Background: Low albumin levels have previously been shown to be a risk factor for increased complications in the 30-day postoperative period after total hip or knee arthroplasty. In this study, we examined the effect that albumin levels have on complications in all total joint primary arthroplasties or revisions (shoulder, elbow, wrist, hip, knee, ankle, and fingers). Methods: Patients who underwent a primary total joint arthroplasty or revision from 2005 to 2015 and who had preoperative serum albumin concentration levels recorded were identified from the U.S. National Surgical Quality Improvement Program (NSQIP) database. Patients were grouped into those with normal serum albumin concentrations (≥3.5 g/dL) and those who were hypoalbuminemic (<3.5 g/dL); hypoalbuminemia was subdivided into quartiles for statistical analysis. Univariate analyses were conducted with use of the Student t test for categorical outcomes and the chi-square test for continuous variables. Following univariate analysis, all significant comorbidity variables for both the primary and revision arthroplasty groups were used in a multivariate regression analysis to determine independent association of hypoalbuminemia and postoperative outcomes. Results: Using available data from 2005 to 2015, 135,008 patients fit the eligibility criteria, including those who had undergone primary arthroplasty (n = 125,162) and those who had undergone revision arthroplasty (n = 9,846). The revision arthroplasties included the shoulder (2%), hip (46%), and knee (52%), and the primary arthroplasties included the shoulder (3%), hip (39%), knee (57%), and other (1%). We found that patients who had lower albumin levels had a greater rate of postoperative complications including cardiac arrest, myocardial infarction, cerebrovascular accident, organ or space surgical site infection, sepsis, septic shock, pneumonia, renal insufficiency in general, unplanned intubation, return to the operating room within 30 days, urinary tract infection, and wound infection (all p < 0.005). Conclusions: There was a significant difference in 30-day postoperative complications between patients with normal preoperative albumin levels and those with low albumin levels after all primary total joint arthroplasties or revisions. Patients with low albumin levels were at significantly increased risk for infection, pneumonia, sepsis, myocardial infarction, and other adverse outcomes. Further research is needed to develop interventions to improve serum albumin concentrations preoperatively to mitigate adverse outcomes. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Introduction: The Locking Compression Plate (LCP) system is a versatile technology that can be used either through conventional compression plating techniques or as an internal fixator with locking head screws. There have been only a few biomechanical studies examining the role of locked screw configuration on construct stability with most recommendations based upon empirical evidence or data from compression plating. This study will attempt to determine how different locked screw configurations, fracture gaps (distance between bone fragments), and interface gaps (distance between plate and bone) will affect the peak stress(von Mises stress) experienced by the plate-screw construct and, thereby, look at ways to minimize the risk of hardware failure. Materials Methods: A finite element model (FEM) was developed of a transverse mid shaft femoral fracture bridged by an eight-hole titanium LCP. Seven different screw configurations were investigated. Three different fracture gaps and three different interface gaps were studied as well. Results: The 1368 configuration was found to experience the least peak stress of 2.10 GPa while the 2367, 2457, and all filled configurations were found to have the highest peak stress (25.29 GPa, 22.78 GPa, and 23.54 GPa, respectively). Peak stress increased when the interface gap increased. Peak stress also increased as the fracture gap increased, with the largest jump between the 1 mm and 2 mm gaps. Conclusions: Every fracture is unique, and has a vast amount of parameters that must be considered when the surgeon is developing a treatment plan. For transverse femoral shaft fractures, the results of this study suggest that a working length of 2 screw holes on either side of the fracture may also lead to lower peak stress. In addition, our results demonstrate that minimizing the fracture gap and interface gap will lead to decreased stress in the plate-screw construct.

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