Hemiarthroplasty vs Total Hip Arthroplasty for Femoral Neck Fractures: 2010-2017 Trends in Complication Rates.

BACKGROUND: Optimal treatment of femoral neck fractures (FNFs) remains debated. Recent data suggest that total hip arthroplasty (THA) confers improved functional outcomes compared to hemiarthroplasty (HA) in active patients. However, temporal trends in complication rates between these treatments lack study. METHODS: The National Surgical Quality Improvement Program database was retrospectively queried to compare differences between HA and THA over time (2010-2012, 2013-2015, and 2016-2017) in blood transfusions, operation time, major complications, minor complications, and 30-day readmission, among FNF patients aged ≥50 years. Analyses adjusted for age, gender, anesthesia type, smoking, body mass index, hypertension, bleeding disorder, steroid use, and American Society of Anesthesiologists classification. RESULTS: In total, 16,213 patients were identified. THA was associated with higher transfusion rates in 2010-2012 (mean = 0.34 vs 0.28, P = .001) and 2013-2015 (mean = 0.21 vs 0.19, P = .002), but not in 2016-2017 (mean = 0.13 vs 0.14, P = .146). Operation time was significantly higher for THA across all periods (P's < .001), but declined over time. In recent years, THA was associated with less major (2016-2017: 5.4% vs 10.2%, P = .02; 2013-2015: 5.3% vs 10.3%, P < .001) and minor (2016-2017: 6.2% vs 9.8%, P = .02; 2013-2015: 7.2% vs 12.4%, P < .001) complications compared to 2010-2012 (major: 7.2% vs 10.6%, P = .87; minor: 12.6% vs 10.1%, P = .89). No differences in 30-day readmission were noted. CONCLUSION: THA was associated with less major and minor complications in recent time periods compared to HA for the treatment of FNF, controlling for comorbidities. THA trends in transfusions and operation duration have improved over time compared to HA.

Does the Timing of the Second Surgery of a Staged Bilateral Total Joint Arthroplasty Affect the Rate of Hospital Adverse Events and Perioperative Outcomes?

BACKGROUND: The optimal timing of the second surgery in primary staged bilateral total hip/knee arthroplasty remains uncertain. Perioperative hospital adverse events represent a significant issue, even "minor events" lead to substantial costs in workup tests, interconsultations, and/or increased hospital length-of-stay (LOS). Therefore, we sought to ascertain whether the timing of the second arthroplasty affects perioperative outcomes and/or rates of adverse events. METHODS: We retrospectively reviewed a consecutive series of 670 primary staged bilateral total hip/knee arthroplasty performed by 2 surgeons (2010-2016) at a single institution. The days between both arthroplasties were calculated for each pair of hips or knees. We evaluated demographics and LOS, discharge disposition, adverse events (ie, nausea, pulmonary embolism), and transfusion rates. The second arthroplasties (n = 335) were set apart in 2 groups based on the time they were done with respect to their corresponding contralateral first arthroplasty using 3 different thresholds: (1) ≤90 vs >90 days, (2) ≤180 vs >180 days, and (3) ≤365 vs >365 days. RESULTS: No significant differences in outcome comparisons were observed using either 90 or 180 days thresholds. However, using the 365 days thresholds, the mean LOS (2.21 vs 1.92 days, P = .015), adverse event (26% vs 15.3%, P = .021), total transfusion (7.4% vs 1.5%, P = .020), and allogeneic transfusion (6.9% vs 1.5%, P = .033) rates were significantly higher in second arthroplasties performed at or less than 1 year apart from the first, respectively. CONCLUSION: Staging the second arthroplasty more than a year apart from the first one seems to offer better LOS and rates of hospital adverse events, transfusions. However, unless patients are willing to wait a year between surgeries, our data also suggest no increased risk in regards to adverse events when proceeding before or after 90/180 days. LEVEL OF EVIDENCE: Level III.

Hospital Adverse Events and Perioperative Outcomes in Bilateral Direct Anterior Approach Total Hip Arthroplasty.

BACKGROUND: Perioperative hospital adverse events represent a significant outcome that is often overlooked. Even "minor events" such as fever or tachycardia may lead to significant costs due to workup tests, interconsultations, and/or increased length of stay (LOS). The optimal timing of bilateral direct anterior approach total hip arthroplasty (DAA-THA) remains unsettled. Consequently, we wanted to compare hospital LOS, discharge disposition, hospital adverse events (major and minor), and transfusion rates between simultaneous and staged bilateral DAA-THA. METHODS: A retrospective chart review was conducted on a consecutive series of 347 primary bilateral DAA-THAs (204 patients) performed by 2 surgeons in a single institution (2010-2016). The hips finally included were categorized as simultaneous (Sim-n = 61), staged 1 (Stg1-n = 143), or staged 2 (Stg2-n = 143). We also compared simultaneous with staged surgeries performed ≤1 and >1 year apart. Baseline demographics, LOS, discharge disposition, hospital adverse events, and transfusions were assessed. RESULTS: The simultaneous group had significantly younger patients and a higher proportion of males when compared with the staged groups and showed significant longer LOS [2.61 (Sim) vs 2.06 (Stg1) vs 1.63 (Stg2) days, P < .001], lower proportion of home discharge [77% (Sim) vs 91.6% (Stg1) vs 96.5% (Stg2), P < .001], as well as higher (overall) rate of adverse events [31.1% (Sim) vs 28.7% (Stg1) vs 14.0% (Stg2), P = .003] and transfusions [45.9% (Sim) vs 6.3% (Stg1) vs 7.0% (Stg2), P < .001]. However, most transfusions were autologous [37.7% (Sim) vs 3.5% (Stg1) vs 0% (Stg2), P < .001]. CONCLUSION: Our data show that bilateral DAA-THAs performed in a staged fashion, rather than simultaneously, have a shorter hospital LOS and decreased rates of adverse events and overall transfusions. Notwithstanding, simultaneous surgery should still be considered an option in selected patients. LEVEL OF EVIDENCE: Level III.

Are Patients More Satisfied With a Balanced Total Knee Arthroplasty?

BACKGROUND: Patient-reported outcome measures are increasingly recognized as an important tool in quantifying the clinical success of arthroplasty surgery. The aim of this study is to measure post-operative joint awareness and satisfaction in patients with and without a quantitatively balanced knee following primary total knee arthroplasty (TKA). METHODS: In this multi-center study, a total of 318 eligible patients were assigned to one of the 2 patient groups: sensor-guided TKA or surgeon-guided TKA. In the sensor-guided group, quantitative balancing was performed according to intercompartmental tibiofemoral load measurements measured by an instrumented tibial trial component. In contrast, for the surgeon-guided group, the knees were balanced according to the surgeons' standard manual techniques while blinding the surgeon to the sensor measurements. Patients were blinded to their allocation and filled out the validated Forgotten Joint Score and 2011 Knee Society Satisfaction questionnaires at 6 weeks and 6 months. For the purposes of this study, the subjects were pooled and stratified by their state of soft tissue balance, based on the mediolateral load differential through the range of motion. RESULTS: In the surgeon-guided group, approximately 50% of the cases yielded a quantitatively balanced knee. Significantly more balanced knees were observed in the sensor-guided group (84.0%). More importantly, for both outcome measures, the balanced group of patients reported significantly better outcomes scores. CONCLUSION: This demonstrates that using sensor feedback during knee arthroplasty surgery results in a more reproducible procedure, resulting in a higher percentage of balanced patients who in turn demonstrate superior clinical outcomes compared to unbalanced patients.

What Is the Optimal Criteria to Use for Detecting Periprosthetic Joint Infections Before Total Joint Arthroplasty?

BACKGROUND: The purposes of this study were to (1) test the accuracy of α-defensin and combined α-defensin-aspiration cultures in diagnosing periprosthetic joint infection (PJI) before revision total knee and hip arthroplasty and (2) evaluate Musculoskeletal Infection Society (MSIS) criteria and α-defensin as predictors of successful reimplantation (second-stage) at 1 year after surgery. METHODS: We retrospectively evaluated a total of 97 synovial fluid aspirations performed between August 2014 and September 2016 before revision due to septic or aseptic failures (n = 70) or before second-stage (n = 27) joint arthroplasty. Revisions were categorized as either septic or aseptic according to the MSIS criteria. Synovial fluid was tested for α-defensin, cell count with differential, and cultures. Reimplantations were assessed for success or failure (defined as the need for reoperation due to infection) within 1 year after surgery. RESULTS: For septic and aseptic revision arthroplasty, the sensitivity, specificity, positive predictive value, and negative predicted value of α-defensin was 97% while for the combined α-defensin and aspiration culture, it was 96%, 100%, 100%, and 97%. Despite being performed with negative MSIS criteria and α-defensin test results, 11% (3/27) of reimplantations (second-stage) failed within 1 year postoperatively because of infection. CONCLUSION: Alpha-defensin is an accurate diagnostic test for the diagnosis of PJI before revision arthroplasty. The combination of α-defensin and aspiration cultures has higher specificity and positive predictive value. MSIS criteria and α-defensin may help predict the success of reimplantations within 1 year after surgery.

Anthropometric Measurements of Knee Joints in the Hispanic Population.

BACKGROUND: Total knee arthroplasty (TKA) systems provide a set of incrementally sized tibial and femoral components intended to accommodate most knee parameters. However, the most commonly used systems in the United States were developed using data from Caucasian patients which might not lead to the best fit in non-Caucasians. Therefore, we wanted to evaluate whether these TKA systems proportionally match femoral and tibial measurements in Hispanics. METHODS: All lower extremity magnetic resonance imaging performed at our institution between January 2007 and October 2015 were screened. A total of 500 nonarthritic knees from the same number of Hispanic patients were included in this retrospective descriptive radiographic study. Intraoperative osseous TKA resections were simulated on magnetic resonance imaging. Linear regression analyses were used to contrast the mediolateral (ML) width/anteroposterior (AP) length of simulated resected femoral condyle and tibia with the ML/AP dimensions of components offered by 4 current TKA systems. RESULTS: Simulated resected male femurs tended to be wider than most TKA system components for a given AP size, probably leading to component ML underhang. Altogether, systems studied accommodated most AP and ML measurements of female condyles. However, we identified subsets of Hispanic female patients with certain AP lengths and/or ML widths that particular knee systems could not accommodate. Resected male and female tibias tended to be slightly narrower than all TKA systems for a given AP size. CONCLUSION: The results of our study provide valuable data concerning the unique morphology of the Hispanic knee. These data can assist surgeons in the selection of the most suitable TKA systems for these patients.

Caregiver Burden for Patients With Severe Osteoarthritis Significantly Decreases by One Year After Total Knee Arthroplasty.

BACKGROUND: The impact of total knee arthroplasty (TKA) on patients' informal caregivers (eg, family members, friends) has gone largely ignored. The goals of this study are to measure the impact of TKA on the caregiver and identify factors contributing to higher burden. METHODS: One hundred fifty primary TKA patients and their designated caregivers were prospectively enrolled. The Caregiver Strain Index (CSI) was completed by caregivers preoperatively, at 4 weeks, and at 1 year after surgery. Additional outcomes included the Knee injury and Osteoarthritis Outcome Score for patients only and the Veterans Rand 12 Item Health Survey for both patients and caregivers. Univariate analysis and multivariate regression modeling were performed. RESULTS: Mean CSI scores at 1 year were significantly lower than preoperative values (P < .01), where lower scores indicate better results. Higher mean CSI values for younger caregivers were identified preoperatively (r = -0.21, P < .01) and at 4 weeks (r = -0.26, P < .01). There were higher mean CSI values for employed caregivers preoperatively (P = .01) and at 4 weeks (P < .01). A negative correlation was identified between CSI and the caregiver's Veterans Rand 12 Item Health Survey Mental Component Score preoperatively (r = -0.15, P = .03) and at 4 weeks (r = -1.5, P = .03). CONCLUSION: Caregiver burden nearly doubled in the early postoperative period, which was related to several caregiver and patient factors. However, the burden was close to zero by 1 year postoperatively. Thus, TKA is a beneficial intervention for both patient and caregiver.

Effectiveness of Novel Adjuncts in Pain Management Following Total Knee Arthroplasty: A Randomized Clinical Trial.

BACKGROUND: Total knee arthroplasty (TKA) can be associated with significant pain which can negatively impact outcomes. Multiple strategies have been employed to reduce pain. The aim of this study is to compare the effectiveness of 3 different pain management modalities after TKA that included (1) our standardized knee injection cocktail and oral acetaminophen, (2) liposomal bupivacaine periarticular injection and oral acetaminophen, and (3) our standardized knee injection cocktail and intravenous (IV) acetaminophen. METHODS: A prospective randomized clinical trial was conducted with 3 perioperative pain management regimes: oral acetaminophen and our standardized knee injection cocktail (standard group), oral acetaminophen and liposomal bupivacaine periarticular injection (LB group), and IV acetaminophen and our standardized knee injection cocktail (IVA group). Primary outcome measures included visual analog scale, total morphine equivalents, and the opioid-related symptoms distress scale at 24 and 48 hours postoperatively. RESULTS: There were no significant differences on visual analog scale/opioid-related symptoms distress scale scores 24 hours after surgery. The LB group required significantly more narcotics (total morphine equivalents) than the standard (P = .025) and IVA groups (P = .032). No significant differences were observed on any of the outcomes measured at 48 hours after surgery. CONCLUSION: Our data suggest that there is no added benefit in the routine use of IV acetaminophen or liposomal bupivacaine after TKA.

Fluoroscopically Guided Acetabular Component Positioning: Does It Reduce the Risk of Malpositioning in Obese Patients?

BACKGROUND: Obesity has been described as an independent risk factor for acetabular component malpositioning. The purpose of this study was to determine if this could be overcome by use of fluoroscopic navigation in total hip arthroplasty (THA). METHODS: The first, postoperative, standing, anteroposterior pelvis radiographs from 1599 consecutive patients who underwent fluoroscopic-guided THAs via anterior approach during a six-year period were obtained. We retrospectively reviewed this prospectively collected data. Inclination and anteversion were measured as described by Barrack et al. Intraoperative target ranges for inclination and anteversion angles were 30°-50° and 5°-25°. Patients were divided into 3 cohorts by body mass index, nonobese (<30 kg/m2) obese (between 30 and 40 kg/m2) and morbidly obese (>40 kg/m2), looking for significant differences in acetabular component positioning. RESULTS: Of the 1599 patients, 1065 were nonobese, 506 obese, and 28 morbidly obese. Overall, average inclination was 37.7° and anteversion was 16.3°. Regarding inclination, 95.0% of cups were positioned in the safe zone, 95.7% for anteversion, and 91.2% for both inclination and anteversion. Analysis of each cohort individually revealed an average inclination of 37.5° in the nonobese, 37.9° in the obese, and 39.9° in the morbidly obese patients. For anteversion, each group's averages were 16.1°, 16.5°, and 16.0°, respectively. There was no significant relationship between a patient's body mass index and cup position for inclination (P = .867), anteversion (P = .673), or both inclination and anteversion (P = .624). CONCLUSION: Fluoroscopy is a useful tool for achieving a targeted acetabular component orientation in direct anterior THA, irrespective of patient BMI.

Effect of Amidated Low-Methoxyl Pectin on Physicochemical Characteristics of Jumbo Squid (Dosidicus gigas) Mantle Muscle Gels.

Jumbo squid (Dosidicus gigas) muscle proteins show low functionality with limited use in gel products. This work aims to assess the influence of adding the natural and commercially available fibre, amidated low-methoxyl pectin (at 0.5, 1.0, 1.5, 2.0 and 3.0%), on the physicochemical and functional characteristics of jumbo squid (Dosidicus gigas) mantle muscle gels. The addition of 0.5% fibre showed an immediate effect on the gel texture profile analysis, improving hardness (p<0.05) from (3.4±0.7) N of the control (no added fibre) to (5.2±0.9) N, and increasing elasticity (p≥0.05). Shear force was significant only at 3.0% fibre addition. Water holding capacity also improved (p<0.05) with fibre addition (from 75% in the control to 90-95% after the treatments). Whiteness was affected (p<0.05) when 3.0% fibre was added. Differential scanning calorimetry showed two endothermic transition peaks in the gels. The second peak (actin) increased (p<0.05) by 1-2 °C with fibre addition. Therefore, the present study demonstrates that amidated low-methoxyl pectin (0.5-3.0%) is an excellent ingredient to improve jumbo squid mantle muscle protein functionality, increasing the gel texture and water retention characteristics.

Closed Suction Drainage Has No Benefits in Anterior Hip Arthroplasty: A Prospective, Randomized Trial.

BACKGROUND: Many studies have challenged routine drain placement in patients undergoing total hip arthroplasty. Some studies suggest increased transfusion rate with the use of closed suction drains. The use of tranexamic acid to control surgical bleeding and aspirin for venous thromboembolism prophylaxis has gained popularity. No study has evaluated the use of drains in patients undergoing direct anterior total hip arthroplasty under these conditions. METHODS: We performed a prospective, randomized study in patients undergoing direct anterior total hip arthroplasty to evaluate whether closed suction drain placement provides any clinical benefit. Patients randomly assigned to the control group had closed suctions drains placed; patients randomly assigned to the treatment group had no drains placed. The primary outcome measures were hematoma formation, wound complications, and transfusion rates. The secondary outcome measures were estimated blood loss, decrease in hemoglobin and hematocrit levels, total hemoglobin loss, calculated blood loss, hidden blood loss, and total length of hospital stay. Differences in outcomes between groups were considered to be significant at P ≤ .05. RESULTS: There were no significant differences between groups in transfusion rate (P = .49), postoperative decrease in hemoglobin levels (P = .95), average calculated blood loss (P = .65), complications (P = .49), or length of hospital stay (P = .14). There was no hematoma formation observed in either group. CONCLUSION: Our study showed no clinical benefit or disadvantage to closed suction drainage in anterior hip arthroplasty with the concomitant use of tranexamic acid for surgical hemostasis and aspirin for venous thromboembolism prophylaxis.

Accuracy of Fluoroscopic Guided Acetabular Component Positioning During Direct Anterior Total Hip Arthroplasty.

Acetabular component malposition contributes to increased complications and early revision. Supine positioning during direct anterior approach (DAA) THA facilitates the use of fluoroscopy to improve component positioning. This study evaluated the accuracy of acetabular component orientation using intraoperative fluoroscopy in DAA THA. A total of 780 surgeries by two surgeons were retrospectively reviewed over a 3-year period. Ranges for abduction (30°-50°) and version (5°-250) were employed. Overall, 92% fell within the targeted abduction range, 93% fell within the targeted anteversion range, and 88% met both criteria. The accuracy of component positioning for combined abduction and anteversion improved yearly (79.2%, 2011; 90.9%, 2012; and 95.6%, 2013). Fluoroscopy in DAA THA is a useful tool to improve acetabular component orientation, though a learning curve exists with its interpretation.

Prospective, Randomized Trial to Evaluate Efficacy of a Bipolar Sealer in Direct Anterior Approach Total Hip Arthroplasty.

Total hip arthroplasty can be associated with substantial blood loss requiring allogenic transfusions. Intraoperative blood loss patterns in DAA differ from other approaches. This study evaluated the hemostatic efficacy of a bipolar sealer in DAA THA on surgical blood loss and transfusion requirements. 118 patients were enrolled in this prospective, randomized, double-blinded trial. Primary outcome measure was transfusion rate, while secondary measures included calculated blood loss. A lower transfusion rate was found in the treatment group (3.5 % vs 16.4%, P=.03). There were differences in Hemoglobin-drop (P=.04), calculated blood loss (P=.02), and hidden blood loss (P=.02), favoring the treatment group. The use of a bipolar sealer decreased intraoperative blood loss and transfusion requirements in the study population.

Prospective, randomized trial to evaluate efficacy of a thrombin-based hemostatic agent in total knee arthroplasty.

Total knee arthroplasty (TKA) can be associated with substantial blood loss, leading to increased morbidity and transfusion rates. The study objective was to evaluate routine use of a thrombin-based topical hemostatic matrix in reducing blood loss and transfusion requirements in primary TKA. 108 patients were enrolled in a prospective, randomized, single-center trial. Patients receiving the hemostatic agent demonstrated a lower mean calculated blood loss (1325.2±464.8mL vs. control, 1509.3±432.8mL; P=0.02), drain output (415.6±202.0mL vs. control, 579.9±306.7mL; P=0.008), and length of stay (3.3±0.8days vs. control, 3.7±1.1days; P=0.03), without a statistically significant difference in mean hemoglobin loss or transfusion requirements. The clinical utility of this hemostatic agent to reduce transfusions after uncomplicated, primary TKA continues to remain unclear.

Incidence of heterotopic ossification in direct anterior total hip arthroplasty: a retrospective radiographic review.

Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6 months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip.

Comprehensive approach to the evaluation of groin pain.

Groin pain is often related to hip pathology. As a result, groin pain is a clinical complaint encountered by orthopaedic surgeons. Approximately one in four persons will develop symptomatic hip arthritis before age 85 years. Groin injuries account for approximately 1 in 20 athletic injuries, and groin pain accounts for 1 in 10 patient visits to sports medicine centers. Many athletes with chronic groin pain have multiple coexisting pathologies spanning several disciplines. In treating these patients, the orthopaedic surgeon must consider both musculoskeletal groin disorders and nonorthopaedic conditions that can present as groin pain. A comprehensive history and physical examination can guide the evaluation of groin pain.

Do patient-reported outcome measures improve after aseptic revision total hip arthroplasty?

BACKGROUND: The purpose of this study was to determine patient-reported outcome measures (PROMs) changes in: (1) pain, function and global health; and (2) predictors of PROMs in patients undergoing aseptic revision total hip arthroplasty (rTHA) using a multilevel model with patients nested within surgeon. METHODS: A prospective cohort of 216 patients with baseline and 1-year PROMs who underwent aseptic rTHA between January 2016 and December 2017 were analysed. The most common indication for rTHA was aseptic loosening, instability, and implant failure. The PROMs included in this study were HOOS Pain and HOOS Physical Function Short-form (PS), Veterans RAND-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (MCS). Multivariable linear regression models were constructed for predicting 1-year PROMs. RESULTS: Mean 1-year PROMs improvement for aseptic revisions were 30.4 points for HOOS Pain and 22.1 points for HOOS PS. Predictors of better pain relief were patients with higher baseline pain scores. Predictors of better 1-year function were patients with higher baseline function and patients with a posterolateral hip surgical approach during revision. Although VR-12 PCS scores had an overall improvement, nearly 50% of patients saw no improvement or had worse physical component scores. Only 30.7% of patients reported improvements in VR-12 MCS. CONCLUSIONS: Overall, patients undergoing aseptic rTHA improved in pain and function PROMs at 1 year. Although global health assessment improved overall, nearly half of aseptic rTHA patients reported no change in physical/mental health status. The associations highlighted in this study can help guide the shared decision-making process by setting expectations before aseptic revision THA.

Removal of trabecular metal osteonecrosis intervention implant and conversion to primary total hip arthroplasty.

Core decompression and placement of the Trabecular Metal Osteonecrosis Intervention Implant have shown to be initially successful in treating early osteonecrosis. When treatment fails, however, patients often undergo primary total hip arthroplasty (THA) requiring removal of a previously inserted trabecular metal implant. We describe a technical tip for removal of a well-ingrown trabecular metal screw. A metal-cutting trephine placed over the screw allows for removal in an efficient manner while minimizing additional dissection and bone loss during conversion to THA.

Digital Fluoroscopic Navigation for Limb Length Restoration During Anterior Total Hip Arthroplasty.

Background: Restoration of limb length is important in total hip arthroplasty. Clinical evaluation and preoperative templating establish the intended lengthening. The purpose of this study was to assess whether digital fluoroscopic navigation (DF) improved the accuracy of planned lengthening in direct anterior approach total hip arthroplasty (DAA-THA). Methods: Planned lengthening measurements on 100 consecutive unilateral DAA-THA patients, along with patient characteristics, were prospectively collected by 2 surgeons. One surgeon utilized DF to achieve intended length (n = 50), while the other utilized unaided standard fluoroscopy (SF; n = 50). A third surgeon blinded to the procedures assessed actual limb length using an ipsilateral overlay technique on the 6-week postoperative radiograph. The difference between the mean planned and actual limb lengthening stratified by DF and SF was assessed using bivariate and multivariate statistics. Results: The mean (standard deviation) planned lengthening in DF and SF groups was 3.96 (2.1) and 3.47 (2.2) mm, respectively. The mean (standard deviation) actual lengthening in DF and SF groups was 3.11 (4.0) and 0.68 (4.6) mm, respectively. After accounting for age, sex, body mass index, laterality, and the Bone Index, multivariate regression results showed that the average difference between planned and actual limb lengthening in the DF group was significantly lower than that in the SF group (ß = -1.92; 95% confidence interval: -3.51, -0.33; P < .02). A greater percentage of patients in the DF group (66% vs 40%) were within 3 mm of the intended plan (P < .01). Conclusions: Fluoroscopy helps achieve the intended surgical lengthening in DAA-THA. The use of DF resulted in more accurate execution of lengthening.

Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty: A Risk-adjusted Comparison of 30-day Outcomes Using National Data From 2014 to 2018.

Background: When clinically indicated, the choice of performing a total knee arthroplasty (TKA) vs a unicompartmental knee arthroplasty (UKA) is dictated by patient and surgeon preferences. Increased understanding of surgical morbidity may enhance this shared decision-making process. This study compared 30-day risk-adjusted outcomes in TKA vs UKA using a national database. Methods: We analyzed data from the National Safety and Quality Improvement Program database, for patients who received TKA or UKA between 2014-2018. The main outcomes were blood transfusion, operation time, length of stay, major complication, minor complication, unplanned reoperation, and readmission. Comparisons of odds of the outcomes of interest between TKA and UKA patients were analyzed using multivariate regression models accounting for confounders. Results: We identified 274,411 eligible patients, of whom 265,519 (96.7%) underwent TKA, while 8892 (3.3%) underwent UKA. Risk-adjusted models that compared perioperative and postoperative outcomes of TKA and UKA showed that the odds of complications such as blood transfusion (adjusted odds ratio [aOR], 19.74; 95% confidence interval [CI]: 8.19-47.60), major (aOR, 1.87; 95% CI: 1.27-2.77) and minor complications (aOR, 1.43; 95% CI: 1.14-1.79), and readmission (aOR, 1.41; 95% CI: 1.16-1.72) were significantly higher among patients who received TKA than among those who received UKA. In addition, operation time (aOR, 7.72; 95% CI: 6.72-8.72) and hospital length of stay (aOR, 1.11; 95% CI: 1.05-1.17) were also higher among the TKA recipients compared to those who received UKA. Conclusions: UKA is associated with lower rates of adverse perioperative outcomes compared to TKA. Clinical indications and surgical morbidity should be considered in the shared-decision process.