Femoral Head Core Decompressions: Characterization of Subsequent Conversion to Total Hip Arthroplasty and Related Complications.

Background: Core decompression is a minimally invasive joint-preserving approach for early-stage osteonecrosis. The rate at which core decompression patients require total hip arthroplasty (THA) and rates of perioperative adverse outcomes have not been well-characterized.

Methods: Adult patients undergoing core decompression and/or THA with osteonecrosis of the femoral head were identified from the 2015 to 2021 Q3 PearlDiver M157 database.

Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement.

Background: Total knee arthroplasty (TKA) is commonly considered to address symptomatically limiting knee osteoarthritis. With increasing utilization, understanding the variability and related drivers may help the healthcare system optimize delivery to the large numbers of patient to whom it is offered.

Methods: A total of 1,066,327 TKA patients who underwent primary TKA were isolated from a 2010 to 2021 PearlDiver national dataset.

Socioeconomic factors affecting outcomes in total knee and hip arthroplasty: a systematic review on healthcare disparities.

Background: Recent studies showed that healthcare disparities exist in use of and outcomes after total joint arthroplasty (TJA). This systematic review was designed to evaluate the currently available evidence regarding the effect socioeconomic factors, like income, insurance type, hospital volume, and geographic location, have on utilization of and outcomes after lower extremity arthroplasty.

Methods: A comprehensive search of the literature was performed by querying the MEDLINE database using keywords such as, but not limited to, "disparities", "arthroplasty", "income", "insurance", "outcomes", and "hospital volume" in all possible combinations.

Race, Utilization, and Outcomes in Total Hip and Knee Arthroplasty: A Systematic Review on Health-Care Disparities.

Background: Previous studies have shown that utilization and outcomes of total joint arthroplasty (TJA) are not equivalent across different patient cohorts. This systematic review was designed to evaluate the currently available evidence regarding the effect that patient race has, if any, on utilization and outcomes of lower-extremity arthroplasty in the United States.

Methods: A literature search of the MEDLINE database was performed using keywords such as "disparities," "arthroplasty," "race," "joint replacement," "hip," "knee," "inequities," "inequalities," "health," and "outcomes" in all possible combinations.

Rapidly destructive osteoarthritis and total hip arthroplasty: A new technique for acetabular reconstruction in the setting of extensive bone loss.

We report the case of a 58-year-old woman who presented with rapidly destructive osteoarthritis (RDO) of the hip that had been causing her severe pain and disability. By the time of presentation to our institution, she had a significant leg length discrepancy resulting from extensive destruction of the posterior acetabular wall, posterior column, and femoral head with a superiorly migrated femoral shaft. She underwent structural acetabular allograft augmentation of the pelvis re-enforced with a locking plate, concomitant total hip replacement with dual mobility implants, and extensive soft tissue releases to restore length to the extremity.

Occupational hazards of orthopaedic surgery and adult reconstruction: A cross-sectional study.

Background: Occupational injuries and hazards related to orthopaedic surgery are not well studied, and what is published on this topic is largely based on in vitro or in vivo animal studies.

Objectives: To evaluate the self-reported prevalence of musculoskeletal (MSK) overuse disorders and other conditions among orthopaedic surgeons, especially those performing total hip (THA) or total knee arthroplasty (TKA), and report the factors placing these surgeons at higher risk for occupational health hazards.

Methods: This was a cross-sectional study of 66 currently practicing orthopaedic surgeons in the Midwestern United States.

No differences in short-term outcomes between patients with anaerobic and aerobic culture positive prosthetic joint infection.

Background: Prosthetic joint infection (PJI) is a devastation complication of total joint arthroplasty that can result in poor patient outcomes. Anaerobic organisms make up a small proportion of PJI cases and are much less studied. Studies comparing patient outcomes in anaerobic PJI to outcomes in aerobic PJI are sparse.

Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors.

Aims: Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty.

Methods: Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed.

Use of dual mobility components in total hip arthroplasty: Indications and outcomes.

Instability after total hip arthroplasty (THA) can be a problematic complication and remains one of the leading causes of revision surgery in the early post-operative period. Dual mobility (DM) implants decrease dislocation risk after THA but they come with their own set of complications. Selective use of DM implants for THA in high risk groups can confer the advantages of this construct while mitigating the risks.

Outcome reporting patterns in total knee arthroplasty: A systematic review.

Background: Total knee arthroplasty (TKA) is one of the most effective ways to treat end-stage painful conditions of the knee. However, non-standardized reporting patterns can make quantitative analysis of patient outcomes difficult.

Methods: A systematic review of the literature was performed using keywords "total knee arthroplasty" and "total knee replacement.

Are current DRG-based bundled payment models for revision total joint arthroplasty risk-adjusting adequately?

Aims: Currently, the US Center for Medicaid and Medicare Services (CMS) has been testing bundled payments for revision total joint arthroplasty (TJA) through the Bundled Payment for Care Improvement (BPCI) programme. Under the BPCI, bundled payments for revision TJAs are defined on the basis of diagnosis-related groups (DRGs). However, these DRG-based bundled payment models may not be adequate to account appropriately for the varying case-complexity seen in revision TJAs.

Outcome Reporting Patterns in Total Hip Arthroplasty: A Systematic Review of Randomized Clinical Trials.

Background: There has been a shift toward using patient-reported outcome measures (PROMs) to capture functional improvement and patient satisfaction after total hip arthroplasty (THA). Because there is no standard measure or set of measures, variability in reporting patterns makes comparison across studies difficult.

Methods: We performed a review of the literature using the keywords "total hip arthroplasty" and "total hip replacement" to electronically search PubMed, using the date range August 1, 2014, to August 1, 2019.

Risk Factors for Mid-Flexion Instability After Total Knee Arthroplasty: A Systematic Review.

Background: Mid-flexion instability after total knee arthroplasty (TKA) is a clinical entity that is not well studied and one that has been associated with patient dissatisfaction and inferior outcomes. We sought to provide a comprehensive review of risk factors associated with mid-flexion instability.

Methods: A comprehensive literature search of PUBMED, EMBASE, Google Scholar, and Cochrane Library was performed using keywords "mid flexion," "instability," and "knee arthroplasty" in all possible combinations.

Medical Device Recalls in Orthopedics: Recent Trends and Areas for Improvement.

Background: Medical device recalls have the potential to affect patient outcomes in orthopedic surgery. We assessed high-risk orthopedic medical device recalls in the recent past.

Methods: The publicly available Food and Drug Administration medical device recall database was mined for information on class 1 and class 2 recalls of orthopedic implants or medical devices related to orthopedic surgery from January 1, 2015 to December 31, 2019.

Nerve Injuries with the Direct Anterior Approach to Total Hip Arthroplasty.

* While no single approach for total hip arthroplasty (THA) has been proven to be superior to others in terms of patient outcomes, the direct anterior approach (DAA) is becoming increasingly popular. * All of the described techniques for THA carry a small risk of nerve injury. * Identifying risk factors for nerve injury and mitigating these risks where feasible are imperative in order to reduce the incidence of this complication with any approach for THA.

What Are the Costs of Hip Osteoarthritis in the Year Prior to a Total Hip Arthroplasty?

Background: The majority of the cost analysis literature on total hip arthroplasties (THAs) has been focused around the perioperative and postoperative period, with preoperative costs being overlooked.

Methods: The Humana Administrative Claims database was used to identify Medicare Advantage (MA) and Commercial beneficiaries undergoing elective primary THAs. Preoperative healthcare resource utilization in the year prior to a THA was grouped into the following categories: office visits, X-rays, magnetic resonance imagings, computed tomography scans, intra-articular steroid and hyaluronic acid injections, physical therapy, and pain medications.

Are Joint Surgeons Being Adequately Compensated for Single-Component versus Double-Component Revision TKA? An Analysis of Relative Value Units.

Relative value units (RVUs) are used for ensuring that physicians are appropriately reimbursed based on case complexity. While past research has elucidated that surgeons are reimbursed at a higher rate for primary total knee arthroplasty (TKA) versus revision TKA, no study has explored differences in reimbursements between single-component and double-component revisions, considering a double-component revision is likely to require more effort/skill as compared with single-component revision. The 2015 to 2016 American College of Surgeons National Surgical Quality Improvement Program files were queried using Current Procedural Terminology (CPT) codes for single-component revision TKA (CPT-27486) and double-component revision TKA (CPT-27487).

Does Surgeon Volume Affect Outcomes Following Primary Total Hip Arthroplasty? A Systematic Review.

Background: Surgeon volume has been identified as an important factor impacting postoperative outcome in patients undergoing orthopedic surgeries. With an absence of a detailed systematic review, we sought to collate evidence on the impact of surgeon volume on postoperative outcomes in patients undergoing primary total hip arthroplasty.

Methods: PubMed (MEDLINE) and Google Scholar databases were queried for articles using the following search criteria: ("Surgeon Volume" OR "Provider Volume" OR "Volume Outcome") AND ("THA" OR "Total hip replacement" OR "THR" OR "Total hip arthroplasty").

Comparing Different Surgical Techniques for Addressing the Posterior Malleolus in Supination External Rotation Ankle Fractures and the Need for Syndesmotic Screw Fixation.

Trimalleolar ankle fractures are unstable injuries with possible syndesmotic disruption. Recent data have described inherent morbidity associated with screw fixation of the syndesmosis, including the potential for malreduction, hardware irritation, and post-traumatic arthritis. The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament.

Adolescent Hip Fracture-Dislocation: Transphyseal Fracture with Posterior Dislocation of the Proximal Femoral Epiphysis: A Case Report.

Case: A 13-year-old male patient sustained a posterior transphyseal hip fracture-dislocation while playing football. A surgical hip dislocation with a trochanteric flip osteotomy, as described by Ganz and colleagues, was performed. Drilling of the dislocated epiphysis demonstrated no blood flow.

Anatomical considerations in adult femoral neck fractures: how anatomy influences the treatment issues?

Femoral neck fractures in physiologically young adults are relatively uncommon. The reported incidence of avascular necrosis and nonunion rates remain relatively high despite the advancement in understanding and surgical management. Understanding the normal femoral neck anatomy and its relationship to presenting fracture pathology in young adults could help to lessen reported high complication rates to provide better clinical outcomes.