Research
Predicting Patient Discharge Disposition after Total Joint Arthroplasty in the United States
Barsoum WK, Murray TG, Klika AK, Green K, Miniaci SL, Wells BJ, Kattan MW. Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplasty 2010; 25(6):885-92.
Abstract: The purpose of this study was to develop an easily administered tool to preoperatively predict patient discharge disposition after total joint arthroplasty in the United States. Data were collected in a retrospective review of 517 medical charts and analyzed using logistic regression to develop a model for predicting the likelihood that a patient will not be discharged directly home. The resulting regression model was the basis for the nomogram, named the Predicting Location after Arthroplasty Nomogram. This model demonstrated a bootstrap-corrected concordance index of 0.867, excellent calibration, and external validation as demonstrated by a concordance index of 0.861. Preoperative knowledge that a patient is likely to require an extended care facility allows the clinical care team to make appropriate arrangements and avoid potential delays in patient discharge.
- Nomogram (graphical application of prediction regression algorithm)
- Online Calculator (numerical and clinical application of prediction regression algorithm)
Reprinted from Journal of Arthroplasty, Vol. 25(6), WK Barsoum, TG Murray, AK Klika, K Green, SL Miniaci, BJ Wells, MW Kattan, Predicting patient discharge disposition after total joint arthroplasty in the United States, pp. 885-892. Copyright 2010, with permission from Elsevier.
Preoperative Prediction of Success Following Irrigation and Debridement with Polyethylene Exchange for Hip and Knee Prosthetic Joint Infections
Buller LT, Sabry FY, Easton RW, Klika AK, Barsoum WK. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty 2012; 27(6):857-64.
Abstract: Although the criterion standard for the treatment of prosthetic joint infections (PJIs) is 2-stage revision with interim placement of an antibiotic-loaded spacer, irrigation and debridement with polyethylene exchange offer advantages such as fewer surgeries, reduced potential for intraoperative complications, and lower direct costs. The purpose of this study was to develop a tool to preoperatively predict the probability of successful infection eradication following irrigation and debridement with polyethylene exchange for hip or knee PJIs. A total of 10,411 surgical cases were retrospectively reviewed, and data were collected from 309 charts. Overall, 149 (48.2%) cases failed to eradicate the infection following irrigation and debridement with polyethylene exchange. Univariate analysis identified multiple variables independently associated with reinfection including duration of symptoms, preoperative inflammatory markers, and infecting organism. Logistic regression was used to generate a model (bootstrap-corrected concordance index of 0.645) to predict successful eradication of the infection, which was the basis for a nomogram. Using commonly obtained preoperative variables, the nomogram can be used to predict the probability of infection-free survival at 1, 2, 3, 4, and 5 years. Preoperative knowledge of the probability that a treatment strategy will eradicate a patient's PJI may improve risk assessment.
Reprinted from Journal of Arthroplasty, Vol. 27(6), LT Buller, FY Sabry, RW Easton, AK Klika, WK Barsoum, The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections, pp. 857-864. Copyright 2012, with permission from Elsevier.
Contribution of the Acetabular Labrum to Hip Joint Stability
Mutnal A, Bottros J, Colbrunn R, Butler SR, Klika AK, Barsoum WK. The contribution of the acetabular labrum to hip joint stability: a quantitative analysis using a dynamic 3-D robot model. Presented at International Society for Technology in Arthroplasty (ISTA). October 2012.
Multicenter Orthopaedic Outcomes Network (MOON) Collaboration
Cleveland Clinic's Orthopaedic & Rheumatologic Institute is one of the founding centers of a group - Vanderbilt University, Washington University (St. Louis), The Ohio State University, University of Iowa, Hospital for Special Surgery, University of Colorado - that is identifying modifiable risk factors for short-, intermediate- and long-term outcome measures after anterior cruciate ligament reconstruction.
The co-investigators are responsible for:
- 39 publications in print
- 57 presentations and posters
- Two NIH grants, and received more than $9 million in funding
The collaborators won the 2012 American Academy of Orthopaedic Surgeons Kappa Delta Award for their work.
Meniscus Tear in Osteoarthritis Research (MeTeOR) Collaboration
Meniscus Tears in Osteoarthritis Research (MeTeOR) Collaboration
The Orthopaedic & Rheumatologic Institute is collaborating with principal investigator Brigham and Women's Hospital, Boston, and several other centers on an NIH-funded study. The goals of the randomized, controlled trial are:
- To establish the efficacy of surgery compared with nonoperative therapy in patients with symptomatic meniscal tear and osteoarthritis
- To identify baseline patient characteristics associated with worse outcomes
- To conduct a cost-effectiveness analysis
Enrollment in the study (351 patients) was completed in July 2011.
Multicenter ACL Reconstruction Revision Study (MARS) Collaboration
Multicenter ACL Reconstruction Revision Study (MARS) Collaboration
Cleveland Clinic is one of the largest contributors of patients for MARS. The study, funded by the American Orthopaedic Society for Sports Medicine and the NIH:
- Is focused on identifying the causes and modifiable risk factors for worse outcomes in revision anterior cruciate ligament reconstruction
- Is led by a principal investigator from Washington University, St. Louis
- Received more than $3.5 million in funding
Innovations
Innovative Software and Virtual Bone-Modeling Techniques for Orthopaedic Implants
American Joint Replacement Registry Collaboration
Cleveland Clinic's Orthopaedic & Rheumatologic Institute is providing a leadership role in the American Joint Replacement Registry, both as a pilot study site and in the development of its data points.
- The registry is being developed for all total joint replacements performed in the USA.
- Its goals are to improve the quality and survivorship of implants.
- The registry also is investigating the comparative effectiveness of specific total joint implants.
