The use of technology, such as navigation and robotic systems, may improve the accuracy of component positioning in total hip arthroplasty (THA) but its impact on patient reported outcomes measures (PROMs) remains unclear. This study aims to identify the association between intraoperative use of technology and patient reported outcomes measures (PROMs) in patients who underwent primary total hip arthroplasty (THA). We retrospectively reviewed patients who underwent primary THA between 2016 and 2020 and answered a post-operative PROM questionnaire. Patients were separated into three groups depending on the technology utilized intraoperatively: navigation, robotics, or no technology (i.e. manual THA. The Forgotten Joint Score (FJS-12) and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS, JR) were collected at various time points (FJS: 3m, 1y, and 2y; HOOS, JR: pre-operatively, 3m, and 1y). Demographic differences were assessed with chi-square and ANOVA. Mean scores between all groups were compared using univariate ANCOVA, controlling for observed demographic differences.Introduction
Methods
The Comprehensive Care for Joint Replacement (CJR) model was implemented in April-2016 to standardize cost and improve quality of care for two of the most commonly billed inpatient procedures for Medicare patients, total knee and total hip arthroplasty. The purpose of this study is to compare one institution's predicted savings and losses under the CJR model with actual savings and losses after two years of implementation and discuss new methods to maintain savings. Using our institution's data, we calculated the mean cost per episode of care. We calculated the percent reduction in target price and percent savings or losses per case for the CJR and Bundle Payment Care Initiative (BPCI) for each Medicare Severity Diagnosis Related Group (MS-DRG) using mean cost per episode and CJR and BPCI target prices. We compared the target prices, annual savings, and losses per episode of care for both CJR and BPCI. All CJR savings, projected and actual, were computed by comparing CJR savings to that of 2018 BPCI savings.Background
Methods
We investigated whether a novel, real-time fluoroscopy based navigation system optimized component positioning and leg length in fluoroscopically aided Direct Anterior Approach Total Hip Arthroplasty (DAA-THA). We retrospectively reviewed 75 fluoroscopically assisted DAA-THA performed by a single surgeon: 37 procedures used the software intraoperatively to overlay anteversion, inclination, and leg length information over the existing fluoroscopic radiograph with the aim of enhancing component positioning. The control group consisted of 38 procedures from the single surgeon's patient pool who had undergone non-navigated fluoroscopic assisted DAA-THA one month prior to the system's trial. We used the software to compute each data point on an immediate post operative AP radiograph to replicate the intra operative measurement process. Our results demonstrate that the navigation group measurements were significantly closer to the target numbers with less variation. The mean values were significantly closer to target values anteversion (control: 14°, navigated: 19.1°), inclination (control: 37.7°, navigated: 40.8°) and leg length discrepancy (control: 4.7mm, navigated: 0.1mm). The mean difference from target value were also statistically significant: for anteversion (control: −6.0°, navigated: −0.9°), inclination (control: −2.3°, navigated: 0.8°) and leg length discrepancy (control: 2.7°, navigated: −1.9°). In addition, surgical time was shorter in the navigation group (75.7 vs. 74 minutes; p=0.001). The p values were all statistically significant (anteversion 0.0001, inclination 0.0019, LLD < 0.001 and surgical time 0.001). The real-time feedback and calculations provided by the navigation software provided a reproducible precision for component positioning and leg length measurement during DAA-THA. For any figures or tables, please contact authors directly.
Proponents of the THA anterior approach have advocated for the use of dedicated surgical tables similar to those used in lower extremity fracture care that allow for traction, rotation, and angulation of the limb during surgery. Some tables require a specially-trained assistant to manipulate the table, whereas some may be manipulated by the surgeon. The purpose of this study is to compare the clinical outcomes in patients who underwent THA through an anterior approach on an assistant-controlled (AC) versus a surgeon-controlled (SC) table. This is a retrospective study of 343 consecutive THA patients from January 2017 – October 2017. Surgical and clinical data included surgical time, LOS, presence of pain (groin, hip, or thigh pain) at latest follow-up, and revision for any reason. Immediate postoperative radiographs were compared with latest follow-up radiographs to assess for LLD, stem alignment, and stem subsidence.INTRODUCTION
METHODS
Total hip arthroplasty (THA) candidates have received high doses of opioids within the perioperative period for the management of surgical pain. Healthcare systems have responded by improving opioid administration documentation and are now implementing opioid-sparing protocols (OSP) into THA integrated care pathways (ICP). Here we evaluate the effectiveness of a novel OSP in primary THA at out institution. Between January 2019 to April 2019, all patients undergoing primary THA were placed under a novel OSP (Table 1). Patient demographics, inpatient/surgical factors, and inpatient opiate administration events were collected. A historical 2:1 cohort was subsequently derived from patients undergoing THA between January 2018 to August 2018. Opiate administration events collected from our EDW were converted into Morphine Milligram Equivalences (MMEs) and transformed into average MME's per patient per 24-hour interval. Nursing documented visual analog scale (VAS) pain scores were also queried and averaged per patient per 12-hour interval. To assess immediate postoperative functional status, the validated Activity Measure for Post-Acute Care (AM-PAC) Short Forms tool was utilized.Introduction
Methods
