S. Mohanty, Meeki K. Lad, David S. Casper, N. Sheth, Comron Saifi
Background: Since its 2012 inception, the U.S. Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (HRRP) has espoused cost-effective health-care delivery by financially penalizing hospitals with excessive 30-day readmission rates. In this study, we hypothesized that socioeconomic factors impact readmission rates of patients undergoing spine surgery. Methods: In this study, 2,830 patients who underwent a spine surgical procedure between 2012 and 2018 were identified retrospectively from our institutional database, with readmission (postoperative day [POD] 0 to 30 and POD 31 to 90) as the outcome of interest. Patients were linked to U.S. Census Tracts and ZIP codes using the Geographic Information Systems (ArcGIS) mapping program. Social determinants of health (SDOH) were obtained from publicly available databases. Patient income was estimated at the Public Use Microdata Area level based on U.S. Census Bureau American Community Survey data. Univariate and multivariable stepwise regression analyses were conducted. Significance was defined as p < 0.05, with Bonferroni corrections as appropriate. Results: Race had a significant effect on readmission only among patients whose estimated incomes were <$31,650 (χ2 = 13.4, p < 0.001). Based on a multivariable stepwise regression, patients with estimated incomes of <$31,000 experienced greater odds of readmission by POD 30 compared with patients with incomes of >$62,000; the odds ratio (OR) was 11.06 (95% confidence interval [CI], 6.35 to 15.57). There were higher odds of 30-day readmission for patients living in neighborhoods with higher diabetes prevalence (OR, 3.02 [95% CI, 1.60 to 5.49]) and patients living in neighborhoods with limited access to primary care providers (OR, 1.39 [95% CI, 1.10 to 1.70]). Lastly, each decile increase in the Area Deprivation Index of a patient’s Census Tract was associated with higher odds of 30-day readmission (OR, 1.40 [95% CI, 1.30 to 1.51]). Conclusions: Socioeconomically disadvantaged patients and patients from areas of high social deprivation have a higher risk of readmission following a spine surgical procedure. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"The Impact of Social Determinants of Health on 30 and 90-Day Readmission Rates After Spine Surgery","authors":"S. Mohanty, Meeki K. Lad, David S. Casper, N. Sheth, Comron Saifi","doi":"10.2106/JBJS.21.00496","DOIUrl":"https://doi.org/10.2106/JBJS.21.00496","url":null,"abstract":"Background: Since its 2012 inception, the U.S. Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (HRRP) has espoused cost-effective health-care delivery by financially penalizing hospitals with excessive 30-day readmission rates. In this study, we hypothesized that socioeconomic factors impact readmission rates of patients undergoing spine surgery. Methods: In this study, 2,830 patients who underwent a spine surgical procedure between 2012 and 2018 were identified retrospectively from our institutional database, with readmission (postoperative day [POD] 0 to 30 and POD 31 to 90) as the outcome of interest. Patients were linked to U.S. Census Tracts and ZIP codes using the Geographic Information Systems (ArcGIS) mapping program. Social determinants of health (SDOH) were obtained from publicly available databases. Patient income was estimated at the Public Use Microdata Area level based on U.S. Census Bureau American Community Survey data. Univariate and multivariable stepwise regression analyses were conducted. Significance was defined as p < 0.05, with Bonferroni corrections as appropriate. Results: Race had a significant effect on readmission only among patients whose estimated incomes were <$31,650 (χ2 = 13.4, p < 0.001). Based on a multivariable stepwise regression, patients with estimated incomes of <$31,000 experienced greater odds of readmission by POD 30 compared with patients with incomes of >$62,000; the odds ratio (OR) was 11.06 (95% confidence interval [CI], 6.35 to 15.57). There were higher odds of 30-day readmission for patients living in neighborhoods with higher diabetes prevalence (OR, 3.02 [95% CI, 1.60 to 5.49]) and patients living in neighborhoods with limited access to primary care providers (OR, 1.39 [95% CI, 1.10 to 1.70]). Lastly, each decile increase in the Area Deprivation Index of a patient’s Census Tract was associated with higher odds of 30-day readmission (OR, 1.40 [95% CI, 1.30 to 1.51]). Conclusions: Socioeconomically disadvantaged patients and patients from areas of high social deprivation have a higher risk of readmission following a spine surgical procedure. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"106 33","pages":"412 - 420"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91407940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sze-Ee Soh, Ian A. Harris, K. Cashman, E. Heath, M. Lorimer, S. Graves, I. Ackerman
Background: For patient-reported outcome measures (PROMs) to provide meaningful information to support clinical care, we need to understand the magnitude of change that matters to patients. The aim of this study was to estimate minimal clinically important changes (MCICs) for the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) among people undergoing joint replacement for osteoarthritis. Methods: Individual-level data from the Australian Orthopaedic Association National Joint Replacement Registry’s pilot PROMs program were used for this analysis. Preoperative and 6-month postoperative HOOS-12 and KOOS-12 domain and summary impact scores plus a rating of patient-perceived change after surgery (on a 5-point scale ranging from “much worse” to “much better”) were available. Three anchor-based approaches—mean change, receiver operating characteristics (ROC) based on Youden’s J statistic, and predictive modeling using a binary logistic regression model—were used to calculate MCICs based on patient-perceived change. Results: Data were available for 1,490 patients treated with total hip replacement (THR) (mean age, 66 years; 54% female) and 1,931 patients treated with total knee replacement (TKR) (mean age, 66 years; 55% female). Using the mean change method, the MCIC ranged from 24.0 to 27.5 points for the HOOS-12 and 17.5 to 21.8 points for the KOOS-12. The ROC analyses generated comparable MCIC values (28.1 for HOOS-12 and a range of 15.6 to 21.9 for KOOS-12) with high sensitivity and specificity. Lower estimates were derived from predictive modeling following adjustment for the proportion of improved patients (range, 15.7 to 19.2 for HOOS-12 and 14.2 to 16.5 for KOOS-12). Conclusions: We report MCIC values for the HOOS-12 and KOOS-12 instruments that we derived using 3 different methods. As estimates obtained using predictive modeling can be adjusted for the proportion of improved patients, these may be the most clinically applicable. These MCIC values can be used to interpret important changes in pain, function, and quality of life from the patient’s perspective. Levels of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Minimal Clinically Important Changes in HOOS-12 and KOOS-12 Scores Following Joint Replacement","authors":"Sze-Ee Soh, Ian A. Harris, K. Cashman, E. Heath, M. Lorimer, S. Graves, I. Ackerman","doi":"10.2106/JBJS.21.00741","DOIUrl":"https://doi.org/10.2106/JBJS.21.00741","url":null,"abstract":"Background: For patient-reported outcome measures (PROMs) to provide meaningful information to support clinical care, we need to understand the magnitude of change that matters to patients. The aim of this study was to estimate minimal clinically important changes (MCICs) for the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) among people undergoing joint replacement for osteoarthritis. Methods: Individual-level data from the Australian Orthopaedic Association National Joint Replacement Registry’s pilot PROMs program were used for this analysis. Preoperative and 6-month postoperative HOOS-12 and KOOS-12 domain and summary impact scores plus a rating of patient-perceived change after surgery (on a 5-point scale ranging from “much worse” to “much better”) were available. Three anchor-based approaches—mean change, receiver operating characteristics (ROC) based on Youden’s J statistic, and predictive modeling using a binary logistic regression model—were used to calculate MCICs based on patient-perceived change. Results: Data were available for 1,490 patients treated with total hip replacement (THR) (mean age, 66 years; 54% female) and 1,931 patients treated with total knee replacement (TKR) (mean age, 66 years; 55% female). Using the mean change method, the MCIC ranged from 24.0 to 27.5 points for the HOOS-12 and 17.5 to 21.8 points for the KOOS-12. The ROC analyses generated comparable MCIC values (28.1 for HOOS-12 and a range of 15.6 to 21.9 for KOOS-12) with high sensitivity and specificity. Lower estimates were derived from predictive modeling following adjustment for the proportion of improved patients (range, 15.7 to 19.2 for HOOS-12 and 14.2 to 16.5 for KOOS-12). Conclusions: We report MCIC values for the HOOS-12 and KOOS-12 instruments that we derived using 3 different methods. As estimates obtained using predictive modeling can be adjusted for the proportion of improved patients, these may be the most clinically applicable. These MCIC values can be used to interpret important changes in pain, function, and quality of life from the patient’s perspective. Levels of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"246 1","pages":"980 - 987"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85164223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The purpose of the present study was to determine specific fluoroscopic views of the femoral neck to accurately identify partially extraosseous (“in-out-in”; IOI) placement of the posterosuperior screw for fixation of femoral neck fractures. Methods: A 3.2-mm guide pin was placed in the posterosuperior aspect of 2 synthetic femur models: 1 entirely intraosseous and 1 IOI. Sequential fluoroscopic images were made at 5° intervals in order to identify which fluoroscopic projections identified IOI guide pin placement. These images were utilized to inform screw placement and assessment in the second phase of the study, which involved the use of cadaveric specimens. In Phase II, the posterosuperior screw of the inverted triangle was placed in 10 cadaveric specimens with use of a standard posteroanterior fluoroscopic view and 1 of 2 lateral views, either (1) neck in line with the shaft, i.e., 0° lateral; or (2) a −15° rollunder view. The final fluoroscopic views (i.e., the posteroanterior and multiple lateral and oblique views) were randomized and blinded for review by 10 orthopaedic residents and 5 attending orthopaedic traumatologists. Specimens were stripped of soft tissue and inspected for screw perforation. Results: Overall accuracy of respondents was 68.8%, with no difference between the attending traumatologists (71.8%) and resident surgeons (67.4%; p = 0.173). Interobserver reliability was moderate (κ = 0.496). Dissection identified that 4 (40%) of 10 screws were extraosseous. All of the extraosseous screws were placed with use of the 0° lateral view. The −15° rollunder lateral view was the most sensitive (81.7%) and specific (92.2%) view for identifying IOI screw placement. Conclusions: Surgeons often utilize the standard posteroanterior and 0° lateral fluoroscopic views to safely place screws; however, many of these screws are IOI. The addition of a −15° rollunder lateral view significantly improved identification of IOI screws in the posterosuperior femoral neck. Unidentified IOI screw placement may result in damage to the blood supply of the femoral head.
{"title":"A Novel Fluoroscopic View for Improved Assessment of the Safety of the Posterosuperior Screw in Femoral Neck Fracture Fixation","authors":"E. Terhune, Evan M. Polce, Joel C. Williams","doi":"10.2106/JBJS.21.00959","DOIUrl":"https://doi.org/10.2106/JBJS.21.00959","url":null,"abstract":"Background: The purpose of the present study was to determine specific fluoroscopic views of the femoral neck to accurately identify partially extraosseous (“in-out-in”; IOI) placement of the posterosuperior screw for fixation of femoral neck fractures. Methods: A 3.2-mm guide pin was placed in the posterosuperior aspect of 2 synthetic femur models: 1 entirely intraosseous and 1 IOI. Sequential fluoroscopic images were made at 5° intervals in order to identify which fluoroscopic projections identified IOI guide pin placement. These images were utilized to inform screw placement and assessment in the second phase of the study, which involved the use of cadaveric specimens. In Phase II, the posterosuperior screw of the inverted triangle was placed in 10 cadaveric specimens with use of a standard posteroanterior fluoroscopic view and 1 of 2 lateral views, either (1) neck in line with the shaft, i.e., 0° lateral; or (2) a −15° rollunder view. The final fluoroscopic views (i.e., the posteroanterior and multiple lateral and oblique views) were randomized and blinded for review by 10 orthopaedic residents and 5 attending orthopaedic traumatologists. Specimens were stripped of soft tissue and inspected for screw perforation. Results: Overall accuracy of respondents was 68.8%, with no difference between the attending traumatologists (71.8%) and resident surgeons (67.4%; p = 0.173). Interobserver reliability was moderate (κ = 0.496). Dissection identified that 4 (40%) of 10 screws were extraosseous. All of the extraosseous screws were placed with use of the 0° lateral view. The −15° rollunder lateral view was the most sensitive (81.7%) and specific (92.2%) view for identifying IOI screw placement. Conclusions: Surgeons often utilize the standard posteroanterior and 0° lateral fluoroscopic views to safely place screws; however, many of these screws are IOI. The addition of a −15° rollunder lateral view significantly improved identification of IOI screws in the posterosuperior femoral neck. Unidentified IOI screw placement may result in damage to the blood supply of the femoral head.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"502 1","pages":"889 - 895"},"PeriodicalIF":0.0,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80056995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Holler, Abigail Cortez, S. Challa, E. Eliezer, Billy Hoanga, Saam Morshed, D. Shearer
Background: Open fractures, especially of the tibia, require prompt intervention to achieve optimal patient outcomes. While open tibial shaft fractures are common injuries in low- and middle-income countries (LMICs), there is a dearth of literature examining delays to surgery for these injuries in low-resource settings. This study investigated risk factors for delayed management of open tibial fractures in Tanzania. Methods: We conducted an ad hoc analysis of adult patients enrolled in a prospective observational study at a tertiary referral center in Tanzania from 2015 to 2017. Multivariable models were utilized to analyze risk factors for delayed hospital presentation of ≥2 hours, median time from injury to the treatment hospital, and delayed surgical treatment of ≥12 hours after admission among patients with diaphyseal open tibial fractures. Results: Two hundred and forty-nine patients met the inclusion criteria. Only 12% of patients used an ambulance, 41% were delayed ≥2 hours in presentation to the first hospital, 75% received an interfacility referral, and 10% experienced a delay to surgery of ≥12 hours after admission. After adjusting for injury severity, having insurance (adjusted odds ratio [aOR] = 0.48; 95% confidence interval [CI] = 0.24 to 0.96) and wounds with approximated skin edges (aOR = 0.37; 95% CI = 0.20 to 0.66) were associated with a decreased risk of delayed hospital presentation. Interfacility referrals (2.3 hours greater than no referral; p = 0.015) and rural injury location (10.9 hours greater than urban location; p < 0.001) were associated with greater median times to treatment hospital admission. Older age (aOR = 0.54 per 10 years; 95% CI = 0.31 to 0.95), single-person households (aOR = 0.12 compared with ≥8 people; 95% CI = 0.02 to 0.96), and an education level greater than pre-primary (aOR = 0.16; 95% CI = 0.04 to 0.62) were associated with fewer delays to surgery of ≥12 hours after admission. Conclusions: Prehospital network and socioeconomic characteristics are associated with delays to open tibial fracture care in Tanzania. Reducing interfacility referrals and implementing surgical cost-reduction strategies may help to reduce delays to open fracture care in LMICs. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Risk Factors for Delayed Hospital Admission and Surgical Treatment of Open Tibial Fractures in Tanzania","authors":"J. Holler, Abigail Cortez, S. Challa, E. Eliezer, Billy Hoanga, Saam Morshed, D. Shearer","doi":"10.2106/JBJS.21.00727","DOIUrl":"https://doi.org/10.2106/JBJS.21.00727","url":null,"abstract":"Background: Open fractures, especially of the tibia, require prompt intervention to achieve optimal patient outcomes. While open tibial shaft fractures are common injuries in low- and middle-income countries (LMICs), there is a dearth of literature examining delays to surgery for these injuries in low-resource settings. This study investigated risk factors for delayed management of open tibial fractures in Tanzania. Methods: We conducted an ad hoc analysis of adult patients enrolled in a prospective observational study at a tertiary referral center in Tanzania from 2015 to 2017. Multivariable models were utilized to analyze risk factors for delayed hospital presentation of ≥2 hours, median time from injury to the treatment hospital, and delayed surgical treatment of ≥12 hours after admission among patients with diaphyseal open tibial fractures. Results: Two hundred and forty-nine patients met the inclusion criteria. Only 12% of patients used an ambulance, 41% were delayed ≥2 hours in presentation to the first hospital, 75% received an interfacility referral, and 10% experienced a delay to surgery of ≥12 hours after admission. After adjusting for injury severity, having insurance (adjusted odds ratio [aOR] = 0.48; 95% confidence interval [CI] = 0.24 to 0.96) and wounds with approximated skin edges (aOR = 0.37; 95% CI = 0.20 to 0.66) were associated with a decreased risk of delayed hospital presentation. Interfacility referrals (2.3 hours greater than no referral; p = 0.015) and rural injury location (10.9 hours greater than urban location; p < 0.001) were associated with greater median times to treatment hospital admission. Older age (aOR = 0.54 per 10 years; 95% CI = 0.31 to 0.95), single-person households (aOR = 0.12 compared with ≥8 people; 95% CI = 0.02 to 0.96), and an education level greater than pre-primary (aOR = 0.16; 95% CI = 0.04 to 0.62) were associated with fewer delays to surgery of ≥12 hours after admission. Conclusions: Prehospital network and socioeconomic characteristics are associated with delays to open tibial fracture care in Tanzania. Reducing interfacility referrals and implementing surgical cost-reduction strategies may help to reduce delays to open fracture care in LMICs. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"7 1","pages":"716 - 722"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88336195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hevesi, Ryan R. Wilbur, Lucas K. Keyt, M. Abdel, B. Levy, D. Saris, M. Stuart, A. Krych
Background: Proximal tibial osteotomy (PTO) is a well-established treatment for coronal deformity and focal cartilage defects. However, the utility of joint-preserving interventions must be weighed against potential effects on subsequent total knee arthroplasty (TKA). The purpose of this study was to determine the effect of PTO on subsequent TKA by comparing outcomes in patients with bilateral TKAs following unilateral PTO. Methods: Patients who underwent bilateral TKAs from 2000 to 2015 at a single institution and had previously undergone a unilateral valgus-producing PTO were reviewed. We evaluated 140 TKAs performed in 70 patients (24 female, 46 male) with a mean age at PTO of 50 ± 8 years. The patients underwent conversion to TKA at a mean of 14 ± 7 years following ipsilateral PTO and were followed for a mean of 25 ± 7 years (range, 6 to 40 years) following PTO. The Knee Society Score (KSS), Forgotten Joint Score-12 (FJS-12), subjective knee preference, and revision were compared between the PTO-TKA and contralateral TKA-only sides. Results: The PTO side demonstrated similar KSS Knee subscores (41 ± 16) compared with the contralateral side (39 ± 16, p = 0.67) immediately prior to arthroplasty. Patients had significant improvements in KSS (p < 0.001) after TKA, with clinically similar KSS values at 2 to 15 years of follow-up when knees were compared in a pairwise fashion (p = 0.10 to 0.83). Five PTO-TKA knees (7%) and 4 control TKA-only knees (6%) underwent revision at a mean of 5 years postoperatively (p = 0.76). The number of all-cause reoperations was approximately twice as high in PTO-TKA knees (13% compared with 6% in TKA-only knees, p = 0.24). At the time of final follow-up, PTO-TKA knees demonstrated similar FJS-12 scores (72 ± 26) compared with the contralateral knees (70 ± 28, p = 0.57). Nineteen percent of patients preferred the PTO-TKA knee, 19% preferred the contralateral TKA-only knee, and 62% stated that their knees were equivalent (p > 0.99). The final Tegner activity score was 2.5 ± 1.4. Conclusions: Long-term clinical function of TKA following PTO was excellent, with patients demonstrating comparable subjective outcomes and equivalent knee preference compared with the contralateral TKA-only knees. Further, well-matched studies are needed to evaluate long-term revision and reoperation rates following PTO-TKA. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Total Knee Arthroplasty Function at 25 Years Following Proximal Tibial Osteotomy","authors":"M. Hevesi, Ryan R. Wilbur, Lucas K. Keyt, M. Abdel, B. Levy, D. Saris, M. Stuart, A. Krych","doi":"10.2106/JBJS.21.00761","DOIUrl":"https://doi.org/10.2106/JBJS.21.00761","url":null,"abstract":"Background: Proximal tibial osteotomy (PTO) is a well-established treatment for coronal deformity and focal cartilage defects. However, the utility of joint-preserving interventions must be weighed against potential effects on subsequent total knee arthroplasty (TKA). The purpose of this study was to determine the effect of PTO on subsequent TKA by comparing outcomes in patients with bilateral TKAs following unilateral PTO. Methods: Patients who underwent bilateral TKAs from 2000 to 2015 at a single institution and had previously undergone a unilateral valgus-producing PTO were reviewed. We evaluated 140 TKAs performed in 70 patients (24 female, 46 male) with a mean age at PTO of 50 ± 8 years. The patients underwent conversion to TKA at a mean of 14 ± 7 years following ipsilateral PTO and were followed for a mean of 25 ± 7 years (range, 6 to 40 years) following PTO. The Knee Society Score (KSS), Forgotten Joint Score-12 (FJS-12), subjective knee preference, and revision were compared between the PTO-TKA and contralateral TKA-only sides. Results: The PTO side demonstrated similar KSS Knee subscores (41 ± 16) compared with the contralateral side (39 ± 16, p = 0.67) immediately prior to arthroplasty. Patients had significant improvements in KSS (p < 0.001) after TKA, with clinically similar KSS values at 2 to 15 years of follow-up when knees were compared in a pairwise fashion (p = 0.10 to 0.83). Five PTO-TKA knees (7%) and 4 control TKA-only knees (6%) underwent revision at a mean of 5 years postoperatively (p = 0.76). The number of all-cause reoperations was approximately twice as high in PTO-TKA knees (13% compared with 6% in TKA-only knees, p = 0.24). At the time of final follow-up, PTO-TKA knees demonstrated similar FJS-12 scores (72 ± 26) compared with the contralateral knees (70 ± 28, p = 0.57). Nineteen percent of patients preferred the PTO-TKA knee, 19% preferred the contralateral TKA-only knee, and 62% stated that their knees were equivalent (p > 0.99). The final Tegner activity score was 2.5 ± 1.4. Conclusions: Long-term clinical function of TKA following PTO was excellent, with patients demonstrating comparable subjective outcomes and equivalent knee preference compared with the contralateral TKA-only knees. Further, well-matched studies are needed to evaluate long-term revision and reoperation rates following PTO-TKA. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"1 1","pages":"552 - 558"},"PeriodicalIF":0.0,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89185723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin Zhu, A. Acuña, Linsen T Samuel, Daniel Grits, A. Kamath
Background: The utilization of hyaluronic acid (HA) for the management of knee osteoarthritis (OA) remains controversial, and more information is needed regarding how its utilization and financial burden have changed over recent years. The purpose of our analysis was to evaluate changes in overall utilization and health-care costs associated with HA injections among Medicare beneficiaries over a contemporary time frame. Methods: The 2012 to 2018 Medicare Fee-for-Service Provider Utilization and Payment Public Use Files (PUFs) were utilized for our analysis. Organized by Healthcare Common Procedure Coding System (HCPCS) codes, these files capture 100% of Medicare Part B claims. Payment and utilization data were collected for all HCPCS codes corresponding to injection of an HA formulation. The number of services involving HA as well as the total cost of HA administration in 2020 U.S. dollars were tabulated. Mann-Kendall trend tests were used to evaluate trends in utilization for providers nationally and when segregated by specialty. Results: Total HA utilization increased significantly from 2012 (n = 1,090,503) through 2018 (n = 1,209,489; p = 0.04). Although orthopaedic surgeons did not demonstrate significant changes in total utilization rates (p = 0.23), the average number of services per orthopaedic surgeon increased significantly (p = 0.02). Reflecting a substantial growth in the number of advanced practice providers (APPs) providing injections, there was a significant increase in utilization and associated costs among physician assistants (p < 0.01) and nurse practitioners (p < 0.01). Total costs associated with HA services increased significantly from $290.10 million to $325.02 million (p < 0.01). Conclusions: Despite the 2013 American Academy of Orthopaedic Surgeons clinical practice guideline recommending against the clinical utility of these injections, HA services continued to be widely implemented among Medicare beneficiaries. Although there were variations across specialties when evaluating overall utilization rates as well as rates per provider, APPs largely contributed to the increase seen in the U.S. over this study period. More data are needed to support continued implementation and spending on this low-value care.
{"title":"Hyaluronic Acid Injections for Knee Osteoarthritis","authors":"Kevin Zhu, A. Acuña, Linsen T Samuel, Daniel Grits, A. Kamath","doi":"10.2106/JBJS.21.00832","DOIUrl":"https://doi.org/10.2106/JBJS.21.00832","url":null,"abstract":"Background: The utilization of hyaluronic acid (HA) for the management of knee osteoarthritis (OA) remains controversial, and more information is needed regarding how its utilization and financial burden have changed over recent years. The purpose of our analysis was to evaluate changes in overall utilization and health-care costs associated with HA injections among Medicare beneficiaries over a contemporary time frame. Methods: The 2012 to 2018 Medicare Fee-for-Service Provider Utilization and Payment Public Use Files (PUFs) were utilized for our analysis. Organized by Healthcare Common Procedure Coding System (HCPCS) codes, these files capture 100% of Medicare Part B claims. Payment and utilization data were collected for all HCPCS codes corresponding to injection of an HA formulation. The number of services involving HA as well as the total cost of HA administration in 2020 U.S. dollars were tabulated. Mann-Kendall trend tests were used to evaluate trends in utilization for providers nationally and when segregated by specialty. Results: Total HA utilization increased significantly from 2012 (n = 1,090,503) through 2018 (n = 1,209,489; p = 0.04). Although orthopaedic surgeons did not demonstrate significant changes in total utilization rates (p = 0.23), the average number of services per orthopaedic surgeon increased significantly (p = 0.02). Reflecting a substantial growth in the number of advanced practice providers (APPs) providing injections, there was a significant increase in utilization and associated costs among physician assistants (p < 0.01) and nurse practitioners (p < 0.01). Total costs associated with HA services increased significantly from $290.10 million to $325.02 million (p < 0.01). Conclusions: Despite the 2013 American Academy of Orthopaedic Surgeons clinical practice guideline recommending against the clinical utility of these injections, HA services continued to be widely implemented among Medicare beneficiaries. Although there were variations across specialties when evaluating overall utilization rates as well as rates per provider, APPs largely contributed to the increase seen in the U.S. over this study period. More data are needed to support continued implementation and spending on this low-value care.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"51 1","pages":"e43"},"PeriodicalIF":0.0,"publicationDate":"2021-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84851255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Shaw, Colleen M. Moreland, T. Hunt, Colleen Barkley, F. O'Brien, Keith L. Jackson
➤ Femoral neck stress fractures (FNSFs) are an infrequent condition in athletic and military populations.➤ A high index of suspicion with liberal use of magnetic resonance imaging (MRI) is vital for early recognition and treatment initiation.➤ An associated hip effusion on MRI is a risk factor for an evolving stress injury and requires close assessment and consideration for repeat MRI.➤ Stress reactions and stable, incomplete FNSFs (<50% of femoral neck width) can be treated nonsurgically.➤ Surgical intervention is accepted for high-risk, incomplete (≥50% of femoral neck width), and complete FNSFs.➤ Overall, there is a paucity of high-quality literature on the rates of return to activity following FNSF.
{"title":"Femoral Neck Stress Fractures in Athletes and the Military","authors":"K. Shaw, Colleen M. Moreland, T. Hunt, Colleen Barkley, F. O'Brien, Keith L. Jackson","doi":"10.2106/JBJS.21.00896","DOIUrl":"https://doi.org/10.2106/JBJS.21.00896","url":null,"abstract":"➤ Femoral neck stress fractures (FNSFs) are an infrequent condition in athletic and military populations.➤ A high index of suspicion with liberal use of magnetic resonance imaging (MRI) is vital for early recognition and treatment initiation.➤ An associated hip effusion on MRI is a risk factor for an evolving stress injury and requires close assessment and consideration for repeat MRI.➤ Stress reactions and stable, incomplete FNSFs (<50% of femoral neck width) can be treated nonsurgically.➤ Surgical intervention is accepted for high-risk, incomplete (≥50% of femoral neck width), and complete FNSFs.➤ Overall, there is a paucity of high-quality literature on the rates of return to activity following FNSF.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"26 1","pages":"473 - 482"},"PeriodicalIF":0.0,"publicationDate":"2021-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83627605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lee HJ, Jeong JY, Kim CK, Kim YS. Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg. 2016 Jul;25(7):1107-14. ### Question: In patients with reparable rotator cuff tears and symptomatic lesions of the long head of the biceps brachii tendon (LHBT), what is the comparative efficacy of tenotomy and tenodesis? ### Design: Randomized (allocation not concealed)*, blinded (patients and outcome assessors), controlled trial with follow-up at a mean of 20 or 25 months. ### Setting: The Catholic University of Korea, Seoul, Republic of Korea. ### Patients: 137 patients (mean age, 63 years; 77% women) who needed surgical repair for small to medium-sized rotator cuff tears and had concomitant symptomatic partial tears of the LHBT (confirmed with magnetic resonance imaging) that had shown no improvement after ≥1 month of conservative treatment with medication or corticosteroid injections. The exclusion criteria were large or massive rotator cuff tears, previous shoulder surgery or trauma, glenohumeral arthritis, …
{"title":"In Reparable Rotator Cuff Tears with Lesions of the Long Head of the Biceps Brachii Tendon, Tenotomy Did Not Differ from Tenodesis in Terms of Function or Pain","authors":"J. Karlsson","doi":"10.2106/JBJS.16.01383","DOIUrl":"https://doi.org/10.2106/JBJS.16.01383","url":null,"abstract":"Lee HJ, Jeong JY, Kim CK, Kim YS. Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg. 2016 Jul;25(7):1107-14.\u0000\u0000### Question:\u0000\u0000In patients with reparable rotator cuff tears and symptomatic lesions of the long head of the biceps brachii tendon (LHBT), what is the comparative efficacy of tenotomy and tenodesis?\u0000\u0000### Design:\u0000\u0000Randomized (allocation not concealed)*, blinded (patients and outcome assessors), controlled trial with follow-up at a mean of 20 or 25 months.\u0000\u0000### Setting:\u0000\u0000The Catholic University of Korea, Seoul, Republic of Korea.\u0000\u0000### Patients:\u0000\u0000137 patients (mean age, 63 years; 77% women) who needed surgical repair for small to medium-sized rotator cuff tears and had concomitant symptomatic partial tears of the LHBT (confirmed with magnetic resonance imaging) that had shown no improvement after ≥1 month of conservative treatment with medication or corticosteroid injections. The exclusion criteria were large or massive rotator cuff tears, previous shoulder surgery or trauma, glenohumeral arthritis, …","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"57 1","pages":"351"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76978022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Yi, J. Cho, Ji‐Beom Kim, Jaeyoung Kim, Suyeon Park, Woo-Chun Lee
Background: Mobile-bearing total ankle replacement (TAR) enables motion at the tibial implant-polyethylene insert interface. This motion could lead to coronal translation of the talus relative to the tibia and may affect radiographic outcome. We aimed to assess the translation of the talus before and after mobile-bearing TAR to determine whether translation of the talus after TAR is associated with coronal plane alignment of the lower limb and hindfoot as well as to investigate the complications associated with talar translation. Methods: In this retrospective cohort study, we enrolled 153 patients (159 ankles) with a minimum follow-up of 3 years who underwent mobile-bearing TAR. The location of the talus in the coronal plane was quantified with use of talar center migration (TCM) on anteroposterior radiographs both preoperatively and at postoperative intervals, and the relationship between them was investigated. Radiographic parameters in the coronal plane—including mechanical axis deviation (MAD), lateral distal tibial angle (LDTA), hindfoot alignment angle, and hindfoot moment arm—were measured. The relationship between TCM and radiographic parameters in the coronal plane was assessed in each group. The complications associated with talar translation were examined during the same period. Results: During the 36-month follow-up period, the postoperative TCM showed a strong relationship with the preoperative TCM. Moreover, MAD, LDTA, and hindfoot alignment were significantly related to talar translation (p < 0.01). Complications included medial malleolar impingement in 5 cases (including delayed medial malleolar fracture due to medial impingement in 2 cases), insert dislocation in 1 case, and edge-loading in 2 cases; all of the cases with complications demonstrated implant overhang with talar translation. Conclusions: Talar translation in the coronal plane after mobile-bearing TAR correlates with the preoperative talar translation. Talar translation arises from deformities of MAD, LDTA, and hindfoot alignment, and it may be accompanied by various complications, as observed on coronal radiography. Therefore, additional realignment procedures for coronal malalignment should be considered to prevent talar translation after mobile-bearing TAR. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
{"title":"Change in Talar Translation in the Coronal Plane After Mobile-Bearing Total Ankle Replacement and Its Association with Lower-Limb and Hindfoot Alignment","authors":"Y. Yi, J. Cho, Ji‐Beom Kim, Jaeyoung Kim, Suyeon Park, Woo-Chun Lee","doi":"10.2106/JBJS.15.01340","DOIUrl":"https://doi.org/10.2106/JBJS.15.01340","url":null,"abstract":"Background: Mobile-bearing total ankle replacement (TAR) enables motion at the tibial implant-polyethylene insert interface. This motion could lead to coronal translation of the talus relative to the tibia and may affect radiographic outcome. We aimed to assess the translation of the talus before and after mobile-bearing TAR to determine whether translation of the talus after TAR is associated with coronal plane alignment of the lower limb and hindfoot as well as to investigate the complications associated with talar translation. Methods: In this retrospective cohort study, we enrolled 153 patients (159 ankles) with a minimum follow-up of 3 years who underwent mobile-bearing TAR. The location of the talus in the coronal plane was quantified with use of talar center migration (TCM) on anteroposterior radiographs both preoperatively and at postoperative intervals, and the relationship between them was investigated. Radiographic parameters in the coronal plane—including mechanical axis deviation (MAD), lateral distal tibial angle (LDTA), hindfoot alignment angle, and hindfoot moment arm—were measured. The relationship between TCM and radiographic parameters in the coronal plane was assessed in each group. The complications associated with talar translation were examined during the same period. Results: During the 36-month follow-up period, the postoperative TCM showed a strong relationship with the preoperative TCM. Moreover, MAD, LDTA, and hindfoot alignment were significantly related to talar translation (p < 0.01). Complications included medial malleolar impingement in 5 cases (including delayed medial malleolar fracture due to medial impingement in 2 cases), insert dislocation in 1 case, and edge-loading in 2 cases; all of the cases with complications demonstrated implant overhang with talar translation. Conclusions: Talar translation in the coronal plane after mobile-bearing TAR correlates with the preoperative talar translation. Talar translation arises from deformities of MAD, LDTA, and hindfoot alignment, and it may be accompanied by various complications, as observed on coronal radiography. Therefore, additional realignment procedures for coronal malalignment should be considered to prevent talar translation after mobile-bearing TAR. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"29 1","pages":"e13"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87315953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sevag A Bastian, J. Ippolito, Santiago A Lopez, J. Eloy, Kathleen S Beebe
Background: The Hirsch index (h-index), widely considered a valuable measure of assessing academic productivity, has been studied in various medical and surgical specialties and has shown strong associations between higher h-indices and academic promotion, as well as with National Institutes of Health (NIH) awards. Additionally, the m-index and e-index may complement the h-index in this assessment of merit. The purpose of this study was to investigate the relationship between the h, m, and e-indices and academic rank for 2,061 academic orthopaedic surgeons in the United States. Methods: The h-indices of faculty members from 120 academic orthopaedic surgery residency programs were organized and calculated using the Scopus and Google Scholar databases. Additionally, m-index and e-index scores were calculated from Google Scholar. After application of exclusion criteria, 2,061 academic orthopaedic surgeons were included. Results: Academic rank (assistant professor, associate professor, professor, and chair) increases as mean h-index, m-index, and e-index scores increase. Among 976 assistant professors, 504 associate professors, 461 professors, and 120 chairs, mean h, m, and e-indices increased with each academic rank. In the comparison of male and female surgeons, there was no significant difference in h, m, or e-index scores, with the exception of increased h-index scores among male assistant professors. Conclusions: Scholarly impact, as defined by academic productivity and scientific relevance, can be classified by the h-index and supplemented by the m and e-indices. This study has revealed well-defined differences in h, m, and e-indices with regard to academic rank among orthopaedic surgeons. Although the h, m, and e-indices may be of value as adjunct assessment devices for scholarly merit, careful consideration of their limitations must be maintained.
{"title":"The Use of the h-Index in Academic Orthopaedic Surgery","authors":"Sevag A Bastian, J. Ippolito, Santiago A Lopez, J. Eloy, Kathleen S Beebe","doi":"10.2106/JBJS.15.01354","DOIUrl":"https://doi.org/10.2106/JBJS.15.01354","url":null,"abstract":"Background: The Hirsch index (h-index), widely considered a valuable measure of assessing academic productivity, has been studied in various medical and surgical specialties and has shown strong associations between higher h-indices and academic promotion, as well as with National Institutes of Health (NIH) awards. Additionally, the m-index and e-index may complement the h-index in this assessment of merit. The purpose of this study was to investigate the relationship between the h, m, and e-indices and academic rank for 2,061 academic orthopaedic surgeons in the United States. Methods: The h-indices of faculty members from 120 academic orthopaedic surgery residency programs were organized and calculated using the Scopus and Google Scholar databases. Additionally, m-index and e-index scores were calculated from Google Scholar. After application of exclusion criteria, 2,061 academic orthopaedic surgeons were included. Results: Academic rank (assistant professor, associate professor, professor, and chair) increases as mean h-index, m-index, and e-index scores increase. Among 976 assistant professors, 504 associate professors, 461 professors, and 120 chairs, mean h, m, and e-indices increased with each academic rank. In the comparison of male and female surgeons, there was no significant difference in h, m, or e-index scores, with the exception of increased h-index scores among male assistant professors. Conclusions: Scholarly impact, as defined by academic productivity and scientific relevance, can be classified by the h-index and supplemented by the m and e-indices. This study has revealed well-defined differences in h, m, and e-indices with regard to academic rank among orthopaedic surgeons. Although the h, m, and e-indices may be of value as adjunct assessment devices for scholarly merit, careful consideration of their limitations must be maintained.","PeriodicalId":22579,"journal":{"name":"The Journal of Bone and Joint Surgery","volume":"58 1","pages":"e14"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89106492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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