Is the American Joint Replacement Registry Able to Correctly Classify Revision Total Knee Arthroplasty Procedural Diagnoses?

Background: The American Joint Replacement Registry (AJRR) is a powerful tool for the study of revision total knee arthroplasty (rTKA). The AJRR uses International Classification of Diseases-10 (ICD-10-CM) codes for recording surgical diagnoses. However, the validity of this methodology is unknown.

Increased Incidence of Methicillin-Resistant Staphylococcus aureus in Knee and Hip Prosthetic Joint Infection.

Background: Periprosthetic joint infection (PJI) is a devastating complication of knee and hip arthroplasty. Past literature has shown that gram-positive bacteria are commonly responsible for these infections, although limited research exists studying the changes in the microbial profile of PJIs over time. This study sought to analyze the incidence and trends of pathogens responsible for PJI over three decades.

Smokeless Tobacco Use is Associated With Worse Outcomes Following Total Knee Arthroplasty.

Background: Studies have demonstrated increased complication risk after total knee arthroplasty (TKA) in patients who smoke cigarettes, but it is unclear if smokeless tobacco use confers a similar impact. The purpose of this study was to (1) evaluate rates of postoperative complications after TKA in smokeless tobacco users and smokers as compared to matched controls, and (2) compare rates of postoperative complications in smokeless tobacco users versus smokers to determine if one is associated with significantly higher rates of postoperative complications.

Methods: A retrospective cohort study was conducted using a national database.

Patient Resilience Influences Opioid Consumption in Primary Total Joint Arthroplasty Patients.

Background: Resilience and depression may influence opioid consumption in patients undergoing primary hip and knee arthroplasty (TJA); however, data evaluating these relationships are limited.

Methods: We retrospectively identified 119 patients undergoing TJA who completed preoperative questionnaires to measure resilience (Brief Resilience Scale) and depression (PHQ-9) from 2017 to 2018 at a single institution. Patients were stratified into high, normal, and low resilience groups as well as no, mild, and major depression groups.

Is cement mantle thickness a primary cause of aseptic tibial loosening following primary total knee arthroplasty?

Background: Aseptic tibial loosening following primary total knee replacement is one of the leading causes of long-term failure. Cement mantle thickness has been implicated as a source of aseptic tibial loosening. Therefore, the following study was designed to determine (1) what is the cement mantle thickness in patients that develop aseptic tibial loosening, and (2) is there a difference in cement mantle thickness based on the interface of failure?

Method: This retrospective cohort included 216 patients revised for aseptic tibial loosening.

The Influence of Femoral Fixation on Mortality and Revision After Hip Arthroplasty in Femoral Neck Fractures in Patients Older Than 65 Years. A Matched Cohort Analysis From the American Joint Replacement Registry.

Introduction: In the United States, most hip arthroplasties for femoral neck fractures are done with a noncemented stem despite worldwide registry data suggesting that cemented fixation has improved long-term survivorship in patients older than 65 years. We, therefore, evaluated the effect of femoral fixation on the risk of revision, revision for periprosthetic fracture (PPFx), and mortality in patients undergoing hip arthroplasty for femoral neck fractures.

Methods: Seventeen thousand one hundred thirty-eight cases of cemented femoral stems were exactly matched to noncemented fixation cases in a 1:1 fashion based on age, sex, and Charlson Comorbidity Index as reported in the American Joint Replacement Registry.

Optimizing Use of Large Databases in Joint Arthroplasty and Orthopaedics.

The potential users of "big data" need to consider many factors when choosing whether to use a large observational database for their research question and, if so, which database is the best fit for the scientific question. The first section of this paper, written by Dr. James A.

Total Hip Arthroplasty: Direct Anterior Approach Versus Posterior Approach in the First Year of Practice.

Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has been popularized as a less invasive technique, however outcomes within the first year of practice after fellowship have not been investigated. The primary aim was to determine differences in complications and outcomes between DAA and posterior approach (PA) in the first year of practice. The secondary aim was to determine if there was a learning curve factor in DAA and PA after fellowship training.

2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

Objective: To develop updated American College of Rheumatology/American Association of Hip and Knee Surgeons guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA).

Methods: We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process.

2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

Objective: To develop updated guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA).

Methods: We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process.

2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.

Objective: To develop updated guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA).

Methods: We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process.

Total Hip Arthroplasty in Patients With Severe Chronic Pubic Diastasis.

Background: Total hip arthroplasty (THA) in patients with severe chronic pubic diastasis from either congenital or acquired causes presents an exceptionally difficult challenge that has rarely been addressed in the arthroplasty literature. The purpose of this paper is to present a series of THAs in patients with severe chronic pubic diastasis, asking the following research questions: (1) What is the survivorship and clinical outcomes after THA in patients with severe chronic pubic diastasis? And (2) What is the rate of complications after THA surgery in this challenging patient population? We additionally describe our algorithm for preoperative planning and rationale for surgical technique and implant position.

Material And Methods: We retrospectively queried the prospective arthroplasty database of 2 high-volume referral centers, yielding 6 THA in 4 patients with severe chronic pubic diastasis (minimum 8 cm) with a mean follow-up of 2.

The 2021 American Association of Hip and Knee Surgeons Annual Meeting Proceedings to be Published Online; Open to All.

This year's 2021 American Association of HIp and Knee Surgeons Annual Meeting Proceeding will be published online and open access.

Mepivacaine Versus Bupivacaine Spinal Anesthesia for Primary Total Joint Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Mepivacaine is an intermediate acting amide local anesthetic that can be used for neuraxial anesthesia in total joint arthroplasty (TJA) with a shorter duration of action (1.5-2 hours) compared to the more commonly used local anesthetic bupivacaine. The purpose of this study was to perform a systematic review and meta-analysis comparing bupivacaine and mepivacaine spinal anesthesia during elective TJA and the surgical outcomes of the time to full neurologic motor return, pain, mobility, length of stay (LOS), and complications including transient neurologic symptoms and urinary function.

Has the time come for regional periprosthetic joint infection centers in the United States? A first-year experience.

Several fields of orthopedics have concluded benefits from volume thresholds. We postulate that we could similarly optimize periprosthetic joint infection (PJI) treatment by creating a regional referral center, concentrating expertise and resources. Here, we review our reasoning and our first-year experience of a PJI referral center in the United States.

Irrigation Solutions and Antibiotic Powders: Should I Use Them in Primary and Revision Total Joint Arthroplasty?

Background: The prevention and treatment of periprosthetic joint infection is of utmost importance to orthopedic surgeons. Irrigation solutions have become a popular additive to the prevention and treatment armamentarium.

Methods: This symposium summarizes the mechanism of action, basic science, and clinical research to date on the use of irrigation solutions.

Chitranjan S. Ranawat Award: Motion During Total Knee Cementing Significantly Decreases Tibial Implant Fixation Strength.

Background: Aseptic tibial loosening following primary total knee arthroplasty persists despite technique and device-related advancements. The mechanisms for this mode of failure are not well understood. We hypothesized that knee movement while the cement was curing dispersed lipids at the implant-cement interface and would result in decreased tibial fixation strength.

Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry.

Background: The purpose of this study was to evaluate outcomes and complications because it relates to surgeon and hospital volume for patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using the American Joint Replacement Registry from 2012 to 2017.

Methods: A retrospective study was conducted on Medicare-eligible cases of primary elective THAs and TKAs reported to the American Joint Replacement Registry database and was linked with the available Centers of Medicaid and Medicare Services claims and the National Death Index data from 2012 to 2017. Surgeon and hospital volume were defined separately based on the median annual number of anatomic-specific total arthroplasty procedures performed on patients of any age per surgeon and per hospital.

Antibiotic Prophylaxis for Prosthetic Joint Patients Undergoing Invasive Dental Procedures: Time for a Rethink?

Background: In the United States, it has been common practice to recommend that dentists provide antibiotic prophylaxis (AP) before invasive dental procedures (IDPs) to prevent late periprosthetic joint infections (LPJIs) in patients who have prosthetic arthroplasties despite lack of evidence for a causal relationship between IDP and LPJI and a lack of evidence for AP efficacy.

Methods: A recent study quantified the IDP incidence over the 15-month period prior to LPJI hospital admissions in the United Kingdom for which dental records were available. A case-crossover analysis compared IDP incidence in the 3 months before LPJI admission with the preceding 12 months.

The Effect of Femoral Fixation on Revision and Mortality Following Elective Total Hip Arthroplasty in Patients Over the Age of 65 years. An Analysis of the American Joint Replacement Registry.

Background: With the overwhelming use of cementless femoral fixation for primary total hip arthroplasty in the United States, the associations of stem fixation on the risk of revision and mortality are poorly understood. We evaluated the relationship between femoral fixation and risk of revision and mortality in patients included in the American Joint Replacement Registry.

Methods: Elective, primary, unilateral total hip arthroplasties in the American Joint Replacement Registry, in patients over the age of 65 years were considered.