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Learn from some of the top orthopaedic surgeons in the world! In Ask the Expert, ICJR gets answers on the hottest topics in orthopaedics from leading authorities in hip and knee replacement, shoulder procedures, and sports medicine.

Current Articles

How Do Outcomes Compare in Younger Versus Older Revision TKA Patients?
Dr. James Keeney answers ICJR’s questions about a study in which he and his colleagues evaluated preoperative surgical indications, timing of the aseptic revision, and outcomes of revision total knee arthroplasty in younger patients compared with older patients.
By James A. Keeney MD - Posted 09 Dec 2021

Is Total Shoulder Arthroplasty Appropriate for Patients Under Age 60?
Dr. Paul Cagle and Dr. Brad Parsons answer ICJR’s questions about their study evaluating long-term survivorship in patients with glenohumeral osteoarthritis who were younger than age 60 at the time of total shoulder arthroplasty.
By Bradford O. Parsons, MD, Paul J. Cagle MD - Posted 02 Dec 2021

How Soon Is Too Soon for Revision THA to Treat Instability?
Dr. Nathanael Heckmann and Dr. Craig Della Valle answer ICJR’s questions about their study that investigated whether the amount of time between the index total hip arthroplasty and a revision procedure for instability is associated with an increased risk of complications.
By Craig J. Della Valle MD, Nathanael D. Heckmann MD - Posted 01 Dec 2021

Are Radiographs Necessary at 1 Year After Routine, Uncomplicated TJA?
Dr. Nicolas Noiseux answers ICJR’s questions about his study that examined whether routine radiographs obtained 1 year postoperatively are necessary for clinical management of total hip and total knee arthroplasty patients and whether these patients are even showing up for their follow-up visits.
By FRCSC, MD, MS, Nicolas O. Noiseux - Posted 29 Nov 2021

What Are the Ramifications of Delaying rTSA in Proximal Humerus Fracture Patients?
Dr. Lewis Shi answers ICJR's questions about a study he co-authored that evaluated outcomes of acute versus delayed primary reverse total shoulder arthroplasty – including revision rates and medical and surgical complications – in more than 5000 older patients with a proximal humerus fracture.
By Lewis L Shi MD - Posted 15 Nov 2021

What Causes Failure of a 2-Stage Exchange for PJI?
Dr. Omar Behery and Dr. Scott Sporer answer ICJR’s questions about the organisms responsible for reinfection after 2-stage exchange in hip and knee arthroplasty patients treated for a periprosthetic joint infection.
By Omar A. Behery MD MPH, Scott M. Sporer MD - Posted 15 Nov 2021

Can a Real-Component Articulating Spacer Eradicate Infection in Revision TKA?
Dr. Jenna Bernstein answers ICJR’s question about a study she co-authored that compared outcomes of a real component-based articulating spacer versus an all-cement articulating spacer in patients undergoing 2-stage revision total knee arthroplasty for periprosthetic joint infection.
By Jenna A. Bernstein MD - Posted 10 Nov 2021

How Can Surgeons Reduce Dislocations after Revision THA?
Dr. Jesus Villa and Dr. Carlos Higuera-Rueda answer ICJR’s question about their study that investigated which factors are most important in protecting against early dislocations in patients undergoing aseptic total hip arthroplasty revisions with stem retention.
By Carlos A. Higuera-Rueda MD, Jesus M. Villa MD - Posted 20 Oct 2021

How Does Aspirin Compare with Factor Xa Inhibitors for VTE Prophylaxis?
Dr. Emanuele Chisari and Dr. Javad Parvizi answer ICJR’s questions about their study on 90-day outcomes in total joint arthroplasty patients who received either a factor Xa inhibitor or aspirin to prevent post-surgery venous thromboembolism.
By Emanuele Chisari MD, Javad Parvizi MD FRCS - Posted 18 Oct 2021

Why Are Some Patients Poor Candidates for Outpatient THA?
Dr. Patawut Bovonratwet and Dr. Michael Ast answer ICJR’s questions about their study using the NSQIP database to evaluate the 30-day readmission rate following outpatient primary total hip arthroplasty, as well as the risk factors contributing to readmission.
By Michael P. Ast MD, Patawut Bovonratwet MD - Posted 12 Oct 2021

Why Are Some Patients Poor Candidates for Outpatient TKA?
Dr. Patawut Bovonratwet and Dr. Michael Ast answer ICJR’s questions about their study that evaluated the 30-day readmission rate following outpatient primary total knee arthroplasty, as well as the risk factors contributing to readmission, using the NSQIP database.
By Michael P. Ast MD, Patawut Bovonratwet MD - Posted 11 Oct 2021

Is Head and Liner Exchange an Acceptable Option for THA Revision?
Dr. Ran Schwarzkopf answers ICJR’s questions about a study in which he and his NYU Langone Orthopedic Hospital colleagues evaluated 2-year outcomes of isolated head and liner exchange versus full acetabular revision.
By MD, MSc, Ran Schwarzkopf - Posted 30 Sep 2021

What Are the Long-Term Outcomes of 2-Stage Exchange for Chronic PJI?
Dr. Beau Kildow and Dr. Bryan Springer answer ICJR’s questions about their multicenter study investigating eradication, reinfection, and mortality rates among knee and hip arthroplasty patients who were at least 5 years out from 2-stage exchange for periprosthetic joint infection.
By Beau J. Kildow MD, Bryan D. Springer MD - Posted 29 Sep 2021

Is Aspirin an Effective Way to Prevent VTE in Hip Fracture Patients?
Dr. Emanuele Chisari and Dr. Javad Parvizi answer ICJR’s questions about their study comparing outcomes in femoral neck fracture patients who received either aspirin or a more potent anticoagulant following total hip arthroplasty or hemiarthroplasty.
By Emanuele Chisari MD, Javad Parvizi MD FRCS - Posted 28 Sep 2021

Is Anatomic Total Shoulder Arthroplasty an Appropriate Treatment for Older Patients with Glenohumeral OA?
Dr. Joaquin Sanchez-Sotelo answers ICJR’s questions about a study from Mayo Clinic evaluating outcomes in patients age 70 and older who underwent anatomic total shoulder arthroplasty to treat glenohumeral osteoarthritis.
By Joaquin Sanchez-Sotelo MD PhD - Posted 27 Sep 2021

What Can Surgeons Do to Alleviate Pain in Their Post-TJA Patients?
Dr. Claudette Lajam answers ICJR’s questions about the evolution of a protocol for managing pain in total hip and total knee arthroplasty patients at NYU Langone Health.
By Claudette M. Lajam MD FAAOS FAOA FAAHKS - Posted 24 Jun 2021

What’s a Typical DVT Prophylaxis Protocol for TJA Patients?
Dr. Anna Cohen-Rosenblum answers ICJR’s questions about protocols for managing total joint arthroplasty patients at low and high risk for postoperative deep vein thrombosis/pulmonary embolism.
By Anna Cohen-Rosenblum MD MSc - Posted 07 Jun 2021

What Do Surgeons Need to Know About Pain Management After Shoulder Surgery?
Dr. Vani Sabesan answers ICJR’s questions about multimodal pain management following shoulder procedures, the role of patient education, and how state laws are changing opioid prescribing habits.
By Vani J. Sabesan MD - Posted 15 Mar 2021

Why Would Surgeons Want to Adopt Calipered Kinematic Alignment for TKA?
Dr. Stephen Howell answers ICJR’s questions about calipered kinematic alignment total knee arthroplasty, including the learning curve, how to set the femoral and tibial components, and how to reduce the risk of complications.
By Stephen M. Howell MD - Posted 14 Sep 2020

How Should Surgeons Work Up the Post-TKA Patient with Lingering Knee Pain?
Dr. Samik Banerjee and Dr. Matthew Austin answer ICJR’s questions about their algorithm for determining which of the many possible intrinsic and extrinsic causes is triggering persistent knee pain in patients who have undergone total knee arthroplasty.
By Matthew S. Austin MD, Samik Banerjee MD - Posted 25 Jun 2020

What Are the Considerations for Static vs. Articulating Antibiotic Spacers in Revision THA?
Dr. Scott Sporer answers ICJR’s questions about the types of antibiotic spacers available to surgeons performing revision total hip arthroplasty, the pros and cons of the different types of spacers, and his recipe for antibiotic cement.
By MD, Scott M. Sporer - Posted 04 Jun 2020

What Causes a Stiff Knee after TKA – and How Can It Be Prevented?
Dr. Jesse Otero answers ICJR’s questions about the most common causes of knee stiffness after total knee arthroplasty, what to do if a patient presents with stiffness, and when to consider a revision procedure.
By Jesse E. Otero, MD, PhD - Posted 28 May 2020

When Is Revision Surgery Indicated for a Patient with a Painful Metal-on-Metal THA?
Dr. Richard McCalden answers ICJR’s questions about diagnosing hip pain in patients with a metal-on-metal implant, findings that indicate the implant is the cause of the pain, and considerations for performing a revision procedure in these patients.
By Richard W. McCalden MD MPhil (Edin.) FRCSC - Posted 07 May 2020

Which Medicare Patients Undergoing TKA Should Be Inpatients versus Outpatients?
Dr. James Browne answers ICJR’s questions about the removal of total knee arthroplasty from the Medicare inpatient-only list and shares a scoring tool he and his colleagues at the University of Virginia developed to evaluate TKA patients.
By James A. Browne, MD - Posted 30 Apr 2020

How Should Surgeons Implant Articulating Antibiotic Spacers in Revision TKA?
Dr. Jeremy Gililland, Dr. Victor Carlson, and Dr. Lucas Anderson answer ICJR’s questions about their technique for building and then implanting an articulating antibiotic spacer in the first stage of revision total knee arthroplasty.
By Jeremy M. Gililland MD, Lucas A. Anderson MD, Victor R. Carlson MD - Posted 20 Apr 2020

How Should Surgeons Work Up a Patient with Instability Following THA?
Dr. Ajit Deshmukh answers ICJR’s questions about the causes of instability/dislocation in primary total hip arthroplasty patients, how surgeons can prevent instability, and when they should consider a revision procedure.
By Ajit Deshmukh, MD - Posted 16 Apr 2020

How Can Surgeons Prevent and Treat Instability in TKA Patients?
Dr. William Barrett answers questions from ICJR about the types of knee instability can develop in total knee arthroplasty patients, the steps surgeons can take to prevent instability, the workup for suspected instability, and the treatment options available.
By William P. Barrett MD - Posted 09 Apr 2020

What Are the Risks and Benefits of Simultaneous Bilateral TKA?
Dr. Stefano Bini answers ICJR’s questions about simultaneous versus staged bilateral total knee arthroplasty in his practice, including his contraindications and what he tells patients to expect.
By Stefano A. Bini MD - Posted 30 Mar 2020

How Should Surgeons Manage Symptoms of Psoas Tendinitis after THA?
Dr. Michael Taunton answers ICJR’s questions about the diagnosis, causes, and treatment options for patients who present with groin pain following total hip arthroplasty.
By Michael J. Taunton MD - Posted 23 Mar 2020

How Should Surgeons Work Up a Patient with Hip Pain Following THA?
Dr. Michael Flierl and Dr. Scott Sporer answer ICJR’s questions about intrinsic and extrinsic causes of pain after total hip arthroplasty and the stepwise approach to evaluating and diagnosing that pain.
By Michael A. Flierl MD, Scott M. Sporer MD - Posted 10 Feb 2020

What Are Your Perioperative Protocols for Primary TKA Patients?
Dr. Denis Nam, Dr. Ran Schwarzkopf, and Dr. Scott Sporer respond to questions from ICJR about perioperative management of primary total knee arthroplasty patients, including BMI cutoff, antibiotic prophylaxis, and use of tranexamic acid.
By Denis Nam MD MSc, Ran Schwarzkopf MD MSc, Scott Sporer MD MS - Posted 04 Sep 2019

What Are Your Perioperative Protocols for Primary THA Patients?
Dr. Antonia Chen, Dr. James Browne, and Dr. Jonathan Vigdorchik respond to questions from ICJR about perioperative management of primary total hip arthroplasty patients, including BMI cutoff, antibiotic prophylaxis, and the use of tranexamic acid.
By Antonia F. Chen MD MBA, James A. Browne MD, Jonathan M. Vigdorchik MD - Posted 03 Sep 2019

Is There a Preferred Position for Arthroscopic Rotator Cuff Repair?
Dr. Michael Bender and Dr. Brent Morris respond to questions from ICJR about the beach chair versus the lateral decubitus position for patients undergoing arthroscopic surgery to repair a rotator cuff tear.
By Brent J. Morris MD, Michael J. Bender MD - Posted 16 Apr 2018

Which Patients Can Be Discharged the Same Day as Surgery?
Dr. Stefan Kreuzer answers ICJR’s questions about the steps he and his staff take to ensure patients can safely return home the same day as their joint replacement procedure.
Posted 02 Apr 2018

How Should the Surgeon Treat Shoulder Instability with Bone Loss?
Dr. Josef Eichinger answers ICJR’s questions on the treatment options for patients who present with shoulder instability that is revealed to involve bipolar bone loss as well.
By Josef Eichinger MD - Posted 15 Feb 2018

What Are the Top Considerations for the Table Used in a DAA THA?
Dr. Stephen J. Nelson and Dr. Lee E. Rubin of Yale University answer ICJR’s questions about the debate over the use of an orthopaedic traction table versus a regular OR table when performing a direct anterior approach total hip arthroplasty.  
By Stephen J. Nelson MD, Lee E. Rubin MD - Posted 05 Feb 2018

Which Patients with SLAP Tears Benefit from Surgery?
Dr. Timothy Reish answers questions from ICJR about non-operative versus operative treatment options for SLAP tears, including which patients are the best candidates for a surgical procedure.
By Timothy G. Reish MD - Posted 31 Jan 2018

Is Hip Resurfacing a Viable Option for Patients with Hip OA?
Dr. George Grammatopoulos and Dr. Paul Beaulé answer questions from ICJR about their indications and experience with hip resurfacing as an alternative to total hip arthroplasty in patients with hip osteoarthritis.
By Paul Beaulé MD FRCSC, George Grammatopoulos MRCS - Posted 25 Jan 2018

What Is the Current State of Biologics for Augmenting Rotator Cuff Repairs?
Dr. Raffy Mirzayan answers questions from ICJR about the biologic options surgeons can consider to help reduce re-tears in patients with rotator cuff tears.
By Raffy Mirzayan MD - Posted 15 Jan 2018

What Are the Benefits of Using Barbed Suture?
Dr. Michael Nett answers questions from ICJR about barbed versus conventional suture material and offers tips for surgeons who want to adopt the use of barbed suture.
By Michael P. Nett MD - Posted 04 Jan 2018

Is Shoulder Arthroplasty a Good Option for Younger Patients?
Dr. Matthew Ramsey answers questions from ICJR about shoulder arthroplasty in younger patients who present with osteoarthritis.
By Matthew L. Ramsey MD - Posted 05 Dec 2017

What Are the Treatment Options for TKA Patients with a PJI?
Dr. Bryan Springer answers questions from ICJR about managing a total knee arthroplasty patient who has a deep periprosthetic joint infection, in part 2 of a 2-part series. Part 1 was published yesterday.
By Bryan D. Springer MD - Posted 29 Nov 2017

What Are the Guidelines for Working Up a Suspected PJI?
Dr. Bryan Springer answers questions from ICJR about evaluating a total knee arthroplasty patient who may have a deep periprosthetic joint infection, in part 1 of a 2-part series. Part 2 will be published tomorrow.  
By Bryan D. Springer MD - Posted 28 Nov 2017

Is Outpatient Surgery a Viable Option for Shoulder Arthroplasty?
Dr. Quin Throckmorton answers questions from ICJR on the future of shoulder replacement as an outpatient procedure.
By Thomas Quin Throckmorton MD - Posted 20 Nov 2017

What Are the Options for Managing Pelvic Discontinuity?
Dr. Christopher Melnic and Dr. Scott Sporer answer questions from ICJR about managing patients who present with acute or chronic pelvic discontinuity.
Posted 14 Nov 2017

What Are the Most Important Factors in Preop Patient Optimization?
Dr. Brian Curtin answers questions from ICJR about the key parameters surgeons should consider when optimizing patients for joint replacement surgery.
By Brian M. Curtin MD - Posted 09 Nov 2017

Should Obese Patients Undergo Bariatric Surgery before TJA?
Dr. Alexander McLawhorn answers questions from ICJR about the potential benefits of referring joint replacement patients with an elevated BMI for weight management that may include bariatric surgery.
By Alexander S. McLawhorn MD MBA - Posted 23 Oct 2017

How Should Surgeons Manage Proximal Humerus Fractures?
Dr. Michael McKee answers questions from ICJR about the options for surgical treatment of these fractures in older patients.
By Michael D. McKee MD FRCSC - Posted 12 Oct 2017

What Are the Criteria for Patient Selection with the Direct Anterior Approach?
Dr. Preetesh Patel answers questions from ICJR about how patient selection evolves as the surgeon becomes more familiar and comfortable with the direct anterior approach for total hip arthroplasty.
By Preetesh D. Patel MD - Posted 09 Oct 2017