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Background: Surgical approaches for total knee arthroplasty (TKA) include the medial parapatellar (MPA), subvastus (SV), midvastus (MV), and lateral parapatellar approach (LPA); it remains unclear which approach is superior. Methods: Patients having undergone TKA at our institution were retrospectively organized into matched groups according to surgical approach (MPA, MV, SV, or LPA). Outcomes between the groups were compared using the Short-Form 12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS), and range of motion (ROM) up to 2 years postoperative. Results: Sixty-eight MV patients, 8 SV patients, and 4 LPA patients were matched with groups of MPA patients. There was no difference in outcomes between the MPA and MV groups up to 2 years. The SV group had significantly higher SF-12 Physical Composite Score (PCS; p = 0.036) and WOMAC stiffness score (p = 0.014) at 2 years, but significantly lower flexion at 1 year (p = 0.022) than the MPA group. The LPA group had significantly lower SF-12 PCS (p = 0.011) and WOMAC function scores (p = 0.022) at 1 year than the MPA group. Conclusion: There was no significant difference between the MPA and MV approach. The SV approach had some improved long-term outcomes over the MPA aproach (SF-12 and WOMAC), but had significantly lower flexion at 1 year. The LPA group showed inferior outcomes than the MPA group but had more severe valgus preoperative deformity (p = 0.024). Further studies are required to investigate the potential benefit of quadriceps-sparing approaches. Contexte : Les voies chirurgicales d'arthroplastie totale du genou (ATG) sont les suivantes : parapatellaire interne (PI), subvastus (SV), midvastus (MV), et parapatellaire externe (PE); il n'est pas clair quelle voie est superieure. Methodes : Les patients qui ont subi une ATG dans notre etablissement ont ete classes retrospectivement en groupes apparies selon la voie chirurgicale (PI, MV, SV ou PE). Les resultats des differents groupes ont ete compares au moyen du Short-Form 12 (SF-12), de l'indice Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), du score de la Knee Society (KSS) et de l'amplitude du mouvement jusqu'a 2 ans apres l'operation. Resultats : Au total, 68 patients traites par voie MV, 8 par voie SV et 4 par voie PE ont ete apparies avec des groupes de patients traites par voie PI. Il n'y avait aucune difference dans les resultats entre les groupes PI et MV jusqu'a 2 ans. Comparativement au groupe PI, le groupe SV avait des resultats significativement plus eleves pour le score physique fonctionnel (PCS) du SF-12 (p = 0,036) et le score de raideur de l'indice WOMAC (p = 0,014) apres 2 ans, mais une flexion significativement plus faible apres 1 an (p = 0,022). Encore comparativement au groupe PI, le groupe PE avait des resultats significativement plus faibles pour le PCS du SF-12 (p = 0,011) et les scores fonctionnels de l'indice WOMAC (p = 0,022) apres 1 an. Conclusion : Il n'y avait pas de difference significative entre les voies PI et MV. La voie SV offrait de meilleures issues a long terme que la voie PI (SF-12 et WOMAC), mais une flexion significativement plus faible apres 1 an. Le groupe PE a eu des issues moins bonnes que le groupe PI, mais presentait plus souvent une deformation valgus preoperatoire grave (p = 0,024). D'autres etudes seront requises pour etablir les bienfaits potentiels de voies evitant le quadriceps., Many approaches have been described for total knee arthroplasty (TKA), including the medial parapatellar (MPA), subvastus medialis (SV), midvastus (MV), and lateral parapatellar (LPA) approaches. The most commonly used of [...]

Background: There has been a continuing trend toward decreasing the length of hospital stay for patients undergoing total hip arthroplasty (THA). We aimed to investigate the impact of timing of discharge on gait and patient-reported outcomes early after THA. Methods: In this prospective observational cohort study conducted from May 2014 to November 2015, we measured gait velocity, stride length, single-limb support and single-limb support symmetry in adults aged 18-75 years before direct anterior THA, at discharge from the hospital, and 2, 6 and 12 weeks postoperatively. All procedures were performed by a single surgeon. Patients were discharged on the same day as surgery (outpatient group) or stayed at least 1 night in hospital (inpatient group). Participants also completed the Timed Up and Go test (all postoperative time points) and a series of questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index [6 and 12 wk], 12-Item Short Form Health Survey [2, 6 and 12 wk], Harris Hip Score [12 wk] and a pain visual analogue scale [all postoperative time points]). Results: Thirty-six participants were enrolled in the study, of whom 16 were outpatients and 20 were inpatients. The mean pain rating at the time of discharge was lower in the outpatient group than in the inpatient group (adjusted mean difference -1.5, 95% confidence interval-3.0 to 0.0). We found no other significant differences between the groups for any gait, patient-reported or surgical outcome. Conclusion: There were no statistically significant differences in gait or patient-reported outcomes after direct anterior THA between patients who stayed overnight and those who were discharged as outpatients. Patients discharged as outpatients were younger than those who stayed overnight. Our results suggest that discharging patients as an outpatient after direct anterior THA may have a similar impact on patient function and outcomes as a standard overnight stay in hospital. Contexte: La tendance a reduire la duree de l'hospitalisation des patients soumis a une intervention pour prothese totale de la hanche (PTH) se maintient. Nous avons voulu evaluer l'impact du moment du conge sur la demarche et sur les parametres rapportes par les patients peu de temps apres la PTH. Methodes: Au cours de cette etude de cohorte observationnelle prospective realisee entre mai 2014 et novembre 2015, nous avons mesure la vitesse de la deambulation, la longueur de la foulee, l'equilibre sur une jambe et sa symetrie chez des adultes de 18 a 75 ans avant une PTH anterieure directe, au moment du conge hospitalier et 2, 6 et 12 semaines apres l'intervention. Toutes les interventions ont ete effectuees par 1 seul chirurgien. Les patients recevaient leur conge le jour meme de l'operation (groupe de patients ambulatoires) ou sejournaient au moins 1 nuit a l'hopital (groupe de patients hospitalises). Les participants effectuaient aussi un test de lever-marcher chronometre (Timed Up and Go test) a toutes les evaluations postoperatoires, et on leur administrait une serie de questionnaires: score WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) a 6 et 12 semaines, SF-12 (12-Item Short Form Health Survey) a 2, 6 et 12 semaines, score de hanche de Harris a 12 semaines et echelle visuelle analogique d'intensite de la douleur a toutes les evaluations postoperatoires. Resultats: Trente-six participants ont ete inscrits a l'etude, dont 16 dans le groupe ambula-toire et 20 dans le groupe hospitalise. L'evaluation moyenne de la douleur au moment du conge etaient moindre dans le groupe de patients hospitalises (difference moyenne ajustee -1,5, intervalle de confiance de 95 %-3,0 a 0,0). Nous n'avons observe aucune autre difference significative entre les groupes pour la demarche et les parametres autorapportes ou operatoires. Conclusion: Nous n'avons observe aucune difference statistiquement significative entre les groupes aux plans de la demarche ou des parametres autorapportes apres la PTH anterieure directe selon que les patients avaient sejourne 1 nuit a l'hopital ou qu'ils avaient recu leur conge le jour meme. Les patients non hospitalises etaient plus jeunes que les patients hospitalises. Selon nos resultats, l'impact sur le fonctionnement et sur les parametres des patients pourrait etre le meme, que ces derniers recoivent leur conge hospitalier le jour meme ou le lendemain., Total hip arthroplasty (THA) is a successful procedure for the treatment of osteoarthritis. Length of stay after this procedure continues to decrease, and some institutions have started to perform THA [...]

Though radiostereometric analysis (RSA) is the gold standard for migration tracking, computed tomography‐based RSA (CT‐RSA) does not require marker beads and is available for clinical adoption. This study investigated CT‐RSA in comparison to RSA for assessing hip implant stability with inducible displacement (ID) examinations. Patients (n = 48) from a previous study returned to be re‐examined for femoral stem stability with CT‐RSA and RSA imaging. Implant migration since patients last follow‐up was calculated as a measure of stability. ID was assessed between alternated leg rotation scans for CT‐RSA and between supine and weight‐bearing scans for RSA. Measurements from ID and double examinations were compared between CT‐RSA and RSA. All stems were well‐fixed with migration <0.2 mm/year. ID measurements were lower with CT‐RSA than RSA for distal translation (mean difference = 0.122 mm, p < 0.0001), total translation (mean difference = 0.158 mm, p < 0.0001), and total rotation (mean difference = 0.449°, p < 0.0001). The ID and double exam were significantly different for total translation and total rotation for CT‐RSA, and significantly different for medial, distal, and total translation, and total rotation for RSA. Precision ranged from 0.049 to 0.130 mm in translation and 0.061° to 0.220° in rotation for CT‐RSA, and from 0.108 to 0.269 mm in translation and 0.151° to 0.670° in rotation for RSA. ID measurements from both CT‐RSA and RSA were minimal, consistent for a cohort with well‐fixed stems. CT‐RSA demonstrated superior precision in all axes compared to RSA. Clinical Significance: Future work should explore the use of CT‐RSA in patients with suspected loosening as a potential diagnostic tool. [ABSTRACT FROM AUTHOR]

Background: Total hip arthroplasty (THA) via the direct anterior approach has increased in popularity in the last decade, with research supporting enhanced early recovery; however, some investigators have reported increased early revision rates in direct anterior THA. We examined outcomes from a single institution's experience with a fully hydroxyapatite-coated collared femoral stem implanted via the anterior or the lateral approach. Method: Patients who had received fully hydroxyapatite-coated collared femoral stems as part of THA surgery performed by 1 of 3 surgeons between January 2012 and September 2017 were identified from our institutional database. We examined revision rates for the 2 approaches and compared them between the 2 groups. We also analyzed outcomes on plain film radiographs obtained immediately postoperatively and at 1 and 2 years. Results: A total of 695 patients received a fully hydroxyapatite-coated collared stem during the study period. Total hip arthroplasty was performed via the direct anterior approach in 281/778 hips (36.1%) and via the direct lateral approach in 497 (63.9%). Nineteen patients (2.5%) underwent subsequent revision surgery; there was no statis tically significant difference in the revision rate between the anterior and lateral approaches (2.5% v. 2.4%, p = 0.95). The mean subsidence of the stem at 1 year was 1.68 mm (standard deviation 11.7 mm). No statistically significant differences were observed between the cohorts for any of the radiographic measurements at either follow-up time Conclusion: We found no significant difference in revision rates between the direct anterior and direct lateral approach. Stem subsidence levels were in keeping with expected values, and no major changes in stem position occurred during the first postoperative year. Surgical approach did not appear to substantially affect biomechanical stem behaviour. Contexte : L'arthroplastie totale de la hanche (ATH) par voie anterieure directe a gagne en popularite dans les 10 dernieres annees, la recherche ayant montre qu'elle favorisait un retablissement rapide; certains chercheurs ont toutefois signale qu'elle etait associee a un taux accru d'operations de revision precoces. Nous avons etudie les issues de l'installation d'une tige femorale a collier entierement recouverte d'hydroxy apatite par voie anterieure ou laterale dans un etablissement. Methodes : Nous avons interroge la base de donnees de notre etablissement pour y recenser les patients ayant subi, entre janvier 2012 et septembre 2017, une ATH au cours de laquelle 1 de 3 chirurgiens a installe une tige femorale a collier entierement recouverte d'hydroxyapatite. Nous avons ensuite examine le taux d'operations de revision pour les 2 approches etudiees, et avons compare les issues des 2 groupes. Nous avons egalement analyse les cliches radiographiques pris immediatement apres l'intervention, de meme de ceux pris aux suivis a 1 et a 2 ans. Resultats : Durant la periode a l'etude, 695 patients se sont fait installer une tige femorale a collier entierement recouverte d'hydroxyapatite. Sur 778 hanches, 281 (36,1 %) avaient subi une ATH par voie anterieure directe, et 497 (63,9 %), une ATH par voie laterale directe. Dix-neuf patients (2,5 %) ont du subsequemment subir une operation de revision; aucune difference statistiquement significative n'a ete observee entre le groupe voie anterieure et le groupe voie laterale en ce qui a trait au taux de revision (2,5 % c. 2,4 %; p = 0,95). L'affaissement moyen de la tige au suivi a 1 an etait de 1,68 mm (ecart type 11,7 mm). Les mesures radiographiques des 2 groupes ne presentaient pas de differences statistiquement significatives, quel que soit le moment du suivi. Conclusion : Nous n'avons constate aucune difference significative dans le taux de revision entre les 2 groupes. L'affaissement observe etait dans les valeurs attendues, et la position de la tige n'avait pas change de facon importante au cours de la premiere annee. La voie chirurgicale utilisee ne semblait pas influencer considerablement le comportement biomecanique de la tige., Total hip arthroplasty (THA) is one of the most reliable and reproducible procedures in orthopedic surgery today, with a success rate as high as 97%.1 With recent advances in implant [...]

Background: Currently, the gold standard treatment for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is 2-stage revision, but few studies have looked at the economic impact of PJI on the health care system. The objective of this study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in TKA and to assess the economic impact of PJI after TKA compared to uncomplicated primary TKA. Methods: We identified consecutive patients in our institutional database who had undergone 2-stage revision TKA for PJI between 2010 and 2014 and matched them on age and body mass index with patients who had undergone uncomplicated primary TKA over the same period. We calculated all costs associated with the 2 procedures and compared mean costs, length of stay, clinical visits and readmission rates between the 2 groups. Results: There were 73 patients (mean age 68.8 [range 48-91] yr) in the revision TKA cohort and 73 patients (mean age 65.9 [range 50-86] yr) in the primary TKA cohort. Two-stage revision surgery was associated with a significantly longer hospital stay (mean 22.7 d v. 3.84 d, p < 0.001), more outpatient clinic visits (mean 8 v. 3, p < 0.001), more readmissions (29 v. 0, p < 0.001) and higher overall cost (mean $35 429.97 v. $6809.94, p < 0.001) than primary TKA Conclusion: Treatment for PJI after TKA has an enormous economic impact on the health care system. Our data suggest a fivefold increase in expenditure in the management of this complication compared to uncomplicated primary TKA. Contexte : A l'heure actuelle, le traitement par excellence d'une infection de prothese articulaire (IPA) survenant apres une arthroplastie totale du genou (ATG) est l'arthroplastie de revision en 2 etapes. Toutefois, peu d'etudes se sont penchees sur les repercussions economiques de l'IPA sur le systeme de sante. La presente etude visait donc a estimer de facon precise le cout de prise en charge de l'IPA par les etablissements, ainsi qu'a evaluer les repercussions economiques de l'IPA apres une ATG, comparativement a celles d'une ATG primaire sans complications. Methodes : Nous avons recense, dans la base de donnees de notre etablissement, tous les patients consecutifs ayant subi une ATG de revision en 2 etapes pour une IPA entre 2010 et 2014, puis les avons jumeles en fonction de l'age et de l'indice de masse corporelle avec des patients ayant subi une ATG primaire sans complications durant la meme periode. Nous avons calcule tous les couts associes aux 2 interventions, et avons compare la moyenne des couts, de la duree d'hospitalisation, des visites cliniques et des readmissions entre les 2 groupes. Resultats : On comptait 73 patients (age moyen 68,8 ans [plage 48-91 ans]) dans la cohorte d'ATG de revision, et 73 patients (age moyen 65,9 ans [plage 50-86 ans]) dans la cohorte d'ATG primaire. LATG de revision en 2 etapes, comparativement a l'ATG primaire, a ete associee a une duree d'hospitalisation significativement plus longue (moyenne 22,7 j c. 3,84 j; p < 0,001), a un plus grand nombre de visites en clinique externe (moyenne 8 visites c. 3 visites; p < 0,001), a un taux plus eleve de readmission (29 readmissions c. 0 readmission; p < 0,001) et a des couts globaux plus eleves (moyenne 35 429,97 $ c. 6809,94 $; p < 0,001). Conclusion : Le traitement de l'IPA apres une ATG a d'enormes repercussions economiques sur le systeme de sante. Selon nos donnees, les depenses liees a la prise en charge de cette complication pourraient etre 5 fois plus elevees que celles liees a une ATG primaire sans complications., Periprosthetic joint infection (PJI) is one of the most common and devastating complications following total knee arthroplasty (TKA). (1) The incidence has been reported to range from 1% to 2% [...]

A variety of total knee arthroplasty (TKA) designs offer increased congruency bearing options, primarily to compensate for a loss of posterior cruciate ligament (PCL) function. However, their efficacy in providing sufficient stability under different circumstances requires further investigation. The preclinical testing of prosthesis components on joint motion simulators is useful for quantifying how design changes affect joint stability. However, this type of testing may not be clinically relevant because surrounding ligaments are either ignored or greatly simplified. This study aimed to assess the kinematics and stability of TKA joints during various motions using condylar-stabilized (CS) bearings without a PCL versus cruciate-retaining (CR) bearings with an intact PCL. TKA prosthetic components were tested on a joint motion simulator while being stabilized with five different sets of specimen-specific virtual ligament envelopes. In comparison to CR knees, CS knees without a PCL exhibited a greater amount of posterior tibial displacement laxity, with a mean increase of 2.7±2.1 mm (p = 0.03). Additionally, significant differences were observed in the anterior–posterior kinematics of the knee joint during activities of daily living (ADL) between the two designs. These results were consistent with previous cadaveric investigations, which indicated that CS knees without a PCL are less resistant to posterior tibial displacement than CR knees with one. This study employing virtual ligaments confirms previous findings that the raised anterior lip of some CS bearings may not completely compensate for the absence of the PCL; however, as both studies used reduced joint contact forces, the contributions of this design feature may be attenuated. [ABSTRACT FROM AUTHOR]

Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today's health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p < 0.001), mean number of clinic visits (9.2 v. 3.8, p < 0.001), number of readmissions (12 v. 1, p < 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p < 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA. Contexte : L'infection articulaire periprothetique (IAP) arrive au troisieme rang des principales causes d'echec de l'arthroplastie (ou prothese) totale de la hanche (PTH). Meme si elle est controversee, la revision en 2 etapes demeure le traitement standard pour l'IAP dans la plupart des cas. A ce jour, peu d'etudes ont decrit l'impact economique de l'IAP dans l'environnement actuel des soins de sante. Le but de la presente etude etait d'obtenir une estimation precise des couts institutionnels associes a la prise en charge de l'IAP dans la PTH et d'evaluer le fardeau economique de l'IAP comparativement a une PTH primaire non compliquee. Methodes : Nous avons passe en revue les cas de PTH primaire et de revision de PTH en 2 etapes pour cause d'IAP dans notre etablissement. Les patients ont ete assortis selon l'age et l'indice de masse corporelle. Tous les couts associes a chaque intervention ont ete consignes. Des statistiques descriptives ont servi a resumer les donnees recueillies. Nous avons compare les couts moyens, la duree des sejours, les visites a la clinique et les taux de readmission associes aux 2 cohortes. Resultats : Cinquante cas consecutifs de revision de PTH ont ete assortis a 50 cas de PTH primaire non compliquee entre 2006 et 2014. Comparativement a la cohorte de PTH primaire, les cas d'IAP ont ete associes a une augmentation significative de la duree moyenne du sejour hospitalier (26,5 j c. 2,0 j, p < 0,001), du nombre moyen de visites a la clinique (9,2 c. 3,8, p < 0,001), du nombre des readmissions (12 c. 1, p < 0,001) et du cout global moyen (38 107 $ CA c. 6764 $ CA, t = 8,3, p < 0,001). Conclusion : Le traitement de l'IAP represente un enorme fardeau economique. Selon nos donnees, les depenses hospitalieres associees a sa prise en charge sont 5 fois plus grandes que pour la PTH primaire non compliquee., Deep infection is a devastating complication in total hip arthroplasty (THA) resulting in significant patient and institutional burden. Current literature suggests that the incidence of periprosthetic joint infection (PJI) is [...]

Background: Corrosion at the head-neck junction of femoral stems is a rare complication of total hip arthroplasty (THA) with manifestations ranging from subclinical wear to failure. Prior studies have identified a single femoral component design with an increased propensity for catastrophic trunnion failure. The purpose of the present study was to quantify trunnion damage of this femoral component retrieved from patients undergoing revision THA for non-trunnionosis indications. Methods: 24 femoral components from a single manufacturer were identified for study inclusion. Each prosthesis underwent stereomicroscopic inspection. Corrosion and fretting scores were assigned per the Goldberg criteria to quadrants of the trunnion. Material loss was calculated based on cone angles across trunnion quadrants. This was carried out using a coordinate measuring machine that digitised each trunnion surface. Stems were compared to a series of femoral stems with the same trunnion design. Results: 20 of the 24 (83%) trunnions demonstrated corrosion, all 24 trunnions demonstrated fretting. Corrosion scores did not statistically differ with respect to trunnion zone (p = 0.53), while fretting scores were higher in the inferior compared to the superior zones (p < 0.001). There was no significant difference in cone angles assessing material loss between stems (p = 0.25). Conclusions: Evidence of trunnion damage was observed in each stem retrieved for non-trunnionosis revision. Fretting occurred more frequently about the inferior quadrants. However, digitised trunnion shapes were similar between compared stems exhibiting no material loss. Therefore, it is possible that previous reports of trunnion failures for this implant are not a systemic issue, and that further investigation is required. [ABSTRACT FROM AUTHOR]

Component-on-component impingement in total hip arthroplasty may lead to post-operative complications including dislocation. Despite numerous clinical studies focusing on reducing this risk, assessment methods remain limited to qualitative radiography, finite element analysis, and cadaver studies. There is a need for more precise measurements of impingement in the research setting. We aimed to validate a novel RSA-based impingement metric to measure component-on-component impingement in vivo. A phantom experiment of a standard metal-on-polyethylene total hip system was performed. RSA examinations were performed as typical for a traditional weight-bearing RSA exam for large joints. The phantom was placed in 10 possible impinged positions and one neutral position. Double exposure radiographs were taken to measure repeatability. The closest distance between the skirt of the head and the inner circumference of the acetabular cup liner was measured to assess impingement risk. Distances between the closest point of the hood to the edge of the cup in 10 impinged positions ranged from 0.05 to 1.03 mm, with the average being 0.67 mm. In the neutral position, the distance measured is 11.02 mm. Excellent repeatability was observed, with a standard deviation of 0.03 mm with an r value of 0.09. A validated RSA-based risk metric was established to evaluate in vivo hip impingement. A 1 mm threshold may be proposed to define impingement where distances approaching 1.00 mm are at a greater risk of impingement. This simplified metric holds promise for upcoming clinical studies on component-on-component impingement. [ABSTRACT FROM AUTHOR]

Background: With the growing number of total hip arthroplasty (THA) procedures performed, revision surgery is also proportionately increasing, resulting in greater health care expenditures. The purpose of this study was to assess clinical outcomes and cost when using a collared, fully hydroxyapatite-coated primary femoral stem for revision THA compared to commonly used revision femoral stems. Methods: We retrospectively identified patients who underwent revision THA with a primary stem between 2011 and 2016 and matched them on demographic variables and reason for revision to a similar cohort who underwent revision THA. We extracted operative data and information on in-hospital resource use from the patients' charts to calculate average cost per procedure. Patient-reported outcomes were recorded preoperatively and 1 year postoperatively. Results: We included 20 patients in our analysis, of whom 10 received a primary stem and 10, a typical revision stem. There were no significant between-group differences in mean Western Ontario and McMaster Universities Osteoarthritis Index score, Harris Hip Score, 12-Item Short Form Health Survey (SF-12) Mental Composite Scale score or Physical Composite Scale score at 1 year. Operative time was significantly shorter and total cost was significantly lower (mean difference -3707.64, 95% confidence interval -5532.85 to -1882.43) with a primary stem than with other revision femoral stems. Conclusion: We found similar clinical outcomes and significant institutional cost savings with a primary femoral stem in revision THA. This suggests a role for a primary femoral stem such as a collared, fully hydroxyapatite-coated stem for revision THA. Contexte: Avec le nombre croissant d'interventions pour prothese de hanche (PTH) effectuees, la chirurgie de revision est aussi proportionnellement en hausse, ce qui entraine des couts superieurs pour le systeme de sante. Le but de cette etude etait d'evaluer les resultats cliniques et le cout associes a l'emploi d'une prothese femorale primaire a collerette entierement recouverte d'hydroxyapatite pour la revision de PTH, comparativement a d'autres protheses d'usage courant utilisees pour les revisions. Methodes: Nous avons identifie retrospectivement les patients ayant subi une revision de PTH avec une prothese primaire entre 2011 et 2016 et nous les avons assortis selon les caracteristiques demographiques et le motif de la revision a une cohorte simil aire soumise a une revision de PTH. Nous avons extrait les donnees sur l'operation et sur l'utilisation des ressources hospitalieres a partir des dossiers des patients pour calculer le cout par intervention. Les resultats declares par les patients ont ete notes avant l'intervention et 1 an apres. Resultats: Nous avons inclus 20 patients dans notre analyse, dont 10 ont recu une prothese primaire et 10, une revision de prothese typique. On n'a note aucune difference significative entre les groupes pour ce qui est du score WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) moyen pour l'arthrose, du score de Harris pour la hanche, ou des sous-echelles sante mentale ou sante physique a 1 an du questionnaire SF-12 (12-Item Short Form Health Survey). L'intervention a dure significativement moins longtemps et le cout a ete significativement moindre (difference moyenne -3707,64, intervalle de confiance de 95% -5532,85 a -1882,43) avec une prothese primaire qu'avec les autres protheses de revision. Conclusion: Nous avons observe des resultats cliniques similaires et des economies significatives pour l'etablissement avec la prothese primaire utilisee pour la revision de PTH. Cela donne a penser que la prothese femorale primaire, par exemple, a collerette et entierement recouverte d'hydroxyapatite, aurait un role a jouer pour la revision de PTH., Although total hip arthroplasty (THA) is considered a widely successful operation, the increasing number of procedures has resulted in a growing number of revision operations. (1)' (2) The most common [...]

Total knee arthroplasty (TKA) is one of the most successful procedures in orthopedic surgery. Nevertheless, postoperative patellofemoral complications remain a challenging problem, affecting a substantial proportion of patients. Complications involving the patellofemoral joint (PFJ) can occur in both resurfaced and nonresurfaced patellae. Types of PFJ complications include anterior knee pain, maltracking, fracture, avascular necrosis and patellar clunk. The causes of patellofemoral complications can be categorized into patient-, surgeon- and implant-related factors. Patient characteristics such as female sex, young age, depression and increased body mass index have been linked with increased complications. Important technical considerations to avoid complications include achieving appropriate rotational alignment of the femoral and tibial components, maintaining joint line height, medializing the patellar button and avoiding 'overstuffing' the PFJ. Component design features such as conformity, shape and depth of the femoral trochlea have also been shown to be important. Although the cause of patellofemoral complications after TKA may sometimes be unknown, it remains important to minimize errors that can lead to these complications.La prothese totale du genou (PTG) est l'une des interventions qui reussit le mieux en chirurgie orthopedique. Les complications femoro-patellaires postoperatoires n'en restent pas moins un probleme complexe qui affecte une proportion substantielle de patients. Les complications affectant l'articulation femoro-patellaire (AFP) peuvent survenir en presence de rotules resurfacees ou non. Les types de complications de l'AFP incluent, douleur au devant du genou, defaut d'alignement, fracture, necrose avasculaire et accrochage rotulien. Les causes des complications femoro-patellaires peuvent appartenir a diverses categories selon qu'elles sont liees au patient, au chirurgien ou a la prothese elle-meme. Des caracteristiques liees aux patients, comme le fait d'etre de sexe feminin, le jeune age, la depression et un indice de masse corporelle eleve, sont associees a une hausse des complications. Les enjeux techniques importants pour eviter les complications incluent : obtenir un alignement rotationnel approprie des elements femoraux et tibiaux, maintenir la hauteur de la ligne articulaire, medialiser le bouton patellaire et eviter d'encombrer l'AFP. Les caracteristiques de la modelisation des elements, comme la conformite, la forme et la profondeur de la trochlee femorale se sont aussi revelees importantes. Meme si la cause des complications femoro-patellaires post-PTG est parfois inconnue, il est important de prevenir les erreurs susceptibles de mener a de telles complications., Patellofemoral complications historically have contributed up to 50% of revision surgery. (1) With modern design refinements and improved techniques, the burden of revision from patellofemoral complications is less than it [...]

Background: A substantial portion of the cost of total knee arthroplasty (TKA) results from the postoperative inpatient length of stay (LOS). Considering the annual increase in TKAs, reducing LOS represents a potential for cost savings. We sought to compare in-hospital costs and patient-reported outcomes for an early discharge protocol compared with the standard LOS following TKA.Methods: We conducted a retrospective matched cohort study, matching patients on age, sex, body mass index and preoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score. We compared costs associated with time in the operating room, intraoperative pain control and inpatient stay as well as 1-year postoperative patient-reported outcomes between early discharge and standard LOS groups.Results: We included 50 patients in our study (25 per group). The average LOS in the early discharge group was 26.5 hours, compared with 48.9 hours in the standard care group. The early discharge group had higher intraoperative costs associated with pain control (mean difference 26.98, 95% confidence interval 14.41-37.90, p < 0.01); however, this difference was offset by substantial savings associated with the reduced LOS. The mean total cost for the early discharge group was $649.62 [+ or -] $281.71 versus $1279.71 [+ or -] $515.98 for the standard care group. There were no significant differences in SF12 or WOMAC scores between groups at 1 year postoperative.Conclusion: In-hospital costs were significantly lower with a postoperative day 1 discharge protocol than with standard LOS following TKA, with no difference in patient-reported outcomes.Contexte: Une portion substantielle du cout de l'arthroplastie pour prothese totale du genou (PTG) est liee a la duree du sejour postoperatoire. Compte tenu de l'augmentation annuelle des cas de PTG, abreger les sejours represente une source potentielle d'economies. Nous avons compare les couts hospitaliers et les resultats signales par les patients avec un protocole de conge rapide et avec le sejour de duree standard apres la PTG.Methodes: Nous avons procede a une etude de cohorte retrospective appariee, ou les patients etaient assortis selon le l'age, le sexe, l'indice de masse corporelle et le score WOMAC (Western Ontario & McMaster Universities Osteoarthritis) preoperatoire. Nous avons compare les couts associes au temps passe au bloc operatoire, au controle de la douleur peroperatoire et au sejour hospitalier, de meme que les resultats signales par les patients 1 an apres l'intervention entre les 2 groupes (conge rapide c. duree de sejour standard).Resultats: Nous avons inclus 50 patients dans notre etude (25 par groupe). Le sejour moyen du groupe soumis au conge rapide a ete de 26,5 heures, contre 48,9 heures pour le sejour standard. Le groupe soumis au conge rapide a presente des couts peroperatoires plus eleves associes au controle de la douleur (difference moyenne 26,98, intervalle de confiance de 95% 14,41-37,90, p < 0,01); par contre, cette difference a ete compensee par d'importantes economies associees a des sejours plus courts. Le cout total moyen pour le groupe soumis au conge rapide a ete de 649,62 $ [+ or -] 281,71 $ contre 1279,71 $ [+ or -] 515,98 $ pour le sejour standard. On n'a note aucune difference significative pour ce qui est des scores SF12 ou WOMAC entre les groupes 1 an apres l'intervention.Conclusion: Les couts perhospitaliers ont ete significativement moindres avec le protocole de conge postoperatoire rapide (apres 1 jour), comparativement au sejour standard apres la PTG, sans difference en ce qui concerne les resultats signales par les patients., Total knee arthroplasty (TKA) is an established, effective intervention for advanced osteoarthritis (OA) of the knee. The prevalence of knee OA is rapidly increasing, resulting in a rising demand for [...]