Transverse posterior wall acetabular fracture pattern is associated with increased risk of periprosthetic joint infection after conversion total hip arthroplasty.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. 18. J Am Acad Orthop Surg. 2022 Jun 1;30(11):e811-e821. doi: 10.5435/JAAOS-D-21-00946. Epub 2022 Feb 21. Effects of Hospital and Surgeon Volume on Patient Outcomes After Total Joint Arthroplasty: Reported From the American Joint Replacement Registry. Siddiqi A(1), Alamanda VK, Barrington JW, Chen AF, De A, Huddleston JI 3rd, Bozic KJ, Lewallen D, Piuzzi NS, Mullen K, Porter KR, Springer BD. Author information: (1)From the Division of Ortho Alliance NJ, Orthopedic Institute Brielle Orthopaedics, Manasquan, NJ (Siddiqi), the Department of Orthopedic Surgery, Hackensack Meridian School of Medicine, Nutley, NJ (Siddiqi), the Department of Orthopedic Surgery, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ (Siddiqi), the Department of Orthopedics, OrthoVirginia, Reston, VA (Alamanda), Plano Orthopedic and Sports Medicine Center, Plano, TX (Barrington), the Department of Orthopedic Surgery, Brigham and Woman's Hospital, Boston, MA (Chen), the American Joint Replacement Registry, American Academy of Orthopedic Surgeons, Chicago, IL (De, Mullen, and Porter), the Department of Orthopedic Surgery, Stanford, Redwood City, CA (Huddlesto), the Department of Orthopedic Surgery, Dell Medical School, The University of Texas at Austin, Austin, TX (Bozic), the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (Lewallen), the Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH (Piuzzi), and the Department of Orthopedics Atrium Musculoskeletal Institute (Springer), OrthoCarolina Hip and Knee Center, Charlotte, NC. BACKGROUND: The purpose of this study was to evaluate outcomes and complications because it relates to surgeon and hospital volume for patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) using the American Joint Replacement Registry from 2012 to 2017. METHODS: A retrospective study was conducted on Medicare-eligible cases of primary elective THAs and TKAs reported to the American Joint Replacement Registry database and was linked with the available Centers of Medicaid and Medicare Services claims and the National Death Index data from 2012 to 2017. Surgeon and hospital volume were defined separately based on the median annual number of anatomic-specific total arthroplasty procedures performed on patients of any age per surgeon and per hospital. Values were aggregated into separate surgeon and hospital volume tertile groupings and combined to create pairwise comparison surgeon/hospital volume groupings for hip and knee. RESULTS: Adjusted multivariable logistic regression analysis found low surgeon/low hospital volume to have the greatest association with all-cause revisions after THA (odds ratio [OR], 1.63, 95% confidence interval [CI], 1.41-1.89, P < 0.0001) and TKA (OR, 1.72, 95% CI, 1.44-2.06, P < 0.0001), early revisions because of periprosthetic joint infection after THA (OR, 2.50, 95% CI, 1.53-3.15, P < 0.0001) and TKA (OR, 2.18, 95% CI, 1.64-2.89, P < 0.0001), risk of early THA instability and dislocation (OR, 2.47, 95% CI, 1.77-3.46, P < 0.0001), and 90-day mortality after THA (OR, 1.72, 95% CI, 1.27-2.35, P = 0.0005) and TKA (OR, 1.47, 95% CI, 1.15-1.86, P = 0.002). CONCLUSION: Our findings demonstrate considerably greater THA and TKA complications when performed at low-volume hospitals by low-volume surgeons. Given the data from previous literature including this study, a continued push through healthcare policies and healthcare systems is warranted to direct THA and TKA procedures to high-volume centers by high-volume surgeons because of the evident decrease in complications and considerable costs associated with all-cause revisions, periprosthetic joint infection, instability, and 90-day mortality. LEVEL OF EVIDENCE: III. Copyright © 2022 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-21-00946