Joint Arthroplasty in Patients With Left Ventricular Assist Devices.

Impact of IL-23 inhibition versus methotrexate on select major fracture risk and progression to joint arthroplasty in psoriatic patients.

Hip and knee osteoarthritis are highly prevalent conditions associated with pain, disability and increasing demand on orthopaedic services. Best practice guidance emphasises early identification and optimisation of modifiable risk factors to improve outcomes following joint replacement, yet these are often inconsistently addressed in routine musculoskeletal care. This quality improvement project aimed to improve the consistency with which clinicians identified and acted on key modifiable risk factors during orthopaedic interface consultations. The project was conducted in an NHS Orthopaedic Interface Service using the Model for Improvement. A retrospective audit of 291 consultations demonstrated low rates of documented action despite a high prevalence of modifiable risk factors. Four domains were prioritised: excess body weight, smoking, diabetes optimisation and psychosocial factors. A bundle of low-burden interventions was introduced through sequential plan-do-study-act cycles. Prospective monthly sampling of 180 consultations over six months assessed change over time. Across 180 prospective consultations, documented action increased from 30% to 78% among consultations where at least one targeted modifiable factor was present. Improvement was clearest for weight-related advice and signposting. Smoking, diabetes and psychosocial findings were limited by small denominators or variable documentation and were interpreted descriptively. The largest increase was observed following introduction of embedded workflow supports, although attribution to any single component is limited by the sequential QI design. A simple quality improvement bundle was associated with improved documentation of action on modifiable risk factors during routine osteoarthritis consultations, particularly for weight-related advice and signposting. Embedded documentation prompts may support more reliable care processes, but further work is needed to assess sustainability, patient-level outcomes and transferability to other settings.

Liquid crystal elastomers for orthopedic applications: Comparative analysis of formulations and viscoelastic properties.

Osteoarthritis case identification in the million veteran program cohort: Comparison of diagnostic codes versus clinical notes.

Fretting wear behavior of micro-arc oxidized Ti6Al4V articulating against ZTA and CoCrMo for taper junctions in artificial hip joints

Principal Care Management Codes: An Underutilized Tool to Capture Preoperative Optimization Care.

Objective Sleep Disturbance After Total Hip and Knee Arthroplasty: A Systematic Review of Wearable-Derived Metrics and Targeted Interventions.

Stratified Recovery Curves for Patient-Reported Outcomes After Primary Total Knee Arthroplasty.

Medial knee osteoarthritis is increasingly diagnosed in younger adults who are often unsuitable for joint replacement. High tibial osteotomy corrects varus malalignment but is invasive. Gait retraining is a low-cost, non-surgical option to reduce medial tibiofemoral loading, but its effects in varus deformity are unclear. We quantified the immediate biomechanical effects of short-term gait modifications on internal tibiofemoral loading. Twenty-nine patients (30 knees) with medial knee osteoarthritis scheduled for high tibial osteotomy performed three modified gaits: toe out, wide base, and medial thrust. Motion capture and musculoskeletal modelling estimated internal tibiofemoral joint forces in this pre- high tibial osteotomy, varus-aligned cohort. Toe out increased medial loading in early stance but reduced it in late stance. Wide base increased medial and lateral forces early, then reduced medial loading later with compensatory lateral increases. Medial thrust was difficult: only 20/30 knees achieved the target reduction in maximum knee adduction angle, and successful trials still increased early-stance loading. Overall effects were modest, phase-specific, and inconsistent. Generic gait modifications produced small, phase-dependent changes in internal tibiofemoral loading, with early-stance increases, late-stance reductions, and occasional compensatory lateral loading. Longer-term, individualised retraining incorporating symptoms is needed to determine net clinical benefit.

Intraoperative Liposomal Bupivacaine Is Associated With Reduced Opioid Use and Enhanced Recovery After Total Knee Arthroplasty: A Multicenter Registry Study.

The Clopidogrel Dilemma in Thromboprophylaxis Following Total Joint Arthroplasty: Commentary on an article by Sahil S. Telang, BS, et al.: "Postoperative Clopidogrel Thromboprophylaxis in TJA. Increased Risk of Transfusion but Similar Venous Thromboembolic Risk Compared with Aspirin".

Medicare reimbursements for orthopaedic surgeries have consistently declined over past decades, raising concerns about surgeons opting out of Medicare and reducing coverage for older adults. However, little is known about this phenomenon. We conducted a retrospective evaluation of orthopaedic surgeon Medicare opt-outs as of January 2025. We analyzed charge-payment ratios of orthopaedic surgeries performed in areas with versus without opt-outs and examined the 3-year moving averages and population demographics for areas with opt-outs. As of January 2025, 341 orthopaedic surgeons have opted out of Medicare, representing 0.7% of all opted-out practitioners and 1.7% of 2022 Medicare-enrolled orthopaedic surgeons. The median charge-payment ratio for all orthopaedic surgeries is 18.3% higher in areas with these opt-outs compared with those without (95% confidence interval [CI], 11.7% to 30.1%; P < 0.0001) and 34.5% higher for joint arthroplasty and reconstruction surgeries (95% CI, 9.2% to 51.9%; P = 0.0003). These opt-outs primarily occurred in high-cost regions, with approximately 70% of surgeons practicing in areas with regional price parities greater than 110% of the national average. Consequently, Medicare opt-outs by orthopaedic surgeons have risen from 0.3 to 32.0 annually from 2002-2004 to 2022-2024. In 2022, there were 958 reported Medicare beneficiaries of orthopaedic surgeries per zip code in areas with opt-outs, 612 higher than in areas without opt-outs (95% CI, 277 to 629; P < 0.0001). The median proportion of Medicare-eligible individuals by age in areas with opt-outs is 35.8%, 18.1% higher than the national rate (95% CI, 16.3% to 19.3%; P < 0.0001). Orthopaedic surgeons practicing in high-cost and relatively lower reimbursed areas are increasingly opting out of Medicare, disproportionately affecting older adults and higher need areas. These results suggest that correcting declining Medicare surgery reimbursements is critical to minimize coverage lapses for a growing older adult population, which is an important issue in orthopaedic surgery.

➢ Despite substantial health-care spending, both the U.S. and U.K. lack standardized, operational definitions of value in specialty care, limiting their ability to optimize patient-centric health outcomes and appropriate selection and utilization of resources. ➢ First-generation value-based specialty care models in the U.S., like the Bundled Payments for Care Improvement Initiative and Comprehensive Care for Joint Replacement, have achieved modest savings by focusing on post-acute care and procedural efficiency, without negatively impacting quality metrics. Similarly, the Getting It Right First Time initiative in the U.K. aimed to bring about higher-quality care in hospitals, at lower cost, by reducing unwanted variations in services and practices. However, there remains no true understanding of impact on value, of efficacy based on measurement of patient-centric health outcomes that matter to patients, or of whether interventions were appropriately selected in the first place. ➢ A standardized value metric, specifically the incremental cost-effectiveness ratio (ICER), is critical to measuring quality in specialty care, enabling health-care systems to compare treatment options on the basis of both cost and patient-centric outcomes. ➢ The ICER integrates quality-adjusted life years, cost data, and the duration of effectiveness, providing a framework for shared decision-making, care variation reduction, and more strategic site-of-service decisions. ➢ Health-care systems and policymakers should adopt ICER-based frameworks to transition from volume-based incentives to value-based models that support innovation, accountability, and whole-person musculoskeletal specialty care.

With an aging population in the United States, the demand for joint arthroplasty procedures continues to rise. As patient volumes increase in arthroplasty clinics, the documentation burden for each clinic day also grows, creating a demand for tools that can help alleviate this workload. Artificial intelligence (AI)-powered tools, such as automated charting assistants, may enhance provider efficiency by reducing documentation time. This study evaluates whether implementing an AI scribe in an orthopaedic clinic decreases documentation time for providers. A retrospective, nonexperimental analysis was conducted after the adoption of a commercially available Health Insurance Portability and Accountability Act (HIPAA)-compliant AI scribe software tool. Active electronic medical record time per clinic day was measured for a team comprising one orthopaedic surgeon, one physician associate, and one orthopaedic surgery fellow. Resident physicians were excluded because of frequent rotation changes. Before AI implementation, providers saw an average of 38.7 patients (±2.2) over 34 clinic days, compared with 39.9 patients (±2.3) over 27 clinic days after implementation (P = 0.043). Total active EMR time per clinic day significantly decreased by 26.1% after implementation (after: 339.1 ± 78.7 vs. before: 458.8 ± 95.6 minutes; P < 0.0001). Average EMR time per patient decreased by 35.3% (after: 7.7 ± 2.9 vs. before: 11.9 ± 2.5 minutes; P < 0.0001). Total EMR time per clinic day (P = 0.0046) and per patient (P = 0.0002) demonstrated a significant, continual decline throughout the postimplementation period. The use of an AI-powered scribing assistant markedly reduced documentation time in an orthopaedic clinic, enhancing provider efficiency. These findings suggest a promising strategy for alleviating documentation burden, potentially improving clinic workflow as patient volume increases. Larger, multicenter studies are needed to confirm these benefits and explore long-term effects on provider workload and patient care.

Periprosthetic joint infection (PJI) remains a devastating complication of joint arthroplasty. Although intraoperative frozen section histology (> 5 neutrophils/HPF) is incorporated into the 2018 MSIS diagnostic criteria, its prognostic value for predicting postoperative PJI remains controversial. Primary or revision THA/TKA procedures in our hospital between January 1, 2015 and December 31, 2021 with intraoperative frozen section histologic results were eligible for inclusion. Association between intraoperative frozen section histology and postoperative PJI was investigated based on the medical records, and a similar analysis of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) was also performed. A total of 14,969 knee/hip procedures were identified. After case selection, 797 cases comprising 529 (66.4%) primary and 268 (33.6%) revision were included. According to our data, frozen section positivity showed no PJI association, both in primary (OR, 1.206 [95% CI, 0.133-10.914], P > 0.999) and revision procedures (OR, 1.287 [95% CI, 0.331-5.007], p = 0.717). Conversely, elevated CRP (OR, 15.196 [95% CI, 1.916-120.523], p = 0.001) and ESR (OR, 5.794 [95% CI, 1.4979-22.4129], p = 0.008) predicted PJI exclusively in revisions. Therefore, isolated positive frozen section results should not be the sole basis for surgical strategy. Elevated CRP/ESR levels during revision surgery warrant heightened vigilance and consideration of extended anti-infective treatment. III.

Incidence of spinal-epidural haematoma after neuraxial anaesthesia for total hip and knee arthroplasty: a single-centre analysis of 96 103 consecutive cases from 2013 to 2023.

Ultra-high molecular weight polyethylene (UHMWPE) is widely utilized for artificial joints to its superior wear resistance and biocompatibility. Nevertheless, restricted mechanical strength and surface hardness still pose a challenge, and formation of wear debris can lessen implant life. In this research, UHMWPE was reinforced with functionalized multi-walled carbon nanotubes (fMWCNTs) in combination with nano-hydroxyapatite (nHA) as hybrid nanofiller (HNF) to enhance both mechanical and tribological features. The fMWCNTs were prepared by oxidative-ammonolysis treatment, confirmed by FT-IR analysis showing hydroxyl, carbonyl, and amine functional groups that enhanced compatibility and bonding strength with the polymer matrix. Nanocomposites with HNF concentrations ranging from 0.5% to 5.0 wt% were fabricated and characterized for tensile, flexural, hardness, and wear performance. The resulting data revealed that the addition of HNFs (1:1 in wt%) improved all mechanical characteristics at low and intermediate loadings, with the optimum enhancement at 3.0 wt%. This particular specimen displayed increases of (11.6, 12.4, and 9.6)% in each tensile strength, flexural strength, and hardness, respectively, relative to the neat polymer. In addition, a decrease of 63.0% of specific wear rate implies exceptional wear resistance owing to homogeneous filler distribution and stable tribofilm development. However, a high content of 5.0 wt% demonstrated minimized mechanical efficiency caused by agglomeration, as reflected in FE-SEM images. These findings indicate that fMWCNTs- nHA blending yields a synergistic enhancement of strength, hardness and wear resistance of the matrix, making the present hybrid system a potential prospect in orthopedic implant uses.

Clinical Outcomes of Surgical Options for Base-of-Thumb Arthritis: A Systematic Review and Network Meta-Analysis.

To explore the clinical feasibility and effect of minimally invasive treatment of accidentally sutured surgical drains after arthroplasty with orthopedic broken screw hollow saw, in order to provide a safe and convenient solution for clinical practice. Between January 2016 and October 2023, the clinical data of 5 patients with accidentally sutured surgical drains after orthopedic joint replacement were retrospectively analyzed. There were 4 males and 1 female with an average age of 69.6 years ranging from 65 to 75 years. The hollow saw for broken screws in the orthopedic tool kit for broken screws was used to closely follow the drainage tube wall to the suture site for precise cutting operation without additional self-made tools or enlarged incision. By measuring the length of the extracted drainage tube and cross-checking it with the original record, while simultaneously examining the tube's integrity to confirm the absence of any residue. The drainage tubes were successfully removed in 5 patients, and the removal process took 3-8 minutes, with an average of 5.4 minutes (excluding the time of instrument preparation and disinfection). After removal, all the drainage tubes were complete in shape, the measured length was completely consistent with the intraoperative depth record, and no fracture or residue was confirmed; no high-density foreign body shadow was found in the postoperative X-ray examination. There was no exudation or incision dehiscence after operation. All patients were followed up 24 months, and there was no sign of joint dysfunction, chronic pain or infection, and no complications related to delayed foreign body residues. The application of orthopedic broken screw hollow saw in the treatment of accidentally sutured surgical drains after orthopedic joint replacement has the advantages of simple operation, minimally invasive, short time-consuming, high success rate and no need for self-made tools.