Background: While racial and ethnic disparities in postoperative outcomes for total hip and knee arthroplasty (THA/TKA) are well-documented, a significant gap remains in understanding patient-reported barriers to care. This study investigates racial and ethnic disparities in self-reported barriers to health care among THA/TKA patients. Methods: This cross-sectional study used data from the All of Us Research Program. Adult patients undergoing THA or TKA were identified using Current Procedural Terminology codes. Multivariable logistic regression was used to analyze 11 self-reported barriers across racial/ethnic groups (non-Hispanic White, Black, Hispanic, and Other). Odds ratios (ORs) were calculated from models after adjusting for age, sex, and/or neighborhood-level Community Deprivation Index (CDI). Results: A total of 4,419 patients were analyzed: 3,706 (83.9%) White, 325 (7.4%) Black, 235 (5.3%) Hispanic, and 153 (3.5%) Other. After adjusting for age, sex, and CDI, Black patients had significantly higher odds of delaying care because of cost of follow-up (OR 2.01, 95% confidence interval [CI] 1.26-3.21), general visits (OR 2.07, 95% CI 1.24-3.47), and co-pays (OR 2.31, 95% CI 1.44-3.71). Both Black (OR 1.99, 95% CI 1.32-2.98) and Hispanic (OR 1.79, 95% CI 1.13-2.82) patients had significantly higher odds of experiencing transportation-related delays. Conclusion: Significant racial and ethnic disparities in affordability and access persist among THA/TKA patients, even after controlling for neighborhood-level socioeconomic deprivation. Black and Hispanic patients experience multifaceted barriers, underscoring that interventions should address not only individual patient circumstances but also structural community-level factors to achieve equitable arthroplasty care. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

The Lumbar Pelvic Angle (L1PA) was introduced as a convenient intraoperative and postoperative measure of sagittal alignment. However, the utility of L1PA for short segment lumbar fusions remains incompletely understood. This study investigates the relationship between L1PA and segmental parameters of spinal alignment for short segment lumbar fusions. This retrospective analysis was conducted on adult patients with degenerative conditions undergoing primary spinal fusion surgery between L4 and S1. Patients with 35° of regional lordosis at L4-S1 postoperatively and (2) those with >5% change in Lumbar Distribution Index (LDI). Spinopelvic parameters were compared between preoperative and postoperative measurements. The study cohort included 539 patients, of which 360 (66.8%) had an L1PA change less than <5° pre- to postoperatively. Patients in both Group 1 and 2 had significant increases in the L5-S1 segmental angle (both p<.001) without a significant change at the L4-L5 segment. In Group 2, there was a significant increase in PI-LL mismatch (p<.001). In both groups there was a significant increase in L4-S1 lordosis, a relaxation in L1-L4 lordosis (both p<.001), and no significant change in total LL. This investigation assessed L1PA in over 500 patients undergoing lumbar fusion between L4 and S1 and found that despite value to the measure, important changes to spinal shape and segmental alignment may occur even in the face of Δ L1PA <5°. As such, L1PA serves as a potentially useful adjunct to clinical assessment and radiographic measurement in lumbar degenerative fusion but should not serve as a stand-alone measurement.

Study Design.: Systematic review and meta-analysis. Objective.: To compare functional, radiographic, and complication outcomes among ACDF, PCDF, and laminoplasty for multilevel cervical spondylotic myelopathy (CSM). Summary of Background Data.: CSM is a major source of patient morbidity in the United States. Three surgical approaches are commonly employed for this degeneration: ACDF, PCDF, and laminoplasty. Comparative data is warranted to guide approach selection. Methods.: In accordance with PRISMA guidelines, PubMed, Embase, CENTRAL, and Scopus were searched through February 2026 to identify comparative studies reporting outcomes among adult patients undergoing ACDF, PCDF, or laminoplasty for multilevel (≥3 levels) CSM. Twelve studies comprising 1,129 patients met inclusion criteria and were organized into three pairwise comparisons: ACDF versus laminoplasty, PCDF versus laminoplasty, and ACDF versus PCDF. Functional, radiographic, and complication outcomes were comparatively assessed. Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CI). Dichotomous outcomes were pooled as odds ratios (OR) with 95% CI. Heterogeneity was assessed using the I² statistic. Results.: JOA score improvement did not differ between ACDF and laminoplasty (MD=−0.20, P =0.43) or ACDF and PCDF (MD=1.06, P =0.21). VAS neck pain favored ACDF over laminoplasty (MD=−1.05, P =0.03). ACDF demonstrated reduced cervical range of motion (MD=−9.14°, P <0.001) compared with laminoplasty. Hospital stay was shorter after ACDF (MD=−2.62 days, P =0.002) and longer after PCDF (MD=1.19 days, P <0.001) relative to laminoplasty. ACDF was associated with lower rates of axial pain (Peto OR=0.21, P =0.007) and C5 palsy (Peto OR=0.27, P =0.049) but higher rates of dysphagia (Peto OR=5.88, P <0.001) compared with laminoplasty. SSI was more frequent after PCDF than laminoplasty (Peto OR=4.27, P =0.01). Conclusions.: ACDF, PCDF, and laminoplasty demonstrated similar neurological recovery for multilevel CSM. Procedure-specific differences in cervical range of motion, length of stay, and complication profiles support approach selection guided by preoperative alignment and patient-specific concerns.