Total hip replacement in congenital dislocation and dysplasia of the hip.

The results of thirty-one total hip replacements in twenty-four patients with either severe congenital dysplasia or dislocation, after an average follow-up of four years, were excellent in eleven, good in sixteen, fair in one, and poor in one.The operative technique included superolateral bone grafts to increase the acetabular coverage in six hips. Twenty-seven hips required smaller and straighter femoral components than normal. The incidence of major complications was 19 per cent.     

The Future is Non-cemented Total Knee Arthroplasty: Volume Trends at the Hospital for Special Surgery

IntroductionThe optimal fixation method for total knee arthroplasty (TKA) is still a debate. Cemented fixation has excellent long-term results and is the gold standard. However, longevity in the younger, heavier, and more active population is suboptimal. Cementless TKA offers the opportunity to gain biological fixation and overcome these shortcomings.MethodsThis is a retrospective review of all consecutive cementless TKA procedures performed at a single academic institution from 2016 until 2020. Demographics, aseptic revisions, and septic revisions were pulled from the electronic medical record. The number of yearly implanted cementless TKA prosthesis was determined to analyze utilization trends.ResultsEight-hundred and two patients were identified with a mean age of 61.57 ± 7.78 years, and a mean of BMI 32.12 ± 5.98 kg/m². The mean time to revision was 12.31 ± 13.91 months. There were four septic failures and nine aseptic failures during the study period. Of these nine aseptic failures only five were due to mechanical loosening. There was a yearly linear increase in the use of cementless fixation.ConclusionCementless fixation is here to stay, and its use will continue to increase. Early and mid-term outcomes have been excellent thus far. Changing clinical practice takes time but we have already seen this transition take place in total hip arthroplasty. As technology and design continue to evolve, we believe it is a possibility.     

Properties of the patient administered questionnaires: new scales measuring physical and psychological symptoms of hip and knee disorders

The Patient Administered Questionnaires (PAQ) incorporate physical and psychological symptoms into one scale and permit more comprehensive self-reports for hip and knee disorders. We tested the psychometric properties of the PAQ-Hip and PAQ-Knee. Correlations between baseline PAQ-Hip and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were .39 to .72 (n = 102), .39 to .69 for score change (n = 68 post-total hip arthroplasty), and most κ values > .60 (n = 50). Correlations between baseline PAQ-Knee and WOMAC were .35 to .64 (n = 100), .62 to .79 for score change (n = 43 post-total knee arthroplasty), and most κ values >.60 (n = 51). For both scales, effect sizes were higher than for the WOMAC, and there was modest correlation between physical and psychological questions, indicating these concepts are not completely interchangeable. Thus, the PAQ scales have strong psychometric properties and are unique compared with existing scales by including physical and psychological symptoms.     

Tibial stem tip pain in stemmed revision total knee arthroplasty: treatment with tension band plating

The use of stemmed modular components in revision total knee arthroplasty has led to increasingly described pain located at the tip of the stem of the implant. This has been described in the literature as being due to the elastic modulus mismatch between the stem tip and the host bone. Current management is re-revision total knee arthroplasty in an attempt to alleviate the mismatch. This case report describes a novel technique using a dynamic compression plate acting as a tension band at the stem tip to successfully treat this condition.     

Minimum 5-year wear analysis of first-generation highly cross-linked polyethylene in patients 65 years and younger

The purpose of this study was to analyze wear rates of highly cross-linked polyethylene comparing the Martell and the Roman methods in 112 total hip arthroplasties in patients 65 years and younger, with a mean follow-up of 5.7 years. The mean wear rates in the Martell and Roman methods were 0.014 ± 0.05 mm/y and 0.011 ± 0.04 mm/y when including all values and 0.043 ± 0.028 mm/y and 0.038 ± 0.02 mm/y when negative values were assumed to be zero, respectively. Both Roman and Martell methods showed similar low wear rates with negative values. The Roman method had higher precision and was more user friendly because it required less steps to measure wear, especially when comparing with the manual feature of Martell method.     

A Novel Method for Accurate and Reproducible Functional Cup Positioning in Total Hip Arthroplasty

Cup positioning is an important variable for short and long term function, stability, and durability of total hip arthroplasty (THA). This novel method utilizes internal and external bony landmarks, and the transverse acetabular ligament for positioning the acetabular component. The cup is placed parallel and superior to the transverse ligament and inside the anterior wall notch of the true acetabulum, then adjusted for femoral version and pelvic tilt and obliquity based on weight bearing radiographs. In 78 consecutive THAs, the mean functional anteversion and abduction angles were 17.9 ° ± 4.7 ° and 41.7 ° ± 3.8 °, respectively. 96% of the functional anteversion measurements and 100% of the functional abduction angles were within the safe zone. This technique is an easy, reproducible, and accurate method for functional cup placement.     

Assessment of Reactive Synovitis in Rotating-Platform Posterior-Stabilized Design : A 10-Year Prospective Matched-Pair MRI Study

This is the first long-term (mean 11.6 years), prospective, matched-pair study (based on age, gender, BMI and UCLA scores) using MAVRIC (multi-acquisition variable-resonance image combination) magnetic resonance imaging to analyze reactive synovitis and osteolysis between rotating-platform posterior-stabilized (RP-PS), fixed-bearing metal-back (FB-MB), and all-polyethylene tibial (APT) in active patients (24 total, 8 in each group, mean age of 64 years, mean UCLA of 8.5) with identical femoral component and polyethylene. Reactive synovitis was observed in 6 RP-PS (75%), all 8 FB-MB (100%), and 6 APT (75%). There was a significant difference between the RP-PS and FB-MB knees in volumetric synovitis (P = 0.023). Osteolysis with bone loss more than 4 mm was seen in 3 FB-MB, 2 APT and none for RP-PS. These were not statistically significant.     

Targeted Preoperative Autologous Blood Donation in Total Knee Arthroplasty Reduces the Need for Postoperative Transfusion

Background

Preoperative donation of autologous blood has been widely used to minimize the potential risk of allogeneic transfusions in total knee arthroplasty. A previous study from our center revealed that preoperative autologous donation reduces the allogeneic blood exposure for anemic patients but has no effect for non-anemic patients.

Questions/Purposes

The current study investigates the impact of a targeted blood donation protocol on overall transfusion rates and the incidence of allogeneic blood transfusions.

Methods

Prospectively, 372 patients undergoing 425 unilateral primary knee replacements were preoperatively screened by the Blood Preservation Center between 2009 and 2012. Anemic patients with a hemoglobin level less than 13.5 g/dL were advised to donate blood, while non-anemic patients did not donate.

Results

Non-anemic patients who did not donate blood required allogeneic blood transfusions in 5.9% of the patients. The overall rate of allogeneic transfusion was significantly lower for anemic patients who donated autologous blood (group A, 9%) than those who did not donate (group B, 33%; p?<?0.001). Donating autologous blood did increase the overall transfusion rate of anemic patients to 0.84 per patient in group A compared to 0.41 per patient in group B (p?<?0.001).

Conclusion

This investigation confirms that abandoning preoperative autologous blood donation for non-anemic patients does not increase allogeneic blood transfusion rates but significantly lowers overall transfusion rates.     

Resveratrol ‐ an ingredient of red wine abrogates the reproductive capacity in male mice

Resveratrol has been considered as an antioxidant in biological system. However, its role in male reproductive biology has not yet been evaluated in much detail. Present study analysed its effect on male reproductive function in adult mouse, after its intraperitoneal administration (2, 8 and 20 mg kg b.wt.^?1 per day) for 2 weeks. The generation of reactive oxygen species and lipid peroxidation in testis increased with concomitant decrease in sperm count and motility following resveratrol treatment as compared with the control group. Resveratrol had a negative impact on the activities of antioxidant enzymes namely catalase and superoxide dismutase and on the level of reduced glutathione. Increase in the level of oxidised glutathione by resveratrol lead to a shift in the redox ratio. Additionally, a significant loss of Leydig cells and alterations in testicular histomorphology (excessive vacuolisation and shrinkage of seminiferous tubules) was also observed. In conclusion, the deleterious effects of resveratrol on germ cells could be attributed to its pro‐oxidant ability leading to testicular tissue damage.