Incidence of Rapidly Progressive Osteoarthritis Following Intra-articular Hip Corticosteroid Injection: A Systematic Review and Meta-Analysis.

Background: The American Academy of Orthopedic Surgery recommends intra-articular corticosteroid injections (CSIs) for managing hip osteoarthritis (OA) based on short-term, prospective studies. Recent retrospective studies have raised concerns that CSIs may lead to rapidly progressive OA (RPOA). We sought to systematically review the literature of CSIs for hip OA to estimate the incidence of RPOA. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify original research of hip OA patients receiving CSIs. Overall, 27 articles involving 5831 patients published from 1988 to 2022 were included. Study design, patient characteristics, CSI details, follow-up, and cases of RPOA were recorded. Studies were classified by their ability to detect RPOA based on follow-up. Random effects meta-analysis was used to calculate the incidence of RPOA for studies able to detect RPOA. Results: The meta-analytic estimate of RPOA incidence was 6% (95% confidence interval, 3%-9%) based on 10 articles classified as able to detect RPOA. RPOA definitions varied from progression of OA within 6 months to the presence of destructive changes. These studies were subject to bias from excluding patients with missing post-CSI radiographs. The remaining 17 articles were classified as unable to detect RPOA, including all of the studies cited in the American Academy of Orthopedic Surgery recommendation. Conclusions: The incidence of RPOA after CSIs remains unknown due to variation in definitions and follow-up. While RPOA following CSIs may be 6%, many cases are not severe, and this may reflect selection bias. Further research is needed to understand whether clinically significant RPOA is incident enough to limit CSI use.

Nutritional Laboratory Studies Prior to Total Knee Arthroplasty: Practice Versus Publication.

BACKGROUND: Recent emphasis has been placed on nutritional status assessment prior to total knee arthroplasty (TKA), including multiple American Academy of Orthopaedic Surgeons publications recommending specific laboratory studies; however, the frequency with which surgeons obtain these laboratory studies remains unclear. We sought to assess the incidence of ordering nutritional laboratory studies in the 90 days prior to TKA, utilizing data from a large administrative claims database. METHODS: With use of the PearlDiver database, we identified 557,670 patients undergoing primary TKA from 2011 to 2020 with a metabolic panel or blood cell count claim within 90 days prior to TKA. We then determined the incidence of prealbumin, transferrin, vitamin D, and zinc laboratory tests claimed 90 days prior to TKA. Associations between claims and the year of surgery, patient demographics, and clinical characteristics were assessed by comparing proportions and chi-square testing. RESULTS: Nutritional laboratory studies were infrequently claimed within 90 days prior to TKA, with studies for prealbumin being performed in 2.2% of patients; transferrin, 1.9%; vitamin D, 10.2%; and zinc, 0.2%. From 2011 to 2020, there was a moderate but steady increase in the proportion of patients with claims for prealbumin (change from 0.8% in 2011 to 3.4% in 2020; p < 0.001), transferrin (0.8% to 2.7%; p < 0.001), and vitamin D (7.6% to 9.4%; p < 0.001) laboratory tests but there was less of a change for zinc (0.1% to 0.2%; p < 0.001). There were weak-to-absent associations of age, gender, obesity, diabetes, and anemia with laboratory claims. CONCLUSIONS: Despite multiple publications and recommendations, nutritional laboratory studies are infrequently ordered prior to TKA. Although there has been a slight increase in the use of nutritional laboratory studies over the past decade, patient factors such as gender and obesity were not associated with this increase. Understanding current practice patterns may help target future areas for improvement. LEVEL OF EVIDENCE: Diagnostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Robotic-Assisted Total Knee Arthroplasty is Safe in the Ambulatory Surgery Center Setting.

BACKGROUND: Robotic-assisted total knee arthroplasty (RA-TKA) has become more popular in the United States. With the significant trend towards performing TKA in outpatient and ambulatory surgery center (ASC) settings, this study was implemented to determine the safety and efficacy of RA-TKA in an ASC. METHOD: A retrospective review identified 172 outpatient TKAs (86 RA-TKAs and 86 TKAs) performed between January 2020 and January 2021. All surgeries were performed by the same surgeon at the same free-standing ASC. Patients were followed for at least 90 days after surgery; complications, reoperations, readmissions, operative time, and patient-reported outcomes were recorded. RESULTS: In both groups, all patients were successfully discharged home from the ASC on the day of surgery. No differences were noted in overall complications, reoperations, hospital admissions, or delays in discharge. RA-TKA had slightly longer operative times (79 vs 75 min [p = 0.017]) and total length of stay at the ASC (468 vs 412 min [p < 0.0001]) than conventional TKA. No significant differences were noted in outcome scores at 2-, 6-, or 12-week follow-ups. CONCLUSIONS: Our results showed that RA-TKA can be successfully implemented in an ASC, with similar outcomes compared with TKA using conventional instrumentation. Initial surgical times were increased secondary to the learning curve of implementing RA-TKA. Long-term follow-up is necessary to determine implant longevity and long-term outcomes. METHOD: A retrospective review identified 172 outpatient TKAs (86 RA-TKAs and 86 TKAs) performed between January 2020 and January 2021. All surgeries were performed by the same surgeon at the same free-standing ASC. Patients were followed for at least 90 days after surgery; complications, reoperations, readmissions, operative time, and patient-reported outcomes were recorded. RESULTS: In both groups, all patients were successfully discharged home from the ASC on the day of surgery. No differences were noted in overall complications, reoperations, hospital admissions, or delays in discharge. RA-TKA had slightly longer operative times (79 vs 75 min [p = 0.017]) and total length of stay at the ASC (468 vs 412 min [p < 0.0001]) than conventional TKA. No significant differences were noted in outcome scores at 2-, 6-, or 12-week follow-ups. CONCLUSIONS: Our results showed that RA-TKA can be successfully implemented in an ASC, with similar outcomes compared with TKA using conventional instrumentation. Initial surgical times were increased secondary to the learning curve of implementing RA-TKA. Long-term follow-up is necessary to determine implant longevity and long-term outcomes.

Necrotizing Soft-Tissue Infections After Hip Arthroplasty.

Necrotizing soft-tissue infections are a rare complication following hip arthroplasty procedures. These rapidly spreading infections have a high mortality rate and must be diagnosed and treated in an expeditious manner. This article discusses the epidemiology, classification, diagnosis, and treatment of these conditions and describes 2 related case reports.

Reliability of the log-transformed EMG amplitude-power output relationship for incremental knee-extensor ergometry.

INTRODUCTION: The purpose of this investigation was to determine the reproducibility of the log-transformed model for electromyography (EMG) amplitude during incremental single-leg knee-extensor exercise. METHODS: Eight healthy college-aged men performed 3 incremental tests on separate occasions on a knee-extensor ergometer. EMG amplitude was analyzed for each participant on each occasion for the rectus femoris and vastus medialis muscles at 4 different exercise power outputs (30%, 50%, 70%, and 90%) corresponding to each participant's maximal power output. Intraclass correlation coefficients (ICC) were determined for the slope and y-intercept terms derived from the log-transformed EMG amplitude-power output relationship for each muscle. RESULTS: The ICC values for the rectus femoris (slope = 0.779; y-intercept = 0.787) and vastus medialis (slope = 0.756; y-intercept = 0.763) muscles were high. CONCLUSIONS: The log-transformed EMG amplitude-power output relationship is a reliable index for measuring motor unit activation.