Bio

Clinical Focus


  • Orthopaedic Surgery
  • Knee Replacement Arthroplasty
  • Arthritis
  • Hip Replacement Arthroplasty
  • Revision Hip and Knee Replacement Arthroplasty

Academic Appointments


Administrative Appointments


  • Medical Director, Total Joint Replacement Center, Stanford Hospital and Clinics (2009 - Present)
  • Associate Residency Program Director, Department of Orthopaedic Surgery, Stanford University School of Medicine (2011 - Present)

Honors & Awards


  • Marshall R. Urist Award, Association of Bone and Joint Surgeons (2009)
  • American Travelling Hip Fellow, British and American Hip Societies (2008)
  • Young Investigator, Osteolysis and Implant Wear Symposium, Orthopaedic Research Society (2007)
  • American Society of Clinical Pathologists' Award for Academic Excellence, University of Vermont College of Medicine (1996)

Professional Education


  • Internship:Brigham and Women's Hospital Harvard Medical School (2000) MA
  • Fellowship:Massachusetts General Hospital (2005) MA
  • Residency:Massachusetts General Hospital (2004) MA
  • Board Certification: Orthopaedic Surgery, American Board of Orthopaedic Surgery (2007)
  • Medical Education:University of Vermont College of Medicine (1999) VT
  • Fellowship, Massachusetts General Hospital, Adult Reconstructive Surgery (2005)
  • Residency, Harvard Medical School, Orthopaedic Surgery (2004)
  • MD, University of Vermont, Medicine (1999)
  • BS, Yale University, Biology (1994)

Community and International Work


  • Kikuyu Orthopaedic Rehabilitation Centre, Kikuyu, Kenya

    Topic

    orthopaedic surgery

    Partnering Organization(s)

    Medical Benevolence Foundation

    Populations Served

    Kikuyu, Kenya

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


My primary research interests include arthritis, clinical outcomes of primary and revision hip and knee replacement surgery, evaluation of the inflammatory cascade that leads to premature failure of hip and knee replacements, biomaterials, and the design of hip and knee implants and instrumentation.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Causes of instability after total knee arthroplasty. journal of arthroplasty Song, S. J., Detch, R. C., Maloney, W. J., Goodman, S. B., Huddleston, J. I. 2014; 29 (2): 360-364

    Abstract

    The purpose of the present study was to characterize the underlying causes that lead to instability after total knee arthroplasty (TKA). We reviewed 83 revision TKAs (79 patients) performed for instability. After detailed analysis of patient's history, physical examination, operative report and radiographs, we identified six categories: flexion/extension gap mismatch, component malposition, isolated ligament insufficiency, extensor mechanism insufficiency, component loosening, and global instability. Twenty-five knees presented with multi-factorial instability. When these knees were classified according to the most fundamental category, each category above included 24, 12, 11, 10, 10 and 16 knees respectively. The unstable TKA may result from a variety of distinct etiologies which must be identified and treated at the time of revision. The revision TKA could be tailored to the specific causes.

    View details for DOI 10.1016/j.arth.2013.06.023

    View details for PubMedID 23896358

  • Fractography and oxidative analysis of gamma inert sterilized posterior-stabilized tibial insert post fractures: Report of two cases KNEE Ansari, F., Chang, J., Huddleston, J., Van Citters, D., Ries, M., Pruitt, L. 2013; 20 (6): 609-613

    Abstract

    Highly crosslinked ultra-high molecular weight polyethylene (UHMWPE) has shown success in reducing wear in hip arthroplasty but there remains skepticism about its use in Total Knee Replacement (TKR) inserts that are known to experience fatigue loading and higher local cyclic contact stresses.Two Legacy Posterior-Stabilized (LPS) Zimmer NexGen tibial implants sterilized by gamma irradiation in an inert environment with posts that fractured in vivo were analyzed. Failure mechanisms were determined using optical and scanning electron microscopy along with oxidative analysis via Fourier Transform Infra-Red (FTIR) spectroscopy.Micrographs of one retrieval revealed fatigue crack initiation on opposite sides of the post and quasi-brittle micromechanisms of crack propagation. FTIR of this retrieval revealed no oxidation. The fracture surface image of the second retrieval indicated a brittle fracture process and FTIR revealed oxidation in the explant.These two cases suggest that crosslinking of UHMWPE as a manufacturing process or sterilization method in conjunction with designs that incorporate high stress concentrations, such as the tibial post, may reduce material strength. Moreover, free radicals generated from ionizing radiation can render the polymer susceptible to oxidative embrittlement.Our findings suggest that tibial post fractures may be the results of in vivo oxidation and low level crosslinking. These and previous reports of fractured crosslinked UHMWPE devices implores caution when used with high stress concentrations, particularly when considering the potential for in vivo oxidation in TKR.

    View details for DOI 10.1016/j.knee.2013.04.004

    View details for Web of Science ID 000330824200046

    View details for PubMedID 24220187

  • Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee Results of a Randomized Controlled Trial JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Bozic, K. J., Belkora, J., Chan, V., Youm, J., Zhou, T., Dupaix, J., Bye, A. N., Braddock, C. H., Chenok, K. E., Huddleston, J. I. 2013; 95A (18): 1633-1639
  • MI TKA: a risk factor for early revision surgery. The journal of knee surgery Mayle, R. E., Graw, B. P., Huddleston, H. G., Woolson, S. T., Goodman, S. B., Huddleston, J. I. 2012; 25 (5): 423-427

    Abstract

    Minimal incision total knee arthroplasty (MI TKA) was developed with the potential to decrease surgical trauma, pain, and recovery time. While this procedure has increased in popularity, some surgeons have questioned its safety and long-term efficacy. In this study 58 consecutive revision total knee arthroplasties (TKAs) (57 patients) performed at one academic medical center from 2006 to 2008 are reviewed. Prospectively collected clinical and radiographic data included: incision length, gender, age, time to revision surgery, and primary diagnosis at time of revision. Of these, 34 knees involving infection and rerevision were excluded. Of the remaining 24 knees, 11 knees that met inclusion criteria had undergone MI TKA. There were no differences between the groups with regard to age, diagnosis, body mass index, and gender. Average time to revision was shorter for the MI TKA patients (29 vs. 65 months, p < 0.032, odds ratio 14.7). Reasons for revision were aseptic loosening (55%), pain/stiffness (27%), malrotation (9%), and instability (9%) in the MI TKA group and aseptic loosening (53%), instability (15%), pain/stiffness (8%), malrotation (8%), combined malrotation and instability (8%), and polyethylene wear/osteolysis (8%) in the traditional TKA group. These data suggest that MI TKA may be a risk factor for early revision.

    View details for DOI 10.1055/s-0032-1313757

    View details for PubMedID 23150354

  • Heparin-induced thrombocytopenia after total knee arthroplasty, with subsequent adrenal hemorrhage. journal of arthroplasty Chow, V. W., Abnousi, F., Huddleston, J. I., Lin, L. H. 2012; 27 (7): 1413 e15-8

    Abstract

    Heparin-induced thrombocytopenia (HIT) is a life-threatening immune-mediated adverse effect of chemoprophylaxis for venous thromboembolic events. We present the case of a 44-year-old man who developed bilateral adrenal hemorrhage (BAH) as a sequela of HIT after bilateral total knee arthroplasty. In our review of clinical management of HIT-induced BAH, we discuss the 21 published cases of this phenomenon, 14 of which occurred after orthopedic surgery. Given the potentially fatal consequences and the importance of early intervention, physicians should be on the alert for recognizing HIT-induced BAH in patients experiencing shock unresponsive to fluid resuscitation. In addition, chemoprophylaxis with alternative agents such as a synthetic pentasaccharide factor Xa inhibitor and oral direct thrombin inhibitors that are associated with lower risks of HIT in orthopedic patients merits exploration.

    View details for DOI 10.1016/j.arth.2012.01.012

    View details for PubMedID 22397862

  • Advanced Age and Comorbidity Increase the Risk for Adverse Events After Revision Total Hip Arthroplasty JOURNAL OF ARTHROPLASTY Koenig, K., Huddleston, J. I., Huddleston, H., Maloney, W. J., Goodman, S. B. 2012; 27 (7): 1402-1407

    Abstract

    With the institution of quality-assurance parameters in health care, physicians must accurately measure and report the true baseline rates of adverse events (AEs) after complex surgical interventions. To better quantify the risk of AEs for revision total hip arthroplasty (THA), we divided a cohort of 306 patients (322 procedures) into age groups: group I (<65 years, n = 138), group II (65-79 years, n = 119), and group III (?80 years, n = 65). Ninety-day rates of major AE were 9%, 19%, and 34% in the groups, respectively. Group III had an increased chance of experiencing major AE compared with groups I and II. Age and Charlson Comorbidity Index independently predicted major complications, whereas body mass index, sex, and type of revision did not.

    View details for DOI 10.1016/j.arth.2011.11.013

    View details for Web of Science ID 000307317100024

    View details for PubMedID 22245123

  • Commentary: Is the hip bone connected to the spine bone? SPINE JOURNAL Huddleston, J. I., Maloney, W. J. 2012; 12 (5): 370-371

    Abstract

    COMMENTARY ON: Prather H, Van Dillen LR, Kymes SM, et al. Impact of coexistent lumbar spine disorders on clinical outcomes and physician charges associated with total hip arthroplasty. Spine J 2012;12:363-9 (in this issue).

    View details for DOI 10.1016/j.spinee.2012.05.002

    View details for Web of Science ID 000305298300002

    View details for PubMedID 22698149

  • Decreased Length of Stay After TKA Is Not Associated With Increased Readmission Rates in a National Medicare Sample CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Vorhies, J. S., Wang, Y., Herndon, J. H., Maloney, W. J., Huddleston, J. I. 2012; 470 (1): 166-171

    Abstract

    There is a trend toward decreasing length of hospital stay (LOS) after TKA although it is unclear whether this trend is detrimental to the overall postoperative course. Such information is important for future decisions related to cost containment.We determined whether decreases in LOS after TKA are associated with increases in readmission rates.We retrospectively reviewed the rates and reasons for readmission and LOS for 4057 Medicare TKA patients from 2002 to 2007. We abstracted data from the Medicare Patient Safety Monitoring System. Hierarchical generalized linear modeling was used to assess the odds of changing readmission rates and LOS over time, controlling for changes in patient demographic and clinical variables.The overall readmission rate in the 30 days after discharge was 228/4057 (5.6%). The 10 most common reasons for readmission were congestive heart failure (20.4%), chronic ischemic heart disease (13.9%), cardiac dysrhythmias (12.5%), pneumonia (10.8%), osteoarthrosis (9.4%), general symptoms (7.4%), acute myocardial infarction (7.0%), care involving other specified rehabilitation procedure (6.3%), diabetes mellitus (6.3%), and disorders of fluid, electrolyte, and acid-base balance (5.9%); the top 10 causes did not include venous thromboembolism syndromes. We found no difference in the readmission rate between the periods 2002-2004 (5.5%) and 2005-2007 (5.8%) but a reduction in LOS between the periods 2002-2004 (4.1 ± 2.0 days) and 2005-2007 (3.8 ± 1.7 days).The most common causes for readmission were cardiac-related. A reduction in LOS was not associated with an increase in the readmission rate in this sample. Optimization of cardiac status before discharge and routine primary care physician followup may lead to lower readmission rates.

    View details for DOI 10.1007/s11999-011-1957-0

    View details for Web of Science ID 000298103100021

    View details for PubMedID 21720934

  • Long-Term Comparison of Mobile-Bearing vs Fixed-Bearing Total Knee Arthroplasty JOURNAL OF ARTHROPLASTY Woolson, S. T., Epstein, N. J., Huddleston, J. I. 2011; 26 (8): 1219-1223

    Abstract

    Few published reports have been published regarding a comparison of the long-term outcomes between mobile- (MB) and fixed-bearing component designs for knee arthroplasty. The minimum 10-year clinical and radiologic follow-up of an unselected consecutive series of 89 patients (107 knees) who were randomized to have one of these different designs for primary arthroplasty was done. Twenty-six patients (30 knees) who had a fixed-bearing design and 24 patients (33 knees) who had an MB prosthesis were available for follow-up. Two MB knees were revised for aseptic loosening of a tibial component in one and femoral component fracture in the other. In patients who did not have revision surgery, there were no differences between the groups with respect to mean Knee Society scores, knee flexion, or pain scores.

    View details for DOI 10.1016/j.arth.2011.01.014

    View details for Web of Science ID 000297389100017

    View details for PubMedID 21397453

  • Readmission and Length of Stay After Total Hip Arthroplasty in a National Medicare Sample JOURNAL OF ARTHROPLASTY Vorhies, J. S., Wang, Y., Herndon, J., Maloney, W., Huddleston, J. I. 2011; 26 (6): 119-123

    Abstract

    Evaluation of hospital readmissions after total hip arthroplasty may help improve patient safety and cost reduction. This study investigates the rates and reasons for readmission as well as length of hospital stay (LOS) for 1802 total hip arthroplasty patients from 2002 to 2007. Data were abstracted from the Medicare Patient Safety Monitoring System. The overall 30-day rate of readmission was 6.8%. There was no difference in readmission rate from 2002 to 2004 (7.1%) to 2005 to 2007 (6.3%) (odds ratio, 0.90; 95% confidence interval, 0.63-1.30; P = .58). The overall mean LOS was 4.2 ± 2.2 days. There was a significant reduction in LOS from 2002 to 2004 (4.4 ± 2.5 days) to 2005 to 2007 (3.8 ± 1.7 days) (odds ratio, 1.28; 95% confidence interval, 1.25-1.31; P < .0001). The most common causes for readmission were cardiac related. A reduction in LOS was not associated with an increase in the rate of readmission in this sample. Efforts to optimize cardiac status before discharge may lead to lower rates of readmission in the future.

    View details for DOI 10.1016/j.arth.2011.04.036

    View details for Web of Science ID 000294393000023

    View details for PubMedID 21723700

  • Use and Cost-Effectiveness of Intraoperative Acid-Fast Bacilli and Fungal Cultures in Assessing Infection of Joint Arthroplasties JOURNAL OF ARTHROPLASTY Wadey, V. M., Huddleston, J. I., Goodman, S. B., Schurman, D. J., Maloney, W. J., Baron, E. J. 2010; 25 (8): 1231-1234

    Abstract

    The objective of this study is to determine a protocol for collecting acid-fast bacilli (AFB) and fungal intraoperative cultures during orthopedic procedures. An observational study was undertaken. Four hundred forty-six AFB cultures and 486 fungal cultures were processed over a 2-year period. The number of positive cultures was determined. A protocol specific to handling these types of specimens was developed. Cost analysis was completed to determine both the time and money saved if the new protocol was implemented. The infrequency of positive AFB and fungal cultures in this study suggests that it is only necessary to routinely request AFB and fungal cultures on 1 of 5 samples. Implementation of this protocol has potential to lead to substantial cost reduction and resource savings without diminishing patient outcomes.

    View details for DOI 10.1016/j.arth.2009.08.018

    View details for Web of Science ID 000284749500009

    View details for PubMedID 19879728

  • Synovial Tissue-Infiltrating Natural Killer Cells in Osteoarthritis and Periprosthetic Inflammation ARTHRITIS AND RHEUMATISM Huss, R. S., Huddleston, J. I., Goodman, S. B., Butcher, E. C., Zabel, B. A. 2010; 62 (12): 3799-3805

    Abstract

    Infiltrating immune cells play a central role in degenerative joint disease associated with osteoarthritis (OA) and particle-mediated periprosthetic osteolysis. The goal of this study was to characterize a newly identified population of synovial tissue-infiltrating natural killer (NK) cells obtained from patients with OA or patients with periprosthetic joint inflammation.Synovial and interfacial tissue samples were collected from patients with OA who were undergoing primary or revision total joint replacement (TJR) surgery. The histologic features of OA synovium obtained from patients undergoing primary surgery and interfacial tissue obtained from patients undergoing revision surgery were determined by immunohistochemistry and immunofluorescence. Synovial tissue-infiltrating NK cells were evaluated for the expression of surface receptors, using flow cytometry. Chemoattractant and cytokine protein and RNA levels in synovial and interfacial tissue and fluid were assessed by Luminex assay and real-time quantitative polymerase chain reaction. Cytokine production and degranulation by stimulated synovial tissue versus normal blood NK cells were evaluated by intracellular cytokine staining.NK cells comprised nearly 30% of the CD45+ mononuclear cell infiltrate in synovial tissue obtained from patients undergoing primary TJR and from patients undergoing revision TJR. NK cells from both groups expressed CXCR3, CCR5, L-selectin, ?4 integrins, and cutaneous lymphocyte antigen. Synovial fluid from patients undergoing revision surgery contained elevated concentrations of the NK cell attractants CCL4, CCL5, CXCL9, and CXCL10; all levels in synovial fluid obtained from patients undergoing revision surgery were higher than those in synovial fluid from patients undergoing primary surgery. Cytokine-stimulated interferon-? production was significantly impaired in NK cells derived from primary and revision TJRs compared with blood NK cells.NK cells are a principal tissue-infiltrating lymphocyte subset in patients with OA and patients with periprosthetic inflammation and display a quiescent phenotype that is consistent with postactivation exhaustion.

    View details for DOI 10.1002/art.27751

    View details for Web of Science ID 000285210200034

    View details for PubMedID 20848566

  • Candida infection in total knee arthroplasty with successful reimplantation. The journal of knee surgery Graw, B., Woolson, S., Huddleston, J. I. 2010; 23 (3): 169-174

    Abstract

    Fungal infections associated with prosthetic joints are uncommon. The first case report describes a woman with insidious onset of a candidal infection of a revision total knee arthroplasty. After multiple joint debridements and prolonged antibacterial and antifungal therapy, she had a successful reimplantation of a knee prosthesis. The second case report concerns a man who had a primary cemented total knee arthroplasty that became infected with Candida albicans. He underwent resection arthroplasty with eventual replant without recurrence at 20 years. Although resection arthroplasty should be maintained as the gold standard in the surgical treatment of this problem, the first case shows a successful short-term outcome ofreimplantation of a patient with fungal infection of long-stemmed, revision total knee replacement. It also shows a treatment failure with fluconazole that was cured by voriconazole and caspofungin, two more recently developed antifungal agents.

    View details for PubMedID 21329258

  • Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Graw, B. P., Woolson, S. T., Huddleston, H. G., Goodman, S. B., Huddleston, J. I. 2010; 468 (9): 2372-2376

    Abstract

    Minimal incision total hip arthroplasty (MI THA) techniques were developed to decrease postoperative pain and recovery time. Although these techniques have increased in popularity, the long-term survivorship of these procedures is unknown.We therefore investigated whether the time to revision in our referral practice was shorter for patients who underwent primary MI THA compared to primary traditional THA.We retrospectively reviewed 46 revision THAs performed during a 3-year period. We excluded revisions performed for infection and rerevisions. Patients with incisions less than or equal to 10 cm were defined as having had MI THA. Fifteen of the 46 patients (33%) had undergone primary MI THA. At the time of primary index THA, the mean ages of the MI and non-MI patients were 65 years and 55 years, respectively.The mean time to revision was 1.4 years for the MI patients compared with 14.7 years for the non-MI patients. Twelve of the 15 patients having MI THA required revision within 2 years of primary THA compared to 4 of the 31 patients without MI surgery (OR = 26.5, 95% CI 4.4-160.0). There were no differences between the groups with regard to age, gender, or body mass index. The most common reasons for revision in the MI THA group were intraoperative fracture and failure of femoral component osseointegration.Our data suggest MI THA may be a risk factor for early revision surgery and the long-term survival therefore may be lower than that for non-MI surgery.Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

    View details for DOI 10.1007/s11999-010-1300-1

    View details for Web of Science ID 000280594200011

    View details for PubMedID 20352391

  • Patellar Management in Revision Total Knee Arthroplasty JOURNAL OF ARTHROPLASTY Patil, N., Lee, K., Huddleston, J. I., Harris, A. H., Goodman, S. B. 2010; 25 (4): 589-593

    Abstract

    The management of the patella during revision total knee arthroplasty (TKA) depends on the indication for revision, the type and stability of the patellar component in place, and availability of bone stock. We prospectively compared the clinical outcome and satisfaction rates in revision TKA patients managed with patellar resurfacing (n = 13, group I) to retention of the patellar component (n = 22, group II) or patelloplasty (n = 11, group III) at a minimum follow-up of 2 years. There were no differences in the improvement of Knee Society Scores, Short-Form 36 Scores, and satisfaction rates between the groups. There were no revision surgeries for patellar component failure or patellar fractures. Satisfactory results can be achieved using a variety of methods of patellar management in revision TKA by individualizing the treatment modality depending on the clinical scenario.

    View details for DOI 10.1016/j.arth.2009.04.009

    View details for Web of Science ID 000278905300016

    View details for PubMedID 19493648

  • Aseptic versus septic revision total knee arthroplasty: Patient satisfaction, outcome and quality of life improvement KNEE Patil, N., Lee, K., Huddleston, J. I., Harris, A. H., Goodman, S. B. 2010; 17 (3): 200-203

    Abstract

    We prospectively compared the clinical outcomes and patient satisfaction rates of aseptic (n=30) versus septic revision TKA (n=15) at a mean follow-up of 40 months. We hypothesized that the clinical results of septic revision TKA would be inferior to aseptic revision TKA. The indication for revision in aseptic group was stiffness in 11 patients, aseptic loosening in 13, patellar loosening or maltracking in 6 patients. Patients operated for infection had better post-operative Knee Society Scores (KSS), Function Scores and SF-36 Mental Scores than aseptic group but there were no significant differences in the satisfaction rates. Patients operated for infection had more improvement in their KSS (p=0.004) and Function Scores (p=0.02) than patients revised for stiffness. Moreover, patients operated on for patellar problems had higher satisfaction rates than patients revised for stiffness (p=0.01) or aseptic loosening (p=0.01). Thus, patients undergoing septic revision TKA had better outcomes compared to those with aseptic revision TKA. However, in the aseptic group, revision TKA for stiffness was associated with the poorest outcomes. The indication for aseptic revision is an important variable when discussing treatment and outcome with patients.

    View details for DOI 10.1016/j.knee.2009.09.001

    View details for Web of Science ID 000277698100005

    View details for PubMedID 19875297

  • Hylamer vs Conventional Polyethylene in Primary Total Hip Arthroplasty: A Long-Term Case-Control Study of Wear Rates and Osteolysis JOURNAL OF ARTHROPLASTY Huddleston, J. I., Harris, A. H., Atienza, C. A., Woolson, S. T. 2010; 25 (2): 203-207

    Abstract

    The long-term results of Hylamer implants have not been reported previously. Clinical and radiographic results of a consecutive series of 43 patients (45 hips) who had primary total hip arthroplasty using Hylamer liners were compared with those of 37 patients (43 hips) who had conventional liners after 10-year follow-up. The linear wear rates for Hylamer and conventional polyethylene acetabular liners were 0.21 and 0.20 mm/y, respectively. The number of pelvic osteolytic lesions and their size detected on plain radiographs were significantly greater for Hylamer liners. Seven Hylamer hips were revised or are pending revision for osteolysis (16%) compared with 1 control hip. Close radiographic surveillance of patients who have Hylamer liners and evidence of osteolysis found on plain radiographs is warranted.

    View details for DOI 10.1016/j.arth.2009.02.006

    View details for Web of Science ID 000277580900006

    View details for PubMedID 19264443

  • Primary Total Hip Arthroplasty Using an Anterior Approach and a Fracture Table Short-term Results From a Community Hospital JOURNAL OF ARTHROPLASTY Woolson, S. T., Pouliot, M. A., Huddleston, J. I. 2009; 24 (7): 999-1005

    Abstract

    There are no data regarding the efficacy and safety of minimally invasive hip arthroplasty technique performed by community practice orthopedists. The early clinical and radiographic results of primary total hip arthroplasty using a minimally invasive anterior approach to the hip performed on a fracture table were studied. Two hundred thirty-one consecutive patients (247 hips) of 5 community practice surgeons were studied. The average surgical time (164 minutes) and estimated blood loss (858 mL) were more than double, and the major complication rate (9%) was 6 times that reported by an innovator of the procedure. However, no postoperative dislocations occurred. Adequate training is critical to reduce the risk of complications during the learning experience of minimally invasive hip arthroplasty procedures by community practice surgeons.

    View details for DOI 10.1016/j.arth.2009.04.001

    View details for Web of Science ID 000270764600001

    View details for PubMedID 19493651

  • Early Catastrophic Failure of a Porous-Coated Acetabular Cup due to Bead Shedding. A Case Report HIP INTERNATIONAL Hsu, A. R., Vaughn, Z., Huddleston, J. I. 2009; 19 (4): 392-395

    Abstract

    We present a patient in whom an uncemented porous-coated acetabular cup underwent early catastrophic failure due to debonding and was successfully managed with a revision total hip arthroplasty. Early bead shedding of an acetabular cup leading to a sudden component failure requiring revision surgery is a rare event.

    View details for Web of Science ID 000275580700016

    View details for PubMedID 20041389

  • Adverse Events After Total Knee Arthroplasty A National Medicare Study JOURNAL OF ARTHROPLASTY Huddleston, J. I., Maloney, W. J., Wang, Y., Verzier, N., Hunt, D. R., Herndon, J. H. 2009; 24 (6): 95-100

    Abstract

    Adverse events from 2033 total knee arthroplasty patients were documented by nonphysician abstractors. The annual rate of adverse events from 2002 to 2004 was 9.2%, 6.4%, and 5.8%, respectively. Congestive heart failure (odds ratio, 2.1; 95% confidence interval, 1.2-3.5; P < .01) and chronic obstructive pulmonary disease (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) were associated with a significantly increased risk of experiencing any adverse event during the index hospitalization. The 30-day postprocedure rate of readmission for all causes was 5.5%. Experiencing an adverse event during the index hospitalization increased the length of stay (P < .001). The rate of symptomatic venous thromboembolism 30 days postprocedure was 1.7%. The 30-day postprocedure mortality rate was 0.3%. Experiencing any adverse event was associated with an increased 30-day postprocedure mortality (P < .001). Compared with previous studies of Medicare claims, these data reveal a substantial decrease in the mortality rate, an increased readmission rate, and no substantial change in the rate of venous thromboembolism.

    View details for DOI 10.1016/j.arth.2009.05.001

    View details for Web of Science ID 000269607800020

    View details for PubMedID 19577884

  • How Often Do Patients with High-Flex Total Knee Arthroplasty Use High Flexion? CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Huddleston, J. I., Scarborough, D. M., Goldvasser, D., Freiberg, A. A., Malchau, H. 2009; 467 (7): 1898-1906

    Abstract

    Although high-flexion TKA designs aim to safely accommodate deep flexion, it is unknown how often patients use deep flexion outside the laboratory. We used a validated smart-activity monitor to document the prevalence of knee flexion greater than 90 degrees in 20 consecutive patients (21 knees) who had high-flexion TKAs, at a minimum of 2 years' followup. Patients wore the device continuously for a mean of 35.7 +/- 0.5 hours. The 21 knees flexed more than 90 degrees for an average of 10 +/- 3.8 minutes (0.5%). Activities performed with flexion greater than 90 degrees were, on average, 70% in single-limb stance, 12% moving from sitting to standing, 8% walking, 7% moving from standing to reclining, 2% stepping, 0.9% moving from lying to standing, and 0.1% running. Eight knees flexed greater than 120 degrees for an average of 2.2 minutes (range, 0.2-15 minutes), or 0.1% of the testing time. Activities performed with flexion greater than 120 degrees were, on average, 90% in single-limb stance, 6% moving from sitting to standing, 3% walking, 0.6% moving from standing to reclining, 0.3% stepping, and 0.1% moving from lying to standing. Peak flexion used at any time during testing was, on average, 84% +/- 11% of maximum postoperative flexion (125 degrees +/- 12 degrees). These patients rarely used deep flexion.Level IV, therapeutic study.

    View details for DOI 10.1007/s11999-009-0874-y

    View details for Web of Science ID 000266652000041

  • Early outcome of a modular femoral component in revision total hip arthroplasty JOURNAL OF ARTHROPLASTY Kang, M. N., Huddleston, J. I., Hwang, K., Imrie, S., Goodman, S. B. 2008; 23 (2): 220-225

    Abstract

    Forty-six hips in 42 patients underwent revision surgery with a modular femoral component (ZMR; Zimmer, Warsaw, Ind). Thirty-nine hips with 2 to 5 years' follow-up were evaluated radiographically and clinically by the Harris hip score and WOMAC pain/stiffness/function scores. The Harris hip score improved from 47.4 to 72.3 (P<.001), with significant improvements in the WOMAC pain/stiffness/function scores. The mean subsidence was 4.4 mm, with 5 hips demonstrating significant subsidence of more than 5 mm. Four hips required reoperation, 1 due to failure of the femoral component. No early complications were encountered regarding the modular junction. Modular, cementless, extensively porous, coated femoral components have demonstrated early clinical and radiographic success. Distal intramedullary fit helps ensure initial stability; proximal modularity further maximizes fit while optimizing hip offset and length.

    View details for DOI 10.1016/j.arth.2007.03.006

    View details for Web of Science ID 000253649200011

    View details for PubMedID 18280416

  • How have alternative bearings (such as metal-on-metal, highly cross-linked polyethylene, and ceramic-on-ceramic) affected the prevention and treatment of osteolysis? JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Callaghan, J. J., Cuckler, J. M., Huddleston, J. I., Galante, J. O. 2008; 16: S33-S38

    Abstract

    Osteolysis is a multifactorial process dependent on surgical technique, implant design, patient factors, and material composition. Alternative bearing surfaces, such as highly cross-linked polyethylene, ceramic-on-ceramic, and metal-on-metal articular surfaces, have been introduced in an attempt to reduce wear and osteolysis following total hip arthroplasty. Intermediate-term follow-up data available suggest that the prevalence and severity of osteolysis may be reduced with these materials compared with conventional metal-on-polyethylene bearing surface couples. However, long-term data are presently unavailable; the future performance of these bearings awaits clinical validation.

    View details for Web of Science ID 000257474600008

    View details for PubMedID 18612011

  • Modulation of allograft incorporation by growth factors over a prolonged continuous infusion of duration in vivo BONE Ma, T., Gutnick, J., Salazar, B., Larsen, M. D., Suenaga, E., Zilber, S., Huang, Z., Huddleston, J., Smith, R. L., Goodman, S. 2007; 41 (3): 386-392

    Abstract

    Morselized cancellous allograft bone is frequently used in the reconstruction of bone defects in cases of revision total joint replacement, trauma, spine fusion and treated infection. However, the initial lack of viable bone cells in morselized allograft bone significantly slows the process of graft incorporation compared to autograft bone. This study examined the effects of prolonged local infusion of the growth factors bone morphogenic protein-7 (BMP-7 or OP-1) and fibroblast growth factor-2 (FGF-2 or basic FGF) in the process of allograft incorporation using a rabbit tibial chamber model. New bone formation was evaluated by two indices, the activity of alkaline phosphatase and the level of birefringence. The markers of osteoclast-like cells were also measured. Without the infusion of the growth factors, lower levels of new bone formation were observed in the allograft group, compared to the autograft group. Infusion of growth factors FGF-2 and OP-1, singly or in combination, for 4 weeks, diminished this difference. The numbers of osteoclast-like cells were much higher in the allograft group before the growth factors were delivered. The infusion of FGF, singly, diminished this difference. However, the infusion of OP-1 or the combination of FGF and OP-1 did not decrease the number of osteoclast-like cells to a level comparable to autograft only. Local infusion of growth factors appears to be a useful adjunct to promote the incorporation of allograft bone in vivo.

    View details for DOI 10.1016/j.bone.2007.05.015

    View details for Web of Science ID 000248898600012

    View details for PubMedID 17613298

  • Ambulatory measurement of knee motion and physical activity: preliminary evaluation of a smart activity monitor JOURNAL OF NEUROENGINEERING AND REHABILITATION Huddleston, J., Alaiti, A., Goldvasser, D., Scarborough, D., Freiberg, A., Rubash, H., Malchau, H., Harris, W., Krebs, D. 2006; 3

    Abstract

    There is currently a paucity of devices available for continuous, long-term monitoring of human joint motion. Non-invasive, inexpensive devices capable of recording human activity and joint motion have many applications for medical research. Such a device could be used to quantify range of motion outside the gait laboratory. The purpose of this study was to test the accuracy of the modified Intelligent Device for Energy Expenditure and Activity (IDEEA) in measuring knee flexion angles, to detect different physical activities, and to quantify how often healthy subjects use deep knee flexion in the ambulatory setting.We compared Biomotion Laboratory (BML) "gold standard" data to simultaneous IDEEA measures of knee motion and gait, step up/down, and stair descent in 5 healthy subjects. In addition, we used a series of choreographed physical activities outside the BML to confirm the IDEEA's ability to accurately measure 7 commonly-performed physical activities. Subjects then continued data collection during ordinary activities outside the gait laboratory.Pooled correlations between the BML and IDEEA knee flexion angles were .97 +/- .03 for step up/down, .98 +/- .02 for stair descent, and .98 +/- .01 for gait. In the BML protocol, the IDEEA accurately identified gait, but was less accurate in identifying step up/down and stair descent. During sampling outside the BML, the IDEEA accurately detected walking, running, stair ascent, stair descent, standing, lying, and sitting. On average, subjects flexed their knees >120 degrees for 0.17% of their data collection periods outside the BML.The modified IDEEA system is a useful clinical tool for evaluating knee motion and multiple physical activities in the ambulatory setting. These five healthy subjects rarely flexed their knees >120 degrees.

    View details for Web of Science ID 000251258600001

    View details for PubMedID 16970818

  • Femoral Alignment Revision Total Knee Arthroplasty Huddleston JI, Gobezie R, Rubash HE 2005
  • Zone 4 femoral radiolucent lines in hybrid versus cemented total knee arthroplasties: are they clinically significant? Clinical Orthopaedics and Related Research Huddleston JI, Wiley J, Scott RD 2005; 441: 334-339
  • Determination of neutral tibial rotational alignment in rotating platform TKA Clinical Orthopaedics and Related research Huddleston JI, Scott RD, Wimberley DW 2005; 440: 101-106
  • A comparison of subjective, psychomotor and physiologic effects of a novel muscarinic analgesic, LY 297802 tartrate, and oral morphine in occasional drug users Drug and Alcohol Dependence Petry NM, Bickel WK, Huddleston J, Tzanis E, Badger GJ 1998; 50: 29-36

Conference Proceedings


  • Age and Obesity Are Risk Factors for Adverse Events After Total Hip Arthroplasty Huddleston, J. I., Wang, Y., Uquillas, C., Herndon, J. H., Maloney, W. J. SPRINGER. 2012: 490-496

    Abstract

    Defining the epidemiology of adverse events after THA will aid in the development of strategies to enhance perioperative care.We identified (1) risk factors for adverse events in Medicare beneficiaries while hospitalized after THA and (2) trends in the rates of adverse events.Data were abstracted from medical records of 1809 Medicare beneficiaries who underwent THA from 2002 to 2007. We used the hierarchical generalized linear modeling approach to assess the odds of change in adverse events over time, the association of adverse events with outcomes, and the relationship of adverse events with patient characteristics by modeling the log-odds of adverse events as a function of demographic and clinical variables adjusted for year variable.The overall rate of adverse events was 5.8%; the 30-day mortality rate was 1.00%. Increased age, obesity, and year of procedure were risk factors for experiencing any adverse event. Annual rates of adverse events from 2002 to 2007 were 9.1%, 8.2%, 4.9%, 4.1%, 3.5%, and 3.0%, respectively. Experiencing any adverse event was associated with an increased length of stay and an increased chance of readmission but not with an increased chance of mortality. The annual rate of all adverse events decreased from 2002-2004 to 2005-2007 (odds ratio = 0.83; 95% confidence interval, 0.74-0.92).Older and obese patients should be counseled regarding their increased risk for the development of adverse events after THA. The cause of the decline in the rate of adverse events between two time periods is unclear and warrants further investigation to confirm and identify the cause.

    View details for DOI 10.1007/s11999-011-1967-y

    View details for Web of Science ID 000299056000022

    View details for PubMedID 21796477

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