Orthop Clin North Am
· 2025 Apr · PMID 40044349
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Current risk stratification scores provide some guidance in determining the possibility of a venous thromboembolism (VTE) event following total joint arthroplasties (TJA). The current literature supports low-dose aspirin...Current risk stratification scores provide some guidance in determining the possibility of a venous thromboembolism (VTE) event following total joint arthroplasties (TJA). The current literature supports low-dose aspirin of 81 mg twice daily as an ideal thromboprophylaxis agent for low-risk patients undergoing elective primary or revision total hip arthroplasty and total knee arthroplasty. Anticoagulants are suggested for high-risk patients. Intermittent mechanical compression and early mobilization are mechanical factors that can contribute to the reduction of VTE following major orthopedic surgeries. Surgeons should consider classification of TJA patients in low-risk or high-risk patients based upon validated risk assessment modules.
Haider MA, Cardillo C, Connolly P
… +1 more, Schwarzkopf R
Orthop Clin North Am
· 2025 Apr · PMID 40044348
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Publisher ↗
Total hip arthroplasty and total knee arthroplasty are among the most successful orthopedic procedures, with increasing numbers performed annually in the United States. However, adverse perioperative complications like a...Total hip arthroplasty and total knee arthroplasty are among the most successful orthopedic procedures, with increasing numbers performed annually in the United States. However, adverse perioperative complications like acute kidney injury (AKI) can adversely affect patient outcomes and increase health care costs. The incidence of AKI post-total joint arthroplasty varies widely, with large-scale studies reporting less than 2% and smaller studies indicating rates as high as 21.9%. Holding angiotensin converting enzyme inhibitors, aldosterone receptor blockers, NSAIDs, diuretics, and avoiding nephrotoxic antibiotics can help mitigate the risk.
Christopher ZK, Peters CL, Gililland JM
… +1 more, Anderson LA
Orthop Clin North Am
· 2025 Apr · PMID 40044347
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Publisher ↗
Anterior approaches including the direct anterior and anterior-based muscle sparing approaches have grown in popularity for total hip arthroplasty. Despite many benefits, some studies have demonstrated an increased risk...Anterior approaches including the direct anterior and anterior-based muscle sparing approaches have grown in popularity for total hip arthroplasty. Despite many benefits, some studies have demonstrated an increased risk of periprosthetic fracture. Preoperatively, patient selection, careful templating, and strategic implant choice may decrease fracture risk. Recently, cemented stems and modern tapered, collared uncemented stems have been associated with lower fracture rates as well. Using careful surgical techniques, obtaining adequate exposure through sequential releases, and understanding various broaching strategies can all play a role in decreasing periprosthetic facture through anterior approaches to total hip arthroplasty.
Wu KA, Kutzer KM, Kugelman DN
… +1 more, Seyler TM
Orthop Clin North Am
· 2025 Apr · PMID 40044346
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Despite the success of total knee arthroplasty and total hip arthroplasty, patients face an increased risk of postoperative falls, often due to surgery-induced changes in muscle strength. Falls can lead to serious conseq...Despite the success of total knee arthroplasty and total hip arthroplasty, patients face an increased risk of postoperative falls, often due to surgery-induced changes in muscle strength. Falls can lead to serious consequences, including fractures and reduced quality of life. The majority of falls related to total joint arthroplasty occurs outside the hospital. Effective fall prevention strategies, such as patient education, exercise interventions, environmental modifications, and medication management, are crucial for reducing fall risks and improving patient outcomes. Continued research and innovation in fall prevention are essential for improving patient safety and well-being following joint arthroplasty.
Steuer F, Marcaccio S, McMahon S
… +3 more, Como M, Charles S, Lin A
Orthop Clin North Am
· 2025 Apr · PMID 40044345
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Publisher ↗
The most common surgical treatment options for anterior shoulder instability include the arthroscopic Bankart repair with or without adjunct procedures such as remplissage, the open Bankart repair, the Bristow-Latarjet p...The most common surgical treatment options for anterior shoulder instability include the arthroscopic Bankart repair with or without adjunct procedures such as remplissage, the open Bankart repair, the Bristow-Latarjet procedure, and anterior free bone block transfers. The choice between non-operative treatment and 1 of the aforementioned procedures inherently impact the risk of recurrent instability. The purpose of this article is to discuss the timing of surgery in the in-season athlete, evaluate the evolving concept of glenoid and bipolar bone loss, and to discuss various surgical treatment options with a specific focus on minimizing recurrent instability rates following surgical stabilization.
Orthop Clin North Am
· 2025 Apr · PMID 40044344
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Publisher ↗
This article assesses the shoulder surgery literature relating to unplanned hospital readmissions following primary total shoulder arthroplasty (TSA). With increasing demand for TSA and the challenges posed by unplanned...This article assesses the shoulder surgery literature relating to unplanned hospital readmissions following primary total shoulder arthroplasty (TSA). With increasing demand for TSA and the challenges posed by unplanned hospital readmissions, it is essential to have a concrete understanding of the risk factors and implications of readmissions. Patient Intrinsic and Extrinsic factors such as patient demographics, comorbidities, and surgical variables contribute to readmission risk. Despite low overall readmission rates, the negative patient health, financial, and resource burdens of unplanned readmissions remain significant. This study emphasizes the importance of developing targeted interventions to minimize readmission risks and improve patient outcomes.
Orthop Clin North Am
· 2025 Jan · PMID 39581649
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Publisher ↗
Ambulatory surgery centers (ASCs) are an alternative to hospitals for outpatient orthopedic surgeries. ASCs can offer lower costs, faster turnover times, and lower operative times while maintaining similar safety and rea...Ambulatory surgery centers (ASCs) are an alternative to hospitals for outpatient orthopedic surgeries. ASCs can offer lower costs, faster turnover times, and lower operative times while maintaining similar safety and readmission rates. However, hospitals can offer more robust care in the perioperative period and are better equipped to handle any complications. Physician-owned ASCs offer a unique perspective into what a potential physician-owned health care model could look like and raise the question of whether there should be a push for physician-owned hospitals, given the efficiencies seen in ASCs.
Orthop Clin North Am
· 2025 Jan · PMID 39581648
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Ethical decision-making in the amputation versus limb salvage context requires consideration of respect for patient autonomy, beneficence, and nonmaleficence. The surgical options demonstrate near equivalent outcomes for...Ethical decision-making in the amputation versus limb salvage context requires consideration of respect for patient autonomy, beneficence, and nonmaleficence. The surgical options demonstrate near equivalent outcomes for traumatic indications, while reconstruction is generally favored for threatened limbs due to diabetic complications. The decision for amputation versus limb salvage must be considered in each individual patient's situation, with a shared decision-making process of paramount importance. Discussion should involve the best, worst, and most likely case for each surgical option to allow the patient to better understand the range of potential postoperative courses and make an informed decision.
Coble TJ, Jestus JW, Bell JA
… +2 more, Weller WJ, Calandruccio JH
Orthop Clin North Am
· 2025 Jan · PMID 39581647
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Maintaining professionalism during a difficult patient interaction is paramount to providing excellent patient care, but it can be challenging. As the patient-physician relationship has evolved, patient autonomy has incr...Maintaining professionalism during a difficult patient interaction is paramount to providing excellent patient care, but it can be challenging. As the patient-physician relationship has evolved, patient autonomy has increased and shared decision-making is prioritized. This evolution has led to improved patient support and satisfaction; however, it has added a complexity to the physician-patient interaction. In addition, communication barriers, noncompliance, cultural and socioeconomic differences, mental health issues, impairments, and legal concerns can lead to challenging patient interactions. Strategies used to address these delicate situations can help lead to improved physician and patient satisfaction as well as improved patient outcomes.
Orthop Clin North Am
· 2025 Jan · PMID 39581646
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Publisher ↗
Decision-making capacity in pediatric health care is crucial for upholding ethical practices and protecting patient autonomy. It involves a patient's ability to understand the benefits, risks, and alternatives of a propo...Decision-making capacity in pediatric health care is crucial for upholding ethical practices and protecting patient autonomy. It involves a patient's ability to understand the benefits, risks, and alternatives of a proposed treatment or intervention, demonstrate understanding, appreciate the consequences, reason clearly, and communicate their wishes. Informed consent and assent are essential concepts in pediatric decision-making, ensuring that patients, including children, clearly understand their treatment options, and voluntarily agree to them. The involvement of children in medical decisions should be proportional to their developmental stage, with adolescents having more autonomy in health care decisions.
Orthop Clin North Am
· 2025 Jan · PMID 39581645
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Intimate partner violence is common among orthopedic patients and leads to significant morbidity and mortality. The orthopedic surgeon may be the first contact a survivor has with the health care system and is in an impo...Intimate partner violence is common among orthopedic patients and leads to significant morbidity and mortality. The orthopedic surgeon may be the first contact a survivor has with the health care system and is in an important place to identify victims. By improving screening and identifying victims in the clinic, interventions that improve housing and safety can be established to improve the overall well-being of victims.
Orthop Clin North Am
· 2025 Jan · PMID 39581644
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Contemporary care of patients with orthopedic trauma is complex from surgical, cultural, administrative, financial, and linguistic perspectives. Surgeons must understand patients' backgrounds and resources to have an ide...Contemporary care of patients with orthopedic trauma is complex from surgical, cultural, administrative, financial, and linguistic perspectives. Surgeons must understand patients' backgrounds and resources to have an idea of the manner in which care can be delivered most effectively. Recognizing patients from traditionally underserved or vulnerable groups will help the surgeon to individualize their approach to the care of each individual patient. Understanding patient funding, or lack thereof, will inform the provider as to the extent of the resources and access available to the patient and assist in planning episodes of care.
Orthop Clin North Am
· 2025 Jan · PMID 39581643
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A multitude of factors influence implant choice in total joint replacement surgeries, including surgeon choice. Attempts at limiting health care costs by restricting implant choice have become commonplace. A spectrum of...A multitude of factors influence implant choice in total joint replacement surgeries, including surgeon choice. Attempts at limiting health care costs by restricting implant choice have become commonplace. A spectrum of strategies exists including price transparency, patient demand matching, capitation pricing, and limited vendor agreements. The benefits and drawbacks of these various strategies in optimizing costs must be considered along with physician autonomy and independence in performing the surgeries.
Branstetter R, Piedy E, Rajendra R
… +2 more, Bronstone A, Dasa V
Orthop Clin North Am
· 2025 Jan · PMID 39581642
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The emergence of technological advancements such as artificial intelligence, virtual reality, and robotics may offer new solutions to address crucial deficiencies in surgical residency training. However, these technologi...The emergence of technological advancements such as artificial intelligence, virtual reality, and robotics may offer new solutions to address crucial deficiencies in surgical residency training. However, these technologies also introduce ethical dilemmas and practical complexities. Achieving a balance between embracing innovation and refining traditional surgical techniques is essential in molding well-rounded, proficient surgeons. Addressing concerns such as disparities in access to technology and the risk of excessive automated system dependence demands thorough deliberation and the establishment of universal guidelines. By approaching these challenges with care and insight, surgeons can utilize new technology to elevate both surgical training and outcomes.
Orthop Clin North Am
· 2025 Jan · PMID 39581641
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Publisher ↗
Total joint arthroplasty (TJA) is one of the most common surgeries performed in the United States and is a durable and effective option in managing osteoarthritis of the hip and knee. Recent research regarding the proced...Total joint arthroplasty (TJA) is one of the most common surgeries performed in the United States and is a durable and effective option in managing osteoarthritis of the hip and knee. Recent research regarding the procedure has focused on preoperative optimization and weight loss in particular. Obesity has been shown in prior studies to increase risks associated with TJA, and, as a result, debate has focused on whether a body mass index (BMI) cutoff is a prudent tool for preoperative optimization. This article discusses the ethical dilemma of instituting a BMI cutoff and reviews current literature regarding the topic.
Orthop Clin North Am
· 2025 Jan · PMID 39581640
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Preoperative optimization of modifiable risk factors for total hip and knee arthroplasty remains a foundational cornerstone in reducing postoperative complications and enhancing patient outcomes. With an increasing preva...Preoperative optimization of modifiable risk factors for total hip and knee arthroplasty remains a foundational cornerstone in reducing postoperative complications and enhancing patient outcomes. With an increasing prevalence of high-risk comorbidities among total joint arthroplasty patients with morbid obesity (body mass index ≥40 kg/m2), uncontrolled diabetes (hemoglobin A1c ≥ 7.5%), and active smoking and tobacco use, many joint arthroplasty surgeons face complex ethical decisions when surgical intervention poses a higher risk for potential harm. Creating definitive numerical cutoffs may lead to access-to-care issues with a difficult balance between helping and harming patients.
Orthop Clin North Am
· 2024 Oct · PMID 39216955
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Publisher ↗
Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and of...Total ankle replacement (TAR) is an effective operative treatment of end-stage ankle osteoarthritis (OA) in the appropriate patient, conferring improved kinematic function, decreased stress across adjacent joints, and offering equivalent pain relief in comparison to ankle arthrodesis (AA). It is important to consider patient age, weight, coronal tibiotalar deformity, joint line height, and adjacent joint OA to maximize clinical and patient outcomes. Both mobile-bearing and fixed-bearing implants have demonstrated favorable clinical outcomes, marked improvement in patient-reported outcomes, and good survivorship; however, implant survivorship decreases with longer term follow-up, necessitating constant improvement of primary and revision TAR options.