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https://www.readbyqxmd.com/read/28102615/comparative-effectiveness-of-venous-thromboembolism-prophylaxis-options-for-the-patient-undergoing-total-hip-and-knee-replacement-a-network-meta-analysis
#1
A Kapoor, A Ellis, N Shaffer, J Gurwitz, A Chandramohan, J Saulino, A Ishak, T Okubanjo, F Michota, E Hylek, T A Trikalinos
: Essentials Despite trial data, guidelines have not endorsed direct oral Xa inhibitors above other options. We provide profiles of venous thromboembolism and hemorrhage risk for 12 options. Direct oral Xa inhibitors had a favorable profile compared with low-molecular-weight heparin. Other options did not have favorable profiles compared with low-molecular-weight heparin. SUMMARY: Background There are numerous trials and several meta-analyses comparing venous thromboembolism (VTE) prophylaxis options after total hip and knee replacement (THR and TKR)...
November 7, 2016: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28089984/achieving-consensus-on-total-joint-replacement-trial-outcome-reporting-using-the-omeract-filter-endorsement-of-the-final-core-domain-set-for-total-hip-and-total-knee-replacement-trials-for-endstage-arthritis
#2
Jasvinder A Singh, Michelle M Dowsey, Michael Dohm, Susan M Goodman, Amye L Leong, Marieke M J H Scholte Voshaar, Peter F Choong
OBJECTIVE: Discussion and endorsement of the OMERACT total joint replacement (TJR) core domain set for total hip replacement (THR) and total knee replacement (TKR) for endstage arthritis; and next steps for selection of instruments. METHODS: The OMERACT TJR working group met at the 2016 meeting at Whistler, British Columbia, Canada. We summarized the previous systematic reviews, the preliminary OMERACT TJR core domain set and results from previous surveys. We discussed preliminary core domains for TJR clinical trials, made modifications, and identified challenges with domain measurement...
January 15, 2017: Journal of Rheumatology
https://www.readbyqxmd.com/read/28089185/joint-replacement-volume-positively-correlates-with-improved-hospital-performance-on-centers-for-medicare-and-medicaid-services-quality-metrics
#3
Rachel A Sibley, Vanessa Charubhumi, Lorraine H Hutzler, Albit R Paoli, Joseph A Bosco
BACKGROUND: The Center for Medicare and Medicaid Services (CMS) is transitioning Medicare from a fee-for-service program into a value-based pay-for-performance program. In order to accomplish this goal, CMS initiated 3 programs that attempt to define quality and seek to reward high-performing hospitals and penalize poor-performing hospitals. These programs include (1) penalties for hospital-acquired conditions (HACs), (2) penalties for excess readmissions for certain conditions, and (3) performance on value-based purchasing (VBP)...
December 21, 2016: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28079735/incidence-of-local-anesthetic-systemic-toxicity-in-orthopedic-patients-receiving-peripheral-nerve-blocks
#4
Eva E Mörwald, Nicole Zubizarreta, Crispiana Cozowicz, Jashvant Poeran, Stavros G Memtsoudis
BACKGROUND AND OBJECTIVES: Peripheral nerve blocks are increasingly used. However, despite low complication rates, concerns regarding local anesthetic systemic toxicity remain. Although recent studies suggest that this severe complication has decreased considerably, there is a paucity of data about it on a national level. We sought to elucidate the incidence of local anesthetic systemic toxicity on a national level and therefore provide guidance toward the need for preparedness in daily anesthetic practice...
January 9, 2017: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/28078394/kinematics-of-a-bicruciate-retaining-total-knee-arthroplasty
#5
Thomas J Heyse, Joshua Slane, Geert Peersman, Margo Dirckx, Arne van de Vyver, Philipp Dworschak, Susanne Fuchs-Winkelmann, Lennart Scheys
PURPOSE: The recently reintroduced bicruciate-retaining Total Knee Arthroplasty (BCR TKA) is an interesting approach in the quest for close replication of knee joint biomechanics and kinematics closer to the native knee. Therefore, this study aimed at providing a detailed biomechanical view on the functional resemblance of BCR TKA to the native knee joint. METHODS: Seven fresh-frozen full leg cadaver specimens (76 ± 10 year) were mounted in a 6 degrees-of-freedom kinematic rig that applied a dynamic squatting motion knee flexion...
January 11, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/28074774/the-dair-debridement-antibiotics-and-implant-retention-procedure-for-infected-total-knee-replacement-a-literature-review
#6
Sultan Naseer Qasim, Andrew Swann, Robert Ashford
Prosthetic joint infection (PJI) is a devastating complication in total knee arthroplasty (TKA) and third most common cause of revision of TKA with significant morbidity and surgical challenges. Treatment options include non-operative measures with long term antibiotic suppression, debridement and implant retention (DAIR), one- or two-stage revision arthroplasty, arthrodesis and amputation. Implant retention without infection is ideal and DAIR has been reported to have variable success rates depending on patient factors, duration of infection, infecting micro-organisms, choice of procedure, single or multiple debridement procedures, arthroscopic or open, antibiotic choice and duration of antibiotic use...
2017: SICOT-J
https://www.readbyqxmd.com/read/28073671/fast-track-recovery-technique-applied-to-primary-total-hip-and-knee-replacement-surgery-analysis-of-costs-and-complications
#7
C Wilches, J D Sulbarán, J E Fernández, J M Gisbert, J M Bausili, X Pelfort
PURPOSE: To determine the cost reduction and complication rates of using an enhanced recovery pathway (Fast-track) when compared to traditional recovery in primary total hip replacement (THR) and total knee replacement (TKR), as well as to determine if there were significant differences in complication rates. MATERIAL AND METHODS: Retrospective review of 100 primary total arthroplasties using the Fast-track recovery system and another 100 using conventional recovery...
January 7, 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/28073138/-long-term-complications-due-to-polyethylene-wear-in-total-knee-arthroplasty-a-case-report
#8
Matthias Aurich
This is the case of an 84-year-old patient 18 years after total knee replacement. Regular follow-up examinations did not take place beyond 10 years of implantation, so that subsequent wear of the polyethylene insert was not detected. The patient presented because of knee pain, swelling of the calf, and a drop foot. Examination showed a large ganglion with pressure on the peroneal nerve, and a loose knee replacement with severe inlay wear and extensive osteolysis around the tibial and femoral implants. This rare case demonstrates the importance of regular clinical and radiological follow-up examinations after total joint replacements, particularly in the long term...
January 10, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28070650/revision-total-knee-arthroplasty-due-to-bone-cement-and-metal-hypersensitivity
#9
Ioannis P Stathopoulos, Nicolaos Andrianopoulos, Dimitrios Paschaloglou, Ioannis Tsarouchas
INTRODUCTION: Hypersensitivity to implants is a rare complication of total knee arthroplasty (TKA). Metal and, less frequently, bone cement can produce allergic symptomatology that if unresponsive to conservative treatment could lead to revision. MATERIALS AND METHODS: We present the case of a patient with generalized pruritus and metal taste starting during the first postoperative month after TKA. Dermal allergy exams revealed that the patient had hypersensitivity to nickel sulphate and cobalt chloride and bone cement...
January 9, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28061841/supervised-neuromuscular-exercise-prior-to-hip-and-knee-replacement-12-month-clinical-effect-and-cost-utility-analysis-alongside-a-randomised-controlled-trial
#10
Linda Fernandes, Ewa M Roos, Søren Overgaard, Allan Villadsen, Rikke Søgaard
BACKGROUND: There are indications of beneficial short-term effect of pre-operative exercise in reducing pain and improving activity of daily living after total hip replacement (THR) and total knee replacement (TKR) surgery. Though, information from studies conducting longer follow-ups and economic evaluations of exercise prior to THR and TKR is needed. The aim of the study was to analyse 12-month clinical effect and cost-utility of supervised neuromuscular exercise prior to THR and TKR surgery...
January 6, 2017: BMC Musculoskeletal Disorders
https://www.readbyqxmd.com/read/28060228/risk-adjusted-hospital-outcomes-in-medicare-total-joint-replacement-surgical-procedures
#11
Donald E Fry, Michael Pine, Susan M Nedza, David G Locke, Agnes M Reband, Gregory Pine
BACKGROUND: Comparative measurement of hospital outcomes can define opportunities for care improvement and will assume great importance as alternative payment models for inpatient total joint replacement surgical procedures are introduced. The purpose of this study was to develop risk-adjusted models for Medicare inpatient and post-discharge adverse outcomes in elective lower-extremity total joint replacement and to apply these models for hospital comparison. METHODS: Hospitals with ≥50 qualifying cases of elective total hip replacement and total knee replacement from the Medicare Limited Data Set database of 2010 to 2012 were studied...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28060227/preoperative-opioid-use-is-associated-with-early-revision-after-total-knee-arthroplasty-a-study-of-male-patients-treated-in-the-veterans-affairs-system
#12
Alon Ben-Ari, Howard Chansky, Irene Rozet
BACKGROUND: Opioid use is endemic in the U.S. and is associated with morbidity and mortality. The impact of long-term opioid use on joint-replacement outcomes remains unknown. We tested the hypothesis that use of opioids is associated with adverse outcomes after total knee arthroplasty (TKA). METHODS: We performed a retrospective analysis of patients who had had TKA within the U.S. Veterans Affairs (VA) system over a 6-year period and had been followed for 1 year postoperatively...
January 4, 2017: Journal of Bone and Joint Surgery. American Volume
https://www.readbyqxmd.com/read/28053387/reference-axes-for-optimal-femoral-rotational-alignment-in-varus-osteoarthritic-indian-knees-a-ct-based-study
#13
A V Gurava Reddy, Rajat Kumar Mathur, Aakash Mugalur, Krishna Kiran Eachempati, Anil Reddy
BACKGROUND: Optimal rotational alignment of femoral component is important for longevity and success of total knee replacement. Whiteside line (WL), posterior condylar axis (PCA) and femoral transepicondylar axis are various intra-operative landmarks to guide femoral rotation. Each of these has its pros and cons. The aims of our study were to assess the relationship of posterior condylar axis and the antero-posterior axis of femur with the surgical epicondylar axis and evaluate whether degree of deformity or severity of osteoarthritis alters the rotational alignment of the femur when posterior condylar axis is taken as a reference...
October 2016: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28053383/retrospective-study-of-asymmetric-vs-symmetric-tibial-plates-and-ultracongruent-vs-posterior-stabilized-inserts-in-indian-population-an-indian-experience-of-natural-knee-ii
#14
Ajay Deep Singh
BACKGROUND: Results of asymmetric tibial base plates vs symmetric tibial base plates and ultracongruent insert vs posterior stabilized insert in Indian population. METHODS: A total of 47 knee replacements with mean age of 65.2 years in 38 patients (16 males and 22 females) between 2007-2011 were included. Natural Knee II (21 models) were compared with 26 models of other knees (12 PFC-Sigma, one PFC-RPF, 10 Nexgen and three Vanguard). RESULTS: The ultracongruent insert of NK II lead to creation of greater post-op mean flexion deformity of 18° (range 15-20°) as compared to 5...
October 2016: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/28052489/preoperative-education-prior-to-elective-knee-arthroplasty-surgery-does-not-change-patient-outcomes
#15
Lawrence Stephen Moulton, Peter A Evans, Ian Starks, Tony Smith
Enhanced recovery programmes have improved outcomes following elective arthroplasty surgery. There are few studies assessing the role of patient education. In our enhanced recovery programme, all patients are offered the chance to attend a preoperative education class. Not all patients attend, enabling a comparison of outcomes. We have published data demonstrating that patients undergoing hip arthroplasty have improved outcomes. In the present article, we present data for total knee arthroplasty. Using a prospectively collected database, we identified all patients undergoing elective primary total knee arthroplasty...
January 4, 2017: Musculoskeletal Care
https://www.readbyqxmd.com/read/28050540/keblish-s-lateral-surgical-approach-enhances-patellar-tilt-in-valgus-knee-arthroplasty
#16
José Roberto Tonelli Filho, Marcus Ceregatti Passarelli, João Alberto Salles Brito, Gustavo Constantino Campos, Alessandro Rozim Zorzi, João Batista de Miranda
OBJECTIVE: To compare the clinical and radiological outcomes of conventional medial and lateral approaches for total knee replacement in the valgus osteoarthritic knee. METHODS: In this randomized controlled trial, 21 patients with valgus knee osteoarthritis were randomized to total knee replacement through medial or lateral approach. The primary outcome was radiographic patellar tilt. Secondary outcomes were visual analog scale of pain, postoperative levels of hemoglobin, and clinical aspect of the operative wound...
November 2016: Revista Brasileira de Ortopedia
https://www.readbyqxmd.com/read/28050539/comparative-analysis-of-pain-in-patients-who-underwent-total-knee-replacement-regarding-the-tourniquet-pressure
#17
Marcos George de Souza Leão, Gladys Pedrosa Martins Neta, Lucas Inoue Coutinho, Thiago Montenegro da Silva, Yacov Machado Costa Ferreira, Waryla Raissa Vasconcelos Dias
OBJECTIVES: To evaluate through the visual analog scale (VAS) the pain in patients undergoing total knee replacement (TKR) with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard) and the other with systolic blood pressure plus 100 mmHg (P + 100)...
November 2016: Revista Brasileira de Ortopedia
https://www.readbyqxmd.com/read/28049019/the-causal-role-of-smoking-on-the-risk-of-hip-or-knee-replacement-due-to-primary-osteoarthritis-a-mendelian-randomisation-analysis-of-the-hunt-study
#18
M B Johnsen, G Å Vie, B S Winsvold, J H Bjørngaard, B O Åsvold, M E Gabrielsen, L M Pedersen, A I Hellevik, A Langhammer, O Furnes, G B Flugsrud, F Skorpen, P R Romundstad, K Storheim, L Nordsletten, J A Zwart
OBJECTIVE: Smoking has been associated with a reduced risk of hip and knee osteoarthritis (OA) and subsequent joint replacement. The aim of the present study was to assess whether the observed association is likely to be causal. METHOD: 55,745 participants of a population-based cohort were genotyped for the rs1051730 C > T single-nucleotide polymorphism (SNP), a proxy for smoking quantity among smokers. A Mendelian randomization analysis was performed using rs1051730 as an instrument to evaluate the causal role of smoking on the risk of hip or knee replacement (combined as total joint replacement (TJR))...
January 1, 2017: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/28027387/impact-of-smoking-cessation-counseling-prior-to-total-joint-arthroplasty
#19
Sina Akhavan, Long-Co Nguyen, Vanessa Chan, Jamal Saleh, Kevin J Bozic
Perioperative smoking has been linked to surgical complications including poor wound healing, infection, myocardial infarction, prolonged length of stay, need for mechanical ventilation, and death. This study evaluated the effectiveness of preoperative counseling on smoking cessation for patients undergoing elective total joint arthroplasty. Thirty smokers with hip or knee osteoarthritis seeking hip or knee replacement surgery were enrolled prospectively. Interventions included counseling, referrals to smoking cessation programs including the California Smokers' Helpline and the Fontana Tobacco Treatment Program, nicotine replacement therapy (NRT), or instructing patients quit through the "cold turkey" method of abstinence...
December 27, 2016: Orthopedics
https://www.readbyqxmd.com/read/28027386/paresis-of-the-peroneal-nerve-a-rare-but-severe-long-term-complication-of-polyethylene-wear-in-knee-arthroplasty
#20
Matthias Aurich, Mark Lenz, Norman Best
One of the most important limiting factors in the long-term success of total knee arthroplasty is polyethylene wear. Particles of the polyethylene inserts have been shown to elicit a foreign body response, which produces bone resorption and osteolysis, ultimately leading to loosening and component failure. The authors report on a case of an elderly patient who underwent a total knee arthroplasty almost 2 decades ago. Clinical and radiological checkups of the knee had not been performed recently. He now presented with a painful and swollen knee, recurrent joint effusion and swelling of the lower leg, and paresis of the peroneal nerve...
December 27, 2016: Orthopedics
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