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Fast-track arthroplasty

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https://www.readbyqxmd.com/read/29676839/analgesic-consumption-trajectories-in-8-975-patients-1-year-after-fast-track-total-hip-or-knee-arthroplasty
#1
C C Jørgensen, M Petersen, H Kehlet, E K Aasvang
BACKGROUND: Persistent or increased long-term opioid consumption has previously been described following total hip- (THA) and knee arthroplasty (TKA). However, detailed information on postoperative analgesic consumption trajectories and risk factors associated with continued need of analgesics in fast-track THA and TKA is sparse. METHODS: Descriptive multicenter study in primary unilateral fast-track THA or TKA with prospective data on patient characteristics and information on reimbursement entitled dispensed prescriptions of paracetamol, non-steroidal anti-inflammatory drugs, opioids, anticonvulsants, and antidepressants one month preoperatively and one year postoperatively...
April 20, 2018: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/29671152/predictive-simulations-of-neuromuscular-coordination-and-joint-contact-loading-in-human-gait
#2
Yi-Chung Lin, Jonathan P Walter, Marcus G Pandy
We implemented direct collocation on a full-body neuromusculoskeletal model to calculate muscle forces, ground reaction forces and knee contact loading simultaneously for one cycle of human gait. A data-tracking collocation problem was solved for walking at the normal speed to establish the practicality of incorporating a 3D model of articular contact and a model of foot-ground interaction explicitly in a dynamic optimization simulation. The data-tracking solution then was used as an initial guess to solve predictive collocation problems, where novel patterns of movement were generated for walking at slow and fast speeds, independent of experimental data...
April 18, 2018: Annals of Biomedical Engineering
https://www.readbyqxmd.com/read/29405303/iron-deficiency-and-preoperative-anaemia-in-patients-scheduled-for-elective-hip-and-knee-arthroplasty-an-observational-study
#3
Ø Jans, C S Nielsen, N Khan, K Gromov, A Troelsen, H Husted
BACKGROUND AND OBJECTIVES: Preoperative anaemia is prevalent in elderly patients scheduled for major orthopaedic surgery and is associated with increased transfusion risk and postoperative morbidity. New guidelines recommend preoperative correction of anaemia and iron deficiency in all patients with a Hb < 13 g/dl. However, iron deficiency and other causes of preoperative anaemia in hip- (THA) and knee (TKA) arthroplasty are only sparsely studied. MATERIALS AND METHODS: Preoperative Hb and iron status were prospectively collected from 882 unselected elective fast-track THA/TKA patients and analysed according to both WHO anaemia criteria (Hb < 12 g/dl females, <13 g/dl males) and Hb < 13 g/dl for both genders...
April 2018: Vox Sanguinis
https://www.readbyqxmd.com/read/29387645/clinical-evidence-of-traditional-vs-fast-track-recovery-methodologies-after-total-arthroplasty-for-osteoarthritic-knee-treatment-a-retrospective-observational-study
#4
Sergio Castorina, Claudia Guglielmino, Paola Castrogiovanni, Marta Anna Szychlinska, Francesco Ioppolo, Paolo Massimino, Pietro Leonardi, Christian Maci, Maurizio Iannuzzi, Angelo Di Giunta, Giuseppe Musumeci
Background: During the last years, programs to enhance postoperative recovery and decrease morbidity after total knee arthroplasty, have been developed across a variety of surgical procedures and referred to as "Fast-Track Surgery". In this study we aimed to find some answers in the management of osteoarthritic patients subjected to total knee arthroplasty, by using the Fast-Track methodology. To this purpose we evaluated parameters such as early mobilization of patients, better pain management, bleeding, possible complications, reduced hospitalization time, an overall improved recovery and patient satisfaction...
July 2017: Muscles, Ligaments and Tendons Journal
https://www.readbyqxmd.com/read/29306574/incidence-and-risk-factors-of-postoperative-urinary-retention-and-bladder-catheterization-in-patients-undergoing-fast-track-total-joint-arthroplasty-a-prospective-observational-study-on-371-patients
#5
Ruben Scholten, Keetie Kremers, Sebastiaan A W van de Groes, Diederik M Somford, Sander Koëter
BACKGROUND: Postoperative urinary retention (POUR) appears to be a common complication in lower limb joint arthroplasty; however, reports on its incidence vary. There is no general consensus on its definition and there is no scientific evidence on treatment principles. We performed a prospective observational study to establish the incidence of POUR and its risk factors, including the preoperative postvoid residual urine volume and the perioperative fluid balance, in fast-track total joint arthroplasty (TJA)...
December 13, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29260691/-fast-track-hip-arthroplasty
#6
Torben Bæk Hansen, Kirill Gromov, Billy B Kristensen, Henrik Husted, Henrik Kehlet
Fast-track surgery implies a coordinated perioperative approach aimed at reducing surgical stress and facilitating post-operative recovery. The fast-track programme has reduced post-operative length of stay and has led to shorter convalescence with more rapid functional recovery and decreased morbidity and mortality in total hip arthroplasty. It should now be a standard total hip arthroplasty patient pathway, but fine tuning of the multiple factors in the fast-track pathway is still needed in patients with special needs or high comorbidity burden...
December 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29208509/the-use-of-an-intraarticular-catheter-on-fast-track-primary-knee-arthroplasty-is-it-a-step-forward
#7
L Cáceres-Sánchez, J B García-Benítez, V Coronado-Hijón, M Montero-Pariente
OBJECTIVE: This study compares the efficacy in post-operative pain control of the intraarticular catheter compared to the epidural catheter after primary total knee arthroplasty. MATERIAL AND METHOD: Randomised clinical trial consisting of two groups of patients. A control group with intradural anaesthesia and an intraoperative epidural catheter (ropivacaine) and an intervention group using the same anaesthetic technique and an intraarticular catheter with an elastomeric pump (ropivacaine+dexketoprofen)...
January 2018: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/29204497/decreased-risk-of-knee-buckling-with-adductor-canal-block-versus-femoral-nerve-block-in-total-knee-arthroplasty-a-retrospective-cohort-study
#8
Ryan R Thacher, Thomas R Hickernell, Matthew J Grosso, Roshan Shah, Herbert J Cooper, Robert Maniker, Anthony Robin Brown, Jeffrey Geller
Background: Femoral nerve (FNB) and adductor canal blocks (ACB) are used in the setting of total knee arthroplasty (TKA), but neither has been demonstrated to be clearly superior. Although dynamometer studies have shown ACBs spare perioperative quadriceps function when compared to FNBs, ACBs have been widely adopted in orthopaedic surgery without significant evidence that they decrease the risk of perioperative falls. Methods: All patients who received single-shot FNB (129 patients) or ACB (150 patients) at our institution for unilateral primary TKA from April 2014 to September 2015 were retrospectively reviewed for perioperative falls or near-falls during physical therapy and inpatient care...
December 2017: Arthroplasty Today
https://www.readbyqxmd.com/read/29202644/outpatient-total-hip-and-knee-arthroplasty
#9
Stephan B W Vehmeijer, Henrik Husted, Henrik Kehlet
As a result of the introduction of fast-track programs, the length of hospital stay after arthroplasty has decreased to a point where some patients meet the discharge criteria on the day of surgery. In several studies, well-established fast-track centers have demonstrated the feasibility of outpatient procedures in selected patients. However, in literature the term "outpatient" is sometimes also used for patients who spend one or more nights in hospital. We therefore propose to use "outpatient" solely for patients who are discharged to their own home on the day of surgery and do not have an overnight stay at either the hospital or another non-home facility...
December 5, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/29198872/a-randomized-non-inferiority-trial-of-adductor-canal-block-for-analgesia-after-total-knee-arthroplasty-single-injection-versus-catheter-technique
#10
Steven Lee, Nirooshan Rooban, Himat Vaghadia, Andrew N Sawka, Raymond Tang
BACKGROUND: Adductor canal blocks (ACBs) provide effective analgesia following total knee arthroplasty. We hypothesized that ACB single injection plus intravenous (IV) dexamethasone (Dex) shows non-inferiority to catheter, while ACB single injection does not. METHODS: One hundred eighty patients were randomized and 177 analyzed from among 1 of 3 ACB interventions: (1) 0.5% ropivacaine 20 mL; (2) 0.5% ropivacaine 20 mL plus IV Dex 8 mg; (3) 0.5% ropivacaine 20 mL followed by continuous infusion of 0...
April 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29160123/fast-tracking-for-total-knee-replacement-reduces-use-of-institutional-care-without-compromising-quality
#11
Konsta J Pamilo, Paulus Torkki, Mikko Peltola, Maija Pesola, Ville Remes, Juha Paloneva
Background and purpose - Fast-tracking shortens the length of the primary treatment period (length of stay, LOS) after total knee replacement (TKR). We evaluated the influence of the fast-track concept on the length of uninterrupted institutional care (LUIC) and other outcomes after TKR. Patients and methods - 4,256 TKRs performed in 4 hospitals between 2009-2010 and 2012-2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register. Hospitals were classified as fast track (Hospital A) and non-fast track (Hospitals B, C and D)...
November 21, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/29102512/ninety-day-morbidity-and-mortality-in-risk-screened-and-optimized-patients-undergoing-two-team-fast-track-simultaneous-bilateral-tka-compared-with-unilateral-tka-a-prospective-study
#12
Vikas Kulshrestha, Santhosh Kumar, Barun Datta, V K Sinha, Gaurav Mittal
BACKGROUND: Simultaneous bilateral total knee arthroplasty (SBTKA) offers significant socioeconomic benefits. However, retrospective studies and public health data show increased mortality and morbidity rates in patients undergoing SBTKA compared with those undergoing unilateral TKA (UTKA), and there have been recommendations against the use of SBTKA. High-volume centers, which feature careful patient selection and fast-tracked surgery, continue to perform SBTKA and have published their results in favor of the procedure...
March 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29022751/prospective-psychometric-characterization-of-hip-and-knee-arthroplasty-patients
#13
Silas Hinsch Gylvin, Anders Fink-Jensen, Henrik Kehlet, Christoffer Calov Jørgensen, Mogens Berg Laursen, Kirill Gromov, Henrik Morville Schroder, Susanne Jung Høvsgaard, Heidi Raahauge Wede, Phillip Raphael Kyle, Per Bech
BACKGROUND: Psychiatric conditions and psychopharmacological treatments have been demonstrated to be important risk-factors for prolonged hospital length of stay, readmission and morbidity, following fast-track total hip (THA) and total knee arthroplasty (TKA). AIMS: The aim of the study was to provide a detailed description of the preoperative psychiatric characteristics of a well-defined patient population undergoing THA and TKA, using the 90-item Symptom Checklist (SCL-90-R)...
January 2018: Nordic Journal of Psychiatry
https://www.readbyqxmd.com/read/28985252/age-and-sex-based-recovery-curves-to-track-functional-outcomes-in-older-adults-with-total-knee-arthroplasty
#14
Yong-Hao Pua, Felicia Jie-Ting Seah, Cheryl Lian-Li Poon, John Wei-Ming Tan, Ross Alan Clark, Jennifer Suet-Ching Liaw, Hwei-Chi Chong
Background: older adults with total knee arthroplasty (TKA) frequently undergo rehabilitation to address limited knee flexion range-of-motion, quadriceps weakness and gait speed limitations. This study aimed to develop age- and sex-specific recovery curves of knee flexion range-of-motion, quadriceps strength and fast gait speed post-TKA. Methods: a population-based sample of 2,987 patients undergoing primary TKA participated, of whom 2015 (68%) were 65 years of age or older...
January 1, 2018: Age and Ageing
https://www.readbyqxmd.com/read/28933332/the-impact-of-caregivers-anxiety-on-patients-anxiety-before-fast-track-knee-arthroplasty
#15
COMPARATIVE STUDY
P Zietek, B Zarzycka, J Zietek, M Stepien-Slodkowska, E Sienko-Awierianow, D Kotrych, K Dobiecki
PURPOSE OF THE STUDY Anxiety may have negative repercussions on the surgery including poorer outcomes. On the other hand, the majority of patients reporting preoperative anxiety fear not receiving enough attention from a caregiver. In patients undergoing fast-track knee arthroplasty, we determined the relationship between patients' preoperative anxiety and the anxiety the patient's caregiver. We also analyzed the influence of selected psychosocial and demographic variables on the relationship between caregivers' and patients' anxiety...
2017: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
https://www.readbyqxmd.com/read/28918788/-fast-track-total-knee-arthroplasty
#16
Kirill Gromov, Billy B Kristensen, Christoffer Calov Jørgensen, Torben Bæk Hansen, Henrik Kehlet, Henrik Husted
Fast-track total knee arthroplasty (TKA) is a well-established concept including optimized logistics and evidence-based treatment, focusing on minimizing surgical stress and improved post-operative recovery, thus leading to lower mortality and morbidity as well as high patient satisfaction. All patients are eligible for fast-track TKA, and hence the fast-track concept should be standard at all joint replacement facilities. Future challenges of fast-track TKA include safe introduction of outpatient protocols, acute and chronic pain after surgery and optimal utilization of post-operative physiotherapy...
September 18, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28914103/the-first-6-weeks-of-recovery-after-primary-total-hip-arthroplasty-with-fast-track
#17
Lisette C M Klapwijk, Nina M C Mathijssen, Jeroen C van Egmond, Bianca M Verbeek, Stephan B W Vehmeijer
No abstract text is available yet for this article.
February 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/28900757/low-incidence-of-postoperative-urinary-retention-with-the-use-of-a-nurse-led-bladder-scan-protocol-after-hip-and-knee-arthroplasty-a-retrospective-cohort-study
#18
N P Kort, Y Bemelmans, R Vos, M G M Schotanus
PURPOSE: Postoperative urinary retention (POUR), defined as the inability to empty the bladder voluntary after surgery, is a commonly reported complication. This study reports the incidence and possible risk factors for POUR after elective fast-track hip or knee arthroplasty when using a nurse-led bladder scan protocol. METHODS: This retrospective cohort study included data from 803 patients who underwent unilateral hip or knee arthroplasty. Patients' digital clinical records were reviewed for eligibility...
February 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/28880108/reduced-length-of-uninterrupted-institutional-stay-after-implementing-a-fast-track-protocol-for-primary-total-hip-replacement
#19
Konsta J Pamilo, Paulus Torkki, Mikko Peltola, Maija Pesola, Ville Remes, Juha Paloneva
Background and purpose - Fast-track protocols have been successfully implemented in many hospitals as they have been shown to result in shorter length of stay (LOS) without compromising results. We evaluated the effect of fast-track implementation on the use of institutional care and results after total hip replacement (THR). Patients and methods - 3,193 THRs performed in 4 hospitals between 2009-2010 and 2012-2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register...
February 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/28854533/safety-aspects-of-preoperative-high-dose-glucocorticoid-in-primary-total-knee-replacement
#20
C C Jørgensen, F T Pitter, H Kehlet
Background: Preoperative single high-dose glucocorticoid may have early outcome benefits in total hip arthroplasty (THA) and knee arthroplasty (TKA), but long-term safety aspects have not been evaluated. Methods: From October 2013, the departments reporting to the prospective Lundbeck Foundation Database for Fast-track Hip and Knee Replacement introduced preoperative methylprednisolone (MP) 125 mg as part of a multimodal analgesic protocol in TKA. We analysed the risk of length of hospital stay (LOS) >4 days, 30 and 90 day readmissions in patients with MP vs patients having TKA before the use of MP and adjusted for comorbidity and place of surgery...
August 1, 2017: British Journal of Anaesthesia
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