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2.
J Arthroplasty ; 35(2): 313-317.e1, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31601455

RESUMO

BACKGROUND: The majority of the cost analysis literature on total hip arthroplasties (THAs) has been focused around the perioperative and postoperative period, with preoperative costs being overlooked. METHODS: The Humana Administrative Claims database was used to identify Medicare Advantage (MA) and Commercial beneficiaries undergoing elective primary THAs. Preoperative healthcare resource utilization in the year prior to a THA was grouped into the following categories: office visits, X-rays, magnetic resonance imagings, computed tomography scans, intra-articular steroid and hyaluronic acid injections, physical therapy, and pain medications. Total 1-year costs and per-patient average reimbursements for each category have been reported. RESULTS: Total 1-year preoperative costs amounted to $21,022,883 (average = $512/patient) and $4,481,401 (average = $764/patient) for MA and Commercial beneficiaries, respectively. The largest proportion of total 1-year costs was accounted for by office visits (35% in Commercial; 41% in MA) followed by pain medications (28% in Commercial; 35% in MA). Conservative treatments (steroid injections, hyaluronic acid injections, physical therapy, and pain medications) alone accounted for 40%-44% of the total 1-year costs prior to a THA. A high healthcare utilization within the last 3 months prior to surgery was noted for opioids and steroid injections. CONCLUSION: On average, $500-$800/patient is spent on hip osteoarthritis-related care in the year prior to a THA. Despite their potential risks, opioids and steroid injections are often utilized in the last 3 months prior to surgery.

3.
J Bone Joint Surg Am ; 101(18): 1619-1627, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567798
4.
J Knee Surg ; 2019 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-30861538

RESUMO

Relative value units (RVUs) are used for ensuring that physicians are appropriately reimbursed based on case complexity. While past research has elucidated that surgeons are reimbursed at a higher rate for primary total knee arthroplasty (TKA) versus revision TKA, no study has explored differences in reimbursements between single-component and double-component revisions, considering a double-component revision is likely to require more effort/skill as compared with single-component revision. The 2015 to 2016 American College of Surgeons National Surgical Quality Improvement Program files were queried using Current Procedural Terminology (CPT) codes for single-component revision TKA (CPT-27486) and double-component revision TKA (CPT-27487). A total of 1,962 single-component and 4,184 double component revisions were performed during this period. Total RVUs, RVU/min, and dollar amount/min were calculated for each case. The mean RVU was 21.12 and 27.11 for single-component and double-component revision TKAs, respectively. A statistically significant difference was noted in mean operative time (single component = 100.44 vs. double component = 144.29; p < 0.001) between the two groups. Single-component revision had a significantly higher mean RVU/min (0.267) versus double-component revision (0.223). The reimbursement amounts calculated for single-component versus double-component revisions were per minute ($9.58/min vs. $8.00/min), per case ($962.22 vs. $1,154.32), and per day ($5,773.32 vs. $4,617.28) with a projected annualized cost difference of $184,966. Orthopaedic surgeons are reimbursed at a higher rate for single-component revision TKAs as compared with double-component revision TKAs, despite the higher complexity and longer operative times required in the latter. The study highlights the need for a change in the RVUs for either double-component or single-component revision to ensure reimbursement per unit time is adequate for performing a complex case such as double-component revision TKA.

6.
J Arthroplasty ; 33(10): 3329-3342, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29921502

RESUMO

BACKGROUND: Surgeon volume has been identified as an important factor impacting postoperative outcome in patients undergoing orthopedic surgeries. With an absence of a detailed systematic review, we sought to collate evidence on the impact of surgeon volume on postoperative outcomes in patients undergoing primary total hip arthroplasty. METHODS: PubMed (MEDLINE) and Google Scholar databases were queried for articles using the following search criteria: ("Surgeon Volume" OR "Provider Volume" OR "Volume Outcome") AND ("THA" OR "Total hip replacement" OR "THR" OR "Total hip arthroplasty"). Studies investigating total hip arthroplasty being performed for malignancy or hip fractures were excluded from the review. Twenty-eight studies were included in the final review. All studies underwent a quality appraisal using the GRADE tool. The systematic review was performed in accordance with the PRISMA guidelines. RESULTS: Increasing surgeon volume was associated with a shorter length of stay, lower costs, and lower dislocation rates. Studies showed a significant association between an increasing surgeon volume and higher odds of early-term and midterm survivorship, but not long-term survivorships. Although complications were reported and recorded differently in studies, there was a general trend toward a lower postoperative morbidity with regard to complications following surgeries by a high-volume surgeon. CONCLUSION: This systematic review shows evidence of a trend toward better postoperative outcomes with high-volume surgeons. Future prospective studies are needed to better determine long-term postoperative outcomes such as survivorship before healthcare policies such as regionalization and/or equal-access healthcare systems can be considered.


Assuntos
Artroplastia de Quadril/mortalidade , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Humanos , Ortopedia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Resultado do Tratamento
7.
J Foot Ankle Surg ; 56(4): 730-734, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28633768

RESUMO

Trimalleolar ankle fractures are unstable injuries with possible syndesmotic disruption. Recent data have described inherent morbidity associated with screw fixation of the syndesmosis, including the potential for malreduction, hardware irritation, and post-traumatic arthritis. The posterior malleolus is an important soft tissue attachment for the posterior inferior syndesmosis ligament. We hypothesized that fixation of a sizable posterior malleolar (PM) fracture in supination external rotation type IV (SER IV) ankle fractures would act to stabilize the syndesmosis and minimize or eliminate the need for trans-syndesmotic fixation. A retrospective review of trimalleolar ankle fractures surgically treated from October 2006 to April of 2011 was performed. A total of 143 trimalleolar ankle fractures were identified, and 97 were classified as SER IV. Of the 97 patients, 74 (76.3%) had a sizable PM fragment. Syndesmotic fixation was required in 7 of 34 (20%) and 27 of 40 (68%), respectively, when the PM was fixed versus not fixed (p = .0002). When the PM was indirectly reduced using an anterior to posterior screw, 7 of 15 patients (46.7%) required syndesmotic fixation compared with none of 19 patients when the PM fragment was fixated with direct posterior lateral plate fixation (p = .0012). Fixation of the PM fracture in SER IV ankle fractures can restore syndesmotic stability and, thus, lower the rate of syndesmotic fixation. We found that fixation of a sizable PM fragment in SER IV or equivalent injuries through posterolateral plating can eliminate the need for syndesmotic screw fixation.


Assuntos
Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Amplitude de Movimento Articular/fisiologia , Supinação/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fraturas do Tornozelo/diagnóstico por imagem , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
8.
JBJS Case Connect ; 6(3): e62, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29252639

RESUMO

CASE: A 13-year-old male patient sustained a posterior transphyseal hip fracture-dislocation while playing football. A surgical hip dislocation with a trochanteric flip osteotomy, as described by Ganz and colleagues, was performed. Drilling of the dislocated epiphysis demonstrated no blood flow. Transepiphyseal and transphyseal fracture fixation with screws was performed. Two years after the injury, the patient had no evidence of osteonecrosis or functional limitations. CONCLUSION: Traumatic transepiphyseal fracture-dislocations are rare injuries that commonly result in osteonecrosis. Application of the Ganz surgical hip-dislocation technique to a difficult pediatric hip fracture-dislocation achieved an excellent result.


Assuntos
Futebol Americano/lesões , Fixação Interna de Fraturas , Luxação do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Adolescente , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Recuperação de Função Fisiológica
9.
Injury ; 46(3): 453-8, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25549821

RESUMO

Femoral neck fractures in physiologically young adults are relatively uncommon. The reported incidence of avascular necrosis and nonunion rates remain relatively high despite the advancement in understanding and surgical management. Understanding the normal femoral neck anatomy and its relationship to presenting fracture pathology in young adults could help to lessen reported high complication rates to provide better clinical outcomes.


Assuntos
Fraturas do Colo Femoral/patologia , Fraturas do Colo Femoral/cirurgia , Colo do Fêmur/patologia , Fixação Interna de Fraturas/efeitos adversos , Adulto , Fraturas do Colo Femoral/complicações , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/prevenção & controle , Colo do Fêmur/anatomia & histologia , Fraturas não Consolidadas/etiologia , Fraturas não Consolidadas/prevenção & controle , Humanos , Adulto Jovem
10.
J Pediatr Orthop B ; 23(5): 411-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24977943

RESUMO

Pediatric proximal tibial epiphysis fractures are uncommon and have subsequently received little attention in terms of treatment and outcomes. We studied the clinical and functional outcomes of 13 patients with Salter-Harris III and IV fractures of the proximal tibial epiphysis after operative fixation. Associated meniscus, ligamentous, or neurovascular injury was present in 100% of this cohort. Provisional external fixation and locked plating spanning the open physis were used in the majority of cases. The mean clinical follow-up was 15.69 months, where all fractures progressed to union. Good functional outcomes with a low complication rate are possible after operative fixation of these infrequent injuries.


Assuntos
Epífises/lesões , Fixação Interna de Fraturas/métodos , Traumatismos do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Criança , Feminino , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Radiografia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento
12.
Orthopedics ; 35(11): e1659-63, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23127461

RESUMO

Deep vein thrombosis is a frequent complication following total joint arthroplasty and other major orthopedic procedures. Pulmonary embolism occurs with or without a diagnosis of deep vein thrombosis, although infrequently (1.5%-10%). In patients with congenital cardiac defects, such as a patent foramen ovale, paradoxical cerebral embolism may also occur. This article describes a case of a 52-year-old woman who sustained a paradoxical cerebral embolism following total knee arthroplasty. In the workup of a patient with a known murmur and stroke symptoms, paradoxical cerebral embolism should be included in the differential. The initial evaluation should incorporate transesophageal echocardiography because of its accuracy in the demonstration of the cardiac physiology. An abnormal intracardiac or intrapulmonary shunt is essential for paradoxical cerebral embolism, allowing the entrance of the thrombus into cerebral circulation from the venous system. No clear consensus has been reached on the management of patients at risk for paradoxical cerebral embolism prior to orthopedic procedures. However, when an embolic stroke is diagnosed acutely, ideal management includes thrombolytic therapy, but further research is needed to confirm that this is the correct management. Due to the risk of recurrence, postoperative thromboprophylaxis is recommended with or without closure of the foramen ovale. Most importantly, and as demonstrated by the current patient, who partially recovered but did not require walking assistance after 2-year follow-up, treating physicians should be prepared to counsel patients through a lengthened physical rehabilitative process.


Assuntos
Artroplastia do Joelho/efeitos adversos , Embolia Paradoxal/diagnóstico , Embolia Paradoxal/etiologia , Embolia Intracraniana/diagnóstico , Embolia Intracraniana/etiologia , Embolia Paradoxal/cirurgia , Feminino , Humanos , Embolia Intracraniana/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
13.
J Pediatr Orthop B ; 21(3): 230-4, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22422006

RESUMO

A digastric approach has been used successfully to treat adult patients with femoral neck osteochondromas; however, to our knowledge, this has not been described in pediatric patients with open proximal femur growth plates. A case of femoral neck osteochondroma in an 11-year-old boy is presented and treatment using a digastric approach is described. No intraoperative femoral neck fracture or postoperative avascular necrosis occurred. There is no recurrence of the tumor at the 7-year follow-up. Surgical hip dislocation through a digastric approach provides adequate exposure of the femoral neck for osteochondroma resection and this technique should be considered for such circumstances.


Assuntos
Neoplasias Ósseas/cirurgia , Colo do Fêmur/cirurgia , Osteocondroma/cirurgia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Nádegas/cirurgia , Criança , Intervalo Livre de Doença , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Osteocondroma/complicações , Osteocondroma/patologia , Dor/etiologia , Dor/fisiopatologia , Músculo Quadríceps/cirurgia , Radiografia , Amplitude de Movimento Articular , Resultado do Tratamento
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