Revision Hip Arthroplasty Performed by Fellowship-Trained Versus Non-Fellowship-Trained Surgeons: A Comparison of Perioperative Management and Complications.

Background: Successful revision hip arthroplasty (rTHA) requires major resource allocation and a surgical team adept at managing these complex cases. The purpose of this study was to compare the results of rTHA performed by fellowship-trained and non-fellowship-trained surgeons.

Methods: A national administrative database was utilized to identify 5,880 patients who underwent aseptic rTHA and 1,622 patients who underwent head-liner exchange for infection by fellowship-trained and non-fellowship-trained surgeons from 2010 to 2020 with a 5-year follow-up.

Three Differing Methods of Treating Intraoperative Nondisplaced Calcar Fractures Demonstrate Similar Radiographic Stem Subsidence.

Background: Several management strategies have been described to treat intraoperative calcar fractures during total hip arthroplasty (THA), including retaining the primary implant and utilizing cerclage cables (CCs) or switching the implant to one that bypasses the fracture and achieves diaphyseal fixation. However, the radiographic and clinical outcomes of these differing strategies have never been described and compared.

Methods: We retrospectively identified 50 patients who sustained an intraoperative calcar fracture out of 9,129 primary total hip arthroplasties (0.

Modern Description of Antibiotic Spacer Options for PJI in Revision Total Knee Arthroplasty: Clinical Outcomes and Infection Eradication Rates.

Background: As the burden of periprosthetic joint infections (PJIs) increases, there is growing interest in understanding the efficacy and morbidity reduction of 2-stage revision and various antibiotic spacer options. This study aimed to expand the description and evaluation of spacers from solely their articulation status to include their ability to support full (functional) or partial weight-bearing (nonfunctional).

Methods: Between 2002 and 2021, 391 patients who had Musculoskeletal Infection Society criteria for PJI with 1-stage or 2-stage revision were included.

A Systematic Review of the Efficacy and Safety of Ketamine in Total Joint Arthroplasty.

Background: Ketamine is administered intraoperatively to treat pain associated with primary total hip (THA) and knee arthroplasty (TKA). The purpose of this study was to evaluate the efficacy and safety of ketamine in primary THA and TKA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons (AAHKS), American Academy of Orthopaedic Surgeons (AAOS), Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management (ASRA).

Methods: The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published prior to 2020 on ketamine in THA and TKA.

Recurrent Failures After 2-Stage Exchanges are Secondary to New Organisms Not Previously Covered by Antibiotics.

Background: Prior studies have shown that the majority of re-infections following two-stage revisions are due to organisms different from the initial organisms identified. It remains unknown whether these new organisms were susceptible to the antibiotics given (indicating the patient likely developed another infection following successful treatment) or not susceptible (indicating these organisms may have been initially present, but were not identified, and thus, inadequately treated). The purpose of this study was to determine if bacteria identified at time of re-infection following two-stage revisions were susceptible to the antibiotics administered during treatment of the index infection, in order to understand if these are new infections or from organisms that were present but not initially identified.

The Cost-Effectiveness of Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty.

Background: The purpose of this study is to evaluate the cost-effectiveness of tibial cones in revision total knee arthroplasty.

Methods: A Markov model was used for cost-effectiveness analysis. The average cone price was obtained from Orthopedic Network News.

Machine learning algorithms predict within one size of the final implant ultimately used in total knee arthroplasty with good-to-excellent accuracy.

Purpose: To develop a novel machine learning algorithm capable of predicting TKA implant sizes using a large, multicenter database.

Methods: A consecutive series of primary TKA patients from two independent large academic and three community medical centers between 2012 and 2020 was identified. The primary outcomes were final tibial and femoral implant sizes obtained from an automated inventory system.

Conforming Polyethylene Inserts in Total Knee Arthroplasty: Beyond the Posterior-Stabilized and Cruciate-Retaining Debate.

Total knee arthroplasty continues to be one of the most commonly performed surgical procedures worldwide. However, considerable controversy exists regarding the optimal implant design. Total knee implants with both posterior-stabilized and cruciate-retaining designs have excellent long-term outcomes with inadequate data demonstrating superiority of either design.

Is American Joint Replacement Registry Data Representative of National Data? A Comparative Analysis.

Introduction: The American Academy of Orthopaedic Surgeons American Joint Replacement Registry (AJRR) is the largest registry of total hip and knee arthroplasty (THA and TKA) procedures performed in the United States. The purpose of this study was to examine whether AJRR data are representative of the national experience with hip and knee arthroplasty as represented in the National (Nationwide) Inpatient Sample (NIS).

Methods: All patients undergoing a THA or TKA procedure between 2012 to 2018 (AJRR) and 2012 to 2016 (NIS) were identified.

Trends of Femoral Neck Fracture Treatment Using Total Hip Arthroplasty: Reported From the American Joint Replacement Registry.

Introduction: Total hip arthroplasty (THA) rather than hemiarthroplasty for displaced femoral neck fracture (FNF) is often chosen for younger patients who are more active and/or have underlying hip osteoarthritis. However, instability remains the primary concern of doing THA. Dual mobility (DM) has been shown to decrease this risk through a larger effective head size and greater head-to-neck ratio compared with conventional THA.

Knee Arthrodesis With an Intramedullary Antegrade Rod as a Salvage Procedure for the Chronically Infected Total Knee Arthroplasty.

Introduction: Infection is a challenging complication after total knee arthroplasty (TKA) that is often treatable. However, recurrent infection may require resection, amputation, or arthrodesis. The purpose of this study was to evaluate the results of antegrade nailing with an intramedullary rod for the treatment of a chronically infected TKA.

The Impact of Race and Socioeconomic Status on Total Joint Arthroplasty Care.

Background: Racial minorities and patients from lower socioeconomic backgrounds are less likely to undergo total joint arthroplasty (TJA) for degenerative joint disease (DJD). However, when these patients do present for care, little is known about the overall severity of DJD and surgical wait times.

Methods: A retrospective cohort of 407 patients (131 black and 276 white) who presented to an arthroplasty clinic and went on to receive TJA was established.

Clinical Outcomes in Isolated Tibial Revision With Cruciate Retaining Total Knee Arthroplasty.

Background: Tibial component loosening is one of the most common modes of failure in contemporary total knee arthroplasty (TKA). Limited literature is available on the outcomes of isolated tibial revision with retention of the cruciate retaining (CR) femoral component. The purpose of this study was to determine the results of isolated tibial revisions in CR TKA.

Randomized Trial of Static and Articulating Spacers for Treatment of the Infected Total Hip Arthroplasty.

Background: The purpose of this randomized clinical trial is to compare perioperative and postoperative variables between static and articulating spacers for the treatment of chronic periprosthetic joint infection (PJI) complicating total hip arthroplasty (THA).

Methods: Fifty-two patients undergoing resection arthroplasty as part of a 2-stage exchange for PJI at 3 centers were randomized to either a static (n = 23) or articulating spacer (n = 29). The primary endpoint was operative time of the second-stage reimplantation and power analysis determined that 22 patients per cohort were necessary to detect a 20-minute difference.

A Randomized Trial of Static and Articulating Spacers for the Treatment of Infection Following Total Knee Arthroplasty.

Background: There is no consensus whether the interim antibiotic spacer utilized in the 2-stage exchange arthroplasty should immobilize the joint or allow for motion. The purpose of this multicenter, randomized clinical trial was to compare static and articulating spacers as part of the 2-stage exchange arthroplasty for the treatment of chronic periprosthetic joint infection complicating total knee arthroplasty as defined with use of Musculoskeletal Infection Society criteria.

Methods: Sixty-eight patients undergoing 2-stage exchange arthroplasty were randomized to either a static (32 patients) or an articulating (36 patients) spacer.

Spacer Design Options and Consideration for Periprosthetic Joint Infection.

An articulating or nonarticulating antibiotic hip spacer can be placed following the first stage implant removal of a periprosthetic hip joint infection. Antibiotic spacers help fill in the dead space created at the time of resection and provide a high local concentration of antibiotics. Theoretical advantages of a static spacer include a higher elution of antibiotics because of the increased surface area, the ability to protect deficient bone in the proximal femur/acetabulum, and the ability to immobilize the periarticular soft tissues.

Who Is Prescribing Opioids Preoperatively? A Survey of New Patients Presenting to Tertiary Care Adult Reconstruction Clinics.

Introduction: Preoperative opioid use is detrimental to outcomes after hip and knee arthroplasty. This study aims to identify the prevalence of preoperative opioid prescriptions and the specialty and practice setting of the prescriber, as well as the percentage of patients who do not report their opioid prescriptions and any variables associated with preoperative opioid prescriptions.

Methods: A total of 461 consecutive new patients evaluated for an arthritic hip or knee were retrospectively studied using institutional data from a tertiary-care, urban center at a university-affiliated private-practice and the state Prescription Monitoring Program to identify opioid prescriptions (including medication, number of pills and dosage, refills, prescriber specialty, and practice setting) within 6 months before their first appointment.

Periprosthetic Fractures of the Distal Femur: Is Open Reduction and Internal Fixation or Distal Femoral Replacement Superior?

Background: The purpose of this study is to compare open reduction and internal fixation (ORIF) to distal femoral replacement (DFR) for treatment of displaced periprosthetic distal femur fractures.

Methods: We identified 72 patients with minimum 2-year follow-up following a displaced periprosthetic distal femur fracture: 50 were treated with ORIF and 22 with DFR. Outcomes were assessed with multivariate regression analysis and include Knee Society Scores (KSS), infection rates, revision incidence, and mortality.

Dilute Betadine Lavage Reduces the Risk of Acute Postoperative Periprosthetic Joint Infection in Aseptic Revision Total Knee and Hip Arthroplasty: A Randomized Controlled Trial.

Background: The purpose of this randomized, controlled trial is to determine whether dilute betadine lavage compared to normal saline lavage reduces the rate of acute postoperative periprosthetic joint infection (PJI) in aseptic revision total knee (TKA) and hip arthroplasty (THA).

Methods: A total of 478 patients undergoing aseptic revision TKA and THA were randomized to receive a 3-minute dilute betadine lavage (0.35%) or normal saline lavage before surgical wound closure.

Midlevel Providers in Orthopaedic Surgery: The Patient's Perspective.

Background: Midlevel providers (i.e. physician assistants [PAs] and nurse practitioners [NPs]) are being integrated into systems of care due to the exponentially increasing demand for orthopaedic care.

Superior Survivorship for Posterior Stabilized Versus Constrained Condylar Articulations After Revision Total Knee Arthroplasty: A Retrospective, Comparative Analysis at Short-Term Follow-Up.

Background: The decision to use a posterior stabilized (PS) or constrained condylar knee (CCK) articulation in revision total knee arthroplasty (RTKA) has traditionally been based on surgeon preference and knee stability. The purpose of this study is to compare various outcomes and survivorship in RTKA with PS or CCK articulations.

Methods: A retrospective comparative study of RTKA with CCK or PS articulations (PS = 106/CCK = 147) was performed with minimum 2-year follow-up.

Evaluation of the Painful Total Knee Arthroplasty.

Total knee arthroplasty (TKA) has been associated with notable improvements in health-related quality of life of patients with end-stage knee arthritis. Although most patients experience substantial symptomatic relief after TKA, up to 19% of patients are unsatisfied with their outcome. With the dramatic, projected increase in the number of TKAs performed annually, it is crucial to appreciate the various modes of failure associated with this procedure.

High Failure at a Minimum 5-Year Follow-Up in Primary Total Hip Arthroplasty Using a Modular Femoral Trunnion.

Background: Modular femoral trunnions enable the surgeon to independently adjust offset, leg length, and anteversion in total hip arthroplasty (THA). However, modularity may result in an increased risk of fretting and corrosion along with a higher risk of implant dissociation or fracture. The purpose of this study is to evaluate mid-term survivorship of THAs using a cementless modular system.