Anticoagulant Usage After Anterior Cruciate Ligament Reconstruction Is Associated With Increased Rate of Manipulation Under Anesthesia.

Background: Arthrofibrosis after anterior cruciate ligament reconstruction (ACLR) is a notable but uncommon complication of ACLR. To improve range of motion after ACLR, aggressive physical therapy, arthroscopic/open lysis of adhesions, and revision surgery are currently used. Manipulation under anesthesia (MUA) is also a reasonable choice for an appropriate subset of patients with inadequate range of motion after ACLR.

Decreased Implant Survival is Associated With Younger Patients Undergoing Total Knee Arthroplasty.

: Younger patients are undergoing total knee arthroplasty (TKA) at increasing rates and may face multiple revisions during their lifetimes due to mechanical complications or infections. : We sought to compare the early complication rates and revision-free implant-survival rates across age groups of patients undergoing TKA, with particular focus on implant survival in younger patients. : We conducted a retrospective analysis of data taken from a national insurance database on patients who underwent primary TKA from 2007 to 2015.

Cervical spine degenerative disease is an independent risk factor for increased revision rate following total knee arthroplasty.

Introduction: The relationship between cervical degenerative pathology and total knee arthroplasty (TKA) revision rates is not well understood. The aim of the study was to determine whether cervical spine degenerative diseases have a role in complications following TKA within 2 years.

Methods: Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007-2017.

Hospital Discharge Within a Day After Total Knee Arthroplasty Does Not Affect 1-Year Complications Compared With Rapid Discharge.

Introduction: In patients undergoing total knee arthroplasty (TKA), it is unclear whether a difference in complication rates exists between patients discharged the day of surgery compared with subsequent postoperative days.

Methods: Data were collected from the PearlDiver Patient Records Database from 2007 to 2017. Subjects were identified using International Classification of Diseases codes.

Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty.

Background: It has not been determined yet whether hip arthroscopy (HA) leads to adverse outcomes after total hip arthroplasty (THA). The purpose of this study was to (1) determine 2-year conversion rate of HA done for osteoarthritis (OA) to THA and (2) explore the relationship between HA performed in patients with hip osteoarthritis and the risk of revision THA within 2 years of index arthroplasty.

Methods: Data was collected from the Medicare Standardized Analytic Files insurance database using the PearlDiver Patient Records Database from 2005-2016.

Association of Lumbar Degenerative Disease and Revision Rate following Total Knee Arthroplasty.

Recently, a variety of studies have analyzed the potential correlation between lumbar degenerative disease (LDD) and inferior clinical outcomes after total hip arthroplasty. However, there has been limited data concerning the role of LDD as a risk factor for failure after total knee arthroplasty (TKA). The aim of our study was to determine: (1) what is the association of LDDs with TKA failure (all-cause revision) within 2 years of index arthroplasty and (2) if patients with LDD and lumbar fusion are at increased risk of TKA revision within 2 years compared with LDD patients without fusion.

Chronic Osteomyelitis of the tibia and ankle treated with Limb Salvage Reconstruction.

To confirm the success of our limb salvage treatment protocol and determine what factors are predictive of success versus failure in limb salvage techniques for patients with chronic osteomyelitis of the tibia and ankle. Retrospective case series analyzing factors and outcomes in patients who underwent limb salvage techniques for chronic osteomyelitis of tibia or ankle. Main outcome measurements included infection controlled without the need for amputation or chronic antibiotic suppression and union of infected non-unions.

Elbow contracture following operative fixation of fractures about the elbow.

Background: The rates of elbow contracture and contracture release after surgically treated elbow trauma are poorly defined. The purpose of this study was to define the incidence of elbow contracture diagnosis and release after surgical treatment for elbow trauma.

Methods: The Humana insurance database was queried using the PearlDiver Patient Records Database between 2007 and 2017.

Hospital Discharge Within a Day After Total Hip Arthroplasty Does Not Compromise 1-Year Outcomes Compared With Rapid Discharge: An Analysis of an Insurance Claims Database.

Background: As health care costs continue to rise, same-day and rapid discharge have become popular options for total hip arthroplasty (THA). However, it remains unclear if there is a difference between within-a-day discharge and early discharge for 1-year clinical outcomes.

Methods: Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007 to 2017, identifying patients receiving a primary THA.

Prior Knee Arthroscopy Is Associated With Increased Risk of Revision After Total Knee Arthroplasty.

Background: Knee arthroscopy (KA) is frequently performed to provide improved joint function and pain relief. However, outcomes following total knee arthroplasty (TKA) after prior KA are not fully understood. The purpose of this study is to determine the relationship between prior KA within 2 years of TKA on revision rates after TKA.

Complications associated with staged versus simultaneous bilateral total knee arthroplasty: An analysis of 7747 patients.

Background: Benefits of simultaneous bilateral total knee replacement (TKR) include lower costs, decreased hospital stay, and shorter rehabilitation. This study evaluated complications associated with simultaneous versus staged bilateral TKR within 12 months. We hypothesized that after controlling for comorbidities, the simultaneous group would have the highest rate of complications.

Incidence and safety profile of outpatient unicompartmental knee arthroplasty.

Background: Outpatient surgery is an increasingly attractive option for patients undergoing procedures with established, acceptable risk profiles. Benefits of outpatient surgery include cost savings, enhanced patient experience and improved resource allocation at busy hospitals. The purpose of this study was to compare 90-day complication and readmission rates for patients undergoing unicompartmental knee arthroplasty (UKA) in the outpatient as opposed to the inpatient setting.

Inflammatory Arthritis Is a Risk Factor for Multiple Complications After Total Hip Arthroplasty: A Population-Based Comparative Study of 68,348 Patients.

Background: Patients with inflammatory arthritis (IA) are likely at higher risk of postoperative complications following total hip arthroplasty (THA), from the underlying disease, the degree of articular deformity, and immunosuppressive medications. The purpose of this study was to perform a comparative study of the risk of complications after THA between IA and osteoarthritis.

Methods: A national private insurance database was used to select patients undergoing unilateral primary THA.

Diagnosing Prosthetic Joint Infections in Patients With Inflammatory Arthritis: A Systematic Literature Review.

Background: Patients with inflammatory arthritis (IA) are at increased risk of prosthetic joint infections (PJI), yet differentiating between septic and aseptic failure is a challenge. The aim of our systematic review is to evaluate synovial biomarkers and their efficacy at diagnosing PJI in patients with IA.

Methods: A comprehensive literature search was performed in the following databases from inception to January 2018: Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library.

Comparison of pharmacologic prophylaxis in prevention of venous thromboembolism following total knee arthroplasty.

Background: Anticoagulants are used following total knee arthroplasty (TKA) to prevent venous thromboembolism (VTE). These drugs reduce VTE risk but may lead to bleeding-related complications. Recently, surgeons have advocated using antiplatelet agents including aspirin (ASA).

Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty.

Background: Recent studies have shown that intra-articular injections ≤3 months before total knee arthroplasty increase the risk of periprosthetic joint infection. We are aware of no previous study that has differentiated the risk of periprosthetic joint infection on the basis of the type of medication injected. In addition, we are aware of no prior study that has evaluated whether hyaluronic acid injections increase the risk of infection after total knee arthroplasty.

Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail.

Introduction: Femoral lengthening is performed by distraction osteogenesis via lengthening over a nail (LON) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. However, the increased cost of implants has led many to question whether MLN is cost-effective compared with LON.

Has Tranexamic Acid in Total Knee Arthroplasty Made Tourniquet Use Obsolete?

The application of tranexamic acid (TXA) in total joint arthroplasty has dramatically improved peri-operative blood management. In light of these benefits, a study by Huang et al., "Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty," evaluates the need for continued use of the intra-operative tourniquet, which remains a routine practice with documented benefits and adverse effects.

Type of Anticoagulant Used After Total Knee Arthroplasty Affects the Rate of Knee Manipulation for Postoperative Stiffness.

Background: The aim of this study was to perform a population-level analysis on the effect of different types of anticoagulation on postoperative stiffness after total knee replacement, requiring manipulation under anesthesia. We hypothesized that patients receiving warfarin would have a higher rate of manipulation under anesthesia compared with patients receiving low-molecular-weight heparin. We also hypothesized that aspirin, direct factor Xa inhibitors, and fondaparinux would have no effect on the rate of manipulation under anesthesia.

Short-term Complications After Revision Hip Arthroplasty for Prosthetic Joint Infection Are Increased Relative to Noninfectious Revisions.

Background: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is associated with significant morbidity and cost. The purpose of this study was to determine how rates of perioperative complications, operative duration, and postoperative length of stay (LOS) in patients undergoing revision THA for PJI compare to primary THA and to revision THA for non-PJI.

Methods: We used the National Surgical Quality Improvement Program registry from 2005 to 2015 to identify all patients who underwent primary and revision THA.

Adult Reconstruction Hip and Knee Fellowship Program Content and Accessibility.

Background: The objective of the study was to assess the accessibility and content of accredited adult reconstruction hip and knee fellowship program websites.

Methods: Using the online database of the American Association of Hip and Knee Surgeons (AAHKS), we compiled a list of accredited adult hip and knee/tumor reconstruction fellowship programs. A full list of adult reconstruction hip and knee fellowship programs was gathered from the AAHKS website.

Rates and Risk Factors of Conversion Hip Arthroplasty After Closed Reduction Percutaneous Hip Pinning for Femoral Neck Fractures-A Population Analysis.

Background: Closed reduction with percutaneous pinning (CRPP) for nondisplaced or valgus impacted femoral neck fractures is a relatively low-risk operation that can produce excellent union rates in some patients; however, failure can occur in selected patients requiring conversion to arthroplasty. The primary aim of this study was to perform a population-level analysis to determine the rate and timeframe of conversion from CRPP to total hip arthroplasty (THA) or hemiarthroplasty.

Methods: The PearlDiver database was queried from 2007-2015 for all patients who underwent CRPP for a femoral neck fracture.

Handheld Navigation Device and Patient-Specific Cutting Guides Result in Similar Coronal Alignment for Primary Total Knee Arthroplasty: a Retrospective Matched Cohort Study.

Background: Proper alignment of total knee arthroplasty (TKA) is essential for TKA function and may reduce the risk of aseptic failure. Technologies that prevent malalignment may reduce the risk of revision surgery.

Questions/purposes: The purpose of this study was to compare two competing TKA systems that purport improved alignment: patient-specific instrumentation (PSI), and a handheld portable navigation device (NAV).