Variation in KOOS JR improvement across total knee implant designs: a cohort study from Michigan Arthroplasty Registry Collaborative Quality Initiative.

Background And Purpose:  Arthroplasty registries report revision risk, but patient-reported outcomes may also measure implant performance. We aimed to evaluate (i) change in patient-reported outcome measures (PROMs) across multiple total knee arthroplasty (TKA) designs in a regional registry, (ii) the association of patellar resurfacing on the change in PROMs, and (iii) the variation in PROMs change within implants with or without patellar resurfacing.

Methods:  This is a cohort of primary TKAs from Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) performed between January 1, 2017 and September 30, 2021.

Site of Service Changes Have Resulted in Increased Opioid Prescriptions for Primary Total Hip and Knee Patients in Michigan, a Michigan Arthroplasty Registry Collaborative Quality Initiative Quality Study.

Background: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) successfully changed opioid prescribing patterns by instituting guidelines for total hip (THAs) and knee arthroplasties (TKAs). Given Medicare changes, cases are moving to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). We aimed to assess whether these sites adopted the well-proven opioid recommendations.

Achieving the Centers for Medicare and Medicaid Services Defined Substantial Clinical Benefit Following Total Knee Arthroplasty and Total Hip Arthroplasty in the Michigan Arthroplasty Registry Collaborative Quality Initiative.

Background: The Centers for Medicare & Medicaid Services (CMS) mandates patient-reported outcome measure (PROM) reporting for inpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) starting July 1, 2024, requiring preoperative (0 to 90 days) and postoperative (300 to 425 days) scores for ≥ 50% of claims. Substantial clinical benefit (SCB) is defined as a 22-point Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement improvement for THA and a 20-point Knee injury and Osteoarthritis Outcome Score for Joint Replacement improvement for TKA, with a CMS-defined goal for hospitals to achieve SCB for ≥ 60% of patients. The purpose of this study was to assess the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) sites' readiness to meet these CMS patient-reported outcome measures collection requirements and their success in achieving SCB thresholds.

Increasing Use of Cemented Stems Is Associated With Reduced Early Fracture After Total Hip Arthroplasty: A Michigan Arthroplasty Registry Collaborative Quality Initiative Study.

Background: The Michigan Arthroplasty Registry Quality Collaborative Initiative (MARCQI) identified periprosthetic fracture as the most common reason for early total hip arthroplasty (THA) revision of uncemented hips. This analysis described a state-wide quality improvement project to reduce fracture and early revision.

Methods: The MARCQI reports data to participants through reports and in-person meetings and incorporated postoperative hip fracture into pay-for-performance incentives as part of a quality improvement project in 2018.

Intraoperative Irrigation and Topical Antibiotic Use Fail to Reduce Early Periprosthetic Joint Infection Rates: A Michigan Arthroplasty Registry Collaborative Quality Initiative Study.

Background: Periprosthetic joint infections remain a major complication in total joint arthroplasty. Tremendous efforts made intraoperatively to prevent periprosthetic joint infection during primary procedures include antiseptics or antibiotics in irrigation solutions. This study analyzed the incidence of postoperative infection in relation to use of irrigation solutions and antibiotic powder.

Uncemented Total Knee Arthroplasty in the State of Michigan has Higher Rates of Revision Through 5-Year Follow-Up.

Background: While cemented total knee arthroplasty (TKA) is considered the gold standard, uncemented designs are gaining popularity, especially in young men who are at higher risk of cemented failure. Assessing this growth's impact, the Michigan Arthroplasty Registry Collaborative Quality Initiative analyzed adoption rates of uncemented TKA and the effect of fixation technique on revision rates with the goal of assessing the revision rates and survivorship at five years of cemented versus uncemented TKA to further classify which patients may be more ideal candidates for cementless fixation.

Methods: The Michigan Arthroplasty Registry Collaborative Quality Initiative data from 2017 to 2022 was analyzed to determine the survivorship of cemented versus uncemented TKAs.

Early Identification of Poorly Performing Implants in Michigan With the Example of the Vanguard XP.

Background: Arthroplasty registries play a critical role in improving the quality of care and performing post-market surveillance of medical devices. We report the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) findings specific to the Biomet Vanguard XP bicruciate-retaining total knee implant.

Methods: Data were collected from MARCQI's 2019 report (February 15, 2012, through December 31, 2018).

A systematic review of crosswalks for converting patient-reported outcome measure scores in hip, knee, and shoulder replacement surgery.

Background And Purpose:  We aimed to systematically review studies of crosswalks for converting patient-reported outcome measure (PROM) scores used in joint replacement, and develop a database of published crosswalks.

Methods:  4 electronic databases were searched from January 2000 to May 2023 to identify studies reporting the development and/or validation of crosswalks to convert PROM scores in patients undergoing elective hip, knee, or shoulder replacement surgery. Data on study and sample characteristics, source and target PROMs, and crosswalk development and validation methods were extracted from eligible studies.

The Impact of Surgeon Volume on Unicompartmental Knee Arthroplasty Survivorship: A Michigan Arthroplasty Registry Collaborative Quality Initiative Database Analysis.

Background: The utilization of unicompartmental knee arthroplasty (UKA) has remained low when compared to total knee arthroplasty (TKA), possibly due to higher rates of revision and reoperation. This study aimed to quantify surgeon UKA case-volumes and measure the effect of surgeon volume on early revision. We hypothesized that surgeons who have high case volumes would have lower revision rates compared to medium- and low-volume surgeons.

Individualized Surgeon Reports in a Statewide Registry: A Pathway to Improved Outcomes.

Despite progress with the development of joint replacement registries in the United States, surgeons may have limited opportunities to determine the cumulative outcome of their own patients or understand how those outcomes compare with their peers; this information is important for quality improvement. In order to provide surgeons with accurate data, it is first necessary to have a registry with complete coverage and patient matching. Some international registries have accomplished this.

Opioid Consumption After Discharge From Total Knee and Hip Arthroplasty: A Systematic Review and Meta-Analysis.

Background: Pain is challenging after recovery from total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures, and patients often receive prescription opioids. However, opioid consumption by patients remains unclear, and unused opioids may lead to risks including misuse and diversion. The objective of this systematic review and meta-analysis was to compare prescription size versus patient-reported consumption of opioids after discharge following TKA and THA.

Establishing the Minimally Important Difference for the KOOS-Joint Replacement and PROMIS Global-10 in Patients After Total Knee Arthroplasty.

Background: Despite the overall prevalence and success of total knee arthroplasty (TKA), a significant portion of patients are dissatisfied with their outcomes.

Purpose: To assess the responsiveness and determine the minimally important difference (MID) of 2 patient-reported outcome measures (PROMs)-the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) and the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS 10)-in patients after TKA.

Study Design: Cohort study (diagnosis); Level of evidence, 3.

The Differential Effect of COVID on Total Joint Arthroplasty Between Hospital and Ambulatory Surgery Centers/Hospital Outpatient Departments: A Michigan Arthroplasty Registry Collaborative Quality Initiative Analysis.

Background: Coronavirus disease (COVID) created unprecedented challenges, especially for high-volume elective subspecialties like total joint arthroplasty. Limited inpatient capacity and resource conservation led to new outpatient selection criteria and site of service changes. As a Michigan Arthroplasty Registry Quality Collaborative Initiative quality project, demographic changes, complications, and differential effects on inpatient vs outpatient centers pre- and post-COVID were analyzed.

Total Hip and Knee Arthroplasty Implant Revision Risk to 5 Years From a State-wide Arthroplasty Registry in Michigan.

Background: Information on the revision risk of implants is useful for improving the quality of care for elective hip and knee arthroplasty. The purpose of this study was to report on the revision risk of implants using a state-wide registry in the United States.

Methods: The Michigan Arthroplasty Registry Collaborative Quality Initiative systematically collects data on elective primary and revision hip and knee arthroplasty cases in Michigan.

Do 'Surgeon Champions' and High-Volume Surgeons Have Lower Rates of Periprosthetic Femur Fracture? Perspective From a State-Wide Quality Improvement Registry.

Background: Recently, a state-wide registry identified fracture as a major cause of total hip arthroplasty revision. There were 52.8% of revisions occurring within 6 months (fracture leading cause).

How Much Perioperative Pain and Dysfunction Underlie the HOOS JR and KOOS JR?

Background: The Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) scores represent pain and dysfunction as a single number ranging from 0 (extreme pain and dysfunction) to 100 (no pain or functional limitations). However, scores between 0 and 100 lack a simple interpretation because they reflect varying combinations of pain levels and dysfunction. Given that most adverse events and improvement occur within the first 90 days after surgery, a deeper understanding of the level of pain and dysfunction may reveal missed opportunities for patient care.

Early Survivorship of Uncemented Total Knee Arthroplasty Varies by Age and Sex Based on Data From the Michigan Arthroplasty Registry Collaborative Quality Initiative.

Background: Outcome data for newer uncemented total knee arthroplasty (TKA) designs has been mixed. Registry studies showed worse survivorship, but clinical trials have not demonstrated differences compared to cemented designs. There has been renewed interest in uncemented TKA with modern designs and improved technology.

Identification of implant outliers in joint replacement registries.

Recent concerns surrounding joint replacements that have a higher than expected rate of revision have led to stricter controls by regulatory authorities with regards to the introduction of new devices into the marketplace. Implant post-market surveillance remains important, and joint replacement registries are ideally placed to perform this role. This review examined if and how joint replacement registries identified outlier prostheses, outlined problems and suggested solutions to improve post-market surveillance.

Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis.

Background: This study aimed to determine if "short" femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates.

Methods: Using the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of "short" uncemented femoral hip stems during THA.

Strategies for Combatting Health Disparities in Prioritization Schema for Medically-Necessary Time-Sensitive Orthopaedic Surgeries.

A decrease in non-emergent procedure volume was observed during the COVID-19 pandemic to conserve protective equipment, increase hospital capacity, and limit nosocomial infection. Decreasing COVID-19 infection rates, paired with increasing hospital financial pressure and concerns for patient welfare, have prompted the development of guidelines for re-introduction of medically-necessary time-sensitive (MeNTS) procedures. Such protocols have received criticism for potentially perpetuating inequities disfavoring vulnerable populations.

Association Between Initial Prescription Size and Likelihood of Opioid Refill After Total Knee and Hip Arthroplasty.

Background: The present study was designed to test the hypothesis that there was no association between initial opioid prescription size and the likelihood of refill after elective primary total knee (TKA) and hip arthroplasty (THA).

Methods: We retrospectively analyzed large national datasets of commercial and Medicare insurance claims to identify a weighted cohort of 120,889 primary total joint arthroplasties (76,900 TKA and 43,989 THA) comprised of opioid-naive patients aged 18 to 75 years who had surgery between January 2015 and November 2019. The primary outcome was refill of any prescription opioid medication within 30 days after discharge, and the primary predictor variable was the total amount of opioid filled in the initial discharge prescription measured in oral morphine equivalents (OMEs).

State-Based and National U.S. Registries: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), California Joint Replacement Registry (CJRR), and American Joint Replacement Registry (AJRR).

The concept of a total joint registry as a tool to gather and compare longitudinal clinical outcome data emerged in the early 1970s; although initially begun as a single-institution effort, it soon spread to the development of large nationwide registries, first in Scandinavia and subsequently around the world. These national registries established the value of population-wide results, large cohorts, and the importance of ongoing implant surveillance efforts, as detailed elsewhere in this series. In the United States, concerted efforts to establish a national total joint registry for the hip and knee began in earnest in the early 2000s and culminated with the incorporation of the American Joint Replacement Registry (AJRR) in 2009.

Multicenter Validation of Natural Language Processing Algorithms for the Detection of Common Data Elements in Operative Notes for Total Hip Arthroplasty: Algorithm Development and Validation.

Background: Natural language processing (NLP) methods are powerful tools for extracting and analyzing critical information from free-text data. MedTaggerIE, an open-source NLP pipeline for information extraction based on text patterns, has been widely used in the annotation of clinical notes. A rule-based system, MedTagger-total hip arthroplasty (THA), developed based on MedTaggerIE, was previously shown to correctly identify the surgical approach, fixation, and bearing surface from the THA operative notes at Mayo Clinic.

Nutritionist Referral Modestly Improves Weight Loss and Increases Surgery Rate in Obese Patients Seeking Total Joint Arthroplasty.

Background: Obesity is associated with increased complications after total joint arthroplasty (TJA), leading some surgeons to recommend nutrition counseling and weight loss. We aim to evaluate the effect of preoperative nutritionist referral on weight loss and likelihood of surgery in obese patients seeking primary TJA.

Methods: A retrospective cohort of patients seeking primary TJA who were referred to a licensed nutritionist for weight loss was matched by age, sex, and body mass index (BMI) to an unreferred control group.