Featured Publications
Total Hip Arthroplasty Imageless Navigation Does Not Reduce 90-Day Adverse Events or Five-Year Revisions in a Large National Cohort
Jayaram R, Gillinov S, Caruana D, Kammien A, Joo P, Rubin L, Grauer J. Total Hip Arthroplasty Imageless Navigation Does Not Reduce 90-Day Adverse Events or Five-Year Revisions in a Large National Cohort. The Journal Of Arthroplasty 2022, 38: 862-867. PMID: 36529197, DOI: 10.1016/j.arth.2022.12.012.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipHumansJoint DislocationsOdds RatioOsteoarthritisPostoperative ComplicationsRetrospective StudiesConceptsTotal hip arthroplastyAdverse eventsImageless navigationMultivariate analysisLarge national administrative databaseElixhauser comorbidity index scorePrimary total hip arthroplastyComorbidity Index scoreFive-year incidencePostoperative adverse eventsNational administrative databaseLarge national cohortLarge national databaseCause revisionTHA patientsWound dehiscenceNational cohortTHA casesAdministrative databasesDislocation rateHip arthroplastyHigher oddsNavigation groupIndex scoreComputer navigationWhat Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients
Moore HG, Schneble CA, Kahan JB, Sculco PK, Grauer JN, Rubin LE. What Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients. The Journal Of Arthroplasty 2021, 37: 425-430. PMID: 34871749, DOI: 10.1016/j.arth.2021.11.036.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansMedicaidMedicareRetrospective StudiesRisk FactorsSurgeonsUnited StatesConceptsBilateral total hip arthroplastyTotal knee arthroplastyTotal hip arthroplastyContralateral total hip arthroplastySame surgeonDifferent surgeonsAdverse eventsContralateral jointGreater oddsSurgery-related adverse eventsBilateral total knee arthroplastyNational Provider Identifier numberFirst joint replacementFirst total hip arthroplastyPossible independent predictorsContralateral replacementIndependent predictorsSicker patientsKnee arthroplastyAdministrative databasesHip arthroplastyLower oddsPatientsArthroplastyJoint replacementAnatomic Navigation Using the Transverse Acetabular Ligament for Acetabular Component Positioning in Total Hip Arthroplasty Through the Direct Anterior Approach
Molho DA, Kuether JP, Rubin LE. Anatomic Navigation Using the Transverse Acetabular Ligament for Acetabular Component Positioning in Total Hip Arthroplasty Through the Direct Anterior Approach. Journal Of The American Academy Of Orthopaedic Surgeons 2021, 30: 100-103. PMID: 35772088, DOI: 10.5435/jaaos-d-20-00839.Peer-Reviewed Original ResearchMeSH KeywordsAcetabulumArthroplasty, Replacement, HipHip JointHip ProsthesisHumansLigaments, ArticularConceptsDirect anterior approachTotal hip arthroplastyTransverse acetabular ligamentAnterior approachHip arthroplastyImplant positioningSingle-surgeon case seriesAcetabular component positioningLewinnek safe zoneCase seriesComponent positioningAnatomic landmarksPreoperative planImplant positionArthroplastyPilot dataLigamentSafe zoneExposureAcetabulumEssential elements of an outpatient total joint replacement programme.
Li J, Rubin LE, Mariano ER. Essential elements of an outpatient total joint replacement programme. Current Opinion In Anaesthesiology 2019, 32: 643-648. PMID: 31356361, DOI: 10.1097/aco.0000000000000774.Peer-Reviewed Original ResearchMeSH KeywordsAmbulatory Surgical ProceduresArthroplasty, Replacement, HipArthroplasty, Replacement, KneeCritical PathwaysFeasibility StudiesHealth Plan ImplementationHumansLength of StayMedicaidMedicarePatient Education as TopicPatient ReadmissionPatient SatisfactionPatient SelectionPostoperative ComplicationsProgram EvaluationTreatment OutcomeUnited StatesConceptsTotal joint arthroplastyOutpatient total joint arthroplastyPatient satisfactionLong-term functional outcomePatient/family educationTotal knee arthroplasty patientsOpioid-sparing analgesiaShort-term complicationsTotal joint replacement programKnee arthroplasty patientsSubset of patientsStandardized clinical pathwayPositive surgical outcomesProper patient selectionJoint replacement programEvidence-based guidanceNew care paradigmPostdischarge planningAdverse eventsArthroplasty patientsPatient selectionSurgical outcomesFunctional outcomeOutpatient surgeryInpatient proceduresTotal Hip and Knee Arthroplasty in Patients Older Than Age 80 Years
Rubin LE, Blood TD, Defillo-Draiby JC. Total Hip and Knee Arthroplasty in Patients Older Than Age 80 Years. Journal Of The American Academy Of Orthopaedic Surgeons 2016, 24: 683-690. PMID: 27579814, DOI: 10.5435/jaaos-d-15-00278.Peer-Reviewed Original ResearchMeSH KeywordsAccidental FallsAge FactorsAged, 80 and overArthroplasty, Replacement, HipArthroplasty, Replacement, KneeFemaleHip JointHumansJoint DiseasesKnee JointReoperationRisk FactorsUnited StatesConceptsTotal hipKnee arthroplastyOlder patientsLength of hospitalRisk of morbidityAge 80 yearsTotal knee arthroplastyPain reliefElderly patientsMinor complicationsPerioperative safetyYounger patientsClinical outcomesFunctional outcomePatient satisfactionRevision surgeryAdvanced ageMortality ratePatientsOrthopaedic surgeonsArthroplastyHipMorbidityDemographic profileSurgeons
2023
Patients With Down Syndrome and Total Hip and Total Knee Arthroplasty: Outcome Measures Show Increased Risk of Perioperative Complications
Halperin S, Dhodapkar M, Radford Z, Frumberg D, Rubin L, Grauer J. Patients With Down Syndrome and Total Hip and Total Knee Arthroplasty: Outcome Measures Show Increased Risk of Perioperative Complications. JAAOS Global Research And Reviews 2023, 7: e23.00108. PMID: 38054749, PMCID: PMC10697628, DOI: 10.5435/jaaosglobal-d-23-00108.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipArthroplasty, Replacement, KneeDown SyndromeHumansOsteoarthritisOutcome Assessment, Health CarePostoperative ComplicationsConceptsTotal knee arthroplastyTotal hip arthroplastyAcute kidney injuryUrinary tract infectionAdverse eventsDown syndromePostoperative eventsKnee arthroplastyRevision ratePerioperative risk assessmentMinor adverse eventsOutcomes of patientsMultivariable logistic regressionTotal joint arthroplastyPatient/family counselingKidney injuryPerioperative complicationsTKA patientsAdult patientsTract infectionsDS patientsIncreased riskTotal hipCare pathwayJoint arthroplastyTotal Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement
Halperin S, Dhodapkar M, Radford Z, Li M, Rubin L, Grauer J. Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement. The Journal Of Arthroplasty 2023, 38: 2259-2263. PMID: 37279847, DOI: 10.1016/j.arth.2023.05.072.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansMedicaidMedicarePatient ReadmissionUnited StatesConceptsTotal knee arthroplastyTKA patientsPrimary total knee arthroplastyPostoperative emergency departmentPostoperative adverse eventsRisk of readmissionMultivariable linear regressionPerioperative periodPostoperative eventsAdverse eventsAppropriate patientsKnee osteoarthritisEmergency departmentPatients surgeryKnee arthroplastyOncologic indicationsCost-containment strategiesSurgical proceduresExclusion criteriaPatientsOptimize deliveryOverall reimbursementAdmissionReimbursementGreater increaseUrgent Care Visits Sought After Primary Total Hip Arthroplasty: A Potentially Overlooked Resource
Dhodapkar M, Gouzoulis M, Halperin S, Radford Z, Rubin L, Grauer J. Urgent Care Visits Sought After Primary Total Hip Arthroplasty: A Potentially Overlooked Resource. The Journal Of Arthroplasty 2023, 38: 2361-2365. PMID: 37196730, DOI: 10.1016/j.arth.2023.05.012.Peer-Reviewed Original ResearchMeSH KeywordsAmbulatory CareArthroplasty, Replacement, HipComorbidityEmergency Service, HospitalFemaleHumansOsteoarthritisPatient ReadmissionRetrospective StudiesConceptsUrgent care visitsTotal hip arthroplastyPrimary total hip arthroplastyUrgent care utilizationCare visitsED utilizationCare utilizationUrgent careHip arthroplastyLess comorbidity burdenEmergency department visitsLarge national databaseLow-acuity diagnosesComorbidity burdenPostoperative EDED visitsDepartment visitsIndependent predictorsTHA patientsMultivariable analysisPostoperative weekUrgent evaluationSurgical sitePatient needsGreater incidence
2022
Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study
Maloy GC, Kammien AJ, Rubin LE, Grauer JN. Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study. The Journal Of Arthroplasty 2022, 38: 525-529. PMID: 36272511, DOI: 10.1016/j.arth.2022.10.020.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood TransfusionDatabases, FactualFemaleHumansMalePostoperative ComplicationsRetrospective StudiesRisk FactorsConceptsTotal hip arthroplastyPostoperative adverse eventsAdverse eventsDay of surgeryHip arthroplastyDays of THAHigher Elixhauser-Comorbidity Index scoresElixhauser comorbidity index scoreComorbidity Index scoreLate adverse eventsTime of diagnosisPostoperative day 31THA patientsPredictive factorsPatient counselingPatient riskDatabase studyPrevention strategiesIndex scoreDay 31SurgeryInterquartile rangeAdministrative datasetsPatientsArthroplastyIncidence, Timing, and Predictors of Hip Dislocation After Primary Total Hip Arthroplasty for Osteoarthritis
Gillinov SM, Joo PY, Zhu JR, Moran J, Rubin LE, Grauer JN. Incidence, Timing, and Predictors of Hip Dislocation After Primary Total Hip Arthroplasty for Osteoarthritis. Journal Of The American Academy Of Orthopaedic Surgeons 2022, 30: 1047-1053. PMID: 35947825, PMCID: PMC9588560, DOI: 10.5435/jaaos-d-22-00150.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipFemaleHip DislocationHip ProsthesisHumansIncidenceJoint DislocationsOsteoarthritisProsthesis FailureReoperationRetrospective StudiesRisk FactorsConceptsPrimary total hip arthroplastyTotal hip arthroplastyElixhauser Comorbidity IndexBody mass indexComorbidity indexMass indexHip dislocationRevision surgeryRisk factorsHip arthroplastyIndex total hip arthroplastyHigher Elixhauser comorbidity indexPrimary THA patientsFirst-time dislocationCumulative incidenceMost patientsPostoperative dataTHA patientsRecurrent episodesControl subjectsFemale sexLarge cohortPatientsMultivariate analysisYounger ageOutcomes Following Total Hip Arthroplasty in Patients With Postpolio Syndrome: A Matched Cohort Analysis
Mercier MR, Moore HG, Wolfstadt JI, Rubin LE, Grauer JN. Outcomes Following Total Hip Arthroplasty in Patients With Postpolio Syndrome: A Matched Cohort Analysis. The Journal Of Arthroplasty 2022, 37: 1822-1826. PMID: 35447277, DOI: 10.1016/j.arth.2022.04.016.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipCohort StudiesHumansJoint DislocationsOdds RatioPatient ReadmissionPostoperative ComplicationsRetrospective StudiesRisk FactorsConceptsTotal hip arthroplastyPostpolio syndromeUrinary tract infectionPPS patientsControl patientsProsthetic dislocationTract infectionsRevision arthroplastyHip arthroplastyFive-year postoperative periodMatched Cohort AnalysisFive-year incidencePostoperative adverse eventsLong-term outcomesBasis of ageComorbidity burdenAdverse eventsPatient demographicsPostoperative periodPostoperative surveillanceHospital readmissionHip arthritisControl cohortAdministrative databasesCohort analysisJump in Elective Total Hip and Knee Arthroplasty Numbers at Age 65 Years: Evidence for Moral Hazard?
Rankin KA, Freedman IG, Moore HG, Halperin SJ, Rubin LE, Grauer JN. Jump in Elective Total Hip and Knee Arthroplasty Numbers at Age 65 Years: Evidence for Moral Hazard? JAAOS Global Research And Reviews 2022, 6: e22.00035. PMID: 35315795, PMCID: PMC8942773, DOI: 10.5435/jaaosglobal-d-22-00035.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeFemaleHumansMaleMedicareMoralsPostoperative ComplicationsRetrospective StudiesUnited StatesConceptsTotal knee arthroplastyTotal hip arthroplastyAge 65 yearsNational Surgical Quality Improvement Program databaseIncidence of TKAElective total knee arthroplastyQuality Improvement Program databaseLower body mass indexElective total hipPostoperative adverse eventsPreoperative American SocietyImprovement Program databaseLower functional statusBody mass indexNon-Hispanic whitesNumber of proceduresAnesthesiologists classPreoperative characteristicsOlder patientsAdverse eventsTHA patientsMass indexTotal hipFunctional statusKnee arthroplastyTotal Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival
Gillinov SM, Burroughs PJ, Moore HG, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival. The Journal Of Arthroplasty 2022, 37: 1333-1337. PMID: 35257821, PMCID: PMC9177736, DOI: 10.1016/j.arth.2022.02.107.Peer-Reviewed Original ResearchConceptsTotal hip arthroplastyNon-hemophilia patientsMinor adverse eventsSerious adverse eventsAdverse eventsClassic hemophiliaHaemophilia patientsImplant survivalHip arthroplastyGreater oddsMultivariate analysisFive-year implant survivalPrimary total hip arthroplastyAcute kidney injuryVenous thromboembolism prophylaxisElixhauser Comorbidity IndexKaplan-Meier analysisEvidence-based guidelinesThromboembolism prophylaxisVTE prophylaxisComorbidity indexKidney injuryTHA patientsFactor replacementRetrospective study
2021
Patients With Ehlers-Danlos Syndromes Experience Higher Rates of Prosthetic Dislocation After Total Hip Arthroplasty and Worse Implant Survival at 5 Years
Moore HG, Burroughs PJ, Rubin LE, Frumberg DB, Sculco PK, Grauer JN. Patients With Ehlers-Danlos Syndromes Experience Higher Rates of Prosthetic Dislocation After Total Hip Arthroplasty and Worse Implant Survival at 5 Years. Journal Of The American Academy Of Orthopaedic Surgeons 2021, 30: 177-183. PMID: 34967762, DOI: 10.5435/jaaos-d-21-00347.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipEhlers-Danlos SyndromeHumansJoint DislocationsJoint InstabilityRetrospective StudiesConceptsEhlers-Danlos syndromeTotal hip arthroplastyImplant survivalHip arthroplastyAdverse eventsDiagnosis of EDSGenetic connective tissue disorderNinety-day incidenceWorse implant survivalHigh rateDay of surgeryLong-term outcomesLog-rank testMultivariate logistic regressionConnective tissue disordersMultiple organ systemsConnective tissue laxityPerioperative dislocationPeriprosthetic dislocationPostoperative complicationsPostoperative periodProsthetic dislocationHospital readmissionControl subjectsAdministrative databasesRevision Total Hip and Knee Arthroplasty are Associated With Lower Hospital Consumer Assessment of Healthcare Providers and Systems Patient Satisfaction Scores Compared With Primary Arthroplasty
Mercier MR, Galivanche AR, Pathak N, Mets EJ, Molho DA, Elaydi AH, Grauer JN, Rubin LE. Revision Total Hip and Knee Arthroplasty are Associated With Lower Hospital Consumer Assessment of Healthcare Providers and Systems Patient Satisfaction Scores Compared With Primary Arthroplasty. Journal Of The American Academy Of Orthopaedic Surgeons 2021, 30: e336-e346. PMID: 34851861, DOI: 10.5435/jaaos-d-21-00839.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHealth PersonnelHospitalsHumansPatient SatisfactionRetrospective StudiesConceptsRevision total hip arthroplastyTotal knee arthroplastyTotal hip arthroplastyRevision THA patientsHospital Consumer AssessmentTHA patientsHCAHPS surveyHCAHPS scoresTKA patientsKnee arthroplastyRevision proceduresHealthcare providersPrimary total joint arthroplastyPrimary total knee arthroplastyPrimary total hip arthroplastyConsumer AssessmentLonger hospital lengthRevision TKA patientsHigher American SocietyPatient satisfaction outcomesPatient satisfaction scoresRate of revisionRevision total hipTotal joint arthroplastySystems Patient Satisfaction ScoresTotal Hip Arthroplasty in Patients With Cerebral Palsy: A Matched Comparison of 90-Day Adverse Events and 5-Year Implant Survival
Moore HG, Gardezi M, Burroughs PJ, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Cerebral Palsy: A Matched Comparison of 90-Day Adverse Events and 5-Year Implant Survival. The Journal Of Arthroplasty 2021, 36: 3534-3537. PMID: 34176692, DOI: 10.1016/j.arth.2021.05.039.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipCerebral PalsyHumansReoperationRetrospective StudiesRisk FactorsConceptsTotal hip arthroplastyFive-year implant survivalUrinary tract infectionCerebral palsyImplant survivalAdverse eventsTract infectionsComorbid factorsPeriprosthetic fracturesHigher oddsHip arthroplastyPerioperative urinary tract infectionNinety-day incidencePerioperative adverse eventsLong-term outcomesLog-rank testKaplan-Meier plotsMultivariate logistic regressionPerioperative complicationsPostoperative complicationsCP cohortHospital readmissionMatched ComparisonAdministrative databasesPatientsPatient Factors and Perioperative Outcomes Affect Hospital Consumer Assessment of Healthcare Providers and Systems Survey Response Rates After Primary Total Hip Replacement.
Mercier MR, Pathak N, Adrados M, Galivanche AR, Malpani R, Hilibrand AS, Rubin LE, Grauer JN. Patient Factors and Perioperative Outcomes Affect Hospital Consumer Assessment of Healthcare Providers and Systems Survey Response Rates After Primary Total Hip Replacement. JAAOS Global Research And Reviews 2021, 5 PMID: 33798127, DOI: 10.5435/jaaosglobal-d-21-00052.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipHealth PersonnelHospitalsHumansRetrospective StudiesSurveys and QuestionnairesUnited StatesConceptsTotal hip arthroplastyHospital Consumer AssessmentSurvey response rateAdverse eventsHCAHPS surveyElective primary total hip arthroplastyResponse rateHealthcare providersPrimary total hip replacementPrimary total hip arthroplastyPatient satisfaction survey resultsConsumer AssessmentHigher American SocietyMajor adverse eventsMinority of patientsSurgical patient populationHCAHPS survey resultsTotal hip replacementMultivariate regression analysisHospital reimbursement ratesAnesthesia scorePerioperative outcomesPerioperative variablesAdult patientsPatient characteristics
2020
Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty.
Malpani R, Mclynn RP, Bovonratwet P, Bagi PS, Yurter A, Mercier MR, Rubin LE, Grauer JN. Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty. Orthopedics 2020, 43: 233-238. PMID: 32674174, DOI: 10.3928/01477447-20200624-02.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood Coagulation DisordersDatabases, FactualFemaleHumansMaleMiddle AgedMultivariate AnalysisOutcome Assessment, Health CarePatient ReadmissionPostoperative ComplicationsRetrospective StudiesRisk FactorsYoung AdultConceptsHigher international normalized ratioInternational normalized ratioMajor adverse eventsTotal hip arthroplastyPartial thromboplastin timeHigher partial thromboplastin timeMinor adverse eventsAdverse eventsLow plateletsHematological conditionsSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseTotal knee arthroplasty (TKA) populationQuality Improvement Program databasePrimary total hip arthroplastyDependent functional statusImprovement Program databasePostsurgical adverse eventsTotal knee arthroplastyMultiple adverse eventsPreoperative coagulopathyTHA cohortTKA groupTKA patientsHospital readmissionPerioperative Outcomes of Hemiarthroplasty Versus Total Hip Arthroplasty for Geriatric Hip Fracture: The Importance of Studying Matched Populations
Haynes MS, Ondeck NT, Ottesen TD, Malpani R, Rubin LE, Grauer JN. Perioperative Outcomes of Hemiarthroplasty Versus Total Hip Arthroplasty for Geriatric Hip Fracture: The Importance of Studying Matched Populations. The Journal Of Arthroplasty 2020, 35: 3188-3194. PMID: 32654940, DOI: 10.1016/j.arth.2020.06.015.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipFemoral Neck FracturesHemiarthroplastyHip FracturesHumansPostoperative ComplicationsRetrospective StudiesConceptsTotal hip arthroplastyHip fractureAdverse eventsPropensity matchingBlood transfusionHip arthroplastyNational Surgical Quality Improvement databaseGeriatric femoral neck fracturesGreater readmission ratesGeriatric hip fracturesLower transfusion rateMajor adverse eventsMinor adverse eventsPostoperative adverse outcomesFemoral neck fracturesQuality improvement databaseRetrospective comparative studyMultivariate logistic regressionTransfusion ratePerioperative outcomesReadmission ratesSelect patientsTHA groupGeriatric patientsNeck fracturesPreoperative Risk Factor Optimization Lowers Hospital Length of Stay and Postoperative Emergency Department Visits in Primary Total Hip and Knee Arthroplasty Patients
Dlott CC, Moore A, Nelson C, Stone D, Xu Y, Morris JC, Gibson DH, Rubin LE, O'Connor MI. Preoperative Risk Factor Optimization Lowers Hospital Length of Stay and Postoperative Emergency Department Visits in Primary Total Hip and Knee Arthroplasty Patients. The Journal Of Arthroplasty 2020, 35: 1508-1515.e2. PMID: 32113812, DOI: 10.1016/j.arth.2020.01.083.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipArthroplasty, Replacement, KneeEmergency Service, HospitalHospitalsHumansLength of StayPatient ReadmissionPostoperative ComplicationsRetrospective StudiesRisk FactorsConceptsED visitsContemporary cohortHistorical cohortHospital lengthRisk factorsSignificant decreaseElective primary total hip arthroplastyPostoperative emergency department visitsPrimary total hip arthroplastyLower hospital lengthPostoperative emergency departmentRisk factor optimizationPrimary total hipModifiable risk factorsPercentage of patientsTotal joint replacement programEmergency department visitsKnee arthroplasty patientsSurgical site infectionOptimization of patientsTotal knee arthroplastyJoint replacement programTotal hip arthroplastyPatient-centered approachRisk factor identification