Total Hip Arthroplasty in Patients with Hip Osteoporosis: A Narrative Review.

Osteoporosis and osteopenia can affect patients undergoing arthroplasty of the hip, which is typically recommended for patients with severe osteoarthritis or elderly patients with a femoral neck fracture. Preoperative screening for this type of bone loss could be helpful to patients and prevent poor outcomes due to the rate of underdiagnosis of osteoporosis, which can reach 73% in patients undergoing hip arthroplasty. Complications associated with low bone mineral density include periprosthetic fractures as well as an increased revision rate.

Outpatient Versus Inpatient Total Hip and Knee Arthroplasty in Morbidly Obese Patients.

Background: Morbidly obese patients undergoing total joint arthroplasty (TJA) face increased postoperative complications, yet studies assessing the safety of this surgery in the outpatient setting for this population are lacking. This study aimed to fill this gap by assessing the safety and benefits of outpatient TJA in morbidly obese patients.

Methods: This study is a retrospective review of a commercial claims database.

Osteoporosis in the setting of knee arthroplasty: a narrative review.

Patients undergoing knee replacement, which is mainly indicated in severe osteoarthritis, are frequently co-affected by osteoporosis and osteopenia. With a prevalence standing at around 20% in patients receiving knee arthroplasty, osteoporosis could lead to poor outcomes postoperatively. Some of these complications include periprosthetic fractures and an increased revision rate.

Primary Total Hip Arthroplasty Outcomes for Labral Tears are Comparable to Advanced Osteoarthritis.

Background: There is a paucity of evidence on outcomes following total hip arthroplasty (THA) in patients who have symptomatic degenerative labral tears and mild to moderate osteoarthritis (OA). The purpose of this study was to determine if outcomes of primary THA in the setting of painful, symptomatic labral tear and mild to moderate arthritic changes were comparable to outcomes of primary THA performed for severe arthritic changes. Primary outcomes were patient-reported outcome (PRO) scores.

Optimizing Total Hip and Knee Arthroplasty Among an Underserved Population: Lessons Learned From a Quality-Improvement Initiative.

Background: Under-represented minorities and those with noncommercial insurance have higher medical comorbidities and complications following elective total joint arthroplasty (TJA). In an effort to bridge this gap, our center implemented a preoperative optimization protocol for TJA in a Medicaid Clinic (Clinic). The purpose of this study is to assess the effectiveness of that protocol and highlight challenges associated with caring for this patient population.

Race and ethnic disparities arthroplasty trends and hotspots: Bibliometric analysis.

Introduction: Despite continual advancements in total joint arthroplasty and perioperative optimization, there remains national variability in outcomes. These outcome variabilities have been in part attributed to racial and ethnic disparities in healthcare quality and access to care. This study aims to identify arthroplasty racial and ethnic disparities research and to predict future hotspots.

Perioperative Nutritional, Functional, and Bone Health Optimization in Spine Surgery: A National Investigation of Spine Surgeons' Perceptions and Practices.

Introduction: While perioperative nutritional, functional, and bone health status optimization in spine surgery is supported with ample evidence, the implementation and surgeon perception regarding such efforts in clinical practice remain largely unexplored. This study sought to assess the current perception of spine surgeons and implementation regarding the nutritional, functional status, and bone health perioperative optimization.

Methods: An anonymous 30-question survey was distributed to orthopaedic spine fellowship and neurosurgery program directors identified through the North American Spine Society and American Association of Neurological Surgeons contact databases.

Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty.

Background: Total knee arthroplasty (TKA) is a successful treatment for end-stage osteoarthritis, yet some patients still experience postoperative pain. Genicular nerve radiofrequency ablation (GNRFA) has become a potential modality to address pain in TKA. This systematic review aims to critically analyze the applicability of GNRFA in perioperative pain control prior to TKA, as well as a treatment modality for chronic painful well-appearing TKA.

Evaluating the optimal management strategy for intraoperative iatrogenic injury to the medial collateral ligament during primary total knee arthroplasty: A systematic review.

Introduction: Intraoperative iatrogenic MCL injuries during primary TKA are rare complications that lack a gold standard management protocol. This review aims to provide insight into various treatment modalities and evidence-based guidance for improved patient outcomes.

Methods: A comprehensive search across five databases identified relevant randomized control trials and retrospective cohort studies with reported outcomes.

Outcomes of Image-Free Robotic Assisted Total Knee Arthroplasty in Patients Who Have Valgus Knee Deformities.

Background: Valgus knee deformities pose a unique challenge in total knee arthroplasty (TKA) due to the complexity of achieving ligamentous balance and satisfactory alignment compared to varus or neutral deformities. Robotic-assisted (RA) TKA could aid in achieving improved component alignment and balance.

Methods: We retrospectively evaluated a matched cohort of patients to compare image-free RA-TKA (n = 44) versus conventional manual (CM) TKA (n = 30) techniques in patients who have valgus deformity of 5 to 15 degrees, including radiographic and patient-reported outcomes measures (PROMs) over a 3-year period.

Bibliometric analysis of machine learning trends and hotspots in arthroplasty literature over 31 years.

Background: Artificial intelligence has demonstrated utility in orthopedic research. Algorithmic models derived from machine learning have demonstrated adaptive learning with predictive application towards outcomes, leading to increased traction in the literature. This study aims to identify machine learning arthroplasty research trends and anticipate emerging key terms.

Frailty Among Revision Total Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes.

Background: Frailty has been shown to correlate with worse outcomes after total knee arthroplasty (TKA), although less is known regarding its effect on revision TKA (rTKA). This study examines the epidemiologic characteristics and inpatient outcomes of patients with frailty undergoing rTKA.

Methods: Discharge data from National Inpatient Sample registry were used to identify all patients aged 50 years or older who underwent rTKA between 2006 and 2015.

The utilization of US-based large data in arthroplasty research: Bibiliometric analysis of trends and hotspots.

Background: The accessibility of digital information has expanded orthopaedic surgery with expanded role of Big Databases. The increasing interest have led to creation of large databases with increasing utilization in retrospective studies. The aim of this study is to identify Big Database research and predict future hotspots.

Tourniquet-free minimally invasive total knee arthroplasty is associated with early aseptic loosening.

Background: While tourniquet-free (T-) total knee arthroplasty (TKA) has gained popularity, tourniquet-use during minimally-invasive (MIS)-TKA has not been adequately studied. Traditional techniques employ knee hyper-flexion, compressing vasculature and reducing impact of bleeding, while MIS-TKA embraces the semi-extended knee position, which does not restrict the effects of bleeding on cementation and visualization. We compared the risk of aseptic loosening between patients undergoing T- MIS-TKA compared to T + MIS-TKA.

Anterior Knee Pain After Total Knee Arthroplasty: A Critical Review of Peripatellar Variables.

» Despite the widespread success of total knee arthroplasty (TKA), postoperative anterior knee pain (AKP) remains a common occurrence and source of dissatisfaction with several readily discernible and diagnosable causes of AKP after TKA, including component malpositioning, infection, wear and osteolysis, instability, and loosening, among others.» In the setting of the well-appearing but painful TKA, potential intraoperative contributors to AKP have been extensively investigated, but remain controversial and include patellar resurfacing, patellar denervation, and patellofemoral joint overstuffing or understuffing.» Intraoperative management of peripatellar soft tissues has comparatively attained substantially less attention recently, and persistent controversy exists in the literature to make informed decisions on soft-tissue management and identify potential contributors to AKP.

Improved performance of machine learning models in predicting length of stay, discharge disposition, and inpatient mortality after total knee arthroplasty using patient-specific variables.

Background: This study aimed to compare the performance of ten predictive models using different machine learning (ML) algorithms and compare the performance of models developed using patient-specific vs. situational variables in predicting select outcomes after primary TKA.

Methods: Data from 2016 to 2017 from the National Inpatient Sample were used to identify 305,577 discharges undergoing primary TKA, which were included in the training, testing, and validation of 10 ML models.

Assessing the predictive capacity of machine learning models using patient-specific variables in determining in-hospital outcomes after THA.

Background: Machine learning is a subset of artificial intelligence using algorithmic modeling to progressively learn and create predictive models. Clinical application of machine learning can aid physicians through identification of risk factors and implications of predicted patient outcomes.

Aims: The aim of this study was to compare patient-specific and situation perioperative variables through optimized machine learning models to predict postoperative outcomes.

Epidemiology of primary and revision total knee arthroplasty: analysis of demographics, comorbidities and outcomes from the national inpatient sample.

Introduction: Primary total knee arthroplasty (TKA) is a preferred treatment for end-stage knee osteoarthritis. In the setting of a failed TKA, revision total knee arthroplasty (rTKA) acts as a salvage procedure and carries a higher risk compared to primary TKA. Given increased interest in postoperative outcomes from these procedures, a thorough understanding of the demographics, comorbidities, and inpatient outcomes is warranted.

Cannabis use disorder is associated with shorter length of stay and increased home discharge after primary total joint arthroplasty: a propensity-weighted analysis.

Introduction: Increased legalization of cannabis use across the United States has been correlated with increased cannabis use in the clinical setting. However, little is known regarding the characteristics and postoperative outcomes after primary joint arthroplasty (TJA) for patients with cannabis use disorder (CUD).

Methods: This retrospective cohort study used data from the National Inpatient Sample of patients undergoing primary TJA between 2006 to 2015.

Comorbidity, Racial, and Socioeconomic Disparities in Total Knee and Hip Arthroplasty at High Versus Low-Volume Centers.

Introduction: The purpose of this study was to compare the epidemiologic and demographic profiles and inpatient postoperative complication and economic outcomes of patients undergoing total joint arthroplasty of the hip and knee (TJA) at high-volume centers (HVCs) versus low-volume centers (LVCs) using a large national registry.

Methods: This retrospective cohort study used data from the National Inpatient Sample from 2006 to the third quarter of 2015. Discharges representing patients aged 40 years or older receiving a primary total hip arthroplasty or total knee arthroplasty were included.

Frailty Among Total Hip and Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes.

Introduction: Total joint arthroplasty (TJA) is one of the most successful and frequently performed procedures in the United States. The number of these procedures is projected to continue growing rapidly in the coming years, and with it comes the demand for more sophisticated perioperative risk and complication assessment. This study examines the effect of frailty on postoperative inpatient complications and hospital resource utilization after TJA.

Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes.

Background: Primary THA (THA) is a successful procedure for end-stage hip osteoarthritis. In the setting of a failed THA, revision total hip arthroplasty (rTHA) acts as a salvage procedure. This procedure has increased risks, including sepsis, infection, prolonged surgery time, blood loss, and increased length of stay.