Prior nonarthroplasty shoulder surgery and modifiable risk factors negatively affect patient outcomes after shoulder arthroplasty.

Background: Total shoulder arthroplasty frequently is performed in patients with a history of shoulder surgery. The purpose of this study was to evaluate clinical outcomes after primary shoulder arthroplasty in patients with a history of nonarthroplasty shoulder surgery, and whether certain modifiable risk factors (MRFs) were negatively associated with final outcome measures. The secondary purpose was to determine if costs or complications were higher in patients with prior shoulder surgery.

Chronic kidney disease increases cost of care and readmission risk after shoulder arthroplasty.

Background: Chronic kidney disease (CKD) is associated with adverse outcomes and higher costs after lower extremity arthroplasty from higher rates of infection, aseptic loosening, and transfusion and longer hospital length of stay (LOS). The purpose of this study was to compare health care utilization and 90-day encounter charges after shoulder arthroplasty (SA) in patients with and without renal disease. A secondary aim was to define the characteristics of patients with renal disease.

Modifiable risk factors increase length of stay and 90-day cost of care after shoulder arthroplasty.

Background: Baseline health conditions can negatively impact cost of care and risk of complications after joint replacement, necessitating additional care and incurring higher costs. Bundled payments have been used for hip and knee replacement and the Centers for Medicare & Medicaid Services (CMS) is testing bundled payments for upper extremity arthroplasty. The purpose of this study was to determine the impact of predefined modifiable risk factors (MRFs) on total encounter charges, hospital length of stay (LOS), related emergency department (ED) visits and charges, and related hospital readmissions within 90 days after shoulder arthroplasty.

Healing rates after rotator cuff repair for patients taking either celecoxib or placebo: a double-blind randomized controlled trial.

Background: Use of anti-inflammatory medications (NSAIDs) is an important component of multimodal pain control after orthopedic procedures to avoid opioid overutilization and abuse. However, the deleterious effects of NSAIDs on tendon healing are of particular concern in rotator cuff repair (RCR). The purpose of this study was to evaluate the effect of celecoxib or placebo on healing rates after RCR when administered in the perioperative and immediate postoperative period using MRI evaluation at one year postoperatively.

Celecoxib significantly reduces opioid use after shoulder arthroplasty.

Background: The opioid crisis has illuminated the risks of opioid use for pain management, with renewed interest in reducing opioid consumption after common orthopedic procedures. Anti-inflammatory medication is an important component of multimodal pain management for patients undergoing orthopedic surgery. The purpose of this study was to evaluate the effect of celecoxib on pain control and opioid use after shoulder surgery.

Rotator Cuff Repair With Knotless Technique Is Quicker and More Cost-Effective Than Knotted Technique.

Purpose: To determine the cost-effectiveness of knotted (KT) versus knotless (KL) methods for rotator cuff surgical repair and to assess differences in patients' outcomes.

Methods: We retrospectively identified all patients who underwent arthroscopic rotator cuff repair at 1 institution by 1 surgeon over 2 6-month periods of time (KT technique from August 1, 2013, through January 31, 2014; and KL technique from December 1, 2014, through May 31, 2015) to calculate the direct and indirect costs associated with arthroscopic KT or KL suture bridge rotator cuff repair. Patient demographics, number of anchors used, tendons repaired, procedure time, operative time, and clinical results were also evaluated.

Estimated blood loss and anemia predict transfusion after total shoulder arthroplasty: a retrospective cohort study.

Background: Reported blood transfusion rates after total shoulder arthroplasty (TSA) range from 4.5% to 43%, and reported risk factors include race, female sex, prosthesis type (reverse), revision, age, anemia, low preoperative hemoglobin, and number of comorbidities. The purpose of this study was to develop a predictive model for transfusion in anatomic/hemi and reverse shoulder arthroplasty patients and to estimate the transfusion rate in a community hospital setting.

2019 Chitranjan S. Ranawat Award: Elective joint arthroplasty outcomes improve in malnourished patients with nutritional intervention: a prospective population analysis demonstrates a modifiable risk factor.

Aims: To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery.

Patients And Methods: An analytical report was extracted from the electronic medical record (EMR; Epic, Verona, Wisconsin) of a five-hospital network joint arthroplasty patient data set between 2014 and 2017.

Modifiable Risk Factors in Primary Joint Arthroplasty Increase 90-Day Cost of Care.

Background: Risk factors in demographics and health status have been identified that increase the risk of complications after joint arthroplasty, necessitating additional care and incurring additional charges. The purpose of this study was to identify the number of patients in a hospital network database who had one or more predefined modifiable risk factors and determine their impact on average length of stay, need for additional care during the 90-day postoperative period, and the 90-day charges for care.

Methods: An electronic hospital record query of 6968 lower extremity joint arthroplasty procedures under Diagnosis-Related Group 469/470 performed in 2014-2015 was reviewed, and total 90-day charges were calculated.

Hip Fracture Does Not Belong in the Elective Arthroplasty Bundle: Presentation, Outcomes, and Service Utilization Differ in Fracture Arthroplasty Care.

Background: Center for Medicare and Medicaid Services reimbursement is the same for hip arthroplasty performed electively for arthritis and urgently for femoral neck fracture.

Methods: An analytic report of hip arthroplasty for a 5-hospital network identified 2362 cases performed from January 2014 to May 2016. Resource utilization was determined using 90-day charges.

Functional Outcomes After Total Knee Arthroplasty Correlate With Spine Disability.

Background: Despite pain resolution in most patients after total knee arthroplasty (TKA), poor function persists in approximately 20% of patients and frequently is associated with patient dissatisfaction. Lumbar spine problems are a leading cause of functional disability. This study sought to determine the association between lower knee function scores and history of spine disability.

Does Extended-Release Liposomal Bupivacaine Better Control Pain Than Bupivacaine After Total Knee Arthroplasty (TKA)? A Prospective, Randomized Clinical Trial.

Liposomal bupivacaine periarticular injection (PAI) offers sustained bupivacaine release after TKA, but few prospective independent studies exist. In this prospective, blinded study, liposomal bupivacaine was randomized against bupivacaine and incorporated into a comprehensive multimodal pain management protocol. 111 primary TKAs were randomized to receive PAI: 58 patients received 266 mg (20cc) liposomal bupivacaine mixed with 75 mg (30cc) 0.

The Oxford unicompartmental knee fails at a high rate in a high-volume knee practice.

Background: The Oxford knee is a unicompartmental implant featuring a mobile-bearing polyethylene component with excellent long-term survivorship results reported by the implant developers and early adopters. By contrast, other studies have reported higher revision rates in large academic practices and in national registries. Registry data have shown increased failure with this implant especially by lower-volume surgeons and institutions.

Benefits of prolonged postoperative cyclooxygenase-2 inhibitor administration on total knee arthroplasty recovery: a double-blind, placebo-controlled study.

A double-blind, placebo-controlled study of a selective cyclooxygenase (COX)-2 inhibitor administered in 107 patients for 6 weeks after total knee arthroplasty was done to determine any benefits. All patients received celecoxib preoperatively and during hospitalization. At hospital discharge, patients were randomized to receive celecoxib or placebo for 6 weeks.

Isokinetic strength testing of minimally invasive total knee arthroplasty recovery.

Fifty patients underwent isokinetic muscle strength testing before surgery and at 6 weeks, 3 months, 6 months, and 1 year after unilateral total knee arthroplasty using the minisubvastus surgical technique. Quadriceps muscle strength returned to preoperative levels by 3 months postoperatively and was 17% stronger at 6 months and 30% stronger at 1 year than preoperative levels (P < .05).

Effects of increased surgical volume on total knee arthroplasty complications.

The effect of increased total knee arthroplasty (TKA) surgical volume on the incidence of knee complications within a single surgeon's practice was determined. Data were collected prospectively on 600 primary TKAs. Major complications required knee reoperation.

Association of increased knee flexion and patella clunk syndrome after mini-subvastus total knee arthroplasty.

This study reviewed 747 consecutive posterior stabilized total knee arthroplasty (TKA) to explain the increased incidence of patella clunk syndrome that occurred when the surgeon switched from a medial parapatellar arthrotomy to a mini-subvastus (MIS) TKA technique. The incidence of patella clunk syndrome increased with increased postoperative knee flexion. Six weeks after surgery, knees that developed patella clunk had a mean flexion of 124 degrees vs 117 degrees for knees that did not develop this syndrome (P = .

Surgical accuracy with the mini-subvastus total knee arthroplasty a computer tomography scan analysis of postoperative implant alignment.

A total of 50 total knee arthroplasty (TKA) patients, 25 traditional and 25 minimally invasive surgical (MIS), underwent computed tomography scans to determine if a loss of accuracy in implant alignment occurred when a surgeon switched from a traditional medial parapatellar arthrotomy to a mini-subvastus surgical technique. Surgical accuracy was determined by comparing the computed tomography measured implant alignment with the surgical alignment goals. There was no loss in accuracy in the implantation of the tibial component with the mini-subvastus technique.

Mini-subvastus approach for total knee arthroplasty.

The mini-subvastus surgical technique avoids both quadriceps arthrotomy and patella eversion. Since March 2003, this quad-sparing minimally invasive surgical (MIS) technique has been applied to more than 98% of our primary total knee arthroplasty (TKA) patients. This study compares our first 150 MIS TKA patients to our previous 150 traditional TKA patients.

Applicability of the mini-subvastus total knee arthroplasty technique: an analysis of 725 cases with mean 2-year follow-up.

Recent total knee arthroplasty (TKA) studies suggest a more rapid functional recovery with minimally invasive surgical (MIS) techniques. These studies often fail to disclose the percentage of primary TKA that underwent the MIS technique, raising the concern that positive clinical outcomes are a result of patient selection. This study evaluates the applicability of the mini-subvastus technique in one surgeon's consecutive primary TKA patients.