Journal of Arthroplasty最新文献

{"title":"Cost-Volume Analysis of Primary Total Knee and Hip Arthroplasty in the United States.","authors":"Giselle Porter, Jeffrey Balian, Ayesha P Ng, Hugo Mannings, Devon Jeffcoat, Peyman Benharash","doi":"10.1016/j.arth.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.041","url":null,"abstract":"<p><strong>Background: </strong>Utilization of total knee (TKA) and total hip (THA) arthroplasty is increasing along with associated hospitalization costs. A contemporary analysis of the impact of hospital case volume on the costs of TKA and THA is lacking.</p><p><strong>Methods: </strong>Adults undergoing primary elective TKA or THA who had a diagnosis of osteoarthritis were identified from an inpatient all-payer database from 2012 to 2019. Operative volume was ascertained with restrictive cubic spline analysis. The volume corresponding to the inflection point of the spline was used to stratify hospitals as high volume (HVH) or low volume (LVH). Multivariable regression models were developed to examine the association of volume with hospitalization costs, adverse events, lengths of stay, and non-home discharges.</p><p><strong>Results: </strong>Of the 7,781,233 patients undergoing TKA or THA over the study period, 73.1% of primary TKA and 77.1% of primary THA were managed at HVH. Upon adjustment for patient and hospital covariates, treatment at high-volume TKA or THA hospitals was associated with a cost decrement of $2,200 (95% CI [confidence interval], 2,900 to 2,400, P < 0.001, Ref: LVH) and $1,900 (95% CI, 2,100 to 1,600), respectively. Notably, the disparity in hospitalization costs between HVH and LVH significantly increased during the study period (P < 0.001).</p><p><strong>Conclusions: </strong>Greater TKA and THA volume was associated with reduced hospitalization costs. These findings suggest that regionalization of care to experienced hospitals may improve the value of orthopaedic surgical care.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can a Large Language Model Interpret Data in the Electronic Health Record to Infer Minimum Clinically Important Difference Achievement of Knee Osteoarthritis Outcome Score-Joint Replacement Score Following Total Knee Arthroplasty?","authors":"Abdul Zalikha, Thomas S Hong, Easton Small, Michael Constant, Alex H S Harris, Nicholas J Giori","doi":"10.1016/j.arth.2025.03.049","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.049","url":null,"abstract":"<p><strong>Background: </strong>Obtaining total knee arthroplasty (TKA) patient-reported outcomes for quality assessment is costly and difficult. We asked whether a large language model (LLM) could interpret electronic health record (EHR) notes to differentiate patients attaining a one-year minimum clinically important difference (MCID) for the Knee Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) from those who did not. We also investigated whether sufficient information to infer MCID achievement exists in the chart by having a blinded orthopaedic surgeon make the same determination.</p><p><strong>Methods: </strong>In this retrospective case-control study, we selected 40 TKA patients who achieved 1-year KOOS-JR MCID and 40 who did not. Orthopaedic, emergency medicine, and primary care notes from zero to six months preoperatively and nine to 15 months postoperatively were deidentified. ChatGPT 3.5 interpreted these notes to determine whether the patient improved after surgery. A blinded orthopaedic surgeon classified these patients using all chart information. The sensitivity, specificity, and accuracy of ChatGPT 3.5 and the surgeon's responses were calculated.</p><p><strong>Results: </strong>ChatGPT 3.5 classified 78 of 80 cases with 97% sensitivity, but only 33% specificity. The surgeon's assessment had 90% sensitivity and 63% specificity. Given the equal distribution of patients meeting or not meeting MCID, Chat GPT's accuracy was 65%. The surgeon's was 76%.</p><p><strong>Discussion: </strong>ChatGPT's assessment of KOOS-JR MCID attainment had 97% sensitivity, but only 33% specificity. False positives were commonly due to the LLM not having access to, or not properly interpreting, signs of problems in the chart. This was an initial evaluation of the current ability of a general-purpose LLM to evaluate patient outcomes based on information in chart notes. An orthopaedic surgeon's assessment of the full chart suggests an opportunity to improve on this baseline performance, possibly enabling quality monitoring and identification of best practices across a large health care system. Additional work is needed to optimize model performance and confirm the utility of this approach.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Travel Staff in Total Hip Arthroplasty is Associated with Increased Operating Room Costs and Decreased Efficiency.","authors":"Ilya Bendich, Caleb Ford, Michele Christy, Ryan Nunley","doi":"10.1016/j.arth.2025.03.053","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.053","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) is a cost-effective procedure that benefits from operating room (OR) efficiencies supported by consistent staff. Travel staff (TS), including travel nurses, surgical scrub technologists (ST), and registered nurse first-assists (RNFA) have been increasingly utilized, potentially introducing surgical team inconsistencies. The purpose of this study was to report on the economic impact of travel staff in THA.</p><p><strong>Methods: </strong>A retrospective review of 947 primary THAs at a high-volume tertiary center (from April 1, 2023, to March 31, 2024) categorized procedures as manual posterior approach (PA), robotic arm-assisted (RA) PA, or direct anterior approach (DAA). Staff roles included ST, circulator (C), or RNFA, classified as TS or full-time (FT) staff. There were 13 TS-ST, 27 FT-ST, 15 TS-C, 25 FT-C, four TS-RNFA, and 20 FT-RNFA. The OR times and wasted supply costs (unused opened supplies) were tracked. The THAs with TS and FT staff were compared, adjusting for surgeon. The OR cost per minute was $46. The OR efficiency was also analyzed for cases utilizing orientee and relief staff.</p><p><strong>Results: </strong>Travel ST impacted OR times more than travel C or RNFA (P < 0.05). The TS-ST increased OR times across all THA subgroups: RA-THA (+25 minutes, P = 0.006), PA-THA (+12 minutes, P = 0.004), and DAA-THA (+eight minutes, P = 0.009). This equates to an increased cost of $1,150, $552, and $368 for each RA-THA, PA-THA, and DAA-THA, respectively, with TS-ST. Wasted supply costs increased by an average of $58 per case (P = 0.05) with TS-ST. Orientee and relief staffing in the OR was also found to increase OR times and supply costs.</p><p><strong>Conclusion: </strong>Travel staff in THA is associated with inefficiency and increased cost, with TS-ST having the greatest impact. This study highlights the potential economic benefit of retaining consistent, permanent surgical teams.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implant Selection and Radiographic and Clinical Outcomes in Patients Receiving Staged Bilateral Total Hip Arthroplasty with Discordant Surgical Approaches.","authors":"Nathan A Huebschmann, Joseph X Robin, David A Bloom, Matthew S Hepinstall, Joshua C Rozell, Ran Schwarzkopf","doi":"10.1016/j.arth.2025.03.050","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.050","url":null,"abstract":"<p><strong>Introduction: </strong>To our knowledge, outcomes of patients undergoing staged, bilateral total hip arthroplasty (THA) via dissimilar surgical approaches have not yet been investigated. This study examined demographics, implant selection, technology utilization, and component positioning between hips in patients who underwent one THA via posterior and one via direct anterior approach and secondarily evaluated patient-reported outcomes.</p><p><strong>Methods: </strong>There were 36 patients (72 hips) who underwent staged, bilateral, primary, elective THAs via different approaches from January 2012 to December 2023. Patient demographics, intraoperative technology utilization, implants used, and pre- and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement (HOOS-JR) scores were recorded. The hip center of rotation, acetabular height and anteversion, and metaphyseal canal fill were measured on postoperative radiographs. Femoral stem coronal and sagittal plane angulation following both approaches were also compared on postoperative radiographs.</p><p><strong>Results: </strong>There were 15 (41.7%) patients who underwent posterior THA first. The mean time between operations was five years (range, 0.93 to 10.2). Intraoperative technology utilization was more common for the anterior THA (P = 0.002). There were no significant differences in hip center of rotation (P = 0.292), acetabular anteversion (P = 0.428), or acetabular height (P = 0.935) between patients' anterior and posterior approach THAs. The proportion of patients who had posterior stem angulation was significantly greater following anterior THA; neutral stem angulation was seen more frequently following posterior THA (P = 0.005). Lipped liners (P < 0.001), high offset femoral stems (P = 0.007), and dual or triple-taper stems (P < 0.001) were more commonly utilized in posterior THAs. For patients who had pre- and postoperative HOOS-JR for each hip, there was no significant difference in postoperative score improvement between anterior and posterior THAs (P = 0.697), with a mean follow-up time of 2.4 years (range, 0.3 to 9.28) for posterior and 6.1 years (range, 2.8 to 10.3) for anterior THAs (P = 0.249).</p><p><strong>Conclusions: </strong>Patients undergoing staged, bilateral THAs via different surgical approaches exhibit radiographic characteristics likely attributable to technical challenges for each approach. However, these differences related to approach do not seem to impact short-term clinical and patient-reported outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constrained Liners During Acetabular Revision: Clinical Results of an Impingement Avoidance Strategy.","authors":"Kevin R Steelman, Thomas Cheslik, Cody Green, George Haidukewych","doi":"10.1016/j.arth.2025.03.054","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.054","url":null,"abstract":"<p><strong>Background: </strong>Instability after total hip arthroplasty (THA) remains a challenging problem. Component revision or bearing exchange can be successful; however, constraints may be necessary. This study evaluated the results of revision THA for instability that required constrained liners (CL) to determine whether revising or retaining the acetabular component is preferred.</p><p><strong>Methods: </strong>This single-surgeon, retrospective study included 50 consecutive patients who required CL during acetabular revision for instability. Indications for constraint included the absence of functioning abductors and failed previous CL or dual mobility. A CL was used in existing cups if the cup position was deemed acceptable with a reasonable impingement-free arc of motion. If unacceptable, it was revised, or, if the internal diameter allowed, a CL was cemented into the existing cup in a \"face changing\" (FC) position to minimize impingement. All patients had a minimum 2-year follow-up. Recurrent instability occurred in 15 of 50 patients overall (30%). Results were analyzed based on if the cup/liner position was changed: Group 1 - Cup revision, or cemented CL with \"face change\" (n=28); Group 2 - CL implanted into existing cup without FC (n=22).</p><p><strong>Results: </strong>Group 1 had recurrent instability in four of 28 (14%), while Group 2 had instability in 11 of 22 (50%) (P=0.012). Cemented liners with FC failed in four of 16 cases. Cup revision had the lowest rate of recurrent instability (0 of 12) versus 15 of 38 (39%) when the cup was retained (P= 0.01).</p><p><strong>Conclusion: </strong>This study demonstrated significantly lower rates of recurrent instability when CLs can be positioned to minimize impingement, either by revising the cup or cementing the liner independent of the existing cup: a so-called \"face-change.\" Cup revision demonstrated the lowest rate of recurrent instability with predictable osteointegration at the mean 4-year follow-up.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigated and Robotic Total Knee Arthroplasty Do Not Confer Improved 5-Year Survivorship Compared to Conventional TKA: An Analysis from the American Joint Replacement Registry.","authors":"Alexa K Pius, Scott M Sporer, Oliva Sterling, Mita De, Mahveen Jahan, James A Browne, Bryan D Springer, James I Huddleston","doi":"10.1016/j.arth.2025.03.047","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.047","url":null,"abstract":"<p><strong>Introduction: </strong>Computer-assisted navigation (nTKA) and/or the use of robotics (rTKA) at the time of the primary total knee arthroplasty have been shown to improve implant position, minimize alignment outliers, and possibly improve patient outcomes compared to conventional instrumentation (cTKA). The purpose of this study was to use the linked Medicare dataset from the American Joint Replacement Registry (AJRR) to compare the mid-term (five-year) outcomes of nTKA and rTKA to those of cTKA.</p><p><strong>Methods: </strong>All primary TKA procedures submitted to AJRR between January 2017 and December 2022 among patients aged 65 years and older were included in the analysis. The data were stratified into patients who underwent nTKA, rTKA, or cTKA at the time of their index procedure. The all-cause revision rate, mechanical loosening rate, and the other mechanical complication rate were determined at five years postoperatively. The survival model was adjusted for age, sex, fixation type, and year.</p><p><strong>Results: </strong>At five years postoperatively, the survival model found computer navigation use to not be significant in TKA all-cause revision (P = 0.32) or mechanical loosening (P = 0.91) but was significant for other mechanical complications (P = 0.004). Robotic use was not found to be significant in TKA all-cause revision (P = 0.75), mechanical loosening (P = 0.42), or other mechanical complications (P = 0.46).</p><p><strong>Conclusions: </strong>Navigation and/or the use of robotics at the time of primary total knee arthroplasty did not demonstrate a decrease in the need for revision at mid-term (5-year) follow-up among Medicare beneficiaries. While this study was unable to assess other important clinical outcomes following total knee arthroplasty with advanced technology, the purported benefits of utilizing this technology to improve component survival are not supported.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Surgical Approach in Total Hip Arthroplasty Affect Postoperative Corticosteroid Injection Requirements?","authors":"Braden V Saba, Casey Cardillo, Muhammad A Haider, Ran Schwarzkopf, Roy I Davidovitch","doi":"10.1016/j.arth.2025.03.045","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.045","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroid injections following total hip arthroplasty (THA) are commonly utilized to address soft-tissue pathology such as bursitis and tendinitis. The THA surgical approaches differ in the extent of muscle and soft-tissue dissection. The aim of this study was to compare the impact of surgical approach on postoperative corticosteroid injection requirements when controlling for multiple covariates. A secondary aim was to identify risk factors associated with the various injection types.</p><p><strong>Methods: </strong>This was a propensity-matched retrospective study of 10,907 THA patients from June 2016 to December 2022 at a single, urban, academic health center. Patients were stratified into cohorts based on surgical approach: anterior (n = 4,287) and posterior (n = 6,620), then propensity-matched 1:1 with nearest-neighbor matching to form two cohorts of 4,287 patients. Baseline characteristics and corticosteroid injection data for soft-tissue pathology were obtained and analyzed. Chi-square and multivariate logistic regression analyses were used to assess the impact of patient and surgical factors on receiving postoperative steroid injections.</p><p><strong>Results: </strong>A posterior approach conferred increased risk of postoperative injections (aOR [adjusted odds ratio] 1.242, P = 0.001) after controlling for multiple covariates. The posterior approach also had higher total rates of greater trochanter (GT) bursitis injections postoperatively compared to the anterior group (11.5 versus 7.3%, P < 0.001). Both surgical approaches demonstrated comparable rates of iliopsoas bursitis injections (P = 0.39), gluteus medius tendinosis injections (P = 0.09), and lateral femoral cutaneous nerve injections (P = 0.27). The strongest predictor of postoperative injections was a history of preoperative injection (aOR 3.772, P < 0.001).</p><p><strong>Conclusion: </strong>Posterior approach, women, and history of preoperative corticosteroid injection were identified as the strongest risk factors for postoperative GT bursitis injection or postoperative soft-tissue injection. These factors should be considered when counseling patients on expected postoperative outcomes and the likelihood of corticosteroid injections following THA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Analysis of Direct Anterior versus Direct Lateral Approach for Outpatient Total Hip Arthroplasty: Does Surgical Approach Impact Cost?","authors":"Jacquelyn D Marsh, Bryn Zomar, Anthony Tannous, James Howard, Steven MacDonald, Brent Lanting","doi":"10.1016/j.arth.2025.03.052","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.052","url":null,"abstract":"<p><strong>Background: </strong>Total hip arthroplasty (THA) is an effective surgery for advanced osteoarthritis. The rising demand for THA and increasing wait times are having a substantial impact on healthcare resources, resulting in increased pressure to move to outpatient care. This has most commonly been enabled through a minimally invasive, direct anterior (DA) surgical approach; however, recently, the direct lateral (DL) approach has also been used in outpatient THA. The purpose of this study was to compare costs between outpatient THA using a DA compared to a DL approach.</p><p><strong>Methods: </strong>The present study is a secondary analysis of a randomized controlled trial and a prospective cohort study. Participants undergoing primary THA using the DA approach were randomly assigned to be discharged on the same day as surgery (outpatient) or on day one post-surgery (inpatient). The cohort study included patients undergoing outpatient THA using the DL approach. We compared patients in the outpatient arm of the randomized trial to the prospective cohort of outpatient DL THAs. We recorded all costs associated with each surgical approach. Following discharge, participants also completed a self-reported cost diary regarding any resource utilization such as emergency department visits or subsequent hospitalizations, tests and procedures, consultations or follow-up, healthcare professional services, rehabilitation, medications, informal care, productivity losses, and out-of-pocket expenditures up to three months postoperative. There were 127 patients in the DA group and 51 patients in the DL group. The mean age of patients in the DA group was 66 years compared to 59 years in the DL group (P < 0.01).</p><p><strong>Results: </strong>There were no statistically significant differences in costs between groups from either the healthcare payer (DA = 7,910.19, DL = 7,847.17, P = 0.80) or societal perspectives (DA = 14,657.21, DL = 14,581.21, P = 0.96).</p><p><strong>Conclusion: </strong>Our results suggest similar overall mean costs over 90 days postoperative between outpatient THA using a DL or DA surgical approach.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Pulmonary Embolism Risk in Morbidly Obese Patients on Aspirin Monotherapy After Total Knee Arthroplasty: A Claims Database Analysis.","authors":"Aymen Alqazzaz, Thompson Zhuang, Weston E Smith, Emannuel Gibon, Charles L Nelson","doi":"10.1016/j.arth.2025.03.046","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.046","url":null,"abstract":"<p><strong>Background: </strong>Aspirin is the most common drug used for venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA). Morbid obesity is a potential risk factor for VTE, prompting some to use stronger anticoagulants. However, there are no established guidelines for VTE prevention in obese or morbidly obese patients undergoing primary TKA.</p><p><strong>Methods: </strong>Using a national administrative claims database, patients who underwent primary TKA were divided into three cohorts based on body mass index (BMI): < 30, 30 to 39.9, or ≥ 40. Each patient had a prescription claim for aspirin, but no other prophylaxis agents within three days after the index procedure. We assessed deep vein thrombosis (DVT) and pulmonary embolism (PE) incidence at 90 and 180 days postoperatively. Secondary outcomes included wound dehiscence, hematoma, periprosthetic joint infection (PJI), and debridement, antibiotics, and implant retention (DAIR) or explantation procedures. We included 20,097 patients, of whom 4,277 (21%), 10,663 (53%), and 5,157 (26%) had a BMI < 30, 30 to 39.9, and ≥ 40, respectively.</p><p><strong>Results: </strong>In the multivariable analysis, there was no difference in the incidence of DVT or PE within 90 or 180 days after surgery for the BMI 30 to 39.9 compared to the BMI < 30 cohort. However, the incidence of PE within 90 days after surgery was higher in the BMI ≥ 40 cohort (OR [odds ratio]: 2.74), an effect that disappeared by 180 days. There was a higher adjusted odds of DAIR procedures in the BMI ≥ 40 compared to the BMI < 30 cohort; otherwise, the incidence of secondary outcomes did not differ by BMI.</p><p><strong>Conclusion: </strong>When aspirin was utilized as a standardized monotherapy for VTE prophylaxis following primary TKA, there was an increased 90-day incidence of PE in morbidly obese patients but no difference in DVT or PE incidence in obese patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Debridement, Antibiotics, and Implant Retention for Acute Periprosthetic Joint Infection: Results of 126 Primary Hip Arthroplasties at Extended Follow-Up of Seven Years.","authors":"E Bailey Terhune, Khaled A Elmenawi, Jessica A Grimm, Charles P Hannon, Nicholas A Bedard, Elie F Berbari, Daniel J Berry, Matthew P Abdel","doi":"10.1016/j.arth.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.arth.2025.02.009","url":null,"abstract":"<p><strong>Background: </strong>There is renewed interest in debridement, antibiotics, and implant retention (DAIR) for acute periprosthetic joint infections (PJIs). The purpose of this study was to assess the results of single DAIRs for acute PJI after primary hip arthroplasty in a large series with extended follow-up.</p><p><strong>Methods: </strong>We identified 126 hips (108 total hip arthroplasties, 18 hemiarthroplasties) with acute PJIs treated with DAIR followed by chronic antibiotic suppression between 2000 and 2021 at a single institution. Acute postoperative PJI was defined as infection within four weeks of primary hip arthroplasty, and acute hematogenous PJI was defined as infection occurring more than four weeks after primary hip arthroplasty with symptoms for less than 21 days. The mean age was 67 years, 44% were women, and the mean body mass index was 34. Kaplan-Meier survivorship analyses were performed. The mean follow-up was seven years.</p><p><strong>Results: </strong>Survivorship free of reinfection was 80% at one year, 79% at two years, and 77% at five years. There was no difference in survivorship free of reinfection between early postoperative and acute hematogenous PJIs (P = 0.1). McPherson Host Grade C was predictive of reinfection (hazard ratio 5, P = 0.03). Reinfection was caused by the original organism in 33% of hips. The median time to reinfection was 13 days. Survivorship free of any revision was 82% at five years. Indications for revision included recurrent PJI (91%), dislocation (5%), and aseptic failures (5%).</p><p><strong>Conclusions: </strong>In this large series of acute PJIs after primary hip arthroplasties treated with a single DAIR, infection-free survival was 77% at five years. Poor host status predicted reinfection. With a rigorous definition of acute PJI, success was markedly improved at extended follow-up compared to many historical series.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}