2024
Impact of Atopic Dermatitis (Eczema) and Its Treatment on the Risk of Adverse Events Following Total Knee Arthroplasty
Smith-Voudouris J, Dhodapkar M, Halperin S, Cohen J, Grauer J. Impact of Atopic Dermatitis (Eczema) and Its Treatment on the Risk of Adverse Events Following Total Knee Arthroplasty. JAAOS Global Research And Reviews 2024, 8: e23.00267. PMID: 39436712, PMCID: PMC11498930, DOI: 10.5435/jaaosglobal-d-23-00267.Peer-Reviewed Original ResearchConceptsAtopic dermatitisAdverse eventsOdds of pneumoniaTotal knee arthroplastyPerioperative outcomes of patientsModerate-to-severe diseaseIncreased oddsEmergency departmentUrinary tract infectionChronic inflammatory skin conditionOutcomes of patientsLog-rank testRisk of adverse eventsInflammatory skin conditionIncreased odds of pneumoniaKnee arthroplastyTotal knee arthroplasty patientsPerioperative outcomesImmunosuppressive medicationsTract infectionsAggregate adverse eventsAdult patientsImpact of atopic dermatitisPatient characteristicsMultivariate analysisRisk of Postoperative Complications After Total Hip and Total Knee Arthroplasty in Behcet Syndrome Patients
Ratnasamy P, Diatta F, Allam O, Kauke-Navarro M, Grauer J. Risk of Postoperative Complications After Total Hip and Total Knee Arthroplasty in Behcet Syndrome Patients. JAAOS Global Research And Reviews 2024, 8: e24.00040. PMID: 39392934, PMCID: PMC11469891, DOI: 10.5435/jaaosglobal-d-24-00040.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBehcet SyndromeFemaleHumansMaleMiddle AgedPostoperative ComplicationsReoperationRetrospective StudiesRisk FactorsConceptsBehcet's syndromeAdverse eventsTotal knee arthroplastyMultivariate analysisRevision surgeryRisk of postoperative complicationsRisk of perioperative adverse eventsTotal hip arthroplastyLog-rank testElixhauser Comorbidity Index scoreRetrospective cohort studyMultisystem autoimmune disorderPostoperative adverse eventsPerioperative adverse eventsComorbidity Index scoreNational administrative databaseKnee arthroplastyTotal knee arthroplasty patientsPostoperative complicationsNo significant differencePatient ageAutoimmune disordersPerioperative managementSyndrome patientsCohort study
2023
Patients With Down Syndrome and Total Hip and Total Knee Arthroplasty: Outcome Measures Show Increased Risk of Perioperative Complications
Halperin S, Dhodapkar M, Radford Z, Frumberg D, Rubin L, Grauer J. Patients With Down Syndrome and Total Hip and Total Knee Arthroplasty: Outcome Measures Show Increased Risk of Perioperative Complications. JAAOS Global Research And Reviews 2023, 7: e23.00108. PMID: 38054749, PMCID: PMC10697628, DOI: 10.5435/jaaosglobal-d-23-00108.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipArthroplasty, Replacement, KneeDown SyndromeHumansOsteoarthritisOutcome Assessment, Health CarePostoperative ComplicationsConceptsTotal knee arthroplastyTotal hip arthroplastyAcute kidney injuryUrinary tract infectionAdverse eventsDown syndromePostoperative eventsKnee arthroplastyRevision ratePerioperative risk assessmentMinor adverse eventsOutcomes of patientsMultivariable logistic regressionTotal joint arthroplastyPatient/family counselingKidney injuryPerioperative complicationsTKA patientsAdult patientsTract infectionsDS patientsIncreased riskTotal hipCare pathwayJoint arthroplastyRates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction
Kahan J, Burroughs P, Petit L, Schneble C, Joo P, Moran J, Modrak M, Mclaughlin W, Nasreddine A, Grauer J, Medvecky M. Rates of subsequent surgeries after meniscus repair with and without concurrent anterior cruciate ligament reconstruction. PLOS ONE 2023, 18: e0294964. PMID: 38015977, PMCID: PMC10684064, DOI: 10.1371/journal.pone.0294964.Peer-Reviewed Original ResearchMeSH KeywordsAnterior Cruciate Ligament InjuriesAnterior Cruciate Ligament ReconstructionArthroplasty, Replacement, KneeHumansKnee JointMenisci, TibialMeniscusConceptsConcurrent anterior cruciate ligament reconstructionAnterior cruciate ligament reconstructionSecondary surgery rateCruciate ligament reconstructionSurgery ratesMeniscus repairLigament reconstructionKnee surgeryArthroscopic anterior cruciate ligament reconstructionMeniscal repairSecondary surgical proceduresLarge national databaseLarge patient databaseSubsequent surgerySecondary proceduresSecondary surgeryLarge cohortSurgical proceduresPatient databasePatientsSurgeryCohortNational databaseSignificant differencesRepairTotal Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement
Halperin S, Dhodapkar M, Radford Z, Li M, Rubin L, Grauer J. Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement. The Journal Of Arthroplasty 2023, 38: 2259-2263. PMID: 37279847, DOI: 10.1016/j.arth.2023.05.072.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansMedicaidMedicarePatient ReadmissionUnited StatesConceptsTotal knee arthroplastyTKA patientsPrimary total knee arthroplastyPostoperative emergency departmentPostoperative adverse eventsRisk of readmissionMultivariable linear regressionPerioperative periodPostoperative eventsAdverse eventsAppropriate patientsKnee osteoarthritisEmergency departmentPatients surgeryKnee arthroplastyOncologic indicationsCost-containment strategiesSurgical proceduresExclusion criteriaPatientsOptimize deliveryOverall reimbursementAdmissionReimbursementGreater increaseMagnetic Resonance Imaging in the Year Prior to Total Knee Arthroplasty: A Potential Overutilization of Healthcare Resources
Rudisill K, Ratnasamy P, Joo P, Rubin L, Grauer J. Magnetic Resonance Imaging in the Year Prior to Total Knee Arthroplasty: A Potential Overutilization of Healthcare Resources. JAAOS Global Research And Reviews 2023, 7: e22.00262. PMID: 37205731, PMCID: PMC10566819, DOI: 10.5435/jaaosglobal-d-22-00262.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, KneeDelivery of Health CareFemaleHumansKnee JointMagnetic Resonance ImagingMedicareUnited StatesConceptsTotal knee arthroplastyMagnetic resonance imagingElixhauser Comorbidity IndexComorbidity indexKnee arthroplastyDegenerative changesHigher Elixhauser comorbidity indexAdvanced degenerative changesLower extremity magnetic resonance imagingExtremity magnetic resonance imagingEvidence-based medicineRacial/Ethnic Disparities in Physical Therapy Utilization After Total Knee Arthroplasty
Ratnasamy P, Oghenesume O, Rudisill K, Grauer J. Racial/Ethnic Disparities in Physical Therapy Utilization After Total Knee Arthroplasty. Journal Of The American Academy Of Orthopaedic Surgeons 2023, 31: 357-363. PMID: 36735406, PMCID: PMC10038831, DOI: 10.5435/jaaos-d-22-00733.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, KneeEthnicityHealthcare DisparitiesHumansMedicarePatient Acceptance of Health CarePhysical Therapy ModalitiesUnited StatesConceptsTotal knee arthroplastyRace/ethnicityPhysical therapyLower household incomeKnee arthroplastyUtilization of PTPatient race/ethnicityPhysical therapy utilizationRacial/Ethnic DisparitiesElixhauser Comorbidity IndexHealth administrative dataOutpatient physical therapyPatient demographic factorsCommon orthopaedic proceduresMedicare data setExpansion of careHousehold incomeComorbidity indexTKA patientsPredictive factorsTherapy utilizationMedicare patientsOrthopedic proceduresPatientsLevel III
2022
Admission NarxCare Narcotic Scores Are Associated With Increased Odds of Readmission and Prolonged Length of Hospital Stay After Primary Elective Total Knee Arthroplasty
Galivanche A, Zhu J, Mercier M, McLean R, Wilhelm C, Varthi A, Grauer J, Rubin L. Admission NarxCare Narcotic Scores Are Associated With Increased Odds of Readmission and Prolonged Length of Hospital Stay After Primary Elective Total Knee Arthroplasty. JAAOS Global Research And Reviews 2022, 6: e22.00040. PMID: 36732305, PMCID: PMC9726283, DOI: 10.5435/jaaosglobal-d-22-00040.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, KneeHospitalizationHumansLength of StayNarcoticsPatient ReadmissionConceptsPrimary elective total knee arthroplastyElective total knee arthroplastyTotal knee arthroplastyNarcotic scoreOverall opioid usageAdverse eventsTKA patientsHospital stayKnee arthroplastyRisk of AEsOdds of readmissionPrimary TKA patientsPreoperative narcotic useTime of admissionDose-dependent increaseOpioid usagePostoperative outcomesPatient characteristicsProlonged lengthNarcotic useAdverse outcomesSingle institutionRevision surgeryReadmissionPatientsAdverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study
Maloy GC, Kammien AJ, Rubin LE, Grauer JN. Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study. The Journal Of Arthroplasty 2022, 38: 525-529. PMID: 36272511, DOI: 10.1016/j.arth.2022.10.020.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood TransfusionDatabases, FactualFemaleHumansMalePostoperative ComplicationsRetrospective StudiesRisk FactorsConceptsTotal hip arthroplastyPostoperative adverse eventsAdverse eventsDay of surgeryHip arthroplastyDays of THAHigher Elixhauser-Comorbidity Index scoresElixhauser comorbidity index scoreComorbidity Index scoreLate adverse eventsTime of diagnosisPostoperative day 31THA patientsPredictive factorsPatient counselingPatient riskDatabase studyPrevention strategiesIndex scoreDay 31SurgeryInterquartile rangeAdministrative datasetsPatientsArthroplastyJump in Elective Total Hip and Knee Arthroplasty Numbers at Age 65 Years: Evidence for Moral Hazard?
Rankin KA, Freedman IG, Moore HG, Halperin SJ, Rubin LE, Grauer JN. Jump in Elective Total Hip and Knee Arthroplasty Numbers at Age 65 Years: Evidence for Moral Hazard? JAAOS Global Research And Reviews 2022, 6: e22.00035. PMID: 35315795, PMCID: PMC8942773, DOI: 10.5435/jaaosglobal-d-22-00035.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeFemaleHumansMaleMedicareMoralsPostoperative ComplicationsRetrospective StudiesUnited StatesConceptsTotal knee arthroplastyTotal hip arthroplastyAge 65 yearsNational Surgical Quality Improvement Program databaseIncidence of TKAElective total knee arthroplastyQuality Improvement Program databaseLower body mass indexElective total hipPostoperative adverse eventsPreoperative American SocietyImprovement Program databaseLower functional statusBody mass indexNon-Hispanic whitesNumber of proceduresAnesthesiologists classPreoperative characteristicsOlder patientsAdverse eventsTHA patientsMass indexTotal hipFunctional statusKnee arthroplastyTotal Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival
Gillinov SM, Burroughs PJ, Moore HG, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival. The Journal Of Arthroplasty 2022, 37: 1333-1337. PMID: 35257821, PMCID: PMC9177736, DOI: 10.1016/j.arth.2022.02.107.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHematomaHemophilia AHumansPostoperative ComplicationsPulmonary EmbolismRetrospective StudiesRisk FactorsVenous ThromboembolismVenous ThrombosisConceptsTotal hip arthroplastyNon-hemophilia patientsMinor adverse eventsSerious adverse eventsAdverse eventsClassic hemophiliaHaemophilia patientsImplant survivalHip arthroplastyGreater oddsMultivariate analysisFive-year implant survivalPrimary total hip arthroplastyAcute kidney injuryVenous thromboembolism prophylaxisElixhauser Comorbidity IndexKaplan-Meier analysisEvidence-based guidelinesThromboembolism prophylaxisVTE prophylaxisComorbidity indexKidney injuryTHA patientsFactor replacementRetrospective study
2021
What Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients
Moore HG, Schneble CA, Kahan JB, Sculco PK, Grauer JN, Rubin LE. What Factors Affect Whether Patients Return to the Same Surgeon to Replace the Contralateral Joint? A Study of Over 200,000 Patients. The Journal Of Arthroplasty 2021, 37: 425-430. PMID: 34871749, DOI: 10.1016/j.arth.2021.11.036.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansMedicaidMedicareRetrospective StudiesRisk FactorsSurgeonsUnited StatesConceptsBilateral total hip arthroplastyTotal knee arthroplastyTotal hip arthroplastyContralateral total hip arthroplastySame surgeonDifferent surgeonsAdverse eventsContralateral jointGreater oddsSurgery-related adverse eventsBilateral total knee arthroplastyNational Provider Identifier numberFirst joint replacementFirst total hip arthroplastyPossible independent predictorsContralateral replacementIndependent predictorsSicker patientsKnee arthroplastyAdministrative databasesHip arthroplastyLower oddsPatientsArthroplastyJoint replacementRevision Total Hip and Knee Arthroplasty are Associated With Lower Hospital Consumer Assessment of Healthcare Providers and Systems Patient Satisfaction Scores Compared With Primary Arthroplasty
Mercier MR, Galivanche AR, Pathak N, Mets EJ, Molho DA, Elaydi AH, Grauer JN, Rubin LE. Revision Total Hip and Knee Arthroplasty are Associated With Lower Hospital Consumer Assessment of Healthcare Providers and Systems Patient Satisfaction Scores Compared With Primary Arthroplasty. Journal Of The American Academy Of Orthopaedic Surgeons 2021, 30: e336-e346. PMID: 34851861, DOI: 10.5435/jaaos-d-21-00839.Peer-Reviewed Original ResearchMeSH KeywordsAdultArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHealth PersonnelHospitalsHumansPatient SatisfactionRetrospective StudiesConceptsRevision total hip arthroplastyTotal knee arthroplastyTotal hip arthroplastyRevision THA patientsHospital Consumer AssessmentTHA patientsHCAHPS surveyHCAHPS scoresTKA patientsKnee arthroplastyRevision proceduresHealthcare providersPrimary total joint arthroplastyPrimary total knee arthroplastyPrimary total hip arthroplastyConsumer AssessmentLonger hospital lengthRevision TKA patientsHigher American SocietyPatient satisfaction outcomesPatient satisfaction scoresRate of revisionRevision total hipTotal joint arthroplastySystems Patient Satisfaction ScoresHospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty
Mercier MR, Galivanche AR, David WB, Malpani R, Pathak N, Hilibrand AS, Rubin LE, Grauer JN. Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty. PLOS ONE 2021, 16: e0257555. PMID: 34582475, PMCID: PMC8478166, DOI: 10.1371/journal.pone.0257555.Peer-Reviewed Original ResearchConceptsTotal knee arthroplastyPrimary total knee arthroplastyHospital Consumer AssessmentPostoperative outcomesPatient characteristicsHCAHPS survey resultsHCAHPS surveySurvey response rateKnee arthroplastyResponse rateHealthcare providersConsumer AssessmentHigher American SocietyMultivariate regression analysisAnesthesia scorePostoperative variablesTKA patientsAdult patientsPrimary outcomePatient factorsSurgical variablesPatient populationPatient satisfactionSingle institutionHospital experienceCenters for Medicare & Medicaid Services' 2018 Removal of Total Knee Arthroplasty From the Inpatient-only List Led to Broad Changes in Hospital Length of Stays
Rankin KA, Freedman IG, Rubin LE, Grauer JN. Centers for Medicare & Medicaid Services' 2018 Removal of Total Knee Arthroplasty From the Inpatient-only List Led to Broad Changes in Hospital Length of Stays. Journal Of The American Academy Of Orthopaedic Surgeons 2021, 29: 1061-1067. PMID: 33960970, DOI: 10.5435/jaaos-d-20-01228.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, KneeCenters for Medicare and Medicaid Services, U.S.HospitalsHumansInpatientsLength of StayMedicaidMedicareRetrospective StudiesUnited StatesConceptsTotal knee arthroplastyHospital lengthKnee arthroplastyNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseMedicare eligibilityCategorical data comparisonsOverall practice patternsRetrospective cohort studyImprovement Program databaseSame dayRemoval of TKAPearson's chi-squared testChi-squared testMann-Whitney testLOS daysProlonged LOSMost patientsTKA patientsCohort studyMore patientsPractice patternsPatient characterizationProgram databaseActual LOS
2020
Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty
Keswani AH, Snyder DJ, Ahn A, Austin DC, Jayakumar P, Grauer JN, Poeran J, Bozic KJ, Moschetti WE, Jevsevar DS, Galatz LM, Bronson MJ, Chen DD, Moucha CS. Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty. The Journal Of Arthroplasty 2020, 36: 801-809. PMID: 33199096, DOI: 10.1016/j.arth.2020.10.007.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansPatient Care BundlesPatient DischargeRisk AdjustmentUnited StatesConceptsPatient-reported outcomesTotal joint arthroplastyRisk adjustmentJoint arthroplastyLength of stayUrban health systemSurgeon performanceBundled payment programsBundled payment modelReadmission ratesPRO collectionInclusion criteriaPatientsLevel IIIHealth systemArthroplastyPayment modelsAcceptable targetsPayment programsImportant mechanismAdjustmentTargetIncidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty
Haynes MS, Alder KD, Bellamkonda K, Kuzomunhu L, Grauer JN. Incidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty. PLOS ONE 2020, 15: e0239239. PMID: 32941539, PMCID: PMC7498016, DOI: 10.1371/journal.pone.0239239.Peer-Reviewed Original ResearchConceptsTotal knee arthroplastyTotal hip arthroplastyIndependent risk factorPostoperative day twoPostoperative strokeKnee arthroplastyRisk factorsHip arthroplastyElective primary total hip arthroplastyTHA/TKANational Surgical Quality Improvement databaseElective total hip arthroplastyDay twoPrimary total hip arthroplastyPost-operative strokePostoperative day nineTiming of strokeHigher American SocietyIncidence of strokePostoperative day oneMajority of strokesQuality improvement databaseRetrospective comparative studyAnesthesiologists (ASA) scoreCouncil patientsCoagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty.
Malpani R, Mclynn RP, Bovonratwet P, Bagi PS, Yurter A, Mercier MR, Rubin LE, Grauer JN. Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty. Orthopedics 2020, 43: 233-238. PMID: 32674174, DOI: 10.3928/01477447-20200624-02.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood Coagulation DisordersDatabases, FactualFemaleHumansMaleMiddle AgedMultivariate AnalysisOutcome Assessment, Health CarePatient ReadmissionPostoperative ComplicationsRetrospective StudiesRisk FactorsYoung AdultConceptsHigher international normalized ratioInternational normalized ratioMajor adverse eventsTotal hip arthroplastyPartial thromboplastin timeHigher partial thromboplastin timeMinor adverse eventsAdverse eventsLow plateletsHematological conditionsSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseTotal knee arthroplasty (TKA) populationQuality Improvement Program databasePrimary total hip arthroplastyDependent functional statusImprovement Program databasePostsurgical adverse eventsTotal knee arthroplastyMultiple adverse eventsPreoperative coagulopathyTHA cohortTKA groupTKA patientsHospital readmission
2019
Abnormally High, as Well as Low, Preoperative Platelet Counts Correlate With Adverse Outcomes and Readmissions After Elective Total Knee Arthroplasty
Malpani R, Haynes MS, Clark MG, Galivanche AR, Bovonratwet P, Grauer JN. Abnormally High, as Well as Low, Preoperative Platelet Counts Correlate With Adverse Outcomes and Readmissions After Elective Total Knee Arthroplasty. The Journal Of Arthroplasty 2019, 34: 1670-1676. PMID: 31072745, DOI: 10.1016/j.arth.2019.04.012.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAnemiaArthroplasty, Replacement, KneeDatabases, FactualDiabetes ComplicationsElective Surgical ProceduresFemaleHumansLength of StayMaleMiddle AgedPatient ReadmissionPlatelet CountPostoperative ComplicationsPostoperative PeriodPreoperative PeriodRetrospective StudiesThrombocytopeniaThrombocytosisTreatment OutcomeUnited StatesYoung AdultConceptsTotal knee arthroplastyElective total knee arthroplastyMinor adverse eventsPreoperative platelet countAbnormal platelet countLow platelet countPlatelet countHigher platelet countsAdverse eventsPostoperative complicationsTKA patientsAdverse outcomesKnee arthroplastyNational Surgical Quality Improvement Program databaseElective primary total knee arthroplastyMultivariate analysisQuality Improvement Program databasePrimary total knee arthroplastyMulticenter patient populationImprovement Program databasePostoperative adverse outcomesPlatelet count thresholdRetrospective comparative studyNormal platelet countLarger patient sample sizeChanges in Discharge to Rehabilitation: Potential Unintended Consequences of Medicare Total Hip Arthroplasty/Total Knee Arthroplasty Bundled Payments, Should They Be Implemented on a Nationwide Scale?
Zogg CK, Falvey JR, Dimick JB, Haider AH, Davis KA, Grauer JN. Changes in Discharge to Rehabilitation: Potential Unintended Consequences of Medicare Total Hip Arthroplasty/Total Knee Arthroplasty Bundled Payments, Should They Be Implemented on a Nationwide Scale? The Journal Of Arthroplasty 2019, 34: 1058-1065.e4. PMID: 30878508, PMCID: PMC6884960, DOI: 10.1016/j.arth.2019.01.068.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeComputer SimulationDecision TreesElective Surgical ProceduresHumansMedicareMiddle AgedMonte Carlo MethodPatient DischargePatient Protection and Affordable Care ActPatient ReadmissionQuality of LifeRehabilitationReimbursement MechanismsSkilled Nursing FacilitiesUnited StatesConceptsExtent of therapyHealth-related qualityType of rehabilitationFunctional recoveryPatients' health-related qualitySkilled nursing facility useElective total hipPrimary TKA patientsOutcomes of patientsPatient-centered outcomesPatients' functional recoveryInpatient rehabilitation facilityNursing facility useEpisode of careAverage functional outcomeBundled payment programsDischarge dispositionTKA patientsUnplanned readmissionTotal hipFunctional outcomeAffordable Care ActOutcome measuresRehabilitation facilityBundled Payments