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Arthroplasty Today

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https://www.readbyqxmd.com/read/29564377/is-a-shortened-length-of-stay-and-increased-rate-of-discharge-to-home-associated-with-a-low-readmission-rate-and-cost-effectiveness-after-primary-total-knee-arthroplasty
#1
Steven J Barad, Stephen M Howell, Joyce Tom
Background: It is controversial whether shortening the average length of hospital stay and increasing discharge from a rehabilitation facility to home with either health care or outpatient physical therapy is safe and cost-effective. Methods: We computed the average length of hospital stay; the rate of discharge to a rehabilitation facility, home with health care, or home with outpatient physical therapy; the all-cause readmission rate within 30 days of discharge per year; and cost savings for 2328 consecutive patients treated with a unilateral primary total knee replacement between 2009 and 2014...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29564376/the-ratio-of-patient-body-mass-index-to-age-a-cost-effective-implant-selection-guideline-for-total-knee-arthroplasty
#2
Feroz A Osmani, Nicholas Bolz, Khalid Odeh, Craig Bearison, Ran Schwarzkopf, Richard Iorio
Background: We sought to develop an objective implant selection guideline based on the ratio of patient body mass index (BMI) to age in order to select implants preoperatively and reduce cost while maintaining quality. The BMI-to-age ratio can be used to distinguish patient demand and select those patients who may benefit from newer technology and higher cost implants and those who would do well with standard-demand implants. Methods: A retrospective analysis investigated the types of implants received by patients undergoing total knee arthroplasty from January 2012 to August 2014...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29564375/a-nonsurgical-protocol-for-management-of-postarthroplasty-wound-drainage
#3
Michael S Reich, Kace A Ezzet
Persistent wound drainage after total joint arthroplasty can potentiate periprosthetic joint infection. Although current recommendations are to treat persistent wound drainage with surgical debridement, we believe nonoperative treatment may be successful in selected patients. We performed a retrospective analysis of 25 persistently draining hip and knee arthroplasty wounds treated with a protocol consisting of a combination of surgical site aspiration, closure of open wound edges, cessation of anticoagulants, activity modification, and antibiotics (in select patients)...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560410/response-to-letter-to-the-editor-on-early-intraprosthetic-dislocation-in-dual-mobility-implants-a-systematic-review
#4
Ivan De Martino, Rocco D'Apolito, Bradford S Waddell, Alexander S McLawhorn, Peter K Sculco, Thomas P Sculco
No abstract text is available yet for this article.
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560409/letter-to-the-editor-on-early-intraprosthetic-dislocation-in-dual-mobility-implants-a-systematic-review
#5
Domenico Tigani, Jean Louis Prudhon, Luca Amendola, Thierry Aslanian
No abstract text is available yet for this article.
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560408/postoperative-prophylactic-antibiotics-in-total-joint-arthroplasty
#6
Adolph J Yates
The Center for Disease Control and Prevention recently released their 2017 Guideline for the Prevention of Surgical Site Infection. One of their recommendations is the ordering of a single dose of preoperative prophylactic antibiotics with no subsequent postoperative dosing; this recommendation includes perioperative antibiotics for patients undergoing total joint arthroplasty. At this time, the American Association of Hip and Knee Surgeons (AAHKS) does not agree with this recommendation vis-a-vis total joint arthroplasty because it contradicts current international standards of care with limited evidence and study...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560407/the-effect-of-wound-dressings-on-infection-following-total-joint-arthroplasty
#7
Kevin K Chen, Ameer M Elbuluk, Jonathan M Vigdorchik, William J Long, Ran Schwarzkopf
Background: The use of perioperative surgical wound dressings is an important factor in the mitigation of infection following total joint arthroplasty (TJA). Few studies have been published comparing wound dressings and infection rates after TJA. Methods: MEDLINE, PubMed, and EMBASE were searched for studies published between 2006 and 2016 reporting infection rates in patients using various wound dressings after undergoing TJA. All studies comparing Hydrofibre dressings to Standard dressings or Absorbent dressings were included in this meta-analysis...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560406/don-t-forget-the-hip-hip-arthritis-masquerading-as-knee-pain
#8
Florian F Dibra, Hernan A Prieto, Chancellor F Gray, Hari K Parvataneni
Background: Hip osteoarthritis typically manifests with groin or thigh pain. Other atypical pain patterns, including knee pain, have been described. Except for 2 case reports, there is no literature on this subject. Methods: From our institutional database, between 2011 and 2016, we identified 21 patients who were referred for treatment of knee pain but ultimately diagnosed with hip pathology as the cause of their pain. This group was evaluated for duration of symptoms prior to diagnosis, previous interventions, presence of walking aids, and symptom resolution after treatment of the hip pathology...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560405/physical-therapists-collect-different-outcome-measures-after-total-joint-arthroplasty-as-compared-to-most-orthopaedic-surgeons-a-new-england-study
#9
Allicia Imada, Nathaniel Nelms, David Halsey, Michael Blankstein
Background: Following total knee and hip arthroplasty, patient progress can be assessed with patient-reported outcome measures (PROMs) and performance-based outcome measures (PBOMs). The American Joint Replacement Registry 2016 guide recommends collecting several measures, including Patient Reported Outcome Measure Information System Global, Knee Injury and Osteoarthritis Outcome Score Jr, and Hip Injury and Osteoarthritis Outcome Score Jr. This study aimed to assess the current and anticipated use of PROMs and PBOMs by New England physical therapists...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560404/can-an-arthroplasty-risk-score-predict-bundled-care-events-after-total-joint-arthroplasty
#10
Blair S Ashley, Paul Maxwell Courtney, Daniel J Gittings, Jenna A Bernstein, Gwo Chin Lee, Eric L Hume, Atul F Kamath
Background: The validated Arthroplasty Risk Score (ARS) predicts the need for postoperative triage to an intensive care setting. We hypothesized that the ARS may also predict hospital length of stay (LOS), discharge disposition, and episode-of-care cost (EOCC). Methods: We retrospectively reviewed a series of 704 patients undergoing primary total hip and knee arthroplasty over 17 months. Patient characteristics, 90-day EOCC, LOS, and readmission rates were compared before and after ARS implementation...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560403/correlation-between-single-assessment-numerical-evaluation-score-and-lysholm-score-in-primary-total-knee-arthroplasty-patients
#11
Ted Sueyoshi, Gen Emoto, Toru Yato
Background: There are numerous subjective rating scales available to evaluate outcomes of total knee arthroplasty (TKA). Single Assessment Numerical Evaluation (SANE) score was developed to reduce the burden of patients or clinicians to evaluate patients' status by asking patients to simply rate the current status of their injured body part on a scale of 0-100. The purpose of this study is to investigate the correlation between SANE score and Lysholm score in patients who underwent primary TKA...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560402/continuing-versus-discontinuing-antiplatelet-drugs-vasodilators-and-or-cerebral-ameliorators-on-perioperative-total-blood-loss-in-total-knee-arthroplasty-without-pneumatic-tourniquet
#12
Sachiyuki Tsukada, Motohiro Wakui
Background: Although studies have supported the utility of perioperative continuation of antiplatelet drugs, vasodilators, and cerebral ameliorators in most procedures, no study compared total volume of blood loss after total knee arthroplasty (TKA) in patients continuing and discontinuing these drugs. Methods: We retrospectively reviewed 266 consecutive patients undergoing TKA, and included 67 patients (25.2%) taking antiplatelet drugs, vasodilators, or cerebral ameliorators in this study...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560401/a-prospective-randomized-comparative-study-of-intravenous-alone-and-combined-intravenous-and-intraarticular-administration-of-tranexamic-acid-in-primary-total-knee-replacement
#13
Paolo Adravanti, Eleonora Di Salvo, Giuseppe Calafiore, Sebastiano Vasta, Aldo Ampollini, Michele Attilio Rosa
Background: Studies on the use of tranexamic acid (TXA) to improve clinical outcomes after joint arthroplasty have reported contrasting results between intravenous (IV) TXA alone and combined IV and intraarticular (IA) administration. We compared the effectiveness of the 2 methods in providing higher postoperative hemoglobin (Hb) levels in patients undergoing primary total knee arthroplasty (TKA). Methods: A total of 100 TKA patients were randomly assigned to receive either IV TXA alone (group 1) or combined IV and topical IA TXA (group 2)...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560400/a-computer-assisted-tibia-first-technique-for-improved-femoral-component-rotation-in-total-knee-arthroplasty
#14
Chong Meng Lee, Malkit K Dhillon, Mohd Amin Sulaiman
Background: The use of navigation for total knee arthroplasty (TKA) improves limb alignment in the coronal and sagittal planes. However, similar improvements in femoral and tibial component rotation have not yet been realized using currently available systems. Methods: We developed a modified navigated TKA technique in which femoral rotation was set using the resected tibial plane as the reference with the aim of achieving a rectangular flexion gap. Limb alignment was assessed in a cohort of 30 knees using the navigation system...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560399/tranexamic-acid-increases-early-perioperative-functional-outcomes-after-total-knee-arthroplasty
#15
Matthew J Grosso, David P Trofa, Jonathan R Danoff, Thomas R Hickernell, Taylor Murtaugh, Akshay Lakra, Jeffrey A Geller
Background: The purpose of this study was to investigate the influence of tranexamic acid (TXA) on functional outcomes in the immediate postoperative period after total knee arthroplasty (TKA). We hypothesized that the known benefits of TXA would confer measurable clinical improvements in physical therapy (PT) performance, decrease pain, and decrease hospital length of stay (LOS). Methods: We retrospectively analyzed 560 TKA patients, including 280 consecutive patients whose surgery was performed before the initiation of a standardized TXA protocol and the first 280 patients who received TXA after protocol initiation...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560398/antibiotic-impregnated-total-femur-spacers-a-technical-tip
#16
Colin D Canham, Christopher P Walsh, Stephen J Incavo
Simultaneous prosthetic joint infection of ipsilateral hip and knee arthroplasties is often accompanied by significant bone loss and presents a challenging reconstructive problem. Two-stage reconstruction is favored and requires the placement of a total femur spacer, which is not a commercially available device. We describe a surgical technique, reporting on 2 cases in which a customized total femur antibiotic impregnated spacer was created by combining an articulating knee spacer and an articulating hip spacer with a reinforced cement dowel construct connecting the 2 spacers...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560397/biarticular-total-femur-spacer-for-massive-femoral-bone-loss-the-mobile-solution-for-a-big-problem
#17
Pablo Sanz-Ruiz, Jose Antonio Calvo-Haro, Manuel Villanueva-Martinez, Jose Antonio Matas-Diez, Javier Vaquero-Martín
Bone cement spacers loaded with antibiotic are the gold standard in septic revision. However, the management of massive bone defects constitutes a surgical challenge, requiring the use of different nails, expensive long stems, or cement-coated tumor prostheses for preparing the spacer. In most cases, the knee joint must be sacrificed. We describe a novel technique for preparing a biarticular total femur spacer with the help of a trochanteric nail coated with antibiotic loaded cement, allowing mobility of the hip and knee joints and assisted partial loading until second step surgery...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560396/renal-failure-after-placement-of-an-articulating-antibiotic-impregnated-polymethylmethacrlyate-hip-spacer
#18
Robert P Runner, Amanda Mener, Thomas L Bradbury
A 58-year-old male presented with native joint septic arthritis of the hip and osteomyelitis. After treatment with an articulating antibiotic spacer, he developed acute renal failure requiring dialysis. He continued to have elevated serum tobramycin levels exclusively from the antibiotic spacer elution as no intravenous tobramycin was used. Subsequent explantation was required to correct his renal failure. Although renal failure after antibiotic impregnated cement placement is rare, the risk of this potential complication should be considered preoperatively and in the postoperative management of these patients...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560395/intraoperative-femoral-head-dislodgement-during-total-hip-arthroplasty-a-report-of-four-cases
#19
Ahmed Siddiqi, Carl T Talmo, James V Bono
Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon...
March 2018: Arthroplasty Today
https://www.readbyqxmd.com/read/29560394/intraoperative-bladder-perforation-during-primary-total-hip-arthroplasty
#20
Andrew Konopitski, Anthony Boniello, Patrick Wang, Mitesh Shah, Andrew Old, Kevin Gingrich
We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality...
March 2018: Arthroplasty Today
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