Peter K. Sculco's research while affiliated with Mayo Clinic - Rochester and other places

Publications (169)

Conference Paper
Background and Aims Post-operative hyponatremia is a relatively common occurrence. We identified risk factors (see table 1) for the development of hyponatremia and developed a risk calculator (http://orthoapps.shinyapps.io/Hponatremia_TJA/ ) (Kunze, 2022). In a prospective study, a best practice alert (BPA) was sent to the practitioner advising the...
Article
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Robotic-assisted total hip arthroplasty (THA) using a computerized-tomography (CT) based workflow increases surgical time relative to traditional manual technique. The purpose of this investigation was to compare the intra-operative efficiencies of two robotic THA systems: a fluoroscopy-based platform (FL-RTHA) and a contemporary, CT-based (CT-RTHA...
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Background While robotic-assisted total hip arthroplasty (RA-THA) has been associated with improved accuracy of component placement, the perioperative and early postoperative outcomes of fluoroscopy-based RA-THA systems have yet to be elucidated. Methods This retrospective cohort analysis included a consecutive series of patients who received manu...
Article
Objectives Arthrofibrosis is characterized by excessive collagen production and adhesions that result in restricted joint motion (stiffness) and pain. The rate of procedural intervention (i.e. manipulation under anesthesia or surgical contracture release) ranges from 0.7% to 35% after anterior cruciate ligament (ACL) reconstruction surgery, and up...
Article
Periprosthetic femur fracture (PFF) is a major complication following total hip arthroplasty (THA) that carries significant morbidity, mortality, and economic burden. Currently, uncemented stems are highly preferred in primary THA, but have been associated with higher risk of PFF compared to cemented stems. The use of collared stems in uncemented p...
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In this case report, we present a rare case of a female patient who developed pain and swelling after a total knee arthroplasty. An extensive diagnostic workup including serum and synovial testing to rule out infection was performed in addition to advanced imaging including an MRI of the knee, but it was only after an arthroscopic synovectomy that...
Article
Introduction: The John N. Insall Knee Society Traveling Fellowship selects four international arthroplasty or sports fellowship-trained orthopaedic surgeons to spend one month traveling to various Knee Society members' joint replacement and knee surgery centers in North America. The fellowship aims to foster research and education and share ideas...
Article
Introduction: Atrial septal defects (ASDs) are a common congenital heart defect. This study aimed to determine whether patients diagnosed with ASDs undergoing total joint arthroplasty (TJA) have differences in 1) medical complications, 2) readmissions, 3) lengths of stay (LOS), and 4) costs. Methods: Using an administrative claims dataset, a ret...
Article
Background: Adoption of robotic-assisted total hip arthroplasty (RA-THA) systems can improve the accuracy of acetabular cup placement, but no group has reported the learning curve of novel, fluoroscopy-based RA-THA systems. Methods: A learning-curve cumulative summation (LC-CUSUM) analysis was performed on a consecutive series of the first 100 p...
Article
Introduction: Acetabular bone loss is a challenging clinical problem when performing revision total hip arthroplasty (rTHA). This study aimed to evaluate how acetabular bone loss severity influences (1) clinical outcomes and (2) patient reported outcome measures (PROMs) in rTHA patients. Methods: Patients who underwent rTHA with acetabular compo...
Article
Background: Extensively porous-coated cylindrical stems have demonstrated excellent results in revision THA. However, most studies are midterm follow-up and modest cohort size. This study aimed to evaluate long-term outcomes of a large series of extensively porous-coated stems. Methods: From 1992-2003, 925 extensively porous-coated stems were ut...
Article
Aims The purpose of this study was to assess mid-term survivorship following primary total knee arthroplasty (TKA) with Optetrak Logic components and identify the most common revision indications at a single institution. Methods We identified a retrospective cohort of 7,941 Optetrak primary TKAs performed from January 2010 to December 2018. We rev...
Article
Background: Rising utilization rates for total shoulder arthroplasty (TSA) paired with an aging US population heralds increased future economic burden. Previous research has demonstrated evidence of "pent-up demand" in health care (delaying medical care until financially able) accompanying insurance status changes. The purpose of this study was to...
Article
Introduction: Minimal Clinical Important Difference (MCID) defines meaningful clinical change in patient reported outcome measures (PROM). Patient acceptable symptom state (PASS) provides a PROM threshold value to indicate a satisfactory clinical state. MCID and PASS for revision total knee arthroplasty (rTKA) are ill-defined. Moreover, it is unkn...
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Background The extent to which hemoglobinopathies other than sickle anemia (HbSS) are associated with hip osteonecrosis is unknown. Sickle cell trait (HbS), hemoglobin SC (HbSC), and sickle/β-thalassemia (HbSβTh) may also predispose to osteonecrosis of the femoral head (ONFH). We sought to compare the distributions of indications for a total hip ar...
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Background: Dissatisfaction occurs in nearly 20% of patients after total knee arthroplasty (TKA); however, there remains only limited understanding of the biologic mechanisms that may contribute to suboptimal postoperative outcomes requiring revision surgery. Expansion of effector T and B cells, could promote an abnormal healing response via local...
Article
Background The objective of this study was to evaluate the reoperation and complication rate following trochanteric plate fixation of greater trochanter (GT) periprosthetic femur fractures associated with total hip arthroplasty (THA) and to identify risk factors for subsequent reoperation, nonunion, and hardware failure (plate/cable breakage or mig...
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A subset of patients undergoing total knee arthroplasty (TKA) for knee osteoarthritis develop debilitating knee stiffness (reduced range of motion) for poorly understood reasons. Dysregulated inflammatory and immune responses to surgery correlate with reduced surgical outcomes, but the dysregulated gene signatures in patients with stiffness after T...
Article
Background Multiple options are available for the tibial insert in total knee arthroplasty (TKA). A systematic review (SR) and network meta-analysis (NMA) to compare available randomized controlled trials (RCTs) could assist with decision making. We aim to show that designs with increased conformity may improve function and satisfaction without an...
Article
Background A substantial number of randomized controlled trial (RCT) studies in total joint arthroplasty (TJA) are published each year in the United States (US). However, it is unknown how closely the demographic and clinical characteristics of these cohorts resemble that of the US patient population undergoing TJA. Thus, the purpose of this system...
Article
This technology has the capability of providing extensive data on gait kinematics that may be used to understand differences in gait patterns and associated clinical diagnoses. Ultimately, this innovative technology will allow surgeons to use data and analytics to examine differences in recovery between patient groups and thus set better recovery g...
Article
»: Functional acetabular safe zones based on patient-specific factors during total hip arthroplasty are theorized to result in more optimal component stability than the use of traditional safe zones based on static targets. »: Preoperative planning that takes into account functional pelvic positions and spinopelvic mobility is increasingly recom...
Article
Introduction: Outcomes after aseptic revision total hip arthroplasty (THA) are variable and it is unknown whether the indication for aseptic revision THA influences postoperative clinical improvement. Minimal Clinical Important Difference (MCID) assesses if changes in patient reported outcome (PROM) result in meaningful clinical benefit to patient...
Chapter
Total knee arthroplasty (TKA) is one of the most common and most successful operations in orthopedic surgery. Despite its wide use over the last years, the initial efforts for TKA were challenging. Since the nineteenth century, orthopedic surgeons had introduced the idea of the replacement of joint surfaces. The initial operations were performed wi...
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Introduction: Ehlers-Danlos syndromes (EDS) are genetic connective tissue disorders affecting multiple organ systems that frequently result in connective tissue hyperlaxity and early osteoarthritis. Short- and long-term outcomes after total hip arthroplasty in this cohort remain poorly characterized. Methods: Data were abstracted from the 2010 t...
Article
Stiffness following total knee arthroplasty is a challenging complication for both the patient and surgeon, with an incidence that ranges from 1% to 13%1. There are several correctable mechanical causes for stiffness including malposition, malalignment, overstuffing, aseptic loosening, patella baja, and heterotopic ossification2. Idiopathic stiffne...
Article
Introduction: Overlapping surgery is defined as two cases occurring in separate operating rooms (ORs), where the same attending surgeon conducts the critical surgical portions of each case at different times. Although it has been suggested that this established practice may improve the utilization of resources, allow for more opportunities to teac...
Article
Aims Spinopelvic mobility plays an important role in functional acetabular component position following total hip arthroplasty (THA). The primary aim of this study was to determine if spinopelvic hypermobility persists or resolves following THA. Our second aim was to identify patient demographic or radiological factors associated with hypermobility...
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Background Questions exist about the release of cobalt and chromium ions from dual mobility (DM) cups. Modular implants, with potential backside wear between the cobalt-chromium liner and titanium cup, are of particular concern. This study compares the metal ion profile of patients with contemporary monoblock and modular DM articulations from two c...
Article
Introduction Patients with hip and knee arthritis often undergo bilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a staged or simultaneous fashion. However, when staged, the incidence and factors associated with having both procedures performed by the same surgeon or different surgeon are not well studied. Methods All pat...
Article
Background Patient satisfaction, with both process of care and outcome of care, is critical for measuring the quality and value of elective procedures such as arthroplasty. The purpose of this study was to evaluate the correlation between early postoperative satisfaction with the process of care and 2-year satisfaction with the outcome of care afte...
Article
Background: Instability constitutes over 20% of revisions after total hip arthroplasty (THA). Dual mobility (DM) designs were introduced as a solution to this problem. However, the few publications that have reported promising results for monobloc DM constructs have been limited by sample size or length of follow-up. The purpose of this study is t...
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Background Patients with morbid obesity may require both bariatric surgery and total knee/hip arthroplasty (TKA/THA). How to sequence these two procedures with better outcomes remains largely unstudied. Methods This cohort study extracted claims data on patients with an obesity diagnosis that received both bariatric surgery and TKA/THA surgery wit...
Article
Background Accurate acetabular component placement may reduce the risk of complication after total hip arthroplasty (THA). While surgeon experience and volume may reduce outliers, little is known how cup positioning accuracy and consistency relates to level of training (resident, fellow, attending) and whether trainee level impacts the magnitude an...
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Differences in immune responses to viruses and autoimmune diseases such as systemic lupus erythematosus (SLE) can show sexual dimorphism. Age-associated B cells (ABC) are a population of CD11c ⁺ T-bet ⁺ B cells critical for antiviral responses and autoimmune disorders. Absence of DEF6 and SWAP-70, two homologous guanine exchange factors, in double-...
Article
Aims This study used an artificial neural network (ANN) model to determine the most important pre- and perioperative variables to predict same-day discharge in patients undergoing total knee arthroplasty (TKA). Methods Data for this study were collected from the National Surgery Quality Improvement Program (NSQIP) database from the year 2018. Pati...
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Background: Heterotopic ossification (HO) is abnormal growth of ectopic bone and negatively affects the outcomes after total knee arthroplasty (TKA). This systematic review and meta-analysis were performed to characterize the prevalence and severity of HO after primary TKA. Methods: A systematic review of the literature was performed according t...
Article
Background: Over 1 million Americans undergo joint replacement each year, and approximately 1 in 75 will incur a periprosthetic joint infection. Effective treatment necessitates pathogen identification, yet standard-of-care cultures fail to detect organisms in 10% to 20% of cases and require invasive sampling. We hypothesized that cell-free DNA (c...
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Objective The optimal strategy for perioperative glucocorticoid (GC) management in patients with rheumatoid arthritis (RA) on chronic GCs is unknown. Although there is a concern for hypotension if inadequate doses are used, higher GC exposure may increase perioperative complications. We aimed to investigate the relationships between perioperative G...
Article
Aim: To evaluate the prevalence of self-directed cannabidiol (CBD) use in patients with end-stage degenerative hip and knee arthritis who underwent total hip arthroplasty and total knee arthroplasty. Materials & methods: Anonymous surveys for 109 patients were completed at 6 weeks follow-up after either total hip arthroplasty or total knee arthropl...
Article
Background Imageless computer navigation improves component placement accuracy in total hip arthroplasty (THA), but variations in the registration process are known to impact final accuracy measurements. We sought to evaluate the registration accuracy of an imageless navigation device during THA performed in the lateral decubitus position. Methods...
Article
Aims: Surgeons commonly resect additional distal femur during primary total knee arthroplasty (TKA) to correct a flexion contracture, which leads to femoral joint line elevation. There is a paucity of data describing the effect of joint line elevation on mid-flexion stability and knee kinematics. Thus, the goal of this study was to quantify the ef...
Article
Background Although preoperative opioid use has been associated with poor postoperative patient-reported outcome measures and delayed return to work in patients undergoing total joint arthroplasty, direct surgery-related complications in patients on chronic opioids are still not clear. Thus, we sought to perform a systematic review of the literatur...
Article
Aims: Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral...
Article
Purpose This systematic review characterizes the safety and efficacy of total knee arthroplasty (TKA) in end stage renal disease (ESRD) patients due to the unique challenges they face. Results The cumulative complication rate for 3684 patients on dialysis for ESRD after primary TKA was 25%(N = 925/3702), with incidence rates of 2.5%(N = 92/3702) f...
Article
Introduction With improved materials and bearing surfaces, the use of total hip arthroplasty (THA) in young patients is increasing. Functional outcomes and activity level are particularly relevant in this higher-demand patient population. There is a paucity of data on patient-reported outcomes and activity levels after THA in extremely young (<21 y...
Article
Background Several studies have evaluated the survivorship and clinical outcomes of constrained acetabular liners (CALs) in complex primary and revision total hip arthroplasty with hip instability; however, there remains no consensus on the overall performance of this constrained implant. We therefore performed a systematic review of the literature...
Article
Background: Little is known about the relationship between infection and the risk of risk of venous thromboembolism (VTE) following orthopaedic surgery. We assessed the 90-day risk of VTE following revision total knee replacement to measure the association between periprosthetic joint infection and the risk of postoperative VTE. Methods: We used...
Article
Background Bilateral knee osteoarthritis requiring total knee arthroplasty (TKA) can be addressed simultaneously in one surgical setting, staggered a few days apart during a single hospitalization, or staged several weeks to months apart. Several studies have reported on the complications and clinical outcomes of staggered bilateral TKA (BTKA) in a...
Article
Introduction Recent data suggests that a modified, more lenient set of precautions after total hip arthroplasty (THA) performed through the posterolateral approach may safely allow more patient movement and exercise in the immediate postoperative period. We hypothesize that: 1) patients undergoing THA given modified precautions will demonstrate a f...
Article
Background The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absol...
Article
Purpose Simultaneous bilateral unicompartmentsl knee arthroplasty (BUKA) is considered safe and effective. We performed a systematic review to assess the postoperative outcomes. Methods The US National Library of Medicine (PubMed/MEDLINE), Google Scholar, and the Cochrane Database of Systematic Reviews were queried for publications. Results Ten a...
Article
The articular design of a polyethylene insert influences the kinematics and overall function of a total knee arthroplasty (TKA). Standard symmetric posterior-stabilized and cruciate-retaining polyethylene designs have a long track record of high patient satisfaction and longevity in TKA. However, the number and variety of polyethylene inserts and a...
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Background The optimal route and dosing regimen of tranexamic acid (TXA) in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unclear. As such, we sought to analyze if there was a synergistic effect of intravenous (IV) and topical TXA on blood loss and transfusions. Methods We retrospectively analyzed 6720 primary TKAs...
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Early periprosthetic fractures after total knee arthroplasty are rare but devastating complications which require revision surgery and lead to poor patient satisfaction. We present 2 siblings who underwent primary total knee arthroplasty on the same day and then both presented 2 weeks after surgery with atraumatic periprosthetic femur fractures. Th...
Article
Introduction Periprosthetic femur fracture is one of the most common indications for reoperation following total hip arthroplasty (THA). Our objectives were to evaluate the incidence of reoperation following the surgical treatment of periprosthetic femur fractures and to compare the mechanisms of failure between fractures around a stable femoral co...
Article
With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to to...
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Introduction Medial Pivot Total Knee Arthroplasty was introduced in clinical practice in 1990s to reproduce the in vivo-natural knee kinematics. This design is characterized by an asymmetric constraint profile, with aa highly congruent medial compartment, and a less congruent lateral compartment. Short-term outcomes of the medial pivot systems in p...
Article
Background: Knee arthroscopy may be performed prior to total knee arthroplasty (TKA) in patients with symptomatic degenerative knee changes that do not yet warrant TKA. The purpose of this study was to determine whether the time interval between knee arthroscopy and subsequent primary TKA is associated with increased rates of revision and certain...
Article
Introduction: This study aimed to assess the quality of online resources pertaining to cannabidiol (CBD) for the nonoperative management of hip and knee arthritis. Methods: Websites were identified on the three most popular global search engines using terms relevant to CBD, hip or knee pain, and arthritis. Websites were scored based on a 25-poin...
Preprint
Full-text available
Sex differences characterize immune responses to viruses and autoimmune diseases like SLE. ABCs are an emerging population of CD11c+ T-bet+ B cells critical for antiviral responses and autoimmune disorders. DEF6 and SWAP70, are two homologous molecules whose combined absence in double-knock-out mice (DKOs) leads to a lupus syndrome in females marke...
Article
Background Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty (THA) due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data. Methods The records of 383 patients who underwent primary THA between August 2016-Augus...
Preprint
Full-text available
Background: Inflammatory arthritis (IA) patients are at increased risk for prosthetic joint infections (PJI); however, diagnosis is challenging because active IA patients have elevated inflammatory markers that may mimic joint infection and definitive microbiologic diagnosis may be delayed. The objective of this pilot study was to identify the clin...
Article
Background Total hip arthroplasty (THA) is one of the most successful operations in all of medicine in improving patient pain and restoring function. However, complications do arise after primary and revision THA. Dislocation of a THA, also known as instability, occurs in 1–2% of primary THAs and up to 30% of revision THAs. Most dislocations in the...
Article
Preoperative templating provides several benefits to the patient, surgeon, and hospital. Appropriate implant selection and sizing optimizes surgical workflow and leads to efficient care-delivery systems. Accurate templating establishes intraoperative targets for component position and reduces complications such as leg length inequality, impingement...
Article
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Background The aim of this study was to determine the impact of operative time on the development of early postoperative complications in patients undergoing revision total hip arthroplasty (THA).Methods In this retrospective cohort study, data were collected through the American College of Surgeons National Quality Improvement Program Database. Al...
Article
Introduction In addition to the significant morbidity and mortality associated with periprosthetic joint infection (PJI), the cost of treating PJI is substantial. Prior high-quality national estimates of the economic burden of PJI utilize data up to 2009 to project PJI growth in the United States through 2020. Now in the year 2020, it is appropriat...
Article
Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the...
Article
Given the growing rate of revision total knee arthroplasties (TKAs), it is important to understand the potential risk factors associated with postoperative complications. The aim of this study was to determine the role of operative time in postoperative complications in revision TKA. A retrospective cohort study was performed using data from the Am...
Article
Background Gout is a common synovial pathology, but its prevalence in patients undergoing total knee arthroplasty (TKA) and potential association with complications such as periprosthetic infection (PJI) and revision are unknown. Methods Medicare data from 2009 to 2013 was retrospectively reviewed using PearlDiver. All patients 65 years of age or...
Article
Background In selected patients, knee arthroscopy is performed prior to unicompartmental knee arthroplasty (UKA) to treat symptomatic mechanical pathology, delay arthroplasty, and assess the knee compartments. The purpose of this study was to determine if knee arthroscopy prior to UKA is associated with increased rates of UKA failure or conversion...
Article
Introduction Improper cup positioning and leg length discrepancy (LLD) are two of the most common errors following total hip arthroplasty (THA) and are associated with potentially significant consequences. Obesity is associated with increased risk of mechanical complications, including dislocations, which may be secondary to cup malposition and fai...
Article
Background Historically, there was up to a 60% risk of blood transfusion for patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). As such, the goal of this study was to analyze the rate and risk factors for allogeneic blood transfusions in patients undergoing SBTKA with tranexamic acid (TXA). Methods We retrospectively ident...
Article
Introduction: Computer-assisted navigation (CAN) and robotic-assisted (RA) total knee arthroplasty (TKA) both necessitate the use of tracking pins rigidly fixed to the femur and tibia. Although rare, there is paucity of literature on periprosthetic fractures through tracking pin sites as a potential complication. Therefore, the purpose of this stud...
Article
Background: Periprosthetic joint infection (PJI) is among the leading causes of failure in total joint arthroplasty. A recently proposed risk factor for PJI is symptomatic benign prostatic hyperplasia (sBPH). This study aims to determine if sBPH is associated with PJI following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
Article
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Background Changes in acetabular or hip center of rotation (HCOR) commonly occur during acetabular component preparation during total hip arthroplasty (THA). HCOR displacement in mediolateral or superoinferior directions is known to influence offset and leg length, but the incidence and range of HCOR change in the anteroposterior direction is less...
Article
Introduction: Revision total hip arthroplasty (rTHA) is becoming a more common procedure due to the increasing volume of primary total hip arthroplasty. Diabetes mellitus (DM) is currently projected to affect 4.4% of the global population by 2030. Diabetes has been associated with poor outcomes for a variety of surgical interventions. However, the...
Article
Background Dual mobility (DM) constructs effectively reduce the risk of dislocation in revision and high risk primary total hip arthroplasty. However, modular DM designs require the use of a cobalt-chrome liner against a titanium cup which may induce corrosion, metal ions release, and associated biologic response. The purpose of this systematic rev...
Article
Background While ETO is an effective technique for femoral stem removal and for the concomitant management of proximal femoral deformities, complications including persistent pain, trochanteric non-union, painful hardware, can occur. Methods The US National Library of Medicine (PubMed/MEDLINE), and the Cochrane Database of Systematic Reviews were...
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Objectives Human immunodeficiency virus (HIV) remains a major challenge to global health. However, advances in treatment have transformed HIV infection into a more manageable chronic disease, dramatically increasing the life expectancy of people living with HIV (PLWH). As a result, the range and extent of comorbidities in PLWH have expanded beyond...