Introduction \"When can I fly after my hip or knee replacement?\" is a question frequently encountered by surgeons. Both air travel and arthroplasty increase the risk of venous thromboembolism (VTE); however, few studies examine the risk of air travel following arthroplasty. This study aimed to review the advice given to patients by surgeons, airlines, and insurance providers about flying after arthroplasty. We also review the current literature and available guidelines. Materials and methods A survey was sent to consultants with a special interest in hip or knee arthroplasty at 14 hospital trusts in the United Kingdom (UK) asking how long they would advise patients to avoid flying after surgery. We contacted all UK commercial airlines asking if they imposed any limitations on flying after arthroplasty. We contacted 15 UK insurance providers to determine whether they would provide insurance coverage following arthroplasty. Results A total of 110 knee surgeons and 105 hip surgeons were contacted. The response rate was 42% for hip surgeons and 44% for knee surgeons. Advised time to avoid flying varied widely from 14 to 180 days. A total of 22 airlines were contacted, and the response rate was 63% (n=14). Five airlines would not allow passengers to fly following arthroplasty and seven airlines required certification from a doctor. Fifteen insurance providers were contacted and the response rate was 73% (n=11). Seven insurance providers had restrictions on providing cover to passengers after arthroplasty. Conclusion Advice given to patients by surgeons, airlines, and insurance providers about flying following arthroplasty varies greatly. There is an absence of evidence-based guidelines to inform such advice. Further study is required to provide the evidence on which to base such advice. Therefore, we recommend that surgeons exercise caution when providing advice to patients.

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In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.
2020年，美国髋关节和膝关节外科医师学会（AAHKS）、美国区域麻醉和疼痛医学学会（ASRA）、美国骨科医师学会（AAOS）、美国髋关节协会（THS）、美国膝关节协会（TKS）联合制定了在初次人工全关节置换术（total joint arthroplasty，TJA）中使用阿片类药物的临床实践指南。该指南针对阿片类药物在初次TJA中与有效性和安全性相关的一些常见且重要问题制定了推荐意见。本文对该指南进行解读，以期为临床医师的治疗决策提供帮助。.

OBJECTIVE: The associated patient morbidity and resource-intensive nature of managing surgical site infections (SSI) has focused attention toward not only improving treatment protocols but also enhancing preventative measures. The purpose of this review was to summarize the relevant updated CDC guidelines for the prevention of SSI that were released in 2017. The CDC recommends the integration of the guidelines for improvement in quality metrics, reportable outcomes, and patient safety.
RESULTS: The updated guidelines include generalized recommendations for parenteral antimicrobial prophylaxis, non-parenteral antimicrobial prophylaxis, glycemic control, normothermia, oxygenation, and antiseptic prophylaxis. The arthroplasty section includes recommendations for blood transfusion, systemic immunosuppressive therapy, and antibiotics during drain use. There was low-quality evidence precluding recommendations for preoperative intra-articular corticosteroid injections, orthopedic surgical space suits, and biofilm management. The recommendations provided throughout this review, including more recent guidelines from other organizations such as the AAOS and ACR, should assist clinicians in developing and/or refining surgical site prevention protocols for their patients undergoing total joint arthroplasty procedures.

BACKGROUND: The development of Deep Vein Thrombosis (DVT) is a major concern following orthopaedic surgery. No study has yet to compare the rate and risk factors for DVT between total joint and orthopaedic trauma patients. To evaluate if DVT prophylaxis for trauma should differ from total joints, we explored the rate and risk factors for DVT between both cohorts.
METHODS: Using a CPT code search from 2005 to 2013 in the ACS-NSQIP database, 150,657 orthopaedic total joint patients and 44,594 orthopaedic trauma patients were identified. DVT complications, patient demographics, preoperative comorbidities, and surgical characteristics were collected for each patient. A chi-squared test was used to compare the risk factors for DVT between orthopaedic trauma and total joint patients. A multivariable logistic regression model was built to adjust for comorbidities for each cohort.
RESULTS: The rate of DVT diagnosis in the total joint population was 0.8% (N = 1186) and 0.98% (N = 432) in the orthopaedic trauma population (p = 0.57). After controlling for individual comorbidities, dyspnea, peripheral vascular disease, and renal failure were significant risk factors for DVT in total joint patients (p < 0.05), whereas age, ascites and steroid use were significant risk factors for DVT in orthopaedic trauma patients (p < 0.05).
CONCLUSIONS: Historically, the risks for DVT in total joints have been emphasized, yet based on our results, the incidence of DVT is the same for orthopaedic trauma. However, the risk factors varied. It is therefore important to consider specialty-specific DVT prophylaxis for orthopaedic trauma patients in order to improve care and reduce postoperative complications.

There are no core outcome domain or measurement sets for Total Joint Replacement (TJR) clinical trials. Our objective was to achieve an International consensus by orthopaedic surgeons on the OMERACT core domain/area set for TJR clinical trials.
We conducted surveys of two orthopaedic surgeon cohorts, which included (1) the leadership of international orthopaedic societies and surgeons (IOS; cohort 1), and (2) the members of the American Academy of Orthopaedic Surgeons\' Outcome Special Interest Group (AAOS-Outcome SIG), and/or the Outcome Research Interest Group of the Orthopaedic Research Society (ORS; cohort 2). Participants rated OMERACT-endorsed preliminary core area set for TJR clinical trials on a 1 to 9 scale, indicating 1-3 as domain of limited importance, 4-6 being important, but not critical, and 7-9 being critical.
Eighteen survey participants from the IOS group and 69 participants from the AAOS-Outcome SIG/ORS groups completed the survey questionnaire. The median (interquartile range [IQR]) scores were seven or higher for all six proposed preliminary core areas/domains across both groups, IOS and AAOS-Outcome SIG/ORS, respectively: pain, 8 [8, 9] and 8 [7, 9]; function, 8 [8, 8] and 8 [7, 9]; patient satisfaction, 8 [7, 9] and 8 [7, 8]; revision surgery, 7 [6, 9] and 8 [6, 8]; adverse events, 7 [5, 8] and 7 [6, 9]; and death, 7 [7, 9] and 8 [5, 9]. Respective median scores were lower for two additional optional domains: patient participation, 6.5 [5, 7] and 6 [5, 8]; and cost, 6 [5, 7] and 6 [5, 7].
This study showed that two independent surveys dervied from three groups of orthopaedic surgeons with international representation endorsed a preliminary/draft OMERACT core domain/area set for Joint Replacement clinical trials.