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      Resiliency

      editorial
      , MD
      Arthroplasty Today
      Elsevier

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          Abstract

          We are now 2 years into the global COVID-19 pandemic. The Omicron variant has peaked and waned, mask mandates are relaxing, and we are gradually resuming a new normalcy in clinical operations and in our lives. The American Academy of Orthopaedic Surgeons Annual Meeting is just around the corner in Chicago, and the American Association of Hip and Knee Surgeons (AAHKS) Spring Meeting is upcoming in May in San Francisco. Soon, the American Academy of Orthopaedic Surgeons will be holding 2 Resident Courses in Arthroplasty at the Orthopaedic Learning Center in Rosemont. It feels as though a difficult period is ending, and, in a small way, we can breathe easier, worry less, and get back to our routines. Staffing has presented substantial challenges for all of us in the effort to maintain our clinical practices and was the number one problem for surgeons, according to a poll at the AAHKS Annual Meeting in November. At present, the world is transfixed on the Russian invasion of Ukraine, which has already had resulted in enormous human casualties [1], forced migration, caused disruption in global markets, and stoked fears of a potential nuclear action. We are in tumultuous times that challenge our resiliency. Take time and attention to maintain your mindfulness and personal wellness and stay aware of the toll that these stresses take on your mindset and on the mental health of your colleagues and peers. While the pandemic is hopefully waning, this issue has 2 informative articles about the impact of COVID-19 on access to surgery and the effect of vaccination status on postoperative symptomatic COVID-19 after elective arthroplasty [2,3]. Other highlights include a study looking at the effectiveness of resorbable beads in treatment of infection with debridement and implant retention [4] and another article investigating patients’ perception of their scar after different surgical approaches for hip arthroplasty [5]. I am pleased to announce the promotion of Anna Cohen-Rosenblum, MD, to the position of Social Media Editor. She assumes the reins on April 1, taking over for Jaime Bellamy, DO, who has been hired to replace Chad Krueger, MD, as the Social Media Editor for the Journal of Arthroplasty. Jaime has been instrumental in raising our presence with her creative posts and visual abstracts, and we wish her well in her new role. We have made great strides in transparency of conflict of interest reporting and documentation of informed consent of patients for case reports [6]. As a result, we are poised to apply for Clarivate indexing, which is a major milestone. As always, I am humbly indebted to the support of our editorial board, the AAHKS staff, the staff at Elsevier, our peer review manager Taylor Bowen, our authors, reviewers, and readers, without whom we could not function. Thanks also to Michael Mont, MD, Editor-in-Chief of the Journal of Arthroplasty, for his unyielding support of Arthroplasty Today and me personally. In difficult times, we need to stand together to support each other, take the best care of our patients, serve our communities, advocate, and educate, to fulfill our mission and vision. Thank you for the tremendous opportunity to serve in this capacity as the Editor-in-Chief of Arthroplasty Today. It is a team sport, to be sure, and I trust that we as orthopaedic surgeons will remain leaders and beacons of resiliency. Conflicts of Interest G. Golladay receives royalties from Stryker, Inc, has received research support from KCI and Cerus, has received financial support from AAHKS, is on the editorial board for JOA and Arthroplasty Today, and is a committee member for AAHKS and a board member of the Virginia Orthopaedic Society.

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          Most cited references4

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          Incidence of Symptomatic COVID-19 in Unvaccinated Patients within One Month after Elective Total Joint Arthroplasty: A Multicentre Study

          Background The safety of continuing Total Joint Arthroplasty (TJA), as an elective procedure, during the pandemic is controversial. The present study aimed to investigate the incidence of symptomatic COVID-19 and its related risk factors in unvaccinated patients after TJA within one month post-discharge in two large cities of our country. Methods The present prospective study included all the patients admitted to three hospitals, located in two high-populated cities of our country from April 1st, 2020, to April 1st, 2021, for elective TJA. Urgent TJA (traumatic fractures) were excluded. The primary outcome was symptomatic COVID-19 within one-month after discharge that was diagnosed using the SARS-CoV-2 RT-PCR test. Afterward, the incidence of the COVID-19 in the study population was compared with the general population to estimate the safety of elective TJA during the pandemic. Results From the 1007 patients undergoing TJA, 755 patients met the inclusion criteria. None of the patients was vaccinated against COVID-19. Among them, 18 patients (2.4%) developed symptomatic COVID-19 within one-month after discharge. In the same time interval, the incidence of COVID-19 was 2.2% in the general population of these two cities, which was similar to the incidence reported in the study population. Of the patients who were positive for COVID-19, four patients were hospitalized, and 3 of them were ICU-admitted; however, no mortality was reported. Conclusion The TJA will be a safe elective procedure for the patients during the pandemic if the preventive protocols are followed strictly.
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            Do Antibiotic-Loaded Calcium Sulfate Beads Improve Outcomes After Debridement, Antibiotics, and Implant Retention? A Matched Cohort Study

            Background Dissolvable antibiotic-loaded calcium sulfate beads are used as an intraoperative adjunct during debridement with antibiotics and implant retention (DAIR) for periprosthetic joint infections (PJI) to reduce the historically higher failure rates than one- or two-stage exchange. This study evaluated clinical outcomes after DAIRs performed with and without these antibiotic beads. The primary outcome was post-DAIR failure secondary to recurrent PJI at 2 years. The secondary outcome was early failure secondary to recurrent PJI within 90 days. Material and methods DAIRs performed for acute or acute hematogenous PJI at a single institution were retrospectively identified between 2013 and 2018. All DAIRs with adjunctive antibiotic beads (cases) were then exactly matched to a cohort of DAIRs without beads (controls) based on Charlson Comorbidity Index. The McNemar’s test and Wilcoxon signed-rank test were used to evaluate differences in outcomes and patient characteristics. Results Twenty DAIR cases (with antibiotic beads) were matched with 20 DAIR controls. There was no difference in age, sex, body mass index, joint, erythrocyte sedimentation rate, C-reactive protein, microbiology profile, antibiotic-resistance profile, or intraoperative lavage adjuncts between groups. There were no statistically significant differences between cases and controls for either overall infection-related failure at 2 years ( P  = .21) or early infection-related failure at 90 days ( P  = 1.00). Conclusion Adjunctive dissolvable antibiotic-loaded calcium sulfate beads did not reduce the incidence of recurrent PJIs at 2 years or 90 days postoperatively after DAIR. Given the added cost of these antibiotic dissolvable beads without clinical benefits, we cannot recommend their use as an adjunct treatment during DAIRs.
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              Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery

              Background Although insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. COVID-19 negatively impacted access to care, while simultaneously widening pre-existing health care disparities. The purpose of the current study was to document this phenomena within orthopedics. Methods Patients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients undergoing arthroplasty prior to the pandemic (March 2020) and after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared. Results 269 (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher BMI, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. Comparing case volumes showed a larger decrease at ZSFGH compared to UCSF post-COVID. Wait times between the two sites pre- and post-COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH pre-COVID were more than double the wait times at UCSF post-COVID. Conclusions COVID-19 worsened access to primary hip and knee arthroplasty at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with non-private insurance were affected most.
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                Author and article information

                Contributors
                Role: Editor-in-Chief
                Journal
                Arthroplast Today
                Arthroplast Today
                Arthroplasty Today
                Elsevier
                2352-3441
                29 March 2022
                April 2022
                29 March 2022
                : 14
                : 204
                Article
                S2352-3441(22)00082-6
                10.1016/j.artd.2022.03.012
                8961235
                35359701
                1f9ae84e-4b85-4bda-adbd-5b7a1217695f
                © 2022 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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