Assessment of Medical and Social Risk Factors Before Arthroplasty in Argentina: A Poll of Argentinian Hip and Knee Association (ACARO) Members.

BACKGROUND: Assessment of risk factors is crucial for lowering complication rates and costs of hip and knee arthroplasty. The objective of this study was to assess if members of the Argentinian Hip and Knee Association (ACARO) are influenced by such risk factors when planning surgery. METHODS: In 2022, a survey was distributed as an electronically based questionnaire to 370 members of the ACARO. A descriptive analysis was performed on 166 proper answers (44.9%). RESULTS: There were 68% of the respondents who were specialists in joint arthroplasty and 32% practiced general orthopedics. A large number had large volumes at private hospitals without service/residents and 48.2% had been in practice for more than 15 years. Of the responding surgeons, 99% routinely performed a preoperative reversible risk factors evaluation that considered diabetes, malnutrition, weight, and smoking, and 95% canceled/postponed the surgery for abnormalities. Malnutrition was important for 79% of the polled with blood albumin being used by 69.3%. Fall risk assessment was performed by 60.2% of the surgeons. Only 44% of the surgeons felt free to choose the implant for the arthroplasty, possibly because 69.9% work for a capitated system. Important delays for surgery were reported by 63.9 and 84.3% had waiting lists. 74.7% of the polled noted physical or psychological deterioration during such delays. CONCLUSION: Socioeconomic factors firmly impact on the accessibility to arthroplasty in Argentina. Despite these barriers, the qualitative analysis of this poll let us demonstrate greater awareness of preoperative risk factors, especially diabetes as the most reported comorbidity.

Multicenter Retrospective Study of Neurostimulation With Exit of Therapy by Explant.

INTRODUCTION: Spinal cord stimulation (SCS) devices are cost effective and improve function as well as quality of life. Despite the demonstrated benefits of SCS, some patients have the device explanted. We are interested in exploring the patient characteristics of those explanted. METHODS: This is a retrospective chart review of neurostimulation patients who underwent explantation at 18 centers across the United States within the previous five years. RESULTS: Data from 352 patients were collected and compiled. Failed Back Surgery syndrome was the most common diagnosis (38.9%; n = 136/350) and over half of the patients reported numerical rating scale (NRS) scores ≥8 prior to implant (64.3%; n = 207/322). All patients reported changes in NRS scores across time, with an initial decrease after implant followed by a pre-explant increase (F (2, 961) = 121.7, p < 0.001). The most common reason for device explant was lack or loss of efficacy (43.9%; 152/346) followed by complications (20.2%; 70/346). Eighteen percent (18%; 62/343) of patients were explanted by a different physician than the implanting one. Rechargeable devices were explanted at a median of 15 months, whereas primary cell device explants occurred at a median of 36 months (CI 01.434, 2.373; median endpoint time ratio = 2.40). DISCUSSION: Loss or lack of efficacy and complications with therapy represent the most frequent reasons for neurostimulation explantation. Of the devices that were explanted, therapy was terminated earlier when devices were rechargeable, when complications occurred, or when pain relief was not achieved or maintained. Furthermore, in nearly 20% of the cases, a different provider than the implanting physician performed device removal. CONCLUSIONS: SCS is largely a safe and efficacious strategy for treating select chronic refractory pain syndromes. Further prospective data and innovation are needed to improve patient selection, maintain SCS therapeutic efficacy and reduce the reasons that lead to device explant.