vs. 9 days; p < 0.001) were longer in the cementless stem group. CONCLUSION: Cemented fixation in stem revision due to Vancouver B2 periprosthetic hip fracture could be an optimal option with faster recovery which could decrease the rate of complications and reintervention, without compromising the fracture healing and patient mortality. Thus, this option can be considered when an anatomical reduction can be obtained, especially in elderly patients with multiple comorbidities in which a less aggressive surgical option should be considered.

Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013-2022.

INTRODUCTION: Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status. AIM: To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques. MATERIALS AND METHODS: Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden. RESULTS: In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3-5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9-2.3, p < 0.001). CONCLUSIONS: All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.

Unicompartmental knee replacement: controversies and technical considerations.

BACKGROUND: Unicompartmental knee replacement (UKR) is one of the effective interventions for the treatment of symptomatic knee osteoarthritis. Moreover, it has multiple advantages over total knee arthroplasty (TKA), including reduced intraoperative blood loss, decreased risk of transfusion, and faster recovery. This study aimed to discuss critical technical considerations regarding UKR and some of the controversies and updates. METHODS: We conducted a review to provide an overview of the controversies and technical considerations about UKR in several aspects. Only peer-reviewed articles were included, up to December 2023 using PubMed, Google Scholar, ERIC, and Cochrane database for systematic reviews databases. RESULT: UKR is associated with superior patient-reported clinical and functional outcomes, as well as shorter hospital stays, fewer postoperative complications, and revealed favorable outcomes in patients' return to sport. The choice between mobile- and fixed-bearing prostheses depends, in part, on the surgeon's preference. The mobile-bearing UKR is a less constrained prosthesis and can potentially result in less wear, but it is more technically demanding. While no significant difference between mobile-bearing versus fixed-bearing prostheses, cementless is superior to cemented design. Furthermore, UKR can be a good alternative for high tibial osteotomy (HTO) and still can be considered after a failed HTO. Lastly, recent reviews have shown a revision rate comparable to that of TKA. This is probably influenced by Improved comprehension of the best indications, patient selection criteria, as well as of the design, materials, and technological advances. CONCLUSION: UKR treatment for unicompartmental knee osteoarthritis is secure and effective. Based on clinical and functional outcomes, decreased morbidity and mortality, and cost-effectiveness, long-term studies suggest that UKR is superior to TKA. Further investigation in this area is warranted.

Equivalent revision rates and patient reported outcomes with routine use of a short (125mm) cemented stem for total hip arthroplasty compared to a standard length (150mm) cemented stem. A two surgeon series of 1335 patients.

BACKGROUND: Routine total hip arthroplasty (THA) using a short cemented stem as compared with a standard length cemented stem may have benefits in terms of stress distribution, bone preservation, stem subsidence and ease of revision surgery. Two senior arthroplasty surgeons transitioned their routine femoral implant from a standard 150 mm Exeter V40 cemented stem to a short 125 mm Exeter V40 cemented stem for all patients over the course of several years. We analysed revision rates, adjusted survival, and PROMS scores for patients who received a standard stem and a short stem in routine THA. METHODS: All THAs performed by the two surgeons between January 2011 and December 2021 were included. All procedures were performed using either a 150 mm or 125 mm Exeter V40 stem. Demographic data, acetabular implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the New Zealand Joint Registry (NZJR), and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were also recorded. RESULTS: 1335 THAs were included. 516 using the 150 mm stem and 819 using the 125 mm stem. There were 4055.5 and 3227.8 component years analysed in the standard stem and short stem groups respectively due to a longer mean follow up in the 150 mm group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the standard 150 mm stem (0.44 revisions/100 component years) and the short 125 mm stem (0.56 revisions/100 component years) with no statistically significant difference found (p = 0.240). CONCLUSION: Routine use of a short 125 mm stem had no statistically significant impact on revision rate or PROMS scores when compared to a standard 150 mm stem. There may be benefits to routine use of a short cemented femoral implant.