INTRODUCTION:Practice guidelines in the United States (US) recommend cemented femoral fixation in hemiarthroplasty (HA) and total hip arthroplasty (THA) to treat femoral neck fractures (FNFs) for older patients. The purpose of this study was to assess regional variation and hospital characteristics associated with cement use for HA and THA used to treat FNFs and to determine the impact of cement use on adverse outcomes. METHODS:All FNF patients ≥ 65 years treated with HA or THA from 2012 to 2021 in the American Joint Replacement Registry (AJRR) were analyzed. There were 81,610 cases included: 15,282 THAs and 66,328 HAs. Patient demographics, cement use stratified by region and hospital type, and adverse outcomes were recorded. Multivariate analyses were performed. RESULTS:Cemented femoral fixation was used in 39.8% of combined HA and THA cases with greater frequency in HA (44.5%) compared with THA (19.2%, P < 0.001). Cement utilization ranged from 6 to 83% by state with 2-fold variation comparing Midwest and Southern regions (56 versus 29%, respectively, P < 0.001). Major teaching centers were more likely to use cement than non-teaching institutions (odds ratio (OR) 1.84, P < 0.001). Cemented compared with cementless fixation had a lower hazard ratio for all-cause revision (hazard ratio (HR): 0.75; P < 0.001), revision at three months (HR: 0.64; CI [confidence interval]: 0.554 to 0.75, P < 0.001), and revision for periprosthetic fracture (HR: 0.21; CI: 0.15 to 0.30, P < 0.001). Cemented fixation had an 8.9% higher hazard for mortality (HR: 1.089; CI: 1.06 to 1.12; P = 0.001). CONCLUSIONS:There is significant regional variation regarding the prevalence of cemented femoral fixation used to treat FNFs with either HA or THA in the US. Cemented fixation resulted in a lower risk of periprosthetic fracture and revision surgery. Higher mortality was associated with cemented fixation, but may relate to selection bias. The observed variation in clinical practice and lack of conformity to published guidelines is an opportunity for quality improvement.

The Platelet-Rich Plasma (PRP) for Knee Osteoarthritis Technology Overview is based on a systematic review of current scientific and clinical research. Through analysis of the current best evidence, this technology overview seeks to evaluate the efficacy of PRP for patients with knee osteoarthritis. The systematic literature review resulted in 54 articles: 36 high-quality and 18 moderate-quality. The findings of these studies were summarized to present findings on PRP versus control/placebo, acetaminophen, non-steroidal anti-inflammatory drugs, corticosteroids, exercise, prolotherapy, autologous conditioned serum, bone marrow aspirate concentrate, hyaluronic acid, and ozone therapy. In addition, the work group highlighted areas that needed additional research when evidence proved lacking on the topic and carefully noted the potential harms associated with an intervention, required resource utilization, acceptability, and feasibility.

The Concentrated Bone Marrow Aspirate (CBMA) for Knee Osteoarthritis Technology Overview is based on a systematic review of current scientific and clinical research. Through analysis of the current best evidence, this technology overview seeks to evaluate the efficacy of CBMA for patients with knee osteoarthritis. The systematic literature review resulted in 12 articles: three high-quality, four moderate-quality, and five low-quality. The findings of these studies were summarized to present findings on CBMA versus placebo and CBMA versus other treatment modalities. In addition, the work group highlighted areas for needed additional research when evidence proved lacking on the topic and carefully noted the potential harms associated with an intervention, required resource utilization, acceptability, and feasibility.

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) for the Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Developmental Dysplasia of the Hip in Infants up to Six Months of Age: Intended for Use by Orthopaedic Specialists AUC clinical patient scenarios were derived from indications typical of patients presenting with developmental dysplasia of the hip in clinical practice. The 432 patient scenarios and three treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, a separate multidisciplinary, Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) for Surgical Management of Osteoarthritis of the Knee. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Surgical Management of Osteoarthritis of the Knee AUC clinical patient scenarios were derived from indications of patients under consideration for surgical treatment of osteoarthritis of the knee as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the three treatments. The 864 patient scenarios and 3 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons (AAOS) has developed Appropriate Use Criteria (AUC) for Management of Carpal Tunnel Syndrome . Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. To provide the evidence foundation for this AUC, the AAOS Evidence-Based Medicine Unit provided the writing panel and voting panel with the 2016 AAOS Clinical Practice Guideline titled Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. The Management of Carpal Tunnel Syndrome AUC clinical patient scenarios were derived from indications typical of patients with suspected carpal tunnel syndrome in clinical practice, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of treatments. The 135 patient scenarios and 6 treatments were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the Appropriate Use Criteria (AUC) document Treatment of Hip Fractures in the Elderly to improve patient care and obtain optimal outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from indications typical of patients commonly presenting with hip fractures in clinical practice, as well as from current evidence-based clinical practice guidelines and supporting literature. The 30 patient scenarios and 6 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. A separate, multidisciplinary Voting Panel made up of specialists and nonspecialists rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons, in collaboration with the American Dental Association, has developed Appropriate Use Criteria (AUC) for the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures . Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The Management of Patients with Orthopaedic Implants Undergoing Dental Procedures AUC clinical patient scenarios were derived from indications of patients with orthopaedic implants presenting for dental procedures, as well as from current evidence-based clinical practice guidelines and supporting literature to identify the appropriateness of the use of prophylactic antibiotics. The 64 patient scenarios and 1 treatment were developed by the writing panel, a group of clinicians who are specialists in this AUC topic. Next, a separate, multidisciplinary, voting panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Quinn, Robert H. MD; Murray, Jayson MA; Pezold, Ryan MA; Members of the Writing and Voting Panels of the AUC on Surgical Management of Osteoarthritis of the Knee

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Management of Osteochondritis Dissecans of the Femoral Condyle. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany osteochondritis dissecans of the femoral condyle, as well as from current evidence-based clinical practice guidelines and supporting literature. The 64 patient scenarios and 12 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Lastly, a separate, multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Treatment of Anterior Cruciate Ligament Injuries. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany an anterior cruciate ligament injury, as well as from current evidence-based clinical practice guidelines and supporting literature. The 56 patient scenarios and 8 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Lastly, a separate, multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

These Appropriate Use Criteria (AUC) for the Management of Anterior Cruciate Ligament (ACL) Injuries are based on a review of the available literature regarding the treatment and prevention of ACL injuries1 as well as a list of clinical patient scenarios constructed by an expert Writing Panel and voted on by a separate multidisciplinary Voting Panel. The AUC development methods are adapted from the RAND/UCLA Appropriateness Method (RAM)2. The full Appropriate Use Criteria for the Management of Anterior Cruciate Ligament Injuries, along with the Appropriate Use Criteria tables, final appropriateness ratings, and a list of panel members, can be accessed on the AAOS website at http://www.aaos.org/auc. The ACL AUC is also available as a web-based application; to access this application, please visit http://www.orthoguidelines.org/auc.Members of the Writing Panel developed a list of fifty-six patient scenarios regarding ACL injury treatment and forty-eight patient scenarios regarding ACL injury prevention based on the identified patient indications (Tables I and II) and defined subclassifications along with six treatments and one prevention intervention (Tables III and IV), for a total of 352 ACL injury treatment voting items and forty-eight …

Quinn, Robert H. MD; Murray, Jayson N. MA; Pezold, Ryan MA; Members of the Writing and Voting Panels of the AUC on the Treatment of Hip Fractures in the Elderly and the AUC on Postoperative Rehabilitation of Low Energy Hip Fractures in the Elderly

The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) on the Management of Pediatric Supracondylar Humerus Fractures (PSHF). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The PSHF AUC clinical patient scenarios were derived from patient indications that generally accompany a PSHF as well as from current evidence-based clinical practice guidelines and supporting literature. The 220 patient scenarios and 14 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

Sanders, James O. MD; Keith, Michael Warren MD; Murray, Jayson MA; Pezold, Ryan MA; Members of the Writing, Review, and Voting Panels of the AUC on Optimizing the Management of Full-Thickness Rotator Cuff Tears Author Information