Disruptive Bleeding and Comorbidity Burden in Total Knee Arthroplasty: Associations with Costs, Lengths of Stay, and Readmissions.

Introduction: Total knee arthroplasty (TKA) is a widely performed procedure for end-stage knee osteoarthritis, with over 1.2 million annual cases projected by 2025. While generally successful, TKA can lead to perioperative complications, including disruptive bleeding or hemorrhagic events requiring medical intervention.

Risk factors for non-union after distal phalangeal fractures of the hand: a nationwide study in the US.

Introduction: This study aims to identify risk factors associated with non-union following distal phalangeal fractures of the hand.

Materials And Methods: This retrospective cohort study utilized the PearlDiver database (2010-2022) to identify adult patients with distal phalangeal fractures and at least one year of follow-up. Patients were categorized into union and nonunion groups using ICD and CPT codes.

Optimal Timing of Bronchoscopy After Total Joint Arthroplasty: Impact on Periprosthetic Joint Infection and Revision Rates.

Background: The possible contribution of bronchoscopy to elevated periprosthetic joint infection (PJI) risks after total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is a critical knowledge gap, despite its widespread use. This study aimed to (1) determine the PJI and revision rates over 30 months following TKA and THA in patients who underwent bronchoscopy within 18 months after surgery and (2) assess the role of the interval between arthroplasty and bronchoscopy in influencing these outcomes.

Methods: In this retrospective study, a large national database that includes data from more than 165 million cases was used to identify patients who had bronchoscopy within 18 months after TJA and patients who had not.

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.

Association Between Total Joint Arthroplasty and Surgical Complications in Patients With Valvular Heart Replacement: An Observational Study.

Background: Valvular heart replacement (VHR) is associated with increased cardiac complications and mortality risk in patients undergoing noncardiac surgery. There are limited data on total joint arthroplasty outcomes in patients with a prior history of VHR.

Methods: In this retrospective cohort study, we identified patients who underwent elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) between 2010 and 2022 using the PearlDiver national database.

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.

A Systematic Review of Randomized Controlled Trials on Contemporary Cementless Total Knee Arthroplasty.

Background: The number of total knee arthroplasties (TKAs) continues to grow, and there is a renewed, growing interest in cementless fixation. The aim of this study was to perform a systematic review of recent randomized controlled trials (RCTs) evaluating contemporary cementless TKA survivorship and patient-reported outcome measures (PROMs).

Methods: A search of PubMed and Embase was performed.

Does Previous Coronary Angiography Influence Complications in Total Joint Arthroplasty, and Should the Surgery Be Postponed?

Background: Cardiovascular diseases are common in total joint arthroplasty (TJA) patients, many of whom undergo coronary angiography (CAG) before total hip (THA) or knee (TKA) arthroplasty. This study evaluated whether a history of CAG increases postoperative complications and how its timing affects outcomes.

Methods: Using a national database, we analyzed patients undergoing THA or TKA between 2012 and 2020.

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.

A Critical Evaluation of Social Determinants of Health in Total Joint Arthroplasty.

The social determinants of health (SDOH) have been found to greatly impact patient health outcomes across medical specialties, including orthopaedic surgery. Despite a recent focus on these impacts, there is currently no clear comprehension of how composite and individual SDOH measures impact outcomes following total joint arthroplasty (TJA). With an increasing demand for TJA, understanding and addressing these factors is necessary to improve patient outcomes and reduce overall healthcare costs.

The Role of Cell Therapies for the Treatment of Osteonecrosis of the Femoral Head.

Background: Osteonecrosis of the femoral head (ONFH) can cause pain, diminished function, and eventual articular collapse, disproportionately impacting younger patients. Core decompression (CD) is used to halt or at least delay postcollapse disease in patients who suffer from ONFH, but it can have variable outcomes. Orthobiologics are cellular therapies, growth factors, and biomaterial substances obtained from human cells and tissue that promote biological healing and have recently gained attention in the treatment of osteonecrosis.

Neighborhood Deprivation and Association With Implant Complications Following Total Joint Arthroplasty: A Nationwide Analysis.

Background: Comprised of 17 census-based markers, the Area Deprivation Index (ADI) is a weighted index of material deprivation within neighborhoods, defined as the lack of basic resources and services. The literature lacks studies on associations of neighborhood deprivation, or aggregate socioeconomic status within neighborhoods, with implant survivorship. The purpose of our study was to assess whether patients who have high ADIs (greater disadvantage) undergoing primary total joint arthroplasties were associated with differences in implant-related complications.

Whole-Exome Sequencing of Total Joint Arthroplasty Patients Who Have Known Pulmonary Embolism: A Pilot Study.

Background: The purpose of this study was to identify genetic mutations in exome sequences of patients who had a history of pulmonary embolism (PE) after total joint arthroplasty (TJA).

Methods: From June 2017 to August 2021, 21 patients who had a history of TJA and subsequent postoperative PE were enrolled in three academic institutions for whole-exome sequencing. Their average age was 64 years (range, 46 to 81), and 15 (71.

The Reverse Peroneus Brevis Flap for Preventing Major Level Amputation in Multimorbid Patients.

Introduction: The use of free tissue transfers has overshadowed the much simpler approach of using simpler local rotation flaps for soft tissue coverage, especially in the foot and ankle. In this study, the authors aimed to examine the results of a single surgeon experience (CB) of the distally based reverse peroneus brevis muscle flap as the first line flap coverage for soft tissue coverage of the foot and ankle in medically high-risk patients who would otherwise require a major amputation.

Methods: All patients underwent Doppler examination only, prior to and intraoperatively prior to elevation of the distally based (reverse) peroneus brevis muscle flap; formal angiography or CT angiogram was not performed.

Return to play and performance metrics following ulnar collateral ligament reconstruction in major league baseball pitchers.

Background: The introduction of ulnar collateral ligament reconstruction (UCLR) (i.e., Tommy John surgery) has revolutionized the management of UCL injury.

Stress fracture risk factors in soccer players: A systematic review.

Background: This study conducted a systematic review to evaluate stress fracture risk factors in soccer players, aiming to enhance injury prevention strategies.

Methods: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, focusing on professional soccer players. Database searches (Medline, Scopus, CENTRAL, Embase, and Web of Science) used predefined terms in November 2024.

No Increased Complications Seen Among Obese Patients After Unicompartmental Knee Arthroplasty at 5-Year Follow-Up.

Background: Body mass index (BMI) cutoffs remain controversial in unicompartmental knee arthroplasty (UKA), as one must balance complication risks and the need for conversion to total knee arthroplasty (TKA). This study aimed to analyze the impact of BMI, stratified by obesity class, on: (1) 90-day and 1- and 2-year postoperative complications; and (2) the 2- and 5-year TKA conversion rates.

Methods: We used a national, all-payer database to identify 4,823 patients who underwent UKA from 2016 to 2022 who had a history of osteoarthritis.

Efficacy of DAIR (Debridement, Antibiotics, and Implant Retention) in Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Introduction: Periprosthetic joint infection (PJI) remains a challenging complication in total joint arthroplasty, often leading to the necessity of revision surgery. The treatment strategy of debridement, antibiotics, and implant retention (DAIR) is widely employed for the management of acute PJI, with variable success rates across studies. We aimed to examine the effectiveness of DAIR in the management of PJI after primary hip and knee arthroplasties.

Osteonecrosis: A More Appropriate Term than Avascular Necrosis-Pathophysiologic Rationale.

Background: Nontraumatic osteonecrosis has historically been attributed to vascular insufficiency, leading to oxygen and nutrient deprivation and subsequent bone death. However, terminology used to describe this condition remains inconsistent and often fails to capture its complex pathogenesis. Terms such as "avascular necrosis" and "ischemic necrosis" may inappropriately emphasize vascular mechanisms, potentially limiting diagnostic and therapeutic approaches.

Evaluation of surgeon demographics and association with postoperative complication rates after total hip arthroplasty at the United States News and World Report top-ranked orthopaedic hospitals.

Introduction: The rankings provided by the U.S. News & World Report (USNWR) are widely consulted to identify leading hospitals.

Condylar-Stabilized Designs in Total Knee Arthroplasty: A Classification System and Review of Outcomes.

Background: Increased use of condylar-stabilized (CS) bearings in primary total knee arthroplasty can be attributed to bony preservation with the option for posterior cruciate ligament resection without compromising kinematics. There are a variety of CS designs, but no system of nomenclature, making comparisons challenging. A comprehensive classification system of differing CS designs based on articular surface and femoral component geometries and kinematic principles is proposed.

Part II: Biologic Augmentation Strategies as Useful Adjuncts in Musculoskeletal Surgery.

Osseous healing after injury, whether by arthritis, osteonecrosis, or fracture, follows a fairly predictable and stepwise order of events. New bone formation requires osteoinductive, osteoconductive, and osteogenetic signals and environments for rapid and complete healing. Biologic augmentation strategies, such as bone marrow aspirate concentrates and other forms of mesenchymal stem cells, have been studied with renewed interest as a way to enhance healing in patients who have osteoarthritis, osteonecrosis, delayed unions, and nonunions.

The impact of surgical approach in total hip arthroplasty on the organisms profile of periprosthetic joint infections? A systematic review and meta-analysis.

Purpose: To investigate the impact of the surgical approach in total hip arthroplasty (THA) on the organism profile associated with periprosthetic joint infections (PJI).

Methods: This systematic review and meta-analysis rigorously followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Four online databases (Medline, Embase, Web of Science, Scopus) were searched from inception till the 2nd of Sep 2023.

Preoperative psychotherapy for primary total hip arthroplasty patients: an evaluation of its modifiability on readmissions and implant complications in patients who have depression.

Introduction: Few studies have evaluated nonpharmacologic interventions, including preoperative psychotherapy, in patients who have depression. We studied whether psychotherapy visits prior to total hip arthroplasty (THA) in patients with depression were associated with lower: (1) readmissions; and (2) implant complications in patients who have depression.

Methods: A nationwide database was queried from 2010 to 2021.