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Joint replacement hip and knee

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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
#1
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/29757058/outcomes-following-hip-and-knee-replacement-in-diabetic-versus-nondiabetic-patients-and-well-versus-poorly-controlled-diabetic-patients-a-prospective-cohort-study
#2
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
#3
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
#4
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
#5
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
#6
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/29721359/acute-cauda-equina-syndrome-following-orthopedic-procedures-as-a-result-of-epidural-anesthesia
#7
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
#8
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
#9
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
#10
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/29691166/improved-perioperative-care-of-elective-joint-replacement-patients-the-impact-of-an-orthopedic-perioperative-hospitalist
#11
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
#12
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
#13
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
https://www.readbyqxmd.com/read/29671497/osteoarthritis-rapid-evidence-review
#14
Mark H Ebell
Osteoarthritis (OA) should be suspected in patients with pain in the fingers, shoulders, hips, knees, or ankles, especially if they are older than 40 years. Patients older than 50 years who have joint pain, minimal morning stiffness, and functional impairment likely have OA. Radiography can confirm the diagnosis and may be helpful before surgical referral, but findings generally do not correlate well with symptoms. Exercise, physical therapy, knee taping, and tai chi are beneficial for knee OA. Medical therapy provides modest benefits in pain reduction and functional improvement; however, nonsteroidal anti-inflammatory drugs, tramadol, and other opioids have significant potential harms...
April 15, 2018: American Family Physician
https://www.readbyqxmd.com/read/29663554/implant-associated-bacterial-biofilm-and-quorum-sensing-in-periprosthetic-joint-infections
#15
Jake A Mooney, Eric M Pridgen, Robert Manasherob, Gina Suh, Helen E Blackwell, Annelise E Barron, Paul L Bollyky, Stuart B Goodman, Derek F Amanatullah
Periprosthetic joint infection (PJI) continues to be a common complication after total knee arthroplasty and total hip arthroplasty leading to severe morbidity and mortality. With an aging population and increasing prevalence of total joint replacement procedures, the burden of PJI will be felt not only by individual patients, but in increased healthcare costs. Current treatment of PJI is inadequate resulting in incredibly high failure rates. This is believed to be largely mediated by the presence of bacterial biofilms...
April 16, 2018: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
https://www.readbyqxmd.com/read/29662786/comparison-of-topical-and-intravenous-administration-of-tranexamic-acid-for-blood-loss-control-during-total-joint-replacement-review-of-literature
#16
REVIEW
Georgi P Georgiev, Panayot P Tanchev, Zlatka Zheleva, Plamen Kinov
Purpose: Many randomised controlled trials and meta-analysis studies have presented the efficacy of tranexamic acid (TXA) without an increase of complications. However, questions still remain about the type of administration, optimal dose and secondary outcomes of TXA in total hip arthroplasty and total knee arthroplasty. The aim of this review is to summarise the existing information in literature concerning the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use...
April 2018: Journal of Orthopaedic Translation
https://www.readbyqxmd.com/read/29657477/evaluation-of-the-multi-attribute-prioritisation-tool-for-total-joint-replacement
#17
Michael Nganga, Donald Bramwell, Jenifer Monaghan, Christine Doerr, Graham Mercer, Jeganath Krishnan
Rationale aims and objectives: The demand for arthroplasty is increasing and will continue to rise with an ageing population. Obesity and lengthy waiting time for Total Joint Replacement (TJR) have been associated with poorer outcomes postoperatively. This study aimed to evaluate the Multi-Attribute Prioritisation Tool (MAPT) for TJR patients. The primary objective was to explore if patients prioritised by the MAPT had an improvement in score post-operative. Further to identify any relationship between MAPT score and length of time on the waiting list or obesity...
March 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29657460/a-quality-improvement-project-decreases-incidence-of-pulmonary-embolism-following-arthroplasty
#18
Iyad Eid, Dane Moran, Lynn Morrison, Eyad HajHussein, Hanna Hill, Rasha Ansari, Tammy Williams, Mojieb Manzary
Objective: To develop a quality improvement initiative to reduce the incidence of pulmonary embolism (PE) following elective lower extremity joint replacement surgery. Methods: 866 Patients undergoing a total knee or total or partial hip replacement surgery at a from 2014 to 2016 were included in this prospective pre-post interventional study. Results: There were 13 PE's before the intervention and 2 after the intervention. The incidence of PE was significantly higher prior to the intervention (2...
March 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29648889/patient-reported-allergies-do-not-predict-poorer-promis-function-pain-and-depression-scores-following-foot-and-ankle-surgery
#19
Devon C Nixon, Brian M Cusworth, Jeremy J McCormick, Jeffrey E Johnson, Sandra E Klein
BACKGROUND: Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery...
April 1, 2018: Foot & Ankle International
https://www.readbyqxmd.com/read/29643693/joint-perception-and-patient-perceived-satisfaction-after-total-hip-and-knee-arthroplasty-in-the-american-population
#20
Matthew Varacallo, Rajit Chakravarty, Kevin Denehy, Andrew Star
Background: Total hip (THA) and knee arthroplasty (TKA) are two of the most successful procedures in orthopedics. Current evaluation trends focus on patient-reported outcomes. We sought to compare the changing WOMAC scores from various time points from pre-operative to 1-year follow-up between separate THA and TKA cohorts. In addition, we compared THA and TKA patients' joint perception, satisfaction, and function via a questionnaire. Methods: One hundred elective THA (n = 50) and TKA (n = 50) patients at one institution were randomly selected and contacted between 2 and 4 years after the index surgery...
June 2018: Journal of Orthopaedics
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