Advertisement for orthosearch.org.uk
Results 1 - 16 of 16
Results per page:
The Bone & Joint Journal
Vol. 103-B, Issue 6 Supple A | Pages 38 - 44
1 Jun 2021
DeMik DE Carender CN Glass NA Brown TS Callaghan JJ Bedard NA

Aims

The purpose of this study was to assess total knee arthroplasty (TKA) volume and rates of early complications in morbidly obese patients over the last decade, where the introduction of quality models influencing perioperative care pathways occurred.

Methods

Patients undergoing TKA between 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI < 40 kg/m2 and ≥ 40 kg/m2 and evaluated by the number of cases per year. The 30-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between groups using odds ratios (ORs) and multivariate analyses.


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 39 - 39
1 Oct 2020
DeMik DE Carender CN Glass NA Brown TS Bedard NA Callaghan JJ
Full Access

Introduction

Perioperative optimization efforts have improved outcomes following primary total knee arthroplasty (TKA). However, morbidly obese patients continue to have increased rates of complications. The purpose of this study was to assess if rates of early complications after TKA have similarly improved for both morbidly obese and non-morbidly obese patients.

Methods

Elective, primary TKA patients from 2011–2018 were identified in the National Surgical Quality Improvement Program database. Patients were stratified by body mass index (BMI) <40 kg/m2 and ≥40 kg/m2. Thirty-day rates of infectious complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between BMI groups utilizing odds ratios (OR) and multivariate analyses.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 18 - 18
1 Oct 2019
DeMik DE Bedard NA Carender CN Glass NA Callaghan JJ
Full Access

Introduction

There have been significant advancements in postoperative care following total hip arthroplasty (THA) over the past decade and it is essential to quantify the impact of efforts made to better optimize patients and improve postoperative care. The purpose of this study was to assess trends in discharge destination, length of stay (LOS), and readmissions following primary THA.

Methods

Patients undergoing primary THA during 2011–2017 were identified in the American College of Surgeons National Quality Improvement Program using CPT code 27130. Non-elective surgery and simultaneous bilateral THA procedures were excluded. Patients were classified as having discharged home or to not home locations. Trends in discharge destination, LOS, 30-day readmission, 30-day reoperation, and American Society of Anesthesiologists (ASA) classification were assessed using the Cochran-Armitage test.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 13 - 13
1 Oct 2019
Bedard NA DeMik DE Carender CN Browne JA Schwarzkopf R Callaghan JJ
Full Access

Introduction

In 2015, the healthcare system transitioned from International Classification of Diseases, Ninth Revision (ICD-9) coding to the Tenth Revision (ICD-10). Given that administrative claims are used for quality initiatives, risk adjustment models and clinical research, we sought to determine the effect of new, more detailed coding on the incidence of complications following primary total knee arthroplasty (TKA).

Methods

The Humana administrative claims database was queried from 2-years prior to October 1, 2015 (ICD-9 cohort) and for 1-year after this date (ICD-10 cohort) to identify all primary TKA procedures. Each TKA was then tracked for occurrence of an arthroplasty specific post-operative complication within 6 months of surgery using the respective coding systems. Laterality and joint specific codes were utilized for the ICD-10 cohort to ensure complications occurred on the same side and joint as the index procedure. Incidence of each complication was compared between cohorts using risk ratios (RR) and 95% confidence intervals.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_13 | Pages 27 - 27
1 Oct 2018
Callaghan JJ DeMik DE Bedard NA Dowdle SB Elkins J Brown TS Gao Y
Full Access

Purpose

Obesity has previously been demonstrated to be an independent risk factor for increased complications following total hip (THA) and total knee arthroplasty (TKA). The purpose of this study was to compare the effects of obesity and BMI to determine whether the magnitude of the effect was similar for both procedures.

Materials & Methods

We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients who underwent primary THA or TKA between 2010 and 2014. Patients were stratified by procedure and classified as non-obese, obese, or morbidly obese according to BMI. Thirty-day rates of wound complications, deep infection, total complications, and reoperation were compared using univariate and multivariate logistic regression analyses.


The Bone & Joint Journal
Vol. 100-B, Issue 7 | Pages 829 - 830
1 Jul 2018
Callaghan JJ Haddad FS


The Bone & Joint Journal
Vol. 100-B, Issue 1_Supple_A | Pages 62 - 67
1 Jan 2018
Bedard NA DeMik DE Dowdle SB Callaghan JJ

Aims

The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Materials and Methods

We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA.


The Bone & Joint Journal
Vol. 99-B, Issue 5 | Pages 585 - 591
1 May 2017
Buckland AJ Puvanesarajah V Vigdorchik J Schwarzkopf R Jain A Klineberg EO Hart RA Callaghan JJ Hassanzadeh H

Aims

Lumbar fusion is known to reduce the variation in pelvic tilt between standing and sitting. A flexible lumbo-pelvic unit increases the stability of total hip arthroplasty (THA) when seated by increasing anterior clearance and acetabular anteversion, thereby preventing impingement of the prosthesis. Lumbar fusion may eliminate this protective pelvic movement. The effect of lumbar fusion on the stability of total hip arthroplasty has not previously been investigated.

Patients and Methods

The Medicare database was searched for patients who had undergone THA and spinal fusion between 2005 and 2012. PearlDiver software was used to query the database by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedural code for primary THA and lumbar spinal fusion. Patients who had undergone both lumbar fusion and THA were then divided into three groups: 1 to 2 levels, 3 to 7 levels and 8+ levels of fusion. The rate of dislocation in each group was established using ICD-9-CM codes. Patients who underwent THA without spinal fusion were used as a control group. Statistical significant difference between groups was tested using the chi-squared test, and significance set at p < 0.05.


The Bone & Joint Journal
Vol. 99-B, Issue 1_Supple_A | Pages 14 - 17
1 Jan 2017
Carlson SW Liu SS Callaghan JJ

Aims

The aim of this study was to compare the survivorship and radiographic outcomes at ten-year follow-up of three prospective consecutive series of patients each of which received a different design of cementless femoral components for total hip arthroplasty (THA).

Patients and Methods

In Cohort 1, 91 consecutive patients (100 hips) underwent THA with a cementless porous-coated anatomic femoral stem (PCA) between October 1983 and January 1986. In Cohort 2, 86 consecutive patients (100 hips) underwent THA with an extensively porous-coated cementless femoral stem (Prodigy) between June 1994 and October 1997. In Cohort 3, 88 consecutive patients (100 hips) underwent THA with a proximally porous-coated triple-tapered cementless stem (Summit) between April 2002 and October 2003. All three groups underwent prospective clinical and radiographic evaluation.


The Bone & Joint Journal
Vol. 96-B, Issue 11_Supple_A | Pages 70 - 72
1 Nov 2014
Callaghan JJ Liu SS Phruetthiphat O

A common situation presenting to the orthopaedic surgeon today is a worn acetabular liner with substantial acetabular and pelvic osteolysis. The surgeon has many options for dealing with osteolytic defects. These include allograft, calcium based substitutes, demineralised bone matrix, or combinations of these options with or without addition of platelet rich plasma. To date there are no clinical studies to determine the efficacy of using bone-stimulating materials in osteolytic defects at the time of revision surgery and there are surprisingly few studies demonstrating the clinical efficacy of these treatment options. Even when radiographs appear to demonstrate incorporation of graft material CT studies have shown that incorporation is incomplete. The surgeon, in choosing a graft material for a surgical procedure must take into account the efficacy, safety, cost and convenience of that material.

Cite this article: Bone Joint J 2014;96-B (11 Suppl A):70–2.


The Bone & Joint Journal
Vol. 95-B, Issue 11_Supple_A | Pages 41 - 45
1 Nov 2013
Zywiel MG Mont MA Callaghan JJ Clohisy JC Kosashvili Y Backstein D Gross AE

Down’s syndrome is associated with a number of musculoskeletal abnormalities, some of which predispose patients to early symptomatic arthritis of the hip. The purpose of the present study was to review the general and hip-specific factors potentially compromising total hip replacement (THR) in patients with Down’s syndrome, as well as to summarise both the surgical techniques that may anticipate the potential adverse impact of these factors and the clinical results reported to date. A search of the literature was performed, and the findings further informed by the authors’ clinical experience, as well as that of the hip replacement in Down Syndrome study group. The general factors identified include a high incidence of ligamentous laxity, as well as associated muscle hypotonia and gait abnormalities. Hip-specific factors include: a high incidence of hip dysplasia, as well as a number of other acetabular, femoral and combined femoroacetabular anatomical variations. Four studies encompassing 42 hips, which reported the clinical outcomes of THR in patients with Down’s syndrome, were identified. All patients were successfully treated with standard acetabular and femoral components. The use of supplementary acetabular screw fixation to enhance component stability was frequently reported. The use of constrained liners to treat intra-operative instability occurred in eight hips. Survival rates of between 81% and 100% at a mean follow-up of 105 months (6 to 292) are encouraging. Overall, while THR in patients with Down’s syndrome does present some unique challenges, the overall clinical results are good, providing these patients with reliable pain relief and good function.

Cite this article: Bone Joint J 2013;95-B, Supple A:41–5.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 11_Supple_A | Pages 19 - 21
1 Nov 2012
Callaghan JJ Liu SS Haidukewych GJ

Options for the treatment of subcapital femoral neck fractures basically fall into two categories: internal fixation or arthroplasty (either hemiarthroplasty or total hip arthroplasty). Historically, the treatment option has been driven by a diagnosis-related approach (non-displaced neck fractures versus displaced neck fractures). More recently, the traditional paradigm has changed. Instead of a diagnosis-related approach, it has become more of a patient-related approach. Treatment options take in to consideration the patient’s age, functional demands, and individual risk profile. A simple algorithm can be helpful in terms of directing the treatment. Non-displaced fractures, regardless of age of the patient, should be treated with closed reduction and internal fixation. For displaced femoral neck fractures, the treatment differs depending on the age of the patient. The younger patient should be treated with urgent ORIF with the goal of an anatomic reduction. For displaced femoral neck fractures in the elderly, cognitive function should be determined. For those who are cognitively functioning, total hip arthroplasty appears to be the best option. In the cognitively dysfunctional, a bipolar hemiarthroplasty or a total hip arthroplasty with use of larger heads (32 mm or 36 mm) and/or constrained sockets are a viable option.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 16 - 16
1 Mar 2010
Callaghan JJ Piyaworakhun S Liu S Goetz D Johnston R
Full Access

Purpose: To our knowledge, there are no 35 year follow-up studies of the Charnley total hip arthroplasty in the United States. The purpose of the study was to evaluate the results of a single surgeon series of primary Charnley total hip arthroplasties performed with cement at a minimum 35 year follow-up interval.

Method: Between July 1970 and April 1972, the senior author performed 330 Charnley total hip replacements with cement using a hand-packing cement technique. At minimum 35 years post-operatively, 13 patients (16 hips) were alive, with 1 patient (1 hip) lost to follow-up. Living patients were evaluated clinically with a standard terminology questionnaire, and WOMAC. Radiographic evaluation included loosening, lysis, and need for reoperation.

Results: After a minimum 35 year follow-up, only 25 (8%) acetabular components and 10 (3%) femoral components revised for aseptic loosening. For the 16 hips in living patients, 7 acetabular components (44%) and 2 femoral component (12%) were revised for aseptic loosening. Overall, 87% of the original prosthesis remains intact at the time of final follow-up, or at the time of the patient’s death. The average linear wear rate for all patients with minimum 10 year radiographic follow-up was 0.09 mm/year.

Conclusion: Our follow-up study at a minimum 35 years following Charnley total hip arthroplasty with cement demonstrates the remarkable durability of the procedure. As demonstrated in this study, the long term challenge has been revisions associated with bearing surface wear. This study should provide a benchmark for comparison to follow-up studies of other procedures and devices as they reach this interval of follow-up.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 16 - 16
1 Mar 2010
Callaghan JJ Hennessy D Liu S
Full Access

Purpose: The original AML prosthesis was fully coated and later the manufacturer switched it to 5/8ths coating. The second generation Prodigy femoral component was developed to return to full coating of the prosthesis and to provide a medial relief to decrease bone stress shielding. The purpose of this study was to evaluate the minimum ten year results using this device and to compare the results to the same surgeon’s results at 10 years using a first generation proximally coated device.

Method: 100 consecutive primary total hip replacements were performed by a single surgeon in 86 patients using the Prodigy (DePuy, Warsaw, Indiana) femoral component between 1994 and 1997. The components were mated with 80 HGI and 20 Duraloc acetabular components. Patients were evaluated with WOMAC ratings, need for revision and radiographic loosening. The same parameters had been evaluated at minimum 10-year follow-up for the same surgeon’s initial 100 consecutive PCA (Stryker, New Jersey) primary THR’s and were compared to the present series.

Results: At minimum 10 year follow-up, 71 patients with 83 hips were living. The average clinical follow-up for the living patients was 11 years (range 10 to 12 years) and the average radiographic follow-up was 9.2 years for this group (range 7–12 years). No femoral component was revised for loosening and all femoral components were bone ingrown on radiographs. 7 acetabular components required a liner exchange or revision for polyethylene wear. This compares favorably to the same surgeon’s 10 year results with the PCA where 6 femoral components were revised for wear or loosening and an additional 2 were radiographically loose.

Conclusion: The Prodigy femoral component demonstrated excellent durability at 10 years. With the newer cementless stems with a wide variety of sizes, femoral loosening is rarely a clinical problem.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 24 - 24
1 Mar 2010
Callaghan JJ Malin A Bozic K Liu S Goetz D Sullivan N Kelley S
Full Access

Purpose: Few reports are available at minimum 15 year follow-up of cemented modular cruciate retaining TKA, especially where all polyethylene patella components were utilized. This paper addresses the questions “What is the durability of cemented modular cruciate retaining TKA with all polyethylene patella components at 15 years?” and “Did modular tibial trays demonstrate their utility in terms of the potential for less costly and less complex revisions?”

Method: 101 Press Fit Condylar TKA’s were performed consecutively over a 27 month interval and followed prospectively for a minimum of 15 years. The average age at surgery was 72 years. Clinical Knee Society scores, need for revision, radiographic evidence of loosening, and osteolysis were recorded. All patients were recalled at 5 year intervals.

Results: At minimum 15 year follow-up, 34 patients with 45 knees were living and 40 patients with 54 knees were deceased (one patient [2 knees] was lost to follow-up). 81% of living patients had 15 year radiographs. 6 knees were revised (all related to wear and osteolysis). Average Knee Society clinical scores only deteroriated from 92 points to 89 points between 10 and 15 years.

Conclusion: This cemented modular CR TKA performed well at 15 years with only 6% of knees requiring revision. All revisions occurred after 10 years and were related to wear and osteolysis. 2/3 of the revisions could be salvaged without tibial component revision in this closely followed series. Hopefully these results can be improved with better wear-resistant designs and better quality polyethylene. Especially into the second decade, patients with modular tibial tray TKA constructs should be closely followed to optimize their utility allowing less costly and less complex revisions in cases with polyethylene wear.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 2 | Pages 322 - 326
1 Mar 1997
Katz RP Callaghan JJ Sullivan PM Johnston RC

We performed 83 consecutive cemented revision total hip arthroplasties in 77 patients between 1977 and 1983 using improved cementing techniques. One patient (two hips) was lost to follow-up. The remaining 76 patients (81 hips) had an average age at revision of 63.7 years (23 to 89).

At the final follow-up 18 hips (22%) had had a reoperation, two (2.5%) for sepsis, three (4%) for dislocation and 13 (16%) for aseptic loosening. The incidence of rerevision for aseptic femoral loosening was 5.4% and for aseptic acetabular loosening 16%. These results confirm that cemented femoral revision is a durable option in revision hip surgery when improved cementing techniques are used, but that cemented acetabular revision is unsatisfactory.