Preventing Complications in Complex Repeat Revision Total Knee Arthroplasty: Advanced Implant Fixation Techniques and Management of Infection.

Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. The survivorship of rTKA is significantly lower than that of primary total knee arthroplasty, resulting in increasing numbers of repeat rTKA. These repeat rTKAs present unique challenges including potentially massive bone loss and increased risk of infection.

Preventing Complications in Complex Repeat Revision Total Knee Arthroplasty: Advanced Exposure, Implant Removal, and Handling the Extensor Mechanism.

Revision total knee arthroplasty (rTKA) is an increasingly common challenge for arthroplasty surgeons. The survivorship of rTKA is significantly lower than that of primary total knee arthroplasty, resulting in an increasing incidence of repeat rTKA. These cases present multifactorial challenges including the skin and soft-tissue envelopes, bone loss, ligamentous compromise, and often a history of periprosthetic joint infection.

Biofilm Formation is Durably Prevented on Pre-Fabricated Antibiotic Cement Spacers Compared to Cobalt Chrome and Polyethylene.

Background: A 2-stage revision remains the standard for managing chronic periprosthetic joint infection. Despite multiple spacer options, whether a particular one better resists biofilm formation remains unclear. Prefabricated polymethylmethacrylate (PMMA) articulating spacers containing antibiotics and a proprietary pore structure were developed to increase antibiotic elution characterized by a rapid burst phase for the initial one to two days and an extended slow-release phase for > 28 days.

Fellowship-Trained Surgeons Experience a Learning Curve Performing Revision Total Joint Arthroplasty.

Background: Revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) require considerable surgical proficiency, but are frequently delegated to the least experienced surgeons. This study examined the influence of surgeon experience on revision outcomes.

Methods: Prospective data on confirmed aseptic rTHAs (n = 122) and rTKAs (n = 195) performed by 4 fellowship-trained surgeons in the same practice were retrospectively analyzed.

Total Joint Arthroplasty and Sleep: The State of the Evidence.

Background: As the number of total hip and knee arthroplasties (TJA) performed increases, there is heightened interest in perioperative optimization to improve outcomes. Sleep is perhaps one of the least understood perioperative factors that affects TJA outcomes. The purpose of this article is to review the current body of knowledge regarding sleep and TJA and the tools available to optimize sleep perioperatively.

Efficacy and Safety of Catheter Interventions for Postoperative Urinary Retention After Primary Hip and Knee Total Joint Arthroplasty.

Introduction: Postoperative urinary retention (POUR) is a common barrier to rapid-discharge hip and knee total joint arthroplasty (TJA). We evaluated the efficacy and safety of catheterization intervention methods for POUR before and after discharge.

Methods: A total of 1,659 primary TJAs were retrospectively reviewed.

Survivorship and Patient Outcomes of Conforming Bearings in Modern Primary Total Knee Arthroplasty: Mean 3.5 Year Follow-Up.

Background: The use of conforming and congruent bearings in total knee arthroplasty (TKA) have rapidly increased due to the benefits of increased stability and the potential for replicating normal knee kinematics. However, limited data exist for these newly available bearings. This study evaluated revision-free survivorship and patient-reported outcome measures (PROMs) of a large granular database of primary TKAs using a single conforming bearing design.

Durability of Primary Total Hip Arthroplasty With Cementless Stems Without a Collar in Elderly Patients Age 75 Years and Over.

Background: Cementless femoral fixation in total hip arthroplasty (THA) has increased in prevalence worldwide. However, cementless fixation in elderly patients is controversial due to the risks of periprosthetic fracture and aseptic loosening. This study evaluated outcomes in patients undergoing primary THA utilizing a cementless stem without a collar, comparing those less than 75 years to those older than 75 years.

Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty.

Introduction: Dislocation rates in patients who have fixed spinopelvic motion have been reported up to 20%. Few studies have directly compared dislocation rates in patients who have spine pathology undergoing total hip arthroplasty (THA) through different surgical approaches. This study compared postoperative dislocation rates in patients who had lumbar spine disease and underwent primary THA using a posterior or direct lateral approach.

Incidence and Predictors of Subsidence Using Modular, Tapered, Fluted Titanium Femoral Stems in Aseptic Revision Total Hip Arthroplasty.

Background: Tapered, fluted titanium (TFT) femoral stems have become the gold standard in revision total hip arthroplasty (rTHA). However, there is a paucity of data on TFT stem subsidence rates following aseptic rTHA. Subsidence can lead to instability, mechanical failure, leg-length discrepancy, and may require revision surgery.

Nutritional Laboratory Studies Prior to Total Knee Arthroplasty: Practice Versus Publication.

Background: Recent emphasis has been placed on nutritional status assessment prior to total knee arthroplasty (TKA), including multiple American Academy of Orthopaedic Surgeons publications recommending specific laboratory studies; however, the frequency with which surgeons obtain these laboratory studies remains unclear. We sought to assess the incidence of ordering nutritional laboratory studies in the 90 days prior to TKA, utilizing data from a large administrative claims database.

Methods: With use of the PearlDiver database, we identified 557,670 patients undergoing primary TKA from 2011 to 2020 with a metabolic panel or blood cell count claim within 90 days prior to TKA.

Obesity is Associated With Greater Improvement in Patient-Reported Outcomes Following Primary Total Knee Arthroplasty.

Background: Body mass index (BMI) cutoffs have been established for total knee arthroplasty (TKA) patients due to increased risk of medical complications in obese patients. However, evidence-based medical optimization may mitigate risk in these patients. This study examined the influence of BMI on patient-reported outcome measures (PROMs) following primary TKA with specialized perioperative optimization.

Medicaid Patients Travel Disproportionately Farther for Revision Total Joint Arthroplasty.

Background: Access to high-quality care for revision total joint arthroplasty (rTJA) is poorly understood but may vary based on insurance type. This study investigated distance traveled for hip and knee rTJA based on insurance type.

Methods: A total of 317 revision hips and 431 revision knees performed between 2010 and 2020 were retrospectively reviewed.

Time Required for Planned and Unplanned Episodes of Care in Aseptic Hip and Knee Revision Arthroplasty.

Background: Studies indicate aseptic revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) requires much more effort but is reimbursed less than primary procedures per minute work time. This study quantified planned and unplanned work performed by the surgeon and/or their team during the entire episode of care "reimbursement window" and compared it to allowed reimbursement times by Centers for Medicare and Medicaid Services (CMS).

Methods: Between October, 2010, and December, 2020, all unilateral aseptic rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed.

Patients With Previous COVID-19 Infection Can Safely Undergo Primary Total Joint Arthroplasty.

Background: The COVID-19 virus is believed to increase the risk of diffusing intravascular coagulation. Total joint arthroplasty (TJA) is one of the most common elective surgeries and is also associated with a temporarily increased risk of venous thromboembolism (VTE). However, the influence of a history of COVID-19 infection on perioperative outcomes following TJA remains unknown.

Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience.

Background: With hospital inpatient capacity increasingly limited and primary total joint arthroplasty (TJA) rapidly transitioning to outpatient settings, the feasibility of outpatient aseptic revision and conversion TJA (rTJA) has been considered. Before the widespread adoption of outpatient rTJA, guidelines must be established to prevent patient harm. To this end, this study describes our initial experience with same-day-discharge (SDD) aseptic rTJA.

The Fate and Relevance of the Patella in Two-Stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection.

Background: It remains unclear whether reimplantation of a patellar component during a two-stage revision for periprosthetic total knee arthroplasty infection (PJI) affects patient reported outcome measures (PROMs) or implant survivorship. The purpose of this study was to evaluate whether patellar resurfacing during reimplantation confers a functional benefit or increases implant survivorship after two-stage treatment for PJI.

Methods: Two-stage revisions for knee PJI performed by three surgeons at a single tertiary care center were reviewed retrospectively.

The Effect of Joint Line Elevation on Patient-Reported Outcomes After Contemporary Revision Total Knee Arthroplasty.

Background: Joint line elevation in revision total knee arthroplasty (rTKA) is considered a risk factor for inferior outcomes, engendering a dogmatic protocol of joint line restoration. However, this precedent is based on historical data using rudimentary revision systems and unvalidated outcome measures. This study's purpose was to evaluate the effect of joint line height elevation on validated patient-reported outcome measures (PROMs) using modern revision implants.

Dually Insured Medicare/Medicaid Patients Undergoing Primary TJA Have More Comorbidities, Higher Complication Rates, and Lower Reimbursements Compared to Privately Insured Patients.

Background: Dual eligibility status (DES: qualifying for both Medicare and a Medicaid supplement) was recently proposed by the Center for Medicare and Medicaid Services as a socioeconomic qualifier for risk adjustment in primary total joint arthroplasty. However, the profile and outcomes of DES patients have never been compared to privately insured patients.

Methods: A retrospective case-control study of the Mariner database within the PearlDiver server between 2010 and 2017 was performed.

Time Required for Planned and Unplanned Episodes of Care in Septic Two-Stage Revision Hip and Knee Arthroplasty.

Background: Septic revision total hip (rTHA) and knee (rTKA) arthroplasty requires more effort but is reimbursed less than primary procedures per minute of intraoperative time. This study quantified planned and unplanned work performed by the surgical team for septic 2-stage revision surgeries during the entire episode-of-care "reimbursement window" and compared that time to allowable reimbursement amounts.

Methods: Between October 2010 and December 2020 all unilateral septic 2-stage rTHA and rTKA procedures performed by a single surgeon at a single institution were retrospectively reviewed.

Complications and Outcomes Associated With a Novel, Prefabricated, Articulating Spacer for Two-Stage Periprosthetic Joint Infection Treatment.

Background: Various prefabricated articulating spacer options have been described for 2-stage treatment of chronic periprosthetic joint infection, but their results are poorly generalizable between designs due to differing antibiotic and material properties. This study reports outcomes for a novel, prefabricated, commercially available cement-on-cement articulating spacer.

Methods: A retrospective review of prospectively collected data for patients undergoing treatment with a prefabricated articulating cement spacer was performed.