Can I pickle Doc? Return to Pickleball and other Racket Sports after Total Joint Arthroplasty.

Background: Participation in pickleball and other racket sports is growing, particularly among older adults who may also be candidates for joint arthroplasty (JA). Currently, there is limited data on performance, safety, and return to racket sports after JA.

Methods: An online survey was sent to 7,200 patients who had undergone at least one primary JA at a single academic center over the past 10 years (five surgeons).

Analysis of Synovial Fluid Aspirations in Aseptic Loosening and Instability After Total Knee Arthroplasty.

Background: Aseptic total knee arthroplasty (TKA) complications can be challenging to diagnose. Many studies have defined periprosthetic joint infection (PJI) using synovial aspirations, but few studies have described aspiration characteristics in aseptic TKA problems. The aim of this study was to determine the synovial fluid characteristics of patients who had TKA failure caused by two common aseptic diagnoses: aseptic loosening and instability.

Conversational Engagement Using a Short Message Service Chatbot After Total Joint Arthroplasty.

Background: Utilizing conversational analytics in orthopaedic surgery may provide insights into patients' experiences and outcomes. This study retrospectively assessed how patients interacted with a perioperative chatbot and whether the topic of patients' queries could offer insight on their outcomes after total knee or hip arthroplasty.

Methods: We identified 1338 patients (746 knees and 592 hips) who enrolled in a short message service chatbot from 2020-2022 with greater than 3 months of follow-up.

Conversion of Tibial Plateau Fractures to Total Knee Arthroplasty is Associated With Worse Patient-Reported Outcomes, Increased Operative Times, and Increased Complications.

Background: Prior open reduction and internal fixation (ORIF) of tibial plateau fracture (TPF) adds complexity to subsequent total knee arthroplasty (TKA). The purpose of this study was to compare the outcomes of patients undergoing a TKA following prior ORIF of TPF to patients undergoing a primary TKA for osteoarthritis and an aseptic revision TKA.

Methods: There were 52 patients who underwent primary TKA following prior ORIF of TPF between January 2009 and June 2021, who were included and matched in a 1:4 ratio to 208 patients undergoing primary TKA.

Is ultrasound-guided hip aspiration more successful than fluoroscopic-guided aspiration in diagnosing prosthetic joint infection?

: aspiration of total hip arthroplasty (THA) is commonly performed to assist in the diagnosis of prosthetic joint infection (PJI). This study aimed to determine whether fluoroscopic- or ultrasound- guided hip aspiration differs in the ability to acquire synovial fluid and in the accuracy of diagnosing infection. all THA aspirations performed between 2014 and 2021 at our institution were retrospectively identified.

Similar Efficacy and Lower Cost Associated With Ceftazidime Compared to Tobramycin Coupled With Vancomycin in Antibiotic Spacers in the Treatment of Periprosthetic Joint Infection.

Background: Vancomycin and tobramycin have traditionally been used in antibiotic spacers. In 2020, our institution replaced tobramycin with ceftazidime. We hypothesized that the use of ceftazidime/vancomycin (CV) in antibiotic spacers would not lead to an increase in treatment failure compared to tobramycin/vancomycin (TV).

Discharge to a Skilled Nursing Facility After Hip Fracture Results in Higher Rates of Periprosthetic Joint Infection.

Background: Femoral neck fractures (FNFs) in elderly patients are associated with major morbidity and mortality. The influence of postoperative discharge location on recovery and outcomes after arthroplasty for hip fractures is not well understood.

Methods: A multisite retrospective cohort from 9 academic centers identified patients who had FNF treated with hemiarthroplasty or total hip arthroplasty between 2010 and 2019.

Risk Factors for Return to the Emergency Department and Readmission After Same-Day Discharge Total Joint Arthroplasty.

Background: Same-day discharge (SDD) after total joint arthroplasty (TJA) is safe and cost effective. However, benefits may be offset by the potential cost of emergency department (ED) visits and readmissions. We identified risk factors for return to the ED and readmission in patients who underwent SDD and inpatient (IP) stays after TJA.

Decreased Patellar Fractures and Subluxation With Patellar Component Replacement at Stage-One Spacer.

Background: Periprosthetic joint infection is a devastating complication of total knee arthroplasty and is often treated with 2-stage revision. We retrospectively assessed whether replacing the patellar component with articulating stage-one spacers was associated with improved outcomes compared to spacers without patellar component replacement.

Methods: A total of 139 patients from a single academic institution were identified who underwent an articulating stage-one revision total knee arthroplasty and had at least 1-year follow-up.

A "Dry Tap" in Prosthetic Joint Infection Workup of Total Hip Arthroplasty Is Not Reassuring.

Background: Synovial fluid analysis is important in diagnosing prosthetic joint infection (PJI). The rate of culture-positive PJI in patients who have a dry tap of a total hip arthroplasty (THA) is not well described.

Methods: We reviewed all image-guided THA aspirations, performed from 2014 to 2021 at a single academic institution.

Outpatient Total Joint Arthroplasty at a High-Volume Academic Center: An Analysis of Failure to Launch.

Background: Unanticipated failure to discharge home (failure to launch, FTL) following scheduled same-day discharge (SDD) total joint arthroplasty (TJA) is problematic for the surgical facility with respect to staffing, care coordination, and reimbursement concerns. The aim of this study was to review rates, etiologies, and contributing factors for FTL in SDD TJA at an inpatient academic medical center.

Methods: All patients who underwent primary TJA between February 2021 and February 2023 were retrospectively reviewed.

Metallosis and Corrosion Associated With Revision Total Knee Arthroplasties With Metaphyseal Sleeves.

Metallosis and corrosion have been associated with metal-on-metal and modular total hip arthroplasty but are rarely described in the setting of primary or revision total knee arthroplasty (TKA). In this series, we report on cases of metallosis due to mechanically assisted crevice corrosion at modular junctions of machined trunnion-bore tapers in a revision TKA system with metaphyseal sleeves. The unique design of metal modular junctions used in sleeve-based revision TKA, along with potential patient and surgical factors, may predispose these designs to fretting, corrosion, and adverse reaction to metal debris.

Recovery Curve for Patient Reported Outcomes and Objective Physical Activity After Primary Total Knee Arthroplasty-A Multicenter Study Using Wearable Technology.

Background: This study aimed to describe the trajectory of recovery based on patient-reported outcomes (PROs) and objective metrics of physical activity measures over the first 12 months post-total knee arthroplasty (TKA).

Methods: In total, 1,005 participants who underwent a primary unilateral TKA surgery between November 2018 and September 2021 from a multisite prospective study were analyzed. Generalized estimating equations were used to evaluate PROs and objective physical activity measures over time.

Trends in Total Knee Arthroplasty Cementing Technique Among Arthroplasty Surgeons-A Survey of the American Association of Hip and Knee Surgeons Members.

Background: Aseptic loosening persists as one of the leading causes of failure following cemented primary total knee arthroplasty (TKA). Cement technique may impact implant fixation. We hypothesized that there is variability in TKA cement technique among arthroplasty surgeons.

Hip aspiration: A comparison of ultrasound and fluoroscopic guidance.

Introduction: Hip aspirations are commonly performed for diagnostic purposes using either fluoroscopic or ultrasound guidance. The superiority of one type of image guidance over another for aspiration of a native or replaced hip remains a matter of debate. The questions to be evaluated in this study include 1) to determine if hip aspiration using fluoroscopy or ultrasound guidance more often obtains fluid from native and post-arthroplasty hip joints, and 2) to identify patient-related factors associated with the ability to obtain fluid.

Bilateral Erosive Septic Hip Arthritis Following Pregnancy.

We report on a 34-year-old female whose normal spontaneous vaginal delivery was complicated by Group B streptococcus (GBS) colonization. She developed postpartum, bilateral, rapidly destructive septic hip arthritis. She was treated with bilateral articulating, antibiotic-impregnated spacers, 6 weeks of parenteral antibiotics, and subsequent conversion to total hip arthroplasties.

Prospective, Randomized, Surgeon-Blinded Comparison of Standard Magnification Assumption vs Magnification Marker Usage for Preoperative Templating in Total Hip Arthroplasty.

Background: We undertook this prospective, randomized, surgeon-blinded study to compare the accuracy of using of a magnification marker on preoperative radiographs for templating vs using a standard 21% magnification.

Methods: One hundred consecutive total hip arthroplasties were randomized to preoperative templating using a 25-mm magnification marker (50 patients) or a standard 21% magnification (50 patients). Intraoperative data were collected regarding the actual and predicted size of the femoral and acetabular components.

Acetabular Abduction and Dislocations in Direct Anterior vs Posterior Total Hip Arthroplasty: A Retrospective, Matched Cohort Study.

Background: There is purported improvement in component positioning and hip stability with the use of direct anterior approach (DAA) total hip arthroplasty (THA). We sought to determine if there is a difference in acetabular component position or dislocation frequency between DAA and posterior THA.

Methods: One arthroplasty fellowship-trained surgeon introduced DAA THA into his practice.

Inaccuracies in the Use of Magnification Markers in Digital Hip Radiographs.

Background: With the ubiquity of digital radiographs, the use of digital templating for arthroplasty has become commonplace. Although improved accuracy with digital radiographs and magnification markers is assumed, it has not been shown.

Questions/purposes: We wanted to (1) evaluate the accuracy of magnification markers in estimating the magnification of the true hip and (2) determine if the use of magnification markers improves on older techniques of assuming a magnification of 20% for all patients.

Modular Versus Nonmodular Femoral Necks for Primary Total Hip Arthroplasty.

In total hip arthroplasty (THA), proximal femoral neck stem modularity (PFNSM) has theoretical advantages over nonmodular stems, including the ability to more closely reconstruct anatomy and improve stability. However, risks of metallosis and breakage at the junction must be considered. In this study, we compared the head centers of a modular neck system with that of its nonmodular counterpart.

Cost comparison of cementless versus cemented hemiarthroplasty for displaced femoral neck fractures.

Hip hemiarthroplasties are frequently performed for displaced femoral neck fractures. The purpose of this study was to identify the costs associated with cementless and cemented hemiarthroplasties, compare operative times, and identify complications. The hypothesis was that cementless hemiarthroplasties cost less than cemented hemiarthroplasties, require less operative time, and have fewer perioperative complications.

Lessons learned from managing a prospective, private practice joint replacement registry: a 25-year experience.

Background: In 1984, we developed a private practice joint replacement registry (JRR) to prospectively follow patients undergoing THA and TKA to assess clinical and radiographic outcomes, complications, and implant survival. Little has been reported in the literature regarding management of this type of database, and it is unclear whether and how the information can be useful for addressing longer-term questions.

Questions/purposes: We answered the following questions: (1) What is the rate of followup for THA and TKA in our JRR? (2) What factors affect followup? (3) How successful is this JRR model in capturing data and what areas of improvement are identified? And (4) what costs are associated with maintaining this JRR?

Methods: We collected clinical data on all 12,047 patients having primary THA and TKA since 1984.

Total hip arthroplasty after failed internal fixation of proximal femoral fractures.

Between February 1987 and October 2008, we performed 102 total hip arthroplasties (THAs) after failed internal fixation of a prior hip fracture. There were 39 intertrochanteric fractures and 63 femoral neck fractures. Etiology of failure included 35 cases of osteonecrosis, 32 cases of arthritis, 25 cases of early failure of fixation, and 10 cases of nonunion.