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Rainey JP, Blackburn BE, Moore ZJ, Archibeck MJ, Pelt CE, Anderson LA, Gililland JM. Decreased Patellar Fractures and Subluxation With Patellar Component Replacement at Stage-One Spacer. J Arthroplasty 2024; 39:S317-S322. [PMID: 38432530 DOI: 10.1016/j.arth.2024.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection is a devastating complication of total knee arthroplasty and is often treated with 2-stage revision. We retrospectively assessed whether replacing the patellar component with articulating stage-one spacers was associated with improved outcomes compared to spacers without patellar component replacement. METHODS A total of 139 patients from a single academic institution were identified who underwent an articulating stage-one revision total knee arthroplasty and had at least 1-year follow-up. Of the 139 patients, 91 underwent patellar component removal without replacement, while 48 had a patellar component replaced at stage-one revision. Patellar fracture and reinfection at any point after stage-one were recorded. Knee range of motion (ROM), patellar thickness, lateral tilt, and lateral displacement were measured at 6-weeks post stage-one. Chi-square, Fisher's exact, and t-tests were utilized for comparisons. There were no significant demographic differences between groups. RESULTS Patellar component replacement at stage-one revision was associated with fewer patellar fractures (2.1 versus 12.1%, P = .046), less lateral patellar displacement (1.7 versus 16.0 mm, P < .01), and improved pre to postoperative knee ROM 6 weeks after stage-one (+5.9 versus -11.4°, P = .03). There was no difference in reinfections after stage-2 revision for the replaced or unreplaced patellar groups (15.4 versus 15%, P = 1.000). While the mean time between stage-one and stage-2 was not different (5.2 versus 4.5 months, P = .50), at one-year follow-up, significantly more patients in the patellar component replacement group were satisfied and refused stage-2 revision (45.8 versus 3.3%, P < .001). CONCLUSIONS Replacing the patellar component at stage-one revision is associated with a decreased rate of patellar fracture and lateral patellar subluxation, improved ROM, and possible increased patient satisfaction, as reflected by nearly half of these patients electing to keep their spacer. There was no difference in reinfection rates between the cohorts.
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Affiliation(s)
- Joshua P Rainey
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Brenna E Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Zachary J Moore
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | | | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Banks SA, Catani F, Deckard ER, Mahoney OM, Matsuda S, Meneghini RM, Victor JMK. Total Knee Arthroplasty Kinematics Predict Patient-Reported Outcome Measures: Implications for Clinical Kinematic Examinations. J Arthroplasty 2024; 39:S224-S229. [PMID: 38360280 DOI: 10.1016/j.arth.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND A core tenet of total knee arthroplasty (TKA) is that achieving more natural kinematics will lead to superior patient outcomes. Yet this relationship has not been proven for large representative cohorts of TKA patients because accurately measuring 3-dimensional TKA kinematics is time-consuming and expensive. But advanced imaging systems and machine learning-enhanced analysis software will soon make it practical to measure knee kinematics preoperatively and postoperatively in the clinic using radiographic methods. The purpose of this study was to assess the reported relationships between TKA kinematics and outcomes and distill those findings into a proposal for a clinically practical protocol for a clinical kinematic exam. METHODS This study reviewed the recent literature relating TKA kinematics to patient outcomes. There were 10 studies that reported statistical associations between TKA kinematics and patient outcome scores utilizing a range of functional activities. We stratified these activities by the complexity of the radiographic examination to create a proposed examination protocol, and we generated a list of requirements and characteristics for a practical TKA clinical kinematic examination. RESULTS Given considerations for a clinically practical kinematic exam, including equipment, time and other resources, we propose 3 exam levels. With basic radiographs, we suggest studying single-leg stance in extension, lunge or squat, and kneeling. For fluoroscopic systems with X-ray pulses up to 20 ms, we propose chair-rise or stair ascent to provide additional dynamic information. For fluoroscopic systems with X-ray pulses of less than 10 ms, we propose rapid open-chain knee flexion-extension to simulate the highly dynamic swing phase of gait. CONCLUSIONS It is our hope that this proposed examination protocol spurs discussion and debate so that there can be a consensus approach to clinical examination of knee and TKA kinematics when the rapidly advancing hardware and software capabilities are in place to do so.
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Affiliation(s)
- Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Evan R Deckard
- Indiana Joint Replacement Institute, Indianapolis, Indiana
| | - Ormonde M Mahoney
- Athens Orthopedic Clinic, Athens, Georgia; Department of Orthopedics, Medical College of Georgia, Augusta, Georgia
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Robert M Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jan M K Victor
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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203
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Zitsch BP, Salaymeh JK, Burdyny MR, Buckner BC, Lyden ER, Konigsberg BS, Garvin KL, Hartman CW. Metaphyseal Fixation Using Cones and Sleeves for Severe Proximal Tibial Bone Loss. J Arthroplasty 2024; 39:S256-S262. [PMID: 38604279 DOI: 10.1016/j.arth.2024.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Tibial bone defects are commonly encountered in revision total knee arthroplasty (rTKA) and can be managed with metaphyseal cones or sleeves. Few studies have directly compared tibial cones and sleeves in rTKA, and none have limited this comparison to the most severe tibial defects. The purpose of this study was to evaluate and compare the outcomes of metaphyseal cones and sleeves for tibial reconstruction in rTKA regarding implant fixation and clinical outcomes. METHODS A retrospective review was conducted on patients undergoing rTKA in which metaphyseal cones or sleeves were utilized for addressing metaphyseal bone loss (34 cones and 18 sleeves). Tibial bone loss was classified according to the Anderson Orthopaedic Research Institute bone defect classification, with types 2B and 3 being included. Patient-reported outcomes and postoperative complications were collected, and a radiographic evaluation of osseointegration or loosening was performed. RESULTS There were 52 knees included (34 cones, 18 sleeves), with a median follow-up of 41.0 months. All-cause implant survival was 100% at 2 years and 96% (95% confidence interval: 76 to 99%) at 4 years, with 98% of tibial components demonstrating osseointegration at the final follow-up. During follow-up, there were a total 11 revisions, of which 1 sleeve was revised secondary to implant loosening. Tibial sleeves had a higher risk of revision compared to tibial cones (P < .01), and sleeves fixed with a hybrid technique were more likely to need revision than cones fixed by the same method (P = .01). CONCLUSIONS Porous metaphyseal tibial cones and tibial metaphyseal sleeves both performed well at a 41-month median follow-up with no difference in aseptic survivorship between the 2 constructs. Both demonstrate high rates of osseointegration, low rates of aseptic failure, and significant improvement in Knee Society Scores in patients with severe tibial defects in rTKA.
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Affiliation(s)
- Bradford P Zitsch
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jamal K Salaymeh
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Michael R Burdyny
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Brandt C Buckner
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elizabeth R Lyden
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Beau S Konigsberg
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kevin L Garvin
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Curtis W Hartman
- Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, Nebraska
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204
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Lewis-Lloyd CA, Lobo DN. A comparison of the top 500 papers in Clinical Nutrition ranked by citation and Altmetric Attention Scores. Clin Nutr 2024; 43:1790-1797. [PMID: 38943805 DOI: 10.1016/j.clnu.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND AND AIMS Citation scores (CS) have been traditionally used to measure the impact of scientific publications. Sourced from the Internet, Altmetric Attention Scores (AAS) are complementary metrics that assess how often publications are discussed and used globally. We compared by rank the top 500 papers by CS and AAS published in Clinical Nutrition with corresponding AAS and CS. METHODS A search for all publications in Clinical Nutrition was performed on Dimensions (https://app.dimensions.ai/discover/publication) on 3rd April 2024. Outputs were ranked according to CS and then by AAS with the top 500 in each category selected. Scores, year and type of publication were recorded. Correlation was expressed as the Spearman's rank coefficient (ϱ). RESULTS We identified 18,790 outputs. Within the top 500 publications ranked by CS, there was a significant weak positive correlation (ϱ = 0.235, P < 0.0001) between CS [median (IQR) 149 (116-223)] and AAS [7 (3-22)]. Ranked by AAS, there was a non-significant very weak positive correlation (ϱ = 0.072, P = 0.106) between AAS [55.5 (36-115)] and CS [42 (16.5-94.5)]. Trends remained similar when grouped by publication type. Guidelines, ranked by CS, had the highest CS and ranked by AAS, the highest CS and AAS. Publications per year, by year, ranked by CS, had a negatively skewed distribution peaking in 2012 and declined thereafter, but when ranked by AAS, had a moderately positive linear trend from 2001 to 2024 (ϱ = 0.513, P < 0.0001). CONCLUSION Correlation between CS and AAS was weak. Guidelines had the highest CS and AAS. CS are iterative taking years to mature while AAS are immediate.
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Affiliation(s)
- Christopher A Lewis-Lloyd
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK. https://twitter.com/ChrisLewisLloyd
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Division of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. https://twitter.com/DL08OMD
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Gill VS, Haglin JM, Tummala SV, Sullivan G, Spangehl MJ, Bingham JS. Regional Differences in Primary Total Knee Arthroplasty Utilization, Physician Reimbursement, and Patient Characteristics. Arthroplast Today 2024; 28:101454. [PMID: 39100412 PMCID: PMC11295465 DOI: 10.1016/j.artd.2024.101454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/05/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background The primary purpose of this study was to evaluate how utilization, physician reimbursement, and patient populations have changed for primary total knee arthroplasty (TKA) from 2013 to 2021 at both a regional and national level within the Medicare population. Methods The Medicare Physician and Other Practitioners database was queried for all episodes of primary TKA between years 2013 and 2021. TKA utilization per 10,000 beneficiaries, inflation-adjusted physician reimbursement per TKA, and patient demographics of each TKA surgeon were extracted each year. Data were stratified geographically, and Kruskal-Wallis tests were utilized. Results Between 2013 and 2021, TKA utilization per 10,000 beneficiaries increased at the greatest rate in the Northeast (+15.1%). In 2021, TKA utilization was highest in the Midwest (97.6/10,000; P < .001). The Midwest had the greatest decline in average physician reimbursement per TKA between 2013 and 2021 (-26.3%) and the lowest average reimbursement ($988.70, P < .001) in 2021. Alternatively, the Northeast had the smallest decline in average TKA reimbursement (-22.6%). Nationally, the average number of beneficiaries per TKA surgeon declined (-6.8%), while the average number of TKAs per surgeon (+5.7%) and average services per beneficiary (+24.3%) both increased. The average number of patient comorbidities and proportion of patients with dual Medicare-Medicaid eligibility decreased over time across all regions. Conclusions This study demonstrates that TKA utilization is increasing and average physician reimbursement per TKA is declining at varying rates across the country, with the Northeast and Midwest most affected. These findings should be addressed in policy discussions to ensure equitable arthroplasty care.
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Affiliation(s)
- Vikram S. Gill
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
| | - Jack M. Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Georgia Sullivan
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
- Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA
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Catton E, Puddy A, Tyagi V, Kurkis GM, Shau DN. The Trend of Medicare Reimbursement for Total Joint Arthroplasty: Using Mathematical Models to Predict Possible Per-Hour Rate Out to 2030. Arthroplast Today 2024; 28:101434. [PMID: 39100420 PMCID: PMC11295619 DOI: 10.1016/j.artd.2024.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/21/2024] [Accepted: 05/01/2024] [Indexed: 08/06/2024] Open
Abstract
Background While multiple studies have assessed the trends of Medicare reimbursement for orthopedic total joint arthroplasty (TJA) surgeries, none have forecasted reimbursement in relatable per-hour figures. The purposes of this study are to examine trends of reimbursement for primary and revision TJA and translate forecasted primary TJA reimbursement to relatable per-hour compensation. Methods The Center for Medicare and Medicaid Services reimbursement data from 1992 to 2024 were used to create a historical view of reimbursement for primary and revision TJA. All monetary values were converted to 2023 USD to account for inflation. Polynomial and linear forecast equations were used to predict the future of the TJA reimbursement to 2030. Relative Value Scale Update Committee standard times for procedures were used with the forecasts to establish per-hour rates. Results Total reimbursement for primary total hip arthroplasty/total knee arthroplasty is forecasted to decrease 85.36%/86.14% by 2030. Using prior trends in reimbursement, TJA procedures are predicted to reimburse at or less than $100.00 2023 USD per Medicare case by 2030. Moreover, TJA surgeons are forecasted to earn $13.93/h per primary total hip arthroplasty and $14.97/h per primary total knee arthroplasty by 2030. Conclusions This study highlights the concerning trends for both primary and revision arthroplasties as TJA surgeons are on a path to earn below minimum wage for primary TJAs by 2030. Mathematical models forecast a bleak future for orthopedic TJA reimbursement. This downward trajectory poses a risk to access and quality of care.
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Affiliation(s)
- Evan Catton
- University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - Alan Puddy
- Hip & Knee Surgery, Texas Hip and Knee Center, Fort Worth, TX, USA
| | - Vineet Tyagi
- Hip & Knee Surgery, Atlantic Health, Bridgewater, NJ, USA
| | | | - David N. Shau
- Hip & Knee Surgery, Texas Hip and Knee Center, Fort Worth, TX, USA
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207
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Gaggiotti S, Foissey C, Pineda T, Batailler C, Gaggiotti G, Gaggiotti S, Servien E, Lustig S. Enhancing robotic precision in medial UKA: Image-based robot-assisted system had higher accuracy in implant positioning than imageless robot-assisted system across 292 knees. Knee Surg Sports Traumatol Arthrosc 2024; 32:2097-2106. [PMID: 38690988 DOI: 10.1002/ksa.12215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The objective of this study was to compare the degree of accuracy in implant positioning and limb alignment offered by two robot-assisted (RA) systems: an image-based robot-assisted (IBRA) versus an imageless robot-assisted (ILRA) system for the treatment of medial knee osteoarthritis with unicompartmental knee arthroplasty (UKA). METHODS This retrospective radiographic study included medial UKAs performed between 2011 and 2023. Radiographic measurements taken preoperatively and at 1-year postoperative control visit focusing on hip-knee-ankle angle (HKA), posterior tibial slope (PTS), tibial component coronal alignment relative to Cartier's angle and restoration of proper joint line (JL) height were analyzed. Outliers for postoperative measurements were defined as follows: HKA <175° or >180°, PTS <2° or >8°, >3° or <-3° alterations in Cartier's angle and ±2 mm changes in the height of the joint line. RESULTS The final sample consisted of 292 medial UKAs: 95 (32.5%) with an IBRA system and 197 (67.5%) with an ILRA system. Implant positioning and limb alignment were more accurate in the group of patients treated with IBRA, HKA (77.9% vs. 67.5%, p = 0.07), PTS (93.7% vs. 82.7%, p = 0.01), restoration of tibial varus relative to Cartier's angle (87.4% vs. 65%, p < 0.001) and restoration of JL height (81.1% vs. 69.5%, p = 0.04). CONCLUSION Medial UKA surgery using an IBRA system was associated with a higher degree of accuracy in implant positioning and postoperative limb alignment as compared to an ILRA system. This is a valuable contribution to help communicate the advantages of using this surgical technique and improve its reproducibility. LEVEL OF EVIDENCE Level III, Retrospective cohort study.
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Affiliation(s)
- Stefano Gaggiotti
- COT Rafaela - COT Santa Fe, Rafaela-Santa Fe, Argentina
- Sanatorio Mayo, Santa Fe, Argentina
| | - Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | | | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
| | - Gabriel Gaggiotti
- COT Rafaela - COT Santa Fe, Rafaela-Santa Fe, Argentina
- Sanatorio Mayo, Santa Fe, Argentina
| | - Santino Gaggiotti
- COT Rafaela - COT Santa Fe, Rafaela-Santa Fe, Argentina
- Sanatorio Mayo, Santa Fe, Argentina
| | - Elvire Servien
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
- EA 7424, Interuniversity Laboratory of Human Movement Science, Université Lyon 1, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Center of Excellence, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Hameed D, Sodhi N, Dubin J, Schneider A, Barrack RL, Mont MA. Integrating Smartphone Applications and Wearable Devices for Postoperative Rehabilitation in Total Knee Arthroplasty: A Critical Review. J Arthroplasty 2024; 39:2028-2039.e1. [PMID: 38403080 DOI: 10.1016/j.arth.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Smartphone and wearable technologies offer innovative methods for monitoring postoperative recovery in total knee arthroplasty (TKA) patients. This review assessed the benefits of these technologies in postoperative care, focusing on (1) smartphone applications, (2) wearable devices, and (3) their combination. METHODS A systematic search identified studies on smartphone applications and wearables for post-TKA monitoring. The review analyzed 2,119 studies, with 58 meeting criteria: 25 on applications, 25 on wearables, and 8 on both. Studies were rated with a methodology index as well as by levels of evidence. They were then analyzed by categorizing them by adherence and patient satisfaction, functional outcomes and pain scores, gait analyses and ranges of motion, and measurement and comparison tools. RESULTS A review of 24 of 25 publications related to smartphone applications used for postoperative recovery in TKA showed the potential for improved patient's satisfaction, gait recovery, pain medication scheduling guidance with improved pain management, cost savings, and functional outcomes. Wearable technologies used in postoperative recovery demonstrated monitoring accuracy in 25 studies. These devices also showed effectiveness in gait and motion analysis. Other demonstrated benefits of the wearables were improved outcomes, return to function, cost reduction, and again, better management of pain due to patient interaction and guidance. Studies that combined applications and wearables demonstrated the individual findings with the addition of adherence, patient's satisfaction, and overall mobility improvement at 3 months. CONCLUSIONS Smartphone applications and wearables can enhance postoperative rehabilitation for TKA patients. Smartphone applications and wearables have been shown in randomized trials to be accurate, effective, and useful in the postoperative rehabilitation of TKA patients. A recurring theme in the review was improved adherence to care plans and medication schedules that ultimately result in improved functional outcomes. These technologies and the data that they generate offer direct patient benefits and the potential for future cost savings.
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Affiliation(s)
- Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, North Shore University Hospital, Northwell Health, New York, New York
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Andrew Schneider
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Robert L Barrack
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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209
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Wahlig BD, Shirley MB, Hadley ML, Thapa P, Krych AJ, Stuart MJ, Trousdale RT. Knee Arthroscopy Following Total Knee Arthroplasty is Not Associated With an Elevated Risk of Infection. J Arthroplasty 2024; 39:S290-S293. [PMID: 38408714 DOI: 10.1016/j.arth.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Recent literature has suggested that knee arthroscopy (KA) following ipsilateral primary total knee arthroplasty (TKA) may be associated with an increased risk of periprosthetic joint infection (PJI). However, prior studies on this subject have relied on insurance databases or have lacked control groups for comparison. This study aimed to evaluate the risk of PJI in patients undergoing ipsilateral KA after primary TKA at a single institution. METHODS Our total joint registry was queried to identify 167 patients (178 knees) who underwent ipsilateral KA for any indication other than infection following primary TKA (KA + TKA group). The average time from TKA to KA was 2.1 ± 2.3 years. The average follow-up from primary TKA and from KA was 8.4 ± 5.4 years and 6.3 ± 5.4 years, respectively. The mean patient age was 63 ± 11 years, the mean body mass index was 31 ± 5, and 64% were women. The most common indications for KA were patellar clunk or patellofemoral synovial hyperplasia (66%) and arthrofibrosis (16%). Patients in the KA + TKA group were matched to 523 patients who underwent TKA without subsequent KA (TKA group) based on age, sex, date of surgery, and body mass index. The primary outcome measure was survivorship free from PJI. RESULTS There was no statistical difference in the overall rate of PJI between the KA + TKA group (n = 2, 1.1%) compared to the TKA group (n = 3, 0.6%) (hazard ratio 2.0, 95% confidence interval 0.3 to 12.0, P = .4). At 5 and 10 years after TKA, there was no difference in survivorship free of PJI between the 2 groups (P = .8 and P = .3, respectively). CONCLUSIONS A PJI is a rare complication of KA after TKA. The rate of PJI in patients undergoing KA following TKA is not significantly increased. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Brian D Wahlig
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Matthew L Hadley
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Prabin Thapa
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Reddy A, Miley EN, Parvataneni HK, Prieto HA, Gray CF. Reversal of the Halo Effect: Prolonged Participation in Comprehensive Care for Joint Replacement Negatively Impacts Revision Metrics. Arthroplast Today 2024; 28:101466. [PMID: 39100415 PMCID: PMC11295625 DOI: 10.1016/j.artd.2024.101466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/10/2024] [Indexed: 08/06/2024] Open
Abstract
Background The downstream regional effect of the Comprehensive Care for Joint Replacement (CJR) program on care pathway-adjacent patients, including revision arthroplasty patients, is poorly understood. Prior studies have demonstrated that care pathways targeting primary total joint arthroplasty may produce a halo effect, impacting more complex patients with parallel care pathways. However, neither the effect of regional referral changes from CJR nor the durability of these positive changes with prolonged bundle participation has been assessed. Methods Blinded data were pulled from electronic medical records. Primary analyses focused on the effect of CJR participation from 2015 (baseline) to 2020 (final participation year) at a tertiary care safety-net hospital. Patient demographics were evaluated using multivariate analysis of variance and chi-square calculations between procedure types over time. Results Patients who underwent revision total knee arthroplasty (N = 376) and revision total hip arthroplasty (N = 482) were included. More patients moved through the revision-care pathway over the participation period, with volume increasing by 42% over time. Patients became more medically complex: the Charlson comorbidity index increased from 3.91 to 4.65 (P = .01). The mean length of stay decreased from 5.14 days to 4.50 days (P = .03), but the all-cause complication (8.3%-15.2%; P = .02) and readmission rates (13.6%-16.6%; P = .19) increased over time. Conclusions Despite care pathway improvements over 5 years of CJR participation, revision patients did not display clear benefits in quality metrics but demonstrated a considerable increase in volume and medical complexity over time. The care of these patients may supersede even thoughtfully implemented care pathways, especially when referral burden increases, as may be prone to happen in regional, financial risk-conferring value-based programs. Understanding the impact of mandatory bundled payment programs like CJR on the care of arthroplasty patients regionally will be essential as value-based programs evolve.
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Affiliation(s)
- Akshay Reddy
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Emilie N. Miley
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, FL
| | | | - Hernan A. Prieto
- Department of Orthopaedic Surgery, College of Medicine, University of Florida, Gainesville, FL
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Suhardi VJ, Oktarina A, Hammad M, Niu Y, Li Q, Thomson A, Lopez J, McCormick J, Ayturk UM, Greenblatt MB, Ivashkiv LB, Bostrom MPG, Yang X. Prevention and treatment of peri-implant fibrosis by functionally inhibiting skeletal cells expressing the leptin receptor. Nat Biomed Eng 2024:10.1038/s41551-024-01238-y. [PMID: 39085645 DOI: 10.1038/s41551-024-01238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/25/2024] [Indexed: 08/02/2024]
Abstract
The cellular and molecular mediators of peri-implant fibrosis-a most common reason for implant failure and for surgical revision after the replacement of a prosthetic joint-remain unclear. Here we show that peri-implant fibrotic tissue in mice and humans is largely composed of a specific population of skeletal cells expressing the leptin receptor (LEPR) and that these cells are necessary and sufficient to generate and maintain peri-implant fibrotic tissue. In a mouse model of tibial implantation and osseointegration that mimics partial knee arthroplasty, genetic ablation of LEPR+ cells prevented peri-implant fibrosis and the implantation of LEPR+ cells from peri-implant fibrotic tissue was sufficient to induce fibrosis in secondary hosts. Conditional deletion of the adhesion G-protein-coupled receptor F5 (ADGRF5) in LEPR+ cells attenuated peri-implant fibrosis while augmenting peri-implant bone formation, and ADGRF5 inhibition by the intra-articular or systemic administration of neutralizing anti-ADGRF5 in the mice prevented and reversed peri-implant fibrosis. Pharmaceutical agents that inhibit the ADGRF5 pathway in LEPR+ cells may be used to prevent and treat peri-implant fibrosis.
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Affiliation(s)
- Vincentius Jeremy Suhardi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Research Institute, Hospital for Special Surgery, New York, NY, USA
| | | | - Mohammed Hammad
- Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Yingzhen Niu
- Research Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Qingdian Li
- Research Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedics, Guangdong Provincial People's Hospital, Southern Medical University, Guangzhou, P. R. China
| | - Andrew Thomson
- Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Juan Lopez
- Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Jason McCormick
- Flow Cytometry Core Facility, Weill Cornell Medicine, New York, NY, USA
| | - Ugur M Ayturk
- Research Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Matthew B Greenblatt
- Research Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Mathias P G Bostrom
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Research Institute, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Xu Yang
- Research Institute, Hospital for Special Surgery, New York, NY, USA.
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, NY, USA.
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212
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Liu S, Patanwala AE, Stevens J, Penm J, Naylor J. A pilot multicentre randomised clinical trial to determine the effect of a pharmacist-partnered opioid tapering intervention before total hip or knee arthroplasty. Anaesthesia 2024. [PMID: 39083657 DOI: 10.1111/anae.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth-based pharmacist-partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care. METHODS This study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre-operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre-operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by > 50% before surgery. RESULTS Between December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1-4 [1-6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p < 0.001). CONCLUSIONS The findings of this pilot study support the feasibility of a telehealth-delivered, pharmacist-partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted.
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Affiliation(s)
- Shania Liu
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Asad E Patanwala
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Jennifer Stevens
- School of Clinical Medicine, St Vincent's Clinical Campus, University of New South Wales, Sydney, NSW, Australia
- University of Notre Dame, Sydney, NSW, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Sydney, NSW, Australia
| | - Justine Naylor
- Ingham Institute, Whitlam Orthopaedic Research Centre, Liverpool, NSW, Australia
- South West Sydney Clinical Campus, School of Clinical Medicine, Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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213
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Leal J, Kugelman DN, Seyler TM, Jiranek WA, Wellman SS, Bolognesi MP, Ryan SP. Same Day Discharge Total Knee Arthroplasty: Hospital Demonstrates Similar Outcomes to Ambulatory Surgery Center in a More Complex Patient Population. J Arthroplasty 2024:S0883-5403(24)00800-3. [PMID: 39089395 DOI: 10.1016/j.arth.2024.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The purpose of this study was to compare outcomes between patients undergoing same-day discharge (SDD) total knee arthroplasty (TKA) at an ambulatory surgery center (ASC) versus a tertiary care university hospital setting. METHODS A single tertiary academic center's institutional database was reviewed for patients that underwent primary TKA and were discharged the same day from August 2021 to January 2024. Patients who did not have at least one year of follow-up were excluded. Patient demographics, comorbidities, patient-reported outcome measures (PROMs), emergency department (ED) visits, admissions, reoperations, and revisions were collected. Patients were stratified by the location of their surgery: ASC versus hospital. Specific criteria had to be met prior to surgery at the ASC, and the final decision regarding the location of surgery was made via shared decision-making between the patient and their surgeon. Patients who did not meet ASC criteria underwent TKA at the main hospital. Univariable analyses were used to compare groups, and multivariable logistic regression was used to determine if surgical location was a significant factor. Of the 449 TKAs meeting inclusion criteria, 63.3% (284) were performed at the ASC and 36.7% (165) at the university hospital at a mean follow-up of 1.51 years (range, 1.00 to 2.40). Of those 165 whose surgery was done at the hospital, 93.9% met at least one ASC exclusion criteria. RESULTS Patients whose TKA was done at the hospital had significantly higher weight (P = 0.003), body mass index (BMI) (P < 0.001), Elixhauser comorbidity index (ECI) (P < 0.001), proportion of patients who had an American Society of Anesthesiologists (ASA) classification of 3 (P = 0.023), and proportion of patients who required general anesthesia (P < 0.001). Additionally, patients whose TKA was done at the hospital had higher preoperative patient-reported outcome measurement information system (PROMIS) pain interference (PI) (62.0 [59.0, 66.0] versus 63.0 [61.8, 67.0]; P = 0.006), and lower physical function (PF) (39.0 [36.0, 43.0] versus 38.0 [34.0, 41.0]; P = 0.001). At 1 year, however, patients in both groups had similar PROMIS PI (53.0 [49.0, 59.0] versus 54.0 [44.0, 59.0]; P = 0.785) and PROMIS PF (47.0 [42.0, 51.0] versus 47.0 [41.0, 50.0]; P = 0422) scores as well as similar rates of achieving minimum clinically important difference (MCID) for PROMIS PI (64.4 versus 71.4%; P = 0.336) and PROMIS PF (60.5 versus 71.4%; P = 0.124). They also had a similar number of ED visits and admissions at 30 and 90 days, as well as similar reoperation-free (92.0 versus 93.3%; P = 0.79) and revision-free (95.5 versus 99.4%; P = 0.59) survival at 2 years. CONCLUSION Although ASCs have strict patient criteria for SDD TKA, complex patients at a tertiary university hospital can be sent home the same day with equivalent outcomes. Therefore, unhealthier patients can safely achieve SDD without compromising outcomes if done in the appropriate setting.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA.
| | - David N Kugelman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Baez C, MacDonell R, Tishad A, Prieto HA, Miley EN, Deen JT, Gray CF, Parvataneni HK, Pulido L. Comparison of Five-Day vs. Fourteen-Day Incubation of Cultures for Diagnosis of Periprosthetic Joint Infection in Hip Arthroplasty. J Clin Med 2024; 13:4467. [PMID: 39124734 PMCID: PMC11313486 DOI: 10.3390/jcm13154467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Periprosthetic joint infections (PJI) are among the most morbid complications in total hip arthroplasty (THA). The ideal incubation time, however, for intraoperative cultures for PJI diagnosis remains unclear. As such, the aim of this study was to determine if any differences existed in culture-positive rates and organism detection between five-day and fourteen-day cultures. Methods: This retrospective cohort study consisted of THA cases diagnosed with PJI performed between May 2014 and May 2020 at a single tertiary-care institution. Analyses compared five-day and fourteen-day cultures and carried out a pre-specified subgroup analysis by organism and PJI type. Results: A total of 147 surgeries were performed in 101 patients (57.1% females), of which 65% (n = 98) obtained five-day cultures and 34% (n = 49) obtained fourteen-day cultures. The positive culture rate was 67.3% (n = 99) with Staphylococcus aureus being the most common pathogen identified (n = 41 specimens, 41.4%). The positive culture rate was not significantly different between groups (66.3% five-day, 69.4% fourteen-day, p = 0.852). Fourteen-day cultures had a significantly longer time-to-positive culture (5.0 days) than five-day cultures (3.0 days, p < 0.001), a higher rate of fungi (5.6% vs. 0%), and a lower rate of Gram-negatives (4.5% vs. 18.7%, p = 0.016). Conclusions: Fourteen-day cultures did not increase the positivity rate, had higher rates of slow-growth pathogens, and had a longer time-to-positivization than five-day cultures. Prolonged culture holds may provide more thorough organism detection for PJI without increasing the diagnostic culture yield.
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Affiliation(s)
- Catalina Baez
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL 32607, USA; (R.M.); (H.A.P.); (E.N.M.)
| | - Robert MacDonell
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL 32607, USA; (R.M.); (H.A.P.); (E.N.M.)
| | - Abtahi Tishad
- College of Medicine, University of Florida, Gainesville, FL 32607, USA;
| | - Hernan A. Prieto
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL 32607, USA; (R.M.); (H.A.P.); (E.N.M.)
| | - Emilie N. Miley
- Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL 32607, USA; (R.M.); (H.A.P.); (E.N.M.)
| | - Justin T. Deen
- Florida Orthopaedic Institute, Gainesville, FL 32607, USA; (J.T.D.); (C.F.G.); (H.K.P.)
| | - Chancellor F. Gray
- Florida Orthopaedic Institute, Gainesville, FL 32607, USA; (J.T.D.); (C.F.G.); (H.K.P.)
| | - Hari K. Parvataneni
- Florida Orthopaedic Institute, Gainesville, FL 32607, USA; (J.T.D.); (C.F.G.); (H.K.P.)
| | - Luis Pulido
- Florida Orthopaedic Institute, Gainesville, FL 32607, USA; (J.T.D.); (C.F.G.); (H.K.P.)
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Lim PL, Sayeed Z, Gonzalez MR, Melnic CM, Bedair HS. Comparison of Time and Rate of Achieving Minimal Clinically Important Difference: Robotic Versus Manual Unicompartmental Knee Arthroplasty. J Am Acad Orthop Surg 2024:00124635-990000000-01057. [PMID: 39083490 DOI: 10.5435/jaaos-d-24-00380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/06/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Robotics in unicompartmental knee arthroplasty (UKA) continues to increase with the ever-growing demand to use technology in the surgical setting. However, no studies have used minimal clinically important difference (MCID) to compare patient-reported outcome measures (PROMs) between robotic UKA (rUKA) and manual UKA (mUKA). This study aimed to compare the rate of achieving MCID for improvement (MCID-I) and worsening (MCID-W) and the time to achieving MCID. METHODS We conducted a retrospective analysis of robotic and manual UKAs performed between 2016 and 2022. Preoperative and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function Short-Form 10a (PF-10a), and Knee Injury and Osteoarthritis Outcome Score-Physical Function Short-Form (KOOS-PS) scores were collected. Patients were stratified on reaching MCID-I, MCID-W, or "no notable change" (score between MCID-W and MCID-I). Survival curves with and without interval censoring were used to assess the time to achieving the MCID. Log-rank and weighted log-rank tests were used to compare groups. RESULTS A total of 256 UKAs (64 robotic and 192 manual) were analyzed. No differences were observed in the proportion of patients achieving MCID-I or MCID-W across all three PROMs. Similarly, median time to achieving MCID showed no significant differences between rUKA and mUKA for PROMIS Global Physical (3.3 versus 4.9 months, P = 0.44), PROMIS PF-10a (7.7 versus 8.3 months, P = 0.93), and KOOS-PS (3.0 versus 6.0 months, P = 0.055) scores, both with and without interval censoring. DISCUSSION This study indicates that rUKA and mUKA exhibit comparable rates of achieving MCID-I and MCID-W, along with similar median time to reach MCID. These findings offer valuable patient-centric insights into the effectiveness of rUKA. Additional studies evaluating the long-term outcomes of rUKA are needed to determine its long-term advantages. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Perry L Lim
- From the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Lim, Sayeed, Gonzalez, Melnic, and Bedair), and the Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA (Lim, Sayeed, Gonzalez, Melnic, and Bedair)
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216
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Rainer M, Ommerli SM, Burden AM, Betschart L, Stämpfli D. Opioid exit plans for tapering postoperative pain control in noncancer patients: a systematic review. Patient Saf Surg 2024; 18:25. [PMID: 39080780 PMCID: PMC11290124 DOI: 10.1186/s13037-024-00408-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND A growing number of countries have reported sharp increases in the use and harm of opioid analgesics. High rates of new opioid initiation are observed in postoperative patients. In response, various tertiary care institutions have developed opioid exit plans (OEPs) to curb potential opioid-related harm. METHODS PubMed and Embase were systematically searched to identify, summarize, and compare the interventional elements of OEPs for postoperative patient populations published from January 1, 2000, to June 4, 2024. Two researchers independently screened the articles for eligibility following the PRISMA 2020 guidelines, extracted the data, and assessed the study quality and risk of bias. Data synthesis was performed for study characteristics, intervention details, efficacy, and development. RESULTS A total of 2,585 articles were screened, eight of which met the eligibility criteria. All studies were conducted in North America and focused on orthopedic surgery patients following total hip or knee arthroplasty (n = 5) or neurosurgery (n = 3). Most studies (n = 7) included a pre-post (n = 4) or randomized clinical design (n = 3). Three studies were of good quality, and none had a low risk of bias. The interventions varied and ranged from educational sessions (n = 1) to individualized tapering protocols (n = 4) or a combination of the two (n = 2). Key elements were instructions on how to anticipate patients' postoperative need for opioid analgesics and tapering strategies based on 24-h predischarge opioid consumption. Six studies included efficacy as an endpoint in their analysis, of which four assessed statistical significance, with all four identifying that the OEPs were successful in reducing postoperative opioid use. CONCLUSION Despite differences in design and implementation, the identified OEPs suggest that they are efficacious in reducing outpatient opioid consumption. They provide a robust estimate of postoperative analgesic requirements and a rationale for tapering duration and rate. However, more rigorous studies are needed to evaluate their real-world effectiveness.
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Affiliation(s)
- Marcel Rainer
- Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog Weg 1-5/10, 8093, Zurich, Switzerland
- Hospital Pharmacy, Department Medical Services, Kantonsspital Baden, Im Ergel, 5404, Baden, Switzerland
| | - Sarah Maleika Ommerli
- Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog Weg 1-5/10, 8093, Zurich, Switzerland
| | - Andrea Michelle Burden
- Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog Weg 1-5/10, 8093, Zurich, Switzerland
| | - Leo Betschart
- Chemistry | Biology | Pharmacy Information Center, ETH Zurich, Vladimir-Prelog Weg 10, 8093, Zurich, Switzerland
| | - Dominik Stämpfli
- Institute of Pharmaceutical Sciences, ETH Zurich, Vladimir-Prelog Weg 1-5/10, 8093, Zurich, Switzerland.
- Hospital Pharmacy, Department Medical Services, Kantonsspital Baden, Im Ergel, 5404, Baden, Switzerland.
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217
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Hoveidaei AH, Ghaseminejad-Raeini A, Esmaeili S, Movahedinia M, Karbasi S, Khonji MS, Nwankwo BO, Shrestha A, Conway JD. Knee fusion versus above knee amputation as two options to deal with knee periprosthetic joint infection. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05429-9. [PMID: 39068619 DOI: 10.1007/s00402-024-05429-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Periprosthetic joint infection (PJI) poses a significant challenge in total knee arthroplasty (TKA), with recurrence rates as high as 14-28%, leading to substantial morbidity and treatment costs. When conventional treatments fail, knee fusion and above-the-knee amputation (AKA) emerge as alternative options. Existing literature offers conflicting views on the efficacy and impact of knee fusion versus AKA with varied outcomes and limitations. METHODS This retrospective national study spanning 2010-2022 investigates Knee Fusion and AKA as options for addressing Knee PJI. Utilizing PearlDiver Patient Records Database, procedural, and reimbursement data on over 100 million individuals from all the US was evaluated. Readmission rates, costs, and complications of the mentioned procedures were assessed using ICD-9 and ICD-10 codes within a 90-day period and one-year post-operation. Statistical analyses, including chi-square tests and regression models, were conducted using integrated R software. RESULTS The study reveals a substantial escalation (p < 0.0001) in the proportion of patients opting for AKA compared to arthrodesis. While age as a demographic factor showed no significant difference, arthrodesis patients exhibited lower comorbidity scores (3.6 ± 2.9 vs. 4.6 ± 3.4, p < 0.001). Arthrodesis correlated with higher 90-day thromboembolism rates (9.2% vs. 7.3%, p < 0.001), blood transfusion requirements (23.2% vs. 14.4%, p < 0.001), and acute renal failure incidence (p = 0.008) but demonstrated lower rates of urinary tract infections (p = 0.047) and cerebrovascular accidents (p < 0.001). At 1 year, arthrodesis was associated with higher infection rates (38.7% vs. 36.4%, p < 0.001). Arthrodesis patients had significant increased 90-day and 1-year readmission rates and hospitalization costs ($12,732 vs. $18,826, p < 0.001). CONCLUSIONS We found higher rates of 1-year thromboembolism, infection, acute renal failure, and readmission in the arthrodesis group. AKA patients had more sepsis and cerebrovascular accidents. A patient-centered conversation is best for persistent infections and failed revision TKA. Considering the patient's quality of life, goals, and health status, this discussion should cover each procedure's risks and complications.
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Affiliation(s)
- Amir Human Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | | | - Sina Esmaeili
- Sina University Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Movahedinia
- Orthopedics Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Karbasi
- Department of Medicine, Isfahan University of Medical Sciences (MUI), Isfahan, Iran
| | - Mohammad Saeid Khonji
- Bone and Joint Reconstruction Research Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Basilia Onyinyechukwu Nwankwo
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation, Howard University Hospital, Washington, DC, USA
| | - Ashesh Shrestha
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Janet D Conway
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA.
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218
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Zeng J, Yang X, Lei H, Zhong X, Lu X, Liu X, Peng X. Enhanced Postoperative Pain Management and Mobility Following Arthroscopic Knee Surgery: A Comparative Study of Adductor Canal Block with and without IPACK Block. Med Sci Monit 2024; 30:e943735. [PMID: 39068511 PMCID: PMC11299957 DOI: 10.12659/msm.943735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/06/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Arthroscopic knee surgery (AKS) is minimally invasive, reducing hospital stay compared to traditional surgery, but postoperative pain remains a significant issue. This study compared the analgesic and functional outcomes following AKS following anesthesia using adductor canal block (ACB) with and without anesthesia using the interspace between the popliteal artery and posterior capsule of the knee (IPACK) block under spinal anesthesia (SA). MATERIAL AND METHODS We randomly allocated 120 patients into 3 groups: IPACK+ACB+SA for Group A (n=40), ACB+SA for Group B (n=40), and SA for Group C (n=40). The outcome was the visual analog scale (VAS) score evaluated at rest and during activity at 3 h, 6 h, 12 h, 24 h, and 48 h postoperatively, the frequency of administration of postoperative rescue analgesic, and the maximal walking distance at 24 h and 48 h postoperatively. RESULTS Compared with Group C, the VAS scores in Group A were significantly lower at 48 h postoperatively (P<0.05). There was a significant difference in the frequency of postoperative rescue analgesia use among the 3 groups (P=0.001). In a subgroup analysis of meniscus shaping under arthroscopy, the resting VAS score in Group A was lower than that in Group B and Group C at 48 h postoperatively (P<0.05). The maximum walking distance of Group A was longer than that of Group B and Group C at 24 h and 48 h postoperatively (P<0.01). CONCLUSIONS The effect of postoperative analgesia in the group receiving IPACK combined with ACB after AKS was obviously superior. In arthroscopic meniscus repair surgery, the duration of analgesia was longer, and the maximum walking distance at 48 h postoperatively was longer.
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Affiliation(s)
- Jian Zeng
- Department of Anesthesiology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China
- Department of Anesthesiology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, PR China
| | - Xiongtiao Yang
- Department of Anesthesiology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, PR China
| | - Hongyi Lei
- Department of Anesthesiology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, PR China
| | - Xiao Zhong
- Department of Anesthesiology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, PR China
| | - Xiaoqin Lu
- Department of Anesthesiology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Xianbao Liu
- Department of Anesthesiology, Guangdong Provincial Key Laboratory of Major Obstetric Diseases; Guangdong Provincial Clinical Research Center for Obstetrics and Gynecology; The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Xiaomin Peng
- Department of Anesthesiology, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong, PR China
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219
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Park KB, Kim JM, Lee BS, Kim MS, Park JH. Clinical outcomes of two-stage revision arthroplasty using a spiked tibial cement spacer in infected total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06257-7. [PMID: 39066904 DOI: 10.1007/s00264-024-06257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE A tibial cement spacer (TCS) with spikes offers better initial stability than a conventional TCS and reduces spacer-related problems in two-stage revision total knee arthroplasty (R-TKA) for infection. We compared the clinical outcomes of two-stage revision arthroplasty for infected TKA using spiked TCS with that of conventional TCS. METHODS This retrospective cohort study included 29 patients who underwent two-stage revision arthroplasty using an articulating cement spacer and who could be followed up for at least one year. Group S comprised 14 patients using spiked TCS, whereas Group C comprised 15 patients using conventional TCS. Demographic data, the interval from first to second stage revision, motion arc, numerical rating scale (NRS), Knee Society (KS) score, serum levels of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and frequency of repeating the first-stage and infection recurrence after R-TKA between the groups were analyzed. RESULTS No significant differences were observed in the female ratio and mean age between both groups. The mean interval between the first and second stage revision was significantly shorter in Group S than in Group C. The mean motion arc was significantly larger in Group S than in Group C. The mean NRS was significantly lower in Group S than in Group C. The mean KS score in Group S was significantly higher than that in Group C. Serum ESR and CRP levels did not differ between the groups. The frequency of repeating the first stage was lower in Group S than in Group C. However, the recurrence rate after R-TKA was higher in Group S than in Group C. CONCLUSION Compared with conventional TCS, spiked TCS shortened the period until R-TKA and improved pain and function levels. However, no significant difference existed in the rate of infection recurrence after R-TKA.
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Affiliation(s)
- Ki-Bong Park
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 288-1, Poongnap-dong, Songpa-gu, Seoul, 137-736, Republic of Korea.
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 288-1, Poongnap-dong, Songpa-gu, Seoul, 137-736, Republic of Korea
| | - Min-Seok Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jae-Hwan Park
- Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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220
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Tang Y, Jin Z, Lu Y, Chen L, Lv S, Xu T, Tong P, Chen G. Comparing the Efficacy of Antiosteoporotic Drugs in Preventing Periprosthetic Bone Loss Following Total Hip Arthroplasty: A Systematic Review and Bayesian Network Meta-Analysis. Orthop Surg 2024. [PMID: 39056482 DOI: 10.1111/os.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/15/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Periprosthetic bone loss is a well-known phenomenon following total hip arthroplasty (THA). However, the choice of drugs for prevention remains controversial. Therefore, the aim of this study was to determine the best drug to treat periprosthetic bone loss by comparing changes in bone mineral density (BMD) at different times after THA. METHODS A comprehensive search of five databases and two clinical trial registration platforms was undertaken from their inception through to August 31, 2023 to identify eligible randomized controlled trials. A Bayesian network meta-analysis (NMA) was carried out for calculating the standardized mean difference (SMD) and the surface under cumulative ranking curve (SUCRA) of the BMD in calcar (Gruen zone 7) at 6 months, 12 months, and 24 months and over. RESULTS Twenty-nine trials involving 1427 patients and 10 different interventions were included. The results demonstrated that at 6 months, denosumab had the highest ranking (SUCRA = 0.90), followed by alendronate (SUCRA = 0.76), and zoledronate (SUCRA = 0.73). At 12 months, clodronate ranked highest (SUCRA = 0.96), followed by denosumab (SUCRA = 0.84) and teriparatide (SUCRA = 0.82). For interventions with a duration of 24 months and over, denosumab had the highest SUCRA value (SUCRA = 0.96), followed by raloxifene (SUCRA = 0.90) and zoledronate (SUCRA = 0.75). CONCLUSION Investigating the existing body of evidence revealed that denosumab demonstrates potential as an intervention of superior efficacy at the three specifically examined time points. However, it remains crucial to conduct further research to confirm these findings and determine the most effective treatment strategy.
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Affiliation(s)
- Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Yichen Lu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Taotao Xu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, China
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221
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Gur S, Segal D, Tavdi A, Fuchs Y, Perl D, Fainzack A, Ohana N, Markushevich M, Brin YS. Are Routine Postoperative Hemoglobin Tests Justified in All Patients Who Undergo Total Hip Arthroplasty Due to a Displaced Femoral Neck Fracture? J Clin Med 2024; 13:4371. [PMID: 39124638 PMCID: PMC11313077 DOI: 10.3390/jcm13154371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Total hip arthroplasty (THA) is a standard treatment for a displaced femoral neck fracture in the elderly. In contemporary healthcare, there is a global shift towards fast-track treatment modalities, prioritizing early hospital discharge for patients. Consequently, routine postoperative blood tests may become redundant, offering significant time and cost savings. We aim to evaluate postoperative hemoglobin levels in trauma-related THA cases and identify patient profiles for whom these tests hold significance. Methods: A retrospective review of 176 THA procedures performed between 2018 and 2022, focusing on individuals undergoing THA for displaced femoral neck fractures. Multivariable logistic regression analysis was employed to identify factors associated with postoperative hemoglobin levels below 8.5 g/dL. Results: Of the 176 patients included, 109 (61.9%) were women and the mean age was 69.09 ± 8.13 (range 27 to 90) years. The majority of the patients underwent surgery within 48 hours of admission. The mean preoperative hemoglobin (Hb) level was 13.1 ± 1.4 g/dL, while the mean postoperative Hb level was 10.5 ± 1.2 g/dL. Only six patients (3.41%) exhibited postoperative Hb levels of ≤8.5 g/dL. No significant associations were found between postoperative Hb levels ≤ 8.5 and any demographic, surgical, or medical characteristics. Conclusions: Our findings suggest that routine postoperative blood count testing may not be necessary for most patients undergoing THA for displaced femoral neck fractures, particularly those without complications or significant comorbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yaron Shraga Brin
- Department of Orthopedic Surgery, Meir Medical Center, Tel-Aviv University, Kfar-Saba 4428164, Israel
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222
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Kates SL, Owen JR, Beck CA, Muthukrishnan G, Daiss JL, Golladay GJ. Dilution of humoral immunity: Results from a natural history study of healthy total knee arthroplasty patients. J Orthop Res 2024. [PMID: 39054760 DOI: 10.1002/jor.25942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 07/27/2024]
Abstract
The incidence of prosthetic joint infection (PJI) following elective primary total knee arthroplasty (TKA) is very low but serious risk remains. To identify unknown risk factors, we completed a natural history study of IgG specific for Staphylococcus aureus antigens previously phenotyped as protective (anti-Atl) and pathogenic (anti-Isd). Twenty-five male and 25 female optimized patients 50-85 years of age and BMI 24-39 undergoing primary TKA were prospectively enrolled. Blood sampling was performed preoperatively, postoperative Day 1, and at 2, 6, and 12 weeks, to assess serum cytokine, anti-staphylococcal IgG levels and anti-tetanus toxoid IgG measured via custom Luminex assay. Clinical, demographic, and PROMIS-10 data were collected with outcomes to 2 years postop. All participants completed the study and 2-year follow-up. No patients were readmitted or noted to develop a surgical site infection or serious adverse event, and patient-reported outcomes were improved. Serology revealed a highly significant decrease in six out of eight antibody titers against specific S. aureus antigens on Day 1 (p < 0.0001), five of which normalized to preoperative levels within 2 weeks. These changes were commensurate with a decrease and recovery of anti-tetanus toxoid titers, and a 20% drop in hemoglobin 13.8 ± 1.7 at preop to 11.1 ± 1.8 mg/dL on Day 1 (p < 0.0001). After TKA, a significant decrease in humoral immunity commensurate with blood loss and hemodilution was recorded. This decrease in circulating anti-staphylococcal antibodies in the early postop period may represent a periprosthetic joint infection risk factor for patients.
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Affiliation(s)
- Stephen L Kates
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John R Owen
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Christopher A Beck
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | | | - John L Daiss
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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223
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Poursalehian M, Soltani Farsani A, Habibi MA, Razzaghof M, Nafisi M, Ayati Firoozabadi M, Mortazavi SJ. Current Evidence Does Not Support the Use of Tibial Stem Extension in Total Knee Arthroplasty of Obese Patients: A Systematic Review. J Arthroplasty 2024:S0883-5403(24)00795-2. [PMID: 39067777 DOI: 10.1016/j.arth.2024.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Obesity rates have been increasing globally, leading to a higher incidence of knee osteoarthritis and a surge in primary and revision total knee arthroplasty (TKA). The debate continues on the impact of obesity on TKA success, particularly regarding the use of stemmed tibial components in obese patients. This systematic review aimed to compare the effectiveness of stemmed tibial components versus standard keeled tibial components in obese patients undergoing TKA, hypothesizing that stemmed components would yield better clinical and radiological outcomes. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Databases including PubMed, Embase, Scopus, and Web of Science were searched from inception to December 2023. The eligibility criteria were based on the PICO framework; Participants: Patients who have obesity undergoing TKA, Intervention: stemmed TKA, Comparator: standard keeled tibial TKA, Outcome: aseptic loosening, Patient-Reported Outcome Measures (PROMs), and overall revision. Data extraction and quality assessment were performed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane risk-of-bias tool for randomized trials. RESULTS The search yielded 470 studies, with 10 studies (42,533 knees) meeting the inclusion criteria. These studies included three randomized clinical trials and seven retrospective cohorts. The primary outcomes measured were aseptic loosening and overall revision rates, while secondary outcomes included PROMs. Results indicated mixed findings, with some studies suggesting improved outcomes with stemmed components in cases of aseptic loosening and mechanical failure, while others showed no significant difference. The PROMs did not show a significant difference between groups post-TKA. The certainty of the evidence was graded as "very low" using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. CONCLUSION Current literature does not provide conclusive evidence to support the routine use of stemmed tibial components in TKA for obese patients. The decision to use stem extensions should not solely rely on the patient's obesity status. Further high-quality studies are needed to clarify the role of stemmed components in TKA for this patient population.
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Affiliation(s)
- Mohammad Poursalehian
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Soltani Farsani
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Nafisi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ayati Firoozabadi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sm Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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224
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Boyle AB, Harris IA. Unnecessary care in orthopaedic surgery. ANZ J Surg 2024. [PMID: 39051610 DOI: 10.1111/ans.19171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
Unnecessary care, where the potential for harm exceeds the potential for benefit, is widespread in medical care. Orthopaedic surgery is no exception. This has significant implications for patient safety and health care expenditure. This narrative review explores unnecessary care in orthopaedic surgery. There is wide geographic variation in orthopaedic surgical practice that cannot be explained by differences in local patient populations. Furthermore, many orthopaedic interventions lack adequate low-bias evidence to support their use. Quantifying the size of the problem is difficult, but the economic burden and morbidity associated with unnecessary care is likely to be significant. An evidence gap, evidence-practice gap, cognitive biases, and health system factors all contribute to unnecessary care in orthopaedic surgery. Unnecessary care is harming patients and incurring high costs. Solutions include increasing awareness of the problem, aligning financial incentives to high value care and away from low value care, and demanding low bias evidence where none exists.
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Affiliation(s)
- Alex B Boyle
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia
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225
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Blackburn AZ, Prasad AK, Scott B, Cote M, Humphrey TJ, Katakam A, Salimy MS, Lim P, Heng M, Melnic CM, Bedair HS. The Role of Risk Tolerance in a Patient's Decision to Undergo Total Knee and Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00796-4. [PMID: 39067776 DOI: 10.1016/j.arth.2024.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND A patient's decision-making process to undergo surgery is crucial for surgeons to understand for patient counseling purposes. Total knee and hip arthroplasty, like any other major surgery, is associated with serious, sometimes life-threatening, complications. Using the results of discrete choice experiments (DCE), we aimed to understand the relationship between a patient's risk tolerance and choosing to undergo surgery in real life. METHODS This is a retrospective study of prospectively collected DCE results for 142 potential knee or hip arthroplasty clinic patients from October 2021 to March 2022. The DCE presented the patient with two scenarios, each of which was made up of different combinations of attributes and levels. A hierarchal Bayesian model was utilized to obtain a risk score that reflected the risk attributes chosen by each patient. Logistic regressions were then utilized to evaluate the association between a patient's willingness to incur risk and their decision to undergo a total joint arthroplasty (TJA). RESULTS Out of the 142 patients enrolled in the DCE, 89 (62.3%) underwent a TJA. Risk score (OR [odds ratio] = 2.6, 95% CI [confidence interval] 1.1 to 6.6, P = 0.0400), men (OR = 2.5, 95% CI 1.1 to 5.9, P = 0.0280), and patients who have hip osteoarthritis (OR = 2.4, 95% CI 1.1 to 5.5, P = 0.0360) increased the odds of undergoing arthroplasty, whereas physical function of at least 75% at the initial visit (OR = 0.3, 95% CI 0.1 to 0.7, P = 0.0040) decreased these odds. CONCLUSIONS We found that a patient's willingness to incur risk, lower baseline physical function, and men were all independently associated with undergoing total knee arthroplasty. We believe that these findings prompt much-needed future studies that focus solely on the relationship between patients inherent risk behavior and surgical and patient-reported outcomes.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Anoop K Prasad
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Bryan Scott
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mark Cote
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tyler J Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Medhi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Perry Lim
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Marilyn Heng
- Department of Orthopaedic Surgery, University of Miami, Miller School of Medicine, Miami, Florida
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
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226
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Fu X, She Y, Jin G, Liu C, Liu Z, Li W, Jin R. Comparison of robotic-assisted total knee arthroplasty: an updated systematic review and meta-analysis. J Robot Surg 2024; 18:292. [PMID: 39052153 PMCID: PMC11272701 DOI: 10.1007/s11701-024-02045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
This study was conducted to compare the changes in different clinical scores and imaging indexes of patients who underwent robot-assisted total knee arthroplasty (RA-TKA) and manual total knee arthroplasty (M-TKA). PubMed, Web of Science, Cochrane Library and Embase were searched according to PRISMA guidelines in June 2024. Search terms included "robot-assisted", "manual" and "total knee arthroplasty". Outcome indicators included American Knee Society Score (KSS), Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), range of motion (ROM), Hospital for Special Surgery (HSS) score, Forgotten Joint Score (FJS), 36-Item Short Form Health Survey (SF-36), operation duration (min), intraoperative blood loss (ml), pain score, patient's satisfaction scores, hip-knee-ankle (HKA) angle, frontal femoral component angle, frontal tibia component angle, lateral femoral component angle and lateral tibia component angle. A total of 1,033 articles were obtained after removing duplicates, and 12 studies involving 2,863 patients (1,449 RA-TKAs and 1,414 M-TKAs) were finally meta-analyzed (22-32). The baseline data of both groups were similar in all results. Meta-analysis suggested a better performance of the RA-TKA group than the M-TKA group regarding the HKA angle. The manual TKA reduced the operation time and significantly improved the range of motion. The results of > 6 months follow-up showed that M-TKA was better than RA-TKA in terms of KSS score and WOMAC. Compared with M-TKA, RA-TKA can produce more accurate prosthetic alignment, but it does not lead to better clinical results. Orthopedic surgeons should choose between two surgical procedures according to their own experience and patients' characteristics.
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Affiliation(s)
- Xinyu Fu
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Yiming She
- Department of Nephrology, Yanbian University Hospital, Yanji, Jilin, 133002, China
| | - Guangwen Jin
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Chengri Liu
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Ze Liu
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Wei Li
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China
| | - Ri Jin
- Department of Orthopedics, Yanbian University Hospital, 1327 Juzi Street, Yanji Jilin, 133002, China.
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227
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Hitchman KJ, Baumann AN, Welch SE, Anastasio AT, Walley KC, Eward W. Assessing extremely negative online patient reviews and complaints of musculoskeletal oncology surgeons in the United States: a retrospective analysis. J Orthop Surg Res 2024; 19:425. [PMID: 39044200 PMCID: PMC11265366 DOI: 10.1186/s13018-024-04881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Physician-review websites (PRWs) are commonly used by patients while searching for a surgeon. There is no current literature investigating the factors that contribute to online one-star reviews of musculoskeletal oncology surgeons. This retrospective study aims to identify these factors to determine areas of care affecting patient's subjective reviews. METHODS Patient ratings and comments regarding musculoskeletal oncology surgeons from the Musculoskeletal Tumor Society (MSTS) were collected from Vitals.com. One-star reviews with comments were then classified as either operative or nonoperative. These complaints were then further classified based on content including wait time, uncontrolled pain, time spent with the physician, surgical outcomes, medical staff/institutional complaints, and bedside manner. RESULTS A total of 169 reviews (375 complaints) from 181 physicians were included. Of these complaints, 198 were from patients in the operative category while 177 were from patients in the nonoperative category. Bedside manner was the most common complaint. Operative patients reported higher instances of uncontrolled pain in their reviews, whereas nonoperative patients more frequently cited wait time. No significant difference in the complaints that mentioned the amount of time spent with the physician, bedside manner, a disagreement with the plan, or the medical staff or institution was found. CONCLUSION Online one-star reviews of musculoskeletal oncology surgeons on Vitals.com referenced both surgical and non-surgical aspects of patient encounters, with bedside manner being the most popular complaint overall. Surgical patients were more likely to complain of uncontrolled pain whereas non-operative patients were more likely to complain of wait time. TYPE OF STUDY Outcomes 2c.
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Affiliation(s)
- Kyle J Hitchman
- Department of Emergency Medicine, University of Louisville, Louisville, KY, USA.
| | - Anthony N Baumann
- College of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Sarah E Welch
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | - Kempland C Walley
- Department of Orthopaedics, University of Michigan, Ann Arbor, MI, USA
| | - William Eward
- Department of Orthopaedics, Duke University, Durham, NC, USA
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228
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Chen Y, Niu D, Yinyin W, Zhao T, Xin W, Qian Q, Fu P. Perioperative Dexamethasone Split Between Two Doses Further Reduced Early Postoperative Nausea and Vomiting Than Single Dose Dexamethasone: A Randomized Blinded Placebo-Controlled Trial. J Arthroplasty 2024:S0883-5403(24)00752-6. [PMID: 39053664 DOI: 10.1016/j.arth.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVE We investigated whether two perioperative doses of dexamethasone are more effective than a single dose in reducing early postoperative nausea and vomiting (PONV) during total knee arthroplasty (TKA). METHODS A total of 150 patients between June 1, 2021 and June 1, 2022 were randomized into three groups: two doses of normal saline (group A); a single dose of 10 mg dexamethasone before surgery and normal saline after surgery (group B); and two doses of 5 mg dexamethasone during the perioperative period (group C). Primary outcomes were incidences and severity of PONV within 24 hours after surgery; the number of patients requiring and the consumption of morphine and metoclopramine; and VAS scores for nausea and vomiting at 2, 4, 6, and 24 hours after surgery. Blood glucose levels on days 1, 2, and 3 after operation and incidences of surgical site infection (SSI) as well as gastrointestinal bleeding (GIB) within 45 days after operation were compared. RESULTS Within 24 hours after operation, the number of patients requiring and the amount of consumption of morphine and metoclopramide in groups B and C were significantly lower than those in group A, however, differences between groups B and C were insignificant (P > 0.05). Incidences and severity of PONV in groups B and C were significantly lower than those in group A, and differences between groups B and C were also significant (P < 0.05). At 2, 4, 6, and 24 hours after operation, there were significant differences in visual analogue scale (VAS) scores of PONV between groups A and B, A and C, as well as B and C. On postoperative days 1, 2, and 3, there were no significant differences in blood glucose levels among the groups, and there were no incidences of SSI or GIB in any group within 45 days after operation. CONCLUSION Dexamethasone significantly reduces PONV within 24 hours after TKA, does not result in significant changes in postoperative blood glucose levels, and does not increase the risk of SSI as well as GIB. In addition, perioperative two-dose dexamethasone is more advantageous than single-dose dexamethasone in reducing PONV incidence and severity within 24 hours after TKA.
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Affiliation(s)
- Yancheng Chen
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China
| | - Dawei Niu
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China
| | - Wang Yinyin
- Ambulatory surgery center, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China
| | - Tianlei Zhao
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China
| | - Wei Xin
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China
| | - Qirong Qian
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China
| | - Peiliang Fu
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai, 200003, China.
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Kurtz MA, Aslani S, Smith JA, Klein GR, Spece H, Kurtz SM. Titanium-Titanium Junctions in the Knee Corrode, Generating Damage Similar to the Hip. J Arthroplasty 2024:S0883-5403(24)00748-4. [PMID: 39053666 DOI: 10.1016/j.arth.2024.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Previous studies identified corrosion between the modular tibial components of total knee arthroplasty devices. However, gaps persist. Compared to the hip, damage modes that occur within taper junctions in the knee remain poorly understood. In this study, we investigated corrosion on total knee arthroplasty components with titanium-titanium junctions. We asked the following question: under typical in vivo cyclic loading conditions, will the same alloy damage modes from total knee arthroplasty devices resemble those documented in the hip? METHODS A total of 50 paired titanium alloy tibial baseplates and stems were collected and semiquantitatively analyzed using Goldberg corrosion scoring. To characterize damage, a subsection of moderately and severely corroded components was sectioned and imaged using scanning electron and digital optical microscopy. RESULTS Of the 100 device components, 95% showed visual evidence of corrosion. The initial contact area between the stem and bore generally occurred 3 mm from the stem taper base. Scanning electron microscopy revealed 4 damage modes, including oxide film formation, crevice corrosion, selective dissolution, and pitting. CONCLUSIONS Each of the damage modes identified in modular titanium-titanium tibial junctions was previously reported by total hip arthroplasty retrieval studies. Cumulatively, our results suggest that mechanically assisted crevice corrosion promoted this damage in vivo.
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Affiliation(s)
- Michael A Kurtz
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Shabnam Aslani
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - James A Smith
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Gregg R Klein
- Department of Orthopaedic Surgery, Hackensack University Medical Center, Hackensack, New Jersey
| | - Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
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Pietrzak S, Marciniak W, Derkacz R, Matuszczak M, Kiljańczyk A, Baszuk P, Bryśkiewicz M, Sikorski A, Gronwald J, Słojewski M, Cybulski C, Gołąb A, Huzarski T, Dębniak T, Lener MR, Jakubowska A, Kluz T, Soroka M, Scott RJ, Lubiński J. Cobalt Serum Level as a Biomarker of Cause-Specific Survival among Prostate Cancer Patients. Cancers (Basel) 2024; 16:2618. [PMID: 39123346 PMCID: PMC11310964 DOI: 10.3390/cancers16152618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024] Open
Abstract
Prostate cancer is the most common cancer diagnosed in men and the second leading cause of death in male cancer patients. The WHO suggests that cobalt is involved in the carcinogenesis of prostate cancer. There are, however, no studies associating cobalt levels and prostate cancer patient survival. In this study, 261 Polish prostate cancer (n = 261) patients were recruited into a prospective cohort between 2009 and 2015. Serum cobalt levels were measured using ICP-MS after prostate cancer diagnosis and before treatment. All study participants were assigned into quartiles (QI-QIV) based on the distribution of serum cobalt levels among censored patients. Univariable and multivariable COX regression models were used to calculate hazard ratios (HRs) for each serum cobalt level quartile. We found a significant relationship between high serum cobalt levels and poor prostate cancer patient total survival (HR = 2.60; 95% CI: 1.17-5.82; p = 0.02). In relation to prostate cancer patients who died as a result of other non-cancer causes, the association with high levels of cobalt was even stronger (HR = 3.67; 95% CI: 1.03-13.00; p = 0.04). The impact of high serum cobalt levels on overall survival of prostate cancer-specific-related deaths was not statistically significant.
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Affiliation(s)
- Sandra Pietrzak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Wojciech Marciniak
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
| | - Róża Derkacz
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
| | - Milena Matuszczak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Adam Kiljańczyk
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Piotr Baszuk
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
| | - Marta Bryśkiewicz
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
| | - Andrzej Sikorski
- Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 71-899 Szczecin, Poland; (A.S.); (M.S.); (A.G.)
| | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 71-899 Szczecin, Poland; (A.S.); (M.S.); (A.G.)
| | - Cezary Cybulski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
| | - Adam Gołąb
- Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, al. Powstańców Wielkopolskich 72, 71-899 Szczecin, Poland; (A.S.); (M.S.); (A.G.)
| | - Tomasz Huzarski
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
- Department of Clinical Genetics and Pathology, University of Zielona Góra, ul. Zyty 28, 65-046 Zielona Góra, Poland
| | - Tadeusz Dębniak
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Marcin R. Lener
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Anna Jakubowska
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
| | - Tomasz Kluz
- Department of Gynecology, Gynecology Oncology and Obstetrics, Fryderyk Chopin University Hospital No. 1, ul. Szopena 2, 35-055 Rzeszow, Poland;
- Institute of Medical Sciences, Medical College of Rzeszow University, al. Rejtana 16c, 35-959 Rzeszow, Poland
| | - Marianna Soroka
- Department of Genetics and Genomics, Institute of Biology, University of Szczecin, ul. Felczaka 3c, 71-412 Szczecin, Poland;
| | - Rodney J. Scott
- Priority Research Centre for Cancer Research, Innovation and Translation, Hunter Medical Research Institute, New Lambton, NSW 2305, Australia;
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Division of Molecular Medicine, Pathology North, John Hunter Hospital, New Lambton, NSW 2305, Australia
| | - Jan Lubiński
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland; (S.P.); (M.M.); (A.K.); (P.B.); (M.B.); (J.G.); (C.C.); (T.H.); (T.D.); (M.R.L.); (A.J.)
- Read-Gene, Grzepnica, ul. Alabastrowa 8, 72-003 Dobra (Szczecińska), Poland; (W.M.); (R.D.)
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Strait AV, Ho H, Fricka KB, Hamilton WG, Sershon RA. Outpatient Total Joint Arthroplasty in the "Unhealthy": Staying Safe Using Institutional Protocols. J Arthroplasty 2024:S0883-5403(24)00749-6. [PMID: 39053661 DOI: 10.1016/j.arth.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Recent expansion in the indications for outpatient total joint arthroplasty has led to debates over patient selection. The purpose of this study was to compare early clinical outcomes and complications of same-day discharge (SDD) hip and knee arthroplasties from a high-volume institution based on the American Society of Anesthesiologists (ASA) physical status classification. METHODS Prospectively collected data were reviewed for all SDD primary joint arthroplasties between January 2013 and August 2023. There were 8 surgeons who performed 7,258 cases at hospital outpatient (n = 4,288) or ambulatory surgery centers (n = 2,970). This included 3,239 total hip arthroplasties, 1,503 total knee arthroplasties, and 2,516 unicompartmental knee arthroplasties. The ASA 1 group comprised 506 subjects, compared to 5,005 for ASA 2 and 1,736 for ASA 3. The primary outcomes included emergency department (ED) visits, readmissions, complications, and revisions within 24 hours and 90 days of surgery. The ASA 3 group was older (ASA 1 = 55 versus ASA 2 = 63 versus ASA 3 = 66 years; P < .01) and had a higher body mass index (ASA 1 = 25.4 versus ASA 2 = 28.5 versus ASA 3 = 32.7; P < .01). RESULTS There were no differences between ASA groups in joint-related ED visits, readmissions, and complications within 24 h and 90 days of surgery (P > .05). Subjects in the ASA 3 group experienced greater 90-day revisions compared to the other groups (ASA 1 = 1 of 506, 0.2% versus ASA 2 = 15 of 5,005, 0.3% versus ASA 3 = 15 of 1,736, 0.9%; P = .01). Regarding systemic events, ASA 1 subjects experienced significantly greater 24-hour complications (8 of 506, 1.6%) and ED visits (5 of 506, 1.0%), and the ASA 3 subjects had a higher incidence of 90-day readmissions (19 of 1,736, 1.1%) compared to the other groups (P < .05). Within 24 hours of discharge, urinary retention and syncope were the most frequent complications that required additional health care utilization. CONCLUSIONS Medically optimized patients categorized as ASA 3 can safely undergo SDD hip and knee arthroplasty without increased risk of 24-hour or 90-day complications. Patient preference for outpatient care, reliable social support, and independent functional status are imperative for a successful outpatient program.
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Affiliation(s)
| | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Kevin B Fricka
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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Aubert T, Gerard P, Butnaru M, Graff W, Rigoulot G, Auberger G, Aubert O. Archetype analysis of the spine-hip relationship identifies distinct spinopelvic profiles. Orthop Traumatol Surg Res 2024:103944. [PMID: 39048457 DOI: 10.1016/j.otsr.2024.103944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION The position of the pelvis in the sagittal plane can vary considerably between different functional positions. Adapting the position of the acetabular cup in relation to the alignment between the spine and the hip of each individual, prior to prosthesis placement, can prevent the risk of prosthetic impingement. Taken individually, risk factors for unfavorable spinopelvic kinematics can be difficult to interpret when trying to precisely predict which patients are at risk. Furthermore, the use of classifications or algorithms can be complex, most often associated with limited values and often difficult to apply in current practices of risk assessment. HYPOTHESIS We hypothesized that the deconstruction of the data matrix including age and spinopelvic parameters (SPT, LL, PI, LF and PI-LL) correlated with the analysis of spinopelvic kinematics could be used to define an individualized hip-spine relationship. MATERIAL AND METHOD We applied archetypal analysis, which is a probabilistic, data-driven and unsupervised approach, to a complete phenotype cohort of 330 patients before total hip arthroplasty to define the spinopelvic profile of each individual using the spinopelvic parameters without threshold value. For each archetype, we analyzed the spinopelvic kinematics, not implemented in the creation of the archetypes. RESULTS An unsupervised learning method revealed seven archetypes with distinct spinopelvic kinematic profiles ranging from -8.9 ° to 13.15 ° (p = 0.0001) from standing to sitting and -5. 35 ° to -10.81 ° (p = 0.0001) from supine to standing. Archetype 1 represents the "ideal" patient (A1); young patients without spinopelvic anomaly and the least at risk of mobility anomaly. Followed by 3 archetypes without sagittal imbalance according to their lumbar lordosis and pelvic incidence, from the highest to the lowest (archetypes 2-4), archetype 4 exposing a greater risk of spinopelvic kinematic anomaly compared to others. Then 2 archetypes with sagittal imbalance: archetype 5, with an immobile pelvis in the horizontal plane from standing to sitting position in anterior tilt and archetype A6, with significant posterior pelvic tilt standing, likely compensating for the imbalance and associated with the greatest anomaly of spinopelvic kinematics. Finally, archetype 7 with the stiffest lumbar spine without sagittal imbalance and significant unfavorable kinematics from standing to sitting. CONCLUSION An archetypal approach to patients before hip replacement can refine diagnostic and prognostic features associated with the hip-spine relationship and reduced heterogeneity, thereby improving spinopelvic characterization. This risk stratification of spinopelvic kinematic abnormalities could make it possible to target patients who require adapted positioning or types of implants before prosthetic surgery. LEVEL OF EVIDENCE IV retrospective study.
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Affiliation(s)
- Thomas Aubert
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France.
| | - Philippe Gerard
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | - Michael Butnaru
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | - Wilfrid Graff
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
| | | | - Guillaume Auberger
- Groupe Hospitalier Diaconesses Croix Saint Simon, 125 Rue d'Avron, Paris 75020, France
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Parikh N, Hobbs J, Gabrielli A, Sakaria S, Wellens B, Krueger CA. Rising Costs and Diminishing Surgeon Reimbursement From Primary to Revision Total Hip and Knee Arthroplasty: An Analysis of Medicare Advantage and Commercial Insurance. J Am Acad Orthop Surg 2024:00124635-990000000-01055. [PMID: 39053143 DOI: 10.5435/jaaos-d-23-01196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/28/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Revision total joint arthroplasty (rTJA) is a resource-intensive procedure addressing failed primary total joint hip (total hip arthroplasty [THA]) and knee arthroplasty (total knee arthroplasty [TKA]). Despite predictions of increased demand, reimbursement for rTJA has not kept pace with increasing costs and may be insufficient compared with primary procedures. The study aimed to highlight the diminishing surgeon reimbursement between primary and revision THA (rTHA) and TKA. METHODS This study is a retrospective analysis of billing data for primary and rTHA and TKA procedures from a single institution between 2019 and 2022. Insurance claims and charges data were provided by a local affiliate of a major national carrier which includes Medicare Advantage (MA) and commercial patients. Using insurance data, the study evaluates the total surgery costs for primary and rTHA and TKA and the individual charges that make up the total surgery cost. RESULTS Nine hundred five patients insured by the same carrier, who underwent a primary or rTJA, were identified. Irrespective of MA or commercial insurance, the average surgery cost for a primary THA was $26,043, compared with $53,456 for rTHA. Surgeon reimbursement for primary THA was 20% ($5,323) of the total surgery cost. Despite the doubled surgery cost for rTHA, surgeon reimbursement was 10% ($5,257) of the total surgery cost. Primary TKA surgery costs were $24,489, while revision costs were $43,074. Surgeon reimbursement for primary TKA was 20% ($4,918) of the total surgery cost, while reimbursement for revision TKA was 13% ($5,560). MA reimbursement was markedly lower than commercial reimbursement for primary and revision cases. CONCLUSION Despite the higher total costs for rTJA, surgeon reimbursement is disproportionately diminished. The findings highlight the lack of incentive for revision cases. Surgeon reimbursement from MA and commercially insured patients for rTJA remains inadequate. This may limit patient access-to-care, leading to suboptimal outcomes and increased healthcare utilization.
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Affiliation(s)
- Nihir Parikh
- From the Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA (Parikh, Hobbs, Gabrielli, Wellens, and Krueger), and Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL (Sakaria)
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Longo UG, De Salvatore S, Valente F, Villa Corta M, Violante B, Samuelsson K. Artificial intelligence in total and unicompartmental knee arthroplasty. BMC Musculoskelet Disord 2024; 25:571. [PMID: 39034416 PMCID: PMC11265144 DOI: 10.1186/s12891-024-07516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 05/13/2024] [Indexed: 07/23/2024] Open
Abstract
The application of Artificial intelligence (AI) and machine learning (ML) tools in total (TKA) and unicompartmental knee arthroplasty (UKA) emerges with the potential to improve patient-centered decision-making and outcome prediction in orthopedics, as ML algorithms can generate patient-specific risk models. This review aims to evaluate the potential of the application of AI/ML models in the prediction of TKA outcomes and the identification of populations at risk.An extensive search in the following databases: MEDLINE, Scopus, Cinahl, Google Scholar, and EMBASE was conducted using the PIOS approach to formulate the research question. The PRISMA guideline was used for reporting the evidence of the data extracted. A modified eight-item MINORS checklist was employed for the quality assessment. The databases were screened from the inception to June 2022.Forty-four out of the 542 initially selected articles were eligible for the data analysis; 5 further articles were identified and added to the review from the PUBMED database, for a total of 49 articles included. A total of 2,595,780 patients were identified, with an overall average age of the patients of 70.2 years ± 7.9 years old. The five most common AI/ML models identified in the selected articles were: RF, in 38.77% of studies; GBM, in 36.73% of studies; ANN in 34.7% of articles; LR, in 32.65%; SVM in 26.53% of articles.This systematic review evaluated the possible uses of AI/ML models in TKA, highlighting their potential to lead to more accurate predictions, less time-consuming data processing, and improved decision-making, all while minimizing user input bias to provide risk-based patient-specific care.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Rome, 200 - 00128, Italy.
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, Rome, 21 - 00128, Italy.
| | - Sergio De Salvatore
- IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Federica Valente
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, Rome, 21 - 00128, Italy
| | - Mariajose Villa Corta
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, Rome, 21 - 00128, Italy
| | - Bruno Violante
- Orthopaedic Department, Clinical Institute Sant'Ambrogio, IRCCS - Galeazzi, Milan, Italy
| | - Kristian Samuelsson
- Department of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, Rome, 21 - 00128, Italy
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Dubin JA, Bains SS, Monárrez R, Gilmor R, Swartz GN, Katanbaf RM, Mont MA, Nace J, Delanois RE. The Effect of Insurance Type on Length of Stay Following Total Knee Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00695-8. [PMID: 39047921 DOI: 10.1016/j.arth.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/05/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION With the expansion of the Affordable Care Act in 2014, there has been a growing interest in how the Medicaid population will affect postoperative outcomes following total knee arthroplasty (TKA). Studies have shown that lower socioeconomic status, non-Caucasian race, women, cardiac and renal disorders, and younger age have been associated with increased lengths of stay (LOS) after TKA. The primary purpose of our study was to compare total complications and LOS among patients undergoing TKA who have cash, commercial, government, Medicaid, and Medicare insurances. METHODS We queried a national, all-payer administrative claims database from 2016 to 2022 among patients undergoing TKA who had cash (n = 3,923), commercial (n = 966,169), government (n = 25,644), Medicaid (n = 56,184), and Medicare (n = 524,034) insurances. We compared and analyzed various baseline demographics, total complications, and LOS (< 1 day, 1 to 2 days, 3 to 4 days, and > 4 days), between the insurance types. RESULTS Medicaid and Medicaid insurance types had patients who had the most comorbidities at baseline, including a comorbidity index > 3 (P < 0.0001), women, alcohol abuse, diabetes, obesity, tobacco use, chronic kidney disease, and congestive heart disease (all P < 0.0001). In accounting for comorbidities, Medicaid was the biggest risk factor for total complications (P < 0.001) as well as increased LOS after TKA at 4 to 6 days, 7 to 9 days, and > 9 days (P < 0.0001). CONCLUSION Medicaid insurance is a risk factor for increased total complications and LOS following TKA. Appropriate preoperative and perioperative management of these patients is essential in order to mitigate the risk and burden on the healthcare system in this population.
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Affiliation(s)
- Jeremy A Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Rubén Monárrez
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Ruby Gilmor
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Gabrielle N Swartz
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Reza M Katanbaf
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD.
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Tran P, Knecht S, Tamine L, Faure N, Orban JC, Bronsard N, Gonzalez JF, Micicoi G. Risk prediction of kalaemia disturbance and acute kidney injury after total knee arthroplasty: use of a machine learning algorithm. Orthop Traumatol Surg Res 2024:103958. [PMID: 39047862 DOI: 10.1016/j.otsr.2024.103958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 05/22/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty. HYPOTHESIS A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty. MATERIAL AND METHODS This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K+ A). Two groups were formed of K+ A and non-K+ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 - specificity. RESULTS Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate. Overall performance was good with an area under the curve of 0.979 [CI95% 0.938-1.02], sensitivity was 90.3% [CI95% 86.2-94.4] and specificity 89.7% [CI95% 85.5-93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on https://arthrorisk.com. CONCLUSION The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model. LEVEL OF EVIDENCE IV; retrospective study of case series.
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Affiliation(s)
- Pierre Tran
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06000 Nice, France
| | - Siam Knecht
- Aix-Marseille Université, CNRS, EFS, ADES, 13007 Marseille, France
| | - Lyna Tamine
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06000 Nice, France
| | - Nicolas Faure
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06000 Nice, France
| | - Jean-Christophe Orban
- Département d'Anesthésie Réanimation et Médecine Péri-Opératoire, Hôpital Privé Cannes Oxford, 06400 Cannes, France
| | - Nicolas Bronsard
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06000 Nice, France
| | - Jean-François Gonzalez
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06000 Nice, France
| | - Grégoire Micicoi
- Institut Universitaire Locomoteur et du Sport (IULS), Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06000 Nice, France.
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Pahlevani M, Taghavi M, Vanberkel P. A systematic literature review of predicting patient discharges using statistical methods and machine learning. Health Care Manag Sci 2024:10.1007/s10729-024-09682-7. [PMID: 39037567 DOI: 10.1007/s10729-024-09682-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 06/29/2024] [Indexed: 07/23/2024]
Abstract
Discharge planning is integral to patient flow as delays can lead to hospital-wide congestion. Because a structured discharge plan can reduce hospital length of stay while enhancing patient satisfaction, this topic has caught the interest of many healthcare professionals and researchers. Predicting discharge outcomes, such as destination and time, is crucial in discharge planning by helping healthcare providers anticipate patient needs and resource requirements. This article examines the literature on the prediction of various discharge outcomes. Our review discovered papers that explore the use of prediction models to forecast the time, volume, and destination of discharged patients. Of the 101 reviewed papers, 49.5% looked at the prediction with machine learning tools, and 50.5% focused on prediction with statistical methods. The fact that knowing discharge outcomes in advance affects operational, tactical, medical, and administrative aspects is a frequent theme in the papers studied. Furthermore, conducting system-wide optimization, predicting the time and destination of patients after discharge, and addressing the primary causes of discharge delay in the process are among the recommendations for further research in this field.
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Affiliation(s)
- Mahsa Pahlevani
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, B3H 4R2, NS, Canada
| | - Majid Taghavi
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, B3H 4R2, NS, Canada
- Sobey School of Business, Saint Mary's University, 923 Robie, Halifax, B3H 3C3, NS, Canada
| | - Peter Vanberkel
- Department of Industrial Engineering, Dalhousie University, 5269 Morris Street, Halifax, B3H 4R2, NS, Canada.
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Giarritiello F, Romanò CL, Lob G, Benevenia J, Tsuchiya H, Zappia E, Drago L. Enhancing Pathogen Detection in Implant-Related Infections through Chemical Antibiofilm Strategies: A Comprehensive Review. Antibiotics (Basel) 2024; 13:678. [PMID: 39061360 PMCID: PMC11274042 DOI: 10.3390/antibiotics13070678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Implant-related infections (IRIs) represent a significant challenge to modern surgery. The occurrence of these infections is due to the ability of pathogens to aggregate and form biofilms, which presents a challenge to both the diagnosis and subsequent treatment of the infection. Biofilms provide pathogens with protection from the host immune response and antibiotics, making detection difficult and complicating both single-stage and two-stage revision procedures. This narrative review examines advanced chemical antibiofilm techniques with the aim of improving the detection and identification of pathogens in IRIs. The articles included in this review were selected from databases such as PubMed, Scopus, MDPI and SpringerLink, which focus on recent studies evaluating the efficacy and enhanced accuracy of microbiological sampling and culture following the use of chemical antibiofilm. Although promising results have been achieved with the successful application of some antibiofilm chemical pre-treatment methods, mainly in orthopedics and in cardiovascular surgery, further research is required to optimize and expand their routine use in the clinical setting. This is necessary to ensure their safety, efficacy and integration into diagnostic protocols. Future studies should focus on standardizing these techniques and evaluating their effectiveness in large-scale clinical trials. This review emphasizes the importance of interdisciplinary collaboration in developing reliable diagnostic tools and highlights the need for innovative approaches to improve outcomes for patients undergoing both single-stage and two-stage revision surgery for implant-related infections.
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Affiliation(s)
- Fabiana Giarritiello
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (F.G.); (E.Z.)
| | | | - Guenter Lob
- Section Injury Prevention, Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), 10117 Berlin, Germany;
| | - Joseph Benevenia
- Orthopaedics Department, Rutgers New Jersey Medical School, Newark, NJ 07103, USA;
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 921-8641, Japan;
| | - Emanuele Zappia
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (F.G.); (E.Z.)
| | - Lorenzo Drago
- Clinical Microbiology and Microbiome Laboratory, Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- UOC Laboratory of Clinical Medicine with Specialized Areas, IRCCS MultiMedica, 20138 Milan, Italy
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239
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Plancher KD, Briggs KK, Comulada DB, DiVella MF, Schwartz EN, Mannina CM, Petterson S. Fixed-Bearing Lateral Unicompartment Knee Arthroplasty in Degenerative ACL-Deficient and ACL-Intact Knees: A Matched Pair Analysis. J Arthroplasty 2024:S0883-5403(24)00747-2. [PMID: 39047920 DOI: 10.1016/j.arth.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 07/11/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL)-deficient knees are no longer considered a contra-indication for unicompartment knee arthroplasty (UKA). The purpose of this study was to determine if patients who had an ACL-deficient knee who underwent lateral UKA had similar mean 10-year outcomes compared to patients who had an ACL-intact knee and lateral UKA. METHODS Patients who underwent a lateral UKA with ACL deficiency by a single surgeon between 2004 and 2016 were identified. Preoperative magnetic resonance images were utilized to identify a torn or absent ACL in all knees. The absence of an ACL was confirmed during arthroscopy prior to UKA. Patients were matched 1:2 based on age and sex with patients who underwent lateral UKA with an ACL intact knee. The primary patient-reported outcome variable was survival without conversion to total knee arthroplasty. Secondary outcomes included Veterans Rand-12, the Lysholm score, the Knee Osteoarthritis Outcome Score activities of daily living subscale, and Sport subscale. A power analysis showed that 14 patients were needed to identify differences of 10 points on the Knee Osteoarthritis Outcome Score with a power of 80% (P = .05). RESULTS The cohort of patients who had an ACL-deficient lateral UKA included 4 men and 12 women (43 to 82 years of age). The matched control group included 32 patients. The mean age of both groups was 67 years (range, 43 to 85). There were 2 patients in the ACL-deficient group who failed. At 10 years, survivorship in the ACL-deficient group was 85%, while survival in the ACL-intact group was 100% (P = .035). At an average follow-up of 11 years (range, 4 to 19.6), there was no difference in outcome scores between ACL-deficient and ACL-intact patients. CONCLUSION Fixed-bearing lateral UKA in the ACL-deficient knee resulted in lower survival than patients who had an intact ACL. Patient-reported outcomes were similar in both groups. The ACL-deficient patient who wishes to undergo lateral UKA should be counseled on the lower survival. LEVEL OF EVIDENCE Level III. Retrospective cohort study.
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Affiliation(s)
- Kevin D Plancher
- Plancher Orthopaedics & Sports Medicine, New York, New York; Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, New York; Department of Orthopaedic Surgery, Weil Cornell Medical College, New York, New York; The Orthopaedic Foundation, Stamford, Connecticut
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Kurmis AP. Gender differences in unintended anterior pelvic roll during primary THA in the lateral position. J Orthop Surg Res 2024; 19:419. [PMID: 39033130 PMCID: PMC11265053 DOI: 10.1186/s13018-024-04811-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/23/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Fundamental morphologic differences between male and female pelvises are historically recognised. Despite this, little consideration has been given as to whether or not conventional positioning supports used for primary total hip arthroplasties (THAs) performed in the lateral position do an equally effective job of maintaining the intended set up position when comparing genders. Given that recent research has highlighted that unintended pelvic roll occurs commonly during hip surgery, and that such movement may have a mechanically-deleterious consequence upon final construct performance and complication rates, this study was undertaken to explore the differences in pelvic roll between genders. METHODS The output of a high-precision, commercially-available, imageless intra-operative navigation system was prospectively-collected for 85 consecutive patients undergoing unilateral, primary THAs. These data were separated by gender and were utilised to determine differences in pelvic movement around a central sagittal axis. RESULTS Demographic data were similar between genders, with no between-group differences in mean BMI (p = 0.09) or indication for surgery (p = 0.66), however participating males (mean 68.04) were slightly younger than females (mean 73.31). The mean anterior pelvic roll for females was 9.50°, and for males 8.68°. There were no statistically significant independent correlations observed between gender (p = 0.21) and pelvic roll. CONCLUSION The findings of this novel study do not suggest gender differences in the magnitude of unintended, intra-operative, anterior roll, even when corrected for BMI and surgical indication. Average roll of ~ 9° was demonstrated across both groups. An awareness of such positional change during THA surgery may reduce potentially-avoidable post-operative complications.
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Affiliation(s)
- Andrew P Kurmis
- Discipline of Medical Specialties, University of Adelaide, Adelaide, SA, Australia.
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia.
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
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241
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Mann KA, Miller MA, Gandhi SA, Kusler JE, Tatusko ME, Biggs AE, Oest ME. Peri-operative zoledronic acid attenuates peri-prosthetic osteolysis in a rat model of cemented knee replacement. J Orthop Res 2024. [PMID: 39032112 DOI: 10.1002/jor.25941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/23/2024] [Accepted: 06/28/2024] [Indexed: 07/22/2024]
Abstract
Progressive osteolysis can occur at the cement-bone interface of joint replacements and the associated loss of fixation can lead to clinical loosening. We previously developed a rat hemiarthroplasty model that exhibited progressive loss of fixation with the development of cement-bone gaps under the tibial tray that mimicked patterns found in human arthroplasty retrievals. Here we explored the ability of a bisphosphonate (zoledronic acid, ZA) to attenuate cement-bone osteolysis and maintain implant stability. Sprague-Dawley rats (n = 59) received a poly(methylmethacrylate) cemented tibial component and were followed for up to 12 weeks. Treatment groups included peri-operative administration of ZA (ZA group), administration of ZA at 6 weeks postop (late ZA group), or vehicle (Veh group). There was a 60% reduction in the rate of cement-bone gap formation for the ZA group (0.15 mm3/week) compared to Veh group (0.38 mm3/week, p = 0.016). Late ZA prevented further progression of gap formation but did not reverse bone loss to the level achieved in the ZA group. Micromotion from five times body weight toggle loading was positively correlated with cement-bone gap volume (p = 0.009) and negatively correlated with the amount of cement in the metaphysis (p = 0.005). Reduced new bone formation and enduring nonviable bone in the epiphysis for the ZA group were found. This suggests that low bone turnover in the epiphysis may suppress the early catabolic response due to implantation, thereby maintaining better fixation in the epiphysis. This preclinical model presents compelling supporting data documenting improved maintenance of the cement-bone fixation with the use of peri-operative bisphosphonates.
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Affiliation(s)
- Kenneth A Mann
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Mark A Miller
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Sachin A Gandhi
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Jace E Kusler
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Megan E Tatusko
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amy E Biggs
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Megan E Oest
- Department of Orthopedic Surgery, Institute for Human Performance, SUNY Upstate Medical University, Syracuse, New York, USA
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242
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Cornman HL, Kambala A, Nandi TR, Kwatra SG, Nandi S. No increased risk of postoperative adverse events in patients with hidradenitis suppurativa following a total joint replacement. Clin Exp Dermatol 2024; 49:879-881. [PMID: 38308633 DOI: 10.1093/ced/llae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 02/05/2024]
Abstract
There is concern for increased risk of adverse events, particularly periprosthetic joint infection (PJI), following total joint replacement (TJR) in patients with hidradenitis suppurativa (HS) because of a compromised skin barrier and bacterial colonization of lesions. We used the TriNetX health research database to identify patients who had undergone TJR with (n = 1760) and without (n = 1760) HS matched by age, sex, ethnicity, race and risk factors for PJI. Multivariate analysis was performed and revealed that 90-day risk of PJI, reoperation, wound dehiscence, delayed wound healing, emergency room visits and readmission were not increased among patients with HS who underwent TJR. Given these findings, dermatologists and orthopaedists should not defer TJR access for patients with HS, as risk of postoperative complications is not prohibitive.
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Affiliation(s)
- Hannah L Cornman
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anusha Kambala
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sumon Nandi
- Department of Orthopedic Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
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243
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Howell CC, Witvoet S, Scholl L, Coppolecchia A, Bhowmik-Stoker M, Chen AF. Postoperative Complications and Readmission Rates in Robotic-Assisted Versus Manual Total Knee Arthroplasty: Large, Propensity Score-Matched Patient Cohorts. J Am Acad Orthop Surg 2024:00124635-990000000-01054. [PMID: 39029449 DOI: 10.5435/jaaos-d-23-01117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/22/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION There is a paucity of research comparing postoperative complication rates between manual total knee arthroplasty (M-TKA) and robotic-assisted total knee arthroplasty (RA-TKA). This study aims to compare 90-day postoperative complication, readmission, and emergency department rates between RA-TKA and M-TKA. METHODS A retrospective review of a multihospital database identified patients who underwent TKA between January 2016 and May 2023. Surgeons who used the robotic-assisted surgery technique in <10% or >90% of their cases annually were excluded. This resulted in 15,999 cases (8,853 RA-TKAs; 7,146 M-TKAs) from 282 surgeons. RA-TKA and M-TKA cohorts were one-to-one matched based on patient sex, age, body mass index, hospital setting, surgeon experience, primary payer, and anesthesia type. Each cohort consisted of 7,146 patients (N = 14,292). 90-day revisits, specifically readmissions, readmissions with >23 hours of observation, and ED visit rates were compared between cohorts. Complications were classified according to the Clinical Classification Software schema and compared between cohorts. Mann-Whitney U, chi-squared, and Fisher exact tests, along with Bonferroni correction, were used to statistically compare cohorts. RESULTS All-cause 90-day readmission rates were 2.4% for RA-TKA and 2.6% for M-TKA (P = 0.36). RA-TKA had fewer revisits (RA-TKA: 7.8%; M-TKA: 8.8%, P = 0.027) and rates of readmission with >23 hours of observation (RA-TKA: 1.4%; M-TKA: 2.0%, P = 0.003). RA-TKA had fewer hospital revisits due to joint stiffness (RA-TKA: 17 revisits; M-TKA: 42 revisits, P = 0.002) and chronic pain (RA-TKA: 1 revisit; M-TKA: 8 revisits, P = 0.039). Fewer readmissions were observed for acute injuries (lower extremity muscle/tendon strains) in the RA-TKA cohort (RA-TKA: 1; M-TKA: 9, P = 0.021). RA-TKA had fewer ED visits due to hematomas (RA-TKA: 0 visits; M-TKA: 7 visits, P = 0.016). CONCLUSION In this retrospective matched cohort analysis, RA-TKA was associated with markedly fewer revisits and readmissions with >23 hours of observation compared with M-TKA. No differences in all-cause 90-day readmission were observed between cohorts. LEVEL OF EVIDENCE Level III. STUDY DESIGN Retrospective review.
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Affiliation(s)
- Cole C Howell
- From the Albany Medical College, Albany, NY (Howell), Stryker, Amsterdam, the Netherlands (Witvoet), the Stryker, Mahwah, NJ (Scholl, Coppolecchia, and Bhowmik-Stoker), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Chen)
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Flener JL, Chen BPH, Ernst FR, Libolt A, Gunja NJ, Barrett WP. Advanced Multi-Layer Watertight Closure versus Conventional Closure in Total Hip and Knee Replacement Surgery. Pragmat Obs Res 2024; 15:93-102. [PMID: 39049871 PMCID: PMC11268763 DOI: 10.2147/por.s450183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Background In total joint replacement procedures, surgeons have increasingly adopted advanced multi-layer, watertight closure. The objective of the study was to compare the clinical and economic outcomes for advanced multi-layer, watertight closure patients to those with conventional closure with sutures and skin staples. Methods Patients aged ≥18 years were included in the study if they underwent total joint arthroplasty of the hip or knee as an elective, primary, inpatient procedure between January 2014 and March 2019. Cohorts having advanced multi-layer, watertight closure or conventional closure were compared using multivariable regression analysis of surgical site infections, length of stay, operating room time, procedure time, discharge status, readmissions, reoperations, and hospital emergency department visits. Results A total of 1828 patients received at least one total hip or knee replacement, of which 434 (23.7%) had advanced multi-layer, watertight closure and 1394 (76.3%) had conventional closure. Unadjusted time to readmission, when occurring, was considerably longer following advanced multi-layer, watertight closure (89.9 vs 51.1 days, p < 0.0001), and a lower proportion of the advanced multi-layer, watertight closure cohort required reoperation within 90 days (0.0% vs 2.6%, p < 0.0001). Adjusted mean hospital length of stay was approximately half of a day shorter for advanced multi-layer, watertight closure patients (1.10 vs 1.65 days; p < 0.001), and they were also more likely to be discharged to home (Odds Ratio: 4.61; p = 0.002). Conclusion Among patients undergoing total hip and knee arthroplasty in a highly optimized real-world clinical practice, advanced multi-layer, watertight closure was associated with significantly shorter inpatient length of stay and increased likelihood of being discharged to home compared with conventional closure. These findings suggest that advanced multi-layer, watertight closure is a valuable component of an optimal workflow for total hip or knee replacement, and may be especially valuable for high-risk patients.
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Affiliation(s)
| | | | - Frank R Ernst
- Real World Evidence and Late Phase, CTI Clinical Trial and Consulting Services, Covington, KY, USA
| | - Aaron Libolt
- Proliance Orthopedic Associates, Renton, WA, USA
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Maart RA, Ernstzen DV, Mji G, Morris LD. Understanding the value of rehabilitation: Perspectives from South African Stakeholders. Afr J Disabil 2024; 13:1406. [PMID: 39114451 PMCID: PMC11304207 DOI: 10.4102/ajod.v13i0.1406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/21/2024] [Indexed: 08/10/2024] Open
Abstract
Background The need for rehabilitation in South Africa has doubled between 1990 and 2017 and is expected to increase in the coming years. However, the rehabilitation needs of South Africans (and globally) remain largely unmet. Establishing a common understanding of the value of rehabilitation can inform clinical practice and policymaking to achieve Universal Health Coverage (UHC). Objectives This study aims to explore the value of rehabilitation services in South Africa's public healthcare sector by gathering perspectives from stakeholders. The goal is to inform policy decisions related to the implementation of National Health Insurance (NHI) in South Africa. Method The study used a phenomenological approach and interpretivist paradigm. Semi-structured interviews were conducted face-to-face, online, or telephonically with 12 stakeholders from various rehabilitation sectors. The value of rehabilitation was analysed and categorised into five main categories: context, service delivery, patient outcomes, economic and financial components, and collaboration within and between sectors. Results The value of rehabilitation was found to be multifaceted, because of the varying health, economic, and social challenges faced by many South Africans. Conclusion The study identified components of value-based rehabilitation that should be prioritised in the proposed NHI of South Africa. Future research should explore all stakeholder perspectives, including patients, and provide empirical evidence of rehabilitation's economic and societal value. Contribution We highlight priority areas that are central to the value of rehabilitation in South Africa and other low- and middle-income countries (LMICs). Tailoring rehabilitation services to patient and community needs is crucial for achieving value-based care. Given South Africa's commitment to the United Nations Convention on the Rights of Persons with Disabilities, prioritising rehabilitation remains essential.
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Affiliation(s)
- Rentia A Maart
- Department of Rehabilitation and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Dawn V Ernstzen
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gubela Mji
- Division of Disability and Rehabilitation Studies, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Linzette D Morris
- Department of Rehabilitation Sciences, College of Health Sciences, Qatar University, Doha, Qatar
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Addi A, Duguay T, Valentin E, Anract P, Hardy A. Simple Hip Value: a simple score to evaluate Hip function. Orthop Traumatol Surg Res 2024:103952. [PMID: 39032864 DOI: 10.1016/j.otsr.2024.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 07/23/2024]
Abstract
BACKGROUND Several self-administered questionnaires are available for assessing hip function in clinical practice (HOOS-12, Oxford-12). These questionnaires can be used to assess and monitor patients with hip pathology. However, they are sometimes difficult to deploy in clinical practice. Recent studies on the shoulder and knee have shown that a single-question assessment provides a relevant evaluation of joint function, and correlates with more complex scores. However, this has not yet been evaluated for the hip. We set out to develop a single-question test that would enable patients to assess their hip function between 0 and 100. Therefore, we did a prospective study aiming to assess: (1) the relevance of the SHV (Simple Hip Value) test by comparing it with the Oxford-12 and HOOS-12 scores, (2) the discriminatory capacity and reproducibility of this test. HYPOTHESIS The hypothesis of this study was that the assessment of hip function by a single-question patient-completed questionnaire (PROM) would be reliable and useful in clinical practice. PATIENTS AND METHODS We conducted a prospective study including 74 patients operated on for total hip arthroplasty from February 2020 to April 2021 in a high-volume center and 20 healthy subjects. The SHV questionnaire, as well as HOOS-12 and OXFORD-12 were submitted on average 18 months after surgery, with values scaled to 100 points. A second test containing the 3 questionnaires was resubmitted to 20 patients randomly chosen from hip arthroplasty group to evaluate the reproducibility of the test. To evaluate the discrimination capacity of our test, 20 controls were selected to respond to the three questionnaires. RESULTS Test results were median SHV, Oxford-12 and HOOS-12 scores of 90/100 (Interquartile Range [IQR]: 80-95), 88.5 (IQR: 77.1-95.8) and 79.1 (IQR: 65.1-93.2), respectively. The SHV was strongly correlated with the Oxford-12 (Spearman coefficient: 0.63 [IQR: 0.45-0.76]) and the HOOS-12 (Spearman coefficient: 0.66 [IQR: 0.46-0.79]). The SHV differed significantly from the control group (90.0 vs 100.0 in the control group [p < 0.001]) and had excellent reproducibility (Interclass Correlation Coefficient [ICC]: ICC: 0.82 [CI95%, 0.59-0.93]). DISCUSSION The SHV test seems to be a reliable, reproducible and discriminating tool for assessing hip function after total hip arthroplasty, thus offering a simplified and practical approach for practitioners. Further testing in different populations would be useful to validate this test. LEVEL OF EVIDENCE III; prospective comparative diagnostic study.
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Affiliation(s)
- Alix Addi
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France.
| | - Tristan Duguay
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Eugenie Valentin
- Clinique du Sport Paris 5, 36 Boulevard Saint-Marcel, 75005, Paris, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique, AP-HP Centre-Université de Paris, Hôpital Cochin, Paris, France
| | - Alexandre Hardy
- Clinique du Sport Paris 5, 36 Boulevard Saint-Marcel, 75005, Paris, France
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247
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Faschingbauer M, Hambrecht J, Schwer J, Martin JR, Reichel H, Seitz A. Tibial insert design significantly alters knee kinematics using a single cruciate-retaining total knee implant. Bone Jt Open 2024; 5:592-600. [PMID: 39019478 PMCID: PMC11254455 DOI: 10.1302/2633-1462.57.bjo-2024-0033.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024] Open
Abstract
Aims Patient dissatisfaction is not uncommon following primary total knee arthroplasty. One proposed method to alleviate this is by improving knee kinematics. Therefore, we aimed to answer the following research question: are there significant differences in knee kinematics based on the design of the tibial insert (cruciate-retaining (CR), ultra-congruent (UC), or medial congruent (MC))? Methods Overall, 15 cadaveric knee joints were examined with a CR implant with three different tibial inserts (CR, UC, and MC) using an established knee joint simulator. The effects on coronal alignment, medial and lateral femoral roll back, femorotibial rotation, bony rotations (femur, tibia, and patella), and patellofemoral length ratios were determined. Results No statistically significant differences were found regarding coronal alignment (p = 0.087 to p = 0.832). The medial congruent insert demonstrated restricted femoral roll back (mean medial 37.57 mm; lateral 36.34 mm), while the CR insert demonstrated the greatest roll back (medial 42.21 mm; lateral 37.88 mm; p < 0.001, respectively). Femorotibial rotation was greatest with the CR insert with 2.45° (SD 4.75°), then the UC insert with 1.31° (SD 4.15°; p < 0.001), and lowest with the medial congruent insert with 0.8° (SD 4.24°; p < 0.001). The most pronounced patella shift, but lowest patellar rotation, was noted with the CR insert. Conclusion The MC insert demonstrated the highest level of constraint of these inserts. Femoral roll back, femorotibial rotation, and single bony rotations were lowest with the MC insert. The patella showed less shifting with the MC insert, but there was significantly increased rotation. While the medial congruent insert was found to have highest constraint, it remains uncertain if this implant recreates native knee kinematics or if this will result in improved patient satisfaction.
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Affiliation(s)
| | - Jakob Hambrecht
- Department of Orthopedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Jonas Schwer
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany
| | - John R. Martin
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Heiko Reichel
- Department of Orthopedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Andreas Seitz
- Institute of Orthopaedic Research and Biomechanics, University of Ulm, Ulm, Germany
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248
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Azarboo A, Ghaseminejad-Raeini A, Teymoori-Masuleh M, Mousavi SM, Jamalikhah-Gaskarei N, Hoveidaei AH, Citak M, Luo TD. Risk factors of postoperative urinary retention following total hip and knee arthroplasty. Bone Jt Open 2024; 5:601-611. [PMID: 39022904 PMCID: PMC11256004 DOI: 10.1302/2633-1462.57.bjo-2024-0003.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Aims The aim of this meta-analysis was to determine the pooled incidence of postoperative urinary retention (POUR) following total hip and knee arthroplasty (total joint replacement (TJR)) and to evaluate the risk factors and complications associated with POUR. Methods Two authors conducted searches in PubMed, Embase, Web of Science, and Scopus on TJR and urinary retention. Eligible studies that reported the rate of POUR and associated risk factors for patients undergoing TJR were included in the analysis. Patient demographic details, medical comorbidities, and postoperative outcomes and complications were separately analyzed. The effect estimates for continuous and categorical data were reported as standardized mean differences (SMDs) and odds ratios (ORs) with 95% CIs, respectively. Results A total of 31 studies were included in the systematic review. Of these, 29 studies entered our meta-analysis, which included 3,273 patients diagnosed with POUR and 11,583 patients without POUR following TJR. The pooled incidence of POUR was 28.06%. Demographic risk factors included male sex (OR 1.81, 95% CI 1.26 to 2.59), increasing age (SMD 0.16, 95% CI 0.04 to 0.27), and American Society of Anesthesiologists grade 3 to 4 (OR 1.39, 95% CI 1.10 to 1.77). Patients with a history of benign prostatic hyperplasia (OR 1.99, 95% CI 1.41 to 2.83) and retention (OR 3.10, 95% CI 1.58 to 6.06) were more likely to develop POUR. Surgery-related risk factors included spinal anaesthesia (OR 1.44, 95% CI 1.19 to 1.74) and postoperative epidural analgesia (OR 2.82, 95% CI 1.65 to 4.82). Total hip arthroplasty was associated with higher odds of POUR compared to total knee arthroplasty (OR 1.10, 95% CI 1.02 to 1.20). Postoperatively, POUR was associated with a longer length of stay (SMD 0.21, 95% CI 0.02 to 0.39). Conclusion Our meta-analysis demonstrated key risk variables for POUR following TJR, which may assist in identifying at-risk patients and direct patient-centered pathways to minimize this postoperative complication.
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Affiliation(s)
- Alireza Azarboo
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Seyed M. Mousavi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Amir H. Hoveidaei
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Mustafa Citak
- Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany
| | - T. D. Luo
- Orthopaedics Northeast, Fort Wayne, Indiana, USA
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249
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Iljazi A, Sørensen MS, Winther-Jensen M, Overgaard S, Petersen MM. Discontinuing the recommendation of hip precautions does not increase the risk of early dislocation after primary total hip arthroplasty using 36-mm heads: a population-based study from the Danish Hip Arthroplasty Register. Acta Orthop 2024; 95:407-414. [PMID: 39023400 PMCID: PMC11257070 DOI: 10.2340/17453674.2024.41168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND AND PURPOSE Dislocation is a severe complication following total hip arthroplasty (THA). Hip precautions have been recommended in the initial postoperative period but evidence supporting this practice is limited. We therefore conducted a population-based study to evaluate the association between discontinuing recommending postoperative hip precautions and the risk of early dislocation. METHODS This is a cohort study with data from the Danish Hip Arthroplasty Register and the Danish National Patient Register. We included patients who underwent primary THA for osteoarthritis in 2004-2019 in public hospitals in the Capital Region of Denmark. The cohort was divided into the hip precautions group, comprising patients operated on between 2004 and 2009, and the no-precautions group operated on between 2014 and 2019. The primary outcome was the difference in the absolute risk of dislocation within 3 months post-surgery. The secondary outcome assessed the same risk within 2 years. We evaluated the difference in absolute risk using absolute risk regression (ARR). RESULTS The cumulative incidence of dislocation within 3 months was 2.9% (confidence interval [CI] 2.5-3.3) in the hip precautions group and 3.5% (CI 3.1-3.9) in the no-precautions group. The risk of dislocation was higher in the no-precautions group but failed to reach statistical significance in the crude (ARR 1.2, CI 0.9-1.6) and multivariate model (ARR 1.4, CI 0.9-2.2). CONCLUSION We found a higher but statistically insignificant increase in the risk of early dislocation in the no-precautions group. The lack of significance in the association may be explained by the increased use of 36-mm femoral heads after the guideline revision.
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Affiliation(s)
- Afrim Iljazi
- Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet.
| | - Michala Skovlund Sørensen
- Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet; Department of Orthopedic Surgery, Zealand University Hospital; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Centre for Clinical Research and Prevention, Copenhagen University Hospital Bispebjerg-Frederiksberg
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg-Frederiksberg; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| | - Michael Mørk Petersen
- Department of Orthopedic Surgery, Copenhagen University Hospital Rigshospitalet; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
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250
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Domagalski RS, Dugiełło B, Rokicka S, Czech S, Skowroński R, Rokicka D, Wróbel MP, Strojek K, Stołtny T. Bone graft incorporation failure with inappropriate limb load transfer can lead to aseptic acetabular loosening of metal-on-metal prosthesis: A case report. World J Orthop 2024; 15:668-674. [PMID: 39070935 PMCID: PMC11271694 DOI: 10.5312/wjo.v15.i7.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/11/2024] [Accepted: 05/09/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Aseptic acetabular loosening can result from various factors that can be categorized into groups: patient-related, surgeon-related and implant-related. We present a case of a 63-year-old patient who at first underwent a total hip arthroplasty (THA) using a metal-on-metal bearing due to hip arthrosis. Follow-up visits revealed no complications after the procedure. Two years after the THA, acetabular component loosening occurred due to subsequent trauma of the opposite hip, necessitating a revision THA using a ceramic-on-ceramic bearing. CASE SUMMARY We aim to illustrate a rare case where the primary reason for undergoing THA revision was not only incomplete bone graft incorporation but also improper limb load distribution. Following the revision arthroplasty, a 9-year follow-up visit revealed improvements in all evaluation measures on questionnaire compared to the state before surgery: Harris Hip Score (before surgery: 15; after surgery: 95), Western Ontario and McMaster Universities Arthritis Index (before surgery: 96; after surgery: 0), and Visual Analogue Scale (before surgery: 10; after surgery: 1). CONCLUSION Opposite-hip trauma caused a weight transfer to the limb after a THA procedure. This process led to a stress shielding effect, resulting in acetabular component loosening.
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Affiliation(s)
| | - Bogdan Dugiełło
- District Railway Hospital, Medical University of Silesia, Katowice 40-760, Poland
| | - Sonia Rokicka
- Faculty of Medicine, Medical University of Gdańsk, Gdańsk 80-210, Poland
| | - Szymon Czech
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary Śląskie 41-940, Poland
| | - Rafał Skowroński
- “ALFA” Orthopaedics and Traumatology Center, Białystok 15-763, Poland
| | - Dominika Rokicka
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
| | - Marta Patrycja Wróbel
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
| | - Krzysztof Strojek
- Department of Internal Medicine, Diabetology and Cardiometabolic Disorders, Faculty of Medical Sciences Zabrze, Medical University of Silesia, Zabrze 41-800, Poland
| | - Tomasz Stołtny
- District Hospital of Orthopaedics and Trauma Surgery in Piekary Śląskie, Piekary Śląskie 41-940, Poland
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