Antonia Faustina Chen

Background/Objectives: Solid bone cement is a poor vehicle for delivering antibiotics, and porous bone cement lacks mechanical robustness. Inspired by the different structural phases of bone, we hypothesized that porous shell cements (PSCs) could be synthesized to be both mechanically resilient and effective in eluting antibiotics. Our objective was to synthesize and characterize PSCs and compare their physicochemical properties to solid and porous cements. Methods: PSCs were synthesized with thin versus thick outer porous shells and compared to homogenous solid and porous cements as controls. Porosity and architecture were assessed through scanning electron microscopy and microcomputed tomography. Mechanical properties were quantified by compression testing. Antibiotic release kinetics and antibiotic activity were measured via release assays, disc diffusion assays, and minimum inhibitory concentration tests. Results: PSCs exhibit both solid and porous regions within a single bone cement construct with enhanced surface area to volume ratios in porous regions. Cements with porous regions have lower synthesis heat during polymerization. The mechanical strength of PSCs correlates with the ratio of solid core to porous shell thickness. The addition of the porous shell layer significantly increases antibiotic elution and increases the inhibition of Staphylococcus aureus and Staphylococcus epidermidis strains. Conclusions: We are able to synthesize customizable PSCs that balance the mechanical strength of solid bone cement with the antibiotic release profile of porous cement as a new biomaterial strategy to prevent orthopaedic device infection.

Infection remains one of the most catastrophic complications following orthopaedic surgery. Despite substantial advances in molecular diagnostics, biomarker assays, and consensus definitions, accurately diagnosing orthopaedic infection continues to challenge even the most experienced clinicians. There are differences in the diagnosis and treatment of infections that are related to different anatomic regions. The difficulty arises from the inherent biological diversity of infecting organisms and surgical locations, variable host responses, and the absence of a true diagnostic “gold standard.” This article summarizes the current diagnostic challenges and emerging solutions, drawing on recent high-impact evidence and consensus frameworks.

Purpose of Review Revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) are high-cost procedures that disproportionately burden patients and healthcare systems. While disparities in primary total joint arthroplasty (TJA) are well documented, inequities specific to revision TJA remain less clearly characterized and are inconsistently interpreted. This scoping review synthesizes studies published from January 2019 onward to examine racial, sex-based, and geographic disparities in revision total hip or knee arthroplasty. Recent Findings Twenty-six studies met the inclusion criteria. Racial disparities were the most consistently documented, with multiple large database and registry studies demonstrating higher aseptic revision risk following primary TKA among Black patients compared with White patients. These disparities persisted after adjusting for patient, surgeon, and hospital characteristics. In contrast, racial disparities in revision THA were less consistent. Sex-based differences in revision TJA were smaller in magnitude and more heterogeneous, often reflecting biologic and biomechanical variation rather than access-related inequities. Geographic disparities highlighted substantial regional variation in revision TJA utilization and the influence of community-level social determinants of health on revision TJA risk and access. Summary Disparities in revision TJA are multifactorial and reflect the interaction of differential revision TJA risk, unequal access to revision TJA care, and cumulative exposure to social determinants of health across the arthroplasty care continuum. Advancing revision TJA equity will require integrating measures of revision TJA risk and revision TJA access, incorporating social vulnerability into risk stratification, and designing policy interventions that address structural determinants of surgical care.

Background: Decision aids (DAs) are evidence-based tools to improve patient-centered care, but their use in routine care is limited. The purpose of this project was to work with orthopedic practices to deliver DAs. Methods: Eligible sites needed to identify an administrative and clinical champion and have access to DAs for treatment of hip, knee, and/or spine conditions. The implementation strategies included an Orthopaedic Learning Collaborative (OLC), external facilitation, and audit and feedback. The project was conducted over 15 mo with 5 OLC sessions, individual monthly meetings, and monthly data reports. Clinicians and staff completed a baseline survey prior to the start of the project. Sites provided details on their DA workflow and number of DAs delivered. We calculated adoption (the number of specialists who used DAs) and estimated reach (percentage of eligible patients who received DAs). We calculated descriptive statistics and explored predictors of reach. Results: Twelve participating sites had an average annual orthopedic surgical volume of 550, half were academic medical centers, and some (4/13, 30.7%) had prior experience with orthopedic DAs. Adoption was 76% (60/79 physicians). Sites distributed 9,626 DAs and reached 44% of eligible patients (range 7%–100%). Sites that indicated at baseline that DA delivery was a high priority for staff had higher reach (60% reach for high v. 47% for moderate v. 9% for low priority, P = 0.21). Sites with no prior experience with DAs had higher reach than those with prior experience did (60% v. 38%, P = 0.26, d = 0.71). Conclusions: Participating sites were able to implement workflows that reached about half of eligible patients. Establishing DA delivery as a priority for staff at the outset appears important for reach, while prior experience does not. Highlights: The 12 sites were able to reach, on average, 44% of eligible patients with decision aids in routine care demonstrating feasibility of distribution. The study and associated implementation toolkit provide concrete examples of workflows for orthopedic practices interested in incorporating decision aids into routine care. A bundle of implementation strategies, including a learning collaborative, external facilitation, and audit and feedback, helped most sites meet targets for decision aid implementation.

Introduction: This study evaluated whether major depressive disorder (MDD), a common comorbidity affecting outcomes after total hip arthroplasty (THA), is independently associated with new-onset psychiatric and somatic morbidity. Methods: Adults undergoing primary THA (2015-2024) were identified from a multi-institutional database, excluding patients with prior hip pathology or psychiatric diagnoses other than MDD. Propensity score-matched cohorts were compared at 90 days and 1 year using odds ratios (OR) with 95% confidence intervals (CI). Results: After exclusions, 5,864 patients with MDD and 144,640 control subjects were identified, yielding 3,412 matched pairs. P < 0.001 unless otherwise noted. MDD was associated with significantly higher odds of new-onset psychiatric disorders at 90 days and 1 year, including generalized anxiety disorder (OR _90d , 22.48: 95% CI, 14.6-34.5; OR _1yr , 16.53: 95% CI, 12.0-22.8), adjustment disorder (OR _90d , 5.81: 95% CI, 3.9-8.6; OR _1yr , 5.40: 95% CI, 3.9-7.4), posttraumatic stress disorder (OR _90d , 4.14: 95% CI, 2.8-6.1; OR _1yr , 7.33: 95%, CI 5.4-9.9), schizophrenia (OR _90d , 2.21: 95% CI, 1.1-4.6: P = 0.03; OR _1yr , 2.22: 95% CI, 1.3-3.8: P = 0.002), alcohol use disorder (OR _90d , 3.73: 95% CI, 2.6-5.4; OR _1yr , 2.61: 95% CI, 1.9-3.6), opioid use disorder (OR _90d , 2.31: 95% CI, 1.2-4.3: P = 0.02; OR _1yr , 2.69: 95% CI, 1.7-4.2), dementia (OR _90d , 12.24: 95% CI, 8.2-18.3; OR _1yr , 9.27: 95% CI, 6.6-13.0), and suicide (OR _1yr , 6.71: 95% CI, 3.7-12.0). Somatic risks included mortality (OR _90d , 2.26: 95% CI, 1.1-4.5: P = 0.02; OR _1yr , 1.96: 95% CI, 1.4-2.7), chest pain (OR _90d , 1.74: 95% CI, 1.3-2.3; OR _1yr , 1.25: 95% CI, 1.1-1.5, P = 0.007), shortness of breath (OR _90d , 1.28: 95% CI, 1.0-1.7: P = 0.0498; OR _1yr , 1.28: 95% CI, 1.1-1.5, P = 0.002), dizziness (OR _1yr , 1.49: 95% CI, 1.2-1.8), and postoperative emergency department visits (OR _1yr , 1.27: 95% CI, 1.1-1.5). Conclusion: In patients with isolated MDD, the condition independently increased psychiatric, cognitive, somatic, and mortality risks after THA.

Periprosthetic joint infections (PJIs), particularly those caused by multidrug-resistant organisms (MDROs), remain a major therapeutic challenge. Antimicrobial blue light (ABL) offers a promising non-antibiotic approach, inducing bacterial killing through photoexcitation of endogenous chromophores and subsequent reactive oxygen species generation. However, conventional single-point illumination systems are limited by uneven light distribution and poor penetration, restricting their use to superficial infections. We evaluated a novel isotropic optical fiber designed to overcome these geometric and optical constraints. The fiber was tested against vancomycin-resistant Enterococcus faecium (VR-Ef) and carbapenemase-producing Klebsiella pneumoniae (CP-Kp) in time-to-kill assays under low-power (20.1 mW mm−1) and high-power (40.3 mW mm−1) conditions over 60 min. Bacterial counts (CFU per mL) were determined at 0, 10, 20, 30, and 60 min. A one-way analysis of variance (ANOVA) with Tukey's post hoc test assessed time-dependent reductions; a two-way ANOVA evaluated the combined effects of illumination power and exposure time. ABL exposure resulted in time- and intensity-dependent bacterial reduction in both strains. Significant CFU reductions occurred from 30 min onward under high-power ABL (HP-ABL) and after 60 min under low-power ABL (LP-ABL) for both VR-Ef and CP-Kp (p<0.001). The two-way ANOVA revealed significant main and interaction effects of illumination power and exposure time (all p<0.001). Although bactericidal thresholds (≥3log 10 reduction) were not reached, bacterial killing increased markedly with higher power and longer exposure. This novel isotropic optical fiber enables uniform intraluminal ABL delivery, potentially extending blue-light therapy from superficial to deep surgical infections such as PJIs. Further optimization of illumination parameters and potential integration with photosensitizers may enhance its antimicrobial efficacy and clinical applicability.