34 results on '"Nipun Sodhi"'
Search Results
2. Relationship Between Preoperative Nutritional Status and Predicting Short-Term Complications Following Revision Total Hip Arthroplasty
- Author
-
Jamie C. Heimroth, Eric V. Neufeld, Nipun Sodhi, Timothy Walden, Max L. Willinger, and Sreevathsa Boraiah
- Subjects
Orthopedics and Sports Medicine - Published
- 2023
3. Surgical Technique: Robotic-Assisted 1.5-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infection
- Author
-
Jonathan R. Danoff, Jamie Heimroth, Max Willinger, Sally Trout, and Nipun Sodhi
- Subjects
Orthopedics and Sports Medicine ,Surgery - Published
- 2023
4. Nationwide trends of surgical site infections rates after primary shoulder arthroplasty
- Author
-
Anthony A. Romeo, Michael A. Mont, Nipun Sodhi, Hiba K. Anis, Eric T. Ricchetti, Christopher J. Hadley, and Brandon J. Erickson
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Incidence (epidemiology) ,Level iv ,medicine.disease ,Wound infection ,Arthroplasty ,Surgery ,Acs nsqip ,Sepsis ,Surgical site ,Medicine ,Current Procedural Terminology ,Orthopedics and Sports Medicine ,business - Abstract
Background Surgical site infections (SSI) are relatively uncommon, but can be debilitating complications following shoulder arthroplasty. Infections can result in further complications including sepsis and revision surgery. Methods The National Surgical Quality Improvement Program database was queried for all total and reverse total shoulder arthroplasty cases (Current Procedural Terminology code 23472) between 2012 and 2015 yielding 8438 total cases. The outcome of interest was 30-day SSI incidence, defined as a superficial and/or deep wound infection. The infection incidence for each year was calculated. Results The total number of primary shoulder arthroplasties increased from 2012 to 2015 (1191 to 3227; 271% increase). Over the 4-year study period, the incidence of SSIs following TSA was 0.40%. A downward trend in SSI rates was observed over time. An inverse relationship between SSI rates and year of surgery (R2−0.17) was observed; however, this was not statistically significant (P> .05). Infection rates in 2015 decreased by 48% when compared to 2012 (0.31 vs. 0.50%, P> .05). A larger decrease in SSI rate (76%) was noted between 2015 and 2013 (0.31 vs. 0.69%, P> .05). Conclusion SSI rates following shoulder arthroplasty declined from 2012 to 2015 by 48%. There was an inverse relationship between SSI rate and year of surgery, with the lowest infection rate found to be in the most recent year studied. It is hoped that continued measures will further promulgate these downward trends of these devastating complications. Level of Evidence Level IV; Retrospective Case Series
- Published
- 2021
5. Does Structured Postgraduate Training Affect the Learning Curve in Direct Anterior Total Hip Arthroplasty? A Single Surgeon’s First 200 Cases
- Author
-
Cesar Iturriaga, Sreevathsa Boraiah, Peter A. Gold, Luke J. Garbarino, Nipun Sodhi, and Michael A. Mont
- Subjects
medicine.medical_specialty ,Radiography ,Logistic regression ,Odds ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Statistical significance ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Learning curve ,Original Research ,030222 orthopedics ,business.industry ,Incidence (epidemiology) ,Fellowship training ,Odds ratio ,Perioperative ,Confidence interval ,Surgery ,lcsh:RD701-811 ,Direct anterior approach ,Total hip arthroplasty ,business - 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
6. Can the Caprini score predict thromboembolism and guide pharmacologic prophylaxis after primary joint arthroplasty?
- Author
-
Nipun Sodhi, Michael A. Mont, Giles R. Scuderi, Peter A. Gold, Luke J. Garbarino, Terence Y. Ng, and Josephine R. Coury
- Subjects
030222 orthopedics ,Past medical history ,medicine.medical_specialty ,Aspirin ,Rivaroxaban ,business.industry ,Mortality rate ,Incidence (epidemiology) ,Warfarin ,030229 sport sciences ,Article ,Dabigatran ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Orthopedics and Sports Medicine ,Apixaban ,cardiovascular diseases ,business ,medicine.drug - Abstract
AIMS: Venous thromboembolism (VTE) has a 30-day mortality rate of between 10 and 30%. The Caprini score is a VTE risk assessment model, which assigns points to 20 past medical history and current health factors. We hypothesized that the Caprini score could predict VTE incidence and recommend prophylaxis following total joint arthroplasty. PATIENTS AND METHODS: We performed a retrospective review of prospectively collected institutional data identifying Caprini scores on 2155 primary hip (n = 840) and knee (n = 1315) arthroplasties. Surgeons were blinded to Caprini scores when prescribing VTE prophylaxis. Patients were separated into prophylaxis groups receiving Aspirin (81 mg BID or 325 mg BID) or other (Rivaroxaban, Warfarin, Enoxaparin, Apixaban, Dabigatran, Heparin). Univariate, multivariate, and Cohen's effect size analyses assessed the predictive power of the Caprini score on VTE incidence. RESULTS: The mean Caprini score was 9.49 (5–25). A majority, 83% (1792) of patients were in the Aspirin group, and 17% (363) in the other group. Other prophylaxis patients had statistically significantly higher Caprini scores (10 vs. 9, p 40 or Caprini scores ≥11 to predict VTE incidence in the Aspirin or other prophylaxis groups (p = 0.52 and p = 0.15 respectively). Cohen's effect size was small, comparing Caprini scores in patients who had and had not had a VTE in both Aspirin and other prophylaxis groups (Cohen's d = 0.25 and d = 0.16 respectively). CONCLUSION: Surgeons rely on stronger pharmacologic prophylaxis for a select high risk group of their primary lower extremity total joint arthroplasty patients. When controlling for prophylaxis, the Caprini score had a small effect size and did not have the predictive power necessary to guide treatment
- Published
- 2020
7. Thirty-Day Complications in Osteonecrosis Patients Following Total Hip Arthroplasty
- Author
-
Lynne C. Jones, Nipun Sodhi, Nicolas S. Piuzzi, Hiba K. Anis, Marine Coste, and Michael A. Mont
- Subjects
Reoperation ,medicine.medical_specialty ,Databases, Factual ,Arthroplasty, Replacement, Hip ,Operative Time ,Avascular necrosis ,Patient Readmission ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,THIRTY-DAY ,medicine ,Humans ,Orthopedics and Sports Medicine ,Risk factor ,030222 orthopedics ,business.industry ,Incidence (epidemiology) ,Osteonecrosis ,Length of Stay ,medicine.disease ,Surgery ,Treatment Outcome ,Propensity score matching ,Current Procedural Terminology ,Complication ,business ,Total hip arthroplasty - Abstract
Thirty-day complications in osteonecrosis (ON) patients undergoing total hip arthroplasty (THA) are inconsistently reported. Therefore, the purpose of this study is to evaluate (1) the incidence of THA, (2) operative times, (2) length of stay, (3) reoperation rates, (4) readmission rates, and (5) complication rates, in the general vs ON THA populations. We also substratified and compared these cohorts based on ON-specific risk factors.Using the National Surgical Quality Improvement Program database, Current Procedural Terminology code 27130, International Classification of Disease, Ninth Edition code 733.42, and a 1:1 propensity score match, a total of 8344 matched ON and non-ON THA patients were identified. ON patients were also substratified based on key risk factors. The above variables were compared between the matched ON and non-ON cohorts as well as for patients with each risk factor using Pearson's chi-square and Student t-tests.The proportion of THAs performed on ON patients decreased by 35% from 2008 to 2015. Mean operative times were constant between the ON and non-ON patients (102 minutes). ON patients had shorter mean length of stay (3.1 vs 3.4 days, P = .002). Of the 17 different 30-day complications evaluated, superficial surgical site infection (1.2% vs 0.6%, P = .004), pneumonia (0.8% vs 0.2%, P = .001), transfusion (15.6% vs 5.4%, P.001), and readmission (5.1% vs 2.3%, P = .012) were higher among ON patients. ON patients with a history of corticosteroid use, higher American Society of Anesthesiologists score, and smoking were also found to have higher complication rates compared to non-ON patients with the same risk factors.This is one of the first studies to compare postoperative THA outcomes between matched ON vs non-ON patients, while also taking into consideration specific risk factors between the cohorts.
- Published
- 2020
8. The Effects of Opioid Use on Thromboembolic Complications, Readmission Rates, and 90-Day Episode of Care Costs After Total Hip Arthroplasty
- Author
-
Martin W. Roche, Michael A. Mont, Hiba K. Anis, Carlos A. Higuera, Rushabh M. Vakharia, Alexander J. Acuña, Nipun Sodhi, and Nicolas S. Piuzzi
- Subjects
medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Deep vein ,Episode of Care ,Logistic regression ,Patient Readmission ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,030222 orthopedics ,Episode of care ,business.industry ,Opioid use ,Opioid use disorder ,Opioid-Related Disorders ,medicine.disease ,Thrombosis ,Pulmonary embolism ,Analgesics, Opioid ,medicine.anatomical_structure ,business ,Total hip arthroplasty - Abstract
The purpose of this study was to investigate whether opioid use disorder (OUD) patients are at greater odds than non-opioid use disorder (NUD) patients in developing (1) thromboembolic complications; (2) readmission rates; and (3) costs of care.All patients with a 90-day history of OUD before total hip arthroplasty (THA) were identified from a national database. Patients were matched 1:5 to controls by age, gender, Elixhauser Comorbidity Index scores, and high-risk medical comorbidities, yielding 38,821 patients with (n = 6398) and without (n = 31,883) OUD. Multivariate logistic regression analyses were performed to compare the risks of developing venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) 90 days after the index procedure, 90-day readmission rates, and total global 90-day episode of care costs.Patients with a history of OUD were found to be at greater risk for 90-day venous thromboembolisms (2.38 vs. 1.07%; OR: 2.25, 95% CI: 1.86-2.73, P.0001) compared with matched NUD patients. Specifically, OUD patients were at greater risk for both deep vein thromboses (2.13 vs. 0.87%; OR: 2.46, 95% CI: 2.00-3.03, P.001) and pulmonary embolism (0.61 vs. 0.27%; OR: 2.24, 95% CI: 1.53-3.27, P.0001). In addition, patients with OUD were at an increased risk for 90-day readmission (28.68 vs. 22.62%; OR: 1.37, 95% CI: 1.29-1.46, P.0001) compared with controls. Primary THA patients with OUD incurred a 14.72% higher cost of care ($20,610.65 vs. $17,964.58) compared with NUD patients.These findings demonstrate that primary THA patients with a history of OUD are at greater risks for thromboembolic complications, readmissions, and higher costs of care in the 90-day postoperative period.
- Published
- 2020
9. Are We Treating Similar Patients? Hospital Volume and the Difference in Patient Populations for Total Knee Arthroplasty
- Author
-
Carlos A. Higuera, Hiba K. Anis, Michael A. Mont, Deepak Ramanathan, Nicholas R. Arnold, Robert M. Molloy, Brendan M. Patterson, and Nipun Sodhi
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Hospitals, Low-Volume ,Referral ,business.industry ,Preoperative risk ,Total knee arthroplasty ,Odds ratio ,Logistic regression ,Confidence interval ,03 medical and health sciences ,Logistic Models ,0302 clinical medicine ,Hospital volume ,Risk Factors ,Internal medicine ,Odds Ratio ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,business ,Body mass index ,Aged - Abstract
Early findings of superior total knee arthroplasty (TKA) outcomes at high volume centers have been thought to have led to distinct referral patterns. However, the effect of these selective referral processes has not been well assessed. Therefore, this study compared the characteristics of primary TKA patients at high, intermediate, and low volume hospitals.A total of 12,541 primary TKA patients were stratified into risk groups based on age (65 years), body mass index (40), and Charlson Comorbidity Index (≥4). Hospitals were classified as low, intermediate, or high volume based on mean annual TKA volumes (250, 250-499, and500). Multivariate logistic regression models evaluated the relationship between baseline patient characteristics and hospital volume.There was a greater percentage of high risk patients at high volume (19%, n = 853) compared to those at intermediate (16%, n = 899) or low volume (17%, n = 444) hospitals (P.001). Patients with a body mass index40 were more likely to be treated at high compared to intermediate (odds ratio [OR] 1.4, 95% confidence interval [CI] 1.2-1.6, P.001) and low volume centers (OR 1.4, 95% CI 1.2-1.7, P.001). Patients with Charlson Comorbidity Index scores ≥4 were also more likely be treated at high compared to intermediate (OR 1.5, 95% CI 1.3-1.6, P.001) or low (OR 1.2, 95% CI 1.0-1.4, P = .002) volume centers.This study found that TKA patients at high volume centers have significantly different baseline characteristics compared to those at lower volume centers. This study highlights the importance of considering hospital volume status and the associated disparity in the preoperative risk of patients when comparing primary TKA outcomes between centers.
- Published
- 2020
10. Does Intermittent Catheterization Compared to Indwelling Catheterization Decrease the Risk of Periprosthetic Joint Infection Following Total Knee Arthroplasty?
- Author
-
Michael A. Mont, Luke J. Garbarino, Jonathan R. Danoff, Peter A. Gold, Sreevathsa Boraiah, Vijay J. Rasquinha, Nipun Sodhi, and Hiba K. Anis
- Subjects
030222 orthopedics ,Univariate analysis ,medicine.medical_specialty ,Prosthesis-Related Infections ,Urinary bladder ,Urinary retention ,business.industry ,Patient demographics ,Urinary Bladder ,Total knee arthroplasty ,Periprosthetic ,Odds ratio ,Surgery ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Humans ,Orthopedics and Sports Medicine ,medicine.symptom ,Arthroplasty, Replacement, Knee ,Urinary Catheterization ,business ,Urinary catheter - Abstract
Catheterization for the prophylaxis against or treatment for urinary retention commonly occurs after total knee arthroplasty (TKA). Recent studies have questioned the use of the indwelling catheterization, especially in its potential role as a nidus for infection. We are still unsure of its downstream effects on periprosthetic joint infections (PJIs). Therefore, this study aimed to compare the risks of postoperative PJI following intermittent vs indwelling catheterization after TKA.Between 2017 and 2019, 15 hospitals in a large health system collected data on patients undergoing TKA. Patient treatments with indwelling catheter only, intermittent straight catheter only, and both indwelling and intermittent straight catheterizations were recorded. Patient demographics, comorbidities, body mass indices, and PJIs were collected from time of surgery to time of data collection at mean 14 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models to compare catheterization treatment types.A total of 9123 TKAs were performed, with patients receiving indwelling catheter only (62%, n = 734), intermittent straight catheter only (25%, n = 299), or both indwelling and intermittent catheterizations (13%, n = 160). Univariate analyses showed that PJIs occurred in 1.1% of no-catheter patients and 2.3% of patients treated with bladder catheterization (P = .002). Using multivariate analyses, indwelling catheter use (odds ratio [OR] 2.647, P.001), diabetes (OR 1.837, P = .005), and peripheral vascular disease (OR 2.372, P = .046) were found to have a statistically significant increased risk for PJIs. The use of intermittent straight catheterization (OR 1.249, P = .668) or both indwelling and intermittent (OR 1.171, P = .828) did not increase the risk for PJIs.Urinary bladder catheterization is commonly required for prophylaxis against or treatment for urinary retention following TKA. The use of a urinary catheter can provide a potential nidus for infection in these patients. This study found that indwelling catheterization, but not intermittent catheterization, was associated with an increased risk for PJI. Surgeons should therefore limit the duration of catheterization in an effort to decrease the risk for PJI.
- Published
- 2020
11. Effects of Depressive Disorders on Patients Undergoing Primary Total Knee Arthroplasty: A Matched-Control Analysis
- Author
-
Martin W. Roche, Nipun Sodhi, Rushabh M. Vakharia, Samuel J. Swiggett, Joseph O. Ehiorobo, and Michael A. Mont
- Subjects
Depressive Disorder ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Matched control ,Total knee arthroplasty ,Length of Stay ,Patient Readmission ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Arthroplasty, Replacement, Knee ,business - Abstract
Studies evaluating the effects of depressive disorders in patients undergoing primary total knee arthroplasty (TKA) are sparse. Therefore, the purpose of this study is to investigate whether patients who have depressive disorders undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) readmission rates, (3) medical complications, (4) implant-related complications, and (5) costs of care.Patients with depressive disorders undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, sex, and comorbidities. The query yielded 138,076 patients who had (n = 23,061) or did not have (n = 115,015) depressive disorders. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, and costs of care. A P value less than .003 was considered statistically significant.Patients who have depressive disorders had significantly longer in-hospital LOS (6.2 days vs 3.1 days; P.0001). Additionally, study group patients had a higher incidence and odds of readmissions (15.5% vs 12.1%; odds ratio [OR], 1.33; P001), medical complications (5.0% vs 1.6%; OR, 3.34; P.0001), and implant-related complications (3.3% vs 1.7%; OR; 1.97; P.0001) Study group patients also incurred significantly higher day of surgery ($12,356.59 vs $10,487.71; P.0001) and 90-day costs ($23,386.17 vs $22,201.43; P.0001).After adjusting for age, sex, and comorbidities, this study demonstrated that patients who have depressive disorders have increased rates of in-hospital LOS, readmissions, complications, and cost. The study is useful in allowing orthopedists to adequately educate patients of potential complications which may occur.
- Published
- 2020
12. Opioid Disorders Are Associated With Thromboemboli Following Primary Total Knee Arthroplasty
- Author
-
Martin W. Roche, Karim G. Sabeh, Wayne B. Cohen-Levy, Rushabh M. Vakharia, Michael A. Mont, and Nipun Sodhi
- Subjects
medicine.medical_specialty ,Total knee arthroplasty ,Medicare ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Thromboembolism ,Internal medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Medical prescription ,Arthroplasty, Replacement, Knee ,Aged ,030222 orthopedics ,business.industry ,Confounding ,Opioid use disorder ,Odds ratio ,medicine.disease ,United States ,Analgesics, Opioid ,Distress ,Opioid ,business ,medicine.drug - Abstract
Opioid use disorder (OUD) is defined as a problematic pattern of opioid abuse and dependency leading to problems or distress. The purpose of this study is to investigate whether OUD patients undergoing primary total knee arthroplasty (TKA) have higher rates of venous thromboembolisms (VTEs), readmissions, and costs of care.Patients undergoing TKA with OUD were identified and matched to controls in a 1:4 ratio according to age, gender, comorbidity index, and comorbidities within the Medicare database. Ninety-day VTEs, 90-day readmissions, and costs of care were compared. A P-value less than .01 was considered statistically significant.The study yielded 54,480 patients with (n = 10,929) and without (n = 43,551) OUD undergoing primary TKA. Matching was successful as there were no significant differences in baseline characteristics. OUD patients were found to have greater odds of VTEs (odds ratio 2.27, P.0001) 90 days following primary TKA. OUD patients were found to have greater odds of 90-day readmissions (odds ratio 1.39, P.0001) in addition to incurring higher day of surgery ($13,360.73 vs $11,911.94, P.0001) and 90-day costs ($18,380.89 vs $15,565.57, P.0001) compared to controls.After adjusting for confounders, this analysis of 54,480 patients identified that patients with OUD have higher rates of VTEs, readmissions, and costs following primary TKA. In addition to using these data to help educate and counsel patients, the study should be used to help further regulate and control opioid prescriptions written by healthcare professionals.
- Published
- 2019
13. Does Patient Experience After a Total Knee Arthroplasty Predict Readmission?
- Author
-
Michael A. Mont and Nipun Sodhi
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Multivariable regression analysis ,business.industry ,Total knee arthroplasty ,Patient Readmission ,Hospitals ,Patient care ,Continuous variable ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Patient Satisfaction ,Medication information ,Patient experience ,Physical therapy ,medicine ,Humans ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,business ,Healthcare providers ,Retrospective Studies - Abstract
Background To our knowledge, the relationship between patient Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and patient outcomes in total knee arthroplasty (TKA) has not yet been analyzed. Therefore, the purpose of this study is to determine whether readmissions within the 30 or 90 days postoperative window after TKA were predicted by patient satisfaction scores, as measured by the HCAHPS survey. Methods We analyzed HCAHPS survey scores from all patients who underwent primary or revision TKA at our institution between January 1, 2016 and September 1, 2016. Demographic readmission information, preoperative baseline health status measures, validated patient-reported pain and joint function measures, and HCAHPS survey scores were collected. To determine whether 30-day or 90-day readmissions were independently associated with HCAHPS scores, statistical analyses were conducted using chi-squared and Student’s t-tests for categorical and continuous variables. Multivariable regression analysis adjusted for patient-level risk factors. Results Patients readmitted within 30 days were significantly less likely to choose the highest rating on survey questions in several dimensions of patient satisfaction when compared to patients who were not readmitted. These dimensions included physician communication (P = .045), discharge information (P = .016), and transition of care (P = .044). Similarly, patients who were readmitted within 90 days were less likely to choose the highest rating in survey questions that pertained to physician communication (P = .046), medication information (P = .040), and quietness of the hospital environment (P = .048). Conclusion Our results show that readmission is predicted by lower patient satisfaction scores in several dimensions of patient care including physician communication, hospital environment, medication information, discharge information, and transition of care.
- Published
- 2019
14. Biologic Therapies for the Treatment of Knee Osteoarthritis
- Author
-
Chukwuweike U. Gwam, Nicole E George, Nipun Sodhi, Michael A. Mont, Ronald E. Delanois, Ralph Frank Henn, and Jennifer I. Etcheson
- Subjects
Oncology ,medicine.medical_specialty ,medicine.medical_treatment ,Pain ,Osteoarthritis ,Cochrane Library ,Mesenchymal Stem Cell Transplantation ,Injections, Intra-Articular ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,030222 orthopedics ,Platelet-Rich Plasma ,business.industry ,Mesenchymal stem cell ,Biologic therapies ,Mesenchymal Stem Cells ,Small sample ,Stem-cell therapy ,Osteoarthritis, Knee ,medicine.disease ,Biological Therapy ,Orthopedic surgery ,business - Abstract
Background The use of biologic therapies for the management of knee osteoarthritis has increased, despite insufficient evidence of efficacy. Our aim was to complete a systematic review and analysis of reports utilizing the highest level-of-evidence evaluating: (1) platelet-rich plasma injections (PRPs); (2) bone marrow-derived mesenchymal stem cells (BMSCs); (3) adipose-derived mesenchymal stem cells (ADSCs); and (4) amnion-derived mesenchymal stem cells (AMSCs). Methods PubMed, Embase, and Cochrane Library databases were queried for studies evaluating PRP injections, BMSCs, ADSCs, and AMSCs in patients with knee osteoarthritis. Of 1009 studies identified within the last 5 years, 123 met inclusion criteria. A comprehensive analysis of all levels-of-evidence was performed, as well as separate analysis on level-of-evidence I studies. Level-of-evidence was determined by the American Academy of Orthopedic Surgeons classification system. Results Although the majority of PRP reports demonstrated improvements in pain and/or function, others revealed no substantial improvements. Similar findings were noted for BMSCs, ADSCs, and AMSCs. Assessments of BMSC studies yielded majority with positive clinical results, although short-lived. Studies on ADSCs revealed improved clinical outcomes, but equivocal radiographic outcomes. Studies evaluating AMSCs demonstrated improvements in pain and function, and decreased radiographic evidence of osteoarthritis. Conclusion Despite some promising early results for PRP, BMSC, ADSC, and AMSC therapies, the majority of level-of-evidence I studies have multiple problems: small sample sizes, potentially inappropriate control cohorts, short-term follow-up, and so on. Despite the limitations, there still appears to be evidence justifying their use for knee osteoarthritis management. More high-level, larger human studies utilizing standardized protocols are needed.
- Published
- 2019
15. Hip and Knee Section, Treatment, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections
- Author
-
Konstantinos N. Malizos, Anton Khlopas, Jorge Manrique, Marianthe Papanagiotoy, Rafael J. Sierra, Andrew Battenberg, Katsufumi Uchiyama, Adolph V. Lombardi, John Stammers, Jeffrey Granger, Maik Stiehler, Nipun Sodhi, Moneer M. Abouljoud, Derek Ward, Per Kjærsgaard-Andersen, Kyung-Hoi Koo, Andrew A. Freiberg, Yona Kosashvili, Matthew J. Dietz, Anna Ziogkou, Tae Kyun Kim, Percia Lazarovski, Michael A. Mont, Alejo Erice, Timothy L. Tan, David Backstein, Adam Katchky, and Jennifer Leighton
- Subjects
Reconstructive Flap ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Section (typography) ,Arthroscopy ,Dentistry ,Metallic implant ,Surgical implants ,Article ,Implant removal ,Orthopedic surgery ,Medicine ,Orthopedics and Sports Medicine ,business - Published
- 2019
16. General Assembly, Prevention, Blood Conservation: Proceedings of International Consensus on Orthopedic Infections
- Author
-
Seng Jin Yeo, Sumon Nandi, Luis Pulido, Mandus Akonjom, Xisheng Weng, Robert M. Molloy, Martin Sarungi, D. T. Wallace, Seung Beom Han, William A. Jiranek, Nicola Gallagher, Woo Young Jang, Yale A. Fillingham, Rafael Tibau Olivan, Jorge Manrique, Andrew Battenberg, Nipun Sodhi, Kalin Mihov, David E. Beverland, Maria Tibau Alberdi, Jae Hyuck Choi, Javad Parvizi, Michael A. Mont, Henry Wynn-Jones, and Trisha Peel
- Subjects
Aspirin ,medicine.medical_specialty ,Blood transfusion ,Blood conservation ,business.industry ,medicine.medical_treatment ,Clopidogrel ,Adenosine diphosphate receptor inhibitor ,Erythropoietin ,Anesthesia ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,business ,Tranexamic acid ,medicine.drug - Published
- 2019
17. Hip and Knee Section, Treatment, One Stage Exchange: Proceedings of International Consensus on Orthopedic Infections
- Author
-
László Bucsi, Jerzy Białecki, Shengjie Guo, Robert M. Molloy, Rhidian Morgan-Jones, Ariel Saldaña, Fares S. Haddad, Erik N. Hansen, Michael A. Mont, Pedro Foguet, Malte Ohlmeier, Stephen Jones, Akos Zahar, R. Walker, S. McHale, Kristóf Jánvári, Andrew Toms, Navin Fernando, Peter Keogh, and Nipun Sodhi
- Subjects
medicine.medical_specialty ,business.industry ,General surgery ,Section (typography) ,Orthopedic surgery ,Medicine ,One stage ,Orthopedics and Sports Medicine ,business ,Surgical morbidity - Published
- 2019
18. A comparison of relative value units in revision hip versus revision knee arthroplasty
- Author
-
Luke J. Garbarino, Nicolas S. Piuzzi, Nipun Sodhi, Michael A. Mont, Jared M. Newman, Assem A Sultan, Peter A. Gold, Bilal Mahmood, Sarah E. Dalton, Hiba K. Anis, and Anton Khlopas
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Relative value ,business.industry ,medicine.medical_treatment ,Value based care ,030229 sport sciences ,Arthroplasty ,Article ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Physical therapy ,Cost analysis ,Orthopedics and Sports Medicine ,business - Abstract
The purpose of this study was to compare the: 1) RVUs; 2) lengths-of-surgery; 3) RVU per minute between revision hip (THA) and knee (TKA) arthroplasties; and 4) perform an annualized surgeon cost analysis. Using the ACS-NSQIP from 2008 to 2015, 8081 revision TKAs, 7233 THAs were compared. Revision THA had greater mean RVUs (30.27 vs. 27.10 RVUs, p
- Published
- 2019
19. Survivorship of revised and multiply revised knee replacements
- Author
-
Michael A. Mont, Nipun Sodhi, and Hytham S Salem
- Subjects
Rheumatology ,business.industry ,Survivorship curve ,Immunology ,Immunology and Allergy ,Medicine ,business ,Demography - Published
- 2021
20. What provides a better value for your time? The use of relative value units to compare posterior segmental instrumentation of vertebral segments
- Author
-
Assem A Sultan, Michael A. Mont, Anton Khlopas, R. Douglas Orr, Thomas E. Mroz, Sarah E. Dalton, Jason W. Savage, Jared M. Newman, Morad Chughtai, and Nipun Sodhi
- Subjects
Adult ,Male ,Current Procedural Terminology ,Adolescent ,Databases, Factual ,Operative Time ,Context (language use) ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Instrumentation (computer programming) ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,Relative value ,business.industry ,Retrospective cohort study ,Health Care Costs ,Middle Aged ,Relative Value Scales ,Quality Improvement ,Spine ,Resource-based relative value scale ,Cohort ,Costs and Cost Analysis ,Female ,Surgery ,Neurology (clinical) ,Nuclear medicine ,business ,Student's t-test - Abstract
Relative value units (RVUs) are a compensation model based on the effort required to provide a procedure or service to a patient. Thus, procedures that are more complex and require greater technical skill and aftercare, such as multilevel spine surgery, should provide greater physician compensation. However, there are limited data comparing RVUs with operative time. Therefore, this study aims to compare mean (1) operative times; (2) RVUs; and (3) RVU/min between posterior segmental instrumentation of 3-6, 7-12, and ≥13 vertebral segments, and to perform annual cost difference analysis.A total of 437 patients who underwent instrumentation of 3-6 segments (Cohort 1, current procedural terminology [CPT] code: 22842), 67 patients who had instrumentation of 7-12 segments (Cohort 2, CPT code: 22843), and 16 patients who had instrumentation of ≥13 segments (Cohort 3, CPT code: 22844) were identified from the National Surgical Quality Improvement Program (NSQIP) database. Mean operative times, RVUs, and RVU/min, as well as an annualized cost difference analysis, were calculated and compared using Student t test. This study received no funding from any party or entity.Cohort 1 had shorter mean operative times than Cohorts 2 and 3 (217 minutes vs. 325 minutes vs. 426 minutes, p.05). Cohort 1 had a lower mean RVU than Cohorts 2 and 3 (12.6 vs. 13.4 vs. 16.4). Cohort 1 had a greater RVU/min than Cohorts 2 and 3 (0.08 vs. 0.05, p.05; vs. 0.08 vs. 0.05, p.05). A $112,432.12 annualized cost difference between Cohorts 1 and 2, a $176,744.76 difference between Cohorts 1 and 3, and a $64,312.55 difference between Cohorts 2 and 3 were calculated.The RVU/min takes into account not just the value provided but also the operative times required for highly complex cases. The RVU/min for fewer vertebral level instrumentation being greater (0.08 vs. 0.05), as well as the $177,000 annualized cost difference, indicates that compensation is not proportional to the added time, effort, and skill for more complex cases.
- Published
- 2018
21. Evidence-Based Management of Trunnionosis in Metal-on-Polyethylene Total Hip Arthroplasty: A Systematic Review
- Author
-
Robert M. Molloy, William A. Cantrell, Assem A Sultan, Anton Khlopas, Nipun Sodhi, Ryan J. Berger, Michael A. Mont, and Viktor E. Krebs
- Subjects
medicine.medical_specialty ,Osteolysis ,Arthroplasty, Replacement, Hip ,Aseptic loosening ,Prosthesis Design ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Intensive care medicine ,Taper corrosion ,030222 orthopedics ,business.industry ,Incidence ,Incidence (epidemiology) ,Evidence-based management ,Metal debris ,medicine.disease ,Prosthesis Failure ,Corrosion ,Metals ,Polyethylene ,Metal on polyethylene ,Hip Prosthesis ,business ,Algorithms ,Total hip arthroplasty - Abstract
Multiple recent reports have indicated a rising awareness of trunnionosis-related implant failures, accounting for up to 3% of all total hip arthroplasty revisions. Moreover, aseptic loosening and osteolysis from local release of metal debris can be the presenting manifestations, and thus the true incidence of trunnionosis is thought to be underreported. Furthermore, the relatively unclear and multifactorial pathogenesis and the widely variable clinical presentations pose a diagnostic challenge. A consensus regarding the ideal intervention and its timing is also lacking. Because of the relative paucity of reports regarding the diagnosis and management of trunnionosis, we conducted this evidence-based review to evaluate the (1) incidence, (2) pathogenesis, (3) diagnosis, and (4) treatment of trunnionosis in metal-on-polyethylene total hip arthroplasty. We then propose an algorithm for the diagnostic work-up and management of this condition.
- Published
- 2018
22. Robotic Arm–Assisted Total Knee Arthroplasty
- Author
-
Robert M. Molloy, Assem A Sultan, Morad Chughtai, Anton Khlopas, Michael A. Mont, and Nipun Sodhi
- Subjects
030222 orthopedics ,Surgical team ,medicine.medical_specialty ,Knee Joint ,business.industry ,Total knee arthroplasty ,Reproducibility of Results ,Human factors and ergonomics ,030229 sport sciences ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Robotic Surgical Procedures ,Patient Satisfaction ,Cadaver ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Medical physics ,Patient Reported Outcome Measures ,Arthroplasty, Replacement, Knee ,business ,Robotic arm ,Learning Curve - Abstract
Background Robotic arm–assisted total knee arthroplasty (RATKA) has a number of potential advantages. Therefore, in order to more comprehensively assess this technology, we reviewed the (1) accuracy and precision; (2) soft-tissue protection; (3) patient satisfaction; (4) learning curve; and (5) its other potential benefits. Methods A literature review was conducted using PubMed search database for studies reporting clinical outcomes, cadaver results, radiographic outcomes, surgeon experience, and robotic accuracy. Forty articles were included for the final analysis. Results Advantages of RATKA may include greater component accuracy and precision, soft-tissue protection, increased patient satisfaction, a short learning curve, optimal ergonomic design, and less surgeon and surgical team fatigue. The aforementioned advantages might help improve clinical, surgical, and patient-reported outcomes. Conclusion Although there are a number of studies that highlight the potential advantages of RATKA, most of these studies report of short-term outcomes. It is hoped that longer term studies will continue to support the use of this technology in providing higher patient satisfaction and other clinical outcomes.
- Published
- 2018
23. The Association Between Readmission and Patient Experience in a Total Hip Arthroplasty Population
- Author
-
Nathan W. Mesko, Damien Billow, Robert J. Nickodem, Kim L. Stearns, George F. Muschler, Jay M. Levin, Lukas M. Nystrom, Anthony Miniaci, Peter J. Brooks, Trevor G. Murray, Assem A Sultan, Michael A. Mont, Joseph P. Iannotti, Daniel Bokar, Wael K. Barsoum, Kevin Phipps, Peter J. Evans, William H. Seitz, Michael W. Kattan, John McLaughlin, Nicolas S. Piuzzi, James Rosneck, Michael R. Bloomfield, Kurt P. Spindler, Juan C. Suarez, Jonathan Schaffer, Viktor E. Krebs, Anton Khlopas, Elizabeth Sosic, Eric T. Ricchetti, Morad Chughtai, Carmen Kestranek, Preetesh D. Patel, Greg Strnad, Michael J. Joyce, Robert M. Molloy, Carlos A. Higuera, Susannah L. Rose, Nipun Sodhi, and Gregory J. Gilot
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Population ,Negative association ,Logistic regression ,Patient Readmission ,Cohort Studies ,Continuous variable ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Patient experience ,Odds Ratio ,Humans ,Pain Management ,Medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,education ,Aged ,Aged, 80 and over ,030222 orthopedics ,education.field_of_study ,Chi-Square Distribution ,business.industry ,Middle Aged ,Pain management ,Hospitals ,Patient Discharge ,Logistic Models ,Patient Satisfaction ,Joint pain ,Physical therapy ,Female ,medicine.symptom ,business ,Total hip arthroplasty - Abstract
Our goal was to determine whether readmissions within 30 or 90 days following discharge are associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for total hip arthroplasty (THA) patients.HCAHPS surveys from all patients who underwent THA between January 2016 and September 2016 in our institution were analyzed. Readmissions, demographics, baseline joint pain, joint function, and Veterans RAND-12 scores were collected. Statistical analyses involved Pearson's chi-squared tests for categorical variables and Student's t-tests for continuous variables. Multivariable logistic regression models were used to determine whether 30-day or 90-day readmissions were independently associated with HCAHPS scores.A total of 1868 patients were identified, the survey was sent to 969 patients and 578 completed the survey (59.6%). Eight patients (1.4%) were readmitted within 30 days, and 28 patients (4.8%) within 90 days. These patients were more likely to undergo revision THA (P.001). For the 30-day readmission cohort, 4 of 8 patients (50.0%) rated the hospital a 9 or 10 out of 10 compared to 466 of 567 patients (82.2%) of the non-readmitted cohort (P = .019). Thirty-day readmissions were associated with significantly lower likelihood of rating the hospital a 9 or 10 out of 10 (odds ratio 0.18).Our results demonstrate a significant negative association between readmission and HCAHPS scores under several dimensions of the survey including nurse communication, doctor communication, pain management, and global satisfaction with the hospital experience.
- Published
- 2018
24. What Influence Does the Time of Year Have on Postoperative Complications Following Total Knee Arthroplasty?
- Author
-
Carlos A. Higuera, Anton Khlopas, Nipun Sodhi, Assem A Sultan, Michael A. Mont, Jaiben George, Sarah E. Dalton, Mitchell Ng, and Nicolas S. Piuzzi
- Subjects
Male ,Reoperation ,Current Procedural Terminology ,medicine.medical_specialty ,Multivariate statistics ,Multivariate analysis ,Blood transfusion ,medicine.medical_treatment ,Lower risk ,Cohort Studies ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Linear regression ,Humans ,Medicine ,Blood Transfusion ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Aged ,030222 orthopedics ,Geography ,business.industry ,Incidence ,Univariate ,Postoperative complication ,Middle Aged ,Hospitals ,United States ,Surgery ,Multivariate Analysis ,Regression Analysis ,Female ,Seasons ,business ,Complication - Abstract
Background The time of year might influence the occurrence of surgical complications. Therefore, this study investigated correlations between the time-of-year and 30-day postoperative complication rates following primary total knee arthroplasty (TKA). Specifically, we determined (1) postoperative complication rates across all quarters; and (2) time-of-year influence on complications using univariate and multivariate regression analyses. Methods CPT code 27447 identified 147,473 TKAs from the NSQIP database. Readmissions, reoperations, as well as medical and surgical complications occurring within 30 postoperative days were assessed. All TKAs were divided into 4 cohorts based on the quarter-of-the-year (Q1-Q4) during which the surgery was performed. Chi-Square, ANOVA, linear regression, as well as univariate and multivariate analyses were performed to compare complication rates. A P Results Q3 had a higher risk of superficial infection when compared to Q1 (OR 1.37; 95% CI 1.12-1.69; P = .002). There was a lower risk of pneumonia between Q2 and Q1 (OR: 0.7; 95% CI 0.54-0.90; P = .007) as well as Q4 and Q1 (OR 0.76; 95% CI 0.6-0.96; P = .017). Blood transfusion was lower in Q2, Q3, and Q4 compared to Q1 (P = .02, P Conclusion This study provides a baseline analysis correlating the time of year and outcomes of TKA. However, since seasonality and weather can vary greatly in the United States by geographic region and time of year, future studies should be performed at a more granular level using hospital-specific data correlating weather and region to TKA outcomes.
- Published
- 2018
25. Total shoulder arthroplasty in octogenarians: Is there a higher risk of adverse outcomes?
- Author
-
Michael A. Mont, Danielle J. Casagrande, Andrew Yang, Jared M. Newman, Andrew J. Hayden, Nipun Sodhi, James P. Doran, Anant Dixit, and Sarah G Stroud
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Adverse outcomes ,business.industry ,Patient demographics ,medicine.medical_treatment ,Perioperative ,Arthroplasty ,Article ,Odds ,Acs nsqip ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Functionally independent ,medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,business ,human activities - Abstract
This study used the National Surgical Quality Improvement Program to evaluate octogenarians who underwent total shoulder arthroplasty (TSA). Specifically, we evaluated: (1) patient demographics; (2) perioperative factors; and (3) 30-day postoperative complications. Compared to controls, the octogenarians had more females, white patients, lower BMIs, fewer smokers, less functionally independent, higher ASA scores, shorter operative times, and longer LOS. Octogenarians had greater odds for developing any (OR = 2.05; 95%CI, 1.70–2.46), any major (OR = 2.28; 95%CI, 1.66–3.13), and any minor (OR = 1.99; 95%CI, 1.63–2.45) complications. Perioperative risk management strategies for elective TSA in the elderly may help mitigate the increased perioperative risks associated with age.
- Published
- 2018
26. Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Hip Arthroplasty
- Author
-
George A. Yakubek, Gannon L. Curtis, Nipun Sodhi, Mhamad Faour, Alison K. Klika, Michael A. Mont, Wael K. Barsoum, and Carlos A. Higuera
- Subjects
Male ,Operating Rooms ,Databases, Factual ,Arthroplasty, Replacement, Hip ,Operative Time ,Osteoarthritis, Hip ,Cohort Studies ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Humans ,Orthopedics and Sports Medicine ,Postoperative Period ,030212 general & internal medicine ,Aged ,030222 orthopedics ,Length of Stay ,Middle Aged ,Quality Improvement ,Hospitals ,Patient Discharge ,United States ,Treatment Outcome ,Female - Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Furthermore, COPD patients are at increased risk of complications following surgery. The purpose of this study was to evaluate the postoperative total hip arthroplasty (THA) outcomes of COPD patients. Specifically, we asked the following questions: (1) Is COPD associated with adverse perioperative outcomes and (2) Does COPD increase the risk of short-term complications following THA?The American College of Surgeons National Surgical Quality Improvement Program database was used to identify 64,796 patients who underwent THA between 2008 and 2014. A total of 2426 patients with COPD were identified. COPD and non-COPD cohorts were compared based on the following outcomes: hospital length-of-stay, operative times, discharge disposition, and 30-day postoperative complications.COPD patients were found to have a longer length-of-stay and be discharged to an extended care facility (P.001). COPD patients were also at significantly (P.05) increased risk for any complication, such as mortality, myocardial infarction, pneumonia, septic shock, unplanned reintubation, use of a mechanical ventilator48 hours, deep infection, require a blood transfusion, return to operating room, and a readmission within 30 days postoperatively.COPD patients are more likely to suffer from postoperative complications following THA when compared to non-COPD patients. Many of these complications are medical, pulmonary evaluation and medical optimization are a critical step in preoperative management for these patients.
- Published
- 2018
27. The Impact of Spino-Pelvic Alignment on Total Hip Arthroplasty Outcomes: A Critical Analysis of Current Evidence
- Author
-
Assem A Sultan, Nicolas S. Piuzzi, Michael A. Mont, Nipun Sodhi, Morad Chughtai, and Anton Khlopas
- Subjects
Adult ,Male ,Risk ,musculoskeletal diseases ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Joint Dislocations ,Pelvis ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Spine deformity ,medicine ,Humans ,Orthopedics and Sports Medicine ,In patient ,Aged ,Retrospective Studies ,Aged, 80 and over ,Surgeons ,030222 orthopedics ,Lumbar Vertebrae ,business.industry ,Acetabulum ,Middle Aged ,Surgical correction ,equipment and supplies ,musculoskeletal system ,Arthroplasty ,Spine ,Surgery ,Spinal Fusion ,surgical procedures, operative ,Increased risk ,Spinal fusion ,Spinal deformity ,Physical therapy ,Female ,business ,Algorithms ,030217 neurology & neurosurgery ,Total hip arthroplasty - Abstract
In this review, we (1) evaluated the effect of adult spine deformity (ASD) and its surgical correction on patients who had a total hip arthroplasty (THA); (2) evaluated the outcomes of THA in patients who have had previous spinal fusion; and (3) we presented an algorithm on how to surgically address patients who simultaneously require THA and ASD correction.A comprehensive literature search was conducted. Our final analysis included 14 studies. Overall, there were 3 studies that reported on the impact of ASD on THA outcomes, 6 studies reported on the effect of ASD correction on THA outcomes, and 5 studies reported on the effect of spinal fusion on THA outcomes.Patients with concurrent ASD and THA are at increased risk of THA dislocations and revisions with studies reporting a compiled 2.9% dislocation rate in 1167 patients. Patients who underwent ASD correction demonstrated a post-operative reduction of acetabular anteversion (mean reduction range 4.96°-11.2°, P.001) and tilt (mean -7° ± 10°, P.001). In THA patients with concurrent lumbosacral fusion, dislocation rates ranged between 3% at 1 year and 7.5% at 2 years compared to 0.4%-2.1% dislocation rates in matching cohorts (P.001).Spine balance can alter THA outcomes, but the exact mechanism is yet to be elucidated. We aimed at bridging the gap between hip and spine surgeons with an up-to-date analysis of the best available evidence and presented an algorithm for approaching patients who may simultaneously need ASD correction and THA.
- Published
- 2018
28. Cementless Total Knee Arthroplasty in Knee Osteonecrosis Demonstrated Excellent Survivorship and Outcomes at Three-Year Minimum Follow-Up
- Author
-
Anton Khlopas, Steven F. Harwin, Michael A. Mont, Prem N. Ramkumar, Nipun Sodhi, Mark L. Denzine, and Assem A Sultan
- Subjects
Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Knee Joint ,Radiography ,medicine.medical_treatment ,Total knee arthroplasty ,Kaplan-Meier Estimate ,Survivorship ,03 medical and health sciences ,0302 clinical medicine ,Survivorship curve ,medicine ,Humans ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Arthroplasty, Replacement, Knee ,Aged ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Osteonecrosis ,Sequela ,030229 sport sciences ,Middle Aged ,musculoskeletal system ,medicine.disease ,Arthroplasty ,Confidence interval ,Surgery ,Treatment Outcome ,surgical procedures, operative ,Radiological weapon ,Female ,Implant ,Knee Prosthesis ,business ,Follow-Up Studies - Abstract
Background Lack of consensus exists on the use of cementless total knee arthroplasty (TKA) in patients with knee osteonecrosis. Therefore, this study was conducted to evaluate (1) implant survivorship; (2) clinical outcomes and complications; and (3) radiographic outcomes of primary cementless TKA in knee osteonecrosis. Methods This study included 46 patients (49 knees) who had knee osteonecrosis and underwent primary cementless TKA and had a mean follow-up of 44 months (range 36-96). Kaplan-Meier analysis was used to evaluate implant survivorship. Follow-up was performed post-operatively at 6 weeks, 3 months, and annually thereafter. Clinical outcomes including the Knee Society Scores (KSS) for pain and function, changes in range-of-motion, complications, and radiographic outcomes were analyzed. Results Aseptic implant survivorship was 97.9% (95% confidence interval 1.01-0.93) and all-cause implant survivorship was 95.9% (95% confidence interval 1.01-0.9), with 1 septic and 1 aseptic failures. The mean KSS for pain was 93 points (range 85-100) and the mean KSS for function was 84 points (range 70-90). Additionally, 1 patient had superficial wound necrosis and was treated with local wound care with no further sequela. Otherwise, no evidence of loosening, subsidence, or progressive radiolucencies were noted on radiological evaluation. Conclusion Excellent implant survivorship, clinical, and radiographic outcomes of primary cementless TKA in the setting of knee osteonecrosis was demonstrated. Although further long-term study is needed to validate survivorship, new generation cementless TKA implants provide promising results in this subset of patients.
- Published
- 2018
29. Association Between Body Mass Index and Thirty-Day Complications After Total Knee Arthroplasty
- Author
-
Nicolas S. Piuzzi, Anton Khlopas, Mitchell Ng, Michael A. Mont, Jaiben George, and Nipun Sodhi
- Subjects
Male ,Reoperation ,Risk ,medicine.medical_specialty ,Multivariate statistics ,Databases, Factual ,medicine.medical_treatment ,Total knee arthroplasty ,Overweight ,Patient Readmission ,Body Mass Index ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Weight management ,medicine ,Humans ,Blood Transfusion ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,Aged, 80 and over ,Arthritis, Infectious ,030222 orthopedics ,business.industry ,Middle Aged ,Osteoarthritis, Knee ,medicine.disease ,Arthroplasty ,Obesity ,Obesity, Morbid ,Pulmonary embolism ,Multivariate Analysis ,Female ,medicine.symptom ,Pulmonary Embolism ,business ,Body mass index - Abstract
Although previous studies have evaluated the effect of obesity on the outcomes of total knee arthroplasty (TKA), most considered obesity as a binary variable. It is important to compare different weight categories and consider body mass index (BMI) as a continuous variable to understand the effects of obesity across the entire range of BMI. Therefore, the objective of this study is to analyze the effect of BMI on 30-day readmissions and complications after TKA, considering BMI as both a categorical and a continuous variable.The National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 150,934 primary TKAs. Thirty-day rates of readmissions, reoperations, and medical/surgical complications were compared between different weight categories (overweight: BMI25 and ≤30 kg/mObese patients were at increased risk of pulmonary embolism (PE) (P.001), while morbidly obese patients were at increased risk of readmission (P.001), reoperation (P.001), superficial infection (P.001), periprosthetic joint infection (P.001), wound dehiscence (P.001), PE (P.001), urinary tract infection (P = .003), reintubation (P = .004), and renal insufficiency (P.001). Transfusion was lower in overweight (P.001), obese (P.001), and morbidly obese (P.001) patients. BMI had a nonlinear relationship with readmission (P.001), reoperation (P.001), periprosthetic joint infection (P = .041), PE (P.001), renal insufficiency (P = .046), and transfusion (P.001).Obesity increased the risk of readmission and various complications after TKA, with the risk being dependent on the severity of obesity. Relationships between BMI and complications showed considerable variations with some outcomes like readmission and reoperation showing a U-shaped relationship. Based on our findings, a potential BMI goal in weight management for obese patients could be established around 29-30 kg/m
- Published
- 2018
30. Corrigendum to ‘Effect of Antibiotic-Impregnated Bone Cement in Primary Total Knee Arthroplasty [The Journal of Arthroplasty 34 (2019) 2091-2095]
- Author
-
Nipun Sodhi, Alison K. Klika, Hiba K. Anis, Robert M. Molloy, Wael K. Barsoum, Michael A. Mont, Mhamad Faour, and Carlos A. Higuera
- Subjects
medicine.drug_class ,business.industry ,medicine.medical_treatment ,Antibiotics ,Total knee arthroplasty ,medicine ,Dentistry ,Orthopedics and Sports Medicine ,business ,Bone cement ,Arthroplasty - Published
- 2021
31. Reasons and Risk Factors for Emergency Department Visits After Primary Total Knee Arthroplasty: An Analysis of 1.3 Million Patients
- Author
-
Joseph O. Ehiorobo, Nipun Sodhi, Martin W. Roche, Michael A. Mont, Angelo Mannino, and Rushabh M. Vakharia
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Demographics ,business.industry ,Incidence ,Incidence (epidemiology) ,Binomial regression ,Patient demographics ,Total knee arthroplasty ,Comorbidity ,Odds ratio ,Emergency department ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Emergency medicine ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,Emergency Service, Hospital ,business ,Retrospective Studies - Abstract
Well-powered studies investigating the relationship of emergency department (ED) visits and total knee arthroplasty (TKA) are limited. Therefore, the specific aims of this study were to: 1) compare patient demographics of patients who did and did not have an ED visit; and for the visits, identified: 2) leading reasons; and 3) risk factors for ED visits (prearthroplasty/postarthroplasty).Patients undergoing primary TKA who had an ED visit within 90 days after their index procedure were identified from a nationwide database. The query yielded 1,364,655 patients who did (n = 5689) and did not have (n = 1,358,966) an ED visit. Baseline demographics such as age, sex, and comorbidity prevalence between the two cohorts; reasons for ED visits; and prearthroplasty and postarthroplasty risk factors were analyzed. Odds ratios (ORs) of ED visits were assessed using multivariate binomial logistic regression analyses. A P-value less than 0.001 was considered statistically significant.Patients who did and did not have ED visits differed with respect to age (P.0001) and mean Elixhauser Comorbidity Index scores (9 vs 6, P.0001). Musculoskeletal etiologies were the most common reason for ED visits. Hypertension was the greatest contributor to ED visits prearthroplasty and postarthroplasty. Comorbid conditions associated with ED visits postarthroplasty included peripheral vascular disease (OR: 1.61, P.0001), coagulopathy (OR: 1.58, P.0001), and rheumatoid arthritis (OR: 1.56, P.0001).By identifying demographic patterns of patients, reasons, and risk factors, the information found from this study can help identify targets for quality improvement to potentially reduce the incidence of ED visits after primary TKA.
- Published
- 2021
32. Shoulder replacement survivorship
- Author
-
Michael A. Mont and Nipun Sodhi
- Subjects
medicine.medical_specialty ,Rheumatology ,business.industry ,Survivorship curve ,medicine.medical_treatment ,Immunology ,Immunology and Allergy ,Medicine ,business ,Shoulder replacement ,Surgery - Published
- 2020
33. Erratum to ‘Hip and Knee Section, Treatment, Surgical Technique: Proceedings of International Consensus on Orthopedic Infections’ [The Journal of Arthroplasty 34 (2019) S445-S451]
- Author
-
Per Kjærsgaard-Andersen, Perica Lazarovski, Timothy L. Tan, Konstantinos N. Malizos, Adolph V. Lombardi, Adam Katchky, Jennifer Leighton, Yona Kosashvili, Rafael J. Sierra, Marianthe Papanagiotoy, Jorge Manrique, Maik Stiehler, Kyung-Hoi Koo, Anton Khlopas, Andrew A. Freiberg, Michael A. Mont, Matthew J. Dietz, Tae Kyun Kim, John Stammers, David Backstein, Jeffrey Granger, Alejo Erice, Anna Ziogkou, Moneer M. Abouljoud, Andrew Battenberg, Katsufumi Uchiyama, Nipun Sodhi, and Derek Ward
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Published Erratum ,General surgery ,Orthopedic surgery ,Section (typography) ,medicine ,MEDLINE ,Orthopedics and Sports Medicine ,business ,Arthroplasty - Published
- 2019
34. Survival of total hip replacements
- Author
-
Nipun Sodhi and Michael A. Mont
- Subjects
Hip surgery ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,MEDLINE ,Total hip replacement ,Follow up studies ,General Medicine ,Osteoarthritis ,medicine.disease ,Arthroplasty ,Surgery ,medicine ,business - Published
- 2019
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.