How do Patient-Reported Outcomes Correlate with Real-Time Objective Measures of Function after Total Knee Arthroplasty? A Prospective Study Using Daily Gait Metrics.

Introduction: Patient-reported outcome measures (PROs) are essential for evaluating patients undergoing total knee arthroplasty (TKA). While wearable technologies offer objective measures of physical function through Apple HealthKit, their relationship with PROs in TKA patients is not well understood. We investigated the association between commonly used PROs and objective measures of physical function in patients undergoing TKA.

Daily physical activity following unicompartmental knee arthroplasty: A pilot study.

Purpose: The purpose of this study was to understand how objective measures of daily activity change following unicompartmental knee arthroplasty (UKA). Objective data on post-operative changes in daily physical activity following UKA are limited, highlighting the need for studies using wearable technologies to provide real-time assessments of recovery.

Methods: This pilot study included a secondary analysis of a prospective study of 33 consecutive UKA patients, with data collected using an Apple Watch and a digital care management application.

Healthy but not osteoarthritic human meniscus-derived matrix scaffolds promote meniscus repair.

Meniscus tissue is commonly injured due to sports-related injuries and age-related degeneration and approximately 50% of individuals with a meniscus tear will develop post-traumatic osteoarthritis (PTOA). Given that the meniscus has limited healing potential, new therapeutic strategies are required to enhance meniscus repair. Porcine meniscus-derived matrix (MDM) scaffolds improve meniscus integrative repair, but sources of human meniscus tissue have not been investigated.

Mechanical Failure of Modular Rotating Hinge Femoral Component.

Hinge constructs can be used in revision total knee arthroplasty in cases of major collateral ligament deficiency, global knee instability, repeated failure of constrained implants, or large bone defects. Although the success of this construct in revision total knee arthroplasty varies depending on the type of surgery and bone quality, hinged implants can solve a wide array of complex problems while preserving stable flexion-extension motion for ambulation. The most common reasons for re-revision include patellofemoral complications, aseptic loosening, and infection.

Unsuspected Positive Intra-Operative Cultures in Aseptic Revision Hip Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.

Background: This study aimed to describe the management and outcomes of aseptic revision total hip arthroplasty (arTHA) with unsuspected intraoperative positive cultures (UPCs) compared to those with sterile cultures.

Methods: A single tertiary center's institutional database was retrospectively reviewed for arTHA from January 2013 to October 2023. Preoperative Musculoskeletal Infection Society scores were assigned to patients based on available infectious workup, and those who met the criteria for periprosthetic joint infection (PJI), received antibiotic spacers, or had less than 1-year follow-up were excluded.

Does Femoral Stem Design Influence Periprosthetic Fracture Incidence and Morphology in Total Hip Arthroplasty?

Background: As the incidence of total hip arthroplasty (THA) increases, the number of periprosthetic femur fractures (PFFs) will also rise. The surgical approach and stem design have been shown to influence the rate of PFF. This study evaluated PFF in cementless THA done through the posterior approach and described how stem design influences intraoperative and early postoperative fracture incidence and morphology.

Same Day Discharge Total Knee Arthroplasty: Hospital Demonstrates Similar Outcomes to Ambulatory Surgery Center in a More Complex Patient Population.

Background: The purpose of this study was to compare outcomes between patients undergoing same-day discharge (SDD) total knee arthroplasty (TKA) at an ambulatory surgery center (ASC) versus a tertiary care university hospital setting.

Methods: A single tertiary academic center's institutional database was reviewed for patients who underwent primary TKA and were discharged the same day from August 2021 to January 2024. Patients who did not have at least 1 year of follow-up were excluded.

Continuing Home Oral Hypoglycemic Medications Was Associated With Superior Postoperative Glycemic Control Versus Initiating Sliding Scale Insulin After Total Hip Arthroplasty.

Background: This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty.

Materials And Methods: Patients who were not exclusively receiving home oral hypoglycemic regimens were excluded. Additionally, patients whose diabetes was not managed inpatient postoperatively were excluded.

Mixed Reality Navigation in Hip Fusion Conversion: A Novel Utilization of Advanced Technology: A Case Report.

Case: A 32-year-old woman with a history of hip fusion presented with significant lower back, hip, and knee pain as well as severely limited hip mobility and function. Single-stage fusion takedown and conversion to total hip arthroplasty (THA) was performed using augmented reality navigation. At 1 year, the patient was pain free with improved function.

Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.

Background: The purpose of this study was to evaluate the management and outcomes of aseptic revision total knee arthroplasty (arTKA) with unsuspected positive cultures (UPCs) compared to those with sterile cultures.

Methods: The institutional database at a single tertiary center was retrospectively reviewed for arTKA from January 2013 to October 2023. Patients who met Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) based on available preoperative infectious workup, received antibiotic spacers, or did not have at least 1 year of follow-up were excluded.

Subsequent total joint arthroplasty: Are we learning from the first stage?

Background: With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedures.

Aim: To determine if both physicians and patients learn from the patient's initial arthroplasty, resulting in improved outcomes following the second procedure.

The Posterior Approach is Associated With Lower Total Encounter and 90-Day Costs When Compared to the Direct Anterior Approach.

Background: The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tertiary health system.

Methods: This is a retrospective review of 2,101 THAs (1,092 P and 1,009 DA) by 4 surgeons (2 with the highest volume of DA and P, respectively) from 2017 to 2022 at 1 academic center.

Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty.

Background: This study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early postoperative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral antidiabetic medications and those who switched to insulin postoperatively. The hypothesis was that continuing home medications would lead to lower BG levels without metabolic abnormalities.

Ultracongruent Polyethylene Liners Do Not Affect Survival of Total Knee Arthroplasty for Valgus Deformity.

Background: Valgus knee deformity is observed in nearly 10% of patients undergoing total knee arthroplasty (TKA). The degree of polyethylene constraint required to balance a valgus knee remains controversial, and historically, posterior-stabilized (PS) designs have been favored. This study evaluated the survivorship of TKA done in valgus knees based on implant design and specifically compared posterior-stabilized (PS) and ultracongruent (UC) liners.

Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs.

Background: Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to determine the reliability of stress radiographs for flexion laxity using manual stress as well as a commercially available flexion stress device, with the hypothesis that a commercially available force device would provide increased translation compared to manual stress, and radiographic measurements would be reproducible.

Methods: Ten patients who previously underwent TKA with non-hinged components were prospectively and consecutively enrolled at a single center to undergo stress radiographs.

Does Order of Operation Matter in Patients Who Have Concomitant Hip and Spine Pathology?

Background: In patients, who have coexisting lumbar spine and degenerative hip disease, there remains uncertainty regarding whether hip or spine surgery should be performed first. We hypothesized that undergoing total hip arthroplasty (THA) would protect against subsequent lumbar spine surgery (LSS) in patients who have 'hip-spine syndrome.'

Methods: A retrospective cohort study was performed from 2013 to 2021 on patients who had radiographically-confirmed hip osteoarthritis and degenerative lumbar spine pathology, evaluated separately in spine and arthroplasty clinics prior to surgical intervention.

The Removal of Total Hip Arthroplasty From the Inpatient-Only List has Improved Patient Selection and Expanded Optimization Efforts.

Background: On January 1, 2020, the Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the Inpatient-Only (IPO) list. This study evaluated patient demographics and comorbidities, preoperative optimization efforts, and 30-day outcomes of patients undergoing outpatient THA before and after IPO removal. The authors hypothesized that patients undergoing THA post-IPO removal would have improved optimization of modifiable risk factors and equivalent 30-day outcomes.

A Permanent Articulating Spacer Versus Two-Stage Exchange for Chronic Periprosthetic Joint Infection: A Propensity Score-Matched Study.

Background: Although 2-stage revision has been proposed as gold standard for periprosthetic joint infection treatment, limited evidence exists for the role of articulating spacers as definitive management. The purpose of this study was to compare clinical outcomes and costs associated with articulating spacers (1.5-stage) and a matched 2-stage cohort.

Accelerated discharge after aseptic revision knee arthroplasty is not associated with early readmission and reoperation.

Aims: In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours.

Accelerated Discharge After Aseptic Revision Total Hip Arthroplasty Does Not Predict Inferior 30-Day Outcomes.

Background: Perioperative advancements have made outpatient primary total hip arthroplasty (THA) a viable option for patients. This study evaluated the feasibility of expedited discharge after revision THA and compared 30-day outcomes to patients who had prolonged inpatient hospitalizations. The authors hypothesized that expedited discharge would not result in inferior 30-day outcomes.

The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability?

Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores at academic and private health care centers to assess the impact of trainees on patient satisfaction. From 2013 to 2017, 3454 HCAHPS surveys were collected at the investigating institution from patients who underwent primary total hip and total knee arthroplasty.