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Research Studies is a compilation of published research articles funded by ´óÏóÊÓƵor authored by ´óÏóÊÓƵresearchers.

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1 to 25 of 116 Research Studies Displayed
Ayers DC, Zheng H, Yang W
The Chitranjan S. Ranawat Award: Factors that predict outcome five years following total knee arthroplasty.
The purpose of this study was to identify factors that predict pain and functional outcomes five years after total knee replacement surgery. Researchers analyzed data from 3,688 patients who underwent primary unilateral total knee arthroplasty across multiple centers. They identified several independent predictors of pain outcomes at the five-year mark, including age, insurance status, race, comorbidity index, back pain, other painful joints, mental health status, and baseline pain scores. For functional outcomes, similar factors were significant, with additional influence from body mass index and physical health status. The researchers note that many identified factors are potentially modifiable, particularly musculoskeletal comorbidities, which could be addressed through preoperative optimization programs. These findings can guide surgeons and patients during shared decision-making conversations and help establish realistic expectations before surgery.
AHRQ-funded; HS018910.
Citation: Ayers DC, Zheng H, Yang W . The Chitranjan S. Ranawat Award: Factors that predict outcome five years following total knee arthroplasty. J Arthroplasty 2025 Jul; 40(7S1):S12-S19. doi: 10.1016/j.arth.2025.03.006..
Keywords: Orthopedics, Surgery, Outcomes, Arthritis, Pain
Churchill L, Graber J, Mealer M
Patient and clinician perceptions of a "people-like-me" tool for personalized rehabilitation after total knee arthroplasty: a qualitative interview study.
The purpose of this study was to evaluate perceptions of a decision support tool designed to personalize rehabilitation after knee replacement surgery. Researchers interviewed 16 patients who underwent total knee arthroplasty and 10 clinicians who used the tool during rehabilitation. Analysis revealed four common themes. Most participants felt the tool provided valuable feedback for managing recovery expectations. Both patients and clinicians reported the tool motivated participation in rehabilitation through positive reinforcement or friendly competition. While some participants indicated the tool helped guide treatment decisions or facilitated patient education, most felt it did not significantly influence clinical decision-making. Comprehension issues arose with percentiles, line graphs, and medical terminology for some patients. Overall, the tool was viewed positively for shaping recovery expectations and increasing patient motivation, though participants identified areas for improvement to accommodate varying health literacy levels and enhance clinical utility.
AHRQ-funded; HS025692.
Citation: Churchill L, Graber J, Mealer M . Patient and clinician perceptions of a "people-like-me" tool for personalized rehabilitation after total knee arthroplasty: a qualitative interview study. Phys Ther 2025 May 3; 105(5). doi: 10.1093/ptj/pzaf058..
Keywords: Orthopedics, Surgery, Clinical Decision Support (CDS), Health Information Technology (HIT)
Kim N, Jacobson M
The spillover effects of Medicare's comprehensive care for joint replacement (CJR) model in California.
This study’s objective was to determine the spillover effects of the Comprehensive Care for Joint Replacement (CJR) model on older patients in California covered outside of the traditional Medicare program. The CJR model is a bundled Medicare payment for lower extremity joint replacement (LEJR) and was initially randomized across the United States as an alternative payment model. The study analyzed hospitalizations for hips and knee joint replacement from the California Patient Discharge Dataset. Outcomes measured were hospital length of stay and home discharge rates. Of 312,914 analyzed LEJR hospitalizations, 36.3% were covered by traditional Medicare (TM), 26.6% were covered by Medicare Advantage (MA), and 37.1% were without Medicare coverage. After program implementation, TM and non-Medicare patients in treated hospitals experienced reductions in length of stay and TM, MA and non-Medicare patients in treated hospitals experienced increases in home discharge rates relative to patients in untreated hospitals. CJR also affected health care for non-targeted populations.
AHRQ-funded; HS026488.
Citation: Kim N, Jacobson M . The spillover effects of Medicare's comprehensive care for joint replacement (CJR) model in California. PLoS One 2025 Apr 17; 20(4):e0319582. doi: 10.1371/journal.pone.0319582.
Keywords: Medicare, Orthopedics, Surgery
Graber J, Hinrichs-Kinney LA, Churchill L
Implementation of a "People-Like-Me" tool for personalized rehabilitation after total knee arthroplasty: a mixed methods pilot study.
This study evaluated the implementation of a decision support tool promoting a "people-like-me" (PLM) approach to rehabilitation after total knee arthroplasty in two outpatient physical therapy clinics. Both clinics met most of the pre-specified implementation targets, but did not use the tool as frequently as intended. The authors discuss steps to take in future efforts to implement the PLM tool.
AHRQ-funded; HS025692.
Citation: Graber J, Hinrichs-Kinney LA, Churchill L . Implementation of a "People-Like-Me" tool for personalized rehabilitation after total knee arthroplasty: a mixed methods pilot study. J Eval Clin Pract 2025 Feb; 31(1):e70028. doi: 10.1111/jep.70028..
Keywords: Orthopedics, Surgery, Clinical Decision Support (CDS), Health Information Technology (HIT)
Mancuso CA, Duculan R, Cammisa FP
The influence of previous joint arthroplasty on fulfillment of patients' expectations of subsequent lumbar surgery.
The objective of this study was to analyze the association of previous arthroplasty with patients' postlumbar surgery fulfillment of expectations. The findings indicated that patients had less fulfillment of expectations with subsequent lumbar surgery. The authors concluded that surgeons should discuss potential differences between arthroplasty and lumbar surgery during preoperative evaluations and postoperative assessments.
AHRQ-funded; HS022913.
Citation: Mancuso CA, Duculan R, Cammisa FP . The influence of previous joint arthroplasty on fulfillment of patients' expectations of subsequent lumbar surgery. J Am Acad Orthop Surg 2025 Jan 15; 33(2):e93-e101. doi: 10.5435/jaaos-d-24-00124.
Keywords: Orthopedics, Surgery, Patient Experience, Back Health and Pain
Kilaru AS, Liao JM, Wang E
Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes.
This study’s objective was to determine whether mandatory participation by hospitals in bundled payments for lower extremity joint replacement (LEJR) was associated with changes in outcome disparities for patients dually eligible for Medicare and Medicaid. The authors used Medicare claims data for beneficiaries undergoing LEJR in the United States between 2011 and 2017. They conducted a retrospective observational study using a differences-in-differences method to compare changes in outcome disparities between dual-eligible and non-dual eligible beneficiaries after hospital participation in the Comprehensive Care for Joint Replacement (CJR) program, with the primary outcome LEJR complications. In adjusted analysis, CJR participation was associated with a reduced difference in complications between dual-eligible and non-dual-eligible beneficiaries (-0.9 percentage points). The reduction in disparities was observed among hospitals without prior experience in a voluntary LEJR bundled payment model, and there were no differential changes in 90-day readmissions or mortality.
AHRQ-funded; HS027595.
Citation: Kilaru AS, Liao JM, Wang E . Association between mandatory bundled payments and changes in socioeconomic disparities for joint replacement outcomes. Health Serv Res 2024 Oct; 59(5):e14369. doi: 10.1111/1475-6773.14369..
Keywords: Disparities, Orthopedics, Surgery, Payment, Outcomes, Social Determinants of Health
Kim N, Jacobson M
Outcomes by race and ethnicity following a Medicare bundled payment program for joint replacement.
The objective of this cohort study was to evaluate outcomes associated with the Comprehensive Care for Joint Replacement (CJR) model--a traditional Medicare bundled payment program for lower-extremity joint replacement--among Hispanic patients who were not enrolled in traditional Medicare. Three metropolitan statistical areas (MSAs) were randomly selected in California to participate in CJR. The results indicated that CJR program outcomes differed by race and ethnicity for patients outside traditional Medicare. The authors noted that these findings suggested the importance of considering differential outcomes of Medicare payment policies for racial and ethnic minority patient populations beyond the initially targeted groups.
AHRQ-funded; HS026488.
Citation: Kim N, Jacobson M . Outcomes by race and ethnicity following a Medicare bundled payment program for joint replacement. JAMA Netw Open 2024 Sep 3; 7(9):e2433962. doi: 10.1001/jamanetworkopen.2024.33962..
Keywords: Medicare, Payment, Surgery, Orthopedics, Racial and Ethnic Minorities
Dixit AA, Kim CY, Mariano ER
Hospital-level variability in regional nerve block administration by race for total knee arthroplasty.
To assess hospital-related racial disparities in the setting of anesthetic care, researchers studied whether hospitals with a higher proportion of black patients undergoing total knee arthroplasty (TKA) were less likely to provide nerve blocks. This retrospective cohort study used the Optum Clinformatics® Data Mart Database to create a national sample of patients aged 18 or older who underwent primary TKA. The results indicated that patients treated at hospitals with a higher proportion of black patients were significantly less likely to receive a regional nerve block for TKA, after adjusting for other patient characteristics. The researchers concluded that these findings implied that racial disparities in regional anesthesia may be partially driven by hospital-level factors.
AHRQ-funded; HS027795.
Citation: Dixit AA, Kim CY, Mariano ER . Hospital-level variability in regional nerve block administration by race for total knee arthroplasty. Reg Anesth Pain Med 2024 Sep 2; 49(9):692-94. doi: 10.1136/rapm-2022-104028..
Keywords: Pain, Surgery, Orthopedics, Racial and Ethnic Minorities
Zheng H, Ash AS, Yang W
Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort.
In 2027, the Centers for Medicare & Medicaid Services (CMS) will begin mandating Patient-reported outcome measures (PROMs) to assess the quality of total knee arthroplasty (TKA). Using data from a national cohort of primary unilateral TKA patients, the authors developed, tested, and enhanced a model closely following a CMS-proposed measure to predict substantial clinical benefit. Only the enhanced model predicted success accurately across the spectrum of baseline scores. Findings were virtually identical when analyses were replicated on patients over 65. The authors concluded that adding a baseline knee-specific PROM score to a quality measurement model in a nationally representative cohort dramatically improved its predictive power.
AHRQ-funded; HS018910.
Citation: Zheng H, Ash AS, Yang W . Strengthening quality measurement to predict success for total knee arthroplasty: results from a nationally representative total knee arthroplasty cohort. J Bone Joint Surg Am 2024 Apr 17; 106(8):708-15. doi: 10.2106/jbjs.23.00602..
Keywords: Quality Measures, Quality of Care, Orthopedics, Surgery, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research
Anderson KE, Wu RJ, Darden M
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
To discover whether Medicare Advantage enrollees have a lower utilization of elective surgical procedures such as inpatient hip and knee total joint arthroplasty (TJA), which have usually been covered by traditional Medicare without restrictions, researchers conducted a cross-sectional study comparing traditional Medicare claims and Medicare Advantage encounter records for enrollees aged 65-85. Their results showed a lower incidence of TJA in Medicare Advantage enrollees. The interval from initial diagnosis to contact with an orthopedic surgeon and to the surgical procedure were shorter among traditional enrollees.
AHRQ-funded; HS000029.
Citation: Anderson KE, Wu RJ, Darden M . Medicare Advantage is associated with lower utilization of total joint arthroplasty. J Bone Joint Surg Am 2024 Feb 7; 106(3):198-205. doi: 10.2106/jbjs.23.00507..
Keywords: Medicare, Orthopedics, Surgery
Mattioli DD, Thomas GW, Long S
Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill.
This study evaluated best methods to assess surgical wire navigation skill, which can be objectively evaluated by analysis of intraoperative fluoroscopic image sequences. Prior work suggests that such image-based behavior analysis of operating room (OR) performance can predict performer experience level and agree with expert opinion (the current standard) on the quality of a final implant construct. Objective image-based evaluations were compared to expert assessments for entire technical OR performances. The relationship of three key variables were studied: (1) objective image-based criteria, (2) expert opinions, and (3) performing surgeon experience level. The authors used a paired-comparison survey of seven experts, based upon eight OR fluoroscopic wire navigation image sequences, which showed that the experts' preferences are best explained by objective metrics that reflect psychomotor and decision-making behaviors which are counter-productive to successful implant placement, like image count and behavior tally. One such behavior, adjustments away from goal, uniquely correlated well with all three key variables: a fluoroscopic image-based analysis composite score, expert consensus, and performer experience. The results confirmed that experts view less efficient technical behavior as indicative of lesser technical proficiency.
AHRQ-funded; HS022077; HS025353.
Citation: Mattioli DD, Thomas GW, Long S . Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill. J Orthop Res 2024 Feb; 42(2):404-14. doi: 10.1002/jor.25685..
Keywords: Surgery, Orthopedics
Danielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L . Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy. Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD . Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures. J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W . Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort. J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Ayers DC, Zheng H, Yang W
How back pain affects patient satisfaction after primary total knee arthroplasty.
This study looked at patient-reported outcomes (PROs) for patients with back pain (BP) who underwent total knee arthroscopy (TKA) surgery for pre- and postoperatively. This multicenter cohort study included 9,057 patients undergoing primary unilateral TKA who were enrolled in FORCE-TJ. Back pain (BP) intensity was assessed using the Oswestry back disability index (ODI) pain intensity questionnaire, with BP severity then classified into 4 categories. PROs were collected preoperatively and postoperatively after 1 year including the Knee injury and Osteoarthritis Outcome Score (KOOS) (total score, pain, Activities of Daily Living (ADL), and Quality of Life (QOL), Short-Form health survey 36-item (SF-36) Physical Component Score (PCS), and Mental Component Score (MCS)). At 1 year a total of 18.3% TKA patients were dissatisfied. At the time of surgery, a total of 4,765 patients (52.6%) reported back pain, divided into mild BP (24.9%), moderate (20.3%), and severe (7.2%). Severe back pain was significantly associated with patient dissatisfaction at 1 year after TKA. The predictive variables for dissatisfaction include age [odds ratio (OR) for younger patients <65 years versus older patients ≥65 years], educational level [OR for post high school versus less], smoking [OR for nonsmoker versus current smoker)], and Charlson comorbidity index [OR for CCI ≥2 versus 0]. The authors recommend surgeons consider a spine evaluation in patients who have severe BP prior to TKA.
AHRQ-funded; HS018910.
Citation: Ayers DC, Zheng H, Yang W . How back pain affects patient satisfaction after primary total knee arthroplasty. J Arthroplasty 2023 Jun; 38(6s):S103-s08. doi: 10.1016/j.arth.2023.03.072..
Keywords: Back Health and Pain, Pain, Pain, Patient Experience, Orthopedics, Surgery
Cochran A, Rayo MF
Toward joint activity design: augmenting user-centered design with heuristics for supporting joint activity.
This paper discusses the development of a clinical decision support application for preventing hospital-acquired infection called GeoHAI, which has yielded positive results in early usability testing and is expected to test positively in supporting joint activity, which will be measured through the novel implementation of Joint Activity Monitoring. The design and implementation of this application will help to unify the work of Human-Centered Design and Cognitive Systems Engineering through demonstration of the possibilities and necessities. The authors are calling this unified process Joint Activity Design, which supports designing for machines to be good team players.
AHRQ-funded; HS027200.
Citation: Cochran A, Rayo MF . Toward joint activity design: augmenting user-centered design with heuristics for supporting joint activity. Proc Int Symp Hum Factors Ergon Healthc 2023 Mar; 12(1):19-23. doi: 10.1177/2327857923121006..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Orthopedics
Carey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
AHRQ-funded; HS027786.
Citation: Carey K, Lin MY . Safety-net hospital performance under comprehensive care for joint replacement. Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
AHRQ-funded; HS024714.
Citation: Ko H, Martin BI, Nelson RE . How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care? Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Konnyu KJ, Thoma LM, Cao W
Prehabilitation for total knee or total hip arthroplasty: a systematic review.
This systematic review sought to examine evidence on the benefits and harms of prehabilitation interventions for patients scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. Evidence from 13 total knee arthroplasty studies suggested that prehabilitation may result in increased strength and reduced length of hospital stays and may not lead to increased harms; it may be comparable in terms of pain, range of motion, and activities of daily living. No evidence or insufficient evidence was found for all other outcomes after total knee arthroplasty. No evidence or insufficient evidence was found for all total hip arthroplasty outcomes.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Thoma LM, Cao W . Prehabilitation for total knee or total hip arthroplasty: a systematic review. Am J Phys Med Rehabil 2023 Jan;102(1):1-10. doi: 10.1097/phm.0000000000002006..
Keywords: Rehabilitation, Orthopedics, Evidence-Based Practice, Surgery
Konnyu KJ, Pinto D, Cao W
Rehabilitation for total hip arthroplasty: a systematic review.
This systematic review sought to determine the comparative benefits and harms of rehabilitation interventions for patients who had undergone elective, unilateral total hip arthroplasty (THA) for the treatment of primary osteoarthritis. Evidence from 15 studies suggested that individual rehabilitation programs may not differ in terms of risk of harm, outcomes of pain, strength, activities of daily living, or quality of life. No differences in outcomes were found between different rehabilitation programs after THA. The authors concluded that further evidence is needed to inform decisions on which rehabilitation program attributes are most effective for various outcomes.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Pinto D, Cao W . Rehabilitation for total hip arthroplasty: a systematic review. Am J Phys Med Rehabil 2023 Jan;102(1):11-18. doi: 10.1097/phm.0000000000002007..
Keywords: Rehabilitation, Orthopedics, Surgery, Evidence-Based Practice
Konnyu KJ, Thoma LM, Cao W
Rehabilitation for total knee arthroplasty: a systematic review.
This systematic review sought to determine comparative benefits and harms of rehabilitation interventions for patients had undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. Evidence from 53 studies suggested that diverse rehabilitation programs may lead to comparable improvements in pain, range of motion, and activities of daily living. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period nor among various postacute rehabilitation programs. All findings were of low strength of evidence.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Thoma LM, Cao W . Rehabilitation for total knee arthroplasty: a systematic review. Am J Phys Med Rehabil 2023 Jan;102(1):19-33. doi: 10.1097/phm.0000000000002008..
Keywords: Rehabilitation, Surgery, Orthopedics, Evidence-Based Practice
Graber J, Juarez-Colunga E, Thigpen C
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
This retrospective analysis’ purpose was to develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD). The authors analyzed post-TKA quadriceps strength recovery using a longitudinal dataset consisting of both clinical and research HHD data. They created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape and reference charts from the models to display the recovery of population centiles over the first six postoperative months. They analyzed a total of 588 patient records with 1176 observations. There was a rapid increase in quadriceps strength for both sexes over the first 60 postoperative days followed by a more gradual increase over the next 120 days. They found that males appeared to demonstrate faster recovery and greater strength on average compared to females. The reference charts may aid clinicians’ ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Juarez-Colunga E, Thigpen C . Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty. Disabil Rehabil 2022 Dec;44(24):7535-42. doi: 10.1080/09638288.2021.1995054..
Keywords: Surgery, Orthopedics, Rehabilitation
Ko H, Pelt CE, Martin BI
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
The purpose of this study was to compare baseline and early post-operative global and condition-specific patient reported outcomes (PROs) between patients undergoing cemented versus cementless total knee arthroplasty (TKA). The researchers prospectively collected PROs through the Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial using the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Pre- and post-operative outcomes in 5,961 patients undergoing primary TKA between December 2016 and August 2021 were examined. The study found that significant pre to- post-operative were observed in both groups. The researchers concluded that patients with cemented TKA reported early benefit in KOOS-Jr. over those with cementless TKA.
AHRQ-funded; HS024714.
Citation: Ko H, Pelt CE, Martin BI . Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching. BMC Musculoskelet Disord 2022 Oct 27;23(1):934. doi: 10.1186/s12891-022-05899-1..
Keywords: Orthopedics, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Graber J, Kittelson A, Juarez-Colunga E
Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty.
This study compared the relative strengths and weaknesses of 2 prediction model approaches for predicting functional recovery after knee arthroplasty: a neighbors-based "people-like-me" (PLM) approach and a linear mixed model (LMM) approach. The authors used 2 distinct datasets to train and then test PLM and LMM prediction approaches. They used the Timed Up and Go (TUG)-a common test of mobility-to operationalize physical function. Both approaches use patient characteristics and baseline postoperative TUG values to predict TUG recovery from days 1-425 following surgery. They then compared the accuracy and precision of the two approaches. A total of 317 patient records with 1379 TUG observations were used to train approaches, and 456 patient records with 1244 TUG observations were used to test the predictions. Both approaches performed similarly in terms of mean squared error and bias, but the PLM approach provided more accurate and precise estimates of prediction uncertainty.
AHRQ-funded; HS025692.
Citation: Graber J, Kittelson A, Juarez-Colunga E . Comparing "people-like-me" and linear mixed model predictions of functional recovery following knee arthroplasty. J Am Med Inform Assoc 2022 Oct 7;29(11):1899-907. doi: 10.1093/jamia/ocac123..
Keywords: Orthopedics, Surgery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Outcomes
Mattioli DD, Thomas GW, Long SA
Minimally trained analysts can perform fast, objective assessment of orthopedic technical skill from fluoroscopic images.
The purpose of this study was to test a new system designed to facilitate rapid, inexpensive, repeatable, and precise analysis of intraoperative fluoroscopic images by minimally trained analysts as a means of objectively assessing orthopedic surgical skills. The study included 4 expert and 4 novice analysts who independently measured one objective metric for skill using both the custom analysis software and a commercial alternative. The study found that in comparison to the expert analysts utilizing the commercial software, the novice analysts were able to measure the objective metric three times faster when utilizing the custom software, and without a practical difference in accuracy.
AHRQ-funded; HS025353.
Citation: Mattioli DD, Thomas GW, Long SA . Minimally trained analysts can perform fast, objective assessment of orthopedic technical skill from fluoroscopic images. IISE Trans Healthc Syst Eng 2022;12(3):212-20. doi: 10.1080/24725579.2022.2035022..
Keywords: Orthopedics, Imaging

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