Patient-reported outcome measures (PROMs) are important markers of postsurgical outcomes following total joint arthroplasty (TJA). Recent policies by the Centers for Medicare & Medicaid Services will require hospitals to achieve at least 50% postoperative PROM collection rates in order to qualify for their full annual payment in fiscal year 2028. This study aimed to: (1) quantify provider PROMs collection rates for TJA patients; (2) compare mean improvements in postoperative PROMs in TJA patients; (3) identify the proportion of TJA patients achieving substantial clinical benefit (SCB); and (4) identify factors associated with TJA patient completion of matched PROMs and achievement of SCB at one year.

This retrospective cohort study included 1,493 primary total hip arthroplasty (THA) and 2,959 primary total knee arthroplasty (TKA) patients who underwent surgery at a single institution from May 2019 to December 2023. The primary outcomes were 1-year paired hip or knee PROM collection, measured by the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement surveys, and SCB achievement rates (22 for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and 20 for Knee Injury and Osteoarthritis Outcome Score for Joint Replacement). Secondary outcomes involved identifying factors associated with PROM completion and SCB achievement. Statistical analyses included descriptive statistics, t-tests, and logistic regression analysis.

There were 61.2% of THA patients and 61.1% of TKA patients who completed 1-year paired PROMs, with 72.8% of THA and 53.3% of TKA patients achieving SCB. Factors associated with higher PROMs completion included technology use (PROMs application, text reminders). For TJA patients, a lower preoperative PROM was associated with achievement of SCB at one year. For THA patients, lower body mass index was associated with SCB attainment. For TKA patients, men were significantly associated with SCB attainment.

The study indicates compliance with the 50% PROM collection requirement, but this required significant allocation of resources, including the use of a digital care platform. Substantial clinical benefit was achieved in 72.8% of THA patients but only 53.3% of TKA patients at one year, and this was associated with certain patient demographic factors. Achieving compliance with the Centers for Medicare & Medicaid Services requirement may be difficult for many providers and institutions.

This study aimed to determine the significance of individual questions from the hip osteoarthritis outcome score (HOOS), HOOS Physical Function Shortform (PS), HOOS Joint Replacement (JR), and Veterans-Rand (VR)-12 mental composite score (MCS) in achieving a patient acceptable symptom state (PASS).

A retrospective study of a prospectively collected cohort of 8236 unilateral elective primary THAs was analyzed. Responses were collected for 18 HOOS questions (pain, PS, and JR) and 6 VR-12 questions used to calculate MCS preoperatively and 1-year postoperatively. PASS was assessed through a positive response to a binary satisfaction-related question. The association between responses to questions and outcomes was examined via multivariable logistic regression models stratified by sex.

Sex-specific differences in PASS attainment were observed. In males, a poorer preoperative response in HOOS-PS assessing a patient's difficulty to sit or run comfortably due to their hip was independently associated with reduced odds of achieving PASS at 1-year post-THA (odds ratio [OR] = 0.66 [95% confidence interval [CI] 0.52-0.83], P = 0.001, and OR = 0.83 [0.73-0.95], P = 0.01, respectively). Additionally, a more favorable preoperative response in the MCS metric of feeling down and blue (OR = 1.15 [95% CI 1.03-1.28], P = 0.01) was associated with increased PASS attainment, whereas a poorer preoperative response to having energy (OR = 0.86 [95% CI 0.76-0.97], P = 0.02) was associated with reduced PASS attainment. In females, only a poorer preoperative response in feeling calm and peaceful (OR = 0.87 [95% CI 0.78-0.96], P = 0.01) was associated with reduced odds of PASS attainment.

Individual questions of the HOOS and VR-12 MCS were identified as being independently associated with achieving patient satisfaction at one-year following THA. Notably, predictors of satisfaction differed by sex, with both physical function and mental health factors playing a larger role in males, while mental health alone was predictive in females. Understanding specific aspects that matter most to patients, such as mental health, allows healthcare providers to tailor their care to better meet patients' needs. This approach could involve counseling, stress management techniques, and interventions aimed at reducing feelings of depression and anxiety.

III.

The Hip disability and Osteoarthritis Outcome Score (HOOS) has been used for the evaluation of patients who have hip osteoarthritis. It is one of the most frequently used instruments for the follow-up of patients operated on for total hip arthroplasty (THA) in different national registries. The purpose of this study was to carry out the transcultural adaptation and validation of the Chilean version of the HOOS questionnaire in patients who have hip osteoarthritis.

The translation and cross-cultural adaptation process were based on international guidelines to obtain a Chilean version of the HOOS questionnaire. The Chilean version was evaluated in the pretest phase and then in the validation phase with patients in the outpatient setting, from patients who had initial osteoarthritis to patients who had end-stage disease waiting for surgery. We assessed the psychometric properties as convergent validity, evaluating correlations with the Short Form 12 Health Survey (SF12) questionnaire and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0) tool; structural validity by conducting a confirmatory factor analysis; and internal consistency using Cronbach's alpha.

There were 30 outpatients who participated in the pre-test phase and 111 in the validation phase. There was a positive correlation between the HOOS score in the dimensions of activities of daily living, pain, and symptoms with the physical dimension of the SF12 (r > 0.7; P < 0.001). In the same way, the HOOS quality of life item was correlated with the mental dimension of the SF12 (r = 0.51; P < 0.001). The WHODAS2.0 tool had a moderate negative correlation with all the HOOS dimensions (P < 0.001). Confirmatory factor analysis confirmed good construct validity. Cronbach's alpha was 0.97 for the global questionnaire.

The Chilean version of the HOOS questionnaire showed adequate validity and reliability, with adequate psychometric properties. This could have relevance in the evaluation and treatment of patients who have hip osteoarthritis and in the evaluation of the results of patients undergoing THA.

As the United States health-care system transitions to a value-based model, the minimal clinically important difference (MCID) has become an important metric for assessing perceived benefit in clinical settings. However, there is substantial ambiguity surrounding the MCID value because the calculation method used can lead to substantial changes in the clinical interpretation of surgical success.

A total of 1,113 patients who underwent either total knee arthroplasty (TKA) or total hip arthroplasty (THA) between June 2021 and June 2023 and completed their patient-reported outcomes (the KOOS JR [Knee injury and Osteoarthritis Outcome Score for Joint Replacement] or HOOS JR [Hip disability and Osteoarthritis Outcome Score for Joint Replacement]) preoperatively and at 1 year postoperatively were reviewed for this study. The MCID values for the HOOS JR and KOOS JR were determined using 16 statistically appropriate methods, and the resulting MCID values were applied to the study group to assess how differences in methods changed the number of patients who met the MCID at 1 year postoperatively.

The study cohort consisted of 570 patients who underwent TKA and 543 who underwent THA. The overall cohort was 62.2% female, had a mean age of 69.3 ± 8.3 years, and was 92.3% Caucasian, 2.9% African American, and 4.8% other race (i.e., Asian, multiracial, or "other"). The MCID values varied substantially among the methods evaluated. The mean MCID was 11.5 ± 9.2 (range, 0.5 to 36.6) for the KOOS JR and 12.2 ± 8.9 (range, 0.6 to 34.3) for the HOOS JR. Distribution-based methods led to smaller but more variable MCID values, whereas anchor-based methods were noted to have larger but more consistent MCID values.

Different statistical approaches resulted in substantial variation in the MCID threshold value, which affected the number of patients who reached the MCID. This study demonstrates the ambiguity of the MCID and casts some doubt regarding its utility for assessing the surgical benefit of total joint arthroplasty.

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Patient-reported outcome measures (PROMs) are increasingly important in assessing revision total hip arthroplasty (THA) outcomes, yet diagnosis-specific thresholds for clinical relevance remain largely undefined. This study aimed to determine diagnosis-specific minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit (SCB) thresholds for the Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales in aseptic revision THA.

A prospective cohort of 466 patients who underwent aseptic revision THA between 2016 and 2022 was analyzed. Patients were stratified by diagnosis: aseptic loosening (n = 232), implant failure (n = 112), instability (n = 78), and periprosthetic fracture (n = 44). The HOOS-pain, HOOS-physical function short form (PS), and HOOS-Joint Replacement (JR) scores were collected preoperatively and at a 1-year follow-up. The MCID was calculated using distribution-based methods, while PASS and SCB were determined using anchor-based approaches.

The MCID thresholds ranged from 10.0 (aseptic loosening) to 12.9 (periprosthetic fracture) for HOOS-pain, 9.9 (instability) to 12.9 (periprosthetic fracture) for HOOS-PS, and 8.7 (aseptic loosening) to 12.1 (periprosthetic fracture) for HOOS-JR. The PASS thresholds varied from 67.5 (implant failure) to 72.5 (periprosthetic fracture) for HOOS-pain, 76.6 (periprosthetic fracture) to 80.0 (aseptic loosening, implant failure, and instability) for HOOS-PS, and 64.7 (aseptic loosening) to 73.5 (implant failure and instability) for HOOS-JR. The SCB thresholds spanned 15 (implant failure) to 35 (aseptic loosening) for HOOS-pain, 4.6 (periprosthetic fracture) to 22.0 (instability) for HOOS-PS, and 16.1 (instability) to 25.9 (implant failure) for HOOS-JR.

This study established diagnosis-specific thresholds for MCID, PASS, and SCB across HOOS subscales in aseptic revision THA, demonstrating significant variability by preoperative diagnosis. Patients who have aseptic loosening showed the greatest improvement and highest likelihood of achieving clinically meaningful benefits, while those who have periprosthetic fractures and instability had lower rates of meaningful recovery. These findings provide a critical framework for outcome assessment and personalized patient counseling.

The hip dysfunction and osteoarthritis outcome score for joint replacement (HOOS JR) has been widely used to assess patient hip function. The subjective hip value (SHV) has become increasingly recognized as an efficient single-question survey for assessing hip joint function. This study aimed to determine the psychometric properties of the SHV in evaluating hip function in patients undergoing total hip arthroplasty (THA) in correlation with the traditional HOOS JR.

This was a retrospective review of 1,157 distinct patients who underwent primary THA between January 2021 and December 2023. Scores for SHV and HOOS JR were collected preoperatively, as well as 3 months and 1 year postoperatively. Validity was determined using Pearson's correlation tests between the SHV and HOOS JR.

Overall, the SHV was highly correlated with the HOOS JR at 3 months (R = 0.71, P < 0.001) and 1 year postoperatively (R = 0.79, P < 0.001). Additionally, changes in the SHV showed significant correlations with changes in the HOOS JR between the preoperative and postoperative periods. The SHV also had substantially fewer ceiling effects compared to the HOOS JR.

The SHV is a valid and responsive single-item assessment for hip joint function following primary THA. Despite its limitations, its efficiency and ease of use make it a feasible option for routine clinical assessments, providing clinicians with valuable insights into patients' recovery. Subsequently, the integration of the SHV into orthopedic practice holds promise for enhancing the management of postoperative care and improving patient outcomes.

This study evaluated joint-specific and generic patient-reported outcome measures (PROMs) after total hip arthroplasty (THA) and total ankle arthroplasty (TAA) in matched cohorts, while evaluating implant survivorship and 90-day hospital use.

Primary THA and TAA patients from 1 January 2015 to 1 January 2023 with minimum one-year follow-up were retrospectively reviewed. After applying exclusion criteria, 2,092 THAs and 478 TAAs were analyzed. Demographics, pre- and postoperative PROMs, revision surgeries, emergency department visits, and readmissions were collected. THA and TAA patients were then propensity score matched at a 2:1 ratio for age, sex, race, BMI, American Society of Anesthesiologists classification, and comorbidities, resulting in a final cohort of 844 THAs and 455 TAAs for comparison.

Median preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores between THA and TAA were calculated (66.0 (IQR 62.0 to 70.0) vs 65.0 (IQR 62.0 to 70.0); p = 0.276), and both showed improvement at six weeks. However, THA patients exhibited lower median PROMIS PI scores at one year (53.0 vs 54.0; p = 0.009), as well as a greater median decrease in PROMIS PI from preoperative to one year (-13.0 (IQR -20.0 to -8.0) vs -12.0 (IQR -18.0 to -7.0); p = 0.023). Median preoperative PROMIS physical function (PF) was worse in THA patients (36.0 (IQR 32.0 to 40.0) vs 37.0 (IQR 33.0 to 40.0); p = 0.031), but showed greater median improvement compared to TAA patients at both six weeks (7.0 (IQR 3.0 to 12.0) vs 3.0 (IQR -2.0 to 9.0); p < 0.001) and one year (11.0 (IQR 6.0 to 17.0) vs 8.0 (IQR 4.5 to 13.0); p < 0.001). Preoperative PROMIS depression scores were similar and improved similarly in both groups. Joint-specific PROMs improved in both cohorts.

Patients undergoing THA or TAA experienced improvements in joint-specific PROMs postoperatively which translated to improved generic PROMs across both joints. Generic PROMs can be a useful tool to compare outcomes in THA and TAA. Results suggest that higher functional scores may be achieved sooner in THA.

The aim of this study was to assess the variations in the positioning of components between sides in patients who underwent staged bilateral total hip arthroplasty (THA), and whether these variations affected patient-reported outcome measures (PROMs).

A retrospective review included 207 patients who underwent staged bilateral THA between June 2017 and November 2022. Leg length, the height and anteversion of the acetabular component, and the coronal and sagittal angles of the femoral component were assessed radiologically and compared with the contralateral THA. The effect of the surgical approach and the technology used on this variation was also assessed. Linear regression was used to investigate the variations between the two THAs and the PROMs.

Between the two sides, the mean leg length varied by 4.6 mm (0.0 to 21.2), the mean height of the acetabular component varied by 3.3 mm (0.0 to 13.7), the mean anteversion varied by 8.2° (0.0° to 28.7°), the mean coronal alignment of the femoral component varied by 1.1° (0.0° to 6.9°), and the mean sagittal alignment varied by 2.3° (0.0° to 10.5°). The use of the direct anterior approach resulted in significantly more variation in the alignment of the femoral component in both the coronal (1.3° vs 1.0°; p = 0.036) and sagittal planes (2.8° vs 2.0°; p = 0.012) compared with the use of the posterior approach. The posterior approach generally led to more anteversion of the acetabular component than the anterior approach. The use of robotics or navigation for positioning the acetabular compoment did not increase side-to-side variations in acetabular component-related positioning or leg length. Despite considerable side-to-side variations, the mean Hip disability and Osteoarthritis Outcome, Joint Replacement (HOOS JR) score was not affected by variations in the postioning of the components.

Staged bilateral THA resulted in considerable variation in the positioning of the components between the two sides. The direct anterior approach led to more variations in anteversion of the acetabular component and sagittal alignment of the femoral component than the posterior approach. The use of computer navigation and robotics did not improve the consistency of the positioning of the components in bilateral THA. Variations in the positioning of the components was not associated with differences in PROMs, indicating that patients can tolerate these differences.

Involving patients in developing patient-reported outcome measures (PROMs) is essential for accurately capturing their perspectives. However, understanding how patients were involved in developing PROMs used after hip or knee arthroplasty is limited. This scoping review aimed to evaluate whether patients were involved in the development of these PROMs and how they were involved.

Two independent reviewers documented patient involvement in item development and comprehensibility testing for 50 PROMs used after hip or knee arthroplasty. Trends in patient involvement over time were analyzed using binary logistic regression.

There was no documentation of patient involvement in a collaborative role during the PROM development processes. Regarding the consultative role, of these 26 PROMs, they contributed to item development in 13 PROMs (26%) and comprehensibility testing in four PROMs (8%) and both item development and comprehensibility testing in nine PROMs (18%). Patients who underwent arthroplasty were involved in one or both phases in ten PROMs (20%), while patients with other lower extremity conditions were involved in 16 PROMs (32%). Patients who underwent arthroplasty contributed to both phases in five PROMs: Oxford Knee Score-Activity and Participation Questionnaire, Patient's Knee Implant Performance Questionnaire, Patient-Reported Outcomes Measurement Information System R-Plus-Osteoarthritis of the Knee, Oxford Arthroplasty Early Recovery Score and Oxford Arthroplasty Early Change Score. In addition, our analysis revealed no significant change in patient involvement in a consultative role during either item development or comprehensibility evaluation over time since 1982, when the first PROM included in this review was developed (p = 0.21).

Almost half of PROMs used after arthroplasty did not involve patients in their development, highlighting the need to address this gap in development of PROMs. There is also a need to analyze PROMs to ensure they accurately reflect the outcomes that matter to patients.

Utilization of and access to total joint arthroplasty (TJA) are disproportionately skewed in patients who have low socioeconomic status (SES) and in minority populations. Patient-reported outcome measures (PROMs) are critical markers of post-surgical outcomes following TJA. This study aimed to: 1) evaluate differences in race, SES, and demographic factors between TJA patients who achieved substantial clinical benefit (SCB) and those who did not; 2) assess differences between preoperative PROMs in these patients; and 3) identify whether race and SES are associated with SCB achievement at 1-year post-TJA.

This retrospective cohort study included 1,154 total hip arthroplasty (THA) and 1,879 total knee arthroplasty (TKA) patients who underwent surgery at a single academic medical center from May 2019 to February 2023. Preoperative and postoperative PROMs were collected using the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and Hip Disability and Osteoarthritis Outcome Score for Joint Replacement surveys. Demographic and comorbidity data were collected from charts. Multivariable logistic regression analyzed the association between predictive variables and SCB achievement.

No differences in race were found between patients who achieved SCB and those who did not for both TKA and THA (P > 0.05). However, preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement scores were lower in Black (P = 0.004) and Hispanic (P < 0.001) patients and preoperative Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores were lower in Black patients (P < 0.001) than White patients. A higher proportion of patients in the lowest income category achieved SCB for both THA and TKA than those in other income categories (P = 0.04, P = 0.03, respectively). However, race was not associated with SCB likelihood at one year. For TKA patients, men were negative, and bilateral simultaneous TKA was positively associated with SCB achievement when controlling for race, income, and body mass index (P < 0.001, P = 0.01, respectively).

Race and income category were not significantly associated with achieving SCB at one year among TJA patients. However, non-White patients had a similar likelihood of achieving SCB as White patients, even with lower preoperative PROMs, indicating that these patients may benefit greatly from TJA despite delays in care. Men were negatively associated with TKA SCB achievement, while bilateral simultaneous TKA was positively associated with SCB.

The objective was to examine differences in the gait-specific cognitive representation structures between individuals after total knee- (TKA) and after total hip-joint arthroplasty (THA). The cognitive representation structure was compared between three groups: 1. three months after TKA (n = 12), 2. three months after THA (n = 12), and 3. healthy control group (CG) (n = 12) using the structural dimensional analysis of mental representation (SDA-M). Additionally, perceived joint function was rated by either the KOOS, JR. or HOOS, JR. Mean distribution of perceived joint function was not significantly different between the TKA (60.35 ± 11.2) and THA group (68.01 ± 13.8) (t = - 1.425; p = .173). In the cognitive representation structure, the THA group exhibited functional differences from the TKA group and control group, both of which showed a functional structure. Three months after hip joint replacement the gait-specific cognitive representation structure seems to reflect joint function-specific deviations. Therefore, focussing on functional recovery of cognitive gait representation may facilitate gait rehabilitation in individuals after hip replacement.

Patients who undergo a second THA at least 1 year after the first one may experience different recovery courses after each THA. It is unknown what the clinically relevant improvements and healthcare utilization are after each THA in patients undergoing contralateral THA > 1 year apart.

(1) Do patient-reported outcome measures (PROMs) differ at baseline and 1 year after THA for the first and second hip arthroplasty? (2) Does the likelihood of achieving minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds differ for the first and second hip arthroplasty? (3) Does utilization of healthcare within 90 days of THA, using discharge disposition, length of stay (LOS), and 90-day readmission risk as proxies, differ between the first and second hip arthroplasty?

Between January 2016 and December 2021, a total of 14,023 primary THAs for hip osteoarthritis were performed at a large tertiary academic center, and data from each were longitudinally maintained in an institutional database. In this retrospective study, we excluded nonelective (n = 265), simultaneous bilateral (n = 89), staged bilateral < 1 year apart (n = 1856), unilateral THAs (n = 7541), and those who were lost prior to the minimum study follow-up of 1 year or had incomplete data sets (n =3618), leaving 654 contralateral THAs > 1 year apart (327 patients) for analysis here. The median (range) patient age was 64 years (26 to 88) at the time of the first THA and 66 years (27 to 88) at the second THA. The mean (IQR) time from first THA to second THA was 696 days (488 to 1008). In all, 62% (204 of 327) of patients were women, and 89% (286 of 321) were White. The median (range) BMI was 29 kg/m 2 (first THA 16 to 60, second THA 18 to 56) at both THAs. PROMs were obtained preoperatively and at 1 year after each of the THAs and included Hip Disability and Osteoarthritis Outcome Score pain (HOOS-pain), physical function (HOOS-PS), and joint replacement (HOOS-JR) scores, as well as the Veterans Rand 12-Item Health Survey mental component summary score. Each was scored from 0 to 100, with higher scores representing better patient perceived outcomes. A distribution-based method was used to calculate the MCID thresholds (HOOS-pain 8.35, HOOS-PS 9.47, and HOOS-JR 7.76), while an anchor-based method was utilized for the PASS thresholds (HOOS-pain 80.6, HOOS-PS 83.6, and HOOS-JR 83.6). Healthcare utilization outcomes included discharge disposition, LOS, and 90-day readmission rates.

Patients had slightly lower baseline PROM scores in all HOOS subdomains before the first THA compared with the second THA (median HOOS-pain 38 versus 42, p < 0.001; HOOS-PS 54 versus 58, p < 0.001; HOOS-JR 43 versus 47, p < 0.001). The difference between baseline and 1-year postoperative scores was slightly larger in all HOOS subdomains after the first THA (median HOOS-pain difference 52 versus 50, p < 0.001; HOOS-PS difference 38 versus 31, p < 0.001; HOOS-JR difference 42 versus 39, p < 0.001). There was no difference in the percentage of patients achieving the MCID in HOOS-pain (97% versus 97%; p = 0.93), HOOS-PS (92% versus 88%; p = 0.17), and HOOS-JR (96% versus 94%; p = 0.18) between the first and second THAs. Although there was also no difference in the percentage of patients achieving PASS thresholds in HOOS-pain (81% versus 77%; p = 0.11), HOOS-PS (82% versus 79%; p = 0.055), and HOOS-JR (71% versus 71%; p = 0.39) between the first and second THAs, considerably fewer patients were reaching the PASS threshold in both THAs. After the second THA, slightly more patients were discharged home (95% versus 91%; p = 0.03) and had a very slightly shorter LOS (1.28 versus 1.35 days; p < 0.001). There was no difference in 90-day readmission rates between the first and second THA (4% versus 5%; p = 0.84).

In patients undergoing contralateral THA > 1 year apart, baseline PROMs were slightly worse before the first THA, and improvements were slightly greater compared with the second THA, although these differences were likely not clinically significant. Clinically meaningful improvements, based on MCID and PASS thresholds, were similar at 1 year for both THAs, yet 20% to 25% of patients reported inadequate pain relief after both surgeries. Healthcare utilization was also comparable between both procedures. Surgeons can use these findings to counsel patients on the likely similar outcomes following both their THAs. Future studies should explore factors contributing to inadequate pain relief and identify strategies to improve patient outcomes after both THAs.Level of Evidenc e Level III, therapeutic study.

Functional outcomes after total hip arthroplasty (THA) are generally poorer in obese patients compared to non-obese individuals. However, the effect of obesity on functional improvement following navigation-assisted HA remains controversial. This study investigates whether BMI influences functional outcome improvements following navigation-assisted THA.

We reviewed our institutional database from 2010 to 2024 for patients undergoing navigation-assisted unilateral primary THA. Patients were categorized as Healthy weight (18.5-25.0 Kg/m2), Overweight (25.0-29.9 Kg/m2), and Obese (30-39.9 Kg/m2), based on their preoperative BMI. Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) was compared across BMI groups as the primary outcome. Multiple linear regression models were used to investigate the effect of BMI groups on Delta HOOS JR and postoperative HOOS JR while controlling for confounding variables.

A total of 1,543 cases with a mean age of 62.80 years (range: 23-94) were included. Most patients were Overweight (40.5%), followed by Obese (32.9%) and Healthy weight (26.6%). Although obese patients had significantly lower preoperative and postoperative functional scores (p < 0.05), they demonstrated greater improvements in HOOS symptoms (44.68 ± 22.45 vs. 40.68 ± 22.29, p = 0.006) and activities of daily living (46.36 ± 20.85 vs. 42.10 ± 21.20, p = 0.002) compared to the Healthy weight group. Despite obesity being linked to lower postoperative HOOS JR, regression analysis showed age ≥ 60 years, men, and alcohol consumption-but not BMI status-negatively affected Delta HOOS JR.

The obese group exhibited better improvements in HOOS symptoms and ADL with comparable Delta HOOS JR, supporting navigation-assisted THA as a valuable option for obese patients. The results of this study may help surgeons provide evidence-based preoperative counseling to obese patients regarding the expected clinical outcomes of THA.

Up to 20% of patients report dissatisfaction following primary total joint arthroplasty (TJA). Patient characteristics, surgical techniques, and clinical outcomes do not fully explain dissatisfaction. Dispositional personality traits are related to health behaviors and outcomes. We evaluated the relationship between patient personality and early overall satisfaction after TJA.

Elective unilateral primary TJAs (n = 377) were prospectively enrolled. The sample consisted of 61% women, with an average age and body mass index of 67 years (range, 31 to 89) and 35 (range, 15 to 62), respectively. A validated personality assessment was administered preoperatively. Satisfaction was measured at a mean of 4.8 (range, 2.5 to 6.4) months postoperatively, as were other covariates, including whether expectations for pain and functional improvement were met, joint health scores, mental and physical health, and health literacy. Patient sex, race, age, body mass index, American Society of Anesthesiologists Physical Status classification, surgeon, procedure type, and complications within 90 days of surgery also served as covariates. Variables significantly related to being satisfied with TJA were analyzed using binary logistic regression.

Patient-reported satisfaction was 80% for improvement in recreational activities, 86% for improvement in the ability to perform housework and yardwork, and 93% for pain relief and the overall result of surgery. In multivariable analyses, each unit increase in the personality trait open-mindedness increased overall and pain relief satisfaction by 3.87 and 2.65 times, respectively (P ≤ 0.012), as did each unit increase in expectations being met (2.33 and 5.87 times, respectively, P ≤ 0.001). The area under the receiver operating characteristic curve statistics indicated that accounting for open-mindedness enhanced the classification of satisfied and not satisfied patients beyond accounting for whether expectations were met.

Patient personality influences early patient-reported satisfaction after TJA, warranting careful consideration when using this metric to assess surgical effectiveness and reimbursement.

Cementless femoral fixation in total hip arthroplasty (THA) is the most frequently utilized technique in the United States due to the efficacy of biologic fixation and reduced intraoperative times compared with cemented fixation, but has been associated with complications, including periprosthetic fracture and loosening. A recently introduced collared triple-tapered cementless stem has been engineered to address and mitigate these adverse events, but its safety remains unproven. The purpose of this study was to report early complications and causes of failure of this stem and to report patient satisfaction and function.

A retrospective review of patients who underwent primary THA using this device at a single institution from April 2022 to January 2024 was conducted. A total of 443 cases were performed that met the inclusion criteria. Patient demographics, including age, sex, American Society of Anesthesiologists score, and comorbidities, were collected. The primary outcome of interest was early complications (within 90 days) requiring readmission or revision surgical intervention. Patient-reported outcome measures (PROMs) such as the Veterans Rand 12 Item Health Survey (both physical and mental components), Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement, and the Harris Hip Score were also recorded and analyzed.

A total of six patients (1.4%) required reoperation or readmission following their THA. There was one Vancouver B2 periprosthetic fracture sustained after a fall at physical therapy (0.2%) and one acute periprosthetic infection (0.2%) that required reoperation. There were four patients who had medical issues requiring readmission (0.9%). There were no cases of dislocation or early loosening. Patients experienced significant improvements in their patient-reported outcome measures at both the 6-week mark and at the final postoperative follow-up visit (P < 0.0001).

The recently introduced femoral stem appears to be a safe and effective implant option in the short-term postoperative period, resulting in low complication rates and high levels of patient satisfaction. Future longer-term follow-up studies are necessary to fully characterize its risk profile and effectiveness.

In recent years, orthopaedic surgeons have attempted to decrease opioid consumption through multimodal pain management. However, a limited effort has been made to eliminate opioids entirely in the perioperative period. The purpose of this study was to compare the efficacy and safety of a novel opioid-free pain management pathway with that of an opioid-containing pathway across 5 common orthopaedic subspecialty surgical procedures.

In a 1:1, unblinded fashion, 315 patients were randomized to a perioperative pain management pathway that was either opioid-free (n = 157) or opioid-containing (n = 158). Pain was measured with a numeric rating scale (NRS) for pain of 0 to 10 at 6 hours, 12 hours, 24 hours (the primary outcome assessing noninferiority), 2 weeks, 6 weeks, and 1 year after the surgical procedure. Data on patient characteristics, deviations from the pain management pathway, morphine milligram equivalents (MME), readmissions, adverse events, and patient-reported outcomes were collected.

There were 315 patients in the final group, with a mean age of 63.6 years. Of the patients in the study, 59.7% were female, 85.7% were White, 12.4% were Black/African-American, 1.0% were Hispanic/Latino, 0.6% were American Indian, and 0.3% were unknown. At 24 hours, the median NRS for pain in the opioid-free group (2 [interquartile range (IQR), 0 to 4]) was statistically noninferior (p < 0.0001) to the opioid-containing group (4 [IQR, 2 to 6]). Pain levels were significantly lower in the opioid-free group than in the opioid-containing group at 12 hours (p = 0.0173) and 2 weeks (p = 0.0003). Pain scores at 6 hours, 6 weeks, and 1 year were similar. Patients in the opioid-free group reported significantly greater comfort at 24 hours (p = 0.0392) and higher satisfaction with pain control (p = 0.0355) at 6 weeks. There were no reported adverse events or unplanned readmissions. Demographic characteristics were similar between the 2 groups.

Across 5 common orthopaedic subspecialty procedures, an opioid-free pain management pathway was safe and effective and provided noninferior pain control at 24 hours compared with the opioid-containing pathway.

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Perthes' disease is a hip disorder that presents in childhood but can lead to diminished quality of life (QoL) in adulthood from hip deformities and secondary arthritis. Little is known about adult outcomes following total hip arthroplasty (THA) from the patient's perspective. We employed a web-based survey to gather data on treatment history, demographic details, and patient-reported outcome measures (PROMs) from adults with Perthes' disease who underwent THA. We then compared these PROMs to those of age- and sex-matched normative cohorts, and a Perthes' disease cohort not treated with THA.

We used an English REDCap-based survey on a Perthes' disease study group website, which included Perthes' disease history, University of California, Los Angeles Activity Scale scores, the 36-Item Short-Form Health Survey (SF-36), and the Hip disability and Osteoarthritis Outcome Score (HOOS). A total of 261 THA participants were analyzed (mean age at survey 44.6 years (SD 12.4); mean time since THA 7.2 yrs (SD 8.0)).

Compared to normative cohorts, THA participants had significantly lower HOOS QoL and Sports & Recreation scores across all age groups (p < 0.001). Female THA participants aged under 45 years reported worse HOOS Pain, Symptom, and Activities of Daily Living scores, as well as SF-36 Physical and Social scales (all p < 0.001) compared to normative cohorts. Hip dysplasia and number of years from THA were significantly associated with poorer outcome. In comparison to a Perthes' disease cohort without THA, female THA participants aged 35 to 54 years reported significantly better outcomes across all scores except for sports. Females aged 18 to 34 years had significantly better symptom and pain scores in the THA cohort.

The Perthes' disease cohort who had THA had better pain and symptom scores than the Perthes' disease non-THA cohort, but reported substantially lower QoL scores compared to a normative population. These results highlight the symptom improvements that THA can offer, while suggesting the need for research to improve treatments which will reduce persisting impairments of QoL.

Orthopaedic consultations' influence on perceived barriers to total joint arthroplasty (TJA) remains unclear. This study explores how orthopedic consultations are associated with patient perceptions of barriers to TJA.

We performed a post-hoc analysis of questionnaire responses based on data from a previous study that used semi-structured interviews with patients with advanced osteoarthritis. This earlier study identified 5 key barriers to TJA-trust in surgeon, cost/insurance, recovery, surgical outcome, and timing of surgery-and highlighted significant racial differences in these barriers. Our analysis focused specifically on the role of orthopaedic consultations. Using multiple logistic regression models, we compared responses from patients who had an orthopaedic consultation to those who did not, while adjusting for race, age, Hip Disability and Osteoarthritis Outcome Score, Joint Replacement/Knee Injury and Osteoarthritis Outcome Score, Joint Replacement, insurance status, education level, and prior discussions about TJA.

Of the 696 participants, 88% were female, 77% White, 11% Black, and 9% Hispanic. Nearly half (49%) had an orthopaedic consultation. Participants who had consulted with an orthopaedist were older, more likely to be college graduates, Medicare beneficiaries, have consulted a primary care physician, attempted conservative management including joint injections, braces, and physical therapy. After adjusting for participant factors, orthopaedic consultation was a predictor of fewer perceived cost/insurance and timing barriers. However, no differences were observed in other barriers.

Orthopaedic consultation is associated with fewer reported cost/insurance and timing barriers to TJA. Addressing barriers of concern to patients in the context of orthopaedic consultations could further improve TJA utilization.

Total hip arthroplasty (THA) effectively restores mobility, reduces pain, and enhances the quality of life of patients of all ages. Despite its benefits, concerns regarding the long-term effects of high-impact activities and sports on implant longevity require further study. This study investigated the effect of activity level on long-term radiographic wear of highly cross-linked polyethylene (HXLPE) in young patients undergoing THA.

Between 1999 and 2008, 785 patients (909 hips) aged ≤50 underwent primary THA using first-generation HXLPE liners from 4 different vendors with either metal or ceramic heads. Functional activity and participation questionnaires, including the Hip Injury and Osteoarthritis Outcome Score (HOOS Jr), University of California Los Angeles (UCLA) activity scale, and High-Activity Arthroplasty Score (HAAS), were surveyed in 2018 to 2019. The response rate was 44%. Radiographic linear wear rates were measured using the ROMAN software in patients who had completed questionnaires and had radiographs taken at least 10 years apart, leaving a final cohort of 249 patients (284 hips). Multivariate analyses were performed to determine the relationship between HXLPE wear rates and activity scores.

At the time of the survey, approximately 10% of the patients performed high-impact activities not-recommended by consensus guidelines. The HXLPE linear wear rate was 0.036 mm/year (SD: 0.026). Patients with higher activity levels, as measured on the continuous UCLA/HAAS activity scale, did not exhibit increased wear (β = -0.0009; p = 0.31). Stair climbing was correlated with increased wear rates (β = 0.0066; p = 0.004), whereas walking (β = 0.0005; p = 0.66) and running (β = 0.0017; p = 0.30) were not significantly correlated. Patients performing nonrecommended activities did not show increased wear rates compared with those performing recommended activities (β = 0.0063; p = 0.19).

Linear wear rates of first-generation HXLPE were not related to functional activity or participation in high-impact activities. Future research should include longitudinal assessments of activity levels and data on other potential complications related to high-impact sports to provide robust evidence regarding recommended activity level postoperatively.

Level III, Retrospective Comparative Study. See Instructions for Authors for a complete description of levels of evidence.

This study compared outcomes between patients undergoing outpatient total joint arthroplasty (TJA) at an ambulatory surgery center (ASC) versus a cohort of medically and socially complex patients undergoing TJA at a tertiary healthcare system.

An institutional database at a single academic center was retrospectively reviewed for patients who underwent primary TJA since the opening of an ASC from August 2021 to January 2024. A total of 716 (outpatient: 374; inpatient: 342) total knee arthroplasties and 458 (outpatient: 196; inpatient: 262) total hip arthroplasties met inclusion criteria.

Patients in the inpatient total knee arthroplasty group had a higher proportion of patients requiring an emergency department visit (11.4% vs 4.5%; P = .008) and admission (6.7% vs 2.7%; P = .025) within the first 90 days after surgery than the outpatient group; however, 2-year revision-free (97.9% vs 97.9%; P = .75) survival was similar between groups. Patients in the inpatient total hip arthroplasty group had a higher proportion of patients requiring an emergency department visit (13.0% vs 4.6%; P = .035) and admission (7.3% vs 1.0%; P = .018) within the first 90 days after surgery compared to the outpatient group; however, there was no difference in 2-year revision-free survival (96.4% vs 99.5%; P = .059).

Medically and socially complex patients undergoing TJA required additional resources during the 90-day postoperative window; however, they achieved similar survivorship as patients who met criteria for outpatient surgery.

Total hip arthroplasties (THAs) are increasingly being performed at high-volume centers, causing some patients to travel further distances to receive care. Concerns remain that increased travel distance limits follow-up, which may impact outcomes and early return to the hospital. The purpose of this study is to evaluate the impact of travel distance on 90-day patient-reported outcomes (PROs) and 90-day complication rates.

Patients undergoing inpatient primary THA at a single center by one of three surgeons between 2017 and 2021 were retrospectively reviewed. Patients whose local and distant medical records were available were included. Patients who lived ≥ 40 miles from the location or follow-up were labeled as "travelers," and those < 40 miles were "locals." Primary outcomes included PROs as measured by Veterans Rand 12 Item Health Survey, Harris Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement. Secondary outcomes included rates of 90-day medical complications, emergency department visits, unplanned readmissions, and reoperations.

A total of 413 patients were analyzed at a mean of 897.1 days (range, 92 to 2,196) including 96 travelers. Travelers averaged 96.1 miles for follow-up (range, 40.1 to 678 miles), and locals averaged 14.1 miles for follow-up (range, 0.3 to 39.8 miles). There were no differences in the percentage of patients achieving minimal clinically important difference in PROs. There was no difference in the rate of 90-day medical complications, 90-day readmissions, and reoperations. Local patients were significantly more likely to have unplanned postoperative emergency department visits (travelers = 0%, locals = 7.4%, P = 0.003).

Travelers did not demonstrate any significant differences with respect to rates of achieving minimal clinically important difference in PROs or 90-day complication rates. These data suggest that increased travel distance to treatment centers does not impact outcomes following primary THA.

Patients who undergo total hip arthroplasty (THA) oftentimes have severe osteoarthritis in both hips and may consider staged or simultaneous bilateral THA (bTHA). The goal of this study was to compare the total workdays missed following staged and simultaneous bTHA performed via either postero-lateral (PA) or direct anterior approach (DAA).

Patients who were (1) employed, (2) underwent a staged (within 12 months) or simultaneous bTHA at our institution between February 1, 2016, and December 31, 2021, (3) completed a return-to-work questionnaire, and (4) had the same surgical approach for both THAs were included. The primary outcome of interest was the total days of work missed.

We identified 78 employed patients who had undergone staged bTHA (62 PA, 16 DAA) and 76 patients (44 PA, 32 DAA) who underwent simultaneous bTHA, and had completed the return-to-work questionnaire. Simultaneous bTHA patients missed an average of 25.6 days of work (SD: 14.3 days) compared to staged bTHA patients, who missed an average of 36.9 days of work (SD: 23.4) when combining days missed from both operations (P < 0.001). In multivariate mixed regression analysis adjusted for sex, age, body mass index, American Society of Anesthesiologists status, type of work, and surgical approach, the staged bTHA group missed a mean of 8.2 more days of work (SD: 3.3) compared to the simultaneous bTHA group (95% confidence interval: 1.8 to 14.7, P = 0.013).

Employed patients who underwent simultaneous bTHA missed an average of 8.2 fewer days of work compared to those who were treated with staged bTHA. These findings may help surgeons counsel their employed patients who have bilateral hip osteoarthritis and are considering surgical treatment.

IV, retrospective cohort study.

The direct anterior approach (DAA) to total hip arthroplasty (THA) has increased in popularity, given the potential for improved post-operative recovery. Patient selection is cited as a factor in complication rates compared to the posterior approach (PA). We compared complications by approach, controlling for relevant baseline characteristics.

This is a secondary data analysis from a prospective cohort patient study prescribed a smartphone-based care management platform following THA. Baseline patient characteristics were collected pre-operatively and included in logistic regression models investigating the impact of surgical approach with THA-related adverse events including intraoperative periprosthetic fracture, delayed wound healing, and revision surgery.

In total, 1722 patients were included in analysis; 664 (37.4%) underwent THA via DAA. Pre-operative characteristics including age, HOOS JR, and sex were similar between approach groups, patients undergoing anterior THA had lower comorbidities (p = 0.04) and BMI (p = 0.015). Considering baseline characteristics, anterior approach was associated with reduced odds of revision (OR 0.37, 95%CI 0.12-0.90, p = 0.045). Delayed wound healing occurred more frequently in the anterior approach (OR 3.03, 95%CI 1.39-6.97, p = 0.006), and was associated with BMI (OR 1.10, 95% CI 1.04-1.17, p = 0.002).

This data demonstrated the DAA was associated with lower odds of revision and an increased risk of delayed wound healing. These must be considered when determining the surgical approach, particularly given the effects of BMI on wound healing.

The impact of socioeconomic status on achievement of clinically relevant patient-reported outcome measure (PROM) improvements and satisfaction after total hip arthroplasty (THA) is unknown. Area Deprivation Index (ADI) is a metric that can be used as a proxy for a patient's neighborhood socioeconomic status. This study aimed to assess the association between ADI and failure to achieve: (1) clinically relevant improvements in PROMs; and (2) self-reported satisfaction at 1 year following THA.

A prospective cohort of 7,506 patients who underwent primary unilateral THA from January 2016 to July 2021 was included. The ADI was stratified into quintiles based on their distribution in our sample. Multivariable logistic regression models were created to investigate the effect of ADI on 1-year PROMs. The included PROMs were the Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain, Physical Function Shortform (PS), and Joint Replacement (JR). Clinically relevant improvements were assessed through minimal clinically important difference and patient acceptable symptom state threshold achievement.

There was no significant association between ADI and failure to achieve minimal clinically important difference for HOOS pain (P = 0.42), PS (P = 0.91), or JR (P = 0.20). However, higher ADI scores were independently associated with increased odds of failing to achieve patient acceptable symptom state for HOOS Pain (P = 0.002), PS (P = 0.003), and JR (P = 0.017). The ADI was not associated with failure to achieve patient satisfaction at 1 year (P = 0.93).

Greater neighborhood socioeconomic disadvantage was associated with decreased odds of achieving clinically relevant improvement in patient-perceived symptomatic state, but not associated with patients' perception of their overall pain and function 1 year after THA. Targeted interventions to address access and care pathways for low socioeconomic status patients may present an opportunity to improve patient-perceived outcomes following THA.

Level III.

To our knowledge, outcomes of patients undergoing staged, bilateral total hip arthroplasty (THA) via dissimilar surgical approaches have not yet been investigated. This study examined demographics, implant selection, technology utilization, and component positioning between hips in patients who underwent one THA via posterior and one via direct anterior approach and secondarily evaluated patient-reported outcomes.

There were 36 patients (72 hips) who underwent staged, bilateral, primary, elective THAs via different approaches from January 2012 to December 2023. Patient demographics, intraoperative technology utilization, implants used, and preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement scores were recorded. The hip center of rotation, acetabular height and anteversion, and metaphyseal canal fill were measured on postoperative radiographs. Femoral stem coronal and sagittal plane angulation following both approaches were also compared on postoperative radiographs.

There were 15 (41.7%) patients who underwent posterior THA first. The mean time between operations was 5 years (range, 0.93 to 10.2). Intraoperative technology utilization was more common for the anterior THA (P = 0.002). There were no significant differences in hip center of rotation (P = 0.292), acetabular anteversion (P = 0.428), or acetabular height (P = 0.935) between patients' anterior and posterior approach THAs. The proportion of patients who had posterior stem angulation was significantly greater following anterior THA; neutral stem angulation was seen more frequently following posterior THA (P = 0.005). Lipped liners (P < 0.001), high offset femoral stems (P = 0.007), and dual or triple-taper stems (P < 0.001) were more commonly utilized in posterior THAs. For patients who had preoperative and postoperative Hip Dysfunction and Osteoarthritis Outcome Scores for Joint Replacement for each hip, there was no significant difference in postoperative score improvement between anterior and posterior THAs (P = 0.697), with a mean follow-up time of 2.4 years (range, 0.3 to 9.28) for posterior and 6.1 years (range, 2.8 to 10.3) for anterior THAs (P = 0.249).

Patients undergoing staged, bilateral THAs via different surgical approaches exhibit radiographic characteristics likely attributable to technical challenges for each approach. However, these differences related to approach do not seem to impact short-term clinical and patient-reported outcomes.

Background/Objectives: Reported patient results after total hip arthroplasty (THA) have been described as a function of surgical approach. Such results have commonly been subjective. Though self-reported outcomes are of value and often utilized, inclusion of functional performance measures represents an objective measure to compare THA techniques. Methods: Patients that underwent primary THA surgery at our institution were grouped by surgical approach (Direct Anterior vs Posterior). Patient data were collected pre-operatively, as well as post-operatively at three and twelve months. Hip Dysfunction and Osteoarthritis Outcome Score (HOOS JR) was utilized, and function was assessed with the timed up and go test (TUGT), 4-m walk test (4MWT), and 30 s sit-to-stand (30STS) test. Unpaired T tests were used to compare mean results and differences between the groups. Results: Functional outcome scores were improved to a similar degree for both surgical approach groups at all the time points post-operatively. At 3 months, the TUGT was improved by 2.33 s for the posterior group, the 30STS was increased by 2.71 repetitions, and the 4MWT was increased by 1.23 s; the anterior group had 2.66 s, 2.49 repetition, and 1.18 s improvements in the three functional tests, respectively. At 12 months, the posterior group had improvements of 2.86 s, 3.99 repetition, and 1.19 s, while the anterior group had improvements of 3.15 s, 3.83 repetition, and 1.23 s, respectively. No clinical and statistical significant differences in surgical approach were noted in these measures. In contrast, the anterior group showed a statistically significant but not clinically significant improvement in self-reported HOOS JR scores compared to the posterior group at the 3-month post-operative mark (p = 0.045). Conclusions: This study suggests both anterior and posterior surgical approaches to total hip arthroplasty yield equivalent functional results at 3 months and one year post-operatively, while the anterior approach demonstrates more improved patient satisfaction than the posterior approach at the 3-month post-operative assessment.

Minimal clinically important difference (MCID) thresholds guide clinicians and researchers in determining whether changes in patient-reported outcome measures are truly meaningful from the patient's perspective. This article focuses on MCID calculation methods for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, two widely used patient-reported outcome measures in total hip and total knee arthroplasty. While distribution-based methods (e.g., the half-standard deviation threshold) are common for their simplicity and lack of extra data requirements, they are limited by reliance on statistical properties rather than patient perception. In contrast, anchor-based methods, endorsed by the Consensus-based Standards for the Selection of Health Measurement Instruments, use external "anchors" such as satisfaction or quality-of-life measures to capture the patient's view of improvement. Predictive modeling, a sophisticated anchor-based technique, is particularly robust, producing smaller confidence intervals and adjusting for various patient characteristics. However, all anchor-based approaches depend heavily on the choice and quality of the anchor, highlighting a need for standardization and validation of these external measures. Moreover, MCID thresholds are population-specific and can vary according to baseline function, comorbidities, demographics, and surgical context. Ceiling effects in both Hip Disability and Osteoarthritis Outcome Score for Joint Replacement and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement further complicate MCID assessment. To address these challenges, the article recommends prioritizing anchor-based methods, standardizing anchors, and interpreting MCID values within each study's clinical context. Comprehensive reporting of baseline characteristics and instrument sensitivity (including ceiling effects) is also essential for reliable comparisons and evidence-based practice.

This study sought to evaluate patient-reported outcome measures (PROMs) before primary total joint arthroplasty (TJA) and after successful treatment for periprosthetic joint infection (PJI), with the hypothesis that patients still demonstrate clinical improvement despite the occurrence of PJI.

A single tertiary academic center's institutional database was retrospectively reviewed for patients who underwent primary TJA, developed PJI, and were managed for PJI from January 2019 to December 2023. Patients who did not have PROMs recorded were excluded from the study. Preoperative and postoperative generic and joint-specific PROMs were collected. Patient preprimary and postfinal revision surgery for PJI PROMs were subsequently compared. The minimum follow-up after PJI treatment was 6 months. A total of 55 patients (31 total knee arthroplasty and 24 total hip arthroplasty) were included with a mean follow-up of 1.8 years (range, 6 months to 4.5 years). All PJIs were managed via debridement, antibiotics, and implant retention, 1-stage, 1.5-stage, 2-stage revision, or resection arthroplasty.

After final revision surgery for PJI in total knee arthroplasty, patients had lower median patient-reported outcome measure information system (PROMIS) pain interference scores than before their primary surgery (62.0 [55.0, 67.0] versus 67.0 [65.0, 70.5]; P < 0.01). However, median PROMIS physical function postfinal revision for PJI and preprimary scores were similar (38.0 [33.0, 42.0] versus 34.0 [29.5, 40.0]; P = 0.08). After final revision surgery for PJI in total hip arthroplasty, patients had lower median PROMIS pain interference scores than before their primary surgery (57.5 [53.8, 64.0] versus 68.0 [66.5, 74.0]; P < 0.01). After final revision surgery for PJI, patients also had higher median PROMIS physical function scores than before their primary surgery (39.5 [33.5, 48.2] versus 29.5 [28.8, 34.2]; P < 0.01).

Patients who have been successfully managed for PJI show improvement in generic and joint-specific PROMs compared to their preprimary TJA PROMs.

The purpose of this study was to compare outcomes between patients undergoing same-day discharge (SDD) total knee arthroplasty (TKA) at an ambulatory surgery center (ASC) versus a tertiary care university hospital setting.

A single tertiary academic center's institutional database was reviewed for patients who underwent primary TKA and were discharged the same day from August 2021 to January 2024. Patients who did not have at least 1 year of follow-up were excluded. Patient demographics, comorbidities, patient-reported outcome measures, emergency department visits, admissions, reoperations, and revisions were collected. Patients were stratified by the location of their surgery: ASC versus hospital. Specific criteria had to be met prior to surgery at the ASC, and the final decision regarding the location of surgery was made via shared decision-making between the patient and their surgeon. Patients who did not meet ASC criteria underwent TKA at the main hospital. Univariable analyses were used to compare groups, and multivariable logistic regression was used to determine if surgical location was a significant factor. Of the 449 TKAs meeting inclusion criteria, 63.3% (284) were performed at the ASC and 36.7% (165) at the university hospital at a mean follow-up of 1.51 years (range, 1.00 to 2.40). Of those 165 whose surgery was done at the hospital, 93.9% met at least one ASC exclusion criteria.

Patients whose TKA was done at the hospital had significantly higher weight (P = 0.003), body mass index (P < 0.001), Elixhauser comorbidity index (P < 0.001), proportion of patients who had an American Society of Anesthesiologists classification of 3 (P = 0.023), and proportion of patients who required general anesthesia (P < 0.001). Additionally, patients whose TKA was done at the hospital had higher preoperative patient-reported outcome measurement information system (PROMIS) pain interference (PI) (62.0 [59.0, 66.0] versus 63.0 [61.8, 67.0]; P = 0.006), and lower physical function (PF) (39.0 [36.0, 43.0] versus 38.0 [34.0, 41.0]; P = 0.001). At 1 year, however, patients in both groups had similar PROMIS PI (53.0 [49.0, 59.0] versus 54.0 [44.0, 59.0]; P = 0.785) and PROMIS PF (47.0 [42.0, 51.0] versus 47.0 [41.0, 50.0]; P = 0.422) scores as well as similar rates of achieving minimum clinically important difference for PROMIS PI (64.4 versus 71.4%; P = 0.336) and PROMIS PF (60.5 versus 71.4%; P = 0.124). They also had a similar number of emergency department visits and admissions at 30 and 90 days, as well as similar reoperation-free (92.0 versus 93.3%; P = 0.79) and revision-free (95.5 versus 99.4%; P = 0.59) survival at 2 years CONCLUSIONS: Although ASCs have strict patient criteria for SDD TKA, complex patients at a tertiary university hospital can be sent home the same day with equivalent outcomes. Therefore, unhealthier patients can safely achieve SDD without compromising outcomes if done in the appropriate setting.

Our aim was to determine the most significant barriers to total joint arthroplasty (TJA) for people living in high-poverty communities relative to low-poverty communities.

We created a 21-question survey based on interviews with underrepresented minority patients with osteoarthritis targeting five barriers to TJA: trust in surgeon, recovery concerns, cost and/or insurance issues, fear of poor surgical outcomes, and timing considerations. Participants rated the importance of each barrier on a 5-point Likert scale, dichotomized into "very or extremely important" and "not as important." The survey was distributed at New York City clinics and nationally through an arthritis advocacy group. We used geocoding to link addresses to census tracts, defining high-poverty communities as those with ≥20% of residents living below the poverty level. Logistic regression models assessed the association between community poverty status and rating barriers as very or extremely important, with adjustment for demographic and clinical factors.

Of the 702 survey participants, 16.8% were residents of high-poverty communities. After adjustment, participants from high-poverty communities were more likely to rate trust in surgeon (adjusted odds ratio [aOR] 1.87, 95% confidence interval [CI] 1.24-2.82) and fear of poor surgical outcome (aOR 1.68, 95% CI 1.08-2.61) as very or extremely important.

People from high-poverty communities identified lack of trust in surgeons and fear of poor surgical outcomes as more significant barriers to TJA compared to people from low-poverty communities.

Value is defined as the ratio of patient outcomes to the cost of care. One method to assess value is through patient-level value analysis (PLVA). To our knowledge, this tool has not previously been implemented in the setting of total hip arthroplasty (THA). The purposes of this study were to perform PLVA for a 1-year episode of care among patients undergoing primary THA and to identify characteristics that affect value in a metropolitan health-care system.

The patient-reported outcome (PRO) measure database of the institution was queried for all primary THAs from 2018 to 2019. The PRO measure that was utilized was the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Cost was evaluated with use of time-driven activity-based costing (TDABC) for a 1-year episode of care (consisting of the day of surgery, inpatient stay, discharge facility, postoperative appointments, and physical therapy). The primary outcome was the 1-year value quotient, or the ratio of the 1-year change in HOOS-JR to the cost of the episode of care (VHOOS). The value quotient was compared among all included patients and evaluated for variables that may affect the overall value of the episode of care.

In total, 480 patients were included in the analysis. The mean improvement in the HOOS-JR was +34.9 ± 16.1 (95% confidence interval [CI]: 33.5, 36.3). The mean cost was $13,835 ± $3,471 (95% CI: $13,524, $14,146). The largest contributor to cost was implants (39.0%), followed by post-recovery care (i.e., inpatient stay and specialized nursing facilities; 24.1%). Change in the HOOS-JR was poorly correlated with the cost of care (r = -0.06; p = 0.19). THAs performed at an ambulatory surgery center (ASC) with discharge to home demonstrated higher value (VHOOS = 0.42) than THAs performed at a hospital with discharge to a rehabilitation facility (VHOOS = 0.15; analysis of variance F-test, p < 0.01).

Our study found that PROs did not correlate with costs in the setting of primary THA. Implants were the largest cost driver. Surgical setting (an ASC versus a hospital) and discharge destination influenced value as well. PLVA is a value measurement tool that can be utilized to optimize components of the care delivery pathway.

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Total hip (THA) and knee arthroplasty (TKA) rates in the outpatient setting continue to increase in the United States. Patient resiliency is one facet surgeons may consider when determining whether a patient would make a suitable candidate for same-day discharge (SDD). This study examined the relationship between resilience and success of SDD in patients undergoing primary THA and TKA.

A retrospective review was conducted to examine the effects of preoperative resiliency scores (Pain Self-Efficacy Questionnaire Abbreviated Two-Item Form [PSEQ-2]) on SDD rates and patient-reported outcome measures (PROMs) at 3 months and 1 year postoperatively. Data analyses utilized logistic regressions to evaluate the odds of SDD success with preoperative PSEQ-2 resiliency scores. Mixed linear models were utilized to evaluate the relationship between preoperative PSEQ-2 resiliency scores and postoperative PROMs.

Of the cohort of 700 (TKA) patients, after controlling for confounding factors such as age and body mass index patients who were discharged home on the day of surgery had significantly higher preoperative PSEQ-2 scores (P = 0.022). Of the cohort of 530 THA patients, again after controlling for confounding factors such as age and body mass index, patients who were discharged home on the day of surgery trended toward significantly higher preoperative PSEQ-2 scores, although statistical significance was not reached (P = 0.058). There was a significant inverse relationship seen between preoperative PSEQ-2 scores and Global Mental Health scores at 3 months and 1 year postoperatively (P = 0.023). No other statistically significant relationships were seen between preoperative PSEQ-2 and the other PROMs.

Preoperative resiliency scores were significantly higher in patients undergoing primary THA and TKA that were discharged home on the day of surgery. Preoperative resiliency scores did not predict higher postoperative PROMs.

Nowadays, total hip arthroplasty (THA) is one of the most successful procedures in the field of orthopedics and trauma. The posterior approach has historically been associated with a higher rate of hip dislocation. To reduce the rate of hip dislocation in the posterior approach, most orthopedic surgeons would recommend hip precautions (HP) for their patients postoperatively based on previous theories. However, recent randomized controlled trials have shown no significant difference in hip dislocation rates with or without HP, in contrast to previous theories. Based on these, this study conducted a meta-analysis of these randomized controlled trials to try to get qualitative conclusions.

Randomized controlled trials of HP after THA up to July 28, 2023, were searched in 3 databases, PubMed, Embase, and the Cochrane Library. Data extraction and literature quality assessment were performed by 2 independent authors and extracted hip dislocation, hip disability and Osteoarthritis Outcome Score, joint replacement (HOOS JR) scores over 6 weeks, and time to discontinuation of mobility aids. Stata software and Revman software were used to perform this meta-analysis.

Following screening, 3 papers with a total of 1215 participants were included in the analysis. This meta-analysis showed that there was no statistically significant difference in hip dislocation rates with or without HP after THA undergoing the posterior approach and that the without HP group instead showed better outcomes in terms of HOOS JR scores and time to discontinuation of mobility aids.

THA with a posterior approach does not require hip precautions.

Paper-based patient-reported outcome measures (PROMs) and patient education can assist in improving outcomes but is administratively burdensome. Mobile phone applications ('apps') can distribute extensive information and PROMs at relevant time points. This study aimed to assess the suitability of an app to guide postoperative management and record PROMs based on satisfaction and compliance.

Thirty-four patients who were scheduled for a total hip/knee arthroplasty were enrolled into the study. Automatic notifications were sent by the app to complete PROMs at the appropriate time points. Patients were reminded via phone call if PROMs were not completed. An app satisfaction questionnaire was also completed, where a high score represented satisfaction with the app.

Patients remained satisfied with the app throughout the study with a mean score of 19.0 out of 25. 57% found the app to be helpful with completing surveys, with 63% preferring the app over paper handouts. Majority of the participants (68%) stated that they would use the app again. There was an overall mean compliance of 78% at all time points. Most patients (82%) required at least one phone call reminder, with 18% of patients completing their PROMs prompted by the app notification alone.

A mobile phone app can be useful for both distributing patient education and collecting PROMs. PROMs collected using a mobile phone app still caused some administrative burden with many participants requiring multiple reminders to complete their questionnaires. While paper-forms will still be required for some patients, most found the app preferable to paper-form.

Adverse mental health status has been linked to less successful surgical outcomes across several orthopaedic subspecialties. Mental health represents a modifiable risk factor that can be optimized preoperatively to maximize outcomes for hip preservation surgery. This study examines the relationship between preoperative mental health status and preoperative and postoperative outcomes for adolescent and adult patients undergoing hip preservation surgery. A prospectively enrolled registry of patients undergoing periacetabular osteotomy or hip arthroscopy at a single institution between 2013 and 2021 was retrospectively reviewed to collect demographics and outcomes before and after surgery. We identified patients self-reporting anxiety/depression or no anxiety/depression preoperatively based on responses to the EuroQol-5D anxiety/depression dimension and compared their preoperative and postoperative Hip disability and Osteoarthritis Outcome Scores (HOOSs) using multivariable linear models and multivariable mixed effects models. Seventy-three patients were included, 40 patients with no anxiety/depression and 33 patients with anxiety/depression. Patients with anxiety/depression had worse preoperative HOOS pain (b = -12.5, P = .029), function in daily living (b = -12.0, P = .045), function in sports and recreational activities (b = -15.1, P = .030), and quality of life (b = -16.3, P = .005) as compared to patients with no anxiety/depression. Patients with anxiety/depression had worse postoperative HOOS compared to patients with no anxiety/depression, but these associations were not statistically significant after adjusting for preoperative HOOS. There were no significant differences between both groups for percent achieving minimal clinically important difference. Patients who reported anxiety/depression preoperatively had worse preoperative pain and function before hip preservation surgery, with both groups achieving similar levels of clinical effectiveness.

Osteoarthritis management programs (OAMPs) have become a more common way to deliver patient-centered care. However, there is limited information on real-world use of these programs to guide implementation, payment policy, accessibility, and scaling in the United States. This paper describes 5-year use metrics for the Duke Joint Health Program, an OAMP embedded within a US academic health system.

This analysis includes patients referred into the Program between October 2017 and April 2022. We generated descriptive statistics of referral and enrollment totals, demographics and patient-reported measures of enrollees, retention and healthcare use metrics (e.g., office visit frequency), and data capture rates for patient-reported outcomes.

During the study period, 6863 patients were referred to the program and 4162 (61 ​%) enrolled. We observed statistically significant differences between those who did and did not enroll by age (mean difference ​± ​SE: 2.49 ​± ​2.8 years), sex (70.0 ​% vs 67.7 ​% female), race (65.1 ​% vs 55.3 ​% Caucasian/White), employment status (50.0 ​% vs 40.2 ​% retired), and insurance type (53.5 ​% vs 47.0 ​% Medicare). The median (Q1, Q3) number of visits was 2 (1, 4) and ranged from 1 to 67. The median (Q1, Q3) number of days from first to last program visit was 23 (0, 84) days. Questionnaire completion rates were 72 ​% at baseline, 46 ​% at 6 weeks, 39 ​% at 3 months, and 40 ​% at 6 and 12 months.

Findings can guide the planning, development, and implementation of future OAMPs and inform policies to ensure programs are accessible and equitable.

Several self-administered questionnaires are available for assessing hip function in clinical practice (HOOS-12, Oxford-12). These questionnaires can be used to assess and monitor patients with hip pathology. However, they are sometimes difficult to deploy in clinical practice. Recent studies on the shoulder and knee have shown that a single-question assessment provides a relevant evaluation of joint function, and correlates with more complex scores. However, this has not yet been evaluated for the hip. We set out to develop a single-question test that would enable patients to assess their hip function between 0 and 100. Therefore, we did a prospective study aiming to assess: (1) the relevance of the SHV (Simple Hip Value) test by comparing it with the Oxford-12 and HOOS-12 scores, (2) the discriminatory capacity and reproducibility of this test.

The hypothesis of this study was that the assessment of hip function by a single-question patient-completed questionnaire (PROM) would be reliable and useful in clinical practice.

We conducted a prospective study including 74 patients operated on for total hip arthroplasty from February 2020 to April 2021 in a high-volume center and 20 healthy subjects. The SHV questionnaire, as well as HOOS-12 and OXFORD-12 were submitted on average 18 months after surgery, with values scaled to 100 points. A second test containing the 3 questionnaires was resubmitted to 20 patients randomly chosen from hip arthroplasty group to evaluate the reproducibility of the test. To evaluate the discrimination capacity of our test, 20 controls were selected to respond to the three questionnaires.

Test results were median SHV, Oxford-12 and HOOS-12 scores of 90/100 (Interquartile Range [IQR]: 80-95), 88.5 (IQR: 77.1-95.8) and 79.1 (IQR: 65.1-93.2), respectively. The SHV was strongly correlated with the Oxford-12 (Spearman coefficient: 0.63 [IQR: 0.45-0.76]) and the HOOS-12 (Spearman coefficient: 0.66 [IQR: 0.46-0.79]). The SHV differed significantly from the control group (90.0 vs 100.0 in the control group [p < 0.001]) and had excellent reproducibility (Interclass Correlation Coefficient [ICC]: ICC: 0.82 [CI95%, 0.59-0.93]).

The SHV test seems to be a reliable, reproducible and discriminating tool for assessing hip function after total hip arthroplasty, thus offering a simplified and practical approach for practitioners. Further testing in different populations would be useful to validate this test.

III; prospective comparative diagnostic study.

Plain radiographs remain the standard for diagnosing osteoarthritis (OA). Total hip arthroplasty (THA) is generally offered only for advanced OA by plain radiographs. Advanced imaging is used as an adjunct to assess OA severity in cases of progressive symptoms with less advanced OA by plain radiographs. The objective of this study was to compare outcomes following THA in patients who have advanced OA visualized by plain radiographs to patients who have less severe OA visualized by plain radiographs.

From February 2016 to February 2020, 93 patients who had Kellgren-Lawrence (KL) grade 0 to 2 OA and underwent THA were identified. The median age was 65 years, and 55% were women. They were matched 1:3 to patients who underwent THA for KL 4 OA based on age, sex, body mass index, and Charlson Comorbidity Index. The primary outcome was achievement of the Hip Injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) minimum clinically important difference, substantial clinical benefit, and patient-acceptable symptom state at 1 year postoperatively.

There was no difference between the KL 0 to 2 and KL 4 cohorts in the achievement of HOOS JR minimum clinically important difference (86 versus 85.6%, P = .922), substantial clinical benefit (81.7 versus 80.2%, P = .751), or patient-acceptable symptom state (89.2 versus 85.6%, P = .374). The KL 0 to 2 cohort had a similar improvement in their 2-year HOOS JR (42.5 versus 38.6, P = .019).

In this series, there was no difference in outcomes following primary THA between patients who have severe OA on plain radiographs (KL 4) compared to those who have less severe OA (KL 0 to 2). In the setting of severe symptoms and the absence of advanced OA on radiographs, advanced imaging can be used to guide treatment and select patients who could benefit from THA.

Iliopsoas tendinitis after total hip arthroplasty (THA) has become more prevalent with the increased use of large-diameter femoral heads impinging on native surrounding tissues. Anatomically contoured heads (ACH) are soft-tissue-friendly femoral heads created to minimise this issue. This retrospective study assesses iliopsoas tendinitis prevalence and re-operations in primary THAs with ACH, while determining the minimal clinically important difference (MCID) achievement and improvement with 5 patient-reported outcome measures (PROMs).

We conducted a retrospective analysis of 53 ACHs from January 2020 to July 2023. Patients who completed Hip Injury and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF SF-10a), PROMIS Global Health (GH)-Mental, or PROMIS GH-Physical, and pain score questionnaires were identified. PROM scores were collected preoperatively and at 3-month and 1-year postoperative intervals. Comparisons using chi-square and ANOVA tests were applied.

The rates of achieving MCID and improvement within the first year were (69.2 vs. 76.9%) for PROMIS GH-Physical, (38.5 vs. 46.2%) for PROMIS GH-Mental, (71.4 vs. 92.9%) for HOOS-PS, (80.0 vs. 80.0%) for PROMIS PF SF-10a, and (74.0 vs. 91.7%) for pain scores. PROM scores at 3 months and 1 year significantly varied across all categories, except for PROMIS GH-Mental. No patients had iliopsoas tendinitis, dislocations, or re-operations.

ACH implants may alleviate anterior hip pain, while maintaining comparable strength and bio-compatibility to conventional femoral heads. This study underscores the early safety and potential of ACH implants in reducing iliopsoas tendinitis and impingement.

The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain.

This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients.

Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (r = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (r = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (r = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values.

This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.

Value-based health care has been accelerated by alternative payment models and has catalyzed the redesign of care delivery across the nation. Lifestyle medicine (LM) is one of the fastest growing medical specialties and has emerged as a high-value solution for root cause treatment of chronic disease. This review detailed a large integrated health care delivery system's value transformation efforts in the nonoperative treatment of musculoskeletal (MSK) conditions by placing patient-centric, team-based, lifestyle-focused care at the foundation. With an economic and treatment imperative to reimagine care, recognizing more intervention is not always better, a collaborative approach was designed, which placed functional improvement of the patient at the center. This article described the process of implementing LM into an MSK model of care. The change management process impacted clinical, operational, and benefit plan design to facilitate an integrated care model. A new understanding of patients' co-occurring physical impairments, medical comorbidities, and behavioral health needs was necessary for clinicians to make the shift from a pathoanatomic, transactional model of care to a biopsychosocial, longitudinal model of care. The authors explored the novel intersection of the implementation of a biopsychosocial model of care using LM principles to achieve greater value for the MSK patient population.

The Hip Disability and Osteoarthritis Outcome Score (HOOS JR) is a widely used patient-reported outcome measures questionnaire for total hip arthroplasty (THA). However, not all patients choose to complete HOOS JR, and thus, a subset of the THA population may be underrepresented. This study aims to investigate the association between patient demographic factors and HOOS JR response rates.

This was a retrospective cohort study of adult, English-speaking patients who underwent primary THA by a fellowship-trained arthroplasty surgeon between 2017 and 2023 at a single, high-volume academic institution. The HOOS JR completion status-complete or incomplete-was recorded for each patient within 90 days of surgery. Standard statistical analyses were performed to assess completion against multiple patient demographic factors.

Of the 2,908 total patients, 2,112 (72.6%) had complete and 796 (27.4%) had incomplete HOOS JR questionnaires. Multivariate analysis yielded statistical significance (P < .05) for the distribution of patient age, race, insurance, marital status, and income quartile with respect to questionnaire completion. Patient sex or religion did not affect response rates. Failure to complete HOOS JR (all P < .001) was associated with patients aged 18 to 39 (59.8%), who identified as Black (36.4%) or "other" race (39.6%), were never married (38%), and were in the lower half income quartiles (43.9%, 35.9%) when compared to the overall incomplete rate.

Multiple patient demographic factors may affect the HOOS JR response rate. Overall, our analyses suggest that older patients who identify as White and are of higher socioeconomic status are more likely to participate in the questionnaire. Efforts should focus on capturing patient groups less likely to participate to elucidate more generalizable trends in arthroplasty outcomes.

Calcium metabolism dysregulation in the setting of primary hyperparathyroidism (PHPT) mediated chondrocalcinosis is implicated in joint pain, a key element in the decision regarding arthroplasty for osteoarthritis. The relationship between hypercalcemia and joint pain, before and after arthroplasty, is unknown. This study investigates the association between preoperative hypercalcemia and postoperative outcomes following total knee (TKA) and total hip arthroplasty (THA).

A retrospective chart review was conducted on patients who underwent initial elective THA or TKA. Patients with a preoperative serum calcium >10.2 mg/dL were matched (1:2-1:4) with nearest neighbor to patients with normal serum calcium. THA and TKA functional outcomes were measured at baseline and 1-y postoperatively using patient-reported Hip Disability and Osteoarthritis Outcome Scores and Knee Injury and Osteoarthritis Outcome Scores surveys. Postoperative complications, readmissions, length of stay, and functional outcome scores were compared.

Four hundred ninety-five patients (106 hypercalcemic cases, 389 matched controls) were included. Of these, 223 patients underwent THA (46 cases; 177 controls) and 272 patients underwent TKA (61 cases; 211 controls). There were no differences in Hip Disability and Osteoarthritis Outcome Scores and Knee Injury and Osteoarthritis Outcome Scores scores, postoperative complications, readmissions, or length of stay between cases and controls. Only 19/106 (18%) hypercalcemic patients had a parathyroid hormone (PTH); of these, 9 (47%) had possible PHPT (PTH > 40).

Patients with hypercalcemia undergoing arthroplasty have similar functional and postoperative outcomes as normocalcemic patients. As PTH was obtained in <20% of hypercalcemic cases and 50% had possible PHPT, we recommend that hypercalcemic patients undergo PHPT workup. Additional investigation is needed to determine the effect of PHPT on arthroplasty outcomes.