Rapid Discharge to Home After Total Knee Arthroplasty Is Safe in Eligible Medicare Patients.

BACKGROUND: This study was aimed at assessing the risk of readmission for Medicare patients discharged home within a day of total knee arthroplasty (TKA) compared to those discharged on day 2 or beyond in a community medical center. METHODS: A hospital inpatient database was queried for all unilateral, primary TKAs performed on patients 65 years or older from January 1, 2013, to December 31, 2015. A total of 2287 patients met the study criteria, of which 1502 were discharged within a day (short stay), and 785 were discharged on day 2 or beyond (traditional stay). The main outcome measures were all-cause 30-day and unplanned 90-day readmissions. RESULTS: Short-stay patients did not experience a higher 30-day readmission rate (1.1%) compared to the traditional-stay patients (2.7%), nor did they experience a higher rate of unplanned 90-day readmissions (1.7% vs 3.6%). The short-stay group had more favorable demographics compared to the traditional-stay group. Logistic regression results revealed that none of the demographic factors considered had a statistically significant impact on 30-day readmission odds for either group. For unplanned 90-day readmissions, the results showed that for the short-stay patients, with the exception of age, none of the other demographic factors had significant impact on readmission odds and none were significant for the traditional-stay group. CONCLUSION: Our results suggest that the Medicare patients meeting discharge criteria and discharged home within a day of TKA do not have an increased risk of 30-day and 90-day readmission.

The AAHKS Clinical Research Award: Liposomal Bupivacaine and Periarticular Injection Are Not Superior to Single-Shot Intra-articular Injection for Pain Control in Total Knee Arthroplasty.

BACKGROUND: Intraoperative injections can help reduce early postoperative pain in total knee arthroplasty. We proposed that liposomal bupivacaine would not be superior to more common and cheaper injections. METHODS: A single-blinded prospective randomized study with 207 consecutive patients was completed. Patients were randomized to treatment with periarticular liposomal bupivacaine injection, periarticular injection of bupivacaine/morphine, or intra-articular injection of bupivacaine/morphine at the conclusion of the procedure. Postoperative visual analog pain scores and narcotic consumption were recorded and analyzed. RESULTS: There was no significant difference in postoperative visual analog pain scores or narcotic consumption among the 3 study groups. CONCLUSION: Intra-articular injection of bupivacaine and morphine is as effective for postoperative pain control in total knee arthroplasty as periarticular bupivacaine/morphine injection and liposomal bupivacaine. Use of liposomal bupivacaine in total knee arthroplasty is costly and not justified.

Proximal femoral replacement and allograft prosthesis composite in the treatment of periprosthetic fractures with significant proximal bone loss.

Femoral bone loss due to periprosthetic fracture, a challenging problem in total hip arthroplasty (THA), is increasingly encountered due to a rise in the number of revision THAs performed. Allograft prosthesis composite (APC) and proximal femoral replacement (PFR) are two available options for management of patients with difficult type-B3 Vancouver periprosthetic fractures. The treatment algorithm for patients with these fractures has been extensively studied and is influenced by the age and activity level of the patient. APC is often preferred in young and active patients in an attempt to preserve bone stock while older and less active patients are considered candidates for PFR. In spite of the high rate of overall complications with these two procedures, reported survivorship is acceptable. Treating patients with these complicated fractures is fraught with complications and, even with successful treatment, the outcomes are not as promising as those associated with primary hip replacement. In this paper, we aimed to review available published reports about PFR and APC for treatment of periprosthetic fractures around THAs.

What are young patients doing after hip reconstruction?

We assessed primary hip arthroplasty patients younger than 50 years in terms of activity and function. We hypothesized that young patients are more active than previously thought. Physician activity recommendations were compared with patient-reported participation levels in activities. Sixty-one patients (65.3%) were reached by telephone. Average age was 43.18 years; body mass index, 29.46. "Recommended activities" increased by 33%. High-Activity Arthroplasty Score and University of California at Los Angeles scores were 11.69 and 6.87, respectively. Patients were 98% satisfied with their postoperative function, and 95% would redo the procedure. Activities stopped due to fear of injury (29%), physician recommendation (26%), hip pain (14%), early fatigue (17%), and decreased interest (14%). The average period to postoperative survey administration was 30.06 months (range, 10-81 months). Postoperative recommendations for the young total hip arthroplasty patient should be a balance between joint prosthesis preservation and regular activity participation.

Bilateral knee periprosthetic infection with Mycobacterium fortuitum.

Periprosthetic infections after total joint arthroplasty are infrequent but potentially devastating complications. Gram-positive bacteria is the typical causative organism. However, uncommon sources such as Mycobacterium fortuitum have been documented in the literature. We report a case, the first to our knowledge, of bilateral infections involving this organism after total knee arthroplasty. M. fortuitum is notoriously resistant to many standard antibacterial medications, and a delay in initial diagnosis due to inadequate incubation time has been reported. In poor surgical candidates, long-term antibiotic suppression may be a viable alternative.