Orthopedics[JOURNAL]
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200 papers
Surprise Billing Is Common in Total Joint Arthroplasty and Negatively Impacts Patient Satisfaction.
McCahon JAS, Cheesman QT, Radack TM … +3 more , Ong AC, Post ZD, Deirmengian GK
Orthopedics · 2024 · PMID 39073045 · Publisher ↗
BACKGROUND: Patients undergoing total joint arthroplasty (TJA) may receive unexpected medical bills. Such "surprise" bills may cause financial hardship for patients, which prompted policymakers to pass the No Surprises A...
BACKGROUND: Patients undergoing total joint arthroplasty (TJA) may receive unexpected medical bills. Such "surprise" bills may cause financial hardship for patients, which prompted policymakers to pass the No Surprises Act. The purpose of this study was to determine the incidence of surprise bills for patients undergoing TJA and the effect of surprise billing on patient satisfaction. MATERIALS AND METHODS: This was a retrospective study of patients who underwent a primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a large multi-state institution. Patients completed a questionnaire regarding the incidence of surprise bills after their surgery, details of those bills, and how the bills affected their surgical satisfaction. Independent predictors for receiving a surprise bill were assessed through a multivariate regression analysis. RESULTS: Twelve percent of participants received at least one surprise bill after their TJA. The most common surprise bill came from the surgical facility (48%), followed by anesthesia (36%). Multivariate logistic regression analysis identified older age and Black race to be independent predictors of surprise billing. Furthermore, surgery occurring after the No Surprises Act bill enforcement on January 1, 2022, was found to increase a patient's likelihood of receiving a surprise bill (=.039, effect size=0.18). Patients who received a surprise bill reported being significantly less satisfied with their surgery (=.002, effect size=0.45). Forty-nine percent of patients with a surprise bill felt their billing negatively affected their surgical satisfaction. CONCLUSION: Surprise billing continues to occur after TJA and can negatively affect patient satisfaction. Although surgeons may be unable to limit the amount of bills patients receive postoperatively, increased communication and education regarding the perioperative billing process may prove to be beneficial for both patient satisfaction and the physician-patient relationship. [ 2024;47(5):283-288.].
Tranexamic Acid Reduces the Amount of Blood Transfused in Revision Total Hip Arthroplasty for Vancouver B2/B3 Periprosthetic Femur Fractures.
Connors JP, Magaldi RJ, Strecker SE … +2 more , Carangelo RJ, Witmer D
Orthopedics · 2024 · PMID 39073044 · Publisher ↗
BACKGROUND: Periprosthetic fractures around total hip arthroplasty (THA) represent a significant source of morbidity and mortality. The use of tranexamic acid (TXA) in arthroplasty is well described, yet little literatur...
BACKGROUND: Periprosthetic fractures around total hip arthroplasty (THA) represent a significant source of morbidity and mortality. The use of tranexamic acid (TXA) in arthroplasty is well described, yet little literature supports its role in periprosthetic femur fractures (PFFs). This study investigated the effect of preoperative TXA administration on transfusion rate and volume, length of stay, and 90-day complication rates in patients undergoing revision THA for PFF. MATERIALS AND METHODS: All patients undergoing revision THA for PFF (Vancouver B2/B3) at our institution from August 2016 to June 2022 were identified. Routine TXA administration at surgical start was introduced in 2018. Patient demographics, operative time, blood product use, length of stay, and 90-day complications were collected. Patients were divided into those who received TXA preoperatively and those who did not. RESULTS: A total of 56 patients were included. There was no difference in age, sex, anesthetic type, fracture classification, or preoperative blood values between cohorts. TXA significantly lowered the amount of blood product required (2.3 units vs 3.2 units, =.023). Preoperative TXA did not independently reduce length of stay; however, blood transfusion was associated with increased length of stay (7 days vs 4.7 days, =.003). There were no differences in 90-day complications. CONCLUSION: Among patients who underwent revision THA for Vancouver B2/B3 PFF, TXA did not affect transfusion rates but did result in the use of fewer blood products without an increase in complications. We support routine use of TXA in this patient population. Future studies should assess earlier administration of TXA in the emergency department or once patients' conditions have been medically optimized. [. 2024;47(5):e261-e267.].
Health Numeracy Is Associated With a Patient's Ability to Interpret Patient-Reported Outcome Measures Data.
Schultz EA, Eppler SL, Gardner M … +7 more , Hu SS, Chou L, Safran M, Amanatullah DF, Abrams GD, Shapiro LM, Kamal RN
Orthopedics · 2024 · PMID 39073043 · Publisher ↗
BACKGROUND: Patient-reported outcome measures (PROMs) were originally developed as research tools; however, there is increasing interest in using PROMs to inform clinical care. Prior work has shown the benefits of implem...
BACKGROUND: Patient-reported outcome measures (PROMs) were originally developed as research tools; however, there is increasing interest in using PROMs to inform clinical care. Prior work has shown the benefits of implementing PROMs at the point of care, but a patient's health numeracy (their ability to understand and work with numbers) may affect their ability to interpret PROM results. MATERIALS AND METHODS: We recruited patients presenting to an outpatient orthopedic clinic. Forty-nine patients completed a survey that included demographic information, the short-form General Health Numeracy Test, and accuracy questions about four PROM displays (bar graph, table, line graph, pictograph) that indicated the same PROM results. RESULTS: Patients with higher health numeracy answered all display accuracy questions correctly (=.016). Patients who preferred using the table were more likely to answer display accuracy questions incorrectly (odds ratio, 0.013, =.024). The two most frequently preferred PROM formats were bar graphs and tables, and most patients preferred to learn about their PROM function scores via a combination of displays and verbal discussions. CONCLUSION: Patient health numeracy is associated with the ability to correctly interpret visual displays of PROMs. Implementation of PROMs at point of care currently does not account for health numeracy. Efforts to account for health numeracy when using PROMs at point of care may improve the efficacy of using PROMs to improve outcomes in orthopedic surgery. [. 2024;47(5):e255-e260.].
Effect of Insulin Dependence on Perioperative Risk in Patients With Diabetes Undergoing Total Shoulder Arthroplasty.
Razaeian S, Zhang D
Orthopedics · 2024 · PMID 39073042 · Publisher ↗
BACKGROUND: Approximately 15% of patients who undergo total shoulder arthroplasty (TSA) have diabetes mellitus, and this group is particularly at risk for perioperative complications. The objective of this study was to q...
BACKGROUND: Approximately 15% of patients who undergo total shoulder arthroplasty (TSA) have diabetes mellitus, and this group is particularly at risk for perioperative complications. The objective of this study was to quantify the effects of insulin dependence on the risk of 30-day perioperative adverse events after TSA in patients with diabetes mellitus using a large national database. MATERIALS AND METHODS: We retrospectively identified patients with diabetes mellitus who underwent TSA in the National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2020. Patients were grouped as having insulin-dependent or non-insulin-dependent diabetes mellitus. The primary outcome was 30-day complication, and secondary outcome variables included 30-day readmission, reoperation, and death. Multivariable logistic regression analyses adjusted for baseline differences were performed. The cohort included 5888 patients with diabetes mellitus who underwent TSA, with 1705 patients in the insulin-dependent group and 4183 patients in the non-insulin-dependent group. RESULTS: The 30-day postoperative complication rate was higher in patients with insulin-dependent diabetes mellitus (8.7%) than in patients with non-insulin-dependent diabetes mellitus (5.6%). The 30-day hospital readmission rate was higher in patients with insulin-dependent diabetes mellitus (4.8%) than in patients with non-insulin-dependent diabetes mellitus (3.3%). These significant differences in complication and readmission rates persisted in the multivariable logistic regression analyses after adjusting for baseline differences between the two groups. Reoperation and death were not associated with insulin dependence. CONCLUSION: Patients with insulin-dependent diabetes mellitus have higher odds of episode-of-care complication and readmission compared with patients with non-insulin-dependent diabetes mellitus, even after adjusting for between-group baseline differences. [. 2024;47(5):295-300.].
Diagnosing the Severity of Knee Osteoarthritis Using Regression Scores From Artificial Intelligence Convolution Neural Networks.
Fei M, Lu S, Chung JH … +3 more , Hassan S, Elsissy J, Schneiderman BA
Orthopedics · 2024 · PMID 39073041 · Publisher ↗
BACKGROUND: This study focused on using deep learning neural networks to classify the severity of osteoarthritis in the knee. A continuous regression score of osteoarthritis severity has yet to be explored using artifici...
BACKGROUND: This study focused on using deep learning neural networks to classify the severity of osteoarthritis in the knee. A continuous regression score of osteoarthritis severity has yet to be explored using artificial intelligence machine learning, which could offer a more nuanced assessment of osteoarthritis. MATERIALS AND METHODS: This study used 8260 radiographic images from The Osteoarthritis Initiative to develop and assess four neural network models (VGG16, EfficientNetV2 small, ResNet34, and DenseNet196). Each model generated a regressor score of the osteoarthritis severity based on Kellgren-Lawrence grading scale criteria. Primary performance outcomes assessed were area under the curve (AUC), accuracy, and mean absolute error (MAE) for each model. Secondary outcomes evaluated were precision, recall, and F-1 score. RESULTS: The EfficientNet model architecture yielded the strongest AUC (0.83), accuracy (71%), and MAE (0.42) compared with VGG16 (AUC: 0.74; accuracy: 57%; MAE: 0.54), ResNet34 (AUC: 0.76; accuracy: 60%; MAE: 0.53), and DenseNet196 (AUC: 0.78; accuracy: 62%; MAE: 0.49). CONCLUSION: Convolutional neural networks offer an automated and accurate way to quickly assess and diagnose knee radiographs for osteoarthritis. The regression score models evaluated in this study demonstrated superior AUC, accuracy, and MAE compared with standard convolutional neural network models. The EfficientNet model exhibited the best overall performance, including the highest AUC (0.83) noted in the literature. The artificial intelligence-generated regressor exhibits a finer progression of knee osteoarthritis by quantifying severity of various hallmark features. Potential applications for this technology include its use as a screening tool in determining patient suitability for orthopedic referral. [. 2024;47(5):e247-e254.].
Effect of Gabapentin on Tendon-to-Bone Healing in a Rat Model of Rotator Cuff Repair.
Chung SW, Chung SH, Kim DH … +5 more , Lee HJ, Park EJJ, Shim BJ, Kim DH, Yoon JP
Orthopedics · 2024 · PMID 39073040 · Publisher ↗
BACKGROUND: Gabapentin is often used as an analgesic after rotator cuff repair surgery and is recommended as an additional analgesic for arthroscopic rotator cuff repairs. However, evidence of its effects on biological h...
BACKGROUND: Gabapentin is often used as an analgesic after rotator cuff repair surgery and is recommended as an additional analgesic for arthroscopic rotator cuff repairs. However, evidence of its effects on biological healing mechanisms is lacking. The objective of this study was to investigate the potential of gabapentin in improving tendon-to-bone healing after rotator cuff repair using a rat model. MATERIALS AND METHODS: A total of 20 male rats were randomly allocated to one of two groups: group 1 (repair only, n=10) or group 2 (gabapentin injection, n=10). The rats in the experimental group (group 2) were administered 80 mg/kg of gabapentin subcutaneously 30 minutes before surgery, followed by 80 mg/kg subcutaneously every 24 hours for 48 hours. We used the left shoulder of every rat, while for biomechanical analysis, we used the right shoulder. RESULTS: There was no significant difference in the load to failure, ultimate stress, or elongation between the groups. Collagen continuity, orientation, and density were better in group 2 than group 1. CONCLUSION: In a rat model of rotator cuff repair, gabapentin had a positive impact on the quality of collagen organization at the junction between the tendon and bone, while preserving the biomechanical properties. We propose the use of gabapentin as a supplementary analgesic agent for postoperative pain relief after arthroscopic rotator cuff repair; however, further studies of the effect of gabapentin on biological healing mechanisms are required. [. 2024;47(5):e241-e246.].
Therapeutic Interventions for Prevention of Musculoskeletal Pain Among Orthopedic Surgeons.
Armando C, Voulo M, Plafcan D … +1 more , Herickhoff P
Orthopedics · 2024 · PMID 39038107 · Publisher ↗
Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postu...
Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into "preop," "intraop," and "postop" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [. 2024;47(4):e214-e216.].
Infection as a Cause of Nonunion After Ulnar-Shortening Osteotomy.
Hansen LM, Lindahl AC, Eller EB … +1 more , Day CS
Orthopedics · 2024 · PMID 39038106 · Publisher ↗
Ulnar-shortening osteotomy is a reliable solution to treat ulnar impaction syndrome, but it has a significant rate of nonunion as a known complication. Generally nonunion after the procedure is attributed to noninfectiou...
Ulnar-shortening osteotomy is a reliable solution to treat ulnar impaction syndrome, but it has a significant rate of nonunion as a known complication. Generally nonunion after the procedure is attributed to noninfectious causes. When infections happen, they follow the microbiological trends of nonunions elsewhere in the body. We present a case of ulnar-shortening osteotomy using an oblique-cut osteotomy system that resulted in septic nonunion. At the time of revision surgery, and were isolated from the osteotomy site. The patient was successfully treated using intravenous antibiotics and the two-stage Masquelet technique and eventually went on to bony union. As is rarely encountered in this context, this report highlights the need to consider all possible pathogens in the workup of a potentially septic nonunion. Surgeons should consider bacteria such as that require prolonged incubation for isolation from cultures, which may not be part of many institutions' usual protocol. [. 2024;47(4):e211-e213.].
Opioid Use After Robotic-Assisted Versus Conventional Total Hip Arthroplasty: A National Database Analysis.
Zhuang T, Young B, Hooper J … +3 more , Amanatullah DF, Shapiro L, Kamal RN
Orthopedics · 2024 · PMID 38976847 · Publisher ↗
BACKGROUND: In this study, we tested the null hypothesis that robotic-assisted total hip arthroplasty (THA) vs conventional THA was not associated with (1) the amount of postoperative opioid use and (2) the incidence of...
BACKGROUND: In this study, we tested the null hypothesis that robotic-assisted total hip arthroplasty (THA) vs conventional THA was not associated with (1) the amount of postoperative opioid use and (2) the incidence of new, persistent opioid use. MATERIALS AND METHODS: We used a large, national administrative database to identify patients 50 years and older undergoing primary robotic or conventional THA. Patients with hip fractures or a history of malignancy, hip infection, or opioid use disorder were excluded. Patients who filled an opioid prescription within 1 year to 30 days preoperatively or who underwent a subsequent procedure within 1 year after THA were excluded. Outcomes included the morphine milligram equivalents (MMEs) filled within the THA perioperative period and the incidence of new, persistent opioid use. Multivariable logistic regression models were used to evaluate associations between robotic-assisted THA and new, persistent opioid use, adjusting for age, sex, insurance plan, region, location of surgery, and comorbidities. RESULTS: In the postoperative period, robotic-assisted THA, compared with conventional THA, was associated with a lower mean total MMEs filled per patient (452.2 vs 517.1; <.001) and a lower mean MMEs per patient per day (71.53 vs 74.64; <.001). Patients undergoing robotic-assisted THA had decreased odds of developing new, persistent opioid use compared with patients undergoing conventional THA (adjusted odds ratio, 0.82 [95% CI, 0.74-0.90]). CONCLUSION: Robotic-assisted THA is associated with lower postoperative opioid use and a decreased odds of developing new, persistent opioid use compared with conventional THA. For the purposes of reducing opioid use, our results support the adoption of robotic-assisted THA. [. 2024;47(5):289-294.].
Preventing Iatrogenic Fibula Fractures Using the Push-Pull Technique: A Biomechanical Comparison of Unicortical Versus Bicortical Post Screws.
McCown SA, Weatherby PJ, Morris RP … +4 more , Panchbhavi VK, Hagedorn JC, Weiss WM, Chen J
Orthopedics · 2024 · PMID 38976846 · Publisher ↗
BACKGROUND: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina sprea...
BACKGROUND: Displaced diaphyseal fractures can be reduced using the push-pull technique, wherein a plate is affixed to the distal fragment of the fracture, a post screw is placed proximal to the plate, and a lamina spreader creates distraction. This study evaluated the load to failure and mechanism of failure of bicortical and unicortical post screws during reduction. MATERIALS AND METHODS: Four matched pairs of cadaver legs were subjected to a 2-cm oblique osteotomy simulating a displaced, oblique diaphyseal fracture. A 6-hole compression plate was affixed to the distal fragment with 2 unicortical locking screws, and a 12-mm unicortical or 20-mm bicortical screw was inserted as a post screw proximal to the plate. A lamina bone spreader was used to exert a distraction force between the plate and the post screw. A mechanical actuator simulated the distraction procedure until failure. Maximum applied load, displacement, and absorbed energy were recorded and compared across unicortical and bicortical groups by paired tests. RESULTS: At maximum load, we found statistically significant differences in displacement (=.003) and energy absorbed (=.022) between the two groups. All unicortical screws failed through screw toggle and bone cut-out. Bicortical screws failed through bending, with no visible damage to the bone at the screw site. CONCLUSION: When diaphyseal fractures are significantly shortened and require a greater distraction force to achieve reduction, bicortical screws demonstrate a higher mechanical load to failure and increased bone loss from the screw-removal site. A unicortical post screw may be used if minimal distraction is needed. [. 2024;47(5):308-312.].
Factors Affecting Operating Room Scheduling Accuracy for Primary and Revision Total Knee Arthroplasty: A Retrospective Study.
Cardillo C, Garry C, Katzman JL … +4 more , Meftah M, Rozell JC, Schwarzkopf R, Lajam C
Orthopedics · 2024 · PMID 38976845 · Publisher ↗
BACKGROUND: Optimizing operating room (OR) scheduling accuracy is important for improving OR efficiency and maximizing value of total knee arthroplasty (TKA). However, data on factors that may impact TKA OR scheduling ac...
BACKGROUND: Optimizing operating room (OR) scheduling accuracy is important for improving OR efficiency and maximizing value of total knee arthroplasty (TKA). However, data on factors that may impact TKA OR scheduling accuracy are limited. MATERIALS AND METHODS: A retrospective review of 7655 knee arthroplasties (6999 primary TKAs and 656 revision TKAs) performed between January 2020 and May 2023 was conducted. Patient baseline characteristics, surgeon experience (years in practice), as well as actual vs scheduled OR times were collected. Actual OR times that were at least 15% shorter or longer than scheduled OR times were considered to be clinically important. Logistic regression analyses were employed to assess the influence of specific patient and surgeon factors on OR scheduling inaccuracies. RESULTS: Using adjusted odds ratio, patients with primary TKA who had a lower body mass index (<.001) were independently associated with overestimation of scheduled surgical time. Conversely, younger age (<.001), afternoon procedure start time (<.001), surgeons with less than 10 years of experience (=.037), and higher patient body mass index (<.001) were associated with underestimation of scheduled surgical time. For revision TKA, female sex (=.021) and morning procedure start time (=.038) were associated with overestimation of scheduled surgical time, while surgeons with less than 10 years of experience (=.014) and patients who underwent spinal/epidural/block anesthesia (=.038) were associated with underestimation of scheduled surgical time. CONCLUSION: This study highlights patient, surgeon, and intraoperative variables that impact the accuracy of scheduling for TKA procedures. Health systems should take these variables into consideration when creating OR schedules to fully optimize resources and available space. [. 2024;47(5):313-319.].
Pelvic Tilt in Adults With Cerebral Palsy and Its Relationship With Prior Hamstrings Lengthening.
Cirrincione PM, Nichols ET, Zucker CP … +8 more , Chandran V, Zanini S, Jezequel J, Assip B, Backus SI, Doyle SM, Scher D, Selber P
Orthopedics · 2024 · PMID 38935848 · Publisher ↗
BACKGROUND: Current studies assessing the change in pelvic tilt for ambulatory patients with cerebral palsy (CP) after surgical hamstring lengthening (SHL) lack a comparison cohort without prior SHL and are limited to yo...
BACKGROUND: Current studies assessing the change in pelvic tilt for ambulatory patients with cerebral palsy (CP) after surgical hamstring lengthening (SHL) lack a comparison cohort without prior SHL and are limited to younger patients. This study presents gait data of middle-aged adults with CP, primarily focusing on the pelvis, and compares pelvic tilt, trunk tilt, and knee flexion between those with and without prior SHL. MATERIALS AND METHODS: A consecutive series of 54 adults with CP, a mean age of 36±13 years, and Gross Motor Function Classification System (GMFCS) levels I-III were included. Thirty-two (59%) had SHL performed at a mean age of 8±5 years. Three-dimensional gait analysis data prospectively collected at a mean of 28±14 years postoperatively were retrospectively analyzed. Chi-square tests were used to compare demographic and surgical history data and statistical parameter mapping was used to compare knee flexion during stance and pelvic and trunk tilts during the gait cycle between SHL and SHL-naive groups. RESULTS: Age, GMFCS level, sex, race, topography, and ethnicity were not different between the groups (=.217-.612). Anterior pelvic tilt throughout gait was significantly greater in the SHL group compared with the SHL-naive group (63%-87%; =.033). This difference was augmented after accounting for other surgical history and revision SHL (0%-32%, =.019; and 46%-93%, =.007). CONCLUSION: Within a cohort of adults with CP, GMFCS levels I-III, and a mean age of 36 years, those with a history of SHL, performed a mean of 28 years prior to 3-dimensional gait analysis, walked with increased anterior pelvic tilt compared with those without a history of SHL. [. 2024;47(5):270-275.].
Antiphospholipid Syndrome Increases Postoperative Complications After Total Hip and Knee Arthroplasty.
Hirpara A, Carpenter M, Dayton M … +1 more , Hogan C
Orthopedics · 2024 · PMID 38935847 · Publisher ↗
BACKGROUND: Antiphospholipid syndrome (APS) is a systemic autoimmune condition that predisposes patients to venous thromboembolism (VTE). Although many studies have explored risk factors for VTE after joint reconstructiv...
BACKGROUND: Antiphospholipid syndrome (APS) is a systemic autoimmune condition that predisposes patients to venous thromboembolism (VTE). Although many studies have explored risk factors for VTE after joint reconstructive procedures, the impact of APS is still unclear. MATERIALS AND METHODS: A retrospective cohort study was conducted using TriNetX, a health care database that includes 442,494 patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Ninety-day postoperative complications and 1- and 2-year surgical complications were compared between patients with and without preexisting APS. Patients underwent propensity score matching in a 1:1 ratio based on relevant comorbidities. RESULTS: Patients undergoing THA or TKA with APS, compared with those without, had higher rates of deep venous thrombosis (hip: 9.2% vs 6.0%, odds ratio, 1.589, =.022; knee: 10.5% vs 4.1%, odds ratio, 2.763, <.001), pulmonary embolism (hip: 6.9% vs 3.6%, odds ratio, 1.992, =.005; knee: 8.4% vs 3.0%, odds ratio, 2.989, <.001), and anemia (hip: 24.8% vs 18.6%, odds ratio, 1.447, =.004; knee: 18.5% vs 13.9%, odds ratio, 1.406, =.007). Patients undergoing THA with APS also had higher rates of urinary tract infection (5.0% vs 2.8%, odds ratio, 1.842, =.029) and pneumonia (3.7% vs 1.8%, odds ratio, 2.119, =.025). APS did not impact rates of surgical complications or revision surgery. CONCLUSION: Overall, APS heightens patients' risk for complications after THA and TKA. Specific anticoagulation protocols and preoperative risk stratification should be implemented to reduce the risk of adverse events. [. 2024;47(5):301-307.].
Continuing Home Oral Hypoglycemic Medications Was Associated With Superior Postoperative Glycemic Control Versus Initiating Sliding Scale Insulin After Total Hip Arthroplasty.
Leal J, Wellman SS, Jiranek WA … +3 more , Seyler TM, Bolognesi MP, Ryan SP
Orthopedics · 2024 · PMID 38935846 · Publisher ↗
BACKGROUND: This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty. MATERIALS AND METHODS: Patients...
BACKGROUND: This retrospective study investigated the impact of continuing vs discontinuing home oral hypoglycemic medications for patients with diabetes undergoing total hip arthroplasty. MATERIALS AND METHODS: Patients who were not exclusively receiving home oral hypoglycemic regimens were excluded. Additionally, patients whose diabetes was not managed inpatient postoperatively were excluded. Included patients were retrospectively evaluated for early postoperative glycemic control, renal function, and metabolic abnormalities. Patients were then compared based on whether their home oral hypoglycemic regimen was continued vs discontinued in favor of initiating insulin while inpatient and analyzed using multivariable regression analysis. RESULTS: A total of 532 patients undergoing total hip arthroplasty met inclusion criteria, with 78.6% continuing their home oral hypoglycemic regimen. Those who continued showed significantly lower median maximum inpatient blood glucose (178.5 mg/dL vs 249.5 mg/dL; <.001) and median average inpatient blood glucose (138.4 mg/dL vs 178.6 mg/dL; <.001). Linear regression analysis, adjusting for various potential confounding factors, revealed a positive correlation between discontinuation of home hypoglycemic medications and higher maximum in-patient blood glucose (β=70.15 [95% CI, 59.27-81.03]; <.001). Patients in the continuation group had lower proportions of acute kidney injury (18.7% vs 41.2%; <.001) and metabolic acidosis (4.3% vs 17.5%; <.001), along with a shorter length of stay (1.0 vs 2.0 days; <.001). CONCLUSION: These findings suggest that continuing a home oral hypoglycemic regimen for patients with diabetes after total hip arthroplasty is associated with superior glycemic control without exacerbating renal abnormalities or increasing metabolic complications. [. 2024;47(5):276-282.].
Prolonged Opioid Use and Associated Factors After Open Reduction and Internal Fixation of Tibial Shaft Fractures.
Chakrani Z, Stocchi C, Alasadi H … +4 more , Zubizarreta N, Stern BZ, Poeran J, Forsh DA
Orthopedics · 2024 · PMID 38864647 · Publisher ↗
BACKGROUND: The aim of this retrospective cohort study was to determine the rate of prolonged opioid use and identify associated risk factors after perioperative opioid exposure for tibial shaft fracture surgery. MATERIA...
BACKGROUND: The aim of this retrospective cohort study was to determine the rate of prolonged opioid use and identify associated risk factors after perioperative opioid exposure for tibial shaft fracture surgery. MATERIALS AND METHODS: We used the MarketScan Commercial Claims and Encounters database (IBM) to identify patients 18 to 64 years old who filled a peri-operative opioid prescription after open reduction and internal fixation of a tibial shaft fracture from January 2016 to June 2020. Multivariable logistic regression identified factors (eg, demographics, comorbidities, medications) associated with prolonged opioid use (ie, filling an opioid prescription 91 to 180 days postoperatively); adjusted odds ratios (ORs) and 95% CIs were reported. RESULTS: The rate of prolonged opioid use was 10.5% (n=259/2475) in the full cohort and 6.1% (n=119/1958) in an opioid-naive subgroup. In the full cohort, factors significantly associated with increased odds of prolonged use included preoperative opioid use (OR, 4.76; 95% CI, 3.60-6.29; <.001); perioperative oral morphine equivalents in the 4th (vs 1st) quartile (OR, 2.68; 95% CI, 1.75-4.09; <.001); age (OR, 1.03; 95% CI, 1.02-1.04; <.001); and alcohol or substance-related disorder (OR, 1.66; 95% CI, 1.15-2.40; =.01). Patients in the Northeast and North Central (vs South) regions had decreased odds of prolonged use (OR, 0.61-0.69; =.02-.04). When removing preoperative use, findings were similar in the opioid-naive subgroup. CONCLUSION: Prolonged opioid use is not uncommon in this orthopedic trauma population, with the strongest risk factor being preoperative opioid use. Nevertheless, shared risk factors exist between the opioid-naive and opioid-tolerant subgroups that can guide clinical decision-making. [. 2024;47(4):e188-e196.].
Pain Self-Efficacy Can Improve During a Visit With an Orthopedic Surgeon.
Lemos JL, Gomez GI, Tewari P … +6 more , Amanatullah DF, Chou L, Gardner MJ, Hu S, Safran M, Kamal RN
Orthopedics · 2024 · PMID 38864646 · Publisher ↗
BACKGROUND: Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE i...
BACKGROUND: Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE improves during a visit with an orthopedic surgeon and (2) identify modifiable visit factors that are associated with an increase in PSE. MATERIALS AND METHODS: We performed a prospective observational study of orthopedic clinic visits at a multispecialty clinic from February to May 2022. New patients who presented to one of six orthopedic surgeons were approached for the study. Patients who provided consent completed a pre-visit questionnaire including the Pain Self-Efficacy Questionnaire (PSEQ) and demographic questions. A trained research member recorded the five-item Observing Patient Involvement in Decision Making Instrument (OPTION-5) score, number of questions asked, and visit duration. Immediately after the visit, patients completed a post-visit questionnaire consisting of the PSEQ and Perceived Involvement in Care Scale (PICS). RESULTS: Of 132 patients enrolled, 61 (46%) had improved PSE after the orthopedic visit, with 38 (29%) having improvement above a clinically significant threshold. There were no significant differences between patients with increased PSE and those without increased PSE when comparing the PICS, OPTION-5, questions asked, or visit duration. CONCLUSION: Almost half of the patients had improvement in PSE during an orthopedic visit. The causal pathway to how to improve PSE and the durability of the improved PSE have implications in strategies to improve patient outcomes in orthopedic surgery, such as communication methods and shared decision-making. Future research can focus on studying different interventions that facilitate improving PSE. [. 2024;47(4):e197-e203.].
Differences in Perioperative Metrics by Race and Ethnicity and Insurance After Pelvic Fracture: A Nationwide Study.
Okewunmi J, Stern BZ, Arroyave Villada JS … +4 more , Restrepo Mejia M, Zubizarreta N, Poeran J, Forsh DA
Orthopedics · 2024 · PMID 38864645 · Publisher ↗
BACKGROUND: Disparities in orthopedic trauma care have been reported for racial-ethnic minority and socially disadvantaged patients. We examined differences in perioperative metrics by patient race and ethnicity and insu...
BACKGROUND: Disparities in orthopedic trauma care have been reported for racial-ethnic minority and socially disadvantaged patients. We examined differences in perioperative metrics by patient race and ethnicity and insurance after pelvic fracture in a national sample in the United States. MATERIALS AND METHODS: The 2016-2019 National Inpatient Sample was queried for White, Black, and Hispanic patients 18 to 64 years old with private, Medicaid, or self-pay insurance who underwent non-elective pelvic fracture surgery. Associations between combined race and ethnicity and insurance subgroups and perioperative metrics (time to surgery, length of stay, inhospital complications, institutional discharge) were assessed using multivariable generalized linear and logistic regression models. Adjusted percent differences or odds ratios (ORs) were reported. RESULTS: A weighted total of 14,375 surgeries were included (68.8% in White patients, 16.1% in Black patients, and 15.1% in Hispanic patients; 60.0% private insurance, 26.3% Medicaid, and 13.7% self-pay). Compared with White patients with private insurance, all Black insurance subgroups had longer length of stay (+15.38% to +38.78%, ≤.001), as did Hispanic patients with Medicaid (+28.03%, <.001), White patients with Medicaid (+13.08%, <.001), and White patients with self-pay (+9.47%, =.04). Additionally, compared with White patients with private insurance, decreased odds of institutional discharge were observed for all patients with self-pay (OR, 0.24-0.37, <.001) as well as White patients with Medicaid (OR, 0.70, =.003) and Hispanic patients with Medicaid (OR, 0.57, =.002). There were no significant adjusted associations between race and ethnicity and insurance subgroups and in-hospital complications or time to surgery. CONCLUSION: These differences in perioperative metrics, primarily for Black patients and patients with self-pay insurance, warrant further examination to identify whether they reflect disparities that should be addressed to promote equitable orthopedic trauma care. [. 2024;47(5):e233-e240.].
Limited Health Literacy Among Patients With Orthopedic Injuries: A Cross-sectional Survey of Patients Who Underwent Orthopedic Trauma Surgery in a County Hospital Setting.
Aynaszyan S, Lonza GC, Sambare TD … +6 more , Son SJ, Alvarez I, Tomasek G, Bryman J, Shymon SJ, Andrawis JP
Orthopedics · 2024 · PMID 38810131 · Publisher ↗
BACKGROUND: Patients with limited health literacy have difficulty understanding their injuries and postoperative treatment, which can negatively affect their outcomes. MATERIALS AND METHODS: This cross-sectional question...
BACKGROUND: Patients with limited health literacy have difficulty understanding their injuries and postoperative treatment, which can negatively affect their outcomes. MATERIALS AND METHODS: This cross-sectional questionnaire-based study of 103 adult patients sought to quantify patients' health literacy at a single county hospital's orthopedic trauma clinic and to examine their ability to understand injuries and treatment plans. Demographics, Newest Vital Sign (NVS) health literacy assessment, and knowledge scores were used to assess patients' comprehension of their injuries and treatment plan. Patients were grouped by NVS score (NVS <4: limited health literacy). Fisher's exact tests and tests were used to compare demographic and comprehension scores. Multivariate logistic regression analysis was used to examine the association among low health literacy, sociodemographic variables, and knowledge scores. RESULTS: Of the 103 patients, 75% were determined to have limited health literacy. Patients younger than 30 years were more likely to have adequate literacy (50% vs 23%, =.01). Patients who spoke Spanish as their primary language were 8.77 times more likely to have limited health literacy with respect to sociodemographic factors (odds ratio, 8.77; 95% CI, 1.03-76.92; =.04). Low health literacy was 3.52 and 4.14 times more likely to predict discordance in answers to specific bone fractures and the narcotics prescribed (=.04 and =.02, respectively). CONCLUSION: Spanish-speaking patients have demonstrated limited health literacy and difficulty understanding their injuries and postoperative treatment plans compared with English-speaking patients. Patients with low health literacy are more likely to be unsure regarding which bone they fractured or their prescribed opiates. [. 2024;47(4):249-255.].
Impact of COVID-19 on Pulmonary Embolism Rates in Patients Undergoing Total Joint Arthroplasty.
Barronian T, Scaramella AYE, Ponzio DY … +2 more , Post ZD, Ong AC
Orthopedics · 2024 · PMID 38810130 · Publisher ↗
BACKGROUND: The purpose of this study was to evaluate the incidence and severity of pulmonary embolism (PE) in patients undergoing total hip and knee arthroplasties after the onset of the coronavirus disease 2019 (COVID-...
BACKGROUND: The purpose of this study was to evaluate the incidence and severity of pulmonary embolism (PE) in patients undergoing total hip and knee arthroplasties after the onset of the coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS: Patients who underwent a total hip arthroplasty or a total knee arthroplasty between 2017 and 2022 and had a PE within 90 days postoperatively were included. Demographics, medical history, procedural information, and PE outcomes were collected and evaluated. RESULTS: There were 5933 procedures and 17 PE events (0.27%) before COVID-19 compared with 3273 procedures and 16 PE events (0.49%) after COVID-19 (=.12). There was an increase in intensive care unit admission after COVID-19 (44% vs 0%, <.05). CONCLUSION: This study showed a trend toward an increased incidence of PE events in the post-COVID-19 cohort and a statistically significant increase in the severity. [. 2024;47(4):233-237.].
Outcomes and Risks Associated With Subsequent Contralateral Hip Fractures.
Chapman PN, Georgiadis GM, Seegert S … +4 more , Russell B, O'Mara-Gardner K, Bair JM, Tank JC
Orthopedics · 2024 · PMID 38810129 · Publisher ↗
BACKGROUND: Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and s...
BACKGROUND: Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures. MATERIALS AND METHODS: This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contralateral hip fracture, with the second treated at our tertiary referral center. RESULTS: The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event. CONCLUSION: Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [. 2024;47(5):264-269.].
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