Hidden costs of first choice alternatives: A financial model of thromboprophylaxis and prosthetic joint infection prophylaxis in total knee arthroplasty.

Background: Aspirin has been shown to be equally or more effective than factor Xa inhibitors for thromboprophylaxis following total knee arthroplasty (TKA). Cefazolin has been proven more effective than vancomycin in preventing prosthetic joint infection (PJI) after TKA. This study aimed to compare costs between different drug combinations for prevention of venous thromboembolism (VTE) and PJI following TKA, focusing on costs associated with PJI management.

Mini-Navigation Utilization in THA Results in Shorter Length of Stay, Increased Home Discharge, and Higher Physical Therapy Mobilization Scores Compared to THA Without Navigation.

Background: As volume of total hip arthroplasty (THA) continues to increase, the utilization and availability of in-traoperative advanced technologies to arthroplasty surgeons continues to rise as well. Our primary goal was to determine whether the use of a mini navigation technology extended operative times and secondarily if it affected postoperative outcomes following elective THA.

Methods: A single-institution total joint arthroplasty da-tabase was utilized to identify adult patients who underwent elective THA from 2017 to 2019.

Impact of Selective Posterior Cruciate Ligament Fiber Release on Femoral Rollback in Cruciate-Retaining Total Knee Arthroplasty: A Computational Study.

Background: Partial or total release of the posterior cruciate ligament (PCL) is often performed intraoperatively in cruciate-retaining total knee arthroplasty (CR-TKA) to alleviate excessive femoral rollback. However, the effect of the release of selected fibers of the PCL on femoral rollback in CR-TKA is not well understood. Therefore, we used a computational model to quantify the effect of selective PCL fiber releases on femoral rollback in CR-TKA.

Total knee arthroplasty survivorship and outcomes in young patients: a review of the literature and 40-year update to a longitudinal study.

Introduction: Growing numbers of younger patients are electing to undergo total knee arthroplasty (TKA) for end-stage osteoarthritis. The purpose of this study was to compare established literature regarding TKA outcomes in patients under age 55, to data from an ongoing longitudinal young patient cohort curated by our study group. Further, we aimed to provide a novel update on survivorship at 40 years post-TKA from our longitudinal cohort.

An Artificial Intelligence Chatbot is an Accurate and Useful Online Patient Resource Prior to Total Knee Arthroplasty.

Background: Online information is a useful resource for patients seeking advice on their orthopaedic care. While traditional websites provide responses to specific frequently asked questions (FAQs), sophisticated artificial intelligence tools may be able to provide the same information to patients in a more accessible manner. Chat Generative Pretrained Transformer (ChatGPT) is a powerful artificial intelligence chatbot that has been shown to effectively draw on its large reserves of information in a conversational context with a user.

The Use of Computer Navigation and Robotic Technology in Complex Total Hip Arthroplasty.

Computer assisted surgical (CAS) navigation and robotic-assisted total hip arthroplasty (THA) have the potential to improve the reproducibility of accurate component positioning and facilitate complex cases, including revision and preoperative deformity. Numerous studies, including multiple comparing technology with conventional THA control groups, suggest that CAS navigation may improve component accuracy in cases of deformity such as hip dysplasia and significant leg length discrepancy. Revision THA data is also encouraging but limited.

The Financial Burden of Aspirin versus Oral Factor Xa Inhibitors for Thromboprophylaxis Following Total Knee Arthroplasty.

Background: Aspirin and oral factor Xa inhibitor thromboprophylaxis regimens are associated with similarly low rates of venous thromboembolism following total knee arthroplasty (TKA). However, the rate of prosthetic joint infection (PJI) is lower with aspirin use. This study aimed to compare the cost differential between aspirin and factor Xa inhibitor thromboprophylaxis with respect to PJI management.

Exposure to Extended Reality and Artificial Intelligence-Based Manifestations: A Primer on the Future of Hip and Knee Arthroplasty.

Background: Software-infused services, from robot-assisted and wearable technologies to artificial intelligence (AI)-laden analytics, continue to augment clinical orthopaedics - namely hip and knee arthroplasty. Extended reality (XR) tools, which encompass augmented reality, virtual reality, and mixed reality technology, represent a new frontier for expanding surgical horizons to maximize technical education, expertise, and execution. The purpose of this review is to critically detail and evaluate the recent developments surrounding XR in the field of hip and knee arthroplasty and to address potential future applications as they relate to AI.

Spine or Hip First? Outcomes in Patients Undergoing Sequential Lumbar Spine or Hip Surgery.

Background: Lumbar spine pathology frequently coexists in patients who have hip arthrosis. There is controversy on whether lumbar or hip pathology should be first addressed. The purpose of this study was to evaluate the outcomes of sequential lumbar spine (LSP) or hip arthroplasty (THA).

Aspirin Thromboprophylaxis Following Primary Total Knee Arthroplasty Is Associated With a Lower Rate of Early Prosthetic Joint Infection Compared With Other Agents.

Background: Patients undergoing total knee arthroplasty (TKA) are at increased risk of venous thromboembolism (VTE). Aspirin has been shown to be effective at reducing rates of VTE. In select patients, more potent thromboprophylaxis is indicated, which has been associated with increased rates of bleeding and wound complications.

Indications for Conversion of Spinal into General Anesthesia During Total Joint Arthroplasty.

Introduction: Spinal anesthesia (SA) is the preferred method of anesthesia at many centers for total joint arthro- plasty (TJA). However, a small subset of patients fails SA, necessitating a conversion to general anesthesia (GA). This report assesses the patient characteristics associated with failed SA.

Role of non-ASA VTE prophylaxis in risk for manipulation following primary total knee arthroplasty.

Introduction: Stiffness and decreased range of motion frequently lead to hindrance of activities of daily living and dissatisfaction follow total knee arthroplasty (TKA). This study aims to evaluate the effect of non-aspirin (ASA) chemoprophylaxis and determine patient-related risk factors for stiffness and need for manipulation under anesthesia (MUA) following primary TKA.

Materials And Methods: A review of all patients undergoing primary TKA from 2013 to 2019 at a single academic orthopedic hospital was conducted.

Impact of preoperative opioid use on patient-reported outcomes following primary total knee arthroplasty.

Purpose: The previous literature suggests that 25-30% of patients who undergo total knee arthroplasty (TKA) are using opioids prior to their surgery. This study aims to investigate the effect of preoperative opioid use on clinical outcomes and patient-reported outcome measures (PROMs) following TKA.

Methods: We retrospectively reviewed 329 patients who underwent primary TKA from 2019 to 2020, answered the preoperative opioid survey, and had available PROMs.

Outcomes of isolated head-liner exchange versus full acetabular component revision in aseptic revision total hip arthroplasty.

Introduction: Isolated head and liner exchange in aseptic revision total hip arthroplasty (rTHA) is an appealing option rather than full acetabular component revision; however, early outcome reports suggest high rates of complications requiring re-revision. This study seeks to compare the outcomes of these procedures.

Methods: This retrospective study assessed 124 head and liner exchanges and 59 full acetabular cup revisions conducted at a single center between 2011 and 2019 with at least 2 years of follow-up.

The Effects of Patient Point of Entry and Medicaid Status on Postoperative Opioid Consumption and Pain After Primary Total Hip Arthroplasty.

Introduction: Medicaid expansion has allowed more patients to undergo total hip arthroplasty (THA). Given the continued focus on the opioid epidemic, we sought to determine whether patients with Medicaid insurance differed in their postoperative pain and narcotic requirements compared with privately or Medicare-insured patients.

Methods: A single-institution database was used to identify adult patients who underwent elective THA between 2016 and 2019.

Increased Rate of Early Periprosthetic Joint Infection in Total Hip Arthroplasty With the Use of Alternatives to Cefazolin Despite Additional Gram-Negative Coverage.

Background: Periprosthetic joint infection (PJI) remains one of the most devastating complications following total joint arthroplasty. Appropriate prophylactic antimicrobial administration and antibiotic stewardship are major factors impacting the risk of PJI in total hip arthroplasty (THA). The purpose of our study was to evaluate whether cefazolin administration was superior to noncefazolin antibiotics in prevention of PJI after primary THA.

Increased Rates of Tibial Aseptic Loosening in Primary Cemented Total Knee Arthroplasty With a Short Native Tibial Stem Design.

Background: Emerging evidence has suggested that both obesity and a short, native tibial stem (TS) design may be associated with early aseptic loosening in total knee arthroplasty. The use of short, fully cemented stem extensions may mitigate this risk. As such, we devised a multicenter study to confirm or negate these claims.

A Novel Machine Learning Predictive Tool Assessing Outpatient or Inpatient Designation for Medicare Patients Undergoing Total Knee Arthroplasty.

Background: Removal of total joint arthroplasty from the inpatient-only list has created significant confusion regarding which patients qualify for an inpatient designation. The purpose of this study is to develop and validate a novel predictive tool for assessing who will be an outpatient vs inpatient after total knee arthroplasty (TKA).

Methods: A cohort of Medicare patients undergoing primary TKA between January 2018 and September 2019 were retrospectively reviewed.

Inaccuracy of the intramedullary femoral guide: traditional instrumentation lacks precision and accuracy.

Purpose: The purpose of the study was to utilize a large-scale biomorphometric computer tomography (CT) database to determine the desirable starting point and angle for placement of the femoral intramedullary rod in the sagittal plane.

Methods: A CT-based modeling and analytics system (SOMA, Stryker, Mahwah, NJ) was used to evaluate 1029 entire-femur CT scans. From this, 19,464 simulations were run to test whether a 20 cm intramedullary rod, with a radius of 4 mm, would successfully pass through the femoral canal before contacting cortical bone.

Cefazolin remains the linchpin for preventing acute periprosthetic joint infection following primary total knee arthroplasty.

Aims: Despite recent literature questioning their use, vancomycin and clindamycin often substitute cefazolin as the preoperative antibiotic prophylaxis in primary total knee arthroplasty (TKA), especially in the setting of documented allergy to penicillin. Topical povidone-iodine lavage and vancomycin powder (VIP) are adjuncts that may further broaden antimicrobial coverage, and have shown some promise in recent investigations. The purpose of this study, therefore, is to compare the risk of acute periprosthetic joint infection (PJI) in primary TKA patients who received cefazolin and VIP to those who received a non-cephalosporin alternative and VIP.

Safe and effective use of active robotics for TKA: Early results of a multicenter study.

Background: A novel active robotic system for total knee arthroplasty (TKA) performs automated milling of bone surfaces. Study objectives were to assess system safety and effectiveness in a US population.

Methods: A multicenter clinical trial was conducted, following 115 patients for at least 6-months.

Primary total hip arthroplasty outcomes in octogenarians.

Aims: As our population ages, the number of octogenarians who will require a total hip arthroplasty (THA) rises. In a value-based system where operative outcomes are linked to hospital payments, it is necessary to assess the outcomes in this population. The purpose of this study was to compare outcomes of elective, primary THA in patients ≥ 80 years old to those aged < 80.