RESUMO
Background: The purpose of this study was to compare the cost differences for single- versus double-incision distal biceps repair at an ambulatory surgery center (ASC) given that similar clinical outcomes have been reported between these methods. Methods: A retrospective review of financial and medical records was completed for patients who underwent distal biceps tendon repair over a three-year period at a single private orthopedic practice. Variables analyzed include the cost to the ASC of operative time and the cost of differential surgical supplies, specifically implants and disposable supplies. Results: A total of 10 surgeons performed 104 repairs. Nine surgeons performed repairs through a single incision with use of cortical button or suture anchor fixation, and one surgeon performed transosseous suture fixation through a double-incision approach. The median tourniquet time and procedure length were 31 (interquartile range [IQR] 27-40) and 44 (IQR 39-54) minutes for single-incision repairs and 68 minutes (IQR 61-75) and 110 minutes (IQR 103-113) for double-incision repairs which were significantly different across groups (P < .001, P < .001). The total surgical cost (operative time, implants, and disposables) for single-incision repairs was a median of $758 (IQR 732-803) compared with $606 (IQR 567-629) for double-incision repairs (P < .001). However, the procedure cost with implants (not including disposables) was not significantly different for single- (median [Mdn] = $500 [IQR 475-552]) and double-incision repairs (Mdn $552 [IQR 514-564]) (P = .14) although the procedure cost with disposables (not including implant costs) favored single-incision repairs (Mdn = $478 [IQR 452-523]) over double-incision repairs (Mdn = $606 [IQR 567-629]) (P < .001). Conclusion: In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs. Differences in surgical time cost between the two approaches could be consequential for ASCs and other stakeholders.
RESUMO
PURPOSE: Metallic radial head replacement with a prosthesis that is too thick has been reported to be associated with stiffness, pain, and capitellar wear. Radiographic widening of the lateral ulnohumeral joint after radial head replacement has been used as a criterion to diagnose overstuffing. The purpose of this study was to show that widening of the lateral ulnohumeral joint is a normal anatomic variant and therefore cannot be used conclusively to diagnose joint overstuffing. METHODS: Fifty normal standardized anteroposterior radiographs from 50 patients were reviewed to evaluate variations in the joint space between the medial and lateral ulnohumeral joints. Measurements were taken on 3 occasions by one surgeon and on a single occasion by a second surgeon. At 4-times magnification, 2 lines were drawn perpendicular to the lateral ulnohumeral joint and 2 lines perpendicular to the medial ulnohumeral joint. Measurements were then compared to evaluate joint space width and parallelism. RESULTS: Intraclass correlation coefficients indicated excellent intrarater and interrater reliability. The width of the lateral ulnohumeral joint space was greater than that of the medial ulnohumeral joint space. The medial joint space was parallel, and the lateral joint space was nonparallel. CONCLUSIONS: The lateral ulnohumeral joint space is often wider than the medial ulnohumeral joint space on anteroposteror radiographs of the normal elbow. Although the medial joint space is usually parallel, the lateral joint space may be nonparallel and wider laterally; therefore, lateral joint space widening is not a reliable indicator of radiocapitellar joint overstuffing. A nonparallel medial ulnohumeral joint space may suggest possible overstuffing of a radial head arthroplasty; however, comparing radiographs of the uninjured elbow is likely the best investigation to consider when overstuffing is suspected.