Keith R Berend

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..6 to 4.8 g of tobramycin or gentamicin and 3.0 to 4.0 g of vancomycin per 40-g unit and massaged to fill any voids. After curing, the temporary spacers are removed from the molds, trimmed smooth, and cemented loosely into the joint space...

..Accurate soft tissue reconstruction may decrease trochanteric and thigh pain and improve function following THA...

..Newer designs featuring large heads, improved range of motion, and reduced impingement hold the promise of improved results...

..Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants...

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..The oxycodone is continued for the first 24 hours of the hospital stay. Patients are then managed with oxycodone and hydrocodone. Length of stay has decreased and currently averages <2 days...

..Refined perioperative protocols in combination with a less invasive, mini-arthrotomy approach using special instrumentation resulted in earlier discharge to home, higher range of motion and improved clinical and pain scores...

..The alumina matrix composite femoral head on an alumina liner provided high survivorship. Level of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence...

..Level of Evidence: Level III, therapeutic study. See the guidelines online for a complete description of level of evidence...

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

..The data suggest manufacturing technique influences backside wear in total knee arthroplasty polyethylene inserts...

..2% for noncoated stems and 100% for hydroxyapatite stems. The long-term survivorship of plasma-sprayed titanium tapered stems was excellent regardless of hydroxyapatite application, with neither benefit nor detriment observed...

..Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages...

..1%] vs 1/269 [0.4%]), and only 1 (1/269 [0.4%]) femoral revision (infection) at 2-year follow-up. Short stems represent the logical progression of a proven precedent in standard-length tapered stems...

..While the latter goal is certainly desirable, the priority of the former should never be overlooked...

..Reliable long-term results including functional improvement, pain relief, and implant survival have been reported with standard tapered stems, but will a short taper perform as well?..

..Caution is advised when potting or anchoring any stem in the femoral diaphysis without reconstituting proximal bone stock and support...

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..However, little data exist on whether simultaneous unicompartmental knee arthroplasty can be performed without increasing the perioperative risk compared with staged unicompartmental knee arthroplasty...

..3% vs 1.1%; P = .0006), and failure for metal-bearing complications (2.2% vs 0.6%; P = .0126). There appear to be gender factors influencing the success of MoM THA, which may include hormonal, anatomic, or functional differences...

..Modular systems were associated with a higher degree of technical difficulty, operative time, and blood loss...

..However, there are fewer reports describing techniques for lateral unicompartmental arthroplasty and whether technique influences ROM and function compared to reports for medial unicompartmental arthroplasty...

..0246). Metal-on-improved polyethylene devices had superior results compared with MoM in this study. Furthermore, 5 MoIP revisions were liner exchanges, a conservative option not available with MoM...

..The benefits of articulating spacers are prevention of soft-tissue contracture, promotion of range of motion, and facilitation of antibiotic delivery...

..Based on these mid-term results, the authors conclude that a metal-on-metal articulation represents a viable alternative in young, high-demand, active patients...

..Early discharge appears to be safe and does not transfer the burden of care to other facilities or home health rehabilitation services...

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

..LEVEL OF EVIDENCE: Prognostic study, Level IV-2 (case series). See the Guidelines for Authors for a complete description of levels of evidence...

..This device allows a higher range of motion before prosthetic impingement and maintains a higher levering out strength when impingement occurs. These changes should provide long lasting hip stability in these difficult cases...

..Therefore, this device addresses, in the majority of cases, the concerns that arise from backside wear...

..Overall implant survival was 98% at an average of 5 years. No perioperative deaths or significant orthopedic complications were identified. Advanced age is not a contraindication for tapered cementless THA...

..The purpose of this study is to report the complication rate, types of complications, and outcomes of hip resurfacing during the early experience of two high-volume hip surgeons...

..Designed to improve alignment accuracy and precision, the patient-specific positioning guide is predicated on restoration of the overall mechanical axis and is a multifaceted new tool in achieving traditional goals of TKA...

..1%, they should be used cautiously, with a 42.1% long-term failure rate observed in this series. Dislocation was common despite constraint with previous history as a significant risk...

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

..When managed intraoperatively with cerclage wire or cable, the mid- to long-term results appear unaffected with 100% femoral component survival at up to 16 years...

..No other revisions were performed. The stepwise algorithmic approach to treating fixed flexion deformity presented in this study in primary total knee arthroplasty is safe and effective...

..Irrigation and debridement should play a limited role in the PJI treatment algorithm regardless of organism type...

..Overall stem survivorship is 98.2% at up to 18 years...

..A tapered, titanium component is reliably placed into appropriate position and is forgiving as to varus implant position...

..In this large series of 318 unicompartmental knee arthroplasties performed in 270 patients, these standard preoperative contraindications had no influence on the successful outcome of the procedure using the Oxford phase 3 device...

..Furthermore, risk stratification and multimodal management may prove to be the safest and most effective way to manage VTD prevention...

..The clinical scenarios for which total femoral arthroplasty is indicated and a recommended surgical technique are reviewed...

..In light of this investigation and the work of others, preoperative radiographic changes in the patellofemoral joint can be safely ignored when considering patients for medial UKA without compromising survivorship...

..Intraoperative proximal femoral fracture is a risk in total hip arthroplasty (THA) with cementless stems with reported rates of 1.5-27.8%. Certain designs or designs associated with certain types of instrumentation may have higher rates...

..Length of stay, although longer, was only 2.3 days in OSA patients, demonstrating the safety and efficacy of IN anesthesia in these patients...

..05). A lower, but not statistically significant, failure rate was observed in the hybrid group in comparison with the cemented group...

..4 days. Unicompartmental arthroplasty using less invasive surgical techniques, a rapid recovery protocol, and multimodal venous thromboembolism prevention is a safe and effective procedure associated with a low rate of morbidity...

..2%: odds ratio 19.6 (P =.0082). A significant increase was observed in rates of VTD with ileus. We recommend using parenteral chemical and mechanical prophylaxis in patients with ileus following total hip and total knee arthroplasties...

..Level of Evidence: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence...

..Although not without complications, manipulation under epidural anesthesia represents a viable option for treatment of persistent stiffness after TKA; 80% of these difficult cases achieved successful results...

..1 years. Only 4 patients required stem revision for loosening (7.4%). THA after FVFG provides improved functional results comparable to the published results of primary THA in osteonecrosis in young patients...

..Although in vitro and early in vivo clinical studies show promising results, these devices must be measured against cemented fixation, which continues to be the "gold standard" in TKA...

..The minimally invasive nature and rapid recovery associated with unicompartmental knee arthroplasty may support approaching the procedure more as an arthroscopy than an arthroplasty in terms of venous thromboembolic disease prevention...

..This method of preoperative templating and referencing the well leg intraoperatively is an inexpensive, reliable, and accurate method for determining leg length in primary THA and has few significant radiographic or clinical outliers...

..Combining these results with minimally invasive techniques and instrumentation should make recovery even faster...

..It is now recommended that multiple cultures be obtained and that a single isolate may not be a significant finding...

..The performance of TKA through less than traditional visualization presents a new set of problem areas...

..There was a lower rate of intraoperative and postoperative transfusions in the bipolar sealer group...

..Additionally, the majority of femora demonstrated increased cortical thickness in all zones around the stem prosthesis. Level of Evidence: Therapeutic Level III...

..A 69% reduction in lateral release supports the hypothesis that tourniquet pressure has an effect on patellar tracking. Lateral release appears to be effective in restoring normal patellar tilt, and obesity increases its need...

..Surgeons should have the option of modifying the degree of constraint at the time of surgical intervention. Currently, many TKA implant systems offer such flexibility...

..In addition to these negative results, the hospital system realized a 28% reduction and the surgeon suffered a 15% reduction in potential reimbursement...

..Dislocation is higher than in primary total hip arthroplasty utilizing the same surgical approach. The results do not support routine use of arthroplasty in treatment of intertrochanteric hip fractures in the elderly...

..This case report profiles a patient who required removal of Brooker stage III heterotopic ossification after a 2-incision minimally invasive total hip THA. This is the first report of this complication after 2-incision THA...

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..Cadaver dissections and one-on-one mentoring are recommended when implementing this approach in one's practice...

..Advantages over conventional total femoral replacement or ORIF include less dissection, maintenance of soft tissue attachments, and immediate component stability to allow for early mobilization...

..Use of larger-diameter femoral heads appears to have the potential to substantially reduce the early risk of dislocation of the prosthetic hip arthroplasty...