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1. Robotic-Assistance in Total Hip Arthroplasty Is Associated With Decreased Dislocation Rates

Author

Gabrielle N. Swartz, BS, Sandeep S. Bains, MD, DC, MBA, Jeremy A. Dubin, BA, Reza Katanbaf, MD, MBA, Hunter Hayes, DO, James Nace, DO, MPT, Michael A. Mont, MD, and Ronald E. Delanois, MD

Subjects
Total hip arthroplasty, Osteoarthritis, Robotic-assistance, Dislocation, Technology, Orthopedic surgery, RD701-811
Abstract

Background: As the use of robotics in total hip arthroplasty (THA) continues to gain popularity, differences in clinical outcomes when compared to manual techniques have remained unclear. This study aimed to compare postoperative complications between patients undergoing robotic-assisted techniques and manual THA for primary osteoarthritis at 90 days, 1 year, and 2 years. Methods: Using an all-payer national database, we identified 405,048 patients who underwent either robotic-assisted or manual THA for primary osteoarthritis. A propensity match was performed for age, sex, a comorbidity index, chronic kidney disease, obesity, and diabetes, resulting in 7652 patients in each cohort. We assessed postoperative outcomes, including surgical site infections, pulmonary emboli, venous thromboemboli, wound complications, dislocations, aseptic revisions, periprosthetic joint infections, and periprosthetic fractures. We completed bivariate analyses via chi-square tests to assess categorical variables. We utilized student’s t-tests to compare continuous variables, including ages and comorbidities. Odds ratios (ORs) were calculated for complications using 95% confidence intervals (CIs). Results: The robotic-assisted cohort had lower rates of dislocation at 90 days (0.93 vs 1.41%, OR 0.65, 95% CI 0.48-0.88, P = .007), 1 year (1.32 vs 1.92%, OR 0.68, 95% CI 0.53-0.88, P = .004), and 2 years (1.66 vs 2.1%, OR 0.79, 95% CI 0.62-0.99, P = .049). Total surgical complications were significantly lower in the robotic-assisted cohort at 1 year (5.29 vs 6.16%, OR 0.85, 95% CI 0.74-0.98, P = .0205), but were similar at 90 days and 2 years. At 90 days, the rates of medical complications, including surgical site infections, pulmonary emboli, venous thromboemboli, and wound complications, were similar (all P > .05). The rates of periprosthetic joint infections, aseptic revision, periprosthetic fractures, and aseptic loosening were similar at all time points (all P > .05). Conclusions: Patients who underwent robotic-assisted THA had lower rates of dislocation at 90 days, 1 year, and 2 years. This finding supports the use of robotic assistance in THA, though further research is needed to confirm and strengthen these findings.

Published
2024
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2. Are Activity Restrictions Necessary After Total Hip Arthroplasty: A Systematic Review

Author

Sagar Telang, BS, Amir Human Hoveidaei, MD, MSc, Cory K. Mayfield, MD, Jay R. Lieberman, MD, Michael A. Mont, MD, and Nathanael D. Heckmann, MD

Subjects
Hip replacement, Total hip arthroplasty, Activity restrictions, Aseptic loosening, Dislocation, Orthopedic surgery, RD701-811
Abstract

Background: There remains a lack of universal guidelines regarding the appropriate level of postoperative activity restrictions following total hip arthroplasty (THA). This systematic review aims to assess whether the liberalization of postoperative activity restrictions following THA impacts implant survivorship, return to sport, patient satisfaction, and functional health outcomes. Methods: A comprehensive search strategy was completed across PubMed, Scopus, and Web of Science databases using targeted keywords from January 1, 2010, to November 22, 2023. Inclusion criteria included randomized clinical trials, case-control, and cohort studies written in English. Data extraction focused on activity levels, rehabilitation protocols, implant survivorship, and physical and psychological outcomes. The primary search yielded 7420 articles, with 28 studies included after screening. Results: Return to sports outcomes demonstrated notable variability (20%-98.5%). Most studies reported improved survivorship in high-activity patients. High-activity participants had all-cause revision rates of 0.9%-8.57% and aseptic revision rates of 0.4%-5.7%. Low-activity participants had all-cause revision rates of 0.7%-3.4% and aseptic revision rates of 0.0%-2.1%. There was no clear association between activity level and dislocation rates. Positive associations between post-THA activities and improved mental health and patient satisfaction were observed. Conclusions: The current arthroplasty literature demonstrates that patients engaging in high-activity levels after THA exhibit similar or improved implant survivorship rates compared to patients participating in low-activity levels. However, high-quality prospective studies are needed to provide evidence-based guidelines. Patients should be encouraged to partake in activities at their own comfort levels with an understanding of their own limitations and risks.

Published
2024
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3. Maryland’s Global Budget Revenue model associated with lower inpatient costs and 30-day readmissions in patients undergoing total hip arthroplasty

Author

Wayne A. Wilkie, Iciar M. Dávila Castrodad, Ronald E. Delanois, Ethan A. Remily, Michael A. Mont, Andrew N. Pollak, and Nequesha S. Mohamed

Subjects
African american, 030222 orthopedics, medicine.medical_specialty, business.industry, Patient characteristics, Healthcare economics, 03 medical and health sciences, lcsh:RD701-811, Readmissions, 0302 clinical medicine, Global budget revenue, lcsh:Orthopedic surgery, Emergency medicine, Inpatient stays, Medicine, Total hip arthroplasty, Orthopedics and Sports Medicine, Surgery, In patient, 030212 general & internal medicine, Costs and charges, business, Medicaid, Original Research
Abstract

Background: Maryland implemented the Global Budget Revenue (GBR) to reduce hospital costs, improve quality, and decrease readmissions. Studies assessing its impact on inpatient total hip arthroplasty (THA) procedures are lacking. This study compared before and after GBR changes in 1) patient characteristics; 2) discharge dispositions and lengths of stay (LOS); 3) costs and charges of inpatient stays; and 4) 30-day readmission rates (RR) for THA recipients. Methods: The Maryland State Inpatient Database was queried for patients who underwent THA between 2010 and 2016 utilizing the ICD-9 and ICD-10 procedure codes (n = 43,251). Pre- and post-GBR periods were grouped as 2010 to 2013 and 2014 to 2016, respectively. Chi-square analyses were used to analyze patient characteristics. Student’s t-tests were utilized to compare ages, LOS, costs, charges, and RR. Results: There were no differences in the proportion of minorities undergoing THA between the pre- and post-GBR periods (18.3% vs 19.4% African American, 1.2% vs 1.3% Hispanic; P = .056). The number of THA patients with Medicaid insurances increased during post-GBR (4.0% vs 6.7%; P < .001). There was an increased rate of home discharges during post-GBR (33.1% vs 40.9%; P < .001). We found lower LOS (−0.50 days; 95% CI: −0.458 to −0.533; P < .001), mean inpatient costs (−$1417.44; 95% CI −$1143.76 to −$1150.32; P < .001), and mean inpatient charges (−$2196.50; 95% CI: −$1980.10 to −$2412.90; P

Published
2020

4. The Technique of Total Knee Arthroplasty E-Book

Author

William M. Mihalko, Michael A. Mont, Kenneth Krackow, William M. Mihalko, Michael A. Mont, and Kenneth Krackow

Subjects
Artificial knee, Total knee replacement
Abstract

In 1990, Dr. Kenneth Krackow wrote The Technique of Total Knee Arthroplasty to teach the basics of TKA for end-stage arthritis—everything from nonsurgical to surgical intervention and postoperative rehabilitation. Now completely revised for a new generation of surgeons, the 2nd Edition of this classic text continues its original goal of helping advanced practitioners acquire more knowledge and skill in primary and revision total knee arthroplasty. This fully updated volume, revised by Dr. Krackow and his former fellows Drs. William M. Mihalko and Michael A. Mont, keeps you current with major changes and advances in field, including patient optimization, outpatient procedures, robotics and new technology, difficult decisions during surgery, and more. - Offers comprehensive and expert coverage of both inpatient and outpatient primary TKA, now fully revised with new chapters on Patient Considerations, Modifications, Optimizing the Important Comorbidities, TKA Balancing, and more. - Addresses key issues of patient optimization such as obesity, diabetes, heart disease, rheumatoid arthritis, and peripheral vascular disease. - Provides evidence for TKA outcomes and complications:'What do I tell my patient? - Focuses on the latest and best techniques and surgical approaches, including computer and robotic assisted surgery, uncemented TKA, assessing and planning for the difficult TKA, outpatient TKA considerations, and preventing readmissions post-surgery. - Discusses how to handle all deformity aspects of the lower extremity, bone defects, and ligamentous insufficiency during surgery. - Includes numerous illustrations, line art, radiographs, and clinical photos for optimal visualization of each procedure.

Published
2023

5. Machine learning and primary total knee arthroplasty: patient forecasting for a patient-specific payment model

Author

Eric Wang, Michael A. Mont, Sergio M. Navarro, Prem N. Ramkumar, Viktor E. Krebs, Heather S. Haeberle, and Brendan M. Patterson

Subjects
Patient-Specific Modeling, Databases, Factual, media_common.quotation_subject, Big data, Total knee arthroplasty, Comorbidity, Bayesian inference, Machine Learning, 03 medical and health sciences, Naive Bayes classifier, 0302 clinical medicine, medicine, Humans, Orthopedics and Sports Medicine, Operations management, 030212 general & internal medicine, Arthroplasty, Replacement, Knee, health care economics and organizations, Reimbursement, media_common, Inpatients, 030222 orthopedics, Receiver operating characteristic, business.industry, Bayes Theorem, Length of Stay, medicine.disease, Payment, Models, Economic, ROC Curve, Costs and Cost Analysis, Health Expenditures, business, Algorithms, Patient Care Bundles
Abstract

Background: Value-based and patient-specific care represent 2 critical areas of focus that have yet to be fully reconciled by today’s bundled care model. Using a predictive naïve Bayesian model, the objectives of this study were (1) to develop a machine-learning algorithm using preoperative big data to predict length of stay (LOS) and inpatient costs after primary total knee arthroplasty (TKA) and (2) to propose a tiered patient-specific payment model that reflects patient complexity for reimbursement. Methods: Using 141,446 patients undergoing primary TKA from an administrative database from 2009 to 2016, a Bayesian model was created and trained to forecast LOS and cost. Algorithm performance was determined using the area under the receiver operating characteristic curve and the percent accuracy. A proposed risk-based patient-specific payment model was derived based on outputs. Results: The machine-learning algorithm required age, race, gender, and comorbidity scores (“risk of illness” and “risk of morbidity”) to demonstrate a high degree of validity with an area under the receiver operating characteristic curve of 0.7822 and 0.7382 for LOS and cost. As patient complexity increased, cost add-ons increased in tiers of 3%, 10%, and 15% for moderate, major, and extreme mortality risks, respectively. Conclusion: Our machine-learning algorithm derived from an administrative database demonstrated excellent validity in predicting LOS and costs before primary TKA and has broad value-based applications, including a risk-based patient-specific payment model.

Published
2018

6. Nonoperative Treatment of Knee Arthritis

Author

Maria S. Goddard, Stephen R. Thompson, Harpal S. Khanuja, Michael A. Mont, and Marc W. Hungerford

Subjects
Knee arthritis, medicine.medical_specialty, business.industry, medicine, business, medicine.disease, Surgery, Nonoperative treatment
Published
2012
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7. Contributors

Author

Aryeh M. Abeles, Paolo Aglietti, Azhar A. Ali, Annunziato Amendola, Allen F. Anderson, Christian Noel Anderson, Jason D. Archibald, Elizabeth Arendt, Jean-Noël Argenson, Amy F. Austin, Bernard R. Bach, David Backstein, Geoffrey S. Baer, Sarvottam Bajaj, Andrea Baldini, Mark A. Baldwin, Sue Barber-Westin, Joseph Barker, Christopher P. Beauchamp, Martin Bédard, Keith R. Berend, Richard A. Berger, Thomas Bernasek, Daniel J. Berry, Jack M. Bert, Kevin F. Bonner, Adam C. Brekke, Karen K. Briggs, Claire L. Brockett, Michael K. Brooks, James A. Browne, Brandon J. Bryant, Jarett S. Burak, Alissa Burge, Charles Bush-Joseph, Asokumar Buvanendran, John Callaghan, Tom R. Carter, Eli Chen, Anikar Chhabra, Constance R. Chu, Randy Clark, Henry D. Clarke, David E. Cohen, Brian J. Cole, Thomas M. Coon, John H. Currier, Fred D. Cushner, Diane L. Dahm, Timothy A. Damron, Joseph P. DeAngelis, Bridget M. Deasy, David DeJour, Craig J. Della Valle, A. Lee Dellon, Guillaume Demey, Douglas A. Dennis, Ezra Deutsch, Ian D. Dickey, David R. Diduch, Mark E. Easley, Kostas Economopoulos, Gerard A. Engh, Gregory C. Fanelli, Jack Farr, Christopher M. Farrell, Thomas K. Fehring, Julian Feller, Jonathan T. Finnoff, John Fisher, Wolfgang Fitz, Clare K. Fitzpatrick, John P. Fletcher, John M. Flynn, Andrew G. Franks, Richard J. Friedman, Nicole A. Friel, Freddie H. Fu, John P. Fulkerson, Robert Kyle Fullick, Theodore J. Ganley, Donald S. Garbuz, Burhan Gharaibeh, Thomas J. Gill, Maria S. Goddard, Andreas Gomoll, Carlos Gonzalez, Christopher R. Gooding, Robert C. Grumet, F. Winston Gwathmey, Steve Haas, Mahmoud Hafez, George J. Haidukewych, Christopher A. Hajnik, Arlen D. Hanssen, Christopher D. Harner, Joseph M. Hart, William L. Healy, Peter F. Heeckt, Sarah E. Henry, Benton E. Heyworth, Richard Y. Hinton, Aaron A. Hofmann, Siegfried Hofmann, Ginger E. Holt, Terese T. Horlocker, Stephen M. Howell, Johnny Huard, Catherine Hui, Christophe Hulet, Maury L. Hull, Marc W. Hungerford, Anthony F. Infante, John N. Insall, David J. Jacofsky, James G. Jarvis, Louise Jennings, Charles E. Johnston, V. Karthik Jonna, Thomas Keller, Donna R. Kesselman, Craig Kessler, Saurabh Khakharia, Harpal S. Khanuja, Raymond H. Kim, Sung Jae Kim, Yair D. Kissin, Kevin Klingele, Mininder S. Kocher, Richard D. Komistek, Gabrielle P. Konin, Sandra L. Kopp, Nathan Kopydlowski, Dennis Kramer, Christopher M. Kuenze, Paul F. Lachiewicz, Jason E. Lang, Joshua R. Langford, Robert F. LaPrade, Peter J. Laz, Matthew Leidl, James M. Leone, Filip Leszko, David Levi, Gabriel Levi, Randall J. Lewis, Martin Lind, Eric M. Lindvall, David R. Lionberger, Frank A. Liporace, Martin Logan, Adolph V. Lombardi, William J. Long, Jess H. Lonner, Sébastien Lustig, Steven Lyons, Travis G. Maak, Jeffrey A. Macalena, Samuel D. Madoff, Shinichi Maeno, Robert A. Magnussen, Suzanne A. Maher, Mohamed R. Mahfouz, Sabine Mai, Patrick G. Marinello, J. Bohannon Mason, Bassam A. Masri, Henry Masur, Kevin R. Math, Richard C. Mather, Kenneth B. Mathis, Shuichi Matsuda, Jeremy McCandless, Kristen E. McClure, R. Michael Meneghini, Mark Miller, Douglas Mintz, Michael A. Mont, Claude T. Moorman, Michael J. Morris, William B. Morrison, Kenneth R. Morse, John Kyle P. Mueller, Thomas Muellner, David Murray, Volker Musahl, Michael D. Neel, Joshua Nelson, Michael P. Nett, Philippe Neyret, Philip C. Noble, Frank R. Noyes, Mary I. O’Connor, Matthew E. Oetgen, Mark W. Pagnano, Christopher J. Palestro, Sebastien Parratte, Brian S. Parsley, Nilesh Patil, Henrik B. Pedersen, Lars Peterson, Michael H. Pillinger, Leo Pinczewski, William R. Post, Sridhar R. Rachala, Craig S. Radnay, Adam J. Rana, R. Lor Randall, Robert S. Reiffel, Michael D. Ries, Samuel P. Robinson, Scott A. Rodeo, William G. Rodkey, Jose Rodriquez, Gregory J. Roehrig, Aaron G. Rosenberg, Pamela B. Rosenthal, Paul J. Rullkoetter, Paulo R.F. Saggin, Lucy Salmon, Roy Sanders, Robert C. Schenck, Oliver S. Schindler, Verena M. Schreiber, Richard D. Scott, Susan Craig Scott, W. Norman Scott, Giles R. Scuderi, Ari D. Seidenstein, Jon K. Sekiya, Elvire Servien, Erik P. Severson, Nicholas A. Sgaglione, Adrija Sharma, Seth L. Sherman, Michael S. Shin, Werner E. Siebert, Rafael J. Sierra, C. Van Sikes, David L. Skaggs, Gideon P. Smith, Gary E. Solomon, Kurt P. Spindler, Andrew I. Spitzer, Bryan D. Springer, J. Richard Steadman, Kelly Stets, Anna L. Stevens, James B. Stiehl, Eric J. Strauss, Michael Stuart, S. David Stulberg, Eric Tannenbaum, Dean C. Taylor, Kimberly Templeton, Stephen R. Thompson, Thomas Thornhill, Gehron Treme, Alfred J. Tria, Kimberly A. Turman, Hans K. Uhthoff, Anthony S. Unger, Thomas Parker Vail, Douglas W. Van Citters, Geoffrey S. Van Thiel, Haris S. Vasiliadis, Vincent J. Vigorita, Kelly G. Vince, Bruno Violante, James E. Voos, Shail Vyas, Daniel M. Walz, David Warwick, Nicholas P. Webber, Jennifer Weiss, Kurt R. Weiss, Barbara N. Weissman, Leo A. Whiteside, Thomas L. Wickiewicz, Bryan S. Williams, Riley J. Williams, Yi-Meng Yen, Hong Zhang, Sumesh M. Zingde, and Adam C. Zoga

Published
2012
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9. List of Contributors

Author

J. Mack Aldridge, Champ L. Baker, Nikolaos V. Bardakos, Paul E. Beaulé, Martin Beck, Michel P.J. v/d Bekerom, Benoit Benoit, Karen K. Briggs, Robert L. Buly, Denise Chan, Lorenzo Childress, John C. Clohisy, Ronald E. Delanois, Octavia Devon, Michael Dienst, Keelan R. Enseki, Teresa M. Ferguson, Reinhold Ganz, Michael B. Gerhardt, James A. Goulet, Carlos A. Guanche, Daniël Haverkamp, Marcia A. Horner, Victor M. Ilizaliturri, Jon A. Jacobson, David Kahan, Bryan T. Kelly, Vikas Khanduja, Mininder S. Kocher, Jason Koh, David A. Kuppersmith, Christopher M. Larson, Jo-Ann Lee, Michael Leunig, Kartik Logishetty, Dean G. Lorich, Travis Maak, Tallal Charles Mamisch, Aditya V. Maheshwari, David R. Marker, René K. Marti, Hal David Martin, RobRoy L. Martin, Joseph C. McCarthy, Mike S. McGrath, Morteza Meftah, William C. Meyers, Nick G. Mohtadi, Michael A. Mont, Ryan M. Nunley, M. Elizabeth Pedersen, Murat Pekmezci, Aaron Perdue, Marc J. Philippon, Mario Quesada, Amar S. Ranawat, Anil S. Ranawat, Chitranjan S. Ranawat, Margaret M. Rich, Hassan Sadri, Marc R. Safran, Thomas G. Sampson, Perry L. Schoenecker, Karl F. Schultz, Jon K. Sekiya, Michael K. Shindle, Klaus A. Siebenrock, Moritz Tannast, Mehul M. Taylor, James R. Urbaniak, Zackary D. Vaughn, Richard N. Villar, James E. Voos, Stuart L. Weinstein, Stefan Werlen, Yi-Meng Yen, and Chad T. Zehms

Published
2011
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11. Contributors

Author

Omar Abdul-Hadi, Ashutosh Acharya, Mir H. Ali, Carles Amat, G. Rebecca Aspinall, Matthew S. Austin, Khalid Azzam, B. Sonny Bal, Paul E. Beaulé, Benjamin Bender, Keith R. Berend, Michael E. Berend, Gurdeep S. Biring, Petros J. Boscainos, R. Stephen J. Burnett, William N. Capello, Isabelle Catelas, John C. Clohisy, Pablo Corona, Ross Crawford, J. de Beer, Ronald E. Delanois, Douglas A. Dennis, Anthony M. DiGioia, Bill Donnelly, Lawrence D. Dorr, Gavan P. Duffy, John Dumbleton, Michael J. Dunbar, Clive P. Duncan, Thomas A. Einhorn, C. Anderson Engh, Xavier Flores, Reinhold Ganz, Donald S. Garbuz, J.W.M. Gardeniers, Kevin L. Garvin, G.A. Gie, Kenneth A. Greene, Allan E. Gross, Ernesto Guerra, Mahmoud A. Hafez, Arlen D. Hanssen, Curtis W. Hartman, James W. Heitz, Kirby Hitt, Ginger E. Holt, William J. Hozack, Bill K. Huang, B. Jaramaz, Eric Jones, Michael Kain, Eoin C. Kavanagh, Stephen Kearns, Catherine F. Kellett, Tracy L. Kinsey, Brian A. Klatt, Gregg R. Klein, Frank R. Kolisek, George Koulouris, Steven Kurtz, Paul F. Lachiewicz, Jo-Ann Lee, P.D. Michael Leunig, David G. Lewallen, Jay R. Lieberman, Adolph V. Lombardi, William T. Long, P.J. Lusty, Steven J. MacDonald, Aditya Vikram Maheshwari, Ormonde M. Mahoney, Arthur L. Malkani, W. James Malone, John Manfredi, Michael Manley, Bassam A. Masri, James P. McAuley, Joseph C. McCarthy, John B. Medley, Michael A. Mont, William Morrison, Joseph P. Nessler, Michael Nogler, Michelle O'Neill, Alvin Ong, Fabio R. Orozco, Mark W. Pagnano, Panayiotis J. Papagelopoulos, Wayne G. Paprosky, Javad Parvizi, Frank A. Petrigliano, Simon Pickering, James Purtill, Amar S. Ranawat, Chitranjan S. Ranawat, Camilo Restrepo, Raymond R. Ropiak, Richard H. Rothman, B.W. Schreurs, Peter F. Sharkey, Klaus A. Siebenrock, Rafael J. Sierra, Franklin H. Sim, Mark J. Spangehl, Scott M. Sporer, R.G. Steele, Kate Sutton, Moritz Tannast, Marco Teloken, Andrew John Timperley, Slif D. Ulrich, Thomas Parker Vail, Eugene R. Viscusi, W.L. Walter, Aiguo Wang, Madhusudhan R. Yakkanti, D. Young, Eric J. Yue, and Adam C. Zoga

Published
2009
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13. The Hip

Author

Michael A. Mont, German A. Marulanda, Ronald E. Delanois, Thorsten M. Seyler, and Alan Friedman

Published
2008
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14. The Knee

Author

Michael E. Frey, Bryan J. O'Young, German A. Marulanda, Michael A. Mont, and Thorsten M. Seyler

Published
2008
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15. Contributors

Author

Mindy Aisen, Gulseren Akyuz, Gad Alon, Ronit Aloni, Dheera Ananthakrishnan, J. Michael Anderson, Charles E. Argoff, Rita N. Ayyangar, John R. Bach, Karen Barr, Jeffrey R. Basford, Linamara Batistella, Kathleen R. Bell, Scott E. Benjamin, Leland Berkwits, Peter E. Biglin, Valerie S. Bodeau, Elliot B. Bodofsky, Michael L. Boninger, Joanne Borg-Stein, Randall L. Braddom, Diane W. Braza, Scott E. Brown, Stephen P. Burns, Ralph M. Buschbacher, Rene Cailliet, David A. Cassius, Leighton Chan, Tsai Chao, Howard Choi, James R. Christensen, Jeffrey M. Cohen, Neil B. Cohen, Jeffrey L. Cole, Rory A. Cooper, Tyler Childs Cymet, Joseph Czerniecki, Shashank J. Dave, Ronald E. Delanois, Timothy R. Dillingham, Peter Daniel Donofrio, Hy Dubo, Joan E. Edelstein, Nasser Eftekhari, Arieh Eldad, Maury R. Ellenberg, Peter C. Esselman, Frank J.E. Falco, Gerald Felsenthal, Veronika Fialka-Moser, Andrew A. Fischer, Paul Fishman, Michael E. Frey, Richard A. Frieden, Alan Friedman, Michael B. Furman, Vincent Gabriel, Fae H. Garden, Susan J. Garrison, Mouli Madhab Ghatak, William Gibbs, Theresa A. Gillis, Alessandro Giustini, John Giusto, Lance L. Goetz, Gary Goldberg, Stephen Goldberg, Barry Goldstein, Peter H. Gorman, Patricia Graham, Christoph Gutenbrunner, Rochelle V. Habeck, Harlan Hahn, Kevin Hakimi, Eugen M. Halar, Margaret Hammond, Robert L. Harmon, Mark Harrast, Richard L. Harvey, Michael Hatzakis, Joseph M. Helms, Rafi J. Heruti, Jeanne E. Hicks, Steven R. Hinderer, Howard J. Hoffberg, Joseph C. Honet, Lawrence J. Horn, Edward A. Hurvitz, Marta Imamura, Tom Jackson, Jennifer J. James, Galen O. Joe, Kurt Johnson, Richard T. Katz, David J. Kennedy, Ofer Keren, D. Casey Kerrigan, Seema Khurana, Charles Kim, David Kim, Heakyung Kim, R. Lee Kirby, Stanley H. Kornhauser, Karen J. Kowalske, Ashley E. Kurz, Jorge Lains, Mathew Lee, Peter Lee, Yehoshua A. Lehman, James W. Leonard, Charles E. Levy, Karen Y. Lew, Jan Lexell, Janet C. Limke, Mark A. Lissens, James Little, Ruth Torkelson Lynch, Ian B. Maitin, German A. Marulanda, Edward McFarland, Thomas McGunigal, Gregg D. Meekins, Arun J. Mehta, Jeffrey Meyers, William F. Micheo-Martínez, Marc S. Micozzi, Michael A. Mont, Stanley J. Myers, Fred Newton, Subhadra Lakshmi Nori, Rory J. O'Connor, Abna A. Ogle, Bryan J. O'Young, Jeffrey B. Palmer, Atul T. Patel, Jaywant J.P. Patil, Inder Perkash, Frank S. Pidcock, James M. Plunkett, Russell K. Portenoy, Joel M. Press, Michael M. Priebe, Kristjan T. Ragnarsson, Mark Randall, Ira G. Rashbaum, Rajiv R. Ratan, Albert C. Recio, John B. Redford, Rina Reyes, Mary Richardson, Haim Ring, Lawrence R. Robinson, Richard C. Robinson, Arthur A. Rodriquez, Richard A. Rogachefsky, Robert D. Rondinelli, Barry Rosenblum, Elliot J. Roth, Nathan J. Rudin, Abner Salas, Vivencio Salcedo, Richard Salcido, Francisco H. Santiago, Carson D. Schneck, Andrew Sears, Thorsten M. Seyler, Tarek S. Shafshak, Jay P. Shah, Aaron Shamberg, Shoshana Shamberg, Ki Y. Shin, David A.N. Siegel, Kenneth H. Silver, Warren Slaten, Nachum Soroker, Michelle Stern, Ninad D. Sthalekar, Beth A. Stiens, Steven A. Stiens, Margaret G. Stineman, Nancy E. Strauss, Jonathan Strayer, Gregory Strock, Gerold Stucki, Jelena N. Svircev, Atsushi Tasaki, Mitch Tepper, Donna C. Tippett, Melissa K. Trovato, Rhodora C. Tumanon, Gerard P. Varlotta, Richard Verville, Stanley F. Wainapel, Mao Bin Wang, Ninghua Wang, Ruth K. Westheimer, Olajide Williams, Stuart Willick, Sam Wu, Eva Young, Mark A. Young, Marlene M. Young, and Gabi Zeilig

Published
2008
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16. Total Knee Arthroplasty in Human Immunodeficiency Virus Patients: A Literature Review

Author

Asaf Miller, BS, Daniel Hameed, MD, Jeremy Dubin, BA, Michael A. Mont, MD, FAAOS, Deepak V. Patel, MD, MSc Orth, MS Orth, FCPS Orth, D Orth, Christopher Bibbo, DO, FACS, FAAOS, and Ian S. Hong, MD

Subjects
Human immunodeficiency virus (HIV), Total knee arthroplasty (TKA), Outcomes, Knee osteonecrosis (ON), Orthopedic surgery, RD701-811
Abstract

Background: Total knee arthroplasty (TKA) has become a common surgical intervention for human immunodeficiency virus (HIV)-positive patients who develop osteonecrosis of the knee. This paper summarized existing literature regarding the outcomes of HIV-positive patients undergoing TKA in 4 subsections: (1) complications; (2) survivorship analyses; (3) patient-reported outcomes; and (4) infections. Methods: A review of PubMed was performed, searching for articles focused on HIV-positive patients undergoing TKA. There were 6 reports selected, containing 4765 HIV-positive patients, and data regarding the various domains was tabulated and analyzed. To ensure article quality, a methodology score and level of evidence were determined for selected studies. Results: Complication rates for HIV-positive patients were low, with a larger study reporting that 7.8% of HIV-positive patients developed a complication in comparison to 8% of HIV-negative patients. Survivorship analyses showed similar results, with a study reporting implant survivorship of 98% for HIV-positive and 99% for HIV-negative patients. There were no differences in patient-reported outcomes; HIV-positive patients improved from baseline with respect to the mean Knee Society objective and mean Knee Society functional scores, and the University of California, Los Angeles self-reported activity levels. The infection rate for HIV-positive patients was low, with a larger database study reporting that 0.6% of HIV-positive patients developed a wound infection in comparison to 0.4% of HIV-negative patients. Conclusions: A TKA is an effective treatment for HIV-positive patients who develop osteonecrosis of the knee. Results showed similar patient-reported outcomes, implant survivorships, revisions, and complication rates when compared to non-HIV patients.

Published
2024
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17. Return to Work and Driving After Robotic Arm–Assisted Total Knee Arthroplasty

Author

Manoshi Bhowmik-Stoker, PhD, Kevin K. Mathew, BS, Zhongming Chen, MD, Antonia F. Chen, MD/MBA, William J. Hozack, MD, Ormonde Mahoney, MD, Fabio R. Orozco, MD, and Michael A. Mont, MD

Subjects
Return to work, Return to driving, Robotic arm assisted, Total knee arthroplasty, Orthopedic surgery, RD701-811
Abstract

Background: Robotic arm–assisted total knee arthroplasty (RATKA) has demonstrated improved patient-reported outcome measures. Less evidence has been reported on how frequently patients return to complex activities of daily living. Our purposes were to investigate (1) hospital lengths of stay (LOSs) (2) discharge dispositions and (3) the rates and postoperative time intervals at which patients returned to driving and working. Methods: A total of 50 RATKA patients who were employed prior to surgery were included. Outcomes included hospital LOS, discharge dispositions, return to driving, and return to work. Results: A total of 48 patients (96%) were discharged home with self-care or health aid discharge after a mean LOS of 1.2 ± 0.6 days. Twelve patients (24%) returned to driving within 3 weeks of surgery. In our study, 100% of patients who underwent RATKA returned to driving after a mean of 29 days (range, 4 to 62 days). Forty-five patients (90%) returned to their preoperative level of work after a mean of 46 days (range, 2 to 96 days). Nineteen patients (38%) returned to work within 3 weeks. Conclusions: This study showed fast recovery after RATKA, with >90% returning to driving and working at full capacity within 2 months. Many (38%) returned to work within 3 weeks. Further studies to demonstrate the value of RATKA with respect to recovery of complex activities are needed. Compared to controls from previously published literature on manual total knee arthroplasties, it appears that patients who undergo RATKA have similar or better outcomes in reference to return to driving.

Published
2022
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18. Does Structured Postgraduate Training Affect the Learning Curve in Direct Anterior Total Hip Arthroplasty? A Single Surgeon’s First 200 Cases

Author

Luke Garbarino, MD, Peter Gold, MD, Nipun Sodhi, MD, Cesar Iturriaga, DO, Michael A. Mont, MD, and Sreevathsa Boraiah, MD

Subjects
Direct anterior approach, Total hip arthroplasty, Learning curve, Fellowship training, Orthopedic surgery, RD701-811
Abstract

Background: The direct anterior approach (DAA) used for primary total hip arthroplasty has been shown to improve early postoperative outcomes, but prior studies have identified a marked learning curve for surgeons transitioning to this approach. However, these studies do not capture surgeons with postgraduate fellowship training in DAA. Therefore, the purpose of this study was to evaluate the learning curve by comparing perioperative outcomes for the first 100 to latter 100 cases and first 50 to final 50 cases. Methods: The first 200 consecutive primary total hip arthroplasties performed by a single surgeon were prospectively followed up for up to 2 years postoperatively. Data on demographic and perioperative factors, 90-day readmissions, and short- and long-term complications were collected. Radiographic outcomes included acetabular cup anteversion and abduction measurements. Logistic regressions were used to calculate odds ratios and confidence intervals for surgical time greater than 2 hours. Results: The first 100 and second 100 cases had significant differences in operative times (118.1 vs 110.4 minutes, P = .009), acetabular abduction (38.3 vs 35.5 degrees, P = .001) and anteversion (13.5 vs 15.1 degrees, P = .009), and incidence of neuropraxia (41 vs 9%, P < .001). Estimated blood loss, transfusions, discharge disposition, length of stay, readmission, and other complications had no statistical significance between the first and second 100 cases. The first 50 cases had higher odds of surgical time greater than 2 hours (odds ratio = 5.2, 95% confidence interval = 1.84-14.75, P = .002) than the final 50 cases. Conclusions: When compared with the existing literature, incorporation of DAA into fellowship training can lead to reduction in fractures and reoperation rates.

Published
2021
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19. Maryland’s Global Budget Revenue model associated with lower inpatient costs and 30-day readmissions in patients undergoing total hip arthroplasty

Author

Iciar M. Dávila Castrodad, MD, Nequesha S. Mohamed, MD, Wayne A. Wilkie, DO, MHSA, Ethan A. Remily, DO, Andrew N. Pollak, MD, Michael A. Mont, MD, and Ronald E. Delanois, MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Background: Maryland implemented the Global Budget Revenue (GBR) to reduce hospital costs, improve quality, and decrease readmissions. Studies assessing its impact on inpatient total hip arthroplasty (THA) procedures are lacking. This study compared before and after GBR changes in 1) patient characteristics; 2) discharge dispositions and lengths of stay (LOS); 3) costs and charges of inpatient stays; and 4) 30-day readmission rates (RR) for THA recipients. Methods: The Maryland State Inpatient Database was queried for patients who underwent THA between 2010 and 2016 utilizing the ICD-9 and ICD-10 procedure codes (n = 43,251). Pre- and post-GBR periods were grouped as 2010 to 2013 and 2014 to 2016, respectively. Chi-square analyses were used to analyze patient characteristics. Student’s t-tests were utilized to compare ages, LOS, costs, charges, and RR. Results: There were no differences in the proportion of minorities undergoing THA between the pre- and post-GBR periods (18.3% vs 19.4% African American, 1.2% vs 1.3% Hispanic; P = .056). The number of THA patients with Medicaid insurances increased during post-GBR (4.0% vs 6.7%; P < .001). There was an increased rate of home discharges during post-GBR (33.1% vs 40.9%; P < .001). We found lower LOS (−0.50 days; 95% CI: −0.458 to −0.533; P < .001), mean inpatient costs (−$1417.44; 95% CI −$1143.76 to −$1150.32; P < .001), and mean inpatient charges (−$2196.50; 95% CI: −$1980.10 to −$2412.90; P

Published
2020
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