Introduction

Readmission after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) places a great burden on the health care system. As reimbursement systems place increased emphasis on quality measures such as readmission rates, understanding the causes for readmission becomes increasingly important.

Introduction

Readmission after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA) places a great burden on the health care system. As reimbursement systems place increased emphasis on quality measures such as readmission rates, identifying and understanding the most common drivers for readmission becomes increasingly important.

INTRODUCTION

Osteoarthritis (OA) of the hip and the knee has been found to affect sexual activity. Few retrospective studies have investigated the role of total hip replacement on sexual function. We designed a prospective study to evaluate the influence of total hip arthroplasty (THA) and total knee arthroplasty (TKA) on the physical and psychological aspects of sexuality of patients.

Limited strong data exists in current literature comparing the 90-day morbidity and mortality following general or spinal anesthetic in patients who underwent total hip or knee arthroplasty, especially between matched cohorts. Because of this, there continues to be an ongoing debate regarding the risks and benefits of using general versus spinal anesthetic for patients undergoing elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) for end-stage osteoarthritis.

The Alberta Bone and Joint Health Institute (ABJHI) database was searched to identify all patients who underwent either primary THA or TKA between April 2005 and December 2015. Those identified were matched 1:1 based on age, sex, type of joint replacement (THA or TKA), American Society of Anesthesiologists (ASA) score, and anesthetic type. Patients were stratified into two groups based on whether they received a general anesthesia (GA) or a spinal anesthesia (SA) at the time of their index surgery. Perioperative complications (medical events, mechanical events, deep infection, need for blood transfusion), length of stay (LOS), 30-day readmission, and 90-day mortality were compared between cohorts.

Included in this study are 5,580 patients who underwent THA and 7,712 patient who underwent TKA. All were successfully matched based on similar categorical criteria (THA, 2,790 matched-pairs, TKA, 3,856 matched-pairs). Following stratifications of cohorts, no statistical differences were appreciated between patient baseline demographics. Patients who underwent GA showed a trend towards higher 90-day mortality, however no statistical differences were found between anesthetic type on rates of 90-day mortality following either THA or TKA (THA, p = 0.290, TKA, p = 0.291). Considering this, patients who underwent THA with SA experienced fewer 90-day complications (medical events, p = 0.022, mechanical events, p = 0.017), needed fewer blood transfusions (p < 0 .001), and required shorter LOS (p = 0.038). Moreover, patient who underwent TKA with SA had fewer blood transfusion (p < 0 .001), 30-day readmission rates (p = 0.011), and fewer deep infections (p = 0.030) that required additional surgery compared to those in the GA cohort. Regardless of surgery performed, patients in the SA cohorts were more commonly discharged home without requiring additional support (i.e. home care).

General anesthesia during THA and TKA appears to be associated with increased 90-day morbidity and more frequent need for allogenic blood transfusion. No statistical difference in 90-day mortality is reported between cohorts for either THA or TKA, yet a trend is appreciated favoring SA. Surgeons who commonly perform these surgeries should consider the added benefits of spinal anesthesia for those patients who are candidates.

Introduction

There has been much discussion in the literature concerning the possible detrimental effects of metal ion circulating in the body after MOM THR. This study seeks to evaluate the differences in observed Co and Cr levels in blood after TKR and several popular THR options.

Canada is second only to the United States worldwide in the number of opioid prescriptions per capita. Despite this, little is known about prescription patterns for patients undergoing total joint arthroplasty (TJA). The purpose of this study was to detail preoperative opioid use patterns and investigate the effect it has on perioperative quality outcomes in patients undergoing elective total hip and total knee arthroplasty surgery (THA and TKA). The study cohort was constructed from hospital Discharge Abstract Data (DAD) and National Ambulatory Care Reporting System (NACRS) data, using Canadian Classification of Health Intervention codes to select all primary THA and TKA procedures from 2017-2020 in Nova Scotia. Opioid use was defined as any prescription filled at discharge as identified in the Nova Scotia Drug Information System (DIS). Emergency Department (ED) and Family Doctor (FD) visits for pain were ascertained from Physician Claims data. Multivariate logistic regression was used to test for associations controlling for confounders. Chi-squared statistics at 95% confidence level used to test for statistical significance. In total, 14,819 TJA patients were analysed and 4306 patients (29.0%) had at least one opioid prescription in the year prior to surgery. Overall, there was no significant difference noted in preoperative opiate use between patients undergoing TKA vs THA (28.8% vs 29.4%). During the period 2017-2019 we observed a declining year-on-year trend in preoperative opiate use. Interestingly, this trend failed to continue into 2020, where preoperative opiate use was observed to increase by 15% and exceeded 2017 levels. Within the first 90 days of discharge, 22.9% of TKA and 20.9% of THA patients presented to the ED or their FD with pain related issues. Preoperative opiate use was found to be a statistically significant predictor for these presentations (TKA: odds ratio [OR], 1.45; 95% confidence interval [CI], 1.29 to 1.62; THA: OR, 1.46; 95% CI, 1.28 to 1.65). Preoperative opioid consumption in TJA remains high, and is independently associated with a higher risk of 90 day return to the FD or ED. The widespread dissemination of opioid reduction strategies introduced during the middle of the last decade may have reduced preoperative opiate utilisation. Access barriers and practice changes due to the COVID-19 pandemic may now have annulled this effect

The coronavirus pandemic has reduced the capability of Canadian hospitals to offer elective orthopaedic surgery requiring admission, despite ongoing and increasing demands for elective total hip and total knee arthroplasty surgery (THA and TKA). We sought to determine if the coronavirus pandemic resulted in more outpatient THA and TKA in Nova Scotia, and if so, what effect increased outpatient surgery had on 90 day post-operative readmission or Emergency Department/Family Doctor (FD) visits. The study cohort was constructed from hospital Discharge Abstract Data (DAD), inpatient admissions, and National Ambulatory Care Reporting System (NACRS) data, day surgery observations, using Canadian Classification of Health Intervention codes to select all primary hip and knee procedures from 2005-2020 in Nova Scotia. Emergency Department and General Practitioner visits were identified from the Physician Billings data and re-admissions from the DAD and NACRS. Rates were calculated by dividing the number of cases with any visit within 90 days after discharge. Chi-squared statistics at 95% confidence level used to test for statistical significance. Knee and hip procedures were modelled separately. There was a reduction in THA and TKA surgery in Nova Scotia during the coronavirus pandemic in 2020. Outpatient arthroplasty surgery in Nova Scotia in the years prior to 2020 were relatively stable. However, in 2020 there was a significant increase in the proportion and absolute number of outpatient THA and TKA. The proportion of THA increased from 1% in 2019 to 14% in 2020, while the proportion of TKA increased from 1% in 2019 to 11% in 2020. The absolute number of outpatient THA increased from 16 cases in 2019, to 163 cases in 2020. Outpatient TKA cases increased from 21 in 2019, to 173 in 2020. The increase in outpatient surgery resulted in an increase in 90 day presentations to ED following TKA but not THA which was not statistically significant. For outpatient THA and TKA, there was a decrease in 90 day readmissions, and a statistically significant decrease in FD presentations. Outpatient THA and TKA increased significantly in 2020, likely due to the restrictions imposed during the coronavirus pandemic on elective Orthopaedic surgery requiring admission to hospital. The increase in outpatient surgery resulted in an increase in 90 day presentations to ED for TKA, and a decrease in 90 day readmissions and FD presentations for THA and TKA. Reducing the inpatient surgical burden may result in a post-operative burden on ED, but does not appear to have caused an increase in hospital readmission rates

Dysglycemia in the post-operative period has been associated with increased rates of infection following total joint arthroplasty. Additionally, patients without clinical diagnosis of diabetes with hemoglobin A1c% values between 5.7% and 6.4% have been shown to be dysglycemic in the peri-operative period. This study examines the influence of post-operative blood glucose management on rates of re-operation for infection in patients undergoing total joint arthroplasty in diabetic, and clinically non-diabetic patients. We performed a retrospective review of prospectively collected data, for all primary, elective total hip and total knee arthroplasties performed at The Ottawa Hospital between April 2010 and October 2017. Kaplan-Meier survivorship, and mutivarient regression analysis were used to determine predictors of infection based on pre-operative diabetes status, HbA1c%, and post-operative insulin management. 4159 joints met inclusion criteria. Patients with HbA1c 5.7–6.4% had lower rate of revision for infection if they received post-operative blood glucose management (0.80%), vs without glucose management (1.20%). Kaplan-Meier survivorship analysis showed this difference to be insignificant (p=0.23). Patients with DM1 had statistically worse survivorship when compared to other groups (p=0.010). Patients with undiagnosed perioperative dysglycemia may be at a greater predisposition for developing infection, requiring re-operation, following total joint arthroplasty. This study may be underpowered due to overall low rates of revision. More rigorous peri-operative glucose management strategies may be required for patients, who otherwise receive no glycemic management outside of hospital. This is more pertinent with trends towards decreasing post-operative lengths-of-stay

An expert panel of orthopaedic surgeons is going to be evaluating primary and revision total hip and total knee replacements submitted by the audience. Participants will present the x-rays and clinical findings of difficult cases for which they are seeking an expert opinion from the panel. The panel will probably have conflicting opinions which will lead to an entertaining and educational session. The moderator will also provide some extremely challenging cases once again, to stimulate more controversy. This session has been very popular in the past and is fast moving, humorous and educational

Increasing demand for total hip and total knee arthroplasty in an era of economic uncertainty and shrinking budgets has put pressure on surgeons to deliver excellent results and early functional recovery with shorter hospital stays. Patients receiving these operative interventions tend to be younger and more active. Their ultimate source of information is the Internet, which may be compromised by low quality, non-peer reviewed information, or information not at an appropriate reading level for comprehension by lower literacy individuals. Unfortunately, not all patients undergoing total hip and total knee arthroplasty are satisfied with their operative intervention. The most significant etiology of this dissatisfaction is reported to be lack of clarification and alignment of expectations between the surgeon and the patient, which may result from misinformation or lack of understanding by the patient. Furthermore, in the era of rapid recovery, length of stay has significantly decreased from 3–5 days a decade ago, now down to 1–2 days, and in some cases same day surgery. In an effort to mitigate this compromise in communication, we have developed a set of frequently asked questions and responses. These are divided into preoperative questions, perioperative questions, and postoperative questions. These are part of our patient educational materials and provide both office and hospital staff with structured responses to avoid miscommunication and misinformation. We have found it to be imperative that all information provided by the office and hospital have a consistent message

An expert panel of orthopaedic surgeons is going to be evaluating primary and revision total hip and total knee replacements submitted by the audience. Participants will present the x-rays and clinical findings of difficult cases for which they are seeking an expert opinion from the panel. The panel will probably have conflicting opinions which will lead to an entertaining and educational session. The moderator will also provide some extremely challenging cases to stimulate more controversy. This session has been very popular in the past and is fast moving, humorous and educational

Introduction and aims. Robotic Assisted Arthroplasty (RAA) is increasingly proliferative in the international orthopaedic environment. Traditional bibliometric methods poorly assess the impact of surgical innovations such as robotic technology. Progressive Scholarly Acceptance (PSA) is a new model of bibliographic analysis which quantitatively evaluates the impact of robotic technology in the orthopaedic scientific community. Methods. A systematic literature search was conducted to retrieve all peer-reviewed, English language publications studying robotic assisted hip and knee arthroplasty between 1992 and 2017. Review articles were excluded. Articles were classified as either “initial investigations” or “refining studies” according to the PSA model, described by Schnurman and Kondziolka. The PSA end-point is defined as the point in time when the number of studies focussed on refining or improving a novel technique (RAA) outnumbers the number of initial studies assessing its efficacy. Results. The study identified 73 original studies published since 1992 in the field of RAA. The procedures reported were total hip and total knee replacement, and uni-compartmental knee replacement. Publications originated from 17 countries and 117 organisations. Fifty percent of studies identified were published in the last 5 years at an average of 7 publications per year, compared to an average of 2.7 publications per year from 1992 to 2012. Fifty-eight publications (79.4%) were classified as initial investigations and 15 (20.5%) were classified as refining studies. Conclusions. PSA model analysis of RAA is indicative of a significant increase in published research, particularly over the last 5 years. However, the majority of publications are efficacious rather than technique refining. This implies that RAA has not reached the threshold of general acceptance by the Orthopaedic community

Introduction and aims. The International Orthopaedic community is eagerly adopting Robotic Assisted Arthroplasty (RAA) technology. However, the evidence for the benefits of this technology are unproven and at best equivocal. This study is a comprehensive bibliometric analysis of all published research in the field of RAA. Methods. A systematic literature search was conducted to retrieve all peer-reviewed, English language, publications studying robot- assisted hip and knee arthroplasty between 1992 and 2017. Review articles were excluded. Articles were classified by type of study and level of evidence according to the Oxford Centre for Evidence-based Medicine (OCEBM) Levels of Evidence System. The number of citations, authorship, year of publication, journal of publication, and country and institution of origin were also recorded for each publication. Results. We identified 73 original studies published since 1992 in the field of RAA. The procedures reported were total hip and total knee replacement, and uni-compartmental knee replacement. Publications originated from 17 countries and 117 organisations. Fifty percent of studies identified were published in the last 5 years at an average of 7 publications per year, compared to an average of 2.7 publications per year from 1992 to 2012. Thirty-six percent of original studies were of level 5 evidence or below, with a preponderance of biomechanical and cadaveric studies. The most cited paper was Bargar, Bauer and Borner's original RCT proving efficacy and safety of the Robodoc system for total hip replacement. Most publications originated in the US (36.9%) and more than 15% were published in the Journal of Arthroplasty. Conclusions. Analysis of publication patterns in robotic orthopaedic surgery allow us a unique insight into the qualities, characteristics, clinical innovations and advances in the evolution of RAA research

INTRODUCTION. In the United States, the Centers for Medicare and Medicaid Services consider rates of unplanned hospital readmissions to be indicators of provider quality. Understanding the common reasons for readmission following total joint arthroplasty will allow for improved standards of care and better outcomes for patients. The current study seeks to evaluate the rates, reasons, and Medicare costs for readmission after total hip and total knee arthroplasty. METHODS. This study used the Limited Data Set (LDS) from the Centers for Medicare and Medicaid Services (CMS) to identify all primary, elective Total Knee Arthroplasties (TKA) and Total Hip Arthroplasties (THA) performed from January 2013 through June 2016. The data were limited to Diagnosis-Related Group (DRG) 470, which is comprised of major joint replacements without major complications or comorbidities. Readmissions were classified by corresponding DRG. Readmission rates, causes, and associated Medicare Part A payments were aggregated over a ninety-day post-discharge period for 804,448 TKA and 409,844 THA. RESULTS. There were 31,172 readmissions in the ninety days following THA, for a readmission rate of 7.6%. There were 51,768 readmissions following TKA, for a readmission rate of 6.4%. The leading causes of readmission post-THA were revision of hip or knee replacement (17.66%); septicemia (4.76%); and postoperative infections (3.74%). The most common reasons for readmission post-TKA were postoperative infections (6.42%); septicemia (4.84%); and esophagitis (3.85%). In contrast to THA, implant revisions only accounted for 2.51% of readmissions after TKA. The mean cost of readmission post-THA was $11,682, while the mean cost of readmission post-TKA was $8,955. DISCUSSION AND CONCLUSION. Ninety-day readmission rates for both THA and TKA remained stable for the duration of the study period, suggesting the need for additional research on the efficacy of various programs intended to reduce the incidence of readmission

An expert panel of orthopaedic surgeons is going to be evaluating primary and revision total hip and total knee replacements submitted by the audience. Participants will present the x-rays and clinical findings of difficult cases for which they are seeking an expert opinion from the panel. The panel will probably have conflicting opinions which will lead to an entertaining and educational session. The moderator will also provide some extremely challenging cases once again, to stimulate more controversy. This session has been very popular in the past and is fast moving, humorous and educational

Contemporary crosslinked polymers didn't just happen. The material was, has, and continues to be studied more than any other bearing surface material used in the total hip and total knee replacement construct. Historical failures and successes provided the information needed to make it the success that it is today as we approach the end of the second decade of extensive use. Recognition that wear particles, not cement, was the major cause of osteolysis was important. Next, understanding that oxidation from free radical formation was deleterious to wear resistant polyethylene was understood and finally, that crosslinking was responsible for magnitude increases in wear resistance. Although manufacturers have developed multiple processes to develop their crosslinked polymers (gamma and e beam radiation, melting and annealing, and most recently the addition of antioxidants) there are excellent 10-year results demonstrating head penetration rates (indicative of wear and creep) in the 0.02 to 0.04 mm/year range for many materials with minimal if any detection of osteolysis on radiographs and close to 0% revised for wear at 10+ years. Are there any cautions? Recently, at 10- to 15-year follow up, some clinically insignificant osteolysis has been noted in one study and in that same study, 36 mm heads had twice the volumetric wear as 32 mm heads, but it was still a relatively low volume compared to the previous generation polyethylenes. We need further follow up, but at two decades of use, crosslinked polymers have dramatically reduced the osteolysis problem

An expert panel of orthopaedic surgeons is going to be evaluating primary and revision total hip and total knee replacements submitted by the audience. Participants will present the x-rays and clinical findings of difficult cases for which they are seeking an expert opinion from the panel. The panel will probably have conflicting opinions which will lead to an entertaining and educational session. The moderator will also provide some extremely challenging cases once again, to stimulate more controversy. This session has been very popular in the past and is fast moving, humorous and educational

An expert panel of orthopaedic surgeons is going to be evaluating primary and revision total hip and total knee replacements submitted by the audience. Participants will present the x-rays and clinical findings of difficult cases for which they are seeking an expert opinion from the panel. The panel will probably have conflicting opinions which will lead to an entertaining and educational session. The moderator will also provide some extremely challenging cases once again, to stimulate more controversy. This session has been very popular in the past and is fast moving, humorous and educational

Background. Readmission following any total joint arthroplasty has become a closely watched metric for many hospitals in the United States because financial penalties imposed by CMS for excessive readmissions occurring within thirty days of discharge has occurred since 2015. The purpose of this study was to identify both preoperative comorbidities associated with and postoperative reasons for readmission within thirty days following primary total joint arthroplasty in the lower extremity. Methods. Retrospective data was collected for patients who underwent elective primary total hip arthroplasty (CPT code 27130), total knee arthroplasty (27447), and total ankle arthroplasty (27702) from January 1, 2008, to December 31, 2013 at our institution. The sample was separated into readmitted and non-readmitted cohorts. Demographic variables, preoperative comorbidities, Charlson Comorbidities Index (CCI), operative parameters, readmission rates, and causes of readmission were compared between the groups using univariate and multivariate regression analysis. Results. There were 42 (3.4%), 28 (2.2%), and 1 (0.5%) readmissions within 30 days for THA, TKA, and TAA, respectively. The most common cause of readmission within 30 days following total joint arthroplasty in lower extremity was infection. Trauma was the second most common reason for readmission of a THA while wound dehiscence was the second most common cause for readmission following TKA. With univariate regression, there were multiple associated factors for readmission among total hip and total knee arthroplasty patients including BMI, metabolic equivalent (MET), and CCI. Multivariate regression revealed that hospital length of stay was significantly associated with 30-day readmission after THA and TKA. Conclusion. Patient co-morbidities and pre-operative functional capacity significantly affect 30-day readmission rate following total joint arthroplasty. Adjustments for these parameters should be considered when hospital penalties are calculated with regard to 30-day readmission. Level of Evidence. Level III; Retrospective cohort study

An expert panel of orthopaedic surgeons is going to be evaluating primary and revision total hip and total knee replacements submitted by the audience. Participants will present the x-rays and clinical findings of difficult cases for which they are seeking an expert opinion from the panel. The panel will probably have conflicting opinions which will lead to an entertaining and educational session. The moderator will also provide some extremely challenging cases once again, to stimulate more controversy. This session has been very popular in the past and is fast moving, humorous and educational