Advancing Musculoskeletal Health Through Research
Our Recent Publications
Explore MaineHealth Musculoskeletal Innovation & Quality Collaborative's commitment to advancing musculoskeletal health, arthritis care, and joint replacement in Maine through groundbreaking research and impactful publications. Our findings directly improve patient outcomes and care. Join us in our mission to shape the future of orthopedic medicine.
Fractured Autonomy: The Cost of Orthopedic Practice Consolidation
Commentary
Alexander T. Bradley MD MBA, Robert A. Burnett MD, Philo Hall JD, Joshua Kerr MA, Adam J. Rana MD
Abstract
The financial sustainability of orthopaedic private practices is under major threat due to continuous reductions in Medicare physician reimbursement, particularly for hip and knee arthroplasty procedures. These cuts, driven by healthcare policy over the last few decades, have had dramatic effects on joint arthroplasty surgeons, resulting in an 18% decrease in real dollar reimbursement between 2020 and 2026, and a 43% decrease in real dollar reimbursement from 1994 to 2026. As professional fees fall and inflation-adjusted practice costs rise, surgeons face mounting pressure from increasing overhead expenses, regulatory burdens, and administrative demands. This squeeze with reduced revenue and increased costs has accelerated consolidation trends across the orthopaedic field, shifting practice models from independent and small groups toward hospital employment, multispecialty mergers, and private equity-backed organizations. The resulting healthcare consolidation has major downstream effects, including increased healthcare costs to the broader system, reduced patient access, potential declines in care quality, and ultimately a loss of physician autonomy. Recent mergers and acquisitions illustrate a national trend toward a concentrated orthopaedic market, as shown by the rising Herfindahl-Hirschman Index (HHI). Advocacy efforts by the American Association of Hip and Knee Surgeons (AAHKS) aim to address these systemic issues by pushing for inflation-adjusted reimbursement, site-neutral payments, and other initiatives, with a goal of preserving physician autonomy. Without meaningful reform, arthroplasty surgeons risk losing control over clinical decision-making, and patient access to high-quality, efficient healthcare stands to be compromised.
Preoperative Patient Education as a Tool for Reducing Postoperative Opioid Use Following Primary Total Hip Arthroplasty: One Institution’s Experience
Original Research
Catherine M. Call MD, Zoë A. Walsh MPH, Diane Jeselskis BSN, Ryan J. Mountjoy MD, Brian J. McGrory MD, MS, Adam J. Rana MD
Abstract
Background
Minimizing postoperative opioids remaining after total hip arthroplasty (THA) is important for patient outcomes and community safety. The purpose of this study was to investigate whether completion of one preoperative patient education class prior to THA was associated with reduced opioid consumption at 2 weeks postoperatively. Secondary goals included evaluating whether satisfaction scores and postoperative healthcare utilization were impacted by class attendance, and whether demographic characteristics varied between groups that may highlight care disparities for our practice to address.
Methods
Patients undergoing primary THA between January 2022 and December 2024 at a single large academic institution were retrospectively evaluated for inclusion, identifying 372 patients who completed the education class and 30 patients who did not. All patients received a multimodal perioperative pain management protocol standardized at our institution.
Results
The number of morphine milligram equivalents (MMEs) consumed in the 2 weeks following THA was significantly lower among the class completion group (84.60 vs 127.30 MMEs; P = .04). On multivariable analysis, patients who attended the preoperative education class consumed 41.57 fewer MMEs compared to those who do not attend (95% confidence interval: −75.87 to −7.27; P = .018). No differences in complications, 2-week refill requests, emergency department visits, or readmission were noted. Functional outcome and satisfaction scores were high among both groups.
Conclusions
THA patients who completed an education class preoperatively consumed significantly fewer prescribed opioids as measured at the 2-week mark following surgery compared to those who did receive education. Our results support the role of patient education in reducing opioid use following arthroplasty.
Physician Payment Reform in Orthopaedic Surgery: Balancing Cost, Quality, and Access
Editorial
Zachary C. Lum DO, R. Michael Meneghini MD, James I. Huddleston MD, Adam Rana MD
Abstract
Recent proposals by the Centers for Medicare & Medicaid Services (CMS) to revalue (and likely reduce) the work-relative value unit (wRVU) reimbursement for common hip and knee arthroplasty Current Procedural Terminology codes have serious and deleterious implications for access to high-quality care, the viability of private practices, the continuation of consolidation in health care, and the morale of the surgical workforce. These proposals arrive at a time when nonphysician health care providers are striking for wage increases tied to inflation, and, ironically, physicians have experienced repeated cuts or stagnation in reimbursement.
A Call to Action: National Funding for the American Joint Replacement Registry
Commentary
Robert A. Burnett MD, Omar Shalakhti MS, James I. Huddleston MD, Adam J. Rana MD
Abstract
The American Joint Replacement Registry (AJRR) is the world’s largest national registry of hip and knee arthroplasty data. The registry originated with the American Academy of Orthopaedic Surgeons (AAOS) in 2009. In 2017, the AAOS approved a major multiyear investment in the Registry Program. Under the guidance of a multistakeholder steering committee, it has grown markedly over the past decade, now with over 4.6 million procedures submitted from various care settings, including hospitals, ambulatory surgery centers (ASC), and private practice groups throughout all 50 states. The aim of AJRR is to collect, analyze, and report on orthopedic data to enhance patient care, improve evidence-based practices, and improve quality efforts nationwide.