Predicting patient discharge disposition after total joint arthroplasty in the United States.

The purpose of this study was to develop an easily administered tool to preoperatively predict patient discharge disposition after total joint arthroplasty in the United States. Data were collected in a retrospective review of 517 medical charts and analyzed using logistic regression to develop a model for predicting the likelihood that a patient will not be discharged directly home. The resulting regression model was the basis for the nomogram, named the Predicting Location after Arthroplasty Nomogram. This model demonstrated a bootstrap-corrected concordance index of 0.867, excellent calibration, and external validation as demonstrated by a concordance index of 0.861. Preoperative knowledge that a patient is likely to require an extended care facility allows the clinical care team to make appropriate arrangements and avoid potential delays in patient discharge.

Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks.

PURPOSE: The purpose of this study was to evaluate the clinical results of bioabsorbable tacks (Suretac; Smith & Nephew Endoscopy, Mansfield, MA) for the arthroscopic repair of full-thickness rotator cuff tears. TYPE OF STUDY: Prospective case series. METHODS: A prospective clinical review was performed on 53 patients (38 men, 15 women) with full-thickness rotator cuff tears repaired arthroscopically using bioabsorbable tacks. Minimum follow-up was 24 months and patients were evaluated using preoperative and postoperative American Shoulder and Elbow Society (ASES) scores and Short-Form 36 Health Surveys (SF-36). A Constant and Murley score was performed at a minimum of 2 years postoperatively. RESULTS: The average patient age was 51 years (range, 23 to 74 years) and the average time for review was 29 months (range, 24 to 60 months). The average size of rotator cuff tears measured 2.5 cm (range, 1 to 5 cm) and an average of 2 Suretacs (range, 1 to 4) were used for the repair. Ten patients had tears larger than 3 cm and 5 patients had tears that measured 5 cm or larger. The average total score according to the ASES shoulder index improved from 33 to 85 points. The average score for pain improved from 6.9 to 1.3 points. The score for function improved from 11 to 25 points. These results were statistically significant (P < 0.01). There was a significant improvement in all components of the SF-36 survey. The average postoperative Constant score was 87 with the pain component measuring 12 points, range of movement 38 points, and power 21 points. CONCLUSIONS: Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks produces satisfactory outcomes with regard to objective orthopaedic criteria as well as overall patient satisfaction in terms of pain relief and function. Arthroscopic rotator cuff repairs are technically demanding procedures. The use of tacks facilitates this procedure without any apparent deterioration in clinical results. LEVEL OF EVIDENCE: Level IV, case series.