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1.
Bone Joint J ; 102-B(7_Supple_B): 122-128, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32600203

RESUMEN

AIMS: Earlier studies dealing with trends in the management of osteonecrosis of the femoral head (ONFH) identified an increasing rate of total hip arthroplasties (THAs) and a decreasing rate of joint-preserving procedures between 1992 and 2008. In an effort to assess new trends in the management of this condition, this study evaluated the annual trends of joint-preserving versus arthroplasties for patients aged < or > 50 years old, and the incidence of specific operative management techniques. METHODS: A total of 219,371 patients with ONFH were identified from a nationwide database between 1 January 2009 and 31 December 2015. The mean age was 54 years (18 to 90) and 105,298 (48%) were female. The diagnosis was made using International Classification of Disease, Ninth revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) procedure codes. The percentage of patients managed using each procedure during each year was calculated and compared between years. The trends in the use of the types of procedure were also evaluated. RESULTS: The rate of joint-preserving procedures was significantly higher in patients aged < 50 years compared with those aged > 50 years (4.93% vs 1.52%; p < 0.001). For the overall cohort, rates of arthroplasty were far greater than those for joint-preserving procedures. THA was the most commonly performed procedure (291,114; 94.03%), while osteotomy (3,598; 1.16%), partial arthroplasty (9,171; 2.96%), core decompression (1,200; 0.39%), and bone graft (3,026; 0.98%) were performed markedly less frequently. The annual percentage of patients managed using a THA (93.56% to 89.52%; p < 0.001), resurfacing (1.22% to 0.19%; p < 0.001), and osteotomy (1.31% to 1.05%; p < 0.001) also decreased during the study period. CONCLUSION: We found that patients with ONFH have been most commonly managed with non-joint-preserving procedures. Our findings provide valuable insight into the current management of this condition and should increase efforts being made to save the hip joint. Cite this article: Bone Joint J 2020;102-B(7 Supple B):122-128.

2.
J Knee Surg ; 2020 Jun 19.
Artículo en Inglés | MEDLINE | ID: mdl-32559788

RESUMEN

BACKGROUND: Newer generation cementless total knee arthroplasty (TKA) designs have provided stronger osteointegration between the implant and bone. Despite excellent survivorship and outcomes with cemented TKAs, areas of concern within the bone-cement interface remain a concern and necessitate studies on alternative constructs. This study assesses: (1) implant survivorship; (2) clinical outcomes; and (3) complications with radiographic outcomes at a 5-year minimum follow-up of cementless highly porous titanium-coated baseplates in TKAs. METHODS: Part of this study has been reported. We retrospectively reviewed a prospectively collected database at a single high-volume institution between July 1, 2013 and June 30, 2014 for patients who underwent a primary TKA using cementless highly porous titanium-coated baseplate implants. Patients were evaluated clinically at postoperative follow-up visits at a minimum of 5 years. To calculate the survivorship, Kaplan-Meier analysis was performed to determine all-cause, aseptic, and septic implant survivorship at each final follow-up for all patients. RESULTS: A total of 228 TKAs were performed and followed for a minimum of 5 years (range, 5-6 years). As of the latest follow-up, one case of septic loosening of the patellar button and one case of patellar dislodgment secondary to physical manipulation were recorded and revised. Overall, the cohort displayed implant survivorship of 99.5% at 5-year minimum follow-up. Improvements were seen in both Knee Society pain and function scores and were 37 points (range, 17-60 points) and 28 points (range, 15-47 points), respectively. The mean improvement in flexion was 17.8 (range, -20 to 40 degrees) and mean improvement in extension was -5.5 (range, -30 to 5 degrees). DISCUSSION: Cementless TKAs serve as strong alternative choice to cemented TKAs. Although cemented fixation is commonly known as the gold standard, results of this study confirm the findings of previous investigations on the survivorship of cementless TKA implants. Therefore, patients who undergo primary TKA with a cementless tritanium baseplate can expect excellent clinical outcomes at a 5-year minimum follow-up.

3.
J Arthroplasty ; 2020 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-32561265

RESUMEN

BACKGROUND: Maryland possesses a unique, population-based alternative payment model named Global Budget Revenue (GBR). This study evaluated the effects of GBR on demographics and outcomes for patients who underwent primary total hip arthroplasty (THA) by comparing Maryland to the United States (U.S.). METHODS: We identified primary THA patients in the Maryland State Inpatient Database (n = 35,925) and the National Inpatient Sample (n = 2,155,703) between 2011 and 2016 utilizing International Classification of Diseases 9 and 10 diagnosis codes. Qualitative analysis was used to report trends. Multiple regressions were used for difference-in-difference (DID) analyses to compare Maryland to the U.S. between pre-GBR (2011-2013) and post-GBR (2014-2016) periods. RESULTS: After GBR implementation, there were proportionally more patients who were obese (Maryland: +5.1% vs U.S.: +3.0%), used Medicare (+1.6% vs +0.7%), used Medicaid (+2.4% vs +1.3%) while less used private insurance (-4.2% vs -1.8%) (all P < .001). There were proportionally less home health care patients in Maryland, but more in the U.S. (-3.5% vs +1.6%; both P < .001). The mean costs decreased for both cohorts (-$1780.80 vs -$209.40; both P < .001). The DID found Maryland saw more Medicaid and less private insurance patients under GBR (both P ≤ .001). Maryland saw more obese patients than would be expected (P = .001). The DID also found decreased costs for patients under GBR (P < .001 for both). CONCLUSION: Maryland has benefitted from GBR with decreased cost and an increase in Medicaid patients. Maryland may provide a viable model for future healthcare policies that incorporate global budgets.

4.
Surg Technol Int ; 372020 Jun 10.
Artículo en Inglés | MEDLINE | ID: mdl-32580234

RESUMEN

INTRODUCTION: Unicompartmental knee arthroplasty (UKA) is a feasible alternative to total knee arthroplasty (TKA) for selected patients with severe single-compartment knee osteoarthritis. Robotic-assisted UKA (rUKA) has recently emerged as a complementary tool to ameliorate previous difficulties with manual UKA (mUKA). However, the influence of rUKA compared to mUKA on patient outcomes are still largely unknown. PURPOSE: To compare outcomes of the manual technique and a single robotic-assisted system in patients undergoing unicompartmental knee arthroplasty. MATERIALS AND METHODS: The PubMed-Medline was searched using terms: "robotic," "unicompartmental," "knee," and "arthroplasty" to identify all studies comparing outcomes of mUKA and rUKA. Data pertaining to the following outcomes were extracted: (1) studies comparing robotic-assisted UKA to manual UKA; (2) reports which only included the Mako UKA system (Mako Surgical Corporation, Fort Lauderdale, Florida) as the robotic-assisted system; and (3) studies which discussed implant survivorship, complications, early postoperative parameters, functional outcomes, or implant positioning. Review articles were excluded. RESULTS: A total of eight publications with 337 patients who underwent rUKA and 481 who underwent mUKA were included in our analysis. Two studies reported that early postoperative pain was decreased with rUKA compared to mUKA. In one study, pain levels in the first eight postoperative weeks were 54% lower in the rUKA group and in the other, pain scores based on the numeric rating scale were significantly lower in rUKA (2.5) compared to mUKA (4.2) upon discharge (p<0.001). Furthermore, mean time to hospital discharge in this study was reduced with rUKA (42.5 ± 5.9 hours) compared to mUKA (71.1 ± 14.6 hours) (p<0.001). One study demonstrated a significant improvement in range of motion at two-year follow up in the rUKA group (15°, range, 5° to 25°) compared to the mUKA group (10°, range 0° to 20°; p=0.04). One study reported that at three-month follow up, mean Knee Society scores were significantly better in the rUKA group (164; interquartile range [IQR] 131 to 178) compared the mUKA group (143; IQR 132 to 166; p=0.04). Three studies reported more accurate implant positioning with rUKA compared to mUKA. Among the five studies that reported implant survivorship, four studies (including a randomized control trial) found no difference between techniques in implant survival rate, while one retrospective analysis reported improved survivorship with mUKA. CONCLUSIONS: In conclusion, unicompartmental knee arthroplasty implants demonstrated comparable survivorship rates whether performed manually or with robotic assistance. However, compared to the manually performed procedure, robotic-assisted unicompartmental knee arthroplasty were found to offer benefits including shorter lengths of hospital stays, decreased postoperative pain scores, and improved functional outcomes.

5.
Bone Joint J ; 102-B(6): 683-692, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475239

RESUMEN

AIMS: Thresholds for operative eligibility based on body mass index (BMI) alone may restrict patient access to the benefits of arthroplasty. The purpose of this study was to evaluate the relationship between BMI and improvements in patient-reported outcome measures (PROMs), and to determine how many patients would have been denied improvements in PROMs if BMI cut-offs were to be implemented. METHODS: A prospective cohort of 3,449 primary total hip arthroplasties (THAs) performed between 2015 and 2018 were analyzed. The following one-year PROMs were evaluated: hip injury and osteoarthritis outcome score (HOOS) pain, HOOS Physical Function Shortform (PS), University of California, Los Angeles (UCLA) activity, Veterans Rand-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (VR-12 MCS). Positive predictive values for failure to improve and the number of patients denied surgery in order to avoid a failed improvement were calculated for each PROM at different BMI cut-offs. RESULTS: There was a trend to improved outcomes in terms of pain and function improvements with higher BMI. Patients with BMI ≥ 40 kg/m2 had median (Q1, Q3) HOOS pain improvements of 58 points (interquartile range (IQR) 41 to 70) and those with BMI 35 to 40 kg/m2 had median improvements of 55 (IQR 40 to 68). With a BMI cut-off of 30 kg/m2, 21 patients would have been denied a meaningful improvement in HOOS pain score in order to avoid one failed improvement. At a 35 kg/m2 cut-off, 18 patients would be denied improvement, at a 40 kg/m2 cut-off 21 patients would be denied improvement, and at a 45 kg/m2 cut-off 21 patients would be denied improvement. Similar findings were observed for HOOS-PS, UCLA, and VR-12 scores. CONCLUSION: Patients with higher BMIs show greater improvements in PROMs. Using BMI alone to determine eligibility criteria did not improve the rate of clinically meaningful improvements. BMI thresholds prevent patients who may benefit the most from surgery from undergoing THA. Surgeons should consider PROMs improvements in determining eligibility for THA while balancing traditional metrics of preoperative risk stratification. Cite this article: Bone Joint J 2020;102-B(6):683-692.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Índice de Masa Corporal , Medición de Resultados Informados por el Paciente , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Estudios Prospectivos , Resultado del Tratamiento
6.
J Knee Surg ; 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32483801

RESUMEN

Because of the early follow-up positive outcomes with cementless fixation, continued evaluations need to be performed to ensure longer-term efficacy. Additionally, although many studies report on the results of femoral and tibial component fixation, few studies report specifically on patellar outcomes. Therefore, the purpose of this study was to report on the: (1) implant survivorship; (2) complications; and (3) radiographic outcomes in a large cohort of patients who received cementless total knee arthroplasties (TKAs), with particular attention to the patellar component. A total of 261 patients who underwent cementless TKA by a single, high-volume academic surgeon were studied. Patients had a mean age of 66 years and were distributed between 192 women (74%) and 69 men. All patients received the same cementless tibial, femoral, and patellar components. Mean follow-up period was 4.5 years (range, 4-5 years). Primary outcomes evaluated included all postoperative complications, with particular emphasis on the patellar component. Only one patellar loosened leading to a patellar aseptic loosening rate of 0.3% (1 of 261). The one patellar loosening was the component being dislodged after a manipulation under anesthesia (MUA) at 6 weeks. This was revised to a cemented component and the patient is doing well 4 years later. A second patient experienced a patellar tendon rupture, later surgically repaired. Another patient sustained a patella fracture that was managed nonoperatively. The fracture healed by 1 year and the patient continued to have an otherwise successful outcome, now at 2 years follow-up. No progressive radiolucencies, subsidence, or changes in initial postoperative axial alignment were observed at final follow-up. The results from this study highlight a 98% success rate at mean 4.5 years follow-up in a large cohort of patients with a diverse spread of demographic details. Specific to the patella, only one patient experienced an adverse event, which was managed nonoperatively. Therefore, based on this data, patellar fixation in cementless TKA can be considered a safe technique.

7.
J Knee Surg ; 2020 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-32462645

RESUMEN

Large-scale studies evaluating the effects of Parkinson's disease (PD) on primary total knee arthroplasty (TKA) are limited. The purpose of this study was to determine if PD patients undergoing primary TKA have increased: (1) medical complications; (2) implant-related complications; (3) readmission rates; and (4) costs. A query was performed using an administrative claims database. The study group consisted of all patients undergoing primary TKA who had a history of PD. Matched non-PD patients undergoing primary TKA served as a control group. The query yielded 72,326 patients (PD = 18,082; matching cohort = 54,244). Pearson's chi-square tests, logistic regression analyses, and Welch's t-tests were used to test for significance between the cohorts. Primary TKA patients who had PD were found to have greater incidences and odds of medical complications (4.21 vs. 1.24%; odds ratio [OR]: 3.50, 95% confidence interval [CI]: 3.15-3.89, p < 0.0001) and implant-related complications (5.09 vs. 3.15%; OR: 1.64, 95% CI: 1.51-1.79, p < 0.0001) compared with the matching cohort. Additionally, the rates and odds of 90-day readmission were higher (16.29 vs. 12.66%; OR:1.34, p < 0.0001) and episodes of care costs were significantly greater ($17,105.43 vs. $15,252.34, p < 0.0001) in patients who had PD. Results demonstrate that PD patients undergoing primary TKA had higher incidences of medical and implant-related complications. They also had increased 90-day readmission rates and costs compared with controls. The findings of this study should be used in risk stratification and should inform physician-patient discussion but should not be arbitrarily used to deny access to care.

8.
Surg Technol Int ; 36: 379-387, 2020 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-32359168

RESUMEN

Dual mobility constructs have become an increasingly popular option for primary and revision total hip arthroplasty. Two monoblock implants and three modular implants are available for use in the United States. Although short- and mid-term outcome data have been positive overall for these systems, each construct has unique features that the orthopaedic surgeon might consider when selecting the appropriate implant for his or her patient. In this review article, we discuss the design specifications and published literature for each dual mobility system and organize this information into a concise resource that can be easily referenced during preoperative planning.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Humanos , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estados Unidos
10.
J Arthroplasty ; 2020 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-32349891

RESUMEN

BACKGROUND: There is discordance in the literature regarding the presence of chronic obstructive pulmonary disease (COPD) and the development of venous thromboemboli (VTEs). Therefore, the purpose of this study is to determine whether COPD patients undergoing primary total knee arthroplasty (TKA) have higher rates of (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) VTEs; and (4) costs of care. METHODS: COPD patients undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, gender, and medical comorbidities. Patients with a history of VTEs or hypercoagulable states were excluded. The query yielded 211,378 patients in the study (n = 35,230) and control (n = 176,148) cohorts. Outcomes analyzed included in-hospital LOS, readmission rates, VTEs, and costs of care. A P-value less than .01 was considered statistically significant. RESULTS: COPD patients were found to have significantly longer in-hospital LOS (4 vs 3 days, P < .0001). Study group patients were also found to have significantly higher incidence and odds ratio (OR) of readmission rates (20.9% vs 16.3%; OR 1.36, P < .0001) and VTEs (1.75 vs .93; OR 1.18, P < .0001). Additionally, the study demonstrated that COPD patients incurred higher 90-day episode-of-care costs ($15,626.85 vs $14,471.29, P < .0001). CONCLUSION: After adjusting for confounding variables, our study found an association between COPD and higher rates of developing VTEs following primary TKA. The study can be used by orthopedic surgeons to adequately counsel and educate these patients of the potential complications which may arise following their TKA.

11.
J Knee Surg ; 2020 May 05.
Artículo en Inglés | MEDLINE | ID: mdl-32369838

RESUMEN

In 2014, Maryland implemented the Global Budget Revenue (GBR) model for cost reduction and quality improvement. This study evaluated GBR's effect on demographics and outcomes for patients who underwent primary total knee arthroplasty (TKA) by comparing Maryland to the United States (U.S.). We identified primary TKA patients in Maryland's State Inpatient Database (n = 71,022) and the National Inpatient Sample (n = 4,045,245) between 2011 and 2016 utilizing International Classification of Disease (ICD)-9 and ICD-10 diagnosis codes. Multiple regression was used for difference-in-difference (DID) analyses to compare the intervention cohort (Maryland) to the nonintervention cohort (U.S.) between the pre-GBR (2011-2013) and post-GBR (2014-2016) periods. After GBR implementation, there were proportionally less white, obese, morbidly obese, Medicare, and Medicaid patients with proportionally more routine discharge patients in Maryland and the U.S. (all p < 0.001). There were proportionally less home health care (HHC) patients in Maryland, but more in the U.S. (both p < 0.001). The mean lengths of stay (LOS), costs, and complications decreased for both cohorts, while charges increased for the U.S. (all p < 0.001). The DID analysis suggested Maryland saw more Asian and Medicaid patients and less obese and morbidly obese patients under GBR. The DID assessments also found decreased LOS, costs, and charges (p < 0.001 for all) for patients under GBR. As other states such as Pennsylvania and Vermont explore hospital budgets, Maryland may provide a more viable model for future health care policies that incorporate global budgets.

12.
J Knee Surg ; 2020 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-32268402

RESUMEN

A greater number of medically complex patients with multiple comorbidities are now more readily considered for total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine whether comorbidity burden, measured with the Elixhauser Comorbidity Index (ECI), correlated with 90-day medical complications and longer in-hospital lengths-of-stay (LOS) in TKA patients. The PearlDiver supercomputer was queried for all primary TKA patients in the Medicare Standard Analytic Files from 2005 to 2014 using International Classification of Disease, 9th edition codes. Patients were included based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort was matched based on age and gender to the control cohort, resulting in a total of 715,398 patients included for analysis (ECI 1, n = 144,072; ECI 2, n = 144,072; ECI 3, n = 144,072; ECI 4, n = 144,072; ECI 5, n = 139,110). Logistic regression analyses were performed to compare 90-day medical complications and Welch's t-tests were performed to compare LOS between the cohorts. Patients with higher ECI scores were more likely to develop medical complications and have longer LOS compared with matched patients in the control cohort. Compared with matched ECI 1 patients, patients with ECI scores of 2 (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.14-1.24), 3 (OR: 1.27, 95% CI: 1.21-1.32), 4 (OR: 1.32, 95% CI: 1.27-1.38), and 5 (OR: 1.33, 95% CI: 1.27-1.39) were significantly more likely to develop 90-day medical complications. Additionally, the mean LOS of patients in the ECI 2 (2.59 ± 1.49 vs. 2.73 ± 1.52 days), ECI 3 (2.59 ± 1.49 vs. 2.88 ± 1.51 days; p < 0.001), ECI 4 (2.59 ± 1.49 vs. 3.01 ± 1.56 days; p < 0.001), and ECI 5 (2.61 ± 1.49 vs. 3.14 ± 1.61 days; p < 0.001) groups were significantly longer than the mean LOS in the control ECI 1 group. In an increasingly complex patient population, associations between comorbidities and outcomes after TKA procedures can guide providers on how to modify their pre- and postoperative care. These results demonstrate that higher ECI scores are associated with a greater likelihood of 90-day medical complications and longer in-hospital LOS.

13.
J Knee Surg ; 2020 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-32268407

RESUMEN

This review investigated the potential value of computed tomography (CT) scans for the evaluation and management of knee arthritis and arthroplasty. Specifically, we evaluated the following: (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. To compare if CT or X-ray imaging is more accurate and clinically relevant, a search was performed using Boolean search operators and terms: "CT," "radiograph," "joint alignment," "knee," and "arthroplasty," which yielded 661 results. Studies were evaluated based on (1) assessment of arthritis within knee compartments, (2) patellofemoral joint assessment, (3) implant sizing prediction, (4) component alignment, (5) soft-tissue protection, and (6) potential concerns with radiation exposure. Correlative and comparative analyses of imaging modalities to pre-, intra-, and postoperative clinical and patient-related factors were performed for the 63 included studies. CT scans were found to better detect medial and lateral arthritic changes, bony deformities, subchondral cysts, and cartilage losses. CT scans were shown to 99% accurately predict prosthetic sizes preoperatively. CT scans can also help better visualize surrounding anatomy, such as the posterior cruciate ligament, and have therefore been linked to better soft tissue protection during total knee arthroplasty. Although radiation is a potential concern, newer imaging protocols have comparable exposure to plain radiographs. Compared with plain radiographs, CT scans were found to be more accurate and provide more clinically relevant data. Therefore, the authors recommend the use of CT for the evaluation of certain patients with arthritis and for preoperative planning for knee arthroplasty.

15.
Surg Technol Int ; 36: 323-330, 2020 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-32294224

RESUMEN

Manual total knee arthroplasty (TKA) has successfully treated end-stage knee osteoarthritis for several years. However, recent technological advancements have enabled surgeons to perform TKA with more accuracy and precision. Aligning the femoral and tibial components perpendicular to the mechanical axes of the femur and tibia is a fundamental principle for restoring knee kinematics and soft-tissue balance. Computer-assisted robotic TKA has proven its ability to fine tune lower leg alignment, component position, and soft-tissue balancing. Furthermore, robotic-assisted TKA (RATKA) offers the additional benefit of improving soft-tissue protection compared to manual techniques. Numerous systems have been developed in the advancement of technology in computer processing, and the number of robotic surgical systems is increasing as well. The three main categories of navigation systems can be classified as: image-based console navigation, imageless console navigation, and accelerometer-based handheld navigation systems. The purpose of this review was to describe emerging technologies for TKA. Specifically, we outline the available literature pertaining to each system with regards to their: (1) accuracy and precision of component alignment; (2) soft-tissue protection; (3) postoperative outcomes; and (4) other reported outcomes such as costs.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cirugía Asistida por Computador , Fémur , Humanos , Articulación de la Rodilla , Osteoartritis de la Rodilla , Tibia
17.
J Knee Surg ; 2020 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-32330974

RESUMEN

Periprosthetic joint infections (PJIs) following total knee arthroplasty (TKA) are serious orthopaedic complications that pose marked burdens to both patients and health care systems. At our institution, two-stage exchange with a temporary short antibiotic cement-coated intramedullary nail was utilized for the treatment of repeat PJIs in a series of compromised patients with considerable bone loss. This study reports on (1) success rates, (2) functional and pain outcomes, (3) and complications for patients receiving a temporary short intramedullary nail for the treatment of PJI. Our institutional database was queried for all repeat knee PJI patients between March 1st, 2009 and February 28th, 2015. Patients with type II/III Anderson Orthopaedic Research Institute (AORI) bone defects who underwent two-stage exchange arthroplasty with a short antibiotic-coated intramedullary nail were included for analysis (n = 31). Treatment success was determined using the Delphi-based consensus definition of a successfully treated PJI: infection eradication (healed wound with no recurrence of infection by the same organism), no further surgical intervention for infection after reimplantation, and no PJI-related mortality. A paired t-test was performed to assess for continuous variables. A total of 26 patients went on to reimplantation, while 5 patients retained the intramedullary nail. Overall treatment success was 74.2%. Range of motion significantly decreased postoperatively (102.1 vs. 87.3 degrees; p < 0.001), while Knee Society Scores (function) significantly increased (55.6 vs. 77.7, p < 0.001). A majority of patients were full weight-bearing immediately following surgery (38.7%). Treating poor health status patients with PJI of the knee can be difficult after multiple revisions. With a success rate similar to conventional methods, our results demonstrate that two-stage exchange with a temporary short intramedullary nail may be a desirable treatment option for patients with bony defects wishing to avoid amputation or permanent arthrodesis. However, this method does not outperform other treatment modalities, and may not be suitable for all patients. Patient expectations and health status should be carefully assessed to determine if this procedure is appropriate in this complex patient population.

18.
Clin Spine Surg ; 2020 Apr 24.
Artículo en Inglés | MEDLINE | ID: mdl-32341326

RESUMEN

STUDY DESIGN: Level III-retrospective review. OBJECTIVE: To evaluate the impact of hypothyroidism in patients undergoing 1- to 2-level lumbar fusion (1-2LF). SUMMARY OF BACKGROUND DATA: Hypothyroidism is a common cause of morbidity and mortality following surgery. Studies have demonstrated the effects of hypothyroidism following orthopedic surgery, but not 1-2LF. MATERIALS AND METHODS: Patients undergoing 1-2LF with hypothyroidism were identified within the Medicare population, and served as the study group. Study group patients were randomly matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. Primary outcomes analyzed included in-hospital lengths of stay (LOS), 90-day readmission rates, 90-day medical complications, and costs of care. Pearson χ tests were used to compare patient demographics. Logistic regression analyses were used to calculate odds ratios (OR) for medical complications and readmissions. Welch t test was used to test for significance in cost between the cohorts. An α value <0.002 was considered statistically significant. RESULTS: The query yielded 417,483 patients who underwent 1-2LF with (n=69,584) and without (n=347,899) hypothyroidism. Hypothyroid patients had significantly longer in-hospital LOS (8 vs. 4 d; P<0.0001) compared with controls. In addition, study group patients had significantly higher incidence and odds of 90-day readmissions (20.22% vs. 17.62%; OR, 1.18; P<0.0001) and 90-day medical complications (6.38% vs. 1.89%; OR, 3.53; P<0.0001) compared with controls. Study group patients had higher day of surgery costs ($97,304.01 vs. $95,168.35; P=0.014) and 90-day costs of care ($113,514.15 vs. $108,860.60; P=0.0001) compared with controls. CONCLUSIONS: After adjusting for age, sex, and medical comorbidities, the study demonstrates patients who have hypothyroidism have longer in-hospital LOS and higher rates of readmissions, complications, and costs. The study is vital as it can allow orthopedic surgeons to adequately counsel and educate these patients of the potential complications that may occur following their procedure.

20.
J Knee Surg ; 2020 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-32259851

RESUMEN

The number of total knee arthroplasties (TKAs) performed in the United States has increased considerably in recent years, with a major contribution from younger patients. Maximizing survivorship of these implants has always been a point of emphasis. Early TKA designs with cementless fixation were associated with high rates of complications and implant failures. However, recent advances in cementless designs have shown excellent results. The decision to use cemented or cementless fixation for patients undergoing TKA is typically based on the surgeon's experience and preference. However, several patient characteristics must also be taken into account. The purpose of this review was to describe the clinical outcomes of studies in which a cementless TKA system was utilized for patients who (1) were less than 60 years of age, (2) were greater than 75 years of age, (3) were obese, (4) had rheumatoid arthritis, and (5) had osteonecrosis of the knee. Based on the studies included in this review, it appears that cementless fixation is a viable option for patients who have all of the above demographics.

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