Pub Date : 2024-01-21DOI: 10.1177/15563316231214779
J. Wongcharoenwatana, Amber A. Hamilton, J. Hoellwarth, Taylor J Reif, A. Fragomen, S. Rozbruch
The lateral opening wedge distal femoral osteotomy (DFO) is an effective treatment for genu valgum to improve mechanical alignment, decrease lateral compartment loads, and decrease the risk of knee osteoarthritis. Multiple studies have utilized outcome scores assessing functional changes related to pain and joint stability, with a focus solely on knee pain and functional outcomes. The primary aim of this study was to evaluate patient-reported outcome measures (PROMs) that assessed knee function, pain, patient’s perception of body image, and limb deformity-related quality of life, both preoperatively and at least 1-year postoperatively. In a retrospective review of nontraumatic genu valgum patients who underwent bilateral DFO, preoperative and postoperative radiographs were evaluated. Routinely collected preoperative and 1-year postoperative PROMs scores were analyzed, using the Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS-JR) and the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) score, in 72 limbs (36 patients): 7 men (19.44%) and 29 women (80.56%) with an average age of 35.34 ± 13.57 years. The mean follow-up time was 36.85 ± 24.43 months. Overall mechanical axis deviation, lateral distal femoral angle, and mechanical axis alignment angle were significantly improved after DFO in all patients. Both PROMs also improved significantly from preoperative to postoperative scores: LD-SRS (3.10 ± 0.56 vs 4.19 ± 0.44, respectively) and KOOS-JR (63.02 ± 19.25 vs 78.06 ± 16.29, respectively). This retrospective review suggests that bilateral lateral opening-wedge DFOs in patients with symptomatic valgus knee deformity may be associated with improved overall knee health, limb deformity-related quality of life, and patients’ body image. Further study is needed.
{"title":"Bilateral Distal Femoral Osteotomy for Valgus Knee Deformity May Result in Improved Patient-Reported Outcome Scores","authors":"J. Wongcharoenwatana, Amber A. Hamilton, J. Hoellwarth, Taylor J Reif, A. Fragomen, S. Rozbruch","doi":"10.1177/15563316231214779","DOIUrl":"https://doi.org/10.1177/15563316231214779","url":null,"abstract":"The lateral opening wedge distal femoral osteotomy (DFO) is an effective treatment for genu valgum to improve mechanical alignment, decrease lateral compartment loads, and decrease the risk of knee osteoarthritis. Multiple studies have utilized outcome scores assessing functional changes related to pain and joint stability, with a focus solely on knee pain and functional outcomes. The primary aim of this study was to evaluate patient-reported outcome measures (PROMs) that assessed knee function, pain, patient’s perception of body image, and limb deformity-related quality of life, both preoperatively and at least 1-year postoperatively. In a retrospective review of nontraumatic genu valgum patients who underwent bilateral DFO, preoperative and postoperative radiographs were evaluated. Routinely collected preoperative and 1-year postoperative PROMs scores were analyzed, using the Knee Injury and Osteoarthritis Outcome Score Jr. (KOOS-JR) and the Limb Deformity-Modified Scoliosis Research Society (LD-SRS) score, in 72 limbs (36 patients): 7 men (19.44%) and 29 women (80.56%) with an average age of 35.34 ± 13.57 years. The mean follow-up time was 36.85 ± 24.43 months. Overall mechanical axis deviation, lateral distal femoral angle, and mechanical axis alignment angle were significantly improved after DFO in all patients. Both PROMs also improved significantly from preoperative to postoperative scores: LD-SRS (3.10 ± 0.56 vs 4.19 ± 0.44, respectively) and KOOS-JR (63.02 ± 19.25 vs 78.06 ± 16.29, respectively). This retrospective review suggests that bilateral lateral opening-wedge DFOs in patients with symptomatic valgus knee deformity may be associated with improved overall knee health, limb deformity-related quality of life, and patients’ body image. Further study is needed.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"5 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139609935","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}
Pub Date : 2024-01-19DOI: 10.1177/15563316231222287
G. Camino-Willhuber, Soji Tani, L. Schonnagel, T. Caffard, E. Chiapparelli, Krizia Amoroso, Bruno Verna, A. Arzani, Jiaqi Zhu, J. Shue, William D. Zelenty, Gbolabo Sokunbi, D. Lebl, F. Cammisa, F. Girardi, A. Hughes, A. Sama
The modified frailty index (mFI-5) has been shown to be a reliable risk stratification tool in different spine procedures. Its usefulness to predict complications after 1-level or 2-level anterior cervical decompression and fusion (ACDF) has not been studied extensively. We aimed to assess the usefulness of the mFI-5 in 1-level or 2-level ACDF surgery by asking the following questions: (1) Is the mFI-5 a reliable tool to predict complications after 1-level or 2-level ACDF? (2) Is the mFI-5 useful in predicting prolonged hospital stay after 1-level or 2-level ACDF? (3) Is the mFI-5 useful in predicting readmission after 1-level or 2-level ACDF? We performed a retrospective analysis of the medical records of patients who underwent 1-level or 2-level ACDF at our institution. The mFI-5 was calculated based on the presence of 5 comorbidities: (1) congestive heart failure, (2) diabetes mellitus, (3) chronic obstructive pulmonary disease, (4) partially or totally dependent functional status, and (5) hypertension requiring medication. Patients were classified in 3 groups: not frail (mFI-5 items = 0), pre-frail (mFI-5 items = 1), and frail (mFI-5 items ≥2). Postoperative complications, length of stay, and readmission were recorded. In the 662 patients included (mean age 51.4 ± 10.4 years), surgical and medical complications were not significantly different among groups. Lengths of stay and readmission rates were both significantly higher in the pre-frail group. Our study findings suggest that the mFI-5 might not be reliable to assess preoperative risk after 1-level or 2-level ACDF.
{"title":"The Modified 5-Factor Frailty Score May Not be Useful in Predicting Complications and Unplanned Readmission After 1-Level or 2-Level Anterior Cervical Decompression and Fusion","authors":"G. Camino-Willhuber, Soji Tani, L. Schonnagel, T. Caffard, E. Chiapparelli, Krizia Amoroso, Bruno Verna, A. Arzani, Jiaqi Zhu, J. Shue, William D. Zelenty, Gbolabo Sokunbi, D. Lebl, F. Cammisa, F. Girardi, A. Hughes, A. Sama","doi":"10.1177/15563316231222287","DOIUrl":"https://doi.org/10.1177/15563316231222287","url":null,"abstract":"The modified frailty index (mFI-5) has been shown to be a reliable risk stratification tool in different spine procedures. Its usefulness to predict complications after 1-level or 2-level anterior cervical decompression and fusion (ACDF) has not been studied extensively. We aimed to assess the usefulness of the mFI-5 in 1-level or 2-level ACDF surgery by asking the following questions: (1) Is the mFI-5 a reliable tool to predict complications after 1-level or 2-level ACDF? (2) Is the mFI-5 useful in predicting prolonged hospital stay after 1-level or 2-level ACDF? (3) Is the mFI-5 useful in predicting readmission after 1-level or 2-level ACDF? We performed a retrospective analysis of the medical records of patients who underwent 1-level or 2-level ACDF at our institution. The mFI-5 was calculated based on the presence of 5 comorbidities: (1) congestive heart failure, (2) diabetes mellitus, (3) chronic obstructive pulmonary disease, (4) partially or totally dependent functional status, and (5) hypertension requiring medication. Patients were classified in 3 groups: not frail (mFI-5 items = 0), pre-frail (mFI-5 items = 1), and frail (mFI-5 items ≥2). Postoperative complications, length of stay, and readmission were recorded. In the 662 patients included (mean age 51.4 ± 10.4 years), surgical and medical complications were not significantly different among groups. Lengths of stay and readmission rates were both significantly higher in the pre-frail group. Our study findings suggest that the mFI-5 might not be reliable to assess preoperative risk after 1-level or 2-level ACDF.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"46 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139613141","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}
Pub Date : 2024-01-06DOI: 10.1177/15563316231216954
Rachel Ranson, Avilash Das, Connor Littlefield, Taylor Raffa, John W. Belk, Amy Zhao, Alex Gu, James Debritz
Orthopedic-related injuries are a significant proportion of electric scooter (e-scooter) injuries that present to hospitals. There is a lack of global regulatory consensus for e-scooter use. We aimed to synthesize existing data on orthopedic injuries due to e-scooters and identify modifiable risk factors that will help guide policymaking, reduce hospital burden, and aid clinicians in the management of these injuries. A systematic review of the literature was conducted to identify studies pertaining to e-scooter injuries. The U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to November 2022, utilizing keywords pertinent to electric scooter, orthopedic or musculoskeletal injuries, incidence, and prevalence. In total, 30 studies met inclusion criteria. Among all riders, 5.5% were helmeted. Among those injured, 26.3% were intoxicated at the time of injury, 7.6% required inpatient admission, and 20.5% required surgery. The most common orthopedic injuries were to the distal extremities, with wrist fractures being the most reported upper extremity fractures (average 14.9%) and ankle fractures being the most reported lower extremity fractures (average 8.3%). Orthopedic injuries caused by using e-scooters are commonly encountered in the hospital setting. These injuries may continue to rise with the increased accessibility of e-scooters. Lawmakers should instill strict usage guidelines to help prevent injuries from e-scooter use.
{"title":"Orthopedic Injuries Caused by Electric Scooters: A Systematic Review","authors":"Rachel Ranson, Avilash Das, Connor Littlefield, Taylor Raffa, John W. Belk, Amy Zhao, Alex Gu, James Debritz","doi":"10.1177/15563316231216954","DOIUrl":"https://doi.org/10.1177/15563316231216954","url":null,"abstract":"Orthopedic-related injuries are a significant proportion of electric scooter (e-scooter) injuries that present to hospitals. There is a lack of global regulatory consensus for e-scooter use. We aimed to synthesize existing data on orthopedic injuries due to e-scooters and identify modifiable risk factors that will help guide policymaking, reduce hospital burden, and aid clinicians in the management of these injuries. A systematic review of the literature was conducted to identify studies pertaining to e-scooter injuries. The U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to November 2022, utilizing keywords pertinent to electric scooter, orthopedic or musculoskeletal injuries, incidence, and prevalence. In total, 30 studies met inclusion criteria. Among all riders, 5.5% were helmeted. Among those injured, 26.3% were intoxicated at the time of injury, 7.6% required inpatient admission, and 20.5% required surgery. The most common orthopedic injuries were to the distal extremities, with wrist fractures being the most reported upper extremity fractures (average 14.9%) and ankle fractures being the most reported lower extremity fractures (average 8.3%). Orthopedic injuries caused by using e-scooters are commonly encountered in the hospital setting. These injuries may continue to rise with the increased accessibility of e-scooters. Lawmakers should instill strict usage guidelines to help prevent injuries from e-scooter use.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"3 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139380685","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}
Pub Date : 2023-12-25DOI: 10.1177/15563316231213097
Patricia Quinlan, Adero Gaudin, Jake White
{"title":"A Knowledge-Transfer Project to Reduce Postoperative Nausea and Improve Patient Throughput in Orthopedics","authors":"Patricia Quinlan, Adero Gaudin, Jake White","doi":"10.1177/15563316231213097","DOIUrl":"https://doi.org/10.1177/15563316231213097","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"26 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139158383","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}
Pub Date : 2023-12-23DOI: 10.1177/15563316231218249
Daniel F. O’Brien, Thomas C. Sullivan, Bradley S. Lambert, Timothy S. Brown, S. Incavo, Kwan J. Park
In the COVID-19 era, there has been increasing interest in same-day discharge (SDD) after total joint arthroplasty (TJA). However, patient perception of SDD is not well reported. We sought to understand patients’ perceptions and preferences of postoperative care by surveying patients who have completed both an overnight stay (ONS) and an SDD after TJA. We emailed survey links to 67 patients who previously underwent either 2 total hip arthroplasties (THAs) or 2 total knee arthroplasties (TKAs). Fifty-two patients (78%) responded to the survey. Thirty-four (65%) patients underwent staged, bilateral TKAs, and 18 (35%) patients underwent staged, bilateral THAs. Overall, 63% of patients preferred their SDD, 12% had no preference, and 25% preferred their ONS, with no difference in preference between TKA and THA groups. Those who preferred their SDD reported being more comfortable at home. Those who preferred their ONS felt their pain and concerns were better addressed. No differences were found in comfort, sleep quality, appetite, burden on family, return to function, feelings of being discharged too soon, overall experience, 30-day emergency department (ED) visits, or readmissions within 30 days between patients’ SDD and ONS. There was a small statistically significant difference between patients’ perception of safety between SDD and ONS. Our survey found that most patients reported a preference for SDD after TJA over ONS. Although there was a small difference in patient perception of safety, there were no differences in return to the ED or readmissions after SDD and ONS.
在 COVID-19 时代，人们对全关节置换术（TJA）后当天出院（SDD）越来越感兴趣。然而，患者对 SDD 的看法却鲜有报道。我们试图通过对 TJA 术后完成过夜住院（ONS）和 SDD 的患者进行调查，了解患者对术后护理的看法和偏好。我们通过电子邮件向 67 名曾接受过 2 次全髋关节置换术 (THAs) 或 2 次全膝关节置换术 (TKAs) 的患者发送了调查链接。52名患者（78%）回复了调查。34名患者（65%）接受了分期双侧TKA，18名患者（35%）接受了分期双侧THA。总体而言，63%的患者倾向于接受 SDD，12%的患者没有偏好，25%的患者倾向于接受 ONS，TKA 组和 THA 组患者的偏好没有差异。首选 SDD 的患者表示在家中更舒适。喜欢 ONS 的人认为他们的疼痛和担忧得到了更好的解决。SDD组和ONS组患者在舒适度、睡眠质量、食欲、家庭负担、功能恢复、过早出院的感觉、总体体验、30天急诊室就诊率或30天内再入院率方面没有差异。在统计意义上，SDD 和 ONS 患者对安全的感知存在微小差异。我们的调查发现，与 ONS 相比，大多数患者在 TJA 术后更倾向于 SDD。虽然患者对安全性的感知存在微小差异，但 SDD 和 ONS 后在返回急诊室或再入院方面没有差异。
{"title":"Patient Perceptions of Same-Day Discharge Versus Overnight Stay After Total Joint Arthroplasty: Results of a Survey","authors":"Daniel F. O’Brien, Thomas C. Sullivan, Bradley S. Lambert, Timothy S. Brown, S. Incavo, Kwan J. Park","doi":"10.1177/15563316231218249","DOIUrl":"https://doi.org/10.1177/15563316231218249","url":null,"abstract":"In the COVID-19 era, there has been increasing interest in same-day discharge (SDD) after total joint arthroplasty (TJA). However, patient perception of SDD is not well reported. We sought to understand patients’ perceptions and preferences of postoperative care by surveying patients who have completed both an overnight stay (ONS) and an SDD after TJA. We emailed survey links to 67 patients who previously underwent either 2 total hip arthroplasties (THAs) or 2 total knee arthroplasties (TKAs). Fifty-two patients (78%) responded to the survey. Thirty-four (65%) patients underwent staged, bilateral TKAs, and 18 (35%) patients underwent staged, bilateral THAs. Overall, 63% of patients preferred their SDD, 12% had no preference, and 25% preferred their ONS, with no difference in preference between TKA and THA groups. Those who preferred their SDD reported being more comfortable at home. Those who preferred their ONS felt their pain and concerns were better addressed. No differences were found in comfort, sleep quality, appetite, burden on family, return to function, feelings of being discharged too soon, overall experience, 30-day emergency department (ED) visits, or readmissions within 30 days between patients’ SDD and ONS. There was a small statistically significant difference between patients’ perception of safety between SDD and ONS. Our survey found that most patients reported a preference for SDD after TJA over ONS. Although there was a small difference in patient perception of safety, there were no differences in return to the ED or readmissions after SDD and ONS.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"48 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139162723","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}
Pub Date : 2023-12-07DOI: 10.1177/15563316231215796
Sidhant S. Dalal, Kasra Araghi, Eric Mai, Omri Maayan, Karim A. Shafi, Pratyush Shahi, Daniel Shinn, Junho Song, C. Gang, S. Iyer, Sheeraz A Qureshi
Background: The scope of existing annular closure device (ACD) studies examining long-term follow-up data is limited. There is a paucity of studies that report and analyze recent outcomes data following ACD use. Purpose: We sought to summarize the available long-term follow-up data on postoperative outcomes of the Barricaid (Intrinsic Therapeutics) ACD. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Cochrane, and OVID databases were searched to identify studies after 2015 that include direct evaluation of an ACD in a clinical context with a minimum of 2 years of follow-up and inclusion of reherniation and complication rates, while excluding case reports, reviews, and meta-analyses. Outcome measures included patient demographics, study characteristics, surgical technique, defect measurement technique, perioperative statistics, radiographic assessments, complications, patient-reported outcome measures (PROMs), and postoperative outcomes. Results: Five studies—2 randomized controlled trials (RCTs), 2 retrospective studies, and 1 prospective cohort study—were included. Symptomatic reherniation rates in the ACD populations ranged from 3% to 18.8%. Two studies found that control groups herniate significantly more than their ACD counterparts (ACD 18.8% vs non-ACD 31.6% and ACD 3.33% vs non-ACD 20.0%). No significant differences were found in reoperation rates. Of the 4 studies that reported PROMs data, all observed relative improvement in each cohort, although pooled analysis did not find significant differences between ACD and non-ACD groups for Oswestry Disability Index and visual analogue scale–leg pain at 2-year follow-up. Conclusions: For patients undergoing diskectomy for lumbar disk herniation, the Barricaid device is effective in reducing symptomatic reherniation but does not appear to alter postoperative PROMs or reoperation rates. Surgeons must consider that device-related complications can occur.
{"title":"Annular Closure Device Reduces Symptomatic Reherniation Rates: Results of a Meta-analysis","authors":"Sidhant S. Dalal, Kasra Araghi, Eric Mai, Omri Maayan, Karim A. Shafi, Pratyush Shahi, Daniel Shinn, Junho Song, C. Gang, S. Iyer, Sheeraz A Qureshi","doi":"10.1177/15563316231215796","DOIUrl":"https://doi.org/10.1177/15563316231215796","url":null,"abstract":"Background: The scope of existing annular closure device (ACD) studies examining long-term follow-up data is limited. There is a paucity of studies that report and analyze recent outcomes data following ACD use. Purpose: We sought to summarize the available long-term follow-up data on postoperative outcomes of the Barricaid (Intrinsic Therapeutics) ACD. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Cochrane, and OVID databases were searched to identify studies after 2015 that include direct evaluation of an ACD in a clinical context with a minimum of 2 years of follow-up and inclusion of reherniation and complication rates, while excluding case reports, reviews, and meta-analyses. Outcome measures included patient demographics, study characteristics, surgical technique, defect measurement technique, perioperative statistics, radiographic assessments, complications, patient-reported outcome measures (PROMs), and postoperative outcomes. Results: Five studies—2 randomized controlled trials (RCTs), 2 retrospective studies, and 1 prospective cohort study—were included. Symptomatic reherniation rates in the ACD populations ranged from 3% to 18.8%. Two studies found that control groups herniate significantly more than their ACD counterparts (ACD 18.8% vs non-ACD 31.6% and ACD 3.33% vs non-ACD 20.0%). No significant differences were found in reoperation rates. Of the 4 studies that reported PROMs data, all observed relative improvement in each cohort, although pooled analysis did not find significant differences between ACD and non-ACD groups for Oswestry Disability Index and visual analogue scale–leg pain at 2-year follow-up. Conclusions: For patients undergoing diskectomy for lumbar disk herniation, the Barricaid device is effective in reducing symptomatic reherniation but does not appear to alter postoperative PROMs or reoperation rates. Surgeons must consider that device-related complications can occur.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"3 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138592711","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}
Pub Date : 2023-12-07DOI: 10.1177/15563316231212880
Linda A. Russell
Background: It is anticipated that the number of total joint arthroplasties (TJAs) performed worldwide will continue to increase. There is a significant cost to performing TJA. Health care providers must conscientiously work toward providing access and containing costs. There has been an interest in trying to select patients, who may be a candidate for same day discharge, or discharge within 23 hours. Preoperative medical optimization helps decrease intraoperative and postoperative complications. Purposes: Discuss exclusion criteria for which patients are not suitable for same day discharge or discharge within 23 hours. Methods: Available literature is used to support exclusion criteria. Results: Exclusion criteria may include: frailty, malnutrition, uncontrolled diabetes, chronic kidney disease stage 4 or 5, myocardial infarction within the last 6 months, active ischemia on cardiac testing, poorly controlled heart failure, significant valvular disease, hypertrophic cardiomyopathy, ongoing tobacco use, poorly controlled asthma or COPD, home oxygen dependence, known OSA (noncompliant with treatment), cirrhosis, bleeding disorder, anemia and expected to require transfusion, stroke within last 9 months, dementia, and substance abuse. Conclusion: Physicians must assess the complexity of the surgery and the patient’s comorbidities to decide whether the patient is a candidate for same day total joint arthroplasty.
{"title":"Comorbid Factors and Selection for Same-Day Total Joint Arthroplasty","authors":"Linda A. Russell","doi":"10.1177/15563316231212880","DOIUrl":"https://doi.org/10.1177/15563316231212880","url":null,"abstract":"Background: It is anticipated that the number of total joint arthroplasties (TJAs) performed worldwide will continue to increase. There is a significant cost to performing TJA. Health care providers must conscientiously work toward providing access and containing costs. There has been an interest in trying to select patients, who may be a candidate for same day discharge, or discharge within 23 hours. Preoperative medical optimization helps decrease intraoperative and postoperative complications. Purposes: Discuss exclusion criteria for which patients are not suitable for same day discharge or discharge within 23 hours. Methods: Available literature is used to support exclusion criteria. Results: Exclusion criteria may include: frailty, malnutrition, uncontrolled diabetes, chronic kidney disease stage 4 or 5, myocardial infarction within the last 6 months, active ischemia on cardiac testing, poorly controlled heart failure, significant valvular disease, hypertrophic cardiomyopathy, ongoing tobacco use, poorly controlled asthma or COPD, home oxygen dependence, known OSA (noncompliant with treatment), cirrhosis, bleeding disorder, anemia and expected to require transfusion, stroke within last 9 months, dementia, and substance abuse. Conclusion: Physicians must assess the complexity of the surgery and the patient’s comorbidities to decide whether the patient is a candidate for same day total joint arthroplasty.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"51 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593263","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}
Pub Date : 2023-11-28DOI: 10.1177/15563316231210865
Charles Fisher, Catherine Wysin, L. Moeller, Joseph Nguyen
Post-acute care for orthopedic surgery patients continues to evolve with the reduction in hospital length of stay (LOS), shift to ambulatory surgery, increased number of surgeries, and focus on value-based care. We sought to examine outcomes of a cohort of lower-extremity arthroplasty patients receiving telephysical therapy (TelePT) according to hospital LOS, as a means of exploring the viability of TelePT as a value-based discharge option. A retrospective review was conducted of patients who participated in our institution’s HSS@Home TelePT program after undergoing primary unilateral hip or knee arthroplasty, unicondylar knee replacement, or hip resurfacing. Demographic data and outcomes such as hospital LOS, number of days between discharge and TelePT evaluation, number of TelePT visits, number of re-admissions, Hip dysfunction and Osteoarthritis Outcome (HOOS Jr.) or Knee injury and Osteoarthritis Outcome (KOOS Jr.) scores, and patient satisfaction scores were collected. Patients were divided into categories based on hospital LOS to help determine the versatility of program. In the 2814 patients included, we observed an average of 4.1 TelePT visits; 1% of patients were readmitted within 90 days, and 97% of patients were satisfied or highly satisfied. There was no difference in HOOS or KOOS Jr. scores at each follow-up time point, except for the 6-month HOOS Jr. scores. This retrospective study suggests that TelePT may be a viable option for care of lower-extremity arthroplasty patients in the post-acute setting, regardless of hospital LOS. As a discharge option, it may meet the needs of select patients to fill a gap in providing value-based care.
随着住院时间（LOS）的缩短、向非卧床手术的转变、手术数量的增加以及对基于价值的护理的关注，骨科手术患者的后期护理也在不断发展。我们试图根据住院时间来研究接受远程物理治疗（TelePT）的下肢关节置换术患者的治疗效果，以此来探索远程物理治疗作为基于价值的出院选择的可行性。我们对接受初级单侧髋关节或膝关节置换术、单髁膝关节置换术或髋关节置换术后参加本院 HSS@Home TelePT 计划的患者进行了回顾性研究。我们收集了患者的人口统计学数据和结果，如住院时间、出院与 TelePT 评估之间的天数、TelePT 访问次数、再次入院次数、髋关节功能障碍和骨关节炎结果 (HOOS Jr.) 或膝关节损伤和骨关节炎结果 (KOOS Jr.) 评分以及患者满意度评分。根据住院时间将患者分为不同类别，以帮助确定计划的通用性。在纳入的 2814 名患者中，我们观察到平均 4.1 次 TelePT 访问；1% 的患者在 90 天内再次入院，97% 的患者表示满意或非常满意。除 6 个月的 HOOS Jr. 评分外，每个随访时间点的 HOOS 或 KOOS Jr. 评分均无差异。这项回顾性研究表明，无论住院时间长短，TelePT 都是在急性期后护理下肢关节置换术患者的可行选择。作为一种出院选择，它可以满足特定患者的需求，填补提供基于价值的护理方面的空白。
{"title":"Scaled TelePhysical Therapy Program a Promising Option for Post-acute Care of Lower-Extremity Arthroplasty Patients","authors":"Charles Fisher, Catherine Wysin, L. Moeller, Joseph Nguyen","doi":"10.1177/15563316231210865","DOIUrl":"https://doi.org/10.1177/15563316231210865","url":null,"abstract":"Post-acute care for orthopedic surgery patients continues to evolve with the reduction in hospital length of stay (LOS), shift to ambulatory surgery, increased number of surgeries, and focus on value-based care. We sought to examine outcomes of a cohort of lower-extremity arthroplasty patients receiving telephysical therapy (TelePT) according to hospital LOS, as a means of exploring the viability of TelePT as a value-based discharge option. A retrospective review was conducted of patients who participated in our institution’s HSS@Home TelePT program after undergoing primary unilateral hip or knee arthroplasty, unicondylar knee replacement, or hip resurfacing. Demographic data and outcomes such as hospital LOS, number of days between discharge and TelePT evaluation, number of TelePT visits, number of re-admissions, Hip dysfunction and Osteoarthritis Outcome (HOOS Jr.) or Knee injury and Osteoarthritis Outcome (KOOS Jr.) scores, and patient satisfaction scores were collected. Patients were divided into categories based on hospital LOS to help determine the versatility of program. In the 2814 patients included, we observed an average of 4.1 TelePT visits; 1% of patients were readmitted within 90 days, and 97% of patients were satisfied or highly satisfied. There was no difference in HOOS or KOOS Jr. scores at each follow-up time point, except for the 6-month HOOS Jr. scores. This retrospective study suggests that TelePT may be a viable option for care of lower-extremity arthroplasty patients in the post-acute setting, regardless of hospital LOS. As a discharge option, it may meet the needs of select patients to fill a gap in providing value-based care.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139219787","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}
Pub Date : 2023-11-25DOI: 10.1177/15563316231211320
Laura Robbins, Tom Farrey, J. Janosky, Vincent Minjares, Bert R. Mandelbaum, Andrew Pearle
To address the increasing rates of anterior cruciate ligament (ACL) injury among young sports participants, the Hospital for Special Surgery (HSS) and the Aspen Institute convened a meeting of a new national coalition to make ACL injury prevention a fundamental aspect of youth sports. This executive summary outlines the National ACL Injury Coalition’s goals as defined at its inaugural meeting held at HSS on March 27, 2023. Using a theory of change called “collective impact” designed to support collaboration and drive systems-level change, the coalition focused on 4 strategic priorities intended to reduce ACL injury rates in high school sports participants: widespread implementation of interventions (ensuring that student athletes are adequately trained), high-quality education (raising awareness among many stakeholders), equitable access (ensuring that all high school sports participants, regardless of the resources available at their schools, have access to injury prevention resources), and aligning stakeholders (uniting disparate entities—schools, sports clubs, parents, coaches, and others in these efforts). The group outlined short-range, medium-range, and long-range goals over a 3-year period, including the launch of an ACL injury prevention toolkit for use by adolescent sports participants and teams, athletic trainers, coaches, and other key stakeholders.
{"title":"Preventing Anterior Cruciate Ligament (ACL) Injuries in High School Sports Participants: An Executive Summary of the Inaugural Meeting of the National ACL Injury Coalition","authors":"Laura Robbins, Tom Farrey, J. Janosky, Vincent Minjares, Bert R. Mandelbaum, Andrew Pearle","doi":"10.1177/15563316231211320","DOIUrl":"https://doi.org/10.1177/15563316231211320","url":null,"abstract":"To address the increasing rates of anterior cruciate ligament (ACL) injury among young sports participants, the Hospital for Special Surgery (HSS) and the Aspen Institute convened a meeting of a new national coalition to make ACL injury prevention a fundamental aspect of youth sports. This executive summary outlines the National ACL Injury Coalition’s goals as defined at its inaugural meeting held at HSS on March 27, 2023. Using a theory of change called “collective impact” designed to support collaboration and drive systems-level change, the coalition focused on 4 strategic priorities intended to reduce ACL injury rates in high school sports participants: widespread implementation of interventions (ensuring that student athletes are adequately trained), high-quality education (raising awareness among many stakeholders), equitable access (ensuring that all high school sports participants, regardless of the resources available at their schools, have access to injury prevention resources), and aligning stakeholders (uniting disparate entities—schools, sports clubs, parents, coaches, and others in these efforts). The group outlined short-range, medium-range, and long-range goals over a 3-year period, including the launch of an ACL injury prevention toolkit for use by adolescent sports participants and teams, athletic trainers, coaches, and other key stakeholders.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"18 38","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139238114","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}
Pub Date : 2023-11-25DOI: 10.1177/15563316231211318
Sharlynn Tuohy, Jessica Schwartz-Dillard, Danielle McInerney, Joseph Nguyen, Danielle Edwards
Background: The Risk Assessment and Prediction Tool (RAPT) and the Activity Measure for Post-Acute Care “6-Clicks” Mobility Score (AM-PAC) are validated discharge planning tools for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Planning for discharge with these tools considers very different factors and it is important to determine if they relate. Purpose: We sought to determine whether the preoperative RAPT score would correlate with postoperative AM-PAC score for predicting discharge destination for THA and TKA populations. Secondarily, we sought to examine whether the AM-PAC and RAPT scores would remain statistically significant predictors of discharge destination despite covariates. Methods: A retrospective cohort study was performed for patients who underwent THA or TKA from January 2020 to December 2022 at a specialty orthopedic hospital. Primary variables included the RAPT score, the AM-PAC score, and discharge disposition. Correlation between AM-PAC and RAPT scores was tested using Pearson’s correlation coefficient, and association between both scores and discharge destination was tested using chi-square tests and multivariable logistic regression. Results: Our comparison of AM-PAC scores and RAPT scores found a statistically significant, positive correlation in both THA and TKA patients. Regression analysis found that increased RAPT and AM-PAC scores resulted in higher odds of being discharged home for both populations, after adjusting for all other variables. In both cohorts, patients discharged to a facility were more likely to be female, be over the age of 70 years, have Medicare/Medicaid insurance, and have a higher number of preoperative social work visits or any incidence of an intraoperative or hospital complication. Conclusions: This retrospective study found that RAPT score correlated with AM-PAC score for predicting discharge destination for elective THA and TKA populations, suggesting that these scores may be predictors of home discharge destination even when accounting for covariates. Further study is recommended.
{"title":"RAPT and AM-PAC “6-Clicks”: Do They Correlate on Predicting Discharge Destination After Total Joint Arthroplasty?","authors":"Sharlynn Tuohy, Jessica Schwartz-Dillard, Danielle McInerney, Joseph Nguyen, Danielle Edwards","doi":"10.1177/15563316231211318","DOIUrl":"https://doi.org/10.1177/15563316231211318","url":null,"abstract":"Background: The Risk Assessment and Prediction Tool (RAPT) and the Activity Measure for Post-Acute Care “6-Clicks” Mobility Score (AM-PAC) are validated discharge planning tools for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Planning for discharge with these tools considers very different factors and it is important to determine if they relate. Purpose: We sought to determine whether the preoperative RAPT score would correlate with postoperative AM-PAC score for predicting discharge destination for THA and TKA populations. Secondarily, we sought to examine whether the AM-PAC and RAPT scores would remain statistically significant predictors of discharge destination despite covariates. Methods: A retrospective cohort study was performed for patients who underwent THA or TKA from January 2020 to December 2022 at a specialty orthopedic hospital. Primary variables included the RAPT score, the AM-PAC score, and discharge disposition. Correlation between AM-PAC and RAPT scores was tested using Pearson’s correlation coefficient, and association between both scores and discharge destination was tested using chi-square tests and multivariable logistic regression. Results: Our comparison of AM-PAC scores and RAPT scores found a statistically significant, positive correlation in both THA and TKA patients. Regression analysis found that increased RAPT and AM-PAC scores resulted in higher odds of being discharged home for both populations, after adjusting for all other variables. In both cohorts, patients discharged to a facility were more likely to be female, be over the age of 70 years, have Medicare/Medicaid insurance, and have a higher number of preoperative social work visits or any incidence of an intraoperative or hospital complication. Conclusions: This retrospective study found that RAPT score correlated with AM-PAC score for predicting discharge destination for elective THA and TKA populations, suggesting that these scores may be predictors of home discharge destination even when accounting for covariates. Further study is recommended.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"37 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139238110","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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