From Policy to Practice: Challenges in Implementing PROMs Reporting Under the New CMS Mandate.

The Centers for Medicare & Medicaid Services (CMS) recently introduced mandatory reporting of patient-reported outcomes (PROs) following primary, elective total joint arthroplasty (TJA) procedures. This article explores the implications and implementation challenges of this policy shift in the field of orthopaedic surgery. With a review of the existing literature, we analyze the potential benefits and limitations of PROs, discuss the role of CMS in health-care quality improvement initiatives, explain the predicted difficulties in the successful implementation of this new mandate, and provide recommendations for the successful integration of the reporting of PROs in clinical practice.

Utilization of Total Knee Arthroplasty in the United States by Settlement Type: Is There Equity of Access?

Introduction: Total knee arthroplasty (TKA) is one of the most commonly performed orthopaedic surgeries in the United States, yet little information exists regarding its utilization in different settlement types. This study aimed to determine the number of TKA-performing surgeons by settlement type and assess trends in the volume of TKAs in urban, micropolitan, small town, and rural settings.

Methods: Using the Medicare Provider Utilization and Payment Data: Physician and Other Practitioners database, the number of orthopaedic surgeons performing primary and revision TKAs from 2013 to 2020 was determined.

Discharge Disposition after Total Hip Arthroplasty: A 10-Year Analysis of Trends and Predictors of Nonhome Discharge (2011-2021).

Background: Total hip arthroplasty (THA) practices are evolving under the influence of the current value-based healthcare system and bundled payment models. This study aimed to (1) evaluate national trends in discharge disposition and postoperative outcomes after THA, (2) compare discharge cohorts on episode-of-care parameters, and (3) determine predictors of nonhome discharge from 2011 to 2021.

Methods: The National Surgical Quality Improvement Program database was queried for THA data from 2011 to 2021.

Genomic Insights into Host Susceptibility to Periprosthetic Joint Infections: A Comprehensive Literature Review.

Periprosthetic joint infection (PJI) is a multifactorial disease, and the risk of contracting infection is determined by the complex interplays between environmental and host-related factors. While research has shown that certain individuals may have a genetic predisposition for PJI, the existing literature is scarce, and the heterogeneity in the assessed genes limits its clinical applicability. Our review on genetic susceptibility for PJI has the following two objectives: (1) Explore the potential risk of developing PJI based on specific genetic polymorphisms or allelic variations; and (2) Characterize the regulatory cascades involved in the risk of developing PJI.

Intraoperative Patellar Tendon Injuries during Total Knee Arthroplasty: A Comprehensive Review of Incidence, Risk Factors, and Management Strategies.

Patellar tendon rupture (PTR) is a rare and severe postoperative complication of total knee arthroplasty (TKA). Even rarer is the intraoperative occurrence of PTR during TKA. PTR is a major complication as it can lead to chronic disability, functional limitations, and postoperative morbidity.

Robotic-Assisted Conversion of Unicompartmental Knee Arthroplasty to Total Knee Arthroplasty.

Background: Unicompartmental knee arthroplasty (UKA) procedures have become much more common in the United States in recent years, with >40,000 UKAs performed annually. However, it is estimated that 10% to 40% of UKAs fail and thus require conversion to total knee arthroplasty (TKA). In the field of total joint arthroplasty, robotic-assisted surgeries have demonstrated advantages such as better accuracy and precision of implant positioning and improved restoration of a neutral mechanical axis.

Effects of elevated body mass index on the success of total knee and total hip arthroplasty: a comprehensive overview.

Introduction: The average body mass index (BMI) in the United States has tripled over the last five decades despite concerted population-based efforts for weight management. Elevated BMI and, in particular, obesity are risk factors for osteoarthritis. This trend has led to increased demands for total knee (TKA) and total hip arthroplasty (THA), necessitating an in-depth understanding of how elevated BMI impacts TKA and THA.

Techniques of core decompression in the treatment of idiopathic avascular necrosis of the femoral head.

Core decompression was developed as a joint-preserving procedure for patients with early-stage osteonecrosis of the femoral head. Previous studies indicated a high success rate that outperforms nonoperative management of pre-collapse hips. The traditional single-tunnel core decompression technique uses a cannulated drill bit inserted into the lateral cortex of the proximal femur.

Stepping up recovery: integrating patient reported outcome measures and wearable technology for 90-day rehabilitation following total hip arthroplasty.

Introduction: There is conflicting data in the literature regarding the clinical utility of wearable devices. This study examined the association between patient reported outcome measures (PROMs) and step and stair flight counts obtained from wearable devices in postoperative total hip arthroplasty (THA) patients.

Methods: Data was collected from a multicenter prospective longitudinal cohort study from October 2018 to February 2022.

SARS-CoV-2 ORF8 drives osteoclastogenesis in preexisting immune-mediated inflammatory diseases.

Patients with immune-mediated inflammatory diseases (IMIDs) like rheumatoid arthritis (RA) are at higher risk for severe COVID-19 and long-term complications in bone health. Emerging clinical evidence demonstrated that SARS-CoV-2 infection reduces bone turnover and promotes bone loss, but the mechanism underlying worsened bone health remains elusive. This study sought to identify specific immune mediators that exacerbated preexisting IMIDs after SARS-CoV-2 exposure.

Femoral stem extraction devices.

Introduction: As the number of primary total hip arthroplasty (THA) procedures continues to increase, so too does the demand for revision surgery, with a 43-70% rise in revision THA anticipated by 2030. Femoral stem extraction in revision THA is particularly challenging and may lead to complications like femoral bone loss or fractures. However, increasing catalogue of femoral stems available for primary and revision THA has led technological advances in extraction devices to potentially overcome these limitations.

Osteonecrosis of the Femoral Head: Core Decompression Systems.

Osteonecrosis of the femoral head (ONFH) is a chronic progressive debilitating disease that often affects young and active patients. It results from vascular interruption to the femoral head and can be caused by trauma, chronic corticosteroid use, chronic alcoholism, and coagulopathies. Treatment includes core decompression, a surgical procedure that may help delay or forestall disease progression if performed at the early stages of the disease.

Wear, Material Transfer, and Electrocautery Damage Are Ubiquitous on CoCrMo Femoral Knee Retrievals.

Despite high total knee arthroplasty (TKA) survivorship after 10 years (92%-99%), a gap persists where patient satisfaction lags clinical success. Additionally, while cobalt chrome molybdenum (CoCrMo) use decreases in primary total hip arthroplasty, the alloy continues to be widely used in TKA femoral components. In vivo, CoCrMo degradation may be associated with adverse local tissue reactions (ALTR) and compared with the hip, the damage mechanisms that may release metal in the knee and the potential biological effects remain poorly understood.

Distinct Care Needs and Episodes of Care: Comparing Medical versus Orthopaedic Readmissions after Elective Primary Total Knee Arthroplasty.

Hospital readmissions after primary total knee arthroplasty (TKA) significantly drive health care expenditure and resource utilization. Recent studies have suggested differences between medical and orthopaedic readmissions after TKA and their episodes of care (EOCs) but lack patient-level data reporting. This study aimed to compare EOCs for medical and orthopaedic-related readmissions regarding initial readmission wards, services consulted, intensive care unit (ICU) admissions, blood transfusions, surgical interventions, length of stay, and discharge disposition.

Do Overall Weight, Body Mass Index, or Clinically Significant Weight Changes Occur After Total Joint Arthroplasty? A Meta-Analysis of 60,837 Patients.

Background: Total joint arthroplasty (TJA) is well-recognized for improving quality of life and functional outcomes of patients with osteoarthritis; however, TJA's impact on body weight remains unclear. Recent trends have demonstrated a shift among TJA patients, such that patients who have higher body mass indices (BMIs) are undergoing this common surgery. Given this trend, it is critical to characterize the impact TJA has on body weight or BMI.

Neighborhood Socioeconomic Disadvantage May Influence 1-Year Patient-Reported Outcome Measures After Total Hip Arthroplasty.

Background: The impact of socioeconomic status on achievement of clinically relevant patient-reported outcome measure (PROM) improvements and satisfaction after total hip arthroplasty (THA) is unknown. Area Deprivation Index (ADI) is a metric that can be used as a proxy for a patient's neighborhood socioeconomic status. This study aimed to assess the association between ADI and failure to achieve: (1) clinically relevant improvements in PROMs; and (2) self-reported satisfaction at 1 year following THA.

A Longitudinal analysis of weight changes before and after total hip arthroplasty: Weight trends, patterns, and predictors.

Background: It is crucial to understand weight trends in patients undergoing total hip arthroplasty (THA).

Objective: To evaluate preoperative and postoperative weight trends for patients undergoing primary THA and factors associated with clinically significant weight change.

Methods: A prospective cohort who underwent primary unilateral THA (n= 3,011) at a tertiary healthcare system (January 2016 to December 2019) were included in the study.

Degradomics defines proteolysis information flow from human knee osteoarthritis cartilage to matched synovial fluid and the contributions of secreted proteases ADAMTS5, MMP13 and CMA1 to articular cartilage breakdown.

Objectives: Proteolytic cartilage extracellular matrix breakdown is a major mechanism of articular cartilage loss in osteoarthritis (OA) pathogenesis. We sought to determine the overlap of proteolytic peptides in matched knee OA cartilage and synovial fluid on a proteome-wide scale to increase the prospective biomarker repertoire and to attribute proteolytic cleavages to specific secreted proteases.

Design: Matched human knee OA cartilage and synovial fluid (n = 5) were analyzed by N-terminomics using Terminal Amine Isotopic Labeling of Substrates (TAILS), comprising labeling and enrichment of protein N-termini, high-resolution mass spectrometry and positional peptide mapping.

Neighborhood Socioeconomic Disadvantage is Associated With Increased Health Care Utilization After Septic and Aseptic Revision Total Hip Arthroplasty.

Background: A greater area deprivation index (ADI), a tool that gauges socioeconomic disadvantage at the neighborhood level, is associated with worse health care outcomes following primary total hip arthroplasty. However, its association with revision total hip arthroplasty (rTHA) is unknown. This study aimed to determine the association between ADI and rates of postoperative health care resource utilization following rTHA.

Nuclear Imaging in Orthopaedic Practice: A Critical Analysis Review.

» Nuclear imaging techniques, including bone scintigraphy, labeled leukocyte scintigraphy, positron emission tomography (PET), and single-photon emission computed tomography (SPECT) combined with computed tomography (CT), have wide applications in orthopaedics for evaluating trauma, painful total joint arthroplasty, musculoskeletal infection, and orthopaedic oncology.» Three-phase bone scintigraphy is a first-line, highly sensitive nuclear medicine study for evaluating orthopaedic pathology when initial studies are inconclusive. However, its specificity is limited, and findings may be falsely positive for up to 2 years after total joint arthroplasty because of physiologic bone remodeling.

Diamond-like carbon (DLC) surface treatment decreases biofilm burden by S. aureus on titanium alloy in vitro- a pilot study.

Purpose: Periprosthetic joint infection is a complication of total joint arthroplasty with treatment costs over $1.6 billion dollars per year in the US with high failure rates. Therefore, generation of coatings that can prevent infection is paramount.

Impacts of neighborhood deprivation on septic and aseptic revision total knee arthroplasty outcomes: A comprehensive analysis using the area deprivation index.

Background: Community deprivation has been linked to poor health outcomes following primary total knee arthroplasty (pTKA), but few studies have explored revision TKA (rTKA). The present study analyzed implications of neighborhood deprivation on rTKA outcomes by characterizing relationships between Area Deprivation Index (ADI) and (1) non-home discharge disposition (DD), (2) hospital length of stay (LOS), (3) 90-day emergency department (ED) visits, (4) 90-day hospital readmissions, and (5) the effect of race on these healthcare outcomes.

Methods: A total of 1,434 patients who underwent rTKA between January 2016 and June 2022 were analyzed.