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Surachai Kotirum, Bunchai Chongmelaxme, Nathorn Chaiyakunapruk
To analyze the cost-utility of oral dabigatran etexilate, enoxaparin sodium injection, and no intervention for venous thromboembolism (VTE) prophylaxis after total hip or knee replacement (THR/TKR) surgery among Thai patients. A cost-utility analysis using a decision tree model was conducted using societal and healthcare payers' perspectives to simulate relevant costs and health outcomes covering a 3-month time horizon. Costs were adjusted to year 2014. The willingness-to-pay threshold of THB 160,000 (USD 4926) was used...
October 4, 2016: Journal of Thrombosis and Thrombolysis
Susan Nedza, Donald E Fry, Susan DesHarnais, Eric Spencer, Patrick Yep
OBJECTIVES: The Center for Medicare and Medicaid Services (CMS) is actively testing bundled payments models. This study sought to identify relevant details for 90-day post-discharge 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
V Wylde, A Sayers, A Odutola, R Gooberman-Hill, P Dieppe, A W Blom
BACKGROUND: Discrepancies exist between osteoarthritic joint changes and pain severity before and after total hip (THR) and knee (TKR) replacement. This study investigated whether the interaction between pre-operative widespread hyperalgesia and severity of radiographic osteoarthritis (OA) was associated with pain severity before and after joint replacement. METHODS: Data were analysed from 232 patients receiving THR and 241 receiving TKR. Pain was assessed pre-operatively and at 12 months post-operatively using the WOMAC Pain Scale...
August 24, 2016: European Journal of Pain: EJP
Anahita Dua, Sapan S Desai, Cheong J Lee, Jennifer A Heller
INTRODUCTION: Total knee replacement (TKR) and total hip replacement (THR) are associated with an increased risk of deep vein thrombosis (DVT). Advances in DVT prophylaxis over the past decade have led to a decrease in DVT-related morbidity, but gender, racial, and other demographic factors that contribute to a higher risk of DVT are incompletely characterized. This study aimed to determine the incidence of DVT over the past decade and identify factors that were associated with an increased risk of DVT...
August 12, 2016: Annals of Vascular Surgery
S Benjamin, D Warwick
INTRODUCTION Because of the high risk of venous thromboembolism (VTE) in total hip replacement (THR) and total knee replacement (TKR), guidelines are used widely to enhance effective (yet safe) prophylaxis. If patients develop VTEs despite use of such guidelines, then the reasons are that the guidelines were: (i) followed but the VTE occurred anyway; (ii) not implemented appropriately. All VTEs are assessed routinely by root-cause analysis (RCA). METHODS The records and subsequent RCA reports for each patient who experienced clinically significant VTE after THR or TKR were reviewed...
August 11, 2016: Annals of the Royal College of Surgeons of England
S P Mehta, A Sankar, V Venkataramanan, L S Lohmander, J N Katz, G A Hawker, L Gossec, E M Roos, J-F Maillefert, M Kloppenburg, M Dougados, A M Davis
OBJECTIVE: To evaluate the internal consistency and construct validity of the Physical Function short-forms for the Hip and Knee Injury Osteoarthritis Outcome Scores (HOOS-PS/KOOS-PS) and the Intermittent and Constant Osteoarthritis Pain (ICOAP) in a nine country study of patients consulting for total hip or knee replacement (THR or TKR). METHODS: Patients completed HOOS-PS or KOOS-PS, ICOAP and Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) pain and physical function subscales at their consultation visit...
August 4, 2016: Osteoarthritis and Cartilage
David Gwynne-Jones, Ella Iosua
AIM: A key Government health target has been to increase access to elective surgery. Despite this, there is a growing concern about unmet demand and increasing numbers of patients are being declined elective surgery. This study aims to determine whether there has been an increase in the severity of osteoarthritis of the hip and knee in patients undergoing publicly-funded elective total joint replacement (TJR) and any increase in demand for TJR in Otago. METHOD: Demographic details and preoperative patient reported outcome scores (Oxford hip or knee score (OHS,OKS) and a reduced Western Ontario and McMaster Osteoarthritis Index (WOMAC) score (RWS) were collected prospectively in an historical cohort of patients undergoing total hip and knee replacement (THR, TKR) between 2006-2010...
2016: New Zealand Medical Journal
Bengt I Eriksson, Zsolt Mikuska, Martin Feuring, Jean Amiral, Sebastian Haertter, Joachim Stangier, Gerhard Nehmiz, Jeffrey I Weitz
BACKGROUND: In adults with moderate renal impairment (creatinine clearance [CrCl] 30-50mL/min) undergoing total hip or knee replacement (THR/TKR), the recommended dose of dabigatran etexilate is 150mg once daily (qd). We investigated the steady state pharmacokinetics, pharmacodynamics and safety in these patients. METHODS: Single-arm, open-label phase 4 study (NCT01184989) in Caucasian patients receiving dabigatran etexilate 75mg 1-4h after surgery and 150mg qd on days 2-10 (TKR) or days 2-35 (THR)...
August 2016: Thrombosis Research
Kanako K Kumamaru, Hiraku Kumamaru, Brian T Bateman, Jessica Gronsbell, Tianxi Cai, Jun Liu, Laurence D Higgins, Shigeki Aoki, Kuni Ohtomo, Frank J Rybicki, Elisabetta Patorno
Purpose To evaluate the variation among U.S. hospitals in overall use and yield of in-hospital computed tomographic (CT) pulmonary angiography (PA) in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery. Materials and Methods Patients in the Premier Research Database who underwent elective TKR or THR between 2007 and 2011 were enrolled in this HIPAA-compliant, institutional review board-approved retrospective observational study. The informed consent requirement was waived...
December 2016: Radiology
Charles-Marc Samama, Nadia Rosencher, Eva Kleine, Martin Feuring, Martina Brueckmann, Andreas Clemens, Jenny Gullberg, Simon P Frostick
INTRODUCTION: The standard dabigatran etexilate dosage for prevention of venous thromboembolism (VTE) after elective total hip or knee replacement (THR/TKR) is 220mg once daily (qd), with 150mg qd for patients with moderate renal impairment. As clinical trial experience in patients with moderate renal impairment was limited at the time of approval, we conducted an observational study to evaluate the 150mg qd dose. MATERIALS AND METHODS: This open-label, prospective, uncontrolled, observational study in patients with creatinine clearance (CrCl) 30-50mL/min was conducted in seven European countries...
July 2016: Thrombosis Research
Johannes T H Nielen, Pieter J Emans, Pieter C Dagnelie, Annelies Boonen, Arief Lalmohamed, Anthonius de Boer, Bart J F van den Bemt, Frank de Vries
It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from osteoarthritis (OA) due to an increased body mass index (BMI), resulting in mechanical destruction of cartilage. However, previous studies have suggested a coexisting metabolic causality.To evaluate the risk of hip or knee replacement, as a proxy for severe OA, in patients with DM. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity.A population-based case-control study was performed, using the Clinical Practice Research Datalink (CPRD)...
May 2016: Medicine (Baltimore)
Stephen Lyman, Chisa Hidaka
The Center for Medicaid and Medicare Services has recently announced the inclusion of several patient-reported outcome measures (PROMs), including the abbreviated Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score for joint replacement (HOOS, JR and KOOS, JR) for the purpose of quality assessment in total hip and total knee replacement (THR and TKR). Historically, Center for Medicaid and Medicare Services and other agencies have used measures of process (eg, % vaccinated) or adverse events (eg, infection rates, readmission rates) for quality assessment...
June 2016: Journal of Arthroplasty
Stuart Cavill, Kylie McKenzie, Adrienne Munro, Janice McKeever, Lucy Whelan, Luke Biggs, Elizabeth H Skinner, Terry P Haines
OBJECTIVE: The study investigated the effect of prehabilitation on the quality of life and function in patients having total knee replacement (TKR)/total hip replacement (THR). METHODS: A pilot randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis was conducted. Sixty-four people undergoing elective lower-limb arthroplasty were included. Prehabilitation included one-hour twice-weekly sessions for at least three and a maximum of four weeks prior to surgery...
May 2016: Physiotherapy Theory and Practice
Nadia Rosencher, Charles M Samama, Martin Feuring, Martina Brueckmann, Eva Kleine, Andreas Clemens, Simon Frostick
BACKGROUND: Thromboprophylaxis is recommended for patients undergoing total hip or total knee replacement (THR, TKR). An international, open-label, prospective, observational, single-arm study in a routine clinical setting was performed to assess the safety and efficacy of dabigatran etexilate 220 mg once daily in patients undergoing THR or TKR, and in subgroups of patients with potentially increased risk of bleeding or venous thromboembolism (VTE). MATERIALS AND METHODS: Patients were ≥18 years and required to be eligible to receive dabigatran 220 mg once daily (first dose 110 mg 1-4 h after THR/TKR surgery) according to the European Summary of Product Characteristics...
2016: Thrombosis Journal
Alan H Daniels, Satoshi Kawaguchi, Alec G Contag, Farbod Rastegar, Garrett Waagmeester, Paul A Anderson, Melanie Arthur, Robert A Hart
OBJECTIVE Beginning in 2008, the Centers for Medicare and Medicaid Service (CMS) determined that certain hospital-acquired adverse events such as surgical site infection (SSI) following spine surgery should never occur. The following year, they expanded the ruling to include deep vein thrombosis (DVT) and pulmonary embolism (PE) following total joint arthroplasty. Due to their ruling that "never events" are not the payers' responsibility, CMS insists that the costs of managing these complications be borne by hospitals and health care providers, rather than billings to health care payers for additional care required in their management...
August 2016: Journal of Neurosurgery. Spine
D Skinner, B J Tadros, E Bray, M Elsherbiny, G Stafford
Introduction The Elective Orthopaedic Centre in Epsom has an established patient reported outcome measures programme, into which all patients are enrolled. Postoperative complications, Oxford hip/knee scores (OHS/OKS) and EQ-5D™ (EuroQol, Rotterdam, Netherlands) scores are collected up to the second postoperative year. Our population is ageing and the number of joint replacements being performed on the very elderly is rising. The aim of this study was to investigate the outcome of joint replacements in a nonagenarian population...
April 2016: Annals of the Royal College of Surgeons of England
Robin Pourzal, Christopher B Knowlton, Deborah J Hall, Michel P Laurent, Robert M Urban, Markus A Wimmer
BACKGROUND: The longevity of total hip (THR) and knee replacements (TKR) that used historical bearing materials of gamma-in-air sterilized UHMWPE was affected more by osteolysis in THRs than in TKRs, although osteolysis remains a concern in TKRs. Therefore, the study of polyethylene wear is still of interest for the knee, particularly because few studies have investigated volumetric material loss in tibial knee inserts. For this study, a unique collection of autopsy-retrieved TKR and THR components that were well-functioning at the time of retrieval was used to compare volumetric wear differences between hip and knee polyethylene components made from identical material...
August 2016: Clinical Orthopaedics and related Research
Marianne Bakke Johnsen, Alf Inge Hellevik, Valborg Baste, Ove Furnes, Arnulf Langhammer, Gunnar Flugsrud, Lars Nordsletten, John Anker Zwart, Kjersti Storheim
BACKGROUND: The relationship between leisure time physical activity (LPA) and hip and knee OA and subsequent joint replacement has not yet been clearly defined. Some studies have found the risk of knee replacement (TKR) to increase with high levels of LPA, while others have found no overall relationship to either TKR or hip replacement (THR). The aim was to investigate the association between LPA and the risk of severe end-stage OA, defined as THR or TKR due to primary OA, in a large population-based cohort...
2016: BMC Musculoskeletal Disorders
Simon Frostick
Pharmacological and mechanical thromboprophylaxis reduces the risk of venous thromboembolism (VTE) in patients undergoing total knee/hip replacement (TKR/THR). Nurses play a key role in VTE prevention through clinical care, before and after discharge from hospital, and patient education. Conventional pharmacological agents for VTE prophylaxis include low molecular weight heparins (LMWHs) and fondaparinux. However, parenteral administration, increased bleeding risk, and patient/physician non-adherence to treatment and guidelines, are important limitations...
January 14, 2016: British Journal of Nursing: BJN
Marc Rosenman, Xianchen Liu, Hemant Phatak, Rong Qi, Evgenia Teal, Daniel Nisi, Larry Z Liu, J Andrew Parr
Patients who have total hip (THR) or knee (TKR) replacement have an elevated risk of venous thromboembolism (VTE). The American College of Chest Physicians guidelines recommend prophylactic anticoagulation. The aim of the study was to examine pharmacologic prophylaxis against VTE among patients with THR or TKR and to assess demographic and clinical correlates related to VTE prophylaxis. Using 15 years of data (1995-2009) from an electronic medical record system for an inner-city public hospital in the United States, we examined pharmacologic prophylaxis against VTE and associated factors in patients after THR (n = 242) and TKR (n = 317)...
March 2016: American Journal of Therapeutics
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