Background Approximately 23% of patients develop hip pain after total hip arthroplasty (THA). In this systematic review, we aimed to identify risk factors associated with postoperative pain after THA to optimize preoperative surgical planning. Methods Six literature databases were searched for articles published from January 1995 to August 2020. Controlled trials and observational studies that reported measurements of postoperative pain with assessments of preoperative modifiable and non-modifiable risk factors were included. Three researchers performed a literature review independently. Results Fifty-four studies were included in the study for analysis. The most consistent association between worse pain outcomes and the female sex is poor preoperative pain or function, and more severe medical or psychiatric comorbidities. The correlation was less strong between worse pain outcomes and preoperative high body mass index value, low radiographic grade arthritis, and low socioeconomic status. A weak correlation was found between age and worse pain outcomes. Conclusions Preoperative risk factors that were consistently predictive of greater/server postoperative pain after THA were identified, despite the varying quality of studies that prohibited the arrival of concrete conclusions. Modifiable factors should be optimized preoperatively, whereas non-modifiable factors may be valuable to patient education, shared decision-making, and individualized pain management.

Introduction: We report the youngest documented patient (38 years old) to develop an acute popliteal artery thrombus following primary total knee arthroplasty (TKA). Patient Concerns: The patient presented for an elective TKA secondary to posttraumatic arthritis. Past medical history included a tibial plateau fracture, two knee arthroscopies and an elevated body mass index (37.53). A right TKA was performed with no intraoperative complications. Two hours postoperatively, the right foot was poikilothermic and lacking dorsalis pedal pulse. Diagnosis: Popliteal artery thrombus confirmed by angiogram and venous duplex. Interventions: Immediate vascular surgery consult and subsequent embolectomy. Outcomes: At 1 year postoperatively, the patient is doing well with no further complications. Conclusion: Due to the lack of significant past medical history putting this patient at risk, future research should focus on prior trauma, age, and BMI as risk factors, specifically in patients undergoing TKA.

INTRODUCTION: Purpose: Descriptive case study of pre-clinical ultrasound education at the University of Nevada, Las Vegas School of Medicine. BACKGROUND: Point-of-Care Ultrasound (POCUS) is increasingly valued across medical disciplines. As benefits of ultrasound are recognized, so too is the need to integrate ultrasound into undergraduate medical education (UME). Early exposure contributes to ease of use during clinical rotations. Our objective is to describe integration of POCUS before clinical immersion and how efforts were perceived. METHODS: 58 medical students participated in a hands-on training session before initiation of clerkship duties. A brief didactic introduction for ultrasound techniques began each session. Students were divided into duos and rotated through 6 stations designed to provide training in ultrasound of the abdomen, head/neck, and cardiac. Each station consisted of a clinical scenario, ultrasound machine, standardized patient/model, and instructor. Student feedback was collected via 6-point questionnaire at the end of the session. RESULTS: 58/58 students completed the survey, positively evaluating clinical relevance and student satisfaction. 58/58 students answered “yes” that “the session met the stated learning objectives,” 57/58 answered “yes” that “the learning environment was conducive to my acquiring new skills.” Comments were entered in an optional field with the descriptors “great” and “helpful” trending throughout feedback, indicating high student satisfaction. CONCLUSION: UME is changing, with new challenges to preparing students for clinical years including the incorporation of POCUS. The overwhelmingly positive feedback for our session indicates integrating POCUS as an educational tool with hands-on ultrasound practice can provide engaging and applicable skills for medical students.

The orthopedic surgical specialty is strongly tied to partnerships with industry that have fostered innovation and greatly enhanced patient care. A substantial number of orthopedic surgeons currently receive some form of industry support. These relationships are highly scrutinized because they present the possibility of both personal and financial conflicts of interest (COI). The authors examined orthopedic patients' awareness of existing regulation and perceptions of financial COI by performing a prospective survey-based study of patients seen in an academic orthopedic department. Data were collected during 1 year, in a cross-section of hospital-based and community clinical settings. The authors collected 513 surveys during a 1-year period between 4 clinical locations. Of all respondents, 55% were unconcerned regarding gifts or direct compensation their physicians received from industry, and only 16% were very or extremely concerned regarding these benefits. Patients' opinions regarding possible influence of benefits were similarly ambivalent, with 54% of patients minimally or not at all concerned regarding the potential influence of industry gifts or compensation. Seventy-six percent of patients had never heard of the Sunshine Act, and only 3% indicated that they were aware of the legislation and its intention. The income of the respondents and their level of education were positively correlated with increased concern about handling of COI, as well as knowledge regarding the Sunshine Act. These data suggest that orthopedic surgery patients are widely unconcerned regarding physician COI, but specific subsets of patients may be more likely to have concerns regarding these relationships. [ Orthopedics . 2021;44(5):e682–e686.]