Journal of Arthroplasty最新文献

{"title":"Primary Total Hip Arthroplasty Achieves Minimal Clinically Important Difference Faster than Revision Total Hip Arthroplasty.","authors":"Perry L Lim, Kevin Wang, Hany S Bedair, Christopher M Melnic","doi":"10.1016/j.arth.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.002","url":null,"abstract":"<p><strong>Background: </strong>Despite the prevalence of total hip arthroplasty (THA) as a treatment for hip-related conditions, there is limited research directly comparing the patient-reported outcome measures (PROMs) between primary and revision THA. This study compared the time to achieve minimal clinically important difference (MCID) between primary and revision THA.</p><p><strong>Methods: </strong>We conducted a retrospective analysis comparing 6,671 THAs (6,070 primary and 601 all-cause revision THAs) performed between 2016 and 2022. Patient-reported outcomes were evaluated using preoperative and postoperative scores of Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, PROMIS Physical Function-10a (PF-10a), and Hip Injury and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS). The time to achieve MCID was assessed using survival curves with and without interval-censoring, and statistical comparisons were performed using log-rank and weighted log-rank tests.</p><p><strong>Results: </strong>Comparing the time to achieve MCID without interval-censoring, primary THA demonstrated significantly faster median times than revision THA for PROMIS Global Physical (3.3 versus 3.9 months, P < 0.001), PROMIS PF-10a (3.6 versus 6.2 months, P < 0.001), and HOOS-PS (3.1 versus 4.0 months, P < 0.001). Similarly, when using interval-censoring, primary THA continued to achieve MCID significantly faster than revision THA for PROMIS Global Physical (0.23 to 0.24 versus 0.50 to 0.51 months, P < 0.001), PROMIS PF-10a (1.43 to 1.44 versus 3.03 to 3.04 months, P < 0.001), and HOOS-PS (0.87 to 0.87 versus 1.20 to 1.21 months, P < 0.001).</p><p><strong>Conclusion: </strong>Across all PROMs, primary THA achieved MCID significantly faster than revision THA, irrespective of interval-censoring. These findings underscore the importance of setting realistic postoperative recovery expectations during perioperative patient counseling. Future studies should investigate the factors influencing time to achieve MCID and explore how to enhance revision THA techniques and perioperative management for improved patient outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570101","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":"Long-Term Comparison Safety and Outcomes of Simultaneous Bilateral, Staggered Bilateral, and Staged Bilateral Total Knee Arthroplasty.","authors":"Young-Hoo Kim, Jang-Won Park, Young-Soo Jang, Eun-Jung Kim","doi":"10.1016/j.arth.2024.10.097","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.097","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to determine the safety and the clinical outcome of simultaneous bilateral, staggered bilateral, and staged bilateral total knee arthroplasty (TKA) performed by a single surgeon at one academic institute.</p><p><strong>Methods: </strong>We prospectively followed and retrospectively compared the results of 7,155 patients (14,310 knees) who had simultaneous bilateral TKA, 6,671 patients (13,342 knees) who had staggered bilateral TKA, and 4,501 patients (9,002 knees) who had staged bilateral TKA. The mean age of the patients was 67, 65, and 69 years, respectively. The mean follow-up was 15.5, 15.3, and 16.1 years, respectively. The prevalence of mortality and complications were assessed in each group. In addition, patients was assessed clinically and radiographically at each follow-up.</p><p><strong>Results: </strong>The mortality rate (14 patients, 0.2%) of the patients who underwent simultaneous bilateral TKA was similar to those who underwent staggered bilateral TKA (19 patients, 0.3%) and those who underwent staged bilateral TKA (18 patients, 0.4%) (P > 0.05). The major complication (except death) rate (0.8, 0.5, and 0.4%, respectively) and the minor complication rate (20.7, 19, and 19.6%, respectively) were not significantly different among the three groups (P > 0.05). There was no significant difference in the clinical outcomes, radiographic results, revision rate, or survivorship of TKA implants among the three groups (P > 0.05). Transfusion requirements were different among the three groups (10% in the simultaneous bilateral TKA group, 12% in the staggered bilateral TKA group, and 2% in the staged bilateral TKA group).</p><p><strong>Conclusions: </strong>We found no significant differences among the simultaneous bilateral, staggered bilateral, and staged bilateral TKA groups, with regard to the mortality, major complication, minor complication, and revision rates; the survival of TKA implants; and clinical and radiographic results after a mean follow-up of 15.5, 15.3, and 16.1 years, respectively.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570079","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":"Is there a difference in outcome of primary total knee arthroplasty when mobile bearing versus fixed bearing implants are used?","authors":"Quanjun Cui, Zhichang Zhang, Elizabeth Driskill, Corinne Vennitti, Charles Engh, John F Burke, Abtin Alvand, Ahmad Abbaszadeh, Wendy Novicoff","doi":"10.1016/j.arth.2024.10.084","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.084","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570070","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":"Outcomes of Total Hip Arthroplasty in Seronegative Spondyloarthropathies: A Propensity-Matched Cohort Analysis.","authors":"Robert J Burkhart, Aakash K Shah, Monish S Lavu, Davison Beenfeldt, Victoria J Nedder, Andrew J Moyal, Jeremy M Adelstein, Nicholas M Romeo","doi":"10.1016/j.arth.2024.10.111","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.111","url":null,"abstract":"<p><strong>Introduction: </strong>Total hip arthroplasty (THA) is a common surgical intervention for patients who have seronegative spondyloarthropathies (SpA). However, there is a paucity of literature addressing the outcomes of THA specifically in SpA patients. This study aimed to investigate both the short- and long-term systemic and orthopaedic outcomes of THA in SpA patients as a whole, as well as within the individual subtypes of SpA.</p><p><strong>Methods: </strong>This retrospective cohort study utilized a federated health research network, identifying 3,074 SpA patients who underwent THA between 2005 and 2022. Propensity score matching was used to compare SpA and non-SpA patients, balancing baseline characteristics. Short-term (30-day, 180-day, 1-year) and long-term (5-year) postoperative complications were analyzed. The outcomes included systemic and joint complications. Chi-square analyses were done to compare outcomes across categorical data.</p><p><strong>Results: </strong>The SpA patients had increased rates of revision THA, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening at various postoperative intervals. Surgical site infections and myocardial infarctions were more frequent at one month, six months, and one year. Additionally, SpA patients exhibited a higher incidence of deep vein thrombosis at six months and one year. Subtype analysis revealed that ankylosing spondylitis patients were more likely to have revision surgery and prosthetic dislocation, while Psoriatic Arthritis patients had a lower risk of hip dislocation and femur fractures.</p><p><strong>Conclusion: </strong>The SpA patients undergoing THA are at greater risk for systemic and orthopaedic complications compared to non-SpA patients. The increased incidence of infections, thromboembolic events, and prosthetic issues highlight the need for careful preoperative assessment and postoperative management.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570023","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 Utility of Neighborhood Social Vulnerability Indices in Predicting Nonhome Discharge Disposition Following Revision Total Joint Arthroplasty: A Comparison Study.","authors":"Michelle Riyo Shimizu, Anirudh Buddhiraju, Oh-Jak Kwon, Jona Kerluku, Ziwei Huang, Young-Min Kwon","doi":"10.1016/j.arth.2024.10.118","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.118","url":null,"abstract":"<p><strong>Background: </strong>Identifying risk factors associated with non-home discharge (NHD) following revision hip and knee total joint arthroplasty (TJA) could reduce the rate of preventable discharge to rehabilitation or skilled nursing facilities. Neighborhood-level deprivation indices are becoming an increasingly important measure of socioeconomic disadvantage as these indices consider multiple social determinants of health. This study aimed to compare the utility of widely used neighborhood social vulnerability indices in predicting NHD following revision TJA patients.</p><p><strong>Methods: </strong>This study included 1,043 consecutive patients who underwent revision TJA at a single tertiary health system. There were three multivariate logistic regression analyses with the outcome of NHD performed using the area deprivation index (ADI), social deprivation index (SDI), and social vulnerability index (SVI) while controlling for other demographic variables. Neighborhood-level indices were included in the analysis as continuous variables and categorical quartiles, with the lowest quartile representing the least deprived neighborhoods of the patient cohort. The strength of the association of significant indices was measured.</p><p><strong>Results: </strong>Patients in the highest ADI and SDI quartiles demonstrated higher odds of NHD compared to the cohort with the lowest quartile (ADI OR [odds ratio] = 1.93, 95% CI [confidence interval] = 1.23 to 3.03, P = 0.005; SDI OR = 1.86, 95% CI = 1.18 to 2.91, P = 0.007). Discharge disposition was more strongly associated with ADI than SDI (0.68 versus 0.26). Age, ASA status, and alcohol use were independent determinants of discharge disposition. No significant association was seen between SVI and discharge disposition.</p><p><strong>Conclusion: </strong>Area-level indices can be utilized to identify patients at higher risk of NHD following revision TJA. This study highlights the important differences between these indices' utility when evaluating their effects on clinical outcomes in this patient population. The findings shed light on the potential of integrating these tools into policy development, clinical preoperative programs, and research to better understand and address the health disparities in arthroplasty outcomes.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570104","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":"Question# 19: Is Prescribed Postoperative Physical Therapy Necessary after Routine Primary Total Knee or Total Hip Arthroplasty?","authors":"Claudio Diaz-Ledezma, Ilda Molloy, Rob Nelissen, Lipalo Mokete, Julian Costantini","doi":"10.1016/j.arth.2024.10.105","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.105","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570102","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":"Outpatient Versus Inpatient Total Hip and Knee Arthroplasty in Morbidly Obese Patients.","authors":"Mohammad Daher, Jonathan Liu, Nathaniel Smith, Alan H Daniels, Mouhanad M El-Othmani, Thomas J Barrett, Eric M Cohen","doi":"10.1016/j.arth.2024.10.112","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.112","url":null,"abstract":"<p><strong>Background: </strong>Morbidly obese patients undergoing total joint arthroplasty (TJA) face increased postoperative complications, yet studies assessing the safety of this surgery in the outpatient setting for this population are lacking. This study aimed to fill this gap by assessing the safety and benefits of outpatient TJA in morbidly obese patients.</p><p><strong>Methods: </strong>This study is a retrospective review of a commercial claims database. Based on the setting of the procedure, the patients were divided into four groups: inpatient-TKA (total knee arthroplasty), outpatient-TKA, inpatient-THA (total hip arthroplasty), and outpatient-THA. The two TKA groups were matched based on age, sex, and the Charlson comorbidity index (CCI). The THA groups were matched similarly. The 30- and 90-day medical and surgical complications were compared between these groups. There were 5,500 patients included in each of the outpatient and inpatient TKA groups, and 1,550 in each of the outpatient and inpatient THA groups RESULTS: Patients undergoing inpatient TKA had higher rates of pulmonary embolism, UTI (urinary tract infection), transfusions, ICU (intensive care unit) admissions, ED (emergency department) visits, readmissions at 30 days, surgical site infections, periprosthetic joint infection, prosthetic dislocations, and costs. As for the inpatient THA group, they had higher rates of pulmonary embolism, UTI, transfusions, ICU admissions, ED visits, and costs.</p><p><strong>Conclusion: </strong>It is well established that morbidly obese patients undergoing total joint arthroplasty have higher complication rates than normal-weight patients, and patients should be counseled before arthroplasty. This study highlights the safety and benefits of outpatient TJA in morbidly obese patients. However, one should note that this was done using an insurance database, in which results may differ if it was done in a public and lower socioeconomic setting. Therefore, future prospective studies are needed to confirm the findings before implementing outpatient TJA in morbidly obese patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570043","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":"What are the indications for surgical intervention for patients with femoroacetabular impingement of the hip?","authors":"Ali Parsa, Benjamin G Domb, Javad Parvizi, Ibrahim Tuncai, Naomi Kobayashi, Oussama Charr, Amirshahriar Ariamanesh","doi":"10.1016/j.arth.2024.10.115","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.115","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570108","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":"Mapping the Institutional Healthcare Payer Mix for Total Hip and Knee Arthroplasty: Insight into a Large Practice.","authors":"Nihir Parikh, Alam Lam, William DiCiurcio, Nisha Cherian Matthew, Bryan Wellens, Chad A Krueger","doi":"10.1016/j.arth.2024.10.117","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.117","url":null,"abstract":"<p><strong>Introduction: </strong>As the demand for total hip (THA) and knee arthroplasty (TKA) continues to grow exponentially, the economic burden on practices and healthcare payers simultaneously increases. Medicare accounts for over 60% of total joint arthroplasty (TJA) cases nationwide, and the reimbursements are worsening despite alternative payment models. Trending the active payers at an institution provides invaluable insight into the financial health of a practice and projects if annual run rates are sustainable.</p><p><strong>Methods: </strong>Insurance and billing claims were analyzed for all THA and TKA cases between January 1, 2019, and December 31, 2022, from various healthcare payers at a single, high-volume institution. The payers included Medicare, Medicare Advantage, and seven commercial payers. The THA and TKA claims are from institutional facilities across two Northeast states - New Jersey (NJ) and Pennsylvania (PA). Volume, charges, and payments from each payer were trended over three years (2019 to 2022).</p><p><strong>Results: </strong>In the years following the COVID-19 pandemic, the number of institutional patients who had Medicare and Medicare Advantage undergoing TJA drastically increased by 29.1% and 37.8%, respectively. As a result, charges spiked by over $20 million for Medicare and nearly $15 million for Medicare Advantage. Despite a higher caseload, the payments received per case decreased by 24.5% for Medicare and 18.7% for Medicare Advantage. Commercial payers grew 20.6% in annual cases, yet payments received per case similarly decreased by 15.0% at the end of 2022.</p><p><strong>Conclusions: </strong>Rising Medicare and Medicare Advantage TJA volume highlights the increase in costs and resource utilization, while diminishing payments underscore the inadequate reimbursement to hospitals and surgeons. Along with stagnant commercial payments, the trend shows concerns about the financial health of THA and TKA institutions that participate in the care of a large number of Medicare patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570003","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":"Question : Is there a difference in the outcomes between cemented and uncemented primary total knee arthroplasty?","authors":"Hamidreza Yazdi, Amir Mohsen Khorrami, Amir Azimi, Luis Pulido, Guillermo Bonilla, Fatih Yildiz, Rocco Papalia","doi":"10.1016/j.arth.2024.10.083","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.083","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512511","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}