The literature has shown an increase in prevalence of Crohn's disease (CD) within the United States alongside a concomitant rise in primary total knee arthroplasty (TKA) procedures. As such, with these parallel increases, orthopaedic surgeons will invariably encounter CD patients requiring TKA. Limited studies exist evaluating the impact of this disease on patients undergoing the procedure; therefore, this study endeavors to determine whether CD patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) episode of care (EOC) costs. To accomplish this, a nationwide database was queried from January 1, 2005 to March 31, 2014 to identify patients undergoing TKA. The study group, patients with CD, was randomly matched to the controls, patients without CD, in a 1:5 ratio after accounting for age, sex, and medical comorbidities associated with CD. Patients consuming corticosteroids were excluded, as they are at risk of higher rates of adverse events following TKA. This query ultimately yielded a total of 96,213 patients, with 16,037 in the study cohort and 80,176 in the control one. The study compared in-hospital (LOS), 90-day medical complications, and day of surgery and total global 90-day EOC costs between CD and non-CD patients undergoing primary TKA. The results found CD patients undergoing primary TKA had significantly longer in-hospital LOS (4- vs. 3 days, p < 0.0001) compared with non-CD patients. CD patients were also found to have significantly higher incidence and odds of 90-day medical complications (25.31 vs. 10.75; odds ratio: 2.05, p < 0.0001) compared with their counterparts. Furthermore, CD patients were found to have significantly higher 90-day EOC costs ($15,401.63 vs. 14,241.15, p < 0.0001) compared with controls. This study demonstrated that, after adjusting for age, sex, and medical comorbidities, patients with CD have prolonged in-hospital LOS, increased medical complications, and higher EOC costs following primary TKA. Therefore, it establishes the importance for orthopaedists to adequately counsel CD patients of the potential complications and outcomes following their procedure.

Aims Although there is increasing legalization of the use of cannabis in the USA, few well-powered studies have evaluated the association between cannabis use disorder and outcomes following primary total hip arthroplasty (THA). Thus, the aim of this study was to determine whether patients who use cannabis and undergo primary THA have higher rates of in-hospital length of stay (LOS), medical complications, implant-related complications, and costs. Methods Using an administrative database, patients with cannabis use disorder undergoing primary THA were matched to a control group in a 1:5 ratio by age, sex, and various medical comorbidities. This yielded 23,030 patients (3,842 in the study group matched with 19,188 in the control group). The variables which were studied included LOS, 90-day medical complications, two-year implant-related complications, and 90-day costs of care. Mann-Whitney U tests were used to compare LOS and costs. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of developing complications. Results We found that patients in the study group had a significantly longer mean LOS compared with the controls (four days vs three days; p < 0.0001).The study group also had a significantly higher incidence and odds of developing medical (23.0 vs 9.8%, OR 1.6; p < 0.0001) and implant-related complications (16 vs 7.4%, OR 1.6; p < 0.0001) and incurred significantly higher mean 90-day costs ($16,938.00 vs $16,023.00; p < 0.0001). Conclusion With the increasing rates of cannabis use, these findings allow orthopaedic surgeons and other healthcare professionals to counsel patients with cannabis use disorder about the possible outcomes following their THA, with increased hospital stays, complications, and costs. Cite this article: Bone Joint J 2021;103-B(7 Supple B):111–115.

Introduction: As the US population ages, the need for total hip arthroplasty (THA) is predicted to increase by 174% by 2030. The purpose of our study was to examine the rate and risks of 30-day complications and unplanned readmission in patients over the age of 80 years old. Materials and Methods: The National Surgical Quality Improvement Project database for the years 2008 to 2014 was queried for patients over the age of 80 undergoing THA. The risks of major complications, minor complications, bleeding occurrences, unplanned readmissions, and deaths over a 30-day period were examined using univariate and multivariate analyses. Results: A total of 7730 patients were included for analysis; 324 (4.2%) patients experienced a major complication, 1944 (25.1%) patients experienced a minor complication, 1776 (22.9%) patients had a bleeding occurrence requiring transfusion, and 376 (4.9%) patients experienced an unplanned readmission to the hospital within 30 days. A total of 33 (0.4%) patient deaths were recorded within 30 days postoperatively. Patients with congestive heart failure were at increased risk for developing a major complication, odds ratio (OR) 3.618 (1.052-12.437), and postoperative death, OR 11.920 (1.362-104.322). Patients with an American Society of Anesthesiologists >2, OR: 1.351 (1.131-1.613), and an operative time greater than 120 minutes, OR: 1.346 (1.084-1.670), had increased risks of minor complications. Patients with a body mass index greater than 30 had reduced rates of minor complications, OR: 0.609 (0.486-0.763). Increased risk of unplanned readmission was seen in patients with chronic obstructive pulmonary disease, OR: 2.403 (1.324-4.359). Discussion/Conclusion: Elderly patients undergoing THA have high complication and readmission rates. Surgeons should convey these increased risk factors and rates of complications in elective THAs to their elderly patients and work with primary care physicians to mitigate these risks.

The impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.

Contemporary anterior cruciate ligament reconstruction attempts to replicate the anatomical insertion sites on both the femoral and tibial sides to restore knee stability. Creation of the femoral tunnel by independently reaming through an anteromedial portal may allow surgeons to more reproducibly place the tunnel within the anatomic femoral footprint relative to a transtibial approach. However, inherent to the technique is the risk of iatrogenic injury to the articular cartilage of the medial femoral condyle as the reamers are passed adjacent to the condyle. This is particularly an issue with the use of standard nonflexible guide pins and reamers, which are placed with the knee in hyperflexion. We describe a relatively straightforward technique that can be used with standard equipment and that can be quite useful in avoiding this pitfall of the transportal approach.C ontemporary anterior cruciate ligament (ACL) reconstruction attempts to replicate the anatomic insertion sites of the ACL on both the femoral and tibial sides. On the femoral side there has been evolution and controversy in the past decade regarding the ideal technique to optimize tunnel position and restore knee stability. Investigators currently agree that anatomic single-or double-bundle tunnel placement is favored over relatively nonanatomic vertical tunnel placement, which was quite common following the adoption of transtibial femoral tunnel drilling techniques.

Introduction: In the proper age group, there is evidence that total hip arthroplasty (THA) has superior outcomes for the treatment of acetabular fractures compared with open reduction and internal fixation. Studies comparing patient demographics and identifying risk factors for either surgical site infections (SSIs) or periprosthetic joint infections (PJIs) are limited. Therefore, the purpose of this study was to (1) compare baseline demographics of patients who did and did not develop infections and (2) identify risk factors associated with developing either SSIs or PJIs. Methods: A retrospective study from 2005 to 2014 was done using a nationwide claims database. The inclusion criteria consisted of patients sustaining an acetabular fracture and treated with THA who developed either SSIs or PJIs within 90 days or 2 years, respectively, whereas patients not developing infections served as control subjects. The final study yielded 13,059 patients within the study (n = 988) and control cohort (n = 12,071). Baseline demographics were compared. A multivariate regression model calculated the odds ratio (OR) associated with development of infections. P value less than 0.002 was considered statistically significant. Results: The study demonstrated significant differences among the cohorts regarding baseline demographics. The greatest risk factors for SSIs within 90 days were morbid obesity (OR: 1.84, P < 0.0001), pathologic weight loss (OR: 1.64, P < 0.0001), and iron deficiency anemia (OR: 1.59, P = 0.001). An increased risk of PJIs was associated with iron deficiency anemia (OR: 1.97, P < 0.0001), pathologic weight loss (OR: 1.72, P < 0.0001), and morbid obesity (OR: 1.70, P = 0.0001). Conclusion: This study found notable differences between baseline demographics of the cohorts and a myriad of risk factors associated with developing infections after THA for acetabular fractures. This study provides insight into orthopaedic surgeons and other healthcare professionals on the need of properly educating these high-risk patients of the potential consequences which they may encounter after their procedure. Level of evidence: Level III

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Studies investigating the relationship of rheumatoid arthritis (RA) in patients undergoing primary total hip arthroplasty (THA) are limited. Therefore, the purpose of this study was to analyze whether RA patients undergoing primary THA have higher rates of: (1) in-hospital lengths of stay (LOS), (2) medical complications, (3) implant-related complications, and (4) costs of care. A query using an administrative claims database was performed identifying patients who underwent primary THA with RA, whereas patients without RA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 518,927 patients with (n = 86,507) and without (n = 432,420) RA undergoing primary THA. A p-value of less than 0.002 was considered statistically significant. Patients with RA were found to have significantly longer in-hospital LOS (4 vs. 3 days, p < 0.0001). Additionally, RA patients had significantly higher incidence and odds (odds ratio [OR]) of medical (6.39 vs. 1.18%; OR: 5.71, p < 0.0001) and implant-related complications (7.45 vs. 3.35%; OR: 2.32, p < 0.0001) compared with patients without RA. Furthermore, RA patients were found to have significantly higher day of surgery ($12,422.19 vs. $12,103.08, p < 0.0001) and total global 90-day episode of care costs ($16,560.40 vs. $15,167.67, p < 0.0001). This study of 518,927 patients demonstrates patients with RA undergoing primary THA have significantly longer in-hospital LOS, in addition to higher rates of complications and costs. The study is informative as orthopaedists can adequately counsel and educate RA patients of the potential complications which may occur following their procedure.