Exploring ChatGPT's Efficacy in Orthopaedic Arthroplasty Questions Compared to Adult Reconstruction Surgeons.

Background: Chat Generative Pre-trained Transformer (ChatGPT) is a language model designed to conduct conversations utilizing extensive data from the internet. Despite its potential, the utility of ChatGPT in orthopaedic surgery, particularly in arthroplasty, is still being investigated. This study assesses ChatGPT's performance on arthroplasty-related questions in comparison to an Adult Reconstruction Fellow and a Senior level attending.

The Timing of Direct Oral Anticoagulant Usage Did Not Impact Outcomes Following Hip Arthroplasty for Femoral Neck Fractures.

Background: Orthopaedic surgeons routinely delay surgical management of femoral neck fractures in patients taking direct oral anticoagulants (DOACs) to decrease perioperative bleeding and associated complications. However, this practice contradicts the principles of hip fracture management, as early surgery is associated with morbidity and mortality benefits. The purpose of this study was to quantify the association of DOAC use and perioperative outcomes in patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fractures.

A Novel Seven-Day Abbreviated Two-Stage Exchange Arthroplasty with Intra-Articular Antibiotic Irrigation for Chronic Periprosthetic Joint Infection of the Knee: A Case Report.

Introduction: The current standard for treating chronic periprosthetic joint infection (PJI) in North America, a two-stage exchange arthroplasty, has success rates of 65-90% but involves prolonged interstage periods, increased morbidity, and a high 5-years mortality rate of up to 25%. These limitations have driven research into alternative approaches, such as intra-articular antibiotic (IAA) irrigation, which uses a specialized titanium spacer for localized antibiotic delivery over a 7-day period.

Case Report: A 53-year-old male with chronic PJI of the left knee underwent a novel rapid two-stage exchange arthroplasty using an IAA irrigation system.

Three Hundred Periprosthetic Tibial Fractures Around a Total Knee Replacement: Classification and Outcomes from a Single Institution.

Background: Periprosthetic tibial fractures around a total knee replacement (TKR) remain challenging to manage, with little published information for guidance. The purpose of this study was to review the types, management techniques, and outcomes of periprosthetic tibial fractures in the largest series to date.

Methods: We identified 300 periprosthetic tibial fractures (285 patients) around a TKR (43% in primary TKRs and 57% in revision TKRs) sustained between 1996 and 2020.

Isolation of Multiple Positive Cultures at Resection Arthroplasty is a Predictor of Failure Following Reimplantation.

Background: Although it is well established that the type of organism can be a risk factor for failure in patients with periprosthetic joint infection (PJI), no study to date has examined the impact of the number of positive cultures on treatment outcomes in patients undergoing 2-stage exchange. The purpose of this multicenter study was to determine the prognostic utility of multiple positive cultures at resection as a predictor of failure following reimplantation.

Methods: This retrospective multicenter study identified 437 patients with chronic knee PJI who had undergone 2-stage exchange arthroplasty with a minimum of 1 year of follow-up following reimplantation.

Patient Preoperative Optimization: How to Do It and How to Be Paid for the Work.

Background: Preoperative optimization has become an essential component of the orthopaedic surgeon's workflow, especially as outpatient total joint arthroplasty (TJA) becomes more common in ambulatory surgery centers. Surgeons must identify and address modifiable patient risk factors, optimize surgical outcomes, and navigate reimbursement processes for these critical services.

Methods: This review outlines key aspects of preoperative optimization, including medical evaluations for anemia, glycemic control, smoking cessation, and the management of comorbidities like rheumatoid arthritis, obstructive sleep apnea, and peripheral vascular disease.

Periprosthetic joint infection : development of a core outcome set.

Aims: Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty, with substantial morbidity, mortality, and healthcare costs. Despite advances in diagnosis and treatment, inconsistencies in outcome reporting have hindered evidence synthesis, limiting progress in understanding and management. This study aimed to develop a core outcome set (COS) for PJI to standardize outcome reporting in the literature.

Navigated and Robotic Total Knee Arthroplasty Do Not Confer Improved 5-Year Survivorship Compared to Conventional Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry.

Background: Computer-assisted navigation and/or the use of robotics at the time of the primary total knee arthroplasty (TKA) have been shown to improve implant position, minimize alignment outliers, and possibly improve patient outcomes compared to conventional instrumentation. The purpose of this study was to use the linked Medicare dataset from the American Joint Replacement Registry to compare the midterm (5-year) outcomes of navigated TKA and robotic TKA to those of conventional TKA.

Methods: All primary TKA procedures submitted to the American Joint Replacement Registry between January 2017 and December 2022 among patients aged 65 years and older were included in the analysis.

Dual-Mobility Articulations in Primary Total Hip Arthroplasty: Mid-Term Outcomes From the American Joint Replacement Registry.

Background: In recent years, there has been an increased utilization of dual-mobility (DM) implants in primary total hip arthroplasty (THA) to mitigate the risk of postoperative hip instability. This study aimed to present mid-term outcomes of DM bearings in primary THA using data from the American Joint Replacement Registry.

Methods: Screening was conducted on patients aged ≥ 65 years who underwent primary THA between 2012 and 2018.

What Is the Incidence of and Outcomes After Debridement, Antibiotics, and Implant Retention (DAIR) for the Treatment of Periprosthetic Joint Infections in the AJRR Population?

Background: Debridement, antibiotics, and implant retention (DAIR) is used to manage acute periprosthetic joint infections (PJIs) after total joint arthroplasty (TJA). Given the uncertain success of single or multiple DAIR attempts and possible long-term deleterious effects this treatment can create when trying to treat persistent infection, it is important to understand the frequency with which surgeons in the United States are attempting multiple debridements for PJI and whether those procedures are achieving the desired goal.

Question/purposes: In the context of the American Joint Replacement Registry (AJRR), we asked: (1) What proportion of patients who undergo DAIR have only one DAIR, and what percentage of those patients have more than one? (2) Of the patients who undergo one or more DAIR procedures, what is the proportion who progress to additional surgical procedures? (3) What is the cumulative incidence of medical or surgical endpoints related to infection on the affected leg (other than additional DAIR procedures)?

Methods: DAIR procedures to treat PJI, defined by ICD-9/10 and CPT (Current Procedural Technology) codes, reported to the AJRR from 2012 to 2020 were merged with Centers for Medicare and Medicaid Services (CMS) data from 2012 to 2020 to determine the incidence of patients aged 65 and older who underwent additional PJI-related procedures on the same joint.

The Role of a New Hinged Total Knee Arthroplasty System for Use in a Variety of Complex Knee Scenarios: A Case Series.

Hinged knee arthroplasties are commonly used in scenarios where there are major ligament deficiencies or bone loss around the knee. They are applicable in native knees with major deformities and during revisions. They can also be used as a salvage procedure after distal femoral resection.

Cemented Stem Design in Total Hip Arthroplasty: Fixation Philosophies, Biomechanics, and an Updated Classification System.

There is renewed interest in cemented femoral fixation in total hip arthroplasty in the United States, and to fully appreciate the evolution of cemented femoral stem designs, an understanding of their history and design rationale is essential. To adequately study the outcomes of modern-day designs, a comprehensive classification system is also necessary. The biomechanical principles, failure mechanisms, and clinical outcomes associated with various cemented femoral stems are described in this comprehensive review.

Safety Profile of Seven-Day Intra-articular Antibiotic Irrigation for the Treatment of Chronic Periprosthetic Joint Infection: A Prospective Randomized Phase II Comparative Study.

Background: Systemic intravenous antimicrobials yield poor outcomes during treatment of periprosthetic joint infection due to the inability to obtain minimum biofilm eradication concentrations. This study evaluated the safety of a novel method of optimized local delivery of intra-articular antibiotics (IAAs).

Methods: This was a Phase II, multicenter, prospective randomized trial evaluating safety of a rapid (seven-day) two-stage exchange arthroplasty with IAA irrigation compared to standard two-stage exchange.

Modular Revision System for Complex Hip Revisions: A Case Series.

Revision total hip arthroplasty (THA) is a procedure with many challenges, especially when patients exhibit femoral bone defects. The causes of these defects vary, ranging from removal of prior implants to aseptic loosening. As surgeons navigate these challenges, a reliable surgical system is important.

Is American Joint Replacement Registry Data Consistent With International Survivorship in Hip and Knee Arthroplasty? A Comparative Analysis.

Background: In collaboration with the Orthopedic Data Evaluation Panel (ODEP), the American Joint Replacement Registry (AJRR) investigated the consistency of hip and knee arthroplasty survivorship results compared to the UK National Joint Registry (NJR).

Methods: A total of three primary knee devices and three primary hip devices were selected by AJRR and ODEP with known variation in performance. Implant manufacturers independently produced Kaplan Meier survivorship based on NJR data and submitted to ODEP for comparison.

Design and Verification of a Metaphyseal Filling Stem for Total Hip Arthroplasty Based on Novel Measurements of Proximal Femoral Anatomy.

Background: Cementless metaphyseal filling stems rely on fixation in the medial-to-lateral and anterior-to-posterior (AP) planes. The purpose of this preclinical study was to develop Insignia, a new metaphyseal filling system to match the anatomy of the proximal femur, and then compare it to clinically successful stems in multiple simulations.

Methods: In this preclinical study, the geometry of the proximal femur in the AP plane among 1321 healthy subjects was evaluated using computed tomography.

Radiographic Cone Zone Classification of Metaphyseal Cone Fixation in Revision Total Knee Arthroplasty.

Background: No objective radiographic scoring system exists to classify metaphyseal cone stability. Our purpose was to create a novel, systematic method to radiographically evaluate metaphyseal cone fixation based on radiographic findings suggestive of cone stability.

Methods: A retrospective analysis was conducted of revision total knee arthroplasty patients (6/2015-12/2017) using porous titanium femoral or tibial metaphyseal cones in conjunction with short cemented stems (50 mm-75 mm).

The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations.

Glucagon-Like Peptide agonists have traditionally been used for glycemic control in diabetic patients. However, there has been a dramatic rise in their utilization for weight loss management. As such, arthroplasty surgeons will encounter an increasing number of patients on these medications, and therefore it is important to understand the implications of their use in the perioperative period.

Precision or Pitfall? Evaluating the Accuracy of ICD-10 Coding for Cemented Total Hip Arthroplasty: A Multicenter Study.

Background: The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedure Coding System (ICD-10-PCS) was adopted in the U.S. in 2015.