Comparison of Outcomes in High Versus Low Activity Level Patients After Total Joint Arthroplasty.

BACKGROUND: Activity level (AL) recommendations following total joint arthroplasty (TJA) remain controversial. Our purpose was to compare implant survivorship of high activity (HA) and low activity (LA) patients after primary TJA. We hypothesized that there would be no difference in implant survivorship based on AL. METHODS: This was a retrospective 1:1 matched cohort study after primary TJA with minimum 5-year follow-up. High activity patients were designated by the University of California and Los Angeles activity-level rating scale score ≥8 and matched to LA patients based on age (±5), sex, and body mass index (±5). There were 396 HA patients (149 knees and 48 hips) who met inclusion criteria. We analyzed revision rates, adverse events, and radiographic lucencies. RESULTS: Crepitus was the most common adverse events in both HA and LA total knee arthroplasties (TKAs). Adverse events were rare in total hip arthroplasty (THA) cohorts. For both THA and TKA patients, the HA cohort did not have increased reoperations or revisions when compared to the LA cohort. No differences were noted in overall radiographic analysis between HA (16.1%) and LA (12.1%) TKA patients (P = .318), and in THA patients, more radiographic problems were noted in LA (P = .004). CONCLUSION: We found no difference in minimum 5-year postoperative implant survivorship based on AL. This may change AL recommendations after TKA and THA.

Patellofemoral Arthroplasty.

Patellofemoral arthroplasty (PFA) as a treatment option for isolated patellofemoral disease continues to evolve. Enhancement in patient selection, surgical technique, implant design, and technology has led to improved short-term and midterm outcomes. Furthermore, in the setting of a younger patient with isolated patellofemoral arthritis, PFA represents an option for improved function with faster recovery times, bone preservation, maintenance of ligamentous proprioception, and the ability to delay total knee arthroplasty (TKA). The most common reason for revising PFA to a TKA is progression of tibiofemoral arthritis. In general, conversion of PFA to TKA leads to successful outcomes with minimal bone loss and the ability to use primary TKA implants and instrumentation. PFA seems to be a cost-effective alternative to TKA in appropriately selected patients with 5-, 10-PFA survivorships of 91.7% and 83.3%, respectively, and an annual revision rate of 2.18%; however, more long-term clinical studies are needed to determine how new designs and technologies affect patient outcomes and implant performance.

Does Individualization of Cup Position Affect Prosthetic or Bone Impingement Following Total Hip Arthroplasty?

BACKGROUND: Spinopelvic (SP) mobility patterns during postural changes affect three-dimensional acetabular component position, the incidence of prosthetic impingement, and total hip arthroplasty (THA) instability. Surgeons have commonly placed the acetabular component in a similar "safe zone" for most patients. Our purpose was to determine the incidence of bone and prosthetic impingement with various cup orientations and determine if a preoperative SP analysis with individualized cup orientation lessens impingement. METHODS: A preoperative SP evaluation of 78 THA subjects was performed. Data were analyzed using a software program to determine the prevalence of prosthetic and bone impingement with a patient individualized cup orientation versus 6 commonly selected cup orientations. Impingement was correlated with known SP risk factors for dislocation. RESULTS: Prosthetic impingement was least with the individualized choice of cup position (9%) versus preselected cup positions (18%-61%). The presence of bone impingement (33%) was similar in all groups and not affected by cup position. Factors associated with impingement in flexion were age, lumbar flexion, pelvic tilt (stand to flexed seated), and functional femoral stem anteversion. Risk factors in extension included standing pelvic tilt, standing SP tilt, lumbar flexion, pelvic rotation (supine to stand and stand to flexed seated), and functional femoral stem anteversion. CONCLUSION: Prosthetic impingement is reduced with individualized cup positioning based on SP mobility patterns. Bone impingement occurred in one-third of patients and is a noteworthy consideration in preoperative THA planning. Known SP risk factors for THA instability correlated with the presence of prosthetic impingement in both flexion and extension.

Screening and Management of Malnutrition in Total Joint Arthroplasty.

Malnutrition is an increasingly prevalent problem in patients undergoing total joint arthroplasty (TJA). Increased risks associated with TJA in the setting of malnourishment have been well documented. Standardized scoring systems in addition to laboratory parameters such as albumin, prealbumin, transferrin, and total lymphocyte count have been developed to identify and evaluate malnourished patients. Despite an abundance of recent literature, there is no consensus on the best approach for screening TJA patients from a nutritional standpoint. Although there are a variety of treatment options, including nutritional supplements, nonsurgical weight loss therapies, bariatric surgery, and the involvement of dieticians and nutritionists, the effect of these interventions on TJA outcomes has not been well characterized. This overview of the most current literature aims to provide a clinical framework for approaching nutrition status in arthroplasty patients. A comprehensive understanding of the tools available for managing malnourishment will facilitate improved arthroplasty care.

The 50 Most Cited Articles in the Indications, Risk Factors, Techniques, and Outcomes of ACL Revision Surgery.

The rate of anterior cruciate ligament (ACL) retear remains high and revision ACL reconstruction has worse outcomes compared with primaries. To make advances in this area, a strong understanding of influential research is necessary. One method for systematically evaluating the literature is by citation analysis. This article aims to establish and evaluate "classic" articles. With consideration of these articles, this article also aims to evaluate gaps in the field and determine where future research should be directed. The general approach for data collection and analysis consisted of planning objectives, employing a defined strategy, reviewing search results using a multistep and multiauthor approach with specific screening criteria, and analyzing data. The collective number of citations for all publications within the list was 5,203 with an average of 104 citations per publication. "Biomechanical Measures during Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport" by Paterno et al contained both the highest number of total citations and the highest number of citations per year, with 403 total citations and 43.9 citations per year. The most recurring level of evidence were level II (n = 18) and level III (n = 17). "Clinical Outcomes" was the most common article type (n = 20) followed by "Risk Factors" (n = 10). The American Journal of Sports Medicine had the highest recorded Cite Factor with over 50% of the articles (n = 27) published. The most productive authors included R.W. Wright (n = 6), S.D. Barber-Westin (n = 5), F.R. Noyes (n = 5), and K.P. Spindler (n = 5). Historically, influential studies have been published in the realms of clinical outcome and risk factor identification. It has been established that revision ACL reconstruction has worse outcomes and more high-level studies are needed. Additionally, prospective studies that apply the knowledge for current known risk factor mitigation are needed to determine if graft tear rates can be lowered.

A Rare Case of Isolated Salmonella Species Group B Sacroiliitis in a Healthy Collegiate-Level Swimmer: A Case Report.

CASE: We present a case of isolated Salmonella species group B sacroiliitis in a healthy 19-year-old collegiate-level swimmer with no known risk factors. To our knowledge, there are no similar cases described in the current literature. CONCLUSION: Pyogenic sacroiliitis (PS) is a rare form of septic arthritis, especially in adults. PS is most commonly seen in the setting of intravenous drug use or in an immunocompromised patient. If a patient does not fit either of these demographics, PS initially can be a difficult diagnosis because of its rarity and vague symptomatology.