Time from surgery end to discharge following total knee arthroplasty: implications for same day discharge.

BACKGROUND: Understanding the average time from surgery to discharge is important to successfully and strategically schedule cases planned for same day discharge (SDD) for total knee arthroplasty (TKA). The purpose of this study was to (1) evaluate the average time to discharge following unilateral TKA performed in a community hospital and (2) describe patient characteristics and peri-operative factors that may impact SDD. METHODS: This retrospective review included 75 patients having achieved SDD following unilateral TKA between March 2017 and September 2021 at a high-volume multi-specialty community hospital. Time to discharge was calculated from end of surgery, defined as completion of dressing application, to physical discharge from the hospital. Time surgery completed and association with time of discharge was also examined. Pearson's correlations were performed to evaluate the relationship between total time to discharge and patient demographics. RESULTS: The average age for all patients was 66.6 ± 10.9 years (Range: 38 to 86) and average BMI of 29.9 ± 5.6 kg/m2 (Range: 20.4 to 46.3). The average time to discharge was 5.8 ± 1.8 h (range: 2.2 to 10.5 h). Time to discharge was significantly longer for patients finishing surgery prior to noon (6.0 ± 1.8 h), than after noon (4.8 ± 1.4 h, p = 0.046). Total time to discharge was not correlated with age (r = 0.018, p = 0.881) or BMI (r=-0.158, p = 0.178), but was negatively correlated with surgical start time (r=-0.196, p = 0.094). CONCLUSION: An average of six hours was required to achieve SDD following unilateral TKA performed in a community hospital. The time required for SDD was not found to be related to intrinsic patient factors but more likely due to extrinsic factors associated with time of scheduled surgery. To improve success of SDD, focus should be placed on the development of efficient discharge pathways rather than unchangeable intrinsic patient characteristics.

Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital.

INTRODUCTION: The safety of single-stage bilateral total knee arthroplasty (SSBTKA) compared to unilateral total knee arthroplasty (TKA) remains controversial. The present study compares the 90-day postoperative complications encountered following SSBTKA and unilateral TKA in an unselected cohort of patients performed at a high-volume community hospital. MATERIALS AND METHODS: The perioperative electronic medical records of an unselected consecutive cohort of 1032 patients (1345 knees) having undergone unilateral or SSBTKA were reviewed. Ninety-day postoperative complications or need for additional procedures were compared between unilateral and SSBTKA groups. RESULTS: A total of 719 and 313 patients underwent unilateral and SSBTKA, respectively. There were no significant differences in age or BMI between groups. Patients undergoing SSBTKA were more likely to be male (p = 0.019), have longer lengths of stay (p < 0.001) and were less likely to discharge directly home (13.1%) compared to unilateral patients (80.9%) (p < 0.001). Patients undergoing SSBTKA were more likely to require a transfusion (14.7%) compared to unilateral patients (2.2%) (p < 0.001). Interestingly, mortality rate following unilateral TKA (1.7%) was significantly higher than SSBTKA (0.0%) (p = 0.013). There were no significant differences regarding other complications or need for additional procedures within 90 days following surgery. CONCLUSION: SSBTKA did not result in greater complications when compared to unilateral TKA in this particular cohort. As expected, transfusion rates will likely be higher and there will be a greater need for acute inpatient care following surgery for SSBTKA patients.

The influence of mental health on early outcomes following total hip arthroplasty.

BACKGROUND: Poor mental health is difficult to recognize and as a result, its association with recovery from total joint arthroplasty is difficult to assess. The purpose of this study was to investigate the relationship between overall mental health scores and outcomes in the early postoperative period following unilateral total hip arthroplasty (THA). METHODS: This is a retrospective review of prospectively collected data involving 142 patients who underwent primary unilateral THA. Independent variables included patient demographics and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS), Global Physical Health (GPH) and Global Mental Health (GMH) and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) scores as well as diagnoses of depression or anxiety. Dependent variables included length of stay (LOS), disposition at discharge, narcotic consumption until discharge, 6-week postoperative GPH, GMH and HOOS JR scores and magnitude of change compared to preoperative scores. Preoperative GMH and postoperative outcomes were compared using Pearson correlation coefficient, independent t-tests, Pearson's Chi-Square test, and univariate logistic regression. RESULTS: Patients with preoperative GMH scores below the 25% quartile were less likely to be discharged home and resulted in lower GPH, GMH and HOOS JR scores at 6-week follow-up compared to patients with preoperative GMH scores in the top 25% quartile. However, patients with low preoperative GMH scores demonstrated a greater magnitude of improvement in both the GPH and GMH scores compared to patients in the top 25% quartile. There was no difference in opioid consumption or LOS between either groups. When comparing patients with and without depression/anxiety, no difference was seen in any of the outcomes measured. CONCLUSION: Unilateral THA offers significant improvements in both physical and mental function to patients with hip osteoarthritis and poor mental health, though overall scores remain lower than in those with better mental health.

Higher intra-operative narcotic requirements and weakness with quadratus lumborum compared to paravertebral nerve block for total hip arthroplasty.

BACKGROUND: This was a prospective single-blinded study comparing the peri-operative opioid consumption and motor weakness for patients undergoing total hip arthroplasty (THA) with either a Quadratus Lumborum Type 3 Nerve Block (QLB) or a Paravertebral Nerve Block (PVB). METHODS: A consecutive cohort of patients undergoing elective anterior approach (AA) THA by a single high-volume surgeon were randomly assigned an anesthesiologist by the charge anesthesiologist. One anesthesiologist performed all QLBs, and the other six anesthesiologists performed the PVBs. Pertinent data include prospectively collected qualitative surveys from blinded medical personnel, floor nurses, and physical therapists as well as demographic information and post-operative complications. RESULTS: Overall, 160 patients were included in the study divided equally between the QLB and PVB groups. The QLB group had a statistically higher peri-operative narcotic use (p < 0.001), greater intra-operative peak systolic blood pressure (p < 0.001) and respiratory rate (p < 0.001), and higher incidence of post-operative lower extremity muscle weakness (p = 0.040). There were no statistical group differences for floor narcotic use, post-operative hemoglobin levels or hospital length of stay. CONCLUSION: The QLB required greater intraoperative narcotic use and resulted in greater post-operative weakness, however provided nearly equal post-operative pain management and did not adversely affect rapid discharge success. LEVEL OF EVIDENCE: III, Non-randomized controlled cohort/follow-up study.

Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty.

BACKGROUND: Accuracy of acetabular cup positioning during total hip arthroplasty (THA) can be improved with intra-operative imaging but may be influenced by body mass index (BMI). This study assessed the influence of BMI (kg/m2) on cup accuracy when using intra-operative fluoroscopy (IF) alone or supplemented with a commercial product. METHODS: This retrospective review included four consecutive cohorts of patients having undergone anterior approach THA with IF alone (2011-2015), IF and Overlay (2015-2016) (Radlink Inc., Los Angeles, CA), IF and Grid (2017-2018) (HipGrid Drone™, OrthoGrid Systems Inc., Salt Lake City, UT) and IF and Digital (2018-2020) (OrthoGrid Phantom®, OrthoGrid Systems, Inc., Salt Lake City, UT). Component placement accuracy was measured on 6-week post-operative weight bearing radiographs and compared between four BMI patient groups (BMI ≤ 25, 25 < BMI ≤ 30, 30 < BMI ≤ 35, and 35 < BMI). Total fluoroscopy times were also recorded directly from the fluoroscopy unit. RESULTS: Abduction angle significantly increased as BMI increased (p = 0.003) with IF alone but no difference was present in groups with guidance technology. Anteversion was significantly different between BMI groups for IF alone (p = 0.028) and Grid (p = 0.027) but was not different in Overlay (p = 0.107) or Digital (p = 0.210). Fluoroscopy time was significantly different between BMI categories for IF alone (p = 0.005) and Grid (p = 0.018) but was not different in Overlay (p = 0.444) or Digital (p = 0.170). CONCLUSION: Morbid obesity (BMI > 35) increases risk for malpositioning of acetabular cups and increases surgical time with IF alone or the Grid. Additional IF guidance technology (Overlay or Digital) increased cup positioning accuracy without decreasing surgical efficiency.

Preoperative Educational Classes in Elderly Patients May Not be Necessary Prior to Elective Joint Arthroplasty.

Preoperative arthroplasty classes decrease complications and readmissions, however, in-person classes are inconvenient for elderly patients with mobility limitations. This retrospective review included 232 patients (305 joints) with in-person preoperative educational classes (IPC) and 155 patients (192 joints) with telephone preoperative educational classes (TC). Compared to IPC, TC patients had a shorter length of stay (P<.009), but a greater percentage made at least one postoperative clinic call (22.8% vs 40%; P<.001). No differences were noted in complications, but emergency room visits significantly decreased for total knee TC patients (P=.039). The increase in clinic calls may be addressed through focused changes to the preoperative telephone dialogue, providing a safe and efficient alternative to IPCs.

Allometric Scaling Hip Joint Moments Optimally Reduces Anthropometric Differences in Males and Females.

Running biomechanics are scaled to reduce the effects of anthropometric differences between participants. Ratio scaling has limitations, and allometric scaling has not been applied to hip joint moments. The aim was to compare raw, ratio and allometrically scaled hip joint moments. Sagittal and frontal plane moments of 84 males and 47 females were calculated while running at 4.0 m/s. Raw data were ratio scaled by body mass (BM), height (HT), leg length (LL) and BM multiplied by HT (BM*HT) and LL (BM*LL). Log-linear (for BM, HT and LL individually) or log-multilinear regression (BM*HT and BM*LL) exponents were calculated. Correlations and r2 values assessed the effectiveness of each scaling method. Eighty-five per cent of raw moments were positively correlated to the anthropometrics with r2 values of 10-19%. In ratio scaling, 26-43% were significantly correlated to the moments and a majority were negative, indicating overcorrections. The most effective scaling procedure was the allometric BM*HT, as the mean shared variance between the hip moment and anthropometrics was 0.1-0.2% across all sexes and moments and none had significant correlations. Allometric scaling of hip joint moments during running are advised if the goal is to remove the underlying effects of anthropometrics across male and female participants.

COVID-19 had Limited Impact on Resumption of Elective Joint Arthroplasty and Ethnic Disparities.

In response to the COVID-19 pandemic, federal and state recommendations included the postponement of elective arthroplasties until adequate safety measures could be implemented. Following resumption of arthroplasties, exposure fears and financial concerns may have restricted access for some demographics. Therefore, the purpose of this study was to (1) investigate how the COVID-19 pandemic impacted the incidence of arthroplasty, both overall and by various demographics, and (2) evaluate if pre-operative patient-reported measures were different throughout the pandemic. Data were collected prospectively as part of an on-site joint registry between January 2019 and April 2021. Phase 1 (N=518) included all patients prior to the cancelation of elective procedures (average 36 cases/month), Phase 2 (N=121) was defined from restart until monthly caseload met/surpassed the average Phase 1 caseload (5 months), and Phase 3 (N=277) included all remaining cases. Multiple analysis of variance and chi-squared tests were performed to compare patient demographics and outcomes between phases. No significant differences were noted in patient demographics, with the exception of a decrease in Native Hawaiian/Pacific Islander patients and an increase in Asian patients during Phase 2 (P =.004). Length of stay decreased for unilateral arthroplasty from Phase 1 (0.9±1.1 days) to Phase 2 (0.4±0.6 days) and Phase 3 (0.6±0.7 days) (P <.001), while pre-operative patient reported outcomes remained similar across the 3 time periods. By implementing proper safety measures, the current orthopedic center achieved a timely recovery with no long-lasting inconsistencies in patient cohorts upon resumption of arthroplasties.

Can single-stage bilateral unicompartmental knee arthroplasty be safely performed in patients over 70?

Background: For patients with bilateral, symptomatic unicompartmental knee arthritis, single-stage bilateral unicompartmental knee arthroplasty (ssBUKA) presents an attractive option. However, most studies have examined younger patient cohorts and the safety of ssBUKA remains controversial for older individuals. Therefore, the purpose of this study was to compare complication rates following ssBUKA for patients ≤70 and > 70 years old. Methods: A retrospective chart review of 238 patients having undergone ssBUKA was performed, including 134 patients ≤70 and 104 patients >70. Post-operative complications were recorded at the six-week post-operative visit, along with emergency room visits and hospital readmissions within 90 days. Results: Compared to patients ≤70, patients >70 were more frequently female (43.3% and 55.8%, respectively) (p = 0.037) and had significantly lower body mass index (30.41 ± 4.64 and 27.30 ± 3.68, respectively) (p < 0.001). Patients >70 were discharged home (50%) less commonly than patients ≤70 (73.1%) (p < 0.001). Two patients ≤70 (1.5%) and two patients >70 (1.9%) sought emergency room treatment (p = 0.589), with respiratory complications most common. There were no differences regarding any postoperative complications between patients ≤70 and > 70 years old. Conclusion: These results suggest that patients >70 can safely undergo ssBUKA, as it does not appear to increase the incidence of early post-operative complications compared to patients ≤70. However, 50% of patients >70 were not able to discharge directly home following surgery.

How Do Liquid-Junction Potentials and Medium Polarity at Electrode Surfaces Affect Electrochemical Analyses for Charge-Transfer Systems?

The importance of electrochemical analysis for charge-transfer science cannot be overstated. Interfaces in electrochemical cells present certain challenges in the interpretation and the utility of the analysis. This publication focuses on: (1) the medium polarity that redox species experience at the electrode surfaces that is smaller than the polarity in the bulk media and (2) the liquid-junction potentials from interfacing electrolyte solutions of different organic solvents, namely, dichloromethane, benzonitrile, and acetonitrile. Electron-donor-acceptor pairs of aromatics with similar structures (i.e., 1-naphthylamine and 1-nitronaphthalene, 10-methylphenothiazine and 9-nitroanthracene, and 1-aminopyrene and 1-nitropyrene) serve as redox analytes for this study. Using the difference between the reduction potentials of the oxidized donors and the acceptors eliminates the effects of the liquid junctions on the analysis of charge-transfer thermodynamics. This analysis also offers a means for evaluating the medium polarity that the redox species experience at the surface of the working electrode and the effects of the liquid junctions on the measured reduction potentials. While the liquid-junction potentials between the dichloromethane and acetonitrile solutions amount to about 90 mV, for the benzonitrile-acetonitrile junctions, the potentials are only about 30 mV. The presented methods for analyzing the measured electrochemical characteristics of donors and acceptors illustrate a means for improved evaluation of the thermodynamics of charge-transfer systems.

Can a community hospital successfully transition to outpatient total knee arthroplasty in unselected patients?

BACKGROUND: The removal of total knee arthroplasty (TKA) from the Inpatient-Only list in 2018 created pressure on community hospitals to develop rapid discharge protocols (RAP) to increase outpatient discharge. The purpose of this study, therefore, was to compare the efficacy, safety and barriers in achieving outpatient discharge between the standard discharge protocol and newly developed RAP in unselected, unilateral TKA patients. METHODS: This retrospective chart review included 288 standard protocol patients and the first 289 RAP patients following unilateral TKA in a community hospital. The RAP focused on patient discharge expectations and post-operative patient management, with no change in post-operative nausea or pain management. Non-parametric tests were performed to compare demographics, perioperative variables and 90-readmission/complication rates between standard and RAP groups, as well as between inpatient and outpatient discharged RAP patients. Multivariate, stepwise logistic regression was performed to evaluate patient demographics and discharge status, presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Demographics were similar between groups, however, outpatient discharge significantly increased from 22.2% to 85.8% for standard discharge and RAP, respectively (p < 0.001), with no significant difference in post-operative complications. For RAP patients, age (OR:1.062, CI:1.014-1.111; p = 0.011) and female gender (OR:2.224, CI:1.042-4.832; p = 0.039) increased the risk of inpatient and 85.1% of RAP outpatients were discharged home. CONCLUSIONS: While RAP was successful, 15% of patients required inpatient care and 15% of patients achieving outpatient discharged were not discharged to their home environment, emphasizing the difficulties of achieving true outpatient status in 100% of patients from a community hospital.

Do older patients fare worse following unilateral or single stage bilateral total knee arthroplasty?

INTRODUCTION: The safety and benefits of single stage bilateral total knee arthroplasty (SSBTKA) among older patients as compared to unilateral TKA remains controversial. This study aimed to evaluate the influence of age and comorbidities on complications and early outcomes for unilateral and BTKA in patients over and under 70 years of age. MATERIALS AND METHODS: This prospective study compared postoperative complications and early patient-reported outcomes at 6 weeks of 142 unilateral TKA patients (N = 75, ≤ 70; N = 67, > 70) and 89 SSBTKA patients (N = 48, ≤ 70; N = 41, > 70). Patients completed the KOOS JR and PROMIS Global Mental (GMH) and Global Physical Health (GPH) surveys. Knee Society Scores for Knee (KSS-K) and Function (KSS-F) were completed in the clinic. Parametric tests were performed for comparisons of unilateral and BTKA outcomes and complications for patients over and under 70. RESULTS: While patient demographics were similar, patients > 70 had more comorbidities than patients ≤ 70 (p < 0.004). There were no significant differences in postoperative complications or readmissions between age groups or procedures. Unilateral TKA patients > 70 had significantly lower pre- (p < 0.001) and post-operative (p = 0.011) KSS-F scores compared to those ≤ 70. SSBTKA patients > 70 had significantly higher preoperative GMH (p = 0.029), postoperative KSS-K (p = 0.027), KOOS JR scores (p = 0.039) and satisfaction (p = 0.048) compared to those ≤ 70. CONCLUSION: Age did not influence the risk of early postoperative complications. Additionally, the greater improvements in KOOS JR and higher patient satisfaction for SSBTKA patients > 70 suggests that SSBTKA may meet elderly patient expectations and should not necessarily be discouraged due to safety concerns.

True "outpatient discharge" following single-stage bilateral unicompartmental knee arthroplasty may be unrealistic for most.

BACKGROUND: Single-stage bilateral unicompartmental knee arthroplasty (BUKA) has shown post-operative function and cost benefits over staged bilateral procedures, without increased complications. A rapid discharge protocol at the current study site has reported outpatient discharge for the unilateral procedure exceeding 97%. However, the feasibility of outpatient discharge following BUKA remains unclear. Therefore, the purpose of this study was to determine the success of achieving outpatient (< 24 h) discharge following BUKA, and identify patient variables associated with failure. METHODS: A retrospective chart review was completed for 104 BUKA patients. All patients with bilateral, symptomatic unicompartmental knee arthritis were offered the single-stage procedure. Data collection included patient demographics, discharge status, and disposition location. Independent t tests (continuous) and Chi-squared tests (categorical) determined differences between discharge (outpatient/inpatient) and disposition (home/other) groups. Variables associated with discharge status and location were assessed with multivariable regression. RESULTS: While 96 (92.3%) patients discharged within 24 h, only 63.5% were able to discharge directly home. Patients requiring a longer hospital stay (> 24 h) were more likely to require a pre-operative assistive device (62.5% and 25.0%, p = 0.037) and live alone (37.5 vs 8.3%, p = 0.033). For those discharged within 24 h, living alone significantly increased the risk (odds ratio: 5.800, p = 0.038) of requiring an acute inpatient facility prior to transition home. CONCLUSION: Achieving "true" outpatient discharge is only modestly successful for most BUKA patients, as many required an acute inpatient or short-term rehabilitation facility prior to returning home. BUKA should be differentiated from the unilateral procedure regarding outpatient discharge expectations. LEVEL OF EVIDENCE: III, Case-control study; Retrospective comparative study.

Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty.

Single-stage bilateral total knee arthroplasty (ssBTKA) can be used for patients presenting with bilateral arthritis and may result in fewer systemic and wound complications compared with two, independent procedures. However, the safety of ssBTKA in the elderly remains controversial. Therefore, the purpose of this study was to compare early complications and transfusion rates following ssBTKA in patients ≤ 70 years old or > 70 years old. This retrospective chart review of 313 consecutive patients undergoing ssBTKA included 174 patients ≤ 70 years old and 139 patients > 70 years old. Perioperative variables and postoperative complications were compared with univariate analyses between age groups. Multivariate analyses were performed to determine risk factors for developing perioperative complications and transfusions. Compared with patients ≤ 70, patients > 70 had significantly lower body mass index (p < 0.001) and were more commonly female (p = 0.024). Although wound (p > 0.12) and systemic complications (p > 0.54) were similar, 23% of patients > 70 required transfusion compared with only 8% of patients ≤ 70 (p < 0.001). Patients with preoperative anemia (p < 0.001), age > 70 (p = 0.002), or diabetes mellitus (p = 0.007) were at 5.7, 3.3, and 2.9 times greater risk for requiring a transfusion, respectively. Patients > 70 undergoing ssBTKA have a similar complication profile to patients ≤ 70 years old, suggesting age should not be an absolute exclusion criterion for ssBTKA. However, the risk of transfusion was significantly higher in those > 70, despite lower tourniquet times. Treatment of preoperative anemia may decrease the risk of transfusion and could provide adequate safety for patients > 70 to undergo ssBTKA by an experienced surgeon.

A smaller femoral stem is needed for asian females.

BACKGROUND: Current femoral implants are manufactured based on Western anatomical structures and may be too large for smaller physiques, such as those of Asian females. This study reviewed the femoral stem size distribution used in a high-volume total hip arthroplasty (THA) practice and evaluated malalignment in patients receiving a size one implant. MATERIALS AND METHODS: A consecutive cohort of female patients self-reported as Asian (257 patients, 331 hips) or Caucasian (158 patients and 190 hips) were retrospectively evaluated. A single femoral stem type was used in all cases, performed by a single surgeon. Global hip offset (GHO) and leg length difference (LLD) were measured before and 6 weeks following THA. Differences between races were evaluated through Mann-Whitney U tests and chi-squared tests for continuous and categorical variables, respectively. RESULTS: The proportion of size one implants was higher amongst Asian patients (20.5%) than Caucasian patients (2.6%) (p < 0.001). A LLD greater than 6 mm was noted in 24.6% of size one patients and 11.4% of all other sizes (p = 0.010). Varus malalignment occurred in 47.9% of size one patients and 22.1% of all other sizes (p < 0.001). No fractures occurred in size one patients, and nine fractures (one intraoperative and eight post-operative) occurred in all other sizes (p = 0.258). CONCLUSION: The high proportion of size one stems required in Asian females and the higher incidence of LLD > 6 mm and varus malalignment suggest a distinct need for smaller femoral implants, especially for Asian females.

Fixed 6° distal femoral cut consistently achieves neutral alignment for Asians, Caucasians, and Native Hawaiian/Pacific Islanders.

BACKGROUND: Restoration of a neutral mechanical axis (MA) is important to the success of total knee arthroplasty (TKA). While known differences are present between Asians and Caucasians regarding native knee alignment, it is unknown whether such differences exist amongst Native Hawaiian/Other Pacific Islanders (NHPI) or if utilizing a fixed distal femoral cut of 6° can consistently achieve a neutral MA in these minority racial groups. This study examines the preoperative deformities presented by Asians, Caucasians, and NHPI, and the resulting knee alignment achieved following TKA when a fixed 6° distal femoral cut is targeted for all patients. METHODS: Preoperative and postoperative MA was measured from 835 Asian, 447 Caucasian, and 163 NHPI hip-to-ankle radiographs. All patients underwent TKA in which a standard distal femoral cut of 6° valgus was targeted for all patients. Data were evaluated as continuous variables and by groupings of varus (MA < - 3°), valgus (MA > 3°), and neutral (- 3° ≤ MA ≤ 3°) alignment. RESULTS: Preoperative deformity ranged from 38° varus to 29° valgus. The proportion of Asian and NHPI presenting with varus alignment prior to surgery was significantly greater than Caucasian patients in both males (Asians: 80.6%; Caucasians: 67.0%; NHPI: 79.0%, p = 0.001) and females (Asians: 66.1%; Caucasians: 45.7%; NHPI: 63.2%, p < 0.001). There was no difference in the proportion of patients (72-79%) achieving a neutral MA amongst all three racial groups. CONCLUSION: NHPI appear to have similar preoperative deformities to Asians with both groups having significantly more varus alignment than Caucasians. Despite a wide range of preoperative deformity, application of a fixed distal femoral cut of 6° valgus successfully established a neutral MA equally in the majority of patients across all three racial groups.

Improved hip symmetry with an adjustable fluoroscopic grid during total hip arthroplasty.

BACKGROUND: The use of intraoperative fluoroscopy (IF) is common with direct anterior total hip arthroplasty (THA), however image distortion in IF may limit its usefulness. The supplementation of IF with an adjustable grid (AG) may provide consistently better accuracy in component placement. Therefore, the purpose of this study was to compare the accuracy, consistency, and surgical efficiency between IF only and AG supplementation. METHODS: 2 cohorts were retrospectively evaluated, including 573 IF only patients and 211 AG patients having undergone unilateral THA between 2011 and 2018. Post-THA radiographic assessment was performed to evaluate the accuracy of component placement, with target placements for global hip offset (GHO) and leg-length differences (LLD) <10 mm and acetabular cup abduction of 45° (±10°). Accuracy and surgical efficiency were evaluated between groups and over time. RESULTS: The AG group had a significant greater percentage of components placed within the target zone compared to IF only for GHO (99.5%, 92.7%, p < 0.001), LLD (99.1%, 96.5%, p = 0.039) and abduction (99.5%, 96.3%, p = 0.009), with no difference in fluoroscopic time (p = 0.973). Over time, accuracy was significantly different in IF group for GHO (p = 0.008) and abduction (p = 0.002) and trended toward significance for LLD (p = 0.055). There were no significant differences over time for the AG group. CONCLUSIONS: The addition of an AG to IF significantly increased the accuracy of component placement during direct anterior THA. These results were consistent over 2 years of use and did not decrease surgical efficiency.

Reducing transfusion in hip arthroplasty: tranexemic acid diminishes influence of anesthesia administered.

BACKGROUND: The risk of transfusion following total hip arthroplasty (THA) continues to be problematic. The best choice of anesthesia (spinal vs general) and impact of tranexamic acid (TXA) use in reducing transfusions following surgery remain unclear. Therefore, the purpose of this study was to compare rates of blood transfusion following THA via the anterior approach using three different anesthesia protocols with and without TXA. MATERIALS AND METHODS: This retrospective review included 1399 patients (1659 hips), receiving spinal anesthesia (SA) without (248 patients) and with TXA (77 patients), general anesthesia (GA) without (151 patients) and with TXA (171) and general anesthesia with paravertebral block (GA-PVB) and TXA (748 patients). All procedures were performed by a single surgeon. Chi-Squared tests and logistic regression were performed to evaluate the rate and risks of transfusion between groups. RESULTS: Without TXA, transfusion rate with GA (24.5%) was higher than SA (13.4%) (p = 0.004). With TXA, there was no difference in transfusion rates between GA (4.6%), SA (3.9%) or GA-PVB (4.0%). The multivariable regression revealed bilateral (Odds Ratio (OR): 6.473; p < 0.001), female (OR: 2.046; p = 0.004), age (OR: 1.028; p = 0.012) and pre-operative anemia (OR: 2.604; p < 0.001) as increasing the risk of transfusion while use of TXA (OR: 0.168; p < 0.001) significantly reduced transfusion risk. CONCLUSION: The use of TXA during THA via the anterior approach removed the influence of anesthesia type regarding risk of transfusion. The use of TXA may reverse presumed disadvantages of GA alone, potentially facilitating rapid discharge following surgery.

Bruins-in-Genomics: Evaluation of the impact of a UCLA undergraduate summer program in computational biology on participating students.

Recruiting, training and retaining scientists in computational biology is necessary to develop a workforce that can lead the quantitative biology revolution. Yet, African-American/Black, Hispanic/Latinx, Native Americans, and women are severely underrepresented in computational biosciences. We established the UCLA Bruins-in-Genomics Summer Research Program to provide training and research experiences in quantitative biology and bioinformatics to undergraduate students with an emphasis on students from backgrounds underrepresented in computational biology. Program assessment was based on number of applicants, alumni surveys and comparison of post-graduate educational choices for participants and a control group of students who were accepted but declined to participate. We hypothesized that participation in the Bruins-in-Genomics program would increase the likelihood that students would pursue post-graduate education in a related field. Our surveys revealed that 75% of Bruins-in-Genomics Summer participants were enrolled in graduate school. Logistic regression analysis revealed that women who participated in the program were significantly more likely to pursue a Ph.D. than a matched control group (group x woman interaction term of p = 0.005). The Bruins-in-Genomics Summer program represents an example of how a combined didactic-research program structure can make computational biology accessible to a wide range of undergraduates and increase participation in quantitative biosciences.

Outcomes After Hip Labral Reconstruction Using Peroneus Longus Graft: A Novel Graft Experience.

Currently, there is no consensus on the ideal graft for hip labral reconstruction. The purpose of this study was to describe the surgical technique and report the short-term outcomes after hip labral reconstruction using a peroneal longus allograft. Eleven patients diagnosed with femoracetabular impingement and irreparable damage to the acetabular labrum underwent labral reconstruction with a peroneus longus allograft. The average follow-up time was 227 days (range: 26-457 days). Pre-operative radiographic measurements included an average pre-operative center edge angle of 29.0° (range: 19° to 37°) and an average alpha angle of 62.9° (range: 55° to 71°). All patients underwent femoroplasty, with additional procedures including 7 acetabuloplasties and 6 microfractures. The average visual analogue score for pain improved from 4.91±2.17 preoperatively to 3.85±2.0 postoperatively but this was not significant (P=.26). No patients sustained post-operative complications or allograft failures during follow up. Compared to other acetabular labral reconstruction options, the strength and shape of thedcd peroneus tendon may best replicate the native hip labrum. The current findings of no immediate post-operative complications or early failures suggests the peroneus longus allograft may be a viable option for hip labrum reconstruction.