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Perception of Risk: A Poll of American Association of Hip and Knee Surgeons Members
Adolph J. Yates Jr.,Lynne C. Jones,Charles L. Nelson,Ramon L. Jimenez,Josh M. Kerr,Mary I. O’Connor
doi : 10.1016/j.arth.2020.10.059
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 5, P1471-1477, MAY 01, 2021
Providers of total hip and knee replacements are being judged regarding quality/cost by payers using competition-based performance measures with poor medical and no socioeconomic risk adjustment. Providers might assume that other providers shed risk and the perception of added risk can influence practice. A poll was collected to examine such perceptions.
Early and Direct Rehab Transfer Leads to Significant Cost Savings and Decreased Hospital Length of Stay for Total Joint Arthroplasty in a Veteran Population
Kelly R. Stiegel,Matthew T. Valentine,Jonathan G. Lash,Justin M. Cardenas,Melvyn A. Harrington,David M. Green
doi : 10.1016/j.arth.2020.12.010
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 5, P1478-1483, MAY 01, 2021
Total joint arthroplasty is the most common elective orthopedic procedure in the Veterans Affairs hospital system. In 2019, physical medicine and rehabilitation began screening patients before surgery to select candidates for direct transfer to acute rehab after surgery. The primary outcome of this study was to demonstrate that the accelerated program was successful in decreasing inpatient costs and length of stay (LOS). The secondary outcome was to show that there was no increase in complication, reoperation, and readmission rates.
Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States
Ajay Premkumar,David A. Kolin,Kevin X. Farley,Alexander S. McLawhorn,Michael B. Cross,Peter K. Sculco
doi : 10.1016/j.arth.2020.12.005
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 5, P1484-1489.E3, MAY 01, 2021
In addition to the significant morbidity and mortality associated with periprosthetic joint infection (PJI), the cost of treating PJI is substantial. Prior high-quality national estimates of the economic burden of PJI utilize data up to 2009 to project PJI growth in the United States through 2020. Now in the year 2020, it is appropriate to evaluate these past projections and incorporate the latest available data to better understand the current scale and burden of PJI in the United States.
The Effect of Medicare’s Bundled Payments for Care Initiative on Patient Risk Factors Prior to Total Knee Arthroplasty
Oren I. Feder,Mackenzie A. Roof,Shengnan Huang,Lorraine H. Hutzler,James D. Slover,Joseph A. Bosco III
doi : 10.1016/j.arth.2020.12.031
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 5, P1490-1495, MAY 01, 2021
Medicare’s Bundled Payments for Care Initiative (BPCI) is a risk-sharing alternative payment model. There is a concern that BPCI providers may avoid operating on obese patients and active smokers to reduce costs. We sought to understand if increased focus on these patient factors has led to a change in patient demographics in Medicare-insured patients undergoing total knee arthroplasty (TKA).
Septic Revision Total Hip Arthroplasty Is Not Adequately Compensated by Work Relative Value Units
Theodore Quan,Matthew J. Best,Alex Gu,Seth Stake,Gregory J. Golladay,Savyasachi C. Thakkar
doi : 10.1016/j.arth.2020.11.034
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 5, P1496-1501, MAY 01, 2021
Performing revision total hip arthroplasty (rTHA) for periprosthetic joint infection is complex and may require greater time and resources than aseptic revision cases. Work relative value units (RVUs) assigned may not reflect the difference in actual work required for septic revision hip cases. The purpose of this study is to compare the work effort between aseptic and septic revision hip cohorts, and determine if physicians are appropriately compensated.
Association Between Epidemiological Factors and Nonresponders to Total Joint Replacement Surgery in Primary Osteoarthritis Patients
Christie A. Costello,Ming Liu,Andrew Furey,Proton Rahman,Edward W. Randell,Guangju Zhai
doi : 10.1016/j.arth.2020.11.020
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1502-1510.E5, MAY 01, 2021
While total joint replacement (TJR) is the most effective treatment for end-stage osteoarthritis (OA), one-third of patients do not experience clinically important improvement in pain or function following the surgery. Thus, it is important to identify factors for nonresponders and develop strategies to improve TJR outcomes.
Presenteeism and Absenteeism Before and After Total Hip and Knee Arthroplasty
Mark A. Fontana,Wasif Islam,Michelle A. Richardson,Cathlyn K. Medina,Alexander S. McLawhorn,Catherine H. MacLean
doi : 10.1016/j.arth.2020.11.024
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1511-1519.E5, MAY 01, 2021
Absenteeism is costly, yet evidence suggests that presenteeism—illness-related reduced productivity at work—is costlier. We quantified employed patients’ presenteeism and absenteeism before and after total joint arthroplasty (TJA).
Resilience and Depression Influence Clinical Outcomes Following Primary Total Joint Arthroplasty
Jonathan Q. Trinh,Christopher N. Carender,Qiang An,Nicolas O. Noiseux,Jesse E. Otero,Timothy S. Brown
doi : 10.1016/j.arth.2020.11.032
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1520-1526, MAY 01, 2021
Resilience and depression may impact clinical outcomes following primary total joint arthroplasty (TJA). This study aimed to quantify baseline resilience and depression prevalence in patients undergoing primary TJA and evaluate their influence on patient-reported clinical outcomes.
Predictive Factors of Extended Length of Hospital Stay Following Total Joint Arthroplasty in a Veterans Affairs Hospital Population
Trenden L. Flanigan,Eric M. Kiskaddon,Jonathan A. Rogozinski,Matthew D. Thomas,Andrew W. Froehle,Anil B. Krishnamurthy
doi : 10.1016/j.arth.2020.11.006
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1527-1532, MAY 01, 2021
Improved perioperative care for total joint arthroplasty (TJA) procedures has resulted in decreased hospital length of stay (LOS), including effective discharge on postoperative day (POD) 1 in many patients. It remains unclear what contributes to discharge delay in patients that are not discharged on POD 1. This study investigated factors associated with delayed discharge in patients whose original planned discharge was on POD 1.
Hospital Frailty Risk Score Outperforms Current Risk Stratification Models in Primary Total Hip and Knee Arthroplasty
Matthias Meyer,Lukas Parik,Felix Greimel,Tobias Renkawitz,Joachim Grifka,Markus Weber
doi : 10.1016/j.arth.2020.12.002
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1533-1542, MAY 01, 2021
Models for risk stratification and prediction of outcome, such as the Charlson Comorbidity Index (CCI), the Elixhauser Comorbidity Method (ECM), the 5-factor modified Frailty Index (mFI-5), and the Hospital Frailty Risk Score (HFRS) have been validated in orthopedic surgery. The aim of this study is to compare the predictive power of these models in total hip and knee replacement.
Low-Dose Aspirin Administered for Venous Thromboembolism Prophylaxis Reduces the Incidence of Heterotopic Ossification in Total Joint Arthroplasty
Duncan S. Van Nest,Samuel Clarkson,Emanuele Chisari,Matthew B. Sherman,Javad Parvizi
doi : 10.1016/j.arth.2020.12.021
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1543-1547, MAY 01, 2021
Heterotopic ossification (HO) is a common complication following total joint arthroplasty (TJA). However, the pathophysiology of HO is not entirely understood. Inflammation may play a significant role in the pathogenesis of HO as nonsteroidal anti-inflammatory drugs are effective in the prevention of HO. The purpose of this study is to examine if aspirin (ASA), when used as venous thromboembolism (VTE) prophylaxis, influenced the rate of HO formation following TJA.
Dental Screening in Elective Total Joint Arthroplasty: Risk Factors for Failure
James G. Kohler,Andrew J. Holte,Natalie A. Glass,Nicholas A. Bedard,Timothy S. Brown
doi : 10.1016/j.arth.2020.12.026
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1548-1550, MAY 01, 2021
Active dental infection at the time of total joint arthroplasty (TJA) or in the acute postoperative period following TJA is thought to increase the risk of periprosthetic joint infection (PJI). Many surgeons recommend preoperative dental screening. This study aimed to identify how many elective TJA patients failed preoperative dental screening and what patient risk factors were associated with failure.
Hepatitis C Antiviral Treatment Decreases All-Cause Complications After Total Joint Arthroplasty Regardless of the Presence of Fibrosis
Ella Cornell,David Novikov,Ruijia Niu,Kevin Staatz,Ran Schwarzkopf,Eric L. Smith
doi : 10.1016/j.arth.2020.12.025
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 5, P1551-1555, MAY 01, 2021
Patients with hepatitis C virus (HCV) have an increased risk of complications after total joint arthroplasty (TJA). There is a limited but growing body of evidence on the benefit of preoperative antiviral treatment to reduce complications after TJA. What has not been well established is the effect of preoperative antiviral treatment among those with advanced disease as indicated by hepatic fibrosis.
Prior Knee Arthroscopy Increases the Failure Rate of Subsequent Unicompartmental Knee Arthroplasty
Safa C. Fassihi,Alex Gu,Lauren E. Wessel,Savyasachi C. Thakkar,Peter K. Sculco,Michael P. Ast
doi : 10.1016/j.arth.2020.10.060
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1556-1561.E1, MAY 01, 2021
In selected patients, knee arthroscopy is performed prior to unicompartmental knee arthroplasty (UKA) to treat symptomatic mechanical pathology, delay arthroplasty, and assess the knee compartments. The purpose of this study was to determine if knee arthroscopy prior to UKA is associated with increased rates of UKA failure or conversion to total knee arthroplasty (TKA).
Comparison of Long-Term Survival Analysis Between Open-Wedge High Tibial Osteotomy and Unicompartmental Knee Arthroplasty
Quan He Jin,Won-Gyun Lee,Eun-Kyoo Song,Cheng Jin,Jong-Keun Seon
doi : 10.1016/j.arth.2020.11.008
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1562-1567.E1, MAY 01, 2021
To compare unicompartmental knee arthroplasty (UKA) and open-wedge high tibial osteotomy (OWHTO) in a long-term follow-up propensity score matching analysis.
Development of a Machine Learning Algorithm to Predict Nonroutine Discharge Following Unicompartmental Knee Arthroplasty
Yining Lu,Zain M. Khazi,Avinesh Agarwalla,Brian Forsythe,Michael J. Taunton
doi : 10.1016/j.arth.2020.12.003
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1568-1576, MAY 01, 2021
Reliable and effective prediction of discharge destination following unicompartmental knee arthroplasty (UKA) can optimize patient outcomes and system expenditure. The purpose of this study is to develop a machine learning algorithm that can predict nonhome discharge in patients undergoing UKA.
Modular Tibial Stem Use and Risk of Revision for Aseptic Loosening in Cemented Primary Total Knee Arthroplasty
Adrian D. Hinman,Heather A. Prentice,Elizabeth W. Paxton,Matthew P. Kelly
doi : 10.1016/j.arth.2020.11.003
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1577-1583, MAY 01, 2021
Modular tibial stem extensions in total knee arthroplasty (TKA) are designed to reduce the risk of aseptic loosening of the tibial base plate. However, these implants add significant cost and an evaluation of their effectiveness in reducing this risk of loosening has not been studied in a large cohort. We sought to evaluate modular tibial stem utilization in primary TKA.
A Prospective Randomized Controlled Trial Comparing Medial-Pivot versus Posterior-Stabilized Total Knee Arthroplasty
Justin S. Chang,Babar Kayani,Peter D. Moriarty,Jenni E. Tahmassebi,Fares S. Haddad
doi : 10.1016/j.arth.2021.01.013
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1584-1589.E1, MAY 01, 2021
The medial-pivot (MP) design for total knee arthroplasty (TKA) aims to restore more natural “ball-and-socket” knee kinematics compared to the traditional posterior-stabilized (PS) implants for TKA. The objective of this study is to determine if there was any difference in functional outcomes between patients undergoing MP-TKA vs PS-TKA.
Cryoneurolysis before Total Knee Arthroplasty in Patients With Severe Osteoarthritis for Reduction of Postoperative Pain and Opioid Use in a Single-Center Randomized Controlled Trial
William M. Mihalko,Anita L. Kerkhof,Marcus C. Ford,John R. Crockarell Jr.,James W. Harkess,James L. Guyton
doi : 10.1016/j.arth.2020.11.013
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1590-1598, MAY 01, 2021
We hypothesized that preoperative cryoneurolysis of the superficial genicular nerves in patients with osteoarthritis would decrease postoperative opioid use relative to standard of care (SOC) treatment in patients undergoing total knee arthroplasty (TKA).
Comparison of Intravenous and Topical Dexamethasone for Total Knee Arthroplasty: A Randomized Double-Blinded Controlled Study of Effects on Dexamethasone Administration Route and Enhanced Recovery
Donghai Li,Qiuru Wang,Xin Zhao,Yue Luo,Pengde Kang
doi : 10.1016/j.arth.2020.11.019
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1599-1606, MAY 01, 2021
The optimal route for dexamethasone (DEX) administration regimen for patients undergoing primary TKA has not been investigated. This study aims to determine whether intravenous and topical DEX provide different clinical effects in patients with TKA.
Incidence of Leg-Length Discrepancy After Index Hinge Total Knee Arthroplasty
Joshua R. Labott,Christopher N. Warne,Cody C. Wyles,Robert T. Trousdale
doi : 10.1016/j.arth.2020.11.018
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1607-1610, MAY 01, 2021
Leg-length discrepancies are not commonly associated with total knee arthroplasty (TKA); however, hinge TKA is a complex form of knee reconstruction where functionality of all knee ligaments is replaced by the TKA construct. The purpose of this study is to evaluate the incidence of leg-length discrepancies after unilateral index hinge TKA and association with patient outcomes.
Are Patients Taking Benzodiazepines at Increased Risk for Complications Following Primary Total Knee Arthroplasty?
Nicholas M. Hernandez,Daniel J. Cunningham,Zoe W. Hinton,Christine J. Wu,Thorsten M. Seyler
doi : 10.1016/j.arth.2020.12.004
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1611-1616, MAY 01, 2021
Benzodiazepines are commonly taken by patients who are undergoing total knee arthroplasty (TKA), but there is a paucity of studies evaluating any associations. Therefore, we hoped to study if patients taking preoperative benzodiazepines would have increased complications following TKA.
The Impact of Transitioning From International Classification of Diseases, Ninth Revision to International Classification of Diseases, Tenth Revision on Reported Complication Rates Following Primary Total Knee Arthroplasty
Nicholas A. Bedard,Christopher N. Carender,David E. DeMik,James A. Browne,Ran Schwarzkopf,John J. Callaghan
doi : 10.1016/j.arth.2020.12.009
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1617-1620, MAY 01, 2021
In 2015, the healthcare system transitioned from International Classification of Diseases, Ninth Revision (ICD-9) coding to the Tenth Revision (ICD-10). We sought to determine the effect of this change on the reported incidence of complications following total knee arthroplasty (TKA).
Body Mass Index, American Society of Anesthesiologists Score, and Elixhauser Comorbidity Index Predict Cost and Delay of Care During Total Knee Arthroplasty
Zoe W. Hinton,Amanda N. Fletcher,Sean P. Ryan,Christine J. Wu,Michael P. Bolognesi,Thorsten M. Seyler
doi : 10.1016/j.arth.2020.12.016
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1621-1625, MAY 01, 2021
Body mass index (BMI), American Society of Anesthesiologists (ASA) score, and Elixhauser Comorbidity Index are measures that are utilized to predict perioperative outcomes, though little is known about their comparative predictive effects. We analyzed the effects of these indices on costs, operating room (OR) time, and length of stay (LOS) with the hypothesis that they would have a differential influence on each outcome variable.
Elevated Body Mass Index Is a Risk Factor for Failure to Achieve the Knee Disability and Osteoarthritis Outcome Score-Physical Function Short Form Minimal Clinically Important Difference Following Total Knee Arthroplasty
Akhil Katakam,Charles R. Bragdon,Antonia F. Chen,Christopher M. Melnic,Hany S. Bedair
doi : 10.1016/j.arth.2020.12.019
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1626-1632, MAY 01, 2021
The aims of this study are (1) to assess the association between body mass index (BMI) and failure to achieve the 1-year Knee Disability and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS) minimal clinically important difference (MCID) for total knee arthroplasty (TKA) patients and (2) to determine if there is a BMI threshold beyond which the risk of failing to achieve the MCID is significantly increased.
Intraosseous Regional Administration of Vancomycin in Primary Total Knee Arthroplasty Does Not Increase the Risk of Vancomycin-Associated Complications
Antonio Klasan,Chetan Kumar Patel,Simon William Young
doi : 10.1016/j.arth.2020.12.034
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1633-1637, MAY 01, 2021
Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a rare but major complication. Owing to an increasing antibiotic resistance in bacteria causing PJI, vancomycin has been investigated as a prophylactic agent. Intraosseous regional administration (IORA) of vancomycin achieves significantly higher local tissue concentrations than systemic administration. There are limited data on IORA of vancomycin with respect to vancomycin-associated complications.
Effect of Different Tourniquet Pressure on Postoperative Pain and Complications After Total Knee Arthroplasty: A Prospective, Randomized Controlled Trial
Piya Pinsornsak,Punnawit Pinitchanon,Krit Boontanapibul
doi : 10.1016/j.arth.2020.12.049
PRIMARY KNEE| VOLUME 36, ISSUE 5, P1638-1644, MAY 01, 2021
Tourniquet pressure inflation is commonly selected between 100 and 150 mm Hg above the systolic blood pressure (SBP). Given the lack of evidence to support a given inflation pressure, our study aimed to ascertain the lowest tourniquet pressure that facilitated total knee arthroplasty (TKA) and resulted in the least postoperative pain and complications.
Return to Sports After Total Hip Arthroplasty: A Survey Among Members of the European Hip Society
Martin Thaler,Ismail Khosravi,David Putzer,Klaus A. Siebenrock,Luigi Zagra
doi : 10.1016/j.arth.2020.11.009
PRIMARY HIP| VOLUME 36, ISSUE 5, P1645-1654, MAY 01, 2021
The study’s aim was to summarize the recommendations given by members of the European Hip Society (EHS) regarding sport activities after total hip arthroplasty (THA).
Development of a Novel, Potentially Universal Machine Learning Algorithm for Prediction of Complications After Total Hip Arthroplasty
Akash A. Shah,Sai K. Devana,Changhee Lee,Reza Kianian,Mihaela van der Schaar,Nelson F. SooHoo
doi : 10.1016/j.arth.2020.12.040
PRIMARY HIP| VOLUME 36, ISSUE 5, P1655-1662.E1, MAY 01, 2021
As the prevalence of hip osteoarthritis increases, the number of total hip arthroplasty (THA) procedures performed is also projected to increase. Accurately risk-stratifying patients who undergo THA would be of great utility, given the significant cost and morbidity associated with developing perioperative complications. We aim to develop a novel machine learning (ML)-based ensemble algorithm for the prediction of major complications after THA, as well as compare its performance against standard benchmark ML methods.
Understanding the Main Predictors of Length of Stay After Total Hip Arthroplasty: Patient-Related or Procedure-Related Risk Factors?
The Cleveland Clinic OME Arthroplasty Group
doi : 10.1016/j.arth.2020.11.029
PRIMARY HIP| VOLUME 36, ISSUE 5, P1663-1670.E4, MAY 01, 2021
Removing total hip arthroplasty (THA) from the Centers for Medicare & Medicaid Services (CMS) inpatient-only list allows Medicare to cover outpatient THA, driving hospitals to recommend outpatient surgery for appropriate patients and raising safety concerns over which patients’ admissions should remain inpatient. Thus, we aimed to determine the influence of patient-related and procedure-related risk factors as predictors of >1-day Length of Stay (LOS) after THA.
Survival Analysis of Total Hip Arthroplasty for High Hip Dislocation Secondary to Developmental Dysplasia or Septic Arthritis of the Hip
Sheng-Yu Jin,Jing-Yao Jin,Jae-Hyeok Cheon,Taek-Rim Yoon,Kyung-Soon Park
doi : 10.1016/j.arth.2020.11.007
PRIMARY HIP| VOLUME 36, ISSUE 5, P1671-1677, MAY 01, 2021
This retrospective study was conducted to know clinical and radiographic outcomes, complication rate, and survival of THA in patients with high hip dislocation secondary to developmental dysplasia(DDH) or septic arthritis of the hip(SSH).
Articular Noise After THA Using Delta CoC Bearings Has Little Impact on Quality of Life
Jean-Christophe Chatelet,Michel-Henri Fessy,Mo Saffarini,Alain Machenaud,Artro Institute Writing Committee,Laurent Jacquot
doi : 10.1016/j.arth.2020.11.012
PRIMARY HIP| VOLUME 36, ISSUE 5, P1678-1687, MAY 01, 2021
To report clinical outcomes and survival at a minimum of 10 years of a consecutive series of uncemented total hip arthroplasty (THA) with fourth-generation ceramic-on-ceramic (CoC) bearings and determine the incidence of articular noises, their risk factors, and impact on quality of life (QoL).
Mid-Term Survivorship, Performance, and Predictors of Outcome in Primary Total Hip Arthroplasty With a Porous Tantalum Femoral Prosthesis
Faisal Akram,Kyle N. Kunze,Benjamin Kerzner,Alejandro Gonzalez,Arnold Palacios,Brett R. Levine
doi : 10.1016/j.arth.2020.12.001
PRIMARY HIP| VOLUME 36, ISSUE 5, P1688-1694, MAY 01, 2021
Femoral stem subsidence is a known cause of early implant failure, increasing the risk for aseptic loosening and periprosthetic fracture. Overall survivorship and subsidence in a novel porous tantalum-coated femoral prosthesis have not been well-studied.
Dual Mobility and Conventional Bearings Have Comparably Low Dislocation Rates for Anterior-Based Approaches in Total Hip Arthroplasty
Duncan S. Van Nest,William T. Li,Zachary Kozick,Eric B. Smith,William J. Hozack,P. Maxwell Courtney
doi : 10.1016/j.arth.2020.12.022
PRIMARY HIP| VOLUME 36, ISSUE 5, P1695-1699, MAY 01, 2021
Dual mobility (DM) bearings for total hip arthroplasty (THA) have been proposed to reduce the risk of instability in select patients, especially those undergoing revision surgery. The use of DM bearings has not been studied as extensively for use in primary THA. The purpose of this study is to compare outcomes following primary THA with anterior-based approaches between patients receiving DM bearings vs standard bearing hip implants.
Survivorship and Patient-Reported Outcomes of an Uncemented Vitamin E–Infused Monoblock Acetabular Cup: A Multicenter Prospective Cohort Study
Fahd F. Mahmood,Martin Beck,Arthur de Gast,Naeder Helmy,Lutz Hollmann,Joe Baines
doi : 10.1016/j.arth.2020.12.032
PRIMARY HIP| VOLUME 36, ISSUE 5, P1700-1706, MAY 01, 2021
Addition of vitamin E to polyethylene is theorized to reduce the potential for oxidative wear in acetabular components. This paper presents a multicenter prospective cohort study that reports on outcomes from use of a Vitamin E–infused highly cross-linked polyethylene acetabular cup.
A Prospective, Randomized Comparison of the Long-Term Clinical and Radiographic Results of an Ultra-Short vs a Conventional Length Cementless Anatomic Femoral Stem
Young-Hoo Kim,Young-Soo Jang,Eun-Jung Kim
doi : 10.1016/j.arth.2020.12.030
PRIMARY HIP| VOLUME 36, ISSUE 5, P1707-1713, MAY 01, 2021
The purpose of this study is to compare the long-term clinical and radiographic results, survival rates, and complication rates of an ultra-short vs a conventional length cementless anatomic femoral stem.
Contemporary Porous Titanium Acetabular Components for Total Hip Arthroplasty After Pelvic Radiation
Elizabeth P. Wellings,Cory G. Couch,Michael J. Taunton,Mark W. Pagnano,Daniel J. Berry,Matthew P. Abdel
doi : 10.1016/j.arth.2020.12.045
PRIMARY HIP| VOLUME 36, ISSUE 5, P1714-1718, MAY 01, 2021
Patients undergoing primary total hip arthroplasty (THA) following pelvic radiation have historically had poor survivorship free of aseptic acetabular component loosening. However, several series have reported improved results with tantalum acetabular components. The purpose of this study is to assess implant survivorship, radiographic results, and clinical outcomes of contemporary, porous titanium acetabular components in the setting of prior pelvic radiation.
Preoperative Anemia Independently Predicts Significantly Increased Odds of Short-Term Complications Following Aseptic Revision Hip and Knee Arthroplasty
Alex Gu,Aaron Z. Chen,Nicolas A. Selemon,Safa C. Fassihi,Joshua C. Campbell,Peter K. Sculco
doi : 10.1016/j.arth.2020.10.061
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 5, P1719-1728, MAY 01, 2021
Preoperative anemia is an important risk factor for developing complications following revision hip (rTHA) and knee (rTKA) arthroplasty. We aim to determine the effect of anemia severity on 30-day postoperative complications following revision hip and knee arthroplasty.
Cost of Aseptic Revision Total Knee Arthroplasty at a Tertiary Medical Center
John R. Steele,Sean P. Ryan,William A. Jiranek,Samuel S. Wellman,Michael P. Bolognesi,Thorsten M. Seyler
doi : 10.1016/j.arth.2020.11.028
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 5, P1729-1733, MAY 01, 2021
Revision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following: (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost associated with different types of aseptic TKA revisions, based on number and type of components revised, is not well described. We sought to determine differences in cost associated with different revision types, and to correlate this with average national hospital and surgeon reimbursement based on current Centers for Medicare and Medicaid Services data.
Etiology and Complications of Early Aseptic Revision Total Hip Arthroplasty Within 90 Days
Tony S. Shen,Alex Gu,Patawut Bovonratwet,Nathaniel T. Ondeck,Peter K. Sculco,Edwin P. Su
doi : 10.1016/j.arth.2020.11.011
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 5, P1734-1739, MAY 01, 2021
The etiology, complications, and rerevision risks of early aseptic revision total hip arthroplasty (THA) within 90 days are insufficiently documented.
Trabecular Metal Augments for Severe Acetabular Defects in Revision Hip Arthroplasty: A Long-Term Follow-Up
Shane P. Russell,Cathleen J. O'Neill,Eoin J. Fahey,Shane Guerin,Rehan Gul,James A. Harty
doi : 10.1016/j.arth.2020.12.033
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 5, P1740-1745, MAY 01, 2021
Paprosky type IIIa and IIIb acetabular defects remain technically challenging during revision hip arthroplasty. Numerous surgical options exist to counter extensive acetabular bone loss with high postoperative complication and revision rates reported. Our aim was to report comprehensive long-term outcomes of our experience with Trabecular Metal (TM) augments for these difficult cases.
Alpha-Defensin Offers Limited Utility in Routine Workup of Periprosthetic Joint Infection
Lindsay T. Kleeman-Forsthuber,Roseann M. Johnson,Anna C. Brady,Aviva K. Pollet,Douglas A. Dennis,Jason M. Jennings
doi : 10.1016/j.arth.2020.12.018
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 5, P1746-1752, MAY 01, 2021
Alpha-defensin (AD) is a synovial biomarker included as a minor criterion in the scoring system for diagnosing periprosthetic joint infection (PJI). The purpose of this study is to study the impact of AD on diagnosis and management of PJI.
The Cost-Effectiveness of Silver-Impregnated Occlusive Dressings for Infection Prevention After Total Joint Arthroplasty
Alexander J. Toppo,Nicholas R. Pagani,Michael A. Moverman,Richard N. Puzzitiello,Mariano E. Menendez,Joseph J. Kavolus
doi : 10.1016/j.arth.2020.11.017
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 5, P1753-1757, MAY 01, 2021
Prosthetic joint infection (PJI) is a catastrophic complication after total joint arthroplasty that exacts a substantial economic burden on the health-care system. This study used break-even analysis to investigate whether the use of silver-impregnated occlusive dressings is a cost-effective measure for preventing PJI after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Fungal Periprosthetic Joint Infection: A Review of Demographics and Management
Christopher E. Gross,Craig J. Della Valle,James C. Rex,Sophia A. Traven,Elizabeth C. Durante
doi : 10.1016/j.arth.2020.11.005
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 5, P1758-1764, MAY 01, 2021
Periprosthetic joint infection (PJI) is one of the most feared complications of total joint arthroplasty (TJA). Although commonly the result of colonization by Staphylococcal species, a growing number of cases of PJI with fungal pathogens have been reported within the last decade. Although standard treatment with two-stage exchange mirrors that of bacterial PJI, the variability in virulence between fungal species makes for an unpredictable and challenging treatment course.
Outcome of Irrigation and Debridement With Topical Antibiotics Delivery for the Management of Periprosthetic Joint Infection Occurring Within 3 Months Since the Primary Total Joint Arthroplasty
Wenbo Mu,Boyong Xu,Wentao Guo,Baochao Ji,Tuerhongjiang Wahafu,Li Cao
doi : 10.1016/j.arth.2020.11.033
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 5, P1765-1771, MAY 01, 2021
Irrigation and debridement with modular component exchange is appealing for surgeons to treat early-stage periprosthetic joint infection (PJI). However, the indication, perioperative protocol, and success rate remain controversial. This study is the first one to present results of debridement, antibiotics, and implant retention (DAIR) with integrated MIT (modular component exchange, povidone-iodine and topical antibiotics delivery) protocol for treating PJI occurring within 3 months since the primary total joint arthroplasty.
Iliopsoas Impingement After Direct Anterior Approach Total Hip Arthroplasty: Epidemiology, Risk Factors, and Treatment Options
Leonard T. Buller,Luke G. Menken,Evan J. Hawkins,Gilbert C. Roc Jr.,H. John Cooper,Jose A. Rodriguez
doi : 10.1016/j.arth.2020.12.012
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 5, P1772-1778, MAY 01, 2021
The objective of this study is to evaluate the incidence, natural history, response to treatment, and risk factors for anterior iliopsoas impingement (AIPI) after direct anterior approach (DAA) total hip arthroplasty (THA).
Revision Surgery for Instability After Total Hip Arthroplasty: Does Timing Matter?
Nathanael D. Heckmann,JaeWon Yang,Kevin L. Ong,Brian C. Fuller,Daniel D. Bohl,Craig J. Della Valle
doi : 10.1016/j.arth.2020.12.035
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 5, P1779-1783.E2, MAY 01, 2021
Instability is a common reason for revision surgery after total hip arthroplasty (THA). Recent studies suggest that revisions performed in the early postoperative period are associated with higher complication rates. The purpose of this study is to assess the effect of timing of revision for instability on subsequent complication rates.
The Change in Posterior Tibial Slope After Cementless Unicondylar Knee Arthroplasty
Enejd Veizi,Ahmet F?rat,Osman Tecimel,?ahin ?epni,?zzet ?zay Suba??,Kas?m K?l?çarslan
doi : 10.1016/j.arth.2020.12.041
BASIC SCIENCE| VOLUME 36, ISSUE 5, P1784-1791, MAY 01, 2021
The posterior tibial slope (PTS) is an important factor in patients undergoing unicondylar knee arthroplasty. It is an area subjected to high shear and compressive forces. Our objective is to investigate the changes taking place on the tibial slope of cementless unicondylar knee arthroplasties and define its relationship with functional scores.
Impact of Valgus vs Varus Mechanical Axis Correction During Primary Total Knee Arthroplasty on Postoperative Periarticular Bone Mineral Density
Julien Chapleau,Bradley S. Lambert,Thomas C. Sullivan,Terry A. Clyburn,Stephen J. Incavo
doi : 10.1016/j.arth.2020.12.011
BASIC SCIENCE| VOLUME 36, ISSUE 5, P1792-1798, MAY 01, 2021
Knee periarticular bone mineral density (BMD) is influenced by limb malalignment. The purpose of this study is to determine if the nature and magnitude of alignment correction (?Align°) performed during primary total knee arthroplasty (TKA) had an impact on BMD at the metaphysis of the distal femur (DFmr) and proximal tibia (PTb).
Are We Being Fooled by Fluoroscopy? Distortion May Affect Limb-Length Measurements in Direct Anterior Total Hip Arthroplasty
Victor R. Carlson,Iain S. Elliott,Graham J. DeKeyser,Christopher E. Pelt,Lucas A. Anderson,Jeremy M. Gililland
doi : 10.1016/j.arth.2020.11.021
BASIC SCIENCE| VOLUME 36, ISSUE 5, P1799-1803, MAY 01, 2021
Distortion is an intrinsic phenomenon associated with image-intensified fluoroscopy that is both poorly understood and infrequently appreciated by orthopedic surgeons. Little information exists regarding its potential influence on intraoperative parameters during orthopedic surgery, let alone during direct anterior (DA) total hip arthroplasty (THA). The purpose of this study was to quantify the amount of potential error caused by fluoroscopic distortion during DA THA.
Disparities Among Leading Publishers of Arthroplasty Research
Raylin F. Xu,Nathan H. Varady,Antonia F. Chen
doi : 10.1016/j.arth.2020.11.014
MISCELLANEOUS| VOLUME 36, ISSUE 5, P1804-1809, MAY 01, 2021
Despite the importance of diversity in advancing scientific progress, diversity among leading authors in arthroplasty has not been examined. This study aimed to identify, characterize, and assess disparities among leading authors in arthroplasty literature from 2002 to 2019.
Bibliometric Analysis of the Top-Cited Articles on Unicompartmental Knee Arthroplasty
Jinwen He,Liangzhi He,Bin Geng,Yayi Xia
doi : 10.1016/j.arth.2020.11.038
MISCELLANEOUS| VOLUME 36, ISSUE 5, P1810-1818.E3, MAY 01, 2021
Unicompartmental knee arthroplasty (UKA) has been proven to be an effective surgical technique for unilateral compartment osteoarthritis. The purpose of this study is to identify and analyze the top 100 cited articles in the field of UKA research.
Noise Evaluation of Arthroplasty Theaters: Results From the NEAT Study
Jonathan S. Palmer,Hossam H. Fraig,Christopher J. Wilson,Simon J.W. Garrett
doi : 10.1016/j.arth.2020.11.026
MISCELLANEOUS| VOLUME 36, ISSUE 5, P1819-1822, MAY 01, 2021
The aim of this study was to define the levels of noise exposure for the surgeon, assistant, scrub nurse, and anesthetist during total hip and knee arthroplasty surgery. In addition, we sought to determine whether the noise exposure during these procedures reaches or exceeds the action values set out by the U.K. Noise at Work Regulations (2005).
Readmission, Complication, and Disposition Calculators in Total Joint Arthroplasty: A Systemic Review
Cole M. Howie,Simon C. Mears,C. Lowry Barnes,Jeffrey B. Stambough
doi : 10.1016/j.arth.2020.10.052
SYSTEMATIC REVIEW & META-ANALYSES| VOLUME 36, ISSUE 5, P1823-1831, MAY 01, 2021
Predictive tools are useful adjuncts in surgical planning. They help guide patient selection, candidacy for inpatient vs outpatient surgery, and discharge disposition as well as predict the probability of readmissions and complications after total joint arthroplasty (TJA). Surgeons may find it difficult due to significant variation among risk calculators to decide which tool is best suited for a specific patient for optimal decision-based care. Our aim is to perform a systematic review of the literature to determine the existing post-TJA readmission calculators and compare the specific elements that comprise their formula. Second, we intend to evaluate the pros and cons of each calculator.
Clinical Decision Support Tools for Predicting Outcomes in Patients Undergoing Total Knee Arthroplasty: A Systematic Review
Jodie A. Cochrane,Traci Flynn,Adrian Wills,Frederick R. Walker,Michael Nilsson,Sarah J. Johnson
doi : 10.1016/j.arth.2020.10.053
SYSTEMATIC REVIEW & META-ANALYSES| VOLUME 36, ISSUE 5, P1832-1845.E1, MAY 01, 2021
Total knee arthroplasty is the standard surgical treatment for end-stage osteoarthritis. Although widely accepted as a successful procedure, approximately 30% of patients are not satisfied due to non-optimal postoperative outcomes. Clinical decision support tools that are able to accurately predict post-surgery outcomes would assist in providing individualized advice or services to help alleviate possible issues, resulting in significant benefits to both the healthcare system and individuals.
Letter to the Editor on “Tibial Implant Fixation Behavior on Total Knee Arthroplasty: A Study With 5 Different Cements”
David R. Lionberger
doi : 10.1016/j.arth.2020.11.023
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E31, MAY 01, 2021
Response to Letter to the Editor on “Tibial implant Fixation Behavior in Total Knee Arthroplasty – A Study With Five Different Types of Bone Cements”
Thomas M. Grupp,Christoph Schilling,Jens Schwiesau,Andreas Pfaff,Brigitte Altermann,William M. Mihalko
doi : 10.1016/j.arth.2020.11.022
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E32-E33, MAY 01, 2021
Letter to the Editor on “Stiffness After Total Knee Arthroplasty: Is It a Result of Spinal Deformity?”
Kangming Chen,Jun Xia
doi : 10.1016/j.arth.2021.01.084
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E34, MAY 01, 2021
Response to Letter to the Editor on “Stiffness After Total Knee Arthroplasty: Is It a Result of Spinal Deformity?”
Jonathan M. Vigdorchik,Abhinav K. Sharma,David J. Mayman,Kaitlin M. Carroll,Peter K. Sculco,Seth A. Jerabek,Oren I. Feder,Aaron J. Buckland,William J. Long
doi : 10.1016/j.arth.2021.01.085
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E35, MAY 01, 2021
Letter to the Editor on “In the Era of Tranexamic Acid, Are Type and Screens for Primary Total Joint Arthroplasty Obsolete?”
Jorge H. Nu?ez,Francesc Angles,Joan Minguell-Monyart
doi : 10.1016/j.arth.2021.01.061
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E36-E37, MAY 01, 2021
Response to Letter to the Editor on “In the Era of Tranexamic Acid, Are Type and Screens for Primary Total Joint Arthroplasty Obsolete?”
John R. Martin,Thomas K. Fehring
doi : 10.1016/j.arth.2021.01.063
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E38, MAY 01, 2021
Letter to the Editor on “Perioperative Mortality After Cemented or Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures—A Systematic Review and Meta-Analysis”
Yuxu Li,Xiaowei Yang,Huan Min
doi : 10.1016/j.arth.2021.01.060
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E39, MAY 01, 2021
Response to Letter to the Editor on “Perioperative Mortality After Hemiarthroplasty for Displaced Femoral Neck Fractures—A Systematic Review and Meta-Analysis”
Christopher Fenelon,Evelyn P. Murphy,Eoghan Pomeroy,Robert P. Murphy,William Curtin,Colin G. Murphy
doi : 10.1016/j.arth.2021.01.062
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E40, MAY 01, 2021
Letter to the Editor on “Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials”
Lanping Huang,Jing Wu
doi : 10.1016/j.arth.2021.01.012
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E41, MAY 01, 2021
Response to Letter to the Editor on “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 Packer,Gareth G. Jones,Bheeshma Ravi
doi : 10.1016/j.arth.2021.01.011
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E42-E43, MAY 01, 2021
Letter to the Editor on “Impact of Postoperative Zolpidem Use on Primary Total Knee Arthroplasty: A Retrospective Matched-Controlled Analysis of a Private Insurance Database”
Ahmed K. Emara,Nicolas S. Piuzzi
doi : 10.1016/j.arth.2021.02.020
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E44, MAY 01, 2021
Response to Letter to the Editor on “Impact of Postoperative Zolpidem Use on Primary Total Knee Arthroplasty: A Retrospective Matched-Controlled Analysis of a Private Insurance Database”
Andrew D. Ardeljan,Teja S. Polisetty,Joseph R. Palmer,Justin J. Toma,Rushabh M. Vakharia,Martin W. Roche
doi : 10.1016/j.arth.2021.02.022
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E45, MAY 01, 2021
Letter to the Editor on “Disparities Among Leading Publishers of Arthroplasty Research”
Kara McConaghy,Nicolas S. Piuzzi
doi : 10.1016/j.arth.2020.12.058
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E46-E47, MAY 01, 2021
Response to Letter to the Editor on “Disparities Among Leading Publishers of Arthroplasty Research”
Raylin F. Xu,Nathan H. Varady,Antonia F. Chen
doi : 10.1016/j.arth.2020.12.052
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E48-E49, MAY 01, 2021
Letter to the Editor on “Does Topical Administration Provide Better Pain Relief on First Post-Operative Day Than Intravenous Dexamethasone After TKA?”
Vivek Tiwari,Samir Dwidmuthe
doi : 10.1016/j.arth.2020.12.014
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E50, MAY 01, 2021
Response to Letter to the Editor on “Does Topical Administration Provide Better Pain Relief on First Post-Operative Day Than Intravenous Dexamethasone After TKA?”
Donghai Li,Pengde Kang
doi : 10.1016/j.arth.2020.12.013
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E51-E52, MAY 01, 2021
Letter to the Editor on “Comparison of Intravenous and Topical Dexamethasone for Total Knee Arthroplasty: A Randomized Double-Blinded Controlled Study of Effects on Dexamethasone Administration Route and Enhanced Recovery”
Yong Lin,Songbo Lu
doi : 10.1016/j.arth.2020.12.050
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E53, MAY 01, 2021
Response to Letter to the Editor on “Comparison of Intravenous and Topical Dexamethasone for Total Knee Arthroplasty: A Randomized Double-Blinded Controlled Study of Effects on Dexamethasone Administration Route and Enhanced Recovery”
Donghai Li,Pengde Kang
doi : 10.1016/j.arth.2020.12.053
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E54-E55, MAY 01, 2021
Letter to the Editor on “The Cost-Effectiveness of Silver-Impregnated Occlusive Dressings for Infection Prevention After Total Joint Arthroplasty”
Prashant V. Rajan,Nicolas S. Piuzzi
doi : 10.1016/j.arth.2021.01.002
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E56, MAY 01, 2021
Response to Letter to the Editor on “The Cost-Effectiveness of Silver-Impregnated Occlusive Dressings for Infection Prevention After Total Joint Arthroplasty”
Alexander J. Toppo,Nicholas R. Pagani,Michael A. Moverman,Richard N. Puzzitiello,Mariano E. Menendez,Joseph J. Kavolus
doi : 10.1016/j.arth.2021.01.001
LETTER TO THE EDITOR| VOLUME 36, ISSUE 5, E57, MAY 01, 2021
Corrigendum to ‘The Potential Value of Performing Preoperative Urinalysis Prior to Total Knee Arthroplasty’ [The Journal of Arthroplasty 36 (2021) 118-121]
Daniel J. Johnson,Logan M. Hansen,Haley E. Smith,Mark A. Oyer,David W. Manning
doi : 10.1016/j.arth.2021.02.021
CORRIGENDUM| VOLUME 36, ISSUE 5, P1846, MAY 01, 2021
Table of Contents
doi : 10.1016/S0883-5403(21)00309-0
CONTENTS LIST| VOLUME 36, ISSUE 5, PA12, MAY 01, 2021
Conflict of Interest
doi : 10.1016/S0883-5403(21)00310-7
MISCELLANEOUS| VOLUME 36, ISSUE 5, PA15, MAY 01, 2021
