Surgical Techniques
Single-Sided Reciprocating Saw for Tibial Component Removal During Revision Total Knee Arthroplasty
Revision total knee arthroplasty often necessitates removing well-fixed components. Tibial tray removal is challenging becaue of 1) physical barriers posed by the component pegs, keel, or stem in accessing the implant-bone interface circumferentially and 2) proximity of vulnerable structures including the patellar tendon, collateral ligaments, popliteal artery, and distal femur. In this report, we present a step-by-step technique for removal of a well-fixed tibial component using a single-sided reciprocating saw.A Simple, Personalized Opioid Stratification Pathway Dramatically Reduces Opioid Utilization
Orthopaedic surgeons account for the largest proportion of opioid prescriptions in the United States among surgical specialties. In total joint arthroplasty, increased opioid use has been associated with poorer clinical and functional outcomes. Despite an abundance of literature on opioid mitigation strategies, most fail to provide personalized prescriptions. Typically, most protocols prescribe the same opioid regimen regardless of patient factors or the extent of the planned procedure. We present a simple opioid stratification pathway that can be used by physicians and office staff as they prepare patients for arthroplasty.Combating the Opioid Epidemic: Experience with a Single Prescription for Total Joint Arthroplasty
Despite advances in perioperative total joint arthroplasty (TJA) pain protocols, opiates continue to play a major role in postoperative pain control. This brief communication reports our experience with a restrictive opioid protocol allowing patients only a single prescription of low-dose opioids.A Vertical Measurement System to Predict the Change in Leg Length in Total Hip Arthroplasty
The management of leg lengths in total hip arthroplasty continues to challenge orthopaedic surgeons. The aim of this study is to test the reliability of a measuring device used to measure the resected femoral head and how the resulting intra operatively calculated change in leg length compares to the radiographically measured change in leg length. Four orthopaedic surgeons measured 20 femoral heads and the intra class coefficients of the raters were between 0.955 and 0.990 with a mean difference less 1 mm, indicating the reliability of the device.A Novel Method of Determining Acetabular Component Size to Guide Explant in Revision Hip Arthroplasty
Revision hip arthroplasty is a frequently performed procedure and is projected to increase annually. Removal of a well-fixed acetabular component can involve loss of much needed bone stock. Contemporary instruments allow acetabular removal with minimal morbidity; however, their use requires accurate knowledge of the component size. We describe a technique that allows sizing to be determined accurately, without specialized equipment, in situations where component details are unavailable. Our technique multiplies ratio of head:cup on pre-operative X-ray by the diameter of the index femoral head which is removed intra-operatively to predict index cup size.Drug-Induced Thrombocytopenia Secondary to Commonly Used Antibiotics in Total Joint Arthroplasty
Drug-induced thrombocytopenia secondary to antibiotic exposure is a rare complication more commonly associated with other medications. In this review, we present a case of antibiotic-induced thrombocytopenia and discuss the clinical picture and approach to identifying the complication. With increasing use of antibiotics that may be associated with drug-induced thrombocytopenia in perioperative prophylaxis protocols, surgeons need to be cognizant of this cause of thrombocytopenia in the postoperative patient.Total knee arthroplasty in patients with multiple hereditary exostoses
We present a case report of a patient with severe valgus deformity of the right knee due to multiple hereditary exostoses (MHEs) treated with total knee arthroplasty (TKA). The surgical management of MHE affecting the knee encompasses exostoses resection, joint deformity rectification, and limb-length discrepancy alignment. On rare occasions, distraction osteogenesis and TKA have been used to correct valgus deformities of the knee. TKA in MHE patients with knee involvement has only been described in 6 cases.Circular hexapod external fixation for periprosthetic tibial fracture
A poor soft tissue envelope often accompanies periprosthetic tibia fracture around a well-fixed total knee arthroplasty and the tibial stem leaves little room for screw fixation. This article describes the practicability and effectiveness of a novel surgical technique using circular hexapod external fixation, in patients with this clinical scenario. It was applied for fixation of periprosthetic tibia fracture in 2 patients. Contact between the external fixation pins and the prosthesis was avoided.
