Faculty Bibliography

AIMS/UNASSIGNED:Total hip arthroplasty (THA) in the setting of proximal femoral defects and poor bone stock often necessitates distal fixation using specialized implants, such as monolithic tapered, fluted titanium stems (TFTSs), to ensure adequate stability. This study evaluates the mid-term outcomes of TFTS in both primary and revision THA. METHODS/UNASSIGNED:This was a multi-institutional retrospective review of patients who received monolithic TFTS between July 2016 and June 2020 during either complex primary THA or revision THA. Outcomes included pre-, intra- and postoperative characteristics, as well as five-year all-cause, septic and aseptic revisions, and Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) at different postoperative timepoints. RESULTS/UNASSIGNED:A total of 115 patients with a mean follow-up of 6.3 years (SD 1.2) were included. Femoral component survivorship free from aseptic revisions was 99.1% (95% CI 97.3 to 100) at 5.1 years after TFTS. Aseptic revision occurred in a single patient (0.9%) due to periprosthetic acetabular fracture that necessitated femoral component removal for exposure 60.6 months following TFTS. Survivorship from septic revisions was 93.2% (95% CI 91.5 to 99.9) at 5.3 years. Septic revisions included debridement, irrigation and exchange of modular components (n = 3, 2.6%), and two-stage revision arthroplasties (n = 4, 3.5%) at a mean of 27.7 months after surgery (1.5 to 63.9). All-cause survivorship from any revision was 92.4% (95% CI 90.5 to 100) at 5.3 years after TFTS. HOOS, JR scores improved from preoperative to five-year follow-up (46.1 (SD 20.8) to 83.8 (SD 19.0), respectively). CONCLUSION/UNASSIGNED:The TFTS demonstrates excellent mid-term survivorship (99.1% at five years) and significant clinical improvement in complex primary and revision THA. These outcomes suggest that the TFTS can be considered a valuable option in this challenging patient population.

BACKGROUND:Despite theoretical risks of fatigue wear, there is little empirical evidence correlating postoperative impact level from physical activity with failure rates following total hip and knee arthroplasty (THA and TKA). This study aimed to assess the relationship between the impact level from self-reported sports and physical activity participation and revision rates following primary arthroplasty. METHODS:A survey was conducted on recreational sports participation among primary elective THA and TKA patients from an urban, academic health system between June 1, 2011, and January 31, 2022. A total of 1,622 THA and 1,388 TKA respondents were included in the study. The survey was administered cross-sectionally at various time points, with a minimum follow-up of at least one year required for inclusion (THA, 5.3 years; TKA, 4.8 years postoperation on average). Patients were divided into four cohorts based on participation and intensity of the sport: no sports, low-impact sports, intermediate-impact sports, and high-impact sports. Descriptive comparisons were made to evaluate revision rates and mean time to follow-up among these groups in THA and TKA patients. The Kaplan-Meier method was utilized to assess 10-year implant survivability. RESULTS:Healthier and younger patients who underwent THA or TKA were significantly more likely to participate in intermediate- to high-impact sports and were found to have noninferior revision rates than those who engaged in no sports or low-impact sports: THA (2.9 [no sports] versus 1.9 [low impact] versus 1.6% [intermediate/high impact]), TKA (3.0 versus 1.6 versus 0.0%). When analyzing aseptic versus septic revisions separately, no notable patterns or differences were observed. CONCLUSIONS:At a mean 5-year follow-up, healthier and younger patients who participated in intermediate- and high-impact physical activities had noninferior revision rates as than patients who were less active. These findings offer guidance for clinicians when advising patients on the safe resumption of sports activities following total joint arthroplasty.

BACKGROUND:This study examined whether the timing of total hip or knee arthroplasty (TJA) relative to elective hand surgery (HS) is associated with perioperative TJA outcomes, as both are among the most common orthopaedic procedures in the United States. METHODS:A retrospective cohort study was conducted of patients who underwent elective HS and TJA between 2011 and 2024. Patients were grouped by surgical order: HS first (HSF, n = 645) and TJA first (TJAF, n = 785). Differences between HSF and TJAF were assessed. Multivariable logistic regressions, Cox proportional hazards regressions, and linear regressions were used to adjust for patient demographics and comorbidities. The HSF patients were older (67.1 versus 64.3 years, P < 0.001), more prone to be discharged home (90.7 versus 83.8%, P < 0.001), and had a shorter length of stay (45.6 versus 60.4 hours, P < 0.001) compared to TJAF patients. RESULTS:Surgical order showed no association with 90-day emergency department visits and readmissions. Multivariable Cox regressions revealed that HSF was associated with a significantly higher hazard of aseptic revision (hazard risk (HR) = 2.65, P = 0.012). Functional TJA outcomes did not differ (P > 0.05) between groups. Although both groups improved in Patient-Reported Outcomes Measurements Information System (PROMIS) Pain Intensity and Pain Interference scores after TJA, HSF patients showed significantly less improvement in Pain Intensity at all timepoints (P < 0.05). Surgical order was not associated with improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, Hip Injury and Osteoarthritis Outcome Score for Joint Replacement, or PROMIS Pain Interference scores. CONCLUSIONS:The timing of these elective surgeries is associated with TJA outcomes. While HSF is linked to a higher adjusted risk of aseptic revision, it is also independently associated with less adjusted improvement in PROMIS Pain Intensity. These findings suggest that although surgical order impacts specific recovery metrics, a patient's comorbidities may be the primary driver of complications.

The rise in solid organ transplantations (SOTs) has led to increased long-term survival and also a higher incidence of joint degenerative diseases, necessitating more total joint arthroplasties (TJAs). SOT recipients face unique challenges, including immunosuppression, infection risks, and altered bone metabolism, requiring meticulous perioperative management. Despite higher complication rates, TJAs in SOT patients provide significant pain relief and functional improvement. Preoperative evaluation, tailored antibiotic prophylaxis, and careful implant selection are crucial. Multidisciplinary collaboration is essential to optimize outcomes, reduce complications, and improve quality of life for this high-risk population.

BACKGROUND:There is a growing number of patients who undergo multiple primary hip and knee joint arthroplasties during their lifetime. Whether patients who have multiple replaced joints are at an increased long-term risk of periprosthetic joint infection (PJI) is not known. The purpose of this study was to compare rates of PJI in patients who have more than one primary arthroplasty. METHODS:We reviewed 36,129 patients who underwent primary total joint arthroplasty at a single institution from 2011 to 2024. Patients were categorized as having one to four primary hip or knee arthroplasties. The PJI incidence was compared using Chi-square testing and binary logistic regressions, and multivariate models adjusted for sex, body mass index, diabetes, renal disease, smoking status, and Charlson Comorbidity Index (CCI). Sub-analyses compared patients who had one versus two, three, and four arthroplasties. RESULTS:When comparing patients who had one, two, three, or four primary joint arthroplasties, there was no significant difference in the rates of PJI between groups (P = 0.112). Multivariate analyses showed no statistically significant association between the number of arthroplasties and PJI (adjusted odds ratio (OR) for two, three, and four arthroplasties versus one: 1.34, 95% confidence interval (CI) 1.02 to 1.74, P = 0.083; 1.98, 95% CI 0.77 to 4.12, P = 0.105; 1.57, 95% CI 0.09 to 7.24, P = 0.657, respectively). Sub-analyses comparing one versus three and one versus four arthroplasties showed no significant differences. CONCLUSION/CONCLUSIONS:In this single-institution cohort, additional primary hip or knee arthroplasties did not appear to substantially increase PJI risk. These findings suggest a potential trend that requires confirmation with larger, prospective, multicenter, or registry-based studies. Nevertheless, these results provide preliminary evidence to inform patient counseling and guide future research on the risks of multiple arthroplasties.

PURPOSE/OBJECTIVE:To investigate the incidence and risk factors for dressing-induced allergic contact dermatitis (DIACD) following total hip and knee arthroplasty (THA and TKA, respectively) across different dressings and sealants. METHODS:A retrospective review was conducted of patients who underwent primary, elective THA or TKA between 2019 and 2024 with ≥ 90 days of follow-up. Incidences of DIACD were identified by reviewing medical records for "allergy" diagnoses and use of antihistamines or corticosteroids within 30 days postoperatively. Patient characteristics, prior exposure, treatment, dressing type, and allergy history were analyzed. RESULTS:A total of 61 (0.3%) of the 23,396 investigated patients developed a DIACD on average 12.2 ± 7.3 days postoperatively. Overall, 41% had a preoperative allergy (excluding seasonal), and 55.7% were treated with topical or low-dose oral antihistamines and corticosteroids. The majority (41%) of the DIACD involved mesh-adhesive dressings, and a liquid skin adhesive (2-octyl cyanoacrylate) was also used in 41% of cases, often in combination with the primary dressing. Of the 61 DIACD patients, 24 (39.3%) had previously undergone THA or TKA, and nearly half of these (n = 11, 45.8%) had been exposed to the same dressing without prior occurrence of DIACD. DIACD patients were significantly more likely to have undergone TKA (73.8 vs. 58.3%, p = 0.015) and to have never smoked (75.4 vs. 58.4%, p = 0.014). The effect sizes of these findings were negligible (Cramer's V = 0.016 and 0.019, respectively). CONCLUSIONS:The incidence of DIACD following joint arthroplasty is low (0.3%) but remains a frustrating complication, primarily occurring two weeks postoperatively, with mesh-adhesive dressings most frequently implicated. Patients with prior exposure to dressings, those undergoing TKA, and non-smokers are at higher risk. Identifying at-risk patients can guide dressing selection and application.

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.

INTRODUCTION/BACKGROUND:The integration of computer-assisted navigation systems (CASs) in total knee arthroplasty (TKA) procedures has gained popularity in recent years. However, additional validation of the accuracy of CAS feedback is necessary. We used short-length and full-length postoperative radiographs to quantify the differences between alignment parameters measured by a novel imageless CAS and alignment outcomes as evidenced on postoperative radiographs. MATERIALS AND METHODS/METHODS:A retrospective analysis was conducted on prospectively collected data from a cohort of patients undergoing navigated primary TKA. Fifty-eight patients had met inclusion criteria, and intraoperative CAS measurements were obtained from device recordings. Alignment parameters were measured digitally and included femorotibial angle on short-length films and hip-knee-ankle axis, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) on full-length films. These were compared between CAS and radiograph measurements using a 2-tailed t test. RESULTS:The mean mLDFA measured by the CAS was 0.7° ± 1.1°, compared with 1.3° ± 1.4° as measured on full-body radiographs (P = .1). The mean mMPTA measured by the CAS was 0.2° ± 1.0°, compared with 0.9° ± 1.4° as measured on full-body radiographs (P = .06). On average, radiograph and CAS measurements differed by 0.5° ± 1.5° for mLDFA and 0.7° ± 1.5° for mMPTA. The average postoperative hip-knee-ankle axis was 177.6° ± 2.1°, and the average femorotibial angle was 176.0° ± 9.6° as measured on radiographs. CONCLUSION/CONCLUSIONS:No significant differences in either average or individual measured values for mLDFA or mMPTA were observed between the intraoperative CAS measurements and alignment outcomes postoperatively. Our data highlight the clinical utility of CASs to accurately achieve intended TKA alignment objectives.

BACKGROUND/UNASSIGNED:Technological advancements in total hip arthroplasty (THA), including robotic-assisted (RA-THA) and navigation-assisted (NA-THA) techniques, aim to improve outcomes. However, impact on recovery timing remains unclear. This study examined whether these technologies reduce the time to reach the minimal clinically important difference (MCID) on the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement compared with conventional THA. METHODS/UNASSIGNED:This retrospective study analyzed osteoarthritic THA patients (01/2020-04/2023) who completed preoperative and postoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement questionnaires. The exclusion criteria included bilateral procedures or revision within 1 year. MCID was defined using anchor-based (23 points) and distribution-based thresholds (7.6 points). Multivariable interval-censored accelerated failure time models assessed time to MCID. RESULTS/UNASSIGNED:= .140). CONCLUSIONS/UNASSIGNED:Anchor-based MCID demonstrated comparable recovery times across RA, NA, and conventional THA, suggesting no patient-perceived advantage with technology. Distribution-based thresholds indicated RA-THA achieved faster statistically significant improvement, though the relevance remains uncertain.