Faculty Bibliography

This prospective cohort study compares functional outcomes of bicompartmental knee arthroplasty (BKA) and total knee arthroplasty (TKA) in patients with osteoarthritis (OA) of the patellofemoral and medial compartments. Eligibility criteria included bicompartmental OA with less than grade 2 OA in the lateral compartment and intact cruciate ligaments. Fifty-six patients met eligibility criteria (21 BKA, 33 TKA). Enrolled participants completed Short-Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index assessments at baseline and postoperatively at 3 months, 1 year, and 2 years. In the early postoperative period, the BKA cohort had significantly less pain (P = .020) and better physical function (P = .015). These trends did not continue past 3 months. When adjusting for age, sex, body mass index, and preoperative status, only 3-month Western Ontario and McMaster Universities Osteoarthritis Index stiffness scores significantly differed between cohorts (P = .048). Despite less early stiffness in the BKA cohort, a significantly higher BKA complication rate (P = .045) has led us to recommend TKA for patients with this pattern of OA.

From April 2006 to May 2007, 261 patients undergoing primary unilateral total hip arthroplasty or total knee arthroplasty were offered voluntary participation in a one-on-one preoperative educational program. Length of stay (LOS) and inpatient data were monitored and recorded, prospectively. Education participants enjoyed a significantly shorter LOS than nonparticipants for both total hip arthroplasty (3.1 +/- 0.8 days vs 3.9 +/- 1.4 days; P = .0001) and total knee arthroplasty (3.1 +/- 0.9 days vs 4.1 +/- 1.9 days; P = .001).

A tip-apex distance (TAD) of greater than 25 mm has been shown to be an accurate predictor of lag screw cut-out when sliding hip screws (SHS) are used to treat peritrochanteric (PT) hip fractures. The purpose of this study was to determine which factors, including TAD, correlated with successful clinical outcomes of PT hip fractures surgically treated with intramedullary (IM) devices. A total of 192 patients were included in this retrospective study. The TAD values of this cohort were radiographically analysed at a mean follow-up of 13 months. This was correlated with limited functional status and the rate of revision for implant failure or inability to achieve fracture union. Only 82 patients had adequate follow-up to fracture union or definitive failure. There were 46 intertrochanteric (IT) hip fractures and 36 subtrochanteric (ST) fractures. Overall, seven patients (8.5%) went on to experience lag screw cut-out. The average TAD of the patients who did not cut-out was 18 mm, compared to 38 mm for those who did (p = 0.012). All patients who cut-out had IT fractures (p = 0.017). The percentage of cut-outs correlated directly to both the severity of IT fractures and the TAD. Using a cutoff of 25 mm there was a statistically significant difference in the incidence of lag screw cut-out (p < 0.001). As in sliding hip screws, surgeons should strive for a TAD less than 25 mm when using IM devices in the treatment of PT hip fractures to help avoid lag screw cut-out.

The purpose of this study was to investigate factors affecting the short-term outcome of primary total hip arthroplasty (THA) and develop a multivariate regression equation to predict the short-term outcome of primary THA. Prospectively collected data for 101 primary THAs performed at a single institution were used in this study. Twelve independent variables were analyzed via correlation and multivariate regression analyses. Correlation analyses showed that three variables significantly influenced Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function (PF) score at minimum follow-up of 1 year: preoperative WOMAC PF score (P < .0001), sex (GN, P = .0159), and the presence of preoperative comorbidities (CMB, P = .0246). Multivariate regression analysis yielded the following equation: Outcome = PF0.45 - GN9 + CMB8 + 62, which can be used to predict the general short-term outcome of primary THA.

Total knee arthroplasty (TKA) is typically an extremely successful method of restoring pain-free function and providing good long-term outcomes for patients with end-stage knee disease. However, outcomes are less predictable in persons with Parkinson disease. The limited literature available and our experience lead us to conclude that complication rates in the perioperative and postoperative periods with TKA are comparatively high in persons with Parkinson disease. In addition, a good functional outcome is less certain than in the general population. For persons with Parkinson disease who require TKA, we propose an integrative, collaborative approach to avoid complications and optimize outcomes.

The purpose of this study was to evaluate the stiffness of 3 different constructs for the fixation of comminuted Vancouver B1 periprosthetic femoral shaft fractures: a single lateral locking plate, a single lateral locking plate plus an anterior strut allograft, and a lateral locking plate plus an anterior locking plate. The axial stiffness, lateral bending stiffness, and torsional stiffness of 10 synthetic periprosthetic femur fracture models were tested. Differences in stiffness between constructs were determined with a 1-way repeated-measures analysis of variance. Fixation technique was found to have a significant effect for all loading modalities (P < .0001). A lateral locked plate plus an anterior locked plate was significantly stiffer than the allograft that in turn was significantly stiffer than the single plate (P < .0001).

Orthopaedic adult reconstruction subspecialists are sued for alleged medical malpractice at a rate over twice that of the physician population as a whole, and the rate appears disproportionately high in the first decade of practice. The overall risk of a malpractice claim is related to years spent in practice. After 30 years in an adult reconstruction practice, the cumulative rate of being sued at least once is over 90%. Previous investigations suggest factors such as practice setting and size, fellowship training, years in practice, volume, and location of practice correlate with malpractice risk. In contrast, we were unable to identify any relationship between the type, size, or location of practice, fellowship training, or surgery volume and the risk of an adult reconstruction surgeon being named as a defendant in a malpractice suit. LEVEL OF EVIDENCE: Level V, economic and decision analysis. See the Guidelines for Authors for a complete description of levels of evidence.

Total hip arthroplasty (THA), an effective treatment for patients with end-stage arthritic hip conditions, provides dramatic pain relief, enhances mobility, and restores function.The success of THA in older patients, in concert with improvements in techniques and biomaterials, has stimulated demand for this procedure in younger, more active patients hoping to regain full activity. Although young age remains a relative contraindication to THA, the weight of this factor has diminished. Several investigators have reported results of low-friction arthroplasty in young patients. Unfortunately, the value of these studies is limited because of heterogeneous hip pathology in the younger groups, particularly given that preoperative pathology has proved to significantly affect implant survival. In this review of the literature, we focus on THA survival in young, active patients with a preoperative diagnosis of noninflammatory osteoarthritis.

OBJECTIVE: To assess the impact of inpatient fragility fracture education on follow-up care at an urban tertiary care center with a multidisciplinary inpatient education and follow-up initiative. METHODS: Participants included 139 patients with low energy fragility fractures who were identified, educated, and referred for follow-up by a coordinator. Education consisted of an initial 30 to 40-minute session with the patient and family followed by 10-minute sessions on subsequent hospitalization days. Follow-up activities with primary care physicians (PCPs) and orthopaedic surgeons were documented. RESULTS: Of the 129 patients still living at the end of the study period, 74 (57%) had followed up with their PCP while 93 (72%) had returned to see their orthopaedic surgeons. Women were 2.7 times more likely than men to address the cause of the fragility fracture (95% confidence interval [CI], 1.13-6.97; P = .038) and were 6.18 times more likely to receive treatment or to have bone mineral density (BMD) testing (95% CI, 1.29-29.61; P = .023). Patients previously treated for osteoporosis were 3 times more likely to follow-up with their PCPs (95% CI, 1.10-8.02; P = .02), while patients who had previous BMD tests were 4.9 times more likely to follow-up (95% CI, 1.89-12.79; P = .001). We observed a 42% reduction in the likelihood of seeing a physician for osteoporosis evaluation for each additional 10 years of age (95% CI, 13%-61% reduction in odds; P = .008). CONCLUSION: In the urban setting, follow-up rates are not sufficiently improved by inpatient education. Improved, persistent communication between the orthopaedic surgeon, PCP, and patient is needed to effectively treat patients and prevent future fractures.

Treatment of isolated compartment osteoarthritis with unicompartmental knee arthroplasty (UKA) has had mixed reported results and still remains a controversial procedure. More recently, adherence to more stringent patient selection criteria and refined surgical technique has resulted in improved clinical outcomes and survivorship. The popularization of UKA as a more tissue-sparing procedure and minimally invasive alternative to total knee arthroplasty has also played an integral role in its recent resurgence. This review details the history, evolution, and varied results of UKA. Many different prostheses have emerged, some with exceptional long-term results. Long-term prospective analyses will be critical in determining the role of UKA as a mainstay in the treatment of single compartment knee degenerative joint disease.