Scholars@Duke
Samuel S. Wellman

Samuel S. Wellman CV

Associate Professor of Orthopaedic Surgery
Orthopaedic Surgery
samuel.wellman@duke.edu
DUMC Box 104002, Durham, NC 27710
311 Trent Drive, Durham, NC 27710
CV

Selected Publications

Dual Mobility Articulation in Total Hip Arthroplasty: Mixed Femoral and Acetabular Components are a Feasible Option.

Journal Article J Arthroplasty · September 2024 BACKGROUND: The utilization of a different manufacturer for the prosthetic femoral head and the polyethylene insert in dual mobility (DM) for total hip arthroplasty (THA) may be necessary, especially in the revision setting. However, there is no data in th ... Full text Link to item Cite

The Posterior Approach is Associated With Lower Total Encounter and 90-Day Costs When Compared to the Direct Anterior Approach.

Journal Article J Arthroplasty · September 2024 BACKGROUND: The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tert ... Full text Link to item Cite

Ultracongruent Polyethylene Liners Do Not Affect Survival of Total Knee Arthroplasty for Valgus Deformity.

Journal Article J Arthroplasty · August 2024 BACKGROUND: Valgus knee deformity is observed in nearly 10% of patients undergoing total knee arthroplasty (TKA). The degree of polyethylene constraint required to balance a valgus knee remains controversial, and historically, posterior-stabilized (PS) des ... Full text Link to item Cite

Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty.

Journal Article J Arthroplasty · August 2024 BACKGROUND: This study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early postoperative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral anti ... Full text Link to item Cite

Subsequent total joint arthroplasty: Are we learning from the first stage?

Journal Article World J Orthop · March 18, 2024 BACKGROUND: With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedure ... Full text Link to item Cite

A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study.

Journal Article J Arthroplasty · August 2023 BACKGROUND: Although 2-stage revision has been proposed as gold standard for periprosthetic joint infection treatment, limited evidence exists for the role of articulating spacers as definitive management. The purpose of this study was to compare clinical ... Full text Link to item Cite

The Removal of Total Hip Arthroplasty From the Inpatient-Only List has Improved Patient Selection and Expanded Optimization Efforts.

Journal Article J Arthroplasty · July 2023 BACKGROUND: On January 1, 2020, the Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the Inpatient-Only (IPO) list. This study evaluated patient demographics and comorbidities, preoperative optimization efforts, and 30-d ... Full text Link to item Cite

Does Order of Operation Matter in Patients Who Have Concomitant Hip and Spine Pathology?

Journal Article J Arthroplasty · July 2023 BACKGROUND: In patients, who have coexisting lumbar spine and degenerative hip disease, there remains uncertainty regarding whether hip or spine surgery should be performed first. We hypothesized that undergoing total hip arthroplasty (THA) would protect a ... Full text Link to item Cite

Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs.

Journal Article J Orthop Surg Res · June 1, 2023 BACKGROUND: Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to determine the reliability of stress radiographs for ... Full text Link to item Cite

Accelerated Discharge After Aseptic Revision Total Hip Arthroplasty Does Not Predict Inferior 30-Day Outcomes.

Journal Article J Arthroplasty · March 2023 BACKGROUND: Perioperative advancements have made outpatient primary total hip arthroplasty (THA) a viable option for patients. This study evaluated the feasibility of expedited discharge after revision THA and compared 30-day outcomes to patients who had p ... Full text Link to item Cite

Accelerated discharge after aseptic revision knee arthroplasty is not associated with early readmission and reoperation.

Journal Article Bone Joint J · December 2022 AIMS: In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and ... Full text Link to item Cite

Short-Stay Arthroplasty is Not Associated With Increased Risk of 90-Day Hospital Returns.

Journal Article J Arthroplasty · August 2022 BACKGROUND: With the removal of total hip arthroplasty (THA) and total knee arthroplasty (TKA) from the inpatient-only list, medical centers are faced with challenging transitions to outpatient surgery. We investigated if short-stay arthroplasty, defined a ... Full text Link to item Cite

Clinical Outcomes After Stage-One Antibiotic Coated Molded Hip Spacer.

Journal Article J Arthroplasty · July 2022 BACKGROUND: Two-stage exchange remains the gold standard for managing periprosthetic joint infection (PJI). We evaluated the outcomes of patients treated with a specific molded articulating antibiotic hip spacer for PJI at a tertiary referral center. METHO ... Full text Link to item Cite

Early Infection After Aseptic Revision Knee Arthroplasty: Prevalence and Predisposing Risk Factors.

Journal Article J Arthroplasty · June 2022 BACKGROUND: Although patient factors have been associated with prosthetic joint infection (PJI) after primary total knee arthroplasty, there are insufficient data on the relationship of patient and technical factors with early PJI after aseptic revision. M ... Full text Link to item Cite

Preoperative Weight Loss and Postoperative Weight Gain Independently Increase Risk for Revision After Primary Total Knee Arthroplasty.

Journal Article J Arthroplasty · April 2022 BACKGROUND: The current American Association of Hip and Knee Surgeons (AAHKS) guidelines recommend preoperative weight loss before total knee arthroplasty (TKA) in patients with body mass index (BMI) ≥40 kg/m2. However, there is a paucity of evidence on TK ... Full text Link to item Cite

Postoperative changes in cognition and cerebrospinal fluid neurodegenerative disease biomarkers.

Journal Article Ann Clin Transl Neurol · February 2022 OBJECTIVE: Numerous investigators have theorized that postoperative changes in Alzheimer's disease neuropathology may underlie postoperative neurocognitive disorders. Thus, we determined the relationship between postoperative changes in cognition and cereb ... Full text Open Access Link to item Cite

The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability?

Journal Article Orthopedics · 2022 Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores ... Full text Link to item Cite

Flash Sterilization and Component Reimplantation Is a Viable Option for Articulating Antibiotic Spacers in Periprosthetic Knee Infections.

Journal Article J Knee Surg · August 2021 The articulating antibiotic spacer is a treatment utilized for two-stage revision of an infected total knee arthroplasty. The original femoral component is retained and reused in one described variation of this technique. The purpose of this study is to de ... Full text Link to item Cite

Varus-Valgus Constrained Implants in Revision Total Knee Arthroplasty: Mean Clinical Follow-Up of Six Years.

Journal Article J Arthroplasty · July 2021 BACKGROUND: There is scant literature evaluating varus-valgus constrained (VVC) prostheses in contemporary revision total knee arthroplasty (TKA). Therefore, we aimed to evaluate the durability of VVC revision TKA with selective use of cones. METHODS: A re ... Full text Link to item Cite

Is there a problem with modular dual mobility acetabular components in revision total hip arthroplasty at mid-term follow-up?

Journal Article Bone Joint J · July 2021 AIMS: Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim ... Full text Link to item Cite

Unexpected high rate of revision of a modern cemented fixed bearing modular posterior-stabilized knee arthroplasty.

Journal Article Bone Joint J · June 2021 AIMS: To establish our early clinical results of a new total knee arthroplasty (TKA) tibial component introduced in 2013 and compare it to other designs in use at our hospital during the same period. METHODS: This is a retrospective study of 166 (154 patie ... Full text Link to item Cite

Cost of Aseptic Revision Total Knee Arthroplasty at a Tertiary Medical Center.

Journal Article J Arthroplasty · May 2021 BACKGROUND: Revision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following: (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost as ... Full text Link to item Cite

1.5-Stage Exchange Arthroplasty for Total Knee Arthroplasty Periprosthetic Joint Infections.

Journal Article The Journal of arthroplasty · March 2021 BackgroundPeriprosthetic joint infection (PJI) in total knee arthroplasty (TKA) is a challenging problem. The purpose of this study was to outline a novel technique to treat TKA PJI. We define 1.5-stage exchange arthroplasty as placing an articula ... Full text Cite

The Effect of the COVID-19 Pandemic on Hip and Knee Arthroplasty Patients in the United States: A Multicenter Update to the Previous Survey.

Journal Article Arthroplast Today · February 2021 BACKGROUND: In March 2020, elective total hip and knee arthroplasty (THA and TKA) were suspended across the United States in response to the COVID-19 pandemic. We had previously published the results of a survey to the affected patients from 6 institutions ... Full text Open Access Link to item Cite

Intraoperative Fire Risk: Evaluating the 3-Minute Wait After Chlorhexidine-Alcohol Antiseptic Scrub.

Journal Article J Orthop Trauma · January 1, 2021 OBJECTIVE: We sought to determine the flammability of the skin at different time intervals after chlorhexidine-alcohol antiseptic scrub application, to provide evidence for hospital protocols recommending a 3-minute drying time. METHODS: Swine feet, which ... Full text Link to item Cite

Synergistic Roles of Macrophages and Neutrophils in Osteoarthritis Progression.

Journal Article Arthritis Rheumatol · January 2021 OBJECTIVE: To evaluate the role of immune cells and their effector cytokines in the pathogenesis and progression of knee osteoarthritis (OA) in matched OA synovial fluid (SF) and synovial tissue samples. METHODS: Cells from matched samples of synovial tiss ... Full text Link to item Cite

The Calpain Gene is Correlated With Metal-on-Metal Hip Replacement Failures.

Journal Article J Arthroplasty · January 2021 BACKGROUND: Metal-on-metal (MOM) total hip arthroplasty is associated with unacceptable failure rates secondary to metal ion reactions. Efforts to identify which patients will go on to failure have been limited; recently, there has been a suggestion for a ... Full text Link to item Cite

All-Polyethylene Tibia: An Opportunity for Value-Based Care in Bundled Reimbursement Initiatives.

Journal Article Orthopedics · January 1, 2021 Surgeons play a critical role in making cost-effective decisions that maintain high-quality patient outcomes, which is the current focus of the Centers for Medicare & Medicaid Services. All-polyethylene tibial (APT) components often cost less during total ... Full text Link to item Cite

A Specific Capsular Repair Technique Lowered Early Dislocations in Primary Total Hip Arthroplasty Through a Posterior Approach.

Journal Article Arthroplast Today · December 2020 BACKGROUND: Dislocation is a challenging problem after total hip arthroplasty (THA). We sought to evaluate the incidence of early dislocation with 2 different posterior repair techniques after THA using a posterior approach. METHODS: From September of 2008 ... Full text Link to item Cite

A protocol to reduce self-reported pain scores and adverse events following lumbar punctures in older adults.

Journal Article J Neurol · July 2020 OBJECTIVE: Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort st ... Full text Link to item Cite

Anti-inflammatory effects of naproxen sodium on human osteoarthritis synovial fluid immune cells.

Journal Article Osteoarthritis Cartilage · May 2020 OBJECTIVE: To evaluate the anti-inflammatory effects of clinically relevant naproxen sodium (Nx) concentrations on human monocyte-derived macrophages in a controlled in vitro system and human primary synovial fluid (SF) cells. DESIGN: Using phorbol 12-myri ... Full text Link to item Cite

Surgeon-Performed High-Dose Bupivacaine Periarticular Injection With Intra-Articular Saphenous Nerve Block Is Not Inferior to Adductor Canal Block in Total Knee Arthroplasty.

Journal Article J Arthroplasty · May 2020 BACKGROUND: Periarticular injection or anesthesiologist-performed adductor canal block are commonly used for pain management after total knee arthroplasty. A surgeon-performed, intra-articular saphenous nerve block has been recently described. There is ins ... Full text Link to item Cite

Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management.

Journal Article Orthopedics · May 1, 2020 Venous thromboembolism and ischemic stroke are major complications following total knee arthroplasty (TKA) and potentially are associated with a patent foramen ovale (PFO). Although this association has been shown in other surgical disciplines, it has not ... Full text Link to item Cite

Antibiotic Cement Spacers for Infected Total Knee Arthroplasties.

Journal Article J Am Acad Orthop Surg · March 1, 2020 Periprosthetic infection remains a frequent complication after total knee arthroplasty. The most common treatment is a two-stage procedure involving removal of all implants and cement, thorough débridement, insertion of some type of antibiotic spacer, and ... Full text Link to item Cite

Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns.

Journal Article J Orthop Surg (Hong Kong) · 2020 PURPOSE: Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to com ... Full text Link to item Cite

Undersedation During Total Hip Arthroplasty Reduction Results in Worse Patient Outcomes.

Journal Article J Arthroplasty · December 2019 BACKGROUND: Total hip arthroplasty (THA) dislocation is a common reason for presentation to the emergency department (ED) postoperatively. Prior literature has shown that propofol conscious sedation provides the fewest complications and the shortest time t ... Full text Link to item Cite

The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty.

Journal Article J Arthroplasty · November 2019 BACKGROUND: Research has linked malnutrition to more complications in total joint arthroplasty (TJA) patients. The role of preoperative albumin in predicting length of stay (LOS) and 90-day outcomes remains understudied. Often, an albumin cut-off ≤3.5 g/dL ... Full text Link to item Cite

Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? A randomized controlled trial.

Journal Article Bone Joint J · September 2019 AIMS: Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arth ... Full text Link to item Cite

Prior Hip Arthroscopy Increases Risk for Perioperative Total Hip Arthroplasty Complications: A Matched-Controlled Study.

Journal Article J Arthroplasty · August 2019 BACKGROUND: Arthroscopic hip surgery is becoming increasingly popular for the treatment of femoroacetabular impingement and labral tears. Reports of outcomes of hip arthroscopy converted to total hip arthroplasty (THA) have been limited by small sample siz ... Full text Link to item Cite

Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty.

Journal Article J Arthroplasty · July 2019 BACKGROUND: The Comprehensive Care for Joint Replacement (CJR) model has resulted in the evolution of preoperative optimization programs to decrease costs and hospital returns. At the investigating institution, one center was not within the CJR bundle and ... Full text Link to item Cite

Should Medical Severity-Diagnosis Related Group Classification Be Utilized for Reimbursement? An Analysis of Elixhauser Comorbidities and Cost of Care.

Journal Article J Arthroplasty · July 2019 BACKGROUND: The Center for Medicare and Medicaid Services (CMS) classifies reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on Medical Severity-Diagnosis Related Groups (MS-DRGs) 469 (with major complication/comorbidit ... Full text Link to item Cite

Traditional Laboratory Markers Hold Low Diagnostic Utility for Immunosuppressed Patients With Periprosthetic Joint Infections.

Journal Article J Arthroplasty · July 2019 BACKGROUND: Although predictive laboratory markers and cutoffs for immunocompetent patients are well-studied, similar reference ranges and decision thresholds for immunosuppressed patients are less understood. We investigated the utility of typical laborat ... Full text Link to item Cite

Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty.

Journal Article Knee · June 2019 BACKGROUND: There is a growing interest in avoiding discharging patients to rehab to maximize outcome and minimize complications after total knee arthroplasty (TKA). In addition, use of postoperative pain pathways that minimize opioid use is critical amids ... Full text Link to item Cite

Donning Gloves Before Surgical Gown Eliminates Sleeve Contamination.

Journal Article J Arthroplasty · June 2019 BACKGROUND: There are numerous studies in the literature that have recognized the importance of the glove-gown interface as a potential source of intraoperative bacterial contamination. It has been demonstrated that the methods with which one dons their su ... Full text Link to item Cite

Comparing Standard Versus Extended Culture Duration in Acute Hip and Knee Periprosthetic Joint Infection.

Journal Article J Am Acad Orthop Surg · May 1, 2019 INTRODUCTION: Periprosthetic joint infection (PJI) is a devastating complication of hip and knee arthroplasties. Surgical cultures are essential for the diagnosis and treatment of PJI. Yet, the ideal culture duration remains unclear. This study compares cu ... Full text Link to item Cite

Polymicrobial Infections in Hip Arthroplasty: Lower Treatment Success Rate, Increased Surgery, and Longer Hospitalization.

Journal Article J Arthroplasty · April 2019 BACKGROUND: Polymicrobial hip arthroplasty infections are a subset of periprosthetic joint infection (PJI) with distinct challenges representing 10%-47% of PJI. METHODS: Records were reviewed from all PJIs involving partial or total hip arthroplasty with p ... Full text Link to item Cite

The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction.

Journal Article J Am Geriatr Soc · April 2019 BACKGROUND/OBJECTIVES: Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of ... Full text Open Access Link to item Cite

Fracture of the neck of an uncemented femoral component unrelated to trunnion corrosion.

Journal Article Arthroplast Today · March 2019 This is the first report, to our knowledge, of a fracture, unrelated to trunnion corrosion, through the midneck of a well-fixed uncemented cobalt-chromium alloy femoral component that had been implanted via a total hip revision arthroplasty 25 years ago. T ... Full text Link to item Cite

Preoperative Hemoglobin Predicts Postoperative Transfusion Despite Antifibrinolytics During Total Knee Arthroplasty.

Journal Article Orthopedics · March 1, 2019 Current antifibrinolytics have decreased perioperative blood loss; however, some patients still require transfusions postoperatively. The authors sought to determine the risk factors associated with postoperative transfusions and to establish a "cutoff" pr ... Full text Link to item Cite

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting.

Journal Article J Arthroplasty · January 2019 BACKGROUND: Conversion total hip arthroplasties (THAs) from prior free vascularized fibular grafting (FVFG) are infrequently reported in the literature. We characterized the perioperative outcomes of patients undergoing conversion THA and compared them wit ... Full text Link to item Cite

A Geometric Model to Determine Patient-Specific Cup Anteversion Based on Pelvic Motion in Total Hip Arthroplasty.

Journal Article Adv Orthop · 2019 INTRODUCTION: Cup position is critical to stability in total hip arthroplasty and is affected by pelvis motion during positions of daily life. The purpose of this study was to explicitly define the relationship between sagittal pelvic motion and resultant ... Full text Link to item Cite

Early to Midterm Clinical and Radiographic Survivorship of the All-Polyethylene Versus Modular Metal-Backed Tibia Component in Primary Total Knee Replacement.

Journal Article J Surg Orthop Adv · 2019 The purpose of this study was to compare the all-polyethylene tibial component with the modular metal-backed component in primary total knee arthroplasty. A retrospective review of 1064 patients recorded clinical failure, as determined by need for revision ... Link to item Cite

Recurrent Dislocation After Total Hip Arthroplasty: Controversies and Solutions.

Journal Article Instr Course Lect · 2019 Instability remains one of the most common complications after total hip arthroplasty and a notable cause of patient morbidity as well as patient and surgeon dissatisfaction. Isolated dislocations can often be managed successfully with closed reduction; ho ... Link to item Cite

Impact of lumbar arthrodesis on outcomes after elective total hip arthroplasty

Journal Article Seminars in Arthroplasty JSES · December 1, 2018 Background: Acetabular component malpositioning has been associated with major complications including dislocation, edge-loading, stripe wear and squeaking. Anteversion is determined by pelvic orientation; flexion of the pelvis increases and extension decr ... Full text Cite

Albumin Versus American Society of Anesthesiologists Score: Which Is More Predictive of Complications Following Total Joint Arthroplasty?

Journal Article Orthopedics · November 1, 2018 Malnutrition is not uncommon in arthroplasty patients, and hypoalbuminemia has been shown to be predictive of postoperative complications. The authors sought to compare albumin concentration with a global assessment of physical health, the American Society ... Full text Link to item Cite

Acute Pain Is Associated With Chronic Opioid Use After Total Knee Arthroplasty.

Journal Article Reg Anesth Pain Med · October 2018 BACKGROUND AND OBJECTIVES: Pain scores are routinely reported in clinical practice, and we wanted to examine whether this routinely measured, patient-reported variable provides prognostic information, especially with regard to chronic opioid use, after tak ... Full text Link to item Cite

The Impact of Electronic Medical Record Implementation on Labor Cost and Productivity at an Outpatient Orthopaedic Clinic.

Journal Article J Bone Joint Surg Am · September 19, 2018 BACKGROUND: Widespread adoption of electronic medical record (EMR) systems is increasing. EMR implementation can be costly and typically requires workflow redesign. To our knowledge, no studies to date have examined the impact of EMR implementation using a ... Full text Link to item Cite

Outcomes of Articulating Spacers With Autoclaved Femoral Components in Total Knee Arthroplasty Infection.

Journal Article J Arthroplasty · August 2018 BACKGROUND: In 2-stage revision of total knee arthroplasty (TKA) infection, articulating antibiotic spacers show similar eradication rates and superior range of motion compared with static spacers. This study evaluated infection control and other outcomes ... Full text Link to item Cite

The James A. Rand Young Investigator's Award: Battling the Opioid Epidemic with Prospective Pain Threshold Measurement.

Journal Article J Arthroplasty · July 2018 BACKGROUND: Responsible analgesic prescribing is paramount in the opioid epidemic era, yet no standardized protocol exists. We aim to (1) quantify and correlate outpatient opioid need after total knee and hip arthroplasties (TKA and THA) with preoperative ... Full text Link to item Cite

Association Between Pseudotumor Formation and Patient Factors in Metal-on-Metal Total Hip Arthroplasty Population.

Journal Article J Arthroplasty · July 2018 BACKGROUND: Pseudotumor formation from metal-on-metal (MoM) hip implants is associated with implant revision. The relationship between pseudotumor type and patient outcomes is unknown. METHODS: We retrospectively reviewed patients with a MoM total hip arth ... Full text Link to item Cite

Comparison of Postoperative Complications Following Metal-on-Metal Total Hip Arthroplasty With Other Hip Bearings in Medicare Population.

Journal Article J Arthroplasty · June 2018 BACKGROUND: The use of metal-on-metal (MoM) hip bearings has declined in the recent years due to strong evidence of their high complication rates and early failure. Hip implants with highly cross-linked polyethylene liners and ceramic bearings have become ... Full text Link to item Cite

Dual Diagnosis and Total Hip Arthroplasty.

Journal Article Orthopedics · May 1, 2018 The co-occurrence of a mental illness and a substance abuse disorder (SUD) is common and has been referred to as a "dual diagnosis" (DD). Although studies have independently investigated mental illness alone and SUD alone, few have examined the effects of ... Full text Link to item Cite

Risk Factors, Outcomes, and Timing of Manipulation Under Anesthesia After Total Knee Arthroplasty.

Journal Article J Arthroplasty · January 2018 BACKGROUND: Knee stiffness requiring manipulation under anesthesia (MUA) is an undesirable outcome following total knee arthroplasty (TKA), but risk factors for, and optimal timing of, MUA remain unclear. METHODS: Primary TKAs performed at a single center ... Full text Link to item Cite

Epsilon Aminocaproic Acid to Reduce Blood Loss and Transfusion After Total Hip and Total Knee Arthroplasty.

Journal Article J Arthroplasty · January 2018 BACKGROUND: Total hip and knee arthroplasty (THA and TKA) are associated with significant blood loss and some patients require postoperative blood transfusion. While tranexamic acid has been studied extensively among this population, we tested the hypothes ... Full text Link to item Cite

Primary knee arthroplasty

Chapter · January 1, 2018 Cite

What Should Define Preoperative Anemia in Primary THA?

Journal Article Clin Orthop Relat Res · November 2017 BACKGROUND: The use of tranexamic acid (TXA) in THA decreases the risk of transfusion after surgery. However, nearly 10% of patients still undergo a transfusion, which has been independently associated with an increased risk of complications. Preoperative ... Full text Link to item Cite

Performance Comparison of Single-Radius Versus Multiple-Curve Femoral Component in Total Knee Arthroplasty: A Prospective, Randomized Study Using the Lower Quarter Y-Balance Test.

Journal Article Orthopedics · November 1, 2017 Midflexion stability after total knee arthroplasty (TKA) is dependent, in part, on implant design. Midflexion performance of a single-radius (SR) design and a multi-radius, or J-curve (JC), design were compared using the Lower Quarter Y-Balance Test (YBT-L ... Full text Link to item Cite

Outcomes of Modular Dual Mobility Acetabular Components in Revision Total Hip Arthroplasty.

Journal Article J Arthroplasty · September 2017 BACKGROUND: There is a high rate of dislocation after revision total hip arthroplasty. This study evaluated the outcomes of 1 modular dual mobility component in revision total hip arthroplasty in patients at high risk of dislocation. METHODS: We reviewed 6 ... Full text Link to item Cite

Common Medical Comorbidities Correlated With Poor Outcomes in Hip Periprosthetic Infection.

Journal Article J Arthroplasty · September 2017 BACKGROUND: Periprosthetic infection has been linked to risk factors such as diabetes, obesity, and smoking among others. This study examined the relationship between common patient comorbidities and hip periprosthetic infection outcomes. METHODS: We retro ... Full text Link to item Cite

Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium.

Journal Article Clin Neurophysiol · August 2017 OBJECTIVE: Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. METHODS ... Full text Link to item Cite

Reproducible transient asystolic arrest during intramedullary reaming of the femoral canal: A case report.

Journal Article J Clin Orthop Trauma · August 2017 The utilization of intramedullary devices in the surgical fixation of hip fractures is increasing. Although intramedullary devices offer many advantages in the treatment of these injuries, they are also associated with a unique set of potential complicatio ... Full text Link to item Cite

A randomised trial of peri-operative positive airway pressure for postoperative delirium in patients at risk for obstructive sleep apnoea after regional anaesthesia with sedation or general anaesthesia for joint arthroplasty.

Journal Article Anaesthesia · June 2017 Previous pilot work has established an association between obstructive sleep apnoea and the development of acute postoperative delirium , but it remains unclear to what extent this risk factor is modifiable in the 'real world' peri-operative setting. In a ... Full text Link to item Cite

Specific Infectious Organisms Associated With Poor Outcomes in Treatment for Hip Periprosthetic Infection.

Journal Article J Arthroplasty · June 2017 BACKGROUND: Periprosthetic hip infection treatment remains a significant challenge for orthopedics. Some studies have suggested that methicillin resistance and gram-negative organism type are associated with increased treatment failure. The aim of this res ... Full text Link to item Cite

What Factors Drive Inpatient Satisfaction After Knee Arthroplasty?

Journal Article J Arthroplasty · June 2017 BACKGROUND: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, developed by the Centers for Medicare & Medicaid Services, is directly tied to hospital reimbursement. The purpose of this study is to analyze survey response ... Full text Link to item Cite

Complications of total hip arthroplasty following solid organ transplantation.

Journal Article J Orthop Sci · March 2017 PURPOSE: Solid organ transplants (SOT) continue to increase with recipients living longer than ever before. The lifelong immunosuppression in these patients also may place them at increased risk for postoperative complications. The efficacy of total hip ar ... Full text Link to item Cite

Acute Intraprosthetic Dissociation of a Dual-Mobility Hip in the United States.

Journal Article Am J Orthop (Belle Mead NJ) · 2017 After decades of use in Europe, dual-mobility (DM) components for total hip arthroplasty (THA) were approved by the US Food and Drug Administration (FDA) in 2011 for use in the United States. DM-THAs are designed with an inner articulation between the femo ... Link to item Cite

Complications Are Not Increased With Acetabular Revision of Metal-on-metal Total Hip Arthroplasty.

Journal Article Clin Orthop Relat Res · October 2016 BACKGROUND: Isolated revision of the acetabular component in the setting of total hip arthroplasty has an increased risk of dislocation. With local soft tissue destruction frequently associated with failed metal-on-metal (MoM) bearings, it is presumed that ... Full text Link to item Cite

Psychiatric disorders increase complication rate after primary total knee arthroplasty.

Journal Article Knee · October 2016 BACKGROUND: Psychiatric disease is difficult to screen preoperatively and the incidence of mental health disorders in patients undergoing total knee arthroplasty (TKA) may be underappreciated. The purpose of this study is to evaluate the perioperative comp ... Full text Link to item Cite

Should We Think Twice About Psychiatric Disease in Total Hip Arthroplasty?

Journal Article J Arthroplasty · September 2016 BACKGROUND: Psychiatric disease (PD) is common, and the effect on complications in total hip arthroplasty (THA) is poorly understood. The purpose of this study was to evaluate the medical and surgical postoperative complication profile in patients with PD, ... Full text Link to item Cite

Is Metal-On-Metal Total Hip Arthroplasty Associated With Neurotoxicity?

Journal Article J Arthroplasty · September 2016 BACKGROUND: Isolated case reports in the literature describe systemic neurologic side effects associated with metal-on-metal (MOM) bearing surfaces, yet the incidence of these effects have not been evaluated beyond individual cases. The purpose of this stu ... Full text Link to item Cite

Perioperative Dexamethasone Administration Does Not Increase the Incidence of Postoperative Infection in Total Hip and Knee Arthroplasty: A Retrospective Analysis.

Journal Article J Arthroplasty · August 2016 BACKGROUND: Dexamethasone is frequently used for the treatment of postoperative nausea and vomiting and as an adjunct in multimodal postoperative analgesia after total joint arthroplasty; however, the incidence of periprosthetic joint infection (PJI) after ... Full text Link to item Cite

Computer-Navigated Total Knee Arthroplasty Utilization.

Journal Article J Knee Surg · July 2016 Computer-navigated total knee arthroplasty (CN-TKA) has been used to improve component alignment, though the evidence is currently mixed on whether there are clinically significant differences in long-term outcomes. Given the established increased costs an ... Full text Link to item Cite

Percent Body Fat Is More Predictive of Function After Total Joint Arthroplasty Than Body Mass Index.

Journal Article J Bone Joint Surg Am · May 18, 2016 BACKGROUND: Obesity has an important impact on the future of total joint arthroplasty; however, the definition and influence of obesity on surgical risks and outcomes remain controversial. Our hypothesis was that percent body fat was better than body mass ... Full text Link to item Cite

Independent Evaluation of a Mechanical Hip Socket Navigation System in Total Hip Arthroplasty.

Journal Article J Arthroplasty · March 2016 BACKGROUND: Acetabular cup malpositioning during total hip arthroplasty may lead to impingement, instability, wear-induced osteolysis, and increased rates of revision surgery. The purpose of this study was to independently evaluate the accuracy of acetabul ... Full text Link to item Cite

How Do Previous Solid Organ Transplant Recipients Fare After Primary Total Knee Arthroplasty?

Journal Article J Arthroplasty · March 2016 INTRODUCTION: Total knee arthroplasty (TKA) has been proven to increase knee outcome scores after solid organ transplantation (SOT), but many authors are concerned about a higher complication rate. The purpose of this study is to evaluate the complication ... Full text Link to item Cite

Opioid-Based Analgesia: Impact on Total Joint Arthroplasty.

Journal Article J Arthroplasty · December 2015 The objective of this study was to characterize the impact of opioid-based analgesia in total joint arthroplasty. The primary outcomes were incidence of in-hospital complications, length of stay, and discharge destination. Six hundred and seventy-three pri ... Full text Link to item Cite

Outcomes after Total Knee Arthroplasty for post-traumatic arthritis.

Journal Article Knee · December 2015 INTRODUCTION: Total Knee Arthroplasty (TKA) is an important treatment for posttraumatic arthritis (PTA), but evidence on outcomes is sparse. The purpose of this study was to evaluate the impact of PTA versus primary osteoarthritis (OA) on postoperative out ... Full text Link to item Cite

Current Evidence Does Not Support Medicare's 3-Day Rule in Primary Total Joint Arthroplasty.

Journal Article Am J Orthop (Belle Mead NJ) · October 2015 Patients who undergo total joint arthroplasty and are destined for discharge to an extended-care facility--particularly Medicare beneficiaries--are required to have an inpatient stay of at least 3 consecutive days. The primary objective of this study was t ... Link to item Cite

Medicare's 3-Day Rule: Time for a Rethink.

Journal Article J Arthroplasty · September 2015 A pilot study was undertaken to examine the impact of Medicare's 3-day rule on length of stay (LOS). One hundred consecutive patients who underwent primary total joint arthroplasty and were discharged to extended care facilities were retrospectively review ... Full text Link to item Cite

Treatment of osteonecrosis of the femoral head with vascularized bone grafting.

Journal Article Curr Rev Musculoskelet Med · September 2015 Osteonecrosis of the femoral head (ONFH) is a challenging diagnosis for the patient and treating surgeon. Though its cause is poorly understood, several methods of surgical treatment exist and are performed with variable success. Vascularized bone grafting ... Full text Link to item Cite

Arthroplasty in organ transplant patients.

Journal Article Arthroplast Today · June 2015 The number of solid organ transplants performed in the United States continues to increase annually as does survival after transplant. These unique patients are increasingly likely to present to arthroplasty surgeons for elective hip or knee replacement se ... Full text Open Access Link to item Cite

The Association of ASA Class on Total Knee and Total Hip Arthroplasty Readmission Rates in an Academic Hospital.

Journal Article J Arthroplasty · May 2015 Total hip and knee arthroplasties are two of the most successful orthopaedic procedures. However, with the increasing demand, estimated future costs for these procedures are enormous. Recent data suggest post-discharge care may account for up to 35% of tot ... Full text Link to item Cite

Preoperative pain level and patient expectation predict hospital length of stay after total hip arthroplasty.

Journal Article J Arthroplasty · April 2015 The purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not requi ... Full text Open Access Link to item Cite

Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty.

Journal Article J Arthroplasty · April 2015 The purpose of this study was to identify preoperative predictors of discharge destination after total joint arthroplasty. A retrospective study of three hundred and seventy-two consecutive patients who underwent primary total hip and knee arthroplasty was ... Full text Open Access Link to item Cite

Preoperative predictors of extended hospital length of stay following total knee arthroplasty.

Journal Article J Arthroplasty · March 2015 The purpose of this study was to identify the preoperative predictors of hospital length of stay after primary total knee arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors tha ... Full text Open Access Link to item Cite

Total hip arthroplasty in very young bone marrow transplant patients.

Journal Article J Surg Orthop Adv · 2015 Concerns remain about total hip arthroplasty (THA) performed in very young patients, especially those with complex medical history such as allogeneic bone marrow transplantation (ABMT). This study retrospectively reviews the perioperative courses and funct ... Full text Link to item Cite

Percent body fat more associated with perioperative risks after total joint arthroplasty than body mass index.

Journal Article J Arthroplasty · September 2014 Understanding the impact of obesity on elective total joint arthroplasty (TJA) remains critical. Perioperative outcomes were reviewed in 316 patients undergoing primary TJA. Higher percent body fat (PBF) was associated with postoperative blood transfusion, ... Full text Open Access Link to item Cite

Risk versus reward: total joint arthroplasty outcomes after various solid organ transplantations.

Journal Article J Arthroplasty · August 2014 Clinical outcomes were retrospectively reviewed for 76 primary total hip (THA) and total knee arthroplasties (TKA) performed after kidney, liver, cardiac, and lung transplantation with follow-up of 30.2 and 41.2 months, respectively. For the THA and TKA co ... Full text Link to item Cite

Custom intramedullary intercalating device for treatment of supracondylar fracture between constrained total knee arthroplasty and well-fixed total hip arthroplasty.

Journal Article Knee · March 2014 Management of periprosthetic fractures between ipsilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA) is difficult, and is further complicated in the setting of poor femoral bone stock. We present a case of supracondylar fracture betwee ... Full text Link to item Cite

Impact of perioperative allogeneic and autologous blood transfusion on acute wound infection following total knee and total hip arthroplasty.

Journal Article J Bone Joint Surg Am · February 19, 2014 BACKGROUND: Patients undergoing total hip or knee arthroplasty frequently receive blood transfusions. The relationship between transfusion and the risk of infection following total joint arthroplasty is unclear. In this study, we sought to examine the impa ... Full text Link to item Cite

Spacers.

Journal Article J Arthroplasty · February 2014 Full text Link to item Cite

Spacers.

Journal Article J Orthop Res · January 2014 Full text Link to item Cite

Outcomes of primary total joint arthroplasty after lung transplantation.

Journal Article J Arthroplasty · January 2014 Lung transplantation is increasingly common with improving survival rates. Post-transplant patients can be expected to seek total hip (THA) and knee arthroplasty (TKA) to improve their quality of life. Outcomes of 20 primary total joint arthroplasties (15 ... Full text Link to item Cite

Unicompartmental knee arthroplasty and total knee arthroplasty among Medicare beneficiaries, 2000 to 2009.

Journal Article J Bone Joint Surg Am · November 20, 2013 BACKGROUND: Unicompartmental knee arthroplasty is a less-invasive alternative to total knee arthroplasty for patients with arthritis affecting only the medial or lateral compartment. However, little is known about recent trends in the use of these procedur ... Full text Link to item Cite

Simultaneous vs staged bilateral total knee arthroplasty among Medicare beneficiaries, 2000-2009.

Journal Article J Arthroplasty · September 2013 Simultaneous bilateral total knee arthroplasty (TKA) reportedly has higher postoperative complication rates than staged procedures, but little is known about recent trends and outcomes among Medicare patients. In a 5% national sample of Medicare beneficiar ... Full text Link to item Cite

Developing a high-efficiency operating room for total joint arthroplasty in an academic setting.

Journal Article Clin Orthop Relat Res · June 2013 BACKGROUND: Developing a high-efficiency operating room (OR) for total joint arthroplasty (TJA) in an academic setting is challenging given the preexisting work cultures, bureaucratic road blocks, and departmental silo mentalities. Also, academic instituti ... Full text Link to item Cite

Creation of a femoral cortical window to facilitate total hip arthroplasty in patients with sickle cell hemoglobinopathies.

Journal Article J Arthroplasty · February 2013 Patients with sickle cell hemoglobinopathies often have femoral head osteonecrosis with collapse, and can benefit greatly from total hip arthroplasty. However, numerous procedural challenges and perioperative complications make these cases difficult. More ... Full text Link to item Cite

Knee fusion with external fixation

Journal Article Techniques in Knee Surgery · June 1, 2012 External fixation for knee arthrodesis has some advantages over internal fixation and intramedullary nailing. It can be used in actively septic knees, it allows control of compression and alignment after surgery, and it has the theoretic advantage of not l ... Full text Cite

Late liner disassociation of a Pinnacle system acetabular component.

Journal Article Orthopedics · April 2012 This article describes a case of late locking mechanism failure and disassociation of a Pinnacle acetabular cup (DePuy, Warsaw, Indiana) and Marathon polyethylene liner (DePuy) 53 months after routine primary total hip arthroplasty in an active patient. Fo ... Full text Link to item Cite

Citrobacter koseri as a cause of early periprosthetic infection after primary total hip arthroplasty.

Journal Article J Arthroplasty · September 2011 Periprosthetic joint infection in the acute setting is usually caused by gram-positive species and remains a major problem facing total joint surgeons. We report a case of a 53-year-old male who presented with drainage 3 weeks after primary total hip arthr ... Full text Link to item Cite

Implementation of an accelerated mobilization protocol following primary total hip arthroplasty: impact on length of stay and disposition.

Journal Article Curr Rev Musculoskelet Med · September 2011 With improvements in surgical techniques, implant design, and patient caremaps, surgeons have sought to accelerate early rehabilitation after total hip arthroplasty. Many authors have reported results of fundamentally similar protocols to achieve this end. ... Full text Link to item Cite

Cost-effectiveness analysis of free vascularized fibular grafting for osteonecrosis of the femoral head.

Journal Article J Surg Orthop Adv · 2011 Management of symptomatic pre-collapse osteonecrosis of the femoral head continues to be controversial. Patients are often young and active, therefore hip-preserving procedures such as free vascularized fibular grafting (FVFG) have been developed to reliev ... Link to item Cite

Knee fusion with external fixation

Journal Article Techniques in Knee Surgery · December 1, 2009 External fixation for knee arthrodesis has some advantages over internal fixation and intramedullary nailing. It can be used in actively septic knees, it allows control of compression and alignment after surgery, and it has the theoretic advantage of not l ... Full text Cite

Ankle arthrodesis using ring external fixation

Journal Article Techniques in Foot and Ankle Surgery · September 1, 2006 Contemporary recommendations for primary and revision ankle arthrodesis favor internal compression techniques using screw and/or plate fixation, with satisfactory outcomes being reported for most patients. Recently, comparable union rates and results of pr ... Full text Cite