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    Routine Pathologic Examination of Femoral Head Specimens from Total Hip Arthroplasty May Not Be Indicated or Cost-effective: A Systematic Review

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    Author
    Nandi, Sumon
    Schwarzkopf, Ran
    Chen, Antonia
    Seyler, Thorsten
    Wheeler, Lauren
    Parvizi, Javad
    Adelani, Muyibat A.
    Brown, Timothy S.
    Clohisy, John C.
    Courtney, Maxwell
    Dietz, Matthew J.
    Levine, Brett R.
    Mears, Simon C.
    Otero, Jesse E.
    Sporer, Scott M.
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    Date
    2022-01-01
    Journal
    Arthroplasty Today
    Publisher
    Elsevier
    Type
    Article
    
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    See at
    https://doi.org/10.1016/j.artd.2022.03.016
    Abstract
    Background: There is considerable disparity in institutional practices surrounding routine pathologic examination of femoral heads removed during total hip arthroplasty (THA). Multiple groups have studied the merits of routine femoral head pathology in THA, without clear consensus. We sought to further investigate the existing evidence on routine pathologic examination of femoral heads retrieved during THA to determine if this practice provides additional clinical value and is cost-effective. Material and methods: To conduct a systematic review of the literature, a medical librarian was consulted to develop and perform comprehensive searches in PubMed (1809-present), Embase (embase.com 1974-present), CINAHL (EBSCO, 1937-present), and the Cochrane Central Register of Controlled Trials (Wiley). Final searches resulted in 727 references. Through multiple reviewer screenings and assessments of eligible full-text articles, we included 14 articles for review. Results: Our systematic review yielded pathologic examination results from 17,388 femoral head specimens collected during THA. In 0.85% of cases, the pathologic diagnosis differed in a meaningful way from the preoperative clinical diagnosis. Routine pathology changed patient management in approximately 0.0058% of cases. The average cost for pathologic examination of each specimen was $126.38. Conclusion: Routine pathologic examination of femoral heads retrieved during THA has limited impact on patient management. With an estimated 500,000 THAs performed in 2019, the economic feasibility of routine femoral head pathology is limited at an annual cost of up to $63,000,000 and cost per quality-adjusted life-year approaching infinity. However, surgeon discretion on a patient-specific or practice-specific basis should be used to make the final determination on the need for femoral head pathology.
    Keyword
    Arthroplasty
    Cost
    Femoral head
    Hip
    Pathology
    Routine
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/18961
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.artd.2022.03.016
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