Assessing osteoporosis screening compliance in total joint surgery: a retrospective chart review.

CONTEXT: Osteoporosis is a prevalent concern, particularly among aging populations, leading to increased risk of fractures, including those related to hip and knee arthroplasty procedures. Screening for osteoporosis, especially with dual X-ray absorptiometry (DXA) scans, is crucial for early detection and management. OBJECTIVES: This study aimed to assess adherence to osteoporosis screening guidelines among patients aged 65 and older undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) within a single health network. Factors influencing screening adherence were also explored. METHODS: A retrospective chart review of 2,160 patients undergoing elective THA or TKA between January 2019 and January 2023 was conducted. Demographic data, osteoporosis screening status, and occurrence of periprosthetic fractures were analyzed. Statistical analysis included descriptive statistics and chi-square tests. RESULTS: Only 24.1 % of eligible patients underwent a DXA scan prior to surgery. Females were more likely to undergo screening than males, and race was also associated with screening status. A total of 45 periprosthetic fractures were identified, with no significant correlation between osteoporosis status, DXA screening, and fracture occurrence. CONCLUSIONS: Adherence to osteoporosis screening guidelines among geriatric patients undergoing elective total joint arthroplasty remains low within the studied health network. Despite the lack of correlation between screening and fracture occurrence in this study, the importance of screening and potential optimization in high-risk patients is emphasized. Further research is needed to assess outcomes associated with different care pathways in bone health screening and management for elective geriatric total joint patients.

Early Experience with a Short, Tapered Titanium Porous Plasma Sprayed Stem with Updated Design.

INTRODUCTION: Short stem femoral components in primary total hip arthroplasty (THA) have increased in popularity since the advent of minimally invasive surgical techniques. The concept of a short stem is particularly compatible with tapered designs where the goal is to offload forces proximally in the femur. The purpose of this retrospective review was to review our early experience with a short, tapered titanium femoral component with updated design features. MATERIALS AND METHODS: Beginning in November 2011 through February 2012, 92 consented patients (93 hips), at a single center, were treated with primary cementless THA using a short stem, tapered femoral component (Taperloc® Complete Microplasty; Zimmer Biomet, Warsaw, Indiana) and were available for review with a minimum two-year follow-up. Mean patient age at surgery was 63.2 years and body mass index (BMI) was 30.8 kg/m2. Mean stem length used was 110.3mm (range, 95-125). RESULTS: Mean follow-up was 4.5 years (2-6). Harris hip scores improved from 52.5 preoperatively to 84.7 at most recent. One stem was revised the same day for periprosthetic fracture. One patient with early infection was treated with single-stage exchange followed by recurrence that was treated successfully with two-stage exchange. A non-healing wound in one patient was treated with incision and debridement. Radiographic assessment demonstrated no evidence of loosening, osteolysis, distal hypertrophy, or pedestal formation in any hip, and all components appeared well fixed and in appropriate alignment. CONCLUSION: In this series of patients treated with primary THA using a short, tapered titanium porous plasma-sprayed femoral component with updated design features, good results were achieved with a low incidence of complications and revision. No aseptic loosening or osteolysis has occurred. Radiographic assessment was excellent for all patients.

Early Experience with a Tapered Titanium Porous Plasma Sprayed Stem with Updated Design.

INTRODUCTION: The Taperloc® Complete femoral stem (Zimmer Biomet, Warsaw, Indiana) builds on the widespread clinical success of the original Taperloc design used since 1982. Enhancements to the Complete design include a lowered caput-collum-diaphyseal (CCD) angle from 138° to 133° for improved offset, optimized neck taper with polished neck flats to increase range of motion, reduced distal geometry to improve proximal canal fill, and gradual off-loading that is the goal of tapered geometry. A retrospective review was conducted to assess our early experience with the updated design. MATERIALS AND METHODS: A query of our practice's arthroplasty registry revealed 97 consented patients (103 hips) who underwent primary cementless THA performed with a Taperloc® Complete femoral component between November 2010 and March 2011. A high offset option, accomplished by a constant 7.8mm medial shift of the trunnion, was utilized in 94 hips (91%). Mean age was 61.8 years and body mass index (BMI) was 31.3 kg/m2. Underlying diagnoses were osteoarthritis in 96 (93%), four avascular necrosis, two post-traumatic arthritis, and one acute fracture. RESULTS: Mean follow-up was 5.3 years (2-7). Harris hip scores improved from 53.6 preoperatively to 87.9 at most recent. One stem was revised for periprosthetic fracture. Other reoperations were one cup revised for iliopsoas impingement, one lateral femoral cutaneous neurectomy, and one incision and debridement for a non-healing wound. Postoperative radiographs revealed satisfactory position and alignment of components with no radiolucencies observed in all patients with no evidence of osteolysis, distal hypertrophy, or pedestal formation. CONCLUSION: In this group, good results with a low frequency of complications and stem revision were achieved with a tapered titanium porous plasma-sprayed femoral component with updated design features. No aseptic loosening or osteolysis occurred. Radiographic findings were excellent in all hips.