Arthroplasty Today最新文献

{"title":"Trends in Outpatient Primary Total Hip and Knee Replacement From the Hospital Outpatient Department and Ambulatory Surgery Center Settings in New York State","authors":"Nikhil Ailaney MD,&nbsp;Derek T. Schloemann MD,&nbsp;Sarah J. Wegman BS,&nbsp;Jonathan Umelo MD,&nbsp;Caroline P. Thirukumaran MBBS, MHA, PhD,&nbsp;Benjamin F. Ricciardi MD","doi":"10.1016/j.artd.2025.101695","DOIUrl":"10.1016/j.artd.2025.101695","url":null,"abstract":"<div><h3>Background</h3><div>While ambulatory surgery centers (ASCs) are increasingly used for outpatient total hip replacement and total knee replacement, collectively total joint replacement (TJR), due to association with similar or lower rates of postsurgical complications, readmissions, and reduced cost, ASC utilization trends have not been well studied. The purpose of this study was to analyze patients undergoing inpatient and outpatient TJR in New York State to identify 1) temporal site-of-service trends for inpatient and outpatient TJR and 2) characteristics of patients undergoing outpatient TJR in hospital outpatient departments (HOPDs) and ASC versus inpatient.</div></div><div><h3>Methods</h3><div>New York Statewide Planning and Research Cooperative System database was used to identify TJR patients in each procedure setting (hospital inpatient department, HOPD, and ASC) from 2011 to 2021. We report outpatient TJR trends from 2011 to 2021 and use a multivariable generalized linear mixed model to determine characteristics of patients who have greater odds of TJR in the HOPD or ASC setting.</div></div><div><h3>Results</h3><div>Outpatient TJR volume substantially increased over time. TJR patients in ASC compared to hospital inpatient department were younger and privately insured and had fewer comorbidities. Older, non-Hispanic Black, Hispanic patients with more medical comorbidities and patients with Medicare, Medicaid, or workers’ compensation exhibited decreased odds of TJR in both HOPDs and ASCs. Patients residing in rural areas were more likely to undergo surgery in an ASC relative to the in-patient setting for total knee replacement only.</div></div><div><h3>Conclusions</h3><div>Patients who are older, are non-White, have increased comorbidity burdens, or are publicly insured were less likely to undergo outpatient TJR in both the HOPD and ASC settings.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101695"},"PeriodicalIF":1.5,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Body Mass Index is Associated With Increased Cost for Primary Total Knee Arthroplasty Exclusive of Readmissions and Complications","authors":"Bryce E. Maxwell BS ,&nbsp;Kranti C. Rumalla BA ,&nbsp;Isaac Sontag-Milobsky BS ,&nbsp;Austin R. Chen BA ,&nbsp;T. Jacob Selph Jr BS ,&nbsp;Adam I. Edelstein MD","doi":"10.1016/j.artd.2025.101689","DOIUrl":"10.1016/j.artd.2025.101689","url":null,"abstract":"<div><h3>Background</h3><div>Surgeons participating in alternative payment models may encounter financial disincentives in caring for high-cost patients. While prior studies have shown a relationship between body mass index (BMI) and cost in total knee arthroplasty (TKA), this question has not been examined using recent data in a nationally-representative dataset. We sought to use recent data to assess the relationship between BMI and cost in TKA.</div></div><div><h3>Methods</h3><div>We queried the 2016-2022 PINC AI Healthcare Dataset for primary TKAs identified by the Current Procedural Terminology code 27447. Baseline patient demographics, characteristics, and outcomes were gathered. Patient costs included index and 90-day period costs starting from the surgical encounter. A multivariate generalized linear model estimated patient costs across eight BMI categories (WHO BMI categories, with BMI &gt;40 grouped into BMI 40-45, BMI 45-50, and BMI &gt;50), and a linear regression model assessed the effect of BMI on costs. Both models controlled for age, sex, payer, race, ethnicity, and Elixhauser Comorbidity Index.</div></div><div><h3>Results</h3><div>A total of 24,064 primary TKAs were included. Patient characteristics were age (mean 68 years, SE 0.06), sex (62.3% female), payer (63.8% Medicare), race (88.6% white), ethnicity (3.1% Hispanic), and Elixhauser Comorbidity Index (mean 2.07, SE 0.01). The mean BMI was 32.0 (SE 0.1), with mean index and 90-day costs of $14,051 ± $32.6 and $17,377 ± 107.3, respectively. Predicted patient index and 90-day costs were both highest in the BMI &gt;50.0 category at $15,555 and $20,716, respectively. Predicted index and 90-day costs were lowest in the 25.0-29.9 ($13,765) and &lt;18.5 ($16,403) categories, respectively. The multivariate analysis showed that patient index and 90-day costs increased by $23.20 (<em>P</em> &lt; .001) and $48.10 (<em>P</em> &lt; .01), respectively, per one-point increase in BMI.</div></div><div><h3>Conclusions</h3><div>Higher patient BMI is associated with increased index and 90-day episodic costs for primary TKA. Stakeholders may consider incorporating this information in bundled payment models and other value-based reimbursement models.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101689"},"PeriodicalIF":1.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to Editor on “Association of Knee Osteoarthritis Treatment Types, Patient Characteristics, and Medical History With Subsequent Risk for Total Knee Arthroplasty: Data From a New Real-World Registry”","authors":"Andrew L. Concoff MD,&nbsp;Jennifer H. Lin PhD,&nbsp;Andrew I. Spitzer MD,&nbsp;Vinod Dasa MD,&nbsp;Adam Rivadeneyra MD,&nbsp;David Rogenmoser DO,&nbsp;Mitchell K. Ng MD,&nbsp;Mary DiGiorgi PhD, MPH,&nbsp;Stan Dysart MD,&nbsp;Joshua Urban MD,&nbsp;William M. Mihalko MD, PhD,&nbsp;Michael A. Mont MD","doi":"10.1016/j.artd.2025.101691","DOIUrl":"10.1016/j.artd.2025.101691","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101691"},"PeriodicalIF":1.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Chronic Anticoagulation on Early Postoperative Outcomes Following Total Knee Arthroplasty: A TriNetX Database Study","authors":"Andrea H. Johnson MSN CRNP,&nbsp;Jane C. Brennan MS,&nbsp;Shawn S. Simpson PA-C,&nbsp;Justin J. Turcotte PhD MBA,&nbsp;Paul J. King MD","doi":"10.1016/j.artd.2025.101690","DOIUrl":"10.1016/j.artd.2025.101690","url":null,"abstract":"<div><h3>Background</h3><div>Medications used for pharmacologic venous thromboembolism prophylaxis are associated with postoperative complications including bleeding, wound complications, and infection. These same medications are used for chronic anticoagulation, and little research has been done on total knee arthroplasty (TKA) complications associated with these medications, particularly manipulation under anesthesia (MUA) and revision TKA. The purpose of this study is to evaluate the rate of MUA and other early postoperative complications in patients undergoing TKA with a preoperative history of chronic anticoagulation.</div></div><div><h3>Methods</h3><div>The TriNetX database was retrospectively queried for all patients undergoing TKA with perioperative tranexamic acid. Patients were divided into cohorts by whether or not they had a history of chronic anticoagulant use and had an anticoagulant medication prescribed within 6 months of surgery. The cohorts were propensity score matched on demographic and comorbidity data; 7367 patients remained in each cohort after matching.</div></div><div><h3>Results</h3><div>Patients with chronic anticoagulant use were 1.72 times more likely to undergo an MUA (odds ratio [OR]: 1.718, 95% confidence intervals [CI]: 1.403-2.104; <em>P</em> &lt; .001), 1.32 times more likely to have a revision TKA (OR: 1.324, 95% CI: 1.006-1.742; <em>P</em> = .044), and were 1.53 times more likely to have wound disruption (OR: 1.530, 95% CI: 1.214-1.927; <em>P</em> &lt; .001) within the 1-year postoperative period.</div></div><div><h3>Conclusions</h3><div>Patients undergoing TKA while on chronic anticoagulation have worse outcomes within 1 year postoperatively than patients not on chronic anticoagulation. Further studies are needed to validate these findings and to identify sources of the increased risk of complications in this population, as well as identify factors that may mitigate this risk.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101690"},"PeriodicalIF":1.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Femorofemoral Bypass Occlusion in the Contralateral Leg Following Total Hip Arthroplasty","authors":"Rae Tarapore MD ,&nbsp;Candace Cephers MD ,&nbsp;Akinade Ojemakinde MD ,&nbsp;Sarah Shan MD ,&nbsp;Alexandre Debetencourt PA-C ,&nbsp;Jason Crowner MD ,&nbsp;Farhang Alaee MD","doi":"10.1016/j.artd.2025.101700","DOIUrl":"10.1016/j.artd.2025.101700","url":null,"abstract":"<div><div>Total hip arthroplasty is an effective operation for treating hip osteoarthritis, carrying with it a high success rate and low rate of complications; especially vascular complications. We are reporting an incidence of femorofemoral artery bypass graft occlusion and subsequent contralateral acute limb ischemia during a total hip arthroplasty through a posterior approach with use of a hip positioner. The patient was taken back to the operating room on the same day for thrombectomy of the femorofemoral bypass graft, profunda femoris, and superficial arteries in addition to 4 compartment fasciotomies. The purpose of this case report is to educate readers about risk factors, prevention methods, and necessary post complication procedures for this rare but serious complication.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101700"},"PeriodicalIF":1.5,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding the Horizon of Multidisciplinarity: Incorporating Biomechanical, Metabolic, and Functional Factors Into Registry-Based Research to Predict Subsequent Risk for Total Knee Arthroplasty","authors":"Francesco Pegreffi MD, PhD (Prof),&nbsp;Maria Tiziana Di Leo MD,&nbsp;Giuseppe Fanzone MD,&nbsp;Arcangelo Russo MD, PhD (Prof),&nbsp;Sara Bravaccini MD, PhD (Prof),&nbsp;Raoul Saggini MD (Prof)","doi":"10.1016/j.artd.2025.101697","DOIUrl":"10.1016/j.artd.2025.101697","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101697"},"PeriodicalIF":1.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing-specific Debridement, Antibiotics, and Implant Retention and 2-Stage Revision for Megaprosthesis-Related Infection: Optimizing the Window Period for Improved Outcomes","authors":"Rajeev K. Sharma MS, DNB, Mch ,&nbsp;Imelda Lumban-Gaol MD ,&nbsp;Udit Vinayak MS, DNB ,&nbsp;Nicolaas C. Budhiparama MD, PhD","doi":"10.1016/j.artd.2025.101688","DOIUrl":"10.1016/j.artd.2025.101688","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to evaluate the outcomes of debridement, antibiotics, and implant retention (DAIR) procedures and 2-stage revision surgeries in patients with periprosthetic joint infection following megaprosthesis, including treatment failure; the patient-reported outcomes; and to determine the survival rates of the revised megaprosthesis.</div></div><div><h3>Methods</h3><div>A retrospective study of 30 patients diagnosed with periprosthetic joint infection following megaprosthesis between 2018 and 2023, with minimum 1-year follow-up. Patients with previous unsuccessful debridement in other institutions were excluded. Patients presenting within 4 weeks of megaprosthesis implantation underwent the DAIR procedure, while those presenting after this window were taken for a 2-stage revision surgery. The primary outcome was treatment failure, defined as persistent wound complication or the need for subsequent surgical intervention. The secondary outcomes included patient-reported outcomes, assessed with the Oxford Hip Score and Oxford Knee Score, and the survival rates of the revised megaprosthesis.</div></div><div><h3>Results</h3><div>The mean follow-up duration for all patients was 38 ± 12.6 months. Improvement was found for Oxford Hip Score and Oxford Knee Score with mean 34.22 ± 9.2 and 32.40 ± 8.1, respectively, at the 1-year follow-up. DAIR achieved an 81% success rate (13 out of 16) and 2-stage exchange had a 71.4% success rate (10 out of 14).</div></div><div><h3>Conclusions</h3><div>Both DAIR and 2-stage exchange procedures yielded favorable functional outcomes with satisfactory 2-year survival function. Careful patient selection and indication management are crucial for optimal results.</div></div><div><h3>Level of evidence</h3><div>Level IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101688"},"PeriodicalIF":1.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Low Mini-Midvastus Approach for Minimally Invasive Total Knee Arthroplasty","authors":"Kein Boon Poon MD, MSc, FAMS,&nbsp;Justin Zi Xian Chou MBBS,&nbsp;Zachariah Gene Wing Ow MBBS,&nbsp;Joel Wei-An Lim MBBS, MRCS, MMed, FRCSEd, FAMS,&nbsp;Wei Ming Siow BSc, MBBS, M Med, FRCSEd, FAMS","doi":"10.1016/j.artd.2025.101686","DOIUrl":"10.1016/j.artd.2025.101686","url":null,"abstract":"<div><div>The low mini-midvastus approach is a refinement of minimally invasive techniques in total knee arthroplasty (TKA). This technique involves making a precise muscle-splitting incision along the vastus medialis obliquus, retaining a 1-cm wide inferomedial cuff of the muscle belly, preserving the extensor mechanism while maintaining sufficient surgical exposure. We hypothesize that the low mini-midvastus approach minimizes postoperative pain, accelerates recovery, and enhances patient satisfaction by optimizing vastus medialis obliquus integrity. It is suitable for primary TKA and adaptable to challenging anatomical variations. In this study, we describe our surgical technique and experience with such an approach for conventional primary TKA that represents a refinement of the midvastus spectrum that prioritizes muscle preservation while maintaining adequate exposure.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101686"},"PeriodicalIF":1.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Are the Preferences in Patient-Physician Communication Among Total Joint Arthroplasty Patients?","authors":"Siddhartha Dandamudi BBA ,&nbsp;Kyleen Jan MD ,&nbsp;Ilyass Majji BS ,&nbsp;Anne DeBenedetti MSc ,&nbsp;Omar Behery MD, MPH ,&nbsp;Brett R. Levine MD, MS","doi":"10.1016/j.artd.2025.101682","DOIUrl":"10.1016/j.artd.2025.101682","url":null,"abstract":"<div><h3>Background</h3><div>Effective communication is essential in fostering a strong physician-patient relationship. With a growing number of patient engagement platforms, understanding communication preferences is crucial in guiding patient contact strategies more effectively. The goal of this study is to explore communication medium preferences of hip and knee arthroplasty patients.</div></div><div><h3>Methods</h3><div>A 10-question survey focused on patient communication preferences with the surgical team was distributed anonymously to patients at clinic visits of multiple arthroplasty surgeons at a large academic center. No identifying information was collected.</div></div><div><h3>Results</h3><div>Four hundred seventy-two responses were collected. Of the patients, 95.6% were willing to share their phone number with the surgical team. Of those responding, 53.5% and 35.4% indicated that a phone call and text, respectively, were their preferred communication medium. A majority (93%) of respondents had positive feelings towards receiving 1-way message updates with reminders, videos, and expected milestones perioperatively. Most patients (92.5%) want an open line of communication with the surgical team, and almost every respondent (99.6%) believes that the surgeon or insurance company is responsible financially for this means of communication or patient engagement platform.</div></div><div><h3>Conclusions</h3><div>Our data suggest that direct communication via phone calls and texts are the preferred media of communication with arthroplasty patients. Financially, surgeons should be aware that engagement platforms may add to practice costs. However, incorporating these insights into practice can enhance patient satisfaction, ultimately leading to better outcomes and more efficient care. Understanding these preferences may afford clearer, more effective interactions with patients and potentially improve overall engagement and outcome data collection.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101682"},"PeriodicalIF":1.5,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to “Revision Rates for Aseptic Loosening in the Obese Patient: A Comparison Between Stemmed, Uncemented, and Unstemmed Tibial Total Knee Arthroplasty Components” [Arthroplasty Today 32 (2025) 101,621]","authors":"Bernard H. van Duren,&nbsp;Amy M. Firth,&nbsp;Reshid Berber,&nbsp;Hosam E. Matar,&nbsp;Peter J. James,&nbsp;Benjamin V. Bloch","doi":"10.1016/j.artd.2025.101683","DOIUrl":"10.1016/j.artd.2025.101683","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101683"},"PeriodicalIF":1.5,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143829297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}