Healthcare disparities: patients' perspectives on barriers to joint replacement.

OBJECTIVE: Racial and ethnic disparities in arthroplasty utilization are evident, but the reasons are not known. We aimed to identify concerns that may contribute to barriers to arthroplasty from the patient's perspective. METHODS: We identified patients' concerns about arthroplasty by performing a mixed methods study. Themes identified during semi-structured interviews with Black and Hispanic patients with advanced symptomatic hip or knee arthritis were used to develop a questionnaire to quantify and prioritize their concerns. Multiple linear and logistic regression analyses were conducted to determine the association between race/ethnicity and the importance of each theme. Models were adjusted for sex, insurance, education, HOOS, JR/KOOS, JR, and discussion of joint replacement with a doctor. RESULTS: Interviews with eight participants reached saturation and provided five themes used to develop a survey answered by 738 (24%) participants; 75.5% White, 10.3% Black, 8.7% Hispanic, 3.9% Asian/Other. Responses were significantly different between groups (p < 0.05). Themes identified were "Trust in the surgeon" "Recovery", "Cost/Insurance", "Surgical outcome", and "Personal suitability/timing". Compared to Whites, Blacks were two-fold, Hispanics four-fold more likely to rate "Trust in the surgeon" as very/extremely important. Blacks were almost three times and Hispanics over six times more likely to rate "Recovery" as very/extremely important. CONCLUSION: We identified factors of importance to patients that may contribute to barriers to arthroplasty, with marked differences between Blacks, Hispanics, and Whites.

Orthopedic fracture hospitalizations are revving up from E-Scooter related injuries.

INTRODUCTION: Due to market expansion of electric-scooter companies, a significant rise of personal e-scooter use in dense, urban communities has been observed. No literature has specifically focused on e-scooter fracture epidemiology and risk factors associated with direct hospital admission. The aims of this study were to evaluate the 1) patterns of e-scooter related orthopaedic fractures 2) risk factors associated with direct hospital admission. MATERIALS AND METHODS: A retrospective review of National Electronic Injury Surveillance System (NEISS) from the United States between 2015 and 2019 was utilized to identify e-scooter fracture epidemiology. Uni/multivariable analyses were conducted to identify independent variables associated with direct hospital admission. RESULTS: 5,016 patients were identified. The most common fracture location was the upper extremity (25.4%). Multiple distinct fractures diagnoses (p < 0.001), fracture of the upper arm (p = 0.01), metacarpal (p = 0.03), skull(p < 0.001), and associated internal organ injury (p = 0.02) all had a statistical increase over time. Fracture of the upper leg (OR 58.31), lower trunk (OR: 47.04), and associated internal organ damage (OR: 37.82) had the greatest association with direct hospital admission. DISCUSSION: This study highlights that e-scooter fracture related injuries continue to progress, and without appropriate educational and public health efforts, these injuries will continue to rise.

A Histologic Analysis of a Retrieved Specimen 24 Years after Hemiresurfacing for Avascular Necrosis.

Reports of long-term evaluation of the viability of the femoral head after a hemiresurfacing arthroplasty (HRA) are scarce. We report the case of a 41-year-old female with lupus and right HRA (performed 24 years previously for avascular necrosis) that was revised to a total hip arthroplasty for worsening right groin pain due to chondrolysis. We present a histologic evaluation of the resurfaced femoral head retrieved 24 years after HRA. To the authors' knowledge, this is the longest reported histologic follow-up of such a case. There was no evidence of fracture or inflammation and the underlying bone was viable. At 5-year follow-up after the revision, the patient is pain-free, fully functional, and walks without any assistive device.

Mycobacterium thermoresistibile infection following knee-replacement surgery.

We report a case of Mycobacterium thermoresistibile as a cause of infection following total knee replacement. This infection was masked by the prior isolation of a vancomycin-resistant enterococcus. The infection was resolved with long-term therapy using moxifloxacin and doxycycline.