Thomas L. Bradbury’s research while affiliated with Northside Hospital and other places

Revision total hip arthroplasty (RTHA) is expected to see exponential growth within the next decade, further compounding an already large economic burden to the global healthcare community. Enhanced recovery protocols, improved surgical techniques, and effective patient education strategies have resulted in a profound reduction in length of stay after primary THA. As same-day discharge primary THA has become more routine, more primary THA cases are performed in ambulatory surgery centers (ASC). This transition to the ASC has resulted in an improved patient experience without a compromise in safety or outcomes. The use of these same principles has reduced length of stay after RTHA. However, RTHA has remained a predominantly inpatient procedure. With appropriate patient selection, surgical complexity, surgeon comfort, and payor contracts, RTHA in the ASC can offer a safe and effective alternative to the inpatient setting. Integral to the success of an ASC RTHA program is a defined and reproducible perioperative protocol including preoperative education, multimodal pain strategies, and postoperative physical therapy. A comprehensive understanding of the logistical challenges of incorporating revision procedures in an established total joint arthroplasty (TJA) ASC will provide the surgical team a framework to adjust operational considerations accordingly.

Total hip arthroplasty (THA) utilization is projected to significantly increase, with primary and revision procedures expected to rise significantly in the coming decades. This chapter discusses the direct anterior (DA) approach for revision THA (rTHA) and its effectiveness in accommodating a range of revision scenarios. The chapter includes optimal patient positioning and surgical techniques for both femoral and acetabular exposure, including the importance of adequate soft tissue releases. Additionally, the DA approach can be used for complex acetabular and femoral reconstructions, including periprosthetic fractures and various osteotomy techniques. The DA approach offers a promising and versatile option for revision THA and continues to gain popularity.

Background Despite increased utilization of robotic assistance during unicompartmental knee arthroplasty (UKA), its impact on postoperative outcomes remains unclear. This study aimed to compare rates of postoperative revision and complications among patients undergoing robotic-assisted UKA (RA-UKA) versus manual UKA. Methods A retrospective matched cohort study was performed. Trends analysis of the annual proportion of RA-UKA between 2010 and 2021 was performed, and RA-UKA patients (n = 3976) were matched 1:3 with manual UKA patients (n = 11,766) across age, sex, Elixhauser Comorbidity Index, and comorbidities. Rates of 2-year prosthesis-related complications were compared between the matched cohorts using multivariable logistic regression. Results The annual proportion of UKA procedures performed with robotic assistance trended significantly upward (1.51% to 5.19%, P < .001). Within 2 years postoperatively, the RA-UKA cohort exhibited significantly lower rates of aseptic revision (1.84% vs 2.37%; odds ratio: 0.76; P = .040) and aseptic loosening (0.13% vs 0.42%; odds ratio: 0.32; P = .010). Total cost for the index UKA was significantly higher for the RA-UKA cohort ($10,321 vs$7,366; P < .001). Conclusions There has been a marked increase in utilization of RA-UKA. Compared to matched manual UKA, RA-UKA had lower rates of revision and aseptic loosening at 2-year follow-up, but at a higher total cost for the index procedure. Further research exploring the use of robotics in UKA with attention to patient outcomes and cost is crucial for defining its evolving role in orthopaedic surgery.

This study aimed to compare outcomes and complication rates between posterior cruciate ligament (PCL) retention and excision utilizing a medial congruent (MC) polyethylene insert in total knee arthroplasty (TKA) in a specialized ambulatory surgery center (ASC) dedicated to hip and knee arthroplasty. A retrospective review was performed between May 2023 and October 2023 analyzing 398 patients who underwent primary MC TKA by high-volume joint arthroplasty surgeons (n = 9) with either PCL preservation (n = 264) or sacrifice (n = 134) in a single free-standing ASC. Patients were matched chronologically on a 2:1 basis. Demographics, baseline function, 90-day complications, and patient-reported outcomes were recorded for each patient. There were no differences in preoperative baseline function or patient-reported outcome measures, Charlson Comorbidity Index, or American Society of Anesthesiologists class among patient groups. The PCL-preserve and PCL-sacrifice cohorts showed significant variation in 12-week postoperative Knee Injury and Osteoarthritis Outcome, Junior (KOOS, JR.) scores. Specifically, the number of patients who achieved the minimal clinically important difference (MCID) in KOOS, JR. scores was higher in the PCL-sacrifice group (p < 0.05). Yet, no complications within the 90-day period were associated with PCL status and other patient-reported outcomes. This study comparing outcomes between MC TKAs with PCL retention and sacrifice suggests that both techniques are viable options with similar functional outcomes, pain scores, and complication rates, which may have benefits in an ASC setting. The PCL-sacrifice group exhibited a statistically significant increase in patients who achieved the MCID in KOOS, JR. score compared with the PCL-preserving at early follow-up. Future research should employ prospective, randomized designs to further validate these findings and explore long-term implications.

Osteotomy techniques used for wide exposure during femoral component revision include the extended trochanteric osteotomy and its modifications. We describe an anterior proximal femur osteotomy technique starting from the inside of the femoral canal at the bone-implant interface and heading outward. The technique is used in conjunction with the extended direct anterior approach and allows direct access to and visualization of the anterior, medial, and lateral bone-implant interfaces. This technique is most useful for the removal of collared, fully hydroxyapatite-coated double-tapered femoral stems, in which bone-implant interfaces need to be accessed for removal of a well-osseointegrated hip arthroplasty implant.