Faculty Bibliography

INTRODUCTION/BACKGROUND:Patient-reported outcome measures (PROMs) can be used to evaluate post-operative health care quality and patient satisfaction. The Patient's Joint Perception (PJP) question gathers a single PRO to measure how patients appraise their joint. This study compares PJP to the Forgotten Joint Score (FJS) at 21-months post-operation to assess its value. METHODS:A retrospective review was performed at an orthopedic specialty hospital for patients who completed both PJP and FJS questionnaires in 2020-2021 and underwent either a unilateral elective primary Total Knee Arthroplasty (TKA) or Total Hip Arthroplasty (THA). Spearman's correlation coefficients and p-values were calculated to determine external validity of PJP. Floor and ceiling effects were analyzed and considered significant if ≥15% of patients achieved the worst or best score (0-4 for PJP and 0-100 for FJS). RESULTS:In total, 534 patients (327 THA and 207 TKA) were surveyed at 21 months post-operation. External validity against FJS was assessed for both TKA (r=0.66, p<0.01) and THA (r=0.69, p<0.01). For TKA, the floor and ceiling effects were 0.97% and 25.12% for PJP and 3.86% and 4.83% for FJS, respectively. For THA, the floor and ceiling effects were 0.92% and 50.46% for PJP and 2.47% and 20.50% for FJS, respectively. CONCLUSION/CONCLUSIONS:PJP was correlated with FJS moderately for both TKA and THA and can be collected with less burden. However, ceiling effects were significantly higher in both TKA and THA for PJP compared with FJS. Further studies are needed to investigate the questionnaires at additional timepoints and to evaluate the implications of high ceiling effects.

Introduction/UNASSIGNED:The use of tourniquets and bipolar sealers are effective methods of hemostasis during total knee arthroplasty (TKA). However, their effect on perioperative patient outcomes is unknown. The purpose of this study is to compare the efficacy of tourniquet-less, tourniquet-less with use of a bipolar sealer, and tourniquet use on postoperative pain and surgical outcomes following TKA. Methods/UNASSIGNED: = 40). Results/UNASSIGNED: = 0.025). Conclusion/UNASSIGNED:Our findings demonstrate that both bipolar sealer and tourniquet use in TKA are associated with similar postoperative pain levels and LOS in comparison to tourniquet-less only TKA. However, bipolar sealer and tourniquet use may lead to better longer term improvement such as greater PRO score improvement and fewer readmissions.

INTRODUCTION/UNASSIGNED:The use of thin highly cross-linked polyethylene (HXLPE) liners in total hip arthroplasty (THA) allows utilisation of larger femoral heads. However, concern surrounding postoperative complications remains. This study aims to investigate rates of revision and re-admission associated with thin HXLPE liners at short-term follow-up. METHODS/UNASSIGNED: = 2027) received >5.1-mm liners with >52-mm size cups. Outcomes were compared using multi-variable logistic regressions while controlling for all significant demographic differences. RESULTS/UNASSIGNED: = 0.068). Liners were exchanged for liner wear in 1 hip (1%), aseptic reasons in 38 hips (66%), and peri-prosthetic joint infection in 19 hips (33%). CONCLUSIONS/UNASSIGNED:Patients undergoing THA with a thin liner were not significantly predisposed to higher rates of revision surgery or poorer clinical outcomes at short-term follow-up when compared to those who received a thicker liner. Consequently, further long-term studies regarding the utility of thin HXLPE implants in reducing complications should be pursued.

BACKGROUND:The prevalence of obesity in total hip arthroplasty (THA) patients has been studied in the past. However, there has not been direct comparison against obesity in the general population. This study compared yearly trends in BMI and obesity rates between patients who had undergone primary THA and those from the general patient population. METHODS:We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA and those who had an annual routine physical exam between January 2013 and December 2020 at our academic tertiary medical center. Baseline demographics were controlled in our statistical models. Significance of yearly trends was determined through a linear regression analysis. Independent samples t-test and Chi-square test were used to compare means and proportions between the two groups, respectively. RESULTS:A total of 11,250 primary THA patients and 1,039,918 annual physical exam patients were included. Average BMI for the THA group was significantly higher (P < 0.001) each year compared to the annual physicals group (APG). Higher obesity rates were observed in all obesity subgroups (all classes, and class I-III individually) for THA patients each year compared to the APG. Interestingly, while we found a significantly increasing trend in obesity for the general population (P < 0.001), BMI and obesity rates remained stable in the THA population. CONCLUSION/CONCLUSIONS:While our general patient population showed significant increase in BMI and obesity over time, THA patients had higher, yet stable, BMI. Further investigation is required to determine the role of risk optimization in these findings. LEVEL III EVIDENCE/METHODS:Retrospective Cohort Study.

BACKGROUND:Cost excess in bundled payment models for total joint arthroplasty (TJA) is driven by discharge to rehabilitation or a skilled nursing facility (SNF). A recently published preoperative risk prediction tool showed very good internal accuracy in stratifying patients on the basis of likelihood of discharge to an SNF or rehabilitation. The purpose of the present study was to test the accuracy of this predictive tool through external validation with use of a large cohort from an outside institution. METHODS:A total of 20,294 primary unilateral total hip (48%) and knee (52%) arthroplasty cases at a tertiary health system were extracted from the institutional electronic medical record. Discharge location and the 9 preoperative variables required by the predictive model were collected. All cases were run through the model to generate risk scores for those patients, which were compared with the actual discharge locations to evaluate the cutoff originally proposed in the derivation paper. The proportion of correct classifications at this threshold was evaluated, as well as the sensitivity, specificity, positive and negative predictive values, number needed to screen, and area under the receiver operating characteristic curve (AUC), in order to determine the predictive accuracy of the model. RESULTS:A total of 3,147 (15.5%) of the patients who underwent primary, unilateral total hip or knee arthroplasty were discharged to rehabilitation or an SNF. Despite considerable differences between the present and original model derivation cohorts, predicted scores demonstrated very good accuracy (AUC, 0.734; 95% confidence interval, 0.725 to 0.744). The threshold simultaneously maximizing sensitivity and specificity was 0.1745 (sensitivity, 0.672; specificity, 0.679), essentially identical to the proposed cutoff of the original paper (0.178). The proportion of correct classifications was 0.679. Positive and negative predictive values (0.277 and 0.919, respectively) were substantially better than those of random selection based only on event prevalence (0.155 and 0.845), and the number needed to screen was 3.6 (random selection, 6.4). CONCLUSIONS:A previously published online predictive tool for discharge to rehabilitation or an SNF performed well under external validation, demonstrating a positive predictive value 79% higher and number needed to screen 56% lower than simple random selection. This tool consists of exclusively preoperative parameters that are easily collected. Based on a successful external validation, this tool merits consideration for clinical implementation because of its value for patient counseling, preoperative optimization, and discharge planning. LEVEL OF EVIDENCE/METHODS:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

PURPOSE/OBJECTIVE:The purpose of the study was to utilize a large-scale biomorphometric computer tomography (CT) database to determine the desirable starting point and angle for placement of the femoral intramedullary rod in the sagittal plane. METHODS:A CT-based modeling and analytics system (SOMA, Stryker, Mahwah, NJ) was used to evaluate 1029 entire-femur CT scans. From this, 19,464 simulations were run to test whether a 20 cm intramedullary rod, with a radius of 4 mm, would successfully pass through the femoral canal before contacting cortical bone. First, modelling included varying angles from 0-6 degrees in the sagittal plane, at 1-degree intervals. Next, the start point was adjusted with an assumed 3 degrees of induced flexion in comparison to the mechanical axis. RESULTS:A total of 5012 simulations were able to place the femoral intramedullary rod 20 cm into the canal. The angle of the rod that created the highest proportion of successful jig placement was at a 3-degree angle of induced flexion to the orthogonal plane of the transepicondylar axis (TEA), with 33.7% successful jig placements. The starting point for the greatest proportion of successful guide placements was 48.5% along the distance between the sTEA, slightly closer to the lateral side. In the AP plane, the average distance to the ideal start point was 12.1 mm anterior to the PCL. CONCLUSION/CONCLUSIONS:By examining over a thousand femoral CT scans, an angle of 3 degrees of induced flexion was identified in the sagittal plane with the highest proportion of successful placement of an intramedullary rod before cortical contact. It is important to note the high rate of failure in completely inserting the 20 mm rod. LEVEL OF EVIDENCE/METHODS:This is a prospective computer based model.

INTRODUCTION/BACKGROUND:The purpose of this study is to report on the association between the number of stairs to enter home and length of stay (LOS), discharge disposition, and patient reported outcome measures (PROMs) among patients who underwent primary total joint arthroplasty (TJA). MATERIALS AND METHODS/METHODS:We retrospectively reviewed patients who underwent primary total hip or knee arthroplasty between January 2016 and March 2020. Only patients with documentation of the number of stairs to enter their homes were included in the study. The two cohorts were separated into four groups: none, 1-10, 11-20, and > 20 stairs. Collected variables included demographic data, LOS, discharge disposition, and PROMs. Chi-square and ANOVA were utilized to determine significance. RESULTS:Of the 1116 patients included, 510 underwent THA, and 606 underwent TKA. There was no statistical difference in LOS (THA: p = 0.308; TKA: p = 0.701) and discharge disposition (THA: p = 0.371; TKA: p = 0.484) in both cohorts regardless the number of stairs. There was no statistical difference in FJS-12 scores at 3 months (THA: p = 0.590; TKA: p = 0.206), 12 months (THA: p = 0.217; TKA: p = 0.845), and 21 months (THA: p = 0.782; TKA: p = 0.296) postoperatively for both cohorts. There was no statistical difference in HOOS, JR scores preoperatively (p = 0.278) and at 3 months postoperatively (p = 0.527) for the THA cohort, as well as KOOS, JR scores preoperatively and at 3 and 12 months postoperatively (p = 0.557; p = 0.522; p = 0.747) for the TKA cohort. CONCLUSION/CONCLUSIONS:We found no statistical differences in LOS, discharge disposition, and PROMs in patients who underwent TJA, irrespective of the number of stairs negotiated to enter their home. These findings can aid surgeons to provide preoperative education and reassurance to patients who have concerns with their discharge planning due to the walk-up stairway at their residence.