Focus areas

The AJRR-C is focused on research areas with significant methodology gaps in total joint replacement research.

Application of natural language processing informatics tools in joint replacement research

AJRR-C investigators develop natural language processing tools for automated extraction of surgical data from electronic health records.

Related publication:

• Fu S, Wyles CC, Osmon DR, Carvour ML, Sagheb E, Ramazanian T, Kremers WK, Lewallen DG, Berry DJ, Sohn S, Kremers HM. Automated detection of periprosthetic joint infections and data elements using natural language processing. Journal of Arthroplasty. 2021.

Computer vision methods for automated radiographic grading

AJRR-C investigators develop deep learning computer vision algorithms for automated grading of total joint replacement radiographs. Automated radiographic measures have huge potential as objective outcome measures in studies that assess progression of complications.

Related publication:

• Rouzrokh P, Khosravi B, Johnson QJ, Faghani S, Vera Garcia DV, Erickson BJ, Maradit Kremers H, Taunton MJ, Wyles CC. Applying deep learning to establish a total hip arthroplasty radiography registry: A stepwise approach. The Journal of Bone & Joint Surgery. 2022.

Clinical and surgical trials

Multicenter total joint arthroplasty clinical trials are widely needed but very rare — particularly pragmatic trials of interventions in real-world settings. The collaborative's research addresses technical and methodological issues with various total joint arthroplasty clinical trial designs, as well as intervention-specific issues, to make multicenter trials more feasible and successful.

Confounding and bias in total joint replacement research

AJRR-C investigators are working to describe the types of confounding and bias that arise in observational and interventional studies in total joint arthroplasty using real-world examples.

Related publication:

• Devick KL, Zaniletti I, Larson DR, Lewallen DG, Berry DJ, Maradit Kremers H. Avoiding systematic bias in orthopedics research through informed variable selection: A discussion of confounders, mediators, and colliders. The Journal of Arthroplasty. 2022.

Epidemiological research

There are few reliable estimates of the true population impact of total joint replacements. AJRR-C researchers have pooled data from local and national databases to estimate the total number of Americans living with hip and knee arthroplasty — 2.5 million and 4.7 million, respectively. This work provides the most robust estimates of total joint arthroplasty prevalence. Investigators in the collaborative continue to study methodological issues and mortality trends after both primary and revision total joint replacement procedures.

Related publication:

• Maradit Kremers H, Larson DR, Crowson CS, Kremers WK, Washington RE, Steiner CA, Jiranek WA, Berry DJ. Prevalence of total hip and knee replacement in the United States. The Journal of Bone and Joint Surgery. 2015

Health services research

AJRR-C researchers have performed several studies and identified patient-level risk factors associated with health care utilization and costs in total joint arthroplasty. Furthermore, upon request from the Centers for Disease Control and Prevention, the collaborative validated the National Healthcare Safety Network risk models for surgical site infections using linked data from multiple databases and electronic health records.

Implementation research

Translating findings on effective total joint replacement practices into patient care can be improved by embedding dissemination and implementation principles into clinical research projects.

Long-term safety of total joint arthroplasty

Although total joint arthroplasty is generally a safe procedure, there is growing concern about the long-term systemic effects of artificial implants due to metal and plastic debris. AJRR-C researchers are performing a series of observational, clinical and pathological studies examining the neurotoxicity and cardiotoxicity risks in patients undergoing total joint replacement surgery.

Related publication:

• Vassilaki M, Kremers WK, Machulda MM, Knopman DS, Petersen RC, Laporta ML, Berry DJ, Lewallen DG, Maradit Kremers H. Long-term cognitive trajectory after total joint arthroplasty. JAMA Network Open. 2022.

Patient-reported outcomes

Patient-reported outcomes are increasingly used in total joint arthroplasty. The collaborative uses real-life data from both the AJRR and Mayo Total Joint Registry to study various aspects of patient-reported outcomes in total joint replacement surgery research.

Collection of patient-reported outcome measures from patients undergoing total joint replacement surgery at Mayo Clinic dates back to the 1970s. Using historical data, AJRR-C researchers demonstrated that patient-reported outcomes can be used to identify high-risk patients. They also can be used to individualize follow-up after surgery, which remains a major challenge for many orthopedic centers. The collaborative is studying the implementation of patient-reported outcome measures that meet different purposes without overburdening patients.