Faculty Bibliography

BACKGROUND:Different approaches for total hip arthroplasty (THA) may offer advantages in regard to achieving same-day-discharge (SDD) success. METHODS:We retrospectively identified patients aged ≥ 18 years who underwent elective primary THA from 2015 to 2020 who were formally enrolled in a single institution's SDD program. A total of 1,127 and 207 patients underwent THA via direct anterior approach and posterior approach, respectively, were included. Cohorts were assigned based on approach. The primary outcome was failure-to-launch, defined as hospital stay extending past 1 midnight. Secondary outcomes included Forgotten Joint Score-12, Hip Disability and Osteoarthritis Outcome Score for Joint Replacement, 90-day readmission and revision rate, and surgical time. Patient-reported outcomes were collected at 3 and 12 months. RESULTS:After controlling for demographic differences, posterior approach patients had higher rates of failure-to-launch (12.1% versus 5.9%, P = .002) and longer surgical times (99 versus 80 minutes; P < .001) compared to direct anterior approach patients. The cohorts had similar readmission (1.7% versus 1.4%; P = .64) and revision rates (1% versus 1%; P = .88). The magnitude of improvement in Hip Disability and Osteoarthritis Outcome Score for Joint Replacement scores from preoperative to 12 months was similar between cohorts (35.3 versus 34.5; P = .42). The differences in outcome scores between cohorts at each time point were not considered clinically significant. CONCLUSION/CONCLUSIONS:Our analysis suggests that patient selection and surgical approach may be important for achieving SDD. Surgical approach did not significantly impact readmission or revision rates nor did it have a meaningful impact on patient-reported outcomes in the first year after surgery.

AIMS/OBJECTIVE:The purpose of this study is to systematically review the randomized controlled trials on the various treatment options that can be utilized in the management of displaced proximal humerus fractures. MATERIALS & METHODS/METHODS:Based on the PRISMA guidelines, three independent reviewers performed a systematic review of the literature. Randomized control trials (RCTs) focusing on the outcomes of the following interventions in the management of PHFs were considered for inclusion; (1) non-operative or conservative (NOC) management, (2) open reduction and internal fixation (ORIF), (3) intra-medullary nailing (IMN), (4) shoulder hemi-arthroplasty (HA), and (5) reverse shoulder arthroplasty (RSA). Network meta-analyses were performed using R and studies were ranked according to their P-score. RESULTS:Our study included 13 RCTs. RSA had improvements in abduction, constant score, flexion, as well as lowest rates of malunion and osteonecrosis when compared to other management modalities (P-Score = 0.9786, P-Score = 0.9998, P-Score = 0.9909, P-Score = 0.9590 and P-Score = 0.8042 respectively). HA was found to have improvements in health-related quality of life scores when compared to other management modalities (P-Score = 0.9672). ORIF had the highest improvement in quick disability of arm, shoulder and hand scores and visual analogue scale scores (P-Score = 0.8209 and P-Score = 0.7155 respectively). NOC was found to have the lowest rate of conversion to surgical intervention, with RSA having the lowest rate of surgical interventions (P-Score = 0.9186 and P-Score = 0.7497 respectively). DISCUSSION & CONCLUSION/CONCLUSIONS:RSA offers satisfactory improvements in clinical and functional outcomes when compared to other non-operative and operative treatment options in the management of carefully selected proximal humerus fractures, with a minimal revision rate when compared to other surgical management modalities. LEVEL OF EVIDENCE/METHODS:I - Systematic Review & Meta-Analysis of Randomized Control Trials.

AIMS/OBJECTIVE:Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits. METHODS:We retrospectively reviewed all patients who underwent TJA from 2011 to 2021 at a single, large, tertiary urban institution. Patients were separated into two cohorts based on whether they underwent primary or revision TJA (rTJA). Outcomes of interest included ED visit within 90-days of surgery, as well as reasons for ED visit and readmission rate. Multivariable logistic regressions were performed to compare the two groups while accounting for all statistically significant demographic variables. RESULTS:Overall, 28,033 patients were included, of whom 24,930 (89%) underwent primary and 3,103 (11%) underwent rTJA. The overall rate of 90-day ED visits was significantly lower for patients who underwent primary TJA in comparison to those who underwent rTJA (3.9% vs 7.0%; p < 0.001). Among those who presented to the ED, the readmission rate was statistically lower for patients who underwent primary TJA compared to rTJA (23.5% vs 32.1%; p < 0.001). CONCLUSION/CONCLUSIONS: 2022;3(7):543-548.

PURPOSE/OBJECTIVE:The purpose of this study was to perform a network meta-analysis of the randomized controlled trials (RCTs) in the literature in order to assess the evidence defining the optimal combination of surgical technique single row repair (SRR), double-row repair (DRR), or transosseous-equivalent/suture-bridge (TOE/SB) arthroscopic rotator cuff repair (ARCR) and postoperative rehabilitation (early or late) protocol for ARCR. METHODS:The literature search was performed based on the PRISMA guidelines. Randomized SSR-Early trials (RCT) comparing SRR vs DRR vs TOE/SB ARCR techniques were included, as well as early versus late postoperative ROM. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score. RESULTS:28 studies comprising 2,181 total shoulders met the inclusion criteria. TOE/SB-late (OR 0.19 [0.08;0.46) and DRR-late (OR 0.25 [0.12;0.52) were found to significantly reduce the rate of re-tear, with TOE/SB-late resulting in the highest P-score for the American Shoulder & Elbow Surgeons (ASES) (P Score: 0.7911) score and re-tear rate (P Score: 0.8725). DRR-early did not result in any significant improvements over the SRR-early group, except in internal rotation. There was no significant difference in forward flexion between groups, with almost equivalent P-Scores. Furthermore, TOE/SB-early and TOE/SB-late trended toward worsening external rotation compared to the control. CONCLUSION/CONCLUSIONS:The current study suggests that rotator cuff repair using the transosseous-equivalent/suture-bridge technique and late postoperative mobilization yields the highest functional outcomes and lowest re-tear rate in the arthroscopic management of symptomatic rotator cuff tears.

BACKGROUND:The purpose of this study was to examine the geographic and demographic variations and time trends of different types of meniscal procedures in New York State to determine whether disparities exist in access to treatment. METHODS:The New York Statewide Planning and Research Cooperative System (SPARCS) outpatient database was reviewed to identify patients who underwent elective, primary knee arthroscopy between January 1, 2003, and December 31, 2015, for 1 of the following diagnosis-related categories: Group 1, meniscectomy; Group 2, meniscal repair; and Group 3, meniscal allograft transplantation, with or without anterior cruciate ligament reconstruction (ACLR). The 3 groups of meniscal procedures were compared on geographic distribution, patient age, insurance, concomitant ACLR, and surgeon and hospital volume over the study period. RESULTS:A total of 649,470 patients who underwent knee arthroscopy between 2003 and 2015 were identified for analysis. Both meniscectomies and meniscal repairs had a scattered distribution throughout New York State, with allograft volume concentrated at urban academic hospitals. The majority of patients who underwent any meniscal procedure had private insurance, with Medicaid patients having the lowest rates of meniscal surgery. At high-volume hospitals, meniscal repairs and allografts are being performed with increasing frequency, especially in patients <25 years of age. Meniscal repairs are being performed concomitantly with ACLR with increasing frequency. CONCLUSIONS:Meniscal repairs and allografts are being performed at high-volume hospitals for privately insured patients with increasing frequency. Geographic access to these treatments, particularly allografts, is limited. CLINICAL RELEVANCE/CONCLUSIONS:Disparities in the availability of advanced meniscal treatment require further investigation and understanding to improve access to care.