Javad Parvizi

..The goal of this review is to provide a concise overview of the principles and results of multimodal pain management regimens as a practical guide for the management of joint arthroplasty patients...

..Based on available evidence, it is our opinion that simultaneous bilateral TKA carries a higher risk of morbidity and mortality and should be reserved for select few...

..The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty...

..Given the current knowledge and planned future research, the medical community should be prepared to effectively manage this increasingly prevalent disease...

..Surgical options for FAI include arthroscopy, open surgical dislocation, or mini-direct anterior approaches. Arthroscopic and open treatments of FAI have been commonly performed and have had promising results in athletes. Hypothesis/..

..abstract:..

..abstract:..

....

..Recent years have witnessed extensive research related to the management of this condition. This article reviews the current status with regard to aetiology, diagnosis and treatment of arthritis of the hip in the young adult...

..While informed consent is mandated for almost all clinical trial involving human subjects, there are situations of emergency research and trials with minimal risk that call for a waiver of the consent...

..Exchange of polyethylene lining of a metal backed implant or revision of the all polyethylene acetabular component can successfully address late instability in the majority of patients...

..While amputation may be unpopular with patients it provides a greater ability to reconstruct, with an external prosthesis, a functioning joint...

..This new technology has the potential to eliminate periprosthetic infection, a major and growing problem in orthopedic practice...

..We believe that the AAOS guidelines for thromboprophylaxis take into account all risks associated with anticoagulation therapy and may prove to be a safer option for our patients...

..Young and healthy patients may be candidates for one-stage bilateral total hip arthroplasty without an increase in complications and with lower costs...

..We evaluated the early outcomes and prevalence of complications following revision total hip arthroplasty in patients older than eighty years of age and compared them with those in a younger patient population...

..In this study, we sought to determine the outcome of reconstructive surgery with the use of a modular proximal femoral replacement (a so-called megaprosthesis) in patients with proximal femoral bone loss due to non-neoplastic conditions...

....

..The challenge is to distinguish which require treatment and which do not...

..Component malpositioning was found to be the major cause of recurrent instability in this successfully treated cohort...

..Level of Evidence: Therapeutic studies, level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence...

..C-reactive protein (CRP) serum assays are a standard element of the diagnostic workup for periprosthetic joint infection (PJI). However, because CRP is a marker for systemic inflammation, this test is not specific to PJI...

....

..PAD seems to be effective in reducing allogenic transfusions after THA but not TKA...

..Use of multiple diagnostic criteria within the joint arthroplasty community raises concerns in patient treatment and comparison of research pertaining to PJI...

..Our hypothesis was that dislocation was more likely to occur in patients who were not placed on these restrictions...

..Such an approach should prevent the mismanagement of these complications...

..Regulations regarding conflict of interest represent an attempt to ensure that research is not biased by financial or other interest and to maintain public trust...

..With this meta-analysis of the published literature, we intended to assess efficacy and safety in the use of antibiotic-impregnated cement for uninfected arthroplasty...

..Hence novel techniques for the treatment of periprosthetic infection are desperately needed...

..This article presents the findings of some of these studies and briefly discusses our current understanding of its molecular mechanisms...

..However, it is unclear whether preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are more likely elevated in these patients than those without overt infection...

..LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence...

..In this prospective study, we determined the sensitivity and specificity of one of these enzymes, leukocyte esterase, in diagnosing periprosthetic joint infection...

..Radiographically in the major group, tantalum cups yielded better fixation. Level of Evidence: Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence...

..We sought to identify definite cutoff values for both the fluid leukocyte count and the neutrophil percentage that may help to diagnose infection at the site of a prosthetic joint...

..Despite the lower oxidation displayed by conventional retrievals, this study provides strong evidence that delamination secondary to in vivo oxidation may occur during the second decade of implantation...

..Level of Evidence: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence...

..These results clearly demonstrate that this novel thin sol-gel technology can be used for the targeted delivery of antibiotics for the treatment of periprosthetic as well as other bone infections...

..The complexity of revision THA usually leads surgeons to use multiple revision hip designs to address these issues...

..In addition, the potential influence of the different sterilization processes on the wear performance of the polyethylene components was examined...

..Two-stage exchange arthroplasty is the accepted standard of care, but reported failure rates are increasing. It has been suggested this is due to the increased prevalence of methicillin-resistant infections...

..Bone grafts are frequently used to supplement bone stock and to establish structural stability. However, graft-associated infection represents a challenging complication leading to increased patient morbidity and healthcare costs...

..These findings indicate that antibiotic derivatization of implants can result in a surface that can resist bacterial colonization. This technology holds great promise for the prevention and treatment of periprosthetic infections...

..Since the covalently tethered antibiotic is stable, is active, retains its specificity, and does not exhibit toxicity, it is concluded that this modified allograft holds great promise for decreasing bone graft-associated infections...

..We examined the role of this diagnostic test in a large cohort of patients from a single institution...

..However, their direct impact on patient mobility and wear damage while implanted remains poorly understood...

..A number of unique mechanisms of failure, including fracture, squeaking, and adverse tissue reactions, have been reported with these hard bearing surfaces. However, the incidence varies among the published studies...

..Although malposition could be an important contributing factor, the latter cannot be the sole reason based on our findings. Further investigation to elucidate the etiology is warranted...

..While intraoperative Gram stains are routinely performed during revision total knee arthroplasty, their value remains unclear...

..These results demonstrate that we have effectively engineered a stable, bactericidal Ti surface. This new surface holds great promise in terms of mitigating or preventing periprosthetic infection...

..Based on these observations, covalent modification of the titanium surface with an antibiotic may be viewed as a potential new tool in preventing or eliminating periprosthetic infection...

..In recent years, a number of alternative bearing surfaces, such as ceramic on ceramic, are being used in THA. Squeaking after THA is a recently recognized complication; however, its incidence is unknown...

..It is unclear whether in vivo oxidation will occur in unirradiated inserts sterilized with EtO...

..Currently, there are no proper indicators that can guide orthopaedic surgeons in patient selection for two-stage exchange or the appropriate conditions in which to reimplant...

..A total of 20.3% (12/59) of constrained liners failed. Isolated liner exchange, history of revision, and use of a 28-mm head were associated with failure in revision THA for instability...

..More accurate diagnostic tools are needed to support clinical judgment in monitoring infection progress and thus deciding whether to proceed with TKA reimplantation. LEVEL OF EVIDENCE: Level II, therapeutic study...

..The high association between DVT and PE that is assumed to exist does not seem to hold true for orthopedic surgery patients...

..Our study confirms that navigation is a reliable tool for performing in vivo assessment of range of motion...

..Since the tethered antibiotic appeared to have little or no effect on any of these activities, it was concluded that the stable, tethered antibiotic prevented bacterial infection while not modifying bone cell function...

..LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence...

..Using this technique, we believe it is possible to passivate many complex implant designs/geometries as a first step toward covalent bonding of antibiotics or other bioactive factors...

..New preventive and therapeutic strategies are needed. LEVEL OF EVIDENCE: Level IV, therapeutic study...

..The current study aimed to determine the cut-off values for ESR and CRP that improve clinical differentiation between aseptic failure and PPI in total hip arthroplasty (THA)...

..The high failure rate of this procedure implies that it should be preferably limited to select healthy patients with low virulence organisms and equivocal intraoperative findings...

..This data suggest infected patients benefit from revision arthroplasty and achieve functional, pain, and mental health status at 2-year followup similar to those of noninfected patients...

..There were no morbidities or complications after the revision surgery rendering isolated head-and-liner exchange to a metal-on-highly cross-linked polyethylene a relatively benign procedure...

..The objective of this study was to investigate the role of patient education, accelerated rehabilitation, and improved pain control on the outcome of total hip arthroplasty performed through a small incision...

..We also evaluated the results of preoperative treatment with inferior vena cava (IVC) filter...

..A dramatic increase in the demand for TKA is expected. The current burden of revision TKA is well known but the incidence and etiology of nonrevision reoperations after primary TKA is not...

....

..Revision arthroplasty may be indicated when a surgically correctable cause of limb-length discrepancy can be identified...

..0, or none. Patients at elevated (above standard) risk of both PE and major bleeding should be considered for aspirin, warfarin with an INR goal of < or =2.0, or none...

..Because of the challenges of treating stiffness, efforts should be invested in preventing this complication...

..We evaluated the outcome of salvage knee reconstructions that had been performed with use of modern-generation modular segmental kinematic rotating hinged total knee prostheses...

..Polymerase chain reactions can detect necrotic bacteria, so the clinical importance of positive results of this analysis in the absence of other features of infection remains to be determined...

..The purpose of this study was to evaluate the clinical and radiographic outcome of this technique with use of a tripolar constrained liner that was cemented into a well-fixed cementless acetabular shell...

..Revision total hip arthroplasty (THA), although relieving pain and restoring function, fails in some patients. In contrast to failures in primary THA, the frequency of the causes of failure in revision THA has been less well established...

..This may, in turn, translate to better clinical outcome of the knee arthroplasty...

..At 2 years, the results in both groups were the same...

..26% for knees compared to rural (0.61% for hips and 0.69% for knees) and urban-teaching hospitals (0.73% for hips and 0.77% for knees). We found an increasing number of joint arthroplasties being diagnosed with periprosthetic infection...

..The purpose of this review is to discuss the recent technologic advances in bearing surfaces and offer an insight to the potential benefits and concerns with the alternative bearing surfaces...

..Isolated acetabular liner exchange performed through an anterolateral approach carries an acceptable dislocation rate...

..There were 4 revisions for aseptic loosening of the femoral component in this series, accounting for an overall survivorship of 99.4%. The study confirms that the midterm outcome of this stem is excellent, with a low revision rate...

..This study evaluated the clinical and radiographic results of uncemented total hip arthroplasty in young adults with osteonecrosis of the femoral head and compared these results to those seen in young adults with osteoarthritis...

..In order to enhance the bone stock, the proximal part of the femur, however poor in quality, should be retained for reapproximation onto the implant...

..There was no evidence of radiographic subsidence or loosening around any stems. The overall medium- to long-term outcome of the Taperloc stem is excellent, with a low revision rate and high patient satisfaction...

....

..However, considering the relatively high rate of complications, this procedure should be reserved for patients where alternative treatments are not possible...

..There were 25 (29%) deaths. Cementless total hip arthroplasty using a tapered proximally coated femoral stem is a viable option for the treatment of a displaced hip fracture and preexistent arthritis...

..Released lactate dehydrogenase ratios were severely increased in osteoblasts. These data suggest the balance between the targeted microbicidal effects and host cellular toxicity is critical for skeletal cell survival and function...

..This article presents a synopsis of published studies on late instability and outlines our institutional experience with treatment of late dislocation following total hip arthroplasty occurring due to polyethylene wear...

..Overall, this study provides a framework for thorough and efficient digestive methods for UHMWPE wear debris extraction...

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

..Cautious anticoagulation to prevent hematoma formation and/or wound drainage is critical to prevent periprosthetic infection and its undesirable consequences...

..This study suggests that patients with deteriorated physical status or those who receive greater than one antibiotic after surgery are at a higher risk for developing C difficile-associated diarrhea after TJA...

..As a result, patient pain, suffering and morbidity will be minimized. ..