The Journal of Arthroplasty

Elevated Risk of Periprosthetic Joint Infection and Revision in Patients Who Have Psoriasis after Total Knee Arthroplasty: A Propensity-Matched Cohort Analysis

2026-08-17

Total knee arthroplasty (TKA) is a highly successful procedure for managing arthritis, though complications such as periprosthetic joint infection (PJI), periprosthetic fracture (PPFx), and mechanical loosening can occur. Psoriasis has been associated with an increased likelihood of requiring TKA.

A Review of Patient-Reported Outcome Measures and Patient Demographics in Randomized Controlled Trials Used to Synthesize Clinical Practice Guidelines for Hip Fractures in Older Adults

2026-08-14

Clinical practice guidelines (CPGs) are vital to uphold quality orthopaedic care in various populations. The outcome measures and patient demographics in studies used to synthesize the CPGs may not be fully representative of the general population, even though many studies have demonstrated the impact of sociocultural elements with musculoskeletal outcomes. Assessing the linguistic, racial, and ethnic representation of participants as well as the linguistic and cultural adaptation of patient-reported outcome measures (PROMs) used in trials informing CPGs for hip fractures in older adults is essential.

Complication Profile of A Computed Tomography-Guided Robotic-Arm Assisted Unicompartmental Knee Arthroplasty System: A Systematic Review and Meta-Analysis

2026-08-14

Robotic-arm-assisted unicompartmental knee arthroplasty (rUKA) has grown in popularity, but the spectrum of complications associated with any one platform remains incompletely characterized. This systematic review and meta-analysis evaluated the intraoperative, perioperative, and postoperative complication profile of a single computed tomography (CT)-guided, semi-active robotic platform and compared this against contemporary manual (mUKA) cohorts.

Prognostic Prediction of Femoral Head Collapse Using Necrotic Size and Lateral Extent on Computed Tomography Images in Osteonecrosis of the Femoral Head

Keiji Otaka, Yusuke Osawa, Hiroto Funahashi, Yasuhiko Takegami, Shiro Imagama — 2026-08-14

The accurate prediction of femoral head collapse is essential for managing osteonecrosis of the femoral head (ONFH). In this study, we aimed to evaluate the utility of combining the coronal vertical diameter ratio (CVDR), as a simple alternative for necrotic size, and the lateral necrotic extent ratio (LNER), as an indicator of lateral lesion extension for prognostic prediction.

Japanese Knee Osteoarthritis Measure at Two Weeks as a Key Predictor of Early Functional Recovery After Total Knee Arthroplasty

2026-08-14

Early postoperative functional recovery is a major determinant of patient satisfaction following total knee arthroplasty. Although patient-reported outcome measures are increasingly used, the prognostic value of early postoperative assessments remains incompletely understood.

Administration of Preoperative Cryoneurolysis is Associated with Continued and Persistent Opioid Reduction and Improved Outcomes in Primary Total Knee Arthroplasty

2026-08-14

Cryoneurolysis, a percutaneous technique applying targeted cold therapy to sensory nerves, has emerged as a non-opioid adjunct that may provide sustained analgesia after total knee arthroplasty (TKA). This study aimed to (1) determine whether preoperative cryoneurolysis reduces postoperative opioid use, (2) evaluate its effect on pain severity, and (3) assess functional recovery after TKA.

Mitigation of Vascular Complications in Revision Total Hip Arthroplasty with Intra-Pelvic Migration of Implants: A Pre-Operative Algorithmic Approach

2026-08-14

Intra-pelvic migration of implants or cement following total hip arthroplasty (THA) is a rare, but serious complication that can lead to life-threatening vascular injuries during revision surgery. The close proximity of migrated components to major pelvic vessels markedly increases the risk of intraoperative hemorrhage, necessitating a strategic preoperative and intraoperative approach.

Total Hip Arthroplasty in Patients Who Have a Body Mass Index ≥ 40: Outcomes at an Institution Without Cutoffs

2026-08-13

Morbid obesity (body Mass Index [BMI] ≥ 40) has been associated with increased perioperative risk following total hip arthroplasty (THA), leading many institutions to impose strict BMI cutoffs. Our institution does not restrict THA based on BMI, providing an opportunity to evaluate outcomes in a medically complex population.

Association of Extended Oral Antibiotic Prophylaxis With 90-Day Complication Rates After Primary Total Knee Arthroplasty: A Propensity-Matched Retrospective Cohort Study

2026-08-13

While perioperative antibiotic prophylaxis has been widely implemented to reduce periprosthetic joint infection (PJI) rates, the efficacy of an extended oral antibiotic prophylaxis (EOAP) regimen postoperatively remains equivocal among arthroplasty surgeons. This study investigated the association of EOAP with PJI rates after primary total knee arthroplasty (TKA) using a large database and propensity-matched cohorts.

Functional Limb Length Preservation and Coronal Alignment Categories in Revision Total Knee Arthroplasty

2026-08-12

This study evaluated functional limb-length (LL) and coronal-alignment preservation after revision total knee arthroplasty (rTKA) relative to contralateral and pre-rTKA baselines, examining their association with patient-reported outcome measures (PROMs).

Smart Implantable Device Use is Associated with Decreased Post-Discharge Hospital Utilization in Total Knee Arthroplasty Patients Who Have Metabolic Syndrome: A Propensity Score-Matched Analysis

2026-08-12

Studies have demonstrated an increased risk of postoperative complications in patients who have metabolic syndrome undergoing total knee arthroplasty (TKA). Smart implantable devices (SIDs) and remote monitoring have shown promise in improving outcomes. The purpose of this study was to evaluate whether patients who have metabolic syndrome and a SID TKA had decreased post-discharge hospital utilization.

Isolated versus Full-Component Revision Total Knee Arthroplasty for Aseptic Loosening: Systematic Review and Meta-Analysis

2026-08-11

Aseptic loosening after total knee arthroplasty (TKA) is a challenging complication. Outcomes regarding an isolated versus full component revision TKA (rTKA) are not well summarized in the literature. To address this, we conducted a systematic review of the literature regarding this topic along with a meta-analysis to clarify inconsistent conclusions in the literature.

Comparison of Postoperative Outcomes Following Simultaneous versus Staged Bilateral Total Knee Arthroplasty in Obese Patients: A Database Study

2026-08-10

Obesity is associated with higher complication risk after total knee arthroplasty (TKA), and evidence comparing simultaneous versus staged bilateral TKA (BTKA) across obesity severity is limited.

Racial and Ethnic Disparities in the Utilization of Robotic-Assisted Total Hip Arthroplasty: A Propensity Score-Matched Analysis

Emmanuel Ogu, Angel Valencia, Senthil Sambandam — 2026-08-10

Robotic-assisted total hip arthroplasty (RA-THA) has seen rapid adoption across the United States, yet whether racial and ethnic disparities in conventional total hip arthroplasty (THA) utilization extend to this emerging technology remains unknown. This study evaluated differences in RA-THA utilization across racial and ethnic groups.

Collared Stems Are Associated With Reduced Early Aseptic Loosening and All-Cause Revision Rate

Felix C. Oettl, Dimitris Dimitriou, Patrick O. Zingg, Armando Hoch — 2026-08-10

The influence of collar design on femoral stem survival in total hip arthroplasty (THA) remains debated despite its potential biomechanical advantages. This registry analysis investigated whether collared stems demonstrate superior survival compared to non-collared designs in primary THA.

Conversion Total Knee Arthroplasty After Tibial Plateau Fracture Open Reduction and Internal Fixation: A Propensity-Matched Analysis of 90-Day and One- and Three-Year Outcomes

2026-08-08

Conversion total knee arthroplasty (TKA) following tibial plateau fracture (TPF) open reduction and internal fixation (ORIF) is surgically complex. This study utilized a national-level database to compare 90-day and one- and three-year outcomes between TKA following TPF ORIF and primary TKA.

Comparison of 90-Day Complications Between Direct Anterior and Postero-Lateral Total Hip Arthroplasty in Morbidly Obese Patients

Jordan A. Bauer, Brooke Birbara, Matthew J. Grosso — 2026-08-08

Morbidly obese (MO) patients undergoing total hip arthroplasty (THA) are at increased risk of postoperative complications. The effect of surgical approach on outcomes in this population remains unclear. This study compared perioperative outcomes and 90-day complications between direct anterior (DA) and postero-lateral (PL) approaches in MO and non-MO patients.

Femoral Shortening Osteotomy Techniques in Total Hip Arthroplasty for Hartofilakidis Type C Developmental Hip Dysplasia: A 25-Year Single-Surgeon Series

2026-08-08

Total hip arthroplasty (THA) for high-grade developmental dysplasia of the hip (DDH) is technically demanding, particularly when reconstruction of the true acetabulum requires substantial limb lengthening. Femoral shortening osteotomy is commonly necessary to facilitate safe reduction and minimize neurovascular complications. However, the optimal osteotomy level and technique are still debated.

Failure Rates After Treatment of Periprosthetic Joint Infection Using Musculoskeletal Infection Society Outcome Reporting Tool, Delphi, and Clinical Outcome Definitions

John R. Tyler, Whisper Grayson, Amy Wozniak, Daniel Schmitt, Nicholas M. Brown — 2026-08-08

Reported success rates after treatment of periprosthetic joint infection (PJI) vary widely, in part because treatment failure is not defined uniformly. Modern consensus outcome frameworks such as the Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT) and Delphi criteria may not fully capture clinically meaningful outcomes. This study compared failure rates after treatment of PJI using MSIS-ORT, Delphi, and a pragmatic clinical definition; assessed agreement between these definitions at the patient level; and examined the criteria responsible for discordant classifications.

More Technology, but Similar Early Safety: Robotic Versus Conventional Unicompartmental Knee Arthroplasty, a 30-Day Outcome National Database Study

2026-08-08

Robotic assistance in unicompartmental knee arthroplasty (UKA) has been increasingly adopted, but evidence regarding early safety remains constrained by heterogeneities and limitations such as Current Procedural Terminology (CPT) code layering designs, smaller sample sizes, and baseline imbalances. Accordingly, this study compares short-term (30-day) adverse events and outcomes between robotic UKA (R-UKA) and conventional UKA (C-UKA) using a propensity-matched, uniformly-defined cohort.

Sensor-Based Gait Recovery Analysis After Total Hip and Knee Arthroplasty: A One-Year Follow-Up Study Integrating Muscle Strength and Patient-Reported Outcomes

2026-08-06

Functional recovery after total joint arthroplasty (TJA) is multifactorial. This study aimed to characterize the one-year recovery trajectory in elderly patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) by integrating objective gait analysis, muscle strength assessment, and patient-reported outcome measures (PROMs).

Incidence of Postoperative Patellar Crepitus in Total Knee Arthroplasty with Unresurfaced Patellae in Cruciate-Retaining and Posterior-Stabilized Designs

2026-08-05

Patellar crepitus is a complication most seen in patients implanted with a posterior-stabilized (PS) total knee arthroplasty (TKA). The primary objective of the study was to examine the incidence of patellar crepitus in unresurfaced patellae in modern PS- and cruciate-retaining (CR)-TKA designs.

Diagnostic Accuracy of Artificial Intelligence Systems in Early Prediction of Dislocation and Aseptic Loosening After Total Hip Arthroplasty

2026-08-05

Artificial intelligence (AI) is increasingly used in total hip arthroplasty (THA), yet its role in postoperative imaging remains limited. This study evaluated the diagnostic performance of AI systems in interpreting postoperative radiographs following THA.

Outcomes of Total Knee Arthroplasty in Patients Receiving Chronic Antithrombotic Therapy: A Systematic Review

2026-08-03

With population aging and increasing cardiovascular comorbidity, more patients undergoing total knee arthroplasty (TKA) require chronic antithrombotic therapy. The impact of long-term anticoagulant or antiplatelet use on perioperative and longer-term outcomes after TKA remains unclear. This systematic review summarizes postoperative outcomes in patients receiving chronic antithrombotic therapy, examines differences by antithrombotic class, and compares outcomes with non-anticoagulated controls.

Risk Factor Analysis of Delayed Union or Nonunion After Total Hip Arthroplasty Combined with Subtrochanteric Transverse Osteotomy in Patients Who have Crowe Type IV Developmental Dysplasia of the Hip

2026-08-03

Total hip arthroplasty (THA) combined with subtrochanteric transverse osteotomy (STO) is a standard surgical approach for the treatment of Crowe IV developmental dysplasia of the hip (DDH). However, delayed union or nonunion at the osteotomy site remains a major complication, impeding postoperative functional rehabilitation and compromising patient outcomes. Identifying the risk factors associated with this complication is crucial for refining surgical techniques.

Modular Fluted Tapered Stems in Periprosthetic Femoral Fractures: Curved Stems are Protective Against Intraoperative Fracture and Postoperative Subsidence

2026-08-03

Modular fluted tapered (MFT) stems are widely used to treat periprosthetic femoral fractures (PFFs). This study aimed to report the clinical and radiographic outcomes of revision hip arthroplasty using straight or curved MFT stems in patients who have PFFs.

Keloidosis is Associated with an Increased Risk for Developing Arthrofibrosis After Total Knee Arthroplasty

2026-08-01

Arthrofibrosis is a complication of total knee arthroplasty (TKA) and a common cause of aseptic revision TKA (rTKA). Since keloidosis and arthrofibrosis are both fibroproliferative disorders, we hypothesized that a history of keloids may predispose patients to developing arthrofibrosis post-TKA. The purpose of this study was to evaluate the impact of prior keloid formation on arthrofibrosis and rTKA incidence within one and two years post-TKA.

Liposomal Bupivacaine in Periarticular Injection Cocktails for Pain Management After Total Knee Arthroplasty: A Systematic Review of Randomized Controlled Trials

Mitchell K. Ng, Leonidas E. Mastrokostas, Paul G. Mastrokostas, Michael A. Mont — 2026-08-01

Postoperative pain remains a major barrier to recovery after total knee arthroplasty (TKA), contributing to delayed mobilization, prolonged opioid use, and extended hospitalization. Liposomal bupivacaine (LB), an extended-release local anesthetic, has gained interest as a component of periarticular injection (PAI) protocols to improve analgesia and reduce opioid use. However, its utility remains debated due to inconsistent findings. This systematic review aimed to assess (1) the effectiveness of LB in improving postoperative pain control; (2) its impact on short-term opioid consumption; and (3) its influence on functional recovery, patient satisfaction, and adverse events.

Hip Decompression Augmented With Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma for Corticosteroid-Induced Osteonecrosis of the Femoral Head: A Minimum 10-Year Follow-Up

2026-07-31

Biologic augmentation with bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) has been used in conjunction with hip decompression (HD) for the treatment of pre-collapse osteonecrosis (ON) of the femoral head. This study reports a concise minimum 10-year follow-up of a previously published prospective cohort of patients who had corticosteroid-induced ON treated with HD augmented with BMAC and PRP.

Index Procedure Length of Stay and Achievement of Patient Acceptable Symptom State Predict Outcomes of Contralateral Total Hip Arthroplasty Within 1-Year

2026-07-31

Many patients who have bilateral hip osteoarthritis eventually undergo contralateral total hip arthroplasty (THA), yet limited data exist on how recovery differs between staged procedures performed within one year. This study evaluated differences in patient-reported outcomes and healthcare utilization following staged bilateral THA and identified predictors of suboptimal outcomes after the second surgery.

10-Year Outcomes of Total Knee Arthroplasty for Fracture Compared to Osteoarthritis Indications

2026-07-31

Total knee arthroplasty (TKA) performed after periarticular knee fracture is technically complex and has demonstrated higher complication rates within five years compared with osteoarthritis (OA)-indicated TKA. Comparative outcomes beyond five years in a large United States cohort remain limited. We compared 10-year surgical outcomes after fracture-indicated versus OA-indicated primary TKA.

Field and Stream Recovery: Patient-Reported Return to Hunting and Fishing After Total Knee Arthroplasty

2026-07-31

Patient motivation for total knee arthroplasty (TKA) often includes returning to activities limited by pain. While studies have examined TKA and return to sports such as golf, tennis, and skiing, data on outdoor activities like hunting and fishing are limited. This study evaluated patient ability to resume hunting and fishing following TKA.

Preoperative Hip Abductor Muscle Strength Predicts Patient-Reported Functional Outcomes Following Total Hip Arthroplasty

2026-07-31

Total hip arthroplasty (THA) is a widely performed and effective intervention for the management of hip osteoarthritis. Despite its overall success, substantial variability persists in postoperative functional recovery. Hip abductor weakness has been associated with altered gait patterns, impaired balance, and reduced hip function following THA. These deficits are reflected in commonly used patient-reported outcome measures, including the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and Veterans RAND 12-Item Health Survey (VR-12).

A Comparative Study of Fixed-Bearing Unicompartmental Knee Arthroplasty for Spontaneous Osteonecrosis and Osteoarthritis of the Knee

Pengyu Liu, Lei Hou, Yao Chen, Yuqi Jiang, Xiao Hu, Liangliang Li, Min Zhang — 2026-07-31

The purpose of the study was to investigate the two-year clinical efficacy differences between fixed-bearing unicompartmental knee arthroplasty (FB-UKA) for treating spontaneous osteonecrosis of the knee (SONK) and medial knee osteoarthritis (MKOA).

Conversion of Patello-femoral Arthroplasty to Total Knee Arthroplasty: Survivorship, Function, and Predictors of Patellar Revision

2026-07-31

Patello-femoral arthroplasty (PFA) is used to treat isolated patello-femoral osteoarthritis, but progression of tibio-femoral disease or implant failure may require conversion to total knee arthroplasty (TKA). Data describing outcomes after conversion and factors associated with patellar component management at conversion are limited. We evaluated survivorship, radiographic outcomes, and clinical outcomes after conversion of PFA to TKA and assessed whether pre-conversion patellar alignment was associated with patellar component revision at conversion.

Irritable Bowel Syndrome and Periprosthetic Joint Infection Risk Following Total Hip and Knee Arthroplasty

2026-07-31

Past studies have shown that inflammatory bowel disease (IBD) is associated with increased periprosthetic joint infection (PJI) risk, but none have investigated the risk in irritable bowel syndrome (IBS). The purpose of this study was to evaluate the risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients who have IBS.

Risk Factors for Readmission Following Same-Day Discharge in Primary Total Hip Arthroplasty

2026-07-30

Same-day discharge (SDD) following primary total hip arthroplasty (THA) is increasingly utilized and has been shown to be safe in appropriately selected patients. However, limited data compare whether specific patient risk factors for postoperative readmission exert different magnitudes of influence in the SDD versus in the non–same-day discharge (NSDD) cohorts. Identifying risk factors that disproportionately affect SDD patients may refine SDD selection criteria and improve postoperative safety.:

Femoro-Tibial Size Mismatch Does Not Increase Polyethylene Wear in Fixed-Bearing Total Knee Arthroplasty: A Retrieval Analysis

2026-07-30

This study aimed to determine whether femoro-tibial component size mismatch in a fixed-bearing total knee arthroplasty (TKA) design is associated with increased polyethylene (PE) wear. We hypothesized that mismatched knees, particularly a femur greater than a tibia, would demonstrate higher PE wear.

Preoperative Methicillin-Resistant Staphylococcus aureus Colonization and Risk of Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis

2026-07-28

Although preoperative screening and decolonization of methicillin-resistant Staphylococcus aureus (MRSA) reduce the risk of periprosthetic joint infection (PJI) and surgical site infections (SSI) after total joint arthroplasty (TJA), the residual infection risk in MRSA-colonized patients who undergo decolonization remains debated. This systematic review investigated the association between preoperative MRSA colonization and the risk of PJI and SSI after TJA.

Periarticular Injection Alone Provides Comparable Early Recovery to Combined Adductor Canal and Infiltration between the Popliteal Artery and Capsule of the Knee Blocks Following Total Knee Arthroplasty: A Prospective Randomized Trial

2026-07-28

The relative effectiveness of commonly used regional anesthesia techniques, including adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the knee (IPACK), compared with periarticular injection (PAI) alone in total knee arthroplasty (TKA) remains unclear.

Minimum Five-Year Results of Acetabular Revision Using Uncemented Monoblock Dual-Mobility Cups for Moderate-to-Severe Bone Loss

2026-07-28

Acetabular revision in the setting of moderate-to-severe bone loss is associated with high risks of instability and mechanical failure. Uncemented monoblock dual-mobility (UMDM) cups combine biological fixation with enhanced stability, but data beyond 5 years in complex revision settings remain limited. This study evaluated implant survivorship, complications, and clinical and radiographic outcomes of a UMDM cup used for acetabular revision with moderate-to-severe bone loss.

Diabetic Neuropathy Is Associated with Increased Orthopedic and Medical Complications After Total Hip Arthroplasty

2026-07-28

Diabetes affects over 38 million people in the United States, and diabetic neuropathy is a common complication associated with adverse musculoskeletal and vascular effects. Despite its prevalence, the impact of diabetic neuropathy on outcomes following total hip arthroplasty (THA) remains poorly defined. This study evaluated the effect of diabetic neuropathy on postoperative outcomes after THA compared with non-diabetic patients and patients who had diabetes without neuropathy.

Radiographic Factors Associated With Tibial Metaphyseal Sleeve Survivorship in Revision Total Knee Arthroplasty: A Matched Cohort Study

Patrick M. Mazza, Eric L. Colomb, Jeremiah A. Yarden, Wayne E. Moschetti — 2026-07-27

Metaphyseal sleeves are increasingly utilized in revision total knee arthroplasty (rTKA) to obtain zonal fixation in the metaphysis and improve implant survivorship. However, radiographic factors associated with long-term sleeve survival remain poorly defined. We previously characterized a cohort of aseptically failed tibial sleeves. This study compared those rare failures to long-term surviving sleeves, assessing whether lack of medial baseplate support and undersized sleeves and stems are more common in aseptic failures.

Safety of Ketorolac in Primary Total Hip Arthroplasties: An Analysis of over 7,000 Cases

2026-07-27

Ketorolac is commonly utilized perioperatively in primary total hip arthroplasty (THA), either intravenously (IV) or via periarticular infiltration analgesia (PAI). While effective for pain control, concerns remain regarding its potential to cause acute kidney injury (AKI), particularly in patients who have chronic kidney disease (CKD). This study evaluated the association between perioperative ketorolac administration and postoperative AKI, stratified by baseline renal function and administration route.

A Comparative Analysis of Robotic-Assisted and Manual Techniques for Unicondylar Knee Arthroplasty Conversion to Total Knee Arthroplasty: Revision Component Use, Surgical Time, and Cost

2026-07-27

Unicondylar knee arthroplasty (UKA) conversion to total knee arthroplasty (TKA) is more complex than primary TKA, requiring additional time, effort, and occasionally revision components. Robotic assistance may alleviate the additional time and complexity when converting UKA to TKA. The aim of this study was to compare the use of revision components (e.g., stems, cones, augments), polyethylene characteristics, time, and cost between manual versus robotic UKA conversion to TKA.

The Growing Role of Large Language Models in Arthroplasty Manuscripts: High-Productivity Authors Lead the Way

2026-07-25

The extent and characteristics of Large Language Model (LLM) utilization in arthroplasty literature remain undefined. In this study, we aimed to quantify the extent of LLM utilization in manuscripts across major arthroplasty journals. Additionally, we sought to assess temporal trends in LLM utilization, as well as associations with author productivity, geographic origin, and citation impact.

Preoperative Factors Associated With Achieving Patient Acceptable Symptom State After Robot-Assisted Total Hip Arthroplasty Differ According to the Outcome Measure Used

2026-07-25

Despite excellent overall satisfaction, patients undergoing total hip arthroplasty (THA) do not always achieve the expected outcomes, even with optimized implant positioning using robotic assistance. We hypothesized that preoperative factors associated with achieving patient-acceptable symptom state (PASS) would differ across patient-reported outcome measures (PROMs), reflecting distinct dimensions of postoperative recovery. This study aimed to identify preoperative factors associated with achieving the PASS after robot-assisted THA, according to different functional outcome scores.

Projected Case Volume and Economic Burden of Knee Aseptic Loosening in Inpatient Total Knee Arthroplasty in the United States

2026-07-24

Aseptic loosening after total knee arthroplasty (TKA) is an important complication often requiring revision surgery. The purpose of this study was to characterize and project the annual incidence and associated total inpatient costs of revision TKA (rTKA) for aseptic loosening.

National Case Volume and Economic Burden of Inpatient Revision Hip Arthroplasty for Aseptic Loosening: Trends and Future Projections from 2012 to 2032

2026-07-24

Aseptic loosening after hip arthroplasty is a major complication often necessitating revision procedures. Revision hip arthroplasty is associated with major morbidity and healthcare expenditure, but the national volumes and associated economic burden of revision hip arthroplasty for aseptic loosening have not been characterized. In this study, we estimated the nationwide annual incidence and average costs of inpatient revision arthroplasty for prosthetic loosening and projected future costs.

Finding the Sweet Spot: A Mixed-Effects Analysis of Four Tourniquet Strategies and Blood Conservation in 15,394 Primary Total Knee Arthroplasties

2026-07-23

Tourniquet use in total knee arthroplasty (TKA) remains variable, and its effect on perioperative blood loss in the era of tranexamic acid (TXA) is debated. This study compared four contemporary tourniquet strategies and their associations with hemoglobin drop, calculated blood loss, and transfusion risk.

Collar-Calcar Contact Reduces Risk for Early Periprosthetic Fracture and Subsidence in Dorr Type C Femora Using Collared, Fully Hydroxyapatite-Coated, Cementless Stems

Jessiah Aura M. Navarro, Yoko Miura, Kazuhiro Oinuma, Taishi Ninomiya — 2026-07-22

Collared, fully hydroxyapatite-coated stems are designed to enhance axial and rotational stability through collar-calcar contact, reducing the risk for implant subsidence and periprosthetic fracture. The purpose of this study was to address the uncertainty surrounding the use of cementless stems in Dorr C femora by evaluating the association between collar-calcar gap with periprosthetic fracture and subsidence in patients who underwent THA through the direct anterior approach.

Linking Joint-Specific Recovery to Overall Health Through Patient-Reported Outcome Measures: A Propensity-Score Matched Cohort Study in Total Joint Arthroplasty

Jaeyoung Park, Emilie N. Miley, Xiang Zhong, Chancellor F. Gray — 2026-07-22

Patient-reported outcome measures (PROMs) are increasingly used to evaluate disease-specific and overall health improvements following total hip and knee arthroplasty (THA/TKA). While disease-specific changes are well documented, the extent to which these procedures influence perceived overall health remains unclear. The aim of this study was to analyze changes in both disease-specific and overall health PROMs from the preoperative visit to one-year postoperatively in patients who underwent THA and TKA.

Preoperative Gait Analysis Predicts Surgical Candidacy and Clinical Severity in Hip Osteoarthritis

Jiang Hu, Wenjie Zhong, Caiyuan Liu, Xiaoxi Yang, Haowen Cui, Hong Cheng — 2026-07-22

Hip osteoarthritis (OA) is a common cause of chronic pain, functional limitation, and eventual total hip arthroplasty (THA). Surgical decision-making is mainly based on radiographic findings and patient-reported outcomes, which may not adequately reflect functional impairment during dynamic activities. This study examined the relationships between preoperative gait parameters and structural, pain-related, and functional indicators in hip osteoarthritis and assessed their relevance to 12-months postoperative outcomes.

Distribution of Total Knee Arthroplasty Periprosthetic Infection Care in the United States: Reported From the American Joint Replacement Registry

2026-07-21

There has been growing interest in establishing periprosthetic joint infection (PJI) centers of excellence in the United States (US). However, the current distribution of total knee arthroplasty (TKA) PJI surgeries in the US remains unknown. We aimed to evaluate the surgical volume of institutions and surgeons caring for knee PJI in the US using data from the American Joint Replacement Registry.

Reduced Wound Complications With Absorbable Deep Dermal Staples in Direct Anterior Total Hip Arthroplasty

Lema O. Abuoqab, Samuel W. Rice, David A. Crawford — 2026-07-21

The direct anterior approach (DAA) for total hip arthroplasty has been increasingly adopted for its muscle-sparing nature. However, wound complications remain a well-documented limitation in DAA cohorts. We evaluated the efficacy of absorbable staple augmentation as an alternative to conventional barbed sutures for incision closure in DAA total hip arthroplasty. We hypothesized that absorbable staple augmentation would be associated with reduced incidence of wound complications, particularly in patients who have elevated body mass index (BMI).

“Two Strikes, You’re Out”: Contemporary Revision Patterns Following Instability after Posterior and Anterior Approach Total Hip Arthroplasty

2026-07-20

Dislocation remains one of the most challenging complications after total hip arthroplasty (THA). Previous studies suggested that three or more dislocations were a threshold for revision; however, these data predate contemporary implants and modern surgical approaches. We used a contemporary cohort of primary THA patients to evaluate the relationship between dislocation recurrence, timing of instability, and subsequent revision for instability.

Biomechanical Assessment of Pin-Site Fractures in Intra- versus Extra-Incisional Pinning Technique for Robotic Total Knee Arthroplasty: A Cadaver Study

2026-07-16

Robotic-assisted total knee arthroplasty (rTKA) offers enhanced precision, but introduces new challenges, including pin-site fracture risk from tracker fixation, with incidence rates of 0.06 to 4.8%. This study aimed to evaluate the effects of intra- versus extra-incisional pin placement on torsional rigidity to fracture failure in cadaver specimens.

Efficacy of Intra-Articular Corticosteroid Injection for Hip Osteoarthritis: A Systematic Review with Meta-Analysis

Allison Kelliher, Sophia Ann Beilharz, Ryan Sutton — 2026-07-16

Intra-articular corticosteroid injection (CSI) is widely used for hip osteoarthritis (OA), yet its efficacy profile and safety remain incompletely characterized. The 2023 American Academy of Orthopaedic Surgeons guidelines assigned CSI a high-evidence, moderate-strength recommendation, underscoring the need for updated synthesis.

Pseudotumor-Related Compression Neuropathies Following Total Hip Arthroplasty

2026-07-16

Pseudotumor-related compression neuropathies following total hip arthroplasty (THA) represent a severe phenotype of adverse local tissue reaction. While historically attributed to metal-on-metal (MoM) bearings, other constructs such as dual-modular necks and taper corrosion with cobalt-chrome femoral heads have been implicated as well. Furthermore, inflammatory responses to polyethylene wear debris and non-foreign body sources can similarly stimulate pseudotumor formation, resulting in symptomatic nerve compression.

Short-Acting Spinal Anesthetics for Total Joint Arthroplasty: A Systematic Review and Network Meta-Analysis

2026-07-16

As total hip arthroplasty (THA) and total knee arthroplasty (TKA) increasingly shift toward outpatient and short-stay care, recovery milestones such as ambulation and bladder function have become critical determinants of discharge readiness. Although spinal anesthesia is widely used in total joint arthroplasty, the relative recovery profiles of commonly used intrathecal agents remain incompletely defined.

Dexamethasone Is Associated With a Dose-Dependent Reduction in Venous Thromboembolic Complications Following Total Knee and Hip Arthroplasty

2026-07-16

Venous thromboembolism (VTE) following total knee (TKA) and hip (THA) may be mediated by postoperative inflammatory dysregulation. Emerging literature has suggested that perioperative dexamethasone may reduce the risk of VTE by mitigating inflammation-driven thrombogenesis. The present study sought to compare postoperative VTE complications across patients receiving varying perioperative dexamethasone doses.

Magnetic Resonance Imaging Quantitative Indices Predict Collapse in Osteonecrosis for Lesions Occupying More Than the Medial Two-Thirds of the Weight-Bearing Portion of the Femoral Head

2026-07-16

Accurate prediction of femoral head collapse remains challenging in osteonecrosis of the femoral head (ONFH), particularly in hips classified as Japanese Investigation Committee (JIC) types C1 or C2. Conventional two-dimensional radiographic classifications provide insights into the three-dimensional morphology of necrotic lesions. This study evaluated the association between three-dimensional magnetic resonance imaging (MRI)-based quantitative indices and femoral head collapse.

Low-Dose Aspirin Once Daily Is Noninferior for Venous Thromboembolic Prophylaxis After Primary Total Joint Arthroplasty: An Analysis of 8,073 Cases Over 10 Years

2026-07-15

Venous thromboembolism (VTE) is a well-known complication after primary total joint arthroplasty (TJA). Aspirin is increasingly used for VTE prophylaxis after total hip arthroplasty and total knee arthroplasty given its efficacy and favorable side effect profile, although optimal dosing and frequency remain uncertain. Given the long-term effect of aspirin on platelet function, the conventional twice-daily frequency (or higher dosing) of aspirin may be unnecessary. The purpose of this study was to investigate the VTE incidence in patients receiving 81 mg aspirin once daily for prophylaxis after primary TJA, which has been our institution’s protocol for the past decade.

Equivalent Functional Recovery and Radiographic Outcomes in Human Immunodeficiency Virus-Positive and Virus-Negative Patients Undergoing Robot-Assisted Total Knee Arthroplasty

2026-07-15

Robot-assisted total knee arthroplasty (RA-TKA) improves alignment accuracy and soft-tissue preservation, which may be beneficial in biologically vulnerable populations such as people living with human immunodeficiency virus (HIV). However, comparative outcome data in high-prevalence settings remain limited. This study compared perioperative safety, radiographic accuracy, and functional outcomes of RA-TKA in HIV-positive and HIV-negative patients.

Posterior Condylar Offset and Joint Line Restoration Are Associated With Improved Patient-Reported Outcomes After Robotic-Arm–Assisted Total Knee Arthroplasty

Vincentius J. Suhardi, Kyle McCormick, Matthew Hepinstall, Morteza Meftah — 2026-07-15

The relationship between sagittal alignment in total knee arthroplasty (TKA) and patient-reported outcomes remains incompletely defined. Prior studies have largely relied on conventional instrumentation and radiographic measurements, which are limited by variability between planned and executed component position and inability to precisely quantify intraoperative balance. Robotic-arm–assisted TKA enables highly reproducible execution, providing an opportunity to identify sagittal parameters that are measurable, actionable, and clinically meaningful.

Determining the Mechanical Axis of the Femur From a Standard Antero-Posterior Knee Radiograph With Deep Learning

2026-07-14

As the femoral head is not visible on a standard antero-posterior (AP) knee view, surgeons looking to assess alignment on a patient who has only an AP view must either (i) forgo crucial long leg measurements, (ii) use the less meaningful anatomic axis, or (iii) use crude approximations. The purpose of this study was to develop a deep learning (DL) model for predicting the correction factor between the anatomical and mechanical axes.

Patients Undergoing Manipulation Under Anesthesia Recover Mobility, But Have Worse Functional Outcomes

2026-07-14

To regain range of motion (ROM) after total knee arthroplasty, manipulation under anesthesia (MUA) may be recommended; however, restoration of gait following MUA requires clarification. The purpose of this study was to compare gait quality metrics, function, and ROM between stiff-kneed patients who underwent and did not undergo MUA.

Does Cement Viscosity Influence 10-year Outcomes in Primary Total Knee Arthroplasty Under Standardized Surgical Technique?

Won Seok Lee, Heeyoon Chung, Jisoo Lee, Chong Bum Chang — 2026-07-14

Aseptic loosening remained a leading cause of failure following total knee arthroplasty (TKA). Although cement viscosity was a potentially modifiable factor influencing fixation, prior clinical and registry studies have reported conflicting results regarding its association with aseptic loosening. This study evaluated whether cement viscosity independently influences the risk of revision for aseptic loosening and the occurrence of radiolucent lines (RLLs).

Discordant Results by Study Design: A Systematic Review and Meta-Analyses of Mobile versus Fixed Bearing for Unicompartmental Knee Arthroplasty

2026-07-14

Previous reviews comparing mobile-bearing and fixed-bearing implants in unicompartmental knee arthroplasty report mixed results. It has yet to be explored whether such differences are influenced by study design. This systematic review and meta-analysis aimed to compare adverse events, patient-reported outcomes, and range of motion between the two implant types, overall and by study design (randomized trial, observational study, and registry study).

Depression as a Predictor of Postoperative Pain and Function After Total Knee Arthroplasty: Meta-Analysis of Prospective Comparative Studies

2026-07-14

Depression is common among patients undergoing total knee arthroplasty (TKA) and has been associated with worse patient-reported outcomes after surgery. However, it remains unclear whether preoperative depression limits postoperative improvement or primarily influences absolute postoperative pain and function levels. We asked the following questions: (1) Are postoperative pain and patient-reported functional outcomes different in patients who had preoperative depression compared with those who did not after primary TKA? (2) Does preoperative depression influence the magnitude of postoperative improvement? and (3) Is preoperative depression associated with postoperative satisfaction?

Predicting Patient-Reported Outcome Measures, Satisfaction, Health-care Utilization, Mortality, and Return to Work After Total Knee Arthroplasty Using Machine Learning: A 14,900-Patient Study

2026-07-14

Patient-reported outcome measures and health-care utilization metrics are increasingly used to evaluate the success of total knee arthroplasty (TKA). Predictive models may improve preoperative planning, patient counseling, and resource allocation. This study developed and validated machine learning models to predict postoperative patient-reported outcomes, satisfaction, health-care utilization, mortality, and return to work after primary TKA.

Heterogeneity in Complication Risks and Temporal Trends Across Aseptic Indications for Revision Total Hip Arthroplasty

Shaylan R. Bera, Tyler T. Brady, Andrew P. Adamczyk, George Grammatopoulos — 2026-07-14

With the increasing burden of revision total hip arthroplasty (rTHA), the comparative postoperative risk profiles among aseptic rTHA indications remain incompletely understood. This study evaluated postoperative periprosthetic joint infection (PJI), reoperation, and rerevision following rTHA for periprosthetic fracture (PPFx), dislocation, and mechanical failure. Secondarily, medical complications and temporal trends were assessed.

Impact of the Comprehensive Care for Joint Replacement Model on Spending and Care Endpoints: A Systematic Review

2026-07-14

The Centers for Medicare & Medicaid Services implemented the Comprehensive Care for Joint Replacement (CJR) bundled-payment model (2016 to 2024) to improve value for total hip arthroplasty and knee arthroplasty (THA/TKA). We systematically reviewed the model’s impact on episode spending, clinical outcomes, discharge destination, and total joint arthroplasty utilization.

The Effect of Dual Mobility Articulations on Re-Revision After Revision for Dislocation

2026-07-13

Recurrent instability remains a challenge after revision total hip arthroplasty (THA). This study evaluated whether dual mobility (DM) acetabular constructs used during revision for instability are associated with lower rerevision rates than fixed-bearing constructs.

Cefazolin Prophylaxis in Patients ≥120 Kilograms: Comparison of Periprosthetic Joint Infection Following Total Hip Arthroplasty With Two Versus Three Grams Dosing

2026-07-13

High-body weight total hip arthroplasty (THA) patients face elevated risks for postoperative complications such as periprosthetic joint infection (PJI). Although guidelines recommend three grams of cefazolin for patients weighing greater than 120 kg, supporting evidence is limited and conflicting. This study compared PJI incidence among patients receiving two versus three grams of prophylactic cefazolin.

Trochanteric Osteotomy in Two-Stage Revision Total Hip Arthroplasty for Periprosthetic Joint Infection: A Retrospective Cohort Study

2026-07-13

Trochanteric osteotomy may be utilized during revision to improve femoral component access and facilitate implant removal, yet its effect on surgical outcomes in the context of periprosthetic joint infection (PJI) remains uncertain. This study aimed to compare intra- and postoperative outcomes between patients undergoing two-stage revision for PJI who had and did not have a trochanteric osteotomy.

Undernourished and Underweight: Independent Predictors of Worse Outcomes Following Total Hip Arthroplasty

2026-07-13

Total hip arthroplasty (THA) provides pain relief and restored mobility, yet recovery remains challenging for underweight patients whose nutritional deficits may compromise outcomes. This study examined the impact of low body mass index (BMI) and hypoalbuminemia on postoperative complications following THA.

Trauma-Related Arthroplasty Is Associated With Earlier and Microbiologically Distinct Periprosthetic Joint Infection: A 20-Year Single-Center Study

2026-07-13

Periprosthetic joint infection (PJI) following arthroplasty performed for trauma (e.g., hip fracture) may differ from PJI after elective arthroplasty in terms of timing, microbiology, and outcomes, but comparative data remain limited.

Preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement Scores Predict Timing and Achievement of Substantial Clinical Benefit Following Primary Total Hip Arthroplasty

2026-07-12

Given the recent shift toward use of substantial clinical benefit (SCB) as a measure of success following primary total hip arthroplasty (THA), an understanding of the timing and rate of SCB achievement is necessary. The purpose of this study was to determine the timing and rate of SCB achievement within the first year following primary THA and to determine what patient- and surgery-level factors may influence the timing and likelihood of SCB achievement at one year following primary THA.

Preoperative Sepsis Is Associated With an Elevated Rate of Periprosthetic Joint Infection and Mortality Following Total Hip Arthroplasty in a Time-Dependent Manner

2026-07-11

Patients who have sepsis often experience persistent immune system and physiological dysregulation. However, the impact of preoperative sepsis on outcomes following elective total hip arthroplasty (THA) remains poorly defined. Thus, the purpose of this study was to evaluate the impact of preoperative sepsis on medical and surgical complications following primary THA, with attention to timing and etiology of sepsis in relation to adverse outcomes at 90 days and two years postoperatively.

The American Association of Hip and Knee Surgeons Position Statement on OrthoBiologics for Advanced Hip and Knee Osteoarthritis

2026-07-11

An increasing number of facilities and physicians are offering intra-articular injections of stem cells and/or platelet-rich plasma (PRP) as a nonsurgical treatment of advanced hip and knee osteoarthritis (OA) [1]. Administration of PRP injections in the United States increased more than 400% from 2010 to 2020 [2]. The global market for biologic injections is expected to become a multi-billion-dollar entity within the near future [3]. There are more than 40 commercial PRP systems in existence [4]; many of these systems were brought to market via the Food and Drug Administration (FDA) 510(k) pathway based on prior clearance of equivalent devices designed to mix PRP with bone graft [5].

Acute Kidney Injury Following Antibiotic-Loaded Spacer Insertion in Two-Stage Knee Arthroplasty Revision for Periprosthetic Joint Infection: A Retrospective Cohort Study

2026-07-06

Antibiotic-loaded cement spacers (ACS) are integral to two-stage revision total knee arthroplasty (TKA) for periprosthetic joint infection. While effective in infection eradication, concerns have emerged regarding nephrotoxicity due to systemic absorption of high-dose antibiotics. This study aimed to determine the incidence and risk factors for acute kidney injury (AKI) following very high-dose ACS insertion in two-stage revision TKA using a within-patient controlled design.

Tourniquet Use in Cemented Total Knee Arthroplasty: Small Gains in Fixation, No Clear Benefit in Aseptic Loosening. A Systematic Review and Meta-Analysis

2026-07-06

The effect of tourniquet (TQ) use in primary total knee arthroplasty (TKA) on implant fixation and survival remains uncertain. This review evaluated fixation and revision outcomes after TKA performed with versus without TQ.

Comparative Analysis of Periprosthetic Joint Infection Rates After Total Hip Arthroplasty Across Facility Types: A Single Institution Study

2026-07-04

As the surgical volume of total hip arthroplasty (THA) has grown, there has been a concomitant shift away from performing this procedure in traditional, inpatient facilities toward various outpatient centers. Several studies have investigated rates of surgical site and periprosthetic joint infections (PJIs) among patients undergoing common orthopaedic procedures stratified by facility type. However, there is a paucity of studies comparing PJI rates after THA performed in tertiary hospital centers, community hospitals, orthopaedic specialty hospitals, and ambulatory surgical centers (ASCs) associated with a single health system.

Patient Satisfaction and Outcomes at a Mean 11-Year Follow-Up Following Total Hip Arthroplasty With Subtrochanteric Osteotomy for Dislocated Hips After Schanz Osteotomy

2026-07-04

Total hip arthroplasty (THA) for chronically dislocated hips after Schanz osteotomy is technically demanding, with limited data on outcomes and patient satisfaction. This study aimed to determine clinical outcomes, implant survivorship, and factors associated with poor functional outcome and dissatisfaction after THA with subtrochanteric osteotomy.

Preoperative Pneumonia and Its Association With Periprosthetic Joint Infection and Postoperative Complications After Total Hip and Knee Arthroplasty

2026-07-03

Pneumonia (PNA) is a leading cause of hospitalization among older adults, yet its effect on complications following total joint arthroplasty (TJA) remains unknown. This study evaluated the association between PNA within two years prior to total hip arthroplasty (THA) or total knee arthroplasty (TKA) and periprosthetic joint infection (PJI) and other complications.

Conversion Total Hip Arthroplasty Following Prior Internal Fixation: A Comparison With Primary and Revision Total Hip Arthroplasty

Kalter Hali, Marc A. Manzo, Bahar Entezari, Bheeshma Ravi, Johnathan R. Lex — 2026-07-01

With rising life expectancy, the incidence of total hip arthroplasty (THA) following prior femoral and/or acetabular fracture fixation is increasing. Conversion THA (cTHA) following these procedures is technically complex and associated with unique challenges. However, direct comparisons between primary THA (pTHA), cTHA, and revision THA (rTHA) remain limited.

The Relationship Between Patient Satisfaction and the Degree of Valgus Deformity in Lateral Unicompartmental Knee Arthroplasty at a Mean 3-Year Follow-Up

Gong Long, Liu Yuan, Liu Qing, Cao Guanglei, Liu Jian, Huang Ye — 2026-07-01

Lateral unicompartmental knee arthroplasty (LUKA) is a technically demanding procedure for isolated lateral compartment osteoarthritis, but the impact of preoperative valgus deformity severity on patient satisfaction remains unclear.

Integrating Robotic-Assisted Arthroplasty Into Orthopaedic Education: The Fellows’ Perspective

2026-07-01

Robotic-assisted total joint arthroplasty is increasingly used to improve patient outcomes and reduce revision rates in total joint arthroplasty. With robotic-assisted total knee arthroplasty (RTKA) projected to exceed 70% of cases by 2030, concern exists about whether orthopaedic residents are being adequately trained.

Kneeling After Total Knee Arthroplasty: Does Resurfacing the Patella Affect the Ability to Kneel?

2026-07-01

Difficulty and pain with kneeling is a common postoperative complaint after total knee arthroplasty (TKA), but the cause of this issue has not been identified. The purpose of this study was to investigate the effect of patella resurfacing on a patient’s kneeling ability after TKA with consideration of the preoperative presence of patellar osteoarthritis (P-OA).

Distribution of Total Hip Arthroplasty Periprosthetic Infection Care in the United States: Reported From the American Joint Replacement Registry

2026-06-29

There has been recent interest in developing periprosthetic joint infection (PJI) centers of excellence in the United States (US). However, little is known regarding the current distribution of hip PJI management in the US. The purpose of this study was to utilize the American Joint Replacement Registry to evaluate the surgical volume of institutions and surgeons caring for PJI of the hip.

Risk Factors for Increased Hospital Cost for Primary Total Knee Arthroplasty

2026-06-29

Patients who have more complex medical comorbidities increase the cost of primary total knee arthroplasty (TKA). The goal of this study was to evaluate and quantify the impact of medical comorbidities on the cost of primary TKA.

The Effect of Mobile-Based Training on Anxiety, Kinesiophobia, and Physical Function in Patients Undergoing Total Knee Arthroplasty

Alkay Kara, Neziha Karabulut — 2026-06-29

Total knee arthroplasty (TKA) has been performed with increasing frequency worldwide, and patients often experience anxiety, pain, reduced physical function, kinesiophobia, and sleep disturbances during the perioperative period. Evidence regarding mobile health interventions that begin preoperatively and continue after discharge remains limited. This study aimed to evaluate the effects of a mobile-based education and exercise program on anxiety, pain, physical function, and sleep quality in TKA patients.

Complication and Reoperation Rates of Post-Distal Femoral Osteotomy Total Knee Arthroplasty versus Primary Total Knee Arthroplasty: Matched Cohorts from a Nationwide Database

2026-06-29

Distal femoral osteotomy (DFO) can be indicated for young patients to correct malalignment and prevent joint overload. Progressive arthritis can require total knee arthroplasty (TKA) after DFO. While primary TKA has reliable outcomes, the perioperative risks associated with post-DFO TKA remain uncertain. We aimed to compare the outcomes and complications between patients who underwent TKA after previous DFO versus primary TKA.

Influence of Compartment on Outcome and Survivorship in Unicompartmental Knee Arthroplasty in Younger Patients

2026-06-29

Unicompartmental knee arthroplasty (UKA) is an effective treatment for compartmental osteoarthritis (OA), offering advantages over total knee arthroplasty (TKA), such as faster recovery, fewer complications, and preserved kinematics. However, 10-year to 12-year survivorship and outcome comparisons between medial and lateral UKA remain unclear, especially in younger patient cohorts, for whom there are fewer published data in the peer-reviewed literature.

Unicompartmental Knee Arthroplasty in Octogenarians Is a Safe and Durable Procedure: Outcomes at 12-Year Follow-Up

Marco Bargagliotti, Matteo Ponzo, Enrico Zero, Sergio Romagnoli — 2026-06-29

The role of unicompartmental knee arthroplasty (UKA) in elderly patients remains debated due to concerns about comorbidities and implant durability. This study aimed to evaluate the safety, functional outcomes, and 12-year survivorship of medial UKA in patients over 80 years of age.

What Are the Rates of Recurrent Dislocation and Re-Revision After Revision Total Hip Arthroplasty for Instability?

2026-06-29

Instability is a leading cause of revision total hip arthroplasty (rTHA). This study aimed to (1) determine rates of recurrent dislocation and re-revision following rTHA for instability and (2) identified patient and surgical risk factors associated with failure.

Trends of Inhospital Mortality After Inpatient Elective Total Hip and Knee Arthroplasty: A 2016 to 2023 Population-Based Study

2026-06-29

Utilization of inpatient total hip arthroplasty and total knee arthroplasty (THA and TKA) has surged in older, more comorbid patients, but the impact of this shift on inhospital mortality remains unclear. Using a United States database, we described inhospital mortality trends of inpatient THA and TKA.

Optimal Route of Tranexamic Acid Administration in Total Knee Arthroplasty: A Bayesian Network Meta-Analysis with Decision-Analytic Cost Evaluation

2026-06-29

Tranexamic acid (TXA) is widely used in total knee arthroplasty (TKA) to reduce blood loss and transfusion; however, the optimal route of administration remains uncertain, particularly when considering both clinical outcomes and cost.

Minimal Clinically Important Difference of the Timed Up and Go Test, 10-Meter Walk Test, and 2-Minute Walk Test in Patients in the Acute Phase After Total Hip Arthroplasty

2026-06-29

The recovery of mobility and ambulation are primary rehabilitative goals to allow for an early and safe discharge after total hip arthroplasty (THA). Although the timed up and go test (TUG), 10-meter walk test (10MWT), and 2-minute walk test (2MWT) are widely used performance-based tests to assess functional progress and readiness for discharge, their minimal clinically important difference (MCID) has never been investigated in the early phase after THA. The study aimed to determine the MCID of the TUG, 10MWT, and 2MWT in patients in the early postoperative phase after THA.

Improving the Reliability of a Novel Baldini Classification for Revision Total Knee Arthroplasty: The Development and Validation of the Modified Grading System

2026-06-29

The concept of zonal fixation has revolutionized our approach to bone loss in revision total knee arthroplasty. Recently a quantitative grading system for each zone has been introduced, which allows for independent grading for the epiphysis, metaphysis, and diaphysis. The current study reports on the intra and interobserver reliability of this scoring system in a nonselected patient cohort.

A Meta-Analysis Comparing Accelerometer-Based Portable Navigation Systems and Traditional Techniques in Total Knee Arthroplasty: Assessment of Radiological and Clinical Outcomes

2026-06-29

Accelerometer-based portable navigation (ABN) systems have been widely applied in total knee arthroplasty (TKA). However, their accuracy versus traditional techniques remains debated. Since previous meta-analyses have reported inconsistent results, a high-quality meta-analysis is required to compare radiological and functional outcomes of TKA with ABN versus conventional techniques.

A New Perspective on Manual Versus Technology-Assisted Total Knee Arthroplasty: Complications Stratified by Surgeon Subspecialty Designation

2026-06-29

Prior studies of technology-assisted total knee arthroplasty (TA-TKA) versus manual total knee arthroplasty (mTKA) have not accounted for surgeon subspecialty training, a possible modifier of outcomes. This study analyzed surgical complications following TA-TKA versus mTKA performed by fellowship-trained adult reconstruction surgeons versus other orthopaedic surgery subspecialties.

Total Knee and Hip Arthroplasty in Patients Who Had Prior Septic Arthritis: A Systematic Review and Meta-Analysis

2026-06-29

Septic arthritis predisposes joints to secondary osteoarthritis and complicates later arthroplasty. As arthroplasty becomes more common, surgeons increasingly encounter patients who had prior septic arthritis, yet the risk of periprosthetic joint infection (PJI) after total knee and hip arthroplasty (TKA/THA) remains unclear. This systematic review and meta-analysis assessed PJI risk in this population and examined the impact of surgical timing and procedural strategy.

Quarterly Trends in Total Knee Arthroplasty Utilization in the United States: Insurance Cost-Sharing Drives Seasonal Variation

2026-06-27

Amid total knee arthroplasty (TKA) expansion and shrinking reimbursements, optimization is a priority. Out-of-pocket cost sharing has been shown to influence elective surgery scheduling; however, utilization patterns have yet to be demonstrated in TKA. The purpose of this study was to evaluate the relationship between insurance cost-sharing and TKA utilization.

Rising Volume of Periprosthetic Fractures After Primary Total Hip and Knee Arthroplasty: A Contemporary Epidemiologic Analysis

2026-06-27

Periprosthetic fractures following total hip arthroplasty and total knee arthroplasty are complications associated with substantial morbidity and mortality. As the volume of primary arthroplasty continues to increase in the United States, the incidence and overall burden of periprosthetic fractures are expected to rise accordingly. However, contemporary trends and future projections in emergency department (ED) visits and operative management for these injuries remain incompletely characterized.

Reassessing Total Joint Arthroplasty Case Volumes in the United States: Accounting for Ultralow-Volume Surgeons

2026-06-26

Reported average total joint arthroplasty (TJA) volumes among orthopaedic surgeons in the United States range from 22 to 65 cases per year. However, this figure is influenced by a large cohort of ultralow-volume surgeons who perform fewer than 10 TJAs annually, representing a relatively small number of patients. This study reassessed surgeon volume trends by taking ultralow-volume surgeons into account while also quantifying the average caseload of a typical TJA patient’s surgeon.

Is the Incidence of Conversion From Unicompartmental to Total Knee Arthroplasty Higher Among Surgeons Who Do Not Have Arthroplasty Fellowship Training?

Kyle L. McCormick, Olivia C. Schaffer, David Novikov, Joshua C. Rozell — 2026-06-26

Unicompartmental knee arthroplasty (UKA) may offer advantages over total knee arthroplasty (TKA) for select patients, but implant failure leading to conversion to TKA remains a concern. The purpose of this study was to compare two-year conversion rates to TKA following UKA performed by arthroplasty fellowship-trained surgeons versus surgeons who did not have arthroplasty fellowship training at a single academic institution.

The American Association of Hip and Knee Surgeons Position Statement on Outpatient Joint Replacement

Ugo N. Ihekweazu, Sharon Walton, Charles P. Hannon — 2026-06-26

In 2018, the American Association of Hip and Knee Surgeons (AAHKS), in collaboration with The Hip Society, The Knee Society, and the American Academy of Orthopaedic Surgeons (AAOS), published a position statement on outpatient total joint arthroplasty (TJA) [1]. At the time it was published, outpatient TJA was an emerging topic with limited data available on outcomes, safety and the effort required to run a successful outpatient program. Since that time, there has been a marked increase in the number of outpatient TJA procedures performed in the United States.

Temporal Trends in Revision Burden Ratio for Hip and Knee Arthroplasty: A Comparative Analysis of Large National Registries

2026-06-25

The proportion of revision surgeries among all arthroplasties performed annually suggests a higher revision burden for total knee arthroplasty (TKA) than for total hip arthroplasty (THA). This study analyzed temporal trends in the knee-to-hip (K/H) revision burden ratio (RBR) over the past decade; evaluated hip and knee RBRs separately; compared trends across four national arthroplasty registries; and assessed changes in revision causes for THA and TKA over time.

Hip Arthroscopy Is Associated With Increased Risk of Total Hip Arthroplasty Failure and Increased Resource Allocation in Middle-Aged Total Hip Arthroplasty Patients

2026-06-24

Hip arthroscopy (HA) rates continue to increase. Many HA patients will eventually develop osteoarthritis necessitating total hip arthroplasty (THA). Presently, there is limited, conflicting literature on the correlation between preceding HA and subsequent THA outcomes. The purpose of this study was to evaluate the risk of prior HA on subsequent THA revision rates and their resource allocation in middle-aged THA patients (40 to 65 years old).

Risk Stratification in Periprosthetic Hip Fracture Surgery: The Risk Analysis Index Is Superior to the Five-Item Modified Frailty Index for Predicting 30-Day Complications

2026-06-24

Periprosthetic femoral fractures account for up to 16% of all revision total hip arthroplasties with one- and two-year mortality rates of 23.4 and 29.2%, respectively. Given the substantial clinical and financial burden, accurate preoperative risk assessment is essential. This study evaluated the predictive performance of the Five-Item Modified Frailty Index (mFI-5) and Risk Analysis Index (RAI) in patients undergoing surgery for PFs, aiming to improve preoperative assessment, inform surgical decision-making, and facilitate postoperative planning.

Classification and Outcomes of 214 Periprosthetic Patellar Fractures in Primary Total Knee Arthroplasty

2026-06-23

Long-term data following periprosthetic patellar fractures around primary total knee arthroplasty (TKA) are lacking. The purpose of this study was to describe the classification, management, and outcomes of periprosthetic patellar fractures in, to our knowledge, the largest series to date.

United States Trends in Utilization and One-Year Revision Risk of Cementless Total Knee Arthroplasty: An Analysis of American Joint Replacement Registry Data

2026-06-22

Cementless total knee arthroplasty (TKA) has emerged as an alternative to cemented fixation. We used the American Joint Replacement Registry (AJRR) to assess trends in cementless TKA utilization and associated one-year revision rates.

Operative Cultures Rarely Necessitate Change to Periprosthetic Joint Infection Antibiotic Plan Based on Monomicrobial Preoperative Aspiration

2026-06-22

Periprosthetic joint infections (PJI) are complex to manage and frequently result in prolonged hospitalization while awaiting outpatient antibiotic therapy coordination. Moving this work to the preoperative setting for nonemergent PJI cases could potentially provide more efficient and cost-effective care. This study sought to evaluate the appropriateness of antibiotic treatment plans based upon monomicrobial preoperative cultures.

Efficacy of Intraosseous Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

Yongjie Chen, Li Cao, Baochao Ji, Guoqing Li, Xiaogang Zhang — 2026-06-22

Tranexamic acid (TXA) reduces blood loss and transfusion requirements in patients who underwent primary total hip arthroplasty. However, the optimal route of TXA administration remains unclear. This randomized controlled trial evaluated whether intraosseous (IO) TXA administration was noninferior to intravenous (IV) or topical administration.

Proceedings of the 2025 American Association of Hip and Knee Surgeons Annual Meeting

Leonard T. Buller — 2026-06-19

The 2025 annual meeting of the American Association of Hip and Knee Surgeons (AAHKS) marked a historic milestone as we celebrated our organization’s 35th annual meeting. Over the past three and a half decades, AAHKS has grown from a small society of dedicated arthroplasty surgeons into the premier international forum for education, innovation, and scientific exchange in adult reconstruction. This year's meeting honored that legacy and advanced the specialty through groundbreaking research, thoughtful discussion, and collaboration among surgeons, researchers, industry partners, and allied health professionals from around the world.

Internet Promotion of Orthobiologics by the American Association of Hip and Knee Surgeons Members: Claims versus Evidence in Patient-Facing Websites

2026-06-19

Orthobiologic therapies such as platelet-rich plasma (PRP), bone marrow aspirate concentrate, and hyaluronic acid are increasingly offered for orthopaedic conditions, but their online promotion may not accurately reflect the often-mixed clinical evidence. This study examined the extent and nature of orthobiologics’ promotion on surgeon websites and compared the claims to current peer-reviewed evidence.

Pain Catastrophizing Improves After Total Knee Arthroplasty, but Still Has a Negative Effect on Outcomes in Japanese Patients

2026-06-19

Preoperative pain catastrophizing has been reported to influence postoperative outcomes in total knee arthroplasty (TKA). However, little is known about how catastrophizing changes after surgery. This study assessed the longitudinal changes in pain catastrophizing following TKA and its clinical impact.

Neutrophil-Lymphocyte Ratio Trajectories Predict Mortality and Medical Complications in Hip Fracture Patients Undergoing Hemiarthroplasty

2026-06-19

Hip fractures are associated with high rates of mortality and medical complications. The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker gaining recognition as a prognostic indicator. Here, we sought to identify a high-risk patient population with a pathologic postoperative inflammatory response using NLR trajectories.

The EQ-5D-3L Questionnaire Demonstrates Moderate Ceiling Effects at One and Two Years After Total Hip Arthroplasty: Preoperative Predictors and Clinical Implications

Yeon Joo Lee, Nicholas D. Clement, Vipin Asopa, David H. Sochart — 2026-06-19

The objectives were to evaluate whether the EQ-5D-3L questionnaire demonstrated a ceiling effect after total hip arthroplasty (THA), identify which patients were more likely to reach the ceiling score, and determine whether this limited assessment of potential improvement, relative to baseline, in their outcomes.

Axial Plane Alignment of the Knee: A Bony-Based Framework for Describing Flexion-Plane Knee Phenotypes and Its Association With Intraoperative Flexion-Gap Patterns

Muyang Yu, Mingwei Hu, Te Liu, Hao Xu, Xisheng Weng, Bin Feng — 2026-06-19

A structured classification describing knee alignment in flexion would be valuable in total knee arthroplasty (TKA). This study introduces the axial plane alignment of the knee (APAK) classification, which integrates distal femoral rotation and tibial coronal alignment at 90° of flexion, and evaluates its association with intraoperative flexion-gap patterns.

Time-Dependent Revision Risk and Failure Modes After Total Hip Arthroplasty and Hemiarthroplasty for Displaced Femoral Neck Fracture in Patients Younger Than 70 Years: A Multicenter Analysis of 1,176 Consecutive Cases

2026-06-19

Although total hip arthroplasty (THA) and hemiarthroplasty (HA) are widely used for femoral neck fractures in younger adults, outcome data in this population are limited. We analyzed revision risks, failure patterns, and clinical outcomes of THA or HA in femoral neck fracture patients younger than 70 years across eight institutions.

Factors Associated With Patient-Reported Outcome Measure Noncompletion One Year After Total Joint Arthroplasty: A Retrospective Cohort Study

2026-06-19

Patient-reported outcome measures (PROMs) collected one year after total hip or knee arthroplasty (THA/TKA) are important benchmarks for evaluating surgical success and are required for Medicare quality reporting. However, many patients do not complete 1-year PROMs. We aimed to identify factors associated with noncompletion of 1-year PROMs to inform strategies for improving completion rates.

Cement Viscosity Is Associated With Aseptic Loosening After Primary Total Knee Arthroplasty: An Analysis of the American Joint Replacement Registry

2026-06-19

The mechanical properties of polymethylmethacrylate cement in total knee arthroplasty (TKA) can be influenced by both viscosity and the addition of antibiotics. Although smaller studies have reported high survivorship with commercially available formulations of polymethylmethacrylate in primary TKA, the independent and combined effects of viscosity and antibiotic additives on revision risk remain subject to debate.

Balanced Peer Review in the Era of Artificial Intelligence

2026-06-18

Artificial intelligence (AI) is rapidly transforming academic medicine, scientific writing, and the peer-review process itself. Large language models now possess the ability to summarize manuscripts, critique methodology, identify statistical concerns, generate reviewer comments, and even draft editorial recommendations within seconds. These capabilities offer substantial opportunities to improve efficiency, consistency, and technical rigor within scientific publishing [1–4]. Recent orthopaedic editorial literature has similarly emphasized that deep learning and AI-assisted technologies are likely to substantially influence the future of arthroplasty research and scientific communication, while also requiring thoughtful implementation and responsible oversight [5].

Comparable Survivorship and Patient-Reported Outcomes Following Unicompartmental Knee Arthroplasty in Obese and Nonobese Patients: An Updated Systematic Review

Michelle Cruickshank, Helena Son, Hassaan Abdel Khalik, Brian P. Chalmers — 2026-06-18

The influence of obesity on outcomes after unicompartmental knee arthroplasty (UKA) remains controversial. This systematic review evaluated whether obesity affects survivorship, reasons for revision, and patient-reported outcome measures (PROMs) following UKA.

Use of Zonal Fixation Therapy and Metal Augmentation for Rotating-Hinge Knee Arthroplasty in Charcot Arthropathy: A Comparative Study

Weikun Zheng, Junfen Tang, Wende Xiao, Xinliang Wang, Jianwei Wang — 2026-06-18

Charcot knee arthropathy requiring primary total knee arthroplasty (pTKA) with a rotating-hinge knee (RHK) is rare, with no established reconstructive guidelines. Bone defect management in these cases is technically challenging. This study evaluated the zonal fixation theory for guiding RHK-pTKA, compared outcomes between Charcot and non-Charcot arthropathy, and assessed bone defect reconstruction methods.

Declining Medicaid Reimbursement for Total Hip and Knee Arthroplasty From 2014 to 2022: A Comparison of Expansion and Nonexpansion States

2026-06-18

The purpose of this study was to evaluate national- and state-level trends in inflation-adjusted Medicaid physician reimbursement for total knee arthroplasty (TKA) and total hip arthroplasty (THA) from 2014 to 2022 and to assess whether these trends differ based on Medicaid expansion status.

Language-Concordant Preoperative Education Is Associated With Reduced Readmission Rates after Total Knee Arthroplasty

2026-06-18

Language barriers in surgical care are linked to reduced patient satisfaction and care quality. Preoperative education improves patient understanding and postoperative outcomes, but its impact on disparities among non-English-speaking patients remains unclear. In January 2023, our institution implemented a Spanish-speaking nurse educator to provide language-concordant preoperative education to patients undergoing hip and knee arthroplasty. This study evaluated whether this intervention affected readmission rates compared to English-speaking patients.

Impact of Intervention Timing on the Failure of Debridement, Antibiotics, and Implant Retention for Acute Postoperative Periprosthetic Joint Infections: A Contemporary United States Population-Level Analysis

Ahmad M. Zedan, Thomas Barber, Stefano A. Bini, Claudio A. Diaz-Ledezma — 2026-06-18

Time to intervention is a critical determinant of failure after debridement, antibiotics, and implant retention (DAIR) in acute postoperative periprosthetic joint infection (PJI). While International Consensus Meeting (ICM) guidelines have expanded the recommended therapeutic window from 4 to 6 weeks, emerging European data suggest extension to 12 weeks. This study evaluated the association between DAIR timing and treatment failure after primary total hip and knee arthroplasties, leveraging a large United States database to identify an optimal threshold.

Soft-Tissue Balance and Quadriceps Muscle Strength Are Associated With Patient-Reported Outcomes Following Total Knee Arthroplasty, Independent of Alignment Strategy: A Prospective Randomized Trial

2026-06-18

Kinematically aligned (KA) and mechanically aligned (MA) total knee arthroplasty (TKA) have been widely compared; however, the relative impact of alignment strategy versus other factors on clinical outcomes remains unclear. This study aimed to investigate the independent influence of alignment strategy, soft-tissue balance, and muscle strength on subjective outcomes.

Rotating-Hinge Revision Total Knee Arthroplasty for Arthrofibrosis Improves Motion Without Increasing Complications: A Systematic Review and Meta-Analysis

2026-06-18

Arthrofibrosis remains a challenging indication for revision total knee arthroplasty (rTKA), frequently resulting in persistent stiffness and limited postoperative range of motion (ROM). Rotating-hinge (RH) implants are often selected in this setting to allow for aggressive soft-tissue release and improved stability; however, the magnitude of ROM improvement and comparative effectiveness versus nonhinged revision (NHR) constructs remain incompletely defined.

Why Total Knees Fail and Re-Fail: An Analysis of 20,568 Revision Cases From the Swiss Implant Registry

2026-06-18

Despite advances in total knee arthroplasty (TKA), revision procedures represent a major clinical challenge and are expected to rise with growing primary volumes. This study aimed to analyze trends in first and repeated revisions over the past decade, focusing on timing, causes, and patient-related factors.

Developing International Clinical Practice Guidelines: Lessons Learned in Achieving Global Consensus for the Association Research Circulation Osseous Guideline

2026-06-18

The development of international clinical practice guidelines offers an opportunity to harmonize evidence-based care across diverse health-care systems but presents substantial logistical, methodological, and implementation challenges. These challenges are particularly pronounced for nontraumatic osteonecrosis of the femoral head, a condition characterized by heterogeneous disease biology, evolving diagnostic criteria, and limited high-certainty evidence.

A History of Preoperative Falls Is Associated With Increased Risk of Postoperative Medical and Surgical Complications Following Total Hip Arthroplasty: A Propensity-Matched Analysis

2026-06-18

Falls are common among older adults and reflect multisystem vulnerability that may predispose patients to adverse surgical outcomes. Although traditional preoperative risk factors for complications following total hip arthroplasty (THA) are well established, the independent prognostic value of a preoperative fall history remains poorly defined. This study aimed to evaluate whether a documented preoperative history of falls was associated with an increased risk of postoperative complications following primary THA in older adults.

30-Year Outcomes of a Cementless Total Knee Arthroplasty System in Patients Under 50 Years Old

Alexander W. Nielsen, Roy D. Bloebaum, Aaron A. Hofmann — 2026-06-18

Cementless total knee arthroplasty (TKA) was developed to address limitations of cemented fixation, particularly in younger, active patients. Design features aimed to enhance patellar tracking, optimize implant fit, and promote durable biologic fixation. Despite early concerns, outcome data remain limited. This study evaluated clinical and radiographic results at 30 years postoperatively.

The AAHKS Clinical Research Award: Maximizing Bearing Size Markedly Reduces Dislocations in Primary Total Hip Arthroplasty

2026-06-18

Modern polyethylene allows larger bearings in fixed-bearing total hip arthroplasty (THA), but any stability benefits of fully maximizing bearing diameter (e.g., 36-millimeter (mm) in 48/50-mm cups) are not well-established. We hypothesized that maximizing bearing diameter reduces odds of dislocation in primary fixed-bearing THA.

Transfusions Are Associated With an Elevated Risk of Venous Thromboembolism and Periprosthetic Joint Infection Following Revision Total Knee Arthroplasty

2026-06-17

Blood transfusions have been associated with an increased risk of venous thromboembolism (VTE) and infectious complications following primary total joint arthroplasty. However, the thrombogenic and immunomodulatory effects associated with transfusions in the revision total knee arthroplasty (TKA) population have not been quantified. Accordingly, the present study sought to evaluate VTE and infectious complications between transfused and nontransfused patients following revision TKA.

Obesity and Chronic Opioids Were Not Negatively Associated With Achieving Centers for Medicare and Medicaid Services Mandated Thresholds for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement Scores After Primary Total Hip Arthroplasty

2026-06-17

The Centers for Medicare and Medicaid Services (CMS) will begin mandating Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) improvement thresholds for total hip arthroplasty (THA) starting in 2026 and have established a 22-point improvement target. Surgeon and institutional data will be publicly reported, and some may avoid patients who have risk factors for poor outcomes such as chronic opioid use. The purpose of this study was to identify predictors of HOOS JR improvement based on the CMS-mandated HOOS JR improvement threshold.

The Most Common Organisms in Periprosthetic Joint Infection: A Survey of the International Orthopaedic Device Infection Network

2026-06-17

Periprosthetic joint infection (PJI) remains a major source of morbidity, mortality, and economic burden, both in the United States (US) and internationally. Understanding regional microbiology profiles in PJI is essential to assist with empiric antibiotic selection. The purpose of this study was to survey an international database to identify and compare the microbiological profile of hip and knee PJI across international sites.

Kidney Injury and Mortality Are Minimal Following Two-Stage Treatment of Periprosthetic Joint Infection

2026-06-16

The current gold standard treatment for chronic periprosthetic joint infection (PJI) is a two-stage surgery with antibiotics between implant resection and reimplantation. Recently, claims have been reported of nephrotoxic antibiotic exposure and acute kidney injury (AKI) during the two-stage PJI treatment. This study evaluated kidney function and mortality before, during, and after two-stage revisions for PJI using a standardized protocol.

The Impact of Spinal Anesthetic Dose on Lengths of Stay in Primary Total Knee Arthroplasty

2026-06-16

The implementation of neuraxial anesthesia in total knee arthroplasty (TKA) has been shown to shorten hospital lengths of stay (LOSs) compared to general anesthesia. Despite these advances, LOS for TKA in a hospital outpatient department (HOPD) setting remains high. We examined the association between the dose of neuraxial anesthesia and LOS in patients undergoing primary TKA.

The John Charnley Award: A Randomized Controlled Trial of Dual Mobility and Single Bearings for Patients at High Risk of Dislocation Following Primary Total Hip Arthroplasty

2026-06-16

This multicenter randomized controlled trial sought to determine if dual-mobility (DM) bearings reduce dislocations in patients at high-risk for instability undergoing primary total hip arthroplasty compared to single bearing (SB) femoral heads.

A Contemporary Comparison of Modern Cementless to Cemented Femoral Stems for the Treatment of Femoral Neck Fractures

2026-06-16

Cemented femoral fixation is considered the gold standard in hip arthroplasty for femoral neck fractures (FNFs), given lower periprosthetic fracture risk than cementless fixation. However, one major concern with cementation is bone-cement implantation syndrome (BCIS), a phenomenon involving cardiopulmonary distress attributed to cement pressurization. This study compared outcomes based on fixation method and stem design and evaluated the utilization of cemented versus cementless fixation following FNF.

Triple-Taper Stems in Obese Total Hip Arthroplasty Patients: Complication and Revision Rates From a United States Registry

2026-06-16

Obesity is a known risk factor for complications and revision following total hip arthroplasty (THA). A triple-taper femoral stem design may improve metaphyseal engagement and rotational stability. This study investigated outcomes in obese patients undergoing cementless primary THA by stem design.

Propensity Score-Matched Comparison of Patient-Reported Outcomes Between Crowe I Developmental Dysplasia of the Hip and Primary Osteoarthritis Following Total Hip Arthroplasty

Anand Saluja, John Eschert, Renee Ren, Zachary Wong, Edwin Su — 2026-06-12

Total hip arthroplasty (THA) is commonly performed for Crowe I developmental dysplasia of the hip (DDH) and primary osteoarthritis (OA), but comparative survivorship and patient-reported outcome measure (PROM) data remain limited with mixed findings. This study aimed to compare PROMs, revision rates, and implant survivorship between propensity score-matched THA patients who had Crowe I DDH and OA.

Disparities in Preoperative Weight Loss and Obesity Treatment Before Total Joint Arthroplasty

2026-06-12

Institutions often implement body mass index (BMI) cutoffs for offering total hip (THA) and knee (TKA) arthroplasty. The goals of this study were to determine disparities in preoperative obesity prevalence, obesity treatment utilization, and weight loss efficacy.

Social Determinants of Health Z-Codes Are Associated With Low Compliance With Patient-Reported Outcome Measures After Total Hip Arthroplasty

Matthew W. Parry, Yagiz Ozdag, Austin Kloc, Jason Salvato, John J. Mercuri — 2026-06-12

There is limited literature on compliance rates for completing patient-reported outcome measures (PROMs) after elective total hip arthroplasty (THA). Social determinants of health (SDOH) refers to social factors that are not classifiable elsewhere and can have a major impact on health-care outcomes. The purpose of this investigation was to assess the relationship between SDOH codes, demographic and surgical factors, and compliance rates for filling out PROMs after THA.

Comparative Analysis of Clinically Meaningful Recovery Trajectories Following Unicompartmental and Patello-femoral Arthroplasty

2026-06-12

Medial unicompartmental knee arthroplasty (UKA), lateral UKA, and patello-femoral arthroplasty (PFA) are established treatments for isolated compartmental knee osteoarthritis. Despite its growing popularity, the speed of functional recovery between procedures remains poorly defined. We assessed the time to the minimal clinically important difference (MCID) between procedures for various patient-reported outcome measures (PROMs).

Differences Between Inpatient and Outpatient Medicare Total Knee Arthroplasty: Substantial Clinical Benefit Thresholds on Knee Injury and Osteoarthritis Outcome Score for Joint Replacement

2026-06-12

The Centers for Medicare and Medicaid Services patient-reported outcome-based performance measure mandates collection of patient-reported outcome measures after total knee arthroplasty (TKA) and defines success as achieving substantial clinical benefit (SCB) on the Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) of ≥ 20 points. As TKA increasingly shifts to outpatient care and patient complexity varies by care setting, a single universal threshold may misclassify improvement.

What Factors Increase the Risk of Dislocation After Primary Total Hip Arthroplasty Using the Direct Anterior Approach?

2026-06-12

While the direct anterior approach (DAA) for total hip arthroplasty (THA) is associated with a lower risk of dislocation, this complication has not been eliminated and can be acutely disabling when it occurs. This study aimed to identify patient, surgical, and radiographic factors that contribute to dislocation risk for the DAA based on primary THAs performed over a 15-year period.

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 prophylaxis in high-risk patients. In nonorthopaedic populations, concurrent NSAID–anticoagulant increases bleeding risk, but post-TKA safety data remain limited.

Complications of Ceramic-on-Ceramic Total Hip Arthroplasty With Large Heads: 10-Year Minimum Follow-Up

2026-06-12

The fourth-generation ceramic bearings allow the use of larger femoral heads, but inevitably create thinner liners, raising concerns regarding liner fracture and long-term biological responses. We extended our study to evaluate late dislocation, ceramic-related complications, and long-term clinical and radiographic outcomes more than 10 years after ceramic-on-ceramic total hip arthroplasty (THA).

Robotic Total Hip Arthroplasty in Atypical Hip Anatomy: Accuracy of Component Positioning and Clinical Outcomes in 192 Complex Cases

2026-06-12

The objectives of this study were to determine the accuracy of component positioning, patient satisfaction, functional outcomes, component survivorship, and complications of robotic total hip arthroplasty (THA) in patients who have atypical hip anatomy.

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) mandates reporting of Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement to support a hospital-level patient-reported outcome performance measure. The current CMS requires matched preoperative and postoperative patient-reported outcome measures 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 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 Rerevision

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-based 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 or direct oral anticoagulants 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 nonarthroplasty 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), (2) infectious complications (periprosthetic joint infection and surgical site infection), (3) aseptic revision, and 4) venous thromboembolism.

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

2026-06-04

This symposium, presented at the 2025 American Association of Hip and Knee Surgeons Annual Meeting, provides an overview of concepts and techniques used during revision total hip arthroplasty.

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. 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 health care 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 Laboratory Tests 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 have 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 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 femoral 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 J. 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 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 and 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 (OA) 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 OA 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. Despite comparable outcomes to total knee arthroplasty, 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

Seokha Hong, Minsu An, Seokjin Kong, Chungsu Hyun, Seungbeom Han, Sangmin Kim — 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. This study aimed 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

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

2026-05-22

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

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 noncefazolin 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; however, the assessment remains subjective. We aimed to develop and validate a deep learning model using multisequence knee magnetic resonance imaging (MRI) for automated detection of isolated medial compartment BoB osteoarthritis in unicompartmental knee arthroplasty 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 L. Toavs, Vijay H. Sudheendra, Thomas Barrett, Brandon Lentine — 2026-05-20

Cryoanalgesia is increasingly used in total knee arthroplasty (TKA) as a nonopioid 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. However, up to one in four patients experience chronic postsurgical 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 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–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. 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 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.

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.

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. 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%. Although 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 perioperative 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.

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 are 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 after THA with HXLPE versus CPE liners.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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 Rerevision 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 rerevision surgeries is anticipated to rise. Revision THA (rTHA) presents challenges because of higher mortality risks and its substantial economic burden on the United States (US) health care system. This study aimed to assess the incidence, diagnoses, and risk factors for both revision and re-rTHA, considering patient- and surgeon-related variables.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 total hip arthroplasty (THA). However, data regarding outcomes following early dislocation are dated and limited in scope. Whether these existing data apply to contemporary practice with the broad adaptation of high-stability bearings and modern surgical techniques is unknown. Therefore, we assessed revision and redislocation 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.

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, (3) Oxford Knee Score, (4) Short-form 36 physical and (5) mental 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, 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. An umbrella review (CRD420251070340) of the available scientific evidence was performed to determine whether telerehabilitation is an effective alternative to conventional rehabilitation among patients after TKA.

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).

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.

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.

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?

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 Differences 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

2026-08

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.

2026-08

Masthead

2026-08

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

2026-08

Androgen Awareness: Navigating Testosterone Replacement Therapy in Total Joint Arthroplasty

Maximillian P. Ganz, Michael A. Mont, Giles R. Scuderi — 2026-08

Testosterone replacement therapy (TRT) utilization has experienced a multi-billion-dollar surge over the last two decades [1]. Driven by an aging population, expanding indications in longevity medicine, and rising utilization in gender-affirming hormonal therapy, more orthopaedic patients present with exogenous androgens. This issue may become increasingly relevant as younger and more medically optimized patients undergo elective arthroplasty, including individuals pursuing longevity medicine, metabolic optimization, and body composition management.

Reconsidering Centers for Medicare & Medicaid Services Functional Status Measures for Total Hip and Knee Arthroplasty: From Process Compliance to Meaningful Outcome Assessment

Antonia F. Chen, Craig J. Della Valle, Mathias P.G. Bostrom, Michael A. Mont — 2026-08

The integration of patient-reported outcome measures (PROMs) into total hip arthroplasty (THA) and total knee arthroplasty (TKA) represents one of the most important advances in orthopaedic quality assessment over the past two decades (Figure 1). Large-scale, longitudinal outcome tracking could markedly improve implant performance, surgical technique, and patient outcomes, as early registry-based initiatives in Scandinavia and the United Kingdom showed [1–8]. Concurrently, the creation and validation of PROM tools like the Oxford Hip Score, Oxford Knee Score, Hip Disability and Osteoarthritis Outcome Score, Knee injury and Osteoarthritis Outcome Score, and Patient-Reported Outcomes Measurement Information System increased the capacity to measure pain, function, and health-related quality of life directly from the view point of the patient.

Reply to Letter to the Editor on “Optimizing Postoperative Pain Management in Total Knee Arthroplasty With Preoperative Methadone: A Prospective Randomized Study”

John E. Whitaker, Arthur L. Malkani — 2026-08

We appreciate Dr. Maricar’s thoughtful commentary on our manuscript, “Optimizing Postoperative Pain Management in Total Knee Arthroplasty With Preoperative Methadone: A Prospective Randomized Study.” We thank him for the opportunity to clarify methodological aspects and contextualize our findings within multimodal pain management.

Response to Letter to the Editor on “Patient-Specific Instrumentation versus Standard of Care in Total Knee Arthroplasty in an Obese Population: Minimum 5-year Follow-Up”

2026-08

We thank the author for the thoughtful and constructive comments regarding our article, “Patient-Specific Instrumentation versus Standard of Care in Total Knee Arthroplasty in an Obese Population: Minimum 5-year Follow-Up.” We appreciate the opportunity to further discuss key aspects of our study and to place our findings within the broader context of contemporary total knee arthroplasty (TKA) practice.

Letter to the Editor on “Patient-Specific Instrumentation versus Standard of Care in Total Knee Arthroplasty in an Obese Population: Minimum Five-Year Follow-Up”

Soner Kocak — 2026-08

I read with great interest the article by Braun et al. entitled “Patient-Specific Instrumentation versus Standard of Care in Total Knee Arthroplasty in an Obese Population: Minimum Five-Year Follow-Up” [1]. The authors should be commended for reporting a prospective randomized study with minimum 5-year follow-up in an obese population, a clinically challenging group in which surgical exposure, soft-tissue management, and component positioning are often more demanding. Their central finding—no clinically meaningful improvement in radiographic alignment, patient-reported outcomes, complications, or revisions with patient-specific instrumentation compared with conventional instrumentation—adds valuable long-term evidence to a field that has historically been dominated by short follow-ups and surrogate end points [1–3].

Letter regarding “Optimizing Postoperative Pain Management in Total Knee Arthroplasty With Preoperative Methadone: A Prospective Randomized Study”

Muhammed Abdulqadir Maricar, Maryam Tariq — 2026-08

We read with great interest the study by Whitaker et al. titled “Optimizing Postoperative Pain Management in Total Knee Arthroplasty With Preoperative Methadone: A Prospective Randomized Study.” The authors present an important contribution to postoperative pain and opioid outcomes, discussing the role of preoperative methadone versus oxycodone in total knee arthroplasty [1]. However, there are several methodological critiques that warrant further discussion.

Reply to Letter to the Editor On “Preserving Scientific Integrity in Academic Publishing: Navigating Artificial Intelligence, Journal Policies, and the Impact Factor as a Quality Indicator”

2026-08

We appreciate Professor Matsubara's insightful letter to the editor on our editorial, “Preserving Scientific Integrity in Academic Publishing: Navigating Artificial Intelligence, Journal Policies, and the Impact Factor as a Quality Indicator” [1]. We value his interest in the manuscript and are grateful for the chance to reply.

Reply to Letter to the Editor On “Preserving Scientific Integrity in Academic Publishing: Navigating Artificial Intelligence, Journal Policies, and the Impact Factor as a Quality Indicator”

Shigeki Matsubara — 2026-08

Kayaalp et al. [1] warn that the current publishing environment is increasingly distorted by the rapid spread of artificial intelligence (AI), the rise of mega-journals, and the manipulation of impact factors. Their proposed countermeasures are persuasive. However, I believe that without resetting a more fundamental mindset, the problems surrounding academic publishing will not be resolved and may even worsen. In my view, the publish-or-perish culture accounts for much of the current publication crisis.

Reply to Letter to the Editor on “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, Mustafa Citak — 2026-08

We sincerely thank Dr Lin Zhang for his thoughtful and constructive feedback on our manuscript, “Synovial Absolute Neutrophil Count as a Superior Diagnostic Biomarker for Acute Periprosthetic Joint Infection in Hip and Knee Arthroplasty With Low-Virulence Organisms” [1]. We greatly value this scholarly dialogue and appreciate the opportunity to address the comments raised.

Letter to the Editor Regarding: “Synovial Absolute Neutrophil Count as a Superior Diagnostic Biomarker for Acute Periprosthetic Joint Infection in Hip and Knee Arthroplasty With Low-Virulence Organisms”

Lin Zhang — 2026-08

We read with great interest the recent work by Karlidag et al. [1], who reported that synovial absolute neutrophil count demonstrates strong diagnostic performance for acute periprosthetic joint infection and may be especially useful in cases involving low-virulence organisms. While the study provides valuable insights, several methodological issues merit further discussion because they influence both the interpretation and the general applicability of the findings.