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Aim: The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. Methods: We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Results: Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Conclusion: Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.

Introduction More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%–0.5% fatal PE, and over 1000 deaths. Antithrombotic prophylaxis is standard of care but evidence is limited and conflicting. We will compare effectiveness of three commonly used chemoprophylaxis agents to prevent all-cause mortality (ACM) and clinical venous thromboembolism (VTE) while avoiding bleeding complications.Methods and analysis Pulmonary Embolism Prevention after HiP and KneE Replacement is a large randomised pragmatic comparative effectiveness trial with non-inferiority design and target enrolment of 20 000 patients comparing aspirin (81 mg two times a day), low-intensity warfarin (INR (International Normalized Ratio) target 1.7–2.2) and rivaroxaban (10 mg/day). The primary effectiveness outcome is aggregate of VTE and ACM, primary safety outcome is clinical bleeding complications, and patient-reported outcomes are determined at 1, 3 and 6 months. Primary data analysis is per protocol, as preferred for non-inferiority trials, with secondary analyses adherent to intention-to-treat principles. All non-fatal outcomes are captured from patient and clinical reports with independent blinded adjudication. Study design and oversight are by a multidisciplinary stakeholder team including a 10-patient advisory board.Ethics and dissemination The Institutional Review Board of the Medical University of South Carolina provides central regulatory oversight. Patients aged 21 or older undergoing primary or revision hip or knee replacement are block randomised by site and procedure; those on chronic anticoagulation are excluded. Recruitment commenced at 30 North American centres in December 2016. Enrolment currently exceeds 13 500 patients, representing 33% of those eligible at participating sites, and is projected to conclude in July 2024; COVID-19 may force an extension. Results will inform antithrombotic choice by patients and other stakeholders for various risk cohorts, and will be disseminated through academic publications, meeting presentations and communications to advocacy groups and patient participants.Trial registration NCT02810704.

Purpose. To review mid-term results after replacing the polyethylene liner in a well-fixed acetabular shell. Methods. 22 patients underwent replacement of the polyethylene liner in a well-fixed acetabular shell using cementation. The inner surface of the metal shell was scored with grooves (1 to 2 mm deep) for cement interdigitation. Trial liners were used to assess the appropriate size, with an aim to provide at least 2 mm of an even cement mantle behind the polyethylene liner. None of the liners were constrained or lipped. Clinical and radiographic outcomes were evaluated, and Harris Hip Scores obtained. Radiographic loosening of the acetabular shell was recorded. Implant survival was evaluated using the Kaplan-Meier estimator. Results. After a mean follow-up of 70 (range, 21–189) months, 17 patients had stable hips and their mean Harris Hip Score was 89 (range, 72–93). Four patients underwent re-revision after 28 to 108 months for aseptic loosening of the acetabular shell (n=2) and recurrent dislocation (n=2). One patient showed radiographic evidence of acetabular migration but was stable. The femoral components of all patients were stable. 92% of patients had good-to-excellent results. Implant survival at 60 months was 81% (95% confidence interval [CI], 51–94%); it became 91% (95% CI, 61–99%) if reductions for dislocations were excluded. Conclusion. Cementation of an undersized polyethylene liner into a non-modular shell is one option for revision of a well-fixed acetabular shells. Nonetheless, further follow-up is required to determine if it remains a viable option in the long term. If there is any doubt about the stability of the acetabular shell, a complete revision should be performed.

Purpose. To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries. Methods. 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to 400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen. Conclusion. Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.

Traditional imaging techniques for the localization and monitoring of bacterial infections, although reasonably sensitive, suffer from a lack of specificity. This is particularly true for musculoskeletal infections. Bacteria possess a thymidine kinase (TK) whose substrate specificity is distinct from that of the major human TK. The substrate specificity difference has been exploited to develop a new imaging technique that can detect the presence of viable bacteria.Eight subjects with suspected musculoskeletal infections and one healthy control were studied by a combination of [(124)I]FIAU-positron emission tomography and CT ([(124)I]FIAU-PET/CT). All patients with proven musculoskeletal infections demonstrated positive [(124)I]FIAU-PET/CT signals in the sites of concern at two hours after radiopharmaceutical administration. No adverse reactions with FIAU were observed.[(124)I]FIAU-PET/CT is a promising new method for imaging bacterial infections.

Bone morphogenetic proteins (BMPs) are capable of promoting bone healing and even induce de novo osteogenesis. Their clinical application in spinal fusion surgery has recently increased in popularity. This is especially true for the use of BMPs in combination with artificial bone substitutes that have the capability to replace autologous bone graft, which can be associated with severe harvesting complications. This review will examine the use of BMP-2 and BMP-7 as commercially available products that have proven their osteoinductive capacity in spinal fusion. We will perform an overview of the literature for scientific evidence supporting the use of these new technologies. Despite their high osteoinductive potency, the use of BMPs does not replace proper surgical stabilization in spinal fusion. Safety issues with BMPs are osteoclast activation, postoperative swelling and hyperostosis. Despite these issues, manufacturers continue to expend more effort concerning proper application, dosage and carriers for these devices for spinal fusion, both presently and in the future. [ABSTRACT FROM AUTHOR]

Background: As the use of robotics in total hip arthroplasty (THA) continues to gain popularity, differences in clinical outcomes when compared to manual techniques have remained unclear. This study aimed to compare postoperative complications between patients undergoing robotic-assisted techniques and manual THA for primary osteoarthritis at 90 days, 1 year, and 2 years. Methods: Using an all-payer national database, we identified 405,048 patients who underwent either robotic-assisted or manual THA for primary osteoarthritis. A propensity match was performed for age, sex, a comorbidity index, chronic kidney disease, obesity, and diabetes, resulting in 7652 patients in each cohort. We assessed postoperative outcomes, including surgical site infections, pulmonary emboli, venous thromboemboli, wound complications, dislocations, aseptic revisions, periprosthetic joint infections, and periprosthetic fractures. We completed bivariate analyses via chi-square tests to assess categorical variables. We utilized student’s t-tests to compare continuous variables, including ages and comorbidities. Odds ratios (ORs) were calculated for complications using 95% confidence intervals (CIs). Results: The robotic-assisted cohort had lower rates of dislocation at 90 days (0.93 vs 1.41%, OR 0.65, 95% CI 0.48-0.88, P = .007), 1 year (1.32 vs 1.92%, OR 0.68, 95% CI 0.53-0.88, P = .004), and 2 years (1.66 vs 2.1%, OR 0.79, 95% CI 0.62-0.99, P = .049). Total surgical complications were significantly lower in the robotic-assisted cohort at 1 year (5.29 vs 6.16%, OR 0.85, 95% CI 0.74-0.98, P = .0205), but were similar at 90 days and 2 years. At 90 days, the rates of medical complications, including surgical site infections, pulmonary emboli, venous thromboemboli, and wound complications, were similar (all P > .05). The rates of periprosthetic joint infections, aseptic revision, periprosthetic fractures, and aseptic loosening were similar at all time points (all P > .05). Conclusions: Patients who underwent robotic-assisted THA had lower rates of dislocation at 90 days, 1 year, and 2 years. This finding supports the use of robotic assistance in THA, though further research is needed to confirm and strengthen these findings.

Background: There remains a lack of universal guidelines regarding the appropriate level of postoperative activity restrictions following total hip arthroplasty (THA). This systematic review aims to assess whether the liberalization of postoperative activity restrictions following THA impacts implant survivorship, return to sport, patient satisfaction, and functional health outcomes. Methods: A comprehensive search strategy was completed across PubMed, Scopus, and Web of Science databases using targeted keywords from January 1, 2010, to November 22, 2023. Inclusion criteria included randomized clinical trials, case-control, and cohort studies written in English. Data extraction focused on activity levels, rehabilitation protocols, implant survivorship, and physical and psychological outcomes. The primary search yielded 7420 articles, with 28 studies included after screening. Results: Return to sports outcomes demonstrated notable variability (20%-98.5%). Most studies reported improved survivorship in high-activity patients. High-activity participants had all-cause revision rates of 0.9%-8.57% and aseptic revision rates of 0.4%-5.7%. Low-activity participants had all-cause revision rates of 0.7%-3.4% and aseptic revision rates of 0.0%-2.1%. There was no clear association between activity level and dislocation rates. Positive associations between post-THA activities and improved mental health and patient satisfaction were observed. Conclusions: The current arthroplasty literature demonstrates that patients engaging in high-activity levels after THA exhibit similar or improved implant survivorship rates compared to patients participating in low-activity levels. However, high-quality prospective studies are needed to provide evidence-based guidelines. Patients should be encouraged to partake in activities at their own comfort levels with an understanding of their own limitations and risks.

Background: Osteoarthritis (OA) is the leading cause of disability among US adults and most commonly affects the knee. Guidelines for knee OA treatment include behavioral, nonpharmacological, pharmacological, and surgical interventions. While emerging knee OA treatments show promise for pain control, data gaps remain regarding the efficacy, safety, comparative effectiveness, and real-world value of treatments. Objectives: The Innovations in Genicular Outcomes Registry (IGOR) is prospectively collecting real-world data to assess clinical effectiveness, safety, health-related quality of life, and healthcare resource utilization of knee OA treatments. Design: The IGOR is a prospective, observational, longitudinal, multicenter registry (NCT05495334) examining knee OA pain treatment outcomes at intervals up to 18 months after treatment. Methods and analysis: All clinical management decisions are made via shared decision-making involving both the physician and the patient. Index joint-directed treatments may include various intra-articular injections, oral opioid and nonopioid medications (including nonsteroidal anti-inflammatory drugs), cryo nerve blocks, radiofrequency ablations, novel treatment modalities, other physical therapy modalities (including muscle strengthening), and total knee arthroplasties. Patient-reported assessments along with physician-provided medical record data are recorded. Regular data quality assessments are conducted for each site, and an outside monitor ensures data quality and integrity. A steering committee ensures transparency and oversees administrative, legal, ethical, and scientific decisions. Treatment outcomes within and between therapies are compared. Ethics: Ethical approval was granted by Advarra, Inc. (protocol number, Pro00050981). Discussion: Data from the IGOR registry study will further elucidate the effectiveness, safety, and real-world value of knee OA treatments individually or in combination. Characterization of real-world treatment patterns will help better understand the impact of specific treatments. Trial registration: Clinicaltrials.gov, NCT05495334.

Background: Total knee arthroplasty (TKA) has become a common surgical intervention for human immunodeficiency virus (HIV)-positive patients who develop osteonecrosis of the knee. This paper summarized existing literature regarding the outcomes of HIV-positive patients undergoing TKA in 4 subsections: (1) complications; (2) survivorship analyses; (3) patient-reported outcomes; and (4) infections. Methods: A review of PubMed was performed, searching for articles focused on HIV-positive patients undergoing TKA. There were 6 reports selected, containing 4765 HIV-positive patients, and data regarding the various domains was tabulated and analyzed. To ensure article quality, a methodology score and level of evidence were determined for selected studies. Results: Complication rates for HIV-positive patients were low, with a larger study reporting that 7.8% of HIV-positive patients developed a complication in comparison to 8% of HIV-negative patients. Survivorship analyses showed similar results, with a study reporting implant survivorship of 98% for HIV-positive and 99% for HIV-negative patients. There were no differences in patient-reported outcomes; HIV-positive patients improved from baseline with respect to the mean Knee Society objective and mean Knee Society functional scores, and the University of California, Los Angeles self-reported activity levels. The infection rate for HIV-positive patients was low, with a larger database study reporting that 0.6% of HIV-positive patients developed a wound infection in comparison to 0.4% of HIV-negative patients. Conclusions: A TKA is an effective treatment for HIV-positive patients who develop osteonecrosis of the knee. Results showed similar patient-reported outcomes, implant survivorships, revisions, and complication rates when compared to non-HIV patients.

Abstract Introduction The incidence of osteonecrosis of the femoral head is estimated at about 10 to 20,000 patients annually, and, when left untreated, 80% or more of cases progress to femoral head collapse. A series of joint-preserving procedures have been developed to prevent/delay the need for hip arthroplasty. The aim of this study was to provide a five-year update: (1) evaluating temporal trends of arthroplasty vs. joint-preservation techniques such as core decompression, bone grafting, osteotomies, and arthroscopy; (2) determining proportions of procedures in patients aged less than vs. over 50 years; and (3) quantifying rates of specific operative techniques. Methods A total of 10,334 patients diagnosed with osteonecrosis of the femoral head and having received hip surgery were identified from a nationwide database between 1 January 2010 and 31 December 2019, by using the International Classification of Disease, the Ninth/Tenth revision (ICD-9/10) codes. The percentage of patients managed by each operative procedure was calculated annually. To identify trends, patients were grouped by age under/over 50 years and divided into a joint-preserving and a non-joint-preserving (arthroplasty) group. Chi-squared tests were performed to compare the total number of procedures per year. Results Rates of arthroplasty far exceeded those for joint-preserving procedures. However, from 2015 to 2019, significantly more joint-preserving procedures were performed than in 2010 to 2014 (4.3% vs. 3.0%, P

Background: Robotic arm–assisted total knee arthroplasty (RATKA) has demonstrated improved patient-reported outcome measures. Less evidence has been reported on how frequently patients return to complex activities of daily living. Our purposes were to investigate (1) hospital lengths of stay (LOSs) (2) discharge dispositions and (3) the rates and postoperative time intervals at which patients returned to driving and working. Methods: A total of 50 RATKA patients who were employed prior to surgery were included. Outcomes included hospital LOS, discharge dispositions, return to driving, and return to work. Results: A total of 48 patients (96%) were discharged home with self-care or health aid discharge after a mean LOS of 1.2 ± 0.6 days. Twelve patients (24%) returned to driving within 3 weeks of surgery. In our study, 100% of patients who underwent RATKA returned to driving after a mean of 29 days (range, 4 to 62 days). Forty-five patients (90%) returned to their preoperative level of work after a mean of 46 days (range, 2 to 96 days). Nineteen patients (38%) returned to work within 3 weeks. Conclusions: This study showed fast recovery after RATKA, with >90% returning to driving and working at full capacity within 2 months. Many (38%) returned to work within 3 weeks. Further studies to demonstrate the value of RATKA with respect to recovery of complex activities are needed. Compared to controls from previously published literature on manual total knee arthroplasties, it appears that patients who undergo RATKA have similar or better outcomes in reference to return to driving.

Aims: The aim of this study was to report patient and clinical outcomes following robotic-assisted total knee arthroplasty (RA-TKA) at multiple institutions with a minimum two-year follow-up. Methods: This was a multicentre registry study from October 2016 to June 2021 that included 861 primary RA-TKA patients who completed at least one pre- and postoperative patient-reported outcome measure (PROM) questionnaire, including Forgotten Joint Score (FJS), Knee Injury and Osteoarthritis Outcomes Score for Joint Replacement (KOOS JR), and pain out of 100 points. The mean age was 67 years (35 to 86), 452 were male (53%), mean BMI was 31.5 kg/m2 (19 to 58), and 553 (64%) cemented and 308 (36%) cementless implants. Results: There were significant improvements in PROMs over time between preoperative, one- to two-year, and > two-year follow-up, with a mean FJS of 17.5 (SD 18.2), 70.2 (SD 27.8), and 76.7 (SD 25.8; p < 0.001); mean KOOS JR of 51.6 (SD 11.5), 85.1 (SD 13.8), and 87.9 (SD 13.0; p < 0.001); and mean pain scores of 65.7 (SD 20.4), 13.0 (SD 19.1), and 11.3 (SD 19.9; p < 0.001), respectively. There were eight superficial infections (0.9%) and four revisions (0.5%). Conclusion: RA-TKA demonstrated consistent clinical results across multiple institutions with excellent PROMs that continued to improve over time. With the ability to achieve target alignment in the coronal, axial, and sagittal planes and provide intraoperative real-time data to obtain balanced gaps, RA-TKA demonstrated excellent clinical outcomes and PROMs in this patient population. Cite this article: Bone Jt Open 2022;3(7):589–595.

Background: The direct anterior approach (DAA) used for primary total hip arthroplasty has been shown to improve early postoperative outcomes, but prior studies have identified a marked learning curve for surgeons transitioning to this approach. However, these studies do not capture surgeons with postgraduate fellowship training in DAA. Therefore, the purpose of this study was to evaluate the learning curve by comparing perioperative outcomes for the first 100 to latter 100 cases and first 50 to final 50 cases. Methods: The first 200 consecutive primary total hip arthroplasties performed by a single surgeon were prospectively followed up for up to 2 years postoperatively. Data on demographic and perioperative factors, 90-day readmissions, and short- and long-term complications were collected. Radiographic outcomes included acetabular cup anteversion and abduction measurements. Logistic regressions were used to calculate odds ratios and confidence intervals for surgical time greater than 2 hours. Results: The first 100 and second 100 cases had significant differences in operative times (118.1 vs 110.4 minutes, P = .009), acetabular abduction (38.3 vs 35.5 degrees, P = .001) and anteversion (13.5 vs 15.1 degrees, P = .009), and incidence of neuropraxia (41 vs 9%, P < .001). Estimated blood loss, transfusions, discharge disposition, length of stay, readmission, and other complications had no statistical significance between the first and second 100 cases. The first 50 cases had higher odds of surgical time greater than 2 hours (odds ratio = 5.2, 95% confidence interval = 1.84-14.75, P = .002) than the final 50 cases. Conclusions: When compared with the existing literature, incorporation of DAA into fellowship training can lead to reduction in fractures and reoperation rates.

Abstract Background Limiting treatment to those recommended by the American Academy of Orthopaedic Surgeon Clinical Practice Guidelines has been suggested to decrease costs by 45% in the year prior to total knee arthroplasty, but this only focuses on expenditures leading up to, but not including, the surgery and not the entire episode of care. We evaluated the treatment costs following knee osteoarthritis (OA) diagnosis and determined whether these are different for patients who use intra-articular hyaluronic acid (HA) and/or knee arthroplasty. Methods Claims data from a large commercial database containing de-identified data of more than 100 million patients with continuous coverage from 2012 to 2016 was used to evaluate the cumulative cost of care for over 2 million de-identified members with knee OA over a 4.5-year period between 2011 and 2015. Median cumulative costs were then stratified for patients with or without HA and/or knee arthroplasty. Results Knee OA treatment costs for 1,567,024 patients over the 4.5-year period was $6.60 billion (mean $4210/patient) as calculated by the authors. HA and knee arthroplasty accounted for 3.0 and 61.5% of the overall costs, respectively. For patients who underwent knee arthroplasty, a spike in median costs occurred sooner for patients without HA use (around the 5- to 6-month time point) compared to patients treated with HA (around the 16- to 17-month time point). Conclusions Non-arthroplasty therapies, as calculated by the authors, accounted for about one third of the costs in treating knee OA in our cohort. Although some have theorized that limiting the use of HA may reduce the costs of OA treatment, HA only comprised a small fraction (3%) of the overall costs. Among patients who underwent knee arthroplasty, those treated with HA experienced elevated costs from the surgery later than those without HA, which reflects their longer time to undergoing knee arthroplasty. The ability to delay or avoid knee arthroplasty altogether can have a substantial impact on the cost to the healthcare system.

Background: Maryland implemented the Global Budget Revenue (GBR) to reduce hospital costs, improve quality, and decrease readmissions. Studies assessing its impact on inpatient total hip arthroplasty (THA) procedures are lacking. This study compared before and after GBR changes in 1) patient characteristics; 2) discharge dispositions and lengths of stay (LOS); 3) costs and charges of inpatient stays; and 4) 30-day readmission rates (RR) for THA recipients. Methods: The Maryland State Inpatient Database was queried for patients who underwent THA between 2010 and 2016 utilizing the ICD-9 and ICD-10 procedure codes (n = 43,251). Pre- and post-GBR periods were grouped as 2010 to 2013 and 2014 to 2016, respectively. Chi-square analyses were used to analyze patient characteristics. Student’s t-tests were utilized to compare ages, LOS, costs, charges, and RR. Results: There were no differences in the proportion of minorities undergoing THA between the pre- and post-GBR periods (18.3% vs 19.4% African American, 1.2% vs 1.3% Hispanic; P = .056). The number of THA patients with Medicaid insurances increased during post-GBR (4.0% vs 6.7%; P < .001). There was an increased rate of home discharges during post-GBR (33.1% vs 40.9%; P < .001). We found lower LOS (−0.50 days; 95% CI: −0.458 to −0.533; P < .001), mean inpatient costs (−$1417.44; 95% CI −$1143.76 to −$1150.32; P < .001), and mean inpatient charges (−$2196.50; 95% CI: −$1980.10 to −$2412.90; P

Update. This article was updated on September 10, 2020 because of previous errors. In Tables I and II, on pages 2 and 3, data observations with a count of £10 were reported in individual table cells, which is against a provision of the State Data Use Agreement put forth by the Agency for Healthcare Research and Quality. Thus, all values of £10 have been replaced by a symbol pointing to the footnote: “Censored in accordance with the Agency for Healthcare Research and Quality Data Use Agreement to maintain patient confidentiality.” An erratum has been published: JBJS Open Access. 2020;5(3):e19.00041ER. Background:. In 2014, Maryland received a waiver for the Global Budget Revenue (GBR) program. We evaluated GBR’s impact on patient and hospital trends for total knee arthroplasty (TKA) in Maryland compared with the U.S. Specifically, we examined (1) patient characteristics, (2) inpatient course, and (3) costs and charges associated with TKAs from 2014 through 2016. Methods:. A comparative analysis of TKA-treated patients in the Maryland State Inpatient Database (n = 36,985) versus those in the National Inpatient Sample (n = 2,117,191) was performed. Patient characteristics included race, Charlson Comorbidity Index (CCI), morbid obesity, patient income status, and primary payer. Inpatient course included length of hospital stay (LOS), discharge disposition, and complications. Results:. In the Maryland TKA cohort, the proportion of minorities increased from 2014 to 2016 while the proportion of whites decreased (p = 0.001). The proportion of patients with a CCI of ≥3 decreased (p = 0.014), that of low-income patients increased (p < 0.001), and that of patients covered by Medicare or Medicaid increased (p < 0.001). In the U.S. TKA cohort, the proportion of blacks increased (p < 0.001), that of patients with a CCI score of ≥3 decreased (p < 0.001), and the proportions of low-income patients (p < 0.001) and those covered by Medicare or Medicaid increased (p < 0.001). In both Maryland and the U.S., the LOS (p < 0.001) and complication rate (p < 0.001) decreased while home-routine discharges increased (p < 0.001). Costs and charges decreased in Maryland (p < 0.001 for both) whereas charges in the U.S. increased (p < 0.001) and costs decreased (p < 0.001). Conclusions:. While the U.S. health reform and GBR achieved similar patient and hospital-specific outcomes and broader inclusion of minority patients, Maryland experienced decreased hospital charges while hospital charges increased in the U.S. Level of Evidence:. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The use of total hip arthroplasty (THA) continues to grow partially because of the increasing life expectancy of the American population. Whether to use cemented or cementless femoral fixation options in older patients is often debated. The purpose of the present study was to compare the clinical and radiographic outcomes after cementless THA in patients ≥80 years to younger patients. Clinical and radiographic data were gathered on 33 patients (35 hips) all 80 years or older who had undergone proximally coated cementless total hip arthroplasties. Outcomes were compared with a matching group for age, body mass index, and diagnosis, who had undergone the same procedure by the same surgeon at a similar time. Harris hip scores were evaluated pre- and postoperatively, and radiographs were reviewed for evaluation of fixation and stability. At a mean follow-up of 4 years, 97% of the hips (34 of 35) remained unrevised and the mean Harris hip score had improved by 39 points to 83 points (range, 26-100 points). On radiographic evaluation, 91% were found to have full bony ingrowth, with 1 hip having osteolysis of the proximal femur. Mortality was 23% at 86 months. Except for mortality, the outcomes and complication rates were similar to the younger group except that the matching group had higher final postoperative Harris hip scores. Proximally coated tapered cementless THA is a safe and efficacious method for providing good clinical outcomes with low revision rates in patients 80 years of age or older.

Objective: This collaboration between the American College of Rheumatology and the American Association of Hip and Knee Surgeons developed an evidence-based guideline for the perioperative management of antirheumatic drug therapy for adults with rheumatoid arthritis (RA), spondyloarthritis (SpA) including ankylosing spondylitis and psoriatic arthritis, juvenile idiopathic arthritis (JIA), or systemic lupus erythematosus (SLE) undergoing elective total hip (THA) or total knee arthroplasty (TKA)., Methods: A panel of rheumatologists, orthopedic surgeons specializing in hip and knee arthroplasty, and methodologists was convened to construct the key clinical questions to be answered in the guideline. A multi-step systematic literature review was then conducted, from which evidence was synthesized for continuing versus withholding antirheumatic drug therapy and for optimal glucocorticoid management in the perioperative period. A Patient Panel was convened to determine patient values and preferences, and the Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of evidence and the strength of recommendations, using a group consensus process through a convened Voting Panel of rheumatologists and orthopedic surgeons. The strength of the recommendation reflects the degree of certainty that benefits outweigh harms of the intervention, or vice versa, considering the quality of available evidence and the variability in patient values and preferences., Results: The guideline addresses the perioperative use of antirheumatic drug therapy including traditional disease-modifying antirheumatic drugs, biologic agents, tofacitinib, and glucocorticoids in adults with RA, SpA, JIA, or SLE who are undergoing elective THA or TKA. It provides recommendations regarding when to continue, when to withhold, and when to restart these medications, and the optimal perioperative dosing of glucocorticoids. The guideline includes 7 recommendations, all of which are conditional and based on low- or moderate-quality evidence., Conclusion: This guideline should help decision-making by clinicians and patients regarding perioperative antirheumatic medication management at the time of elective THA or TKA. These conditional recommendations reflect the paucity of high-quality direct randomized controlled trial data., (Copyright © 2017 Elsevier Inc and the American College of Rheumatology. Published by Elsevier Inc. All rights reserved.)