Sean Ryan

Assistant Professor of Orthopaedic Surgery

Orthopaedic Surgery

Office hours Available by email appointment request

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Selected Publications

Dual Mobility Articulation in Total Hip Arthroplasty: Mixed Femoral and Acetabular Components are a Feasible Option.

Journal Article J Arthroplasty · September 2024 BACKGROUND: The utilization of a different manufacturer for the prosthetic femoral head and the polyethylene insert in dual mobility (DM) for total hip arthroplasty (THA) may be necessary, especially in the revision setting. However, there is no data in th ... Full text Link to item Cite

Timing of Renal Transplant Prior to Total Knee Arthroplasty Impacts 90-Day Postoperative Outcomes.

Journal Article J Arthroplasty · September 2024 BACKGROUND: Renal transplant (RT) patients are at increased risk for complications after total knee arthroplasty (TKA); however, it is unknown if the time from RT to TKA influences such risks. This study evaluated RT patients undergoing primary TKA at vari ... Full text Link to item Cite

The Posterior Approach is Associated With Lower Total Encounter and 90-Day Costs When Compared to the Direct Anterior Approach.

Journal Article J Arthroplasty · September 2024 BACKGROUND: The clinical impact of the surgical approach in total hip arthroplasty (THA) has been widely reviewed. This study evaluated the total encounter and 90-day costs of THA for 2 surgical approaches (posterior [P] and direct anterior [DA]) in 1 tert ... Full text Link to item Cite

Reliability of the Sundsvall Method for Femoral Offset Evaluation.

Journal Article Hip Pelvis · September 1, 2024 PURPOSE: Acetabular and femoral offset (FO) play an important role in total hip arthroplasty (THA). The Sundsvall method has been proposed to account for both FO and cup offset in one global hip offset measurement. In this study, we examine the agreement a ... Full text Link to item Cite

Femoral Component Design Is Associated With the Risk of Periprosthetic Femur Fracture After Cementless THA in Patients 65 Years or Older.

Journal Article Clin Orthop Relat Res · August 1, 2024 BACKGROUND: Periprosthetic femur fracture is a known complication after THA. The associated risk of cementless femoral component design for periprosthetic femur fracture in a registry population of patients older than 65 years has yet to be clearly identif ... Full text Link to item Cite

Ultracongruent Polyethylene Liners Do Not Affect Survival of Total Knee Arthroplasty for Valgus Deformity.

Journal Article J Arthroplasty · August 2024 BACKGROUND: Valgus knee deformity is observed in nearly 10% of patients undergoing total knee arthroplasty (TKA). The degree of polyethylene constraint required to balance a valgus knee remains controversial, and historically, posterior-stabilized (PS) des ... Full text Link to item Cite

Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty.

Journal Article J Arthroplasty · August 2024 BACKGROUND: This study evaluated blood glucose (BG), creatinine levels, metabolic issues, length of stay (LOS), and early postoperative complications in diabetic primary total knee arthroplasty (TKA) patients. It examined those who continued home oral anti ... Full text Link to item Cite

Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively.

Journal Article World J Orthop · July 18, 2024 BACKGROUND: Tobacco use is a well-documented modifiable risk factor for perioperative complications. AIM: To determine the tobacco abstinence rates of patients who made cessation efforts prior to a total joint arthroplasty (TJA) procedure. METHODS: A retro ... Full text Link to item Cite

Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.

Journal Article J Arthroplasty · June 8, 2024 BACKGROUND: The purpose of this study was to evaluate the management and outcomes of aseptic revision total knee arthroplasty (arTKA) with unsuspected positive cultures (UPCs) compared to those with sterile cultures. METHODS: The institutional database at ... Full text Link to item Cite

Decreasing Hip Offset in Total Hip Arthroplasty Results in Decreased Physical Function Scores.

Journal Article J Arthroplasty · June 6, 2024 BACKGROUND: Acetabular and femoral offset play an important role in total hip arthroplasty (THA) for postoperative stability and biomechanical function. However, it is unknown whether offset impacts patient-reported outcomes (PROs). This study evaluated pa ... Full text Link to item Cite

Total Joint Arthroplasty Is a Viable Treatment Option for Patients With Osteonecrosis and Osteoarthritis After Bone Marrow Transplantation.

Journal Article Arthroplast Today · June 2024 BACKGROUND: Long-term survival in patients who receive bone marrow transplantation (BMT) is increasing. However, osteonecrosis and secondary osteoarthritis (OA) of the hip and knee are common complications in this population due to post-transplant steroid ... Full text Link to item Cite

The relationship between pseudotumours and infected complications in patients who have undergone metal-on-metal total hip arthroplasty.

Journal Article Bone Joint J · June 1, 2024 AIMS: This study aims to assess the relationship between history of pseudotumour formation secondary to metal-on-metal (MoM) implants and periprosthetic joint infection (PJI) rate, as well as establish ESR and CRP thresholds that are suggestive of infectio ... Full text Link to item Cite

Outcome Disparities in Total Knee and Total Hip Arthroplasty among Native American Populations.

Journal Article J Racial Ethn Health Disparities · April 2024 BACKGROUND: No prior racial disparities studies in total knee arthroplasty (TKA) and total hip arthroplasty (THA) have specifically evaluated outcomes among American Indian or Alaska Native (AIAN) patients. We hypothesized that AIAN patients have worse out ... Full text Link to item Cite

Patient Perceptions and Interest in Robotic-Assisted Total Joint Arthroplasty.

Journal Article Arthroplast Today · April 2024 BACKGROUND: Robotic-assisted total joint arthroplasty (rTJA) has growing interest among patients and surgeons. However, patient interest in and perceptions of rTJA have not been well explored. We sought to investigate the influence of patient demographics ... Full text Link to item Cite

Highlights of the 2023 American Joint Replacement Registry Annual Report.

Journal Article Arthroplast Today · April 2024 The 2023 report represents a full decade of published annual reports of the American Joint Replacement Registry (AJRR). The number of cases being captured continues to rapidly grow, as are over 3.2 million patients included in AJRR. Matched-pair primary an ... Full text Link to item Cite

Mixed Reality Navigation in Hip Fusion Conversion: A Novel Utilization of Advanced Technology: A Case Report.

Journal Article JBJS Case Connect · April 1, 2024 CASE: A 32-year-old woman with a history of hip fusion presented with significant lower back, hip, and knee pain as well as severely limited hip mobility and function. Single-stage fusion takedown and conversion to total hip arthroplasty (THA) was performe ... Full text Link to item Cite

Subsequent total joint arthroplasty: Are we learning from the first stage?

Journal Article World J Orthop · March 18, 2024 BACKGROUND: With the increasing incidence of total joint arthroplasty (TJA), there is a desire to reduce peri-operative complications and resource utilization. As degenerative conditions progress in multiple joints, many patients undergo multiple procedure ... Full text Link to item Cite

Inferior Outcomes for Patients Transferred Between Surgical Stages for Knee Periprosthetic Joint Infection.

Journal Article J Arthroplasty · February 2024 BACKGROUND: Periprosthetic joint infection (PJI) in total knee arthroplasty may result in 2-stage revision surgery. There are limited data describing outcomes when the first stage is completed at an outside hospital and the patient is referred to a tertiar ... Full text Link to item Cite

Does Medically Supervised Weight Loss Prior to Total Knee Arthroplasty Improve Patient-Reported Pain and Physical Function?

Journal Article J Arthroplasty · February 2024 BACKGROUND: Weight loss is commonly recommended before total knee arthroplasty (TKA) despite inconsistent evidence for better outcomes. This study sought to examine the impacts of preoperative weight loss on patient-reported and adverse outcomes among TKA ... Full text Link to item Cite

Risk Factors for Early Readmission and Reoperation After Outpatient Total Hip Arthroplasty.

Journal Article Orthopedics · 2024 Outpatient total hip arthroplasty (THA) is a safe option for select patients. The purpose of this study was to analyze a national database and understand risk factors that lead to unplanned early readmission and reoperation after outpatient THA. The Nation ... Full text Link to item Cite

Dual Mobility Articulation in Total Hip Arthroplasty: Mixed Femoral and Acetabular Components are a Feasible Option.

Timing of Renal Transplant Prior to Total Knee Arthroplasty Impacts 90-Day Postoperative Outcomes.

The Posterior Approach is Associated With Lower Total Encounter and 90-Day Costs When Compared to the Direct Anterior Approach.

Reliability of the Sundsvall Method for Femoral Offset Evaluation.

Femoral Component Design Is Associated With the Risk of Periprosthetic Femur Fracture After Cementless THA in Patients 65 Years or Older.

Ultracongruent Polyethylene Liners Do Not Affect Survival of Total Knee Arthroplasty for Valgus Deformity.

Continuation of Oral Antidiabetic Medications Was Associated With Better Early Postoperative Blood Glucose Control Compared to Sliding Scale Insulin After Total Knee Arthroplasty.

Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively.

Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.

Decreasing Hip Offset in Total Hip Arthroplasty Results in Decreased Physical Function Scores.

Total Joint Arthroplasty Is a Viable Treatment Option for Patients With Osteonecrosis and Osteoarthritis After Bone Marrow Transplantation.

The relationship between pseudotumours and infected complications in patients who have undergone metal-on-metal total hip arthroplasty.

Outcome Disparities in Total Knee and Total Hip Arthroplasty among Native American Populations.

Patient Perceptions and Interest in Robotic-Assisted Total Joint Arthroplasty.

Highlights of the 2023 American Joint Replacement Registry Annual Report.

Mixed Reality Navigation in Hip Fusion Conversion: A Novel Utilization of Advanced Technology: A Case Report.

Subsequent total joint arthroplasty: Are we learning from the first stage?

Inferior Outcomes for Patients Transferred Between Surgical Stages for Knee Periprosthetic Joint Infection.

Does Medically Supervised Weight Loss Prior to Total Knee Arthroplasty Improve Patient-Reported Pain and Physical Function?

Risk Factors for Early Readmission and Reoperation After Outpatient Total Hip Arthroplasty.

Management of Intraoperative Acetabular Fractures During Total Hip Arthroplasty.

Journal Article Orthop Clin North Am · January 2024 Intraoperative fractures of the acetabulum are a rare but serious complication during total hip arthroplasty. Acute fractures generally require attention with plating, whereas chronic acetabular fractures may be approached with distraction, a Burch-Schneid ... Full text Link to item Cite

Risk factors for failure after rotational muscle flap coverage for prosthetic knee infections.

Journal Article J Orthop Surg (Hong Kong) · 2024 INTRODUCTION: Soft tissue defects are a devastating complication of prosthetic joint infections (PJI) after total knee arthroplasty (TKA). Rotational flaps are commonly utilized to address these defects with variable reports of success. This study aimed to ... Full text Link to item Cite

A Cost Analysis of Surgical Approach in Total Hip Arthroplasty.

Journal Article Orthopedics · 2024 BACKGROUND: With pressures to decrease the financial burden of total hip arthroplasty (THA), it is imperative to understand the cost drivers of this procedure. This study evaluated operative and total encounter costs for two surgical approaches to THA-post ... Full text Link to item Cite

Enhanced Total Hip Arthroplasty Education Using Augmented Reality: A Survey From a Tertiary Center.

Journal Article Orthopedics · 2024 BACKGROUND: For total hip arthroplasty (THA), a new technology in the evolution of computer-assisted surgery has emerged in the form of augmented reality (AR). We sought to determine the impact of AR on resident and fellow education after implementation at ... Full text Link to item Cite

Higher Risk of Reoperation after Total Knee Arthroplasty in Young and Elderly Patients.

Journal Article Materials (Basel) · November 2, 2023 As outcomes and survivorship improve, total knee arthroplasty (TKA) has expanded into broader age groups. The purpose of this study is to analyze the impact of age on TKA outcomes using the National Surgical Quality Improvement Program (NSQIP) database fro ... Full text Link to item Cite

The Removal of Total Hip Arthroplasty From the Inpatient-Only List has Improved Patient Selection and Expanded Optimization Efforts.

Journal Article J Arthroplasty · July 2023 BACKGROUND: On January 1, 2020, the Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the Inpatient-Only (IPO) list. This study evaluated patient demographics and comorbidities, preoperative optimization efforts, and 30-d ... Full text Link to item Cite

Does Order of Operation Matter in Patients Who Have Concomitant Hip and Spine Pathology?

Journal Article J Arthroplasty · July 2023 BACKGROUND: In patients, who have coexisting lumbar spine and degenerative hip disease, there remains uncertainty regarding whether hip or spine surgery should be performed first. We hypothesized that undergoing total hip arthroplasty (THA) would protect a ... Full text Link to item Cite

Cemented Femoral Fixation in Total Hip Arthroplasty Reduces the Risk of Periprosthetic Femur Fracture in Patients 65 Years and Older: An Analysis From the American Joint Replacement Registry.

Journal Article J Arthroplasty · July 2023 BACKGROUND: Periprosthetic femur fracture (PPFx) is a devastating complication after total hip arthroplasty (THA). Despite concerns for increased PPFx, cementless fixation predominates in the United States. This study used the American Joint Replacement Re ... Full text Link to item Cite

Periarticular Injection in Total Knee Arthroplasty.

Journal Article J Am Acad Orthop Surg · June 15, 2023 Optimal pain management after total knee arthroplasty (TKA) can expedite postoperative recovery, improve perioperative outcomes, and increase patient satisfaction. Periarticular injections (PAIs) have become increasingly used to improve pain management aft ... Full text Link to item Cite

Evaluation of anterior translation in total knee arthroplasty utilizing stress radiographs.

Journal Article J Orthop Surg Res · June 1, 2023 BACKGROUND: Flexion instability is a common cause for revision after total knee arthroplasty (TKA); however, little objective criteria exist to determine excessive laxity in flexion. This study sought to determine the reliability of stress radiographs for ... Full text Link to item Cite

A Multicenter Prospective Investigation on Patient Physical and Mental Health After Girdlestone Resection Arthroplasty.

Journal Article J Arthroplasty · May 2023 BACKGROUND: Girdlestone resection arthroplasty is a salvage procedure for hip periprosthetic joint infection (PJI) that controls infection and reduces chronic pain, but may result in limited postoperative joint function. The aim of this study was to assess ... Full text Link to item Cite

Short Course of Oral Antibiotic Treatment After Two-Stage Exchange Arthroplasty Appears to Decrease Early Reinfection.

Journal Article J Arthroplasty · May 2023 BACKGROUND: Recent evidence has suggested a benefit to extended postoperative prophylactic oral antibiotics after two-stage exchange arthroplasty for treatment of periprosthetic joint infections. We sought to determine reinfection rates with and without a ... Full text Link to item Cite

Opioid Legislation Decreases Opioid Prescribing in Total Knee Arthroplasty.

Journal Article Orthopedics · May 2023 The purpose of this study was to evaluate the impact of opioid-limiting legislation on perioperative opioid prescriptions in total knee arthroplasty. The hypothesis was that opioid legislation has reduced opioid prescription filling above levels anticipate ... Full text Link to item Cite

Accelerated Discharge After Aseptic Revision Total Hip Arthroplasty Does Not Predict Inferior 30-Day Outcomes.

Journal Article J Arthroplasty · March 2023 BACKGROUND: Perioperative advancements have made outpatient primary total hip arthroplasty (THA) a viable option for patients. This study evaluated the feasibility of expedited discharge after revision THA and compared 30-day outcomes to patients who had p ... Full text Link to item Cite

Midterm Results of Contemporary Uncemented Total Hip Arthroplasty in Patients 45 Years or Younger.

Journal Article Orthopedics · 2023 Total hip arthroplasty (THA) in young patients has varying results, and some reports show inferior results when compared with those of older patients. This study evaluated the outcomes of contemporary uncemented THA in patients 45 years or younger. This wa ... Full text Link to item Cite

Influence of Limb Position on Venous Blood Flow After Total Knee Arthroplasty: A Prospective Randomized Study.

Journal Article Orthopedics · 2023 Previous studies have suggested a clinical advantage when placing the limb in flexion after total knee arthroplasty (TKA). We sought to measure venous flow compared with control values after TKA. Our hypothesis was that the knee flexed positioning would no ... Full text Link to item Cite

Body Mass Index and American Society of Anesthesiologists Score Predict Perioperative Delays in Different Phases for Total Hip Arthroplasty.

Journal Article J Surg Orthop Adv · 2023 Perioperative efficiency has become increasingly important with cost constraints and expanding indications for total hip arthroplasty (THA). We chose to analyze body mass index (BMI) and American Society of Anesthesiologists (ASA) score, in predicting peri ... Link to item Cite

Effect of commonly used lavage solutions on the polymerization of bone cement.

Journal Article Orthop Traumatol Surg Res · December 2022 INTRODUCTION: Little is known about the impact irrigation solutions have on the material properties of cement used in hip and knee arthroplasty. We sought to compare the effect of three commonly used lavage solutions on cement polymerization. METHODS: Ten ... Full text Link to item Cite

Total joint arthroplasty following solid organ transplants: complications and mid-term outcomes.

Journal Article Int Orthop · December 2022 PURPOSE: Survival after solid organ transplant (SOT) is improving, and demand for total joint arthroplasty (TJA) among SOT recipients is rising. Outcomes including revision, periprosthetic joint infection, and survivorship based on SOT type are variable. W ... Full text Link to item Cite

Effect of commonly used lavage solutions on the polymerization of bone cement

Journal Article Revue de Chirurgie Orthopedique et Traumatologique · December 1, 2022 Introduction: Little is known about the impact irrigation solutions have on the material properties of cement used in hip and knee arthroplasty. We sought to compare the effect of three commonly used lavage solutions on cement polymerization. Methods: Ten ... Full text Cite

Primary Total Knee Arthroplasty in Patients Aged 45 Years or Younger: 162 Total Knee Arthroplasties With a Mean Follow-up Duration of 7 Years.

Journal Article Arthroplast Today · December 2022 BACKGROUND: There are few large studies evaluating total knee arthroplasty (TKA) in young patients. Therefore, we sought to evaluate patients aged 45 years or younger undergoing a primary TKA. METHODS: This was a retrospective, single-institution study, fr ... Full text Link to item Cite

Accelerated discharge after aseptic revision knee arthroplasty is not associated with early readmission and reoperation.

Journal Article Bone Joint J · December 2022 AIMS: In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and ... Full text Link to item Cite

Total Hip Arthroplasty in Morbidly Obese: Does a Strict Body Mass Index Cutoff Yield Meaningful Change?

Journal Article Hip Pelvis · September 2022 PURPOSE: The number of obese patients seeking total hip arthroplasty (THA) continues to expand despite body mass index (BMI) cutoffs. We sought to determine the outcomes of THA in the morbidly obese patient, and hypothesized they would have comparable outc ... Full text Link to item Cite

Sleep disturbance, dyspnea, and anxiety following total joint arthroplasty: an observational study.

Journal Article J Orthop Surg Res · August 19, 2022 BACKGROUND: Patient-Reported Outcomes Measurement Information System (PROMIS) domains for sleep disturbance, anxiety, and dyspnea have been under-reported for total joint arthroplasty (TJA). The aims of this study were to report postoperative differences f ... Full text Open Access Link to item Cite

Short-Stay Arthroplasty is Not Associated With Increased Risk of 90-Day Hospital Returns.

Journal Article J Arthroplasty · August 2022 BACKGROUND: With the removal of total hip arthroplasty (THA) and total knee arthroplasty (TKA) from the inpatient-only list, medical centers are faced with challenging transitions to outpatient surgery. We investigated if short-stay arthroplasty, defined a ... Full text Link to item Cite

Current Trends in Revision Hip Arthroplasty: Indications and Types of Components Revised.

Journal Article J Arthroplasty · July 2022 BACKGROUND: The materials and techniques for both primary and revision total hip arthroplasty (THA) have changed over time. This study evaluated if the indications for revision THA, rates of components utilized (femoral or acetabulum, both, or head/liner e ... Full text Link to item Cite

Frank Stinchfield Award: Does Bariatric Surgery Prior to Primary Total Hip Arthroplasty Really Improve Outcomes?

Journal Article J Arthroplasty · July 2022 BACKGROUND: Optimal management of morbid obesity before total hip arthroplasty (THA) remains debated. Recently, bariatric procedures have become more common with advancements in surgical techniques. We hypothesized that bariatric surgery prior to primary T ... Full text Link to item Cite

Does Bariatric Surgery Prior to Primary Total Knee Arthroplasty Improve Outcomes?

Journal Article J Arthroplasty · June 2022 BACKGROUND: Recent advancements in bariatric surgical techniques have increased its utilization for the management of morbid obesity prior to total knee arthroplasty (TKA). We hypothesized that bariatric surgery prior to primary TKA would mitigate postoper ... Full text Link to item Cite

Patterns and Predictors of Weight Change Before and After Total Hip Arthroplasty in Class 2 and 3 Obese Patients.

Journal Article J Arthroplasty · May 2022 BACKGROUND: This study aimed to better understand body mass index (BMI) change patterns and factors associated with BMI change before and after total hip arthroplasty (THA) in Class 2 and 3 obese patients, and assess if preoperative or postoperative BMI ch ... Full text Link to item Cite

Treatment Outcomes in Spinal Metastatic Disease With Indeterminate Stability.

Journal Article Global Spine J · April 2022 STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The purpose of this study was to compare outcomes between different treatment modalities for metastatic disease with indeterminate instability (Spinal Instability Neoplastic Score [SINS] 7-12). METHODS: ... Full text Link to item Cite

Preoperative Weight Loss and Postoperative Weight Gain Independently Increase Risk for Revision After Primary Total Knee Arthroplasty.

Journal Article J Arthroplasty · April 2022 BACKGROUND: The current American Association of Hip and Knee Surgeons (AAHKS) guidelines recommend preoperative weight loss before total knee arthroplasty (TKA) in patients with body mass index (BMI) ≥40 kg/m2. However, there is a paucity of evidence on TK ... Full text Link to item Cite

Efficacy of Common Antiseptic Solutions Against Clinically Relevant Planktonic Microorganisms.

Journal Article Orthopedics · 2022 Prosthetic joint infections (PJIs) are among the most devastating complications after joint replacement. There is limited evidence regarding the efficacy of different antiseptic solutions in reducing planktonic microorganism burden. The purpose of this stu ... Full text Link to item Cite

The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability?

Journal Article Orthopedics · 2022 Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores ... Full text Link to item Cite

Metaphyseal Fixation for Revision Total Knee Arthroplasty

Journal Article Operative Techniques in Orthopaedics · December 1, 2021 Initial and long-term metaphyseal fixation is critical for implant survivorship after revision total knee arthroplasty. When bone loss is encountered following removal of primary components or with osteolysis, reconstructive options for small defects inclu ... Full text Cite

Opioid legislation and narcotic filling in total hip arthroplasty: descriptive study of time and state-level trends in the United States.

Journal Article Subst Abuse Treat Prev Policy · September 28, 2021 BACKGROUND: The opioid misuse epidemic focused national attention on reducing opioid overprescribing. The purpose of this study is to describe the relationship of time and state-level interventions and opioid filling surrounding total hip arthroplasty (THA ... Full text Open Access Link to item Cite

The Effects of Dexamethasone in Diabetic Patients Undergoing Primary Total Joint Arthroplasty.

Journal Article Orthop Nurs · September 2021 Dexamethasone reduces postoperative pain and nausea, with no evidence of increased rate of infection in total joint arthroplasty. However, the effects of dexamethasone on diabetic patients undergoing total joint arthroplasty remain relatively unexplored. T ... Full text Link to item Cite

Intraoperative Fracture of a Dual Modular Delta Ceramic Femoral Head During Total Hip Arthroplasty: A Case Report.

Journal Article JBJS Case Connect · August 16, 2021 CASE: A 39-year-old man with cerebral palsy and hip dysplasia status post right Chiari osteotomy presented with right hip osteoarthritis in consultation for total hip arthroplasty (THA). During THA, a Delta ceramic head was misaligned on the taper, but thi ... Full text Link to item Cite

Is there a problem with modular dual mobility acetabular components in revision total hip arthroplasty at mid-term follow-up?

Journal Article Bone Joint J · July 2021 AIMS: Modular dual mobility (MDM) acetabular components are often used with the aim of reducing the risk of dislocation in revision total hip arthroplasty (THA). There is, however, little information in the literature about its use in this context. The aim ... Full text Link to item Cite

Incidence and Risk Factors for Flap Coverage After Total Ankle Arthroplasty.

Journal Article Foot Ankle Int · June 2021 BACKGROUND: Wound complications following total ankle arthroplasty (TAA) can have a significant impact on patient morbidity, particularly when they require flap coverage. We sought to determine the risk factors associated with the need for flap coverage af ... Full text Link to item Cite

Mid-term results of tibial cones : reasonable survivorship but increased failure in those with significant bone loss and prior infection.

Journal Article Bone Joint J · June 2021 AIMS: Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. Because there are few studies evaluating mid-term outcomes with a sufficient cohort, the purpose of this study was to evaluate tibial cone survival an ... Full text Link to item Cite

Cost of Aseptic Revision Total Knee Arthroplasty at a Tertiary Medical Center.

Journal Article J Arthroplasty · May 2021 BACKGROUND: Revision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following: (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost as ... Full text Link to item Cite

Body Mass Index, American Society of Anesthesiologists Score, and Elixhauser Comorbidity Index Predict Cost and Delay of Care During Total Knee Arthroplasty.

Journal Article J Arthroplasty · May 2021 BACKGROUND: Body mass index (BMI), American Society of Anesthesiologists (ASA) score, and Elixhauser Comorbidity Index are measures that are utilized to predict perioperative outcomes, though little is known about their comparative predictive effects. We a ... Full text Link to item Cite

Efficacy of common antiseptic solutions against clinically relevant microorganisms in biofilm.

Journal Article Bone Joint J · May 2021 AIMS: Periprosthetic joint infections (PJIs) are among the most devastating complications after joint arthroplasty. There is limited evidence on the efficacy of different antiseptic solutions on reducing biofilm burden. The purpose of the present study was ... Full text Link to item Cite

A Preoperative Risk Prediction Tool for Discharge to a Skilled Nursing or Rehabilitation Facility After Total Joint Arthroplasty.

Journal Article J Arthroplasty · April 2021 BACKGROUND: Discharge to rehabilitation or a skilled nursing facility (SNF) after total joint arthroplasty remains a primary driver of cost excess for bundled payments. An accurate preoperative risk prediction tool would help providers and health systems i ... Full text Link to item Cite

Intraoperative Fire Risk: Evaluating the 3-Minute Wait After Chlorhexidine-Alcohol Antiseptic Scrub.

Journal Article J Orthop Trauma · January 1, 2021 OBJECTIVE: We sought to determine the flammability of the skin at different time intervals after chlorhexidine-alcohol antiseptic scrub application, to provide evidence for hospital protocols recommending a 3-minute drying time. METHODS: Swine feet, which ... Full text Link to item Cite

A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty.

Journal Article J Arthroplasty · January 2021 BACKGROUND: The Center for Medicare and Medicaid Services is faced with a challenge of decreasing the cost of care for total knee arthroplasty (TKA) but must make efforts to prevent patient selection bias in the process. Currently, no appropriate modifier ... Full text Link to item Cite

All-Polyethylene Tibia: An Opportunity for Value-Based Care in Bundled Reimbursement Initiatives.

Journal Article Orthopedics · January 1, 2021 Surgeons play a critical role in making cost-effective decisions that maintain high-quality patient outcomes, which is the current focus of the Centers for Medicare & Medicaid Services. All-polyethylene tibial (APT) components often cost less during total ... Full text Link to item Cite

Next-generation sequencing not superior to culture in periprosthetic joint infection diagnosis.

Journal Article Bone Joint J · January 2021 AIMS: Use of molecular sequencing methods in periprosthetic joint infection (PJI) diagnosis and organism identification have gained popularity. Next-generation sequencing (NGS) is a potentially powerful tool that is now commercially available. The purpose ... Full text Link to item Cite

Revision Total Joint Arthroplasty: Final Stop Tertiary Referral Center.

Journal Article Orthopedics · 2021 High complication rates associated with revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) may unequally burden tertiary referral centers, which manage medically complex patients. The authors aimed to quantify TKA and THA referral patt ... Full text Link to item Cite

Commercially Available Polymerase Chain Reaction Has Minimal Utility in the Diagnosis of Periprosthetic Joint Infection.

Journal Article Orthopedics · November 1, 2020 The use of genetic sequencing modalities in the diagnosis of periprosthetic joint infection (PJI) and the identification of organisms has gained popularity recently. Polymerase chain reaction (PCR) offers timely results for common organisms. The purpose of ... Full text Link to item Cite

Arthroplasty Surgeons Do Not Improve Acute Outcomes for Patients With Hip Fracture Relative to Other Subspecialists.

Journal Article Orthopedics · September 1, 2020 As bundled reimbursement models continue to evolve, there is a continued effort to increase the value of care for patients undergoing arthroplasty. The authors sought to evaluate the effect of surgeon specialization (arthroplasty vs non-arthroplasty) on ac ... Full text Link to item Cite

Patient Risk Profile for Unplanned 90-Day Emergency Department Visits Differs Between Total Hip and Total Knee Arthroplasty.

Journal Article Orthopedics · September 1, 2020 Numerous studies have explored 90-day readmissions following total joint arthroplasty; however, there is a paucity of literature concerning 90-day emergency department (ED) visits. The authors aimed to characterize the risk factors for ED presentations and ... Full text Link to item Cite

Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training.

Journal Article J Arthroplasty · June 2020 BACKGROUND: Hip fractures have significant economic implications as a result of their associated direct and indirect medical costs. Under alternative payment models, it has become increasingly important for institutions to find avenues by which costs could ... Full text Link to item Cite

Impact of Patent Foramen Ovale on Total Knee Arthroplasty Cerebrovascular Accident Perioperative Management.

Journal Article Orthopedics · May 1, 2020 Venous thromboembolism and ischemic stroke are major complications following total knee arthroplasty (TKA) and potentially are associated with a patent foramen ovale (PFO). Although this association has been shown in other surgical disciplines, it has not ... Full text Link to item Cite

Response to Letter to the Editor on "The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty".

Journal Article J Arthroplasty · March 2020 Full text Link to item Cite

Extended Oral Antibiotics and Infection Prophylaxis after a Primary or Revision Total Knee Arthroplasty.

Journal Article J Knee Surg · February 2020 One of the most common reasons for failure of primary total knee arthroplasty and need for revision surgery is periprosthetic infection. Antibiotics are one of the mainstays of treatment to address prosthetic joint infections, but the route of administrati ... Full text Link to item Cite

Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns.

Journal Article J Orthop Surg (Hong Kong) · 2020 PURPOSE: Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to com ... Full text Link to item Cite

Undersedation During Total Hip Arthroplasty Reduction Results in Worse Patient Outcomes.

Journal Article J Arthroplasty · December 2019 BACKGROUND: Total hip arthroplasty (THA) dislocation is a common reason for presentation to the emergency department (ED) postoperatively. Prior literature has shown that propofol conscious sedation provides the fewest complications and the shortest time t ... Full text Link to item Cite

Perioperative Selective Serotonin Reuptake Inhibitor Use Is Associated With an Increased Risk of Transfusion in Total Hip and Knee Arthroplasty.

Journal Article J Arthroplasty · December 2019 BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) have been shown in both orthopedic and general surgery literature to be associated with an increased risk of blood loss, and this is thought to occur via diminished platelet serotonin reuptake and ... Full text Link to item Cite

The Role of Malnutrition in Ninety-Day Outcomes After Total Joint Arthroplasty.

Journal Article J Arthroplasty · November 2019 BACKGROUND: Research has linked malnutrition to more complications in total joint arthroplasty (TJA) patients. The role of preoperative albumin in predicting length of stay (LOS) and 90-day outcomes remains understudied. Often, an albumin cut-off ≤3.5 g/dL ... Full text Link to item Cite

Value-Based Care Has Not Resulted in Biased Patient Selection: Analysis of a Single Center's Experience in the Care for Joint Replacement Bundle.

Journal Article J Arthroplasty · September 2019 BACKGROUND: Bundled reimbursement models for total knee arthroplasty (TKA) by the Center for Medicare and Medicaid Services have resulted in an effort to decrease the cost of care. However, these models may incentivize bias in patient selection to avoid ex ... Full text Link to item Cite

Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty.

Journal Article Foot Ankle Int · September 2019 BACKGROUND: The Comprehensive Care for Joint Replacement (CJR) model includes total ankle arthroplasty (TAA), under which a target reimbursement is established. Whether this reimbursement is sufficient to cover average cost remains unknown. We hypothesized ... Full text Link to item Cite

Tranexamic acid or epsilon-aminocaproic acid in total joint arthroplasty? A randomized controlled trial.

Journal Article Bone Joint J · September 2019 AIMS: Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arth ... Full text Link to item Cite

Prior Hip Arthroscopy Increases Risk for Perioperative Total Hip Arthroplasty Complications: A Matched-Controlled Study.

Journal Article J Arthroplasty · August 2019 BACKGROUND: Arthroscopic hip surgery is becoming increasingly popular for the treatment of femoroacetabular impingement and labral tears. Reports of outcomes of hip arthroscopy converted to total hip arthroplasty (THA) have been limited by small sample siz ... Full text Link to item Cite

Response to Letter to the Editor on "Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty".

Journal Article J Arthroplasty · August 2019 Full text Link to item Cite

No Changes in Patient Selection and Value-Based Metrics for Total Hip Arthroplasty After Comprehensive Care for Joint Replacement Bundle Implementation at a Single Center.

Journal Article J Arthroplasty · August 2019 BACKGROUND: Alternative payment models for total hip arthroplasty (THA) were initiated by the Center for Medicare and Medicaid Services to decrease overall healthcare cost. The associated shift of financial risk to participating institutions may negatively ... Full text Link to item Cite

Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty.

Journal Article J Arthroplasty · July 2019 BACKGROUND: The Comprehensive Care for Joint Replacement (CJR) model has resulted in the evolution of preoperative optimization programs to decrease costs and hospital returns. At the investigating institution, one center was not within the CJR bundle and ... Full text Link to item Cite

Is There a Difference in Infection Risk Between Single and Multiple Doses of Prophylactic Antibiotics? A Meta-analysis.

Journal Article Clin Orthop Relat Res · July 2019 BACKGROUND: The prevention of surgical site infection guidelines issued by the Centers for Disease Control and Prevention (CDC) recently recommended that only a single dose of preoperative antibiotics be administered to patients undergoing clean-contaminat ... Full text Link to item Cite

Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization.

Journal Article J Arthroplasty · July 2019 BACKGROUND: Current Procedural Terminology coding currently makes no distinction between primary total knee arthroplasty (TKA) and conversion TKA, in which periarticular hardware components must be removed prior to or during TKA. We hypothesize that conver ... Full text Link to item Cite

Should Medical Severity-Diagnosis Related Group Classification Be Utilized for Reimbursement? An Analysis of Elixhauser Comorbidities and Cost of Care.

Journal Article J Arthroplasty · July 2019 BACKGROUND: The Center for Medicare and Medicaid Services (CMS) classifies reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on Medical Severity-Diagnosis Related Groups (MS-DRGs) 469 (with major complication/comorbidit ... Full text Link to item Cite

Clinical Impact of Routine Complete Blood Counts Following Total Knee Arthroplasty.

Journal Article J Arthroplasty · July 2019 BACKGROUND: Routine laboratory studies are generally obtained following total knee arthroplasty (TKA), and often continued daily until discharge. This study aims to investigate the utility and cost-effectiveness of complete blood count (CBC) tests followin ... Full text Link to item Cite

Predicting Inpatient Dissatisfaction Following Total Joint Arthroplasty: An Analysis of 3,593 Hospital Consumer Assessment of Healthcare Providers and Systems Survey Responses.

Journal Article J Arthroplasty · May 2019 BACKGROUND: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, created by the Centers for Medicare and Medicaid, is directly tied to hospital reimbursement. The purpose of this study is to identify factors that are predic ... Full text Link to item Cite

A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty.

Journal Article J Arthroplasty · May 2019 BACKGROUND: Evolving reimbursement models increasingly compel hospitals to assume costs for 90-day readmission after total joint arthroplasty. Although risk assessment tools exist, none currently reach the predictive performance required to accurately iden ... Full text Link to item Cite

A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty.

Journal Article J Bone Joint Surg Am · March 20, 2019 BACKGROUND: A reliable prediction tool for 90-day adverse events not only would provide patients with valuable estimates of their individual risk perioperatively, but would also give health-care systems a method to enable them to anticipate and potentially ... Full text Link to item Cite

Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single Dose Is as Effective as Multiple Doses.

Journal Article J Bone Joint Surg Am · March 6, 2019 BACKGROUND: Recent surgical site infection prevention guidelines recommend that no additional prophylactic antibiotics be administered after the surgical incision is closed in clean-contaminated procedures. Although there is ample evidence to support this ... Full text Link to item Cite

Predicting Costs Exceeding Bundled Payment Targets for Total Joint Arthroplasty.

Journal Article J Arthroplasty · March 2019 BACKGROUND: The Center for Medicare and Medicaid Services has instituted bundled reimbursement models for total joint arthroplasty (TJA), which includes target prices for each procedure. Some patients exceed these targets; however, currently there are no t ... Full text Link to item Cite

Preoperative Hemoglobin Predicts Postoperative Transfusion Despite Antifibrinolytics During Total Knee Arthroplasty.

Journal Article Orthopedics · March 1, 2019 Current antifibrinolytics have decreased perioperative blood loss; however, some patients still require transfusions postoperatively. The authors sought to determine the risk factors associated with postoperative transfusions and to establish a "cutoff" pr ... Full text Link to item Cite

Medicaid Insurance Correlates With Increased Resource Utilization Following Total Hip Arthroplasty.

Journal Article J Arthroplasty · February 2019 BACKGROUND: With increased restraints and efforts to contain costs in total hip arthroplasty (THA), an emphasis has been placed on risk stratification. The purpose of this study was to determine whether Medicaid patients have increased resource utilization ... Full text Link to item Cite

Treatment of Prosthetic Joint Infection: Established Patient Relationships May Impact Medical Decision-Making.

Journal Article J Arthroplasty · February 2019 BACKGROUND: Choosing the intervention for prosthetic joint infections, whether debridement, antibiotics, and implant retention (DAIR), or explant and antibiotic spacer placement, is multifactorial. One characteristic that may influence this decision is a p ... Full text Link to item Cite

Utilization of an Electronic Patient Portal Following Total Joint Arthroplasty Does Not Decrease Readmissions.

Journal Article J Arthroplasty · February 2019 BACKGROUND: At the investigating institution, an electronic messaging portal (MyChart) allows patients to directly communicate with their healthcare provider. As reimbursement models evolve, there is an increasing effort to decrease 90-day hospital resourc ... Full text Link to item Cite

Transfemoral amputation following total knee arthroplasty: mortality and functional outcomes.

Journal Article Bone Joint J · February 2019 AIMS: The aim of this study was to characterize the factors leading to transfemoral amputation after total knee arthroplasty (TKA), as well as the rates of mortality and functional independence after this procedure in these patients. PATIENTS AND METHODS: ... Full text Link to item Cite

Outcomes of Conversion Total Hip Arthroplasty From Free Vascularized Fibular Grafting.

Journal Article J Arthroplasty · January 2019 BACKGROUND: Conversion total hip arthroplasties (THAs) from prior free vascularized fibular grafting (FVFG) are infrequently reported in the literature. We characterized the perioperative outcomes of patients undergoing conversion THA and compared them wit ... Full text Link to item Cite

Predicting Success of Two-Stage Exchange for Prosthetic Joint Infection Using C-Reactive Protein/Albumin Ratio.

Journal Article Adv Orthop · 2019 Two-stage exchange is most commonly used for treatment of prosthetic joint infections (PJI) but, this may fail to eradicate infections. C-reactive protein/albumin ratio (CAR) has been used to predict survival and operative success in other surgical subspec ... Full text Link to item Cite

Diabetes and Total Joint Arthroplasty: Infection Risk May Not Be Predictable by Markers of Glycemic Control.

Journal Article J Surg Orthop Adv · 2019 With an increasing prevalence of diabetes, there is a need to risk stratify arthroplasty patients preoperatively and characterize postoperative infections. This study sought to determine if perioperative markers of diabetic control were associated with inf ... Link to item Cite

Incidence of Periprosthetic Femur Fractures Utilizing the Posterior Approach with a Single Wedge Tapered Stem.

Journal Article J Surg Orthop Adv · 2019 We sought to determine early periprosthetic femur fracture rate and stem-related failures in primary total hip arthroplasty (THA) performed through a posterior approach with a cementless wedge stem. We reviewed 818 primary THAs in 713 patients with a singl ... Link to item Cite

Anterior vs. Posterior Lumbar Interbody Fusion: Does Cage Geometry Matter More Than Surgical Approach?

Journal Article Duke Orthopaedic Journal · 2019 Cite

Skilled Nursing Facilities After Total Knee Arthroplasty: The Time for Selective Partnerships Is Now!

Journal Article J Arthroplasty · December 2018 BACKGROUND: Bundled payment initiatives for total knee arthroplasty (TKA) patients are dramatically impacted by discharges to skilled nursing facilities (SNFs), making target prices set by the Center for Medicare and Medicaid Services difficult to achieve. ... Full text Link to item Cite

Albumin Versus American Society of Anesthesiologists Score: Which Is More Predictive of Complications Following Total Joint Arthroplasty?

Journal Article Orthopedics · November 1, 2018 Malnutrition is not uncommon in arthroplasty patients, and hypoalbuminemia has been shown to be predictive of postoperative complications. The authors sought to compare albumin concentration with a global assessment of physical health, the American Society ... Full text Link to item Cite

Preoperative Hypoalbuminemia Predicts Poor Short-term Outcomes for Hip Fracture Surgery.

Journal Article Orthopedics · November 1, 2018 Hip fractures are common in elderly patients, and which surgical modality to pursue is often debated. Malnutrition, which cannot be corrected preoperatively in this population, is often not considered. Therefore, the authors sought to investigate the assoc ... Full text Link to item Cite

New Techniques for Diagnosis and Treatment of Musculoskeletal Tumors: Methods of Intraoperative Margin Detection

Conference Techniques in Orthopaedics · September 1, 2018 Although frozen section analysis remains the standard for intraoperative margin detection for some cancers, there are critical limitations with using this method in the treatment of musculoskeletal tumors. Extensive work has been done to develop more accur ... Full text Cite

Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications.

Journal Article J Arthroplasty · August 2018 BACKGROUND: With the increasing incidence of hip fractures and hip preservation surgeries, there has been a concomitant rise in the number of conversion total hip arthroplasties (THAs) performed. Prior studies have shown higher complication rates in conver ... Full text Link to item Cite

The Value of MRI in Distinguishing Subtypes of Lipomatous Extremity Tumors Needs Reassessment in the Era of MDM2 and CDK4 Testing.

Journal Article Sarcoma · 2018 INTRODUCTION: Extremity lipomas and well-differentiated liposarcomas (WDLs) are difficult to distinguish on MR imaging. We sought to evaluate the accuracy of MRI interpretation using MDM2 amplification, via fluorescence in-situ hybridization (FISH), as the ... Full text Link to item Cite

Chronic Osteomyelitis of the Distal Femur Treated with Resection and Delayed Endoprosthetic Reconstruction: A Report of Three Cases.

Journal Article Case Rep Orthop · 2017 Chronic osteomyelitis involving the distal femur often results in amputation or arthrodesis. This article presents three cases of chronic osteomyelitis treated with a staged approach culminating in endoprosthetic reconstruction. Stage one involved resectio ... Full text Link to item Cite

Inferior vena cava filter and aspirin in thromboprophylaxis during resection of pelvic malignancies

Journal Article Current Orthopaedic Practice · December 1, 2015 Background: Patients with pelvic malignancies at risk of postoperative hemorrhage often are not given antithrombolic chemoprophylaxis after large surgical resections, increasing the risk of a fatal pulmonary embolism (PE). The appropriate prophylactic stra ... Full text Cite