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Kelly M, Huff T, Schabel K, Yoo J, Lieberman E, Kagan R. Active Amphetamine Abuse in Total Hip Arthroplasty Carries Increased Risk for Postoperative Surgical and Medical Complications. Arthroplast Today 2024; 27:101372. [PMID: 38654888 PMCID: PMC11035087 DOI: 10.1016/j.artd.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background The impact of amphetamine abuse on total hip arthroplasty (THA) outcomes has yet to be studied. As the rates of methamphetamine abuse continue to rise, understanding the risk profile of this population is imperative. This study aims to determine the risk of major surgical and medical complications for those with amphetamine abuse undergoing THA, with the hypothesis that amphetamine abuse carries increased risk. Methods A retrospective review was performed with all-claims data files of a large national database querying International Classification of Disease, tenth revision, procedure codes identifying 333,038 primary THA, and 1027 with active amphetamine abuse. Medical and surgical complications including infection, dislocation, implant failure, periprosthetic fracture, and revision, as well as length of hospital stay and 90-day readmission rate, were identified. Univariate analysis compared rates of dependent outcomes. To account for independent variables, logistic regression was performed using age, Charlson comorbidity index, sex, obesity, tobacco use, and alcohol use. The results were presented as odds ratios (OR) and P values with significance set at <0.05. Results Patients with active amphetamine abuse carried an increased risk of dislocation (OR 1.82, P ≤ .001), infection (OR 2.37, P ≤ .001), mechanical complications (OR 1.64, P ≤ .001), periprosthetic fracture (OR 1.53, P ≤ .05), revision (OR 1.70, P ≤ .001), 90-day readmission (OR 1.79, P ≤ .001), as well as medical complications (1.43, P = .02) compared to those without documented amphetamine abuse. Conclusions Patients with amphetamine abuse are at increased risk of postoperative surgical and medical complications following THA. We recommend consideration of these risks prior to primary THA in this patient population.
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Affiliation(s)
- Mackenzie Kelly
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Huff
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | | | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Kim H, Hart KD, Senders A, Schabel K, Ibrahim SA. Elective Joint Replacement Among Medicaid Beneficiaries: Utilization and Postoperative Adverse Events by Racial and Ethnic Groups. Popul Health Manag 2024; 27:128-136. [PMID: 38442304 DOI: 10.1089/pop.2023.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Hip and knee replacement have been marked by racial and ethnic disparities in both utilization and postoperative adverse events among Medicare beneficiaries, but limited knowledge exists regarding racial and ethnic differences in joint replacement care among Medicaid beneficiaries. To close this gap, this study used Medicaid claims in 2018 and described racial and ethnic differences in the utilization and postoperative adverse events of elective joint replacements among Medicaid beneficiaries. Among the 2,260,272 Medicaid beneficiaries, 5987 had an elective joint replacement in 2018. Asian (0.05%, 95% confidence interval [CI]: 0.03%-0.07%) and Hispanic beneficiaries (0.12%, 95% CI: 0.07%-0.18%) received joint replacements less frequently than American Indian and Alaska Native (0.41%, 95% CI: 0.27%-0.55%), Black (0.33%, 95% CI: 0.19%-0.48%), and White (0.37%, 95% CI: 0.25%-0.50%) beneficiaries. Black patients demonstrated the highest probability of 90-day emergency department visits (34.8%, 95% CI: 32.7%-37.0%) among all racial and ethnic groups and a higher probability of 90-day readmission (8.0%, 95% CI: 6.9%-9.0%) than Asian (3.4%, 95% CI: 0.7%-6.0%) and Hispanic patients (4.4%, 95% CI: 3.4%-5.3%). These findings indicate evident disparities in postoperative adverse events across racial and ethnic groups, with Black patients demonstrating the highest probability of 90-day emergency department visits. This study represents an initial exploration of the racial and ethnic differences in joint replacement care among Medicaid beneficiaries and lay the groundwork for further investigation into contributing factors of the observed disparities.
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Affiliation(s)
- Hyunjee Kim
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon, USA
| | - Kyle D Hart
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon, USA
| | - Angela Senders
- Center for Health Systems Effectiveness, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, USA
| | - Said A Ibrahim
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, USA
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Peterson DF, Schabel K. Cold Welding of the Synthes Femoral Neck System Encountered at Conversion to Arthroplasty: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00008. [PMID: 37437052 DOI: 10.2106/jbjs.cc.22.00530] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
CASE The Synthes Femoral Neck System (FNS) is a relatively new device available to the market in 2019 designed to reduce complication and revision rates after femoral neck fracture stabilization. We present a 77-year-old man with Parkinson disease and avascular necrosis after femoral neck fracture initially managed with the FNS. Subsequent challenges in device removal occurred because of its propensity for bony integration, plate and locking screw welding, and screw head recess destruction. CONCLUSION Surgeons must recognize the need for additional available equipment (e.g., burr or broken screw removal set) for successful extraction when FNS removal is required.
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Affiliation(s)
- Danielle F Peterson
- Department of Orthopaedics, Oregon Health and Science University, Portland, Oregon
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Hegde V, Kendall J, Schabel K, Pelt CE, Yep P, Mullen K, De A, Kagan R. The James A. Rand Young Investigator's Award: Increased Revision Risk With Mobile Bearings in Total Knee Arthroplasty: An Analysis of the American Joint Replacement Registry. J Arthroplasty 2023:S0883-5403(23)00007-4. [PMID: 36639116 DOI: 10.1016/j.arth.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/22/2022] [Revised: 12/25/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mobile-bearing (MB) total knee arthroplasty (TKA) may reduce wear and improve patellar tracking but may increase revision risk due to tibial component design, balance complexity, and bearing dislocation. We utilized the American Joint Replacement Registry to examine risk of revision with MB compared to fixed-bearing (FB) designs. METHODS An analysis of primary TKA in patients over 65 years was performed with American Joint Replacement Registry data linked to Centers for Medicare and Medicaid Services data from 2012 to 2019. Analyses compared MB to FB designs with a subanalysis of implants from a single company. We identified 485,024 TKAs, with 452,199 (93.2%) FB-TKAs and 32,825 (6.8%) MB-TKAs. Cox proportional hazards regression modeling was used for all-cause revision and revision for infection, adjusting for sex, age, and competing risk of mortality. Event-free survival curves evaluated time to all-cause revision and revision for infection. RESULTS MB-TKAs were at an increased risk for all-cause revision: hazard ratio (HR) 1.36 ([95% confidence interval (CI) 1.24-1.49], P < .0001) but not revision for infection: HR 1.06 ([95% CI 0.90-1.25], P = .52). When comparing implants within a single company, MB-TKAs were at an increased risk of all-cause revision: HR 1.55 ([95% CI 1.38-1.73], P < .0001). Event-free survival curves demonstrated increased risk for all-cause revision for MB-TKA across all time points, with a greater magnitude of risk up to 8 years. CONCLUSION Although survivorship of both designs was outstanding, MB-TKA designs demonstrated increased risk for all-cause revision. Additional investigation is needed to determine if this is related to patient selection factors, surgical technique, bearing, or implant design.
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Affiliation(s)
- Vishal Hegde
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Jamil Kendall
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
| | - Christopher E Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Patrick Yep
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Kyle Mullen
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Ayushmita De
- American Academy of Orthopaedic Surgeons, Registries and Data Science Department, Rosemont, Illinois
| | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon
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Kagan R, Zhao S, Stone A, Johnson AJ, Huff T, Schabel K, Woodworth GE, Ivie RMJ. Spinal anesthesia in a designated block bay for total joint arthroplasty: improving operating room efficiency. Reg Anesth Pain Med 2020; 45:975-978. [DOI: 10.1136/rapm-2020-101773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/22/2020] [Accepted: 08/27/2020] [Indexed: 01/07/2023]
Abstract
BackgroundCreating highly efficient operating room (OR) protocols for total joint arthroplasty (TJA) is a challenging and multifactorial process. We evaluated whether spinal anesthesia in a designated block bay (BBSA) would reduce time to incision, improve first case start time and decrease conversion to general anesthesia (GA).MethodsRetrospective cohort study on the first 86 TJA cases with BBSA from April to December 2018, compared with 344 TJA cases with spinal anesthesia performed in the OR (ORSA) during the same period. All TJA cases were included if the anesthetic plan was for spinal anesthesia. Patients were excluded if circumstances delayed start time or time to incision (advanced vascular access, pacemaker interrogation, surgeon availability). Data were extracted and analyzed via a linear mixed effects model to compare time to incision, via a Wilcoxon rank-sum test to compare first case start time, and via a Fisher’s exact test to compare conversion to GA between the groups.ResultsIn the mixed effect model, the BBSA group time to incision was 5.37 min less than the ORSA group (p=0.018). The BBSA group had improved median first case start time (30.0 min) versus the ORSA group (40.5 min, p<0.0001). There was lower conversion to GA 2/86 (2.33%) in the BBSA group versus 36/344 (10.47%) in the ORSA group (p=0.018). No serious adverse events were noted in either group.ConclusionsBBSA had limited impact on time to incision for TJA, with a small decrease for single OR days and no improvement on OR days with two rooms. BBSA was associated with improved first case start time and decreased rate of conversion to GA. Further research is needed to identify how BBSA affects the efficiency of TJA.
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Langston JR, Ramsey DC, Skoglund K, Schabel K. Angiotensin II blockade had no effect on range of motion after total knee arthroplasty: a retrospective review. J Orthop Surg Res 2020; 15:48. [PMID: 32050991 PMCID: PMC7017493 DOI: 10.1186/s13018-020-1555-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/06/2019] [Accepted: 01/12/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Stiffness and pain from arthrofibrosis following total knee arthroplasty (TKA) is a challenging problem, and investigating methods to prevent or reduce the incidence of postoperative arthrofibrosis is critical. Studies have shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are efficacious at preventing fibrotic disorders in the lungs, liver, kidneys, and eyes. Our aim was to determine if ACEI or ARB use postoperatively reduces the incidence of arthrofibrosis in TKA patients. METHODS In a retrospective review, we analyzed 141 consecutive TKAs performed at a single institution by a single surgeon from December 2010 to December 2014. Range of motion (ROM) in patients already taking ACEI, ARB, or neither medication was compared. Independent variables recorded were gender, age, BMI, presence of diabetes or preoperative opioid or statin use, preoperative ROM, and use of ACEIs or ARBs. Dependent variables recorded were postoperative knee flexion, extension, and total arc of motion. The primary outcome variable was success or failure of achieving 118o total arc of motion postoperatively, based on a study that found significant compromise of function in TKA patients who failed to obtain this goal. Secondary endpoints were postoperative knee flexion, extension, and total arc of motion. RESULTS The use of neither ACEIs nor ARBs showed a significant difference in attaining greater than 118° of motion postoperatively compared to controls at 6 months. Significant predictors of obtaining > 118° motion were BMI (p < 0.05), preoperative flexion (p < 0.001), and preoperative total arc of motion (p < 0.002). Significant predictors of secondary ROM outcomes were preoperative ROM and BMI. CONCLUSIONS Our study demonstrated that the principle predictor of postoperative ROM is BMI and preoperative ROM. The use of ACEIs or ARBs did not result in a greater likelihood of obtaining satisfactory ROM postoperatively.
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Affiliation(s)
- Joseph R Langston
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP31, Portland, OR, 97239, USA
| | - Duncan C Ramsey
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP31, Portland, OR, 97239, USA
| | - Kathryn Skoglund
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP31, Portland, OR, 97239, USA
| | - Kathryn Schabel
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code OP31, Portland, OR, 97239, USA.
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DeHaan A, Huff T, Schabel K, Doung YC, Hayden J, Barnes P. Multiple cultures and extended incubation for hip and knee arthroplasty revision: impact on clinical care. J Arthroplasty 2013; 28:59-65. [PMID: 23886405 DOI: 10.1016/j.arth.2013.03.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 08/16/2012] [Revised: 02/20/2013] [Accepted: 03/10/2013] [Indexed: 02/01/2023] Open
Abstract
The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10 days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were reviewed one year post-operatively. When compared to the prior standard of obtaining only one intra-operative culture, the protocol changed the microbiological diagnosis in 26/77 cases (34%, 95% Confidence Interval (CI): 23-45%) and antibiotic treatment in 23/77 cases (30%, 95% CI: 20-41%). In addition, the protocol had a predictive value of joint sterility in culture negative cases of 95% (95% CI: 85-99%). This data demonstrated the new protocol significantly changed patient care, and suggests that 1 or 2 cultures are insufficient. Adopting a similar protocol should be considered by surgeons and institutions as a new minimum standard for management of prosthetic joint infections.
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Affiliation(s)
- Alexander DeHaan
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon
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Peters CL, Schabel K, Anderson L, Erickson J. Open treatment of femoroacetabular impingement is associated with clinical improvement and low complication rate at short-term followup. Clin Orthop Relat Res 2010; 468:504-10. [PMID: 19885709 PMCID: PMC2806994 DOI: 10.1007/s11999-009-1152-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [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: 01/31/2023]
Abstract
BACKGROUND Since the modern description of femoroacetabular impingement (FAI) a decade ago, surgical treatment has become increasingly common. Although the ability of open treatment of FAI to relieve pain and improve function has been demonstrated in a number of retrospective studies, questions remain regarding predictability of clinical outcome, the factors associated with clinical failure, and the complications associated with treatment. QUESTIONS/PURPOSES We therefore described the change in clinical pain and function after open treatment, determined whether failure of treatment and progression of osteoarthritis was associated with Outerbridge Grade IV hyaline cartilage injury, and described the associated complications. METHODS We retrospectively reviewed all 94 patients (96 hips) (55 males and 39 females; mean age, 28 years) who underwent surgical dislocation for femoroacetabular impingement between 2000 and 2008. Seventy-two of the 96 hips had acetabular articular cartilage lesions treated with a variety of methods, most commonly resection of damaged hyaline cartilage and labral advancement. Patients were followed for a minimum of 18 months (mean, 26 months; range, 18-96 months). RESULTS Mean Harris hip scores improved from 67 to 91 at final followup. Six of the 96 hips (6%) were converted to arthroplasty or had worse Harris hip score after surgical recovery. Four of these six had Outerbridge Grade IV acetabular cartilage lesions and two had Legg-Calvé-Perthes disease or slipped capital epiphysis deformities. Two hips (2%) had refixation of the greater trochanter. CONCLUSIONS At short-term followup, open treatment for femoroacetabular impingement in hips without substantial acetabular hyaline cartilage damage reduced pain and improved function with a low complication rate. Treatment of Outerbridge Grade IV acetabular cartilage delamination remains the major challenge. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher L. Peters
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Kathryn Schabel
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Lucas Anderson
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
| | - Jill Erickson
- Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108 USA
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