Faculty Bibliography

BACKGROUND:Patients who undergo primary total knee arthroplasty (TKA) may return to work at variable times following surgery, the timeline for which is partly affected by the physical intensity of their occupation. The purpose of this study was to evaluate patient satisfaction and limitations when returning to work following TKA. METHODS:This retrospective review surveyed patients undergoing primary TKA between June 2011 and January 2022, with at least 1 year of follow up, regarding return to work. Of the 914 respondents, 507 (55.5 %) worked preoperatively and were stratified into high intensity (HI) (i.e., laborer, construction), standard intensity (SI) (i.e., walking, climbing stairs), or low intensity (LI) (i.e., sedentary desk jobs) groups. Baseline characteristics and survey responses were compared across groups. Among those who worked preoperatively, 35 (6.9 %), 213 (42 %), and 259 (51.1 %) were in the HI, SI, and LI groups, respectively. RESULTS:Of the 507 patients who worked prior to TKA, 447 (88.2 %) returned to work after surgery and 60 (11.8 %) did not. The HI group was comprised of more young males and more smokers than the SI and LI groups. In the LI group, 30 % returned within 1 month following surgery and an additional 44 % within 2 months. Similarly in the SI group, 11 % returned to work in less than 1 month with an additional 39 % returning within 2 months. In the HI group, 4 % returned within the first month and additional 42 % returned within 2 months. HI workers were more commonly hindered in their return (HI: 30.8 %, SI: 23.1 %, LI: 7.7 %), 'moderately declined' in their work ability (HI: 23.1 %, SI: 9.7 %, 3.0 %), and 'very unsatisfied' with their return (HI: 11.5 %, SI: 10.8 %, LI: 8.1 %). CONCLUSION/CONCLUSIONS:TKA leads to improvements in work function and satisfaction across all intensity levels, but HI work is associated with longer recovery times and comparatively lower return-to-work satisfaction compared to SI and LI groups.

INTRODUCTION/BACKGROUND:While the number of absolute and relative contraindications to total joint arthroplasty (TJA) has gradually decreased, active cancer patients have traditionally been challenging surgical candidates. We sought to compare perioperative and two-year postoperative clinical outcomes of patients with and without active cancer. METHODS:Patients over 18 years with active cancer undergoing primary, unilateral TJA from 2017 to 2023 at a single urban academic center were reviewed for a minimum two-year follow-up. Cancer status, type, and stage were confirmed manually. 68 cancer patients were propensity-matched 3:1 to 204 non-cancer patients from a pool of 9,382 based on age, sex, BMI, smoking status, race, and ASA class. Demographic, perioperative, and clinical data were analyzed using t-tests, Chi-square, and ANOVA. Subgroup analyses compared cancer patients receiving active therapy versus those not on treatment. RESULTS:There were no significant demographic differences between groups, except Charlson Comorbidity Index (P < 0.001). The most common cancers were breast (22%) and prostate (20%). There were no differences in discharge disposition (P = 0.20), operative time (P = 0.87), or length of stay (P = 0.29). The all-cause revision rate (including infection) was higher in patients with active cancer (7.4% vs. 2.5%), though not statistically significant (P = 0.15; Power = 46.5%). Of the various causes for revision, infection was significantly more likely in cancer patients than other causes compared (4.4% vs. 0%, P = 0.003). When analyzing only the active cancer group, those receiving cancer therapy had higher revision rates, though this was not statistically significant (11.1% vs. 6.0%, P = 0.487). DISCUSSION/CONCLUSION/CONCLUSIONS:Despite often being excluded from arthroplasty studies, active cancer patients demonstrated comparable overall outcomes after primary TJA. Although infection-related revisions were more common, they were effectively treated. With proper preoperative optimization and multidisciplinary care, TJA can be safely performed in selected active cancer patients.

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.

INTRODUCTION/BACKGROUND:The subset of patients admitted to the intensive care unit (ICU) following total joint arthroplasty (TJA) has yet to be studied in detail. Specifically, there is little data on the effects of vasopressor administration in patients who require critical care after TJA. We sought to characterize patient outcomes and mortality by vasopressor administration in the ICU following primary TJA. METHODS:We retrospectively reviewed 187 patients who required admission to the ICU within 14 days following primary, unilateral TJA from 2012 to 2024, out of 47,083 patients who underwent TJA during this time (0.40%). Exclusion criteria included TJA for trauma, acute fracture, and revision or conversion TJA. Patients were classified by whether they received any vasopressor (i.e., norepinephrine, phenylephrine, or vasopressin) medication at any point during their ICU stay. Limited intraoperative use of vasopressor did not qualify. Demographic and surgical data were collected and compared. Primary outcomes included complications, revisions/reoperations. RESULTS:Of the 187 patients requiring ICU admission following primary TJA, 20 received vasopressors during their stay. No significant demographic differences were found between cohorts. Hypotension (26%) was the most common indication for ICU admission. Vasopressor use was not associated with a significant increase in 30-day or one-year mortality (5.0 vs. 0.6%, P=0.07; 5.0 vs. 1.2%, P=0.20, respectively), but was associated with a significant increase in revisions/reoperations 25.0 vs 6.0%, P=0.005). No significant differences were observed for 90-day VTE events (P=0.62). Dislocations were significantly more common in patients who received vasopressors (14.3 vs. 1.0%, P=0.047). CONCLUSION/CONCLUSIONS:Patients who received vasopressors in the ICU following TJA had significantly higher rates of revisions, reoperations, and dislocation. There were no differences in mortality rates or VTE rates between groups. Further investigation is required to better characterize outcomes following vasopressor requirement in the total joint arthroplasty population.

BACKGROUND:10 years after changing our institution's total hip arthroplasty (THA) preoperative antibiotic prophylactic protocol by adding gram-negative (GN) coverage, this study aimed to assess the impact of adding GN specific coverage (GNSC) prior to THA on periprosthetic joint infection (PJI) rates. METHODS:This was a retrospective case-control study of 14,598 patients who underwent primary, elective THA between July 2012 and January 2022, with minimum 1-year follow-up. All patients were under perioperative antibiotic protocol that included GNSC with either weight-based gentamicin or aztreonam (+GNSC) and were compared to a historical control group of patients for which the antibiotic prophylactic protocol did not include GNSC (-GNSC). PJI and nephrotoxicity rates, as well as the severity of nephrotoxicity according to the RIFLE criteria, were compared between the study populations and 4122 controls. RESULTS: = 0.567), which are the two more severe forms of nephrotoxicity, were comparable between the groups. CONCLUSIONS:The addition of gentamicin or aztreonam prior to THA reduces the incidence of GN-related PJIs. Increased nephrotoxicity rates were limited to the mildest form, usually associated with reversibility and favourable outcomes.

BACKGROUND:The relationship between total hip arthroplasty (THA) surgeon volume and outcomes is informative in this era of health care value optimisation. The purpose of this study was to evaluate outcomes based on modern-day surgeon practice volumes. METHODS:The SPARCS database was queried for patients undergoing primary THA from 2010 to 2020. Annual case volume thresholds were 30 and 150, differentiating high-volume (HV), intermediate-volume (IV), and low-volume (LV) groups. Perioperative outcomes and all-cause cumulative revision rates were evaluated. RESULTS: 0.001). While controlling for confounders, multivariate regression revealed increased odds of PJI for IV (1.5) and LV (1.87) and increased all-cause revision hazard ratio for IV (1.1) and LV (1.3). Cumulative revision rates were lower for HV at 1 and 2 years, but rates converged with IV group at 9 years. CONCLUSIONS:HV surgeons have the most favourable short-term outcomes. However, in the long-term the difference in all-cause revision event rates becomes less apparent.