State-Based and National U.S. Registries: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), California Joint Replacement Registry (CJRR), and American Joint Replacement Registry (AJRR)

Rates of Registry Research Have Increased in Podium and Poster Presentations at the American Association of Hip and Knee Surgeons

Background

As state, regional, and national registries have rapidly expanded, the goal of this study is to assess the frequency of registry abstracts accepted for both podium and poster presentations at the American Association of Hip and Knee Surgeons between 2012 and 2022.

Methods

Final programs and poster e-collections were examined over the past 11 years. Two reviewers evaluated each abstract to determine if they utilized large datasets and the location of each registry. Studies were excluded if they used institutional registries. Reviewers also identified the most frequently utilized registries to determine how their use has fluctuated over this time frame.

Results

A total of 3354 abstracts were reviewed and included. Of those, 577 abstracts utilized data obtained from orthopaedic registries (17.2%): 450 of which were poster presentations (16.5% of total poster acceptances), and 127 were podium presentations (20.5% of accepted podiums). The National Surgical Quality Improvement Program (NSQIP) was the most frequent dataset utilized, with 118 (20.5%) abstracts. Of note, NSQIP's use peaked between 2018 and 2020 and has since slowly trended downward. On the other hand, use of both American Joint Replacement Registry (AJRR) and PearlDiver registry have drastically increased since 2019, with only 6 abstracts chosen in 2019 and 28 abstracts in 2022 (10 AJRR [3 podiums] and 18 PearlDiver [6 podiums]). The proportion of registry data has increased, with the registry abstracts peaking in 2022 as 24% of posters and 37% of podium utilized data from large registry data sets (P < .001).

Conclusions

There has been a significant increase in the number of studies utilizing registry data for both podium and poster presentations at the American Association of Hip and Knee Surgeons annual meeting. While NSQIP was the most utilized, its use has steadily declined while AJRR and PearlDiver use have increased over the past 3 years. Individuals should understand the strengths and weaknesses of each registry before making conclusions on study results.

Level of Evidence

Level IV.

Prediction of gap balancing based on 2-D radiography in total knee arthroplasty for knee osteoarthritis patients

BACKGROUND

To investigate the influence of osteophytes on postoperative gap balancing, and to work out a predictive model of the relationship between osteophyte size and gap gaining in primary total knee replacement.

METHODS

One hundred and ten patients were enrolled in the study. Pre- and postoperative radiographs were collected and analyzed. They were assigned to the training dataset and test dataset randomly at a ratio of 9:1 by using the statistical package R (version 4.0.5). Size and marginal distances of osteophytes, planned bone cut planes, predicted bone cuts and joint gaps were labeled on the preoperative standing anteroposterior and lateral views, while actual bone cuts and joint gaps were recorded on the postoperative plain films, respectively. Statistical analysis was performed.

RESULTS

Actual joint gaps were significantly related to the distances of medial and lateral predictive bone cutting lines, bone cut thickness on tibial side and posterior condylar, as well as size and marginal distances of osteophytes (P < 0.05). A predictive equation was generated, with a root mean square error (RMSE) of 3.4761 in validation. A 2-D planning system with adjustable input parameters and dim predictive outputs on joint gap was developed. The equation is [Formula: see text] CONCLUSION: Postoperative joint gap can be predicted on the basis of preoperative measurements on 2-D plain films. Larger sample size may help improve the effectiveness and accuracy of the predictive equation.

Patient-Reported Outcome Measures: State of the Art in Patient-Reported Outcome Measure Application in Lower Extremity Orthopaedics

With an increasing shift toward a value-based and outcome-driven healthcare system, patient-reported outcome measures (PROMs) will continue to play a prominent role in assessing performance, making clinical decisions, shared decision making, and determining the comparative effectiveness of procedures such as total joint arthroplasty for lower extremity conditions, such as ankle, hip, and knee osteoarthritis. As the application of PROMs in evaluating surgical outcomes has evolved from that of a research setting to that of a clinical setting, their use in the decision-making process has become more prevalent. As a result, preoperative optimization, surgical indications, and improved outcomes after surgery have been greatly enhanced. To enable benchmarking, quality reporting, and performance measurement at an aggregate level, it is crucial to have a comprehensive PROM collection system. However, achieving this goal is contingent upon addressing the variability in reported PROMs and the patient-centered benchmarks used to analyze clinical significance.