Journal of Arthroplasty最新文献

{"title":"Basics of Orthopaedic Commercial and Government Bundling","authors":"Isaac Y. Hung BA ,&nbsp;Troy Simonson BA ,&nbsp;David S. Jevsevar MD, MBA ,&nbsp;Zeev N. Kain MD, MBA","doi":"10.1016/j.arth.2024.11.025","DOIUrl":"10.1016/j.arth.2024.11.025","url":null,"abstract":"<div><h3>Background</h3><div>The health care system is transitioning from fee-for-service models to value-based care frameworks, with bundled payments emerging as a promising approach to improve cost efficiency and patient outcomes. Bundled payments consolidate costs for multiple services into a single payment for specific treatments or conditions. This study reviews the development and implementation of bundling models in orthopaedics, comparing government and commercial approaches and discussing their benefits and challenges.</div></div><div><h3>Methods</h3><div>A review of the literature was conducted to examine existing bundling programs in orthopaedics, including Medicare initiatives like the Bundled Payments for Care Improvement and Comprehensive Care for Joint Replacement model, as well as commercial programs from insurers such as Cigna and UnitedHealthcare. The review focused on published studies, reports, and case examples to identify trends, outcomes, and barriers associated with these models.</div></div><div><h3>Results</h3><div>Government programs such as Comprehensive Care for Joint Replacement have demonstrated improved care coordination and cost control but face challenges in engaging physicians and aligning financial incentives. Commercial models, with greater flexibility in their prospective payment structures, allow for customization and better financial predictability but require careful negotiation and compliance with quality metrics. Both approaches highlight the importance of robust data management, multidisciplinary collaboration, and innovative partnerships to improve care delivery. Condition-based bundling, though conceptually aligned with value-based care, remains in its early stages within orthopaedics.</div></div><div><h3>Conclusions</h3><div>Bundled payment models represent a key strategy for advancing sustainable and efficient health care delivery in orthopaedics. Despite challenges like stakeholder alignment and resource demands, these models offer potential to enhance care quality and reduce costs. Future directions should prioritize collaboration, technology integration, and the resolution of implementation barriers to fully realize the benefits of bundling in orthopaedic practices.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages 259-262"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649736","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":"Not all Costs Are Created Equal: What Are the Types of Costs and Why Do They Matter?","authors":"Matthew L. Magruder MD ,&nbsp;Elie J. Mansour MD ,&nbsp;Giles R. Scuderi MD ,&nbsp;Ronald E. Delanois MD ,&nbsp;Michael A. Mont MD","doi":"10.1016/j.arth.2024.11.033","DOIUrl":"10.1016/j.arth.2024.11.033","url":null,"abstract":"<div><div>Value-based care models are health care economic frameworks that aim to prioritize and financially incentivize quality of care, provider performance, and patient experience. The focus on value-based care metrics will undoubtedly lead to a greater weight placed on economic analyses in arthroplasty. Authors of cost analyses in arthroplasty often use the term “cost” in ways that have vastly different underlying meanings. It is imperative that surgeons understand the different characteristics of cost data, where they come from, and how to interpret them. There are three types of costs: 1) costs to the health care providers; 2) costs to the payer; and 3) costs to society. In this review, we evaluate where each type of cost data comes from, what are the appropriate conclusions to be drawn from them, and examples of how they are used in the literature.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages 272-275"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142696112","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":"Critical Analysis of “Complication Rates are not Higher After Outpatient Versus Inpatient Fast-Track Total Knee Arthroplasty: A Propensity-Matched Prospective Comparative Study”","authors":"Raju Vaishya MS, MCh,&nbsp;Abhishek Vaish MS, MCh, DNB","doi":"10.1016/j.arth.2024.09.032","DOIUrl":"10.1016/j.arth.2024.09.032","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Page e9"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958414","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":"Preoperative Abnormal Posture Improves After Total Knee Arthroplasty: Knee–Hip–Spine Syndrome","authors":"Yasushi Oshima MD, PhD ,&nbsp;Nobuyoshi Watanabe MD, PhD ,&nbsp;Toru Takeoka ,&nbsp;Yoshiteru Kajikawa MD, PhD ,&nbsp;Tadahiko Yotsumoto MD, PhD ,&nbsp;Tokifumi Majima MD, PhD","doi":"10.1016/j.arth.2024.08.028","DOIUrl":"10.1016/j.arth.2024.08.028","url":null,"abstract":"<div><h3>Background</h3><div>Spinal, pelvic, and lower extremity alignment is crucial for maintaining a healthy body posture. However, with aging, this posture becomes challenging to maintain due to muscle weakness and skeletal degeneration. Osteoarthritis (OA) of the hip and knee can also lead to abnormal posture, known as hip-spine and knee-spine syndrome. Total knee arthroplasty (TKA) can help relieve pain and improve lower extremity alignment. This may also improve abnormal posture, such as in knee–hip–spine syndrome. However, the condition of the contralateral knee may affect this improvement. This study evaluated the effects of TKA on clinical outcomes and radiographic body posture.</div></div><div><h3>Methods</h3><div>Patients scheduled for primary one-sided TKA were divided into 2 groups: the unilateral group comprised patients who had contralateral knee OA conditions. The bilateral group included patients who had prior contralateral TKA. Knee range of motion, the Knee Injury and Osteoarthritis Outcome Score, radiographic lateral femorotibial angle, hip and knee flexion angles, and sagittal vertical axis while standing were measured 24 months after TKA.</div></div><div><h3>Results</h3><div>Both groups showed improved knee extension, the Knee Injury and Osteoarthritis Outcome Score, and radiographical femorotibial angle and hip and knee flexion angles 24 months after TKA. The sagittal vertical axis also improved 6 months after TKA in both groups and was maintained in the bilateral group, while it deteriorated again in the unilateral group 24 months after TKA.</div></div><div><h3>Conclusions</h3><div>A TKA can improve abnormal body posture due to knee OA as in knee–hip–spine syndrome. However, the condition of a contralateral knee can affect TKA outcomes.</div></div><div><h3>Level of Evidence</h3><div>Level III; prospective case-control study.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages 416-422"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is There a Threshold Limit for Body Mass Index for Patients Undergoing Primary Total Knee or Total Hip Arthroplasty?","authors":"Elizabeth K. Carlino MD ,&nbsp;Kyle H. Cichos PhD ,&nbsp;Sultan Al Maskari MD ,&nbsp;Federico J. Burgo MD ,&nbsp;Richard de Steiger PhD ,&nbsp;Seper Ekhtiari MD ,&nbsp;Antron Spooner MD ,&nbsp;Fatih Yildiz MD ,&nbsp;Elie S. Ghanem MD","doi":"10.1016/j.arth.2024.10.040","DOIUrl":"10.1016/j.arth.2024.10.040","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages S18-S20"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480129","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":"Should the Patella Be Resurfaced During Primary Total Knee Arthroplasty? An Updated Meta-Analysis and Systematic Review","authors":"Nazanin Kermanshahi ,&nbsp;Nicolaas C. Budhiparama MD, PhD ,&nbsp;Mahmood Shihab Wahhab MD ,&nbsp;Claudia Arias MD ,&nbsp;Weihua Xu MD ,&nbsp;Del Schutte MD ,&nbsp;Ping-Keung Chan MD ,&nbsp;Gwo-Chin Lee MD ,&nbsp;Javad Parvizi MD","doi":"10.1016/j.arth.2024.10.048","DOIUrl":"10.1016/j.arth.2024.10.048","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages S102-S108"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480158","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":"Does the Use of Robotic Technology Improve Outcomes in Primary Total Hip Arthroplasty?","authors":"Alisagib A. Dzhavadov MD ,&nbsp;Goksel Dikmen MD ,&nbsp;Michele R. D'Apuzzo MD ,&nbsp;Seng Jin Yeo MD ,&nbsp;Luigi Zagra MD ,&nbsp;Omer Faruk Bilgen MD ,&nbsp;Emrah Caliskan MD ,&nbsp;Micheal A. Mont MD ,&nbsp;Javad Parvizi MD ,&nbsp;Ibrahim Tuncay MD","doi":"10.1016/j.arth.2024.10.057","DOIUrl":"10.1016/j.arth.2024.10.057","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages S130-S131"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512501","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":"Predictive Modeling of Medical and Orthopaedic-Related 90-Day-Readmissions Following Primary Total Knee Arthroplasty","authors":"Shujaa T. Khan MD ,&nbsp;Ignacio Pasqualini MD ,&nbsp;Pedro J. Rullán MD ,&nbsp;Josh Tidd MD ,&nbsp;Nicolas S. Piuzzi MD","doi":"10.1016/j.arth.2024.07.041","DOIUrl":"10.1016/j.arth.2024.07.041","url":null,"abstract":"<div><h3>Background</h3><div>As the demand for total knee arthroplasty (TKA) escalates, 90-day readmissions have emerged as a pressing clinical and economic concern for the current value-based health care system. Consequently, health care providers have focused on estimating the risk levels of readmitted patients; however, it is unknown if specific factors are associated with different types of complications (ie, medical or orthopaedic-related) that lead to readmissions. Therefore, this study aimed to (1) determine the overall, medical-related, and orthopaedic-related 90-day readmission rate and (2) develop a predictive model for risk factors affecting overall, medical-related, and orthopaedic-related 90-day readmissions following TKA.</div></div><div><h3>Methods</h3><div>A prospective cohort of primary unilateral TKAs performed at a large tertiary academic center in the United States from 2016 to 2020 was included (n = 10,521 patients). Unplanned readmissions were reviewed individually to determine their primary cause, either medical or orthopaedic-related. Orthopaedic-related readmissions were specific complications affecting the joint, prosthesis, or surgical wound. Medical readmissions were due to any other cause requiring medical management. Multivariable logistic regression models were used to investigate associations between prespecified risk factors and 90-day readmissions, as well as medical and orthopaedic-related readmissions independently.</div></div><div><h3>Results</h3><div>Overall, the rate of 90-day readmissions was 6.7% (n = 704). Over 82% of these readmissions were due to medical-related causes (n = 580), with the remaining 18% being orthopaedic-related (n = 124) readmissions. The area under the curve for the 90-day readmission model was 0.68 (95% confidence interval: 0.67 to 0.70). Sex, smoking, length of stay, and discharge disposition were associated with orthopaedic readmission, while age, sex, race, the Charlson Comorbidity Index, insurance, surgery day, opioid overdose risk score, length of stay, and discharge disposition were associated with medical-related 90-day readmissions.</div></div><div><h3>Conclusions</h3><div>Medical-related readmissions after TKA are more prevalent than orthopaedic-related readmissions. Through successfully constructing and validating multiple 90-day readmission predictive models, we highlight the distinct risk profiles for medical and orthopaedic-related readmissions. This emphasizes the necessity for nuanced, patient-specific risk stratification and preventive measures.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages 286-293.e2"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141914503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postero-Central Slice Osteotomy of the Proximal Tibia: A Novel Technique for Correcting Resistant Tight Extension Gaps in Posterior-Stabilized Total Knee Arthroplasty for Varus Osteoarthritis","authors":"Amyn M. Rajani MSOrthopaedics ,&nbsp;Anmol R.S. Mittal MSOrthopaedics ,&nbsp;Urvil A. Shah MSOrthopaedics ,&nbsp;Vishal U. Kulkarni MSOrthopaedics ,&nbsp;Rishab Dubey MSOrthopaedics ,&nbsp;Alisha A. Rajani MBBS","doi":"10.1016/j.arth.2024.08.012","DOIUrl":"10.1016/j.arth.2024.08.012","url":null,"abstract":"<div><h3>Background</h3><div>The aim of total knee arthroplasty (TKA) is to circumvent the pain due to advanced osteoarthritis of the knee joint and correct the limb alignment and biomechanics to improve patients’ quality of life. Apart from medio-lateral balancing, balancing flexion and extension gaps is a prerogative to achieve good results. This study proposes a novel surgical technique of postero-central slice osteotomy of the proximal tibia (PCSO-PT) for correcting tight extension gaps in posterior-stabilized knees and assesses its clinical and functional outcomes.</div></div><div><h3>Methods</h3><div>A prospective study was conducted on 84 consecutive knees with tricompartmental osteoarthritis and varus deformity, requiring PCSO-PT during posterior-stabilized TKA between January 2016 and July 2018. Knee Society scores, flexion deformity, range of motion, antero-posterior instability, and complications were assessed at regular intervals for a minimum of 2 years postoperatively.</div></div><div><h3>Results</h3><div>Residual flexion deformities less than 11° after posterior capsular release were successfully corrected by the osteotomy. The mean preoperative flexion deformity of 18.1 ± 2.5° improved to 8.6 ± 2.2° intraoperatively after posterior capsular release from the femoral end and to 0.65 ± 0.76° intraoperatively immediately after the osteotomy, with no residual flexion deformity noted in any patient 6 weeks postoperatively. It had no negative effect on the significant post-TKA improvement of the mean Knee Society score from 32 ± 12 preoperatively to 94 ± 3 at the terminal follow-up. A direct correlation between preoperative flexion deformity and a resistant, tight extension gap (<em>P</em> = 0.003) was noted. There was no increase in coronal plane or sagittal plane instabilities in midflexion or on mobilization throughout the follow-up period, nor were any major adverse effects noted in this period.</div></div><div><h3>Conclusions</h3><div>A PCSO-PT is an effective and safe alternative to overcoming tight extension during TKA after femoral-end capsular release, instead of capsular release from the tibial end or midcapsular region.</div></div><div><h3>Level of evidence</h3><div>Level IV, therapeutic study.</div></div>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages 400-408"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983856","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":"Response to Letter to the Editor on “Predictive Modeling of Medical- and Orthopaedic-Related 90-Day Readmissions Following Primary Total Hip Arthroplasty”","authors":"Shujaa T. Khan MD,&nbsp;Yuxuan Jin MS,&nbsp;Peter Imrey PhD,&nbsp;Ignacio Pasqualini MD,&nbsp;Pedro J. Rullán MD,&nbsp;Josh Tidd MD,&nbsp;Alison K. Klika MS,&nbsp;Matthew E. Deren MD,&nbsp;Nicolas S. Piuzzi MD","doi":"10.1016/j.arth.2024.10.017","DOIUrl":"10.1016/j.arth.2024.10.017","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 2","pages":"Pages e12-e13"},"PeriodicalIF":3.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958439","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}