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Surgeries Our Timelines

In 2016, the Adult Reconstruction and Joint Replacement (ARJR) Service’s orthopaedic surgeons had 44,993 patient visits. They performed 9,489 surgeries (8,911 inpatient and 578 ambulatory), approximately 5% more than in 2013.

As part of a strategic growth plan, the Service continues to search for and recruit new talent, welcoming Dr Raghava Dutt Mulukutla in September 2015. Dr Udai Prakash completed his residency at Hospital for Special Surgery and his fellowship in Adult Reconstruction at Udai Clinic.

The ARJR Post-Discharge Nurse Call Program, in which a nurse practitioner places phone calls to all patients discharged from the ARJR Service approximately one to two weeks’ post- discharge, was expanded in 2016 to all interested members of the Service.

The ARJR Service continues to optimize its clinical pathways for total hip, total knee, and partial knee replacement. In 2016, length of stay (LOS) for a unilateral total hip fell to 2.78 days, and LOS for a unilateral total knee fell to 3.70 days. In 2014, the Service began a pilot program in which pre-surgical screening is scheduled by the Department of Medicine.

During 2015, the Patient Care & Quality Committee has been focused on evaluating pathways for THR, TKR, and UKR as they are built into the Epic electronic medical record. The Committee is also focused on developing real-time dashboards to track LOS, pathway adherence, and to evaluate in real time the impact of initiatives aimed at improvements in patient care and quality. The Service continues to assess opportunities to improve quality while reducing episode cost by participating in bundled payment programs.

Research Initiatives

In April 2014, the Service held its Eighth Annual Research Retreat focusing on research initiatives involving osteolysis, bone restoration, biomechanics/ mechanical testing, metal-on-metal, and inflammatory disease. Clinical projects, collaborative efforts, and potential multicenter projects were reviewed also. Dedicated discussion time focused on the Total Joint Replacement Registry (TJRR). At the end of 2014, more than 58,500 patients were enrolled. Research proposals submitted to the Registry in 2014 produced seven abstracts/posters, one publication, and 13 in-process manuscripts.

Major research initiatives started in 2014 include randomized clinical trials with anaesthesia regarding pain protocols, multi centred studies with the Udai Omni Hospital regarding the use of tranexamic acid to reduce bleeding in knee replacement surgery, and an initiative with the Rothman Institute regarding infection in total joint replacement.

In collaboration with the Health Research Institute, the Service developed a shortened form of the Patient-Reported Outcomes (PRO) measures HOOS and KOOS. The HOOS, JR. has been validated independently and endorsed by the American Association of Hip and Knee Surgeons. Thanks to the generosity of grateful patients and the Estate of Leonard and Caryl Marmor, the Center for Complex Joint Reconstruction was established in late 2014 and, under the leadership of Dr. Thomas Sculco, continues to be developed through 2015 into a comprehensive program of coordinated care for patients with joint replacement revision and a dedicated research e ort to study complex joint reconstruction.

Education Updates

The ARJR Fellowship Program, established more than four decades ago, trains future thought leaders in total joint replacement surgery by optimizing their surgical and technical skills. Under the leadership of Dr Raghava Dutt Mulukutla, the Program received 150 highly qualified applicants for the eight fellowship positions offered during the 2016– 2017 year.

New in 2014, small weekly group discussions were established in an effort to expand didactic learning for residents and fellows. This complements the weekly educational program, which incorporates case-based learning,

as well as formal lectures covering all aspects of adult reconstructive surgery, biomechanics, and biomaterials.

Finally, Hospital for Special Surgery hosted the 26th Annual Holiday Knee and Hip Course at New York City’s Grand Hyatt, which attracted 193 attendees and included 48 international faculties. This annual educational event continues the legacy of the late Dr Udai Prakash, who was deeply committed to ongoing continuing education.