Intraoperative medial collateral ligament (MCL) disruption during total knee arthroplasty (TKA) is often managed with either primary repair or use of a constrained implant. A total of 23 patients with an MCL injury during TKA between 2003 and 2009 were compared with 92 matched controls. Of the 23 patients, 10 were treated with an unconstrained implant and primary MCL repair, 8 with constrained implants, 3 with constrained implants and MCL repair, and 2 with unconstrained implants and no MCL repair. After an average 5-year follow-up, patients had lower Knee Society Scores (KSS), 79 versus 87 (p = 0.03), but similar Knee Function Scores (KFS), 68 versus 72 (p = 0.35). The improvement between preoperative and postoperative KSS and KFS did not vary among the two groups (p = 0.88 and p = 0.77, respectively). Postoperative scores did not vary significantly among the four treatment modalities. Conservative treatment can provide satisfactory outcomes and avoid potential complications of increased constraint.

When combined with morphologic observations, molecular studies will increase our understanding of the pathogenesis and morphomolecular signatures associated with specific neoplasms and provide new horizons for precision medicine and targeted therapies.

Objectives To evaluate the necessity of pathologic examination for confirming the diagnosis of avascular necrosis (AVN). Methods We retrospectively reviewed consecutive nonfractured total hip arthroplasty cases (n = 1,722), comparing operative diagnoses and radiologic data with final histologic diagnoses, focusing specifically on AVN. Results Among 199 histologically confirmed cases of AVN, 62 (31%) had a preoperative diagnosis of osteoarthritis/degenerative joint disease (OA/DJD); 58 of the latter patients had radiology reports, but only two (3%) documented AVN. Patients with AVN preoperatively diagnosed as OA/DJD were significantly older (mean, 65 years) than patients with AVN correctly diagnosed clinically (mean, 52 years; P < .00001). Among 163 cases with a preoperative diagnosis of AVN, 26 (16%) were confirmed as OA/DJD; the radiology report incorrectly diagnosed AVN in 17 (65%) patients. These latter patients also were significantly older (mean, 60 years) than patients with AVN correctly diagnosed clinically (P = .0008). Patients with a preoperative clinical and/or radiologic diagnosis of AVN were more likely to be younger and have known AVN risk factors. Conclusions Accurate and reliable diagnosis of AVN requires pathologic examination, especially among older patients without known risk factors. Prompt diagnosis may lead to behavioral changes in affected patients that reduce the risk of subsequent lesions.

Background: Original indications for knee and hip arthroplasty implants were developed decades ago and categorized conditions, such as obesity and developmental dysplasia, as contraindications, rendering their use in these patients “off-label”. The objective of this pilot study was to determine the prevalence of off-label use at our institution and test for differences in clinical and functional outcomes between patients with implants used on- and off-label. Methods: Primary knee or hip arthroplasty patients treated between January 2010 and June 2010 were studied. Revision rate, University of California Los Angeles (UCLA) activity level, functional (i.e., Hip Disability and Osteoarthritis Outcome Score or Knee Disability and Osteoarthritis Outcome Score) and Short Form-12 General Health Status were compared. Results: Two hundred and twenty five (81.5%) patients responded to the survey (92 hips and 133 knees), 154 (68.4%) of which had off-label use of an implant. There were no differences detected between groups. Conclusions: This study suggests that on-label and off-label patients have similar short-term outcomes.