The Journal of Arthroplasty

Risk and Benefit Profile with Concurrent Nonsteroidal Anti-Inflammatory Drugs and Direct Oral Anticoagulants Following Total Knee Arthroplasty

2026-06-12

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed after total knee arthroplasty (TKA) for analgesia and inflammation control in conjunction with direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) prophylaxis in high-risk patients. In non-orthopaedic populations, concurrent NSAID–anticoagulant increases bleeding risk, but post-TKA safety data remain limited.

Revision Total Joint Arthroplasty at the Ambulatory Surgery Center: A Single Institutional Experience

2026-06-10

The safety and efficacy of outpatient primary total joint arthroplasty (TJA) in appropriately selected patients have been established. As rates of revision TJA (rTJA) continue to increase, there is growing interest regarding the complications and revision incidence among procedures performed in the outpatient setting. The purpose of this study was to report outcomes of revision TJA procedures performed at an ambulatory surgery center (ASC).

Jumbo Femoral Heads in Total Hip Arthroplasty: Improved Early Stability Without Added Complications

2026-06-10

Larger femoral heads have been proposed to reduce dislocation risk following total hip arthroplasty (THA). While the benefit of increasing head size from 28 or 32 mm to ≥ 36 mm is well established, it remains unclear whether jumbo (40 or 44 mm) femoral heads confer additional stability over traditional large (36 mm) heads. This study aimed to determine whether jumbo heads improve stability or alter early complication rates.

Dogma Under the Knife: Challenging the Status Quo in Primary Total Knee Arthroplasty

2026-06-10

Primary total knee arthroplasty (TKA) is among the most successful procedures in orthopaedic surgery, reliably providing pain relief, functional improvement, and durable implant survivorship. Despite these achievements, approximately 10 to 20% of patients report persistent dissatisfaction following primary TKA, even in the absence of technical failure. This disconnect between implant longevity and patient-perceived success has prompted renewed examination of the foundational principles that have historically guided TKA practice.

A Proposed Alternative Sampling Strategy for Centers for Medicare & Medicaid Services Arthroplasty Patient-Reported Outcome Performance Measure Compliance

2026-06-10

The Centers for Medicare & Medicaid Services (CMS) mandate reporting of Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) and Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR.) to support a hospital-level patient-reported outcome performance measure (PRO-PM). The current CMS requires matched pre- and postoperative PROMs for ≥ 50.0% of all eligible patients, regardless of hospital volume. This may yield unreliable performance estimates for low-volume centers and potentially biased and unnecessarily large estimates for large hospitals.

The “Distal Femoral Replacement Downgrade”: Technique of Using Bicondylar Femoral Cones with a Hinge Total Knee Arthroplasty Revision in Patients Who Have Massive Distal Femoral Bone Loss as an Alternative

2026-06-10

Massive femoral bone loss with collateral insufficiency in revision total knee arthroplasty (TKA) is often managed with distal femoral replacement (DFR), but this procedure sacrifices bone stock and carries notable risks. We described outcomes of a bone-preserving alternative (the “DFR downgrade”) that pairs bicondylar, metadiaphyseal-engaging femoral cones with a hinge construct.

First Revision Total Hip Arthroplasty for Instability: 10-Year Outcomes and Risk Factors Associated with Re-Revision

2026-06-10

Recurrent instability remains a leading cause of failure after revision total hip arthroplasty (rTHA). This study assessed the 10-year survivorship of the first rTHA when undertaken for instability and identified factors associated with failure.

How Do Operating Room Timings Differ Between Anterior and Posterior Approaches for Total Hip Arthroplasty

2026-06-09

Total hip arthroplasty (THA) is commonly performed using either an anterior- or posterior-based approach (AA or PA), with similar long-term outcomes. However, operative timings, including time for patient positioning, device implantation, wound closure, and total operating room (OR) time, may differ between these approaches. This study assessed differences in various OR timings between AA and PA for primary THA.

Comparing Clinical and Radiological Outcomes for a Three-Dimensional Printed Highly-Porous Cup and a Hydroxyapatite-Coated Non-Highly-Porous Cup in Total Hip Arthroplasty Using Propensity Score Matching

2026-06-09

The use of highly-porous acetabular components in total hip arthroplasty (THA) has gained popularity. To elucidate the clinical and radiological outcomes of three-dimensional (3D)-printing highly porous cups, we compared highly-porous cups and hydroxyapatite (HA)-coated non-highly-porous cups in computed tomography (CT)-based navigated THA.

Factor XI and XIa Inhibitors for Venous Thromboembolism Prophylaxis After Total Knee Arthroplasty: A Review From Mechanism to Phase III Trials

2026-06-09

Venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA) has improved substantially, yet the field continues to balance two competing priorities: reduction of symptomatic deep vein thrombosis and pulmonary embolism while minimizing bleeding, wound complications, and downstream infection risk. Contemporary practice has shifted toward aspirin as prophylaxis for many low-risk patients after TKA, with direct oral anticoagulants (DOAC) and low-molecular-weight heparin (LMWH) reserved for higher-risk patients; however, these agents still affect common-pathway thrombin generation and can increase bleeding or compromise wound healing.

Aspirin is Associated with Improved Venous Thromboembolism Prophylaxis Compared with Anticoagulants After Total Hip Arthroplasty in Patients Who Have Prior Hematologic Malignancy

2026-06-09

Patients who have prior hematologic malignancies undergoing total hip arthroplasty (THA) have elevated venous thromboembolism (VTE) risk. Although guidelines favor low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) in high-risk patients, these agents may increase bleeding and wound complications. Evidence supporting aspirin in this population remains limited.

Intraosseous Sustained-Release Anesthetics Promote Early Ambulation and Functional Recovery after Total Knee Arthroplasty

2026-06-09

Postoperative pain is a primary impediment to functional recovery in patients who undergo total knee arthroplasty (TKA).This work aimed to evaluate the efficacy of intraosseous sustained-release anesthetics, administered into the subchondral trabecular space before the insertion of a prosthesis during TKA, in promoting early ambulation and functional recovery.

Outcomes of Total Hip Arthroplasty Based on Surgeon Fellowship and Case Volume

2026-06-08

Total hip arthroplasty (THA) is a highly successful procedure performed by orthopaedic surgeons of various fellowship training, case volumes, and practice types. This study aimed to compare postoperative outcomes between fellowship-trained (FT) arthroplasty and non-arthroplasty surgeons, stratified by low, intermediate, and high case volume. Outcomes were collected for up to two years postoperatively: 1) mechanical complications (dislocation, aseptic loosening, and periprosthetic fracture (PPFX)), 2) infectious complications (periprosthetic joint infection (PJI) and surgical site infection (SSI)), 3) aseptic revision, and 4) venous thromboembolism (VTE).

Functional Outcomes, Complications, and Survivorship After Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Cohort Study with a Median Follow-up of 4.6 Years

2026-06-08

Simultaneous bilateral total hip arthroplasty (sbTHA) offers the advantages of single-stage treatment for end-stage bilateral hip disease, but raises concerns about increased perioperative risk and implant survivorship. This study aimed to evaluate functional outcomes, complications, and implant survivorship following sbTHA under contemporary perioperative protocols with a median follow-up of 4.6 years.

Does An Isolated Elevated Erythrocyte Sedimentation Rate Warrant Further Work-Up for Periprosthetic Joint Infection After Total Joint Arthroplasty?

2026-06-05

Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are widely used as screening tools for periprosthetic joint infection (PJI) following total knee and hip arthroplasty (TKA and THA, respectively). However, the significance of an isolated elevated ESR with a normal CRP, especially in cases with low clinical suspicion, remains unclear.

A Concise Update on Decision-Making and Optimal Techniques in Revision Total Hip Arthroplasty

Anna Cohen-Rosenblum, Nathanael Heckmann, Andrew Manktelow, Fares Haddad — 2026-06-04

This symposium from the 2025 American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting contains an overview of concepts and techniques to use during revision total hip arthroplasty (THA).

Subsidence Starts Distally: Scaffolding Versus Reconstitution Closure of the Extended Trochanteric Osteotomy in Revision Total Hip Arthroplasty

2026-06-03

Extended trochanteric osteotomy (ETO) facilitates safe removal of well-fixed femoral stems during revision total hip arthroplasty (rTHA). The optimal ETO closure method, scaffolding (open ETO during canal preparation) or reconstitution (ETO reduced prior to preparation), remains unclear, especially regarding subsidence of tapered splined titanium stems (TSTS). We evaluated the impact of the ETO closure technique on postoperative TSTS subsidence, hypothesizing no significant difference.

Does Preoperative Air Travel Increase Infection Risk After Total Knee Arthroplasty? A Propensity-Matched Analysis

2026-06-03

Infection after total knee arthroplasty (TKA), particularly periprosthetic joint infection (PJI), is a serious complication associated with high morbidity, revision, and healthcare burden. Although venous thromboembolism has been linked to perioperative air travel, little is known about infection risk. This study sought to clarify whether preoperative air travel is associated with (1) PJI at 90 days and two years, (2) superficial surgical site infection (SSI) at 30 and 90 days, and (3) septicemia at 30 and 90 days.

Retrospective Review of Outcomes of Conversion Total Hip Arthroplasty Following Failed Internal Fixation at Mean 3.1-Year Follow-Up

2026-06-02

Conversion total hip arthroplasty (THA) following failed open reduction and internal fixation (ORIF) of a hip fracture is a challenging and complex procedure. While outcomes and surgical considerations of primary and revision THA are well-reported in the literature, conversion THA remains far less studied. This study evaluates the three- to five-year survivorship and clinical outcomes of conversion THA following failed ORIF to treat a hip fracture.

Is Fretting Corrosion at the Modular Junction of Revision Total Knee Arthroplasty Actually a Problem?

2026-06-02

Corrosion at modular junctions in total knee arthroplasty (TKA) implants is recognized, but its clinical relevance remains unclear. This study evaluated corrosion at modular stem-bore junctions and examined whether severity correlated with radiographic evidence of adverse local tissue reactions or osteolysis.

The Impact of Photographic Evidence on Postoperative Range of Motion Following Total Knee Arthroplasty: A Randomized Control Trial

2026-06-02

Improved function is a key goal following total knee arthroplasty (TKA). Providing patients who have postoperative photographic evidence of their knee range of motion (ROM) may encourage engagement in rehabilitation and improve outcomes.

Advocacy 101 for the Early-Career Arthroplasty Surgeon: Payment, Policy, and Professional Sustainability

2026-06-01

Modern hip and knee arthroplasty surgeons graduate prepared to manage complex deformity, revision surgery, complications, and high-volume clinical practice—but often receive little formal preparation for the payment and policy systems that determine whether that care remains accessible and sustainable. For early-career surgeons, this gap between clinical work and reimbursement reality can feel confusing, frustrating, and outside their control. Yet payment policy directly shapes patient access, practice viability, workforce morale, and professional autonomy.

Preoperative Nutritional Labs Are Infrequently Obtained and Weakly Associated with 90-Day Reoperation Following Total Knee Arthroplasty

2026-05-28

Preoperative optimization is an established practice for reducing complications following total knee arthroplasty (TKA). Several publications have recommended specific laboratory studies for nutritional assessment. We aimed to evaluate the frequency these labs are obtained and their association with 90-day reoperation rates.

Trends in Reimbursement for One- Versus Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection

2026-05-28

Emerging evidence suggests similar efficacy of one- and two-stage revision for periprosthetic joint infection (PJI). However, there is concern that extended surgical time and lower reimbursement for one-stage exchange may disincentivize surgeons from performing this procedure.

Statistical Choices in Propensity Score Matching Influence the Conclusions in Arthroplasty Outcomes Research

2026-05-28

Randomized controlled trials (RCTs) provide the most rigorous framework for evaluating treatment effects, yet their cost, logistical complexity, and ethical constraints often limit their feasibility, especially in surgical research. As a result, much of the arthroplasty literature is based on retrospective observational studies, in which differences in patient characteristics between treatment groups must be addressed to permit a valid comparison. Propensity score matching (PSM), first described by Rosenbaum and Rubin, was developed to address the bias arising from measured confounders (1).

Outcomes of Total Hip Arthroplasty for Painful Spastic Hip in Patients Who Have Cerebral Palsy: A Retrospective Cohort Study with Two to Eight Years of Follow-up

2026-05-28

Hip dislocation associated with increased spasticity is a frequent condition in patients who have cerebral palsy (CP) that contributes to the early development of osteoarthritis (OA) and pain in this population. Total hip arthroplasty (THA) has been established as an effective treatment for osteoarthritis; however, there remains limited evidence on clinical outcomes and complication rates in patients who have CP. The purpose of our study was to evaluate the outcomes beyond two years after THA in patients who have CP and painful spastic hips.

Results of a Novel Modular Plating System for Periprosthetic Fractures Around the Hip: A Multi-Center Experience

2026-05-28

Periprosthetic femur fractures (PPFFs) around a total or hemi hip arthroplasty present complex fixation challenges, particularly when preserving a well-fixed femoral stem. Traditional laterally based plates may be limited by contouring demands and implant bulk. A novel modular periprosthetic plating system was developed to enhance intraoperative flexibility and anatomic fit. The purpose of this study was to assess clinical and radiographic outcomes of patients who had PPFFs treated with a modular, periprosthetic plating system.

Introduction to the 2025 Hip Society Proceedings and 2026 Awards

Christopher L. Peters, Steven MacDonald — 2026-05-27

Welcome to the Hip Society Proceedings, a collection of scientific work emerging from the 2025 Hip Society Members Meeting held September 25 to 27, 2025, in Toronto, Ontario, Canada. The meeting brought together leaders in hip surgery and musculoskeletal research for several days of scientific exchange, thoughtful discussion, and collaboration centered on advancing patient care and improving outcomes for individuals with hip disorders.

Time to Reimplantation: Waiting Longer May Increase the Risk of Subsequent Failure

2026-05-27

To date, few studies in the orthopaedic literature have evaluated the association between the time from resection arthroplasty to reimplantation and subsequent outcomes following completion of a two-stage exchange. The purpose of this study was to evaluate the impact of time to reimplantation on the risk of failure in two-stage exchange patients.

High and Sustained Release of the Novel Echinocandin Rezafungin from Bone Cement: An In Vitro Comparison with Liposomal Amphotericin B and Micafungin

2026-05-27

Fungal periprosthetic joint infections (PJIs) are difficult-to-treat infections due to the complexity of fungal biofilm and to the limited number of antifungal agents that both elute effectively and remain active when incorporated into polymethylmethacrylate (PMMA) bone cement. Rezafungin (REZA), a next-generation, long-acting echinocandin with antibiofilm activity, may overcome these limitations. This study evaluated the in vitro elution kinetics of REZA from PMMA, assessed whether antibiofilm activity was maintained after elution, and compared its performance with micafungin (MICA) and gold standard liposomal amphotericin B (AmB).

Development of Machine Learning Algorithms Predicting Psychological Distress After Total Joint Arthroplasty

2026-05-27

Psychological distress is associated with suboptimal outcomes after total joint arthroplasty (TJA). This study aimed to develop and evaluate machine learning (ML) models to predict a high psychological distress phenotype using only preoperative data.

Patient-Specific Flanged Acetabular Component Failure is Associated with Excess Lateral Position Relative to Planned Position and Excess Cranial Position Relative to Anatomic Hip Center

2026-05-27

Patient-specific custom flanged acetabular components (CFACs) are custom implants used in complex acetabular revision. Although CFACs are designed for precise positioning, accurate placement can be challenging. It is unclear whether placement accuracy of CFACs impacts aseptic loosening and survivorship. This study aimed to 1) evaluate accuracy of CFAC placement relative to (a) planned position and (b) anatomic hip center (AHC), and 2) determine whether placement accuracy is associated with radiographic failure or re-revision.

A Randomized Controlled Trial to Compare a Mobile Bearing Cementless and Cemented Unicompartmental Knee: Results of an Investigational Device Exemption Study in the United States

2026-05-26

Cementless implants have seen a resurgence in knee arthroplasty to improve long-term bone fixation. The purpose of this study was to report the results of the United States (US) Investigational Device Exemption (IDE) study comparing the mobile bearing cementless and cemented unicompartmental knee arthroplasty (UKA).

How Long is Orthopaedic Team Work Time During the Surgical Encounter for Outpatient Total Joint Arthroplasty?

Kent R. Kraus, Evan R. Deckard, Leonard T. Buller, R. Michael Meneghini — 2026-05-23

Outpatient total joint arthroplasty (TJA) volume has increased substantially, while cuts to reimbursement for primary TJA have been continually reduced by the Centers for Medicare & Medicaid Services (CMS). This study quantified the total time an orthopaedic team dedicated to patient care on the day of surgery for outpatient primary TJA.

Impact Of Prior Bariatric Surgery Versus Immediate Total Knee Arthroplasty On Knee Function Among Patients Who Have Severe Obesity And Advanced Knee Osteoarthritis: The SWIFT Trial

2026-05-23

Severe obesity and its association with advanced knee osteoarthritis are established risk factors for surgical complications and associated costs of total knee arthroplasty (TKA). This clinical trial examines the functional knee outcomes of severely obese patients who have severe knee osteoarthritis undergoing bariatric surgery versus immediate TKA and examines the impact of surgical weight loss on the pursuit of TKA.

Ipsilateral Knee Reoperation Rates Following Patello-Femoral Arthroplasty: Analysis of a Statewide Database

Amanda Avila, Sallie Yassin, Kobe Rodney, Julia Spang, Joseph A. Bosco — 2026-05-23

Patello-femoral arthroplasty (PFA) is a mainstay treatment of isolated patello-femoral osteoarthritis (PFOA). Despite comparable outcomes to total knee arthroplasty (TKA), the reoperation rate following PFA remains poorly characterized in the literature. This study aimed to determine the cumulative incidence and temporal patterns of ipsilateral knee reoperation following primary PFA.

Differential Effects of Degenerative Spine Disease and Spinal Fusion on the Risk and Progression of Hip Osteoarthritis: A Nationwide Time-Varying Cohort Study

2026-05-22

The hip and lumbar spine function as an integrated biomechanical unit, and spinal pathology may influence hip joint loading. However, population-level evidence regarding whether lumbar degeneration or spinal fusion increases the risk of hip osteoarthritis (HOA) remains limited. The purpose of this study was to investigate whether degenerative spine disease and spinal fusion are associated with the incidence and progression of HOA in a nationwide cohort.

Early Postoperative Gait Metrics After Superior Transverse Anatomic Reconstruction (STAR) Versus Direct Anterior Total Hip Arthroplasty: A Prospective Comparative Study

2026-05-22

The direct anterior approach (DAA) is a widely used muscle-sparing technique for total hip arthroplasty (THA) designed to minimize soft-tissue injury and support early recovery. The Superior Transverse Anatomic Reconstruction (STAR) approach is a piriformis-preserving modification of the postero-lateral approach that aims to combine the visualization advantages of posterior access with the muscle-sparing benefits of DAA. This study evaluated whether piriformis preservation through the STAR approach achieves early postoperative gait symmetry and spatio-temporal recovery comparable to DAA THA.

Cemented Femoral Stem Design Is Not Associated With Differences in All-Cause Revision or Specific Failure Modes After Total Hip Arthroplasty for Femoral Neck Fracture

2026-05-22

Cemented stem fixation in total hip arthroplasty (THA) for femoral neck fracture (FNF) has increased in utilization. Cemented stems reduce the periprosthetic fracture risk compared to cementless fixation, but it is unclear whether revision varies by stem design in this cohort. We compared taper-slip versus composite beam cemented stems among FNF patients undergoing THA using a modern classification system.

Return to Sport and Exercise After Direct Anterior Approach Total Hip Arthroplasty: Minimum Five-Year Outcomes

2026-05-22

Younger, more active patients increasingly undergo total hip arthroplasty (THA) and commonly inquire about expectations and timelines regarding return to sport (RTS) and exercise. The direct anterior approach (DAA) may facilitate faster recovery and decreased instability risk, but long-term RTS data are limited.

C-Reactive Protein and Fibrinogen Dynamics are Predictors of Reinfection Risk after Explantation in Two-Stage Periprosthetic Joint Revision

J. Straub, L. Willmann, K. Staats, R. Windhager, C. Böhler — 2026-05-22

This study aimed to evaluate early postoperative changes in C-reactive protein (CRP) and fibrinogen after explantation in two-stage revision surgeries and their potential to predict early treatment failure.

One-Stage Revision Total Knee Arthroplasty for Chronic Periprosthetic Joint Infection Requiring Gastrocnemius Flap Reconstruction: A Feasibility Study Using Propensity Score Matching.

2026-05-22

A one-stage revision total knee arthroplasty (TKA) has been increasingly adopted for the treatment of chronic periprosthetic joint infection (PJI) in specialized centers. However, patients who require soft-tissue reconstruction with a gastrocnemius flap are often excluded from one-stage strategies because soft-tissue deficiency is considered a marker of advanced disease. Data evaluating the impact of flap reconstruction within a one-stage revision strategy remain limited.

Metal Block Augmented Tibial Prosthesis Construct in Primary and Aseptic Revision Cemented Total Knee Arthroplasty: Patient-Reported Outcome Measures and Implant Survival

2026-05-22

Bone loss presents a technical challenge in total knee arthroplasty (TKA). Despite increasing utilization, there is limited evidence concerning the functional outcomes and implant survivorship associated with the use of medial tibial block augments.

Can Arthroplasty Stem Influence Outcome (CASINO): A Seven-Year Follow-Up of a Randomized Controlled Trial of Stem Length in Cemented Total Hip Arthroplasty

N.D. Clement, T.R. Williamson, S. Chopra, N.E. Ohly, G.J. Macpherson, P. Gaston — 2026-05-22

To assess whether a cemented short (125 mm) polished taper slip (PTS) stem offered an equivalent hip-specific outcome, health-related quality of life (HRQoL), satisfaction, and survival compared to the standard (150 mm) stem when used for total hip arthroplasty (THA).

The Efficacy of Cefazolin Alternatives for Periprosthetic Joint Infection Prevention after Primary Total Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

2026-05-22

Periprosthetic joint infection (PJI) remains a challenging complication following total joint arthroplasty (TJA). Current guidelines recommend the use of first-generation cephalosporins for prophylactic antibiotic coverage. The primary aim of this investigation was to determine if there was a difference in the incidence of postoperative PJI between TJA patients who were treated with cefazolin and non-cefazolin prophylaxis. The secondary aim of this study was to evaluate differences among those treated with cefazolin prophylaxis and higher generation cephalosporins.

Does Obstructive Sleep Apnea Affect Complications or Patient-Reported Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis

2026-05-21

Obstructive sleep apnea (OSA) affects more than 10% of adults. Prior studies have reported conflicting findings regarding the impact of OSA on postoperative outcomes following primary total knee arthroplasty (TKA), and few have examined patient-reported outcome measures (PROMs). This study aimed to compare PROMs and postoperative complications after primary TKA in patients who had and did not have OSA using a propensity-matched analysis.

Do Cobalt-Chromium Femoral Heads Have Reduced Revision Risk Compared to Stainless Steel Metal Heads With a Single Cemented Femoral Design? A New Zealand Joint Registry Study

Jian-Sen Ng, Scott M. Bolam, Christopher M.A. Frampton, Rocco P. Pitto — 2026-05-21

In primary total hip arthroplasty (THA), a stainless steel (SS) femoral stem can often be implanted with either low-friction ion-treated (LFIT) cobalt-chromium or SS metallic heads. An LFIT head is sometimes favored for its higher Young’s modulus and lower friction, thought to reduce wear. However, combining different metals (i.e., an LFIT head with an SS alloy stem) may increase corrosion or fretting at the head-neck junction. Furthermore, LFIT heads are more expensive in some markets. This registry-based study aimed to compare survivorship and reason(s) for revision between SS femoral stems implanted using SS or LFIT heads.

The AAHKS Surgical Techniques and Technologies Award: What Is the Ideal Technique and Implant in Aseptic Revision Total Knee Arthroplasty? An Analysis of Second Revision and Component Loosening Rates From the Australian Orthopaedic Association National Joint Replacement Registry

2026-05-21

Failed total knee arthroplasties (TKAs) can be revised via a range of techniques and fixation strategies. This study assessed the cumulative percent second revision (CP2R) rates based on what components were revised and the stem extensions and porous metal augments (cones/sleeves) used.

No Improvement in Infection or Complication Rate with Extended Oral Antibiotic Prophylaxis After Primary Total Joint Arthroplasty

2026-05-21

Periprosthetic joint infection (PJI) leads to increased complications and cost after total hip and knee arthroplasty (THA and TKA). Extended oral antibiotic prophylaxis (EOA) has attracted interest as a measure to prevent PJI among high-risk patients, but efficacy and risks of additional complications are uncertain. The goal of this retrospective cohort study was to evaluate these aspects of EOA in THA and TKA.

Socioeconomic Disparities in Outcomes Following Primary Total Hip Arthroplasty: A Large Database Analysis of 2,280,000 Procedures

Alishah Ahmadi, Dhruba Podder, Margot Richards, Ethan Parisier, Daniel Zelazny — 2026-05-21

Total hip arthroplasty (THA) is one of the most common and cost-effective orthopaedic procedures in the United States, yet disparities in access, complication rates, and discharge disposition persist across socioeconomic groups. Although racial disparities after THA are well described, the influence of socioeconomic status (SES)—particularly income and insurance type—on in-hospital outcomes during the index admission remains less clearly defined. Clarifying these relationships is essential for improving equity in joint arthroplasty care.

Select Femoral Revisions Without an Extended Trochanteric Osteotomy Demonstrated Excellent 10-Year Survivorship in Over 600 Revision Total Hip Arthroplasties

2026-05-21

Modern implants, instruments, and techniques afford femoral component revision without the utilization of an extended trochanteric osteotomy (ETO) in a subset of patients. The aim of this study was to evaluate the survivorship free of any revision and reoperation, radiographic results, complications, and clinical outcomes associated with femoral revisions performed without the use of an ETO.

Monoblock and Modular Tapered Fluted Stems Versus Proximal Femoral Replacement in Revision Total Hip Arthroplasty: A Survivorship Analysis Using the Paprosky Classification

2026-05-20

Periprosthetic bone loss is often challenging in revision total hip arthroplasty (THA). This study compared survivorship of monoblock, modular, and proximal femoral replacements (PFR) across various stages of femoral bone loss.

A Novel 2.5-Dimensional Deep Learning Model for “Bone-on-Bone” Detection on Magnetic Resonance Imaging in Medial Unicompartmental Knee Arthroplasty Candidates

Changquan Liu, Hangyu Ping, Qidong Zhang, Weiguo Wang, Wanshou Guo, Cheng Huang — 2026-05-20

Accurate identification of “bone-on-bone” (BoB) osteoarthritis is critical for patient selection for medial unicompartmental knee arthroplasty (mUKA); however, the assessment remains subjective. We aimed to develop and validate a deep learning model using multi-sequence knee magnetic resonance imaging (MRI) for automated detection of isolated medial compartment BoB osteoarthritis in UKA candidates, thereby reducing avoidable indication-related failures.

Neutralization of Joint Line Obliquity Improves Early Joint Function in Valgus Coronal Plane Alignment of the Knee Phenotypes After Primary Total Knee Arthroplasty

2026-05-20

The debate between kinematic and mechanical alignment centers on whether constitutional coronal plane alignment should be preserved or “corrected.” This study examined whether changes in coronal plane alignment of the knee (CPAK) following manual total knee arthroplasty (TKA) were associated with patient-reported outcomes across constitutional phenotypes.

Outcomes of Rotational Acetabular Osteotomy Combined With Femoral Valgus Wedge Osteotomy for Osteoarthritis of the Hip: A Median 23-year Follow-Up Study of 47 Hips

2026-05-20

Rotational acetabular osteotomy (RAO) combined with femoral valgus wedge osteotomy is a joint-preserving option for patients who have developmental dysplasia of the hip accompanied by femoral head deformity, as well as for those who have advanced secondary osteoarthritis (OA). This study aimed to identify significant predictors of long-term outcomes after this procedure in a cohort with a median 23-year follow-up, with conversion to total hip arthroplasty (THA) as the primary outcome and progression to end-stage OA as the secondary outcome.

Cup-Cage and Custom Triflange Implants in Revision Total Hip Arthroplasty for Acetabular Bone Loss: A Systematic Review and Meta-Analysis

2026-05-20

Management of severe acetabular bone loss during revision total hip arthroplasty (rTHA) remains challenging. Cup-cage constructs and custom triflange acetabular components are commonly used, but comparative outcomes remain poorly defined.

Debridement, Antibiotics, and Implant Retention in Periprosthetic Joint Infection After Unicompartmental Knee Arthroplasty: A Systematic Review and Meta-Analysis

Andrzej Bałoniak, Tin Jancevski, Eduardo C. Martins — 2026-05-20

This study aimed to evaluate the effectiveness of debridement, antibiotics, and implant retention (DAIR) in treating periprosthetic joint infection (PJI) after unicompartmental knee arthroplasty (UKA).

Concordance of Dislocation Direction and Surgical Approach Is an Approach-Dependent Risk for Recurrent Instability Following Total Hip Arthroplasty

2026-05-20

Hip instability after total hip arthroplasty (THA), while uncommon, is a leading cause for revision. The purpose of the study was to quantify the risk of recurrent hip dislocation in relation to concordance of dislocation directionality and surgical approach.

Cryoneurolysis Reduces Postoperative Opioid Use in Patients Undergoing Total Knee Arthroplasty

Trevor Toavs, Vijay Sudheendra, Thomas Barrett, Brandon Lentine — 2026-05-20

Cryoanalgesia is increasingly used in total knee arthroplasty (TKA) as a non-opioid pain control modality. This study evaluated the effect of cryoanalgesia on postoperative opioid use and recovery of range of motion in patients who underwent TKA for end-stage knee osteoarthritis.

Satisfaction and Persistent Pain Outcomes after Knee Arthroplasty: A Prospective Cohort Study

2026-05-19

Knee arthroplasty relieves pain and improves function for most patients who have end-stage knee osteoarthritis (OA). However, up to one in four patients experience chronic post-surgical pain (CPSP), which is associated with opioid use, dissatisfaction, delayed recovery, and reduced quality of life. Psychological factors, such as preoperative coping and mental health, may influence these outcomes, but their role in recovery from elective knee surgery is not well understood.Our primary objective was to determine the prevalence of CPSP at six months; secondary objectives were to determine the prevalence of CPSP at three and 12 months, the prevalence of dissatisfaction and opioid use at three, six, and 12 months, and to evaluate baseline predictors of these outcomes.

Tourniquet Use Increases Harm Without Benefit in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2026-05-19

Approximately 60% of orthopaedic surgeons worldwide use tourniquets (TQ) during primary total knee arthroplasty (TKA) surgeries. Currently, there are no established guidelines or recommendations; therefore, we aimed to conduct a systematic review and meta-analysis to investigate the effects of tourniquet application.

Latent Classes of Fear of Falling Trajectories and Associated Factors Among Older Patients After Total Knee Arthroplasty: A Prospective Longitudinal Study

Yuxin Xia, Yuhang Wang, Guoli Zhang, Xuelei Li, Yun Zhang, Shoufang Xu, Ting Sun — 2026-05-19

This study aimed to examine trajectories of fear of falling (FOF) and their associated factors in older patients who underwent total knee arthroplasty (TKA) and provide evidence to tailor postoperative rehabilitation for different patient groups.

Task-Specific Electromyographic Changes in Gastrocnemius Medialis and Tibialis Anterior Muscles After Total Knee Arthroplasty

Saidan Shetty, Sandeep Vijayan, Mohandas Rao KG, Sapna Marpalli, Bincy M. George — 2026-05-19

Knee osteoarthritis causes pain, altered joint mechanics, and muscle dysfunction, often requiring total knee arthroplasty (TKA). Although quadriceps and hamstring muscle deficits after TKA are well-documented, neuromuscular adaptations of distal leg muscles remain underexplored. The gastrocnemius medialis (GM) and tibialis anterior (TA) muscles are key for dynamic stability, propulsion, and gait. Understanding their activation following TKA is vital for optimizing rehabilitation. This study evaluated task-specific electromyographic changes in GM and TA before and after TKA and their associations with clinical outcomes post-TKA.

Optimizing Anemia in Total Hip Arthroplasty: Experience with an Institutional Protocol

2026-05-19

Preoperative anemia is a modifiable risk factor in total hip arthroplasty (THA), yet standardized anemia optimization strategies remain poorly defined. This study aimed to characterize typical anemia etiologies presenting in THA patients and evaluate the performance of an institutional anemia optimization protocol.

Diverging Surgeon Distribution in Primary Versus Revision Arthroplasty: A National Analysis

2026-05-19

Total hip (THA) and total knee arthroplasty (TKA) utilization has increased substantially over the past decade, highlighting the importance of understanding how operative volume is distributed among surgeons. While prior studies have focused on consolidation at the health-system level, surgeon-level procedural concentration remains incompletely characterized.

From Consensus to Everyday Clinical Practice: Quantifying the Knowledge Translation of the 2018 International Consensus Meeting on Musculoskeletal Infection

2026-05-19

Experts from all over the world came together at the 2018 International Consensus Meeting (ICM) on Musculoskeletal Infection to discuss important issues in the identification, management, and avoidance of periprosthetic joint infections (PJI) and associated musculoskeletal infections. With the goal of harmonizing global approaches, guiding clinical practice, and standardizing definitions, the proceedings produced 71 manuscripts published in various orthopaedic subspecialties. Despite the widespread dissemination of the ICM 2018 proceedings, their scholarly influence has not been systematically quantified.

Limited Femoral Joint-Line Alteration and Preserved Extension Lateral Laxity Enhanced Early Outcomes in Restricted Kinematic Alignment Total Knee Arthroplasty

Do Weon Lee, Du Hyun Ro, Hyuk-Soo Han — 2026-05-18

Restricted kinematic alignment (rKA) total knee arthroplasty (TKA) seeks to restore native alignment while limiting excessive correction. The influence of alignment change magnitude and intraoperative gap characteristics on early patient-reported outcome measures (PROMs) after robotic rKA TKA remains unclear.

Comparative Outcomes of Modular Versus Monoblock Fluted Tapered Stems in Revision Total Hip Arthroplasty: An American Joint Replacement Registry Analysis

2026-05-18

Modular and monoblock fluted tapered femoral stems have become the workhorse in revision total hip arthroplasty (rTHA). This study compared the associated risk of all-cause revision, infection, dislocation, periprosthetic fracture (PPFx), or aseptic loosening between modular and monoblock fluted tapered stem designs.

Functional Outcomes Five to 20 Years After Total Hip Arthroplasty in Patients Under Age of 40 Years: A Comparative Study With Asymptomatic Age-Matched Controls

Sibel Bozgeyik-Bağdatli, Ezgi Çelebi, Ömür Çağlar — 2026-05-18

Total hip arthroplasty (THA), originally developed for elderly patients who have advanced hip osteoarthritis, is increasingly performed in younger adults. Despite advances in implant technology and surgical technique, functional outcomes five to 20 years after arthroplasty in this population remain limited. This study aimed to compare, at five to 20 years, functional performance, hip-related outcomes, and health-related quality of life between individuals who underwent THA before the age of 40 years and asymptomatic age-matched controls.

Clinical, Radiological, and Kinematic Impact of Gluteus Maximus Tendon Release During Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

2026-05-18

Release of the gluteus maximus tendon during a total hip arthroplasty (THA) can lead to gluteal dysfunction. Sciatic nerve injury, while rare, remains a serious complication of THA. During deep hip flexion, release of the tendon increases the distance between the femoral neck and the sciatic nerve, potentially reducing the risk of nerve injury. The functional consequences of such a release have yet to be investigated. The aim of this study was to evaluate the effects of gluteus maximus tendon release on the development of gluteal dysfunction using clinical, radiological, and kinematic measurements.

Rates of New-Onset Postoperative Heart Failure Among Type 2 Diabetics Who Use Nonsteroidal Anti-Inflammatory Drugs for Total Hip Arthroplasty

2026-05-17

Nonsteroidal anti-inflammatory drugs (NSAIDs) increase fluid retention and the risk of heart failure (HF). The NSAIDs are commonly used in total hip arthroplasty (THA) as part of a modern multimodal pain protocol, but the risk of selective cyclooxygenase-2 (COX-2)–preferential NSAIDs in THA for Type 2 diabetes mellitus (T2DM) patients, who have an increased risk for cardiac disease, is not well understood. This study aimed to compare rates of new-onset HF following THA in T2DM patients receiving perioperative meloxicam or celecoxib.

Certificate-of-Need Legislation That Targets Construction of Ambulatory Surgery Centers Is Associated With Increased Patient Migration Out-of-State for Primary Hip and Knee Arthroplasty

2026-05-13

With the migration of arthroplasty to the ambulatory surgery center (ASC) setting, it is critical to understand the impact of certificate-of-need (CON) laws limiting ASC construction on the manner patients receive care. This study examined location of care within a practice that straddles the border of a CON state (Illinois) and non-CON state (Indiana) to determine the proportion of patients traveling away from their home state for surgery. The cost of care for cases that migrated out-of-state was investigated.

Fully Hydroxyapatite-Coated, Collared, Triple-Taper Stems May Be Safe for all Patients Undergoing Primary Total Hip Arthroplasty: Minimum Two-Year Follow-Up

2026-05-13

The triple-tapered, collared, hydroxyapatite-coated stems for cementless total hip arthroplasty (THA) show a low rate of early failure and excellent performance. The purpose of this study was to evaluate the possibility of implanting these stems for any patient undergoing THA, regardless of age and bone quality.

Amyloid in Primary Hip Arthroplasty Specimens: An Opportunity for Early Detection of Amyloidosis?

2026-05-13

Recent advances in pharmacologic therapies to treat amyloidosis demand renewed focus on early identification of patients who will benefit from these therapies. Incidental detection of amyloid in orthopaedic specimens has been previously described, but the clinical significance of these findings remains unclear. Modern techniques for amyloid detection and subtyping may identify clinically relevant amyloid in routine orthopaedic specimens. The purpose of this study was to assess the prevalence of amyloid in a unique contemporary cohort of total hip arthroplasty (THA) specimens using recently recognized histologic patterns of amyloid deposition.

Low Heterotopic Ossification Recurrence Following Surgical Excision in a Total Hip Arthroplasty Population

2026-05-13

Postoperative heterotopic ossification (HO) is a rare, but important complication following total hip arthroplasty (THA). Historically, surgical HO excision has been associated with a high incidence of complications and recurrence, and data are limited to guide treatment strategies. The purpose of this study was to assess functional and radiographic outcomes of HO excision with contemporary techniques following THA.

The One-Year Postoperative Trajectories of Knee Joint Angle Recovery During Walking After Total Knee Arthroplasty in Women: A Cross-Sectional Study

2026-05-13

Total knee arthroplasty (TKA) effectively alleviates pain in end-stage knee osteoarthritis; however, postoperative functional recovery, particularly gait restoration, remains variable. Although knee range of motion typically recovers early after surgery, its relationship with patient-reported outcomes such as the Knee injury and Osteoarthritis Outcome Score (KOOS) is inconsistent. Understanding how dynamic knee joint kinematics during walking evolve over time and relate to perceived function may provide sensitive recovery indicators.

Impact of Fellow Involvement on Patient Outcomes in Total Hip and Knee Arthroplasty

2026-05-13

Total joint arthroplasty fellowships are increasingly common for surgical specialization, yet evidence regarding the impact of fellow involvement on patient-reported outcome measures (PROMs) and operative efficiency remains limited. This study evaluated if an arthroplasty fellow affects clinical outcomes or surgical theater efficiency compared to an attending surgeon operating alone.

Definition of Femoral Morphotypes Based on the Coronal Plane Alignment of the Hip Classification

2026-05-13

In total hip arthroplasty (THA), accurate reconstruction of physiological joint biomechanics is determined by the individual patient’s proximal femoral anatomy and stem design. Previous studies demonstrated a wide variation of femoral canal shapes and an association with extramedullary geometrical features. The purpose of this study was to propose a comprehensive classification for the Coronal Plane Alignment of the Hip (CPAH) that incorporates intramedullary and extramedullary parameters. We sought to determine the distribution of femoral morphotypes in an osteoarthritic cohort and to assess the reconstructive potential of four common femoral stem designs in each CPAH type.

Incidence of Early Periprosthetic Hip Fractures in Patients Over Age 70 Years Following Primary Total Hip Arthroplasty Using a Novel Triple-Tapered Collared Femoral Stem

2026-05-13

Periprosthetic hip fractures are a known complication following cementless total hip arthroplasty (THA), especially in elderly patients. A triple-tapered collared femoral stem was introduced to provide multidirectional contact, resist torsional forces, and distribute load to help reduce subsidence. The purpose of this study was to determine the incidence of periprosthetic femoral fractures with a novel triple-tapered collared femoral stem in a group of patients who were aged greater than 70 years undergoing primary THA.

Incidence of Bone Cement Implantation Syndrome Is Not Associated With Cement in a Modern Series of Patients Treated With Arthroplasty for Femoral Neck Fracture

Charles A. Engh, James R. Temple, Wendy M. Novicoff, James A. Browne — 2026-05-13

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.

10-Year Results of Metal-on-Metal Hip Resurfacing with Computer-Assisted Navigation

2026-05-13

Hip resurfacing arthroplasty is a bone-conserving alternative to total hip arthroplasty for young, active men. Femoral component malalignment is a known contributor to early mechanical failure. Computer-assisted navigation improves femoral component positioning; however, its long-term clinical impact remains uncertain. This study compared survivorship, radiographic alignment, and patient-reported outcomes between navigation-assisted and conventional hip resurfacing.

Emerging Concepts in Periprosthetic Joint Infection Research: RNA, DNA, and Protein Sequencing Tools for the Characterization and Diagnosis of Periprosthetic Joint Infection

2026-05-13

Culture-based diagnostics have been utilized historically by the orthopaedic community to help identify the causative organism for patients with periprosthetic joint infection (PJI) following total joint arthroplasty (TJA). However, conventional cultures fail to isolate the causative organisms in up to 42% of cases. This is concerning, as treatment of culture-negative PJI poses a real challenge, often requiring prolonged administration of multiple antimicrobials. Furthermore, counseling patients regarding a diagnosis of PJI, the need for multiple surgical procedures, and prolonged antimicrobial therapy without identification of a causative organism is challenging and highlights the diagnostic uncertainty that complicates prognostication, antimicrobial selection, and shared decision-making in culture-negative cases.

Should Inter-Prosthetic Screws Be Placed When Prophylactically Plating a Femur?

2026-05-13

Apposing intramedullary femoral implants can increase the risk of an interprosthetic femoral fracture. The aim of this study was to determine optimal screw configuration when prophylactically plating a femur with an interprosthetic segment of bone.

Effect of Diluent on Molecular Iodine Release From On-Site Diluted Povidone-Iodine

John P. Meehan, Zachary C. Lum, Chris Moses, Jack Kessler, Ilker S. Bayer — 2026-05-13

The global expansion of antibiotic-resistant organisms has led to a renewed interest in antiseptic principles of infection prevention. On-site dilutions of povidone-iodine (PI) with normal saline have increased substantially, but little information exists regarding the concentration of the singular active biocidal agent, i.e., molecular (free) iodine, in these formulations. The purpose of this study was to analyze the differences in the amount of molecular iodine released from on-site dilutions of five different commercially available 10% PI products and three different dilution ratios in normal saline and in sterile water.

Cementless Total Knee Arthroplasty in the Morbidly Obese Patient Using a Highly Porous Tibial Baseplate: Minimum 10-Year Follow-Up

2026-05-13

Morbidly obese patients undergoing cemented primary total knee arthroplasty (TKA) have demonstrated higher revision incidence. Cementless TKA implants have demonstrated good five-year results in this patient population. The purpose of this study was to review 10-year results of primary TKA in morbidly obese (body mass index ≥ 39.5) patients using a highly porous, cementless tibial baseplate.

Underperformance of Machine Learning Algorithms Predicting Extended Lengths of Stay and Readmission in Underrepresented Patient Cohorts After Primary Total Hip Arthroplasty

2026-05-13

The demand for total hip arthroplasty (THA) is increasing, yet disparities in access and outcomes persist across racial, ethnic, and socioeconomic groups. Machine learning (ML) models can aid in predicting THA complications such as prolonged lengths of stay (LOS) and 30-day readmission, which is particularly useful for populations at risk of poorer outcomes. However, limited studies to date have assessed ML prediction performance in smaller patient subcohorts that are less commonly represented. Therefore, this study aimed to assess the fairness and performance of ML model prediction of prolonged LOS and 30-day readmission among subcohorts of underrepresented patient groups following primary THA.

Technology-Assisted Total Knee Arthroplasty Is Associated With Faster Initial Recovery, but Similar 1-Year Outcomes: A Retrospective Cohort Study of Patient-Reported Outcomes in 2,002 Patients

Kareem Omran, Colleen M. Wixted, Daniel Waren, Joshua C. Rozell, Ran Schwarzkopf — 2026-05-12

Robotic- and navigation-assisted (RA and NA) total knee arthroplasty (TKA) systems aim to optimize surgical performance; however, their influence on the speed of functional recovery remains unclear. This study compared the time to achieve a Minimal Clinically Important Difference (MCID) among patients undergoing RA, NA, and conventional TKA using Knee injury and Osteoarthritis Outcome Score for Joint Replacement questionnaires.

Femoral Stem Collar Overhang Is Associated With Iliopsoas Impingement After Direct Anterior Total Hip Arthroplasty

2026-05-08

Iliopsoas impingement (IPI) is an underrecognized complication following total hip arthroplasty (THA), typically attributed to anterior acetabular component overhang. As modern implants have shifted toward collared stem designs, an overhanging femoral collar may also contribute to IPI. We aimed to determine whether the degree of femoral stem collar overhang is associated with IPI in direct anterior approach THA.

Standardized Sagittal Alignment Targets Fail to Restore Native Medial and Lateral Posterior Tibial Slope in Primary Total Knee Arthroplasty

2026-05-08

Prior studies report high variability of the posterior tibial slope (PTS) in patients undergoing total knee arthroplasty (TKA). However, these studies are often performed using radiographs and do not differentiate between the medial and lateral PTS. The purpose of this study was to report the medial and lateral PTS using computed tomography (CT) on patients undergoing primary TKA.

Is It Really Less Painful to Undergo Total Hip Arthroplasty than Total Knee Arthroplasty?

2026-05-08

Although total hip (THA) and knee (TKA) arthroplasties can provide pain relief in patients who have severe joint osteoarthritis, an assessment and comparison of their postoperative course of improvement in pain scores is lacking.

Accuracy of Fluoroscopic Navigation for Predicting Leg Length and Offset in Primary Hip Arthroplasty

2026-05-08

Fluoroscopic-assisted computer navigation is widely used to guide intraoperative decisions on leg length (LL) and offset in primary total hip arthroplasty (THA), but its accuracy remains under-evaluated. This study assessed the precision of a fluoroscopy-based navigation system by comparing its intraoperative predictions to validated postoperative measurements.

Reassessing Valgus Lower Extremity Alignment: Is Lateral Condyle Hypoplasia a Myth?

2026-05-08

Lower-extremity coronal alignment influences joint loading, gait mechanics, and the progression of osteoarthritis, yet the relative contributions of hip and knee anatomy remain incompletely defined. Valgus lower extremity alignment has traditionally been attributed to lateral femoral condyle hypoplasia, but the major contributor to valgus alignment and that femoral version and tibial bowing are more strongly associated with valgus deformity.

How Does Total Hip Impingement Risk During Activities of Daily Living Change With Pelvic Tilt and Spinopelvic Mobility?

Alessandro Navacchia, Matthew K. Stein, David G. Deckey, Thorsten M. Seyler — 2026-05-08

Dislocation remains one of the leading causes for revision following total hip arthroplasty (THA). With the advent of robotic technology allowing more personalized implant positioning, there is the potential to improve stability. The purpose of this study was to evaluate personalized THA postoperative risk of impingement by simulating 12 dynamic activities of daily living (ADLs) with different spinopelvic parameters.

Advanced Practice Providers in Total Joint Arthroplasty: A National Assessment Demonstrates Increasing Prevalence and Unique Practice Characteristics

2026-05-07

Advanced practice providers (APPs) are increasingly involved in surgical care delivery. This study analyzed Medicare data for total joint arthroplasty services delivered by APPs and explored their geographic distribution and practice characteristics.

The Effect of Concomitant Use of Potent Anticoagulants and Anti-Inflammatories on the Early Outcomes of Total Hip Arthroplasty

2026-05-07

Concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) in anticoagulated patients following total hip arthroplasty (THA) raises concerns about increased bleeding and related complications. This study evaluated postoperative pain, opioid consumption, and complications in anticoagulated THA patients who did and did not use concomitant NSAIDs.

Is Point of Care Three-Dimensional Printing of Polyaryletherketone Triflange Cups Feasible for Revision Total Hip Arthroplasty?

2026-05-07

Titanium three-dimensional (3D) printed triflange cups are an established treatment option for severe pelvic discontinuity, but are costly and, when produced offsite, involve weeks of surgical delay. Three-dimensional printing of polyetheretherketone (PEEK) at the point of care (POC) has recently been 510(k) cleared by the Food and Drug Administration for cranioplasty to reduce implant cost and time to treatment. We asked in this pilot study whether 3D-printed triflange cups from high-strength polyaryletherketone (PAEK) polymers like PEEK could be produced with sufficient strength for revision total hip arthroplasty and whether annealing could improve cup strength.

Surrogate End Points Are Associated With Favorable Results in Hip and Knee Arthroplasty Randomized Controlled Trials

2026-05-07

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.

Custom Three-Dimensional Printed Hemipelvis Reconstructions: Encouraging Early Results for Oncologic and Nononcologic Cases

Matthew P. Abdel, Aaron R. Owen, Oliver B. Dilger, Peter S. Rose — 2026-05-07

Additive manufacturing allows for the creation of custom acetabular components with unique shapes, geometries, and sizes for patients who have massive bone loss. The aim of the present study was to evaluate the implant survivorship, imaging results, and clinical outcomes of custom, three-dimensional (3D)-printed hemipelvis reconstructions in both the oncologic and nononcologic setting.

Open Reduction Internal Fixation of 105 Vancouver B1 Periprosthetic Femur Fractures: High Mortality at Five Years

2026-05-07

Periprosthetic femoral fractures around well-fixed femoral components in total hip arthroplasty remain challenging to treat. The purpose of this study was to report implant survivorship, clinical outcomes, and radiographic results of a large series of operatively treated Vancouver B1 periprosthetic femoral fractures.

Does the Magnitude of Change in Coronal Plane Alignment of the Knee Affect Clinical Outcomes in Functional and Mechanical Alignment Total Knee Arthroplasty?

2026-05-07

Changes to native coronal plane alignment of the knee (CPAK) phenotypes following total knee arthroplasty (TKA) may influence outcomes, particularly with mechanical alignment (MA). This relationship has not been evaluated with functional alignment (FA). This study compared the magnitude of coronal alignment change between MA and FA and whether this influenced patient-reported outcomes.

Total Hip Arthroplasty in Legg-Calve-Perthes Disease: Mean Nine-Year Outcomes of 201 Hips

2026-05-05

Legg-Calvé-Perthes disease (LCPD) is an uncommon, but challenging indication for total hip arthroplasty (THA). We aimed to report one of the largest single-center contemporary series of THA associated with this condition.

Is Inflammatory Arthritis an Absolute Indication for Patellar Resurfacing in Total Knee Arthroplasty?

2026-05-05

Inflammatory arthritis (IA) has been considered an absolute indication for patellar resurfacing (PR) in total knee arthroplasty (TKA), yet limited data supports this. The purpose of this study was (1) to compare outcomes of TKA without PR for IA and osteoarthritis (OA) and (2) to compare outcomes of TKA for IA with and without PR.

Comparative Analysis of Relaxed- and Flexed-Seated Radiographs for Assessing Spino-Pelvic Mobility in Total Hip Arthroplasty

2026-05-04

This study evaluated the comparative value of relaxed- and flexed-seated lateral radiographs in assessing spino-pelvic mobility in patients undergoing total hip arthroplasty.

Nanotechnology-Based Device Reduces Pain and Immediate Opioid Requirements and Facilitates Earlier Discharge From the Hospital Following Total Knee Arthroplasty: A Randomized Placebo-Controlled Trial

2026-05-04

Opioids are often used to control pain following total knee arthroplasty (TKA). Opioid-sparing pain relief tools are needed in the current setting of the opioid crisis. This prospective randomized placebo-controlled study assessed the ability of a nanotechnology-based device (NBD) to reduce pain and opioid consumption following TKA.

The Chitranjan S. Ranawat Award: Surgeon-Performed, Intraoperative Adductor Canal Blocks are Non-Inferior to Anesthesiologist-Performed Adductor Canal Blocks in Total Knee Arthroplasty

2026-04-30

For total knee arthroplasty (TKA) performed in an ambulatory setting, reliable analgesia is essential for same-day discharge (SDD). Although adductor canal blocks (ACBs) are effective, access to anesthesiologist-performed ACBs (aACBs) may be limited by regional anesthesia availability in resource-constrained centers. Even when expertise exists, lack of perioperative workflow integration can reduce efficiency, prolong procedural time, and increase costs. The objective of this study was to evaluate whether surgeon-performed ACBs (sACBs) are non-inferior to aACBs regarding time to discharge, perioperative outcomes, and patient-reported outcome measures.

Risk Factors Associated With Osteonecrosis of the Femoral Head After Undergoing Lumbar Decompression and Fusion

2026-04-30

Osteonecrosis of the femoral head (ONFH) after spinal fusion is poorly characterized. This study sought to identify factors associated with ONFH following lumbar, lumbo-sacral, or lumbo-pelvic fusion. We hypothesized that abnormal postoperative spino-pelvic alignment and modifiable intraoperative factors may increase ONFH risk. Furthermore, we felt these factors may reduce survivorship free from total hip arthroplasty (THA) after lumbar fusion.

Uncemented Monoblock Cups in Primary Total Hip Arthroplasty: Average 10-Year Follow-Up

2026-04-30

The use of large diameter metal-on-metal (LDMOM) heads and dual mobility (DM) articulations has reduced the risk of dislocation after primary total hip arthroplasty (THA). Furthermore, the monoblock cup versions eliminate the risks associated with modularity, such as corrosion. The purpose of this study was to determine the average 10-year outcomes and survivorship of modern uncemented monoblock cups (UMCs) in primary THA.

Outcomes of Triple-Tapered Collared Cementless versus Cemented Stems in Total Hip Arthroplasty for Femoral Neck Fracture: A Propensity Score Overlap-Weighted Cohort Study

2026-04-30

Cemented femoral fixation is recommended for arthroplasty in femoral neck fracture (FNF) because of lower periprosthetic fracture risk, but carries cement-related risks, longer operative time, and technical variability. Modern collared cementless stems have emerged as potential alternatives. This study compared a triple-tapered collared cementless stem with a collared composite beam cemented stem in total hip arthroplasty (THA) for displaced FNF. We asked: (1) Is periprosthetic fracture risk different between fixation strategies? (2) Are revision rates and survivorship different? (3) Are functional outcomes comparable? and (4) Are mortality and complications affected by fixation type?

Outcomes of Metaphyseal Versus Diaphyseal Stems in Conversion Total Hip Arthroplasty After Intramedullary Nailing

2026-04-30

Diaphyseal-engaging stems are conventionally used in conversion total hip arthroplasty (cTHA) after prior intramedullary nailing (IMN) to bypass screw holes and previously instrumented meta-diaphyses. However, it remains unclear if cementless metaphyseal or standard cemented stems can also provide satisfactory fixation in this scenario. This study compared the early outcomes of cTHA using three femoral stem designs: metaphyseal cementless, diaphyseal cementless, and standard cemented.

Controlling Leg Length Change During Total Hip Arthroplasty Using Three-Dimensional Modeling and a Single Intraoperative Distance Measurement

Alexander F. Heimann, Stephen B. Murphy — 2026-04-30

Leg length inequality following total hip arthroplasty (THA) is a major cause of patient dissatisfaction. This study evaluated the accuracy and feasibility of a workflow combining computed tomography–based preoperative planning with a single intraoperative linear distance measurement for leg length restoration in primary THA.

Who Fails? Identifying Risks for Aseptic Loosening After Cementless Total Knee Arthroplasty

2026-04-30

Cementless total knee arthroplasty (TKA) is increasingly used in younger, active patients, yet aseptic loosening remains a leading cause of failure. While biomechanical factors have been explored, large-scale data identifying patient- and surgery-specific risk factors are limited. This study aimed to identify independent predictors of aseptic loosening in cementless TKA.

The Cementless, Triple-Tapered, Collared Stem Has Minimal Proximal Femoral Stress Shielding at One Year

2026-04-30

The triple-tapered, collared (TTC) femoral stems are increasingly being used in primary total hip arthroplasty (THA) and have demonstrated favorable clinical outcomes. However, their effect on proximal femoral bone mineral density (BMD) and stress shielding remains unknown. The purpose of this study was to assess changes in proximal femoral BMD at one year following implantation of a cementless TTC stem. The secondary aims were to evaluate the influence of surgical approach and collar seating on postoperative BMD and to compare BMD changes associated with the TTC stem to those of a cementless, single-tapered, wedge-type (STW) stem.

Surgeon Experience Influences Posterior Approach Total Hip Arthroplasty Dislocation Risk, But It Is Mitigated by Robotic Assistance

2026-04-30

Dislocation remains a common complication after total hip arthroplasty (THA). While higher annual surgical volume has been associated with lower dislocation rates, the influence of surgeon experience is poorly understood. We evaluated whether early-career surgeons have higher rates of dislocation compared to experienced career surgeons and whether enabling technology, specifically computer navigation or robotic assistance (RA), mitigates this risk.

Unsupervised Machine Learning Drives Dynamic Alignment Classification in Navigated Total Knee Arthroplasty

2026-04-30

Current classifications used for total knee arthroplasty (TKA) are static and fail to capture the dynamic behavior of the limb during gait. This study introduces a novel intraoperative method to measure dynamic hip-knee-ankle (dHKA) angle using an intra-articular device coupled with a computer-assisted orthopaedic surgery system. This device applies a quasi-constant distraction force throughout the knee joint range of motion. A machine learning model was utilized to identify natural data groupings and develop a classification based on patient-specific dHKA profiles.

Postmortem Analysis of Osseointegration in Cementless Acetabular Components After Total Hip Arthroplasty: A Multimodal Study

2026-04-30

Press-fit acetabular components achieve long-term fixation through osseointegration, yet the extent of bone ingrowth necessary for durable stability in well-functioning implants remains unclear. Postmortem retrievals provide a unique opportunity to directly assess the bone-cup interface in clinically successful total hip arthroplasties (THAs). This study evaluated osseointegration and biomechanical fixation strength in deceased-donor acetabular components to better define the characteristics of stable long-term fixation.

Up to 10-Year Follow-Up of Thin Polyethylene Liners in Total Hip Arthroplasty

2026-04-30

Using thin polyethylene liners with large-diameter femoral heads in total hip arthroplasty (THA) may decrease the risk of instability. This study investigated the 1-to-10-year survivorship of thin highly cross-linked polyethylene (HXLPE) liners.

Cefazolin Alone versus Vancomycin Plus Cefazolin for Intravenous Prophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis

CaiMin Yang, CaiLing Peng, Jin Yan, Jie Chen, HaiYing Mao — 2026-04-30

Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty, leading to substantial morbidity and increased health care costs. Cefazolin is the standard agent for perioperative antibiotic prophylaxis. However, the rising prevalence of methicillin-resistant Staphylococcus aureus has prompted the use of dual prophylaxis with vancomycin and cefazolin. The efficacy and safety of this combined strategy remain controversial.

American Association of Hip and Knee Surgeons Position Statement on Opioid Use for the Treatment of Osteoarthritis of the Hip and Knee

Sumon Nandi, Ajay K. Srivastava, Charles P. Hannon — 2026-04-29

Osteoarthritis of the hip and knee is common and affects millions of patients [1]. Symptoms may include stiffness and loss of mobility, as well as pain. Managing pain in the nonoperative setting can be challenging and has been the subject of debate.

Differences and Similarities in Hip and Knee Acute Periprosthetic Joint Infections After Primary Arthroplasty Treated with Irrigation and Debridement: An International, Multicenter Retrospective Study

2026-04-29

Debridement, antibiotics, and implant retention (DAIR) are the recommended surgical treatments for acute periprosthetic joint infections (PJI). The success of DAIR has been variable due to the patient heterogeneity. This multinational study evaluated the success rate and risk factors of failure of a DAIR procedure after primary arthroplasty and was separated for total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Is There Maintenance of Preoperative Hemoglobin A1c Optimization Following Total Joint Arthroplasty in Patients Who Have Diabetes?

2026-04-29

The prevalence of diabetes mellitus in total joint arthroplasty (TJA) patients has been reported as high as 20%. While preoperative hemoglobin A1c (HbA1c) optimization has been heavily studied and associated with improved outcomes in diabetic patients undergoing TJA, there is still limited research on the sustainability of maintaining optimized HbA1C levels during the peri- and postoperative period following TJA.

Comparable Survivorship at Five Years Between Octogenarians and Younger Controls Undergoing Revision Total Knee Arthroplasty

2026-04-29

There is limited and conflicting evidence regarding the clinical outcomes of octogenarian patients following revision total knee arthroplasty (rTKA), particularly at longer follow-up intervals. This study aimed to compare (1) 90-day, (2) 2-year, and (3) 5-year outcomes between octogenarians and younger matched controls.

Postoperative Coronal Plane Alignment of the Knee Analysis Following Planned Mechanical Alignment: A Comparison of Manual, Computer-Navigated, and Robotic-Assisted Total Knee Arthroplasty

2026-04-29

The coronal plane alignment of the knee (CPAK) classification provides an objective framework for describing coronal alignment in total knee arthroplasty (TKA). Mechanical alignment (MA) traditionally aims to achieve CPAK type V, defined by neutral arithmetic hip–knee–ankle angle (aHKA) and neutral joint line obliquity (JLO). However, inconsistency in achieving this target has been reported, and the clinical value of postoperative neutral alignment remains uncertain. This study sought to (1) characterize the postoperative distribution of CPAK phenotypes following MA-TKA across three surgical technologies and (2) determine whether achieving MA targets is associated with improved outcomes.

Preservation of the Constitutional Coronal Plane Alignment of the Knee Phenotype in Varus and Neutral Knees Is Associated With Improved Early Functional Recovery: A Prospective In-Office Gait-Analysis

2026-04-28

The coronal plane alignment of the knee (CPAK) classification provides an objective framework to describe alignment changes after total knee arthroplasty (TKA). Although preserving the native phenotype improves intraoperative soft-tissue balance in varus and neutral knees, its functional benefits remain uncertain. We therefore evaluated whether preserving the preoperative CPAK phenotype in varus and neutral knees is associated with superior early postoperative gait patterns following TKA.

Comprehensive Cost Estimation of an Enhanced Recovery Pathway in Hip and Knee Arthroplasty Using an Expanded Time-Driven Activity-Based Costing Framework

2026-04-27

Total hip (THA) and total knee arthroplasty (TKA) are among the most frequently performed surgeries worldwide, creating a substantial financial burden. Enhanced Recovery After Surgery (ERAS) pathways aim to improve outcomes while reducing costs, aligning with the principles of Value-Based Healthcare (VBHC). Time-Driven Activity-Based Costing (TDABC) is recommended for VBHC cost calculation, yet its application to ERAS is rarely reported. This study calculated total and ERAS-related costs of a comprehensive ERAS pathway for THA and TKA using TDABC.

Toward Understanding the Differences Between Satisfaction and Improvement After Primary Total Hip Arthroplasty

2026-04-27

While satisfaction is often used by clinicians to assess outcomes after primary total hip arthroplasty (THA), the Centers for Medicare & Medicaid Services (CMS) has defined a 22-point increase in the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) at 1-year follow-up as their improvement metric representing a substantial clinical benefit (SCB). To better understand the differences between satisfaction and improvement, this study evaluated self-reported patient satisfaction and HOOS JR score changes at 1-year follow-up.

Do Hip Precautions Matter After Posterior Approach Total Hip Arthroplasty With Capsular Repair? A Randomized Control Trial

2026-04-27

The clinical efficacy of posterior hip precautions in preventing dislocation after primary posterior approach total hip arthroplasty (THA) remains uncertain. Such mobility restrictions may delay patients’ return to daily activities and functional recovery. The aim of this study was to determine whether THA hip precautions impact hip dislocation rates.

An Unsustainable Reimbursement Model: A 12-Year Analysis of Compensation for Revision Total Hip Arthroplasty

2026-04-27

Revision total hip arthroplasty (rTHA) is a complex and resource-intensive procedure. However, physician and hospital compensations have not evolved to reflect such complexity. Therefore, we sought to describe trends in (1) physician, (2) 90-day episode-of-care, and (3) procedure type reimbursements during a 12-year period.

The Impact of Enabling Technology on Surgeon Workload in Total Knee Arthroplasty: A National Survey Comparing Manual and Technology-Enabled Procedures

Drake G. LeBrun, Corey F. Hryc, James I. Huddleston, Ugonna N. Ihekweazu — 2026-04-27

Robotic and computer-assisted technologies in total knee arthroplasty (TKA) have grown rapidly, yet their effect on surgeon workload remains unclear. While enabling technologies may reduce physical strain, they may also increase cognitive and organizational demands. This study evaluated surgeon-perceived workload in manual versus technology-enabled TKA using a validated surgical workload assessment instrument.

One Patient, Two Knees, No Difference: Magnesium Sulfate Fails to Improve Total Knee Arthroplasty Outcomes

2026-04-27

Whether the addition of magnesium sulfate (MgSO4) to intra-articular analgesic cocktails improves early pain after total knee arthroplasty (TKA) remains uncertain.

The Impact of Body Mass Index on the Risk of Postoperative 90-Day Infection Differs Between Primary Total Hip and Knee Arthroplasty: A Large Registry Collaborative Quality Initiative Analysis

2026-04-24

Body mass index (BMI) is widely used to guide surgical candidacy in total joint arthroplasty, with many institutions and payors applying uniform BMI thresholds, commonly ≥ 40, to both total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, several differences between these procedures may influence how BMI affects postoperative infection risk. Emerging evidence suggests that BMI-related risk may differ between THA and TKA. This study assessed whether BMI confers differential 90-day postoperative deep infection risk between THA and TKA using a large statewide arthroplasty registry.

Robotic Unicompartmental Knee Arthroplasty Demonstrates Improved Recovery During the First 90 Postoperative Days Compared With Robotic Total Knee Arthroplasty: A Prospective Remote Monitoring Study

2026-04-24

Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty have been extensively compared; however, prior studies have largely relied on manual surgical techniques and patient-reported outcomes collected at discrete time points, limiting characterization of recovery during the initial postoperative period. With increasing adoption of robotic assistance and wearable technology, higher-resolution assessment of recovery is possible. This study compared recovery following robotic-assisted UKA (rUKA) and robotic-assisted TKA (rTKA) using continuous remote patient monitoring during the first 90 postoperative days.

Methylprednisolone Taper After Total Knee Arthroplasty: A Prospective Single-Blinded Randomized Trial

2026-04-24

The use of short-term postoperative corticosteroid regimens has been reported to improve pain control and decrease opioid consumption following total knee arthroplasty (TKA). The purpose of this study was to evaluate the effect of a methylprednisolone taper (MPT) on reducing patients' subjective pain levels and opioid consumption in the early postoperative period following primary TKA.

Postoperative Swelling Did Not Return to Preoperative Levels in Most Patients Two Years after Total Knee Arthroplasty

2026-04-24

Swelling after a total knee arthroplasty (TKA) can result in pain, decreased range of motion, muscular inhibition, limitations in function, and negative perception of recovery. The objectives of this study were to determine how swelling changes after TKA and if swelling is associated with patient-reported outcomes, functional outcomes, or impairment measures.

Excellent 20-Year Survivorship for Highly Cross-Linked Compared to Conventional Polyethylene in Total Hip Arthroplasty

2026-04-24

Highly cross-linked polyethylene (HXLPE) liners have demonstrated excellent wear resistance in total hip arthroplasty (THA). However, there is limited long-term data directly comparing outcomes between HXLPE and conventional polyethylene (CPE) liners. This study compared the 20-year implant survivorship and clinical outcomes in patients who underwent THA using HXLPE or CPE.

Promising Clinical Outcomes Using Rotational Achilles Autograft for Knee Arthroplasty Terrible Triad

2026-04-24

The knee arthroplasty terrible triad (TT) is a combination of periprosthetic joint infection, extensor mechanism insufficiency, and soft tissue defect. The TT is a limb-threatening condition that has historically poor functional results and high probability of amputation or fusion. The rotational gastrocnemius-Achilles rotational flap (GARF) holds promise as native soft tissue to provide coverage and muscular power to assist with knee extension. We hypothesized that application of the GARF in conjunction with two-stage revision improves functional and limb-salvage outcomes compared to previous rates.

Divergent Dynamics: Unicompartmental Knee Arthroplasty Enables Greater Propulsive Joint Moments Than Total Knee Arthroplasty

Gregor Kuntze, Robert Korley, Gregory Abelseth, Janet Ronsky, Kelly Johnston — 2026-04-24

Current evidence indicates better functional performance following unicompartmental (UKA) compared to total knee arthroplasty (TKA). This randomized controlled trial addressed the differential effects of UKA and TKA on functional joint mechanics and patient-reported outcome measures (PROMs).

Duration of Opioid Use Following Revision Total Knee Arthroplasty Varies Significantly With Reason for Revision

2026-04-24

Few studies have evaluated postoperative opioid use after revision total knee arthroplasty (TKA). The primary objective of this study was to evaluate postoperative opioid (in-hospital and outpatient) use in revision TKA.

Total Hip Arthroplasty Following Failed Cephalomedullary Nailing: An Analysis of Outcomes and Complications Associated With Failures

2026-04-24

Total hip arthroplasty (THA) is a highly successful operation for patients who have primary osteoarthritis and for those requiring conversion for traumatic arthritis. This study aimed to compare the clinical outcomes, complication rates, and overall functional results between THA performed after failed cephalomedullary nailing (CMN) for hip fractures and primary THA for osteoarthritis.

The One-Year Infection Rates After Vancomycin Powder and Dilute Povidone-Iodine Lavage in High-Risk Primary Total Joint Arthroplasty: A Multicenter Randomized Controlled Trial

2026-04-24

Given the severe morbidity, mortality, and substantial cost of periprosthetic joint infection (PJI), substantial research has been conducted to compare perioperative and postoperative infection-prevention strategies. To our knowledge, there are no studies to date that have evaluated the 1-year efficacy of intraoperative vancomycin powder and/or dilute povidone-iodine lavage versus saline lavage in total joint arthroplasty. We previously reported no significant group differences at 3 months in a large multicenter randomized controlled trial.

Return to Function Implications After Periacetabular Osteotomy

2026-04-24

Periacetabular osteotomy (PAO) is a well-established surgical intervention for symptomatic acetabular dysplasia in young, active patients. While radiographic and clinical outcomes are well documented, less is known about functional return to daily and athletic activities postoperatively. This study aimed to assess post-PAO return to activity, including sport, school, work, driving, and sexual activity.

Antithrombotic Therapies and Their Associations With Periprosthetic Joint Infection Risk After Total Knee and Hip Arthroplasty: A 12-Year Review

2026-04-23

The impact of postoperative antithrombotic therapy (ATT) on complications such as periprosthetic joint infection (PJI) after total knee and hip arthroplasty (TKA and THA, respectively) remains understudied. We aimed to evaluate temporal trends in ATT use and the association between ATT type and PJI following primary TKA and THA.

Preoperative Malnutrition Is Associated With Increased Risk of Periprosthetic Joint Infection and Reduced Revision-Free Survival Following Unicompartmental Knee Arthroplasty

2026-04-22

Malnutrition is a recognized risk factor for adverse outcomes following total joint arthroplasty, yet its influence on unicompartmental knee arthroplasty (UKA) remains poorly defined. This study aimed to evaluate the potential association between preoperative laboratory markers of malnutrition and the risk of 90-day postoperative medical complications, as well as implant-related complications in patients undergoing UKA.

Does Tourniquet Use Influence Patient-Reported Outcomes in Obese Patients Undergoing Primary Total Knee Arthroplasty? A Propensity-Matched Study

2026-04-22

Obese patients are at increased risk of complications after primary total knee arthroplasty (TKA). Tourniquets are commonly used intraoperatively to reduce bleeding and improve visualization, but their impact on patient-reported outcome measures (PROMs) in obese populations is not well understood. This study aimed to compare PROMs and complication rates after primary TKA in obese patients who did and did not have tourniquets using a propensity-matched analysis.

Pelvic Tilt Reproducibility Using Fluoroscopy in Direct Anterior Approach Total Hip Arthroplasty

2026-04-22

Precise acetabular component positioning depends heavily on accurately recreating pelvic tilt (PT) during total hip arthroplasty (THA). The direct anterior approach (DAA) facilitates intraoperative fluoroscopy for real-time assessment, yet the accuracy of recreating preoperative standing PT intraoperatively remains unexplored. This study evaluated the precision of intraoperative PT recreation between pre- and intra-operative antero-posterior (AP) radiographic images during DAA THA.

Minimum Two-Year Survivorship of Large Femoral Heads With Titanium Sleeves in Primary Total Hip Arthroplasty: An Analysis From the American Joint Replacement Registry

2026-04-22

Ceramic femoral heads with titanium sleeves (TSs) are used in revision total hip arthroplasty (THA) with femoral component retention to reduce the risk of femoral head fracture and trunnion corrosion. Their utility in primary THA, particularly for larger heads, is unknown. We sought to evaluate the influence of TSs on the risk of revision total hip arthroplasty based on ceramic head size.

Does Pre- and Intraoperative Culture Negativity Affect the Outcome of Debridement, Antibiotics, and Implant Retention in Acute Periprosthetic Joint Infection: A Single-Center Retrospective Cohort Study

2026-04-21

Debridement, antibiotics, and implant retention (DAIR) are standard treatments for acute hip and knee periprosthetic joint infection (PJI). However, culture-negative (CN) cases complicate diagnosis and management, and their impact on DAIR outcomes remains unclear. This study evaluated whether pre- and intraoperative culture negativity influences clinical outcomes following DAIR.

Changes in Lateral Femoral Bowing and Varus Alignment During 10-Year Follow-Up After Total Knee Arthroplasty

2026-04-21

It is unclear whether bone morphology remains stable over time following total knee arthroplasty (TKA). This study aimed to evaluate lower limb bone morphological changes 10 years after TKA.

The Otto Aufranc Award: Iodine-Containing Products Are Safe in Allergy-Labeled Patients Undergoing Total Joint Arthroplasty: A Prospective Observational Study

2026-04-21

Povidone-iodine (PVP-I) and iodophor-impregnated drapes are essential antiseptic measures for total joint arthroplasty (TJA). However, many surgical settings may prevent surgeons from using iodine-containing products when a patient has a documented allergy, even if the cross-reactivity is unproven or based on distant self-reported history. As iodine has been a well-accepted measure to reduce periprosthetic joint infections and surgical site infection, this study sought to prospectively evaluate the safety of using iodine-containing products (iodophors) in iodine allergy labeled patients undergoing TJA.

Does Patellar Resurfacing Impact Patient-Perceived Outcomes Following Primary Total Knee Arthroplasty? A Propensity-Matched Analysis

2026-04-21

Patellar resurfacing is performed in up to 87% of total knee arthroplasties (TKAs) in the United States. While reducing anterior knee pain is a theoretical benefit, there are no established best practices for resurfacing in primary TKA. Previous studies comparing resurfacing-related patient-reported outcome measures (PROMs) were limited by sample size and a lack of propensity matching. This study aimed to compare the impact of patellar resurfacing on complication rates and clinically meaningful PROMs in propensity-matched primary TKA patients using an institutional database.

Evaluating the Utility and Acceptability of an Artificial Intelligence-Powered Care Aid for Perioperative Patient Inquiries in Joint Arthroplasty Surgery

2026-04-21

Conventional educational materials for total joint arthroplasty frequently exhibit deficiencies in readability and personalization. This investigation assessed a custom-tailored artificial intelligence (CTAI) platform to evaluate its efficacy in enhancing preoperative patient education within arthroplasty surgery.

Survivorship of Cemented versus Cementless Total Knee Arthroplasty Using the Same Contemporary Design: A Minimum 5-Year Follow-Up Study

2026-04-21

Attention to biologic fixation has been growing in total knee arthroplasty (TKA) over the past years due to the evolution of highly porous metals and improved implant designs. The aim of this study was to assess the minimum 5-year survivorship of a contemporary cementless TKA design, as compared to its cemented counterpart.

The Impact of Preoperative Activity on Postoperative Outcomes in Total Knee Arthroplasty: A Retrospective Cohort Analysis

2026-04-20

Preoperative activity levels may influence postoperative outcomes in total knee arthroplasty (TKA) patients. This study investigates how preoperative activity impacts the risks of revision surgery and sepsis at one, two, and three years following TKA.

Periarticular Injection for Pain Control After Surgical Treatment of Knee Periprosthetic Joint Infection

2026-04-20

Periprosthetic joint infection (PJI) is a serious complication after total knee arthroplasty, and treatment often requires extensive surgery. Intraoperative periarticular injection (PAI) of local anesthetic is commonly used during primary total knee arthroplasty to improve postoperative pain control, but it is not typically used for infection-related procedures due to fears of spreading infection. This study evaluated the safety and efficacy of the use of PAI in the treatment of knee PJI.

Revision Outcomes of Mixed Versus Matched Components in Primary Total Hip Arthroplasty: A Population-Based Study

Talal Al-Jabri, Matthew J. Wood, Zameer Shah, Lauren L. Nowak, Emil Schemitsch — 2026-04-20

Most manufacturers specify that surgeons should use all the components of their total hip arthroplasty (THA) system to avoid working “off-label.” Despite this, studies show that mixing certain components in THA can produce comparable or even superior results to matched THA. Our primary aim was to compare all-cause revision rates for mixed and matched THA in Ontario, Canada.

Characteristics and Outcomes of Younger Traditional Medicare Beneficiaries Who Have a Disability and Underwent Elective Inpatient Total Hip Arthroplasty

2026-04-20

There is limited research on total hip arthroplasty (THA) outcomes in patients who have disabilities. We aimed to describe the characteristics and outcomes of younger traditional Medicare beneficiaries who have a disability undergoing elective inpatient THA and explore the role of specific disabling conditions.

Distinct Risk Profiles After Conversion Total Knee Arthroplasty: Prior High Tibial Osteotomy Versus Unicompartmental Knee Arthroplasty

Chase W. Smitterberg, Adam M. Gordon, Patrick P. Nian, Michael A. Mont — 2026-04-20

Conversion to total knee arthroplasty (TKA) following prior knee procedures such as unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO) is increasingly common. Outcomes may differ between these groups due to variation in patient demographics, comorbidities, and mechanical alterations introduced by the initial surgery. This study compared demographic characteristics and implant-related complications following conversion TKA after UKA or HTO using a large national database.

Do Tibial and Femoral Bowing Explain the Natural History of Valgus (Coronal Plane Alignment of the Knee Types 3, 6, and 9) Knees?

2026-04-20

Coronal plane alignment of the knee (CPAK) characterizes knee phenotypes using arithmetic hip-knee-ankle angle (aHKA) and joint line obliquity (JLO). Medial tibial and lateral femoral bowing (fBOW) increase valgus aHKA and apex-proximal JLO, revealing the natural history of valgus knees. This study correlated bowing with aHKA and JLO and asked if arithmetic correction of long bone bowing shifts outliers toward CPAK2.

Changing Surgical Approach During Periprosthetic Joint Infection Treatment Does Not Increase Risk of Eradication Failure: A Multicenter Retrospective Cohort Study

2026-04-20

Hip approach discordance in aseptic revision total hip arthroplasty is not associated with increased dislocation or rerevision risk. Whether the same holds true for the treatment of periprosthetic joint infection (PJI) is unknown. This study reported the rate of hip approach discordance during PJI treatment, identified associated factors, and tested possible associations with outcomes (septic and aseptic failures).

Instability Following Head and Liner Exchange: Eight-Fold Reduction in Dislocation With the Direct Anterior Approach

2026-04-20

Isolated head and liner exchange (HLE) can be utilized as a less invasive option for specific indications in revision total hip arthroplasty. Historically, the most common complication following HLE is dislocation. The objective of this study was to determine if the direct anterior approach (DAA) results in a lower incidence of dislocation when compared to the posterolateral approach (PLA) for HLE.

Outcomes of Conversion of Hip Resurfacing Arthroplasty to Total Hip Arthroplasty With Retention of the Acetabular Component

2026-04-20

Complications of hip resurfacing arthroplasty (HRA) may require conversion to total hip arthroplasty (THA). While well-fixed acetabular components are often retained during conversion, data on implant survival and associated risks are limited. This study evaluated implant-related outcomes, survivorship, and complications in patients who undergo HRA to THA conversion with acetabular component retention.

The Effects of Disease-Modifying Anti-Rheumatic Drugs on Total Hip Arthroplasty Outcomes in Patients Who Have Inflammatory Arthropathies

2026-04-17

Disease-modifying anti-rheumatic drugs (DMARDs) are essential in managing inflammatory arthritides such as rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. As total hip arthroplasty (THA) and DMARD use become more common, it is unclear how DMARD use affects outcomes in this population. This study compared complications and implant survivorship after THA in patients who have inflammatory arthritis who had and did not have DMARD treatment.

Failure to Achieve an Early Distribution-Based Minimum Clinically Important Difference Almost Triples the Odds of Poor Patient-Reported Outcomes Within the First Year Following total Hip Arthroplasty: A Retrospective Cohort Study

Kareem Omran, Colleen Wixted, Daniel Waren, Joshua C. Rozell, Ran Schwarzkopf — 2026-04-17

Postoperative improvement in patient-reported outcomes is a key measure of total hip arthroplasty success. The Minimum Clinically Important Difference (MCID) represents the smallest improvement perceived as beneficial. Distribution-based MCIDs have been criticized for producing thresholds smaller than anchor-based values, questioning their clinical relevance. We hypothesized they may capture early biological recovery signals associated with subsequent patient-reported outcomes and aimed to determine whether failure to achieve an early distribution-based MCID (seven to 31 days) was associated with failure to achieve a late anchor-based MCID (90 to 365 days).

Increased Risk of Infection in Unicompartmental Knee Arthroplasty Conversions Compared to Revision Primary Total Knee Arthroplasty in the Aseptic Setting: Answering the International Consensus Meeting Call for Database Research

Tyler T. Brady, Shaylan R. Bera, George Grammatopoulos, Andrew Adamczyk — 2026-04-17

The risk of periprosthetic joint infection (PJI) following conversion of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains unknown. Literature is limited to high-volume centers, prompting the International Consensus Meeting on Infection to call for database research. This study compared PJI incidence between UKA-to-TKA conversions and TKA-to-TKA revisions. The secondary objectives included identifying independent PJI risk factors and evaluating trends in UKA utilization and conversion over time.

Preoperative Femoral Bone Texture Features on Radiographs Are Associated with Femoral Stem Subsidence Following Total Hip Arthroplasty

2026-04-17

Femoral stem subsidence greater than two mm after total hip arthroplasty has been associated with worse patient outcomes. Identifying poor bone quality preoperatively could help surgeons choose implant designs that minimize subsidence risk. The purpose of this exploratory study was to evaluate whether radiographic bone texture is associated with early femoral stem migration.

Prospective Assessment of Expectations of Recovery Following Total Hip Arthroplasty: Patients Expect Less Pain With the Direct Anterior Approach

2026-04-17

Use of the direct anterior approach (DAA) total hip arthroplasty (THA) continues to grow, and patient preferences have evolved. This study aimed to determine whether preoperative expectations of postoperative recovery differ between patients who prefer the DAA THA versus those who do not.

Preoperative Glucagon-Like Peptide-1 Agonist Use Is Associated With Decreased Complications Compared to Bariatric Surgery Following Primary Total Hip Arthroplasty

2026-04-17

Obesity is a risk factor for adverse outcomes following total hip arthroplasty (THA). While weight loss strategies exist, the comparative impact of these approaches on surgical outcomes remains underexplored. This study aimed to compare complications among patients who had bariatric surgery versus prescription weight loss medications before THA.

Obesity and Total Knee Arthroplasty Revisited: Minimal Impact on Loosening and Mechanical Failure in the Modern Era

2026-04-17

Obesity has historically been considered a risk factor for mechanical failure after total knee arthroplasty (TKA), particularly tibial aseptic loosening. However, advances in implant design, fixation strategies, and perioperative practices may have mitigated these risks. This study evaluated the association between obesity severity and mechanical failure in a contemporary TKA cohort while examining implant- and patient-related factors associated with loosening and revision.

Hip and Knee Disability and Osteoarthritis Outcome Scores Minimal Clinically Important Differences Vary by Payer Type: Implications for Mandatory Patient-Reported Outcome Reporting

Allyson N. Pfeil, Corey F. Hryc, Anay R. Patel, Drake G. LeBrun — 2026-04-17

Recent mandates from the Centers for Medicare and Medicaid Services have tied patient-reported outcome measure (PROM) metrics to hospital reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Concurrently, the proportion of patients meeting certain PROM metrics at each hospital will be publicly available. Threshold values such as the minimal clinically important difference (MCID) may vary across patient subpopulations. The Centers for Medicare and Medicaid Services proposal to apply blanket threshold values to all hospitals may skew results depending on the population being served.

Excellent Implant Survivorship and Knee Function of a Fixed Lateral Unicompartmental Knee Arthroplasty: A Consecutive Single-Center Series of 1,015 Knees at a Mean Follow-Up of Five Years

2026-04-17

Isolated lateral-compartment knee osteoarthritis (OA) remains a condition challenging to treat. Lateral unicompartmental knee arthroplasty (UKA) may offer therapeutic advantages over total knee arthroplasty (TKA); however, it remains infrequently performed. This study determined implant survivorship and reoperation-free survival in a consecutive single-center series of primary lateral UKA. Furthermore, patient-reported outcome measures (PROMs) and radiological outcomes were assessed.

Outcomes of a Cementless Nonmodular Dual Mobility Acetabular Cup Inserted via Posterior Approach Without Technology: Mean Two-Year Follow-Up

2026-04-17

Nonmodular dual mobility (DM) articulations in total hip arthroplasty (THA) aim to reduce dislocations through a large outer bearing diameter while minimizing wear via a smaller inner bearing where most motion occurs. Although routine use remains uncommon in the United States, this construct may protect against dislocation. This study aimed to evaluate clinical outcomes of a cementless, nonmodular DM acetabular cup at a mean follow-up of two years.

Delayed Administration of Apixaban and Rivaroxaban is Associated with Reduced Rates of Postoperative Bleeding Without Increasing Thromboembolic Risk Following Elective Total Hip Arthroplasty

2026-04-17

The optimal timing for initiation of anticoagulation using direct oral anticoagulants following total hip arthroplasty (THA) remains a subject of debate. While direct oral anticoagulants are effective prophylactic agents against venous thromboembolism (VTE), bleeding risks remain a concern. This study sought to compare the incidence of postoperative bleeding and thromboembolic complications following elective THA between patients receiving either apixaban or rivaroxaban on postoperative day (POD) zero versus one.

Postoperative Femoro-tibial Rotational Change and High Rotational Offset Are Associated With Worse Clinical Outcomes in Total Knee Arthroplasty

2026-04-16

Perioperative changes in femoro-tibial rotational alignment and the optimal postoperative femoro-tibial rotational alignment following total knee arthroplasty (TKA) are not well characterized. This study aimed to evaluate femoro-tibial rotational alignment following TKA and the effects on postoperative patient-reported outcome measures.

The Assessment of Coronal Plane Lower-Limb Alignment on Pre- and Postoperative Long-Leg Radiographs Using Deep Learning

2026-04-16

Coronal plane lower-limb alignment, defined by metrics including the hip–knee–ankle angle (HKAA), lateral distal femoral angle (LDFA), and medial proximal tibial angle (MPTA), is useful for surgical planning and postoperative assessment in knee arthroplasty. The purpose of this study was to develop and validate a flexible deep learning algorithm capable of accurately measuring HKAA, LDFA, and MPTA on long-leg radiographs, independent of the operative status of any joint in the image.

Navigating the Ambulatory Surgery Center Setting: How to Go From Operating to Thriving

2026-04-16

This symposium described how hip and knee surgeons can thrive in the ambulatory surgery center (ASC) setting and focused on patient selection, patient care, efficiency, financial profitability, and enabling technology. Faculty highlighted how to safely increase the volume of surgical candidates through proper screening and protocols; described how to optimize types of patients not previously considered ASC candidates and transition them into the ASC setting; and outlined methods to optimize perioperative and clinical throughput and surgical efficiency.

Indications for Use of Dual Mobility Demonstrate Significant Differences in Subsequent Instability

2026-04-16

Dual mobility (DM) constructs are widely used to mitigate instability following primary and revision total hip arthroplasty (THA). However, the effectiveness of DM constructs may vary substantially depending on the surgical indication. This study aimed to quantify the rates of subsequent dislocation in DM constructs across various primary and revision surgical indications.

Pre- and Postoperative Alignment of the Knee Impacts Ankle Alignment: Analysis of 4,698 Total Knee Arthroplasties

2026-04-16

Limited data exist on the effects of total knee arthroplasty (TKA) on ankle alignment. This large-scale study aimed to assess preoperative and postoperative ankle alignment in patients undergoing TKA using long-leg radiographs.

Epidemiology and Outcomes of Total Hip Arthroplasty in Patients Aged ≤ 30 Years: A Nationwide Population-Based Study in France From 2011 to 2022

2026-04-16

Total hip arthroplasty (THA) is an effective procedure, commonly performed following osteoarthritis in those over 70 years of age. In younger patients who have a longer life expectancy and higher functional demands, often with heterogeneous and complex hip disorders, it raises concerns about durability, complications, and follow-up care. Yet population-level data on this subgroup remains limited.

High-Offset Stems Are Associated With an Increase in Revision due to Femoral Loosening and All-Cause: A Registry-Based Observational Retrospective Cohort Study

2026-04-16

The influence of femoral offset on the survival of cementless femoral stems in total hip arthroplasty (THA) remains unclear. This study aimed to evaluate the influence of total femoral offset (TFO – stem plus head) on the risk of revision for early aseptic femoral loosening (AFL) and all-cause revision (ACR).

Machine Learning Using Preoperative Patient Factors Can Predict the Severity of Pain Following Primary Total Hip Arthroplasty

2026-04-16

Persistent postoperative pain is a challenge in total hip arthroplasty (THA), yet a lack of accurate predictive tools exists for this outcome. This study aimed to develop and validate machine learning (ML) models to predict long-term pain following THA and to identify key predictors.

The Impact of Arthroplasty Training on Outcomes Following Hemiarthroplasty: A Propensity Score–Matched Analysis

2026-04-16

Hip hemiarthroplasty is the most frequently performed treatment for femoral neck fractures, which are projected to rise in incidence over the next century with an aging population. This study sought to compare the incidences of complications, including periprosthetic joint infections, periprosthetic fractures, and dislocations, between patients who underwent hip hemiarthroplasty by an arthroplasty-trained surgeon versus a nonarthroplasty surgeon at 90 days, one year, and two years.

Highly Porous Metal Revision Cup With a Cemented Dual Mobility Bearing Reduces Instability Following Complex Acetabular Reconstructions: A Minimum Two-Year Follow-Up

Paul Kooner, Nabil Algarni, Michael Tanzer, Anthony Albers, Adam Hart — 2026-04-16

The aim of this study was to look at instability following complex acetabular reconstructions using a highly porous metal cup with a cemented dual mobility bearing for the reconstruction of large acetabular defects. The secondary outcomes were survivorship free of aseptic loosening and all-cause revision.

Do Customized Implants Yield Superior Clinical and Functional Outcomes Compared to Off-the-Shelf Implants in Primary Total Knee Arthroplasty? A Propensity-Matched Analysis

2026-04-15

Customized individually made (CIM) total knee arthroplasty (TKA) implants are designed using preoperative computed tomography to optimize component fit, mechanical alignment, and joint line restoration. Despite their theoretical advantages, clinical adoption and evidence demonstrating meaningful functional benefits over off-the-shelf (OTS) implants are limited. This study aimed to compare clinical outcomes and rates of achieving the minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) between CIM and OTS implants using a propensity-matched analysis.

Non-Articulating Spacers Increase the Risk of Patella Baja in the Treatment of Chronic Periprosthetic Joint Infections of the Knee

2026-04-15

Patellar baja is a known complication following primary and revision total knee arthroplasty. Static, or non-articulating, spacers for total knee arthroplasty periprosthetic joint infection can result in shortening of the extensor mechanism, though no comparison to articulating spacers has been performed. This study aimed to evaluate the association between spacer type and the incidence of true patellar baja.

Calcar Resorption Is Commonly Seen With a Modern Triple-Tapered Collared Stem in Primary Total Hip Arthroplasty

2026-04-15

The impacts of load transfer between the collar of modern triple-tapered collared hip stems and the femoral calcar remain unknown. The aim of this study was to determine whether the calcar remodels in response to stress loading or stress shielding in the setting of a well-fixed modern triple-tapered collared stem.

Impact of Smoking Status on Early Outcomes and Healthcare Utilization Following Primary Total Knee Arthroplasty: A Retrospective Cohort Study

2026-04-13

Smoking is a modifiable risk factor associated with adverse surgical outcomes. However, its effects on recovery and healthcare utilization after total knee arthroplasty (TKA) remain unclear. This study evaluated the impact of smoking status on early postoperative pain, complications, and healthcare resource utilization.

Implant Survival and Clinical Results of a Cementless Femoral Stem: Minimum 30-Year Follow-Up of 348 Primary Total Hip Arthroplasties

2026-04-13

Cementless femoral stems in total hip arthroplasty (THA) demonstrate excellent survival rates at 20 to 25 years, although evidence beyond this period remains very limited. Therefore, this study aimed to determine the 33-year results of a cementless femoral stem.

Revision Total Knee Arthroplasty for Aseptic Failure After Staged Exchange for Periprosthetic Joint Infection: High Rates of Reoperation and Reinfection

2026-04-13

Data are limited regarding the outcomes of revision total knee arthroplasty (TKA) for aseptic failure following the successful eradication of periprosthetic joint infection (PJI) with two-stage exchange. The purpose of this study was to evaluate 5-year survivorship of revision TKA for aseptic failure in patients who have a history of two-stage exchange for PJI.

Novel Classification System to Predict Case Difficulty in Direct Anterior Approach Total Hip Arthroplasty

2026-04-13

Although the learning curve for direct anterior approach (DAA) total hip arthroplasty (THA) is steep, no classification exists to predict technically challenging cases. We propose and validate a new Davidovitch direct anterior (DDA) classification system for predicting DAA THA case complexity.

Factors that Affect the Return-to-Driving Timeline Following Direct Anterior Approach Primary Total Hip Arthroplasty

2026-04-13

When patients can return to driving (RTD) following direct anterior approach (DAA) primary total hip arthroplasty (pTHA) is a common concern. Current prospective literature is limited and does not consider individual patient factors. Here, we aimed to determine an accurate RTD timeline and develop a clinical calculator using patient-specific variables.

Increasing Procedural Volume and Economic Impact of Revision Total Hip Arthroplasty for Hip Instability in the United States

2026-04-10

Instability remains one of the most common complications after total hip arthroplasty (THA) and is a notable cause of patient morbidity, pain, and dissatisfaction. Despite advances in implant technology and surgical techniques, the national incidence of instability after THA remains poorly defined. As THA continues to rise, our study aimed to characterize the contemporary volume and economic impact of revision THA (rTHA) for instability in the United States (U.S.).

The 2026 Centers for Medicare & Medicaid Services Physician Fee Schedule Final Rule: Understanding the 7% Cut to Procedural Reimbursement

Drake G. LeBrun, Alexander T. Bradley, Nicholas B. Frisch, Adam J. Rana — 2026-04-10

The 2026 Physician Fee Schedule (PFS) final rule from the Centers for Medicare & Medicaid Services (CMS) took effect on January 1, 2026. The direct impact of this policy on arthroplasty reimbursement is important: a 7% reduction in surgeon reimbursement for primary hip and knee arthroplasty.

Lateral-Conforming Dual-Pivot Versus Nonconforming Anterior-Stabilized Bearings in Valgus Knees Undergoing Primary Total Knee Arthroplasty

2026-04-10

Personalized alignment strategies in total knee arthroplasty (TKA) have gained in popularity to recreate native biomechanics and improve outcomes. Prior studies have reported better patient-reported outcome measures (PROMs) for preoperative valgus deformities (compared to varus) when medial-conforming bearings are used. This study evaluated PROMs in a lateral-conforming dual-pivot (DP) bearing compared to a nonconforming anterior-stabilized (AS) bearing after primary TKA.

Rurality Is Not Associated With 90-Day Readmissions or Complications After Primary Total Hip or Knee Arthroplasty Independent of Patients’ Underlying Geographic Social Vulnerability in New York State

2026-04-10

Social determinants of health (SDOH) and rurality can impact orthopaedic surgery outcomes; however, the relative contribution of each factor remains unclear. The purpose of this study was to examine the association between patients’ rurality and geographical SDOH, with 90-day complications and readmissions in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA) in the state of New York.

Surgically Relevant Knee Phenotypes: The Modified Coronal Plane Alignment of the Knee System—A Deep Learning–Based Classification

2026-04-10

The coronal plane alignment of the knee (CPAK) classification proposes nine knee phenotypes based on constitutional limb alignment and joint line obliquity. However, there is considerable confusion and variability in defining types, and its impact on surgical decision-making is unclear. A simple modified CPAK system is proposed to improve accuracy and facilitate decision-making. Herein, we applied a deep learning model to automate knee phenotyping and analyzed modified CPAK distributions in a large cohort.

Nontraumatic Osteonecrosis of the Femoral Head: An International Evidence-Based Clinical Practice Guideline∗

2026-04-10

Nontraumatic osteonecrosis of the femoral head (ONFH) can lead to major disability in patients of all ages. It presents at various levels of severity and can be either symptomatic or asymptomatic. There is a vast array of management strategies. Treatment is often subject to physician bias. Clinical practice guidelines that are broad-based, internationally developed, consensus-driven, and strictly evidence-based are needed. The aim of this guideline by the Association Research Circulation Osseous (ARCO) was to develop international evidence-based recommendations to assist physicians and patients in managing ONFH.

Contemporary Total Hip Arthroplasty for Sequelae of Slipped Capital Femoral Epiphysis: 15-Year Outcomes of 165 Cases

2026-04-09

Slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder whose sequelae may require total hip arthroplasty (THA) at a young age. The outcomes of contemporary THA in this population need to be defined further. We aimed to evaluate survivorship, complications, radiographic results, and clinical outcomes in this population.

Does the Presence of Metabolic Syndrome or Its Components Influence Patient-Reported Outcomes After Total Hip Arthroplasty?

2026-04-09

An increasing number of individuals who suffer from hip osteoarthritis (OA) undergoing total hip arthroplasty (THA) have metabolic comorbidities. Among these, metabolic syndrome (MetS) has been identified as a potential key contributor to OA pathogenesis. Although MetS is also known to increase perioperative risks, its impact on treatment outcomes remains poorly understood. We conducted a prospective cohort study aimed at evaluating whether the presence of MetS and its individual components influences postoperative hip function, health-related quality of life, and mental health outcomes following THA.

Clinical Outcomes of Fixed-Bearing Medial Unicompartmental Knee Arthroplasty in Patients Older than 80 Years: A Matched Control Study

2026-04-09

Unicompartmental knee arthroplasty (UKA) has a proven track record of success in patients who have medial knee osteoarthritis. However, it is still unclear whether outcomes in elderly patients are as satisfactory five years postoperatively and beyond as those in younger patients. In this study, we compared these two groups undergoing fixed-bearing cemented medial UKA.

The Frank Stinchfield Award: How Accurate Is the United States Centers for Medicare & Medicaid Services Definition of Success for Patients Undergoing Total Hip Arthroplasty?

Mohamed Yousef, Hua Zheng, Shao-Hsien Liu, David C. Ayers — 2026-04-09

Total hip arthroplasty (THA) is a highly effective treatment for patients who have advanced arthritis. The United States Centers for Medicare & Medicaid Services (CMS) defines a successful THA as achieving a minimum 22-point improvement in the Hip Injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR). However, the accuracy of this criterion and how it correlates with patient satisfaction remains unclear. This study aimed to evaluate the validity of the CMS success criteria following primary THA.

The Mark Coventry Award: Five-Year Outcomes of a Randomized Controlled Trial on Cemented versus Uncemented Total Knee Arthroplasty: The KneeFix Trial

2026-04-09

Uncemented total knee arthroplasty (TKA) components were developed to improve fixation relative to cemented implants. While uncemented femoral components have yielded favorable results, outcomes for earlier uncemented tibial and patellar designs have been inconsistent. Contemporary trabecular-metal implants aim to enhance biological fixation by optimizing osseointegration, yet randomized data comparing fully uncemented constructs, including the patella, are limited. We conducted a prospective, single-blinded randomized controlled trial comparing 5-year radiological, clinical, and patient-reported outcomes of fully cemented and fully uncemented trabecular-metal TKA with patella resurfacing.

Utility of Machine Learning in Predicting Catastrophic Cardiac Complications Following Hip and Knee Periprosthetic Fracture Surgery Using Preoperative Parameters

2026-04-08

With the rising prevalence of primary total hip (THA) and knee arthroplasties (TKAs), the number of periprosthetic fractures (PPFs) is expected to increase. Myocardial infarction (MI) and cardiac arrest (CA) are devastating complications following PPF surgery. There is a paucity of literature demonstrating the utility of machine learning (ML) in predicting rare clinical outcomes in revision arthroplasty. This study aimed to develop ML models to predict cardiac complications following PPF surgery.

Institutional Surgical Volume and Operative Efficiency in Robotic-Assisted Total Knee Arthroplasty: An Analysis From the American Joint Replacement Registry

2026-04-08

Robotic-assisted total knee arthroplasty (RA-TKA) has gained momentum as a method to enhance precision and potentially improve surgical outcomes. However, institutional adoption patterns and associated institutional operative efficiency remain inadequately characterized. This study aimed to assess how institutional surgical volume influences the operational efficiency of RA-TKA across the United States.

Fear and the Adoption of Technology in Total Hip Arthroplasty

2026-04-08

Fear is a powerful and often underappreciated driver of human behavior. The Gartner Hype Cycle [1] and Rogers’ Adoption Curve (Figure 1) [2] highlight how individuals and organizations respond to innovation. In simple terms, innovation relies on early innovators and early adopters, followed by the early and late majority adopting the innovation, and finally the late adopters. Each of these groups has different motivations. In the innovation trigger phase, fear of missing out (FOMO) motivates innovators and early adopters to experiment with unproven ideas, while others hesitate, fearing wasted time or resources.

Establishing Minimal Clinically Important Difference and Substantial Clinical Benefit Thresholds for Objective Gait Metrics After Total Knee Arthroplasty

2026-04-08

Assessment of objective gait recovery in patients who are undergoing total knee arthroplasty (TKA) is becoming increasingly prevalent. However, few studies determined minimal clinically important difference (MCID) or substantial clinical benefit (SCB) thresholds in arthroplasty populations for clinical interpretation. This analysis aimed to calculate these values for various gait metrics following TKA.

Standardizing Safe Cefazolin Use in Total Joint Arthroplasty: A Multidisciplinary Triage Protocol

2026-04-08

Cefazolin is the first-line perioperative antimicrobial for total joint arthroplasty (TJA) due to its efficacy against typical skin pathogens, favorable safety profile, and cost-effectiveness. Its use reduces the risk of periprosthetic joint infection (PJI) by over 30% compared to second-line antimicrobials. Approximately 15% of patients report a penicillin allergy, although true allergy is confirmed in only 1 to 10% of these cases. Cefazolin’s unique molecular structure of the R1 side chain prevents immediate immunoglobulin E (IgE)-mediated cross-reactivity with penicillin or other cephalosporins.

The Multiply Revised Knee: Techniques for What to Do Next

2026-04-07

The multiply revised total knee arthroplasty (TKA) poses unique surgical challenges. Patients who present to the office with a failed TKA or revision TKA expect durable, long-term fixation and improved function, yet bone loss and extensor mechanism insufficiency can easily complicate the reconstruction. The aim of this American Association of Hip and Knee Surgeons symposium was to provide up-to-date guidance for rerevision TKA with a specific focus on (1) safe exposure; (2) improved fixation with impaction grafting; (3) improved fixation using porous metal structural augmentation; and (4) managing the patella.

Risk Factors for Failure and Reinfection Following One-Stage Revision Total Knee Arthroplasty: A Matched Case-Control Study

Chenchen Yang, Baochao Ji, Guoqing Li, Xiaogang Zhang, Yang Wang, Li Cao — 2026-04-07

Limited evidence exists on risk factors for failure after one-stage revision for periprosthetic joint infection (PJI). This study aimed to characterize patients who failed one-stage revision for chronic knee PJI under broad inclusion criteria and to identify associated risk factors.

Iliopsoas Tendonitis After Total Hip Arthroplasty Refractory to Nonoperative Management: A Long Patient Road to Diagnosis and Surgery

2026-04-07

Patients who have symptomatic iliopsoas tendonitis after total hip arthroplasty (THA) often describe a prolonged time to diagnosis and subsequent surgical management. The purpose of this study was to quantify time from symptom onset to diagnosis and subsequent arthroscopic iliopsoas fractional lengthening, including number of providers seen, in patients diagnosed with iliopsoas impingement.

Perioperative Administration of Mirogabalin for Postoperative Pain Management Following Total Hip Arthroplasty: A Randomized Controlled Trial

2026-04-06

Mirogabalin, a selective α2δ-1 ligand, has been proposed to exhibit potent analgesic effects with fewer central nervous system (CNS) side effects than prior gabapentinoids. Its effectiveness for acute postoperative pain after total hip arthroplasty (THA) remains uncertain.

Sex-Specific Differences in Microbiological Patterns and Outcomes in Periprosthetic Joint Infection

Sophie Bapst, Leonard Knoll, Emanuel F. Liechti, Maria C. Thurnheer, Nora Renz — 2026-04-06

The impact of sex-specific aspects on patients suffering from periprosthetic joint infections (PJIs) is widely unknown. In this retrospective study, microbiology and outcome were compared between men and women suffering from PJI, aiming at offering a sex-specific perspective of this entity.

Perioperative Nutritional Optimization in Total Joint Arthroplasty: From Screening to Supplementation

Ahmed Siddiqi, Khalid M. Yousuf, Antonia F. Chen, Paul B. Jacob, Andrew Wickline — 2026-04-06

Malnutrition and suboptimal nutrient status are increasingly recognized as modifiable risk factors influencing outcomes after total joint arthroplasty (TJA). Older adults and medically complex patients are particularly vulnerable to perioperative catabolism, impaired wound healing, and delayed functional recovery. This review synthesized current evidence on perioperative nutritional optimization, including biochemical screening, micronutrient correction, essential amino acid (EAA) supplementation, and adjunctive metabolic strategies, to support recovery in patients undergoing total hip arthroplasty and total knee arthroplasty.

Comorbidities Affect the Racial Disparities in the Incidence of Periprosthetic Joint Infection After Total Knee Arthroplasty

Daisuke Furukawa, C. William Pike, Gavin Hui, Jeremy Coyle, Derek F. Amanatullah — 2026-04-06

Racial disparity exists in arthroplasty-related outcomes. However, there is little known about racial disparity in the incidence and management of periprosthetic joint infections (PJIs). This study aimed to evaluate racial differences in the incidence of PJI after total knee arthroplasty (TKA) and in the incidence of above-knee amputation (AKA) after PJI.

Intraoperative Fractures in Primary Total Knee Arthroplasty: Incidence and Outcomes From a Matched Analysis

2026-04-05

Intraoperative fractures during primary total knee arthroplasty (TKA) are rare, but potentially devastating complications. Given their infrequent occurrence, the true incidence, epidemiology, fixation strategies, and outcomes are not well understood.

The Impact of Femoral Component Rotation on Patellar Position and Functional Outcomes in Total Knee Arthroplasty

2026-04-05

Patellar malalignment may occur after total knee arthroplasty (TKA) and can lead to pain and dysfunction. The purpose of this study was to examine the relationship between femoral component rotation and patellar position in TKA.

Postoperative Oral Antibiotics Continue to Increase in Prevalence Without Associated Improvements in One-Year Periprosthetic Joint Infection Rates

2026-04-03

In an effort to reduce periprosthetic joint infections (PJIs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA), extended oral antibiotic prophylaxis has gained national popularity. Given conflicting literature on the topic, the aim of this study was to determine if prescription of oral antibiotics at the time of primary arthroplasty was associated with a reduced risk of PJI at one year.

Risk Factors for the Development of Heterotopic Ossification After Conversion Total Hip Arthroplasty

2026-04-02

Heterotopic ossification (HO) is an extensively studied complication of primary total hip arthroplasty (THA); however, there remains a paucity of research as to its incidence with conversion to THA from prior internal fixation of acetabular or hip fractures.

Sagittal Femoral Component Flexion in Primary Total Knee Arthroplasty: Is There a Clinically Relevant Inflection Point for Clinical Outcomes?

Ozan Altun, Süleyman Albayrak — 2026-04-02

The purpose of our study was to determine whether sagittal malalignment of the femoral component after primary total knee arthroplasty (TKA) has a flexion threshold beyond which postoperative clinical outcomes deteriorate.

A Magnetic Resonance Imaging Study Comparing Varus Arthritic to Normal Knees Indicates that the Medial Collateral Ligament Does Not Contract in up to 15° of Varus Deformity, Whereas the Lateral Collateral Ligament May Elongate

Arun B. Mullaji, Rubens R. Nadal — 2026-04-02

The question of whether the superficial medial collateral ligament (MCL) undergoes contracture in the presence of osteoarthritic changes remains unresolved. Addressing this fundamental scientific inquiry is crucial for determining the surgical technique of correcting varus deformity and evaluating the need for deploying alternative alignment philosophies.

Underperformance of Machine Learning Models Predicting Readmission and Prolonged Length of Stay Following Total Knee Arthroplasty Among Underrepresented Populations: Fairness Analysis and Mitigation Strategies

2026-04-02

While machine learning (ML) models demonstrate high predictive accuracy, recent studies reveal that ML models underperform for smaller subcohorts such as racial and ethnic minorities, suggesting inherent ML biases that may exacerbate health disparities. To assume a “one-size-fits-all” approach perpetuates inequities in decision-making for underrepresented groups. This study assessed validated ML model “fairness” for total knee arthroplasty (TKA) outcomes and explored bias mitigation strategies to enhance equitable prediction performance.

Toward Understanding the Differences Between Satisfaction and Improvement after Unicondylar and Primary Total Knee Arthroplasty

2026-04-02

While satisfaction is often used by clinicians to assess outcomes after knee arthroplasty, the Centers for Medicare & Medicaid Services (CMS) has defined a 20-point increase in the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) at 1-year follow-up as their improvement metric representing a substantial clinical benefit (SCB). To better understand the differences between satisfaction and improvement, this study evaluated self-reported patient satisfaction, KOOS JR scores, and whether the CMS SCB was achieved at 1-year follow-up.

The CCJR® Gerard A. Engh, MD Excellence in Knee Research Award: Patient Factors Associated With Achieving Substantial Clinical Benefit after Total Knee Arthroplasty

2026-04-02

The Centers for Medicare and Medicaid Services (CMS) now require the collection of preoperative and postoperative patient-reported outcome measures (PROMs) for elective inpatient Medicare total joint arthroplasty procedures. There are concerns CMS will utilize the percentage of patients meeting the substantial clinical benefit (SCB) threshold in determining hospital reimbursement. However, understanding of what drives SCB achievement remains limited.

What Guides the Expert Knee Surgeon? Fixation and Patellar Resurfacing Decisions in Primary Total Knee Arthroplasty Among Knee Society Members

Maximillian P. Ganz, Pierre Tamer, Giles R. Scuderi — 2026-04-02

Total knee arthroplasty (TKA) remains a highly successful and frequently performed procedure with variability in surgeon preferences regarding implant fixation and patellar resurfacing. This study aimed to characterize current practice patterns among members of the Knee Society and to identify key factors influencing implant fixation and patella resurfacing.

Association Between Adoption of Robotic Total Knee Arthroplasty in Canada and Major Surgical Complications

2026-04-02

Robotic-assisted total knee arthroplasty (rTKA) is being adopted rapidly, but data on its real-world safety compared with conventional TKA (cTKA) outside specialized centers are limited. The purpose of this study was to evaluate the association between rTKA and major surgical complications in a large, population-based cohort.

Primary Total Knee Arthroplasty Using a Functional Alignment Concept With Kinematic Versus Inverse Kinematic Technique: Does it Make a Difference?

2026-04-02

There is an increasing trend toward a functional alignment in total knee arthroplasty (TKA). Functional alignment can be performed using a kinematic technique, FA(k), or an inverse kinematic approach, FA(ik). The purpose of this study was to compare the results of kinematic versus inverse kinematic techniques during primary TKA using a functional alignment concept.

Primary Total Hip Arthroplasty in Patients Who Have Morbid Obesity: A Propensity-Weighted Analysis of Dual Mobility and Standard Fixed-Bearing Implants

2026-04-02

Dual mobility (DM) bearings in total hip arthroplasty (THA) are designed to offer enhanced stability compared to traditional fixed-bearing constructs. However, the stability and durability of DM implants subjected to increased forces in the setting of morbid obesity remain underexplored. This study aimed to compare outcomes of DM and fixed-bearing constructs among morbidly obese patients following primary THA.

Oral Dexamethasone Versus Methylprednisolone Taper for Postoperative Pain and Recovery After Total Knee Arthroplasty

2026-04-02

Systemic corticosteroids are playing an increasingly important role in elective total knee arthroplasty (TKA) to aid in postoperative recovery. Corticosteroids reduce inflammation that can cause pain, limit range of motion (ROM), and prolong narcotic use following TKA. Dexamethasone and methylprednisolone are corticosteroids used perioperatively during TKA, but, to our knowledge, a comparative analysis assessing pain and narcotic use has not been done. We sought to determine if a difference exists between these two medications in reducing pain and narcotic usage while also assessing clinical outcomes and complications.

Evaluating the Impact of Artificial Intelligence Scribes on Clinical Workflow and Documentation Quality: A Randomized Controlled Trial

2026-04-02

The adoption of artificial intelligence (AI) scribes has grown rapidly in recent years, aiming to improve clinical workflow, increase efficiency, and reduce administrative burden by transcribing doctor–patient interactions. These systems capture in-office conversations and generate summaries using either standard or surgeon-specific templates. However, to date, no randomized controlled trials have rigorously assessed the proposed benefits of AI scribes. This randomized controlled trial focused on assessing AI scribe efficiency, error rate, accuracy, and patients’ perceptions in comparison to traditional clinical dictation-transcription methods.

Trends and Risk Factors in Revision and Re-Revision Total Hip Arthroplasty in Medicare Patients from 2016 to 2022

2026-04-02

With the increasing prevalence of total hip arthroplasty (THA), the burden of revision and re-revision surgeries is anticipated to rise. Revision THA (rTHA) presents challenges due to higher mortality risks and its substantial economic burden on the US healthcare system. This study aimed to assess the incidence, diagnoses, and risk factors for both revision and re-revision THA, considering patient- and surgeon-related variables.

Quiet Knee Rehabilitation Protocol After Primary Total Knee Arthroplasty Is Associated With Lower Opioid Exposure and No Added Risks: A Retrospective Cohort Study

2026-04-01

Conventional early rehabilitation after total knee arthroplasty (TKA) that emphasizes immediate, aggressive range of motion and ambulation may heighten early inflammation and pain. We implemented a supervised 10-day “quiet knee” protocol prioritizing edema control, limited passive range of motion, rest, and telerehabilitation oversight.

A Comparison of Recovery Curves in Total Knee Arthroplasty With and Without Soft-Tissue Releases

2026-04-01

The use of alternative alignment strategies has become commonplace in performing total knee arthroplasty (TKA). A primary reported benefit of these techniques is a reduction in the need for soft-tissue releases for appropriate balance. Using patient-reported outcome measures (PROMs), we compared the incidence, demographics, and recovery curves of TKAs performed with and without the need for a soft-tissue release.

Obesity Severity and Stiffness After Total Knee Arthroplasty Revisited: A Contemporary Analysis of Patients Requiring Manipulation Under Anesthesia

2026-04-01

Obesity has historically been associated with worse outcomes following total knee arthroplasty (TKA), and concerns regarding postoperative stiffness and poor response to manipulation under anesthesia (MUA) have contributed to body mass index–based restrictions on surgical eligibility. Contemporary optimization and rehabilitation protocols may have mitigated these risks. This study evaluated the association between obesity severity and postoperative stiffness requiring MUA and post-MUA range of motion outcomes in a large modern obese cohort.

The Presence of Osteonecrosis in Patients Who Have Systemic Lupus Erythematosus Undergoing Total Knee Arthroplasty Is Not Associated With Worse Outcomes

2026-04-01

Systemic lupus erythematosus (SLE) patients seeking total knee arthroplasty (TKA) typically present with secondary osteonecrosis of the knee. Whether osteonecrosis negatively affects TKA outcomes in this high-risk population has not previously been studied. This study aimed to compare TKA survivorship, clinical outcomes, and postoperative complication rates between SLE patients who did and did not have osteonecrosis.

A Propensity-Matched Analysis of Anatomic Risk Factors for Periprosthetic Patellar Fractures After Total Knee Arthroplasty

2026-03-31

Periprosthetic patellar fracture (PPPF) after total knee arthroplasty (TKA) is a rare complication, but can dramatically affect patient function and implant survival. This study sought to better identify radiographic and anatomical risk factors for PPPF compared to a propensity-matched cohort.

Sleeping Patterns in Patients Undergoing Total Knee Arthroplasty: A Prospective Study Using a Wearable Device

2026-03-31

Sleep disturbance is a common, poorly understood complaint following total knee arthroplasty (TKA). We characterized sleep patterns in a cohort of TKA patients.

Tibial Component Varus Alignment Does Not Affect Survivorship of Cementless Robotic-Assisted Total Knee Arthroplasty With Functional Knee Positioning

2026-03-31

Cementless fixation is increasingly adopted in total knee arthroplasty (TKA). In parallel, robotic-assisted (RA) techniques have enabled personalized alignment strategies like functional knee positioning (FKP). However, evidence on survivorship for cementless robotic-assisted-TKA (RA-TKA) with FKP remains limited. This study evaluated revision risk and clinical outcomes after cementless RA-TKA with FKP at a minimum 2-year follow-up and explored whether tibial component varus alignment, age, sex, or body mass index (BMI) were associated with revisions.

Retaining Well-Balanced Articulating Metal-on-Polyethylene Total Knee Spacers for Periprosthetic Joint Infection: A Potential Alternative to Two-Stage Exchange

2026-03-31

Although the gold standard for treatment of periprosthetic joint infection (PJI) is a two-stage exchange, patients may elect to retain a well-functioning spacer. The aim of this retrospective review was to evaluate the survivorship, complications, and patient-reported outcome measures (PROMs) of retained articulating total knee arthroplasty (TKA) spacers with patellar component replacement.

Anatomic Mapping of the Inferior Branch of the Superior Gluteal Nerve: Implications for Revision Total Hip Arthroplasty

2026-03-31

The superior gluteal nerve (SGN) is at risk for iatrogenic injury during primary total hip arthroplasty (THA), with reported rates as high as 8%. The SGN integrity is critical for abductor function, especially in the revision setting where instability rates are inherently higher. The Adelaide approach is an extended posterior approach facilitating improved exposure and identification of the SGN bundle during complex revision THA. Few studies have detailed the anatomy of the inferior branch of the SGN, which is in close proximity, particularly in revisions for acetabular bone loss.

Periprosthetic Fractures of the Acetabulum: A Rare, but Serious Complication of Total Hip Arthroplasty

2026-03-31

Periprosthetic acetabular fractures in the postoperative period are a relatively rare complication of total hip arthroplasty (THA). There are limited data describing this patient population, their treatment, and outcomes.

Aspirin Versus Potent Venous Thromboembolism Chemoprophylaxis in Total Knee Arthroplasty: Reduced Postoperative Pain and Complications With Aspirin Use

2026-03-31

The optimal postoperative venous thromboembolism chemoprophylaxis (VTEC) to balance venous thromboembolism (VTE) reduction with pain management, wound complications, and functional outcomes remains controversial. This study compared postoperative pain and early outcomes in patients undergoing total knee arthroplasty (TKA) who received aspirin versus potent anticoagulation (AC) regimens.

Single- versus Dual-Component Revision Following Total Knee Arthroplasty Failure for Isolated Tibial or Femoral Loosening

2026-03-31

Aseptic loosening is a leading cause of failure in total knee arthroplasty (TKA). When loosening is limited to either the femoral or tibial component, the choice between single- and dual-component revision remains a debated topic. This investigation examines outcomes between single- versus dual-component revision for isolated component loosening in TKA.

Cruciate-Retaining versus Medial-Congruent Bearings in Total Knee Arthroplasty: A Retrospective Comparison of Ranges of Motion, Patient-Reported Outcomes, and Complications

2026-03-31

Cruciate-retaining (CR) total knee arthroplasty (TKA) demonstrates excellent long-term (≥ 10 years) outcomes. Medial-congruent (MC) bearings have gained popularity for enhancing midflexion stability and replicating native knee kinematics. In 2020, the senior author transitioned from CR to MC bearings while maintaining an identical surgical technique and implant system. This study aimed to compare short-term (≤ two years) clinical outcomes and complication rates between bearing types.

Increased Opioid Consumption Following Total Knee Arthroplasty Is Associated With an Increased Risk of Manipulation Under Anesthesia

2026-03-31

Manipulation under anesthesia (MUA) is performed to treat knee stiffness following total knee arthroplasty (TKA). Many surgeons have empirically noted decreased pain tolerance to be a risk factor for MUA; however, there are limited data to link postoperative opioid consumption with the risk of MUA. The present study sought to examine the relationship between inpatient postoperative opioid consumption and the risk of MUA.

Coronal Knee Alignment in Adult Spinal Deformity Patients: Implications for Total Knee Arthroplasty Planning and Coronal Plane Alignment of the Knee Classification Reliability

2026-03-31

Kinematic alignment in total knee arthroplasty has been increasingly investigated for its potential improved functional outcomes. The coronal plane alignment of the knee (CPAK) classification was developed to better define native coronal alignment (to act as a target) using joint line obliquity (joint line apex [distal, neutral, or proximal]) and the arithmetic hip-knee-ankle angle (varus, neutral, or valgus). Since the literature is limited in addressing how spinal deformity influences CPAKs, this study examined the distribution of CPAK types in patients who had adult spinal deformity and evaluated whether surgical correction of the spinal deformity alters this distribution.

Total Lymphocyte Count Fails as a Predictor of Acute Periprosthetic Joint Infection for Total Hip or Knee Arthroplasty

2026-03-31

Malnutrition is associated with an increased risk of periprosthetic joint infection (PJI) following total joint arthroplasty (TJA). Total lymphocyte count (TLC) has been employed as a measure of nutritional status, with a value of less than 1,500 cells/μL often used as a marker of malnutrition. This study sought to evaluate TLC as a continuous variable to determine a threshold below which the risk of PJI increases. The secondary aim was to quantify the predictive utility of TLC for the risk of PJI.

Improved Patient-Reported Outcomes With Extended Oral Tranexamic Acid Following Total Hip and Knee Arthroplasty

2026-03-31

Tranexamic acid (TXA) is widely used in total joint arthroplasty (TJA) to reduce perioperative blood loss and transfusion requirements. There is a growing body of literature on the use of extended postoperative TXA following total knee arthroplasty (TKA). This study evaluated the impact of an extended postoperative oral TXA regimen following total hip arthroplasty (THA) and TKA.

Dislocation Risk in Modern Total Hip Arthroplasty: Comparing Surgical Approaches With and Without Enabling Technology

2026-03-31

Dislocation remains a common complication following total hip arthroplasty (THA). Although surgical approach and enabling technologies may influence dislocation risk, their combined impact remains unclear. This study compared dislocation, periprosthetic fracture, and revision rates across four THA cohorts defined by surgical approach and technology use.

Collared Cementless Stems Show Equivalent Rates of Periprosthetic Fractures Compared to Collarless Cemented Stems in an Exclusively Elderly Cohort of Patients

2026-03-31

The optimal femoral stem fixation for total hip arthroplasty for older patients remains debated due to the heightened risk of periprosthetic fractures (PPFx) with decreased bone density. Previous studies in elderly patients have shown cemented fixation leads to fewer revisions, reduced PPFx, and improved long-term implant survival. We hypothesized that modern collared cementless stems would reduce PPFx and overall complications compared to cemented and uncemented collarless stems. To our knowledge, this study represents the first single-center analysis of outcomes in older patients traditionally recommended for cemented fixation.

Influence of Conscious Sedation Versus Spinal Anesthesia on Range of Motion and Pain Scores Following Manipulation Under Anesthesia After Total Knee Arthroplasty

2026-03-31

Manipulation under anesthesia (MUA) is a common intervention for postoperative stiffness following total knee arthroplasty (TKA). While monitored anesthesia care (MAC) is most frequently used, short-acting spinal anesthesia (SA) is increasing in popularity. There is limited research comparing outcomes of these anesthetics, specifically functional and patient-reported outcomes. This study aimed to compare the impact of MAC versus SA on postoperative range of motion (ROM) and Patient-Reported Outcome Measure Information System (PROMIS) scores following MUA.

Biomechanical Comparison of Surgical Techniques to Compensate for Resection of the Posterior Cruciate Ligament in Medially Congruent Total Knee Arthroplasty

2026-03-31

In medially congruent (MC) total knee arthroplasty (TKA), posterior cruciate ligament (PCL) resection eliminates challenges in intraoperative balancing; however, it increases anterior-posterior (AP) laxity in flexion. Common compensating strategies include reducing tibial slope, upsizing the femoral component, or converting to posterior-stabilized (PS) TKA. Therefore, we developed a computational model to quantify the effects of these options on AP laxity and associated tradeoffs, including elevated medial collateral ligament (MCL) tension and reduced femoral rollback in MC-TKA after PCL resection.

Outcomes Following Supplementary Oral Methylprednisolone Pack After Outpatient Total Knee Arthroplasty: A Matched Cohort Study

2026-03-31

The growing expansion of outpatient total knee arthroplasty (TKA) and emphasis on multimodal pain control to reduce opioid consumption are essential in optimizing perioperative care. This study aimed to assess postoperative outcomes when prescribing a supplemental oral methylprednisolone after primary TKA.

Aspirin Is Noninferior to Other Anticoagulants in Low-Risk Patients for Venous Thromboembolism Undergoing Aseptic Revision Total Hip Arthroplasty

2026-03-31

While aspirin (ASA) has been widely adopted as an effective method for deep vein thrombosis (DVT) prevention following primary total hip arthroplasty (THA), concerns remain with regard to its efficacy in the setting of revision THA (rTHA). This study aimed to compare venous thromboembolism (VTE) and transfusion rates between patients receiving ASA versus nonaspirin (non-ASA) anticoagulation following aseptic rTHA.

Laxity Phenotype Assessment of the Knee (LPAK) Classification: A Mathematical Approach to Quantifying Soft Tissue Laxity in Total Knee Arthroplasty Using the Pythagorean Theorem

James V. Bono, Vincenzo A. Bonaddio, Daniel E. Gerow, Olivia J. Bono — 2026-03-31

A new classification for soft tissue laxity in total knee arthroplasty (TKA) is presented to allow reproducible patient-specific gap balancing.

Differences in Capture Rates of Patient-Reported Outcome Measures Between Ambulatory Surgery Centers and Hospitals From the American Joint Replacement Registry

2026-03-31

The Centers for Medicare & Medicaid Services is requiring patient-reported outcome measures (PROMs) to demonstrate the value of total joint arthroplasty (TJA). While effective PROM utilization offers major benefits, capture rates and outcomes may vary across practice settings. This study aimed to (1) compare PROMs capture rates between ambulatory surgery centers (ASCs) and hospitals and (2) evaluate relationships between surgical setting, PROM capture rates, and clinical outcomes.

Synovial Fluid Electrochemical Properties Are Altered After Total Knee Arthroplasty: A Necropsy Retrieval Study

2026-03-31

Primary total knee arthroplasty (TKA) relies on cobalt chrome alloy (CoCrMo) implants to replace the degraded joint and restore patient function. However, retrieval analysis documents wear processes on femoral components, associated with metal accumulation in the periprosthetic tissue. It remains unclear how TKA affects synovial fluid and whether arthroplasty promotes oxidation within the joint capsule. To address these gaps, we asked, does TKA alter the synovial fluid’s physical and electrochemical properties?

Outcomes of Simultaneous Versus Staged Hardware Removal and Total Knee Arthroplasty

2026-03-31

This study compares clinical and functional outcomes between simultaneous hardware removal during total knee arthroplasty (TKA) and staged TKA after prior hardware removal.

Third-Generation Flexible Metaphyseal Cones in Revision Total Knee Arthroplasty: Minimum Two-Year Follow-up

2026-03-31

Porous metal cones are commonly utilized in revision total knee arthroplasty (rTKA) to manage severe bone loss. Flexible metaphyseal cones (FMCs) allow for macrodeformation, more uniform stress distribution, and diminished peak stresses to the compromised cortical bone, potentially reducing fracture risk during impaction. This study aimed to evaluate the early outcomes of FMCs used to treat severe bone loss in rTKA.

Tibial Post Fracture in Posterior-Stabilized Total Knee Arthroplasty: Is Fatigue Alone the Culprit?

2026-03-31

Tibial post fracture in posterior-stabilized total knee arthroplasty (PS TKA) is a rare but serious complication resulting from insufficient post strength and polyethylene wear. Although highly cross-linked polyethylene (HXLPE) reduces wear compared to ultra-high–molecular weight polyethylene (UHMWPE), its mechanical strength is not improved. This study reports a series of tibial post fractures and evaluates whether fatigue alone accounts for such failures.

Stable Fixation in Cementless Total Knee Arthroplasty Even for Low Local Bone Mineral Density

2026-03-31

Cementless fixation is increasingly popular for total knee arthroplasty (TKA). Prior research suggested that volumetric bone mineral density (vBMD) measured in preoperative computerized tomography (CT) scans could be useful to identify suitable candidates for cementless TKA with sufficient bone strength to avoid aseptic loosening. However, the clinically relevant thresholds of vBMD for cementless knees have not been defined. As a step toward defining such thresholds, we sought to relate the preoperative vBMD to the migration of tibial baseplates after TKA as a marker of aseptic loosening.

The John N. Insall Award: Reduced Reinfection Rate With Intraosseous Vancomycin Administration at Reimplantation in Two-Stage Revision Total Knee Arthroplasty

2026-03-31

Recurrent periprosthetic joint infection (PJI) after two-stage exchange total knee arthroplasty (TKA) is associated with increased morbidity and mortality. Intraosseous (IO) vancomycin has been shown to reduce PJI rates in primary and aseptic revision TKA, but its role in two-stage revision for infection remains unknown. This study aimed to compare reinfection rates following IO vancomycin versus intravenous (IV) antibiotic prophylaxis at the time of reimplantation.

Dynamic Alignment of the Knee (DyAK) Classification: Advancing Knee Evaluation in Robotic Arthroplasty

2026-03-31

Total knee arthroplasty (TKA) has moved toward a more personalized approach, but achieving the ideal coronal alignment is still challenging, as most knees naturally change alignment throughout the range of motion. This study introduced the dynamic alignment of the knee (DyAK) classification, based on robotic hip-knee-ankle measurements in extension (rHKA-E) and flexion (rHKA-90F), and evaluated the clinical impact of changes in DyAK type.

Patella Resurfacing Is Associated With Improving Six-Month Outcomes in Kinematically Aligned Total Knee Arthroplasty: A Propensity Score–Matched Analysis

2026-03-31

Kinematic alignment (KA) seeks to restore each patient’s native knee anatomy. Limited research compares functional outcomes between KA robotic-assisted total knee arthroplasty (rTKA) and conventional KA-TKA (cTKA). This study examined differences in early and 6-month functional outcomes between imageless, table-mounted rTKA and cTKA.

The James A. Rand Young Investigator’s Award: “Nickel-Free” Oxinium Hypoallergenic Versus Standard Cobalt-Chrome–Containing Total Knee Arthroplasty: Is There a Difference in Synovial Metal Ions at Minimum of Two-Year Follow-Up?

2026-03-31

Allergy and adverse local tissue reaction (ALTR) to metal debris may both be modes of failure in total knee arthroplasty (TKA). Yet, the intra-articular synovial fluid metal ion levels in well-fixed implants beyond the first postoperative day remain unknown. The aim of this study was to compare intraarticular synovial fluid levels of metal ions in patients who had a hypoallergenic TKA implant versus a matched cohort with a standard cobalt-chromium (Co-Cr)-containing TKA implant at a minimum 2-year follow-up.

A Synthetic Form of Cannabinoid Does Not Decrease Opioid Use After Total Knee Arthroplasty: A Prospective, Randomized, Triple-Blind, Placebo-Controlled Study

2026-03-31

Self-reported cannabis use in patients undergoing total knee arthroplasty (TKA) has increased since its legalization. Despite endorsement, its efficacy has never been studied in a prospective randomized study in orthopaedic surgery. The purpose of this study was to determine whether a synthetic delta-9-tetrahydrocannabinol (sTHC), dronabinol, decreases opioid use after TKA.

The Impact of Anticoagulant Choice on Rates of Manipulation Under Anesthesia, Hematoma Formation, and Venous Thromboembolic Events

2026-03-31

Anticoagulation after total knee arthroplasty (TKA) remains a balance between clot prevention and postoperative bleeding. This study aimed to analyze anticoagulant choice for deep vein thrombosis prophylaxis on rates of stiffness requiring manipulation under anesthesia (MUA) and hematoma formation after TKA.

Radiographic Joint Space Widening of the Unaffected Compartment in Varus or Valgus Knees Is Associated With Abnormal Intraoperative Ligamentous Laxity

2026-03-31

Krackow described type II valgus deformity as valgus alignment with obvious attenuation of the medial collateral ligament complex. However, little quantitative information exists documenting the associated medial collateral ligament laxity encountered intraoperatively. Furthermore, a corollary may exist in advanced varus deformity with associated lateral ligament laxity, but this has not been well described. This study evaluated whether increased preoperative medial or lateral radiographic joint space width (JSW) in valgus or varus knees, respectively, was associated with increased intraoperative soft-tissue laxity of the associated compartment in patients undergoing robotic-assisted total knee arthroplasty (raTKA).

Why Do Robotic Total Knee Arthroplasties Fail?

2026-03-31

Robotic platforms can provide increased information and accuracy to the procedure of total knee arthroplasty (TKA). However, it is unclear whether these advantages translate to decreased failures over time. Therefore, the purpose of this study was to describe aseptic failures following robotic TKA by examining (1) types of failure and (2) subsequent procedures/reoperations.

Why Are Total Knee Arthroplasties Failing Today: What Has Changed After Two Decades?

2026-03-31

There were two previous studies at our institution that evaluated the reasons behind total knee arthroplasty (TKA) failure, the first from 1997 to 2000 and the second from 2003 to 2012. The purpose of this study was to evaluate the frequency and causes for TKA failure over the past decade and provide an updated comparison with our previous findings.

Implant Survivorships and Complications Among Patients Undergoing Primary Total Hip Arthroplasty for Osteonecrosis Versus Osteoarthritis: Five-Year Minimum Follow-up

Adam M. Gordon, Patrick P. Nian, Chase W. Smitterberg, Michael A. Mont — 2026-03-31

Survivorship of total hip arthroplasty (THA) may differ in patients who have osteonecrosis (ON) or osteoarthritis (OA), but this may reflect risk factors known to lead to poor results. This study compared two- and 5-year implant complications, including (1) mechanical complications (dislocation, aseptic loosening, and periprosthetic fracture), (2) periprosthetic joint infections (PJIs), and (3) all-cause revisions, after THA for ON without specified risk factors versus OA.

Surgeon Variation Is Likely the Primary Confounding Factor in Observational Studies of Technology Use in Total Knee Arthroplasty

2026-03-31

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.

A Systematic Review of Registry and Large Database Studies Comparing Contemporary Cementless and Cemented Total Knee Arthroplasty

Adolph V. Lombardi, Joshua P. Rainey, Jeremy M. Gililland, Michael A. Mont — 2026-03-31

Interest is growing in durable, cementless fixation in total knee arthroplasty (TKA). This study aimed to systematically review registry and large database studies, evaluating their quality of evidence and assessing implant survivorship. Additionally, we compared these findings to a systematic review of randomized controlled trials.

Coronal Tibio-Femoral Subluxation Leads to Inferior 15-Year Survival After Mobile-Bearing Unicompartmental Knee Arthroplasty

2026-03-31

The impact of coronal tibiofemoral subluxation (CTFS) on 15-year outcomes after unicompartmental knee arthroplasty (UKA) remains unclear. This study evaluated whether preoperative CTFS influences implant survivorship.

Impact of Combined Immersive Virtual Reality and Spinal Anesthesia on Sedative Consumption in Total Knee Arthroplasty

2026-03-31

Perioperative anxiety plays a key role in patients, particularly for postoperative recovery. Immersive virtual reality (VR), which has been developed in recent years for use in regional anesthesia, may help reduce this anxiety and limit intraoperative sedative consumption. The aim of this study was to objectively assess the impact of VR distraction on perioperative anxiety by evaluating sedative use during total knee arthroplasty (TKA) under spinal anesthesia (SA).

Spontaneous Osteonecrosis of the Knee Is Associated With Increased Five-Year Implant Complications Compared to Osteoarthritis Patients Undergoing Primary Total Knee Arthroplasty

Adam M. Gordon, Patrick P. Nian, Chase W. Smitterberg, Michael A. Mont — 2026-03-31

Spontaneous osteonecrosis of the knee (SPONK) is a potential, although uncommon, indication for total knee arthroplasty (TKA). Unlike secondary osteonecrosis, SPONK typically affects a single femoral condyle in patients over 50 years of age and is sometimes treated with TKA once joint-preserving strategies fail. However, implant survivorship of TKA for SPONK versus osteoarthritis (OA) remains under-characterized. This study aimed to compare outcomes, including (a) mechanical complications (aseptic loosening, periprosthetic fracture), (b) periprosthetic joint infection, and (c) all-cause revision, between patients undergoing TKA for SPONK and OA at two and five years.

Evaluating the Optimal Timing Between Staged Bilateral Total Knee Arthroplasties for Improved Clinical Outcomes

2026-03-31

Simultaneous bilateral total knee arthroplasty (BTKA) is avoided due to higher perioperative risk, favoring staged procedures. This study evaluated how the interval between staged TKAs affects patient-reported outcome measures (PROMs) and compared complications between the first and second procedures.

Practice Management Strategies Among the Current Members of the American Association of Hip and Knee Surgeons

Jay R. Lieberman, Leonard T. Buller, R. Michael Meneghini — 2026-03-31

At the 2025 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS), a survey was conducted to determine practice management strategies among the AAHKS members.

Tip-of-Stem Pain Is a Rare Complication Following Revision Total Knee Arthroplasty at a Mean 6.9-Year Follow-Up

2026-03-31

Tip-of-stem pain is a rare complication of revision total knee arthroplasty (TKA). This study evaluates the incidence of tip-of-stem pain and its associations with clinical and radiographic outcomes in revision TKA.

Preoperative Contralateral Joint And/Or Back Pain Impact on Achieving the Substantial Clinical Benefit for Hip Disability and Osteoarthritis Outcome Score–Joint Replacement

2026-03-31

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.

Achieving Anatomic Kinematics in a Noncruciate Total Knee Arthroplasty: Preclinical Evaluation Using a Crouching Machine

2026-03-31

Studies on patients have shown that normal anatomic motion is often not achieved with current total knee arthroplasty (TKA) designs. The purpose of this study was to determine whether anatomic motion could be restored using a design where intercondylar guiding surfaces were positioned between the medial and lateral femoral condyles.

Coronal Plane Alignment of the Knee Classification Remains Best Determined on Long-Leg Radiographs Compared to Computed Tomography Scanograms or Short Knee Radiographs

2026-03-31

The coronal plane alignment of the knee (CPAK) classification is a pragmatic method to characterize constitutional limb alignment. The CPAK classification was originally described using radiographic measurements from standing long-leg radiographs (LLRs). Surgeons who do not obtain LLRs before total knee arthroplasty (TKA) may estimate CPAK using alternative modalities, including supine computed tomography (CT) scanograms and standing short knee radiographs. This study was performed to evaluate the correlation in measurements of lower limb alignment and the agreement of CPAK classification between these three imaging modalities.

Impact of Implant Size Variation on Surgical and Clinical Outcomes in Staged, Bilateral Total Knee Arthroplasty

2026-03-31

This study evaluated differences in surgical and clinical outcomes among patients who have identical versus different implant sizes in sequential total knee arthroplasty (TKA) surgeries.

Cementless Total Knee Arthroplasty Is Associated With Improved Outcomes in Patients Who Have a Body Mass Index of 35 or More

2026-03-31

Indications for cementless fixation in total knee arthroplasty (TKA) remain unclear despite increasing use. Previous findings have suggested that obese patients have favorable outcomes with cementless TKA, but evidence is sparse. This paper compared the following outcomes in patients who have a body mass index (BMI) of 35 or more: (1) mechanical complications, including periprosthetic fracture and aseptic loosening; (2) infectious complications, including periprosthetic joint infection (PJI) and surgical site infection; 3) venous thromboembolism; and 4) aseptic revision through five years postoperatively.

Patello-femoral Tracking Optimization in Robotic-Assisted Total Knee Arthroplasty

2026-03-30

Robotic-assisted total knee arthroplasty (RA-TKA) allows for intraoperative component positioning to personalize alignment and gaps. However, traditional trochlear designs not optimized for patellar tracking in kinematic alignment result in femoral internal rotation (IR) relative to the surgical transepicondylar axis. We sought to determine the femoral component alignment’s effect on patellar tracking in RA-TKA.

Polymerase Chain Reaction as an Adjunct to Conventional Culture for Periprosthetic Joint Infection Diagnosis

2026-03-30

Periprosthetic joint infection (PJI) remains one of the most challenging complications after total joint arthroplasty. While conventional culture remains the standard for identification of causative pathogens in PJI, rapid identification techniques such as polymerase chain reaction (PCR) are becoming increasingly popular, with little comparative data.

Emerging Nonopioid Analgesic Strategies in Total Joint Arthroplasty: Mechanisms, Evidence, and Practical Implementation

Ahmed Siddiqi, Antonia F. Chen, Paul Jacob, Andrew Wickline, Khalid M. Yousuf — 2026-03-29

Total joint arthroplasty (TJA), encompassing total hip and knee arthroplasty, remains one of the most effective procedures for end-stage arthritis, but is frequently associated with substantial postoperative pain. Opioid-based analgesia, although effective, carries risks of dependence, respiratory depression, and delayed recovery. In response to the opioid crisis, multimodal nonopioid strategies have gained prominence to improve outcomes while minimizing adverse effects.

Minimal Clinically Importance Difference and Substantial Clinical Benefit in Total Knee Arthroplasty: Delayed Achievers and Maintaining Improvement

2026-03-29

Improvement in Knee injury Osteoarthritis Outcome Survey, Joint Replacement (KOOS, JR) scores is commonly used as a marker of patient satisfaction following total knee arthroplasty (TKA). The purpose of this study was to determine predictors of patients who had delayed achievement of satisfied KOOS, JR scores following TKA and those who did not maintain their score despite achieving an early high score.

High Mortality in Patients Presenting With Periprosthetic Joint Infection and Concomitant Sepsis

2026-03-28

Periprosthetic joint infection (PJI) has a 5-year mortality rate comparable to many cancers and can progress to a life-threatening sepsis. The aim of this study was to investigate the mortality of patients presenting with simultaneous PJI and sepsis after hip and knee arthroplasty.

The Fate of the Patient Who Has Early Dislocation After Contemporary Primary Total Hip Arthroplasty

2026-03-27

Recurrent instability remains a leading indication for revision following primary THA. However, data regarding outcomes following early dislocation is dated and limited in scope. Whether this existing data applies to contemporary practice with the broad adaptation of high-stability bearings and modern surgical techniques is unknown. Therefore, we assessed revision and re-dislocation rates following early dislocation in a contemporary group of patients following primary THA.

Attention Should Be Paid to the Bone Mineral Density Status of Patients Undergoing Unicompartmental Knee Arthroplasty: A 1,164-Case Follow-Up Study

Dehua Liu, Xue Wang, Xu Dong, Mengchao Liu, Gang Ji, Guobin Liu — 2026-03-26

Osteoporosis is a systemic skeletal disorder, which can compromise implant fixation strength and increase the risk of postoperative complications. Currently, the relationship between the abnormal bone mass and clinical outcomes following unicompartmental knee arthroplasty (UKA) remains unclear.

An Increase in the Treatment of High-Risk Total Joint Arthroplasty Patients Who Have Medicare at Teaching Hospitals

2026-03-26

The Comprehensive Care for Joint Replacement Medicare model may not adequately compensate for increased resource utilization in complex total joint arthroplasty (TJA) cases, raising concern for potential biased selection of healthier patients and avoidance of complex or high-comorbidity patients. This study quantified national trends among Medicare beneficiaries undergoing TJA, comparing comorbidity characteristics at teaching versus nonteaching hospitals.

Dual Mobility versus Conventional Total Hip Arthroplasty for Femoral Neck Fractures: A Multicenter Propensity-Matched Study on Dislocation Risk

2026-03-24

Total hip arthroplasty (THA) is a common treatment for displaced femoral neck fractures (FNFs). Dual mobility (DM) THA has been advocated to reduce dislocation risk in high-risk patients, such as those who have FNF. However, comparative studies remain limited. The purpose of our study was to answer the following questions: (1) What is the dislocation incidence between DM-THA and conventional THA (c-THA) in patients who have FNF? (2) What is the revision incidence between DM-THA and c-THA in patients who have FNF? and (3) What are the risk factors for dislocation in patients who have THA for FNF?

Kinematic Impact of Patella Resurfacing in Bicruciate-Stabilized Total Knee Arthroplasty: A Comparative Analysis of Femoro-Tibial Motion and Patellar Classification

2026-03-23

Understanding patello-femoral and femoro-tibial kinematics is essential for optimizing outcomes following total knee arthroplasty (TKA). Registry data indicate higher revision rates in TKA patients who have unresurfaced patellae, yet the kinematic implications of patellar resurfacing remain underexplored. This study investigated the influence of patellar resurfacing on patellar height classification and knee kinematics.

Untreated Onychomycosis Is Associated With Increased Risk of Periprosthetic Joint Infection Following Total Joint Arthroplasty

2026-03-23

Onychomycosis, a fungal infection of the nail, is often perceived as a benign condition. The purpose of this study was to evaluate whether onychomycosis is associated with an increased risk of periprosthetic joint infection (PJI) in patients undergoing total joint arthroplasty.

Baseline Characteristics Explain Sex Differences in Primary Total Knee Arthroplasty Outcomes: A Prospective Multicenter Study With 4-Year Follow-Up

2026-03-23

Women report worse outcomes following total knee arthroplasty (TKA), but it remains unclear whether sex independently predicts outcomes or whether observed differences reflect baseline characteristics. This study aimed to characterize sex differences across a 4-year recovery period and determine whether they persist after adjusting for confounding factors.

Recovery Plateaus and Ceiling Effects of Commonly Used Patient-Reported Outcome Measures Following Primary Total Knee Arthroplasty

2026-03-23

Various patient-reported outcome measures (PROMs) are used following total knee arthroplasty (TKA), but the timing of recovery plateaus and the presence of ceiling effects remain unclear. This study aimed to describe these characteristics of commonly used PROMs following TKA.

Outcomes Following Total Hip Arthroplasty in Patients Who Have Cutaneous Psoriasis and Psoriatic Arthritis

2026-03-22

Cutaneous psoriasis (PsC) and psoriatic arthritis (PsA) are associated with higher risks for soft-tissue infection. However, there is sparse literature examining psoriasis and infectious complications following total hip arthroplasty (THA). Therefore, the purpose of this study was to observe and compare the rates of (1) superficial surgical site infections (superficial SSIs), (2) deep SSIs (deep SSI), and (3) 90-day sepsis rates, and 2-year revision rates following THA in patients who have PsC and PsA compared to patients who did not have psoriasis.

Iliopsoas Impingement Risk in Collared Femoral Implants: Beware of Small Femora in the Setting of a Constant Length Collar

2026-03-22

Collared femoral stems have seen a resurgence in total hip arthroplasty (THA) due to improved axial and rotational mechanical stability and lower early complication rates, including periprosthetic fracture. However, the presence of a collar over the femoral calcar may cause pain due to iliopsoas impingement (IPI). The objective of this article was to analyze temporal trends in collared stem use and determine risk factors for associated IPI.

Agreement of Patient Responses Between Electronic and Paper Patient-Reported Outcome Measures in Total Hip Arthroplasty

2026-03-20

Total hip arthroplasty (THA) outcomes are commonly assessed using patient-reported outcome measures (PROMs). As electronic PROMs (ePROMs) gain popularity, ensuring equivalence to paper PROMs (pPROMs) is essential. This study aimed to evaluate the interchangeability of ePROMs and pPROMs in patients undergoing THA.

Asymptomatic Bacteriuria and Periprosthetic Joint Infection Risk: A Systematic Review and Meta-Analysis

2026-03-20

Periprosthetic joint infection (PJI) is a serious complication of hip and knee arthroplasty. Although hematogenous seeding is a recognized cause, the contribution of asymptomatic bacteriuria (ASB) remains uncertain. Therefore, we conducted a systematic review and meta-analysis to evaluate this association.

Failure Incidence and Predictors Following Manipulation Under Anesthesia for the Stiff Total Knee Arthroplasty

2026-03-20

Manipulation under anesthesia (MUA) is a common treatment for stiffness following total knee arthroplasty (TKA). The purpose of this study was to evaluate the outcomes following MUA and identify risk factors for additional surgical intervention.

Impact of Chronic Obstructive Pulmonary Disease on Complications and Readmissions Following Total Knee Arthroplasty: A Retrospective Matched Cohort Study

2026-03-20

Chronic obstructive pulmonary disease (COPD) is a common comorbidity among patients undergoing total knee arthroplasty (TKA). We compared preoperative characteristics, perioperative management methods, postoperative complications, and readmissions after TKA in patients who did and did not have COPD.

The 10- to 23-Year Outcomes of Cemented Total Hip Arthroplasty Utilizing Impaction Bone Grafting for Severe Acetabular Bone Defects in Osteoarthritis and Rheumatoid Arthritis

2026-03-18

Long-term outcomes of impaction bone grafting (IBG) with a cemented cup in primary total hip arthroplasty (THA), particularly in Asian populations who have prevalent developmental dysplasia of the hip, remain limited. We evaluated outcomes at ≥ 10 years after primary cemented THA using IBG for severe acetabular defects in osteoarthritis or rheumatoid arthritis (RA).

Kinematic and Mechanical Alignment Yield Similar Outcomes in Total Knee Arthroplasty: A Systematic Review and a Meta-Analysis of Randomized Controlled Trials

2026-03-18

Although mechanical alignment (MA) is the current gold standard for total knee arthroplasty (TKA), suboptimal patient satisfaction rates have prompted the exploration of alternative alignment strategies. This review examined whether kinematic alignment (KA) improves outcomes following TKA compared to MA.

Equivalent Functional Outcomes in Cruciate-Retaining and Posterior-Stabilized Total Knee Arthroplasty for Knee Osteoarthritis with Severe Fixed Flexion Deformity: A Propensity Matched-Pair Analysis

2026-03-17

Cruciate-retaining (CR) total knee arthroplasty (TKA) is generally avoided in knees with severe fixed flexion deformity (FFD). The need for additional distal femoral resection, posterior soft-tissue releases, and gap balancing typically favors posterior-stabilized (PS) implants. This study compared CR- and PS-TKA in severe FFD by evaluating clinical and patient-reported outcomes at two years: (1) range of motion (ROM), (2) Knee Society Score (KSS), (3) Oxford Knee Score (OKS), (4) Short-form 36 (SF-36) Physical (PCS) and (5) Mental (MCS) Component Scores.

Defining the Patient Acceptable Symptom State for the 12-Item Hip Disability and Osteoarthritis Outcome Score One Year After Total Hip Arthroplasty for Hip Joint Osteoarthritis

2026-03-17

Patient-reported outcome measures (PROMs) are valuable for evaluating treatment success from the patient’s perspective. The 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) is a PROM scored from 0 to 100, worst to best, that assesses pain, function, and quality of life (QOL). Interpreting PROMs to determine patient satisfaction with treatment can be challenging. The patient acceptable symptom state (PASS) defines the PROM value beyond which patients consider their condition satisfactory.

High Utilization of Neuraxial Anesthesia in Revision Total Joint Arthroplasty Is Safe and Effective

2026-03-17

Evidence in support of neuraxial anesthesia in revision total joint arthroplasty (rTJA) is still emerging. The purpose of this study was to demonstrate whether most rTJAs performed at an orthopaedic specialty hospital can be safely completed under neuraxial anesthesia.

Impact of a Prior Debridement, Antibiotics, and Implant Retention on Outcomes of Two-Stage Exchange Knee Arthroplasty in Periprosthetic Joint Infection

2026-03-16

In periprosthetic joint infection (PJI), prior studies evaluating failed debridement, antibiotics, and implant retention (DAIR) before two-stage exchange arthroplasty report conflicting outcomes and exclude initially successful DAIR cases. This study (1) compared two-stage exchange arthroplasty success with and without a preceding failed DAIR and (2) evaluated outcomes with initially successful DAIR cases included.

Racial Differences in Patient-Reported Outcomes After Total Joint Arthroplasty

2026-03-16

Racial differences in total joint arthroplasty (TJA) remain poorly defined. The purpose of this study was to investigate racial/ethnic differences in postoperative clinical and patient-reported functional outcomes between non-Hispanic White, African American, Hispanic, Asian, and Native American populations using the American Joint Replacement Registry.

Clinically Relevant Threshold Achievement Evolves Over Time Following Primary Total Hip Arthroplasty

2026-03-16

Patient-reported outcome thresholds add clinical relevance to functional outcome scores. This study aimed to define the patient acceptable symptom state (PASS) and minimal clinically important difference (MCID) for the modified Harris Hip Score (mHHS), visual analog scale (VAS) for pain, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), and Forgotten Joint Score (FJS) and identify differences in threshold achievement over time.

Intraosseous Vancomycin for Primary Total Knee Arthroplasty Is Associated With a Lower Rate of Postoperative Acute Kidney Injury Than Intravenous Vancomycin

2026-03-16

Perioperative vancomycin administration can be difficult to time and can lead to adverse systemic effects. Intraosseous vancomycin (IOV) is becoming increasingly utilized for total knee arthroplasty (TKA) prophylaxis. The primary purpose was to compare the rate of acute kidney injury (AKI) following primary TKA that utilized IOV or intravenous vancomycin (IVV).

Increased Risk of Postoperative Complications Following Total Knee Arthroplasty in Patients Who Have Metabolic Syndrome

2026-03-15

Postoperative outcomes after total knee arthroplasty (TKA) are influenced by patient comorbidities. Metabolic syndrome (MetS) combines hypertension, diabetes, obesity, and dyslipidemia, which have been associated with increased short-term surgical complications. However, its independent impact on TKA outcomes beyond the perioperative period (> 90 days) remains unclear. This study compared outcomes following TKA between patients who had and did not have MetS, including (1) mechanical complications (mechanical loosening and periprosthetic fracture), (2) infectious complications (surgical site infection and periprosthetic joint infection), and (3) reoperations (all-cause revision, septic revision, and manipulation under anesthesia), at 90 days, 1 year, and 2 years.

Patient-Reported Outcomes and Satisfaction Following Total Knee Arthroplasty in Rheumatoid Arthritis: An Observational Cohort Study

2026-03-15

Advances in pharmacologic therapy for rheumatoid arthritis (RA), including biologics and Janus kinase inhibitors, have reduced joint damage and the need for surgery. However, total knee arthroplasty (TKA) remains essential in patients who have RA and are generally favorable; most studies emphasize physician-reported outcomes, with limited focus on patient-reported outcome measures (PROMs).

Conversion Total Knee Arthroplasty in Patients Who Have Periarticular Hardware: One Operation May Be Enough

2026-03-14

Patients undergoing total knee arthroplasty (TKA) not infrequently have periarticular hardware in place from prior surgical intervention(s). The optimal management of hardware around the knee is not known, with some surgeons preferring simultaneous removal while others stage hardware removal and TKA. This study compared outcomes in patients with hardware in place who underwent simultaneous or staged management of the hardware and TKA.

Do Patients Undergoing Unicompartmental Knee Arthroplasty Who Fail to Achieve Minimal Clinically Important Difference Have Higher Rates of Conversion to Total Knee Arthroplasty?

2026-03-13

With an increase in unicompartmental knee arthroplasty (UKA) being performed in the United States, arthroplasty surgeons may benefit from strategies to identify the UKA patients at high risk for conversion to total knee arthroplasty (TKA). These patients may benefit from closer monitoring, targeted physical therapy, and timely interventions. A strategy for monitoring at-risk patients may be the utilization of the Minimal Clinically Important Difference (MCID) threshold. The UKA patients who experience unresolved pain, suboptimal biomechanics, or are unable to actively participate in their recovery may not achieve MCID, which may contribute to higher conversion rates.

Comparable Outcomes of Total Joint Arthroplasty Performed at Ambulatory Surgery Centers and Hospital Outpatient Departments

2026-03-13

As the volume of outpatient total joint arthroplasty (TJA) continues to rise, evaluating outcomes across surgical settings has become increasingly important. Our study compared rates of 90-day complications between patients undergoing outpatient TJA at an ambulatory surgery center (ASC) and a hospital outpatient department (HOPD).

Comparison of Functional Recovery Between Unicompartmental Knee Arthroplasty and Medial Meniscus Posterior Root Tear Repair in Patients Aged over 50 Years: A One-Year Propensity Score–Weighted Study

Krit Boontanapibul, Saowabhak Nitayavardhana, Yot Tanariyakul, Piya Pinsornsak — 2026-03-13

Medial meniscus posterior root tear (MMPRT) accelerates knee osteoarthritis progression. Meniscal root repair (MRR) in patients older than 50 years is controversial due to unpredictable healing and mild to moderate cartilage degeneration, which may lead surgeons to consider unicompartmental knee arthroplasty (UKA). This study compared clinical outcomes of UKA versus MRR in patients older than 50 years who had MMPRT and Kellgren–Lawrence (KL) grade ≤ 3 arthritis.

Closer and Wealthier, Not Healthier: Proximity and Socioeconomic Status Drive Ambulatory Surgery Center Selection More than Comorbidity

2026-03-12

Ambulatory surgery centers (ASCs) are increasingly used for total joint arthroplasty (TJA), offering lower costs and shorter stays than hospitals. However, access to ASC-based arthroplasty remains uneven, with socioeconomic and geographic disparities suspected to influence which patients receive outpatient care. This study evaluated how community-level socioeconomic status (SES) and travel distance affect the likelihood of undergoing TJA at an ASC versus a hospital.

Radiographic Measures of Patellar Tracking After Total Knee Arthroplasty: Comparing the Native Patellar Midpoint Versus Median Ridge as Reference Landmarks

2026-03-11

Accurate radiographic assessment of patellar tracking in total knee arthroplasty (TKA) is important. A commonly used method references the midpoint of the native patella (MPNP), which assumes central patella implant positioning and overlooks asymmetric patellar morphology in TKAs in which the patella is not resurfaced. Alternative measurement techniques that reference the patellar median ridge (MR) or center of the patellar prosthesis (CPP) may more accurately reflect true patellar position. This study compared MPNP with MR/CPP methods to determine whether landmark selection meaningfully alters the measured magnitude or direction of patellar translation.

Total Knee Arthroplasty in Postpolio Residual Paralysis: A Systematic Review and Pooled Analysis of Its Outcomes and Complications

2026-03-11

Total knee arthroplasty (TKA) in patients who have postpolio residual paralysis (PPRP) is technically challenging due to bone deformities, ligamentous laxity, and variable quadriceps muscle strength. Despite these challenges, TKA is increasingly being performed in this population, yet outcomes remain variably reported. This review aimed to systematically assess postoperative complications and revision rates following TKA in patients who had PPRP through a pooled analysis of available studies.

Effects of Ankylosing Spondylitis on Total Knee Arthroplasty Outcomes and Postoperative Manipulation Under Anesthesia Rates

2026-03-11

Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthropathy primarily affecting the spine and sacroiliac joints, with up to 70% of patients developing asymmetric oligoarthritis in lower-limb joints. With the rise in total knee arthroplasty (TKA) among the elderly, more AS patients are undergoing this procedure. This study aimed to assess whether AS patients undergoing TKA have a higher rate of manipulation under anesthesia (MUA) compared to non-AS patients, hypothesizing that AS patients' increased inflammatory state would lead to more synovial hypertrophy, scarring, and stiffness, resulting in a higher need for MUA.

Comparing Medicare and Non-Medicare Inpatient Total Hip Arthroplasty: Is the New Centers for Medicare & Medicaid Services Patient-Reported Outcomes Performance Measure Mandate Applicable to All?

2026-03-11

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.

Patients Who Have a Preoperative Flexion Contracture Demonstrate Inferior Outcomes Following Unicompartmental Knee Arthroplasty Compared to Total Knee Arthroplasty

2026-03-11

The traditional criteria for unicompartmental knee arthroplasty (UKA) excluded patients who have a flexion contracture greater than 5°. However, the outcomes of patients undergoing UKA who have a flexion contracture remain poorly studied.

Is Low-Dose Aspirin the Safest Prophylaxis for Venous Thromboembolism Following Primary Total Hip Arthroplasty?

Sri Tummala, Aruni S. Areti, Yida Liu, Antonia F. Chen, Senthil N. Sambandam — 2026-03-11

Venous thromboembolism (VTE) remains a serious complication following primary total hip arthroplasty (THA), prompting routine use of perioperative chemoprophylaxis. In 2022, the International Consensus Meeting (ICM) endorsed low-dose aspirin (LDA) as the preferred VTE prophylactic agent for both hip and knee arthroplasty patients. Prior THA studies lack stratification by VTE risk and direct comparisons between aspirin monotherapy, combination regimens, and alternative anticoagulants. This study aimed to evaluate the safety and efficacy of LDA monotherapy compared to other anticoagulants across high- and low-risk THA cohorts.

Solving Intraoperative Challenges During Primary Total Hip Arthroplasty: Prevention, Recognition, and Management

2026-03-11

Intraoperative challenges during total hip arthroplasty can importantly impact surgical outcomes and patient satisfaction. Effective management of these complications is essential to avoid adverse events and optimize recovery.

Building Bridges, Not Dependencies: Empowering Local Surgeons as the Future of Global Arthroplasty Outreach

Jose C. Alcerro, Michael J. Christie — 2026-03-10

Short-term medical missions have provided episodic access to total knee arthroplasty (TKA) in low- and middle-income countries, but concerns persist regarding sustainability and continuity of care. We hypothesized that a Honduran surgeon-led TKA program would achieve clinically meaningful improvements in patient-reported outcomes with complication rates within national registry-reported benchmarks.

Does Prior Arthroscopy Delay Clinically Relevant Improvement Timelines Following Unicompartmental Knee Arthroplasty and Primary Total Knee Arthroplasty?

2026-03-10

Prior knee arthroscopy before total knee arthroplasty (TKA) may lead to worse patient-reported outcomes. However, the impact of prior arthroscopy on unicompartmental knee arthroplasty (UKA) is unclear. Moreover, to our knowledge, no previous investigation has examined how prior arthroscopy is associated with the time to achieve the minimal clinically important difference (MCID). Thus, this study investigated whether prior arthroscopy is associated with the time to MCID achievement after both UKA and TKA.

A Combined Multi-Route Regimen of Multiple Low-Dose Intravenous and Periarticular Dexamethasone Improves Perioperative Outcomes After Total Knee Arthroplasty: A Prospective, Double-Blind, Randomized Controlled Trial

Yanze Xia, Honghui Song, Jia Jin, Haibin Zhou, Liubing Li, Wei Xu — 2026-03-03

The objective of our study was to compare five low-dose perioperative dexamethasone (DEX) regimens on early recovery after total knee arthroplasty and identify an optimal route combination.

Aspirin Is Associated With Improved Thromboprophylaxis Versus Low-Molecular-Weight Heparin Following Revision Knee Arthroplasty for Periprosthetic Joint Infection

2026-03-02

There is no consensus regarding the optimal venous thromboembolism (VTE) chemoprophylaxis agent following surgery for periprosthetic joint infection (PJI). Aspirin (ASA) and low-molecular-weight heparin (LMWH) are two commonly used agents; however, efficacy data in this population is lacking. This study compared ASA to LMWH among patients undergoing first-stage revision total knee arthroplasty for PJI.

Effectiveness of Telerehabilitation After Total Knee Arthroplasty: An Umbrella Review

Huiping Xu, Vivian W.Q. Lou, Zixin Guo, Ruiqing Di, Xinyu Zhang, Yanjin Liu — 2026-03-02

The use of telerehabilitation is increasing worldwide among patients who have undergone total knee arthroplasty (TKA). However, its efficacy and credibility in clinical settings remain unclear.

Dual Mobility versus Jumbo Head (≥ 40 mm) Following Primary Total Hip Arthroplasty: A Registry-Based Cohort Study

2026-03-01

Instability remains a leading complication following primary total hip arthroplasty (THA). Large articulations enhance stability by increasing jump distance and range of motion. Dual mobility (DM) and ≥ 40 mm jumbo heads (JHs) are both large articulation options when compared to ≤ 36 mm heads, and debate exists between these two given differences in complexity, cost, and failure mechanism.

Negative Influence of Joint Line Change on 10.8-Year Outcomes and Survival of Medial Unicompartmental Knee Arthroplasty

2026-02-28

This study aimed to investigate the effect of changes in joint line height on clinical outcomes and survival rates of unicompartmental knee arthroplasty (UKA) for medial compartmental knee osteoarthritis at a mean follow-up of 10.8 years

Blood Transfusion in the Age of Tranexamic Acid: Who Needs a Type and Screen Before Total Knee Arthroplasty?

2026-02-28

Tranexamic acid (TXA) has reduced, but not eliminated, blood transfusions surrounding total knee arthroplasty (TKA). Identifying risk factors for transfusion remains important for risk reduction and type and screen (T and S) optimization.

Implant Survivorship and Functional Recovery Utilizing a Modern Knee Fusion Nail Spacer for Periprosthetic Joint Infection

2026-02-25

Traditional indications for static spacers include substantial bone loss, ligamentous insufficiency, extensor mechanism dysfunction, or severe soft-tissue compromise. However, conventional designs are associated with high complication rates and morbidity. A knee fusion nail spacer (FNS) construct combines mechanical stability with targeted antibiotic delivery. This study aimed to (1) describe outcomes of FNS use in terms of total knee arthroplasty (TKA) reimplantation, infection eradication, and limb salvage; (2) determine FNS survivorship with reinfection as the endpoint; and (3) report complications and functional recovery.

Total Knee Arthroplasty Using Robotic-Assisted Technology in Patients Who Have Prior Anterior Cruciate Ligament Reconstruction

2026-02-23

Total knee arthroplasty (TKA) in patients who have prior anterior cruciate ligament reconstruction (ACLR) has demonstrated decreased survivorship, with instability as the primary etiology of failure. Robotic-assisted TKA (RA-TKA) provides intraoperative gap data to help achieve a balanced soft-tissue sleeve. The purpose of this study was to evaluate outcomes, patient-reported outcome measures (PROMs), complications, and revisions in patients undergoing primary RA-TKA who had a history of prior ACLR.

Beyond Gram-Negative and Gram-Positive Bacteria: Virulence as a Determinant of Clinical Outcome in Periprosthetic Joint Infections

2026-02-23

Gram-negative (GN) periprosthetic joint infections (PJIs) are still less frequent than gram-positive (GP) PJIs. There is only little data available on a direct comparison of GP- and GN-associated PJIs. Therefore, we investigated the outcome of GN and GP hip and knee PJI according to the virulence of the pathogens in a matched cohort.

Varus/Valgus or Hinge Constraint in Primary Total Knee Arthroplasty: Indications and Outcomes of Planned and Unplanned Use

Zachary H. Clarke, Nancy L. Parks, Jacqueline R. Ray, Kevin B. Fricka — 2026-02-23

Varus/valgus constrained and rotating hinge prosthetic designs are occasionally required in primary total knee arthroplasty (TKA) to manage major instability. This study evaluated the clinical indications and postoperative outcomes of both planned and unplanned use of constraint in primary TKA.

Survivorship of Total Hip Arthroplasty After Acute Hip Fracture and Failed Osteosynthesis Based on the Finnish Arthroplasty Register With a 4-Year Mean Follow-Up

2026-02-23

Surgical treatment options for femoral neck fracture include arthroplasty and internal fixation (IF). An IF is associated with faster operation time, less blood loss, and fewer hospitalization days than arthroplasty. However, reoperation rates are significantly higher than treatment with total hip arthroplasty (fracture-THA). Most reoperations following IF include implant removal surgeries and conversions to THA (salvage-THA).

Improvement After Total Knee Arthroplasty to a Knee Injury and Osteoarthritis Outcome Score for Joint Replacement Score Greater Than 71: Implications for Merit-Based Reimbursements

2026-02-22

The Center for Medicare and Medicaid is introducing the merit-based incentive payment system, requiring outcome reporting. A potential measure is the proportion of patients who have a postoperative Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS Jr.) score of 71. This study aimed to determine the percentage of patients who achieved this threshold at one year following primary total knee arthroplasty, the various predictors of this outcome, and the proportion who achieved substantial clinical benefit (SCB).

Quality-Adjusted Life Year Gains After Total Hip and Knee Arthroplasty: A Review of Cost-Effectiveness Evidence and Policy Implications

2026-02-22

The use of health-related quality of life (HRQoL) instruments and quality-adjusted life years (QALYs) has led to a better understanding of cost-effectiveness and quality-of-life improvements after total joint arthroplasty (TJA). The purpose of this review was to characterize the effect that primary TJA has on QALYs. Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are both highly cost-effective interventions that provide patients with reliable improvements in quality of life and overall satisfaction.

The Limited Utility of Synovial C-Reactive Protein in the Diagnosis of Knee and Hip Periprosthetic Joint Infection: Proposed New Diagnostic Cutoffs

2026-02-20

The utility of synovial C-reactive protein (CRP) in diagnosing periprosthetic joint infection (PJI) remains controversial. This study examined the performance of synovial CRP for PJI diagnosis following total knee arthroplasty and total hip arthroplasty.

Does Cement Mantle Grading of Distal Femoral Replacements Correlate With Implant Survivorship?

2026-02-19

Distal femoral replacement (DFR) is increasingly being used as a salvage procedure for both oncologic and nononcologic cases. However, as aseptic loosening after this complex surgery remains a concern, there is a concomitant uncertainty in the role of cemented fixation in DFRs. The purpose of this study was to evaluate the outcomes following DFR according to femoral stem-to-construct ratio and cement mantle grading.

Silk Fibroin Mesh Significantly Reduces Skin Reactions Compared to Cyanoacrylate Adhesives in Total Joint Arthroplasty

2026-02-18

Medical adhesive–related skin injuries (MARSI) are common complications associated with traditional cyanoacrylate-based adhesives, leading to a range of adverse patient outcomes. Silk fibroin mesh (SFM) has emerged as a biocompatible alternative, designed to minimize these reactions while maintaining effective wound support; however, comparative data assessing its effectiveness in reducing wound complications remain limited. This study compared the incidence of MARSI, particularly allergic contact dermatitis, between cyanoacrylate mesh (CM) and SFM wound closure systems in total joint arthroplasty.

Diagnostic Accuracy of Alpha Defensin Lateral Flow Assay in Total Hip and Knee Arthroplasty

2026-02-18

Accurate diagnosis of periprosthetic joint infection (PJI) remains suboptimal. Of the tests used, one is the alpha defensin lateral flow assay (ADLFA). This study assessed ADLFA for the diagnosis of PJI in total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). We hypothesized that ADLFA would have high specificity and sensitivity for diagnosing PJI, but that certain clinical features would influence test reliability.

Femoral Bowing in Total Knee Arthroplasty: Angular Deviation as a Primary Mediator of Poor Five-Year Function and Evidence-Based Thresholds for Intervention

2026-02-18

Femoral bowing compromises intramedullary-guided distal femoral resection accuracy in total knee arthroplasty (TKA), yet its impact on 5-year functional outcomes remains incompletely characterized. This study investigated whether bowing affects TKA outcomes through angular deviation during resection and established clinically actionable thresholds for risk stratification.

Rethinking the Sequence of Arthroplasty-Focused Evaluation: Is It Time to Look at the Radiograph First?

2026-02-18

Internal medicine training models intended for wide, symptom-driven differentials are the source of the conventional orthopaedic diagnostic sequence of history, physical examination, and subsequent imaging. However, this approach may cause inefficiencies in modern arthroplasty-focused clinics that are inconsistent with the structural basis of the majority of hip and knee pathologies. In high-volume clinics, patients are frequently roomed, sent for radiography, and then reroomed, which interferes with productivity and results in task switching and cognitive fragmentation.

The Enlarged Lymph Node Ratio Performs Well for Diagnosing Periprosthetic Joint Infection After Total Hip Arthroplasty

Bingbing Li, Runxing Kang, Mao Yuan, Bo Sheng, Yun Mao, Jia Li — 2026-02-18

The aim of this study was to evaluate the predictive value of the enlarged lymph node ratio (ELNR) derived from regional lymph nodes (LNs) for periprosthetic joint infection (PJI) following total hip arthroplasty.

Less of the Lesser: Postero-lateralization of the Lesser Trochanter Was Associated With Symptomatic Iliopsoas Tendinitis Following Total Hip Arthroplasty

2026-02-18

Iliopsoas tendinitis following total hip arthroplasty (THA) has been described to result from acetabular component overhang and prominent femoral collars. However, a portion of patients experience iliopsoas tendinitis in the setting of well-positioned components. The purpose of this study was to assess anatomic factors predisposing to iliopsoas tendinitis after THA.

Zonal Fixation With Metaphyseal Sleeves in Reconstruction of Bone Defects in Complex Primary and Revision Total Knee Arthroplasty

2026-02-12

The purpose of this study was to evaluate the clinical, radiological, and functional outcomes of bone-loss reconstruction in revision and complex primary total knee arthroplasty (TKA) using metaphyseal sleeves.

Impact of Frailty on Total Knee Arthroplasty Outcomes: A Propensity-Matched Study of 133,264 Patients Using the Modified Frailty Index

2026-02-09

Frailty is a known critical determinant of surgical outcomes. However, it lacks routine integration into total knee arthroplasty (TKA) risk assessment. This study evaluated the association between preoperative frailty, measured by the five-factor modified frailty index (mFI-5), and adverse medical and surgical outcomes following TKA.

Ultra-Congruent Versus Cruciate-Retaining Inserts in Bilateral Simultaneous Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Kushagra Pathak, Sahil Batra, Arpit Sahu, Vikrant Manhas, Rajesh Malhotra — 2026-02-09

The prosthetic design landscape for total knee arthroplasty (TKA) is extensive. Modified surface geometries aim to replicate native kinematics for superior outcomes, yet evidence remains conflicting regarding optimal design efficacy based on patient-reported and objective metrics. The primary aim of this study was to compare the patient satisfaction between ultra-congruent (UC) and cruciate-retaining (CU) insert designs in bilateral simultaneous TKA, and the secondary aim was to study the parameters validating potential reasons behind any differences in the outcomes between these two design philosophies.

Impact of Body Mass Index and Radiographic Parameters on Complications and Operative Times Comparing Anterior and Postero-lateral Approaches

2026-02-09

As total hip arthroplasty (THA) continues to grow in the United States, so does patients’ body mass index (BMI). This study evaluated links between BMI, operative times, complications, and radiographic parameters in THA using direct anterior (DAA) and postero-lateral (PL) approaches.

Bilateral Versus Unilateral Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Safety and Functional Outcomes

2026-02-09

Total knee arthroplasty (TKA) is a common procedure for end-stage knee osteoarthritis. The comparative safety and functional outcomes of simultaneous bilateral TKA (SBTKA) versus unilateral TKA (UTKA) remain uncertain. This systematic review evaluated the complication rate, range of motion (ROM), functional recovery, and health-related quality of life (HRQoL) in patients who underwent SBTKA or UTKA.

Implant Costs Consume a Large Proportion of the Reimbursement in Revision Hip and Knee Arthroplasties

2026-02-06

Revision total hip arthroplasty (rTHA) and revision total knee arthroplasty (rTKA) burdens continue to increase while overall reimbursement decreases. We sought to evaluate the percentage and variability of the diagnosis-related group (DRG) reimbursement spent on implants in revision arthroplasty.

Decoding the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement: A Critical Investigation of a Common Orthopaedic Outcome Following Total Knee Arthroplasty

2026-02-06

The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) is a composite patient-reported outcome measure intended to represent overall knee health. Limited investigations exist to determine the validity of KOOS JR as a marker of joint function among total knee arthroplasty patients. The goal of this study was to evaluate the underlying construct of KOOS JR.

The Five-Year Outcomes of Total Knee Arthroplasty in Patients Who Have Cancer

2026-02-06

Cancer prevalence has largely risen as better survivorship has allowed more patients to live into older adulthood. Total knee arthroplasty (TKA) is a widely performed and increasingly common procedure for end-stage arthritis, and while 90-day outcomes in cancer patients have been described, little is known about outcomes beyond five years. Given the known effects of cancer on bone structure and immunity, this study evaluated implant survival and functional outcomes at five years post-TKA in patients who had cancer compared with a matched cancer-free cohort.

Treatment Failure Rates Decrease Significantly at Approximately One Year Following Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection

2026-02-06

The two-stage exchange arthroplasty is a preferred treatment for chronic periprosthetic joint infection (PJI). A gap in knowledge remains surrounding the optimal follow-up period for staged revision. This study aimed to determine the length of time PJIs should be monitored after two-stage exchange arthroplasty and the timepoints by which most failures occur.

Intramedullary Arthrodesis for Periprosthetic Joint Infection After Total Knee Arthroplasty: A Systematic Review of Constructs, Fusion Rates, and Clinical Outcomes

2026-02-06

Intramedullary arthrodesis is a common limb-salvage strategy for patients who have recurrent periprosthetic joint infection after total knee arthroplasty (TKA). Although various constructs have been used, outcomes have not been systematically compared. The purpose of this study was to evaluate the modes of failure, functional outcomes, and perioperative complications associated with intramedullary arthrodesis following septic TKA failure.

Prior Venous Thromboembolism Increases the Risk of Postoperative Thromboembolic Events and Periprosthetic Joint Infection Following Total Knee Arthroplasty

2026-02-05

Venous thromboembolism (VTE) is a serious complication following total knee arthroplasty (TKA). Although a history of prior VTE is a recognized risk factor for subsequent events, the impact of its timing relative to surgery on postoperative outcomes is unclear. This study examined the association between prior VTE timing and postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), readmission, and periprosthetic joint infection (PJI) following TKA.

Corynebacterium Periprosthetic Joint Infections: A Single-Institution's Experience With a Virulent Organism

2026-02-05

The outcome of periprosthetic joint infections (PJIs) is not only contingent on treatment strategy and host factors, but also on the infecting organism. Corynebacterium, a genus of gram-positive bacterium, is uncommonly implicated in PJIs, but represents a challenge when present, as it commonly demonstrates resistance to often-used antibiotics. Given the limited data available, we sought to report on our institution's historical experience with managing PJI of the hip or knee due to Corynebacterium.

Performance of an Artificial Intelligence–Based Software for Automated Kellgren-Lawrence Grading of Knee Osteoarthritis: A Multicenter Cohort Study

Byung Sun Choi, Sung Hwan Hong, Han-Jun Lee, Seong Hwan Kim — 2026-02-04

The Kellgren-Lawrence (KL) grading system is the standard for assessing knee osteoarthritis (OA) severity. However, it is limited by major observer variability. Artificial intelligence (AI) may standardize grading, yet external validation is limited. This study evaluated the diagnostic efficacy of AI-based software on a large, independent, multicenter clinical dataset.

Total Knee Arthroplasty in Post-Traumatic Knee Osteoarthritis Shows Higher Failure Rates Depending on Implant Constraint: An Evaluation of the German Arthroplasty Register

2026-02-03

Total knee arthroplasty (TKA) performed for post-traumatic osteoarthritis (PTOA) is associated with higher complication and revision rates than TKA for primary osteoarthritis (OA). This study aimed to compare implant survival and identify risk factors for revision in TKA performed for PTOA versus OA using registry data.

Primary Cemented Total Knee Arthroplasty With Fully Cemented Short-Stemmed Tibial Components Is Not Associated With Reduced Five-Year Survival

2026-02-02

Emerging evidence suggests revision for early aseptic loosening following total knee arthroplasty (TKA) is associated with both short, native tibial stem (TS) design and morbid obesity (body mass index ≥ 40). The use of short, fully cemented stem extensions has been suggested to mitigate this risk.

An Assessment of Quality in Hip and Knee Arthroplasty Randomized Controlled Trials: A Systematic Review

2026-02-02

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.

Mixing Components From Different Manufacturers in Total Hip Arthroplasty: An Analysis of the American Joint Replacement Registry

2026-02-02

As implants in primary total hip arthroplasty (THA) continue to evolve, surgeons may elect to combine femoral and acetabular components from different manufacturers. However, the prevalence of mixing implants in contemporary hip arthroplasty is unknown, as is the consequence that this may or may not have on implant survival.

Quantifying Clinical Encounters for Orthopaedic Hip and Knee Surgeries: A Retrospective Analysis of Provider Workload

2026-02-02

The time spent providing postoperative care for total hip arthroplasty (THA) and total knee arthroplasty (TKA) has increased provider workload, drawing attention to the Relative Value Scale Update Committee’s (RUC) current estimation of work relative value units. Our aim for this study was to quantify the postoperative work performed by the surgeon and their team for THA and TKA during the 90-day global period. We hypothesized that the work intensity and time spent on postoperative communication were higher than estimated by current work relative value units.

Fixed- versus Mobile-Bearing Knee Arthroplasty: A Randomized Trial With a Minimum of 10-Year Follow-Up

2026-01-27

The mobile-bearing knee arthroplasty features a highly congruent mobile meniscal bearing allowing both rotation and antero-posterior translation. At present, it remains unclear whether fixed-bearing platforms are clinically advantageous over mobile bearings. In this randomized trial, we sought to compare patient-reported outcomes, complications, and revision rates in patients undergoing fixed versus mobile-bearing total knee arthroplasty (TKA) for osteoarthrosis.

Using Early Gait Data From a Smart-Enabled Total Knee Arthroplasty to Identify Patient Function and Activity at 90 Days Postoperative

Joseph M. Schwab, Michael E. Raynor — 2026-01-26

A subset of total knee arthroplasty (TKA) patients experiences suboptimal recovery manifested by a decline in function, activity, or both. Smart implantable devices capable of continuous, adherence-independent kinematic monitoring offer an opportunity for early risk identification. This study aimed to determine whether early gait data from a smart implant could predict 90-day recovery outcomes reported as a three-class measure (green, yellow, and red).

Dual-Mobility versus Fixed-Bearing Constructs in Revision Total Hip Arthroplasty: A Systematic Review of Comparative Outcomes

Joshua P. Rainey, Logan E. Radtke, Jeremy M. Gililland, Michael A. Mont — 2026-01-26

Dual-mobility (DM) constructs were developed to improve stability in total hip arthroplasty (THA) and may be of particular utility in revision THA, given the increased risk of instability. The aim of this systematic review was to assess dislocation rates of DM versus fixed-bearing (FB) constructs in revision THA.

Do Surgeon Volume and Experience Correlate With Patient-Reported Outcomes or Costs of Care in Unicompartmental Knee Arthroplasty?

2026-01-26

Surgeon volume and experience may impact patient-reported outcome measures (PROMs) and costs in total knee arthroplasty. However, whether the same relationship exists in unicompartmental knee arthroplasty (UKA) is unclear. We investigated whether surgeon volume and experience drove variations in PROMs or time-driven activity-based costing (TDABC) in UKA.

High Failure Rates Following Repeat Two-Stage Revision for Chronic Knee Periprosthetic Joint Infection: A Multicenter Study

2026-01-23

Recurrent periprosthetic joint infection (PJI) after two-stage revision total knee arthroplasty remains challenging. Repeat two-stage revision is a salvage option, but outcomes are poorly defined. This multicenter study evaluated the success of repeat two-stage knee revision for chronic PJI.

Risk of Revision for Periprosthetic Fracture Following Cementless Total Hip Arthroplasty Using a Specific Type 1 Blade Design Stem: A Registry-Based Cohort Study

2026-01-21

Implant survival following total hip arthroplasty (THA) may differ by femoral stem design. In a series of patients, a consistent pattern of low-energy periprosthetic fracture (PPF) with a specific blade design stem was observed. Therefore, we conducted a cohort study comparing revision risk with a specific stem to other stems.

Is the Posterior Cruciate Ligament Necessary in Cruciate-Substituting Total Knee Arthroplasty? A Cadaveric Comparison of Knee Kinematics With or Without the Posterior Cruciate Ligament Versus the Native Knee

Shota Shigekiyo, Daisuke Hamada, Keizo Wada, Yasuaki Tamaki, Koichi Sairyo — 2026-01-21

This study sought to determine knee kinematics after cruciate-substituting total knee arthroplasty (TKA) using an insert with or without the posterior cruciate ligament (PCL) in the same-specimen fresh-frozen cadavers using a within-knee repeated-measures design.

Evaluating Measures of Clinical Meaningfulness for Patient-Reported Outcome Measures in Total Joint Arthroplasty: A Systematic Review

2026-01-21

Recently, the Centers for Medicare and Medicaid Services mandated the collection of patient-reported outcome measures (PROMs) for all primary total joint arthroplasties (TJAs), reinforcing their role in evaluating clinical outcomes. This systematic review investigated the calculation methods and anchor questions used to derive key PROM-based thresholds such as Minimal Clinically Important Difference (MCID), substantial clinical benefit (SCB), and the patient acceptable symptom state (PASS) for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR).

Safety Net Hospitals Are at Risk for Major Financial Penalties With New Centers for Medicare & Medicaid Services Patient-Reported Outcome Measure Reporting Requirements for Primary Hip and Knee Arthroplasty

2026-01-20

Starting in 2027, the Centers for Medicare & Medicaid Services (CMS) will penalize hospitals that do not have complete paired patient-reported outcome measures (PROMs) data on at least 50% of patients undergoing inpatient total hip (THA) and knee arthroplasty (TKA). Patients must also meet the minimum substantial clinical benefit (SCB) threshold for Hip Disability and Osteoarthritis Outcome Score Joint Replacement and Knee Injury and Osteoarthritis Outcome Score Joint Replacement scores (22 and 20 points, respectively).

The Effects of Perioperative Intra-Articular Corticosteroids During Manipulation Under Anesthesia After Total Knee Arthroplasty: A Retrospective Study

2026-01-20

Postoperative stiffness after total knee arthroplasty (TKA) is uncommon, but may lead to major knee dysfunction. Manipulation under anesthesia (MUA) is an effective tool for improving postoperative stiffness. We hypothesized that intra-articular corticosteroid administration during MUA better preserves postmanipulation range of motion (ROM) compared to MUA without a glucocorticoid adjunct.

How Can Arthroplasty Surgeons Best Use Preoperative Patient-Reported Outcome Measures Across Multiple Domains to Predict Minimal Clinically Important Difference and Patient-Acceptable Symptom State Achievement in Medial Unicompartmental Knee Arthroplasty? Findings From a Prospectively Maintained Multi-Institutional Arthroplasty Registry

2026-01-19

Patient-reported outcome measures (PROMs) are increasingly utilized in medial unicompartmental knee arthroplasty (UKA). Total knee arthroplasty studies have shown preoperative PROMs across multiple domains (knee physical function, general physical health, mental health, etc.) influence achievement of minimal clinically important difference (MCID) or patient acceptable symptom state (PASS). However, the utility of preoperative PROMs in medial UKA is underexplored. We investigated the impact of preoperative PROMs across multiple domains on MCID and PASS achievement in medial UKA.

Ten-Year Functional Outcomes Following Robotic-Assisted Total Hip Arthroplasty: A Case Series

2026-01-19

Robotic-assisted total hip arthroplasty (rTHA) has been shown to assist with precision in component placement. However, limited evidence exists evaluating its effects on minimum 10-year clinical outcomes. The purpose of this study was to report the minimum 10-year clinical outcomes in a case series of patients who underwent rTHA.

Timing Matters – Exploring Outcomes in Patients Undergoing Joint Arthroplasty Before and After Elective Hand Surgery

2026-01-19

This study examined whether the timing of total hip or knee arthroplasty (total joint arthroplasty [TJA]) relative to elective hand surgery (HS) is associated with perioperative TJA outcomes, as both are among the most common orthopaedic procedures in the United States.

Intraoperative Vancomycin Does Not Change Periprosthetic Joint Infection Risk in Patients Undergoing Total Joint Arthroplasty

2026-01-14

Cephalosporins are the primary prophylactic antibiotic in primary total hip and knee arthroplasty (THA and TKA). There is interest in augmenting this effect by adding intraoperative vancomycin via intrawound, intraosseous, or intravenous routes. However, low periprosthetic joint infection (PJI) rates have hindered statistical power and consensus within prior research. This study aimed to compare 90-day infectious and medical complications and 5-year revision-free survival among patients who did and did not have intraoperative vancomycin within a large, nationally representative population.

Repeat Two-Stage Revision Arthroplasty for Periprosthetic Joint Infection of the Hip: A Multicenter Study With a Mean 10-Year Follow-Up

2026-01-12

Repeat two-stage revision remains a salvage option for managing recurrent periprosthetic joint infection (PJI) of the hip after a failed initial revision. However, the evidence base for this approach is limited. This study aimed to evaluate treatment outcomes and identify risk factors for failure following repeat two-stage revision arthroplasty for hip PJI.

Survivorship and Functional Outcomes of Condylar-Stabilized Total Knee Arthroplasty Designs: An Analysis of the American Joint Replacement Registry

2026-01-12

The use of condylar-stabilized (CS) designs in total knee arthroplasty (TKA) is increasing. However, CS designs lack consistent classification and data examining survivorship. This study assessed revision risk and patient-reported outcome measures (PROMs) among CS designs and compared them to cruciate-retaining (CR) and posterior-stabilized (PS) designs.

Attainment of Substantial Clinical Benefit Following Primary Total Knee Arthroplasty Is Impacted by Preoperative Patient-Reported Outcome Measures

2026-01-12

The Centers for Medicare & Medicaid Services (CMS) has made the collection of patient-reported outcome measures (PROMs) mandatory for inpatient total knee arthroplasty (TKA). The reporting of the proportion of patients who reach the substantial clinical benefit (SCB) threshold between preoperative and postoperative PROMs based on Knee Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) scores is also necessary for reimbursement. Our study evaluated characteristics among patients who did and did not meet SCB to understand trends that may help surgeons to comply with CMS policies and maximize patient outcomes following TKA.

Long-Term Dislocation Risk Following Primary Total Hip Arthroplasty Due to Osteoarthritis: A Population-Based Cohort Study From the Danish Hip Arthroplasty Register

2026-01-12

Population-based data on long-term dislocation risks are currently lacking in literature. Thus, the purpose of this study was to investigate the long-term cumulative incidence of dislocation after total hip arthroplasty (THA) stratified by femoral head size. Furthermore, we investigated the difference in cumulative incidence of dislocation over different time periods.

Quadrangular Taper Cementless Designs Are Associated With Lower Risks of Postoperative Periprosthetic Fracture Compared With Cemented Stems and Other Cementless Designs Following Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

2026-01-12

Although cementless stems are increasingly favored in primary total hip arthroplasty (pTHA), the impact of stem designs on postoperative complications, such as periprosthetic femoral fracture (PFF), remains debated. This study compared PFF rates between cemented and cementless pTHA, focusing on cementless stem geometries.

Comparing Outcomes in Sexual Function After Total Hip and Knee Arthroplasty: A Systematic Review

Sai Yaswanth Pendyala, Nimra Akram, Vipin Asopa, David Harold Sochart — 2026-01-12

Sexual function is an important contributor to quality of life for people undergoing lower limb arthroplasty, yet it is rarely discussed in clinics and inconsistently measured in research. Evidence suggests improvement after surgery, but findings are scattered across hips and knees, instruments vary, and a direct joint-wise comparison is lacking. This review compares sexual outcomes after total hip arthroplasty (THA) and total knee arthroplasty (TKA) across three prespecified domains: return to sexual activity (RTSA), frequency of sexual activity (FSA), and sexual satisfaction (SS) or fulfillment of preoperative expectations.

Evaluation of Intraoperative and Early Postoperative Periprosthetic Fractures Following Total Knee Arthroplasty and Identification of Contributing Risk Factors

2026-01-12

Previous research on periprosthetic fractures (PPFs) following total knee arthroplasty (TKA) has primarily addressed late postoperative complications. Evidence concerning intraoperative and early (≤ 90 days) fractures remains limited, particularly within Eastern European and Middle Eastern populations. This study aimed to evaluate the incidence and identify risk factors for such fractures in a large national cohort.

Preoperative Hip Flexion and Extension Range of Motion and Global Sagittal Alignment Affect Sagittal Spino-pelvic Alignment in Patients Undergoing Total Hip Arthroplasty

2026-01-11

This study aimed to determine how preoperative hip flexion–extension range of motion (ROM) and sagittal vertical axis (SVA) affect postoperative ROM recovery, changes in sagittal spino-pelvic alignment, and patient-reported outcome measures (PROMs) following total hip arthroplasty (THA).

Anatomical Relationship of the Popliteal Artery to Tibial Landmarks at Resection Levels in Total Knee Arthroplasty: A Cadaver Study

2026-01-11

Injury to the popliteal artery (PA) is a severe complication during total knee arthroplasty (TKA). Current information on the anatomical proximity of the PA to the posterior tibial cortex is mostly derived from imaging studies, which may not accurately represent surgical conditions. Additionally, anatomical differences between sexes remain unclear. This cadaver study aimed to determine the anatomical relationship between the PA and tibial landmarks at clinically relevant tibial resection levels during TKA, emphasizing potential sex-based differences.

Rising Body Mass Index Increased Early Complications, But Not Early Reoperations Following Aseptic Revision Total Knee Arthroplasty

2026-01-11

Elevated body mass index (BMI) contributes to osteoarthritis and demand for total knee arthroplasty (TKA). Increased BMI is an established risk factor for complications following primary TKA. However, literature on BMI and outcomes of revision TKA (rTKA) is less conclusive. This study evaluated the association between BMI and outcomes in the early postoperative period following aseptic rTKA. We hypothesized that increasing BMI would be associated with a higher risk of short-term complications.

When Forced to Choose, Larger Femoral Head Size Confers Greater Protection Against Risk for Dislocation than a Lipped Acetabular Liner

Alejandro J. Friedman, Haroun Haque, Gabriel Lama, Matthew L. Magruder — 2026-01-11

Increasing femoral head size or using lipped polyethylene acetabular liners both reduce revision risk due to dislocation after total hip arthroplasty (THA). At some cup sizes, surgeons must choose between larger heads or lipped liners. This study compares 32-mm heads with 10° lipped liners against 36-mm heads with neutral liners for stability and revision risk.

Timing of Periprosthetic Joint Infections Following Primary and Revision Arthroplasty in Ontario: A Population-Based Retrospective Cohort Study Using Administrative Databases From 2003 to 2017

2026-01-10

Periprosthetic joint infections (PJIs) of the hip and knee are a devastating outcome of arthroplasty, resulting in profound morbidity. As more arthroplasties are performed, there is a need to monitor the long-term risk and trends of infection.

Metabolic Syndrome Is Associated With Higher Odds of Postoperative Complications After Total Hip Arthroplasty

2026-01-10

Metabolic syndrome (MetS), a cluster of interrelated metabolic abnormalities typically including obesity, dyslipidemia, diabetes, and hypertension, has been linked to surgical complications, but its impact on total hip arthroplasty (THA) beyond 90 days is unclear. This study compared 90-days, 1-year, and 2-year THA outcomes in patients who had and did not have MetS, and identified which component of MetS (i.e., diabetes, hypertension, obesity, or hypertriglyceridemia) was most strongly associated with each complication.

The Association Between Social Determinants of Health and Total Hip Arthroplasty Outcomes: A Study of Neighborhood Disadvantage Indices

2026-01-09

Total hip arthroplasty (THA) is a highly effective procedure, but outcomes may be influenced by social determinants of health. We investigated the association between neighborhood disadvantage indices, the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), and postoperative outcomes following THA in a large, multicenter cohort.

Defining Preoperative Anemia Thresholds for Revision Total Knee Arthroplasty

2026-01-08

In an era of value-based medical management, anemia optimization before revision total knee arthroplasty (TKA) could improve outcomes. Using a simulation model, we evaluated whether outcomes would improve for revision TKA if patients were either approved/denied surgery based on incremental preoperative anemia thresholds.

Assessing Medicaid Accessibility to Total Knee Arthroplasty: Comparison of Ambulatory Surgery Centers and Hospitals

2026-01-08

Ambulatory surgery centers (ASCs) are increasingly becoming the preferred setting for elective orthopaedic procedures, including total knee arthroplasty (TKA). The ASC’s favorable cost containment, reimbursements, and patient outcomes have driven their growth, but access to the Medicaid population remains an issue. This study aimed to evaluate these barriers for patients seeking TKA at ASCs compared to public hospitals using a cross-sectional survey design.

Preoperative Testosterone Replacement Therapy Is Associated With Increased Complication Risk After Total Hip Arthroplasty: A Propensity-Matched Analysis of Real-World Data

2026-01-08

While testosterone replacement therapy (TRT) is known to affect cardiovascular physiology, its impact on outcomes following total hip arthroplasty (THA) remains unclear. This study aimed to assess whether preoperative TRT use is associated with increased complications following THA.

Preoperative Thrombocytopenia and Risk of Periprosthetic Joint Infection After Total Knee Arthroplasty: A Propensity-Matched Cohort Study

2026-01-08

Periprosthetic joint infection (PJI) remains one of the most devastating complications following total joint arthroplasty. While platelets are recognized for their role in hemostasis, growing evidence suggests they also serve as immune effectors. Experimental data support a link between platelet depletion and infection risk, yet clinical evidence is limited.

Reduced Lengths of Hospital Stay but No Difference in Survivorship Following Robotic Arm-Assisted Primary Total Hip Arthroplasty at 3.5 Years Follow-Up: A Propensity Score-Matched Prospective Cohort Study

2026-01-08

Although robotic arm-assisted total hip arthroplasty (RA-THA) has been increasing in popularity, the outcomes following its use are still uncertain.

Cementless Unicompartmental Knee Arthroplasty: A Systematic Review of Survivorship and Revision Indications

2026-01-08

Surgeons use cementless unicompartmental knee arthroplasty (UKA) as a joint-preserving alternative to total knee arthroplasty. However, cementless UKA survivorship and revision data remain fragmented. To address this gap, we systematically reviewed (1) survivorship of cementless UKAs reported at time points ≤ five years and ≥ 10 years and (2) the revision indications across implant types.

Outcomes of Curved Intertrochanteric Varus Osteotomy for Osteonecrosis of the Femoral Head With a Beak-Shaped Healthy Area

2026-01-08

Indications for curved intertrochanteric varus osteotomy (CVO) for osteonecrosis of the femoral head (ONFH) with a beak-shaped healthy area (BHA) remain unclear. This study aimed to evaluate the clinical outcomes and radiographic findings of CVO for ONFH with BHA.

Teenage Total Hip Arthroplasty Yields High Satisfaction and Excellent Survival up to 20-Year Follow-Up

2026-01-08

Total hip arthroplasty (THA) is increasingly performed in patients younger than 20 years who have destructive hip pathology. The unique anatomical and developmental characteristics of this population, along with the high likelihood of future revision surgery, have led to cautious clinical decision-making. Data on safety, effectiveness, and long-term (20 years) outcomes in teenagers remain limited. This study aimed to evaluate implant survival, patient satisfaction, functional outcomes, and complications following THA in teenagers.

Patellar Height and Functional Outcomes after Distal Femoral Replacement: Higher Patella Improves Flexion, While Patella Baja Predicts Worse Outcomes

2026-01-07

Distal femoral replacement (DFR) is a common limb salvage option for bone tumors. Postoperative outcomes partly depend on the integrity of the extensor mechanism, yet patellar height and joint line position have not been well studied in oncologic reconstructions.

How Effective Are Constrained Liners at Preventing Dislocation After Revision Total Hip Arthroplasty?

2026-01-07

Recurrent instability continues to challenge arthroplasty surgeons, and constrained liners may be utilized for cases of recurrent or multidirectional instability following revision total hip arthroplasty (rTHA). The purpose of this study was to evaluate dislocation rates and survivorship after rTHA using constrained liner (CL) prostheses.

Diagnosing Seronegative Periprosthetic Joint Infection After Total Hip and Knee Arthroplasties

2026-01-06

Serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are used to screen for periprosthetic joint infection (PJI) of total hip arthroplasties (THAs) and total knee arthroplasties (TKAs). However, PJI may exist in the absence of elevated ESR and CRP. We aimed to report the incidence of seronegative PJIs in THAs and TKAs and the utility of arthrocentesis for PJI workup.

Severe Coronal Plane Deformity Correction in Total Knee Arthroplasty Is Associated With Increased Surgeon Physiologic Demand

2026-01-06

Coronal plane deformity in total knee arthroplasty (TKA) can introduce major variability in difficulty between cases based on the type and degree of deformity. The purpose of this study was to compare the energy expenditure of TKA in varus and valgus knees.

Is Septic Revision Knee Arthroplasty Associated With Higher Thromboembolic Events? A Matched Cohort Study

2026-01-06

There is a paucity of literature assessing the incidence and characteristics of acute and chronic thromboembolic events following septic versus aseptic revision knee arthroplasty. The current study aimed to evaluate these complications between these populations.

Implant Prices and Physician Reimbursement Have Declined More Than Total Costs and Hospital Payments in Total Joint Arthroplasty

2026-01-06

Understanding implant price trends is critical amid growing demand for total joint arthroplasty (TJA) and increasing cost containment pressures. Previous studies have documented trends in costs, reimbursements, and volume for TJA. However, the relationship between implant prices, hospital and physician reimbursement, and patient financial burden remains poorly defined. This study evaluated inflation-adjusted implant pricing trends in TJA and their alignment with physician and hospital reimbursement and patient out-of-pocket (OOP) costs.

Contemporary Outcomes of Highly Porous Metaphyseal Cones in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2026-01-06

Metaphyseal bone loss represents a major challenge in revision total knee arthroplasty (RTKA). Highly porous metaphyseal cones have potential for osseointegration and durable fixation. While early evidence was limited to tantalum cones, newer designs, such as three-dimensional–printed titanium cones, have been introduced by multiple manufacturers, necessitating an updated synthesis of the literature.

Withholding Prophylactic Antibiotics Improves Culture Yield in Revision Total Knee Arthroplasty for Periprosthetic Joint Infection With Negative Aspirations: A Multicenter Retrospective Study

2026-01-06

Preincision antibiotic prophylaxis reduces infection risk in total knee arthroplasty, but its role in revision procedures for periprosthetic joint infection (PJI) remains uncertain. Early antibiotic administration may suppress culture yield or alter concordance with preoperative aspiration, potentially leading to false-negative results that complicate postoperative antimicrobial selection.

Migration of Primary Total Knee Arthroplasty From Inpatient to Outpatient Facilities in the United States (2019 to 2022): Trends, Demographics, and Comorbidities

2026-01-06

Primary total knee arthroplasty (TKA) has shifted from inpatient to outpatient facilities in the United States, driven by surgical advances, the 2018 Center for Medicare & Medicaid Services inpatient-only list change, and COVID-19 pressures. Limited national data and unclear patient profiles in outpatient facilities versus hospitals prompt this study. Outpatient TKA patients are often younger and have fewer comorbidities, but safety debates persist. Using a national database, we examined (1) trends in knee arthroplasty settings, (2) demographic differences, and (3) comorbidity variations to inform patient selection, outcomes, and policy.

External Validation of a New Classification for Bone Loss in Failed Stemmed Prostheses After Revision Total Knee Arthroplasty

2026-01-06

Evaluation and management of bone loss in revision total knee arthroplasty (rTKA) poses a demanding challenge. The rising number of knee revisions and rerevisions has led to increasing bone loss severity, and previous bone loss classification systems fail to provide adequate assessment of the diaphysis. The Scuderi classification was recently introduced to better assess diaphyseal bone loss and underwent internal validation. The purpose of this study was to perform an external validation using preoperative radiographs of failed stemmed rTKA and describe the interobserver and intraobserver reliability.

Early Greater Trochanteric Avulsion Fracture After Posterior Approach Primary Total Hip Arthroplasty: A Clinically Relevant and Potentially Avoidable Complication

2026-01-06

A greater trochanteric (GT) fracture after primary total hip arthroplasty (THA) is a clinically relevant complication that can lead to gait abnormalities and chronic lateral hip pain. Early postoperative GT avulsion fractures are rare, possibly resulting from poor bone quality or the use of two transosseous drill holes for posterior capsular repair. Computer- and robotic-assisted surgery may increase fracture risk due to cortical defects from temporary pins. This study aimed to assess the rate of early GT fractures and identify contributing factors and prevention strategies.

Opioid Consumption Trends in Resurfaced versus Unresurfaced Patellae in Total Knee Arthroplasty

2026-01-06

Patellar resurfacing in total knee arthroplasty (TKA) is a highly debated topic, with equivocal results. While past literature has investigated pain, functional outcomes, and the cost of resurfaced versus unresurfaced patellae, examining opioid consumption is critical in the wake of the opioid epidemic. We sought to compare postoperative opioid consumption in patients who did and did not undergo patellar resurfacing in primary TKA.

Body Mass Index of 45 Is a Safe Cut-Off for Cementless Total Knee Arthroplasty

2025-12-31

It is widely perceived that morbid obesity is associated with unacceptable rates of complication after total knee arthroplasty (TKA), with many surgeons using a body mass index (BMI) of 40 as a cutoff. Also, cemented TKA is widely perceived as the gold standard. However, these two perceptions are not consistently supported by the literature. The aim of this study was to assess the outcomes of two patient groups undergoing cementless TKA in a high-volume unit: one with morbid obesity (BMI 40 to 44.9) and the other nonobese (BMI 20 to 29.9).

Aspirin May Be a Suitable Prophylaxis for Cancer Patients Undergoing Primary Total Knee Arthroplasty

2025-12-30

Aspirin is the prophylactic agent of choice for venous thromboembolism prevention in low-risk patients undergoing primary total knee arthroplasty (TKA). However, there remains a paucity of data in the literature on the efficacy of aspirin as a mode of chemoprophylaxis in patients who have a diagnosis of cancer. The purpose of this study was to determine the efficacy of aspirin versus other anticoagulant medications in primary TKA patients who had a diagnosis of active visceral organ malignancy within one year of their arthroplasty procedure.

There Is No Difference in Outpatient Costs Within One Year Post-Total Hip Arthroplasty when Comparing Surgical Approach

2025-12-30

Total hip arthroplasty (THA) continues to be a substantial financial burden to the Canadian health care system. The purpose of this study was to determine the impact of surgical approach on the associated outpatient cost of THA.

Outcomes After Conversion of High Tibial Osteotomy to Total Knee Arthroplasty: Nearly 14-Year Follow-Up in a United States Population

2025-12-19

High tibial osteotomy (HTO) is a joint-preserving treatment for younger patients who have unicompartmental knee osteoarthritis. Although effective, concerns persist that prior HTO may compromise subsequent total knee arthroplasty (TKA). This study aimed to assess the revision-free survival of TKA following ipsilateral HTO and identify factors associated with failure of both procedures in a U.S. population.

The Shift to Outpatient Total Hip and Knee Arthroplasty: Perioperative Work Has Not Changed

2025-12-18

Total hip arthroplasty (THA) and knee arthroplasty (TKA) are increasingly being performed on an outpatient basis. With this shift in site of service, the volume and complexity of work required for these procedures may be affected. The purpose of this study was to quantify the amount of perioperative work performed by the surgeon and advanced practice providers for same-day THA and TKA.

General, Spinal, and Regional Nerve Blocks: Do Different Anesthesia Practices Affect Same-Day Discharge in Primary Total Hip and Knee Arthroplasty?

2025-12-18

The purpose of this study was to compare the effect of spinal anesthesia (SA) versus general anesthesia (GA) on acute 90-day outcomes in same-day discharge (SDD) total hip (THA) and total knee arthroplasty (TKA) patients, including subgroup analysis of peripheral nerve block usage.

Concentration, Antibacterial Effect, and Safety of Combining Intra-articular Epsilon-Aminocaproic Acid and Vancomycin in Primary Total Knee Arthroplasty: A Randomized Study

Yifan Zhang, Jitong Wei, Chunyang Su, Mingwei Hu, Hao Xu, Shuai Xiang — 2025-12-18

In this study, we aimed to investigate the intra-articular concentration, antibacterial effect, and safety of a combination of vancomycin and epsilon-aminocaproic acid (EACA) in primary total knee arthroplasty (TKA).

Subsidence of Modular Fluted Tapered Stems After Femoral Revision Surgery: Risk Factors and a Novel Classification System

2025-12-18

Modular fluted tapered (MFT) stems are widely used in femoral revision surgery for their ability to achieve diaphyseal fixation in the setting of bone loss. This study aimed to identify factors influencing MFT stem subsidence.

Primary Total Hip Arthroplasty in Patients Who Have a Body Mass Index > 50: Is the Risk Worth the Reward?

2025-12-18

The obesity epidemic has given rise to a growing number of patients who have a body mass index (BMI) exceeding 50. As BMI cutoffs are no longer recommended, arthroplasty surgeons continue to push the limits of surgical feasibility in total hip arthroplasty (THA) despite possible risks.

Uncontrolled Diabetes Mellitus in the Year Prior to Total Hip or Knee Arthroplasty Is Associated with Similar Perioperative Glucose Control, Early Complication Rates, and 5-Year Reoperation Rates after Preoperative Diabetes Mellitus Optimization

2025-12-18

Perioperative glycemic control is considered a modifiable risk factor prior to primary total hip and total knee arthroplasty; however, it is still unknown whether preoperatively optimizing hemoglobin A1C values affects perioperative glucose control or postoperative complications. The purpose of this study was to compare patients who required preoperative diabetes mellitus (DM) optimization in the year prior to surgery (defined as hemoglobin A1C ≥ 8%) versus patients who had DM who did not require preoperative DM optimization to compare (1) postoperative glycemic control and (2) 90-day complications and incidence of revision arthroplasty.

Physiologic and Clinical Sequelae After Pneumatic Tourniquet Release in Frail Patients Undergoing Total Knee Arthroplasty Under Regional Anesthesia: A Prospective Observational Study

Gautham Patel, Shubhkarman Kahlon, Ajay Singh, Santosh Chipre, Vivek Anand — 2025-12-18

Tourniquet deflation during total knee arthroplasty (TKA) produces abrupt reperfusion physiology, including hyperkalemia, acidosis, and hemodynamic instability. Frail patients are particularly vulnerable; however, this population has not been prospectively studied.

Can External Rotator Preservation Reduce Dislocation Risk Following Posterior Approach Total Hip Arthroplasty in High-Risk Patients? A Propensity-Matched Comparative Study

2025-12-18

Although multiple studies have examined the efficacy of muscle-sparing techniques in reducing dislocation after posterior approach THA, their findings are limited by small sample sizes and short follow-up durations, and to our knowledge, none have specifically evaluated outcomes in high-risk patients. This study compared the overall and 90-day dislocation risks of the previously described external rotator preservation (ERP) and standard posterior approach THA in high-risk patients.

Moderate-to-Severe Varus Deformity Is Associated With Conversion to Arthroplasty in Patients Who Have Subchondral Insufficiency Fracture of the Knee

2025-12-18

Although untreated subchondral insufficiency fractures of the knee may result in progression of osteoarthritis, leading to arthroplasty in approximately 30% of cases, the factors associated with the requirement for arthroplasty remain unknown. We hypothesized that varus deformity would be associated with increased risk of nonoperative treatment failure and conversion to arthroplasty in patients who have subchondral insufficiency fractures with early osteoarthritis.

Standard of Care and Its Implications on Joint Arthroplasty: A Primer

2025-12-17

“Standard of care” refers to the level of clinical practice that a reasonably competent physician is expected to provide under similar circumstances, based on evidence, specialty guidelines, and professional consensus. This article reviews current literature on the standard of care in total joint arthroplasty and orthopaedic surgery, clarifying its definition, application, and role in reducing malpractice risk through evidence-based protocols. Specifically, the authors examined (1) the definition and evolution of standard of care; (2) the role of clinical guidelines, including arthroplasty specific; (3) legal implications in malpractice; (4) differences in elective versus emergent arthroplasty; (5) postoperative protocols central to practice; and (6) challenges and open questions in defining and updating standards of care.

A Comparison of the Efficacy and Complications Between Intraosseous and Periarticular Multimodal Analgesic Cocktail Injections After Primary Total Knee Arthroplasty: A Randomized Controlled Trial

Warunyoo Suttikadsanee, Parn Pinsornsak, Piya Pinsornsak — 2025-12-17

Early postoperative pain control after total knee arthroplasty (TKA) plays a crucial role in patient satisfaction following surgery. Despite current multimodal pain management strategies, postoperative pain remains a concern for patients and can hinder the decision to undergo TKA. With the advent of intraosseous (IO) analgesic injections, the efficacy of IO multimodal analgesic cocktail administration compared to standard periarticular (PA) injections remains controversial.

Prevalence, Progression, and Clinical Impact of Stem Notching in Ceramic-on-Ceramic Total Hip Arthroplasty: A Minimum 15-Year Follow-Up Study

Sang Yoon Kang, Li Loong Loh, Yeong June Jeon, Hong Seok Kim, Jeong Joon Yoo — 2025-12-17

Stem notching, resulting from impingement between the femoral stem and ceramic liner in ceramic-on-ceramic (CoC) total hip arthroplasty (THA), has been linked to adverse outcomes such as ceramic-related noise and ceramic component fractures. Despite its potential significance, its true incidence is infrequently documented, and the long-term clinical impact remains uncertain. This study aimed to assess the minimum 15-year outcomes and complications associated with stem notching in CoC THA.

Does Traumatic Brain Injury Increase Opioid Utilization After Primary Total Knee Arthroplasty?

2025-12-17

Traumatic brain injury (TBI) is a common neurological injury with widespread systemic effects, leading to increased pain and opioid utilization. In this study, we investigated how a prior TBI affects perioperative opioid utilization in patients undergoing a total knee arthroplasty (TKA) and the risk of prolonged opioid usage.

Excision Versus Preservation of the Infrapatellar Fat Pad During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2025-12-17

This study aimed to evaluate whether preservation versus resection of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) affects clinical outcomes.

Minimum 10-Year Outcomes of Total Hip Arthroplasty With Highly Cross-Linked Polyethylene in Patients Under 50 Years: A Systematic Review and Meta-Analysis

2025-12-16

Total hip arthroplasty (THA) is increasing in utilization among young patients. While THA markedly improves outcomes in those who have degenerative hip disease, patients under 50 years face an extended lifetime risk for complications and revisions. Highly cross-linked polyethylene (HXLPE) is associated with reduced wear, revision rates, and osteolysis compared to conventional polyethylene, potentially enhancing implant longevity in this younger, active population. This study systematically reviewed and meta-analyzed the outcomes of THA using HXLPE in patients under 50 years of age at a minimum 10-year follow-up.

Artificial Intelligence–Driven Decision-Making for Knee Joint Manipulation Following Primary Total Knee Arthroplasty

2025-12-15

Manipulation under anesthesia (MUA) is a commonly performed procedure to address postoperative stiffness after total knee arthroplasty (TKA), yet optimal timing, motion thresholds, and outcome expectations remain poorly defined due to limited high-quality evidence and heterogeneous patient presentations.

Predicting Acetabular Fixation Failure and Bone Loss in Total Hip Arthroplasty: A Combined In Silico and In Vitro Approach

António Ramos, Mariana Matos — 2025-12-13

Total hip arthroplasty continues to rise in prevalence in both the United States and Europe. The leading cause of revision surgery remains acetabular failure, primarily associated with instability and peri-implant bone loss. This study aimed to investigate bone loss around acetabular components following total hip arthroplasty.

Recognizing Sarcopenia in Total Knee Arthroplasty Patients: A Call for Greater Awareness

Murat Taşcı, Mehmet Özer, Savaş Çamur — 2025-12-13

Suspected sarcopenia, marked by early muscle weakness and functional decline, is increasingly recognized in elderly patients and may negatively affect total knee arthroplasty (TKA) outcomes. Although formal diagnosis may not always be practical, early identification through simple screening tools such as the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire and basic functional tests can help detect at-risk patients and improve postoperative management and prognosis.

Multiple Primary Joint Arthroplasties and the Risk of Periprosthetic Joint Infection: Evidence From a Large Retrospective Cohort

2025-12-13

There is a growing number of patients who undergo multiple primary hip and knee joint arthroplasties during their lifetime. Whether patients who have multiple replaced joints are at an increased long-term risk of periprosthetic joint infection (PJI) is not known. The purpose of this study was to compare rates of PJI in patients who have more than one primary arthroplasty.

Social Determinants of Health Disparities Are Associated With Prolonged Opioid Utilization After Total Joint Arthroplasty

2025-12-12

Social determinants of health disparities (SDHDs) have been associated with an increased risk of poor outcomes after total joint arthroplasty (TJA). The purpose of this study was to assess whether SDHDs are associated with prolonged postoperative opioid use after primary TJA.

Draining Sinus Tracts and Periprosthetic Joint Infections: Traditional Synovial Fluid Counts May Be Misleading

2025-12-10

Serologic and synovial laboratory values guiding the diagnosis of periprosthetic joint infection (PJI) are well-established. We hypothesized that these values would be lower in patients who had a draining sinus tract. The purpose of this study was to determine if patients who had sinus tracts had lower values for serum erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), synovial white blood cell (WBC) count, and synovial percent neutrophils.

Low Follow-Up Rates After a Total Hip Arthroplasty Prosthesis Recall

2025-12-09

A modern hip arthroplasty liner was recalled for premature polyethylene wear with the potential for catastrophic osteolysis and failure. Physicians and hospitals are responsible for communicating recall information to patients. Our center instituted a protocol to reach patients who had recalled implants for follow-up. Our study looked at the effectiveness of this effort and risk factors for nonresponse.

Aseptic Revision Total Hip Arthroplasty in the Elderly: Is There a Higher Incidence of Early Complications?

2025-12-09

There is conflicting evidence on whether revision total hip arthroplasty (rTHA) in elderly patients (age ≥ 80 years) predisposes them to increased early complications compared to younger patients. This study compared 90-day complications, readmissions, and reoperations following aseptic rTHA between these two cohorts.

Cemented Femoral Stem Design Is Not Associated With Risk of Revision After Total Hip Arthroplasty in Patients Aged ≥ 65 Years: An Analysis of the American Joint Replacement Registry

2025-12-02

Cemented femoral fixation for total hip arthroplasty (THA) in those aged ≥ 65 years has potential benefits. However, few resources exist to assist in selecting cemented femoral implant designs. We examined the associated risk for all-cause revision, risk of periprosthetic femoral fracture, and aseptic loosening based on a modern classification of cemented femoral stem designs.

Identifying Risk Factors for Aseptic Loosening and Infection Following Distal Femoral Replacement for Periprosthetic Fracture in the Nononcologic Patient

Tyler T. Brady, Shaylan R. Bera, George Grammatopoulos, Andrew P. Adamczyk — 2025-12-01

Distal femoral replacement (DFR) is increasingly used for periprosthetic distal femoral fractures (PDFFs). Although infection and aseptic loosening are known complications, predictors, particularly of loosening, remain poorly defined in nononcologic populations. This study aimed to identify patient risk factors for aseptic loosening and infection following DFR for PDFF in a nononcologic cohort. Additionally, DFR utilization trends for PDFF were assessed over time.

The Impact of Major Depressive Disorder on Postoperative Somatic and Psychiatric Complications Following Total Knee Arthroplasty: A Database Study

2025-11-28

Major depressive disorder (MDD) is a psychiatric condition characterized by persistent low mood, anhedonia, sleep disturbances, guilt, fatigue, impaired concentration, appetite changes, psychomotor abnormalities, and suicidal ideation. It is a prevalent comorbidity among patients undergoing total knee arthroplasty (TKA) and may affect recovery. While prior research has emphasized pain and functional outcomes, the broader impact of MDD on postoperative psychiatric, systemic, and mortality outcomes remains underexplored.

Substantial Clinical Benefit Thresholds for Hip Disability and Osteoarthritis Outcome Score Subscales and Associated Risk Factors for Nonattainment After Total Hip Arthroplasty: A Prospective Cohort Study of 9,229 Patients

2025-11-28

The Centers for Medicare & Medicaid Services (CMS) now requires patient-reported outcome measures (PROMs) collection after total hip arthroplasty (THA), emphasizing substantial clinical benefit (SCB) in the Hip Disability and Osteoarthritis Outcome Score - Joint Replacement (HOOS-JR). This study aimed to establish SCB thresholds for HOOS-Pain, Physical Function Short Form (PS), and JR and to identify factors influencing SCB achievement after THA.

Is the Use of New Ceramic Heads With Titanium Sleeves on Retained Femoral Stems in Revision Total Hip Arthroplasty Associated With Femoral Head or Neck Junction Failure at Mean Eight-Year Follow-Up?

2025-11-27

Ceramic heads used in revision total hip arthroplasty (rTHA) typically utilize a titanium sleeve adapter to prevent damage by the retained stem taper; however, there is sparse mid-to long-term data on this practice, and risk factors for failure remain relatively unknown. This study aimed to determine revision-free survival, specifically for failure of the head and/or neck junction (HNJ) and all-cause re-revision in this patient population, and to identify factors associated with failure.

Delayed Administration of Apixaban, but Not Rivaroxaban, Reduces Transfusion Risk Without Increasing Thromboembolic Rates Following Revision Total Hip Arthroplasty

2025-11-27

The optimal timing for initiating direct oral anticoagulants for venous thromboembolism prophylaxis following revision total hip arthroplasty (rTHA) is unknown. This study compared rates of thromboembolic and bleeding complications between patients beginning prophylactic courses of apixaban or rivaroxaban on postoperative day (POD) zero versus POD one.

Caring for the Caregiver: Caregiver Preparation and Stress Following Total Joint Arthroplasty

2025-11-27

Social support improves outcomes after total hip and knee arthroplasties (THA/TKA), but the demands on informal caregivers, especially as surgeries transition to outpatient care, are understudied. This study strived to assess caregiver burden, predictors, and implications following joint arthroplasty.

Associations Between Preoperative Seasonal Vaccination and Complications After Total Joint Arthroplasty

2025-11-27

Vaccinations against common respiratory pathogens are recommended for the general population. However, associations between respiratory vaccinations and outcomes following total joint arthroplasty (TJA) have not been investigated.

National Trends in Unicompartmental Knee Arthroplasty During a Period of Major Survivorship Improvements: Insights From the Dutch Arthroplasty Register

2025-11-25

The rising use of unicompartmental knee arthroplasty (UKA) among various Western countries raises questions regarding the multifaceted determinants driving this trend. Therefore, this study aimed to examine trends and their associations with 3-year survivorship, focusing on patient, implant, hospital, and revision-related factors.

Recovery Benchmarks After Total Knee Arthroplasty: The Impact of Motion-Restoring Surgery, Contracture, and Comorbidities on Costs and Utilization

Maha Karim, Samantha J. Beckley, Shaun K. Stinton, Thomas P. Branch — 2025-11-25

This study aimed to establish a claims-based timeline for recovery following unilateral total knee arthroplasty (TKA), including the impact of comorbidities and postoperative complications such as motion-restoring surgery (MRS) and joint contracture.

Socioeconomic Deprivation and Outcomes After Total Joint Arthroplasty: An Analysis of the American Joint Replacement Registry Using the Area Deprivation Index

2025-11-24

There is an increasing interest in socioeconomic deprivation and its influence on outcomes in orthopaedics. This study aimed to examine the relationship between neighborhood-level social deprivation and its impact on 90-day readmission, length of stay, and all-cause revision after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Osteonecrosis of the Femoral Head: A Dysbiotic Condition?

Augusto Ferrini, Mincong He, Michael A. Mont, Stuart B. Goodman, Javad Parvizi — 2025-11-24

Osteonecrosis of the femoral head (ONFH) is a progressive and disabling condition of the hip joint that primarily affects young and active individuals, leading to progressive collapse of subchondral bone and often secondary arthritis. Despite extensive investigation, the precise etiology often remains unclear. While high-dose corticosteroids, chronic alcohol ingestion, and smoking are known associated risk factors, approximately 20 to 30% of ONFH cases are classified as idiopathic.Recently, the concept of gut dysbiosis, i.e., disruption of the normal intestinal microbial balance, has gained increasing attention due to its systemic immunologic and metabolic implications.

Comparison of Unicompartmental versus Total Knee Arthroplasty in Morbidly Obese Patients: A Database Analysis from 2013 to 2023

Aritra Chakraborty, Whisper Grayson, Kevin B. Fricka, Nicholas M. Brown — 2025-11-24

Patients who have a body mass index (BMI) over 40 face unique risks when undergoing joint arthroplasty. Although unicompartmental knee arthroplasty (UKA) may offer benefits such as reduced recovery time, its safety profile in morbidly obese populations remains unclear. This study compared postoperative complication rates between UKA and total knee arthroplasty (TKA) in patients who had a BMI above 40.

Surgeon Volume and Experience Both Independently Drive Value in Primary Total Joint Arthroplasty: Findings From a Patient-Level Value Analysis of 4,989 Procedures With Time-Driven Activity-Based Costing

2025-11-24

Surgeon and surgeon experience may influence clinical outcomes in both total knee arthroplasty (TKA) and total hip arthroplasty (THA). Clinical outcomes can be integrated with costs to calculate value. We aimed to determine if surgeon experience and volume were associated with increased value in arthroplasty.

Femoral Valgus Leads to Earlier Total Hip Arthroplasty Independent of Acetabular Coverage, While Varus Deformity Has a Protective Effect

2025-11-24

The presence of acetabular dysplasia or femoro-acetabular impingement increases the chance of an earlier total hip arthroplasty (THA). Surprisingly, the influence of femoral and acetabular parameters on the age at which THA is required remains poorly investigated. The aim of this study was to evaluate the radiographic hip morphotype at the time of THA using an artificial intelligence-based analysis to assess potential differences.

Does Testosterone Replacement Therapy Increase Risk of Thrombosis After Total Hip or Knee Arthroplasty?

2025-11-21

Testosterone is a prothrombotic hormone, but the effect of exogenous testosterone on venous thromboembolic events (VTEs) following total joint arthroplasty (TJA) remains unclear. This study investigated the association between testosterone replacement therapy (TRT) and postoperative risk of VTE following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Glucagon-Like Peptide-1 Receptor Agonists, Readmission, and Postoperative Complications in Arthroplasty: A Systematic Review and Meta-Analysis

2025-11-21

Agonists targeting the glucagon-like peptide-1 receptor have gained prominence in treating individuals who have type 2 diabetes and obesity. However, their influence on postoperative medical complications following total joint arthroplasty remains poorly characterized.

Synovial Absolute Neutrophil Count as a Superior Diagnostic Biomarker for Acute Periprosthetic Joint Infection in Hip and Knee Arthroplasty With Low-Virulence Organisms

Taner Karlidag, Ashwin Mundhe, Luigi Zanna, Thorsten Gehrke, Mustafa Citak — 2025-11-20

Diagnosing acute periprosthetic joint infection (PJI) soon after surgery presents a challenge because the inflammation caused by the procedure can mimic that of an infection. Key diagnostic measures include synovial white blood cell (WBC) count, polymorphonuclear percentage (PMN%), and alpha-defensin (AD). Nevertheless, the precise thresholds, particularly for infections with low virulence, remain ambiguous. This research assessed the effectiveness of synovial absolute neutrophil count (ANC) in diagnosing acute PJI in hip and knee joints and established specific thresholds based on the procedure and the organism involved.

Variation and Slower-Than-Recommended Recovery of Daily Life Activities Following Knee Arthroplasty With a Personalized eHealth Program: Results of the ACTIVE Trial Intervention Cohort

2025-11-20

The rising prevalence of knee arthroplasty (KA) affects daily life, especially for working-age patients who have high expectations for resuming activities. Variability in guidelines and lack of personalized recovery recommendations highlight the need for improved guidance, such as through eHealth solutions. This study identifies the most important daily activities chosen in an eHealth application and evaluates patients’ recovery times compared to expert recommendations.

Development and Validation of a Nomogram for Predicting High-Risk Hidden Blood Loss After Total Knee Arthroplasty

2025-11-19

Hidden blood loss (HBL) accounts for 49% of total postoperative blood loss after total knee arthroplasty (TKA), predisposing patients to anemia, infection, and delayed functional recovery. Despite partial elucidation of its pathophysiology, standardized predictive models for HBL remain lacking, rendering current clinical management reliant on subjective judgment and precluding individualized risk stratification. This study aimed to identify predictors of high-risk HBL after TKA and develop a validated visual prediction model integrating multiple clinical parameters.

Age-Related Risk of Conversion to Total Knee Arthroplasty After Mobile-Bearing Unicompartmental Knee Arthroplasty: A Survival and Competing Risk Analysis

2025-11-19

Mobile-bearing unicompartmental knee arthroplasty (UKA) is a well-established treatment for isolated compartment osteoarthritis. However, long-term outcomes may vary with the age of the patient at arthroplasty. This study evaluated the association between age and the risk of conversion to total knee arthroplasty (TKA) and the ultimate outcome for patients undergoing conversion from UKA to TKA.

The In Vitro Performance of Surgical Irrigation Solutions in Preventing Biofilm Formation on Implants

2025-11-19

Total joint arthroplasties are widely performed in the United States. Although various intraoperative irrigation solutions have been studied, comprehensive in vitro comparisons of their efficacy in preventing biofilm formation across multiple implant materials remain limited. This study evaluated the effectiveness of nine commercially available irrigation solutions in preventing biofilm formation by Staphylococcus aureus and Pseudomonas aeruginosa on four orthopaedic implant materials under clinically relevant conditions.

An Asymmetric Medio-Lateral Flexion Laxity Target Yields Excellent Results in Robotic-Assisted Total Knee Arthroplasty With Functional Knee Positioning

2025-11-18

Functional knee positioning (FKP) in robotic-assisted (RA) total knee arthroplasty (TKA) aims to optimize soft-tissue balance through patient-specific implant fine-tuning. However, it remains unclear (1) how intraoperative ligament laxity affects joint awareness and (2) whether the discrepancy between intraoperative planned and achieved laxity is affected by preoperative coronal limb alignment or fixed flexion deformity (FFD).

Optimizing Postoperative Care: The Role of a Total Joint Hotline in Reducing Unnecessary Emergency Department Visits

2025-11-18

Postoperative concerns after total joint arthroplasty (TJA) frequently lead to emergency department (ED) visits. To reduce unnecessary ED use, our institution implemented a Total Joint Hotline (TJH) to triage patient concerns. The purpose of this study was to determine if the TJH effectively reduced avoidable ED visits.

Should Total Hip Arthroplasty Surgeons Be Concerned that a Delay Between the Date of Surgical Booking and Surgery Influences Patient Body Mass Index and Short-Term Outcomes?

2025-11-18

Obesity is a known risk factor for complications after total hip arthroplasty (THA), with societal guidelines recommending surgical delay for patients above body mass index (BMI) targets. Consequently, patients are motivated to reach BMI targets before the office visit discussing surgical booking. Our study investigates BMI fluctuations between surgical booking and the surgery date and whether these fluctuations have implications for perioperative and postoperative outcomes.

Total Knee Arthroplasty in the Stiff and Ankylosed Knee at a Mean Follow-Up of 16 Years

Madhu KK, Kalpana Aggarwal, Ashok Rajgopal — 2025-11-17

Total knee arthroplasty (TKA) in patients who have stiff or ankylosed knees (range of motion [ROM] < 20°) presents technical challenges. Outcomes of TKA in this group of patients at follow-up greater than 12 years are under-reported. This study assesses the outcomes of TKA in this cohort at a mean follow-up of 16.3 years.

Patient Perception of Leg-Length Discrepancy and Satisfaction Following Primary Total Hip Arthroplasty

2025-11-17

Leg-length discrepancy (LLD) is a common complication following total hip arthroplasty (THA), which might affect patient function and satisfaction. It is unclear how a patient's perception of LLD changes over time. The purpose of our study was to evaluate the incidence, affecting factors, and lapse of perceived LLD after primary THA.

Predicting Outcomes of Early and Late Acute Periprosthetic Joint Infections Treated With Debridement, Irrigation, and Implant Retention: An External Validation of the CRIME80 (COPD, C-Reactive Protein, Rheumatoid Arthritis, Index Surgery, Male, Exchange of Mobile Components, Age Greater than 80 years) Score

2025-11-17

Debridement, antibiotics, and implant retention (DAIR) requires careful patient selection. The CRIME80 (COPD, C-reactive protein, Rheumatoid arthritis, Index surgery, Male, Exchange of mobile components, age greater than 80 years) score is a tool designed to predict treatment failure in patients who have late-acute PJI treated with DAIR. We aimed to assess the predictive performance of the CRIME80 score in patients who have early and late acute PJI.

Ten-Year Outcomes of Hypoallergenic Coated and Standard Implants in Total Knee Arthroplasty: A Randomized Controlled Trial

2025-11-17

Patients who have metal allergies frequently request hypoallergenic implants. In total knee arthroplasty (TKA), coating of standard implants is commonly used, with almost 10% of all primary TKAs in Germany in 2023. Registry data, however, have shown increased revision rates for coated implants. Whether this is due to the coating itself or the characteristics of allergy-prone patients remains unclear. The aim of this study was to compare revision rates, patient-reported outcomes, and serum metal levels in patients receiving coated versus standard TKA.

Return to Sports After Total Hip Arthroplasty: Patterns of Participation and Sport-Specific Outcomes

2025-11-15

Return to sports is a concern for many patients undergoing total hip arthroplasty (THA). As younger, active patients increasingly undergo THA, identifying factors that influence athletic recovery is critical. Although prior work has reported favorable outcomes, large-scale studies comparing return rates across both surgical approaches and sport types remain limited.

Disease-Modifying Antirheumatic Drugs May Reduce the Risk of Manipulation Under Anesthesia or Lysis of Adhesions Following Primary Total Knee Arthroplasty

2025-11-14

Stiffness is a debilitating complication following total knee arthroplasty (TKA), often necessitating manipulation under anesthesia (MUA) or arthroscopic lysis of adhesions (LOA). While nonsteroidal anti-inflammatory drugs and corticosteroids have been shown to reduce the risk of stiffness, the effect of disease-modifying antirheumatic drugs (DMARDs) remains unknown. This study aimed to evaluate whether DMARD use was associated with reduced rates of MUA or LOA after TKA.

Diabetic Neuropathy Is a Strong Risk Factor for Poor Orthopaedic Outcomes Following Total Knee Arthroplasty

2025-11-13

The aim of this study was to investigate the impact of diabetic peripheral neuropathy (DPN) on total knee arthroplasty (TKA) outcomes when compared with both nondiabetic and diabetic patients who did not have neuropathy (DM).

Liposomal Bupivacaine Versus Ropivacaine With Perineural Dexamethasone in Adductor Canal Block for Total Knee Arthroplasty: A Randomized Clinical Trial

Chao Liao, Jun Li, Xuping Hu, Yiwu Sun, Kangyan Zheng, Xing Pan, Liang Wang — 2025-11-13

Adductor canal block (ACB) provides effective analgesia for knee surgery while preserving quadriceps muscle strength. However, conventional local anesthetics yield only a short-lasting effect. To extend analgesia duration and reduce opioid usage, the administration of liposomal bupivacaine and perineural dexamethasone has been proposed. The present study assessed and compared the analgesic effectiveness and duration between liposomal bupivacaine and ropivacaine with perineural dexamethasone in patients undergoing total knee arthroplasty (TKA).

Do Implant-Specific Associations Exist Between Patellar Resurfacing and All-Cause Revision Risk After Primary Total Knee Arthroplasty? A Retrospective Analysis of Two National Joint Registries

2025-11-12

The role of patellar resurfacing during primary total knee arthroplasty (TKA) remains controversial. It is unclear if patellar resurfacing impacts revision risk differently across implant systems. The purpose of this study was to compare estimated revision rates for highly utilized TKA implants based on the presence or absence of primary patellar resurfacing.

Use of Cementless or Cemented Stems in One-Stage Exchange for Periprosthetic Joint Infection in Total Hip Arthroplasty Does Not Affect Outcomes: A Propensity-Matched Cohort Study from an Institutional Registry With a Mean Follow-Up of Six Years

2025-11-12

Periprosthetic joint infection (PJI) is the most dramatic complication of total hip arthroplasty (THA). We investigated whether a one-stage arthroplasty using a cemented or uncemented stem was associated with better survival in terms of infection and mechanical complications.

The Influence of Total Knee Arthroplasty Surgical Approach on Range of Motion, Patient-Reported Outcome Measures, and Reoperation Rates: A Systematic Review of Randomized Controlled Trials

Joshua P. Rainey, Logan E. Radtke, Jeremy M. Gililland, Michael A. Mont — 2025-11-12

Various surgical approaches may be used to perform total knee arthroplasty (TKA). This systematic review assessed randomized controlled trials (RCTs) evaluating various TKA approaches and their influence on knee range of motion (ROM), patient-reported outcome measures (PROMs), and reoperation rates.

Outcomes and Complications of Total Hip Arthroplasty for Crowe Type IV Dysplasia of the Hip: An International Multicenter Study

2025-11-12

Crowe type IV developmental dysplasia of the hip (DDH) represents the most severe form of hip dislocation and poses major technical challenges for total hip arthroplasty (THA). This study aimed to evaluate outcomes and complications of THA in Crowe type IV hips across multiple international centers, highlighting outcomes that may be relevant across practices in technique and implant selection.

Contemporary Cemented Revision Stems Demonstrate Excellent Survivorship in Revision Total Hip Arthroplasty up to 13-Year Follow-Up

2025-11-11

An extended diaphyseal femoral fixation can be mandatory in complex femoral revision total hip arthroplasty (THA). While outcomes of uncemented revision components are well documented in this context, little data are available about cemented revision stems with different options. This study aimed to evaluate survivorship, risk factors for re-revision, and radiographic and clinical outcomes of a series of one contemporary monoblock cemented revision stem implanted for femoral revision.

Validity of Substantial Clinical Benefit Estimates in Knee Arthroplasty Is Weak Based on Comparisons to a Gold Standard of Meaningful Improvement

Daniel L. Riddle, Levent Dumenci — 2025-11-11

Estimates of the substantial clinical benefit (SCB) for knee arthroplasty have been endorsed by the Centers for Medicare and Medicaid Services but have not been validated. We examined validity by comparing SCB estimates to an externally validated gold standard of meaningful improvement.

Single Functioning Kidney Patients Face Increased Odds for Defined Complications Following Total Knee Arthroplasty

Lucas Y. Kim, Albert H. Lee, Wesley Day, Lee E. Rubin, Jonathan N. Grauer — 2025-11-10

Total knee arthroplasty (TKA) patients may present with a single functioning kidney (SFK) for reasons including congenital agenesis, living donation, or resection due to malignancy. While many SFK patients are asymptomatic, this may predispose them to adverse events following TKA. The present study investigated the correlation of SFK and its various etiologies on postoperative outcomes following TKA.

Stairway to Heavenly Results: Do Stairs Affect Postoperative Recovery After Total Joint Arthroplasty?

2025-11-09

A common concern for patients undergoing total hip arthroplasty (THA) or knee arthroplasty (TKA) is the presence of stairs in their home. However, there is currently no evidence to suggest how stairs affect postoperative recovery. The aim of this study was to evaluate how stairs impact patient-reported outcomes (PROs) and physical activity metrics following TKA or THA in relatively young, active patients.

Admission Lymphocyte-to-C-Reactive Protein Ratio Predicts 90-Day Adverse Outcomes Following Aseptic Revision Total Hip Arthroplasty

Taner Karlidag, Luigi Zanna, Ashwin Mundhe, Thorsten Gehrke, Mustafa Citak — 2025-11-07

Revision total hip arthroplasty (rTHA) is linked to a greater risk of adverse postoperative outcomes in comparison to primary THA, owing to heightened surgical complexity and the burden of patient comorbidities. Consequently, there is an imperative need for an easily accessible predictor to facilitate preoperative risk stratification before rTHA. This study was conducted to evaluate the predictive utility of the admission lymphocyte-to-C-reactive protein ratio (LCR) concerning adverse events within 90 days postoperatively following aseptic rTHA.

Preoperative Hemoglobin as a Continuous Predictor of Postoperative Complications Following Elective Total Hip Arthroplasty

2025-11-07

Preoperative anemia is associated with adverse outcomes following total hip arthroplasty (THA). However, discrete hemoglobin thresholds may obscure potentially meaningful relationships between anemia severity and postoperative risk. This study assessed preoperative hemoglobin as a continuous variable to predict periprosthetic joint infection (PJI), medical, and surgical complications following elective THA.

International Classification of Diseases-10–Based Risk Stratification and Implant Selection for Knee Arthroplasty Among Patients Who Have Psychiatric and Neurologic Comorbidities: A Registry-Based Analysis of 549,234 Cases

2025-11-07

Psychiatric and neurologic comorbidities may worsen outcomes after total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). We compared risks across eight International Classification of Diseases, Tenth Revision, German Modification clusters—psychiatric F00 to F39 and neurologic G20 to G64—and by implant constraint (unconstrained, constrained, and unicompartmental).

The Application of Flowable Gelatin Without Thrombin in Total Joint Arthroplasty: A Propensity Score-Matched Comparative Study

Yi Zhang, Jiale Yuan, Yuanjie Zhang, Peijian Tong, Zhipeng Wu, Bangjian He — 2025-11-06

Flowable gelatin (FG) without thrombin is a widely utilized intraoperative hemostatic agent, yet its efficacy in total joint arthroplasty remains debated. This study aimed to assess its clinical impact on total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Association of Admission Nutritional Status Evaluated by the Controlling Nutritional Status Score With Periprosthetic Joint Infection After Primary Total Joint Arthroplasty: An Exploratory Analysis

2025-11-06

The relationship between admission malnutrition and periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) remains unclear due to limited evidence. This study aimed to assess the association between admission nutritional status and PJI risk within one year after TJA.

Morbidity and Mortality Analysis of Primary Total Knee Arthroplasty in Patients Aged > 90 Years: Insights From the German Arthroplasty Registry

2025-11-06

This study aimed to evaluate the safety of primary total knee arthroplasty (TKA) in patients aged ≥ 90 years by assessing complication and mortality rates. Additionally, we compared these outcomes with those of younger patient groups and identified comorbidities associated with increased morbidity and mortality.

Trends in Antibiotic-Resistant Bacteria in Surgically Treated Periprosthetic Joint Infection: A Decade of Experience at a Regional Referral Center

2025-11-06

Periprosthetic joint infection (PJI) represents a devastating complication following total joint arthroplasty. Understanding trends in causative organisms and antibiotic resistance patterns is necessary for optimizing treatment strategies. We investigated (1) whether there has been a change in prevalence of drug-resistant organisms in surgically treated PJI over the past decade and (2) if there are risk factors associated with drug-resistant PJI.

High Satisfaction Despite 32% Persistent Hip Flexor Weakness After Endoscopic Tenotomy for Iliopsoas Impingement Following Total Hip Arthroplasty

2025-11-06

Iliopsoas impingement (IPI) is a serious complication after total hip arthroplasty (THA), causing chronic pain and functional impairment. Endoscopic iliopsoas tenotomy (EIT) is considered among the least invasive options to prevent implant revision. This study aimed to evaluate postoperative outcomes with a focus on pain relief, objective hip flexor strength, and patient satisfaction. We hypothesized that patients would report high satisfaction despite potential persistent strength deficits.

Is It Safe to Give Meloxicam or Celecoxib to Chronically Anticoagulated Patients Following Primary Total Knee Arthroplasty?

2025-11-06

The nonsteroidal anti-inflammatory drugs (NSAIDs) are foundational components of multimodal pain protocols and have been shown to improve pain and range of motion following total knee arthroplasty (TKA). Patients receiving chronic anticoagulation therapy undergoing TKA are potentially disadvantaged because there are concerns with concurrent NSAID use due to bleeding concerns. Evidence suggests that cyclo-oxygenase 2 (Cox-2) inhibitors may not be associated with increased bleeding risk. The purpose of this study was to evaluate the safety of concurrent administration of NSAIDs in chronically anticoagulated patients undergoing primary TKA.

Conversion Total Knee and Hip Arthroplasty Requires Increased Energy Expenditure Compared to Primary Knee Arthroplasty

2025-11-05

Conversion total knee arthroplasty (TKA) requires increased preoperative planning, surgical time, and perioperative resources; yet, there is currently no separate procedural code for conversion TKA as there is for conversion total hip arthroplasty (THA). The purpose of this study was to compare energy expenditure for the surgeon when performing primary, conversion, and revision TKA/THA.

Cementless Titanium Fibermesh Cup in Cup-Cage Construct for Severe Acetabular Defect in Revision Total Hip Arthroplasty

I-Hsin Chen, Shi-Chien Tzeng, Chen-Ti Wang — 2025-11-05

Addressing bony defects in cases of severe acetabular bone loss remains challenging, and the cup-cage construct presents a potential solution. While tantalum cups have demonstrated favorable outcomes within the cup-cage construct, the efficacy of employing cup-cage constructs with titanium fibermesh remains to be elucidated.

Spin Is Prevalent in the Majority of Abstracts of Patello-femoral Arthroplasty Studies

2025-11-05

The purpose of our study was to investigate the prevalence and types of reporting biases in patello-femoral arthroplasty (PFA) studies.

Enhancing Diagnostic Accuracy for Uncertain Periprosthetic Joint Infection: Combining Cultures With Intraoperative Multisite Sonication

2025-11-05

Accurate diagnosis of periprosthetic joint infection (PJI) remains challenging, particularly in uncertain cases under the International Consensus Meeting (ICM) 2018 criteria. We explored whether combining cultures with intraoperative multisite sonication could improve diagnostic performance, especially in ambiguous cases. We addressed the following questions: (1) Does multisite sonication combined with standard culture reduce diagnostic uncertainty in PJI? (2) Does multisite sonication improve intraoperative culture positivity? and (3) Do preoperative and intraoperative postsonication bacterial profiles differ?

Diagnosing Flexion Laxity After Knee Arthroplasty Using the “Hanging” Clunk Test and the Standard-To-Hanging Lateral Difference

Thomas J. Blumenfeld, William L. Bargar, Derek F. Amanatullah — 2025-11-04

Flexion laxity after total knee arthroplasty (TKA) may be difficult to diagnose. We describe simple clinical and radiographic tests that may aid in the identification of this problem.

Joint Line Obliquity Affects Survivorship Following Total Knee Arthroplasty: 12.7-Year Follow-Up of 800 Cases

Hong Yeol Yang, Eun Kyoo Song, Ji Ho Seo, Sung Ju Kang, Jong Keun Seon — 2025-11-03

The purpose of this study was to evaluate the influence of joint line obliquity (JLO) on survivorship following total knee arthroplasty (TKA) over a mean follow-up of 12.7 years

History of Venous Thromboembolism Is Not a Contraindication to Aspirin Prophylaxis in Patients Undergoing Total Joint Arthroplasty

2025-11-02

Although aspirin has become the prophylactic agent of choice for venous thromboembolism (VTE) prevention in low VTE risk patients undergoing primary total joint arthroplasty (TJA), there remains a paucity of data in the literature on the efficacy of aspirin as a mode of chemoprophylaxis in patients who have previously experienced a VTE episode. The purpose of this study was to determine the efficacy of aspirin versus other anticoagulant medications in primary TJA patients who have a documented history of a prior thromboembolic event.

Impact of Obesity on Daily Activity Following Total Knee Arthroplasty

2025-10-31

Obesity is a major risk factor for knee osteoarthritis, frequently requiring total knee arthroplasty (TKA). Although TKA improves mobility and reduces pain, obesity's influence on postoperative activity and gait metrics remains unclear. This study investigated the impact of body mass index (BMI) on daily activity following TKA.

Are Patients Who Have Sarcoidosis at Increased Risk of Adverse Postoperative Outcomes Following Total Knee Arthroplasty?

2025-10-31

Sarcoidosis is a multisystem inflammatory disease most observed in middle-aged adults, a population increasingly electing for total joint reconstruction. Musculoskeletal manifestations of sarcoidosis, including arthritis, occur in up to 40% of cases, prompting the need for orthopaedic involvement. Our study investigated whether sarcoidosis patients undergoing total knee arthroplasty (TKA) would be at increased risk for adverse postoperative outcomes.

The Impact of Bone Marrow Transplant on Total Joint Arthroplasty Outcomes in Patients Diagnosed With Multiple Myeloma

2025-10-31

As screening and treatment for multiple myeloma (MM) improve, 5-year survival rates continue to rise. Bone marrow transplant (BMT) remains a challenging, but effective therapy with lasting benefit. Although postoperative outcomes after total joint arthroplasty (TJA) are well-studied in solid organ transplant recipients, data for BMT recipients are limited. This study aimed to define the impact of BMT on 90-day TJA outcomes.

Short versus Long Venous Thromboembolism Prophylaxis Following Elective Total Hip Arthroplasty: A Bayesian Network Meta-Analysis of Efficacy and Safety

2025-10-31

Pharmacological venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) lacks consensus regarding optimal duration. We conducted a network meta-analysis (NMA) to evaluate the efficacy and safety of commonly used prophylactic strategies.

Preoperative Testosterone Replacement Therapy Is Associated With Increased Complication Risk After Total Knee Arthroplasty: A Propensity-Matched Analysis of 13,250 Patients

2025-10-31

While testosterone replacement therapy (TRT) is known to affect cardiovascular physiology, its impact on outcomes following total knee arthroplasty (TKA) remains unclear. This study aimed to assess whether preoperative TRT use is associated with increased complications following TKA.

PhysiotherApeutic Treat-To-Target Intervention After Total Hip and Knee Arthroplasty Does Not Improve Outcomes Compared to Usual Physical Therapy: The PATIO Study

2025-10-31

This nationwide superiority cluster randomized controlled trial evaluated the effectiveness of a personalized, treat-to-target postoperative physical therapy (PPT) strategy compared to usual care after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Characterizing the Cost Trends of Readmissions After Aseptic Revision Total Hip Arthroplasty

2025-10-30

As the prevalence of primary total hip arthroplasty rises in the United States, there is a corresponding increase in revision total hip arthroplasty (rTHA), particularly among younger patients. This study explored the etiologies, financial burdens, and risk factors for 90-day readmission following aseptic rTHA, with an emphasis on distinguishing these factors from septic revision cases.

Sleep Management Combined With Rehabilitation Exercise to Alleviate Chronic Pain Following Total Knee Arthroplasty: A Randomized Controlled Trial

2025-10-29

Chronic pain following total knee arthroplasty (TKA) remains a frequent and debilitating complication that impairs recovery and quality of life. Current pharmacological treatments provide limited relief for persistent pain, especially when complicated by sleep or mood disorders. This study investigated whether combining cognitive behavioral therapy for insomnia (CBT-I) with structured rehabilitation exercise could offer a nonpharmacologic solution.

Nationwide Comparison of Cemented Versus Uncemented Hemiarthroplasty for Femoral Neck Fractures in the Elderly: A Propensity Score-Matched Analysis Using Japan's Diagnosis Procedure Combination Database

2025-10-29

Femoral neck fractures in the elderly are a major public health issue. Hemiarthroplasty is widely used for displaced fractures; however, the optimal fixation method, cemented versus uncemented, remains controversial. In Japan, despite a high prevalence of osteoporosis, cemented hemiarthroplasty is underutilized. To date, no large-scale Japanese study has directly compared early outcomes between cemented and uncemented fixation.

Influence of Coronal and Sagittal Femoral Stem Alignment on Mid-Term Functional Outcomes in Direct Anterior Approach Total Hip Arthroplasty Utilizing a Cementless, Trochanteric-Sparing Short Stem

2025-10-28

Neutral femoral-stem alignment is thought to promote durability and function after total hip arthroplasty (THA), but the clinical relevance of modest malalignment, particularly in modern, cementless short stems inserted through a direct anterior approach (DAA), remains uncertain. This study aimed to evaluate whether coronal or sagittal femoral stem malalignment affects pain and function after DAA THA with a cementless short stem.

Intravenous Meloxicam Versus Ketorolac for Pain Control Following Total Joint Arthroplasty: A Double-Blind Randomized Controlled Trial

2025-10-28

Although joint arthroplasty surgery is considered safe and effective in reducing osteoarthritis-related pain long-term, the surgery is known to be painful in the immediate postoperative period. Therefore, optimal pain management has become a crucial goal for orthopedic surgeons. Nonsteroidal anti-inflammatory drugs are often used but can cause adverse effects due to their mechanism of action. Meloxicam, however, has a unique mechanism of action, allowing it to better spare the gut lining, translating to reduced complications.

Is a Combination of Diosmin and Hesperidin Effective on Swelling, Pain, and Range of Motion After Total Knee Arthroplasty?

Ahmet B. Girgin, Evrim Duman — 2025-10-27

Swelling is one of the hindrances to functional recovery after total knee arthroplasty (TKA). The aim of this study was to investigate the effect of a diosmin and hesperidin combination on early rehabilitation of patients after TKA.

Rotating Hinge Implants for Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of 6,554 Knees

2025-10-27

Implant design improvements and expanded indications for total knee arthroplasty (TKA) have led to the increasing use of rotating hinge implants in primary TKA. Revisions following primary rotating hinge total knee arthroplasty (RH-TKA) are complex and often cause major patient morbidity. This review amalgamated survivorship data on primary RH-TKAs, causes for revision, and patient-reported outcome measures (PROMs).

Compatibility of Retrograde Intramedullary Nails With Knee Prostheses: A Comprehensive Analysis

2025-10-27

Periprosthetic distal femoral fractures pose major challenges in orthopaedic surgery, particularly among aging populations with total knee arthroplasties. Retrograde intramedullary nailing has emerged as a viable fixation option due to its biomechanical stability, less invasive nature, and facilitation of early weight-bearing. However, the compatibility between retrograde nails and various knee prostheses remains a critical determinant of surgical success. This review consolidated existing knowledge and evaluated current nail-prosthesis compatibility and options for lateral femoral periprosthetic plating and provided a compatibility matrix for fixation options for these complex fractures.

Defining Preoperative Hemoglobin Thresholds Can Help Avoid Transfusion or Adverse Events for Revision Total Joint Arthroplasty

2025-10-27

Anemia optimization before revision total joint arthroplasty (rTJA) could improve outcomes; however, there is little literature on hemoglobin optimization efforts before rTJA. Simulation models in orthopaedic literature help define the likelihood of successful surgery based on thresholds of preoperative parameters. We evaluated whether certain preoperative hemoglobin thresholds could be defined for revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) in order to predict reduced likelihood of intraoperative or postoperative transfusion or perioperative adverse events.

Perioperative Management of Diabetic Medications in Patients Undergoing Elective Total Joint Arthroplasty: A Review of Current Guidelines and Recommendations

Jayanth Kumar, Mason A. Fawcett, Courtney E. Sherman, Bryan D. Springer — 2025-10-27

The prevalence of diabetes in patients undergoing total joint arthroplasty (TJA) is steadily increasing. Diabetes predisposes patients to major complications such as prosthetic joint infection, which poses major challenges to the patient and surgeon. Therefore, careful perioperative glucose management in these patients is critical. Medications have been the mainstay in the management of diabetes; however, these medications are each associated with their unique risk profile in the perioperative period.

Effect of Vancomycin Powder in Reducing Infection After Primary and Revision Hip and Knee Arthroplasty and Its Complications: An Umbrella Review and Meta-Analysis

2025-10-27

Periprosthetic joint infection (PJI) after hip or knee arthroplasty greatly increases morbidity and costs. Local antibiotic powders may help curb infections while minimizing systemic toxicity. We assessed their efficacy and safety in preventing PJI.

Results of Two-Stage Exchange for Periprosthetic Joint Infection Following Total Knee Arthroplasty: Low Rates of Failure in 463 Knees at 10 Years

2025-10-27

Some recent data suggest similar reinfection rates between two- and one-stage exchange arthroplasties for infected total knee arthroplasties (TKAs). However, those data are limited in follow up and analysis of aseptic failure rates. The purpose of this study was to assess the 10-years results of TKA two-stage exchange in one of the largest series to date.

Outcomes and Implant Survival in Lateral Unicompartmental Knee Arthroplasty: The Path Less Traveled

Tobenna N. Nwankwo, Katherine K. Li, Nancy L. Parks, Kevin B. Fricka — 2025-10-27

Unicompartmental knee arthroplasty (UKA) is an effective treatment for isolated lateral compartment osteoarthritis (OA). Surgeons have been reticent to adopt this procedure due to the difficulty of exposure and historically higher rates of revision when compared to total knee arthroplasty (TKA). The purpose of this study was to evaluate our series of lateral UKAs.

Robotic-Assisted Joint Arthroplasty: European Perspectives on Surgeon Adoption and Utilization Trends

2025-10-27

Robotic-assisted total joint arthroplasty (TJA) has improved surgical precision and implant positioning, yet surgeon perceptions and adoption patterns remain incompletely understood. This study addresses three key questions: (1) What are the current trends in robotic technology use and interest across regions? (2) How does utilization vary by procedure type, and how familiar are surgeons with different robotic systems? and (3) Which factors most influence surgeons’ decisions to adopt or avoid robotic assistance in arthroplasty?

Rotational Alignment in Total Knee Arthroplasty: A Randomized Clinical Trial of Akagi Versus Sahin Tibial Referencing Techniques

2025-10-23

Rotational malalignment of the tibial component in total knee arthroplasty (TKA) contributes to patellofemoral complications and functional impairment. While several anatomical landmarks have been proposed for intraoperative referencing, no single method has been universally accepted. This study compared the rotational accuracy and clinical outcomes of Akagi’s line and Sahin’s combined axis referencing techniques.

A Complete Infrapatellar Fat Pad Resection Is Associated With New Postoperative Patella Baja and Persistent Pain, but a Lower Risk of Manipulation Under Anesthesia After Primary Total Knee Arthroplasty

2025-10-23

Patella baja after total knee arthroplasty (TKA) is associated with postoperative stiffness, and there is conflicting evidence regarding the patellar fat as a source of pain. We hypothesized that a complete infrapatellar fat pad resection during primary TKA does not increase the incidence of new postoperative patella baja while reducing the incidence of persistent pain and improving postoperative function. Specifically, we evaluated the odds of 1) new patella baja, 2) persistent pain, 3) knee society score, 4) range of motion, and 5) manipulation under anesthesia.

Triple-Taper Collared Stem Morphology Influences Periprosthetic Femoral Fracture Risk: A Comparison of Single-, Dual-, Triple-, and Quadrangular-Taper Stems

Drake G. LeBrun, Vanessa Ruiz, Elizabeth B. Gausden, Geoffrey H. Westrich — 2025-10-23

Stem morphology is an important contributor to periprosthetic femoral fracture (PFF) risk following total hip arthroplasty (THA). New-generation triple-taper collared stems may be associated with a lower risk of PFF. Our objective was to compare the incidence of PFFs in triple-taper collared stems to three other cementless stem morphologies.

Unicompartmental Knee Arthroplasty for Isolated Compartment Osteonecrosis: A 20-Year Experience

2025-10-23

Osteonecrosis of the knee, whether primary (spontaneous) or secondary, can often necessitate surgical intervention. If advanced osteonecrosis is confined to a single compartment, unicompartmental knee arthroplasty (UKA) is often considered. The purpose of this study was to update and extend our prior series, with specific emphasis on implant survivorship, radiographic results, clinical outcomes, and complications in a concise cohort of UKAs for osteonecrosis.

Defining Preoperative Anemia Thresholds for Revision Total Hip Arthroplasty

2025-10-23

In an era of value-based medical management, anemia optimization before revision total hip arthroplasty (THA) could improve outcomes. Simulation models in orthopedic literature help define the likelihood of successful surgery based on varying thresholds of preoperative parameters. We evaluated outcomes for revision THA if patients were either approved/denied surgery based on incremental preoperative anemia thresholds.

The Elixhauser Comorbidity Index as a Predictor of Disruptive Bleeding in Total Hip Arthroplasty: Impact on Outcomes and Costs

2025-10-17

With an estimated one million cases per year anticipated by 2030, total hip arthroplasty (THA) is a popular and successful treatment for end-stage hip osteoarthritis. The objectives of this study were to: (1) measure the incidence of disruptive bleeding; (2) determine the demographics of patients and the burden of Elixhauser comorbidity related to disruptive bleeding; and (3) assess the effect of disruptive bleeding on health care utilization (inpatient costs, hospital lengths of stay, and 90-day readmission rates).

Efficacy of Commercially Available Irrigation Solutions on Removal of Biofilms Grown on Porous Titanium Implants: An In Vitro Study

Adam Miller, Momin Nasir, Therese Bou-Akl, Paula Pawlitz, David C. Markel — 2025-10-17

Periprosthetic joint infection (PJI) remains a major complication in orthopaedic surgery. A challenge in treating PJI is bacterial biofilm formation on implants, which confers a barrier to conventional antibiotic therapies and often necessitates implant removal and revision surgery. The goal of this study was to compare the efficacy of six commercially available irrigation solutions in decreasing bacterial load and disrupting biofilm formed on three dimensionally printed porous titanium discs that are similar to the surface characteristics of TJA implants.

Increased Postoperative Complications in Nontobacco Nicotine Users Following Total Hip Arthroplasty

2025-10-17

Nicotine use is associated with increased complications after total joint arthroplasty, but data on nontobacco nicotine dependence (NTND), including vaping and smokeless nicotine, are limited. This study evaluated perioperative and postoperative outcomes in NTND patients undergoing total hip arthroplasty (THA).

Greater Resource Utilization for Patient-Reported Outcome Measures Collection in Medicare Inpatient Versus Outpatient Total Knee Arthroplasty: Implications for the New Centers for Medicare and Medicaid Services Patient-Reported Outcomes-Based Performance Measure Policy

2025-10-15

The Centers for Medicare and Medicaid Services now mandates the collection and reporting of patient-reported outcome measures (PROMs) for total joint arthroplasty. However, ensuring adequate follow-up remains a challenge. Furthermore, differences in PROMs capture rates and collection strategies between inpatient and outpatient Medicare total knee arthroplasty (TKA) populations are not well understood. We aimed to (1) evaluate differences in PROMs collection processes and success rates between inpatient and outpatient Medicare TKA patients and (2) identify factors associated with requiring active follow-up to obtain 1-year PROMs.

Medicare Reimbursement Trends for Common Knee Arthroplasty Procedures: A Generational Perspective, 2006 to 2024

2025-10-09

The primary aim of this study was to assess the trends in Medicare reimbursement for knee arthroplasty procedures between 2006 and 2024.

Chronic Postsurgical Pain after Primary Total Hip Arthroplasty for Osteoarthritis: A Nationwide Cross-Sectional Survey Study

2025-10-08

Total hip arthroplasty (THA) is frequently performed in patients who have osteoarthritis to relieve pain and improve quality of life. However, there is limited contemporary data on satisfaction and risk of persistent postsurgical pain, even though it is essential for informed decision-making. The objective of our study was to investigate the incidence of chronic postsurgical pain, pain characteristics, use of analgesics, patient satisfaction, and willingness to undergo surgery again one year after THA for osteoarthritis.

Chronic Kidney Disease and Outcomes of Total Hip Arthroplasty Patients Who Have Periprosthetic Hip Fractures

2025-09-25

Patients who have end-stage renal disease (ESRD) and chronic kidney disease (CKD) have an increased risk of mortality and perioperative complications after primary total hip arthroplasty. The association between increasing severity of renal disease with clinical and financial end points in patients treated for hip periprosthetic fracture (PPF) is underexplored in the literature.

Trends in Utilization of Technology-Assisted Navigation in Unicompartmental and Total Knee Arthroplasty Between 2009 and 2022

2025-09-06

In cases of isolated, single-compartment osteoarthritis of the knee, both unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) can be effective treatment options. This study evaluated rates of technology-assisted utilization in UKA (TA-UKA) using a national claims database over a contemporary 13-year period to determine the trends in use of TA-UKA relative to TKA in the United States.

Fully Randomized Predictor-Outcome Pairings Using a National Database Yield Frequent Statistical Significance Without Clinical Meaning

Whisper Grayson, Aritra Chakraborty, Nicholas M. Brown — 2025-08-28

Large national databases have enabled extensive outcomes research in arthroplasty. Their vast sample sizes, however, raise concerns regarding the identification of statistically significant, but clinically meaningless associations. We hypothesized that completely random pairings between database variables, without any clinical rationale, would still frequently yield statistically significant associations, which were driven purely by sample size rather than any meaningful relationship. This study examines the extent of false discovery risk in data-driven analysis of large clinical datasets.

Etiology of Failure in Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2025-07-14

Revision total knee arthroplasty (TKA) remains a burden and will continue to increase in incidence. The purpose of this systematic review and meta-analysis was to analyze the current revision rates and most common etiologies of failure of revision TKA.

Complications Are Elevated in Patients Who Have Decubitus Ulcers Undergoing Hemiarthroplasty, but There Are No Significant Difference in Two-Year Outcomes

2025-07-03

Patients undergoing hemiarthroplasty for femoral neck fracture are generally frail and prone to complications. Decubitus ulcers, associated with poor mobility, may indicate worse outcomes, though this relationship remains understudied. We hypothesized that preoperative decubitus ulcers increase the risk of postoperative complications at 90 days and two years following hemiarthroplasty.

Conflict of Interest Statement

2026-07

The following form must be filled out completely and submitted by each author (example, 6 authors, 6 forms). If no discloser is required, please write/type “none” at the end of each sentence.

2026-07

Masthead

2026-07

Publication Information:The Journal of Arthroplasty (ISSN 0883-5403) is published monthly by Elsevier Inc., 1600 John F. Kennedy Boulevard, Suite 1818 Market Street, Philadelphia, PA 19103, United States. USA POSTMASTER: Send address changes to Name of Journal, Elsevier, Journal Returns, 1799 Highway 50 East, Linn, MO 65051, USA

Editorial Board

2026-07

Reply to Letter Regarding “A Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Dexamethasone Combined with Neuraxial Anesthesia in Reducing Pain and Opioid Consumption after Primary Cementless Total Hip Arthroplasty Using the Direct Anterior Approach”

2026-07

We thank the authors for their scientifically grounded commentary regarding our randomized controlled trial evaluating a single intraoperative dose of 10 mg intravenous dexamethasone in patients undergoing primary total hip arthroplasty (THA) via the direct anterior approach under neuraxial anesthesia. We appreciate the opportunity to clarify several methodological and clinical considerations.

Letter regarding ‘A Randomized, Double-Blind, Placebo-Controlled Trial on the Efficacy of Dexamethasone Combined with Neuraxial Anesthesia in Reducing Pain and Opioid Consumption after Primary Cementless Total Hip Arthroplasty Using the Direct Anterior Approach’

Ali İhsan Uysal, Eylem Yaşar — 2026-07

We read with great interest the study by Schroven et al. [1], investigating the effects of 10 mg intravenous dexamethasone on pain and opioid consumption after primary total hip arthroplasty (THA). While the authors demonstrate significant early analgesic benefits, we believe, in view of current evidence, that further discussion on the aspects of rebound pain monitoring and metabolic disturbances is warranted.

Reply to Letter to the Editor on “Predictive Factors of Pain and Functional Outcome Five Years Following Total Hip Arthroplasty: A Prospective Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement Cohort Study”

David C. Ayers — 2026-07

In Reply:

Reply to Letter Regarding “Is It Safe to Give Meloxicam or Celecoxib to Chronically Anticoagulated Patients Following Primary Total Knee Arthroplasty?”

Jiabin Liu, Gwo-Chin Lee — 2026-07

We read with great interest the letter from Drs Smitterberg and Mont on our recently published manuscript titled “Is It Safe to Give Meloxicam or Celecoxib to Chronically Anticoagulated Patients Following Primary Total Knee Arthroplasty?” We appreciate their interest and thoughtful comments on this common clinical question. Please find below our responses to the authors’ comments and concerns.

Letter Regarding “Is It Safe to Give Meloxicam or Celecoxib to Chronically Anticoagulated Patients Following Primary Total Knee Arthroplasty?”

Chase W. Smitterberg, Michael A. Mont — 2026-07

The paper by Lee et al. assessing the safety of concurrent celecoxib or meloxicam in patients receiving primary total knee arthroplasty (TKA) who are continuously anticoagulated using the MarketScan database caught our attention [1].

Response to the Letter to the Editor Commenting on “Impact of Obesity on Daily Activity Following Total Knee Arthroplasty”

2026-07

It is with sincere appreciation that we have reviewed the recent letter commenting on our work [1]. We are grateful that our study generated discussion, as thoughtful critique helps advance the scientific dialogue and ultimately improves our understanding of recovery after total knee arthroplasty.

Letter Regarding “Impact of Obesity on Daily Activity Following Total Knee Arthroplasty”

Zirvecan Güneş — 2026-07

I read with interest the recent article by Wu et al. [1], which investigated the relationship between body mass index (BMI) and postoperative daily activity after total knee arthroplasty (TKA) through wearable technology measurements. The study provides valuable information about TKA recovery through continuous activity tracking, yet it is not without methodological limitations. I respectfully highlight these points for scholarly discussion.

Reply to Letter Regarding: “Rotational Alignment in Total Knee Arthroplasty: A Randomized Clinical Trial of Akagi Versus Sahin Tibial Referencing Techniques”

2026-07

We sincerely thank Sun et al. for their thoughtful and constructive comments regarding our recently published randomized clinical trial comparing Akagi’s line and Sahin’s axis for tibial rotational alignment in total knee arthroplasty [1]. We appreciate their interest in our study and the opportunity to further clarify our findings.

Letter Regarding “Rotational Alignment in Total Knee Arthroplasty: A Randomized Clinical Trial of Akagi Versus Sahin Tibial Referencing Techniques”

Xianwen Sun, Jiekun Jian — 2026-07

We read with great interest the article by Rodrigo P.S. Nunes et al., entitled “Rotational Alignment in Total Knee Arthroplasty: A Randomized Clinical Trial of Akagi versus Sahin Tibial Referencing Techniques” (https://doi.org/10.1016/j.arth.2025.10.047), recently published in The Journal of Arthroplasty [1]. This well-designed randomized trial of 78 patients compared two methods for tibial component rotational alignment in total knee arthroplasty (TKA): the traditional Akagi line versus the Sahin referencing technique.