Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons
Background: Current literature does not provide conclusive evidence on whether routine pathologic examination of femoral heads from total hip arthroplasty is indicated or cost-effective. As a result, there is substantial variation in opinion among surgeons related to this issue. Our study aim was to...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-02-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344122002576 |
| _version_ | 1797924689406853120 |
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| author | Sumon Nandi, MD, MBA Javad Parvizi, MD, FRCS Muyibat A. Adelani, MD Timothy S. Brown, MD John C. Clohisy, MD P. Maxwell Courtney, MD Matthew J. Dietz, MD Brett R. Levine, MD, MS Simon C. Mears, MD, PhD Jesse E. Otero, MD, PhD Ran Schwarzkopf, MD, MSc Thorsten M. Seyler, MD, PhD Scott M. Sporer, MD, MS |
| author_facet | Sumon Nandi, MD, MBA Javad Parvizi, MD, FRCS Muyibat A. Adelani, MD Timothy S. Brown, MD John C. Clohisy, MD P. Maxwell Courtney, MD Matthew J. Dietz, MD Brett R. Levine, MD, MS Simon C. Mears, MD, PhD Jesse E. Otero, MD, PhD Ran Schwarzkopf, MD, MSc Thorsten M. Seyler, MD, PhD Scott M. Sporer, MD, MS |
| author_sort | Sumon Nandi, MD, MBA |
| collection | DOAJ |
| description | Background: Current literature does not provide conclusive evidence on whether routine pathologic examination of femoral heads from total hip arthroplasty is indicated or cost-effective. As a result, there is substantial variation in opinion among surgeons related to this issue. Our study aim was to determine factors that impact surgeon propensity to order pathologic examination of femoral heads. Methods: A 12-question survey was created to evaluate surgeon practices, indications, and patient care implications surrounding routine pathologic examination of femoral heads. The email survey was distributed to all members of the American Association of Hip and Knee Surgeons (n = 2598). Results: There were 572 survey respondents. Out of all respondents, 28.4% always send femoral heads to pathology, and 27.6% reported an institutional requirement to do so. Of the 572 surgeons, 73.6% report femoral head pathology has never resulted in a change in patient disease course. Factors that increase the likelihood of surgeons ordering femoral head pathologic examination include institutional requirements, medicolegal concern, and prior experience with femoral head pathologic examination changing patients' disease course (P < .001). Cost concern decreases the likelihood of surgeons ordering femoral head pathologic examination (P = .0012). Conclusions: A minority of surgeons routinely send femoral heads from total hip arthroplasty for pathologic examination, mostly because of institutional requirement. The majority of surgeons feel that femoral head pathologic examination never changes patient management, although others have infrequently detected malignancy and infection. Institutional policy, concern for litigation, and prior experience with discordant pathologic diagnoses increase femoral head pathologic examinations, while cost concern decreases them. |
| first_indexed | 2024-04-10T15:04:55Z |
| format | Article |
| id | doaj.art-0d192804ff41464cbbd0a3c9497d84d8 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-04-10T15:04:55Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-0d192804ff41464cbbd0a3c9497d84d82023-02-15T04:28:24ZengElsevierArthroplasty Today2352-34412023-02-0119101079Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee SurgeonsSumon Nandi, MD, MBA0Javad Parvizi, MD, FRCS1Muyibat A. Adelani, MD2Timothy S. Brown, MD3John C. Clohisy, MD4P. Maxwell Courtney, MD5Matthew J. Dietz, MD6Brett R. Levine, MD, MS7Simon C. Mears, MD, PhD8Jesse E. Otero, MD, PhD9Ran Schwarzkopf, MD, MSc10Thorsten M. Seyler, MD, PhD11Scott M. Sporer, MD, MS12University of Maryland School of Medicine, Baltimore, MD, USA; Corresponding author. University of Maryland School of Medicine, 110 S. Paca St., Suite 300, Baltimore, MD 21201, USA. Tel.: +1 410-683-2130.Rothman Institute, Thomas Jefferson University; Philadelphia, PA, USAWashington University, St. Louis, MO, USAUniversity of Iowa, Iowa City, IA, USAWashington University, St. Louis, MO, USARothman Institute, Thomas Jefferson University; Philadelphia, PA, USAWest Virginia University, Morgantown, WV, USARush University, Chicago, IL, USAUniversity of Arkansas, Little Rock, AR, USAOrthoCarolina, Charlotte, NC, USANYU Grossman School of Medicine, New York, NY, USADuke University School of Medicine, Durham, NC, USARush University, Chicago, IL, USABackground: Current literature does not provide conclusive evidence on whether routine pathologic examination of femoral heads from total hip arthroplasty is indicated or cost-effective. As a result, there is substantial variation in opinion among surgeons related to this issue. Our study aim was to determine factors that impact surgeon propensity to order pathologic examination of femoral heads. Methods: A 12-question survey was created to evaluate surgeon practices, indications, and patient care implications surrounding routine pathologic examination of femoral heads. The email survey was distributed to all members of the American Association of Hip and Knee Surgeons (n = 2598). Results: There were 572 survey respondents. Out of all respondents, 28.4% always send femoral heads to pathology, and 27.6% reported an institutional requirement to do so. Of the 572 surgeons, 73.6% report femoral head pathology has never resulted in a change in patient disease course. Factors that increase the likelihood of surgeons ordering femoral head pathologic examination include institutional requirements, medicolegal concern, and prior experience with femoral head pathologic examination changing patients' disease course (P < .001). Cost concern decreases the likelihood of surgeons ordering femoral head pathologic examination (P = .0012). Conclusions: A minority of surgeons routinely send femoral heads from total hip arthroplasty for pathologic examination, mostly because of institutional requirement. The majority of surgeons feel that femoral head pathologic examination never changes patient management, although others have infrequently detected malignancy and infection. Institutional policy, concern for litigation, and prior experience with discordant pathologic diagnoses increase femoral head pathologic examinations, while cost concern decreases them.http://www.sciencedirect.com/science/article/pii/S2352344122002576Femoral headHipArthroplastyPathologyRoutineCost |
| spellingShingle | Sumon Nandi, MD, MBA Javad Parvizi, MD, FRCS Muyibat A. Adelani, MD Timothy S. Brown, MD John C. Clohisy, MD P. Maxwell Courtney, MD Matthew J. Dietz, MD Brett R. Levine, MD, MS Simon C. Mears, MD, PhD Jesse E. Otero, MD, PhD Ran Schwarzkopf, MD, MSc Thorsten M. Seyler, MD, PhD Scott M. Sporer, MD, MS Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons Arthroplasty Today Femoral head Hip Arthroplasty Pathology Routine Cost |
| title | Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons |
| title_full | Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons |
| title_fullStr | Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons |
| title_full_unstemmed | Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons |
| title_short | Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons |
| title_sort | routine pathologic examination of the femoral head in total hip arthroplasty a survey study of the american association of hip and knee surgeons |
| topic | Femoral head Hip Arthroplasty Pathology Routine Cost |
| url | http://www.sciencedirect.com/science/article/pii/S2352344122002576 |
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