Publications by authors named "Craig J Della-Valle"
Background: The clinical and financial burden of revision total hip arthroplasty (rTHA) continues to grow. Therefore, further investigation is needed to characterize case volume, reason for failure, and postoperative complications. The purpose of this study was to characterize contemporary indications for and complications following rTHA.
View Article and Find Full Text PDFBackground: Intraoperative femoral fractures are a rare, but serious complication of primary total hip arthroplasty (THA), and little is known about the rates of complications and reoperations in these patients. The objective of this investigation was to describe the two-year outcomes and revision rates in patients who sustain an intraoperative femoral fracture during THA.
Methods: A large administrative claims database was queried for patients who sustained an intraoperative femoral fracture during primary and elective THA from 2015 to 2022.
Background: Ambulatory surgery centers (ASCs) have been shown to deliver high-quality care to patients at major cost savings to the health care system. The objective of this investigation was to examine trends in the Medicare facility and surgeon professional fee payments for hip and knee arthroplasty.
Methods: Publicly available Medicare data were analyzed to determine professional and facility fee payments for unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and total hip arthroplasty (THA) to ASCs and hospitals between 2018 and 2024.
Background: Revision of a unicompartmental to a total knee arthroplasty (TKA) is often compared to primary TKA with regard to its technical difficulty and complication rates. We sought to compare medical and surgical complications following revision unicompartmental knee arthroplasty (UKA) to those following primary TKA and aseptic revision TKA.
Methods: A national administrative claims database was queried for patients undergoing revision UKA between 2010 and 2019.
Background: It remains unknown how timing of preoperative intra-articular knee hyaluronic acid (HA) injections impacts risk for developing postoperative periprosthetic joint infection (PJI) following total knee arthroplasty (TKA).
Methods: The PearlDiver Mariner database was utilized to identified patients undergoing primary TKA between 2015 and 2022 who received an HA injection without a corticosteroid injection within 12 months prior to surgery. The HA cohort was matched 1:1 to a control cohort undergoing no preoperative injections (corticosteroid or HA).
Background: As the volume of primary total knee arthroplasty (TKA) continues to grow, the clinical and financial burden of revision total knee arthroplasty (rTKA) is expected to increase. The purpose of this investigation was to characterize contemporary indications and complications for rTKA.
Methods: Patients undergoing rTKA between 2010 and 2021 were identified within an administrative claims database.
Article Synopsis
- The study aimed to evaluate how preoperative use of bisphosphonates, a medication for osteoporosis, affects complication risks after total knee arthroplasty (TKA) in osteoporosis patients.
- The analysis involved matching 21,058 patients who used bisphosphonates with those who did not, observing no significant difference in periprosthetic fracture rates, but a notable reduction in overall revision surgeries for bisphosphonate users.
- Patients with osteoporosis had a higher risk of fractures when treated with cementless implants, but bisphosphonate use led to similar fracture rates regardless of the implant type.
The optimal timing of contralateral surgery following unicompartmental knee arthroplasty (UKA) remains unknown. Therefore, the objective of this study was to examine the differences in postoperative complications in patients undergoing unilateral, simultaneous, and staged bilateral UKA.The PearlDiver administrative claims database was queried for patients undergoing UKA between 2015 and 2020.
View Article and Find Full Text PDFBackground: Total hip arthroplasties (THAs) are increasingly being performed at high-volume centers, causing some patients to travel further distances to receive care. Concerns remain that increased travel distance limits follow-up, which may impact outcomes and early return to the hospital. The purpose of this study is to evaluate the impact of travel distance on 90-day patient-reported outcomes (PROs) and 90-day complication rates.
View Article and Find Full Text PDFArticle Synopsis
- - The study aimed to evaluate the analgesia and anesthesia practices among members of the American Association of Hip and Knee Surgeons (AAHKS) and track changes over time, using a survey distributed in May 2023.
- - A total of 527 surgeons (16% response rate) participated, revealing a significant decrease in prescribed opioid pills after total knee (from 49 to 32) and total hip arthroplasties (from 44 to 18), along with increased use of multimodal analgesics, rising from 74% to 93%.
- - The findings indicate a growing trend towards multimodal pain management strategies, with more surgeons implementing peripheral nerve blocks and local infiltration anesthesia alongside traditional methods.
Background: The 2018 American Association of Hip and Knee Surgeons clinical practice guideline (CPG) 'tranexamic acid use in total joint arthroplasty' evaluated the efficacy and safety of tranexamic acid in primary total joint arthroplasty. The following review assessed the statistical fragility of the randomized controlled trial (RCT) outcomes on which the CPG recommendations were based using a fragility analysis.
Methods: All dichotomous outcomes from the RCTs used to guide the CPG from its associated network, and direct meta-analyses were analyzed.
Introduction: Unicompartmental knee arthroplasty (UKA) has been shown to improve pain and function in appropriately selected patients. Limited data exists regarding outcomes and complication rates following UKA among octogenarians.
Methods: The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2010-2022.
Cerebral palsy (CP) is a neurodevelopmental condition that can result in altered gait biomechanics, joint dysfunction, and imbalance. The complications associated with total knee arthroplasty (TKA) in patients with CP have not yet been well described. Therefore, our analysis sought to compare the 90-day and 2-year complications following TKA in patients with and without CP.
View Article and Find Full Text PDFBackground: Successful revision hip arthroplasty (rTHA) requires major resource allocation and a surgical team adept at managing these complex cases. The purpose of this study was to compare the results of rTHA performed by fellowship-trained and non-fellowship-trained surgeons.
Methods: A national administrative database was utilized to identify 5,880 patients who underwent aseptic rTHA and 1,622 patients who underwent head-liner exchange for infection by fellowship-trained and non-fellowship-trained surgeons from 2010 to 2020 with a 5-year follow-up.
Background: Outpatient primary total knee arthroplasty (TKA) has been well-established as a safe and effective procedure; however, the safety of outpatient revision TKA remains unclear. Therefore, this study utilized a large database to compare outcomes between outpatient and inpatient revision TKA.
Methods: An all-payor database was queried to identify patients undergoing revision TKA from 2010 to 2022.
Background: Modular dual mobility (DM) bearings have a junction between a cobalt chrome alloy (CoCrMo) liner and titanium shell, and the risk of tribocorrosion at this interface remains a concern. The purpose of this study was to determine whether liner malseating and liner designs are associated with taper tribocorrosion.
Methods: We evaluated 28 retrieved modular DM implants with a mean in situ duration of 14.
Objectives: The ideal timing for patients undergoing bilateral total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare 90-day outcomes between unilateral, simultaneous bilateral, and staged bilateral TKA.
Methods: The PearlDiver database was used to retrospectively identify 231,119 patients undergoing primary TKA during 2015-2020, of which 67,956 (29.
Background: Several management strategies have been described to treat intraoperative calcar fractures during total hip arthroplasty (THA), including retaining the primary implant and utilizing cerclage cables (CCs) or switching the implant to one that bypasses the fracture and achieves diaphyseal fixation. However, the radiographic and clinical outcomes of these differing strategies have never been described and compared.
Methods: We retrospectively identified 50 patients who sustained an intraoperative calcar fracture out of 9,129 primary total hip arthroplasties (0.
Article Synopsis
- - This study explored the link between elevated body mass index (BMI) and the risk of instability following total hip arthroplasty (THA) for osteoarthritis, aiming to assess whether higher BMI leads to more dislocations or revisions.
- Researchers analyzed data from patients who underwent primary THA from 2010 to 2022 and categorized them based on BMI, while matching them to controls with normal BMI for fair comparison.
- The results showed no significant differences in dislocation rates or revision needs related to instability across different BMI groups when compared to normal-weight patients, suggesting that higher BMI may not increase these specific risks after THA.
Article Synopsis
- - A multicenter randomized clinical trial studied the effects of anti-inflammatory medications alongside manipulation under anesthesia (MUA) on knee stiffness after total knee arthroplasty (TKA) in 124 patients.
- - The trial found that while the overall range of motion (ROM) improved significantly by 46° immediately after MUA, adding medications like dexamethasone and celecoxib did not lead to better ROM outcomes compared to control.
- - Both treatment and control groups showed similar clinical outcomes at 6 weeks and 1 year post-MUA, indicating that further research is needed to optimize anti-inflammatory treatment strategies.
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.
View Article and Find Full Text PDFBackground: Advancements in artificial intelligence (AI) have led to the creation of large language models (LLMs), such as Chat Generative Pretrained Transformer (ChatGPT) and Bard, that analyze online resources to synthesize responses to user queries. Despite their popularity, the accuracy of LLM responses to medical questions remains unknown. This study aimed to compare the responses of ChatGPT and Bard regarding treatments for hip and knee osteoarthritis with the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Clinical Practice Guidelines (CPGs) recommendations.
View Article and Find Full Text PDFBackground: Periprosthetic fractures following total hip arthroplasty (THA) often occur in the early postoperative period. Recent data has indicated that early revisions are associated with higher complication rates, particularly periprosthetic joint infection (PJI). The purpose of this study was to assess the effect of timing of periprosthetic fracture surgery on complication rates.
View Article and Find Full Text PDFBackground: Osteoporosis is common among patients undergoing primary total hip arthroplasty (THA). This study aimed to evaluate the effect of bisphosphonate treatment on osteoporotic patients undergoing primary THA.
Methods: Using a national database, 30,137 patients who had osteoporosis before primary elective THA were identified during 2010 to 2020.
Background: Recent advances in high-throughput DNA sequencing technologies have made it possible to characterize the microbial profile in anatomical sites previously assumed to be sterile. We used this approach to explore the microbial composition within joints of osteoarthritic patients.
Methods: This prospective multicenter study recruited 113 patients undergoing hip or knee arthroplasty between 2017 and 2019.