Health Care Utilization and Costs in the Year Before and After Total Hip Arthroplasty.

Background: In the era of value-based care, cost-reduction strategies for total hip arthroplasty (THA) have focused on surgical bundles and reductions in postacute care spending. Few studies have evaluated the costs of nonoperative treatment and the impact of THA as a cost-saving measure for longitudinal spending. The purpose of this study was to determine the costs of care for THA patients in the year before and the year following THA.

An Analysis of Costs in the Year Before and After Total Knee Arthroplasty.

Background: While insurance claims database studies have reported on costs before total knee arthroplasty (TKA), the cost-efficacy of nonoperative treatment remains unclear in patients who eventually undergo TKA. Furthermore, we hypothesized that patients undergoing primary TKA would have lower costs in the year following surgery than if patients continued nonoperative treatment. The purpose of this study was to determine the costs of various nonoperative treatment modalities in the year before and following primary TKA.

Total Joint Arthroplasty Patients From Distressed Communities Participate in Sports and Physical Activities at Lower Rates.

Background: Patients often desire to participate in sports following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but may be limited functionally and also socioeconomically. The purpose of this study is to investigate the sports participation rates in total joint arthroplasty (TJA) patients based on their Distressed Communities Index (DCI).

Methods: Patients who underwent TJA at our institution from 2015 to 2020 were surveyed on sports/physical activity participation before and after TJA.

Ten-Year Trends in Venous Thromboembolism Prophylaxis at a High-Volume Arthroplasty Center.

Introduction: Venous thromboembolism (VTE) prophylaxis is the standard of care after total joint arthroplasty. However, there have been changes in the prevalence of certain medication classes used by institutions over time driven by the literature and national clinical practice guidelines. The purpose of this study was to analyze the patterns of VTE medications over the past 10 years at our institution.

Undergoing Meniscectomy Within One Year Before Primary Total Knee Arthroplasty Is Associated With Worse Postoperative Outcomes.

Background: Patients undergoing primary total knee arthroplasty (TKA) who have a history of meniscectomy have worse postoperative functional outcomes, increased rates of early postoperative complications, and higher revision rates. Despite knowing this, to the best of our knowledge, it has not been previously studied whether the timing of meniscectomy before TKA impacts functional outcomes after undergoing TKA. Compared to patients who underwent meniscectomy more than one year before TKA, do patients who have meniscectomy less than one year before TKA have significantly different postoperative outcomes?

Methods: A retrospective cohort study was conducted at an academic medical center.

Improvements in Noise Symptoms, Forgotten Joint Scores, and Functional Outcomes With Greater Time Following Total Knee Arthroplasty.

Background: Total knee arthroplasty (TKA) is an impactful procedure with goals that include pain reduction and improved function, with low levels of prosthesis awareness. The purpose of this study was to determine if patients reported prosthetic noise and noise-related symptoms diminished over the course of time after TKA.

Methods: This study was a single institutional, retrospective study of patients who underwent primary unilateral TKA from 2018 to 2021.

Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study.

Background: Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery.

Purpose: To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries.

Study Design: Case series; Level of evidence, 4.

Impact of Climate on Stress Ultrasound Findings of the Elbow Ulnar Collateral Ligament in Professional Baseball Pitchers: An 18-Year Study.

Background: The ulnar collateral ligament (UCL) is the primary soft tissue stabilizer to valgus stress in the elbow and is placed under this valgus stress during the throwing motion. Although there are known risk factors for UCL injury, it is unknown whether the UCL undergoes adaptive changes in athletes from different climates.

Purpose: To compare elbow stress ultrasound (SUS) findings between professional baseball pitchers from warm climates versus cold climates and assess significant differences in adaptive and morphologic changes in the UCL.

Preoperative Oswestry Disability Index Should not be Utilized to Determine Surgical Eligibility for Patients Requiring Lumbar Fusion for Degenerative Lumbar Spine Disease.

Study Design: Retrospective cohort study.

Objective: To evaluate how preoperative Oswestry Disability Index (ODI) thresholds might affect minimal clinically important difference (MCID) achievement following lumbar fusion.

Summary Of Background Data: As payers invest in alternative payment models, some are suggesting threshold cutoffs of patient-reported outcomes (PROMs) in reimbursement approvals for orthopedic procedures.

Return to Sport After Unicompartmental Knee Arthroplasty and Patello-Femoral Arthroplasty.

Background: Data on sports/physical activity participation following unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty (PFA) is variable and limited. The purpose of this study was to assess participations, outcomes, and limitations in sports following UKA and PFA.

Methods: Patients who underwent UKA and PFA at a single institution from 2015 to 2020 were surveyed on sports participation before and after surgery.

The Impact of Socioeconomic Status on the Presence of Advance Care Planning Documents in Patients With Acute Cervical Spinal Cord Injury.

Introduction: Patients presenting with spinal cord injury (SCI) often times have notable deficits or polytrauma and may require urgent decision making for early management. However, their presentation may affect decision-making ability. Although advance care planning (ACP) may help guide spine surgeons as to patient preferences, the rate at which they are available and disparities in ACP completion are still not understood.

Mini-open Femoroacetabular Osteoplasty in Patients With Tönnis Grade 2 or Higher Osteoarthritis is Associated With a Higher Risk of Subsequent Conversion to THA.

Background: The severity of degenerative changes of the hip is known to adversely impact the outcomes of the treatment of femoroacetabular impingement (FAI). Although the operative indications for FAI have expanded to include patients with moderate degrees of hip osteoarthritis, the exact stage of hip osteoarthritis at which surgery for FAI can offer clinical benefits is still uncertain.

Questions/purposes: (1) How does the survivorship free from conversion to THA and survivorship free from revision differ between patients with preexisting Tönnis Grades 2 or 3 changes and those without advanced degenerative changes (Tönnis Grade 0 or 1) after mini-open femoroacetabular osteoplasty? (2) What are the differences in hip-specific and general health outcome scores between the two groups after mini-open femoroacetabular osteoplasty?

Methods: From December 2003 to April 2019, we treated 901 patients for FAI, and their clinical data were systematically recorded in a longitudinally maintained database.

Association Between Draft Order and Stress Sonography of the Ulnar Collateral Ligament of the Elbow in Professional Baseball Pitchers: An 18-Year Study.

Background: The Major League Baseball (MLB) draft is a common route for players to enter professional baseball in the United States. Players taken in earlier rounds are typically higher-performing players. When looking at pitchers specifically, higher performance at the amateur level may be associated with an increased frequency of adaptive change in the throwing elbow.

Trigger Finger Release: Are Sutures Requiring Removal Necessary?

Purpose: There is no consensus regarding optimal closure for trigger finger release (TFR) surgery. The purpose of this study was to compare the number of postoperative visits and complications following TFR closure with nonabsorbable sutures versus those following TFR closure with absorbable sutures and skin glue. The hypothesis was that wound closure with absorbable sutures and glue will result in fewer postoperative visits, while having similar complication rates as that with nonabsorbable sutures.

Joint line position change in primary total knee arthroplasty: a radiographic analysis comparing conventional and robotic techniques.

Purpose: Joint line (JL) position change in total knee arthroplasty (TKA) may alter knee biomechanics and impact function. The purpose of this study was to compare the change in JL position between robotic-assisted TKA (RA-TKA) and conventional TKA (C-TKA).

Methods: A retrospective, radiographic analysis was conducted of patients who underwent RA-TKA and C-TKA to compare JL position change.

Development and Validation of a Risk Calculator for Intensive Care Unit Admission After Total Hip Arthroplasty.

Background: The purpose of this study was to develop and validate a risk stratification calculator to determine the risk of a patient requiring intensive care unit (ICU) admission following primary and revision total hip arthroplasty (THA).

Methods: Using a database of 12,342 THA procedures, with 132 ICU admissions, from 2005 to 2017, we developed models of ICU admission risk based on previously identified preoperative factors including age, heart disease, neurologic disease, renal disease, unilateral versus bilateral surgery, preoperative hemoglobin, blood glucose, and smoking status. Prior to developing the calculator, a set of logistic regressions were analyzed to determine weight and scoring for each variable.

Distressed communities demonstrate increased readmission and health care utilization following shoulder arthroplasty.

Background: Socioeconomic status (SES) has been shown to affect outcomes following total shoulder arthroplasty (TSA), but little is known regarding how SES and the communities in which patients reside can affect postoperative health care utilization. With the growing use of bundled payment models, understanding what factors put patients at risk for readmission and the ways in which patients utilize the health care system postoperatively is crucial for preventing excess costs for providers. This study helps surgeons predict which patients are high-risk and may require additional surveillance following shoulder arthroplasty.

Hyponatremia Is an Overlooked Sign of Trouble Following Total Joint Arthroplasty.

Background: Hyponatremia is a common electrolyte abnormality in arthroplasty patients. This issue, underrecognized by surgeons, can impact the postoperative course of patients. There are, however, little data on the implications of sodium disturbances following total joint arthroplasty (TJA).

Using machine learning to predict venous thromboembolism and major bleeding events following total joint arthroplasty.

Venous thromboembolism (VTE) and major bleeding (MBE) are feared complications that are influenced by numerous host and surgical related factors. Using machine learning on contemporary data, our aim was to develop and validate a practical, easy-to-use algorithm to predict risk for VTE and MBE following total joint arthroplasty (TJA). This was a single institutional study of 35,963 primary and revision total hip (THA) and knee arthroplasty (TKA) patients operated between 2009 and 2020.

Larger Perioperative Opioid Prescriptions Lead to Prolonged Opioid Use After Hand and Upper Extremity Surgery: A Multicenter Analysis.

Introduction: The opioid epidemic remains an ongoing public health crisis. The purpose of this study was to investigate whether surgeons' prescribing patterns of the initial postoperative opioid prescription predispose patients to prolonged opioid use after upper extremity surgery.

Methods: This multicenter retrospective study was done at three academic institutions.

Mortality and Complications Following Early Conversion Arthroplasty for Failed Hip Fracture Surgery.

Background: Hip fracture in older patients leads to high morbidity and mortality. Patients who are treated surgically but fail acutely face a more complex operation with conversion total hip arthroplasty (THA). This study investigated mortalities and complications in patients who experienced failure within one year following hip fracture surgery requiring conversion THA.

Predicting Hospital Readmissions After Total Shoulder Arthroplasty Within a Bundled Payment Cohort.

Introduction: Given the rising demand for shoulder arthroplasty, understanding risk factors associated with unplanned hospital readmission is imperative. No study to date has examined the influence of patient and hospital-specific factors as a predictive model for 90-day readmissions within a bundled payment cohort after primary shoulder arthroplasty. The purpose of this study was to determine predictive factors for 90-day readmissions after primary shoulder arthroplasty within a bundled payment cohort.

Do Patient Outcomes Predict Loss to Long-Term Follow-Up After Spine Surgery?

Objective: To determine if spine surgery patients with greater improvement in patient-reported outcomes measures (PROMs) at early postoperative follow-up are more likely to be lost to follow-up at the 1-year and 2-year postoperative visits.

Methods: All patients older than 18 years who underwent primary or revision decompression or fusion surgery for degenerative spinal conditions at an academic institution were retrospectively identified. Univariate analysis compared patient demographics, surgical factors, and changes in short-term and long-term postoperative PROMs (Neck Disability Index, Oswestry Disability Index, visual analog scale [VAS] neck, VAS arm, VAS back, VAS leg, and Short-Form 12 Physical and Mental Component Scores) across groups with and without 1 year and 2 years follow-up.

The Use of Cement and Tourniquet During Total Knee Arthroplasty Does Not Increase the Risk of Venous Thromboembolism Postoperatively.

Background: Venous thromboembolism (VTE) is a severe complication of total knee arthroplasty (TKA). Cementation and the use of tourniquet during TKA have both been hypothesized to be risk factors of VTE. The purpose of our study was to determine if either of these surgical factors increases the risk of VTE in patients undergoing TKA.