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Rovere G, Bosco F, Miceli A, Ratano S, Freddo G, D'Itri L, Ferruzza M, Maccauro G, Farsetti P, Camarda L. Adoption of blockchain as a step forward in orthopedic practice. Eur J Transl Myol 2024; 34:12197. [PMID: 38785351 PMCID: PMC11264218 DOI: 10.4081/ejtm.2024.12197] [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: 12/18/2023] [Accepted: 02/25/2024] [Indexed: 05/25/2024] Open
Abstract
Blockchain technology has gained popularity since the invention of Bitcoin in 2008. It offers a decentralized and secure system for managing and protecting data. In the healthcare sector, where data protection and patient privacy are crucial, blockchain has the potential to revolutionize various aspects, including patient data management, orthopedic registries, medical imaging, research data, and the integration of Internet of Things (IoT) devices. This manuscript explores the applications of blockchain in orthopedics and highlights its benefits. Furthermore, the combination of blockchain with artificial intelligence (AI), machine learning, and deep learning can enable more accurate diagnoses and treatment recommendations. AI algorithms can learn from large datasets stored on the blockchain, leading to advancements in automated clinical decision-making. Overall, blockchain technology has the potential to enhance data security, interoperability, and collaboration in orthopedics. While there are challenges to overcome, such as adoption barriers and data sharing willingness, the benefits offered by blockchain make it a promising innovation for the field.
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Affiliation(s)
- Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy; Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome.
| | - Francesco Bosco
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
| | - Angelo Miceli
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
| | - Salvatore Ratano
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
| | - Giuseppe Freddo
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
| | - Lorenzo D'Itri
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
| | - Massimo Ferruzza
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
| | - Giulio Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome.
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome.
| | - Lawrence Camarda
- Department of Precision Medicine in the Medical, Surgical and Critical Care Area (ME.PRE.C.C.), University of Palermo, Palermo.
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Chen W, Tay ML, Bolam S, Monk AP, Young SW. Accuracy and completeness of registry-reported unicompartmental knee arthroplasty revision. ANZ J Surg 2024. [PMID: 38741460 DOI: 10.1111/ans.19035] [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: 03/03/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The key outcome of joint registries is revision events, which inform clinical practice and identify poor-performing implants. Registries record revision events and reasons, but accuracy may be limited by a lack of standardized definitions of revision. Our study aims to assess the accuracy and completeness of unicompartmental knee arthroplasty (UKA) revision and indications reported to the New Zealand Joint Registry (NZJR) with independent clinical review. METHODS Case record review of 2272 patients undergoing primary UKA at four large tertiary hospitals between 2000 and 2017 was performed, identifying 158 patients who underwent revision. Detailed review of clinical findings, radiographs and operative data was performed to identify revision cases and the reasons for revision using a standardized protocol. These were compared to NZJR data using chi-squared and Fisher exact tests. RESULTS The NZJR recorded 150 (95%) of all UKA revisions. Osteoarthritis progression was the most common reason on the systematic clinical review (35%), however, this was underreported to the registry (8%, P < 0.001). A larger proportion of revisions reported to the registry were for 'pain' (30% of cases vs. 5% on clinical review, P < 0.001). A reason for revision was not reported to the registry for 10% of cases. CONCLUSION The NZJR had good capture of UKA revisions, but had significant differences in registry-reported revision reasons compared to our independent systematic clinical review. These included over-reporting of 'pain', under-reporting of osteoarthritis progression, and failing to identify a revision reason. Efforts to improve registry capture of revision reasons for UKA could be addressed through more standardized definitions of revision and tailored revision options for UKA on registry forms.
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Affiliation(s)
- William Chen
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
| | - Mei Lin Tay
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand
| | - Scott Bolam
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Auckland, New Zealand
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Favre P, Bischoff J. Identifying the patient harms to include in an in silico clinical trial. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 241:107735. [PMID: 37544163 DOI: 10.1016/j.cmpb.2023.107735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Clinical trials represent a crucial step in the development and approval of medical devices. These trials involve evaluating the safety and efficacy of the device in a controlled setting with human subjects. However, traditional clinical trials can be expensive, time-consuming, and ethically challenging. Augmenting clinical trials with data from computer simulations, so called in silico clinical trials (ISCT), has the potential to address these challenges while satisfying regulatory requirements. However, determination of the patient harms in scope of an ISCT is necessary to ensure all harms are sufficiently addressed while maximizing the utility of the ISCT. This topic is currently lacking guidance. The objective of this work is to propose a general method to determine which patient harms should be included in an ISCT for a regulatory submission. METHODS The proposed method considers the risk associated with the harm, the impact of the device on the likelihood of occurrence of the harm and the technical feasibility of evaluating the harm via ISCT. Consideration of the risk associated with the harm provides maximum clinical impact of the ISCT, in terms of focusing on those failure modes which are most relevant to the patient population. Consideration of the impact of the device on a particular harm, and the technical feasibility of modeling a particular harm supports that the technical effort is devoted to a problem that (1) is relevant to the device in question, and (2) can be solved with contemporary modeling techniques. RESULTS AND CONCLUSIONS As a case study, the proposed method is applied to a total shoulder replacement humeral system. With this framework, it is hoped that a consistent approach to scoping an ISCT can be adopted, supporting investment in ISCT by the industry, enabling consistent review of the ISCT approach across device disciplines by regulators, and providing maximum impact of modeling technologies in support of devices to improve patient outcomes.
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Affiliation(s)
| | - Jeff Bischoff
- Zimmer Biomet, 1800 West Center Street, Warsaw, IN 46580, USA
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de Marinis R, Marigi EM, Atwan Y, Yang L, Oeding JF, Gupta P, Pareek A, Sanchez-Sotelo J, Sperling JW. Current clinical applications of artificial intelligence in shoulder surgery: what the busy shoulder surgeon needs to know and what's coming next. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:447-453. [PMID: 37928999 PMCID: PMC10625013 DOI: 10.1016/j.xrrt.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Artificial intelligence (AI) is a continuously expanding field with the potential to transform a variety of industries-including health care-by providing automation, efficiency, precision, accuracy, and decision-making support for simple and complex tasks. Basic knowledge of the key features as well as limitations of AI is paramount to understand current developments in this field and to successfully apply them to shoulder surgery. The purpose of the present review is to provide an overview of AI within orthopedics and shoulder surgery exploring current and forthcoming AI applications. Methods PubMed and Scopus databases were searched to provide a narrative review of the most relevant literature on AI applications in shoulder surgery. Results Despite the enormous clinical and research potential of AI, orthopedic surgery has been a relatively late adopter of AI technologies. Image evaluation, surgical planning, aiding decision-making, and facilitating patient evaluations over time are some of the current areas of development with enormous opportunities to improve surgical practice, research, and education. Furthermore, the advancement of AI-driven strategies has the potential to create a more efficient medical system that may reduce the overall cost of delivering and implementing quality health care for patients with shoulder pathology. Conclusion AI is an expanding field with the potential for broad clinical and research applications in orthopedic surgery. Many challenges still need to be addressed to fully leverage the potential of AI to clinical practice and research such as privacy issues, data ownership, and external validation of the proposed models.
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Affiliation(s)
- Rodrigo de Marinis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Hospital Dr. Sótero del Rio, Santiago, Chile
| | - Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yousif Atwan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Linjun Yang
- Orthopedic Surgery Artificial Intelligence Lab (OSAIL), Mayo Clinic, Rochester, MN, USA
| | - Jacob F. Oeding
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Puneet Gupta
- Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ayoosh Pareek
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - John W. Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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MacLean CH, Antao VC, Chin AS, McLawhorn AS. Population-Based Applications and Analytics Using Patient-Reported Outcome Measures. J Am Acad Orthop Surg 2023; 31:1078-1087. [PMID: 37276464 PMCID: PMC10519290 DOI: 10.5435/jaaos-d-23-00133] [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: 02/10/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/07/2023] Open
Abstract
The intersection of big data and artificial intelligence (AI) has resulted in advances in numerous areas, including machine learning, computer vision, and natural language processing. Although there are many potentially transformative applications of AI in health care, including precision medicine, this industry has been slow to adopt these technologies. At the same time, the operations of health care have historically been system-directed and physician-directed rather than patient-centered. The application of AI to patient-reported outcome measures (PROMs), which provide insight into patient-centered health outcomes, could steer research and healthcare delivery toward decisions that optimize outcomes important to patients. Historically, PROMs have only been collected within research registries. However, the increasing availability of PROMs within electronic health records has led to their inclusion in big data ecosystems, where they can inform or be informed by other data elements. The use of big data to analyze PROMs can help establish norms, evaluate data distribution, and determine proportions of patients achieving change or threshold standards. This information can be used for benchmarking, risk adjustment, predictive modeling, and ultimately improving the health of individuals and populations.
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Affiliation(s)
- Catherine H. MacLean
- From the Center for the Advancement of Value in Musculoskeletal Care (Dr. MacLean, Dr. Antao, Ms. Chin), Hospital for Special Surgery, New York, NY (MacLean, Antao, and Chin), and the Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY (McLawhorn)
| | - Vinicius C. Antao
- From the Center for the Advancement of Value in Musculoskeletal Care (Dr. MacLean, Dr. Antao, Ms. Chin), Hospital for Special Surgery, New York, NY (MacLean, Antao, and Chin), and the Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY (McLawhorn)
| | - Amy S. Chin
- From the Center for the Advancement of Value in Musculoskeletal Care (Dr. MacLean, Dr. Antao, Ms. Chin), Hospital for Special Surgery, New York, NY (MacLean, Antao, and Chin), and the Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY (McLawhorn)
| | - Alexander S. McLawhorn
- From the Center for the Advancement of Value in Musculoskeletal Care (Dr. MacLean, Dr. Antao, Ms. Chin), Hospital for Special Surgery, New York, NY (MacLean, Antao, and Chin), and the Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY (McLawhorn)
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Bouguennec N, Thaunat M, Barth J, Cavaignac E, Gunepin FX, Letartre R, Netten A, Pujol N, Rousseau T, Sbihi J, Mouton C, Sfa TFAS. Consensus statement on data to be entered in the ACL tear registry: SFA-DataLake. Orthop Traumatol Surg Res 2022; 108:103392. [PMID: 36064107 DOI: 10.1016/j.otsr.2022.103392] [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: 05/26/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is a frequent procedure, with room for improvement by rehabilitation measures and associated peripheral and meniscal surgeries that are currently under assessment, requiring follow-up. Outside France, there have been ACL registries for 20 years now. The French Arthroscopy Society (SFA) decided to set up an ACL tear registry within its SFA DataLake registry platform. MATERIAL AND METHOD This article presents the methodology underlying the ACL Tear Registry: i.e., identification, definition and coding of essential and relevant data. A test phase comprised an initial assessment to improve data quality and overall coherence, to optimize data-entry time for patients and practitioners, who are the guarantors of the registry's use and efficacy. RESULTS The SFA DataLake ACL Tear Registry was made available to SFA members in December 2021. It aims to enable a review of practices for surgeons, early detection of failure of procedures and implants, with rates of failure and abnormal complications, and identification of prognostic factors for outcome, especially regarding original items that do not figure in previous registries. CONCLUSION SFA DataLake strikes a balance between "indispensable" and "original" items. The choice of contents and data quality is founded on a robust methodology with overall coherence, enabling analysis of large cohorts and comparisons with the literature and other registries. However, it remains to assess rates of data entry and item relevance as the Registry progresses. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Mathieu Thaunat
- Ramsay santé, centre orthopédique Santy, hôpital privé Jean-Mermoz, 24, avenue Paul-Santy, 69008 Lyon, France
| | - Johannes Barth
- Clinique des Cèdres, 21, avenue Albert-Londres, 38130 Échirolles, France
| | - Etienne Cavaignac
- Clinique universitaire du sport, 1, place du Docteur Joseph-Baylac, 31300 Toulouse, France
| | - François-Xavier Gunepin
- Clinique mutualiste de la porte de l'Orient, 3 rue Robert-de-La-Croix, 56100 Lorient, France
| | - Romain Letartre
- Ramsay santé, hôpital privé la Louvière, 126, rue de la Louvière, 59800 Lille, France
| | | | - Nicolas Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Thomas Rousseau
- Clinique mutualiste catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Jaafar Sbihi
- Clinique Juge, 116, rue J.-Mermoz, 13008 Marseille, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, centre hospitalier Luxembourg, clinique d'Eich, Luxembourg, Luxembourg
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Beit Ner E, Nakamura N, Lattermann C, McNicholas MJ. Knee registries: state of the art. J ISAKOS 2022; 7:118-131. [PMID: 34407996 DOI: 10.1136/jisakos-2021-000625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/10/2021] [Indexed: 01/11/2023]
Abstract
Sports injuries, trauma and the globally ageing and obese population require increasing levels of knee surgery. Shared decision making has replaced the paternalistic approach to patient management. Evidence-based medicine underpins surgical treatment strategies, from consenting an individual patient to national healthcare system design. The evolution of successful knee-related registries starting from specific arthroplasty registries has given rise to ligament reconstruction, osteotomy and cartilage surgery registries developing as platforms for surgical outcome data collection. Stakeholders include surgeons and their patients, researchers, healthcare systems, as well as the funding insurers and governments. Lately, implant manufacturers have also been mandated to perform postmarket surveillance with some hoping to base that on registry data. Aiming to assess the current status of knee-related registries, we performed a comprehensive literature and web search, which yielded 23 arthroplasty, 8 ligament, 4 osteotomy and 3 articular cartilage registries. Registries were evaluated for their scope, measured variables, impact and limitations. Registries have many advantages as they aim to increase awareness of outcomes; identify trends in practice over time, early failing implants, outlier surgeon or institution performance; and assist postmarketing surveillance. International collaborations have highlighted variations in practice. The limitations of registries are discussed in detail. Inconsistencies are found in collected data and measured variables. Potential measurement and selection biases are outlined. Without mandated data collection and with apparent issues such as unverified patient reporting of complications, registries are not designed to replace adverse event recording in place of a proper safety and efficacy study, as demanded by regulators. Registry 'big data' can provide evidence of associations of problems. However, registries cannot provide evidence of causation. Hence, without careful consideration of the data and its limitations, registry data are at risk of incorrectly drawn conclusions and the potential of misuse of the results. That must be guarded against. Looking at the future, registry operators benefit from a collective experience of running registries as they mature, allowing for improvements across specialties. Large-scale registries are not only of merit, improving with stakeholder acceptance, but also are critical in furthering our understanding of our patients' outcomes. In doing so, they are a critical element for our future scientific discourse.
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Affiliation(s)
- Eran Beit Ner
- Department of Trauma and Orthopaedic Surgery, Manchester University NHS Foundation Trust, Manchester, UK; Department of Orthopedic Surgery, Yitzhak Shamir Medical Center (Assaf Harofeh), affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Zerifin, Israel
| | - Norimasa Nakamura
- Global Center of Medical Engineering and Informatics, Osaka University, Osaka, Japan; Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Christian Lattermann
- Department of Orthopaedic Surgery MassGeneralBrigham (MGB), Brigham and Women's Distinguished Chair in Orthopaedic Surgery Chief: Division of Sports Medicine Director: Cartilage Repair Center Brigham and Women's Hospital Harvard Medical School, Chestnut Hill, Massachusetts, USA
| | - Michael James McNicholas
- Trauma and Orthopaedics, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, The University of Manchester, Manchester, UK.
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Grady-Benson JC. Registries Tell Us What We Are Actually Doing: Commentary on an article by Jamil Kendall, MD, et al.: "Revision Risk for Total Knee Arthroplasty Polyethylene Designs in Patients 65 Years of Age or Older. An Analysis from the American Joint Replacement Registry". J Bone Joint Surg Am 2022; 104:e77. [PMID: 36069801 DOI: 10.2106/jbjs.22.00656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- John C Grady-Benson
- Orthopaedic Associates of Hartford PC, Hartford, Connecticut.,The Bone and Joint Institute at Hartford HealthCare, Hartford, Connecticut
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Black NR, Winslade WJ, Lindsey RW, Gugala Z. The Legal, Ethical, and Scientific Considerations for Returning Explanted Orthopaedic Hardware to the Patient. J Bone Joint Surg Am 2022; 104:e37. [PMID: 34793340 DOI: 10.2106/jbjs.21.00318] [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] [Indexed: 02/01/2023]
Abstract
Orthopaedic hardware explantation is a multifaceted topic with complex legal, ethical, and scientific aspects that require thorough exploration. Issues of device ownership, explant-induced disease propagation, and potential device resale pose legal risks to providers and health-care institutions. Ethically, implant removal highlights the potential that performing procedures at the request of the patient will incentivize patient compliance and strengthen the patient-surgeon relationship. However, the return of explanted hardware to patients could hinder scientific study and innovation, ultimately limiting advancement in risk reduction and patient outcomes. Continued research into these topics remains paramount to ensure that clinicians and institutions deliver optimal patient care while abiding with legal and ethical imperatives. This article addresses the legal, ethical, and scientific issues that are pertinent to returning an explanted orthopaedic implant to the patient and the potential ramifications of such practice.
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Affiliation(s)
- Natalie R Black
- Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - William J Winslade
- Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston, Texas
| | - Ronald W Lindsey
- Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
| | - Zbigniew Gugala
- Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas
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Rubinger L, Ekhtiari S, Gazendam A, Bhandari M. Registries: Big data, bigger problems? Injury 2021:S0020-1383(21)01001-9. [PMID: 34930582 DOI: 10.1016/j.injury.2021.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/04/2021] [Indexed: 02/02/2023]
Abstract
Patient registries have grown in size and number along with general computing power and digitization of the healthcare world. In contrast to databases, registries are typically patient data systematically created and collected for the express purpose of answering health-related questions. Registries can be disease-, procedure-, pathology-, or product-based in nature. Registry-based studies typically fit into Level II or III in the hierarchy of evidence-based medicine. However, a recent advent in the use of registry data has been the development and execution of registry-based trials, such as the TASTE trial, which may elevate registry-based studies into the realm of Level I evidence. Some strengths of registries include the sheer volume of data, the inclusion of a diverse set of participants, and their ability to be linked to other registries and databases. Limitations of registries include variable quality of the collected data, and a lack of active follow-up (which may underestimate rates of adverse events). As with any study type, the intended design does not automatically lead to a study of a certain quality. While no specific tool exists for assessing the quality of a registry-based study, some important considerations include ensuring the registry is appropriate for the question being asked, whether the patient population is representative, the presence of an appropriate comparison group, and the validity and generalizability of the registry in question. The future of clinical registries remains to be seen, but the incorporation of big data and machine learning algorithms will certainly play an important role.
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Affiliation(s)
- Luc Rubinger
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON Canada.
| | - Seper Ekhtiari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON Canada; Centre for Evidence-Based Orthopaedics, 293 Wellington St. N, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Aaron Gazendam
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON Canada; Centre for Evidence-Based Orthopaedics, 293 Wellington St. N, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Mohit Bhandari
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON Canada; Centre for Evidence-Based Orthopaedics, 293 Wellington St. N, Suite 110, Hamilton, ON L8L 8E7 Canada
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Helmer C, Louvrier A, Meyer C. Creation of a national registry about temporomandibular joint prosthesis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 122:331-332. [PMID: 34273572 DOI: 10.1016/j.jormas.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Charlotte Helmer
- Chirurgie Maxillo-Faciale, stomatologie et odontologie hospitalière, CHU Besançon, 25000 Besançon, France
| | - Aurélien Louvrier
- Chirurgie Maxillo-Faciale, stomatologie et odontologie hospitalière, CHU Besançon, 25000 Besançon, France; UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, 25000 Besançon, France
| | - Christophe Meyer
- Chirurgie Maxillo-Faciale, stomatologie et odontologie hospitalière, CHU Besançon, 25000 Besançon, France; Laboratoire Nano Médecine, Imagerie, Thérapeutique, Univ. Bourgogne Franche-Comté, EA 4662 25000, Besançon, France.
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Vuillermin C, Canizares MF, Bauer AS, Miller PE, Goldfarb CA. Congenital Upper Limb Differences Registry (CoULD): Registry Inclusion Effect. J Hand Surg Am 2021; 46:515.e1-515.e11. [PMID: 33423846 DOI: 10.1016/j.jhsa.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/11/2020] [Accepted: 11/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To advance the understanding of the epidemiology and treatment outcomes of congenital upper limb differences, a multicenter registry for Congenital Upper Limb Differences (CoULD) was established. After 4 years of recruitment, we sought to examine whether the relative frequency of congenital conditions compares with prior cross-sectional research and how the data have matured over time by (1) comparing our registry population with previous studies in similar populations and (2) evaluating the change over time of relative frequencies of selected conditions within the CoULD registry cohort, specifically to investigate for registry inclusion effects. METHODS Data from the 2 founding centers in the CoULD registry were analyzed over a 4-year period. We compared patients included in the CoULD registry against 2 prior studies by matching each condition according to the Oberg-Manske-Tonkin classification system. The relative frequency of 4 representative conditions was calculated to evaluate change over time and to determine when the inception cohort effect diminished. RESULTS The CoULD cohort of 1,381 patients was found to have notable differences compared with a 1-year cross-sectional cohort from the U.S. Midwest and a Swedish birth registry. Each of these registries had differences from the CoULD population in prevalence for approximately 33% of the diagnosis categories. The CoULD registry identified and included more pathologies of late presentation and those that do not commonly require surgical care. Changes in relative frequencies of incident and prevalent conditions, the registry inclusion effect, occurred early and stabilized by the third year. CONCLUSIONS The CoULD registry captures a different relative frequency of conditions than prior studies in similar populations. The findings highlight the CoULD registry may be a more accurate representation of clinical practice in tertiary referral centers; however, it is important to note that there was a registry inclusion effect identified. CLINICAL RELEVANCE Inclusion criteria are an important consideration with any longitudinal data collection method and data should display stability prior to registry reporting.
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Affiliation(s)
- Carley Vuillermin
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
| | - Maria F Canizares
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Andrea S Bauer
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E Miller
- Harvard Medical School, Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Charles A Goldfarb
- Washington University School of Medicine, Department of Orthopedic Surgery, St. Louis Children's Hospital, St. Louis, MO; Department of Orthopedic Surgery, Shriners Hospitals for Children-St. Louis, St. Louis, MO
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Calfee RP, Antes AL, Rozental TD, Goldfarb CA, Wolf JM, Levin LS, Chung KC. Applying the Delphi Method to Define a Focus for the National Outcomes Registry for Tracking the Hand (NORTH). J Hand Surg Am 2021; 46:417-420. [PMID: 33722474 DOI: 10.1016/j.jhsa.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
Surgical registries have provided reliable, generalizable, and applicable clinical data that have shaped many fields. Broad collection of defined data can answer clinical questions with greater numbers of patients and more ability to generalize to routine clinical care than randomized trials. National hand surgical registries exist outside the United States. Before the pursuit of a registry, the focus of such an effort must be defined to ensure that registry goals are feasible. This article presents the consensus process conducted by the American Society for Surgery of the Hand's Registry Task Force exploring potential diagnoses for a hand registry.
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Affiliation(s)
- Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.
| | - Alison L Antes
- Division of General Medical Sciences, Washington University School of Medicine, St Louis, MO
| | - Tamara D Rozental
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Jennifer M Wolf
- Department of Orthopaedic Surgery, University of Chicago School of Medicine, Chicago, IL
| | - L Scott Levin
- Department of Orthopaedic Surgery, Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Surgery, Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kevin C Chung
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
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Schmalbach CE, Brereton J, Bowman C, Denneny JC. American Academy of Otolaryngology-Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities. Otolaryngol Head Neck Surg 2021; 164:964-971. [PMID: 33433257 DOI: 10.1177/0194599820984135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology-Head and Neck Surgery/Foundation and ultimately define "quality" for our field of otolaryngology-head and neck surgery. METHODS Data analytics was performed on Reg-ent (2015-2020). RESULTS A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and "private" was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis-unspecified and sensorineural hearing loss-bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. DISCUSSION Reg-ent benefits are vast-from monitoring one's practice to defining otolaryngology-head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology-head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. IMPLICATIONS FOR PRACTICE Reg-ent provides the first ever registry that is specific to otolaryngology-head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.
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Affiliation(s)
- Cecelia E Schmalbach
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Jean Brereton
- American Academy of Otolaryngology-Head and Neck Surgery/ Foundation, Alexandria, Virginia, USA
| | - Cathlin Bowman
- American Academy of Otolaryngology-Head and Neck Surgery/ Foundation, Alexandria, Virginia, USA
| | - James C Denneny
- American Academy of Otolaryngology-Head and Neck Surgery/ Foundation, Alexandria, Virginia, USA
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Rahardja R, Allan R, Frampton CM, Morris AJ, McKie J, Young SW. Completeness and capture rate of publicly funded arthroplasty procedures in the New Zealand Joint Registry. ANZ J Surg 2020; 90:2543-2548. [PMID: 33135863 DOI: 10.1111/ans.16385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Registry-based studies have become more common due to the availability of a large study cohort. However, the validity of findings is dependent on the completeness of the registry. This study aimed to validate the capture rate of the New Zealand Joint Registry (NZJR) by matching procedures that have been recorded separately via clinical coding by the New Zealand Government's National Surgical Site Infection Improvement Programme (SSIIP). METHODS The National Health Index, a unique identification code for all patients, was combined with the arthroplasty procedure performed (primary total knee arthroplasty (TKA), primary total hip arthroplasty (THA), revision TKA or revision THA) and operation side. Publicly funded procedures recorded in the NZJR were matched with procedures recorded by the SSIIP on a record-by-record basis. This identified the total number of arthroplasty procedures performed in New Zealand, which was used as the denominator value to calculate the procedure capture rate of the NZJR. RESULTS Between 2013 and 2018, 24 556 primary TKA, 28 970 primary THA, 2107 revision TKA and 4263 revision THA procedures were recorded by both datasets. The NZJR recorded 95.5% of primary TKA procedures, 96.3% of primary THA procedures, 97.1% of revision TKA procedures and 95.2% of revision THA procedures. CONCLUSION The NZJR recorded >95% of publicly funded arthroplasty procedures. In contrast, there were inaccuracies in clinical coding by hospitals, particularly with revision procedures, demonstrating the benefits of an arthroplasty registry. However, data recorded by an infection surveillance programme may supplement arthroplasty registry data to strengthen the quality of research.
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Affiliation(s)
- Richard Rahardja
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Rachele Allan
- Canterbury District Health Board, Christchurch, New Zealand
| | | | - Arthur J Morris
- Health Quality and Safety Commission, Surgical Site Infection Improvement Programme, Wellington, New Zealand
| | - John McKie
- New Zealand Joint Registry, Christchurch, New Zealand
| | - Simon W Young
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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Development of the Italian fractures registry (RIFra): A call for action to improve quality and safety. Injury 2020; 54 Suppl 1:S58-S62. [PMID: 33077163 DOI: 10.1016/j.injury.2020.10.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
In recent years, there has been an increasing interest in the development of arthroplasty registries, therefore, in our country, the Italian Arthroplasty Registry (RIAP), was issued by the National Law No. 221/2012. In the last decade, however, some European countries -namely Sweden, Denmark, Norway, and Germany (in development)- have introduced another nationwide orthopaedic registry than arthroplasty registers: the fracture registry. The development of this new tool aims to improve quality and safety in fracture management, thus trying to provide a better postoperative quality of life in trauma patients. Based on these findings, the AO-Trauma Italy Council encouraged the development of a national fracture registry in Italy. The present study aims to (1) provide an overview of the fracture registries in Europe and (2) to develop, for the first time, a pilot Italian Fracture Registry (RIFra). Thirteen AO-Trauma Italy members, chairmen of Level-I orthopaedic and trauma centres, diffused throughout Italy, were involved in the RIFra project. The RIFra form, developed between November 2019 and March 2020, consists of 5 main sections, namely: epidemiologic data, previous surgical procedure (if any), patient and fracture features, surgical procedure, surgical implant details. This study constitutes the first step to start, in future years, the bureaucratic procedure leading to the final establishment of a RIAP-like fracture registry in Italy.
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Ojeda-Thies C, Brent L, Currie CT, Costa M. Fragility Fracture Audit. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-3-030-48126-1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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Shah RF, Bini S, Vail T. Data for registry and quality review can be retrospectively collected using natural language processing from unstructured charts of arthroplasty patients. Bone Joint J 2020; 102-B:99-104. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1574.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Natural Language Processing (NLP) offers an automated method to extract data from unstructured free text fields for arthroplasty registry participation. Our objective was to investigate how accurately NLP can be used to extract structured clinical data from unstructured clinical notes when compared with manual data extraction. Methods A group of 1,000 randomly selected clinical and hospital notes from eight different surgeons were collected for patients undergoing primary arthroplasty between 2012 and 2018. In all, 19 preoperative, 17 operative, and two postoperative variables of interest were manually extracted from these notes. A NLP algorithm was created to automatically extract these variables from a training sample of these notes, and the algorithm was tested on a random test sample of notes. Performance of the NLP algorithm was measured in Statistical Analysis System (SAS) by calculating the accuracy of the variables collected, the ability of the algorithm to collect the correct information when it was indeed in the note (sensitivity), and the ability of the algorithm to not collect a certain data element when it was not in the note (specificity). Results The NLP algorithm performed well at extracting variables from unstructured data in our random test dataset (accuracy = 96.3%, sensitivity = 95.2%, and specificity = 97.4%). It performed better at extracting data that were in a structured, templated format such as range of movement (ROM) (accuracy = 98%) and implant brand (accuracy = 98%) than data that were entered with variation depending on the author of the note such as the presence of deep-vein thrombosis (DVT) (accuracy = 90%). Conclusion The NLP algorithm used in this study was able to identify a subset of variables from randomly selected unstructured notes in arthroplasty with an accuracy above 90%. For some variables, such as objective exam data, the accuracy was very high. Our findings suggest that automated algorithms using NLP can help orthopaedic practices retrospectively collect information for registries and quality improvement (QI) efforts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):99–104.
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Affiliation(s)
- Romil F. Shah
- Department of Orthopedic Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Stefano Bini
- Department of Orthopedic Surgery, University of California - San Francisco, San Francisco, California, USA
- Department of Orthopedic Surgery, University of Texas at Austin, Austin, Texas, USA
| | - Thomas Vail
- Department of Orthopedic Surgery, University of California - San Francisco, San Francisco, California, USA
- Department of Orthopedic Surgery, University of Texas at Austin, Austin, Texas, USA
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Oliver G, Jaldin L, Camprubí E, Cortés G. Observational Study of Total Knee Arthroplasty in Aseptic Revision Surgery: Clinical Results. Orthop Surg 2020; 12:177-183. [PMID: 31916370 PMCID: PMC7031607 DOI: 10.1111/os.12593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To review the long-term clinical results after revision surgery and the relationship between the different clinical variables involved with a failed total knee arthroplasty (TKA) and its evolution to provide a better understanding of the current treatment methods. METHODS The present study involved 89 subjects with a failed knee arthroplasty that ended up requiring revision surgery and component replacement between 2011 and 2015. The study included patients with pain remaining after TKA and indication from the knee unit surgeon to review the implant, without presenting with thromboembolic or neurological changes that could bias the results. The demographic data, surgical information, type of implant, and causes of failure were analyzed. The patients subjected to replacement surgery were specifically asked to fill out clinical and satisfaction questionnaires (Lysholm and KOOS). The mean follow-up was 5.6 years (range, 3-11 years) and the analysis was divided into early revision (<5 years) and late revision (>5 years). The R statistical package version 3.2.5 for Windows was used, with significance less than 0.05 Cohort observational study. RESULTS The results indicated that implant revisions accounted for 5.57% of total primary implants, with a mean survival of 6 years for primary prosthesis failure. The mean revision surgery result on the Lysholm knee scoring scale was 68.73 out of 100 points. A better score was obtained for revisions undertaken on TKA with over 5 years' survival and there were no significant differences in terms of the type of implant used. The causes of TKA failure were aseptic loosening (77.38%), instability (9.52%), and painful prosthesis (13.10%). The results were statistically significant when isolated revisions were performed on one component. Rating worse on most of the questionnaire subscales. CONCLUSION The clinical results were better in primary implant replacements with at least 5 years' survival. The replacement of only one of the components (tibial or femoral) provided worse clinical results than total replacement.
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Affiliation(s)
- Gabriel Oliver
- Orthopaedics Department, Head of Knee Unit, Barcelona, Spain
| | - Luis Jaldin
- Orthopaedics Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Eric Camprubí
- Orthopaedics Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Guillermo Cortés
- Orthopaedics Department, Hospital Universitario de Bellvitge, Barcelona, Spain
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Hengelbrock J, Höhle M. Evaluating quality of hospital care using time-to-event endpoints based on patient follow-up data. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2019. [DOI: 10.1007/s10742-019-00202-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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George A, Ofori-Atta P. Joint replacement surgery in Ghana (West Africa)-an observational study. INTERNATIONAL ORTHOPAEDICS 2019; 43:1041-1047. [PMID: 30680518 PMCID: PMC6470119 DOI: 10.1007/s00264-019-04286-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/02/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION With the continued and effective transfer of orthopaedic knowledge and skills across continents, the incidence of hip and knee replacement surgery has increased in the developing world. More patients are having these procedures done locally rather than having to travel over to the more developed western countries at great financial costs for those who cannot really afford it. We report the data collected by an orthopaedic charity MOTEC LIFE UK which has been offering hip and knee arthroplasty procedures to patients who require them. The time period of the procedures was February 2013-October 2017. METHODS The data was collated prospectively and this included age, sex, indication for procedure, and side of procedure (including if bilateral). The information on hip implants used were also collected-implant type (cemented or uncemented), type of bearing surface, size of acetabular cup, liner, femoral head size, and stem size and including if screws were used to augment the fixation of the femoral cup. For the knee implants used, information on the type of implant (semi-constrained, cruciate retaining, or Stanmore hinge knee prosthesis), femoral and tibia stem size, insert type (fixed bearing or mobile bearing), and size; patella button size (whether patella replacement or circumcision) were collected. The surgical approach used in both knee and hip arthroplasty cases was noted. RESULTS It is seen from the data collected that a total of 113 hip arthroplasty procedures from 109 patients were carried out and for total knee replacements, 82 knee arthroplasty procedures from 76 patients were carried out. The above procedures were carried out in two separate hospitals. Degenerative osteoarthritis still remains the main indication for hip and knee arthroplasty surgery in our study and this is similar to other joint registries around the world. It was noted that the incidence of avascular necrosis as an indication hip surgery was higher than that seen in registries for developed countries. The mean age for the hip and knee replacement patient in our data was much lower than that what is obtained in the developed world. Furthermore, it was observed that there was increased use of semi-constrained knee prosthesis due to the severe osteoarthritic deformities noted in the patients seen when compared to rate of use of similar implants in the developed world. CONCLUSION This observational study could serve as a springboard for establishment of arthroplasty registries for countries in the sub-region as a whole.
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Affiliation(s)
- Akintunde George
- Tissue Engineering Unit, Department of Chemical Engineering, University of Bath, Bath, UK.
| | - Paul Ofori-Atta
- West Hertfordshire NHS Trust, St. Joseph's Orthopaedic Hospital, Koforidua, Ghana
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Davies PS, Graham SM, Maqungo S, Harrison WJ. Total joint replacement in sub-Saharan Africa: a systematic review. Trop Doct 2019; 49:120-128. [PMID: 30636518 PMCID: PMC6535807 DOI: 10.1177/0049475518822239] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Outcomes of arthroplasty in sub-Saharan Africa are not widely reported. To our knowledge, this systematic review is the first to explore this topic. Scopus, EMBASE, Medline and PubMed databases were searched, utilising MeSH headings and Boolean search strategies. All papers from South Africa were excluded. Twelve papers reporting 606 total hip replacements (THRs) and 763 total knee replacements (TKRs) were included. Avascular necrosis was the most common indication for THR, whereas osteoarthritis was the main indication for TKR. HIV prevalence of up to 33% was seen. Improvements were seen in patient-reported outcome measures in both THR and TKR. The dislocation rate in THR was 1.6%. The deep infection rate was 1.6% for TKRs and 0.5% for THRs. Positive results were reported, with comparable complications to high-income countries. However, there is likely to be significant reporting bias and the introduction of mandatory registries would enable more accurate monitoring across the region.
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Affiliation(s)
- Peter Se Davies
- 1 Registrar, Department of Trauma and Orthopaedics, Ninewells Hospital and Medical School, Dundee, UK
| | - Simon M Graham
- 2 Limb Reconstruction and Orthopaedic Trauma Fellow, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa.,3 Welcome Trust Clinical Research Fellow, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Sithombo Maqungo
- 4 Consultant Surgeon and Professor, Orthopaedic Research Unit, Department of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - William J Harrison
- 5 Consultant Surgeon and Professor, Department of Trauma and Orthopaedics, Countess of Chester Hospital, Chester, UK
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Unger RZ, Burnham JM, Gammon L, Malempati CS, Jacobs CA, Makhni EC. The Responsiveness of Patient- Reported Outcome Tools in Shoulder Surgery Is Dependent on the Underlying Pathological Condition. Am J Sports Med 2019; 47:241-247. [PMID: 29323925 DOI: 10.1177/0363546517749213] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Given the high number of available patient-reported outcome (PRO) tools for patients undergoing shoulder surgery, comparative information is necessary to determine the most relevant forms to incorporate into clinical practice. PURPOSE To determine the utilization and responsiveness of common PRO tools in studies involving patients undergoing arthroscopic rotator cuff repair or operative management of glenohumeral instability. STUDY DESIGN Systematic review. METHODS A systematic review of rotator cuff and instability studies from multiple databases was performed according to PRISMA guidelines. Means and SDs of each PRO tool utilized, study sample sizes, and follow-up durations were collected. The responsiveness of each PRO tool compared with other PRO tools was determined by calculating the effect size and relative efficiency (RE). RESULTS After a full-text review of 238 rotator cuff articles and 110 instability articles, 81 studies and 29 studies met the criteria for final inclusion, respectively. In the rotator cuff studies, 25 different PRO tools were utilized. The most commonly utilized PRO tools were the Constant (50 studies), visual analog scale (VAS) for pain (44 studies), American Shoulder and Elbow Surgeons (ASES; 39 studies), University of California, Los Angeles (UCLA; 20 studies), and Disabilities of the Arm, Shoulder and Hand (DASH; 13 studies) scores. The ASES score was found to be more responsive than all scores including the Constant (RE, 1.94), VAS for pain (RE, 1.54), UCLA (RE, 1.46), and DASH (RE, 1.35) scores. In the instability studies, 16 different PRO tools were utilized. The most commonly used PRO tools were the ASES (13 studies), Rowe (10 studies), Western Ontario Shoulder Instability Index (WOSI; 8 studies), VAS for pain (7 studies), UCLA (7 studies), and Constant (6 studies) scores. The Rowe score was much more responsive than both the ASES (RE, 22.84) and the Constant (RE, 33.17) scores; however, the ASES score remained more responsive than the Constant (RE, 1.93), VAS for pain (RE, 1.75), and WOSI (RE, 0.97) scores. CONCLUSION Despite being frequently used in the research community, the Constant score may be less clinically useful as it was less responsive. Additionally, it is a greater burden on the provider because it requires objective strength and range of motion data to be gathered by the clinician. In contrast, the ASES score was highly responsive after rotator cuff repair and requires only subjective patient input. Furthermore, separate PRO scoring methods appear to be necessary for patients undergoing rotator cuff repair and surgery for instability as the instability-specific Rowe score was much more responsive than the ASES score.
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Affiliation(s)
- R Zackary Unger
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lee Gammon
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Chaitu S Malempati
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Cale A Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Eric C Makhni
- Department of Orthopedic Surgery, Henry Ford Medical Center, Detroit, Michigan, USA
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Samaniego Alonso R, Gaviria Parada E, Pons Cabrafiga M, Espallargues Carreras M, Martinez Cruz O. Arthroplasty knee registry of Catalonia: What scientific evidence supports the implantation of our prosthesis? Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2017.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Lübbeke A, Silman A, Barea C, Prieto-Alhambra D, Carr A. Mapping existing hip and knee replacement registries in Europe. Health Policy 2018; 122:548-557. [DOI: 10.1016/j.healthpol.2018.03.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/18/2022]
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Arthroplasty knee registry of Catalonia: What scientific evidence supports the implantation of our prosthesis? Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:290-296. [PMID: 29501394 DOI: 10.1016/j.recot.2017.12.006] [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: 08/02/2017] [Revised: 11/14/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In our environment, it is increasingly necessary to perform an activity based on scientific evidence and the field of prosthetic surgery should be governed by the same principles. The national arthroplasty registries allow us to obtain a large amount of data in order to evaluate this technique. The aim of our study is to analyse the scientific evidence that supports the primary total knee arthroplasties implanted in Catalonian public hospitals, based on the Arthoplasty Registry of Catalonia (RACat) MATERIAL AND METHODS: A review of the literature was carried out on knee prostheses (cruciate retaining, posterior stabilized, constricted and rotational) recorded in RACat between the period 2005-2013 in the following databases: Orthopedic Data Evaluation Panel, PubMed, TripDatabase and Google Scholar. The prostheses implanted in fewer than 10 units (1,358 prostheses corresponding to 62 models) were excluded. RESULTS 41,947 prostheses (96.86%) were analysed out of 43,305 implanted, corresponding to 74 different models. In 13 models (n = 4,715) (11.24%) no clinical evidence to support their use was found. In the remaining 36 models (n = 13,609) (32.45%), level iv studies were the most predominant evidence. CONCLUSIONS There was a significant number of implanted prostheses (11.24%) for which no clinical evidence was found. The number of models should be noted, 36 out of 110, with fewer than 10 units implanted. The use of arthroplasty registries has proved an extremely useful tool that allows us to analyse and draw conclusions in order to improve the efficiency of this surgical technique.
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Health Policy and Financial Issues Related to New Total Knee Arthroplasty Technology. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mullaji AB. CORR Insights ®: What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty? Clin Orthop Relat Res 2017; 475:2960-2962. [PMID: 28421517 PMCID: PMC5670048 DOI: 10.1007/s11999-017-5261-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/23/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Arun B. Mullaji
- 0000 0004 1799 5016grid.414597.aBreach Candy Hospital & Mullaji Knee Clinic, 101, Cornelian, Kemp’s Corner, Cumballa Hill, Mumbai, 400036 India
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Yao JJ, Maradit Kremers H, Schleck CD, Larson DR, Singh JA, Berry DJ, Lewallen DG. Patient-Reported Outcomes Can Be Used to Streamline Post-Total Hip Arthroplasty Follow-Up to High-Risk Patients. J Arthroplasty 2017; 32:3319-3321. [PMID: 28683979 DOI: 10.1016/j.arth.2017.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient-reported outcomes are increasingly used to capture the patients' perspective in total hip arthroplasty (THA). They can potentially be used to streamline post-THA follow-up to high-risk patients. We aimed to determine whether the long-term revision risk in THA relates to patient-reported measures at 2 and 5 years. METHODS In a single-institution cohort of primary THA procedures, we examined the association between 2-year and 5-year pain and Mayo Hip Scores and the risk of revision. RESULTS The absolute scores at 2 and 5 years were both significantly associated with the risk of revisions. Every 10-unit decline in the 2-year Mayo Hip Score <60 was associated with a significant 50% increase in the risk of revision (hazard ratio, 1.5 per 10 units; 95% confidence interval, 1.3-1.8). Similarly, every 10-unit decline in the 5-year Mayo Hip Score <60 was associated with almost doubling of the risk of revision (hazard ratio, 1.9 per 10 units; 95% confidence interval, 1.7-2.1). CONCLUSION We conclude that patient-reported outcomes in THA have prognostic importance and can be taken into account when planning frequency of aftercare. This will improve the efficiency of follow-up in large registry-based follow-up efforts.
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Affiliation(s)
- Jie J Yao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Cathy D Schleck
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Dirk R Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Characteristics associated with joint replacement in early symptomatic knee or hip osteoarthritis: 6-year results from a nationwide prospective cohort study (CHECK). Br J Gen Pract 2017; 67:e724-e731. [PMID: 28760738 DOI: 10.3399/bjgp17x692165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/08/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Many patients with osteoarthritis (OA) of the knee and/or hip undergo total joint replacement (TJR) because of severely progressed symptoms. AIM To determine patient and disease characteristics associated with undergoing TJR in participants with recent-onset knee and/or hip OA. DESIGN AND SETTING Participants with hip or knee pain from the nationwide prospective Cohort Hip and Cohort Knee (CHECK) study were included. METHOD The outcome measure was total hip arthroplasty (THA) or total knee arthroplasty (TKA) during 6 years of follow-up. Joint-dependent characteristics were compared using generalised estimating equations (GEE). Multivariable models were built for both subgroups. Differences in symptomatic and radiographic progression were determined between baseline and 2-year follow-up (T2). RESULTS The knee subgroup included 751 participants (1502 knees), and there were 538 participants in the hip subgroup (1076 hips). Nineteen participants (22 knees) underwent TKA and 53 participants (62 hips) THA. Participants who underwent TKA had higher baseline body mass index, painful knee flexion, and higher Kellgren and Lawrence scores. Participants who underwent THA had painful internal hip rotation and showed more severe radiographic OA features. Participants who underwent TKA or THA showed more rapid symptomatic and radiographic OA progression at T2. CONCLUSION In patients with recent-onset knee or hip pain, radiographic OA features already exist and a substantial number of patients fulfil existing criteria for knee and hip OA. A trend was observed in rapid progression of radiographic and symptomatic OA severity among patients with TKA and THA. Early detection of OA by the GP is important in managing knee and hip OA.
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Burnham JM, Meta F, Lizzio V, Makhni EC, Bozic KJ. Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment. Curr Rev Musculoskelet Med 2017; 10:233-239. [PMID: 28421386 PMCID: PMC5435638 DOI: 10.1007/s12178-017-9407-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to review the basic concepts of healthcare value, patient outcome measurement, and cost-effectiveness analyses as they relate to the introduction of new surgical techniques and technologies in the field of orthopedic surgery. RECENT FINDINGS An increased focus on financial stewardship in healthcare has resulted in a plethora of cost-effectiveness and patient outcome research. Recent research has made great progress in identifying orthopedic technologies that provide exceptional value and those that do not meet adequate standards for widespread adoption. As the pace of technological innovation advances in lockstep with an increased focus on value, orthopedic surgeons will need to have a working knowledge of value-based healthcare decision-making. Value-based healthcare and cost-effectiveness analyses can aid orthopedic surgeons in making ethical and fiscally responsible treatment choices for their patients.
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Affiliation(s)
- Jeremy M Burnham
- UPMC Center for Sports Medicine, University of Pittsburgh, 3200 S Water St, Pittsburgh, PA 15203 USA
| | - Fabien Meta
- Henry Ford Health System, Department of Orthopedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202 USA
| | - Vincent Lizzio
- Henry Ford Health System, Department of Orthopedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202 USA
| | - Eric C. Makhni
- Henry Ford Health System, Department of Orthopedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202 USA
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, 1400 Barbara Jordan Blvd, Austin, TX 78723 USA
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Arias-de la Torre J, Capdevila A, Martínez O, Domingo L, Marinelli M, Robles N, Nardi J, Puig-Verdié L, Pallisó F, Espallargues M. A decade of the Catalonian Arthroplasty Register (RACat): Variability, exhaustivity, and survival of prostheses between 2005 and 2014. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Arias-de la Torre J, Capdevila A, Martínez O, Domingo L, Marinelli M, Robles N, Nardi J, Puig-Verdié L, Pallisó F, Espallargues M. A decade of the Catalonian Arthroplasty Register (RACat): Variability, exhaustivity, and survival of prostheses between 2005 and 2014. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:70-81. [PMID: 28223094 DOI: 10.1016/j.recot.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/21/2016] [Accepted: 01/09/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIM The Catalonian Arthroplasty Register (RACat) is a public health-based population register used to analyse and evaluate hip and knee replacements in Catalonia. The aim of this study is to present the outcomes after 10 years in operation (January 2005-December 2014). METHODOLOGY Using the information from the RACat and the minimum basic data set at hospital discharge, an analysis was made of the quality and exhaustivity of the data, as well as a descriptive analysis of the patients, prostheses, and care process. Survival was also analysed by calculating the accumulated incidence of revisions (according to the cause of intervention in hip replacements and conservation or sacrifice of the posterior cruciate ligament in knee replacement). The relationship between revision risk and the fixation technique of the prosthesis is also analysed, using competitive risk models adjusted for gender, age, and comorbidities. RESULTS The main reason for the primary hip and knee replacement surgery was arthrosis. The accumulated incidence of revisions at 10 years was 3.9% in hip replacements caused by arthrosis, and 2.3% in those caused by fracture. Conservation of the posterior cruciate ligament was achieved in 4.4% of knee replacements, with sacrifice in 5.1%. DISCUSSION The RACat is consolidated as a tool for the evaluation of joint replacements, with great potential in the analysis of medium and long-term efficacy, the study of the variability in clinical practice, and post-marketing surveillance.
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Affiliation(s)
- J Arias-de la Torre
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España.
| | - A Capdevila
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España
| | - O Martínez
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España
| | - L Domingo
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España
| | - M Marinelli
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - N Robles
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - J Nardi
- Hospital Universitari de la Vall d'Hebron, Barcelona, España
| | - L Puig-Verdié
- Servei de Cirurgia Ortopèdica i Traumatologia, Parc de Salut Mar Barcelona, Institut Mar d'Investigació Médica (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - F Pallisó
- Hospital Universitari de Santa Maria, Lérida, España
| | - M Espallargues
- Departament de Salut, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
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Big Data, Big Research: Implementing Population Health-Based Research Models and Integrating Care to Reduce Cost and Improve Outcomes. Orthop Clin North Am 2016; 47:717-24. [PMID: 27637658 DOI: 10.1016/j.ocl.2016.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent trends in clinical research have moved attention toward reporting clinical outcomes and resource consumption associated with various care processes. This change is the result of technological advancement and a national effort to critically assess health care delivery. As orthopedic surgeons traverse an unchartered health care environment, a more complete understanding of how clinical research is conducted using large data sets is necessary. The purpose of this article is to review various advantages and disadvantages of large data sets available for orthopaedic use, examine their ideal use, and report how they are being implemented nationwide.
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Review and comparison of orthopaedic registries in the United States and Norway. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hopkins C, Fu SC, Chua E, Hu X, Rolf C, Mattila VM, Qin L, Yung PSH, Chan KM. Critical review on the socio-economic impact of tendinopathy. Asia Pac J Sports Med Arthrosc Rehabil Technol 2016; 4:9-20. [PMID: 29264258 PMCID: PMC5730665 DOI: 10.1016/j.asmart.2016.01.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 12/16/2022] Open
Abstract
There are currently no studies that determine the total burden that tendinopathy places on patients and society. A systematic search was conducted to understand the impact of tendinopathy. It demonstrated that the current prevalence is underestimated, particularly in active populations, such as athletes and workers. Search results demonstrate that due to the high prevalence, impact on patients' daily lives and the economic impact due to work-loss, treatments are significantly higher than currently observed. A well-accepted definition by medical professionals and the public will improve documentation and increase awareness, in order to better tackle the disease burden.
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Affiliation(s)
- Chelsea Hopkins
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eldrich Chua
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaorui Hu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Christer Rolf
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Ville M. Mattila
- Division of Orthopaedics and Biotechnology, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland
| | - Ling Qin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Translational Medicine Research and Development Centre, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Abstract
Total knee arthroplasty (TKA) is a cost effective and extremely successful operation. As longevity increases, the demand for primary TKA will continue to rise. The success and survivorship of TKAs are dependent on the demographics of the patient, surgical technique and implant-related factors. Currently the risk of failure of a TKA requiring revision surgery ten years post-operatively is 5%. The most common indications for revision include aseptic loosening (29.8%), infection (14.8%), and pain (9.5%). Revision surgery poses considerable clinical burdens on patients and financial burdens on healthcare systems. We present a current concepts review on the epidemiology of failed TKAs using data from worldwide National Joint Registries. Cite this article: Bone Joint J 2016;98-B(1 Suppl A):105–12.
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Affiliation(s)
- M. Khan
- University College London Hospitals, Ground
Floor, 250 Euston Road, London, NW1 2PG, UK
| | - K. Osman
- University College London Hospitals, Ground
Floor, 250 Euston Road, London,
NW1 2PG, UK
| | - G. Green
- University College London Hospitals, Ground
Floor, 250 Euston Road, London,
NW1 2PG, UK
| | - F. S. Haddad
- University College London Hospitals, Ground
Floor, 250 Euston Road, London, NW1 2PG, UK
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Kornilov NN, Kulyaba TA, Fil AS, Muravyeva YV. Data of knee arthroplasty register of Vreden Russian Research Institute of Traumatology and Orthopedics for period 2011-2013. ACTA ACUST UNITED AC 2015. [DOI: 10.21823/2311-2905-2015-0-1-136-151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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