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  • Long-term Results of a First-Generation Annealed Highly Cross-Linked Polyethylene in Young, Active Patients

    The survivorship of total hip arthroplasty in younger patients is dependent on the wear characteristics of the bearing surfaces. Long-term results with conventional polyethylene in young patients show a high failure rate. This study assessed the long-term results of a first-generation annealed highly cross-linked polyethylene (HCLPE) in uncemented total hip arthroplasty in young, active patients.

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  • Incidence of Heterotopic Ossification Following a Multimodal Pain Protocol in Total Hip Arthroplasty With the Posterior Approach

    Heterotopic ossification (HO) is prevalent after total hip arthroplasty (THA). Oral nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 (COX-2) inhibitors have reduced the incidence of HO; however, to the authors’ knowledge, no studies have reported the incidence and severity of HO with a pain protocol highlighted by celecoxib in the pre- and postoperative period with a posterolateral approach.

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  • Preliminary Clinical and Radiographic Results of Large Ceramic Heads on Highly Cross-Linked Polyethylene

    Data are limited regarding large ceramic femoral heads with highly cross-linked polyethylene. We hypothesized that large ceramic head articulation with highly cross-linked polyethylene is safe with a low wear rate, comparable to metal-on-highly cross-linked polyethylene.

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  • Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty

    Although total knee arthroplasty is a successful and cost-effective procedure, patient dissatisfaction remains as high as 50%. Postoperative residual knee pain after total knee arthroplasty, with or without crepitation, is a major factor that contributes to patient dissatisfaction. The most common location for residual pain after total knee arthroplasty is anteriorly.

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  • Arthrofibrosis After Total Knee Arthroplasty

    Six total knee arthroplasties in five patients were revised because of persistent limited motion after the primary arthroplasty. All of the revised implants were of an appropriate size and not malpositioned. No cause of stiffness was identified other than soft tissue contracture. Four of the components were posterior cruciate retaining and two were posterior cruciate substituting. Heterotopic bone formation was observed in two knees before the revision surgery and five knees after the revision surgery. Arc of motion was increased from 36 °(range, 20 °–70 °) before revision surgery to 86 °(range, 70 °–110 °) after revision surgery. What triggers the proliferation of extensive scar tissue formation in patients with arthrofibrosis is not clear. Some patients may be predisposed to this condition or may have it develop as a response to the surgical trauma and postoperative rehabilitation. However, when arthrofibrosis does develop after total knee arthroplasty, some improvement in motion and pain can be achieved with revision surgery.

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  • Durable Fixation Achieved With Medialized, High Hip Center Cementless THAs for Crowe II and III Dysplasia

    A high hip center total hip arthroplasty (THA) for dysplasia allows more complete socket coverage by native bone at the expense of abnormal hip biomechanics. Despite poor results with cemented components, intermediate-term results with cementless cups at a high hip center have been promising, but there are few reports at long-term followup without bone graft.

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  • Challenges in Outcome Measurement: Discrepancies Between Patient and Provider Definitions of Success

    Some orthopaedic procedures, including TKA, enjoy high survivorship but leave many patients dissatisfied because of residual pain and functional limitations. An important cause of patient dissatisfaction is unfulfilled preoperative expectations. This arises, in part, from differences between provider and patient in their definition of a successful outcome.

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  • Alternative Payment Models in Total Joint Arthroplasty Under the Affordable Care Act

    Since the passage of the U.S. Patient Protection and Affordable Care Act (ACA), health care has transitioned from a volume-based enterprise to a quality-based enterprise. Under this legislation, Alternative Payment Models (Bundled Payments for Care Improvement [BPCI], Comprehensive Care for Joint Replacement [CJR], and Accountable Care Organizations [ACOs]) have been developed to provide stakeholders with reimbursement systems that reward high-quality care and cost reduction.
    » The goal of this article was to elaborate on the various Alternative Payment Models and recent amendments and how these unique payment paradigms may offer orthopaedic surgeons innovative principles to further advance the quality and efficiency of total joint arthroplasty.

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  • The Historical Development of Value-Based Care: How We Got Here

    The original architects of Medicare modeled the payment system on the existing fee-for-service (FFS) structure that historically dominated the health-insurance market. Under the FFS paradigm, health-care expenditures experienced an exponential rise. In response, the managed care and capitation models of health-care delivery were developed. However, changes in Medicare reimbursement, along with an increasing volume of orthopaedic procedures and escalating implant costs, call into question the cost-effectiveness of this service line. The success of the Medicare Acute Care Episode (ACE) Demonstration Project proved the feasibility of value-based care and ushered in a new era of bundled payment initiatives.

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  • Long-Term Performance of Ceramic and Metal Femoral Heads on Conventional Polyethylene in Young and Active Patients

    Ceramic femoral heads produce less wear of the opposing polyethylene than do metal femoral heads in wear simulation studies. This is a matched-pair analysis of the wear of ceramic and metal femoral heads on conventional polyethylene in uncemented total hip replacements in young, active patients at a minimum of fifteen years of follow-up.

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