The Effect of the COVID Pandemic on the Rate of Same-Day Discharge in Primary Hip and Knee Arthroplasty.

Background: Same-day discharge (SDD) following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) started increasing prior to 2020. The purpose of this study was to evaluate the change in the rate of SDD after the pandemic and determine whether those changes became permanent.

Methods: The annual rate of SDD for 15,208 primary THA and TKA cases performed between January 1, 2015, and September 9, 2022, at a single institution was determined.

Does Powered Femoral Broaching Compromise Patient Safety in Total Hip Arthroplasty?

Background: During manual broaching (MB) in total hip arthroplasty (THA), off-axis forces delivered to the proximal femur and broach malalignment can lead to fractures and cortical perforations. Powered broaching (PB) is a novel alternative that delivers consistent impaction forces and reduces workload. This is the first large-scale study to compare intraoperative and 90-day rates of periprosthetic femur fractures (PFFs) and perforations in THA performed using MB vs PB.

Spinal Anesthesia for Primary Hip and Knee Arthroplasty: Comparative Rates of Transient Neurological Symptoms and Urinary Retention Using Lidocaine, Mepivacaine, and Bupivacaine.

Background: Short-acting spinal anesthetics enable rapid recovery after hip and knee arthroplasty; however, concerns with transient neurological symptoms (TNS) cause some to avoid using lidocaine. Postoperative urinary retention (POUR) is also a concern with spinal anesthesia. We sought to study the comparative rates of TNS and POUR between lidocaine, mepivacaine, and bupivacaine in a high-volume hip and knee arthroplasty setting.

Prospective Randomized Study Using Pharmacogenetics to Customize Postoperative Pain Medication Following Hip and Knee Arthroplasty.

Background: The purpose of this study is to determine whether pharmacogenetic testing could be used to effectively customize postoperative pain medicine following total joint replacement.

Methods: Buccal swabs were collected preoperatively from 107 patients. Pharmacogenetic testing was performed for genetic variants on a panel of 16 genes, including CYP2D6, CYP2C9, OPRM1, and CYP1A2, which affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and many opioids.

Early Results of a Randomized Controlled Trial of Partial Versus Total Knee Arthroplasty.

Background: Debate still exists regarding the benefits of unicompartmental (UKA) versus total knee arthroplasty (TKA) for the treatment of medial compartment osteoarthritis. The purpose of this randomized trial is to compare the early outcomes of UKA versus TKA.

Methods: One-hundred and seven candidates for UKA were randomized at two centers; 57 candidates received UKA and 50 received TKA.

Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience.

Background: One purported benefit of the direct anterior approach (DAA) for total hip arthroplasty (THA) is a lower rate of postoperative dislocation.

Methods: An institutional database was used to identify 8840 primary THAs performed from 2003 to 2020 including 5065 (57%) performed using the DAA and 3775 (43%) performed via the posterior approach (PA). Direction and mechanism of dislocation were determined from chart review.

Does Approach Influence the Dislocation Rate Following Head and Liner Exchange in Revision Hip Arthroplasty?

Background: Revision total hip arthroplasty with modular component exchange can limit morbidity by retaining well-fixed components but dislocation has been a relatively frequent postoperative complication. This study evaluated the effect of surgical approach on dislocation rate in a modern revision cohort.

Methods: From 2010 to 2020, 248 aseptic head and liner exchanges were performed at a single institution.

Effect of a Clean Surgical Airflow Layer on the Incidence of Infection in Total Hip Arthroplasty.

The Center for Health Design estimates that more than 30% of surgical site infections are caused by airborne pathogens. A device that creates a localized clean air field directly adjacent to and surrounding the incision site is meant to shield a surgical site from particulate in the operating room. The purpose of this study was to determine whether the routine use of this device would reduce the rate of infection following total hip arthroplasty (THA).

A lower threshold for revision of aseptic unicompartmental vs total knee arthroplasty.

Aims: It has been hypothesized that a unicompartmental knee arthroplasty (UKA) is more likely to be revised than a total knee arthroplasty (TKA) because conversion surgery to a primary TKA is a less complicated procedure. The purpose of this study was to determine if there is a lower threshold for revising a UKA compared with TKA based on Oxford Knee Scores (OKSs) and range of movement (ROM) at the time of revision.

Methods: We retrospectively reviewed 619 aseptic revision cases performed between December 1998 and October 2018.

Using pharmacogenetics to structure individual pain management protocols in total knee arthroplasty.

Aims: The purpose of this study was to use pharmacogenetics to determine the frequency of genetic variants in our total knee arthroplasty (TKA) patients that could affect postoperative pain medications. Pharmacogenetic testing evaluates patient DNA to determine if a drug is expected to have a normal clinical effect, heightened effect, or no effect at all on the patient. It also predicts whether patients are likely to experience side effects from medicine.

Does a "July Effect" Exist for Fellowship Training in Total Hip and Knee Arthroplasty?

Background: The hypothetical association between health-care errors and the transition of the medical academic year has been termed the "July effect." Data supporting its existence are conflicting, particularly in orthopedic surgery, and prior studies have inappropriately grouped fellows with resident trainees. No studies to date have examined whether a training initiation effect exists among surgical fellows in adult reconstructive orthopedics.

A Prospective, Randomized Study of Surgical Positioning Software Shows Improved Cup Placement in Total Hip Arthroplasty.

Several technologies are available to assist surgeons with acetabular component positioning in total hip arthroplasty. The purpose of this study was to determine whether surgical positioning software would improve cup position compared with fluoroscopy. This prospective, randomized study compared 200 primary total hip arthroplasty cups placed with and without surgical positioning software.

Operating room traffic in total joint arthroplasty: Identifying patterns and training the team to keep the door shut.

Background: Surgical site infections after joint arthroplasty are devastating complications and are influenced by patient, surgical, and operating room environmental factors.

Methods: In an effort to reduce the incidence of door openings (DOs) during total joint arthroplasty cases, this prospective observational study consisted of 3 phases. Phase 1 determined the baseline incidence of DOs, followed by installation of a mechanical door counter (phase 2).

The Lawrence D. Dorr Surgical Techniques & Technologies Award: "Running Two Rooms" Does Not Compromise Outcomes or Patient Safety in Joint Arthroplasty.

Background: Scrutiny from the federal government and the media regarding the safety of 1 surgeon doing cases in 2 operating rooms (ORs) on the same day, prompted us to examine our own institutional data. Over the past 11 years, surgeons at our facility have operated consecutively in 1 OR on a given day or used 2 alternating ORs. This study compares these cases with a focus on revisions and complications in both groups.

Perioperative Pain Management and Anesthesia: A Critical Component to Rapid Recovery Total Joint Arthroplasty.

Multimodal pain management has become the standard of care following total hip and knee replacement. The advantages include decreasing opioid consumption and its associated side effects, facilitating earlier mobilization, and faster return to function. An effective rapid recovery protocol includes the use of multiple different types of medications targeting each area of the pain pathway, preemptive analgesia, regional nerve blockade, and local infiltration analgesia.

Comparison of Wound Complications and Deep Infections With Direct Anterior and Posterior Approaches in Obese Hip Arthroplasty Patients.

Background: The purpose of this study was to compare the posterior approach (PA) with the direct anterior approach (DAA) among obese and nonobese total hip arthroplasty patients to determine if obese DAA patients have a higher risk of infection or wound complications compared with obese PA patients.

Methods: We retrospectively evaluated 4651 primary total hip cases performed via anterior approach or PA between 2009 and 2015. Patients were divided into 4 study groups based on approach and body mass index (BMI): (1) DAA <35 kg/m, (2) DAA ≥35 kg/m, (3) PA <35 kg/m, and (4) PA ≥35 kg/m.

Intraoperative fluoroscopy with a direct anterior approach reduces variation in acetabular cup abduction angle.

Introduction: The purpose of this study was to compare acetabular cup position for 2 cohorts of total hip arthroplasty (THA) patients who had a direct anterior approach.

Methods: 100 THA cases were performed with an anterior approach using intraoperative fluoroscopy (IF) to aid in cup positioning. Another group of 100 cases underwent THA with an anterior approach without the use of any fluoroscopy.

Patellar Cut and Composite Thickness: The Influence on Postoperative Motion and Complications in Total Knee Arthroplasty.

Background: Little data exist on the influence of patellar thickness on postoperative motion or complications after total knee arthroplasty (TKA). This study addresses the following questions: Is postoperative motion influenced by change in composite patellar thickness? Is change in patellar thickness associated with more complications? And do more complications occur in the knees with a patellar bone remnant (<12 mm) and a native patellar thickness <18 mm?

Methods: In total, 3655 TKAs were performed by 3 surgeons over a 28-year interval. All knees had caliper measurement of patellar thickness before the patellar cut, after implantation of the component and postoperative motion recorded in the database 1 or 2 years after TKA.

Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty.

Background: The orthopedic literature documents that obesity can place patients at increased risk for complications. This is the first study to document the increased risk of infection in obese patients after direct anterior approach (DAA) primary total hip arthroplasty (THA).

Methods: We retrospectively evaluated 1621 consecutive primary THAs performed with a DAA.

New Approach and Stem Increased Femoral Revision Rate in Total Hip Arthroplasty.

This study compared the femoral stem revision and loosening rates in primary total hip arthroplasty between 2 different approaches and stem designs. Recent reports comparing the direct anterior approach with either the posterior or lateral approach showed that patients undergoing the direct anterior approach have less pain and an accelerated functional recovery in the early postoperative period. After converting to an anterior approach, the authors observed an increased rate of femoral stem revision.

Comparison of Cup Alignment, Jump Distance, and Complications in Consecutive Series of Anterior Approach and Posterior Approach Total Hip Arthroplasty.

The purpose of this study was to compare cup position, jump distance, and rate of dislocations in 100 total hip arthroplasty (THA) cases performed with the direct anterior approach (DAA) and 100 cases performed with the posterior approach (PA). Abduction and anteversion angles were measured using Martell Hip Analysis software. The average cup anteversion in the DAA group (17.

Can We Quantify Functional Improvement Following Total Knee Arthroplasty in the Clinical Setting?

The purpose of this study was to determine if improvements in knee function after arthroplasty could be practicably measured in the clinical setting using available, validated technology. The tools we assessed included a timed test of common activities, a platform posturography analysis, and a portable gait laboratory device to quantify body segment motion. We measured the function of 25 total knee arthroplasty patients before surgery and at 1, 4, 12, and 24 months after surgery.

Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty.

The purpose of this study was to determine the rate of thromboembolic and bleeding complications when using mechanical prophylaxis with preoperative risk stratification following total knee arthroplasty (TKA). Between 1994 and 2007, 4037 TKAs were performed on 3144 patients at our institution. Mechanical VTE prophylaxis was used for standard risk patients, which included AV impulse foot pumps, thigh high stockings, and early mobilization.

Patient satisfaction with mobile compression devices following total hip arthroplasty.

The goal of this study was to evaluate patient satisfaction with the use of a mobile compression device after anterior total hip arthroplasty. Two hundred forty-seven patients used the mobile compression device for 10 days after surgery with recommended adjunctive 325 mg aspirin therapy. The device has a rechargeable battery pack that weighs 1.

A prospective randomized study of bicompartmental vs. total knee arthroplasty with functional testing and short term outcome.

The purpose of this study was to compare 50 bicompartmental knee arthroplasty (BKA) and total knee arthroplasty (TKA) cases, particularly in restoring knee function. Patients were between 30 and 65 years old, with a BMI under 35, and had osteoarthritis in the medial and patellofemoral compartments. Knee Society scores, Oxford questionnaires, radiographs, and functional tests were performed preoperatively, and at 1, 4, 12, and 24 months postoperatively.