INTRODUCTION:Patients with musculoskeletal complaints often search online to identify an appropriate healthcare provider. With the increasing availability of large language models (LLMs), these artificial intelligence (AI) tools can direct patients to providers. This study evaluated the ability of LLMs to recommend appropriate providers based on representative patient musculoskeletal queries. METHODS:Three LLMs (ChatGPT, DeepSeek, and Gemini) were prompted with standardized musculoskeletal queries for two US cities (Lynchburg, VA, and Trumbull, CT). Provider recommendations were considered appropriate if the physician was currently practicing in the requested location and specialized in the relevant area. Listed phone numbers were checked for accuracy. Descriptive statistics and Fisher exact tests were used to summarize findings. RESULTS:The appropriateness of recommended providers differed across models with ChatGPT being most often appropriate (17/17, 100%) compared with Gemini (9/21, 43%) and DeepSeek (4/10, 40%), (P < 0.001). Of the 18 inappropriate recommendations, 13 (72%) were real providers in unrelated specialties and 5 (28%) were hallucinations, all from DeepSeek. Phone number accuracy differed significantly across models with Gemini being most accurate (5/6, 83%), outperforming both ChatGPT (6/9, 67%; P = 0.60) and DeepSeek (2/10, 20%; P = 0.04). DISCUSSION:LLMs showed potential to direct patients to local, specialized musculoskeletal providers based on their report, although the specific contact information was at times inaccurate. As these tools evolve, providers should be aware of AI's ability to make provider recommendations and work to ensure the presentation of their contact information is accessible by these models as best possible.

Background: Large language models (LLMs), an artificial intelligence tool, have become widely available and used by patients and members of the general public to answer health care questions.Purpose: We sought to understand whether currently available LLMs can recommend an appropriate total knee arthroplasty (TKA) surgeon when prompted.Methods: We used 3 widely available LLMs (ChatGPT, Gemini, and DeepSeek) to conduct searches for a TKA surgeon, with 1 of 4 home cities specified (Lynchburg, VA; Trumbull, CT; Chicago, IL; and New York, NY). The first prompt posed was (1) "I was told by my primary care provider that I need a knee replacement, I live in (city, state), who would you recommend that I see?" Once the list of surgeons was elicited, the LLM was prompted: (2) "Why did you recommend this (these) surgeon(s)?"; (3) "Where did you get your information about this (these) surgeon(s)?"; and (4) "How do I get in contact with this (these) surgeon(s)?" Recommendations were considered appropriate if the surgeon routinely performed TKA and was actively practicing in the area. Descriptive statistics and Fisher's exact tests were used to summarize findings.Results: Across the 3 LLMs, 49 of the 74 (66%) recommendations were deemed appropriate, although this varied by model: Gemini (26/30, 87%), ChatGPT (14/19, 74%), and DeepSeek (9/25, 36%). Of the inappropriate responses, 6 of the surgeons were out of area, 13 were not performing TKA, and 6 were hallucinated names. When asked for rationales for the recommendations, LLMs most commonly cited hospital and practice Web sites and patient reviews, which tended to favor surgeons with longer local practice tenure. Of the 74 contact details provided, only 17 (23%) were accurate, with significant variation among models: ChatGPT (13/19, 79%), DeepSeek (2/25, 8%), and Gemini (2/30, 7%).Conclusion: While LLMs show potential in identifying TKA surgeons, the 3 LLMs we tested varied in their ability to validate surgeon expertise and provide reliable contact information. Further research may be necessary to elucidate the criteria by which LLMs recommend surgeons.

Background: Total joint arthroplasty (TJA) represents the single largest procedural cost for the Centers for Medicare & Medicaid Services. Discharge to a skilled nursing facility (SNF) remains a primary driver of post-acute care costs. The COVID-19 pandemic led to a decrease in number of discharges to SNFs. Examining preoperative patient characteristics of those who are still admitted to SNFs, despite cultural shifts, may help providers identify patients still at high risk for SNF discharge. Methods: This retrospective study included patients who had elective total hip arthroplasty or total knee arthroplasty from January through December 2022 at a high-volume orthopaedic institute. Preoperative patient-reported outcome scores, demographics, and clinical characteristics were collected from patient charts and compared between patients who were discharged home vs SNF. Multivariate logistic regression analyses were used to determine potential predictors for discharge to SNF. Results: In the total sample (N 1/4 2795), 96.4% of patients were discharged home, and 3.6% were discharged to a SNF. Medicare insurance was associated with being discharged to a SNF (P < .05), while having commercial insurance was associated with being discharged home (P < .05). Being older, having longer procedure length, longer hospital length of stay, and a lower preoperative Patient-Reported Outcomes Measurement Information System (PROMIS 10) score were significant predictors of discharge to SNF (P < .05). Conclusions: This was the first study to identify PROMIS 10 score as a potential predictor of discharge to a SNF after TJA. Findings from this study may help providers redefine contemporary predictors of SNF admission following TJA. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Does the use of robotics improve the outcome of primary total knee arthroplasty?Recommendation: The use of robotics appears to improve radiographic alignment in the coronal plane for primary total knee arthroplasty, but there is no clear improvement in functionor outcome measures, based on a number of meta-analyses of randomized controlled trials. Level of Evidence: Moderate. Delegate Vote: Agree: 85%, Disagree: 11%, Abstain: 4%.

BACKGROUND:Intraoperative complications are ideally prevented altogether, but are nevertheless an inherent and unavoidable risk in primary total knee arthroplasty (TKA). METHODS:This article provides a review of a symposium on primary TKA intraoperative complications that was presented at the American Association of Hip and Knee Surgeons 2024 Annual Meeting. RESULTS:The following four intraoperative complications were reviewed: 1) medial collateral ligament injury; 2) neurovascular injury; 3) extensor mechanism injury; and 4) periprosthetic fracture. CONCLUSIONS:As the nationwide and per-surgeon volume of primary TKA continues to increase, it is imperative for arthroplasty surgeons to be prepared to prevent, identify, and manage intraoperative complications during primary TKA.

Background The increased emphasis on reimbursement, diversity, and burnout in hip and knee arthroplasty necessitates a foundational understanding of the surgeon workforce. The purpose of the study was to cross sectionally survey a representative sample of the AAHKS surgeon membership on the subject of salary, practice patterns, and demographic factors to establish a baseline framework for future advocacy efforts and initiatives. Methods An online survey was sent to AAHKS members between December 20, 2022 and January 19, 2023. Surgeon demographic data, experience, practice geography and type, and annual case volume were solicited. Univariate and multivariate analyses were performed to describe the association of respondent characteristics with reported salary directly from patient care, as well as indirect revenue streams. Results A total of 730 AAHKS members responded to the survey. The largest proportion of surgeons performed 251-400 cases annually (36%); 81% (n = 592) and 93% (n = 679) of respondents identified as white and male, respectively. Case volume was the primary determinant for surgeon salary, followed by practice type, years in practice, and gender. After controlling for confounding variables, multivariate analyses revealed the direct salary of women surgeons was 14.4% less than men [95% confidence interval, 0.4%-28.3%]. When considering indirect revenue, the gender pay gap widened. Salary was not associated with reported hours worked per week, geographic location, or ethnicity. Conclusions Salary is an important but underdiscussed subject that reflects the realities of our culture and value system in medicine. A direct relationship between salary and modifiable variables like case volume is clear. However, after controlling for confounders, women arthroplasty surgeons still earn 86 cents on the dollar compared to their male colleagues from direct surgical revenue.

Introduction This study evaluates the effectiveness of a comprehensive hip fracture protocol, with a focus on specific readmission reasons. Methods A retrospective cohort study of hip fracture patients aged 60 and older who underwent surgery before (control) and after (intervention) implementation of a comprehensive hip fracture program. Objectives included identifying readmission reasons and rates, time to operating room (TOR), length of stay (LOS), reoperation, and mortality rates. Logistic regression was utilized to determine significance. Results One hundred and sixty-three patients (control) vs. 238 patients (intervention) were identified. The intervention group had higher odds of 90-day readmission for a medical reason (OR = 1.735, p = 0.028). Thirty-three out of forty-two patients (79%) in the control group and 68/78 patients (87%) in the intervention group were readmitted secondary to a medical reason (pulmonary etiology being the most common). Surgical-related readmissions (surgical site infections and dislocations are most common) were lower in the intervention group compared with the control group, with 10/78 patients (13%) and 9/42 patients (21%), respectively. Twenty-four-hour TOR was achieved in 125 patients (52.5%) in the intervention group vs. 70 patients (42.9%) in the control group. LOS was shorter by 1.1 days for the intervention group (p = 0.010). Mortality was lower in the intervention group. Discussion A comprehensive hip fracture protocol can reduce LOS, TOR, mortality rate, and even surgical-related readmissions. Readmission rates are mainly due to medical problems, which may be unavoidable and thus may not be an adequate hip fracture effectiveness metric. Potential areas of improvement and additional study may include closer internal medicine oversight and primary care follow-up after discharge.

Background: Robotic systems for total knee arthroplasty (TKA) may utilize computed tomography three-dimensional modeling and intraoperative ligamentous balancing data to assist surgeons with implant size and position. This study evaluated the effect of such robotic systems on implant selection. Methods: We reviewed 645 TKAs performed with a single prosthetic design at 2 academic medical centers between 2016 and 2022. A robotic system was utilized in 304 TKAs, 341 were conventionally instrumented. Implant sizing was compared between cohorts. Multivariate analyses assessed for confounding and effect modification on the basis of demographics. Results: The 2 cohorts exhibited no significant differences in age (P = .33), weight (P = .29), or race (P = .24). The robotic-arm cohort had fewer women (58.9% vs 66.7% P = .04) and was taller on average (66.3 in vs 65.0 in P < .001). Mean polyethylene liner thickness was larger in the manual cohort (10.3 robotic and 10.6 manual; P < .00). On multivariate analysis, robotic-arm TKAs had larger tibial components (P < .001) and smaller femoral components (P = .017). Conclusions: Robotic-arm assisted TKA with computed tomography-based three-dimensional planning was associated with a larger mean tibial component size and a smaller mean femoral component size when compared to conventionally instrumented TKAs. Observed differences likely reflect differences in the data informing implant size selection; effects on clinical outcomes warrant further study. (c) 2024 The Authors. Published by Elsevier Inc. on behalf of The American Association of Hip and Knee Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Background There are high reported rates of burnout and job turnover among orthopedic surgeons. The purpose of this study was to investigate the prevalence of job change among early-career adult reconstruction surgeons and to examine which demographic or practice factors influenced job change. Methods An electronic survey was distributed to all practicing surgeon members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group. The survey included questions about practice type, demographics, job change, and a validated burnout questionnaire. Survey responses were collected using a secure database. Statistical analysis was performed to examine relationships between respondent characteristics and job change. Results There were 201/389 responses (51.7%). The most common motivators for job change were better workplace culture (64%), opportunities for career growth (52%), and better alignment with values of the department/institution (45%). There were few female respondents; however, they trended toward reporting higher rates of job change (35.6% female vs 21.3% male, P = .3). Respondents who were considering changing jobs but had not done so were significantly more likely to report symptoms of burnout in all studied subscales: emotional exhaustion (P < .0001), depersonalization (P = .0002), and sense of personal accomplishment (P = .007). Conclusions Surgeons changing jobs cited social factors such as workplace culture as reasons for leaving. Burnout symptoms were higher in surgeons considering changing jobs but improved in those who had already changed jobs. It is important to identify factors that lead to job change to guide young surgeons in job selection and improve retention.

Background: As demand for total hip arthroplasty and total knee arthroplasty increases, more surgeons have pursued subspecialty training in adult reconstruction. However, little information is available regarding the practice environment in which these fellowship-trained surgeons practice. The purpose of this study was to describe the practice environments of contemporary adult reconstruction surgeons. Methods: A survey was developed and distributed to members of the American Association of Hip and Knee Surgeons from December 2022 to January 2023. Information was collected on surgeon demographics, practice setting, call requirements, and educational debt. Responses were recorded using frequencies and proportions. Results: A total of 886 of 2471 (36%) surgeons completed the survey, with 93% identifying as male and 81% as white. The primary surgical practice locations were: community hospital 53%, academic/tertiary hospital 24%, specialty orthopedic hospital 17%, and ambulatory surgery center 7%. Nearly half (49%) of the respondents practiced in orthopedic specialty groups, and 60% spent 50%-66% of their clinical time in the office. The majority of surgeons performed between 101-250 (20%) and 251-400 (31%) arthroplasty cases per year, though this varied considerably. Call was taken by 77% of surgeons, yet only 54% received compensation. Conclusions: The most common practice setting for adult reconstruction surgeons was in a community-based hospital as part of a large orthopedic specialty group. Despite the considerable variability in annual procedure volume, the majority of surgeons spent over half their clinical time in office and had call obligations with variable compensation models.

In the dynamic landscape of modern health care, the development of novel technologies has become increasingly common. Due to the growing number of advancements being pushed to market, there is increasing pressure on arthroplasty surgeons from industry, peers, and patients to adopt new technology. Many contemporary advancements in the field of arthroplasty are in the form of digital technologies, such as artificial intelligence, robotics, additive manufacturing, smart sensors, or augmented reality [ 1 Haeberle H.S. Helm J.M. Navarro S.M. Karnuta J.M. Schaffer J.L. Callaghan J.J. et al. Artificial intelligence and machine learning in lower extremity arthroplasty: a review. J Arthroplasty. 2019; 34: 2201-2203 Abstract Full Text Full Text PDF PubMed Google Scholar , 2 Agarwal N. To K. McDonnell S. Khan W. Clinical and radiological outcomes in robotic-assisted total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty. 2020; 35: 3393-3409.e2 Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar , 3 Trauner K.B. The emerging role of 3D printing in arthroplasty and orthopedics. J Arthroplasty. 2018; 33: 2352-2354 Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar , 4 Iyengar K.P. Gowers B.T.V. Jain V.K. Ahluwalia R.S. Botchu R. Vaishya R. Smart sensor implant technology in total knee arthroplasty. J Clin Orthop Trauma. 2021; 22101605 Abstract Full Text Full Text PDF Scopus (19) Google Scholar , 5 Lex J.R. Koucheki R. Toor J. Backstein D.J. Clinical applications of augmented reality in orthopaedic surgery: a comprehensive narrative review. Int Orthop. 2023; 47: 375-391 Crossref PubMed Scopus (11) Google Scholar ]. Compared to advancements of the past few decades (which have included changes in the physical composition of implants, materials, or bearing surfaces), these digital technologies are increasingly convoluted and difficult to understand for surgeons without a background in engineering or computer science. It is essential for modern arthroplasty surgeons to critically evaluate new technology prior to implementation, especially given the consistently excellent postoperative outcomes after total hip arthroplasty and total knee arthroplasty [ 6 Evans J.T. Evans J.P. Walker R.W. Blom A.W. Whitehouse M.R. Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019; 393: 647-654 Abstract Full Text Full Text PDF PubMed Scopus (332) Google Scholar , 7 Ingelsrud L.H. Wilkinson J.M. Overgaard S. Rolfson O. Hallstrom B. Navarro R.A. et al. How do patient-reported outcome scores in international hip and knee arthroplasty registries compare?. Clin Orthop Relat Res. 2022; 480: 1884-1896 Crossref PubMed Scopus (10) Google Scholar ].

BackgroundIn primary total knee arthroplasty (TKA), there is ongoing controversy about optimal fixation (cemented vs cementless). Cemented TKA remains the gold standard, with the largest body of long-term evidence available to support it. However, cementless TKA implants are gaining popularity due to potential biomechanical advantages and a growing body of literature supporting survivorship. Due to paucity of literature investigating fixation methods in robotic-assisted TKA (Ra-TKA), we aim to compare clinical outcomes of cementless Ra-TKA with those of cemented Ra-TKA.MethodsThis is a retrospective cohort study of patients who underwent Ra-TKA by 19 surgeons comparing results of cases using cementless vs cemented fixation. We observed short-term complications, emergency room visits, and readmissions. We collected patient-reported outcomes measurement information system and knee injury and osteoarthritis outcome scores preoperatively and 12 weeks after surgery.ResultsA total of 582 TKA cases were included: 335 cementless and 247 cemented. The patients in the cementless group were younger and had a higher body mass index. The cemented group had a higher rate of return to the operating room, with manipulation under anesthesia for stiffness being the most common indication in both groups. There were no statistically significant differences in 30-day readmissions, 90-day emergency room visits, or patient-reported outcomes.ConclusionsOur retrospective study demonstrated higher return to operating room in the cemented group vs the cementless group. We reported no differences in any other short-term outcomes between the cementless and cemented Ra-TKA. Our data support efficacy and safety of cementless Ra-TKA at 3-month follow-up.

BackgroundIn revision total knee arthroplasty, tibial cones have demonstrated improved longevity and reduced incidence of aseptic loosening. Several currently available “off-the-shelf” (OTS) cone systems may not have sizes to accommodate all patient bone morphologies.MethodsComputed tomographies from one hundred primary total knee arthroplasty patients and dimensions of 4 OTS cones were obtained. Press-fit stems were positioned in 3D tibia models to fit the diaphyseal trajectory. Cones were positioned around the stem at 1, 6, and 13 mm resections measured from the trough of the medial tibial plateau, simulating proximal tibial cuts and bone loss. Tibias were examined for cortical breaching following modeled cone preparation.ResultsIncreased rate of breaching was observed as size and depth of the cone increased. In 2/49 (4.1%) male and 19/46 (41.3%) female tibias, cones could not be positioned without breaching. No breaches were found in 22/49 (45.0%) male and 5/46 (10.9%) female tibias. For every 1 centimeter increase in patient height, odds of breaching decreased by 12% (odds ratio: 0.88, confidence interval: 0.84, 0.92). For every size increase in cone width, odds of breaching increased by 34% (odds ratio: 1.34, confidence interval: 1.28, 1.47). Placing cones deeper also increased breaching compared to the 1 mm cut.ConclusionsIn revision total knee arthroplasty, smaller OTS or custom tibial cones may be needed to fit a patient’s proximal tibial geometry. This is especially true in patients not accommodated by the OTS cone sizes we tested, which impacted shorter patients and/or those with substantial bone loss requiring more tibial resection and deeper cone placement. Use of smaller or custom tibial cones should be considered where indicated.

BACKGROUND:Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies. METHODS:The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database. Primary outcomes were operating room time and readmission rates. Secondary outcomes were length of stay, discharge status, revision rates within 90- and 365-day follow-up, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A sensitivity analysis was conducted using the nearest neighbor matching as the covariate balancing technique. RESULTS:The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up. Operating room time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes; P < 0.001). Hip-related readmission rates were markedly lower (P < 0.001) for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology. Results showed increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. Revision rates were similar for both cohorts. CONCLUSION:Using computer-assisted fluoroscopic navigation in THA was associated with markedly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared with robotic-assisted technology.

BACKGROUND:This study evaluates trends of cemented versus press-fit total knee arthroplasty (TKA). We hypothesized that press-fit TKA is more common in younger and obese patients. There may also be racial, geographic, and institutional variation. METHODS:The American Joint Replacement Registry was used to conduct a retrospective review of primary TKA procedures for osteoarthritis in the United States between January 2019 and March 2022. The objective was to identify differences in incidence, demographics, body mass index (BMI), Charlson Comorbidity Index (CCI), and institutional teaching status (teaching vs. non-teaching) between press-fit and cemented TKAs. RESULTS:Two hundred ninety-seven thousand four hundred two patients (61% female, average age 68 years, 88.3% White) underwent cemented TKA versus 50,880 patients (52% female, average age 65 years, 89% White) underwent press-fit TKA. Overall, 20.8% of press-fit versus 19.9% of cemented TKA had a BMI of 35 to 39.9 and 15.2% of press-fit versus 12.5% of cemented TKA had BMI >40 ( P < 0.001). Patients undergoing press-fit TKA were less likely Black (OR = 0.727; P < 0.0001), Asian (OR = 0.651, P < 0.0001), and Native Hawaiian/other Pacific Islander (OR = 0.705, P < 0.02) with White as the reference group. Northeastern and Southern United States were more likely to use press-fit TKA than the Midwest (OR = 1.89 and OR = 1.87, P < 0.0001) and West (OR = 1.67; and OR = 1.65; P < 0.0001). Press-fit TKA incidence in 2019 was 9.9% versus 20.6% in 2022 ( P < 0.001). CONCLUSION:Press-fit TKA is increasingly more common in Northeastern and Southern United States, and patients are older than expected. Patients with BMI >35 had a slightly higher rate of undergoing press-fit than cemented TKA. Notable racial differences also exist. Additional research addressing racial disparities and evaluating longevity of press-fit designs is needed.

BACKGROUND: As the population ages and demand for total joint arthroplasty increases, rates of periprosthetic joint infection are expected to increase in the geriatric population. Studies comparing prevalence of risk factors, etiology, management, and mortality of prosthetic joint infection in older patients are lacking. METHODS: We compared clinical characteristics, management, and mortality of patients < 75 vs = 75 years of age with first prosthetic joint infection of the hip or knee admitted to a tertiary medical center between September 2017 and December 2019. RESULTS: Ninety-eight patients (< 75 years of age [n = 63]; = 75 years of age (n = 35) were studied. Groups were similar in terms of etiology, culture-directed therapy, antibiotic suppression, and length of stay. There was no difference in surgical management, performed in almost 97% of cases in both groups. Arrhythmia and heart failure were more prevalent in those aged = 75 years. Readmission related to prosthetic joint infection occurred less often in older individuals (P =.005). Deaths within 1 year of diagnosis were rare (n = 4; 4.1%), occurring in older patients and resulting mostly from sepsis. CONCLUSION: In our single-center study, patients with first prosthetic joint infection had similar management, regardless of age. We identified cardiac history as one of the host factors for prosthetic joint infection most seen in patients = 75 years of age. Although deaths were rare, 1-year mortality was higher in patients aged = 75. Prospective, multicenter studies are needed to explore risk factors and management strategies of prosthetic joint infection among elderly populations.

Background: Stereotypes may discourage women from going into the historically male-dominated field of Adult Reconstruction. Other factors such as interest, confidence, and a sense of belonging may in-fluence subspecialty choice. The objective of this study was to survey orthopedic surgery residents regarding their perceptions about Adult Reconstruction. Methods: A validated survey evaluating social determinants of behavior was adapted to assess ortho-pedic surgery residents' perceptions of Adult Reconstruction. The survey was electronically distributed to residents from 16 United States and Canadian Accreditation Council for Graduate Medical Education-accredited residency programs. There were 93 respondents including 39 women (42%) and 54 men (58%). Study data were collected and managed using an electronic data capture tool. Descriptive statistics were reported for all continuous variables. Percentiles and sample sizes were reported for categorical variables. Results: Women and men reported similar interest in Adult Reconstruction (46% versus 41%, P = .60). Fewer women reported that they were encouraged to go into Adult Reconstruction by faculty (62% versus 85%, P = .001). Women and men reported similar confidence in their own ability to succeed in the subspecialty of Adult Reconstruction. However, when asked about the ability of other residents, both sexes rated men as having higher levels of confidence. Women and men perceived other residents and faculty felt "men are better Adult Reconstruction surgeons," but did not personally agree with this statement. Conclusion: Women and men residents expressed similar rates of interest and self-confidence in Adult Reconstruction, but there were social barriers including negative stereotypes that may prevent them from pursuing careers in Adult Reconstruction. & COPY; 2023 Elsevier Inc. All rights reserved.

Background As the popularity of unicondylar knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) have expanded, more patients who have limited arthritis are undergoing partial knee arthroplasty. No studies have evaluated if any regional differences in the United States (U.S.) exist between partial versus total knee arthroplasty (TKA). The purpose of this study was to utilize the American Joint Replacement Registry to evaluate regional differences in UKA, PFA, and TKA. Methods The American Joint Replacement Registry was queried for all TKA, PFA, and UKA procedures between 2012 and 2021. Surgical volume was compared between the Midwest (MW), Northeast (NE), South, and West (W) regions. Trends were compared using multivariate logistic regression analyses and least squared mean logistic regression models. Results Since 2012, there has been a steady increase in the amount of UKAs performed across the U.S., except during the COVID-19 pandemic when numbers decreased. Logistic regression analyses demonstrated a higher likelihood of receiving a UKA compared to TKA in the NE compared to other regions, and higher likelihood of receiving a PFA in the NE and W compared to other regions over the study period. Other factors that increased the likelihood of having a UKA nationally were men, the procedure being performed at a teaching hospital, and having surgery in urban areas. Patients were more likely to have a PFA in the NE compared to the S and MW, and higher odds in the South and W compared to the MW, with rates of PFA consistently lower in the MW compared to other regions. Conclusions Patients were more likely to have a UKA in the NE compared to other regions of the country. Patients had higher odds of having a PFA in the NE and W regions relative to the MW. Men had higher odds of having either UKA or PFA than women across the nation.