The most recent literature demonstrates promising results in regard to hydrofiber dressings as an independent risk factor for primary prosthetic joint infection reduction, which in turn is also linked with cost savings. As our understanding of safe yet effective concentrations of antiseptic solutions develops, dilute betadine in particular has demonstrated encouraging efficacy which warrants continued investigation through controlled trials. In summary, we found that the application of a hydrofiber dressing may prove beneficial in decreasing the risk of prosthetic joint infection following primary total hip and knee arthroplasty. The gold standard for an infection prevention protocol continues to be explored and optimized.

Background: Despite anticoagulation use, total joint arthroplasty has a 0.16-1.51% pulmonary embolism (PE) rate and a 0.1-0.2% fatal PE rate. The purpose of this study was to describe the post-operative thrombotic events and complications in patients at high-risk in two groups, those who had an IVC filter placed prior to total joint replacement surgery and those who did not.Methods: Patients from a single surgeon's practice were reviewed between January 1, 2012 to December 31, 2015 that were identified as high-risk for post-operative thrombotic events. Patient demographics, medical history, Charlson Comorbidity Index, filter-related complications, as well as post-operative deep vein thrombosis, pulmonary embolism, bleeding events and hospitalizations were collected retrospectively from the electronic medical records.Results: Fifty-five patients were identified, thirty-six of whom had a filter placed. Two of these had filter placement and removal on separate occasions for separate arthroplasty surgeries. Of the IVC filters placed, two insertional complications were identified. No filter retrieval complications occurred in the filters that were removed. There were nineteen patients deemed high risk for postoperative thrombotic events that did not undergo filter placement. Of these, there were no cases of pulmonary embolism. One patient was found to have a chronic lower-extremity DVT on post-operative work-up. Conclusion:In our series, there were two complications related to filter placement. The group of nineteen high risk patients without a filter placed showed no cases of symptomatic PE. Further multicenter study is required to make definitive recommendations on the use of IVC filters in select arthroplasty patients.

Revision total hip arthroplasty in the setting of severe femoral bone loss can be challenging, with salvage options often limited to modular tapered stems, allograft prosthetic composites, and megaprostheses. This case highlights a 79-year-old woman with 2 years of thigh pain who is 8 years status post a revision proximal femoral allograft prosthetic composite reconstruction. Radiographs demonstrated significant stem subsidence into the femoral condyle. In an attempt to avoid a total femoral replacement and spare her functioning native knee, a tibial cone was used in conjunction with a proximal femoral replacement to structurally fill the flaring femoral canal and serve as a stable pedestal for the megaprosthesis body and provide the potential for biologic ingrowth. At 12-month follow-up, she ambulates with a cane, and radiographs reveal stable implant position.

This case highlights a fracture of a modern tibia basetray. The patient is a 52-yearold female who underwent a total knee arthroplasty that had catastrophic posterior medial polyethylene wear 5-years following the original surgery. She underwent a polyethylene exchange to an anterior constrained style polyethylene and a year and a half later presented with severe medial pain and a locked knee. Radiographs initially demonstrated significant anterior translation of the tibia on the femur and she was indicated for revision surgery. Radiographs the day prior to revision demonstrate a fractured posterior medial corner of the base tray and a disengaged polyethylene in the suprapatellar pouch. Revision TKA was undertaken and given the inability to control AP translation with a none or semi constrained knee design, reconstruction with a rotating hinge knee was performed.

Failure of the tibial post in a bicruciate substituting total knee prosthesis is a rare but catastrophic complication. The authors report 2 cases of a fracture of the polyethylene tibial post with subsequent episodes of knee subluxation. Prompt recognition and early revision of these complications are associated with a favorable early outcome.