The Fate of the Inconclusive Periprosthetic Joint Infection Workup and Reliability of Data Points.

In 2018, periprosthetic joint infection (PJI) criteria were revised to include a new category labeled "inconclusive." The purpose of this study was to characterize and describe the fate of the inconclusive PJI workup and to analyze preoperative factors associated with outcomes. We reviewed all PJI workups at our institution during a 3-year period (426 patients).

What are the 2-year survivorship outcomes of custom hemipelvis reconstruction after hemipelvectomy and revision arthroplasty? The evolution of a custom ilium "monoflange".

Background: Innovations in machined and three-dimensionally (3D) printed implant technology have allowed for customized complex pelvic reconstructions. We sought to determine the survivorship of custom hemipelvis reconstruction using ilium-only fixation at a minimum 2-year follow-up, their modes of failure, and the postoperative complications resulting from the procedure.

Methods: A retrospective review identified 12 consecutive patients treated with custom hemipelvis reconstruction.

Abnormal Spinopelvic Motion and Spine Deformity are Associated With Native Femoral Retroversion in the Setting of Total Hip Arthroplasty.

Background: The effect of spinopelvic pathology on femoral version is unclear. This study investigated variability in native femoral anteversion in patients undergoing total hip arthroplasty (THA) and its relationship to the patient's underlying spinopelvic pattern.

Methods: A retrospective chart review was performed to include in the study all patients undergoing robot-assisted THA over a 3-year period.

Robotic-Assisted Total Knee Arthroplasty Allows for Trainee Involvement and Teaching Without Lengthening Operative Time.

Background: Robot-assisted total knee arthroplasty (RA-TKA) is more accurate than mechanical total knee arthroplasty (M-TKA) and can provide real-time feedback about alignment and soft-tissue balancing that may be helpful in trainee education. However, both robotic-assist and trainee involvement potentially increase the surgical time. This study sought to evaluate whether RA-TKA procedures were longer than M-TKA procedures and whether trainee participation added additional surgical time.

Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model.

Background: Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment of acute PJI, whether postoperatively or with late hematogenous seeding. There are two broad DAIR strategies: single debridement and planned double debridement.

A Contemporary Classification System of Femoral Bone Loss in Revision Total Hip Arthroplasty.

Background: Current femoral bone loss classification systems in revision total hip arthroplasty were created at a time when the predominant reconstructive methods used cylindrical porous-coated cobalt-chrome stems. As these stems have largely been replaced by fluted-tapered titanium stems, the ability of these classification systems to help guide implant selection is limited. The purpose of this study was to describe a novel classification system based on contemporary reconstructive techniques.

What Is The Value Of A Star When Choosing A Provider For Total Joint Replacement? A Discrete Choice Experiment.

The past decade witnessed a rapid rise in the public reporting of surgeon- and hospital-specific quality-of-care measures. However, patients' interpretations of star ratings and their importance relative to other considerations (for example, cost, distance traveled) are poorly understood. We conducted a discrete choice experiment in an outpatient setting (an academic joint arthroplasty practice) to study trade-offs that patients are willing to make in choosing a provider for a hypothetical total joint arthroplasty.

The July Effect for Total Joint Arthroplasty Procedures.

The "July effect" refers to the assumed increased risk of complications during the months when medical school graduates transition to residency programs. The actual existence of a July effect is controversial. With this study, the authors sought to determine whether evidence exists for the presence of a July effect among total joint arthroplasty (TJA) procedures.

Hip Disarticulation for Periprosthetic Joint Infection: Frequency, Outcome, and Risk Factors.

Background: Currently, the largest available series of hip disarticulation (HD) procedures performed for periprosthetic joint infection (PJI) includes only 6 patients. Given the lack of data on this dreadful outcome, we sought to determine the frequency of and risk factors for HD performed for a primary diagnosis of PJI.

Methods: The National Inpatient Sample from 1998 to 2016 was used to estimate the annual incidences of HD associated with PJI, elective primary total joint arthroplasty (control group 1), and other surgical procedures associated with PJI (control group 2) using National Inpatient Sample trend weights.

Can a Convolutional Neural Network Classify Knee Osteoarthritis on Plain Radiographs as Accurately as Fellowship-Trained Knee Arthroplasty Surgeons?

Background: Osteoarthritis (OA) is the leading cause of disability among adults in the United States. As the diagnosis is based on the accurate interpretation of knee radiographs, use of a convolutional neural network (CNN) to grade OA severity has the potential to significantly reduce variability.

Methods: Knee radiographs from consecutive patients presenting to a large academic arthroplasty practice were obtained retrospectively.

Why Do Patients Stay Longer Than Three Nights Following Hip and Knee Arthroplasty?

Background: Prolonged length of stay (PLOS) is frequently cited by secondary data studies as an adverse outcome following hip and knee arthroplasty. Although perhaps indisputable that PLOS increases the cost of hospitalization, it is unknown whether it is an appropriate measure of the quality of an arthroplasty procedure.

Methods: We searched our institution's database for all hip and knee arthroplasty procedures over a 5-year period using MS-DRG (Medicare Severity-Diagnosis Related Group) 469 and 470.

Is There an Optimal Cutoff for Aspiration Fluid Volume in the Diagnosis of Periprosthetic Joint Infection?

Background: The diagnosis of periprosthetic joint infection is often challenging in the setting of low aspiration volumes, or in the presence of infection with a slow-growing organism. We sought to determine if an optimal threshold of aspiration fluid volume exists when cultures from the preoperative aspiration are compared to intraoperative cultures.

Methods: All revision total hip and knee arthroplasty procedures over 5 years at our institution were reviewed.

Aversion to Total Joint Arthroplasty: Functional Scores Predict Patient Preferences.

Many patients who may benefit from total hip arthroplasty and total knee arthroplasty prefer to avoid surgery. Reasons for avoidance may include, but are not limited to, experience or dissatisfaction with prior treatment, living status, and symptom severity. Taking these variables into account, the authors sought to determine whether preoperatively collected functional scores would predict an aversion to total joint arthroplasty.

Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014.

Unlabelled: Opioids are routinely prescribed to manage acute postoperative pain, but changes in postoperative opioid prescribing associated with the marketing of long-acting opioids such as OxyContin have not been described in the surgical cohort.

Methods: Using a large commercial claims data set, we studied postoperative opioid prescribing after selected common surgical procedures between 1994 and 2014. For each procedure and year, we calculated the mean postoperative morphine milligram equivalents (MME) filled on the index prescription and assessed the proportion of patients who filled a high-dose prescription (≥350 MME).

Frequency, Cost, and Clinical Significance of Incidental Findings on Preoperative Planning Images for Computer-Assisted Total Joint Arthroplasty.

Background: The frequency of incidental findings with computer-assisted total joint arthroplasty (CA TJA) preoperative imaging and their clinical significance are currently unknown.

Methods: We reviewed 573 patients who underwent primary CA TJA requiring planning imaging. Incidental findings were defined as reported findings excluding those related to the planned arthroplasty.

The Clinical and Financial Consequences of the Centers for Medicare and Medicaid Services' Two-Midnight Rule in Total Joint Arthroplasty.

Background: To lessen the financial burden of total joint arthroplasty (TJA) and encourage shorter hospital stays, the Centers for Medicare and Medicaid Services (CMS) recently removed TKA from the inpatient-only list. This policy change now requires providers and institutions to apply the two-midnight rule (TMR) to short-stay (1-midnight) inpatient hospitalizations (SSIH).

Methods: The National Inpatient Sample from 2012 through 2016 was used to analyze trends in length of stay following elective TJA.

A novel technique for retrieval of a broken biopsy needle.

A broken needle is a rare complication of bone biopsy. We describe an easily applied technique of retrieval of a retained biopsy needle fragment using a cannulated drill typically used for internal fixation of femoral neck fractures. This approach allows for removal under moderate conscious sedation and can be performed by a radiologist using fluoroscopic or CT-fluoroscopic guidance in the radiology suite.

Characterizing extremely negative reviews of total joint arthroplasty practices and surgeons on yelp.com.

Background: Although physicians tend to prefer data-driven quality metrics, emerging evidence suggests that patients prefer crowd-sourced information containing patient narrative descriptions of the care experience. Currently, yelp.com is the most commonly accessed Web resource among patients who use online information to choose a surgeon.

Heads-up Cataract Surgery: Complication Rates, Surgical Duration, and Comparison With Traditional Microscopes.

Purpose: To compare the complication rates and surgical duration between a three-dimensional visualization system (heads-up surgery) and traditional binocular microscope in cataract surgery.

Methods: This retrospective case series included 2,320 eyes that received cataract surgery using either a three-dimensional display system (n = 1,673 eyes) (3D group) or a traditional binocular microscope (n = 647 eyes) (traditional group). The medical records of consecutive patients who underwent cataract surgery by a single surgeon in The Eye Institute of West Florida from August 2016 to July 2017 using either a three-dimensional display system or the traditional binocular microscope for visualization were reviewed.

Two-Stage Debridement With Prosthesis Retention for Acute Periprosthetic Joint Infections.

Background: Historically, infection control rates with debridement and component retention have been poor in the management of acute prosthetic joint infections. We previously described a 2-stage debridement with prosthesis retention protocol for acute periprosthetic joint infection and reported a 90% success rate in a sample of 20 patients.

Methods: A retrospective review of 83 patients who underwent a 2-stage debridement with implant retention with a minimum 1-year follow-up was performed.