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Elbuluk AM, Jerabek SA, Suhardi VJ, Sculco PK, Ast MP, Vigdorchik JM. Head-to-Head Comparison of Kinematic Alignment Versus Mechanical Alignment for Total Knee Arthroplasty. J Arthroplasty 2022; 37:S849-S851. [PMID: 35093548 DOI: 10.1016/j.arth.2022.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/04/2022] [Accepted: 01/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Seeing as there are many alignment strategies for total knee arthroplasty (TKA), we need to determine differences between them in a rigorous scientific way. Therefore, we sought to compare perioperative and postoperative functional outcomes in patients undergoing TKA for varus osteoarthritis with a mechanical alignment target vs a kinematic alignment target, both executed with the same implant and same technological guidance. METHODS One hundred consecutive patients who underwent TKA using a mechanical alignment technique were 1:1 matched to 100 patients who underwent TKA using a kinematic alignment (KA) technique, using the same implant and robotic technology. Patient-reported outcomes were measured postoperatively at 1 and 2 years. Power analysis revealed 94 patients to detect a significant difference. RESULTS Mean Visual Analog Scale scores were higher in the mechanical alignment group during the first 6 weeks (P = .04), but statistically similar at 1 year. Six-week Veterans RAND 12 Item Health Survey mental and physical components were statistically similar (P = .1). Patients did not differ in 6-week or 1-year knee range of motion (P > .43). Knee Injury and Osteoarthritis Outcome Score Joint Replacement was significantly better in the KA group at 6 weeks, 1 year, and 2 years (P = .09). Forgotten Joint Score at 1 and 2 years postoperatively were significantly higher in the KA group (P < .001). CONCLUSION Patients undergoing TKA with KA experienced less pain in 6 weeks after surgery, and higher Forgotten Joint Scores at 1 and 2 years postoperatively. Alternative TKA alignment and balancing strategies should be considered to increase patient satisfaction.
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Affiliation(s)
- Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Vincentius J Suhardi
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
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Sharma AK, Vigdorchik JM, Kolin DA, Elbuluk AM, Windsor EN, Jerabek SA. Assessing Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty Using Sensor Technology. Arthroplast Today 2022; 13:98-103. [PMID: 35106344 PMCID: PMC8784288 DOI: 10.1016/j.artd.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/03/2021] [Accepted: 11/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of our study was to assess the accuracy of a commercially available wearable sensor in replicating pelvic tilt movement in both the sitting and standing position in patients before total hip arthroplasty. Methods This prospective study evaluated patients undergoing a primary unilateral total hip arthroplasty by a single surgeon. Patients were excluded if they had a body mass index (BMI) greater than 40 kg/m2. Two sensors were adhered directly to patients’ skin at S2 and T12. The S2 angle was recorded on the sensor at maximum flexion and extension angles and compared with pelvic tilt measurements on both sitting and standing radiographs. The primary outcomes recorded were patients’ pelvic tilts measured using radiographs (PT-RAD) and sensors (PT-SEN), with Pearson correlation coefficients and intraclass correlation coefficients (ICCs) calculated. Results Sixty-one patients (35 males and 26 females) with an average age of 61.5 ± 8.5 years and BMI of 26.9 ± 4.1 kg/m2 were analyzed. The mean prestanding PT-RAD and PT-SEN were 1.5 ± 8.3 and 1.0 ± 8.1, respectively, with an ICC of 0.98 (95% confidence interval, 0.96-0.99). The mean presitting PT-RAD and PT-SEN were -21.9 ± 12.5 and -20.9 ± 11.7, respectively, with an ICC of 0.97 (95% confidence interval, 0.95-0.98). The multiple R2 was 0.95 for the prestanding and presitting comparisons. The R2 for all comparisons between PT-RAD and PT-SEN was >0.85, regardless of BMI or sex. Conclusions Although the use of wearable technology may have limitations, based on our results, a wearable sensor is accurate in replicating pelvic tilt movement.
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Affiliation(s)
- Abhinav K. Sharma
- Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA
- Corresponding author. 101 The City Drive South Pavillion III, Building 29A, Orange, CA 92868, USA. Tel.: +1 714-456-7012
| | - Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - David A. Kolin
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eric N. Windsor
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Seth A. Jerabek
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Abstract
Dislocation following total hip arthroplasty (THA) is a well-known and potentially devastating complication. Clinicians have used many strategies in attempts to prevent dislocation since the introduction of THA. While the importance of postoperative care cannot be ignored, particular emphasis has been placed on preoperative planning in the prevention of dislocation. The strategies have progressed from more traditional approaches, including modular implants, the size of the femoral head, and augmentation of the offset, to newer concepts, including patient-specific component positioning combined with computer navigation, robotics, and the use of dual-mobility implants. As clinicians continue to pursue improved outcomes and reduced complications, these concepts will lay the foundation for future innovation in THA and ultimately improved outcomes. Cite this article: Bone Joint J 2022;104-B(1):8-11.
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Affiliation(s)
- Joshua Wright-Chisem
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Ameer M Elbuluk
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - David J Mayman
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Seth A Jerabek
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Peter K Sculco
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Jonathan M Vigdorchik
- Hospital for Special Surgery, Division of Adult Reconstruction and Joint Replacement, New York, New York, USA
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4
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Wang D, Nawabi DH, Krych AJ, Jones KJ, Nguyen J, Elbuluk AM, Farshad-Amacker NA, Potter HG, Williams RJ. Synthetic Biphasic Scaffolds versus Microfracture for Articular Cartilage Defects of the Knee: A Retrospective Comparative Study. Cartilage 2021; 13:1002S-1013S. [PMID: 32046514 PMCID: PMC8808844 DOI: 10.1177/1947603520903418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the results of a biphasic synthetic scaffold (TruFit, Smith & Nephew) to microfracture for the treatment of knee cartilage defects and identify patient- and lesion-specific factors that influence outcomes. DESIGN Prospectively collected data from 132 patients (mean age, 41.8 years; 69% male) with isolated chondral or osteochondral femoral defects treated with biphasic synthetic scaffolds (n = 66) or microfracture (n = 66) were reviewed. Clinical outcomes were evaluated longitudinally over 5 years with the Short Form-36 (SF-36), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), International Knee Documentation Committee (IKDC), and Marx Activity Scale. Cartilage-sensitive magnetic resonance imaging (MRI) was performed to evaluate osseous integration and cartilage fill in a subgroup of patients. Multivariate regression analysis was used to identify predictors of clinical outcomes within the scaffold group. RESULTS Both groups demonstrated clinically significant improvements in knee clinical scores over 5 years (P < 0.01). There were no significant differences in KOS-ADL and IKDC scores between groups up to 5 years postoperatively. Marx activity level scores in the microfracture group declined over time, while significant improvements in activity level scores were observed in the scaffold group over 5 years (P < 0.01). Good-quality tissue fill and cartilage isointensity were more often observed in the scaffold group compared with the microfracture group, particularly with longer time intervals. Increasing age, high body mass index, prior microfracture, and traumatic etiology were predictors for inferior outcomes in the scaffold group. CONCLUSIONS Activity level and MRI appearance following treatment of cartilage lesions with the biphasic synthetic scaffold were superior to microfracture over time in this nonrandomized, retrospective comparison.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery,
University of California Irvine, Orange, CA, USA,Dean Wang, UC Irvine Health, 101 The City
Drive South, Pavilion III, Building 29A, Orange, CA 92868, USA.
| | - Danyal H. Nawabi
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Aaron J. Krych
- Department of Orthopaedic Surgery, Mayo
Clinic, Rochester, MN, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David
Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph Nguyen
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | - Riley J. Williams
- Sports Medicine Service, Hospital for
Special Surgery, New York, NY, USA
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Sharma AK, Elbuluk AM, Gkiatas I, Kim JM, Sculco PK, Vigdorchik JM. Mental Health in Patients Undergoing Orthopaedic Surgery: Diagnosis, Management, and Outcomes. JBJS Rev 2021; 9:01874474-202107000-00013. [PMID: 34297704 DOI: 10.2106/jbjs.rvw.20.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Mental health and psychosocial factors play a critical role in clinical outcomes in orthopaedic surgery. » The biopsychosocial model of disease defines health as a product of physiology, psychology, and social factors and, traditionally, has not been as emphasized in the care of musculoskeletal disease. » Improvement in postoperative outcomes and patient satisfaction is incumbent upon the screening, recognition, assessment, and possible referral of patients with high-risk psychosocial factors both before and after the surgical procedure.
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Affiliation(s)
- Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Julia M Kim
- Clinical Psychology, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Vigdorchik JM, Sharma AK, Buckland AJ, Elbuluk AM, Eftekhary N, Mayman DJ, Carroll KM, Jerabek SA. 2021 Otto Aufranc Award: A simple Hip-Spine Classification for total hip arthroplasty : validation and a large multicentre series. Bone Joint J 2021; 103-B:17-24. [PMID: 34192913 DOI: 10.1302/0301-620x.103b7.bjj-2020-2448.r2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Patients with spinal pathology who undergo total hip arthroplasty (THA) have an increased risk of dislocation and revision. The aim of this study was to determine if the use of the Hip-Spine Classification system in these patients would result in a decreased rate of postoperative dislocation in patients with spinal pathology. METHODS This prospective, multicentre study evaluated 3,777 consecutive patients undergoing THA by three surgeons, between January 2014 and December 2019. They were categorized using The Hip-Spine Classification system: group 1 with normal spinal alignment; group 2 with a flatback deformity, group 2A with normal spinal mobility, and group 2B with a stiff spine. Flatback deformity was defined by a pelvic incidence minus lumbar lordosis of > 10°, and spinal stiffness was defined by < 10° change in sacral slope from standing to seated. Each category determined a patient-specific component positioning. Survivorship free of dislocation was recorded and spinopelvic measurements were compared for reliability using intraclass correlation coefficient. RESULTS A total of 2,081 patients met the inclusion criteria. There were 987 group 1A, 232 group 1B, 715 group 2A, and 147 group 2B patients. A total of 70 patients had a lumbar fusion, most had L4-5 (16; 23%) or L4-S1 (12; 17%) fusions; 51 patients (73%) had one or two levels fused, and 19 (27%) had > three levels fused. Dual mobility (DM) components were used in 166 patients (8%), including all of those in group 2B and with > three level fusions. Survivorship free of dislocation at five years was 99.2% with a 0.8% dislocation rate. The correlation coefficient was 0.83 (95% confidence interval 0.89 to 0.91). CONCLUSION This is the largest series in the literature evaluating the relationship between hip-spine pathology and dislocation after THA, and guiding appropriate treatment. The Hip-Spine Classification system allows surgeons to make appropriate evaluations preoperatively, and it guides the use of DM components in patients with spinopelvic pathology in order to reduce the risk of dislocation in these high-risk patients. Cite this article: Bone Joint J 2021;103-B(7 Supple B):17-24.
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Affiliation(s)
- Jonathan M Vigdorchik
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Abhinav K Sharma
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Aaron J Buckland
- NYU Langone Health, Department of Orthopaedic Surgery, New York, New York, USA
| | - Ameer M Elbuluk
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Nima Eftekhary
- NYU Langone Health, Department of Orthopaedic Surgery, New York, New York, USA
| | - David J Mayman
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Kaitlin M Carroll
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA
| | - Seth A Jerabek
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, New York, USA
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Elbuluk AM, Wright-Chisem JI, Vigdorchik JM, Nunley RM. Applying the Hip-Spine Relationship: What X-Rays and Measurements Are Important? J Arthroplasty 2021; 36:S94-S98. [PMID: 33752926 DOI: 10.1016/j.arth.2021.02.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
Understanding spinopelvic motion and the dynamic relationship of the hip, spine, and pelvis is essential in decreasing the risk of instability after total hip arthroplasty. The hip-spine relationship is complex, and a detailed analysis of each patient's spinopelvic mobility is warranted to help guide safe acetabular component positioning. Through the use of a standing anteroposterior pelvis X-ray, lateral spinopelvic radiographs in the standing and seated position, and advanced functional imaging, key spinopelvic parameters can be obtained. A systematic preoperative workup can help to identify hip-spine pathology that predisposes patients to instability, and can help in planning and establishing a patient-specific "safe zone." Based on the presence of concomitant hip-spine pathology, patients must be evaluated thoroughly with preoperative imaging to plan for the optimal target acetabular cup position. This paper guides readers through important parameters and imaging associated to spinopelvic motion as it relates to total hip arthroplasty stability.
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Affiliation(s)
- Ameer M Elbuluk
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Joshua I Wright-Chisem
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Ryan M Nunley
- Department of Orthopedic Surgery, Washington University at St. Louis, St. Louis, MO
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Narayanan R, Elbuluk AM, Chen KK, Eftekhary N, Zuckerman JD, Deshmukh AJ. Does femoral morphology and stem alignment influence outcomes of cementless total hip arthroplasty with proximally coated double-tapered titanium stems? Hip Int 2021; 31:354-361. [PMID: 31912748 DOI: 10.1177/1120700019891702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Stem subsidence and thigh pain can cause significant patient dissatisfaction after cementless THA. The purpose of this study was to examine the effect of proximal-femoral morphology and stem alignment on clinical outcomes using a double-tapered, cementless titanium femoral component. METHODS We retrospectively reviewed 281 consecutive, primary THAs from 2012 to 2014 with a mean follow-up of 4 years. Preoperative radiographs were used to assess femoral neck shaft angle (FNS), canal flare index (CFI), Dorr classification, and greater trochanter (GT) overhang. Postoperative radiographs were used to determine stem alignment and 6-week follow-up radiographs were used to determine subsidence. Clinical outcomes included thigh pain, leg-length discrepancy (LLD), patient-reported outcome measures (PROMs) and revision surgeries. RESULTS 271 stems (96%) did not subside (<4 mm) and 10 (4%) showed evidence of subsidence (>4 mm). Subsidence was significantly associated with subsequent revision surgery (p < 0.01). 278 stems (99%) were in neutral alignment and 3 in varus (1%). Alignment did not significantly influence subsidence, thigh pain, LLD, revisions, or PROMs. Femoral morphology measures (FNS, CFI, Dorr classification, and GT overhang) were not significantly associated with stem alignment, subsidence, LLD, or revisions. CFI was significantly associated with intraoperative calcar fractures (p = 0.02). GT overhang was associated with thigh pain (p = 0.03) and FNS was inversely associated with postoperative HOOS scores. CONCLUSIONS Subsidence and proximal-femoral morphology are potential sources of postoperative morbidity in certain cementless THA patients. In accordance with prior studies, CFI was identified as a potential risk factor for intraoperative calcar fractures. More research into preoperative femoral morphologies, such as GT overhang and FNS, is warranted as these may contribute to unsatisfactory results related to cementless THA.
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Affiliation(s)
| | | | - Kevin K Chen
- NYU Langone Orthopedic Hospital, New York, NY, USA
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9
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Windsor EN, Sharma AK, Gkiatas I, Elbuluk AM, Sculco PK, Vigdorchik JM. An Overview of Telehealth in Total Joint Arthroplasty. HSS J 2021; 17:51-58. [PMID: 33967642 PMCID: PMC8077983 DOI: 10.1177/1556331620972629] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022]
Abstract
With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians' ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.
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Affiliation(s)
- Eric N. Windsor
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Abhinav K. Sharma
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Ameer M. Elbuluk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Vigdorchik JM, Sharma AK, Madurawe CS, Elbuluk AM, Baré JV, Pierrepont JW. Does Prosthetic or Bony Impingement Occur More Often in Total Hip Arthroplasty: A Dynamic Preoperative Analysis. J Arthroplasty 2020; 35:2501-2506. [PMID: 32507449 DOI: 10.1016/j.arth.2020.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Impingement is a leading cause for instability resulting in revision total hip arthroplasty (THA). Impingement can be prosthetic, bony, or soft tissue. The purpose of this study is to investigate, using a virtual simulation, whether bony or prosthetic impingement presents first in well-positioned THAs. METHODS Twenty-three patients requiring THA were planned for a ceramic-on-poly cementless construct using dynamic planning software. Cups were orientated at 45° inclination and 25° anteversion when standing. Femoral components and neck lengths were positioned to reproduce native anteversion and match contralateral leg length and offset. The type and location of impingement was then recorded with recreation of anterior and posterior impingement during standard and extreme ranges of motion (ROM). RESULTS In standard ROM, flexion produced both prosthetic and bony impingement and extension resulted in prosthetic impingement in models with lipped liners. In extreme ROM, anterior impingement was 78% bony in 32-mm articulations, and 88% bony in 36-mm articulations. Posterior impingement was 65% prosthetic in 32-mm articulations, and 55% prosthetic in 36-mm articulations. Dual mobility cups showed the greatest risk of posterior prosthetic impingement in hyperextension (74%). CONCLUSION In standard ROM, both bony and prosthetic impingement occurred in flexion, while prosthetic impingement occurred in extension in models with lipped liners. In hyperextension, prosthetic impingement was more common than bony impingement, and was exclusively the cause of impingement when a lip was used. In flexion, impingement was primarily bony with the use of a 36-mm head. The risk of posterior prosthetic impingement was greatest with dual mobility cups. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY
| | | | - Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY
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Elbuluk AM, Coxe FR, Schimizzi GV, Ranawat AS, Bostrom MP, Sierra RJ, Sculco PK. Abductor Deficiency-Induced Recurrent Instability After Total Hip Arthroplasty. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.18.00164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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12
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Elbuluk AM, Coxe FR, Fabricant PD, Ramos NL, Alaia MJ, Jones KJ. Does Medial-Row Fixation Technique Affect the Retear Rate and Functional Outcomes After Double-Row Transosseous-Equivalent Rotator Cuff Repair? Orthop J Sports Med 2019; 7:2325967119842881. [PMID: 31205960 PMCID: PMC6537075 DOI: 10.1177/2325967119842881] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Double-row transosseous-equivalent (TOE) rotator cuff repair techniques have
been widely accepted because of their superior biomechanical properties when
compared with arthroscopic single-row repair. Concerns regarding repair
overtensioning with medial-row knot tying have led to increased interest in
knotless repair techniques; however, there is a paucity of clinical data to
guide the choice of technique. Hypothesis: Arthroscopic TOE repair techniques using knotless medial-row fixation will
demonstrate lower retear rates and greater improvements in the Constant
score relative to conventional knot-tying TOE techniques. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of 3 databases (PubMed, Cochrane, and Embase) was
performed using PRISMA (Preferred Reporting Items for Systematic
Meta-Analyses) guidelines. Inclusion criteria were English-language studies
that examined repair integrity or Constant scores after arthroscopic rotator
cuff repair with TOE techniques. Two investigators independently screened
results for relevant articles. Data regarding the study design, surgical
technique, retear rate, and Constant shoulder score were extracted from
eligible studies. A quality assessment of all articles was performed using
the Methodological Index for Non-Randomized Studies (MINORS) criteria. Results: The systematic review identified a total of 32 studies (level of evidence,
1-4) that met inclusion and exclusion criteria. Of the 32 studies, 5
reported on knotless TOE techniques, 25 reported on knot-tying TOE
techniques, and 2 reported on both. In the knotless group, retear rates
ranged from 6% to 36%, and Constant scores ranged from 38-65 (preoperative)
to 73-83 (postoperative). In the knot-tying group, retear rates ranged from
0% to 48%, and Constant scores ranged from 42-64 (preoperative) to 55-96
(postoperative). Conclusion: Despite several theoretical advantages of knotless TOE repair, both knotless
and knot-tying techniques reported considerable improvement in functional
outcomes after rotator cuff repair. Although tendon failure rates showed a
downward trend in knotless studies, additional prospective studies are
warranted to better understand the role of medial-row fixation on tendon
repair integrity and postoperative clinical outcomes.
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Affiliation(s)
| | | | | | - Nicholas L Ramos
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York, USA
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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Abstract
BACKGROUND Health disparities exist among many patient populations, with race, payer status, hospital size and access to teaching versus non-teaching hospitals potentially affecting whether certain patients have access to the benefits of total wrist arthroplasty (TWA). METHODS The National Inpatient Sample Database (NIS) was queried from 2001 to 2013 for TWA using the ICD-9 code 81.73. Patient-level data included age, sex, race, payer status, and year of discharge. Hospital-level data included hospital bed size, location, teaching status, and region. RESULTS There were 1,213 patients identified who underwent TWA between 2001 and 2013. Total number of procedures decreased from 88 TWAs in 2001 to 65 in 2013. The yearly volume ranged from 33 in 2005 to 128 in 2007. The male-female ratio was 2.5 to 1. The majority of TWA procedures were performed at urban teaching hospitals (60.8%). CONCLUSIONS The NIS database shows a downward trend of total wrist arthroplasty utilization. The majority of total wrist arthroplasties were performed at urban teaching hospitals indicating treatment occurs most often at academic centers of excellence.
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Affiliation(s)
- Ameer M Elbuluk
- † Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Michael T Milone
- * Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - John T Capo
- * Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Joseph A Bosco
- * Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Christopher S Klifto
- * Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
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14
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Elbuluk AM, Slover J, Anoushiravani AA, Schwarzkopf R, Eftekhary N, Vigdorchik JM. The cost-effectiveness of dual mobility in a spinal deformity population with high risk of dislocation: a computer-based model. Bone Joint J 2018; 100-B:1297-1302. [PMID: 30295522 DOI: 10.1302/0301-620x.100b10.bjj-2017-1113.r3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
AIMS The routine use of dual-mobility (DM) acetabular components in total hip arthroplasty (THA) may not be cost-effective, but an increasing number of patients undergoing THA have a coexisting spinal disorder, which increases the risk of postoperative instability, and these patients may benefit from DM articulations. This study seeks to examine the cost-effectiveness of DM components as an alternative to standard articulations in these patients. PATIENTS AND METHODS A decision analysis model was used to evaluate the cost-effectiveness of using DM components in patients who would be at high risk for dislocation within one year of THA. Direct and indirect costs of dislocation, incremental costs of using DM components, quality-adjusted life-year (QALY) values, and the probabilities of dislocation were derived from published data. The incremental cost-effectiveness ratio (ICER) was established with a willingness-to-pay threshold of $100 000/QALY. Sensitivity analysis was used to examine the impact of variation. RESULTS In the base case, patients with a spinal deformity were modelled to have an 8% probability of dislocation following primary THA based on published clinical ranges. Sensitivity analysis revealed that, at its current average price ($1000), DM is cost-effective if it reduces the probability of dislocation to 0.9%. The threshold cost at which DM ceased being cost-effective was $1180, while the ICER associated with a DM THA was $71 000 per QALY. CONCLUSION These results indicate that under specific clinical and economic thresholds, DM components are a cost-effective form of treatment for patients with spinal deformity who are at high risk of dislocation after THA. Cite this article: Bone Joint J 2018;100-B:1297-1302.
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Affiliation(s)
- A M Elbuluk
- Hospital for Special Surgery, New York, New York, USA
| | - J Slover
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - A A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - N Eftekhary
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
| | - J M Vigdorchik
- Department of Orthopaedic Surgery, New York University Langone Orthopedic Hospital, New York, New York, USA
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15
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Elbuluk AM, Ast MP, Stimac JD, Banka TR, Abdel MP, Vigdorchik JM. Peer-to-Peer Collaboration Adds Value for Surgical Colleagues. HSS J 2018; 14:294-298. [PMID: 30258335 PMCID: PMC6148583 DOI: 10.1007/s11420-018-9616-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 04/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peer-to-peer advisory among colleagues in orthopedic surgery is commonplace in academic medical centers. In the private practice setting, however, it becomes more difficult for surgeons to discuss complex cases among peers. PURPOSE/QUESTIONS We sought to study the effect of peer-to-peer mentorship on surgeons' decision-making and on patient care across academic and private adult joint reconstruction practices via the use of group secured messages. METHODS From 2013 to 2016, we established a messaging system that was compliant with the Health Insurance Portability and Accountability Act (HIPAA) among five previous adult hip and knee reconstruction co-fellows in order to discuss complex cases. Data collected from each case included patient demographics (age and sex), history and physical examination, relevant imaging in orthogonal planes, and preliminary diagnosis and treatment plans. Data collected from group responses included nature of additional inquiries, literature citations, operative recommendations, and sample imaging of similar cases previously treated. RESULTS The group consisted of two private practice surgeons and three academic surgeons. Data was collected on 283 cases discussed during the study period. None of the patients had any HIPAA violations. The mean number of reviewers who commented on a case was 2.4, with at least one response in 97% of cases. In 33% of the cases, the peers confirmed the initial treatment plan, and in 67% of the cases, an alternative treatment plan was recommended and executed. The case distribution was 94 primary and 189 revision procedures, including 173 hips, 103 knees, three ankles, two shoulders, and two pelvises. CONCLUSION In the majority of cases exchanged between young surgeons via a group messaging system, a significant impact on patient care was appreciated. In a technology-driven era, peer-to-peer advisory for difficult cases via a rapid feedback method may allow for substantial improvement in patient care, particularly for surgeons not practicing at a large academic medical center with access to several partners and multiple opinions.
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Affiliation(s)
- Ameer M. Elbuluk
- 0000 0001 2285 8823grid.239915.5Hospital for Special Surgery, New York, NY 10021 USA
| | | | | | - Trevor R. Banka
- 0000 0001 2160 8953grid.413103.4Henry Ford Medical Center, Dearborn, MI 48216 USA
| | - Matthew P. Abdel
- 0000 0004 0459 167Xgrid.66875.3aDepartment of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905 USA
| | - Jonathan M. Vigdorchik
- 0000 0004 1936 8753grid.137628.9Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10003 USA
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16
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Narayanan R, Anoushiravani AA, Elbuluk AM, Chen KK, Adler EM, Schwarzkopf R. Irrigation and Debridement for Early Periprosthetic Knee Infection: Is It Effective? J Arthroplasty 2018; 33:1872-1878. [PMID: 29428466 DOI: 10.1016/j.arth.2017.12.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Irrigation and debridement (I&D) is performed for early management of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Symptom reporting is a subjective measure and may miss direct management of PJI. Utilizing an objective time interval from index procedure to I&D may better inform treatment decisions. METHODS From 2009 to 2017, retrospective review was performed of 55 knee PJI cases at our institution. All patients underwent polyethylene liner exchange and I&D for PJI. Patients were stratified by time from index procedure to I&D (≤2 weeks, >2 weeks). Success was defined as eradication of infection and resolution of presenting symptoms. Failed cases required subsequent procedures due to infection. RESULTS Average follow-up time after index TKA was 2.5 years. Among patients with I&D within 2 weeks of index TXA, 14 patients (82%) were successfully treated while 3 (18%) had infection recurrence. These outcomes were significantly improved compared to patients with I&D after 2 weeks: 19 (50%) successes and 19 (50%) failures (P = .024). Staphylococcal species were the most frequent pathogen in patients treated before and after 2 weeks of index TKA (39% and 50%, respectively). Outcomes were pathogen-independent in PJIs treated before or after 2 weeks of index TKA (P = .206 and .594, respectively). CONCLUSION Our results demonstrate that patients with early PJI managed with I&D and liner exchange within 2 weeks of index TKA had higher rates of treatment success when compared to those with I&D beyond 2 weeks. These findings suggest that time from index TKA to I&D is an objective and reliable indicator of treatment success when considering I&D in acute onset knee PJI.
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Affiliation(s)
- Rajkishen Narayanan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | | | - Ameer M Elbuluk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Kevin K Chen
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Edward M Adler
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, New York
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17
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Elbuluk AM, Kim KY, Chen KK, Anoushiravani AA, Schwarzkopf R, Iorio R. Respiratory Synchronized Versus Intermittent Pneumatic Compression in Prevention of Venous Thromboembolism After Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. Orthop Clin North Am 2018; 49:123-133. [PMID: 29499814 DOI: 10.1016/j.ocl.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted. Compared with control groups, the risk ratio of deep vein thrombosis development was 0.51 with NSIPCDs and 0.47 with RSCDs. This review demonstrates that RSCDs may be marginally more effective at preventing VTE events than NSIPCDs. Furthermore, the addition of mechanical prophylaxis to any chemoprophylactic regimen increases VTE prevention.
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Affiliation(s)
- Ameer M Elbuluk
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA
| | - Kelvin Y Kim
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA
| | - Kevin K Chen
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA
| | - Afshin A Anoushiravani
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA
| | - Richard Iorio
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA.
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18
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Chen KK, Elbuluk AM, Vigdorchik JM, Long WJ, Schwarzkopf R. The effect of wound dressings on infection following total joint arthroplasty. Arthroplast Today 2018; 4:125-129. [PMID: 29560407 PMCID: PMC5859663 DOI: 10.1016/j.artd.2017.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022] Open
Abstract
Background The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA. Methods MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA. All studies comparing Hydrofibre dressings to Standard dressings or Absorbent dressings were included in this meta-analysis. Studies looking at TJA secondary to trauma were excluded. Two individuals independently extracted data, and study results were divided based on type of treatment. The primary outcome was to compare the infection rate of Hydrofibre dressings to that of both Standard Dressings and Absorbent dressings. Results Of a total of 3721 participants, 1483 were treated with Standard dressings (non-impregnated gauze), 1911 with Hydrofibre dressings, and 327 with Absorbent dressings. The risk ratio for infection comparing Standard with Hydrofibre was 4.16 (95% confidence interval, 1.71-10.16) as compared to 2.60 (95% confidence interval, 0.66-10.27) when comparing Absorbent with Hydrofibre dressings. Conclusions Our analysis suggests that Hydrofibre dressings may be significantly better than Standard and Absorbent dressings with respect to reducing infection. However, given the observed heterogeneity and small number of studies included, more comparative studies are needed to definitively recommend superiority among dressings following TJA. Level of Evidence Level 1.
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Affiliation(s)
- Kevin K Chen
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Ameer M Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - William J Long
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center's Hospital for Joint Diseases, New York, NY, USA
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19
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Anil U, Elbuluk AM, Ziegler J, Schwarzkopf R, Long WJ. Hospital Consumer Assessment of Healthcare Providers and Systems Scores Do Not Predict Outcomes After Total Hip Arthroplasty. J Arthroplasty 2018; 33:337-339.e6. [PMID: 29066110 DOI: 10.1016/j.arth.2017.09.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/24/2017] [Accepted: 09/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With the establishment of the Hospital Value-Based Purchasing program, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score has been incorporated into the calculation of the total performance score, which determines redistribution of up to 2% of Medicare payments. This study aims to assess whether the HCAHPS score correlates with validated outcome measures after total hip arthroplasty. METHODS Data from 63 patients who underwent a total hip arthroplasty and completed both an HCAHPS score and patient-reported outcome measures (PROMs) at our institution during the study period from January 1, 2015 to September 2016 were analyzed. The HCAHPS overall hospital rating scores were correlated with the preoperative to postoperative change in validated PROMs, namely EuroQol-EQ-5D Instrument and Hip Disability and Osteoarthritis Outcome Score. RESULTS There was no statistically significant correlation between the HCAHPS overall hospital rating score and PROMs. CONCLUSION This study shows a lack of correlation between established validated PROMs used in orthopedic surgery, and the HCAHPS survey scores, an important determinant of compensation in the pay-for-performance reimbursement models.
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Affiliation(s)
- Utkarsh Anil
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Ameer M Elbuluk
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Jacob Ziegler
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - William J Long
- Department of Orthopaedic Surgery, New York University Langone Medical Center, Hospital for Joint Diseases, New York, New York; Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, New York
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20
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Elbuluk AM, Wojack P, Eftekhary N, Vigdorchik JM. Three-Dimensional Templating for Acetabular Component Alignment During Total Hip Arthroplasty. Orthopedics 2017; 40:e708-e713. [PMID: 28558114 DOI: 10.3928/01477447-20170522-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
Appropriate placement of the acetabular cup is an important determinant of implant stability and longevity. Malposition of acetabular cups negatively influences prosthesis survival and leads to an increased dislocation rate. The objective of the study was to determine the role of 3-dimensional templating in obtaining accurate acetabular component placement in total hip arthroplasty. In this computed tomography-based study, the authors identified 93 patients who underwent primary total hip arthroplasty with computer-assisted navigation. Using 3-dimensional planning, the authors templated the acetabular component at an inclination of 40° and anteversion of 20°. To classify acetabular cup coverage by bone, the acetabulum was used as a clock face with the center of the transverse acetabular ligament (TAL) as 6-o'clock. Analyses revealed that 72% of cups were uncovered between 9- to 1-o'clock for right hips. On the left side, 88% of cups were uncovered between 11- to 3-o'clock. Across all hips, 74% of cups had a 1-o'clock position at the most lateral aspect. Further analysis revealed that 46% of acetabular cups had a teardrop at the same level of the most inferior aspect of the cup, whereas only 37% of cups had a teardrop above the inferior aspect of the cup. Finally, the acetabular component was aligned with the TAL in 76% of hips, retroverted to the TAL in 16%, and anteverted to the TAL in 8%. The current study demonstrates a useful gross intraoperative reference tool to standardize cup position without the need for additional equipment and reliance on anatomical landmarks. [Orthopedics. 2017; 40(4):e708-e713.].
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21
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Elbuluk AM, Old AB, Bosco JA, Schwarzkopf R, Iorio R. Strategies for reducing implant costs in the revision total knee arthroplasty episode of care. Arthroplast Today 2017; 3:286-288. [PMID: 29204498 PMCID: PMC5712020 DOI: 10.1016/j.artd.2017.03.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/02/2017] [Accepted: 03/10/2017] [Indexed: 11/29/2022] Open
Abstract
Background Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models. Methods Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014. Average cost of components for each case was calculated and compared to the total hospital cost for that admission. Costs for an all-component revision were then compared to a proposed "direct to hospital" (DTH) standardized pricing model and a fixed price revision option. Potential savings were calculated from these figures. Results On average, 28% of the total hospital cost was spent on implants for rTKA. The average cost for revision of all components was $13,640 and ranged from $3000 to $28,000. On average, this represented 32.7% of the total hospital cost. Direct to hospital implant pricing could potentially save approximately $7000 per rTKA, and the fixed pricing model could provide a further $1000 reduction per rTKA-potentially saving $8000 per case on implants alone. Conclusions Alternative implant pricing models could help lower the total cost of rTKA, which would allow hospitals to achieve significant cost containment.
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Affiliation(s)
- Ameer M Elbuluk
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Andrew B Old
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Joseph A Bosco
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
| | - Richard Iorio
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA
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