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Real Time Conversations: Changes to the Letters to the Editor
C.A. Krueger,D.J. Backstein,J.A. Browne,V.E. Krebs,J.B. Mason,M.A. Mont,M.J. Taunton,J.J. Callaghan
doi : 10.1016/j.arth.2021.05.011
EDITORIAL| VOLUME 36, ISSUE 7, P2249, JULY 01, 2021
Electronic Medical Record Audit Time Logs as a Measure of Preoperative Work Before Total Joint Arthroplasty
Samantha A. Mohler, MS,Simon C. Mears, MD, PhD,Ashleigh R. Kathiresan, MS,C. Lowry Barnes, MD,Jeffrey B. Stambough, MD
doi : 10.1016/j.arth.2021.01.050
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2250-2253, JULY 01, 2021
In order to achieve rapid recovery total joint arthroplasty, surgeons and their teams are spending more time in the weeks before surgery to prepare patients. This study aims to quantify total knee and hip prearthroplasty work using retrospective electronic medical record (EMR) activity audit log analysis.
Quantifying the Surgeon's Increased Burden of Postoperative Work for Modern Arthroplasty Surgery
Roshan P. Shah, MD, JD ,Matthew M. Levitsky, MD,Alexander L. Neuwirth, MD,Jeffrey A. Geller, MD,H. John Cooper, MD
doi : 10.1016/j.arth.2021.01.014
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2254-2257, JULY 01, 2021
Arthroplasty payment traditionally includes 118 minutes for postoperative rounds and 69 minutes for postoperative office visits, amounting to 187 minutes and 7 work relative value units. Rapid recovery, ambulatory procedures, and bundled payments have altered the burden of care, with multiple studies showing an increase in physician work. Policy changes during the COVID-19 pandemic allow for precise documentation of patient touchpoints. We analyzed the duration of video, telephone, and text messaging to quantify modern arthroplasty work.
Staging Total Hip and Knee Arthroplasty Procedures Within 90 Days Increases Costs in Bundled Payment Programs
Samantha L. Harrer,Michael Yayac, MD,Matthew S. Austin, MD,P. Maxwell Courtney, MD ,Jonathan M. Vigdorchik, MD
doi : 10.1016/j.arth.2020.11.002
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2258-2262, JULY 01, 2021
Under current Medicare bundled payment programs, when a patient undergoes a subsequent elective procedure within the 90-day episode-of-care, the first procedure is excluded from the bundle and a new episode-of-care initiated. The purpose of this study was to determine if staging bilateral total hip (THA) and total knee arthroplasty (TKA) procedures within 90 days have an effect on bundled episode-of-care costs.
In a Bundled Payment Model, the Costs Associated With Total Joint Replacement in Those Aged Older Than 80 Years Are Significantly Greater
Stephen G. Zak, BA,Katherine A. Lygrisse, MD,Alex Tang, BS,Joseph A. Bosco, MD,Ran Schwarzkopf, MD, MSc,William J. Long, MD, FRCSC
doi : 10.1016/j.arth.2020.11.036
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2263-2267, JULY 01, 2021
The number of octogenarians requiring a total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) will rise disproportionally in the coming decade. Although outcomes are comparable with younger patients, management of these older patients involves higher medical complexity at a greater expense to the hospital system. The purpose of this study was to compare the cost of care for primary THA and TKA in our bundled care patients aged ?80 years to those aged 65-80 years.
National Trends in Post-Acute Care Costs Following Total Knee Arthroplasty From 2007 to 2016
Robert A. Burnett III, MD,Joseph Serino, MD,JaeWon Yang,Craig J. Della Valle, MD,P. Maxwell Courtney, MD
doi : 10.1016/j.arth.2021.01.021
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2268-2275, JULY 01, 2021
Post-acute care continues to represent a target for cost savings with increasing popularity of value-based payment models in total knee arthroplasty (TKA). Rapid recovery and accelerated rehabilitation protocols have been successful in reducing costs at the institutional level, but national trends are less clear. This study aimed to determine if advancements in perioperative care led to a reduction in post-acute care costs and resource utilization following TKA.
Amount of CMS Reduction in Facility Reimbursement Following Removal of Total Hip Arthroplasty From the Inpatient-Only List Far Exceeds Reduction in Actual Care Cost
Jeffrey C. Lynch, DO,Michael Yayac, MD,Chad A. Krueger, MD,P. Maxwell Courtney, MD
doi : 10.1016/j.arth.2020.08.038
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2276-2280, JULY 01, 2021
Starting in 2020, Centers for Medicare and Medicaid Services (CMS) removed total hip arthroplasty (THA) from the inpatient-only list, resulting in an average of $1637 per case reduction in facility reimbursement. The purpose of this study is to determine whether the reduction in reimbursement is justified by comparing the difference in true facility costs between inpatient and outpatient THA.
Preoperative Anemia in Primary Arthroplasty Patients—Prevalence, Influence on Outcome, and the Effect of Treatment
Adrian Bailey, BSc,Isabel Eisen, BHSc,Antony Palmer, MA, DPhil, FRCS (Tr & Orth),Ottawa Arthroplasty Blood Preservation Group,,Paul E. Beaulé, MD, FRCSC,Dean A. Fergusson, PhD, MHA,George Grammatopoulos, MBBS (Hons), DPhil (Oxon), FRCS (Tr & Orth)
doi : 10.1016/j.arth.2021.01.018
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 7, P2281-2289, JULY 01, 2021
This study aims to: 1) Determine the prevalence of preoperative anemia in arthroplasty; 2) Assess whether preoperative anemia is associated with inferior outcomes; and 3) Ascertain whether optimization in a dedicated blood management program (BMP) is associated with improved outcomes.
A Web-Based Interactive Patient-Provider Software Platform Does Not Increase Patient Satisfaction or Decrease Hospital Resource Utilization in Total Knee and Hip Arthroplasty Patients in a Single Large Hospital System
Anabelle T. Visperas, PhD,Kenneth A. Greene, MD,Viktor E. Krebs, MD,Alison K. Klika, MS ,Nicolas S. Piuzzi, MD,Carlos A. Higuera-Rueda, MD
doi : 10.1016/j.arth.2021.01.037
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 7, P2290-2296.E1, JULY 01, 2021
Web-based platforms used to enhance patient-provider communication are being explored to improve patient satisfaction and care delivery, and decrease cost. This study tested a web-based interactive patient-provider software platform (IPSP), JointCOACH, which enabled patient communication with their care team and preparatory/recovery guidance. The aims of this study are to compare (1) patient satisfaction and (2) healthcare resource utilization by patients who underwent total knee and hip replacements and added IPSP to standard of care (SOC).
Has Removal From the Inpatient-Only List Increased Complications After Outpatient Total Knee Arthroplasty?
David E. DeMik, MD, PharmD ,Christopher N. Carender, MD,Qiang An, MBBS, MPH,John J. Callaghan, MD,Timothy S. Brown, MD,Nicholas A. Bedard, MD
doi : 10.1016/j.arth.2021.02.049
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2297-2301.E1, JULY 01, 2021
On 1/1/2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the Inpatient-Only (IPO) list. This change allowed expansion of outpatient TKA, potentially to include older, more frail patients at greater risk for perioperative complications. The purpose of this study was to evaluate the impact of removing TKA from the IPO list on early complications.
Daily Dose of Preoperative Opioid Prescriptions Affects Outcomes After Total Knee Arthroplasty
E. Bailey Terhune, MD ,Charles P. Hannon, MD, MBA,Robert A. Burnett, MD,Craig J. Della Valle, MD
doi : 10.1016/j.arth.2021.01.016
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2302-2306, JULY 01, 2021
The use of preoperative opioids is associated with complications after total knee arthroplasty (TKA), but the dosing threshold that constitutes this risk is not known. The purpose of this study was to identify the preoperative daily opioid dose associated with increased complications after primary TKA.
Reduction of Opioid Quantities at Discharge After TKA Did Not Increase the Risk of Manipulation Under Anesthesia: An Institutional Experience
Brian P. Chalmers, MD ,Juliana Lebowitz, MS,Yu-fen Chiu, MS,Amethia M. Joseph, MHA,Douglas E. Padgett, MD,Mathias P. Bostrom, MD,Alejandro G. Della Valle, MD
doi : 10.1016/j.arth.2021.02.045
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2307-2312, JULY 01, 2021
In response to the opioid epidemic, our arthroplasty service sequentially reduced the opioid quantities prescribed at primary total knee arthroplasty (TKA) discharge. However, its effect on postdischarge pain control and rehabilitation is unknown. We assessed if this decrease was associated with an increase in the risk of manipulation under anesthesia (MUA).
Reasons and Risk Factors for Emergency Department Visits After Primary Total Knee Arthroplasty: An Analysis of 1.3 Million Patients
Rushabh M. Vakharia, MD ,Joseph O. Ehiorobo, MD,Nipun Sodhi, MD,Angelo Mannino, MD,Michael A. Mont, MD,Martin W. Roche, MD
doi : 10.1016/j.arth.2021.02.077
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2313-2318.E2, JULY 01, 2021
Well-powered studies investigating the relationship of emergency department (ED) visits and total knee arthroplasty (TKA) are limited. Therefore, the specific aims of this study were to: 1) compare patient demographics of patients who did and did not have an ED visit; and for the visits, identified: 2) leading reasons; and 3) risk factors for ED visits (prearthroplasty/postarthroplasty).
A Prophylactic Tibial Stem Reduces Rates of Early Aseptic Loosening in Patients with Severe Preoperative Varus Deformity in Primary Total Knee Arthroplasty
Vishal Hegde, MD,Daniel N. Bracey, MD, PhD,Anna C. Brady, BS,Lindsay T. Kleeman-Forsthuber, MD,Douglas A. Dennis, MD,Jason M. Jennings, MD, DPT
doi : 10.1016/j.arth.2021.01.049
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2319-2324, JULY 01, 2021
Patients with a preoperative varus deformity >8 degrees are at increased risk of aseptic loosening after total knee arthroplasty. This study analyzes the effect of a tibial stem on the rate of aseptic loosening in patients with a severe preoperative varus deformity.
Patients With Parkinson’s Disease Have Poorer Function and More Flexion Contractures After Total Knee Arthroplasty
Graham S. Goh, MBBS, MRCS (Edin) ,Gerald J. Zeng, MBBS, MRCS (Eng),Darren K. Tay, MBBS, FRCSEd (Orth),Ngai-Nung Lo, MBBS, FRCS (Edin),Seng-Jin Yeo, MBBS, FRCS (Edin),Ming Han Lincoln Liow, MBBS, FRCSEd (Orth)
doi : 10.1016/j.arth.2020.11.016
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2325-2330, JULY 01, 2021
Parkinson’s disease (PD) may negatively influence the rehabilitative course after total knee arthroplasty (TKA). However, functional outcomes in this select group remain poorly defined. We compared complication, mortality and revision rates, as well as patient-reported outcomes, and satisfaction between patients with PD and controls after TKA.
Effect of Tourniquet Use on Patient Outcomes After Cementless Total Knee Arthroplasty: A Randomized Controlled Trial
Austin F. Smith, MD,Rashad H. Usmani, MD,Khaleel D. Wilson,Langan S. Smith,Arthur L. Malkani, MD
doi : 10.1016/j.arth.2021.01.053
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2331-2334, JULY 01, 2021
Tourniquet use is common in total knee arthroplasty (TKA), but debate exists regarding its use and effect on patient outcomes. The study purpose was to compare the effect of short tourniquet (ST) time vs long tourniquet (LT) time on pain, opioid consumption, and patient outcomes.
How Does Spinopelvic Mobility and Sagittal Functional Cup Orientation Affect Patient-Reported Outcome 1 Year after THA?—A Prospective Diagnostic Cohort Study
Moritz M. Innmann, MD, PhD,Franz Reichel, MD,Bibiane Schaper, MS,Christian Merle, MD, MSc,Paul E. Beaulé, MD, FRCSC,George Grammatopoulos, MBBS, DPhil (Oxon), FRCS (Tr&Orth)
doi : 10.1016/j.arth.2021.02.014
PRIMARY HIP| VOLUME 36, ISSUE 7, P2335-2342, JULY 01, 2021
This prospective cohort study aimed to characterize how spinopelvic characteristics change post-total hip arthroplasty (THA) and determine how patient-reported outcome measures are associated with 1) individual spinopelvic mobility and 2) functional sagittal cup orientation post-THA.
Osteoarthritis and Osteonecrosis in Total Hip Arthroplasty: 90-Day Postoperative Costs and Outcomes
Oliver C. Sax, DO, MS,Sahir S. Pervaiz, MD, MS,Scott J. Douglas, MD,Ethan A. Remily, DO,Michael A. Mont, MD,Ronald E. Delanois, MD
doi : 10.1016/j.arth.2020.10.039
PRIMARY HIP| VOLUME 36, ISSUE 7, P2343-2347, JULY 01, 2021
Two common diagnoses for patients undergoing total hip arthroplasty (THA) are osteoarthritis (OA) and osteonecrosis (ON), pathologically different diseases that affect postoperative complication rates. The underlying pathology of ON may predispose patients to a higher rate of certain complications. Previous research has linked ON with higher mortality and revisions, but a comparison of costs and complication rates may help elucidate further risks. This study reports 90-day costs, lengths of stay (LOS), readmission rates, and complication rates between patients undergoing THA for OA and ON.
High Rate of Re-Revision in Patients Less Than 55 Years of Age Undergoing Aseptic Revision Total Knee Arthroplasty
Brian P. Chalmers, MD ,Marie Syku, BA,Amethia D. Joseph, MHA,David J. Mayman, MD,Steve B. Haas, MD,Jason L. Blevins, MD
doi : 10.1016/j.arth.2020.12.008
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 7, P2348-2352, JULY 01, 2021
There are limited data on the outcomes of revision total knee arthroplasty in young patients. We sought to characterize the re-revision-free survival and risk factors for re-revision in patients less than 55 years who underwent aseptic revision TKA.
Mortality After Revision Total Hip Arthroplasty
Mitzi S. Laughlin, PhD ,Emily A. Vidal, BS,Arin A. Drtil, BA,Robin N. Goytia, MD,Vasilios Mathews, MD,Anay R. Patel, MD
doi : 10.1016/j.arth.2021.01.022
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 7, P2353-2358, JULY 01, 2021
In counseling patients about the complications of revision total hip arthroplasty (revTHA), it is imperative that mortality be considered. The actual mortality rate by indication of revision is ill-defined. The purpose of this study is to determine the mortality rate after revTHA.
Low-Dose vs Regular-Dose Aspirin for Venous Thromboembolism Prophylaxis in Primary Total Joint Arthroplasty
Mason E. Uvodich,Matthew P. Siljander,Michael J. Taunton,Tad M. Mabry,Kevin I. Perry,Matthew P. Abdel
doi : 10.1016/j.arth.2021.02.007
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 7, P2359-2363, JULY 01, 2021
Consensus on whether low-dose (81 mg) or regular-dose (325 mg) aspirin (ASA) is more effective for venous thromboembolism (VTE) chemoprophylaxis in primary total joint arthroplasties (TJAs) is not reached. The goal of this study is to evaluate the efficacy of low-dose and regular-dose ASA for VTE chemoprophylaxis in primary total hip arthroplasties and total knee arthroplasties.
Utilization Patterns, Efficacy, and Complications of Venous Thromboembolism Prophylaxis Strategies in Revision Hip and Knee Arthroplasty as Reported by American Board of Orthopaedic Surgery Part II Candidates
Robert P. Runner,David N. Shau,Christopher A. Staley,James R. Roberson
doi : 10.1016/j.arth.2021.01.072
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 7, P2364-2370, JULY 01, 2021
The optimum venous thromboembolism (VTE) prophylaxis strategy to minimize risk of VTE and bleeding complications following revision total hip and knee arthroplasty (rTHA/rTKA) is controversial. The purpose of this study is to describe current VTE prophylaxis patterns following revision arthroplasty procedures to determine efficacy, complication rates, and prescribing patterns for different prophylactic strategies.
Prevalence of Risk Factors for Adverse Spinopelvic Mobility Among Patients Undergoing Total Hip Arthroplasty
Jonathan M. Vigdorchik,Abhinav K. Sharma,Chameka S. Madurawe,Jim W. Pierrepont,Douglas A. Dennis,Andrew J. Shimmin
doi : 10.1016/j.arth.2020.12.029
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 7, P2371-2378, JULY 01, 2021
Patients with adverse spinopelvic mobility have higher complication rates following total hip arthroplasty (THA). Risk factors include a stiff lumbar spine, standing posterior pelvic tilt ? ?10°, and a severe sagittal spinal deformity (pelvic incidence minus lumbar lordosis mismatch ?20°). The purpose of this study is to define the spinopelvic risk factors and quantify the prevalence of risk factors for pathologic spinopelvic mobility.
Effects of Posterior Tibial Slope on a Posterior Cruciate Retaining Total Knee Arthroplasty Kinematics and Kinetics
Milad Khasian,Bradley A. Meccia,Michael T. LaCour,Richard D. Komistek
doi : 10.1016/j.arth.2020.12.007
BASIC SCIENCE| VOLUME 36, ISSUE 7, P2379-2385, JULY 01, 2021
It has been hypothesized that increasing posterior tibial slope can influence condylar rollback and play a role in increasing knee flexion. However, the effects of tibial slope on knee kinematics are not well studied. The objective of this study is to assess the effects of tibial slope on femorotibial kinematics and kinetics for a posterior cruciate retaining total knee arthroplasty design.
Effects of the Medial Plateau Bearing Insert Conformity on Mid-Flexion Paradoxical Motion in a Posterior-Stabilized Total Knee Arthroplasty Design
Milad Khasian,Bradley A. Meccia,Michael T. LaCour,Richard D. Komistek
doi : 10.1016/j.arth.2021.01.071
BASIC SCIENCE| VOLUME 36, ISSUE 7, P2386-2392, JULY 01, 2021
One of the most common kinematic abnormalities reported for posterior-stabilized (PS) total knee arthroplasty (TKA) design is paradoxical anterior sliding during early and mid-flexion. PS TKAs have been designed such that the cam-post mechanism does not engage until later in flexion, making these implants vulnerable to anterior sliding during early and mid-flexion. The objective of this study is to investigate the biomechanical effect of increasing bearing conformity on a PS TKA.
Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion?
Aidin Eslam Pour,Ran Schwarzkopf,Kunj Pareshkumar Patel,Manan Anjaria,Jean Yves Lazennec,Lawrence D. Dorr
doi : 10.1016/j.arth.2021.02.017
BASIC SCIENCE| VOLUME 36, ISSUE 7, P2393-2401, JULY 01, 2021
To create a safe zone, an understanding of the combined femoral and acetabular mating during hip motion is required. We investigated the position of the femoral head inside the acetabular liner during simulated hip motion. We hypothesized that cup and stem anteversions do not equally affect hip motion and combined hip anteversion.
Closed Incision Negative Pressure Wound Therapy for Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Nikhil Ailaney,William L. Johns,Gregory J. Golladay,Benjamin Strong,Niraj V. Kalore
doi : 10.1016/j.arth.2020.11.039
SYSTEMATIC REVIEW & META-ANALYSIS| VOLUME 36, ISSUE 7, P2402-2411, JULY 01, 2021
Persistent wound drainage after total joint arthroplasty (TJA) increases the risk of surgical site infections (SSIs). Closed incision negative pressure wound therapy (ciNPWT) decreases infections in traumatic wounds, but evidence for its use after elective TJA is limited. The purpose of this meta-analysis of level I studies is to determine the effect of ciNPWT on risk of SSI and wound complications following TJA.
Projections of the Impact to Arthroplasty Surgeons With Changes to the 2021 Medicare Physician Fee Schedule—A Looming Crisis of Access to Care?
Chad A. Krueger,P. Maxwell Courtney
doi : 10.1016/j.arth.2021.02.081
HEALTH POLICY & ECONOMICS| VOLUME 36, ISSUE 7, P2412-2417, JULY 01, 2021
The Centers for Medicare and Medicaid Services 2021 Physician Fee Schedule (PFS) includes increases in office reimbursement but decreases in the valuation of total hip arthroplasty and total knee arthroplasty and the conversion factor. The purpose of this study was to determine the financial impact of these changes on arthroplasty surgeons.
The Changing Characteristics of Arthroplasty Patients: A Retrospective Cohort Study
Seper Ekhtiari,Andrew K. Sefton,Thomas J. Wood,Danielle T. Petruccelli,Mitchell J. Winemaker,Justin D. de Beer
doi : 10.1016/j.arth.2021.02.051
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 7, P2418-2423, JULY 01, 2021
Total joint arthroplasty (TJA) is among the most common operations performed worldwide, with global volumes on the rise. It is important to understand if the characteristics of this patient population are changing over time for resource allocation and surgical planning. The purpose of this study is to examine how this patient population has changed between 2003 and 2017.
Assessment of Informal Caregiver Assistance and Strain With Total Hip and Knee Arthroplasty
Bryn O. Zomar,Dianne M. Bryant,Jacquelyn D. Marsh,Brent A. Lanting
doi : 10.1016/j.arth.2021.02.024
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 7, P2424-2430.E1, JULY 01, 2021
The purpose of our study is to assess which patient-related and caregiver-related factors are predictive of caregiver strain and assistance when caring for total hip and knee arthroplasty (THA and TKA) patients within 2 weeks after surgery.
Routine Radiographs After Total Joint Arthroplasty: Is There Clinical Value?
Alexander A. Hart,David E. DeMik,Timothy S. Brown,Nicolas O. Noiseux
doi : 10.1016/j.arth.2021.02.050
PRIMARY HIP & KNEE ARTHROPLASTY| VOLUME 36, ISSUE 7, P2431-2434, JULY 01, 2021
Routine radiographs have historically been obtained during routine care after total joint arthroplasty (TJA). However, substantial improvements in surgical technique, biomaterials, and changes in payment models placing greater emphasis on value have occurred. Recently, there has been interest in a transition to performing follow-up visits virtually. The purpose of this study was to assess how frequently patients attend postoperative appointments and the clinical utility of routine radiographs after TJA.
Prosthetic Alignment and Clinical Outcomes of Navigation-Assisted Unicompartmental Knee Arthroplasty by an Experienced Surgeon Compared With Inexperienced Surgeons
Hiroshi Inui,Ryota Yamagami,Kenichi Kono,Kohei Kawaguchi,Shuji Taketomi,Sakae Tanaka
doi : 10.1016/j.arth.2021.02.053
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2435-2439, JULY 01, 2021
To improve the accuracy of tibial cut during unicompartmental knee arthroplasty (UKA), navigation-assisted UKA has been implemented. It has been reported that inexperienced surgeons who use a navigation system achieve better alignment than experienced surgeons who do not use a navigation system. However, there have been no reports comparing the alignments and clinical outcomes of navigation-assisted UKA performed by experienced surgeons in comparison with that by inexperienced surgeons. This study aims to compare these parameters of navigation-assisted UKA performed by experienced and inexperienced surgeons.
Impact of Polyethylene Thickness on Clinical Outcomes and Survivorship in Medial Mobile-Bearing Unicondylar Knee Arthroplasty
David A. Crawford,Lauren Lapsley,Jason M. Hurst,Michael J. Morris,Adolph V. Lombardi Jr.,Keith R. Berend
doi : 10.1016/j.arth.2021.02.062
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2440-2444, JULY 01, 2021
The thickness of the polyethylene bearing in medial unicondylar knee arthroplasty (UKA) is determined by the depth of the tibial resection, degree of correctable deformity, and balance of the knee. The purpose of this study is to evaluate whether polyethylene thickness in medial mobile-bearing UKA impacts clinical outcomes and survivorship.
Prior Nonarthroplasty Surgery Increases Risk of Complication in Primary Total Knee Arthroplasty
Nicole D. Quinlan,Brian C. Werner,James A. Browne
doi : 10.1016/j.arth.2021.02.055
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2445-2451.E1, JULY 01, 2021
Prior ipsilateral knee surgery may increase the risk for complications after total knee arthroplasty (TKA). It remains unclear if the extent of previous surgery affects those risks disparately. The purpose of this study is to evaluate prior nonarthroplasty bony procedure (BP) and soft tissue only procedure (STP) as a potential risk factor for complications after TKA and determine the association with charges or reimbursement of the primary TKA.
Failure to Optimize Before Total Knee Arthroplasty: Which Modifiable Risk Factor is the Most Dangerous?
Nick R. Johnson,Joseph M. Statz,Susan M. Odum,Jesse E. Otero
doi : 10.1016/j.arth.2021.02.061
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2452-2457, JULY 01, 2021
Complications after total knee arthroplasty (TKA) are devastating for patients, and surgeons are held accountable in alternative payment models. Optimization of modifiable risk factors has become a mainstay in the preoperative period. We sought to evaluate the consequence of failure to optimize key risk factors in a modern cohort of patients who underwent TKA.
Is Patient Satisfaction After Total Knee Arthroplasty Predictable Using Patient Characteristics and Preoperative Patient-Reported Outcomes?
Yvette Pronk,Maud C.W.M. Peters,Justus-Martijn Brinkman
doi : 10.1016/j.arth.2021.02.064
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2458-2465, JULY 01, 2021
Dissatisfaction after total knee arthroplasty (TKA) remains a difficult problem. Patient characteristics and preoperative patient-reported outcomes (PROs) are potential predictors of satisfaction one year after TKA. Being able to predict the outcome preoperatively might reduce the number of less satisfied patients.
Early Postoperative Pain After Total Knee Arthroplasty Is Associated With Subsequent Poorer Functional Outcomes and Lower Satisfaction
Louise Woon Theng Lo,Jimin Suh,Jerry Yongqiang Chen,Seng Jin Yeo,Tet Sen Howe,Joyce Suang Bee Koh
doi : 10.1016/j.arth.2021.02.044
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2466-2472, JULY 01, 2021
There are few studies investigating the effects of acute postoperative pain on functional outcomes after total knee arthroplasty (TKA). The aims of this study are to identify perioperative factors associated with increased early postoperative pain and investigate the effects of acute postoperative day 1 and 2 pain on outcomes at 6 months and 2 years post-TKA.
Early Identification of Patient Satisfaction Two Years After Total Knee Arthroplasty
Kathryn L. Young-Shand,Michael J. Dunbar,Elise K. Laende,Joanna E. Mills Flemming,Janie L. Astephen Wilson
doi : 10.1016/j.arth.2021.02.057
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2473-2479, JULY 01, 2021
There are numerous reports of poor satisfaction after total knee arthroplasty (TKA), yet there is little known about when to use evidence-based models of care to improve patient outcomes.
Periprosthetic Tissue Reaction Independent of LTT Result and Implanted Materials in Total Knee Arthroplasty
Brian A. Schneiderman,Steven Yang,Matthew Dipane,Conrad Lu,Edward J. McPherson,Thomas P. Schmalzried
doi : 10.1016/j.arth.2021.02.036
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2480-2485, JULY 01, 2021
An allergic reaction may rarely cause a painful or stiff total knee arthroplasty (TKA). However, no consensus diagnostic criteria for TKA immune failure exist. Lymphocyte transformation testing (LTT) measures immune sensitivity to various materials, but its role in diagnosing an allergic reaction to a TKA has not been established. This study compares TKA periprosthetic tissues in a) LTT-positive versus -negative patients and b) patients with conventional CoCrNi versus hypoallergenic implants.
Do Patients With Diabetes Have Poorer Improvements in Patient-Reported Outcomes After Total Knee Arthroplasty?
Siyuan Zhang,Mark Chong,Bernard Puang Huh Lau,Yau Hong Ng,Xinyu Wang,Weiliang Chua
doi : 10.1016/j.arth.2021.02.070
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2486-2491, JULY 01, 2021
Diabetes is one of the most common comorbidities in patients undergoing total knee arthroplasty (TKA) for osteoarthritis. However, the evidence remains unclear on how it affects patient-reported outcome measures after TKA.
Does the Use of a Tourniquet Influence Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial
Stephen G. Zak,David Yeroushalmi,William J. Long,Morteza Meftah,Erik Schnaser,Ran Schwarzkopf
doi : 10.1016/j.arth.2021.02.068
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2492-2496, JULY 01, 2021
Intraoperative tourniquet use in total knee arthroplasty (TKA) is a common practice which may improve visualization of the surgical field and reduce blood loss. However, the safety and efficacy associated with tourniquet use continues to be a subject of debate among orthopedic surgeons. The primary purpose of this study is to evaluate the effects of tourniquet use on pain and opioid consumption after TKA.
Where Is the “Weak Link” of Fixation in Contemporary Cemented Total Knee Replacements?
J. Ryan Martin,Jesse E. Otero,J. Bohannon Mason,Thomas K. Fehring
doi : 10.1016/j.arth.2021.02.029
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2497-2501, JULY 01, 2021
Aseptic tibial loosening is a frequent cause of long-term failure following primary cemented total knee replacement. Failure of the tibial implant can occur at the implant-cement interface or at the cement-bone interface. Currently, it is unknown at which interface failure occurs in cases of aseptic tibial loosening. The following study was designed to determine which interface represents the “weak link” for tibial implant fixation.
Minimum Five Years Follow-Up of Total Knee Arthroplasty Using Morphometric Implants in Patients With Osteoarthritis
Florent Bernard de Villeneuve,Christophe Jacquet,Stephane Puech,Sebastien Parratte,Matthieu Ollivier,Jean-Noel Argenson
doi : 10.1016/j.arth.2021.02.052
PRIMARY KNEE| VOLUME 36, ISSUE 7, P2502-2509, JULY 01, 2021
The use of morphometric implants in total knee arthroplasty (TKA) has shown better early clinical outcomes compared to conventional implants. The primary objective of this study is to evaluate the functional outcome and the implant survivorship of a morphometric TKA at a minimum of 5 years of follow-up.
A Deep Learning Tool for Automated Radiographic Measurement of Acetabular Component Inclination and Version After Total Hip Arthroplasty
Pouria Rouzrokh,Cody C. Wyles,Kenneth A. Philbrick,Daniel J. Berry,Bradley J. Erickson,Hilal Maradit Kremers
doi : 10.1016/j.arth.2021.02.026
PRIMARY HIP| VOLUME 36, ISSUE 7, P2510-2517.E6, JULY 01, 2021
Inappropriate acetabular component angular position is believed to increase the risk of hip dislocation after total hip arthroplasty. However, manual measurement of these angles is time consuming and prone to interobserver variability. The purpose of this study was to develop a deep learning tool to automate the measurement of acetabular component angles on postoperative radiographs.
Total Hip Arthroplasty in Patients With Osteoarthritis Associated With Legg-Calve-Perthes Disease: Perioperative Complications and Patient-Reported Outcomes
Chris A. Anthony,Marcin K. Wasko,Gail E. Pashos,Robert L. Barrack,Ryan M. Nunley,John C. Clohisy
doi : 10.1016/j.arth.2021.02.031
PRIMARY HIP| VOLUME 36, ISSUE 7, P2518-2522, JULY 01, 2021
Complications and patient-reported outcomes (PROs) of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) have demonstrated variable results. The purpose of this study was to use a validated grading scheme to analyze complications associated with THA in patients with residual LCPD deformities. Second, we report PROs and intermediate-term survivorship in this patient population.
The Effect of a Degenerative Spine and Adverse Pelvic Mobility on Prosthetic Impingement in Patients Undergoing Total Hip Arthroplasty
Yolanda M. Gu,Woosung Kim,Jim W. Pierrepont,Qing Li,Andrew J. Shimmin
doi : 10.1016/j.arth.2021.02.035
PRIMARY HIP| VOLUME 36, ISSUE 7, P2523-2529, JULY 01, 2021
Despite the placement of acetabular components in the traditional “safe-zone”, dislocations and all parts of the instability spectrum, including impingement, continue to be an issue. Recent research has established the importance of a degenerative spine and adverse pelvic mobility on functional acetabular orientation. The purpose of this study is to quantify the clinical consequences of a degenerative spine and adverse pelvic mobility on prosthetic impingement in patients undergoing total hip arthroplasty.
Use of Dual Mobility Acetabular Component and Anterior Approach in Patients With Displaced Femoral Neck Fracture
Yuta Jinnai,Yasuhiro Homma,Tomonori Baba,Xu Zhuang,Kazuo Kaneko,Muneaki Ishijima
doi : 10.1016/j.arth.2021.02.056
PRIMARY HIP| VOLUME 36, ISSUE 7, P2530-2535, JULY 01, 2021
Although the antidislocation effect of total hip arthroplasty (THA) via the direct anterior approach (DAA) with dual mobility cup (DMC) for displaced femoral neck fracture (FNF) has already been reported, the clinical result of DMC-DAA-THA for displaced FNF in terms of mortality, complications, and walking ability are still unclear.
Clinical Outcomes in Isolated Tibial Revision With Cruciate Retaining Total Knee Arthroplasty
Robert W. Tracey,Faisal Akram,Craig J. Della Valle,Scott M. Sporer,Richard A. Berger,Tad L. Gerlinger
doi : 10.1016/j.arth.2021.02.013
REVISION ARTHROPLASTY| VOLUME 36, ISSUE 7, P2536-2540, JULY 01, 2021
Tibial component loosening is one of the most common modes of failure in contemporary total knee arthroplasty (TKA). Limited literature is available on the outcomes of isolated tibial revision with retention of the cruciate retaining (CR) femoral component. The purpose of this study was to determine the results of isolated tibial revisions in CR TKA.
External Validation Demonstrates Limited Clinical Utility of a Preoperative Prognostic Calculator for Periprosthetic Joint Infection
Rubén Mon?rrez,Mitchell G. Maltenfort,Andrew Figoni,Antonia F. Chen,Erik N. Hansen,Michael M. Kheir
doi : 10.1016/j.arth.2021.02.067
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 7, P2541-2545, JULY 01, 2021
Preoperative calculation of treatment failure risk in patients undergoing surgery for periprosthetic joint infection (PJI) is imperative to allow for medical optimization and targeted prevention. A preoperative prognostic model for PJI treatment failure was previously developed, and this study sought to externally validate the model.
Perioperative Continuation of Biologic Medications Increases Odds of Periprosthetic Joint Infection in Patients With Inflammatory Arthropathy
Victor R. Carlson,Lucas A. Anderson,Chao-Chin Lu,Brian C. Sauer,Brenna E. Blackburn,Jeremy M. Gililland
doi : 10.1016/j.arth.2021.02.025
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 7, P2546-2550, JULY 01, 2021
Rates of prosthetic joint infection (PJI) are elevated among patients with inflammatory arthropathy (IA). The effect of continuing biologic drugs perioperatively with regard to PJI is unknown. The purpose of this study is to compare rates of perioperative biologic continuation in IA patients who did and did not develop PJI after primary total joint arthroplasty (TJA).
Perioperative Medical Optimization of Symptomatic Benign Prostatic Hyperplasia Is an Economically Justified Infection Prevention Strategy in Total Joint Arthroplasty
Michael A. Moverman,Matthew J. Bruha,Nicholas R. Pagani,Richard N. Puzzitiello,Mariano E. Menendez,C. Lowry Barnes
doi : 10.1016/j.arth.2021.02.059
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 7, P2551-2557, JULY 01, 2021
Abnormal voiding dynamics may be a modifiable risk factor for prosthetic joint infection (PJI) after total joint arthroplasty (TJA), but the cost-effectiveness of their optimization in the perioperative setting is unknown. Using a break-even analysis, we calculated the economic viability of perioperative voiding optimization for infection prevention after TJA in patients with symptomatic benign prostatic hyperplasia (BPH).
Accuracy of Predictive Algorithms in Total Hip and Knee Arthroplasty Acute Periprosthetic Joint Infections Treated With Debridement, Antibiotics, and Implant Retention (DAIR)
Brian P. Chalmers,Milan Kapadia,Yu-Fen Chiu,Michael W. Henry,Stephen Lyman,Alberto V. Carli
doi : 10.1016/j.arth.2021.02.039
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 7, P2558-2566, JULY 01, 2021
Debridement, antibiotics, and implant retention (DAIR) failure remains high for total hip and knee arthroplasty periprosthetic joint infection (PJI). We sought to determine the predictive value of the CRIME80 and KLIC for failure of DAIR in acute hematogenous (AH) and acute postoperative (AP) PJIs, respectively.
Total Femur Antibiotic Spacers: Effective Salvage for Complex Periprosthetic Joint Infections
Mark J. Heidenreich,Matthew W. Tetreault,David G. Lewallen,Kevin I. Perry,Arlen D. Hanssen,Matthew P. Abdel
doi : 10.1016/j.arth.2021.02.072
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 7, P2567-2574, JULY 01, 2021
A simultaneous periprosthetic joint infection (PJI) of an ipsilateral hip and knee arthroplasty is a challenging complication of lower extremity reconstructive surgery. We evaluated the use of total femur antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers in the staged treatment of such limb-threatening PJIs.
Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency
Christian Hipfl,Teresa Carganico,Vincent Leopold,Carsten Perka,Michael Müller,Sebastian Hardt
doi : 10.1016/j.arth.2021.02.040
COMPLICATIONS - INFECTION| VOLUME 36, ISSUE 7, P2575-2585, JULY 01, 2021
High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a nonspacer two-stage revision. This study reports on the clinical course of a contemporary two-stage exchange for periprosthetic hip infection without spacer insertion.
Efficacy and Safety of Mechanical IVC Filtration for Preventing Pulmonary Embolism in High-Risk Orthopedic Patients Undergoing Total Hip or Knee Arthroplasty
Osman Ahmed,Ye Joon Kim,Mikin V. Patel,Hue H. Luu,Bryan Scott,Kenneth Cohen
doi : 10.1016/j.arth.2021.02.042
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 7, P2586-2590, JULY 01, 2021
To determine the efficacy and safety of inferior vena cava (IVC) filters in preventing pulmonary embolism (PE) in high-risk patients undergoing hip or knee arthroplasty.
Retrospective Population-Based Cohort Study of Incidence, Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures
Simo S.A. Miettinen,Samuli V. T?rm?,Janne M. Lappalainen,Reijo Sund,Heikki Kr?ger
doi : 10.1016/j.arth.2021.02.060
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 7, P2591-2596, JULY 01, 2021
The aim of this study is to investigate the population and primary total hip arthroplasty (THA)-based incidences, fracture types, complications, and survival of operatively treated periprosthetic femoral fracture (PFF).
Periprosthetic Femur Fractures After Total Hip Arthroplasty: Does the Mode of Failure Correlate With Classification?
Elizabeth B. Gausden,Zodina A. Beiene,Jason L. Blevins,David L. Helfet,Peter K. Sculco,David J. Mayman
doi : 10.1016/j.arth.2021.02.048
COMPLICATIONS - OTHER| VOLUME 36, ISSUE 7, P2597-2602, JULY 01, 2021
Periprosthetic femur fracture is one of the most common indications for reoperation after total hip arthroplasty. Our objectives were to evaluate the incidence of reoperation after the surgical treatment of periprosthetic femur fractures and to compare the mechanisms of failure between fractures around a stable femoral component and those with an unstable femoral component.
On the Formation Mechanism of Column Damage Within Modular Taper Junctions
Zita Zachariah,Shanoob Balachandran,Zhilong Liu,Alfons Fischer,Dierk Raabe,Michael Herbig
doi : 10.1016/j.arth.2021.02.073
BASIC SCIENCE| VOLUME 36, ISSUE 7, P2603-2611.E2, JULY 01, 2021
Column damage is a unique degradation pattern observed in cobalt-chromium-molybdenum (CoCrMo) femoral head taper surfaces that resemble column-like troughs in the proximal-distal direction. We investigate the metallurgical origin of this phenomenon.
Effectiveness of Different Wound Dressings in the Reduction of Blisters and Periprosthetic Joint Infection After Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis
Feng-Chih Kuo,Chih-Wei Hsu,Timothy L. Tan,Pao-Yen Lin,Yu-Kang Tu,Po-Cheng Chen
doi : 10.1016/j.arth.2021.02.047
SYSTEMATIC REVIEW & META ANALYSIS| VOLUME 36, ISSUE 7, P2612-2629, JULY 01, 2021
The optimal type of dressing in the setting of total joint arthroplasty (TJA) remains uncertain. The aim of this network meta-analysis was to compare various wound dressings and identify the optimal type of dressings for blister reduction and prevention of periprosthetic joint infection (PJI) in patients after TJA.
Two-Stage Reimplantation of a Prosthetic Hip Infection: Systematic Review of Long-Term Reinfection and Pathogen Outcomes
Michael R. Otten,Beau J. Kildow,Harlan R. Sayles,Danielle Drummond,Kevin L. Garvin
doi : 10.1016/j.arth.2021.02.046
SYSTEMATIC REVIEW & META ANALYSIS| VOLUME 36, ISSUE 7, P2630-2641, JULY 01, 2021
Although two-stage exchange for chronic periprosthetic hip infections remains an effective option for infection eradication, long-term outcome reporting remains scarce. Compiling outcomes data for this standard of care is necessary to characterize long-term reinfection risk and identify bacteria associated with reinfection. The purpose of our study was to perform a systematic review to determine the long-term risk of reinfection after two-stage reimplantation. The second purpose was to identify the proportion of reinfections caused by the same or different organism(s) relative to the index infection.
Onlay Patellofemoral Arthroplasty in Patients With Isolated Patellofemoral Arthritis: A Systematic Review
Jordan C. Villa,Albit R. Paoli,Howard W. Nelson-Williams,Rhamee N. Badr,Katharine D. Harper
doi : 10.1016/j.arth.2021.02.054
SYSTEMATIC REVIEW & META ANALYSIS| VOLUME 36, ISSUE 7, P2642-2649, JULY 01, 2021
Patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis (OA) remains controversial due to variable postoperative outcomes and high failure rates. Second-generation (2G) onlay prostheses have been associated with improved postoperative outcomes. This systematic review was performed to assess the current overall survivorship and functional outcomes of 2G PFA.
Letter to the Editor on “Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty”
Aditya Kaushal,Sandeep Patel,Vishal Kumar,Mandeep Singh Dhillon
doi : 10.1016/j.arth.2021.03.014
LETTER TO THE EDITOR| VOLUME 36, ISSUE 7, E63-E64, JULY 01, 2021
Response to Letter to the Editor on “Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty”
Hany S. Bedair
doi : 10.1016/j.arth.2021.03.012
LETTER TO THE EDITOR| VOLUME 36, ISSUE 7, E65, JULY 01, 2021
A Letter to the Editor on “Effectiveness of Periarticular Injection After Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture in Elderly Patients: A Double-Blinded Randomized, Controlled Study”
Qin Xu,Xiaoling Guo
doi : 10.1016/j.arth.2021.02.065
LETTER TO THE EDITOR| VOLUME 36, ISSUE 7, E66, JULY 01, 2021
Response to the Letter to the Editor on “Effectiveness of Periarticular Injection After Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture in Elderly Patients: A Double-Blinded Randomized, Controlled Study”
Qin Xu,Xiaoling GuoOng-art Phruetthiphat,Attaporn Lawanprasert,Warat Tassanawipas
doi : 10.1016/j.arth.2021.02.066
LETTER TO THE EDITOR| VOLUME 36, ISSUE 7, E67, JULY 01, 2021
Letter to the Editor: Does the Use of Intraoperative Technology Yield Superior Patient Outcomes Following Total Knee Arthroplasty?
Ahmed Siddiqi,Nicolas S. Piuzzi
doi : 10.1016/j.arth.2020.12.044
LETTER TO THE EDITOR| VOLUME 36, ISSUE 7, E68-E69, JULY 01, 2021
Response to Letter to the Editor on “Does the Use of Intraoperative Technology Yield Superior Patient Outcomes Following Total Knee Arthroplasty?”
Vivek Singh,Benjamin Fiedler,Trevor Simcox,Vinay K. Aggarwal,Ran Schwarzkopf,Morteza Meftah
doi : 10.1016/j.arth.2020.12.042
LETTER TO THE EDITOR| VOLUME 36, ISSUE 7, E70-E71, JULY 01, 2021
Conflict of Interest
doi : 10.1016/S0883-5403(21)00431-9
MISCELLANEOUS| VOLUME 36, ISSUE 7, P2650, JULY 01, 2021
Ed board
doi : 10.1016/S0883-5403(21)00428-9
EDITORIAL BOARD| VOLUME 36, ISSUE 7, PA1, JULY 01, 2021
Table of Contents
doi : 10.1016/S0883-5403(21)00430-7
CONTENTS LIST| VOLUME 36, ISSUE 7, PA5-A10, JULY 01, 2021
