Research Leads to Improved Joint Replacement Care


Due to aging Baby Boomers, there is expected to be a large increase in the number of total hip and total knee joint replacement surgeries performed over the next 10-15 years. As one of the region’s leading healthcare systems, St. Elizabeth Healthcare felt they could improve care for future joint replacement patients by studying their past patients.

St. Elizabeth Healthcare clinical research and orthopaedic departments, collaborated with R. Michael Greiwe, MD, an affiliated surgeon with OrthoCincy Orthopaedics & Sports Medicine who practices at St. Elizabeth Healthcare, to review nearly 6,000 health records of patients who received total joint replacement surgery over a 56-month period at St. Elizabeth Edgewood.

“The goal of the research is to improve future patient care,” says Dr. Greiwe. “There is a lot to learn from how past patients did with total joint surgery. By looking through health records to find reasons patients had exceptional outcomes, or had some complications, we can alter how we care for future patients.”

Karen Tepe, Director of Orthopedics and Neurosciences at St. Elizabeth Healthcare. “Most of our total joint replacement patients are scheduled elective procedures. We want these patients to have an exceptional experience with exceptional outcomes. With the ultimate goal, to make Northern Kentucky one of the healthiest communities in America, it’s at the core of everything we do.”

Hospital readmissions after surgery

One of the main drivers of patient outcomes and healthcare cost is readmission to the hospital within a defined time period after joint replacement surgery. Typically, hospitals will review 30-day and 90-day readmission rates as an indicator of patient outcomes. In the St. Elizabeth study, published in The Journal of Arthroplasty in June 2019, 5,732 patient charts were reviewed, and researchers found 237 patients were readmitted within 30 days, while 547 were readmitted within 90 days.

“Using statistical analysis, it was determined that certain conditions were indicators of readmission,” says Tepe. “The more of these indicators a patient has, the higher the likelihood they will be readmitted within 30 to 90 days after surgery.”

The study found these conditions were indicators of readmission post total joint replacement:

  • Age
  • Body mass index (BMI)
  • Cardiac dysrhythmias (heart rhythm issues)
  • Emergency Room visits
  • Heart failure
  • High use of medication
  • Intravenous drug abuse
  • Previous total joint replacement (within 12 months)
  • Psychiatric conditions
  • Use of narcotic medications

Dr. Greiwe says, “We can now look at each one of these patients and adapt their treatment plan if they have one or several of these indicators of readmission. The goal is to avoid the patient needing a second hospitalization.”

Personalized care for at-risk patients

St. Elizabeth Healthcare utilized the data from this research to build a readmission risk tool that would allow for individualized treatment plans based on each patient’s identified readmission risk.

In the fall of 2019, the Total Joint Center team began using the readmission risk tool to identify patients at-risk of readmission weeks prior to joint replacement surgery.

Tepe explains, “The readmission risk tool will assign a readmission risk score based on the known indicators of readmission to the hospital. If their score is low, they may follow our normal protocol. If it is high, the care team will look at steps that can be taken to modify their treatment pathway based on their particular needs.”

Based on the known indicators of readmission and the patient’s health history, the team will:

  • Share the risk score with the physician performing the surgery so they can use that information to better care for their patient.
  • Provide more education before and after surgery.
  • Increase follow-up calls and appointments after surgery.
  • Provide a clear understanding of where and when to seek treatment after surgery should you need more care.

“This is still a work in process. We are exploring various options and working with the physicians to ensure patients are getting the education, support and care they need before and after surgery. The goal is to use this readmission risk model to medically optimize patients to achieve the best outcome possible,” says Tepe.

Joint replacement at St. Elizabeth

“Creating a healthy community is truly our mission,” says Dr. Greiwe. “When we see an opportunity to study how we care for patients today to improve future treatment, we do it.”

Learn more about our joint replacement options by telling us where it hurts by using our interactive pain chart. To make an appointment with one of our joint replacement experts, please call our affiliated orthopaedic surgeons from OrthoCincy Orthopaedics & Sports Medicine at (859) 301-BONE (2663).

If you would like to read the whole research article, click here.