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Table of Contents
doi : 10.1016/S0883-5403(20)31184-0
Volume 36, Issue 1, January 2021, Pages A5-A10
Overlap Between Medicare's Comprehensive Care for Joint Replacement Program and Accountable Care Organizations
Joshua M. Liao, Eric Z. Shan, Yueming Zhao, Yash Shah, ... Amol S. Navathe
doi : 10.1016/j.arth.2020.07.039
Volume 36, Issue 1, January 2021, Pages 1-5
Overlap between Medicare's Comprehensive Care for Joint Replacement (CJR) model and accountable care organizations (ACOs) may result in positive or negative synergies. In this study, we describe the overlap between the programs at the beneficiary and hospital levels.
Is the Patient-Reported Outcome Measurement Information System Feasible in Bundled Payment for Care Improvement Total Knee Arthroplasty Patients?
Charles M. Lawrie, Wahid Y. Abu-Amer, John C. Clohisy
doi : 10.1016/j.arth.2020.07.041
Volume 36, Issue 1, January 2021, Pages 6-12
Several bundled payment plans, like the Bundled Payment for Care Improvement (BPCI) initiative for total joint arthroplasty, have been introduced to decrease costs and improve clinical care. Measuring clinical outcomes with efficient, standardized methodologies is essential to determine the relative value of total joint arthroplasty care. We investigated feasibility and responsiveness of the recently developed Patient-Reported Outcomes Measurement Information System (PROMIS) in total knee arthroplasty (TKA) patients.
Are We at the Bottom? BPCI Programs Now Disincentivize Providers Who Maintain Quality Despite Caring for Increasingly Complex Patients
Chad A. Krueger, Michael Yayac, Chris Vannello, John Wilsman, ... P. Maxwell Courtney
doi : 10.1016/j.arth.2020.07.048
Volume 36, Issue 1, January 2021, Pages 13-18
The Bundled Payments for Care Improvement (BPCI) initiative has been successful at reducing Medicare costs after total joint arthroplasty (TJA). Target pricing is based on each institution's historical performance and is periodically reset. The purpose of this study was to examine the performance of our BPCI program accounting for patient complexity, quality, and resource utilization.
High Bundled Payment Costs Following Total Hip and Knee Arthroplasty in African Americans
Emanuele Chisari, Matthew J. Grosso, Elie Kozaily, Charles L. Nelson, ... P. Maxwell Courtney
doi : 10.1016/j.arth.2020.07.053
Volume 36, Issue 1, January 2021, Pages 19-23
Concerns exist that minorities who utilize more resources in an episode-of-care following total hip (THA) and knee arthroplasty (TKA) may face difficulties with access to quality arthroplasty care in bundled payment programs. The purpose of this study is to determine if African American patients undergoing TKA or THA have higher episode-of-care costs compared to Caucasian patients.
Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?
Kent R. Kraus, Leonard T. Buller, Peter P. Caccavallo, Mary Ziemba-Davis, R. Michael Meneghini
doi : 10.1016/j.arth.2020.07.021
Volume 36, Issue 1, January 2021, Pages 24-29
Total joint arthoplasty (TJA) cost containment has been a key focus for the Centers for Medicare and Medicaid Services spawning significant research and programmatic change, including a move toward early discharge and outpatient TJA. TJA outpatients receive few, if any, medical interventions before discharge, but the type and quantity of interventions provided for TJA patients who stay overnight in the hospital is unknown. This study quantified the nature, frequency, and outcome of interventions occurring overnight after primary TJA.
Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols
Leonard T. Buller, Trey A. Hubbard, Mary Ziemba-Davis, Evan R. Deckard, R. Michael Meneghini
doi : 10.1016/j.arth.2020.07.062
Volume 36, Issue 1, January 2021, Pages 30-36
Advances in perioperative care have enabled early discharge and outpatient primary total joint arthroplasty (TJA). However, the safety of early discharge after revision TJA (rTJA) remains unknown and the COVID-19 pandemic will force decreased hospitalization. This study compared 90-day outcomes in patients undergoing aseptic rTJA discharged the same or next day (early) to those discharged 2 or 3 days postoperatively (later).
A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty
Sean P. Ryan, Christine J. Wu, Johannes F. Plate, Michael P. Bolognesi, ... Thorsten M. Seyler
doi : 10.1016/j.arth.2020.07.066
Volume 36, Issue 1, January 2021, Pages 37-41
The Center for Medicare and Medicaid Services is faced with a challenge of decreasing the cost of care for total knee arthroplasty (TKA) but must make efforts to prevent patient selection bias in the process. Currently, no appropriate modifier codes exist for primary TKA based on case complexity. We sought to determine differences in perioperative parameters for patients with complex primary TKA with the hypothesis that they would require increased cost of care, prolonged care times, and have worse postoperative outcome metrics.
Is the New Outpatient Prospective Payment System Classification for Outpatient Total Knee Arthroplasty Appropriate?
Edwin Theosmy, Michael Yayac, Chad A. Krueger, P. Maxwell Courtney
doi : 10.1016/j.arth.2020.07.051
Volume 36, Issue 1, January 2021, Pages 42-46
In 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the inpatient-only list, resulting in payment through the Outpatient Prospective Payment System with an average $3157 reduction. The purpose of this study is to determine if the reimbursement is justified by comparing the difference in facility costs between inpatient and outpatient TKAs.
Target Price Adjustment for Hip Fractures Is Not Sufficient in the Bundled Payments for Care Improvement Initiative
Hope Skibicki, Michael Yayac, Chad A. Krueger, P. Maxwell Courtney
doi : 10.1016/j.arth.2020.07.069
Volume 36, Issue 1, January 2021, Pages 47-53
Under the Bundled Payments for Care Improvement (BPCI) initiative, the Centers for Medicare and Medicaid Services (CMS) adjusts the target price for total hip arthroplasty (THA) based upon the historical proportion of fracture cases. Concerns exist that hospitals that care for hip fracture patients may be penalized in BPCI. The purpose of this study is to compare the episode-of-care (EOC) costs of hip fracture patients to elective THA patients.
Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: a 4.5- to 6-Year Prospective Randomized Comparative Study
Aditya K. Aggarwal, K. Poornalingam, Ashish Jain, Mahesh Prakash
doi : 10.1016/j.arth.2020.07.010
Volume 36, Issue 1, January 2021, Pages 54-61
Avascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression (CD) remains controversial.
A Study on the Evaluation of a Risk Score of Osteonecrosis of the Femoral Head Based on Survival Analysis
Jiaqi Zheng, Huan Wang, Youshui Gao, Zisheng Ai
doi : 10.1016/j.arth.2020.07.046
Volume 36, Issue 1, January 2021, Pages 62-71
This study aimed at developing a risk score predicting the probability of developing an osteonecrosis of the femoral head (ONFH) in patients with femoral neck fracture within 3 years after closed reduction internal fixation and evaluating its performance, clinical utility, and internal validity.
Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty
Akhil Katakam, Christopher M. Melnic, Charles R. Bragdon, Nicholas Sauder, ... Hany S. Bedair
doi : 10.1016/j.arth.2020.07.055
Volume 36, Issue 1, January 2021, Pages 72-77
Malnutrition is a devastating condition which disproportionally affects the elderly population. Malnutrition furthers the pre-existing elevated risk for osteoarthritis in this population, thus exacerbating joint damage in patients and furthering the need for total joint arthroplasty (TJA). A marker for malnutrition is a low body mass index (BMI). The purpose of this study is to investigate whether low BMI status increased the risk for 2-year mortality or reoperation, 90-day readmission, or extended length of stay (LOS) following TJA.
The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty
Frederique J. Hafkamp, Jolanda de Vries, Taco Gosens, Brenda L. den Oudsten
doi : 10.1016/j.arth.2020.07.071
Volume 36, Issue 1, January 2021, Pages 78-87
This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms.
African American Patients Have Improved Functional Gains and Comparable Clinical Outcomes to Caucasian Patients After Total Hip and Knee Arthroplasty
Emanuele Chisari, Matthew J. Grosso, Charles L. Nelson, Elie Kozaily, ... P. Maxwell Courtney
doi : 10.1016/j.arth.2020.07.022
Volume 36, Issue 1, January 2021, Pages 88-92
With the increasing popularity of alternative payment models, minorities who use more postacute care resources may face difficulties with access to quality total hip arthroplasty (THA) and total knee arthroplasty (TKA) care. The purpose of this study is to compare differences in perioperative complications and functional outcomes between African American and Caucasian patients undergoing THA and TKA.
Current Trends and Projected Burden of Primary and Revision Total Knee Arthroplasty in Korea Between 2010 and 2030
Tae Woo Kim, Seung-Baik Kang, Chong Bum Chang, Sun-Young Moon, ... Kyung-Hoi Koo
doi : 10.1016/j.arth.2020.06.064
Volume 36, Issue 1, January 2021, Pages 93-101
This study aimed to (1) document the total knee arthroplasty (TKA) use in Korea from 2010 to 2018, (2) evaluate whether rapid increase in TKA use has been maintained, and (3) estimate the projected TKA burden to 2030 based on the current use.
A Poster Summarizing the American Academy of Orthopaedic Surgeons Knee Osteoarthritis Clinical Practice Guideline Is a Powerful Tool for Patient Education: A Randomized Controlled Trial
Monte Squiers, Nathaniel J. Nelms, Alan T. Davis, David A. Halsey, ... Michael Blankstein
doi : 10.1016/j.arth.2020.07.007
Volume 36, Issue 1, January 2021, Pages 102-106.e5
In 2013, the American Academy of Orthopaedic Surgeons (AAOS) published an evidence-based clinical practice guideline (CPG) on conservative treatment options for patients with knee osteoarthritis (OA). The purpose of this study is to evaluate the effectiveness of a poster outlining the AAOS knee OA CPG on patient comprehension and satisfaction in the clinic.
The Mid- to Long-Term Outcomes of the Lateral Domed Oxford Unicompartmental Knee Replacement: An Analysis From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man
Hasan R. Mohammad, Gulraj S. Matharu, Andrew Judge, David W. Murray
doi : 10.1016/j.arth.2020.07.031
Volume 36, Issue 1, January 2021, Pages 107-111
Lateral unicompartmental knee replacement (UKR) is an alternative to total knee replacement for isolated lateral unicompartmental knee arthritis. The geometry and mechanics of the lateral compartment differ to the medial compartment with the Lateral Domed Oxford UKR designed to address this. We used the National Joint Registry (NJR) data to report the mid- to long-term outcomes of this device.
Can Machine Learning Methods Produce Accurate and Easy-to-Use Preoperative Prediction Models of One-Year Improvements in Pain and Functioning After Knee Arthroplasty?
Alex H.S. Harris, Alfred C. Kuo, Thomas R. Bowe, Luisa Manfredi, ... Nicholas J. Giori
doi : 10.1016/j.arth.2020.07.026
Volume 36, Issue 1, January 2021, Pages 112-117.e6
Approximately 15%-20% of total knee arthroplasty (TKA) patients do not experience clinically meaningful improvements. We sought to compare the accuracy and parsimony of several machine learning strategies for developing predictive models of failing to experience minimal clinically important differences in patient-reported outcome measures (PROMs) 1 year after TKA.
The Potential Value of Performing Preoperative Urinalysis Prior to Total Knee Arthroplasty
Daniel J. Johnson, Logan M. Hansen, Haley E. Smith, Mark A. Oyer, David W. Manning
doi : 10.1016/j.arth.2020.07.014
Volume 36, Issue 1, January 2021, Pages 118-121
Although the practice of checking a urinalysis prior to elective total knee arthroplasty (TKA) is relatively common, very little has been reported on the association between a preoperative urinary tract infection (UTI) and adverse events in primary TKA. The goal of this study is to investigate the risk of postoperative complication following TKA as it relates to preoperative UTI.
Adductor Canal Block Combined With iPACK (Interspace Between the Popliteal Artery and the Capsule of the Posterior Knee) Block vs Periarticular Injection for Analgesia After Total Knee Arthroplasty: A Randomized Noninferiority Trial
Wannida Kertkiatkachorn, Wirinaree Kampitak, Aree Tanavalee, Srihatach Ngarmukos
doi : 10.1016/j.arth.2020.06.086
Volume 36, Issue 1, January 2021, Pages 122-129.e1
The combination of adductor canal block (ACB) and infiltration between the popliteal artery and the posterior capsule of the knee (iPACK) block may provide sufficient motor-sparing anterior and posterior knee analgesia after total knee arthroplasty. This study aimed to determine if ACB with iPACK block was noninferior to ACB with periarticular injection (PAI) when combined with postoperative multimodal analgesia regimen.
Combination Effect of High-Dose Preoperative and Periarticular Steroid Injection in Total Knee Arthroplasty. A Randomized Controlled Study
Vincent Wai Kwan Chan, Ping Keung Chan, Henry Fu, Chi Wing Chan, ... Kwong Yuen Chiu
doi : 10.1016/j.arth.2020.07.033
Volume 36, Issue 1, January 2021, Pages 130-134.e2
Postoperative pain remains a major barrier to a patient’s recovery after total knee arthroplasty (TKA). Periarticular corticosteroids in local infiltration analgesics (LIA) and high-dose intravenous corticosteroids have individually shown to improve pain control after TKA. However, potential interactions between them have not been investigated.
Single Use Instruments for Implanting a Contemporary Total Knee Arthroplasty System Are Accurate, Efficient, and Safe
William D. Bugbee, David J. Kolessar, John S. Davidson, Anthony J. Gibbon, ... Kirstin D. Cosgrove
doi : 10.1016/j.arth.2020.07.025
Volume 36, Issue 1, January 2021, Pages 135-139.e2
Single use instruments (SUI) is a potential mechanism to improve efficiency and reduce cost in total knee arthroplasty (TKA). New technology requires patient safety and surgical accuracy. A multi-center study of SUI vs reusable mechanical instrumentation (RUI) for a TKA system compared implant placement accuracy and operating room (OR) efficiency.
Titanium Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty Results in Good to Excellent Clinical and Radiographic Outcomes in Metal Allergy Patients With Medial Knee Osteoarthritis
Riccardo D’Ambrosi, Alessandro Nuara, Ilaria Mariani, Fabrizio Di Feo, ... Michael Hirschmann
doi : 10.1016/j.arth.2020.07.028
Volume 36, Issue 1, January 2021, Pages 140-147.e2
The main purpose of the present study was to analyze the clinical and radiological outcomes of patients with positive skin patch tests who underwent medial mobile-bearing titanium niobium nitride unicompartmental knee arthroplasty (UKA) during a mid-term follow-up.
Impact of Compensated Cirrhosis Etiology on Postoperative Outcomes Following Total Knee Arthroplasty
Joshua E. Bell, Raj Amin, Lawal A. Labaran, Sean B. Sequeira, ... Brian C. Werner
doi : 10.1016/j.arth.2020.07.019
Volume 36, Issue 1, January 2021, Pages 148-153.e1
Cirrhotics often demonstrate worse outcomes than their non-cirrhotic counterparts following orthopedic surgery; however, there are limited arthroplasty-focused data on this occurrence. Additionally, variances in postoperative outcomes among the different etiologies of cirrhosis have not been well described. The aim of this study is to evaluate the effect compensated cirrhosis had on postoperative outcomes following elective total knee arthroplasty (TKA).
Residents’ Learning Curve of Total Knee Arthroplasty Based on Radiological Outcome Parameters: A Retrospective Comparative Study
Nina Hoerlesberger, Mathias Glehr, Florian Amerstorfer, Georg Hauer, ... Patrick Sadoghi
doi : 10.1016/j.arth.2020.07.045
Volume 36, Issue 1, January 2021, Pages 154-159
This study aimed to plot the impact of a learning curve for a resident’s first 103 total knee arthroplasties (TKAs) based on radiological deviations and incision to closure time (ICT), and to compare it to 103 matched TKAs performed by a senior surgeon.
Reduction of Opioids Prescribed Upon Discharge After Total Knee Arthroplasty Significantly Reduces Consumption: A Prospective Study Comparing Two States
Brian P. Chalmers, David J. Mayman, Seth A. Jerabek, Peter K. Sculco, ... Michael P. Ast
doi : 10.1016/j.arth.2020.07.032
Volume 36, Issue 1, January 2021, Pages 160-163
Opioids prescribed for acute pain after total knee arthroplasty (TKA) play a contributing role in the number of opioid pills in circulation. At the height of an opioid epidemic in the United States, opioids are increasingly diverted, misused, and abused. Therefore, many states have enacted narcotic regulations in an attempt to curb opioid diversion and misuse. The purpose of this study is to evaluate the effect of stricter state prescribing regulations on opioid consumption following TKA.
A Postdischarge Multimodal Pain Management Cocktail Following Total Knee Arthroplasty Reduces Opioid Consumption in the 30-Day Postoperative Period: A Group-Randomized Trial
William T. Li, Kerri L. Bell, Michael Yayac, Jacob A. Barmann, ... Matthew S. Austin
doi : 10.1016/j.arth.2020.07.060
Volume 36, Issue 1, January 2021, Pages 164-172.e2
Traditional pain management after total knee arthroplasty (TKA) relies heavily on opioids. Although there is evidence that in-hospital multimodal pain management (MMPM) is more effective than opioid-only (OO) analgesia, there has been little focus on postdischarge pain management. The hypothesis of this study was that MMPM after TKA would reduce pain scores and opioid consumption in the 30-day period after hospital discharge.
More Patients Are Being Discharged Home After Total Knee Arthroplasty, However Rates Vary Between Large Databases
David E. DeMik, Christopher N. Carender, Natalie A. Glass, John J. Callaghan, Nicholas A. Bedard
doi : 10.1016/j.arth.2020.07.059
Volume 36, Issue 1, January 2021, Pages 173-179
There have been significant advancements in perioperative care for total knee arthroplasty (TKA). It is essential to quantify the impact of efforts to better optimize patients and deliver care. The purpose of this study is to assess trends in discharge destination, length of stay (LOS), and complications.
Preoperative Analgesia, Complications, and Resource Utilization After Total Hip Arthroplasty: Tramadol Is Associated With Less Risk Than Other Preoperative Opioid Medications
Jacob M. Wilson, Andrew M. Schwartz, Kevin X. Farley, James R. Roberson, ... George N. Guild
doi : 10.1016/j.arth.2020.07.036
Volume 36, Issue 1, January 2021, Pages 180-186
Preoperative opioid use is known to be detrimental to outcomes after total hip arthroplasty (THA). This is concerning as multiple societies recommend tramadol for the management of arthritis. The purpose of this study was to determine if tramadol is associated with postoperative complications, increased resource utilization, and revision when compared with patients receiving nontramadol opioids (NTOs) and those who are opioid naive (ON).
Class III Obesity Increases Risk of Failure to Achieve the 1-Year Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form Minimal Clinically Important Difference Following Total Hip Arthroplasty
Akhil Katakam, Isabella S. Florissi, Yhan E. Colon Iban, Charles R. Bragdon, ... Hany S. Bedair
doi : 10.1016/j.arth.2020.07.035
Volume 36, Issue 1, January 2021, Pages 187-192
The relationship between obesity and failure to achieve a minimal clinically important difference (MCID) following total hip arthroplasty (THA) has not been well defined. The aims of this study are to determine whether increasing body mass index (BMI) is associated with failure to achieve the 1-year Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS) MCID and to determine a threshold BMI beyond which this risk is significantly increased.
Lateral Trochanteric Pain Following Primary Total Hip Arthroplasty: Incidence and Success of Nonoperative Treatment
Hope E. Skibicki, Jason A. Brustein, Fabio R. Orozco, Danielle Y. Ponzio, ... Alvin C. Ong
doi : 10.1016/j.arth.2020.07.043
Volume 36, Issue 1, January 2021, Pages 193-199
Our study aimed at quantifying the overall incidence of lateral trochanteric pain (LTP) following total hip arthroplasty (THA) and risk based on surgical approach. The success of conservative treatment and potential risk factors for failure of conservative treatment were evaluated.
Reconstruction of Acetabular Defects With Impaction Grafting in Primary Cemented Total Hip Arthroplasty Produces Favorable Results: Clinical and Radiographic Outcomes Over 6.4 Years on Average
Guydo M.H. Duarte, Robinson E. Pires, Carla J. Machado, Marco A.P. Andrade
doi : 10.1016/j.arth.2020.07.044
Volume 36, Issue 1, January 2021, Pages 200-209
Cemented primary total hip arthroplasty (THA) associated with acetabular reconstruction (AR) involving impacted bone grafting has been employed successfully in the revision of cavitary defects but the results are reportedly less predictable for segmental defects. The objective of the study is to evaluate the clinical and radiographic results of patients who had presented cavitary, segmental, and combined acetabular defects and received THA/AR involving impacted morselized cancellous bone autografts followed by rigorous postoperative management.
High Offset Stems Are Protective of Dislocation in High-Risk Total Hip Arthroplasty
Jonathan M. Vigdorchik, Abhinav K. Sharma, Ameer M. Elbuluk, Kaitlin M. Carroll, ... Jay R. Lieberman
doi : 10.1016/j.arth.2020.07.016
Volume 36, Issue 1, January 2021, Pages 210-216
Spinal stiffness has been shown to increase risk of dislocation due to impingement and instability. Increasing anteversion of the acetabular component has been suggested to prevent dislocation, but little has been discussed in terms of femoral or global offset restoration. The purpose of this study is to quantify dislocation rates after primary THA using standard versus high-offset femoral components and to determine how differences in offset affect impingement-free range of motion in a stiff spine cohort using a novel impingement model.
Can Dislocation Rates Be Decreased Using the Anterior Approach in Patients With Lumbar Spondylosis or Lumbar Instrumented Fusion?
Timothy L. Kahn, Patrick J. Kellam, Lucas A. Anderson, Christopher E. Pelt, ... Jeremy M. Gililland
doi : 10.1016/j.arth.2020.07.056
Volume 36, Issue 1, January 2021, Pages 217-221
Although spinopelvic stiffness is known to contribute to instability following total hip arthroplasty (THA), it is unknown whether use of an anterior surgical approach is associated with decreased postoperative instability rates in patients with lumbar spondylosis or fusion.
Comparison of Postoperative Outcomes Between Traditional Longitudinal Incision and Bikini Incision in Total Hip Arthroplasty via Direct Anterior Approach: A Randomized Controlled Trial
Qiuru Wang, Yong Yue, Zhouyuan Yang, Liyile Chen, ... Pengde Kang
doi : 10.1016/j.arth.2020.07.047
Volume 36, Issue 1, January 2021, Pages 222-230
The purpose of this study is to compare a traditional longitudinal incision to an oblique “bikini” incision during total hip arthroplasty (THA) via direct anterior approach (DAA), in terms of the aesthetic appearance of the scar, postoperative functional recovery, and complications.
Outpatient Hip Safety in an Ambulatory Surgery Center Is Independent of Approach
Zachary K. Pharr, Carson M. Rider, Jack W. Bell, James H. Wilde, ... Patrick C. Toy
doi : 10.1016/j.arth.2020.07.068
Volume 36, Issue 1, January 2021, Pages 231-235
There are few data comparing the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in the outpatient setting. The purpose of this study is to compare 90-day complications between the 2 approaches. We hypothesized that they would be equally safe and effective.
The Calpain Gene is Correlated With Metal-on-Metal Hip Replacement Failures
Joseph J. Kavolus, Alexander L. Lazarides, Christina Moore, Thorsten M. Seyler, ... Benjamin A. Alman
doi : 10.1016/j.arth.2020.07.054
Volume 36, Issue 1, January 2021, Pages 236-241.e3
Metal-on-metal (MOM) total hip arthroplasty is associated with unacceptable failure rates secondary to metal ion reactions. Efforts to identify which patients will go on to failure have been limited; recently, there has been a suggestion for a potential genetic basis for the increased risk of revision in MOM hip replacements (MOMHRs). The purpose of this study is to determine whether certain immunologic genotypes are predictive of the need for revision in patients with MOM total hip implants.
Asymptomatic Gluteal Tendinopathies Negatively Impact Outcomes of Total Hip Arthroplasty: A Propensity Score-Matched Study
Philip J. Rosinsky, Rishika Bheem, Mitchell B. Meghpara, Marshall Haden, ... Benjamin G. Domb
doi : 10.1016/j.arth.2020.07.063
Volume 36, Issue 1, January 2021, Pages 242-249
The purpose of this study is to compare outcomes after total hip arthroplasty (THA) in patients with preoperative asymptomatic gluteus medius and minimus (GMM) pathology to a control group with no GMM pathology.
Anterior Revision Hip Arthroplasty is Associated With Higher Wound Complications but Fewer Dislocations Compared to Posterior Revision Hip Surgery
Gregory M. Kurkis, Samir Chihab, Kevin X. Farley, Albert T. Anastasio, ... George N. Guild
doi : 10.1016/j.arth.2020.07.030
Volume 36, Issue 1, January 2021, Pages 250-254
Wound complication after primary direct anterior (DAA) hip arthroplasty has been reported in the literature but there has been no comparison regarding revision anterior vs revision posterior (PA) hip arthroplasty. The authors hypothesize that anterior approach revision surgery may have increased wound complications compared with posterior hip revisions and also report on secondary outcome metrics.
Outcome and Risk Factors Associated with Failures of Isolated Bearing Exchange for Osteolysis in Well-Fixed Cementless Total Hip Arthroplasty
Wenhao Chen, Christian Klemt, Anand Padmanabha, Venkatsaiakhil Tirumala, ... Young-Min Kwon
doi : 10.1016/j.arth.2020.06.026
Volume 36, Issue 1, January 2021, Pages 255-260
It is often challenging to decide whether to revise only the bearing or femoral acetabular component in the setting of progressive osteolysis without component loosening in revision total hip arthroplasty (THA). In this study, we aimed to (1) compare the survivorship of isolated bearing exchange and single/both component revision for patients with periprosthetic osteolysis without component loosening, and (2) identify potential risk factors associated with failures of isolated bearing exchange.
Mid-Term Clinical and Radiographic Outcomes of a Long Cementless Monobloc Stem for Revision Total Hip Arthroplasty
Jean-Christophe Chatelet, Tarik Ait-Si-Selmi, Alain Machenaud, Sonia Ramos-Pascual, ... Michel-Henri Fessy
doi : 10.1016/j.arth.2020.07.057
Volume 36, Issue 1, January 2021, Pages 261-267
For the past 2 decades, the authors have been using a long tapered cementless stem made of titanium and fully coated with hydroxyapatite for revision total hip arthroplasty. The purpose of this multicentric study is to assess clinical outcomes, radiographic outcomes, re-revision rates, and survival rates of this revision stem at a minimum 5-year follow-up.
Modern Revision Femoral Stem Designs Have No Difference in Rates of Subsidence
Steven Yacovelli, Jesse Ottaway, Samik Banerjee, P. Maxwell Courtney
doi : 10.1016/j.arth.2020.07.078
Volume 36, Issue 1, January 2021, Pages 268-273
Both modular and monoblock tapered fluted titanium (TFT) stems have gained popularity over fully porous-coated cylindrical (FPCC) femoral stem designs, but limited data exist comparing subsidence rates following revision total hip arthroplasty (THA). The purpose of this study is to determine differences in subsidence and clinical outcomes among 3 revision femoral stem designs.
International Organism Profile of Periprosthetic Total Hip and Knee Infections
Jesus M. Villa, Tejbir S. Pannu, Ibrahim Theeb, Martin A. Buttaro, ... Daniel O. Kendoff
doi : 10.1016/j.arth.2020.07.020
Volume 36, Issue 1, January 2021, Pages 274-278
There is scarce literature describing pathogens responsible for periprosthetic joint infections (PJIs) around the world. Therefore, we sought to describe periprosthetic joint infection causative organisms, rates of resistant organisms, and polymicrobial infections at 7 large institutions located in North/South America and Europe.
The 2018 New Definition of Periprosthetic Joint Infection is Valuable for Diagnosis of Persistent Infection at Reimplantation in Patients without Synovial Fluid
Qiao Jiang, Chi Xu, Wei Chai, Yong-Gang Zhou, ... Ji-Ying Chen
doi : 10.1016/j.arth.2020.07.023
Volume 36, Issue 1, January 2021, Pages 279-285
Diagnosis of persistent infection at reimplantation of 2-stage exchange revision is a challenging problem. The aim of our study is to evaluate the performance of the 2018 new definition and Musculoskeletal Infection Society (MSIS) criteria in determining the persistent infection at reimplantation in patients without synovial fluid.
Topical Vancomycin Powder and Dilute Povidone-Iodine Lavage Reduce the Rate of Early Periprosthetic Joint Infection After Primary Total Knee Arthroplasty
Daniel B. Buchalter, David J. Kirby, Greg M. Teo, Richard Iorio, ... William J. Long
doi : 10.1016/j.arth.2020.07.064
Volume 36, Issue 1, January 2021, Pages 286-290.e1
Vancomycin powder and dilute povidone-iodine lavage (VIP) was introduced to reduce the incidence of periprosthetic joint infection (PJI) in high-risk total knee arthroplasty (TKA) patients. We hypothesize that VIP can reduce the incidence of early PJI in all primary TKA patients, regardless of preoperative risk.
Diagnostic Utility of Platelet Count/Lymphocyte Count Ratio and Platelet Count/Mean Platelet Volume Ratio in Periprosthetic Joint Infection Following Total Knee Arthroplasty
Venkatsaiakhil Tirumala, Christian Klemt, Liang Xiong, Wenhao Chen, ... Young-Min Kwon
doi : 10.1016/j.arth.2020.07.038
Volume 36, Issue 1, January 2021, Pages 291-297
Diagnosing a periprosthetic joint infection (PJI) can be challenging and often requires a combination of clinical and laboratory findings. Monocyte/lymphocyte ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio (PLR), and platelet/mean platelet volume ratio (PVR) are simple predictors for inflammation that can be readily obtained from complete blood count. The aim of this study is to evaluate the diagnostic utility of these markers in predicting PJI in total knee arthroplasty (TKA) patients.
Single-Stage Revision of the Infected Total Knee Arthroplasty Is Associated With Improved Functional Outcomes: A Propensity Score–Matched Cohort Study
Christian Klemt, Venkatsaiakhil Tirumala, Ruben Oganesyan, Liang Xiong, ... Young-Min Kwon
doi : 10.1016/j.arth.2020.07.012
Volume 36, Issue 1, January 2021, Pages 298-304
Single-stage revision is an alternative to the standard 2-stage revision, potentially minimizing morbidities and improving functional outcomes. This study aimed at comparing single-stage and 2-stage revision total knee arthroplasty (TKA) for chronic periprosthetic joint infection (PJI) with regard to patient-reported outcome measures (PROMs) and complication rates.
Success Rates of Debridement, Antibiotics, and Implant Retention in 230 Infected Total Knee Arthroplasties: Implications for Classification of Periprosthetic Joint Infection
Mark F. Zhu, Katy Kim, Alana Cavadino, Brendan Coleman, ... Simon W. Young
doi : 10.1016/j.arth.2020.07.081
Volume 36, Issue 1, January 2021, Pages 305-310.e1
Prosthetic joint infection (PJI) is the most common cause of failure following total knee arthroplasty (TKA). This study aimed to determine the success of debridement, antibiotics, and implant retention (DAIR) in a large cohort of TKA PJIs and assess the utility of current classification systems in predicting DAIR outcomes in early postoperative, late hematogenous, and chronic PJIs.
Characterizing Femoral and Acetabular Bone Loss in Two-Stage Revision Total Hip Arthroplasty for Infection
Matthew J. Grosso, Elie Kozaily, Giorgio Cacciola, Javad Parvizi
doi : 10.1016/j.arth.2020.07.024
Volume 36, Issue 1, January 2021, Pages 311-316
The process of infection and multiple procedure-related factors in 2-stage exchange arthroplasty may lead to severe bone loss that can complicate subsequent reimplantation. The primary purpose of this study is to quantitatively characterize the extent of bone loss on the femoral and acetabular side prior to reimplantation during 2-stage revision hip arthroplasty for infection.
Nationwide Analysis of Lower Extremity Periprosthetic Fractures
Nicholas R. Pagani, Nathan H. Varady, Antonia F. Chen, Sean S. Rajaee, Joseph J. Kavolus
doi : 10.1016/j.arth.2020.07.050
Volume 36, Issue 1, January 2021, Pages 317-324
Although the annual incidence of primary total joint arthroplasty is increasing, trends in the annual incidence of periprosthetic fractures have not been established. This study aimed to define the annual incidence of periprosthetic fractures in the United States.
Association of Perioperative Red Blood Cell Transfusion With Symptomatic Venous Thromboembolism Following Total Hip and Knee Arthroplasty
Aaron Jackson, Karan Goswami, Michael Yayac, Timothy L. Tan, ... Javad Parvizi
doi : 10.1016/j.arth.2020.07.027
Volume 36, Issue 1, January 2021, Pages 325-330
Prior registry data suggest that perioperative red blood cell (RBC) transfusion may increase the incidence of venous thromboembolism (VTE) in patients status post surgery. However, there are limited data that explore VTE risk after perioperative transfusion in the setting of primary total joint arthroplasty (TJA). Our aim is to investigate the association between perioperative RBC transfusion and the development of symptomatic VTE after adjusting for confounding variables.
Risk Factors and Effect of Acute Kidney Injury on Outcomes Following Total Hip and Knee Arthroplasty
Michael Yayac, Zachary S. Aman, Alexander J. Rondon, Timothy L. Tan, ... James J. Purtill
doi : 10.1016/j.arth.2020.07.072
Volume 36, Issue 1, January 2021, Pages 331-338
Development of acute kidney injury (AKI) following primary total joint arthroplasty (TJA) is a potentially avoidable complication associated with negative outcomes including discharge to facilities and mortality. Few studies have identified modifiable risk factors or strategies that the surgeon may use to reduce this risk.
Lysis of Adhesion for Arthrofibrosis After Total Knee Arthroplasty Is Associated With Increased Risk of Subsequent Revision Total Knee Arthroplasty
William M. Cregar, Zain M. Khazi, Yining Lu, Brian Forsythe, Tad L. Gerlinger
doi : 10.1016/j.arth.2020.07.018
Volume 36, Issue 1, January 2021, Pages 339-344.e1
The aim of this study is to determine incidence of lysis of adhesion (LOA) for postoperative arthrofibrosis following primary total knee arthroplasty (TKA), patient factors associated with LOA, and impact of LOA on revision TKA.
The Effect of Femoral Head Size, Neck Length, and Offset on Dislocation Rates of Constrained Acetabular Liners
Yaniv Warschawski, Simon P. Garceau, Denis A. Joly, Paul Kuzyk, ... Oleg Safir
doi : 10.1016/j.arth.2020.07.067
Volume 36, Issue 1, January 2021, Pages 345-348
Constrained acetabular liners (CALs) are used in both primary and revision total hip arthroplasty in cases where stability and abductor deficiency are of concern. The efficacy of CALs has been shown to be design dependent. There is clear evidence that the use of small head sizes and shorter offset in unconstrained total hip arthroplasty is associated with higher rates of dislocation. To our knowledge, no such study has assessed the effect of femoral head size, neck length, and offset for CALs.
Micromotion and Migration of Cementless Tibial Trays Under Functional Loading Conditions
Shuyang Han, Rikin V. Patel, Sabir K. Ismaily, Hugh L. Jones, ... Philip C. Noble
doi : 10.1016/j.arth.2020.07.017
Volume 36, Issue 1, January 2021, Pages 349-355
The outcome of cementless total knee arthroplasty (TKA) relies on successful bony ingrowth into the implant surfaces. Failures due to aseptic loosening are still reported, especially in younger and more active patients. The objective of this study is to quantify the micromotion of a commercially available design of cementless tibial tray under loading conditions simulating walking and stair descent.
A Biomechanical Comparison of the Effect of Baseplate Design and Bone Marrow Fat Infiltration on Tibial Baseplate Pullout Strength
Blane C. Kelly, John R. Owen, Shalin C. Shah, Aaron J. Johnson, ... Stephen L. Kates
doi : 10.1016/j.arth.2020.07.049
Volume 36, Issue 1, January 2021, Pages 356-361
Early clinical results of a new total knee arthroplasty (TKA) implant design show promise for improved outcomes and patellofemoral function scores. However, reports of early tibial component-cement interface debonding requiring revision have been published. This study investigated the biomechanical properties of three different tibial baseplates to understand potential causes of failure.
Micromotion Analysis of Various Tibial Constructs in Moderate Tibial Defects in Revision Total Knee Arthroplasty
Vincent Alipit, Amanda Kirk, Daniel Scholl, Gregg Schmidig, ... Gwo-Chin Lee
doi : 10.1016/j.arth.2020.07.013
Volume 36, Issue 1, January 2021, Pages 362-367.e1
The purpose of this study is to compare the micromotion of various tibial reconstruction strategies including short cemented and long cementless stems with or without metaphyseal augmentation.
The Anatomical Course of the Lateral Femoral Cutaneous Nerve in Relation to Various Skin Incisions Used for Primary and Revision Total Hip Arthroplasty With the Direct Anterior Approach
Martin Thaler, Dietmar Dammerer, Faro Hechenberger, Romed H?rmann, ... Hannes Stofferin
doi : 10.1016/j.arth.2020.07.052
Volume 36, Issue 1, January 2021, Pages 368-373
Although the direct anterior approach (DAA) has become a standard for primary and revision total hip arthroplasty, it involves a high risk of injuring the lateral femoral cutaneous nerve (LFCN). The aim of this study is to examine the course of the LFCN in relation to various skin incisions and approach extensions used for the DAA.
Functional Anatomy of the Hip Joint
Nathanael Heckmann, Taro Tezuka, Russell J. Bodner, Lawrence D. Dorr
doi : 10.1016/j.arth.2020.07.065
Volume 36, Issue 1, January 2021, Pages 374-378
The functional anatomy of the osteoarthritic hip joint in the sagittal plane has not been defined. The purpose of this study was to define the functional anatomy of the hip using clinical and radiographic analyses.
Anteversion Angle Measurement in Suspected Torsional Malalignment of the Femur in 3-Dimensional EOS vs Computed Tomography—A Validation Study
Hermann O. Mayr, Jan-Peter Schmidt, Florian Haasters, Anke Bernstein, ... Wolf C. Prall
doi : 10.1016/j.arth.2020.07.058
Volume 36, Issue 1, January 2021, Pages 379-386
Computed tomography (CT) scan is the standard for assessment of femoral torsion. This observational study was conducted to evaluate the comparability of the EOS radiation dose scanning system (EOS imaging, Paris, France) and the CT scan in patients with suspected torsional malalignment of the femur.
Biomechanical Comparison of Periprosthetic Femoral Fracture Risk in Three Femoral Components in a Sawbone Model
Logan Windell, Ashwin Kulkarni, Enrique Alabort, Daniel Barba, ... Harvinder P. Singh
doi : 10.1016/j.arth.2020.07.061
Volume 36, Issue 1, January 2021, Pages 387-394
The increasing use of orthopedic total hip arthroplasty implants has led to a consequent rise in the incidence of associated periprosthetic fractures (PPFs). Analysis of the National Joint Registry data showed the choice of cemented hip stem influenced the risk of a PPF occurring. However, the effect of implant design in relation to the risk of PPFs has not been investigated.
Letter to the Editor on “Postoperative Serum Cytokine Levels Are Associated With Early Stiffness After Total Knee Arthroplasty: A Prospective Cohort Study”
Hong Xu, Jinwei Xie, Yiting Lei, Fuxing Pei
doi : 10.1016/j.arth.2020.09.040
Volume 36, Issue 1, January 2021, Pages e1-e2
Reply to Letter to the Editor on ‘Postoperative Serum Cytokine Levels Are Associated With Early Stiffness After Total Knee Arthroplasty: A Prospective Cohort Study”
Meghan A. Kirksey, Valeria L. Rotundo, Haoyan Zhong
doi : 10.1016/j.arth.2020.09.039
Volume 36, Issue 1, January 2021, Pages e3-e4
