Incidence and Risk Factors of Orthostasis After Primary Hip and Knee Arthroplasty.

BACKGROUND: Postoperative orthostatic intolerance can limit mobilization after hip and knee arthroplasty. The literature is lacking on the incidence and risk factors associated with orthostatic intolerance after elective arthroplasty. METHODS: A retrospective case-control study of primary total hip, total knee, and unicompartmental knee arthroplasty patients was conducted. Patients with orthostatic events were identified, and potential demographic and perioperative risk factors were recorded. Orthostatic intolerance was defined as postoperative syncope, lightheadedness, or dizziness, limiting ambulation and/or requiring medical treatment. Statistical analysis was completed using Pearson's chi-square test for categorical data and t-tests for continuous data. Binary logistic regression was performed. RESULTS: A total of 500 consecutive patients were included. The overall incidence of orthostatic intolerance was 18%; 25% in total hip arthroplasty (THA) and 11% in total knee arthroplasty. On univariate analysis, significant risk factors for developing postoperative orthostatic intolerance include older age, female gender, THA surgery, lower American Society of Anesthesiologists class, absence of recreational drug use, lower estimated blood volume, lower preoperative diastolic blood pressure, spinal with monitored anesthesia care (MAC), posterior approach for THA, bupivacaine use in spinal, percent of blood loss, postoperative oxycodone or tramadol use, higher postoperative intravenous fluid volume, and lower postoperative hemoglobin. Multivariate analysis demonstrated persistent significance of female gender, THA surgery, spinal with MAC, bupivacaine use in spinal, and more intravenous fluid administered postoperatively. CONCLUSION: Orthostatic intolerance affects a significant number of arthroplasty patients. Awareness of risk factors and modification of perioperative variables linked to orthostatic intolerance may assist the surgeon in choosing the appropriate surgical setting, educating patients, and improving early postoperative recovery.

Anterior Revision Hip Arthroplasty is Associated With Higher Wound Complications but Fewer Dislocations Compared to Posterior Revision Hip Surgery.

BACKGROUND: Wound complication after primary direct anterior (DAA) hip arthroplasty has been reported in the literature but there has been no comparison regarding revision anterior vs revision posterior (PA) hip arthroplasty. The authors hypothesize that anterior approach revision surgery may have increased wound complications compared with posterior hip revisions and also report on secondary outcome metrics. METHODS: Ninety-nine DAA and 191 PA revisions were included for analysis. Preoperative demographic characteristics, indication for revision, operative details, type of revision performed, components utilized, and postoperative complications were compared between DAA and PA groups including multivariate analysis. RESULTS: The DAA cohort demonstrated an increased risk of superficial wound complications (7.1% vs 0.5%, P = .003) and a decreased dislocation rate (2.0% vs 13.1%, P = .002). There was a trend toward increased overall complications in the PA group (OR 1.71, P = .078). CONCLUSION: Revision DAA THA is associated with an increased risk of superficial wound complications, but may impart a decreased dislocation rate.

Patient Perceptions and Current Trends in Internet Use by Orthopedic Outpatients.

BACKGROUND: Many studies have highlighted concerns about the completeness and quality of information found online and how this may affect patients' education about their medical problems. One aspect of internet usage that has received less attention in the literature, however, is patient perception of the information that is gathered online, and how patients use it related to their musculoskeletal care. QUESTIONS/PURPOSES: The objective of the study is to utilize a cross-sectional study design to describe internet usage and patient perceptions of orthopedic online information and to identify differences in usage patterns. METHODS: One thousand two hundred ninety-six questionnaires were distributed to consecutive patients at orthopedic outpatient clinics which consisted of questions pertaining to patients' internet use. Basic demographic data were collected, and subgroup analyses were performed to examine the effect of three variables (age, gender, and clinic type) on various outcomes. RESULTS: 84.9% of patients reported access to the internet. Of patients with internet access, 64.7% reported using the internet for obtaining orthopedic information. 43.1% of the respondents who searched for orthopedic information rated it as "very useful," 56.3% found it "somewhat useful," and 0.6% found it "not at all useful". Younger patients were more likely to have used the internet for health and orthopedic information and to have found this information either very or somewhat useful. Males were more likely to have found the internet information very useful. Overall, only 33.7% of patients who researched their current orthopedic complaint accessed the institutional website for information. CONCLUSION: A large proportion of patients use the internet to research orthopedic information and most patients, especially younger males, find the information useful.

Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.

This study used a national database to compare 90-day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA): (1) non-obese patients (n=66,523), (2) morbidly obese patients who did not have bariatric surgery (n=11,294) and (3) morbidly obese patients who underwent bariatric surgery prior to TKA (n=219). Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P=0.001) and minor (OR 0.61, P=0.01) complications compared to morbidly obese patients who did not have bariatric surgery. Bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not to the same level as non-obese patients.