The Utilization of Press-Fit Total Knee Arthroplasty is Not Evenly Distributed: A National Registry Review.

BACKGROUND: This study evaluates trends of cemented versus press-fit total knee arthroplasty (TKA). We hypothesized that press-fit TKA is more common in younger and obese patients. There may also be racial, geographic, and institutional variation. METHODS: The American Joint Replacement Registry was used to conduct a retrospective review of primary TKA procedures for osteoarthritis in the United States between January 2019 and March 2022. The objective was to identify differences in incidence, demographics, body mass index (BMI), Charlson Comorbidity Index (CCI), and institutional teaching status (teaching vs. non-teaching) between press-fit and cemented TKAs. RESULTS: Two hundred ninety-seven thousand four hundred two patients (61% female, average age 68 years, 88.3% White) underwent cemented TKA versus 50,880 patients (52% female, average age 65 years, 89% White) underwent press-fit TKA. Overall, 20.8% of press-fit versus 19.9% of cemented TKA had a BMI of 35 to 39.9 and 15.2% of press-fit versus 12.5% of cemented TKA had BMI >40 ( P < 0.001). Patients undergoing press-fit TKA were less likely Black (OR = 0.727; P < 0.0001), Asian (OR = 0.651, P < 0.0001), and Native Hawaiian/other Pacific Islander (OR = 0.705, P < 0.02) with White as the reference group. Northeastern and Southern United States were more likely to use press-fit TKA than the Midwest (OR = 1.89 and OR = 1.87, P < 0.0001) and West (OR = 1.67; and OR = 1.65; P < 0.0001). Press-fit TKA incidence in 2019 was 9.9% versus 20.6% in 2022 ( P < 0.001). CONCLUSION: Press-fit TKA is increasingly more common in Northeastern and Southern United States, and patients are older than expected. Patients with BMI >35 had a slightly higher rate of undergoing press-fit than cemented TKA. Notable racial differences also exist. Additional research addressing racial disparities and evaluating longevity of press-fit designs is needed.

Racial Disparities in Total Knee and Hip Arthroplasty in a Medically Underserved Community with a Diverse Population.

INTRODUCTION: Previous studies have demonstrated lower total joint arthroplasty utilization rates and worse postoperative outcomes among non-White patients. Our study examined whether these disparities exist in the setting of a diverse population. METHODS: This retrospective study included patients with a self-reported race who underwent total knee (TKA) or hip (THA) arthroplasty procedures in a racially diverse county. Patients who did not identify as White or Hispanic/Latino were excluded from the study due to small sample sizes. Demographic, intra and postoperative outcome differences were calculated. A multivariate logistic regression was developed to examine the association between patients' race and undesired postoperative outcomes. RESULTS: Five hundred fifty-five patients were included in our study with 490 identifying as non-Hispanic/Latino White (88.8%) and 65 as Hispanic/Latino (11.2%). Hispanic/Latino-identifying patients were significantly younger (61.9 ± 12.79 versus 68.58 ± 9.00 years), had lower Charlson Comorbidity Index scores, and were more likely to use non-Medicare/Medicaid insurance. We observed no differences between our cohorts in postoperative adverse events, emergency department visits, and hospital readmissions. Patients' self-identified race was not correlated with undesired postoperative outcomes. CONCLUSIONS: Although Hispanic/Latino-identifying patients constitute 50.2% of the county population of our study cohort, they accounted for only 11.2% of the patients in our study. This is noteworthy considering the lack of evidence suggesting a decreased prevalence of osteoarthritis among individuals of different races and ethnicities. Further, the demographic differences we observed suggest an exclusive Hispanic/Latino patient population utilizing TKA or THA procedures. Future studies controlling for risk factors and less invasive treatment options may explain these disparities.

Osteoporosis-related appendicular fractures in Tikur Anbessa Specialized Hospital, Ethiopia: a prospective observational study.

We examined the frequency of osteoporotic fractures among patients presenting to Tikur Anbessa Specialized Hospital. Osteoporotic fractures accounted for 10.4% of all fractures and 31.8% of those 40 years and older. In addition, hip fractures accounted for 60%. Therefore, devising strategies for preventing, treating, and rehabilitating osteoporotic fractures is critical. PURPOSE: Examine the frequency of osteoporotic fractures among patients presenting to Tikur Anbessa Specialized Hospital. METHODS: This is an observational study of prospectively collected data between January 2018 and December 2021. Patients were categorized as having osteoporotic fracture if they were 40 years or older, sustained a low-energy injury, and had characteristic fracture patterns to the hip, proximal humerus, distal radius, tibia (in females only), clavicle, and scapula. A descriptive analysis was carried out to assess patient demographics. Risk factors were then evaluated using a binary logistic regression model. RESULTS: A total of 4712 orthopedic injury patients presented to the emergency department with 4422 fracture cases. Of these, 461 fulfilled the diagnostic criteria for osteoporotic fractures. The overall rate of osteoporotic fractures was 10.4% of all patients with fractures and 31.8% of those 40 years or older. Overall, 63.3% were female. One in four females and 5% of males with musculoskeletal trauma had an osteoporotic fracture. Osteoporotic hip fractures made up 59.9% of osteoporotic fractures and 5.9% of all fractures, followed by distal radius (23%), tibia in females (8.2%), and proximal humerus (7.4%). Pelvis (2.6%), clavicle (0.9%), and scapula (0.2%) fractures were found to be rare. Among all patients with fractures following low-energy injuries, when patients were aged 50 years and older, there was a higher risk that the trauma resulted in an osteoporotic fracture. This figure was highest among those aged 80 years and older (odds ratio (OR), 11.88; 95% CI, 7.01-20.11). CONCLUSIONS: Further studies need to be done to show the prevalence of osteoporosis and osteoporotic fractures in Ethiopia and examine risk factors. Devising strategies for preventing, treating, and rehabilitating osteoporotic fractures is critical.

Orthopaedic injury patterns at a tertiary referral hospital in Ethiopia: a prospective observational study.

OBJECTIVES: This study aimed to identify the composition of orthopaedic injuries in Ethiopia. BACKGROUND: Injuries are among the most common causes of death worldwide. This is especially true in developing countries, which lag in preventive efforts and have inadequate resources to treat injuries efficiently. As a result, understanding the trauma burden is crucial for future prevention and treatment accessibility initiatives. METHODS: We conducted an observational study using prospectively collected emergency orthopaedic trauma data between January 2018 and December 2021 from Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. The incidence of all fractures, demographic data, trauma mechanisms, and injury types were examined by stratifying cases based on patients presenting from Addis Ababa, the capital city, or outside of Addis Ababa. These groups were chosen to account for the demographic differences that exist between individuals living in the capital city and other regions. RESULTS: Our study included 4712 patients with similar distribution from Addis Ababa and outside of Addis. Overall, 70% were between 18 to 55 (median 30). Road traffic incidents accounted for the most overall injuries (41%), including 130 motorcycle injuries (2.8%), while falls were the predominant mechanism (51.3%) for patients from Addis. Injuries of the lower limb accounted for 66% of injuries (n=4262/6412), the femur being the most affected (22%), followed by the pelvis and acetabulum (16%). One-quarter presented with open fractures and another quarter had multiple injuries. Multivariate analysis further demonstrated patients outside of Addis were 37% more likely to have multiple fractures and 69% more likely to have open fractures. CONCLUSION: Future directives should focus on preventive measures and address the management of complex injuries to overcome trauma injuries' health and economic impacts. The initiatives shall focus on the varying primary mechanisms of injury for the different population groups in the capital city and in rural regions outside of the capital city.