Spin and reporting bias in the use of platelet-rich plasma for the treatment of knee osteoarthritis.

Introduction: Systematic reviews and meta-analyses evaluating platelet-rich plasma (PRP) injections are vulnerable to spin (i.e., misrepresentation of study findings).

Novel Technologies in Periprosthetic Joint Infection: Emerging Diagnostics.

Periprosthetic joint infection (PJI) is one of the most challenging complications following total joint arthroplasty (TJA), contributing to high morbidity, increased healthcare costs, and frequent implant failures. The current diagnostic methods, including synovial fluid analysis and microbiological cultures, are limited by their sensitivity and specificity, particularly in culture-negative infections. As a result, there is a growing need for novel diagnostic technologies that can provide rapid and reliable detection of PJI.

Erratum to 'The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis' [The Journal of Arthroplasty 40 (2025) 1836-1844].

Background: Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.

Total Hip Arthroplasty Among Superobese Patients: Proceed With Caution.

Background: Morbid obesity, defined as body mass index (BMI) ≥40 kg/m, increases perioperative risk following total hip arthroplasty (THA). However, limited contemporary data exists on outcomes of superobese patients (BMI ≥50 kg/m) following primary THA. Using a large modern cohort, this study seeks to quantify the risk of infection and surgical, medical, and thromboembolic complications among superobese THA patients.

Neutrophil-Lymphocyte Ratios and Optimal Surgical Timing for Hemiarthroplasty for Femoral Neck Fracture.

Introduction: Femoral neck fractures are highly morbid injuries, and patients with greater perioperative risk are commonly treated with hemiarthroplasty (HA). Neutrophil-lymphocyte ratios (NLRs) are measures of inflammation and predict mortality after surgery. We hypothesize that patients presenting with a femoral neck fracture and dysregulated inflammatory response treated with delayed hemiarthroplasty (HA) will have lower rates of inpatient mortality than those treated immediately.

Novel Technologies in Periprosthetic Joint Infections: Emerging Therapeutics.

Periprosthetic joint infection (PJI) remains one of the most challenging complications following total joint arthroplasty, contributing to major morbidities, increased health care costs, and high failure rates of conventional treatments. The gold standard for chronic PJI treatment, the two-stage revision, is associated with prolonged hospitalizations, high attrition rates, and variable success rates, necessitating novel approaches to improve patient outcomes. Despite advancements in surgical techniques, infection control methods, and antibiotic therapies, the incidence and success rates of PJI management have remained largely unchanged over the past decades.

The Management of Chronic Periprosthetic Joint Infection: No Longer Is It "One Size Fits All".

Historically, the methods for treating chronic periprosthetic joint infection (PJI) have only encompassed a single option of two-stage exchange. However, our methods for treating chronic PJI have now expanded to include two-stage exchange, one-stage exchange, and the new kid on the block, the 1.5-stage exchange.

Estrogen Replacement Therapy Decreases Associated Risk of Postoperative Venous Thromboemboli and Medical Complications After Total Joint Arthroplasty.

Background: Estrogen replacement therapy (ERT) and total joint arthroplasty (TJA) are prevalent in the geriatric population, with limited evidence for how ERT influences postoperative outcomes. ERT is often held before arthroplasty due to the perceived risk for venous thromboembolism (VTE). Our primary aim was to investigate the relationship between ERT and VTE risk and secondarily to investigate major medical complications following TJA.

Medicare Reimbursement for Primary Hip and Knee Arthroplasty Is Disproportionately Decreasing Relative to Other High-Volume Inpatient Procedures: Leader of the Pack.

Background: Decreasing Medicare surgeon reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA) may limit access to care. The purpose of this study was to examine trends in Medicare reimbursement fees for primary THA and TKA and compare reimbursement to other high-volume nonarthroplasty procedures.

Methods: A nationally representative database was retrospectively queried to identify the most frequently performed inpatient procedures in the United States from 2016 to 2020.

Low-Level Evidence Used to Substantiate Insurance Coverage Policies for Knee and Hip Arthroplasty.

Background: Access to total knee arthroplasty (TKA) or total hip arthroplasty (THA) has become increasingly regulated by health care insurance providers that require specific criteria be met prior to authorizing surgery as medically necessary. The purpose of this study was to examine references from coverage policies and assess whether they justify the presurgery criteria mandated by insurance providers for approval of total joint arthroplasty in patients who have symptomatic knee and hip degenerative disease.

Methods: The largest private commercial insurance providers in the United States were identified, of which nine had publicly accessible coverage policies for TKA and THA.

Increased Incidence of Spin and Reporting Bias on the Use of Hyaluronic Acid for the Treatment of Knee Osteoarthritis: An Evaluation of Systematic Reviews and Meta-Analyses.

Background: The use of hyaluronic acid (HA) for the treatment of knee osteoarthritis holds clinical and financial implications for manufacturers, incentivizing spin, or the misrepresentation of study findings. We sought to identify the incidence of spin in abstracts of systematic reviews and meta-analyses evaluating the efficacy of HA injections used for the treatment of knee osteoarthritis.

Methods: Systematic reviews and meta-analyses reporting on HA for knee osteoarthritis were extracted through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search of Embase, PubMed, and Cochrane databases.

Rivaroxaban Utilization Without Perioperative Tranexamic Acid Is Associated With an Increased Risk of Bleeding Complications Following Total Joint Arthroplasty.

Background: Rivaroxaban provides effective venous thromboembolic prophylaxis, but there are concerns about associated bleeding in total joint arthroplasty (TJA) patients. This study aimed to investigate whether the perioperative administration of tranexamic acid (TXA) in TJA patients receiving rivaroxaban for thromboprophylaxis is associated with a reduced risk of postoperative bleeding complications.

Methods: A healthcare database was utilized to identify all primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) patients between 2015 and 2021.

Emerging Concepts in Periprosthetic Joint Infection Research: Intracellular Organisms.

Despite advances in the treatment of periprosthetic joint infection (PJI), recurrence is a concern for both patients and orthopaedic surgeons. Staphylococcal species are commonly implicated in PJI and are associated with more instances of treatment failure and recalcitrance relative to other organisms. A possible explanation for this is the ability of staphylococci to undergo phenotypic transformation into a quasidormant small colony variant (SCV) phenotype.

Effect of BMI on the risk of postoperative complications following total hip arthroplasty.

Aims: While obesity is associated with an increased risk of complications after total hip arthroplasty (THA), the relationship between BMI and the risk of early postoperative complications has not been fully characterized. This study sought to describe the relationship between BMI and the risk of early postoperative complications, including periprosthetic joint infection (PJI), and composite surgical and composite medical complications.

Methods: Primary, elective THAs performed from 1 October 2015 to 31 December 2021 were identified using the Premier Healthcare Database.

The Rise of Medicare Advantage is Impacting the Fidelity of Traditional Medicare Claims Data: Implications for Reporting of Long-Term Total Knee Arthroplasty Survivorship.

Background: Traditional Medicare (TM) claims data are widely used by researchers and registries to report survivorship following total knee arthroplasty (TKA). The purpose of the present study was to investigate whether the mass exodus of patients from TM to Medicare Advantage (MA) has compromised the fidelity of TM data.

Methods: We identified 11,717 Medicare-eligible patients (15,282 knees) who had undergone primary TKA from 2000 to 2020 at a single institution.

Medicare Reimbursement for Primary and Revision Total Hip and Knee Arthroplasty: An Updated Analysis From 2000 to 2024.

Background: With physician reimbursements for primary and revision total hip (THA) and knee arthroplasty (TKA) remaining central to health care policy and payment reforms, an updated analysis of inflation-adjusted Medicare surgeon fees for these procedures is essential. Examining recent payment trends offers valuable insights for surgeons, payers, and health care policymakers to understand the evolving reimbursement landscape. This study aimed to analyze physician reimbursement trends for THA and TKA from 2000 to 2024.

Dexamethasone Is Associated With Lower Rates of Pulmonary Complications Following Cemented Femoral Fixation During Primary Total Hip Arthroplasty.

Background: The utilization of cemented femoral fixation during total hip arthroplasty (THA) has increased in recent years. Perioperative corticosteroids have been shown to attenuate the inflammatory cascade associated with cement-induced cardiopulmonary complications. Therefore, the purpose of this study was to determine if dexamethasone (DEX) utilization was associated with decreased perioperative pulmonary complications associated with cemented THA.

Stacked Cone Constructs for the Treatment of Extensive Tibial Bone Loss in Revision Total Knee Arthroplasty: A Series of 22 Patients.

Background: Highly porous metaphyseal cones have emerged as a promising fixation strategy to address extensive proximal tibial bone loss in the multiply revised knee. Despite a paucity of literature regarding stacked cone constructs, they have gained popularity. This study reports on the early outcomes of stacked tibial cone constructs that are used during revision total knee arthroplasty (TKA).

Efficacy of a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system in restoring limb length and offset.

Introduction: Optimizing leg length discrepancy (LLD) and restoring global and femoral offset (GO, FO) are integral to improving the stability and longevity of total hip arthroplasty (THA). A novel robotic-assisted THA (RA-THA) platform has been developed to utilize pre-operative templating and intraoperative fluoroscopic imaging to guide the restoration of native biomechanics. We sought to evaluate the effectiveness of this novel, pin-less, fluoroscopy-based RA-THA system to restore templated LLD and offset parameters.

Preoperative Anemia as a Predictor of Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Continuous Variable Analysis.

Background: Preoperative anemia, defined by the World Health Organization as hemoglobin levels below 12.0 g/dL in women and below 13.0 g/dL in men, has been associated with postoperative complications following total knee arthroplasty (TKA).

Albumin as a Predictor of Periprosthetic Joint Infection Following Total Joint Arthroplasty: Identifying a New Data-Driven Threshold Utilizing a Continuous Variable Analysis.

Background: Albumin is a preoperative risk stratification tool for patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, existing literature predominantly evaluates serum albumin levels as a categorical variable using predetermined cut-off values, limiting our ability to identify a data-driven risk threshold. Our study addresses this gap by analyzing albumin as a continuous variable, aiming to establish a more clinically relevant preoperative threshold for identifying patients at increased risk of postoperative complications.

A "1.5-Stage" Spacer Construct Using Revision Components for the Management of Periprosthetic Joint Infection of the Knee.

Background: The two-stage surgical protocols used for the treatment of periprosthetic joint infection following total knee arthroplasty are associated with marked patient morbidity. As such, alternatives, such as durable "1.5-stage" spacer constructs, have gained popularity.

The Limited Utility of Hemoglobin A1c as a Predictor for Periprosthetic Joint Infection Following Total Joint Arthroplasty: A Continuous Variable Analysis.

Background: Patients who have poorly controlled diabetes mellitus are at increased risk of periprosthetic joint infection (PJI). Nevertheless, an optimal preoperative hemoglobin A1c (HbA1c) threshold has not been established. This study sought to identify preoperative HbA1c thresholds that were predictive of adverse outcomes for total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.

Identifying a Reliable Intra-articular Landmark to Avoid Vascular Injury During Transacetabular Screw Fixation: A 3D Computed Tomography Study.

Introduction: Vascular injury during acetabular screw fixation is a life-threatening complication of total hip arthroplasty. This study uses three-dimensional computed tomography to (1) measure absolute distance from the external iliac artery (EIA) to the acetabulum, (2) determine available bone stock along the EIA path, and (3) create a novel acetabular vascular risk map.

Methods: A retrospective radiographic study was conducted using three-dimensional CT.