High-volume surgeons and hospital systems have been shown to deliver higher value care in several studies. However, no evidence-based volume thresholds for cost currently exist in total hip arthroplasty (THA). The objective of this study was to establish clinically meaningful volume thresholds based on cost for surgeons and hospitals performing THA. A secondary objective was to analyze the relative market share of THAs among the newly defined surgeon and hospital volume strata. Using 136,501 patients from the New York State Department of Health's SPARCS database undergoing total hip arthroplasty, we used stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve to generate volume thresholds predictive of increased costs for both surgeons and hospitals. Additionally, we examined the relative proportion of annual THA cases performed by each of these surgeon and hospital volume strata we had established.BACKGROUND
METHODS
The advent of value-based conscientiousness and rapid-recovery discharge pathways presents surgeons, hospitals, and payers with the challenge of providing the same total hip arthroplasty episode of care in the safest and most economic fashion for the same fee, despite patient differences. Various predictive analytic techniques have been applied to medical risk models, such as sepsis risk scores, but none have been applied or validated to the elective primary total hip arthroplasty (THA) setting for key payment-based metrics. The objective of this study was to develop and validate a predictive machine learning model using preoperative patient demographics for length of stay (LOS) after primary THA as the first step in identifying a patient-specific payment model (PSPM). Using 229,945 patients undergoing primary THA for osteoarthritis from an administrative database between 2009– 16, we created a naïve Bayesian model to forecast LOS after primary THA using a 3:2 split in which 60% of the available patient data “built” the algorithm and the remaining 40% of patients were used for “testing.” This process was iterated five times for algorithm refinement, and model performance was determined using the area under the receiver operating characteristic curve (AUC), percent accuracy, and positive predictive value. LOS was either grouped as 1–5 days or greater than 5 days.Background
Methods
Telerehabilitation has been shown to both promote effective recovery after shoulder arthroplasty and may improve adherence to treatment. Such systems require demonstration of feasibility, ease of use, efficacy, patient and clinician satisfaction, and overall cost of care, and much of this data has yet to be provided. Few augmented reality rehabilitation approaches have been developed to date. Evidence suggests augmented reality rehabilitation may be equivalent to conventional methods for adherence, improvement of function, and relief of pain seen in these musculoskeletal conditions. We proposed that the development of an augmented reality rehabilitation platform during the pre and postoperative period (including post-shoulder arthroplasty) could be used to track patient activity and range of motion as well as promote recovery. A prototype augmented reality platform equipped with a motion sensor system optimised for the upper arm was developed to be used to validate 4 arcs of shoulder motion and complete directed upper arm exercises designed for post-shoulder arthroplasty rehabilitation was built and tested. This system combined augmented reality instructions and motion tracking to follow patients over the course of their therapy, along with a telehealth patient-clinician interface.BACKGROUND
METHODS
The purpose of this observational study was to investigate and analyze the nature of the shared content of lower extremity total joint arthroplasty (TJA) patients on Instagram. Specifically, we evaluated: 1) perspective and timing of the social media posts (pre-, peri-, or post-operative); 2) tone of the post (positive or negative); 3) focus of the post (including activities of daily living (ADLs), rehabilitation, return-to-work (RTW)); and 4) compare these findings between hip and knee arthroplasties. A search of the public Instagram domain was performed over a 6 month period. Total hip and knee arthroplasty were selected for the analysis using the following terms: “#totalhipreplacement,” “#totalkneereplacement,” and associated terms. A total of 1,287 individual public posts of human subjects were shared during the period. A categorical scoring system was manually applied for media format (photo or video), time (pre-, peri- or post-operative) period, tone (positive or negative), RTW reference, ADLs reference, rehabilitation reference, surgical site reference, radiograph image, satisfaction and dissatisfaction references. The post perspective was recorded.Objectives
Methods
We have treated a total of 82 patients, 78 of them where men and 4 women, between 18 and 58 years old. Most of the patients were included in, first in the 40–50 (21 patients) and second in the 30-40 (26 patients) years-old range. Out of the 82 patients, 64 had ostheomyelitis, 10 arthritis and 8 soft tissue infection. The first localization for the ostheomyelitis has been in tibia (30 cases) and in femur (8 cases). The etiology is distributed in: 32 infections after osteosynthesis and 27 after an open fracture. The germs mostly isolated were Gram positives: Staphylococcus coagula negatives (21), staphylococcus methicillin-sensitive(14) y enterococcus (5); Gram negatives: Pseudomona aeruginosa (14), Serratia (3), Enterobacter (2).
