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Heckmann ND, Chung BC, Liu KC, Chen XT, Lovro LR, Kistler NM, White E, Christ AB, Longjohn DB, Oakes DA, Lieberman JR. Metal artifact reduction sequence-MRI abnormalities in asymptomatic patients with dual-mobility hip prostheses. Bone Joint J 2024; 106-B:89-96. [PMID: 38423076 DOI: 10.1302/0301-620x.106b3.bjj-2023-0643.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Aims Modular dual-mobility (DM) articulations are increasingly used during total hip arthroplasty (THA). However, concerns remain regarding the metal liner modularity. This study aims to correlate metal artifact reduction sequence (MARS)-MRI abnormalities with serum metal ion levels in patients with DM articulations. Methods A total of 45 patients (50 hips) with a modular DM articulation were included with mean follow-up of 3.7 years (SD 1.2). Enrolled patients with an asymptomatic, primary THA and DM articulation with over two years' follow-up underwent MARS-MRI. Each patient had serum cobalt, chromium, and titanium levels drawn. Patient satisfaction, Oxford Hip Score, and Forgotten Joint Score-12 (FJS-12) were collected. Each MARS-MRI was independently reviewed by fellowship-trained musculoskeletal radiologists blinded to serum ion levels. Results Overall, two patients (4.4%) had abnormal periprosthetic fluid collections on MARS-MRI with cobalt levels > 3.0 μg/l. Four patients (8.9%) had MARS-MRI findings consistent with greater trochanteric bursitis, all with cobalt levels < 1.0 μg/l. A seventh patient had a periprosthetic fluid collection with normal ion levels. Of the 38 patients without MARS-MRI abnormalities, 37 (97.4%) had cobalt levels < 1.0 μg/l, while one (2.6%) had a cobalt level of 1.4 μg/l. One patient (2.2%) had a chromium level > 3.0 μg/l and a periprosthetic fluid collection. Of the 41 patients with titanium levels, five (12.2%) had titanium levels > 5.0 μg/l without associated MARS-MRI abnormalities. Conclusion Periprosthetic fluid collections associated with elevated serum cobalt levels in patients with asymptomatic DM articulations occur infrequently (4.4%), but further assessment is necessary due to implant heterogeneity.
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Affiliation(s)
- Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Brian C Chung
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Kevin C Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | | | - Luke R Lovro
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Natalie M Kistler
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Eric White
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Donald B Longjohn
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Daniel A Oakes
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck Medical Center of the University of Southern California, Los Angeles, California, USA
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Lovro LR, Kang HP, Bolia IK, Homere A, Weber AE, Heckmann N. Knee Arthroscopy After Total Knee Arthroplasty: Not a Benign Procedure. J Arthroplasty 2020; 35:3575-3580. [PMID: 32758379 DOI: 10.1016/j.arth.2020.06.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Outcomes of knee arthroscopy (KA) after total knee arthroplasty (TKA) have been limited to small case series with short-term follow-up. The purpose of this study is to report the outcomes of patients who undergo a KA after a TKA using a large longitudinal database. METHODS The PearlDiver Medicare database was queried for patients who underwent a KA procedure after a TKA on the ipsilateral extremity. A randomly selected control group was created by matching controls to cases in a 3:1 ratio based on age, gender, year of procedure, and Elixhauser Comorbidity Index. Revision for infection and all-cause revision were used as end points. RESULTS A total of192 TKA patients who underwent a subsequent KA (TKA + KA group) were compared to 571 TKA patients who did not have a subsequent KA (TKA - KA group). The incidence of revision for infection was 6.3% in the TKA + KA group compared to 2.2% in the TKA - KA group (odds ratio, 2.87; P = .009). The incidence of all-cause revision was 18.8% in the TKA + KA group compared to 5.1% in the TKA - KA group (odds ratio, 4.34; P < .001). CONCLUSION KA after TKA was associated with increased infection-related and all-cause revision. The association between KA and subsequent infection requires further investigation.
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Affiliation(s)
- Luke R Lovro
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Hyunwoo P Kang
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Department of Orthopaedic Surgery-Sports Medicine, Los Angeles, CA
| | - Andrew Homere
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Department of Orthopaedic Surgery-Sports Medicine, Los Angeles, CA
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Grant TW, Lovro LR, Licini DJ, Warth LC, Ziemba-Davis M, Meneghini RM. Cementless Tapered Wedge Femoral Stems Decrease Subsidence in Obese Patients Compared to Traditional Fit-and-Fill Stems. J Arthroplasty 2017; 32:891-897. [PMID: 27793497 DOI: 10.1016/j.arth.2016.09.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/01/2016] [Accepted: 09/08/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral component stability and resistance to subsidence is critical for osseointegration and clinical success in cementless total hip arthroplasty. The purpose of this study was to radiographically evaluate the anatomic fit and subsidence of 2 different proximally tapered, porous-coated modern cementless femoral component designs. METHODS A retrospective cohort study of 126 consecutive cementless total hip arthroplasties was performed. Traditional fit-and-fill stems were implanted in the first 61 hips with the remaining 65 receiving morphometric tapered wedge stems. Preoperative bone morphology was radiographically assessed by the canal flare index. Canal fill in the coronal plane, subsidence, and the sagittal alignment of stems was measured digitally on immediate and 1-month postoperative radiographs. RESULTS Demographics and canal flare indices were similar between groups. The percentage of femoral canal fill was greater in the tapered wedge compared to the fit-and-fill stem (P = .001). There was significantly less subsidence in the tapered wedge design (0.3 mm) compared to the fit-and-fill design (1.1 mm) (P = .001). Subsidence significantly increased as body mass index (BMI) increased in the fit-and-fill stems, a finding not observed in the tapered wedge design (P = .013). CONCLUSION An anatomically designed morphometric tapered wedge femoral stem demonstrated greater axial stability and decreased subsidence with increasing BMI than a traditional fit-and-fill stem. The resistance to subsidence, irrespective of BMI, is likely due to the inherent axial stability of a tapered wedge design and may be the optimal stem design for obese patients.
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Affiliation(s)
- Tanner W Grant
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luke R Lovro
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - David J Licini
- IU Health Bloomington Hospital, Orthopedics, Indiana University Health Southern Indiana Physicians, Bloomington, Indiana
| | - Lucian C Warth
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - Mary Ziemba-Davis
- IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
| | - Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; IU Health Saxony Hospital, Orthopedics, Indiana University Health Physicians Orthopedics and Sports Medicine, Fishers, Indiana
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Abstract
Liposomal bupivacaine has gained popularity for pain control after total knee arthroplasty (TKA), yet its true efficacy remains unproven. We compared the efficacy of two different periarticular injection (PAI) techniques for liposomal bupivacaine with a conventional PAI control group. This retrospective cohort study compared consecutive patients undergoing TKA with a manufacturer-recommended, optimized injection technique for liposomal bupivacaine, a traditional injection technique for liposomal bupivacaine, and a conventional PAI of ropivacaine, morphine, and epinephrine. The optimized technique utilized a smaller gauge needle and more injection sites. Self-reported pain scores, rescue opioids, and side effects were compared. There were 41 patients in the liposomal bupivacaine optimized injection group, 60 in the liposomal bupivacaine traditional injection group, and 184 in the conventional PAI control group. PAI liposomal bupivacaine delivered via manufacturer-recommended technique offered no benefit over PAI ropivacaine, morphine, and epinephrine. Mean pain scores and the proportions reporting no or mild pain, time to first opioid, and amount of opioids consumed were not better with PAI liposomal bupivacaine compared with PAI ropivacaine, morphine, and epinephrine. The use of the manufacturer-recommended technique for PAI of liposomal bupivacaine does not offer benefit over a conventional, less expensive PAI during TKA.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Deren Bagsby
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Philip H Ireland
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Luke R Lovro
- Department of Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
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Meneghini RM, Ziemba-Davis MM, Lovro LR, Ireland PH, Damer BM. Can Intraoperative Sensors Determine the "Target" Ligament Balance? Early Outcomes in Total Knee Arthroplasty. J Arthroplasty 2016; 31:2181-7. [PMID: 27155997 DOI: 10.1016/j.arth.2016.03.046] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/25/2016] [Accepted: 03/25/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The optimal "target" ligament balance for each patient undergoing total knee arthroplasty (TKA) remains unknown. The study purpose was to determine if patient outcomes are affected by intraoperative ligament balance measured with force-sensing implant trials and if an optimal "target" balance exists. METHODS A multicenter, retrospective study reviewed consecutive TKAs performed by 3 surgeons. TKA's were performed with standard surgical techniques and ligament releases. After final implants were made, sensor-embedded smart tibial trials were inserted, and compartment forces recorded throughout the range of motion. Clinical outcome measures were obtained preoperatively and at 4 months. Statistical analysis correlated ligament balance with clinical outcomes. RESULTS One hundred eighty-nine consecutive TKAs were analyzed. Patients were grouped by average medial and lateral compartment force differences. Twenty-nine TKAs (15%) were balanced within 15 lbs and 53 (28%) were "balanced" greater than 75 lbs. Greater improvement in University of California Los Angeles activity level was associated with a mediolateral force difference <60 lbs. (P = .006). Knee Society objective, function, and satisfaction scores, and self-reported health state were unrelated to mediolateral balance in the knee. CONCLUSION Intraoperative force-sensing has potential in providing real-time objective data to optimize TKA outcomes. These data support some early outcomes may improve by balancing TKAs within 60 lbs difference. Close follow-up is warranted to determine if gait pattern adaptations affect longer term outcomes with greater or less ligament "imbalance."
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Affiliation(s)
- Robert M Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Physicians Orthopedics and Sports Medicine, IU Health Saxony Hospital, Fishers, Indiana
| | - Mary M Ziemba-Davis
- Indiana University Health Physicians Orthopedics and Sports Medicine, IU Health Saxony Hospital, Fishers, Indiana
| | - Luke R Lovro
- Indiana University Health Physicians Orthopedics and Sports Medicine, IU Health Saxony Hospital, Fishers, Indiana
| | - Phillip H Ireland
- Indiana University Health Physicians Orthopedics and Sports Medicine, IU Health Saxony Hospital, Fishers, Indiana
| | - Brent M Damer
- Central Indiana Orthopaedics, IU Health Ball Memorial Hospital, Muncie, Indiana
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Meneghini RM, Lovro LR, Wallace JM, Ziemba-Davis M. Response to Letter to the Editor on "Large Metal Heads and Vitamin E Polyethylene Increase Frictional Torque in Total Hip Arthroplasty". J Arthroplasty 2016; 31:2376. [PMID: 27491445 DOI: 10.1016/j.arth.2016.05.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luke R Lovro
- Indiana University Health Physicians, Indianapolis, Indiana
| | | | - Mary Ziemba-Davis
- Department of Mechanical and Biomedical Engineering, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana
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Meneghini RM, Lovro LR, Wallace JM, Ziemba-Davis M. Large Metal Heads and Vitamin E Polyethylene Increase Frictional Torque in Total Hip Arthroplasty. J Arthroplasty 2016; 31:710-4. [PMID: 26482682 DOI: 10.1016/j.arth.2015.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/01/2015] [Accepted: 09/22/2015] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Trunnionosis has reemerged in modern total hip arthroplasty for reasons that remain unclear. Bearing frictional torque transmits forces to the modular head-neck interface, which may contribute to taper corrosion. The purpose of this study is to compare frictional torque of modern bearing couples in total hip arthroplasty. METHODS Mechanical testing based on in vivo loading conditions was used to measure frictional torque. All bearing couples were lubricated and tested at 1 Hz for more than 2000 cycles. The bearing couples tested included conventional, highly crosslinked (XLPE) and vitamin E polyethylene, CoCr, and ceramic femoral heads and dual-mobility bearings. Statistical analysis was performed using Student t test for single-variable and analysis of variance for multivariant analysis. P ≤ .05 was considered statistically significant. RESULTS Large CoCr metal heads (≥36 mm) substantially increased frictional torque against XLPE liners (P = .01), a finding not observed in ceramic heads. Vitamin E polyethylene substantially increased frictional torque compared with XLPE in CoCr and ceramic heads (P = .001), whereas a difference between conventional and XLPE was not observed (P = .69) with the numbers available. Dual-mobility bearing with ceramic inner head demonstrated the lowest mean frictional torque of all bearing couples. CONCLUSION In this simulated in vivo model, large-diameter CoCr femoral heads and vitamin E polyethylene liners are associated with increased frictional torque compared with smaller metal heads and XLPE, respectively. The increased frictional torque of vitamin E polyethylene and larger-diameter femoral heads should be considered and further studied, along with reported benefits of these modern bearing couples.
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Affiliation(s)
- R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Fishers, Indiana; Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Luke R Lovro
- Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
| | - Joseph M Wallace
- Department of Biomedical Engineering, Purdue School of Engineering and Technology at Indiana University-Purdue University, Indianapolis, Indiana
| | - Mary Ziemba-Davis
- Orthopedics and Sports Medicine, Indiana University Health Physicians, Fishers, Indiana
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Meneghini RM, Lovro LR, Smits SA, Ireland PH. Highly Cross-Linked Versus Conventional Polyethylene in Posterior-Stabilized Total Knee Arthroplasty at a Mean 5-Year Follow-up. J Arthroplasty 2015; 30:1736-9. [PMID: 26021902 DOI: 10.1016/j.arth.2015.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/28/2015] [Accepted: 05/01/2015] [Indexed: 02/01/2023] Open
Abstract
Concerns of highly cross-linked polyethylene (XLPE) in total knee arthroplasty (TKA) exist regarding fatigue resistance and oxidation, particularly in posterior-stabilized (PS) designs. A prospective cohort study of 114 consecutive PS TKAs utilized conventional polyethylene in 50 knees and second-generation annealed XLPE in 64 TKAs. Clinical (Short-Form 36, Knee Society Scores, and LEAS) and radiographic outcomes were evaluated at a mean of 5 years in 103 TKAs. Mean KSS scores were 12 points higher (P=0.01) and SF-36 physical function subset 14 points higher (P=0.005) in the XLPE group. There was no radiographic osteolysis or mechanical failure related to the tibial polyethylene in either group. At 5-year follow-up, no deleterious effects related to highly cross-linked posterior stabilized tibial polyethylene inserts were observed.
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Affiliation(s)
- R Michael Meneghini
- Indiana University Health Physicians, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Luke R Lovro
- Indiana University Health Physicians, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Shelly A Smits
- Indiana University Health Physicians, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
| | - Philip H Ireland
- Indiana University Health Physicians, Indianapolis, Indiana; Indiana University School of Medicine, Indianapolis, Indiana
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Ying W, Gamage LSR, Lovro LR, Herndon JW, Jenkins NW, Herndon JW. Direct synthesis of arenecarboxamides through Friedel-Crafts acylation using ureas. Tetrahedron Lett 2014; 55:4541-4544. [PMID: 25071296 PMCID: PMC4111261 DOI: 10.1016/j.tetlet.2014.06.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The reaction of urea derivatives that contain the phenothiazine unit with trifluoromethanesulfonic anhydride in the presence of electron-rich aromatic compounds leads to the formation of arenecarboxamides. The reaction has been successfully demonstrated for several inter- and intramolecular systems.
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Affiliation(s)
- Wenjiang Ying
- Department of Chemistry and Biochemistry; New Mexico State University, MSC 3C, Las Cruces, NM 88003, USA
| | - Lalith S. R. Gamage
- Department of Chemistry and Biochemistry; New Mexico State University, MSC 3C, Las Cruces, NM 88003, USA
| | - Luke R. Lovro
- Department of Chemistry and Biochemistry; New Mexico State University, MSC 3C, Las Cruces, NM 88003, USA
| | - James W. Herndon
- Department of Chemistry and Biochemistry; New Mexico State University, MSC 3C, Las Cruces, NM 88003, USA
| | - Nathan W. Jenkins
- Department of Chemistry and Biochemistry; New Mexico State University, MSC 3C, Las Cruces, NM 88003, USA
| | - James W. Herndon
- Department of Chemistry and Biochemistry; New Mexico State University, MSC 3C, Las Cruces, NM 88003, USA
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