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Healthcare reorganization and bundled payment schemes have resulted in increased patient travel distances in orthopedics. Travel distance has been previously associated with increased complication risk but has yet to be studied in orthopedics. We analyzed the impact of patient travel distance on short-term complications. We reviewed 38,887 TJAs performed between 2008 and 2011 and identified 1606 complications in 1110 procedures. There was no significant association between complication risk and patient travel distance. Complication risk was associated with age, ASA class, Medicare and Medicaid status (P

Background Although Medicaid expansion has improved access to primary care services, its impact on surgical specialty utilization remains unclear. The aim of this study is to determine whether Medicaid expansion is associated with increased utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid). Methods Using administrative data sources, we analyzed 374,877 total hospitalizations (236,333 in Illinois and 138,544 in Missouri) for THA/TKA from 2011 to 2016 (Illinois’ Medicaid expansion date: January 1, 2014). Results The percentage of THA/TKA funded by Medicaid in Illinois was 2.4% in 2013 and 3.9% in 2016 (Missouri 2013: 2.7%; 2016: 2.6%). A difference-in-difference analysis (adjusted for patient age and gender, county-level Area Deprivation Index, and number of orthopedic surgeons) demonstrated a statistically significant increase in Medicaid-funded THA/TKA in Illinois in 2016 compared to 2013 (P = .012). Conclusion Our study demonstrates that Medicaid expansion in Illinois was associated with increased utilization of THA and TKA. Further study is needed to understand the impact of Medicaid expansion in other states and for other procedures.

Reaming for resurfacing arthroplasty may endanger the blood supply at the head-neck junction, possibly predisposing to osteonecrosis and femoral neck fracture. The current study hypothesizes that reaming endangers femoral head vasculature. Vascular foramina were identified on 16 cadaveric femora and registered on computed tomographic models. Virtual reaming was performed after templating of resurfacing components. Almost half (41.8%) of foramina was located in the anterosuperior quadrant. Loss of foramina after reaming averaged 28% (P = .03), with up to 34.6% and 33.1% loss in the anterosuperior and posterosuperior quadrants, respectively. Reaming for resurfacing arthroplasty endangers a substantial number of vascular foramina. Notching or malpositioning of components may worsen injury to the vascular supply and could subsequently increase the risk of implant failure.

Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, 2,560,314 patients who underwent primary total hip or knee arthroplasty from 1991 to 2006 were categorized by whether an HVH (>200 annual TJAs) was available locally. Associations among patient characteristics, hospital utilization, and in-hospital complications were estimated using regression modeling. The complication risk was higher (Odds Ratio 1.18 [95% CI: 1.16, 1.20]) if patients went to a local low volume hospital. Black and Medicaid patients were more likely to utilize the local low volume hospital than a local HVH. Utilizing a local HVH is associated with lower complication risks. However, patients from vulnerable groups were less likely to utilize these patterns.

Recovery expectations (RE) after total hip and knee arthroplasty (THA–TKA) influence outcomes. We surveyed AAHKS members to determine variation in surgeon RE. Four vignettes depicting patients with high and low expectations after THA and TKA were distributed with a validated RE survey. Responses were analyzed for clinically significant differences between surgeons and within surgeons. Of 1049 surgeons surveyed, 358 (34%) responded. There was a clinically significant difference in 85% (high-THA), 46% (low-THA), 74% (high-TKA), and 57% (low-TKA) of pairs. Disagreement was significantly greater in high expectation vignettes. Individual surgeons distinguished between high and low expectation patients in 76% (THA) and 72% (TKA) of cases. There was no association between surgeon RE and practice demographics. Wide variations in RE were observed, especially among high expectation patients.

Reaming for resurfacing arthroplasty may endanger the blood supply at the head-neck junction, possibly predisposing to osteonecrosis and femoral neck fracture. The current study hypothesizes that reaming endangers femoral head vasculature. Vascular foramina were identified on 16 cadaveric femora and registered on computed tomographic models. Virtual reaming was performed after templating of resurfacing components. Almost half (41.8%) of foramina was located in the anterosuperior quadrant. Loss of foramina after reaming averaged 28% (P = .03), with up to 34.6% and 33.1% loss in the anterosuperior and posterosuperior quadrants, respectively. Reaming for resurfacing arthroplasty endangers a substantial number of vascular foramina. Notching or malpositioning of components may worsen injury to the vascular supply and could subsequently increase the risk of implant failure.

In-hospital falls (IFs) increase morbidity, cost, and may result in litigation. We analyzed the Nationwide Inpatient Sample to quantify the incidence of IFs in patients who underwent hip and knee arthroplasty and to define trends, patient’s demographics, risk factors, complications, and hospital cost. Patients operated on between 1998 and 2007 were identified and grouped depending on the presence of a diagnosis of IF. Of those, 0.85% had an IF, representing 2.1 falls per 1000 inpatient days. The incidence of IF increased from 0.4% to 1.3% during the study period. Independent risk factors included revision surgery, advanced age, male sex, minority race, and the presence of comorbidities. Patients having IF had a longer hospital stay and were less likely to be discharged to their primary residence. In-hospital mortality, complications, and cost were higher in patients sustaining IF. Given the associated morbidity, mortality, and increased cost, resources should be allocated to minimize the risk of IF in this population.

In-hospital falls (IFs) increase morbidity, cost, and may result in litigation. We analyzed the Nationwide Inpatient Sample to quantify the incidence of IFs in patients who underwent hip and knee arthroplasty and to define trends, patient's demographics, risk factors, complications, and hospital cost. Patients operated on between 1998 and 2007 were identified and grouped depending on the presence of a diagnosis of IF. Of those, 0.85% had an IF, representing 2.1 falls per 1000 inpatient days. The incidence of IF increased from 0.4% to 1.3% during the study period. Independent risk factors included revision surgery, advanced age, male sex, minority race, and the presence of comorbidities. Patients having IF had a longer hospital stay and were less likely to be discharged to their primary residence. In-hospital mortality, complications, and cost were higher in patients sustaining IF. Given the associated morbidity, mortality, and increased cost, resources should be allocated to minimize the risk of IF in this population.