Seper Ekhtiari

Was not provided for this article.

Was not provided for this article.

Background: Obesity is an independent risk factor for complications following total hip arthroplasty (THA). Preoperative bariatric surgery to facilitate weight loss has been used to reduce complication risk, but its effectiveness remains unclear. The purpose of this study was to evaluate the impact of bariatric surgery on the risk of surgical complications in patients with morbid obesity undergoing THA. Methods: A population-based, retrospective cohort study was conducted using administrative data from Ontario, Canada. All adults undergoing primary elective THA from 2002 to 2023 were subclassified according to the presence of morbid obesity (body mass index [BMI], ≥40 kg/m ² ) and whether they had undergone prior bariatric surgery. The primary outcome was a composite of major surgical complications within 1 year, including revision arthroplasty, periprosthetic fracture, periprosthetic joint infection (PJI), and dislocation. Secondary outcomes were 30-day hospital readmission and length of stay. Multivariable logistic regression adjusted for demographic, medical, and surgical factors was used. Results: A total of 148,977 patients who underwent THA were identified, including 10,287 patients (6.9%) with morbid obesity and 637 patients (0.4%) who had undergone prior bariatric surgery. Patients who had undergone bariatric surgery had the highest risk of major surgical complications, particularly PJI. Even among patients who achieved a BMI of 2 following bariatric surgery, there was a higher risk of major complications (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.16 to 2.94]) and PJI (OR, 3.36 [95% CI, 1.48 to 7.63]) compared with patients with a similar BMI who had not undergone prior bariatric surgery. Prior bariatric surgery did not reduce revision risk, including in patients achieving a BMI of 2 (p = 0.077). All bariatric and morbidly obese cohorts demonstrated higher 30-day readmission rates. Conclusions: Prior bariatric surgery did not significantly reduce major surgical complications or infection risk following THA. Our findings suggest that THA should not be routinely delayed for bariatric surgery to reduce postoperative complications. Alternative strategies for obesity management and perioperative risk mitigation warrant further investigation. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Background: Periprosthetic joint infection (PJI) is the most common reason for revision total knee arthroplasty (TKA). Recent evidence has demonstrated that patients who develop PJI within 1 year following total hip arthroplasty have a significantly elevated risk of mortality within 10 years. Thus, the aim of this study was to compare long-term mortality rates between patients who did and did not develop PJI within 1 year following the index TKA. Methods: This was a retrospective population-level database study. All eligible participants interacted with a single-payer public health-care system. The primary outcome measure was mortality at 10 years following index TKA; 1- and 5-year mortality were also compared. Mortality was compared for propensity-score-matched groups. Results: Of the total of 263,204 patients who underwent primary TKA in the study period (mean age and standard deviation, 67.9 ± 9.3 years), 1,228 (0.5%) subsequently developed PJI within 1 year. Across the entire sample, patients who developed PJI within 1 year following the index TKA were more likely to be male, have frailty, and have a Charlson-Deyo score of >0; they also had significantly higher rates of congestive heart failure and chronic obstructive pulmonary disease compared with those who did not develop PJI within 1 year. A total of 1,202 patients who developed PJI within 1 year of the index TKA were matched to 1,202 patients who did not develop PJI within 1 year of the index TKA, with standardized differences of <0.10 for all covariates, indicating a robust match. After matching, TKA recipients who developed PJI in the first year had a significantly higher 10-year mortality rate (7.2% [86] versus 1.6% [19]; absolute risk difference = 5.45% [95% confidence interval (CI) = 3.41% to 7.74%]; hazard ratio = 4.66 [95% CI = 2.84 to 7.66]). Conclusions: Patients who developed PJI within 1 year following TKA were at significantly higher risk for mortality at 10 years post-TKA compared with those who did not develop PJI within 1 year following TKA. The etiological factors leading to this increased risk remain unclear and warrant further investigation alongside efforts to further the prevention, diagnosis, and management of PJI. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Periprosthetic joint infection (PJI) is a catastrophic complication following total joint arthroplasty (TJA), with an incidence ranging from 1% to 2% in primary procedures. Despite various prevention strategies, the management of PJI remains challenging, leading to significant revision surgeries. Identifying the causative microorganism is crucial for effective treatment, but limited research exists on the temporal changes in microbial profiles of PJIs. This retrospective cohort study analyzed septic exchange hip and knee arthroplasty cases at a high-volume tertiary infection referral center in Europe between 2001 and 2022. PJI cases were identified using the institution's electronic joint infection database. Patients’ demographics, culture results, CRP values, and antibiotic sensitivity were collected. Among 2,392 patients with infected hips (60.7%) and knees (39.3%), Staphylococcus was the most common causative organism (60.6%), followed by Streptococcus (10.9%) and Enterococcus (7.8%). Gram-negative organisms accounted for 4.7% of cases, with fluctuating rates over time. Culture-negative cases comprised 10.6% of all infections. Polymicrobial infections increased over the study period, reaching almost 40% in 2022. Rates of difficult-to-treat bacteria rose significantly from 22.8% in 2017 to 53.0% in 2022, with methicillin-resistant Staphylococcus aureus being the most common resistant organism. The rise in resistant organisms and polymicrobial infections poses challenges in managing PJI. Improved diagnostic techniques, such as next-generation sequencing, may aid in identifying culture-negative cases and refining PJI management strategies. Effective antimicrobial stewardship is essential to combat growing antibiotic resistance in PJI.

Total hip and knee arthroplasty (THA and TKA) are among the most reliable medical interventions, providing pain relief and long survivorship in the vast majority of patients. Nonetheless, some patients are at higher risk of complications and sub-optimal outcomes following total joint arthroplasty (TJA). Obesity has been proposed in some literature as a risk factor for poorer outcomes and increased complications following TJA. Given the high prevalence of patients living with obesity in Canada, and the continuing rise in the prevalence of overweight and obesity, it is important to understand the relationship between obesity and TJA outcomes. Thus, the aim of this study was to evaluate the short-, medium-, and long-term outcomes of TJA in patients with different body mass index (BMI) classifications. Data was retrieved from a prospectively collected and maintained institutional database. All patients undergoing TJA since September 1998, and who had at least 1 year follow-up, were included. Patients were classified based on BMI category. Baseline and post-operative (1 year, 2 years, 3 years, 5 years, 7 years, and 10 years) Oxford scores were collected. Revision surgery and mortality were collected from provincial data and linked with patient records. Analysis of Variance (ANOVA) was performed to compare continuous outcomes across groups, while Chi-Square was used to compare categorical data. A total of 10,851 patients were included (4216 THA, 6635 TKA). Sixty-one percent (6601/10851) were female, and 39% (4246/10851) were male. There was no significant difference between patients with and without obesity in terms of change from baseline in Oxford score at 1, 2, 3, 5, 7, or 10 years post-operatively. Reoperation rates ranged from 3.1% to 4.4% across BMI groups, with no significant differences between groups. Overall mortality was 26.8% in non-obese patients, and 23.3% in obese patients (p < 0.01). The findings were similar when TKA and THA patients were analyzed separately. Patients with obesity have comparable gains from baseline following TJA at short-, medium-, and long-term. Reoperation and mortality rates are also similar in the long term, with a statistically significant lower mortality rate among patients with obesity. Obesity is associated with a range of health conditions, and can lead to more difficult TJA operations, which may be associated with increased risk of infection and less precise implant positioning. However, based on this large institutional database, functional gains, revision rates, and mortality rates are similar between obese and non-obese patients.

Pain and musculoskeletal conditions can have important consequences on the mental health of patients living with them. Hip pathology in young adult patients can be particularly troubling, as it can impact a range of important domains in a patient's life, including physical activity participation and sexual activity. Hip preservation surgery to treat conditions such as femoroacetabular impingement and acetabular dysplasia improve function and return patients to their physical activities. It is important to understand if there is a concordant improvement in mental health among these patients. Thus, the purpose of this study was to evaluate anxiety and depression scores before and after hip preservation surgery (hip arthroscopy and periacetabular osteotomy (PAO)). The Non-Arthroplasty Hip Registry (NAHR) collects data on patients undergoing hip preservation surgery across the United Kingdom. Patients in the registry who had undergone hip arthroscopy or PAO were included in this study. The EuroQol-5-Dimensions (EQ-5D), and the International Hip Outcome Tool (iHOT-12) are routinely collected as part of the NAHR data collection. Paired samples analyses were performed to evaluate the change from baseline to 1-year post-operative. Sensitivity analyses included separate analysis of hip arthroscopy and PAO, and separate analysis of male and female patients. A total of 8408 patients were included, of whom 1327 underwent PAO and 7081 underwent hip arthroscopy. Mean age among the included patients was 35.4 (standard deviation: 11.1). The mean score on the Social/Emotional Domain of the International Hip Outcome Tool (iHOT-12) improved significantly from 32.8 at baseline to 42.7 at 6 weeks (p < 0.001), and 57.3 at 6 months. These improvements were maintained at one year (58.5). Based on the EQ-5D, the proportion of patients who stated they were “not anxious or depressed” at baseline was 41.6%, which increased significantly to 55.7% at six months (p < 0.001), and remained at 55.3% at one year. The findings were similar between when patients undergoing hip arthroscopy and PAO were analyzed separately, and when male and female patients were analyzed separately. Patients undergoing hip preservation surgery demonstrate measurable improvements in their mental health, including significant improvements in anxiety and depression scores at six months post hip preservation surgery, and these improvements are maintained at one year. In addition to functional improvements demonstrated in previous literature, hip preservation surgery is associated with a substantial improvement in social and emotional health. Future studies should evaluate the long-term mental and social health of patients undergoing hip preservation surgery.

With over 100,000 procedures done per year, hip and knee replacements are two of the most common surgical procedures performed in Canada. Post-operatively, Patient Reported Outcome Measures (PROMs) will start to plateau with time as patients reach the limits of how a prosthetic joint can function for them. There has been literature indicating that PROMs will start to plateau between 6 and 12 months. Having an understanding of the precise timeframe, as well as the factors that can impact this trajectory, can be beneficial for setting patient expectations, and directing patient follow-up. Thus, our purpose was to analyze the trajectory of PROMs following total hip and knee arthroplasty (THA and TKA), as well as assess the impact of any potential confounders on this trajectory. This study was a retrospective analysis of data from a prospective database of a consecutive series of primary THA and TKA patients. The database is collected at a single academic arthroplasty centre, located in Ontario, Canada. Patients were eligible if they had undergone an elective, primary THA/TKA with Oxford Scores recorded pre-operatively, and at least at two of the following three time points: 6 weeks, 6 months, 1 year, and 2 years. Clinically meaningful change from one timepoint to the next was defined as 5 points, based on previously established minimal clinically important difference (MCID) values for both hip and knee scores. General linear models with repeated measures were used to assess for change between timepoints. American Society of Anesthesiologist (ASA) class and date of operation were included as potential between subject factors in the respective hip and knee models. Mean data reported along with standard deviation in parentheses. Overall, 8,276 joints were eligible for inclusion in the study. There were more female patients, with 60.4% being female (N = 5,000). Mean age was 67.9 years (9.6), while mean body mass index (BMI) was 31.6 kg/m2 (6.8). Nearly two-thirds (66.1%) of operative joints were knees (5,467/8,276). Mean pre-operative scores were 18.0 (7.8) for THA, and 20.1 (7.5) for TKA. For both THA and TKA, there were statistically significant interval improvements in Oxford scores from 6 weeks [THA: 33.8 (7.9)/TKA: 28.7 (7.8)] to 6 months [THA: 40.2 (7.3)/TKA: 35.9 (8.3)], and from 6 months to 1 year [THA: 41.0 (7.3)/TKA: 37.3 (8.4)], but not from 1 to 2 years [THA: 40.0 (8.5)/TKA: 36.4 (9.6)]. The change from 6 months to 1 year for both hip and knee patients was below the threshold for a clinically meaningful change based on an MCID value of 5.0. None of the between-subject factors identified as potential sources and bias and included in the model (BMI, ASA, or date of surgery) demonstrated a significant interaction effect. Patients undergoing both THA and TKA can expect clinically meaningful improvements up to 6 months, at which point there is a plateau in PROM scores. These findings are important for both for setting patient expectations in pre-operative discussions, and allowing surgeons to have a realistic understanding of their patients' expected post-operative course.