Muscle strength and knee range of motion after femoral lengthening: 2- to 5-year follow-up

Background and purpose — Femoral lengthening may result in decrease in knee range of motion (ROM) and quadriceps and hamstring muscle weakness. We evaluated preoperative and postoperative knee ROM, hamstring muscle strength, and quadriceps muscle strength in a diverse group of patients undergoing femoral lengthening. We hypothesized that lengthening would not result in a significant change in knee ROM or muscle strength. Patients and methods — This prospective study of 48 patients (mean age 27 (9–60) years) compared ROM and muscle strength before and after femoral lengthening. Patient age, amount of lengthening, percent lengthening, level of osteotomy, fixation time, and method of lengthening were also evaluated regarding knee ROM and strength. The average length of follow-up was 2.9 (2.0–4.7) years. Results — Mean amount of lengthening was 5.2 (2.4–11.0) cm. The difference between preoperative and final knee flexion ROM was 2° for the overall group. Congenital shortening cases lost an average of 5% or 6° of terminal knee flexion, developmental cases lost an average of 3% or 4°, and posttraumatic cases regained all motion. The difference in quadriceps strength at 45° preoperatively and after lengthening was not statistically or clinically significant (2.7 Nm; p = 0.06). Age, amount of lengthening, percent lengthening, osteotomy level, fixation time, and lengthening method had no statistically significant influence on knee ROM or quadriceps strength at final follow-up. Interpretation — Most variables had no effect on ROM or strength, and higher age did not appear to be a limiting factor for femoral lengthening. Patients with congenital causes were most affected in terms of knee flexion

Health Policy Views and Political Advocacy of Arthroplasty Surgeons: A Survey of the American Association of Hip and Knee Surgeons Members

BACKGROUND: The American Association of Hip and Knee Surgeons (AAHKS) is the largest specialty society for arthroplasty surgeons in the United States and is dedicated to education, research, and advocacy. The purpose of this study was to identify the health policy views of AAHKS members and better characterize their advocacy participation. METHODS: A 22 question survey was electronically distributed multiple times via email link to all 3,638 US members of AAHKS who were in practice or training in 2022. Study results were analyzed using descriptive statistics. RESULTS: There were 311 responses (9%), with 18% of respondents being within 5 years of practice and 38% having more than 20 years in practice. Respondents identified as Republicans (40%), Independents (37%), and Democrats (21%). Top policy issues included preserving physician reimbursement and equitable fee schedule representation (95%), the burden of prior authorization (53%), the impact of Center of Medicare and Medicaid Services regulations (39%), and medical liability and tort reform (39%). Members ranked maintaining appropriate physician reimbursement (44%) and advocating for patients (37%) as the top benefits to participation in advocacy. A majority of respondents (81%) stated that they spend more time on pre-surgery optimization now than 10 years ago. The most common barrier to advocacy participation was a lack of time (77%). CONCLUSION: Responding AAHKS members are well-informed, politically engaged, patient-oriented, and eager for a voice in policy decisions that affect the professional future of arthroplasty surgeons. These results can be used to help direct strategic efforts of the AAHKS Advocacy Committee to further increase advocacy efforts

Oncology patients incur significantly higher costs under the current bundled payment model for total joint replacement

Introduction: In 2016, the Centers for Medicare and Medicaid Services (CMS) implemented the Comprehensive Care for Joint Replacement (CJR) model, a bundled payment system which requires hospitals to account for the cost and quality of a 90-day episode of care. The objective of this study was to compare costs in patients enrolled in the CJR model undergoing joint replacement for local hip or knee tumors versus primary osteoarthritis. Methods: We performed a retrospective review of bundle-eligible patients undergoing joint replacement for local tumor or osteoarthritis at OHSU from 2016-2018. Abstracted chart data included age, BMI, smoking status, and medical comorbidities. Hospital cost data was provided by OHSU financial services. Rates of reimbursement were provided by CMS. We compared costs between groups using two-tailed t-tests. We created a linear regression model with a log-link to adjust for covariates. Results: 370 patients met inclusion criteria; 15 had a joint replacement for primary or metastatic tumor, and 355 for osteoarthritis. Mean hospital costs were significantly higher in tumor patients ($37,152 vs$16,824, p\u3c0.001). The inclusion of other covariates including gender, age, obesity, diabetes, smoking, and bleeding disorders did not alter the statistical significance of the association between oncologic diagnosis and higher costs. Conclusion: Oncology patients enrolled in the CJR bundle incur significantly higher costs than patients with primary osteoarthritis. As costs associated with these patients exceed the CJR reimbursement, we recommend that oncology patients be excluded from the CJR bundle