Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"The PROMIS-10 Global Mental Health T-Score: An Independent Predictor of In-Hospital Recovery Following a Total Hip Arthroplasty.","authors":"Regina O Kostyun, Daniel K Witmer, Peter Lucchio, Matthew J Solomito","doi":"10.5435/JAAOS-D-24-00430","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00430","url":null,"abstract":"<p><strong>Background: </strong>Currently, few investigations explore the connection between global mental health and recovery following total hip arthroplasty (THA). The increased utilization of patient-reported outcomes tools provides an opportunity to assess a patient's mental health without undue survey burden. The purpose of this study was to explore how mental health is associated with a patient's immediate in-hospital recovery regardless of a formally diagnosed mental illness.</p><p><strong>Methods: </strong>This retrospective study consisted of patients undergoing elective primary THA. Patients were grouped by both their PROMIS 10 Global Mental Health T-score (MHT) and whether they had a formally diagnosed mental illness. The resulting four patient groups were compared using multivariate regression analyses to determine differences in in-hospital pain reporting, opioid consumption, and discharge disposition.</p><p><strong>Results: </strong>One thousand four hundred and twenty nine patients were included in this study. MHT was an independent predictor of pain reporting at discharge (P < 0.001) and inpatient opioid consumption (P = 0.002). Regardless of the presence of mental illness, patients self-reporting poor mental health (MHT<40) reported higher pain levels, consumed more opioids, and were more likely to be discharged to a facility than those with an MHT >50.</p><p><strong>Conclusion: </strong>Mental illness was not an independent predictor of immediate postoperative outcomes, but self-reported global mental health assessed using the MHT was. Therefore, surgeons should be aware of their patient's global mental health status before surgery because it is associated with in-hospital recovery following THA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787584","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":"Atlantoaxial Osteoarthritis: An Overlooked Condition.","authors":"Zhi Wang, Maroun Rizkallah","doi":"10.5435/JAAOS-D-24-00513","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00513","url":null,"abstract":"<p><p>Atlantoaxial osteoarthritis (AAOA) is a clinical syndrome that consists of occipitocervical pain and cervical rotation limitation. Its clinical recognition is often deficient leading to misdiagnosis and suboptimal treatment. The incidence of AAOA varies from 5% in the sixth decade to as much as 18% in the ninth decade of life. Age, female sex, and excessive occupational cervical weight-bearing are the main risk factors for AAOA. Pain originates from the degeneration of the lateral C1-C2 joints and may be referred through the greater occipital nerve. Although AAOA is not easy to see on classic cervical spine views, the open mouth odontoid view has great diagnostic value. Magnetic resonance imaging, CT scan, and/or injections may be used for confirmatory testing. Initial treatment is conservative, including physiotherapy, pain medication, and imaging-guided injections. As many as two-thirds of patients improve with conservative treatment. Indication for surgery is incapacitating pain recalcitrant to nonoperative management. Surgeons' thorough knowledge of surgical anatomy and techniques is key for the notable clinical benefits expected with the surgery. New surgical technology helps C1-C2 fusion become safer and more reliable. This review aims to synthetize available data related to AAOA and to improve the understanding of this condition and its management in the orthopaedic community.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786670","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":"Can Cadaver Testing Replicate In Vivo Kinematics of Total Knee Arthroplasty?","authors":"Kenichi Kono, Takaharu Yamazaki, Teruya Ishibashi, Keiji Iwamoto, Masashi Tamaki, Kazuomi Sugamoto, Darryl D D'Lima, Tetsuya Tomita","doi":"10.5435/JAAOS-D-23-00963","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00963","url":null,"abstract":"<p><strong>Introduction: </strong>Whether the kinematics of cadaveric knees recreate those of the patient's knees after total knee arthroplasty (TKA) remains unknown. This study compared in vivo and in vitro fluoroscopic kinematics of knees after TKA during knee bending using the same implant design.</p><p><strong>Methods: </strong>Patients who had undergone cruciate-retaining and cruciate-substituting total knee arthroplasty (CR-TKA and CS-TKA) did squatting motions. Fresh-frozen human cadaveric knees were tested under dynamic closed-chain knee extension in an Oxford knee rig. Fluoroscopic kinematics were measured in vivo and in vitro using a 2-dimensional to 3-dimensional registration technique. The axial rotation angle and anterior-posterior translation of medial and lateral contact points of the femoral implant relative to the tibial implant was evaluated in each flexion angle.</p><p><strong>Results: </strong>No notable differences in the axial rotation angles were found between in vivo and in vitro measurements in both CR-TKA and CS-TKA. In early flexion, the medial and lateral contact points in cadaver knees were located more posterior than those in in vivo after CR-TKA. From early flexion to high flexion, the medial and lateral contact points in cadaver knees were located more posterior than those in in vivo after CS-TKA.</p><p><strong>Conclusions: </strong>The axial rotation angle of cadaveric knees in the Oxford knee rig was similar to that measured in vivo after TKA. However, the anterior-posterior location of the femoral implant in cadaver knee was more posterior than that in in vivo knees after TKA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786889","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":"Lower Total Shoulder Arthroplasty Cost of Care at an Ambulatory Surgical Center Versus a Main Hospital.","authors":"Alexander S Guareschi, Caroline P Hoch, James M Deacon, Josef K Eichinger, Richard J Friedman, Christopher E Gross, Daniel J Scott","doi":"10.5435/JAAOS-D-23-00901","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00901","url":null,"abstract":"<p><strong>Introduction: </strong>Total shoulder arthroplasty (TSA) is an increasingly common orthopaedic procedure. Expansion of TSA to outpatient surgical settings has the potential to reduce costs, although there is limited research on the cost and efficiency of this shift in surgical site of care. The purpose of this study is to compare costs and efficiency of TSA between an ambulatory surgical center (ASC) and a hospital.</p><p><strong>Methods: </strong>Retrospective cost and time data were obtained from 175 surgeries performed from 2019 to 2020 using a single institution's existing cost accounting system (hospital = 97, ASC = 78). In addition, 34 patients were prospectively enrolled undergoing primary anatomic (n = 10) or reverse (n = 24) TSA. Hand-timed data were collected at each location (ASC = 23, hospital = 11) throughout the entire episode of perioperative care. Data were analyzed to investigate the effects of surgery location on labor cost, efficiency, and provider time.</p><p><strong>Results: </strong>The cost per TSA in the ASC was markedly lower than that in the hospital (ASC = $27,250.59, hospital = $30,266.80; P < 0.001). Examining individual discrete activities, TSA performed at the ASC was markedly longer in multiple preoperative, intraoperative, and postanesthesia care unit categories, with the greatest difference being case duration (ASC = 2.2 hours, hospital = 1.7 hours; P = 0.002). The decreased cost in the ASC, despite longer case duration, can be explained by differences in cost margins between locations with ASC cases having markedly lower costs for almost all categories.</p><p><strong>Conclusion: </strong>It is markedly more expensive for patients to undergo TSA in a hospital setting than in an ASC. Furthermore, preoperative and postanesthesia care unit times markedly contribute to differences in efficiency associated with different surgical platforms, representing target areas to focus on improving efficiency of care delivery. These findings should be considered by orthopaedic surgeons when considering TSA in patients who are suitable to undergo TSA at an outpatient ASC.</p><p><strong>Level of evidence: </strong>Level II, Prospective cohort study.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787317","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":"Predictors of Internal Rotation-Dependent Activities of Daily Living Performance and Favorable Satisfaction Despite Loss of Objective Internal Rotation After Reverse Shoulder Arthroplasty.","authors":"Robert J Cueto, Kevin A Hao, Rachel L Janke, Timothy R Buchanan, Keegan M Hones, Lacie M Turnbull, Jonathan O Wright, Thomas W Wright, Kevin W Farmer, Aimee M Struk, Bradley S Schoch, Joseph J King","doi":"10.5435/JAAOS-D-24-00267","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00267","url":null,"abstract":"<p><strong>Introduction: </strong>Previous research has determined that objective and subjective internal rotation (IR) may be discordant. The purpose of this study was to identify predictors of patient-reported ability to perform IR-dependent activities of daily living (IRADLs) and favorable patient satisfaction after reverse shoulder arthroplasty (RSA) despite the loss of objective IR.</p><p><strong>Methods: </strong>A single, institutional, shoulder arthroplasty database was queried for patients undergoing primary RSA with a minimum 2-year follow-up. Patients who were wheelchair bound or had a preoperative diagnosis of infection, fracture, or tumor were excluded. We first identified patients in the overall cohort that lost objective IR from pre- to postoperative assessment, defined as a one-point reduction in the eight-point Flurin scale. In this cohort, we identified patient characteristics that were predictive of patient-reported ability to perform IRADLs and overall patient satisfaction and thresholds in postoperative objective IR.</p><p><strong>Results: </strong>Out of 599 RSAs initially identified, 107 RSAs lost objective IR (45% female, mean age 70 years). On average, patients lost 1.7 IR score points pre- to postoperatively. Greater preoperative IR and lesser loss of objective IR pre- to postoperatively were associated with greater patient-reported ability to perform all 4 IRADLs (odds ratio 1.54 to 2.5), whereas female sex was associated with worse patient-reported ability to perform 3 IRADLs (odds ratio 0.26 to 0.36). We identified that patients with postoperative IR below the sacrum were unlikely to be able to perform IRADLs and those with postoperative IR at or above L4-L5 were likely to be satisfied.</p><p><strong>Conclusion: </strong>Despite losing objectively assessed IR after RSA, many patients are still able to perform IRADLs and report favorable satisfaction as long as objective IR reaches L4/5. Female sex and postoperative IR below the sacrum were associated with the inability to perform IRADLs, whereas postoperative IR to or above L4-L5 was associated with subjective ratings of satisfaction.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787561","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":"Optimal Timing for Safe Bivalving of Fiberglass Casts Is Before the Exothermic Peak.","authors":"Jay J Byrd, Annemarie K Leonard, Kaeli K Samson, Jill E Larson, Jordan Shaw, Matthew A Halanski","doi":"10.5435/JAAOS-D-24-00729","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00729","url":null,"abstract":"<p><strong>Introduction: </strong>Cast saw injury is a notable source of medicolegal risk. Previous work with plaster casts demonstrated that cast saw injury was minimized by waiting 12 minutes before removal. In this study, we evaluate the safety parameters of fiberglass casting materials.</p><p><strong>Methods: </strong>Eight-ply plaster and fiberglass casts were applied to a pediatric forearm model at variable dip-water temperatures, and the mean time to reach their exothermic peak was determined. Fiberglass casts were then maintained at the manufacturer's recommended dip-water temperature and removed at intervals of 2 (before exothermic peak), 6 (approximately fiberglass's exothermic peak), or 12 (after exothermic peak) minutes. All casts were removed by a pediatric orthopaedic surgeon blinded to the cast set time. Cast/blade temperature, saw force, blade-to-skin contact, bivalve time, cast spreading force, and cut completeness were assessed individually and as short (<6-minutes) or long (≥6-minutes) set times.</p><p><strong>Results: </strong>Fiberglass casts exothermically peaked markedly earlier (5.2 [IQR = 5-5.4] minutes) than plaster (14.8 [IQR = 13.7-15.3] minutes), P < 0.0001, at maximum temperatures, which did not markedly differ. Downward force applied during fiberglass cast removal was markedly lower in the short versus long set time groups [average forces of 8.3 (IQR = 6.4-10.4) versus 12.9 (IQR = 11.1-14.5) Newtons, P < 0.0001, as were maximum forces: 23.2 (IQR = 18.9-26.6) versus 43.8 (IQR = 38.6-48.5) Newtons, P < 0.0001]. Bivalve time and maximum cast spreading force were decreased in short set times with 40.5 (IQR = 39.2-44.7) versus 44.4 (IQR = 40.6-47.3) seconds (P = 0.06) and 15.5 (IQR = 14-18.5) versus 21.5 (IQR = 18-26.5) N (P = 0.07), respectively. Maximum saw blade temperature was markedly lower in the short (99.6°C [IQR = 98.2-105.6°C]) versus long (130.6°C [IQR = 121.9-141°C]) set times (P = 0.04). No notable differences in blade-to-skin touches or touch duration were detected.</p><p><strong>Discussion: </strong>Unlike plaster, fiberglass casts cut before exothermically peaking were associated with less downward force, faster bivalve times, and decreased spread force without increased blade temperature or skin contacts. This suggests that fiberglass casts can be bivalved markedly earlier without increased risk of injury.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787526","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":"American Academy of Orthopaedic Surgeons/ASSH Clinical Practice Guideline Summary Management of Carpal Tunnel Syndrome.","authors":"Lauren M Shapiro, Robin N Kamal","doi":"10.5435/JAAOS-D-24-01179","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01179","url":null,"abstract":"<p><p>Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline is based on a systematic review of published studies with regard to the diagnosis and treatment of carpal tunnel syndrome in adult patients (≥18 years of age). The scope of this guideline addresses the diagnosis and treatment of carpal tunnel syndrome and contains nine recommendations to assist orthopaedic surgeons and all qualified clinicians managing patients presenting with signs and symptoms which may be attributable to carpal tunnel syndrome based on the best current available evidence. It is also intended to serve as an information resource for professional healthcare practitioners, health services researchers, and developers of practice guidelines and recommendations. In addition to providing pragmatic practice recommendations, this guideline also highlights gaps in the literature and informs areas for future research and quality measure development.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786610","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":"Medicaid Insurance Is Associated With Increased Readmissions and Mortality After Surgery for Periprosthetic Joint Infection.","authors":"Mary K Richardson, Julian Wier, Dara Bruce, Kevin C Liu, Anna Cohen-Rosenblum, Jay R Lieberman, Nathanael D Heckmann","doi":"10.5435/JAAOS-D-24-00165","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00165","url":null,"abstract":"<p><strong>Background: </strong>Patients with Medicaid insurance are at an increased risk of postoperative complications following total knee arthroplasty and total hip arthroplasty (TJA); however, their outcomes following revision TJA for periprosthetic joint infection (PJI) requires further study.</p><p><strong>Methods: </strong>A retrospective query was conducted for adult patients undergoing implant explantation and antibiotic spacer placement for TJA PJI from the Premier Healthcare Database between December 1, 2016, and December 31, 2021. Patients were then grouped by Medicaid or non-Medicaid insurance status and were age matched through exact caliper matching. Multivariable regression models addressed potential confounding. Adjusted risks of 90-day postoperative complications were reported.</p><p><strong>Results: </strong>Of the 40,346 patients identified, 2,711 Medicaid patients were matched to 10,844 non-Medicaid patients on age (56.1 vs. 56.1 years, P = 1.000). Patients with Medicaid experienced higher risk of sepsis (adjusted odds ratio [aOR] = 1.20, P = 0.010), readmission (aOR = 1.12, P = 0.022), being discharged to a skilled nursing facility (aOR = 1.13, P = 0.031), and had longer length of stay (9.48 vs. 6.67 days, P < 0.001), compared with patients with non-Medicaid. Medicaid patients had a higher rate of inpatient mortality (0.81% vs. 0.48%, P = 0.038); however, the risk was similar after accounting for differences in comorbidities.</p><p><strong>Conclusion: </strong>Following revision TJA for PJI, patients with Medicaid were at an increased risk for postoperative complication, including sepsis and readmission. They experienced a higher rate of inpatient mortality that may be driven by differences in comorbidities. Insurers and policy makers should consider this information to develop risk stratification-based payment strategies that take into account the healthcare burden of this high-risk patient population.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787501","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":"Shoulder Arthroplasty Patients Are Underscreened for Osteoporosis.","authors":"Alisa Malyavko, Amil R Agarwal, Jacob D Mikula, Matthew J Best, Uma Srikumaran","doi":"10.5435/JAAOS-D-23-00408","DOIUrl":"https://doi.org/10.5435/JAAOS-D-23-00408","url":null,"abstract":"<p><strong>Introduction: </strong>Osteoporosis screening and subsequent treatment has been shown to be efficacious in decreasing the rates of fragility fractures and periprosthetic fractures (PPF). However, current screening and treatment rates are low. This study aims to determine (1) the prevalence of total shoulder arthroplasty (TSA) patients who meet criteria for osteoporosis screening, (2) the prevalence of those screened, and (3) the 5-year cumulative incidence of fragility fracture (FF) and periprosthetic fractures (PPF).</p><p><strong>Methods: </strong>The PearlDiver database was used to identify all patients older than 50 years who underwent TSA. Guidelines from the American Association of Clinical Endocrinologists were used to stratify patients into \"high risk\" and \"low risk\" of osteoporosis cohorts using International Classification of Disease codes for various risk factors. The prevalence of osteoporosis screening using dual-energy x-ray absorptiometry (DXA) scan was analyzed, and the 5-year cumulative incidence of FF and PPF was calculated between the \"low-risk\" and \"high-risk\" groups using Kaplan-Meier analysis.</p><p><strong>Results: </strong>In total, 66,140 (65.5%) who underwent TSA were considered \"high risk\" for osteoporosis. Of the \"high-risk\" patients, 11.7% patients received routine osteoporosis screening preoperatively. Within 5 years, \"high-risk\" TSA patients had markedly higher cumulative incidence for PPF (HR: 1.4; 95% CI: 1.0-1.9; P = 0.037) and FF (HR: 2.42; 95% CI: 2.1-2.8; P < 0.001) when compared with those at \"low risk\".</p><p><strong>Discussion: </strong>There is a high prevalence of osteoporosis among patients undergoing TSA but a low rate of routine osteoporosis screening in this cohort. Patients with osteoporosis who are categorized as \"high risk\" have an increased rate of fragility fractures and PPF. Therefore, there is an opportunity to increase appropriate osteoporosis screening and management in this cohort, which may affect future risk of FF and periprosthetic fracture.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787580","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":"Trends in Surgeon Reimbursement for Primary Total Hip and Knee Joint Arthroplasty: An Analysis of 2,421,710 Medicare Part B Claims From 2017 to 2022.","authors":"Henry Hojoon Seo, Michelle Riyo Shimizu, Anirudh Buddhiraju, Jung Ho Gong, MohammadAmin RezazadehSaatlou, Young-Min Kwon","doi":"10.5435/JAAOS-D-24-00943","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00943","url":null,"abstract":"<p><strong>Background: </strong>Primary hip and knee total joint arthroplasties (TJAs) are among the most frequently performed orthopaedic surgeries in the United States, with demand projected to increase to two million cases per year by 2040. Despite the growing demand, previous studies have shown a declining value of Medicare surgeon reimbursements. Given recent inflationary trends, an updated analysis of the changing value of primary TJA reimbursement is necessary. This study examines surgeon reimbursement trends for primary TJA among Medicare patients from 2017 to 2022.</p><p><strong>Methods: </strong>We analyzed Medicare Part B claims data from the Centers for Medicare and Medicaid Services Medicare Physician & Other Practitioners database. Using Healthcare Common Procedure Coding System codes for primary TJA, we queried the database for procedures performed between 2017 and 2022. Yearly service counts and allowed Medicare reimbursements were examined. Reimbursement values were adjusted for inflation using the Consumer Price Index with all values converted to 2022 U.S. dollars.</p><p><strong>Results: </strong>The study included 2,421,710 Medicare claims for primary TJA from 2017 to 2022. During this period, the volume of primary TJA increased by 2.9%. However, average reimbursement decreased by 4.2%, from $1,343 in 2017 to $1,286 in 2022. When adjusted for inflation, the decrease in reimbursement was more pronounced, falling by 19.6% from $1,600 to $1,286. Trends in reimbursement varied by procedure type and geographic region.</p><p><strong>Conclusion: </strong>Between 2017 and 2022, while the volume of primary TJA increased, Medicare surgeon reimbursement for these procedures decreased, with a markedly greater reduction when adjusted for inflation. These trends highlight the need for policy reforms to ensure sustainable reimbursement for surgeons performing primary TJA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787602","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}