Identifying Critical Evidence Gaps in Wound Closure and Incision Management After Total Hip Arthroplasty: Delphi Panel Insights.

Background: In total hip arthroplasty (THA), proper management of surgical incisions is essential for optimal wound healing and patient outcomes. Despite advances in surgical techniques, significant challenges remain in preventing complications and infections. This study aimed to identify evidence gaps in THA wound care, including presurgical preparation, intraoperative practices, and postsurgical complications.

Clinical Outcomes and Overall Satisfaction of Patents Enrolled in an Artificial Intelligence-Powered Chatbot Following Periacetabular Osteotomy.

Background: The role of technology in the perioperative care of patients continues to grow. A surgeon-specific perioperative chatbot may improve the care of patients by answering questions or concerns. The purpose of this retrospective review was to assess if enrollment in a perioperative chatbot was associated with differences in clinical outcomes or patient satisfaction following periacetabular osteotomy.

Modular Splined Tapered Stems Through the Direct Anterior Approach: Should I Make an Accessory Incision?

Background: Femoral preparation through a proximal accessory incision (PAI) has been suggested for placement of modular splined tapered stems (STSs) during revision direct anterior (DA) total hip arthroplasty. However, outcomes using PAIs have not been previously reported. The purpose of this study was to compare femoral revisions using a PAI with revisions in which all preparation was done through the Heuter interval, specifically looking for differences in: (1) survivorship, (2) complications, and (3) patient-reported outcomes.

Insufficient Mandatory Patient-Reported Outcome Rates at an Academic Hospital Despite Increased Resource Allocation.

Background: Beginning July 1, 2024, the Centers for Medicare and Medicaid Services (CMS) began mandating at least 50% institutional compliance of patient-reported outcome-based performance measures (PRO-PMs) for Medicare fee-for-service patients undergoing inpatient, elective arthroplasty. The purpose of this study was to quantify a single institution's PRO-PM capture rates before the deadline and determine risk factors for noncompliance.

Methods: There were 2,692 patients who underwent primary elective hip and knee arthroplasty at a single institution from 2021 to 2022.

Evolving Patterns in Revision Total Hip Arthroplasty: Frequency, Complexity, and Indications Over Two Decades at a High-Volume Tertiary Referral Center.

Background: Patterns in revision total hip arthroplasty (THA) have continued to evolve throughout the decades. We investigated whether these trends could vary by practice location and analyzed the indications and incidence of revision and "complex" revision THA at our isolated regional academic referral center over the past two decades. We hypothesized that our regional referral center has attracted an increasing level of complexity in revision THA cases over time.

Cementless Hemiarthroplasty Complication Risk Does Not Support Contemporary Utilization Patterns.

Background: Hemiarthroplasty (HA) is commonly performed in the setting of femoral neck fracture to allow for early mobilization. Fixation of the femoral component can be either press fit or cemented. The purpose of this study was to compare cemented and cementless HA utilization and complications.

Comparative Outcomes with an Artificial Intelligence-Powered Short Message Service Chatbot After Total Joint Arthroplasty.

Introduction: Access to a patient's surgeon has become increasingly difficult given increased volumes of total joint arthroplasty (TJA). A surgeon-specific conversational chatbot has the theoretical advantage of engaging and guiding patients through the perioperative journey irrespective of surgeon availability. The purpose of this study was to retrospectively assess if enrollment in a perioperative chatbot was associated with improved outcomes following TJA compared to a historical cohort not enrolled.

Increasing Limb Length During Stage 1 Revision Leads to Higher Rates of Instability Following Stage 2 Revision Total Hip Arthroplasty.

Background: Currently, two-stage revision total hip arthroplasty is the gold standard in managing periprosthetic joint infection (PJI) of the hip; however, complications are common, including instability. The purpose of this study was to determine how alterations in limb length during a stage 1 articulating spacer affect dislocation rates of the stage 2 revision.

Methods: A retrospective study of consecutive patients who underwent two-stage revision total hip arthroplasty for PJI between December 2013 and December 2022 was performed.

Special Considerations Before Total Hip Arthroplasty for Rapidly Progressive Osteoarthritis With a Recent Corticosteroid Injection.

Background: Rapidly progressive osteoarthritis (RPOA) has been associated with hip corticosteroid injections (CSIs), but may also mimic septic arthritis, which demonstrates similar erosive findings. This retrospective review evaluated a consecutive series of patients who had RPOA of the hip following CSI who underwent total hip arthroplasty (THA) and assessed outcomes and potential infection screening implications.

Methods: All radiographic reports concerning RPOA were retrospectively identified at a single academic referral center from January 2014 to January 2023.

Liposomal bupivacaine versus standard periarticular injections in total hip and knee arthroplasty: a prospective, randomized non-inferiority trial.

Introduction: Numerous multimodal pain protocols have been developed to optimize pain control, reduce narcotics consumption, and shorten the length of stay after total hip and knee arthroplasty (THA/TKA). Liposomal bupivacaine (LB) has been postulated to reduce narcotic requirements after arthroplasty but is not without additional cost. The aim of this study was to determine if the addition of LB to our standard periarticular injection would improve postoperative pain and shorten the length of stay in patients undergoing TKA or THA.

Preventing Periprosthetic Femur Fractures in Anterior-Based Approaches.

Anterior approaches including the direct anterior and anterior-based muscle sparing approaches have grown in popularity for total hip arthroplasty. Despite many benefits, some studies have demonstrated an increased risk of periprosthetic fracture. Preoperatively, patient selection, careful templating, and strategic implant choice may decrease fracture risk.

Radiographic and Clinical Comparisons of a Modern Symmetrical Versus Asymmetrical Implant Design in Primary Total Knee Arthroplasty.

Background: While asymmetrical, left/right specific, femoral, and tibial components are commonly used in modern total knee arthroplasty (TKA), the recent introduction of a modern symmetrical, left/right nonspecific, design may afford benefits as a result of reduced implant and instrumentation requirements. Given the symmetrical trochlear design of left/right nonspecific femoral components, some concerns over patient outcomes and patellar tracking may exist. The purpose of this study was to compare the clinical and radiographic outcomes in a symmetrical TKA design to a more commonly used asymmetrical femoral component.

Unicompartmental Knee Arthroplasty Patients Recover More like Total Hip Patients than Total Knee Patients: A Prospective Longitudinal Study.

Background: The differences in physical activity (PA) recovery between patients who have total hip arthroplasty (THA), unicompartmental knee arthroplasty (UKA), and total knee arthroplasty (TKA) are lacking. We described the trajectory of recovery based on objective metrics of PA over the first 12 months post-joint arthroplasty (JA).

Methods: Data from 4,700 patients, who underwent a primary unilateral JA surgery between November 2018 and September 2021 from a multisite prospective study, were analyzed.

Can I Pickle Doc? Return to Pickleball and Other Racket Sports After Total Joint Arthroplasty.

Background: Participation in pickleball and other racket sports is growing, particularly among older adults who may also be candidates for joint arthroplasty (JA). Currently, there are limited data on performance, safety, and return to racket sports after JA.

Methods: An online survey was sent to 7,200 patients who had undergone at least one primary JA at a single academic center over the past 10 years (five surgeons).

Analysis of Synovial Fluid Aspirations in Aseptic Loosening and Instability After Total Knee Arthroplasty.

Background: Aseptic total knee arthroplasty (TKA) complications can be challenging to diagnose. Many studies have defined periprosthetic joint infection (PJI) using synovial aspirations, but few studies have described aspiration characteristics in aseptic TKA problems. The aim of this study was to determine the synovial fluid characteristics of patients who had TKA failure caused by two common aseptic diagnoses: aseptic loosening and instability.

Conversational Engagement Using a Short Message Service Chatbot After Total Joint Arthroplasty.

Background: Utilizing conversational analytics in orthopaedic surgery may provide insights into patients' experiences and outcomes. This study retrospectively assessed how patients interacted with a perioperative chatbot and whether the topic of patients' queries could offer insight on their outcomes after total knee or hip arthroplasty.

Methods: We identified 1338 patients (746 knees and 592 hips) who enrolled in a short message service chatbot from 2020-2022 with greater than 3 months of follow-up.

Leg Length Discrepancy in Total Hip Arthroplasty: Not All Discrepancies Are Created Equal.

The original review article, published in 2006, describing leg length discrepancy after total hip arthroplasty commented that "equal leg length should not be guaranteed." There has been considerable advancement in surgical technique and technology over the past decade, allowing surgeons to "hit the target" much more consistently. In this interval paper, we review leg length discrepancy and introduce some technologies designed to mitigate this complication.

Conversion of Tibial Plateau Fractures to Total Knee Arthroplasty is Associated With Worse Patient-Reported Outcomes, Increased Operative Times, and Increased Complications.

Background: Prior open reduction and internal fixation (ORIF) of tibial plateau fracture (TPF) adds complexity to subsequent total knee arthroplasty (TKA). The purpose of this study was to compare the outcomes of patients undergoing a TKA following prior ORIF of TPF to patients undergoing a primary TKA for osteoarthritis and an aseptic revision TKA.

Methods: There were 52 patients who underwent primary TKA following prior ORIF of TPF between January 2009 and June 2021, who were included and matched in a 1:4 ratio to 208 patients undergoing primary TKA.

Intramedullary Total Femur via a Direct Anterior Approach for Complex Revision Total Hip and Knee Arthroplasty.

Total femur replacement is a well-recognized salvage procedure and an alternative to hip disarticulation in patients with massive femoral bone loss. Compared to conventional total femur replacement, intramedullary total femur (IMTF) requires less soft tissue dissection and preserves femoral bone stock and soft-tissue attachments. Despite these advantages, patients can still anticipate compromised functional outcomes and high complication rates following IMTF.

Patient Engagement Platforms: How Technology Is Impacting Perioperative Communication and Engagement in Total Hip and Knee Arthroplasty.

Orthopedic clinics are becoming strained with clinical volume outpacing resources and personnel. Patient engagement platforms can help bridge the communication and engagement gaps between patients and their healthcare teams as total hip and knee arthroplasty transitions to the outpatient setting. These platforms provide a digital infrastructure that allows patients to participate in their healthcare journey while alleviating the burdens on clinic staff.

Identifying Critical Evidence Gaps in Wound Closure and Incision Management After Total Knee Arthroplasty: Delphi Panel Insights.

Background: Effective surgical wound management in total knee arthroplasty (TKA) is crucial for optimal healing and patient outcomes. Despite surgical advances, managing wounds to prevent complications remains challenging. This study aimed to identify and address evidence gaps in TKA wound management, including preoperative optimization, intraoperative options, and postoperative complication avoidance.

The incidence of subsequent hip arthroscopy after rectus-sparing periacetabular osteotomy.

Aims: Periacetabular osteotomy (PAO) is the preferred treatment for symptomatic acetabular dysplasia in adolescents and young adults. There remains a lack of consensus regarding whether intra-articular procedures such as labral repair or improvement of femoral offset should be performed at the time of PAO or addressed subsequent to PAO if symptoms warrant. The purpose was to determine the rate of subsequent hip arthroscopy (HA) in a contemporary cohort of patients, who underwent PAO in isolation without any intra-articular procedures.

Similar Efficacy and Lower Cost Associated With Ceftazidime Compared to Tobramycin Coupled With Vancomycin in Antibiotic Spacers in the Treatment of Periprosthetic Joint Infection.

Background: Vancomycin and tobramycin have traditionally been used in antibiotic spacers. In 2020, our institution replaced tobramycin with ceftazidime. We hypothesized that the use of ceftazidime/vancomycin (CV) in antibiotic spacers would not lead to an increase in treatment failure compared to tobramycin/vancomycin (TV).

Staged Bilateral Total Knee Arthroplasty: Differing Results Comparing the First and Second Knees.

Background: Patients often prefer one knee over the other following staged bilateral total knee arthroplasty (BTKA). Our study compared patient-reported outcomes scores of each knee following BTKA and identified factors that may contribute to the identified discrepancies.

Methods: All patients who underwent staged BTKA between July 2014 and August 2022 were identified.