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INTRODUCTION: An estimated 54 million Americans currently suffer from debilitating arthritis. Patients who have exhausted conservative measures can be subject to chronic pain and resort to symptomatic management with anti-inflammatories, acetaminophen, and opioids. Cannabidiol (CBD) is a non-psychoactive cannabinoid that has shown promise in preclinical studies to reduce inflammation and pain associated with arthritis. The purpose of this study was to explore patient perceived effects of cannabidiol on symptoms of arthritis. METHODS: A novel anonymous questionnaire was created to evaluate perceived efficacy of cannabidiol for the treatment of arthritis. A self-selected convenience sample (N=428) was recruited through online methods including social media accounts and newsletters (The Arthritis Foundation and Savvy Cooperative) between May 5, 2020, and November 5, 2020. Statistical analysis was performed to determine differences between types of arthritis and improvements in quality-of-life symptoms. Furthermore, a regression analysis was performed to identify variables associated with decreasing or discontinuing other medications. RESULTS: CBD use was associated with improvements in pain (83%), physical function (66%), and sleep quality (66%). Subgroup analysis by diagnosis type (osteoarthritis, rheumatoid, or other autoimmune arthritis) found improvements among groups for physical function (P=0.013), favoring the osteoarthritis group. The overall cohort reported a 44% reduction in pain after CBD use (P<0.001). The osteoarthritis group had a greater percentage reduction (P=0.020) and point reduction (P<0.001) in pain compared to rheumatoid arthritis and other autoimmune arthritis. The majority of respondents reported a reduction or cessation of other medications after CBD use (N=259, 60.5%): reductions in anti-inflammatories (N=129, 31.1%), acetaminophen (N=78, 18.2%), opioids (N=36, 8.6%) and discontinuation of anti-inflammatories (N=76, 17.8%), acetaminophen (N=76, 17.8%), and opioids (N=81, 18.9%). CONCLUSION: Clinicians and patients should be aware of the various alternative therapeutic options available to treat their symptoms of arthritis, especially in light of the increased accessibility to cannabidiol products. The present study found associations between CBD use and improvements in patient's arthritis symptoms and reductions in other medications. Future research should focus on exploring the benefits of CBD use in this patient population with clinical trials.
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BACKGROUND: Hip instability following total hip arthroplasty (THA) can be a major cause of revision surgery. Physiological patient position impacts acetabular anteversion and abduction, and influences the functional component positioning. Osteoarthritis of the spine leads to abnormal spinopelvic biomechanics and motion, but there is no consensus on the degree of component variability for THAs performed by anterior approach. Therefore, we sought to present guidelines for changes in acetabular component positioning between supine and standing positions for patients undergoing primary THA by a uniform anterior approach. METHODS: Perioperative patient radiographs of the pelvis and lumbar spine were collected. Images were used to determine acetabular component positioning and degree of coexisting spinal pathology, categorized as a Lane Grade (LG). Final analysis of variance was performed on a sample size of 643 anterior primary THAs. RESULTS: From supine to standing position, as the severity of lumbar pathology increased the change in anteversion also increased (LG:0 = -0.11° ± 4.65°, LG:1 = 2.02° ± 4.09°, LG:2-3 = 5.78° ± 5.72°, P < .001). The mean supine anteversion in patients with absent lumbar pathology was 19.72° ± 5.05° and was lower in patients with worsening lumbar pathology (LG:1 = 18.25° ± 4.81°, LG:2-3 = 16.73° ± 5.28°, P < .001). CONCLUSION: Patients undergoing primary THA by anterior approach with worsening spinal pathology have larger increases in component anteversion when transitioning from supine to standing positions. Consideration should be given to this expected variability when placing the patient's acetabular component.
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Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Humanos , Vértebras Lumbares/cirugía , Radiografía , Estudios RetrospectivosRESUMEN
PURPOSE OF REVIEW: Chronic pain after total joint replacement (TJA), specifically total knee replacement (TKA), is becoming more of a burden on patients, physicians, and the healthcare system as the number of joint replacements performed increases year after year. The management of this type of pain is critical, and therefore, understanding the various modalities physicians can use to help patients with refractory pain after TJA is essential. RECENT FINDINGS: The modalities by which chronic pain can be successfully managed include genicular nerve radioablation therapy (GN-RFA), neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and peripheral subcutaneous field stimulation (PSFS). Meta-analyses and case reports have demonstrated the effectiveness of these treatment options in improving pain and functional outcomes in patients with chronic pain after TKA. The purpose of this paper is to review and synthesize the current literature investigating the different ways that refractory pain is managed after TJA, with the goal being to provide treatment recommendations for providers treating these patients.
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Artroplastia de Reemplazo/efectos adversos , Manejo del Dolor/métodos , Dolor Postoperatorio/terapia , Humanos , Dolor Postoperatorio/etiologíaRESUMEN
Several recent intraoperative and wound management techniques have been developed and implemented in the United States over the past decade; however, it is unclear what the effects of these newer modalities have on reducing surgical site infection (SSI) rates. Therefore, the purpose of this study was to track the annual rate and trends of (1) overall, (2) deep, and (3) superficial SSIs following revision total knee arthroplasty (TKA). The National Surgical Quality Improvement Program database was queried for all revision TKA cases performed between 2011 and 2016, which yielded 9,887 cases. Cases with superficial and/or deep SSIs were analyzed separately and then combined to evaluate overall SSI rates. After an overall 6-year correlation and trends analysis, univariate analysis was performed to compare the most recent year, 2016, with the preceding 5 years. Correlation coefficients and chi-square tests were used to determine correlation and statistical significance. No significant correlations between combined, deep, and/or superficial SSI rates and year were noted (p > 0.05). The lowest overall SSI incidence was in 2012 (1.16%), while the greatest incidence was in 2014 (1.76%). The deep SSI incidence over the 6 years was 0.67% (66 out of 9,887 cases). Deep SSI rate decreased by 10% in 2016 compared with 2011 (0.50 vs. 0.56%, p > 0.05). In this 6-year period, 94 cases out of 9,887 were complicated by a superficial SSI, an incidence of 0.95%. The lowest superficial SSI incidence occurred in 2015 (n = 17, 0.77%). Overall, the incidence of SSIs in revision TKA has remained fairly low with some annual variance, indicating room for improvement. These variations likely as revision surgeries can be more complex and have several associated confounding factors influencing outcomes, when compared with primary cases. Further research is needed to identify revision-specific strategies to reduce the risk of surgical site infections.
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Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Infección de la Herida Quirúrgica/epidemiología , Bases de Datos Factuales , Humanos , Incidencia , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Although intermittent catheters are immediately removed, indwelling catheterization may lead to decreased ambulation and participation in physical therapy, critical components to post-total knee arthroplasty (TKA) management. Therefore, this study aimed to compare the effect of catheterization treatments on (1) postoperative ambulation distances, (2) deep vein thromboses (DVTs), and (3) pulmonary emboli (PEs) following TKA. METHODS: A total of 9123 prospectively collected primary TKA patients were assessed based on postoperative catheter status. Patient demographics, Charlson Comorbidity Indices, body mass indices, DVT prophylaxes, first ambulation distances, DVTs, and PEs were collected at approximately mean 12 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models in order to compare catheterization techniques. RESULTS: There were 1193 patients who had urinary retention and treated with either indwelling only (62%, n = 734), both indwelling and intermittent catheterizations (13%, n = 160), or intermittent only (25%, n = 299). Multivariate analyses found that indwelling catheter-only use had an 11% decrease in ambulation distance (P < .001). Additionally, the indwelling catheterization-only group was found to be at increased risk of DVTs (odds ratio 2.605, P < .001), even after controlling for DVT prophylaxes (odds ratio 2.807, P < .001). CONCLUSION: This study showed that the use of an indwelling catheter for treatment of urinary retention significantly decreased TKA patient ambulation distance and subsequently increased the risk for DVTs. This information is important as we would recommend the treatment with intermittent catheterization rather than indwelling catheters to decrease the risk of immobilization and postoperative DVTs.
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Artroplastia de Reemplazo de Rodilla , Tromboembolia Venosa , Artroplastia de Reemplazo de Rodilla/efectos adversos , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Vejiga Urinaria , Cateterismo Urinario/efectos adversos , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , CaminataRESUMEN
BACKGROUND: Catheterization for the prophylaxis against or treatment for urinary retention commonly occurs after total knee arthroplasty (TKA). Recent studies have questioned the use of the indwelling catheterization, especially in its potential role as a nidus for infection. We are still unsure of its downstream effects on periprosthetic joint infections (PJIs). Therefore, this study aimed to compare the risks of postoperative PJI following intermittent vs indwelling catheterization after TKA. METHODS: Between 2017 and 2019, 15 hospitals in a large health system collected data on patients undergoing TKA. Patient treatments with indwelling catheter only, intermittent straight catheter only, and both indwelling and intermittent straight catheterizations were recorded. Patient demographics, comorbidities, body mass indices, and PJIs were collected from time of surgery to time of data collection at mean 14 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models to compare catheterization treatment types. RESULTS: A total of 9123 TKAs were performed, with patients receiving indwelling catheter only (62%, n = 734), intermittent straight catheter only (25%, n = 299), or both indwelling and intermittent catheterizations (13%, n = 160). Univariate analyses showed that PJIs occurred in 1.1% of no-catheter patients and 2.3% of patients treated with bladder catheterization (P = .002). Using multivariate analyses, indwelling catheter use (odds ratio [OR] 2.647, P < .001), diabetes (OR 1.837, P = .005), and peripheral vascular disease (OR 2.372, P = .046) were found to have a statistically significant increased risk for PJIs. The use of intermittent straight catheterization (OR 1.249, P = .668) or both indwelling and intermittent (OR 1.171, P = .828) did not increase the risk for PJIs. CONCLUSION: Urinary bladder catheterization is commonly required for prophylaxis against or treatment for urinary retention following TKA. The use of a urinary catheter can provide a potential nidus for infection in these patients. This study found that indwelling catheterization, but not intermittent catheterization, was associated with an increased risk for PJI. Surgeons should therefore limit the duration of catheterization in an effort to decrease the risk for PJI.
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Artroplastia de Reemplazo de Rodilla , Infecciones Relacionadas con Prótesis , Artroplastia de Reemplazo de Rodilla/efectos adversos , Catéteres de Permanencia/efectos adversos , Humanos , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/prevención & control , Vejiga Urinaria , Cateterismo Urinario/efectos adversosRESUMEN
BACKGROUND: Urinary bladder catheters are potential sources of infection after total hip arthroplasty (THA). Therefore, the goal of this study was to determine if intermittent catheterization provides a decreased risk of postoperative urinary tract infections (UTIs) compared with indwelling catheterization in THA patients. METHODS: Patients undergoing THA at 15 hospitals within a large health system were prospectively collected between 2017 and 2019 and then stratified based on catheterization technique: no-catheter; indwelling catheter-only; intermittent catheter-only; and both intermittent and indwelling catheter. Patient demographics, medical comorbidities, anesthesia types, and postoperative UTIs were assessed. Independent Student t-tests were used to perform univariate analyses for the catheterization groups. Multiple linear regression models were used to compare the different groups while controlling for confounding variables. RESULTS: There were a total of 7306 THA patients recorded with 5513 (75%) no-catheter, 1181 (16%) indwelling catheter-only, 285 (3.9%) intermittent catheter-only, and 327 (4.5%) indwelling and intermittent catheterization patients. A total of 580 patients experienced postoperative UTI. Urinary bladder catheterization increased the risk of postoperative UTIs (P < .001) in univariate analyses. Multiple linear regression models showed that indwelling catheter-only (OR: 2.178, P < .001), intermittent catheterization (OR: 1.975, P = .003), and both indwelling and intermittent (OR: 2.372, P = .002) were more likely to experience UTIs compared with no catheters. CONCLUSION: This study found that patients treated with indwelling catheterization, with or without preceding intermittent catheterization, were significantly more likely to experience UTIs. Therefore, in an effort to decrease the risk of UTIs, THA patients experiencing postoperative urinary retention should be treated with intermittent catheterization.
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Artroplastia de Reemplazo de Cadera , Infecciones Urinarias , Artroplastia de Reemplazo de Cadera/efectos adversos , Catéteres de Permanencia , Humanos , Vejiga Urinaria , Cateterismo Urinario/efectos adversos , Catéteres Urinarios , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & controlRESUMEN
BACKGROUND: Substance abuse disorder (SUD), alcohol abuse disorder (AUD), and depression have been identified as independent risk factors for complications after total knee arthroplasty (TKA). However, these mental health disorders are highly co-associated, and their cumulative effect on postoperative complications have not been investigated. Therefore, this study aimed to determine if patients who have more than one mental health disorder (SUD, AUD, or depression) were at an increased risk for postoperative complications following TKA. METHODS: A total of 11,403 TKA patients were identified from a prospectively collected institutional database between January 1, 2017 and April 1, 2019. Patients who had depression, SUD, and AUD were separated into 7 mental health subgroups including each of these diagnoses alone and their combined permeations. Patient demographics, body mass indices, medical comorbidities, and 15 postoperative complications were collected. Univariate analyses were performed using independent Student's t-tests. Multivariate analyses were then performed to identify odds ratios (ORs) for mental health disorders subgroups associated with complications. RESULTS: We found a total of 2073 (18%) patients diagnosed with either SUD (4%), AUD (0.6%), or depression (12%). Univariate analyses showed that depression was associated with mechanical failures (P < .001). SUD was associated with periprosthetic joint infection (PJI) (P < .001), wound complications (P = .022), and aseptic loosening (P = .007). AUD was associated with PJI (P < .001) and deep vein thromboses (P = .003). Multivariate analyses found that AUD (OR: 19.419, P < .001) and SUD (OR:3.693, P = .010) were independent risk factors for PJI. Compared with SUD alone, patients with depression plus SUD were found to have a 4-fold (OR: 13.639, P < .001) and 2-fold (OR:4.401, P = .021) increased risk for PJI and cellulitis, respectively. CONCLUSIONS: Patients who had depression, SUD, or AUD were at increased risk for postoperative complications following primary TKA. When patients have more than one mental health diagnosis, their risk for complications was amplified. The results of this study can help identify those patients who are at greater risk of postoperative complications to enable improved preoperative optimization and patient education.
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Artritis Infecciosa , Artroplastia de Reemplazo de Rodilla , Trastornos Relacionados con Sustancias , Artritis Infecciosa/cirugía , Artroplastia de Reemplazo de Rodilla/efectos adversos , Depresión/epidemiología , Depresión/etiología , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Factores de RiesgoRESUMEN
BACKGROUND: Prompt identification and treatment of wound complications is essential after joint arthroplasty, but emergency department and office visits for urgent evaluation of normal incisions are a source of unnecessary cost. The purpose of this study is to evaluate the use of an online image messaging platform for remote monitoring of surgical incision sites. METHODS: We conducted a retrospective review of 1434 hip and knee arthroplasty patients who registered for an online platform in the perioperative period. We reviewed images sent by patients to evaluate potential wound abnormalities. Medical records were reviewed to determine whether assessments based on wound photographs corresponded with subsequent in-person findings and ultimate disposition. RESULTS: Four hundred thirty patients (42%) sent at least one text or image message to their provider. Elimination of redundant images resulted in 104 image encounters, with 76 discrete encounters in 41 patients related to the surgical wound. Most showed normal wound appearance; patients were reassured and urgent visits were avoided. At scheduled in-person follow-up, none of these patients demonstrated unrecognized wound complications. Seventeen image encounters in 7 patients showed possible wound abnormalities. These prompted in-person follow-up on average less than 1 day later for 4 issues deemed urgent (2 patients received surgical treatment) and 5 days later for issues deemed nonurgent. Photos were also used to monitor abnormal wounds over time and to send information unrelated to wounds. CONCLUSION: Utilization of an online physician-patient messaging platform can prevent unnecessary visits for normal appearing wounds, while facilitating rapid in-person treatment of wound complications.
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Infección de la Herida Quirúrgica/diagnóstico , Herida Quirúrgica , Telemedicina/estadística & datos numéricos , Envío de Mensajes de Texto , Factores de Edad , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotograbar , Relaciones Médico-Paciente , Estudios Retrospectivos , Infección de la Herida Quirúrgica/etiología , Telemedicina/métodosRESUMEN
BACKGROUND: Revision total knee arthroplasty (TKA) is associated with increased rates of infections, readmissions, longer operative times, and lengths-of-stay (LOS) compared to primary TKA. Additionally, increasing operative times and prolonged postoperative LOS are independent risk factors for these postoperative complications in lower extremity total joint arthroplasty (TJA). This has led to an increased effort to reduce these risk factors in order to improve patient outcomes and reduce cost. However, the relationship between operative time and LOS has not been well assessed in revision arthroplasty. Therefore, the purpose of this study was to: (I) identify predictors of longer operative times; (II) identify predictors of longer LOS; and (III) evaluate the effects of operative time, treated as both a categorical variable and a continuous variable, on LOS after revision TKA. METHODS: The NSQIP database was queried for all revision TKA cases (CPT code 27487) between 2008 and 2016 which yielded 10,604 cases. Mean operative times were compared between patient demographics including age groups, sex, and body mass indexes (BMIs). To determine predictors of LOS, mean LOS were also compared between patient demographics in the same groups. To assess the correlation of operative time on LOS, the mean LOS for 30-minute operative time intervals were compared. Univariate analysis was performed with one-way analysis of variance (ANOVA) and t-tests. A multivariate analysis with a multiple linear regression model was performed to evaluate the association of LOS with operative times after adjusting for patient age, sex, and BMI. RESULTS: The mean LOS for revision TKA was 4 (±3) days. Further analysis showed that young age is associated with increased LOS (P<0.01). An analysis of operative times showed positive correlations with young age, BMI greater than 30 and male sex (P<0.05). The mean LOS of revision TKA patients was found to increase with increasing operative time in 30-minute intervals (P<0.001). Multivariate analysis showed that longer operative times had significant associations with longer LOS even after adjusting for patient factors (ß=0.102, SE =0.001, P<0.001). These results also showed that out of all of the study covariates, operative times had the greatest effect on LOS after revision TKA. CONCLUSIONS: Revision TKA is a complex procedure, often requiring increased operative times compared to primary TKA. This study provides unique insight by correlating operative times to LOS in over 10,000 revision TKAs from a nationwide database. Our results demonstrate that out of all the study covariates (age, sex, and BMI), operative times had the greatest effect on LOS. The results from this study indicate that less time spent in the operating room can lead to shorter LOS for revision TKA patients. This relationship further underscores the need for improved preoperative planning and intra-operative efficiency in an effort to decrease LOS and improve patient outcomes.
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BACKGROUND: Substantial efforts have been made to reduce the risk of infection after total hip arthroplasty (THA), including pre-operative patient optimization, skin preparation with alcohol-based solutions, perioperative antibiotics, and minimizing wound drainage with novel sutures and dressings. While these approaches have been effective in primary THA, their effects on revision THA to improve surgical site infection (SSI) rates are less clear. Therefore, the purpose of this study was to identify the annual rates and trends of: (I) overall; (II) deep; and (III) superficial SSIs following revision THA using the most recent results (2011 to 2016) from a large, nationwide database. METHODS: The National Surgical Quality Improvement Program (NSQIP) database was queried for all revision THA cases (CPT code 27134) between 2011 and 2016, yielding 8,562 cases. A steady increase in the total number of revision THA cases was observed from 2011 to 2016 (750 vs. 1,951, 260%). Cases with reported superficial and/or deep SSI were analyzed separately and then combined to evaluate overall SSI rates. The infection incidence for each year was calculated. After an overall 6-year correlation and trends analysis, univariate analysis was performed to compare the most recent year, 2016, with each of the preceding 5 years. Additionally, percent differences between 2016 and each previous year were calculated to evaluate rate changes. Pearson correlation coefficients and chi-squared tests were used to determine correlation and statistical significance which was maintained at a P value less than 0.05. RESULTS: There were 217 cases out of 8,562 (2.53% of all cases) complicated by any SSI. Overall, there was an inverse correlation between combined SSI rate and year, however, this was not statistically significant (P>0.05). The lowest incidence was in 2016 (n=41, 2.10%), while the highest incidence was in 2014 (n=45, 2.86%). The combined SSI rate in 2016 decreased by 22% when compared to 2015 (2.10% vs. 2.69%, P>0.05). A larger, 27% decrease in rate was found between 2016 and 2014 (2.10% vs. 2.86%, P>0.05). For deep SSI, there was an inverse correlation between rate and year of surgery, however, this was not statistically significant (P>0.05). The deep SSI incidence over the 5 years was 1.38% (118 out of 8,562 cases). There was a 35% decrease in deep SSI rate from 2016 to 2015 (0.92% vs. 1.43%, P>0.05). A larger, 53% decrease, was seen between 2016 and 2014 (0.92% vs. 1.04%, P<0.01). For superficial SSI, there was an inverse correlation between rate and year, however, this was not statistically significant (P>0.05). In this 6-year period, 99 cases out of 8,562 were complicated by a superficial SSI; an incidence of 1.16%. The lowest incidence occurred in 2014 (n=14, 0.89%), while 2012 had the highest incidence (n=17, 1.61%). The rate in 2016 decreased by 6% when compared to 2015 (1.18% vs. 1.07%, P>0.05). A larger, 27% decrease in rate was observed between 2016 and 2012 (1.18% vs. 1.61%, P>0.05). CONCLUSIONS: Revision total hip arthroplasties exhibited a trend towards decreasing overall SSI nationwide between 2011 and 2016. Deep SSI rates had marked improvements, specifically between 2014 and 2016. This trend indicates some benefit from pre- and post-operative infection preventative strategies, but importantly, indicates continued room for improvement. Due to the potentially devastating complications associated with infection in revision THAs, further research is required to identify revision-specific strategies to lower the rates of SSIs.
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Continuous femoral nerve block (CFNB) has been used to prevent the breakthrough pain after total knee arthroplasty (TKA). Multimodal drug injection (PMDI) has also been shown to decrease opioid consumption and pain. We investigated whether the use of PMDI further improves analgesic and rehabilitation outcomes when used in conjunction with CFNB. This is a prospective randomized controlled study of 44 patients undergoing primary TKA. The treatment group (n = 23) received a PMDI of combined ropivacaine, epinephrine, ketorolac and morphine, and the controlled group (n = 21) received saline at wound closure. Total opioid consumption, pain scores, knee range of motion (ROM) outcomes, length of stay, and patient satisfaction were measured and compared. The total consumption of morphine is similar between the two groups (52.6 ± 40.6 vs. 41.5 ± 32.9, p = 0.325). The mean morphine consumption of the treatment group was significantly lower than the control at 4 h after surgery (4.2 ± 5.5 vs. 11.3 ± 8.1, p = 0.002) but comparable on POD1, POD2, and POD3. The mean pain scores were significantly higher in the treatment group than the control group at POD2 (at rest: 47.3 ± 29.1 vs. 23.8 ± 20.6, p = 0.004; after PT: 57.7 ± 25.4 vs. 35.2 ± 26.8, p = 0.007) and POD3 (at rest: 30.9 ± 30.3 vs. 14.8 ± 20.9, p = 0.045; after PT: 50.2 ± 30.6 vs. 29.0 ± 32.1, p = 0.035), and not significantly different at 4 h after surgery or at POD1. Mean maximal knee flexion ROM in degrees during active and active assisted mobilization showed no significant difference between the control and the treatment groups on POD2 and POD3. The mean length of stay of the treatment group is significantly longer than the control group (5.1 ± 2.1 vs. 3.8 ± 1.6, p = 0.032). At discharge, no significant difference exists between the two groups for mean patient satisfaction. The addition of PMDI led to a decrease in opioid consumption in the immediate postoperative period but with no significant difference in the total consumption within the first three days postoperatively. This finding provides an opportunity for appropriate preoperative treatment and education for both patients and caregivers.
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Studies on cost containment of total knee arthroplasty (TKA) have generated substantial interest over the past decade. Although multiple studies have evaluated the various intraoperative methods to control cost, no prior study has evaluated the economic impact and the clinical outcome based on amount of bone cement needed for a primary TKA. At a minimum of 3 years follow-up, we observed no difference in implant survivorship or Knee Society scores, but did observe substantial cost savings when one versus two packets of bone cement were used in combination with a hand mixing technique. By eliminating several extra cement mixing products, we achieved an approximately $1,000 cost saving per case with no difference in clinical outcomes at midterm follow-up.
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Artroplastia de Reemplazo de Rodilla/economía , Cementos para Huesos/economía , Cementación/economía , Cementación/métodos , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Rodilla/métodos , Ahorro de Costo , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Falla de Prótesis , Estudios RetrospectivosRESUMEN
The use of barbed sutures has become increasingly popular; however, their efficacy and safety continues to be debated. We review the records of 333 primary total knee arthroplasties (TKAs) to determine the difference in wound closure and total operative time between patients closed with a barbed versus standard sutures. We also evaluated complication rates and cost differences between the two groups. Overall, we saw no significant difference in either wound closure time (31 vs. 30 minutes) or total operative time (115 vs. 114 minutes). No significant differences were observed in the complication rate. Material costs were lower overall in the barbed suture group ($66.78 vs. 82.59). Further studies will be required to determine the role of barbed sutures in TKA.
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Artroplastia de Reemplazo de Rodilla/economía , Suturas , Anciano , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Estudios Retrospectivos , Técnicas de Sutura , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
Periprosthetic distal femoral fractures can present significant reconstructive challenges when associated with poor bone stock, comminution, or component loosening. Revision arthroplasty with stemmed components or distal femoral replacement arthroplasty often becomes necessary. This retrospective study reviewed the results of femoral revision arthroplasty in 16 knees with acute, extreme distal (Su type 3), supracondylar periprosthetic fractures using cemented, midlevel constrained implants. The mean patient age was 71 years and mean follow-up was 5 years. All fractures united with mean Knee Society scores of 86 and 55, at the last follow-up. All patients returned to preinjury activity level. Complications included one valgus malunion with shortening and one reoperation for functional lateral instability. This treatment modality achieved reliable fracture union and return of function. Moreover, the final salvage option of distal femoral arthroplasty is preserved.
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Artroplastia de Reemplazo de Rodilla , Fracturas del Fémur/cirugía , Complicaciones Posoperatorias/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Estudios RetrospectivosRESUMEN
The use of tapered, fluted, modular, distally fixing stems has increased in femoral revision surgery. The goal of this retrospective study was to assess mid-term to long-term outcomes of this implant. Seventy-one hips in 70 patients with a mean age of 69 years were followed for an average of 10 years. Preoperative HHS averaged 50 and improved to 87 postoperatively. Seventy-nine percent hips had Paprosky type 3A or more bone-loss. All stems osseointegrated distally (100%). Two hips subsided >5mm but achieved secondary stability. Sixty-eight percent hips had evidence of bony reconstitution and 21% demonstrated diaphyseal stress-shielding. One stem fractured near its modular junction and was revised with a mechanical failure rate of 1.4%. Distal fixation and clinical improvement were reproducibly achieved with this stem design.
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Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Oseointegración , Dimensión del Dolor , Complicaciones Posoperatorias , Diseño de Prótesis , Falla de Prótesis , Reoperación , Reproducibilidad de los Resultados , Estudios Retrospectivos , Titanio , Resultado del TratamientoRESUMEN
Blood loss remains a substantial problem associated TKA. This study evaluated the efficacy of a fibrin sealant on: (1) blood loss; (2) blood transfusions; and (3) length of stay. We evaluated the records of 113 consecutive patients with sealant and 70 without sealant. There was no significant difference in the hemoglobin levels (all 9.5-10 g/dL) on each of three postoperative days. There was also no significant difference in the intraoperative blood loss, postoperative blood loss or the total perioperative blood loss in both groups. The mean requirement in each patient was 2.5 ± 2.4 units in the fibrin sealant group compared to 2.0 ± 0.8 units in the non-fibrin sealant group. We have stopped using fibrin sealant based on this study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Adhesivo de Tejido de Fibrina/uso terapéutico , Hemoglobinas/análisis , Hemostáticos/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/prevención & control , Transfusión Sanguínea , Femenino , Hematócrito , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/prevención & control , Estudios RetrospectivosRESUMEN
BACKGROUND: Symptomatic osteonecrosis of the joint is a frequent debilitating complication in patients who have been infected with the human immunodeficiency virus (HIV). In earlier reports, outcomes of primary total joint arthroplasty in such patients have been poor due to early failures, high infection rates, and increased complication rates. We report on the clinical and radiographic outcomes of primary total hip arthroplasty (THA) in nonhemophilic, HIV-infected patients as compared with the outcomes in a cohort of osteonecrosis patients who did not have this disease. METHODS: Thirty-four HIV-infected patients (forty-four hips) who underwent primary THA for the treatment of osteonecrosis during the period of 2001 through 2008 were compared with a control cohort of seventy patients (seventy-eight hips) who also underwent THA for the treatment of osteonecrosis but did not have HIV or other high-risk factors for revision. The patients in the HIV study group (eleven women and twenty-three men) had a mean age of forty-eight years (range, thirty-four to eighty years) and were followed for a mean of seven years (range, four to eleven years). Evaluated outcomes included implant survivorship, Harris hip score, infection rate, activity score, postoperative Short-Form 36 (SF-36) health survey score, and radiographic outcome. RESULTS: Kaplan-Meier survival analysis demonstrated no significant difference in aseptic implant survivorship between the HIV and comparison cohorts at the five-year (100% vs. 98%, respectively) and ten-year (95% vs. 96.5%, respectively) follow-up times. In addition, at the time of final follow-up, the mean postoperative Harris hip scores (85 points in the HIV group vs. 87 points in the comparison group), activity scores (5.7 points in the HIV group vs. 6.1 points in the comparison group), and SF-36 physical (43 points in the HIV group versus 46 points in the comparison group) and mental component summary scores (54 points in the HIV group versus 57 points in the comparison group) were statistically similar between the two cohorts. There were two late infections in the HIV cohort as compared with none in the comparison cohort. CONCLUSIONS: Our results demonstrated excellent implant survivorship, clinical and radiographic outcomes, and minimal complications at the time of midterm follow-up in the HIV-infected patient group. We believe that the outcomes associated with primary THA are improving in this patient population as a result of better medical management; however, late infections are potential complications.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Infecciones por VIH/complicaciones , Osteonecrosis/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Osteonecrosis/virología , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
The purpose of this study was to compare the outcomes of cementless primary total hip arthroplasty (THA) in sickle cell patients compared to the remaining cohort of osteonecrosis patients who did not have this disease. Thirty-two sickle cell patients (42 hips) who had a mean age of 37 years and mean follow-up of 7.5 years (range, 5-11 years) were compared to 87 non-sickle cell osteonecrosis patients (102 hips) who had mean age of 43 years and mean follow-up of 7 years (range, 3-10.5 years). Outcomes evaluated included implant survivorship, Harris hip scores, complication rates, radiographic outcomes, and Short Form-(SF-36) health questionnaire. There were no significant differences in aseptic implant survivorship (95 vs. 97%), Harris hip scores (87 vs. 88 points), SF-36 score, or radiographic findings between the two patient cohorts. In light of these findings, we believe that the outcomes of THA improved in sickle cell patients with optimized medical management and the use of cementless prosthetic devices.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Artroplastia de Reemplazo de Cadera , Osteonecrosis/cirugía , Adolescente , Adulto , Artroplastia de Reemplazo de Cadera/efectos adversos , Estudios de Seguimiento , Prótesis de Cadera , Humanos , Persona de Mediana Edad , Osteonecrosis/etiología , Adulto JovenRESUMEN
The purpose of this study was to compare the outcomes of total hip arthroplasty (THA) in systemic lupus erythematosus (SLE) compared to a cohort of osteonecrosis patients who did not have this disease. Between 2001 and 2008, 60 THAs in 44 SLE patients who had a mean age of 42 years (range, 18 to 87 years) and a mean follow-up of 7 years (range, 4 to 11 years) were evaluated. These SLE patients were compared to a cohort of 82 THAs in 70 osteonecrosis patients who did not have this disease. Outcomes evaluated included implant survivorship, Harris hip scores, complications, as well as radiographic results. There was no significant difference in implant survivorship (98% vs. 97.5%), Harris hip score (87 vs. 88 points) and complications (1.7% versus 2.4%) between the SLE and the comparison cohort. The authors believe that SLE does not negatively affect the outcomes of primary total hip arthroplasty at mid-term follow-up.