Accelerated rehabilitation following total joint replacement (TJR) surgery has become more common in contemporary orthopaedic practice. Increased utilization demands improvements in resource allocation with continued improvement in patient outcomes. We describe an accelerated rehab protocol (AR) instituted at a community based hospital. All patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included. The AR consisted of preoperative patient education, standardization of perioperative pain management, therapy, and next day in-home services consultation following discharge. Outcomes of interest include average length of stay (ALOS), discharge disposition, 42-day return to Urgent Care (UC), Emergency Department (ED), or readmission. A total of 4 surgeons performed TJR procedures on 1,268 patients in the study period (696 TKA, 572 THA). ALOS was reduced from 3.5 days at the start of the observation period to 2.4 days at the end. Discharge to skilled nursing reduced from 25&#x25; to 14&#x25;. A multifaceted and evidence based approach to standardization of care delivery has resulted in improved patient outcomes and a reduction in resource utilization. Adoption of an accelerated rehab protocol has proven to be effective as well as safe without increased utilization of UC, ER, or readmissions.

Nicholas B. Robertson

Tibor Warganich

John Ghazarossian

Monti Khatod

Implementation of an Accelerated Rehabilitation Protocol for Total Joint Arthroplasty in the Managed Care Setting: The Experience of One Institution

<i>Introduction</i>. Currently, there are no definitive guidelines for the resection of a cam lesion. The purpose of this study was to investigate factors indicating the potential differences in low and high volume hip arthroscopists in marking the area of resection in cam lesions using X-rays for preoperative planning.<i> Methods</i>. Thirty-nine surgeons with varying levels of hip arthroscopy experience participated in the study. Surgeons filled out a survey and traced the area of optimal resection on radiographs with varying amounts of cam FAI. Participants were grouped by number of hip arthroscopies performed, years of surgical experience, and number of surgeries performed.<i> Results</i>. Surgeons who perform osteoplasty as a high percentage of their total hip surgeries per year correlate to the total number of hip arthroscopies performed per year (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2063904pt" id="M1" height="8.55521pt" version="1.1" viewBox="-0.0498162 -8.34882 48.5582 8.55521" width="48.5582pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-115" d="M393 379C402 394 400 411 393 422C384 437 365 448 348 448C301 448 237 372 186 285H182L193 335C210 408 205 448 178 448C150 448 80 402 29 344L45 321C80 355 114 373 122 373C128 373 130 365 124 330C106 228 76 98 50 -5L57 -12C82 -5 112 3 132 6L172 203C196 256 234 304 254 329C275 355 293 367 306 367C318 367 330 360 342 348C347 343 355 343 365 350S386 367 393 379Z"/></g><g transform="matrix(.013,0,0,-0.013,9.12,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.013,0,0,-0.013,20.383,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,26.623,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,29.587,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,35.827,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,42.067,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g></svg>, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M2" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg>) and number of years of experience (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.2063904pt" id="M3" height="8.55521pt" version="1.1" viewBox="-0.0498162 -8.34882 42.2948 8.55521" width="42.2948pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-115"/></g><g transform="matrix(.013,0,0,-0.013,9.12,0)"><use xlink:href="#g117-34"/></g><g transform="matrix(.013,0,0,-0.013,20.383,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,26.623,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,29.587,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.013,0,0,-0.013,35.829,0)"><use xlink:href="#g113-51"/></g></svg>, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M4" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-50"/></g></svg>). Surgeons performing greater than 50 cases per year traced a larger resection area for 3 different patients’ radiographs as compared to those performing less than 50 cases per year (117%, 143%, and 173%, <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M5" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-54"/></g></svg>).<i> Conclusions</i>. This study demonstrates that surgeons with less experience (decreased number of years operating and total number of surgeries) plan for resecting less cam than do experienced surgeons.

Derek Ochiai

Skye Donovan

Farshad Adib

Eric Guidi

Variation in Planned Resection of CAM FAI Based on Surgeon Experience

<i>Aim.</i> To evaluate whether aseptic hypertrophic nonunion in the long bones of the lower extremity can be treated successfully with LISS applied with closed methods without grafting.<i> Materials and Methods.</i> The study included 7 tibias and 9 femurs of 16 patients. All cases had hypertrophic nonunion. Initial surgical treatment was with intramedullary nailing in 14 cases, 6 of which had required an exchange of intramedullary nail. All the patients were treated with LISS plate with closed methods.<i> Results.</i> Union was obtained at mean 7 months in all patients. No implant loosening or breakage of the implant was observed and there was no requirement for secondary surgery.<i> Conclusion.</i> Cases of hypertrophic nonunion have excellent blood supply and biological potential. Therefore, there is no need for bone grafting and the addition of fracture stability is enough to achieve full union. Using a limited approach and percutaneous screw insertion, LISS provides fracture stabilization with soft tissue protection.

Metin Uzun

Murat &#xc7;akar

Ahmet Murat B&#xfc;lb&#xfc;l

Adnan Kara

Treatment of Aseptic Hypertrophic Nonunion of the Lower Extremity with Less Invasive Stabilization System (New Approach to Hypertrophic Nonunion Treatment)

Incisional negative pressure wound therapy (INPWT) has been used for high-risk surgery across specialties but has yet to be utilised for revision hip and knee surgery. Between 2013 and 2014, patients who underwent revision arthroplasty by the senior author were identified. 36 (9 hips and 27 knees) operations in 36 patients identified 18 (8 male, median age 77 (61&#x2013;86)) who received standard dressing and 18 (12 male, median age 67 (58&#x2013;81)) who received single use portable INPWT dressings (4 hips, 14 knees). Wound complications were seen in 3 (2 knees) from the standard group and 1 (hip) in the INPWT group (<svg  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"   style="vertical-align:-3.32502pt" id="M1" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.37 11.6608" width="45.37pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-113" d="M573 302C573 402 527 451 414 451C386 451 343 446 313 437L330 513L320 522C295 508 261 484 243 463L230 415C194 400 159 383 126 359L131 330C159 344 187 357 222 368L109 -147C96 -204 80 -214 18 -223L13 -255L256 -244L259 -212L236 -210C184 -205 180 -195 191 -141L219 -1C240 -10 268 -12 284 -12C352 4 431 48 484 104C543 166 573 240 573 302ZM481 290C481 165 381 37 305 37C280 37 249 56 235 71L302 395C328 399 353 402 372 402C427 402 481 378 481 290Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="597" vert-adv-y="597" /></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="611" vert-adv-y="611" /></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><path id="g50-47" d="M117 -12C153 -12 178 12 178 50C178 84 153 110 118 110C84 110 59 84 59 50C59 12 84 -12 117 -12Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="237" vert-adv-y="237" /></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><path id="g50-50" d="M389 0V32C297 38 291 46 291 118V635C234 613 175 595 109 583V556L161 554C203 552 207 547 207 497V118C207 46 201 38 110 32V0H389Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><path id="g50-53" d="M462 177V227H365V632H320C217 496 116 350 21 208V177H284V109C284 43 280 38 190 31V0H451V31C369 38 365 43 365 108V177H462ZM284 227H88C155 336 218 430 282 519H284V227Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g></svg>). There was no statistical difference in age or gender between groups. Risk factors (BMI &#x3e; 30, smoking, and diabetes) were identified in 9 patients, median ASA 3, in the standard group and 10 patients, median ASA 2, in the INPWT group. There were no dressing related complications. This is the first study of INPWT with a low pressure single use 80 mmHg dressing with revision arthroplasty. This initial study showed a threefold decrease in wound complication in the INPWT group and that INPWT is a safe alternative to standard dressings.

Thomas Hester

Shoib Mahmood

Farid Moftah

Is Single Use Portable Incisional Negative Pressure Wound Therapy System Suitable for Revision Arthroplasty?

<i  >Background</i>. The infrapatellar fat pad (IPFP) is currently resected in approximately 88&#x25; of Total Knee Arthroplasties (TKAs). We hypothesised that an intact IPFP would improve outcomes after TKA.<i  > Methods</i>. Patients with an intact IPFP participated in this cross-sectional study by completing two surveys, at 6 and 12 months after TKA. Both surveys included questions regarding kneeling, with the Oxford Knee Score also included at 12 months.<i  > Results</i>. Sixty patients participated in this study. At 6 and 12 months, a similar number of patients were able to kneel, 40 (66.7&#x25;) and 43 (71.7&#x25;), respectively. Fifteen (25.0&#x25;) patients were unable to kneel due to knee pain at 6 months; of these, nine (15&#x25;) were unable to kneel at 12 months. Moreover, at 12 months, 90.0&#x25; of the patients reported minimal or no knee pain. There was no correlation between the inability to kneel and knee pain (<svg  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"   style="vertical-align:-3.32502pt" id="M1" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.37 11.6608" width="45.37pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-113" d="M573 302C573 402 527 451 414 451C386 451 343 446 313 437L330 513L320 522C295 508 261 484 243 463L230 415C194 400 159 383 126 359L131 330C159 344 187 357 222 368L109 -147C96 -204 80 -214 18 -223L13 -255L256 -244L259 -212L236 -210C184 -205 180 -195 191 -141L219 -1C240 -10 268 -12 284 -12C352 4 431 48 484 104C543 166 573 240 573 302ZM481 290C481 165 381 37 305 37C280 37 249 56 235 71L302 395C328 399 353 402 372 402C427 402 481 378 481 290Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="597" vert-adv-y="597" /></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="611" vert-adv-y="611" /></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><path id="g50-47" d="M117 -12C153 -12 178 12 178 50C178 84 153 110 118 110C84 110 59 84 59 50C59 12 84 -12 117 -12Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="237" vert-adv-y="237" /></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><path id="g50-50" d="M389 0V32C297 38 291 46 291 118V635C234 613 175 595 109 583V556L161 554C203 552 207 547 207 497V118C207 46 201 38 110 32V0H389Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><path id="g50-52" d="M290 377C321 398 342 415 358 430C378 450 389 473 389 502C389 578 329 635 238 635H237C184 635 137 610 109 578L64 515L88 493C112 529 154 573 208 573S303 542 303 482C303 409 233 370 141 341L149 308C165 313 190 319 215 319C272 319 341 283 341 193C342 98 292 43 222 43C163 43 122 72 96 94C88 101 79 100 70 94C61 87 47 73 46 60C44 47 48 37 62 23C76 10 118 -12 165 -12C238 -12 430 62 430 223C430 297 379 359 290 375V377Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g></svg>). There was a significant correlation between the inability to kneel and reduced overall standardised knee function scores (<svg  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"   style="vertical-align:-3.32502pt" id="M2" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.37 11.6608" width="45.37pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-113" d="M573 302C573 402 527 451 414 451C386 451 343 446 313 437L330 513L320 522C295 508 261 484 243 463L230 415C194 400 159 383 126 359L131 330C159 344 187 357 222 368L109 -147C96 -204 80 -214 18 -223L13 -255L256 -244L259 -212L236 -210C184 -205 180 -195 191 -141L219 -1C240 -10 268 -12 284 -12C352 4 431 48 484 104C543 166 573 240 573 302ZM481 290C481 165 381 37 305 37C280 37 249 56 235 71L302 395C328 399 353 402 372 402C427 402 481 378 481 290Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="597" vert-adv-y="597" /></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="611" vert-adv-y="611" /></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><path id="g50-47" d="M117 -12C153 -12 178 12 178 50C178 84 153 110 118 110C84 110 59 84 59 50C59 12 84 -12 117 -12Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="237" vert-adv-y="237" /></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g><g transform="matrix(.013,0,0,-0.013,38.799,0)"><path id="g50-51" d="M414 144C384 79 371 75 317 75H135L276 221C367 316 408 376 408 465C408 570 327 635 237 635C179 635 131 609 100 575L42 494L67 471C94 510 138 565 205 565C277 565 321 517 321 435C321 348 258 270 195 195C146 137 88 81 33 26V0H411C423 44 433 88 446 135L414 144Z" /><glyph.data ascent="3443" descent="-2856" horiz-adv-x="487" vert-adv-y="487" /></g></svg>).<i  > Conclusions</i>. This was the first study to demonstrate improved kneeling and descending of stairs after TKA with IPFP preservation. These results in the context of current literature show that IPFP preservation reduces the incidence of knee pain 12 months after TKA.

Leigh White

Nicholas Hartnell

Melissa Hennessy

Judy Mullan

The Impact of an Intact Infrapatellar Fat Pad on Outcomes after Total Knee Arthroplasty

The antibiotic elution profiles from calcium phosphate cement (CPC) used for treating infection sites after total joint arthroplasty vary depending on the type and number of impregnated antibiotics. The purpose of this study was to develop a method for efficiently eluting vancomycin hydrochloride (VCM) and gentamicin sulfate (GM) from CPC. Examination of the antibiotic elution profiles of CPC impregnated with either VCM (CPC/V) or GM (CPC/G) or both (CPC/VG) revealed that the early elution of VCM from CPC/VG was impaired compared to CPC/V. However, the elution of GM from CPC/VG was similar or higher compared to CPC/G. Scanning electron microscopy showed that the pore structure of CPC markedly differed depending on the type and number of antibiotics present. The pore size of CPC/VG was smaller compared to CPC/V but was larger compared to CPC/G. Thus, the inhibition of the early elution of VCM, which is a larger molecule than GM, was attributed to the decreased pore size of CPC/VG. These findings suggest that when dual treatment with VCM and GM is required for infection following total joint arthroplasty, each antibiotic should be individually impregnated into CPC to maximize the elution efficiency of VCM.

Masataka Uchino

Ken Sugo

Kouji Naruse

Kentaro Uchida

Noriko Hirakawa

Masahiro Toyama

Genyou Miyajima

Ken Urabe

Elution Characteristics of Vancomycin, Gentamicin, and Vancomycin/Gentamicin Combination from Calcium Phosphate Cement

Obesity is becoming a critical problem in the developed world and is associated with an increased incidence of osteoarthritis of the hip. The Oxford Hip Score was used to determine if Body Mass Index (BMI) is an independent factor in determining patient outcome following primary total hip arthroplasty (THA). Using data from 353 operations we found that patients with BMI &#x2265; 30 had an absolute score that was lower preoperatively and postoperatively compared to those with a BMI &#x3c; 30. There was no difference in pre- and postoperative point score change within each group; Kendall&#x2019;s rank correlation was 0.00047 (95&#x25; CI, &#x2212;0.073 to 0.074 (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.32502pt" id="M1" height="11.6608pt" version="1.1" viewBox="-0.0498162 -8.33578 45.3699 11.6608" width="45.3699pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-113" d="M573 302C573 402 527 451 414 451C386 451 343 446 313 437L330 513L320 522C295 508 261 484 243 463L230 415C194 400 159 383 126 359L131 330C159 344 187 357 222 368L109 -147C96 -204 80 -214 18 -223L13 -255L256 -244L259 -212L236 -210C184 -205 180 -195 191 -141L219 -1C240 -10 268 -12 284 -12C352 4 431 48 484 104C543 166 573 240 573 302ZM481 290C481 165 381 37 305 37C280 37 249 56 235 71L302 395C328 399 353 402 372 402C427 402 481 378 481 290Z"/></g><g transform="matrix(.013,0,0,-0.013,11.438,0)"><path id="g54-34" d="M556 331V384H55V331H556ZM556 140V193H55V140H556Z"/></g><g transform="matrix(.013,0,0,-0.013,23.056,0)"><path id="g50-49" d="M245 635C92 635 37 457 37 312C37 149 91 -12 244 -12C395 -12 449 166 449 312C449 469 395 635 245 635ZM243 598C332 598 358 454 358 312C358 173 334 26 245 26C158 26 128 174 128 313S152 598 243 598Z"/></g><g transform="matrix(.013,0,0,-0.013,29.387,0)"><path id="g50-47" d="M117 -12C153 -12 178 12 178 50C178 84 153 110 118 110C84 110 59 84 59 50C59 12 84 -12 117 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,32.468,0)"><path id="g50-58" d="M247 635C116 635 39 518 39 421C39 315 113 237 221 237C239 237 258 241 281 253L349 289C315 140 204 42 60 19L66 -15C90 -15 153 -5 207 16C344 70 447 199 447 385C447 521 373 635 247 635ZM231 598C329 598 356 478 356 390C356 371 355 347 352 325C330 309 297 297 262 297C179 297 127 369 127 456C127 515 156 598 231 598Z"/></g><g transform="matrix(.013,0,0,-0.013,38.8,0)"><use xlink:href="#g50-58"/></g></svg>)) and demonstrated no trend. There was no statistically significant difference in change between those with BMI &#x2265; 30 and &#x3c; 30 <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.32507pt" id="M2" height="12.6134pt" version="1.1" viewBox="-0.0498162 -9.28833 54.7129 12.6134" width="54.7129pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g50-41" d="M309 -142C211 -61 151 99 151 271S210 601 309 683L288 710C141 611 75 451 75 272V271C75 90 141 -72 288 -169L309 -142Z"/></g><g transform="matrix(.013,0,0,-0.013,4.654,0)"><use xlink:href="#g50-113"/></g><g transform="matrix(.013,0,0,-0.013,16.092,0)"><use xlink:href="#g54-34"/></g><g transform="matrix(.013,0,0,-0.013,27.71,0)"><use xlink:href="#g50-49"/></g><g transform="matrix(.013,0,0,-0.013,34.041,0)"><use xlink:href="#g50-47"/></g><g transform="matrix(.013,0,0,-0.013,37.122,0)"><path id="g50-55" d="M141 347C171 480 264 541 327 570C364 587 403 599 436 605L429 641C389 634 339 622 300 609C191 570 37 458 37 239C37 86 126 -12 245 -12C367 -12 454 89 454 210C454 314 380 397 272 397C252 397 230 390 208 380L141 347ZM231 338C323 338 366 257 366 174C366 108 340 27 263 27C180 27 129 123 129 244C129 268 130 292 135 310C158 323 193 338 231 338Z"/></g><g transform="matrix(.013,0,0,-0.013,43.453,0)"><path id="g50-54" d="M158 548H390L417 615L410 623H122L83 318C105 326 143 337 185 337C296 337 350 275 350 188C350 116 308 42 225 42C164 42 122 74 100 93C90 101 82 99 72 92C60 82 51 68 50 59C48 46 52 38 66 24C82 9 125 -12 172 -12C225 -11 292 15 346 59C408 108 437 166 437 226C437 309 371 397 242 397C214 397 170 382 133 369L158 548Z"/></g><g transform="matrix(.013,0,0,-0.013,49.784,0)"><path id="g50-42" d="M283 271C283 451 220 610 70 710L48 683C146 603 207 443 207 271S149 -59 48 -142L70 -169C220 -67 283 90 283 271Z"/></g></svg>. We suggest that those with a higher BMI be considered for THA as they can expect the same degree of improvement as those with a lower BMI. Given the on-going increase in obesity these findings could be significant for the future of THA.

Zuned Hakim

Claire Rutherford

Elizabeth Mckiernan

Tony Helm

Outcome in Patients with High Body Mass Index following Primary Total Hip Arthroplasty

Here, we describe an arthroscopic method specifically developed to augment rotator cuff repair using a flexible acellular dermal patch (ADP). In this method, an apparently complex technique is simplified by utilizing specific steps to augment a rotator cuff repair. In this method, using a revised arthroscopic technique, rotator cuff repair was performed. This technique allowed easy passage of the graft, excellent visualization, minimal soft tissue trauma, and full four-corner fixation of an ADP. Twelve patients underwent rotator cuff repair with augmentation using the combination of this method and ADP. Due to the technique and biomechanical characteristics of the material, the repairs have been stable and with high patient satisfaction.

Anthony C. Levenda

Natalie R. Sanders

A Simplified Approach for Arthroscopic Repair of Rotator Cuff Tear with Dermal Patch Augmentation

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Advances in Orthopedic Surgery