The decline in air quality from wildfires is known to have detrimental health impacts locally, but less is known about the effects far from the source. To address this gap, we analyzed visits to the University of Virginia Emergency Department from 2017 to 2023 by examining the impact of elevated PM2.5 levels on respiratory visits. For this analysis, high exposure days were defined as those with PM2.5 levels 2 or more standard deviations above the 2017–2023 average, specifically during the summer of 2023 when the Québec wildfires plume was advected over central Virginia. The results showed higher odds ratios on high PM2.5 days compared to dates with normal exposure (1.190 [1.026,1.380]). This result was observed in males (1.388, [1.122,1.716]) and in white individuals (1.220 [1.009, 1.475]). Additionally, a comparison of mean ED visit departures (detrended and deseasoned) revealed that same day respiratory visits were significantly elevated on high exposure days (mean departure difference = + 1.886, p = 0.027). These findings indicate that wildfires can have measurable health impacts in areas far from their origin.

BACKGROUND:Randomized controlled trials (RCTs) remain the gold standard for evaluating the efficacy and safety of novel interventions. This systematic review assessed the current quality of hip and knee arthroplasty RCTs using a modified Jadad scale, along with other key metrics, including trial registration and conduct of power analyses. METHODS:PubMed was queried in May 2024 to identify hip and knee arthroplasty RCTs published from 2014 through 2023 in four leading orthopaedic journals. Each RCT was scored using a modified Jadad scale, which assesses randomization, blinding, and participant withdrawal, categorizing studies into low, moderate, or high quality. Chi-square analyses were used to assess associations between article characteristics. RESULTS:Of 566 RCTs, 47.5% were graded as high quality, 39.8% as moderate quality, and 12.7% as low quality according to the modified Jadad scale, largely due to a lack of double blinding. Low or moderate quality was more common in RCTs that reported industry funding (relative risk, 1.27; 95% confidence interval, 1.08 to 1.49; P = 0.006) or those focused on surgical technology (relative risk, 1.65; 95% confidence interval, 1.42 to 1.90; P < 0.001). Trial registration was not reported in 41.2% of articles, funding statements were not identified in 22.3% of RCTs, and a priori power analyses were not conducted in 16.3% of RCTs. Of the 474 RCTs that did conduct a power analysis, 130 (27.4%) did not retain enough patients to meet sufficient statistical power per their power analyses. Among these 130 studies, 77 (59.2%) did not identify any statistically significant difference between groups. CONCLUSIONS:More than half of recent hip and knee arthroplasty RCTs were of low to moderate quality, with notable deficiencies in blinding, trial registration, and power analyses. Continued efforts to improve methodological rigor and transparency are essential to advance the quality and credibility of arthroplasty research.

BackgroundFew studies have investigated return to play after surgical stabilization of syndesmotic injuries without fracture with minimal data on patient-reported outcome measures. The purpose of this study was to evaluate patient-reported outcomes, patient satisfaction, and return to play after surgical repair of syndesmosis injuries in competitive athletes.MethodsA retrospective review of competitive athletes who underwent surgery for an unstable syndesmosis was performed. Patients were excluded if they were not competitive athletes or had the presence of a concomitant fracture. Patient-reported outcome measures were collected via telephone questionnaires. These included the Foot and Ankle Ability Measure (FAAM) Sports Subscale as well as 7 other questions regarding subjective assessment of function, patient satisfaction, and return to play.ResultsA total of 29 ankles in 28 competitive athletes were included. Twenty-four of 28 (86%) patients were male, and 4 of 28 (14%) patients were female. Average age at surgery was 20.7 ± 2.4 (15-24). Twenty-five of 28 (89.3%) athletes completed the post-operative telephone questionnaire with a mean follow-up of 41 months (minimum 9 months). In total, 100% of patients returned to athletic activity. Nineteen of 20 patients (95%) eligible to do so returned to competition, with 16 of 25 (64%) patients reporting a return to pre-injury level of function. The average FAAM-sports score was 29.6 (max 32) ± 3.5. Twenty-four of 25 patients reported post-operative function as normal or nearly normal. Twenty-four of 25 patients reported that they were either very satisfied or satisfied. Patient-reported time of return to unrestricted play was 19.9 ± 9.8 weeks. Injury grade, repair technique, acuity of injury, and concomitant injuries were not associated with prolonged return to play or decreased FAAM scores.ConclusionA high percentage of competitive athletes undergoing surgical treatment of syndesmosis injury were able to return to their previous level of competition, with nearly all achieving good-to-excellent outcome scores and satisfaction. Severity of injury, concomitant injury, or repair technique was not found to have an effect on outcomes.Level of EvidenceIV, single-arm retrospective case series.

BACKGROUND:Surrogate end points, such as radiographic measurements or biomarkers, are often used as substitutes for clinically meaningful outcomes in arthroplasty research. However, they may not accurately reflect how a patient feels, functions, or survives, and their reliability in demonstrating true clinical benefits is uncertain. This study assessed whether randomized controlled trials (RCTs) using surrogate end points as primary outcomes were more likely to report favorable results than those using true clinical outcomes. METHODS:The RCTs on hip and knee arthroplasty published in four leading orthopaedic journals from 2014 through 2023 were systematically identified and analyzed by multiple reviewers. The primary study outcome was classified as a surrogate end point or true clinical outcome. Study results were classified as favorable, neutral, or unfavorable to the control based on statistical significance in the primary outcome. Unadjusted Chi-square analyses were conducted to determine the relationship between primary outcome type and intervention assessment, and regression analyses were used to evaluate adjusted associations. RESULTS:Of the 566 articles, 243 (42.9%) used surrogate end points and 323 (57.1%) used true clinical outcomes as primary outcomes. The RCTs using surrogate primary outcomes were more likely to report favorable results than those using true clinical outcomes (53.1 versus 34.1%). Chi-square analyses revealed a statistically significant association between the type of primary outcome and intervention assessment, with RCTs using surrogate primary outcomes demonstrating a higher likelihood of reporting favorable interventions (relative risk, 1.56; 95% confidence interval, 1.29 to 1.89; P < 0.001). The RCTs focused on surgical technology were more likely to utilize surrogate primary outcomes (relative risk, 1.52; 95% confidence interval, 1.27 to 1.83; P < 0.001). These associations remained significant after adjustment for study characteristics. CONCLUSIONS:The use of surrogate end points as primary outcomes in hip and knee arthroplasty RCTs is significantly associated with reporting favorable interventions compared to those using true clinical outcomes.

Introduction Bone cement implantation syndrome (BCIS) has been defined as complication of cementing implants that is characterized by intraoperative hypoxia and hypotension potentially leading to cardiac arrest and death. A BCIS grading system provides a score according to the severity of intraoperative vital sign changes. The purpose of this study was to investigate the predictive value of BCIS grade on 30-day and 1-year mortality in a modern patient cohort. Methods A retrospective review at a tertiary academic care center of all patients that underwent a total hip arthroplasty (THA) or hemiarthroplasty (HA) for acute femoral neck fracture between 2017–2024 was completed. Demographic and comorbidity data were recorded. Intraoperative anesthesia records were reviewed for vital sign changes and BCIS grade was calculated. Mortality data was collected through chart review, public obituaries, and patient phone calls. Data were analyzed using binary logistic regression and multivariate logistic regression. Results 418 patients met inclusion criteria. Of these, 197 patients were treated with THA (90 cemented stems, 107 cementless stems) and 221 patients treated with HA (204 cemented stems, 17 cementless stems). There were 125 patients with BCIS grade 0 (29.9%), 212 patients with BCIS grade 1 (50.7%), and 81 patients BCIS grade 2 (19.4%). No patients met criteria for BCIS grade 3 (complete cardiopulmonary collapse). The overall 30-day mortality was 14/418 (3.35%) and the 1-year mortality was 89/418 (21.29%). BCIS grade was not found to be associated with 30-day mortality (p=0.437) or 1-year mortality (p=0.902). Multivariate analysis showed that dementia (p=0.007) and HA (p=0.017) were associated with 30-day mortality, whereas CHF (p=0.040), aortic stenosis (p=0.033), COPD (p=0.047), cirrhosis (p=0.011), and CKD (p=0.023) were all associated with 1-year mortality. Conclusion BCIS grade was not predictive of 30-day or 1-year mortality in a modern cohort of patients undergoing THA or HA for femoral neck fracture.

Background Randomized controlled trials (RCTs) remain crucial in establishing evidence-based care, yet little is known about which studies drive the most academic and public attention. This study aimed to identify the most impactful hip and knee arthroplasty RCTs published from 2014 through 2023 using traditional citation metrics and Altmetric data as well as determining study characteristics associated with greater impact. Methods Clinically oriented hip and knee arthroplasty RCTs were identified and analyzed from 4 leading orthopedic journals published from 2014 through 2023. Article impact was assessed by citation velocity (citations per year) and Altmetric Attention Scores (AAS). Inequality in citation and AAS distributions was measured using Gini coefficients. Mann-Whitney U tests were used to explore associations between impact metrics and study characteristics such as funding and the presence of statistically significant findings. Results Among the 566 RCTs, the mean citation velocity was 5.3 citations per year, and the mean AAS was 12.3. Citation velocity and AAS were weakly correlated (r = 0.34, P < .01). Gini coefficients were 0.42 and 0.77 for citation velocity and AAS, respectively, indicating a highly unequal distribution of both scholarly and online attention. Industry funding was not associated with citation velocity (P = .988) or AAS (P = .957). However, studies with statistically significant results in the primary outcome favoring the experimental intervention had an 18% higher citation velocity than those without (P = .018). Conclusions The impact of hip and knee arthroplasty RCTs is highly skewed, with a small number of articles receiving a disproportionate amount of attention. Importantly, RCTs with statistically significant results were more likely to be cited, suggesting that favorable findings may disproportionately shape the arthroplasty literature.

Background Large observational datasets are increasingly being used to study the impact of technology on the outcomes of total knee arthroplasty (TKA). The validity of these studies is unclear, and they may be susceptible to bias. We aimed to uncover potential confounding variables for patients receiving technology during TKA. Methods A retrospective review of 1,001 consecutive patients who underwent primary TKA from 2021 to 2023 at an academic medical center was performed. All four surgeons at this institution selectively used technology (computer navigation, robotics, or augmented reality). Patient charts and radiographs were manually assessed for multiple medical and orthopedic variables. Univariate analyses were performed with Chi-square tests, t-tests/Kruskal-Wallis tests, and analysis of variance tests to compare those patients who had technology used versus those who did not. Binary logistic regression analyses were used to determine the relationship between variables from the univariate analysis with P < 0.1. Results There were 45% of the patients who had technology used during TKA. For univariate analyses, age, range of motion, preoperative Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) score, surgeon, payer, diabetes, liver disease, limb alignment, peripheral vascular disease, retained hardware, excessive bone loss, and obesity were significant variables associated with technology use (P < 0.05). For multivariate analyses, surgeon, excessive bone loss, retained hardware, and peripheral vascular disease remained significant (P < 0.05). The surgeon performing the procedure explained the greatest amount of variation in the model for whether technology was used (P < 0.001). Conclusions The surgeon performing the operation appears to be a strong confounding variable when assessing the use of technology during TKA. Administrative and registry data studies that do not adjust for the surgeon are likely confounded and may lead to misleading conclusions. Several additional variables were also identified that may further confound observational research on this topic.

BACKGROUND:Bone cement implantation syndrome (BCIS) has been characterized by hypotension and/or hypoxia during cementation of a prosthesis; however, the casual link between cement and the pathophysiology of BCIS is unclear. This study aimed to determine if there is an association between cement and the incidence of BCIS by comparing cemented versus noncemented hip arthroplasties in a modern series of patients who had a femoral neck fracture. METHODS:A single-institution multisurgeon retrospective review of 428 patients who underwent either hemiarthroplasty (HA) or total hip arthroplasty (THA) for acute femoral neck fracture between May 2017 and December 2024 was performed. Data including American Society of Anesthesiologists classification, comorbidities, type of anesthesia, operative time, and use of cement for fixation were recorded. Intraoperative anesthesia records were manually reviewed for hypoxia and hypotension, and the grade of BCIS was calculated where applicable. Data were then analyzed using multivariate logistic regressions, analyses of variances, t-tests, and Chi-square analyses. Of the 428 patients, 301 (70%) had a cemented arthroplasty (211 HAs and 90 THAs), whereas the remaining 127 (30%) had cementless implants (18 HAs and 109 THAs). Of the patients who met the BCIS criteria, 219 (51%) were grade I and 83 (19%) were grade II. RESULTS:There were no patients who were grade III (cardiovascular collapse requiring cardiopulmonary resuscitation). Of the patients who met the BCIS criteria, there was no statistical association with cemented versus cementless fixation. In the multivariate analyses, only the type of anesthesia (spinal versus general) was associated with BCIS grade I or II (odds ratio = 2.37 [95% confidence interval: 1.55 to 3.61], P < 0.001). There were no other recorded variables that reached statistical significance. CONCLUSIONS:In this modern series of patients undergoing arthroplasty for femoral neck fracture, no association was found between intraoperative BCIS and the use of cement fixation. Prior assumptions regarding BCIS may need to be reconsidered given contemporary surgical and anesthetic techniques.

BackgroundAs the need for total joint replacement increases with an aging population, there is increased attention to perioperative healthcare utilization. Efforts to mitigate complexity which may lead to deviations from successful surgical outcomes are critical, now more than ever. Analysis of predictive variables associated with increased healthcare utilization postoperatively can aid the effort to decrease emergency department (ED) visits and overall burden to the healthcare system.MethodsA retrospective review was completed of all patients with total knee or total hip arthroplasty between 2017 and 2020 at a single institution. Inclusion criteria were patients who underwent primary, elective total knee or hip arthroplasty and received a minimum of one year follow up. Zip code was used to determine the social vulnerability index (SVI) for each patient. Preoperative ED visits were collected for 90 days and 12 months prior to surgery.ResultsThere were 1,059 patients included, 193 with an ED visit 12 months prior to surgery and 45 with an ED visit 90 days prior to surgery with an average SVI of 0.50. Analysis of the postoperative outcomes demonstrated 104 patients with ED visits within 90 days following the procedure. Comparisons between SVI and all preoperative and postoperative variables demonstrated no statistical significance. Preoperative ED visit within 90 days or 12 months of surgery was associated with increased likelihood of postoperative ED visit within 90 days (p < 0.001, OR 4.64; p < 0.001, OR 3.78). Preoperative ED visit within 90 days or 12 months was also associated with increased risk of readmission (p = 0.008, OR 6.09; p = 0.005, OR 3.80) and revision surgery or reoperation (p = 0.039, OR 3.57; p = 0.041, OR 2.20).ConclusionPreoperative ED visit within 90 days or 12 months prior to surgery is a strong predictor of postoperative ED visit, readmission, and overall perioperative healthcare utilization regardless of socioeconomic factors.

Abstract To examine racial disparities in weather‐related mortality in Virginia from 2005 to 2020. An ecological descriptive study using daily mortality data from the Virginia Department of Health and weather data from the National Climatic Data Center. Generalized additive models and distributed lag nonlinear models were used to estimate the relative risk of mortality as the primary endpoint associated with temperature extremes over a 21‐day lag period, stratified by race. Black residents of the state had a higher risk of dying at both high and low temperatures compared to white residents; however, the risk was more profound with low temperatures. On the coldest days, the mortality risk for the Black population was more than three times that of the white population. Notably, the impact of cold on the Black population extended through lag day 15, while for white people, the impact only lasted through lag day 5. Heat‐related mortality risk for Black individuals also exceeded that for white individuals, but only when the minimum temperature exceeded 20°C. Racial disparities exist in weather‐related mortality in Virginia, with the Black population experiencing a disproportionately higher risk of death as well as poorer health outcomes, especially during extreme cold weather events. Policymakers should consider developing and evaluating policies that protect vulnerable communities when they are subject to weather extremes.

BACKGROUND:Discharging total knee arthroplasty (TKA) patients to post-acute care facilities remains a common practice, particularly in elderly patients who have major comorbidities. Efforts have been made to limit discharge to these facilities to avoid increased health care costs and potentially improve outcomes. The aim of this study was to compare patient-reported outcomes (PROs) of TKA patients discharging to a facility versus home. METHODS:We conducted a retrospective study using the Pulmonary Embolism Prevention after Hip and Knee Replacement database of TKA patients who were discharged to a facility or home between 2016 and 2019. Propensity score matching was used to create comparable groups of patients. The PROs, including Knee Injury and Osteoarthritis Outcomes Score (KOOS Jr) and Patient-Reported Outcomes Measurement Information System (PROMIS) global physical health (GPH), and PROMIS global mental health (GMH) were collected pre- and post-operatively. Outcomes were assessed between the two groups using general linear models. RESULTS:After propensity matching, a total of 942 patients (471 home, 471 facility) were included in the study. The KOOS Jr. scores were not significantly different between the two groups at any time point, and both groups saw significant improvement in scores from baseline to the 1-month visit. Patients discharged to a post-acute care facility had significantly worse scores on both the PROMIS GPH and GMH scores at all time points despite an initial increase from preoperative baseline. Nonhome discharge patients had declining GMH scores at the 3-month and 6-month visits, whereas in the home discharge cohort, GMH scores continued to rise. CONCLUSIONS:Our data suggest discharge disposition may influence PROs in matched patients following TKA. Similar trajectories of improvement were seen in KOOS Jr. and GPH scores. The GMH scores started lower and declined after the 1-month time point in the nonhome group. Further study is required to determine if the discharge to a post-acute care facility is causal in the declining mental health scores seen in that cohort. LEVEL OF EVIDENCE:Level III.

BACKGROUND:Physicians may choose to opt out of accepting reimbursements through the Medicare program. There is limited information on arthroplasty surgeons who elect to opt out of Medicare. METHODS:The public Centers for Medicare & Medicaid Services Opt-Out Affidavits Dataset was used to identify individual orthopaedic surgeons performing hip and knee arthroplasty who had opted out of Medicare as of February 2024. Publicly available internet pages were used to investigate individual surgeon characteristics and evaluate trends among those surgeons who opted out of Medicare over time. RESULTS:Of the 308 orthopaedic surgeons who did not accept Medicare, 85 performed hip and/or knee arthroplasty. Of these surgeons, 37% practiced in or near New York City, while 27% practiced in the Southwest United States. All practiced in urban areas. At the time of opt out, physicians had an average time in practice of 21.3 years and a median of 20 years (range, five to 46). Surgeons had an average H-index of 17.6 and a median of six (range, zero to 82). Approximately, half of the surgeons were fellowship-trained in arthroplasty. Of these, 39% completed their training at the same institution. Surgeons received a mean of $377,178 and a median of $2,520 (range, zero to $10,631,606) from industry payments in the most recent year. This includes 47 (56%) who received less than $5,000 and nine (11%) who received over $1,000,000. In addition, 53% accepted insurance plans other than Medicare, and 25% had ownership of outpatient surgery centers. Also, the annual incidence of arthroplasty surgeon opt outs was higher in 2023 than in any year previously. CONCLUSIONS:Arthroplasty surgeons who opt out of Medicare have diverse demographic, academic, and financial characteristics. Features commonly shared were geographic location and fellowship institution, while other characteristics vary substantially.

Patellar crepitus and patellar clunk syndrome are potential complications seen in patients undergoing total knee arthroplasty (TKA). The etiology of this phenomenon is incompletely understood. A retrospective chart review was performed to identify a consecutive series of patients who underwent primary TKA with either a traditional posterior-stabilized implant (group 1, 728 TKAs) or a cruciate substituting implant (group 2, 393 TKAs). All surgical procedures were performed by a single surgeon at the same institution using the same surgical technique, including selective patellar resurfacing and release of the posterior cruciate ligament. The incidence of patellar clunk requiring arthroscopic debridement was recorded. Statistical analysis was performed. The incidence of patellar clunk requiring arthroscopic debridement was significantly higher in group 1 versus group 2 (6.6% vs. 0% respectively, p < 0.001) with standardization of surgeon and technique factors, suggesting implant design is a critical variable in the development of this complication. (Journal of Surgical Orthopaedic Advances 34(1):046-049, 2025).

The pathogenesis of adrenal dysfunction (AD) in cirrhosis is incompletely understood. We aimed to evaluate potential effects of cirrhosis on hypothalamic–pituitary–adrenal axis (HPA) functionality in stable outpatients with decompensated disease. Outpatients with decompensated cirrhosis were prospectively recruited at a transplant center. Biomarkers reflective of HPA activity, glucocorticoid synthesis, cholesterol metabolism, systemic neurohormonal activity, and the immune system were measured prior to administration of a standard-dose adrenocorticotrophic hormone (ACTH) stimulation test. Adrenal dysfunction was defined as an increase in serum total cortisol level (delta TC) of < 9 µg/dL. Patients were followed for up to 12 months for assessment of clinical outcomes including portal hypertension-related decompensation, hospitalization, liver transplant, and death. Seventy-six participants were enrolled (AD 33

e23290 Background: Patients with lung cancer have increased risk of venous thromboembolism (VTE). ASCO guidelines do not support routine VTE prophylaxis but encourage use of risk-stratification tools such as the Khorana Risk Score (KRS) to determine its need. We investigated the efficacy of the KRS and examined other clinical variables including demographics, actionable genomic alterations (AGA), and treatment regimens in predicting VTE risk in a real-world population of patients with advanced lung cancer. We also determined the impact of developing a VTE on healthcare utilization and overall survival (OS). Methods: We performed a retrospective analysis of patients with advanced lung cancer treated at our institution between 2015 and 2023. Our cohort included patients with extensive stage small cell lung cancer (ES-SCLC) and stage III and IV non-small cell lung cancer (NSCLC). Patient demographics, genomics, treatment information, and outcomes were obtained via review of the medical record. Chi square analysis was used to assess the correlation between KRS and incidence of VTE. Results: 552 patients with advanced lung cancer, including 67 patients with ES-SCLC and 485 patients with NSCLC were analyzed. We observed VTE events in 123 patients (22.3%) with a median follow up period of 18.6 months. VTE occurred in 8 patients with ES-SCLC (11.9%) and 115 patients with NSCLC (23.7%). 51 patients developed deep vein thrombosis (DVT, 41.5%), 50 developed pulmonary embolism (PE, 40.7%),13 developed concurrent DVT and PE (10.6%), and 9 developed other types of VTE (7.3%). Median time to VTE was 251 days (range 39 – 1,108 days). Age less than 66 years (p = 0.0001), black race (p = 0.025), NSCLC histology (p = 0.03), and the presence of either EGFR, ALK, RET, or MET mutations were independently associated with increased risk of VTE in our patient population. Chi square analysis of VTE incidence did not show a correlation between low (0-1) and high (≥2) KRS across all patients (Pearson correlation coefficient 0.200). VTE incidence in patients on anticoagulation prior to treatment initiation was 5.6% versus 24.8% for those not on anticoagulation (p = 0.001). Among patients with a VTE, 40% had an ED visit, of which 80% resulted in hospitalization. Five hospitalized patients (4.1%) experienced thrombosis related mortality. Overall survival was not impacted by VTE diagnosis. Conclusions: KRS assigns intermediate risk (1 point) to patients with lung cancer, however, there are many distinct types of lung cancer. In our study population, KRS did not correlate with risk of VTE. We observed higher rates of VTE in patients with NSCLC vs SCLC. In patients with NSCLC, the presence of an AGA further increased their risk. Our results indicate that risk models need to account for the histologic and biologic heterogeneity among lung cancers to better identify patients at highest risk for VTE.

Background: Prior literature has demonstrated that ipsilateral hindfoot arthrodesis may increase the risk for reoperation after total ankle arthroplasty (TAA) and that simultaneous hindfoot arthrodesis with TAA could result in short-term clinical and radiologic improvements. The purpose of this study is to compare the reoperation rates after TAA with prior hindfoot arthrodesis vs simultaneous arthrodesis and TAA. Methods: Patients who underwent primary TAA were identified in the PearlDiver database. Patients were sorted into 2 study cohorts: hindfoot arthrodesis prior to TAA and simultaneous arthrodesis and TAA. Propensity matched control cohorts were identified for each study group. Multivariate analysis was conducted to account for any confounding variables and covariates when identifying differences in complications between cohorts. Results: 297 patients underwent TAA with prior hindfoot arthrodesis and 174 underwent TAA and hindfoot arthrodesis concurrently. The incidence of reoperation (13.8% vs 5.2%, P < .001) and infection (12.6% vs 5.9%, P = .011) for the simultaneous cohort was higher when compared to the matched control cohort. In contrast, there was no statistically significant difference when comparing the prior arthrodesis cohort to the matched control cohort in reoperation rates (5.1% vs 4.7%, P = .787) or infection rates (4.4% vs 4.8%, P = .734). Those undergoing simultaneous procedures had increased incidences of reoperation, wound complications, infection, and emergency department visits ( P < .0167) when compared to the TAA with prior arthrodesis cohort. Conclusion: Patients undergoing TAA and hindfoot arthrodesis concurrently were found to have higher rates of reoperation and infection when compared to the matched control cohort . In contrast, there was no difference in these rates in patients undergoing TAA with prior hindfoot arthrodesis compared with their matched control cohort. Patients undergoing simultaneous procedures had increased rates of reoperations, wound complications, infection, and emergency department visits compared to the TAA with prior arthrodesis cohort.