Paul F Lachiewicz

..Clinical studies have demonstrated the efficacy and safety of intravenous acetaminophen in elective total hip and knee arthroplasty, knee arthroscopy, lumbar spine surgery, and for acute traumatic limb pain...

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..Fracture of the tibial post is an uncommon but disabling complication after posterior-stabilized TKA that requires operative treatment...

..Metaphyseal fixation using porous tantalum cones has been proposed for severe bone loss. Whether this approach achieves osseointegration with low complication rates is unclear...

..Second-generation components were designed to reduce the incidence of these problems but it is unclear whether the changes achieved these goals...

..Tantalum acetabular components provide stable fixation in difficult acetabular revisions. Level of Evidence: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence...

..Polyethylene wear and intraprosthetic dislocation are concerns, as is the lack of long-term data. Caution is thus advised in the routine use of dual-mobility components in primary and revision total hip arthroplasty...

..Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence...

..Even with an articulating surface with considerable polyethylene wear debris, these second-generation proximally coated titanium fiber-metal femoral components had a survival rate of 100% at a mean 10.5-year followup...

..LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence...

..A significant association was identified between younger patient age and osteolysis. We continue to routinely implant a similar modular posterior stabilized total knee prosthesis...

..0001). The high rate of success and low rate of polyethylene wear and pelvic osteolysis at this length of follow-up may be related to the new design features of this modular acetabular component...

..However, there are little data on the long-term survival and complications associated with use of these components...

..The rate of radiographic failure and revision of this component implanted with conventional polyethylene and cobalt chrome heads is similar to that reported with other "modern" femoral components...

..1 years (range, 2-11 years). However, there have been 7 patients (20%) with recurrent dislocation and all required reoperation. Dislocation was significantly lower when an elevated rim liner was used...

..Metal-on-metal hip resurfacing should only be used by a limited number of hip surgeons. The risks and complications of metal-on-metal hip resurfacing outweigh any possible advantages...

..4%). Constrained condylar knees are used infrequently now but are successful for the treatment of the unstable primary knee that cannot be balanced. These results may be design specific...

..These forces may eventually contribute to failure of the component due to loosening, dissociation, breakage, or recurrent dislocation. Studies of these components show a failure rate of 4% to 29% at relatively short-term follow-up...

..The rate of dislocation was significantly higher in the patients treated with isolated acetabular revision, and routine postoperative bracing is now recommended for that group...

..The authors report a case of a highly cross-linked all-polyethylene patellar component that failed as a result of fracture in vivo in a patient 3 years after TKA...

..However, until additional clinical results are available, a cautious approach is warranted to the widespread use of highly cross-linked polyethylene in total knee arthroplasty...

..The constrained condylar TKA remains indicated for knees with severe valgus deformity, incompetent medial collateral ligament, or severe flexion contracture in which the knee cannot be properly balanced...

..The purpose of this randomized clinical trial was to compare the survival of two femoral components with similar geometry but substantially different surface finishes...

..5%) knees, respectively. The accuracy of component sizing in this study is greater than previously reported. The prevalence of alignment outliers in this study is less than previously reported for conventional techniques...

..We identified no complications related to the larger femoral heads. The use of larger femoral heads did not notably reduce the prevalence of early dislocation after primary THA in high risk patients compared to historical controls...

..At the time of reoperation, the components appeared well fixed and a linerhead exchange was performed. One year after surgery, the mass had not recurred and the patient had minimal symptoms...

..There has been a change in the indications for revision hip arthroplasty compared with 10 years ago, with a statistically significant increase in revisions for dislocation, wear-osteolysis, and loosening of the femoral component only...

..Antibiotic cement may be used in patients at higher risk for infection. The 10-year results of cemented femoral components in these patient populations are excellent...

..Attention to detail during surgery is likely the most critical factor to the success of patellar resurfacing in total knee arthroplasty...

..The lateral retinaculum was left open to provide for better motion. At 1 year postoperatively, she ambulated with a cane, with range of motion examination revealing 5 degrees flexion contracture and 80 degrees flexion...

..We found a low incidence of lateral retinacular release and patella complications using these components and this protocol for the patellofemoral articulation...

..The relative indications for revision total knee arthroplasty have changed over the past decade. Greater emphasis may be needed on improved balancing techniques to prevent instability and new bearing surfaces to decrease wear...

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..3%), and minor femoral osteolysis was seen in 3 hips (4%). Used in this manner in this patient population, precoating is not detrimental to successful fixation at 10 years' mean follow-up of primary hybrid THA...

..Surgical treatment, consisting of release or resection of the iliopsoas tendon, alone or in combination with acetabular revision for an anterior overhanging component, usually provides permanent pain relief...

..Well-fixed metal-metal hip resurfacing components are removed for infection, instability, or hypersensitivity reactions. This article presents a technique for removal of a porous resurfacing acetabular component with minimal bone loss...

..The result was good at 5 years, with healed fracture and no loosening or osteolysis of either component...

..The data confirm the efficacy of a multimodal protocol with thigh-calf mechanical prophylaxis for almost all patients undergoing primary or revision total hip arthroplasty...

..These guidelines are reviewed here...

..Abductor tendon repair has had inconsistent results in persons with avulsion following THA. Reconstruction with a gluteus maximus muscle flap or Achilles tendon allograft has provided promising short-term results in small series...