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Barrett W.,Valley Orthopaedics | Hoeffel D.,Summit Orthopaedics | Dalury D.,Towson Orthopaedics | Mason J.B.,OrthoCarolina | And 2 more authors.
Journal of Arthroplasty

Patient specific instrumentation (PSI) was developed to increase total knee arthroplasty (TKA) accuracy and efficiency. The study purpose was to compare immediate post-operative mechanical alignment, achieved using PSI, with conventional and computer assisted surgery (CAS) instruments in high volume TKA practices. This prospective, multicenter, non-randomized study accrued 66 TKA patients using PSI. A computed tomography (CT) based algorithm was used to develop the surgical plan. Sixty-two percent were females, 99% were diagnosed with osteoarthritis, average age at surgery was 66. years, and 33 was the average body mass index. A historical control group was utilized that underwent TKA using conventional instruments (n. =. 86) or CAS (n. =. 81), by the same set of surgeons. Postoperative mechanical alignment was comparable across the groups. Operative time mean and variance were significant. © 2014 Elsevier Inc. Source

Wang H.,University of North Carolina at Charlotte | Fleischli J.E.,OrthoCarolina | Zheng N.N.,University of North Carolina at Charlotte
Clinical Biomechanics

Background: Normal ambulatory kinematics of the knee joint is often not fully restored after anterior cruciate ligament reconstruction, which may increase the risk for cartilage degeneration and premature osteoarthritis in the involved knees. Lower limb dominance may have impacts on knee joint kinematics after anterior cruciate ligament reconstruction, which may lead to a different prevalence of cartilage degeneration. This study aimed to evaluate the knee joint kinematics among patients with reconstruction on the dominant and non-dominant side. Methods: Forty-one subjects with unilateral anterior cruciate ligament reconstruction (19 dominant, 22 non-dominant) were recruited after being discharged from rehabilitation programs. Twenty healthy subjects were recruited as the control group. Six degrees-of-freedom tibiofemoral motion during level walking was determined using a redundant point cluster-based marker set. Tibiofemoral joint motion and its bilateral differences were compared within each group and between groups. Findings: The non-dominant reconstructed knees had less extension compared to their contralateral knees at heel strike and during middle stance phase (P = 0.02); whereas, the dominant reconstructed knees exhibited significantly reduced varus rotation (- 2.1° on mean, P = 0.027) and internal tibial rotation (P = 0.034) compared to their contralateral knees during both stance and swing phases. Interpretation: The results show that different kinematics has been developed between the involved dominant and non-dominant knees after anterior cruciate ligament reconstruction, especially the secondary rotations. The differences are consistent with the unequal prevalence of cartilage degeneration in the knee joint. The findings demonstrated that the lower limb dominance had a significant effect on post-surgery knee kinematics. © 2011 Elsevier Ltd. All rights reserved. Source

Melvin J.S.,OrthoCarolina | Karthikeyan T.,Lexington Clinic Orthopedics Sports Medicine Center | Cope R.,OrthoCarolina Research Institute Inc. | Fehring T.K.,OrthoCarolina Hip and Knee Center
Journal of Arthroplasty

Between 2001 and 2011, 1168 revision hip arthroplasties were reviewed for "early" failures within 5. years of the primary total hip arthroplasty (THA). 24.1% underwent revision within 5. years of index THA. Aseptic loosening, infection, instability, metallosis, and fracture were common modes of failure. In our previous report from 1986 to 2000, 33% were "early" revisions, with instability and aseptic loosening accounting for over 70% of these early failures. While the proportion of "early" revisions decreased 9% from our previous report, this rate remains alarming. The emergence of metallosis and aseptic loosening of monoblock metal on metal shells as leading causes of early failures is concerning. This report suggests caution in the early adoption of new innovations before evidence based medicine is available to justify the risk of their use. © 2014 Elsevier Inc. Source

Taunton M.J.,Mayo Medical School | Fehring T.K.,OrthoCarolina | Edwards P.,Florida Orthopedic Institute | Bernasek T.,Florida Orthopedic Institute | And 2 more authors.
Clinical Orthopaedics and Related Research

Background: Pelvic discontinuity is an increasingly common complication of THA. Treatments of this complex situation are varied, including cup-cage constructs, acetabular allografts with plating, pelvic distraction technique, and custom triflange acetabular components. It is unclear whether any of these offer substantial advantages. Questions/purposes: We therefore determined (1) revision and overall survival rates, (2) discontinuity healing rate, and (3) Harris hip score (HHS) after treatment of pelvic discontinuity with a custom triflange acetabular component and (4) the cost of this reconstructive operation compared to other constructs. Methods: We retrospectively reviewed 57 patients with pelvic discontinuity treated with revision THA using a custom triflange acetabular component. We reviewed operative reports, radiographs, and clinical data for clinical and radiographic results. We also performed a cost comparison with utilization of other techniques. Minimum followup was 24 months (average, 65 months; range, 24-215 months). Results: Fifty-six of 57 (98%) were free of revision for aseptic loosening at latest followup. Fifty-four (95%) were free of revision of the triflange component for any reason. Thirty-seven (65%) were free of revision for any reason. Twenty-eight (49%) were free of revision for any reason and free of any component migration and had a healed discontinuity. Forty-six (81%) had a stable triflange component with a healed pelvic discontinuity. Average HHS was 74.8. The costs of the custom triflange implants and a Trabecular Metal ® cup-cage construct were equivalent: $12,500 and $11,250, respectively. Conclusions: In this group of patients with osteolytic pelvic discontinuity, triflange implants provided predictable mid-term fixation at a cost equivalent to other treatment methods. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. © 2011 The Association of Bone and Joint Surgeons® References :. Source

Steele G.D.,OrthoCarolina | Fehring T.K.,OrthoCarolina | Odum S.M.,OrthoCarolina Research Institute Inc. | Dennos A.C.,OrthoCarolina Research Institute Inc. | Nadaud M.C.,Knoxville Orthopedic Clinic
Journal of Arthroplasty

The ASR (articular surface replacement) XL (DePuy, Warsaw, Ind) metal-on-metal hip arthroplasty offers the advantage of stability and increased motion. However, an alarming number of early failures prompted the evaluation of patients treated with this system. A prospective study of patients who underwent arthroplasty with the ASR XL system was performed. Patients with 2-year follow-up or any revision were included. Failure rates, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and radiographs were evaluated. Ninety-five patients (105 hips) were included. There were 16 revisions. Thirteen (12%) were aseptic acetabular failures. Eight were revised for aseptic loosening; 4, for metallosis; 1, for malposition; 2, for infection; and 1, for periprosthetic fracture. Mean time to revision was 1.6 years (0.18-3.4 years). The ASR XL with a revision rate of 12% is the second reported 1 piece metal-on-metal system with a significant failure rate at early follow-up. This particular class of implants has inherent design flaws that lead to early failure. Source

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