American Association Of Hip And Knee Surgeons Research Articles

Tips and Tricks to Save You During Revision Total Knee Arthroplasty

The number of revision total knee arthroplasties (TKAs) performed annually continues to rise. This article is a summary of a symposium on revision TKAs presented at the 2023 American Association of Hip and Knee Surgeons annual meeting. It will provide an overview of the surgical tips and tricks for exposure and component removal, use of metaphyseal fixation and stems to manage bone loss and optimize fixation, constraint in TKA, as well as how to manage extensor mechanism disruptions with a synthetic mesh reconstruction. Level of evidenceV.

Do social media use and patient satisfaction scores correlate with online award recognition among hip and knee arthroplasty specialists?

IntroductionThe physician–patient interaction now begins before patients arrive in the office. Online ratings, social media profiles, and online award status are all components of physician online reputation which contributes to the patient's initial impressions. Therefore, it is important to understand the interplay of these factors and determine if there is a consistent trend indicating the value of this information. MethodsWe Identified all (N ​= ​160) registered American Association of Hip and Knee Surgeons (AAHKS) in New England using the https://findadoctor.aahks.net/tool for Massachusetts (MA), Connecticut (CT), Rhode Island (RI), Vermont (VT), New Hampshire (NH), and Maine (ME) on 6/26/2023. We collected surgeon age, fellowship graduation year, and practice type (i.e. Academic or Private). The average 5-star rating and number of ratings were collected from four websites. Any professional-use Facebook, Instagram, Twitter, LinkedIn, YouTube Channel, Personal Websites, or Institutional Websites were identified and a modified SMI Score was calculated. Finally, Castle Connolly Top Doctor, Local Magazine (e.g. Boston Magazine) Top Doctor, or the presence of having any award was noted for each surgeon. ResultsWe identified several significant trends indicating that online awards were associated with higher online ratings. Social media presence, as determined by SMI Score, was also correlated with higher ratings overall and a higher likelihood of having an online award. ConclusionGiven the observed trends and reported importance patients place on ratings and awards, surgeons may consider increasing online engagement via social media and encouraging patients to share their experience via online ratings.

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

BackgroundA survey was conducted at the 2023 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to assess practice management strategies among current AAHKS members. MethodsMembers of AAHKS used an app to answer both multiple-choice and “yes or no” questions related to a variety of issues related to their practices. ResultsThe number of AAHKS members in private practice (37%) continues to decline, and 4% are now in private equity–employed practices. Fee for service (30%) and relative value units (30%) are the major forms of compensation. The number of AAHKS members that perform total joint arthroplasties at ambulatory surgery centers continues to increase, and supply chain issues (91%) remain a problem. There has been a decrease in surgeon participation in bundled payment programs and gainsharing arrangements with hospitals. ConclusionsThis member’s survey provides valuable information regarding practice patterns. The shift to outpatient surgery has continued. Future surveys will be performed to monitor changes in practice patterns over time.

Diversity of Backgrounds and Academic Accomplishments for Presidents Elected to Hip and Knee Arthroplasty Societies in the United States

BackgroundAcademic accomplishments and demographics for presidents of hip and knee arthroplasty societies are poorly understood. This study compares the characteristics of presidents nominated to serve the Hip Society, Knee Society, and American Association of Hip and Knee Surgeons. MethodsThis was a cross-sectional study of arthroplasty presidents in the United States (1990 to 2022). Curriculum vitae and academic websites were analyzed for demographic, training, bibliometric, and National Institutes of Health (NIH) funding data. Comparisons were made between organizations and time periods (1990 to 2005 versus 2006 to 2022). ResultsThere were 97 appointments of 78 unique arthroplasty presidents (80%). Most presidents were male (99%) and Caucasian (95%). There was 1 woman (1%) and 5 non-Caucasian presidents (2% Asian, 3% Hispanic). There were no differences in demographics between the 3 arthroplasty organizations and the 2 time periods (P > .05). Presidents were appointed at 55 ± 10 years old, which was on average 24 years after completion of residency training. Most presidents had arthroplasty fellowship training (68%), and the most common were the Hospital for Special Surgery (21%) and Massachusetts General Hospital (8%). The median h-index was 53 resulting from 191 peer-reviewed publications, which was similar between the 3 organizations (P > .05). There were 2 presidents who had NIH funding (2%), and there were no differences in NIH funding between the 3 organizations (P > .05). ConclusionsArthroplasty society presidents have diverse training pedigrees, high levels of scholarly output, and similar demographics. There may be future opportunities to promote diversity and inclusion among the highest levels of leadership in total joint arthroplasty.

The Practice Patterns of American Association of Hip and Knee Surgeons for the Management of Chronic Periprosthetic Joint Infection After Total Knee Arthroplasty

BackgroundThe management of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) has considerable variation. In order to better capture current preferences for the management of PJI, this study sought to poll the current members of American Association of Hip and Knee Surgeons (AAHKS) first to characterize the distribution of practice patterns. MethodsThere were 32 questions in an online survey distributed to members of AAHKS. The questions were multiple choice regarding the management of PJI for TKA. There were 844 out of 2,752 members who completed the survey (response rate of 31%). ResultsMost of the members were in private practice (50%) compared to 28% being in an academic setting. On average, members were performing between 6 to 20 PJI cases per year. Two-stage exchange arthroplasty was performed in over 75% of the cases with either a cruciate retaining (CR) or posterior stabilized (PS) primary femoral component used in over 50% of the cases and 62% using an all-polyethylene tibial implant. Most of the members were using vancomycin and tobramycin. Typically, 2 to 3 grams of antibiotics were added per bag of cement regardless of the cement type. When indicated, amphotericin was the most often-used antifungal. Post-operative management had major variability with range of motion, brace use, and weight-bearing restrictions. ConclusionThere was variability in the responses from the members of AAHKS, but there was a preference toward performing a two-stage exchange arthroplasty with an articulating spacer using a metal femoral component and an all-polyethylene liner.

Perception of Perioperative Risk for Arthroplasty Patients: A Poll of Australian Orthopedic Surgeons

BackgroundThere is growing interest in the perioperative management of patients who have indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, poorly controlled diabetes, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients who have modifiable risk factors. MethodsThe survey tool used in the AAHKS study was adapted for use in the Australian context and distributed to the membership of the Arthroplasty Society of Australia via SurveyMonkey. There were 77 responses received, representing a response rate of 64%. ResultsThe majority of respondents were experienced, high volume arthroplasty surgeons. Overall, 91% of respondents restricted access to arthroplasty for patients who have modifiable risk factors. There were 72% restricting access for excessive body mass index, 85% for poor diabetic control, and 46% for smoking. Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures. While 49% of surgeons believed that current payment systems did not impair their ability to achieve good outcomes, 58% believed that certain arthroplasty patients would benefit from additional intervention, based on their socioeconomic status. ConclusionOver 90% of surgeons who responded address modifiable risk factors prior to surgery. This finding aligns with the practice patterns of AAHKS members, despite differences in healthcare systems.

International Perception of Perioperative Risk for Arthroplasty—Experience of the Colombian Health System

BackgroundFollowing a recent publication of the American Association of Hip and Knee Surgeons (AAHKS) which found that 95% of respondents address risk factors before surgery and the challenges in the ultimate access to care, the authors proposed an international collaboration in order to gain insight on how performance measures affect access to care as well as what medical and/or socioeconomic factors are considered obstacles to good outcomes from an international perspective. The aim of this study was to poll Colombia's arthroplasty surgeons regarding their approach to patients who have modifiable risk factors. MethodsThe survey used in the AAHKS study was adapted for use in the Colombian context and distributed to the members of the Colombian Society of Hip and Knee Surgeons (SOCCAR) via a collaborative format online, and it was completed by 109 out of 163 members, a response rate of 67%. ResultsOverall, 67% limit or restrict surgery in patients with specific modifiable risk factors. Those factors most likely to delay or restrict treatment were malnutrition/hypoalbuminemia (95.9%), poor diabetic control (89%), and active smoking (61.6%). Limited social support was considered a liability by 82.2% of surgeons. Over 80% of respondents decide based on personal experience or literature review. Low socioeconomic status was considered a factor for limiting access by 53.4% of polled surgeons. 91.8% believe some patient populations would benefit with better access to care if payment systems provided better risk adjustment. ConclusionOnly 67% of Colombian arthroplasty surgeons limit or restrict elective surgery in patients with modifiable risk factors, mainly considering malnutrition and poorly controlled diabetes as a cause for restriction, and half of the surgeons consider low socioeconomic status as a limitation to arthroplasty surgery. These findings contrast dramatically to the practice patterns of American AAHKS members.

Perception of Perioperative Risk for Arthroplasty Patients: A Poll of Indian Orthopedic Surgeons

BackgroundA survey of the American Association of Hip and Knee Surgeons (AAHKS) reported that 95% of respondents attempted to modify risk factors prior to arthroplasty. This study investigated Indian arthroplasty surgeons’ approach to patients who have modifiable risk factors. MethodsThe AAHKS survey tool was adapted for Indian surgeons and distributed to the membership of the Indian Society of Hip and Knee Surgeons and Indian Arthroplasty Association via a Survey Monkey. A total of 92 survey responses were received, representing a response rate of 12%. ResultsOverall, 87% of respondents restricted access to arthroplasty surgery for patients who have modifiable risk factors, but only 51% of respondents reported delays or restricted treatment because of risk factors. Respondents reported that financial implications were more likely to delay or restrict treatment in 97% and social/family reasons in 66%. Poor diabetic control (81%), previous infection (57%), and malnutrition/hypoalbuminemia (47%) were the most frequent modifiable risk factors. There were 82% of surgeons reporting that the patient’s socioeconomic status influenced treatment including: 71% of patients who have low socioeconomic status, 57% who do not have insurance, and 45% who have limited social supports. Most surgeons (92%) reported that funding influenced the type of care provided and the choice of implants. ConclusionOver 97% of Indian arthroplasty surgeons thought socioeconomic factors impaired access to orthopaedic treatment. Only half the surgeons restricted access for comorbidities and these were more often related to infection risks and diabetes. These findings contrast dramatically to the practice patterns of American AAHKS members.

Health Policy Views and Political Advocacy of Arthroplasty Surgeons: A Survey of the American Association of Hip and Knee Surgeons Members

BackgroundThe American Association of Hip and Knee Surgeons (AAHKS) is the largest specialty society for arthroplasty surgeons in the United States and is dedicated to education, research, and advocacy. The purpose of this study was to identify the health policy views of AAHKS members and better characterize their advocacy participation. MethodsA 22 question survey was electronically distributed multiple times via email link to all 3,638 United States members of AAHKS who were in practice or training in 2022. Study results were analyzed using descriptive statistics. ResultsThere were 311 responses (9%), with 18% of respondents being within 5 years of practice and 38% having more than 20 years of practice. Respondents identified as Republicans (40%), Independents (37%), and Democrats (21%). Top policy issues included preserving physician reimbursement and equitable fee schedule representation (95%), the burden of prior authorization (53%), the impact of Center of Medicare and Medicaid Services regulations (39%), and medical liability and tort reform (39%). Members ranked maintaining appropriate physician reimbursement (44%) and advocating for patients (37%) as the top benefits to participation in advocacy. A majority of respondents (81%) stated that they spend more time on presurgery optimization now than 10 years ago. The most common barrier to advocacy participation was a lack of time (77%). ConclusionResponding AAHKS members are well-informed, politically engaged, patient-oriented, and eager for a voice in policy decisions that affect the professional future of arthroplasty surgeons. These results can be used to help direct strategic efforts of the AAHKS Advocacy Committee to further increase advocacy efforts.

PERCEPTION OF PERIOPERATIVE RISK FOR ARTHROPLASTY PATIENTS: A POLL OF AUSTRALIAN ORTHOPAEDIC SURGEONS

There is growing interest in the peri-operative management of patients with indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, type 2 diabetes mellitus, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients with modifiable risk factors.The survey tool used in the AAHKS study was adapted for use in the Australian context and distributed to the membership of the Arthroplasty Society of Australia via Survey Monkey.Seventy-seven survey responses were received, representing a response rate of 64%. The majority of respondents were experienced, high volume arthroplasty surgeons. Overall, 91% of respondents restricted access to arthroplasty for patients with modifiable risk factors. Seventy-two percent of surgeons restricted access for excessive body mass index, 85% for poor diabetic control, and 46% for smoking. Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures.Despite differences in healthcare systems, our findings were similar to those of the AAHKS survey, although their responses were more restrictive in all domains. Differences were noted in responses concerning financial considerations for potentially underprivileged populations. The survey is currently being administered by arthroplasty societies in six other countries, allowing comparison of orthopaedic practice across different healthcare systems around the world.In conclusion, over 90% of Australian arthroplasty surgeons who responded to the survey address modifiable risk factors prior to surgery.

Prior Authorization in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership

BackgroundThis study surveyed the impact that prior authorization has on the practices of total joint arthroplasty (TJA) members of the American Association of Hip and Knee Surgeons (AAHKS). MethodsA 24-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,802 board-certified members of AAHKS. ResultsThere were 353 survey responses (13%). Ninety-five percent of surgeons noted a 5-year increase in prior authorization. A majority (71%) of practices employ at least 1 staff member to exclusively work on prior authorization. Average time spent on prior authorization was 15 h/wk (range, 1 to 125) and average number of claims peer week was 18 (range, 1 to 250). Surgeries (99%) were the most common denial. These were denied because nonoperative treatment had not been tried (71%) or had not been attempted for enough time (67%). Most (57%) prior authorization processes rarely/never changed the treatment provided. Most (56%) indicated that prior authorization rarely/never followed evidence-based guidelines. A majority (93%) expressed high administrative burden as well as negative clinical outcomes (87%) due to prior authorization including delays to access care (96%) at least sometimes. DiscussionPrior authorization has increased in the past 5 years resulting in high administrative burden. Prior authorizations were most common for TJA surgeries because certain nonoperative treatments were not attempted or not attempted for enough time. Surgeons indicated that prior authorization may be detrimental to high-value care and lead to potentially harmful delays in care without ultimately changing the management of the patient.

Trends in Total Knee Arthroplasty Cementing Technique Among Arthroplasty Surgeons—A Survey of the American Association of Hip and Knee Surgeons Members

BackgroundAseptic loosening persists as one of the leading causes of failure following cemented primary total knee arthroplasty (TKA). Cement technique may impact implant fixation. We hypothesized that there is variability in TKA cement technique among arthroplasty surgeons. MethodsA 28-question survey regarding variables in surgeons’ preferred TKA cementation technique was distributed to 2,791 current American Association of Hip and Knee Surgeons (AAHKS) members with a response rate of 30.8% (903 respondents). Patterns of responses were analyzed by grouping respondents by their answers to certain questions including cementing technique, tibial cement location, and femoral cement location. ResultsA total of 73.5% reported performing at least 7 of 8 of the highest consensus techniques, including vacuum mixing (79.9%), using two bags (76.1%), tibial implant first (95.2%), single-stage cementing (96.9%), compression of the implants in extension (91.7%), and use of a tourniquet (84.3%). Medium and high viscosity cement was most commonly used (37.9 and 37.8%, respectively). Finger pressurization was most common (76.1%) compared to a gun (29.8%). There were 26.5% of respondents performing 6 or fewer of the most common majority techniques and seemed to perform other less common techniques (eg, use of a single bag of cement, trialing or closure prior to cement curing, and heating to accelerate cement curing). Cement was most commonly applied to the entire bone and implant surface on both the tibia (46.4%) and femur (47.7%), leaving much variation in the remaining cement application location responses. DiscussionThere appears to be variability in cemented TKA technique among arthroplasty surgeons. There were 26.5% of respondents performing less of the majority techniques and also performed other additional low-response rate techniques. Further studies that look at the impacts of variation in techniques on outcomes may be warranted. Our study demonstrates the need for defining best practices for cement technique given the substantial variability identified.

A Systematic Review of the Efficacy and Safety of Ketamine in Total Joint Arthroplasty

BackgroundKetamine is administered intraoperatively to treat pain associated with primary total hip (THA) and knee arthroplasty (TKA). The purpose of this study was to evaluate the efficacy and safety of ketamine in primary THA and TKA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons (AAHKS), American Academy of Orthopaedic Surgeons (AAOS), Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management (ASRA). MethodsThe MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published prior to 2020 on ketamine in THA and TKA. All included studies underwent qualitative assessment and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of ketamine. After a critical appraisal of 136 publications, 7 high-quality studies were included for analyses. ResultsHigh-quality evidence demonstrates that intraoperative ketamine decreases postoperative opioid consumption. Four of 7 studies found that ketamine reduces postoperative pain. Intraoperative ketamine is not associated with an increase in adverse events and may reduce postoperative nausea and vomiting (relative risk [RR] 0.68; 95% CI 0.50-0.92). ConclusionHigh-quality evidence supports the use of ketamine intraoperatively in THA and TKA to reduce postoperative opioid consumption. Most studies found ketamine reduces postoperative pain, nausea, and vomiting. Moderate quality evidence supports the safety of ketamine, but it should be used cautiously in patients at risk for postoperative delirium, such as the elderly.

Corticosteroids in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

The American Association of Hip and Knee Surgeons (AAHKS), The American Academy of Orthopaedic Surgeons (AAOS), The Hip Society, The Knee Society, and The American Society of Regional Anesthesia and Pain Medicine (ASRA) have worked together to develop evidence-based guidelines on the use of corticosteroids in primary total joint arthroplasty (TJA). The purpose of these guidelines is to improve the treatment of primary TJA patients and reduce practice variation by promoting a multidisciplinary, evidence-based approach to the use of corticosteroids following primary TJA.

Ketamine in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

The American Association of Hip and Knee Surgeons (AAHKS), The American Academy of Orthopaedic Surgeons (AAOS), The Hip Society, The Knee Society, and The American Society of Regional Anesthesia and Pain Medicine (ASRA) collaborated to develop evidence-based guidelines on the use of ketamine in primary total joint arthroplasty (TJA). The purpose of these guidelines is to improve the treatment of primary TJA patients and reduce practice variation by promoting a multidisciplinary, evidence-based approach to the use of ketamine in primary TJA.

Regional Nerve Blocks in Primary Total Hip Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

The American Association of Hip and Knee Surgeons (AAHKS), The American Academy of Orthopaedic Surgeons (AAOS), The Hip Society, The Knee Society, and The American Society of Regional Anesthesia and Pain Medicine (ASRA) have worked together to develop evidence-based guidelines on the use of regional nerve blocks in primary total hip arthroplasty (THA). The purpose of these guidelines is to improve the treatment of orthopedic surgical patients and reduce practice variation by promoting a multidisciplinary, evidence-based approach to the use of regional nerve blocks following primary THA.

Periarticular Injection in Total Joint Arthroplasty: The Clinical Practice Guidelines of the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

The American Association of Hip and Knee Surgeons (AAHKS), The American Academy of Orthopaedic Surgeons (AAOS), The Hip Society, The Knee Society, and The American Society of Regional Anesthesia and Pain Medicine (ASRA) have worked together to develop evidence-based guidelines on the use of periarticular injection in primary total joint arthroplasty (TJA). The purpose of these guidelines are to improve the treatment of primary TJA in patients and reduce practice variation by promoting a multidisciplinary, evidence-based approach for the use of periarticular injection in primary TJA.

Correction to: “Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)–International Committee American Association of Hip and Knee Surgeons (AAHKS)–Arthroplasty Society in Asia (ASIA) survey of members”

Correction to: “Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)–International Committee American Association of Hip and Knee Surgeons (AAHKS)–Arthroplasty Society in Asia (ASIA) survey of members”

Editorial: Proceedings of the Knee Society: A Knee Society-Journal of Arthroplasty Collaborative Partnership!

It is a distinct privilege for the Journal of Arthroplasty to be awarded the opportunity to publish the Proceedings of The Knee Society going forward. The Knee Society was founded in 1983, with Chitranjan Ranawat as the first president, for education and research in the area of total knee arthroplasty as well as in the pathogenesis and non-arthroplasty treatment of osteoarthritis and other disease processes that lead to end-stage arthritis of the knee. The goal was to have membership based on a proven ability to perform research, teach, and demonstrate exceptional skills as a clinician and surgeon. The membership currently consists of 206 members, including North American, International, and Emeritus members who are internationally recognized thought-leaders, innovators, mentors, researchers, and educators, and who, as was the vision of the Society founders, are committed to promoting outstanding care to patients who have disorders of the knee through innovation, research, and education. Since its conception, the Society has recognized the need for candid exchange of ideas on implant design and surgical techniques. Hence, annually in the fall, the members convene to present and discuss their most current research in the field of arthritis-related knee surgery. Importantly, the Society recognizes the need and desire to educate the global arthroplasty community on current, data-generated implant design concepts and surgical techniques. Specialty Day at the American Academy of Orthopaedic Surgeons annual meeting has been the forum for this exchange since the inception of the Society. As a highlight of that program, three award papers named in honor of three of the founding members: Drs John Insall, Mark Conventry, and Chitranjan Ranawat are presented. The open call for award worthy research papers, in the previous fall, consistently result in a robust number of high-quality submissions from which to choose these prestigious legacy awards. The published Proceedings of The Knee Society have evolved to a publication of papers from the Fall members meeting and the award papers from the following American Academy of Orthopaedic Surgeons Specialty Day open meeting of the Knee Society which is presently co-sponsored with the American Association of Hip and Knee Surgeons. With the ensuing collaborative partnership between the Journal of Arthroplasty and the Knee Society, the intent will be to produce a robust Proceedings of The Knee Society that archives and memorializes the fall members meeting as well as the outstanding competitive award papers presented at the following annual open meeting of the Knee Society. To publish a meaningful (to the international arthroplasty community [ie, clinicians, researchers, and patients]) Proceedings that truly archives the members’ meeting and publishes the following year’s award papers in a timely manner is a daunting challenge. It can only be done with a truly collaborative relationship and effort with a shared purpose. The production of this Proceedings began with the President of the Society, Robert Trousdale, his Program Chairman and Editor of the Proceedings, Rafael J. Sierra, and the Society staff, led by Olga Foley, committing to, and finalizing a program months in advance and engaging the membership to contribute their work to the Proceedings by the required deadline. Dedicated, experienced, and punctual reviewers from the Society and the Journal of Arthroplasty to assure the requirement for high quality relevant scientific research and an experienced production and Editorial Staff were critical. Regular organized communication among Knee Society and Journal of Arthroplasty staff, editors, reviewers, and authors was paramount. This inaugural Proceedings of The Knee Society in Journal of Arthroplasty is the product of this Knee Society-Journal of Arthroplasty collaboration and team effort intended to provide the most current scientific and innovative work of our Knee Society members to the clinicians, surgeons, researchers, and patients in the arthroplasty community. It is the hope that the Knee Society-Journal of Arthroplasty collaborative product is eagerly anticipated annually by Journal of Arthroplasty readership. The quality of this production would not be possible without grants from two non-profit organizations: AAHKS (American Association of Hip and Knee Surgeons) and OREF (Orthopaedic Research and Education Foundation). Download .pdf (.03 MB) Help with pdf files Conflict of Interest Statement for Callaghan Download .docx (.02 MB) Help with docx files Conflict of Interest Statement for Mont

Preoperative Weight Loss and Postoperative Weight Gain Independently Increase Risk for Revision After Primary Total Knee Arthroplasty.

The current American Association of Hip and Knee Surgeons (AAHKS) guidelines recommend preoperative weight loss before total knee arthroplasty (TKA) in patients with body mass index (BMI) ≥40 kg/m2. However, there is a paucity of evidence on TKA outcomes after preoperative weight loss. This study therefore evaluated predictors of preoperative and postoperative BMI changes and their impact on outcomes after TKA. This is a retrospective review of 3058 primary TKAs at an academic institution from 2015 to 2019. BMI was collected on the day of surgery. Preoperative and postoperative BMI at 6 months and 1 year were also obtained. BMI change of ≥5% was considered clinically significant. Mean follow-up was 3.2 years. Patient demographics, acute postoperative outcomes, and all-cause revisions were compared between patients who gained, lost, or maintained weight using univariate and multivariable analyses. Preoperative weight loss was predictive of postoperative weight gain (P < .001), and preoperative weight gain was predictive of postoperative weight loss (P < .001). Cox regression analysis revealed that ≥5% BMI loss preoperatively increased risk for all-cause revisions (P= .030), while ≥5% BMI gain postoperatively increased risk for prosthetic joint infections (P= .016). Patients who lost significant weight both before and after surgery had the highest risk for all-cause revisions (P= .022). Weight gain postoperatively was associated with inferior outcomes. Significant weight loss before surgery led to a "rebound" in weight gain, and independently increased risk for all-cause revision. Therefore, current recommendations for weight loss before TKA in morbidly obese patients should be re-evaluated.