The Journal of arthroplasty
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Femoral neck fractures (FNFs) are a significant cause of mortality and disability among the elderly population. Total hip arthroplasty (THA) is the preferred treating method in active, cognitively intact patients. The direct anterior approach (DAA) has suggested a lower dislocation risk and a significant reduction in postoperative pain and recovery time in elective THA. This study aimed to compare clinical outcomes, perioperative complications, and mortality of THA through the DAA between FNF and elective cases. ⋯ THA through the DAA might be a credible and safe option for patients presenting an FNF, with excellent functional outcomes, less surgery-related complications, and lower short-term and long-term mortality than those reported in the literature. Early intervention and perioperative stabilization of the patients with FNF could potentially increase the survival rate.
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Assessing patients' functional outcomes following total hip arthroplasty with traditional scoring systems is limited by their ceiling effects. The Forgotten Joint Score (FJS) has been suggested as a more discriminating option. The actual score in the FJS which constitutes a "forgotten joint," however, has not been defined. The emerging concept of joint perception led to the development of the Patient's Joint Perception question (PJP) to assess the patient's opinion of their prosthetic joint. ⋯ A forgotten hip perception corresponds to an FJS >93. In 20%-30% of the cases, the WOMAC and FJS failed to identify the forgotten joint, or reached the maximum score when the patients did not feel their hip was natural. The PJP is a simple and reliable tool that enables identification of patients who feel replaced hip is natural.
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While the 11-factor modified frailty index (mFI) has been shown to predict adverse outcomes in patients undergoing total joint arthroplasty, the 5-factor index has not been evaluated in this patient population. The goal of this study was to evaluate the utility of the mFI-5 as a predictor of morbidity and mortality in patients undergoing primary total hip and knee arthroplasty. ⋯ III.
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Two-stage revision utilizing spacers loaded with high-dose antibiotic cement prior to reimplantation remains the gold standard for treatment of periprosthetic joint infections (PJI) in total hip arthroplasty (THA) in North America, but there is a paucity of data on mid-term outcomes. We sought to analyze the survivorship free of infection, clinical outcomes, and complications of a specific articulating spacer utilized during 2-stage revision. ⋯ Insertion of an articulating antibiotic spacer during a 2-stage revision THA for PJI demonstrates reliable infection eradication and improvement in clinical function, including the spacer phase. Patients with trochanteric deficiency and an articulating spacer dislocation are at high risk of post-reimplantation dislocation; judicial use of a dual-mobility or constrained device should be considered in these patients.
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This study investigated the effects of dronabinol on pain, nausea, and length of stay following total joint arthroplasty (TJA). ⋯ These findings suggest that further investigation into the role of cannabinoid medications for non-opioid pain control in the post-arthroplasty patient may hold merit.