Post-operative anticoagulation therapy after knee or hip replacement: The role of patients' preferences in selection of therapy.

Objectives: Patients who receive hip or knee replacement surgery should be anticoagulated to prevent thrombosis-related events, such as pulmonary embolism. The Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER) is a large pragmatic trial studying which anticoagulant (aspirin, warfarin, or rivaroxaban) is optimal. As an adjunct to this study, we examined the role of patients' preferences in individual tailoring of therapy.

Preclinical validation of TGFβ inhibitors as a novel therapeutic strategy for post-traumatic heterotopic ossification.

Heterotopic ossification (HO) is characterized by the abnormal growth of ectopic bone in non-skeletal soft tissues through a fibrotic pathway and is a frequent complication in a wide variety of musculoskeletal injuries. We have previously demonstrated that TGFβ levels are elevated in the soft tissues following extremity injuries. Since TGFβ mediates the initial inflammatory and wound-healing response in the traumatized muscle bed, we hypothesized that targeted inhibition of the TGFβ pathway may be able to abrogate the unbalanced fibrotic phenotype and bone-forming response observed in post-traumatic HO.

AOA Critical Issues Symposium: Current Opinion in Orthopaedics: Orthopaedic Physician Leadership in the Evolving Academic Health-Care System.

Orthopaedic surgeons are called upon to lead in numerous clinical settings, but the importance of physician leadership is also relevant to administrative roles. As the complexity of health care has increased, the challenges confronting the orthopaedic physician leader have increased as well. During the past century, there has been a substantial increase in the number of non-physician CEO leaders, and this is particularly critical in the academic health system, for which investment in the research and education missions is heavily dependent upon the clinical enterprise.

Discharge to Post-Acute Care Facility After Total Knee Arthroplasty Is Associated With Worse Mental Health Outcomes.

Background: Discharging total knee arthroplasty (TKA) patients to post-acute care facilities remains a common practice, particularly in elderly patients who have major comorbidities. Efforts have been made to limit discharge to these facilities to avoid increased health care costs and potentially improve outcomes. The aim of this study was to compare patient-reported outcomes (PROs) of TKA patients discharging to a facility versus home.

Failed Thumb Basal Joint Arthroplasty: An Analysis of Common Etiologies Leading to Reoperation.

Purpose: Hand osteoarthritis contributes considerably to functional disability, and the basal joint is the most common site treated surgically. Procedure choice is largely based on surgeon preference, and causes of primary basal joint arthroplasty failure and prevalence of revision are poorly defined. We seek to understand the etiologies of revision basal joint surgery.

Keepers of the Academic Mission: Calling All Faculty.

Academic medical centers expand their patient care mission through mergers often with nonacademic health care organizations to create more clinical revenue and a larger financial margin with the intent of cross-subsidizing the academic mission. Ironically, an unintended consequence of governance changes implicit in such mergers is the marginalization of the academic mission. Historically, the education and research missions have been effectively cross-subsidized by the medical school dean from the margin derived from the faculty clinical practice plan.

Distinctive Polyethylene Damage in Rotating-Platform Total Knee Arthroplasty: A Comparative Retrieval Study in Patients Revised With Clinical Instability.

Background: Biomechanical studies suggest mobile-bearing rotating-platform total knee arthroplasty (TKA-RP) has limited tolerance of asymmetric flexion gaps, and improper balancing may result in polyethylene insert instability. We sought to identify a distinctive pattern of polyethylene insert damage associated with clinical failure of TKA-RP.

Methods: There were nine patients who had an index TKA-RP and underwent a revision for symptomatic flexion instability (clinical cohort) from 2013 to 2019.

The impact of a patient advisory board on a clinical comparative effectiveness trial: a comparison of patient and researcher perspectives.

To examine contributions of a patient advisory board (PAB) to the design and conduct of The Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER) Trial (NCT02810704) and compare perceptions of PAB members and researchers on the Trial. This evaluation of the PAB was conducted by Clinical Coordinating Center (CCC) members who first discussed PAB contributions, leading to the design of a semi-structured WebEx interview individually querying PAB members on their experience. Two study team members analyzed transcriptions of the interviews for common themes, which were discussed and affirmed at an in-person meeting with PAB members.

Shared Decision-Making in Total Hip and Knee Arthroplasty: Understanding Surgeon and Patient Perspectives Regarding When It Is Time for Surgery.

Background: Although total hip and total knee arthroplasty are highly successful operations, the decision of whether and when to undergo surgery is highly subjective and discretionary, and specific guidelines regarding readiness for surgery remain elusive. The nature of these decisions underscores the importance of shared decision-making, which is founded on the concept that patients substantially contribute to determining their own readiness for surgery. The OPTION survey was developed as a conversation aid to facilitate shared decision-making in the context of total joint arthroplasty.

Morphological and Mechanical Property Differences in Trapeziometacarpal Ligaments of Healthy and Osteoarthritic Female Joints.

Purpose: To identify changes in morphological and mechanical properties in the volar ligament complex (VLC), dorsoradial ligaments (DRL), and posterior oblique ligaments (POL) in healthy and osteoarthritic female trapeziometacarpal (TMC) joints.

Methods: Twenty-four fresh-frozen female cadaveric TMCs were separated into (1) younger healthy/early-stage osteoarthritic, (2) elder healthy/early-stage osteoarthritic, and (3) advanced-stage osteoarthritic groups based on age and Eaton-Littler grading. Stress relaxation and load-to-failure testing were performed to characterize mechanical tensile properties.

Substantial Improvement in Self-Reported Mental Health Following Total Hip Arthroplasty Occurs Independent of Anesthetic Technique.

Background: The influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia (GA) on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia (NA) would provide favorable mental health profiles compared with GA after THA.

Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.

Background: Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using multicentered data,, we compared baseline and early post-operative global and condition-specific PROs between patients undergoing cemented versus cementless TKA.

Methods: With PROs prospectively collected through Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial (ClinicalTrials.

Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol.

Introduction: More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%-0.5% fatal PE, and over 1000 deaths.

Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency: Competency-Based Medical Education and Simulation.

➤: Orthopaedic education should produce surgeons who are competent to function independently and can obtain and maintain board certification.

➤: Contemporary orthopaedic training programs exist within a fixed 5-year time frame, which may not be a perfect match for each trainee.

➤: Most modern orthopaedic residencies have not yet fully adopted objective, proficiency-based, surgical skill training methods despite nearly 2 decades of evidence supporting the use of this methodology.

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.

Functional Flexion Instability After Rotating-Platform Total Knee Arthroplasty.

Background: We sought to define "at risk" loading conditions associated with rotating-platform total knee arthroplasty (TKA-RP) implants that predispose to insert subluxation and spinout and to quantify tolerances for flexion-extension gap asymmetry and laxity in order to prevent these adverse events.

Methods: Biomechanical testing was performed on 6 fresh-frozen cadaveric limbs with a TKA-RP implant with use of a gap-balancing technique, followed by sequential femoral component revision with variable-thickness polyethylene inserts to systematically represent 5 flexion-extension mismatch and asymmetry conditions. Each configuration was subjected to mechanical loading at 0°, 30°, and 60°.

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.

The Effects of Bundled Payment Programs for Hip and Knee Arthroplasty on Patient-Reported Outcomes.

Background: Patient-reported outcomes are essential to demonstrate the value of hip and knee arthroplasty, a common target for payment reforms. We compare patient-reported global and condition-specific outcomes after hip and knee arthroplasty based on hospital participation in Medicare's bundled payment programs.

Methods: We performed a prospective observational study using the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement trial.