Association of Geographic Social Vulnerability with Race-Based Differences in the Utilization of Total Hip Arthroplasty Surgeries for Medicare Beneficiaries.

Background: Racial disparities exist in the utilization of total hip arthroplasties (THAs). The social vulnerability index (SVI), which measures geographic-level disadvantage and includes themes such as socioeconomic status, minority status, and language, may partially explain disparities in THA use. Our objectives were to determine the association of the composite SVI with THA use for (i) White Medicare beneficiaries, (ii) Black Medicare beneficiaries, and (iii) the difference in THA use between White and Black beneficiaries.

Hospital Network Centralization of Primary Total Joint Arthroplasty Is Associated With Reduced Early Complication Rates But Not Reduced Readmission or Reoperation Rates: A Retrospective Database Study.

Background: Hospital networks centralize primary total joint arthroplasty (TJA) within their existing systems to develop specialized service lines with higher surgical volumes to reduce adverse events. It is not known what role hospital network centralization has had on primary TJA outcomes.

Purpose: We sought to determine whether the degree of hospital network centralization for primary TJA is associated with (1) 90-day postoperative complication rates, (2) 90-day hospital readmission rates, or (3) 1-year revision rates.

Cutibacterium acnes invades submicron osteocyte lacuno-canalicular networks following implant-associated osteomyelitis.

Cutibacterium acnes, part of normal skin flora, is increasingly recognized as an opportunistic pathogen capable of causing chronic prosthetic joint infections (PJI) associated with total hip and knee arthroplasty. However, there is a paucity of literature examining the pathogenesis of C. acnes during PJI.

Are Quality Scores in the Centers for Medicaid and Medicare Services Merit-based Incentive Payment System Associated With Outcomes After Outpatient Orthopaedic Surgery?

Background: The Medicare Merit-based Incentive Payment System (MIPS) ties reimbursement incentives to clinician performance to improve healthcare quality. It is unclear whether the MIPS quality score can accurately distinguish between high-performing and low-performing clinicians.

Questions/purposes: (1) What were the rates of unplanned hospital visits (emergency department visits, observation stays, or unplanned admissions) within 7, 30, and 90 days of outpatient orthopaedic surgery among Medicare beneficiaries? (2) Was there any association of MIPS quality scores with the risk of an unplanned hospital visit (emergency department visits, observation stays, or unplanned admissions)?

Methods: Between January 2018 and December 2019, a total of 605,946 outpatient orthopaedic surgeries were performed in New York State according to the New York Statewide Planning and Research Cooperative System database.

Short-Term (6 Months or Less) Pain in Cemented versus Cementless Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Cementless total knee arthroplasty (TKA) has increased in popularity to potentially improve survivorship. Radiostereometric studies demonstrate increased component migration during the first 3 to 6 months in cementless constructs, generating concern for increased postoperative pain during early osseointegration. The purpose of this study was to evaluate short-term (≤ 6 months) pain and function in cemented versus cementless TKA.

Incidence and Risk Factors for Revision Within 1 Year of Primary Carpal Tunnel Release.

Background: The annual volume of carpal tunnel release (CTR) in the United States has been estimated to be 577 000 per year. Our objectives were to evaluate the incidence and risk factors for revision CTR within 1 year of primary CTR.

Methods: We identified all adult patients undergoing primary CTR from October 2015 to September 2019 in the New York Statewide Planning and Research Cooperative System database using () codes.

Association of race and ethnicity with opioid prescribing for Medicare beneficiaries following total joint replacements.

Background: Profound racial and ethnic disparities exist in the use and outcomes of total hip/knee replacements (total joint replacements [TJR]). Whether similar disparities extend to post-TJR pain management remains unknown. Our objective is to examine the association of race and ethnicity with opioid fills following elective TJRs for White, Black, and Hispanic Medicare beneficiaries.

Disparities in the Epidemiology and Management of Fragility Hip Fractures.

Purpose Of Review: The purpose of this review is to synthesize the recently published scientific evidence on disparities in epidemiology and management of fragility hip fractures.

Recent Findings: There have been a number of investigations focusing on the presence of disparities in the epidemiology and management of fragility hip fractures. Race-, sex-, geographic-, socioeconomic-, and comorbidity-based disparities have been the primary focus of these investigations.

Association of Total Knee Replacement Removal From the Inpatient-Only List With Outpatient Surgery Utilization and Outcomes in Medicare Patients.

Importance: Little is known about the association of total knee replacement (TKR) removal from the Medicare inpatient-only (IPO) list in 2018 with outcomes in Medicare patients.

Objective: To evaluate (1) patient factors associated with outpatient TKR use and (2) whether the IPO policy was associated with changes in postoperative outcomes for patients undergoing TKR.

Design, Setting, And Participants: This cohort study included data from administrative claims from the New York Statewide Planning and Research Cooperative System.

Using MaxDiff Analysis to Elicit Patients' Treatment Preferences for Distal Radius Fractures in Patients Aged 60 Years and Older.

Purpose: The objective of our study was to determine how the attributes of surgical and nonsurgical distal radius fracture (DRF) treatments affect patient treatment preferences.

Methods: Two hundred fifty patients aged 60 years and older were contacted from a single-hand surgeon's practice, and 172 chose to participate. We built a series of best-worst scaling experiments for the MaxDiff analysis to determine the relative importance of treatment attributes.

What Factors Are Associated With Revision Cubital Tunnel Release Within 3 Years?

Background: It has been shown that patient demographics such as age, payer factors such as insurance type, clinical characteristics such as preoperative opioid use, and disease grade but not surgical procedure are associated with revision surgery to treat cubital tunnel syndrome. However, prior studies evaluating factors associated with revision surgery after primary cubital tunnel release have been relatively small and have involved patients from a single institution or included only a single payer.

Questions/purposes: (1) What percentage of patients who underwent cubital tunnel release underwent revision within 3 years? (2) What factors are associated with revision cubital tunnel release within 3 years of primary cubital tunnel release?

Methods: We identified all adult patients who underwent primary cubital tunnel release from January 1, 2011, to December 31, 2017, in the New York Statewide Planning and Research Cooperative System database using Current Procedural Terminology codes.

Risk Factors for Failed Nonsurgical Treatment Resulting in Surgery on Thumb Carpometacarpal Arthritis.

Purpose: The thumb carpometacarpal (CMC) joint is the second most common site of osteoarthritis in the hand, yet reported symptoms and ultimate treatment decisions are not simply a function of radiographic appearance. This study aimed to determine the patient- and/or disease-related factors associated with patients undergoing surgical treatment of thumb CMC arthritis.

Methods: This retrospective cohort study analyzed 1,994 patients with thumb CMC arthritis treated at 2 institutions between February 2015 and November 2018.

Pelvic rotation after total hip arthroplasty is dynamic and variable.

Aims: The aims of this study were to determine the change in the sagittal alignment of the pelvis and the associated impact on acetabular component position at one-year follow-up after total hip arthroplasty (THA).

Methods: This study represents the one-year follow-up of a previous short-term study at our institution. Using the patient population from our prior study, the radiological pelvic ratio was assessed in 91 patients undergoing THA, of whom 50 were available for follow-up of at least one year (median 1.

Utility of Serum Biomarkers in the Diagnosis and Stratification of Mild Traumatic Brain Injury.

Objective: The objective was to compare test characteristics of a single serum concentration of glial fibrillary acidic protein (GFAP), S-100β, and ubiquitin carboxyl terminal hydrolase L1 (UCH-L1), obtained within 6 hours of head injury, to diagnose mild traumatic brain injury (mTBI) in head-injured subjects.

Methods: Adults aged 18 to 80 years who presented to one of seven EDs with a blunt closed head injury underwent head CT within 4 hours of injury and had blood drawn for biomarker analysis within 6 hours of injury were eligible. Subjects were considered to have mTBI if they had an initial Glasgow Coma Scale (GCS) > 13 and met one or more of the following criteria: loss of consciousness (LOC), posttraumatic amnesia, or confusion.

Cell autonomous or systemic EGFR blockade alters the immune-environment in squamous cell carcinomas.

Targeting mutations and amplifications in the EGFR has been successful precision therapy for cancers of the lung, oral cavity and gastrointestinal track. However, a systemic immune reaction manifested by dose-limiting inflammation in the skin and gut has been a consistent adverse effect. To address the possibility that intra-tumoral immune changes contribute to the anti-cancer activity of EGFR inhibition, squamous cancers were produced by syngeneic orthografts of either EGFR null or wildtype mouse primary keratinocytes transduced with an oncogenic H-ras retrovirus.

Accelerated partial breast irradiation through brachytherapy for ductal carcinoma in situ: factors influencing utilization and risks of second breast tumors.

The purpose of this study was to examine influencing factors and outcomes of accelerated partial breast irradiation through brachytherapy (APBIb) versus whole breast irradiation (WBI) for ductal carcinoma in situ (DCIS). From the Surveillance Epidemiology and End Results program of the US National Cancer Institute, we identified 40,749 women who were diagnosed with first primary DCIS between 2002 and 2011 and treated with breast-conserving surgery and radiotherapy. A multi-level logistic regression analysis was performed to estimate odds ratios of APBIb use.