Abstract:
BACKGROUND:Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differences are largely uncharacterized, and the Medicare Severity Diagnosis-Related Groups system does not distinguish between THA performed for fracture and OA. QUESTIONS/PURPOSES:(1) What are the differences in in-hospital and 30-day postoperative clinical outcomes for THA performed for femoral neck fracture versus OA? (2) Is a patient's fracture status, that is whether or not a patient has a femoral neck fracture, associated with differences in in-hospital and 30-day postoperative clinical outcomes after THA? METHODS:The National Surgical Quality Improvement Program (NSQIP) database, which contains outcomes for surgical patients up to 30 days after discharge, was used to identify patients undergoing THA for OA and femoral neck fracture. OA and fracture cohorts were matched one-to-one using propensity scores based on age, gender, American Society of Anesthesiologists grade, and medical comorbidities. Propensity scores represented the conditional probabilities for each patient having a femoral neck fracture based on their individual characteristics, excluding their actual fracture status. Outcomes of interest included operative time, length of stay (LOS), complications, transfusion, discharge destination, and readmission. There were 42,692 patients identified (41,739 OA; 953 femoral neck fractures) with 953 patients in each group for the matched analysis. RESULTS:For patients with fracture, operative times were slightly longer (98 versus 92 minutes, p = 0.015), they experienced longer LOS (6 versus 4 days, p < 0.001), and the overall frequency of complications was greater compared with patients with OA (16% versus 6%, p < 0.001). Although the frequency of preoperative transfusions was higher in the fracture group (2.0% versus 0.2%, p = 0.002), the frequency of postoperative transfusion was not different between groups (27% versus 24%, p = 0.157). Having a femoral neck fracture versus OA was strongly associated with any postoperative complication (odds ratio [OR], 2.8; 95% confidence interval [CI], 2.1-3.8]; p < 0.001), unplanned readmission (OR, 1.8; 95% CI, 1.0-3.2; p = 0.049), and discharge to an inpatient facility (OR, 1.7; 95% CI, 1.4-2.0; p < 0.001). CONCLUSIONS:Compared with THA for OA, THA for femoral neck fracture is associated with greater rates of complications, longer LOS, more likely discharge to continued inpatient care, and higher rates of unplanned readmission. This implies higher resource utilization for patients with a fracture. These differences exist despite matching of other preoperative risk factors. As healthcare reimbursement moves toward bundled payment models, it would seem important to differentiate patients and procedures based on the resource utilization they represent to healthcare systems. These results show different expected resource utilization in these two fundamentally different groups of patients undergoing hip arthroplasty, suggesting a need to modify healthcare policy to maintain access to THA for all patients. LEVEL OF EVIDENCE:Level III, therapeutic study.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Schairer WW,Lane JM,Halsey DA,Iorio R,Padgett DE,McLawhorn ASdoi
10.1007/s11999-016-4868-2subject
Has Abstractpub_date
2017-02-01 00:00:00pages
353-360issue
2eissn
0009-921Xissn
1528-1132pii
10.1007/s11999-016-4868-2journal_volume
475pub_type
杂志文章abstract::A quantitative three-dimensional measurement method, radiographic stereophotogrammetry (SPG), was employed to assess the relation between early subsidence of the femoral prosthesis after total hip arthroplasty (THA) and subsequent clinical course. The SPG technique and the authors' error control mechanisms are describ...
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:UNLABELLED:There are many causes of total knee arthroplasty failure, and an accurate preoperative diagnosis is essential to optimize the results of revision surgery. We discuss our standard pre-operative evaluation routine and we retrospectively reviewed the last 295 patients who underwent revision total knee arthropla...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000218727.14097.d5
更新日期:2006-05-01 00:00:00
abstract::The authors retrospectively reviewed 29 hip and 13 knee arthroplasties performed in 17 adolescents and young adults from 1973 through 1979. Most patients had severe multiple joint involvement; 16 had juvenile rheumatoid arthritis. Clinical and roentgenographic evaluations were performed before operation and at routine...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-10-01 00:00:00
abstract::The great toe is affected by many congenital and acquired conditions including arthritis, hallux valgus, and hallux rigidus and disease of the hallucal sesamoids. Many surgical procedures have been described for the treatment of these conditions. With the increased popularity of forefoot surgery comes the potential fo...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-200110000-00008
更新日期:2001-10-01 00:00:00
abstract::Forty-six hands of 23 cadavers (15 female and 8 male) were dissected to observe the patterns of distribution of the median nerve. The findings showed that in 33 hands the median nerve had a normal distribution of its branches. Also identified was the commonly recognized transligamentous variant, where the recurrent br...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1998-07-01 00:00:00
abstract::A series of 131 comminuted fractures of the femoral shaft in 123 patients were externally fixed by the ASIF plating method. Of the 126 fractures in 118 patients, that could be reviewed one to 3 years postoperatively, 115 of 92% presented a good functional result. The most common complication was a fatigue fracture of ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1979-01-01 00:00:00
abstract::In 1079 consecutive patients undergoing total hip arthroplasty between 1984 and 1992, complications of thromboembolic disease and related anticoagulation were reviewed for 6 months after hospital discharge, including cost data. Of 347 patients having venograms, 78 (22.5%) had positive results and 269 (77.5%) had negat...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1996-12-01 00:00:00
abstract::Periprosthetic osteolysis caused by wear debris released from the bearing surface of polyethylene components is the major problem in contemporary hip arthroplasty. Several types of metal on metal prostheses were developed in the 1960s, but by the mid 1970s they were completely displaced by polyethylene bearings. There...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/00003086-199608001-00003
更新日期:1996-08-01 00:00:00
abstract::Genu recurvatum deformities are unusual before total knee arthroplasty (TKA), occurring in less than 1% of patients. Because of its rarity, concern may exist regarding the recurrence of the deformity and the potential for instability after TKA. Recurvatum may be associated with a severe osseous deformity, including ge...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:10.1097/01.blo.0000092988.12414.18
更新日期:2003-11-01 00:00:00
abstract::A classification of tibial shaft fractures based on etiology, morphology, and clinical features is documented in a series of 291 fractures treated by AO/ASIF rigid internal fixation. The fractures were placed in nine main fracture groups, each with three subgroups according to location in the proximal, middle, or dist...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-09-01 00:00:00
abstract::Mature female rhesus monkeys were used to evaluate the effects of a one-year course of tetracycline (50 mg/kg/day, intramuscularly) on the formation, maturation, and mineralization of mandibular bone. The bones from the treated group contained normal concentrations of calcium (Ca), inorganic phosphorus (Pi), and hydro...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-11-01 00:00:00
abstract::Load-bearing porous-surfaced implants in dogs which failed were not incorporated by bone ingrowth. The implants were incorporated only by fibrous tissue ingrowth. Collagen fiber orientation within this fibrous tissue and Sharpey's fiber-like features at the interface between the fibrous tissue and a surrounding layer ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1981-05-01 00:00:00
abstract::Ankle pain after uncomplicated ankle fractures poses a diagnostic and therapeutic challenge, especially in joints that exhibit insignificant radiographic changes. Ankle joint arthroscopy has become an important diagnostic and therapeutic tool for such cases. Adhesion of the distal tibiofibular syndesmosis, as yet an u...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-04-01 00:00:00
abstract::The evaluation and treatment of elbow injuries in throwing athletics has been the topic of numerous articles. The intense and repetitive stresses placed on the elbow may, in rare instances, produce undisplaced olecranon stress fractures. Two cases are presented and the literature is reviewed to propose that the fractu...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1992-05-01 00:00:00
abstract::The effects of fluoride (20 mumol/L) and bovine bone extract (17 micrograms/ml) were determined on cultures of human bone cells, embryonic chick bone cells, and human skin fibroblasts. The incorporation of [3H]thymidine into DNA was measured 16 hours after the addition of factors. After three to five days treatment, T...
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::Two hundred sixteen patients were treated by a simplified unilateral posterior lumbar interbody fusion (U-PLIF) in which the disc was removed and replaced by bone. The disc was approached far laterally by removing two-thirds of the superior facet preserving most of the ligamentum flavum, removing the disc, decorticati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
abstract::Varus derotational osteotomy of the femur is designed to correct coxa valga and femoral anteversion which contribute to progressive hip subluxation and dislocation in certain cases of cerebral palsy. By the application of a careful preoperative evaluation, vigorous postoperative rehabilitation and treatment of complic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-06-01 00:00:00
abstract::Prompt diagnosis of proximal lower extremity deep vein thrombosis in outpatients is critical because of the risk of pulmonary embolism. Our purpose was to determine the accuracy of orthopaedists' clinical decisions regarding the diagnosis of proximal deep vein thrombosis in outpatients. A nationally representative ran...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000152599.53574.a5
更新日期:2005-03-01 00:00:00
abstract::Tumoral calcinosis is the deposition of calcium crystals and salts in the periarticular soft tissues. It commonly is seen as a complication of renal dialysis or in patients with a hereditary disposition. Occasionally, it is seen as an isolated condition with no known cause. Tumoral calcinosis usually affects adults an...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:2005-07-01 00:00:00
abstract:BACKGROUND:Radial head alignment is the key to determine elbow reduction after treatment of subluxations or Monteggia fractures. The radiocapitellar ratio (RCR) quantifies the degree of subluxation, by evaluating radial head alignment with the capitellum of the humerus; this ratio is reproducible when measured on true ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-013-3027-2
更新日期:2013-08-01 00:00:00
abstract::Our research group developed an implant retrieval program to study in vivo degradation of polyethylene. We now have evidence to support our hypothesis that degradation of radiation-sterilized polyethylene occurs in the body for not only historical gamma air sterilized liners, but also for conventional gamma inert ster...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000246547.18187.0b
更新日期:2006-12-01 00:00:00
abstract::Eight patients with osteochondritis dissecans of the talus were reviewed. The average followup was 17.6 months (range, 8-26 months). The mean age of the patients was 31.8 years (range, 22-42 years). All patients had a preoperative examination, magnetic resonance imaging, and radiologic classification of the lesion thr...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200202000-00021
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:Compared with conventional polyethylene, first-generation highly cross-linked polyethylenes have low wear, but controversy exists regarding their reduced mechanical strength and/or retained free radicals. Second-generation highly cross-linked polyethylenes have been developed to reduce wear, maintain mechani...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,多中心研究
doi:10.1007/s11999-011-2177-3
更新日期:2012-06-01 00:00:00
abstract::The dislocation rate of 3197 Charnley prostheses with 22 mm head in which the surgery was done between 1979 and 1991 in 2 orthopaedic centers was compared with that of 2875 Lubinus prostheses with 32 mm head in which the surgery was done between 1980 to 1991 in 3 other centers. A 1-year followup showed an equal rate o...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,多中心研究
doi:
更新日期:1996-12-01 00:00:00
abstract::In the overhand or throwing athlete, the shoulder is extremely vulnerable to injury due to the repetitive, high-energy forces. When these stresses are applied at a rate that exceeds that of tissue repair, progressive damage to the shoulder's stabilizing structures can occur. With continued throwing, the static restrai...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,评审
doi:
更新日期:1993-06-01 00:00:00
abstract::Despite widespread acceptance of total knee replacement surgery's clinical effectiveness, variation persists in long-term functional outcome. Our aim was to quantify the relative contributions of physical and emotional coexisting conditions to the variation in improvement in 12-month post-total knee replacement physic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000185447.43622.93
更新日期:2005-11-01 00:00:00
abstract::Seven patients with chronic osteomyelitis were treated by surgical debridement. Cefamandole was administered intravenously before surgery. During the debridement, cefamandole concentrations were measured in serum and necrotic bone. Although adequate levels of antibiotic were achieved in the serum, minimal or no concen...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-10-01 00:00:00
abstract:BACKGROUND:Total joint arthroplasty (TJA) has been identified as a procedure with substantial variations in inpatient and postacute care payments. Most studies in this area have focused primarily on the Medicare population and rarely have characterized the younger commercially insured populations. Understanding the inp...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-017-5444-0
更新日期:2017-11-01 00:00:00
abstract::The practice of medicine in rural Arizona has changed remarkably in 25 years. Although the delivery of care to the people of the San Carlos Apache Tribe has many challenges including geographic isolation and cultural differences, there are many rewards, such as knowing that some people would not receive care if the or...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200203000-00016
更新日期:2002-03-01 00:00:00
abstract::Orthopedic problems are an important feature of the adult, chronic or non-neuropathic form of Gaucher disease. Thirty-five South African patients have been investigated and of these 29 had significant skeletal complications. Twenty-one had nonspecific bone pains, 14 had episodes of pseudoosteomyelitis and 2 had acute ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1978-11-01 00:00:00