Defining Benchmarks for Case Minimums During Accreditation Council for Graduate Medical Education-Accredited Total Joint Arthroplasty Fellowship Training.

Background: Professional societies and accrediting bodies for arthroplasty training increasingly recognize the need for minimum case numbers to enhance surgical training in the United States. This study elucidated benchmarks for case minimum requirements during Accreditation Council for Graduate Medical Education (ACGME)-accredited arthroplasty fellowship training.

Methods: This was a retrospective cohort study of ACGME-accredited arthroplasty fellows who graduated between 2018 and 2023.

The Fate of Morbidly Obese Patients With Joint Pain: A Retrospective Study of Patient Outcomes.

Background: The number of obese patients seeking a total joint arthroplasty (TJA) continues to increase. Weight loss is often recommended to treat joint pain and reduce risks associated with TJA. We sought to determine the effectiveness of an orthopedic surgeon's recommendation to lose weight.

Preoperative Smoking Cessation as a Durable Form of Long-Term Smoking Cessation.

Smokers who undergo total joint arthroplasty (TJA) face increased rates of medical and surgical complications that can be reduced by preoperative smoking cessation. We investigated the long-term durability of preoperative smoking cessation among TJA patients. Twenty-seven TJA patients who were identified as having an active history of smoking at the preoperative appointment before TJA consented to telephone survey about their perioperative and current smoking status.

Risk Factors for Fungal Prosthetic Joint Infection.

: Fungal prosthetic joint infections (PJIs) are rare and often associated with poor outcome; however, risk factors are not well described. : This was a retrospective case control study among all patients with PJIs from 2006-2016 at two major academic centers. Each fungal PJI case was matched 1:1 with a bacterial PJI control by joint (hip, knee, shoulder) and year of diagnosis.

Optimal Length of Stay Following Total Joint Arthroplasty to Reduce Readmission Rates.

Background: Length of stay (LOS) following total joint arthroplasty (TJA) continues to decrease. The effects of this trend on readmission risk and total cost are unclear. We hypothesize that optimal LOS following TJA minimizes index hospitalization, early readmission risk, and total cost.

Surgical Complications Associated With Atypical Femur Fractures Attributed to Bisphosphonate Use.

Complications of atypical femur fractures (AFFs) are common. AFFs often receive the same treatment as other femoral fractures; however, there appears to be a higher rate of adverse outcomes. Nine patients sustained a total of 13 AFFs, had documented bisphosphonate use before fracture, and had surgery between 2006 and 2012.

Prefrontal versus motor cortex transcranial direct current stimulation (tDCS) effects on post-surgical opioid use.

Background: Pain is often a complaint that precedes total knee arthroplasty (TKA), however the procedure itself is associated with considerable post-operative pain lasting days to weeks which can predict longer-term surgical outcomes. Previously, we reported significant opioid-sparing effects of motor cortex transcranial direct current stimulation from a single-blind trial. In the present study, we used double-blind methodology to compare motor cortex tDCS and prefrontal cortex tDCS to both sham and active-control (active electrodes over non-pain modulating brain areas) tDCS.

Fewer Complications Following Revision Hip and Knee Arthroplasty in Patients With Normal Vitamin D Levels.

Background: Surgeons and hospitals increasingly face penalty for complications and readmission following total joint arthroplasty; therefore, optimization of modifiable risk factors is paramount. Literature associates low vitamin D with risk of periprosthetic joint infection, and we hypothesized low vitamin D to be predictive of increased rate of complications and readmissions.

Methods: A retrospective review of 126 revision total joint arthroplasty patients between 2010 and 2014 was performed.

Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty.

Background: Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA.

Methods: After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation.

Comparison of Lumbar Epidurals and Lumbar Plexus Nerve Blocks for Analgesia Following Primary Total Hip Arthroplasty: A Retrospective Analysis.

Background: Total hip arthroplasty (THA) is associated with significant postoperative pain. Both lumbar epidurals and lumbar plexus nerve blocks have been described for postoperative pain control, but it is unclear if one technique is more beneficial.

Methods: Using electronic medical records, a randomly selected, cohort of 58 patients with lumbar epidurals were compared with 58 patients with lumbar plexus nerve blocks following primary THA.

Complications of hip and knee joint replacement in solid-organ transplant patients.

This study investigated complication rates for 68 solid-organ transplant patients who had undergone 94 primary hip or knee joint replacements at a single institution from 1995 to 2008. There was a deep infection rate of 6.8% in the transplant patients compared to a 1.

The efficacy of automated intermittent boluses for continuous femoral nerve block: a prospective, randomized comparison to continuous infusions.

Study Objective: To determine whether an automated intermittent bolus technique provides enhanced analgesia compared with a continuous infusion for femoral nerve block.

Design: Prospective, single-blinded, randomized controlled trial (ClinicalTrials.gov Identifier: NCT01226927).

Transcranial direct current stimulation (tDCS) reduces postsurgical opioid consumption in total knee arthroplasty (TKA).

Background: Although pain is often a symptom that precedes total knee arthroplasty (TKA), the procedure itself is associated with considerable postoperative pain lasting days to weeks. Postoperative pain control is an important factor in determining recovery time, hospital length of stay, and rehabilitation success. Several brain stimulation technologies including transcranial direct current stimulation (tDCS) have demonstrated promise as treatments for a variety of pain conditions.

A biomechanical comparison of periprosthetic femoral fracture fixation in normal and osteoporotic cadaveric bone.

Several techniques are described for fixation of Vancouver B1 femoral shaft fractures after total hip arthroplasty. Twenty-four femurs were scanned by dual x-ray absorptiometry scanned and matched for bone mineral density. Femurs were implanted with a cemented simulated total hip prosthesis with a simulated periprosthetic femur fracture distal to the stem.

Platelet-rich and platelet-poor plasma: development of an animal model to evaluate hemostatic efficacy.

Hemostasis is important for any surgical procedure. One method uses autologous platelet-rich and/or platelet-poor plasma sprayed on the wound site. Although effective, there are little quantitative data available to fully document the extent to which these autologous products function as hemostats.