A qualitative analysis of the use of intraoperative acupuncture for patients with nosocomephobia.

Background: Nosocomephobia, a type of posttraumatic stress disorder (PTSD), is a diagnosis of an extreme fear of hospitals that can hinder current/future medical care. There is little research on how nosocomephobia affects elective surgery or how acupuncture can help patients cope.

Methods: Using the transactional model of stress/coping, this qualitative case study examined the role of acupuncture in nosocomephobia patients' elective surgery appraisal processes.

Excellent 2-Year Outcomes of a Midlevel Constrained Liner Used in Stemless Primary TKA.

Introduction: Instability after total knee arthroplasty (TKA) remains a leading cause of revision TKA and can lead to patient dissatisfaction. While many companies have developed midlevel constrained (MLC) polyethylene inserts in primary TKAs, there is little data on their outcomes.

Purpose: We sought to analyze short-term outcomes including survivorship, rates of manipulation under anesthesia (MUA), and improvements in patient-reported outcome measures (PROMs) preoperatively to postoperatively in one design of MLC TKA.

Avoiding complications in medial unicompartmental knee arthroplasty.

Medial unicompartmental knee arthroplasty (mUKA) is a highly effective treatment for the management of isolated osteoarthritis in the medial compartment. While favorable long-term survivorship is seen in most series, the long-term rate of revision after mUKAs remains higher than that for total knee arthroplasty. Poor indications and poor surgical technique are often responsible for mUKA failure.

Cementless Versus Cemented Total Knee Arthroplasty of the Same Design: Shorter Operative Times and Minimal Differences in Early Outcomes.

Modern primary cementless total knee arthroplasty (TKA) is increasingly popular, but there is limited evidence on its benefits, early complications, and failures. : We sought to evaluate operative time, early survivorship, and outcomes of cementless versus cemented TKA of the same design. : As part of this single-center, multisurgeon, retrospective cohort study, we reviewed 598 primary, unilateral TKAs (170 cementless, 428 cemented) of the same design from 2016 to 2018.

Functional assessment in patients undergoing total hip arthroplasty.

Aims: Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient's functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA.

AI-Generated Graduate Medical Education Content for Total Joint Arthroplasty: Comparing ChatGPT Against Orthopaedic Fellows.

Background: Artificial intelligence (AI) in medicine has primarily focused on diagnosing and treating diseases and assisting in the development of academic scholarly work. This study aimed to evaluate a new use of AI in orthopaedics: content generation for professional medical education. Quality, accuracy, and time were compared between content created by ChatGPT and orthopaedic surgery clinical fellows.

Advanced Concepts in Outpatient Joint Arthroplasty.

As the adoption and utilization of outpatient total joint arthroplasty continues to grow, key developments have enabled surgeons to safely and effectively perform these surgeries while increasing patient satisfaction and operating room efficiency. Here, the authors will discuss the evidence-based principles that have guided this paradigm shift in joint arthroplasty surgery, as well as practical methods for selecting appropriate candidates and optimizing perioperative care. There will be 5 core efficiency principles reviewed that can be used to improve organizational management, streamline workflow, and overcome barriers in the ambulatory surgery center.

Social Risk Determinants for Successful Same Calendar Day Discharge in Total Joint Arthroplasty.

Background: While many studies have examined the impact of comorbidities on the success of same calendar day discharge (SCDD) in total joint arthroplasty (TJA), literature surrounding the impact of social determinants is lacking.

Purpose: We sought to investigate the relationship between various social determinants and success of SCDD after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: We conducted a retrospective review of 1160 THA and 1813 TKA performed at a single academic institution between November 2020 and August 2022.

Increasing the Volume of Outpatient Total Joint Arthroplasty Procedures: An Evaluation of a Novel Rapid Recovery Pathway Program Within an Academic Medical Center.

Background: There has been a national trend toward shifting joint arthroplasty procedures to the outpatient setting. These cases are often performed in freestanding ambulatory surgery centers (ASCs), which are often not accessible to surgeons within academic practices.

Purposes: We sought to investigate a novel rapid recovery program used to transition arthroplasty patients to an outpatient-based care system within an academic medical center.

The Use of Plant-Based Polysaccharide (PSP) Agents May Improve Early Outcomes Following Total Knee Arthroplasty-A Proof-of-Concept Study.

Our study sought to investigate the effects of a topical plant-based polysaccharide (PSP) as an adjunctive hemostat to minimize blood loss and improve early clinical outcomes in patients undergoing primary TKA. In this multi-center and randomized proof-of-concept study, 61 patients undergoing TKA were randomly assigned to one of two groups: A) intraoperative utilization of PSP (n=31) or B) no intervention (n=30). The primary outcomes were blood loss and change in hemoglobin, measured preoperatively and 24 hours postoperatively.

Risk factors for blood transfusion and postoperative anaemia following total knee arthroplasty.

Aims: Blood transfusion and postoperative anaemia are complications of total knee arthroplasty (TKA) that are associated with substantial healthcare costs, morbidity, and mortality. There are few data from large datasets on the risk factors for these complications.

Methods: We retrospectively reviewed the records of TKA patients from a single tertiary care institution from February 2016 to December 2020.

Referencing the center of the femoral head during robotic or computer-navigated primary total knee arthroplasty results in less femoral component flexion than the traditional intramedullary axis.

Background: During robotic and computer-navigated primary total knee arthroplasty (TKA), the center of the femoral head is utilized as the proximal reference point for femoral component position rather than the intramedullary axis. We sought to analyze the effect on femoral component flexion-extension position between these two reference points.

Methods: We obtained CT 3D-reconstructions of 50 cadaveric intact femurs.

The Risk Assessment and Prediction Tool (RAPT) Score Predicts Discharge Destination, Length of Stay, and Postoperative Mobility After Total Joint Arthroplasty.

Background: Predicting an arthroplasty patient's discharge disposition, length of stay (LOS), and physical function is helpful because it allows for preoperative patient optimization, expectation management, and discharge planning. The goal of this study was to evaluate the ability of the Risk Assessment and Prediction Tool (RAPT) score to predict discharge destination, LOS, and postoperative mobility in patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods: Primary unilateral TKAs (n = 9,064) and THAs (n = 8,649) performed for primary osteoarthritis at our institution from 2018 to 2021 (excluding March to June 2020) were identified using a prospectively maintained institutional registry.

Clinical and Biomechanical Characteristics of Posterior-Stabilized Polyethylene Post Fractures in Total Knee Arthroplasty: A Retrieval Analysis.

Background: Fractures of the polyethylene post are a rare but known complication after posterior-stabilized (PS) total knee arthroplasty (TKA). We evaluated the polyethylene and patient characteristics for 33 primary PS polyethylene components that were revised with fractured posts.

Methods: We identified 33 PS inserts revised between 2015 and 2022.

Does a Uni "Feel Better" than a Total Knee? Not Necessarily, When Using Modern Implant Designs.

: When comparing functional outcomes of patients with unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA), studies often report the UKA as the preferred procedure; however, recent improvements in the design of modern TKA implants have aimed at narrowing this gap. : We sought to compare the "feel" of modern TKA implants to that of UKA, using the Forgotten Joint Score (FJS), a validated patient-reported outcome measure. : We performed a retrospective review of patients who underwent TKA and UKA at 2 institutions between 2014 and 2017.

Predicting Postoperative Anemia and Blood Transfusion Following Total Knee Arthroplasty.

Background: While transfusion and clinically relevant anemia after elective primary total knee arthroplasty (TKA) are uncommon, there remains a question of who needs postoperative hemoglobin monitoring, especially in the setting of increasing incidence of outpatient TKA. The purpose of this study was to create predictive models for postoperative anemia and blood transfusion to guide clinical decision-making.

Methods: The records of consecutive TKA patients were reviewed from February 2016 to December 2020 at a single institution.

Patient perceptions of pain management and opioid use prior to hip arthroplasty.

Objective: Qualitative assessment investigating patients' perceptions related to opioids including their role in pain control, risks, and handling and disposal prior to undergoing hip replacement.

Design: A prospective, cross-sectional survey study.

Setting: Large urban teaching hospital specializing in orthopedic surgery affiliated with Weill Cornell Medical College.

A Systematic Approach to Revision Total Knee Arthroplasty.

With the recent increase in primary total knee arthroplasties and the associated rise in failures of the index operation, there has been growing demand for orthopaedic surgeons to perform revision procedures. The orthopaedic surgeon performing revision total knee arthroplasty should be knowledgeable about the various etiologies of primary total knee arthroplasty failure, the steps for proper patient evaluation, and important factors in the preoperative planning process. A systematic methodology for obtaining surgical exposure, strategies for reconstruction, fundamentals of soft-tissue closure, and postoperative care also should be reviewed.

Orthopaedics in the Real World: The Business and Legal Aspects of Employment in 2022.

As more physicians enter hospital employment on completion of their training, the details and complexity associated with these arrangements are increasing. To better position surgeons to succeed in any employment model, it is important to describe several key topics associated with these business models. First, financial modeling can be used to make smarter choices when evaluating employment opportunities.