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Background: Total ankle replacement (TAR) has gained acceptance as an alternative to traditional ankle arthrodesis (AA)for end-stage ankle arthritis. Little is known about long-term trends in volume, utilization, and patient characteristics. Theobjective of this study was to use longitudinal data to examine temporal trends in TAR and AA.Methods: We identified all United States fee-for-service Medicare beneficiaries who underwent TAR and AA between1991 and 2010 (n = 5871 and 29 532, respectively). We examined changes in patient demographics and comorbidity,nationwide and hospital volume, per capita utilization, and length of stay (LOS).Results: Between 1991 and 2010, both TAR and AA patients had modest shifts in characteristics, with higher rates ofdiabetes and obesity. Overall, TAR Medicare volume increased by more than 1000% from 72 procedures in 1991 to 888in 2010, while per-capita standardized utilization increased 670.8% (P < .001). AA volume increased 35.8% from 1167procedures in 1991 to 1585 in 2010, while per-capita standardized utilization declined 15.6% (P < .001). The percentageof all US hospitals performing TAR increased nearly 4-fold from 3.1% in 1991 to 12.6% in 2010, while the proportionperforming AA remained relatively unchanged. LOS decreased dramatically from 8.7 days in 1991 to 2.3 days in 2010 inTAR and from 5.5 days to 3.2 days in AA (P < .001).Conclusion: Between 1991 and 2010, Medicare beneficiaries undergoing either TAR or AA became more medicallycomplex. Both volume and per-capita utilization of TAR increased dramatically but remained nearly constant for AA. Atthe same time, mean hospital volume for both procedures remained low. Further research should be directed towarddetermining design, surgeon, and hospital variables that relate to optimal outcomes following TAR, which has becomeincreasingly used for the treatment of ankle arthritis.Level of Evidence: Level III, comparative series. [ABSTRACT FROM AUTHOR]

Abstract: Recently, the government has moved towards public reporting of 30-day readmission rates after elective primary total knee (TKA) and total hip arthroplasty (THA). We identified 11,814 and 8105 patients who underwent primary TKA and THA from the 2011 ACS NSQIP. Overall readmission rates within 30-days of surgery were 4.6% for TKA and 4.2% for THA. Complications associated with readmission were predominantly wound infections, sepsis, thromboembolic, cardiac, and respiratory related. In TKA, multivariate analysis identified age (P =0.002), male gender (P =0.03), cancer history (P =0.008), elevated BUN (P =0.002), a bleeding disorder (P <0.001) and high ASA class (P <0.001) as predictors of readmission. In THA, obesity (P =0.008), steroid use (P =0.037), a bleeding disorder (P =0.002), dependent functional status (P =0.022), and high ASA class (P <0.001) predicted readmission. Understanding characteristics associated with readmission will be essential for equitable patient risk stratification. [Copyright &y& Elsevier]

Background To our knowledge, no prior study has evaluated outcomes after elective lumbar spinal surgery in human immunodeficiency virus (HIV) patients without acquired immunodeficiency syndrome (AIDS). This review investigated the impact of HIV-positive status (without AIDS) on outcomes after elective lumbar fusion for degenerative disc disease (DDD). Methods Adult patients registered in the Nationwide Inpatient Sample (2002–2011) undergoing elective lumbar fusion for DDD were extracted. Multivariable regression techniques were used to explore the association of HIV positivity with outcomes after lumbar fusion. Results This cohort included 612,000 hospitalizations (0.07% were HIV positive) of lumbar fusion for DDD. Compared with HIV-negative patients undergoing lumbar fusion, HIV-positive patients were younger (47 vs. 55 years), male (61% vs. 42%), largely insured by Medicare (30% vs. 5%), and had higher rates of chronic obstructive pulmonary disease (23.7% vs. 14.6%) (all P < 0.001) but had lower rates of obesity, hypertension, and diabetes (all P < 0.001). Multivariable models demonstrated HIV positivity to be associated with higher odds for an adverse event (odds ratio [OR], 1.92; P < 0.001), in-hospital mortality (OR, 39.91; P < 0.001), wound complications (OR, 2.60; P = 0.004), respiratory (OR, 5.43; P < 0.001) and neurologic (OR, 1.96; P = 0.039) complications, and higher costs (7.1% higher; P = 0.011) compared with non-HIV patients. There were no differences in thromboembolic events, cardiac or gastrointestinal complications, discharge disposition, or length of stay. Conclusions Even in this selected cohort of well-controlled HIV patients, there were high complications, with concerning rates of death and respiratory complications. These data shed new light on elective spine surgery in HIV patients and may influence the treatment algorithm of surgeons who are familiar with older papers. [ABSTRACT FROM AUTHOR]

Background: Use of large databases for orthopedic research has become extremely popular in recent years. Each database varies in the methods used to capture data and the population it represents. The purpose of this study was to evaluate how these databases differed in reported demographics, comorbidities, and postoperative complications for primary total hip arthroplasty (THA) patients., Methods: Primary THA patients were identified within National Surgical Quality Improvement Programs (NSQIP), Nationwide Inpatient Sample (NIS), Medicare Standard Analytic Files (MED), and Humana administrative claims database (HAC). NSQIP definitions for comorbidities and complications were matched to corresponding International Classification of Diseases, 9th Revision/Current Procedural Terminology codes to query the other databases. Demographics, comorbidities, and postoperative complications were compared., Results: The number of patients from each database was 22,644 in HAC, 371,715 in MED, 188,779 in NIS, and 27,818 in NSQIP. Age and gender distribution were clinically similar. Overall, there was variation in prevalence of comorbidities and rates of postoperative complications between databases. As an example, NSQIP had more than twice the obesity than NIS. HAC and MED had more than 2 times the diabetics than NSQIP. Rates of deep infection and stroke 30 days after THA had more than 2-fold difference between all databases., Conclusion: Among databases commonly used in orthopedic research, there is considerable variation in complication rates following THA depending upon the database used for analysis. It is important to consider these differences when critically evaluating database research. Additionally, with the advent of bundled payments, these differences must be considered in risk adjustment models., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The purpose of this study is to answer the following questions: (1) What is the prevalence of opioid use prior to primary total hip arthroplasty (THA)? (2) What is the typical trend in opioid use following THA over the first post-operative year? (3) What are the risk factors for prolonged opioid use following primary THA?, Methods: Primary THA patients were identified in the Humana database from 2007 to 2015. Pre-operative and post-operative opioid use was measured by monthly prescription refill rates. Rates of opioid use were trended monthly for 1 year post-operatively and compared based on pre-operative opioid user (OU) status as well as other patient demographics and co-morbidities., Results: In total, 37,393 THA patients were analyzed and 14,309 patients (38.2%) were pre-operative opioid users (OUs). Pre-operative opioid use was the strongest predictor for prolonged opioid use following THA, with non-opioid users filling significantly less opioid prescriptions than OUs at every time point analyzed. Younger age, female sex, and all other diagnoses analyzed were found to significantly increase the rate of opioid refilling following THA throughout the entire post-operative year., Conclusion: Over one-third of THA patients use opioids within 3 months prior to THA and this percentage has increased 6% during the years included in this study. Pre-operative opioid use was most predictive of increased refills of opioids following THA. These data provide an important baseline for opioid use trends following THA that can be used for future comparison while identifying risk factors for prolonged use that will be helpful to prescribers as we all work to decrease opioid use, misuse, and abuse., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The purpose of this study is to (1) identify the incidence of surgical delay in hip fractures, (2) evaluate the time point surgical delay puts patients at increased risk for complications, and (3) identify risk factors for surgical delay in the setting of surgical management of hip fractures., Methods: A multi-center database was queried for patients of 60 years of age or older undergoing surgical treatment of a hip fracture. Surgical delay was defined by days from admission until surgical intervention. Univariate analyses and multivariate analyses were performed on all groups., Results: A total of 4215 patients underwent surgery for their hip fracture. Of those experiencing surgical delay, 3304 (78%) patients experienced surgical delay of ≥1 day, 1314 (31%) had delay of ≥2 days, and 480 (11%) experienced delay of ≥3 days. There was a significant difference in complications if patients experienced surgical delay of ≥2 days (P ≤ .01). Multivariate analyses identified multiple risk factors for delay of ≥2 days including congestive heart failure (odds ratio 3.09, 95% confidence interval 2.04-4.66) and body mass index ≥40 (odds ratio 2.31, 95% confidence interval 1.31-4.08). Subgroup analysis identified that patients undergoing total hip arthroplasty were not at risk for complications with surgical delay of ≥2 days., Conclusion: Surgical delay of ≥2 days in the setting of hip fractures is common and confers an increased risk of complications in those undergoing non-total hip arthroplasty procedures. We recommend surgical intervention prior to 48 hours from hospital admission when possible. Healthcare systems can utilize our non-modifiable risk factors when performing quality assessment and cost accounting., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: The United States is in the midst of an opioid epidemic. Little is known about perioperative opioid use for total knee arthroplasty (TKA). The purpose of this study was to identify rates of preoperative opioid use, evaluate postoperative trends and identify risk factors for prolonged use after TKA., Methods: Patients who underwent primary TKA from 2007-2014 were identified within the Humana database. Postoperative opioid use was measured by monthly prescription refill rates. A preoperative opioid user (OU) was defined by history of opioid prescription within 3 months prior to TKA and a non-opioid user (NOU) was defined by no history of prior opioid use. Rates of opioid use were trended monthly for one year postoperatively for all cohorts., Results: 73,959 TKA patients were analyzed and 23,532 patients (31.2%) were OU. OU increased from 30.1% in 2007 to 39.3% in 2014 (P < .001). Preoperative opioid use was the strongest predictor for prolonged opioid use following TKA, with OU filling significantly more opioid prescriptions than NOU at every time point analyzed. Younger age, female sex and other intrinsic factors were found to significantly increase the rate of opioid refilling following TKA throughout the postoperative year., Conclusion: Approximately one-third of TKA patients use opioids within 3 months prior to surgery and this percentage has increased over 9% during the years included in this study. Preoperative opioid use was most predictive of increased refills of opioids following TKA. However, other intrinsic patient characteristics were also predictive of prolonged opioid use., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: When new technologies are introduced, it is important to evaluate the rate of adoption and outcomes compared with preexisting technology. The purpose of this study was to determine the adoption rate of computer-assisted navigation in total knee arthroplasty (TKA), to determine if the short-term complication rate changed over time with navigation, and to compare short-term complication rates of navigated and traditional TKA., Methods: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify 108,277 patients undergoing primary TKA between 2010 and 2014, of which 3573 cases (3.30%) were navigated. Rates of adoption of navigated TKA were determined. Differences in short-term complications by year were compared using propensity score matching., Results: Navigation utilization decreased from 4.96% in 2010 to 3.06% in 2014. Blood transfusion rates for the entire cohort decreased from 19% in 2011 to 6% in 2014, and was not decreased with navigation compared with traditional TKA in 2014 (P = .1309). Operative time was not increased by navigation, and average 94.2 minutes. There were no significant differences in all-cause complications, reoperation rate, unplanned readmission, or length of stay for any year., Conclusions: There was a 38.3% decrease in TKA navigation utilization from 2010-2014. Blood transfusion rates decreased 68% over the 5-year study, and were not decreased with navigation in 2014. Navigation was not found to increase operative time. There were no significant differences in short-term complications, readmission rate, or length of stay between navigated and traditional TKA., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Increased operative time has been associated with increased complications after total joint arthroplasty (TJA). The purpose of the present study was to investigate the effect of operative time on short-term complications after TJA while also identifying patient and operative factors associated with prolonged operative times., Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011-2013 to identify all patients who underwent primary total hip or knee arthroplasty. Patients were stratified by operative time, and 30-day morbidity and mortality data compared using univariate and multivariable analyses., Results: We identified 99,444 patients who underwent primary TJA. The overall incidence of complications after TJA was 4.9%. Overall complications were increased in patients with operative times >120 minutes (5.9%) as compared to patients with operative times <60 minutes or 60-120 minutes (4.6% and 4.8%, respectively; P < .001). Wound complications, including surgical site infection, were also increased for procedures lasting >120 minutes. In a multivariable analysis, operative time exceeding 120 minutes remained an independent predictor of any complication and wound complication, with each 30-minute increase in operative time beyond 120 minutes further increasing risk. Patient age ≤65 years, male sex, black race, body mass index ≥30 kg/m 2 , and an American Society of Anesthesiologists classification of 3 or 4, predicted operative times >120 minutes., Conclusion: We found that operative time >120 minutes was associated with increased short-term morbidity and mortality after primary TJA. Younger age, male sex, black race, obesity, and increased comorbidity were risk factors for operative time exceeding 120 minutes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Blood conservation strategies have evolved greatly over the last 5 years. There is a paucity of large blood utilization studies of total hip arthroplasty (THA) and total knee arthroplasty (TKA) that include recently performed surgery. The purpose of this study was to use a large database to evaluate trends in blood transfusion after THA and TKA, including 2015 data., Methods: The Humana data set was reviewed from 2007 to the third quarter of 2015 for all patients undergoing primary THA and TKA. Rates and type of postoperative blood transfusion were trended through the years of the data set. Further subgroup analysis was performed to evaluate the impact of patients' age, gender, geographic location, and obesity on the incidence of blood transfusion using standard statistical techniques., Results: In total, 69,350 THA patients and 139,804 TKA patients were analyzed. Overall transfusion rate was 18.2% and 12.7% after TKA and THA, respectively. The most common type of blood transfused was allogeneic packed red blood cells (88% of all transfusions) followed by perioperative collected autologous blood (12% of all transfusions). There were no transfusions of preoperatively collected autologous blood. Transfusion rates decreased significantly from 21.3%-8.7% and 17.3%-4.4% for THA and TKA, respectively, over the years 2007-2015 (P < .001)., Conclusion: Rates of blood transfusion after primary THA and TKA have fallen precipitously since 2010 and are now down to 9% and 4% for THA and TKA, respectively. Blood management strategies instituted over the last 5 years have had a large impact on transfusion rates after joint arthroplasty., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We conducted a study of elective hip arthroscopy patients to determine type and incidence of complications and rates of and risk factors for minor and major morbidity. Retrospectively searching the National Surgical Quality Improvement Program database, we identified 1325 patients who underwent elective hip arthroscopy between 2006 and 2013. Univariate and subsequent multivariate analyses were used to identify risk factors for complications. Of the 1325 patients identified, 16 (1.21%) had at least 1 complication, and 6 (0.45%) had at least 1 major complication. The most common complication was bleeding resulting in transfusion (6 patients, 0.45%). Multivariate analysis found age over 65 years was an independent predictor of any complication (odds ratio [OR], 6.52; 95% confidence interval [CI], 1.35-31.54) and minor morbidity (OR, 7.97; 95% CI, 1.21-52.72). Short-term morbidity after elective hip arthroscopy was low, and we conclude that hip arthroscopy should be considered a low-risk procedure. Surgeons who perform hip arthroscopy should be aware that age over 65 years is a risk factor for complications. These results may aid surgeons in counseling patients and may aid health systems in performing quality assessments., Competing Interests: Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Background: Length of hospital stay is a quality metric in joint arthroplasty. Rapid recovery protocols have safely reduced the average length of hospitalization, but it is unclear whether there is a difference in complication and readmission rates between patients discharged the day of surgery or on postoperative day 1 (POD 1). We calculated 30-day complication and readmission after total knee arthroplasty (TKA), total hip arthroplasty (THA), and unicompartmental knee arthroplasty (UKA) based on day of discharge. We then analyzed the rapid recovery group by comparing those discharged the day of surgery and those discharged on POD 1., Methods: Patients undergoing joint arthroplasty between 2011 and 2013 were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program. Demographics, comorbidities, and 30-day complication and readmission were determined based on discharge date. Propensity-matched comparisons were performed between patients discharged POD 0 vs POD 1. We used multivariate logistic regression to determine independent risk factors for 30-day complication and readmission., Results: There was no difference in complication or readmission after TKA or UKA between POD 0 or POD 1 discharge. In the propensity-matched cohort in THA, however, there was an increased rate of any complication in the POD 0 compared with the POD 1 discharge cohort. Risk factors for complication and readmission among THA, TKA, and UKA include age >80 years and smoking, and discharge after day 3., Conclusion: Increased length of stay is associated with increased complication and readmission after joint arthroplasty for patients with a hospital stay of 3 or more days. However, in THA, there was an increased complication rate in patients discharged POD 0 as compared to POD 1. Efforts to improve patient selection are expected to reduce short-term complications after outpatient joint arthroplasty. Further research is needed to determine which patients can be discharged POD 0 without increased complication after THA., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Postoperative discharge to a skilled nursing facility after total joint arthroplasty (TJA) is associated with increased costs, complications, and readmission. The purpose of this study was to identify the risk factors for discharge to a location other than home to build a calculator to predict discharge disposition after TJA., Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2013 to identify patients who underwent primary total hip or total knee arthroplasty. Risk factors were compared between patients discharging home vs a facility. Predictors of facility discharge were converted to discrete values to develop a simple numerical calculator., Results: After primary TJA, patients discharged to a facility were typically older (70.9 vs 64.3, P < .001), female (69.5% vs 55.7%, P < .001), had an elevated American Society of Anesthesiologist (ASA) class, and were more likely to be functionally dependent before surgery (3.8% vs 1.1%, P < .001). Patient age, preoperative functional status, nonelective THA for hip fracture, and ASA class were most predictive of facility discharge. After development of a predictive model, scores exceeding 40 and 80 points resulted in a facility discharge probability of 75% and 99%, respectively., Conclusion: In patients undergoing TJA, advanced age, elevated ASA class, and functionally dependent status before surgery strongly predicted facility discharge. Given that facility discharge imposes a significant cost and morbidity burden after TJA, patients, surgeons, and hospitals may use this simple calculator to target this susceptible patient population., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Total joint arthroplasty is a proven treatment for osteoarthritis of the knee and hip that has failed conservative treatment. While most of total joint arthroplasty is considered elective with surgery on the day of admission, a small subset of patients may require delay in surgery past the day of admission. Recently, surgical delay for primary total knee arthroplasty has been identified. However, the incidence, outcomes, and risk factors for delay in surgery before total hip arthroplasty (THA) have not been previously defined., Questions/purpose: In patients undergoing THA, we sought to define (1) the incidence of and risk factors for delay in surgery, (2) the postoperative complications between surgical delay and no surgical delay cohorts, and (3) association of the Charlson comorbidity index (CCI) in patients with delay of surgery., Methods: We retrospectively queried the National Surgical Quality Improvement Program database using Current Procedural Terminology billing codes and identified 7890 THAs performed between 2006 and 2010. Univariate and subsequent multivariate logistic regression analysis were then used to identify risk factors for surgical delay. Correlation between CCI and surgical delay in THA was evaluated., Results: One-hundred seventy-nine patients (2.31%) were identified as experiencing a surgical delay before THA. Multivariate analysis identified congestive heart failure (CHF) (P = .0038), bleeding disorder (P < .0001), sepsis (P < .0001), prior operation in past 30 days (P = .0001), dependent functional status (P < .0001), American Society of Anesthesiologists class 3 (P = .0001), American Society of Anesthesiologists class 4 (P = .0023), significant weight loss (P = .0109), and hematocrit <38% (P < .0001) as independent risk factors for delay in surgery. Compared with the nondelay cohort, those experiencing surgical delay before THA had higher rates of postoperative surgical (8.9% vs 3.1%, P < .0001) and medical complications (23.5% vs 10.1%, P < .0001). Mean CCI was higher in the THA surgical delay cohort (3.16 vs 2.24, P < .0001) compared with the nondelay group., Conclusion: Surgical delay in patients undergoing THA may cause undue disruption in surgeon and hospital resource utilization. In an era of quality assessment and cost consciousness, it is important to understand that the short-term outcomes of elective, same day THA differ dramatically from those hospitalized for medical necessity before surgery. Surgeons should consider thorough medical evaluation in those with CHF, bleeding disorders, sepsis, significant weight loss, and hematocrit <38% before hospital admission., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Study Design: Retrospective cohort analysis., Objectives: A growing number of publications have utilized the Scoliosis Research Society (SRS) Morbidity and Mortality (M&M) database, but none have compared it to other large databases. The objective of this study was to compare SRS complications with those in administrative databases., Summary of Background Data: The Nationwide Inpatient Sample (NIS) and Kid's Inpatient Database (KID) captured a greater number of overall complications while the SRS M&M data provided a greater incidence of spine-related complications following adolescent idiopathic scoliosis (AIS) surgery. Chi-square was used to obtain statistical significance, with p < .05 considered significant., Methods: The SRS 2004-2007 (9,904 patients), NIS 2004-2007 (20,441 patients) and KID 2003-2006 (10,184 patients) databases were analyzed for AIS patients who underwent fusion. Comparable variables were queried in all three databases, including patient demographics, surgical variables, and complications., Results: Patients undergoing AIS in the SRS database were slightly older (SRS 14.4 years vs. NIS 13.8 years, p < .0001; KID 13.9 years, p < .0001) and less likely to be male (SRS 18.5% vs. NIS 26.3%, p < .0001; KID 24.8%, p < .0001). Revision surgery (SRS 3.3% vs. NIS 2.4%, p < .0001; KID 0.9%, p < .0001) and osteotomy (SRS 8% vs. NIS 2.3%, p < .0001; KID 2.4%, p < .0001) were more commonly reported in the SRS database. The SRS database reported fewer overall complications (SRS 3.9% vs. NIS 7.3%, p < .0001; KID 6.6%, p < .0001). However, when respiratory complications (SRS 0.5% vs. NIS 3.7%, p < .0001; KID 4.4%, p < .0001) were excluded, medical complication rates were similar across databases. In contrast, SRS reported higher spine-specific complication rates. Mortality rates were similar between SRS versus NIS (p = .280) and SRS versus KID (p = .08) databases., Conclusions: There are similarities and differences between the three databases. These discrepancies are likely due to the varying data-gathering methods each organization uses to collect their morbidity data., Level of Evidence: Level IV., (Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Background: Total joint arthroplasty (TJA) utilization continues to increase, and optimizing efficiency while reducing complications is critical to provide a sustainable product. Recent policy has defined several hospital-acquired conditions (HACs) that are the target of reducing complications with significant financial implications. The present study defines the incidence of HACs after TJA as well as patient and hospital factors associated with HACs., Methods: The National Inpatient Sample (NIS) was used to identify all patients from 2009 to 2011 undergoing elective total hip or knee arthroplasty. Patient demographics, comorbidities, and hospital characteristics were obtained from the database, and HACs defined according to established International Classification of Diseases, Ninth Revision, Clinical Modification criteria. The incidence of HACs after TJA was calculated, as were demographic factors and preadmission comorbidities associated with HACs using bivariate and multivariable analysis., Results: The overall incidence of HACs after TJA was 1.3%. Several patient and hospital factors, including increased age, female gender, black race, medium hospital bed size, year of surgery, and Charlson Comorbidity Index ≥1, independently predicted development of a HAC. When evaluating the financial impact of the development of a HAC after TJA, more than 200 million dollars in hospital costs would be lost during the inclusive years of this study, equating to nearly 70 million dollars annually., Conclusion: The incidence of HACs after TJA is 1.3%. Many of the patient factors associated with HACs are nonmodifiable, and risk adjustment should be considered to provide a sustainable product to a diverse patient population., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Rates of hip arthroscopy have been on an exponential rise. The purpose of this study was to evaluate the rate and timing of subsequent total hip arthroplasty (THA) after hip arthroscopy and identify if rates of THA differed based on age, diagnosis of osteoarthritis, or arthroscopic procedure performed., Methods: The Humana administrative claims data set was reviewed from 2007 to 2014 for all patients undergoing hip arthroscopy. Patients were identified using Current Procedural Terminology codes and laterality modifiers. Patients were tracked over time for the occurrence of an ipsilateral THA. Rates and timing of subsequent THA were then determined. Subgroup analysis was performed based on patient age and hip arthroscopy procedure performed., Results: In total, 1577 patients underwent hip arthroscopy. Tracking of patients revealed 84 (5.3%) patients that had an ipsilateral THA after hip arthroscopy during the follow-up period. Of the subsequent THA, 35.7% occurred within 6 months of hip arthroscopy and 83.3% had occurred within 18 months. Hundred percent of subsequent THAs occurred within 48 months of initial hip arthroscopy. Patients aged ≥50 years at the time of hip arthroscopy had a higher odds of conversion to THA (odds ratio: 3.2 [2.05-5.01], P < .001) as did those with chondroplasty included in their procedure (odds ratio: 3.5 [2.10-5.84], P < .001)., Conclusion: Approximately 5% of hip arthroscopies went on to require a subsequent THA, and all conversions to THA occurred within 4 years. These data suggest that when hip arthroscopy fails, it does so relatively soon after the procedure. These results provide a needed understanding of rates and timing of THA after hip arthroscopy., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the incidence, causes, and risk factors for unplanned 30-day readmission after shoulder and knee arthroscopy., Methods: A multicenter, prospective clinic registry, the American College of Surgeons National Surgical Quality Improvement Program, was queried for Current Procedural Terminology codes representing the most common shoulder and knee arthroscopic procedures. Unplanned readmissions within 30 days were evaluated dichotomously, and causes of readmission were identified. Univariate and multivariate logistic regression analyses were used to identify variables predictive of readmission., Results: In total, we identified 15,167 patients who underwent shoulder and knee arthroscopic procedures in 2012. Overall, 136 (0.90%) were readmitted within 30 days, and the rates were similar after shoulder (0.86%) and knee (0.92%) procedures. Readmissions were most common after arthroscopic debridement of the knee (1.56%) and lowest after rotator cuff and labral repairs (0.68%) and cruciate reconstructions (0.78%). The most common causes of readmission were surgical-site infections (37.1%), deep venous thrombosis and pulmonary embolism (17.1%), and postoperative pain (7.1%). Multivariate analysis identified age older than 80 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.5 to 8.1), chronic steroid use (OR, 3.3; 95% CI, 1.5 to 7.2), and elevated American Society of Anesthesiologists class (OR, 4.2; 95% CI, 1.4 to 12.0) as independent risk factors for readmission., Conclusions: The rate of unplanned readmissions within 30 days of shoulder and knee arthroscopic procedures is low, at 0.92%, with wound-related complications being the most common cause. In patients with advanced age, with chronic steroid use, and with chronic systemic disease, the risk of readmission may be higher. These findings may aid in the informed-consent process, patient optimization, and the quality-reporting risk-adjustment process., Level of Evidence: Level III, prognostic study., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Medial protrusio is a recognized complication of total hip arthroplasty, but it is not known if a medial wall breach during cup implantation increases the risk. We thus investigated the effect of up to a 2 cm defect in the medial acetabular wall in a cadaveric model. Separately, we investigated the ability of acetabular screws to rescue the construct., Methods: Nine human fresh-frozen hemipelves were reamed medially to create the defect, implanted with acetabular cups, and then loaded to failure. The nine contralateral hemipelves were reamed in a standard fashion and served as controls. Separately, nine hemipelves with a medial defect were augmented with two acetabular screws each, then loaded to failure, with the contralateral side as a control. Load-to-failure, stiffness, and energy were recorded., Findings: The presence of a medial wall defect decreased the load-to-failure by a mean of 26% (5710 v. 4221 N, p=0.024). The addition of two acetabular screws did not rescue the construct (mean 27% decrease, 4082 v. 2985 N, p=0.024). The majority of specimens failed in a supra-physiologic range of force. Bone density correlated with failure loads (R(2) range of 0.54-0.78), and osteoporotic specimens were more likely to fail at a physiologic range, consistent with forces experienced during minor stumbles or falls., Interpretation: Osteoporotic patients with a medial wall defect after hip arthroplasty may be susceptible to fracture during activities of daily living. Protected weight bearing with an assistive device may be reasonable in order to minimize fall risk until cup ingrowth is achieved.