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https://www.readbyqxmd.com/read/29135661/reconsidering-the-affordable-care-act-s-restrictions-on-physician-owned-hospitals-analysis-of-cms-data-on-total-hip-and-knee-arthroplasty
#1
P Maxwell Courtney, Brian Darrith, Daniel D Bohl, Nicholas B Frisch, Craig J Della Valle
BACKGROUND: Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA)...
November 15, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/29114630/unicompartmental-knee-arthroplasty-modes-of-failure-and-conversion-to-total-knee-arthroplasty
#2
REVIEW
Michele Vasso, Katia Corona, Rocco D'Apolito, Giuseppe Mazzitelli, Alfredo Schiavone Panni
Despite the excellent success rates of the modern unicompartmental knee arthroplasty (UKA), results of knee replacement registries still shows a relatively high revision and failure rate for UKA, especially when compared with traditional total knee arthroplasty (TKA). Bearing dislocation continues to be advocated as the predominant mechanism of failure in mobile UKA, whereas polyethylene wear and aseptic loosening remains the main cause of failure of fixed UKA. Degeneration of the unreplaced compartments has been reported in both mobile and fixed designs...
March 2017: Joints
https://www.readbyqxmd.com/read/29076886/effects-of-forced-air-warming-on-airflow-around-the-operating-table
#3
Kazuhiro Shirozu, Tetsuya Kai, Hidekazu Setoguchi, Nobuyasu Ayagaki, Sumio Hoka
BACKGROUND: Forced air warming systems are used to maintain body temperature during surgery. Benefits of forced air warming have been established, but the possibility that it may disturb the operating room environment and contribute to surgical site contamination is debated. The direction and speed of forced air warming airflow and the influence of laminar airflow in the operating room have not been reported. METHODS: In one institutional operating room, we examined changes in airflow speed and direction from a lower-body forced air warming device with sterile drapes mimicking abdominal surgery or total knee arthroplasty, and effects of laminar airflow, using a three-dimensional ultrasonic anemometer...
October 26, 2017: Anesthesiology
https://www.readbyqxmd.com/read/29026941/neutral-alignment-leads-to-higher-knee-society-scores-after-total-knee-arthroplasty-in-preoperatively-non-varus-patients-a-prospective-clinical-study-using-3d-ct
#4
Omer Slevin, Anna Hirschmann, Filippo F Schiapparelli, Felix Amsler, Rolf W Huegli, Michael T Hirschmann
PURPOSE: The optimal coronal alignment is still under debate. However, in most of the studies, alignment was only assessed using radiographs, which are not accurate enough for assessment of tibial and femoral TKA position. The primary purpose of this study was to assess the relationship between coronal TKA alignment using 3D-reconstructed CTs and clinical outcome in patients with preoperative varus in comparison with patients with natural or valgus deformity. It was the hypothesis that neutral limb alignment shows a better outcome after TKA...
October 12, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28988612/cost-analysis-complications-and-discharge-disposition-associated-with-simultaneous-vs-staged-bilateral-total-knee-arthroplasty
#5
Ali H Sobh, Matthew P Siljander, Anthony J Mells, Denise M Koueiter, Drew D Moore, Mark S Karadsheh
BACKGROUND: Simultaneous vs staged bilateral total knee arthroplasty (BTKA) has long been debated. The primary objective of this study was to compare actual hospital costs and complication rates in patients undergoing simultaneous BTKA (simBTKA) and staged BTKA (staBTKA) at a single institution. METHODS: A total joint arthroplasty database from a single hospital was used to identify all patients who underwent primary BTKA from 2013 to 2016 and divided into simultaneous and staged groups...
September 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28886100/biomechanical-evaluation-of-tibial-bone-adaptation-after-revision-total-knee-arthroplasty-a-comparison-of-different-implant-systems
#6
María Paz Quilez, Belen Seral, María Angeles Pérez
The best methods to manage tibial bone defects following total knee arthroplasty remain under debate. Different fixation systems exist to help surgeons reconstruct knee osseous bone loss (such as tantalum cones, cement, modular metal augments, autografts, allografts and porous metaphyseal sleeves) However, the effects of the various solutions on the long-term outcome remain unknown. In the present work, a bone remodeling mathematical model was used to predict bone remodeling after total knee arthroplasty (TKA) revision...
2017: PloS One
https://www.readbyqxmd.com/read/28878512/comparison-of-postoperative-complications-after-total-hip-arthroplasty-among-patients-receiving-aspirin-enoxaparin-warfarin-and-factor-xa-inhibitors
#7
Perez Agaba, Beau J Kildow, Herman Dhotar, Thorsten M Seyler, Michael Bolognesi
Optimal prophylaxis for prevention of venous thromboembolism (VTE) after total joint arthroplasty (TJA) remains debated. The purpose of this study was to compare postoperative complications in patients receiving different VTE chemoprophylactic regimens. Using a nationwide healthcare database, 72,670 THA patients without a history of VTE were identified. Study cohorts received VTE prophylaxis within 30 days postoperatively. Odds ratios and 95% confidence intervals were used to assess 30-day and 90-day postoperative complications (hematoma, hemorrhage, transfusion, pulmonary embolism (PE), VTE, prosthetic joint infection (PJI), and incision/drainage (I&D))...
December 2017: Journal of Orthopaedics
https://www.readbyqxmd.com/read/28852331/conversion-total-hip-arthroplasty-after-failed-basicervical-hip-fracture-fixation-a-case-report-and-review-of-literature
#8
Vineet Tyagi, Oluwaseun Akinbo
Proximal femur fractures are a common orthopedic injury, and it is estimated that their prevalence will continue to increase over the next twenty years. There has been much debate over the optimal management of basicervical fractures, which can be difficult to identify radiographically. There is also a role for conversion total hip arthroplasty in patients where fracture fixation fails. We present a case report of a proximal femur fracture managed as a basicervical fracture, and subsequently needing a conversion arthroplasty and revision surgery...
2017: Iowa Orthopaedic Journal
https://www.readbyqxmd.com/read/28831821/long-term-outcomes-of-over-8-000-medial-oxford-phase-3-unicompartmental-knees-a-systematic-review
#9
Hasan R Mohammad, Louise Strickland, Thomas W Hamilton, David W Murray
Background and purpose - There is debate as to the relative merits of unicompartmental and total knee arthroplasty (UKA, TKA). Although the designer surgeons have achieved good results with the Oxford UKA there is concern over the reproducibility of these outcomes. Therefore, we evaluated published long-term outcomes of the Oxford Phase 3 UKA. Patients and methods - We searched databases to identify studies reporting ≥10 year outcomes of the medial Oxford Phase 3 UKA. Revision, non-revision, and re-operation rates were calculated per 100 component years (% pa)...
August 23, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28790470/management-guidelines-for-metal-on-metal-hip-resurfacing-arthroplasty-a-strategy-on-followup
#10
Naoki Nakano, Andrea Volpin, Jonathan Bartlett, Vikas Khanduja
Despite the initial promise of metal-on-metal (MoM) implants as the ideal bearing surface for hip replacements and resurfacings, high short term failure rates due to an adverse reaction to metal debris (ARMD) have led to a dramatic reduction in the number of MoM implants used in the modern era. With over one million patients worldwide having undergone hip operations utilizing a MoM bearing surface, the long term outcomes for such patients remains unknown, and there is much debate as to the most effective management of these patients...
July 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/28790467/current-concepts-in-acetabular-positioning-in-total-hip-arthroplasty
#11
Deepu Bhaskar, Asim Rajpura, Tim Board
Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination)...
July 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/28738891/pivotal-trials-of-orthopedic-surgical-devices-in-the-united-states-predominance-of-two-arm-non-inferiority-designs
#12
S Raymond Golish
BACKGROUND: The United States Food and Drug Administration (FDA) reviews class III orthopedic devices submitted for premarket approval with pivotal clinical trials. The purpose of this study was to determine the types of orthopedic devices reviewed, the design of their pivotal clinical trials, and the subjective factors affecting the interpretation of clinical trial data. METHODS: Meetings of the FDA Orthopaedic and Rehabilitation Devices Panel were identified from 2000-2016...
July 24, 2017: Trials
https://www.readbyqxmd.com/read/28658157/efficacy-of-tranexamic-acid-plus-drain-clamping-to-reduce-blood-loss-in-total-knee-arthroplasty-a-meta-analysis
#13
REVIEW
Yan Zhang, Jun-Wei Zhang, Bao-Hua Wang
BACKGROUND: Perioperative blood loss is still an unsolved problem in total knee arthroplasty (TKA). The efficacy of the preoperative use of tranexamic acid (TXA) plus drain-clamping to reduce blood loss in TKA has been debated. This meta-analysis aimed to illustrate the efficacy of TXA plus drain-clamping to reduce blood loss in patients who underwent a TKA. METHODS: In February 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Database of Systematic Reviews, and Google Scholar...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28653546/cruciate-retaining-compared-with-posterior-stabilised-nexgen-total-knee-arthroplasty-results-at-10-years-in-a-matched-cohort
#14
Aiw Mayne, H P Harshavardhan, L R Johnston, W Wang, A Jariwala
INTRODUCTION Debate has persisted for many years about whether to sacrifice or replace the posterior cruciate ligament when performing total knee arthroplasty. A paucity of long-term follow-up studies comparing outcomes between cruciate-retaining and posterior-stabilised knees exist. We aimed to compare results at ten-year follow-up. METHODS A matched paired study comparing a cohort of 107 Zimmer Nexgen® Cruciate Retaining (CR) patients with a cohort of 107 Nexgen Posterior-Stabilised (PS) knees matched for age, sex, body mass index and preoperative American Knee Society score was undertaken...
June 27, 2017: Annals of the Royal College of Surgeons of England
https://www.readbyqxmd.com/read/28640101/liposomal-bupivacaine-versus-traditional-bupivacaine-for-pain-control-after-total-hip-arthroplasty-a-meta-analysis
#15
REVIEW
Ting-Ting Ma, Yu-Hui Wang, Yun-Feng Jiang, Cong-Bin Peng, Chao Yan, Zi-Gui Liu, Wei-Xing Xu
BACKGROUND: In the past, the efficacy of local infiltration of liposomal bupivacaine for total hip arthroplasty (THA) patients was in debate. Therefore, this meta-analysis was conducted to determine whether local infiltration of liposomal bupivacaine provides better pain relief after THA. METHODS: We searched Web of Science, PubMed, Embase, and the Cochrane Library databases to the April 2017. Any studies comparing liposomal bupivacaine and traditional bupivacaine were included in our meta-analysis...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28567339/hallux-rigidus-how-do-i-approach-it
#16
REVIEW
Aaron Lam, Jimmy J Chan, Michele F Surace, Ettore Vulcano
Hallux rigidus is a degenerative disease of the first metatarsalphalangeal (MTP) joint and affects 2.5% of people over age 50. Dorsal osteophytes and narrowed joint space leads to debilitating pain and limited range of motion. Altered gait mechanics often ensued as 119% of the body force transmit through the 1(st) MTP joint during gait cycle. Precise etiology remains under debate with trauma being often cited in the literature. Hallux valgus interphalangeus, female gender, inflammatory and metabolic conditions have all been identified as associative factors...
May 18, 2017: World Journal of Orthopedics
https://www.readbyqxmd.com/read/28526923/focal-articular-prosthetic-resurfacing-for-the-treatment-of-full-thickness-articular-cartilage-defects-in-the-knee-12-year-follow-up-of-two-cases-and-review-of-the-literature
#17
C Becher, E B Cantiller
INTRODUCTION: The rationale of focal articular prosthetic resurfacing used as a primary arthroplasty procedure in the treatment of articular cartilage defects is still under debate. Conflicting reports raise concern about high rates of re-operations and continued development of osteoarthritis, while others have reported good outcomes. The goal of this paper is to present the long-term results of two patients with a 12-year follow-up and to report the results of a literature review. MATERIALS AND METHODS: Two patients (male, 70 years; female 63 years) with a follow-up of 12 years were reviewed...
May 19, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28525999/is-soft-tissue-repair-a-right-choice-to-avoid-early-dislocation-after-tha-in-posterior-approach
#18
Yiqin Zhou, Shiqi Cao, Lintao Li, Manoj Narava, Qiwei Fu, Qirong Qian
BACKGROUND: Dislocation is the second most common complication after total hip arthroplasty (THA). The effectiveness of soft tissue repair to reduce dislocation rate is still debated and thus a meta-analysis was conducted. METHODS: A systematic search in PubMed, Embase, and Cochrane databases was conducted for this meta-analysis. INCLUSION CRITERIA: clinical comparative trials on the use of soft tissue repair including rotators and capsule repair in primary THA...
May 19, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28390888/liposomal-bupivacaine-mixture-has-similar-pain-relief-and-significantly-fewer-complications-at-less-cost-compared-to-indwelling-interscalene-catheter-in-total-shoulder-arthroplasty
#19
William J Weller, Michael G Azzam, Richard A Smith, Frederick M Azar, Thomas W Throckmorton
BACKGROUND: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate. METHODS: In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs...
November 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28390887/single-stage-revision-arthroplasty-for-infection-an-underutilized-treatment-strategy
#20
Jonathan J Negus, Peter B Gifford, Fares S Haddad
BACKGROUND: The burden of revision arthroplasty surgery for infection is rising as the rate of primary arthroplasty surgery increases. Infected arthroplasty rates are now relatively low, but the sheer increase in volume is leading to considerable patient morbidity and significant increases in costs to the health care system. Single-stage revision for infection is one of the several accepted treatment options, but the indications and results are debated. This review aims to clarify the current evidence...
March 2, 2017: Journal of Arthroplasty
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