Instability in Patients With Lumbar Spine Disease Undergoing Posterior Approach and Lateral Approach Primary Total Hip Arthroplasty.

INTRODUCTION: Dislocation rates in patients who have fixed spinopelvic motion have been reported up to 20%. Few studies have directly compared dislocation rates in patients who have spine pathology undergoing total hip arthroplasty (THA) through different surgical approaches. This study compared postoperative dislocation rates in patients who had lumbar spine disease and underwent primary THA using a posterior or direct lateral approach. METHODS: Between 2011 and 2017, consecutive cohorts of primary THAs were retrospectively reviewed. One surgeon routinely used a posterior approach, while the other used a direct lateral approach. Chart and radiographic review were conducted to identify patients who had lumbar spine disease. Dislocations among cohorts with and without lumbar spine disease were compared by posterior and direct lateral approaches. RESULTS: The overall dislocation rate was 1.3% (15/1,198). The top four predictors of dislocation were presence of lumbar spine disease (odds ratio [OR] 5.0; P = 0.014), posterior surgical approach (OR, 6.5; P = 0.074), cases performed for fracture (OR, 4.4; P = 0.035), and women (OR, 4.6; P = 0.050). Dislocation rates among direct lateral approach patients who had lumbar spine pathology were significantly lower than posterior approach patients who had lumbar spine pathology (0.0% versus 3.6%; P = 0.011). DISCUSSION: Although dislocation rates were low in both groups, study results suggest that a direct lateral approach for primary THA may reduce postoperative dislocations for patients who have limited spinopelvic motion due to lumbar spine pathology. Furthermore, surgeons using the posterior approach might consider optimizing the femoral head to acetabular cup ratio in patients who have lumbar spine disease.

Financial Impact of the Indiana University Student-Run Free Clinic.

Student-run free clinics (SRFCs) serve as an important public safety-net for un- and under-insured patients. Few studies have investigated their financial impact or return of investment to the community. The aim of this study was to estimate the financial impact of the Indiana University Student Outreach Clinic (IUSOC) using national market values of medical visits and lab services in 2021.From internal triage classification records maintained from March to December 2021, Current Procedural Terminology (CPT) codes were assigned corresponding to "New Patient," "Returning Quick or Long" and "Fast Track" visits. Total Work Relative Value Units (wRVUs) were calculated to then estimate the total monetary value for medical services. Similarly, the collection of laboratory services rendered from March to December 2021 were assigned costs using the 2021 Center for Medicare and Medicaid Services (CMS) fee schedule.There were a total of 1475 medical visits identified in this study under the triage categories of interest, with 440 New Patient visits, 1032 Returning Quick and Long visits, and 3 Fast Track visits. From the calculated total wRVUs, the estimated monetary value for medical services was $95,413.79. Additionally, there were 3633 eligible lab tests ordered; almost half of these (1523, 41.9%) were categorized as routine lab tests (CMP, BMP, CBC, lipid panel). The estimated value of lab services was $56,296.81.Our estimates reveal that the IUSOC provided nearly $150,000 worth of free healthcare to the community in 2021. Further, most patients were seen for return visits, revealing the opportunity to streamline logistics.