Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 473 | Issue 11 | Nov, 2015

What Drives Variation in Episode-of-care Payments for Primary TKA? An Analysis of Medicare Administrative Data

Peter Cram MD, MBA, Bheeshma Ravi MD, PhD, Mary S. Vaughan-Sarrazin PhD, Xin Lu MS, Yue Li PhD, Gillian Hawker MD, MSc

Episode-of-care payments are defined as a single lump-sum payment for all services associated with a single medical event or surgery and are designed to incentivize efficiency and integration among providers and healthcare systems. A TKA is considered an exemplar for an episode-of-care payment model by many policymakers, but data describing variation payments between hospitals for TKA are extremely limited.

Standard Comorbidity Measures Do Not Predict Patient-reported Outcomes 1 Year After Total Hip Arthroplasty

Meridith E. Greene BA, Ola Rolfson MD, PhD, Max Gordon MD, PhD, Göran Garellick MD, PhD, Szilard Nemes PhD

Comorbidities influence surgical outcomes and therefore need to be included in risk adjustment when predicting patient-reported outcomes. However, there is no consensus on how best to use the available data about comorbidities in registry-based predictive models.

The EQ-5D-5L Improves on the EQ-5D-3L for Health-related Quality-of-life Assessment in Patients Undergoing Total Hip Arthroplasty

Meridith E. Greene BA, Kevin A. Rader PhD, Göran Garellick MD, PhD, Henrik Malchau MD, PhD, Andrew A. Freiberg MD, Ola Rolfson MD, PhD

The EQ-5D is a generic health survey that can be used to compare improvement across different interventions, measure changes in health-related quality of life over time, or to explore cost-effectiveness among treatments, hospitals, or providers. The original EQ-5D survey has three response options for each of five health dimensions; however, with so few response options, ceiling and floor effects are problematic in some populations. A new version, called the EQ-5D-5L, was developed, which gives respondents five answer options (the “5L” refers to five response levels, which is in contrast to the original survey’s three levels). However, the validity of this version has not, to our knowledge, been evaluated in patients undergoing total hip arthroplasty (THA).

Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

Kirill Gromov MD, PhD, Alma B. Pedersen MD, PhD, Søren Overgaard MD, PhD, DMSc, Peter Gebuhr MD, Henrik Malchau MD, PhD, Anders Troelsen MD, PhD, DMSc

Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world’s registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice the results of future revision procedures; however, this has not been documented.

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Dhiren Sheth MD, Guy Cafri PhD, Maria C. S. Inacio PhD, Elizabeth W. Paxton MA, Robert S. Namba MD

Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization.

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Monti Khatod MD, Maria C. S. Inacio PhD, Richard M. Dell MD, Stefano A. Bini MD, Elizabeth W. Paxton MA, Robert S. Namba MD

Total hip arthroplasty (THA) is often performed in patients who are older and may take bisphosphonates to treat a variety of conditions, most commonly osteoporosis. However, the clinical effects of bisphosphonate use on patients who have undergone THA are not well described.

Is a Revision a Revision? An Analysis of National Arthroplasty Registries’ Definitions of Revision

Thoralf R. Liebs MD, PhD, Farina Splietker, Joachim Hassenpflug MD, PhD

The reported survival of implants depends on the definition used for the endpoint, usually revision. When screening through registry reports from different countries, it appears that revision is defined quite differently.

Kaplan-Meier Survival Analysis Overestimates the Risk of Revision Arthroplasty: A Meta-analysis

Sarah Lacny MSc, Todd Wilson BSc, Fiona Clement PhD, Derek J. Roberts MD, Peter D. Faris PhD, William A. Ghali MD, MPH, Deborah A. Marshall PhD

Although Kaplan-Meier survival analysis is commonly used to estimate the cumulative incidence of revision after joint arthroplasty, it theoretically overestimates the risk of revision in the presence of competing risks (such as death). Because the magnitude of overestimation is not well documented, the potential associated impact on clinical and policy decision-making remains unknown.

Are There Modifiable Risk Factors for Hospital Readmission After Total Hip Arthroplasty in a US Healthcare System?

Elizabeth W. Paxton MA, Maria C. S. Inacio PhD, Jasvinder A. Singh MD, MPH, Rebecca Love MPH, RN, Stefano A. Bini MD, Robert S. Namba MD

Although total hip arthroplasty (THA) is a successful procedure, 4% to 11% of patients who undergo THA are readmitted to the hospital. Prior studies have reported rates and risk factors of THA readmission but have been limited to single-center samples, administrative claims data, or Medicare patients. As a result, hospital readmission risk factors for a large proportion of patients undergoing THA are not fully understood.

What Is the Rerevision Rate After Revising a Hip Resurfacing Arthroplasty? Analysis From the AOANJRR

James Min-Leong Wong MBBS, FRCS, Yen-Liang Liu M App Stats, Stephen Graves MBBS, Richard Steiger MBBS, FRACS, FA OrthoA

More than 15,000 primary hip resurfacing arthroplasties have been recorded by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) with 884 primary procedures requiring revision for reasons other than infection, a cumulative percent revision rate at 12 years of 11%. However, few studies have reported the survivorship of these revision procedures.

Does Disability Correlate With Impairment After Hand Injury?

Maryam Farzad PhD, Ali Asgari PhD, Fatemeh Dashab MSc, Fereydoun Layeghi MD, Masoud Karimlou PhD, Seyed Ali Hosseini PhD, Mehdi Rassafiani PhD

Any loss or deviation in body function and structure is considered impairment, whereas limitations on activities are fundamental to the definition of disability. Although it seems intuitive that the two should be closely related, this might not be the case; there is some evidence that psychosocial factors are more important determinants of disability than are objective impairments. However, the degree to which this is the case has been incompletely explored.

What Is the Impact of Comorbidities on Self-rated Hand Function in Patients With Symptomatic Trapeziometacarpal Arthritis?

Ryan Calfee MD, MSc, Jennifer Chu MD, Amelia Sorensen MD, Erin Martens MD, John Elfar MD

The thumb trapeziometacarpal joint is one of the most common sites of arthritic degeneration prompting specialty care. Surgical treatment algorithms are based on radiographic arthritic progression. However, the pain and disability attributable to trapeziometacarpal arthritis do not correlate with arthritic stage, and depression has independently predicted poorer self-rated hand function both at baseline and after treatment in patients’ atraumatic hand conditions.

To What Degree Do Pain-coping Strategies Affect Joint Stiffness and Functional Outcomes in Patients with Hand Fractures?

Young Hak Roh MD, Jung Ho Noh MD, Joo Han Oh MD, Hyun Sik Gong MD, Goo Hyun Baek MD

Patients with hand fractures often have pain, swelling, and stiffness in the joints of the hand, which may lead them to protect their hands, resulting in more stiffness and in delayed recovery. However, the effects of pain-coping strategies and catastrophization (the tendency to expect the worst to occur when pain is present, an approach that can be thought of as the opposite of “coping”) on functional recovery after hand fractures have not been investigated in depth.

Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear?

Chul-Hyun Cho MD, PhD, Kwang-Soon Song MD, Ilseon Hwang MD, Jon J. P. Warner MD

Recently, psychological status, patient-centered outcomes, and health-related quality of life (HRQoL) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized. The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated.

One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress

Michael Q. Potter MD, James D. Wylie MD, Erin K. Granger MPH, Patrick E. Greis MD, Robert T. Burks MD, Robert Z. Tashjian MD

Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments of pain and function. In several other areas of orthopaedics, higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery. To our knowledge, the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated.

What Is the Most Useful Questionnaire for Measurement of Coping Strategies in Response to Nociception?

Joost T. P. Kortlever BSc, Stein J. Janssen MD, Marijn M. G. Berckel BSc, David Ring MD, PhD, Ana Maria Vranceanu PhD

There are several measures of coping strategies in response to nociception. These measures all correlate highly both with each other and with symptom intensity and magnitude of disability in patients with upper limb illness. This study aims to determine if distinct measures of coping strategies in response to nociception address the same underlying aspect of human illness behavior.

Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

Kristin R. Archer PhD, DPT, Christine M. Abraham MA, MEd, William T. Obremskey MD, MPH

There has been increasing evidence to support the importance of psychosocial factors to poor outcomes after trauma. However, little is known about the contribution of pain catastrophizing and fear of movement to persistent pain and disability.

What Is the Relationship Between Depressive Symptoms and Pain During Functional Tasks in Persons Undergoing TKA? A 6-year Perioperative Cohort Study

Daniel L. Riddle PT, PhD, Robert A. Perera PhD, William T. Nay PhD, Levent Dumenci PhD

Preoperative depressive symptoms have been shown in some but not all studies to be associated with poor self-reported pain and function outcomes. In addition, depressive symptoms after surgery have been shown to improve relative to preoperative levels.

Does Race Affect Outcomes in Total Joint Arthroplasty?

Carlos J. Lavernia MD, Jesus M. Villa MD

Several studies suggest worse surgical outcomes among racial/ethnic minorities. There is a paucity of research on preoperative and postoperative pain, general health, and disease-specific measures in which race is the main subject of investigation; furthermore, the results are not conclusive.

Do Upper Extremity Trauma Patients Have Different Preferences for Shared Decision-making Than Patients With Nontraumatic Conditions?

Michiel G. J. S. Hageman MD, Rajesh Reddy BA, Dennis J. S. Makarawung BSc, Jan Paul Briet MD, C. Niek Dijk MD, PhD, David Ring MD, PhD

Shared decision-making is a combination of expertise, available scientific evidence, and the preferences of the patient and surgeon. Some surgeons contend that patients are less capable of participating in decisions about traumatic conditions than nontraumatic conditions.

Do Patient- and Parent-reported Outcomes Measures for Children With Congenital Hand Differences Capture WHO-ICF Domains?

Joshua M. Adkinson MD, Rebecca S. Bickham BS, Kevin C. Chung MD, MS, Jennifer F. Waljee MD, MS

Patient- and parent-reported outcome measures (PROMs) are increasingly used to evaluate the effectiveness of surgery for congenital hand differences (CHDs). Knowledge of an existing outcome measure’s ability to assess self-reported health, including psychosocial aspects, can inform the future development and application of PROMs for CHD. However, the extent to which measures used among children with CHD align with common, accepted metrics of self-reported disability remains unexplored.

Do Surgeons Treat Their Patients Like They Would Treat Themselves?

Stein J. Janssen MD, Teun Teunis MD, Thierry G. Guitton MD, PhD, David Ring MD, PhD

There is substantial unexplained geographical and surgeon-to-surgeon variation in rates of surgery. One would expect surgeons to treat patients and themselves similarly based on best evidence and accounting for patient preferences.

Regional Intraosseous Administration of Prophylactic Antibiotics is More Effective Than Systemic Administration in a Mouse Model of TKA

Simon W. Young FRACS, Tim Roberts MBChB, Sarah Johnson BSc, James P. Dalton PhD, Brendan Coleman FRACS, Siouxsie Wiles PhD

In human TKA studies, intraosseous regional administration (IORA) of prophylactic antibiotics achieves local tissue antibiotic concentrations 10 times greater than systemic administration. However, it is unclear if such high concentrations provide more effective prophylaxis.

Highly Crosslinked-remelted versus Less-crosslinked Polyethylene in Posterior Cruciate-retaining TKAs in the Same Patients

Young-Hoo Kim MD, Jang-Won Park MD, Jun-Shik Kim MD, June-Hyung Lee MD

Concern regarding osteolysis attributable to polyethylene wear after TKA, particularly in younger patients, has prompted the introduction of highly crosslinked-remelted polyethylene (HXLPE) for TKAs. However, few in vivo comparative results of TKAs using HXLPE and less-crosslinked polyethylene inserts in the same patients are available, regarding fracture or failure of the locking mechanism of tibial polyethylene inserts or of osteolysis in patients younger than 60 years.

Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond

Philipp Roth MD, Matthew P. Abdel MD, W. Scott Harmsen MS, Daniel J. Berry MD

Displaced femoral neck fractures frequently are treated with bipolar hemiarthroplasties. Despite the frequency with which bipolar hemiarthroplasty is used to treat these fractures, there are few long-term data.

Should High-grade Extraosseous Osteosarcoma Be Treated With Multimodality Therapy Like Other Soft Tissue Sarcomas?

Zhengfu Fan MD, PhD, Shreyaskumar Patel MD, Valerae O. Lewis MD, B. Ashleigh Guadagnolo MD, Patrick P. Lin MD

Extraosseous osteosarcoma is rare, and the most appropriate therapy is unclear because there are few studies regarding its treatment. The effectiveness of radiation and chemotherapy remains uncertain owing to conflicting results in previous reports.

Implant Design Variations in Reverse Total Shoulder Arthroplasty Influence the Required Deltoid Force and Resultant Joint Load

Joshua W. Giles PhD, G. Daniel G. Langohr MASc, James A. Johnson PhD, George S. Athwal MD

Reverse total shoulder arthroplasty (RTSA) is widely used; however, the effects of RTSA geometric parameters on joint and muscle loading, which strongly influence implant survivorship and long-term function, are not well understood. By investigating these parameters, it should be possible to objectively optimize RTSA design and implantation technique.

Elbow Positioning and Joint Insufflation Substantially Influence Median and Radial Nerve Locations

Michael Hackl MD, Sebastian Lappen, Klaus J. Burkhart MD, PhD, Tim Leschinger MD, Martin Scaal PhD, Lars P. Müller MD, PhD, Kilian Wegmann MD

The median and radial nerves are at risk of iatrogenic injury when performing arthroscopic arthrolysis with anterior capsulectomy. Although prior anatomic studies have identified the position of these nerves, little is known about how elbow positioning and joint insufflation might influence nerve locations.

Can Near-infrared Spectroscopy Detect and Differentiate Implant-associated Biofilms?

John E. Tidwell MD, Ben Dawson-Andoh PhD, Emmanuel O. Adedipe PhD, Kofi Nkansah MS, Matthew J. Dietz MD

Established bacterial diagnostic techniques for orthopaedic-related infections rely on a combination of imperfect tests that often can lead to negative culture results. Spectroscopy is a tool that potentially could aid in rapid detection and differentiation of bacteria in implant-associated infections.

Which Fixation Device is Preferred for Surgical Treatment of Intertrochanteric Hip Fractures in the United States? A Survey of Orthopaedic Surgeons

Emily Niu MD, Arthur Yang MS, Alex H. S. Harris PhD, Julius Bishop MD

The best treatment for intertrochanteric hip fractures is controversial. The use of cephalomedullary nails has increased, whereas use of sliding hip screws has decreased despite the lack of evidence that cephalomedullary nails are more effective. As current orthopaedic trainees receive less exposure to sliding hip screws, this may continue to perpetuate the preferential use of cephalomedullary nails, with important implications for resident education, evidence-based best practices, and healthcare cost.

Does Exercise Influence Pediatric Bone? A Systematic Review

Bonny Specker PhD, Natalie W. Thiex PhD, MPH, Ramu G. Sudhagoni PhD

Periods of growth are thought to be the best time to increase bone mineral content, bone area, and areal bone mineral density (aBMD) through increased loading owing to high rates of bone modeling and remodeling. However, questions remain regarding whether a benefit of exercise is seen at all bone sites, is dependent on pubertal status or sex of the child, or whether other factors such as diet modify the response to exercise.

Determinants of Hip Displacement in Children With Cerebral Palsy

Chia Hsieh Chang MD, Ying Chih Wang MD, Pei Chi Ho MS, Ai Wen Hwang MD, Hsuan Kai Kao MD, Wei Chun Lee MD, Wen E. Yang MD, Ken N. Kuo MD

Coxa valga and femoral anteversion often are seen in patients with spastic hip displacement and osteotomy is recommended. However, the relationship between femoral deformities and hip displacement has not been clearly defined and other factors, such as joint motion and posture, should be considered before recommending treatment.

Letter to the Editor: Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?

Jayme Adriano Farina MD, PhD, Carlos Eduardo Fagotti Almeida MD, PhD, Evelyne Gabriela Schmaltz Chaves Marques MD, João Luis Gil Jorge MD, Renan Victor Kumpel Schmidt Lima MD

A 26-year-old Woman With Bilateral Leg Pain and Pruritus

S. M. Morell MD, Jerad M. Gardner MD, L. J. Suva PhD, C. O. Montgomery MD
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