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As more commercial insurance companies adopt a bundled reimbursement model, similar to the Comprehensive Care for Joint Replacement (CJR) algorithm for Medicare beneficiaries, accurate risk adjustment of patient-reported outcomes (PROs) is critical to ensure success. With this movement toward bundled reimbursement, it is unknown if a formula adjusting for similar risks in the Medicare population could be applied to PROs in commercially insured and Medicare Advantage populations undergoing total knee arthroplasty (TKA). This study was performed to compare PROs after TKA in these insurance groups after adjusting for proposed risks. Demographics and clinical data were abstracted from medical records of 302 patients who underwent TKA performed by a single surgeon at a university-based orthopaedic practice during 2013 to 2017. Differences in PROs between commercially insured, Medicare Advantage, and Medicare patients during the 6 months following surgery were evaluated while controlling for demographics, clinical data, and baseline PRO scores. Medicare and Medicare Advantage patients were older ( p  < 0.001) and had more comorbidities ( p  = 0.001) than commercial patients. During the first 3 months following TKA, patients in all three groups experienced similar rates of recovery. At 6 months after surgery, outcomes began to diverge by insurance group. Medicare patients reported significantly less ability to perform activities of daily living (78.6 vs. 63.2; p  = 0.001), worse physical function (39.6 vs. 44.9; p  = 0.003), and more pain interference (57.9 vs. 52.4; p  = 0.018) at day 180 than commercially insured patients. There were no statistically significant differences between Medicare Advantage patients and either commercially insured or Medicare patients. Therefore, commercial insurance companies that intend to apply a risk-adjusted equation similar to the CJR algorithm to commercial populations should be cautioned since the postoperative outcomes in this investigation differed after adjusting for the same risk factors that have been proposed for inclusion in the CJR algorithm. Nonetheless, further studies should be performed to ensure that companies participating in bundled reimbursement models have a positive influence on comprehensive health care for patients and providers. This is a level III, retrospective prognostic study., Competing Interests: A. B. received payment from LSUHSC for consultation on manuscript preparation for this study. H. S., W. H. W., W. S., S. S., J. M., C. L., and V. D. declare that they have no conflict of interest., (Thieme. All rights reserved.)

An effusion at the onset of viscosupplementation has been thought to diminish the efficacy and increase adverse event rates. This study compares efficacy of hylan G-F 20 in patients with and without an effusion. Patients with knee osteoarthritis (OA) received three weekly injections of hylan G-F 20. A total of 50 patients with an effusion requiring aspiration were compared with 50 matched patients without an effusion. Outcome measurements included Western Ontario and McMaster's Universities Osteoarthritis index (WOMAC) and visual analog scale (VAS). Patients were followed for 26 weeks. Both effusion and control group VAS was significantly lowered at all time points. WOMAC scores improved (p < 0.025) at all visits in the effusion group except for WOMAC A-1 week 14. Control WOMAC scores also significantly improved at all visits (p < 0.027), except for full WOMAC and WOMAC A-1 at week 1. Neither group experienced an adverse event. Presence of an effusion at onset of viscosupplementation requiring aspiration does not negatively impact efficacy of hylan G-F 20 or increase adverse event rates., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)