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Parallax is poorly understood and can mislead surgeons using intraoperative fluoroscopy (IF) to guide cup placement during anterior approach (AA) total hip arthroplasty. The purpose of this study was to examine how changes in fluoroscopic beam positioning in relation to the hip and pelvis affects the projected acetabular image.An acetabular component was positioned in an anatomic pelvis model in 45° and 20° of abduction and anteversion, respectively using a computer assisted cup targeting system. Fluoroscopic images were taken at various caudal and cranially directed angles with the fluoroscopic beam centered over the hip then pelvis. In each position, four independent observers measured the abduction and anteversion angles of the projected cup image using the same computer targeting system.Cup abduction and anteversion measured 43.5° and 19.5° when IF was centered over the hip and 40.5 and 27.5° when centered over the pelvis in the neutral position. Increasing the caudal direction of the beam 20° increased the projected abduction/anteversion angles by approximately 7°/12° and 9°/16° when centered over the hip and pelvis respectively. Increasing the cranial direction of the beam 20° decreased the measured abduction/anteversion angles by roughly 4°/20° and 4°/24° when centered over the hip and pelvis, respectively.The projected image of the acetabular component can change dramatically depending on fluoroscopic beam position relative to the hip and pelvis. Recognizing the approximate direction and magnitude of change with differing fluoroscopy positions may help surgeons avoid cup malpositioning.

Preoperative arthroplasty classes decrease complications and readmissions, however, in-person classes are inconvenient for elderly patients with mobility limitations. This retrospective review included 232 patients (305 joints) with in-person preoperative educational classes (IPC) and 155 patients (192 joints) with telephone preoperative educational classes (TC). Compared to IPC, TC patients had a shorter length of stay (P

In response to the COVID-19 pandemic, federal and state recommendations included the postponement of elective arthroplasties until adequate safety measures could be implemented. Following resumption of arthroplasties, exposure fears and financial concerns may have restricted access for some demographics. Therefore, the purpose of this study was to (1) investigate how the COVID-19 pandemic impacted the incidence of arthroplasty, both overall and by various demographics, and (2) evaluate if pre-operative patient-reported measures were different throughout the pandemic. Data were collected prospectively as part of an on-site joint registry between January 2019 and April 2021. Phase 1 (N=518) included all patients prior to the cancelation of elective procedures (average 36 cases/month), Phase 2 (N=121) was defined from restart until monthly caseload met/surpassed the average Phase 1 caseload (5 months), and Phase 3 (N=277) included all remaining cases. Multiple analysis of variance and chi-squared tests were performed to compare patient demographics and outcomes between phases. No significant differences were noted in patient demographics, with the exception of a decrease in Native Hawaiian/Pacific Islander patients and an increase in Asian patients during Phase 2 (P =.004). Length of stay decreased for unilateral arthroplasty from Phase 1 (0.9±1.1 days) to Phase 2 (0.4±0.6 days) and Phase 3 (0.6±0.7 days) (P

Total knee arthroplasty (TKA) is now considered an outpatient procedure, yet advanced age impacts patients' ability to achieve outpatient discharge. Therefore, the purpose of this study is to determine the rate of successful outpatient discharge for TKA patients above 70 years of age and identify potential barriers to success.This retrospective review included 352 unilateral TKA patients. The rapid discharge protocol was followed for all patients with the intention of discharge within a 24-hour period. Successful outpatient discharge was classified as ≤24-hour stay and failure was any stay exceeding a 24-hour period in the hospital. Univariate logistic regressions were performed to determine the influence of independent variables on discharge status for all patients and only patients70 years old.Overall, 46 patients (13%) failed to achieve outpatient discharge, with 35 (76%) patients being ≥70 years old. For patients ≥70, age was not a predictive variable for failure to achieve outpatient discharge (P = .484). However, being female (odds ratio 3.273, 95% confidence interval 1.286-8.325, P = .013) and the use of an assistive walking device (odds ratio 3.031, 95% confidence interval 1.387-6.625, P = .005) remained independent contributors to prolonged hospital stay.With patients ≥70 years old more likely to require24-hour stays, age should be an evaluated metric for justifying higher levels of reimbursement. Although TKA is now considered an outpatient procedure, greater consideration should be given to patients ≥70 years old for higher levels of reimbursement as outpatient discharge is less likely to be successful.