Shared Decision-Making in Total Hip and Knee Arthroplasty: Understanding Surgeon and Patient Perspectives Regarding When It Is Time for Surgery.

Background: Although total hip and total knee arthroplasty are highly successful operations, the decision of whether and when to undergo surgery is highly subjective and discretionary, and specific guidelines regarding readiness for surgery remain elusive. The nature of these decisions underscores the importance of shared decision-making, which is founded on the concept that patients substantially contribute to determining their own readiness for surgery. The OPTION survey was developed as a conversation aid to facilitate shared decision-making in the context of total joint arthroplasty.

Morphological and Mechanical Property Differences in Trapeziometacarpal Ligaments of Healthy and Osteoarthritic Female Joints.

Purpose: To identify changes in morphological and mechanical properties in the volar ligament complex (VLC), dorsoradial ligaments (DRL), and posterior oblique ligaments (POL) in healthy and osteoarthritic female trapeziometacarpal (TMC) joints.

Methods: Twenty-four fresh-frozen female cadaveric TMCs were separated into (1) younger healthy/early-stage osteoarthritic, (2) elder healthy/early-stage osteoarthritic, and (3) advanced-stage osteoarthritic groups based on age and Eaton-Littler grading. Stress relaxation and load-to-failure testing were performed to characterize mechanical tensile properties.

Substantial Improvement in Self-Reported Mental Health Following Total Hip Arthroplasty Occurs Independent of Anesthetic Technique.

Background: The influence of anesthetic type on mental health after total hip arthroplasty (THA) is poorly understood. Adverse effects of general anesthesia (GA) on cognition following major non-cardiac surgery are well known, but mental health following THA is less well-studied. We hypothesized that neuraxial anesthesia (NA) would provide favorable mental health profiles compared with GA after THA.

Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.

Background: Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using multicentered data,, we compared baseline and early post-operative global and condition-specific PROs between patients undergoing cemented versus cementless TKA.

Methods: With PROs prospectively collected through Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial (ClinicalTrials.

Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol.

Introduction: More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%-0.5% fatal PE, and over 1000 deaths.

Contemporary Issues in the Acquisition of Orthopaedic Surgical Skills During Residency: Competency-Based Medical Education and Simulation.

➤: Orthopaedic education should produce surgeons who are competent to function independently and can obtain and maintain board certification.

➤: Contemporary orthopaedic training programs exist within a fixed 5-year time frame, which may not be a perfect match for each trainee.

➤: Most modern orthopaedic residencies have not yet fully adopted objective, proficiency-based, surgical skill training methods despite nearly 2 decades of evidence supporting the use of this methodology.

The Fate of Morbidly Obese Patients With Joint Pain: A Retrospective Study of Patient Outcomes.

Background: The number of obese patients seeking a total joint arthroplasty (TJA) continues to increase. Weight loss is often recommended to treat joint pain and reduce risks associated with TJA. We sought to determine the effectiveness of an orthopedic surgeon's recommendation to lose weight.

Functional Flexion Instability After Rotating-Platform Total Knee Arthroplasty.

Background: We sought to define "at risk" loading conditions associated with rotating-platform total knee arthroplasty (TKA-RP) implants that predispose to insert subluxation and spinout and to quantify tolerances for flexion-extension gap asymmetry and laxity in order to prevent these adverse events.

Methods: Biomechanical testing was performed on 6 fresh-frozen cadaveric limbs with a TKA-RP implant with use of a gap-balancing technique, followed by sequential femoral component revision with variable-thickness polyethylene inserts to systematically represent 5 flexion-extension mismatch and asymmetry conditions. Each configuration was subjected to mechanical loading at 0°, 30°, and 60°.

Preoperative Smoking Cessation as a Durable Form of Long-Term Smoking Cessation.

Smokers who undergo total joint arthroplasty (TJA) face increased rates of medical and surgical complications that can be reduced by preoperative smoking cessation. We investigated the long-term durability of preoperative smoking cessation among TJA patients. Twenty-seven TJA patients who were identified as having an active history of smoking at the preoperative appointment before TJA consented to telephone survey about their perioperative and current smoking status.

The Effects of Bundled Payment Programs for Hip and Knee Arthroplasty on Patient-Reported Outcomes.

Background: Patient-reported outcomes are essential to demonstrate the value of hip and knee arthroplasty, a common target for payment reforms. We compare patient-reported global and condition-specific outcomes after hip and knee arthroplasty based on hospital participation in Medicare's bundled payment programs.

Methods: We performed a prospective observational study using the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement trial.

Patient-Reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches.

Background: Comparisons of patient-reported outcomes (PROs) based on surgical approach for total hip arthroplasty (THA) in the United States are limited to series from single surgeons or institutions. Using prospective data from a large, multicenter study, we compare preoperative to postoperative changes in PROs between posterior, transgluteal, and anterior surgical approaches to THA.

Methods: Patient-reported function, global health, and pain were systematically collected preoperatively and at 1, 3, and 6 months postoperatively from patients undergoing primary THA at 26 sites participating in the Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement (ClinicalTrials.

Finding Greater Value in the Fourth Year of Medical School: Accelerating the Transition to Residency.

The recent focus on competency-based medical education has heralded a true change in U.S. medical education.

Optimal Length of Stay Following Total Joint Arthroplasty to Reduce Readmission Rates.

Background: Length of stay (LOS) following total joint arthroplasty (TJA) continues to decrease. The effects of this trend on readmission risk and total cost are unclear. We hypothesize that optimal LOS following TJA minimizes index hospitalization, early readmission risk, and total cost.

In vivo model of human post-traumatic heterotopic ossification demonstrates early fibroproliferative signature.

Background: The relationship between the tissue injury healing response and development of heterotopic ossification (HO) is poorly understood. Here we compare a rat blast model and human traumatized muscle from a blast injury to study the early signatures of osteogenesis and fibrosis during the formation of HO.

Methods: Rat and human tissues were characterized using histology, scanning electron microscopy, immunohistochemistry, as well as gene and protein expression analysis.

Failure of Indomethacin and Radiation to Prevent Blast-induced Heterotopic Ossification in a Sprague-Dawley Rat Model.

Background: Although use of nonsteroidal antiinflammatory drugs and low-dose irradiation has demonstrated efficacy in preventing heterotopic ossification (HO) after THA and surgical treatment of acetabular fractures, these modalities have not been assessed after traumatic blast amputations where HO is a common complication that can arise in the residual limb.

Questions/purposes: The purpose of this study was to investigate the effectiveness of indomethacin and irradiation in preventing HO induced by high-energy blast trauma in a rat model.

Methods: Thirty-six Sprague-Dawley rats underwent hind limb blast amputation with a submerged explosive under water followed by irrigation and primary wound closure.

Identification of circulating murine CD34OCN cells.

Background Aims: Previous studies identified a circulating human osteoblastic population that expressed osteocalcin (OCN), increased following fracture and pubertal growth, and formed mineralized colonies in vitro and bone in vivo. A subpopulation expressed CD34, a hematopoietic/endothelial marker. These findings led to our hypothesis that hematopoietic-derived CD34OCN cells exist in the circulation of mice and are modulated after fracture.

Governance of Academic Health Centers and Systems: A Conceptual Framework for Analysis.

Health care has evolved from a cottage industry to a very complex one constituting nearly one-fifth of the U.S. economy.

External Beam Irradiation Preferentially Inhibits the Endochondral Pathway of Fracture Healing: A Rat Model.

Background: External beam irradiation is an accepted treatment for skeletal malignancies. Radiation acts on both cancerous and normal cells and, depending on the balance of these effects, may promote or impair bone healing after pathologic fracture. Previous studies suggest an adverse effect of radiation on endochondral ossification, but the existence of differential effects of radiation on the two distinct bone healing pathways is unknown.