Approach-Based Complication Rates of Total Hip Arthroplasty in the Medicare Population.

Introduction: The direct anterior approach (DAA) has become increasingly more popular for total hip arthroplasty (THA). Critics of the DAA maintain that a higher complication rate exists; however, data collection is prone to bias as the outcome is collected by the surgeons performing either an anterior or posterior approach (PA). This study aims to compare the short-term outcomes, including complication rates, in a Medicare population between THAs performed via DAA and PA.

The Effect of Surgeon and Hospital Volume on Total Knee Arthroplasty Patient-reported Outcome Measures: An American Joint Replacement Registry Study.

Background: The lower morbidity and mortality rate associated with increased surgeon and hospital volume may also correlate with improved patient-reported outcome measures. The goal of this study was to determine the relationship between surgeon and hospital volume and patient-reported outcome measures after total knee arthroplasty (TKA) using American Joint Replacement Registry data.

Methods: Using American Joint Replacement Registry data from 2012 to 2020, 8,193 primary, elective TKAs with both preoperative and 1-year postoperative The Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS-JR) scores were analyzed.

Multiply revised TKAs have worse outcomes compared to index revision TKAs.

Aims: Revision total knee arthroplasty (rTKA) is a technically challenging and costly procedure. It is well-documented that primary TKA (pTKA) have better survivorship than rTKA; however, we were unable to identify any studies explicitly investigating previous rTKA as a risk factor for failure following rTKA. The purpose of this study is to compare the outcomes following rTKA between patients undergoing index rTKA and those who had been previously revised.

The effect of reduced bone mineral density on elective total hip arthroplasty outcomes.

Introduction: Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA.

Methods: A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center.

The Risk of Acute Infection Following Intra-Articular Corticosteroid Injection During Total Knee Manipulation Under Anesthesia.

Background: Manipulation under anesthesia (MUA) is an established option for improving motion in patients presenting with early stiffness following total knee arthroplasty (TKA). Intra-articular corticosteroid injections (IACI) are sometimes administered adjunctively, yet literature examining their efficacy and safety remains limited.

Study Design: Retrospective, Level IV.

Aspirin Thromboprophylaxis Following Primary Total Knee Arthroplasty Is Associated With a Lower Rate of Early Prosthetic Joint Infection Compared With Other Agents.

Background: Patients undergoing total knee arthroplasty (TKA) are at increased risk of venous thromboembolism (VTE). Aspirin has been shown to be effective at reducing rates of VTE. In select patients, more potent thromboprophylaxis is indicated, which has been associated with increased rates of bleeding and wound complications.

Impact of revision TKA indications on resource utilization.

Background: Indications for surgery may impact resource utilization in aseptic revision total knee arthroplasty (rTKA), and understanding these relationships would facilitate risk-stratification preoperatively. The purpose of this study was to investigate the impact of rTKA indications on readmission, reoperation, length of stay (LOS), and cost.

Methods: We reviewed all 962 patients who underwent aseptic rTKA at an academic orthopedic specialty hospital between June 2011-April 2020 with at least 90 days of follow-up.

The Effect of Surgeon and Hospital Volume on Total Hip Arthroplasty Patient-Reported Outcome Measures: An American Joint Replacement Registry Study.

Background: Some studies have shown lower morbidity and mortality rates with increased surgeon and hospital volumes after total hip arthroplasty (THA). This study sought to determine the relationship between surgeon and hospital volumes and patient-reported outcome measures after THA using American Joint Replacement Registry data.

Methods: Using American Joint Replacement Registry data from 2012 to 2020, 4,447 primary, elective THAs with both preoperative and 1-year postoperative Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) scores were analyzed.

The effect of losartan on range of motion and rates of manipulation in total knee arthroplasty: a retrospective matched cohort study.

Introduction: Arthrofibrosis remains a common cause of patient dissatisfaction and reoperation after total knee arthroplasty (TKA). Losartan is an angiotensin receptor blocker (ARB) with inhibitory effects on transforming growth factor beta, previously implicated in tissue repair induced fibrosis, and has been studied to prevent stiffness following hip arthroscopy. This study aimed to evaluate pre- and postoperative range of motion (ROM) and the incidence of manipulation under anesthesia (MUA) following primary TKA in patients taking Losartan preoperatively for hypertension.

Comparison of silver-embedded occlusive dressings and negative pressure wound therapy following total joint arthroplasty in high BMI patients: a randomized controlled trial.

Introduction: High body mass index (BMI) and wound drainage following total joint arthroplasty (TJA) can lead to wound healing complications and periprosthetic joint infection. Silver-embedded occlusive dressings and negative pressure wound therapy (NPWT) have been shown to reduce these complications. The purpose of this prospective trial was to compare the effect of silver-embedded dressings and NPWT on wound complications in patients with BMI ≥ 35 m/kg2 undergoing TJA.

National Football League Wide Receivers and Running Backs Have Decreased Production Following ACL Reconstruction: An Evaluation of Fantasy Football Performance as an Outcome Measure.

Purpose: To use fantasy football points as a simple measure alongside on-field statistics to compare performance in National Football League (NFL) offensive skill position players before and after anterior cruciate ligament (ACL) reconstruction.

Methods: A retrospective review of all NFL quarterbacks (QB), running backs (RB), wide receivers (WR), and tight ends (TE) who sustained an isolated, unilateral ACL injury from 1988 to 2017 was conducted. Data were collected from public data sources, team releases, NFL injury reports, press releases, and other Internet resources.

Increased Rate of Early Periprosthetic Joint Infection in Total Hip Arthroplasty With the Use of Alternatives to Cefazolin Despite Additional Gram-Negative Coverage.

Background: Periprosthetic joint infection (PJI) remains one of the most devastating complications following total joint arthroplasty. Appropriate prophylactic antimicrobial administration and antibiotic stewardship are major factors impacting the risk of PJI in total hip arthroplasty (THA). The purpose of our study was to evaluate whether cefazolin administration was superior to noncefazolin antibiotics in prevention of PJI after primary THA.

Effect of documented and undocumented psychiatric conditions on length of stay and discharge destination after total knee arthroplasty.

Introduction: Length of stay (LOS) and readmissions are quality metrics linked to physician payments and substantially impact the cost of care. This study aims to evaluate the effect of documented and undocumented psychiatric conditions on LOS, discharge location, and readmission following total knee arthroplasty (TKA).

Methods: Retrospective review of all primary, unilateral TKA from 2015 to 2020 at a high-volume, academic orthopedic hospital was conducted.

The Effect of Femoral Head Size on Groin Pain in Total Hip Arthroplasty.

Background: Although increased femoral head size reduces the risk of instability in total hip arthroplasty (THA), it may lead to iliopsoas irritation and increased anterior groin pain. The purpose of this study is to compare outcomes between non-modular dual-mobility (NDM) implants and small (≤32 mm) and large (≥36 mm) fixed-bearing (FB) constructs.

Methods: A retrospective review of all primary total hip arthroplasties from 2011 to 2021 was conducted at a single, urban academic institution.

The Impact of Patient Resilience on Discharge After Total Hip Arthroplasty.

Background: Patients who undergo total hip arthroplasty (THA) require resilience to recover and resume daily functions. Increased resilience may be an important factor for achieving improved outcomes. The purpose of this study is to examine the impact of resilience on time to discharge and on early patient-reported outcomes following primary THA.

Documented and Undocumented Psychiatric Conditions Affect the Length of Stay and Discharge Disposition Following Total Hip Arthroplasty.

Background: Despite increased efforts toward patient optimization, some patients have undocumented conditions that can affect costs and quality metrics for institutions and physicians. This study evaluates the effect of documented and undocumented psychiatric conditions on length of stay (LOS) and discharge disposition following total hip arthroplasty (THA).

Methods: A retrospective review of all primary THAs from 2015 to 2020 at a high-volume academic orthopedic specialty hospital was conducted.

How Accurate Is ICD-10 Coding for Revision Total Knee Arthroplasty?

Background: The International Classification of Diseases-10 (ICD-10) came into effect in October 2015. The new procedural codes (ICD-10-PCS) were designed to specify granular aspects of the procedure, including laterality and revised components. This specificity could improve data collection in institutional databases, large registries, and administrative claims data.

ICD-10 Coding Mismatch in Computer and Robotic Assisted Primary Total Hip Arthroplasty.

Background: The International Statistical Classification of Disease, 10 Revision Procedural Coding System (ICD-10-PCS) is a granular procedural classification system with the ability to precisely classify types of technology utilized in total hip arthroplasty (THA). However, coding nuances and the rapidly evolving nature of technology may lead to coding inaccuracies. The purpose of this study is to determine the accuracy of ICD-10-PCS coding in computer-navigated and robotic THA and discuss its implications on clinical data.

Primary total hip arthroplasty outcomes in octogenarians.

Aims: As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80.

Early, Mid-Term, and Late-Term Aseptic Femoral Revisions After THA: Comparing Causes, Complications, and Resource Utilization.

Background: Registry data suggest increasing rates of early revisions after total hip arthroplasty (THA). We sought to analyze modes of failure over time after index THA to identify risk factors for early revision.

Methods: We identified 208 aseptic femoral revision THAs performed between February 2011 and July 2019 using an institutional database.

Is Surgical Approach for Primary Total Hip Arthroplasty Associated With Timing, Incidence, and Characteristics of Periprosthetic Femur Fractures?

Background: Periprosthetic femur fractures (PFF) involving primary total hip arthroplasty (THA) remain a significant concern. The purpose of this study was to evaluate the effect of surgical approach during primary THA on early PFF with respect to fracture timing, incidence, radiographic parameters, and surgery-related factors.

Methods: A retrospective review of all patients with PFF during or after primary THA from 2011 to 2019 was conducted at a single, urban academic institution.