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Roth S, DeClercq MG, Sacchetti M, Keeley J, Karadsheh M, Runner R. Uncemented Total Knee Arthroplasty is on the Rise. A Report of Patient Demographics and Short-Term Outcomes From the Michigan Arthroplasty Registry Collaborative Quality Initiative. Arthroplast Today 2024; 29:101499. [PMID: 39376669 PMCID: PMC11456906 DOI: 10.1016/j.artd.2024.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/09/2024] [Indexed: 10/09/2024] Open
Abstract
Background Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA from 2017 to 2021 and (2) if there are differences in early complications between cemented and uncemented TKA. Methods A retrospective data review was performed on the Michigan Arthroplasty Registry Collaborative Quality Initiative database of TKA patients from 2017 to 2021 at 6 hospitals. Patients with revision or partial knee arthroplasty were excluded. Patients were divided into 2 groups: uncemented and cemented. Hybrid and reverse hybrid fixation data were collected for incidence, but not for demographics or complications. All patient demographics and 90-day postoperative events were collected and analyzed. Results A retrospective study of 18,749 primary TKAs found that 89.7% were cemented, 9.7% uncemented, and 0.7% hybrid or reverse hybrid. Uncemented patients were younger, men, heavier, current smokers, and diabetics than cemented patients (P < .0001, P = .03). They also had a shorter length of stay (P ≤ .0001) and were on fewer preoperative medications: anticoagulants (P = .0059), antiplatelets (P ≤ .0001), opioids (P = .0091), and steroids (P = .0039). The rate of uncemented TKA increased from 3.3% to 17.1%, while the rate of cemented TKA fell from 96.2% to 81.9% (P = .0048). The readmission rate was higher in cemented TKAs (4.0%) than in uncemented TKAs (2.6%) (P = .0048). Conclusions The use of uncemented TKA increased from 3.3% in 2017 to 17.1% in 2021, while cemented fixation decreased from 96.7% to 81.9%. There were no significant differences in short-term complications between groups. Uncemented patients were younger, men, took fewer medications, had a shorter length of stay, and were less likely to be readmitted. However, they were more likely to have comorbidities than the cemented group.
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Affiliation(s)
- Sarah Roth
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | | | - Michael Sacchetti
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Jacob Keeley
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | - Mark Karadsheh
- Department of Orthopaedic Surgery, William Beaumont University Hospital, Royal Oak, MI, USA
| | - Robert Runner
- Department of Orthopaedic Surgery, William Beaumont University Hospital, Royal Oak, MI, USA
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Merenda M, Earnest A, Ruseckaite R, Tse WC, Elder E, Hopper I, Ahern S. Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review. Aesthet Surg J Open Forum 2024; 6:ojae015. [PMID: 38650972 PMCID: PMC11033681 DOI: 10.1093/asjof/ojae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Little is known about the methods and outcomes of patient-reported outcome measure (PROM) use among high-risk medical device registries. The objective of this scoping review was to assess the utility and predictive ability of PROMs in high-risk medical device registries. We searched Ovid Medline, Embase, APA PsychINFO, Cochrane Library, and Scopus databases for published literature. After searching, 4323 titles and abstracts were screened, and 262 full texts were assessed for their eligibility. Seventy-six papers from across orthopedic (n = 64), cardiac (n = 10), penile (n = 1), and hernia mesh (n = 1) device registries were identified. Studies predominantly used PROMs as an outcome measure when comparing cohorts or surgical approaches (n = 45) or to compare time points (n = 13) including pre- and postintervention. Fifteen papers considered the predictive ability of PROMs. Of these, 8 treated PROMs as an outcome, 5 treated PROMs as a risk factor through regression analysis, and 2 papers treated PROMs as both a risk factor and as an outcome. One paper described PROMs to study implant survival. To advance methods of PROM integration into clinical decision-making for medical devices, an understanding of their use in high-risk device registries is needed. This scoping review found that there is a paucity of studies using PROMs to predict long-term patient and clinical outcomes in high-risk medical device registries. Determination as to why PROMs are rarely used for predictive purposes in long-term data collection is needed if PROM data are to be considered suitable as real-world evidence for high-risk device regulatory purposes, as well as to support clinical decision-making. Level of Evidence 4
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Affiliation(s)
- Michelle Merenda
- Corresponding Author: Mrs Michelle Merenda, Level 3, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia. E-mail:
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Chatad D, Monas A, Rodriguez AN, Roth E, Erez O, Razi AE. Trends and risk factors for readmissions following press-fit total knee arthroplasty for the treatment of end-stage osteoarthritis of the knee: a five-year analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3495-3499. [PMID: 37195308 DOI: 10.1007/s00590-023-03578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION The development of new prostheses with improved osseointegration, bone preservation, and reduced cost has renewed interest in uncemented total knee arthroplasty (UCTKA). In the current study, we aimed to: (1) assess demographic data of patients who were and were not readmitted and (2) identify patient-specific risk factors associated with readmission. METHODS A retrospective query from the PearlDiver database was performed from January 1, 2015, to October 31, 2020. International Classification of Disease, Ninth Revision (ICD-9), ICD-10, or Current Procedural Terminology (CPT) coding was used to distinguish cohorts of patients who had osteoarthritis of the knee and underwent UCTKA. Patients readmitted within 90 days were classified as the study population, while those who were not readmitted were classified as control. A linear regression model was utilized to analyze readmission risk factors. RESULTS The query yielded 14,575 patients, with 986 (6.8%) being readmitted. Patient demographics such as age (P < 0.0001), sex (P < 0.009), and comorbidity (P < 0.0001) were associated with annual 90-day readmission. Patient-specific risk factors associated with 90-day readmission following press-fit total knee arthroplasty were: arrhythmia (OR: 1.29, 95% CI: 1.11-1.49, P < 0.0005), coagulopathy (OR: 1.36, 95% CI: 1.13-1.63, P < 0.0007), fluid and electrolyte abnormalities (OR: 1.59, 95% CI: 1.38-1.84, P < 0.0001), iron deficiency anemia (OR: 1.49, 95% CI: 1.27-1.73, P < 0.0001), and obesity (OR: 1.37, 95% CI: 1.18-1.60, P < 0.0001). DISCUSSION This study demonstrates that patients with comorbidities, such as fluid and electrolyte problems, iron deficiency anemia, and obesity, were at an increased risk of readmission after having an uncemented total knee replacement. The risks of readmission following an uncemented total knee arthroplasty can be discussed with patients who have certain comorbidities by arthroplasty surgeons.
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Affiliation(s)
- Derrick Chatad
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Arie Monas
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Ariel N Rodriguez
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA.
| | - Eric Roth
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Orry Erez
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
| | - Afshin E Razi
- Department of Orthopedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA
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Hunter CW, Deer TR, Jones MR, Chang Chien GC, D’Souza RS, Davis T, Eldon ER, Esposito MF, Goree JH, Hewan-Lowe L, Maloney JA, Mazzola AJ, Michels JS, Layno-Moses A, Patel S, Tari J, Weisbein JS, Goulding KA, Chhabra A, Hassebrock J, Wie C, Beall D, Sayed D, Strand N. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience. J Pain Res 2022; 15:2683-2745. [PMID: 36132996 PMCID: PMC9484571 DOI: 10.2147/jpr.s370469] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Knee pain is second only to the back as the most commonly reported area of pain in the human body. With an overall prevalence of 46.2%, its impact on disability, lost productivity, and cost on healthcare cannot be overlooked. Due to the pervasiveness of knee pain in the general population, there are no shortages of treatment options available for addressing the symptoms. Ranging from physical therapy and pharmacologic agents to interventional pain procedures to surgical options, practitioners have a wide array of options to choose from - unfortunately, there is no consensus on which treatments are "better" and when they should be offered in comparison to others. While it is generally accepted that less invasive treatments should be offered before more invasive ones, there is a lack of agreement on the order in which the less invasive are to be presented. In an effort to standardize the treatment of this extremely prevalent pathology, the authors present an all-encompassing set of guidelines on the treatment of knee pain based on an extensive literature search and data grading for each of the available alternative that will allow practitioners the ability to compare and contrast each option.
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Affiliation(s)
- Corey W Hunter
- Ainsworth Institute of Pain Management, New York, NY, USA
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | | | - Ryan S D’Souza
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | | | - Erica R Eldon
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Johnathan H Goree
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lissa Hewan-Lowe
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jillian A Maloney
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Anthony J Mazzola
- Department of Rehabilitation & Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Jeanmarie Tari
- Ainsworth Institute of Pain Management, New York, NY, USA
| | | | | | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Chris Wie
- Interventional Spine and Pain, Dallas, TX, USA
| | - Douglas Beall
- Comprehensive Specialty Care, Oklahoma City, OK, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Franovic S, Schlosser C, Guo E, Hessburg L, Kuhlmann NA, Okoroha KR, Makhni EC. Investigating the PROMIS Physical Function and Pain Interference Domains in Elite Athletes. Orthop J Sports Med 2021; 9:2325967120970195. [PMID: 33614792 PMCID: PMC7869165 DOI: 10.1177/2325967120970195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Multiple studies have demonstrated the National Institutes of Health (NIH)
Patient-Reported Outcomes Measurement Information System (PROMIS) to be a
responsive and efficient measure for patients undergoing orthopaedic
surgery. While these studies were rigorous in their protocol and
methodology, no efforts in recent literature have been made to identify if
these reference scores apply to elite athletes. Purpose/Hypothesis: The purpose of this study was to determine whether there is a difference in
the baseline scores of elite athletes versus the general population. We
hypothesized that athletes’ PROMIS upper extremity general function
(PROMIS-UE) and general physical function (PROMIS-PF) scores would vary
substantially from the mean health state of the general population. We
further hypothesized that these scores would be affected by specific sport
and level of competition Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three PROMIS computer adaptive test (CAT) domains were administered to elite
athlete (≥18 years) volunteers (either in person or through email). An elite
athlete was defined as one participating in sports at the collegiate level
or higher. Test domains included PROMIS-PF, PROMIS-UE, and pain interference
(PROMIS-PI). PROMIS domain t scores were defined and
assessed against NIH reference values to identify significant differences.
Distribution analysis was conducted using histograms and normality
assessments. Domains were also subject to correlation analysis. Finally,
subgroup analysis was conducted for all athlete characteristics to identify
any factors associated with variance. Results: In total, 196 elite athletes (mean age, 21.1 years; range, 18.0-36.7 years)
completed all 3 PROMIS-CAT forms. Overall, the mean scores were 56.0 ± 6.4,
58.1 ± 7.7, and 47.1 ± 7.3 for PROMIS-UE, PROMIS-PF, and PROMIS-PI,
respectively. Distribution analysis showed nonnormal distribution for all 3
PROMIS domains (Kolmogorov-Smirnov test, P < .001).
Similarly, in all 3 PROMIS domains the athletes displayed more disparate
scores than the NIH-reported reference values (1-way sign test,
P < .001). Only the presence of pain and sport
played showed association with variance in PROMIS domain scores
(P < .001 and P = .003,
respectively). Conclusion: Elite athletes displayed more disparate reference scores than the
NIH-reported average of 50 for PROMIS-UE, PROMIS-PF, and PROMIS-PI.
Furthermore, these forms were sensitive to varying levels of sport among
collegiate athletes.
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Affiliation(s)
| | | | - Eric Guo
- Henry Ford Hospital, Detroit, Michigan, USA
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Marques EMR, Dennis J, Beswick AD, Higgins J, Thom H, Welton N, Burston A, Hunt L, Whitehouse MR, Blom AW. Choice between implants in knee replacement: protocol for a Bayesian network meta-analysis, analysis of joint registries and economic decision model to determine the effectiveness and cost-effectiveness of knee implants for NHS patients-The KNee Implant Prostheses Study (KNIPS). BMJ Open 2021; 11:e040205. [PMID: 33408201 PMCID: PMC7789438 DOI: 10.1136/bmjopen-2020-040205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Knee replacements are highly successful for many people, but if a knee replacement fails, revision surgery is generally required. Surgeons and patients may choose from a range of implant components and combinations that make up knee replacement constructs, all with potential implications for how long a knee replacement will last. To inform surgeon and patient decisions, a comprehensive synthesis of data from randomised controlled trials is needed to evaluate the effects of different knee replacement implants on overall construct survival. Due to limited follow-up in trials, joint registry analyses are also needed to assess the long-term survival of constructs. Finally, economic modelling can identify cost-effective knee replacement constructs for different patient groups. METHODS AND ANALYSIS In this protocol, we describe systematic reviews and network meta-analyses to synthesise evidence on the effectiveness of knee replacement constructs used in total and unicompartmental knee replacement and analyses of two national joint registries to assess long-term outcomes. Knee replacement constructs are defined by bearing materials and mobility, constraint, fixation and patella resurfacing. For men and women in different age groups, we will compare the lifetime cost-effectiveness of knee replacement constructs. ETHICS AND DISSEMINATION Systematic reviews are secondary analyses of published data with no ethical approval required. We will design a common joint registry analysis plan and provide registry representatives with information for submission to research or ethics committees. The project has been assessed by the National Health Service (NHS) REC committee and does not require ethical review.Study findings will be disseminated to clinicians, researchers and administrators through open access articles, presentations and websites. Specific UK-based groups will be informed of results including National Institute for Health Research and National Institute for Health and Care Excellence, as well as international orthopaedic associations and charities. Effective dissemination to patients will be guided by our patient-public involvement group and include written lay summaries and infographics. PROSPERO REGISTRATION NUMBER CRD42019134059 and CRD42019138015.
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Affiliation(s)
- Elsa M R Marques
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
| | - Jane Dennis
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
| | - Julian Higgins
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Howard Thom
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Nicky Welton
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
| | - Linda Hunt
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, Bristol Medical School, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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Cost-Effectiveness of Arthroplasty Management in Hip and Knee Osteoarthritis: a Quality Review of the Literature. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2020. [DOI: 10.1007/s40674-020-00157-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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