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Abstract Background Periprosthetic joint infection (PJI) is a potentially deadly complication of total joint arthroplasty. This study was designed to address how the incidence of PJI and outcome of treatment, including mortality, are changing in the population over time. Methods Primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients with PJI from the 100% Medicare inpatient data set (2005-2015) were identified. Cox proportional hazards regression models for risk of PJI after THA/TKA (accounting for competing risks) or risk of all-cause mortality after PJI were adjusted for patient and clinical factors, with year included as a covariate to test for time trends. Results The unadjusted 1-year and 5-year risk of PJI was 0.69% and 1.09% for THA and 0.74% and 1.38% for TKA, respectively. After adjustment, PJI risk did not change significantly by year for THA (P =.63) or TKA (P =.96). The unadjusted 1-year and 5-year overall survival after PJI diagnosis was 88.7% and 67.2% for THA and 91.7% and 71.7% for TKA, respectively. After adjustment, the risk of mortality after PJI decreased significantly by year for THA (hazard ratio = 0.97; P <.001) and TKA (hazard ratio = 0.97; P <.001). Conclusion Despite recent clinical focus on preventing PJI, we are unable to detect substantial decline in the risk of PJI over time, although mortality after PJI has declined. Because PJI risk appears not to be changing over time, the incidence of PJI is anticipated to scale up proportionately with the demand for THA and TKA, which is projected to increase substantially in the coming decade. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to analyze the utilization and outcomes of ceramic bearings used in revision total hip arthroplasty (R-THA) in the Medicare population.Methods: A total of 31,809 patients aged >65 years at the time of revision surgery who underwent R-THA between 2005 and 2013 were identified from the United States Medicare 100% national administrative claims database. Outcomes of interest included relative risk of readmission (90 days) or infection, dislocation, rerevision, or mortality at any time point after revision. Propensity scores were developed to adjust for selection bias in the choice of bearing type at revision surgery.Results: The utilization of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) bearings in R-THA increased from 5.3% to 26.6% and from 1.8% to 2.5% in between 2005 and 2013, respectively. For R-THA patients treated with C-PE bearings, there was reduced risk of 90-day readmission (hazard ratio, HR: 0.90, P = .007). We also observed a trend for reduced risk of infection with C-PE (HR: 0.88) that did not reach statistical significance (P = .14). For R-THA patients treated with COC bearings, there was reduced risk of dislocation (HR: 0.76, P = .04). There was no significant difference in risk of rerevision or mortality for either the C-PE or COC bearing cohorts when compared with the metal-on-polyethylene bearing cohort.Conclusion: Medicare patients treated in a revision scenario with ceramic bearings exhibit similar risk of rerevision, infection, or mortality as those treated with metal-on-polyethylene bearings. Conversely, we found an association between the use of specific ceramic bearings in R-THA and reduced risk of readmission (C-PE) and dislocation (COC). [ABSTRACT FROM AUTHOR]

Abstract: The purpose of the present study is to determine the differences in cost, complications, and mortality between knee arthroplasty (TKA) patients who stay the standard 3–4 nights in a hospital compared to patients who undergo an outpatient procedure, a shortened stay or an extended stay. TKA patients were identified in the Medicare 5% sample (1997–2009) and separated into the following groups: outpatient, 1–2 days, 3–4 days, or 5+ days inpatient. At two years, costs associated with the outpatient and the 1–2 day stay groups were $8527 and $1967 lower than the 3–4 day stay group, respectively. Out to 2years, the outpatient and 1–2 day stay groups reported less pain and stiffness, respectively, though the 1–2 day group also had a higher risk for revision. [Copyright &y& Elsevier]

Abstract: The purpose of this study is to compare the differences in downstream cost and health outcomes between Medicare hip OA patients who undergo total hip arthroplasty (THA) and those who do not. All OA patients in the Medicare 5% sample (1998–2009) were separated into non-THA and THA groups. Differences in costs and risk ratios for mortality and new disease diagnoses were adjusted using logistic regression for age, sex, race, socioeconomic status, region, and Charlson score. Mortality, heart failure, depression, and diabetes were all reduced in the THA group, though there was an increased risk for atherosclerosis in the short term. The potential for selection bias was investigated with two separate propensity score analyses. This study demonstrates the potential benefit of THA in reducing mortality and improving aspects of overall health in OA patients. [Copyright &y& Elsevier]

Abstract: There are little data that quantify the long term costs, mortality, and downstream disease after Total Knee Arthroplasty (TKA). The purpose of this study is to compare differences in cost and health outcomes between Medicare patients with OA who undergo TKA and those who avoid the procedure. The Medicare 5% sample was used to identify patients diagnosed with OA during 1997–2009. All OA patients were separated into non-arthroplasty and arthroplasty groups. Differences in costs, mortality, and new disease diagnoses were adjusted using logistic regression for age, sex, race, buy-in status, region, and Charlson score. The 7-year cumulative average Medicare payments for all treatments were $63,940 for the non-TKA group and $83,783 for the TKA group. The risk adjusted mortality hazard ratio (HR) of the TKA group ranged from 0.48 to 0.54 through seven years (all P <0.001). The risk of heart failure in the TKA group was 40.9% at 7years (HR=0.93, P <0.001). The results demonstrate the patients in the TKA cohort as having a lower probability of heart failure and mortality, at a total incremental cost of $19,843. [Copyright &y& Elsevier]

We reanalyzed the Libby vermiculite miners’ cohort assembled by Sullivan to estimate potency factors for lung cancer, mesothelioma, nonmalignant respiratory disease (NMRD), and all-cause mortality associated with exposure to Libby fibers. Our principal statistical tool for analyses of lung cancer, NMRD, and total mortality in the cohort was the time-dependent proportional hazards model. For mesothelioma, we used an extension of the Peto formula. For a cumulative exposure to Libby fiber of 100 f/mL-yr, our estimates of relative risk (RR) are as follows: lung cancer, RR = 1.12, 95% confidence interval (CI) =[1.06, 1.17]; NMRD, RR = 1.14, 95% CI =[1.09, 1.18]; total mortality, RR = 1.06, 95% CI =[1.04, 1.08]. These estimates were virtually identical when analyses were restricted to the subcohort of workers who were employed for at least one year. For mesothelioma, our estimate of potency is KM = 0.5 × 10−8, 95% CI =[0.3 × 10−8, 0.8 × 10−8]. Finally, we estimated the mortality ratios standardized against the U.S. population for lung cancer, NMRD, and total mortality and obtained estimates that were in good agreement with those reported by Sullivan. The estimated potency factors form the basis for a quantitative risk assessment at Libby. [ABSTRACT FROM AUTHOR]

• In 2019 the incidence of femoral shaft fractures was 40.8/100,000 inhabitants. • The one-year mortality rate was 24.9% after femoral shaft fracture. • The infection rate was 2.22% [95% CI: 1.90–2.58, currently at risk: 3829] after 24 months. • An early assessment of individual risk factors is crucial for therapeutical treatment. This work aimed at answering the following research questions: (1) What is the incidence of femoral shaft fractures in the geriatric population in the U.S.? (2) What is the rate of mortality, mechanical complications, nonunion and infection, and what are the associated risk factors? In this cross-sectional study, femoral shaft fractures occurred between January 1, 2009, and December 31, 2019, were identified from Medicare records. Rates of mortality, nonunion, infection, and mechanical complications were calculated with the Kaplan-Meier method with Fine and Gray sub-distribution adaptation. Semiparametric Cox regression was applied with twenty-three covariates to determine risk factors. Between 2009 through 2019 the incidence of femoral shaft fractures decreased by 12.07% to 40.8/100,000 inhabitants (p = 0.549). The 5-year mortality risk was 58.5%. Male sex, age over 75 years, chronic obstructive pulmonary disease, cerebrovascular disease, chronic kidney disease, congestive heart failure, diabetes mellitus, osteoporosis, tobacco dependence, and lower median household income were significant risk factors. The infection rate was 2.22% [95%CI: 1.90–2.58] and the union failure rate 2.52% [95%CI: 2.17–2.92] after 24 months. An early assessment of individual patient risk factors may be beneficial in the care and treatment of patients with these fractures. [ABSTRACT FROM AUTHOR]