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Introduction: Periprosthetic joint infection (PJI) following total hip arthroplasty (THA) remains a devastating complication for patients and surgeons. Given the implications of these infections and the current paucity of risk calculators utilizing machine learning (ML), this study aimed to develop an ML algorithm that could accurately identify risk factors for developing a PJI following primary THA using a national database. Materials and methods: A total of 51,053 patients who underwent primary THA between 2013 and 2020 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Demographic, preoperative, intraoperative, and immediate postoperative outcomes were collected. Five ML models were created. The receiver operating characteristic curves, the area under the curve (AUC), calibration plots, slopes, intercepts, and Brier scores were evaluated. Results: The histogram-based gradient boosting (HGB) model demonstrated good PJI discriminatory ability with an AUC of 0.88. The test-specific metrics supported the model’s performance and validation in predicting PJI (calibration curve slope: 0.79; intercept: 0.32; Brier score: 0.007). The top five predictors of PJI were the length of stay (> 3 days), patient weight at the time of surgery (> 94.3 kg), an American Society of Anesthesiologists (ASA) class of 4 or higher, preoperative platelet count (< 249,890/mm3), and preoperative sodium (< 139.5 mEq/L). Conclusion: This study developed a highly specific ML model that could predict patient-specific PJI development following primary THA. Considering the feature importance of the top predictors of infection, surgeons should counsel at-risk patients to optimize resource utilization and potentially improve surgical outcomes. [ABSTRACT FROM AUTHOR]

Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity. Patients undergoing acetabular distraction performed by 5 surgeons from 2002 to 2021 were identified across 5 institutions. Demographic, surgical, and postoperative outcomes, including radiographic component stability, were recorded. There were 53 of 91 (58.2%) patients (5 deceased, 33 lost to follow-up) consisting of 4 Paprosky IIC (7.5%), 8 Paprosky IIIA (15.1%), and 41 Paprosky IIIB (77.4%) defects included, with a mean follow-up time of 4.8 years (range, 2 to 13.5). Modular porous augments were used in 33 (62.3%) cases. Failure was defined as a subsequent revision of the acetabular construct. Among the 13 (24.5%) patients who returned to the operating room, 6 (46.2%) had a prior history of revision total hip arthroplasty before undergoing acetabular distraction. Only 5 (9.4%) patients underwent acetabular revision following acetabular distraction, leading to an overall cup survivorship of 90.6%. Of the remaining 48 patients, 46 (95.8%) had evidence of radiographic bridging callus of the chronic pelvic discontinuity at their last clinical follow-up. To our knowledge, in the largest series to date, acetabular distraction has proven to be a viable treatment for acetabular bone loss with a chronic pelvic discontinuity, with excellent early survivorship and radiographic evidence of bridging callus. Future studies with longer follow-ups are needed to further monitor the efficacy of this technique. Level III, Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Severe acetabular bone loss encountered during revision total hip arthroplasty (THA) poses a clinical challenge. In cases involving pelvic discontinuity, where the ilium is separated superiorly from the inferior ischiopubic segment through the acetabulum, acetabular distraction may be used to restore the biomechanics of the hemipelvis. This technique allows for correct sizing of the acetabulum, and the subsequent peripheral distraction and medial compression at the discontinuity provide initial mechanical stability and biological fixation as bone in growth occurs. Accordingly, this study aimed to assess long-term 5-year outcomes following acetabular distraction across 2 institutions. We retrospectively identified all patients who underwent revision THA in which the acetabular distraction technique was performed for the treatment of chronic pelvic discontinuity between 2002 and 2018. Demographic, operative, and clinical postoperative data were collected. Clinical endpoints included postoperative radiographic outcomes, complications requiring additional surgery, and reoperation for all causes. Only patients who had a minimum 5-year follow-up were included in this study. A total of 15 patients (Paprosky IIC: one patient, 6.7%; Paprosky IIIA: 5 patients, 33.3%; Paprosky IIIB: 9 patients, 60%) who had a mean follow-up time of 9 years (range, 5.1 to 13.5) were analyzed. Porous tantalum augments were used in 11 (73.3%) cases to primarily address posteriorsuperior defects (100%). There were 4 (26.7%) patients that required reoperation, only 2 of which were for indications related to the acetabular construct, leading to an overall survivorship of 86.7%. Both patients had a prior revision THA before the implementation of the distraction technique. Evidence of bridging callus formation was reported radiographically for 14 (93.3%) patients at the time of the last clinical follow-up. For patients who have chronic pelvic discontinuity, acetabular distraction shows promising long-term outcomes. Even so, larger multi-center studies are needed to better support the efficacy of this technique. Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Introduction: Acetabular reconstruction is a challenging problem in orthopaedic oncology, especially in extended defects (Paprosky Type 3A and Type 3B). In revision total hip arthroplasty (THA), 1 option is trabecular metal (TM) augments with a porous metal acetabular component. This study evaluated the use of TM augments in periacetabular malignant bone disease. Methods: 15 patients were identified from our institutional database from 2000 to 2020 with either Paprosky Type 3A or Type 3B acetabular bone loss due to periacetabular malignancies that underwent at least 1 complex THA reconstruction with TM augments. Postoperative complications were documented, and clinical and radiographic outcomes were analysed. Radiological loosening or revision of the acetabular component were defined as endpoints. Results: There were 7 primary and 8 metastatic cancer patients. 5 were Type 3A and 10 were Type 3B defects after tumour resection. The average follow-up time was 23.8 (range 1.5–47) months. 1 patient required revision for acetabular component loosening after 7 months from the initial implantation. An additional 4 patients required surgical intervention for infection, they had stable TM augments at latest follow-up. Conclusion: TM augments with a porous metal acetabular component may be an alternative to the traditional cemented constructs. [ABSTRACT FROM AUTHOR]

Differences in patient-reported outcome measures (PROMs) between primary TKA (pTKA) and revision TKA (rTKA) have not been well-studied. Therefore, we compared pTKA and rTKA patients by the rates of achieving the Minimal Clinically Important Difference for Improvement (MCID-I) and Worsening (MCID-W). A total of 2,448 patients (2,239 pTKAs/209 rTKAs) were retrospectively studied. Patients who completed the Knee Injury and Osteoarthritis Outcome Score-Physical Function Short Form (KOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, or PROMIS Global-Physical questionnaires were identified by Current Procedural Terminology (CPT) codes. Patient-reported outcome measures and MCID-I/MCID-W rates were compared. Multivariate logistic regression models measured relationships between surgery type and postoperative outcomes. Patients who underwent rTKA (all causes) had lower rates of improvement and higher rates of worsening compared to pTKA patients for KOOS-PS (MCID-I: 54 versus 68%, P <.001; MCID-W: 18 versus 8.6%, P <.001), PF10a (MCID-I: 44 versus 65%, P <.001; MCID-W: 22 versus 11%, P <.001), PROMIS Global-Mental (MCID-I: 34 versus 45%, P =.005), and PROMIS Global-Physical (MCID-I: 51 versus 60%, P =.014; MCID-W: 29 versus 14%, P <.001). Undergoing revision was predictive of worsening postoperatively for KOOS-PS, PF10a, and PROMIS Global-Physical compared to pTKA. Postoperative scores were significantly higher for all 4 PROMs following pTKA. Patients reported significantly less improvement and higher rates of worsening following rTKA, particularly for PROMs that assessed physical function. Although pTKA patients did better overall, the improvement rates may be considered relatively low and should prompt discussions on improving outcomes following pTKA and rTKA. Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Introduction: Unicompartmental knee arthroplasty (UKA) is increasingly favored in clinical practice due to its favorable long-term survival rates, positive clinical outcomes, and expedited recovery. Periprosthetic joint infections (PJIs) remain a formidable complication in knee arthroplasty, and guidelines for the management are limited. This study aims to assess the failure rates of débridement, antibiotics, and implant retention (DAIR) in UKAs, providing insights into optimal treatment management and infection-free survival for PJI in this context., Methods: Twenty-five patients met the inclusion criteria of PJI, as defined by Musculoskeletal Infection Society criteria, and were retrospectively reviewed from January 2000 to September 2023. Surgical treatment included 17 DAIRs (78%), six one-stage revision procedures (20%), and three two-stage revision procedures (12%). Seventeen patients (78%) had acute hematogenous infections (<3 weeks of symptoms). Kaplan-Meier survivorship analysis was done for reinfection and revision procedures., Results: The overall infection-free survival and all-cause survival regardless of management at 3 years was 60.1% (95% confidence interval [CI], 45.7% to 89.6%) and 55.8% (95% CI, 38.2% to 81.5%), respectively. Both two-stage and one-stage revision procedures had an infection-free survivorship of 100% at 3 years (95% CI, 100% to 100%). DAIR treatment had an infection-free survival at 3 years of 41.6% (95% CI, 22.4% to 77.4%). Nine of 17 patients (53%) undergoing DAIR were unsuccessful and required subsequent second DAIR, one-stage, or two-stage revision procedures., Discussion: The efficacy of DAIR following PJI in UKA is notably limited, suggesting a need for reevaluation of its role in managing UKA PJIs. Given the absence of established guidelines for PJI management specifically tailored to UKA, there is an urgent and compelling need for future studies to elucidate optimal clinical strategies to allow for the best treatment for patients., Level of Evidence: Level III, retrospective comparative study., (Copyright © 2025 by the American Academy of Orthopaedic Surgeons.)

Introduction: Periprosthetic joint infection (PJI) is a devastating complication of hip hemiarthroplasty (HHA) that is not well-represented in the literature. Therefore, this study aimed to evaluate diagnostic markers for identifying PJI in patients after HHA and compare them with the most recent 2018 International Consensus Meeting on Musculoskeletal Infection criteria., Methods: A total of 98 patients (64 PJIs, 65.3%) were analyzed. Patients were identified by relevant Current Procedural Terminology and International Classification of Diseases-9/10 codes from 2000 to 2021 across a single healthcare system. Preoperative or intraoperative synovial fluid nucleated cell (NC) count, synovial polymorphonuclear (PMN) percentage, serum erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), and serum white blood cell count were compared with Student t -test between aseptic and septic cohorts. Diagnostic utility and laboratory cutoff values were determined using receiver-operating characteristic curves and Youden index, respectively., Results: Mean values were significantly higher in the septic cohort for synovial NC count (120,992.2 versus 1,498.0 cells/μL, P < 0.001), synovial PMN percentage (91.3% versus 56.2%, P < 0.001), serum ESR (75.6 versus 36.3 mm/hr, P < 0.001), serum CRP (20.2 versus 125.8 mg/L, P < 0.001), and serum white blood cell count (8.5 versus 11.5 cells/μL, P < 0.001). Synovial NC count, synovial PMN percentage, and serum CRP had excellent PJI discriminatory ability with an area under the curve of 0.99, 0.90, and 0.93, respectively. Optimal cutoffs were 2,700 cells/μL for synovial NC count (100% sensitivity and 94% specificity), 81.0% for synovial PMN percentage (96% sensitivity and 89% specificity), 52.0 mm/hr for serum ESR (75% sensitivity and 80% specificity), and 40.0 mg/L for serum CRP (85% sensitivity and 92% specificity)., Conclusion: Our findings support the continued use of routine serum and synovial fluid tests for diagnosing PJI in HHA patients. Optimal cutoff values for both synovial fluid biomarkers were very close in alignment with the 2018 International Consensus Meeting criteria., Level of Evidence: Level III, retrospective comparative study., (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.)