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Low- and medium-carbon structural steel components face random vibration and dynamic loads (like earthquakes) in many applications. Thus a modification to improve their mechanical properties, essentially damping properties, is required. The present study focuses on improving and developing these properties, significantly dampening properties, without losing the other mechanical properties. The specimens used in the present study are structural steel ribbed bar ISO 6935 subjected to heating temperatures of (850, 950, and 1050) ˚C, and cooling schemes of annealing, normalizing, sand, and quenching was selected. The damping properties of the specimens were measured experimentally with the area under the curve for the loading and unloading paths experienced from the tensile test. Considering the effect of different parameters on the damping properties, such as heat treatment temperatures, cooling rates, and carbon content, the results show that the damping properties in the annealing process at different temperatures have interesting damping properties, among other processes. Also, the highest damping energy for the annealing cooling scheme was attained at a heating temperature of 1050 ˚C, irrespective of the carbon content. Finally, better damping properties for the medium carbon content of (0.299%C) is achieved for all types of heat treatment process compared with a low carbon content of (0.188% C); and, in general, with increasing carbon content from medium to low, steel response to heat treatment increases and better damping properties are obtained.

Numerous tests are recently conducted to assess vibration's role in accelerating the heat transfer rate in various heat exchangers. In this work, the enhancement of heat transfer by the effect of transfer vibration and inclination angles on the surface of a double pipe heat exchanger experimentally has been investigated. A data acquisition system is applied to record the data of temperatures, flow rates, and frequencies over the tests. A compound technique was adopted, including the application of a set of inclination angles of (0°, 10°, 20°, and 30°) under the effect of frequency of vibration ranging from sub-resonance to over-resonance frequencies. The results showed that the overall heat transfer coefficient enhances by applying the compound technique at all the working fluid's temperatures and flow rate ranges. The maximum increase in overall heat transfer coefficient occurs at an angle of 30° and the resonance frequency. Moreover, the effectiveness of the double pipe heat exchanger gradually expanded when temperature, inclination angles, and vibration amplitude rosed. But the effectiveness value declined as the hot working flow rate increased considerably. Finally, the enhancement factor demonstrated that the combined strategy (vibration frequencies and inclination angles) had been the most effective technique in improving and enhancing heat transfer and was superior to the other ways. Additionally, the extremes improvement in overall heat transfer coefficient, effectiveness, and enhancement factor are 183.4, 191, and 164.4 %. The improvement was situated at the resonance frequency with a 30° inclination angle.

When a vehicle is left parked in the sun for an extended period, the gathered heat causes damage to several interiors within the cabin and causes discomfort for people and animals left inside the car. In the present work, the effect of the orientation of a parked white minibus on temperature distribution and cooling load calculation is studied experimentally in an open environment. Two different cases were studied facing south and facing east. For several hours, the temperature inside the car cabin had been monitored and measured at five separate locations. The cooling load calculations are carried out based on the experimental measurements. The results show that the overheating of parked cars always happens as a result of the radiation load especially when a car has a large surface glass area. Also, the ambient load is directly proportional to the ambient temperature, and the total load related directly to radiation load reaches the maximum value of 2358.1 W at 3:00 pm for 1st case and 2118.3 W at 11:00 am for 2nd case which shows an increase of 11.32 %. Thus, these results emphasized the fact that the orientation of the parked car may considerably affect the temperature distribution and the cooling load of the car cabin. Also, the study may be considered an essential step in designing any assisted ventilation or auxiliary air conditioning system that may enhance the car cabin conditions even while the car’s engine was off (parked automobile).

Failures of the crankshaft-slider mechanism are the most reasons that affect the durability and operational reliability of the internal combustion engine. An accurate and sophisticated nonlinear dynamic model overcomes the obvious simulation errors of linearized models. The present work studies the effect of the non-conservative forces and nonlinear damping on the torsional vibration of single-cylinder internal combustion engines. Comprehensive dynamic modeling based on a developed expression for the instantaneous kinetic energy of the reciprocating parts and a general model of the overall kinetic energy of the system in terms of the inertia parameters were derived. The effect of variable inertia and nonlinear damping on the damped forced response of slider-crank assembly of the engine was investigated using the numerical integration method. The numerical results show that the phenomenon of secondary rolling excitation torque is well activated and gives arises to variation of frequencies and their corresponding amplitudes. Also, the amplitude of the external excitation torque is strengthened by the secondary excitation inertia torque and introduces multi resonance amplitudes phenomenon and widening the critical range of engine speed which results in producing of dangerous vibrational stress amplitudes. Also, the damped forced results indicate that the presents of damping lead to a vital reduction in the amplitude of torsional displacement and excitation torques. The present work aims to enhance nonlinear dynamic modeling and introduces more reliable design for reciprocating engine crankshaft assembly.

Copyright of Journal of Engineering (17264073) is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The continuing bacterial contamination in hospitals operating units and theaters has an important role in the spread of hospital infections. The current study evaluated the level of bacterial contamination in the operating theatres at Al-Hussein Teaching Hospital in Al-Samawah, Iraq. For the purpose of sample collection from surgical equipment surfaces, the swab plate method conducted by nurses and laboratory workers was used to collect the samples in the operating theater. The samples were then transferred to the laboratory unit for diagnosis by standard methods. The present study found different rates among operating theatres. According to bacterial contamination rate, especially for the operating theatre in emergency wings with 334 contaminated isolates, the highest rates of contaminated bacterial isolates were Staphylococcus epidermidis (n=171; 26.1%), Bacillus species (spp.) (n=118; 18%), S. aureus (n=111; 16.9%), Klebsiella spp. (n=92; 14%), Enterobacter spp. (n=82; 12.5%), P.aurogenosa (n=24; 3.7%), and Escherichia coli (n=23; 3.7%). Despite the use of all methods of sterilization among the hospital wards, especially the surgical halls in the hospital wards, bacterial contamination is still widespread among these units. It was noted that the bacteria isolated in this study posed a risk as pathogenic bacteria. [ABSTRACT FROM AUTHOR]

Background: Studies comparing the outcomes of bariatric surgery followed by total knee arthroplasty (TKA) versus TKA alone in obese patients have disparate results. This systematic review and meta-analysis sought to compare TKA with and without prior bariatric surgery in obese patients., Methods: MEDLINE, PubMed, and Embase were searched from inception to April 9, 2023. There were twelve included studies that yielded 2,876,547 patients, of whom 62,818 and 2,813,729 underwent TKA with and without prior bariatric surgery, respectively. Primary outcomes were medical complications (ie, urinary tract infection, pneumonia, renal failure, respiratory failure, venous thromboembolism [VTE], arrhythmia, myocardial infarction, and stroke); surgical complications (ie, wound complications [eg, infection, hematoma, dehiscence, delayed wound healing, and seroma], periprosthetic joint infection, mechanical complications, periprosthetic fracture, knee stiffness, and failed hardware); revision, and mortality. Secondary outcomes were blood transfusion, length of stay (day), and readmission., Results: The odds ratios (OR) of 90-day VTE (OR = 0.75 [0.66, 0.85], P < .00001), 90-day stroke (OR = 0.58 [0.41, 0.81], P = .002), and 1-year periprosthetic fracture (OR = 0.74 [0.55, 0.99], P = .04) were lower in those who underwent bariatric surgery before TKA. Although the mean difference in hospital stays (-0.19 days [-0.23, -0.15], P < .00001) was statistically less in those who underwent bariatric surgery before TKA, it was not clinically relevant. The other outcomes were similar between the groups., Conclusions: Bariatric surgery before TKA is beneficial in terms of a lower risk of VTE, stroke, and periprosthetic fracture. This analysis suggests surgeons consider discussing bariatric surgery before TKA in obese patients, especially those who are at risk of VTE and stroke., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Solar panel installation is generally exposed to dust. Therefore, soiling on the surface of the solar panels significantly reduces the effectiveness of solar panels. Accumulation of dust also shortens their lifespan and reduces efficiency by about 15% to 20%. A significant reduction in the efficiency of solar photovoltaic panels has been observed due to inadequate insulation and dust deposition or shading. To harness maximum solar energy from solar panels up to their rated capacity, they need to be cleaned periodically. Therefore, the current study focuses on the comparative performance analysis of two distinct types of self-cleaning mechanisms, namely self-cleaning wiper (SCW) and nano-coating method. These methods are economical and sustainable for the standard atmospheric conditions of Pakistan. Solar panels (reference, nano-coated, and self-cleaning wiper mechanism) were placed on the roof of the Mechanical Engineering Department MUST Mirpur AJK for five weeks. Solar irradiance, dust density & performance parameters of these three panels were recorded on weekly basis. It was observed that an increase in the rate of dust deposition negatively affects the conversion efficiency of solar panels. When dust density was increased from 7.5 to 18.15 (g/m2), the percentile drops in rated power (50W) for reference, nano-coated, and self-cleaning wiper mechanisms are 37%, 33% and 23%, respectively. Moreover, the payback period of nano-coated and SCW is 1.07 years and 2.79 years, respectively., Competing Interests: NO authors have competing interests, (Copyright: © 2024 Hameed et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Patellar tendon (PT) rupture following total knee arthroplasty (TKA) is a rare, but devastating complication. These injuries occur most frequently in the acute period following TKA due to trauma to the knee. PT ruptures that disrupt the extensor mechanism create a marked functional deficit, impacting every facet of daily life. In complete ruptures of the PT, repair or reconstruction is typically indicated; however, complication rates following intervention remain high. Operative intervention remains the mainstay of treatment, with only certain specific situations where nonoperative intervention is appropriate. Operative techniques are chosen based on the acuity, location of disruption, and status of the residual soft tissues. Treatment options include repair with or without augmentation or reconstruction. Augmentation does reduce the high risk of complications, bringing rates down from 63 to 25%. Augmentation options include autografts, allografts, synthetic grafts, or synthetic meshes. Despite advancements, outcomes are unpredictable and complications are common, highlighting the need for further research to improve treatment protocols. This article provides an overview of PT ruptures following TKA, the various treatment options, and the recommendations of the M.M., R.D., G.S. for each common type of PT injury encountered., Competing Interests: M.A.M. report royalties from Medicus Works LLC, Stryker and consulting fee from 3M, Exactech, Inc, Johnson & Johnson, Kolon TissueGene, Next Science, Pacira, Smith & Nephew, Stryker, also payment or honoraria from Johnson & Johnson, Medtronic, National Institutes of Health (NIAMS & NICHD), Organogenesis, Orthofix, Inc, Patient-Centered Outcomes Research Institute (PCORI), Stryker. He is in leadership role in American Association of Hip and Knee Surgeons, Hip Society, Knee Society. Also has stocks in CERAS Health, MirrorAR, Peerwell, USMI.R.E.D. is a board member of Baltimore City Medical Society. He reports research support from : Biocomposites, Inc.; CyMedica Orthopedics; DePuy Synthes Product, Inc.; Flexion Therapeutics; Microport; Orthopedics, Inc.; Orthofix, Inc.; Patient-Centered Outcomes Research Institute (PCORI); Smith & Nephew; Stryker; Tissue Gene; and United Orthopedic Corporation.G.S. reports royalties from Biomet, Springer, Zimmer and consulting fee from 3M, Biomet, KCI, Zimmer. Also Payment or honoraria from 3M, Biomet, Next Science and stocks from Enhanced medical nutrition, Force Therapeutics, ROM Tech., (Thieme. All rights reserved.)

Recently, robotic-arm assisted total knee arthroplasties have become popular because of their promise to lead to enhanced accuracy and efficient planning of the procedure, as well as improved radiographic and clinical outcomes. One robotic system is based on computed tomography (CT) to help with preoperative planning, intraoperative adjusting, and bone cutting for these procedures. The purpose of this article is to describe the second-generation iteration of this CT-based robotic technique by describing the new features using an actual total knee arthroplasty case. This article then becomes a step-by-step guide to performing the procedure, as well as describing the new features of this upgraded system.

Background: Arthrofibrosis is a debilitating postoperative complication and a major cause of patient dissatisfaction following total knee arthroplasty (TKA). There is no consensus regarding the optimal treatment for stiffness after TKA. For cases not amenable to manipulation under anesthesia (MUA), one component or full revision are both suitable options. In a value-based healthcare era, maximizing cost-effectiveness with optimized clinical outcomes for patients remains the ultimate goal. As such, we compared (1) Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement (KOOS, JR), (2) range of motion (ROM), as well as (3) complication rates, including MUA and lysis of adhesions (LOA), between polyethylene exchange and full component revision for TKA arthrofibrosis., Methods: Patients were queried from an institutional database who underwent revision TKA for arthrofibrosis between January 1, 2015, and April 31, 2021. There were 33 patients who underwent full revision and 16 patients who underwent polyethylene exchange. Demographics and baseline characteristics between the cohorts were analyzed. Postoperative outcomes included MUA, LOA, and re-revision rates as well as KOOS, JR, and extension and flexion ROM at a mean follow-up of 3.8 years. Baseline comorbidities, including age, body mass index, alcohol use, tobacco use, and diabetes, were comparable between the full revision and polyethylene exchange revision cohorts (P > .05). The one and full component revisions had similar preoperative KOOS, JR (43 versus 42, P = .85), and flexion (81 versus 82 degrees, P = .80) versus extension (11 versus 11 degrees, P = .87) ROM., Results: The full component revision had higher KOOS, JR (65 versus 55, P = .04), and flexion (102 versus 92 degrees, P = .02), but similar extension (3 versus 3 degrees, P = .80) ROM at final follow-up compared to the polyethylene exchange revision, respectively. The MUA (18.2 versus 18.8%, P = .96) and LOA (2.0 versus 0.0%, P = .32) rates were similar between full component and polyethylene exchange revisions. There was one re-revision (3.0%) for the cohort of patients who initially underwent full revision. There were four full re-revisions (25.0%) and two polyethylene exchange re-revisions (12.5%) performed in the cohort of patients who initially underwent a polyethylene exchange revision., Conclusions: The full component revision for stiffness after TKA showed favorable KOOS, JR, ROM, and outcomes in comparison to the polyethylene exchange revision. While the optimal treatment for stiffness after TKA is without consensus, this study supports the use of the full component revision when applied to the institutional population at hand. It is imperative that homogeneity exists in preoperative definitions, preoperative baseline patient demographics, ROM and function levels, outcome measures, and preoperative indications, as well as the inclusion of clinical data that assesses complete exchange, single exchange, and tibial insert exchange., (Copyright © 2024. Published by Elsevier Inc.)

Background: A consumer-focused health care model not only allows unprecedented access to information, but equally warrants consideration of the appropriateness of providing accurate patient health information. Nurses play a large role in influencing patient satisfaction following total knee arthroplasty (TKA), but they come at a cost. A specific natural language artificial intelligence (AI) model, ChatGPT (Chat Generative Pre-trained Transformer), has accumulated over 100 million users within months of launching. As such, we aimed to compare: (1) orthopaedic surgeons' evaluation of the appropriateness of the answers to the most frequently asked patient questions after TKA; and (2) patients' comfort level in answering their postoperative questions by using answers provided by arthroplasty-trained nurses and ChatGPT., Methods: We prospectively created 60 questions based on the most commonly asked patient questions following TKA. There were 3 fellowship-trained surgeons who assessed the answers provided by arthroplasty-trained nurses and ChatGPT-4 to each of the questions. The surgeons graded each set of responses based on clinical judgment as: (1) "appropriate," (2) "inappropriate" if the response contained inappropriate information, or (3) "unreliable," if the responses provided inconsistent content. Patients' comfort level and trust in AI were assessed using Research Electronic Data Capture (REDCap) hosted at our local hospital., Results: The surgeons graded 44 out of 60 (73.3%) responses for the arthroplasty-trained nurses and 44 out of 60 (73.3%) for ChatGPT to be "appropriate." There were 4 responses graded "inappropriate" and one response graded "unreliable" provided by the nurses. For the ChatGPT response, there were 5 responses graded "inappropriate" and no responses graded "unreliable." There were 136 patients (53.8%) who were more comfortable with the answers provided by ChatGPT compared to 86 patients (34.0%) who preferred the answers from arthroplasty-trained nurses. Of the 253 patients, 233 (92.1%) were uncertain if they would trust AI to answer their postoperative questions. There were 127 patients (50.2%) who answered that if they knew the previous answer was provided by ChatGPT, their comfort level in trusting the answer would change., Conclusions: One potential use of ChatGPT can be found in providing appropriate answers to patient questions after TKA. At our institution, cost expenditures can potentially be minimized while maintaining patient satisfaction. Inevitably, successful implementation is dependent on the ability to provide information that is credible and in accordance with the objectives of both physicians and patients., Level of Evidence: III., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The use of ChatGPT (Generative Pretrained Transformer), which is a natural language artificial intelligence model, has gained unparalleled attention with the accumulation of over 100 million users within months of launching. As such, we aimed to compare the following: 1) orthopaedic surgeons' evaluation of the appropriateness of the answers to the most frequently asked patient questions after total hip arthroplasty; and 2) patients' evaluation of ChatGPT and arthroplasty-trained nurses responses to answer their postoperative questions., Methods: We prospectively created 60 questions to address the most commonly asked patient questions following total hip arthroplasty. We obtained answers from arthroplasty-trained nurses and from the ChatGPT-3.5 version for each of the questions. Surgeons graded each set of responses based on clinical judgment as 1) "appropriate," 2) "inappropriate" if the response contained inappropriate information, or 3) "unreliable" if the responses provided inconsistent content. Each patient was given a randomly selected question from the 60 aforementioned questions, with responses provided by ChatGPT and arthroplasty-trained nurses, using a Research Electronic Data Capture survey hosted at our local hospital., Results: The 3 fellowship-trained surgeons graded 56 out of 60 (93.3%) responses for the arthroplasty-trained nurses and 57 out of 60 (95.0%) for ChatGPT to be "appropriate." There were 175 out of 252 (69.4%) patients who were more comfortable following the ChatGPT responses and 77 out of 252 (30.6%) who preferred arthroplasty-trained nurses' responses. However, 199 out of 252 patients (79.0%) responded that they were "uncertain" with regard to trusting AI to answer their postoperative questions., Conclusions: ChatGPT provided appropriate answers from a physician perspective. Patients were also more comfortable with the ChatGPT responses than those from arthroplasty-trained nurses. Inevitably, its successful implementation is dependent on its ability to provide credible information that is consistent with the goals of the physician and patient alike., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Total hip arthroplasty (THA) for dislocated hips (Crowe IV dysplasia) presents unique challenges. Conventional approaches involve subtrochanteric osteotomies, but are complex with additional fixation and potentially lead to limb length discrepancies, nerve palsies, and other complications. An alternative strategy is a staged approach, where the femoral head (or remnant) is gradually lowered (distraction technique) to align with the true acetabulum over a period of time, followed by a second-stage anatomically acetabular-positioned THA. External fixation distraction and telescoping internal lengthening devices have been utilized to achieve preoperative alignment. We evaluated these techniques, including the types, time, and amount of distraction needed, as well as outcomes and complication rates., Methods: In this retrospective case series, 14 patients (9 women, 5 men), who had a mean age of 32 years (range, 16 to 67), underwent staged surgical interventions using hip distraction using external fixators or internal lengthening devices for hip dysplasia and other pathologies (Perthes disease, osteonecrosis) in preparation for a second-stage anatomically placed THA. The mean follow-up duration for external-fixation patients was 10 years (range, 6.5 to 13.4)., Results: Staged treatment involved external fixators (n = 8) or internal lengthening devices (n = 6) with a device placement mean of 48 days (range, 42 to 71). The amount of distraction ranged from 6 to 12 cm. There were 2 patients who required uncomplicated revision of the internal lengthening devices, and another patient had a temporary peroneal nerve palsy. There was 1 patient who underwent an acetabular revision at 7 years., Conclusions: We focused on a challenging patient cohort that emphasizes the efficacy of staged interventions in managing Crowe Type IV dysplasia and similar cases. Favorable outcomes were found with the immediate transition to THA after device removal that effectively addressed soft-tissue contractures and femoral migration. Despite the need for further validation via larger, prospective studies, this innovative approach may pave the way toward optimizing this strategy for these difficult hip pathologies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Periprosthetic patella fractures are a rare complication that can lead to severe disability following total knee arthroplasty (TKA). There are several factors that increase the risk of this injury, including patient comorbidities, anatomic considerations, and surgical technique. With these factors limiting healing ability in the area, periprosthetic patellar fractures can pose a major challenge to treat, with potentially lasting morbidity for affected patients. These fractures can occur at any time following TKA and are classified based on their associated implant stability and disruption of the extensor mechanism using the Ortiguera and Berry classification system. Each of the three types of fractures can be managed in their own unique way; however, outcomes remain poor, and the complication rates remain high regardless of fracture type. This article provides an overview of the current literature and the recommended management of periprosthetic patella fractures., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Total hip arthroplasty (THA) has become a common intervention for human immunodeficiency virus (HIV)-positive patients who have osteonecrosis of the femoral head. This paper provides a systematic review to assess survivorships, patient-reported outcomes (PROMs), infection rates, other complications, and immune competence for patients who had THAs who did and did not have HIV., Methods: A comprehensive and systematic review of published studies investigating the outcomes of THA in HIV-positive patients (osteonecrosis and non-osteonecrosis patients) was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 10 studies with 9,534 HIV-positive patients fulfilled the inclusion and exclusion criteria. Manuscript quality was assessed on 2 scales: the Coleman Methodology Score and the level of evidence derived from Center for Evidence-Based Medicine criteria. Data were extracted from studies in the 5 key areas of interest: survivorships, PROMs, infection rates, complications, and clusters of differentiation-4 (CD4+) counts and viral loads., Results: Implant survivorship was between 95% and 100%. Postoperative Harris Hip Scores were significantly improved from preoperative values in HIV-positive patients. Postoperative PROMs and infections did not appear to be different between HIV-positive and HIV-negative patients. Many of the cohort studies demonstrate comparable complication rates to matched controls. Where described (7 reports), mean CD4+ counts ranged from 425 to 646 cells/mm 3 , with low viral loads (3 reports) and variations not found to influence outcomes., Conclusions: THA is an effective treatment for HIV-positive patients, many of whom suffer from osteonecrosis of the femoral head. The results demonstrate excellent implant survivorship, improved quality of life, and a low risk of infections and complications., (Copyright © 2024. Published by Elsevier Inc.)

Background: Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination., Methods: A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on applications, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by adherence and patient satisfaction, functional outcomes and pain scores, gait analyses and ranges of motion, and measurement and comparison tools., Results: A review of 24 of 25 publications related to smartphone applications used for postoperative recovery in TKA showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies used in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months., Conclusions: Smartphone applications and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of TKA patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: In 2021, alternative payment models accounted for 40% of traditional Medicare reimbursements. As such, we sought to examine health disparities through a standardized categorization of social disparity using the social vulnerability index (SVI). We examined (1) risk factors for SVI ≥ 0.50, (2) incidences of complications, and (3) risk factors for total complications between patients who have SVI < 0.50 and SVI ≥ 0.50 who had a total knee arthroplasty (TKA)., Methods: Patients who underwent TKA between January 1, 2022 and December 31, 2022 were identified in the state of Maryland. A total of 4,952 patients who had complete social determinants of health data were included. Patients were divided into 2 cohorts according to SVI: < 0.50 (n = 2,431) and ≥ 0.50 (n = 2,521) based on the national mean SVI of 0.50. The SVI identifies communities that may need support caused by external stresses on human health based on 4 themed scores: socioeconomic status, household composition and disability, minority status and language, and housing and transportation. The SVI theme of household composition and disability encompassed patients aged 65 years and more, patients aged 17 years and less, civilians who have a disability, single-parent households, and English language deficiencies. The higher the SVI, the more social vulnerability or resources are needed to thrive in a geographic area., Results: When controlling for risk factors and patient comorbidities, the theme of household composition and disability (odds ratio 2.0, 95% confidence interval 1.1 to 5.0, P = .03) was the only independent risk factor for total complications. Patients who had an SVI ≥0.50 were more likely to be women (65.8% versus 61.0%, P < .001), Black (34.4% versus 12.9%, P < .001), and have a median household income < $87,999 (21.3% versus 10.2%, P < .001) in comparison to the patients who had an SVI < 0.50, respectively., Conclusions: The SVI theme of household composition and disability, encompassing patients aged 65 years and more, patients aged 17 years and less, civilians who have a disability, single-parent households, and English language deficiencies, were independent risk factors for total complications following TKA. Together, these findings offer opportunities for interventions with selected patients to address social disparities., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: In 2011, the American Academy of Orthopaedic Surgeons released a consensus recommending venous thromboembolism (VTE) prophylaxis after total knee arthroplasty (TKA). The purpose of our study was to examine (1) incidences of postoperative complications, including pulmonary embolism (PE), deep vein thrombosis (DVT), and transfusion rates; (2) trends from 2016 to 2021 in VTE prophylaxis; and (3) independent risk factors for 90-day total complications following TKA between aspirin, enoxaparin, rivaroxaban, and warfarin., Methods: Using a national, all-payer database from 2016 to 2021, we identified all patients who underwent primary TKA. Exclusions included all patients who had prescribed anticoagulants within 1 year prior to TKA, hypercoagulable states, and cancer. Data were collected on baseline demographics, including age, sex, diabetes, and a comorbidity index, in each of the VTE prophylaxis cohorts. Postoperative outcomes included rates of PE, DVT, and transfusion. Multivariable regressions were performed to determine independent risk factors for total complications at 90 days following TKA., Results: From 2016 to 2021, aspirin was the most used anticoagulant (n = 62,054), followed by rivaroxaban (n = 26,426), enoxaparin (n = 20,980), and warfarin (n = 13,305). The cohort using warfarin had the highest incidences of PE (1.8%) and DVT (5.7%), while the cohort using aspirin had the lowest incidences of PE (0.6%) and DVT (1.6%). The rates of aspirin use increased the most from 2016 to 2021 (32.1% to 70.8%), while the rates of warfarin decreased the most (19.3% to 3.0%). Enoxaparin, rivaroxaban, and warfarin were independent risk factors for total complications at 90 days., Conclusions: An epidemiological analysis of VTE prophylaxis use from 2016 to 2021 shows an increase in aspirin following TKA compared to other anticoagulant cohorts in a nationally representative population. This approach provides more insight and a better understanding of anticoagulation trends over this time period in a nationally representative sample., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Despite the recognized importance of managing vascular injury associated with knee dislocation, studies have been limited by small patient sizes, data older than five years, and lack of inclusion of newer procedural and diagnoses codes. This has been reflected in the reported frequency of knee dislocation associated with vascular injury ranging from 1.6 % to 64 %. As such, we sought to determine: (1) the frequency of knee dislocations associated with vascular injuries; (2) the frequency of knee dislocations associated with vascular injuries that required repair; as well as (3) independent risk factors for knee dislocation with vascular injury that require repair, across different age groups, sexes, and United States geographic regions., Methods: A national, all-payer database was queried from January 1, 2010 to June 31, 2022. The frequency of a vascular injury was calculated by dividing the number of vascular injuries within 30 days of all knee dislocations by the total number of knee dislocations in each category. The frequency of a vascular injury that required repair was calculated by dividing the number of vascular injuries that required repair associated with knee dislocation by the total number of vascular injuries associated with knee dislocations. Patients were categorized by year of diagnosis, age, sex, and US geographic region. Multivariable logistic regressions were calculated to determine independent risk factors for knee dislocation with vascular injury., Results: From 2010 to 2022, there were 99,688 knee dislocations. Of the total knee dislocations, there were 1066 (1.1 %) vascular injuries associated with knee dislocations, 96,530 (96.8 %) were closed dislocations, and 3158 (2.2 %) were open dislocations. Of the 1066 vascular injuries associated with knee dislocations, 262 (24.6 %) vascular injuries required repair. Male sex (P < 0.001), Elixhauser Comorbidity Index (ECI) > 3 (P < 0.001), alcohol abuse (P = 0.006), congestive heart failure (P = 0.01), hypothyroidism (P = 0.003), and obesity (P < 0.001), were independent risk factors for knee dislocation with vascular injuries., Conclusion: Our study provides a refined understanding of the historically low incidence of knee dislocation with vascular injury as well as an increase in vascular injuries requiring repair from 2010 to 2022. Given the large expense of irreversible injury in these patients, vulnerable patient populations identified in our study, such as obese patients with additional comorbidities, should be a focus of future intervention. These findings can guide physicians in a clinical setting to appropriately manage the expectations of patients as well as minimize the morbidity and mortality associated with this presentation., Competing Interests: JN- Arthritis Foundation: Board or committee member, Journal of Arthroplasty, Journal of the American Osteopathic Medicine Association, Orthopedic, Knowledge Online: Editorial or governing board, Journal of Knee Surgery: Editorial or governing board, Knee: Editorial or governing board, Microport: Paid consultant; Paid presenter or speaker; Research support, Stryker: Research support, United: Research support. PM- Biocomposites: Other financial or material support, MHE Coalition: Other financial or material support, Novadip: Paid consultant; Research support, Orthofix, Inc.: Other financial or material support; Paid consultant, OrthoPediatrics: Other financial or material support; Paid consultant, Pega Medical: Other financial or material support, Smith & Nephew: Other financial or material support; Paid consultant, Stryker: Other financial or material support, Synthes: Other financial or material support; Paid consultant, Wishbone: Paid consultant, Zimmer: Other financial or material support. RD- Baltimore City Medical Society.: Board or committee member, DePuy Synthes Product, Inc.: Research support, Orthofix, Inc.: Research support, Smith & Nephew: Research support, Stryker: Research support, Tissue Gene: Research support., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

Introduction: While dual mobility systems in total hip replacements have demonstrated reduced dislocation and revision occurrences, concerns persist about the potential elevation of metal ions in the bloodstream, leading to negative tissue reactions. Notably, there's a scarcity of research spanning over five years post-surgery that examines cobalt and chromium levels after such implants. This study aimed to delve into these metal ion concentrations after a five-year period, building on previous metal-ion findings. We focused on: (1) cobalt concentrations in blood and urine; (2) chromium concentrations in blood and urine; (3) cobalt variations based on follow-up duration and specific implant metrics (e.g., offset, cup dimension, stem, and neck inclination); and (4) chromium variations based on the same parameters., Materials and Methods: We tracked 57 individuals who received THA using modular dual mobility systems from January 1, 2011, to December 31, 2016, for an average span of six years (ranging from five to 10 years). At the final check-up, we measured cobalt and chromium levels in serum, plasma, blood, and urine. We also evaluated parameters like head composition and dimension, stem offset, cup dimension, and stem-neck inclination., Results: Cobalt concentrations remained minimal, with average blood and urine values being 0.8+0.6mcg/L (standard <1.8mcg/L) and 1.2+1.0mcg/L (standard <2.8mcg/L), respectively. Two individuals exhibited a slight increase in blood cobalt concentration by 0.1 and 0.2mcg/L. Chromium averages in blood and urine were also minimal, with readings of 0.9+0.2mcg/L (standard <1.2mcg/L) and 1.3 + 0.5mcg/L (standard <2mcg/L), respectively. One individual had a marginally increased blood chromium concentration of 1.3mcg/L. Evaluations considering ceramic or cobalt-chrome heads, up to a decade of follow up, or varying implant metrics showed negligible variations in metal ion concentrations., Conclusion: The findings reveal that over a minimum of five years (average = six years; span, five to 10 years), cobalt and chromium concentrations in patients' systems remained within normal limits and were clinically insignificant, irrespective of the follow-up duration, head material, or implant specifications. This underscores the efficacy of dual mobility systems in ensuring minimal metal ion presence.

Revision total hip arthroplasty (THA) presents a formidable challenge when addressing extensive acetabular defects, particularly in severe cases classified under Paprosky types 3A and 3B and American Academy of Orthopaedic Surgeons types 3 and 4. Traditional methods often fall short, prompting the potential use of custom triflange acetabular components or patient-specific acetabular implants (PSAIs). These implants are specifically designed to conform to an individual's anatomy, aiming to enhance defect reconstruction and pelvic stabilization. This case series describes the utilization of advanced 3-dimensional printing and rapid prototyping technologies to construct customized acetabular components, which can be instrumental in enabling precise preoperative planning and surgical execution for these difficult acetabular cases and potentially leading to improved surgical outcomes.

Introduction: Classical neutral mechanical alignment in total knee arthroplasty (TKA) has been a standard paradigm, while more recently, other alignment schemas, such as kinematic, individualized, and functional, have been explored. This study aimed to investigate the effect of three-dimensional (3D) computed tomography (CT)-based surgical robotics inputs on a classically trained surgeon's TKA component positions and alignment targets over time., Materials and Methods: Data from 1,394 consecutive robotically-assisted TKAs by a single surgeon from 2016 to 2020 were analyzed. Metrics collected included pre-balance planned implant component positions, final planned implant component positions after soft tissue balancing, and constitutional alignment from CT scans. Joint line obliquity was plotted against the arithmetic hip-knee angle (aHKA) using coronal plane alignment of the knee (CPAK). Three categories of alignment strategy were defined: true mechanical alignment (tMA), adjusted mechanical alignment (aMA), and no mechanical alignment (noMA)., Results: A shift to overall varus component positioning was observed over the years. Joint line obliquity according to CPAK showed a wider spread in later years, and the distribution of tibial and femoral coronal alignment angles expanded over time., Conclusion: The study revealed a change in alignment targets and final positioning of components away from neutral biomechanical axes in a large volume of TKAs by a single, classically trained surgeon over five years of using a robotic arm-assisted TKA system with CT-based planning. The most dominant factor for this change was the use of 3D CT planning, allowing the surgeon to assess patient-specific anatomy and plan accordingly. Outcome data is needed to determine if this change in behavior and surgical technique was beneficial. In summary, using a CT scan-based robotically assisted technique led to a gradual and complete shift from tMA to predominantly a non-mechanically aligned philosophy in TKA.

Introduction: Robotic-assisted total hip arthroplasty (RA-THA) provides an alternative to fluoroscopic guidance, thus reducing radiation exposure for orthopaedic surgeons. This study was performed to assess the learning curve associated with the adoption of RA-THA using the direct anterior approach (DAA) with regard to surgical time, use of fluoroscopy, and implant placement. In addition, we compared complication rates and patient-reported outcome scores between both cohorts. A case report of an RA-THA is also presented., Materials and Methods: This was a retrospective, non-randomized evaluation of the learning curve by assessing surgical time on a consecutive series of 89 DAA cases performed by a single surgeon. There were 53 cases that had manual THA with fluoroscopy and 36 cases with RA-THA. All cases had an acetabular component placement target of 40° inclination and 20° anteversion. An independent reviewer blinded to surgical technique used the Widmer method to measure acetabular inclination and version. Patient demographics were similar for both groups., Results: The mean surgical time for the manual fluoroscopic group was 88 ± 21 minutes and 101 ± 14 minutes for the RA-THA group. After 15 RA-THA cases, surgical time reached time neutral compared to the manual fluoroscopic group. The first 17 RA-THA cases utilized fluoroscopy to verify implant position until the surgeon became comfortable with the accuracy of the RA-THA system. After case 17, fluoroscopy was abandoned in all subsequent RA-THA cases. The mean radiation dose delivered to the surgical field was 5.61 ± 5.71 mGy. Manual THA with fluoroscopy resulted in a mean acetabular inclination of 41.3 ± 4.4° and a mean anteversion of 22.4 ± 3.0°. The RA-THA resulted in a mean acetabular inclination of 42.0 ± 4.2° and a mean anteversion of 22.3 ± 3.9°. There was no noted change in RA-THA placement accuracy after case 17, when fluoroscopy was eliminated from the surgical workflow. There were no statistical differences between the manual fluoroscopic and robotic-assisted groups with respect to complications and clinical PROM outcomes., Conclusion: The DAA THA can be performed with RA-THA and achieve comparable acetabular placement without fluoroscopy. Surgical time was higher for the RA-THA group during the learning curve, but then decreased and was consistent with the manual fluoroscopic group after 15 cases.

Introduction: Osteonecrosis of the femoral head (ONFH) poses a substantial burden to orthopaedic surgeons. However, the exact risk attributed by each specific patient factor for those who end up receiving a total hip arthroplasty (THA) are not well known. We assessed: (1) patient demographics (age and sex); (2) blood cell dyscrasias (sickle-cell disease and hypercoagulable states); and (3) substance use (oral corticosteroid use, tobacco use, and alcohol abuse)., Materials and Methods: A retrospective search examined all patients who had a primary THA (n=715,100) between January 1, 2010 and April 30, 2020 using a national, all-payer database. Risk factors studied included age, sex, sickle-cell, hypercoagulable state, oral corticosteroid use, tobacco use, and alcohol abuse., Results: Several risk factors were found to be significantly predictive for ONFH requiring THA: age <55 years (odds ratio [OR] 1.02, 95% confidence interval [CI] of 1.01 to 1.02, p<0.001), men (OR 1.07, 95% CI of 1.04 to 1.10, p<0.001), oral corticosteroid use (OR 1.21, 95% CI of 1.17 to 1.25, p<0.001), tobacco use (OR 1.15, 95% CI of 1.11 to 1.18, p<0.001), and alcohol abuse (OR 1.05, 95% CI of 1.01 to 1.08, p=0.009)., Conclusions: Based on the results of this study, young age, men, oral corticosteroid use, tobacco use, and alcohol abuse are risk factors for patients who have ONFH and had a THA. The degree of risk from greatest to least were: oral corticosteroid use, tobacco use, men, alcohol abuse, and age <55 years old.

Hinged knee arthroplasties are commonly used in scenarios where there are major ligament deficiencies or bone loss around the knee. They are applicable in native knees with major deformities and during revisions. They can also be used as a salvage procedure after distal femoral resection. The new modular hinged device system, namely the Triathlon Hinge Knee (THK) System (Stryker, Mahwah, New Jersey), reflects the advancements of third-generation design and enhances surgical flexibility by allowing streamlined integration with the Triathlon Total Stabilized (TS) System (Stryker, Mahwah, New Jersey) and the Global Modular Replacement System (GMRS, Stryker, Mahwah, New Jersey). Additionally, the Triathlon Revision Tibial Baseplate (Stryker, Mahwah, New Jersey) has been launched as part of THK and is compatible with the Modular Rotating Hinge (MRH , Stryker, Mahwah, New Jersey) femur, which allows the Revision Baseplate to replace the existing tibial component while leaving the existing MRH Femoral Component in place. The Triathlon Revision Tibial Baseplate enables orthopaedic surgeons to use constrained or hinged prostheses, including both distal and total femoral replacement options, without changing the Tibial Baseplate. This is because the TS, MRH, THK, and GMRS femurs are compatible with the new Triathlon Revision Tibial Baseplate. Additionally, the system can be augmented with metaphyseal cone constructs to help provide a stable foundation for reconstruction. This report explores the application of a new modular hinged device system in various scenarios, starting with (1) complex primary hinged knee arthroplasty, followed by revision hinged knee arthroplasty cases including (2) failed TKA with medial collateral ligament (MCL) dysfunction, (3) severe arthrofibrosis post-TKA, (4) revisions for prosthetic joint infection, (5) extensor mechanism deficiency, and (6) arthrofibrosis with extensor mechanism disruption, concluding with a case of (7) distal femoral arthroplasty for periprosthetic fracture post-failed TKA.

Revision total hip arthroplasty (THA) is a procedure with many challenges, especially when patients exhibit femoral bone defects. The causes of these defects vary, ranging from removal of prior implants to aseptic loosening. As surgeons navigate these challenges, a reliable surgical system is important. One modular fluted tapered system provides surgeons with tools to address complex hip revision cases. Introduced in 2003, this system has been utilized in over 180,000 procedures, demonstrating its reliability and effectiveness. Previously, the body stem came in sizes 155mm to 235mm. In the discussed case series, we present six distinct patient cases that highlight the advantages and efficacy of a newly introduced modification of the system; that is the use of smaller stemmed components (now 115mm). With each patient presenting unique challenges, we have demonstrated the use of this new short-stem version for multiple applications for various revision scenarios.

Background: Effective surgical wound management in total knee arthroplasty (TKA) is crucial for optimal healing and patient outcomes. Despite surgical advances, managing wounds to prevent complications remains challenging. This study aimed to identify and address evidence gaps in TKA wound management, including preoperative optimization, intraoperative options, and postoperative complication avoidance. Addressing these issues is vital for patient recovery and surgical success., Methods: This study used the Delphi method with 20 experienced orthopedic surgeons from Europe and North America. Conducted from April to September 2023, the process involved three stages: an initial electronic survey, a virtual meeting, and a concluding electronic survey. The panel reviewed and reached a consensus on 26 statements about TKA wound management based on a comprehensive literature review. Additionally, the panel aimed to identify critical evidence gaps in wound management practices., Results: The panel achieved consensus on various wound management practices but highlighted significant evidence gaps. Consensus was reached on wound closure methods, including mesh-adhesive dressings, skin glue, staples, barbed sutures, and negative pressure wound therapy. However, further evidence is needed to address the cost-effectiveness of these methods and develop best practices for patient outcomes. Identifying these gaps highlights the need for more research to improve TKA wound care., Conclusions: Identifying major evidence gaps underscores the need for targeted research in TKA wound management. Addressing these gaps is crucial for developing effective, efficient, and patient-friendly wound care strategies. Future research should focus on comparative effectiveness studies and developing guidelines for emerging technologies. Bridging these gaps could improve patient outcomes, reduce complications, and enhance TKA surgery success., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Low socioeconomic status based on neighborhood of residence has been suggested to be associated with poor outcomes after total joint arthroplasty (TJA). The area deprivation index (ADI) is a scale that ranks (zero to 100) neighborhoods by increasing socioeconomic disadvantage and accounts for median income, housing type, and family structure. We sought to examine the potential differences between high (national median ADI = 47) and low ADI among TJA recipients at a single institution. Specifically, we assessed: (1) 30-day emergency department visits/readmissions; (2) 90-day and 1-year revisions; as well as (3) medical and surgical complications., Methods: A consecutive series of primary TJAs from September 21, 2015, through December 29, 2021, at a tertiary healthcare system were reviewed. A total of 3,024 patients who had complete ADI data were included. Patients were divided into groups below the national median ADI of 47 (n = 1,896) and above (n = 1,128). Multivariable regressions to determine independent risk factors accounting for ADI, race, age, sex, American Society of Anesthesiologists Classification grade, body mass index, diabetes, congestive heart failure (CHF), chronic obstructive pulmonary disease, hypertension, chronic kidney disease, alcohol abuse, substance abuse, and tobacco use. The primary outcomes of interest include evaluation of the independent association of ADI with total postoperative complications (at 30 days, 90 days, and 1 year) after adjusting for multiple relevant cofactors., Results: After adjusting for multiple relevant cofactors, at 90 days, ADI > 47 (OR, 1.36, 95% CI 1.00-1.83, P = 0.04), men versus women (OR, 0.73, 95% CI 0.54-0.99, P = 0.039), and CHF (OR, 1.90, 95% CI 1.18-3.06, P = 0.009) were independently associated with increased total complications. The ADI was not associated with increased total complications at 30 days or 1-year (All P > 0.05)., Conclusion: Our findings of higher complications of the ADI > 47 cohort at 90 days, reaffirm the complex relationship between ADI, patient demographics, and additional socioeconomic parameters that may influence postoperative outcomes and complications after TJA. This study utilizing ADI demonstrates potential areas of intervention and further investigation for assessing arthroplasty outcomes., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Femoral neck fractures are common in individuals over 65, necessitating quick mobilization for the best outcomes. There's ongoing debate about the optimal femoral component fixation method in total hip arthroplasty (THA) for these fractures. Recent U.S. data shows a preference for cementless techniques in over 93% of primary THAs. Nonetheless, cemented fixation might offer advantages like fewer revisions, reduced periprosthetic fractures, lesser thigh pain, and enhanced long-term implant survival for those above 65. This study compares cementless and cemented fixation methods in THA, focusing on postoperative complications in patients aged 65 and older., Methods: We analyzed a national database to identify patients aged 65+ who underwent primary THA for femoral neck fractures between 2016 and 2021, using either cementless (n = 2,842) or cemented (n = 1,124) techniques. A 1:1 propensity-matched analysis was conducted to balance variables such as age, sex, and comorbidities, resulting in two equally sized groups (n = 1,124 each). We evaluated outcomes like infection, venous thromboembolism (VTE), wound issues, dislocation, periprosthetic fracture, etc., at 90 days, 1 year, and 2 years post-surgery. A P-value < 05 indicated statistical significance., Results: The cemented group initially consisted of older individuals, more females, and higher comorbidity rates. Both groups had similar infection and wound complication rates, and aseptic loosening. The cemented group, however, had lower periprosthetic fracture rates (2.5 versus 4.4%, P = .02) and higher VTE rates (2.9 versus 1.2%, P = .01) at 90 days. After 1 and 2 years, the cementless group experienced more aseptic revision surgeries., Conclusions: This study, using a large, national database and propensity-matched cohorts, indicates that cemented femoral component fixation in THA leads to fewer periprosthetic fractures and aseptic revisions, but a higher VTE risk. Fixation type choice should consider various factors, including age, sex, comorbidities, bone quality, and surgical expertise. This data can inform surgeons in their decision-making process., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Revision shoulder arthroplasty (RevSA) is a complex procedure that can result in various postoperative complications. However, the impact of hepatitis C virus (HCV) on postoperative complications after RevSA remains unclear because of limited and inconsistent evidence. This study aims (1) to investigate the incidence of postoperative complications in patients with HCV undergoing RevSA and (2) to evaluate the impact of HCV treatment on complication rates at different time points after the revision procedure, specifically at 90 days, 1 year, and 2 years., Methods: We queried a national, all-payer database to investigate recent trends in the use of RevSA among HCV patients to assess postoperative complication rates, including venous thromboembolism (VTE), wound complication, transfusion, and periprosthetic joint infection (PJI). Statistical analyses involved propensity score matching to create balanced cohorts and logistic regression to determine the relative risk of postoperative complications. Data were analyzed with SPSS software (version 24.0 for Windows). The study included patients who underwent partial or total RevSA procedures between January 1, 2010, and December 31, 2020. Patients were identified based on medical claims that included procedural codes for RevSA and associated diagnosis codes for PJI or insertion/removal of an antibiotic spacer. A Bonferroni correction was used because many tests were performed and statistical significance was set at P = .0125., Results: The HCV cohort demonstrated higher PJI rates at 1-year (5.5% vs. 3.9%, P = .006) and 2-year follow-ups (6.7% vs. 4.6%, P = .006). However, no significant differences emerged in VTE and wound complication rates between the HCV and non-HCV cohorts. Comparing untreated and treated HCV patients, the former showed significantly higher PJI rates at 2 years (P = .010), whereas the treated group had significantly lower odds ratios for PJI. When comparing treated HCV patients with the non-HCV cohort, minimal differences were found in postoperative outcomes, indicating no significant difference in the risk of complications between the groups., Conclusion: Our study observed an association between HCV patients who received antiviral treatment prior to RevSA and a reduced incidence of PJI compared to untreated HCV patients. When comparing this group to the non-HCV controls, there was no significant difference in the incidence of PJI, suggesting a potential association between antiviral treatment and the observed risk patterns in HCV patients. Proper management of HCV-positive patients during RevSA is crucial for improving outcomes and reducing complications., (Copyright © 2024. Published by Elsevier Inc.)

This report provides an updated analysis for patients with osteoporosis following total hip arthroplasty (THA). The comorbidities of alcohol abuse, chronic kidney disease, cerebrovascular disease, obesity, and rheumatoid arthritis continue to be significant risk factors for periprosthetic femur fracture (PPFFx) and aseptic loosening in the population with osteoporosis. Patients with dual-energy x-ray absorptiometric (DEXA) scans were at risk for PPFFx regardless of femoral fixation method, and patients with DEXA scans with cementless fixation were at risk of aseptic loosening after THA. The patient population with severe osteoporosis may have higher risks for aseptic loosening and PPFFx than previously recognized., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The global incidence of total joint arthroplasty (TJA) has consistently risen over time, and while various forecasts differ in magnitude, future projections suggest a continued increase in these procedures. Differences in future United States projections may arise from the modeling method selected, the nature of the national arthroplasty registry employed, or the representativeness of the specific hospital discharge records utilized. In addition, many models have not accounted for ambulatory surgery as well as all payer types. Therefore, to attempt to make a more accurate model, we utilized a national representative sample that included outpatient arthroplasties and all insurance types to predict the volumes of primary TJA in the USA from 2019 to 2060., Methods: A national, all-payer database was queried. All patients who underwent primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from January 1, 2010, to December 31, 2019, were identified using international classification of disease Ninth Revision (9) and Tenth Revision (10) codes and current procedure terminology codes. Absolute frequencies and incidence rates were calculated per 100,000 for both THA and TKA procedures, with 95% confidence intervals. Mean growth in absolute frequency and incidence rates were calculated for each procedure from 2010 to 2014, and 2010 to 2019, with 95% confidence intervals (CI)., Results: The overall increase in THA and TKA procedures are expected to grow + 10 and + 36%, respectively, using linear regressions and + 9 and + 37%, respectively. The most positive mean growth in procedure frequency occurred from 2010 to 2014 for THA (+ 24, 95% Confidence Interval (CI): + 21, + 27) and 2010-2019 for TKA (+ 11%, 95% CI: + 9, + 14). There positive trend patterns in incidence rate growth for both procedures, with similar 2010-2019 incidence rates + 6%) for THA (+ 3%, 95% CI: + 0, + 6%) and TKA (+ 3%, 95% CI: + 1%, + 6%)., Conclusion: Utilizing a nationally representative database, we demonstrated that TJA procedures would continue with an increased growth pattern to 2060, though slightly decreased from the surge from 2014 to 2019. While this finding applies to the representativeness of the population at hand, the inclusion of outpatient arthroplasty and all payer types validates an approach that has not been undertaken in previous projection studies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Introduction: Given the growing emphasis on patient outcomes, including postoperative complications, in total joint arthroplasty (TJA), investigating the rise of outpatient arthroplasty is warranted. Concerns exist over the safety of discharging patients home on the same day due to increased readmission and complication rates. However, psychological benefits and lower costs provide an incentive for outpatient arthroplasty. The influence of social determinants of health disparities on outpatient arthroplasty remains unexplored. One metric that assesses social disparities, including the following individual components: socioeconomic status, household composition, minority status, and housing and transportation, is the Social Vulnerability Index (SVI). As such, we aimed to compare: (1) mean overall SVI and mean SVI for each component and (2) risk factors for total complications between patients undergoing inpatient and outpatient arthroplasty., Methods: Patients who underwent TJA between January 1, 2022 and December 31, 2022 were identified. Data were drawn from the Maryland State Inpatient Database (SID). A total of 7817 patients had TJA within this time period. Patients were divided into inpatient arthroplasty (n = 1429) and outpatient arthroplasty (n = 6338). The mean SVI was compared between inpatient and outpatient procedures for each themed score. The SVI identifies communities that may need support cause by external stresses on human health based on four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. The SVI uses the United States Census data to rank census tracts for each individual theme, as well as an overall social vulnerability score. The higher the SVI, the more social vulnerability, or resources needed to thrive in that area. Multivariate logistic regression analyses were performed to identify independent risk factors for total complications following TJA after controlling for risk factors and patient comorbidities. Total complications included: infection, aseptic loosening, dislocation, arthrofibrosis, mechanical complication, pain, and periprosthetic fracture., Results: Patients who had inpatient arthroplasty had higher overall SVI scores (0.45 vs. 0.42, P < 0.001). The SVI scores were higher for patients who had inpatient arthroplasty for socioeconomic status (0.36 vs. 0.32, P < 0.001), minority status and language (0.76 vs. 0.74, P < 0.001), and housing and transportation (0.53 vs. 0.50, P < 0.001) compared to outpatient arthroplasty, respectively. There was no difference between inpatient and outpatient arthroplasty for household composition and disability (0.41 vs. 0.41, P = 0.99). When controlling for comorbidities, inpatient arthroplasty [Odds Ratio (OR) 1.91, 95% Confidence Interval (CI) 1.23-2.95, P = 0.004], hypertension (OR 2.11, 95% CI 1.23-3.62, P = 0.007), and housing and transportation (OR 2.00, 95% CI 1.17-3.42, P = 0.012) were independent risk factors for total complications., Conclusion: Inpatient arthroplasty was associated with increased social disparities across several components of deprivation as well as an independent risk factor total complications following TJA. To the best of our knowledge, this study is the first to examine the negative repercussions of inpatient arthroplasty through the lens of social disparities and can target specific areas for intervention., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Soft-tissue balancing is an important factor in primary total knee arthroplasty (TKA), with 30 to 50% of TKA revisions attributed to technical operative factors including soft-tissue balancing. Robotic-assisted TKA (RATKA) offers opportunities for improved soft-tissue balancing methods. This study aimed to evaluate the repeatability and reproducibility of ligamentous laxity assessments during RATKA using a digital tensioner.Three experienced RATKA surgeons assessed preresection and trialing phases of 12 human cadaveric knees with varying degrees of arthritis. Ligamentous laxity was assessed with manual varus and valgus stresses in extension and flexion, with a digital tensioner providing feedback on the change of laxity displacement. Intraclass correlation coefficient (ICC) analyses were used to determine the repeatability within a single surgeon and reproducibility between the three surgeons.The results showed excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA. Surgeons had excellent repeatability for preresection and trialing assessments, with median ICC values representing excellent reproducibility between surgeons. Surgeons were repeatable within 1 or 1.5 mm for preresection and trialing assessments. On average, the variation within a surgeon was 0.33 ± 0.26 mm during preresection and 0.29 ± 0.28 mm during trialing. When comparing surgeons to each other, they were reproducible within an average of 0.69 ± 0.33 mm for preresection and 0.65 ± 0.31 mm for trialing.This study demonstrated the reliability of robotic-assisted soft-tissue balancing techniques, providing control over ligamentous laxity assessments, and potentially leading to better patient outcomes. The digital tensioner used in this study provided excellent repeatability and reproducibility in ligamentous laxity assessment during RATKA, highlighting the potential benefits of incorporating robotics in TKA procedures., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: Our purpose was to quantify the risk of 90-day postoperative infection after arthroscopy, stratified by specific time intervals of corticosteroid injections (CSIs) postoperatively (0-2 weeks, 2-4 weeks, 4-6 weeks, and 6-8 weeks), using a large, all-payer database., Methods: A national, all-payer database was queried. In the primary and secondary analyses, the main outcome was infection at 90 days. Infection was defined by documentation of a septic knee or surgical-site infection according to International Classification of Diseases, Ninth Revision and Tenth Revision codes, and Current Procedural Terminology codes., Results: In the multivariable regression, the odds ratio (OR) of postoperative infection at 90 days was greater in the cohorts receiving CSIs within 0 to 2 weeks (OR, 3.31; 95% confidence interval, 1.85-5.92; P < .001) and 2 to 4 weeks (OR, 2.72; 95% confidence interval, 1.57-4.71; P = .003) than in the control group. On comparison of CSIs administered within 0 to 2 weeks and CSIs administered within 2 to 4 weeks, we observed a greater odds of postoperative infection (OR, 2.50) at 90 days after arthroscopy., Conclusions: CSIs given within 2 weeks after knee arthroscopy increase the risk of postoperative infection the most, whereas CSIs given within 4 weeks increase the risk but to a lesser degree., Level of Evidence: Level III, retrospective, comparative, prognosis study., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: C.B. performs consulting for Arthrex and Supreme Orthopedic Systems and receives payments/royalties from Arthrex. Y.K. owns stock options in Think Surgical; receives research support from Episurf; and is on the editorial board of Journal of Knee Surgery and Knee. R.E.D. receives research support from Biocomposites, CyMedica Orthopedics, DePuy Synthes, Flexion Therapeutics, Microport, Orthopedics, Orthofix, Patient-Centered Outcomes Research Institute (PCORI), Smith & Nephew, Stryker, Tissue Gene, and United Orthopedic. All other authors (J.D., H.S., O.S., S.S.B., D.H.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: With the rise of machine learning applications in health care, shifts in medical fields that rely on precise prognostic models and pattern detection tools are anticipated in the near future. Chat Generative Pretrained Transformer (ChatGPT) is a recent machine learning innovation known for producing text that mimics human conversation. To gauge ChatGPT's capability in addressing patient inquiries, the authors set out to juxtapose it with Google Search, America's predominant search engine. Their comparison focused on: 1) the top questions related to clinical practice guidelines from the American Academy of Family Physicians by category and subject; 2) responses to these prevalent questions; and 3) the top questions that elicited a numerical reply., Methods: Utilizing a freshly installed Google Chrome browser (version 109.0.5414.119), the authors conducted a Google web search (www.google.com) on March 4, 2023, ensuring minimal influence from personalized search algorithms. Search phrases were derived from the clinical guidelines of the American Academy of Family Physicians. The authors prompted ChatGPT with: "Search Google using the term '(refer to search terms)' and document the top four questions linked to the term." The same 25 search terms were employed. The authors cataloged the primary 4 questions and their answers for each term, resulting in 100 questions and answers., Results: Of the 100 questions, 42% (42 questions) were consistent across all search terms. ChatGPT predominantly sourced from academic (38% vs 15%, p = 0.0002) and government (50% vs 39%, p = 0.12) domains, whereas Google web searches leaned toward commercial sources (32% vs 11%, p = 0.0002). Thirty-nine percent (39 questions) of the questions yielded divergent answers between the 2 platforms. Notably, 16 of the 39 distinct answers from ChatGPT lacked a numerical reply, instead advising a consultation with a medical professional for health guidance., Conclusion: Google Search and ChatGPT present varied questions and answers for both broad and specific queries. Both patients and doctors should exercise prudence when considering ChatGPT as a digital health adviser. It's essential for medical professionals to assist patients in accurately communicating their online discoveries and ensuing inquiries for a comprehensive discussion., Competing Interests: Conflicts of Interest MAM receives consultant fees from Stryker, 3M, Centrexion, Ceras Health, Johnson & Johnson, Kolon Tissuegene, MirrorAR, NXSCI, Pacira, PeerWell, Pfizer-Lilly, Skye Biologics, SOLVD Health, Smith & Nephew; receives payments for lectures from Stryker; leadership role for The Knee Society, The Hip Society, Journal of Arthroplasty, Journal of Knee Surgery, Surgical Technology International Orthopaedics; and stock options from Ceras Health, MirrorAR, PeerWell, and US Medical Innovations. RED is a paid consultant for MicroPort Orthopedics; receives research support from a company or supplier as a principal investigator from MicroPort Orthopedics, Stryker, and United Orthopedic Corporation; is on the medical/orthopaedic publications editorial/governing board of Journal of Arthroplasty, Journal of the American Osteopathic Medicine Association, Orthopedic Knowledge, Journal of Knee Surgery, Knee; and is a board member/committee appointments for a society of the Arthritis Foundation. JN receives research support from Johnson & Johnson, Biocomposites, CyMedica Orthopedics, DePuy Synthes product, Flexion Therapeutics, MicroPort Orthopedics, Orthofix, Patient-Centered Outcomes Research Institute, Smith & Nephew, Stryker, Tissue Gene, United Orthopedic Corporation; is on the medical/orthopaedic publications editorial/governing board for Journal of Knee Surgery, and is a board member/committee appointments for Baltimore City Medical Society.