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.

Patient Satisfaction Is Nearly 90% After Total Knee Arthroplasty; We Are Better Than We Were.

Background: Total knee arthroplasty (TKA) is frequently performed to reduce pain and improve quality of life. Patient satisfaction following TKA is commonly reported at 80%. However, given recent advancements in perioperative management, implants, and operative techniques, new assessments on patient satisfaction are warranted.

Modified frailty index can help predict complications following tibial plateau fracture fixation: a NSQIP study involving 2213 patients.

Purpose: The 5-item modified frailty index (mFI-5) has been established as a reliable indicator of poor postoperative outcomes following a variety of orthopaedic procedures. This study aims to determine whether the mFI-5 can be used by surgeons to predict the likelihood of postoperative complications in patients undergoing open reduction internal fixation (ORIF) for tibial plateau fractures.

Methods: From 2006 to 2019, patients aged 50 years or older undergoing ORIF for tibial plateau fracture were identified in the National Surgical Quality Improvement Program database.

Examining the Relationship Between Value and Patient Satisfaction With Treatment in Total Joint Arthroplasty.

Background: A shift toward performance, cost, outcomes, and patient satisfaction has occurred with healthcare reform promoting value-based programs. The purpose of this study was to evaluate the relationship between patient satisfaction and value with treatment in a cohort of patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods: Value was determined by the relationship of treatment outcome with episodic cost.

Characterizing the Native Microbiome Using Next-Generation Sequencing of Bilateral 'Aseptic' Knees.

Background: Next generation sequencing (NGS) has proven ability to identify organisms beyond those identified through traditional culture-based techniques in cases of suspected prosthetic joint infection. However, there is concern that some microorganisms identified may represent the natural joint microbiome rather than pathogenic agents. This work sought to evaluate the presence of microorganisms identified with NGS in bilateral native, presumed "aseptic" knees with osteoarthritis.

Do Patient-Reported Outcomes Reflect Objective Measures of Function? Implications for Total Knee Arthroplasty.

Background: Patient-reported outcomes (PROs) are used in research, clinical practice, and by federal reimbursement models to assess outcomes for patients who have knee osteoarthritis (OA) and total knee arthroplasty (TKA). We examined a large cohort of patients to determine if commonly used PROs reflect observed evaluation as measured by standardized functional tests (SFTs).

Methods: We used data from the Osteoarthritis Initiative, a 10-year observational study of knee osteoarthritis patients.

Universal Screening for Malnutrition Prior to Total Knee Arthroplasty Is Cost-Effective: A Markov Analysis.

Background: Patients undergoing total knee arthroplasty (TKA) who have malnutrition possess an increased risk of periprosthetic joint infection (PJI). Although malnutrition screening and intervention may decrease the risk of PJI, it utilizes healthcare resources. To date, no cost-effectiveness analyses have been performed on the screening and treatment of malnutrition prior to TKA.

Routine Histopathologic Analysis of Hip and Knee Bone Specimens After Total Joint Arthroplasty.

Total hip and total knee arthroplasties (THA/TKA) are some of the most common elective surgeries done in the United States. Routine histopathologic analysis of hip and knee bone specimens after total joint arthroplasty commonly occurs to identify unexpected pathologic findings and serves as a quality assurance measure. As the most common indication for THA and TKA is osteoarthritis, the practice of routine histopathologic analysis may not be routinely warranted.

Does Time to Reimplantation After Explant for Prosthetic Joint Infection Influence the Likelihood of Successful Outcomes at 2 Years?

Background: Consensus recommendations are lacking regarding appropriate timing of reimplantation following 2-stage resection arthroplasty for prosthetic joint infections (PJIs). We investigated whether the time from resection arthroplasty to reimplantation was associated with treatment outcome at 2 years.

Methods: Retrospective cohort review was conducted for 101 patients undergoing resection arthroplasty with an antibiotic spacer for PJI at a single tertiary academic referral institution.

Does Preoperative Opioid Consumption Increase the Risk of Chronic Postoperative Opioid Use After Total Joint Arthroplasty?

Background: Risk-factor identification related to chronic opioid use after surgery may facilitate interventions mitigating postoperative opioid consumption. We evaluated the relationship between opioid use preceding total hip arthroplasty (THA) and total knee arthroplasty (TKA), and chronic use postoperatively, and the risk of chronic opioid use after total joint arthroplasty.

Methods: All primary THAs and TKAs performed during a 6-month period were identified.

Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty?

Background: There is focus on the direct anterior approach (DAA) for total hip arthroplasty because of perceived postoperative functional improvement. We compared baseline, short-term, and long-term outcomes between the DAA and the posterior approach focusing on baseline function.

Material And Methods: Multivariate linear and logistic regression models were used to analyze prospective data on 1457 total hip arthroplasties comparing baseline characteristics, operative time, 90-day reoperation, length of stay (LOS), extended LOS (>3 days), and facility discharge.

Tobacco Exposure Is Associated With Extremely Low Polyethylene Oxidation in Total Knee Arthroplasty Components.

Background: We evaluate whether patient exposures such as tobacco use are associated with high systemic or local in vivo oxidative state and with increased in vivo polyethylene oxidation.

Methods: We performed a case-control study which evaluated clinical factors associated with high systemic or local in vivo oxidative state among patients whose implants have been identified as demonstrating either extreme or minimal oxidation by our implant retrieval laboratory. Analysis of more than 2500 tibial inserts from explanted total knee arthroplasty demonstrated a wide spectrum of polyethylene oxidation.

Perioperative Antibiotic Prophylaxis: Single and 24-Hour Antibiotic Dosages are Equally Effective at Preventing Periprosthetic Joint Infection in Total Joint Arthroplasty.

Background: Perioperative antibiotic prophylaxis is used to prevent surgical site infection and periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). Secondary to a national shortage of cefazolin, patients at our institution began receiving a single preoperative prophylactic antibiotic dose for primary TJA and no 24-hour postoperative antibiotic prophylaxis. The purpose of the study was to compare the efficacy of single-dose antibiotic use versus 24-hour dosing of prophylactic antibiotics in the prevention of acute PJI and short-term complications after primary TJA.

The Emergence of Collaboration in the Education of Fellows and Residents during COVID-19.

Background: COVID-19 has created a void in surgical education. Given social distancing and postponed surgeries, unique educational opportunities have arisen. Attendings from 10 adult reconstruction fellowships led a multi-institution web-based weekly collaborative, the Arthroplasty Consortium (AC), developed to educate trainees through complex arthroplasty case-based discussions.

Is the Proportion of Patients with "Successful" Outcomes After Two-stage Revision for Prosthetic Joint Infection Different When Applying the Musculoskeletal Infection Society Outcome Reporting Tool Compared with the Delphi-based Consensus Criteria?

Background: There are a variety of criteria for defining successful treatment after two-stage exchange arthroplasty for prosthetic joint infection (PJI). To accurately assess current practices and improve techniques, it is important to first establish reliable, clinically relevant, reproducible criteria for defining persistent infection and "successful" outcomes.

Question/purpose: Is the proportion of patients considered to have successful management of PJI after two-stage resection arthroplasty smaller using 2019 Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT) criteria than when using a Delphi-based criterion?

Methods: Patients were retrospectively identified by Current Procedural Technology codes for resection arthroplasty with placement of an antibiotic spacer for infected THA or TKA between April 1, 2011 and January 1, 2018 at a tertiary academic institution.

Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty.

Background: Under bundled payment models, gainsharing presents an important mechanism to ensure engagement and reward innovation. We hypothesized that metric selection, metric targets, and risk adjustment would impact surgeons' performance in gainsharing models.

Methods: Patients undergoing total joint arthroplasty at an urban health system from 2017 to September 2018 were included.

Current Evidence-based Indications for Modern Noncemented Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is one of the most common procedures performed in orthopaedic surgery. Traditionally, most TKAs have been performed by cementing the implant to the bone with polymethyl methacrylate to provide fixation. Noncemented implants that rely on boney ingrowth for fixation are increasingly appealing to surgeons, given success in total hip arthroplasty and the desire for long-term stability of implants in younger patients.

Does the Impact of Joint Arthroplasty Extend Beyond the Patient? The Effect of Total Joint Arthroplasty on Patient's Significant Others.

Background: This prospective cohort study evaluates the impact of total hip arthroplasty and total knee arthroplasty on patient's spouses/significant others (SSOs).

Methods: Patients and SSOs were provided similar outcome metrics (Global Health Patient-Reported Outcomes Measurement Information System, Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement) at preoperative and postoperative visits. Pearson correlation was used to evaluate scores.

A SANE Approach to Outcome Collection? Comparing the Performance of Single- Versus Multiple-Question Patient-Reported Outcome Measures After Total Hip Arthroplasty.

Background: Several patient-reported outcome measures (PROMs) exist to measure outcomes after total hip arthroplasty (THA) but can be limited by patient-perceived burden and completion rates. We analyzed whether the modified single assessment numerical evaluation (M-SANE), a one-question PROM, would perform similarly to multiple-question PROMs among patients undergoing primary THA.

Methods: Patients undergoing THA completed the Patient-Reported Outcomes Measurement Information System-10 (PROMIS-10), the Hip Disability and Osteoarthritis Outcomes Score Junior (HOOS-Jr), and M-SANE questionnaires both preoperatively and postoperatively.

Characterization of native knee microorganisms using next-generation sequencing in patients undergoing primary total knee arthroplasty.

Background: Next-generation sequencing (NGS) offers improved sensitivity compared to culture-based methods for identifying organisms from synovial joints. It remains unclear whether native microorganisms exist in a joint, and positive NGS results may be interpreted as pathologic when in fact they may represent this native microbiome. The purpose of this study was to characterize the native knee microorganism profile in patients undergoing primary total knee arthroplasty (TKA).

Do Medicare's Patient-Reported Outcome Measures Collection Windows Accurately Reflect Academic Clinical Practice?

Background: The Comprehensive Care for Joint Replacement (CJR) mandates collection of patient-reported outcome measures (PROMs) for eligible total hip and total knee arthroplasty (THA and TKA) procedures during specific time periods that may not be attainable within routine academic practice.

Methods: We performed a retrospective analysis of prospectively collected PROM data from a 2017 cohort of primary THA and TKA patients who completed the Patient-Reported Outcomes Measurement Information System-10 global health survey in preoperative or postoperative time periods. The primary outcome was completion rates of Patient-Reported Outcomes Measurement Information System-10 per the CJR collection periods (90-0 days preoperative and 270-365 days postoperative) compared to an extended postoperative collection period of 270-396 days.

What Happens to Unused Opioids After Total Joint Arthroplasty? An Evaluation of Unused Postoperative Opioid Disposal Practices.

Background: This study evaluates the fate of unused opioids after total hip arthroplasty (THA) and total knee arthroplasty (TKA) at our facility.

Methods: Medication disposal after primary elective THA and TKA was classified as appropriate (in accordance with United States Food and Drug Administration guidelines) or inappropriate for all patients undergoing these procedures during the second half of the fiscal year 2015.

Results: In total, 199 THAs and 144 TKAs met inclusion criteria.

Patient-reported outcomes after above-knee amputation for prosthetic joint infection.

Background: Prosthetic joint infection (PJI) is a challenging complication after total knee arthroplasty (TKA). Above-knee amputation (AKA) is a salvage procedure that may be performed after revision TKAs fail to eradicate PJI. Few studies have investigated patient-reported outcomes.

Third-Generation Sequencing in the Clinical Laboratory: Exploring the Advantages and Challenges of Nanopore Sequencing.

Metagenomic sequencing for infectious disease diagnostics is an important tool that holds promise for use in the clinical laboratory. Challenges for implementation so far include high cost, the length of time to results, and the need for technical and bioinformatics expertise. However, the recent technological innovation of nanopore sequencing from Oxford Nanopore Technologies (ONT) has the potential to address these challenges.