Fracture of contemporary femoral stems is a rare occurrence. Earlier THR stems failed due to design issues or post manufacturing heat treatments that weakened the core metal. Our group identified and analyzed 4 contemporary fractured femoral stems after revision surgery in which electrochemical welds contributed to the failure. All four stems were proximally porous coated titanium alloy components. All failures occurred in the neck region post revision surgery in an acetabular cup exchange. All were men and obese. The fractures occurred at an average of 3.6 years post THR redo (range, 1.0–6.5 years) and 8.3 years post index surgery (range, 5.5–12.0 years). To demonstrate the effect of electrocautery on retained femoral stems following revision surgery, we applied intermittent electrosurgical currents at three intensities (30, 60, 90 watts) to the polished neck surface of a titanium alloy stem under dry conditions. At all power settings, visible discoloration and damage to the polished neck surface was observed. The localized patterns and altered metal surface features exhibited were like the electrosurgically-induced damage priorly reported. The neck regions of all components studied displayed extensive mechanical and/or electrocautery damage in the area of fracture initiation. The use of mechanical instruments and electrocautery was documented to remove tissues in all 4 cases. The combination of mechanical and electrocautery damage to the femoral neck and stem served as an initiation point and stress riser for subsequent fractures. The electrocautery and mechanical damage across the fracture site observed occurred iatrogenically during revision surgery. The notch effect, particularly in titanium alloys, due to mechanical and/or electrocautery damage, further reduced the fatigue strength at the fractured femoral necks. While electrocautery and mechanical dissection is often required during revision THA, these failures highlight the need for caution during this step of the procedure in cases where the femoral stem is retained.
Previous studies on Medicare populations have shown improved outcomes and decreased 90-day episode-of-care costs with robotic assisted total knee arthroplasty (rTKA). The purpose of this study was to evaluate the expenditures and utilization following rTKA in the under 65 y/o population. TKA procedures were identified using the OptumInsights Inc. database. A two-year window was studied. The procedures were stratified in two groups: the rTKA or manual (mTKA) cohorts. Propensity score matching (PSM) was performed at 1:5. Utilization and associated costs were analyzed for 90 days following the index procedure. 357 rTKA and 1785 mTKA were included in this analysis.Introduction
Methods
Inpatient rehabilitation services following joint replacement have been estimated to cost over $3 billion/ yr. A shift in reimbursement strategies to bundle payments with the goal of decreasing cost and improving quality has given discharge disposition after joint replacement a front row seat. Our objectives were (1) to establish a correlation between the accuracy of current tools utilized to predict discharge location and (2) compare preoperative and postoperative patient oriented outcomes (POO's) according to discharge disposition. 188 consecutive total hip arthroplasty (THA) surgeries performed by a single surgeon were prospectively studied. Pre-intervention assessment of the probable and preferred discharge disposition was performed using one of 5 tools (1) experienced surgical coordinator evaluation (2) Risk Assessment and Prediction Tool (RAPT); (3) Charlson Score; (4) ASA Score; and (5) Patient Self-Reported Health Status. Demographic characteristics, Visual Analogue Scale, QWB-7, SF-36, WOMAC, clinical scores were recorded before and after surgery. Correlation between final discharge disposition (home vs rehab) and its predictors was performed. Preoperative and postoperative outcomes were compared, p<0.05 was considered significant.Introduction
Methods
Deaths due to overdose involving opioids have nearly quadrupled in USA in the last 20 years. Several published studies have shown that preoperative opioid use independently predicts perioperative complications in total joint arthroplasty. Our objectives were to (1) assess preoperative opioid consumption in patients undergoing total hip arthroplasty (THA) and (2) to determine how preoperative opioid use affects patient oriented outcomes (POO's) and hip scores before and after THA. 54 primary THA by a single surgeon were reviewed. A new patient questionnaire was administered to document preoperative opioid consumption (type, dosage and length of use); preoperatively and postoperatively POO's measurements [visual analog scale (VAS), QWB-7, SF-36, and WOMAC] and hip scores were recorded. Patients were stratified into two groups: (1) Opioid Users and (2) Non-Opioid Users. Oral morphine equivalents (OME) were calculated for opioid using patients using standard methodology.Introduction
Methods
The use of stem cell and platelet-rich plasma (PRP) injections for knee osteoarthritis (OA) is extremely controversial and at best experimental. These treatments are being given to patients across the nation for “cash only payments”. Our objectives were (1) to determine the proportion of board certified orthopedic surgeons who offer stem cell or PRP treatment for knee OA, (2) how much the practices charge for those treatments and (3) if members of the knee society use these therapies. Board certified orthopedic surgeons’ offices in our county were identified by their AAOS active membership. Knee society membership roll was also utilized. Offices were contacted by telephone and presented with a hypothetical patient with end stage knee osteoarthritis searching for specific treatment (stem cells or PRP injections). T-test was used to compare the Dade county board certified orthopedists to knee society members.Introduction
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