High rate of failure after revision extensor mechanism allograft reconstruction.

BACKGROUND: Patients who fail initial extensor mechanism allograft (EMA) reconstruction for extensor mechanism disruption after total knee arthroplasty (TKA) are left with few options. This study evaluated outcomes in patients that underwent revision EMA reconstruction following a failed EMA. METHOD: Ten patients that underwent revision EMA for failed index EMA with minimum 1-year follow-up were retrospectively reviewed. Patients receiving fresh-frozen EMA (quadriceps tendon, patella, patellar tendon, and tibial tubercle) at index and revision EMA were included. The primary outcome was EMA failure defined as revision surgery, extensor lag > 30°, or Knee Society Score (KSS) < 60 at last follow-up. Descriptive statistics were performed, with p < 0.05. RESULTS: Mean extensor lag improved from 55.6°±26.7° pre-revision to 32.8°±29.6° (p = 0.13) at mean follow-up of 43.8 months (range, 12-124 months). Mean KSS improved from 41.0 ±â€¯9.5 pre-revision to 73.4 ±â€¯14.5 at last follow-up (p < 0.001). All patients required assistive devices for ambulation at final follow-up: one (10.0%) required a wheelchair, five (50.0%) required a walker, and four (40.0%) required a cane. Seven (70.0%) patients experienced EMA failure at a mean of 33.6 months (range, 2-124) following revision EMA: three (30.0%) were revised for periprosthetic joint infection (one of which also had extensor lag > 30°), three (30.0%) additional patients had extensor lag > 30°, and one (10.0%) patient had KSS < 60 (this patient developed PJI and was treated nonoperatively with chronic antibiotic suppression). CONCLUSIONS: Revision EMA reconstruction fails at a high rate despite leading to improvements in KSS. Further research is needed to develop effective prevention and treatment strategies for failure after initial EMA reconstruction.

The economics of patients undergoing periacetabular osteotomy for hip dysplasia: the financial relationship between physicians and hospitals.

Periacetabular osteotomy (PAO) is the gold standard for treating hip dysplasia in patients with preserved articular cartilage. The aim of this study is to evaluate the financial relationship between facility and professional revenue for patients undergoing PAO for hip dysplasia and acetabular version abnormalities. All patients who underwent PAO for hip dysplasia by a single surgeon at a tertiary academic medical center between December 2016 and November 2020 were identified. Financial records for facility and professional services were reviewed and analyzed. The orthopedic charge multiplier, the dollars of facility charge created by a single dollar of orthopedic professional charge, and orthopedic net revenue multiplier, the dollars collected by the hospital for facility services generated for each dollar collected by the orthopedic surgeon, were calculated. A total of 36 patients were included in the study. The mean total charge for all patients was $144 939.35 ± $23 726.48 (range $109 002.71 to $227 290.20), and the average total revenue for all patients was $44 218.79 ± $12 352.97 (range $29 397.39 to $90,830.62). The mean orthopedic charge multiplier was 2.47 ± 1.32 (range 0.78-6.53), and the net revenue collection multiplier was 8.62 ± 10.69 (range, 1.20-57.80). The majority of charges and revenue related to care of patients undergoing PAO return to the hospital. The significant mean orthopedic charge multiplier for this procedure increases the value of the service and the surgeon to hospital profitability. This information can help shape the relationship between the hospital and the surgeon and create a firm platform to advocate for program advancement.