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The Bone & Joint Journal
Vol. 103-B, Issue 6 Supple A | Pages 113 - 118
1 Jun 2021
Delanois RE Tarazi JM Wilkie WA Remily E Salem HS Mohamed NS Pollack AN Mont MA

Aims

Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure.

Methods

Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 46 - 46
1 Oct 2020
Wilkie WA Salem HS Remily E Mohamed NS Scuderi GR Mont MA Delanois RE
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Introduction

Social determinants of health (SDOH) may contribute markedly to the total cost of care (COC) for patients undergoing elective total knee arthroplasty (TKA). This study investigated the association between demographics, health status, and SDOH on lengths of stay (LOS) and 30-day COC.

Methods

Patients who underwent TKA between January 2018 and December 2019 were identified. Those who had complete SDOH data were utilized, leaving 234 patients. Data elements were drawn from the Chesapeake Regional Information System, the Center for Disease Control social vulnerability index (SVI), the Food Access Research Atlas (FARA). The SVI identifies areas vulnerable to catastrophic events, with 4 themed scores including: (1) socioeconomic status; (2) household composition and disability; (3) minority status and language; and (4) housing and transportation. Food deserts were defined as neighborhoods located 1 or 10 miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine an association with LOS and cost, after controlling for demographics.


The Bone & Joint Journal
Vol. 102-B, Issue 7 Supple B | Pages 122 - 128
1 Jul 2020
Sodhi N Acuna A Etcheson J Mohamed N Davila I Ehiorobo JO Jones LC Delanois RE Mont MA

Aims

Earlier studies dealing with trends in the management of osteonecrosis of the femoral head (ONFH) identified an increasing rate of total hip arthroplasties (THAs) and a decreasing rate of joint-preserving procedures between 1992 and 2008. In an effort to assess new trends in the management of this condition, this study evaluated the annual trends of joint-preserving versus arthroplasties for patients aged < or > 50 years old, and the incidence of specific operative management techniques.

Methods

A total of 219,371 patients with ONFH were identified from a nationwide database between 1 January 2009 and 31 December 2015. The mean age was 54 years (18 to 90) and 105,298 (48%) were female. The diagnosis was made using International Classification of Disease, Ninth revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) procedure codes. The percentage of patients managed using each procedure during each year was calculated and compared between years. The trends in the use of the types of procedure were also evaluated.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 47 - 47
1 Oct 2019
Sodhi N Etcheson J Mohamed N Davila I Ehiorobo JO Anis HK Jones LC Delanois RE Mont MA
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Introduction

The purpose of this study was to analyze trends in the surgical management of ON in recent years. Specifically, we evaluated the annual prevalences of: 1) joint preserving procedures (osteotomies and core decompression/grafts) and 2) joint non-preserving procedures (total hip arthroplasties [THAs], revision THAs, partial THAs) for the treatment of osteonecrosis of the femoral head (ONFH) between 2009 and 2016.

Background

A total of 406,239 ONFH patients who were treated between 2009 and 2016 were identified from a nationwide database. Treatment procedures were extracted using ICD-9-CM and ICD-10-CM procedure codes. Annual rates of each of the above procedures were calculated and the trends in the procedure types were also evaluated. Chi-square tests were performed to compare the annual prevalence of each procedure. The mean annual prevalence over the 8-year study period was calculated for each procedure.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 25 - 25
1 Oct 2019
Livshetz I Mohamed N Papas PV Delanois RE Mont MA Scuderi GR
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Background

As the number of total knee arthroplasties (TKA) being performed continues to increase, the number of potential failures requiring revision surgery would also be expected to increase. This study analyzed the trends in revision TKA (rTKA) from 2009 to 2016.

Methods

The Nationwide Inpatient Sample (NIS) database was used to identify all rTKA by International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. The diagnoses leading to revision, revision costs, patient and hospital characteristics, and major inpatient complications were compared between 2009 and 2016. Multivariate logistic regression analyses were used to calculate odds ratios (OR) for complications.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 327 - 327
1 May 2009
Marulanda G Ulrich S Delanois RE Seyler T Mont M
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Introduction: Core decompression has historically been used during the early stages of osteonecrosis of the ankle as a treatment method to decrease pain and defer the eventual collapse of the joint. Originally, this procedure was described using large diameter trocars. The multiple locations of the lesions (such as the distal tibia and fibula, the talar dome, the calcaneus, and/or the metatarsals) and the relative small affected bones (compared to the femoral head and distal femur) make this procedure technically difficult. The investigators report on the treatment of osteonecrosis of the ankle with a new technique using multiple small percutaneous 3-mm perforations.

Methods: Between September, 2002 and May, 2004, the senior author treated 44 symptomatic ankles affected with osteonecrosis using the multiple perforation technique. The series included 31 patients (23 women, 8 men) who had a mean age at the time of surgery of 42 years (range, 17 to 61 years). All the procedures were performed using a 3-millimeter Steinman pin technique. Radiographic outcome was assessed during post-operative clinical visits using plain x-rays and magnetic resonance imaging. Clinical outcome was assessed postoperatively using the AOFAS (American Orthopaedic Foot and Ankle Society) score. Progression of the disease (defined as evidence of subchondral collapse or AOFAS score < =80 points) was correlated with demographic variables such as associated risk factors, prior surgical procedures, size, and location of the lesions.

Results: Ankle arthrodesis was avoided in 93% of the cases (41 of 44 ankles) at a mean follow-up of 3.6 years (range, 2 to 5 years). Forty of 44 ankles (91%) had a successful clinical outcome (AOFAS score ≥ 80 points). The AOFAS score for the entire series increased from a preoperative mean of 41 points (range, 34 to 55 points) to a postoperative mean of 88 points (range, 51 to 100 points). The AOFAS score for the series excluding the three ankles that required arthrodesis increased from a preoperative mean of 41 points to 91 points postoperatively. The three cases that required ankle arthrodesis presented initially with osteonecrosis of multiple bones about the ankle (talus, calcaneus, distal tibia and fibula) and two of these cases had HIV as an associated risk factor for osteonecrosis. All but 8 patients presented signs and symptoms of osteonecrosis in other joints (hip, knee, shoulder) and this had a negative correlation with outcome. There were no complications from the procedures, which were all performed as outpatient surgeries.

Discussion: The percutaneous perforations technique appears to be a low-morbidity method of relieving symptoms and deferring ankle arthrodesis (or other invasive procedures) in patients with symptomatic osteonecrotic ankles. The authors believe that these results support the need for a multicenter-randomized study comparing minimally invasive treatment options for osteonecrosis.