Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of ...acetabular component position, but may have a significant learning curve. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual total hip arthroplasty (THA) during the learning curve.
Three types of THAs were compared in this retrospective cohort: (1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior FA) done by a surgeon learning the anterior approach, (2) the first 100 robotic-assisted posterior THAs done by a surgeon learning robotic-assisted surgery (robotic posterior RP), and (3) the last 100 manual posterior (MP) THAs done by each surgeon (200 THAs) before adoption of novel techniques. Component position was measured on plain radiographs. Radiographic measurements were taken by 2 blinded observers. The percentage of hips within the surgeons’ “target zone” (inclination, 30°-50°; anteversion, 10°-30°) was calculated, along with the percentage within the “safe zone” of Lewinnek (inclination, 30°-50°; anteversion, 5°-25°) and Callanan (inclination, 30°-45°; anteversion, 5°-25°). Relative risk (RR) and absolute risk reduction (ARR) were calculated. Variances (square of the standard deviations) were used to describe the variability of cup position.
Seventy-six percentage of MP THAs were within the surgeons’ target zone compared with 84% of FA THAs and 97% of RP THAs. This difference was statistically significant, associated with a RR reduction of 87% (RR, 0.13 0.04-0.40; P < .01; ARR, 21%; number needed to treat, 5) for RP compared to MP THAs. Compared to FA THAs, RP THAs were associated with a RR reduction of 81% (RR, 0.19 0.06-0.62; P < .01; ARR, 13%; number needed to treat, 8). Variances were lower for acetabulum inclination and anteversion in RP THAs (14.0 and 19.5) as compared to the MP (37.5 and 56.3) and FA (24.5 and 54.6) groups. These differences were statistically significant (P < .01).
Adoption of robotic techniques delivers significant and immediate improvement in the precision of acetabular component positioning during the learning curve. While fluoroscopy has been shown to be beneficial with experience, a learning curve exists before precision improves significantly.
Background There has been a great increase in the use of navigation technology in joint arthroplasty in an effort to improve clinical outcomes. In most types of navigation-assisted surgery, several ...temporary pins must be placed in the patient, either within the operative field or percutaneously through separate stab incisions. The goals of this study are (1) to clarify what complications occur with the placement of these pins, and (2) identify any associated risk factors for these complications. Methods This study is a retrospective cohort study on navigation-assisted arthroplasty performed by one of four surgeons at a single institution over a three-year period. All patients having a navigation-assisted unicondylar knee arthroplasty (UKA), navigation-assisted patella-femoral arthroplasty (PFA), and navigation-assisted total hip arthroplasty (THA) were included. Records were reviewed and outcome measures were tabulated in a database. Complications included in the database were pin site infection, deep prosthetic joint infection, neurologic injury, vascular injury, and fracture through a pin site. Results A total of 3136 pin sites in 839 patients were included in the study. Five pin site complications were reported with a complication rate of 0.16% per pin site and 0.60% per patient. The complications per procedure were slightly higher for UKA (0.64%) compared to PFA (0%) and THA (0.46%) but not statistically significant. There were three infections, one neuropraxia, and one suture abscess. No periprosthetic fractures through a pin site were reported. All complications resolved with non-operative treatment. The infections required oral antibiotics. The infections were associated with transcortical drilling in two of the cases, and juxtacortical drilling in the third case. Conclusion Pins required for navigation-assisted arthroplasty have a low complication rate. Transcortical and possibly juxtacortical drilling may be a risk factor for pin site infection; future studies should be directed at quantifying this effect.
As the life expectancy of the worldwide population increases, the number of hip fractures in the elderly cohort is expected to grow. It is important for surgeons to critically analyze available ...treatment options for these injuries, with the goal of optimizing outcomes and minimizing complications. Femoral neck fractures make up approximately half of all hip fractures. Nonoperative treatment of valgus-impacted and nondisplaced (Garden I and II) femoral neck fractures has high rates of secondary displacement, osteonecrosis, and nonunion; only patients with notable risk for perioperative complications are treated nonoperatively. Surgical intervention is the standard of care, with options including internal fixation (IF) with multiple cancellous screws or a sliding hip screw, hemiarthroplasty, or total hip arthroplasty. Patients with a posterior tilt of greater than 20° have a high rate of revision surgery when treated with IF and may benefit from primary arthroplasty. Furthermore, primary arthroplasty has demonstrated lower revision surgery rates and equivalent postoperative mortality when compared with IF. Surgeons should be aware of the functional outcomes, complications, revision surgery rates, and mortality rates associated with each treatment modality to make a patient-specific decision regarding their care.
The growth in social media (SM) use and consumer-driven health care has led more patients to rate surgeons on physician review websites (PRWs). This study assessed surgeon's professional SM presence ...and its relationship to PRW ratings.
This was a cross-sectional study of the American Association of Hip and Knee Surgeons members as of June 15, 2021. The presence of SM (Facebook, Twitter, Instagram, YouTube, LinkedIn, ResearchGate, and personal professional website) and PRW (Google G, Healthgrades HG, and Vitals V) ratings were collected. Statistical analyses compared PRW ratings among surgeons who did and did not have Any SM, defined as having at least one of the following SM accounts: Facebook; Twitter; Instagram; or YouTube.
Of the 2,455 surgeons, 550 (22%) had Any SM. Compared to surgeons who did not have Any SM, surgeons who had Any SM had significantly higher G, HG, and V overall scores (G:4.1 versus 3.7; HG:4.3 versus 4.1; V:4.0 versus 3.8; P < .01), number of ratings (G:36.9 versus 26.5; HG:56.8 versus 38.3; V:45.6 versus 30.9; P < .01), and number of comments (G:24.4 versus 16.4; HG:35.2 versus 22.0; V:21.5 versus 12.3; P < .01). Surgeons who had Any SM were 1.8 (1.4 to 2.3; P < .01), 1.5 (1.2 to 1.9; P < .01), and 1.5 (1.2 to 1.9; P < .01) times more likely to have a G, HG, and V score of ≥4.0, respectively, than surgeons who did not have Any SM.
Surgeons who had Any SM demonstrated a significant association with higher PRW overall scores, number of ratings, and number of comments, suggesting that SM presence may increase surgeon PRW ratings.
Patient medical complexity increases the cost of primary total hip arthroplasty (THA). The goal of this study was to quantify the impact of specific medical comorbidities on the real hospital cost of ...primary THA.
This study consisted of a retrospective analysis of 1,222 patient encounters for Current Procedural Terminology code 27130 (primary THA) between January 2017 and March 2020 at a high-volume urban academic medical center. Patient demographics, comorbidities, and admission data were collected, and univariate and multivariate gamma regression analyses were performed to identify associations with increased costs incurred during THA admission.
The median total cost for THA was $30,580. Univariate analysis showed increased cost for body mass index (BMI) > 35 versus BMI < 35 ($31,739 versus 30,071; P < .05), American Society of Anesthesiologists (ASA) score 3 to 4 versus ASA 1 to 2 ($32,268 versus 30,045; P < .05), prevalence of diabetes ($31,523 versus 30,379; P < .05), congestive heart failure ($34,814 versus 30,584; P < .05), peripheral vascular disease (PVD) ($35,369 versus 30,573; P < .05), chronic pulmonary disease (CPD) ($34,625 versus 30,405; P < .05), renal disease ($31,973 versus 30,352; P < .05), and increased length of stay (r = 0.424; P < .05). Multivariate gamma regression showed that BMI > 35 (relative risk RR = 1.05), ASA 3 to 4 (RR = 1.07), PVD (RR = 1.29), CPD (RR = 1.13), and renal disease (RR = 1.09) were independently associated with increased THA hospital cost (P < .01). Increased costs seen in BMI > 35 versus BMI < 35 patients were largely due to hospital room and board ($6,345 versus 5,766; P = .01) and operating room costs ($5,744 versus 5,185; P < .05).
A BMI > 35, PVD, CPD, renal disease, and ASA 3 to 4 are associated with higher inpatient hospital costs for THA.
Level III; Retrospective cohort study.
A 64-year-old male with a recalled modular-neck stem implant presented with a soft tissue mass in the lateral thigh. Preoperative testing revealed no signs of infection by the 2018 periprosthetic ...joint infection criteria. MRI revealed a large soft tissue mass around the implant consistent with a pseudotumor, and we performed revision surgery of the femoral component for trunnionosis. One intraoperative culture was positive for infection, and the patient was placed on antibiotics. Six weeks following revision surgery of the femoral component, the patient presented with acute drainage and was diagnosed with an acute on chronic periprosthetic joint infection and underwent explantation of the femoral and acetabular components with the placement of an antibiotic spacer. Cultures revealed identical bacteria from the index procedure. Given the clinical course, this case likely represents adverse local tissue reaction with an atypical presentation of periprosthetic joint infection. This is the first case presentation of an adverse local tissue reaction and superimposed periprosthetic joint infection with normal infection workup, representing an important consideration when differentiating between pseudotumor and periprosthetic joint infection in modular-neck femoral stem implants.
All elective procedures were stopped in March 2020 because of the coronavirus disease 2019 (COVID-19) pandemic. We report the 90-day mortality and complications of patients who underwent primary ...arthroplasty before the stopping of elective procedures at a single academic medical center. A retrospective cohort study was conducted including patients who underwent elective primary arthroplasty between December 2019 and mid-March 2020. Their 90-day postoperative mortality and medical complications were statistically compared with those of a historical cohort from the same operative period in 2019. The 2020 and 2019 cohorts included 372 and 410 patients, respectively. Except for the prevalence of diabetes, there was no significant difference between the two cohorts regarding baseline characteristics or preoperative health. The 2020 cohort had statistically significant higher rates of pneumonia (2.7% vs 0.7%;
=.03), readmission (9.1% vs 5.4%;
=.04), pulmonary embolism (1.6% vs 0.2%;
=.04), and 90-day mortality (1.1% vs 0%;
=.04). The 2020 cohort also had a trend for increased rates of deep venous thrombosis (1.1% vs 0.7%;
=.7) and cardiac complications (1.9% vs 0.5%;
=.07) and no change in emergency department visits (14.0% vs 11.7%;
=.3). There were 7 confirmed cases of COVID-19 in the 2020 cohort and 1 death. This study demonstrates that patients who underwent primary arthroplasty procedures at our institution close to the time of the first wave of the COVID-19 pandemic experienced a statistically significant increase in mortality, pneumonia, pulmonary embolism, and readmission compared with a historical cohort. As elective procedures have resumed during the ongoing pandemic, providers and patients should be aware of these increased risks.
. 2024;47(3):135-140..
This study surveyed the impact that prior authorization has on the practices of total joint arthroplasty (TJA) members of the American Association of Hip and Knee Surgeons (AAHKS).
A 24-question ...survey was approved by the AAHKS Advocacy Committee and distributed to all 2,802 board-certified members of AAHKS.
There were 353 survey responses (13%). Ninety-five percent of surgeons noted a 5-year increase in prior authorization. A majority (71%) of practices employ at least 1 staff member to exclusively work on prior authorization. Average time spent on prior authorization was 15 h/wk (range, 1 to 125) and average number of claims peer week was 18 (range, 1 to 250). Surgeries (99%) were the most common denial. These were denied because nonoperative treatment had not been tried (71%) or had not been attempted for enough time (67%). Most (57%) prior authorization processes rarely/never changed the treatment provided. Most (56%) indicated that prior authorization rarely/never followed evidence-based guidelines. A majority (93%) expressed high administrative burden as well as negative clinical outcomes (87%) due to prior authorization including delays to access care (96%) at least sometimes.
Prior authorization has increased in the past 5 years resulting in high administrative burden. Prior authorizations were most common for TJA surgeries because certain nonoperative treatments were not attempted or not attempted for enough time. Surgeons indicated that prior authorization may be detrimental to high-value care and lead to potentially harmful delays in care without ultimately changing the management of the patient.
A 63-year-old woman with ankylosis of the left knee due to severe heterotopic ossification (HO) following total knee arthroplasty (TKA) underwent right TKA with preoperative radiation and ...postoperative chemical prophylaxis for HO. At the one-year follow-up, the patient had no evidence of HO in the right knee. To our knowledge, there are no reports of successful arthroplasty in patients with a history of ankylosis due to severe HO. We present the first case of successful TKA in a patient with ankylosis of the contralateral knee. TKA can be safely performed in patients at high risk for developing ankylosis.
