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  • 1
    Online Resource
    Online Resource
    Robotic Arm-Assisted versus Manual Total Knee Arthroplasty: A Propensity Score-Matched Analysis
    Georg Thieme Verlag KG ; 2023
    In:  The Journal of Knee Surgery Vol. 36, No. 01 ( 2023-01), p. 105-114
    Details
    In: The Journal of Knee Surgery, Georg Thieme Verlag KG, Vol. 36, No. 01 ( 2023-01), p. 105-114
    Abstract: The purpose of this study was to compare (1) operative time, (2) in-hospital pain scores, (3) opioid medication use, (4) length of stay (LOS), (5) discharge disposition at 90-day postoperative, (6) range of motion (ROM), (7) number of physical therapy (PT) visits, (8) emergency department (ED) visits, (9) readmissions, (10) reoperations, (11) complications, and (12) 1-year patient-reported outcome measures (PROMs) in propensity matched patient cohorts who underwent robotic arm-assisted (RA) versus manual total knee arthroplasty (TKA). Using a prospectively collected institutional database, patients who underwent RA- and manual TKA were the nearest neighbor propensity score matched 3:1 (255 manual TKA:85 RA-TKA), accounting for various preoperative characteristics. Data were compared using analysis of variance (ANOVA), Kruskal–Wallis, Pearson's Chi-squared, and Fisher's exact tests, when appropriate. Postoperative pain scores, opioid use, ED visits, readmissions, and 1-year PROMs were similar between the cohorts. Manual TKA patients achieved higher maximum flexion ROM (120.3 ± 9.9 versus 117.8 ± 10.2, p = 0.043) with no statistical differences in other ROM parameters. Manual TKA had shorter operative time (105 vs.113 minutes, p  〈  0.001), and fewer PT visits (median [interquartile range] = 10.0 [8.0–13.0] vs. 11.5 [9.5–15.5] visits, p = 0.014). RA-TKA had shorter LOS (0.48 ± 0.59 vs.1.2 ± 0.59 days, p  〈  0.001) and higher proportion of home discharges (p  〈  0.001). RA-TKA and manual TKA had similar postoperative complications and 1-year PROMs. Although RA-TKA patients had longer operative times, they had shorter LOS and higher propensity for home discharge. In an era of value-based care models and the steady shift to outpatient TKA, these trends need to be explored further. Long-term and randomized controlled studies may help determine potential added value of RA-TKA versus manual TKA. This study reflects level of evidence III.
    Type of Medium: Online Resource
    ISSN: 1538-8506 , 1938-2480
    URL: Article
    DOI: 10.1055/s-0041-1731323
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2023
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  • 2
    Online Resource
    Online Resource
    In-Hospital Mortality Is Associated With Low-Volume Hip Revision Centers After Septic Revision Total Hip Arthroplasty
    SLACK, Inc. ; 2022
    In:  Orthopedics Vol. 45, No. 1 ( 2022-01), p. 57-63
    Details
    In: Orthopedics, SLACK, Inc., Vol. 45, No. 1 ( 2022-01), p. 57-63
    Abstract: Revision total hip arthroplasty (rTHA) after septic failure is associated with higher morbidity and mortality compared with aseptic revisions. The goals of this study were to characterize (1) the in-hospital mortality rate for patients with septic rTHA, (2) the effect of hospital hip revision surgery volume (HRV) on mortality after septic rTHA, and (3) the independent risk factors associated with in-hospital mortality rates after rTHA with 2-year follow-up. The authors analyzed the Healthcare Cost and Utilization Project State Inpatient Databases of New York and Florida to identify cases of septic rTHA from 2007 to 2012 with International Classification of Diseases, Ninth Revision, codes. The authors included patients with (1) no history of THA for 2 years before the index admission and (2) 2 years of follow-up. Groups with primary THA and aseptic rTHA were identified as control groups. Logistic regression was used to evaluate independent associations. Of 3057 patients with septic rTHA, 5.2% (n=160) had in-hospital mortality vs 2.9% of those with primary THA (n=3525, P =.0001) and 2.1% of those with aseptic rTHA (n=252, P =.0001). Octogenarian status, medium-risk Elixhauser comorbidity score, and high-risk Elixhauser comorbidity score were independent risk factors for mortality (adjusted odds ratio [AOR]=1.587, 95% CI=1.103-2.282, P =.0128; AOR=2.439, 95% CI=1.680–3.541, P 〈 .0001; and AOR=6.367, 95% CI=4.134–9.804, P 〈 .0001, respectively). Undergoing rTHA in a high-HRV hospital was associated with lower odds of in-hospital mortality (AOR=0.539, 95% CI=0.332–0.877, P =.0127). Receiving care in a low-HRV hospital increased the risk of 2-year postoperative patient mortality. Similarly, older age and a higher comorbidity burden were independently associated with increased 2-year postoperative mortality. [ Orthopedics . 2022;45(1):57–63.]
    Type of Medium: Online Resource
    ISSN: 0147-7447 , 1938-2367
    URL: Article
    DOI: 10.3928/01477447-20211124-01
    Language: English
    Publisher: SLACK, Inc.
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    In-hospital Mortality after Septic Revision TKA: Analysis of the New York and Florida State Inpatient Databases
    Georg Thieme Verlag KG ; 2022
    In:  The Journal of Knee Surgery Vol. 35, No. 04 ( 2022-03), p. 416-423
    Details
    In: The Journal of Knee Surgery, Georg Thieme Verlag KG, Vol. 35, No. 04 ( 2022-03), p. 416-423
    Abstract: The aims of this study were to investigate (1) in-hospital mortality rates following septic revision total knee arthroplasty (rTKA); (2) compare septic rTKA mortality rates between differing knee revision volume (KRV) hospitals; and (3) identify independent risk factors associated with in-hospital mortality after septic rTKA (up to 2-year follow-up). The Healthcare Cost and Utilization Project State Inpatient Databases of New York and Florida were used to identify septic rTKA, and control groups of aseptic rTKA and primary TKA between 2007 and 2012 via International Classification of Diseases, Ninth Revision codes. Mortality was compared between septic rTKA and aseptic rTKA/primary TKA control groups. Hospital KRV was stratified, and independent risk factors of in-hospital mortality were identified and analyzed using unadjusted and adjusted logistic regression analyses. In this study, 3,531 septic rTKA patients were identified; 105 (3%) patients suffered in-hospital mortality, compared with the control aseptic rTKA (n = 178; 1.7%; p  〈  0.0001) and primary TKA groups (n = 930; 0.6%; p  〈  0.0001). Being an octogenarian (adjusted odds ratio [AOR]: 2.361; 95% confidence interval [CI] : 1.514–3.683; p  〈  0.0002) and having a medium- or high-Elixhauser comorbidity score was associated with in-hospital mortality (AOR: 2.073; 95% CI: 1.334–3.223; p = 0.0012, and AOR: 4.127; 95% CI: 2.268–7.512, p  〈  0.0001). There were no significant in-hospital mortality rate differences in high- versus medium- versus low-KRV hospitals (1.9 vs. 3.6 vs. 2.9%, respectively, p = 0.0558). Age 〉 81 years and higher comorbidity burden were found to contribute to increased risk of 2-year postoperative mortality after septic rTKA. This association could not be established for hospital KRV.
    Type of Medium: Online Resource
    ISSN: 1538-8506 , 1938-2480
    URL: Article
    DOI: 10.1055/s-0040-1715112
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2022
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  • 4
    Online Resource
    Online Resource
    Trochanteric osteotomy in revision total hip arthroplasty
    Bioscientifica ; 2020
    In:  EFORT Open Reviews Vol. 5, No. 8 ( 2020-08), p. 477-485
    Details
    In: EFORT Open Reviews, Bioscientifica, Vol. 5, No. 8 ( 2020-08), p. 477-485
    Abstract: Trochanteric osteotomy is a technique that allows expanded exposure and access to the femoral canal and acetabulum for a number of indications. There has been renewed interest in variants of this technique, including the trochanteric slide osteotomy (TSO), extended trochanter osteotomy (ETO), and the transfemoral approach, for both septic and aseptic revision total hip arthroplasty (THA). Osteotomy fixation is crucial for achieving union, and wire and cable-plate systems are the most common techniques. TSO involves the creation of a greater trochanter fragment with preserved abductor attachment proximally and vastus lateralis attachment distally. This technique may be particularly useful in the setting of abductor deficiency or when augmented acetabular exposure is needed. ETO is a posterior-laterally based extensile approach that has been successfully utilized for aseptic and septic indications; most series report a greater than 90% rate of union. The transfemoral approach, as known as the Wagner osteotomy, is an extensile femoral approach and is more anterior-based than the alternate posterior-based ETO. It may be particularly useful for anterior-based approaches and anterior femoral remodelling; rates of union after this approach in most reports have been close to 100%. Cite this article: EFORT Open Rev 2020;5:477-485. DOI: 10.1302/2058-5241.5.190063
    Type of Medium: Online Resource
    ISSN: 2396-7544 , 2058-5241
    URL: Article
    DOI: 10.1302/2058-5241.5.190063
    Language: English
    Publisher: Bioscientifica
    Publication Date: 2020
    detail.hit.zdb_id: 2844421-8
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  • 5
    Online Resource
    Online Resource
    Work Relative Value Units Do Not Adequately Support the Burden of Infection Management in Revision Knee Arthroplasty
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Journal of Bone and Joint Surgery Vol. 102, No. 3 ( 2020-2-5), p. 230-236
    Details
    In: Journal of Bone and Joint Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 102, No. 3 ( 2020-2-5), p. 230-236
    Abstract: Revision total knee arthroplasty for infection is challenging. Septic revisions, whether 1-stage or 2-stage, may require more time and effort than comparable aseptic revisions. However, the burden of infection may not be reflected by the relative value units (RVUs) assigned to septic revision compared with aseptic revision. The purposes of this study were to compare the RVUs of aseptic and septic revision total knee arthroplasties and to calculate the RVU per minute for work effort. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was analyzed for the years 2006 to 2017. The Current Procedural Terminology (CPT) code 27487 and the International Classification of Diseases, Ninth Revision (ICD-9) code 996.XX, excluding 996.6X, were used to identify all aseptic revision total knee arthroplasties (n = 12,907). The CPT code 27487 and the ICD-9 code 996.6X were used to determine all 1-stage septic revision total knee arthroplasties (n = 891). The CPT codes 27488 and 11981 were used to identify the first stage of a 2-stage revision (n = 293). The CPT codes 27447 and 11982 were used to identify the second stage of a 2-stage revision (n = 279). After 4:1 propensity score matching, 274 cases were identified per septic cohort (aseptic single-stage: n = 1,096). The RVU-to-dollar conversion factor was provided by the U.S. Centers for Medicare & Medicaid Services (CMS), and RVU dollar valuations were calculated. Results: The septic second-stage revision was used as the control group for comparisons. The RVU per minute for the aseptic 2-component revision was 0.215, from a mean operative time of 148.95 minutes. The RVU per minute for the septic, 2-component, 1-stage revision was 0.199, from a mean operative time of 160.6 minutes. For septic, 2-stage revisions, the first-stage RVU per minute was 0.157, from a mean operative time of 138.1 minutes. The second-stage RVU per minute was 0.144, from a mean operative time of 170.0 minutes. Two-component aseptic revision total knee arthroplasty was valued the highest. Conclusions: Despite the increased complexity and worse postoperative outcomes associated with revision total knee arthroplasties for infection, the current physician reimbursement does not account for these challenges. This inadequate compensation may discourage providers from performing these operations and, in turn, make it more difficult for patients with periprosthetic joint infection to receive the necessary treatment. Therefore, the CPT code revaluation may be warranted for these procedures.
    Type of Medium: Online Resource
    ISSN: 0021-9355 , 1535-1386
    URL: Article
    DOI: 10.2106/JBJS.19.00776
    RVK:
    XA 52200.A
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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