Publications by authors named "Darwin D Chen"
Evaluating the Readability, Credibility, and Quality of Spanish-Language Online Educational Resources for Knee Arthroplasty: Implications for Patient Education and Health Disparities.
J Am Acad Orthop Surg
June 2025
Article Synopsis
- Spanish-speaking patients face challenges accessing reliable and understandable information about knee replacement surgery online, highlighting disparities in healthcare education.
- A study analyzed the top 50 Spanish-language websites on knee replacement from three search engines, assessing them for readability, credibility, and quality, revealing that most websites were difficult to read and lacked credibility.
- University-affiliated websites tended to offer better readability and credibility compared to community hospital sites, but overall, many resources did not meet the ideal educational standards, emphasizing the need for improved patient education tools.
Article Synopsis
- - The study investigates the effects of preoperative bisphosphonate (BP) therapy on surgical outcomes for total hip arthroplasty (THA) patients, utilizing national health data from 2016 to 2020.
- - Of almost 92,000 THA patients analyzed, only 1.1% had used BP prior to surgery, but this group showed significantly higher odds of needing revision surgeries and experiencing periprosthetic fractures within one year post-operation.
- - The results highlight that patients taking BP before THA may face more complications, suggesting that healthcare providers should consider this when planning surgeries and advising patients.
Is Limited English Proficiency Associated With Differences in Care Processes and Treatment Outcomes in Patients Undergoing Orthopaedic Surgery? A Systematic Review.
Clin Orthop Relat Res
August 2024
Article Synopsis
- * The systematic review aims to investigate the links between limited English proficiency and differences in clinical care processes, patient engagement, and treatment outcomes for orthopaedic surgery patients in English-speaking countries.
- * A thorough search yielded 29 peer-reviewed studies covering over 362,746 patients, focusing on various aspects of clinical care and outcomes, with an evaluation of study quality revealing issues in about half of the included research.
Article Synopsis
- The study examined the impact of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on home health and outpatient physical therapy (PT) for patients after hip or knee surgeries between two time periods.
- Using national Medicare data, researchers compared outcomes from before the program's implementation (Jan 2013-Sept 2015) to after (Oct 2016-Sept 2019).
- Results showed an increase in home health PT use but fewer visits per episode for both total hip and knee arthroplasties, while outpatient PT visits for knee surgeries slightly increased, highlighting potential issues with care coordination.
Article Synopsis
- A nationwide study evaluated current practices for oral antibiotic prophylaxis prescriptions in outpatient total hip (THA) and knee arthroplasties (TKA) from 2018 to 2021, based on a claims database of patients aged 18 to 64.
- Among 73,015 procedures, only 16.5% received oral antibiotics, primarily using cephalosporins like cephalexin and cefadroxil.
- Factors associated with higher antibiotic prescribing included undergoing THA versus TKA, having certain medical conditions (obesity, diabetes, autoimmune disorders), and procedures performed in ambulatory surgery centers versus hospitals.
Article Synopsis
- Online resources for patient self-education highlight a significant public interest in different surgical approaches to total hip arthroplasty (THA), mainly the direct anterior approach (DAA) and the posterior approach (PA).
- An analysis of the top questions from Google's "People Also Ask" revealed a higher percentage of inquiries related to DAA, with notable differences in the types of information sought, particularly concerning recovery, management, and technical details.
- The credibility and quality of information across websites were generally low, with DAA websites performing particularly poorly, while comparison websites scored better in terms of quality, despite both approaches being written at a complex reading level.
Article Synopsis
- Adverse local tissue reactions are common in total hip arthroplasty, but there are limited reports regarding them in total knee arthroplasty and none for distal femoral replacements.
- A case of a 69-year-old woman with knee pain after complex knee surgery revealed significant corrosion at critical junctions of her knee implant.
- Manual cleaning and replacement of modular components were necessary, highlighting the need to consider corrosion as a potential cause of knee pain in patients with distal femoral replacements.*
Article Synopsis
- The study explores the impact of COVID-19 on the rates of venous thromboembolism (VTE) after total hip and knee surgeries from 2016 to 2021.
- It found that while overall VTE rates decreased during this period, prior COVID-19 infections increased the risk of VTE specifically in total knee arthroplasty patients, but not in total hip arthroplasty patients.
- The authors emphasize the need for continued monitoring of VTE trends and the effects of COVID-19 variants and vaccination rates on surgical outcomes.
Article Synopsis
- A study examined the impact of preoperative corticosteroid and hyaluronic acid injections on the risk of postoperative infections in total knee (TKA) and hip arthroplasty (THA) procedures.
- The research analyzed data from over 600,000 surgeries and found that receiving more than two corticosteroid injections before THA was linked to a higher risk of infections within 90 days post-surgery.
- The findings recommend that patients should limit corticosteroid injections to two or fewer within two years prior to hip surgery to reduce infection risks, while similar associations were not found for knee surgeries.
Sleep Disturbance Trends in the Short-Term Postoperative Period for Patients Undergoing Total Joint Arthroplasty.
J Am Acad Orthop Surg
October 2023
Article Synopsis
- This study investigated sleep disturbances in patients undergoing total joint arthroplasty (TJA) and tracked changes over three months post-surgery, focusing on how preoperative sleep condition influences recovery.
- Results showed that the percentage of patients reporting normal sleep increased from 54.8% preoperatively to 71.8% by three months, with specific patterns in sleep quality changes depending on initial sleep issues.
- Key findings indicated that patients who had moderate to severe preoperative sleep impairment experienced significant improvement in sleep by two weeks post-surgery, and those having total hip arthroplasty were more likely to see notable sleep enhancements.
Background: Osteonecrosis of the femoral head is a common indication for total hip arthroplasty (THA). It is unclear to what extent the COVID-19 pandemic has impacted its incidence. Theoretically, the combination of microvascular thromboses and corticosteroid use in patients who have COVID-19 may increase the risk of osteonecrosis.
View Article and Find Full Text PDFRationale: Preoperative patient education through 'joint class' has potential to improve quality of care for total joint replacement (TJR). However, no formal guidance exists regarding curriculum content, potentially resulting in inter-institutional variation.
Objective: We aimed to (a) synthesize curriculum components of 'joint classes' across high-volume institutions and (b) develop a preliminary theory of change model for development and evaluation guided by the existing curricula and related literature.
Background: Poor preoperative mental health has been associated with worse outcomes after total hip (THA) and total knee arthroplasty (TKA). To fully understand these relationships, we assessed post-THA and post-TKA improvements in patient-reported mental and joint health by preoperative mental health groups.
Methods: Elective cases (367 THA, 462 TKA) were subgrouped by low (<25th percentile), middle (25th-74th), and high (≥75th) preoperative mental health, using Veterans RAND 12-Item Health Survey Mental Component Summary (MCS) scores.
Article Synopsis
- Prosthetic joint infection (PJI) is a rare complication after unicompartmental knee arthroplasty (UKA), and there’s limited research on how to manage it.
- A systematic review analyzed treatment patterns for PJI cases following UKA, evaluating the failure rates associated with different treatments.
- The review identified 97 PJI cases with various treatment methods, finding that debridement, antibiotics, and implant retention (DAIR) were the most common, but no significant differences in failure rates among treatment options were observed, indicating a need for further research.
Racial Differences in Manipulation Under Anesthesia Rates Following Total Knee Arthroplasty.
J Arthroplasty
September 2022
Article Synopsis
- The study investigates racial disparities in the rates and timing of manipulation under anesthesia (MUA) after total knee arthroplasty (TKA) using Medicare data from 2013 to 2018, with a focus on White, Black, and Other racial groups.
- Results show that Black patients had nearly double the odds of needing an MUA compared to White patients and experienced longer wait times for the procedure.
- The findings highlight persistent racial inequalities in TKA care, stressing the need for continued efforts to understand and address these disparities.
Evaluating Resource Utilization for In-Person and Virtual Joint Classes in Total Joint Arthroplasty: An Analysis of Attendance Patterns at a Large Metropolitan Health System.
J Arthroplasty
September 2022
Background: Provider-run "joint classes" educate total joint arthroplasty (TJA) patients on how to best prepare for surgery and maximize recovery. There is no research on potential healthcare inequities in the context of joint classes or on the impact of the recent shift toward telehealth due to coronavirus disease 2019 (COVID-19). Using data from a large metropolitan health system, we aimed to (1) identify demographic patterns in prepandemic joint class attendance and (2) understand the impact of telehealth on attendance.
View Article and Find Full Text PDFBackground: Enhanced recovery after surgery (ERAS) protocols are increasingly used in orthopedic surgery. Data are lacking on which combinations of ERAS components are (1) the most commonly used and (2) the most effective in terms of outcomes.
Methods: This retrospective cohort study utilized claims data (Premier Healthcare, n = 1,539,432 total joint arthroplasties, 2006-2016).
Background: Under bundled payment models, gainsharing presents an important mechanism to ensure engagement and reward innovation. We hypothesized that metric selection, metric targets, and risk adjustment would impact surgeons' performance in gainsharing models.
Methods: Patients undergoing total joint arthroplasty at an urban health system from 2017 to September 2018 were included.
Article Synopsis
- The study investigates the use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) and its impact on infection risk and other clinical outcomes.
- ALBC was used in approximately 27.2% of TKAs from 2006 to 2016, with a notable increase in usage over the years and variations between hospital types.
- Findings indicate that while ALBC reduces the risk of early postoperative infections, it also raises the chances of acute kidney injury, suggesting that it should be used selectively in TKA procedures.
Article Synopsis
- - The study compares research on robotic-assisted unicompartmental knee arthroplasty (UKA) to standard UKA, focusing on aspects like funding sources, author conflicts of interest, and scientific quality from 2012 to 2016.
- - Of the robotic UKA papers, 51% had industry funding or conflicts, compared to 29% of standard UKA papers, and more robotic papers appeared in journals without an impact factor.
- - Despite these funding disparities, there were no significant differences in scientific quality or influence between robotic and standard UKA research, highlighting the importance of considering potential conflicts of interest in interpreting study findings.
The Effect of Door Opening on Positive Pressure and Airflow in Operating Rooms.
J Am Acad Orthop Surg
March 2018
Introduction: Door openings and increased foot traffic in operating rooms (ORs) during total joint arthroplasty are thought to increase the risk of surgical site infection.
Methods: Digital manometers were used to collect pressure data during off-hours at the thresholds of both the outer door (ie, the door to the common OR hallway) and the inner substerile door, which opens to the substerile hallway, of six empty ORs used for total joint arthroplasty. Airflow patterns were visualized with smoke studies to determine whether outside air entered the ORs during single or multiple door openings.
Article Synopsis
- The study investigated S aureus nasal colonization in patients undergoing hip or knee arthroplasty, highlighting that preoperative screening for colonization can reduce infection rates. !* -
- Among 716 patients, 17.5% tested positive for S aureus, with diabetes, renal insufficiency, and immunosuppression identified as significant risk factors for nasal colonization. !* -
- The findings suggest that patients with these comorbidities should be proactively screened and decolonized before surgery to mitigate the risk of surgical site infections. !*
Impact of Gender on 30-Day Complications After Primary Total Joint Arthroplasty.
J Arthroplasty
August 2017
Article Synopsis
- The study examines how gender affects 30-day complications in total hip arthroplasty (THA) and total knee arthroplasty (TKA), something not previously explored in these procedures.
- It analyzes data from the National Surgical Quality Improvement Program for patients who underwent THA or TKA from 2012 to 2014, focusing on complications linked to gender.
- The results show that while being female can protect against certain serious complications, it also increases the risk for urinary tract infections and nonhome discharges, suggesting doctors should consider gender for better patient risk assessment.
Revision for taper corrosion at the neck-body junction following total hip arthroplasty: pearls and pitfalls.
Curr Rev Musculoskelet Med
March 2016
The management of the patient with a recalled, modular neck-body total hip arthroplasty can be complex, as it involves a combination of clinical, technical, and medicolegal challenges. Management begins with a thorough history and physical exam, radiographic evaluation, infection workup, and serum metal ion levels. Three-dimensional imaging is obtained based on patient symptomatology and metal ion levels and is used to evaluate for the presence of an adverse local tissue response as well as the integrity of the existing soft tissue envelope.
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