Pub Date : 2023-11-25DOI: 10.1177/15563316231209308
K. Harper, Thomas C. Sullivan, Austin Wininger, S. Incavo, Bradley S. Lambert
Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are no longer considered inpatient-only procedures. Qualifying for inpatient status reimbursement requires additional, unreimbursed administrative effort, and may limit care to these patients. Purpose: We sought to evaluate and compare the overall health status of patients receiving THA and TKA. Methods: We conducted a retrospective review evaluating 2207 patients undergoing primary THA and TKA from 2015 to 2018 at a single institution. Clinical parameters, surgical procedure, medical history, laboratory values, length of stay (LOS), and discharge location were recorded and compared between the 2 groups. Results: In 2202 patients, we observed differences for body mass index (THA = 29.4 ± 0.4, TKA = 32.1 ± 0.3), low-density lipoprotein cholesterol levels (THA = 105.8 ± 13.5 mg/dL; TKA = 128.6 ± 13.7 mg/dL), and blood glucose levels (THA = 98.2 ± 1.7 mg/dL; TKA = 101.4 ± 1.3 mg/dL), indicating that TKA patients were more likely than THA patients to be classified as obese, hypercholesterolemic, and hyperglycemic. We observed longer LOS in THA patients (51.25 hours, 95% CI ± 3.87 hours) than in TKA patients (36.93 hours, 95% CI ± 1.17 hours). A greater proportion of TKA patients were discharged home (81.97%, N = 1155) rather than to additional care facilities compared with THA patients (71.84%, N = 539). Conclusion: In this retrospective study, we observed that TKA patients had higher rates of comorbidities than did THA patients, but TKA patients spent less time in the hospital and were more likely to be discharged home. Future studies should evaluate reasons for poor clinical outcomes for patients undergoing total joint arthroplasty with an outpatient designation.
{"title":"Health Status of Total Hip Versus Total Knee Arthroplasty Patients and Possible Effects on Decisions Regarding Surgical Location, Cost, and Access to Care","authors":"K. Harper, Thomas C. Sullivan, Austin Wininger, S. Incavo, Bradley S. Lambert","doi":"10.1177/15563316231209308","DOIUrl":"https://doi.org/10.1177/15563316231209308","url":null,"abstract":"Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are no longer considered inpatient-only procedures. Qualifying for inpatient status reimbursement requires additional, unreimbursed administrative effort, and may limit care to these patients. Purpose: We sought to evaluate and compare the overall health status of patients receiving THA and TKA. Methods: We conducted a retrospective review evaluating 2207 patients undergoing primary THA and TKA from 2015 to 2018 at a single institution. Clinical parameters, surgical procedure, medical history, laboratory values, length of stay (LOS), and discharge location were recorded and compared between the 2 groups. Results: In 2202 patients, we observed differences for body mass index (THA = 29.4 ± 0.4, TKA = 32.1 ± 0.3), low-density lipoprotein cholesterol levels (THA = 105.8 ± 13.5 mg/dL; TKA = 128.6 ± 13.7 mg/dL), and blood glucose levels (THA = 98.2 ± 1.7 mg/dL; TKA = 101.4 ± 1.3 mg/dL), indicating that TKA patients were more likely than THA patients to be classified as obese, hypercholesterolemic, and hyperglycemic. We observed longer LOS in THA patients (51.25 hours, 95% CI ± 3.87 hours) than in TKA patients (36.93 hours, 95% CI ± 1.17 hours). A greater proportion of TKA patients were discharged home (81.97%, N = 1155) rather than to additional care facilities compared with THA patients (71.84%, N = 539). Conclusion: In this retrospective study, we observed that TKA patients had higher rates of comorbidities than did THA patients, but TKA patients spent less time in the hospital and were more likely to be discharged home. Future studies should evaluate reasons for poor clinical outcomes for patients undergoing total joint arthroplasty with an outpatient designation.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139237049","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 : 2023-11-24DOI: 10.1177/15563316231213367
Sharlynn Tuohy, M. Ast, Patricia Quinlan, Matthew Titmuss, Danielle Edwards
{"title":"Innovations in Total Hip and Knee Arthroplasty Episodes of Care: Transitioning from Inpatient to Ambulatory Care","authors":"Sharlynn Tuohy, M. Ast, Patricia Quinlan, Matthew Titmuss, Danielle Edwards","doi":"10.1177/15563316231213367","DOIUrl":"https://doi.org/10.1177/15563316231213367","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"88 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139238991","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 : 2023-11-22DOI: 10.1177/15563316231211335
Aaron Gebrelul, Shiv Malhotra, Anna L. Sigueza, Esme Singer, M. Ast, Neil P. Sheth
There has been a national trend toward shifting joint arthroplasty procedures to the outpatient setting. These cases are often performed in freestanding ambulatory surgery centers (ASCs), which are often not accessible to surgeons within academic practices. We sought to investigate a novel rapid recovery program used to transition arthroplasty patients to an outpatient-based care system within an academic medical center. All patients undergoing hip or knee arthroplasty between November 2019 and April 2021 were retrospectively evaluated for their eligibility for a rapid recovery pathway through the Extended Stay Unit (ESU) based on clinical and social criteria. Once admitted, patients were evaluated for whether they were discharged from the unit or if hospital admission was necessary. Out of the 444 patients deemed candidates for the rapid recovery program, 188 patients were admitted to the ESU (42.3%); 18 (9.6%) required inpatient hospital admission, with the majority of these due to failing physical therapy (16; 88.9%). Of the ESU patients who were successfully discharged home, 55 (32.4%) were discharged on postoperative day (POD) 0 and 115 (67.6%) on POD 1 (<23 hours). As total joint arthroplasties shift toward the outpatient setting, surgeons in academic institutions must employ strategies to increase their volume of patient candidates for outpatient procedures. Our retrospective study of prospectively collected data suggests the feasibility of creating a separate rapid recovery unit within the hospital that can be an effective method by which to eventually transition to the ASC setting.
{"title":"Increasing the Volume of Outpatient Total Joint Arthroplasty Procedures: An Evaluation of a Novel Rapid Recovery Pathway Program Within an Academic Medical Center","authors":"Aaron Gebrelul, Shiv Malhotra, Anna L. Sigueza, Esme Singer, M. Ast, Neil P. Sheth","doi":"10.1177/15563316231211335","DOIUrl":"https://doi.org/10.1177/15563316231211335","url":null,"abstract":"There has been a national trend toward shifting joint arthroplasty procedures to the outpatient setting. These cases are often performed in freestanding ambulatory surgery centers (ASCs), which are often not accessible to surgeons within academic practices. We sought to investigate a novel rapid recovery program used to transition arthroplasty patients to an outpatient-based care system within an academic medical center. All patients undergoing hip or knee arthroplasty between November 2019 and April 2021 were retrospectively evaluated for their eligibility for a rapid recovery pathway through the Extended Stay Unit (ESU) based on clinical and social criteria. Once admitted, patients were evaluated for whether they were discharged from the unit or if hospital admission was necessary. Out of the 444 patients deemed candidates for the rapid recovery program, 188 patients were admitted to the ESU (42.3%); 18 (9.6%) required inpatient hospital admission, with the majority of these due to failing physical therapy (16; 88.9%). Of the ESU patients who were successfully discharged home, 55 (32.4%) were discharged on postoperative day (POD) 0 and 115 (67.6%) on POD 1 (<23 hours). As total joint arthroplasties shift toward the outpatient setting, surgeons in academic institutions must employ strategies to increase their volume of patient candidates for outpatient procedures. Our retrospective study of prospectively collected data suggests the feasibility of creating a separate rapid recovery unit within the hospital that can be an effective method by which to eventually transition to the ASC setting.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"800 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139247713","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 : 2023-11-22DOI: 10.1177/15563316231212919
Marissa Guttenberg, Gabriella Argento, Danielle McInerney, Joseph Nguyen, Olivia Wuest
The prevalence of ambulatory total hip arthroplasty (THA) is rising, but it is not appropriate for all patients. Preoperative patient selection considers medical and social factors but overlooks patients’ prior level of physical function. The aim of this study was to evaluate if preoperative physical function, measured by the Timed-Up-and-Go (TUG) test, is associated with length of stay (LOS) in patients who underwent primary THA. A retrospective study was performed using 396 patients who underwent primary THA within a 2-month period at a single institution. Regression analysis evaluated the relationship between preoperative TUG scores and hospital LOS. Receiver-operating characteristic (ROC) curves were generated to identify a cutoff TUG score associated with LOS longer than 24 hours. Univariate regression analysis of those discharged in less than 24 hours and those discharged in more than 24 hours found lower TUG scores (10.7 vs 13.7, respectively) were associated with patient discharge within 24 hours. Multivariate regression analysis showed a higher TUG score (adjusted odds ratio [aOR]: 0.91, 95% confidence interval [CI]: 0.84-0.99) was associated with decreased odds of discharge within 24 hours. Receiver-operating characteristic curve analysis was performed on the entire study cohort and the ambulatory surgery group and identified TUG scores of 10.3 and 10.5 seconds, respectively, associated with LOS of less than 24 hours (OR full cohort: 3.02, 95% CI: 1.94-4.71; OR ambulatory surgery: 2.97, 95% CI: 1.90-4.60). Sensitivity and specificity were not sufficient to support the use of these cutoff scores alone in predicting LOS. Although we were unable to establish a cutoff TUG score in patients who underwent primary THA that could determine LOS of more than 24 hours, the preoperative TUG score may be useful as a tool to aid in identifying patients who may require a longer hospital LOS. Further study is needed.
{"title":"Does the Timed-Up-and-Go Test Predict Length of Stay After Total Hip Arthroplasty? A Retrospective Study","authors":"Marissa Guttenberg, Gabriella Argento, Danielle McInerney, Joseph Nguyen, Olivia Wuest","doi":"10.1177/15563316231212919","DOIUrl":"https://doi.org/10.1177/15563316231212919","url":null,"abstract":"The prevalence of ambulatory total hip arthroplasty (THA) is rising, but it is not appropriate for all patients. Preoperative patient selection considers medical and social factors but overlooks patients’ prior level of physical function. The aim of this study was to evaluate if preoperative physical function, measured by the Timed-Up-and-Go (TUG) test, is associated with length of stay (LOS) in patients who underwent primary THA. A retrospective study was performed using 396 patients who underwent primary THA within a 2-month period at a single institution. Regression analysis evaluated the relationship between preoperative TUG scores and hospital LOS. Receiver-operating characteristic (ROC) curves were generated to identify a cutoff TUG score associated with LOS longer than 24 hours. Univariate regression analysis of those discharged in less than 24 hours and those discharged in more than 24 hours found lower TUG scores (10.7 vs 13.7, respectively) were associated with patient discharge within 24 hours. Multivariate regression analysis showed a higher TUG score (adjusted odds ratio [aOR]: 0.91, 95% confidence interval [CI]: 0.84-0.99) was associated with decreased odds of discharge within 24 hours. Receiver-operating characteristic curve analysis was performed on the entire study cohort and the ambulatory surgery group and identified TUG scores of 10.3 and 10.5 seconds, respectively, associated with LOS of less than 24 hours (OR full cohort: 3.02, 95% CI: 1.94-4.71; OR ambulatory surgery: 2.97, 95% CI: 1.90-4.60). Sensitivity and specificity were not sufficient to support the use of these cutoff scores alone in predicting LOS. Although we were unable to establish a cutoff TUG score in patients who underwent primary THA that could determine LOS of more than 24 hours, the preoperative TUG score may be useful as a tool to aid in identifying patients who may require a longer hospital LOS. Further study is needed.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139246761","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 : 2023-11-18DOI: 10.1177/15563316231212183
Susan Camillieri
{"title":"Adapting Physical Therapy Practice for the “Short-Stay” Total Joint Arthroplasty Patient: A Commentary","authors":"Susan Camillieri","doi":"10.1177/15563316231212183","DOIUrl":"https://doi.org/10.1177/15563316231212183","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"9 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139261369","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 : 2023-11-18DOI: 10.1177/15563316231209500
James B. Chen, Tracy M. Borsinger, Brian P. Chalmers, E. Debbi
Total joint replacement (TJR) surgery in the ambulatory surgery centers (ASCs) has grown significantly over the past several years, along with the ability to improve the value of care. Standardization of high-quality, perioperative care is pivotal to the success of a TJR ASC program. As surgeons are experiencing increasing overhead with decreasing reimbursement, technology integration can provide major advantages. In this article, we will therefore highlight several examples of technologies that are changing the field and improving care in the preoperative, intraoperative, and postoperative settings.
{"title":"Joint Replacement Technology in the Ambulatory Surgery Center: Current and Future Applications","authors":"James B. Chen, Tracy M. Borsinger, Brian P. Chalmers, E. Debbi","doi":"10.1177/15563316231209500","DOIUrl":"https://doi.org/10.1177/15563316231209500","url":null,"abstract":"Total joint replacement (TJR) surgery in the ambulatory surgery centers (ASCs) has grown significantly over the past several years, along with the ability to improve the value of care. Standardization of high-quality, perioperative care is pivotal to the success of a TJR ASC program. As surgeons are experiencing increasing overhead with decreasing reimbursement, technology integration can provide major advantages. In this article, we will therefore highlight several examples of technologies that are changing the field and improving care in the preoperative, intraoperative, and postoperative settings.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"25 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139262206","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 : 2023-11-18DOI: 10.1177/15563316231213334
Charles N. Cornell
{"title":"Our Brave New World and the Transition to Ambulatory Total Joint Arthroplasty","authors":"Charles N. Cornell","doi":"10.1177/15563316231213334","DOIUrl":"https://doi.org/10.1177/15563316231213334","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139261233","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 : 2023-11-16DOI: 10.1177/15563316231205457
Joseph Gallagher, Sandy Merlino
{"title":"VNS Health and HSS Partner to Reduce Length of Stay After Total Joint Arthroplasty: Implications for Home Care Providers","authors":"Joseph Gallagher, Sandy Merlino","doi":"10.1177/15563316231205457","DOIUrl":"https://doi.org/10.1177/15563316231205457","url":null,"abstract":"","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"11 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267057","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 : 2023-10-28DOI: 10.1177/15563316231207632
Brendan J. Navarro, Ling Chen, Christopher J. Dy
The use of telemedicine increased greatly following the onset of the COVID-19 pandemic. It is unclear whether and how sociodemographic factors have affected orthopedics patients’ use of this technology in the pandemic. The aim of this study was to determine how patient demographic variability in telemedicine use is influenced by the Area Deprivation Index (ADI) and distance to clinical site among patients seeking care for hip and knee arthritis from orthopedic surgeons. Demographic data and visit type were collected from the electronic medical record for patients seen in our academic medical center either before or during the COVID-19 pandemic by orthopedic surgeons who specialize in hip and knee arthroplasty. Univariate and multivariate analyses were performed regarding age, race, insurance status, ADI, and distance to a clinical site. In the COVID era, among 4901 visits with 3124 unique patients, those using telemedicine were younger and more likely to be White compared to those who did not use telemedicine. There was no significant difference in telemedicine use based on ADI, distance to a clinical site, or insurance status. This retrospective analysis suggests that orthopedic patients who were White and of younger age were more likely to use telemedicine in the first year of the COVID-19 pandemic. There was no statistically significant relationship between distance from a clinical site or ADI and telemedicine use, suggesting that factors other than these are greater contributors to telemedicine utilization in our cohort. Further information is needed to determine how telemedicine may disproportionately limit access to orthopedic care according to these and other patient factors.
{"title":"Telemedicine Use Following Onset of the COVID-19 Pandemic Was Associated With Youth and White Race but Not With Socioeconomic Deprivation: A Retrospective Cohort Study of Orthopedic Patients","authors":"Brendan J. Navarro, Ling Chen, Christopher J. Dy","doi":"10.1177/15563316231207632","DOIUrl":"https://doi.org/10.1177/15563316231207632","url":null,"abstract":"The use of telemedicine increased greatly following the onset of the COVID-19 pandemic. It is unclear whether and how sociodemographic factors have affected orthopedics patients’ use of this technology in the pandemic. The aim of this study was to determine how patient demographic variability in telemedicine use is influenced by the Area Deprivation Index (ADI) and distance to clinical site among patients seeking care for hip and knee arthritis from orthopedic surgeons. Demographic data and visit type were collected from the electronic medical record for patients seen in our academic medical center either before or during the COVID-19 pandemic by orthopedic surgeons who specialize in hip and knee arthroplasty. Univariate and multivariate analyses were performed regarding age, race, insurance status, ADI, and distance to a clinical site. In the COVID era, among 4901 visits with 3124 unique patients, those using telemedicine were younger and more likely to be White compared to those who did not use telemedicine. There was no significant difference in telemedicine use based on ADI, distance to a clinical site, or insurance status. This retrospective analysis suggests that orthopedic patients who were White and of younger age were more likely to use telemedicine in the first year of the COVID-19 pandemic. There was no statistically significant relationship between distance from a clinical site or ADI and telemedicine use, suggesting that factors other than these are greater contributors to telemedicine utilization in our cohort. Further information is needed to determine how telemedicine may disproportionately limit access to orthopedic care according to these and other patient factors.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139311829","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 : 2023-09-07DOI: 10.1177/15563316231189736
Robert G. Ricotti, Michael Alexander-Malahias, Qian-Li Ma, S. Jang, R. Loucas, Ioannis Gkiatas, Philip P. Manolopoulos, Alex Gu, Danilo Togninalli, V. Nikolaou, P. Sculco
Background: Polyethylene liner exchange and bone grafting is an effective surgical option for the management of periacetabular osteolysis following total hip arthroplasty with well-fixed cups and intact liner locking mechanisms. Purpose: We aimed to evaluate the revision-free survivorship and radiographic lesion progression after polyethylene liner exchange and bone grafting is performed for periacetabular osteolysis. Methods: A systematic review of the literature was performed. We queried Medline, EMBASE, and Cochrane Library for articles published from January 1999 to January 2023 using the following keywords: “osteolysis” AND “well-fixed,” “osteolysis” AND “retro-acetabular,” “bone graft” AND (“retention” OR “retained” OR “stable”) AND “cup,” and “uncemented liner” AND “well-fixed.” Results: Of 596 articles found, 9 articles were selected for final inclusion (227 cases, mean follow-up time 43.6 months). The overall cup revision rate after liner exchange was 6.6% (15 hips) due to progressive osteolysis (5 hips), aseptic loosening of the acetabular component (5 hips), dislocation (4 hips), and periprosthetic infection (1 hip). There was either radiographic resolution or regression of periacetabular osteolysis in all reported cases that provided measurements (52 hips) except 1 (1.9%) requiring revision. All studies reporting clinical outcomes indicated improved pain and functional scores. Conclusion: This systematic review found that isolated liner exchange with bone grafting for the management of periacetabular osteolysis was associated with a high revision-free survival rate (93.4%) and minimal radiographic progression (1.9%) of osteolytic lesions at short-term to medium-term follow-up. Liner exchange with bone grafting is recommended for the management of large periacetabular osteolytic lesions (> 450 mm2) in well-fixed acetabular cups. We encourage future studies to develop a grading scale for lesions to guide clinical management and risk stratification for patients.
{"title":"Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review","authors":"Robert G. Ricotti, Michael Alexander-Malahias, Qian-Li Ma, S. Jang, R. Loucas, Ioannis Gkiatas, Philip P. Manolopoulos, Alex Gu, Danilo Togninalli, V. Nikolaou, P. Sculco","doi":"10.1177/15563316231189736","DOIUrl":"https://doi.org/10.1177/15563316231189736","url":null,"abstract":"Background: Polyethylene liner exchange and bone grafting is an effective surgical option for the management of periacetabular osteolysis following total hip arthroplasty with well-fixed cups and intact liner locking mechanisms. Purpose: We aimed to evaluate the revision-free survivorship and radiographic lesion progression after polyethylene liner exchange and bone grafting is performed for periacetabular osteolysis. Methods: A systematic review of the literature was performed. We queried Medline, EMBASE, and Cochrane Library for articles published from January 1999 to January 2023 using the following keywords: “osteolysis” AND “well-fixed,” “osteolysis” AND “retro-acetabular,” “bone graft” AND (“retention” OR “retained” OR “stable”) AND “cup,” and “uncemented liner” AND “well-fixed.” Results: Of 596 articles found, 9 articles were selected for final inclusion (227 cases, mean follow-up time 43.6 months). The overall cup revision rate after liner exchange was 6.6% (15 hips) due to progressive osteolysis (5 hips), aseptic loosening of the acetabular component (5 hips), dislocation (4 hips), and periprosthetic infection (1 hip). There was either radiographic resolution or regression of periacetabular osteolysis in all reported cases that provided measurements (52 hips) except 1 (1.9%) requiring revision. All studies reporting clinical outcomes indicated improved pain and functional scores. Conclusion: This systematic review found that isolated liner exchange with bone grafting for the management of periacetabular osteolysis was associated with a high revision-free survival rate (93.4%) and minimal radiographic progression (1.9%) of osteolytic lesions at short-term to medium-term follow-up. Liner exchange with bone grafting is recommended for the management of large periacetabular osteolytic lesions (> 450 mm2) in well-fixed acetabular cups. We encourage future studies to develop a grading scale for lesions to guide clinical management and risk stratification for patients.","PeriodicalId":253125,"journal":{"name":"HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126362212","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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