The last two decades have seen remarkable technological advances in total hip arthroplasty (THA) implant design. Porous ingrowth surfaces and highly crosslinked polyethylene (HXLPE) have been expected to dramatically improve implant survivorship. The purpose of the present study was to evaluate survival of contemporary cementless acetabular components following primary THA. 16,421 primary THAs performed for osteoarthritis between 2000 and 2019 were identified from our institutional total joint registry. Patients received one of 12 contemporary cementless acetabular designs with HXLPE liners. Components were grouped based on ingrowth surface into 4 categories: porous titanium (n=10,952, mean follow-up 5 years), porous tantalum (n=1223, mean follow-up 5 years), metal mesh (n=2680, mean follow-up 6.5 years), and hydroxyapatite (HA) coated (n=1566, mean follow-up 2.4 years). Kaplan-Meier analyses were performed to assess the survivorship free of acetabular revision. A historical series of 182 Harris-Galante-1 (HG-1) acetabular components was used as reference. The 15-year survivorship free of acetabular revision was >97% for all 4 contemporary cohorts. Compared to historical control, porous titanium (HR 0.06, 95% CI 0.02–0.17, p<0.001), porous tantalum (HR 0.09, 95%CI 0.03–0.29, p<0.001), metal mesh (HR 0.11, 95%CI 0.04–0.31, p<0.001), and HA-coated (HR 0.14, 95%CI 0.04–0.48, p=0.002) ingrowth surfaces had significantly lower risk of any acetabular revision. There were 16 cases (0.1%) of acetabular aseptic loosening that occurred in 8 (0.07%) porous titanium, 5 (0.2%) metal mesh, and 3 (0.2%) HA-coated acetabular components. 7 of the 8 porous titanium aseptic loosening cases occurred in one known problematic design. There were no cases of aseptic loosening in the porous tantalum group. Modern acetabular ingrowth surfaces and HXLPE liners have improved on historical results at the mid-term. Contemporary designs have extraordinarily high revision-free survivorship, and aseptic loosening is now a rare complication. At mid-term follow-up, survivorship of contemporary uncemented acetabular components is excellent and aseptic loosening occurs in a very small minority of patients.
The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation. Between January 2000 and March 2019, 21,469 primary and revision arthroplasties (10,011 THAs; 11,458 TKAs), which were undertaken in 15,504 patients at a single academic medical centre, were identified from a 27-county linked electronic medical record (EMR) system. Depressive and anxiety disorders were identified by diagnoses in the EMR or by using a natural language processing program with subsequent validation from review of the medical records. Patients with mental health diagnoses other than anxiety or depression were excluded.Aims
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Instability remains a common complication following total hip arthroplasty (THA) and continues to account for the highest percentage of revisions in numerous registries. Many risk factors have been described, yet a patient-specific risk assessment tool remains elusive. The purpose of this study was to apply a machine learning algorithm to develop a patient-specific risk score capable of dynamic adjustment based on operative decisions. 22,086 THA performed between 1998–2018 were evaluated. 632 THA sustained a postoperative dislocation (2.9%). Patients were robustly characterized based on non-modifiable factors: demographics, THA indication, spinal disease, spine surgery, neurologic disease, connective tissue disease; and modifiable operative decisions: surgical approach, femoral head size, acetabular liner (standard/elevated/constrained/dual-mobility). Models were built with a binary outcome (event/no event) at 1-year and 5-year postoperatively. Inverse Probability Censoring Weighting accounted for censoring bias. An ensemble algorithm was created that included Generalized Linear Model, Generalized Additive Model, Lasso Penalized Regression, Kernel-Based Support Vector Machines, Random Forest and Optimized Gradient Boosting Machine. Convex combination of weights minimized the negative binomial log-likelihood loss function. Ten-fold cross-validation accounted for the rarity of dislocation events.Introduction
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Revision total knee arthroplasty (revision TKA) occurs for a wide variety of indications and along with revision total hip arthroplasty is billed for using Diagnosis-Related Groups (DRGs) 466, 467, and 468 in the United States. However, DRGs do not account for revision etiology, a potentially substantial driver of cost. This study investigates revision TKA costs and 30-day complications by indication, employing both local granular as well as national standardized databases. Hospitalization costs and complication rates for 1,422 aseptic revision TKAs performed at a high-volume center between 2009 and 2015 were retrospectively reviewed. Additionally, charges for 28,173 revision TKAs in the National Inpatient Sample (NIS) were converted to costs using the Healthcare Cost and Utilization Project cost-to-charge ratios. 30-day complication rates for 3,450 revision TKAs were obtained using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP). Costs and complications were compared between revision TKAs performed for the indication of fracture, wear/loosening, and instability with use of simultaneous and pairwise comparisons and a multivariable model accounting for American Society of Anesthesiologists (ASA) score, age, and sex.Introduction
Methods
Bilateral total knee arthroplasty (TKA) can be performed under a single-anesthetic (SA) or staged under a two-anesthetic (TA) technique. Recently, our institution began piloting a two-surgeon team SA method for bilateral TKA. The purpose of this study was to compare the inpatient costs and clinical outcomes in the first 90 days after surgery between the team SA, single-surgeon SA, and single-surgeon TA approaches for bilateral TKA. All primary TKA performed from 2007–2017 by the two participating surgeons for each of the 3 groups of interest were identified: team SA (N=42 patients; 84 knees), single-surgeon SA (N=146 patients; 292 knees), single-surgeon TA (N=242 patients; 484 knees). No patients were lost to follow-up.Introduction
Methods
Manual chart review is labor-intensive and requires specialized knowledge possessed by highly-trained medical professionals. The cost and infrastructure challenges required to implement this is prohibitive for most hospitals. Natural language processing (NLP) tools are distinctive in their ability to extract critical information from raw text in the electronic health records (EHR). As a simple proof-of-concept, for the potential application of this technology, we examined its ability to discriminate between a binary classification (periprosthetic fracture [PPFFx] vs. no PPFFx) followed by a more complex classification of the same problem (Vancouver). PPFFx were identified among all THAs performed at a single academic institution between 1977 and 2015. A training cohort (n = 90 PPFFx) selected randomly by an electronic program was utilized to develop a prototype NLP algorithm and an additional randomly-selected 86 PPFFx were used to further validate the algorithm. Keywords to identify, and subsequently classify, Vancouver type PPFFx about THA were defined. The algorithm was applied to consult and operative notes to evaluate language used by surgeons as a means to predict the correct pathology in the absence of a listed, precise diagnosis (e.g. Vancouver B2). Validation statistics were calculated using manual chart review as the gold standard.Introduction
Methods
