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Background In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). Purpose The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. Methods This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Results Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p<0.05). [ABSTRACT FROM AUTHOR]

One important factor for the prevention of surgical site infections is ultraclean air in the operating room (OR). Still, the direct sterilization potential of most technologies, especially in a dynamic clinical setting, is not well understood. We aimed to determine and compare the microbial presence from the inlet and outlet flow of a filtration unit with crystalline ultraviolet-C (C-UVC) light. A prospective study was conducted at a single institution, where primary total joint arthroplasty and spine surgeries were performed. The OR was fitted with a positive ventilation system. In addition, a filtration unit with a C-UVC sterilizing light was placed in the OR. The inlet and outlet air flows were swabbed simultaneously and compared. Swabs were processed for culture and next-generation sequencing. The mean length of the surgical procedures sampled was 68 ± 13 minutes. Overall, 19 out of 200 (9.5%) swabs isolated microorganisms. Inlet air swabs were positive at a higher rate (16 versus 3%; P <.01) compared to the outlet air swabs. A wide variety of Gram-positive, Gram-negative, and anaerobic bacteria were isolated, but fungi were only recovered from inlet air swabs. The detection of microorganisms was also higher when more door openings were performed (32.5 ± 7.1 versus 27.9 ± 5.6; P <.01). Air swabs mainly isolated microorganisms from the inlet flow to the filtration unit with a C-UVC light. The sterilizing unit counteracted factors affecting the air quality in the OR, namely door openings, surgical personnel, and tissue combustion. [ABSTRACT FROM AUTHOR]

Lateral unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated lateral compartment osteoarthritis. However, due to the rarity of the procedure, long-term outcomes and survivorship are poorly understood. We report the clinical and radiographic outcomes after lateral UKA. We retrospectively reviewed a consecutive series of patients who underwent lateral UKA by a single fellowship-trained arthroplasty surgeon from 2001 to 2021 with a minimum 2 year follow up. There were 161 knees in 153 patients (average age 69 years) that met inclusion criteria, with a mean follow up of 10.0 years (range 0.05 to 22.2). All patients underwent the procedure via a minimally invasive lateral parapatellar approach with a fixed-bearing implant. Patient demographics, complications, radiographic findings, patient-reported outcomes, and the need for revision surgery were evaluated. Survivorship was defined with the end point as revision of components. There were 8 patients (5.0%) who underwent conversion to total knee arthroplasty for lateral UKA implant failure or progression of arthritis. There were 3 patients (1.9%) who underwent ipsilateral medial UKA due to medial compartment arthritis progression with preserved mechanical alignment and patellofemoral joint. There were 8 additional procedures that did not require implant changes, including 5 irrigation and debridements for acute periprosthetic joint infection (3.1%), 2 wound closures for dehiscence (1.3%), and one loose body removal (0.6%). Lateral UKA showed a survivorship rate of 98.0% at 5 years, 96.0% at 10 years, and 94.5% at 15 years. When including patients who underwent additional surgery for the progression of arthritis, survivorship was 97.4% at 5 years, 95.4% at 10 years, and 91.3% at 15 years. Lateral UKA should be seen as a durable treatment option for isolated lateral compartment osteoarthritis. [ABSTRACT FROM AUTHOR]

Many patients suffer from osteoarthritis (OA) in multiple joints, possibly resulting in multiple joint arthroplasties (MJAs). Primarily, we determined the cumulative incidence (C in) of MJA in hip and knee joints up to 10 years. Secondly, we calculated the mean time between the first and subsequent joint arthroplasty, and evaluated the different MJA trajectories. Lastly, we compared patient characteristics and outcomes (functionality and pain) after surgery between MJA patients and single hip arthroplasty or knee arthroplasty (HA and KA) patients. Primary index (first) HA or KA for OA were extracted from the Dutch Arthroplasty Register. The 1, 2, 5, and 10-year C in (including competing risk death) of MJA, mean time intervals, and MJA-trajectories were calculated and stratified for primary index HA or KA. Sex, preoperative age, and body mass index were compared using ordinal logistic regression. Outcomes, measured preoperatively, 3, 6, and 12 months postoperatively (function: Hip Disability or Knee Injury and OA Outcome Score; Pain: Numerical Rating Scale), were compared using linear regression. A total of 140,406 HA-patients and 140,268 KA-patients were included. One, 2, 5, and 10-year C in for a second arthroplasty were respectively 8.9% [95% confidence interval (CI): 8.7 to 9.0], 14.3% [95% CI: 14.1 to 14.5], 24.0% [95% CI: 23.7 to 24.2], and 32.7% [95% CI: 32.2 to 33.1] after index HA, and 9.5% [95% CI: 9.4 to 9.7], 16.0% [95% CI: 15.9 to 16.2], 26.4% [95% CI: 26.1 to 26.6], and 35.8% [95% CI: 35.4 to 36.3] after index KA. The 10-year C in for > 2 arthroplasties were small in both the index HA and KA groups. Time-intervals from first to second, third, and fourth arthroplasty were 26 [95% CI: 26.1 to 26.7], 47 [95% CI: 46.4 to 48.4], and 58 [95% CI: 55.4 to 61.1] months after index HA, and 26 [95% CI: 25.9 to 26.3], 52 [95% CI: 50.8 to 52.7], and 61 [95% CI: 58.3 to 63.4] months after index KA. There were 83% of the second arthroplasties placed in the contralateral cognate joint (ie, knee or hip). Differences in postoperative functionality and pain between MJAs and single HAs and KAs were small. The 10-year C in showed that about one-third of patients received a second arthroplasty after approximately 2 years, with the majority in the contralateral cognate joint. Few patients received > 2 arthroplasties within 10 years. Being a women, having a higher body mass index, and being younger increased the odds of MJA. Postoperative outcomes were slightly negatively affected by MJA. [ABSTRACT FROM AUTHOR]

Studies comparing the outcomes of bariatric surgery followed by total knee arthroplasty (TKA) versus TKA alone in obese patients have disparate results. This systematic review and meta-analysis sought to compare TKA with and without prior bariatric surgery in obese patients. MEDLINE, PubMed, and Embase were searched from inception to April 9, 2023. There were twelve included studies that yielded 2,876,547 patients, of whom 62,818 and 2,813,729 underwent TKA with and without prior bariatric surgery, respectively. Primary outcomes were medical complications (ie, urinary tract infection, pneumonia, renal failure, respiratory failure, venous thromboembolism [VTE], arrhythmia, myocardial infarction, and stroke); surgical complications (ie, wound complications [eg, infection, hematoma, dehiscence, delayed wound healing, and seroma], periprosthetic joint infection, mechanical complications, periprosthetic fracture, knee stiffness, and failed hardware); revision, and mortality. Secondary outcomes were blood transfusion, length of stay (day), and readmission. The odds ratios (OR) of 90-day VTE (OR = 0.75 [0.66, 0.85], P <.00001), 90-day stroke (OR = 0.58 [0.41, 0.81], P =.002), and 1-year periprosthetic fracture (OR = 0.74 [0.55, 0.99], P =.04) were lower in those who underwent bariatric surgery before TKA. Although the mean difference in hospital stays (−0.19 days [−0.23, −0.15], P <.00001) was statistically less in those who underwent bariatric surgery before TKA, it was not clinically relevant. The other outcomes were similar between the groups. Bariatric surgery before TKA is beneficial in terms of a lower risk of VTE, stroke, and periprosthetic fracture. This analysis suggests surgeons consider discussing bariatric surgery before TKA in obese patients, especially those who are at risk of VTE and stroke. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy of preoperative pain neuroscience education (PNE) on pain intensity, kinesiophobia, catastrophizing, and disability in individuals undergoing hip or knee arthroplasty. A search was conducted on MEDLINE, CINAHL, Epistemonikos, Scopus, and Web of Science from their inception to March 2023. Two investigators independently assessed the risk of bias with Risk of Bias 2 (ROB2) and Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) of the studies, as well as the certainty of the evidence with Grade of Recommendation, Assessment, Development, and Evaluation (GRADE) for pain intensity, catastrophizing, kinesiophobia and disability at one month, three months and six months of follow-up. A total of 1716 papers were found and two studies on knee arthroplasty were included (n = 147). The intergroup effect sizes for pain intensity were 0.29, 0.07, and 0.25 at one-, three-, and six-months post-surgery, whereas the effect sizes for disability were 0.4, 0.46, and 0.21 (GRADE analysis, moderate certainty, respectively). Catastrophizing showed intergroup effect sizes of 0.78, 1.08, and 0.25, and kinesiophobia of 1.56, 0.92, and 0.33 at follow-up (GRADE analysis, low-moderate certainty). Preoperative PNE in individuals undergoing knee arthroplasty has low to moderate certainty for improving pain intensity, catastrophizing, kinesiophobia, and disability with low to high effect sizes and discrepancy between studies. More research on the effect of a preoperative PNE intervention in people undergoing knee or hip arthroplasty is required. [ABSTRACT FROM AUTHOR]

The present study adopts a multi-facet approach to design bio inspired concentrated alloys for potential application as articulating surfaces in joint replacements. A series of equiatomic, Nb rich and Ti rich TiMoNbZr based medium entropy alloys (MEAs) were processed via arc melting and their mechanical, in-vitro corrosion, wear, and in vitro and in vivo biocompatibility were investigated. Equiatomic MEA had primarily bcc with minor hcp phases where the single bcc was achieved with the addition of Nb. The single bcc Nb rich alloy resulted in 13 % elongation, much higher than equiatomic or Ti rich alloy. All the MEAs showed comparatively higher yield strength due to the climb of edge dislocations which is the main rate limiting mechanism at 300 K, as evident molecular dynamics (MD) simulation. The locally fluctuating energy landscape promotes kinks on edge dislocation, and at local minima nanoscale segments gets pinned. Upon yielding the entangled kink leaves a trail of vacancies/interstitials and escapes via climb motion to render high yield strength. The higher corrosion and pitting resistance of Nb enriched alloys can be attributed to the stable ZrO 2 , Nb 2 O 5 , TiO 2 , and MoO 3 oxides, high polarization resistance (106–105 Ωcm−2), and low defect densities (1016–1018). In vitro cell-materials interaction using MC3T3-E1 showed bioinert but cytocompatible nature of the MEAs. The wear rate of the MEAs was in the range of 7–9 × 10−5 mm3N−1m−1. The wear debris did not show any tissue necrosis when implanted in rabbit femur rather new bone regeneration can be seen around the particles. In the present work, a noble Nb enriched MEAs with superior mechanical, in vitro wear, corrosion and cytocompatibility properties was designed for articulating surfaces in joint replacement. • Single bcc in Nb enriched MEAs resulted in 13 % elongation with high hardness and yield strength. • Climb of entangled edge segment is the rate limiting mechanism in controlling high yield strength of MEAs at 300 K. • High polarization resistance (106–105 Ωcm−2), and low defect densities (1016–1018) attributes to ZrO 2 , Nb 2 O 5 , TiO 2 , and MoO 3 oxides enriched passive film. • Wet sliding wear rate ranged in order 7–9 × 10−5 mm3N−1m−1. In-situ generated wear debris when implanted in rabbit femur did not show any tissue necrosis rather new bone regeneration was observed around debris. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence, prevention measures, and risk factors for occult periprosthetic fractures after primary total hip arthroplasty (THA), as well as to determine whether or not they are the root of early THA failure. Methods From January 2014 to December 2018, 755 patients (769 hips) underwent primary total hip arthroplasty were retrospectively analyzed, including 327 males (339 hips) and 428 females (430 hips). X-ray, CT and 3D reconstruction of hip were performed before and after operation. By using CT to diagnose the occult fractures, the patients were then monitored and evaluated. Age, sex, body mass index (BMI), preoperative diagnosis, osteoporosis, kind of prosthesis, and the surgeon's experience should all be considered. Patients with occult fracture were followed up, the fracture healing and prosthesis stability were recorded and analyzed. Results There are 23 of 769 cases (23/769) had occult fracture around the prosthesis, with an incidence of 2.99% (23/769);. The total revision rate was 0.52% (4/769). The revision patients accounted for 17.39% (4/23) of the patients with occult femoral fractures. The remaining patients received conservative care and successfully joined without their prostheses slipping. Osteoporosis, body mass index, and the surgeon's experience were identified as the risk variables for periprosthetic occult fractures by univariate analysis (P < 0.05). Conclusion Periprosthetic occult fracture was a complication that can not be ignored in primary total hip arthroplasty. It is the cause of early failure of prosthesis. Osteoporosis, BMI and the surgeon's experience are all risk factors for periprosthetic occult fractures. [ABSTRACT FROM AUTHOR]

The effect of metabolic syndrome (MetS) on the risk of revision after hip and knee arthroplasty is debated. The aim of our study was to investigate the risk of short-term (minimum 2.7 years) revision due to periprosthetic joint infection (PJI) after hip and knee arthroplasty. Secondly, we aimed to investigate the risk of revision due to any cause and mortality. During May 2017 to November 2019, a cohort of 2,901 patients undergoing a total of 3,024 hip and knee arthroplasties was established. In the cohort, 62.1% met the criteria for MetS. Data from national registries and a local database were used to determine the presence of MetS and revision surgeries, with a follow-up of at least two years and eight months. Cox regression was applied to the present hazard ratio (HR), associated 95% confidence intervals, and P values. Survival analyses were presented in a Kaplan-Meier plot. The risk of PJI (HR 1.6 (0.5 to 4.9), P =.380), any revision (HR 0.8 (0.4 to 1.3), P =.295), and death (HR 1.3 (0.8 to 2.1), P =.282) was not increased in patients suffering from MetS compared with patients who did not have MetS. There was no PJI in patients not having MetS and receiving a knee arthroplasty. The risk of death was increased in the MetS group receiving a knee arthroplasty (HR 2.7 (1.3 to 5.9), P =.010), but not different from the MetS group receiving a hip arthroplasty. There was no elevated risk of PJI when analyzing morbid obesity (body mass index over 40), men, or diabetes as the exposures. Patients suffering from MetS do not have an increased risk of revision caused by PJI. In general, performing hip and knee arthroplasty in patients suffering from MetS is without increased risk of revision surgery. [ABSTRACT FROM AUTHOR]

In the setting of total knee arthroplasty (TKA), prior patellectomy historically prompted the use of increased constraint implants, specifically posterior-stabilized (PS) designs. However, modern case series have reported similar outcomes utilizing cruciate-retaining (CR) implants. The primary outcome of this study was to compare implant retention rates between these 2 implant designs in prior patellectomy patients. Secondary outcomes included a comparison of patient-reported outcome scores and cause for revision. A comprehensive systematic review was performed using Web of Science, PubMed, and Scopus databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Boolean operator search terms included "patellectomy AND (arthroplasty) OR (replacement)." Case reports, review articles, < 2 years of follow-up, and studies in which the implant design could not be ascertained were excluded. An initial screening of titles and abstracts for inclusion was performed, followed by a full manuscript review of eligible articles. Single-data extraction was performed, followed by subsequent statistical analysis. A total of 9 studies (209 knees) met the inclusion criteria. The average time from patellectomy to TKA was 16.1 years. While all patients had significant improvement in functional outcomes, CR implants displayed proportionally greater improvement in Knee Society Scores compared to PS implants (+108 versus +98%, P ≤.001). However, there was a significantly greater rate of revision in the CR cohort compared to PS (18.6 versus 2.6%, P =.002). Prior patellectomy patients undergoing TKA have significant improvements in patient-reported functional outcomes and high midterm retention rates. While CR implant designs portend a potentially greater improvement in functional outcomes, they also have a greater risk for revision than their PS implant counterparts. However, contemporary implant designs and operative techniques likely render revision rates equivocal between CR and PS implants in postpatellectomy patients. [ABSTRACT FROM AUTHOR]

Open reduction and internal fixation (ORIF) remains the gold standard for adult distal humerus fractures (DHF). However, indications for total elbow arthroplasty (TEA) continue to expand and the incidence of primary and salvage TEA for DHF has increased. The objective of this study was to compare complication and reoperation rate for acute vs. delayed primary and salvage TEA performed for DHF. Patients who underwent TEA for DHF were identified in the PearlDiver database. Patients were sorted into 3 cohorts: (1) acute TEA (within 2 weeks of diagnosis), (2) delayed TEA (between 2 weeks and 6 months after diagnosis), and (3) salvage TEA (after failed ORIF, malunion, nonunion, delayed treatment between 6 months and 1 year or post-traumatic arthritis). Multivariate analysis was used to assess for confounding variables and covariates when identifying differences in complications between cohorts. A total of 788 patients underwent acute TEA, 213 patients underwent delayed TEA, and 422 patients underwent salvage TEA after DHF. The incidence of periprosthetic joint infection (PJI) (8.5% vs. 3.4%, odds ratio [OR] 2.60, P =.002) and triceps injury (2.4% vs. 0.4%, OR 6.29, P =.012) were higher in the delayed compared to acute cohort. The incidence of revision (8.5% vs. 2.1%, OR 3.76, P < 0.001), periprosthetic fracture (4.3% vs. 1.1%, OR 3.64, P =.002), PJI (14.7% vs 3.4%, OR 4.36, P <.001), triceps injury (2.6% vs. 0.4%, OR 5.70, P =.008), and wound complications (6.9% vs 2.9%, OR 2.33, P =.002) were higher in the salvage compared to acute cohort. There was an increased rate of revision (8.5% vs. 1.9%, OR 6.08, P =.002) in the salvage compared to delayed cohort. Patients undergoing salvage TEA after DHF have increased rates of revision, periprosthetic fracture, PJI, triceps injury, and wound complications at 2 years post-operatively. The salvage cohort also had an increased risk of revision when compared to the delayed cohort. However, other than revision rates, patients in the salvage and delayed cohorts have similar postoperative complication rates. [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) aims to restore function in patients with rotator cuff failure and joint arthropathy. After surgery, patients are routinely referred to a rehabilitation specialist to regain range of motion, strength, and function. A key element in these programs is active exercises. The exercises are often selected based on assumed muscle activity, investigated by electromyography (EMG). In particular, in this patient population, activation of the deltoid and the scapular muscles is the focus of exercise therapy. Currently, most studies investigating muscle activity levels during exercises are performed on healthy individuals. To our knowledge, no study exists analyzing EMG activity during exercises in a population of shoulder arthroplasty patients. Therefore, the study aimed to analyze activity in the shoulder girdle muscles during 6 commonly used rehabilitation exercises 12 weeks after reverse shoulder arthroplasty surgery. Forty-four patients (50 shoulders) participated in this cross-sectional study, 12 weeks postoperatively (mean 99.18 ± 12.8 days), aged 68.9 ± 7.75 years. Surface EMG activity was measured in 10 shoulder girdle muscles: the 3 trapezius parts, serratus anterior, the 3 deltoid parts, latissimus dorsi, and 2 pectoralis major parts during 6 exercises, 3 in a closed chain, and 3 open chain elevation exercises. Gravity-minimized exercises (horizontal plane) show low activity for almost all muscles. Vertical closed kinetic chain exercises show an increased activity compared to horizontal plane exercises. Open kinetic chain exercises against gravity showed the greatest activity in deltoid and upper trapezius. For the other muscles, no consistency in progression was found. This study offers a progression of exercises for patients after reverse shoulder arthroplasty based on increased muscle activity. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty (THA) aims to restore joint function and relieve pain. New technology, such as robot assistance, offers the potential to reduce human error, improve precision, and improve postoperative outcomes. The aim of this study was to compare outcomes between conventional and robot-assisted THA. This is a retrospective cohort study utilizing a national database from 2016 to 2019. Patients undergoing THA, conventional or robot-assisted, were identified via the International Classification of Diseases, Tenth Revision code. Multivariate regressions were performed to assess outcomes between groups. Negative binomial regressions were performed to assess discharge disposition, readmission, and reoperation. Gamma regressions with log-link were used to assess total charges and lengths of hospital stays. Patient demographics and comorbidities, measured via the Elixhauser comorbidity index, were controlled for in our analyses. A total of 1,216,395 patients undergoing THA, 18,417 (1.51%) with robotic assistance, were identified. Patients undergoing robot-assisted procedures had increased surgical complications (odds ratio [OR] 1.31 [95% confidence interval [CI] 1.14 to 1.53]; P <.001), including periprosthetic fracture (OR 1.63 [95% CI 1.35 to 1.98]; P <.001). Notably, these patients also had significantly greater total charges (OR 1.20 [95% CI 1.11 to 1.30]; P <.001). Robotic assistance in THA is associated with an increased risk of surgical complications, including periprosthetic fracture, while incurring greater charges. Level III; Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the relationship between risk and reimbursement for both surgeons and hospitals among Medicare patients undergoing primary total joint arthroplasty (TJA). The "2021 Medicare Physician and Other Provider" and "2021 Medicare Inpatient Hospitals" files were used. Patient comorbidity profiles were collected, including the mean patient hierarchal condition category (HCC) risk score. Surgeon data included all primary TJA procedures (inpatient and outpatient) billed to Medicare in 2021, while hospital data included all such inpatient episodes. Surgeon and hospital reimbursements were collected. All episodes were split into a "sicker cohort" with an HCC risk score of 1.5 or more and a "healthier cohort" with HCC risk scores less than 1.5. Variables were compared across cohorts. In 2021, 386,355 primary total hip and knee arthroplasty procedures were billed to Medicare and were included. The mean surgeon reimbursement among the sicker cohort was $1,021.91, which was less than for the healthier cohort of $1,060.13 (P <.001). Meanwhile, for the hospital analysis, 112,012 Medicare TJA patients were admitted as inpatients and included. The mean reimbursement to hospitals was significantly greater for the sicker cohort at $13,950.66, compared to the healthier cohort of $8,430.46. For both analyses, the sicker patient cohorts had a significantly higher rate of all comorbidities assessed (P <.001). This study demonstrates that mean surgeon reimbursement was lower for primary TJA among sicker patients in comparison to their healthier counterparts, while hospital reimbursement was higher for sicker patients. This represents a discrepancy in the incentivization of care for complex patients, as hospitals receive increased remuneration for taking on extra risk, while surgeons get paid less on average for performing TJA on sicker patients. Such data should inform future policy to assure continued access to arthroplasty care among complex patients. [ABSTRACT FROM AUTHOR]

Perioperative tranexamic acid (TXA) use with total knee arthroplasty (TKA) is widely accepted today. Recently, a few international groups have published on the safety and outcomes of extending TXA use in the postoperative period. Through a double-blinded, randomized control trial (RCT), we aimed to investigate the safety and clinical efficacy of extended postoperative oral TXA use in TKA performed in an American, free-standing ambulatory surgery center (ASC). Based on a power analysis, 40 patients undergoing primary TKA were randomized into 2 groups: extended oral TXA versus placebo. Both groups received a standard 1g intravenous TXA dose prior to incision and at the time of closure. The extended TXA group received an additional 1.95 g oral TXA dose following ambulation the day of surgery, plus on postoperative days 1,2, and 3. Patients who had a history of venous thromboembolism (VTE) or cancer were excluded. All patients received 81 mg of aspirin twice daily for VTE prophylaxis. Patients were followed on postoperative day 3 and weeks 2 and 6. Paired t -tests determined statistical significance. Extended TXA patients showed significantly increased knee flexion at 6 weeks (116.05 versus 106.5, P =.0308), improved VAS at 2 (2.5 versus 3.85, P =.039) and 6 weeks (1.35 versus 2.8, P =.011), and superior KOOS JR at 2 (66.87 versus 60.63, P =.03) and 6 weeks (73.33 versus 62.47, P =.0019) compared to placebo patients. No significant differences were found for changes in hemoglobin levels at any time points. No significant differences were found at 12 weeks for any clinical endpoints. No adverse events were noted in either cohort. When compared to placebo, the extended use of oral TXA in the postoperative period may safely result in improved motion, pain, and functional scores. Further investigation into 1-to-2-year outcomes, as well as the duration and dose of postoperative TXA use is warranted. [ABSTRACT FROM AUTHOR]

The primary purpose of this study was to investigate whether anxiety and depression change following total knee arthroplasty (TKA). A secondary objective was to explore the association between preoperative variables and changes in anxiety and depression. This was a prospective, multicenter, cohort study. Participants (n = 1,852, age 64 ± 8.7 years, a body mass index of 31.3, a modified Comorbidity Index of 1.0 ± 1.3, and 61.7% were women) completed the EuroQol 5-dimension 5-level preoperatively and at 1- and 3-month postoperatively. Fulfillment of physical activity expectations and preparedness to resume activities was assessed at 3 months. The anxiety or depression dimension was analyzed using the Paretian classification profile changes and compared with the sign Fisher's exact test. Logistic regressions were used to analyze the relationship between patient characteristics, preoperative anxiety or depression, activity expectations, preparedness to resume activities, and changes in anxiety/depression. The percentage of patients reporting Level 1 (no anxious or depressed feelings) significantly (P <.0001) increased from preoperative (62.2%) to 3 months (77.1%) postoperative, while levels 2 to 5 (slightly through extremely anxious or depressed) all decreased. The percentage of worsening anxiety and depression was significantly (P <.0001) greater in patients who did not feel they were well prepared to resume activities of daily living (17.7 versus 4.4%) and physical recreation (12.9 versus 3.9%). Preoperative anxiety and depression (odds ratio [OR] 52.27, 95% confidence interval [CI]: 34.98, 80.67), EuroQol 5-dimension 5-level (OR: 2.55, 95% CI: 1.04, 6.34), activity of daily living (OR: 1.57, 95% CI: 1.19, 2.06), and body mass index (OR: 1.05, 95% CI: 1.02, 1.08) were significant (P <.05) predictors of an improving Paretian change profile at 3 months postoperative. Anxiety and depression decrease following TKA, and these changes appear heavily dependent on a patient's preoperative psychological well-being and postoperative preparedness to resume daily activities. Physicians' awareness of preoperative patient psychological well-being and management of patient preparedness and expectations to resume physical activity may modulate postoperative anxiety and depression. [ABSTRACT FROM AUTHOR]

The use of administrative databases in arthroplasty research has increased over the past decade. The Nationwide Inpatient Sample (NIS) is one of the first and most frequently used. Despite many published articles using this dataset, there exists no standardization resource accounting for the potential of biased results. The purpose of our study was to assess the amount of discordant data between clinically relevant variables and propose a standard for using this database in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). An initial set of patients undergoing total joint arthroplasty were identified from the NIS between 2016 and 2019 using the International Classification of Diseases, 10th Revision, Procedure Coding System. All records with THA and TKA in any of the procedure variables (PR1-PR20) were included. A total of 63 relevant and consistent variables were selected for individual comparison including diagnosis-related group (1), elective (1), procedure codes (20), day of main procedure (1), and diagnosis codes (40). Descriptive statistics were used. A total of 3,562,819 patients were included in the initial set. Using diagnosis-related groups, 5.3% were revision surgeries, 4.7% were not elective, 2.3% did not have THA or TKA as their primary procedure for hospitalization, and 2.9% of THA and 9.7% of TKA were bilateral. A total of 6.2% of the surgeries were done day(s) before or after admission, and 10.8% of THA and 6.3% of TKA were missing an orthopedic diagnosis for admission. Many had multiple orthopedic diagnoses for admission, 3.2% of THA and 0.7% of TKA. Overall miscoding was 23.3%. Using the NIS without standardized data processing to study elective, unilateral, primary THA and TKA introduces major bias. A logical and stepwise approach to curate the data before analysis is proposed to improve research quality when using this database in hip and knee arthroplasty studies. [ABSTRACT FROM AUTHOR]

Periprosthetic joint infection (PJI) continues to be one of the leading causes of failure following total hip arthroplasty (THA). The objectives of the study were to (1) determine the minimum 2-year infection-free survivorship of 2-stage revision THA, (2) determine the causative organisms for repeat 2-stage revision THA, and (3) characterize the results of failed 2-stage revisions and evaluate patient-reported outcome measures (PROMs). A retrospective chart review was completed for patients who underwent 2-stage revision THA for PJI. Prospective data were collected on each patient, including demographics, causative organisms, complications, and type of reoperation. The PROMs, including Harris Hip Score, 12-item Short-Form Health Survey, and Western Ontario and McMaster Universities Osteoarthritis Index scores were obtained prior to 2-stage revision THA surgery and annually as part of standard clinical and radiographic follow-up. A total of 328 patients who underwent a 2-stage revision THA for a PJI were included in the study (mean age 67 years [range, 28 to 90], mean body mass index of 30.6 [range, 15 to 57]). The overall infection-free survivorship for 2-stage revision THA was 73.8% at a minimum of 2 years (range, 2 to 20). Overall, 194 (59.1%) patients who had successful infection eradication underwent a 2-revision THA only. The most common single organisms infected were Staphylococcus aureus (12.5%) and Staphylococcus epidermidis (11%). Higher reoperation rates were found in cases with methicillin-resistant Staphylococcus aureus and polymicrobial infections. All PROMs showed statistical improvement from preoperatively to the latest follow-up appointment. Two-stage revision THA is associated with a good success rate in the treatment of PJIs at mid-term to long-term follow-up. Polymicrobial and methicillin-resistant Staphylococcus aureus infections are poor prognostic factors, making the eradication of infection more difficult. The management of PJIs continues to be one of the most important orthopaedic challenges to treat. [ABSTRACT FROM AUTHOR]

The incidence of total joint arthroplasty is increasing, with added emphasis on shifting care toward outpatient surgery. This has demonstrated improvements in costs and care; however, safety must be prioritized. Published assessment tools highlight candidates for outpatient surgery; however, they often do not define patients who have a worse prognosis. Limited healthcare resources occasionally force patients to convert to outpatient surgery or risk cancellation, creating a dilemma for both patients and surgeons. We evaluated the short-term (90-day) outcomes of patients converted from planned inpatient admission to same-day discharge on day of surgery outpatients and sought to identify any groups at risk, who may not be appropriate for this conversion. We identified all patients undergoing planned inpatient total hip or knee arthroplasty at a tertiary academic medical center over a 2-year period. We included patients discharged the day of surgery for analysis, excluding revision procedures and those performed for fracture care. A manual chart review identified demographic factors and primary outcome measures; including reoperation, readmission, and emergency room visits within a 90-day postoperative period. We identified a total of 80 patients who converted from inpatient to outpatient surgery over a 2-year interval. Over the first 90 days postoperatively 4 (5%) patients were readmitted: 2 (2.5%) for medical complications and 2 (2.5%) for reoperation. There were 2 (2.5%) reoperations; one (1.25%) for manipulation under anesthesia, and one (1.25%) for periprosthetic joint infection. There were 5 (6.3%) wound complications; however, only one (1.25%) required surgical intervention. A total of 5 (6.3%) patients returned to an emergency department, leading to a single (1.25%) hospital readmission. Hospital and healthcare resources are occasionally limited to the extent that patients must convert to outpatient surgery or risk cancellation. At our institution, the same-day conversion of planned inpatient hip and knee arthroplasty patients to outpatient surgery was safe and did not increase short-term clinical outcomes or complications. [ABSTRACT FROM AUTHOR]

The aim of the study was to analyze the Canadian Cardiovascular Society (CCS) guidelines for routine postoperative troponin testing after elective total hip arthroplasty (THA) to reduce the mortality rate resulting from myocardial injury. The purpose of this study was to assess the prognostic relevance of implementing these guidelines to minimize cardiac events in patients undergoing elective THA. Patients who underwent THA surgery in 2020 were included in the study. The inclusion criteria were elective THA patients aged ≥45 years, while emergency, revision, and simultaneous bilateral THA surgeries were excluded. The patients were categorized into 4 groups based on the CCS guidelines. The study included 669 patients who had an average age of 67 years. There were 43 patients (6.4%), who experienced a rise in troponin levels ≥30 ng/L and developed myocardial injury after noncardiac surgery. Among these patients, 8 developed cardiac complications, and one experienced a serious cardiac event that resulted in death. Notably, there was a significant increase in the length of hospital stay for patients who received the postoperative screening protocol. The implementation of the CCS guidelines for routine postoperative troponin testing in elective THA surgery did not significantly decrease the rate of cardiac events or mortality. [ABSTRACT FROM AUTHOR]

We present a case of iatrogenic iliac vein rupture with venous thrombosis during total hip arthroplasty that was endovascularly treated with the insertion of covered and uncovered stents, aspiration, and balloon maceration of the thrombus. We describe in detail, with a schematic diagram, an endovascular treatment method that can be performed under local anesthesia alone and explain how to overcome the situation when the diameter of the covered stent is inadequate to cover the iliac vein. [ABSTRACT FROM AUTHOR]

• Clinicians should consider comorbidity burden when planning early intervention of older adults undergoing hip surgery. • Improving the nutritional status of older adults awaiting hip surgery could reduce the risk of postoperative pain. • The CCI and MNA are two simple and quick tools for hospital screening and clinical decision making. Hip fracture is a common condition among older adults. The aim of this study was to explore the influence of nutritional status and comorbidity burden on changes in functionality, fall risk, and pain intensity one month after hip surgery in older adults with in-hospital rehabilitation. Thirty-six hip fracture patients (55.6% female) aged 65 years or older with indication for surgical resolution were recruited. The main outcomes were functional independence (Barthel Index), risk of falls (Downton Falls Risk Index) and pain intensity (Visual Analogue Scale), assessed preoperatively and one month after discharge. Covariates included age, sex, BMI, Charlson Comorbidity Index (CCI) and nutritional status (Mini Nutritional Assessment). For the inferential analysis, a one-way analysis of covariance (ANCOVA) was applied. Significant improvements were observed in functional independence (11.0 points, 95% CI: 1.7 to 20.3), risk of falls (-2.8 points, 95% CI: -4.0 to -1.7) and pain intensity (-2.6 points, 95% CI: -3.4 to -1.9). Among the covariates, a significant interaction was found between the CCI and improvements in functional independence (F=7.03, p=0.010, η2p=0.093), while nutritional status showed a significant interaction with pain reduction (F=5.65, p=0.020, η2p=0.075). A lower comorbidity burden was associated with greater postoperative functional independence, while better nutritional status was associated with a greater reduction in postoperative pain intensity. [ABSTRACT FROM AUTHOR]

Background: The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. Methods: A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. Results: Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 (P <.05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 (P <.05) and the EQ-VAS also improved from 53.0 to 63.3 (P =.36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. Conclusion: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate changes in regional and national variations in reimbursement to arthroplasty surgeons, procedural volumes, and patient populations for total hip arthroplasty (THA) from 2013 to 2021. The Medicare Physician and Other Practitioners database was queried for all billing episodes of primary THA for each year between 2013 and 2021. Inflation-adjusted surgeon reimbursement, procedural volume, physician address, and patient characteristics were extracted for each year. Data were stratified geographically based on the United States Census regions and rural–urban commuting codes. Kruskal–Wallis and multivariable regressions were utilized. Between 2013 and 2021, the overall THA volume and THAs per surgeon increased at the highest rate in the West (+48.2%, +20.2%). A decline in surgeon reimbursement was seen in all regions, most notably in the Midwest (−20.3%). Between 2013 and 2021, the average number of Medicare beneficiaries per surgeon declined by 12.6%, while the average number of services performed per beneficiary increased by 18.2%. In 2021, average surgeon reimbursement was the highest in the Northeast ($1,081.15) and the lowest in the Midwest ($988.03) (P <.001). Metropolitan and rural areas had greater reimbursement than micropolitan and small towns (P <.001). Patient age, race, sex, Medicaid eligibility, and comorbidity profiles differ between regions. Increased patient comorbidities, when controlling for patient characteristics, were associated with lower reimbursement in the Northeast and West (P <.01). Total hip arthroplasty (THA) volume and reimbursement differ between US regions, with the Midwest exhibiting the lowest increase in volume and greatest decline in reimbursement throughout the study period. Alternatively, the West had the greatest increase in THAs per surgeon. Patient comorbidity profiles differ between regions, and increased patient comorbidity is associated with decreased reimbursement in the Northeast and the West. This information is important for surgeons and policymakers as payment models regarding reimbursement for arthroplasty continue to evolve. [ABSTRACT FROM AUTHOR]

A consumer-focused health care model not only allows unprecedented access to information, but equally warrants consideration of the appropriateness of providing accurate patient health information. Nurses play a large role in influencing patient satisfaction following total knee arthroplasty (TKA), but they come at a cost. A specific natural language artificial intelligence (AI) model, ChatGPT (Chat Generative Pre-trained Transformer), has accumulated over 100 million users within months of launching. As such, we aimed to compare: (1) orthopaedic surgeons' evaluation of the appropriateness of the answers to the most frequently asked patient questions after TKA; and (2) patients' comfort level in answering their postoperative questions by using answers provided by arthroplasty-trained nurses and ChatGPT. We prospectively created 60 questions based on the most commonly asked patient questions following TKA. There were 3 fellowship-trained surgeons who assessed the answers provided by arthroplasty-trained nurses and ChatGPT-4 to each of the questions. The surgeons graded each set of responses based on clinical judgment as: (1) "appropriate," (2) "inappropriate" if the response contained inappropriate information, or (3) "unreliable," if the responses provided inconsistent content. Patients' comfort level and trust in AI were assessed using Research Electronic Data Capture (REDCap) hosted at our local hospital. The surgeons graded 44 out of 60 (73.3%) responses for the arthroplasty-trained nurses and 44 out of 60 (73.3%) for ChatGPT to be "appropriate." There were 4 responses graded "inappropriate" and one response graded "unreliable" provided by the nurses. For the ChatGPT response, there were 5 responses graded "inappropriate" and no responses graded "unreliable." There were 136 patients (53.8%) who were more comfortable with the answers provided by ChatGPT compared to 86 patients (34.0%) who preferred the answers from arthroplasty-trained nurses. Of the 253 patients, 233 (92.1%) were uncertain if they would trust AI to answer their postoperative questions. There were 127 patients (50.2%) who answered that if they knew the previous answer was provided by ChatGPT, their comfort level in trusting the answer would change. One potential use of ChatGPT can be found in providing appropriate answers to patient questions after TKA. At our institution, cost expenditures can potentially be minimized while maintaining patient satisfaction. Inevitably, successful implementation is dependent on the ability to provide information that is credible and in accordance with the objectives of both physicians and patients. III. [ABSTRACT FROM AUTHOR]

The main goal of this study was to investigate the influence of patient age on humeral implant fixation in stemless reverse shoulder arthroplasty (RSA). The secondary goals were to investigate the influence on the occurrence of complications and on clinical outcomes. We performed a retrospective multicenter study, including a series of patients operated on for stemless RSA. All patients were reviewed at a minimum of 2 years, with clinical and radiographic evaluation. The primary endpoint was the occurrence of migration of the humeral implant at the final follow-up. Secondary endpoints were clinical scores, occurrence of postoperative complications, need for revision surgery, and radiographic changes. Each patient ≥70 year old was matched on gender and body mass index,with a patient < 70 year old on a 1:1 basis. Forty-five patients aged ≥70 years were included and matched, with 45 patients aged <70 years, giving a total of 90 patients (54.4% men) with the mean age being 68.5 ± 7.9 years. There was no difference between the 2 groups in terms of surgical modalities. There was no correlation between age and clinical outcomes. Three migrations of the humeral implant occurred, none leading to a revision, without any influence of age (P = 1.0). We found no correlation between patient age and the occurrence of a postoperative complication (P = 1.0), reoperation (P = 1.0) or any of the other radiographic parameters assessed. This study reported the stability of stemless RSA implants in elderly patients. Clinical outcomes, complication, and revision rates were not affected by age either. [ABSTRACT FROM AUTHOR]

Smoking has been strongly associated with poor healing and worse outcomes following various joint arthroplasties, including worse functional measurements and increased complication rates. While smoking is associated with adverse events and complications in shoulder arthroplasty, the role of smoking in functional measurements and patient-reported outcomes (PROs) remains to be fully characterized. Institutional electronic medical records were used to study patients who underwent primary anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA) between 2009 and 2020 with at least 2 years of follow-up. Patients were called to obtain PROs. Patients were stratified into 3 cohorts, by tobacco smoking status: current, former, and never smokers. Among 498 patients who underwent TSA, 280 were aTSAs and 218 were rTSAs. Within aTSAs, 28 patients were classified as current, 99 as former, and 153 as never smokers. In rTSAs, 20 were current, 68 were former, and 130 were never smokers. Current smokers were younger at the time of surgery than former and never smokers in both aTSA (current: 58.8 ± 8.5; former: 63.9 ± 9.2; never: 62.8 ± 9.0 years; P =.031) and rTSA (current: 59.0 ± 6.8; former: 68.5 ± 7.2; never: 69.0 ± 9.0 years; P <.001). Furthermore, current smokers experienced lower 5-year implant survival in aTSA (current: 84.3%; former: 98.8%; never: 95.0%; P =.015) and rTSA (current: 82.4%; former: 94.5%; never: 94.1%; P =.004). No differences were found among the 3 cohorts for preoperative range of motion (ROM) and strength, or postoperative ROM and strength in the aTSA cohort. rTSA preoperative measurements demonstrated no differences in ROM and strength, and only postoperative forward elevation strength and external rotation strength were found to be different. PROs were found to be of similar magnitude for all patients in the aTSA and rTSA groups. The findings of this study indicate that current smokers exhibited a higher likelihood of necessitating TSA at a younger age and had higher implant failure rates. However, functional measurements were only marginally affected by smoking status. [ABSTRACT FROM AUTHOR]

Disparities in social determinants of health have been linked to worse patient-reported outcomes and higher rates of hospital readmission following shoulder arthroplasty. Identification of perioperative predictors of increased healthcare utilization is of particular interest to surgeons to improve outcomes and mitigate the total cost of care. The effect of social deprivation on healthcare utilization has not been fully characterized in the context of shoulder arthroplasty. A retrospective review was performed from of a single institution's experience with primary shoulder arthroplasty between 2012 and 2020. Demographic variables (age, race, and legal sex) and healthcare utilization (hospital readmission, emergency department (ED) visits, follow-up visits, and telephone calls) were recorded within 90 days of surgery. The Area Deprivation Index was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on Area Deprivation Index tercile and compared. A total of 780 patients were included. The least, intermediate, and most deprived groups consisted of 195, 371, and 214 patients, respectively. The level of social deprivation was not a predictor of increased healthcare utilization through readmission, the ED, or the outpatient clinic. Identifying as Black or African American was an independent predictor of readmission and ED visitation. Female sex was an independent predictor of increased postoperative telephone calls. Patients undergoing shoulder arthroplasty have similar use of hospital resources regardless of their level of social deprivation. We hope these results can be used to guide clinical decision-making, increase transparency, and manage patient outcomes following shoulder arthroplasty surgery. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) refer to social and economic factors that influence a patient's health status. The purpose of this study was to investigate the impact of SDOH on preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores and postoperative resource utilization following primary shoulder arthroplasty (SA). This retrospective chart review evaluated data from all patients who underwent primary SA (including anatomic, reverse, and hemiarthroplasty) at a single health system between May 2020 and May 2022. Patients without at least 6-month postoperative PROMIS questionnaires and those undergoing revision surgeries were excluded. The electronic medical record was used to identify SDOH for each patient, and PROMIS scores for Upper Extremity (PROMIS-UE), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed electronically at respective preoperative and postoperative visits. Univariate analysis using independent 2-group t -tests and Chi-squared tests were used to analyze the mean difference between patient groups based on SDOH. Multivariate linear regressions were performed with all predictors used in the univariate model using the least squares method. The study included 248 patients who underwent SA, with a mean age of 67.9 years. Caucasian patients were over-represented in the highest quartile of median household income (MHI) compared to Black patients (35.1% vs. 17.2%) who were over-represented in the lowest MHI quartile (37.9% vs. 8.3%). At 6-month postoperative, black patients had significantly lower UE (33.8 ± 6.2 vs. 38.1 ± 9.0; P =.03) and greater PI scores (59.1 ± 6.1 vs. 55.6 ± 8.6; P =.145) compared to Caucasian patients. Similarly, at 6-month follow-up, the lowest MHI quartile had lower UE (33.8 ± 7.7 vs. 39.6 ± 8.8; P =.01) and higher PI scores (58.7 ± 6.5 vs. 54.3 ± 8.2; P <.01) compared to the highest MHI quartile, and females demonstrated lower UE (36.3 ± 7.9 vs. 38.6 ± 9.8; P =.04) and higher D scores (46.2 ± 9.1 vs. 42.0 ± 8.6; P =.046) compared to males. Government/public insurance demonstrated lower UE (36.8 ± 8.0 vs. 39.8 ± 10.4; P =.03) and higher D scores (45.9 ± 9.2 vs. 40.6 ± 7.6; P =.03) compared to private insurance. At 12-month follow-up, females demonstrated lower UE scores compared to males (36.0 ± 10.2 vs. 40.1 ± 11.3; P =.03). Black patients harbored lower UE, PI, and D scores compared to Caucasian patients, although not statistically significant. Several socioeconomic factors such as race, gender, and insurance status are associated with differential outcomes after SA. Patients who are Black, female, current smokers, and from the lowest income quartile are associated with inferior PROMIS function, pain, and depression outcomes following SA. [ABSTRACT FROM AUTHOR]

The Humeral retroversion angle (HRA) has been described in the literature as the orientation of the humeral head compared with the epicondylar axis of the distal humerus. HRA is a crucial measurement for designing shoulder prostheses and surgical technique, and is often noted to range from 25° to 35° in healthy adults. However, a wide range of individual variability has been reported in literature, with reported values ranging from −6° to 74°. Various imaging modalities including X-rays, computed tomography scans, and magnetic resonance imaging have historically been used to measure this angle, but conventional 2-dimensional technologies may result in inaccuracy and variability in angular measurements. Therefore, recent studies have focused on using 3-dimensional (3D) modalities to measure HRA. These studies have shown promising results regarding accuracy and clinical significance, although most have only included a small number of subjects and have not procured conclusive findings. This study aims to measure the HRA in a large sample of subjects using 3D imaging to establish measurements for the general population. We examined the right and left cadaveric humerus from 559 individuals (146 females and 413 males). All of the humeri underwent computed tomography scan and surface models generated. 3D landmarks were automatically calculated on each 3D bone using custom-written software in C++. Those landmarks were used to calculate (1) HRA as the angle between the epicondylar axis and the humeral neck axis and (2) humeral proximal neck angle (HPNA) as the angle between the humeral neck axis and the anatomical axis. Descriptive statistics of both HRA and HPNA was analyzed using JMP Pro statistical software version 15.2.0. The HPNA was found to be 137.7° ± 1.04° for males and 136.34° ± 1.4° for females with a 95% confidence interval. HRA was found to be 39.89° ± 12.77° for males and 38.89° ± 3.15° for females with a 95% confidence interval. Results of analysis of variance revealed that males had a statistically significant larger HRA than females (P <.001). Our study suggests using a standardized measurement for the HRA, which we believe may improve operative outcomes. However, future prospective trials are required to validate our results in a clinical setting. [ABSTRACT FROM AUTHOR]

Total elbow arthroplasty (TEA) is an appropriate surgical treatment option for a variety of conditions ranging from inflammatory arthritis to trauma. Because of a high complication profile, implant companies have attempted to improve patient outcomes with evolving design mechanics and philosophy. However, the Nexel TEA prosthesis has been criticized for its unacceptably high revision rate by other research groups in the literature. The purpose of this study was to evaluate the survivorship and revision rates of the Nexel and Coonrad-Morrey TEA implant systems in New Zealand. Prospectively collected National Joint Registry data were used to compare the survival rates of these prostheses. Underlying diagnoses, reasons for revision, and patient demographics were all recorded. Statistical analysis included survival analysis using Kaplan-Meier curves and comparison between groups using independent t tests. Over the 23-year study interval, the Nexel and Coonrad-Morrey prostheses showed similar survivorship and revision rates. The revision rates at 5 years were 7.3% for Nexel and 4.5% for the Coonrad-Morrey cohorts. The average time to revision for those who are revised was 3.13 ± 1.74 years in the Nexel group and 4.93 ± 4.13 years in the Coonrad-Morrey population. Our study confirms a lower revision rate of the Nexel TEA compared to other studies in the literature. Additionally, the Nexel TEA implant performs comparably to its predecessor, the Coonrad-Morrey prosthesis in New Zealand. Although it is difficult to explain the discrepancy in results with the study by Morrey et al, future studies should focus on investigating postoperative radiographs and a deep analysis of the specific surgical technique used for this implant. [ABSTRACT FROM AUTHOR]

Proximal humerus fracture (PHF) is a risk factor for 1-year mortality. This study aimed to determine if surgery is associated with lower mortality compared to nonoperative treatment following PHF in older patients. This retrospective cohort study used the Medicare Limited Data set. Patients aged 65 years and older with a PHF diagnosis in 2017-2020 were included. Treatment was classified as nonoperative, open reduction internal fixation (ORIF), total shoulder arthroplasty (TSA), or hemiarthroplasty. Multivariable logistic regression models examined (a) predictors of treatment type and (b) the association of treatment type with 1-year mortality, adjusting for patient demographics, comorbidities, frailty, and fracture severity among other variables. A subgroup analysis examined how the relationship between treatment type and 1-year mortality varied based on fracture severity. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) are reported. In total, 49,072 patients were included (mean age = 76.6 years, 82.3% female). Most were treated nonoperatively (77.5%), 10.9% underwent ORIF, 10.6% underwent TSA, and 1.0% underwent hemiarthroplasty. Examples of factors associated with receipt of operative (versus nonoperative treatment) included worse fracture severity and lower frailty. The 1-year mortality rate after the initial PHF diagnosis was 11.0% for the nonoperative group, 4.0% for ORIF, 5.2% for TSA, and 6.0% for hemiarthroplasty. Compared to nonoperative treatment, ORIF (aOR 0.55; 95% CI [0.47, 0.64]; P <.001) and TSA (aOR 0.59; 95% CI [0.50, 0.68]; P <.001) were associated with decreased odds of 1-year mortality. In the subgroup analysis, ORIF and TSA were associated with a lower 1-year mortality risk for 2-part and 3-/4-part fractures. Compared to nonoperative treatment, surgery (particularly TSA and ORIF) was associated with a decreased odds of 1-year mortality. This relationship remained significant for 2-part and 3-/4-part fractures after stratifying by fracture severity. [ABSTRACT FROM AUTHOR]

Reverse shoulder arthroplasty (RSA) is a well-recognized treatment for many shoulder conditions, including rotator cuff arthropathy, primary glenohumeral joint arthritis, and rheumatoid arthritis, and can be used in both trauma and revision settings. Over the past 10 years, its popularity in New Zealand has been increasing, with a 6%-7% annual growth rate during this period. Stemless RSA designs have the following proposed advantages: They can preserve humeral bone stock, they can limit periprosthetic fractures, and they can be indicated in patients with abnormal diaphyseal humeral anatomy. To date, only 1 study has evaluated the outcomes of the Lima SMR Stemless implant. We present our data with an aim to report how the stemless reverse arthroplasty compares to a conventional stemmed implant. We performed a retrospective review of a consecutive series of patients treated at a single institution between 2015 and 2020. The endpoint was defined as final follow-up at a minimum of 2 years. Patients were excluded from the final analysis if they underwent revision. Thirty-three patients were identified as having undergone stemless RSA. Thirty patients had patient-reported outcome measures and radiographs at a minimum of 2 years' follow-up. Three patients had undergone revision within 2 years. The same sample size of stemmed RSAs (n = 33) was selected for comparison. A total of 60 patients were included in the final analysis, of whom 30 underwent stemless RSA and 30 underwent stemmed RSA. The demographic characteristics of the 2 groups were comparable except age at operation, which showed a statistically significant difference (P =.001): 77 years (stemmed) vs. 65 years (stemless). The mean Oxford Shoulder Score was 40.1 in the stemless group vs. 40 in the stemmed group. The mean American Shoulder and Elbow Surgeons score was 72.9 in the stemless group vs. 79 in the stemmed group. Patient-reported outcome measures, pain scores, and satisfaction ratings were not statistically significantly different between the 2 groups. In terms of radiographic data, subsidence was observed in 2 patients in the stemless RSA group but the patients had no clinical symptoms. Also in the stemless RSA group, 1 patient had an acromial stress fracture and 1 patient had a superficial wound infection successfully treated with oral antibiotics. In terms of revisions in the stemless RSA group, 1 patient underwent revision owing to chronic infection, 1 underwent revision as a result of a periprosthetic fracture after a fall, and 1 underwent revision for gross instability. The early results of sRSA are promising, and the stemless implant shows similar outcomes to a conventional stemmed implant. [ABSTRACT FROM AUTHOR]

To study the effect of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on postoperative home health and outpatient physical therapy (PT) for total hip or knee arthroplasty (THA/TKA). Retrospective cohort with national Medicare data (5% claims) using a difference-in-differences analysis comparing January 2013-September 2015 (before) versus October 2016-September 2019 (after). Administrative claims from hospitals in 34 metropolitan statistical areas with mandatory CJR participation as of 2018 and 42 control metropolitan statistical areas. Episodes in fee-for-service Medicare beneficiaries (5% claims) undergoing elective THA (n=6327) or TKA (n=10,764) with community discharge. Implementation of CJR bundled payment program. Home health and outpatient PT, including any use and number of visits. Program implementation was associated with an increased percentage of THA episodes using home health PT (+8.0 percentage-point change; 95% CI, +3.5 to +12.6; P =.001) but a decreased per-episode number of home health PT visits for THA (−1.1; 95% CI, −1.6 to −0.6; P <.001) and TKA (−1.1; 95% CI, −1.4 to −0.7; P <.001). The program was also associated with an increased per-episode number of outpatient PT visits for TKA in the primary but not sensitivity analyses (+0.8; 95% CI, +0.1 to +1.4; P =.02). Findings of increased home health PT may reflect an intentional shift in care from the inpatient postacute setting to the community to decrease costs. Alternatively, the limited effect of CJR, particularly on outpatient PT, could reflect challenges with care coordination in a retrospective bundle spanning multiple care settings. [ABSTRACT FROM AUTHOR]

Trapeziometacarpal (TMC) joint replacement has become a valid option in the therapeutic arsenal of TMC joint osteoarthritis in Europe. Good mid-term results of the MAÏA TMC joint prosthesis suggested that it is a reliable procedure. This study aimed to assess the long-term results of this modular uncemented ball-and-socket hydroxyapatite-coated implant. This single-center retrospective study evaluated 92 MAÏA TMC joint prostheses in 76 patients with a minimum of 10 years of follow-up. Indications for the procedure were painful TMC joint osteoarthritis both at rest and during activity, despite nonsurgical treatment for more than six months. Pre- and postoperative clinical and radiographic outcomes were compared. Mean follow-up was 134 months (range: 120–158 months). Mean age at the time of surgery was 67 years (range: 53–84 years). The cohort comprised 86.8% of women (n = 66). The mean Quick Disabilities of the Arm, Shoulder, and Hand score improved from 61.3 ± 17.1 to 19.6 ± 16. Range of motion was restored, and postoperative mobility was comparable with that of the contralateral side. Final Kapandji opposition score was almost normal (9.2 ± 0.7). Final key pinch and grip strength improved by 26% and 39%, respectively. Eight implants were surgically revised, six for trapezium cup loosening and two for instability because of polyethylene wear. Three cases of traumatic fracture of the trapezium in older patients were successfully treated with a cast for eight weeks. Five of 26 (20.8%) cases of preoperative-reducible z-deformity were not totally corrected after surgery. The Kaplan-Meier survival over 10 years was 88% (95% confidence interval: 84–93) versus 93% (95% confidence interval: 87–98) over 5 years. MAÏA TMC joint prosthesis is a reliable long-term surgical procedure for TMC joint osteoarthritis, improving overall function beyond 10 years. Therapeutic IV. [ABSTRACT FROM AUTHOR]

A spectrum of surgical management for temporomandibular joint (TMJ) ankylosis exists ranging from gap arthroplasty to total joint replacement. Reconstruction and rehabilitation of the ramus-condyle unit (RCU) remains a surgical challenge in TMJ ankylosis. Distraction osteogenesis (DO) is a promising technique for joint reconstruction over conventional methods. This review compared the clinically relevant outcomes of transport distraction osteogenesis (TDO) and costochondral graft (CCG) for joint reconstruction in TMJ ankylosis. PubMed, Medline, Embase, CENTRAL and ScienceDirect databases were searched from inception till 30th September 2023. Randomized controlled trials (RCTs) and prospective, retrospective studies on TMJ ankylosis patients comparing TDO and CCG for joint reconstruction and reporting outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration tool. Five studies were included in the review. A significant improvement in the postoperative mouth opening with both groups was reported on follow-up and the analysis favored TDO for the joint reconstruction (p = 0.003). TDO group reported up to 6.1 % lower incidence of postoperative reankylosis in comparison to CCG (p = 0.59). Data was insufficient with regard to facial asymmetry, chin deviation and malocclusion. TDO is a better alternative to CCG for joint reconstruction. Due to paucity of the reported literature and unequal sample distribution between the groups, quality evidence could not be derived regarding long-term stability. Further RCTs are recommended to generate better evidence and evaluate clinically relevant outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Retracted publications are an often-overlooked issue affecting the scientific community, and recent data confirms the overall number of retracted publications is rising. While this has previously been looked at within orthopaedic surgery, a contemporary understanding of retractions is required due to the rapid expansion in publications. Our study aimed to assess the retracted publications within clinical orthopaedic research to evaluate for characteristics and trends. A systematic review was conducted on December 14, 2023, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. There were 4 databases that were queried to identify retracted publications in clinical orthopaedics that assessed operative and nonoperative orthopaedic interventions (excluding basic science). Articles were independently screened by 2 reviewers; those meeting the inclusion criteria were evaluated for various characteristics, including reasons for retraction based on Committee on Publication Ethics guidelines. There were 233 studies that met the inclusion criteria and were retracted between January 1, 1990, and December 14, 2023. Clinical orthopaedics represented 1.18% of all retracted publications identified through PubMed over this period. There were 87 articles that were retracted in 2023, up from 17 in 2022 (a 412% increase). Retracted studies were published in journals with 2022 impact factors up to 9.3, with an average of 3.1 (SD [standard deviation] 1.9). A total of 39.5% of the retracted studies were published in orthopaedic journals, and 60.9% of the retracted articles were published in exclusively open-access journals. The mean time from electronic publication to retraction was 2.1 years (SD 2.2). Retracted articles have been cited up to 180 times (mean 8.6; SD 20). Reasons for retraction included misconduct (45.9%), plagiarism (11.6%), redundant publication (11.6%), unethical research (10.3%), error (9.4%), and others (10.7%). The prevalence of retractions in the clinical orthopaedic literature is increasing. Clinical research is the basis for clinical practice guidelines, the gold standard for informing medical decision-making. Retractions may be one harbinger of lower-quality publications; researchers, institutions, and journals together play important roles in maintaining scientific integrity. [ABSTRACT FROM AUTHOR]

There is an unambiguous sex disparity in the field of orthopaedic surgery, with women making up only 7.4% of practicing orthopaedic surgeons in 2022. This study seeks to evaluate the sex distribution among orthopaedic surgeons engaged in primary total knee arthroplasty (TKA) between 2013 and 2020, as well as the procedural volume attributed to each provider. We retrospectively queried the Medicare dataset to quantify all physicians reporting orthopaedic surgery as their specialty and performing primary TKA from 2013 to 2020. Healthcare Common Procedure Coding System codes for primary TKA procedures were used to extract associated utilization and billing provider information. Trend analyses were performed with 2-sided correlated Mann-Kendall tests to evaluate trends in the number of surgeons by sex and the women-to-men surgeon ratio. During the study period, 6,198 to 7,189 surgeons billed for primary TKA. Of this number, an average of 2% were women. The mean number of procedures billed for by men was 39.02/y (standard deviation: 34.54), and by women was 28.76/y (standard deviation: 20.62) (P <.001). There was no significant trend in the number of men or women surgeons who billed for primary TKA during the study period. Trend analysis of the women-to-men ratio demonstrated an increasing trend of statistical significance (P =.0187). There was a significant upward trend in the women-to-men ratio of surgeons who billed for primary TKA. However, there remains a colossal gender gap, as women only made up 2.4% of surgeons who billed for the procedure. The current study raises awareness of the notable discrepancy in the average number of TKAs performed by women as compared to men. The orthopaedic community should aim to determine ways to increase the number of women arthroplasty surgeons along with the opportunities that women have to perform TKAs. [ABSTRACT FROM AUTHOR]

The influence of position of the humeral tray (inlay or onlay) on clinical outcomes in reverse shoulder arthroplasty (RSA) is a topic of debate. The purpose of this study was to compare clinical and radiographic outcomes of patients with cuff tear arthropathy treated with RSA systems with inlay or onlay humeral tray design, similar neck-shaft angles, and lateralized glenospheres. This was a retrospective study of prospectively obtained data from 1 tertiary care center. We identified all patients who underwent primary RSA between 2009 and 2017 (N = 511). We included 102 patients with diagnosed cuff tear arthropathy treated with RSA prostheses with a lateralized glenosphere and 135° neck-shaft angle (with either an inlay or onlay humeral tray design) who had a minimum of 2 years of follow-up (mean, 44 months; range, 24-125 months). Sixty-three patients (62%) had an inlay humeral tray (inlay group) and 39 (38%) had an onlay tray (onlay group). All patients underwent preoperative and postoperative evaluations, including measures of patient-reported outcomes (PROs), shoulder range of motion (ROM) testing, and radiographic imaging. Clinical relevance of changes in PROs and ROM was evaluated using published values for minimal clinically important differences. The 2 groups did not differ by demographic characteristics except for a higher proportion of women in the inlay group (75%) than in the onlay group (56%) (P =.04). Preoperative PROs and ROM were not significantly different between groups. At final follow-up, PROs and ROM were not different between groups in terms of statistical significance or clinical relevance. We found no significant differences in the rate of baseplate loosening (inlay, 3.2% vs. onlay, 5.1%, P =.63), revision surgery (inlay, 0% vs. onlay 5.1%, P =.07), acromial stress fracture (inlay, 3.2% vs. onlay, 5.1%, P =.63), prosthesis dislocation (inlay, 0% vs. onlay, 2.6%, P =.20), or scapular notching (inlay, 21% vs. onlay, 7.7%, P =.08). At 2-year minimum follow-up, the position of the humeral tray in RSA prostheses (either inlay or onlay) for cuff tear arthropathy was not associated with PROs, shoulder ROM, or rates of complications, including baseplate loosening, acromial stress fracture, and scapular notching. [ABSTRACT FROM AUTHOR]

The need for revision total knee arthroplasty surgery is increasing worldwide, and, in many cases, a constrained implant is required to provide joint stability. The purpose of this study was to examine the early loosening and functional outcome of a novel constrained condylar (CCK) revision total knee system designed to have medial pivot (MP) kinematics. A retrospective cohort study was performed, collecting clinical data from all patients who underwent revision total knee arthroplasty using a novel MP CCK system with a minimum four-year clinical follow-up. Patient demographics, survivorship, complications, and Forgotten Joint Score were analyzed based upon chart review. There were 49 patients available for follow-up, who had a 100% survivorship free of aseptic loosening. All-cause revision survivorship was 92%. There were 4 patients who subsequently underwent rerevision. The causes for rerevision included periprosthetic joint infection in 2 patients, coronal plane instability in one patient, and a traumatic knee dislocation in one patient. There were 45 patients who completed the Forgotten Joint Score, who had an average of 49.8 (± 32.8, range 6.25 to 100). At 4 years, mid-term follow-up, this novel CCK revision total knee system designed to have MP kinematics had good patient-reported outcomes with no revision for aseptic loosening. Future studies should evaluate the mid- and long-term survivorship of this innovative implant. [ABSTRACT FROM AUTHOR]

In 2011, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA). The purpose of our study was to examine (1) incidences of postoperative complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion rates; (2) trends from 2016 to 2021 in VTE prophylaxis; and (3) independent risk factors for 90-day total complications following TKA between aspirin, enoxaparin, rivaroxaban, and warfarin. Using a national, all-payer database from 2016 to 2021, we identified all patients who underwent primary TKA. Exclusions included all patients who had prescribed anticoagulants within 1 year prior to TKA, hypercoagulable states, and cancer. Data were collected on baseline demographics, including age, sex, diabetes, and a comorbidity index, in each of the VTE prophylaxis cohorts. Postoperative outcomes included rates of PE, DVT, and transfusion. Multivariable regressions were performed to determine independent risk factors for total complications at 90 days following TKA. From 2016 to 2021, aspirin was the most used anticoagulant (n = 62,054), followed by rivaroxaban (n = 26,426), enoxaparin (n = 20,980), and warfarin (n = 13,305). The cohort using warfarin had the highest incidences of PE (1.8%) and DVT (5.7%), while the cohort using aspirin had the lowest incidences of PE (0.6%) and DVT (1.6%). The rates of aspirin use increased the most from 2016 to 2021 (32.1% to 70.8%), while the rates of warfarin decreased the most (19.3% to 3.0%). Enoxaparin, rivaroxaban, and warfarin were independent risk factors for total complications at 90 days. An epidemiological analysis of VTE prophylaxis use from 2016 to 2021 shows an increase in aspirin following TKA compared to other anticoagulant cohorts in a nationally representative population. This approach provides more insight and a better understanding of anticoagulation trends over this time period in a nationally representative sample. [ABSTRACT FROM AUTHOR]

The complexity of health care delivery systems presents a unique challenge for the perioperative space. In the area of arthroplasty procedures, the shift of complex patients into ambulatory surgery centers and reimbursement that is no longer commensurate with the inflated costs of performing these procedures have created difficulties for hospitals and physicians alike. Thus, there is a critical need to optimize perioperative workflows while maintaining high-quality care provision. Our institution implemented the Comprehensive Unit-based Safety Program (CUSP) to improve the quality and efficiency of total knee and hip arthroplasties (TKAs and THAs). This initiative involved extensive collaboration with clinical and administrative teams, as well as 5 intervention-driven workgroups. First-case on-time start rates and duration of first-case delays, case length, anesthesia preparation, in-room patient preparation, operation, patient exit, and room turnover after CUSP implementation were analyzed using independent samples median testing, Mann-Whitney U testing, and a percentage-point difference calculation. After CUSP arthroplasty implementation, first-case on-time start rates increased from 43 to 81%. Statistically significant decreases were observed in median times for first-case delays, case length, in-room patient preparation, operation, patient exit, and room turnover for TKAs and THAs, but not anesthesia preparation. The implementation of CUSP arthroplasty for TKAs and THAs resulted in significant improvements in nearly all efficiency metrics, as well as preventions of patient safety missteps. These results exemplify the versatility of CUSP as a quality improvement method that can maintain patient safety and perioperative efficiency in the arthroplasty service of a large-scale medical center. III. [ABSTRACT FROM AUTHOR]

We sought to assess if the medullary diameter to cortical width ratio (MD:CW), canal flair index (CFI), and canal fill (CF) of the proximal radius were associated with the presence of stress shielding (SS) after a MoPyC radial head arthroplasty. We conducted a retrospective, international, multicenter (4 centers) study. A total of 100 radial head arthroplasties in 64 women and 36 men with a mean age of 58.40 years ± 14.90 (range, 25.00-91.00) were included. Radiographic measurements, including MD:CW, CFI, CF, and postoperative SS were captured at a mean follow-up of 3.9 years ± 2.8 (range, 0.5-11). SS was identified in 60 patients. Mean preoperative MD:CW, CFI, and CF were 0.55 ± 0.09, 1.05 ± 0.18, and 0.79 ± 0.11, respectively. The presence of SS was significantly associated with MD:CW (adjusted odds ratio = 13.66; P =.001), and expansion of the stem (adjusted odds ratio = 3.78; P =.001). The amount of the SS was significantly correlated with expansion of the stem (aβ 4.58; P <.001). Our study found that MD:CW was an independent risk factor of SS after MoPyc radial head arthroplasty. Autoexpansion of the MoPyc stem significantly increased the risk of SS and its extent. Further studies involving multiple implants designs are needed to confirm the preliminary observations presented in the current study. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) poses significant therapeutic challenges, particularly OA that affects the hand. Currently available treatment strategies are often limited in terms of their efficacy in managing pain, regulating invasiveness, and restoring joint function. The APRICOTⓇ implant system developed by Aurora Medical Ltd (Chichester, UK) introduces a minimally invasive, bone-conserving approach for treating hand OA (https://apricot-project.eu/). By utilizing polycarbonate urethane (PCU), this implant incorporates a caterpillar track-inspired design to promote the restoration of natural movement to the joint. Surface modifications of PCU have been proposed for the biological fixation of the implant. This study investigated the biocompatibility of PCU alone or in combination with two surface modifications, namely dopamine-carboxymethylcellulose (dCMC) and calcium-phosphate (CaP) coatings. In a rat soft tissue model, native and CaP-coated PCU foils did not increase cellular migration or cytotoxicity at the implant–soft tissue interface after 3 d, showing gene expression of proinflammatory cytokines similar to that in non-implanted sham sites. However, dCMC induced an amplified initial inflammatory response that was characterized by increased chemotaxis and cytotoxicity, as well as pronounced gene activation of proinflammatory macrophages and neoangiogenesis. By 21 d, inflammation subsided in all the groups, allowing for implant encapsulation. In a rat bone model, 6 d and 28 d after release of the periosteum, all implant types were adapted to the bone surface with a surrounding fibrous capsule and no protracted inflammatory response was observed. These findings demonstrated the biocompatibility of native and CaP-coated PCU foils as components of APRICOTⓇ implants. Hand osteoarthritis treatments require materials that minimize irritation of the delicate finger joints. Differing from existing treatments, the APRICOTⓇ implant leverages polycarbonate urethane (PCU) for minimally invasive joint replacement. This interdisciplinary, preclinical study investigated the biocompatibility of thin polycarbonate urethane (PCU) foils and their surface modifications with calcium-phosphate (CaP) or dopamine-carboxymethylcellulose (dCMC). Cellular and morphological analyses revealed that both native and Ca-P coated PCU elicit transient inflammation, similar to sham sites, and a thin fibrous encapsulation in soft tissues and on bone surfaces. However, dCMC surface modification amplified initial chemotaxis and cytotoxicity, with pronounced activation of proinflammatory and neoangiogenesis genes. Therefore, native and CaP-coated PCU possess sought-for biocompatible properties, crucial for patient safety and performance of APRICOTⓇ implant. [Display omitted] [ABSTRACT FROM AUTHOR]

Gluteal tendinopathy (GT) is found in 20 to 25% of patients undergoing total hip arthroplasty (THA). Despite this, there is a scarcity of literature assessing the association between GT and THA outcomes. The aim of this study was to evaluate whether intraoperative diagnosis of GT negatively affected postoperative outcomes. Consecutive patients undergoing primary THA for osteoarthritis via a posterior approach over 5 years were recruited in a prospective study. Gluteal tendinopathy was assessed and graded at the time of surgery, but not repaired. A total of 1,538 (93%) completed the patient-reported outcome measures (PROMs) at 1 year after surgery and were included in the analysis. The PROMs included the Oxford Hip Score (OHS), Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR), and EuroQol 5-Dimension, and were collected preoperatively and one year after THA. The gluteal tendons were graded as 4 distinct grades: normal (n = 1,023, 66%), tendinopathy but no tear (n = 337, 22%), partial thickness tear (n = 131, 9%), and full thickness tear (n = 47, 3%). The occurrence of GT was associated with age, body mass index, and sex. There was no significant difference in baseline OHS or HOOS JR scores according to GT grade. As GT grade increased, lower median 1-year OHS (P =.001) and HOOS JR (P =.016) were observed. This association was confirmed by linear regression analysis with 1-year OHS (B = 0.5, 95% CI = −0.9 to −0.1, P =.011) when controlled for age and sex. Gluteal tendinopathy was commonly observed and was associated with inferior 1-year PROMs in patients undergoing THA via posterior approach. Increasing degree of tendinopathy was a negative prognostic factor for outcomes and patient satisfaction. Level 2 (High quality prospective cohort study). [ABSTRACT FROM AUTHOR]

Academic accomplishments and demographics for presidents of hip and knee arthroplasty societies are poorly understood. This study compares the characteristics of presidents nominated to serve the Hip Society, Knee Society, and American Association of Hip and Knee Surgeons. This was a cross-sectional study of arthroplasty presidents in the United States (1990 to 2022). Curriculum vitae and academic websites were analyzed for demographic, training, bibliometric, and National Institutes of Health (NIH) funding data. Comparisons were made between organizations and time periods (1990 to 2005 versus 2006 to 2022). There were 97 appointments of 78 unique arthroplasty presidents (80%). Most presidents were male (99%) and Caucasian (95%). There was 1 woman (1%) and 5 non-Caucasian presidents (2% Asian, 3% Hispanic). There were no differences in demographics between the 3 arthroplasty organizations and the 2 time periods (P >.05). Presidents were appointed at 55 ± 10 years old, which was on average 24 years after completion of residency training. Most presidents had arthroplasty fellowship training (68%), and the most common were the Hospital for Special Surgery (21%) and Massachusetts General Hospital (8%). The median h-index was 53 resulting from 191 peer-reviewed publications, which was similar between the 3 organizations (P >.05). There were 2 presidents who had NIH funding (2%), and there were no differences in NIH funding between the 3 organizations (P >.05). Arthroplasty society presidents have diverse training pedigrees, high levels of scholarly output, and similar demographics. There may be future opportunities to promote diversity and inclusion among the highest levels of leadership in total joint arthroplasty. [ABSTRACT FROM AUTHOR]

Antibiotic cement spacers have been widely used in the treatment of joint infections. There are no commercially available antibiotic spacers for the elbow. Instead, they are typically fashioned by the surgeon at the time of surgery using cement alone or a combination of cement with sutures, Steinmann pins, external fixator components, or elbow arthroplasty components. There is no consensus regarding the ideal elbow antibiotic spacer and no previous studies have examined the complications associated with these handmade implants in relation to their unique structural design. We retrospectively reviewed 55 patients who had 78 static antibiotic cement spacers implanted between January 1998 and February 2021 as part of a 2-stage treatment plan for infection of an elbow arthroplasty, other elbow surgery, or primary elbow infection. Several antibiotic spacer structures were used during the study period. For analysis purposes, the spacers were classified into linked and unlinked spacers based on whether there was a linking mechanism between the humerus and the ulna. Complications related to these spacers that occurred either during the implantation, between implantation and removal, or during removal were recorded and analyzed from chart review and follow-up x rays. Reoperations due to spacer-related complications were also recorded. Among the 55 patients (78 spacers), there were 23 complications, including 17 minor and 6 major complications. The most common complication of unlinked spacers (intramedullary [IM] dowels, beads and cap spacer) was spacer displacement. Other complications included IM dowel fracture and difficulty locating beads during spacer removal. The major complications of linked cement spacers included two periprosthetic humerus fractures after internal external fixator cement spacers and re-operation due to breakage and displacement of one bushing cement spacer. The major complications of unlinked cement spacers included two reoperations due to IM dowel displacement and one reoperation due to displacement of beads. Among patients who had removal of all components and those with native joints, there was no statistically significant difference between internal external fixator cement spacers and unlinked cement spacers in minor complication rates (30% vs. 16%, P =.16), major complication rates (7% vs. 8%, P =.85) and reoperation rates (0% vs. 8%, P =.12). Static handmade antibiotic elbow spacers have unique complications related to their structural designs. The most common complication of linked and nonlinked cement spacers were failure of the linking mechanism and displacement, respectively. Surgeons should keep in mind the possible complications of different structures of cement spacers when choosing 1 antibiotic spacer structure over another. [ABSTRACT FROM AUTHOR]

The capacity of additive manufacturing and three-dimensional (3D) printing to quickly construct intricate structures and accurate geometries sets them apart from traditional production techniques. The fourth industrial revolution and the digitalization of production were fueled by the emergence of 3D printing, which was made possible by the increasing demand for goods with various designs, functions, and materials. The global influence of 3D printing on healthcare has resulted in the replacement of generic implanted medical devices with patient-customized implants. In the field of oral and maxillofacial surgery, where surgeons use precision medicine daily, this revolution has had a huge influence. Treatments enhanced by 3D technology include orthognathic surgery, complete joint replacement therapy, and trauma. Surgical teams now engage in the 3D design and production of devices at point-of-care treatment facilities with internal infrastructure thanks to the growing and broad adoption of 3D technology in clinical settings. The way doctors approach treatment planning and clinical results are affected greatly by 3D technology. While outlining significant clinical applications, the article presents our viewpoint on the use of 3D-based technology in the field of oral and maxillofacial surgery and the road ahead with the advent of Four-dimensional (4D) printing. [ABSTRACT FROM AUTHOR]

Reconstructing maxillofacial defects is quiet challenging due to the region's complex anatomy, and cosmetic and functional effects on patients. With the help of developing technologies, patient-specific implants (PSIs) using virtual surgical planning based on a Computer aided designing (CAD)/Computer aided manufacturing (CAM) platform is an evolving treatment option. PSIs can be used in patients with maxillofacial defects and reconstruction. PSIs are also being used in the form of preformed plates for virtually planned orthognathic surgeries. Customized temporomandibular joint (TMJ) prosthesis is being routinely used in the debilitating/degenerative joint disease as a part of alloplastic joint replacement. The reconstruction of the maxillofacial region using autogenous tissue will always be gold standard due to near match of the recipient site. However, autogenous bone grafts positioned using PSIs or in certain areas such as the TMJ complex and the orbital region the PSIs are being offered with advantage of reduced donor-site morbidity. The future research is focussed towards the development of PSIs being used as a scaffold for engineering of the recipient tissue to restore the lost anatomy of specific region. This article reviews the varied aspects of this new technology of PSI for correction of various deformities/defects during the maxillofacial reconstruction. [ABSTRACT FROM AUTHOR]