Surgical Techniques
Direct Anterior Cup-Half Cage for Revision and Complex Primary Total Hip Arthroplasty: Surgical Technique
As surgeons' comfort with the direct anterior approach (DAA) for total hip arthroplasty continues to increase, there is a growing interest in performing complex surgeries through this approach. Acetabular bone loss and/or pelvic discontinuity in the primary or revision setting often requires specialized implants such as a cup-cage construct. We describe our surgical technique for implanting modified cup-half cages through the DAA and show 2 case examples of how this technique was utilized in the setting of complex acetabular bone loss.Utilizing a Prefabricated Antibiotic-Impregnated Articular Spacer Combined With an Intramedullary Device for Significant Femoral Bone Loss in Periprosthetic Hip Infection
Periprosthetic joint infection can be a devastating complication following total hip arthroplasty, which often requires a lengthy treatment course that is fraught with complications. There are various types of antibiotic-impregnated spacers that can be used to treat periprosthetic hip infections, with articulating spacers being utilized frequently with the goal of preserving patient range of motion and functionality. Many of these articulating spacers have pre-set sizes and stem options, which accommodate the majority of patients.Tibial Tubercle Screw Fixation on Custom Metaphyseal Cone: Surgical Tip in Severe Metaphyseal Tibia Bone Loss
Tibial tubercle osteotomy (TTO) facilitates exposure in knee arthroplasty revision. However, it comes with complications, especially if it invades the intramedullary canal. Most revisions are characterized by compromised femur and/or tibia bone stock, and the use of metaphyseal cones or sleeves for implant fixation has become increasingly frequent. Several methods of fixation of the tibial tubercle have been proposed, such as screw fixation, cerclage wiring, and suture repair. Despite screws providing the strongest fixation for TTO, their placement around a tibial intramedullary stem or a metaphyseal tibial cone may be difficult.Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision Surgery
Cement removal during hip or knee arthroplasty revision surgery is technically demanding and prone to severe complications such as periprosthetic fractures, incomplete cement removal, or perforations. Several alternative techniques have been developed to enable complete, accurate, and safe removal of cement from bone, including osteotomies and cortical windows, endoscopic instruments, ultrasound devices, lithotripsy, and laser-assisted removal. We describe a cement-on-cement technique with a sterile, single-use tool for cement removal.Conversion of Hip Arthrodesis Using Robotic Arm Technology
Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.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.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 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.Ultrasound gel minimizes third body debris with partial hardware removal in joint arthroplasty
Hundreds of thousands of revision surgeries for hip, knee, and shoulder joint arthroplasties are now performed worldwide annually. Partial removal of hardware during some types of revision surgeries may create significant amounts of third body metal, polymer, or bone cement debris. Retained debris may lead to a variety of negative health effects including damage to the joint replacement. We describe a novel technique for the better containment and easier removal of third body debris during partial hardware removal.Extraction of a well fixed but fractured ceramic acetabular liner
Ceramic fractures have been reported to occur in hip replacements, but the techniques used to extract a well fixed but fractured component are not commonly described. We present a case of ceramic liner fracture and validate a modification of a previously reported extraction technique that allowed us to save the acetabular cup and insert a polyethylene liner. With an increasing trend in ceramic bearing usage, it is likely that the number of ceramic liner fractures will increase and therefore knowledge of successful extraction techniques will be desirable.
