The bikini incision and the incision for the longitudinal extension of the DAA crosses the main branch of the LFCN in 100% of cases.
 
  The fan-type pattern of the LFCN might be harmed by all skin incisions. Chances are high that LFCN branches could be jeopardized with a bikini-type incision and the longitudinal extension of the DAA. The risk of jeopardizing the LFCN with a lazy S-type distal extension is reduced.
 The fan-type pattern of the LFCN might be harmed by all skin incisions. Chances are high that LFCN branches could be jeopardized with a bikini-type incision and the longitudinal extension of the DAA. The risk of jeopardizing the LFCN with a lazy S-type distal extension is reduced.
  The Center for Medicare and Medicaid Services is faced with a challenge of decreasing the cost of care for total knee arthroplasty (TKA) but must make efforts to prevent patient selection bias in the process.  https://www.selleckchem.com/products/inx-315.html  Currently, no appropriate modifier codes exist for primary TKA based on case complexity. We sought to determine differences in perioperative parameters for patients with complex primary TKA with the hypothesis that they would require increased cost of care, prolonged care times, and have worse postoperative outcome metrics.
 
  We performed a single-center retrospective review from 2015 to 2018 of all primary TKAs. Patient demographics, medial proximal tibial angle (mPTA), lateral distal femoral angle (lDFA), flexion contracture, cost of care, and early postoperative outcomes were collected. Complex patients were defined as those requiring stems or augments, and multivariable logistic regression analysis and propensity score matching were performed to evaluate perioperative outcomes.
 
  About 1043 primaryspital returns. This should be considered in future reimbursement models to prevent patient selection bias, and a complexity modifier is warranted.
  There are few data comparing the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in the outpatient setting. The purpose of this study is to compare 90-day complications between the 2 approaches. We hypothesized that they would be equally safe and effective.
 
  Retrospective review identified 432 THAs (346 DAA, 86 PA) performed at a single ambulatory surgery center (ASC). Outcomes compared included demographics, comorbidities, preoperative and discharge pain scores (visual analog scale [VAS]), overall time spent in the ASC, overnight stay, emergency room visits, admission, reoperation, and complications within a 90-day period.
 
  There were no differences in mean preoperative VAS (DAA 4.7, PA 4.5), mean discharge VAS (DAA 0.8, PA 0.7), overall time spent in the ASC (DAA 9.0hours, PA 9.3hours), total number of overnight stays (DAA 0.9%, PA 1.2%), emergency room visits (DAA 1.7%, PA 1.2%), admissions (DAA 1.4%, PA 1.2%), reoperations (DAA 1.4%, PA 1.2%), or complications (DAA 3.5%, PA 2.3%).
 
  There were no differences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon's preferred approach. This study indicates both DAA and PA are equally safe for THA in the outpatient setting, and the choice of surgical approach should be based on patient and surgeon preference.
 There were no differences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon's preferred approach. This study indicates both DAA and PA are equally safe for THA in the outpatient setting, and the choice of surgical approach should be based on patient and surgeon preference.
  The increasing use of orthopedic total hip arthroplasty implants has led to a consequent rise in the incidence of associated periprosthetic fractures (PPFs). Analysis of the National Joint Registry data showed the choice of cemented hip stem influenced the risk of a PPF occurring. However, the effect of implant design in relation to the risk of PPFs has not been investigated.
 
  The main objective is to compare the biomechanics of PPFs as a failure of the Exeter V40, CPT, and DePuy C-Stem stems in a composite Sawbone model to identify whether a difference in the risk of fracture exists between them. Twenty-six Sawbones were divided into 3 groups, cemented with the Stryker Exeter, Zimmer CPT, or DePuy C-Stem and then torqued to fracture.
 
  When compared with the Exeter, the CPT- and C-Stem-implanted Sawbone models would sustain PPFs at a statistically significantly lower rotation to failure (20.1° and 26.7° vs 33.6°,P< .01) and torque to failure (124 Nm and 143 Nm vs 174 Nm,P< .01) values. The energy release rate at failure for the Exeter was significantly higher than that for the CPT and C-Stem (61.2 Nm vs 21.8 Nm and 38.6 Nm,P< .01), which led to more comminution.
 
  The CPT- and C-Stem-implanted femurs, although fracturing earlier, fractured in a simple pattern with less comminution. The differences in stem design mean higher stress at the critical point of failure in the CPT implanted femur compared with the Exeter and DePuy, which is likely the reason behind the observed increased risk of PPFs with the CPT implant.
 The CPT- and C-Stem-implanted femurs, although fracturing earlier, fractured in a simple pattern with less comminution. The differences in stem design mean higher stress at the critical point of failure in the CPT implanted femur compared with the Exeter and DePuy, which is likely the reason behind the observed increased risk of PPFs with the CPT implant.
  Although the annual incidence of primary total joint arthroplasty is increasing, trends in the annual incidence of periprosthetic fractures have not been established. This study aimed to define the annual incidence of periprosthetic fractures in the United States.
 
  Inpatient admission data for 60,887 surgically treated lower extremity periprosthetic fractures between 2006 and 2015 were obtained from the National Inpatient Sample database. The annual incidence of periprosthetic fractures was defined as the number of new cases per year and presented as a population-adjusted rate per 100,000 US individuals. Univariable methods were used for trend analysis and comparisons between groups.
 
  The national annual incidence of periprosthetic fractures presented as a population-adjusted rate of new cases per year peaked in 2008 (2.72; 95% confidence interval [95% CI], 2.39-3.05), remained stable from 2010 (1.65; 95% CI, 1.45-1.86) through 2013 (1.67; 95% CI, 1.55-1.8) and increased in 2014 (1.99; 95% CI, 1.85-2.13) and 2015 (2.