Advertisement for orthosearch.org.uk
Results 1 - 16 of 16
Results per page:
Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_16 | Pages 78 - 78
19 Aug 2024
Holland CT Leal J Easley ME Nunley JA Ryan SP Bolognesi MP Wellman SS Jiranek WA
Full Access

This study evaluates patient reported outcome measurement information system (PROMIS) scores after total hip arthroplasty (THA) and total ankle arthroplasty (TAA) in matched cohorts, while simultaneously evaluating implant survivorship and 90-day hospital utilization. It is hypothesized that while both procedures would yield similar PROMIS score improvements, THA would demonstrate superior mid-term implant survivorship.

Primary THA and TAA patients from 2015–2022 with minimum one-year follow-up were retrospectively reviewed. After applying exclusion criteria, 2,092 THAs and 478 TAAs were included for analysis. Demographics, pre- and post-operative patient reported outcome measures (PROMs), revision surgeries, ED visits, and re-admissions were collected. THA and TAA patients were then propensity score matched at 2:1 ratio for age, sex, race, BMI, ASA, and comorbidities, resulting in a final cohort of 844 THAs and 455 TAAs for comparison.

There were similar pre-operative PROMIS Pain Interference (PI) scores between THA and TAA, with both showing improvement at six weeks. However, THA patients exhibited lower PI scores at one year (53.0 versus 54.0; p=0.009). Pre-operative PROMIS Physical Function (PF) was worse in THA patients but showed greater improvement compared to TAA patients at both six weeks (p<0.001) and one year (p<0.001). Pre-operative PROMIS depression scores were similar and improved similarly in both groups. Joint-specific PROMs (HOOS for THA and FAAM for TAA) improved in both cohorts. THA demonstrated superior survivorship free of all-cause revision at five years compared to TAA (95% versus 77%; p<0.0001).

Patients undergoing THA or TAA experienced significant improvements in their general and joint-specific PROMs post-operatively. However, patients undergoing THA demonstrated higher PROMIS PI and PF scores at one-year when compared to TAA, as well as improved survivorship. Generic PRO instruments enable comparison of medical treatments in different anatomic sites to the patients overall health.


The Bone & Joint Journal
Vol. 106-B, Issue 6 | Pages 555 - 564
1 Jun 2024
Leal J Holland CT Cochrane NH Seyler TM Jiranek WA Wellman SS Bolognesi MP Ryan SP

Aims

This study aims to assess the relationship between history of pseudotumour formation secondary to metal-on-metal (MoM) implants and periprosthetic joint infection (PJI) rate, as well as establish ESR and CRP thresholds that are suggestive of infection in these patients. We hypothesized that patients with a pseudotumour were at increased risk of infection.

Methods

A total of 1,171 total hip arthroplasty (THA) patients with MoM articulations from August 2000 to March 2014 were retrospectively identified. Of those, 328 patients underwent metal artefact reduction sequence MRI and had minimum two years’ clinical follow-up, and met our inclusion criteria. Data collected included demographic details, surgical indication, laterality, implants used, history of pseudotumour, and their corresponding preoperative ESR (mm/hr) and CRP (mg/dl) levels. Multivariate logistic regression modelling was used to evaluate PJI and history of pseudotumour, and receiver operating characteristic curves were created to assess the diagnostic capabilities of ESR and CRP to determine the presence of infection in patients undergoing revision surgery.


The Bone & Joint Journal
Vol. 104-B, Issue 12 | Pages 1323 - 1328
1 Dec 2022
Cochrane NH Kim B Seyler TM Bolognesi MP Wellman SS Ryan SP

Aims

In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours. The authors hypothesized that expedited discharge in select patients would not be associated with increased 30-day readmissions and reoperations.

Methods

Aseptic revision TKAs in the National Surgical Quality Improvement Program database were reviewed from 2013 to 2020. TKAs were stratified by length of hospital stay (greater or less than 24 hours). Patient demographic details, medical comorbidities, American Society of Anesthesiologists (ASA) grade, operating time, components revised, 30-day readmissions, and reoperations were compared. Multivariate analysis evaluated predictors of discharge prior to 24 hours, 30-day readmission, and reoperation.


Bone & Joint Open
Vol. 2, Issue 7 | Pages 493 - 502
12 Jul 2021
George SZ Yan X Luo S Olson SA Reinke EK Bolognesi MP Horn ME

Aims

Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care.

Methods

This was a cross-sectional study of patients from Duke University Department of Orthopaedic Surgery clinics (14 ambulatory and four hospital-based). There were two separate cohorts recruited by convenience sampling (i.e. patients were included in the analysis only if they completed PROMIS measures during a new patient visit). Cohort #1 (n = 12,141; December 2017 to December 2018,) included PROMIS short forms for eight domains (Physical Function, Pain Interference, Pain Intensity, Depression, Anxiety, Sleep Quality, Participation in Social Roles, and Fatigue) and Cohort #2 (n = 4,638; January 2019 to August 2019) included PROMIS Computer Adaptive Testing instruments for four domains (Physical Function, Pain Interference, Depression, and Sleep Quality). Cluster analysis (K-means method) empirically derived subgroups and subgroup differences in clinical and sociodemographic factors were identified with one-way analysis of variance.


The Bone & Joint Journal
Vol. 103-B, Issue 6 Supple A | Pages 158 - 164
1 Jun 2021
Hernandez NM Hinton ZW Wu CJ Ryan SP Bolognesi MP

Aims

Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. Because there are few studies evaluating mid-term outcomes with a sufficient cohort, the purpose of this study was to evaluate tibial cone survival and complications in revision TKAs with tibial cones at minimum follow-up of five years.

Methods

A retrospective review was completed from September 2006 to March 2015, evaluating 67 revision TKAs (64 patients) that received one specific porous tibial cone during revision TKA. The final cohort was composed of 62 knees (59 patients) with five years of clinical follow-up or reoperation. The mean clinical follow-up of the TKAs with minimum five-year clinical follow-up was 7.6 years (5.0 to 13.3). Survivorship analysis was performed with the endpoints of tibial cone revision for aseptic loosening, tibial cone revision for any reason, and reoperation. We also evaluated periprosthetic joint infection (PJI), risk factors for failure, and performed a radiological review.


The Bone & Joint Journal
Vol. 103-B, Issue 1 | Pages 26 - 31
4 Jan 2021
Kildow BJ Ryan SP Danilkowicz R Lazarides AL Penrose C Bolognesi MP Jiranek W Seyler TM

Aims

Use of molecular sequencing methods in periprosthetic joint infection (PJI) diagnosis and organism identification have gained popularity. Next-generation sequencing (NGS) is a potentially powerful tool that is now commercially available. The purpose of this study was to compare the diagnostic accuracy of NGS, polymerase chain reaction (PCR), conventional culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al in the diagnosis of PJI.

Methods

In this retrospective study, aspirates or tissue samples were collected in 30 revision and 86 primary arthroplasties for routine diagnostic investigation for PJI and sent to the laboratory for NGS and PCR. Concordance along with statistical differences between diagnostic studies were calculated.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_10 | Pages 4 - 4
1 Oct 2020
Brekke AC Wu CJ Hinton ZW Kim BI Ryan SP Bolognesi MP Seyler TM
Full Access

Introduction

Survival after contemporary solid organ transplant (SOT) is increasing, and demand for total hip arthroplasty (THA) among SOT recipients is rising accordingly. The purpose of this study is to compare the perioperative outcomes and short-term implant- and patient-survivorship of contemporary THA following the most common types of SOT.

Methods

Among SOT recipients, 119 primary THAs (92 patients, 39% female) were performed at a single institution from 2000–2020 and were retrospectively reviewed at a mean follow-up of 3.6yrs. Revisions, conversion to THA and multiple organs transplanted were excluded. The most common SOT was renal (39%), followed by lung (34%), liver (18%) and heart (8%). Demographics, peri-operative outcomes, 90-day re-admissions, re-operations and mortality were compared between SOT groups using chi-squared, Fisher's exact, Wilcoxon tests and Cox proportional hazard ratios.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 54 - 54
1 Oct 2020
Hernandez NM Hinton ZW Wu CJ Ryan SP Bolognesi† MP
Full Access

Introduction

Tibial cones are often utilized in revision total knee arthroplasty (TKA) with metaphyseal defects. However, there are few studies evaluating outcomes out to five years with a sufficient cohort. The purpose of this study was to evaluate implant survivorship and complications in revision TKAs with tibial cones.

Methods

A retrospective review was completed from September 2006 through March 2018 evaluating 149 revision TKAs that received a tibial cone. The mean follow-up was 5.3 years. According to the AORI classification: 8% were 1, 18% were 2A, 55% were 2B, and 19% were 3.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 15 - 15
1 Oct 2019
Plate JF Ryan SP Black C Howell CB Jiranek WA Bolognesi MP Seyler TM
Full Access

Introduction

Alternative payment models for total hip arthroplasty (THA) were initiated by the Center for Medicare and Medicaid Services (CMS) to decrease overall healthcare cost by optimizing healthcare delivery. The associated shift of financial risk to participating institutions has been criticized to introduce patient selection in order to avoid potentially high cost of care. This study aimed to evaluate the impact of the Comprehensive Care for Joint Replacement (CJR) model on patient selection, care delivery and hospital costs at a single care center.

Methods

This is a retrospective review of THA patient from July 2015-December 2017 was performed. Patient were stratified by insurance type (Medicare and commercial insurance) and whether care was provided before or after implementation of the CJR bundle. Patient age, gender, and BMI, as well as Elixhauser comorbidities and ASA scores were analyzed. Delivery of care variables including surgery duration, discharge disposition, length of stay, and direct hospital costs were compared before and after CJR implementation.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 33 - 33
1 Oct 2019
Jiranek WA Kildow BJ Danilkowicz RM Bolognesi MP Seyler TM
Full Access

Introduction

Recent focus has queried whether of deoxyribonucleic acid (DNA) sequencing modalities of bacterial DNA found in periarticular fluid and tissues will improve in periprosthetic joint infection (PJI) diagnosis and organism identification diagnostic accuracy for periprosthetic joint infection The purpose of this study was to compare the diagnostic accuracy of next generation sequencing (NGS) to polymerase chain reaction (PCR) multiplex, and culture, the Musculoskeletal Infection Society (MSIS) criteria, and the recently proposed criteria by Parvizi et al. [1] in the diagnosis of periprosthetic knee infections.

Methods

In this retrospective study, aspirate or tissue samples were collected in 70 revision and 58 primary knee arthroplasties for routine diagnostic workup for PJI and sent to the laboratory for NGS and PCR multiplex. Concordance along with statistical differences between diagnostic studies were calculated using Chi-squared test for categorical data.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 43 - 43
1 Oct 2019
Ryan SP Plate JF Black C Howell C Jiranek W Bolognesi MP Seyler TM
Full Access

Introduction

Bundled reimbursement models for total knee arthroplasty (TKA) by the Center for Medicare and Medicaid Services (CMS) have resulted in an effort to decrease the cost of care. However, these models may incentivize bias in patient selection to avoid excess cost of care. We sought to determine the impact of the Comprehensive Care for Joint Replacement (CJR) model at a single center.

Methods

This is a retrospective review of primary TKA patients from July 2015-December 2017. Patients were stratified by whether or not their surgery was performed before or after implementation of the CJR bundle. Patient demographic data including age, sex, and BMI were collected in addition to Elixhauser comorbidities and ASA score. In-hospital outcomes were then examined including surgery duration, length of stay, discharge disposition, and direct cost of care.


The Bone & Joint Journal
Vol. 101-B, Issue 9 | Pages 1093 - 1099
1 Sep 2019
Bradley KE Ryan SP Penrose CT Grant SA Wellman SS Attarian DE Green CL Risoli T Bolognesi MP

Aims

Antifibrinolytic agents, including tranexamic acid (TXA) and epsilon-aminocaproic acid (EACA), have been shown to be safe and effective for decreasing perioperative blood loss and transfusion following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are few prospective studies that directly compare these agents. The purpose of this study was to compare the benefits of intraoperative intravenous TXA with EACA.

Patients and Methods

A total of 235 patients (90 THA and 145 TKA) were enrolled in this prospective, randomized controlled trial at a single tertiary-care referral centre. In the THA cohort, 53.3% of the patients were female with a median age of 59.8 years (interquartile range (IQR) 53.3 to 68.1). In the TKA cohort, 63.4% of the patients were female with a median age of 65.1 years (IQR 59.4 to 69.5). Patients received either TXA (n = 119) or EACA (n = 116) in two doses intraoperatively. The primary outcome measures included change in haemoglobin level and blood volume, postoperative drainage, and rate of transfusion. Secondary outcome measures included postoperative complications, cost, and length of stay (LOS).


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 23 - 23
1 Oct 2018
Goltz D Ryan S Howell C Jiranek WA Attarian DE Bolognesi MP Seyler TM
Full Access

Introduction

The Comprehensive Care for Joint Replacement (CJR) model for total hip arthroplasty (THA) involves a target reimbursement set by the Center for Medicare and Medicaid Services (CMS). Many patients exceed these targets, but predicting risk for incurring these excess costs remains challenging, and we hypothesized that select patient characteristics would adequately predict CJR cost overruns.

Methods

Demographic factors and comorbidities were retrospectively reviewed in 863 primary unilateral CJR THAs performed between 2013 and 2017 at a single institution. A predictive model was built from 31 validated comorbidities and a base set of 5 patient factors (age, gender, BMI, ASA, marital status). A multivariable logistic regression model was refined to include only parameters predictive of exceeding the target reimbursement level. These were then assigned weights relative to the weakest parameter in the model.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 54 - 54
1 Oct 2018
Bolognesi MP Ryan S Goltz D Howell CB Attarian DE Jiranek WA Seyler TM
Full Access

Introduction

Hip fractures are a common pathology treated by Orthopaedic surgeons. The Comprehensive Care for Joint Replacement (CJR) model utilizes risk stratification to set target prices for these patients undergoing hemiarthroplasty or total hip arthroplasty (THA). We hypothesized that sub-specialty arthroplasty surgeons would be able to treat patients at a lower cost compared to surgeons of other specialties during cases performed while on call.

Methods

Patients with hemiarthroplasty or THA for hip fractures were retrospectively collected from June, 2013, to May, 2017, from a single tertiary referral center. Demographic information and outcomes based on length of stay (LOS), net payment, and target payment were collected. Patients were then stratified by surgeon subspecialty (arthroplasty trained vs. other specialty). Univariable and multivariable analysis for payment based on treating surgeon was then performed.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 84 - 84
1 Dec 2013
Ismaily S Patel R Suarez A Incavo S Bolognesi MP Noble P
Full Access

Introduction

Malpositioning of the tibial component is a common error in TKR. In theory, placement of the tibial tray could be improved by optimization of its design to more closely match anatomic features of the proximal tibia with the motion axis of the knee joint. However, the inherent variability of tibial anatomy and the size increments required for a non-custom implant system may lead to minimal benefit, despite the increased cost and size of inventory.

This study was undertaken to test the hypotheses:

That correct placement of the tibial component is influenced by the design of the implant.

The operative experience of the surgeon influences the likelihood of correct placement of contemporary designs of tibial trays.

Materials and Methods

CAD models were generated of all sizes of 7 widely used designs of tibial trays, including symmetric (4) and asymmetric (3) designs. Solid models of 10 tibias were selected from a large anatomic collection and verified to ensure that they encompassed the anatomic range of shapes and sizes of Caucasian tibias. Each computer model was resected perpendicular to the canal axis with a posterior slope of 5 degrees at a depth of 5 mm distal to the medial plateau. Fifteen joint surgeons and fourteen experienced trainees individually determined the ideal size and placement of each tray on each resected tibia, corresponding to a total of 2030 implantations. For each implantation we calculated: (i) the rotational alignment of the tray; (ii) its coverage of the resected bony surface, and (iii) the extent of any overhang of the tray beyond the cortical boundary. Differences in the parameters defining the implantations of the surgeons and trainees were evaluated statistically.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 29 - 29
1 Mar 2010
Bolognesi MP Viens NA Marchant MH Vail TP Cook C
Full Access

Purpose: As the prevalence of diabetes mellitus (DM) in people over 60 years of age is expected to increase, the number of diabetic patients who undergo total hip and knee arthroplasty should increase concordantly. In general, patients with DM have significantly increased risk for adverse events following arthroplasty. The goal of this study was to determine whether the quality of glycemic control affected the incidence of perioperative complications in the hospital following joint replacement.

Method: From 1988 to 2003, the Nationwide Inpatient Survey (NIS) recognized 65,769 patients who had DM and underwent joint replacement surgery. In this retrospective study, bivariate and multivariate analyses compared patients with uncontrolled (n=2,872) and not uncontrolled (n=62,897) DM regarding common surgical and systemic complications, mortality, and hospital course alterations. Glycemic control was determined by physicians’ assessments based upon the American Diabetes Association guidelines using a combination of patients’ self-monitoring of blood-glucose testing, the hemoglobin A1C, and related complications.

Results: Patients with uncontrolled DM routinely had an increased length of stay and increased inflation-adjusted costs after surgery (p< 0.001). Uncontrolled patients also had significant increases in the incidence of stroke, pneumonia, urinary tract infection, post-operative hemorrhage, wound infection, and death (p< 0.001).

Conclusion: Patients with well-managed glycemic control have fewer comorbidities in general. Patients with uncontrolled DM exhibited significantly increased risks for surgical and systemic complications, higher mortality, increased length of stay, and higher hospital charges during the index hospitalization following arthroplasty. The consequences are increased cost, greater burden on the healthcare system, and greater risk to these patients.