Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 474 | Issue 1 | Jan, 2016

Time-driven Activity-based Costing More Accurately Reflects Costs in Arthroplasty Surgery

Sina Akhavan BA, Lorrayne Ward MBA, MPP, Kevin J. Bozic MD, MBA

Cost estimates derived from traditional hospital cost accounting systems have inherent limitations that restrict their usefulness for measuring process and quality improvement. Newer approaches such as time-driven activity-based costing (TDABC) may offer more precise estimates of true cost, but to our knowledge, the differences between this TDABC and more traditional approaches have not been explored systematically in arthroplasty surgery.

The Mark Coventry Award: Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Clinical Outcomes at 2 Years Followup

Denis Nam MD, Andrew Park MD, Jeffrey B. Stambough MD, Staci R. Johnson Med, Ryan M. Nunley MD, Robert L. Barrack MD

Custom cutting guides (CCGs; sometimes called patient-specific instrumentation [PSI]) in total knee arthroplasty (TKA) use preoperative three-dimensional imaging to fabricate cutting blocks specific to a patient’s native anatomy.

The Chitranjan Ranawat Award: Running Subcuticular Closure Enables the Most Robust Perfusion After TKA: A Randomized Clinical Trial

Cody C. Wyles BS, Steven R. Jacobson MD, Matthew T. Houdek MD, Dirk R. Larson MS, Michael J. Taunton MD, Franklin H. Sim MD, Rafael J. Sierra MD, Robert T. Trousdale MD

Maintaining robust perfusion is an important physiologic parameter in wound healing. The effect of different closure techniques on wound perfusion after total knee arthroplasty (TKA) has not been established previously and may have implications for wound healing.

The John Insall Award: No Functional Benefit After Unicompartmental Knee Arthroplasty Performed With Patient-specific Instrumentation: A Randomized Trial

Matthieu Ollivier MD, Sebastien Parratte MD, PhD, Alexandre Lunebourg MD, Elke Viehweger MD, PhD, Jean-Noel Argenson MD, PhD

Component alignment can influence implant longevity as well as perhaps pain and function after unicompartmental knee arthroplasty (UKA), but correct alignment is not consistently achieved. To increase the likelihood that good alignment will be achieved during surgery, smart tools such as robotics or patient-specific instrumentation (PSI) have been introduced.

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Douglas A. Dennis MD, Andrew J. Kittelson PT, DPT (PhD Candidate), Charlie C. Yang MD, Todd M. Miner MD, Raymond H. Kim MD, Jennifer E. Stevens-Lapsley PT, PhD

Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA.

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results

Akos Zahar MD, Daniel O. Kendoff MD, PhD, Till O. Klatte MD, Thorsten A. Gehrke MD

Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted.

Is There a Benefit to Highly Crosslinked Polyethylene in Posterior-stabilized Total Knee Arthroplasty? A Randomized Trial

Paul F. Lachiewicz MD, Elizabeth S. Soileau BSN

Polyethylene wear and osteolysis remain a concern with the use of modular, fixed-bearing total knee arthroplasty (TKA). A variety of highly crosslinked polyethylenes (XLPs) have been introduced to address this problem, but there are few data on the results and complications of this polyethylene in posterior-stabilized knee prostheses.

Knee Society Award Papers Are Highly Cited Works

Tommy P. Mroz, Henry D. Clarke MD, Yu-Hui H. Chang PhD, Giles R. Scuderi MD

Since 1993, The Knee Society has presented three annual awards recognizing the best research papers presented at the annual meetings. To date, no quantitative evaluation has determined whether the selection process identifies the most meritorious papers based on subsequent citations. In the absence of validation of this process, it is unclear whether the journal readership should view the award-winning papers as those with potentially greater impact for the specialty.

What Is the Role for Patelloplasty With Gullwing Osteotomy in Revision TKA?

Jeremy M. Gililland MD, Presley Swann MD, Christopher E. Pelt MD, Jill Erickson PA, Nadia Hamad MSc, ATC, Christopher L. Peters MD

Management of the patella in revision total knee arthroplasty (TKA) is challenging as a result of the deficient or unusable bone stock for patellar resurfacing that is frequently encountered. Options proposed in this setting include various patelloplasty procedures, patellectomy, and special patellar components. We sought to better define the role and results of one patelloplasty procedure, the gullwing osteotomy, used in revision TKA.

Surface Damage Is Not Reduced With Highly Crosslinked Polyethylene Tibial Inserts at Short-term

Tong Liu MD, Christina Esposito PhD, Marcella Elpers BS, Timothy Wright PhD

Highly crosslinked ultrahigh-molecular-weight polyethylene (XLPE) has been shown to reduce wear in hip arthroplasty, but the advantages over conventional polyethylene (PE) in total knee arthroplasty (TKA), if any, remain unclear.

Treatment of Periprosthetic Knee Infection With a Two-stage Protocol Using Static Spacers

Paul Lichstein MD, MS, Sharlene Su BS, Hakan Hedlund MD, PhD, Gina Suh MD, William J. Maloney MD, Stuart B. Goodman MD, PhD, James I. Huddleston MD

Two-stage exchange arthroplasty is a standard approach for treating total knee arthroplasty periprosthetic joint infection in the United States, but whether this should be performed with a static antibiotic spacer or an articulating one that allows range of motion before reimplantation remains controversial. It is unclear if the advantages of articulating spacers (easier surgical exposure during reimplantation and improved postoperative flexion) outweigh the disadvantages of increased cost and complexity in the setting of similar rates of infection eradication.

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

David C. Markel MD, Mark W. Allen DO, Nicole M. Zappa DO, MHA

Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks’ (AABB) transfusion guidelines would result in decreased transfusions.

The Knee Society Short Form Reduces Respondent Burden in the Assessment of Patient-reported Outcomes

Giles R. Scuderi MD, Alla Sikorskii PhD, Robert B. Bourne MD, Jess H. Lonner MD, James B. Benjamin MD, Philip C. Noble PhD

The patient’s own evaluation of function and satisfaction is a fundamental component of assessing outcomes after total knee arthroplasty (TKA). The new Knee Society Knee Score was introduced in 2012 and has been shown to be a valid and reliable instrument for measuring the outcome of TKA. This score combines an objective, physician-derived component and a patient-reported component to characterize the expectations, satisfaction, and functional activities of diverse lifestyles of contemporary patients undergoing TKA. However, in the routine clinical setting, the administration and scoring of outcome measures is often resource-intensive, as the expenditure of time and budget for outcome measurement increase with the length and complexity of the instrument used, and so a short-form assessment can help to reduce the burden the assessment of outcomes.

High Risk of Failure With Bimodular Femoral Components in THA

Aidin Eslam Pour MD, Robert Borden BS, Takayuki Murayama MD, Mary Groll-Brown BS, J. David Blaha MD

The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed.

Short-term Risk of Revision THA in the Medicare Population Has Not Improved With Time

Kevin J. Bozic MD, MBA, Kevin Ong PhD, Steven Kurtz PhD, Edmund Lau MS, Thomas P. Vail MD, Harry Rubash MD, Daniel Berry MD

Advances in surgical technique, implant design, and clinical care pathways have resulted in higher expectations for improved clinical outcomes after primary THA; however, despite these advances, it is unclear whether the risk of revision THA actually has decreased with time. Understanding trends in short- and mid-term risks of revision will be helpful in directing clinical, research, and policy efforts to improve THA outcomes.

Early Lessons From a Worldwide, Multicenter, Followup Study of the Recalled Articular Surface Replacement Hip System

Rami Madanat MD, PhD, Daniel K. Hussey BA, Gabrielle S. Donahue BA, Hollis G. Potter MD, Robert Wallace MD, Charles Bragdon PhD, Orhun Muratoglu PhD, Henrik Malchau MD, PhD

Adverse local tissue reactions (ALTRs) around hip arthroplasties are an important reason for failure of metal-on-metal (MoM) hip implants. Little is known about capsular dehiscence patterns as ALTRs decompress from the hip into the surrounding tissue planes; these patterns may also influence the onset and severity of patient symptoms.

Transcriptional Profiling Identifies the Signaling Axes of IGF and Transforming Growth Factor-β as Involved in the Pathogenesis of Osteosarcoma

Rui Yang MD, Sajida Piperdi MS, Yue Zhang PhD, Wei Zhu PhD, Neophytos Neophytou PhD, Bang H. Hoang MD, Gary Mason MD, David Geller MD, Howard Dorfman MD, Paul A. Meyers MD, John H. Healey MD, Donald G. Phinney PhD, Richard Gorlick MD

Osteosarcoma is the most common primary bone tumor in adolescents associated with skeletal development. The molecular pathogenesis of osteosarcoma has not been completely determined, although many molecular alterations have been found in human osteosarcomas and cell lines.

Factors Associated With Reoperation After Fixation of Displaced Olecranon Fractures

Femke M. A. P. Claessen MD, Yvonne Braun MD, Rinne M. Peters BSc, George Dyer MD, Job N. Doornberg MD, PhD, David Ring MD, PhD

Surgery for fixation of olecranon fractures is associated with reoperation, mostly for implant removal. A study of a large cohort of patients treated by many different surgeons allows us to determine if specific techniques or implants are associated with a higher rate of reoperation.

Is Arthroscopic Bone Graft and Fixation for Scaphoid Nonunions Effective?

Ho Jung Kang MD, Yong-Min Chun MD, Il Hyun Koh MD, Jae Han Park MD, Yun Rak Choi MD

Arthroscopic management of scaphoid nonunions has been advanced as a less invasive technique that allows evaluation of associated intrinsic and extrinsic ligamentous injuries; however, few studies have documented the effectiveness of arthroscopic treatment of scaphoid nonunions and which intraarticular pathologies coexist with scaphoid nonunions.

Patients With Thumb Carpometacarpal Arthritis Have Quantifiable Characteristic Expectations That Can Be Measured With a Survey

Lana Kang MD, MSc, Sohaib Z. Hashmi BS, Joseph Nguyen MPH, Steve K. Lee MD, Andrew J. Weiland MD, Carol A. Mancuso MD

Although patient expectations associated with major orthopaedic conditions have shown clinically relevant and variable effects on outcomes, expectations associated with thumb carpometacarpal (CMC) arthritis have not been identified, described, or analyzed before, to our knowledge.

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

Eric Swart MD, Eshan Vasudeva BS, Eric C. Makhni MD, MBA, William Macaulay MD, Kevin J. Bozic MD, MBA

Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program.

Does Strict Adherence to the Ponseti Method Improve Isolated Clubfoot Treatment Outcomes? A Two-institution Review

Nancy H. Miller MD, Patrick M. Carry BA, Bryan J. Mark BA, Glenn H. Engelman BA, Gaia Georgopoulos MD, Sue Graham PA-C, Matthew B. Dobbs MD

Despite being recognized as the gold standard in isolated clubfoot treatment, the Ponseti casting method has yielded variable results. Few studies have directly compared common predictors of treatment failure between institutions with high versus low failure rates.

Are Patient-reported Outcome Measures in Orthopaedics Easily Read by Patients?

Ibraheim El-Daly MBBS, MRCS, PgCert, Hajir Ibraheim MBBS, BSc, MRCP, Karthig Rajakulendran MBBS, BSc, MRCS, Paul Culpan MBBS, BSc, MRCS, FRCS (Tr & Orth), Peter Bates MBBS, BSc, MRCS, FRCS (Tr & Orth)

Patient-reported outcome measures (PROMs) are commonly used by healthcare providers as means of assessing health-related quality of life and function at any given time. The complexity of PROMs can differ and when combined with varying degrees of adult literacy, error can be introduced if patients fail to understand questions. With an average adult literacy level of 11-year-old students in the United Kingdom, it is unclear to what degree PROMs can be read and understood by most patients (readability); to our knowledge, this has not been evaluated.

Does Preoperative Antimicrobial Prophylaxis Influence the Diagnostic Potential of Periprosthetic Tissues in Hip or Knee Infections?

Klemen Bedenčič MD, Martina Kavčič MD, Nataša Faganeli MD, Rene Mihalič MD, Blaž Mavčič MD, PhD, Jožica Dolenc PhD, Zlatka Bajc PhD, Rihard Trebše MD, PhD

Undiagnosed low-grade prosthetic joint infections (PJI) are recognized as an important reason for early failure of presumably aseptic revisions. Preoperatively administered antimicrobial prophylaxis reduces the incidence of PJI but it may reduce the sensitivity of microbiologic periprosthetic tissue cultures and consequently increase the incidence of undiagnosed septic prosthetic joint failures, which can lead to catastrophic serial revisions.

Is Embolization an Effective Treatment for Recurrent Hemorrhage After Hip or Knee Arthroplasty?

Peter I. Kalmar MD, Andreas Leithner MD, Reinhard Ehall MD, Rupert Horst Portugaller MD

Spontaneous recurrent hemorrhage after arthroplasty of the hip or knee is a rare condition. In patients who do not have coagulopathy, the likeliest etiology for hemarthrosis is hypertrophic vascular synovium. Treatments include arthroscopic or open synovectomy, or angiography with embolization; however, because the condition is rare, seldom reported, and debilitating, small case series characterizing the efficacy of any approach are important to allow a collective experience with this condition to emerge.

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