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https://www.readbyqxmd.com/read/29780621/thromboembolism-prophylaxis-in-orthopaedics-an-update
#1
Dimitrios A Flevas, Panayiotis D Megaloikonomos, Leonidas Dimopoulos, Evanthia Mitsiokapa, Panayiotis Koulouvaris, Andreas F Mavrogenis
Venous thromboembolism (VTE) is a serious complication during and after hospitalization, yet is a preventable cause of in-hospital death.Without VTE prophylaxis, the overall VTE incidence in medical and general surgery hospitalized patients is in the range of 10% to 40%, while it ranges up to 40% to 60% in major orthopaedic surgery. With routine VTE prophylaxis, fatal pulmonary embolism is uncommon in orthopaedic patients and the rates of symptomatic VTE within three months are in the range of 1.3% to 10%.VTE prophylaxis methods are divided into mechanical and pharmacological...
April 2018: EFORT Open Reviews
https://www.readbyqxmd.com/read/29780248/incidence-of-symptomatic-venous-thromboembolism-in-2372-knee-and-hip-replacement-patients-after-discharge-data-from-a-thromboprophylaxis-registry-in-montreal-canada
#2
Andréa Senay, Milanne Trottier, Josée Delisle, Andreea Banica, Benoit Benoit, G Yves Laflamme, Michel Malo, Hai Nguyen, Pierre Ranger, Julio C Fernandes
Background: Low-molecular-weight heparin (LMWH) is a recommended anticoagulant for thromboprophylaxis after major orthopedic surgery. Dabigatran etexilate is an oral anticoagulant recognized as noninferior to LMWH. We aimed to assess the incidence of symptomatic venous thromboembolic events (VTEs) after discharge in patients who underwent joint replacement, using a hospital registry. Patients and methods: Patients who underwent total knee and hip arthroplasty between September 2011 and March 2015 were selected...
2018: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29777717/analysis-of-the-postoperative-periarticular-environment-and-influence-on-sustained-drug-delivery-from-a-gel-formulation
#3
Darren Svirskis, Waldron Martis, Prabhat Bhusal, Manisha Sharma, Renus Stowers, Simon W Young
Regional intraarticular delivery of local anaesthetics is effective in treating postoperative pain following total knee or hip replacement. Recent research efforts have been only partially successful in achieving sustained release of the analgesic agent, in part due to limited understanding of the biological environment into which these formulations are administered. This study aimed to detail the composition and properties of postoperative periarticular fluid (PO-PAF). PO-PAF was collected from 8 patients and the composition and physicochemical properties determined...
May 16, 2018: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29758587/regional-vs-general-anesthesia-for-total-knee-and-hip-replacement-an-analysis-of-postoperative-pain-perception-from-the-international-pain-out-registry
#4
Katharina Donauer, Hagen Bomberg, Stefan Wagenpfeil, Thomas Volk, Winfried Meissner, Alexander Wolf
BACKGROUND: Total hip and knee replacements are common surgeries, and an optimal pain treatment is essential for early rehabilitation. Since data from randomized controlled trails on the use of regional anesthesia in joint replacements of the lower extremities are conflicting, we analyzed the international PAIN OUT registry for comparison of regional anesthesia vs. general anesthesia regarding pain and morphine consumption on the first postoperative day. METHODS: International Classification of Diseases-9 (ICD-9) codes were used to identify 2,346 cases for knee and 2,315 for hip arthroplasty between 2010 and 2016 from the PAIN OUT registry...
May 14, 2018: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/29758352/prospective-associations-of-c-reactive-protein-crp-levels-and-crp-genetic-risk-scores-with-risk-of-total-knee-and-hip-replacement-for-osteoarthritis-in-a-diverse-cohort
#5
Aladdin H Shadyab, Robert Terkeltaub, Charles Kooperberg, Alexander Reiner, Charles B Eaton, Rebecca D Jackson, Jessica L Krok-Schoen, Rany M Salem, Andrea Z LaCroix
OBJECTIVE: To examine associations of high-sensitivity C-reactive protein (CRP) levels and polygenic CRP genetic risk scores (GRS) with risk of end-stage hip or knee osteoarthritis (OA), defined as incident total hip (THR) or knee replacement (TKR) for OA. DESIGN: This study included a cohort of postmenopausal white, African American, and Hispanic women from the Women's Health Initiative. Women were followed from baseline to date of THR or TKR, death, or December 31, 2014...
May 11, 2018: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/29757137/reversal-of-apixaban-induced-alterations-in-haemostasis-by-different-coagulation-factor-concentrates-in-patients-after-hip-or-knee-replacement-surgery
#6
Katrin Schmidt, Kerstin Krüger, Elisabeth Langer, Martin Schmutzler, Elke Johnen, Klaus D Wernecke, Christian Von Heymann, Mareike K Körber
BACKGROUND: Apixaban is a direct oral anticoagulant (DOAC) with a specific inhibition of activated factor X (FXa). In case of bleeding or need of urgent surgery a direct antidote is not yet available. Off-label application of non-specific haemostatic agents, such as prothrombin complex concentrate (PCC) and recombinant FVIIa (rFVIIa), has been reported to reverse the effects of apixaban in in vitro and animal studies. The aim of this study is to measure the reversal potential of PCC and rFVIIa in patients with prophylactic apixaban concentrations...
May 11, 2018: Blood Transfusion, Trasfusione del Sangue
https://www.readbyqxmd.com/read/29757058/outcomes-following-hip-and-knee-replacement-in-diabetic-versus-nondiabetic-patients-and-well-versus-poorly-controlled-diabetic-patients-a-prospective-cohort-study
#7
Erik Lenguerrand, Andrew D Beswick, Michael R Whitehouse, Vikki Wylde, Ashley W Blom
Background and purpose - The impact of diabetes and glycemic control before joint replacement on clinical and patient-reported outcomes is unclear. We compared pain, function, complications, and length of hospital stay in diabetic and nondiabetic patients receiving primary total hip (THR) or knee replacement (TKR) and compared these outcomes in patients with poorly controlled versus well-controlled diabetes. Patients and methods - We conducted a prospective cohort study of patients undergoing primary THR (n = 300) or TKR (n = 287) for osteoarthritis...
May 14, 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/29744425/preliminary-focus-on-the-mechanical-and-antibacterial-activity-of-a-pmma-based-bone-cement-loaded-with-gold-nanoparticles
#8
T Russo, A Gloria, R De Santis, U D'Amora, G Balato, A Vollaro, O Oliviero, G Improta, M Triassi, L Ambrosio
In total knee arthroplasty (TKA) and total hip replacement (THR) the restoration of the normal joint function represents a fundamental feature. A prosthetic joint must be able to provide motions and to transmit functional loads. As reported in the literature, the stress distribution may be altered in bones after the implantation of a total joint prosthesis. Some scientific works have also correlated uncemented TKA to a progressive decrease of bone density below the tibial component. Antibiotic-loaded bone cements are commonly employed in conjunction with systemic antibiotics to treat infections...
September 2017: Bioactive Materials
https://www.readbyqxmd.com/read/29737288/effect-of-different-types-of-anticoagulants-in-the-prevention-of-venous-thrombosis-in-the-operation-of-knee-joint-bone-operation
#9
Wensheng Xu, Tao Zhang, Zenghua Yang, Lin Nie
Deep venous thrombosis is one of the common complications after major surgery in the Department of Orthopedics. The selective knee replacement of the lower extremities is more likely to cause the occurrence of DVT. The most commonly used anticoagulants in the Department of Orthopedics now include low molecular weight heparin (LMWH), Rivaroxaban, ordinary heparin, aspirin and warfarin. At present, the clinical application of low molecular weight heparin is the most, and the effect is the most accurate. This study compared the efficacy and safety of three commonly used anticoagulants such as aspirin, LMWH and Rivaroxaban in preventing VTE after hip and knee arthroplasty, so as to provide a theoretical basis for selecting suitable anticoagulant drugs in clinic...
May 2018: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29735456/effect-of-different-types-of-anticoagulants-in-the-prevention-of-venous-thrombosis-in-the-operation-of-knee-joint-bone-operation
#10
Wensheng Xu, Tao Zhang, Zenghua Yang, Lin Nie
Deep venous thrombosis is one of the common complications after major surgery in the Department of Orthopedics. The selective knee replacement of the lower extremities is more likely to cause the occurrence of DVT. The most commonly used anticoagulants in the Department of Orthopedics now include low molecular weight heparin (LMWH), Rivaroxaban, ordinary heparin, aspirin and warfarin. At present, the clinical application of low molecular weight heparin is the most, and the effect is the most accurate. This study compared the efficacy and safety of three commonly used anticoagulants such as aspirin, LMWH and Rivaroxaban in preventing VTE after hip and knee arthroplasty, so as to provide a theoretical basis for selecting suitable anticoagulant drugs in clinic...
May 2018: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29726671/the-ethics-of-bundled-payments-in-total-joint-replacement-cherry-picking-and-lemon-dropping
#11
Casey Jo Humbyrd
The Centers for Medicare & Medicaid Services has initiated bundled payments for hip and knee total joint replacement in an effort to decrease healthcare costs and increase quality of care. The ethical implications of this program have not been studied. This article considers the ethics of patient selection to improve outcomes; specifically, screening patients by body mass index to determine eligibility for total joint replacement. I argue that this type of screening is not ethically defensible, and that the bundled payment program as structured is likely to lead to unfair restrictions on who receives total joint replacements...
2018: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/29721606/the-effects-of-different-durations-of-static-stretching-within-a-comprehensive-warm-up-on-voluntary-and-evoked-contractile-properties
#12
Jonathan C Reid, Rebecca Greene, James D Young, Daniel D Hodgson, Anthony J Blazevich, David G Behm
Evidence for performance decrements following prolonged static stretching (SS) has led to a paradigm shift in stretching routines within a warm-up. Rather than SS, dynamic stretching (DS) and dynamic activity (DA) have replaced SS within warm-up routines. The objective of the present study was to compare the effect of differing lower limb SS durations (30 [SS30s], 60 [SS60s] or 120 s [SS120s] of SS per muscle group or no-stretch control) within a comprehensive warm-up protocol consisting of aerobic activity, DS and DA...
May 2, 2018: European Journal of Applied Physiology
https://www.readbyqxmd.com/read/29721359/acute-cauda-equina-syndrome-following-orthopedic-procedures-as-a-result-of-epidural-anesthesia
#13
Lisa B E Shields, Vasudeva G Iyer, Yi Ping Zhang, Christopher B Shields
Background: Cauda equina syndrome (CES) is a rare complication of spinal or epidural anesthesia. It is attributed to direct mechanical injury to the spinal roots of the cauda equina that may result in saddle anesthesia and paraplegia with bowel and bladder dysfunction. Case Description: The first patient underwent a hip replacement and received 5 mL of 1% lidocaine epidural anesthesia. Postoperatively, when the patient developed an acute CES, the lumbar magnetic resonance imaging (MRI) scan demonstrated clumping/posterior displacement of nerve roots of the cauda equina consistent with adhesive arachnoiditis attributed to the patient's previous L4-L5 lumbar decompression/fusion...
2018: Surgical Neurology International
https://www.readbyqxmd.com/read/29719874/reducing-the-rate-of-post-surgical-urinary-tract-infections-in-orthopedic-patients
#14
Amit Thakker, Natasha Briggs, Azusa Maeda, Julie Byrne, John Roderick Davey, Timothy D Jackson
Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%-80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29697507/population-pharmacokinetics-of-periarticular-ketorolac-in-adult-patients-undergoing-total-hip-or-total-knee-replacement-surgery
#15
Usha Gurunathan, Suzanne L Parker, Richard Maguire, Dale Ramdath, Manu Bijoor, Steven C Wallis, Jason A Roberts
BACKGROUND: Ketorolac tromethamine has been used for joint infiltration by the orthopedic surgeons as a part of postoperative multimodal analgesia. The objective of this study is to investigate the pharmacokinetic properties of S (-) and R (+) enantiomers of ketorolac in adult patients undergoing total hip (THA) and knee arthroplasty (TKA). METHODS: Adult patients with normal preoperative renal function received a periarticular infiltration of 30 mg of ketorolac tromethamine along with 100 mL of 0...
April 23, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29695317/influence-of-joint-kinematics-on-polyethylene-wear-in-anatomic-shoulder-joint-arthroplasty
#16
Steffen Braun, Stefan Schroeder, Ulrike Mueller, Robert Sonntag, Matthias Buelhoff, Jan Philippe Kretzer
BACKGROUND: Despite the positive results in total shoulder arthroplasties (TSAs), a higher revision rate is documented compared with total hip and knee replacements. Wear is the possible main cause of TSA failure in the long-term. This study investigated the effect of joint kinematics and the influence of the rotator cuff on the polyethylene wear performance in an anatomic TSA. METHODS: Lifting a load of 2 kg with an abduction/adduction of 0° to 90° was simulated for 2 × 106 cycles as a primary motion using a fully kinematic joint simulator...
April 23, 2018: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29691817/bioceramics-for-osteochondral-tissue-engineering-and-regeneration
#17
Sandra Pina, Rita Rebelo, Vitor Manuel Correlo, J Miguel Oliveira, Rui L Reis
Considerable advances in tissue engineering and regeneration have been accomplished over the last decade. Bioceramics have been developed to repair, reconstruct, and substitute diseased parts of the body and to promote tissue healing as an alternative to metallic implants. Applications embrace hip, knee, and ligament repair and replacement, maxillofacial reconstruction and augmentation, spinal fusion, bone filler, and repair of periodontal diseases. Bioceramics are well-known for their superior wear resistance, high stiffness, resistance to oxidation, and low coefficient of friction...
2018: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29691166/improved-perioperative-care-of-elective-joint-replacement-patients-the-impact-of-an-orthopedic-perioperative-hospitalist
#18
Steven J Fitzgerald, Terrence C Palmer, Matthew J Kraay
BACKGROUND: We developed an orthopedic hospitalist fellowship program for our total joint replacement program at a large urban academic medical center. The goal of the program was to improve patient outcomes, quality, and healthcare value through collaborative perioperative care and improved care coordination. This study evaluates the implementation and impact of our modified Hospitalist-Orthopaedic Team Co-management model on quality and performance metrics. METHODS: We reviewed our Quality Institute data using 3 databases for the 16 months before (PreOH) and 18 months after (PostOH) implementation...
March 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691152/readmission-patterns-over-90-day-episodes-of-care-among-medicare-fee-for-service-beneficiaries-discharged-to-post-acute-care
#19
Addie Middleton, Yong-Fang Kuo, James E Graham, Amol Karmarkar, Yu-Li Lin, James S Goodwin, Allen Haas, Kenneth J Ottenbacher
OBJECTIVE: Examine readmission patterns over 90-day episodes of care in persons discharged from hospitals to post-acute settings. DESIGN: Retrospective cohort study. SETTING: Acute care hospitals. PARTICIPANTS: Medicare fee-for-service enrollees (N = 686,877) discharged from hospitals to post-acute care in 2013-2014. The cohort included beneficiaries >65 years of age hospitalized for stroke, joint replacement, or hip fracture and who survived for 90 days following discharge...
April 21, 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29688636/-critical-evaluation-of-the-ability-to-diagnose-periprosthetic-infection-in-a-medical-system-in-israel
#20
Raviv Allon, Nofar Ben Basat, Alexander Puhov, Yaron Zaulan, Ronit Wollstein
INTRODUCTION: Prosthetic joint infection is a dangerous complication of joint replacement arthroplasty. Besides its catastrophic consequences, differentiating a deep infection from other complications is not always trivial due to lack of clinical signs of infection, inaccurate tests, lab-dependent analysis, variable normal values and ongoing dispute in the literature regarding the recommended diagnosis algorithm. AIMS: The purpose of this study was to examine the diagnosis algorithm in our medical center...
April 2018: Harefuah
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