Faculty Bibliography

INTRODUCTION/BACKGROUND:Intraprosthetic dislocation (IPD) is a rare but potentially catastrophic complication of dual-mobility (DM) implants, defined by dissociation of the inner femoral head from the polyethylene liner. Modular dual-mobility (MDM) designs were introduced to improve intraoperative flexibility and expand indications for DM technology. However, increasing reports of IPD have raised concerns that implant design and manufacturing differences may influence risk. The true incidence of IPD across MDM manufacturers remains unclear. METHODS:A systematic search of PubMed, Embase, and Web of Science was performed. Studies reporting IPD incidence and stratified outcomes by implant manufacturer were included. A random-effects proportion meta-analysis was conducted to estimate pooled IPD incidence and revision rates overall and by manufacturer. RESULTS:Of 523 identified articles, 32 met inclusion criteria, representing 3996 implants (2711 primary; 1285 revision). Mean follow-up was 3.48 years and mean age was 67.48 years. The overall IPD incidence was 0.38% (15/3996), with a pooled estimate of 0.1% (95% CI, 0-0.5%). Stratified analyses showed IPD rates of 0% for Stryker (95% CI, 0-0.7%), 0% for Zimmer (95% CI, 0-100%), and 0% for Groupe Lépine (95% CI, 0-100%). Reoperation rates were 1.4% (95% CI, 0.9-2.1%) in primary and 8.3% (95% CI, 6.0-11.3%) in revision THA. CONCLUSIONS:The incidence of IPD in MDM implants is low, with pooled rates remaining below 1%. Revision rates were modest and consistent with published data on complex hip arthroplasty. No significant differences between manufacturers were detected, though findings are limited by the small number of non-Stryker implants reported. These findings suggest that MDM designs appear safe with overall low numbers of IPD-related complications, however, larger registry-based studies are needed to better define potential design-related differences in IPD risk.

The 2025 American Joint Replacement Registry Annual Report includes 4.6 million hip and knee arthroplasty procedures, with 4,434,668 validated cases, representing a 20% increase from the prior report. Registry participation continues to expand, with contributions from over 5000 surgeons and 1200 institutions, including an increasing submission of patient-reported outcome measures. A key methodological change includes the adoption of Kaplan-Meier survivorship analysis, allowing improved assessment of time-dependent revision risk. Ongoing efforts to improve data completeness and registry infrastructure continue to support registry-driven research. The full report can be accessed at https://www.aaos.org/registries/publications/ajrr-annual-report/.

Elective total joint arthroplasty (TJA) in patients with a high body mass index (BMI) or obesity is a complex and nuanced topic. Patients' and surgeons' perspectives on how to address the challenges related to TJA in high BMI patients may differ, highlighting an imperative to include perspectives from both groups in strategizing approaches to improve care. Hip and knee arthroplasty surgeons and patients with high BMI and osteoarthritis were included in a consensus working group (Advisory Committee Co-dEsigning SolutionS regarding Obesity and Arthroplasty [ACCESS-OA]) to identify areas of agreement and disagreement on priorities to improve TJA care for patients with a high BMI. In this white paper, we report on the results of this working group. Based on consensus scoring, the working group prioritized addressing uncertainties in (1) presurgical patient optimization, (2) surgeon education and training, and (3) shared decision-making. Advancing research and practice in these priority areas could have important clinical impact.

INTRODUCTION/BACKGROUND:Sarcopenia, the loss of muscle mass and function, is closely linked to poor health and has been associated with inferior outcomes in total hip arthroplasty (THA). Psoas Muscle Index (PMI) is a radiographic metric inversely correlated with sarcopenia. It was hypothesized that low PMI patients would have worse outcomes following THA. METHODS:A retrospective review of 515 patients who underwent robotic primary THA between 2014 and 2022 at a single, urban, academic health system with 2-year follow-up data was performed. Psoas Muscle Index was calculated from preoperative computed tomography imaging of the pelvis. Patient baseline demographics, laboratory values, perioperative data, and outcomes were collected from chart review. RESULTS:Low PMI occurred in 56 (10.8%) of 515 patients. There were no differences in readmissions or reoperations (P = 0.51; P = 0.58). Low PMI was associated with higher HOOS, JR score at 2 weeks and greater improvement from baseline (P = 0.034; P = 0.037), as well as lower Patient-Reported Outcomes Measurement Information System Pain Intensity at 3 months and greater reductions from baseline (P = 0.038; P = 0.013). CONCLUSION/CONCLUSIONS:Psoas Muscle Index did not reliably predict surgical outcomes following THA, and low PMI was associated with better patient-reported outcome measures after surgery. Further investigation into other means of diagnosing sarcopenia may be warranted.

BACKGROUND/UNASSIGNED:Osteoporosis (OP) is a common comorbidity in patients undergoing total hip arthroplasty (THA) and is a known risk factor for poor postoperative outcomes such as periprosthetic fracture (PPF). The impact of preoperative OP medications in patients with OP undergoing THA remains unclear. This study aimed to compare THA outcomes by OP diagnosis and preoperative bone strengthening medication usage. METHODS/UNASSIGNED:This was a retrospective review of primary elective THAs from June 2011-January 2024. Patients were stratified by OP diagnosis and OP medication usage, then propensity matched in a 1:2:3 ratio by age, sex, body mass index, and comorbidities. The resulting cohorts: (1) OP and medication usage for at least 1 year preoperatively and within 7 years of the procedure (n = 296), (2) OP and no medication usage (n = 592), and (3) no diagnosis of OP and no medication usage (n = 888) were then compared for postoperative outcomes. RESULTS/UNASSIGNED:= .009). Of the 12 revisions due to periprosthetic femoral fracture in cohorts 1 and 2 combined, 11 (91.7%) occurred around an uncemented implant. CONCLUSIONS/UNASSIGNED:Osteoporotic patients on OP medications did not have improved outcomes after THA compared with nonmedicated osteoporotic patients or those without a diagnosis of OP. PPF in osteoporotic patients overwhelmingly occurred around uncemented femoral implants. Surgeons should use caution when operating on osteoporotic patients, regardless of utilization of preoperative medications, and strongly consider using cemented femoral implants to decrease the risk of PPF.

This symposium from the 2025 American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting contains an overview of concepts and techniques to use during revision total hip arthroplasty (THA).

Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthopaedic infection continues to challenge even the most experienced clinicians. There are differences in the diagnosis and treatment of infections that are related to different anatomic regions. The difficulty arises from the inherent biological diversity of infecting organisms and surgical locations, variable host responses, and the absence of a true diagnostic "gold standard." This article summarizes the current diagnostic challenges and emerging solutions, drawing on recent high-impact evidence and consensus frameworks.

BACKGROUND/UNASSIGNED:The purpose of this study was to assess the demographic characteristics of orthopaedic surgeons in Louisiana taking care of patients with Medicaid insurance and to assess any perceived barriers to care, with a focus on total joint arthroplasty (TJA). METHODS/UNASSIGNED:An electronic survey was distributed to all practicing surgeon members of the Louisiana Orthopaedic Association with questions about practice type, subspecialty, demographics, estimated percentage of Medicaid patient volume, and perceived barriers to care. Responses were collected using a secure database, and statistical analysis was performed. RESULTS/UNASSIGNED:= .0001). CONCLUSIONS/UNASSIGNED:Most orthopaedic surgeons performing TJA in Louisiana either do not accept or perform a relatively small percentage of their practice volume on patients with Medicaid insurance. Low physician and facility reimbursement rates and difficulty referring to ancillary services were perceived as the greatest barriers to caring for these patients.

BACKGROUND:Patients with Medicaid insurance are at an increased risk of postoperative complications following total knee arthroplasty and total hip arthroplasty (TJA); however, their outcomes following revision TJA for periprosthetic joint infection (PJI) requires further study. METHODS:A retrospective query was conducted for adult patients undergoing implant explantation and antibiotic spacer placement for TJA PJI from the Premier Healthcare Database between December 1, 2016, and December 31, 2021. Patients were then grouped by Medicaid or non-Medicaid insurance status and were age matched through exact caliper matching. Multivariable regression models addressed potential confounding. Adjusted risks of 90-day postoperative complications were reported. RESULTS:Of the 40,346 patients identified, 2,711 Medicaid patients were matched to 10,844 non-Medicaid patients on age (56.1 vs. 56.1 years, P = 1.000). Patients with Medicaid experienced higher risk of sepsis (adjusted odds ratio [aOR] = 1.20, P = 0.010), readmission (aOR = 1.12, P = 0.022), being discharged to a skilled nursing facility (aOR = 1.13, P = 0.031), and had longer length of stay (9.48 vs. 6.67 days, P < 0.001), compared with patients with non-Medicaid. Medicaid patients had a higher rate of inpatient mortality (0.81% vs. 0.48%, P = 0.038); however, the risk was similar after accounting for differences in comorbidities. CONCLUSION/CONCLUSIONS:Following revision TJA for PJI, patients with Medicaid were at an increased risk for postoperative complication, including sepsis and readmission. They experienced a higher rate of inpatient mortality that may be driven by differences in comorbidities. Insurers and policy makers should consider this information to develop risk stratification-based payment strategies that take into account the healthcare burden of this high-risk patient population. LEVEL OF EVIDENCE/METHODS:IV.