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Total hip arthroplasty (THA) is reaching a broader spectrum of younger patients who struggle with incapacitating hip disease. This study aimed to explore national bearing surface trends for young THA recipients. Specifically, we evaluated bearing surface utilization, patient demographics, and hospital demographics in 20- to 50-year-old THA recipients in the United States from 2009 to 2016.The National Inpatient Sample database was queried for patients aged 20 to 50 who underwent primary THA from 2009-2016 (n=279,190). Patients were grouped according to bearing surface type (metal-on-polyethylene [MOP], metal-on-metal [MOM], ceramic-on-ceramic [COC], and ceramic-on-polyethylene [COP]). Demographics included sex, age, race, obesity status, age-adjusted Charlson Comorbidity Index (CCI), primary payer, median household income, region, and teaching status. Chi-square analyses were employed for categorical variables, while independent t-tests were utilized for continuous variables.The incidence of THA for patients aged 20 to 50 increased slightly from 33,003 in 2009 to 33,545 in 2016 (p0.001). Overall, bearing surface type was reported in 46.8% (n=127,876) of THAs. Of the THAs with bearing surface codes, the use of MOP (29.6 to 18.7%) and MOM (39.6 to 4.4%) decreased, while COC (9.0 to 14.3%) and COP (21.8 to 62.6%) utilization increased (p0.001 for all). Those receiving COC implants had the youngest average age (42 years) (p0.001). Females were more likely to receive COC (44.2%) or COP (43.6%) implants (p0.001). Obese individuals were more likely to receive MOP (21.3%) or COP (21.2%) (p0.001).Over an 8-year period, considerable shifts in bearing surface trends have occurred across the United States among 20 to 50-year-old patients. Advantages of ceramic femoral heads, along with increased acceptance of highly cross-linked polyethylene, appear to be reasons for the selection of COP over other bearing surfaces.

Proximally coated, morphometric wedge femoral stems illustrated excellent survivorship and clinical outcomes at a minimum five-year postoperative follow up.We completed a retrospective review of 186 THA patients from three high-volume surgeons to assess clinical- and patient-reported outcomes five years after implantation with a cementless, proximally coated morphometric wedge femoral stem. We reviewed Gruen zones on early postoperative and mid-term radiographs for signs of osteolysis, loosening, and wear. Clinical- and patient-reported outcomes were compared with previously published two-year outcomes for these femoral stems.No progression of radiolucencies or loosening was observed radiographically when comparing minimum one-year and five-year follow up. Reactive radiodense lines were observed in 23 cases (12.64%), and 13 cases (7.14%) exhibited true radiolucencies of 1-3mm, and all remained unchanged between follow ups or were no longer present on the five-year film. Cortical hypertrophy was noted in Gruen zones 3 and/or 5 in 11 cases (6.04%). No stems were revised for mechanical loosening or for periprosthetic fracture. Nine (9) patients (4.87%) underwent revisions during the follow-up period for periprosthetic infection, femoral head and/or acetabular component revisions, and impingement requiring release and femoral head change. Average Harris Hip Scores were excellent at five years and improved slightly when compared to a two-year follow up; however, this change was not statistically significant. Health-related quality of life mental component and physical component scores were a mean of 48.45 and 43.10 at 5 years, respectively. All cause Kaplan-Meier survivorship of the femoral stem was calculated at 98.4% at an average 65.7 months post implantation. Additionally, this cohort exhibited 100% aseptic survivorship during the follow-up period.Newer-generation morphometric wedge femoral stems for THA exhibit excellent radiographic stability, patient satisfaction, and clinical outcomes five years post implantation.

Despite the success of total hip arthroplasty (THA), postoperative pain management remains a concern. Although the nonsteroidal anti-inflammatory drug (NSAID) intravenous (IV) diclofenac is a promising addition, its impact on THA outcomes has not been investigated. This study evaluates the effects of adjunctive IV diclofenac on: 1) postoperative pain intensity; 2) opioid consumption; 3) discharge destination; 4) length of stay; and 5) patient satisfaction in primary THA patients. A retrospective study was performed for patients who underwent primary THA by a single surgeon between May 1 and September 31, 2017. Patients of the study group (n=25) were treated postoperatively with IV diclofenac and the standard pain control regimen while the control group (n=88) did not receive diclofenac. Patients receiving adjunctive IV diclofenac were more likely to be discharged home than to inpatient facilities (O.R. 4.02; p=0.049). Patient satisfaction with respect to how well and how often pain was controlled (p= 0.0436 and p=0.0217, respectively) was significantly greater in the IV diclofenac group. Patients who received IV diclofenac had lower opioid consumption on postoperative days one and two (-67.2 and -129.0mg, respectively; p=0.001 for both). The growth of THA as an outpatient procedure has intensified the urgency of improving postoperative pain management. This study demonstrates that THA patients receiving adjunctive IV diclofenac were more likely to be discharged home, had reduced opioid consumption, and experienced greater satisfaction. To further investigate the optimal regimen, future studies comprising a larger cohort and comparing IV diclofenac to other NSAIDs are warranted.

Managing postoperative pain can be challenging for arthroplasty surgeons. While pain control modalities, such as adductor canal blockade (ACB), have been proven effective, the multifactorial nature of pain perception may serve as an obstacle for optimizing pain control. This study assesses the effect of patient pre-operative physical status on patient perception of pain. Specifically, we compared 1) lengths of hospital stay (LOS), 2) pain levels, and 3) opioid consumption in patients receiving total knee arthroplasty (TKA) who presented with an American Society of Anesthesiologists physical status score (ASA) of 2 and 3.A single hospital, single surgeon database was reviewed for patients who had TKA between January 2015 and April 2016. Only patients with an ASA class of 2 or 3 who received ACB were analyzed. This yielded 106 patients with a mean age of 63 years, comprised of 36 men and 70 women. Patients were stratified into those with an ASA class of 2 (n= 58) and those with an ASA class of 3 (n= 48). Electronic medical records were reviewed to obtain demographic and endpoint data. Pain was quantified using Visual Analog Scale (VAS). Continuous variables were compared using the student' s t-test and analysis of variance, while categorical variables were compared using chi-square analysis.There was no significant difference found between the two groups in LOS (2.25 days vs. 2.19 days; p=0.805), VAS scores (4.95 vs. 5.75; p=0.306), and opioid consumption on day 0 (17.77 morphine eq vs. 23.49 morphine eq; p=0.233) and day 3 (9.11 morphine eq vs. 19.87 morphine eq; p=0.100). However, patients with an ASA score of 2 had a significantly lower opioid consumption on day 1 (32.20 morphine eq vs. 52.70 morphine eq; p=0.049), day 2 (19.21 morphine eq vs. 40.71 morphine eq; p=0.018), and overall (78.30 morphine eq vs. 135.77 morphine eq; p=0.024).Despite the effectiveness of ACB in controlling pain, patient pre-operative status may affect perception of pain. This study demonstrates that patients with a higher ASA physical status classification consumed more opioid medication postoperatively, despite having similar pain scores and lengths of stay to those with a lower classification. Future studies should assess all ASA classifications and stratify for preoperative opioid consumption and tolerance as a possible confounder.