Download Free Medical Modes of Failure in Revision Hip and Knee Replacement PowerPoint Presentation

Modes of Failure in Revision Hip and Knee Replacement PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Orthopedic Surgery, which is titled "Modes of Failure in Revision Hip and Knee Replacement", to know about Hip and Knee Replacement.

Tags : Orthopedic Surgery, Hip, Knee, Replacement

Published on : Jul 20, 2021 | Views : 2474 | Downloads : 3

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Modes of Failure in Revision Hip and Knee Replacement Kevin J. Bozic, MD, MBA Harry E. Rubash, MD J. Berry, MD Khaled J. Saleh, MD, MPH Sridhar M. Durbhakula, MD
Slide 2-

“It’s like déjà vu all over again!”
Slide 3-

Background Total joint replacement is one of the most commonly performed and successful operations in orthopaedics as defined by clinical outcomes and implant survivorship* *
Slide 4-

Background Total joint replacement (TJR) is one of the most cost-effective procedures in all of medicine.
Slide 5-

TJA Volume Estimates
Slide 6-

Source: AHRQ, HCUPnet, 2002 Nationwide Inpatient Sample, http://hcup.ahrq.gov/HCUPnet.asp, site accessed on July 26, 2004. Total Hip Replacement is sum of ICD9-CM Procedure Codes 81.51 and 81.53. 81.51 Total Hip Replacement, 81.53 Revise Hip Replacement. NIS data is collected for calendar years (January – December). Routine discharge is discharge to home only. Discharge to another institution includes discharge to SNF and IRF. U.S. TJR Payer Mix
Slide 7-

DRG 209/471: 1998-2002 % of Medicare Discharges % of Medicare Inpatient Charges
Slide 8-

TJR Failure Despite the success achieved with most primary TJR procedures, factors related to implant longevity and a younger, more active patient population have led to a steady increase in the number of failed TJR’s
Slide 9-

Problem with Current ICD-9-CM Diagnosis Codes Currently, all failed TJR’s are coded as either: 996.4 Mechanical complication of an internal orthopedic device, implant, or graft: Mechanical complications involving external fixation device using internal screw(s), pin(s), or other methods of fixation; grafts of bone, cartilage, muscle, or tendon; internal fixation device such as nail, plate, rod, etc. 996.6 Infection and inflammatory reaction due to internal joint prosthesis
Slide 10-

Problem with Current ICD-9-CM Diagnosis Codes New technologies and surgical techniques are constantly being introduced into the marketplace Despite careful laboratory testing, a certain percentage of new technologies are associated with higher rates of clinical failure Current ICD-9-CM Diagnosis codes limit our ability to track clinical outcomes and complications related to new techniques and technologies in TJR
Slide 11-

TJA: Indications
Slide 12-

Arthritis—Background Arthritis is the second most common chronic condition in the US (sinusitis is first) Most common among elderly 20-30% of people over age 70 suffer from osteoarthritis (OA) of the hip Arthritis affects over 32 million people in the US Total costs associated with arthritis are over $82B/year, including hospital and drug costs, nursing home costs, and lost productivity and work
Slide 13-

Treatment Options: Non-operative Activity Modification Weight Loss Cane/walker Physical Therapy Medications: NSAIDs COX-2 Inhibitors Nutritional supplements Injections: Corticosteroid Viscosupplementation
Slide 14-

Surgical Treatment Options Joint preserving operations Arthroscopy Cartilage transplantation Osteotomy Arthroplasty Options: Hemiarthroplasty Resurfacing arthroplasty Total joint arthroplasty
Slide 15-

Goals of Joint Replacement Surgery Relieve pain!!! Restore function, mobility
Slide 16-

Anatomy—Hip
Slide 17-

THA Implants
Slide 18-

Implant Choice Cemented: Elderly (>65) Low demand Better early fixation ? late loosening
Slide 19-

Implant Choice Cementless: Younger More active Protected weight-bearing first 6 weeks ? Better long-term fixation
Slide 20-

Technique: Total Hip Replacement Femoral neck resection
Slide 21-

Technique: Total Hip Replacement Acetabular reaming Insertion of acetabular component
Slide 22-

Technique: Total Hip Replacement Reaming/broaching of femoral component Insertion of femoral component
Slide 23-

Technique: Total Hip Replacement Femoral head impaction Final implant
Slide 24-

Anatomy—Knee
Slide 25-

Knee Replacement—Implants Patellar component
Slide 26-

Knee Replacement—Bone Cuts
Slide 27-

Knee Replacement—Implants
Slide 28-

Knee Replacement—Implants
Slide 29-

Causes of TJR Failure Wear of articular bearing surface Aseptic/mechanical loosening Osteolysis Infection Instability Peri-prosthetic fracture Implant Failure
Slide 30-

Timing of TJR Failure Early (<10%) Dislocation Infection Implant failure Late (> 5 yrs post op) Wear of articular bearing surface Osteolysis Mechanical loosening Peri-prosthetic fracture
Slide 31-

Dislocation/Instability
Slide 32-

Infection
Slide 33-

Wear of Articular Bearing Surface
Slide 34-

Osteolysis
Slide 35-

Aseptic/Mechanical Loosening
Slide 36-

Peri-Prosthetic Fracture Sri: PP fracture
Slide 37-

Implant Failure
Slide 38-

Major Osseous Defects
Slide 39-

Major Osseous Defects
Slide 40-

Benefits of Revised Codes MEDPAR database Robust source of data for evaluating clinical outcomes, complication rates, and resource utilization in TJR However, current ICD-9 codes do not distinguish between the type of orthopedic device failure or the cause of TJR failure
Slide 41-

Benefits of Revised Codes Ability to specify the cause of implant failure Ability to evaluate implant-specific TJR failure rates => refine indications, surgical technique, and implant choice Facilitates steady, continuous quality improvement by shortening the time span for detection of poor performance of new techniques and technologies
Slide 42-

Benefits of Revised Codes American Joint Replacement Registry(AJRR) Goals Accurately define the epidemiology of TJR in the U.S. Identify risk factors for poor outcomes To improve outcomes through continuous feedback to participating centers and surgeons The success of this project is critically dependent on having revised ICD-9-CM Codes that differentiate between different modes of failure in TJA!!
Slide 43-

Benefits of Revised Codes Credited with substantially reducing revision rates through early identification of failures Revision rate of 8% (vs. 17% in U.S.) Estimated that over 11,000 revisions have been avoided Direct cost savings of $140 million
Slide 44-

Summary Hip and knee replacement are commonly performed and highly successful operations Most TJR’s last 10-15 years or more
Slide 45-

Summary When failure does occur, the type and cause of failure will determine the type of revision joint replacement procedure performed (partial vs. total)
Slide 46-

Summary Current ICD-9-CM Diagnosis codes do not provide any information regarding the type or cause of implant failure Revised codes will benefit patients, providers, and payors by facilitating continuous feedback and improvement in clinical outcomes in TJR
Slide 47-

Thank You!!!
Slide 48-

Questions??