IntroductionRecent investigations have determined that abnormal postoperative glycemia following primary total joint arthroplasty is associated with adverse events. Our study aimed to determine if hyperglycemia and glycemic variability following aseptic revision total joint arthroplasty (rTJA) were associated with periprosthetic joint infection (PJI) within two years postoperatively. MethodsA retrospective review was performed of 2,208 patients within a single institution undergoing aseptic rTJA from 2012 to 2019. Postoperative glucose values were recorded. Glycemic variability was measured via three parameters: coefficient of variation (%CV), mean amplitude of glycemic excursions (MAGE), and J-index. Logistic regression analyses were performed to examine associations with PJI at 90-day, 1-, and 2-year follow-up. ResultsIn revision hips, all glycemic measures were not associated with PJI at any timepoint in logistic regression analyses, except for MAGE, which predicted PJI at one year (P = 0.045); body mass index (BMI) was the only factor associated with PJI at all timepoints in all models. In revision knees, all glycemic measures were not associated with PJI at any timepoint in logistic regression analyses; however, PJI rates differed between diabetics and non-diabetics at all time-points (P < 0.05). ConclusionsOur findings illustrate that decreasing preoperative BMI and postoperative glycemic variability may be critical in reducing PJI rates in revision hips. Furthermore, patients who have diabetes should be counseled that they remain at higher risk of PJI regardless of perioperative glucose control after revision knee surgery.

BackgroundChronic lymphocytic leukemia (CLL) is highly prevalent in the Total Joint Arthroplasty (TJA) age group but has not been properly evaluated. This study aims to assess: 1) 90-day medical complications; 2) implant-related complications; 3) healthcare utilization; and 4) time to revision in CLL and non-CLL TJA. MethodsChronic Lymphocytic Leukemia cases undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified using diagnostic and procedural codes. CLL TKA and THA patients were matched 1:5 with controls based on demographics and comorbidities. Outcomes included 90-day medical complications, 2-year implant complications, length of stay (LOS), 90-day readmission, and time to revision. ResultsThe CLL TKA patients had significantly higher odds of 90-day medical complications compared to controls, notably pneumonia (OR, 9.2; CI, 7.1 to 12.0; P < 0.001) and myocardial infarction (OR, 5.5; CI, 3.9 to 7.9; P < 0.001). Similarly, CLL THA patients had greater odds of 90-day medical complications, especially pneumonia (OR 10.0; CI 8.2 to 12.2; P < 0.001) and acute kidney injury (AKI) (OR 6.3; CI 5.1 to 7.8; P < 0.001). CLL TKA patients faced higher odds of periprosthetic fracture, mechanical loosening, and prosthetic joint infection, while THA patients had increased periprosthetic fractures. Revisions occurred earlier for THA than TKA (337 ± 547 days versus 643 ± 774 days). CLL patients had longer LOS (TKA: 5.9 ± 6.5 versus 3.1 ± 1.6 days; P < 0.001) (THA: 6.3 ± 12.9 versus 3.0 ± 2.4; P < 0.001) and higher 90-day readmission rates (OR, 1.3; CI, 1.1 to 1.5, P < 0.001). ConclusionsOrthopaedic surgeons should consider CLL status for informed patient counseling and complications mitigation.

IntroductionExtensor mechanism disruption is a devastating complication following total knee arthroplasty (TKA). Despite its morbidity, there is no consensus regarding the optimal treatment strategy. We aimed to determine the survivorship, clinical outcomes, and improvement in patient-reported outcome measures (PROMs) after primary repair of acute extensor mechanism disruptions following primary or revision TKA. MethodsA retrospective review identified 41 acute extensor mechanism disruptions (33 primary TKAs and eight revision TKAs) from 2015 to 2021. The study group was 56% women, the mean BMI was 33, the mean age was 66 years, and the mean follow-up was three years. Extensor mechanism disruption occurred at the patellar tendon (n = 17), quadriceps tendon (n = 15), and patella (n = 9) at a mean of 10 months following TKA. Surgical management was primary repair (n = 30) or primary repair with augmentation (allograft or autograft) (n = 11). Kaplan-Meier analysis estimated survivorship. ResultsThe two-year survivorship free from all-cause reoperation was 72 and 23% following primary and revision TKA, respectively (P = 0.013). The two-year survivorship free from all-cause reoperation was 66% for primary repair versus 61% for primary repair with augmentation (P = 0.95). There were 17 (41%) patients who underwent reoperation, most commonly for re-rupture (n = 4) in two primary repairs and two primary repairs with augmentation (P = 0.288). Revision TKA (P = 0.049) and increased time from disruption to repair (P = 0.039) were risk factors for reoperation. The mean extensor lag did not significantly improve, nor did patients see improvement in their PROMs. ConclusionAfter primary and revision TKA, acute extensor mechanism disruption treated with primary repair with or without augmentation had very poor early survivorship free from all-cause reoperation. Patients should be counseled appropriately, and alternative surgical techniques should be considered.

BackgroundThe administration of cocktails that contain glucocorticoids for local infiltration analgesia (LIA) is highly advocated and has been shown to be effective in managing pain in total joint arthroplasty (TJA). However, it remains ambiguous whether this protocol maintains its safety and efficacy in the treatment of periprosthetic joint infection (PJI), a devastating complication of TJA. MethodsA comprehensive retrospective study was carried out on 299 single-stage revision cases for PJI spanning the years 2010 to 2021. Of these, 127 received LIAs containing high-dose compound betamethasone (CB) were termed the CB group, and the other 172 were termed the non-CB group. The rates of reinfection and other postoperative complications, along with postoperative visual analog scale (VAS) scores, and opioid consumption were compared. ResultsDuring minimum 2-year follow-up, there was no significant difference in the reinfection rate between the non-CB and CB groups (9.3 versus 8.7%; P = 0.85), consistent within the subsets of hip (8.4 versus 4.5%; P = 0.51) and knee (10.4 versus 13.3%; P = 0.60) PJIs individually. The administration of high-dose CB was neither an independent risk factor for reinfection (P > 0.05; 95% CI [confidence interval] including 1) nor was it associated with the occurrence of reinfection (P > 0.05). The incidence of postoperative nausea and vomiting (PONV) was significantly lower in the CB group (P < 0.05). In the initial 48-hour postoperative period, the CB group exhibited lower mean scores in both resting and movement VAS evaluations (P < 0.05). Notably, the movement VAS scores of the CB group remained lower even at 72 hours post-surgery for knee PJIs (P < 0.001). Furthermore, within the first 72 hours post-surgery, the necessity for additional opioid analgesics in the CB group was significantly reduced compared to the non-CB group (P < 0.05). ConclusionA LIA with a high-dose compound betamethasone reduces postoperative pain, opioid consumption, and the incidence of PONV following a single-stage revision without affecting reinfection and other complication rates.

Periprosthetic joint infections (PJI) following total knee arthroplasty (TKA) are associated with high patient morbidity, mortality, and healthcare costs. Methods to reduce the burden of PJI have been shown to be efficacious on a small scale. On a national scale, it is unknown whether these methods have reduced PJI rates. A retrospective trend analysis was conducted using a national database. The incidence of 2-year septic revision was observed for the entire cohort and patients who had high-risk co-morbidities from 2010 to 2019. A multivariable logistic regression was performed to compare the odds ratios of 2-year septic revision rates from 2011 to 2019 to the reference year of 2010. Linear regression was used to compare the change throughout this period in the overall and high-risk sub-analysis groups. Among the 860,185 patients, 5,589 underwent septic revision within 2 years. The 2-year septic revision rate decreased from 0.75% in 2010 to 0.69% in 2019 (compounded annual growth rate [CAGR] = -0.94%, P = 0.049). Multivariable logistic regressions demonstrated that the odds of septic revision in 2019 were significantly lower than those in 2010 (OR [odds ratio]: 0.83, 95% CI [confidence interval]: [0.70 to 0.96], P = 0.017). In high-risk patients, the septic revision rate decreased from 1.04 to 0.80% (CAGR = -2.80%, P = 0.004), specifically in those who had a history of psychoses, Medicaid insurance, anemia, heart failure, obesity, liver disease, tobacco use, and drug abuse (P < 0.05 for all). This study demonstrates a national reduction in the 2-year septic revision rate in all TKA patients, including patients considered at high risk for PJI. This suggests current preventative methods may be efficacious on a national scale in TKA. Further research is needed to identify more modalities to reduce the national incidence of this morbid and costly complication.