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Well-powered studies analyzing the relationship and nature of emergency department (ED) visits following primary total hip arthroplasties (THAs) are limited. The aim of this study was to: 1) compare baseline demographics of patients with/without an ED visit; 2) determine leading causes of ED visits; 3) identify patient-related risk factors; and 4) quantify 90-day episode-of-care healthcare costs divided by final diagnosis.Patients undergoing primary THA between January 1, 2010 and October 1, 2020 who presented to the ED within 90-days postoperatively were identified using the Mariner dataset of PearlDiver, yielding 1,018,772 patients. This included 3.9% (n = 39,439) patients who did and 96.1% (n = 979,333) who did not have an ED visit. Baseline demographics between the control/study cohorts, ED visit causes, risk-factors, and subsequent costs-of-care were analyzed. Using Bonferroni-correction, a P-value less than 0.002 was considered statistically significant.Patients who presented to the ED post-operatively were most often aged 65-74 years old (41.09%) or female sex (55.60%). Nonmusculoskeletal etiologies comprised 66.8% of all ED visits. Risk factors associated with increased ED visits included alcohol abuse, depressive disorders, congestive heart failure, coagulopathy, and electrolyte/fluid derangements (P.001 for all). Pulmonary ($28,928.01) and cardiac ($28,574.69) visits attributed to the highest costs of care.Nonmusculoskeletal causes constituted the majority of ED visits. The top five risk factors associated with increased odds of ED visits were alcohol abuse, electrolyte/fluid derangements, congestive heart failure, coagulopathy, and depression. This study highlights potential areas of pre-operative medical optimization that may reduce ED visits following primary THA.

Postoperative ileus (POI) is a feared complication following surgery. The purpose of this study was to (1) compare patient demographics between patients who developed and did not develop POI following primary total hip arthroplasty (THA), (2) compare in-hospital lengths of stay (LOS), and (3) identify patient-related risk factors associated with developing POI after primary THA. Using the 100% Medicare Standard Analytical Files from the PearlDiver from 2005 to 2014, patients developing POI within 3 days following primary THA were identified as the study cohort, whereas patients not developing POI served as the comparison cohort. Primary endpoints of the study included comparing patient demographics, in-hospital LOS, and identifying patient-related risk factors. A multivariate binomial logistic regression analysis was used to identify patient-related risk factors by calculating odds ratio (OR) for the risk of developing POI. A p-value less than 0.001 was considered to be statistically significant. The query yielded 335 patients (0.03%) who developed POI following their primary THA procedure. The study group was significantly different compared with controls with respect to age (p

In recent years, the use of national databases in orthopaedic surgery research has grown substantially with database studies comprising an estimated ∼10% of all published lower extremity arthroplasty research. The aim of this review is to serve as a guide on how to: (1) design; (2) execute; and (3) publish an orthopaedic database arthroplasty project. In part II, we discuss how to collect data, propose a novel checklist/standards for presenting orthopaedic database information (SOPOD), discuss methods for appropriate data interpretation/analysis, and summarize how to convert findings to a manuscript (providing a previously published example study). Data collection can be divided into two stages: baseline patient demographics and primary/secondary outcomes of interest. Our proposed SOPOD is more orthopaedic-centered and builds upon previous standards for observational studies from the EQUATOR network. There are a host of statistical methods available to analyze data to compare baseline demographics, primary/secondary outcomes, and reduce type 1 errors seen in large datasets. When drafting a manuscript, it is important to consider and discuss the limitations of database studies, including their retrospective nature, issues with coding/billing, differences in statistical versus clinical significance (or relevance), lack of surgery details (approach, laterality, and implants), and limited sampling or follow-up. We hope this paper will serve as a starting point for those interested in conducting lower extremity arthroplasty database studies.

Use of clinical and administrative databases in orthopaedic surgery research has grown substantially in recent years. It is estimated that approximately 10% of all published lower extremity arthroplasty research have been database studies. The aim of this review is to serve as a guide on how to (1) design, (2) execute, and (3) publish an orthopaedic administrative database arthroplasty project.In part I, we discuss how to develop a research question and choose a database (when databases should/should not be used), detailing advantages/disadvantages of those most commonly used. To date, the most commonly published databases in orthopaedic research have been the National Inpatient Sample, Medicare, National Surgical Quality Improvement Program, and those provided by PearlDiver. General advantages of most database studies include accessibility, affordability compared to prospective research studies, ease of use, large sample sizes, and the ability to identify trends and aggregate outcomes of multiple health care systems/providers.Disadvantages of most databases include their retrospective observational nature, limitations of procedural/billing coding, relatively short follow-up, limited ability to control for confounding variables, and lack of functional/patient-reported outcomes.Although this study is not all-encompassing, we hope it will serve as a starting point for those interested in conducting and critically reviewing lower extremity arthroplasty database studies.

In response to COVID-19, elective surgeries including unicompartmental knee arthroplasties (UKA) decreased. We aimed to quantify and compare temporal trends in utilization and complications in the calendar year 2019 (pre-pandemic) to 2020 in the USA.The 2019 to 2020 ACS-NSQIP database was queried for patients undergoing elective UKA. Patients prior to COVID-19 (2019 and 2020 Q1) were compared to those after (2020 Q2-Q4). Case volumes, patient demographics, complications, and lengths of stay (LOS) were compared between years. Pearson's chi-square test was used to compare patient demographics. Linear regression was conducted to evaluate the change in case volumes. P values less than 0.05 were significant.In total, 3361 patients underwent UKA: 1880 in 2019 and 1481 in 2020. The number of outpatient UKAs increased (56.4% vs. 65.6%; p 0.001). There was no significant difference in the volume of cases in 2019Q1 through 2020Q1 (p = 0.424). Case volumes fell by 60% in 2020Q2 compared with the average quarterly volume in 2019. Comparing 2019 to 2020, there was no significant difference in rates of total complications (2.1% vs. 2.2%; p = 0.843), minor complications (1.2% vs. 0.9%; p = 0.529), major complications (1.1% vs. 1.4%; p = 0.447), infection complications (1.0% vs. 0.8%; p = 0.652), wound complications (0.1% vs. 0.1%; p = 1.0), cardiac complications (0.0% vs. 0.1%; p = 0.111), pulmonary complications (0.1% vs. 0.2%; p = 0.473), hematology complications (0.1% vs. 0.1%; p = 1.0), renal complications (0.1% vs. 0.0%; p = 1.0), and Clavien-Dindo IV complications (0.1% vs. 0.4%; p = 0.177).UKA case volumes declined during the second quarter of 2020. A significant proportion of surgeries were transitioned outpatient, despite no change in complication rates.

Outpatient primary total hip arthroplasty (THA) accounts for approximately 8% of all total hip arthroplasties (THA) performed annually in the United States. As of 2020, Medicare removed THA from its inpatient-only list, allowing reimbursement as an outpatient procedure. This study aimed to determine whether outpatient primary THA is a potential alternative to inpatient procedures by assessing: 1) 90-day postoperative complications; 2) readmission rates; and 3) total costs of care.Using a national database, a matched case-control study was conducted of primary THAs performed between January 1, 2008 and March 31, 2018. Outpatient primary THAs were identified (n=10,463) and matched in a 1:5 ratio to inpatient primary THAs (n=52,306) for age, sex, and comorbidities. Outcomes assessed were 90-day medical complications, readmissions, and associated total costs of care. Baseline demographics were compared using Pearson's chi-squared analyses, with multivariate logistic regressions to calculate odds ratios (ORs) and 95% confidence intervals (CIs).Patients undergoing outpatient THA had fewer 90-day complications (9.3 vs. 11.9%; OR: 0.80, 95% CI: 0.74 to 0.87, p0.0001) relative to the inpatient cohort. Ninety-day readmission rates between outpatient and inpatient THAs were similar (4.1 vs. 4.8%; OR: 0.92, 95% CI: 0.83 to 1.03, p=0.166). Ninety-day costs were significantly lower for the outpatient cohort ($2,650.00 vs. $19,299.00, p0.0001).Our study includes a large sample size of outpatient primary THAs and is the first to provide data quantifying cost differences relative to inpatient THAs. Our results suggest, in certain populations, that outpatient primary THAs are a safe alternative to inpatient procedures with the potential to decrease healthcare costs.

A 59-year-old man who had previously undergone total hip arthroplasty (THA) with the use of a dual modular (head and neck) total hip implant presented with a mechanical failure at the trunion 9 yr after index surgery with a low-energy mechanism. The fractured stem was then removed and a revision stem implanted to restore the patient's ability to ambulate. We demonstrate and contribute to the small but growing evidence of failure of modular THA systems at the trunion.

A 64-year-old man who had previously undergone total hip arthroplasty (THA) with the use of a dual modular (head and neck) total hip implant presented with a mechanical failure at the neck-stem junction three years after the index surgery with a low energy mechanism. The fractured stem was then removed, and a revision stem was implanted in order to restore the ability to ambulate for the patient. We demonstrate and contribute to the growing evidence of failure of modular THA systems at the neck-stem junction.

Purpose: Studies have shown the prevalence of iron deficiency anemia (IDA) increasing worldwide, and currently the literature is limited on the impact of IDA on outcomes following revision total hip arthroplasty (RTHA). Therefore, the purpose of this study was to determine whether IDA patients undergoing RTHA have longer: 1) in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care. Materials and Methods: A retrospective query of a nationwide administrative claims database was performed. Using Boolean command operations, the study group consisted of all patients in the database undergoing RTHA with IDA; whereas, patients without IDA served as controls. To reduce the effects of confounding, study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities yielding 92,948 patients with (n=15,508) and without (n=77,440) IDA undergoing revision THA. A P-value less than 0.001 was considered statistically significant. Results: IDA patients were found to have significantly longer in-hospital LOS (5 days vs. 4 days, P