Physical and Mental Demand During Total Hip Arthroplasty

This study compared differences in (1) task duration; (2) biometric parameters (ie, caloric energy expenditure, heart rate); and (3) subjective measures of mental as well as physical demand of robotic-assisted total hip arthroplasty (THA) and manual THA. A total of 12 THAs were performed on 6 cadaveric specimens by two surgeons using a wearable technology to track biometric parameters and taking a questionnaire to compare the physical and mental demands. The results of our study suggest that as compared with manual techniques, robotic assistance for THA may reduce mental and physical fatigue.

Mid-Term Survival of Total Hip Arthroplasty in Patients Younger Than 55-year-old

BACKGROUND

Survivorship of total hip arthroplasty (THA) in younger patients is concerning given the inverse relationship between age and lifetime risk for revision. The purpose of this study is to determine if risk of revision has improved for patients aged 55 years or younger who undergo primary THA using modern polyethylene liners.

METHODS

A retrospective review identified 2,461 consented patients (2,814 hips) with minimum 2-year follow-up who underwent primary THA at our institution between September 2007 and August 2014 using components from a single manufacturer (Zimmer Biomet), all with vitamin E-infused highly crosslinked polyethylene acetabular inserts. There were 561 patients (643 THA; 23%) aged 55 or younger and 1,900 (2,171 THA; 77%) older than 55.

RESULTS

Mean follow-up was 5.0 years for both groups. There were more male patients in the younger (55%) than older (41%) group. Body mass index (BMI) was higher in younger patients independent of gender. Improvement in Harris hip score (HHS) was similar between groups. Kaplan-Meier survival to endpoint of all cause revision was similar between groups at 12 years (P = .8808) with 97.5% (95% CI: ±0.7%) for younger versus 97.1% (95% CI: ±0.6%) for older patients. Most frequent reason for revision overall was periprosthetic femoral fracture (21; 0.75%); univariate analysis revealed risk factors were female gender (P = .28) and age ≥65 years (P = .012).

CONCLUSION

Use of modern polyethylene, such as vitamin E-stabilized highly cross-linked, liners during THA may improve survivorship in younger patients undergoing THA. Younger patients undergoing primary THA with highly cross-linked polyethylene liners had no increased rate of revision at mid-term follow-up.

Isolated subtalar dislocation

EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Understand the etiology, epidemiology, and importance of treatment of isolated subtalar dislocation. 2. Understand the most common management practices when treating isolated subtalar dislocation and identify variations in management that may affect prognosis. 3. Consolidate reported patient outcomes as they pertain to variations in management strategies to explore which practices may provide the best prognosis after treatment of isolated subtalar dislocation. 4. Highlight the importance of further study to determine the best course of management for isolated subtalar dislocation regarding variables in treatment. This study reviews the literature on isolated subtalar dislocation published within the past 5 years. Variation in management existed mostly in the categories of treatment choice, immobilizer type, and period of immobilization, with closed reduction, closed reduction and percutaneous pinning, below-knee casting, less than 4 weeks of immobilization, and 6 weeks of immobilization reporting good results. The good results described after the addition of percutaneous K-wire fixation to the initial treatment method of isolated subtalar dislocation, immobilization via below-knee casting, and shorter periods of immobilization suggest that these practices may be useful for the treatment of this rare injury.