Horn Maggie E, George Steven Z, Giczewska Anna, Alhanti Brooke, Tanner Irene L, Bolognesi Michael P
Department of Orthopaedic Surgery, Duke University, Durham, NC, 27710, USA.
Department of Population Health Sciences, Duke University, Durham, NC, 27701, USA.
Arthroplasty. 2025 May 6;7(1):24. doi: 10.1186/s42836-025-00309-y.
Outcomes from Total Joint Arthroplasty (TJA) are variable but generally favorable. However, the literature is lacking regarding direct comparisons of important outcomes across TJA sites. Such comparisons are of paramount importance to informing future bundled care reform and patient optimization. Thus, we compared the rates of adverse events, filled prescriptions, and costs at 90 days and 365 days after TJA for knee, hip, and shoulder patients.
We conducted a retrospective cohort study of multi-payor claims data with patients (n = 2416) who underwent hip (n = 909), knee (n = 1250), or shoulder (n = 257) TJA within an academic health system. Univariable and multivariable logistic regression models were used to assess the association between the TJA surgical site and adverse events (i.e., medical and surgical complications) and prescriptions filled. Univariable and multivariable gamma regression models were used to assess the association between the TJA surgical site and total cost and surgical episode cost.
In all regression models, the hip location was used as the reference group. There were no differences in the adjusted odds of medical complications between the TJA surgical sites after adjusting for confounders at 90 days or 365 days. For surgical complications, the adjusted odds were 2.66 times higher in the knee (P < 0.001) and 4.48 times higher in the shoulder (P < 0.001) at 90 days. At 365 days, the odds were 2.54 times higher in the knee (P < 0.001) and 4.10 times higher in the shoulder (P < 0.001). There was an increase in the adjusted odds of antiepileptic and NSAIDS being filled in knee and shoulder patients compared to hip patients at 31-90 days (both P < 0.001). At 0-365 days, knee patients had increased adjusted odds of filled antibiotic (P = 0.032), antiepileptic (P = 0.001), and opioid (P = 0.005) prescriptions compared to hip patients, while shoulder patients only increased odds of antiepileptic (P = 0.028). Lastly, in adjusted models, both the knee and shoulder had a significant increase in total health system costs, with a 9% and 14% increase in cost, respectively (P < 0.01).
Patients undergoing TKA and TSA may have an increased risk for surgical complications and longer-term opioid prescriptions (TKA only) compared to those undergoing THA. Collectively, these results can inform future population-based approaches to managing osteoarthritis care pathways or reimbursement policies for TJA across multiple joint sites.
全关节置换术（TJA）的结果存在差异，但总体良好。然而，关于TJA不同部位重要结果的直接比较，文献中较为缺乏。此类比较对于指导未来的综合护理改革和患者优化至关重要。因此，我们比较了膝关节、髋关节和肩关节TJA患者术后90天和365天的不良事件发生率、处方配药情况及费用。
我们对一个学术医疗系统中接受髋关节（n = 909）、膝关节（n = 1250）或肩关节（n = 257）TJA的患者（n = 2416）的多支付方索赔数据进行了回顾性队列研究。使用单变量和多变量逻辑回归模型评估TJA手术部位与不良事件（即医疗和手术并发症）及处方配药之间的关联。使用单变量和多变量伽马回归模型评估TJA手术部位与总成本和手术期间成本之间的关联。
在所有回归模型中，以髋关节部位作为参照组。在调整混杂因素后，90天或365天时，TJA各手术部位的医疗并发症调整后比值无差异。对于手术并发症，90天时，膝关节的调整后比值高2.66倍（P < 0.001），肩关节高4.48倍（P < 0.001）。365天时，膝关节的比值高2.54倍（P < 0.001），肩关节高4.10倍（P < 0.001）。在31 - 90天，与髋关节患者相比，膝关节和肩关节患者的抗癫痫药和非甾体抗炎药处方配药调整后比值增加（均P < 0.001）。在0 - 365天，与髋关节患者相比，膝关节患者的抗生素（P = 0.032）、抗癫痫药（P = 0.001）和阿片类药物（P = 0.005）处方配药调整后比值增加，而肩关节患者仅抗癫痫药处方配药比值增加（P = 0.028）。最后，在调整模型中，膝关节和肩关节的医疗系统总成本均显著增加，成本分别增加9%和14%（P < 0.01）。
与接受全髋关节置换术（THA）的患者相比，接受全膝关节置换术（TKA）和全肩关节置换术（TSA）的患者手术并发症风险可能增加，且膝关节置换患者有长期阿片类药物处方（仅TKA）。总体而言，这些结果可为未来基于人群的骨关节炎护理路径管理方法或多关节部位TJA的报销政策提供参考。
