Cost-Effectiveness Analysis of Treatment of Radial Head Subluxation.

PURPOSE: Radial head subluxation (RHS), also called nursemaid's elbow, is a common injury in young children treated by various health care providers. The diagnosis typically does not require radiographs, but they are often ordered in the emergency room. This study aimed to determine if there was a difference in the efficacy, cost, and amount of radiographs taken in RHS treatment according to the provider, specifically between orthopedic surgeons and pediatricians. METHODS: We reviewed the charts of 207 patients presenting with RHS in the emergency department (mean age of presentation = 2.1 years, range: 0.3 to 6.5 years) to determine the provider treating the condition, the number of attempts at reduction, the number of radiographs taken, the post-reduction management, and total hospital cost incurred. RESULTS: One hundred forty-four patients were treated by orthopedic surgeons, 51 by pediatricians, and 13 by residents. The mean number of radiographs obtained was 0.1, 0.8, and 0.5 for groups treated by an orthopedic surgeon, a pediatrician, and a resident, respectively (p = 0.04). The mean cost for reduction of an RHS was $114, $648, and $267 for groups treated by an orthopedic surgeon, a pediatrician, and a resident, respectively (p = 0.04) Conclusion: Although all three groups were effective in treating RHS, there was a significantly reduced hospital cost and a reduced need for radiographs when the provider was an orthopedic surgeon.

Return to Work After Primary Hip Arthroscopy: A Systematic Review and Meta-analysis.

BACKGROUND: Hip arthroscopy is a procedure commonly performed to correct various hip pathologies such as femoroacetabular impingement and labral tears. These hip pathologies commonly affect young, otherwise healthy patients. The recovery after hip arthroscopy can prevent patients from returning to work and impair performance levels, having significant economic repercussions. To date, there has been no cumulative analysis of the existing literature on return to work after hip arthroscopy. PURPOSE: The purpose of this study was to perform a systematic review of the existing literature regarding return to work after hip arthroscopy and analysis of factors associated with the ability to return to work and time to return to work. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: A literature search of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies assessing functional outcomes and return to work, including return to military duty, after hip arthroscopy were included. Patients' ability to return to work, as well as time to return, was compared between selected studies. Where available, workers' compensation status as well as type of work was compared. All statistical analysis was performed using SPSS, Version 22. P < .05 was considered statistically significant. RESULTS: Twelve studies with 1124 patients were included. Patients were followed for an average of 17.6 months. Using weighted means, the average rate of return to work was 71.35%, while full return to previous work duties was achieved at a rate of 50.89%. Modification to work duties was required at a rate of 15.48%. On average, the time to return to work was 115 days (range, 17-219 days). Rate of return by patients with workers' compensation status was found to be 85.15% at an average of 132 days (range, 37-211 days). Rate of return to work in workers performing professions reported as strenuous vs light (ie, mostly sedentary) jobs showed a statistically higher return to work in light professions (risk ratio, 0.53; 95% CI, 0.41-0.69). CONCLUSION: After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. However, full return to work was achieved by only half of patients upon final follow-up.

Platelet-rich plasma outcomes do not correlate with patient satisfaction or perceived cost-effectiveness.

BACKGROUND: As platelet-rich plasma injection for knee osteoarthritis (OA) has increased in popularity, it has become more important to assess its effectiveness and satisfaction with its use in the context of its high cost. The purpose of this study was to determine satisfaction, commercial appeal, and effectiveness of platelet-rich plasma (PRP) for the treatment of knee OA. METHODS: A retrospective review of patients who underwent PRP injection in the knee from 2016 to 2019 was performed. Various patient-reported outcomes were collected, including: satisfaction with the PRP injection (out of 100), whether the patient would want to undergo PRP injection again, whether they would recommend the injection and whether they felt that the injection was worth the cost was collected. VAS pain scores were collected and measured out of 100. Demographics and radiographical information were obtained via chart review. Statistical analyses were conducted including descriptive statistics and binary logistic and linear regressions. RESULTS: Overall, 114 patients were included. The mean pre-injectionpain score was 70.4, and the mean pain level decreased after injection to 36.8. Patients rated their satisfaction on average as neutral along the aforementioned continuous scale (49.2), , 50.9% stated that they would get the PRP injection again, 60.5% would recommend to a friend, and 50.9% felt the injection was worth the cost. Younger age and improved post-injection pain correlated with increasing likelihood of desiring further PRP injection. CONCLUSIONS: Patients on average rated satisfaction slightly below average, indicating net neutrality in terms of satisfaction with their injection. Furthermore, only half of the patients indicated that it was worth the cost and that they would receive it again. Younger age and post-injection pain relief increased desire for further injection, but pain-relief did not correlate with patients saying that the injection was worth the cost.