An Analysis of Component Positioning, Offset, and Limb Length Restoration in Computer-Assisted Hip Resurfacing Arthroplasty.

Introduction: Hip resurfacing arthroplasty (HRA) is a surgical option with positive outcomes at medium-term follow-up for young, active patients with osteoarthritis. However, early failures of HRA often occur due to improper implant placement. The purpose of this study was to assess the utility of computer-assisted navigation in the effort to optimize implant positioning following HRA.

Machine Learning With Electronic Health Record Data Outperforms a Risk Assessment Prediction Tool in Predicting Discharge Disposition After Total Joint Arthroplasty.

The Risk Assessment Prediction Tool (RAPT) predicts discharge disposition after total joint arthroplasty with only 75% accuracy. The goal of this study was to evaluate whether higher accuracy can be achieved with basic electronic health record (EHR) data combined with machine learning (ML) algorithms. Three ML analysis models were developed: model 1 (M1) evaluated the accuracy of predicted discharge disposition in concordance with the RAPT; model 2 (M2) used the RAPT questionnaire to develop an ML algorithm to predict the likelihood of discharge to home vs facility; and model 3 (M3) was developed with non-RAPT data (age, surgeon, and discharge preference) with the same ML training process as M2.

Excellent mid-term outcomes with a hemispheric titanium porous-coated acetabular component for total hip arthroplasty: 7-10 year follow-up.

Introduction: Third-generation hemispheric, titanium porous-coated (HTPC) acetabular cups have been shown to achieve good biologic fixation through enhanced porous ingrowth surfaces. They also allow for a wide range of bearing options, including polyethylene, dual-mobility, and ceramic liners. The purpose of the study is to review the mid-term clinical outcomes an HTPC acetabular cup with a minimum of 7-year follow-up.

Outcomes with Two Tapered Wedge Femoral Stems in Total Hip Arthroplasty Using an Anterior Approach.

Background: The majority of hip arthroplasties in the United States utilize cementless acetabular and femoral components. Despite their similarities, stem geometry can still differ. The purpose of this study is to compare the clinical results of two wedge-type stem designs.

Clinical and Radiographic Outcomes after Direct Anterior Approach Total Hip Arthroplasty Using Two Specialized Surgical Tables.

Background: Specialized tables for direct anterior (DA) approach total hip arthroplasty (THA) have required an unscrubbed assistant for manipulation of the operative limb. A novel surgical table attachment designed for the DA approach is fully surgeon controlled and partially automated. The purpose of this study is to compare the clinical outcomes in patients who underwent THA through a DA approach with an assistant-controlled vs the surgeon-controlled (SC) table.

Similar Outcomes After Hospital-Based Same-Day Discharge vs Inpatient Total Hip Arthroplasty.

Background: There has been increasing interest in performing primary hip and knee replacement with same-day discharge (SDD). The purpose of this study is to compare patient-reported outcome (PRO) scores, pain scores, and readmissions in patients who underwent SDD total hip arthroplasty (THA) with those in patients who underwent traditional inpatient THA.

Methods: A retrospective study was conducted on 963 patients who underwent primary THA at our institution between September 2016 and December 2018.

Barriers to Revision Total Hip Service Lines: A Surgeon's Perspective Through a Deterministic Financial Model.

Background: Revision THA represents approximately 5% to 10% of all THAs. Despite the complexity of these procedures, revision arthroplasty service lines are generally absent even at high-volume orthopaedic centers. We wanted to evaluate whether financial compensation is a barrier for the development of revision THA service lines as assessed by RVUs.

Subsidence Following Revision Total Hip Arthroplasty Using Modular and Monolithic Components.

Background: The ideal femoral component in revision total hip arthroplasty (rTHA) remains undetermined; however, tapered, fluted, titanium (TFT) stems are now widely used with favorable results in all types of revision scenarios. With both modular and monoblock TFT stem options, neither has been proven to be superior. Femoral stem subsidence has been linked to aseptic loosening, instability, and leg length discrepancy.

Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training.

Background: Hip fractures have significant economic implications as a result of their associated direct and indirect medical costs. Under alternative payment models, it has become increasingly important for institutions to find avenues by which costs could be reduced while maintaining outcomes in these cases.

Methods: A multi-institutional retrospective analysis of Medicare patients who underwent total hip arthroplasty (THA) for femoral neck fracture was conducted to assess the impact of fellowship training in adult reconstruction (AR) on the total costs of the 90-day episode of care.

Short-term outcomes with the REDAPT monolithic, tapered, fluted, grit-blasted, forged titanium revision femoral stem.

Aims: Although good clinical outcomes have been reported for monolithic tapered, fluted, titanium stems (TFTS), early results showed high rates of subsidence. Advances in stem design may mitigate these concerns. This study reports on the use of a current monolithic TFTS for a variety of indications.

Comparison of Payment Margins Between the Bundled Payments for Care Improvement Initiative and the Comprehensive Care for Joint Replacement Model Shows a Marked Reduction for a Successful Program.

Background: The Comprehensive Care for Joint Replacement (CJR) model was implemented to address the 2 most commonly billed inpatient surgical procedures, total hip arthroplasty and total knee arthroplasty. The primary purpose of this study was to review the economic implications of 1 institution's mandatory involvement in the CJR in comparison with prior involvement in the Bundled Payments for Care Improvement (BPCI) initiative.

Methods: The mean cost per episode of care was calculated using our institution's historical data.

Cementation of a monoblock dual mobility bearing in a newly implanted porous revision acetabular component in patients undergoing revision total hip arthroplasty.

Background: The most common indications for revision total hip arthroplasty are instability/dislocation and mechanical loosening. Efforts to address this have included the use of dual mobility (DM) articulations. The aim of this study is to report on the use of cemented DM cups in complex acetabular revision total hip arthroplasty cases with a high risk of recurrent instability.

A Novel Opioid-Sparing Pain Management Protocol Following Total Hip Arthroplasty: Effects on Opioid Consumption, Pain Severity, and Patient-Reported Outcomes.

Background: Opioid prescriptions and subsequent opioid-related deaths have increased substantially in the past several decades. Orthopedic surgery ranks among the highest of all specialties with respect to the amount of opioids prescribed. We present here the outcomes of our opioid-sparing pain management pilot protocol for total hip arthroplasty (THA).

Predicting Success of Two-Stage Exchange for Prosthetic Joint Infection Using C-Reactive Protein/Albumin Ratio.

Two-stage exchange is most commonly used for treatment of prosthetic joint infections (PJI) but, this may fail to eradicate infections. C-reactive protein/albumin ratio (CAR) has been used to predict survival and operative success in other surgical subspecialties and so, we assess the association between CAR and reimplantation success during two-stage revision for PJI defined by the Musculoskeletal Infection Society following a primary total hip (THA) or knee (TKA) arthroplasty. From January, 2005 to December, 2015, two institutional databases were queried and patient demographics, antibiotic duration, C-reactive protein, and albumin were collected prior to reimplantation.

Payer type does not impact patient-reported outcomes after primary total knee arthroplasty.

Background: There is a paucity of literature assessing whether payer type has an impact on postoperative patient-reported outcomes (PROs) after total knee arthroplasty (TKA). The aim of this study was to comparatively evaluate TKA PROs among patients with commercial and Medicare insurance.

Methods: We conducted a single-center, retrospective review of patients operated between January 2017 and March 2018.

Cost-Effectiveness of Dual Mobility and a Value-Based Algorithm of Utilization.

Hip dislocation remains a major concern following total hip arthroplasty due to its high frequency and economic burden. This article evaluates the cost-effectiveness regarding dual mobility as an alternative to standard implant designs. A review of literature analyzing the PubMed Central database was undertaken using the following terms in the primary query: dual mobility, cost-effectiveness, cost-analysis, or economic analysis.

Relationship Between the Patient-Reported Outcome Measurement Information System and Traditional Patient-Reported Outcomes for Osteoarthritis.

Background: Incorporating patient-reported outcomes (PROs) is paramount to the creation of a value-based healthcare system that prioritizes patient-centered care in total joint arthroplasty. The relationship between global assessment PROs such as Patient-Reported Outcome Measurement Information System (PROMIS) and joint-specific PROs for hip and knee, such as short form variations of Knee Injury and Osteoarthritis Outcome Score (KOOS-JR) and Hip Injury and Osteoarthritis Outcome Score (HOOS-JR), has yet to be assessed.

Methods: A retrospective analysis was conducted to assess PRO measurements for knee-related and hip-related complaints.