1
|
Chowdary AR, Wukich DK, Sambandam S. Complications of periprosthetic fracture revision vs aseptic revision of total knee arthroplasty. J Orthop 2024; 53:20-26. [PMID: 38450064 PMCID: PMC10912218 DOI: 10.1016/j.jor.2024.02.033] [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: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Background Periprosthetic fractures after total knee arthroplasty (TKA) are a challenging problem due to complex fracture patterns, poor bone quality, and a high-risk patient population. Treatment of both periprosthetic fractures and aseptic complications can include revision TKA. In this study, we compared systemic and orthopaedic complications following periprosthetic fracture associated revision TKA to aseptic revision TKA. Methods This is a retrospective cohort study using data from the years 2010-2020 from a national administrative claims database. Billing codes were used to identify revision TKAs with a diagnosis of periprosthetic fracture or aseptic complications (loosening, dislocation, arthrofibrosis, osteolysis, or prosthetic wear) within one year prior to revision. Pertinent systemic complications and rates of repeat revision TKA, periprosthetic infection, and repeat fractures were compared between the two groups. Results We identified 9891 periprosthetic fracture associated revision TKAs and 47,071 aseptic revision TKAs. Our study found higher rate of systemic complications including AKI, DVT, wound disruption, hematoma, and surgical site infections in periprosthetic fracture associated revision TKA compared to aseptic revision TKA. Furthermore, we found higher rates of repeat revision TKA, periprosthetic infections, and repeat periprosthetic fractures in fracture associated revision TKA group compared to aseptic revision group. Conclusions Our work highlights the significant short- and long-term complications associated with periprosthetic fracture associated revision TKA. Future working comparing functional outcomes and optimal surgical techniques are needed.
Collapse
Affiliation(s)
| | - Dane K. Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Senthil Sambandam
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, TX, USA
- Department of Orthopaedic Surgery, Dallas VA Medical Center, Dallas, TX, USA
| |
Collapse
|
2
|
Panwar KS, Huish EG, Law JL, Deans JT, Staples JR, Eisemon EO, Lum ZC. Revision Total Joint Arthroplasty Places a Disproportionate Burden on Surgeons: A Comparison Using the National Aeronautics and Space Administration Task Load Index (NASA TLX). J Arthroplasty 2024; 39:1550-1556. [PMID: 38218555 DOI: 10.1016/j.arth.2024.01.002] [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: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Perceived surgeon workload of performing primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) is challenging to quantify. The National Aeronautics and Space Administration Task Load Index (NASA TLX) survey was developed to quantify experiences following aviation and has been applied to healthcare fields. Our purposes were to 1) quantify the workload endured by surgeons who are performing primary and revision TKA and THA and 2) compare these values to their Center for Medicare & Medicaid Services (CMS) reimbursement. METHODS A prospective cohort of 5 fellowship-trained adult reconstruction surgeons completed NASA TLX surveys following primary and revision TKA/THA cases. A total of 122 surveys consisting of 70 TKA (48 primaries and 22 revisions) and 55 THA surveys (38 primaries and 17 revisions) were completed. Patient demographics and surgical variables were recorded. Final NASA TLX workloads were compared to 2021 CMS work relative value units. RESULTS Compared to primary TKA, revision TKA had 176% increased intraoperative workload (P < .001), 233% increased mental burden (P < .001), and 150% increased physical burden (P < .001). Compared to primary THA, revision THA had 106% increased intraoperative workload (P < .001), 96% increased mental burden (P < .001), and 91% increased physical burden (P < .001). Operative time was higher in revision versus primary TKA (118 versus 84.5 minutes, P = .05) and THA (150 versus 115 minutes, P = .001). Based upon 2021 CMS data, revision TKA and THA would need to be compensated by an additional 36% and 12.3%, respectively, to parallel intraoperative efforts. CONCLUSIONS Revision hip and knee arthroplasty places a major mental and physical workload upon surgeons and is disproportionately compensated by CMS.
Collapse
Affiliation(s)
- Kunal S Panwar
- Department of Orthopedic Surgery, San Joaquin General Hospital, Stockton, California
| | - Eric G Huish
- Department of Orthopedic Surgery, San Joaquin General Hospital, Stockton, California
| | - Jesua L Law
- Department of Orthopedic Surgery, Doctors Medical Center, Modesto, California
| | - Justin T Deans
- Department of Orthopedic Surgery, Doctors Medical Center, Modesto, California
| | - Jonathon R Staples
- Department of Orthopedic Surgery, Memorial Medical Center, Modesto, California
| | - Eric O Eisemon
- Department of Orthopedic Surgery, Kaiser Permanente, Oakland, California
| | - Zachary C Lum
- Department of Orthopaedic Surgery, UC Davis Medical Center, University of California, Sacramento, California
| |
Collapse
|
3
|
Gerhart CR, Boddu SP, Haglin JM, Bingham JS. Revision Arthroplasty Among Medicare Patients in the United States - Arthroplasty Surgeons are Doing More for Less. J Arthroplasty 2024:S0883-5403(24)00033-0. [PMID: 38266687 DOI: 10.1016/j.arth.2024.01.033] [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: 11/02/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Previously documented trends of major joint arthroplasty demonstrate increasing volume and decreasing reimbursement for primary total knee and total hip arthroplasty procedures. As such, the purpose of this study was to evaluate trends in revision knee and hip arthroplasty volume and true Medicare reimbursements to physicians. METHODS The publicly accessible Centers for Medicare and Medicaid files were evaluated. Data were retrieved from the Part B National Summary Data File and queried for revision knee and hip arthroplasty billed to Medicare from 2000 to 2021. The total charge submitted to Medicare, Medicare reimbursement, number of revision arthroplasty surgeries performed, and average reimbursement per surgery were collected for each year. All monetary data were adjusted for inflation to 2021 dollars. RESULTS There were 492,360 revision total knee arthroplasty surgeries and 424,163 revision hip arthroplasty procedures billed to Medicare from 2000 to 2021. Medicare was billed a total of $919,603,674.86 for revision knee and $862,979,761.57 for revision hip arthroplasty during that time. Medicare reimbursed physicians an average of $1,499.89 per knee revision and $1,603.32 per hip revision surgery. The total volume of revision knee arthroplasty increased by 9,380 (62%) and revision hip decreased by 1,743 (9%) from the year 2000 to 2021. However, there was a decrease of average reimbursement per procedure of more than 37% ($1,987.14 to 1,254) and 39% ($2,149.87 to 1,311.17), respectively. CONCLUSIONS Despite a notable increase in the volume of revision total knee and stagnant revision hip arthroplasty, total billings to and reimbursements from Medicare for these procedures have not changed markedly per year. Importantly, this means that physicians are conducting more of these high-impact procedures yearly, while being reimbursed per procedure at a declining rate. This may indicate a need to re-assess billing and reimbursement rates for revision arthroplasty, in the context of the ever-increasing inflation rate.
Collapse
Affiliation(s)
- Coltin R Gerhart
- Anne Burnett School of Medicine at Texas Christian University, Fort Worth, Texas
| | - Sayi P Boddu
- Alix School of Medicine at Mayo Clinic, Scottsdale, Arizona
| | - Jack M Haglin
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Scottsdale, Arizona
| |
Collapse
|
4
|
Tseng J, Oladipo V, Dandamudi S, Jones CM, Levine BR. Validation of a Classification System for Optimal Application of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infections following Total Knee Arthroplasty: A Retrospective Review. Antibiotics (Basel) 2024; 13:48. [PMID: 38247607 PMCID: PMC10812511 DOI: 10.3390/antibiotics13010048] [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: 11/24/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Periprosthetic joint infection (PJI) remains a serious complication after total knee arthroplasty (TKA). While debridement, antibiotics, and implant retention (DAIR) are considered for acute PJI, success rates vary. This study aims to assess a new scoring system's accuracy in predicting DAIR success. METHODS 119 TKA patients (2008-2019) diagnosed with PJI who underwent DAIR were included for analysis. Data were collected on demographics, laboratory values, and clinical outcomes. This was used for validation of the novel classification system consisting of PJI acuteness, microorganism classification, and host health for DAIR indication. Statistical analysis was carried out using SPSS programming. RESULTS Mean follow-up was 2.5 years with an average age of 65.5 ± 9.1 years, BMI of 31.9 ± 6.2 kg/m2, and CCI of 3.04 ± 1.8. Successful infection eradication occurred in 75.6% of patients. The classification system demonstrated 61.1% sensitivity, 72.4% specificity, and 87.3% positive predictive value (PPV) when the DAIR cutoff was a score less than 6. For a cutoff of less than 8, sensitivity was 100%, specificity was 37.9%, and PPV was 83.3%. CONCLUSIONS To date, no consensus exists on a classification system predicting DAIR success. This novel scoring system, with high PPV, shows promise. Further refinement is essential for enhanced predictive accuracy.
Collapse
Affiliation(s)
| | | | | | | | - Brett R. Levine
- Rush University Medical Center, Department of Orthopaedic Surgery, Chicago, IL 60612, USA; (J.T.); (V.O.); (S.D.); (C.M.J.)
| |
Collapse
|
5
|
De Marziani L, Boffa A, Di Martino A, Andriolo L, Reale D, Bernasconi A, Corbo VR, de Caro F, Delcogliano M, di Laura Frattura G, Di Vico G, Manunta AF, Russo A, Filardo G. The reimbursement system can influence the treatment choice and favor joint replacement versus other less invasive solutions in patients affected by osteoarthritis. J Exp Orthop 2023; 10:146. [PMID: 38135778 PMCID: PMC10746689 DOI: 10.1186/s40634-023-00699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE The aim of this study was to assess how physicians perceive the role of the reimbursement system and its potential influence in affecting their treatment choice in the management of patients affected by osteoarthritis (OA). METHODS A survey was administered to 283 members of SIAGASCOT (Italian Society of Arthroscopy, Knee, Upper Limb, Sport, Cartilage and Orthopaedic Technologies), a National scientific orthopaedic society. The survey presented multiple choice questions on the access allowed by the current Diagnosis-Related Groups (DRG) system to all necessary options to treat patients affected by OA and on the influence toward prosthetic solutions versus other less invasive options. RESULTS Almost 70% of the participants consider that the current DRG system does not allow access to all necessary options to best treat patients affected by OA. More than half of the participants thought that the current DRG system favors the choice of prosthetic solutions (55%) and that it can contribute to the increase in prosthetic implantation at the expense of less invasive solutions (54%). The sub-analyses based on different age groups, professional roles, and places of work allowed to evaluate the response in each specific category, confirming the findings for all investigated aspects. CONCLUSIONS This survey documented that the majority of physicians consider that the reimbursement system can influence the treatment choice when managing OA patients. The current DRG system was perceived as unbalanced in favor of the choice of the prosthetic solution, which could contribute to the increase in prosthetic implantation at the expense of other less invasive options for OA management.
Collapse
Affiliation(s)
- Luca De Marziani
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, Bologna, 1 - 40136, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, Bologna, 1 - 40136, Italy.
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, Bologna, 1 - 40136, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, Bologna, 1 - 40136, Italy
| | - Davide Reale
- Ortopedia e Traumatologia, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessio Bernasconi
- Orthopaedics and Traumatology Unit, Department of Public Health, University Federico II of Naples Federico II, Naples, Italy
| | | | - Francesca de Caro
- Department of Orthopaedic Surgery, Istituto Di Cura Città Di Pavia, Pavia, Italy
| | - Marco Delcogliano
- Servizio di Ortopedia e Traumatologia dell'Ospedale Regionale di Bellinzona e Valli, Ente Ospedaliero Cantonale, Ticino, Switzerland
| | | | - Giovanni Di Vico
- Department of Orthopaedics and Trauma Surgery, Clinica San Michele, Maddaloni, Italy
| | | | | | - Giuseppe Filardo
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
6
|
Roof MA, Aggarwal VK, Schwarzkopf R. The Economics of Revision Arthroplasty for Periprosthetic Joint Infection. Arthroplast Today 2023; 23:101213. [PMID: 37745961 PMCID: PMC10511334 DOI: 10.1016/j.artd.2023.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Mackenzie A. Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Vinay K. Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| |
Collapse
|
7
|
Venkatraman V, Suarez AD, Kirsch EP, Heo H, Wu KA, McDaniel KE, Yang LZ, Jung SH, Dharmapurikar R, Lad SP, Haglund MM. Quantifying the Opportunity Cost of Neurosurgical Resident Education. World Neurosurg 2023; 175:e669-e677. [PMID: 37030478 DOI: 10.1016/j.wneu.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/10/2023]
Abstract
BACKGROUND/OBJECTIVE Education is at the core of neurosurgical residency, but little research in to the cost of neurosurgical education exists. This study aimed to quantify costs of resident education in an academic neurosurgery program using traditional teaching methods and the Surgical Autonomy Program (SAP), a structured training program. METHODS SAP assesses autonomy by categorizing cases into zones of proximal development (opening, exposure, key section, and closing). All first-time, 1-level to 4-level anterior cervical discectomy and fusion (ACDF) cases between March 2014 and March 2022 from 1 attending surgeon were divided into 3 groups: independent cases, cases with traditional resident teaching, and cases with SAP teaching. Surgical times for all cases were collected and compared within levels of surgery between groups. RESULTS The study found 2140 ACDF cases, with 1758 independent, 223 with traditional teaching, and 159 with SAP. For 1-level to 4-level ACDFs, teaching took longer than it did with independent cases, with SAP teaching adding additional time. A 1-level ACDF performed with a resident (100.1 ± 24.3 minutes) took about as long as a 3-level ACDF performed independently (97.1 ± 8.9 minutes). The average time for 2-level cases was 72.0 ± 18.2 minutes independently, 121.7 ± 33.7 minutes traditional, and 143.4 ± 34.9 minutes SAP, with significant differences among all groups. CONCLUSIONS Teaching takes significant time compared with operating independently. There is also a financial cost to educating residents, because operating room time is expensive. Because attending neurosurgeons lose time to perform more surgeries when teaching residents, there is a need to acknowledge surgeons who devote time to training the next generation of neurosurgeons.
Collapse
Affiliation(s)
- Vishal Venkatraman
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander D Suarez
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elayna P Kirsch
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Helen Heo
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin A Wu
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine E McDaniel
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Lexie Z Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Shivanand P Lad
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Michael M Haglund
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA.
| |
Collapse
|
8
|
Iobst CA, Rowan MR, Bafor A. Pediatric Limb Lengthening and Reconstruction Surgical Coding Survey Results. J Pediatr Orthop 2023; 43:232-236. [PMID: 36737053 DOI: 10.1097/bpo.0000000000002359] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND In surgical specialties like orthopaedics, documenting the surgery performed involves applying the appropriate current procedural terminology (CPT) code(s). For limb reconstruction surgeons, the wide-ranging types of surgeries and rapid evolution of the field create a variety of factors making it difficult to code the procedures. We sought to (1) assess whether appropriate limb reconstruction codes currently exist and (2) determine whether there is agreement among experienced pediatric orthopaedic surgeons when applying these codes to similar cases. METHODS A REDCAP survey comprised of 10 common pediatric limb reconstruction cases was sent to experienced pediatric limb reconstruction surgeons in the United States. Based on the description of each case, the surgeons were asked to code the cases as they usually would in their practice. There were no limitations regarding the number or the types of codes each surgeon could choose to apply to the case. Nine additional demographic and general coding questions were asked to gauge the responding surgeon's coding experience. RESULTS Survey participants used various codes for each case, ranging from only 1 code to a maximum of 9 codes to describe a single case. The average number of codes per case ranged from 1.2 to 3.6, with an average of 2.5 among all 10 cases. The total number of unique codes provided by the respondents for each case ranged from 5 to 20. Only 3 of the 10 cases had an agreement >75% for any single code, and only 2 of the 10 cases had >50% agreement on any combination of 2 codes. CONCLUSIONS There are dramatic variations in coding methods among pediatric orthopaedic limb reconstruction surgeons. This information highlights the need to improve the current CPT coding landscape. Possible solutions include developing new codes that better represent the work done, developing standardized guidelines with the existing codes to decrease variation, and improving CPT coding education by developing limb reconstruction coding "champions." LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
- Christopher A Iobst
- Department of Orthopaedic Surgery, Nationwide Children's Hospital, Columbus, OH
| | | | | |
Collapse
|
9
|
Does Work Relative Value Unit Measure Surgical Complexity for Risk Adjustment of Surgical Outcomes? J Surg Res 2023; 287:176-185. [PMID: 36934654 DOI: 10.1016/j.jss.2023.02.001] [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: 09/29/2022] [Revised: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION The purpose of this study was to determine whether the work relative value unit (workRVU) of a patient's operation can be useful as a measure of surgical complexity for the risk adjustment of surgical outcomes. METHODS We retrospectively analyzed the American College of Surgeon's National Surgical Quality Improvement Program database (2005-2018). We examined the associations of workRVU of the patient's primary operation with preoperative patient characteristics and associations with postoperative complications. We performed forward selection multiple logistic regression analysis to determine the predictive importance of workRVU. We then generated prediction models using patient characteristics with and without workRVU and compared c-indexes to assess workRVU's additive predictive value. RESULTS 7,507,991 operations were included. Patients who were underweight, functionally dependent, transferred from an acute care hospital, had higher American Society of Anesthesiologists class or who had medical comorbidities had operations with higher workRVU (all P < 0.0001). The subspecialties with the highest workRVU were neurosurgery (mean = 22.2), thoracic surgery (mean = 21.1), and vascular surgery (mean = 18.8) (P < 0.0001). For all postoperative complications, mean workRVU was higher for patients with the complication than those without (all P < 0.0001). For eight of 12 postoperative complications, workRVU entered the logistic regression models as a predictor variable in the 1st to 4th steps. Addition of workRVU as a preoperative predictive variable improved the c-index of the prediction models. CONCLUSIONS WorkRVU was associated with sicker patients and patients experiencing postoperative complications and was an important predictor of postoperative complications. When added to a prediction model including patient characteristics, it only marginally improved prediction. This is possibly because workRVU is associated with patient characteristics.
Collapse
|
10
|
Patel I, Nham F, Zalikha AK, El-Othmani MM. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:2. [PMID: 36593482 PMCID: PMC9808997 DOI: 10.1186/s42836-022-00156-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/22/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Primary THA (THA) is a successful procedure for end-stage hip osteoarthritis. In the setting of a failed THA, revision total hip arthroplasty (rTHA) acts as a salvage procedure. This procedure has increased risks, including sepsis, infection, prolonged surgery time, blood loss, and increased length of stay. Increasing focus on understanding of demographics, comorbidities, and inpatient outcomes can lead to better perioperative optimization and post-operative outcomes. This epidemiological registry study aimed to compare the demographics, comorbidity profiles, and outcomes of patients undergoing THA and rTHA. METHODS A retrospective review of discharge data reported from 2006 to the third quarter of 2015 using the National Inpatient Sample registry was performed. The study included adult patients aged 40 and older who underwent either THA or rTHA. A total of 2,838,742 THA patients and 400,974 rTHA patients were identified. RESULTS The primary reimbursement for both THA and rTHA was dispensed by Medicare at 53.51% and 65.36% of cases respectively. Complications arose in 27.32% of THA and 39.46% of rTHA cases. Postoperative anemia was the most common complication in groups (25.20% and 35.69%). Common comorbidities in both groups were hypertension and chronic pulmonary disease. rTHA indications included dislocation/instability (21.85%) followed by mechanical loosening (19.74%), other mechanical complications (17.38%), and infection (15.10%). CONCLUSION Our data demonstrated a 69.50% increase in patients receiving THA and a 28.50% increase in rTHA from the years 2006 to 2014. The data demonstrated 27.32% and 39.46% complication rate with THA and rTHA, with postoperative anemia as the most common cause. Common comorbidities were hypertension and chronic pulmonary disease. Future analyses into preoperative optimizations, such as prior consultation with medical specialists or improved primary hip protocol, should be considered to prevent/reduce postoperative complications amongst a progressive expansion in patients receiving both THA and rTHA.
Collapse
Affiliation(s)
- Ishan Patel
- grid.413184.b0000 0001 0088 6903DMC Orthopaedics & Sports Medicine, 3990 John R Street, Detroit, MI 48201 USA
| | - Fong Nham
- grid.413184.b0000 0001 0088 6903DMC Orthopaedics & Sports Medicine, 3990 John R Street, Detroit, MI 48201 USA
| | - Abdul K. Zalikha
- grid.413184.b0000 0001 0088 6903DMC Orthopaedics & Sports Medicine, 3990 John R Street, Detroit, MI 48201 USA
| | - Mouhanad M. El-Othmani
- grid.239585.00000 0001 2285 2675Department of Orthopaedic Surgery, Columbia University Medical Center, 622 W 168th Street, New York, NY 10032 USA
| |
Collapse
|