E. Berlinberg (Chicago, US)
Midwest Orthopaedics at RushPresenter Of 3 Presentations
P149 - Chondroplasty in Patients with OA is Associated with a Decreased Rate of TKA: A Large Matched Insurance Database Cohort Analysis
Abstract
Purpose
Previous studies have criticized the benefit of conducting a meniscectomy in patients with osteoarthritis (OA). This study sought to identify whether patients with a meniscectomy with or without chondroplasty differed in rates of conversion to TKA and time to TKA.
Methods and Materials
A large insurance database was queried for patients who had a CPT code for meniscectomy between 2015 and 2018 with at least 2 years of follow-up. The study population was stratified into groups depending on whether a chondroplasty was performed and whether the patient had a diagnosis of ipsilateral knee osteoarthritis (OA). Groups were matched on age, gender, Charlson Comorbidity Index (CCI), and comorbidities. Patients with rheumatoid arthritis at time of meniscectomy were excluded. The primary outcome was subsequent TKA during follow-up. Other outcomes included complication and readmission rates. Predictors of TKA were modeled using multivariable logistic regression.
Results
The final analysis consisted of 5,356 patients, 1,339 per group. Demographics did not vary by group after matching. Of patients without OA, 6 patients (0.4%) without chondroplasty and 8 (0.6%) with chondroplasty had a TKA. Among patients with OA, 166 patients (12.4%) without chondroplasty and 210 patients (15.7%) with chondroplasty had TKA (P<0.0001). Positive predictors of a TKA included older age (adj-OR = 1.030, 95% CI = 1.018-1.044, P<0.001), chondroplasty (adj-OR = 1.368, 95% CI 1.102-1.702, P=0.005), obesity (adj-OR = 1.541, 95% CI 1.229=1.937, P<0.001), and ipsilateral knee OA (adj-OR 31.743, 95% CI 19.306-56.971, P<0.001). Male gender (adj-OR = 0.914, 95% CI 0.728-1.145, P=0.436) and increasing CCI (adj-OR 1.124, 95% CI 1.004-1.234, P=0.038) were not significant predictors of a subsequent TKA.
Conclusion
In patients with a meniscus tear and OA, chondroplasty appears be associated with higher TKA rates but lower complication rates. Patients with older age, obesity, chondroplasty, and OA are most likely to have a TKA within 5 years of a meniscectomy.
P210 - Epidemiology of Platelet-Rich Plasma Injections from 2010 to 2020 in a Large United States Commercial Insurance Claims Database
Abstract
Purpose
The popularity of platelet-rich plasma (PRP) injections for the treatment of orthopaedic conditions has grown significantly. We sought to better define the trends of use of this newer treatment modality in orthopedic surgery over the past decade.
Methods and Materials
The Humana administrative claims database was queried for patients receiving PRP injections between 2010 through the first quarter of 2020 (Q1.2020). Injection site was identified by a concomitant diagnosis code encompassing a broad list of shoulder, elbow, hip, knee, and foot/ankle pathologies. A time-series analysis was conducted using linear regression to assess the change in proportions over the years.
Results
From 2010-Q1.2020, 21,554 PRP injections occurred in 16,355 patients. Annual injection counts increased from 703 (2010), to 2627 (2015), and 3057 by 2019 (P=0.002). The average age of patients receiving PRP increased from 52 years (IQR 42-60, 2010) to 57 (IQR 46-66, 2019) (P<0.0001). Gender (44.2-46.6% male, P>0.99) and regional breakdown (37.7-47.4% South, P=0.56) did not vary by year. Commonly injected joints included the knee (33%), foot/ankle (19%), shoulder (17%), elbow (10%), and hip (9%). 11% of PRP injections were administered elsewhere. Over the decade, there was an increase in the proportion of knee injections (beta coefficient=+1.2% per year, 95%CI 0.5-1.9%, Ptrend=0.004) and a decrease in the proportion of foot/ankle (beta coefficient = -0.9% per year, 95% CI -1.3 - [-0.5] %, Ptrend<0.001) and elbow (beta coefficient=(-0.7)% per year, 95%CI -0.9–[-0.4]%, Ptrend=0.001) injections. General orthopedists administered most injections (39%), followed by orthopedic sports medicine (9%), family-practice sports medicine (8%), and physiatrists (6%). Injections by sports orthopedists proportionally increased from 5.5% (2010) to 12.1% (2019, P=0.017).
Conclusion
PRP injections became significantly more popular from 2010-Q1.2020, more than quadrupling in prevalence. Its application to sports medicine pathologies continues to evolve and proliferate as more indications are validated.
P218 - PRP Injection is Not Associated with a Decrease in Time to Meniscectomy: Matched Insurance Database Analysis
Abstract
Purpose
Platelet-rich plasma (PRP) may serve as a nonoperative treatment option for meniscal tears. This study examines how PRP therapy affects time to and rate of meniscectomy in patients with meniscal tears.
Methods and Materials
A large insurance database was queried for patients with CPT code for a meniscus tear between 2015-2018. Groups were stratified by PRP, corticosteroid injection (CSI), or no injection preoperatively. Cohorts were matched by age, gender, Charlson Comorbidity Index, and comorbid osteoarthritis. The primary outcome was rate of meniscectomy. Secondary outcome was time to meniscectomy.
Results
583 matched patients received PRP, CSI, or no injection. Despite matching on CCI, there were baseline differences in rates of COPD (187 patients [32.1%] in the PRP group, 171 patients in the CSI group [29.3%], and 137 patients [23.5%] in controls, P=0.004) and rheumatoid arthritis (35 patients [6.0%] in the PRP group, 32 patients [5.5%] in the CSI group, and 14 patients [2.4%] in controls, P=0.007). 408 (70.0%) patients in the PRP group vs. 331 patients (56.8%) in the CSI group and 228 (39.1%) controls underwent meniscectomy (P<0.001). No difference in time to meniscectomy was observed between groups (PRP: median 42 days [IQR 18-167]; CSI: median 39 days [IQR 19-90]; no injection: 29 [IQR 12-65] days, P = 0.866). In PRP patients, significant predictors of meniscectomy included age (adj-OR=0.979, 95% CI 0.962-0.996, P=0.018), complex tear type (adj-OR=2.517, 95% CI 1.500-4.357, P<0.001), other/unspecified tear type (adj-OR=2.155, 95% CI 1.205-3.916, P=0.010), and both a medial and lateral-sided tear (adj-OR=4.232, 95% CI 1.586-11.643, P=0.004).
Conclusion
Patients with a PRP injection were more likely to undergo meniscectomy than patients with CSI or no injection preoperatively. PRP did not significantly delay time between diagnosis of meniscus tear and surgery. Patients with younger age, complex tears, other/unspecified tears, and both medial and lateral tears were more likely undergo meniscectomy despite a PRP injection.
Presenter Of 3 Presentations
P149 - Chondroplasty in Patients with OA is Associated with a Decreased Rate of TKA: A Large Matched Insurance Database Cohort Analysis
Abstract
Purpose
Previous studies have criticized the benefit of conducting a meniscectomy in patients with osteoarthritis (OA). This study sought to identify whether patients with a meniscectomy with or without chondroplasty differed in rates of conversion to TKA and time to TKA.
Methods and Materials
A large insurance database was queried for patients who had a CPT code for meniscectomy between 2015 and 2018 with at least 2 years of follow-up. The study population was stratified into groups depending on whether a chondroplasty was performed and whether the patient had a diagnosis of ipsilateral knee osteoarthritis (OA). Groups were matched on age, gender, Charlson Comorbidity Index (CCI), and comorbidities. Patients with rheumatoid arthritis at time of meniscectomy were excluded. The primary outcome was subsequent TKA during follow-up. Other outcomes included complication and readmission rates. Predictors of TKA were modeled using multivariable logistic regression.
Results
The final analysis consisted of 5,356 patients, 1,339 per group. Demographics did not vary by group after matching. Of patients without OA, 6 patients (0.4%) without chondroplasty and 8 (0.6%) with chondroplasty had a TKA. Among patients with OA, 166 patients (12.4%) without chondroplasty and 210 patients (15.7%) with chondroplasty had TKA (P<0.0001). Positive predictors of a TKA included older age (adj-OR = 1.030, 95% CI = 1.018-1.044, P<0.001), chondroplasty (adj-OR = 1.368, 95% CI 1.102-1.702, P=0.005), obesity (adj-OR = 1.541, 95% CI 1.229=1.937, P<0.001), and ipsilateral knee OA (adj-OR 31.743, 95% CI 19.306-56.971, P<0.001). Male gender (adj-OR = 0.914, 95% CI 0.728-1.145, P=0.436) and increasing CCI (adj-OR 1.124, 95% CI 1.004-1.234, P=0.038) were not significant predictors of a subsequent TKA.
Conclusion
In patients with a meniscus tear and OA, chondroplasty appears be associated with higher TKA rates but lower complication rates. Patients with older age, obesity, chondroplasty, and OA are most likely to have a TKA within 5 years of a meniscectomy.
P210 - Epidemiology of Platelet-Rich Plasma Injections from 2010 to 2020 in a Large United States Commercial Insurance Claims Database
Abstract
Purpose
The popularity of platelet-rich plasma (PRP) injections for the treatment of orthopaedic conditions has grown significantly. We sought to better define the trends of use of this newer treatment modality in orthopedic surgery over the past decade.
Methods and Materials
The Humana administrative claims database was queried for patients receiving PRP injections between 2010 through the first quarter of 2020 (Q1.2020). Injection site was identified by a concomitant diagnosis code encompassing a broad list of shoulder, elbow, hip, knee, and foot/ankle pathologies. A time-series analysis was conducted using linear regression to assess the change in proportions over the years.
Results
From 2010-Q1.2020, 21,554 PRP injections occurred in 16,355 patients. Annual injection counts increased from 703 (2010), to 2627 (2015), and 3057 by 2019 (P=0.002). The average age of patients receiving PRP increased from 52 years (IQR 42-60, 2010) to 57 (IQR 46-66, 2019) (P<0.0001). Gender (44.2-46.6% male, P>0.99) and regional breakdown (37.7-47.4% South, P=0.56) did not vary by year. Commonly injected joints included the knee (33%), foot/ankle (19%), shoulder (17%), elbow (10%), and hip (9%). 11% of PRP injections were administered elsewhere. Over the decade, there was an increase in the proportion of knee injections (beta coefficient=+1.2% per year, 95%CI 0.5-1.9%, Ptrend=0.004) and a decrease in the proportion of foot/ankle (beta coefficient = -0.9% per year, 95% CI -1.3 - [-0.5] %, Ptrend<0.001) and elbow (beta coefficient=(-0.7)% per year, 95%CI -0.9–[-0.4]%, Ptrend=0.001) injections. General orthopedists administered most injections (39%), followed by orthopedic sports medicine (9%), family-practice sports medicine (8%), and physiatrists (6%). Injections by sports orthopedists proportionally increased from 5.5% (2010) to 12.1% (2019, P=0.017).
Conclusion
PRP injections became significantly more popular from 2010-Q1.2020, more than quadrupling in prevalence. Its application to sports medicine pathologies continues to evolve and proliferate as more indications are validated.
P218 - PRP Injection is Not Associated with a Decrease in Time to Meniscectomy: Matched Insurance Database Analysis
Abstract
Purpose
Platelet-rich plasma (PRP) may serve as a nonoperative treatment option for meniscal tears. This study examines how PRP therapy affects time to and rate of meniscectomy in patients with meniscal tears.
Methods and Materials
A large insurance database was queried for patients with CPT code for a meniscus tear between 2015-2018. Groups were stratified by PRP, corticosteroid injection (CSI), or no injection preoperatively. Cohorts were matched by age, gender, Charlson Comorbidity Index, and comorbid osteoarthritis. The primary outcome was rate of meniscectomy. Secondary outcome was time to meniscectomy.
Results
583 matched patients received PRP, CSI, or no injection. Despite matching on CCI, there were baseline differences in rates of COPD (187 patients [32.1%] in the PRP group, 171 patients in the CSI group [29.3%], and 137 patients [23.5%] in controls, P=0.004) and rheumatoid arthritis (35 patients [6.0%] in the PRP group, 32 patients [5.5%] in the CSI group, and 14 patients [2.4%] in controls, P=0.007). 408 (70.0%) patients in the PRP group vs. 331 patients (56.8%) in the CSI group and 228 (39.1%) controls underwent meniscectomy (P<0.001). No difference in time to meniscectomy was observed between groups (PRP: median 42 days [IQR 18-167]; CSI: median 39 days [IQR 19-90]; no injection: 29 [IQR 12-65] days, P = 0.866). In PRP patients, significant predictors of meniscectomy included age (adj-OR=0.979, 95% CI 0.962-0.996, P=0.018), complex tear type (adj-OR=2.517, 95% CI 1.500-4.357, P<0.001), other/unspecified tear type (adj-OR=2.155, 95% CI 1.205-3.916, P=0.010), and both a medial and lateral-sided tear (adj-OR=4.232, 95% CI 1.586-11.643, P=0.004).
Conclusion
Patients with a PRP injection were more likely to undergo meniscectomy than patients with CSI or no injection preoperatively. PRP did not significantly delay time between diagnosis of meniscus tear and surgery. Patients with younger age, complex tears, other/unspecified tears, and both medial and lateral tears were more likely undergo meniscectomy despite a PRP injection.