Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty.

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty.

Fretting Corrosion, Third-Body Polyethylene Damage, and Cup Positioning in Primary vs Revision Dual Mobility Total Hip Arthroplasty.

Background: Dual mobility (DM) articulations were introduced for total hip arthroplasty to reduce the risk of instability for patients who have a high risk of dislocation. The use of DM constructs in both primary and revision total hip arthroplasty has been steadily increasing, leading to concerns regarding potential risks of fretting corrosion, polyethylene wear, metal release, and failure due to component positioning.

Methods: A total of 56 retrieved DM constructs were collected.

Patient-reported outcomes at 1 and 2 years after total hip and knee arthroplasty: what is the minimum required follow-up?

Purpose: The purpose of this study was to test for differences between patient-reported outcome measures (PROMs) at 1 and 2 years following total hip (THA) or knee (TKA) arthroplasty.

Methods: Between 2015 and 2016, n = 469 and n = 414 patients underwent THA and TKA, respectively. Demographic and PROMs data were collected at 1 and 2 years post-operatively.

A Web-Based Interactive Patient-Provider Software Platform Does Not Increase Patient Satisfaction or Decrease Hospital Resource Utilization in Total Knee and Hip Arthroplasty Patients in a Single Large Hospital System.

Background: Web-based platforms used to enhance patient-provider communication are being explored to improve patient satisfaction and care delivery, and decrease cost. This study tested a web-based interactive patient-provider software platform (IPSP), JointCOACH, which enabled patient communication with their care team and preparatory/recovery guidance. The aims of this study are to compare (1) patient satisfaction and (2) healthcare resource utilization by patients who underwent total knee and hip replacements and added IPSP to standard of care (SOC).

Demographic, Comorbidity, and Episode-of-Care Differences in Primary Total Knee Arthroplasty.

Background: Understanding time trends in age, demographic characteristics, and comorbidities is especially critical to highlight the effects on clinical practice change, outcomes, and the value of total knee arthroplasty (TKA). Therefore, the purpose of this study was to identify trends in the demographic characteristics, comorbidities, and episode-of-care outcomes for patients who underwent TKA from 2008 to 2018.

Methods: The National Surgical Quality Improvement Program (NSQIP) was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients who underwent primary TKA from 2008 to 2018 (n = 350,879).

2020 international practice patterns in adult joint reconstruction surgery: a survey of members of the International Society of Orthopaedic Centers.

Purpose: It is important to assess global trends in the practice of adult reconstruction orthopaedic surgery to understand how new evidence is being implemented. The International Society of Orthopaedic Centers (ISOC) is a consortium of academic orthopaedic centers whose members' practices likely reflect contemporary evidence and indicate how orthopaedic surgery residents and fellows are trained.

Methods: We administered a 65 question, electronic survey of adult reconstruction surgeons across the ISOC centers in September 2020 to assess practice patterns.

Diagnosis and Management of Intraoperative Fractures in Primary Total Hip Arthroplasty.

Intraoperative periprosthetic fractures are challenging complications that may affect implant stability and survivorship. Periprosthetic acetabular fractures are uncommon and infrequently are the focus of studies. Acetabular fractures are occasionally recognized after patients report unremitting groin pain weeks postoperatively.

Femoral Stem Cementation in Hip Arthroplasty: The Know-How of a "Lost" Art.

Purpose Of Review: To describe the (1) indications, (2) preoperative precautions, and (3) stepwise technical details of modern femoral stem cemented fixation.

Recent Findings: Femoral stem cementation provides excellent implant longevity with a low periprosthetic fracture rate among patients with compromised bone quality or aberrant anatomy. Unfamiliarity with the details of modern cementation techniques among trainees who may lack frequent exposure to cementing femoral stems may preclude them from offering this viable option to suitable patients in later stages of their careers.

Not All Robotic-assisted Total Knee Arthroplasty Are the Same.

Because value in healthcare has shifted to a measurement of quality relative to the cost, a greater emphasis exists on improving clinical and functional outcomes and patient satisfaction. Despite advances in implant design, surgical technique, and postoperative rehabilitation, multiple studies demonstrate that nearly 20% of patients remain dissatisfied with their overall outcomes after primary total knee arthroplasty (TKA). Because implant positioning, alignment, and equal soft-tissue balance are critical for a successful TKA, malalignment in the coronal, sagittal, and rotational planes continue to increase failure rates and cause poor clinical outcomes.

Bilateral Simultaneous Total Knee Arthroplasty May Not Be Safe Even in the Healthiest Patients.

Background: Bilateral total knee arthroplasty (TKA) has been shown to increase both mortality and complications, but has potential benefits including decreased length of stay, rehabilitation time, and costs. The purpose of this study was to use data from a nationally representative database to identify if there is a population of patients undergoing TKA in whom bilateral TKA can be safely performed, by comparing 30-day mortality and complication rates with those of patients undergoing unilateral TKA.

Methods: The National Surgical Quality Improvement Program (NSQIP) was queried to compare 30-day rates of mortality and any complication between bilateral TKA and unilateral TKA.

Gamer's Health Guide: Optimizing Performance, Recognizing Hazards, and Promoting Wellness in Esports.

Electronic sports (esports), or competitive video gaming, is a rapidly growing industry and phenomenon. While around 90% of American children play video games recreationally, the average professional esports athlete spends 5.5 to 10 h gaming daily.

Estimated glomerular filtration rate is a prognosticator of adverse outcomes after primary total knee arthroplasty among patients with chronic kidney disease and glomerular hyperfiltration.

Background: The goals of this study were: (1) to test whether patients with an Estimated glomerular filtration rate (eGFR) that is higher or lower than population-based standards have an increased risk of 30-day mortality, return to the operating room, readmission, non-home discharge, any complication, major complications, and minor complications after primary total knee arthroplasty (TKA); and (2) to find out whether there is a significant non-linear relationship between eGFR and those same variables.

Methods: A total of 168,919 primary TKAs were identified using The National Surgical Quality Improvement Program (NSQIP) database between 1 January 2008 and 31 December 2016. The following outcomes were assessed at 30 days: mortality, return to the operating room, readmission, non-home discharge, any complication, major complications, and minor complications.

Artificial Intelligence to Identify Arthroplasty Implants From Radiographs of the Hip.

Background: The surgical management of complications surrounding patients who have undergone hip arthroplasty necessitates accurate identification of the femoral implant manufacturer and model. Failure to do so risks delays in care, increased morbidity, and further economic burden. Because few arthroplasty experts can confidently classify implants using plain radiographs, automated image processing using deep learning for implant identification may offer an opportunity to improve the value of care rendered.

Altmetrics Attention Scores for Randomized Controlled Trials in Total Joint Arthroplasty Are Reflective of High Scientific Quality: An Altmetrics-Based Methodological Quality and Bias Analysis.

Introduction: The Altmetric Attention Score (AAS) has been associated with citation rates across medical and surgical disciplines. However, factors that drive high AAS remain poorly understood and there remains multiple pitfalls to correlating these metrics alone with the quality of a study. The purpose of the current study was to determine the relationship between methodologic and study biases and the AAS in randomized controlled trials (RCTs) published in total joint arthroplasty journals.

YouTube as a Source of Patient Information for Total Knee/Hip Arthroplasty: Quantitative Analysis of Video Reliability, Quality, and Content.

Background: YouTube has become a popular platform for disseminating health-related information. However, the quality of such videos has never been assessed based on video source (author). Therefore, the current investigation aimed to quantitatively analyze the (1) accuracy, (2) reliability, (3) quality, and (4) content of total knee (TKA) and hip (THA) arthroplasty videos as a platform for patient information, based on video source.

Blood Management in Total Knee Arthroplasty: A Nationwide Analysis from 2011 to 2018.

Both advances in perioperative blood management, anesthesia, and surgical technique have improved transfusion rates following primary total knee arthroplasty (TKA), and have driven substantial change in preoperative blood ordering protocols. Therefore, blood management in TKA has seen substantial changes with the implementation of preoperative screening, patient optimization, and intra- and postoperative advances. Thus, the purpose of this study was to examine changes in blood management in primary TKA, a nationwide sample, to assess gaps and opportunities.

Transformation from a traditional model to a virtual model of care in orthopaedic surgery: COVID-19 experience and beyond.

Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers.

Patient-Reported Outcome Measures (Pain, Function, and Quality of Life) After Aseptic Revision Total Knee Arthroplasty.

Background: Despite the growing frequency of revision total knee arthroplasty (rTKA), there is limited information regarding patient-reported outcome measures (PROMs) after that procedure. Therefore, the purpose of this study was to determine (1) PROM improvements in pain, function, quality of life (QOL), and global health and (2) predictors of PROMs for patients undergoing aseptic rTKA as determined using a multilevel model with patients nested within surgeons.

Methods: A prospective cohort of 246 patients who underwent aseptic rTKA from January 2016 to December 2017 and had baseline and 1-year postoperative PROMs were analyzed.

Total Hip Arthroplasty for Developmental Dysplasia of Hip vs Osteoarthritis: A Propensity Matched Pair Analysis.

Background: The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program to compare the perioperative and postoperative outcomes after total hip arthroplasty (THA) for DDH and primary OA via a propensity-matched pair analysis and the valuation of THA between both groups.

Material And Methods: All patients who underwent THA between 2008 and 2016 were identified from National Surgical Quality Improvement Program database via the current procedural terminology (CPT) code. Patients were further identified and stratified based on International Statistical Classification of Diseases and Related Health Problems-9/International Statistical Classification of Diseases and Related Health Problems-10 diagnosis codes for primary OA (n = 115,166) and DDH (n = 603), which included codes for congenital hip dislocation, hip dysplasia, or juvenile osteochondrosis.

Validation of a modified Clavien-Dindo Classification for postoperative complications in orthopedic surgery.

Introduction: Postoperative complications (PCs) constitute any deviation from the normal postoperative course. Reporting of PCs remains a challenge, multiple classification systems have been proposed, however these have not been validated across surgical specialties. Clavien and Dindo (DCCS) developed a system for General Surgery and has been adopted in different fields.

The Potential Effects of Imposing a Body Mass Index Threshold on Patient-Reported Outcomes After Total Knee Arthroplasty.

Background: Operative eligibility thresholds based on body mass index (BMI) alone may risk restricting access to improved pain control, function, and quality of life. This study evaluated the use of BMI-cutoffs to offering TKA in avoiding: 1) 90-day readmission, 2) one-year mortality, and 3) failure to achieve clinically important one-year PROMS improvement (MCID).

Methods: A total of 4126 primary elective unilateral TKA patients from 2015 to 2018 were prospectively collected.

In-hospital Mortality after Septic Revision TKA: Analysis of the New York and Florida State Inpatient Databases.

The aims of this study were to investigate (1) in-hospital mortality rates following septic revision total knee arthroplasty (rTKA); (2) compare septic rTKA mortality rates between differing knee revision volume (KRV) hospitals; and (3) identify independent risk factors associated with in-hospital mortality after septic rTKA (up to 2-year follow-up). The Healthcare Cost and Utilization Project State Inpatient Databases of New York and Florida were used to identify septic rTKA, and control groups of aseptic rTKA and primary TKA between 2007 and 2012 via International Classification of Diseases, Ninth Revision codes. Mortality was compared between septic rTKA and aseptic rTKA/primary TKA control groups.