Search

Purpose: There is growing evidence for the safety of wide-awake, office-based, low-risk hand surgery. However, there is limited insight into patient receptiveness to these procedures. Here, we evaluate the public perceptions and degree of tolerance of low-risk, office-based hand surgery. Methods: A prospective study was performed using a 26-question, paid survey via a clinically validated, public, online marketplace. Participants were divided based on (pre-education) perceptions of in-office hand surgery into three cohorts as follows: in-office surgery (IOS), no in-office surgery, or no preference (NP). Educational material was then presented comparing three surgical settings and anesthetic types. Then, participants selected their setting/anesthetic preferences for the following four procedures: trigger finger release, cyst excision, carpal tunnel release, and distal radius fracture. Statistical analyses with unpaired t tests and chi-square tests were performed. P < .05 was significant. Results: There were 509 respondents—266 in the IOS group, 104 in the no in-office surgery group, and 139 in the NP group. Previous outpatient surgery was most frequent in the IOS cohort. In-office surgery and NP cohorts were more likely to believe that surgical procedures could be performed in the clinic setting. The remaining demographics were similar across cohorts. After reviewing the education graphic, 50 of the 139 in the NP group switched to prefer IOS. For procedure-specific questioning, 40.6% (207/509) were amenable to in-office trigger finger release and 58.3% (297/509) for cyst excision, unlike more invasive procedures (carpal tunnel release: 25.6% (130/509); distal radius fracture: 9.8% (50/509). The most influential factors determining surgical location were comfort during the procedure and total encounter time. The IOS group favored location to be at the surgeon’s discretion more than the no in-office surgery group. Conclusions: In-office, low-risk, hand surgery appears desirable to select patients. If presented with the option for in-office trigger finger release or cyst excision, approximately 40.6% (207/509) and 58.3% (297/509), respectively, may be amenable to IOS. Type of study/level of evidence: Prospective IB.

Background: The most common indications for revision total hip arthroplasty are instability/dislocation and mechanical loosening. Efforts to address this have included the use of dual mobility (DM) articulations. The aim of this study is to report on the use of cemented DM cups in complex acetabular revision total hip arthroplasty cases with a high risk of recurrent instability. Methods: A multicenter, retrospective study was conducted. Patients who received a novel acetabular construct consisting of a monoblock DM cup cemented into a fully porous metal shell were included. Outcome data included 90-day complications and readmissions, revision for any reason, and Harris Hip Scores. Results: Thirty-eight hips in 38 patients were included for this study. At a median follow-up of 215.5 days (range 6-783), the Harris Hip Score improved from a mean of 50 ± 12.2 to 78 ± 11.2 (P < .001). One (2.6%) patient experienced a dislocation on postoperative day 1, and was closed reduced with no further complications. There was 1 (2.6%) reoperation for periprosthetic joint infection treated with a 2-stage exchange. Conclusions: In this complex series of patients, cementation of a monoblock DM cup into a newly implanted fully porous revision shell reliably provided solid fixation with a low risk of dislocation at short-term follow-up. Although longer term follow-up is needed, utilization of this novel construct should be considered in patients at high risk for instability. Keywords: Revision hip arthroplasty, Dual mobility, Cemented dual mobility, Dislocation, Instability

Background: There is a paucity of literature assessing whether payer type has an impact on postoperative patient-reported outcomes (PROs) after total knee arthroplasty (TKA). The aim of this study was to comparatively evaluate TKA PROs among patients with commercial and Medicare insurance. Methods: We conducted a single-center, retrospective review of patients operated between January 2017 and March 2018. Knee Disability and Osteoarthritis Outcome Score Junior (KOOS-Jr) and Veterans RAND 12 Health Survey (VR-12) Physical Component (VR-12 PCS) and Mental Component (VR-12 MCS) PRO scores were collected prospectively at baseline and 12 weeks postoperatively via an electronic patient rehabilitation application. Univariable and multivariable linear regressions were utilized to assess the effects of patient insurance type on PRO. Results: In total, 193 TKA candidates had commercial (n = 91) or Medicare (n = 102) as their primary payer type. Demographic variables including age, gender, body mass index, and race varied significantly between the cohorts (P < .05). Length of stay and discharge disposition also varied significantly (P < .05). When compared with commercial payers, Medicare beneficiaries demonstrated a 4.13 ± 2.06 increase in Knee Disability and Osteoarthritis Outcome Score JR. scores at baseline (P < .05). However, after adjusting for patient-specific demographic and perioperative variables, all PROs recorded in this study were similar between the 2 payer groups at baseline and 12 weeks postoperatively (P > .05). Furthermore, ΔPRO scores from baseline to 12 weeks were also similar (P > .05). Conclusions: After adjusting for patient-specific variables, PROs are similar at baseline and 12 weeks postoperatively between commercial and Medicare cohorts. For TKA candidates with similar baseline demographics, surgeons can expect similar perioperative PROs regardless of insurance type. Keywords: Insurance, Patient-reported outcomes, Total knee arthroplasty, Medicare

Oxinium is an alternative bearing surface designed to emulate the superior wear and scratch properties of ceramic femoral heads in total hip arthroplasty while minimizing the risk for brittle fracturing. However, recent studies have indicated that hip dislocation following total hip arthroplasty may be a risk factor for catastrophic failure of the femoral head. Here, we report on a novel case of a catastrophic Oxinium head and polyethylene liner failure in the absence of previous hip dislocation or trauma and review the probable failure mechanism. This report underscores the need to be vigilant about proper acetabular cup and liner seating, particularly in the setting of Oxinium femoral head use. In the event of Oxinium head failure, metallosis may compromise stabilizing soft tissues including the abductors. Dual-mobility articulation, which was successful in this case, is one option to consider when the risk for chronic redislocation is elevated. Keywords: Liner dissociation, Dual-mobility system, Oxinium, Oxidized zirconium, Total hip arthroplasty, Total hip replacement

Vascular complications in revision total hip arthroplasty may occur in cases where the components of the hip implant migrate through the acetabular wall, through the iliopectineal line of the pelvis, and into the pelvic cavity. This migration may lead to substantial intrapelvic vascular compromise, drastically increasing the surgical complexity and potential risk for morbidity and mortality in these surgical cases. Here, we present a case of a 78-year-old woman with significant acetabular protrusio, which resulted in intraoperative compromise of the external iliac artery with rapid extravasation. As a result of prudent preoperative planning, interdisciplinary collaboration, and precautionary measures, significant patient morbidity and mortality was averted. Level of Evidence: Level V, Case Report. Keywords: Vascular surgery, Revision total hip arthroplasty

The Risk Assessment Prediction Tool (RAPT) predicts discharge disposition after total joint arthroplasty with only 75% accuracy. The goal of this study was to evaluate whether higher accuracy can be achieved with basic electronic health record (EHR) data combined with machine learning (ML) algorithms. Three ML analysis models were developed: model 1 (M1) evaluated the accuracy of predicted discharge disposition in concordance with the RAPT; model 2 (M2) used the RAPT questionnaire to develop an ML algorithm to predict the likelihood of discharge to home vs facility; and model 3 (M3) was developed with non-RAPT data (age, surgeon, and discharge preference) with the same ML training process as M2. Evaluation metrics included accuracy for home discharge (HD), positive predictive value for HD (PPV-HD), negative predictive value for HD (NPV-HD), sensitivity, specificity, and area under the receiver operating curve (AUROC). A total of 1405 patients were included. With M1, the overall accuracy for HD was 83.5%, PPVHD was 92.1%, NPV-HD was 45%, sensitivity was 0.88, and specificity was 0.56. With M2, the overall accuracy for HD decreased to 82.8%, PPV-HD was 91.7%, NPV-HD was 43.1%, sensitivity was 0.87, specificity was 0.53, and mean AUROC was 0.87±0.03. With M3, overall accuracy for HD increased to 90.3%, PPV-HD was 95.2%, NPV-HD was 68.6%, sensitivity was 0.93, specificity was 0.76, and AUROC was 0.91±0.02. The use of basic EHR data combined with ML can exceed the accuracy of the RAPT. Applying big data on an individual level for this purpose may allow for safer and more appropriate discharge planning. [Orthopedics. 2022;45(4):e211-e215.]. [ABSTRACT FROM AUTHOR]

Same-day discharge (SDD) surgery in total hip arthroplasty (THA) has been shown to have similar outcomes to non-SDD THA in select patient populations. Hip resurfacing arthroplasty (HRA) is an alternative to THA for young, active patients, making them ideal candidates for SDD. This study compared the safety and efficacy of non-SDD HRA and SDD HRA for specific postoperative outcomes. An electronic data warehouse query was performed for procedures labeled "hip resurfacing." Data collected included demographics, surgical factors, and quality metrics. Statistical analyses were evaluated using a graphing and statistics software program. Categorical variables were analyzed with chi-square tests and continuous variables with Student's t tests, with P<.05 deemed significant. Sixty-three of 274 total HRAs were enrolled in this SDD HRA protocol. No significant difference was observed between SDD HRA and non-SDD HRA baseline characteristics. On postoperative day 0, 98.41% of SDD HRA recipients were discharged successfully. The SDD HRA recipients had shorter stays, with 1.59% requiring a hospital stay of 2 days or more compared with 56.87% of non-SDD HRA recipients (P<.0001). The non-SDD HRA recipients were found to have shorter surgical times than SDD HRA recipients (104.74 vs 125.51 minutes, P=.01). Rates of infection, periprosthetic fractures, emergency department visits, and hospital readmissions were equivalent (P=.99). Same-day discharge HRA is a safe and effective procedure with similar outcomes to non-SDD HRA regarding infections, fractures, emergency department visits, and readmissions. The major benefit of SDD is a shorter hospital stay that may lead to decreased cost while preserving and enhancing quality of care and patient satisfaction. [Orthopedics. 2020;43(6):e595-e600.]. [ABSTRACT FROM AUTHOR]

Electronic health record (EHR) technologies have improved the ease of access to structured clinical data. The standard means by which data are collected continues to be manual chart review. The authors compared the accuracy of manual chart review against modern electronic data warehouse queries. A manual chart review of the EHR was performed with medical record numbers and surgical admission dates for the 100 most recent inpatient venous thromboembolic events after total joint arthroplasty. A separate data query was performed with the authors' electronic data warehouse. Data sets were then algorithmically compared to check for matches. Discrepancies between data sets were evaluated to categorize errors as random vs systematic. From 100 unique patient encounters, 27 variables were retrieved. The average transcription error rate was 9.19% (SD, ±5.74%) per patient encounter and 11.04% (SD, ±21.40%) per data variable. The systematic error rate was 7.41% (2 of 27). When systematic errors were excluded, the random error rate was 5.79% (SD, ±7.04%) per patient encounter and 5.44% (SD, ±5.63%) per data variable. Total time and average time for manual data collection per patient were 915 minutes and 10.3±3.89 minutes, respectively. Data collection time for the entire electronic query was 58 seconds. With an error rate of 10%, manual chart review studies may be more prone to type I and II errors. Computer-based data queries can improve the speed, reliability, reproducibility, and scalability of data retrieval and allow hospitals to make more data-driven decisions. [Orthopedics. 2020;43(5):e404-e408.]. [ABSTRACT FROM AUTHOR]