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1.
J Hand Surg Am ; 46(7): 552-559, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33896647

RESUMO

PURPOSE: Total elbow arthroplasty (TEA) can be used, with varying degrees of success, for the treatment of rheumatoid arthritis, osteoarthritis, and distal humerus fractures and their sequelae in elderly patients. Some of the largest studies of TEA have included data from more than 20 years ago and may not reflect the current practice of TEA. We sought to describe a modern cohort of patients who underwent TEA in a United States integrated health care system. METHODS: All patients aged 18 years and older who underwent primary unilateral TEA from January 1, 2009, through March 31, 2018, were identified to conduct a descriptive study. The patients' characteristics and demographics, including age, body mass index, sex, diabetes status, American Society of Anesthesiologists classification, and surgical indication, were recorded. The crude cumulative revision probability as well as the 90-day postoperative incidence rate of emergency department visit, readmission, and mortality was calculated. RESULTS: A total of 170 patients met our inclusion criteria. The annual procedure volume nearly doubled, from 11 procedures in 2009 to 21 procedures in 2017. The most common indication for TEA was fracture (40.6%), followed by rheumatoid arthritis (36.5%). At 4-year follow up, the crude cumulative revision probability was 9.8% (95% confidence interval, 5.6%-16.9%). Of the 170 patients who underwent TEA, 43 (25.3%) experienced a 90-day emergency department visit, 24 (14.1%) experienced a 90-day readmission, and 2 (1.2%) died within 90 days postoperatively. CONCLUSIONS: This cohort of patients who underwent TEA using modern implants showed a notable increase in the volume of TEA over the study period, with more TEAs performed for trauma. The incidence of readmission and emergency department visits following TEA were high in this study. Further studies are needed to better define the current practice of TEA in the community at large. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Artroplastia de Substituição do Cotovelo , Prestação Integrada de Cuidados de Saúde , Articulação do Cotovelo , Idoso , Cotovelo , Articulação do Cotovelo/cirurgia , Humanos , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia
2.
J Am Acad Orthop Surg ; 28(23): e1049-e1058, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32224701

RESUMO

INTRODUCTION: Revision shoulder arthroplasty is an expensive undertaking with notable morbidity to the patient and less predictable outcomes. Therefore, it is important to avoid even further surgery in these patients. We sought to report the annual revision burden from a large integrated healthcare system and identify patient and operative factors that may predispose patients to revision failure, necessitating further surgery. METHODS: Annual revision burden as a proportion of the overall shoulder arthroplasties performed from 2005 to 2017 was obtained. Patients who underwent aseptic revision between 2005 and 2017 comprised the study sample. Patient characteristics evaluated for re-revision risk included age, sex, body mass index (BMI), race, and diabetes status, whereas surgical characteristics included surgeon cumulative revision volume, revision procedure type, and top reason for revision by primary procedure type. Multivariable Cox proportional hazards regression was used to evaluate the association between the specified factors and re-revision risk. RESULTS: From 2005 to 2017, revisions represented 5.3% to 7.8% of all shoulder arthroplasty procedures performed. Factors associated with re-revision surgery risk by procedure type included increasing BMI and hemiarthroplasty revision procedure compared with reverse total shoulder arthroplasty (RTSA) revision procedure for hemiarthroplasty primaries; diabetes, revision because of instability, and lower cumulative surgeon revision procedure volume for RTSA primaries; and TSA revision procedure compared with RTSA revision procedure for TSA primaries. CONCLUSION: The annual revision shoulder arthroplasty volume increased over the study period. Patient factors, including BMI and diabetes were associated with higher re-revision risks for hemiarthroplasty and RTSA primaries, respectively. RTSA revised for instability had a higher risk of re-revision compared with other indications. TSA and hemiarthroplasty requiring aseptic revision may be best treated with RTSA as opposed to another TSA or hemiarthroplasty. Further studies are needed to verify these findings and identify how the mechanism of failure may affect the procedure selection in the revision setting. LEVEL OF EVIDENCE: Level III.


Assuntos
Artroplastia do Ombro , Hemiartroplastia , Articulação do Ombro , Artroplastia do Ombro/efeitos adversos , Hemiartroplastia/efeitos adversos , Humanos , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Fatores de Risco , Articulação do Ombro/cirurgia , Resultado do Tratamento
3.
J Shoulder Elbow Surg ; 29(5): 898-905, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31831281

RESUMO

BACKGROUND: Shoulder arthroplasty is a common orthopedic procedure, performed historically in the inpatient setting. However, interest in same-day discharge has increased. We sought to evaluate 90-day readmission, 90-day emergency department (ED) visit, 90-day deep infection, 90-day venous thromboembolism (VTE), and 1-year mortality after same-day shoulder arthroplasty compared with an inpatient stay. METHODS: We conducted a retrospective cohort study using data from an integrated health care system's Shoulder Arthroplasty Registry. A total of 6503 elective primary unilateral total shoulder and reverse total shoulder arthroplasties performed between 2005 and 2016 were included; 405 (6%) had same-day discharge. The likelihood of 90-day events, including readmission, ED visit, deep infection, and VTE, and 1-year mortality after same-day discharge was compared with 1- to 4-night inpatient stay using generalized estimating equations with noninferiority testing, adjusting for age, sex, body mass index, race, American Society of Anesthesiologists classification, select comorbidities, osteoarthritis, anesthesia type, procedure type, and surgeon effect. RESULTS: We failed to observe a difference between same-day discharge and 1- to 4-night stay in terms of 90-day readmission, 90-day ED visit, and 1-year mortality. Same-day discharge was not inferior to 1- to 4-night stay regarding 90-day readmission, but we did not have evidence to support noninferiority for 90-day ED visits or 1-year mortality. Ninety-day deep infections and VTE were too infrequent for adjusted analysis. CONCLUSIONS: We found same-day shoulder arthroplasty not to be inferior to an inpatient stay for 90-day readmission. Future investigation into the reasons for readmission and ED visit after same-day shoulder arthroplasty and interventions to mitigate these adverse events is needed.


Assuntos
Artroplastia do Ombro , Hospitalização , Artropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Procedimentos Cirúrgicos Eletivos , Serviço Hospitalar de Emergência , Feminino , Humanos , Artropatias/complicações , Artropatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
4.
Injury ; 50(3): 676-680, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30738568

RESUMO

INTRODUCTION: Hemiarthroplasty of the shoulder is a well established treatment for proximal humerus fractures not amenable to open reduction internal fixation. However, orthopedic surgeons have recently increased utilization of reverse total shoulder arthroplasty (RTSA) in the treatment of these injuries. The purpose of this study was to evaluate the use of hemiarthroplasty and RTSA between 2009 and 2016 for the treatment of proximal humerus fractures within a large United States integrated healthcare system. MATERIALS AND METHODS: A descriptive study was conducted using our integrated healthcare system's Shoulder Arthroplasty Registry. Shoulder arthroplasty cases performed for an acute proximal humerus fracture between the years of 2009 and 2016 were identified. Revision rates were determined, as well as changes in age and gender distribution of the cohort during the study period. RESULTS: In 2015, RTSA utilization surpassed that of hemiarthroplasty for the first time in the healthcare system. The utilization of RTSA in the treatment of proximal humerus fractures increased from 4.5% of all arthroplasties in 2009 to 67.4% of arthroplasties in 2016. During the study period, patients undergoing hemiarthroplasty were younger and less likely to be female. Crude revision rate was 4.0% for hemiarthroplasty and 3.2% for RTSA. CONCLUSIONS: RTSA is increasingly being utilized for the treatment of proximal humerus fractures and now appears to be the treatment of choice. While hemiarthroplasty appears to be falling out of favor in the treatment of fractures of the shoulder, surgeons may still be preferentially using the procedure in younger patients.


Assuntos
Artroplastia do Ombro/estatística & dados numéricos , Hemiartroplastia/estatística & dados numéricos , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/tendências , Feminino , Hemiartroplastia/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Amplitude de Movimento Articular , Fraturas do Ombro/epidemiologia , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Resultado do Tratamento , Estados Unidos/epidemiologia
5.
Perm J ; 21: 16-171, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28746022

RESUMO

CONTEXT: The number of excess deaths associated with elective total joint arthroplasty in the US is not well understood. OBJECTIVE: To evaluate one-year postoperative mortality among patients with elective primary and revision arthroplasty procedures of the hip and knee. DESIGN: A retrospective analysis was conducted of hip and knee arthroplasties performed in 2010. Procedure type, procedure volume, patient age and sex, and mortality were obtained from an institutional total joint replacement registry. An integrated health care system population was the sampling frame for the study subjects and was the reference group for the study. MAIN OUTCOME MEASURES: Standardized 1-year mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. RESULTS: A total of 10,163 primary total knee arthroplasties (TKAs), 4963 primary total hip arthroplasties (THAs), 606 revision TKAs, and 496 revision THAs were evaluated. Patients undergoing primary THA (SMR = 0.6, 95% CI = 0.4-0.7) and TKA (SMR = 0.4, 95% CI = 0.3-0.5) had lower odds of mortality than expected. Patients with revision TKA had higher-than-expected mortality odds (SMR = 1.8, 95% CI = 1.1-2.5), whereas patients with revision THA (SMR = 0.9, 95% CI = 0.4-1.5) did not have higher-than-expected odds of mortality. CONCLUSION: Understanding excess mortality after joint surgery allows clinicians to evaluate current practices and to determine whether certain groups are at higher-than-expected mortality risk after surgery.


Assuntos
Artroplastia de Quadril/mortalidade , Artroplastia do Joelho/mortalidade , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Perm J ; 21: 16-056, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28678693

RESUMO

CONTEXT: Outcomes of total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RTSA) as a function of age are not well known. OBJECTIVE: To understand the effects of age on revision rate, mortality, and hospital readmissions. DESIGN: A retrospective cohort study of prospectively collected data. Using an integrated health care system's shoulder arthroplasty registry, we identified patients who underwent TSA and RTSA between January 2007 and June 2012. Patients were grouped into older (> 75 years) and younger groups (≤ 75 years). MAIN OUTCOME MEASURES: Differences in outcomes between both age groups. RESULTS: The TSA cohort had 2007 patients, and 538 (26.8%) were older than age 75 years. Older patients who underwent TSA had higher risks of 1-year mortality (2.0% vs 0.6%; odds ratio = 3.34, 95% confidence interval [CI] = 1.00-11.11, p = 0.049) and readmission within 90 days (7.6% vs 4.4%; odds ratio = 1.75, 95% CI = 1.17-2.63, p = 0.007). The RTSA cohort had 568 patients, and 295 (51.9%) of them were older than age 75 years. Older RTSA patients had a lower risk of revision (3.7% vs 8.1%; hazard ratio = 0.45, 95% CI = 0.24-0.89, p = 0.020). CONCLUSION: Patient age is one of many important variables that surgeons should consider when performing shoulder arthroplasty. However, the impact of age in the TSA and RTSA populations is different. In the TSA cohort, older patients have higher risk of readmission and mortality. In the RTSA cohort, older patients have lower risk of revision.


Assuntos
Artroplastia do Ombro/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
7.
Arthritis Care Res (Hoboken) ; 69(10): 1574-1581, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-27992683

RESUMO

OBJECTIVE: To evaluate the change in incidence rate of shoulder arthroplasty, the utilization of shoulder arthroplasty for specific indications, and the surgeon volume trends associated with these procedures between 2005 and 2013. METHODS: A population-based cohort study was conducted using the more than 7 million members of an integrated health care system in California. Cases of shoulder arthroplasties performed between 2005 and 2013 were identified using a shoulder arthroplasty registry. Annual shoulder arthroplasty incidence rates per 100,000 patients were determined, and adjusted yearly changes in rates were estimated using incidence rate ratios (IRRs). Changes in surgeon volumes by year and number of surgeons performing different procedures were also compared. RESULTS: The incidence of shoulder arthroplasty per 100,000 members increased from 6.1 (95% confidence interval [95% CI] 5.5-6.7) in 2005 to 13.4 (95% CI 12.5-14.2) in 2013. In patients with osteoarthritis, there was increasing utilization of total shoulder arthroplasty (IRR 1.12 [95% CI 1.11-1.14]) and decreasing utilization of hemiarthroplasty (IRR 0.91 [95% CI 0.89-0.94]). For patients with rotator cuff tear arthropathy, there was an increase in utilization of reverse total shoulder arthroplasty (IRR 1.33 [95% CI 1.29-1.37]) but no change in hemiarthroplasty (IRR 0.99 [95% CI 0.92-1.05]). The average surgeon yearly volume increased for total shoulder arthroplasty (P < 0.001) and for reverse total shoulder arthroplasty (P = 0.020). CONCLUSION: Shoulder arthroplasty is being used with greater frequency in this population. Surgeons are performing a greater yearly volume of total shoulder arthroplasty and reverse total shoulder arthroplasty.


Assuntos
Artroplastia do Ombro/tendências , Hemiartroplastia/tendências , Cirurgiões Ortopédicos/tendências , Padrões de Prática Médica/tendências , Articulação do Ombro/cirurgia , Carga de Trabalho , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/estatística & dados numéricos , California , Criança , Pré-Escolar , Procedimentos Cirúrgicos Eletivos , Feminino , Hemiartroplastia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Tempo , Adulto Jovem
8.
Acta Orthop ; 86(3): 286-92, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25727949

RESUMO

BACKGROUND AND PURPOSE: Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. PATIENTS AND METHODS: Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. RESULTS: During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. INTERPRETATION: Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.


Assuntos
Artroplastia/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Osteoartrite/cirurgia , Sistema de Registros , Lesões do Manguito Rotador , Fraturas do Ombro/cirurgia , Articulação do Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia/métodos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Manguito Rotador/cirurgia , Fraturas do Ombro/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Trombose Venosa/epidemiologia
9.
Clin Orthop Relat Res ; 472(9): 2809-15, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24906812

RESUMO

BACKGROUND: Deep infection after shoulder arthroplasty is a diagnostic and therapeutic challenge. The current literature on this topic is from single institutions or Medicare samples, lacking generalizability to the larger shoulder arthroplasty population. QUESTIONS/PURPOSES: We sought to identify (1) patient-specific risk factors for deep infection, and (2) the pathogen profile after primary shoulder arthroplasty in a large integrated healthcare system. METHODS: A retrospective cohort study was conducted. Of 4528 patients identified, 320 had died and 302 were lost to followup. The remaining 3906 patients had a mean followup of 2.7 years (1 day-7 years). The study endpoint was the diagnosis of deep infection, which was defined as revision surgery for infection supported clinically by more than one of the following criteria: purulent drainage from the deep incision, fever, localized pain or tenderness, a positive deep culture, and/or a diagnosis of deep infection made by the operating surgeon based on intraoperative findings. Risk factors evaluated included age, sex, race, BMI, diabetes status, American Society for Anesthesiologists (ASA) score, traumatic versus elective procedure, and type of surgical implant. For patients with deep infections, we reviewed the surgical notes and microbiology records for the pathogen profile. Multivariable Cox regression models were used to evaluate the association of risk factors and deep infection. Adjusted hazard ratios and 95% CI are presented. RESULTS: With every 1-year increase in age, a 5% (95% CI, 2%-8%) lower risk of infection was observed. Male patients had a risk of infection of 2.59 times (95% CI, 1.27-5.31) greater than female patients. Patients undergoing primary reverse total shoulder arthroplasty had a 6.11 times (95% CI, 2.65-14.07) greater risk of infection compared with patients having primary unconstrained total shoulder arthroplasty. Patients having traumatic arthroplasties were 2.98 times (95% CI, 1.15-7.74) more likely to have an infection develop than patients having elective arthroplasties. BMI, race, ASA score, and diabetes status were not associated with infection risk (all p > 0.05). Propionibacterium acnes was the most commonly cultured organism, accounting for 31% of isolates. CONCLUSIONS: Younger, male patients are at greater risk for deep infection after primary shoulder arthroplasty. Reverse total shoulder arthroplasty and traumatic shoulder arthroplasties also carry a greater risk for infection. Propionibacterium acnes was the most prevalent pathogen causing infection in our primary shoulder arthroplasty population. LEVEL OF EVIDENCE: Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Substituição/efeitos adversos , Artropatias/cirurgia , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Medição de Risco/métodos , Articulação do Ombro/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
10.
J Arthroplasty ; 29(9): 1823-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24836652

RESUMO

One year post-operative mortality among patients with primary elective total shoulder arthroplasty (ETSA) and traumatic shoulder arthroplasty (TSA) were compared to the general population of a large healthcare system. Standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) were calculated. 614 ETSA patients, 1.0% one year mortality, and 168 TSA patients, 5.4% mortality rate, were evaluated. Patients with ETSA (SMR = 0.4, 95% CI 0.1-0.7) had lower odds of mortality than expected, while patients with TSA (SMR = 1.8, 95% CI 0.6-3.0) did not have higher than expected odds of mortality compared to the reference population. Understanding excess mortality following shoulder arthroplasty surgery allows providers to evaluate current practices and identify ways to optimize patients prior to surgery.


Assuntos
Artroplastia de Substituição/mortalidade , Procedimentos Cirúrgicos Eletivos/mortalidade , Osteoartrite/mortalidade , Osteoartrite/cirurgia , Lesões do Ombro , Articulação do Ombro/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/mortalidade , Artrite Reumatoide/cirurgia , Criança , Pré-Escolar , Prestação Integrada de Cuidados de Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Osteonecrose/mortalidade , Osteonecrose/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Manguito Rotador/cirurgia
11.
J Shoulder Elbow Surg ; 22(10): 1338-44, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23571084

RESUMO

BACKGROUND: While shoulder arthroplasty is a well established treatment for a variety of conditions about the shoulder, the results of shoulder replacement in younger patients are not as predictable. The purpose of this study is to examine the indications for shoulder arthroplasty in patients 59 years old and younger, and to analyze revision rates between younger and older patients. METHODS: This is a retrospective cohort study of shoulder arthroplasties performed within a statewide integrated healthcare system between 2005 and 2010. Patients were stratified into 2 groups based on age at time of index replacement procedure: younger patients (≤59 years) and older patients (>59 years). RESULTS: There were 2981 primary arthroplasties followed for a median time of 2.2 years (interquartile range, 1.0-3.8), 90 (3.0%) of which required revisions. After adjusting for procedure type and diagnosis, younger patients had a two times higher risk (95% CI 1.2-3.5, P = .007) of revision than older patients. When looking at the risk of revision in younger and older patients separately, the risk of revision in hemiarthroplasty (RR = 4.5 vs RR = 1.7) and reverse total shoulder arthroplasty (RR = 33.6 vs RR = 3.0) compared to total shoulder arthroplasty were higher in younger patients compared to older patients. CONCLUSION: This study suggests patients 59 years and younger have an increased risk of revision at early follow-up. The higher risk of revision in younger patients receiving hemiarthroplasty may support the use of total shoulder arthroplasty in patients 59 years of age and younger.


Assuntos
Artroplastia/métodos , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Fatores Etários , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
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