• Comparable readmission rates found for inpatient and outpatient TJA

    Patients undergoing outpatient total joint arthroplasty had readmission rates, number of emergency room visits and patient satisfaction outcomes comparable patients who underwent inpatient procedures, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.

    “There has been a recent demand in outpatient total joint arthroplasty [TJA] stemming from better protocols, pain management and physical therapy,” Walter B. Beaver Jr., MD, medical director at OrthoCarolina in Charlotte, N.C., said. “The big question is, are there safety concerns with outpatient TJA? And more recently, there are concerns about penalties for readmission.”

    According to Beaver and his colleagues, under the Patient Care and Affordability Act, Medicare is focusing on 30-day readmission rates for certain diagnoses and is penalizing hospitals financially for readmissions in this timeframe. “In 2015, [CMS is] probably going to include total hip and total knee arthroplasty in the penalties for readmission, and the penalties may be a maximum of 3%,” Beaver said.

    Study inclusion criteria

    Beaver and his colleagues sought to determine whether outpatient or inpatient TJA influenced hospital readmission rates during the 30-day postoperative period. They completed telephone surveys with 235 patients, including 137 outpatients and 98 inpatients who underwent TJA at the same institution between September 2010 and May 2011. One surgeon performed all of the outpatient TJAs, and two surgeons who performed the inpatient TJAs, which included hospital stays with a minimum of 2 days.

    Criteria for outpatient TJA included a body mass index of less than 40 kg/m2 and no active cardiopulmonary issues, sleep apnea, or history of deep venous thrombosis or pulmonary embolus. Patients also had to live less than 1 hour from the hospital and have good family support.

    Readmission rates were 5.7% for inpatient TJA vs. 10.1% for outpatient TJA. “At our cohort size, there was no statistical significance seen,” Beaver said.

    When researchers included emergency room visits with readmissions, 6.7% of inpatients and 12.4% of outpatients required unplanned medical care after hospital discharge; again, according to Beaver, this difference was not statistically significant.

    Readmission rates

    Researchers observed no statistically significant differences between the two groups for readmission during the first 4 postoperative days or when stratified by joint: In the inpatient group, seven total knee arthroplasty (TKA) patients and no total hip arthroplasty (THA) patients were readmitted during the 30-day postoperative period, and in the outpatient group, 16 TKA patients and one THA patient were readmitted.

    Both patient groups reported high patient satisfaction, with no statistically significant difference between the two groups.

    “There was no statistical difference when looking at 30-day hospital readmission rate and patient satisfaction,” Beaver said. “However, there was a higher readmission rate for the outpatient surgery group, which was clinically meaningful. This may have financial implications due to higher readmission rates for the outpatient group. Implications could affect bundled payments in the future, and this is especially true for total knee arthroplasty.”

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  • Hepatitis C infection did not affect outcomes after total hip arthroplasty

    Clinical and patient-reported outcomes following total hip arthroplasty in patients with chronic hepatitis C were comparable to outcomes of patients without the infection at a mean 6-year follow-up, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.

    “Hepatitis C can affect approximately 3% of orthopedic patients, many of whom undergo total joint arthroplasty,” said Samik Banerjee, MBBS, MS, MRCS (Glasg), of the Department of Orthopaedic Surgery and Center for Joint Preservation and Replacement at the Rubin Institute for Advanced Orthopedics and Sinai Hospital of Baltimore. “However, there has been a paucity of reports on the outcomes of primary total hip arthroplasty in patients with hepatitis C.”

    Similar implant survivorship

    Banerjee and his colleagues compared the clinical and patient-reported outcomes of 49 patients (54 hips) who underwent primary total hip arthroplasty (THA) to a matched cohort of 148 THAs in patients without hepatitis C. All patients underwent THA during 2002 to 2011. Patients with hepatitis C included 10 women and 39 men who had a mean age of 57 years. Mean follow-up was 6 years, and the underlying cause of hip disease was end-stage osteoarthritis in 49 hips and avascular necrosis in five. Patients were matched according to age, gender, body mass index, cause of hip disease and mean follow-up duration.

    Overall implant survivorship was statistically similar between the groups: 98% in the patients with hepatitis C and 98.5% in the matched control group. “The hepatitis C group had one aseptic revision, while the matched cohort had two revisions during this period,” Banerjee said during his presentation.

    Researchers also found no difference between the groups in the postoperative Harris hip score, with an improvement to a mean of 89 points in the patients with hepatitis C and an improvement to a mean of 90 points in the comparison group.

    Superficial infection, hematoma

    Banerjee and colleagues also reported no significant differences in the complication rate between the groups, but in the hepatitis C group, he and his colleagues found a superficial infection and two wound hematoma cases. Furthermore, they found no differences in the SF-36 physical and mental component scores or UCLA activity scores. Postoperative radiographic evaluation revealed no component malalignment, symptomatic progressive radiolucencies, change in component position or implant subsidence.

    “From our study, we can agree [with previously published data] that there is no difference in aseptic implant survivorship, activity levels or functional outcomes after THA,” Banerjee said. “We believe that a prior history of chronic hepatitis C alone may not predict inferior clinical outcomes, and we also believe more prospective studies are necessary to better evaluate these outcomes.”

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  • Blood Metal Ions Tied to Failed Hip Replacement, Resurfacing

    Raised levels of blood metal ions are associated with failed metal-on-metal hip resurfacings and total hip arthroplasties, according to a study published in the July 2 issue of The Journal of Bone & Joint Surgery.

    The researchers found that patients with failed arthroplasty had significantly higher blood cobalt and chromium ion levels than patients with non-failed arthroplasty (P < 0.01).

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  • Partial knee replacement safer than total knee replacement

    Partial knee replacement surgery is safer than total knee replacement according to a new study published in The Lancet.

    Patients who had a partial knee replacement are 40 per cent more likely to have a re-operation, known as revision surgery, during the first eight years after the replacement, than those that had a total knee replacement.

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  • Obesity may be driving increasing need for knee and hip replacements in steadily younger patients

    The impact of being overweight has far reaching health implications — implications that may be taking a toll at an earlier age.

    In a new study, researchers found that packing on the pounds may be setting the stage for total knee or hip replacement at increasingly younger ages.

    Further, the scientists found that being overweight or obese had a greater impact on the knee than the hip.

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  • New approach to total knee replacement spares muscle, decreases pain

    Total knee arthroplasty, also known as total knee replacement, is one of the most commonly performed orthopedic procedures. According to the American Academy of Orthopedic Surgeons, as of 2010, more than600,000 total knee replacements were being performed annually in the United States. The number of total knee replacements performed annually in the U.S. is expected to grow by 673 percent to 3.48 million procedures by 2030.

    To start, a rigorous preoperative optimization process is now in place to help minimize the risk of complications after surgery. Patients also attend a joint education class to be advised of what to expect before, during and after the surgery. Studies have shown that these educational classes improve patient outcomes.

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  • Semi-constrained implant improves revision knee arthroplasty outcomes

    Use of a semi-constrained implant in revision knee arthroplasty produced acceptable implant survival and functional outcomes during the long-term follow-up period, according to study results.

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  • Are doctors performing too many unnecessary knee-replacement surgeries?

    More than one-third of total knee replacements performed in the U.S. were deemed "inappropriate" in a new study that used a patient classification system to weigh the risks and benefits.

    The study, published June 30 in the journal Arthritis & Rheumatology, looked at 175 people who underwent total knee replacement surgery.

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  • Ask a Sports Medicine Doc: Hip injuries among youth

    Q: My 14 year old daughter is a competitive ski racer and has been having hip pain. Could she have a labral tear?

    A: Hip injuries are on the rise in adolescent athletes. This is due to the increasing number of young athletes participating in organized sports as well as advances in technology that have improved clinician’s diagnostic ability.

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  • Smith & Nephew DYONICS(TM) PLAN brings first-of-its-kind, individualized surgical planning to hip arthroscopy

    Smith & Nephew (NYSE:SNN;LSE:SN), the global medical technology business, will launch its DYONICS PLAN Hip Impingement Planning System at this week's American Academy of Orthopaedic Surgeons (AAOS) annual meeting in New Orleans. Unlike standard imaging tools, DYONICS PLAN is a revolutionary 3D software system that allows surgeons to visualize, assess and generate a comprehensive surgical report for each patient's unique Femoroacetabular impingement (FAI) surgery before that patient ever enters the operating room.

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