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Weekly News, Analysis, and Commentary

Orthopaedic Crossfire® Features & News

McFarland, Gobezie Debate Treatment for Infected TSA

Image created by RRY Publications, LLC
Image created by RRY Publications, LLC

“This patient MAY be infected,” says Ed McFarland. “For patients who are even a bit ill, I would do a one-stage revision; those who are young and healthy get a two-stage revision. I don’t think debridement adds much.” Reuben Gobezie counters, “If you’re going to do anything to this patient, I think it would be reasonable to get an arthroscopic debridement at the most before you rip their arm out, Ed.”

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Rodriguez, Penenberg Debate Mini Anterior Approach

Image created by RRY Publications, LLC
Image created by RRY Publications, LLC

It’s Penenberg vs. Rodriquez. “The direct anterior approach is quicker and people recover sooner…”, says Dr. Brad Penenberg. Hold on a minute, says Dr. Jose Rodriquez. Success using the direct anterior approach depends on “…by whom, which outcomes, and compared to what.” It’s a lively and extremely informative debate.

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Hofmann, Ranawat Debate Post in Posterior Knee

Image created by RRY Publications, LLC
Image created by RRY Publications, LLC

“I think that the ultracongruent insert provides excellent posterior stability, it’s bone sparing and technically easy, there are fewer complications, and it’s certainly time saving,” says Aaron Hofmann. “Wait,” says Chit Ranawat. “RP-PS has better survivorship and improved ROM compared to fixed bearing posterior stabilized.”

All-Poly Tibia: Cheaper, Better?

David G. Lewallen, M.D., Thomas S. Thornhill, M.D.
David G. Lewallen, M.D., Thomas S. Thornhill, M.D.

“Saying that modular metal backed tibial trays are somehow the ‘gold standard’ for modern TKA just isn’t true,” says David Lewallen. “Wait,” says Tom Thornhill. “Most all-poly tibia results are in low demand patients. And, backside wear is now substantially better than it was during the period of time that David showed us.”

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Patient Specific Instruments: Overpromised, Under Delivered

Paul Lachiewicz, M.D. and Michael E. Berend, M.D.
Paul Lachiewicz, M.D. and Michael E. Berend, M.D.

“Is patient specific instrumentation (PSI) less expensive? Is it easier for you? The answer is definitely ‘no,’” argues Paul Lachiewicz. “PSI provides a way to position the implants specific to that patient’s anatomy (preop valgus, patient height, hip pathology, etc.),” says Mike Berend. And you can do it before you enter the OR…with templating this means it is time neutral.”

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Implant Registries Flawed? Murray v. Lewallen

David Murray, M.D., F.R.C.S. and David G. Lewallen, M.D.
David Murray, M.D., F.R.C.S. and David G. Lewallen, M.D.

“The data proves that registries cannot compare implant designs!” says David Murray. “Going to single surgeon or institutional efforts allow large numbers of patients to be studied very quickly,” says David Lewallen. “What registry studies really do is allow us to ask interesting questions and perhaps direct the next studies.”

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All Poly Tibia: Dunbar Debates Thornhill

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Image created by RRY Publications, LLC

“We shouldn’t be afraid of the all polyethylene construct. There’s been good evidence since 1984 that it’s a safe construct,” says Michael Dunbar. Tom Thornhill counters, “Cost is increasingly going to be an issue…and this is going to be a zero sum game. In my practice I use a modular tibial component that is cemented.”

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Short Stems in Primary Hip: Lombardi v. Whiteside

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Image created by RRY Publications, LLC

“My message is that the short tapered titanium porous plasma sprayed femoral component is efficacious, with less than 1% stem revisions if we look at revisions related to the stem,” says Adolph Lombardi. Leo Whiteside counters, “Despite the literature we must be careful here. I know a lot of good guys who have tried and failed with fractures, migration, and loosening. Let’s avoid the learning curve.”

Cementless Fixation: Kwong v. Scott

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Image created by RRY Publications, LLC

“Cementless fixation is an easy surgery with excellent intermediate to long term clinical performance,” says Louis Kwong. Richard Scott counters, “Cemented TKA is state of the art and has a reoperation rate of 0.5% for the first 15 years. Cementless hasn’t yet been proven to be as reliable as cemented fixation.”

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Su Takes on Dunbar Over Surface Replacement

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Image created by RRY Publications, LLC

“Surface replacement provides several advantages over THR, including bone preservation, greater stability, and a higher activity level,” says Edwin Su. Michael Dunbar disagrees, saying, “Resurfacing is more invasive, has worse outcomes, produces metal ions and pseudotumors, is hard to revise, and does not provide better function.”

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Blaha, Keggi Debate Femoral Neck Modularity

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Image created by RRY Publications, LLC

“I used to extoll the virtues of the modular neck,” says David Blaha. “I’ve changed my mind because the risks have increased. The problem is corrosion.” John Keggi retorts, “Let’s not throw the baby out with the bath water. Modular stems do allow you to reconstruct femurs that you might not be able to reconstruct with a standard stem…and deformities that you definitely cannot reconstruct with a standard stem.”

Whiteside, Callaghan Debate Life-Time Guaranteeing Cementless TKA

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Image created by RRY Publications, LLC

“If I can do an osteointegrated total knee and I can choose the one I want and I do the operation myself then I will guarantee it for a lifetime,’ says Leo Whiteside. John Callaghan: “Lifetime guarantees are dangerous in ALL aspects of life. Look at Vegas…marriage capital of the world…50% of those don’t work out. Death and taxes are the only guarantees.”

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Pagnano, Thornhill Debate Kinematic Alignment of the Knee

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Image created by RRY Publications, LLC

“End the tyranny of the tibia!” exclaims Mark Pagnano. “The data show that for 80% of knee replacements mechanical axis alignment works very well, and it’s been a durable, reliable way to do knee replacement.” Counters Tom Thornhill, “We’re going to look back years from now and see that the stuff we’re putting in now is completely obsolete. I’m interested to see if the satisfaction improves if we improve the kinematics.

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