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https://www.readbyqxmd.com/read/28345356/dysregulation-of-tissue-factor-thrombin-activatable-fibrinolysis-inhibitor-and-fibrinogen-in-patients-undergoing-total-joint-arthroplasty
#1
Christopher Wanderling, Jeffrey Liles, Elissa Finkler, Peter Carlsgaard, William Hopkinson, Nil Guler, Debra Hoppensteadt, Jawed Fareed
Total joint arthroplasty (TJA) of the hip or knee (THA, TKA) has become an increasingly common procedure. While TJA is a successful treatment for individuals experiencing degenerative joint diseases, it is well known that one of the most common perioperative complications of TJA is deep venous thrombosis (DVT). To profile tissue factor (TF), microparticle-tissue factor (MP-TF), thrombin-activatable fibrinolysis inhibitor (TAFI), and fibrinogen levels in patients undergoing TJA to determine potential preexisting Hemostatic dysregulation...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28343831/stepping-toward-objective-outcomes-a-prospective-analysis-of-step-count-after-total-joint-arthroplasty
#2
Meredith P Crizer, Gregory S Kazarian, Andrew N Fleischman, Jess H Lonner, Mitchell G Maltenfort, Antonia F Chen
BACKGROUND: Functional recovery monitoring after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is often limited to surgeon-based assessment and patient self-reporting rather than objective measures. However, traditional outcomes may not reliably gauge return of function. The goal of this study was to evaluate and compare an objective measure of postoperative recovery, daily step-count, with patient self-reported outcomes. METHODS: Prospectively, 589 patients used a mobile step-tracking application to record daily steps...
March 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343830/fall-risk-score-at-the-time-of-discharge-predicts-readmission-following-total-joint-arthroplasty
#3
Bheeshma Ravi, Zhang Nan, Adam J Schwartz, Henry D Clarke
BACKGROUND: Readmission among Medicare recipients is a leading driver of healthcare expenditure. To date, most predictive tools are too coarse for direct clinical application. Our objective in this study is to determine if a pre-existing tool to identify patients at increased risk for inpatient falls, the Hendrich Fall Risk Score, could be used to accurately identify Medicare patients at increased risk for readmission following arthroplasty, regardless of whether the readmission was due to a fall...
February 24, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343827/diabetes-mellitus-and-hyperglycemia-and-the-risk-of-aseptic-loosening-in-total-joint-arthroplasty
#4
Hilal Maradit Kremers, Cathy D Schleck, Eric A Lewallen, Dirk R Larson, Andre J Van Wijnen, David G Lewallen
BACKGROUND: It is unknown to what extent diabetes mellitus modifies the long-term risk of aseptic loosening in total hip arthroplasty (THA) and total knee arthroplasty (TKA). We examined the association between diabetes mellitus, perioperative hyperglycemia, and the likelihood of revisions for aseptic loosening. METHODS: We studied 16,085 primary THA and TKA procedures performed at a large tertiary care hospital between 2002 and 2009. All blood glucose values around the time of surgery (within 1 week) were retrieved...
March 2, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343826/diagnosis-of-periprosthetic-joint-infection-an-algorithm-based-approach
#5
Nicholas T Ting, Craig J Della Valle
BACKGROUND: Periprosthetic joint infection (PJI) remains one of the most challenging and devastating modes of failure after total hip and knee arthroplasties. Despite the profound urgency and impact of PJI on an individual and societal basis, historically, there have not been standardized definitions of and diagnostic algorithms for infection after total joint arthroplasty. METHODS: In a recent symposium, the American Academy of Hip and Knee Surgeons put forth a standardized approach to the prevention, diagnosis, and management of the patient with a suspected PJI...
March 2, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343824/assessment-of-corrosion-fretting-and-material-loss-of-retrieved-modular-total-knee-arthroplasties
#6
Audrey J Martin, Kirsten A Seagers, Douglas W Van Citters
BACKGROUND: Modular junctions in total hip arthroplasties have been associated with fretting, corrosion, and debris release. The purpose of this study is to analyze damage severity in total knee arthroplasties of a single design by qualitative visual assessment and quantitative material loss measurements to evaluate implant performance and patient impact via material loss. METHODS: Twenty-two modular knee retrievals of the same manufacturer were identified from an institutional review board-approved database...
February 28, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343823/process-improvement-project-using-tranexamic-acid-is-cost-effective-in-reducing-blood-loss-and-transfusions-after-total-hip-and-total-knee-arthroplasty
#7
Harry A Demos, Zilan X Lin, William R Barfield, Sylvia H Wilson, Dawn C Robertson, Vincent D Pellegrini
BACKGROUND: Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA. METHODS: After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation...
March 2, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28343822/the-new-surgical-technique-for-improving-total-knee-and-hip-arthroplasty-outcomes-patient-selection
#8
Kevin Magone, Bernard P Kemker, Nataliya Pilipenko, Erin O'Connor, Norman Walter, Theresa Atkinson
BACKGROUND: Inclusion of patient satisfaction scores in setting reimbursements has been suggested by health care policy makers to contain cost and improve outcomes. The Short Form 36 Health Survey (SF-36) score provides a health-related quality of life (HRQoL) measure of arthroplasty outcome. Although previous work identified factors that influence this score for hip and knee arthroplasty patients, they did not focus on how a surgeon might use this information in a clinical setting. The present study examined whether relatively simple criteria might identify patients more likely to experience minimal HRQoL improvement...
March 1, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28342028/disparities-in-knee-and-hip-arthroplasty-outcomes-an-observational-analysis-of-the-acs-nsqip-clinical-registry
#9
Peter Cram, Gillian Hawker, John Matelski, Bheeshma Ravi, Andrew Pugely, Rajiv Gandhi, Timothy Jackson
BACKGROUND: Disparities in total joint arthroplasty (TJA) have largely been studied in single center studies and using administrative data. Our objective was to investigate differences in TJA outcomes in white men, black men, white women, and black women using a large international registry. METHODS: We used 2010-2013 data from the ACS-NSQIP to identify four groups of adults (white men, black men, white women, black women) who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA)...
March 24, 2017: Journal of Racial and Ethnic Health Disparities
https://www.readbyqxmd.com/read/28340617/the-efficacy-of-pregabalin-for-the-management-of-postoperative-pain-in-primary-total-knee-and-hip-arthroplasty-a-meta-analysis
#10
REVIEW
Fei Li, Jianxiong Ma, Mingjie Kuang, Xuan Jiang, Ying Wang, Bin Lu, Xingwen Zhao, Lei Sun, Xinlong Ma
OBJECTIVE: A systematic review of randomized controlled trials (RCTs) was conducted to evaluate the efficacy of pregabalin for the management of postoperative pain in patients undergoing primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA). METHOD: The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched for related articles using search strategy. RevMan 5.3 software was selected to conduct the meta-analysis...
March 24, 2017: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/28339001/centers-for-medicare-medicaid-services-comprehensive-care-for-joint-replacement-the-present-and-future-for-orthopedic-surgeons
#11
Craig A Hogan, Melanie F Sandoval, Lauren M Uhler
The primary aim of this article is to describe the structure and challenges of Medicare and Medicaid reimbursement for a total hip or knee arthroplasty within the context of the Comprehensive Care for Joint Replacement model. The secondary aims are to identify potential challenges for reimbursement and solutions to overcome challenges for the orthopedic surgeon, and to describe and compare the current and projected reimbursement structures for total arthroplasty procedures. Final decisions on reimbursement for total arthroplasty as outlined by the Centers for Medicare & Medicaid Services are reviewed...
March 1, 2017: Orthopedics
https://www.readbyqxmd.com/read/28337731/arthroplasty-registries-around-the-world-valuable-sources-of-hip-implant-revision-risk-data
#12
REVIEW
Richard E Hughes, Aditi Batra, Brian R Hallstrom
PURPOSE OF REVIEW: National and regional arthroplasty registries have proliferated since the Swedish Knee Arthroplasty Register was started in 1975. Registry reports typically present implant-specific estimates of revision risk and patient- and technique-related factors that can inform clinical decision-making about implants and techniques. However, annual registry reports are long and it is difficult for clinicians to extract comparable revision risk data. Since implants may appear in multiple registry reports, it is even more difficult to gather relevant data for clinical decision-making about implant selection...
March 23, 2017: Current Reviews in Musculoskeletal Medicine
https://www.readbyqxmd.com/read/28336947/an-ideal-dielectric-coat-to-avoid-prosthesis-rf-artefacts-in-magnetic-resonance-imaging
#13
U Zanovello, L Matekovits, L Zilberti
The number of people submitted to total hip or knee arthroplasty increased in the last years and it is likely to grow further. Hence, the importance of a proper investigation tool that allows to determine and recognize the potential presence of perioperative and/or postoperative diseases becomes clear. Although the Magnetic Resonance Imaging (MRI) technique demonstrated several advantages over the other common tomography tools, it suffers from the arise of image artefacts if it is performed in presence of metallic prostheses...
March 23, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28336035/effect-of-tranexamic-acid-on-transfusion-rates-following-total-joint-arthroplasty-a-cost-and-comparative-effectiveness-analysis
#14
REVIEW
Perry J Evangelista, Michael W Aversano, Emmanuel Koli, Lorraine Hutzler, Ifeoma Inneh, Joseph Bosco, Richard Iorio
Tranexamic acid (TXA) is used to reduce blood loss in orthopedic total joint arthroplasty (TJA). This study evaluates the effectiveness of TXA in reducing transfusions and hospital cost in TJA. Participants undergoing elective TJA were stratified into 2 cohorts: those not receiving and those receiving intravenous TXA. TXA decreased total hip arthroplasty (THA) transfusions from 22.7% to 11.9%, and total knee arthroplasty (TKA) from 19.4% to 7.0%. The average direct hospital cost reduction for THA and TKA was $3083 and $2582, respectively...
April 2017: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/28336024/postoperative-pain-self-management-behavior-in-patients-who-underwent-total-knee-or-hip-arthroplasty
#15
Ning-Ning Zhu, Pei-Pei Xu, Ting-Ting Lei, Ting Sun, Sally Wai-Chi Chan
The self-management of acute postoperative pain is not well researched. This cross-sectional study investigates postoperative pain and pain self-management behavior. We recruited 127 patients who underwent total knee or total hip arthroplasty in an acute care hospital. We measured postoperative pain intensity and pain self-management behavior for three postoperative days. The results showed that the participants experienced mild and moderate pain intensity and perceived moderate to severe pain interference, which influenced their mood, sleep patterns, ability to walk, and performance of general activities and rehabilitation exercises...
April 2017: AORN Journal
https://www.readbyqxmd.com/read/28331989/does-the-tibia-component-design-affect-the-need-for-offset-stems-in-revision-total-knee-arthroplasty
#16
X Foruria, T Schmidt-Braekling, D Arana Nabarte, M Faschingbauer, M Kasparek, F Boettner
INTRODUCTION: The stem/keel location varies between anatomic and symmetric revision tibial baseplates. The current study investigates the impact of an anatomic versus symmetric stem location on the need for offset couplers in revision total knee arthroplasty. MATERIALS AND METHODS: Hip to ankle standing radiographs and lateral radiographs of 75 patients were analyzed using digital templating software. The offset in the anterior-posterior as well as medial-lateral plane between the center of the tibial diaphysis and the stem of the tibial baseplate were determined for an anatomic and symmetric tibial baseplate, respectively...
March 22, 2017: Archives of Orthopaedic and Trauma Surgery
https://www.readbyqxmd.com/read/28330757/does-new-instrumentation-improve-radiologic-alignment-of-the-oxford%C3%A2-medial-unicompartmental-knee-arthroplasty
#17
Ki-Mo Jang, Hong Chul Lim, Seung-Beom Han, Chandong Jeong, Seul-Gi Kim, Ji-Hoon Bae
BACKGROUND: A new instrument system has been introduced to improve the accuracy and reproducibility of implant positioning in Oxford® unicompartmental knee arthroplasty (UKA). This study aimed to determine if the new instrumentation could improve postoperative implant positioning and limb alignment, and reduce the occurrence of outliers in Oxford® UKA. METHODS: A total of 77 cases of Oxford® UKA with the new instrumentation were included. Individual matching for the conventional instrument group was performed according to age, sex, and body mass index...
March 19, 2017: Knee
https://www.readbyqxmd.com/read/28326415/help-my-rating-looks-bad-coding-comorbidities-in-arthroplasty
#18
Joseph D Galloway, Frank R Voss
In medicine today, there is a trend toward increasing transparency. Higher quality and better value are being sought, and one of the methods being used is publicly reported health care outcomes. However, there is a problem that comes from our loss of anonymity. Physicians who are being individually watched have to choose between doing what is best for the patient and doing what would look good when it is publicly reported. Often this might mean choosing not to treat a particularly sick patient who is unlikely to have a good outcome...
September 2016: Arthroplast Today
https://www.readbyqxmd.com/read/28326404/comparing-contemporary-revision-burden-among-hip-and-knee-joint-replacement-registries
#19
Brian J McGrory, Caryn D Etkin, David G Lewallen
BACKGROUND: Hip and knee arthroplasties are common and successful procedures, however, success and durability are not guaranteed. The revision burden, defined as the ratio of implant revisions to the total number of arthroplasties in a specific period, is a measure of the steady state of arthroplasty success in a given registry. This study examines the hypothesis that revision burden would be similar among contemporary joint replacement registries and improving over time compared with historic controls...
June 2016: Arthroplast Today
https://www.readbyqxmd.com/read/28324232/reducing-surgical-site-infections-following-total-hip-and-knee-arthroplasty-an-israeli-experience
#20
R Finkelstein, O Eluk, T Mashiach, D Levin, B Peskin, G Nirenberg, S Karkabi, M Soudri
PURPOSE: To assess the changes observed in surgical site infection (SSI) rates following total joint arthroplasty (TJA) after the introduction of an infection control programme and evaluate the risk factors for the development of these infections. DESIGN: Prospective cohort study. SETTING: Large tertiary medical centre in Israel. METHODS: Data about SSIs and potential prophylaxis-, patient-, and procedure-related risk factors were collected for all patients who underwent elective total hip and total knee arthroplasty during the study period...
March 21, 2017: Musculoskeletal Surgery
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