Staff Reporter

What: Solving Problems of the Knee and Hip 
When: Wednesday, March 9, 6-7:15 p.m.
Where: Virtual. Register at http://arthritis.arizona.edu/healthy-living/tucson-lecture-series

Gens Goodman, DO, an associate professor of orthopedic surgery in the University of Arizona College of Medicine – Tucson and orthopedic surgeon at Banner University Medicine – Tucson, will present a free lecture, “Solving Problems of the Knee and Hip,” on Wednesday, March 9, at 6 p.m.

The 75-minute talk will be livestreamed and is open to the public, with time for questions and answers from audience members. Dr. Goodman will share the latest developments in the treatment of hip and knee conditions, including:

• Partial and total joint replacement surgery of the knee and hip
• Robotic-assisted orthopedic procedures
• Joint replacement revision surgery
• Pre- and post-operative approaches to pain management
• Nonsurgical treatments for knee and hip pain

Several conditions can cause joint pain and disability and lead patients to consider surgical and nonsurgical treatment approaches. In many cases, joint pain results from arthritis, a fracture or other condition damaging the cartilage that lines the ends of the bones. Pain is the primary symptom of osteoarthritis, the most common form of arthritis and a leading cause of disability worldwide.

Knee and hip replacements are the most commonly performed joint replacements, and as the population ages, these procedures are on the rise. A 2019 study published in the Journal of Rheumatology predicted that the number of total knee replacements in the United States would increase to nearly 3.5 million and total hip replacements would increase to nearly 1.5 million by 2040.

The lecture is a part of the “Living Healthy with Arthritis” series of free lectures presented by the UArizona Arthritis Center at the UArizona College of Medicine – Tucson and supported through the Susan and Saul Tobin Endowment for Research and Education in Rheumatology.

Prior registration is required. For more information or to register, please visit the UArizona Arthritis Center website at arthritis.arizona.edu/healthy-living/tucson-lecture-series or email livinghealthy@arthritis.arizona.edu.

About Dr. Goodman

Dr. Goodman specializes in conditions of the hip and knee, including partial and total joint replacement. He joined the UArizona College of Medicine and Banner Health in May 2021.

After receiving a bachelor’s degree in chemistry and biochemistry from the University of Arizona, Dr. Goodman received his medical degree from Lake Erie College of Osteopathic Medicine and was commissioned into the U.S. Army. He completed his orthopedic surgery training at the William Beaumont Army Medical Center/Texas Tech University Health Sciences Center in El Paso, Texas. In his final year, Dr. Goodman served as chief resident and finished as the Orthopedic Surgery Residency’s Distinguished Honor Graduate.

Dr. Goodman completed his fellowship training in adult reconstruction and total joint surgery at the Anderson Orthopedic Institute, where he mastered skills in minimally invasive partial and total knee replacements and muscle-sparing anterior total hip replacement. Following his fellowship, Dr. Goodman returned to El Paso, where he served as the chief of adult reconstruction at William Beaumont Army Medical Center for six years. During his time in the Army, Dr. Goodman deployed to Iraq as an orthopedic surgeon in 2016 and 2019.

“The robot is an assistant that helps the surgeon fine-tune a knee replacement,” says orthopedic surgeon, Eric Lebby, MD, Chief, Division of Orthopedic Surgery, Lehigh Valley Orthopedic Institute. “A car works best when the wheels are in perfect balance and alignment. A computer helps the mechanic better align the wheels. The robotic system helps the surgeon fine-tune and balance the knee replacement. The robot can make a great surgeon even better.”

Lebby says the robotic system gives surgeons more information, which translates to greater precision. Since each person’s anatomy is different, joint replacement surgery is not a one-size-fits-all endeavor. “This is another instrument to better produce superior results,” he says.

“The robotic system helps the surgeon fine-tune and balance the knee replacement. The robot can make a great surgeon even better.” – Eric Lebby, MD, Chief, Division of Orthopedic Surgery, Lehigh Valley Orthopedic Institute

Not every patient undergoing joint replacement will require robotic-assisted surgery. LVHN surgeons performed nearly 5,000 joint replacement surgeries last fiscal year (July 1, 2020-June 30, 2021), with the majority being partial- or full-knee replacements. That total is expected to increase in the current fiscal year (July 1, 2021-June 30, 2022), though volume in both years was likely slowed slightly by the COVID-19 pandemic.

Newswise — April 18, 2022 – A “bundled care” Medicare program to improve care for patients undergoing hip or knee replacement surgery has led to reductions in some outcome disparities for Black compared with White patients, suggests a study in The Journal of Bone & Joint Surgery. The journal is published in the Lippincott portfolio in partnership with Wolters Kluwer.

The introduction of Medicare’s Comprehensive Care for Joint Replacement (CJR) Model coincided with a reduction of racial differences in hospital readmission rates after hip or knee replacement surgery, according to new research by Calin Moucha, MD, Jashvant Poeran, MD, PhD, and other colleagues at the Icahn School of Medicine at Mount Sinai, New York.

Despite gains, racial differences persist in patient characteristics and outcomes

With use of nationwide Medicare claims data, the researchers analyzed disparities between Black and White patients undergoing total hip or knee replacement surgery, before and after rollout of the CJR Model in 2016. Under the CJR Model, health-care organizations receive a single “bundled” payment for all services throughout an episode of care – from the initial hospitalization to 90 days postoperatively – providing incentives to reduce costs while improving quality of care.

The study included data on nearly 1.5 million hip or knee replacement surgeries performed from 2013 to 2018. About 5% of patients were Black.

The analysis showed substantial racial differences in patient characteristics, outcomes, and Medicare payments, both before and after implementation of the CJR Model. As a group, Black patients had higher rates of other health problems, received more blood transfusions, spent more days in the hospital, and were more likely to be discharged to an institution (such as a skilled nursing facility), rather than being sent directly home.

The CJR program led to improvements in several key outcomes, some of which differed by race. After adjustment for other factors, White patients who were managed under the CJR approach had reductions in length of hospital stay, complication rate, risk of hospital readmission within 90 and 180 days, discharge to institutional care, and Medicare payments to skilled nursing facilities.

Some of the improvements were greater among Black patients. In particular, Black patients had larger reductions in 90-day and 180-day hospital readmission rates, as well as in Medicare payments related to outpatient care.

The greater benefits among Black compared to White patients suggest that the CJR program has improved some pre-existing racial differences. “These observed racial differences may represent true ‘disparities’ as some may not be attributable to clinical factors and may be directly associated with poorer outcomes,” the researchers write.

Dr Moucha comments, “This is an important finding as it provides insights on how to effectively reduce these disparities that we know are widespread, not just on orthopaedics, but in medicine in general.”

Dr. Poeran adds, “These results indeed seem promising, but we do have to consider alternative perspectives and explanations of our results. For example, although the effects on readmission rates are promising, the difference in payments for outpatient care – where we saw lower Medicare payments for Black patients – may also indicate potential under-utilization of postdischarge care in certain subgroups.”

Together with some previous reports of outcomes after introduction of the CJR Model, the new findings “support the notion of adapting and leveraging the bundled payment program design to reduce disparities in [total hip and knee replacement] care and outcomes,” the researchers write. They note that their study could not demonstrate a causal relationship between the CJR Model and the observed improvements in patient outcomes.

“A first step toward reducing racial differences that represent disparities […] is to understand the sources of these disparities,” Dr. Poeran and colleagues conclude. They call for further studies to evaluate the potential of bundled payment models to reduce racial disparities, and the mechanisms by which they do so.

Click here to read “Racial Differences in Care and Outcomes After Total Hip and Knee Arthroplasties: Did the Comprehensive Care for Joint Replacement Program Make a Difference? “

DOI: 10.2106/JBJS.21.00465

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About The Journal of Bone & Joint Surgery

The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2020 annual revenues of €4.6 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,200 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

For more information, visit www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.

Robert Wood Johnson University Hospital (RWJUH) Somerset, an RWJBarnabas Health facility, unveiled plans for a two-story, 76,600-square-foot vertical expansion above the hospital’s existing Orthopedics Pavilion and Emergency Department (ED) building. The space will house the new Orthopedic Center of Excellence, which will include 35 fully private patient rooms and a state-of-the-art rehab gym for orthopedic patients, and an ED Rapid Decision Unit.

“The Orthopedic Center of Excellence will create a preeminent facility to house all of our orthopedic patients in one area, further enhancing the care patients experience from our nationally recognized program. These enhancements will continue to make us a premier destination in the region for orthopedic care,” said Tony Cava, President and CEO of RWJUH Somerset. “The benefits of this expansion project will be felt by patients, their families, and staff across the hospital, as it will enable us to enhance privacy and safety throughout the facility. Additionally, the new space will facilitate future growth opportunities as we continue to evolve with the health care needs of our local community.”

The self-contained Orthopedic Center of Excellence will ensure that joint surgery patients can receive the highest quality pre-and post-operative care close to home, eliminating the need for patients to travel for surgery and rehabilitation. Patients will experience privacy and comfort through 35 thoughtfully furnished private inpatient rooms featuring amenities such as convertible sleeper sofas, USB ports and work services, and a state-of-the-art rehabilitation gym.

The expansion will also include a 10-room Rapid Decision Unit for RWJUH Somerset’s ED. Patients who require additional observation or are waiting for test results will occupy these rooms, helping reduce wait times in the ED providing increased comfort for patients and their families.

Additionally, the new Orthopedics Center of Excellence will allow RWJUH Somerset to convert the majority of the hospital’s existing patient rooms into fully private rooms. New patient rooms will feature larger windows for staff to observe patients reducing disruptions and exposure to enhance patient healing, safety, and the overall care experience. Construction on the expansion project is slated to begin in summer 2022.

RWJUH Somerset has completed several recent renovations and enhancement projects to ensure that the hospital continues to evolve and meet the needs of the community it serves. In February 2022, the facility’s Diabetes Center was moved to a newly renovated, modern space just off the hospital’s main lobby to help patients manage their diabetes in a comfortable, convenient setting. Later that month, the Cardiac Diagnostic Testing Department relocated to a remodeled 10,000-square foot location comprised of six patient bays and eight procedure rooms along with a bright, modern waiting area and featuring state-of-the-art diagnostic technology. Additionally, the hospital has nearly completed a renovation that will transform the first-floor inpatient Eating Disorder Unit into an advanced state-of-the-art facility that utilizes the latest research and evidence-based design principles to simultaneously meet critical safety and security needs, enhance programming and promote healing and wellness.

For more information on RWJUH Somerset visit, www.rwjbh.org/somerset.

About RWJ University Hospital Somerset

Robert Wood Johnson University Hospital Somerset is a nationally accredited, 333-bed hospital in Somerville, New Jersey, providing comprehensive emergency, medical/surgical and rehabilitative services.

The Steeplechase Cancer Center at Robert Wood Johnson University Hospital Somerset has been honored with the prestigious Outstanding Achievement Award from the Commission on Cancer of the American College of Surgeons. The hospital is also distinguished for its Joint Surgery Institute, receiving the Joint Commission’s Gold Seal of Approval for total knee and total hip replacement surgery, and is designated as a Primary Stroke Center by the Joint Commission and the New Jersey Department of Health and Senior Services. Robert Wood Johnson University Hospital Somerset has been named a Center of Excellence in Metabolic and Bariatric Surgery by the Surgical Review Corporation. In addition, it has received the Joint Commission’s Gold Seal of Approval for its acute myocardial infarction program.

Honored as a Leader in LGBT Healthcare Equality by the Human Rights Campaign, the hospital was the first in New Jersey to offer primary care services for the LGBTQIA community.

Robert Wood Johnson University Hospital Somerset also offers outpatient services at convenient locations in Central New Jersey, including physical therapy services in Bridgewater, Hillsborough, Princeton and Flemington and an urgent care center and a sleep disorders center in Hillsborough. In addition, the hospital’s affiliated physician practices provide care for families throughout its community.

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