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David J Jacofsky, Paul Jawin, Geoff Walton, Lisa Fraser
Orthopedics, and especially total joint replacement (TJR), is growing in payer prominence due to large projected increases in volume. The unsustainability of the fee-for-service payment system has lead Centers for Medicare and Medicaid Services to employ new value and risk-based contracting strategies on a population health basis and on an episode of care basis, with programs such as the Bundled Payment for Care Improvement program and the Comprehensive Care for Joint Replacement program. These trends are forcing hospitals and physicians to align to improve quality and reduce costs through new structures such as Accountable Care Organizations, comanagement programs, and gainsharing...
November 4, 2016: Journal of Knee Surgery
J E Scott, J L Mathias, A C Kneebone, J Krishnan
Whether total joint replacement (TJR) patients are susceptible to postoperative cognitive dysfunction (POCD) remains unclear due to inconsistencies in research methodologies. Moreover, cognitive reserve may moderate the development of POCD after TJR, but has not been investigated in this context. The current study investigated POCD after TJR, and its relationship with cognitive reserve, using a more rigorous methodology than has previously been utilized. Fifty-three older adults (aged 50+) scheduled for TJR were assessed pre and post surgery (6 months)...
September 27, 2016: Journal of Clinical and Experimental Neuropsychology
D Thomas, P Knight, K White, M M Mencia
Objective: The number of patients requiring arthroplasty increases annually. Joint replacement surgery can improve a patient's (QOL) quality of life. The effectiveness of this care from a patient's own perspective assessed by patient reported outcome measures is just as important as the clinical measures. The aim of our study was to evaluate patients' satisfaction following total joint replacement procedures. Methods: A cross-sectional study was performed in a major regional hospital, (Port-of-Spain General Hospital, Trinidad)...
March 1, 2016: West Indian Medical Journal
Susan Nedza, Donald E Fry, Susan DesHarnais, Eric Spencer, Patrick Yep
OBJECTIVES: The Center for Medicare and Medicaid Services (CMS) is actively testing bundled payments models. This study sought to identify relevant details for 90-day post-discharge Emergency Department (ED) visits of Medicare beneficiaries following total joint replacement (TJR) surgery meeting eligibility for a CMS bundled payment program. METHODS: The CMS research identifiable file for the State of Texas for 2011-2012 was used to identify patients who underwent TJR...
September 9, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
DongMei He, XiuJuan Yang, FeiYu Wang, Chi Yang, MinJun Dong
Acute traumatic temporomandibular joint disc displacement (ATDD) and its sequelae are not familiar for most surgeons. This study is to discuss its sequelae in cases without disc reduction after failed conservative treatment. From 2010 to 2015, 26 patients with 34 joints were included in the study. All patients had at least 3 months conservative treatment. Their maximal incisor opening (MIO) was measured during follow-ups and MRI examination was used to check the condylar bone degeneration. The mean follow-up for conservative treatment after admission was 8...
2016: Scientific Reports
A Lotesto, M Miloro, L G Mercuri, C Sukotjo
The purpose of this study was to assess the number of alloplastic total temporomandibular joint replacement (TMJ TJR) devices implanted and the complications encountered by members of the American Society of Temporomandibular Joint Surgeons (ASTMJS). A questionnaire was developed using REDCap (Chicago, IL) and an on-line link was e-mailed four times over a 6-week period (February to March 2015) to all members of the ASTMJS. The questionnaire included eight questions related to the surgeon's TMJ TJR experience...
August 23, 2016: International Journal of Oral and Maxillofacial Surgery
P Fulín, D Pokorný, M Šlouf, M Nevoralová, T Vacková, J Dybal, N Kaspříková, I Landor
UNLABELLED: PURPOSE OF THE STUDY Ultrahigh molecular weight polyethylene (UHMWPE) is today the most frequently used bearing surface in total joint replacements (TJR) because of its properties, i.e., excellent biocompatibility, good mechanical and tribological performance and high wear resistance. UHMWPE liners are the most loaded TJR components and, therefore, their properties are decisive for TJR longevity. This study had three objectives: 1) to evaluate the oxidative degradation of explanted UHMWPE components; 2) to look for a statistically significant relationship between the extent of oxidative degradation and the durability of joint replacements; and 3) to investigate whether the durability of a TJR was related to the type of sterilisation used in manufacture...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Lauryn Samelko, Stefan Landgraeber, Kyron McAllister, Joshua Jacobs, Nadim J Hallab
Innate immune reactions to orthopedic implant debris are the primary cause of total joint replacement (TJR) failure over the long term (15-20 years). The role of pathogen associated pattern recognition receptors (i.e. TLRs) in regulating immune reactivity to metal implant particles remains controversial. Do different TLRs (i.e. TLR2 vs. TLR4) activated by their respective ligands in concert with metal implant debris elicit equivalent innate immune responses? In this investigation, our in vitro and in vivo data indicate that Gram-negative PAMPs are more pro-inflammatory than Gram-positive PAMPs...
July 14, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
David Gwynne-Jones, Ella Iosua
AIM: A key Government health target has been to increase access to elective surgery. Despite this, there is a growing concern about unmet demand and increasing numbers of patients are being declined elective surgery. This study aims to determine whether there has been an increase in the severity of osteoarthritis of the hip and knee in patients undergoing publicly-funded elective total joint replacement (TJR) and any increase in demand for TJR in Otago. METHOD: Demographic details and preoperative patient reported outcome scores (Oxford hip or knee score (OHS,OKS) and a reduced Western Ontario and McMaster Osteoarthritis Index (WOMAC) score (RWS) were collected prospectively in an historical cohort of patients undergoing total hip and knee replacement (THR, TKR) between 2006-2010...
2016: New Zealand Medical Journal
Johannes T H Nielen, Pieter J Emans, Pieter C Dagnelie, Annelies Boonen, Arief Lalmohamed, Anthonius de Boer, Bart J F van den Bemt, Frank de Vries
It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from osteoarthritis (OA) due to an increased body mass index (BMI), resulting in mechanical destruction of cartilage. However, previous studies have suggested a coexisting metabolic causality.To evaluate the risk of hip or knee replacement, as a proxy for severe OA, in patients with DM. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity.A population-based case-control study was performed, using the Clinical Practice Research Datalink (CPRD)...
May 2016: Medicine (Baltimore)
Uvoh Onoriobe, Michael Miloro, Cortino Sukotjo, Louis G Mercuri, Anthony Lotesto, Ransome Eke
PURPOSE: The purpose of this study is to provide a statistical projection of the number of alloplastic temporomandibular joint (TMJ) total joint replacements (TJRs) that will be performed in the United States through the year 2030. MATERIALS AND METHODS: The program directors of all 101 Commission on Dental Accreditation-accredited oral and maxillofacial surgery training programs in the United States were surveyed online by use of a questionnaire developed using Redcap (Chicago, IL) over a 6-week period (February 2015-March 2015)...
August 2016: Journal of Oral and Maxillofacial Surgery
Amy Yu, Christopher A Devine, Rachel G Kasdin, Mónica Orizondo, Wendy Perdomo, Aileen M Davis, Laura M Bogart, Jeffrey N Katz
BACKGROUND: Advanced osteoarthritis and total joint replacement (TJR) recovery are painful experiences and often prompt opioid use in developed countries. Physicians participating in the philanthropic medical mission Operation Walk Boston (OpWalk) to the Dominican Republic have observed that Dominican patients require substantially less opioid medication following TJR than US patients. We conducted a qualitative study to investigate approaches to pain management and expectations for postoperative recovery in patients with advanced arthritis undergoing TJR in the Dominican Republic...
May 17, 2016: BMC Musculoskeletal Disorders
Behnam Sharif, Jacek A Kopec, Hubert Wong, Aslam H Anis
OBJECTIVES: To estimate the distribution and drivers of the average direct cost of OA in Canada using a population-based health microsimulation model of osteoarthritis (POHEM-OA) from 2003 to 2010. METHODS: We used a previously published microsimulation model to estimate the distribution of average cost of OA across different cost components and OA stages. OA stages were defined according to the patient flow within the healthcare system. Cost components associated with pharmacological and non-pharmacological treatments, physician visits and hospitalization were included...
May 9, 2016: Arthritis Care & Research
Adéla Galandáková, Jitka Ulrichová, Kateřina Langová, Adéla Hanáková, Martin Vrbka, Martin Hartl, Jiri Gallo
Wear testing of total joint replacement (TJR) is mandatory in preclinical testing before implantation of TJR into the human body. Testing is governed by current international standards that recommend bovine serum (BS) as a lubricating fluid to replace synovial fluid (SF). Recently, the use of BS has been criticized because of differences in content, fluid characteristics, and nonhuman origin. As a result, a more realistic lubricant mimicking SF is needed. To define SF composition, we analyzed SF obtained during revisions of total hip and knee arthroplasties and compared it with SF obtained during primary arthroplasties and from patients without TJR...
April 18, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Emmanuel Gibon, Luis A Córdova, Laura Lu, Tzu-Hua Lin, Zhenyu Yao, Moussa Hamadouche, Stuart B Goodman
Novel evidence-based prosthetic designs and biomaterials facilitate the performance of highly successful joint replacement (JR) procedures. To achieve this goal, constructs must be durable, biomechanically sound, and avoid adverse local tissue reactions. Different biomaterials such as metals and their alloys, polymers, ceramics, and composites are currently used for JR implants. This review focuses on (1) the biological response to the different biomaterials used for TJR and (2) the chronic inflammatory and foreign-body response induced by byproducts of these biomaterials...
April 15, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Allan Villadsen
No abstract text is available yet for this article.
April 2016: Danish Medical Journal
Nathalie Clavel, Carolyn De Coster, Marie-Pascale Pomey, Claudia Sanmartin, Éric Bohm, Michael J Dunbar, C Y Frank, Gillian Hawker, Tom Noseworthy
BACKGROUND: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR. OBJECTIVE: While our previous research focused on the appropriateness of TJR from clinical and patient perspectives, this study is aimed at understanding decision-makers' perspectives...
February 2016: Healthcare Policy, Politiques de Santé
Catherine Riffin, Karl Pillemer, M Cary Reid, Judy Tung, Corinna E Lӧckenhoff
OBJECTIVES: The present study investigates age differences in the types of decision support that total joint replacement (TJR) candidates desire and receive when making the decision to pursue surgery. We consider the social structural (relationship to the patient) and experiential factors (network members' experience with TJR) that influence individuals' support preferences and the interactions of these factors with age. We also examine whether a lack of support is linked with increased decisional conflict and reduced willingness to undergo surgery...
March 11, 2016: Journals of Gerontology. Series B, Psychological Sciences and Social Sciences
Stephen Lyman, Yuo-Yu Lee, Patricia D Franklin, Wenjun Li, Michael B Cross, Douglas E Padgett
BACKGROUND: Medicare is rapidly moving toward using patient-reported outcome measures (PROMs) for outcomes assessment and justification of orthopaedic and other procedures. Numerous measures have been developed to study knee osteoarthritis (OA); however, many of these surveys are long, disruptive to clinic flow, and result in incomplete data capture and/or low followup rates. The Knee injury and Osteoarthritis Outcome (KOOS) physical function short-form (KOOS-PS), while shorter, ignores pain, which is a primary concern of patients with advanced knee OA...
June 2016: Clinical Orthopaedics and related Research
Stephen Lyman, Yuo-Yu Lee, Patricia D Franklin, Wenjun Li, David J Mayman, Douglas E Padgett
BACKGROUND: Patient-reported outcome measures (PROMs) are increasingly in demand for outcomes evaluation by hospitals, administrators, and policymakers. However, assessing total hip arthroplasty (THA) through such instruments is challenging because most existing measures of hip health are lengthy and/or proprietary. QUESTIONS/PURPOSES: The objective of this study was to derive a patient-relevant short-form survey based on the Hip disability and Osteoarthritis Outcome Score (HOOS), focusing specifically on outcomes after THA...
June 2016: Clinical Orthopaedics and related Research
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