Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Intraoperative Periprosthetic Fracture During Total Hip Arthroplasty

Background Periprosthetic fractures around a total hip arthroplasty (THA) can be difficult and morbid complications to treat. As the number of THA procedures performed in the United States continues to rise, the incidence of periprosthetic fractures is expected to increase concurrently. Most of the focus in the literature has been placed on postoperative periprosthetic fractures, but intraoperative fractures are not uncommon and can be challenging to…

Neurovascular Injury in Total Hip Arthroplasty

Introduction Total hip arthroplasty (THA) remains one of the most successful orthopaedic procedures due to its predictable relief of pain and improvement in patient function. For these reasons, coupled with the growing population of elderly patients, the demand for THA is expected to dramatically increase in the near future. Therefore, an understanding of the surgical complications of this procedure is paramount. While neurovascular complications in THA…

Total Hip Arthroplasty Instability

Epidemiology Dislocation subsequent to total hip arthroplasty (THA) represents the most common cause for revision surgery after total hip arthroplasty (rTHA) in the United States. Rates of instability cited in the literature range from 0.5% to 10% after primary THA and from 10% to 25% subsequent to rTHA. In fact, the cumulative risk of dislocation does not remain constant over time; rather, it increases as a…

Component Positioning and Stable Fixation in Total Hip Arthroplasty

Introduction Total hip arthroplasty (THA) is one of the most successful and cost-effective surgical treatments performed within the field of orthopaedics and across all surgical specialties. The main goal of THA is to provide patients with a stable joint that is enduring and painless. In order to achieve such results, it is imperative to obtain adequate fixation of both the femoral and acetabular components in the…

Complications of Exposures for Total Hip Arthroplasty

Introduction Total hip arthroplasty (THA) has evolved significantly since the development of Charnley’s low-fraction arthroplasty in the 1950s and is now one of the most common surgical interventions. , Excellent results have been described with multiple approaches, including the posterior, direct lateral, anterolateral, and direct anterior approaches. While complications can occur irrespective of approach, certain complications have been associated with each approach, albeit sometimes for historical…

Painful Total Knee Arthroplasty Workup

Introduction Total knee arthroplasty (TKA) has seen vast improvement over the past several decades with respect to implant design, improved polyethylene wear properties and advances in surgical technique, all of which have led to excellent survivorship. Despite these improvements, patient satisfaction following TKA continues to be a concern, with approximately 19% of patients not satisfied with their TKA. Patient satisfaction following TKA is based on several…

Patellofemoral Arthroplasty

Introduction Isolated patellofemoral joint (PFJ) arthritis affects ∼10% of the population over the age of 40, with a mean age of onset reported between 40 and 55 years old. There is a relative preponderance in women compared with men, which may be a result of the increased frequency of subtle PF dysplasia and malalignment commonly observed in women. Despite its incidence, PFJ arthritis is rarely debilitating…

Unicompartmental Knee Arthroplasty

Introduction Unicompartmental knee arthroplasty (UKA) was first introduced as an alternative to tibial osteotomy for unicompartmental osteoarthritis in the 1970s. , Inconsistent early outcomes diminished enthusiasm at a time when total knee arthroplasty (TKA) was also evolving and promising results were being published. , Consequently, many surgeons abandoned UKA in favor of TKA. Early failures were likely related to unclear indications and primitive equipment. Improved implant…

Periprosthetic Knee Fractures

Introduction Total knee arthroplasty (TKA) has been shown to be an effective and reliable treatment for end-stage osteoarthritis of the knee. This factor, combined with an aging population, has resulted in an increasing incidence of this procedure, which is expected to continue to rise over the coming decades. , The goals of TKA are to restore patient function and improve pain secondary to degenerative joint disease…

Neurovascular Injury in Total Knee Arthroplasty

Introduction Neurovascular injury is a rare, but distressing and debilitating complication of total knee arthroplasty (TKA). Arthroplasty surgeons must take an active role in understanding the risk factors and have knowledge of the anatomy that plays a pivotal role in reducing the incidence of these complications. A spectrum of vascular complications have been reported, including arterial thrombosis, arteriovenous fistula formation, transection of the popliteal artery, and…

Ligamentous Injury in Total Knee Arthroplasty

Introduction The integrity of the collateral ligaments is critical to knee joint stability and proper kinematics following primary total knee arthroplasty (TKA). Instability following TKA can be the source of residual pain and swelling. It is also a leading cause of early revision following knee replacement surgery. Intraoperative ligament injuries during TKA is a relatively rare event that has been reported to occur in approximately 0.8%…

Achieving Balance and Stability During a Total Knee Arthroplasty

Introduction When considering all of the steps involved with a total knee arthroplasty (TKA), placing the components in proper alignment and with appropriate balance may be the most important. An unstable knee can lead to persistent pain, effusions, and difficulty on unstable ground or stairs, all of which will compromise the patient’s outcome ( Box 8.1 ). TKA instability is one of the leading causes for…

Gaining Surgical Exposure in Total Knee Arthroplasty

Introduction The importance of adequate exposure in revision total knee arthroplasty (TKA) is critical to successful and safe surgery. Even a healthy native knee has a relatively limited soft-tissue envelope; the compromised knee is unforgiving and requires patience and meticulous technique to adequately visualize important structures, access implants, and provide a safe environment to ensure a successful outcome for the patient. First and foremost, appropriate planning…

Preoperative Planning for Total Knee Arthroplasty

Total knee arthroplasty (TKA) is performed for millions of patients on a global scale annually. In the United States, the projected increase in annual primary TKA in 2040 is 401%, based on the National Inpatient Sample database. The increasing numbers of primary TKA being performed have resulted in more revision procedures, causing an increase in clinical and economic burden on our health care system. Common reasons…

Complications and Outcomes of Nonoperative Treatment Modalities in Knee Osteoarthritis

Introduction Osteoarthritis is a slowly progressive degenerative disorder that involves damage to joint cartilage, structural changes in the bone, and inflammation of the soft tissues surrounding the joint. Osteoarthritis of the knee is the most prevalent form of osteoarthritis, symptomatically affecting 13% of women and 10% of men greater than 60 years old. , Knee osteoarthritis can threaten a patient’s ability to participate in healthy physical…

Avoiding Complications with Outpatient Total Hip and Knee Arthroplasty

Introduction The popularity of same-day discharge total joint arthroplasty (TJA) continues to increase, as does the number of these procedures being performed at freestanding ambulatory surgery centers (ASCs). , These procedures are being performed successfully and safely both in the hospital outpatient department (HOPD) and ambulatory surgical setting. There are numerous reasons for the continuous shift from the inpatient to outpatient setting for total joints. Perhaps…

Pain Management Following Total Hip Arthroplasty and Total Knee Arthroplasty

Introduction Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are surgical procedures that have been shown to improve pain, function, and quality of life. However, these procedures are notoriously painful, and postoperative recovery can be challenging. Aside from patient discomfort, poorly controlled pain can prolong length of stay, limit participation in rehabilitation, and increase the cost of care. Severe acute postoperative pain is also a…

Managing Medical Complications Following Total Joint Arthroplasty

Introduction Total joint arthroplasty (TJA) is an effective procedure that relieves pain, restores function, and improves mobility in patients with end-stage osteoarthritis. In 2014 alone, more than 400,000 TJAs were performed in the Medicare population, making it the most common inpatient surgery. By 2030, an estimated 4.0 million TJA procedures will be performed annually. Currently, the quality of care and the associated costs vary greatly among…