Aims. Medical comorbidities are a critical factor in the decision-making process for operative management and risk-stratification. The Hierarchical Condition Categories (HCC) risk adjustment model is a powerful measure of illness severity for patients treated by surgeons. The HCC is utilized by
INTRODUCTION. In the United States, the Centers for
Background. Cementless femoral fixation in total hip arthroplasty (THA) continues to rise worldwide, accompanied by the increasing abandonment of cemented femoral fixation. Cementless fixation is known to contribute to higher rates of post-operative complications and reoperations. New data is available from the Centers for
Introduction. Previous registry studies of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) have focused on revision outcomes following primary surgery. Less is known about the effect of ceramic bearings on infection, dislocation, and mortality as outcomes following primary total hip arthroplasty (THA) for the
Introduction. Previous studies of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) hip bearings have focused on outcomes following primary surgery. Less is known about the utilization or outcomes of ceramic bearings in revision total hip arthroplasty (R-THA) for the
PURPOSE:.
INTRODUCTION. Evolving payment models create new opportunities for assessment of patient care based on total cost over a defined period of time. These models allow for analyses of economic data that was previously unavailable and well beyond our familiar studies which typically include length of stay, surgical complications, and post-operative clinical and radiographic assessments. In the United States, the new Federal program entitled TheBundled Payment for Care Initiative created new opportunities for the assessment of surgical interventions. The purpose of the reported study was to assess the total reimbursement for care as a function of surgical technique in primary total hip arthroplasty (THA). METHODS. The total reimbursement for services performed following primary THA for patients insured by
INTRODUCTION. Early discharge after total joint arthroplasty has started to gain acceptance in select academic centers. The purpose of this study was to compare the risk of readmission of
Background. Substance abuse and dependence is thought to have a strongly negative impact on surgical outcomes. The purpose of this study was to determine the effects of drug misuse on total knee arthroplasty (TKA) revision incidence, revision causes, and time to revision by analyzing the
Introduction. Knee arthroplasty is one of the most common inpatient surgeries procedures performed every year however complications do occur. Prior studies have examined the impact of insurance status on complications after TJA in small or focused cohorts. The purpose of our study was to utilize a large all-payer inpatient healthcare database to evaluate the effect of patient insurance status on complications following knee arthroplasty. Methods. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing knee arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical complications, surgical complications and mortality during the same hospitalization. A secondary analysis was performed using a matched cohort comparing patients with
Introduction. Hip arthroplasty is one of the most common procedures performed every year however complications do occur. Prior studies have examined the impact of insurance status on complications after TJA in small or focused cohorts. The purpose of our study was to utilize a large all-payer inpatient healthcare database to evaluate the effect of patient insurance status on complications following hip arthroplasty. Methods. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing hip arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical complications, surgical complications and mortality during the same hospitalization. A secondary analysis was performed using a matched cohort comparing patients with
Proximal humerus fractures (PHF) are common, accounting for approximately 5% of all fractures. Approximately 30% require surgical intervention which can range from open reduction with internal fixation (ORIF) to shoulder arthroplasty (including hemiarthroplasty, total shoulder arthroplasty, (TSA) or reverse total shoulder arthroplasty (RTSA)). The aim of this study was to assess trends in operative interventions for PHF in an Australian population. Data was retrospectively collected for patients diagnosed with a PHF and requiring surgical intervention between January 2001 and December 2020. Data for patients undergoing ORIF were extracted from the
We present the indications and outcomes of a series of custom 3D printed titanium acetabular implants used over a 9 year period at our institution (Sydney, Australia), in the setting of revision total hip arthroplasty. Individualised image-based case planning with additive manufacturing of pelvic components was combined with screw fixation and off-the-shelf femoral components to treat patients presenting with failed hip arthroplasty involving acetabular bone loss. Retrospective chart review was performed on the practices of three contributing surgeons, with an initial search by item number of the
INTRODUCTION. Shoulder arthroplasty (SA) is an effective procedure for managing patients with shoulder pain secondary to degenerative joint disease or end stage arthritis that has failed conservative treatment. Insurance status has been shown to be an indicator of patient morbidity and mortality. The objective of the current study is to evaluate the effect of patient insurance status on outcomes following shoulder replacement surgery. METHODS. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing shoulder arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical and surgical complications occurring during the same hospitalization with secondary analysis of mortality. Pearson's chi¬squared test and multivariate regression were performed. RESULTS. A data inquiry identified 103,290 patients (68,578
Worldwide, most spine imaging is either “inappropriate” or “probably inappropriate”. The Choosing Wisely recommendation is “Do not perform imaging for lower back pain unless red flags are present.” There is currently no detailed breakdown of lower back pain diagnostic imaging performed in New Brunswick (NB) to inform future directions. A registry of spine imaging performed in NB from 2011-2019 inclusive (n=410,000) was transferred to the secure platform of the NB Institute for Data, Training and Research (NB-IRDT). The pseudonymized data included linkable institute identifiers derived from an obfuscated
Introduction. Bundled budgeting of payments for joint replacement services has become increasing common in an effort to improve quality while lowering cost. In the US, some
The Superior Hip Approach allows for safe reconstruction of the hip while maximizing preservation of the surrounding soft tissues. The procedure involves an incision in the hip joint capsule posterior to the gluteus medius and minimus and anterior to the short external rotators. The technique involves preparation of the femur in-situ through the superior femoral neck and then excision of the femoral head, which avoids the attendant soft tissue dissection or injury associated with dislocation of the native hip. After component implantation, the capsule is closed anatomically. Two separate studies have demonstrated that over a 90-day period, patients whose hips were replaced using this technique consumed the least amount of cost of any patients treated by hip arthroplasty in the Commonwealth of Massachusetts. One study assessed all hips replaced in patients insured by
Introduction. Current CMS reimbursement policy for total joint replacement is aligned with more cost effective, higher quality care. Upon implementation of a standardized evidenced-based care pathway, we evaluated overall procedural costs and clinical outcomes over the 90-day episode of care period for patients undergoing TKA with either conventional (Conv.) or robotic-assisted (RAS) instrumentation. Methods. In a retrospective review of the first seven consecutive quarters of Bundled Payment for Care Improvement (BPCI) Model 2 participation beginning January 2014, we compared 90-day readmission rates, Length of Stay (LOS), discharge disposition, gains per episode in relation to target prices and overall episode costs for surgeons who performed either RAS-TKA (3 surgeons, 147 patients) or Conv. TKA (3 surgeons, 85 patients) at a single institution. All
Introduction. Close to 30% of the surgical causes of readmission within 90 days post-total knee arthroplasty (TKA) and nearly half of those occurring in the first 2 years are caused by instability, arthrofibrosis, and malalignment, all of which may be addressed by improving knee balance. Furthermore, the recently launched Comprehensive Care for Joint Replacement (CJR) initiative mandates that any increase in post-acute care costs through 90-days post-discharge will come directly from the bundle payment paid to providers. Post-discharge costs, including the cost of readmissions for complications are one of the largest drivers of the 90-day cost of care. It is hypothesized that balanced knees post-TKA will lower the true provider costs within the 90-day bundle. Methods. Cost, outcomes and resource utilization data were collected from three independent surgeons pre- and post- adoption of intraoperative technology developed to provide real-time, quantitative load data within the knee. In addition, data were collected from
Pre-operative knowledge. Knowledge-based total hip arthroplasty is becoming increasingly recognised for improved safety, efficiency, and accuracy. Pre-operative knowledge of native and planned femoral anteversion, the exact size of implants, neck length and offset, and head lengths can serve to safely accelerate surgery and reduce the need for intra-operative imaging. Pre-operative knowledge of the effect on change in leg length and offset effected by specific implant combinations can serve to minimise undesired changes. The use of a smart mechanical navigation tool superimposed on this knowledge, can serve to easily and swiftly achieve optimal component position. Cost savings. Economic data from Q1 2013 to Q2 2016 demonstrate that CMS-insured patients treated by knowledge-based surgery using the HipXpert mechanical navigation system combined with the superior hip approach have the lowest cost of all patients treated in Massachusetts by an average of more than $7,000 over 90 days for