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Article ; Online: After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal?

Zeegen, Erik N / Yates, Adolph J / Jevsevar, David S

2020 Volume 35, Issue 7S, Page(s) S37–S41

Abstract: The novel coronavirus, severe acute respiratory coronavirus 2 (SARS-CoV-2), pandemic has delivered a profound and negative impact on the United States. The suspension of elective surgeries including arthroplasty will have a lasting effect on all ... ...

Abstract	The novel coronavirus, severe acute respiratory coronavirus 2 (SARS-CoV-2), pandemic has delivered a profound and negative impact on the United States. The suspension of elective surgeries including arthroplasty will have a lasting effect on all stakeholders including patients, physicians, and healthcare organizations within the US healthcare system. Resumption of elective hip and knee arthroplasty will need to be carefully focused. The purpose of this work is to address potential strategies, concerns, and regulatory barriers in restarting elective hip and knee arthroplasty in the United States.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Delivery of Health Care ; Elective Surgical Procedures ; Humans ; Pandemics ; Pneumonia, Viral/epidemiology ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2020.04.040
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Article: Occlusion of an Aortobifemoral Graft after Revision Total Hip Arthroplasty.

Ishmael, Chad R / Galey, Scott A / Gatto, Jonathan D / Zeegen, Erik N

Arthroplasty today

2021 Volume 8, Page(s) 63–68

Abstract: With the aging population, the demand for total hip arthroplasty is rising. Improvements in arthroplasty techniques and design allow for total hip arthroplasty to be increasingly performed in older patients and those with multiple comorbidities. ... ...

Abstract	With the aging population, the demand for total hip arthroplasty is rising. Improvements in arthroplasty techniques and design allow for total hip arthroplasty to be increasingly performed in older patients and those with multiple comorbidities. Complications are rare in young and healthy patients; however, there is greater risk in patients with multiple medical comorbidities and those who have had prior revision procedures. Large-vessel thrombosis is an especially rare, but potentially devastating, complication, particularly in patients with existing major-vessel bypass grafts. Only 3 case reports of major-vessel graft occlusion after total hip arthroplasty have been reported in the literature, and none after revision. In this article, we report a case of occlusion of an aortobifemoral graft after revision total hip arthroplasty for periprosthetic joint infection.
Language	English
Publishing date	2021-02-27
Publishing country	United States
Document type	Case Reports
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2021.01.002
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Navigated and Robot-Assisted Technology in Total Knee Arthroplasty: Do Outcome Differences Achieve Minimal Clinically Important Difference?

Arshi, Armin / Sekimura, Troy / Kelley, Benjamin V / Zeegen, Erik N / Lonner, Jess H / Stavrakis, Alexandra I

The Journal of arthroplasty

2022 Volume 37, Issue 8, Page(s) 1562–1569

Abstract: Background: In total knee arthroplasty (TKA), computer-assisted navigation (N-TKA) and robotic ... reporting perioperative PROMs for either primary N-TKA or RA-TKA with a C-TKA comparison cohort ... minimal clinically important difference (MCID) values.: Results: After systematic review, 21 studies (N ...

Abstract	Background: In total knee arthroplasty (TKA), computer-assisted navigation (N-TKA) and robotic-assisted methods (RA-TKA) are intended to increase precision of mechanical and component alignment. However, the clinical significance of published patient-reported outcome measure (PROM) differences in comparison to conventional TKA (C-TKA) is unknown. Methods: A systematic review was performed to identify all studies reporting perioperative PROMs for either primary N-TKA or RA-TKA with a C-TKA comparison cohort with a minimum 1-year follow-up. Relative improvements in PROMs for the two cohorts were compared to published minimal clinically important difference (MCID) values. Results: After systematic review, 21 studies (N = 3,214) reporting on N-TKA and eight studies (N = 1,529) reporting on RA-TKA met inclusion criteria. Eighteen of 20 studies (90%) reported improved radiographic outcomes with N-TKA relative to C-TKA; five of five studies reported improved radiographic outcomes with RA-TKA relative to C-TKA. Five of 21 studies (24%) reported statistically significant greater improvements in clinical PROMs for N-TKA relative to C-TKA, whereas only two (10%) achieved clinical significance relative to MCID on a secondary analysis. One of 8 studies (13%) reported statistically significant greater improvements in PROMs for RA-TKA relative to C-TKA, whereas none achieved clinical significance relative to MCID on a secondary analysis. No studies reported a significant difference in revision rates. Conclusion: While most studies comparing RA-TKA and N-TKA with C-TKA demonstrate improved radiographic alignment outcomes, a minority of studies reported PROM differences that achieve clinical significance. Future studies should report data and be interpreted in the context of clinical significance to establish patient and surgeon expectations for emerging technologies.
MeSH term(s)	Arthroplasty, Replacement, Knee/methods ; Humans ; Knee Joint/surgery ; Minimal Clinically Important Difference ; Osteoarthritis, Knee/surgery ; Robotics ; Treatment Outcome
Language	English
Publishing date	2022-03-30
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	632770-9
ISSN	1532-8406 ; 0883-5403
ISSN (online)	1532-8406
ISSN	0883-5403
DOI	10.1016/j.arth.2022.03.075
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Article ; Online: After the COVID-19 Pandemic

Zeegen, Erik N. / Yates, Adolph J. / Jevsevar, David S.

The Journal of Arthroplasty

Returning to Normalcy or Returning to a New Normal?

2020 Volume 35, Issue 7, Page(s) S37–S41

Keywords	Orthopedics and Sports Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	632770-9
ISSN	0883-5403
ISSN	0883-5403
DOI	10.1016/j.arth.2020.04.040
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Comparison of complication profiles for femoral neck, intertrochanteric, and subtrochanteric geriatric hip fractures.

Arshi, Armin / Su, Lisa / Lee, Christopher / Sassoon, Adam A / Zeegen, Erik N / Stavrakis, Alexandra I

Archives of orthopaedic and trauma surgery

2021 Volume 143, Issue 1, Page(s) 49–54

Abstract: Introduction: Most geriatric hip fractures occur in the femoral neck (FN) and intertrochanteric (IT) regions of the femur, while a minority occur in the subtrochanteric (ST) region. Relative outcomes based on the anatomical subtype of fracture are not ... ...

Abstract	Introduction: Most geriatric hip fractures occur in the femoral neck (FN) and intertrochanteric (IT) regions of the femur, while a minority occur in the subtrochanteric (ST) region. Relative outcomes based on the anatomical subtype of fracture are not well studied. This study characterizes postoperative complications and outcomes of hip fractures distinguished by anatomic region. Materials and methods: The targeted hip fracture series of the American College of Surgeons National Surgical Quality Improvement Program database was queried to identify geriatric (≥ 65 years) patients who sustained operative FN, IT, and ST hip fractures. Primary patient demographic and perioperative data were collected and correlated with 30-day postoperative complications and outcomes. Multivariate regression was used to calculate relative risks of adverse events (AEs) between groups. Results: In total, 8220 geriatric hip fracture patients were identified. Risk-adjusted 30-day mortality was not significantly different between patients with ST (5.8%, p = 0.735) and IT (7.3%, p = 0.169) femur fractures relative to those with FN fractures (6.6%). The overall risk-adjusted rate of minor and major medical AEs within 30 days and risk-adjusted rate of wound complications was not significantly different between FN, IT, and ST fractures. Patients with IT [34.4%, OR 2.35 (2.35-3.08), p < 0.001] and ST fractures [49.8%, OR 5.94 (4.58-7.70), p < 0.00] had higher risk-adjusted incidence of postoperative blood transfusion relative to FN fractures (18.5%). Furthermore, patients with IT fractures had a slightly lower risk-adjusted incidence of unplanned reoperation [2.1 vs. 2.7%, OR 0.69 (0.47-0.99), p = 0.046] and hospital readmission (7.8 vs. 9.2%, OR 0.76 [0.63-0.91], p = 0.003) than patients with FN fractures. Conclusions: With respect to anatomic region, geriatric hip fractures have similar short-term mortality and medical AE profiles with differences in transfusion, reoperation, and readmission rates. Knowledge of these short-term outcomes may guide surgeons in counseling hip fracture patients peri-operatively.
MeSH term(s)	Humans ; Aged ; Femur Neck ; Hip Fractures ; Femoral Neck Fractures/complications ; Risk ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology
Language	English
Publishing date	2021-06-10
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-021-03978-x
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Article ; Online: Comparison of total hip arthroplasty outcomes between haemodyalisis and renal transplant patients.

Ahlquist, Seth / Kim, Samuel T / Hsiue, Peter P / Benharash, Peyman / Ponzio, Danielle Y / Photopoulos, Christos / Zeegen, Erik N / Stavrakis, Alexandra I

Hip international : the journal of clinical and experimental research on hip pathology and therapy

2022 Volume 33, Issue 4, Page(s) 640–648

Abstract: Introduction: Total hip arthroplasty (THA) in end-stage renal disease (ESRD) patients is associated with increased complications. Controversy exists whether elective THA should be performed while these patients are on haemodialysis (HD) or following ... ...

Abstract	Introduction: Total hip arthroplasty (THA) in end-stage renal disease (ESRD) patients is associated with increased complications. Controversy exists whether elective THA should be performed while these patients are on haemodialysis (HD) or following renal transplant (RT). This study seeks to compare THA outcomes in HD versus RT patients. Methods: A national database was retrospectively reviewed using ICD codes to identify all HD and RT patients who underwent primary THA from 2010 to 2018. Demographics, comorbidities, and hospital factors were compared between cohorts using Wald and chi-square tests. The primary outcome was in-hospital mortality, while secondary outcomes included length of stay (LOS), non-home discharge, cost, readmission, and medical/surgical complications. Multivariate regression was used to determine independent associations. Significance was determined with a 2-tailed Results: 11,133 patients underwent THA, 61.6% HD and 39.4% RT patients. RT patients were younger, had fewer comorbidities, and more likely to have private insurance. After adjusting for these differences, RT patients had a lower rate of mortality (OR 0.31, Conclusions: These findings suggest HD patients are a high-risk population in THA compared to RT patients and warrant stringent perioperative monitoring.
MeSH term(s)	Humans ; Arthroplasty, Replacement, Hip/adverse effects ; Kidney Transplantation/adverse effects ; Retrospective Studies ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Patient Readmission ; Risk Factors ; Length of Stay
Language	English
Publishing date	2022-04-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	1162513-2
ISSN	1724-6067 ; 1120-7000
ISSN (online)	1724-6067
ISSN	1120-7000
DOI	10.1177/11207000221091994
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Article: After the COVID-19 Pandemic: Returning to Normalcy or Returning to a New Normal?

Zeegen, Erik N / Yates, Adolph J / Jevsevar, David S

J Arthroplasty

Abstract	The novel coronavirus, severe acute respiratory coronavirus 2 (SARS-CoV-2), pandemic has delivered a profound and negative impact on the United States. The suspension of elective surgeries including arthroplasty will have a lasting effect on all stakeholders including patients, physicians, and healthcare organizations within the US healthcare system. Resumption of elective hip and knee arthroplasty will need to be carefully focused. The purpose of this work is to address potential strategies, concerns, and regulatory barriers in restarting elective hip and knee arthroplasty in the United States.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #102378
Database	COVID19

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Article: Trends in Operative Time and Short-Term Outcomes After Conventional and Navigated Total Knee Arthroplasty.

Sekimura, Troy K / Upfill-Brown, Alexander / Hsiue, Peter P / Khoshbin, Amir / Zeegen, Erik N / Stavrakis, Alexandra I

Arthroplasty today

2021 Volume 8, Page(s) 188–193

Abstract: Background: Adoption of navigated total knee arthroplasty (Nav-TKA) is increasing. However, it has been suggested that a perceived decrease in surgical efficiency and a lack of proven superior functional outcomes associated with Nav-TKA have hindered ... ...

Abstract	Background: Adoption of navigated total knee arthroplasty (Nav-TKA) is increasing. However, it has been suggested that a perceived decrease in surgical efficiency and a lack of proven superior functional outcomes associated with Nav-TKA have hindered its widespread adoption. Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients who had undergone TKA with or without navigation between 2012 and 2018. Patients were further subclassified based on the type of navigation used, image-guided or imageless. Multivariate logistic regression was used to compare operative time and 30-day complication rates between conventional TKA (Conv-TKA) and Nav-TKA with and without image guidance. Results: A total of 316,210 Conv-TKAs and 8554 Nav-TKAs (8270 imageless, 284 image-guided) were identified. Across the study period, the use of Nav-TKA was associated with a 1.5-minute increase in operative time. However, the overall time burden decreased over the study period, and by 2018, the mean operative time for Nav-TKA was 2.4 minutes less than that of Conv-TKA. Compared with Conv-TKA, Nav-TKA was associated with decreased rates of postoperative transfusion and surgical site complications but a similar incidence of systemic thromboembolism. Conclusions: This is the first large-scale database study to examine the differences in operative time between Conv-TKA and Nav-TKA. The time burden associated with Nav-TKA decreased over the study period and even reversed by 2018. Nav-TKA was associated with lower rates of postoperative transfusion and surgical site complications. Further studies are needed to evaluate the long-term and functional outcomes between conventional and navigated knee arthroplasty techniques.
Language	English
Publishing date	2021-04-12
Publishing country	United States
Document type	Journal Article
ISSN	2352-3441
ISSN	2352-3441
DOI	10.1016/j.artd.2021.02.015
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Analysis of perioperative outcomes in hip resection arthroplasty.

Nazemi, Alireza K / Upfill-Brown, Alexander / Arshi, Armin / Sekimura, Troy / Zeegen, Erik N / McPherson, Edward J / Stavrakis, Alexandra I

Archives of orthopaedic and trauma surgery

2021 Volume 142, Issue 9, Page(s) 2139–2146

Abstract: Background: Hip resection arthroplasty (HRA) is a salvage surgical technique for the management of complex hip conditions wherein arthroplasty may be contraindicated. The purpose of this study was to review modern-day indications for HRA and compare ... ...

Abstract	Background: Hip resection arthroplasty (HRA) is a salvage surgical technique for the management of complex hip conditions wherein arthroplasty may be contraindicated. The purpose of this study was to review modern-day indications for HRA and compare outcomes between patients undergoing HRA and revision total hip arthroplasty (RTHA). Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to identify patients undergoing HRA or RTHA between 2012 and 2017. Patient demographics, risk factors, and perioperative complications were analyzed. Multivariate regression was used to determine predictors of early postoperative complications. Propensity score matching (PSM) was performed to compare relative risks (RR) of complications in HRA compared to RTHA. Results: 290 patients underwent HRA between 2012 and 2017. Infection was the most common indication for HRA (39.8%), followed by femoral neck fracture or malunion/nonunion (26%) and prosthetic instability (12.2%). Increased body mass index (BMI) (p = 0.012) and chronic obstructive pulmonary disease (COPD) (p = 0.007) were associated with increased risk of complication in HRA. There were no significant differences in short-term complication risks between RTHA and HRA. Conclusions: HRA was associated with short-term complication rates comparable to RTHA. These findings may help in surgical decision-making and appropriate indications in the present day. Level of evidence: III.
MeSH term(s)	Arthroplasty, Replacement, Hip/adverse effects ; Arthroplasty, Replacement, Hip/methods ; Femoral Neck Fractures/surgery ; Humans ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Propensity Score ; Reoperation/adverse effects ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2021-02-24
Publishing country	Germany
Document type	Journal Article
ZDB-ID	80407-1
ISSN	1434-3916 ; 0003-9330 ; 0344-8444
ISSN (online)	1434-3916
ISSN	0003-9330 ; 0344-8444
DOI	10.1007/s00402-021-03833-z
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Article ; Online: Standardized Hospital-Based Care Programs Improve Geriatric Hip Fracture Outcomes: An Analysis of the ACS NSQIP Targeted Hip Fracture Series.

Arshi, Armin / Rezzadeh, Kevin / Stavrakis, Alexandra I / Bukata, Susan V / Zeegen, Erik N

Journal of orthopaedic trauma

2019 Volume 33, Issue 6, Page(s) e223–e228

Abstract: Objective: To determine relative complication rates and outcome measures in patients treated under a standardized hip fracture program (SHFP).: Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried to ... ...

Abstract	Objective: To determine relative complication rates and outcome measures in patients treated under a standardized hip fracture program (SHFP). Methods: The American College of Surgeons National Surgical Quality Improvement Program was queried to identify patients who underwent operative fixation of femoral neck, intertrochanteric hip, and subtrochanteric hip fractures in 2016. Cohorts of patients who were and were not treated under a documented SHFP were identified. Relevant perioperative clinical and outcomes data were collected. Multivariate regression was used to assess risk-adjusted complication rates and outcomes for patients treated in SHFPs. Results: A total of 9360 hip fracture patients were identified of whom 5070 (54.2%) were treated under a documented SHFP. Median age was 84 years, and 69.9% of patients were women. Patients in an SHFP had a lower risk-adjusted incidence of postoperative deep vein thrombosis [odds ratio (OR) 0.48 (0.32-0.72), P < 0.001]. Rates of other medical and surgical complications and 30-day mortality were statistically comparable. Risk-adjusted evaluation showed that SHFP patients were less likely to be discharged to an inpatient facility versus home [OR 0.72 (0.63-0.81), P < 0.001] and had a lower 30-day readmission rate [OR 0.83 (0.71-0.97), P = 0.023]. Furthermore, the SHFP patients had higher rates of immediate postoperative weight-bearing as tolerated [OR 1.23 (1.10-1.37), P < 0.001], adherence to deep vein thrombosis prophylaxis at 28 days [OR 1.27 (1.16-1.38), P < 0.001], and initiation of bone protective medications [OR 1.79 (1.64-1.96), P < 0.001]. Conclusions: Care in a modern hospital-based SHFP is associated with improved short-term outcome measures. Further development and widespread implementation of organized, multidisciplinary orthogeriatric hip fracture protocols is recommended. Level of evidence: Therapeutic Level III.
MeSH term(s)	Aged, 80 and over ; Female ; Hip Fractures/surgery ; Hospitalization ; Humans ; Male ; Orthopedic Procedures/standards ; Postoperative Complications/prevention & control ; Quality Improvement ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2019-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	639099-7
ISSN	1531-2291 ; 0890-5339
ISSN (online)	1531-2291
ISSN	0890-5339
DOI	10.1097/BOT.0000000000001443
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