Demographics and Early Outcomes of Commercial Antibiotic Cement Usage for Infection Prophylaxis During Primary Total Knee Arthroplasty in Patients Older Than 65 Years: An American Joint Replacement Registry Study.

INTRODUCTION: The use of antibiotic-laden bone cement (ALBC) for infection prophylaxis in the setting of primary total knee arthroplasty (TKA) remains controversial. Using data from the American Joint Replacement Registry (AJRR), (1) we examined the demographics of ALBC usage in the United States and (2) identified the effect of prophylactic commercially available ALBC on early revision and readmission for prosthetic joint infection (PJI) after primary TKA. METHODS: This is a retrospective cohort study of the AJRR from 2017 to 2020. Patients older than 65 years undergoing primary cemented TKA with or without the use of commercially available antibiotic cement were eligible for inclusion (N = 251,506 patients). Data were linked to available Medicare claims to maximize revision outcomes. Demographics including age, sex, race/ethnicity, Charlson Comorbidity Index (CCI), preoperative inflammatory arthritis, region, and body mass index (BMI) class were recorded. Cox proportional hazards regression analysis was used to evaluate the association between the two outcome measures and ALBC usage. RESULTS: Patients undergoing cemented TKA with ALBC were more likely to be Non-Hispanic Black ( P < 0.001), have a CCI of 2 or 3 ( P < 0.001), reside in the South ( P < 0.001), and had a higher mean BMI ( P < 0.001). In the regression models, ALBC usage was associated with increased risk of 90-day revision for PJI (hazards ratio 2.175 [95% confidence interval] 1.698 to 2.787) ( P < 0.001) and was not associated with 90-day all-cause readmissions. Male sex, higher CCI, and BMI >35 were all independently associated with 90-day revision for PJI. DISCUSSION: The use of commercial ALBC in patients older than 65 years for primary TKA in the AJRR was not closely associated with underlying comorbidities suggesting that hospital-level and surgeon-level factors influence its use. In addition, ALBC use did not decrease the risk of 90-day revision for PJI and was not associated with 90-day readmission rates.

Same-Day Outpatient Lower-Extremity Joint Replacement: A Critical Analysis Review.

➢ The economics of transitioning total joint arthroplasty (TJA) to standalone ambulatory surgery centers (ASCs) should not be capitalized on at the expense of patient safety in the absence of established superior patient outcomes. ➢ Proper patient selection is essential to maximizing safety and avoiding complications resulting in readmission. ➢ Ambulatory TJA programs should focus on reducing complications frequently associated with delays in discharge. ➢ The transition from hospital-based TJA to ASC-based TJA has substantial financial implications for the hospital, payer, patient, and surgeon.

Total Joint Arthroplasty Training (Prehabilitation and Rehabilitation) in Lower Extremity Arthroplasty.

Lower extremity total joint arthroplasty (TJA) has an established track record of success and a subset of patients who fail to experience desired improvements. Current TJA success can be attributed to refined surgical techniques, improved preparation of patients for surgery, and enhanced postoperative recovery protocols. One aspect of preoperative patient preparation and enhanced postoperative recovery includes training regimens intended to prepare patients for TJA and facilitate TJA functional recovery (often referred to as using the jargon prehabilitation and rehabilitation). The importance of prehabilitation and rehabilitation is open to debate because of historically insufficient and inconsistent evidence. This review aims to provide direction for future investigative efforts by presenting an overview of current preoperative and postoperative TJA training/exercise programs within the framework of utility, timing, form, setting, and cost.

Total hip arthroplasty: the mini-posterior approach.

A successful surgical exposure during total hip arthroplasty must not only provide adequate visualization of both the acetabulum and the proximal femur but also avoid injury to critical neurovascular structures and minimize dissection of soft-tissue hip stabilizers. Numerous surgical approaches to the hip have been described and subsequently modified since the advent of modern total hip arthroplasty. Descendent from the standard posterolateral approach, the mini-posterior approach not only satisfies the prerequisites for a successful total hip arthroplasty exposure but also exemplifies a utilitarian approach to the hip, which is applicable to the entire spectrum of reconstructive cases.

Periacetabular osteotomy: intra-articular work.

The goal of periacetabular osteotomy (PAO) is to correct acetabular pathomorphology and restore a more normal interplay between the acetabulum and proximal femur. After PAO, the biomechanically improved hip joint is presumed to better resist the progression of degenerative joint disease. Isolated PAO without intra-articular inspection often will underestimate the extent of hip disease in young adults. If intra-articular inspection is not performed at the time of PAO, chondrolabral injuries and dysplastic hip pathologies associated with femoroacetabular impingement will not be detected. The interaction of the acetabulum with the proximal femur is critical, and the presence of iatrogenic femoroacetabular impingement can be assessed with intra-articular inspection at the time of PAO.

Prevalence and treatment of intraarticular pathology recognized at the time of periacetabular osteotomy for the dysplastic hip.

BACKGROUND: The indication for hip arthrotomy accompanied by intraarticular work during periacetabular osteotomy (PAO) has not been precisely defined. To validate a role for routine hip arthrotomy accompanied by intraarticular work, frequent intraarticular pathology must exist, and the adjunct procedures must not be associated with inferior relief of pain, reduced function, radiographic osteoarthritis progression, or conversion to THA. QUESTIONS/PURPOSES: (1) What is the prevalence of intraarticular pathology at the time of PAO? (2) Does concomitant hip arthrotomy with associated intraarticular work negatively affect PAO as reflected by differences in Harris hip scores (HHS), Tönnis grade, and failure rates? METHODS: We retrospectively reviewed the intraarticular findings in all 151 patients who underwent PAO accompanied by routine hip arthrotomy and intraarticular work from 2002 to 2009. Using multivariate regression models, we compared the HHS and Tönnis grades of patients receiving arthrotomy with a cohort of 39 patients who received PAO alone. RESULTS: The overall prevalence of intraarticular pathology identified during PAO was 89%. Eight (5.3%) failures were identified within the arthrotomy cohort with mean postoperative HHS, postoperative Tönnis grade, postoperative change in HHS, and postoperative change in Tönnis grade of 87.5, 0.7, 29.8, and 0.3, respectively. By contrast, seven (17.9%) failures were identified in the nonarthrotomy cohort. The mean postoperative HHS, postoperative Tönnis grade, postoperative change in HHS, and postoperative change in Tönnis grade for the nonarthrotomy cohort were 83.1, 1.3, 19.0, and 0.3, respectively. CONCLUSIONS: We believe the high prevalence of intraarticular pathology is sufficient to warrant routine joint inspection at the time of PAO. Hip arthrotomy accompanied by intraarticular work at the time of PAO is safe and does not impose additional patient morbidity. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.