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Joint replacement hip and knee

P Maxwell Courtney, David C Markel
With renewed focus on achieving value for patients in total hip and knee arthroplasty, payors, hospitals, and physicians strive to provide quality care while minimizing cost. Large registry datasets have gained popularity in the United States to track implant survivorship and outcomes after joint replacement. Partnerships among surgeons, insurers, and health systems have improved on earlier administrative datasets from Medicare to measure quality and outcomes. Participation in state and national registries can help surgeons and hospitals gain a financial advantage in several insurers' quality programs and alternative payment models...
October 24, 2016: Journal of Knee Surgery
Joanna Pietrzak, Paulina Kwarta, Michał Karbownik, Łukasz Mokros, Paula Zdanowicz, Dawid Miśkowiec, Andrzej Witusik, Adam Antczak, Tadeusz Pietras
: The progression of the inflammatory process in the course of rheumatoid arthiritis (RA) may cause a permanent destruction of joints, which in case of bigger ones (i.e. hip or knee) may be particularly a psychological burden for a patient. AIM: The aim of the study was to verify whether implantation of hip or knee endoprosthesis affect anxiety and depressive symptoms among patients with RA. MATERIALS AND METHODS: The study enrolled a group of 128 rheumatoid arthritis patients, including 64 patients before and 64 patients after the joint replacement procedure...
October 19, 2016: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Basim Kamil Hassan, Ram Benny Christian Dessau, Arne Sahlström
BACKGROUND: Permanent renal dysfunction is considered as being a serious complication which may occur after major surgery and which furthermore may lead to increased morbidity and mortality. The objective of this study was to analyze the incidence of long-term postoperative renal dysfunction after primary total hip and knee joint replacements. METHODS: Long-term postoperative renal dysfunction was analyzed in a retrospective study of 1301 consecutive primary total hip and knee joint replacements performed between January 2009 and December 2013...
October 19, 2016: Journal of Orthopaedic Surgery and Research
Sophie C Warner, Ana M Valdes
PURPOSE OF REVIEW: Osteoarthritis is a common complex disorder with a strong genetic component. Other identified risk factors such as increasing age and overweight do not fully explain the risk of osteoarthritis. Here, we highlight the main findings from genetic association studies on osteoarthritis to date. RECENT FINDINGS: Currently, genetic association studies have identified 21 independent susceptibility loci for osteoarthritis. Studies have focused on hip, knee and hand osteoarthritis, as well as posttotal joint replacement and minimum joint space width, a proxy for cartilage thickness...
October 17, 2016: Current Opinion in Rheumatology
Panna Sanga, Nathaniel Katz, Elena Polverejan, Steven Wang, Kathleen M Kelly, Juergen Haeussler, John Thipphawong
OBJECTIVE: To evaluate long-term safety and efficacy of fulranumab in patients with moderate-to-severe chronic osteoarthritis (OA) knee or hip pain. METHODS: In this placebo-controlled, phase-2 double-blind (DB) extension study, patients who were equally randomized to 1mgQ4wk, 3mgQ8wk, 3mgQ4wk, 6mgQ8wk, or10mgQ8wk fulranumab (s.c.) or placebo in the 12-week DB efficacy phase, and completed this DB efficacy phase, were eligible to continue the dose throughout a 92-week extension phase followed by a 24-week posttreatment follow-up (PFTU)...
October 16, 2016: Arthritis & Rheumatology
Yongcai Chen, Zhuo Chen, Shuo Cui, Zhiyang Li, Zhengjiang Yuan
BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic drug widely used to reduce blood loss during joint replacements, including total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, there is no final consensus regarding the composition of an optimal administration of TXA regime between topical and systemic (intravenous). The purpose of our study was to compare the efficacy of topical and intravenous (IV) regimen of TXA during TKA and THA. METHODS: Five relevant electronic online databases, PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Chinese Biomedical Database were systematically searched in November 2015...
October 2016: Medicine (Baltimore)
B Fink, R Lass
Background: Total hip arthroplasty (THA) is one of the most common and successful surgical procedures in orthopedic surgery and clinical success can be characterized by the revision rate and improvement of function, as well as the patient's satisfaction and pain. Despite the clinical success of primary THA with 10-year survival rates as high as 96 % (Swedish Hip Arthroplasty Register, 2011), the prevalence of groin pain after conventional total hip replacement ranges from 0.4 to 18.3 % and activity-limiting thigh pain is still an existing problem linked to the femoral component of uncemented hip replacement in up to 1...
October 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Ana M Valdes, Abhishek Abhishek, Kenneth Muir, Weiya Zhang, Rose A Maciewicz, Michael Doherty
OBJECTIVE: Recent findings suggest that β-adrenergic blockers have anti-nociceptive properties. The aim of this study was to compare levels of large joint pain between those on adrenergic blockers and those on other antihypertensive medications Methods: Data from the GOAL study, a secondary care cohort of osteoarthritis (OA), were used. Joint pain was assessed using the Western Ontario and McMaster Universities Arthritis (WOMAC) pain score in 873 individuals who had symptomatic hip and/or knee OA and hypertension, and who were on ≥1 prescription antihypertensive medications...
October 1, 2016: Arthritis Care & Research
S Singh, S Reddy, Raj Shrivastva
This study compared the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) data for total hip replacements (THRs) and total knee replacements (TKRs) from Hospital A [with laminar airflow (LAF)] and Hospital B (without LAF). These hospitals were originally managed by two different trusts that subsequently merged. Consequently, the theatres in Hospital A have always had LAF and those in Hospital B had only conventional ventilation systems. As this merger happened before the establishment of the NJR, it puts us in a unique position, enabling direct comparison of the revision rates for infected hip and knee replacements between the two hospitals that follow similar infection protocols...
September 29, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Sophie Legrève
OBJECTIVE: Multifocal osteonecrosis is rare. A zone of epiphyseal bone-marrow necrosis of three or more joints characterizes it. The most common risk factors are glucocorticoids intake and alcoholism. However, there is a series of other causes that could be incriminated in osteonecrosis, among which antiphospholipid syndrome. This case report, illustrates a primary antiphospholipid syndrome with only one clinical manifestation: multifocal osteonecrosis. OBSERVATIONS: A 30-year-old woman, with a medical history of left total hip replacement (THR), presents with severe right coxalgia and pain in both knees and shoulders...
September 2016: Annals of Physical and Rehabilitation Medicine
Ingrid Milošev, Vesna Levašič, Janja Vidmar, Simon Kovač, Rihard Trebše
BACKGROUND: Due to degradation and metal dissolution during articulation of metal joint replacements the chemical periprosthetic environment may change. The aim was to establish whether metal replacements cause the local changes in pH and elevated metal concentrations. METHODS: pH was measured on samples from 167 patients: native hip and knee osteoarthritic joints, joints with hip and knee replacements revised for aseptic or septic reasons. pH of synovial fluid and periprosthetic tissue was measured perioperatively using a microelectrode and pH indicator papers for removed metal components...
September 23, 2016: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Lisa McCann-Spry, JoAnne Pelton, Glenda Grandy, Dawn Newell
Demand for hip and knee arthroplasty in the United States is rising rapidly. This is creating considerable strain on healthcare systems' institutional resources and finances. To reduce this strain, Spectrum Health in Grand Rapids, MI, developed a strategy to decrease length of stay for most primary hip and knee joint replacement patients. Four specific interventions were undertaken concurrently: (1) communication with providers, (2) modification of patient communications, (3) standardized risk assessment and prediction, and (4) physical therapy on POD (postoperative day) 0 (i...
September 2016: Orthopaedic Nursing
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
Vivian S Lee, Kensaku Kawamoto, Rachel Hess, Charlton Park, Jeffrey Young, Cheri Hunter, Steven Johnson, Sandi Gulbransen, Christopher E Pelt, Devin J Horton, Kencee K Graves, Tom H Greene, Yoshimi Anzai, Robert C Pendleton
IMPORTANCE: Transformation of US health care from volume to value requires meaningful quantification of costs and outcomes at the level of individual patients. OBJECTIVE: To measure the association of a value-driven outcomes tool that allocates costs of care and quality measures to individual patient encounters with cost reduction and health outcome optimization. DESIGN, SETTING, AND PARTICIPANTS: Uncontrolled, pre-post, longitudinal, observational study measuring quality and outcomes relative to cost from 2012 to 2016 at University of Utah Health Care...
September 13, 2016: JAMA: the Journal of the American Medical Association
D Thomas, P Knight, K White, M M Mencia
Objective: The number of patients requiring arthroplasty increases annually. Joint replacement surgery can improve a patient's (QOL) quality of life. The effectiveness of this care from a patient's own perspective assessed by patient reported outcome measures is just as important as the clinical measures. The aim of our study was to evaluate patients' satisfaction following total joint replacement procedures. Methods: A cross-sectional study was performed in a major regional hospital, (Port-of-Spain General Hospital, Trinidad)...
March 1, 2016: West Indian Medical Journal
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
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
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
Stacey M Rigney, Anne Simmons, Lauren Kark
Lower-limb amputees commonly utilize non-articulating energy storage and return (ESAR) prostheses for high impact activities such as sprinting. Despite these prostheses lacking an articulating ankle joint, amputee gait analysis conventionally features a two-link segment model of the prosthetic foot. This paper investigated the effects of the selected link segment model׳s marker-set and geometry on a unilateral amputee sprinter׳s calculated lower-limb kinematics, kinetics and energetics. A total of five lower-limb models of the Ottobock(®) 1E90 Sprinter were developed, including two conventional shank-foot models that each used a different version of the Plug-in-Gait (PiG) marker-set to test the effect of prosthesis ankle marker location...
October 3, 2016: Journal of Biomechanics
Laughter Lisenda, Lipalo Mokete, Joseph Mkubwa, Mkhululi Lukhele
PURPOSE: Total hip and knee joint arthroplasty (TJA) rank among the most successful orthopaedic operations. Several developing countries in Africa have started to perform these procedures that are routine in developed countries. The aims of this study were to measure the incidence and assess the determinants of in-hospital mortality after elective primary TJA in our unit and compare it with published data. METHODS: This was a retrospective study of the first consecutive cohort of patients who underwent elective primary TJA in Princess Marina Hospital, Botswana between March 2009 and October 2015 (6...
August 21, 2016: International Orthopaedics
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