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Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background Length of stay after total hip arthroplasty (THA) has decreased over the last two decades. However, published studies that have examined same-day and early discharge protocols after THA have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects.Questions/purposes The purpose of this study was to evaluate and compare patients undergoing THA who are discharged on the same day as the surgery (''outpatient,'' less than 12-hour stay) with those who are discharged after an overnight hospital stay (''inpatient'') with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission, One of the authors (AFC) has received research support funding from 3M (Maplewood, MN, USA) and Myoscience (Fremont, CA, USA). One of the authors (WGH) has received research support funding from DePuy (DePuySynthes, New Brunswick, NJ, USA), Biomet (Warsaw, IN, USA), and Nimbic Systems (Stafford, TX, USA). The institution of one or more of the authors (NG, SEP, RHH, WGH) has received, during the study period, funding from the Inova Health System (Falls Church, VA, USA). One of the authors (NG), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Cayenne Medical (Scottsdale, AZ, USA) and Stryker Orthopedics (Mahwah, NJ, USA). One of the authors (AFC), or a member of her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from ACI Clinical (Bala Cynwyd, PA, USA). One of the authors (WGH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from DePuy, Biomet, and Nimbic Systems. One of the authors (WJH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker. One of the authors (NG) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Data Trace Publishing Company (Towson, MD, USA) in the amount of USD 10,000 to USD 100,000. One of the authors (AFC) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: SLACK Incorporated (Thorofare, NJ, USA) in the amount of less than USD 10,000. (3) relative work effort for the surgeon's office staff. Methods A prospective, randomized study was conducted at two high-volume adult reconstruction centers between July 2014 and September 2015. Patients who were younger than 75 years of age at surgery, who could ambulate without a walker, who were n...

Musculoskeletal infections (MSKI) remain the bane of orthopedic surgery, and result in grievous illness and inordinate costs that threaten healthcare systems. As prevention, diagnosis, and treatment has remained largely unchanged over the last 50 years, a 2nd International Consensus Meeting on Musculoskeletal Infection (ICM 2018, https://icmphilly.com) was completed. Questions pertaining to all areas of MSKI were extensively researched to prepare recommendations, which were discussed and voted on by the delegates using the Delphi methodology. The questions, including the General Assembly (GA) results, have been published (GA questions). However, as critical outcomes include: (i) incidence and cost data that substantiate the problems, and (ii) establishment of research priorities; an ICM 2018 research workgroup (RW) was assembled to accomplish these tasks. Here, we present the result of the RW consensus on the current and projected incidence of infection, and the costs per patient, for all orthopedic subspecialties, which range from 0.1% to 30%, and $17,000 to $150,000. The RW also identified the most important research questions. The Delphi methodology was utilized to initially derive four objective criteria to define a subset of the 164 GA questions that are high priority for future research. Thirty-eight questions (23% of all GA questions) achieved the requisite > 70% agreement vote, and are highlighted in this Consensus article within six thematic categories: acute versus chronic infection, host immunity, antibiotics, diagnosis, research caveats, and modifiable factors. Finally, the RW emphasizes that without appropriate funding to address these high priority research questions, a 3rd ICM on MSKI to address similar issues at greater cost is inevitable. ICM, International Consensus Meeting; MSKI, musculoskeletal infections; RW, research workgroup. * 2018 ICM RW consensus on the current and projected incidences of infection, and costs per patient, for all orthopedic subspecialties. These estimates, which were compiled from information were obtained from: (i) recent peer-reviewed publications, (ii) analysis of 2015 national administrative data using HCUPNet (https://hcupnet.ahrq.gov/#setup), and (iii) RW expertise. 998 SCHWARZ ET AL.

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Background:Culture-negative periprosthetic joint infection (PJI) is a challenging condition to treat. The most appropriate management of culture-negative PJI is not known, and there is immense variability in the treatment outcome of this condition. The purpose of this study was to elucidate the characteristics, outcomes, and risk factors for failure of treatment of culture-negative PJI.Methods:A retrospective review of 219 patients (138 hips and 81 knees) who had undergone surgery for the treatment of culture-negative PJI was performed utilizing a prospectively collected institutional PJI database. PJIs for which the results of culture were unavailable were excluded. An electronic query and manual review of the medical records were completed to obtain patient demographics, treatment, microbiology data, comorbidities, and other surgical characteristics. Treatment failure was assessed using the Delphi consensus criteria.Results:The prevalence of suspected culture-negative PJI was 22.0% (219 of 996), and the prevalence of culture-negative PJI as defined by the Musculoskeletal Infection Society (MSIS) was 6.4% (44 of 688). Overall, the rate of treatment success was 69.2% (110 of 159) in patients with >1 year of follow-up. Of the 49 culture-negative PJIs for which treatment failed, 26 (53.1%) subsequently had positive cultures; of those 26, 10 (38.5%) were positive for methicillin-sensitive Staphylococcus aureus. The rate of treatment success was greater (p = 0.019) for patients who had 2-stage exchange than for those who underwent irrigation and debridement.Conclusions:The present study demonstrates that culture-negative PJI is a relatively frequent finding with unacceptable rates of treatment failure. Every effort should be made to isolate the infecting organism prior to surgical intervention, including extending the incubation period for cultures, withholding antibiotics prior to obtaining culture specimens, and possibly using newly introduced molecular techniques.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

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