Arthroplasty最新文献

{"title":"Enough is enough: salvage procedures in severe periprosthetic joint infection.","authors":"Yves Gramlich, Javad Parvizi","doi":"10.1186/s42836-023-00182-7","DOIUrl":"10.1186/s42836-023-00182-7","url":null,"abstract":"<p><strong>Background: </strong>In severe cases of periprosthetic joint infection involving negative host-dependent factors, individual-based decisions between a curative therapy vs. salvage procedure are necessary. We aimed to review salvage procedures in severe periprosthetic joint infection cases, where a gold standard of a curative two-stage exchange can no longer be achieved. The options of knee arthrodesis, amputation, persistent fistula (stable drainage), or a debridement, antibiotics, and implant retention procedure in late-onset cases are discussed, including lifelong antibiotic suppression alone.</p><p><strong>Methods: </strong>We focused on known salvage procedures for severe periprosthetic joint infection of the hip and knee, such as amputation, arthrodesis, antibiotic suppression, persistent fistula, and debridement, antibiotics, and implant retention in late-stage infections, and the role of local antibiotics. The current literature regarding indications and outcomes was reviewed.</p><p><strong>Results: </strong>Whereas a successful single-stage above-knee amputation can be a curative effort in younger patients, this is associated with limited outcome in older patients, as the proportion who receive an exoprosthesis leading to independent mobility is low. Therefore, arthrodesis using an intramedullary modular nail is an option for limb salvage, pain reduction, and preservation of quality of life and everyday life mobility, when revision total knee arthroplasty is not an option. Carrying out a persistent fistula using a stable drainage system, as well as a lifelong antibiotic suppression therapy, can be an option, in cases where no other surgery is possible. Active clinical surveillance should then be carried out. A debridement, antibiotics, and implant retention procedure in combination with local degradable antibiotics can be used and is an encouraging new option, but should not been carried out twice.</p><p><strong>Conclusion: </strong>Whereas the gold standard in periprosthetic joint infection treatment of late infections remains the exchange of the prosthesis, salvage procedures should be considered in the cases of reduced life expectancy, several recurrences of the infection, patients having preference and negative host factors. In these cases, the appropriate salvage procedure can temporarily lead to remission of the infection and the possibility to maintain mobility.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10316561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved performance of machine learning models in predicting length of stay, discharge disposition, and inpatient mortality after total knee arthroplasty using patient-specific variables.","authors":"Abdul K Zalikha,&nbsp;Tannor Court,&nbsp;Fong Nham,&nbsp;Mouhanad M El-Othmani,&nbsp;Roshan P Shah","doi":"10.1186/s42836-023-00187-2","DOIUrl":"https://doi.org/10.1186/s42836-023-00187-2","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare the performance of ten predictive models using different machine learning (ML) algorithms and compare the performance of models developed using patient-specific vs. situational variables in predicting select outcomes after primary TKA.</p><p><strong>Methods: </strong>Data from 2016 to 2017 from the National Inpatient Sample were used to identify 305,577 discharges undergoing primary TKA, which were included in the training, testing, and validation of 10 ML models. 15 predictive variables consisting of 8 patient-specific and 7 situational variables were utilized to predict length of stay (LOS), discharge disposition, and mortality. Using the best performing algorithms, models trained using either 8 patient-specific and 7 situational variables were then developed and compared.</p><p><strong>Results: </strong>For models developed using all 15 variables, Linear Support Vector Machine (LSVM) was the most responsive model for predicting LOS. LSVM and XGT Boost Tree were equivalently most responsive for predicting discharge disposition. LSVM and XGT Boost Linear were equivalently most responsive for predicting mortality. Decision List, CHAID, and LSVM were the most reliable models for predicting LOS and discharge disposition, while XGT Boost Tree, Decision List, LSVM, and CHAID were most reliable for mortality. Models developed using the 8 patient-specific variables outperformed those developed using the 7 situational variables, with few exceptions.</p><p><strong>Conclusion: </strong>This study revealed that performance of different models varied, ranging from poor to excellent, and demonstrated that models developed using patient-specific variables were typically better predictive of quality metrics after TKA than those developed employing situational variables.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10315023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10103550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of machine learning in the prevention of periprosthetic joint infection following total knee arthroplasty: a systematic review.","authors":"Yuk Yee Chong, Ping Keung Chan, Vincent Wai Kwan Chan, Amy Cheung, Michelle Hilda Luk, Man Hong Cheung, Henry Fu, Kwong Yuen Chiu","doi":"10.1186/s42836-023-00195-2","DOIUrl":"10.1186/s42836-023-00195-2","url":null,"abstract":"<p><strong>Background: </strong>Machine learning is a promising and powerful technology with increasing use in orthopedics. Periprosthetic joint infection following total knee arthroplasty results in increased morbidity and mortality. This systematic review investigated the use of machine learning in preventing periprosthetic joint infection.</p><p><strong>Methods: </strong>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed was searched in November 2022. All studies that investigated the clinical applications of machine learning in the prevention of periprosthetic joint infection following total knee arthroplasty were included. Non-English studies, studies with no full text available, studies focusing on non-clinical applications of machine learning, reviews and meta-analyses were excluded. For each included study, its characteristics, machine learning applications, algorithms, statistical performances, strengths and limitations were summarized. Limitations of the current machine learning applications and the studies, including their 'black box' nature, overfitting, the requirement of a large dataset, the lack of external validation, and their retrospective nature were identified.</p><p><strong>Results: </strong>Eleven studies were included in the final analysis. Machine learning applications in the prevention of periprosthetic joint infection were divided into four categories: prediction, diagnosis, antibiotic application and prognosis.</p><p><strong>Conclusion: </strong>Machine learning may be a favorable alternative to manual methods in the prevention of periprosthetic joint infection following total knee arthroplasty. It aids in preoperative health optimization, preoperative surgical planning, the early diagnosis of infection, the early application of suitable antibiotics, and the prediction of clinical outcomes. Future research is warranted to resolve the current limitations and bring machine learning into clinical settings.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10265805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9630730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of soft tissue releases in robotic assisted cementless TKA with mechanical alignment and flexion gap balancing.","authors":"Nanchappan Selvanathan,&nbsp;Femi E Ayeni,&nbsp;Rami Sorial","doi":"10.1186/s42836-023-00188-1","DOIUrl":"https://doi.org/10.1186/s42836-023-00188-1","url":null,"abstract":"<p><strong>Background: </strong>To ensure the success of total knee arthroplasty (TKA), precise bone cuts and a well-balanced soft tissue envelope are crucial. Soft tissue release may be necessary, subject to various factors. Therefore, documenting the type, frequency, and necessity of soft tissue releases can establish a benchmark for comparing different alignment techniques and philosophies and evaluating their outcomes. The purpose of this study was to demonstrate that robotic-assisted knee surgery requires minimal soft tissue release.</p><p><strong>Methods: </strong>We prospectively documented and retrospectively reviewed the soft tissue releases employed in securing ligament balance in the first 175 patients who received robotic-assisted TKAs at Nepean Hospital. ROSA was utilized in all surgeries with the aim of restoring mechanical coronal alignment, with a flexion gap balancing technique. Surgeries were performed between December 2019 to August 2021 by a single surgeon who used a standard medial parapatellar approach without a tourniquet, and the cementless persona prosthesis. All patients were followed up for a minimum of 6 months post-surgery. Soft tissue releases included any form of medial release for varus knee, posterolateral release for valgus knee and PCL fenestration or sacrifice.</p><p><strong>Results: </strong>There were 131 female and 44 male patients, aged between 48 to 89 years (average 60 years). The preoperative HKA ranged from 22 degrees varus to 28 degrees valgus, with 71% of patients presenting with a varus deformity. For the whole group, the no need for soft tissue release was documented in 123 patients (70.3%), small fenestrated releases of PCL in 27 (15.4%), sacrifice of PCL in 8 (4.5%), medial releases in 4 (2.3%) and posterolateral releases in 13 (7.4%). In 29.7% of patients in whom a soft tissue release was necessary for balance, over half were/received minor fenestrations of the PCL. Outcomes to date included no revisions or impending revisions, 2 MUAs (1%), and Oxford knee scores averaged 40 at 6 months.</p><p><strong>Conclusion: </strong>We concluded that Robot technology enhanced the precision of bone cuts and allowed for titration of required soft tissue releases to achieve optimal balance.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10245504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9599523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical considerations for an easily-restricted robot-assisted kinematic alignment: a surgical technique note.","authors":"Pieralberto Valpiana,&nbsp;Stefano Ghirardelli,&nbsp;Rosa Susanna Valtanen,&nbsp;Salvatore Risitano,&nbsp;Ferdinando Iannotti,&nbsp;Christian Schaller,&nbsp;Karlos Zepeda,&nbsp;Michael Engl,&nbsp;Pier Francesco Indelli","doi":"10.1186/s42836-023-00191-6","DOIUrl":"https://doi.org/10.1186/s42836-023-00191-6","url":null,"abstract":"<p><strong>Background: </strong>In total knee arthroplasty, the normal kinematics of the knee may not be restored solely based on preoperative gait, fluoroscopic-based, and dynamic radiostereometric analyses.</p><p><strong>Surgical technique case presentation: </strong>This note introduced a 69-year-old male patient who sustained post-traumatic osteoarthritis of his right knee. He underwent robot-assisted total knee arthroplasty based on anatomical reproduction of knee stability during the swing phase of gait. The kinematic alignment was simply achieved within an easy-to-identified range after preoperative radiographic assessment, intraoperative landmarking and pre-validated osteotomy, and intraoperative range of motion testing.</p><p><strong>Conclusions: </strong>This novel technique allows personalized and imageless total knee arthroplasty. It provides a preliminary path in reproducing the anatomy alignment, natural collateral ligament laxity, and accurate component placement within safe-to-identified alignment boundaries.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10240684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar resurfacing and kneeling ability after total knee arthroplasty: a systematic review.","authors":"Owais A Shah,&nbsp;Christopher Spence,&nbsp;Deiary Kader,&nbsp;Nick D Clement,&nbsp;Vipin Asopa,&nbsp;David H Sochart","doi":"10.1186/s42836-023-00184-5","DOIUrl":"https://doi.org/10.1186/s42836-023-00184-5","url":null,"abstract":"<p><strong>Background: </strong>Difficulty kneeling following total knee arthroplasty (TKA) remains highly prevalent, and has cultural, social, and occupational implications. With no clear evidence of superiority, whether or not to resurface the patella remains debatable. This systematic review examined whether resurfacing the patella (PR) or not (NPR) influences kneeling ability following TKA.</p><p><strong>Methods: </strong>This systematic review was conducted by following PRISMA guidelines. Three electronic databases were searched utilizing a search strategy developed with the aid of a department librarian. Study quality was assessed using MINROS criteria. Article screening, methodological quality assessment and data extraction were performed by two independent authors, and a third senior author was consulted if consensus was not reached.</p><p><strong>Results: </strong>A total of 459 records were identified, with eight studies included in the final analysis, and all deemed to be level III evidence. The average MINORS score was 16.5 for comparative studies and 10.5 for non-comparative studies. The total number of patients was 24,342, with a mean age of 67.6 years. Kneeling ability was predominantly measured as a patient-reported outcome measure (PROM), with two studies also including an objective assessment. Two studies demonstrated a statistically significant link between PR and kneeling, with one demonstrating improved kneeling ability with PR and the other reporting the opposite. Other potential factors associated with kneeling included gender, postoperative flexion, and body mass index (BMI). Re-operation rates were significantly higher in the NPR cohort whereas PR cohorts had higher Feller scores, patient-reported limp and patellar apprehension.</p><p><strong>Conclusion: </strong>Despite its importance to patients, kneeling remains not only under-reported but also ill-defined in the literature, with no clear consensus regarding the optimum outcome assessment tool. Conflicting evidence remains as to whether PR influences kneeling ability, and to clarify the situation, large prospective randomized studies are required.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10238242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting 30-day readmission following total knee arthroplasty using machine learning and clinical expertise applied to clinical administrative and research registry data in an Australian cohort.","authors":"Daniel J Gould,&nbsp;James A Bailey,&nbsp;Tim Spelman,&nbsp;Samantha Bunzli,&nbsp;Michelle M Dowsey,&nbsp;Peter F M Choong","doi":"10.1186/s42836-023-00186-3","DOIUrl":"https://doi.org/10.1186/s42836-023-00186-3","url":null,"abstract":"<p><strong>Background: </strong>Thirty-day readmission is an increasingly important problem for total knee arthroplasty (TKA) patients. The aim of this study was to develop a risk prediction model using machine learning and clinical insight for 30-day readmission in primary TKA patients.</p><p><strong>Method: </strong>Data used to train and internally validate a multivariable predictive model were obtained from a single tertiary referral centre for TKA located in Victoria, Australia. Hospital administrative data and clinical registry data were utilised, and predictors were selected through systematic review and subsequent consultation with clinicians caring for TKA patients. Logistic regression and random forest models were compared to one another. Calibration was evaluated by visual inspection of calibration curves and calculation of the integrated calibration index (ICI). Discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC-ROC).</p><p><strong>Results: </strong>The models developed in this study demonstrated adequate calibration for use in the clinical setting, despite having poor discriminative performance. The best-calibrated readmission prediction model was a logistic regression model trained on administrative data using risk factors identified from systematic review and meta-analysis, which are available at the initial consultation (ICI = 0.012, AUC-ROC = 0.589). Models developed to predict complications associated with readmission also had reasonable calibration (ICI = 0.012, AUC-ROC = 0.658).</p><p><strong>Conclusion: </strong>Discriminative performance of the prediction models was poor, although machine learning provided a slight improvement. The models were reasonably well calibrated, meaning they provide accurate patient-specific probabilities of these outcomes. This information can be used in shared clinical decision-making for discharge planning and post-discharge follow up.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9556658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term clinical results of alumina ceramic medial pivot total knee arthroplasty: a 10-year follow-up study.","authors":"Hideki Ueyama,&nbsp;Shigeru Nakagawa,&nbsp;Yuichi Kishimura,&nbsp;Yukihide Minoda,&nbsp;Suguru Nakamura,&nbsp;Junichiro Koyanagi,&nbsp;Mitsuyoshi Yamamura,&nbsp;Yoshinori Kadoya","doi":"10.1186/s42836-023-00180-9","DOIUrl":"https://doi.org/10.1186/s42836-023-00180-9","url":null,"abstract":"<p><strong>Background: </strong>The newly-designed alumina ceramic medial pivot total knee prosthesis was introduced to reduce polyethylene wear and better fit the anatomical morphology of the Asian population. This study aimed to clarify the long-term clinical results of alumina medial pivot total knee arthroplasty over a minimum follow-up period of 10 years.</p><p><strong>Methods: </strong>The data of 135 consecutive patients who underwent primary alumina medial pivot total knee arthroplasty were analyzed in this retrospective cohort study. Patients were examined over a minimum 10-year follow-up period. The knee range of motion, Knee Society Score (KSS) knee score, Knee Society Score function score, and radiological parameters were assessed. The survival rate was also evaluated by using reoperation and revision as endpoints.</p><p><strong>Results: </strong>The mean follow-up period lasted 11.8 ± 1.4 years. Patients who were not followed accounted for 7.4% of the total cohort. Knee and function scores of KSS improved significantly following total knee arthroplasty (P < 0.001). In 27 individuals (28.1%), a radiolucent line was observed. Aseptic loosening occurred in three cases (3.1%). The survival rates for reoperation and revision were 94.8% and 95.8% 10 years after the operation, respectively.</p><p><strong>Conclusions: </strong>During a minimum 10-year follow-up period, the present model of alumina medial pivot total knee arthroplasty showed good clinical outcomes and survival rates.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10197859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9498222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining a successful total knee arthroplasty: a systematic review of metrics of clinically important changes.","authors":"Zodina A Beiene, Kira K Tanghe, Cynthia A Kahlenberg, Alexander S McLawhorn, Catherine H MacLean, Elizabeth B Gausden","doi":"10.1186/s42836-023-00178-3","DOIUrl":"10.1186/s42836-023-00178-3","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing use of patient-reported outcome measures (PROMs), the methodology used to evaluate clinically significant postoperative outcomes after total knee arthroplasty (TKA) is variable. The review aimed to survey studies with identified PROM-based metrics of clinical efficacy and the assessment procedures after TKA.</p><p><strong>Methods: </strong>The MEDLINE database was queried from 2008-2020. Inclusion criteria were: full texts, English language, primary TKA with minimum one-year follow-up, use of metrics for assessing clinical outcomes with PROMs, and primary derivations of metrics. The following PROM-based metrics were identified: minimal clinically important difference (MCID), minimum detectable change (MDC), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB). Study design, PROM value data, and methods of derivation for metrics were recorded.</p><p><strong>Results: </strong>We identified 18 studies (including 46,173 patients) that met the inclusion criteria. Across these studies, 10 different PROMs were employed, and MCID was derived in 15 studies (83%). The MCID was calculated using anchor-based techniques in nine studies (50%) and distribution techniques in eight studies (44%). PASS values were presented in two studies (11%) and SCB in one study (6%) using an anchor-based method; MDC was derived in four studies (22%) using the distribution method.</p><p><strong>Conclusion: </strong>There is variability in the TKA literature with respect to the definition and derivation of measurements of clinically significant outcomes. Standardization of these values may have implications for optimal case selection and PROM-based quality measurement, ultimately improving patient satisfaction and outcomes.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10193600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9543615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient physical therapy bundled payment models are feasible for total hip arthroplasty patients: an evaluation of utilization, cost and outcomes.","authors":"Laura A Stock,&nbsp;Andrea H Johnson,&nbsp;Jane C Brennan,&nbsp;Justin J Turcotte,&nbsp;Paul J King,&nbsp;James H MacDonald","doi":"10.1186/s42836-023-00179-2","DOIUrl":"https://doi.org/10.1186/s42836-023-00179-2","url":null,"abstract":"<p><strong>Background: </strong>Various episode-of-care bundled payment models for patients undergoing total joint arthroplasty have been implemented. However, participation in bundled payment programs has dropped given the challenges of meeting continually lower target prices. The purpose of our study is to investigate the cost of outpatient physical therapy (PT) and the potential for stand-alone outpatient PT bundled payments for patients undergoing total hip arthroplasty (THA).</p><p><strong>Methods: </strong>A retrospective review of 501 patients who underwent primary unilateral THA from November 2017 to February 2020 was performed. All patients included in this study received postoperative PT care at a single hospital-affiliated PT practice. Patients above the 75th percentile of therapy visits were then classified as high-PT utilizers and compared with the rest of the population using univariate statistics. Stepwise multivariate logistic regression was used to assess the predictors of high therapy utilization.</p><p><strong>Results: </strong>Patients averaged 65 ± 10 years of age and a BMI of 29 ± 5 kg/m². Overall, 80% of patients were white and 53% were female. The average patient had 11 ± 8 total therapy sessions in 42 days: one initial evaluation, one re-evaluation and 9 standard sessions. High-PT utilizers incurred estimated average costs of $1934 ± 431 per patient, compared to $783 ± 432 (P < 0.001) in the rest of the population. Further, no significant differences in 90-day outcomes including lower extremity functional scale scores, emergency department returns, readmissions, or returns to the operating room were observed between high utilizers and the rest of the population (all P > 0.08). In the multivariate analysis, women (OR = 1.68, P = 0.017) and those with sleep apnea (OR = 2.02, P = 0.012) were nearly twice as likely to be high utilizers, while white patients were 42% less likely to be high utilizers than patients of other races (OR = 0.58, P = 0.028).</p><p><strong>Conclusions: </strong>Outpatient PT utilization is highly variable in patients undergoing THA. However, despite using more services and incurring increased cost, patients in the top quartile of utilization experienced similar outcomes to the rest of the population. If outpatient therapy bundles are to be developed, 16 visits appear to be a reasonable target for pricing, given this provides adequate coverage for 75% of THA patients.</p>","PeriodicalId":52831,"journal":{"name":"Arthroplasty","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10176925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9828690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}