Is Semaglutide a Safer Weight-Management Option Than Bariatric Surgery for Patients Undergoing Total Hip Arthroplasty?

Background: Weight management strategies before total hip arthroplasty (THA) include bariatric surgery and GLP-1 receptor agonists (GLP-1 RAs), including semaglutide. Previous studies have reported higher THA implant failure in patients who had prior bariatric surgery. This study aimed to evaluate semaglutide as a weight management alternative for patients undergoing THA and any effects on perioperative outcomes.

Can Preoperative Patient-Reported Outcome Measures Predict Clinical Outcomes following Total Knee Arthroplasty?

Introduction: The Centers for Medicare and Medicaid Services now mandates the collection of patient-reported outcome measures (PROMs) before and after total knee arthroplasty (TKA), though their utility in predicting clinical outcomes remains unclear. This study compared the power of preoperative PROMs to predict clinical outcomes after TKA to established indices, including the Charlson Comorbidity Index (CCI) and the Risk Assessment and Prediction Tool (RAPT).

Methods: We retrospectively reviewed 2,923 patients undergoing elective, primary, unilateral TKA who completed the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) and four Patient-Reported Outcomes Measurement Information System (PROMIS®) domains within 90 days preoperatively.

Does vasopressor administration in the ICU affect outcomes following primary total joint arthroplasty?

Introduction: The subset of patients admitted to the intensive care unit (ICU) following total joint arthroplasty (TJA) has yet to be studied in detail. Specifically, there is little data on the effects of vasopressor administration in patients who require critical care after TJA. We sought to characterize patient outcomes and mortality by vasopressor administration in the ICU following primary TJA.

The sustained benefits of gram-negative antimicrobial prophylaxis in total hip arthroplasty: a 10-year retrospective analysis.

Background: 10 years after changing our institution's total hip arthroplasty (THA) preoperative antibiotic prophylactic protocol by adding gram-negative (GN) coverage, this study aimed to assess the impact of adding GN specific coverage (GNSC) prior to THA on periprosthetic joint infection (PJI) rates.

Methods: This was a retrospective case-control study of 14,598 patients who underwent primary, elective THA between July 2012 and January 2022, with minimum 1-year follow-up. All patients were under perioperative antibiotic protocol that included GNSC with either weight-based gentamicin or aztreonam (+GNSC) and were compared to a historical control group of patients for which the antibiotic prophylactic protocol did not include GNSC (-GNSC).

High-volume revision surgeons are more cost-effective following revision total hip and knee arthroplasty.

Background: With the increased rates of revision total hip (rTHA) and total knee arthroplasty (rTKA), the financial burden of these procedures is at risk of straining the healthcare system. Our study sought to create a model to evaluate the cost-effectiveness of rTKA and rTHA performed by high-volume (HV) and low-volume (LV) surgeons.

Methods: The database of rTKA and rTHA from April 2018 to March 2021 at our academic institution was retrospectively reviewed.

Do Differences in Patient-Reported Outcome Measures for Robot-Assisted and Navigated Unicompartmental Knee Replacement Achieve Minimal Clinically Important Differences?

Introduction: Technology is increasingly incorporated into unicompartmental knee arthroplasty (UKA) through computer-assisted navigation (N-UKA) and robot-assisted surgery (R-UKA) to improve alignment, implant positioning, and gap balancing. Whether intraoperative technology helps achieve the minimal clinically important difference (MCID) in patient-reported outcomes (PROMs) compared to conventional UKA (C-UKA) remains unclear. This systematic review aimed to assess whether differences in PROMs between C-UKA and technology-assisted UKA reached MCID values.

High volume total hip arthroplasty surgeons have improved perioperative outcomes and short-term cumulative revision rates.

Background: The relationship between total hip arthroplasty (THA) surgeon volume and outcomes is informative in this era of health care value optimisation. The purpose of this study was to evaluate outcomes based on modern-day surgeon practice volumes.

Methods: The SPARCS database was queried for patients undergoing primary THA from 2010 to 2020.

What Sports Are Safe Following Total Joint Arthroplasty? An Analysis of Revision Rates at a Mean 5-year Follow-Up.

Background: Despite theoretical risks of fatigue wear, there is little empirical evidence correlating postoperative impact level from physical activity with failure rates following total hip and knee arthroplasty (THA and TKA). This study aimed to assess the relationship between the impact level from self-reported sports and physical activity participation and revision rates following primary arthroplasty.

Methods: A survey was conducted on recreational sports participation among primary elective THA and TKA patients from an urban, academic health system between June 1, 2011, and January 31, 2022.

Growth Mixture Modeling of Patient-reported Outcomes After Total Knee Arthroplasty: No Recovery Trajectory Shows Postoperative Decline or Stagnation.

Background: Recovery after total knee arthroplasty (TKA) shows considerable variability in both pain relief and functional improvement. The Knee Injury and Osteoarthritis Outcome Score (KOOS-JR) is a widely used measure for evaluating these outcomes. This study aimed to identify distinct latent recovery trajectories, which represent underlying, unobserved patterns of postoperative recovery inferred from KOOS-JR scores, and to explore patient characteristics associated with these trajectories.

Does Physical Job Intensity Affect Return to Work and Satisfaction Rates Following Primary Total Hip Arthroplasty?

Background: Patients' satisfaction and job limitations after primary total hip arthroplasty (THA) based on occupation intensity have not been evaluated. This study aimed to assess patients' ability and satisfaction with their return to work following primary THA depending on intensity of their occupation.

Methods: This retrospective review surveyed patients undergoing primary THA between June 2011 and January 2022, with at least one year of follow-up, on return to work rates.

C-Reactive Protein Combination Ratios Outperform the Albumin-Globulin Ratio in Diagnosing Periprosthetic Joint Infection After Total Knee Arthroplasty.

Introduction: Obtaining an accurate preoperative diagnosis of periprosthetic joint infections (PJI) is challenging, making differentiating between septic and aseptic failures difficult. We sought to identify the value of common serum biomarkers and evaluate the accuracy of three ratios in the diagnosis of PJI after primary total knee arthroplasty (TKA): albumin-globulin ratio (AGR), C-reactive protein-albumin ratio (CAR), and C-reactive protein-AGR ratio (CAGR).

Methods: Patients undergoing PJI and aseptic revisions after TKA between 2011 and 2021 were retrospectively reviewed at a single institution.

Compensatory changes in lower limb alignment following total knee arthroplasty: large valgus knee correction (≥ 10°) demonstrates substantial alterations in ankle and subtalar joint alignment.

Introduction: Total knee arthroplasty can substantially affect global lower limb alignment. However, its specific impacts on ankle and subtalar joint alignment remain poorly understood. This study investigates changes in ankle and subtalar alignment following varying degrees of varus/valgus knee correction in order to further our understanding of this association.

Incidence of PJI in Total Knee Arthroplasty Patients Following Expanded Gram-Negative Antibiotic Prophylactic Protocol.

The efficacy of "Expanded Gram-Negative Antimicrobial Prophylaxis" (EGNAP) in preventing postoperative infections has been previously reported in total hip arthroplasty (THA). However, it remains unclear as to whether these benefits extend to total knee arthroplasty (TKA). This study investigated whether adding EGNAP to our institution's preoperative antibiotic prophylaxis protocol would affect periprosthetic joint infection (PJI) risk in TKA patients.

Total Hip Arthroplasty in Challenging Settings: Acetabular Fractures, Adolescents, Conversions, and Developmental Dysplasia of the Hip.

Background: Total hip arthroplasty (THA) is one of the most common and successful procedures for the treatment of end-stage hip arthritis. However, in certain complex scenarios, THA can present important and unique challenges, specifically following acetabular fractures in adolescent patients, following failed fixation of proximal femoral fractures, and in developmental dysplasia of the hip. As these cases involve distorted anatomy, poor bone quality, retained hardware, and previous surgeries, detailed planning, specialized instrumentation and implants, and novel surgical techniques are required.

Clinical and patient-reported outcomes of a novel robotic system in total knee arthroplasty.

Background: Robotic assistance (RA) is increasingly used in total knee arthroplasty (TKA) for more accurate bony resection and balancing. However, the impact of robotic TKA (RATKA) on clinical outcomes and patient-reported measures (PROMs) remains unclear. This study aims to compare RATKA and conventional TKA (CTKA) using a novel robotic system.

Does Melatonin Improve Sleep Following Primary Total Hip Arthroplasty? A Randomized, Double-Blind, Placebo-Controlled Trial.

Background: Sleep impairment following total hip arthroplasty (THA) is common and may decrease patient satisfaction and early recovery. Standardized postoperative recommendations for sleep disturbance (SD) have not been established. We aimed to assess whether melatonin use improves sleep quality and quantity in the acute period following THA.

Serum Metal Ion Levels in Modular Dual Mobility Liners After Total Hip Arthroplasty: A Comparison by Years and Implant Manufacturers.

Background: Modular dual-mobility (DM) liners are commonly used in total hip arthroplasty (THA) to decrease the risk of instability. However, there are concerns about accelerated wear, corrosion, and metal ion release in modular DM constructs. This study aimed to investigate serum metal ion levels over time after THA and evaluate any differences between implant manufacturers.

The Three-Month Wound Complication and Infection Rates After Vancomycin Powder and Dilute Povidone-Iodine Lavage for Infection Prophylaxis in High-Risk Total Joint Arthroplasty: A Multicenter Randomized Controlled Trial.

Background: Periprosthetic joint infection (PJI) is a high-cost and extremely morbid complication following total joint arthroplasty; thus, developing a better understanding of perioperative infection prevention strategies is prudent. Literature is mixed regarding the efficacy of vancomycin powder and dilute povidone-iodine lavage, and limited on the combination thereof. To our knowledge, no prospective orthopedic clinical trials to date have evaluated the efficacy of local vancomycin powder, dilute povidone-iodine lavage, or a combination vancomycin-povidone-iodine protocol against normal saline irrigation.

Impact of Spacer Constraint on Outcomes in Two-Stage Exchange Revision Total Knee Arthroplasty.

Background: A two-stage revision has long been the gold standard for chronic periprosthetic joint infections, with real-component articulating spacers becoming overwhelmingly popular. Although several studies have evaluated the success of these spacers in revision total knee arthroplasty, to our knowledge, this is the first to specifically compare outcomes of spacers stratified by the level of liner constraint.

Methods: This retrospective analysis reviewed 135 patients who were indicated for two-stage revision total knee arthroplasty due to periprosthetic joint infections between 2011 and 2023 at a single specialty urban academic institution.

The James A. Rand Young Investigator's Award: What Is the Safest and Most Effective Dose of Intravenous Dexamethasone in Total Knee Arthroplasty? A Multicenter Randomized Controlled Trial.

Background: The purpose of this multicenter, double-blinded, prospective, randomized controlled trial was to determine the safest and most effective dose of intravenous (IV) dexamethasone administered during primary total knee arthroplasty (TKA).

Methods: There were 404 patients undergoing inpatient primary TKA randomized across 11 centers to receive four (n = 138), eight (n = 137), or 16 mg (n = 129) of IV dexamethasone intraoperatively. All sites utilized the same perioperative multimodal protocol.

Patient Characteristics Associated With Loss to Follow-Up After Total Joint Arthroplasty.

Background: Maintaining follow up after total joint arthroplasty (TJA) is critical to monitor patient outcomes and complications. However, patient factors associated with follow-up compliance have not been described previously. This study aimed to characterize demographic and perioperative characteristics associated with TJA follow-up compliance.

Matching the other side at staged bilateral total hip arthroplasty : investigating radiological variations in staged bilateral total hip arthroplasty.

Aims: The aim of this study was to assess the variations in the positioning of components between sides in patients who underwent staged bilateral total hip arthroplasty (THA), and whether these variations affected patient-reported outcome measures (PROMs).

Methods: A retrospective review included 207 patients who underwent staged bilateral THA between June 2017 and November 2022. Leg length, the height and anteversion of the acetabular component, and the coronal and sagittal angles of the femoral component were assessed radiologically and compared with the contralateral THA.

What effect does a perioperative aspiration event have on total joint arthroplasty outcomes?

Introduction: Previous studies have identified perioperative gastric aspiration events as a contributor to varying outcomes following orthopedic trauma patients. However, current literature does not report on the effect an aspiration event has on outcomes for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), nor do current studies identify risk factors for perioperative aspiration events.

Materials And Methods: We retrospectively reviewed patients who underwent primary, unilateral total joint arthroplasty (TJA) from May 2011 to December 2021.

Does the Degree of Liner Constraint Increase Risk of Complications in Articulating Spacers in Two-stage Revision After THA?

Background: Two-stage revisions for chronic periprosthetic joint infections (PJIs) often include antibiotic-loaded cement spacers to control for infection and preserve function. While studies have reported on complications (dislocations, readmissions, and reoperations) after static versus articulating spacer types, there is a paucity of evidence about whether the degree of spacer constraint in articulating spacers affects these complications. This study aims to address a key gap in understanding as to whether the level of spacer constraint affects complications in two-stage revision THA utilizing articulating spacers.

Canal fill and radiographic comparison analysis of novel fully hydroxyapatite coated, variable triple-tapered geometry stems: one-year follow-up after direct anterior approach total hip arthroplasty.

Background: Optimal femoral stem alignment and femoral canal fill have been associated with improved osteointegration in patients undergoing cementless total hip arthroplasty (THA). Direct anterior approach (DAA) has become more popular among new surgeons, and the ability to achieve appropriate stem alignment and canal fill due to limited surgical exposure may pose added risks. To mitigate these concerns, several modern tissue sparing stem designs have been designed.