Herrick J. Siegel, MD

Postoperative chemotherapy may be associated with increased risk of periprosthetic joint infection after total joint arthroplasty, according to published results.

Radiofrequency ablation yielded a rapid and statistically significant improvement in pain relief among patients with metastatic bone disease, according to published results.

Edge-loading, accelerated wear, impingement and dislocation are leading contributors to total hip replacement revision. Component malposition is a major contributor to these variables, which result in an increase in revision THR surgery. Defining an intraoperative target alignment is highly complex and the accuracy of positioning the acetabulum within a “safe zone,” as described by Lewinnek and colleagues, is highly variable. Computer-assisted orthopedic surgery and, more recently, robotics were introduced to improve surgical precision, but there has been slow acceptance by the orthopedic community. This is likely due to the poor definition of what constitutes the correct target alignment for a given individual. Recent literature has questioned whether the commonly accepted guidelines for implant alignment should be considered ideal for every patient since more failures have been observed when following these historical recommendation, than when not.

The direct anterior, or the anterior supine intermuscular, approach for total hip arthroplasty continues to gain acceptance with surgeons as patient demand for the procedure remains high. Many studies have demonstrated advantages with the approach, including improved gait symmetry at 6 weeks postoperatively, decreased dislocation rate, decreased muscle damage, decreased pain and more accurate leg-length restoration when compared with the posterior approach. The reduced hospital stay and earlier return to activities, such as driving, work, and recreation, afforded by the approach is appealing to both middle-age and elderly patients. In experienced hands, the anterior approach total hip arthroplasty is a safe and effective procedure. However, the approach does carry a lengthy learning curve and may result in an increased complication rate during the learning period.