Abstract：
BACKGROUND:Many patients change hospitals for revision total joint arthroplasty (TJA). The implications of changing hospitals must be better understood to inform appropriate utilization strategies. QUESTIONS/PURPOSES:(1) How frequently do patients change hospitals for revision TJA? (2) Which patient, community, and hospital characteristics are associated with changing hospitals? (3) Is there an increased complication risk after changing hospitals? METHODS:We identified 17,018 patients who underwent primary TJA and subsequent same-joint revision in New York or California (1997-2005) from statewide databases. Medicare was the most common payer (56%) followed by private insurance (31%). We identified patients who changed hospitals for revision TJA and those who experienced in-hospital complications. Patient, community, and hospital characteristics were analyzed to determine predictors for changing hospitals for revision TJA and the effect of changing hospitals on subsequent complications. RESULTS:Thirty percent of patients changed hospitals for revision. Older patients were less likely to change hospitals (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.73-0.96); no other patient characteristics were associated with changing hospitals. Patients who had index TJA at the highest-volume hospitals were less likely to change hospitals (OR, 0.52; 95% CI, 0.48-0.57). Overall, changing hospitals was associated with higher complication risk (OR, 1.19; 95% CI, 1.03-1.39). Changing to a lower-volume hospital (6% of patients undergoing revision TJA) was associated with a higher risk of complications (OR, 1.36; 95% CI, 1.05-1.74). A post hoc number needed-to-treat analysis indicates that 234 patients would need to be moved from a lower volume hospital to a higher volume hospital to avoid one overall complication event after revision TJA. CONCLUSIONS:Although the complication risk was higher if changing hospitals, this finding was sensitive to the type of change. Our findings build on the existing evidence of a volume-outcomes benefit for revision TJA by examining the effect of volume in view of potential patient migration. LEVEL OF EVIDENCE:Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Dy CJ,Bozic KJ,Padgett DE,Pan TJ,Marx RG,Lyman Sdoi
10.1007/s11999-014-3515-zsubject
Has Abstractpub_date
2014-07-01 00:00:00pages
2006-15issue
7eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章,多中心研究abstract：:Total hip arthroplasty (THA) or total knee arthroplasty (TKA) is indicated for patients with juvenile rheumatoid arthritis (JRA) when marked joint destruction is present and pain or deformity compromises function despite optimal medical therapy. Relief of pain, reduction of the deformity, and dramatic improvement in f...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1984-01-01 00:00:00
abstract：:A spectrum of medical problems, including self-limited acute mountain sickness, high-altitude retinopathy, and the potentially fatal high-altitude pulmonary and cerebral edemas, may afflict residents and sojourners at higher elevations. However, appropriate prevention and prompt recognition will minimize the impact of...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-03-01 00:00:00
abstract：BACKGROUND:Currently more than 200,000 THAs are performed annually in the United States. In patients with bilateral disease, the chance of subsequent contralateral THA reportedly ranges from 16% to 85%. Factors influencing contralateral THA are not completely understood. QUESTIONS/PURPOSES:We therefore determined (1) ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-2110-9
更新日期：2012-02-01 00:00:00
abstract：:One hundred twenty-one knees with medial compartment osteoarthrosis were treated by unicompartmental arthroplasty with the Oxford Knee. The strict selection criteria were (1) the presence of a functioning anterior cruciate ligament, (2) fully correctable deformity, and (3) full thickness of articular cartilage in the ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
abstract：:The authors review the structure and composition of articular cartilage. This tissue is composed of an extensive extracellular matrix synthesized by chondrocytes. It contains different zones with respect to depth from the articular surface and has a regional organization around the chondrocytes. Its composition varies...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/00003086-200110001-00004
更新日期：2001-10-01 00:00:00
abstract：BACKGROUND:Although gunshot injuries are relatively common, there is little consensus about whether retained bullets or bullet fragments should be removed routinely or only in selected circumstances. QUESTIONS/PURPOSES:We performed a systematic review of the literature to answer the following questions: (1) Is bullet ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1007/s11999-013-3260-8
更新日期：2013-12-01 00:00:00
abstract：:Metal backing of glenoid components for total shoulder replacements and the use of bony ingrowth surfaces on these components have recently been introduced. In this study, finite element analyses were performed to determine the stress fields in the natural glenoid and to calculate the change in bone stresses after imp...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-07-01 00:00:00
abstract：:Giant sacral schwannomas (GSS) are extremely rare. Complete resection of benign but neurologically devastating tumors has been recommended. A 48-year-old man with GSS had a tumor so large that a total sacrectomy was necessary. A special method of lumbar iliac fixation was devised. Two years and nine months after surge...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-09-01 00:00:00
abstract：:The clinical and metallurgical performance of 12 retrieved Noiles total knee prostheses was investigated. Clinical histories and serial roentgenograms were used in conjunction with the American Society for Testing and Materials (ASTM) standard implant retrieval and analysis techniques to assess device performance. All...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-03-01 00:00:00
abstract：:This study evaluates the role of magnetic resonance imaging in assessing the factors affecting the rate and healing time in scaphoid nonunions after surgery. Nineteen patients were assessed before surgery by radiographs, tomography, and magnetic resonance imaging. Fifteen had viable bone marrow and 4 patients had nonv...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199703000-00032
更新日期：1997-03-01 00:00:00
abstract：:Several extracellular matrices are formed by healing fractures, and the collagens within these matrices have been identified in rabbit and rat fracture models. Type III collagen is the major collagen of the fibrous matrix that forms along the periosteal surface. Type I collagen is secreted in large amounts as trabecul...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1990-06-01 00:00:00
abstract：:Medial meniscal anomalies are rare. The anterior horn insertion into the anterior cruciate ligament is the most common. In the course of an arthroscopy for torn lateral meniscus, an anomalous band in continuity with the posterior horn of the medial meniscus was observed to insert into the anterior cruciate ligament. A...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1998-03-01 00:00:00
abstract：:Long thought to be expendable or insignificant for function, the menisci may well be very important structures in the knee joint. Menisci are of critical importance from the standpoint of stability, shock absorption, load transmission, and lubrication, and also play a role in preventing synovial impingement, and in de...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1980-09-01 00:00:00
abstract：:A treatment program for chronic pain is reported which focuses on modification of patient pain behavior. After an outpatient pain clinic screening by a multidisciplinary team, the patient with chronic pain (duration of 6 months or longer) is admitted for a 7--8 week inpatient program followed by a 4-week outpatient pe...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-11-01 00:00:00
abstract：:Protrusio acetabuli is common is rheumatoid arthritis. Progression of this deformity can be measured by serial roentgenograms. The inward progression of the femoral head is the result of upward migration of the acetabular roof and collapse of the femoral head which appears to occur in a ratio of approximately two to o...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-197505000-00012
更新日期：1975-05-01 00:00:00
abstract：:From July 1984 through October 1987, 63 consecutive primary Porous Coated Anatomic total hip arthroplasties were performed. Follow-up observation ranged from one to four years, with a mean of 2.4 years. The mean postoperative Harris hip score in 81 cases was 38% excellent results, 23% good results, 6% fair results, an...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1992-05-01 00:00:00
abstract：:Thirty-two rabbits were used experimentally to study the effect of cortisone in bone, lungs, kidneys, and liver. Cortisone does induce abnormal increases in the serum cholesterol, fatty metamorphosis of the liver and the fatty emboli of the subchondral vessels of the femoral heads. Clofibrate therapy appeared to modif...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1978-01-01 00:00:00
abstract：BACKGROUND:The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known a...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999.0000000000000125
更新日期：2018-05-01 00:00:00
abstract：:An analysis of the patellofemoral joint based on experimental determinations of pressure distributions on the patellar cartilage and vectorial calculations is presented. The extension torque of all quadriceps muscles is similar. The force transmitted to the patella by the retinacula is small in all knee positions. Bec...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-09-01 00:00:00
abstract：:A model was developed to identify and compare the local wound factors that induce acute osteomyelitis in a prospective, controlled investigation. When compared with wounds containing either virulent bacteria or dead bone, statistical analysis disclosed a significant increase in the incidence of osteomyelitis when viru...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-01-01 00:00:00
abstract：:Spinal cord injury (SCI) results in multiple degenerative changes that may in part be related to physical inactivity. There are indications that some of these changes may be reversed by exercise and fitness training. Computerized functional electrical stimulation (FES) allows active exercise of limbs paralyzed by uppe...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-08-01 00:00:00
abstract：:This is a review of 13 patients with chronic osteomyelitis treated at the author's institution using techniques similar to the management of giant cell tumors of bone. This included aggressive serial debridements and appropriate antibiotic coverage and subsequent bone-grafting or soft-tissue coverage procedures. The n...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1994-01-01 00:00:00
abstract：:Degenerative changes in the spine, specifically disc degeneration and facet arthrosis, and osteoporosis are conditions that primarily affect the elderly and may significantly impact the quality of life. The relationship between osteoporosis and degenerative changes in the hip joint has been studied, but their correlat...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199603000-00017
更新日期：1996-03-01 00:00:00
abstract：:A new mouse osteopetrotic mutation, osteosclerosis, has been examined with respect to rickets. These osteopetrotic mice were hypocalcemic and hypophosphatemic, and had greatly thickened epiphyseal plates with abnormalities in matrix vesicles when compared with normal littermates. Such biochemic and morphologic manifes...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1985-12-01 00:00:00
abstract：BACKGROUND:The navigation system was introduced to orthopaedic surgery in the 1990s. More recently, CT-based navigation systems have been used more commonly in spine and joint replacement surgery because of their precision. QUESTIONS/PURPOSES:The aim of our study was to evaluate the accuracy and efficacy of navigation...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-2094-5
更新日期：2012-01-01 00:00:00
abstract：BACKGROUND:The os peroneum is a sesamoid bone in the peroneus longus tendon. Fractures of the os peroneum are rare. Some authors recommend surgery for active patients. CASE DESCRIPTION:A 41-year-old male professional tennis coach sustained a minimally displaced fracture of the os peroneum. He was treated with restrict...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1007/s11999-011-1812-3
更新日期：2011-05-01 00:00:00
abstract：:In 20 patients, the torn posterior cruciate ligament (PCL) was repaired without reinforcement within two weeks after injury. Fourteen patients had a midsubstance tear, and in six the ligament was avulsed from the femur without bone. There were 11 isolated and nine combined injuries. The follow-up period ranged from tw...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1991-06-01 00:00:00
abstract：:Progressive heterotopic ossification leads to ankylosis of the major joints in patients who have fibrodysplasia ossificans progressiva. Joint subluxation has not been recognized widely in patients with this disease. The clinical records and radiographs of 79 patients with fibrodysplasia ossificans progressiva were rev...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1998-01-01 00:00:00
abstract：BACKGROUND:A surgical site infection is a substantial cause of complications in patients. Different methods are being used to decrease surgical site infections; however, these infections still can cause complications, especially in patients undergoing longer operations (> 3 hours). There is evidence that the efficacy o...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-016-4832-1
更新日期：2016-07-01 00:00:00
abstract：:This Classic Article is a reprint of the original work by T. W. Huntington, Case of bone transference. Use of a segment of fibula to supply a defect in the tibia. An accompanying biographical sketch of T. W. Huntington is available at DOI 10.1007/s11999-012-2495-0 . The classic article is 1905 and is reprinted courtes...
journal_title：Clinical orthopaedics and related research
pub_type： 传,古典文章,历史文章,杂志文章
doi：10.1007/s11999-012-2496-z
更新日期：2012-10-01 00:00:00
