Double-Butter: A Cementation Technique That Significantly Reduces Lipid Contamination of the Tibial Baseplate in Total Knee Arthroplasty.

Background: Aseptic loosening is the most common aseptic failure modality following total knee arthroplasty. Recent literature suggests that the implant-cement interface is the "weak-link" in fixation and lipid contamination may drive this debonding pattern. Therefore, the purpose of this study was to determine if the "double-butter" technique would significantly decrease lipid contamination of the tibial tray.

Dual-Mobility Articulations in Primary Total Hip Arthroplasty: Mid-Term Outcomes From the American Joint Replacement Registry.

Background: In recent years, there has been an increased utilization of dual-mobility (DM) implants in primary total hip arthroplasty (THA) to mitigate the risk of postoperative hip instability. This study aimed to present mid-term outcomes of DM bearings in primary THA using data from the American Joint Replacement Registry.

Methods: Screening was conducted on patients aged ≥ 65 years who underwent primary THA between 2012 and 2018.

What Is the Incidence of and Outcomes After Debridement, Antibiotics, and Implant Retention (DAIR) for the Treatment of Periprosthetic Joint Infections in the AJRR Population?

Background: Debridement, antibiotics, and implant retention (DAIR) is used to manage acute periprosthetic joint infections (PJIs) after total joint arthroplasty (TJA). Given the uncertain success of single or multiple DAIR attempts and possible long-term deleterious effects this treatment can create when trying to treat persistent infection, it is important to understand the frequency with which surgeons in the United States are attempting multiple debridements for PJI and whether those procedures are achieving the desired goal.

Question/purposes: In the context of the American Joint Replacement Registry (AJRR), we asked: (1) What proportion of patients who undergo DAIR have only one DAIR, and what percentage of those patients have more than one? (2) Of the patients who undergo one or more DAIR procedures, what is the proportion who progress to additional surgical procedures? (3) What is the cumulative incidence of medical or surgical endpoints related to infection on the affected leg (other than additional DAIR procedures)?

Methods: DAIR procedures to treat PJI, defined by ICD-9/10 and CPT (Current Procedural Technology) codes, reported to the AJRR from 2012 to 2020 were merged with Centers for Medicare and Medicaid Services (CMS) data from 2012 to 2020 to determine the incidence of patients aged 65 and older who underwent additional PJI-related procedures on the same joint.

Pasteurella multocida From a Cat Scratch as a Cause of Recurrent Prosthetic Joint Infection After Previously Successful Single-Stage Exchange Arthroplasty.

We report a case of a 74-year-old female with a history of a prosthetic joint infection that was successfully treated with a single-stage exchange arthroplasty, off antibiotics, and without symptoms for 20 months. She presented 1 week after a cat scratch with acute knee pain, and aspiration grew . She was successfully treated with surgical debridement and a prolonged course of antibiotics.

Cemented Stem Design in Total Hip Arthroplasty: Fixation Philosophies, Biomechanics, and an Updated Classification System.

There is renewed interest in cemented femoral fixation in total hip arthroplasty in the United States, and to fully appreciate the evolution of cemented femoral stem designs, an understanding of their history and design rationale is essential. To adequately study the outcomes of modern-day designs, a comprehensive classification system is also necessary. The biomechanical principles, failure mechanisms, and clinical outcomes associated with various cemented femoral stems are described in this comprehensive review.

Is American Joint Replacement Registry Data Consistent With International Survivorship in Hip and Knee Arthroplasty? A Comparative Analysis.

Background: In collaboration with the Orthopedic Data Evaluation Panel (ODEP), the American Joint Replacement Registry (AJRR) investigated the consistency of hip and knee arthroplasty survivorship results compared to the UK National Joint Registry (NJR).

Methods: A total of three primary knee devices and three primary hip devices were selected by AJRR and ODEP with known variation in performance. Implant manufacturers independently produced Kaplan Meier survivorship based on NJR data and submitted to ODEP for comparison.

Design and Verification of a Metaphyseal Filling Stem for Total Hip Arthroplasty Based on Novel Measurements of Proximal Femoral Anatomy.

Background: Cementless metaphyseal filling stems rely on fixation in the medial-to-lateral and anterior-to-posterior (AP) planes. The purpose of this preclinical study was to develop Insignia, a new metaphyseal filling system to match the anatomy of the proximal femur, and then compare it to clinically successful stems in multiple simulations.

Methods: In this preclinical study, the geometry of the proximal femur in the AP plane among 1321 healthy subjects was evaluated using computed tomography.

Radiographic Cone Zone Classification of Metaphyseal Cone Fixation in Revision Total Knee Arthroplasty.

Background: No objective radiographic scoring system exists to classify metaphyseal cone stability. Our purpose was to create a novel, systematic method to radiographically evaluate metaphyseal cone fixation based on radiographic findings suggestive of cone stability.

Methods: A retrospective analysis was conducted of revision total knee arthroplasty patients (6/2015-12/2017) using porous titanium femoral or tibial metaphyseal cones in conjunction with short cemented stems (50 mm-75 mm).

The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations.

Glucagon-Like Peptide agonists have traditionally been used for glycemic control in diabetic patients. However, there has been a dramatic rise in their utilization for weight loss management. As such, arthroplasty surgeons will encounter an increasing number of patients on these medications, and therefore it is important to understand the implications of their use in the perioperative period.

Precision or Pitfall? Evaluating the Accuracy of ICD-10 Coding for Cemented Total Hip Arthroplasty: A Multicenter Study.

Background: The International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Procedure Coding System (ICD-10-PCS) was adopted in the U.S. in 2015.

Early Radiographic Fit and Fill Analysis of a New Metaphyseal-Filling Triple Taper Stem Designed Using a Large Computed Tomography Scan Database.

Background: Numerous cementless stems are available to maximize implant stability, fit, and survivorship in total hip arthroplasty. Recently, a new metaphyseal-filling triple-taper collared stem was designed using femoral morphology data obtained from over 1300 computed tomography scans. The purpose of this study was to evaluate the radiographic fit and fill of this new stem in the coronal and sagittal dimensions.

Diagnosis and Management of Intraoperative Periprosthetic Fractures in Primary Total Knee Arthroplasty.

Intraoperative periprosthetic fracture is an uncommon but notable complication that can occur during primary total knee arthroplasty. These fractures may occur at various stages during the procedure, including surgical exposure, implant preparation, implant trialing, and final implantation. Management of femoral and tibial fractures necessitates intraoperative recognition, including attentiveness of preoperative patient and surgical risk factors.

Smokeless Tobacco Use is Associated With Worse Medical and Surgical Outcomes Following Total Hip Arthroplasty.

Background: Studies have demonstrated increased complication risk after total hip arthroplasty (THA) in patients who smoke cigarettes. 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 THA in smokeless tobacco users and people who smoke compared to matched controls, and (2) compare rates of postoperative complications in smokeless tobacco users versus patients who smoke.

Anterior capsulectomy versus repair in direct anterior total hip arthroplasty.

Background: Utilization of the direct anterior approach for total hip arthroplasty (DAA THA) has increased over the last ten years. The preservation and repair of the anterior hip capsule has been recommended, while anterior capsulectomy has been described by others. In contrast, the higher risk of posterior dislocation using the posterior approach improved significantly after capsular repair.

Dual Mobility Articulation in Revision Total Hip Arthroplasty: An American Joint Replacement Registry Analysis of Patients Aged 65 Years and Older.

Background: Increasingly, dual mobility (DM) articulations have been used in revision total hip arthroplasty (THA), which may prevent postoperative hip instability. The purpose of this study was to report on outcomes of DM implants used in revision THA from the American Joint Replacement Registry (AJRR).

Methods: Revision THA cases performed between 2012 and 2018 Medicare were eligible and categorized by 3 articulations: DM, ≤32 mm, and ≥36 mm femoral heads.

A Specialist-Led Care Model: Aligning the Patient and Specialist for the Greatest Impact.

In the previous paper, discussing "Risk and the Future of Musculoskeletal Care," we reviewed the basic concepts of the risk corridor, implications on health care overall if we maintain a fee-for-service model, and the need for musculoskeletal specialists to begin taking on/managing risk to reinforce our presence in a "value-based care" system. This paper discusses the successes and failures of recent value-based care models and provides the framework for the paradigm of a specialist-led care model. We posit that orthopedic surgeons are the most knowledgeable physicians to manage musculoskeletal conditions, create new and innovative models, and lead value-based care to the next level.

Risk Should Not Be a "Four-Letter Word" in Healthcare. Risk and the Future of Musculoskeletal Care.

Orthopaedics has seen a rapid transition to value-based care. As we transition away from fee-for-service models, healthcare systems, groups, and surgeons are being asked to take on an increasing amount of risk. While on the surface risk may have a negative connotation, managing risk allows surgeons to maintain autonomy while taking on value-based care to the next level.

Highlights of the 2022 American Joint Replacement Registry Annual Report.

The 2022 American Joint Replacement Registry Annual Report includes data from over 2.8 million hip and knee procedures from over 1,250 institutions that encompass all 50 states and the District of Columbia. This represents a cumulative registered procedural volume growth of 14% compared to the previous year, making the American Joint Replacement Registry the largest arthroplasty registry by volume in the world.

Cemented Femoral Stem Fixation: Back to the Future.

Background: Periprosthetic fractures following elective and nonelective hip arthroplasty remain one of the most common modes of early failure.

Methods: This symposium will explore the current role of cemented fixation and periprosthetic fracture, focusing on history and rationale for cemented stem fixation, registry data, and other potential advantages of cemented stem fixation. A meticulous and methodical surgical technique of cemented stem fixation is paramount to the success and will be thoroughly discussed.

Can the American Joint Replacement Registry Utilize Administrative Claims Data to Accurately Classify Revision Total Hip Arthroplasty (THA) Surgical Diagnoses?

Background: The American Joint Replacement Registry (AJRR) is a valuable tool for studying revision total hip arthroplasty (rTHA). Currently, International Classification of Diseases-10 (ICD-10) codes are utilized by the AJRR for classifying surgical diagnoses. However, the validity of this methodology is unknown.

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.