Accuracy of ICD-10 Coding for Femoral Head Bearing Surfaces in Hip Arthroplasty.

BACKGROUND: The International Classification of Diseases-10 Procedure Code System (ICD-10-PCS) introduced oxidized zirconium (OxZi) and niobium procedural codes to the types of femoral head bearing surfaces in 2017. These codes aimed to increase procedural specificity in coding and improve data collection through administrative claims databases. This study aimed to assess the accuracy of ICD-10-PCS coding for femoral head bearing surfaces (cobalt chrome/metal, ceramic, and OxZi) in hip procedures. METHODS: A retrospective analysis of 6,204 procedures utilizing femoral heads performed between October 1, 2017 and August 26, 2021 at a large, urban academic hospital was conducted. Operative reports and implant logs were queried to determine the femoral head bearing surface, which was used during the total hip arthroplasty. These results were then compared to the ICD-10-PCS codes in the billing records. Coding accuracy was subsequently determined and statistical differences between the three groups were evaluated. RESULTS: The ICD-10-PCS coding was accurate for 90.8% (5,634/6,204) of cases. Coding accuracy for ceramic femoral heads (95.4%, 4,171/4,371) was significantly greater than that of both cobalt chrome/metal (73.7%, 606/822; P < .001) and OxZi (84.8%, 857/1,011; P < .001) femoral heads. CONCLUSION: While coding for ceramic femoral heads was very accurate, OxZi and cobalt chrome/metal femoral heads were miscoded at a rate of approximately 20%. These inaccuracies call for further evaluation of the ICD-10-PCS coding process to ensure that conclusions drawn from clinical research performed through administrative claims databases are not subject to error.

How Does Surgical Approach Affect Characteristics of Dislocation After Primary Total Hip Arthroplasty?

BACKGROUND: Concerns have been voiced regarding how surgical approach impacts risk of dislocation after total hip arthroplasty (THA). This study investigated how surgical approach impacts rate, direction, and timing of dislocations following THA. METHODS: We conducted a retrospective review of 13,335 primary THAs from 2011 to 2020 and identified 118 patients with prosthetic hip dislocation. Patients were stratified into cohorts by surgical approach used during primary THA. Patient demographics, index THA acetabular cup positioning, number, direction, timing of dislocations, and subsequent revisions were collected. RESULTS: Dislocation rate differed significantly between posterior approach (PA), direct anterior approach (DAA), and laterally-based approach (LA) (1.1 versus 0.7% versus 0.5%, P = .026). Rate of hips dislocating anteriorly was lowest in the PA group (19.2%) compared to LA (50.0%) and DAA groups (38.2%, P = .044). There was no difference in rate of hips dislocating posteriorly (P = .159) or multidirectional (P = .508) instability; notably 58.8% of dislocations in the DAA cohort occurred posteriorly. There were no differences in dislocation timing or revision rate. Acetabular anteversion was highest in the PA cohort compared to DAA and LA (21.5 versus 19.2 versus 11.7 degrees, P = .049). CONCLUSION: After THA, patients in the PA group had a slightly higher dislocation rate compared to the DAA and LA groups. The PA group had a lower rate of anterior dislocation and nearly 60% of DAA dislocations occurred posteriorly. However, with no differences in other parameters including revision rates or timing, our data suggests surgical approach may impact dislocation characteristics to a lesser degree than previous studies have suggested.

The Impact of Patient Resilience on Discharge After Total Hip Arthroplasty.

BACKGROUND: Patients who undergo total hip arthroplasty (THA) require resilience to recover and resume daily functions. Increased resilience may be an important factor for achieving improved outcomes. The purpose of this study is to examine the impact of resilience on time to discharge and on early patient-reported outcomes following primary THA. METHODS: A retrospective review of patients who underwent primary THAs and completed the Brief Resilience Scale (BRS) was conducted from 2020 to 2021 at an urban, academic hospital. Patients were separated into 3 cohorts based on BRS score: low (1-2.99), normal (3-4.30), and high (4.31-5) resilience. Demographics, participation in same-day discharge (SDD) program, length of stay (LOS), and preoperative and 3-month postoperative scores on the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) were assessed. SDD patients were excluded from LOS analysis. RESULTS: A total of 393 patients were included. Compared to low resilience patients, odds of being enrolled in SDD program were 1.49 and 3.01 times higher (P = .01) and 3-month HOOS JR scores improved by 4.7% and 11.7% (P = .03) for normal and high resilience patients, respectively. As resilience increased from low to normal to high in non-SDD patients, LOS significantly decreased (53.27 ± 51.92 vs 38.70 ± 28.03 vs 25.64 ± 14.48 hours, respectively; P = .001). CONCLUSION: Increased resilience is positively associated with likelihood of SDD participation or decreased LOS. Increased resilience was associated with increased HOOS JR scores at 3 months, although this did not reach the minimal clinically important difference. The BRS may be a useful tool for predicting patients who can successfully participate in SDD or predicting LOS after primary THA.