Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada.

Objectives: To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services.

Methods: All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients' sex and age.

Development of a Soft Tissue Knee Clinical Decision-Making Tool for Patients Presenting to Primary Point-of-Care Providers in Alberta, Canada.

Several barriers exist in Alberta, Canada to providing accurate and accessible diagnoses for patients presenting with acute knee injuries and chronic knee problems. In efforts to improve quality of care for these patients, an evidence-informed clinical decision-making tool was developed. Forty-five expert panelists were purposively chosen to represent stakeholder groups, various expertise, and each of Alberta Health Services' 5 geographical health regions.

Trends in Cemented Fixation in Hemiarthroplasty for Hip Fractures in Canada.

Bacground: The use of cemented fixation is widely recommended in hip arthroplasty for hip fractures, although it is not used universally.

Methods: We describe the trends in cementing prevalence in hemiarthroplasty for hip fractures in Canada for patients ≥55 years old between April 2017 and March 2022.

Results: The national prevalence of cemented fixation increased from 43% in 2017/18 to 58% in 2021/22, but there was a large variety of both the baseline prevalence and the trends across the country and between individual hospitals.

Wait time management strategies at centralized intake system for hip and knee replacement surgery: A need for a blended evidence-based and patient-centered approach.

Objectives: Delays in access to specialty care and elective hip and knee total joint replacement (TJR) surgery remain a major concern among patients with osteoarthritis (OA) in Canada. Centralized intake systems as a wait time management strategy in the face of resource constraints can increase access and patient flow through the system but are not standard practice. We examine how wait time management strategies for the assessment and triaging referrals in a centralized intake system can inform quality improvement initiatives.

Comparing 1-year and 10-year whole blood metal ion results following Birmingham hip resurfacing for osteoarthritis.

Background: Patients with metal-on-metal hip arthroplasty may develop adverse reactions to metal debris that can lead to clinically concerning symptoms, often needing revision surgery. As such, many regulatory authorities advocate for routine blood metal ion measurement. This study compares whole blood metal ion levels obtained 1 year following Birmingham Hip Resurfacing (BHR) to levels obtained at a minimum 10-year follow-up.

Birmingham Hip Resurfacing for osteoarthritis - a Canadian retrospective cohort study with a minimum 10-year follow-up.

Background: Young men with osteoarthritis of the hip are a growing segment of the population requiring arthroplasty, and there is compelling evidence that the Birmingham Hip Resurfacing (BHR) system provides good functional outcomes and durability in young, active men. We reviewed the survivorship and clinical outcomes of patients who underwent BHR with a minimum follow-up of 10 years.

Methods: We analyzed survivorship using the Kaplan-Meier method.

Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada.

Background: Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes.

Long wait times for knee and hip total joint replacement in Canada: An isolated health system problem, or a symptom of a larger problem?

Introduction: The wait times crisis for hip and knee total joint replacement surgery has been a significant health care issue in Alberta and across Canada. Significant resource and financial efforts have been put forward to reduce wait times for surgery as a means of treating patients with osteoarthritis (OA), but the gains achieved were not sustained.

Objective: To effectively address wait time issues, an alternative perspective on this problem is presented - that the wait times are an immediate problem for those needing surgery, but are also a symptom of the bigger issue of an inability of health care systems in Canada to address the needs of individuals with early OA with first-line treatment protocols.

Existing comorbidities in people with osteoarthritis: a retrospective analysis of a population-based cohort in Alberta, Canada.

Objectives: The purpose of this study is to estimate the prevalence of comorbidities among people with osteoarthritis (OA) using administrative health data.

Design: Retrospective cohort analysis.

Setting: All residents in the province of Alberta, Canada registered with the Alberta Health Care Insurance Plan population registry.

Performance management tools motivate change at the frontlines.

Performance management tools commonly used in business, such as incentives and the balanced scorecard, can be effectively applied in the public healthcare sector to improve quality of care. The province of Alberta applied these tools with the Institute for Health Improvement Learning Collaborative method to accelerate adoption of a clinical care pathway for hip and knee replacements. The results showed measurable improvements in all quality dimensions, including shorter hospital stays and wait times, higher bed utilization, earlier patient ambulation, and better patient outcomes.

Continuous quality improvement program for hip and knee replacement.

Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program.

Hip resurfacing versus total hip arthroplasty: a systematic review comparing standardized outcomes.

Background: Metal-on-metal hip resurfacing was developed for younger, active patients as an alternative to THA, but it remains controversial. Study heterogeneity, inconsistent outcome definitions, and unstandardized outcome measures challenge our ability to compare arthroplasty outcomes studies.

Questions/purposes: We asked how early revisions or reoperations (within 5 years of surgery) and overall revisions, adverse events, and postoperative component malalignment compare among studies of metal-on-metal hip resurfacing with THA among patients with hip osteoarthritis.

Kinematic differences between gender specific and traditional knee implants.

In the ongoing debate about gender-specific (GS) vs. traditional knee implants, there is limited information about patella-specific outcomes. GS femoral component features should provide better patellar tracking, but techniques have not existed previously to test this accurately.

Voluntary versus involuntary waiting for joint replacements: new Alberta wait times rules for hip and knee arthroplasties, with provincial consensus.

Despite various health system improvements across Alberta, the wait times benchmark was not being met for all patients requiring hip or knee arthroplasty. Alberta Health Services Bone and Joint Clinical Network working groups, in collaboration with other provincial organizations, gained consensus on the development and implementation of a set of provincial Wait Times Rules. These rules standardize the definition and measurement of data elements specific to joint replacement and distinguish between voluntary (patient-related) versus involuntary (healthcare system-related) wait times.

A safe overhang limit for unicompartmental knee arthroplasties based on medial collateral ligament strains: an in vitro study.

Excessive tibial component overhang during unicompartmental knee arthroplasty (UKA) may cause medial collateral ligament (MCL) impingement, which, in turn, may lead to medial knee pain [Chau et al. Tibial component overhang 226 following unicompartmental knee replacement-does it matter? The Knee. 2009;16(5):310-3].

The Development and validation of a self-administered quality-of-life outcome measure for young, active patients with symptomatic hip disease: the International Hip Outcome Tool (iHOT-33).

Purpose: The purpose of this study was to develop a self-administered evaluative tool to measure health-related quality of life in young, active patients with hip disorders.

Methods: This outcome measure was developed for active patients (aged 18 to 60 years, Tegner activity level ≥ 4) presenting with a variety of symptomatic hip conditions. This multicenter study recruited patients from international hip arthroscopy and arthroplasty surgeon practices.

Functional outcomes for 2 years comparing hip resurfacing and total hip arthroplasty.

This prospective observational study of 499 patients with hip resurfacing and 255 patients with total hip arthroplasty compared outcomes for 2 years. We used propensity scores to identify matched cohorts of 118 patients with hip resurfacing and 118 patients with total hip arthroplasty. We used these cohorts to compare improvements in the Western Ontario and McMaster University (WOMAC) osteoarthritis index and Medical Outcomes Short-Form 36 physical function component (SF-36 PF) scores at 3 months and at 1 and 2 years postsurgery.

Bilateral femoral insufficiency fractures likely related to long-term alendronate therapy.

Osteoporosis-related fractures are a major public health problem and one in two women and one in four men are affected with osteoporosis-related fractures. Alendronate (Fosamax) is one of the first bisphosphonates used to treat osteoporosis effectively. Recently, however, there is a concern regarding long bone insufficiency fractures related to long-term alendronate therapy.

A study of the effectiveness of performance-focused methodology for improved outcomes in Alberta public healthcare.

This study evaluates the effectiveness of a performance-focused methodology for engaging multidisciplinary, frontline healthcare teams in making behavioural changes that improve patient care and health system efficiency. Results include significant declines in average length of stay in hospital and waiting time for surgery, and a dramatic increase in early patient ambulation. Performance-focused methodology using key performance indicators, targets, measurement, and ongoing feedback, supported by non-monetary incentives, can quickly improve healthcare outcomes.

Chronic coccidioidomycosis infection of the knee: a case report.

Coccidioidomycosis is a rare fungal infection caused by C immitis in endemic areas of the southwestern United States. Extrapulmonary hematogenous dissemination is a feared complication of the primary pulmonary disease. The musculoskeletal system can be involved, and disseminated musculoskeletal infections can be extremely difficult to eradicate.

Revision total knee arthroplasty using large distal femoral augments for severe metaphyseal bone deficiency: a preliminary study.

Managing severe structural femoral metaphyseal bone loss in revision total knee arthroplasty is a challenging problem facing the revision knee surgeon. This study assesses the use of large (30 mm) metal distal femoral augments to compensate for severe bone deficiencies. Hospital for Special Surgery scores, Knee Society scores, and range of motion improved after implantation of femoral components with 30-mm distal femoral augments.