Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Online First™

Articles

Matrix Metalloproteases 1 and 3 Promoter Gene Polymorphism Is Associated With Rotator Cuff Tear

Jorge H. Assunção MD, Alexandre L. Godoy-Santos PhD, Maria Cristina L. G. Santos PhD, Eduardo A. Malavolta PhD, Mauro E. C. Gracitelli PhD, Arnaldo A. Ferreira Neto PhD
3rd February 2017, Clinical Research

Studies suggest that the collagen degeneration and disordered arrangement of collagen fibers in rotator cuff tears are associated with an increase in activity of matrix metalloproteases 1 and 3 (MMP-1 and MMP-3), and that MMP activity may be in part genetically mediated. The degree to which this might be clinically relevant in patients with rotator cuff tears has not been well characterized.

Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

Steven M. Kurtz PhD, Edmund C. Lau MS, Kevin L. Ong PhD, Edward M. Adler MD, Frank R. Kolisek MD, Michael T. Manley FRSA, PhD
20th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs.

Blended Chitosan Paste for Infection Prevention: Preliminary and Preclinical Evaluations

Joel M. Berretta MS, Jessica A. Jennings PhD, Harry S. Courtney PhD, Karen E. Beenken PhD, Mark S. Smeltzer PhD, Warren O. Haggard PhD
17th January 2017, Symposium: 2016 Musculoskeletal Infection Society Proceedings

Local drug delivery devices offer a promising method for delivering vancomycin and amikacin for musculoskeletal wounds. However, current local delivery devices such as beads and sponges do not necessarily allow for full coverage of a wound surface with eluted antibiotics and do not address the need for reducing the antibiotic diffusion distance to help prevent contamination by bacteria or other microorganisms. We blended chitosan/polyethylene glycol (PEG) pastes/sponges to increase biocompatibility and improve antibiotic coverage within the wound.

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Arthur L. Malkani MD, Brian Dilworth MD, Kevin Ong PhD, Doruk Baykal PhD, Edmund Lau MS, Theresa N. Mackin BA, Gwo-Chin Lee MD
12th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

As life expectancy increases, more elderly patients with end-stage hip arthritis are electing to undergo primary THA. Octogenarians undergoing THA have more comorbidities than younger patients, but this is not reflected in risk adjustment models for bundled care programs. The burden of care associated with THA in octogenarians has not been well characterized, and doing so may help these value-based programs make adjustments so that this vulnerable patient population does not risk losing access under accountable care models.

Definitional Differences of ‘Outpatient’ Versus ‘Inpatient’ THA and TKA Can Affect Study Outcomes

Patawut Bovonratwet BS, Matthew L. Webb MD, MHS, Nathaniel T. Ondeck BS, Adam M. Lukasiewicz MD, MSc, Jonathan J. Cui BS, Ryan P. McLynn BS, Jonathan N. Grauer MD
12th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

There has been great interest in performing outpatient THA and TKA. Studies have compared such procedures done as outpatients versus inpatients. However, stated “outpatient” status as defined by large national databases such as the National Surgical Quality Improvement Program (NSQIP) may not be a consistent entity, and the actual lengths of stay of those patients categorized as outpatients in NSQIP have not been specifically ascertained and may in fact include some patients who are “observed” for one or more nights. Current regulations in the United States allow these “observed” patients to stay more than one night at the hospital under observation status despite being coded as outpatients. Determining the degree to which this is the case, and what, exactly, “outpatient” means in the NSQIP, may influence the way clinicians read studies from that source and the way hospital systems and policymakers use those data.

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Andrew J. Schoenfeld MD, MSc, Heeren Makanji MD, Wei Jiang MS, Tracey Koehlmoos PhD, Christopher M. Bono MD, Adil H. Haider MD, MPH
10th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated.