Impact of lumbar pedicle subtraction osteotomy (PSO) level on global alignment and proportion (GAP) score in revision adult iatrogenic flatback spinal deformities.

Purpose: To explore the impact of different lumbar pedicle subtraction osteotomy (L-PSO) levels on Global Alignment and Proportion (GAP) scores.

Methods: Adults at a single center who underwent lumbar PSOs with revision instrumentation [thoracolumbar junction (T9-L1) to pelvis] and a minimum 2-year follow-up were reviewed. The patients were divided by level of PSO (L2, L3, L4, and L5) and compared with respect to demographic and surgical data, sagittal parameters, GAP scores, and mechanical complications requiring revision operations.

Value in Knee Arthroplasty: A Comparative Patient-Level Value Analysis of Cost and Cost-Effectiveness for Unicompartmental Knee Arthroplasty and Primary Total Knee Arthroplasty in the United States.

Background: Value-based health care emphasizes streamlining costs and improving outcomes. We used time-driven activity-based costing and patient-reported outcome measures to perform a patient-level value analysis. We compared the cost and cost-effectiveness of unicompartmental knee arthroplasty (UKA) and primary total knee arthroplasty (TKA).

Robotic Versus Manual Total Hip Arthroplasty: A Marginal Time-driven Activity-based Costing Analysis.

Background: Standard cost analyses of robotic total hip arthroplasty (THA) have been done. However, no studies have used time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care. This study aimed to compare healthcare facility costs between robotic and manual THA using TDABC.

What Patient, Surgical, and Hospital Factors Are Associated With Increased Value in Primary Total Hip Arthroplasty? A Patient-Level Value Analysis of 2,203 Procedures With Time-Driven Activity-Based Costing.

Background: In the context of value-based health care, combining patient-reported outcome measures (PROMs) with cost-effectiveness analyses is essential. Few studies link PROMs with time-driven activity-based costing (TDABC) for total hip arthroplasty (THA). This study analyzed patient-level variations and identified value drivers in primary THA using TDABC and Hip Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS) scores to optimize value in arthroplasty.

Time to Minimal Clinically Important Difference in Patients Undergoing Conversion Total Hip Arthroplasty After Femoral Neck Fracture: A Propensity Score Matched Study.

Background: Conversion total hip arthroplasty (cTHA) is commonly used for patients with persistent osteoarthritis or failed fixation following femoral neck fracture (FNF). There are limited data comparing patient-reported outcomes between patients undergoing cTHA after FNF and primary THA (pTHA) patients. This study aimed to compare the time to reach the minimal clinically important difference for improvement (MCID) for the Hip Disability and Osteoarthritis Outcomes Score-Physical Function Short Form, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical, and PROMIS Physical Function short form 10a (PF-10a).

Comparing Facility Costs, Patient-Reported Outcome Measures, and Revision Rates in Cementless and Cemented Primary Total Knee Arthroplasty: Findings From a Propensity Score-Matched Patient-Level Value Analysis of 380 Procedures With a Mean 4.3-Year Follow-Up.

Background: Health care value accounts for clinical outcomes and cost. A methodology for more accurate cost accounting is time-driven activity-based costing. No prior study has evaluated the value of cementless total knee arthroplasty (TKA) using time-driven activity-based costing.

Does Robotic Assistance Increase the Likelihood of Achieving the Minimal Clinically Important Improvement Following Total Hip Arthroplasty? Findings From a Propensity Score Matched Analysis of 1,364 Procedures.

Background: Robotic-assisted total hip arthroplasty (rTHA) is associated with improved component positioning compared to manual THA (mTHA). However, its impact on achieving the minimal clinically important difference (MCID) in patient-reported outcomes remains unclear. This study compared rates of MCID for improvement (MCID-I), MCID for worsening (MCID-W), and complication rates between rTHA and mTHA.

Conversion Total Hip Arthroplasty Results in Delayed Patient Improvement Timelines Compared to Primary Total Hip Arthroplasty: Findings From a Propensity-Score Matched Analysis of Time to Achieve Minimal Clinically Important Difference in 698 Procedures.

Background: Previous studies have shown that conversion total hip arthroplasty (cTHA) is associated with worse clinical outcomes, increased complications, and higher costs than primary total hip arthroplasty (pTHA). An underinvestigated factor that may vary between cTHA and pTHA is patient postoperative clinical improvement timelines. This study compared the median time to achieve minimal clinically important difference (MCID) between cTHA and pTHA patients.

How Do the Outcomes of Total Hip Arthroplasty for Oncologic Hip Reconstruction Compare With Those Performed for End-Stage Osteoarthritis?-A Propensity-Matched Cohort Study.

Background: Compared with total hip arthroplasty (THA) for end-stage osteoarthritis, poorer outcomes have been reported in THA for oncologic hip reconstruction because of resection of surrounding stabilizing structures and higher patient comorbidity profile. In a matched cohort, we sought to compare postoperative outcomes between these cohorts.

Methods: A retrospective study of patients who underwent THA for oncologic (primary tumor or metastatic bone disease) or nononcologic (end-stage osteoarthritis) indications was conducted.

Venous Thromboembolism Prophylaxis After Revision Hip Arthroplasty: A Multicenter Analysis of Anticoagulant Choice and Weight-Bearing Status.

Background: Aspirin (ASA) is a reliable prophylactic agent for venous thromboembolism (VTE) in revision total hip arthroplasty (THA). While several studies have compared ASA to other anticoagulants, to our knowledge, none have evaluated its effectiveness in patients who have restricted weight-bearing status (WBS). Limited mobilization after surgery increases the risk of VTE complications.

Risk Factors and Thresholds for Minimal Clinically Important Difference in Worsening after Unicompartmental Knee Arthroplasty.

The rising demand for unicompartmental knee arthroplasty (UKA) in the United States has led to high 1-year patient satisfaction rates. However, some patients experience substantial declines in patient-reported outcome measures (PROMs) postoperatively, which we refer to as "minimal clinically important difference for worsening" (MCID-W). We sought to define MCID-W values for specific PROMs and identify risk factors associated with PROMIS Physical Function Short Form 10a (PROMIS PF-10a) declines after UKA.

Time to Achieve Minimal Clinically Important Difference (MCID) in Robotic Versus Manual Total Knee Arthroplasty: A Comparative Analysis.

Background: Robotics in arthroplasty remains controversial due to the uncertainty of clinical outcomes in robotic total knee arthroplasty (rTKA). This study aimed to compare the time to achieve the minimal clinically important difference (MCID) between rTKA and manual TKA (mTKA).

Methods: A total of 726 TKAs (416 robotic and 310 manual) were analyzed.

Recovery Time and Success: A Comparative Study of Robotic and Manual Total Hip Arthroplasty Outcomes.

Background: Despite the growing utilization of robotic-assisted total hip arthroplasty (rTHA), major debate remains regarding its comparative effectiveness in achieving optimal patient outcomes compared to manual total hip arthroplasty (mTHA). This study aimed to compare both the rate and time to achieve minimal clinically important difference (MCID) between rTHA and mTHA.

Methods: We conducted a retrospective analysis comparing 341 rTHAs with a 1:3 propensity score-matched cohort of 1,023 mTHAs performed from 2016 to 2022.

Cost Effectiveness of Fixation Versus Total Hip Arthroplasty in Vancouver B2 Periprosthetic Femur Fractures: A Predictive Markov Analysis.

Background: Although Vancouver B2 periprosthetic fractures (PPFs) have been historically managed with revision total hip arthroplasty (rTHA), open reduction and internal fixation (ORIF) has been proposed as an alternative option for reasons including lower cost and surgical time. The purpose of this study was to, therefore, create a Markov model to assess the cost effectiveness of ORIF versus rTHA for Vancouver B2 periprosthetic femur fractures and evaluate various inflection points for varying costs and outcome measures.

Methods: A Markov model was built using discrete and mutually exclusive health states of the hypothetical patient with Vancouver B2 PPF.

Survivorship of Periprosthetic Joint Infection in Unicompartmental Knee Arthroplasty: A Single Healthcare System's 23-Year Experience.

Introduction: Unicompartmental knee arthroplasty (UKA) is increasingly favored in clinical practice due to its favorable long-term survival rates, positive clinical outcomes, and expedited recovery. Periprosthetic joint infections (PJIs) remain a formidable complication in knee arthroplasty, and guidelines for the management are limited. This study aims to assess the failure rates of débridement, antibiotics, and implant retention (DAIR) in UKAs, providing insights into optimal treatment management and infection-free survival for PJI in this context.

Patient-Reported Outcomes Following Total Knee Arthroplasty With Multiple Sclerosis Demonstrate Similar Functional Outcome Measures: A Propensity-Matched Analysis.

Introduction: Multiple sclerosis (MS) may negatively influence the patient-reported outcomes measures (PROMs) when undergoing total knee arthroplasty (TKA). However, functional outcomes in this select population remains poorly characterized. This study aimed to compare clinical outcomes and rate of achieving Minimal Clinically Important Difference for Improvement (MCID-I) and Minimal Clinically Important Difference for Worsening (MCID-W) between MS and non-MS TKAs.

Inpatient cost comparison of total and unicompartmental knee arthroplasty in patients with medial compartmental osteoarthritis using time-driven activity-based costing.

Purpose: Using time-driven activity-based costing (TDABC), we sought to compare the total facility costs, comprising supply and personnel costs during the episode of care for the index procedure, in patients with isolated medial compartmental knee osteoarthritis (OA) undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA).

Methods: We conducted a retrospective analysis of 100 UKAs and 100 TKAs from 2019 to 2022. From a larger sample of 4899 TKAs and 137 UKAs, patients with isolated medial OA (Kellgren-Lawrence Grade <2 in other compartments) were radiographically identified.

Patients with multiple sclerosis have higher rates of worsening following total hip arthroplasty: a propensity-matched analysis.

Introduction: The progressive nature of multiple sclerosis (MS) may adversely affect outcomes following total hip arthroplasty (THA). As patient-reported outcome measures (PROMs) in this specific group are not well defined, this study aimed to compare the clinical outcomes and the rates of achieving the minimal clinically important difference for improvement (MCID-I) and worsening (MCID-W) between patients with MS and those without MS undergoing THA.

Methods: We conducted a retrospective analysis of 375 THAs, including 75 MS patients and 300 propensity-matched non-MS patients (4:1), performed between 2016 and 2022.

Primary Total Hip Arthroplasty Achieves Minimal Clinically Important Difference Faster than Revision Total Hip Arthroplasty.

Background: Despite the prevalence of total hip arthroplasty (THA) as a treatment for hip-related conditions, there is limited research directly comparing the patient-reported outcome measures between primary and revision total hip arthroplasty (rTHA). This study compared the time to achieve minimal clinically important difference (MCID) between primary and rTHA.

Methods: We conducted a retrospective analysis comparing 6,671 THAs (6,070 primary and 601 all-cause rTHAs) performed between 2016 and 2022.

Cervical Laminoplasty Versus Laminectomy and Fusion: A Comprehensive Time-driven Activity-based Cost Analysis.

Study Design: Retrospective study.

Objective: To compare the true cost between posterior cervical laminectomy and fusion and cervical laminoplasty using time driven activity-based costing methodology.

Summary Of Background Data: Cervical laminoplasty (LP) and posterior cervical laminectomy with fusion (LF) are effective procedures for treating cervical myelopathy.

Comparing Rates of Minimal Clinically Important Difference Between Manual and Robotic-Assisted Total Knee Arthroplasty.

Background: Differences in patient-reported outcome measures (PROMs) between manual total knee arthroplasty (mTKA) and robotic-assisted TKA (rTKA) have not been adequately assessed. We compared the minimal clinically important difference (MCID) for improvement (MCID-I) and worsening (MCID-W) between mTKA and rTKA patients.

Methods: Patients who underwent primary TKA (874 mTKA and 439 rTKA) with complete preoperative and 1-year postoperative PROMs were retrospectively identified using a multihospital joint arthroplasty registry.

Revision Total Knee Arthroplasty Achieves Minimal Clinically Important Difference Faster Than Primary Total Knee Arthroplasty.

Background: Revision total knee arthroplasty (rTKA) remains underexplored regarding patient-reported outcome measures (PROMs), particularly in terms of time to reach minimal clinically important difference (MCID). This study addresses this gap by comparing the time to achieve MCID between primary TKA (pTKA) and rTKA patients, providing valuable insights into their recovery trajectories.

Methods: A total of 8,266 TKAs (7,618 pTKA and 648 rTKA) were retrospectively studied in a multi-institutional arthroplasty registry.

Comparison of Time and Rate of Achieving Minimal Clinically Important Difference: Robotic Versus Manual Unicompartmental Knee Arthroplasty.

Background: Robotics in unicompartmental knee arthroplasty (UKA) continues to increase with the ever-growing demand to use technology in the surgical setting. However, no studies have used minimal clinically important difference (MCID) to compare patient-reported outcome measures (PROMs) between robotic UKA (rUKA) and manual UKA (mUKA). This study aimed to compare the rate of achieving MCID for improvement (MCID-I) and worsening (MCID-W) and the time to achieving MCID.