Listen to the full episode at ESPN West Palm Tonight. 

HSS researchers found that patients form these expectations from a variety of sources, often drawing on more than one. The most common influence was hearing about successful outcomes from friends, family members or others who had undergone knee replacement. Patients also cited their own positive experiences with past orthopedic procedures, conversations with their surgeon, information they found online and a general sense of optimism about their recovery.

The findings suggest that expectations before knee replacement are shaped not only by medical information, but also by personal experiences, social networks and mindset. By better understanding where patients’ expectations come from, clinicians may be able to have more meaningful conversations before surgery and help patients develop realistic expectations about recovery and outcomes.

This prospective preoperative cohort included 232 patients who completed a validated 19-item expectations survey, the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR), and the Positive and Negative Affect Schedule (PANAS). 

Read the full article at ovid.com. 

The traditional Coronal Plane Alignment of the Knee (CPAK) classification describes nine knee phenotypes based on constitutional limb alignment and joint line obliquity. While widely recognized, variability in phenotype definitions and uncertainty regarding its surgical application have limited its clinical utility.

In this study, researchers leveraged a validated deep learning model to automatically analyze full-limb radiographs from 972 patients (1,944 knees), accurately extracting key alignment measurements at scale. This AI-driven approach enabled a comprehensive evaluation of knee phenotypes and facilitated the development of a simplified Modified CPAK classification system designed to improve consistency, accuracy, and clinical decision-making.

Key findings demonstrated that more than 99% of knees can be categorized into just five clinically relevant phenotypes. Knee alignment followed a consistent pattern, with varus alignment primarily driven by the tibia and valgus alignment predominantly driven by the femur.

The Modified CPAK provides a surgically relevant framework for assessing knee alignment and supports alignment-based treatment strategies. By improving the understanding of individual knee anatomy, this approach represents an important step toward personalized arthroplasty, enabling surgeons to tailor alignment decisions to each patient's unique phenotype and ultimately enhance patient care.

Read more at sciencedirect.com.  

The Long Island resident says sports are a vital part of his life. He has an activity for every season and most days of the week. Sailing, sculling, tennis, bicycling, snow skiing and open-water swimming keep him busy year-round.

So, when he developed arthritis, he wasn’t about to let that stop him. “In my late 30s I felt the first twinge of pain in my right hip. Within a couple of years, it had worsened to the point that I needed care. I was told that I had arthritis likely from one of two serious falls as a young man,” he explained. “Because I was still young and active, I held off surgery until I hit 50, by which time I was using a cane.” He had his first hip replacement at HSS more than 20 years ago, and it’s still holding up.  

Years later, at age 66, he felt the same pain in his other hip, and he had a second hip replacement at HSS. This time, with advances in surgical technique and technology, the former attorney says, “I was up and about the following day, and in six weeks I had forgotten all about it.”

“More aging meant more arthritis,” he explained, and in 2024 he had both knees replaced in two separate surgeries by Fred D. Cushner, MD, a knee and hip surgeon at HSS. Four months after his second knee replacement, he went skiing in Vermont. "I am now back to all my activities, and best of all, just being able to walk around town without pain,” added Mr. Hanlon.

Read the full article at newswise.com. 

Dr. Mayman is one of the nation’s leading experts in robotic-assisted and computer-navigated hip and knee replacement surgery. Widely recognized for advancing precision joint replacement, his work focuses on integrating robotics, computer-assisted technologies and personalized surgical planning to improve outcomes for patients undergoing hip and knee arthroplasty.

A member of the prestigious Hip Society and Knee Society, Dr. Mayman is also known for his translational research efforts that bring emerging technologies from the laboratory into clinical practice. He specializes in primary and revision joint replacement, minimally invasive hip and knee surgery, partial knee replacement and the treatment of arthritis in younger, active patients, helping shape the future of technology-driven joint reconstruction.

Read the full article at beckersasc.com. 

In an episode of Live Yes! With Arthritis, a podcast by the Arthritis Foundation, David J. Mayman, MD, Chief of the Adult Reconstruction and Joint Replacement Service at HSS, discusses the different types of joint surgeries, when to consider surgery — and why you might not want to delay it, as you might have 10 years ago. 

Find out what to expect, how to prepare and what to look for to make your surgery experience as successful as possible — so you can get back to living your life with less pain and more mobility. 

Listen to the full episode at arthritis.org. 

Dr. Ast is nationally recognized for advancing rapid-recovery, short-stay and outpatient joint replacement surgery. 

An expert in robotic-assisted hip and knee replacement, he has helped develop and scale outpatient joint replacement programs and innovative surgical technologies focused on improving recovery and patient outcomes. Dr. Ast is widely respected for his leadership in ambulatory joint replacement strategy, orthopedic innovation and technology-driven care models.

Read the full article at beckersasc.com.

It's hard to sell pro athletes on a knee replacement. Olympic skiing champion Lindsey Vonn underwent a partial knee replacement in 2024 after years of chronic pain and multiple surgeries even after retiring from competition.

The robotic-arm-assisted technology used by Dr. Roche enabled him to scan her knee, remove the damaged bone in a minimally invasive way and then seal all the cracks and pockets with titanium implants. The robots keep getting more precise, and the titanium keeps getting more durable, but the real breakthrough was using the technique on a pro athlete in the first place. A few months later, during physical therapy, Vonn did a single-leg box jump on her right leg, and “I cried because I hadn’t done that in 10 years,” she said.

Read the full article at nytimes.com. A subscription is required to access. 

The piece focuses on the importance of hospital reliability and quality transparency; and how patients can evaluate surgeons and hospitals using objective performance data before making important decisions about their care. 

“Americans commonly check restaurant reviews and ratings to make sure they don’t get a bad meal. It should be just as common for patients to compare their physicians and hospitals before undergoing a major procedure. And it’s up to the healthcare system to start proactively providing that evidence. Patients deserve nothing less,” said Dr. Bostrom.

Read the full article at fortune.com. A subscription is required to access. 

“Surgeon volume at our institution was not predictive of periprosthetic joint infection and superficial surgical site infection,” said Dr. Westrich. “It was all of our infection prevention work that is done through the Infection Control Committee and everything we do while the patient is in the hospital.”

“Other hospitals can take this and understand that it is not just surgeon volume,” he continued. “If you have a robust program to prevent infection, that is the driving force.”

Read the full article at healio.com.

Brian Chalmers, MD, hip and knee surgeon at HSS shared, "With more people taking this hormone than ever, and (knee replacement) surgeries expected to exceed 1 million per year by 2030, we wanted to dive deeper into the question of testosterone’s post-surgical effects.” 

Patients who took testosterone within a year of their surgery had a higher risk of infection, blood clots, kidney damage, pneumonia and knee instability after the procedure, researchers reported.

Read the full article at usnews.com.

Matthew S. Austin, MD, hip and knee replacement surgeon at HSS, told Healio about results presented at the American Academy of Orthopaedic Surgeons Annual Meeting. “This study sheds light on the fact that if someone says they have an allergy to an iodine-related product one should not automatically avoid its use,” he said. Dr. Austin and colleagues retrospectively reviewed data from 3,696 patients who reported an allergy to iodine, iodine-containing products or shellfish who either did (n = 1,378) or did not (n = 2,318) receive an iodine-based product during primary TJA. 

“Instead of a blanket policy of if a patient says they have an allergy to an iodine-based product, they cannot receive any iodine-based product, institutions can have a protocol in place where you look at the patient’s history,” Dr. Austin continued. “What is the patient saying the reaction was? How severe was the reaction? How far in the past? Have they safely received an iodine-related product in the interim since they discovered they had this allergy? Putting appropriate pathways and protocols in place will allow many patients to receive an iodine-based product, which may reduce their risk for having an infection from the procedure.”

Read the full article at healio.com.

Read the full article at nytimes.com. 

Read the full article at healio.com. 

Senior author William Long, MD, hip and knee surgeon at HSS, explained, “We looked at the 40-year outcomes of a cohort of 88 young patients who underwent total knee replacement for osteo and post-traumatic arthritis between 1977 and 1992.”

“The most important results are as follows,” noted Dr. Long. “There was a very low rate of complications in these young patients. Patients all experienced an increased level of function following total knee replacement that was sustained over the 40-year timeframe of this study.”

Read the full article at ryortho.com.

“During the last decade or so, we have gained increasing awareness of the importance of understanding the social determinants of health and its implications on outcomes after hip and knee arthroplasty. The transition to shorter hospital stays and ambulatory hip and knee replacement have further highlighted this importance. This study uses non-familial primary contacts as a proxy for a patient’s lack of any direct relatives available to assist with care immediately following surgery. While this may not be perfectly accurate, it appears a reasonable way to evaluate the subject and provides some fascinating, albeit not unexpected, results,” explained Dr. Ast. 

Read the full article at healio.com. 

Billy I. Kim, MD, orthopedic surgery resident at HSS and colleagues performed a study of data from patients with morbid obesity (BMI of 40 kg/m² or more) who underwent primary TKA between January 2010 and October 2022.

Dr. Kim and colleagues compared outcomes between two matched cohorts of patients who filled a prescription for a GLP-1 within at least 90 days before and after surgery and patients who did not use GLP-1s. Overall, 2,975 patients in each cohort were available at 90-day follow-up and 1,766 patients in each cohort were available at 2-year follow-up.

In addition, Kim and colleagues compared outcomes with a cohort of patients with severe obesity (BMI of 35 kg/m² to 39.9 kg/m²). Among this cohort, 5,949 patients were available at 90-day follow-up and 3,530 patients were available at 2-year follow-up.

Among patients with morbid obesity, patients who were taking GLP-1s had a significant decrease in rates of periprosthetic joint infections (1% vs. 1.8%), medical complications (10.6% vs. 12.7%) and readmissions (5.3% vs. 8.9%) compared with patients who were not taking GLP-1s at 90 days. No differences were found in rates of surgical complications between these cohorts at 2-year follow-up.

“It is important to stress that these preliminary results should be interpreted with caution. Association does not imply causation, and the mechanism of action of these agents on complication reduction remains unclear,” Gwo-Chin Lee, MD, hip and knee surgeon at HSS, said. “Weight reduction, improved glycemic control or a combination of both may be at play. Additionally, due to the current cost and limited accessibility of these agents, patient socioeconomic factors may also contribute to these outcomes.”

Read the full article at healio.com. 

Dr. Carli said more research needs to be done on the use of robotics and computer navigation in longer and more technically challenging procedures to see if the technologies contribute to an increase in complications. In addition, he said more work needs to be done to see if robotics and computer navigation lead to meaningful reductions in hip dislocations, dissatisfaction, and residual pain after TKA. 

Read the full article at healio.com. 

“All of these things are useful to know subsequently for cost analyses and patient benefits, but we can at least say with some confidence that computer navigation and robotic assistance do not put the patient at risk of having a higher risk for surgical site infections,” Alberto V. Carli, MD, hip and knee surgeon at HSS. 

Dr. Carli and colleagues retrospectively reviewed data for patients who underwent either primary total hip (n = 12,726) or knee (n = 11,727) arthroplasty between 2018 and 2021 at HSS. Patients were grouped based on whether they had conventional, computer-navigated, or robotic-assisted surgery.

Results showed computer-navigated and robotic-assisted THAs had longer operative times by 3 and 11 minutes, respectively, compared with conventional THA. Researchers found this difference to be significant. Although robotic-assisted TKA had a significantly longer operative time by 14 minutes compared with conventional TKA, researchers found surgical times were similar between the computer navigation and conventional TKA groups.

Read the full article at healio.com. 

Researchers found that patients with nickel allergies who received nickel-free implants had similar revision rates as those without nickel allergies. Led Dr. Chalmers, the study compared patients based on various factors and found no significant differences in revision rates, reoperation rates, satisfaction, or patient-reported outcomes between those with and without nickel allergies. These findings, presented at the American Academy of Orthopaedic Surgeons Annual Meeting, suggest that nickel allergies do not affect TKA outcomes.

Read the full article at healio.com. 

“Data points generate these recovery curves. Now I can actually see how people are doing compared to everyone else early on. The best thing I learned is how to best use the data. Log on, look for the outliers, then call to see how they are doing,” explained Dr. Cushner. 

Listen to the podcast at theshelbournekneecenterpodcast.podbean.com.

Historically, posterior stabilized and cruciate-retaining knee bearings have been popular bearing types among orthopedic surgeons for total knee arthroplasty.

Data from the 2022 American Joint Replacement Registry Annual Report showed posterior stabilized implants were used in more than half of all primary TKA procedures until 2019 when the rate decreased to less than 50%, while cruciate-retaining designs increased annually since 2016, reaching 49.7% in 2021.

However, the report also showed the use of ultracongruent components increased 57% between 2012 and 2021. With the advent of more conforming, polyethylene bearing types, such as medial congruent, medial pivot and ultracongruent bearings, sources who spoke with Healio | Orthopedics Today suggested the kinematic and design changes in newer implants may alter TKA bearing usage patterns, as well as the future of total knee replacements.

“Implants themselves have greatly improved over the years,” said Dr. Haas. “The implants are now more anatomically shaped so they look more like the patient’s anatomy that we are replacing.”

Read the full article at healio.com. 

To assess potential disparities in transfusion rates for total joint arthroplasty between Black and white patients, researchers retrospectively analyzed data from 5,435 patients who underwent TKA and 2,105 patients who underwent THA from 2013 to 2021. According to the study, 67.1% of patients who underwent TKA and 69.8% of patients who underwent THA were white. Overall, transfusion rates were 2.9% in the TKA group and 3.1% in the THA group.

Researchers noted transfusion rates declined during the study period. “However, the rate of decline is not proportional across demographic groups, and being Black is associated with a significantly increased risk of transfusion for TKA patients but not for THA patients,” the investigators wrote. Black patients had higher rates of transfusion for TKA (5.1% vs. 1.8%) and THA (4.1% vs. 2.7%) compared with white patients despite similar hemoglobin levels between the groups.

“As someone who has spent much of my career evaluating disparities at the health system level, it is heartening to see that electronic health records have become robust enough to add important clinical detail to large-scale statistics analyses. In the case of Shelby H. Meckstroth, MPH and colleagues, the addition of hemoglobin and creatinine levels to a study of health disparities in joint arthroplasty allows for a more reliable estimate of the isolated effect of race and/or ethnicity. As a result, we can see that Black patients were more likely to receive a transfusion after joint arthroplasty than their white counterparts independent of clinical characteristics, such as comorbidities, hemoglobin levels or creatinine levels. This suggests that wide racial disparities continue to exist despite clear clinical practice guidelines. Whether this reflects conscious or unconscious bias (or an, as yet, unmeasured or unmeasurable bit of clinical nuance) remains to be investigated by future study teams,” said Dr. Lyman. 

Read the full article at healio.com. 

Although total knee arthroplasty has been commonly performed with cemented fixation, research has shown an increase in cementless fixation during the years.

The American Joint Replacement Registry showed cementless fixation was used in more than 14% of primary TKAs in 2020, while the Swedish Knee Arthroplasty Registry and National Joint Registry reported an increase in the use of cementless fixation of 8% and 4.2%, respectively.

Primarily performed in relatively sedentary older patients, the indications for TKA have expanded to include patients aged 65 years and younger. While cemented TKA may provide long-term survivorship in older patients, Dr. Westrich said younger patients had higher revision rates with cemented TKA possibly due to increased activity levels. Previously published research using radiostereometric analysis also has shown that patients who underwent TKA with cemented fixation had stability at 1-year follow-up but implant migration at 10-year follow-up, which is an indication of potential loosening, according to Westrich. He said this differed from patients who underwent TKA with cementless fixation.

“At 1 year, there may be a bit of settling in [with cementless fixation], but [the implants] are rock solid at year 10,” Dr. Westrich said.

Read the full article at healio.com. 

Patients with moderate to severe osteoarthritis (OA) or osteonecrosis (ON) eligible for total joint arthroplasty (TJA) who have failed one or more nonoperative therapies should proceed directly to surgery, according to the new guideline. 

"One of the reasons for creating this guideline was that many patients have been subjected to delays for surgery after completing nonoperative therapy, despite persistent moderate to severe pain, loss of function, and moderate to severe radiographic OA or ON," said co-authors Susan M. Goodman, MD,  rheumatologist at HSS, and Charles Hannon, MD, orthopedic surgeon at Washington University. "This guideline supports surgery being performed in an expeditious fashion after the decision has been made to proceed with surgery by both the physician and patient through a shared decision-making process," they said.

Read the full article at medscape.com. 

Certain PROMs are knee-specific and can provide an estimate of overall knee health, or the severity of the knee pathology, from the patient’s perspective. These instruments can be used to identify what patients consider clinically meaningful change – a personal threshold that can help determine if an intervention is appropriate or if less invasive treatment is warranted. If, for example, a patient reports their knee is a 4 on a 10-point scale, where a 10 is a “perfect knee”, total knee arthroplasty would appear to be a good option because surgery is likely to improve that score significantly.  However, a patient with the same radiographic findings may report their knee as an 8 out of 10, and for such a patient, surgery is not likely to result in a meaningful marginal improvement.

Recent research has shown that these measures are somewhat predictive of success or failure of knee replacement and can be used to measure the therapeutic benefit of various treatments for knee arthritis. Two PROMs instruments, knee injury and osteoarthritis outcome score (KOOS) and a shorter version called KOOS JR, were developed by researchers at HSS specifically for patients with knee osteoarthritis. The seven-item KOOS JR, which has been shown to be a robust and valid alternative to the longer iteration of the questionnaire, collects information on pain, stiffness, function in the joint and other parameters. The resulting composite score is highly predictive of how well patients respond to knee replacement surgery. 

Using PROMs for knee patients takes relatively little time. The KOOS JR questionnaire can be administered in just a few minutes by the patient prior to their appointment or even in the office setting. Clinicians can then use these reports to guide patients through their decision process and help them determine when a surgical intervention may be right for them individually. Doing so will not only educate them about their particular condition but also raise the likelihood that they will not be surprised by the outcome of their treatment.

Citing added time, cost, additional staffing requirements and other concerns – regulators and insurers have welcomed the instruments as important potential indicators of quality care. The collection of PROMs data is now routinely mandated by both public and private entities. Though these assessments may add some administrative burden, understanding how they work and how they can benefit both patients and physicians is essential.

However, experts agree that using PROMs on their own to measure quality of care or to guide reimbursement for services is premature. Indeed, no study to date has shown that using PROMs preoperatively is linked to improved outcomes for patients. That question is now the focus of a large randomized controlled trial at HSS. PROMs data – at least for the time being – should be one of many datapoints, including clinician assessment, radiographic imaging, and other measures such as range of motion. 

At present, data from even the most robust PROMs contain a certain amount of noise. Tension exists between the minimal clinically important change in a patient’s condition and the substantial clinical benefit they may experience from an intervention. And significant gaps in the understanding of PROMs remain. Too little is known, for example, about how these instruments perform across different populations of patients or how a person’s native language affects responses to a questionnaire written in English. Meanwhile variables such as age, sex and body mass index can influence results in ways that are not fully understood.

There is a lot of potential for PROMs to improve patient selection, enhance patient-involvement in decision making and allow for better delineation between different treatment options. 

- Alexander S. McLawhorn, MD, MBA, and Elizabeth B. Gausden, MD, MPH, hip and knee surgeons at HSS

Smart implants can provide continuous postoperative data and allow surgeons to take better care of their patients, according to Dr. Cushner.

“We have preoperative data with questionnaires and patient-reported knee scores. Intraoperatively, we have robotic data, how we put the knee in, and now we are collecting better postoperative data,” he said. “We will be able to correlate it all to see what is the best way [to treat patients] and even see if, perhaps, there is no one ‘sweet spot’ for everybody.”

Read the full article at https://www.healio.com/. 

Read the full article: https://www.beckersspine.com/.

Research highlights include the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic,  a community-based participatory research approach to assess musculoskeletal health needs, the way in which ultraviolet (UV) exposure triggers immune activation and disease flares in lupus, trends in the use of total knee arthroplasty (TKA) in patients under the age of 21 in the United States (U.S.), and insights that may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS Rheumatologists, Social Worker Honored by American College of Rheumatology
The ACR and ARP have honored HSS rheumatologists Michael D. Lockshin, MD, Melanie H. Smith, MD, PhD and social worker Adena Batterman, LCSW, MSW, with prestigious awards at the ACR Convergence meeting on November 12. Each year, the ACR and ARP recognize members who have made outstanding contributions to the field of rheumatology.

Participation Doubles After Lupus Support Group at HSS Transitions to Virtual Format During Pandemic
An HSS study presented by Giselle Rodriguez, LCSW, social work program coordinator for Charla de Lupus (Lupus Chat)®, highlighted the success of a lupus peer support and education group that transitioned to a virtual format during the COVID-19 pandemic. In addition to receiving high marks from group members, participation more than doubled after the meetings went remote. 

Study Finds Chronic-Pain Management, Falls and Limited Access to Care Are Critical Issues Among Medically Underserved
Titilayo Adeniran, MPH, director of outcomes & data analytics at the HSS Education Institute and colleagues implemented a community-based participatory research approach to assess musculoskeletal health needs, identify health disparities and support the development of initiatives to address unmet needs. Critical issues included a lack of health education and awareness in managing arthritis and other painful conditions; a high incidence of falls in the community; and limited access to care among underserved populations. Findings will help to raise awareness about disparities that continue to affect diverse and underserved populations and the development of community-based initiatives to promote health equity.

HSS Research Uncovers How UV Light Triggers Immune Activation and Disease Flares in Lupus
A study by HSS scientist Theresa T. Lu, MD, PhD and former fellow William Ambler, MD, examined the way in which UV exposure triggers immune activation and disease flares in lupus. Results found an underlying mechanism that explains this association: decreased lymphatic drainage, which contributes to both photosensitivity and an immune response in the lymph nodes. The research also suggests that boosting lymphatic drainage may be an effective treatment for lupus photosensitivity and autoimmunity.

Study Examines Total Knee Replacement in Patients Under 21
HSS rheumatologist Bella Mehta, MBBS, MS, hip and knee surgeon Cynthia A. Kahlenberg, MD, MPH, and colleagues evaluated trends in the use of TKA in patients under 21 years old in the U.S. The researchers retrospectively analyzed the Kids’ Inpatient Database (KID), a national weighted sample of all inpatient hospital admissions of patients under 21 years of age in approximately 4,200 hospitals in 46 states. They also used International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes to identify patients undergoing TKA from 2000-2016 and determine primary diagnosis. 70.3% of TKAs were performed for a primary diagnosis of a tumor; and the number of TKAs for malignant tumors increased slightly over the study period. In contrast, use of TKA for inflammatory arthritis / juvenile idiopathic arthritis (JIA) decreased by more than 70% over the study period, likely due to improvements in medical management of inflammatory arthritis /JIA patients.

Mast Cell Levels May Explain Sex Differences in Osteoarthritis Pain
A study by HSS rheumatologists Dana Orange, MD, MS, Bella Mehta, MBBS, MS, and colleagues discovered that at the time of total knee replacement, women have significantly increased levels of immune cells called mast cells in synovial tissue surrounding the knee joint than men. The findings may help future research explore why women with knee osteoarthritis report worse pain than men.

HSS sports medicine surgeon and study co-author Sabrina M. Strickland, MD, noted, “We know that any type of knee surgery, especially an arthrotomy, can cause scarring and patella baja (an abnormally low lying patella, which is associated with restricted range of motion). I hypothesized that after a patellofemoral arthroplasty, patients may have scarring of their patellar tendon and/or fat pad leading to a decrease in patellar height.”

She continued, “I think the most important finding of this study was that 73% of patients undergoing patellofemoral arthroplasty actually had patella alta [a high patella]. We know this is a risk factor for patellofemoral arthritis and this is just another data point that suggests that potentially, realignment at a young age may prevent this.”

Dr. Strickland concluded, “I was surprised by how many patients with end-stage patellofemoral arthritis still were patella baja as I would have guessed that their patellar tendons would have contracted over time. We did not observe significant postop reduction in patellar height which suggests that those with severe patella alta may benefit from tibial tubercle distalization to optimize tracking.”

Read the full article at Ryortho.com.

Dr. Cushner explained, “What we found was that, compared to wearables, this [sensor-enabled tibial stem] is a highly reliable collection device. The data is not only collected, but it is also transmitted with over 99% success, and we concluded that we can monitor patients’ walking speed, cadence and other gait parameters reliably when this device is placed.”

Dr. Cushner continued, “We are focusing, right now, on recovery, but once these are [implanted] for 1 year, 2 years, 5 years, 10 years – our battery lasts 20 years – we may be able to look at gait patterns for happy patients vs. not happy patients. Who knows, we may see a certain pattern predictive of infection,”

He added, “These are all speculative, but we all know that with big data and [artificial intelligence] AI, we find out a lot of things the more patients that have this done.”

Read the full article at Healio.com.

Additional coverage: 

• Medscape.com
• Everydayhealth.com
• Healio.com

Dr. Westrich explained that navigating stairs is tough immediately after knee surgery, so consider converting a space downstairs into a bedroom for a few weeks if in a multistory home. Set up a temporary bed, or sleep on a couch or recliner. Ideally, “you need to be able to access your bed, a bathroom and the kitchen all on same level,” he noted.

He recommended a sturdy, stable go-to chair with arms to help with standing up or a recliner to elevate the leg and also advised strategically placing chairs in other rooms for a sitting break.

Dr. Westrich suggested renting an ice therapy machine that applies cold therapy along with compression, if it's possible. “A lot of my patients who did one knee years ago and another knee more recently have said emphatically that having an ice machine, they noticed a huge difference in their recovery,” he cited.

Read the full article at AARP.org.

The study was presented at the American Academy of Orthopaedic Surgeons (AAOS) 2021 annual meeting by authors Fernando Quevedo-González, PhD, assistant scientist, and Michael P. Ast, MD, hip and knee surgeon and chief medical innovation officer. The authors said the goal of the study was to evaluate the “biomechanical justification” of cones in revision TKA.

Dr. Quevedo-Gonzalez explained the impetus for the study, “Despite the widespread use of metaphyseal augments, like cones, to supplement fixation in revision TKA, few studies have explored their biomechanical behavior as a means of justifying their routine use or provided biomechanical principles that can guide their use, including the role of the use of stemmed tibial components in combination with metaphyseal cones.”

According to Dr. Quevedo-Gonzalez, on the clinical takeaway of this study, “Metaphyseal cones may help reduce the risk of implant debonding from the cement mantle compared to using cement alone to fill the defect, although both techniques can provide comparable results in contained, moderately sized metaphyseal defects. Moreover, metaphyseal cones can allow using shorter stems with comparable biomechanical behavior to longer stems.”

Read the full article at AAOS.org.

Dr. Westrich explained, “Robotic technology has continued to improve over the past several years. It has taken off, and what we published was that when we looked at a time period from 2010 to 2018, robotic knee replacement increased more than 2,000%.”

“So, there is a tremendous upswing of surgeons now using robotic assistance when they are doing a knee replacement,” he added.

Dr. Westrich noted, “Although the numbers are small, it implies that for every 100 patients who undergo robotic-assisted knee replacement, we can avoid one readmission. That is powerful for the surgeon who is taking care of the patient, powerful for the hospital or ambulatory care center because we want to try to avoid having patients readmitted, but the people that it affects the most are the patients.”

Read the full article at Healio.com/news/orthopedics.

Additional coverage:

• Beckersspine.com
• Healthday.com
• Ryortho.com

Read the full article at Liberty.wnba.com.

Value in healthcare can be loosely defined as the quality or outcomes of care divided by cost. At HSS, our approach to creating value for our patients is to provide the highest-quality care and best outcomes, but to do it in the most cost-effective way. We do this not just during the time a patient is physically in our care but also throughout the entire patient journey, from pre-admission to surgery to the return home – or, as we call it in my area of expertise, across the total episode of care.

What does it mean to choose a hospital that delivers high-value care? It’s a little like shopping in advance for a car that’s reliable versus buying one off the lot because it looks to be in decent condition. When researching a car, you may look up safety data, fuel efficiency or other factors. Similarly, there are questions you can ask hospitals to find out whether the care they provide is trustworthy.

The problem is most hospitals don’t make this information widely available, and too few patients have the information they need to ask for it in the first place. To help people make more informed decisions, we at HSS recently launched a new tool called the HSS Hospital Reliability Scorecard, which is designed to help anyone having surgery, no matter where they seek out care. The tool features five factors of reliability that indicate how consistent a hospital is at performing a given procedure. They include the following: (1) patient-reported success rate, or the percentage of patients who reported an improvement after the surgery; (2) patient experience, or the percentage of patients who would recommend the hospital, their rating on a five-star scale, and the number of patients providing recommendations; (3) rate of complications as compared to the national average; (4) number of avoidable hospital visits and the percentage of patients readmitted to the hospital within 90 days compared to the national rate; and (5) total procedure volume, or the number of surgeries the hospital performs annually and how that compares to the next leading hospital.

The five factors identified above were developed based on feedback from patients regarding the things that matter most to them when deciding where to have surgery. Patients considering a procedure should ask hospitals that they are considering about how they perform on these five factors and compare how the different hospitals perform.

Another factor not represented on the HSS Hospital Reliability Scorecard that I urge patients to consider is the anticipated cost of the entire episode of their care, including the cost of medical services they may require after surgery. Patients may pay extra for these services, not just in dollars and cents but also with their time. For example, rehabilitation is typically required after hip or knee replacement. This may involve accessing services from home or going to a skilled nursing facility or an inpatient rehabilitation facility. Patients with their doctors should carefully consider their health needs for post-surgical care and avoid unnecessary services, which can be very costly.

Being responsible stewards of healthcare spending as providers can not just benefit our individual patients but also gives us an opportunity to improve the quality of care we provide and reduce overall costs. In a study published in the October 2021 issue of NEJM Catalyst Innovations in Care Delivery, my HSS colleagues and I showed that by providing high-quality care efficiently, HSS reduced readmissions and utilization of unnecessary intensive rehabilitation after knee and hip replacements, and at the same time saved the Centers for Medicare & Medicaid Services (CMS) millions of dollars from 2014 to 2019. These results were from our assessment of HSS’s participation in CMS bundled payment programs, called the Bundled Payments for Care Improvement Initiative and the Comprehensive Care for Joint Replacement program.

Participation in these programs has also allowed HSS to use cost savings to develop new initiatives for improving quality across the entire episode of care. For example, we implemented a health optimization program to identify patients with 11 high-risk factors that lead to worse postsurgical outcomes, such as obesity, uncontrolled diabetes and malnutrition. As a result of this program, HSS surgeons recommend counseling and physical therapy before surgery to ensure patients are as fit as possible prior to their procedure. It’s initiatives like these that can help drive down complication and readmission rates even further, which is a result that truly benefits everyone.

• Catherine MacLean, MD, PhD, Chief Value Medical Officer at the HSS Center for the Advancement of Value in Musculoskeletal Care

Dr. Cushner said, “The next game changer for orthopedics is going to be smart implants that are sensor-enabled and provide info and data. The first smart knee was implanted last week, and in time there will be smart hips, smart spine instruments, etc. Big data and AI [artificial intelligence] is going to change orthopedics!”

This coverage originally appeared in Becker's Spine Review. The original article is no longer available online.