December 7, 2020

Abstracts Rated in Top 100 Posters at 30th Annual AAHKS Meeting

Two abstracts submitted by hip and knee surgeons Jeffrey Stambough, M.D., C. Lowry Barnes, M.D., and Simon Mears, M.D. were among the top 100 graded posters selected at the American Association of Hip and Knee Surgeons (AAHKS) 30th Annual Meeting that took place early November. The abstracts (below) will be published in the Proceedings Volume in the Journal of Arthroplasty.

Time Spent in the Electronic Medical Record: A Proxy for Estimating Preoperative Work Before TKA
Author(s):  Samantha Mohler, BS; Simon C. Mears, MD, PhD; Ashleigh Kathiresan, MEd; Paul K. Edwards, MD; C. Lowry Barnes, MD; Jeffrey B. Stambough, MD

Introduction: Recent literature has sought to quantify preoperative work associated with total joint arthroplasty. These studies have utilized surveys or self-reported time logs to estimate the Pre-op Optimization Work (POW) completed by the surgical team. The purpose of this study was to objectively quantify POW associated with total knee arthroplasty (TKA) using electronic medical record (EMR) activity audit logs. Methods: Retrospective analysis of EMR activity for 4 arthroplasty surgeons and their clinical staff was collected for 100 consecutive TKA cases (25 per surgeon). Clinical informatics data was generated using EMR activity audit logs for pre-TKA activity. Every action and mouse-click within a patient’s chart was recorded for each team member. The time between mouse-clicks was calculated and summed for each user. Times exceeding five minutes without activity were assumed to reflect inactivity and excluded. Descriptive statistics were used to determine the surgical teams work associated with TKA preparation. Results: The mean number of days defined in the pre-TKA time period was 67.5 (SD 41.8). The mean time spent in each patient’s chart in the pre-TKA period was 74.6 minutes (SD 42.8) minutes. Surgeon’s POW in the medical record accounted for 3.7 (SD 6.0) of these minutes. Much of the work was conducted by registered nurses (35.1 minutes, SD 34.1) and physician assistants (10.8 minutes, SD 16.9). The majority of work captured in the EMR activity log was associated with medication review, patient optimization, documentation of necessary medical clearances, order sets, patient communication, and prior authorization requests. Conclusions: A considerable amount of preoperative work is required between the clinic date a patient decides to pursue TKA and the day prior to surgery. Retrospective electronic time stamp measurements should represent the absolute minimum time required for surgical preparation.

Functional Outcomes of Modular Knee Fusion for Extensor Disruption and Prosthetic Joint Infection
Author(s): Wesley H Mayes, MD; Jeffrey B. Stambough, MD; Anna C Severin, PHD; Erin M Mannen, PHD; Paul K. Edwards, MD; C. Lowry Barnes, MD; Simon C. Mears, MD, PhD
Introduction: Extensor mechanism disruption (EMD) combined with periprosthetic joint infection (PJI) after total knee arthroplasty is a life-changing complication. The literature suggests that many eventually receive an above-knee amputation (AKA) or knee arthrodesis as definitive treatment. Patients with AKA over the age of 65, however, are very unlikely to walk with a prosthesis. Modular knee fusion with prosthetic components maintains leg length in settings of massive bone loss, but there is a paucity of information regarding the outcomes and biomechanical function of this group. Methods: We retrospectively reviewed patients who underwent 2-stage reconstruction with a modular knee fusion for combined EMD and PJI between 2016-2018. Outcomes measured included complications of surgery (reoperation, recurrent infection, and 90-day mortality), KOOS Jr., and PROMIS scores at one-year after arthrodesis. Biomechanical analysis was conducted on 6 patients at a minimum of one year after surgery to measure gait and balance. Results: 15 patients (average age 68 years) received a modular knee arthrodesis. The average length of the intercalary segment was 88mm. At most recent follow-up (16 months, range 3-47 months), 12 patients still had their modular construct in place and were ambulatory, while 2 died and one opted for conversion to AKA. No patients had a recurrence of infection or were readmitted within 90 days postoperative. Six patients used a walker, 4 patients a cane, and 2 patients walked unassisted. Walking speed was 0.57±0.3 m/s and average center of pressure balance was 2.8±0.6 cm with an average KOOS Jr. of 76±11 and PROMIS physical function score of 37±11.9. Conclusions: Modular knee arthrodesis for EMD and PJI can result in successful early outcomes in terms of preventing additional operations and maintaining ambulation. While gait patterns are variable, this method for limb salvage may allow older patients the ability to ambulate.

Journal of Arthoplasty,  December 2020  Volume 35, Issue 12; Dissociation of Acetabular Polyethylene Liners With a Morse Taper Design
Asa W. Shnaekel, Wesley H. Mayes, Jeffrey B. Stambough, Paul K. Edwards, Simon C. Mears, C. Lowry Barnes
Published online: June 30, 2020