Arthroplasty Today最新文献

{"title":"Toward Opioid-Free Total Hip Arthroplasty: A Retrospective Study of a Targeted Opioid Reduction Program in 229 Patients","authors":"Mary L. Noyes BA ,&nbsp;Kamli N.W. Faour BA ,&nbsp;Zoë A. Walsh MPH ,&nbsp;Catherine M. Call BA ,&nbsp;Johanna A. Mackenzie MPH ,&nbsp;Adam J. Rana MD","doi":"10.1016/j.artd.2025.101726","DOIUrl":"10.1016/j.artd.2025.101726","url":null,"abstract":"<div><h3>Background</h3><div>Prescription opioids leftover following arthroplasty surgery pose risks to patients and communitys. The purpose of this study was to capture opioid utilization patterns following primary total hip arthroplasty before and after a targeted intervention to decrease postoperative opioid prescription quantity. We hypothesized that reducing discharge pill count would not impact pain or functional outcomes.</div></div><div><h3>Methods</h3><div>Primary total hip arthroplasties performed by a high-volume, fellowship-trained arthroplasty surgeon between October 2022 and January 2024 were retrospectively evaluated for study inclusion; 229 patients met inclusion criteria. Beginning in April 2023, the surgeon gradually implemented a 38% reduction in postoperative opioid prescribing from 40 to 24 pills. Opioid consumption was evaluated by patient-reported pill count at the first postoperative visit. Patients were sorted into 2 groups: “preintervention” (n = 157) and “postintervention” (poI) (n = 72). Preintervention patients received between 300 and 420 oral morphine equivalents and poI patients received between 240 and 299.99 oral morphine equivalents. Demographics, pill counts, refills, 30-day emergency department visits, function (Hip Disability and Osteoarthritis Outcome Score Joint Replacement), pain (visual analog scale), and satisfaction scores were analyzed.</div></div><div><h3>Results</h3><div>Proportion of discharge prescription remaining at 2-week postoperative visit did not differ significantly between intervention groups (<em>P</em> = .33). There were no differences in opioid refill requests (<em>P</em> = .82), function (<em>P</em> = .75), or satisfaction with functional improvement (<em>P</em> = .61). Patients in the poI group reported lower pain at 6 weeks postoperatively (<em>P</em> &lt; .05). There were no differences in 30-day emergency department visits between groups (<em>P</em> = .57).</div></div><div><h3>Conclusions</h3><div>Results support that arthroplasty surgeons can prescribe smaller quantities of opioids without compromising care. Such interventions can help reduce the number of prescription opioids available for misuse and diversion.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101726"},"PeriodicalIF":1.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-Assisted Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty: A Surgical Technique Review","authors":"Harold I. Salmons MD ,&nbsp;Andrew D. Pumford BA ,&nbsp;Nicholas A. Bedard MD ,&nbsp;Charles P. Hannon MD, MBA ,&nbsp;Cameron K. Ledford MD","doi":"10.1016/j.artd.2025.101748","DOIUrl":"10.1016/j.artd.2025.101748","url":null,"abstract":"<div><div>Conversion of a failed unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) is challenged by asymmetric bone loss necessitating advanced fixation strategies and alignment considerations. Robotic-assisted TKA is an increasingly utilized tool to augment preoperative surgical planning, improve intraoperative execution, and optimize patient outcomes. However, the use of robotic-assisted TKA in conversion UKA is not well described in the literature. We present the authors' preferred surgical technique of conversion UKA utilizing robotic assistance with a haptically guided robotic system and present a case example of a patient managed with this technique.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101748"},"PeriodicalIF":1.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Anticoagulation is Associated With Significantly Increased Rates of Medical Complications, Periprosthetic Joint Infection, and Revision After Primary Total Knee Arthroplasty","authors":"Rahul K. Goel MD ,&nbsp;Bailey J. Ross MD ,&nbsp;Kevin Y. Heo BS ,&nbsp;Jason A. Shah MD ,&nbsp;Andrew N. Schwartz MD ,&nbsp;Ajay Premkumar MD, MPH ,&nbsp;Jacob M. Wilson MD","doi":"10.1016/j.artd.2025.101749","DOIUrl":"10.1016/j.artd.2025.101749","url":null,"abstract":"<div><h3>Background</h3><div>The proportion of patients undergoing total knee arthroplasty (TKA) who are on chronic anticoagulation (CA) is increasing. As existing literature is limited, the purpose of this study was to compare complication rates after primary TKA among patients who were vs were not on CA.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study using the IBM MarketScan databases. Patients who underwent primary TKA were dichotomized into the CA or control cohort based upon the presence or absence, respectively, of claims for direct oral anticoagulants, warfarin, or low-molecular-weight heparin within 6 months both before and after TKA. Rates of readmissions, medical complications within 90 days, periprosthetic joint infection (PJI), and all-cause revision at 2 years were compared with multivariable logistic regression.</div></div><div><h3>Results</h3><div>A total of 181,760 patients met inclusion criteria, including 13,967 (7.7%) on CA. At 90 days, the CA cohort exhibited significantly higher rates of sepsis (0.9 vs 2.2%; odds ratio (OR) 1.7; <em>P</em> &lt; .001), hematoma (0.3 vs 0.7%; OR 1.7; <em>P</em> &lt; .001), wound dehiscence (1.2 vs 2.1%; OR 1.4; <em>P</em> &lt; .001), and readmission (6.1 vs 14.2%; OR 2.5; <em>P</em> &lt; .001). At 2 years, rates of PJI (0.4 vs 1.1%; OR 2.4; <em>P</em> &lt; .001) and all-cause revision (2.3 vs 3.4%; OR 1.5; <em>P</em> &lt; .001) were significantly higher in the CA cohort.</div></div><div><h3>Conclusions</h3><div>CA was associated with significantly higher rates of readmission, medical complications, PJI, and all-cause revision after primary TKA. This data highlights the importance of preoperative medical optimization and perioperative medical management in this population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101749"},"PeriodicalIF":1.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Frailty Index in Predicting Discharge Disposition and Prolonged Length of Stay Following Enhanced Recovery After Surgery Protocol Total Hip and Knee Arthroplasty","authors":"Tariq Z. Issa MD ,&nbsp;Christopher A. Reynolds MD ,&nbsp;Jennings H. Dooley MD ,&nbsp;W. Christian Thomas MD ,&nbsp;Isaac Sontag-Milobsky BS ,&nbsp;Kevin D. Hardt MD ,&nbsp;David W. Manning MD","doi":"10.1016/j.artd.2025.101729","DOIUrl":"10.1016/j.artd.2025.101729","url":null,"abstract":"<div><h3>Background</h3><div>Predictive tools such as the risk assessment and prediction tool (RAPT) and the 5-item modified Frailty Index (mFI-5) have been created to assist in discharge planning after total joint arthroplasty (TJA) including hip and knee arthroplasty, but there is no uniform determination of frailty risks. The primary objective was to compare the modified Frailty Index and RAPT in assessing outcomes following TJA, and we hypothesized similar performance between both measures.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients aged 50 years and more undergoing primary elective TJA at a single academic tertiary center through the same Enhanced Recovery After Surgery protocol. Patients were stratified using mFI-5 and RAPT scores tabulated during preoperative clinic visits. Multivariable analyses were conducted to assess independent associations of mFI-5 and RAPT with complications, prolonged length of stay, readmissions, and nonhome discharge. Youden’s index was used to construct receiver operating characteristic curves to assess the predictive ability of mFI-5, Charlson Comorbidity Index, and RAPT in classifying outcomes.</div></div><div><h3>Results</h3><div>A total 858 TJA patients were included. Overall, 547 (63.8%) were not frail, 273 (31.8%) were prefrail, and 38 (4.4%) were frail. When stratifying by RAPT, 369 (43.0%) had RAPT &gt; 9 (low-risk), 402 (46.9%) had RAPT 6-9 (moderate-risk), and 87 (10.1%) had RAPT &lt; 6 (high-risk). Prefrailty (odds ratio [OR]: 2.31, <em>P</em> = .006) and frailty (OR: 8.82, <em>P</em> &lt; .001) were associated with higher nonhome discharge. Both RAPT 6-9 (OR: 4.87, <em>P</em> = .001) and RAPT &lt; 6 (OR: 27.2, <em>P</em> &lt; .001) were associated with nonhome discharge. Neither was independently associated with complications or readmissions. These indices were poor independent predictors of complications, readmissions, and prolonged length of stay (all, area under the curve [AUC] &lt; 0.7). While RAPT demonstrated the greatest discriminative ability in identifying nonhome discharge (AUC: 0.772), mFI-5 (AUC: 0.720) was also an acceptable predictors of nonhome discharge.</div></div><div><h3>Conclusions</h3><div>The mFI-5 performs similarly to RAPT in predicting 30-day TJA outcomes. Using the mFI-5 may aid preoperative risk stratification to optimally identify candidates for home discharge.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101729"},"PeriodicalIF":1.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Analysis of the Rebar Technique for Tibial Defects in Total Knee Arthroplasty","authors":"Sean P. Moroze MD ,&nbsp;Miguel A. Diaz MS ,&nbsp;William Baione MD ,&nbsp;Paul Ulrich DO ,&nbsp;Peter Simon PhD ,&nbsp;Steven T. Lyons MD","doi":"10.1016/j.artd.2025.101741","DOIUrl":"10.1016/j.artd.2025.101741","url":null,"abstract":"<div><h3>Background</h3><div>Tibial defects in total knee arthroplasty require appropriate fixation for stability. Smaller defects are treated with cement or a screw and cement construct (rebar technique), while larger defects may require augments. Prior studies validate screws and cement for small defects but caution against use beyond 5 mm. This study compares the stiffness and subsidence of cement-only vs rebar techniques in larger contained and uncontained defects.</div></div><div><h3>Methods</h3><div>Thirty-two proximal tibial composite bone analogs were divided into 2 groups: (1) Cemented and (2) Rebar, with subgroups for contained and uncontained defects (8 each). Tibial defects mimicked Anderson Orthopaedic Research Institute Bone Defect Classification T1 and T2A classifications. Tibial baseplates were implanted using either cement alone or with a rebar technique (2 6.5 mm cancellous screws). Samples were mounted to a testing fixture simulating heel strike and underwent 10,000 cycles at 1 Hz. Tracking points were placed on each sample to measure displacement. Load and displacement data from the test frame were also collected.</div></div><div><h3>Results</h3><div>In the contained defect subgroup, rebar showed higher stiffness than cement alone, but the difference was not statistically significant (<em>P</em> = .349) and both groups had similar micromotion (<em>P</em> = .989). In uncontained defects, cement-only showed slightly higher stiffness than rebar (<em>P</em> = .655), with no statistical difference in micromotion (<em>P</em> = .893). Uncontained defects exhibited significantly more micromotion than contained defects (<em>P</em> = .0018, <em>P</em> = .0055).</div></div><div><h3>Conclusions</h3><div>Rebar and cement-only techniques demonstrated similar biomechanical performance in tibial defects up to 1 cm. The cement and screw technique remains a viable option but may not be necessary in primary and revision total knee arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"34 ","pages":"Article 101741"},"PeriodicalIF":1.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144262399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence Approach in Hip Prosthesis Identification and Addressing Radiographic Outcome Measures","authors":"Omar Musbahi MSc, ChM ,&nbsp;Savvas Hadjixenophontos MEng ,&nbsp;Saran S. Gill ,&nbsp;Iris Soteriou Bsc ,&nbsp;Kyriacos Pouris Bsc ,&nbsp;Takuro Ueno PhD ,&nbsp;Justin P. Cobb MCh","doi":"10.1016/j.artd.2025.101717","DOIUrl":"10.1016/j.artd.2025.101717","url":null,"abstract":"<div><h3>Background</h3><div>Radiographic assessment is crucial for the success of a hip arthroplasty procedure as a correctly positioned prosthesis indicates favorable long-term outcomes. This project aims to develop a novel artificial intelligence (AI)–based method that can (1) automatically identify the presence of a hip resurfacing prosthesis in radiographs and (2) calculate the radiographic neck-shaft angle (NSA) of the prosthesis from 2-dimensional plane images using both anterior-posterior (AP) and lateral radiographs with high accuracy.</div></div><div><h3>Methods</h3><div>Using a computer vision and pattern recognition algorithm, the femur shaft and prosthesis regions were identified, and their respective angles were extracted for NSA calculation. A neural network (NN) was then trained using clinician-generated AP radiograph NSAs as ground truths and AI-generated AP and lateral NSAs as features. Spearman's correlation and Kruskal-Wallis tests were calculated to explore any significant association between the final AI-generated and clinician-generated AP radiographic NSAs. Mean absolute error (MAE) and R-squared values were calculated with and without the NN model to identify the model's accuracy and variability.</div></div><div><h3>Results</h3><div>There was a statistically significant correlation between the final AI-generated AP radiographic NSAs and the clinician-generated AP radiographic NSAs (r_s = 0.93, <em>P</em> &lt; .01). MAE, R², and r_s without the NN were 3.09, 0.37, and 0.83 (<em>P</em> &lt; .01), respectively. MAE and R² with the NN were 1.94 and 0.53, respectively.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that the identification of hip resurfacing prostheses using AI is feasible. By incorporating additional features such as the lateral NSA, the model can provide an accurate prediction of the AP radiographic NSA, closely approximating the ground truth.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101717"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144195092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy of ChatGPT and DeepSeek in Addressing Patient Queries on Gonarthrosis and Total Knee Arthroplasty","authors":"Serhat Gurbuz MD,&nbsp;Hakan Bahar MD,&nbsp;Ulas Yavuz MD,&nbsp;Ahmet Keskin MD, PhD,&nbsp;Bulent Karslioglu MD,&nbsp;Yener Solak MD","doi":"10.1016/j.artd.2025.101730","DOIUrl":"10.1016/j.artd.2025.101730","url":null,"abstract":"<div><h3>Background</h3><div>The advent of artificial intelligence (AI) in healthcare has opened new avenues for patient education and anxiety reduction. This study aims to compare the efficacy of 2 prominent AI platforms, ChatGPT and DeepSeek, in providing accurate and satisfactory responses to patients with gonarthrosis contemplating total knee arthroplasty (TKA).</div></div><div><h3>Methods</h3><div>A prospective, comparative trial was conducted involving 100 patients diagnosed with gonarthrosis and indicated for TKA. Each patient posed 5 questions regarding the surgery and postoperative rehabilitation to both ChatGPT and DeepSeek. Responses were evaluated by 2 blinded orthopaedic specialists on a 10-point scale for accuracy and patient satisfaction. Patients also rated their satisfaction with each response on a 10-point scale. The primary outcome measures were the mean accuracy scores from specialists and mean satisfaction scores from patients.</div></div><div><h3>Results</h3><div>Statistical analysis revealed significant differences between ChatGPT and DeepSeek in both accuracy and patient satisfaction (<em>P</em> &lt; .001). ChatGPT demonstrated superior performance with a mean accuracy score of 8.7 ± 0.9 compared to DeepSeek’s 7.4 ± 1.2. Patient satisfaction scores aligned with expert evaluations, with ChatGPT achieving a mean satisfaction score of 8.9 ± 0.8 vs DeepSeek’s 7.6 ± 1.1. Notably, ChatGPT excelled in providing comprehensive explanations of surgical procedures (mean score 9.2 ± 0.7) and postoperative care (9.1 ± 0.8), while DeepSeek performed better in offering concise summaries of recovery timelines (8.3 ± 0.9).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that ChatGPT offers more accurate and satisfactory responses to patient queries regarding gonarthrosis and TKA compared to DeepSeek. The findings suggest that AI platforms, particularly ChatGPT, can serve as valuable tools in augmenting patient education and potentially reducing preoperative anxiety. Future research should explore the integration of AI-assisted information delivery in clinical practice and its long-term impact on patient outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101730"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mixed Manufacturer Combination With a Cementless Hemispherical Dual Mobility Cup and Polished Taper-Slip Cemented Femoral Stem: Short- to Medium-Term Results in Primary Total Hip Arthroplasty in Elderly Patients","authors":"Blaise Pellegrini MD,&nbsp;Alexander Antoniadis MD,&nbsp;Diane Wernly MD,&nbsp;Maya Kaegi MD,&nbsp;Julien Wegrzyn PhD","doi":"10.1016/j.artd.2025.101710","DOIUrl":"10.1016/j.artd.2025.101710","url":null,"abstract":"<div><h3>Background</h3><div>There is a lack of conclusive literature regarding the mixed-manufacturer combination of the Symbol cementless hemispherical dual mobility cup (Dedienne Santé) and the Exeter V40 cemented femoral stems (Stryker) in patients who underwent primary total hip arthroplasty (THA). This study aimed to evaluate the clinical and radiographic outcomes of this combination, with a particular attention to the occurrence of dislocation and periprosthetic femoral fractures (PFFs).</div></div><div><h3>Methods</h3><div>Between 2021 and 2023, a consecutive series of 123 primary THAs were reviewed at the latest follow-up. The mean age at surgery was 75 ± 9 ys. Postoperative complications were recorded. The clinical outcome was assessed with the Harris Hip Score. Acetabular, femoral, and global hip offset were evaluated on standard radiographs.</div></div><div><h3>Results</h3><div>At a mean follow-up of 23 ± 7 months, the mean preoperative to postoperative Harris Hip Score improved significantly from 46 to 93 (<em>P</em> &lt; .0001.) No dislocation was reported. No Vancouver A or B PFF was observed. One Vancouver C PFF was observed. The revision-free survival rate at 24-month follow-up was 98.6%. The global offset of the hip was restored in all the patients with a mean average increase of 3 ± 5.8 mm.</div></div><div><h3>Conclusions</h3><div>The mixed-manufacturer combination of the Symbol cementless hemispherical dual mobility cup and the Exeter cemented femoral stem resulted in excellent short- to medium-term outcomes in patients who underwent primary THA. This combination was effective in preventing both instability and femoral Vancouver B PFF in these patients at risk, while allowing global hip offset restoration.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101710"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Orthopaedic and Infectious Disease Periprosthetic Joint Infection Clinic Enhances Arthroplasty Fellowship Training: A Survey From a Tertiary Center","authors":"Eric S. Dilbone MD ,&nbsp;Justin Leal MD ,&nbsp;Sean P. Ryan MD ,&nbsp;Thorsten M. Seyler MD, PhD ,&nbsp;Jessica L. Seidelman MD, MPH ,&nbsp;William A. Jiranek MD","doi":"10.1016/j.artd.2025.101736","DOIUrl":"10.1016/j.artd.2025.101736","url":null,"abstract":"<div><h3>Background</h3><div>The rising incidence of periprosthetic joint infections (PJIs) is linked to increasing utilization of total joint arthroplasty and higher rates of obesity, diabetes, and immunosuppression. Despite preoperative risk factor modification and perioperative antibiotic interventions, PJIs remain difficult to prevent and diagnose. Treatment typically requires surgery and prolonged antibiotics. A combined orthopaedics and infectious disease (OID) clinic has emerged as an effective model for managing PJIs, but its utility for trainee education remains underexplored.</div></div><div><h3>Methods</h3><div>In 2020, a combined OID clinic was established at the reporting institution, staffed by arthroplasty fellows and musculoskeletal infectious disease physicians. Fourteen past arthroplasty fellows who participated in the clinic from 2020 to 2024 were sent an anonymous survey consisting of 10 questions to evaluate how their experience influenced their development as clinicians and its relevance to their current practice.</div></div><div><h3>Results</h3><div>All 14 eligible past arthroplasty fellows responded to the anonymous survey. Most respondents (71%) were in academic practice, with others in hospital employment (21%) or private practice (7%). PJI cases comprised 0%-40% of their clinical load. A total of 85% of fellows reported that the multidisciplinary clinic approach prepared them for managing PJIs, and 93% felt this experience would be beneficial for future fellows. Respondents agreed that a half day clinic once per month was sufficient.</div></div><div><h3>Conclusions</h3><div>Arthroplasty fellows found the combined OID clinic valuable for managing PJI patients in their practice. Fellowship programs should consider incorporating such clinics to enhance training in PJI management.</div></div><div><h3>Level of evidence</h3><div>Level IV, Therapeutic Study.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101736"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Declining Service Labor Rates for Total Hip and Total Knee Arthroplasty in Medicare Patients","authors":"John M. Dundon MD, FAAOS ,&nbsp;Nicholas Brown BS ,&nbsp;Jennifer Escobar BS, RN ,&nbsp;Paul M. Lombardi MD, FAAOS","doi":"10.1016/j.artd.2025.101742","DOIUrl":"10.1016/j.artd.2025.101742","url":null,"abstract":"<div><h3>Background</h3><div>Total hip (THA) and knee arthroplasty (TKA) are highly successful surgeries, but reimbursement for these procedures has decreased due to relative value unit scale devaluation and Medicare cuts. The shift to outpatient joint replacements has increased workload for orthopaedic surgeons and office staff while saving Medicare costs. This study evaluates 3 groups of orthopaedic surgeons to determine their hourly rate for Medicare total joints.</div></div><div><h3>Methods</h3><div>We categorized 3 groups of orthopaedic surgeons by operative time and efficiency to assess hourly rates. Group 1 performs 2-3 cases daily, group 2 performs 4-5 cases, and group 3 performs 10+ cases. We evaluated total operative time based on historical data and Centers for Medicare &amp; Medicaid Services guidelines for preoperative and postoperative time.</div></div><div><h3>Results</h3><div>For group 1, average times for THA and TKA were 400 minutes ($188.89/hour) and 408.5 minutes ($184.92/hour). Group 2's times and hourly rates for THA and TKA were 401.5 minutes ($188.18/hour) and 404 minutes ($190.68/hour). Group 3 had total times of 300.5 minutes ($251.50/hour) for THA and 300.25 minutes ($256.57/hour) for TKA.</div></div><div><h3>Conclusions</h3><div>With decreasing actual rates and even further decline in inflation adjusted reimbursement and increasing practice costs, some surgeons may have to consider discontinuation of or minimizing TKA and THA in Medicare patients to maintain financial viability.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101742"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}