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elective Knee replacement

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https://www.readbyqxmd.com/read/28096323/pyoderma-gangrenosum-following-complex-reconstruction-of-a-large-scale-lower-limb-defect-by-combined-parascapular-and-latissimus-dorsi-flap
#1
Tomke Cordts, Amir K Bigdeli, Leila Harhaus, Christoph Hirche, Thomas Kremer, Ulrich Kneser, Volker J Schmidt
A female patient with a critical soft tissue defect after elective knee replacement surgery was transferred to our department for reconstruction. As wounds were rapidly progressing, necrotizing fasciitis was initially suspected but eventually ruled out by histopathological analysis. A 50 × 15 cm defect was then reconstructed by means of a combined Parascapular and latissimus dorsi flap before, a couple days later, the patient developed tender pustules and ulcers involving the flap as well as the donor site...
January 17, 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/28060228/risk-adjusted-hospital-outcomes-in-medicare-total-joint-replacement-surgical-procedures
#2
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/28052489/preoperative-education-prior-to-elective-knee-arthroplasty-surgery-does-not-change-patient-outcomes
#3
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/28027387/impact-of-smoking-cessation-counseling-prior-to-total-joint-arthroplasty
#4
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/27965248/gender-disparities-in-red-blood-cell-transfusion-in-elective-surgery-a-post-hoc-multicentre-cohort-study
#5
Hans Gombotz, Günter Schreier, Sandra Neubauer, Peter Kastner, Axel Hofmann
OBJECTIVES: A post hoc gender comparison of transfusion-related modifiable risk factors among patients undergoing elective surgery. SETTINGS: 23 Austrian centres randomly selected and stratified by region and level of care. PARTICIPANTS: We consecutively enrolled in total 6530 patients (3465 women and 3065 men); 1491 underwent coronary artery bypass graft (CABG) surgery, 2570 primary unilateral total hip replacement (THR) and 2469 primary unilateral total knee replacement (TKR)...
December 13, 2016: BMJ Open
https://www.readbyqxmd.com/read/27931698/the-effectiveness-of-nurse-led-preoperative-assessment-clinics-for-patients-receiving-elective-orthopaedic-surgery-a-systematic-review
#6
Chan Sau-Man Conny, Ip Wan-Yim
PURPOSE: Nurse-led preoperative assessment clinics (POAC) have been introduced in different specialty areas to assess and prepare patients preoperatively in order to avoid last-minute surgery cancellations. Not all patients are referred to POACs before surgery, and the benefits of nurse-led POACs are not well documented in Hong Kong. The purpose of this systemic review was to identify the best available research evidence to inform current clinical practice, guide health care decision making and promote better care...
December 2016: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/27914722/poor-expectations-of-knee-replacement-benefit-are-associated-with-modifiable-psychological-factors-and-influence-the-decision-to-have-surgery-a-cross-sectional-and-longitudinal-study-of-a-community-based-sample
#7
Daniel L Riddle, Gregory J Golladay, Amanda Hayes, Hassan M K Ghomrawi
BACKGROUND: Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA. METHODS: A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations...
November 30, 2016: Knee
https://www.readbyqxmd.com/read/27893033/effect-of-a-decision-aid-on-access-to-total-knee-replacement-for-black-patients-with-osteoarthritis-of-the-knee-a-randomized-clinical-trial
#8
Said A Ibrahim, Marissa Blum, Gwo-Chin Lee, Pekka Mooar, Elina Medvedeva, Aliya Collier, Diane Richardson
Importance: Black patients with advanced osteoarthritis (OA) of the knee are significantly less likely than white patients to undergo surgery. No strategies have been proved to improve access to surgery for black patients with end-stage OA of the knee. Objective: To assess whether a decision aid improves access to total knee replacement (TKR) surgery for black patients with OA of the knee. Design, Setting, and Participants: In a randomized clinical trial, 336 eligible participants who self-identified as black and 50 years or older with chronic and frequent knee pain, a Western Ontario McMaster Universities Osteoarthritis Index score of at least 39, and radiographic evidence of OA of the knee were recruited from December 1, 2010, to May 31, 2014, at 3 medical centers...
January 18, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/27872771/tranexamic-acid-an-exceedingly-rare-cause-of-anaphylaxis-during-anaesthesia
#9
R A Bansal, A Nicholas, A S Bansal
Tranexamic acid (TXA) allergy is extremely rare. An 80-year-old woman without prior exposure to TXA underwent elective knee replacement. Shortly after induction of anaesthesia and intravenous TXA, she developed hypotension, tachycardia, and facial erythema accompanied by a raised serum tryptase. Later, skin prick and intradermal testing confirmed positive responses to TXA in high dilution and with negative results to the other drugs used. While neuromuscular blocking agents, opiates, and antibiotics remain the most frequent cause of anaphylaxis during anaesthesia, allergy to TXA should always be borne in mind and requires skin testing for confirmation as there are presently no blood tests available...
2016: Case Reports in Immunology
https://www.readbyqxmd.com/read/27871190/the-significance-of-social-rules-in-group-training-sessions
#10
Line Blixt, Kari Nyheim Solbrække
PURPOSE: To identify what types of social rules are involved in group interventions led by physiotherapists (PTs), and how these rules influence individual recovery. METHODS: Eight patients; six women and two men, which had recently undergone elective hip or knee replacement surgery, were recruited as informants from an intervention group that investigated effect of task specific exercise. The data comprise observational notes from group training sessions and one-on-one semi-structured interviews with the eight patients...
November 21, 2016: Disability and Rehabilitation
https://www.readbyqxmd.com/read/27861701/preparing-family-caregivers-to-recognize-delirium-symptoms-in-older-adults-after-elective-hip-or-knee-arthroplasty
#11
Margaret J Bull, Lesley Boaz, Mehdi Maadooliat, Mary E Hagle, Lynn Gettrust, Maureen T Greene, Sue Baird Holmes, Jane S Saczynski
OBJECTIVES: To test the feasibility of a telephone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers. DESIGN: Mixed-method, pre-post quasi-experimental design. SETTING: A Midwest Veterans Affairs Medical Center and a nonprofit health system. PARTICIPANTS: Forty-one family caregiver-older adult dyads provided consent; 34 completed the intervention...
November 11, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27797404/pentasaccharides-for-the-prevention-of-venous-thromboembolism
#12
REVIEW
Kezhou Dong, Yanzhi Song, Xiaodong Li, Jie Ding, Zhiyong Gao, Daopei Lu, Yimin Zhu
BACKGROUND: Venous thromboembolism (VTE) is a common condition with potentially serious and life-threatening consequences. The standard method of thromboprophylaxis uses an anticoagulant such as low molecular weight heparin (LMWH) or warfarin. In recent years, another type of anticoagulant, pentasaccharide, an indirect factor Xa inhibitor, has shown good anticoagulative effect in clinical trials. Three types of pentasaccharides are available: short-acting fondaparinux, long-acting idraparinux and idrabiotaparinux...
October 31, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27787880/reducing-hospital-readmission-disparities-of-older-black-and-white-adults-after-elective-joint-replacement-the-role-of-nurse-staffing
#13
Karen B Lasater, Matthew D McHugh
OBJECTIVES: To examine racial differences in readmissions of older adults undergoing elective total hip and knee replacement, to determine the relationship between nurse staffing and readmission, and to study whether the relationship between staffing and readmission differs for older black and white adults. DESIGN: Cross-sectional analysis of multiple linked secondary data sources. SETTING: Nonfederal acute care hospitals in California, Florida, New Jersey, and Pennsylvania (n = 483)...
December 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27637304/postorthopedic-surgery-joint-replacement-surgery-venous-thromboembolism-prophylaxis
#14
REVIEW
Louis M Kwong, Jon A Kimball
Elective total hip or knee arthroplasty places patients at risk for venous thromboembolism (VTE). As our understanding of the pathophysiology of VTE after joint arthroplasty has increased, pharmacologic strategies have been developed to target different aspects of the coagulation cascade. Various approaches have been used as risk reduction strategies. In 2011 and 2014 the Food and Drug Administration approved rivaroxaban and apixaban as new oral antithrombotic agents. Although controversies remain with regard to the ideal VTE pharmacoprophylactic agent, this class of novel oral anticoagulants has been demonstrated to be safe and to be more effective than enoxaparin...
October 2016: Hematology/oncology Clinics of North America
https://www.readbyqxmd.com/read/27623680/exploring-unmet-needs-in-venous-and-arterial-thromboembolism-with-rivaroxaban
#15
Riccardo Cappato, Robert Welsh
The vast clinical research programme for the direct, oral factor Xa inhibitor rivaroxaban has generated a wealth of data since the first rivaroxaban approval in 2008 for the prevention of venous thromboembolism (VTE) in patients undergoing elective hip or knee replacement surgery. While rivaroxaban is widely used across a spectrum of seven indications, there is continuous commitment to investigating its wider benefits in new indications and attempts to refine current evidence. Key data from recently completed randomised controlled trials (RCTs) have shown that rivaroxaban is a feasible anticoagulation option for patients with non-valvular atrial fibrillation (NVAF) undergoing cardioversion or catheter ablation...
September 28, 2016: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/27611713/emergency-department-visits-following-joint-replacement-surgery-in-an-era-of-mandatory-bundled-payments
#16
Susan M Nedza, Donald E Fry, Susan DesHarnais, Eric Spencer, Patrick Yep
OBJECTIVES: The Center for Medicare & Medicaid Services (CMS) is actively testing bundled payments models. This study sought to identify relevant details for 90-day postdischarge emergency department (ED) visits of Medicare beneficiaries following total joint replacement (TJR) surgery meeting eligibility for a CMS bundled payment program. METHODS: The CMS research identifiable file for the State of Texas for 2011-2012 was used to identify patients who underwent TJR...
September 9, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27601761/orthopaedic-enhanced-recovery-programme-for-elective-hip-and-knee-arthroplasty-could-a-regional-programme-be-beneficial
#17
Adam Tucker, Darren McCusker, Nidhi Gupta, Jonathon Bunn, Mark Murnaghan
INTRODUCTION: Arthroplasty is commonplace in orthopaedic practice, and post operative pain has been shown to substantially hinder recovery and discharge from hospital. OBJECTIVES: The current study assessed a multidisciplinary, multimodal Orthopaedic ERP in terms of its effect on patient perceived post operative pain in hip and knee arthroplasty. Secondary outcome was in the form of a cost analysis. METHODS: A prospective study was performed on consecutive arthroplasty patients across a 6 week period in a district orthopaedic unit...
May 2016: Ulster Medical Journal
https://www.readbyqxmd.com/read/27594378/safety-and-efficacy-of-new-oral-anticoagulants-and-low-molecular-weight-heparins-compared-with-aspirin-in-patients-undergoing-total-knee-and-hip-replacements
#18
Johannes T H Nielen, Pieter C Dagnelie, Pieter J Emans, Nicole Veldhorst-Janssen, Arief Lalmohamed, Tjeerd-Pieter van Staa, Annelies E R C H Boonen, Bart J F van den Bemt, Frank de Vries
BACKGROUND: There has been much debate recently on the best type of thromboprophylaxis following elective total joint replacement surgery. OBJECTIVE: This study aims to compare rates of venous thromboembolism (VTE), gastro-intestinal (GI) bleeding and mortality events, with use of new oral anticoagulants (NOAC) or low-molecular-weight heparins (LMWHs) compared with aspirin in patients undergoing total joint replacement. METHODS: A population-based retrospective cohort study was performed using the Clinical Practice Research Datalink...
September 4, 2016: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/27581506/the-prophylaxis-of-venous-thromboembolism
#19
Albrecht Encke, Sylvia Haas, Ina Kopp
BACKGROUND: Venous thromboembolism (VTE) is the third most common cardiovascular condition, after myocardial infarction and stroke. Prophylactic measures in accordance with current guidelines can significantly reduce the risk of VTE and the associated morbidity and mortality. Until now, the German interdisciplinary, evidence- and consensus-based (S3) clinical practice guideline on VTE prophylaxis was based on a complete review of all pertinent literature available in MEDLINE up to January 2008...
August 8, 2016: Deutsches Ärzteblatt International
https://www.readbyqxmd.com/read/27575874/spouse-related-factors-associated-with-quality-of-recovery-of-patients-after-hip-or-knee-replacement-a-nordic-perspective
#20
Åsa Johansson Stark, Sanna Salanterä, Arun K Sigurdardottir, Kirsi Valkeapää, Margareta Bachrach-Lindström
BACKGROUND: Today's shorter hospital stays mean that patients may need support from informal caregivers during their recovery period. The responsibility for providing this support shifts from the healthcare staff to their family members fairly early in the recovery process. Spousal caregivers are considered to be the primary caregivers as their relationship with the patient is more interdependent than that of other family members or caregivers. OBJECTIVES: The aim was to describe spouse-related factors that were associated with patients' quality of recovery on discharge from hospital after elective hip or knee replacement...
November 2016: International Journal of Orthopaedic and Trauma Nursing
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