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241. Accuracy of Hospital Discharge Codes in Medicare Claims for Knee and Hip Replacement Patients. Full Text available with Trip Pro

Accuracy of Hospital Discharge Codes in Medicare Claims for Knee and Hip Replacement Patients. Despite the importance of the hospital discharge destination field ("discharge code" hereafter) for research and payment reform, its accuracy is not well established.The aim of this study was to examine the accuracy of discharge codes in Medicare claims.2012-2015 Medicare claims of knee and hip replacement patients.We identified patients' discharge location in claims and compared it with the discharge (...) code. We also used a mixed-effects logistic regression to examine the association of patient and hospital characteristics with discharge code accuracy.Approximately 9% of discharge codes were inaccurate. Long-term care hospital discharge codes had the lowest accuracy rate (41%), followed by acute care transfers (72%), inpatient rehabilitation facility (80%), and home discharges (83%). Most misclassifications occurred within 2 broad groups of postacute care settings: home-based and institutional

2020 Medical Care

242. Use of National Joint Registries to Evaluate a New Knee Arthroplasty Design. (Abstract)

Use of National Joint Registries to Evaluate a New Knee Arthroplasty Design. The introduction of new technology in joint replacement surgery requires close monitoring to identify early successes and failures. This monitoring can be effectively performed through the analysis of registry data and radiostereometric analysis studies. This study examined the revision rates of a contemporary knee system for total knee arthroplasty (TKA) using National Joint Replacement Registries.A review (...) of the literature was performed to identify comparative studies and registry databases reporting the revision rates of a specific contemporary knee design between 2013 and 2018. The total number of TKA cases performed using this implant was recorded. The latest follow-up or duration of monitoring through a registry database was used to report implant survivorship.There were 4 registry databases and 1 comparative study reporting the revision rates of the contemporary knee system. A total of 41,483 cases were

2020 Journal of Arthroplasty

243. Development of Preoperative Prediction Models for Pain and Functional Outcome After Total Knee Arthroplasty Using The Dutch Arthroplasty Register Data. Full Text available with Trip Pro

Development of Preoperative Prediction Models for Pain and Functional Outcome After Total Knee Arthroplasty Using The Dutch Arthroplasty Register Data. One of the main determinants of treatment satisfaction after total knee arthroplasty (TKA) is the fulfillment of preoperative expectations. For optimal expectation management, it is useful to accurately predict the treatment result. Multiple patient factors registered in the Dutch Arthroplasty Register (LROI) can potentially be utilized (...) to estimate the most likely treatment result. The aim of the present study is to create and validate models that predict residual symptoms for patients undergoing primary TKA for knee osteoarthritis.Data were extracted from the LROI of all TKA patients who had preoperative and postoperative patient-reported outcome measures registered. Multivariable logistic regression analyses were performed to construct predictive algorithms for satisfaction, treatment success, and residual symptoms concerning pain

2020 Journal of Arthroplasty

244. What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample. Full Text available with Trip Pro

What Factors Influence Operative Time in Total Knee Arthroplasty? A 10-Year Analysis in a National Sample. Changes in reimbursement in total knee arthroplasty (TKA) by Centers for Medicare and Medicaid Services (CMS) have been tied to a perceived decrease in the total surgical time required to perform these operations. However, little information is available to CMS about recorded surgical times for TKA across the United States and the variables that drive these values. Therefore, the purpose (...) analysis included 140,890 TKAs. The mean operative time across the study period was found to be 92.60 minutes. Examining quarterly values, operative time stayed within 5 minutes of this mean (range, 89.80-97.51 minutes). Age, sex, functional status, anesthesia type, body mass index, operative year, transfusion requirements, and preoperative laboratory findings significantly influenced operative time (P < .05 for all).Our analysis indicates that while there are numerous factors that influence procedure

2020 Journal of Arthroplasty

245. The Uptake of New Knee Replacement Implants in the UK: Analysis of the National Joint Registry for England and Wales. Full Text available with Trip Pro

The Uptake of New Knee Replacement Implants in the UK: Analysis of the National Joint Registry for England and Wales. Knee replacement (KR) surgery is one of the most common elective procedures in the UK. A large number of different KR implant brands are in use in the UK, which may contribute to variation in uptake and patient outcomes.A cohort of 722,178 primary KRs performed for osteoarthritis (with or without other indications) by 2675 consultant surgeons between 2008 and 2017 in England (...) and Wales from the National Joint Registry was examined. We described the uptake of new (first use >2008) KR implant brands, and variation in uptake by consultant surgeons (primary objectives). We explored consultant-level/patient-level factors associated with use/receipt of new implant brands with multilevel logistic regression models (secondary objectives).Sixty-five new KR implant brands were used in 22,134 KRs (3.1%) by 759 consultants (28.4%) between 2008 and 2017. Consultants used a median of 1

2020 Journal of Arthroplasty

246. Does a "July Effect" Exist for Fellowship Training in Total Hip and Knee Arthroplasty? (Abstract)

Does a "July Effect" Exist for Fellowship Training in Total Hip and Knee Arthroplasty? The hypothetical association between health-care errors and the transition of the medical academic year has been termed the "July effect." Data supporting its existence are conflicting, particularly in orthopedic surgery, and prior studies have inappropriately grouped fellows with resident trainees. No studies to date have examined whether a training initiation effect exists among surgical fellows in adult (...) reconstructive orthopedics.This is a level IV retrospective cohort study reviewing 15,650 primary hip and knee arthroplasties performed from 2006 to 2016 at a single institution. Forty arthroplasty fellows were trained during this 10-year period. Primary outcome measures included intraoperative complications, additional procedures, revisions, and nonoperative complications within 90 days of surgery. These complication rates were analyzed by quarter of academic year and by temporal progression through three

2020 Journal of Arthroplasty

247. Total knee arthroplasty with simultaneous tibial shaft osteotomy in patient with multiple hereditary osteochondromas and multiaxial limb deformity - a case report. Full Text available with Trip Pro

, however the surgical management with coexisting severe axial limb deformity remains unclear.65-year-old man with HME and extra-articular multi-axial limb deformity was admitted to the orthopedic department due to chronic knee pain and limited range of motion caused by secondary osteoarthritis. Regarding to the clinical and radiological examinations, after preoperative planning he was qualified to a one-stage TKA combined with tibial shaft osteotomy (TSO). In a one year follow-up full bone union (...) Total knee arthroplasty with simultaneous tibial shaft osteotomy in patient with multiple hereditary osteochondromas and multiaxial limb deformity - a case report. Hereditary multiple osteochondromas (hereditary multiple exostoses, HME) is a rare genetic disease characterized by the development of benign osteocartilaginous tumors that may cause severe limb deformities and early onset osteoarthritis. Total knee arthroplasty (TKA) is the method of choice for the treatment of advanced gonarthrosis

2020 BMC Musculoskeletal Disorders

248. Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial. Full Text available with Trip Pro

diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA.This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC (...) Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial. It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave

2020 BMC Musculoskeletal Disorders

249. Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario. Full Text available with Trip Pro

Normal trajectory of Interleukin-6 and C-reactive protein in the perioperative period of total knee arthroplasty under an enhanced recovery after surgery scenario. We designed the current study to understand the normal trajectories of interleukin-6 (IL-6) and C-reactive protein (CRP) in the immediate hours and days after primary total knee arthroplasty (TKA) under the management of an enhanced recovery after surgery (ERAS) protocol and examined whether one or the other returned to normal more (...) quickly.In this prospective cross-sectional study, we examined the plasma IL-6 and CRP levels in 100 patients undergoing primary TKA at the following time points: 12 h preoperatively as well as postoperatively 12 h, 48 h, 3 days and 2 weeks. Patients were followed up for 1 year to monitor the postoperative complications, especially the infection.IL-6 peaked at 48 h postoperatively. Then IL-6 started to decline at 3 days postoperatively and went back to baseline level at 2 weeks (p = 0.950). CRP peaked

2020 BMC Musculoskeletal Disorders

250. The association between psychological characteristics and physical activity levels in people with knee osteoarthritis: a cross-sectional analysis. Full Text available with Trip Pro

The association between psychological characteristics and physical activity levels in people with knee osteoarthritis: a cross-sectional analysis. The aim of this study was to examine the relationship between psychological characteristics and physical activity levels, measured as the average number of steps per day, in people with knee osteoarthritis (OA).This study analysed baseline data from a randomized controlled trial (Australian New Zealand Clinical Trials Registry reference (...) : ACTRN12612000308897). A total of 167 adults aged over 50 years, with knee pain rated as four or more on an 11-point numeric rating scale, and knee OA diagnosed using American College of Rheumatology clinical criteria, were recruited from the community (62 men and 105 women, mean age, 62.2 ± 7.5 years). The average number of steps per day over seven consecutive days was measured using an accelerometer-based device. Psychological characteristics evaluated were: depressive symptoms (Depression Anxiety Stress Scale

2020 BMC Musculoskeletal Disorders

251. Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis. Full Text available with Trip Pro

Tibiofemoral rotation alignment in the normal knee joints among Chinese adults: a CT analysis. Consensus on tibial rotation in total knee arthroplasty (TKA) remains controversial. The present study aimed to investigate the closest anatomical reference to surgical epicondylar axis (SEA) among 10 tibial markers in Chinese adults.This study included examination of 122 normal lower extremities. Briefly, 10 axes were drawn on the axial sections: transverse axis of tibia (TAT), axis of medial edge (...) of patellar tendon (MEPT), axis of medial 1/3 of patellar tendon attachment (M1/3), Akagi line, Insall line, axis of medial border of tibial tubercle (MBTT), and axis of anterior border of the tibia 1-4 (ATC1-4). The mean angles between TAT and SEA and that between other axes and the line perpendicular to SEA were measured. Pairwise differences among the 10 tibial axes were examined by applying one-way analysis of variance (ANOVA) and paired t-test.In all the knees, the mean angles of M1/3, Akagi line

2020 BMC Musculoskeletal Disorders

252. Identification of knee osteoarthritis disability phenotypes regarding activity limitation: a cluster analysis. Full Text available with Trip Pro

classify the disability phenotypes of knee OA. The phenotypes were also validated by comparing impairments and participation restrictions.Participants comprised individuals with symptomatic knee OA. They were interviewed and undertook physical examination according to a standard evaluation forms based on the International Classification of Functioning, Disability and Health (ICF) model. Cluster analysis was used to determine those activity limitations which could best classify the phenotypes of knee OA (...) Identification of knee osteoarthritis disability phenotypes regarding activity limitation: a cluster analysis. Studies have reported the subtypes of individuals with knee osteoarthritis (OA) attempting to cluster this heterogonous condition. Activity limitations are commonly used to set goals in knee OA management and better identify subgroups based on level of disability in this patient population. Therefore, the objective of this study was to identify those activity limitations which could

2020 BMC Musculoskeletal Disorders

253. Sjogren's syndrome is associated with higher rate of non-home discharge after primary hip arthroplasty and higher transfusion rates after primary hip or knee arthroplasty: a U.S. cohort study. Full Text available with Trip Pro

Sjogren's syndrome is associated with higher rate of non-home discharge after primary hip arthroplasty and higher transfusion rates after primary hip or knee arthroplasty: a U.S. cohort study. To assess whether Sjogren's Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA).We used the 1998-2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (...) (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region.We examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998 to 2014; 12,772 (0.2%) primary TKAs and 6222 (0.2%) primary THAs were done in people

2020 BMC Musculoskeletal Disorders

254. Absence of pain in subjects with advanced radiographic knee osteoarthritis. Full Text available with Trip Pro

Absence of pain in subjects with advanced radiographic knee osteoarthritis. To investigate the frequency of pain among subjects with advanced radiographic knee osteoarthritis (OA) defined as Kellgren-Lawrence (KL) grade 4 and clinical features associated with pain.Subjects from the Hallym Aging Study (HAS), the Korean National Health and Nutrition Examination Survey (KNHANES), and the Osteoarthritis Initiative (OAI) were included. Participants were asked knee-specific questions regarding (...) the presence of knee pain. Clinical characteristics associated with the presence of pain were evaluated with multivariable logistic regression analysis.The study population consisted of 504, 10,152 and 4796 subjects from HAS, KNHANES, and OAI, respectively. KL grade 4 OA was identified in 9.3, 7.6, and 11.5% of subjects, while pain was absent in 23.5, 31.2, and 5.9% of subjects in KL grade 4 knee OA, respectively. After multivariable analysis, female gender showed a significant association with pain

2020 BMC Musculoskeletal Disorders

255. Association between serum zinc and copper concentrations and copper/zinc ratio with the prevalence of knee chondrocalcinosis: a cross-sectional study. Full Text available with Trip Pro

zinc and copper concentrations and Cu/Zn ratio to the prevalence of knee chondrocalcinosis were examined using generalized estimating equations, respectively.The prevalence of knee chondrocalcinosis was 1.2% in the sample of this study (n = 12,362). In comparison with the lowest tertile, the odds ratios (ORs) of knee chondrocalcinosis adjusted by age, sex and body mass index were 0.74 (95% CI 0.50-1.09) in the second and 0.56 (95% CI 0.36-0.86) in the third tertiles of serum zinc concentrations (P (...) Association between serum zinc and copper concentrations and copper/zinc ratio with the prevalence of knee chondrocalcinosis: a cross-sectional study. Patients with chondrocalcinosis may suffer from a series of symptoms resembling acute gouty arthritis or septic arthritis, but the aetiology and pathogenesis of chondrocalcinosis have not been fully elucidated yet. This study was aimed to assess serum zinc and copper concentrations, as well as the ratio of serum copper to zinc concentrations (Cu

2020 BMC Musculoskeletal Disorders

256. Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy. (Abstract)

Associated Morbidity After the Percutaneous Release of the Medial Collateral Ligament for Knee Arthroscopy. To summarize available data on the morbidity associated with percutaneous release of the medial collateral ligament (MCL) of the knee during arthroscopy via a "pie-crusting" technique.A search of the literature was performed using the MEDLINE and Web of Science databases to identify studies examining the morbidity of percutaneous MCL release during arthroscopy. Only English-language (...) articles were included; technical articles and studies not focused on the use of this technique were omitted. Two independent reviewers performed the literature search, data extraction, and quality assessment. The outcomes analyzed included resultant knee instability, functional outcome scores, visual analog scale pain scores, and saphenous nerve or greater saphenous vein injury.Six studies met the eligibility criteria. The studies included a total of 234 knees undergoing MCL release, with a mean

2020 Arthroscopy

257. The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis. (Abstract)

The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis. To examine the cost-effectiveness of a series (total of 3 injections) of intra-articular platelet-rich plasma (PRP) injections in comparison to that of hyaluronic acid (HA) viscosupplementation for the treatment of symptomatic knee osteoarthritis.Outcome data regarding the use of PRP or HA injections for the treatment of symptomatic knee osteoarthritis were (...) determined from the highest-quality data (Level I) available in the literature until 2015. Health utility values were then derived from these high-quality data. Costs were determined by examining typical charges for patients undergoing a series of either PRP or HA injections for the treatment of this condition at a large private orthopaedic practice. These health utility values and costs were used to create an expected-value decision analysis model.The results of the model revealed that the cost per

2020 Arthroscopy

258. Should we pay attention to surgeon or hospital volume in total knee arthroplasty? Evidence from a nationwide population-based study. Full Text available with Trip Pro

Should we pay attention to surgeon or hospital volume in total knee arthroplasty? Evidence from a nationwide population-based study. Although prior research into the relationship between volume and outcome indicates that this relationship is not linear and that an optimal volume should be specified, consensus is lacking regarding the ideal value of this optimal volume. The purposes of this study were to use a visual method to identify surgeon- and hospital-volume thresholds and to examine (...) the relationships of surgeon and hospital volume thresholds to 30-day readmission.A retrospective nationwide population-based study design was adopted. Patients who received total knee replacement surgery between 2007 and 2008 in any hospital in Taiwan were included. After adjusting for patient, physician, and hospital characteristics, a restricted cubic spline regression model was used to identify optimal surgeon- and hospital-volume thresholds. Further, a patient-level mixed effect model was conducted to test

2019 PLoS ONE

259. Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial (Abstract)

) with a first-time traumatic LPD, with clinical examinations, radiographs, magnetic resonance imaging, and diagnostic arthroscopic surgery performed within 2 weeks of the index injury. The child was randomized to either (1) a knee brace (KB group) for 4 weeks and physical therapy or (2) arthroscopic-assisted repair (R group) of the MPFL with anchors, 4 weeks with a soft cast splint, and physical therapy. The follow-up time was 2 years.The redislocation rate was significantly lower in the R group than (...) Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment.(1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral

2018 EvidenceUpdates

260. Effect of Intraoperative Platelet-Rich Plasma Treatment on Postoperative Donor Site Knee Pain in Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Double-Blind Randomized Controlled Trial (Abstract)

Effect of Intraoperative Platelet-Rich Plasma Treatment on Postoperative Donor Site Knee Pain in Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Double-Blind Randomized Controlled Trial Donor site morbidity in the form of anterior knee pain is a frequent complication after bone-patellar tendon-bone (BPTB) autograft anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to examine the effect of the intraoperative administration of platelet (...) -rich plasma (PRP) on postoperative kneeling pain. It was hypothesized that PRP treatment would reduce knee pain.Randomized controlled trial; Level of evidence, 2.Fifty patients (mean ± SD age, 30 ± 12 years) undergoing BPTB ACL autograft reconstruction were randomized to the PRP (n = 27) or sham (n = 23) treatment. In either case, 10 mL of venous blood was drawn before the induction of anesthesia and either discarded (sham) or processed (PRP) for preparation of a PRP gel to be later mixed

2018 EvidenceUpdates

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