Abstract Introduction The purpose of this study was to evaluate the changing incidence of hip arthroscopy procedures among newly trained surgeons in the United States, the indications for hip ...arthroscopy, and the reported rate of post-operative complications. Methods The ABOS database was used to evaluate the annual incidence of hip arthroscopy procedures between 2006–2010. Procedures were categorized by indication and type of procedure. The rate of surgical complications was calculated and compared between the published literature and hip arthroscopy procedures performed for femoroacetabular impingement (FAI)/osteoarthritis (OA) and for labral tears among the newly trained surgeon cohort taking the ABOS Part II Board exam. Results The overall incidence of hip arthroscopy procedures performed by ABOS Part II examinees increased by over 600% during the 5-year period under study from approximately 83 in 2006 to 636 in 2010. The incidence of hip arthroscopy for FAI/OA increased steadily over the time period under study, while the incidence of hip arthroscopy for labral tears was variable over time. The rate of surgical complications was 5.9% for hip arthroscopy procedures for a diagnosis of FAI/OA vs. 4.4% for a diagnosis of labral tear ( P = 0.36). Conclusions The incidence of hip arthroscopy has increased dramatically over the past 5 years, particularly for the indication of FAI/OA. Reported surgical complication rates are relatively low, but appear higher than those rates reported in previously published series. Appropriate indications for hip arthroscopy remain unclear.
Abstract Periprosthetic joint infection (PJI) represents substantial clinical and economic burdens. This study evaluated patient and procedure characteristics and resource utilization associated with ...revision arthroplasty for PJI. The Nationwide Inpatient Sample (Q4 2005–2010) was analyzed for 235,857 revision THA (RTHA) and 301,718 revision TKA (RTKA) procedures. PJI was the most common indication for RTKA, and the third most common reason for RTHA. PJI was most commonly associated with major severity of illness (SOI) in RTHA, and with moderate SOI in RTKA. RTHA and RTKA for PJI had the longest length of stay. Costs were higher for RTHA/RTKA for PJI than for any other diagnosis except periprosthetic fracture. Epidemiologic differences exist in the rank, severity and populations for RTHA and RTKA for PJI.
Abstract Background Degenerative hip disorders often coexist with degenerative changes of the lumbar spine. Limited data on this patient population suggests inferior functional improvement and pain ...relief after surgical management. The purpose of this study is to compare the rates of prosthetic-related complication following primary total hip arthroplasty (THA) in patients with and without prior lumbar spine arthrodesis (SA). Methods 811,601 Medicare patients undergoing primary THA were identified and grouped by length of prior SA (no fusion, 1-2 levels fused S-SAHA, ≥3 levels fused L-SAHA). Results Compared to controls, patients with prior SA had significantly higher rates of complications including dislocation (control:2.36%; S-SAHA:4.26%; L-SAHA:7.51%), revision (control:3.43%, S-SAHA:5.55%, L-SAHA:7.77%), loosening (control:1.33%, S-SAHA:2.10%, L-SAHA:3.04%) and any prosthetic-related complication (control:7.33%, S-SAHA:11.15% (RR 1.52), L-SAHA:14.16% (RR 1.93)) within 24 months (p<0.001). Conclusion The interplay of coexisting degenerative hip and spine disease deserves further attention of both arthroplasty and spine surgeons.
Abstract Background Opioid therapy is an increasingly utilized modality for treatment of musculoskeletal pain despite multiple associated risks. The purpose of this study was to evaluate how ...pre-operative opioid use affects early outcomes following total joint arthroplasty (TJA). Methods 174 patients undergoing TJA were matched by age, gender, and procedure into 3 groups stratified by preoperative opioid use (non-user, short-acting SAO, e.g. Vicodin, long-acting LAO, e.g. Oxycontin). Results Compared to non-users, preoperative LAO use was associated with increased postoperative mean opioid consumption (46mg vs 366 mg mean morphine equivalents, p<0.001) and independently predicted complications within 90 days (OR: 6.15, CI: 1.46,25.95, p=0.013). Conclusion Preoperative opioid use should be disclosed as a risk factor for complication to patients, and taken into consideration by physicians before initiating opioid management.
Abstract Background The coexistence of degenerative hip disease and spinal pathology is not uncommon with the number of surgical treatments performed for each condition increasing annually. The ...limited research available suggests spinal pathology portends less pain relief and worse outcomes after total hip arthroplasty (THA). We hypothesize that primary THA patients with preexisting lumbar spinal fusions (LSF) experience worse early postoperative outcomes. Methods Retrospective matched cohort study. Primary THA patients at one institution who had undergone prior LSF (spine-arthrodesis-hip-arthroplasty, SAHA), were identified and matched to controls of primary THA without LSF. Early outcomes (<90 days) were compared. Results From 2012-2014, 35 SAHA patients were compared to 70 matched controls. Patients were similar in age, sex, ASA score, BMI and Charlson-Comorbidity-Index. SAHA patients had higher rates of complications (31.4% vs 8.6%, p=0.008), reoperation (14.3% vs 2.9%, p=0.040), and general anesthesia (54.3% vs 5.7%, p=0.0001). Bivariate analysis demonstrated SAHA to predict reoperation (OR 5.67, p=0.045) and complications (OR 4.89, p=0.005). With the numbers available, dislocations (0% vs 2.8%), infections (0% vs 8.6%), readmissions, post-operative walking distance, and disposition only trended to favor controls (p>0.05). Comparing controls to SAHA patients with <3 or ≥3 levels fused, longer fusions had increased cumulative post-operative narcotic consumption (mean-morphine-equivalents 44.3 vs 46.9 vs 169.4, p=0.001). Conclusion Patients with preexisting LSF experience worse early outcomes after primary THA including higher rates of complications and reoperation. Lower rates of neuraxial anesthesia and increased narcotic usage represent potential contributors. The complex interplay between the lumbar spine and hip warrants attention and further investigation.
Abstract The present study evaluated the frequency of periprosthetic fractures and tested the hypothesis that this population’s demographics and outcomes are unique as compared with other ...arthroplasty patients. The National Hospital Discharge Survey provided the raw data. Individuals admitted with a primary TKA, primary THA, or revision TJA were selected. Annual rates were then calculated and demographics and outcomes compared. 30,624 patients were reviewed. The proportion of admissions for periprosthetic fractures ranged from 4.2% to 7.4% annually. As compared to patients admitted for other TJA diagnoses, individuals admitted with periprosthetic fracture were older, were more often female, were more often admitted emergently/urgently, had longer lengths of stay, had higher rates of discharge to places other than home, and had a significantly elevated mortality.
Abstract The purpose of this study was to determine whether patients with diabetes mellitus (DM) have a higher likelihood of immediate, inpatient complications following primary and revision total ...hip (THA) and total knee arthroplasty (TKA) than patients without DM. From 1988 to 2003, the Nationwide Inpatient Sample identified 751340 primary or revision THA or TKA patients. 64262 (8.55%) had DM. Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed using bivariate and multivariate analyses with logistic regression modeling. Diabetic patients had fewer routine discharges and higher inflation-adjusted hospital charges for all procedures. Although complications were not uniformly increased, diabetic patients had significantly increased odds of pneumonia, stroke, and transfusion ( P < .001) after primary arthroplasty. This analysis of a large patient database indicates clinically relevant information for patients and surgeons, suggesting that patients undergoing THA and TKA demonstrate more complications and utilize more resources if they have the comorbidity of DM level II evidence.
Abstract We investigated the hypothesis that a posterior capsular injection of ropivacaine would improve pain and accelerate functional recovery after total knee arthroplasty in a randomized, ...double-blind, placebo-controlled study design. Sixty-six patients received a standardized multimodal anesthesia protocol that included a femoral nerve block. Twenty milliliters of either saline (control) or ropivacaine (study group) was injected into the posterior capsule. Pain and function outcomes were recorded prospectively at 4, 8, 12, and 24 hours postinjection. Significantly more patients in the study group were able to perform a straight-leg raise at 8 and 12 hours. In addition, significantly more patients in the control group had a numeric pain score higher than 7/10 (severe pain) at the 12-hour evaluation. Other parameters of pain or functional recovery were not significantly different between the 2 groups. Posterior capsular injection did not improve the pain or accelerate the functional recovery after 12 hours in patients also receiving a femoral nerve block for pain control after total knee arthroplasty.
Abstract The objectives of this study were to compare the risk of venous thromboembolism (VTE), bleeding, surgical site infection, and mortality in patients receiving aspirin or guideline-approved ...VTE prophylactic therapies (warfarin, low-molecular-weight heparins, synthetic pentasaccharides) in total knee arthroplasty (TKA). We analyzed clinical and administrative data from 93 840 patients who underwent primary TKA at 307 US hospitals over a 24-month period. Fifty-one thousand nine hundred twenty-three (55%) patients received warfarin, 37 198 (40%) received injectable agents, and 4719 (5%) received aspirin. After adjustment for patient and hospital factors, patients who received aspirin VTE prophylaxis (VTEP) had lower odds for thromboembolism compared to warfarin patients but with similar odds compared with injectable VTEP; there were no differences in risk of bleeding, infection, or mortality after adjustment. Our results suggest that aspirin, when used in conjunction with other clinical care protocols, may be effective VTEP for certain TKA patients.
Abstract Introduction Hyaluronic acid (HA) and corticosteroid (CS) injections are frequently used in the management of osteoarthritis (OA) of the knee, despite a lack of strong evidence supporting ...their efficacy in the literature. The purpose of this study is to evaluate trends in HA and CS usage in Medicare patients over the past 15 years. Methods The Medicare 5% national sample database was used to identify 581,022 patients (representing an estimated 11.6 million) with a diagnosis of knee OA between 1999 and 2013. Results The percentage of newly diagnosed knee OA patients who received any injection trended from 39% in 1999 to 47% in 2006 and then declined to 37.5% in 2013. However, the mean number of injections per newly diagnosed OA patient nearly doubled from 0.27 to 0.45 for CS and from 0.18 to 0.36 for HA. Among those having both HA and CS injections, 69% had CS as first-line treatment, whereas 31% had HA first. Conclusion The percentage of newly diagnosed knee OA patients receiving injections peaked in 2007 and then decreased steadily through 2013, as did the proportion of patients receiving HA injections as first-line therapy. However, the number of injections per patient has increased significantly over the past 15 years in both groups.
PDF