What’s New in Adult Reconstructive Knee Surgery

Abstract

The global rebound from the COVID-19 pandemic may be on its way. Despite the difficulties, the orthopaedic community has demonstrated during the last year its commitment to the improvement of health care through innovation and the constant evaluation of practices and treatments for knee conditions. Health Policy and EconomicsA large nationwide insurance database study revealed that net losses were greater for patients with higher Elixhauser Comorbidity Index (ECI) scores 1 . The U.S. Bundled Payments for Care Improvement (BPCI) and Comprehensive Care for Joint Replacement (CJR) payment models may deincentivize the treatment of sicker patients. As more insurance companies adopt bundled payment models such as CJR, it is important to note that Medicare risk-adjustment equations involving patient-reported outcomes cannot be applied without caution to patient-reported outcomes of commercially insured patients undergoing total knee arthroplasty (TKA). Significant differences in outcomes have been shown between Medicare and commercially insured patients when using Medicare risk-adjustment algorithms 2 . Although the volume of revisions has increased, the Medicare orthopaedic physician fee reimbursement for aseptic and septic TKA revision has not kept up with inflation. After adjusting for it, from 2002 to 2019, the mean aseptic revision reimbursement declined 24.83% for 2-component revision and 24.21% for 1-component revision, and septic revision reimbursement decreased even further, by 23.29% for explantation and 33.47% for reimplantation 3 . Lastly, it appears that the public reporting of TKA and total hip arthroplasty (THA) risk-standardized readmission and complication rates is associated with improved outcomes after the surgical procedure 4 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G781).

The Accuracy of a Portable Accelerometer-Based Navigation System for Tibial Alignment Can be Reliable during Total Knee Arthroplasty for Obese Patients

“…The preoperative and postoperative hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), and posterior tibial slope (PTS) angle were evaluated (►Fig. 1).…”

“…Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures worldwide and has excellent long-term outcomes. 1 Recently, advanced technologies such as computer-assisted navigation, patient-specific instrumentation, and robotically assisted systems have become widely used to obtain target alignments. [2][3][4][5][6][7] Of these, a portable navigation system have advantages in terms of being relatively inexpensive and simple to manipulate.…”