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Introduction: Unicompartmental knee arthroplasty (UKA) has been shown to improve pain and function in appropriately selected patients. Limited data exists regarding outcomes and complication rates following UKA among octogenarians., Methods: The PearlDiver Mariner database was queried for patients undergoing primary UKA between 2010-2022. Patients < 80 years old were matched 4:1 to the octogenarian cohort (≥80 years old) by sex, year, Elixhauser Comorbidity Index (ECI), tobacco use, obesity, and diabetes. A total of 1,334 octogenarians and 5,313 controls were included in our analysis. Multivariate logistic regression was utilized to compare medical complications at 90-days post-operatively and surgical complications at 1- and 2-years post-operatively. Our regression analysis controlled for sex, ECI, tobacco use, obesity, and diabetes., Results: Octogenarians had an increased risk of acute kidney injury (OR: 2.306, 95% CI: 1.393-3.749; p < 0.001), pneumonia (OR: 2.367, 95% CI: 1.301-4.189; p = 0.003), UTI (OR: 1.846, 95% CI: 1.304-2.583; p < 0.001), ED visits (OR: 2.229, 95% CI: 1.586-3.105; p < 0.001), and any complication (OR: 1.575, 95% CI: 1.304-1.895; p < 0.001) at 90-days post-operatively. Octogenarians had lower odds of all-cause revision at 2-years (OR: 0.607, 95% CI: 0.382-0.923; p = 0.026). No differences were demonstrated between cohorts in rates of PJI (OR: 0.832, 95% CI: 0.334-1.796; p = 0.664), periprosthetic fracture (OR: 0.516, 95% CI: 0.120-1.520; p = 0.289), or aseptic loosening (OR: 0.285, 95% CI: 0.045-1.203; p = 0.088) at 2-years., Discussion: These findings suggest that despite an increased risk of certain medical complications within the acute post-operative period, octogenarians undergoing UKA experienced similar rates of surgical complications to younger matched controls at 2-year follow-up., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [CDV reports the following disclosures: Royalties (BD, Smith & Nephew, Wolters Kluwer), Paid consultant (Depuy, Zimmer), Stock or stock options (Parvizi Surgical Innovations), Researchs support (Smith & Nephew, Zimmer, Stryker), Other financial support (Wolters Kluwer Health, SLACK incorporated), and Board/Committee member (Arthritis Foundation, Knee Society, Orthopedics Today, MidAmerica Orthopaedic Association). TG reports the following disclosures: IP Royalties (Smith & Nephew), Paid consultant (Smith & Nephew), and research support (Smith & Nephew). AJA, EF, JS, and VM. have nothing to disclose.]., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Lumbar Spine MRI Use for Low Back Pain (OP-8) is calculated by dividing the number of patients who received lumbar magnetic resonance imaging (MRI-L) before receiving alternative treatments (e.g., physical therapy) by the total number of patients receiving MRI-L in the outpatient setting at a given institution. Since the passage of the Post-Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), OP-8 scores became tied to hospital finances. This study aims to determine how MACRA has impacted OP-8 scores since its implementation. We also aim to investigate how regional designation, profit status (for-profit, government, and nonprofit), and hospital setting (critical access, non-critical access) affect OP-8 scores., Methods: Data from the Centers for Medicare and Medicaid Services Hospital Compare database were used to extract information on the national trends in OP-8 scores from 2014 to 2020. A multivariable linear regression model was fit to isolate the impact of hospital characteristics on OP-8 scores., Results: After a decrease from 2015 to 2016, the mean national OP-8 score plateaued, staying around 40% from 2017 through 2020. A critical access setting increased OP-8 scores by 5.41 (95% confidence interval, 3.51-6.77; P ≤ 0.001), compared with a non-critical access setting. Governmental status increased scores by 1.27 (95% confidence interval, 0.28-2.27; P = 0.012), compared with a nonprofit status., Conclusions: The implementation of MACRA seems to have been unsuccessful in altering practice patterns, given the minimal change in OP-8 scores over the last 4 years. Furthermore, institutional factors are clearly correlated with a lack of adherence to magnetic resonance imaging guidelines. Given these findings, there is a need to modify health policies., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Although the anterior approach for total hip arthroplasty has gained increasing utilization, some studies have suggested a higher risk of femoral complications, as well as difficulty with femoral exposure. Techniques of soft tissue releases have been described to offer better femoral exposure, and to help mitigate complications. The purpose of the study is to describe an algorithmic soft tissue femoral release in direct anterior approach total hip arthroplasty and to assess the clinical outcomes of patients upon which this algorithm of femoral soft tissue releases was utilized. Clinical outcomes with the Harris Hip Score, reoperation rates, component survivorship, and complications were analyzed., (© 2019 The Authors.)