Faculty Bibliography

BACKGROUND:This study evaluated differences in surgical and clinical outcomes among patients who have identical versus different implant sizes in sequential total knee arthroplasty (TKA) surgeries. METHODS:We retrospectively reviewed patients who underwent primary, elective, staged, bilateral, same-surgeon, same-prosthesis TKA between 2011 and 2024 at a large academic health system. Patients were grouped by femoral and tibial implant size consistency: same femoral and tibial (SS), different femoral, same tibial, different tibial, same femoral, and different femoral and tibial (DD). RESULTS:A total of 4,536 TKAs were performed in 2,268 patients. The SS had the shortest length of stay compared to DD (51.8 versus 58.2 hours, P < 0.001). The majority had the same femoral (75.6%) and tibial (76.6%) sizes in both knees, whereas polyethylene thickness varied. Undergoing contralateral surgery within one year was associated with receiving the same implant sizes (P < 0.001). The DD were more common in manual surgery, and the SS were more common using navigation assistance (P < 0.001). Different assistance modalities between surgeries increased different femoral, same tibial and DD, whereas the same navigation assistance increased SS (P < 0.001). Complication and revision rates were not significantly different between the groups. All groups showed improvement in their Knee injury and Osteoarthritis Outcome Score for Joint Replacement and Patient-Reported Outcomes Measurement Information System Pain Intensity and Interference scores with no significant intergroup differences (P > 0.05). CONCLUSIONS:Over one-third of patients (37.3%) undergoing staged, bilateral TKA received different implant sizes for at least one component, and over half had different polyethylene thicknesses. Although implant size consistency was influenced by factors such as time between surgeries and assistance modality, these variations did not significantly affect length of stay, complications, or patient-reported outcomes. Surgeons should be aware that minor implant size differences between knees are common, even when using the same prosthesis.

Artificial intelligence (AI) has emerged as one of the most transformative technological forces in modern medicine, with rapidly expanding applications throughout medicine including orthopaedic surgery. Recent advances in machine learning, deep learning, and natural language processing have accelerated the development of AI-enabled tools with direct relevance to orthopaedic practice. This review provides a basic overview of how AI works and current uses of AI in medicine and orthopaedics across multiple domains including documentation efficiency, patient communication, operating room optimization, imaging analysis, rehabilitation, education, and research, and briefly describes AI's limitations, ethical and legal concerns, and cost. These applications are all already being used in orthopaedics or have clear direct translation. AI holds considerable potential to augment orthopaedic care by streamlining workflows, enhancing decision-making, and improving patient outcomes. However, responsible integration requires rigorous validation, transparency, clinician oversight, and ongoing education. As AI adoption accelerates, orthopaedic surgeons must critically evaluate emerging technologies to ensure that.

This study compared distance traveled by total joint arthroplasty (TJA) patients to surgeons' clinics who are language concordant (LC) versus language discordant (LD) with their surgeons. A retrospective review of all non-English speaking patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA), stratified according to language concordance, was conducted at a single institution between 2011 and 2021. The distance from home to clinic zip code where patients received TJA care was recorded. Of the 837 patients receiving THA, 401 (47.9%) were in the LD group and 436 (52.1%) were in the LC group. In total, 1,675 patients received TKA, with 874 (52.2%) in the LD group and 801 (47.8%) in the LC group. Both TKA and THA LD patients traveled significantly farther from home to clinic than the LC groups (p < 0.001). Non-English-speaking patients undergoing TJA who are language concordant with their surgeon may live closer to their surgeons' clinic. Level of Evidence: Level III. (Journal of Surgical Orthopaedic Advances 35(2):077-080, 2026).

BACKGROUND/UNASSIGNED:Arthrofibrosis represents a source of patient dissatisfaction following total knee arthroplasty (TKA). The purpose of this systematic review and meta-analysis was to evaluate the efficacy of perioperative angiotensin II receptor blockers (ARBs) as anti-fibrotic agents in patients undergoing total knee arthroplasty (TKA). METHODS/UNASSIGNED:The Medline, Embase and Cochrane library databases were systematically reviewed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The outcome measures of interest were postoperative knee range of motion (ROM), rates of manipulation under anesthesia (MUA) and revision rates. RESULTS/UNASSIGNED: = 0.3349). CONCLUSION/UNASSIGNED:This systematic review and meta-analysis found that the utilization of perioperative ARBs were not associated with superior postoperative knee ROM nor lower rates of MUA in patients undergoing TKA. Additionally, no difference in revision TKA rates existed between patients in the ARB cohort compared to the control cohort. Based on the current available data, it is the author's current recommendation that perioperative ARB usage is not indicated in the setting of TKA for the prevention of arthrofibrosis. However, this analysis should be interpreted in light of the low level of evidence and under-reporting of data of the included studies. Thus, higher-level evidence, prospective, comparative studies should be conducted to definitively identify if perioperative ARBs can be utilized as effective anti-fibrotic agents in the setting of TKA.

BACKGROUND:Weight management strategies before total hip arthroplasty (THA) include bariatric surgery and Glucagon-like peptide-1 receptor agonists, including semaglutide. Previous studies have reported higher THA implant failure in patients who had prior bariatric surgery. This study aimed to evaluate semaglutide as a weight management alternative for patients undergoing THA and any effects on perioperative outcomes. METHODS:A retrospective review of primary, elective THAs performed between 2012 and 2024 was conducted at a single, urban, academic center. The study identified 224 patients who had a history of bariatric surgery, 202 patients who had perioperative semaglutide use, and a control group of 2,991 patients who had a body mass index (BMI) > 35. Demographic variables and clinical outcomes were compared between cohorts. RESULTS:The bariatric patients were younger (57 versus 61, P = 0.012) and more often women (65.6 versus 57.4 versus 55.4%, P < 0.001) than semaglutide and control patients. Preoperative hemoglobin A1c was lowest in semaglutide patients (6.2 versus 5.7 versus 5.8%, P < 0.001). The changes in BMI varied across groups one year before and after THA (P < 0.001). The bariatric and semaglutide groups decreased their BMI by 1.4 and 0.8, respectively, and control patients increased by 0.4. Implant survivorship was 95.5% at 10 years. There was no correlation found between any cohort and 90-day emergency department visits, readmissions, and all-time revision. Higher American Society of Anesthesiologists class and Charlson Comorbidity Index ≥ 5 conferred increased complications. CONCLUSIONS:Semaglutide appears to be a safe alternative to bariatric surgery for weight management before THA, with similar implant survival and postoperative complication rates. Further studies are warranted to understand outcomes for THA patients who use semaglutide.

BACKGROUND/UNASSIGNED:Despite similar rates of osteoarthritis, minority populations undergo fewer hip and knee arthroplasties and have more complications. More than 90% of US hospitals have certified electronic health records, yet only 40% of patients utilize electronic patient portals (EPPs), with lower rates across some demographics. Adverse quality metrics and lower patient-reported outcome survey completion rates were noted for patients with inactive portals. Activation rates for EPPs can be lower among underrepresented groups, perpetuating existing disparities in access to care. Barriers to EPP activation must be identified to design interventions that improve portal utilization and, therefore, outcomes. We designed this study as there are no published reports analyzing factors which impede EPP utilization by total joint patients. METHODS/UNASSIGNED:In this IRB-exempt qualitative study, sixty-six arthroplasty patients were interviewed using a questionnaire designed to reveal reasons for EPP nonusage. Demographic factors including language, age, sex, insurance type, and zip code were collected from the electronic health records. Dedoose, a qualitative research tool, was used to analyze data and abstract trends from interview notes and transcripts. RESULTS/UNASSIGNED:We found arthroplasty patients' demographics and social drivers of health influenced utilization of EPPs. Older adults struggled with digital literacy or lack of familiarity with technology. Limited internet access was cited as an obstacle to use. Patients with language barriers reported accessibility issues. Patients additionally reported concerns regarding personal information being online and perceptions that portals would not be useful. CONCLUSIONS/UNASSIGNED:EPPs are becoming the preferred method of patient-physician communication. Demographic and social factors impact patient willingness and ability to access EPPs. Certain patients are, therefore, at greater risk of ineffective communication with care teams, delayed follow-up appointments, or challenges with scheduling and managing rehabilitation. This may lead to suboptimal recovery and surgical outcomes. The current study investigated underlying issues impeding EPP usage to inform potential interventions.

BACKGROUND:The impact of liver cirrhosis on surgical outcomes is well-known. This study aimed to compare postoperative outcomes of total hip arthroplasty (THA) in patients with versus without cirrhosis. METHODS: = 10). RESULTS: = 0.479) between non-cirrhotic and cirrhotic THA patients at 120 months of follow-up. CONCLUSIONS:Cirrhotic patients, particularly those categorized as moderate-to-severe, undergoing THA may have higher risk of having a readmission or revision for PJI. However, overall 90-day readmission and revision risk were similar between non-cirrhotic and cirrhotic patients. Future research with larger sample sizes and databases is needed to further risk stratify, optimize and counsel cirrhosis patients surrounding THA.

Genetics is a burgeoning field within adult reconstructive surgery. Genome-wide sequencing has identified genetic variants found to be associated with not only the development of osteoarthritis but also arthroplasty-related complications, such as aseptic loosening, prosthetic joint infection, arthrofibrosis, and postoperative pain. Examples include newer technology, such as next-generation sequencing, in diagnosing culture-negative prosthetic joint infection. Genetics drives new therapeutic technologies, such as gene therapy, gene-editing, and bacteriophage treatment. Although still rare, a handful of phase 3 clinical trials of gene therapy for osteoarthritis have begun to demonstrate efficacy with low-risk profiles. As the field continues to grow, public and professional buy-in as well as cost present challenges.