Publications by authors named "Brett L Hayden"
Objective: Prehabilitation may have benefits for total hip arthroplasty (THA) and total knee arthroplasty (TKA), given an aging population with multimorbidity and the growth of value-based programs that focus on reducing postoperative costs. We aimed to describe prehabilitation use and examine predictors of utilization in fee-for-service Medicare beneficiaries.
Methods: This retrospective cohort study using the Medicare Limited Data Set included fee-for-service Medicare beneficiaries who were ≥ 66 years old and who underwent inpatient elective THA or TKA between January 1, 2016, and September 30, 2021.
Introduction: Previous research has indicated language-based disparities in outcomes after total hip and knee arthroplasty. In this study, we examined the relationship between primary spoken language and outcomes and patient engagement process metrics in a multihospital academic health system.
Methods: This retrospective cohort study included patients who underwent elective primary total hip or knee arthroplasty in 2018 to 2022.
Evaluating the Readability, Credibility, and Quality of Spanish-Language Online Educational Resources for Knee Arthroplasty: Implications for Patient Education and Health Disparities.
J Am Acad Orthop Surg
October 2024
Article Synopsis
- Spanish-speaking patients face challenges accessing reliable and understandable information about knee replacement surgery online, highlighting disparities in healthcare education.
- A study analyzed the top 50 Spanish-language websites on knee replacement from three search engines, assessing them for readability, credibility, and quality, revealing that most websites were difficult to read and lacked credibility.
- University-affiliated websites tended to offer better readability and credibility compared to community hospital sites, but overall, many resources did not meet the ideal educational standards, emphasizing the need for improved patient education tools.
Article Synopsis
- Research on patellar resurfacing in total knee arthroplasty (TKA) shows mixed results, prompting an analysis of statistical fragility using measures like fragility index (FI) and fragility quotient (FQ).
- A systematic review of RCTs revealed 19 relevant studies, finding that significant outcomes had a median FI of 3, while nonsignificant outcomes had a median reverse FI (rFI) of 5.
- The study concluded that outcomes related to patellar resurfacing are statistically fragile, especially those involving patient satisfaction and anterior knee pain, indicating that current data remains inconclusive.
Background: Prehabilitation has potential to improve outcomes in value-based care models. We examined the associations between the receipt of prehabilitation (physical therapy [PT] services within 30 days preoperatively) and postoperative healthcare utilization in a national cohort of fee-for-service Medicare beneficiaries.
Methods: This retrospective cohort study used the 5% fee-for-service claims from the Medicare limited data set to identify unilateral elective inpatient total hip arthroplasty (THA) procedures (n = 25,509) and total knee arthroplasty (TKA) procedures (n = 40,091) from January 1, 2016 to September 30, 2021.
Article Synopsis
- Girdlestone resection arthroplasty (GRA) is an option for patients unable to have prosthesis reimplantation due to infection, and this study investigates factors influencing reimplantation using a large database from 2012-2015.
- Out of 2,772 GRA cases, 73.1% were successfully reimplanted, with a median reimplantation time of 3 months, and factors like age, race, obesity, and comorbidities negatively impacted the likelihood of reimplantation.
- The study highlights that male patients had higher odds for reimplantation, suggesting a need for further research into the reasons behind the variability in patient outcomes after GRA.
Article Synopsis
- - The study investigates the effects of preoperative bisphosphonate (BP) therapy on surgical outcomes for total hip arthroplasty (THA) patients, utilizing national health data from 2016 to 2020.
- - Of almost 92,000 THA patients analyzed, only 1.1% had used BP prior to surgery, but this group showed significantly higher odds of needing revision surgeries and experiencing periprosthetic fractures within one year post-operation.
- - The results highlight that patients taking BP before THA may face more complications, suggesting that healthcare providers should consider this when planning surgeries and advising patients.
Is Limited English Proficiency Associated With Differences in Care Processes and Treatment Outcomes in Patients Undergoing Orthopaedic Surgery? A Systematic Review.
Clin Orthop Relat Res
August 2024
Article Synopsis
- * The systematic review aims to investigate the links between limited English proficiency and differences in clinical care processes, patient engagement, and treatment outcomes for orthopaedic surgery patients in English-speaking countries.
- * A thorough search yielded 29 peer-reviewed studies covering over 362,746 patients, focusing on various aspects of clinical care and outcomes, with an evaluation of study quality revealing issues in about half of the included research.
Treating tibial bone defects in the setting of recalcitrant native knee arthritis presents a challenging biomechanical problem for orthopaedic surgeons. A dynamic antibiotic spacer offers an effective solution to preserve patient function and manage infection. However, severe bone loss may compromise the fixation of the dynamic spacer.
View Article and Find Full Text PDFArticle Synopsis
- The study examined the impact of the Comprehensive Care for Joint Replacement (CJR) bundled payment program on home health and outpatient physical therapy (PT) for patients after hip or knee surgeries between two time periods.
- Using national Medicare data, researchers compared outcomes from before the program's implementation (Jan 2013-Sept 2015) to after (Oct 2016-Sept 2019).
- Results showed an increase in home health PT use but fewer visits per episode for both total hip and knee arthroplasties, while outpatient PT visits for knee surgeries slightly increased, highlighting potential issues with care coordination.
Article Synopsis
- A nationwide study evaluated current practices for oral antibiotic prophylaxis prescriptions in outpatient total hip (THA) and knee arthroplasties (TKA) from 2018 to 2021, based on a claims database of patients aged 18 to 64.
- Among 73,015 procedures, only 16.5% received oral antibiotics, primarily using cephalosporins like cephalexin and cefadroxil.
- Factors associated with higher antibiotic prescribing included undergoing THA versus TKA, having certain medical conditions (obesity, diabetes, autoimmune disorders), and procedures performed in ambulatory surgery centers versus hospitals.
Article Synopsis
- Online resources for patient self-education highlight a significant public interest in different surgical approaches to total hip arthroplasty (THA), mainly the direct anterior approach (DAA) and the posterior approach (PA).
- An analysis of the top questions from Google's "People Also Ask" revealed a higher percentage of inquiries related to DAA, with notable differences in the types of information sought, particularly concerning recovery, management, and technical details.
- The credibility and quality of information across websites were generally low, with DAA websites performing particularly poorly, while comparison websites scored better in terms of quality, despite both approaches being written at a complex reading level.
Article Synopsis
- Randomized controlled trials (RCTs) are considered the most reliable evidence in orthopedic surgery, but their statistical findings can sometimes lack stability, which this study aimed to investigate using fragility metrics.
- The researchers analyzed 108 RCTs on tranexamic acid (TXA) in orthopedic surgery, finding that many outcomes are "fragile" and small changes could affect their statistical significance.
- The study suggests using fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to better interpret the results of these trials in the future.
Article Synopsis
- This study analyzes the fragility of outcomes in orthopaedic research, particularly regarding periprosthetic joint infection (PJI) in total joint arthroplasty randomized controlled trials (RCTs) published from 2010 to 2022.
- It utilizes the fragility index (FI) and fragility quotient (FQ) to assess how many event reversals are needed to change the significance of the outcomes and reveals that many outcomes are statistically weak.
- The findings highlight the importance of conducting fragility analyses to better interpret outcomes in orthopaedic studies, indicating that many reported results may not be statistically robust.
Article Synopsis
- Adverse local tissue reactions are common in total hip arthroplasty, but there are limited reports regarding them in total knee arthroplasty and none for distal femoral replacements.
- A case of a 69-year-old woman with knee pain after complex knee surgery revealed significant corrosion at critical junctions of her knee implant.
- Manual cleaning and replacement of modular components were necessary, highlighting the need to consider corrosion as a potential cause of knee pain in patients with distal femoral replacements.*
Article Synopsis
- The study explores the impact of COVID-19 on the rates of venous thromboembolism (VTE) after total hip and knee surgeries from 2016 to 2021.
- It found that while overall VTE rates decreased during this period, prior COVID-19 infections increased the risk of VTE specifically in total knee arthroplasty patients, but not in total hip arthroplasty patients.
- The authors emphasize the need for continued monitoring of VTE trends and the effects of COVID-19 variants and vaccination rates on surgical outcomes.
Article Synopsis
- A study examined the impact of preoperative corticosteroid and hyaluronic acid injections on the risk of postoperative infections in total knee (TKA) and hip arthroplasty (THA) procedures.
- The research analyzed data from over 600,000 surgeries and found that receiving more than two corticosteroid injections before THA was linked to a higher risk of infections within 90 days post-surgery.
- The findings recommend that patients should limit corticosteroid injections to two or fewer within two years prior to hip surgery to reduce infection risks, while similar associations were not found for knee surgeries.
Article Synopsis
- This study investigated sleep disturbances in patients undergoing total joint arthroplasty (TJA) and tracked changes over three months post-surgery, focusing on how preoperative sleep condition influences recovery.
- Results showed that the percentage of patients reporting normal sleep increased from 54.8% preoperatively to 71.8% by three months, with specific patterns in sleep quality changes depending on initial sleep issues.
- Key findings indicated that patients who had moderate to severe preoperative sleep impairment experienced significant improvement in sleep by two weeks post-surgery, and those having total hip arthroplasty were more likely to see notable sleep enhancements.
Background: Osteonecrosis of the femoral head is a common indication for total hip arthroplasty (THA). It is unclear to what extent the COVID-19 pandemic has impacted its incidence. Theoretically, the combination of microvascular thromboses and corticosteroid use in patients who have COVID-19 may increase the risk of osteonecrosis.
View Article and Find Full Text PDFRationale: Preoperative patient education through 'joint class' has potential to improve quality of care for total joint replacement (TJR). However, no formal guidance exists regarding curriculum content, potentially resulting in inter-institutional variation.
Objective: We aimed to (a) synthesize curriculum components of 'joint classes' across high-volume institutions and (b) develop a preliminary theory of change model for development and evaluation guided by the existing curricula and related literature.
Article Synopsis
- The study focuses on evaluating the statistical fragility of randomized controlled trials (RCTs) related to tourniquet use in total knee arthroplasty (TKA), particularly how P-values are used to inform clinical decisions.
- Investigators analyzed data from 23 studies, calculating the fragility index (FI) and fragility quotient (FQ) to determine how many outcome reversals would affect the significance of their findings, revealing an overall median FI of 4.
- The results suggest that minor changes in outcomes can significantly alter study conclusions, highlighting the importance of fragility analyses for enhancing the reliability of research interpretations in clinical settings.
Background: Poor preoperative mental health has been associated with worse outcomes after total hip (THA) and total knee arthroplasty (TKA). To fully understand these relationships, we assessed post-THA and post-TKA improvements in patient-reported mental and joint health by preoperative mental health groups.
Methods: Elective cases (367 THA, 462 TKA) were subgrouped by low (<25th percentile), middle (25th-74th), and high (≥75th) preoperative mental health, using Veterans RAND 12-Item Health Survey Mental Component Summary (MCS) scores.
Article Synopsis
- Prosthetic joint infection (PJI) is a rare complication after unicompartmental knee arthroplasty (UKA), and there’s limited research on how to manage it.
- A systematic review analyzed treatment patterns for PJI cases following UKA, evaluating the failure rates associated with different treatments.
- The review identified 97 PJI cases with various treatment methods, finding that debridement, antibiotics, and implant retention (DAIR) were the most common, but no significant differences in failure rates among treatment options were observed, indicating a need for further research.