Treatment Failure Rates Significantly Decrease at One and Five Years After Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection in Total Knee Arthroplasty: A 10 Year Cohort Study.

Background: Periprosthetic joint infection (PJI) is a leading cause of total knee arthroplasty (TKA) failure. Debridement, antibiotics, and implant retention (DAIR) is the preferred treatment for acute PJI. The objectives of this study were to determine the length of time TKA PJIs should be monitored after DAIR and the time point where the majority of PJI treatment failure occurs.

Black Patients Had Lower Utilization Rates and Higher Acute Mortalities After Total Knee Arthroplasty.

Background: Despite increasing demand for total knee arthroplasty (TKA), barriers such as race, ethnicity, socioeconomic background, geographic variation, and sex influence patients' decisions or ability to undergo surgery and are known to affect postoperative outcomes. We compared utilization rates and postoperative outcomes of TKA between Black and White patients within our large integrated health system.

Methods: A retrospective study was performed for Black and White patients who underwent primary TKA for osteoarthritis within our health system between January 2016 and December 2023.

Revision Total Joint Arthroplasty for Periprosthetic Joint Infection at Centers of Excellence Decreases Risk of Complications and Improves Discharge Dispositions Despite Further Travel Distance.

Background: Total joint arthroplasty (TJA) is a widely performed and effective procedure for the treatment of degenerative joint disease. Periprosthetic joint infection (PJI) is now recognized as the leading cause of TJA failure, so recent efforts have emphasized the creation of centers of excellence (COEs) for the management of this morbid condition. We sought to understand the difference in outcomes and travel distances for patients undergoing TJA at COEs.

Real Component Spacers for Two-Stage Exchange Demonstrate Low Bacterial Colonization.

Background: Patients undergoing two-stage exchange arthroplasty for chronic periprosthetic joint infection (PJI) with real component spacers (RC) benefit from improved function. While RCs have similar reinfection rates compared to other spacer types, concerns exist regarding the potential for bacterial colonization and biofilm formation on the RC metal components.

Methods: Patients who completed two-stage exchange arthroplasty for treatment of Musculoskeletal Infection Society-defined hip or knee PJI were included and explanted spacer components were sent for sonication fluid culture (SFC).

Performance of Cementless Hip Arthroplasty Stem Types Based on Consolidated Large Registry Data.

Background: Improvements in cementless total hip arthroplasty have been directed at optimizing osseointegration of the femoral implant to reduce aseptic loosening rates. Stem design plays a critical role in the performance of these implants. Given the increase in new stem designs and the creation of an updated classification system, improved understanding of the outcomes of each stem type is warranted.

Benefits and Adverse Events Associated With Extended Antibiotic Use for One Year Following Periprosthetic Joint Infection in Total Knee Arthroplasty: A Prospective Cohort Analysis.

Background: Periprosthetic joint infections (PJIs) are common and serious complications following knee and hip arthroplasty. Our previous retrospective study suggested extended antibiotics following debridement, antibiotics, and implant retention (DAIR) decreased failure rates and were not associated with increased adverse events (AEs) as compared to a standard 6 weeks of antibiotic therapy. Further, extended antibiotics beyond one year did not provide additional benefits.

Shoulder Periprosthetic Joint Infection: Principles of Prevention, Diagnosis, and Treatment.

➢ Shoulder periprosthetic joint infection (PJI) is a potentially devastating complication after arthroplasty and is projected to rise with increasing numbers of performed arthroplasties, particularly reverse shoulder arthroplasties.➢ Important considerations for the diagnosis and treatment of shoulder PJI include age, sex, implant type, primary compared with revision shoulder surgery, comorbidities, and medications (i.e.

Development and Validation of a Mobile Phone Application for Measuring Knee Range of Motion.

Knee range of motion (ROM) is an important indicator of knee function. Outside the clinical setting, patients may not be able to accurately assess knee ROM, which may impair recovery following trauma or surgery. This study aims to validate a smartphone mobile application developed to measure knee ROM compared to visual and goniometer ROM measurements.

Role of the NeuroCuple™ Device for the Postoperative Pain Management of Patients Undergoing Unilateral Primary Total Knee and Hip Arthroplasty: A Pilot Prospective, Randomized, Open-Label Study.

Background: The potential effectiveness of the non-pharmacological and nanotechnology-based NeuroCuple™ device in reducing postoperative surgical pain and opioid consumption remains unknown.

Methods: This randomized controlled open-label study was conducted in patients undergoing a primary unilateral total knee or total hip arthroplasty. In the recovery room, patients were randomized to receive either standard of care (control group) or standard of care plus two NeuroCuple™ devices.

Reasons and Risk Factors for Failed Same-Day Discharge After Total Joint Arthroplasty.

Background: A shift toward same-day discharge (SDD) in primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) has created a need to optimize patient selection and improve same-day recovery pathways. The objectives of this study were (1) to identify our institution's most common causes for failed SDD, and (2) to evaluate risk factors associated with failed SDD.

Methods: A retrospective review of SDD patients undergoing primary TKA or THA from January 2021 to September 2022 was conducted.

SuRxgWell: study protocol for a randomized controlled trial of telemedicine-based digital cognitive behavioral intervention for high anxiety and depression among patients undergoing elective hip and knee arthroplasty surgery.

Background: Mood disorders (anxiety, depression), sleep disorders, and catastrophizing lead to increased post-operative pain perception, increase in postoperative opioid consumption, decreased engagement with physical activity, and increased resource utilization in surgical patients. Psychosocial disorders significantly affect postoperative outcome. Unfortunately, studies focused on perioperative psychological assessment and treatment are scarce.

The Microbiome of Osteoarthritic Hip and Knee Joints: A Prospective Multicenter Investigation.

Background: Recent advances in high-throughput DNA sequencing technologies have made it possible to characterize the microbial profile in anatomical sites previously assumed to be sterile. We used this approach to explore the microbial composition within joints of osteoarthritic patients.

Methods: This prospective multicenter study recruited 113 patients undergoing hip or knee arthroplasty between 2017 and 2019.

An Enhanced Understanding of Culture-Negative Periprosthetic Joint Infection with Next-Generation Sequencing: A Multicenter Study.

Background: The challenges of culture-negative periprosthetic joint infection (PJI) have led to the emergence of molecular methods of pathogen identification, including next-generation sequencing (NGS). While its increased sensitivity compared with traditional culture techniques is well documented, it is not fully known which organisms could be expected to be detected with use of NGS. The aim of this study was to describe the NGS profile of culture-negative PJI.

The presence of a draining sinus is associated with failure of re-implantation during two-stage exchange arthroplasty.

: Reinfection rates after two-stage exchange arthroplasty for prosthetic joint infection (PJI) have been reported as high as 33 % in the literature. Understanding risk factors for treatment failure will help to preoperatively counsel patients on the likelihood of successful treatment and possibly influence the surgeon's treatment algorithm. This study aimed to delineate whether the presence of a draining sinus tract is associated with risk of failure of two-stage exchange arthroplasty.

Perioperative Blood Management in Total Joint Arthroplasty.

Preoperative anemia is an established risk factor for complications following total joint arthroplasty. Postoperative anemia can be managed with allogeneic blood transfusion, but this has inherent risks. A thorough preoperative workup can help to diagnose anemia and optimize these patients for surgery to minimize the need for postoperative transfusion.

Do Culture Negative Periprosthetic Joint Infections Remain Culture Negative?

Background: Diagnosis and treatment of culture negative total knee arthroplasty (TKA) periprosthetic joint infection (PJI) is challenging. There is debate over whether culture negative PJI confers increased risk of failure and which organisms are responsible. It is also unclear as to what factors predict conversion from culture negative to culture positivity.

Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial.

Importance: Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited.

Are Sonication Cultures of Antibiotic Cement Spacers Useful During Second-stage Reimplantation Surgery for Prosthetic Joint Infection?

Background: Organisms may persist on polymethylmethacrylate (PMMA) spacer surfaces, and subclinical infection is postulated to be a source of infection recurrence. Several small patient series have shown a high proportion of positive sonication cultures on PMMA spacers at the second stage of a two-stage revision. However, the association between a positive sonication culture and the risk for recurrence of infection after two-stage exchange is not fully elucidated.