Every month, JBJS publishes a review of the most pertinent and impactful studies from the orthopaedic literature during the previous year in 14 subspecialty areas. Click here for a collection of all such OrthoBuzz Guest Editorial summaries.
This month, Matthew R. Schmitz, MD, JBJS Deputy Editor for Social Media, selected the most clinically compelling findings from among the >50 studies highlighted in the most recent “What’s New in Hip Replacement.”
Preoperative Opioid Usage
–In a matched-control analysis of 42,097 Medicare patients who underwent primary total hip arthroplasty (THA) between 2005 and 2014, patients with opioid use disorder were at higher risk of developing periprosthetic joint infections and having 90-day readmissions, and incurred higher 90-day costs, compared with controls1.
Prior Hip Arthroscopy
–One recent study investigated whether prior hip arthroscopy affects patient-reported outcomes of THA performed later. Using data from the Swedish Hip Arthroplasty Registry, the authors compared 135 patients who had undergone failed hip arthroscopy and underwent conversion to THA and 540 age-matched controls2. At 1-year follow-up, the 2 groups did not differ in terms of hip pain and reported satisfaction.
Surgeon Age as a Risk Factor
–Evaluating 122,043 THAs performed by 298 surgeons, the authors of a propensity-matched cohort study found that middle-aged surgeons (45 to 55 years of age) had the lowest complication rate, while younger surgeons had a higher risk of composite complications, revision, and infection3. Among older surgeons, volume was more important than age in determining the complication rate.
Virtual Clinic Visits
–Virtual follow-up for hip and knee arthroplasty patients was found to be an effective alternative to in-person clinic assessment in a recent investigation including 1,749 patients seen in a virtual visit between January 2017 and December 20184. For the 1-year postoperative visit and routine scheduled follow-up visits, only 7.22% of the patients required a further in-person evaluation, and 82.99% of the patients reported being satisfied or very satisfied with virtual follow-up.
Robotic-Assisted THA
–Investigators examined the question of whether robotic-assisted THA improves outcomes in a recent study of 1,960 consecutive THAs (135 robotic-assisted, 896 navigation-assisted, and 929 with conventionally placed implants)5. No clinically important differences in patient-reported outcome measures were found at 1 and 2 years. The surgical time for the robotics group (119.61 minutes) was significantly greater than that for the navigation group (90.35 minutes) and the conventional group (95.35 minutes).
References
- Vakharia RM, Sabeh KG, Sodhi N, Naziri Q, Mont MA, Roche MW. Implant-related complications among patients with opioid use disorder following primary total hip arthroplasty: a matched-control analysis of 42,097 Medicare patients. J Arthroplasty. 2020 Jan;35(1):178-81. Epub 2019 Aug 7.
- Lindman I, Nåtman J, Öhlin A, Svensson Malchau K, Karlsson L, Mohaddes M, Rolfson O, Sansone M. Prior hip arthroscopy does not affect 1-year patient-reported outcomes following total hip arthroplasty: a register-based matched case-control study of 675 patients. Acta Orthop. 2021 Feb 10:1-5. [Epub ahead of print].
- Matar HE, Jenkinson R, Pincus D, Satkunasivam R, Paterson JM, Ravi B. The association between surgeon age and early surgical complications of elective total hip arthroplasty: propensity-matched cohort study (122,043 patients). J Arthroplasty. 2021 Feb;36(2):579-85. Epub 2020 Aug 22.
- El Ashmawy AH, Dowson K, El-Bakoury A, Hosny HAH, Yarlagadda R, Keenan J. Effectiveness, patient satisfaction, and cost reduction of virtual joint replacement clinic follow-up of hip and knee arthroplasty. J Arthroplasty. 2021 Mar;36(3):816-822.e1. Epub 2020 Aug 15.
- Singh V, Realyvasquez J, Simcox T, Rozell JC, Schwarzkopf R, Davidovitch RI. Robotics versus navigation versus conventional total hip arthroplasty: does the use of technology yield superior outcomes? J Arthroplasty. 2021 Mar 5. [Epub ahead of print].