Glucagon-Like Peptide-1 Receptor Agonist Use is Not Associated With Increased Complications After Total Knee Arthroplasty in Patients With Type-2 Diabetes.

Background: Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, its effects on outcomes following total knee arthroplasty (TKA) are not well known. The purpose of this study was to compare the risk of complications after TKA in patients with type-2 diabetes who were on GLP-1 agonists with those who were not.

Methods: In total, 34,696 type 2 diabetes patients undergoing primary TKA between 2016 and 2021 were retrospectively reviewed utilizing a large national database.

Rates of Extended Oral Antibiotic Prophylaxis After Primary Total Knee Arthroplasty Among High-Risk and Standard-Risk Patients: 2009 to 2022.

Background: Recent evidence suggests extended courses of oral antibiotics (EOA) after total hip arthroplasty and total knee arthroplasty (TKA) may reduce the risk of periprosthetic joint infection in high-risk patients. EOA rates after total hip arthroplasty have risen significantly. However, there is a lack of epidemiologic data on EOA prophylaxis following TKA.

Chronic Anticoagulation is Associated With Increased Risk for Postoperative Complications Following Aseptic Revision Total Hip Arthroplasty.

Background: With an aging global population, the incidence of revision total hip arthroplasty (rTHA) is expected to increase markedly. While patients undergoing primary total hip arthroplasty who require chronic anticoagulation (AC) have been associated with increased postoperative complications, less is known about the impact of chronic AC status on postoperative complications in the rTHA setting. This study sought to compare complication rates following aseptic rTHA between patients who were on chronic AC and those who were not.

Trends in Costs and Professional Reimbursements for Revision Total Hip and Knee Arthroplasty.

Background: With increasing numbers of revision total hip and total knee arthroplasties (rTHAs and rTKAs), understanding trends in related out-of-pocket (OOP) costs, overall costs, and provider reimbursements is critical to improve patient access to care.

Methods: A large database was used to identify 92,116 patients who underwent rTHA or rTKA between 2009 and 2018. The OOP costs associated with the surgery and related inpatient care were calculated as the sum of copayment, coinsurance, and deductible payments.

Rural Hospital Designation Is Associated With Increased Complications and Resource Utilization After Primary Total Hip Arthroplasty: A Matched Case-Control Study.

Background: As the prevalence of hip osteoarthritis increases, the demand for total hip arthroplasty (THA) has grown. It is known that patients in rural and urban geographic locations undergo THA at similar rates. This study explores the relationship between geographic location and postoperative outcomes.

The Cost of Getting in: Is It Time for Change in the Adult Reconstruction Fellowship Application Process?

Background: The number of applicants to adult reconstruction fellowships (ARFs) has increased significantly in recent years, making the application process increasingly competitive. With this, applicants are applying to and interviewing at more programs which has inherent cost and time implications. The purpose of this study was to assess these implications as well as investigate applicant attitudes toward proposed changes.

Trunnion Failure in Revision Total Knee Arthroplasty.

In revision total knee arthroplasty, joint kinematics must be maintained amid bone and ligamentous insufficiency. Current modular designs address defects while allowing for intraoperative prosthesis customization through a variety of stem extensions and constraints. Additional constraint improves knee stability while increasing stress at the implant-host interface and modular junction of the implant.

Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty.

Background: The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures.

Preoperative opioid use is a risk factor for complication and increased healthcare utilization following revision total knee arthroplasty.

Introduction: Prior literature suggests that opioid use prior to primary arthroplasty procedures results in increased risk for complication. Despite this, it is unknown whether preoperative opioid use increases risk following revision TKA. The purpose of this study was to examine this relationship.

The Efficacy and Safety of Acetaminophen in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis.

Background: Oral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.

Methods: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published prior to September 2019 on acetaminophen in primary TJA.

Preoperative Depression Is Associated With Increased Risk Following Revision Total Joint Arthroplasty.

Background: The incidence of revision total hip (rTHA) and knee (rTKA) arthroplasty continues to increase. Preoperative depression is known to influence outcomes following primary arthroplasty. Despite this, it remains unknown whether the same relationship exists for patients undergoing revision procedures.

Current Trends in Clinical Practice for the Direct Anterior Approach Total Hip Arthroplasty.

Background: Despite increased popularity of the direct anterior approach (DAA) for total hip arthroplasty (THA), current practice trends and specific driving factors leading to adoption are not well established.

Methods: We conducted an electronic e-mail survey of members of the American Association of Hip and Knee Surgeons inquiring into the choice of THA surgical approach, perceptions of clinical outcomes, and economic implications associated with the DAA.

Results: Of 996 total respondents (44.

General vs Spinal Anesthesia for Revision Total Knee Arthroplasty: Do Complication Rates Differ?

Background: The incidence of both primary total knee arthroplasty (TKA) and revision TKA is increasing. Data from primary arthroplasty patients suggest a risk reduction with the use of spinal anesthesia when compared with general anesthesia. However, the same relationship has not been examined in the revision knee arthroplasty patient.

Prosthetic Joint Infection Trends at a Dedicated Orthopaedics Specialty Hospital.

Introduction: Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties.

Methods: A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed.

Long-term results of extensor mechanism reconstruction using Achilles tendon allograft after total knee arthroplasty.

Purpose: Disruption of the extensor mechanism after total knee arthroplasty (TKA) is an infrequent but devastating complication. Presently, limited data exists regarding the optimal treatment and long-term outcomes.

Methods: Patients who underwent reconstruction of their knee extensor mechanism using Achilles tendon allograft following TKA between January 2003 and January 2012 were identified.

Modified Frailty Index Is an Effective Risk Assessment Tool in Primary Total Knee Arthroplasty.

Background: "Frailty" is a marker of physiological decline of multiple organ systems, and the frailty index identifies patients who are more susceptible to postoperative complications. The purpose of this study is to validate the modified frailty index (MFI) as a predictor of postoperative complications, reoperations, and readmissions in patients who underwent primary total knee arthroplasty (TKA).

Methods: The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2014 was queried by the Current Procedural Terminology code for primary TKA (27447).

Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination.

Background: A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training.

Methods: Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer).

Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam.

Purpose: A certified list of all operative cases performed within a six month period is required of surgeons by the American Board of Orthopaedic Surgery (ABOS) as a prerequisite to taking the Part II Oral Examination. Using the data on these cases collected and maintained by ABOS, this study assessed the influence of prior fellowship training in adult reconstruction on the volume and surgeon-reported complication rate of knee joint arthroplasty cases over time.

Methods: All data were self reported to a secure Internet database (SCRIBE) by candidates who applied to take Part II of the ABOS Examination for the first time.

Inpatient enoxaparin and outpatient aspirin chemoprophylaxis regimen after primary hip and knee arthroplasty: a preliminary study.

Our institution has used a thromboprophylaxis regimen consisting of inpatient enoxaparin and outpatient aspirin for patients at standard risk for venous thrombosis after hip and knee arthroplasty. We reviewed 500 cases using this protocol. Inpatient treatment with enoxaparin averaged 2.