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Weekly News, Analysis, and Commentary

Orthopaedic Crossfire® Features & News

Implant Registries Flawed? Murray v. Lewallen

Murray and Lewallen
Murray and Lewallen

“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.”

Blaha, Haddad: Four Rounds Over Femoral Neck Modularity

Current Concepts in Joint Replacement/Image created by RRY Publications, LLC
Current Concepts in Joint Replacement/Image created by RRY Publications, LLC

“This is an unnecessary evil. It’s not required for function and may be associated with implant failure,” says David Blaha. Fares Haddad notes, “There are still indications for modularity, but we need to get the design right and simplify the technique. And it has to be generalizable.”

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All Poly Tibia: Dunbar Debates Thornhill

Image created by RRY Publications, LLC
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.”

Short Stems in Primary Hip: Lombardi v. Whiteside

Image created by RRY Publications, LLC
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.”

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Cementless Fixation: Kwong v. Scott

Image created by RRY Publications, LLC
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

Image created by RRY Publications, LLC
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

Image created by RRY Publications, LLC
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.”

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Whiteside, Callaghan Debate Life-Time Guaranteeing Cementless TKA

Image created by RRY Publications, LLC
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.”

Pagnano, Thornhill Debate Kinematic Alignment of the Knee

Image created by RRY Publications, LLC
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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Cameron v. Gehrke Over Hinges

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Image created by RRY Publications, LLC

“There is a role for hinges, but not for these current designs. There are no non-rotating fixed axis hinges!” states Hugh Cameron. Thorsten Gehrke counters, “There are clear indications for a hinge knee, such as with extreme valgus deformities. Other primary indications include bone loss with major instability and extra-articular deformity.”

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Pagnano Takes On Engh Over Poly Insert Exchange

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

“The reasons to do a polyethylene insert exchange might include isolated liner wear, knee instability, or specific circumstances surrounding knee stiffness,” argues Mark Pagnano. “Hold up,” says Jerry Engh. “IF the original implant was a defective poly, and IF good poly is available for the exchange, then it is a reasonable option.”

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Padgett, Callaghan: Three Rounds Over Constrained Liners

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

Doug Padgett says, “Constrained liners are problematic. We looked at 70 liners and found a mean length of implantation of only 26 months. We noted a tremendous amount of wear on both the outer and inner rims.” “But some do need a constraint,” argues John Callaghan. “And when we looked at the tripolar design out to ten years there was a 93% success rate.”

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