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The mode of femoral fixation for primary total hip arthroplasty (THA) is undetermined, with reported outcomes favoring different fixation methods. This study aimed to compare postoperative complications between cemented and cementless fixation at 90 days, 1 year, and 2 years in patients aged 65 years of age and older undergoing THA for osteoarthritis. Using an all-payer, national database, patients 65 years and older undergoing primary THA, either with cementless (n = 56,701) or cemented (n = 6,283) femoral fixation for osteoarthritis were identified. A 1:1 propensity-matched analysis for age, sex, comorbidity index, alcohol abuse, tobacco use, obesity, and diabetes was performed, resulting in n = 6,283 patients in each cohort. Postoperative outcomes, including postoperative periprosthetic joint infection, aseptic revision, surgical site infection, pulmonary embolism, venous thromboembolism, wound complications, dislocation, periprosthetic fracture, and aseptic loosening were assessed. The cemented cohort had higher rates of infection (4.5 versus 0.8%, odds ratio [OR] 5.9, 95% confidence interval [CI] 4.33 to 7.93, P <.001), aseptic revision (2.9 versus 2.0%, OR 1.47, 95% CI 1.17 to 1.85, P =.001), venous thromboembolism (1.8 versus 1.3%, OR 1.40, 95% CI 1.05 to 1.87, P <.001), and aseptic loosening (1.5 versus 0.7%, OR 2.31, 95% CI 1.60 to 3.32, P <.001) at 90-days. At 1 and 2 years, the cemented cohort had higher rates of infection, aseptic revision, and aseptic loosening (all P <.001). Rates of periprosthetic fracture were similar at all time points (all P <.001). Cemented fixation had higher rates of infection, aseptic loosening, and aseptic revision. This finding supports the current use of cementless fixation, but the ultimate decision regarding fixation type should be based on the proper optimization of the patient's comorbidities and bone quality. [ABSTRACT FROM AUTHOR]

Hip periprosthetic fractures (PPFs) after primary total hip arthroplasty are increasing with the number of primary implants and aging population. Mortality has been reported up to 34% at 1-year. The aim of this study was to evaluate the association of Clinical Frailty Scale (CFS) and 1-year mortality, complication rate, and length of stay (LOS) in surgically managed hip PPFs. This was a retrospective study of prospectively collected data from January 2008 to January 2021. A total of 282 surgically managed hip PPFs were identified. Mean age was 79 years (range, 42 to 106). Preoperative scores were analyzed through linear regression to identify significant association with mortality, complication and LOS. Receiver operating characteristic curve and Area Under the Curve (AUC) were generated to evaluate the quality of the models and the discriminatory ability of each clinical score. Significance was considered at P values <.05. Mortality was 7.8% at 3-months and 15.7% at 1-year. Complication rate requiring surgery was 19.5% and mean LOS was 8.9 ± 7 days. The CFS was significantly associated with 3-month (odds ratio 2.23, P <.001) and 1-year mortality (odds ratio 2.01, P <.001). The receiver operating characteristic curve test for 1-year mortality showed a greater AUC for the CFS when compared with American Society for Anesthesiologists score and age-adjusted Charlson Comorbidity Index (AUC 0.80 versus 0.68 versus 0.72, respectively). Frailty is a syndrome with increased risk of mortality after surgically managed PPF. The CFS can be easily assessed at the time of admission and could be considered as a strong and reliable predictor of 1-year mortality with a greater AUC than the conventionally used American Society for Anesthesiologists score. [ABSTRACT FROM AUTHOR]

Bacground: The use of cemented fixation is widely recommended in hip arthroplasty for hip fractures, although it is not used universally. Methods: We describe the trends in cementing prevalence in hemiarthroplasty for hip fractures in Canada for patients ≥55 years old between April 2017 and March 2022. Results: The national prevalence of cemented fixation increased from 43% in 2017/18 to 58% in 2021/22, but there was a large variety of both the baseline prevalence and the trends across the country and between individual hospitals. The proportion of surgeons only performing cementless fixation fell from 30% to 21% between 2018/19 and 2021/22. Conclusions: As cemented fixation is now universally recommended, more coordination is needed to track these trends and to help drive implementation of this evidence-based practice across Canada.

Background: Open and fluoroscopic techniques have been described for localization of the femoral attachment site in medial patellofemoral ligament (MPFL) reconstruction. No study to date has evaluated if one technique is superior to another in terms of complications. Purpose: To review the literature comparing clinical outcomes of MPFL reconstruction using the fluoroscopic versus open technique to localize the site of femoral graft placement. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed via PubMed, Embase, and CINAHL to identify articles published between the inception of these databases and March 1, 2022, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This search yielded 4183 publications for initial review. Studies with at least a 2-year follow-up and complete reporting of patient-reported outcomes, range of motion, recurrent instability, and/or complications (ie, stiffness, infection, persistent pain) were included. We excluded studies of patients with collagen disorders; revision surgeries; surgeries with concomitant procedures; synthetic MPFL reconstruction; MPFL repairs; combined open and radiographic technique; and case series that included <10 patients. A proportional meta-analysis was performed by calculating the pooled estimate of incidence with 95% CIs using a fixed-effects model with double arcsine transformation (Freeman-Tukey) for each type of surgical technique (fluoroscopic or open). Results: A total of 29 studies met our inclusion criteria, of which 15 studies (566 patients) used the open technique and 14 studies (620 patients) used fluoroscopy. There were no significant differences between the open and fluoroscopic techniques in the incidence of postoperative apprehension (P =.4826), postoperative subjective instability (P =.1095), postoperative objective instability (P =.5583), reoperations (P =.7981), recurrent dislocation (P =.6690), or arthrofibrosis (P =.8118). Conclusion: Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to systematically review and compare 2 femoral autograft fixation techniques, namely, interference screws and suture anchors, for isolated medial patellofemoral ligament reconstruction in patients with recurrent patellofemoral instability at mid- to long-term follow-up. Methods: A literature search was performed in September 2020. All studies reporting the outcomes of primary isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability were considered for inclusion. Only studies reporting the type of femoral autograft fixation under examination were considered. Studies reporting data from patients with elevated tibial tuberosity-tibial groove, patella alta, and/or Dejour's trochlear dysplasia types C and D, were not included. Only articles reporting data with a minimum follow-up period of 18 months were considered. Results: Data from 19 studies (615 patients) were retrieved. The overall age was 24.4 ± 6.7 years (mean ± SD). The mean follow-up was 46.5 ± 20.9 months. There were 76 patients in the anchor group and 539 in the screw group. Comparability was found with regard to age and follow-up duration between the 2 study groups. There was comparability between the Kujala, Lysholm, and Tegner scores at baseline. At the last follow-up, no worthy differences were found in terms of mean Kujala (+2.1%; p = 0.04), Lysholm (+1.7%; p = 0.05), and Tegner (+15.8%; p = 0.05) scores. Although complications occurred almost exclusively in the screw cohort, no statistically significant difference was found. Conclusion: Femoral autograft fixation through interference screws or suture anchors report similar clinical scores and rate of apprehension test, persistent joint instability, re-dislocations, and revisions. These results must be interpreted within the limitations of the present study.

Abstract Purpose Reconstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw. Methods This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using a semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device. Results The average follow-up duration was 2 years (range 1–4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received a 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0–5). The median Tegner score was 6 (range 4–10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91 points (range 77–100). The mean Lysholm score was 86 points (74–96). All mentioned scores were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients. Conclusion ACLR with the aforementioned procedure leads to good clinical and radiological outcome.

• Recurrent instability of the patellofemoral joint has higher prevalence in active and young populations. After the first patellar dislocation, up to 96% of patients present damage to the medial patellofemoral ligament and reconstruction may be necessary. • Femoral graft fixation through interference screw produced similar clinical scores and complications compared to the anchors for primary isolated medial patellofemoral reconstruction in patients with recurrent patellofemoral instability at mid- to long-term follow-up. • This study has several limitations, but they are mainly due to the lack of studies in the literature. Thus, data from the present study must be interpreted with caution. The present study aimed to systematically review and compare 2 femoral autograft fixation techniques, namely, interference screws and suture anchors, for isolated medial patellofemoral ligament reconstruction in patients with recurrent patellofemoral instability at mid- to long-term follow-up. A literature search was performed in September 2020. All studies reporting the outcomes of primary isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability were considered for inclusion. Only studies reporting the type of femoral autograft fixation under examination were considered. Studies reporting data from patients with elevated tibial tuberosity-tibial groove, patella alta, and/or Dejour's trochlear dysplasia types C and D, were not included. Only articles reporting data with a minimum follow-up period of 18 months were considered. Data from 19 studies (615 patients) were retrieved. The overall age was 24.4 ± 6.7 years (mean ± SD). The mean follow-up was 46.5 ± 20.9 months. There were 76 patients in the anchor group and 539 in the screw group. Comparability was found with regard to age and follow-up duration between the 2 study groups. There was comparability between the Kujala, Lysholm, and Tegner scores at baseline. At the last follow-up, no worthy differences were found in terms of mean Kujala (+2.1%; p = 0.04), Lysholm (+1.7%; p = 0.05), and Tegner (+15.8%; p = 0.05) scores. Although complications occurred almost exclusively in the screw cohort, no statistically significant difference was found. Femoral autograft fixation through interference screws or suture anchors report similar clinical scores and rate of apprehension test, persistent joint instability, re-dislocations, and revisions. These results must be interpreted within the limitations of the present study. [Display omitted] [ABSTRACT FROM AUTHOR]

Background Anterior cruciate ligament reconstruction (ACLR) is a crucial procedure in orthopedic surgery. This study evaluates the efficacy and safety of ACLR employing suspensory tibial fixation with a polyether ether ketone (PEEK) button. Methodology This retrospective observational study conducted at Sai Shree Hospital, Pune, India, between November 2023 and December 2023 enrolled 47 subjects aged 18-60 years who underwent arthroscopic ACLR utilizing the T-Button-A Adjustable Loop Ultra-High-Molecular-Weight Polyethylene Suture PEEK button. The functional outcomes and patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System Questionnaire (MCRS), the Single Assessment Numeric Evaluation (SANE) score, the Tegner Activity Level (TAL) Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale. Results Femoral fixation utilized 27 (57.4%) Proloop Ultra Adjustable Loop Button 60 mm, 19 (40.4%) Infiloop Fixed Loop Button 20 mm, and 1 (2.1%) Infiloop Fixed Loop Button 30 mm. Tibial fixation solely relied on T-Button A (PEEK Tibial Button With Adjustable Loop 90 mm). Postoperative evaluations revealed favorable IKDC (79.49 ± 12.67), MCRS (81.32 ± 11.57), SANE (77.83 ± 11.11), TAL Scale (3.87 ± 0.99) and KOOS quality of life subscale (83.81 ± 13.07) scores. Conclusions The findings affirm the efficacy and safety of arthroscopic ACLR utilizing suspensory tibial fixation with the PEEK button, supporting its use for improved patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Royal Pune Independent Ethics Committee issued approval RPIEC141023; dated: 14/10/2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Neeraj Adkar, Satwik Thareja, Ravi A Kerhalkar, and Prajwal Sadalagi declare(s) a grant from Healthium Medtech Limited. The study received funding from Healthium Medtech Limited, Bangalore, India. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Adkar et al.)

Bacground: The use of cemented fixation is widely recommended in hip arthroplasty for hip fractures, although it is not used universally., Methods: We describe the trends in cementing prevalence in hemiarthroplasty for hip fractures in Canada for patients ≥55 years old between April 2017 and March 2022., Results: The national prevalence of cemented fixation increased from 43% in 2017/18 to 58% in 2021/22, but there was a large variety of both the baseline prevalence and the trends across the country and between individual hospitals. The proportion of surgeons only performing cementless fixation fell from 30% to 21% between 2018/19 and 2021/22., Conclusions: As cemented fixation is now universally recommended, more coordination is needed to track these trends and to help drive implementation of this evidence-based practice across Canada., (© 2024 Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons.)

Background: There is a paucity of data on the outcomes of distal femoral replacements (DFRs) in patients with total knee arthroplasty (TKA) periprosthetic fractures. We sought to characterize these patients' survivorship free from rerevision.Methods: We retrospectively identified 49 patients, including 34 after primary TKA (primary cohort), 9 after revision TKA, and 6 conversions for failed open reduction and internal fixation (revision cohort) that underwent DFR for a periprosthetic femur fracture. The mean age was 76 years, and 40 patients (82%) were female. The mean follow-up was 4 years. Femoral fixation included 44 cemented stems (90%) and 5 cementless stems (10%). Survivorship free from rerevision was characterized by the Kaplan-Meier method; cox proportional regression was used to analyze the risk factors for rerevision.Results: Survivorship free from any rerevision at 5 years in the primary and revision cohort was 93% and 18%, respectively. The revision cohort had a 5.3× higher risk of re-revision (P = .008). Survivorship free from re-revision for aseptic loosening at 5 years in the primary and revision cohort was 93% and 53%, respectively. Two of the 3 patients with cementless stems in the primary cohort underwent early rerevision for aseptic loosening, but patients with prior primary TKAs treated with cemented femoral fixation (n = 31) had a 97% 5-year survivorship free from re-revision.Conclusion: Patients with periprosthetic fractures around prior primary TKAs treated with DFRs with cemented femoral fixation had a 97% 5-year survivorship free from any re-revision. DFRs for periprosthetic femur fractures around revision TKAs or conversions of failed open reduction and internal fixations have a 5× increased risk of rerevision. [ABSTRACT FROM AUTHOR]

Purpose: Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS). Methods: A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects. Results: Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes. Conclusion: There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies. Level of evidence: 1. [ABSTRACT FROM AUTHOR]

Background: Despite advancements in surgical techniques for anterior cruciate ligament (ACL) treatment, persistent functional impairment, reduced quality of life, and limited physical activity participation continue to be common after postoperative rehabilitation. We modify the traditional ACL reconstruction method by using hamstring tendons grafts and re-tensioning them. Indications: This procedure is indicated for patients undergoing ACL reconstruction surgery with soft tissue grafts, utilizing femoral fixation with an adjustable button and tibial fixation with an interference screw. Technique Description: We employ hamstring grafts for ACL reconstruction and perform femoral fixation using an adjustable button. Initially, we pull the graft approximately 10 mm less than the length of the thickest tunnel drill. This allows for subsequent graft traction after tibial fixation. Following tibial fixation, we pull the graft proximally, inserting it a few millimeters further into the femoral tunnel. This re-tensioning increases tension and enhances physical examination results. In addition, we incorporate the braid graft technique to augment the graft's final thickness. Results: This technique yields reduced postoperative residual laxity during physical examinations. Our institution's ethics committee is currently reviewing a clinical study comparing functional outcomes with traditional techniques. Discussion/Conclusion: The ACL re-tensioning technique is easily implemented and involves a subtle modification to the traditional approach, allowing for graft re-tensioning and diminishing the risk of residual laxity post-interference screw fixation. This approach acknowledges that insertion of the interference screw can inadvertently reduce graft tension, counteracting the tension applied during fixation. Consequently, this technique is expected to yield superior clinical outcomes. Graphical Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Purpose: Reconstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw.Methods: This consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using a semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device.Results: The average follow-up duration was 2 years (range 1-4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received a 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0-5). The median Tegner score was 6 (range 4-10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91 points (range 77-100). The mean Lysholm score was 86 points (74-96). All mentioned scores were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients.Conclusion: ACLR with the aforementioned procedure leads to good clinical and radiological outcome. [ABSTRACT FROM AUTHOR]

Consensus regarding femoral stem fixation options in revision total knee arthroplasty remains controversial. Tapered, modular, fluted titanium (TMFT) stems have an excellent track record in total hip arthroplasty for their ability to provide axial and rotational stability in situations of compromised host bone. We present 3 successfully treated cases in which the Food & Drug Administration granted permission to use custom TMFT stems in situations of failed femoral fixation in multiple revised knees. These stems hold promise to achieve stable fixation in revision total knee arthroplasty where host metadiaphyseal bone is deficient. Implant manufactures should consider dedicating future resources to create adapters that can link existing successful TMFT stems currently used in hip arthroplasty to revision total knee components when host bone is severely compromised.

The aim is to present a technique for pediatric and adult ACL reconstruction using an intraosseous suspensory fixation. This technique uses a 4-strands hamstring graft fixed in the femoral tunnel, with a loop locked in a polyetheretherketone (PEEK) cage. The ACLip® device offers an inside-out drilling system and a closer fixation to the joint than an extracortical button fixation. The technique can be easily used both in adults and in skeletally immature patients. The first practical experience shows promising results regarding the safety and the effectiveness of the technique. Level of evidence: IV., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Purpose: Newer fixation devices for hamstring (HS) autograft have been introduced over the years, yet the impact of these devices on ACLR outcomes requiring surgical intervention remains unclear. We sought to evaluate the risk of aseptic revision and reoperation after HS autograft ACLR according to various femoral-tibial fixation methods.Methods: A cohort study was conducted using the Kaiser Permanente ACLR Registry. Primary isolated unilateral ACLR patients who received a HS autograft were identified (2007-2014). Fixation devices were categorized as crosspin, interference, suspensory, or combination (defined as more than one fixation device used on the same side) and femoral-tibial fixation groups used in more than 500 ACLR were evaluated. Cox proportional-hazard regression was used to evaluate the association between femoral-tibial fixation method and outcomes while adjusting for confounders.Results: 6,593 primary ACLR were included. Four femoral-tibial fixation groups had more than 500 ACLR: suspensory-interference (n = 3004, 45.6%), interference-interference (n = 1659, 25.2%), suspensory-combination (n = 1103, 16.7%), and crosspin-interference (n = 827, 12.5%). After adjusting for covariates, revision risk was lower for crosspin-interference (HR = 0.43, 95% CI 0.29-0.65) and interference-interference (HR = 0.63, 95% CI 0.41-0.95) methods compared to the suspensory-interference. In contrast, reoperation risk was higher for crosspin-interference (HR = 2.13, 95% CI 1.37-3.32) and suspensory-combination (HR = 1.68, 95% CI 1.04-2.69) methods compared to suspensory-interference.Conclusions: ACLR using HS autograft appears to have the lowest risk of aseptic revision when crosspin or interference fixation is used on the femoral side and is coupled with an interference screw on the tibial side.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Background: The optimal femoral fixation method remains unclear. To evaluate the role of femoral fixation techniques in hip resurfacing, we present a comparison of 2 consecutive groups: group 1 (739 hips) with cemented femoral components; group 2 (3274 hips) with uncemented femoral components.Methods: We retrospectively analyzed our clinical database to compare failures, reoperations, complications, clinical results, and radiographic measurements. Groups were consecutive, so cemented cases had longer follow-up. However, all patients from both groups were at least 2 years out from surgery. Two-year clinical and radiographic data were compared. Longer-term comparison data as well as Kaplan-Meier implant survivorship curves specifically focusing on femoral failure modes were analyzed.Results: Kaplan-Meier 10-year implant survivorship using nontraumatic femoral failure as an end point was 98.9% for the cemented and 100% for the uncemented femoral component. The uncemented, group 2 cases showed a significantly lower raw failure rate (1.1% vs 4.6%), 2-year failure rate (0.8% vs 2.8%), 2-year femoral failure rate (0.4% vs 0.9%), and a lower combined rate of femoral complications and failures (0.6% vs 1.8%). In cases that did not fail, patient mean clinical scores, pain scores, and combined range of motion were all significantly better for group 2.Conclusion: We have demonstrated that in the fully porous-coated ReCap device, uncemented femoral fixation is superior to cemented fixation at 11 years follow-up (0.0% vs 1.1% late femoral loosening) in this single-surgeon cohort. Early femoral fractures also reduced from 0.8% to 0.3%, but this may be partially or completely due to a new bone density management program. This study demonstrates better femoral implant survivorship for the uncemented device compared to the cemented femoral resurfacing component for this implant design. [ABSTRACT FROM AUTHOR]

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The use of cemented femoral stem fixation has declined in North America despite numerous favorable long-term outcomes reported. Cemented stems offer some advantages over cementless fixation and should therefore remain part of every orthopaedic surgeon’s armamentarium. Long-term survival, versatility, low periprosthetic fracture risk, decreased risk of infection, and the cement within cement revision technique are all advantages of cemented fixation. Surgeons should be knowledgeable of different cemented stem designs including both the composite-beam and taper-slip philosophies, and must avoid mixing their principles in order to achieve durable clinical success. [ABSTRACT FROM AUTHOR]

Purpose: This cadaveric study compares the biomechanical properties of femoral graft fixation in ACL reconstruction of either quadriceps or hamstring tendon grafts with four different interference screws. The hypothesis was that quadriceps tendon grafts provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared to hamstring tendon grafts with four different interference screws.Methods: Eighty porcine femora underwent interference screw fixation of human tendon grafts for ACL reconstruction. Either quadriceps (Q) or hamstring (H) tendon grafts and four different bioabsorbable interference (Wolf (W), Storz (S), Mitek (M), Arthrex (A)) screws were used, resulting in 8 groups with 10 specimens per groups (WQ, WH, SQ, SH, MQ, MH, AQ, AH). Biomechanical analysis included pretensioning the constructs with 60 N for 30 s, then cyclic loading of 500 cycles between 60 and 250 N at 1 Hz in a servohydraulic testing machine, with measurement of elongation and stiffness including video measurements. After this, ultimate failure load and failure mode analysis were performed.Results: No statistically significant difference could be noted between the groups regarding gap formation during cyclic loading [Cycles 21-500 (mm): WQ 3.6 ± 0.8, WH 3.9 ± 1.4, SQ 3.6 ± 0.8, SH 3.3 ± 1.5, MQ 4.3 ± 0.8, MH 4.6 ± 1.0, AQ 4.8 ± 0.8, AH 4.3 ± 1.5, n.s.], stiffness during cyclic loading [Cycles 21-500 (N/mm): WQ 72.9 ± 16.9, WH 71.6 ± 20.7, SQ 69.5 ± 23.9, SH 77.4 ± 25.1, MQ 59.6 ± 11.2, MH 48.4 ± 15.4, AQ 48.8 ± 12.7, AH 51.9 ± 22.2, n.s.], and ultimate failure load [(N): WQ 474.4 ± 88.0, WH 579.3 ± 124.2, SQ 493.9 ± 105.2, SH 576.0 ± 90.4, MQ 478.6 ± 59.0, MH 543.9 ± 119.7, AQ 480.2 ± 93.8, AH 497.8 ± 74.2, n.s.].Conclusions: Quadriceps tendon grafts yield comparable biomechanical results for femoral interference screw fixation in ACL reconstruction compared to hamstring tendon grafts. From a clinical perspective, quadriceps tendon grafts should therefore be considered as a good option in ACL reconstruction in the future. [ABSTRACT FROM AUTHOR]

We aimed to compare results obtaining from this study related to functional status and activity level of individuals who underwent anterior cruciate ligament (ACL) reconstructive surgery using by two different fixation methods. Material and Method: In this retrospective study, 40 patients undergoing surgery with Ziploop fixation technique (n = 20; mean age = 30.3 yrs.) and Aperfix fixation technique (n = 20, mean age: 32.2 yrs.) were evaluated. All patients were evaluated in the second year of the operation. Muscle strength of the knee muscles, range of motion of knee joint, and thigh circumference were measured. Pain was also assessed using by a visual analogue scale. Lysholm Knee Score form, International Knee Documentation Committee (IKDC) 2000 subjective knee evaluation form, Tegner activity level assessment were used. Results. There were no significant difference between two terms of hamstring and quadriceps muscle strength, range of motion, pain and circumference results, Lysholm knee score form, IKD and Tegner results (p>0.05). Conclusion. The results indicate that there is no superiority between the two methods in terms of recovery and functional level of the knee joint. [ABSTRACT FROM AUTHOR]

Background: Distal fixation achieved with a tapered stem design has demonstrated favorable clinical results in revision total hip arthroplasty in the setting of severe bone defects. However, stem subsidence is common with this stem design.Purpose: The purpose of this study is to compare the initial fixation stability of a tapered stem design to a fully porous-coated cylindrical stem design in a model of severe femoral bone deficiency.Methods: Tapered and cylindrical stems (n = 8) were implanted into a model femur with progressively shorter segments for fixation (9, 6, or 3 cm). The stems were axially loaded, and the force to produce subsidence was recorded.Results: Average loads to produce 150 μm of displacement with a 3-cm segment were higher for the tapered stem (393 N vs 221 N, P < .01). No difference was observed in the 6- or 9-cm models. Average loads to produce failure (>4-mm subsidence) were also higher for tapered stems with a 3-cm segment (1574 N vs 500 N, P < .0001). A regression analysis determined the minimum segment length of 1.5-2.5 cm to obtain stable fixation with a tapered stem design (R(2) = 0.78, P < .001).Conclusions: Tapered stems required higher loads to produce subsidence than cylindrical stems in a revision THA model. Revision tapered stems require a minimum intact segment of 1.5-2.5 cm to obtain adequate initial fixation stability. Revision tapered stems have superior initial fixation stability to cylindrical stems in the setting of severe bone loss. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to analyze and compare the perioperative outcomes of cemented and uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures by utilizing the data from the National Inpatient Sample database., Methods: Data from the National Inpatient Sample Database was analyzed to identify patients who underwent hemiarthroplasty following a displaced femoral neck fracture (cemented and uncemented. Demographic data, comorbidities, length of stay, total charges, and perioperative complications were analyzed., Results: 27390 patients were identified in the cemented group and 29406 in the uncemented group. The patients who underwent uncemented hemiarthroplasty demonstrated a higher incidence of prosthetic dislocation (Odds Ratio (OR) 3.348, p < 0.001), periprosthetic mechanical complications (OR 2.597, p < 0.001), wound dehiscence (OR 2.883, p < 0.001), superficial surgical site infection (OR 2.396, p = 0.043), deep surgical site infection (OR 1.686, p < 0.001), and periprosthetic fractures (OR 2.292, p < 0.001) as compared with patients who underwent cemented hemiarthroplasty. However, patients with uncemented fixation demonstrated a lower incidence of death (OR 0.567, p < 0.001), pulmonary embolism (OR 0.565, p < 0.001), deep vein thrombosis (DVT) (OR 0.746, p < 0.001), myocardial infarction (OR 0.772, p = 0.025) and blood loss anemia (OR 0.869, p < 0.001) as compared with cemented fixation., Conclusion: Our study on displaced femoral neck fractures utilizing the National Inpatient database found that uncemented hemiarthroplasty was associated with a higher incidence of perioperative surgical complications. Cemented hemiarthroplasty, however, was associated with a statistically significant higher rate of death, pulmonary embolism, deep vein thrombosis, and myocardial infarction., Competing Interests: None, (2023 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.)

Background Clinical performance, anterior knee stability, and isokinetic strength after anterior cruciate ligament (ACL) reconstruction with hamstring autografts are mainly influenced by graft selection, femoral tunnel preparation, and type of femoral fixation. Expandable femoral fixation devices are expected to provide a stronger initial fixation with circular graft compression, a blind-ended tunnel in the femur with less enlargement, and a theoretical double-band ACL equivalent through graft rotation. This study aimed to evaluate isokinetic strength and functional capacity after ACL reconstruction with hamstring tendons using two different anatomical femoral fixation techniques (expandable vs fixed-looped button). Methodology A total of 48 male patients with ACL deficient knees were randomized to two different femoral fixation groups, namely, the expandable (AperFix) and the standard cortical (Button) group. The primary outcome measures were isokinetic hamstrings and quadriceps strength capabilities and the hamstrings/quadriceps ratio at 60 degrees/second (°/s) and 180°/s using a Cybex before and at three, six, nine, 12, and 24 months after surgery. Secondary measurements were anteroposterior knee stability at two years (using KT-1000 arthrometer) and the functional outcome using the International Knee Documentation Committee (IKDC 2000) form, the Tegner activity scale, and the Lysholm knee score. Data were compared using a paired t-test and analysis of variance, with a p < 0.05 level of significance. Results Most patients regained the 60°/s quadriceps strength between three and 12 months (62.5% for the Button group vs. 50% for the AperFix group), as well as the 180°/s strength (79.17% vs 70.83%); however, at the 24-month evaluation, seven (29.17%) patients in the Button group and five (20.83%) in the AperFix group had significant deficits. The 60°/s flexor strength was regained in the first six months in 19 (79.17%) patients in the Button group and in 16 (66.7%) patients in the AperFix group, whereas the percentages for the 180°/s strength were 79.17% and 75%, respectively. Beyond the 24-month evaluation, only three (12.5%) patients in the Button group and four (16.67%) in the AperFix group had significant flexor deficits. Regarding the H/Q ratio, at 60°/s, the mean recovery time was six and 7.5 months for the Button and AperFix groups, respectively, whereas 15 and 12 patients, respectively, did not recover during the two-year duration. At 180°/s, a mean recovery time of six months was needed for the button group, and nine patients did not recover two years later. For the AperFix group, nine months were needed, and 12 patients did not recover in two years. Clinical performance and anterior knee stability showed no statistically significant differences between groups. Conclusions Although there were no significant differences in clinical performance, knee stability, and isokinetic strength testing between expandable and cortical button femoral fixation groups, return to play was doubtful at two years postoperatively., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Panagopoulos et al.)

The aim of this study is to compare three modes of femoral fixation, namely Aperfix, Rigidfix and Endobutton, in anterior cruciate ligament (ACL) reconstruction. 120 patients were randomly assigned to three groups, each consisting of 40 patients, and each group was treated by one of the above mentioned methods of femoral fixation. All patients were examined prior to and 24 months after surgery, and they were compared for anterior tibial displacement using the Lysholm score and KT-1000. The three modes of femoral fixation were not significantly different in terms of time of surgery. In the Endobutton group, the Lysholm score rose from 63.21±18.59 prior to ACL reconstruction to 90.64±9.47 after the surgery, while it rose from 65.72±18.74 to 96.22±5.35 in the Aperfix group and from 69.21±17.45 to 90.64±9.47 in the Rigidfix group. Anterior tibial displacement was 3.96±1.58 mm for Endobutton, 4.28±1.48 mm for Rigidfix and 4.03±1.79 mm for Aperfix. Aperfix was indicated to yield a better outcome in terms of instant stability and general results.

This paper reviews instrumented hip joint replacements, instrumented femoral replacements and instrumented femoral fracture stabilizers. Examination of the evolution of such implants was carried out, including the detailed analysis of 16 architectures, designed by 8 research teams and implanted in 32 patients. Their power supply, measurement, communication, processing and actuation systems were reviewed, as were the tests carried out to evaluate their performance and safety. These instrumented implants were only designed to measure biomechanical and thermodynamic quantities in vivo, in order to use such data to conduct research projects and optimize rehabilitation processes. The most promising trend is to minimize aseptic loosening and/or infection following hip or femoral replacements or femoral stabilization procedures by using therapeutic actuators inside instrumented implants to apply controlled stimuli in the bone-implant interface. [ABSTRACT FROM AUTHOR]

Purpose: Hamstring tendon grafts are commonly used in anterior cruciate ligament (ACL) reconstructions. A number of fixation devices are available; however, several have limited clinical support. To our knowledge, no randomized controlled study comparing the EZLoc and the Bone Mulch Screw for femoral fixation in ACL reconstruction exists. Therefore, the purpose of this study was to compare the results following the use of these two femoral fixation devices. Time in surgery for the two methods was also to be compared. Methods: A total of 110 patients between 18 and 45 years old at two orthopaedic departments, A ( n = 55) and B ( n = 55), were randomized to ACL reconstruction with femoral fixation of the hamstring graft with either the EZLoc or the Bone Mulch Screw. Surgical time was measured for each group. The patients were evaluated after 6 weeks and 3, 6, 12 and 24 months. The clinical examination included range of motion, evaluation of intraarticular swelling, tenderness at the lateral femoral condyle, the Lachman test, the Pivot shift test and the KT-1000 arthrometer. In addition, the visual analogue scale score for pain, the Tegner activity score, the Lysholm functional score and the knee injury and osteoarthritis outcome score were recorded. Knee extension and flexion muscle strength were also measured with a Biodex. Results: There were no significant differences in any of the parameters mentioned above at the 2-year follow-up evaluation. Three patients in each group underwent revision ACL reconstruction during the study. More than 95 % of the knees in both groups were found to be stable. Good to excellent results were found for all selected knee scores in both groups. There were no statistically significant differences between the two groups in any of the muscle strength parameters. Time in surgery was statistically significantly shorter in the EZLoc group compared with the Bone Mulch group. Conclusion: There were no statistically significant differences in clinical findings, knee scores or in muscle strength between the EZLoc group and the Bone Mulch group at the 2-year follow-up evaluation. Time in surgery was statistically significantly shorter for patients undergoing ACL reconstruction with hamstring grafts when the EZLoc femoral fixation device was used. Level of evidence: II. [ABSTRACT FROM AUTHOR]