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Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_9 | Pages 20 - 20
1 Oct 2020
Gazgalis A Neuwirth AL Shah R Cooper HJ Geller JA
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Introduction

Both mobile bearing and fixed bearing unicompartmental knee arthroplasty (UKA) have demonstrated clinical success. However, much debate persists about the superiority of a single design. Currently most clinical data is based on high volume centers data, however to reduce bias, we undertook a through review of retrospective national joint registries. In this study, we aim to investigate UKA implant utilization and survivorship between 2000 and 2018.

Methods

Ten annual joint registry reports of various nations were reviewed. Due to the variable statistical methods of reporting implant use and survivorship we focused on three registries: Australia (AOANJRR), New Zealand (NZJR), United Kingdom (NJR) for uniformity. We evaluated UKA usage, survivorship, utilization and revision rates for each implant. Implant survivorship was reported in the registries and was compared within nations due to variation in statistical reporting.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_11 | Pages 11 - 11
1 Oct 2019
Held MB Grosso MJ Gazgalis A Sarpong NO Jennings E Shah RP Cooper HJ Geller JA
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Introduction

Robotic-assisted total knee arthroplasty (TKA) was introduced to improve limb alignment, component positioning, and soft-tissue balance, yet the effect of adoption of this technology has not been established. This study was designed to evaluate whether robotic-assisted TKA leads to improved patient reported outcome measures (PROMs) and patient satisfaction as compared to conventional TKA at 3 and 12 months.

Methods

This IRB-approved single-surgeon retrospective cohort analysis of prospectively collected data compared 113 conventional TKA patients with 145 imageless robotic-assisted TKA patients (Navio™ Surgical System, Smith&Nephew®, Memphis TN). Basic demographic information, intraoperative and postoperative data, and PROMs (SF-P, SF-M, WOMAC pain, WOMAC stiffness, WOMAC Physical Function, KSS) were collected and recorded preoperatively, at 3 months, and at 12 months following surgery. Range of motion (ROM), blood loss, surgical duration, and complication rates between groups were also collected. Continuous measures such as mean difference in PROMs and ROM were compared using unpaired t-tests. Categorical measures such as the percentage of patients with complications were compared using chi-square analysis.


Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_12 | Pages 25 - 25
1 Oct 2018
Geller JA Sarpong NO Grosso M Lakra A Jennings E Heller MS Shah RP Cooper HJ
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Introduction

The success of total knee arthroplasty (TKA) necessitates precise osteotomies and soft tissue balancing to realign the lower extremity to a neutral mechanical axis. While technological advances have facilitated precise osteotomies, soft tissue balancing has traditionally relied mostly on surgeons’ subjective and variable tactile feedback. As soft tissue imbalance accounts for 35% of early TKA revisions in North America, we aimed to compare outcomes when TKA was balanced free-hand versus a sensor-guided balancing device (VERASENSE, OrthoSensor, Inc (Dania, FL)).

Methods

In a randomized-controlled fashion, patients underwent primary TKA soft tissue balancing either free-hand or with VERASENSE (Orthosensor Inc, Dania FL) at our institution beginning January 2018. With VERASENSE, soft-tissue balancing is considered when the pressure difference between the medial and lateral knee compartments was less than 15 pounds. Data regarding patient-reported outcomes, knee range of motion (ROM), pain level, opioid consumption, inpatient ambulation distance, length of stay (LOS), and incidence of arthrofibrosis was collected and analyzed in a two-year minimum follow-up and target patient goal of 120 patients.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 151 - 151
1 Mar 2010
Nellans KW Yoon RS Kim AD Jacobs M Geller JA Macaulay W
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Introduction: Ranked as the second most common cause of long-term disability amongst American adults, osteoarthritis (OA) affects well over 60 million Americans per year. OA is one of the major contributors to health care-related economic cost in the US, which is generally considered unacceptably high when compared other Western industrialized nations.

Methods: Three hundred and thirty-five patients undergoing primary unilateral or bilateral total hip arthroplasty (THA), metal-on-metal hip resurfacing (MOMHR), total knee arthroplasty (TKA), or unicondylar knee arthroplasty (UKA) were offered voluntary participation in an one-on-one preoperative education session with a pre-operative educator. Length of stay (LOS) and in-patient costs was collected for patients who received individual pre-operative education. This was then compared to patients who chose not to participate in the education sessions using linear regression models.

Results: Patients who chose to participate enjoyed a significantly shorter LOS than those who did not receive education, controlling for age, sex, type of procedure, and number of co-morbid conditions (3.1 ± 1.1 vs. 4.5 ± 4.7; p< 0.01). THA patients participating in the preoperative education program exhibited a calculated cost savings of $861 per case over non-educated patients (p=0.06), while TKA patients participating in the program exhibited a statistically significant savings of $1,144 per case (p=0.02). This translated into a cost savings of $84,351 for 93 THA patients and $93,493 for 74 TKA patients at our institution, accounting for the cost of the patient educator. Of higher significant impact on cost savings was the number of co-morbid conditions for both THA (p=0.01) and TKA (p=0.01) patients. If applied in the national setting, national cost savings projections for a mean 0.84 day reduction in LOS for educated THA patients estimated a savings of nearly $800 million; a mean 0.56 day reduction for preoperatively educated TKA translated into a projected savings of $1.1 billion on the national scale.

Conclusion: Preoperative education in the setting of hip and knee arthroplasty is an important cost-savings tool for hospitals, Medicare and third party payers in this era of rising health care costs.