Nipun Sodhi

Association Between Body Mass Index and Thirty-Day Complications After Total Knee Arthroplasty

BACKGROUNDnAlthough previous studies have evaluated the effect of obesity on the outcomes of total knee arthroplasty (TKA), most considered obesity as a binary variable. It is important to compare different weight categories and consider body mass index (BMI) as a continuous variable to understand the effects of obesity across the entire range of BMI. Therefore, the objective of this study is to analyze the effect of BMI on 30-day readmissions and complications after TKA, considering BMI as both a categorical and a continuous variable.nnnMETHODSnThe National Surgical Quality Improvement Project database was queried from 2011 to 2015 to identify 150,934 primary TKAs. Thirty-day rates of readmissions, reoperations, and medical/surgical complications were compared between different weight categories (overweight: BMI >25 and ≤30 kg/m2; obese: BMI >30 and ≤40 kg/m2; morbidly obese: BMI >40 kg/m2) and the normal weight category (BMI >18.5 and ≤25 kg/m2) using multivariate regression models. Spline regression models were created to study BMI as a continuous variable.nnnRESULTSnObese patients were at increased risk of pulmonary embolism (PE) (P < .001), while morbidly obese patients were at increased risk of readmission (P < .001), reoperation (P < .001), superficial infection (P < .001), periprosthetic joint infection (P < .001), wound dehiscence (P < .001), PE (P < .001), urinary tract infection (Pxa0= .003), reintubation (Pxa0= .004), and renal insufficiency (P < .001). Transfusion was lower in overweight (P < .001), obese (P < .001), and morbidly obese (P < .001) patients. BMI had a nonlinear relationship with readmission (P < .001), reoperation (P < .001), periprosthetic joint infection (Pxa0= .041), PE (P < .001), renal insufficiency (Pxa0= .046), and transfusion (P < .001).nnnCONCLUSIONnObesity increased the risk of readmission and various complications after TKA, with the risk being dependent on the severity of obesity. Relationships between BMI and complications showed considerable variations with some outcomes like readmission and reoperation showing a U-shaped relationship. Based on our findings, a potential BMI goal in weight management for obese patients could be established around 29-30 kg/m2, in order to decrease the risk of most TKA postoperative complications.

No Correlation Between Press Ganey Survey Responses and Outcomes in Post–Total Hip Arthroplasty Patients

BACKGROUNDnIn the era of the online orthopedic market, patients tend to equate publicly available online satisfaction surveys with what they presume their ultimate surgical outcome will be. Therefore, the purpose of this study was to assess whether there is a correlation between Press Ganey (PG) scores and (1) Hip Western Ontario and McMaster Universities Osteoarthritis Index and Harris Hip Score; (2) Short Form-12 and Short Form-36 scores; (3) University of California Los Angeles and Visual Analog Scale scores assessed at a mean of 3 years (range, 1 to 6 years) after surgery. In addition, we assessed whether (4) these correlations persist in patients who were evaluated under 2 years and 3 or more years after surgery.nnnMETHODSnSix-hundred ninety-two patients from November 2009 to January 2015 were identified from our institutional PG database. One-hundred ninety (27%) responded to the survey. One-hundred forty-nine (78%) patients were given the total hip arthroplasty assessment tools at a minimum of 2-year follow-up, and 33 patients (17%) completed their survey before 2 years after surgery. We assessed whether overall hospital rating scores correlated with the above assessment tools.nnnRESULTSnPearson correlation analysis revealed no correlation between the PG survey score and the assessment tools. HHS had the highest correlation coefficient (rxa0= .120; Pxa0= .316); however, this was not significant. After removing the patients who had their follow-up survey administered under 2 years after surgery (33 patients), there was still no statistically significant correlation between the above-mentioned outcome scores and PG overall hospital rating (P > .05).nnnCONCLUSIONnNo statistically significant relationship was found between commonly used total hip arthroplasty assessment tools and the PG overall hospital rating. Based on these results, PG surveys may not be a suitable implementation of the Center for Medicare and Medicaid services. A set of measures that can be widely collected and reported by hospitals for patients to use in order to evaluate hip arthroplasty outcomes needs to be developed. These results are of paramount importance, indicating a necessary reevaluation of PG surveys as a major determinant for reimbursements rendered by orthopedists and their use by patients.

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

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.

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

&NA; Robotic arm‐assisted total knee arthroplasty (RATKA) presents a potential, new added value for orthopedic surgeons. In todays health care system, a major determinant of value can be assessed by patient satisfaction scores. Therefore, the purpose of the study was to analyze patient satisfaction outcomes between RATKA and manual total knee arthroplasty (TKA). Specifically, we used the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to compare (1) pain scores, (2) physical function scores, and (3) total patient satisfaction outcomes in manual and RATKA patients at 6 months postoperatively. In this study, 28 cemented RATKAs performed by a single orthopedic surgeon at a high‐volume institution were analyzed. The first 7 days were considered as an adjustment period along the learning curve. Twenty consecutive cemented RATKAs were matched and compared with 20 consecutive cemented manual TKAs performed immediately. Patients were administered a WOMAC satisfaction survey at 6 months postoperatively. Satisfaction scores between the two cohorts were compared and the data were analyzed using Students t‐tests. A p‐value < 0.05 was used to determine statistical significance. The mean pain score, standard deviation (SD), and range for the manual and robotic cohorts were 5 ± 3 (range: 0–10) and 3 ± 3 (range: 0–8, p < 0.05), respectively. The mean physical function score, SD, and range for the manual and robotic cohorts were 9 ± 5 (range: 0–17) and 4 ± 5 (range, 0–14, p = 0.055), respectively. The mean total patient satisfaction score, SD, and range for the manual and robotic cohorts were 14 points (range: 0–27 points, SD: ± 8) and 7 ± 8 points (range: 0–22 points, p < 0.05), respectively. The results from this study further highlight the potential of this new surgical tool to improve short‐term pain, physical function, and total satisfaction scores. Therefore, it appears that patients who undergo RATKA can expect better short‐term outcomes when compared with patients who undergo manual TKA.

Are We Appropriately Compensated by Relative Value Units for Primary vs Revision Total Hip Arthroplasty

BACKGROUNDnRelative value units (RVUs) are used to evaluate the effort required for providing a service to patients in order to determine compensation. Thus, more complicated cases, like revision arthroplasty cases, should yield a greater compensation. However, there are limited data comparing RVUs to the time required to complete the service. Therefore, the purpose of this study is to compare the (1) mean RVUs, (2) mean operative times, and (3) mean RVU/minute between primary and revision total hip arthroplasty (THA) and (4) perform an individualized idealized surgeon annual cost difference analysis.nnnMETHODSnA total of 103,702 patients who underwent primary (current procedural terminology code 27130) and 7273 patients who underwent revision THA (current procedural terminology code 27134) were identified using the National Surgical Quality Improvement Program database. Mean RVUs, operative times (minutes), and RVU/minute were calculated and compared using Student t-test. Dollar amount per minute, per case, per day, and year was calculated to find an individualized idealized surgeon annual cost difference.nnnRESULTSnThe mean RVU was 21.24 ± 0.53 (range, 20.72-21.79) for primary and 30.27 ± 0.03 (range, 30.13-30.28) for revision THA (P < .001). The mean operative time for primary THA was 94 ± 38xa0minutes (range, 30-480xa0minutes) and 152 ± 75xa0minutes (range, 30-475xa0minutes) for revision THA (P < .001). The mean RVU/minute was 0.260 ± 0.10 (range, 0.04-0.73) for primary and 0.249 ± 0.12 (range, 0.06-1.0) for revision cases (P < .001). The dollar amounts calculated for primary vs revision THA were as follows: per minute (

Difficult Cases in Robotic Arm-Assisted Total Knee Arthroplasty: A Case Series

9.33 vs

A Comparison of Relative Value Units in Primary Versus Revision Total Knee Arthroplasty

8.93), per case (

Have the annual trends of total hip arthroplasty in rheumatoid arthritis patients decreased

877.12 vs

The Association Between Readmission and Patient Experience in a Total Hip Arthroplasty Population

1358.32), per day (

The Impact of Spino-pelvic Alignment on Total Hip Arthroplasty Outcomes; A Critical Analysis of Current Evidence

6139.84 vs