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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_12 | Pages 15 - 15
1 Oct 2019
Plate JF Ryan SP Black C Howell CB Jiranek WA Bolognesi MP Seyler TM
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Introduction

Alternative payment models for total hip arthroplasty (THA) were initiated by the Center for Medicare and Medicaid Services (CMS) to decrease overall healthcare cost by optimizing healthcare delivery. The associated shift of financial risk to participating institutions has been criticized to introduce patient selection in order to avoid potentially high cost of care. This study aimed to evaluate the impact of the Comprehensive Care for Joint Replacement (CJR) model on patient selection, care delivery and hospital costs at a single care center.

Methods

This is a retrospective review of THA patient from July 2015-December 2017 was performed. Patient were stratified by insurance type (Medicare and commercial insurance) and whether care was provided before or after implementation of the CJR bundle. Patient age, gender, and BMI, as well as Elixhauser comorbidities and ASA scores were analyzed. Delivery of care variables including surgery duration, discharge disposition, length of stay, and direct hospital costs were compared before and after CJR implementation.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 43 - 43
1 Oct 2019
Ryan SP Plate JF Black C Howell C Jiranek W Bolognesi MP Seyler TM
Full Access

Introduction

Bundled reimbursement models for total knee arthroplasty (TKA) by the Center for Medicare and Medicaid Services (CMS) have resulted in an effort to decrease the cost of care. However, these models may incentivize bias in patient selection to avoid excess cost of care. We sought to determine the impact of the Comprehensive Care for Joint Replacement (CJR) model at a single center.

Methods

This is a retrospective review of primary TKA patients from July 2015-December 2017. Patients were stratified by whether or not their surgery was performed before or after implementation of the CJR bundle. Patient demographic data including age, sex, and BMI were collected in addition to Elixhauser comorbidities and ASA score. In-hospital outcomes were then examined including surgery duration, length of stay, discharge disposition, and direct cost of care.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 91 - 91
1 Dec 2013
Plate JF Augart MA Bracey D Von Thaer S Allen J Sun D Poehling G Jinnah R
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Introduction

There has been renewed interest in the use of unicompartmental knee arthroplasty (UKA) for patients with limited degenerative disease of the knee due to improved surgical techniques and prosthetic design, and the desire for minimally invasive surgery. However, patient satisfaction following UKA for lateral compartment disease have been suboptimal with increased revision rates. Robotic-assisted UKA has been shown to improve precision and accuracy of component placement, which may improve outcomes of lateral UKA. The purpose of this study was to compare the outcome of robotic-assisted UKA to conventional UKA for degenerative disease of the lateral compartment with the hypothesis that robotic-assisted lateral UKA results in superior outcomes compared to conventional UKA.

Methods

The institution's joint registry was searched for patients who underwent UKA for limited degenerative disease of the lateral knee compartment between 2004 and 2012 and a total of 125 lateral UKAs were identified. The medical records of all patients were reviewed and assessed for the type of surgical procedure used (robotic-assisted versus conventional), length of hospital stay, Oxford knee score, and occurrence of revision surgery. Preoperative and postoperative radiographs were assessed for tibiofemoral angle, femoral and tibial joint line angle, posterior tibial slope, and orientation of the femoral and tibial components.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 549 - 549
1 Dec 2013
Tamam C Plate JF Augart MA Von Thaer S Allen J Poehling GG Jinnah R
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Introduction:

Unicompartmental knee arthroplasty (UKA) has gained renewed interest in recent years as an alternative to total knee arthroplasty (TKA) for limited degenerative disease of the knee. However, recurrence of symptoms may be seen, compromising long-term survivorship. Arthroscopy has been used to for diagnosing and treating symptoms in problematic TKA. The aim of this study was to investigate the outcome of arthroscopic procedures in symptomatic UKA. We hypothesized that arthroscopy is a viable tool in diagnosing and treating patients with recurrent symptoms after UKA and identifying patients that will benefit from revision surgery.

Methods:

A search of the institution's joint registry was conducted to identify patients who underwent arthroscopy following UKA between 2003 and 2011. Medical records were analyzed for patient demographics and comorbidities. Clinical results following arthroscopy were evaluated using the Oxford Knee Score. All patient radiograph were assessed for component alignment and loosening.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 181 - 181
1 Dec 2013
Tamam C Plate JF Augart MA Poehling G Jinnah R
Full Access

Introduction

Bicompartmental knee replacement (BKR) may be an alternative to total knee arthroplasty (TKA) for degenerative disease limited to two knee compartments. Most commonly, BKA is a combination of medial compartment and patellofemoral compartment resurfacing. In contrast to TKA, BKA preserves the uninvolved compartment and cruciate ligaments possibly leading to advanced stability and more physiologic knee kinematics. Robotic-assisted systems for unicompartmental knee arthroplasty have shown to provide improved component positioning with dynamic ligament balancing that may improve outcomes of BKA. The purpose of this study was to evaluate the short-term outcomes of patients undergoing BKA at a single institution by a single surgeon using a robotic-assisted system.

Methods

A search of the institution's joint registry was conducted to identify patients that underwent robotic-assisted BKA of the patellofemoral compartment and the medial or lateral compartment between December 2009 and April 2012. All medical records were analyzed for patient demographics and comorbidities. The patients were evaluated preoperatively and at 6,12 months and then annually. The patients were contacted by phone when recent follow-up was not available. The radiographic assessment was also undertaken. The orientation of the tibial and femoral implants was assessed radiologically postoperatively. We examined the clinical results with the Oxford Knee Score (OKS)


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 87 - 87
1 Mar 2013
Plate JF Poehling G Lang J Jinnah R
Full Access

Introduction

Unicompartmental knee arthroplasty (UKA) has seen renewed interest in recent years and is a viable option for patients with limited degenerative disease of the knee as an alternative to total knee arthroplasty. However, the minimally invasive UKA procedure is challenging and accurate component alignment is vital to long-term survival. Robotic-assisted UKA allows for greater accuracy of component placement and dynamic intraoperative ligament balancing which may improve clinical patient outcomes. The purpose of this study was to examine the clinical outcomes in a large, consecutive cohort of patients that underwent robotic-assisted UKA.

Materials and Methods

A search of the institutional joint arthroplasty registry identified 507 patients with a mean age of 63 years (range, 28 to 88 years) who underwent robotic-assisted UKA between July 2008 and June 2010. Clinical outcomes were evaluated using the Oxford Knee Score and patients without recent follow-up were contacted by telephone. The revision rate and time to revision were also examined.