• Good results seen with highly porous acetabular implants in revision THA

    Highly porous, commercially pure, titanium matrix acetabular components are safe and efficacious in patients who underwent revision total hip arthroplasties, according to a study recently presented.

    “We prefer these highly porous jumbo cups for treatment of chronic discontinuity with major bone loss,” Morteza Meftah, MD, of Ranawat Orthopaedics, Hospital for Special Surgery (HSS) in New York City said. “Non-cemented custom cages, cemented cup/cage combination, or allograft are alternative choice if you want to treat Paprosky III or chronic pelvic discontinuity due to osteolysis. In our hands, Tritanium jumbo cups have reduced or eliminated the need for cup/cage combinations in such cases.”

    He added, “The new porous Tritanium theoretically needs less bone (bleeding surface) to osteointegrate. This is important in major revision surgery when the bleeding surface is less than primary. We found that much less (around 30%) of bleeding bony surface is required for fixation with these implants.”

    Jumbo cups

    Researchers evaluated 24 patients who underwent revision total hip arthroplasty for major acetabular defects with Tritanium acetabular components (Stryker; Mahwah, NJ) between 2007 and 2010, and had a mean follow-up of 4 years. Most patients had a preoperative Paprosky classification of IIIA or IIIB with pelvic discontinuity. There were 10 men and 14 women, and patients had a mean age of 69 years.

    Meftah noted the Tritanium cups consist of trabecular metal implants, designed to resemble the trabecular bone structure. The trabecular implants are a highly porous 3-D surface utilizing commercially pure titanium (CPTi) powder technology.

    “The jumbo cups are about 10 mm larger than the native socket, 58 mm or larger in women and 62 mm or larger in men,” Meftah said. “The use of these highly porous cups has theoretically improved osseointegration, due to a small percentage of the bleeding bone that is required.”

    During the revision procedures, surgeons performed progressive reaming to obtain a bleeding bone interface. The interference fit between the anterior inferior iliac spine, pubis and ischium was achieved with the use of Tritanium jumbo cups. Bone graft was utilized before placement of the cup in the non-bleeding portions of the defect.

    “It is a good idea to use a trial component to test the stability prior to the actual implant. Use the distraction technique in chronic discontinuity to obtain a wedge interface with 2-mm to 5-mm oversize jumbo cups and at least two to five screws to enhance fixation,” Meftah said. There were no cup/cages or wedges used in this series. Most patients required a cup diameter of 62 mm or bigger, according to Meftah.


    The investigators analyzed patients’ radiographic and clinical results, and extent of osseointegration. The WOMAC score was 30.5 points, the patient-administered questionnaire (PAQ) score was 25.2 and HSS score was 25.3, with Meftah noting that lower numbers for the WOMAC and PAQ are better and higher numbers for the HSS are better. All three clinical outcomes were good at final follow-up.

    The abduction angle was 43° with an anteversion of 20°. Osseointegration occurred in all cups, with a minimum osseointegration incidence of 30% and maximum of 75%. “The most osseointegration was in zone I, which was superior, and zone VI, which was posterior,” Meftah said.

    He added, “We had good patient satisfaction with significant improvement of pain. None of the patients had any complications, dislocations, infections or failure of osseointegration at final follow-up.” – by Renee Blisard Buddle.

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  • Socially isolated patients with arthritis have more pain after THR

    SAN DIEGO – Socially isolated patients with osteoarthritis are nearly three times more likely to experience serious ongoing pain after total hip replacement than patients with good social ties, according to researchers from Hospital for Special Surgery.

    “Previous studies have shown that social isolation is a risk factor for poor health outcomes,” Lisa A. Mandl, MD, MPH, from Hospital for Special Surgery, stated. “Studies show that people who don’t have good social ties are at increased risk of suffering a heart attack or stroke, and even dying, compared to those who enjoy the social support of family, friends and the community.”

    In the study, social isolation was defined based on whether the patients were married, were members of any community or religious groups or had fewer than six friends or relatives. Mandl and colleagues noted that, although the 132 rheumatoid arthritis (RA) patients and 392 osteoarthritis (OA) patients had similar demographics and proportions of socially isolated patients, the OA patients had a statistically significant association with postoperative decreased WOMAC scores and social isolation, according to the abstract.

    Severe social isolation in OA patients was also significantly associated with WOMAC scores less than 60 points and 2.9 times postoperative pain than control patients, but it was not associated with poor postoperative function.

    Patients with OA who underwent a total hip replacement had worse pain outcomes than patients with RA. In RA patients, severe social isolation was significantly associated with poor postoperative function, but not postoperative pain.

    “We believe further prospective studies should be done to determine whether interventions to evaluate and improve patients’ social ties before surgery could lead to a better pain outcome after hip replacement,” Mandl said. “It could be a way to improve outcomes without medication or other costly interventions. I see no downside to helping patients get the social support they may need to improve their quality of life.”

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  • Healing and Surviving After Knee and Hip Replacements

    For some people with aching bones and joints, knee or hip replacement surgery may be a treatment option. But pre-existing conditions may affect how a patient responds to surgery.

    A recent study found that joint replacement patients with certain pre-existing conditions had a greater risk of having a second surgery or not surviving the next one to 10 years than patients without such disorders.

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  • Surgeons describe new knee ligament

    At the Belgian University Hospitals Leuven, two knee surgeons have for the first time given a full anatomical description of a new ligament that they term the anterolateral ligament (ALL).

    The new ligament is thought to play an important role in anterior cruciate ligament (ACL) tears.

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  • Study: Day-of-surgery discharge found effective for UKA patients using refined perioperative pathway

    Day-of-surgery discharges can be safe, efficient and increase patient satisfaction when using a refined perioperative pathway for appropriately selected patients who undergo unicompartmental knee arthroplasty, according to results of a recently published study.

    “[Unicompartmental knee arthroplasty] UKA patients can be discharged on the day of surgery with a high satisfaction rate,” Steven Barnett, MD, from the Hoag Orthopedic Institute in Irvine, Calif., told Orthopedics Today. “This provides orthopedic surgeons with the ability to effectively treat these patients while minimizing cost associated with this procedure.

    Barnett said surgeons at his institution recognized that UKA patients had less difficulty with pain management, decreased length of stay and achieved better results in physical therapy during hospitalization.

    “This led us to begin managing these patients with a 23-hour overnight stay and eventually discharging them on the day of surgery,” Barnett said.

    Barnett said within a 2-year to 3-year period, surgeons moved UKA patients from an inpatient setting to a day of surgery discharge after adopting techniques related to general and regional anesthesia, local soft-tissue infiltration and oral perioperative pain management.

    Under this perioperative pathway, he and colleagues successfully discharged 160 consecutive UKA patients who were a mean of 65 years old with a mean American Society of Anesthesiology class of 1.8. The mean recovery room time was 121 minutes and no patients had uncontrolled pain or nausea that required an overnight stay. Patients had high satisfaction scores and researchers noted significant improvements in Knee Society Clinical Rating System scores.

    “Our current algorithm is dependent upon patient education prior to surgery. Patients are instructed on crutch use, postoperative wound management, precautions, and [deep vein thrombosis] DVT prophylaxis at an extensive preoperative visit,” Barnett said. “Pain management on the day of surgery entails use of multimodal oral analgesics started prior to the procedure combined with both regional nerve blocks and peri-articular infiltration of a local anesthetic mixture. Activity limitations and weight bearing precautions are reinforced prior to discharge from the surgery center.”

    Barnett said other surgeons performing UKA have adopted the pathway described in this study with success.

    “The authors are confident that results will continue to be optimal and look forward to adapting these protocols to other arthroplasty procedures moving forward,” he said.

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  • Knee Braces for Osteoarthritis Treatment

    Osteoarthritis is the most common joint issue for middle-aged and older adults. The good news is that there may be a simple solution to help patients deal with the pain.

    A recent study examined the effectiveness of wearing a patellofemoral (the joint connecting the back of the knee cap and the thigh bone) knee brace for reducing knee pain and damaged bone marrow (tissue inside the bones).

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  • Sports Injuries Strike Again

    Sports are a great way for kids to get exercise and have fun. But sometimes young athletes get hurt.

    Many sports injuries are mild and heal on their own. Others — such as knee ligament tears — may be more serious and require surgery.

    Athletes who have had surgery to repair knee ligament tears are more likely to experience another knee ligament tear than uninjured athletes, according to a recent study.

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  • Knees Buckling Under Pressure

    Your body weight and your job may be putting considerable pressure on your knees. This pressure could lead to a medical condition called knee osteoarthritis.

    A recent study found that having a higher body mass index (a measure of height and weight) and living a more active lifestyle were both associated with a higher risk of knee osteoarthritis.

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  • Knee Replacement Often Beneficial for RA: Study

    The common belief that rheumatoid arthritis patients don't benefit from knee replacement surgery as much as those with the more common osteoarthritis has been challenged by the findings from a pair of studies by New York City scientists.

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  • Omega-3 fatty acids may help reduce risk of hip fracture in postmenopausal women

    The risk of hip fractures in postmenopausal women may be reduced through consuming more omega-3 polyunsaturated fatty acids, according to a study published in the Journal of Bone and Mineral Research.

    “We don’t yet know whether omega-3 supplementation would affect results for bone health or other outcomes,” Tonya Orchard, PhD, RD, LD, from Ohio State University, stated in a press release. “Though it is premature to make a nutrition recommendation based on this work, I do think this study adds a little more strength to current recommendations to include more omega-3s in the diet in the form of fish, and suggests that plant sources of omega-3 may be just as important for preventing hip fractures in women.”

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