Incidence Of Total Hip Arthroplasty Research Articles

The Impact of Bariatric Surgery on Postoperative Complications and Outcomes following Primary Total Hip Arthroplasty

AbstractThe prevalence of obesity is significantly increasing in the U.S. population and is associated with both increased incidence of total hip arthroplasty (THA) and potentially worsened postoperative outcomes. Current guidelines strongly encourage exercise-based weight loss in morbidly obese THA candidates to decrease patient risk profiles, but data on the impact of receiving bariatric surgery (BS) for weight loss prior to THA are limited and controversial. The purpose of this study was to clarify the impact of BS on postoperative complications and outcomes following THA. Using Current Procedural Terminology, International Classification of Diseases (ICD)-9, and ICD-10 codes, patients undergoing primary THA from 2010 to 2018 were retrospectively collected from PearlDiver's Mariner dataset. Patients were divided into three cohorts who underwent primary THA: nonmorbidly obese patients, morbidly obese patients, and morbidly obese patients who underwent THA within 2 years of BS. Patients were subsequently matched based on age, Charlson Comorbidity Index, gender, and tobacco use. The primary outcome of this study was the frequency of 90-day and 2-year postoperative complications following primary THA. Compared with morbidly obese non-BS patients, morbidly obese patients who underwent BS prior to receiving a primary THA were less likely to have blood transfusion (4.24 vs. 7.44%, p < 0.05), cellulitis (2.92 vs. 6.11%, p < 0.05), myocardial infarction (2.39 vs. 4.91%, p < 0.05), and deep venous thrombosis (1.06 vs. 3.05%, p < 0.05) at 90-day follow-up. The remaining 90-day postoperative outcomes were not found to be statistically different between cohorts. There were no significant differences in 2-year surgical complications between the morbidly obese non-BS cohort and morbidly obese BS cohort. In this study, we found that morbidly obese patients who underwent BS prior to THA had fewer 90-day medical complications and no significant differences in 2-year surgical complications compared with those who did not undergo BS prior to THA.

Excellent Survival Rate of Cemented Modular Stems in One-Stage Revision for Periprosthetic Hip Infections With Massive Femoral Bone Loss: A Retrospective Single-Center Analysis of 150 Cases

BackgroundWith the increasing incidence of total hip arthroplasty (THA), there is also an expected concurrent increase in revision THA (rTHA), which is known to have a high complication and re-revision rate. In the setting of infection, radical debridement is essential and options for femoral bone loss are limited. One viable solution is cemented modular stems, but limited evidence exists on their use in septic revision. This study aimed to analyze survival and complication related to the use of cemented modular stems in one-stage septic rTHA with severe femoral bone loss. MethodsThe institutional database of patients who underwent rTHA for septic one-stage revision with cemented modular stems was reviewed. Exclusion criteria were patients aged less than 18 years and nonseptic or 2 stage revisions. Outcomes measured were complication, re-infection, re-operation, and survivorship of the implant. A total of 150 patients were included. The mean age was 68 years (range, 30 to 91), and the mean follow-up was 105 months (range, 1 to 150). ResultsTreatment was considered successful in 81.3% of cases. Patients who underwent multiple prior surgeries demonstrated a lower rate of treatment success (P < .001). The main cause of failure was re-infection (11 of 28). Among cases failed for aseptic reasons (17 of 28), loosening of the cemented modular stem was the cause of re-revision in 2 patients (1.3%). ConclusionsThe use of modular cemented stems is a viable option in case of septic one-stage rTHA associated with severe femoral bone loss. However, surgeons and patients should be aware that this treatment is still characterized by a high rate of complications, which may lead to further surgeries. Level of evidenceIII.

Metformin Reduces the Risk of Total Hip Arthroplasty in Elderly Patients with Hip Osteoarthritis and Type 2 Diabetes Mellitus.

To assess if metformin could reduce the risk of total hip arthroplasty (THA) in elderly patients with hip osteoarthritis and type 2 diabetes (T2DM). It is a retrospective study among elderly patients (≥65 years) with hip osteoarthritis and T2DM. All included patients were divided into metformin group and non-metformin group, then propensity-score match (PSM) was performed to control potential confounding factors. The primary endpoint was the incidence of the first THA during the study period. Multivariate Cox regression analysis was employed to evaluate the association of metformin with the risk of THA. A matched cohort of 716 patients were finally included, with 308 metformin users and 308 metformin non-users. During a maximum follow-up of 10 years, the incidence of THA in metformin users was significantly lower than that in non-users (4.9% vs 25.0%, P<0.01). Multivariate Cox regression analysis indicated that metformin users were significantly associated with a lower risk of THA compared with non-users (HR = 0.17, 95% CI: 0.10-0.30; P<0.01). In addition, further analyses indicated that participants with long-term metformin use (HR = 0.10, 95% CI: 0.02-0.46; P<0.01) or high metformin dosage (HR = 0.15, 95% CI: 0.04-0.57; P<0.01) had a lower risk of THA. Metformin use could reduce the risk of THA in patients with hip osteoarthritis and T2DM, and the effect is accumulative and dose dependent.

Bilateral Total Hip Arthroplasty: Outcomes of Staged Versus Simultaneous Procedures Performed Using an Anterior-Based Muscle-Sparing Approach

BackgroundThe incidence of total hip arthroplasty (THA) in the United States continues to increase due to its ability to markedly improve patients’ quality of life. This study investigated and compared the perioperative and postoperative outcomes of simultaneous (SI-THA) and staged (ST-THA) bilateral THA procedures using an anterior-based muscle-sparing (ABMS) approach. MethodsThis retrospective case control study evaluated perioperative and postoperative outcomes from primary bilateral SI-THA or ST-THA (within 365 days) performed with the ABMS approach by 3 surgeons at a single institution between January 2013 and August 2020. A total of 226 patients (113 in each cohort) were matched based on age, sex, body mass index, and comorbidity score. ResultsCompared to the ST-THA group, the SI-THA had shorter anesthesia duration (P < .001) and shorter length of stay (P < .001), but longer length of surgery (P = .002). There was no statistical significance between groups in blood transfusion rates, discharge dispositions, emergency department visits, hospital readmissions, or postoperative complications within one year. ConclusionsThe results of this study demonstrate that SI-THA and ST-THA yield comparable results using the ABMS approach. Our perioperative and postoperative results suggest low rates of complications, emergency department visits, readmissions, and high rates of patient satisfaction scores. Therefore, both SI-THA and ST-THA can be considered by experienced surgeons as treatment for advanced bilateral hip arthritis.

Is There Variation in Time to and Type of Treatment for Hip Osteoarthritis Based on Insurance?

BackgroundDisparities in care access based on insurance exist for total hip arthroplasty (THA), but it is unclear if these lead to longer times to surgery. We evaluated whether rates of THA versus nonoperative interventions (NOI) and time to THA from initial hip osteoarthritis (OA) diagnosis vary by insurance type. MethodsUsing a national claims database, patients who had hip OA undergoing THA or NOI from 2011 to 2019 were identified and divided by insurance type: Medicaid-managed care; Medicare Advantage; and commercial insurance. The primary outcome was THA incidence within 3 years after hip OA diagnosis. Multivariable logistic regression models were created to assess the association between THA and insurance type, adjusting for age, sex, region, and comorbidities. ResultsMedicaid patients had lower rates of THA within 3 years of initial diagnosis (7.4 versus 10.9 or 12.0%, respectively; P < .0001) and longer times to surgery (297 versus 215 or 261 days, respectively; P < .0001) compared to Medicare Advantage and commercially-insured patients. In multivariable analyses, Medicaid patients were also less likely to receive THA (odds ratio (OR) = 0.62 [95% confidence intervals (CI): 0.60 to 0.64] versus Medicare Advantage, OR = 0.63 [95% CI: 0.61 to 0.64] versus commercial) or NOI (OR = 0.92 [95% CI: 0.91 to 0.94] versus Medicare Advantage, OR = 0.81 [95% CI: 0.79 to 0.82] versus commercial). ConclusionsMedicaid patients experienced lower rates of and longer times to THA than Medicare Advantage or commercially-insured patients. Further investigation into causes of these disparities, such as costs or access barriers, is necessary to ensure equitable care.

Incidence of total hip arthroplasty in patients with Legg-Calve-Perthes disease after conservative or surgical treatment: a meta-analysis.

This systematic review and meta-analysis aimed to determine the incidence of total hip arthroplasty (THA) in patients with Legg-Calve-Perthes disease (LCPD) treated conservatively or surgically and factors influencing the incidence of THA. Long-term follow-up studies on the conservative or surgical treatments of LCPD from 1950 to 2021 were conducted using six public databases. Articles were screened by two investigators (PRISMA guidelines), and the quality of the included publications (n = 27) was assessed (MINORS criteria). R version 4.2.1 was used for statistical analysis. The overall incidences of THA were 6.8% and 5.14% in patients who were treated conservatively and surgically, respectively. At disease onset, the incidences of THA were 6.79% and 6.17% after conservative treatment and surgery in patients aged < sevenyears, respectively, and 16.97% and 3.61% in patients aged > sevenyears, respectively. The incidences of THA were 4.91%, 5.19%, and 23.18% in patients who were treated conservatively with ≤ 30, 30-40, and > 40years of follow-up, respectively, and 3.68%, 3.11%, 9.66%, and 17.92% in patients who were treated surgically with ≤ ten, ten to20, 20-40, and > 40years of follow-up, respectively. In patients who received conservative treatment, the incidences of THA were 5.79% and 5.29% in patients with Stulberg I-II and III-V, respectively. In surgically treated patients, the incidence of THA was 0% in Stulberg I-II and 8% in Stulberg III-V. Patients with LCPD had relatively low incidences of THA. The greater the age at disease onset and longer the follow-up, the higher the incidence of THA; however, the Stulberg classification was not directly associated with the incidence of THA.

Relative frequency of primary total hip arthroplasty for avascular necrosis in the United States as compared to a regional center: A data review

BackgroundThe relative frequencies of indications for primary total hip arthroplasty (THA) are not well-established. This study aims to establish the incidence of THA performed for Avascular Necrosis of the hip (AVN), as well as the other most common indications for THA in the United States, as compared to the incidences at a high-volume tertiary referral center in Miami, Florida. We hypothesize that the relative incidence of AVN and each other indication for THA will vary significantly between the United States as a whole and the tertiary referral center. MethodsA query of the 2016–2017 National Inpatient Sample (NIS) and a tertiary referral center adult reconstruction registry was completed. The relative frequencies of each indication for THA, demographics, and behavioral risk factors were analyzed. Results225,061 primary THA patients in the National Inpatient Sample database and 447 in the Miami tertiary referral center database were included in the final analysis. The proportion of primary THA for AVN in the NIS database (5.97%) was significantly lower than the same proportion in the tertiary referral center database (22.2%), p < .001. There was no significant difference in the incidence of primary THA for osteoarthritis, inflammatory arthritis, or hip dysplasia between the two populations. ConclusionThe incidence of THA for AVN is significantly different between a tertiary referral center and the greater United States. Patient demographics, race, and behavioral risk factors are associated with the disparity. Orthopaedic surgeons should recognize the differences in THA indication between populations when counseling patients on treatments, outcomes, and the most current literature.

Intra-articular corticosteroids associated with increased risk of total hip arthroplasty at 5 years.

Intra-articular corticosteroid injections are commonly administered for hip pain. However, guidelines are conflicting on their efficacy, particularly in patients without arthritis. This study assessed for an association of corticosteroid injections and the incidence of total hip arthroplasty at 5 years. Patients with a diagnosis of hip pain without femoroacetabular osteoarthritis who were administered an intra-articular corticosteroid injection of the hip within a 2-year period were identified from the Mariner PearlDiver database. Patient were matched to patients with a diagnosis of hip pain who did not receive an injection. 5-year incidence of total hip arthroplasty was compared between matched patients who received an intra-articular corticosteroid injection and those who did not. 2,540,154 patients diagnosed with hip pain without femoroacetabular arthritis were identified. 25,073 (0.9%) patients received a corticosteroid injection and were matched to an equal number of control patients. The incidence of total hip arthroplasty (THA) at 5-year-follow up was significantly higher for the corticosteroid cohort compared to controls (1.1% vs. 0.5%; p < 0.001). The incidence and risk of THA increased along with number of injections (1 injection: 0.8%, OR 1.37; 95% CI, 1.34-1.42; p < 0.001, 2 injections: 1.1%; OR 1.45; CI, 1.40-1.50; p < 0.001, ⩾3 injections: 1.5%; OR 1.48; CI, 1.40-1.56; p < 0.001). There may be a dose-dependent association of corticosteroid injections and a greater risk of total hip arthroplasty at 5 years. These results along with the conflicting guidelines on the efficacy of intra-articular steroids for hip pain should prompt physicians to consider osteoarthritis progression that may occur in the setting of corticosteroid injections in non-arthritic hips.

Irretrievable Morse taper junction of the femoral prosthesis at revision hip arthroplasty for metallosis: A case report

Incidence of total hip arthroplasties being performed is on a rise across the world, consequently we would see more and more revisions hip arthroplasties being done for various indications such as infection, loosening, wear, metallosis, trauma; alone or a combination of the above factors. This case report highlights one of the rare but interesting scenarios that a revision hip surgeon must be prepared to encounter while planning to perform a technically challenging revision hip arthroplasty surgery. This report also thus emphasizes the importance of extensive pre-operative planning in terms of technique and timing of the procedure, the skills set and the armamentarium of tools that may be needed for a demanding revision arthroplasty procedure.

Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades.

IntroductionOver the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. MethodsThis is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019. ResultsThe search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased.ConclusionMedical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.Electronic Supplementary MaterialThe online version of this article (10.1007/s40744-020-00238-z) contains supplementary material, which is available to authorized users.

Long-term total hip arthroplasty rates in patients with acetabular and pelvic fractures after surgery: A population-based cohort study.

Background/objectiveOsteoarthritis typically develops after surgery for traumatic fractures of the acetabulum and may result in total hip arthroplasty (THA). We conducted a population-based retrospective study to investigate the incidence of THA after treatment of acetabular, pelvic, and combined acetabular and pelvic fractures with open reduction-internal fixation surgery compared with that in the control group.DesignA retrospective population-based cohort study.SettingData were gathered from the Taiwan National Health Insurance Research Database.ParticipantsWe enrolled 3041 patients with acetabular fractures, 5618 with pelvic fractures, and 733 with combined pelvic and acetabular fractures between January 1, 1997, and December 31, 2013, totaling 9392 individuals. The control group comprised 664,349 individuals. Study participants were followed up for the occurrence of THA until death or the end of the study period.ResultsThe THA rates after surgical intervention were 17.82%, 7.28%, and 18.01% in patients with acetabular, pelvic, and combined acetabular and pelvic fractures, respectively. Moreover, they were significantly higher for the acetabular fracture, pelvic fracture, and combined-fracture groups (adjusted hazard ratios [aHRs] = 58.42, 21.68, and 62.04, respectively) than for the control group (p < 0.0001) and significantly higher for the acetabular fracture and combined-fracture groups than for the pelvic fracture group (aHRs = 2.59 and 2.68, respectively; p < 0.0001).ConclusionThe incidence rates of THA after surgical intervention in the pelvic fracture, acetabular fracture, and combined-fracture groups were significantly higher than that of the control group.

Thirty-Day Complications in Osteonecrosis Patients Following Total Hip Arthroplasty

BackgroundThirty-day complications in osteonecrosis (ON) patients undergoing total hip arthroplasty (THA) are inconsistently reported. Therefore, the purpose of this study is to evaluate (1) the incidence of THA, (2) operative times, (2) length of stay, (3) reoperation rates, (4) readmission rates, and (5) complication rates, in the general vs ON THA populations. We also substratified and compared these cohorts based on ON-specific risk factors. MethodsUsing the National Surgical Quality Improvement Program database, Current Procedural Terminology code 27130, International Classification of Disease, Ninth Edition code 733.42, and a 1:1 propensity score match, a total of 8344 matched ON and non-ON THA patients were identified. ON patients were also substratified based on key risk factors. The above variables were compared between the matched ON and non-ON cohorts as well as for patients with each risk factor using Pearson’s chi-square and Student t-tests. ResultsThe proportion of THAs performed on ON patients decreased by 35% from 2008 to 2015. Mean operative times were constant between the ON and non-ON patients (102 minutes). ON patients had shorter mean length of stay (3.1 vs 3.4 days, P = .002). Of the 17 different 30-day complications evaluated, superficial surgical site infection (1.2% vs 0.6%, P = .004), pneumonia (0.8% vs 0.2%, P = .001), transfusion (15.6% vs 5.4%, P < .001), and readmission (5.1% vs 2.3%, P = .012) were higher among ON patients. ON patients with a history of corticosteroid use, higher American Society of Anesthesiologists score, and smoking were also found to have higher complication rates compared to non-ON patients with the same risk factors. ConclusionThis is one of the first studies to compare postoperative THA outcomes between matched ON vs non-ON patients, while also taking into consideration specific risk factors between the cohorts.

National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database.

BACKGROUNDHemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIMTo examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups.METHODSWe queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTSOf the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA.CONLUSIONThere has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS.

ANALYSIS OF THE RADIOLOGICAL ASSESSMENT OF RECONSTRUCTION IN TOTAL HIP ARTHROPLASTY

Background: Total hip Arthroplasty (THA) is one of the most common interventions in Orthopaedic surgery. Increase in incidence of THA appears likely with the growing elderly population. THA has revolutionised the management of the patients suffering from pathologies of the hip. The common indications for THA today are osteoarthritis hip, avascular necrosis hip, ankylosing spondylitis, rheumatoid arthritis and in posttraumatic hip.&#x0D; Methods: The study was carried as a retrospective study, from February 2013 to July 2014. After getting the approval from the Ethics Committee of the Institute (Annexure I) and the consent from the patients the study was conducted on 49 patients who underwent Total Hip Arthroplasty after fracture acetabulum.&#x0D; Results: Based on the treatment received for fracture acetabulum, the vertical offset measurement was done for 47 patients. The affected side was compared with the un-affected side in the patient and a restoration of vertical offset on the affected side within 20% of the unaffected side was taken as acceptable. In 31 patients acceptable vertical offset was restored.&#x0D; Conclusion: Radiological assessment of the patients was done using 4 parameters. Measurement of Vertical offset, Horizontal offset, Body lever arm and Acetabular cup inclination was done. The affected side was compared with the un-affected side in the patient and a restoration of parameters on the affected side within 20% of the unaffected side was taken acceptable.&#x0D; Keywords: Radiological, Arthroplasty, Reconstruction

Performance analysis of grafted poly (2-methacryloyloxyethyl phosphorylcholine) on additively manufactured titanium substrate for hip implant applications

The incidence of total hip arthroplasty (THA) has been evidently growing over the last few decades. Surface modification, such as polymer grafting onto implant surfaces using poly (2-methacryloyloxyethyl phosphorylcholine) (PMPC), has been gaining attention due to its excellent biocompatibility and high lubricity behaviour resulting in reducing surgical recurrence number and increasing implant lifetime. Investigating thermal stability and mechanical properties of the grafted polymer is, therefore, extremely important as these properties define the failure mechanism of implants. This study focuses on optimising monomer concentration to achieve the best physical, thermal and mechanical properties of the grafted additively manufactured titanium (Ti6Al4V) implants. Three different concentration of monomers, 0.4 M, 0.6 M and 0.8 M, were investigated, and grafted implants were characterised. The results from thermal analysis confirmed that the PMPC polymer is thermally stable for implant applications regardless of the monomer concentrations. A significant reduction in Young’s modulus of polymer grafted samples (33.2–42.9%), in comparison with untreated Ti6Al4V samples and consequent improvement of wear resistance and elasticity behaviour, proved the potentiality of polymer films for implant applications. In summary, polymer grafted implant prepared with 0.6 M monomer concentration showed the optimal thermal, physical and wear resistance properties.

PROGRESSIVE REHABILITATION AFTER TOTAL HIP ARTHROPLASTY: A PILOT AND FEASIBILITY STUDY

The incidence of total hip arthroplasty (THA) has increased, due in part to younger individuals undergoing the procedure. Surgical techniques and biomaterials have improved, but rehabilitation has not kept pace with the needs of a changing demographic. The purpose of this study was to evaluate the feasibility and preliminary effectiveness of a progressive strengthening and functional retraining intervention after THA. Intervention study. Twenty patients participated in the control group (n=10) or experimental group (n=10). The experimental intervention had few supervised sessions in the early phase after THA (weeks 0-12), followed by supervised, progressive, and high-level activity retraining in the later phase (weeks 12-16). Training in the experimental group was tailored to individual patient goals, which included a variety of vocational and recreational activities. The control group participated in usual rehabilitation care as prescribed by their surgeon. Therefore, the duration and content of rehabilitation of the control group therapy was not constrained. Testing included three-dimensional motion analysis of gait and a clinical evaluation prior to surgery and 16 weeks post-surgery. Change scores were calculated for pain, the Timed Up and Go (TUG), the Stair Climb Test (SCT), the Six-minute Walk Test (6MWT), the Thirty Second Chair Rise Test (30-CRT), strength, the Hip Outcome Scale (HOS), the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS Jr), ground reaction force during stance, hip abduction moment, sit to stand ground reaction force, and symmetry between limbs during stance and sit to stand and compared between groups. Patient satisfaction and number of rehabilitation visits were also compared. Safety and feasibility were assessed using descriptive analysis of the number adverse events. One patient dropped from the control group prior to rehabilitation. The intervention group had a significantly greater improvement for the 6MWT than the control group (p=0.011), functional questionnaires (p=0.034), hip abduction strength on the non-surgical side (p=0.01) and greater satisfaction (96 vs 84 out of 100; p=0.03) at the conclusion of the intervention. The intervention group demonstrated a significantly greater improvement in force symmetry during sit-to-stand (p=0.041) as compared to the control group. There were no other significant differences in change scores for functional measures or discrete biomechanical metrics. This physical therapy protocol, which focused on reducing supervised visits early after THA and retraining higher level activities later in the course of recovery, had a positive effect on biomechanics and functional outcomes without compromising safety. The effect of the experimental intervention was most appreciable for the 6MWT, non-surgical hip strength, satisfaction, and movement symmetry. 2B.

Body Mass Index to Age Ratio: A Cost Effective Implant Selection Guideline for Total Hip Arthroplasty

AbstractThe incidence of total hip arthroplasty (THA) is dramatically increasing, placing a financial burden on the health care system as a whole. These economic challenges have inspired innovation in health care and spurred the implementation of value-based-care models. In this new health care environment, it is imperative to develop strategies that reduce cost while maintaining quality. The authors developed an implant selection guideline system for THA based upon a ratio of patient body mass index (BMI) to age. Patients are divided into either a high, medium, or standard demand category based on a BMI/age ratio of &gt; 0.60, 0.60–0.41, and &lt; 0.40, respectively. Retrospectively, the authors reviewed surgical reports of 1,990 patients who underwent primary THA at their institution from January 2012 to March 2014 to identify the type of implants utilized and analyze the potential cost impact of implementing this standardization system into clinical practice. Of 701 standard demand patients, 31.2% received higher cost implants than their demand necessitates under their model. A 16.5% of the 892 medium demand patients received high demand implants. High and medium demand implants cost 21.1 and 10.5% more than standard demand, respectively. Collectively, application of the BMI/age ratio would have resulted in a 2.2% reduction in overall THA implant cost and 15% if high demand implants had been used in every patient. Implementation of a BMI/age ratio for THA implant selection will reduce costs. This strategy may allow hospitals to more accurately predict and control future costs which is of growing importance in today's bundled payment and value-based-care environment.

Can early rehabilitation after osteoarthritis reduce knee and hip arthroplasty risk?: A national representative cohort study.

This retrospective cohort study evaluated the effects of different frequencies of physical therapy intervention on the total knee arthroplasty (TKA) and total hip arthroplasty (THA) risk of osteoarthritis (OA) patients.We sampled 438,833 insurants from Taiwan National Health Insurance Research Database for patients diagnosed as having OA during 2000 to 2013. OA who received physical therapy within in the first year of OA diagnosis were divided based on the number of sessions they received in that first year: >24, 13–23, and <12 sessions.The results revealed that the TKA and THA incidence rates among patients aged 60 to 80 years were respectively 3.5% and 0.9% in the >24 cohort and 4.9% and 1.4% (all P < .001) in the comparison cohort. Moreover, the HRs of TKA and THA in the >24 cohort were 0.77 (0.67–0.87, P < .001) and 0.71 (0.53–0.96, P = .024), respectively. By contrast, no significant differences were noted between the 13–23 and <12 cohorts and their respective comparison cohorts.In conclusion, our study results indicated that elderly patients aged 60 to 80 years who underwent >24 physical therapy sessions within 1 year of receiving an OA diagnosis exhibited reduced of TKA and THA risks.

Certificate-of-Need State Laws and Total Hip Arthroplasty

BackgroundMany states have certificate-of-need (CON) programs requiring governmental approval to open or expand healthcare services, with the goal of limiting cost and coordinating utilization of healthcare resources. The purpose of the present study was to evaluate the associations between these state-level CON regulations and total hip arthroplasty (THA). MethodsStates were designated as CON or non-CON based on existing laws. The 100% Medicare Standard Analytic Files from 2005 to 2014 were used to compare THA procedure volumes, charges, reimbursements, and distribution of procedures based on facility volumes between the CON and non-CON states. Adverse postoperative outcomes were also analyzed. ResultsThe per capita incidence of THA was higher in non-CON states than CON states at each time period and overall (P < .0001). However, the rate of change in THA incidence over the time period was higher in CON states (1.0 per 10,000 per year) compared to non-CON states (0.68 per 10,000 per year) although not statistically significant. Length of stay was higher and a higher percentage of patients received care in high-volume hospitals in CON states (both P < .0001). No meaningful differences in postoperative complications were found. ConclusionCON laws did not appear to have limited the growth in incidence of THA nor improved quality of care or outcomes during the study time period. It does appear that CON laws are associated with increased concentration of THA procedures at higher volume facilities. Given the inherent potential confounding population and geographic factors, additional research is needed to confirm these findings.

CS3 - Projected Medicare Savings Associated with Lowering the Risk of Total HIP Arthroplasty Revision: An Administrative Claims Database Analysis

In the United States (US), incidence of total hip arthroplasty (THA) and THA revision procedures is increasing due to an aging population, longer life expectancy, and increasing prevalence of osteoarthritis (OA). We conducted a retrospective cohort study to estimate the clinical and economic burden of THA revisions in a Medicare population. We identified persons aged ≥65 in the Medicare 5% Standard Analytic Files who underwent THA for OA between January 1, 2009 and September 30, 2010. Defining a revision as ≥1 medical claim for a revision procedure following discharge from the THA hospitalization, we used the Kaplan-Meier method to calculate 5-year cumulative revision risk (CRR) through September 30, 2015. Medicare expenditures were calculated for the revision episode of care (inpatient stay plus 90-day global period for Medicare bundled payment). Using a 6.22% compound annual growth rate from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, we estimated the number of THAs to be performed in 2018-2027 and calculated the 10-year projected savings to Medicare for a 1% CRR reduction. Among 7,820 eligible patients, mean age was 74.4 years, with 62.4% female. CRR was 4.2% at 5 years, with 30.8% of revisions occurring within 90 days of the THA. At least 25% of revision patients had a complication. Mean (median) episode-of-care expenditures were $39,274 ($36,157). Conservatively (using median episode-of-care expenditures), if it were to achieve a 1% absolute CRR reduction, Medicare could realize savings of $697 million over 10 years; or $985 million when including Medicare Advantage, which represented 29.2% of 2016 Medicare payments. Strategies to reduce the risk of THA revision – such as the use of implant constructs with lower CRR and value-based payment models – are needed to achieve Medicare payment reductions while maintaining or improving quality of care for Medicare beneficiaries.