One-Year Readmissions Following Total Joint Arthroplasty May Be Associated With Failure to Achieve the Minimal Clinically Important Difference of Patient-Reported Outcomes Measurement Information System Physical, Mental, and Physical-Short Form-10a.

The primary aims of our study were to determine if hospital readmissions within one year following primary total joint arthroplasty (TJA) and their relative timing influence patients' ability to achieve the two-year Patient-Reported Outcomes Measurement Information System (PROMIS) physical, PROMIS mental, and PROMIS Physical-Function-Short-Form-10a (SF-10a) minimal clinically important difference (MCID). This is a retrospective study conducted using data from a multi-institutional, arthroplasty registry. Only patients with paired patient-reported outcome measure (PROM) assessments (preoperatively and two years postoperatively) were included.

The Same Day Discharges following Primary Total Knee Arthroplasty: A Single Surgeon, Propensity Score-Matched Cohort Analysis.

This is a retrospective study. As new surgical techniques and improved perioperative care approaches have become available, the same-day discharge in selected total knee arthroplasty (TKA) patients was introduced to decrease health care costs without compromising outcomes. This study aimed to compare clinical and functional outcomes between same-day discharge TKA patients and inpatient-discharge TKA patients.

The Performance of Diagnostic Tests for Identifying Periprosthetic Joint Infection After Failed Partial Knee Arthroplasty.

Background: Indications for unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty are expanding. Despite the lower published infection rates for UKA and patello-femoral arthroplasty than total knee arthroplasty, periprosthetic joint infection (PJI) remains a devastating complication and diagnostic thresholds for commonly utilized tests have not been investigated recently. Thus, this study evaluated if diagnostic thresholds for PJI in patients who had a failed partial knee arthroplasty (PKA) align more closely with previously reported thresholds specific to UKA or the 2018 International Consensus Meeting on Musculoskeletal Infection.

Can machine learning models predict failure of revision total hip arthroplasty?

Introduction: Revision total hip arthroplasty (THA) represents a technically demanding surgical procedure which is associated with significant morbidity and mortality. Understanding risk factors for failure of revision THA is of clinical importance to identify at-risk patients. This study aimed to develop and validate novel machine learning algorithms for the prediction of re-revision surgery for patients following revision total hip arthroplasty.

The Significance of Race/Ethnicity and Income in Predicting Preoperative Patient-Reported Outcome Measures in Primary Total Joint Arthroplasty.

Background: Utilization of total joint arthroplasty (TJA) by minorities is disproportionately low compared to Whites. Contributing factors include poorer outcomes, lower expectations, and decreased access to care. This study aimed to evaluate if race and income were predictive of preoperative patient-reported outcome measures (PROMs) and the likelihood of achieving the minimal clinically important difference (MCID) following TJA.

Artificial Neural Networks Can Predict Early Failure of Cementless Total Hip Arthroplasty in Patients With Osteoporosis.

Background: Total hip arthroplasty (THA) done in the aging population is associated with osteoporosis-related complications. The altered bone density in osteoporotic patients is a risk factor for revision surgery. This study aimed to develop and validate machine learning (ML) models to predict revision surgery in patients with osteoporosis after primary noncemented THA.

Artificial neural networks for the prediction of transfusion rates in primary total hip arthroplasty.

Background: Despite advancements in total hip arthroplasty (THA) and the increased utilization of tranexamic acid, acute blood loss anemia necessitating allogeneic blood transfusion persists as a post-operative complication. The prevalence of allogeneic blood transfusion in primary THA has been reported to be as high as 9%. Therefore, this study aimed to develop and validate novel machine learning models for the prediction of transfusion rates following primary total hip arthroplasty.

The Ability of Deep Learning Models to Identify Total Hip and Knee Arthroplasty Implant Design From Plain Radiographs.

Introduction: The surgical management of patients with failed total hip or knee arthroplasty (THA and TKA) necessitates the identification of the implant manufacturer and model. Failure to accurately identify implant design leads to delays in care, increased morbidity, and healthcare costs. The automated identification of implant designs has the potential to assist in the surgical management of patients with failed arthroplasty.

Artificial intelligence algorithms accurately predict prolonged length of stay following revision total knee arthroplasty.

Purpose: Although the average length of hospital stay following revision total knee arthroplasty (TKA) has decreased over recent years due to improved perioperative and intraoperative techniques and planning, prolonged length of stay (LOS) continues to be a substantial driver of hospital costs. The purpose of this study was to develop and validate artificial intelligence algorithms for the prediction of prolonged length of stay for patients following revision TKA.

Methods: A total of 2512 consecutive patients who underwent revision TKA were evaluated.

Treatment of Severe Acetabular Bone Loss Using a Tantalum Acetabular Shell and a Cemented Monoblock Dual Mobility Acetabular Cup.

As the number of revision total hip arthroplasty increases, innovative solutions to complex problems are needed to address challenges posed by these complex cases. Severe acetabular bone loss, including cases of pelvic discontinuity, is a notable challenge with few solutions. Hip instability after revision arthroplasty remains one of the leading causes of revision and patient morbidity.

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations.

Purpose: The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF.

Methods: A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture.

Regional Implicit Bias Does Not Account for Racial Disparity in Total Joint Arthroplasty Utilization.

Background: Racial disparities surrounding the utilization of total hip and total knee arthroplasty (THA, TKA) are well documented. The Implicit Association Test (IAT) is a validated tool used to measure implicit and explicit bias. The purpose of this study is to evaluate if variations in IAT scores by geographical region in the United States (US) correspond with regional variations in THA and TKA utilization by blacks compared to whites.

Impact of Preoperative Opioid Use on Patient-Reported Outcomes after Revision Total Knee Arthroplasty: A Propensity Matched Analysis.

This is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited.

Tranexamic acid with a pre-operative suspension of anticoagulation decreases operative time and blood transfusion in the treatment of pelvic and acetabulum fractures.

Purpose: The purpose was to evaluate the impact of intra-operative administration of tranexamic acid (TXA) and pre-operative discontinuation of prophylactic chemoprophylaxis in patients undergoing internal fixation of pelvic or acetabular fractures on the need for subsequent blood transfusion. Operative time and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) were also assessed.

Methods: Data from a single level one trauma centre was retrospectively reviewed from January 2014 to December 2017 to identify pelvic ring or acetabular fractures managed operatively.

The Effects of Patient Occupation, Hobbies, and Body Mass Index on Kneeling after Total Knee Arthroplasty.

A common patient concern after total knee arthroplasty (TKA) is the ability to kneel. Kneeling may have a substantial impact on the patients' ability to perform many activities of daily living, occupations, and hobbies. The purpose of this study was to quantify the percentage of patients able to kneel after TKA after 2 years and to evaluate preoperative patient characteristics that influence the patient's perceived ability to kneel after TKA such as obesity, occupation, and hobbies.

MRI Evaluation of Posterior Capsular Dehiscence After Posterior Approach Total Hip Arthroplasty.

Introduction: To our knowledge, no previous study has evaluated the use of MRI to diagnose posterior capsule dehiscence after posterior approach total hip arthroplasty (THA) with capsular repair and its association with postoperative posterior hip dislocation.

Methods: A retrospective chart review of patients who underwent posterior approach THA with capsulotomy repair was performed. Patients were identified who subsequently underwent MRI, and these studies were evaluated for signs of posterior capsular disruption.

Comparison of Patient Demographics and Utilization Trends of Robotic-Assisted and Non-Robotic-Assisted Unicompartmental Knee Arthroplasty.

Robotic-assisted unicompartmental knee arthroplasty (RAUKA) is an emerging area of interest. The purpose of this study was to compare (1) different patient demographic profiles; (2) annual primary and revision utilization rates; (3) risk factors for revision procedures; and (4) survivorship between RAUKA and manual UKA (MUKA). Using the PearlDiver database, patients who underwent RAUKA or MUKA between 2005 and 2014 within the Medicare database were identified, yielding a total of 35,061 patients (RAUKA = 13,617; manual = 21,444).

Opioid Disorders Are Associated With Thromboemboli Following Primary Total Knee Arthroplasty.

Background: Opioid use disorder (OUD) is defined as a problematic pattern of opioid abuse and dependency leading to problems or distress. The purpose of this study is to investigate whether OUD patients undergoing primary total knee arthroplasty (TKA) have higher rates of venous thromboembolisms (VTEs), readmissions, and costs of care.

Methods: Patients undergoing TKA with OUD were identified and matched to controls in a 1:4 ratio according to age, gender, comorbidity index, and comorbidities within the Medicare database.

Prophylactic inferior vena cava filters for operative pelvic fractures: a twelve year experience.

Introduction: Conflicting evidence exists regarding the role of inferior vena cava filters (IVCFs) in the prevention of pulmonary embolism. The aim of this study was to review an institutional policy of prophylactic IVCF placement in all operative pelvic and acetabular fractures as a means of preventing PE by comparing it to a historical prepolicy period of significantly less aggressive IVCF placement.

Methods: The trauma registry of a single level 1 trauma center was retrospectively queried for all pelvic or acetabular fractures for the prepolicy and intervention periods as defined as January 2003-December 2008 and January 2009-December 2014, respectively-yielding 231 patients for analysis.

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients.

There are conflicting results regarding the impact of rheumatoid arthritis (RA) on total knee arthroplasty (TKA) outcomes. Therefore, the purpose of this study was to compare outcomes of patients with and without RA undergoing primary TKA. Specifically, we assessed (1) 90-day medical complications, (2) 90-day readmission rates, (3) short-term implant-related complications, (4) 1-year mortality, and (5) total global 90-day episode-of-care costs.

Perioperative complications in patients with sleep apnea following primary total shoulder arthroplasty: An analysis of 33,366 patients.

Introduction: The study evaluated whether sleep apnea (SA) patients undergoing total shoulder arthroplasty (TSA) are at greater odds of: 1) medical complications; 2) implant-related complications; 3) readmission rates; and 4) costs.

Methods: Complications and readmissions were assessed using logistic regression analysis. Welch's -test was used to compare CCI and cost between cohorts.

Surgical and Medical Costs for Fibromyalgia Patients Undergoing Total Knee Arthroplasty.

The potential added costs of managing fibromyalgia patients after total knee arthroplasty (TKA) have not been assessed. Therefore, the purpose of this study was to perform a cost analysis of fibromyalgia versus nonfibromyalgia patients who underwent TKA. Specifically, we evaluated the following episodes of care: (1) readmission rates, (2) total costs, (3) total reimbursements, and (4) net losses for surgical and medical complications.