Background Polyethylene (PE) wear debris can cause periprosthetic osteolysis and late failure after total hip arthroplasty, but long-term wear behavior of conventional non–cross-linked PE remains unclear. Methods We reviewed 85 consecutive cementless total hip arthroplasties performed between 2002 and 2005 using ArCom non–cross-linked PE liners (Biomet Inc., Warsaw, IN). After excluding 31 hips lost to follow-up and 5 revised hips, 49 hips (45 patients) with ≥20 years of follow-up were analyzed. Femoral head penetration was measured using PolyWare (Draftware Inc., Vevay, IN) by three independent observers. The first postoperative year was defined as the bedding-in phase, and subsequent penetration as the steady-state phase (SSP). Associations between wear and patient, implant, surgical, and clinical factors were assessed. Results The mean Japanese Orthopaedic Association score improved from 39.6 ± 10.6 preoperatively to 84.4 ± 12.9 at 20 years (P < .001). Osteolysis was observed in 18 hips. Mean bedding-in phase and SSP wear rates were 0.235 ± 0.155 mm/y and 0.031 ± 0.023 mm/y, respectively. SSP wear correlated linearly with postoperative time (R2 = 0.99). Hips with higher SSP wear (>0.025 mm/y) had higher 20-year Japanese Orthopaedic Association gait (P = .033), activities of daily living (P = .018), and total scores (P = .013). Charnley category A had higher SSP wear than category B (P = .024), whereas osteolysis did not affect wear rates. Conclusions ArCom conventional PE showed a nearly constant SSP wear rate over 20 years. Exploratory analyses suggested associations with functional status and Charnley category, but not with other patient, implant, or surgical factors.
Background Postoperative dislocation represents a recognized complication following total hip arthroplasty (THA). Standard initial management is closed reduction, with revision arthroplasty reserved for persistent instability. This study examined current treatment patterns for early THA dislocation and evaluated preoperative patient risk factors and complications. Methods A retrospective review of 4904 consecutive primary elective THA patients treated at a single institution between May 15, 2020, and May 30, 2025, was performed. Dislocations occurring within 90 days from the primary case were identified. Patients with a diagnosis of dysplasia, cancer, conversion, or fracture were excluded. Categorical outcomes were compared with chi-squared tests. Logistic analysis assessed correlations between comorbidities and dislocation risk. Results 38 patients (0.77%) dislocated within 90 days. Patients who dislocated had a lower Risk Assessment and Prediction Tool score and Brief Resiliency Scale (BRS). The BRS was lower in those who dislocated (3.2 v 3.9, P < .001), indicating a reduced capacity for recovery. The Risk Assessment and Prediction Tool score was also lower (8.2 v 9.1, P = .021), indicative of a higher disease burden. Patients who underwent a direct anterior approach had reduced rates of dislocation compared to the posterior approach (0.43% v 0.86%), which is not statistically significant (P = .336). Closed reduction alone was sufficient for 60.5% of dislocations. For those requiring surgical treatment, most (60%) were revised to a constrained liner. Conclusions In a large contemporary cohort, over half of early THA dislocations were managed successfully with closed reduction alone. THA dislocations are likely due to a combination of factors, but resiliency has a probable role.
Persistent patellar instability after total knee arthroplasty due to extensor mechanism malalignment poses a significant clinical challenge when prosthetic components are well-fixed and adequately aligned. Revision arthroplasty carries considerable morbidity in these patients. We describe a reproducible soft tissue reconstruction technique using a fresh-frozen Achilles tendon allograft without bone block to reconstruct the medial retinacular stabilizers and redirect the extensor force vector. The allograft is fixed at the femoral medial patellofemoral ligament attachment, passed across the anterior patella, and anchored to provide robust medial restraint without prosthetic revision. In two illustrative cases with ≥24 months of follow-up, central patellar tracking was restored, subjective instability resolved, and no recurrent dislocation or extensor lag occurred.
Background There is a paucity of studies reporting the outcomes of preoperative digital templating in Crowe type 4 hips. The aim of this study was to evaluate the accuracy and clinical role of digital templating applied in Crowe type 4 hips. Methods Patient data were obtained from electronic patient records covering the period from January 2016 to December 2019. Data on side, gender, and age, the amount of femoral shortening, and the size of the implants were noted. Upon two dimensional (2D) digital templating, femoral implant size and positioning, length of femoral shortening, and acetabular implant size and positioning were predicted. The agreement for acetabular size, femoral size, and femoral shortening measurements was tested both for the senior arthroplasty surgeon and the senior resident. Results Senior surgeon templating demonstrated moderate agreement with implanted acetabular (κ = 0.410) and femoral (κ = 0.432) component sizes, outperforming the senior resident (acetabular κ = 0.071; femoral κ = 0.265). Exact acetabular and femoral size prediction by the senior surgeon was 74% and 36%, respectively. Femoral shortening agreement was moderate for the surgeon (intraclass correlation coefficient [ICC] = 0.544) and fair for the resident (ICC = 0.400), whereas interobserver agreement for shortening was excellent (ICC = 0.958). Conclusions The accuracy of 2D digital templating for predicting component size in total hip arthroplasty for Crowe type IV dysplastic hips was limited. Nevertheless, when performed by an experienced surgeon, 2D digital templating remains a valuable preoperative planning tool for planning and estimating the required femoral shortening, while final implant selection should be based on intraoperative findings.
Background Patient-reported ratings can significantly impact patient recruitment. Various factors may affect these ratings on physician review websites (PRWs), including social media presence, academic output, type of fellowship training, and work environment. This study explores how these elements are associated with patient interaction on PRWs. Methods The American Association of Hip and Knee Surgeons directory was searched for all active members and 250 were randomly selected. A summative social media presence score was calculated. Each surgeon’s practice setting, region of practice, medical school, residency, Hirsch index, and ratings on PRWs were recorded. Data were used for statistical comparison. Results A total of 239 surgeons were analyzed (237 men, 2 women). Surgeons in the top 15% of social media presence demonstrated higher average ratings on Google Reviews (4.7 vs 4.4, P < .05) than those in the bottom 85%. Surgeons from top 20 medical schools or residency programs had significantly higher Hirsch index scores (14.7 vs 6.8 and 13.8 vs 6.0, respectively; P < .05), but no consistent advantage in patient ratings. Conclusions Surgeon and practice characteristics may play a role in patient ratings of surgeons. We found that having a higher social media presence was associated with higher patient ratings. Factors such as research productivity, medical school and residency prestige, and region of practice may not play a role in patient ratings. These findings may help adult reconstruction surgeons better understand factors associated with patient engagement and ratings on PRWs. Level of Evidence Level IV.
