Interaction Between Staphylococcal Biofilm and Bone: How Does the Presence of Biofilm Promote Prosthesis Loosening?

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Abstract

17. J Arthroplasty. 2025 Sep;40(9S1):S66-S71. doi: 10.1016/j.arth.2025.04.040. Epub 2025 Apr 19. Patient Preoperative Optimization: How to Do It and How to Be Paid for the Work. Clarke ZH(1), Springer BD(2), Sporer SM(3), Ast MP(4), Chen AF(5), Fricka KB(1). Author information: (1)Anderson Orthopedic Research Institute, Alexandria, Virginia. (2)Department of Orthopedic Surgery at Mayo Clinic in Florida, Jacksonville, Florida. (3)Department of Orthopedic Surgery, RUSH University Medical Center, Chicago, Illinois. (4)Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. (5)Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. BACKGROUND: Preoperative optimization has become an essential component of the orthopaedic surgeon's workflow, especially as outpatient total joint arthroplasty (TJA) becomes more common in ambulatory surgery centers. Surgeons must identify and address modifiable patient risk factors, optimize surgical outcomes, and navigate reimbursement processes for these critical services. METHODS: This review outlines key aspects of preoperative optimization, including medical evaluations for anemia, glycemic control, smoking cessation, and the management of comorbidities like rheumatoid arthritis, obstructive sleep apnea, and peripheral vascular disease. Nutritional and obesity management, the perioperative use of glucagon-like peptide-1 agonists, and the decision-making process for inpatient versus outpatient surgery are also explored. Strategies for optimizing these factors and standardized protocols for risk stratification and patient selection are emphasized. In addition, the introduction of Principal Care Management codes is discussed as a pathway for surgeons to receive reimbursement for preoperative planning efforts. RESULTS: Addressing modifiable risk factors reduces perioperative complications and improves outcomes. For example, tight glycemic control decreases the risk of periprosthetic joint infection, while smoking cessation enhances wound healing. Nutritional interventions, including addressing malnutrition and vitamin D deficiency, reduce complications. Obesity management strategies prioritize patient-centered approaches without strict body mass index cutoffs. Outpatient TJA has shown safety and feasibility and provided careful patient selection, facility readiness, and surgical efficiency. The Principle Care Management billing offers an opportunity for compensation for complex preoperative care. CONCLUSIONS: Preoperative optimization is crucial for minimizing risks and improving outcomes in TJA, particularly as outpatient procedures become more prevalent. Surgeons play a pivotal role in managing patient factors, collaborating with consultants, and implementing standardized protocols. Embracing Principal Care Management codes acknowledges the extensive planning involved in optimizing safety and surgical outcomes, ensuring proper compensation while maintaining high standards of care. Copyright © 2025 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2025.04.040