Coding Education in Residency and in Practice Improves Accuracy of Coding in Orthopedic Surgery.

The goal of training in orthopedic residency is to produce surgeons who are proficient in all aspects of the practice of orthopedic surgery; however, most residents receive either inadequate or no training in medical coding. The purpose of this study was to determine how well orthopedic residents code when compared with practicing surgeons and to identify whether coding education improves accuracy in medical coding. A mock coding survey was developed using commonly encountered orthopedic clinical scenarios.

Intraoperative Surgeon Administered Adductor Canal Blockade Is Not Inferior to Anesthesiologist Administered Adductor Canal Blockade: A Prospective Randomized Trial.

Background: Controlling postoperative pain and reducing opioid requirements after total knee arthroplasty remain a challenge, particularly in an era stressing rapid recovery protocols and early discharge. A single-shot adductor canal blockade (ACB) has been shown to be effective in decreasing postoperative pain. The purpose of the present study is to compare the efficacy of an anesthesiologist administered ACB and a surgeon administered intraoperative ACB.

Which Patients Require Unexpected Admission to Postacute Care Facilities After Total Hip Arthroplasty?

Background: Many surgeons prefer to discharge patients home due to patient preferences, improved outcomes, and decreased costs. Despite an institutional protocol to send total hip arthroplasty (THA) patients home, some patients still required postacute care (PAC) facilities. This study aimed to create two predictive models based on preoperative and postoperative risk factors to identify which patients require PAC facilities.

Total Hip Arthroplasty and the Medicare Inpatient-Only List: An Analysis of Complications in Medicare-Aged Patients Undergoing Outpatient Surgery.

Background: The Centers for Medicare and Medicaid Services has solicited public comments for the 2019 Proposed Rule to remove total hip arthroplasty (THA) from the inpatient-only list. Concerns exist regarding the safety of discharging higher risk Medicare patients as an outpatient and whether hospitals may still be reimbursed for an inpatient procedure. The purpose of this study is to determine whether Medicare-aged patients undergoing outpatient THA have higher complication rates than patients who underwent inpatient THA.

Web-Based, Self-Directed Physical Therapy After Total Knee Arthroplasty Is Safe and Effective for Most, but Not All, Patients.

Background: Recently, self-directed physical therapy (SDPT) programs have gained popularity following total knee arthroplasty (TKA). This study evaluated the safety and efficacy of the routine use of an SDPT program in a nonselect patient population.

Methods: This is a single-surgeon, retrospective study of 296 consecutive patients from August 2016 to October 2017 discharged home after primary, unilateral TKA and enrolled in a web-based SDPT program.

Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection.

Background: One of the most effective prophylactic strategies against periprosthetic joint infection (PJI) is administration of perioperative antibiotics. Many orthopedic surgeons are unaware of the weight-based dosing protocol for cefazolin. This study aimed at elucidating what proportion of patients receiving cefazolin prophylaxis are underdosed and whether this increases the risk of PJI.

Who Goes to Inpatient Rehabilitation or Skilled Nursing Facilities Unexpectedly Following Total Knee Arthroplasty?

Background: Inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) represent a significant portion of post-operative expenses of bundled payments for total knee arthroplasty (TKA). Although many surgeons no longer routinely send patients to IRFs or SNFs, some patients are unable to be discharged directly home. This study identified patient factors for discharge to post-acute care facilities with an institutional protocol of discharging TKA patients home.

Total Joint Arthroplasty in Patients With Parkinson's Disease: Survivorship, Outcomes, and Reasons for Failure.

Background: Gait instability and muscle rigidity are known characteristics of Parkinson's disease (PD), putting PD patients at risk for complications following total joint arthroplasty (TJA). The outcomes of Parkinson's patients undergoing TJA are largely unknown. This study evaluated the outcomes of TJA in this population.

Survivorship and Outcomes in Patients With Multiple Sclerosis Undergoing Total Joint Arthroplasty.

Background: Patients with multiple sclerosis (MS) frequently require total joint arthroplasty (TJA). The outcomes of TJA in patients with MS, who are frequently on immunomodulatory medications and physically deconditioned, remain largely unknown. The aim of this study is to elucidate the survivorship and reasons for failure in this patient population.

Total hip arthroplasty after prior surgical treatment of hip fracture is it always challenging?

Salvage total hip arthroplasty (THA) presents a viable solution for failed open reduction internal fixation. This study compares salvage THA in patients with prior femoral neck fractures vs patients with prior intertrochanteric fractures. One hundred fifty-four hips in 152 patients underwent conversion from open reduction internal fixation to THA.