Journal of Arthroplasty最新文献

{"title":"Does Orthopaedic Subspecialty Training Affect Treatment Decision-Making and Outcomes for Displaced Femoral Neck Fractures.","authors":"Joshua Giordano, Anthony Modica, Jorge A Padilla, Randy M Cohn, James Germano","doi":"10.1016/j.arth.2025.03.058","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.058","url":null,"abstract":"<p><strong>Background: </strong>Approximately 1.3 to 2.2 million femoral neck fractures occur annually globally, with up to 80% being displaced, requiring hemiarthroplasty or total hip arthroplasty (THA). As the population ages, femoral neck fractures may surpass six million by 2050. Optimal treatment for displaced femoral neck fractures is debated with literature supporting both hemiarthroplasty and THA. Our objective was to determine if subspecialty training plays a role in the decision-making and outcomes of displaced femoral neck fractures.</p><p><strong>Methods: </strong>A retrospective analysis was performed of 386 patients who underwent hemiarthroplasty or THA for displaced femoral neck fracture at an academic health system from 2017 to 2023. To assess subspecialty training impact, patients were stratified based on training: adult reconstruction (AR) fellowship or other orthopaedic training (non-AR). Procedure duration, 90-day postoperative complications, length of stay, and discharge disposition were compared between cohorts. A sub-analysis was performed comparing procedures.</p><p><strong>Results: </strong>The AR surgeons performed THA 31.8% for femoral neck fractures compared to 10.5% for non-AR-trained surgeons (P< 0.001). Patients treated by AR-trained surgeons were on average younger (79 versus 82 years; P = 0.01). Procedure duration was shorter for hemiarthroplasty (80.4 versus 90.1 minutes; P = 0.01) and THA (94.9 versus 132.6 minutes; P = 0.01) when performed by AR surgeons (overall P = 0.01). The THA patients were more likely discharged home when treated by AR surgeons (55.3 versus 28%; P = 0.03). The AR-trained surgeons used cemented prostheses less compared to non-AR surgeons (16.9 versus 33.2%; P < 0.001).</p><p><strong>Conclusion: </strong>Subspecialty training plays a role in decision-making, procedure duration, and discharge disposition for femoral neck fractures. The AR-trained surgeons more often perform THA for femoral neck fractures compared to non-AR-trained surgeons. The AR-trained surgeons completed hemiarthroplasty and THA in significantly shorter time compared with non-AR-trained surgeons and more frequently discharged patients home.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Aspirin is Safe and Effective for Prevention of Venous Thromboembolism after Femoral Neck Fracture.","authors":"Amy Y Zhao, Alex Gu, Aribah Shah, Avilash Das, Philip M Parel, James N Debritz, Robert S Sterling","doi":"10.1016/j.arth.2025.03.059","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.059","url":null,"abstract":"<p><strong>Introduction: </strong>Although patients who undergo arthroplasty for hip fractures are at high risk of venous thromboembolism (VTE), current guidelines do not specify the optimal VTE prophylactic agent. Recent evidence demonstrates that aspirin (ASA) may be safe and effective for VTE prevention in these patients. The purpose of this study was to determine the safety and efficacy of low-dose ASA (81 mg) compared to non-ASA agents after arthroplasty for femoral neck fracture.</p><p><strong>Methods: </strong>A total of 36,576 patients who underwent arthroplasty for femoral neck fracture from January 2012 through December 2023 were identified in a national database. Patients were stratified by baseline VTE risk into high-risk and standard-risk groups and further categorized based on the type of VTE prophylaxis received - low-dose ASA only or non-ASA prophylaxis only. Rates and odds of deep vein thrombosis (DVT), pulmonary embolism (PE), and adverse events, including bleeding, blood transfusion requirements, and emergency department visits, were assessed in the 90-day postoperative period for propensity-matched cohorts.</p><p><strong>Results: </strong>Compared to non-ASA prophylaxis, use of low-dose ASA only was associated with significantly lower odds of DVT in both high-risk (odds ratio [OR]: 0.46; 95% confidence interval [CI]: 0.30 to 0.69) and standard-risk (OR: 0.37; 95% CI: 0.18 to 0.76) groups, and lower odds of PE in high-risk patients (OR: 0.27; 95% CI: 0.14 to 0.55). There were no significant differences in odds of PE in standard-risk patients (OR: 0.71; 95% CI: 0.32 to 1.61). Low-dose ASA was associated with lower odds of bleeding events, blood transfusion requirements, and emergency department visits.</p><p><strong>Conclusions: </strong>Use of low-dose ASA is safe and effective in preventing VTE in patients undergoing arthroplasty for femoral neck fracture. As this population is at higher risk of mortality, prospective studies comparing VTE prophylaxis regimens are necessary to further improve clinical outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Treatment Influence Hospital Costs of Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis.","authors":"Aaron S Hammat, Emmanuel S Gnanamanickam, Chan Hee Cho, Boopalan Ramasamy, Renjy Nelson, David Campbell, Lucian B Solomon, Stuart A Callary","doi":"10.1016/j.arth.2025.03.057","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.057","url":null,"abstract":"<p><strong>Background: </strong>This systematic review and meta-analysis aimed to synthesize the hospital costs of revision total hip arthroplasty (rTHA) by periprosthetic joint infection (PJI), periprosthetic fracture (PPF), aseptic loosening, and recurrent dislocation diagnoses. Additionally, as several surgical options are available within some diagnoses, this study aimed to synthesize the evidence on hospital costs for septic rTHA between debridement and implant retention (DAIR), one-stage and two-stage rTHA, and for PPF the cost between rTHA and open reduction internal fixation (ORIF) treatment.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, and Scopus identified all studies reporting the hospital costs of rTHA. Screening, data extraction, and risk of bias assessment were conducted. Hospital costs of each study cohort by main diagnosis and treatment were adjusted to 2024 USD and pooled using a random effects model.</p><p><strong>Results: </strong>Of 866 publications identified, 24 studies were included in the meta-analysis. Mean pooled costs of rTHA for dislocation, aseptic loosening, PPF, and septic rTHA were $25,256, $34,533, $35,904, and $55,707, respectively. The mean cost of septic rTHA (16 study cohorts) at $57,264 was 87% higher than aseptic rTHA (22 cohorts) at $30,224. A two-stage septic rTHA ($70,311) cost 77% more than one-stage septic rTHAs ($39,676). The cost of rTHA for PPF ($35,904) was 26% more than ORIF for PPF ($28,410).</p><p><strong>Conclusion: </strong>The cost of rTHA is progressively higher by diagnosis in the order of dislocation, aseptic loosening, PPF, and infection. Future studies should separately report rTHA costs by diagnosis and treatment type and longitudinally examine the hospital costs of this patient cohort, particularly for septic cases, beyond initial treatment to better understand the burden of rTHA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the Cost Trends of Readmissions after Aseptic Revision Total Knee Arthroplasty.","authors":"Bryce T Hrudka, Andrew Fuqua, Jenny Nguyen, Janice Bonsu, Bridger Rodoni, Ayomide M Ayeni, Jacob Wilson, Ajay Premkumar","doi":"10.1016/j.arth.2025.03.051","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.051","url":null,"abstract":"<p><strong>Introduction: </strong>A rise in total knee arthroplasty (TKA) volume has led to an increased incidence of aseptic revision TKA (rTKA), resulting in significant associated healthcare costs. This study evaluated the economic impact and clinical factors associated with readmission following aseptic rTKA, aiming to identify key drivers of cost and risk factors for readmission.</p><p><strong>Methods: </strong>This retrospective analysis used data from a large national database from January 1, 2009, to June 30, 2022. Patients undergoing aseptic rTKA were identified via CPT (Current Procedural Terminology) codes. Readmissions within 90 days postoperatively were analyzed. Baseline characteristics, comorbidities, and readmission costs were compared, and significant risk factors for readmission were identified. Of 34,144 aseptic rTKA patients, 1,953 (5.7%) were readmitted within 90 days (56.1% medical, 29.2% surgical, 14.8% unknown).</p><p><strong>Results: </strong>The median cost of all readmissions was $25,181. Readmissions requiring reoperation had a higher cost (median $40,524 versus $20,907, P < 0.001). Among readmissions for surgical complications, periprosthetic joint infection was the most common cause (36.3%) and was associated with the greatest cost (median $38,104). The most common medical causes of readmission were rehabilitative care, ischemic cardiac events, and acute kidney injury. Significant risk factors for all-cause readmission included men, index revision for periprosthetic fracture, and comorbidities, including diabetes, coronary artery disease, renal disease, and congestive heart failure.</p><p><strong>Conclusion: </strong>Readmission after aseptic rTKA results in a major economic burden to the healthcare system, particularly in readmission pertaining to surgical complications and requiring reoperation. This study highlights the need for targeted strategies aimed at effectively reducing the rate of and costs associated with readmission post-rTKA with a goal of cost containment and improved patient outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why Do Total Joint Arthroplasties Get Canceled on the Day of Surgery?","authors":"Carlos G Sandoval, Jonathan L Katzman, Patrick Connolly, Eric L Grossman, Armin Arshi, Ran Schwarzkopf","doi":"10.1016/j.arth.2025.03.048","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.048","url":null,"abstract":"<p><strong>Background: </strong>Same-day cancellations of elective surgeries present challenges to patients, providers, and healthcare institutions. This study aimed to investigate the frequency and predictors of same-day cancellations for elective total joint arthroplasty (TJA).</p><p><strong>Methods: </strong>A retrospective review was conducted on 13,744 scheduled primary, elective TJAs at an urban academic center from September 2017 to August 2023. Cases that experienced same-day cancellations were grouped based on the reasoning for cancellation into one of two categories - operative concern (e.g., acute health issues, medication non-compliance) or a nonoperative concern (e.g., financial clearance, transportation issues). Patient demographics were compared between the cancellation and surgery cohorts and between the categorical reasons for cancellation.</p><p><strong>Results: </strong>Out of the 38,849 scheduled TJAs, 362 cases (0.9%) were canceled on the day of surgery. Higher patient body mass index (BMI) was the singular patient factor predictive of same-day cancellation across all TJAs. Non-white race, men, and higher Charlson Comorbidity Index (CCI) were additional significant predictors for THA, but not TKA cancellation. Operative concerns accounted for 74.9% of the cancellations, and nonoperative concerns accounted for 25.1%. Increased patient BMI was predictive of TJAs canceled due to operative concerns, whereas younger patient age was predictive of TJAs canceled due to nonoperative concerns. Of all same-day cancellations, 81.8% were ultimately rescheduled, and rescheduled cases occurred at a median of 25 days (range, one to 425) after cancellation. There were no significant differences in rescheduling rates and time to reschedule cases between the reasons for cancellation.</p><p><strong>Conclusion: </strong>Approximately 1% of patients experienced a same-day cancellation of their elective TJA, most of which occurred due to operative concerns. These findings may guide the development of preoperative optimization strategies aimed at reducing the occurrence of same-day cancellations for high-risk patients, thereby maximizing the utilization of operative resources and enhancing care for TJA patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Resurfacing Arthroplasty in Men: A Minimum 15-Year Follow-Up Study.","authors":"Anand Saluja, Zachary Wong, Louis Andrew Jordan, Jonathan Spaan, Edwin Su","doi":"10.1016/j.arth.2025.03.038","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.038","url":null,"abstract":"<p><strong>Background: </strong>Hip resurfacing arthroplasty (HRA) has emerged as an alternative to total hip arthroplasty (THA) for managing osteoarthritis, particularly in younger, active men. However, long-term data on HRA outcomes in the United States remains limited.</p><p><strong>Methods: </strong>We retrospectively examined 472 consecutive HRA cases in 407 men performed between January 2006 and December 2008 with a minimum 15-year follow-up outcomes. Patient-reported outcome measures (PROMs), including the modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), Visual Analog Scale (VAS) for pain, and University of California-Los Angeles (UCLA) Activity Scale, were collected. Serum metal ion levels, survivorship, and radiographic outcomes were also assessed. Kaplan-Meier survival analysis was performed to evaluate implant survivorship. The mean follow-up was 16.0 years (range, 15.0 to 18.4).</p><p><strong>Results: </strong>The overall survivorship at 15 years was 95.1%. Implants with femoral head sizes ≥ 48 mm demonstrated 95.8% survivorship, while those < 48 mm showed 91.3% survivorship. For unrevised hips, mean final follow-up scores were HOOS-JR 97.8 ± 5.6, mHHS 97.3 ± 6.4, VAS 0.4 ± 1.1, and UCLA Activity 8.0 ± 1.9. The median serum metal ion levels at the final follow-up were 2.3 μg/L for chromium and 1.7 μg/L for cobalt. There were 26 revisions that occurred, with aseptic loosening being the most common cause (n = 11).</p><p><strong>Conclusion: </strong>This study demonstrates that HRA is a viable long-term solution for appropriately selected men with high survivorship and positive functional outcomes at a minimum 15-year follow-up.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are There Differences in Patient-Reported Outcomes Measurement Information System Scores After Total Knee and Total Ankle Arthroplasty in Matched Patients?","authors":"Justin Leal, Christopher T Holland, Christine J Wu, Mark E Easley, James A Nunley, Sean P Ryan, Michael P Bolognesi, Samuel S Wellman, William A Jiranek","doi":"10.1016/j.arth.2025.03.043","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.043","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System (PROMIS) scores, a generic patient-reported outcome measure (PROM), as a tool to compare outcomes between total knee (TKA) and total ankle arthroplasty (TAA).</p><p><strong>Methods: </strong>Patients who underwent TKA or TAA from January 1, 2019, to December 31, 2023, with at least one year of follow-up, were reviewed retrospectively. Upon application of criteria, 2,418 TKAs and 500 TAAs were utilized for analysis. Demographics, PROMs, emergency department (ED) visits, re-admissions, and revision surgeries were collected. Propensity score matching at a 3:1 ratio of TKA to TAA patients was then done, balancing age, sex, race, body mass index (BMI), and American Society of Anesthesiologists (ASA) classification, which resulted in a final cohort of 1,256 TKAs and 470 TAAs.</p><p><strong>Results: </strong>Preoperative PROMIS pain interference scores were similar between TKA and TAA, and both showed improvements by six weeks. Patients undergoing TAA, however, had a greater decrease in pain interference scores at one year (TKA: -10.0 [-15.0 to -5.0]) versus TAA: -11.0 [-17.0 to -6.0]; P = 0.044). Regarding PROMIS physical function, preoperative scores were also similar for TKA and TAA patients. Additionally, patients in both groups had similar improvement in physical function at one year; however, TKA patients had better physical function at six weeks (TKA: 41.0 [36.0 to 46.0] versus TAA: 37.0 [33.0 to 41.0]; P < 0.001). Preoperative PROMIS depression scores were similar between groups and showed similar improvement after surgery. Joint-specific PROMs improved in each cohort, respectively.</p><p><strong>Conclusion: </strong>Both TKA and TAA showed improvement postoperatively in joint-specific PROMs, which concurrently resulted in PROMIS score improvement across all domains in both joints. This suggests that arthroplasties across different anatomic sites can be compared using generic PROMs. For TKA and TAA, similar improvements in PROMIS pain interference, physical function, and depression were noted one year after surgery.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Episode Resource Equivalents (ERQs) as a Novel Methodology to Accelerate Episode Payment Models in Total Joint Arthroplasty.","authors":"Seth Bouwer, Ed S Lee, Leonard T Buller, Evan R Deckard, Gionté C Mason, Kenneth P Nagle, Anthony T Sorkin, R Michael Meneghini","doi":"10.1016/j.arth.2025.03.044","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.044","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services Innovation Center have deployed episode payment models in beneficiaries covered by traditional Medicare for over a decade. However, Medicare Advantage (MA) plans have been slow in implementing episodic models due to varying target prices within MA plans. This study validated a novel methodology overcoming this barrier by calculating an Episode Resource Equivalent (ERQ) based on the occurrence of events quantifying clinical resource consumption regardless of payor analogous to relative value units for physician clinical effort.</p><p><strong>Methods: </strong>Claims data from a Medicare accountable care organization (ACO) were used to calculate the mean spend of 12 clinical events (ERQ events) that drive spend in the overall total joint arthroplasty (TJA) care episode. Coefficients for the 12 ERQ events were calculated by dividing the mean Medicare spend of each ERQ event by the mean inpatient Medicare spend. The episode ERQ is the sum of all ERQ event coefficients incurred during the episode. The relationship between episode ERQs and total spending was validated via the ACO data warehouse (N = 3,316). Transferability of the ERQ methodology was then tested by using the ACO-based ERQ event coefficients in determining the relationship between episode ERQ and total spend on episodes from a local MA plan (N = 700).</p><p><strong>Results: </strong>Mean episode ERQs for TJA surgeons were strongly and significantly associated with actual episode spend for both ACO (P≤0.001, R² = 0.8636, standardized-coefficient = 0.0929, 95% confidence interval (CI), 0.808 to 1.051) and MA-plans (P≤0.001, R² = 0.887, standardized-coefficient = 0.942, 95% CI, 0.688 to 1.195).</p><p><strong>Conclusion: </strong>The ERQ is a novel methodology to measure clinical resource consumption that is transferable between payors for measuring performance targets in episode-based payment models. These data support ERQ as a payor-agnostic metric that can evaluate alternative payment model performance in value-based care.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The CCJR® Gerard A. Engh Excellence in Knee Research Award: Patient-Reported Outcomes Collection and Mandatory Medicare Inpatient TKA-PRO Performance Measures: How to Optimize the Process.","authors":"Jonathan R Franco, Antonia F Chen, John E Ready, Adam S Olsen, Jeffrey K Lange, Vivek M Shah, Richard Iorio","doi":"10.1016/j.arth.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.033","url":null,"abstract":"<p><strong>Background: </strong>The Centers for Medicare and Medicaid Services (CMS) has mandated that patient-reported outcomes (PROs) reporting for total knee arthroplasty (TKA) start on July 1, 2024, which will impact reimbursement in 2028. The financial penalty for not reporting 50% of eligible patients is 25% of the Annual Payment Update (usually 2 to 4%). The CMS will evaluate for a substantial clinical benefit (SCB), defined as a 20-point increase in the Knee Injury and Osteoarthritis Outcome Score (KOOS JR) score. A final \"risk-standardized improvement rate\" (RSIR) will be calculated based on all risk variables and claims data submitted. The purpose of this study was to present our process for complying with these mandates.</p><p><strong>Methods: </strong>We employed a multi-prong approach in a 12-hospital enterprise to collect PROs. We utilized a web-based PRO collection system embedded in our electronic medical record (EMR), a tablet in-person collection system in the clinic, and a patient engagement platform.</p><p><strong>Results: </strong>Since 2019, we enrolled 7,354 TKA patients in a patient engagement platform, and 6,942 (94%) have opted in and used the platform. Percentages of PRO completion were 90% preoperatively, 80% at three months postoperatively, 76% at six months postoperatively, and 79% at one year postoperatively. Patient satisfaction scores averaged 4.51 out of five at 90 days. The KOOS JR. scores improved on average from 52.0 preoperatively to 74.9 in one year. Utilizing our web-based EMR collection system in addition to the in-person tablet PRO collection achieved minimum collection performance.</p><p><strong>Conclusion: </strong>Our study found that using a multi-prong approach to comply with the Inpatient Prospective Payment System (IPPS) CMS Inpatient TKA PRO-Performance Measures will meet the minimum standards of 50% paired PROs reporting. Furthermore, our hospital system was able to meet the required SCB of 20 points on the KOOS JR and collect this information for reporting.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct Anterior Total Hip Arthroplasty Using the Muller Line-to-Line Cement Technique: A Propensity Score Matched Cohort Analysis.","authors":"Vivek P Chadayammuri, Shuvalaxmi D Haselton, Roger H Emerson","doi":"10.1016/j.arth.2025.03.042","DOIUrl":"https://doi.org/10.1016/j.arth.2025.03.042","url":null,"abstract":"<p><strong>Background: </strong>Cemented fixation in primary total hip arthroplasty (THA) has seen renewed interest alongside the increasing adoption of the direct anterior (DA) approach. However, integrating cementation techniques with the DA approach poses challenges, particularly in patients who have morphologies complicating femoral exposure and access. The objective of our study was to assess the feasibility and radiographic outcomes of the Müller line-to-line ('French Paradox') cementation technique in primary cemented DA-THA, compared to a propensity-score-matched (PSM) cohort undergoing press-fit (cementless) DA-THA.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients undergoing primary cemented DA-THA using the Müller line-to-line ('French Paradox') cementation technique between 2016 and 2018. A PSM control cohort with comparable demographics undergoing press-fit DA-THA was generated. A total of 202 patients (101 per cohort) were included. Patients in the cemented group received a polished stainless-steel stem, while the press-fit group utilized a tapered-wedge titanium alloy stem. Radiographic outcomes, including stem malposition, radiolucency > two mm, cement mantle integrity, canal fit-and-fill, and implant stability, were assessed at a mean follow-up of 1.7 years using univariate and multivariate analyses.</p><p><strong>Results: </strong>Symmetric bilateral femoral cortical thinning was observed in 10.8% of the cemented DA-THA cohort, attributed to physiological aging, with no instances of stem malposition, subsidence, or cement mantle compromise. In contrast, 5.9% of patients in the PSM press-fit DA-THA cohort experienced periprosthetic fractures or subsidence requiring revision surgery.</p><p><strong>Conclusions: </strong>While numerous clinical registry studies have driven renewed interest in primary cemented THA, most have focused on conventional cementation techniques performed via posterior or antero-lateral approaches. This study demonstrates that primary DA-THA using the Müller line-to-line cementation technique delivers excellent radiographic outcomes while improving operative efficiency and adaptability in challenging morphologies. Long-term data collection is ongoing to validate these findings.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}