Safe zone of an ischial screw in the sagittal plane was 17deg anterior to 13deg posterior to the ref line from the ASIS through the center of the acetabulum.
Hemiarthroplasty may improve outcomes for patients with unstable intertrochanteric fractures. It remains a good option in the hands of experienced surgeons.
Conflict between the altered biomechanics of the stiff spine and a reconstructed hip occurs in a small percentage of patients and can result in instabilities, dislocations, and revisions.
Read the editorial for free here:
Removal of hardware performed concurrently or within 3mo of
#TKA
is associated with increased odds of
#PJI
at 1yr postop. Do you remove HW concurrent or stage removal?
#VA
by
@DrJRLex
The Dorr classification of femoral canal width: Often discussed and referenced, rarely calculated (math is hard). Measuring the isthmus of the femur alone may alert surgeons of potential issues when using a broach only THA system.
@AAHKS
The mortality rate for patients who undergo a septic revision for a
#TKA
is over 20% at 5 years. Very sobering data from
@UniofNottingham
hospitals
@jaimelbellamyDO
with the VA
Rivaroxaban chemoprophylaxis following TKA and THA was associated with an increased risk of bleeding and prothrombotic complications compared to aspirin and enoxaparin. What do you use?
We are trying to get to 5000 followers by the end of the year. We have two weeks left. Like, repost and follow if you would like to help us achieve our goal!
“Ream-first” & “reduce-first” for treatment of Vancouver type B2 PPFx show similar stability and stem fixation. It is up to the surgeon to decide while considering other patient-specific factors.
Read more for free here:
For high-risk candidates, articulating spacers can preserve knee function, reduce morbidity from second-stage surgery, and lower the costs with similar rates of infection clearance as 2-stage exchange.
No THA approach is superior to another, but certain patient cohorts may benefit more from specific approaches. Women with a BMI ≤ 25 should consider an anterior approach, BMI ≥ 42 a lateral approach, BMI ≥ 46 a posterior approach.
Automated impaction in
#THA
is a safe technique for femoral preparation, which resulted in improved stem coronal alignment, optimized canal fill within the proximal femur, and reduced operative times.
Read more for free here:
This study forms the basis for identifying critical evidence supported by clinical practice for wound management to help reduce variability, advance standardization, and ultimately improve outcomes during TKA.
It seems pretty clear at this point that cementing hip stems for
#THAs
or hemiarthroplasties after femoral neck fractures decreases the risk of periprosthetic fracture
@heckmannortho
@UCLAortho
@AAHKS
In this large-series of patients >65 years of age undergoing primary THA, collared-cementless stems had a nearly 3-fold decrease in risk for early PPF compared to non-collared cementless stems.
End-stage hip osteoarthritis was not associated with an increased prevalence of adverse spinopelvic characteristics compared to matched, asymptomatic volunteers. Age and LLstanding are the strongest predictors of lumbar spine flexion.
More data from
@ParviziJavad
and his group supporting the use of low dose aspirin for VTE prophylaxis for 4 weeks postoperatively. Visual abstract by
@jointdocShields
Mixed-component DM articulations show similar results compared to matching components. When encountering a well-fixed femoral stem or acetabular shell, the use of a mixed component DM articulations may reduce the morbidity for the patient.
Patients with medial compartment OA and underwent
#UKA
had significantly lower joint awareness, decreased pain, improved function, and higher satisfaction than matched TKA patients at minimum 5yr follow-up while maintaining excellent survivorship.
Understanding conflicts is an important part of understanding literature. Interesting study from
@RothmanOrtho
looking at this with robotic TKAs.
@AAHKS
VA by
@DrPeterGold
Compared to primary THAs performed with the PA, DAA cases had a lower risk of dislocation, higher survivorship with dislocation as an endpoint, and a lower risk of revision for instability in this single institution cohort.
@AAHKS_YAG
Good things come to those who wait! If staging
#TKAs
is considered, a delayed interval of at least 6 weeks between may significantly reduce revision and major complications.
Free access here:
Selective DM utilization did not reduce 90d readmissions or reoperations following
#THA
. Other dislocation-mitigation strategies may have masked any benefits of selective DM use.
Read more for free here:
Patients above the age of 90 undergoing fixation of hip fractures have increased serious adverse events. However, waiting 2+ days to perform the surgery appears to decrease those risks
@DrChadKrueger
@HSSProfEd
@JofOrthoTrauma
membership- your thoughts??
More technology to use during
#TKAs
, more precision in the operating room, but still no improvement in short-term patient outcomes.
@AAHKS
@DrChadKrueger
with the VA
Large cementless hip stems have a higher revision rate due to periprosthetic fracture than small-medium stems. Using a collared stem reduces the rate of periprosthetic fracture.
Limb length discrepancy is a relatively common post-op complaint after
#THA
. This article explores how using intra-op radiographs may be able to assist.
@DrChadKrueger
with the visual abstract
The "avoidance of [TKA] surgery should not necessarily be regarded as an indicator of success of nonoperative treatment" for patients with knee arthritis.
@AAHKS
@TheABFM
Visual abstract by
@DrChadKrueger
"For patients without symptoms attributable to the TJA prosthesis, conducting virtual care visits without routine radiographs may be considered"
If you don't have a reason to X-ray, don't get an x-ray.
@uihealthcare
@uiowa
@AAHKS
@jointdocShields
Cementless femur in
#THA
continues to predominate in the US, with cementless having an increased risk of
#PPFx
in patients aged 65yr or more. Surgeons should consider greater use of cemented femoral fixation in this population.
Read more for free here:
Radiographic findings of anterior HO bone formation and cysts that develop after
#TKA
may lead to easier identification of aseptic loosening.
#VA
by
@Ortho_Deck
Un ciclo corto de antibiótico oral después de reimplante disminuye la tasa de reinfección al año en
#PJI
. ¿Usa antibiótico? Si es así ¿Por cuánto tiempo después del reimplante?
*Translation by
@hugortopedista
Instability is no longer the leading etiology of failure following
#THA
with a decline of approximately 40% over the past decade. PJI, ppfx, mechanical loosening, and then instability are now the leading causes of failure.
Read more for free here:
Corticosteroid injections administered up to 3mo prior to THA increased the risk of PJI within 1yr after THA, with an HR of 2.63; however, injections between 3-6mo before surgery did not have a significantly higher infection rate.
Vitamin D levels may be associated with increased implant survival for
#TKA
patients. Seems like an 'easy enough' supplement for most patients to be given?
@DrPeterGold
with the VA
The key message from this registry study seems to be the following: optimize the patient preoperatively. If it takes 12 hours to do so, great. If it takes 72 hours to do so, so be it.
@HSSProfEd
@jaimelbellamyDO
with the visual abstract
Nice summary of various intraoperative and postoperative variables that have been studied in relation to
#PJI
. Check out the article in this month's supplement issue here:
@DrChadKrueger
Surgeons who performed 50 or more THAs per year had significantly fewer intraoperative PFFs than surgeons who did less than 50 THAs per year. Surgeon experience was not significantly related to PFFs.
Robotic Assisted TKA results in greater improvements in postoperative Hospital for Special Surgery score and Western Ontario and McMaster Universities scores compared to conventional TKA.
Excellent visual abstract by
@jaimelbellamyDO
Obese and morbidly obese patients are more likely to require repeat revision surgery. They should be informed of their risk for multiple operations.
Read more for free here:
This tapered, titanium, porous plasma spray-coated femoral component for
#THA
continues to demonstrate high long-term survival with a low rate of femoral component revision for any reason or aseptic loosening/failure of ingrowth.
Read more for free here:
Topical vancomycin powder and dilute povidone-iodine lavage for high-risk TJA patients. More data from
@nyulangone
@MdSchwarzkopf
on these controversial subjects showing the potential benefit of both for
#PJI
reduction.
@AAHKS
VA by
@DrChadKrueger
A constrained acetabular liner (CAL) provides excellent stability in both
#THA
in high-risk individuals and
#rTHA
in active instability. There were no dislocations when using a CAL to treat active instability post-THA.
Read more for free here:
The presence or absence of contact between the medial collar and femoral neck did not affect postoperative BMD changes or radiological or clinical results.