Knee Arthroplasty Research Articles

The Outcomes at 3 Years in 82 Knees with Kellgren and Lawrence 2–3 Osteoarthritis Treated with an Autologous Protein Fluid Concentrate Produced with a Fluid Volume Reducer

Introduction: Knee osteoarthritis (OA) is a highly prevalent and debilitating condition with significant emotional and economic impacts. Current treatment options may only provide temporary pain relief and are not regenerative, thus the progression of knee OA is not deterred and total knee arthroplasty is inevitable. Injection therapies with orthobiologics possess regenerative potential and are an emerging treatment option. We present a prospective study aimed at examining patients with knee OA who had received an autologous platelet concentrate fluid (APCF) injection produced through a fluid volume reducer. Methods: This was an observational review of the results following an APCF injection in a cohort of patients at a single site. Patients were included in the study if they were diagnosed with K/L grade 2–3 knee OA and treated with an APCF knee injection. Patients were excluded if they had obtained an orthobiologic injection in the three months prior to study enrollment or if baseline data were unavailable. Knee score and function score were used to assess patients at the baseline and post-injection follow-ups. Results: Improvements for knee score were statistically significant for the follow-ups at three months, six months, one year, and three years. Function score improved, with statistically significant changes for the three month and three year follow-ups. Conclusions: Our study demonstrates that there is some utility in using APCF injection for knee OA, with improvements that may be sustained up to three years in some patients.

Bizarre Parosteal Osteochondromatous Proliferation With Malignant Transformation and Metastases.

A patient with a benign bizarre parosteal osteochondromatous proliferation (BPOP) located in the anterior knee was treated with resection in preparation for total knee arthroplasty (TKA). The BPOP reoccurred and was treated with re-resection at the time of TKA. The BPOP reoccurred a second time and underwent malignant transformation to a fungating high-grade pleomorphic sarcoma with metastatic lesions. This case highlights the rare potential of a previously benign BPOP to undergo malignant transformation after recurrence. A wide margin resection may be considered primarily when surgery is indicated to prevent recurrence and its potential sequelae. [Orthopedics. 202x;4x(x):xx-xx.].

Comparison of Clinical and Patient Reported Outcomes in One-Sided Cruciate-Retaining Versus Other-Sided Posterior Stabilizing Protheses in Bilateral Simultaneous Total Knee Arthroplasty

Comparison of Clinical and Patient Reported Outcomes in One-Sided Cruciate-Retaining Versus Other-Sided Posterior Stabilizing Protheses in Bilateral Simultaneous Total Knee Arthroplasty

Fixed-bearing medial unicompartmental knee arthroplasty restores pre-arthritic coronal alignment and achieves satisfactory functional outcomes: a retrospective study

PurposeThis study aimed to (1) analyze the Coronal Plane Alignment of the Knee (CPAK) classification in patients undergoing unicompartmental knee arthroplasty (UKA), (2) assess whether UKA can restore pre-arthritic coronal alignment by utilizing the arithmetic hip-knee-ankle angle (aHKA), and (3) evaluate the relationship between patient-reported outcome measures (PROMs) and postoperative alignment following UKA.MethodsWe retrospectively analyzed 152 consecutive patients who underwent fixed-bearing medial UKA. A radiological analysis was conducted using an EOS imaging system. Postoperative alignment was classified as neutral (varus ≤ 3°), mild varus (3° < varus ≤ 7°), or marked varus (varus > 7°) based on the mechanical hip-knee-ankle angle (mHKA). The aHKA was calculated and the CPAK classification was used to categorize knee phenotypes. The PROMs were obtained both before and after the surgery.ResultsA total of 152 knees from 113 patients were included with a mean two-year follow-up. The mean difference between the postoperative mHKA and the estimated aHKA was 0.80° (90% CI 0.35 to 1.24; P = 0.003). Postoperatively, 63 (41.45%) of the 152 knees were in neutral group, 54 (35.53%) mild varus, and 35 (23.03%) marked varus. The neutrally aligned cohort did not exhibit significantly higher scores in range of motion, VAS, HSS, WOMAC, or FJS-12 scores compared to the mild or marked varus cohort (P = 0.205, 0.118, 0.076, 0.140, and 0.788, respectively) during the short-term follow-up.ConclusionNon-robotically assisted, fixed-bearing medial UKA can restore pre-arthritic coronal alignment and achieve satisfactory PROMs. Fixed-bearing medial UKA aims to restore the pre-arthritic alignment rather than achieving neutral mechanical alignment.

Antigravity treadmill training after knee surgery: A scoping review.

Antigravity treadmill training provides a viable option for physiotherapeutic care after knee surgery, especially for conditions that do not allow full weight bearing during the early phase post-intervention. This overview of the current state of knowledge identifies gaps and highlights areas where more research on antigravity treadmill training after knee surgery is needed. This review aimed to analyze and summarize the available evidence concerning the effects of antigravity treadmill training on patients after knee joint surgical procedures, including anterior cruciate ligament reconstruction (ACLR) and total (TKA) and unicompartmental knee arthroplasty (UKA). Several databases were searched for relevant material, including PubMed, Epistemonikos, the Cochrane Library, the Web of Science, and Google Scholar. Seven studies investigating antigravity treadmill training after various procedures were included, including ACLR and TKA. The studies were summarized, and the quality of evidence was evaluated using the appropriate tools. The evidence yielded by these studies suggests that antigravity treadmill training might be useful after knee surgery. However, the superiority over traditional physiotherapeutic measures has yet to be established. Therefore, future high-quality randomized controlled trials (RCTs) are needed to investigate the effect of antigravity treadmill training due to the low quality of available evidence. Also, a cost-effectiveness analysis is required to determine whether the investigated intervention fits the purpose.

The effectiveness of vitamin D supplementation in patients with end-stage knee osteoarthritis: Study protocol for a double-blinded, randomized controlled trial.

Osteoarthritis (OA) knee is one of the most common chronic degenerative conditions that imposes clinical and economic burdens on individuals and societies worldwide. Previous studies showed vitamin D levels correlated positively with lean muscle mass and grip strength, implying that vitamin D supplementation may improve muscle health in knee OA subjects. This randomized controlled trial (RCT) aims to compare the effects of vitamin D supplementation on knee muscle strength, physical function, pain, and sarcopenia status in patients with end-stage knee OA. Patients and outcome assessors will be blinded to group allocation. Fifty-six end-stage knee OA patients with vitamin D insufficiency fulfilling our inclusion criteria will be invited to participate in this study. Patients will be randomly assigned to take vitamin D supplementation (4,000 IU capsule daily) or placebo for six months. Measurements will be taken at baseline, three and six-month after the commencement of the vitamin D supplement, and 6-month after the interventional period. The primary outcome includes the isometric quadriceps and hamstring muscle strength measured by a hand-held dynamometer. Secondary outcomes include pain, performance-based and self-reported physical function and sarcopenia status. The success of this study will provide scientific evidence of whether the relatively cheap and well-tolerated vitamin D supplement can improve quadriceps muscle strength, physical function, pain symptoms, and sarcopenia status of this increasingly large population for end-stage knee OA patients. The study has great clinical significance given Hong Kong's lengthy and growing waiting list for complete knee replacement procedures. Trial registration: The trial was registered on clinicaltrials.gov (NCT05981534) on 31st July 2023.

Related Factors and Risk Prediction of Chronic Pain after Knee Replacement.

This study aimed to explore potential risk factors associated with chronic pain after total knee arthroplasty (TKA) and to establish the risk prediction model of chronic postoperative pain (CPSP). This study retrospectively analyzed the clinical data of 160 patients who underwent TKA in our hospital between January 2021 and January 2024. Relevant data such as the baseline characteristics, past medical history, CPSP condition, and pain numerical rating scale (NRS) were retrieved from the medical information system. Logistic regression analysis was performed on the risk factors affecting the postoperative CPSP of the patients. The identified risk factors were incorporated to develop a risk-prediction model. Among the 160 patients, 67 (41.88%) had CPSP at or around the operation incision. The NRS pain score was significantly higher in the CPSP group than in the non-CPSP group during exercise preoperative and 3 months post-operation. Furthermore, the CPSP group had a higher NRS score than the non-CPSP group at rest 3 months after the procedure (p < 0.05). We observed that the preoperative NRS score, preoperative hospital for special surgery (HSS) score, postoperative functional training, and postoperative adverse events were the independent factors influencing the occurrence of CPSP after TKA (p < 0.05). Additionally, there was a significant positive correlation between preoperative NRS score, postoperative adverse events, and CPSP pain severity, and a significant negative correlation between preoperative HSS score, postoperative functional training, and CPSP pain severity (p < 0.05). The receiver operating characteristic (ROC) curve had excellent calibration and prediction capabilities for the predictive model of CPSP after TKA, with the area under the curve (AUC) of 0.868 (95% CI: 0.811-0.925). In this study, the predictive model of CPSP risk for patients after TKA surgery was initially constructed, which can help medical staff predict the risk of CPSP in patients after surgery individually, thereby preventing the occurrence of CPSP.

Effectiveness of Periarticular Pin Tracker Placement Through a Single Main Incision in Robotic-Assisted Total Knee Arthroplasty: Technical Note and Short-Term Results.

Background and Objectives: Robotic-assisted total knee arthroplasty (TKA) is gaining popularity worldwide, leading to a potential increase in the number of pin tracker-related complications. This study determined the effectiveness of periarticular pin tracker placement in the distal femur and proximal tibia through a single main incision during robotic-assisted TKA over a minimum follow-up period of 6 months. Materials and Methods: A consecutive series of 149 TKAs was performed in 108 patients using the triathlon posterior-stabilized total knee prosthesis with a robotic-assisted system at our hospital from December 2023 to February 2024. Clinical outcomes and complications associated with pin tracker sites, including pin-site infection, neurovascular injury, hematoma, soft-tissue morbidity, and pin-site fracture, were assessed. Results: The mean Knee Society knee score improved from 42.5 preoperatively to 76.3 points at the final follow-up, whereas the mean Knee Society function score improved from 43.1 preoperatively to 78.1 points at the final follow-up (both p < 0.05). No patient experienced any minor or major complications related to the use of pin trackers in the distal femur and proximal tibia. Conclusions: This periarticular technique that uses pin trackers in the distal femur and proximal tibia through a single main incision could be a useful option for orthopedic surgeons while performing robotic-assisted TKA.

Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis

BackgroundWhile the prevalence of total knee arthroplasty (TKA) is increasing, reimbursement is declining. The purpose of this study was to determine how surgeon gender influences procedure volume, reimbursement, practice style, and patient demographics for TKAs nationally and regionally between 2013 and 2021. MethodsThe Medicare Physician and Other Practitioners database was queried from 2013 to 2021 for procedure volume, TKA reimbursement, surgeon characteristics, and patient demographics for any surgeon who performed at least ten primary TKAs per year. Statistical tests were conducted to analyze differences based on surgeon gender, geography, and year. ResultsOf the 2,415,802 TKAs performed between 2013 and 2021, 1.5 % were billed by female surgeons. The number of TKAs performed annually increased by 29.1 % for female surgeons and decreased by 2.6 % for male surgeons. Between 2013 and 2021, reimbursement for TKAs decreased by 23.9 % for male surgeons and 26.2 % for female surgeons. In 2021, male surgeons were reimbursed $1017 per TKA while female surgeons were reimbursed $964 (p = 0.049). Male surgeons performed more TKAs annually in 2021 (Male: 39.3, Female: 30.9, p < 0.001), more total billable services (Male: 4148.0, Female: 2719.3, p < 0.001), and more unique billable services (Male: 70.7, Female: 55.3, p < 0.001) than female surgeons. ConclusionsFemale representation among surgeons who perform TKAs is increasing nationally. However, male surgeons treat more patients, perform more total billable services, and perform more unique billable services than female surgeons. TKA reimbursement is decreasing at a faster rate for female surgeons than male surgeons, although this is likely due to geographical differences.

Complications following total knee arthroplasty in patients with prior extensor mechanism dysfunction: A retrospective review

BackgroundExtensor mechanism disruption following total knee arthroplasty (TKA) is a rare, yet serious complication. While previous patellar abnormalities are a theoretical risk factor for this complication, there is a scarcity of literature describing the impact of prior extensor mechanism dysfunction (EMD) on this and other complications following TKA. In this study, we describe our institutional experience with complications following TKA after EMD. MethodsSixty-one knees that underwent total knee arthroplasty between April 2007 and April 2023 in patients with previous EMD were identified. Extensor mechanism dysfunction types included patellar fracture, patellar tendon rupture, patellar realignment surgery, previous patellar dislocation, and a chronic laterally tracking patella impacting extensor mechanism function. Primary outcomes included extensor mechanism failure, infection, dislocation, aseptic loosening, revision surgery, and stiffness requiring manipulation under anesthesia (MUA). ResultsA total of 61 knees, comprised of 53-patients, were included. There were complications witnessed in fifteen patients, leading to a 24.6 % overall complication rate. There was one extensor mechanism disruption in the form of a partial quadriceps tendon tear requiring repair. There was one patellar dislocation requiring reoperation. There were five superficial infections successfully treated non-operatively and four deep infections requiring reoperation. A total of nine reoperations were performed, four of which were revisions. Four patients underwent MUA due to severe post-operative stiffness. ConclusionIn this study, we found a high complication rate following TKA in patients with previous extensor mechanism dysfunction. There was one case of partial quadriceps tendon rupture requiring repair.

Postoperative decrease in serum albumin as predictor of early acute periprosthetic infection after total knee arthroplasty

PurposePatients with hypoalbuminemia, (serum albumin (SA) < 3.5 g/dL) are at greater risk for complications after surgery, including increased postoperative infection rates after total knee arthroplasty (TKA). This study aimed to analyze both preoperative and postoperative SA in patients who experienced acute periprosthetic infection within the first 4 weeks after surgery.MethodsWe retrospectively analyzed data from 490 consecutive TKAs (314 patients). Five patients developed early acute infection requiring surgical treatment. SA data were collected preoperatively (SA0) and 1 week postoperatively (SA1W) to evaluate SA dynamics. Multiple patient and operative parameters that could influence SA were also analyzed.ResultsNo statistical differences were found in parameters expected to influence SA values between the surgically treated (STG) and non-treated groups (non-STG). None of the patients in STG had SA0 and SA1W below 3.5 g/dL. However, the amount and rate of SA reduction before and after surgery were significantly greater in STG than in non-STG.ConclusionSA dynamics revealed a greater reduction in both the amount and rate in STG before and after surgery than in non-STG. No correlation was found between early acute periprosthetic infection after TKA and each SA0 and SA1W time point. Further evaluation of the SA value of 3.5 g/dL as a threshold for acute early acute infection is warranted.

Is Dexamethasone Administration During Total Hip and Knee Arthroplasty Safe in Diabetic Patients?

Dexamethasone is used extensively during total hip and knee arthroplasty total joint arthroplasty (TJA) to control pain and decrease the risk of nausea and vomiting. However, the safety of dexamethasone utilization in diabetic patients is poorly understood. Therefore, this study aims to evaluate complications associated with perioperative dexamethasone administration during primary TJA in diabetic patients. The Premier Healthcare Database was queried for all patients with diabetes mellitus who underwent primary elective TJA from 2015 to 2020. Patients who received intravenous dexamethasone on the day of surgery were compared with those who did not. Patient characteristics, hospital factors, and rates of medical comorbidities were assessed and compared between the cohorts. Multivariate logistic regression was done to assess the 90-day risk of infectious and noninfectious postoperative complications. Overall, 261,474 diabetic patients were included for analysis, 122,631 (46.9%) of whom received dexamethasone. The two cohorts were similar in patient demographics, hospital characteristics, and comorbidity burden (absolute range of differences: 0.00 to 2.33%). Diabetic patients who received dexamethasone had decreased odds of periprosthetic joint infection (adjusted odds ratio 0.82, 95%-CI: 0.75 to 0.90, P < 0.001) and sepsis (aOR: 0.80, 95%-CI: 0.72 to 0.89, P < 0.001) compared with those who did not. Patients who received dexamethasone had shorter length of stay compared with those who did not (1.87 ± 1.60 days vs. 2.27 ± 1.88 days, P < 0.001). The adjusted odds of postoperative hyperglycemia were markedly higher in the dexamethasone group (aOR: 1.14, 95%-CI: 1.10 to 1.18, P < 0.001). Use of perioperative dexamethasone was not associated with the increased risk of infectious complications among diabetic patients undergoing TJA, supporting its safety in this high-risk population.

Clinical, functional and neuropsychological status of joint replacement patients

Introduction The number of hip and knee replacement surgeries is increasing annually in Russia and worldwide. The majority of patients receiving joint arthroplasties are elderly women.The objective was to assess the clinical, functional and neuropsychological status of patients undergoing total knee or hip replacement.Material and methods The study included 448 patients admitted for elective surgery of total knee or hip replacement at the Department of Traumatology and Orthopedics of the Federal Center for High Medical Technologies (CHMT, Kaliningrad Region). Anthropometric parameters of the patients were measured, the medical history and concomitant diseases recorded. Common blood count and biochemistry test were evaluated preoperatively. Neuropsychological examination included assessment of cognitive and executive functions, levels of distress, depression, anxiety and somatization.Results Almost all patients studied were found to have varying degrees of obesity. A typical combination of concomitant pathology in volunteers was stage 2 hypertension, risk degree 2–3, and chronic gastritis in remission. Half of the volunteers showed moderate and high levels of distress, depression, anxiety and somatization. A significant number of volunteers showed moderate to high levels of cognitive decline. Age- and sex-related blood counts were slightly different from the normal ranges for a CBC and biochemistry. Changes in leukocyte count were detected.Discussion Leukocyte counts indicated the osteoarthritis induced inflammatory process in most patients. Mitochondrial dysfunction and aging of the immune system contributed to the “proinflammatory status.” The high rate of cognitive impairment in volunteers was associated with age and comorbidity, cardiovascular conditions, in particular. Distress and anxiety were associated with emotional reactions to surgery.Conclusion The factors reported can affect the duration and course of rehabilitation. The “pro-inflammatory status” of patients can complicate the healing of a postoperative wound. Neuropsychological disorders noted during postoperative rehabilitation can have a significant impact on physical recovery, social and professional adaptation.

The Effect of Changes in the Body Mass Index After Total Knee and Hip Arthroplasty on Patient Functional Scores

The Effect of Changes in the Body Mass Index After Total Knee and Hip Arthroplasty on Patient Functional Scores

Postoperative Complications in Patients With Metabolic Syndrome Following Unicompartmental Knee Arthroplasty.

Metabolic syndrome is associated with increased risk of postoperative complications following various orthopedic surgeries. This study looked to identify specific postoperative complications in these patients following unicompartmental knee arthroplasty (UKA). Adult patients undergoing primary UKA were queried in the National Surgical Quality Improvement Program database from 2006-2019. Metabolic syndrome was defined by the simultaneous presence of hypertension, diabetes, and body mass index >30 kg/m2. Two patient groups were categorized in this study: patients with metabolic syndrome and patients without metabolic syndrome. Baseline characteristics and postoperative outcomes were compared between the two cohorts with the use of bivariate and multivariate analyses. In total, 10,557 patients underwent UKA. Of these, 9,511 patients (90.1%) did not have metabolic syndrome whereas 1,046 (9.9%) had metabolic syndrome. Following adjustment for potential confounding variables on multivariate analysis, metabolic syndrome patients had an increased risk of an extended length of stay greater than four days (OR 1.66; p=0.016) compared to patients without metabolic syndrome. Metabolic syndrome was associated with an increased risk of extended length of stay greater than four days following UKA. Physicians should be prepared for this complication as well as others when discussing treatment with metabolic syndrome patients.

Preoperative, Intraoperative & Postoperative Concepts to Prevent Infection for Unicompartmental Knee Arthroplasty

Periprosthetic joint infection (PJI) is a complication that occurs in less than 1% of patients after unicompartmental knee arthroplasty (UKA). Though infrequent, it may potentially lead to revision while placing a significant financial burden on the healthcare system. Pre-operative, intra-operative, and postoperative strategies should be implemented to minimize the risk of PJI. Patient optimization prior to surgery can help to identify patients at risk for PJI and also maximize the health of the patient prior to surgery. Intraoperative and postoperative strategies can also mitigate the risk of postoperative infection. This article will summarize the evidence for preoperative, intra-operative, and postoperative strategies to prevent PJI in UKA. This will include topics on malnutrition and obesity, staphylococcus aureus, smoking, human immunodeficiency virus, rheumatoid arthritis, as well as skin preparation, laminar air flow, preoperative antibiotic administration anti-microbial incision drapes, pulsatile lavage, vancomycin powder, wound closure method, thromboprophylactic agents, and closed incisional negative pressure wound therapy dressings.

THE EFFECT OF EXERCISES OF DIFFERENT INTENSITY APPLIED AFTER TOTAL KNEE ARTHROPLASTY ON POST-OPERATIVE PAIN: RANDOMIZED CONTROLLED TRIAL

Purpose: This study aimed to investigate the changes in pain following exercise sessions with different intensities in patients who underwent total knee arthroplasty (TKA). Methods: This is a repeated measure and single-blinded randomized controlled study. Thirty-six patients who underwent TKA (age, 64.9 ± 7.42 years) were randomly assigned to either low-intensity exercises (LIEs) group or high-intensity exercises (HIEs) group. Exercise programs lasted for five days during the hospitalization period. Pain intensity was assessed by visual analog scale (VAS) and pressure pain thresholds (PPTs) were measured over quadriceps and biceps brachii and muscles immediately before and after exercise. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale (pain, stiffness, and physical function) scores were recorded at two points in baseline and discharge from the hospital. Results: The pain intensity decreased in patients in both groups after TKA. PPTs increased in both groups at all tested sites following the first, third, and fifth exercise bouts. HIE program had a greater positive effect on the pain intensity after the first exercise session than LIE program on the PPTs ([Formula: see text] &lt; 0.05). HIE program was more effective in order to reduce pain severity immediately after the exercise sessions in patients ([Formula: see text]: 0.5, [Formula: see text] &lt; 0.05). WOMAC scores significantly improved in both groups during the discharge from the hospital ([Formula: see text] = 0.001). Conclusion: Our results found that both LIE and HIE programs performed during hospitalization after TKA declined pain intensity. Particularly notable were the substantial improvements observed in managing post-operative pain, especially following the second exercise session. The HIE program proved more effective in improving stiffness, and enhancing physical function.

Perioperative Analgesic Interventions for Reduction of Persistent Postsurgical Pain After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-analysis.

High pain levels immediately after surgery have been associated with persistent postsurgical pain. Still, it is uncertain if analgesic treatment of immediate postsurgical pain prevents the development of persistent postsurgical pain. We searched MEDLINE, CENTRAL, and Embase up to September 12, 2023, for randomized controlled trials investigating perioperative analgesic interventions and with reported pain levels 3 to 24 months after total hip or knee arthroplasty in patients with osteoarthritis. The primary outcome was pain score 3 to 24 months after surgery, assessed at rest and during movement separately. Two authors independently screened, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. We conducted meta-analyses and tested their robustness with trial sequential analyses and worst-best and best-worst case analyses. We included 49 trials with 68 intervention arms. All but 4 trials were at high risk of bias for the primary outcome. Moreover, the included trials were heterogeneous in terms of exclusion criteria, baseline pain severity, and which cointerventions the participants were offered. For pain at rest, no interventions demonstrated a statistically significant difference between intervention and control. For pain during movement, perioperative treatment with duloxetine (7 trials with 641 participants) reduced pain scores at 3 to 24 months after surgery (mean difference -4.9 mm [95% confidence interval {CI}, -6.5 to -3.4] on the 0-100 visual analog scale) compared to placebo. This difference was lower than our predefined threshold for clinical importance of 10 mm. We found no perioperative analgesic interventions that reduced pain 3 to 24 months after total hip or knee arthroplasty for osteoarthritis. The literature on perioperative analgesia focused little on potential long-term effects. We encourage the assessment of long-term pain outcomes.

Associations Between Patients' Primary Language and Outcomes and Patient Engagement Process Metrics for Total Joint Arthroplasty.

Previous research has indicated language-based disparities in outcomes after total hip and knee arthroplasty. In this study, we examined the relationship between primary spoken language and outcomes and patient engagement process metrics in a multihospital academic health system. This retrospective cohort study included patients who underwent elective primary total hip or knee arthroplasty in 2018 to 2022. Primary language was categorized as English, Spanish, and Other. Associations were examined between language and perioperative outcomes (same-day discharge, extended hospital length of stay, nonhome discharge, 30-day hospital returns, 90-day readmissions, and 90-day combined complications), and engagement-related metrics (preoperative joint class attendance and patient-reported outcome measure [PROM] completion). We report adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 8,220 patients (7.9% Spanish and 5.1% Other non-English), we found no notable associations between language and same-day discharge, nonhome discharge, 30-day hospital returns, 90-day readmissions, or 90-day complications. Other (versus English) language was significantly associated with decreased odds of extended length of stay (OR 0.49, 95% CI, 0.32 to 0.76, P = 0.001). In patient engagement, Other (versus English) language was associated with significantly decreased odds of preoperative class attendance (OR 0.72, 95% CI, 0.54 to 0.95, P = 0.02). Spanish (versus English) primary language was significantly associated with decreased odds of preoperative and 1-year PROM completion (OR 0.34 to 0.75, P ≤ 0.001), and Other (versus English) primary language was significantly associated with decreased odds of preoperative PROM completion (OR 0.59, 95% CI, 0.47 to 0.73, P < 0.001). Our findings highlight language-based disparities in patient engagement metrics but comparable outcomes. Differences in findings compared with past literature may be related to institution-specific language-related support systems. There is a need for additional resources to support patients' active participation in their care, regardless of their primary spoken language.

The Association of Glycemic Control Medication Regimens and Preoperative Fructosamine Among Total Joint Artrhoplasty Patients.

Although glycated hemoglobin A1C (HbA1c) has classically been used for glycemic control screening before surgery, fructosamine, a short-term glucose variability indicator, has been reported to be a more accurate predictor of postoperative periprosthetic joint infection among patients with diabetes mellitus (DM). Given the variability of diabetic medication management, this study aims to identify the associated effect of glycemic control medication regimen (GCMR) on the incidence rate and associated odds of abnormal preoperative fructosamine levels among diabetic primary total knee arthroplasty or total hip arthroplasty patients. Between 2017 and 2018, consecutive series of total hip arthroplasty and total knee arthroplasty patients were identified, and the final cohort included only diabetic patients. All patients reported preoperative HbA1c and fructosamine levels. GCMR categories included insulin, metformin, and other. Independent risk of GCMR and abnormal fructosamine levels (>293 µmol/L) were identified using multivariable logistic regression, while controlling for preoperative baseline factors including HbA1C. Among 420 patients, 15.7% (66/420) were diabetic, of whom 22.7% (15/66) reported an abnormal fructosamine level. Among patients requiring GCMR, 24.0% (18/75), 56.0% (42/75), and 77.7% (58/75) reported using insulin, other, and metformin, respectively. Multivariable logistic regressions demonstrated that insulin-dependent patients with DM reported a 1.71 (95% confidence interval [CI], 0.096 to 30.213, P = 0.716) increased odds of abnormal fructosamine levels compared with nonactive GCMR patients, whereas patients managed with metformin and other glycemic control medications reported a protective 0.48 (95% CI, 0.418 to 5.407, P = 0.549) and 0.32 (95% CI, 0.216 to 4.508, P = 0.393) decreased odds of abnormal fructosamine levels, respectively. In this study, insulin and other GCMR medications exhibited a trend for increased and decreased odds of having abnormal preoperative fructosamine levels while controlling for baseline HbA1c level compared with patients with DM without active GCMR. This association may be explained by multifactorial short-term glucose variability in insulin users, indicating the continued need and optimization of short-term glycemic variations instead of HbA1c.