Technology Review: CT Scan-Guided, 3-Dimensional, Robotic-Arm Assisted Lower Extremity Arthroplasty.

Robotic-arm assisted lower extremity arthroplasty using computed tomography scan (CT)-based 3-dimensional (3D) modeling operative technologies has increasingly become mainstream over the past decade with over 550,000 procedures performed between first use in 2006 and November 2021. Studies have demonstrated multiple advantages with these technologies, such as decreased postoperative pain and subsequent decreased narcotic usage, decreased lengths of stay, less complications, reduced damage to soft tissues, decreased readmissions, as well as economic advantages in the form of meaningful cost savings for payors. The purpose of this report was to clearly and concisely summarize the good-to-high methodology peer-reviewed, published literature regarding CT scan-based, 3-dimensional robotically-assisted unicompartmental knee arthroplasty, total knee arthroplasty, and total hip arthroplasty stratified by: (1) prospective randomized studies; (2) database comparison studies; (3) national registry studies; (4) health utility studies; (5) comparison studies; and (6) basic science studies.

Long-term Wear Data From a Prospective Multicenter Study of Second-Generation Highly Cross-linked Polyethylene Inserts in Total Hip Arthroplasty.

In a prospective multicenter trial on highly cross-linked polyethylene inserts in patients undergoing total hip arthroplasty, 118 patients consented to 10-year follow-up. Medium-term follow-up results showed low wear at 5 and 7 years after surgery. The current study focuses on long-term data at 10 years.

Novel venous thromboembolic disease (VTED) prophylaxis for total knee arthroplasty-aspirin and fish oil.

Background: Despite the demonstrated success of multiple anticoagulation therapies for post-operative prophylaxis of thromboembolic disease in lower extremity arthroplasties, each modality comes with a unique set of limitations. Thus, the ideal anticoagulation medication which provides adequate therapy with minimal cost, complications, or added patient work is yet to be defined. One promising novel thrombophylactic supplement is fish oil, as many preliminary clinical trials have demonstrated a protective effect of fish oil against thrombosis in multiple clinical settings.

Total knee arthroplasty fibrosis following arthroscopic intervention.

Background: Although arthroscopy is generally considered to be a relatively benign procedure with limited trauma to periarticular soft tissues, post-arthroscopic bleeding as well as osmolality differences between the normal saline used to irrigate and the native synovial fluid (282 . 420 mOs) can lead to capsular reactions. Therefore, the purpose of this study was to evaluate whether capsular reaction occurred after knee arthroscopy, by comparing a matched cohort of patients who either did or did not undergo prior arthroscopic surgery.

Improvement in hamstring and quadriceps muscle strength following cruciate-retaining single radius total knee arthroplasty.

Background: The ability to reach full functional capacity following total knee arthroplasty (TKA) is reliant on the strength of the quadriceps and hamstring muscles. Weakness of these muscles can persist anywhere from 1 to 3 years post-operatively. There remains considerable controversy as to what factors influence restoration of muscle strength after TKA.

Economic evaluation of different suture closure methods: barbed versus traditional interrupted sutures.

Healthcare systems are receiving increasing pressures from payers, such as the Centers for Medicare and Medicaid (CMS), to reduce the costs associated with procedures, and with the implementation of the Affordable Care Act, high costs are addressed through pay-for-performance programs. Thus, multiple areas of total knee arthroplasty (TKA) surgery are under scrutiny, including surgical times, material costs, and the costs of associated complications and readmissions. Suture type has been determined to be a factor that may influence closure times, as well as direct material costs.

Quadriceps and Hamstring Muscle Strength Improves After Unicompartmental Knee Arthroplasty.

Introduction: The ability to reach functional capacity following knee arthroplasty depends on the strength of the quadriceps and hamstring muscles. Following total knee arthroplasty, weakness of these muscles can persist for up to one year postoperatively; however, this phenomenon is not well-studied in unicompartmental knee arthroplasty (UKA) patients. Therefore, we assessed: 1) quadriceps muscle strength; 2) hamstring muscle strength; and 3) correlation to functional outcomes.

Wound Closure Techniques for Total Knee Arthroplasty: An Evidence-Based Review of the Literature.

Background: This literature review is aimed at identifying the different methods for superficial and deep wound closure in total knee arthroplasty and evaluating their outcomes. We evaluated (1) closure time, (2) infection and other complication rates, and (3) local wound-related outcomes.

Methods: A thorough search of the literature was performed using 3 electronic databases.

Hip and Knee Arthroplasty Orthopedic Literature in Medical Journals-Is It Negatively Biased?

Background: Healthcare policy is often determined by well-designed studies most often published in high-impact medical journals. However, concern about the presence of publication bias against lower-extremity arthroplasty-related studies has called into question some of the validity of certain reports. There are only a few studies investigating the presence of the bias in high-impact medical journals against lower-extremity arthroplasty intervention, particularly in the Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and the Lancet.

Does Length of Stay Influence How Patients Rate Their Hospitalization After Total Hip Arthroplasty?

Background: The reimbursement for medical services by Medicare and Medicaid (CMS) has recently changed from fee-for-service to quality-based payments. This is being implemented through the use of patient administered surveys, most commonly Press Ganey. With a recent strive for fast-track total hip arthroplasty (THA), it is important to ascertain whether length-of-stay (LOS) in post-THA patients influences the Press Ganey scores and overall hospital ratings.

Dual Mobility Acetabular Cups in Primary Total Hip Arthroplasty in Patients at High Risk for Dislocation.

Introduction: Postoperative dislocation occurs in approximately 2% of primary total hip arthroplasties (THAs). Risk factors associated with dislocation include: age of 70 years or older, body mass index (BMI) of 30 kg/m2 or greater, alcohol abuse, and neuro-degenerative diseases such as multiple sclerosis or Parkinson's disease. As a result, dual-mobility articulations, which have been typically used for revision procedures, have become an increasingly popular option for these "at risk" primary THAs.

Do Press Ganey Scores Correlate With Total Knee Arthroplasty-Specific Outcome Questionnaires in Postsurgical Patients?

Background: The purpose of this study was to assess whether Center for Medicaid and Medicare services-implemented satisfaction (Press Ganey [PG]) survey results correlate with established total knee arthroplasty (TKA) assessment tools.

Methods: Data from 736 patients who underwent TKA and received a PG survey between November 2009 and January 2015 were analyzed. The PG survey overall hospital rating scores were correlated with standardized validated outcome assessment tools for TKA (Short form-12 and 36 Health Survey; Knee Society Score; Western Ontario and McMaster Universities Arthritis Index; University of California, Los Angeles; and visual analog scale) at a mean follow-up of 1154 days post-TKA.

What Influences How Patients Rate Their Hospital After Total Hip Arthroplasty?

Background: Centers for Medicare and Medicaid Services are now using results from patient satisfaction surveys, such as Press Ganey, for reimbursement. It is unknown what factors influence scores on satisfaction surveys in post-total hip arthroplasty (THA) patients. The purpose of this study was to evaluate what influences these scores in THA patients.

Low Frequency of Early Complications With Dual-mobility Acetabular Cups in Cementless Primary THA.

Background: Dislocation complicates 1% to 5% of primary total hip arthroplasties (THAs). As a result, some surgeons consider dual-mobility articulations, which are usually used in the revision setting to decrease the likelihood of dislocation, as an option for primary THA. However, few studies have evaluated their use in this setting.

What Influences How Patients Rate Their Hospital After Total Knee Arthroplasty?

Introduction: There is increasing pressure from Centers for Medicare and Medicaid Services (CMS) to report quality measures for all hospitalizations. These quality measures are determined based on results from satisfaction surveys, such as Press Ganey® (PG) (Press Ganey® Performance Solutions, Wakefield, Massachusetts). Included in this particular survey element are questions regarding staff, including nurses and doctors, as well as items such as pain control.

Incidence and Future Projections of Periprosthetic Femoral Fracture Following Primary Total Hip Arthroplasty: An Analysis of International Registry Data.

As the number of total hip arthroplasties (THA) increases, the number of fractures will increase as well. The purpose of this study was to determine the incidence and prevalence of intra- and post-operative periprosthetic fractures following THA based on national joint registry data and to create a projection model that estimates the future fracture burden. Registry data from multiple joint registries were analyzed.

Bariatric Orthopaedics: Total Hip Arthroplasty in Super-Obese Patients (Those with a BMI of ≥50 kg/m2).

Background: The purpose of this study was to assess the clinical and patient-reported outcomes of primary total hip arthroplasty in super-obese patients (those with a body mass index [BMI] of ≥50 kg/m(2)) compared with a matched group of patients who had a normal BMI (<30 kg/m(2)). A secondary objective was to assess patients' experiences in finding a treating surgeon.

Methods: Forty-eight hips in forty-five patients who had a minimum BMI of 50 kg/m(2) and who had undergone a primary total hip arthroplasty at one of four high-volume institutions between 2001 and 2010 were reviewed.

Effect of bone type on clinical and radiographic outcomes of a proximally-coated cementless stem in primary total hip arthroplasties.

We determined the effect of pre-operative bone structure upon the temporal effects of remodeling after total hip arthroplasty (THA) in a series of uncemented implants. We evaluated 345 patients (375 hips), who had either Dorr Type-A (238 hips) or Type-B (137 hips) bone, and who received a proximally-coated cementless THA and were followed for a mean of 6 years. Outcomes evaluated included aseptic survivorship, Harris hip scores, and radiographic evaluation for patterns of remodeling.

Proximally coated cementless bipolar hemiarthroplasty in Dorr type C bone.

The current study was conducted to examine the clinical and radiographic outcomes of cementless bipolar arthroplasty in patients who had type C bone at the time of the procedure. A total of 87 patients (105 hips) who had type C femora and had undergone cementless bipolar hemiarthroplasty with a proximally coated cementless prosthesis for the treatment of displaced femoral neck fractures at a single institution were reviewed. Patients included 83 women and 4 men who had a mean age of 84 years (range, 72-100 years) and were followed for a mean of 6 years (range, 2-11 years).

Opioid use prior to total hip arthroplasty leads to worse clinical outcomes.

Purpose: The purpose of this study was to compare the clinical outcomes of patients undergoing total hip arthroplasty (THA) who had been using narcotic medications prior to surgery to those who had not used them.

Methods: Fifty-four patients (62 hips) who had required opioid analgesia for hip pain in the three months prior to THA were compared to a matched group of opioid-naïve patients. Narcotic consumption was converted to a standardized morphine equivalent dose and compared between both groups of patients during their hospital stay, after six weeks, and at final follow-up.

Effectiveness of various hospital-based solutions against community- acquired methicillin-resistant Staphylococcus aureus.

Periprosthetic infections with methicillin-resistant Staphylococcus aureus (MRSA) can be particularly burdensome and difficult to eradicate. One of the measures that infection control officers have emphasized in our hospitals has been the use of various hand sanitizers throughout the hospital. Our objective was to determine the level of growth inhibition of common hand sanitizers and surgical scrub solutions that are used to prevent the spread of community-acquired strains of MRSA.

Tobacco use may be associated with increased revision and complication rates following total hip arthroplasty.

The purpose of this study was to compare the clinical outcomes of total hip arthroplasty in patients who were smokers to patients who were non-smokers. All total hip arthroplasties performed between 2007 and 2009 were reviewed to identify patients who indicated tobacco use. There were 110 smokers who were matched in a 1:2 ratio to 220 non-smoking patients.