Mouhanad M. El-Othmani

Anterior knee pain following primary total knee arthroplasty

Despite improvements in technique and technology for total knee arthroplasty (TKA), anterior knee pain impacts patient outcomes and satisfaction. Addressing the prosthetic and surgical technique related causes of pain after TKA, specifically as it relates to anterior knee pain, can aid surgeons in addressing these issues with their patients. Design features of the femoral and patellar components which have been reported as pain generators include: Improper femoral as well as patellar component sizing or designs that result in patellofemoral stuffing; a shortened trochlear groove distance from the flange to the intercondylar box; and then surgical technique related issues resulting in: Lateral patellar facet syndrome; overstuffed patella/flange combination; asymmetric patellar resurfacing, improper transverse plane component rotation resulting in patellar subluxation/tilt. Any design consideration that allows impingement of extensor mechanism anatomical elements has the possibility of impacting outcome by becoming a pain generator. As the number of TKA procedures continues to increase, it is increasingly critical to develop improved, evidence based prostheses that maximize function and patient satisfaction while minimizing pain and other complications.

Deep Vein Thrombosis and Pulmonary Embolism Considerations in Orthopedic Surgery

Patients undergoing orthopedic surgery have an increased risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). These complications are considered detrimental, as they cause major postoperative morbidity and mortality and lead to a substantial health care burden. Because of the high incidence and serious nature of these complications, it is essential for orthopedic surgeons to have a comprehensive knowledge of the risk factors, diagnosis, and treatment of acute DVT and PE. Perioperative management of orthopedic patients to prevent postoperative DVT and PE and optimize postoperative outcomes is also discussed in this review.

Reimbursement Based on Value in Knee Surgery: What You Need to Know about the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015

Abstract Health care cost is consuming a large portion of the nations gross domestic product while placing added economic burdens on physicians and their patients. With total joint replacement being one of the early‐targeted procedures in the evolving health care environment, knee surgeons will benefit from developing a critical knowledge on health care reforms and their financial implications. The Medicare Access and Childrens Health Insurance Program Reauthorization Act represents a cohesive movement toward value‐based payment reform and contains several unchartered rulings that require detailed attention by knee surgeons. In this article, we provide a contextual framework of health care legislation that has led to the formation of the current health policy, and present a comprehensive summary and update on the Merit‐Based Incentive Payment Systems and Alternative Payment Models reimbursement models.

Perioperative Treatment of Patients with Rheumatoid Arthritis.

Rheumatoid arthritis is an autoimmune disease mediated by a widespread chronic systematic inflammatory process that causes joint deterioration, which leads to pain, disability, and poor quality of life. The increased use of disease-modifying antirheumatic drugs has been shown to markedly slow disease progression, which has translated into a decrease in the need for orthopaedic intervention in this population. However, a substantial percentage of patients with the disease fail optimal pharmacologic treatment and still require surgical intervention. A thorough understanding of medical considerations in these patients and improved knowledge of the medical complications caused by the disease process and the pharmacologic therapy used to treat it may lead to improved preoperative planning and medical clearance, which may ultimately improve the overall postoperative outcome.

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015: What’s New?

The Centers for Medicare and Medicaid Services (CMS) released its Final Rule on the Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization Act (MACRA) in November 2016. The Rule finalizes the details of the merit-based incentive payment system (MIPS) and the alternative payment model (APM), which will now collectively be referred to as the Quality Payment Program (QPP). This article offers the orthopaedic community a summary of the alterations in healthcare policy that will affect practices nationwide.

A Meta-Analysis Comparing All-Polyethylene Tibial Component to Metal-Backed Tibial Component in Total Knee Arthroplasty: Assessing Survivorship and Functional Outcomes

BACKGROUNDnThis meta-analysis compares the clinical performance of all-polyethylene tibial (APT) to the metal-backed tibial (MBT) components.nnnMETHODSnWe included comparative studies in primary total knee arthroplasty involving APT and MBT implant components. The primary outcomes were function, durability, and reports of adverse events.nnnRESULTSnTwenty-eight articles with 95xa0847 knees were available for synthesis. The meta-analysis showed an association of APT with lower revision rates (incidence rate ratio, 0.709; Pxa0=xa0.002) and adverse events (incidence rate ratio, 0.785; Pxa0=xa0.204). Moderator analyses were performed to determine the effect of posterior cruciate ligament status on outcome, and no statistically significant effect was found for revision risk or adverse events incidence.nnnCONCLUSIONnAll-polyethylene tibial components seem to be an equal option, with less financial burden than the MBT.

Outpatient Total Knee Arthroplasty: Are We There Yet? (Part 1)

Recent trends in total joint care have moved toward outpatient surgery. Total knee arthroplasty (TKA) remains a definitive management for end-stage osteoarthritis and has experienced increased utilization over the past several decades. The method by which surgeons conduct outpatient total knee procedures has yet to be fully elucidated as different institutions report different experiences from their pathways. This article will discuss current data and recommendations for implementing successful TKA and unicompartmental knee arthroplasty outpatient protocols. Specifically, this review will provide information regarding cost reduction, patient selection criteria, and preoperative medical optimization.

Rheumatoid Arthritis vs Osteoarthritis: Comparison of Demographics and Trends of Joint Replacement Data from the Nationwide Inpatient Sample

Current literature regarding complications following total joint arthroplasty have primarily focused on patients with osteoarthritis (OA), with less emphasis on the trends and in-hospital outcomes of rheumatoid arthritis (RA) patients undergoing these procedures. The purpose of this study is to analyze the outcomes and trends of RA patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) compared to OA patients. Data from the Nationwide Inpatient Sample from 2006 to 2011 was extracted using the International Classification of Diseases, Ninth Revision codes for patients that received a TKA or THA. Outcome measures included cardiovascular complications, cerebrovascular complications, pulmonary complications, wound dehiscence, and infection. Inpatient and hospital demographics including primary diagnosis, age, gender, primary payer, hospital teaching status, Charlson Comorbidity Index score, hospital bed size, location, and median household income were analyzed. Logistic regression analysis of OA vs RA patients with patient outcomes revealed that osteoarthritic THA candidates had lower risk for cardiovascular complications, pulmonary complications, wound dehiscence, infections, and systemic complications, compared to rheumatoid patients. There was a significantly elevated risk of cerebrovascular complication in osteoarthritic THA compared to RA THA. OA patients undergoing TKA had significantly higher risk for cardiovascular and cerebrovascular complications. There were significant decreases in mechanical wounds, infection, and systemic complications in the OA TKA patients. RA patients are at higher risk for postoperative infection, wound dehiscence, and systemic complications after TKA and THA compared to OA patients. These findings highlight the importance of preoperative medical clearance and management to optimize RA patients and improve the postoperative outcomes.

Total Hip Arthroplasty in the Outpatient Setting: What You Need to Know (Part 1)

The method by which surgeons conduct outpatient total hip arthroplasty (THA) procedures has yet to be fully standardized. Careful examination of components involved in the preoperative phase of outpatient hip arthroplasty procedures may lead to improved outcomes. This article will discuss methods for implementing successful outpatient THA protocols. Specifically it reviews information regarding patient selection criteria, preoperative education, and preoperative medical optimization.

Applications of Tissue Engineering in Joint Arthroplasty: Current Concepts Update

Research in tissue engineering has undoubtedly achieved significant milestones in recent years. Although it is being applied in several disciplines, tissue engineerings application is particularly advanced in orthopedic surgery and in degenerative joint diseases. The literature is full of remarkable findings and trials using tissue engineering in articular cartilage disease. With the vast and expanding knowledge, and with the variety of techniques available at hand, the authors aimed to review the current concepts and advances in the use of cell sources in articular cartilage tissue engineering.