Lower Intraoperative and Immediate Postoperative Complications in Robotic Versus Conventional Primary Total Hip Arthroplasty: A Retrospective Cohort Analysis of Over 360,000 Patients.

PURPOSE: Although a trend of an improved alignment with robotic total hip arthroplasty (THA) over conventional methods has surfaced from recent series, it is unknown whether these results translate into meaningful enhancements in postoperative outcomes. To address this lack in the literature, we compared the perioperative morbidity and mortality with robotic and conventional THA in a large national cohort of 367,894 patients. We hypothesized that no significant differences would exist in the outcomes between the two groups. METHODS: Records were extracted from 2016-2019 from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project which is the largest in-patient database in the United States. From 367,894 THAs, robotics were employed for 7,863 patients. The remaining 360,031 conventional THAs served as controls. The two groups were compared for demographics, admission, and hospital stay details including costs, and mortality and morbidity data including medical and surgical complications. Descriptive statistics were used for demographic data while analytical statistics including t-tests, chi-squared tests, Fischer exact test, and Pearson chi-squared tests were used for perioperative outcomes. Statistical significance was set at p<0.005. RESULTS: Demographic distributions between robotic and conventional THA groups displayed similar age and sex characteristics. Shorter mean lengths of stay (1.87 days) were seen in robotic THA versus conventional THA (2.33 days) while higher costs were noted for the former (mean $68,686.71 vs $66,840.39) (p<0.005). Low overall mortality (0.03% robotic, 0.09% conventional) was seen in both groups (p>0.005). Higher comparative incidences of anemia, acute renal failure, and pneumonia were seen in conventional THA (p<0.005) while no significant differences were noted for other complications including myocardial infarction, pulmonary embolism, deep vein thrombosis, and cardiac arrest (p>0.005). Among others, lower dislocation rates, mechanical complications, periprosthetic joint infection, and periprosthetic fractures were seen with robotic THA (p<0.005). Wound complications and superficial infection rates did not differ between the two groups (p>0.005). CONCLUSIONS: Evidence has emerged from our results to support more routine adaptation of the robotic option of performing a THA. These can be based on lower local, systemic, and mechanical complications as demonstrated by the present study. Further evaluation of these results in follow-up would help establish the foothold of robotic surgery in total hip replacement in the modern context.

Patients With Cirrhosis Have Higher Costs of Care, Longer Length of Stays, and More Perioperative Complications Following Total Knee Arthroplasty: A National Inpatient Sample-Based Study.

Background Cirrhosis is a growing disease affecting millions of people in the United States annually. Many cirrhosis patients undergo significant procedures and are met with increased risks such as encephalopathy, impaired immune response, ascites, variceal bleeding, renal disease, and increased malnutrition. Many cirrhosis patients need to undergo major surgical procedures such as total knee arthroplasty (TKA); however, perioperative complications following TKA in cirrhosis patients have not been studied. The purpose of this study was to analyze the demographic characteristics and perioperative complications of cirrhosis patients following TKA. Methods Using the National Inpatient Sample (NIS) database, we looked at retrospective data from the years 2016-2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as cirrhosis patients, compared with those who are not. A propensity match was conducted to consider associated comorbidities that influence perioperative complications. Results Of the 558,256 patients analyzed who underwent TKA, 1670 (0.3%) were diagnosed with cirrhosis. After matching, cirrhosis patients had a longer LOS (4.22 vs. 3.68 days, p=0.016) and COC ($90,624 vs. 80676.87, p<0.001) than patients in the control group. Moreover, cirrhosis patients had a higher likelihood of developing acute renal failure (odds ratio (OR): 3.05, 95% CI: 2.07-4.50, p<0.001), blood loss anemia (OR: 1.60, 95% CI: 1.34-1.92, p<0.001), periprosthetic fracture (OR: 3.27, 95% CI: 1.31-8.18, p=0.007), periprosthetic infection (OR: 3.14, 95% CI: 1.99-4.95, p<0.001), and blood transfusions (OR: 1.62, 95% CI: 1.12-2.35, p=0.009) than patients in the control group. Conclusion The cirrhosis group had a significantly higher COC, longer LOS, and higher rates of perioperative complications than non-cirrhosis patients. This data will help providers make informed decisions about patient care and resource allocation for cirrhosis patients undergoing TKA.

Total Hip Arthroplasty in Cirrhosis is Associated with Increased Complications during the Hospital Stay, Length of Stay, and Cost of Care: A Propensity Matched Database Study.

Objectives: The aim of the study is to evaluate the impact of cirrhosis on inpatient hospital complications and healthcare costs in elective Total Hip Arthroplasty (THA). Methods: A 4-year retrospective analysis of the Nation Inpatient Sample (NIS) database, who underwent elective THA stratified by the presence or absence of cirrhosis was performed (2016-19). The records of specific postoperative complications, the cost of care (COC), and the length of stay (LOS) were evaluated by statistical analysis. Results: The NIS database identified 367,894 patients who underwent THA, of which 1,134 (0.3%) were cirrhotic. In the unmatched analysis, patients with cirrhosis showed significantly elevated rates (P< 0.05) of in-hospital complications compared to non-cirrhotic controls, including mortality (0.7% vs. 0.1%), acute renal failure (9.2% vs. 2.5%), blood loss anemia (30.4% vs. 19.5%), pneumonia (1.1% vs. 0.3%), periprosthetic fracture (3% vs. 1.2%), dislocations (2.5% vs. 1.4%), infection (4.2% vs. 1%), wound dehiscence (0.8% vs. 0.1%) and blood transfusion (11.3% vs. 3.5%). After propensity matching, significantly higher rates of blood loss anemia (30.4% vs. 26.7%; P=0.05), periprosthetic dislocations (2.4% vs. 1%; P=0.008), and infections (4.2% vs. 2.7%, P=0.05) were seen in the cirrhotic cohort, while the rate of pulmonary embolism was significantly lower (0% vs. 0.8%, P=0.002), as was myocardial infarction (0.08% vs. 0.7%, P=0.017). Concerning LOS in the hospital, patients with cirrhosis stayed significantly longer in both the unmatched (4.2 vs. 2.3 days; P <0.001) and matched (4.2 vs. 3.68; P=0.016) controls. The average COC was greater in the cirrhotic group, with a mean value of $90,264 vs. $66,806.31 (P<0.001) in the unmatched and $90,624 vs. $80,676.87 (P=0.001) in the matched cohort. Conclusion: Cirrhosis is associated with longer lengths of stay, higher hospital costs, and a greater risk of perioperative in-hospital complications such as blood loss anemia, dislocation, and infection after THA. This data could assist during preoperative patient counseling and improve the strategies for effectively utilizing the finite healthcare resources without compromising patient care and financial compensation from payers.

Proximal fibular osteotomy: Systematic review on its outcomes.

BACKGROUND: The morbidity and burden of knee osteoarthritis affecting millions of lives worldwide has created a constant pursuit in finding the ideal treatment for knee osteoarthritis. There has been a paradigm shift in the surgical treatment of osteoarthritis ever since the initial description of Volkmann's tibial osteotomy. This review focuses on one such recent procedure, the proximal fibular osteotomy (PFO) for medial compartment knee osteoarthritis. This review encompasses the history, evidence, risk factors, outcomes and technical considerations of PFO. AIM: To understand the evidence and its techniques, and whether this could be an alternative solution to the problem of knee osteoarthritis in the developing world. METHODS: The phrases "proximal fibular osteotomy" and "knee osteoarthritis" were searched (date of search December 20, 2019) on PubMed to identify articles evaluating the biomechanical and clinical outcomes of PFO in patients with knee osteoarthritis. A total of 258 were retrieved. After reviewing the summary of the texts, 22 articles written in English were marked for abstract review. Articles that were case studies or cadaver experiments were excluded. The abstracts of the remaining articles were read, and only those that focused on the history, outcomes of case studies and technical considerations of PFO were included in the review. A total of 12 articles were included in this review. RESULTS: At least six studies reported improvement in the visual analogue scale(VAS) from the average preoperative VAS score [6.32, 95% confidence interval (CI) = (4.05, 8.59)] to average postoperative VAS score [1.23, 95%CI: (-1.20, 3.71)], which was statistically significant. Similarly, the American Knee Society Score (KSS) functional score improved from an average preoperative KSS functional score [43.11, 95%CI: (37.83, 48.38)] to postoperative KSS functional score [66.145, 95%CI: (61.94, 70.35)], which was statistically significant. The femorotibial angle improved by around 7º, and the hip knee ankle angle improved by around 6º. CONCLUSION: With the existing data, it seems that PFO is a viable option for treating medial joint osteoarthritis in selected patients. Long term outcome studies and progression of disease pathology are some of the important parameters that need to be addressed by use of multicenter randomized controlled trials.