Background:Revision total hip arthroplasty (R-THA) often requires removal of well-fixed acetabular components, where minimizing bone loss and operative time are critical. While manual extraction tools have been the traditional approach, powered systems device may improve efficiency, yet comparative clinical data remain limited. Methods:We performed a retrospective review of 98 R-THAs (32 powered, 66 manual) from an institutional database (2021-2024). Patient demographics, operative characteristics, extraction times, and healthcare utilization outcomes (length of stay [LOS], discharge disposition, 90-day readmission, 90-day complications, and 1-year reoperations) were analyzed using nonparametric and categorical statistical tests. Results:Baseline characteristics were similar across groups. Cup sizes removed and reimplanted were largely comparable between groups, indicating minimal differences in bone preservation. Time to cup removal was significantly shorter with the powered device, with 82% completed in ≤10 minutes and none exceeding 20 minutes, compared with the manual group where 58% required 5 to 10 minutes, 33% required 10 to 20 minutes, and 8% exceeded 20 minutes (p < 0.001). Healthcare utilization metrics, including LOS ≥3 days (50.0% vs. 56.4%, p = 1.000), nonhome discharge (25.0% vs. 18.2%, p = 0.572), 90-day readmission (21.9% vs. 7.6%, p = 0.054), 1-year reoperation (6.3% vs. 7.6%, p = 1.000), and 90-day complications (21.9% vs. 13.6%, p = 0.457), did not differ significantly. Conclusion:The use of the powered acetabular extraction system was associated with significantly reduced extraction times compared with a manual extraction device in R-THA. One-year reoperation rates were comparable, as were complication/readmission rates and replacement cup sizes. These findings highlight the efficiency benefits of powered explantation as well as its safety. Level of evidence:Level III (Retrospective comparative cohort study). See Instructions for Authors for a complete description of levels of evidence.

Background The Centers for Medicare & Medicaid Services recently mandated reporting of patient-reported outcome measures following primary total hip arthroplasty (THA), with emphasis on the substantial clinical benefit (SCB) threshold for the Hip Disability and Osteoarthritis Outcome Score–Joint Replacement (HOOS-JR). The impact of preoperative back and/or contralateral hip pain on achieving SCB and other validated patient-reported outcome measure thresholds remains unclear. Methods We retrospectively analyzed a prospective cohort of 4,412 Medicare primary elective unilateral THAs (2016 to 2023). Patients were stratified by preoperative back and/or contralateral hip pain and severity. Outcomes included achievement of SCB (22-point improvement in HOOS-JR), minimal clinically important difference, patient-acceptable symptom state, and satisfaction at one year. Multivariable logistic regression was adjusted for demographic, clinical, and socioeconomic factors. Results Patients who had both back and contralateral hip pain had the highest odds of failing to achieve SCB (odds ratio (OR) 3.1, 95% confidence interval (CI) 2.4 to 4.1; P < 0.001), followed by isolated contralateral hip pain (OR 1.7, 95% CI 1.1 to 2.6; P = 0.01) and isolated back pain (OR 1.6, 95% CI 1.2 to 2.0; P = 0.002). Risk increased proportionally with pain severity (mild/moderate back pain: OR 1.7; severe back pain: OR 2.8; both P < 0.001). Similar, though less pronounced, patterns were observed for minimal clinically important difference and patient-acceptable symptom state thresholds across HOOS domains. Patients who have both pain sources also reported the highest risk of dissatisfaction (OR 2.1, 95% CI 1.5 to 3.0; P < 0.001). Conclusions Preoperative back and contralateral hip pain, particularly when severe or concurrent, strongly and independently reduce the likelihood of achieving SCB for HOOS-JR following primary THA. These findings underscore the need for risk adjustment under the Centers for Medicare & Medicaid Services patient-reported outcome performance measure framework and highlight the value of multidisciplinary management of comorbid pain to optimize outcomes and ensure equitable benchmarking in value-based care. Level of Evidence II (Prospective).

Hip osteoarthritis (OA) is estimated to affect 62.6 million individuals by 2050. A probable link exists between alcohol use and hip OA. However, the results are inconsistent, and the relationship between alcohol and hip OA remains speculative. To address these gaps, this study aimed to utilize the diverse, nationally representative All of Us Research Program dataset to explore the association between alcohol consumption and hip OA. This retrospective case–control study utilized data from the All of Us Research Program Controlled Tier Dataset v8. 17,517 hip OA cases and 70,068 controls were identified. A 1:4 case-to-control matching ratio was applied based on age and sex. Alcohol use frequency was categorized into five levels: Never, Monthly or Less, Two to Four Times per Month, Two to Three Times per Week, and Four or More Times per Week. Multivariable logistic regression models evaluated the association between alcohol use frequency and hip OA after adjusting for demographic and clinical variables. Multivariable analysis found that alcohol use frequency was not significantly associated with hip OA. Compared to never users, participants with low (OR 0.98, 95

BACKGROUND:Total knee arthroplasty (TKA) provides pain relief and functional improvement for end-stage knee osteoarthritis patients. As TKA use increases in younger patients, return to sports (RTS) has become a key outcome measure. While RTS rates after TKA are generally high, they vary significantly across studies due to differences in study design, patient populations, and RTS definitions. PURPOSE:To determine RTS rates, evaluate return to preoperative sport levels, quantify time to RTS, and identify factors affecting RTS after TKA. STUDY DESIGN:Cohort study; Level of evidence, 2. METHODS:We analyzed 21,466 primary TKAs performed between 2016 and 2022. Of these, 1782 patients (8.3%) were athletes at baseline, with 1464 (82.2%) completing 1-year follow-up. We recorded demographic characteristics, comorbidities, baseline and 1-year RTS status, time to RTS, athlete type, and patient-reported outcomes. Analysis included descriptive statistics, Cox regression for time to RTS, and logistic regression for RTS-associated factors. RESULTS:Of 1464 patients, 782 (53.4%) achieved RTS, while 676 (46.6%) did not; both contact and noncontact sports were included. Among those who returned, 62% resumed their previous sport at the same level, 34.5% at a reduced intensity, and 3.4% switched to a different sport. The median RTS time was 12 weeks, with 90% returning within 27 weeks. Medicaid patients had a delayed RTS compared with those with commercial insurance (hazard ratio [HR], 0.51). Overweight patients returned sooner than normal-weight patients (HR, 1.41). Female patients (odds ratio [OR], 0.76) and Black patients (OR, 2.34) had lower RTS odds, while recreational (OR, 0.06) and competitive athletes (OR, 0.10) had higher RTS odds versus those not participating in athletic activities. CONCLUSION:Over half of athletes returned to sports within 1 year of TKA, most within 27 weeks. RTS rates varied by preoperative competitive level, sex, race, body mass index, and comorbidity burden. These findings can guide patient expectations and shared decision-making regarding post-TKA sports participation. Future research should focus on improving RTS rates in high-risk groups, standardizing RTS criteria, and stratifying outcomes by sport type and impact level to enable more individualized patient recommendations.

BACKGROUND:Socioeconomic disadvantage is increasingly recognized as an important factor associated with outcomes after total joint arthroplasty (TJA). The Area Deprivation Index (ADI) has emerged as a validated measure of socioeconomic disadvantage that specifically captures individual neighborhood levels of structural and material deprivation based on income, education, employment, and housing characteristics. Prior research has demonstrated ADI to be associated with surgical outcomes; however, its relationship to postoperative outcomes after THA and TKA, procedures in which outcomes depend highly on institutional and structural support, home environment, and accessible postacute care resources, has not been well synthesized. Prior studies provide a broad overview of heterogeneous measures of socioeconomic disadvantage that are not directly comparable. QUESTIONS/PURPOSES:(1) Is a higher ADI associated with increased postoperative healthcare utilization after primary THA and TKA? (2) Is a higher ADI associated with differences in patient-reported outcome measures (PROMs)? (3) Is a higher ADI associated with increased postoperative complications? (4) Is ADI associated with differences in implant survivorship after TJA? METHODS:A systematic review of four databases-Ovid Medline, Embase, Cochrane Library, and Web of Science Core Collection-was performed from their inception to March 27, 2025. Each database was last searched on March 27, 2025. In all, 128 records were available. Studies were included if they evaluated patients receiving primary THA or TKA and examined ADI in the Results section of the manuscript in terms of any of the following: 90-day outcomes, healthcare utilization, complications, reoperations, revisions, cost, or PROMs. Studies were excluded if they examined revision hip or knee arthroplasty, hemiarthroplasty, or arthroplasty of any other joint; did not evaluate outcomes in association with ADI; or were case reports, systematic reviews, conference abstracts, editorials, or narrative reviews. Sixteen studies were included for final review. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale (NOS), which has a maximum quality score of nine stars. Included studies had a median (range) NOS score of 8 stars (7 to 9), suggesting that most were of good quality with a low risk of bias. Results were synthesized qualitatively; meta-analyses were not performed because of the heterogeneity of included studies. RESULTS:A higher ADI was consistently associated with greater healthcare utilization, including prolonged length of stay, increased likelihood of nonhome discharge, and increased odds of emergency department visits. PROMs demonstrated worse absolute postoperative scores and lower likelihood of achieving patient acceptable symptom states among patients who live in high ADI neighborhoods despite comparable levels of improvement across all groups. Overall, ADI was not associated with reaching the standard minimum clinically important difference (MCID). All groups achieved the MCID on all domains of the Hip Disability and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score, and Patient-Reported Outcomes Measurement Information System short forms regardless of ADI. A higher ADI was associated with increased odds of medical complications such as infection, venous thromboembolism, cardiopulmonary events, and acute kidney injury. Evidence on implant survivorship was limited but suggested increased odds of reoperation and periprosthetic joint infection within 90 days and increased odds of aseptic revision beyond 90 days in populations with more severe levels of deprivation as measured by the ADI. CONCLUSION:Higher neighborhood socioeconomic deprivation was independently associated with worse postoperative outcomes, greater resource utilization, and signals of inferior early implant survivorship after THA and TKA. The ADI provides meaningful insight into neighborhood-level social risk beyond traditional clinical factors and individual patient demographics and may help identify patients who may benefit from interventions such as more intensive preoperative medical management of comorbidities, tailored perioperative support, easily accessible rehabilitation, or closer postoperative follow-up. Incorporating the ADI into risk-adjustment models and care pathways may help clinicians better anticipate possible barriers to recovery and may help ensure that patients from less affluent communities achieve the results they seek after lower extremity arthroplasty. LEVEL OF EVIDENCE:Level III, therapeutic study.

BACKGROUND:The Centers for Medicare & Medicaid Services implemented the Patient Reported Outcomes Performance Measure policy, mandating reporting of patient-reported outcome measures for total hip arthroplasty. A 22-point improvement in Hip disability and Osteoarthritis Outcome Score for Joint Replacement defines substantial clinical benefit (SCB). However, it remains unclear whether SCB achievement differs across insurance groups. METHODS:We analyzed a prospectively collected cohort of 3,240 total hip arthroplasty patients (2016 to 2023) stratified by insurance: Medicare (n = 2,108), commercial (n = 921), and Medicaid (n = 211). Baseline demographics, comorbidities, and patient-reported outcome measures were compared between Medicare and non-Medicare patients. Multivariable regressions identified predictors of SCB for Hip disability and Osteoarthritis Outcome Score for Joint Replacement. Medicare patients were older (median 72 versus 60 to 61 years, P < 0.001), had lower body mass index (median 29 versus 31 to 31.1, P < 0.001), and greater comorbidity, with over 40% having a Charlson Comorbidity Index ≥ 2 compared to less than 23% in non-Medicare patients (P < 0.001). RESULTS:Medicare patients demonstrated less baseline disability than Medicaid, but lower mental health than commercial patients. Independent predictors of SCB failure included non-White race (odds ratio (OR) = 1.37, P = 0.028), higher comorbidities (OR = 1.12, P = 0.039), and baseline PROM score above the median (OR = 3.92, P < 0.001). Compared with Medicare, commercial insurance was associated with more than twice the odds of SCB failure (OR = 2.08, P = 0.001), while Medicaid showed no difference (OR = 1.14, P = 0.35). A grouped non-Medicare versus Medicare comparison revealed no difference (OR = 1, P = 0.98). CONCLUSIONS:Overall, Medicare patients achieved SCB at rates comparable to or better than non-Medicare patients. These findings highlight the complexity of applying uniform thresholds across insurance groups and underscore the need for refined adjustment. LEVEL OF EVIDENCE:III.

INTRODUCTION:We aimed to estimate the incidence, predictors, and cost of sepsis within 90 days of revision of total knee arthroplasty (TKA) for periprosthetic joint infection (PJI). METHODS:A retrospective analysis of first-time both-component revision TKA for PJI (n = 16,535) using a national all-payer database between 2016 and 2022 was performed. Patients were divided into those who developed sepsis within 90 days of revision TKA for PJI (n = 2365) and those who did not (n = 14,170). Overall and annual incidence of sepsis were estimated. Multivariate regression was performed to predict risk of 90-day sepsis following surgery. Average 90-day reimbursement per patient was compared between patients with and without sepsis after propensity score matching. RESULTS:Overall, 14% of patients developed sepsis within 90 days of surgery. Male gender (OR 1.2, p < 0.001), renal failure (OR 1.2, p < 0.001), tobacco use (OR 1.1, p < 0.01), morbid obesity (OR 1.1, p = 0.01), Elixhauser Comorbidity Index (ECI) (OR 1.08, p < 0.001), and hypoalbuminemia (OR 1.1, p = 0.03) were associated with a higher risk of sepsis within 90 days of revision TKA for PJI. Average reimbursement per patient in the 90 days following surgery was significantly higher among patients who developed sepsis compared to those who did not ($15,979 vs $11,306, p < 0.001). CONCLUSION:Approximately, 14% of revision TKA for PJI patients developed sepsis within 90 days. Male gender, renal failure, tobacco use, morbid obesity, higher ECI, and hypoalbuminemia independently increased the risk of sepsis. Optimizing modifiable risk factors such as smoking may help reduce the incidence and associated cost of sepsis following revision TKA for PJI. LEVEL OF EVIDENCE:IV (retrospective).

Background Removing acetabular implants is time- and labor-intensive, prompting the development of powered and manual extraction systems. Comparative data on force requirements, ergonomics, and operative time remain limited. We compared a powered vs a manual system in novice and expert surgeons using an in vitro model. Methods Composite foam blocks implanted with a 54-mm hemispherical acetabular shell emulated a well-fixed cementless construct and were mounted on a force sensor. Three board-certified, fellowship-trained orthopaedic surgeons and 3 residents each performed 3 trials with a powered extractor and a manual extractor. Participants wore triaxial accelerometers on the back and both hands and an in-line force sensor. Outcomes were peak acceleration (proxy for vibration), peak applied force, and time to extraction. Results Relative to the powered device, the manual device was associated with higher back acceleration (estimate 0.55; 95% confidence interval [CI]: 0.49-0.61; P < .001), greater applied force (5.75; 95% CI: 4.04-7.47; P < .001), and longer time to component removal (61.31 s; 95% CI: 48.04-74.58; P < .001). Surgeon experience did not affect force (estimate −1.03; P = .696) or time (estimate −1.03; P = .696). Conclusions The powered acetabular extraction tool reduced vibration exposure, applied force, and extraction time compared with a manual device across both novice and expert operators. In a field with substantial work-related musculoskeletal injury and growing emphasis on surgeon well-being, powered extraction may improve efficiency while helping preserve surgeon health and career longevity. These data provide objective support for selecting powered systems when available and justify further study in cadaveric and clinical settings to confirm external validity.

Purpose Tirzepatide is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, whereas semaglutide is selective for the GLP-1 receptor. We compared post-operative outcomes after primary total knee or hip arthroplasty (TKA/THA) between patients prescribed tirzepatide and those prescribed semaglutide. Methods A retrospective cohort study was performed using the TriNetX US Collaborative Network. Adults undergoing primary TKA or THA with at least two coded prescription fills for tirzepatide or semaglutide within six months of surgery were identified, and patients taking both agents were excluded. Cohorts were propensity score matched 1:1 (2,858 per group, all standardized differences below 0.05). Odds ratios (OR) with 95% confidence intervals (CI) were calculated at 90 days, 1 year, and 2 years. Results Of 669,698 patients who underwent primary TKA or THA, 8,797 (1.3%) had ≥ 2 tirzepatide or semaglutide prescriptions. At 90 days and 1 year, no surgical, medical, or implant-related outcome differed significantly. At 2 years, tirzepatide exposure was associated with lower odds of mechanical complications (OR 0.64, 95% CI 0.42 to 0.96) and periprosthetic joint infection (PJI) (OR 0.64, 95% CI 0.41 to 0.999; P = .048). Reoperation did not differ significantly (OR 0.68, 95% CI 0.43 to 1.08). Conclusion Tirzepatide and semaglutide prescriptions were associated with similar 90 day and 1 year outcomes, while tirzepatide was associated with lower 2-year mechanical complications and PJI. The distinction between dual GIP/GLP-1 agonism and selective GLP-1 agonism may therefore carry clinical relevance, and these agents should not be presumed equivalent.

Patellar management during revision TKA (rTKA) remains challenging. Metal-backed patella (MBP) with highly porous titanium coating applied by 3D printing may provide improved fixation in TKA, especially in patients with limited bone stock. The primary aim of this study was to assess implant survivorship among patients who received a new-generation MBP during revision TKA. Secondary aims were to assess (1) healthcare utilization, and (2) preoperative and 1-year PROMs. This was a retrospective review of patients who received a MBP during rTKA from 2017 to 2022. In total, 31 patients achieved an average follow-up of 3.0 years (SD 1.5 years). Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, KOOS Physical Function Shortform (PS), KOOS Joint Replacement (JR) and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS) were obtained preoperatively and at 1-year. Most patients had prior ipsilateral prosthetic joint infection (PJI; n = 22, 71

AIMS:Glucagon-like peptide-1 (GLP-1) receptor agonists are increasingly utilised for metabolic optimisation in surgical patients. Their effect on postoperative patient-reported outcomes (PROMs) and satisfaction following primary total hip arthroplasty (THA) has not been well established. This study aimed to describe the association between GLP-1 prescription history and: (1) 1-year postoperative PROMs; (2) 1-year patient satisfaction; and (3) complication rates. METHODS:This is a retrospective study of 12,749 patients who underwent primary unliteral THA at a tertiary medical centre from January 2016 to December 2022. GLP-1 agonist use was defined as a documented prescription history of a GLP-1 agonist within 1-year prior to surgery (n = 145). Multivariable logistic regression was used to evaluate GLP-1 use and 1-year PROMs [Hip disability and Osteoarthritis Outcome Score (HOOS) Pain, Physical function Shortform (PS), and Joint Replacement (JR)]. Clinical improvements were determined by the patient acceptable symptom state (PASS) and minimal clinically importance difference (MCID) thresholds. We also used multivariable logistic regression to assess the independent association between GLP-1 use and postoperative complications. RESULTS:No significant difference was observed between patients with a prescription history for a GLP-1 agonist and failure to achieve PASS, MCID, or satisfaction at 1-year (odds ratio [OR] 0.99, 95% confidence interval [CI], 0.51-1.9; p = 0.98). However, there was reduced odds of 90-day readmission in patients with a prescription history for a GLP-1 agonist (OR = 0.47, p = 0.043) and an increased rate of 90-day medical complications (9.66% vs. 6.01%, p = 0.001). No significant differences were found for length-of-stay, 90-day emergency visits, or 2-year implant complication rates. CONCLUSIONS:This observational study found that patients with GLP-1 agonist prescription history experienced an increased rate of medical complications but a reduced rate of 90-day hospital readmission. Conversely, the negative findings of the study should be interpreted cautiously as the small, exposed cohort limits statistical power.

BACKGROUND:Many patients who have bilateral hip osteoarthritis eventually undergo contralateral total hip arthroplasty (THA), yet limited data exist on how recovery differs between staged procedures performed within one year. This study evaluated differences in patient-reported outcomes and health care utilization following staged bilateral THA and identified predictors of suboptimal outcomes after the second surgery. METHODS:We retrospectively reviewed a prospective institutional registry to identify patients who underwent staged bilateral primary THA within one year (n = 680) and completed 1-year postoperative patient-reported outcome measures for both procedures. The primary outcomes included discharge disposition, prolonged lengths of stay (LOS ≥ three days), 90-day readmission, and 1-year reoperation. The secondary outcomes included Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain, HOOS Physical Function Shortform, and Joint Replacement subscale scores. Minimal clinically important difference and patient acceptable symptom state (PASS) thresholds were applied. Logistic regression identified predictors of suboptimal second-side outcomes. RESULTS:Readmission (4.9 versus 2.8%, P = 0.045) and reoperation (3.1 versus 0.6%, P = 0.001) were more frequent after the second THA. Patients who had a prolonged LOS after the first THA had 20-fold greater odds of prolonged LOS after the second. The 1-year patient-reported outcome measures scores were similar across surgeries, but symptom improvement was consistently lower after the second THA (HOOS Pain: 58 versus 50, P < 0.001; HOOS Physical Function: 43 versus 34, P < 0.001; HOOS Joint Replacement: 46 versus 38, P < 0.001). Failure to achieve the minimal clinically important difference was more common after the second THA, while PASS rates remained stable. Failure to reach PASS thresholds after the first THA strongly predicted failure after the second (odds ratios 7.7 to 14.8). CONCLUSIONS:Patients experienced diminished improvement and greater health care utilization rates after their second surgery. Poor recovery following the first THA was highly predictive of second-side failure. These findings support individualized surgical timing and counseling strategies based on early recovery trajectories.

As robotic systems become increasingly utilized in total knee arthroplasty (TKA), structured certification programs are necessary to ensure that surgeons are proficiently trained for safe and effective use. This review examines the certification requirements for six major robotic TKA systems: Zimmer Biomet's ROSA, Stryker's Mako, Smith and Nephew's CORI, Depuy Synthes' Velys, Corin's ApolloKnee, and Think Surgical's TSolution One and TMINI. However, variation in certification structures and training requirements between each system is evident. This variability in training programs points to a need for standardized protocols across robotic platforms to ease the learning curve for surgeons and promote transferable skills and consistent outcomes. Establishing evidence-based guidelines for robotic TKA certification could facilitate broader adoption and improve clinical results, contributing to the advancement of robotic technology in orthopedic surgical practices.

BACKGROUND:Patients who have chronic pain may experience worse outcomes after total knee arthroplasty (TKA), yet its impact on postoperative metrics remains unclear. This study evaluated the prevalence of chronic pain diagnoses and their association with health care utilization, patient-reported outcome measures, and satisfaction. METHODS:A retrospective analysis of 13,894 primary unilateral TKAs performed from 2016 to 2022 at a tertiary center was conducted. Chronic pain diagnoses were identified via International Classification of Diseases, 9th Revision (338.2, 338.4) and 10th Revision (G89.2, G89.4) codes. Outcomes were compared using multivariable logistic regression. The patient-reported outcome measures included Knee injury and Osteoarthritis Outcome Score (KOOS) Pain, Physical Function Shortform, Joint Replacement (JR), and Veterans RAND 12-Item Mental Component Score. Minimal clinically important difference and patient acceptable symptom state thresholds were assessed. RESULTS:Chronic pain was present in 23.4% (3,258 of 13,894) of patients. These patients had higher odds of 90-day readmission (OR [odds ratio] 1.27, 95% CI [confidence interval]: 1.1 to 1.46; P < 0.001) but were less likely to have a length of stay ≥ two days (OR 0.85, 95% CI: 0.76 to 0.95; P = 0.004). There was no significant association found with nonhome discharge (P = 0.301). Patients who had chronic pain had increased odds of failing to reach minimal clinically important difference in KOOS JR (OR 1.2, 95% CI: 1.0 to 1.43; P = 0.049) and Veterans RAND 12-Item Mental Component Score (OR 1.15, 95% CI: 1.03 to 1.29; P = 0.01). They were also more likely to fail patient acceptable symptom state thresholds in KOOS Pain (OR 1.25; P < 0.001), Physical Function Shortform (OR 1.22; P < 0.001), and JR (OR 1.28; P < 0.001). In addition, chronic pain patients had higher odds of dissatisfaction at one year (OR 1.17, 95% CI: 1.04 to 1.32; P = 0.011). CONCLUSIONS:Chronic pain was independently associated with increased 90-day readmission risk and poorer postoperative outcomes, including failure to reach clinically relevant pain relief, functional improvement, and satisfaction. These findings highlight the need for targeted preoperative optimization strategies for chronic pain patients undergoing TKA. LEVEL OF EVIDENCE:III (prospective).

Background:Arthroscopic meniscectomy (AM) is a common procedure in middle-aged adults with degenerative meniscal tears. As many of these patients eventually require total knee arthroplasty (TKA), concerns have emerged regarding the potential impact of prior AM on TKA outcomes. This study evaluated whether a history of ipsilateral AM is associated with increased short- and mid-term complications following TKA. Methods:Using the PearlDiver national database, adult patients who underwent primary TKA for osteoarthritis between 2016 and 2022 with 1-year of follow-up and laterality available were identified (n = 1,152,444). Patients with prior ipsilateral AM were matched 1:1 to controls without prior AM based on age, sex, comorbidities, and year of surgery (n = 40,341 per group). Multivariate logistic regression was used to evaluate 90-day healthcare utilization (emergency department visits, reoperations, and readmissions) and 1- and 2-year revision risks (all-cause, septic, and aseptic). Results:Approximately 3.5 % of TKA patients had prior AM. Patients with prior AM had significantly higher rates of 90-day emergency department visits (OR, 1.23; 95 % CI, 1.18-1.29), reoperations (OR, 2.10; 95 % CI, 1.95-2.27), and readmissions (OR, 1.43; 95 % CI, 1.32-1.55) (all p < 0.001). At 1-year post-TKA, these patients had increased odds of all-cause revision (OR, 2.47), revision for PJI (OR, 2.15), and aseptic revision (OR, 2.62). These risks remained elevated at 2 years: all-cause revision (OR, 2.83), revision for PJI (OR, 2.33), and aseptic revision (OR, 3.06) (all p < 0.001). Conclusions:Prior ipsilateral AM is associated with significantly increased risks of short- and mid-term complications following primary TKA, including reoperations, readmissions, and both septic and aseptic revisions. These findings highlight the need for careful patient counseling and surgical planning in patients with a history of meniscectomy. Level of evidence:Level III; Retrospective cohort study.

Background The Centers for Medicare & Medicaid Services (CMS) has implemented the Patient-Reported Outcomes Performance Measure policy to assess the quality of total joint arthroplasty. However, the representativeness of this policy of the entire total knee arthroplasty (TKA) population remains uncertain. We aimed to compare characteristics, completion rates for the CMS-mandated variables, and achievement of substantial clinical benefit (SCB) threshold between inpatient Medicare and non-Medicare TKA patients. Methods A prospective cohort of 4,301 primary inpatient TKAs between 2016 and 2022 from a single health care system was analyzed. The cohort was divided into Medicare (n = 2,812), Medicaid (n = 197), commercial (n = 1,232), workers’ compensation (n = 15), and self-paid (n = 45) groups. Demographics and 1-year Knee Injury and Osteoarthritis Outcome Score-Joint Replacement were compared between groups. The SCB for Knee Injury and Osteoarthritis Outcome Score-Joint Replacement was defined using the proposed threshold by CMS. Results Medicare patients accounted for 65% of the total cohort, whereas commercial, Medicaid, self-paid, and workers’ compensation groups represented 29, 5, 1, and 0.3%, respectively. Medicare patients were older (median age 72, P < 0.001) with a higher proportion of patients who had a Charlson Comorbidity Index of ≥ 2 (40%, P < 0.001). Baseline patient-reported outcome measures (PROMs) capture rates were highest in the commercial group (93%), followed by self-paid (90%). At 1-year post-TKA, PROMs capture rates were highest in Medicare and commercial groups (77% each). Non-Medicare patients had higher odds of not achieving SCB-joint arthroplasty than Medicare patients (odds ratio = 1.3, P = 0.02). Conclusions Medicare patients constituted two-thirds of inpatient TKA cases, were older, had more comorbidities, different PROMs capture rates, and higher odds of meeting CMS SCB-joint arthroplasty thresholds than non-Medicare groups. To improve the application of the new CMS policy, accounting for these disparities is essential. Level of Evidence III.

BACKGROUND:Given improved treatments and prolonged life expectancy, the number of patients who have heart failure (HF) and undergo total hip arthroplasty (THA) will likely increase; however, few studies evaluate patient-reported outcome measures (PROMs) after THA among these patients. This study aimed to 1) compare achievement of clinically relevant PROM thresholds after THA between HF patients and patients who do not have HF, and 2) report health-care utilization after THA between these patient cohorts and HF patients who have various ejection fraction percentages (EF%). METHODS:A prospective cohort of 10,590 primary THA patients at a tertiary center was included. A total of 372 patients had HF and were categorized by EF%: preserved (≥ 50%), mildly reduced (41 to 49%), and reduced (≤ 40%). The PROMs included the Hip Injury and Osteoarthritis Outcome Score for Pain (HOOS-Pain), Hip Disability and Osteoarthritis Outcome Score-Physical Function (HOOS-PS), and Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) with minimal clinically important differences (MCIDs) and patient-acceptable symptom state (PASS) thresholds. Health-care utilization outcomes included prolonged length of stay (LOS), nonhome discharge disposition (DD), mortality within one year, and others. A multivariable linear regression modeled predictors of PROMs and utilization outcomes. All tests were two-sided, with a significance level of 0.05. RESULTS:Despite lower median PROMs among HF patients at one year, similar proportions of patients who have and do not have HF achieved HOOS minimal clinically important differences. However, greater proportions of HF patients failed to achieve PASS thresholds for HOOS-Pain (P = 0.006), HOOS-Physical Function (P = 0.003), and HOOS-Joint Replacement (P = 0.005). Also, greater proportions of HF patients experienced length of stay (P < 0.001), discharge disposition (P < 0.001), and mortality within one year (P < 0.001). Heart failure, but not EF%, was a significant predictor of length of stay (P < 0.001), discharge disposition (P = 0.003), and 1-year mortality (P = 0.008). CONCLUSIONS:Despite lower PROMs and increased utilization, HF patients, like non-HF patients, can expect perceived improvements in pain and function after THA. While HF predicted healthcare utilization, EF% was not associated with these outcomes.

INTRODUCTION:Total joint arthroplasty (TJA) is evolving with new technologies and techniques introduced in fellowship training, but the effect on surgeons' future practices remains unclear. We assessed current practice patterns and influential factors among fellowship-trained arthroplasty surgeons. METHODS:An electronic survey was sent to all currently practicing surgeons (n = 90) who had completed a high-volume adult reconstruction fellowship at a single tertiary academic center from 1986 to 2022. The survey consisted of 73 questions regarding surgeon and practice characteristics for primary and revision total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty. Data were tabulated and analyzed in REDCap software. RESULTS:The survey was completed by 53 surgeons (59%): 46% had been in practice for 0 to 5 years, 32% for 6 to 10 years, and 21% for 11 to 20 years. Overall, 81% performed at least 100 THAs, and 77% performed at least 150 TKAs annually. Revision TJA constituted 0% to 20% of surgical practice for 70% of surgeons, whereas 30% performed revision TJA in 21% to 40% of cases. The most common approach for THA was direct anterior (28/53, 53%), followed by posterior (22/53, 42%). Fellowship experience was the most influential factor on the choice of THA approach (57%), as well as on the choice of THA (64%) and TKA (57%) implants. Among surgeons with access to robots, 52% did not perform any robotic THAs, whereas 27% performed more than 80% of their THAs robotically. By contrast, 64% of surgeons performed more than 80% of their primary TKAs robotically, and only 13% did no robotic TKAs despite having access to a robot. CONCLUSION:Fellowship experience was the primary factor influencing approach and implant choices in both THA and TKA, highlighting its notable effect on shaping trainees' future practices. Therefore, fellowship programs should offer exposure to diverse technologies and techniques to enable informed decision making.

BACKGROUND:This study sought to evaluate (1) clinically meaningful improvements in patient-reported outcome measures, (2) self-reported satisfaction, and (3) health care utilization among patients undergoing total knee arthroplasty (TKA) with and without a preoperative psychiatric diagnosis. METHODS:Patients undergoing elective primary, unilateral TKA at a single tertiary academic medical center in the United States between 2016 and 2022 were included. Preoperative psychiatric diagnoses included anxiety, bipolar disorder, depression, posttraumatic stress disorder, psychosis, substance abuse, and "multiple diagnoses." A total of 13,894 patients who had 14,900 TKAs were included in the study. There were 3,830 patients (28%) who had a preoperative psychiatric diagnosis. The patient-reported outcome measure scores included the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale, Physical Function Shortform (KOOS-PS), and Joint Replacement (KOOS-JR). RESULTS:Psychiatric disease was independently associated with failure to achieve minimal clinically important difference in KOOS-PS (P = 0.016), as well as failure to achieve PASS in KOOS pain (P = 0.016), KOOS-PS (P = 0.014), and KOOS-JR (P = 0.002). Subgroup analysis demonstrated that patients who had multiple psychiatric diagnoses had even higher odds of failing to achieve PASS for KOOS-JR (P = 0.001). Patients who had mental health conditions were also 19% less likely to be satisfied at 1-year (P = 0.005). Also, patients who had a preoperative psychiatric diagnosis were more likely to experience a prolonged length of stay (P = 0.009), nonhome discharge (P < 0.001), and 90-day hospital readmission (P < 0.001). CONCLUSIONS:Over a quarter of individuals undergoing TKA have a preexisting mental health condition. Psychiatric disease was an independent predictor of failure to achieve clinically meaningful improvements in knee pain, function, and satisfaction after surgery and was significantly associated with increased health care utilization. A multidisciplinary approach to preoperative mental health optimization and postoperative surgical care may help.