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COVID Will End But Telemedicine May be Here to Stay
C.A. Krueger,M.A. Mont,D.J. Backstein,J.B. Mason,M.J. Taunton,J.J. Callaghan
doi : 10.1016/j.arth.2021.01.034
VOLUME 36, ISSUE 3, P789-790, MARCH 01, 2021
Medicare Cuts to Hip and Knee Arthroplasty Surgeon Fees in 2021: Will Access to Care Be Jeopardized?
Nathanael D. Heckmann,Cory K. Mayfield,Brian C. Chung,Brett R. Levine,Craig J. Della Valle,Jay R. Lieberman
doi : 10.1016/j.arth.2021.01.003
VOLUME 36, ISSUE 3, P791-794, MARCH 01, 2021
Free Falling: Declining Inflation-Adjusted Payment for Arthroplasty Surgeons
Suresh K. Nayar,Aoife MacMahon,Jacob D. Mikula,Marc Greenberg,Kawsu Barry,Sandesh S. Rao
doi : 10.1016/j.arth.2020.09.047
VOLUME 36, ISSUE 3, P795-800, MARCH 01, 2021
Over the past decade, there have been ongoing concerns over declining surgeon compensation for lower extremity arthroplasty. We aimed to determine changes in surgeon payment, patient charges, and overall reimbursement rates for patients undergoing unicompartmental arthroplasty (UKA) and both primary and revision total knee (TKA) and hip (THA) arthroplasty.
Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty
Aakash H. Keswani,Daniel J. Snyder,Amy Ahn,Michael J. Bronson,Darwin D. Chen,Calin S. Moucha
doi : 10.1016/j.arth.2020.10.007
VOLUME 36, ISSUE 3, P801-809, MARCH 01, 2021
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.
Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty
Tanmaya D. Sambare,Kevin J. Bozic
doi : 10.1016/j.arth.2020.09.028
VOLUME 36, ISSUE 3, P810-815, MARCH 01, 2021
With a history of steadily rising healthcare costs, the United States faces an unprecedented set of health and financial challenges. The COVID-19 pandemic will only exacerbate these challenges, and it is of paramount importance to reform and refine health systems to maximize the value of care delivered to the patient. Recent developments related to value improvement in total joint arthroplasty suggest that episode-based payment is likely to become standard practice given the current healthcare environment. Consequently, developing episode-based care models for total joint arthroplasty is in the best interests of surgeons, health systems, and patients. In this article, we review important developments related to value-based care in total joint arthroplasty and present an episode-based framework for delivering high-value, patient-centric care. We examine each phase of a total joint arthroplasty episode—preoperative, acute, post-acute, and follow up—and present several ideas with developing bodies of evidence that can improve the value of care delivered to the patient.
Effectiveness, Patient Satisfaction, and Cost Reduction of Virtual Joint Replacement Clinic Follow-Up of Hip and Knee Arthroplasty
Abd-Allah H. El Ashmawy,Kathleen Dowson,Ahmed El-Bakoury,Hazem A.H. Hosny,Rathan Yarlagadda,Jonathan Keenan
doi : 10.1016/j.arth.2020.08.019
VOLUME 36, ISSUE 3, P816-822.E1, MARCH 01, 2021
Total hip and knee arthroplasties are increasingly performed operations, and routine follow-up places huge demands on orthopedic services. This study investigates the effectiveness, patients’ satisfaction, and cost reduction of Virtual Joint Replacement Clinic (VJRC) follow-up of total hip arthroplasty and total knee arthroplasty patients in a university hospital. VJRC is especially valuable when in-person appointments are not advised or feasible such as during the COVID-19 pandemic.
Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project: Phase I Outcomes
Cody C. Wyles,Hugh M. Smith,Adam W. Amundson,Kevin I. Perry,Tad M. Mabry,Matthew P. Abdel
doi : 10.1016/j.arth.2020.09.003
VOLUME 36, ISSUE 3, P823-829, MARCH 01, 2021
This study aimed to improve institutional value-based patient care processes, provider collaboration, and continuous process improvement mechanisms for primary total hip arthroplasties and total knee arthroplasties through establishment of a perioperative orthopedic surgical home.
Radiologist Overreads of Intraoperative Radiographs—Value or Waste?
Matthew J. Braswell,Keith A. Fehring,Jeff J. Barry,John Martin J. Ryan,Brian M. Curtin,Thomas K. Fehring
doi : 10.1016/j.arth.2020.09.013
VOLUME 36, ISSUE 3, P830-832, MARCH 01, 2021
All aspects of the arthroplasty pathway must be scrutinized to maximize value and eliminate unnecessary cost. Radiology providers’ contracts with hospitals often call for readings of all radiographs. This policy has little effect on patient care when intraoperative radiographs are taken and used to make real-time decisions. In order to determine the value of radiologist overreads, we asked 3 questions: what was the delay between the time an intraoperative radiograph was taken and time the report was generated, were the overreads accurate, and what is the associated cost?
Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?
Katherine A. Lygrisse,Stephen Zak,Vivek Singh,Lorraine H. Hutzler,Ran Schwarzkopf,Joshua C. Rozell
doi : 10.1016/j.arth.2020.09.021
VOLUME 36, ISSUE 3, P833-836, MARCH 01, 2021
As the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.
Reducing Acute Hospitalization Length of Stay After Total Knee Arthroplasty: A Quality Improvement Study
Yehoshua Gleicher,Naveed Siddiqui,Yusuke Mazda,John Matelski,David J. Backstein,Jesse I. Wolfstadt
doi : 10.1016/j.arth.2020.09.054
VOLUME 36, ISSUE 3, P837-844, MARCH 01, 2021
The introduction of bundled funding for total knee arthroplasty (TKA) has motivated hospitals to improve quality of care while minimizing costs. The aim of our quality improvement project is to reduce the acute hospitalization length of stay to less than 2 days and decrease the percentage of TKA patients discharged to inpatient rehabilitation using an enhanced recovery after surgery bundle.
Common Practices in Intra-Articular Corticosteroid Injection for the Treatment of Knee Osteoarthritis: A Survey of the American Association of Hip and Knee Surgeons Membership
Michael Blankstein,Brandon Lentine,Nathaniel J. Nelms
doi : 10.1016/j.arth.2020.09.022
VOLUME 36, ISSUE 3, P845-850, MARCH 01, 2021
Knee osteoarthritis nonoperative management options remain limited. Our aim is to define the current American Association of Hip and Knee Surgeons (AAHKS) members’ practices and perceptions in terms of the frequency, formulation, use of concomitant aspiration, maximum lifetime number of injections, efficacy, interval between injection and surgery and complication rates.
How Is Surgical Risk Best Assessed? A Cohort Comparison of Measures in Total Joint Arthroplasty
Rebecca L. Johnson,Elizabeth B. Habermann,Madeline Q. Johnson,Matthew P. Abdel,Alanna M. Chamberlain,Carlos B. Mantilla
doi : 10.1016/j.arth.2020.09.046
VOLUME 36, ISSUE 3, P851-856.E3, MARCH 01, 2021
We designed this study to determine whether a Frailty Deficit Index (FI) confers added risk stratification beyond more traditional methods. The associations of preoperative scores on FI, American Society of Anesthesiologists (ASA) physical status, and Charlson Comorbidity Index (CCI) with complications after total joint arthroplasty (TJA) were compared.
Canceled Total Joint Arthroplasty: Who, What, When, and Why?
Chad A. Krueger,Elie Kozaily,Zane Gouda,Emanuele Chisari,P. Maxwell Courtney,Matthew S. Austin
doi : 10.1016/j.arth.2020.09.006
VOLUME 36, ISSUE 3, P857-862, MARCH 01, 2021
Unexpected cancelation of scheduled total joint arthroplasty (TJA) procedures creates patient distress and disruption for the clinical team. The purpose of this study is to identify the etiology and fate of cancelations for scheduled TJAs.
Rates and Causes of 90-day Complications and Readmissions Following Outpatient Hip and Knee Arthroplasty: A Retrospective Analysis of 525 Patients in a Single Institution
Mark H.F. Keulen,Martijn G.M. Schotanus,Emil H. van Haaren,Wouter L.W. van Hemert,Ide C. Heyligers,Bert Boonen
doi : 10.1016/j.arth.2020.09.019
VOLUME 36, ISSUE 3, P863-878, MARCH 01, 2021
Outpatient joint arthroplasty (OJA) has gained increasing popularity and success in a well-defined population. Safety concerns, in terms of complications and readmissions, however still exist.
Same-Day vs One-Day Discharge: Rates and Reasons for Emergency Department Return After Hospital-Based Total Joint Arthroplasty
Grayson C. Kelmer,Justin J. Turcotte,Paul J. King
doi : 10.1016/j.arth.2020.09.027
VOLUME 36, ISSUE 3, P879-884, MARCH 01, 2021
As short stay and outpatient total joint arthroplasties (TJAs) are more widely adopted, it is important to assess whether reducing length of stay leads to increased emergency department (ED) visits or readmissions.
Does Total Hip or Knee Arthroplasty Have an Effect on the Patients’ Functional or Behavioral Outcome and Health-Related Quality of Life of the Affected Partners?
Burkhard Moellenbeck,Frank Horst,Georg Gosheger,Christoph Theil,Leonie Seeber,Tobias Kalisch
doi : 10.1016/j.arth.2020.08.066
VOLUME 36, ISSUE 3, P885-891, MARCH 01, 2021
Spouses are the primary caregivers of patients living with osteoarthritis (OA). Little is known about how the quality of life (QoL) of OA patients’ partners change after total joint replacement surgery (TJR).
Risk Factors for Failure and Optimal Treatment of Total Joint Arthroplasty for Septic Arthritis
Timothy Tan,Chi Xu,Feng-Chih Kuo,Elie Ghanem,Carlos Higuera,Javad Parvizi
doi : 10.1016/j.arth.2020.09.020
VOLUME 36, ISSUE 3, P892-896, MARCH 01, 2021
Patients with native joint septic arthritis are one of the highest risk groups for developing complications following total joint arthroplasty (TJA), especially periprosthetic joint infection(PJI). There is a paucity of information on the risk factors for developing PJI and the optimal treatment modality of the native septic joint that can mitigate that risk. This multicenter study aimed to determine these risk factors, including prior treatment.
Does Symptomatic Benign Prostatic Hyperplasia Increase the Risk of Periprosthetic Joint Infection After Primary Total Joint Arthroplasty?
Alex Gu,Amil Agarwal,Safa C. Fassihi,Patawut Bovonratwet,Joshua C. Campbell,Peter K. Sculco
doi : 10.1016/j.arth.2020.09.017
VOLUME 36, ISSUE 3, P897-904, MARCH 01, 2021
Periprosthetic joint infection (PJI) is among the leading causes of failure in total joint arthroplasty. A recently proposed risk factor for PJI is symptomatic benign prostatic hyperplasia (sBPH). This study aims to determine if sBPH is associated with PJI following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
Operative Duration and Short-Term Postoperative Complications after Unicompartmental Knee Arthroplasty
Michael B. Held,Venkat Boddapati,Nana O. Sarpong,Herbert J. Cooper,Roshan P. Shah,Jeffrey A. Geller
doi : 10.1016/j.arth.2020.09.007
VOLUME 36, ISSUE 3, P905-909, MARCH 01, 2021
Prolonged operative duration is an independent risk factor for postoperative complications in many orthopedic procedures ranging from shoulder arthroscopy to total hip and knee arthroplasties. It has not been well studied in unicompartmental knee arthroplasty (UKA). The purpose of this study is to assess the effect of operative duration on complications after UKA.
Predictors of Satisfactory Outcomes With Fixed-Bearing Lateral Unicompartmental Knee Arthroplasty: Up to 7-year Follow-Up
Huaming Xue,Tong Ma,Tao Wen,Tao Yang,Long Xue,Yihui Tu
doi : 10.1016/j.arth.2020.10.001
VOLUME 36, ISSUE 3, P910-916, MARCH 01, 2021
There is little literature available examining factors that may predict functional recovery after lateral unicompartmental knee arthroplasty (UKA). The purpose of this study was to report short to mid-term effectiveness and evaluate predictors of better outcome following lateral UKA.
Fixed-Bearing Medial Unicompartmental Knee Arthroplasty in Patients Younger Than 55 Years of Age at 4-19 Years of Follow-Up: A Concise Follow-Up of a Previous Report
Tyler E. Calkins,Charles P. Hannon,Yale A. Fillingham,Chris C. Culvern,Richard A. Berger,Craig J. Della Valle
doi : 10.1016/j.arth.2020.09.042
VOLUME 36, ISSUE 3, P917-921, MARCH 01, 2021
Unicompartmental knee arthroplasty (UKA) is an effective alternative to total knee arthroplasty (TKA) in isolated unicompartmental disease; however, mid-term to long-term results in young patients are unknown. The purpose of this study is to determine the mid-term outcomes of fixed-bearing medial UKA in patients less than 55 years of age.
Use of Natural Language Processing Algorithms to Identify Common Data Elements in Operative Notes for Knee Arthroplasty
Elham Sagheb,Taghi Ramazanian,Ahmad P. Tafti,David G. Lewallen,Sunghwan Sohn,Hilal Maradit Kremers
doi : 10.1016/j.arth.2020.09.029
VOLUME 36, ISSUE 3, P922-926, MARCH 01, 2021
Natural language processing (NLP) methods have the capability to process clinical free text in electronic health records, decreasing the need for costly manual chart review, and improving data quality. We developed rule-based NLP algorithms to automatically extract surgery specific data elements from knee arthroplasty operative notes.
Natural Language Processing of Patient-Experience Comments After Primary Total Knee Arthroplasty
Patawut Bovonratwet,Tony S. Shen,Wasif Islam,Michael P. Ast,Steven B. Haas,Edwin P. Su
doi : 10.1016/j.arth.2020.09.055
VOLUME 36, ISSUE 3, P927-934, MARCH 01, 2021
There is interest in improving patient experience after total knee arthroplasty (TKA) due to recent shifts toward value-based medicine. Patient narratives are a valuable but unexplored source of information.
Artificial Intelligence to Identify Arthroplasty Implants From Radiographs of the Knee
Jaret M. Karnuta,Bryan C. Luu,Alexander L. Roth,Brendan M. Patterson,Viktor E. Krebs,Prem N. Ramkumar
doi : 10.1016/j.arth.2020.10.021
VOLUME 36, ISSUE 3, P935-940, MARCH 01, 2021
Revisions and reoperations for patients who have undergone total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA), and distal femoral replacement (DFR) necessitates accurate identification of implant manufacturer and model. Failure risks delays in care, increased morbidity, and further financial burden. Deep learning permits automated image processing to mitigate the challenges behind expeditious, cost-effective preoperative planning. Our aim was to investigate whether a deep-learning algorithm could accurately identify the manufacturer and model of arthroplasty implants about the knee from plain radiographs.
Process Mapping Total Knee Arthroplasty: A Comparison of Instrument Designs
Glenn S. Slick,Charles M. Davis III,John C. Elfar,Lucas E. Nikkel
doi : 10.1016/j.arth.2020.09.035
VOLUME 36, ISSUE 3, P941-945, MARCH 01, 2021
Total knee arthroplasty (TKA) is commonly performed with proprietary, manual instrumentation provided by the surgical implant manufacturer. Registry studies and meta-analysis, with few outliers, have consistently shown similar functional outcomes and implant survival after TKA regardless of implant manufacturer, implant design, or surgical technique. We hypothesized that process mapping could identify areas for improvement in TKA instrumentation.
Robotic-Assisted Total Knee Arthroplasty: An Assessment of Content, Quality, and Readability of Available Internet Resources
Sean Z. Griffiths,Mohamed F. Albana,Lauryn D. Bianco,Manuel C. Pontes,Eddie S. Wu
doi : 10.1016/j.arth.2020.09.033
VOLUME 36, ISSUE 3, P946-952, MARCH 01, 2021
The use of robotic-assisted total knee arthroplasty (TKA) has significantly increased over the past decade. Internet content is largely unregulated and may contain inaccurate and/or misleading information about robotic TKA. Our goal was to assess the content, quality, and readability of online material regarding robotic-assisted TKA.
Randomized Controlled Trial of Sensor-Guided Knee Balancing Compared to Standard Balancing Technique in Total Knee Arthroplasty
Thomas J. Wood,Mitchell J. Winemaker,Dale S. Williams,Danielle T. Petruccelli,Daniel M. Tushinski,Justin de V. de Beer
doi : 10.1016/j.arth.2020.09.025
VOLUME 36, ISSUE 3, P953-957, MARCH 01, 2021
Despite advances in total knee arthroplasty (TKA) technology, up to 1 in 5 patients remain dissatisfied. This study sought to evaluate if sensor-guided knee balancing improves postoperative clinical outcomes and patient satisfaction compared to a conventional gap balancing technique.
Four-Millimeter Additional Bone Resection in the Distal Femur Does Not Result in an Equivalent Increase in the Extension Joint Gap in Total Knee Arthroplasty
Yukihide Minoda,Ryo Sugama,Yoichi Ohta,Hideki Ueyama,Susumu Takemura,Hiroaki Nakamura
doi : 10.1016/j.arth.2020.09.002
VOLUME 36, ISSUE 3, P958-962, MARCH 01, 2021
Additional bone resection in the distal femur is performed to increase the extension joint gap in total knee arthroplasty (TKA). The present study aimed to analyze the relationship between the amount of additional bone resection in the distal femur and the increase in the extension joint gap in TKA.
Posterior Cruciate Ligament Resection Does Not Consistently Increase the Flexion Space in Contemporary Total Knee Arthroplasty
Lucian C. Warth,Evan R. Deckard,R. Michael Meneghini
doi : 10.1016/j.arth.2020.09.041
VOLUME 36, ISSUE 3, P963-969, MARCH 01, 2021
It is accepted dogma in total knee arthroplasty (TKA) that resecting the posterior cruciate ligament (PCL) increases the flexion-space by approximately 4mm. Unfortunately, this doctrine is based on historical studies of limited size with variable technique. The aim of this study was to determine the effect of PCL-resection on in vivo tibiofemoral joint space dimensions in a cohort of modern TKAs.
Choosing the Optimal Wound Dressing for Bathing After Total Knee Arthroplasty
Richard M. Michelin,Eli Ahdoot,Bishoy L. Zakhary,Mitchell McDowell,Michael French
doi : 10.1016/j.arth.2020.09.023
VOLUME 36, ISSUE 3, P970-977, MARCH 01, 2021
Many surgical dressings claim to be waterproof and safe for bathing postoperatively. The purpose of this study is to evaluate and compare the effectiveness of commonly used dressings' ability to prevent water penetration while bathing. Additionally, a survey was used to determine satisfaction and cost analysis performed.
Intranasal Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Total Knee Arthroplasty Under General Anesthesia
Suvi-Maria Sepp?nen,Ronja Kuuskoski,Keijo T. M?kel?,Teijo I. Saari,Panu Uusalo
doi : 10.1016/j.arth.2020.09.032
VOLUME 36, ISSUE 3, P978-985.E1, MARCH 01, 2021
Total knee arthroplasty (TKA) causes severe pain, and strong opioids are commonly used in postoperative analgesia. Dexmedetomidine is a novel alpha-2-adrenoceptor-activating drug indicated for procedural sedation, but previous studies have shown clinically relevant analgesic and antiemetic effects. We evaluated retrospectively the effect of intranasal dexmedetomidine on the postoperative opioid requirement in patients undergoing TKA.
Functional Outcomes are Comparable Between Posterior Stabilized and Cruciate-Substituting Total Knee Arthroplasty Designs at Short-Term Follow-up
Steven Yacovelli,Luis C. Grau,William J. Hozack,P. Maxwell Courtney
doi : 10.1016/j.arth.2020.09.008
VOLUME 36, ISSUE 3, P986-990, MARCH 01, 2021
Posterior stabilized (PS) polyethylene inserts have been shown to have excellent long-term functional results following total knee arthroplasty (TKA). A cruciate-substituting (CS) design has been introduced to minimize bony resection and eliminate concerns regarding wear on the PS post. The purpose of this study is to compare the outcomes of patients who underwent TKA using either a PS or CS insert.
Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection
Ceramic Coating in Cemented Primary Total Knee Arthroplasty is Not Associated With Decreased Risk of Revision due to Early Prosthetic Joint Infection
doi : 10.1016/j.arth.2020.09.011
VOLUME 36, ISSUE 3, P991-997, MARCH 01, 2021
Prosthetic joint infection (PJI) is one of the most frequent and devastating causes of short-term revision total knee arthroplasty (TKA). In vitro evidence suggests ceramic surfaces demonstrate resistance to biofilm, but the clinical effect of bearing surface modifications on the risk of PJI remains unclear. This premier registry-based study examines the influence of ceramic bearing surface coatings on the outcome in cemented primary TKA.
Midterm Outcomes and Survivorship of Anterior Stabilized Versus Cruciate Retaining Bearing in Primary Total Knee Arthroplasty
Jesua I. Law,Jason M. Hurst,Michael J. Morris,Keith R. Berend,Adolph V. Lombardi Jr.,David A. Crawford
doi : 10.1016/j.arth.2020.09.053
VOLUME 36, ISSUE 3, P998-1002, MARCH 01, 2021
There has been increasing utilization of ultracongruent bearings with a cruciate retaining (CR) femoral component in primary total knee arthroplasty. The purpose of this study is to compare outcomes and survivorship between an ultracongruent anterior stabilized (AS) and CR bearing.
Intra-Articular Hyaluronic Acid Injections Less Than 6 Months Before Total Hip Arthroplasty: Is It Safe? A Retrospective Cohort Study in 565 Patients
Sascha Colen,Alexander Hoorntje,Liselore Maeckelbergh,Alain Dalemans,Michel P.J. van den Bekerom,Michiel Mulier
doi : 10.1016/j.arth.2020.09.024
VOLUME 36, ISSUE 3, P1003-1008, MARCH 01, 2021
Intra-articular hyaluronic acid (IAHA) can be injected into an osteoarthritic hip joint to reduce pain and to improve functionality. Several studies report IAHA to be safe, with minor adverse effects that normally disappear spontaneously within a week. However, intra-articular corticosteroids prior to total hip arthroplasty (THA) have been associated with increased infection rates. This association has never been investigated for IAHA and THA. We aimed to assess the influence of IAHA on the outcome of THA, with an emphasis on periprosthetic joint infection (PJI).
Impact of Dexamethasone on Length of Stay and Early Pain Control in Direct Anterior Approach Total Hip Arthroplasty With Neuraxial Anesthesia
McKayla E. Kelly,Justin J. Turcotte,Jacob M. Aja,James H. MacDonald,Paul J. King
doi : 10.1016/j.arth.2020.09.015
VOLUME 36, ISSUE 3, P1009-1012, MARCH 01, 2021
Dexamethasone has been shown to reduce postoperative pain and opioid consumption for total joint arthroplasty patients; however, its impact on patients who received neuraxial anesthesia (NA) is not well described. We examined the impact of perioperative dexamethasone on outcomes for patients undergoing direct anterior approach total hip arthroplasty (THA) under NA.
General vs Neuraxial Anesthesia in Direct Anterior Approach Total Hip Arthroplasty: Effect on Length of Stay and Early Pain Control
McKayla E. Kelly,Justin J. Turcotte,Jacob M. Aja,James H. MacDonald,Paul J. King
doi : 10.1016/j.arth.2020.09.050
VOLUME 36, ISSUE 3, P1013-1017, MARCH 01, 2021
Recent literature has suggested some benefits for neuraxial anesthesia (NA) as an alternative for general anesthesia (GA) for primary total hip arthroplasty patients. We examined the impact of NA vs GA on outcomes for patients undergoing direct anterior (DA) approach total hip arthroplasty (THA) in an institution with established rapid recovery protocols.
Pigmented Villonodular Synovitis of the Hip in Patients Undergoing Total Hip Arthroplasty: A Retrospective Case-Controlled Analysis
Andrew D. Ardeljan,Teja S. Polisetty,Joseph R. Palmer,Justin J. Toma,Gagan Grewal,Martin W. Roche
doi : 10.1016/j.arth.2020.08.064
VOLUME 36, ISSUE 3, P1018-1022, MARCH 01, 2021
Pigmented villonodular synovitis (PVNS) is a condition affecting larger joints such as the hip and knee. Little is known regarding the impact of PVNS on total hip arthroplasty (THA). Therefore, the aim of this study is to determine if patients with PVNS of the hip undergoing primary THA experience greater (1) in-hospital lengths of stay (LOS); (2) complications; (3) readmission rates; and (4) costs.
Iron Deficiency Anemia is Associated with Increased Early Postoperative Surgical and Medical Complications Following Total Hip Arthroplasty
Sean B. Sequeira,Nicole D. Quinlan,Alyssa D. Althoff,Brian C. Werner
doi : 10.1016/j.arth.2020.09.043
VOLUME 36, ISSUE 3, P1023-1028, MARCH 01, 2021
Iron deficiency anemia (IDA) is a medical comorbidity commonly diagnosed in those undergoing primary total hip arthroplasty (THA). The authors sought to evaluate IDA as a risk factor for early postoperative complications following discharge and describe the hospital resource utilization of this patient population.
The Association of Preoperative Smoking With Postoperative Outcomes in Patients Undergoing Total Hip Arthroplasty
Shubham Agrawal,Jerry Ingrande,Engy T. Said,Rodney A. Gabriel
doi : 10.1016/j.arth.2020.09.049
VOLUME 36, ISSUE 3, P1029-1034, MARCH 01, 2021
Preoperative smoking is an easily modifiable risk factor and has associations with increased postoperative morbidity and mortality. It is important to clarify these risks for specific procedures to provide improved and evidence-based quality of care. The purpose of the present study aims to identify the associations between preoperative smoking and 30-day postoperative outcomes in patients undergoing total hip arthroplasty.
Total Hip Arthroplasty in 52 Active Advanced Tubercular Arthritic Hips
Pradeep B. Bhosale,Rishabh Jaiswal,Shaligram Purohit,Shreekar M. Arte
doi : 10.1016/j.arth.2020.09.016
VOLUME 36, ISSUE 3, P1035-1042, MARCH 01, 2021
The role of total hip arthroplasty (THA) in healed tuberculosis (TB) of the hip has been reported with success in the past. However, the role and success of THA in active TB of the hip has remained controversial.
Short vs Standard-Length Femoral Stems Cemented According to the “French Paradox”: A Matched Paired Prospective Study Using Ein Bild Roentgen Analyze Femoral Component at Two-Year Follow-Up
Pierre Laboudie,Firas El Masri,Luc Kerboull,Moussa Hamadouche
doi : 10.1016/j.arth.2020.09.004
VOLUME 36, ISSUE 3, P1043-1048, MARCH 01, 2021
The purpose of this prospective matched paired study is to compare the in vivo migration patterns using Ein Bild Roentgen Analyze femoral component of shortened vs standard-length stems cemented line-to-line in primary total hip arthroplasty (THA) at 2-year follow-up.
Long-Term Results of Total Hip Arthroplasty in Young Patients With Osteonecrosis After Allogeneic Bone Marrow Transplantation for Hematological Disease: A Multicenter, Propensity-Matched Cohort Study With a Mean 11-Year Follow-Up
Seung-Chan Kim,Young-Wook Lim,Woo-Lam Jo,Soo-Bin Park,Yong-Sik Kim,Soon-Yong Kwon
doi : 10.1016/j.arth.2020.09.010
VOLUME 36, ISSUE 3, P1049-1054, MARCH 01, 2021
The number of young patients with hematological disease requiring total hip arthroplasty (THA) is expected to increase. We aimed to investigate the long-term THA outcomes in patients with osteonecrosis of the femoral head (ONFH) following allogeneic bone marrow transplantation (BMT) for hematological disease.
Study to Assess the Rate of Adverse Reaction to Metal Debris in Hip Resurfacing at a Minimum 13-year Follow-up
Graham R. Hastie,Sophie C. Collinson,Adeel Aqil,David E. Temperley,Timothy N. Board,Henry Wynn-Jones
doi : 10.1016/j.arth.2020.09.056
VOLUME 36, ISSUE 3, P1055-1059, MARCH 01, 2021
Hip Resurfacing (HR), although reducing in popularity, is still used in the younger male population. Excellent medium-term results have been published; however, the use of metal on metal has reduced with increased awareness of adverse reactions to metal debris (ARMD). ARMD has been shown to often be clinically “silent” following large Head MoM total hip replacement (THR). The purpose of our study was to report the incidence of ARMD following HR with a minimum follow-up of 13 years.
Conversion of Fused Hip to Total Hip Arthroplasty: Long-Term Clinical and Radiological Outcomes
Guido Grappiolo,Carmine F. Bruno,Mattia Loppini,Davide Castioni,Giorgio Gasparini,Olimpio Galasso
doi : 10.1016/j.arth.2020.09.030
VOLUME 36, ISSUE 3, P1060-1066, MARCH 01, 2021
Despite promising results at the mid-term followup, several aspects of conversion of the fused hip to total hip arthroplasty (THA) remain controversial. The aim of this study was to evaluate clinical and radiological outcomes with a minimum 5-year followup in patients who underwent conversion of the fused hip to THA.
Outcome of Revision Surgery for the Idiopathic Stiff Total Knee Arthroplasty
Liang Xiong,Christian Klemt,Jonathan Yin,Venkatsaiakhil Tirumala,Young-Min Kwon
doi : 10.1016/j.arth.2020.09.005
VOLUME 36, ISSUE 3, P1067-1073, MARCH 01, 2021
Idiopathic stiff total knee arthroplasty (TKA) represents one of the most challenging subsets of the stiff TKA, as the etiology is unknown and there is no consensus on the most appropriate surgical treatment modality. Therefore, the aim of this study is to report on postoperative outcomes of revision surgery for idiopathic stiff TKA.
Revisions for Periprosthetic Hip Infections Do Not Fail More Than Revisions for Aseptic Loosening, but Mortality is Higher
Maurizio Montalti,Barbara Bordini,Simone Natali,Monica Cosentino,Francesco Castagnini,Francesco Traina
doi : 10.1016/j.arth.2020.09.038
VOLUME 36, ISSUE 3, P1074-1079, MARCH 01, 2021
The influence of the reasons for revision on the outcomes of revision hip arthroplasties is controversial and poorly described. A registry study was designed to compare the revision hips performed for periprosthetic hip infection (PHI) to the revision hips performed for aseptic loosening. The aims of this study were the long-term assessment and comparison of survival rates, reasons for rerevisions, and mortality rates between these two cohorts.
Conical Primary Cementless Stem in Revision Hip Arthroplasty: 94 Consecutive Implantations at a Mean Follow-Up of 12.7 years
Sergio Romagnoli,Matteo Marullo,Michele Corbella,Enrico Zero,Andrea Parente,Marco Bargagliotti
doi : 10.1016/j.arth.2020.10.006
VOLUME 36, ISSUE 3, P1080-1086, MARCH 01, 2021
Revision of a failed total hip arthroplasty (THA) poses technical challenges. The use of primary stems for revision can be advantageous for maintaining bone stock and reducing complications: small case series have reported promising results in the short-term to mid-term follow-up. The aim of this study was to evaluate the long-term clinical and functional results and survivorship of a consecutive series of THA femoral component revisions using a conical primary cementless stem (PCS).
Outcome of Debridement, Antibiotics, and Implant Retention With Modular Component Exchange in Acute Culture-Negative Periprosthetic Joint Infections
Venkatsaiakhil Tirumala,Evan Smith,Hayden Box,Janna van den Kieboom,Christian Klemt,Young-Min Kwon
doi : 10.1016/j.arth.2020.08.065
VOLUME 36, ISSUE 3, P1087-1093, MARCH 01, 2021
Modular component exchange and culture-directed antibiotic treatment is routinely employed for acute periprosthetic joint infection (PJI). However, as many as 7%-23% of PJIs have been reported to yield negative culture results. The efficacy of debridement, antibiotics, and implant retention (DAIR) with modular component exchange in the setting of acute culture negative PJI remains largely unknown. The aim of our study is to evaluate the outcomes of DAIR with modular component exchange in acute culture-positive and culture-negative PJI.
Outcomes and Risk Factors Associated With 2-Stage Reimplantation Requiring an Interim Spacer Exchange for Periprosthetic Joint Infection
Christian Klemt,Evan J. Smith,Venkatsaiakhil Tirumala,Georges Bounajem,Janna van den Kieboom,Young-Min Kwon
doi : 10.1016/j.arth.2020.09.012
VOLUME 36, ISSUE 3, P1094-1100, MARCH 01, 2021
Patients undergoing a 2-stage revision for periprosthetic joint infection (PJI) often require a repeat spacer in the interim due to persistent infection. This study aims to report outcomes for patients with repeat spacer exchange and to identify risk factors associated with interim spacer exchange in 2-stage revision arthroplasty.
Trends of Prosthetic Joint Infection Organisms and Recurrence for a Single High-Volume Arthroplasty Surgeon Over 20 Years
Caleb M. Yeung,Vincentius J. Suhardi,Nathan H. Varady,James H. Maguire,Antonia F. Chen,Daniel M. Estok II
doi : 10.1016/j.arth.2020.10.002
VOLUME 36, ISSUE 3, P1101-1108, MARCH 01, 2021
Prosthetic joint infection (PJI) is a morbid complication following total joint arthroplasty (TJA). PJI diagnosis and treatment has changed over time, and patient co-management with a high-volume musculoskeletal infectious disease (MSK ID) specialist has been implemented at our institution in the last decade.
Tranexamic Acid Administration is Associated With a Decreased Odds of Prosthetic Joint Infection Following Primary Total Hip and Primary Total Knee Arthroplasty: A National Database Analysis
Genewoo J. Hong,Lauren A. Wilson,Jiabin Liu,Stavros G. Memtsoudis
doi : 10.1016/j.arth.2020.10.003
VOLUME 36, ISSUE 3, P1109-1113, MARCH 01, 2021
Tranexamic acid (TXA) for the reduction of blood loss in orthopedic surgery is coming into greater adoption. Because TXA administration lowers the incidence of blood transfusion and of hematoma formation, risk factors for infection, we asked whether TXA use might be associated with a lower incidence of periprosthetic joint infection (PJI) following orthopedic surgery.
1.5-Stage Exchange Arthroplasty for Total Knee Arthroplasty Periprosthetic Joint Infections
Nicholas M. Hernandez,Michael W. Buchanan,Thorsten M. Seyler,Samuel S. Wellman,Jessica Seidelman,William A. Jiranek
doi : 10.1016/j.arth.2020.09.048
VOLUME 36, ISSUE 3, P1114-1119, MARCH 01, 2021
Periprosthetic joint infection (PJI) in total knee arthroplasty (TKA) is a challenging problem. The purpose of this study was to outline a novel technique to treat TKA PJI. We define 1.5-stage exchange arthroplasty as placing an articulating spacer with the intent to last for a prolonged time.
Preoperative Patient Factors and Postoperative Complications as Risk Factors for New-Onset Depression Following Total Hip Arthroplasty
Jacob M. Wilson,Andrew M. Schwartz,Kevin X. Farley,Thomas L. Bradbury,George N. Guild
doi : 10.1016/j.arth.2020.10.009
VOLUME 36, ISSUE 3, P1120-1125, MARCH 01, 2021
Depression is known to be a risk factor for complication following primary total hip arthroplasty (THA), but little is known about new-onset depression (NOD) following THA. The purpose of this study is to determine the incidence of NOD and identify risk factors for its occurrence after THA.
Electrocautery Induced Damage of Total Knee Implants
Kirsten C. Miller,Brian R. Morrow,Jameson H. Sorrels,Christina M. Arnholt,William M. Mihalko
doi : 10.1016/j.arth.2020.09.044
VOLUME 36, ISSUE 3, P1126-1132, MARCH 01, 2021
Pitting damage on implants has been reported and attributed to the use of electrocautery. This study aimed to determine how different total knee arthroplasty bearing surfaces are susceptible to this type of damage and whether surgeons are aware that this damage can occur.
In Vivo Corrosion of Sleeved Ceramic Femoral Heads: A Retrieval Study
Cody C. Wyles,Joshua M. Kolz,Douglas W. Van Citters,Daniel J. Berry,Robert T. Trousdale
doi : 10.1016/j.arth.2020.10.005
VOLUME 36, ISSUE 3, P1133-1137, MARCH 01, 2021
The purpose of this study was to evaluate a series of retrieved sleeved ceramic femoral heads used in total hip arthroplasty (THA) and determine qualitative and quantitative damage and corrosion patterns.
The Anatomical Course of the Superior Gluteal Nerve With Regard to the Direct Anterior Approach for Primary and Revision Total Hip Arthroplasty
Vasco Starke,Hannes Stofferin,Sidney Mannschatz,Romed H?rmann,Dietmar Dammerer,Martin Thaler
doi : 10.1016/j.arth.2020.09.045
VOLUME 36, ISSUE 3, P1138-1142, MARCH 01, 2021
During primary and revision total hip arthroplasty (THA) lesions of the superior gluteal nerve (SGN) can substantially compromise patient outcome. For the primary direct anterior approach (DAA) and its proximal approach extensions, especially the muscular branch entering the tensor fasciae latae (TFL) muscle is at risk. SGN lesions can result in fatty atrophy and functional loss of the TFL. Therefore, the course and branching pattern of the SGN were examined and related to the DAA and its proximal approach extension. The aim of the study is to describe safe and danger zones for the SGN with regard to the DAA and its proximal extensions.
EOS Imaging is Accurate and Reproducible for Preoperative Total Hip Arthroplasty Templating
Leonard T. Buller,Alexander S. McLawhorn,Joseph D. Maratt,Kaitlin M. Carroll,David J. Mayman
doi : 10.1016/j.arth.2020.09.051
VOLUME 36, ISSUE 3, P1143-1148, MARCH 01, 2021
Templating is a critical part of preoperative planning for total hip arthroplasty (THA). The accuracy of templating on images acquired with EOS is unknown. This study sought to compare the accuracy and reproducibility of templating for THA using EOS imaging to conventional digital radiographs.
Accuracy of Preoperative Templating in Total Hip Arthroplasty With Special Focus on Stem Morphology: A Randomized Comparison Between Common Digital and Three-Dimensional Planning Using Biplanar Radiographs
Marco Brenneis,Sebastian Braun,Stefan van Drongelen,Timur Tarhan,Felix Stief,Andrea Meurer
doi : 10.1016/j.arth.2020.10.016
VOLUME 36, ISSUE 3, P1149-1155, MARCH 01, 2021
Accurate preoperative planning is a key component of successful total hip arthroplasty (THA). The purpose of the present study was to compare the accuracy and reliability of three-dimensional (hipEOS) and common digital two-dimensional (TraumaCad) templating with special focus on stem morphology.
Analysis of Hip and Knee Reconstruction Questions on the Orthopedic In-Training Examination
Ajay Premkumar,Drake G. Lebrun,Tony S. Shen,Bridget K. Ellsworth,Mathias P.G. Bostrom,Michael B. Cross
doi : 10.1016/j.arth.2020.09.018
VOLUME 36, ISSUE 3, P1156-1159, MARCH 01, 2021
It is vital for orthopedic residents and residency programs to have a current understanding of the materials and resources utilized on the Orthopedic In-Training Examination (OITE) to tailor resident educational curricula accordingly. This study presents an updated analysis of the hip and knee section of the OITE.
Are Cemented Endoprosthetic Reconstructions Superior to Uncemented Endoprostheses in Terms of Postoperative Outcomes and Complications in Patients with Extremity-Located Bone Metastasis Scheduled for Adjuvant Radiotherapy?
Bulent Erol,Fevzi Saglam
doi : 10.1016/j.arth.2020.09.026
VOLUME 36, ISSUE 3, P1160-1167, MARCH 01, 2021
Adjuvant radiotherapy frequently is used for prevention of recurrence following resection and endoprosthetic reconstruction of bone metastases. Besides this positive effect, radiotherapy can negatively affect both cemented and uncemented endoprostheses.
Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Johnathan R. Lex,Thomas C. Edwards,Timothy W. Packer,Gareth G. Jones,Bheeshma Ravi
doi : 10.1016/j.arth.2020.10.010
VOLUME 36, ISSUE 3, P1168-1186, MARCH 01, 2021
The objective of this review is to examine the effect of perioperative systemic corticosteroids at varying doses and timings on early postoperative recovery outcomes following unilateral total knee and total hip arthroplasty. The primary outcome was length of stay (LOS).
Comparative Efficacy of the Different Surgical Approaches in Total Knee Arthroplasty: A Systematic-Review and Network Meta-Analysis
Pierre-Alban Bouché,Simon Corsia,Rémy Nizard,Matthieu Resche-Rigon
doi : 10.1016/j.arth.2020.09.052
VOLUME 36, ISSUE 3, P1187-1194.E1, MARCH 01, 2021
Several surgical approaches including midvastus, subvastus, mini-parapatellar, quadriceps-sparring (QS) and parapatellar are currently used to perform total knee arthroplasty (TKA). Since none of published study exhibited a simultaneous comparison of all of them, a network meta-analysis has been conducted to compare the most widely used knee surgical approaches regarding the improvement of functional outcomes and the range of motion (ROM).
Letter to the Editor on: “Intraarticular Injections of the Hip and Knee With Triamcinolone Versus Ketorolac: A Randomized Controlled Trial”
Weerachai Kosuwon,Witchaporn Witayakom,Kamolsak Sukhonthamarn
doi : 10.1016/j.arth.2020.11.031
VOLUME 36, ISSUE 3, E21, MARCH 01, 2021
Response to Letter to the Editor on “Intraarticular Injections of the Hip and Knee With Triamcinolone Versus Ketorolac: A Randomized Controlled Trial”
Kevin Jurgensmeier,Darin Jurgensmeier,Derek Edward Kunz,Peter Gerard Fuerst,Lucian C. Warth,Steven Bradley Daines
doi : 10.1016/j.arth.2020.11.030
VOLUME 36, ISSUE 3, E22, MARCH 01, 2021
