Background: This study compared the incidence of osteolysis, aseptic loosening, and revision following use of highly cross-linked polyethylene (HXLPE) or conventional polyethylene (CPE) at medium to long-term (>5 to 15 years) follow-up in primary total hip arthroplasty (THA). Incidences were quantified and compared with regard to age and method of implant fixation. Methods: Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, 12 randomized controlled trials and 18 cohort studies were investigated for evidence-based outcomes following HXPLE and CPE use in 2,539 hips over a 5 to 15-year follow-up. Results: Lower rates of osteolysis, aseptic loosening, and implant revision were reported following use of HXLPE liners. Osteolysis was reduced from 25.4% with CPE to 4.05% with HXLPE in young patients, and from 29.7% to 6.6% in the older patient cohort. Similarities in osteolysis rates were observed when cemented (24.9% for CPE and 6.5% for HXLPE) and uncemented components (32.8% for CPE and 7.1% for HXLPE) were compared. No clear advantage in the type of HXLPE used was observed. Conclusions: Over a follow-up period of up to 15 years, when compared with CPE, use of HXLPE liners reduced the incidence of osteolysis, aseptic loosening, and implant revision, regardless of the fixation method and including in younger and potentially more active patients. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Customized total knee arthroplasty (C-TKA) systems are becoming increasingly popular in patients with end-stage knee arthritis. Manufactured with use of patient data derived from computed tomography or magnetic resonance imaging, these systems aim to restore the individual bone anatomy of the patient by providing customized fit and geometries. This retrospective study investigated implant survivorship, patient satisfaction, and functional outcomes following C-TKA with a cruciate-retaining prosthesis. Methods: We retrospectively reviewed data from 540 knees in 433 patients who underwent C-TKA performed by a single surgeon at a single institution. Patient demographics, surgical variables, complications, and reoperations were evaluated. Follow-up evaluations were performed via a single telephone call to assess patient satisfaction, functional outcomes according to the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) questionnaire, and implant survivorship following C-TKA. Descriptive statistics were analyzed. Results: At the time of C-TKA, the mean age was 71.8 years and the mean body mass index was 29.1 kg/m². The mean follow-up was 2.8 years. Patient satisfaction was high, with 89% of C-TKA patients being either satisfied or very satisfied. The mean KOOS-JR was 82. There were 8 revisions (1.5%) at an average of 0.7 years after the index C-TKA; hence, there was an implant survivorship of 98.5%. Conclusions: To our knowledge, this was the largest retrospective study to date to report on patient satisfaction, functional outcomes, and implant survivorship following C-TKA. We observed a high satisfaction rate, satisfactory functional outcomes, and high implant survivorship at midterm follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. Purpose: To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players. Study Design: Systematic review. Methods: A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities. Results: A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity–related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs. Conclusion: Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.

Customized unicompartmental knee arthroplasty (C-UKA) utilizes implants manufactured on an individual patient basis, derived from pre-operative computed tomography images in an effort to more closely approximate the natural anatomy of the knee. The outcomes from 349 medial and lateral fixed-bearing C-UKA were reviewed. Implant survivorship analysis was conducted via retrospective chart review, and follow-up analysis was conducted via a single postoperative phone call or email. The rate of follow-up was 69% (242 knees). The average age at surgery was 71.1 years and the average body mass index was 28.8 kg/m². Seven revision arthroplasties (2.1%) had knowingly been performed at an average of 1.9 years postoperatively (range: 0.1–3.9 years), resulting in an implant survivorship of 97.9% at an average follow-up of 4.2 years (range: 0.1–8.7) and 97.9% at an average of 4.8 years (range: 2.0–8.7) when knees with less than two years of follow-up were excluded. The reasons for revision were implant loosening (one knee), infection (two knees), progression of osteoarthritis (two knees), and unknown reasons (two knees). The average KOOS, JR. interval score was 84 (SD: 14.4). Of those able to be contacted for follow-up analysis, 67% were “very satisfied,” 26% were “satisfied,” 4% were “neutral,” 2% were “dissatisfied,” and 1% were “very dissatisfied.” When asked if the knee felt “natural,” 60% responded with “always,” 35% responded with “sometimes,” and 5% responded with “never.” After analyzing a large cohort of C-UKA, we found favorable rates of survivorship, satisfaction, and patient-reported functional outcomes.

» Conventional total hip arthroplasty (THA) largely remains an unguided procedure dependent on the ability and experience of the surgeon. New technologies, such as patient-specific instrumentation and robotics, have shown promising results in improving implant positioning, which has the potential to improve patient outcomes. » The use of off-the-shelf (OTS) implant designs, however, limits the success of the technological advances since they are unable to recreate the native anatomy of the joint. The inability to restore femoral offset and version or the presence of implant-related leg-length discrepancies often lead to suboptimal surgical results that increase the risk of dislocation, fractures, and component wear, compromising postoperative functional outcomes and implant longevity. » A customized THA system, whereby the femoral stem is designed to restore patient anatomy, has recently been introduced. The THA system uses computed tomography (CT)-derived 3D imaging to create a custom stem, patient-specific component placement, and patient-specific instrumentation that matches the patient’s native anatomy. » The purpose of this article is to provide information on the design and manufacturing process of this new THA implant, to illustrate the associated preoperative planning, and to describe the surgical technique; 3 surgical cases are presented.

Residual instability after a complex hip dislocation is rare and difficult to manage. Orthopaedic traumatologists should be aware of adjunctive techniques that provide additional internal constraints and enhance hip joint stability after bony fixation. Ligamentum teres reconstruction has gained attention in the sports medicine and pediatric literature for reconstructing the secondary stabilizer of the hip. In this technique, we describe the use of a femoroacetabular suspension device to address residual instability in 6 patients with complex hip dislocations. In essence, deployment of a suspensory fixation device across the femoroacetabular joint provides an internal stabilization strategy to maintain reduction, serving as a salvage option or as a primary stabilization method in select cases where traditional fixation or soft tissue repair is unlikely to restore stability, and thereby avoiding the need for postreconstruction immobilization or more complex reconstructive procedures.