Total knee arthroplasty (TKA) is increasingly being performed in younger adults, although most published data have focused on older populations. This study aimed to describe the clinical characteristics, etiologies, and inpatient outcomes of TKA in patients aged 18–54 years using a large national database. We performed a retrospective descriptive analysis of TKA hospitalizations in patients aged 18–54 years using the Nationwide Inpatient Sample (2016–2019). Patients were identified using ICD-10 procedural codes. Age groups were compared with respect to etiologies, demographics, comorbidities, in-hospital complications, length of stay, and total hospital charges. Statistical analyses were based on weighted frequencies, chi-square tests, and t tests. Primary osteoarthritis was the most common indication across all age groups. Patients aged 18-34.9 years had the highest proportion of Medicaid coverage and the highest proportion of post-traumatic and inflammatory etiologies. In unadjusted analyses, this youngest group also had the longest mean hospital stay and the highest mean total hospital charges, as well as higher rates of blood loss anemia and blood transfusion. In-hospital mortality was rare and did not differ significantly across age groups. In this nationwide inpatient descriptive analysis, younger adults undergoing TKA demonstrated distinct etiologic, demographic, and comorbidity profiles, with unadjusted differences in in-hospital complications and healthcare utilization across age groups. These findings should be interpreted cautiously because the study was limited to inpatient outcomes and did not include multivariable adjustment or longitudinal follow-up.
D. Maman, L. Laver, Yaniv Steinfeld et al.· Discover medicine· 0 citations
Navigation-guided total hip arthroplasty (THA) has been increasingly adopted to improve implant positioning and early outcomes; however, its population-level clinical and economic impact remains uncertain.
Using the Nationwide Readmissions Database (NRD) (2020–2022), elective primary THA performed on hospital day 0 was identified in this study. Navigation-guided cases were compared with conventional THA. A 1:5 propensity score–matched cohort was constructed adjusting for demographics, payer, comorbidities, calendar year, and hospital characteristics. Primary outcomes included index hospitalization complications and 90-day readmission with readmission-associated procedural escalation. Readmission resource utilization and modeled 100-case episode-of-care costs were assessed.
Among 366,375 elective THA procedures, navigation use increased from 2.9% (2020) to 4.3% (2022). In the matched cohort (
n
= 77,214), navigation was associated with shorter length of stay and lower rates of intraoperative fracture, blood loss anemia, acute kidney injury, and hip dislocation (all
p
< 0.01). Ninety-day readmission was lower with navigation (3.6% vs. 4.9%; odds ratio 0.72, 95% confidence interval 0.65–0.79), as were early revision and reoperation events. However, index hospitalization charges were higher (+$15,384 per case), and a modeled episode-of-care analysis did not demonstrate cost offset within 90 days.
Navigation-guided elective THA was associated with improved short-term outcomes but higher upfront charges. Because the NRD does not capture surgical approach, implant positioning, implant-specific details, surgeon volume, or longer-term outcomes, these findings should be interpreted as hypothesis-generating associations rather than definitive evidence of a causal technology effect.
D. Maman, Yaniv Steinfeld, Y. Berkovich· Frontiers in Surgery· 0 citations
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