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  • 1
    Online Resource
    Online Resource
    Cementless Fixation Is Associated With Increased Risk of Early and All-Time Revision After Hemiarthroplasty But Not After THA for Femoral Neck Fracture: Results From the American Joint Replacement Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Clinical Orthopaedics & Related Research Vol. 479, No. 10 ( 2021-10), p. 2194-2202
    Details
    In: Clinical Orthopaedics & Related Research, Ovid Technologies (Wolters Kluwer Health), Vol. 479, No. 10 ( 2021-10), p. 2194-2202
    Abstract: Despite ample evidence supporting cemented femoral fixation for both hemiarthroplasty and THA for surgical treatment of displaced femoral neck fractures, cementless fixation is the preferred fixation method in the United States. To our knowledge, no nationally representative registry from the United States has compared revision rates by fixation for this surgical treatment. Question/purpose After controlling for relevant confounding variables, is femoral fixation method (cemented or cementless) in hemiarthroplasty or THA for femoral neck fracture associated with a greater risk of (1) all-cause revision or (2) revision for periprosthetic fracture? Methods Patients with Medicare insurance who had femoral neck fractures treated with hemiarthroplasty or THA reported in the American Joint Replacement Registry database from 2012 to 2017 and Centers for Medicare and Medicaid Services claims data from 2012 to 2017 were analyzed in this retrospective, large-database study. Of the 37,201 hemiarthroplasties, 42% (15,748) used cemented fixation and 58% (21,453) used cementless fixation. Of the 7732 THAs, 20% (1511) used cemented stem fixation and 80% (6221) used cementless stem fixation. For both the hemiarthroplasty and THA cohorts, most patients were women and had cementless femoral fixation. Early revision was defined as a procedure that occurred less than 90 days from the index procedure. All patients submitted to the registry were included in the analysis. Patient follow-up was limited to the study period. No patients were lost to follow-up. Due to inherent limitations with the registry, we did not compare medical complications, including deaths attributed directly to cemented fixation. A logistic regression model including the index arthroplasty, age, gender, stem fixation method, hospital size, hospital teaching affiliation, and Charlson comorbidity index score was used to determine associations between the index procedure and revision rates. Results For the hemiarthroplasty cohort, risk factors for any revision were cementless stem fixation (odds ratio 1.42 [95% confidence interval 1.20 to 1.68]; p 〈 0.001), younger age (OR 0.96 [95% CI 0.95 to 0.97]; p 〈 0.001), and higher Charlson comorbidity index (OR 1.06 [95% CI 1.02 to 1.11]; p = 0.004). Risk factors for early revision were cementless stem fixation (OR 1.77 [95% CI 1.43 to 2.20] ; p 〈 0.001), younger age (OR 0.98 [95% CI 0.97 to 0.99]; p 〈 0.001), and higher Charlson comorbidity index (OR 1.09 [95% CI 1.04 to 1.15]; p 〈 0.001). Risk factors for revision due to periprosthetic fracture were cementless fixation (OR 6.19 [95% CI 3.08 to 12.42]; p 〈 0.001) and higher Charlson comorbidity index (OR 1.16 [95% CI 1.06 to 1.28]; p = 0.002). Risk factors for early revision due to periprosthetic fracture were cementless fixation (OR 7.38 [95% CI 3.17 to 17.17] ; p 〈 0.001), major teaching hospital (OR 2.10 [95% CI 1.08 to 4.10]; p = 0.03), and higher Charlson comorbidity index (OR 1.20 [95% CI 1.09 to 1.33] ; p 〈 0.001). For the THA cohort, there were no associations. Conclusion These data suggest that cemented fixation should be the preferred technique for most patients with displaced femoral neck fractures treated with hemiarthroplasty. The fact that stem fixation method did not affect revision rates for those patients with displaced femoral neck fractures treated with THA may be due to current practice patterns in the United States. Level of Evidence Level III, therapeutic study.
    Type of Medium: Online Resource
    ISSN: 0009-921X , 1528-1132
    URL: Article
    DOI: 10.1097/CORR.0000000000001932
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2018318-5
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  • 2
    Online Resource
    Online Resource
    Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 30, No. 11 ( 2022-06-1), p. e811-e821
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 11 ( 2022-06-1), p. e811-e821
    Abstract: The purpose of this study was to evaluate outcomes and complications because it relates to surgeon and hospital volume for patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using the American Joint Replacement Registry from 2012 to 2017. Methods: A retrospective study was conducted on Medicare-eligible cases of primary elective THAs and TKAs reported to the American Joint Replacement Registry database and was linked with the available Centers of Medicaid and Medicare Services claims and the National Death Index data from 2012 to 2017. Surgeon and hospital volume were defined separately based on the median annual number of anatomic-specific total arthroplasty procedures performed on patients of any age per surgeon and per hospital. Values were aggregated into separate surgeon and hospital volume tertile groupings and combined to create pairwise comparison surgeon/hospital volume groupings for hip and knee. Results: Adjusted multivariable logistic regression analysis found low surgeon/low hospital volume to have the greatest association with all-cause revisions after THA (odds ratio [OR], 1.63, 95% confidence interval [CI] , 1.41-1.89, P 〈 0.0001) and TKA (OR, 1.72, 95% CI, 1.44-2.06, P 〈 0.0001), early revisions because of periprosthetic joint infection after THA (OR, 2.50, 95% CI, 1.53-3.15, P 〈 0.0001) and TKA (OR, 2.18, 95% CI, 1.64-2.89, P 〈 0.0001), risk of early THA instability and dislocation (OR, 2.47, 95% CI, 1.77-3.46, P 〈 0.0001), and 90-day mortality after THA (OR, 1.72, 95% CI, 1.27-2.35, P = 0.0005) and TKA (OR, 1.47, 95% CI, 1.15-1.86, P = 0.002). Conclusion: Our findings demonstrate considerably greater THA and TKA complications when performed at low-volume hospitals by low-volume surgeons. Given the data from previous literature including this study, a continued push through healthcare policies and healthcare systems is warranted to direct THA and TKA procedures to high-volume centers by high-volume surgeons because of the evident decrease in complications and considerable costs associated with all-cause revisions, periprosthetic joint infection, instability, and 90-day mortality. Level of Evidence: III
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-21-00946
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    Representativeness of the American Spine Registry: a comparison of patient characteristics with the National Inpatient Sample
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2023
    In:  Journal of Neurosurgery: Spine ( 2023-05-01), p. 1-10
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), ( 2023-05-01), p. 1-10
    Abstract: The American Spine Registry (ASR) is a collaborative effort between the American Academy of Orthopaedic Surgeons and the American Association of Neurological Surgeons. The goal of this study was to evaluate how representative the ASR is of the national practice with spinal procedures, as recorded in the National Inpatient Sample (NIS). METHODS The authors queried the NIS and the ASR for cervical and lumbar arthrodesis cases performed during 2017–2019. International Classification of Diseases, 10th Revision and Current Procedural Terminology codes were used to identify patients undergoing cervical and lumbar procedures. The two groups were compared for the overall proportion of cervical and lumbar procedures, age distribution, sex, surgical approach features, race, and hospital volume. Outcomes available in the ASR, such as patient-reported outcomes and reoperations, were not analyzed due to nonavailability in the NIS. The representativeness of the ASR compared to the NIS was assessed via Cohen’s d effect sizes, and absolute standardized mean differences (SMDs) of 〈 0.2 were considered trivial, whereas 〉 0.5 were considered moderately large. RESULTS A total of 24,800 arthrodesis procedures were identified in the ASR for the period between January 1, 2017, and December 31, 2019. During the same time period, 1,305,360 cases were recorded in the NIS. Cervical fusions comprised 35.9% of the ASR cohort (8911 cases) and 36.0% of the NIS cohort (469,287 cases). The two databases presented trivial differences in terms of patient age and sex for all years of interest across both cervical and lumbar arthrodeses (SMD 〈 0.2). Trivial differences were also noted in the distribution of open versus percutaneous procedures of the cervical and lumbar spine (SMD 〈 0.2). Among lumbar cases, anterior approaches were more common in the ASR than in the NIS (32.1% vs 22.3%, SMD = 0.22), but the discrepancy among cervical cases in the two databases was trivial (SMD = 0.03). Small differences were illustrated in terms of race, with SMDs 〈 0.5, and a more significant discrepancy was identified in the geographic distribution of participating sites (SMDs of 0.7 and 0.74 for cervical and lumbar cases, respectively). For both of these measures, SMDs in 2019 were smaller than those in 2018 and 2017. CONCLUSIONS The ASR and NIS databases presented a very high similarity in proportions of cervical and lumbar spine surgeries, as well as similar distributions of age and sex, and distribution of open versus endoscopic approach. Slight discrepancies in anterior versus posterior approach among lumbar cases and patient race, and more significant discrepancies in geographic representation were also identified, yet decreasing trends in differences suggested the improving representativeness of the ASR over the course of time and its progressive growth. These conclusions are important to underline the external validity of quality investigations and research conclusions to be drawn from analyses in which the ASR is used.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2023.3.SPINE221264
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2023
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  • 4
    Online Resource
    Online Resource
    Surgeon input can increase the value of registry data: early experience from the American Spine Registry
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2023
    In:  Journal of Neurosurgery: Spine ( 2023-05-01), p. 1-7
    Details
    In: Journal of Neurosurgery: Spine, Journal of Neurosurgery Publishing Group (JNSPG), ( 2023-05-01), p. 1-7
    Abstract: Clear diagnostic delineation is necessary for the development of a strong evidence base in lumbar spinal surgery. Experience with existing national databases suggests that International Classification of Diseases, Tenth Edition (ICD-10) coding is insufficient to support that need. The purpose of this study was to assess agreement between surgeon-specified diagnostic indication and hospital-reported ICD-10 codes for lumbar spine surgery. METHODS Data collection for the American Spine Registry (ASR) includes an option to denote the surgeon’s specific diagnostic indication for each procedure. For cases treated between January 2020 and March 2022, surgeon-delineated diagnosis was compared with the ICD-10 diagnosis generated by standard ASR electronic medical record data extraction. For decompression-only cases, the primary analysis focused on the etiology of neural compression as determined by the surgeon versus that determined on the basis of the related ICD-10 codes extracted from the ASR database. For lumbar fusion cases, the primary analysis compared structural pathology, which may have required fusion, as determined by the surgeon versus that determined on the basis of the extracted ICD-10 codes. This allowed for identification of agreement between surgeon delineation and extracted ICD-10 codes. RESULTS In 5926 decompression-only cases, agreement between the surgeon and ASR ICD-10 codes was 89% for spinal stenosis and 78% for lumbar disc herniation and/or radiculopathy. Both the surgeon and database indicated no structural pathology (i.e., none) suggesting the need for fusion in 88% of cases. In 5663 lumbar fusion cases, agreement was 76% for spondylolisthesis but poor for other diagnostic indications. CONCLUSIONS Agreement between surgeon-specified diagnostic indication and hospital-reported ICD-10 codes was best for patients who underwent decompression only. In the fusion cases, agreement with ICD-10 codes was best in the spondylolisthesis group (76%). In cases other than spondylolisthesis, agreement was poor due to multiple diagnoses or lack of an ICD-10 code that reflected the pathology. This study suggested that standard ICD-10 codes may be inadequate to clearly define the indications for decompression or fusion in patients with lumbar degenerative disease.
    Type of Medium: Online Resource
    ISSN: 1547-5654
    URL: Article
    DOI: 10.3171/2023.4.SPINE23135
    RVK:
    XA 55270.1
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2023
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  • 5
    Online Resource
    Online Resource
    The Influence of Femoral Fixation on Mortality and Revision After Hip Arthroplasty in Femoral Neck Fractures in Patients Older Than 65 Years. A Matched Cohort Analysis From the American Joint Replacement Registry
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of the American Academy of Orthopaedic Surgeons Vol. 30, No. 24 ( 2022-12-15), p. e1591-e1598
    Details
    In: Journal of the American Academy of Orthopaedic Surgeons, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 24 ( 2022-12-15), p. e1591-e1598
    Abstract: In the United States, most hip arthroplasties for femoral neck fractures are done with a noncemented stem despite worldwide registry data suggesting that cemented fixation has improved long-term survivorship in patients older than 65 years. We, therefore, evaluated the effect of femoral fixation on the risk of revision, revision for periprosthetic fracture (PPFx), and mortality in patients undergoing hip arthroplasty for femoral neck fractures. Methods: Seventeen thousand one hundred thirty-eight cases of cemented femoral stems were exactly matched to noncemented fixation cases in a 1:1 fashion based on age, sex, and Charlson Comorbidity Index as reported in the American Joint Replacement Registry. Outcome variables included revision for PPFx, all-cause revision within 1 year and 90 days, and in-hospital mortality at 90 days and 1 year. The primary independent variable was femoral fixation (cemented and noncemented), and covariates included race (black, white, and others), ethnicity (Hispanic and non-Hispanic), hospital teaching status (minor, major, and nonteaching), and hospital size (number of beds: 1 to 99, 100 to 399, and ≥400). Chi square tests and multivariable logistic regression models were used for statistical analysis. Results: Hip arthroplasty with a cemented stem was associated with a 30% reduction in all-cause revision at 90 days (odds ratio [OR]:0.692, confidence interval [CI] :0.558 to 0.86), a 29% reduction in revision at 1 year (OR:0.709, CI:0.589 to 0.854), and an 86% reduction in revision for PPFx (OR:0.144, CI:0.07 to 0.294). However, cemented stem fixation was associated with increased odds of in-hospital (OR: 2.232 CI: 1.644 to 3.3031), 90-day, and 1-year (OR:1.23, CI:1.135 to 1.339; and OR:1.168, CI:1.091 to 1.25, respectively) mortality. Dicussion: In this exact match study, cemented stem fixation for femoral neck fracture was associated with a markedly reduced risk of revision for PPFx and for all-cause revision. This must be weighed against the associated increased risk in mortality, which warrants additional investigation.
    Type of Medium: Online Resource
    ISSN: 1067-151X , 1940-5480
    URL: Article
    DOI: 10.5435/JAAOS-D-22-00003
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 6
    Online Resource
    Online Resource
    Use of Cementless Metaphyseal Fixation in Revision Total Knee Arthroplasty in the United States
    Elsevier BV ; 2022
    In:  The Journal of Arthroplasty Vol. 37, No. 3 ( 2022-03), p. 554-558
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 37, No. 3 ( 2022-03), p. 554-558
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2021.11.027
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2041553-9
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  • 7
    Online Resource
    Online Resource
    The Effect of Femoral Fixation on Revision and Mortality Following Elective Total Hip Arthroplasty in Patients Over the Age of 65 years. An Analysis of the American Joint Replacement Registry
    Elsevier BV ; 2022
    In:  The Journal of Arthroplasty Vol. 37, No. 6 ( 2022-06), p. 1105-1110
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 37, No. 6 ( 2022-06), p. 1105-1110
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2022.01.088
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 8
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    Online Resource
    Spinal Versus General Anesthesia in Total Knee Arthroplasty: Are There Differences in Complication and Readmission Rates?
    Elsevier BV ; 2023
    In:  The Journal of Arthroplasty Vol. 38, No. 4 ( 2023-04), p. 673-679.e1
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 38, No. 4 ( 2023-04), p. 673-679.e1
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2022.10.036
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2041553-9
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  • 9
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    Lower Rates of Ceramic Femoral Head Use in Non-White Patients in the United States, a National Registry Study
    Elsevier BV ; 2022
    In:  The Journal of Arthroplasty Vol. 37, No. 8 ( 2022-08), p. S919-S924.e2
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 37, No. 8 ( 2022-08), p. S919-S924.e2
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2022.03.050
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2041553-9
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  • 10
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    Online Resource
    Outcomes Vary Significantly Using a Tiered Approach to Define Success After Total Knee Arthroplasty
    Elsevier BV ; 2022
    In:  The Journal of Arthroplasty Vol. 37, No. 7 ( 2022-07), p. 1266-1272
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 37, No. 7 ( 2022-07), p. 1266-1272
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2022.02.065
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2041553-9
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