Journal of Arthroplasty最新文献

Introduction: Total hip arthroplasty (THA) is a common surgical intervention for patients who have seronegative spondyloarthropathies (SpA). However, there is a paucity of literature addressing the outcomes of THA specifically in SpA patients. This study aimed to investigate both the short- and long-term systemic and orthopaedic outcomes of THA in SpA patients as a whole, as well as within the individual subtypes of SpA.

Methods: This retrospective cohort study utilized a federated health research network, identifying 3,074 SpA patients who underwent THA between 2005 and 2022. Propensity score matching was used to compare SpA and non-SpA patients, balancing baseline characteristics. Short-term (30-day, 180-day, 1-year) and long-term (5-year) postoperative complications were analyzed. The outcomes included systemic and joint complications. Chi-square analyses were done to compare outcomes across categorical data.

Results: The SpA patients had increased rates of revision THA, prosthetic dislocation, periprosthetic joint infection, and aseptic loosening at various postoperative intervals. Surgical site infections and myocardial infarctions were more frequent at one month, six months, and one year. Additionally, SpA patients exhibited a higher incidence of deep vein thrombosis at six months and one year. Subtype analysis revealed that ankylosing spondylitis patients were more likely to have revision surgery and prosthetic dislocation, while Psoriatic Arthritis patients had a lower risk of hip dislocation and femur fractures.

Conclusion: The SpA patients undergoing THA are at greater risk for systemic and orthopaedic complications compared to non-SpA patients. The increased incidence of infections, thromboembolic events, and prosthetic issues highlight the need for careful preoperative assessment and postoperative management.

Background: Identifying risk factors associated with non-home discharge (NHD) following revision hip and knee total joint arthroplasty (TJA) could reduce the rate of preventable discharge to rehabilitation or skilled nursing facilities. Neighborhood-level deprivation indices are becoming an increasingly important measure of socioeconomic disadvantage as these indices consider multiple social determinants of health. This study aimed to compare the utility of widely used neighborhood social vulnerability indices in predicting NHD following revision TJA patients.

Methods: This study included 1,043 consecutive patients who underwent revision TJA at a single tertiary health system. There were three multivariate logistic regression analyses with the outcome of NHD performed using the area deprivation index (ADI), social deprivation index (SDI), and social vulnerability index (SVI) while controlling for other demographic variables. Neighborhood-level indices were included in the analysis as continuous variables and categorical quartiles, with the lowest quartile representing the least deprived neighborhoods of the patient cohort. The strength of the association of significant indices was measured.

Results: Patients in the highest ADI and SDI quartiles demonstrated higher odds of NHD compared to the cohort with the lowest quartile (ADI OR [odds ratio] = 1.93, 95% CI [confidence interval] = 1.23 to 3.03, P = 0.005; SDI OR = 1.86, 95% CI = 1.18 to 2.91, P = 0.007). Discharge disposition was more strongly associated with ADI than SDI (0.68 versus 0.26). Age, ASA status, and alcohol use were independent determinants of discharge disposition. No significant association was seen between SVI and discharge disposition.

Conclusion: Area-level indices can be utilized to identify patients at higher risk of NHD following revision TJA. This study highlights the important differences between these indices' utility when evaluating their effects on clinical outcomes in this patient population. The findings shed light on the potential of integrating these tools into policy development, clinical preoperative programs, and research to better understand and address the health disparities in arthroplasty outcomes.

Background: Morbidly obese patients undergoing total joint arthroplasty (TJA) face increased postoperative complications, yet studies assessing the safety of this surgery in the outpatient setting for this population are lacking. This study aimed to fill this gap by assessing the safety and benefits of outpatient TJA in morbidly obese patients.

Methods: This study is a retrospective review of a commercial claims database. Based on the setting of the procedure, the patients were divided into four groups: inpatient-TKA (total knee arthroplasty), outpatient-TKA, inpatient-THA (total hip arthroplasty), and outpatient-THA. The two TKA groups were matched based on age, sex, and the Charlson comorbidity index (CCI). The THA groups were matched similarly. The 30- and 90-day medical and surgical complications were compared between these groups. There were 5,500 patients included in each of the outpatient and inpatient TKA groups, and 1,550 in each of the outpatient and inpatient THA groups RESULTS: Patients undergoing inpatient TKA had higher rates of pulmonary embolism, UTI (urinary tract infection), transfusions, ICU (intensive care unit) admissions, ED (emergency department) visits, readmissions at 30 days, surgical site infections, periprosthetic joint infection, prosthetic dislocations, and costs. As for the inpatient THA group, they had higher rates of pulmonary embolism, UTI, transfusions, ICU admissions, ED visits, and costs.

Conclusion: It is well established that morbidly obese patients undergoing total joint arthroplasty have higher complication rates than normal-weight patients, and patients should be counseled before arthroplasty. This study highlights the safety and benefits of outpatient TJA in morbidly obese patients. However, one should note that this was done using an insurance database, in which results may differ if it was done in a public and lower socioeconomic setting. Therefore, future prospective studies are needed to confirm the findings before implementing outpatient TJA in morbidly obese patients.

Introduction: As the demand for total hip (THA) and knee arthroplasty (TKA) continues to grow exponentially, the economic burden on practices and healthcare payers simultaneously increases. Medicare accounts for over 60% of total joint arthroplasty (TJA) cases nationwide, and the reimbursements are worsening despite alternative payment models. Trending the active payers at an institution provides invaluable insight into the financial health of a practice and projects if annual run rates are sustainable.

Methods: Insurance and billing claims were analyzed for all THA and TKA cases between January 1, 2019, and December 31, 2022, from various healthcare payers at a single, high-volume institution. The payers included Medicare, Medicare Advantage, and seven commercial payers. The THA and TKA claims are from institutional facilities across two Northeast states - New Jersey (NJ) and Pennsylvania (PA). Volume, charges, and payments from each payer were trended over three years (2019 to 2022).

Results: In the years following the COVID-19 pandemic, the number of institutional patients who had Medicare and Medicare Advantage undergoing TJA drastically increased by 29.1% and 37.8%, respectively. As a result, charges spiked by over $20 million for Medicare and nearly $15 million for Medicare Advantage. Despite a higher caseload, the payments received per case decreased by 24.5% for Medicare and 18.7% for Medicare Advantage. Commercial payers grew 20.6% in annual cases, yet payments received per case similarly decreased by 15.0% at the end of 2022.

Conclusions: Rising Medicare and Medicare Advantage TJA volume highlights the increase in costs and resource utilization, while diminishing payments underscore the inadequate reimbursement to hospitals and surgeons. Along with stagnant commercial payments, the trend shows concerns about the financial health of THA and TKA institutions that participate in the care of a large number of Medicare patients.