Anton Khlopas

Do Press Ganey Scores Correlate With Total Knee Arthroplasty—Specific Outcome Questionnaires in Postsurgical Patients?

BACKGROUND The purpose of this study was to assess whether Center for Medicaid and Medicare services-implemented satisfaction (Press Ganey [PG]) survey results correlate with established total knee arthroplasty (TKA) assessment tools. METHODS Data from 736 patients who underwent TKA and received a PG survey between November 2009 and January 2015 were analyzed. The PG survey overall hospital rating scores were correlated with standardized validated outcome assessment tools for TKA (Short form-12 and 36 Health Survey; Knee Society Score; Western Ontario and McMaster Universities Arthritis Index; University of California, Los Angeles; and visual analog scale) at a mean follow-up of 1154 days post-TKA. RESULTS There was no correlation between PG survey overall hospital rating score and the above-mentioned outcome assessment tools. CONCLUSION Our study shows that there is no statistically significant relationship between established arthroplasty assessment tools and the PG overall hospital rating. Therefore, PG surveys may not be an appropriate tool to determine reimbursement for orthopedists performing TKAs.

An evidence-based guide to the treatment of osteonecrosis of the femoral head

Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients. However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively. The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head. Cite this article: Bone Joint J 2017;99-B:1267-79.

Determining Cost-Effectiveness of Total Hip and Knee Arthroplasty Using the Short Form-6D Utility Measure

BACKGROUND With the implementation of the Patient Protection and Affordable Care Act, cost-effectiveness analyses are becoming increasingly important for resource allocation, and particularly for the justification of costly procedures, such as total knee and total hip arthroplasties (TKAs and THAs). Therefore, using the Short Form-6D (SF-6D) utility values, the purpose of this study was to determine (1) the quality-adjusted life years (QALYs) gained and (2) and the cost-effectiveness of undergoing THA and TKA. METHODS A total of 844 patients (357 men, 487 women) who had a mean age of 65 years (range, 39 to 80 years) underwent primary TKA, and 224 patients who had a mean age of 69 years (range, 44 to 88 years) underwent primary THAs at 7 institutions. The SF-6D values were derived for each patient preoperatively and at 1-year follow-up. QALYs were estimated at 1 year, and lifetime QALYs gained were determined using predicted life-expectancy values, at a discounted rate of 3% per year of life expectancy, to reflect a diminishing gain with time. National-level costs were determined using the 2011 Nationwide Inpatient Sample, and incremental cost-effectiveness ratios (ICER) were deduced for both groups. RESULTS The preoperative SF-6D values for the THA and TKA cohorts were 0.614 (range, 0.37 to 1) and 0.62 (range, 0.3 to 0.93). Postoperatively, SF-6D values improved significantly at 1 year in both groups. One-year QALYs for TKA and THA were 0.768 and 0.799. Lifetime QALYs gained for the groups were 2.07 and 1.85 (1.39 and 1.34 if discounted at a rate of 3% per year). The estimated ICER for TKA vs baseline presurgery was

Does gender influence how patients rate their patient experience after total hip arthroplasty

43,107 per QALY, and

Does Addition of Multimodal Periarticular Analgesia to Adductor Canal Block Improve Lengths of Stay, Pain, Discharge Status, and Opioid Use After Total Knee Arthroplasty?

39,453 per QALY for THA vs baseline presurgery. CONCLUSION The ICER showed that THA and TKA are cost-effective, compared to the

Coronal Correction for Severe Deformity Using Robotic-Assisted Total Knee Arthroplasty

50,000 USD/QALY threshold for cost-effectiveness, and justify resources allocated to these surgeries. The SF-6D can utilize existing functional outcome data, which makes these cost calculations considerably easier and more feasible for practicing orthopedists.

The Stem-Cell Market for the Treatment of Knee Osteoarthritis: A Patient Perspective

Background: Patient satisfaction, as measured by Press Ganey (PG) surveys, partially determines reimbursement rates. Knowing what influences these scores can lead to higher reimbursement for total hip arthroplasty (THA) surgeons. Currently, it is unknown whether gender biases exist in satisfaction surveys post-THA. Therefore, we asked: (i) which PG survey factors most influence hospital ratings among men and women after THA; and (ii) is there a difference in survey element responses and overall hospital ratings between men and women post-THA? Methods: We queried the PG database for patients who underwent THA from November 2009 to January 2015, which yielded 692 patients (277 men, 415 women). Weighted means were analysed for the scores of PG domains between men and women. A multiple regression analysis was performed for each gender, with overall hospital satisfaction as the dependent variable, in order to assess the influence (β-weight) of each PG domain. Results: For men, pain management (β = 0.317, p = 0.021) most influenced overall hospital rating. For women, staff responsiveness (β = 0.451, p<0.001) most influenced overall hospital rating. This was followed by communication with nurses (β = 0.373, p<0.001), and doctors (β = 0.236, p = 0.002). There were no significant differences in mean overall hospital rating between groups. Conclusions: It is advantageous for orthopaedic surgeons to focus on the PG domains most pertinent to each patient gender post-THA. Focusing efforts based on gender may allow for better patient satisfaction, optimised reimbursements, and improved hospital ratings.

Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Review

BACKGROUND Postoperative pain after total knee arthroplasty (TKA) can be burdensome. Multiple methods of pain control have been used, including adductor canal block (ACB) and multimodal periarticular analgesia (MPA). These two techniques have been studied have proven to be efficacious separately. The purpose of this study was to compare: (1) lengths of stay (LOS), (2) pain level, (3) discharge status, and (4) opioid use in TKA patients who received ACB alone vs patients who received ACB and MPA. METHODS A single surgeon database was reviewed for patients who had a TKA between January 2015 and April 2016. Patients who received ACB with or without MPA were included. This yielded 127 patients who had a mean age of 63 years. Patients were grouped into having received ACB alone (n = 52) and having received ACB and MPA (n = 75). Patient records were reviewed to obtain demographic and end point data (LOS, pain, discharge status, and opioid use). Student t test and chi-squared test were used to compare continuous and categorical variables respectively. RESULTS There were no significant difference in mean LOS (P = .934), pain level (P = .142), discharge status (P = .077), or total opioid use (P = .708) between the 2 groups. CONCLUSION There was no significant difference in LOS, pain levels, discharge status, and opiate requirements between the 2 groups. ACB alone may be as effective as combined ACB and MPA in TKA patients for postoperative pain control. Larger prospective studies are needed to verify these findings and to improve generalization.

Patient Satisfaction Outcomes after Robotic Arm-Assisted Total Knee Arthroplasty: A Short-Term Evaluation

Abstract Although robotic‐assisted total knee arthroplasty (TKA) has the potential to accurately reproduce neutral alignment, it is still unclear if this correction is attainable in patients who have severe varus or valgus deformities. Therefore, the purpose of this study was to assess a single surgeons experience with correcting coronal deformities using the robotic‐assisted TKA device. Specifically, we looked at correction of varying degrees of varus and valgus deformity in patients who underwent robotic arm‐assisted TKA. A total of 330 robotic‐assisted TKA cases performed by a single surgeon were analyzed. Preoperative CT scans were registered to the robotic‐assisted software to create a three‐dimensional rendering from which coronal alignment was measured. Postoperative coronal alignment measurements were taken in the operating room using the robotic‐assisted device after trial component placement. The robotic‐assisted device uses optical tracking from navigation probes placed on the distal femur and proximal tibia. The robotic‐assisted software can register these probes as bony landmarks to measure coronal alignment in the distal plane of the femoral component and proximal plane of the tibial component. A total of 261 cases were of varus knees, 46 cases were of valgus knees, and 23 cases had 0° preoperative alignment. Severe deformity was defined as 7° or greater deformity. Preoperative neutral alignment was defined as 0°, while postoperative neutral alignment was defined as 0° ± 3°. There were 129 patients with and initial severe varus and 7 patients with an initial severe valgus deformity of 7° or greater. Patients were divided into varus or valgus cohorts, and analysis was performed on the overall cohort, as well as nonsevere (<7°) and severe (7° or greater) deformity cohorts. All 132 knees with initial varus deformity of less than 7° were corrected to neutral (mean 1°, range ‐1‐3°). A total of 82 knees (64%) with 7° or greater varus deformity were corrected to neutral (mean 2°, range 0‐3°). However, roughly 30% of patients with severe deformity who were not corrected to neutral were still corrected within a couple of degrees of neutral. There were seven knees with 7° or greater valgus deformity, and all were corrected to neutral (mean 2°, range 0‐3°). This study demonstrated that all knees were corrected in the appropriate direction within a few degrees of neutral, and no knees were overcorrected. The implication of this ability to achieve alignment goals on clinical outcomes will need to be evaluated in future studies. The results from this study demonstrate the potential for the robotic‐assisted device during TKA in helping surgeons achieve a preoperatively planned desired neutral alignment.

Outcomes of Newer Generation Cementless Total Knee Arthroplasty: Beaded Periapatite-Coated vs Highly Porous Titanium-Coated Implants

Abstract The use of stem‐cell therapies for the treatment of various musculoskeletal conditions, especially knee osteoarthritis (OA), is rapidly expanding, despite only low‐level evidence to support its use. Centers offering these therapies are often marketing and charging patients out‐of‐pocket costs for such services. Therefore, the purpose of this study was to determine the current marketed: (1) prices and (2) clinical efficacy of stem‐cell therapies for knee OA. This was a prospective cross‐sectional study which queried 317 U.S. centers that offered direct‐to‐consumer stem‐cell therapies for musculoskeletal conditions. A total of 273 of 317 centers were successfully contacted via phone or e‐mail, using a simulated 57‐year‐old male patient with knee OA. Scripted questions were asked by the simulated patient to determine the marketed prices and clinical efficacy. Centers generally reported the proportion of patients who had “good results” or “symptomatic improvement.” The mean price of a unilateral (same‐day) stem‐cell knee injection was