Is outpatient joint arthroplasty safe in a high volume academic centre? A retrospective monocentric study using an institutional pathway.

PURPOSE: Hip and knee arthroplasties are daily procedures in orthopaedic departments. Recently, same-day discharge (SDD) became increasingly popular, but doubts remain about its safety and generalization. Our hypothesis is that outpatient arthroplasty, in a high volume centre and with an institutional protocol, is an effective and reliable practice. METHODS: We realized a monocentric retrospective study of patients undergoing outpatient partial (UKA) or total (TKA) knee or hip arthroplasty (THA) in a high volume academic centre using a well-defined institutional pathway. Epidemiological data and complications occurring in the month following surgery were studied. RESULTS: 498 patients undergoing 501 arthroplasties (219 hips and 282 knees) were examined. The percentage of men and women was 60.28% and 39.72% respectively, mean age was 64.56 ± 9.59 years, mean BMI was 26.87 ± 4.2 and the most represented ASA score was 2. The success rate for same-day discharge was 97.21%. The most frequent causes of failure were urinary retention (28.6%), orthostatic hypotension (28.6%) and insufficiently controlled pain (14.3%). The readmission rate in the month following the operation was 0.8% and the rate of emergency department visits was 1.6%. Finally, the rate of early consultation visits was 7.98%. The comparison between success and failure subgroups in the outpatient setting of our cohort did not highlight statistically significant differences for studied parameters. CONCLUSION: Outpatient arthroplasty, performed in a center used to managing such operations and with a well-established institutional pre- and post-operative protocol, is a safe practice.

Evolution and characteristics of nocturnal knee pain after knee arthroplasty.

INTRODUCTION: Nocturnal knee pain and sleep disorders are two common but poorly studied issues contributing to dissatisfaction following knee arthroplasty. This study aims to evaluate the prevalence and associated factors of nocturnal pain and sleep disturbance in a population undergoing knee arthroplasty. METHODS: We included in this prospective observational study 111 patients undergoing knee athroplasty (79 TKA and 32 UKA). Sleep quality, nocturnal knee pain (preoperatively, at day 3, at 3 and 6 weeks, at 3 months and one year after surgery), pain during mobilization and neuropathic pain were evaluated by scores. Painkillers and sleeping pills intake were recorded. Potentially predictive factors for postoperative nocturnal pain evolution were studied. RESULTS: Poor sleeping quality rate was 54% for the pre-operative patients and was still 53% at one year after surgery. The prevalence of nocturnal knee pain was 38,74% before surgery and 2,9% at one year after arthroplasty. This study has been performed at the University Hospital Saint Luc Brussels. Evolution and Characteristics of nocturnal knee pain after knee arthroplasty. Nocturnal pain after knee surgery was significantly associated with higher pain scores at rest during activity and at night. Nocturnal pain was significantly associated with a higher PSQI and DN4 scores and a higher consumption of painkillers or sleeping pills at W6. The multiple variable regression showed a statistically significant correlation between preoperative and postoperative nocturnal pain at D3 and W3. Compared to TKA, UKA patients reported significantly less nocturnal pain at W3 and W6. CONCLUSIONS: Bad sleeping quality is present in 54% of knee arthroplasty patients before and after surgery. Nocturnal pain is present in 39% of knee arthroplasty patients before surgery and this drops to 3% after one year. Nocturnal pain is associated with higher pain intensity, neuropathic symptoms, increased medication consumption and poor sleeping quality. Night pain disappeared faster after UKA than TKA, with a tipping point around 6 weeks postoperatively.

Excellent survival of second-generation uncemented dual mobility cups compared with first-generation cups at a minimum of 10 years follow-up in primary total hip arthroplasty.

INTRODUCTION: This study aimed to compare the revision rate and long-term survival between two generations of uncemented dual mobility cup (DMC) from the same manufacturer in primary total hip arthroplasty (THA) at a minimum follow-up of 10 years. METHODS: This retrospective monocentric study included all THA performed with an uncemented DMC from the same company. The cohort included 150 patients with 22 first-generation DMC and 128 second-generation DMC. The coating of the second generation was a double-coating Plasma spray of Titanium and Hydroxyapatite (HAP), compared to the coating of alumina and HAP for the first generation. The mean follow-up was 14.2 ± 1.2 years. The mean age was 76.0 ± 10.1 years. The Harris hip score (HHS), complications, and revisions were collected at the last follow-up. Ten- and fifteen-year Kaplan-Meier survival was calculated. RESULTS: At the last follow-up, the mean HHS was 83.2 ± 9.1. There were two acetabular loosenings with the old coating (9.1%) and one case with the new one (0.78%) (p = 0.056). There was one extra-prosthetic dislocation (0.67%) and one postoperative infection (0.67%). Survival without acetabular revision at 10 and 15 years was 90.9% for the 1st generation and 99.2% for the 2nd generation (p = 0.009). CONCLUSION: Survival without acetabular revision was significantly higher at 10 and 15 years of follow-up with the second generation of DMC with plasma-sprayed titanium and HAP coating compared to the first generation of DMC coat. The dislocation was uncommon, thanks to the dual mobility concept. This second generation of uncemented DMC can be safely used in primary THA.