Outpatient vs. inpatient designation in total hip arthroplasty: can we predict who will require hospitalization?

Introduction: Following removal of total hip arthroplasty (THA) from the inpatient only (IPO) list by the Center for Medicare Services (CMS), arthroplasty surgeons face increased pressure to perform procedures on an outpatient (OP) basis. The purposes of the present study were to compare patients booked for THA as OP who required conversion to IP status postoperatively, to patients who were booked as, and remained OP, and to identify factors predictive of conversion from OP to IP status.

Methods: We retrospectively reviewed all patients who underwent a primary THA at our institution between January 1, 2020 and April 26, 2022.

Interpreting the Current Literature on Outcomes of Robotic-Assisted Versus Conventional Total Knee Arthroplasty Using Fragility Analysis: A Systematic Review and Cross-Sectional Study of Randomized Controlled Trials.

Background: Fragility analysis is a method of further characterizing outcomes in terms of the stability of statistical findings. This study assesses the statistical fragility of recent randomized controlled trials (RCTs) evaluating robotic-assisted versus conventional total knee arthroplasty (RA-TKA versus C-TKA).

Methods: We queried PubMed for RCTs comparing alignment, function, and outcomes between RA-TKA and C-TKA.

Predictors of reoperation for spinal disorders in Chiari malformation patients with prior surgical decompression.

Background: Chiari malformation (CM) is a cluster of related developmental anomalies of the posterior fossa ranging from asymptomatic to fatal. Cranial and spinal decompression can help alleviate symptoms of increased cerebrospinal fluid pressure and correct spinal deformity. As surgical intervention for CM increases in frequency, understanding predictors of reoperation may help optimize neurosurgical planning.

Persistent Lower Extremity Compensation for Sagittal Imbalance After Surgical Correction of Complex Adult Spinal Deformity: A Radiographic Analysis of Early Impact.

Background And Objectives: Achieving spinopelvic realignment during adult spinal deformity (ASD) surgery does not always produce ideal outcomes. Little is known whether compensation in lower extremities (LEs) plays a role in this disassociation. The objective is to analyze lower extremity compensation after complex ASD surgery, its effect on outcomes, and whether correction can alleviate these mechanisms.

The effect of traumatic head injuries on the outcome of middle-aged and geriatric orthopedic trauma patients.

Background: The purpose of this study is to characterize the effects of head injuries amongst the middle-aged and geriatric populations on hospital quality measures, costs, and outcomes in an orthopedic trauma setting.

Methods: Patients with head and orthopedic injuries aged >55 treated at an academic medical center from October 2014-April 2021 were reviewed for their Abbreviated Injury Score for Head and Neck (AIS-H), baseline demographics, injury characteristics, hospital quality measures and outcomes. Univariate comparative analyses were conducted across AIS-H groups with additional regression analyses controlling for confounding variables.

Patients Aged 40 Years and Older Demonstrate Durable and Comparable Results to Patients Aged Less Than 40 Years After Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity Matched Study at Minimum 10-Year Follow-Up.

Purpose: To compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), after primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared with a propensity-matched control group of patients <40 years.

Methods: A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013. Patients ≥40 years old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years old.

Anesthetic Methods for Hip Fracture.

Purpose Of Review: To review the benefits, risks, and contraindications of traditional and new anesthesia approaches for hip fracture surgery and describe what is known about the impact of these approaches on postoperative outcomes.

Recent Findings: This review describes general and spinal anesthesia, peripheral nerve block techniques used for pain management, and novel, local anesthesia approaches which may provide significant benefit compared with traditional approaches by minimizing high-risk induction time and decreasing respiratory suppression and short- and long-term cognitive effects. Hip fracture surgery places a large physiologic stress on an already frail patient, and anesthesia choice plays an important role in managing risk of perioperative morbidity.

Clinical Outcomes After Open and Endoscopic Repair of Proximal Hamstring Tendon Tears at a Minimum Follow-up of 5 Years.

Background: Current evidence supports favorable short-term clinical outcomes with few complications after surgical management of proximal hamstring injuries; however, the durability of clinical benefits beyond approximately 2 years after surgery is unknown.

Purpose: To evaluate patient-reported clinical outcomes and complication rates associated with open and endoscopic repair of proximal hamstring tears at minimum 5-year follow-up.

Study Design: Case series; Level of evidence, 4.

Temporal trends in surgical implants for in situ fixation of stable slipped capital femoral epiphysis.

Stable slipped capital femoral epiphysis (SCFE) is a pediatric hip disorder managed with in situ fixation of the proximal femoral epiphysis, otherwise known as 'pinning the hip'. The objective of this study was to characterize how the choice of implant for in situ fixation of stable SCFE has changed over time. A systematic review of publications concerning in situ fixation of stable SCFE from January 1993 to November 2021 was conducted.

Age Is Not Just a Number: The Intersection of Age, Orthopedic Injuries, and Worsening Outcomes Following Low-Energy Falls.

Background: The purpose of this study is to stratify the age at which older adults are most likely to sustain injuries and major complications resulting from low-energy falls so that fall prevention strategies may be targeted to more susceptible age groups.

Methods: A consecutive series of 12 709 patients older than 55 years enrolled in an orthopedic trauma registry from October 2014 to April 2021 were reviewed for demographic factors, hospital quality measures, and outcomes. Patients were grouped by age brackets in 5-year intervals.

Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery.

Background: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications.

Objective: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers.

Study Design/setting: Retrospective cohort study of a prospectively collected multicenter database.

A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery.

Study Design: Retrospective cohort study.

Objective: Construct an individualized cervical realignment strategy based on patient parameters at the presentation that results in superior 2-year health-related quality of life metrics and decreased rates of junctional failure and reoperation following adult cervical deformity surgery.

Summary Of Background Data: Research has previously focused on adult cervical deformity realignment thresholds for maximizing clinical outcomes while minimizing complications.

Predictors of Complication Severity Following Adult Spinal Deformity Surgery: Smoking Rate, Diabetes, and Osteotomy Increase Risk of Severe Adverse Events.

Background: Given the physical and economic burden of complications in spine surgery, reducing the prevalence of perioperative adverse events is a primary concern of both patients and health care professionals. This study aims to identify specific perioperative factors predictive of developing varying grades of postoperative complications in adult spinal deformity (ASD) patients, as assessed by the Clavien-Dindo complication classification (Cc) system.

Methods: Surgical ASD patients ≥18 years were identified in the American College of Surgeons' National Surgical Quality Improvement Program from 2005 to 2015.

Editorial Commentary: Diminished Hip Labral Width May Predict Inferior Outcome After Hip Femoroacetabular Impingement Surgery: Diminutive Labral Width Is a Relative Indication for Labral Reconstruction.

Hip labral "width" should be defined as the distance from the chondrolabral junction to the tip of the labrum in triangular cross-section. "Height" should refer to the distance from the joint surface to the perilabral recess (perpendicular to the width). "Length" is the distance from the anterior end of the labrum, adjacent to the anterior transverse acetabular ligament (TAL), to the posterior end of the labrum, adjacent to the posterior TAL (as may be relevant in reconstructions).

A Digital Platform for the Self-Management of Knee Arthritis: MyArthritisRx.com.

MyArthritisRx.com (MARx) is an online digital platform with resources to effectively manage osteoarthritis and directs patients to the appropriate information and tools to manage their disease. The key to self-management is a self-evaluation and staging program powered by an algorithm based on 150,000 arthritis patients.

Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes.

Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL).

Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes.

Development of Risk Stratification Predictive Models for Cervical Deformity Surgery.

Background: As corrective surgery for cervical deformity (CD) increases, so does the rate of complications and reoperations. To minimize suboptimal postoperative outcomes, it is important to develop a tool that allows for proper preoperative risk stratification.

Objective: To develop a prognostic utility for identification of risk factors that lead to the development of major complications and unplanned reoperations.

Highest Achievable Outcomes for Patients Undergoing Cervical Deformity Corrective Surgery by Frailty.

Background: Frailty is influential in determining operative outcomes, including complications, in patients with cervical deformity (CD).

Objective: To assess whether frailty status limits the highest achievable outcomes of patients with CD.

Methods: Adult patients with CD with 2-year (2Y) data included.

The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention.

Summary Of Background Data: The influence of frailty on economic burden following corrective surgery for the adult cervical deformity (CD) is understudied and may provide valuable insights for preoperative planning.

Objective: To assess the influence of baseline frailty status on the economic burden of CD surgery.

Study Design: Retrospective cohort.

Posterior tibial tubercle measured by the sagittal TT-TG distance correlates with increased risk for patellofemoral chondral lesions.

Purpose: To evaluate the variation in tibial tubercle sagittal alignment in patients with and without patellofemoral (PF) cartilage wear.

Methods: This was a single-centre, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014 to 2020. Patients were matched in a 1:2 ratio for age, sex and BMI to partial meniscectomy patients as controls.