Location of Initial Closed Reduction Attempt Significantly Increases Cost and Length of Stay in Total Hip Arthroplasty.

Background: Prosthetic hip dislocation remains one of the most frequent complications following total hip replacement. Dislocations are predominantly managed by a closed reduction in the emergency department (ED) or the operating room (OR). This study aimed to evaluate how the location of an initial closed reduction attempt impacts a patient's course of care including length of stay (LOS) and cost of care. Material and methods: A retrospective chart review was performed on all patients presenting to a single ED with a unilateral prosthetic hip dislocation from 2009 to 2019. A total of 108 patients were identified. Data collected included patient demographics, ED/hospital course, and hospital charges. Results: Seventy-four patients (69%) had initial reduction attempted in the ED (65/74, 88% were successful), while 34 patients (31%) went directly to OR (100% successful with closed reduction). Failed closed reduction in ED or direct to OR resulted in a greater LOS and rate of placement to a skilled nursing facility following discharge. Median hospital charges for successful ED reduction were $6,837, while failed ED closed reduction or direct to OR resulted in median charges of $27,317 and $20,481, respectively. Conclusion: Many patients successfully underwent closed reduction in the ED, and there was no difference in complications, independent of where the reduction was first performed. Patients undergoing reduction in the OR had greater LOS and cost of care, independent of whether a reduction attempt was performed and failed in the ED, than those successfully reduced in the ED.

Early outcomes of shoulder arthroplasty according to sex.

HYPOTHESIS: Among patients undergoing shoulder arthroplasty (SA), female patients would have worse outcomes than their male counterparts. METHODS: A multicenter prospective cohort of 2364 patients (1365 female and 999 male patients) treated with total SA or reverse total SA from 2007 to 2015 was retrospectively analyzed. Results were assessed using several validated outcome measures and range-of-motion testing. A multivariable analysis identified differences in preoperative values, postoperative values, and preoperative-to-postoperative improvements while adjusting for possible confounders. RESULTS: The mean follow-up period was 45.9 ± 23.7 months in female patients and 46.4 ± 23.6 months in male patients. Women underwent SA at a significantly older age (70.8 ± 8.4 years) than men (67.6 ± 8.8 years, P < .01) and began with lower preoperative outcome scores and range-of-motion measurements: American Shoulder and Elbow Surgeons score (P < .01), Constant score (P < .01), Simple Shoulder Test score (P < .01), active abduction (P < .01), forward flexion (P < .01), and external rotation (P = .02). Postoperatively, both groups showed significant improvement. When we evaluated overall improvement from preoperative values, female patients showed increased improvements in the American Shoulder and Elbow Surgeons score (P = .04) and Simple Shoulder Test score (P < .01), as well as active forward elevation (P < .01) and external rotation (P = .02). However, the difference in improvements did not reach the minimal clinically important difference. Women had a higher incidence of component loosening (P = .03) and periprosthetic fractures due to falls (P = .01), whereas men showed a higher incidence of periprosthetic joint infections (P < .01). CONCLUSION: This study found that female patients undergo SA at an older age and begin with worse shoulder range of motion and outcome scores than male patients. Although women experienced a greater improvement postoperatively in outcome scores and range of motion, this improvement did not reach the minimal clinically important difference. These findings suggest that male and female patients can expect similar improvements in function after undergoing SA; however, the incidence of complications may vary depending on sex.

Emergency Department Visit Within One Year Prior to Elective Total Joint Arthroplasty Is Predictive of Postoperative Return to Emergency Department Within 90 Days.

BACKGROUND: The Comprehensive Care for Joint Replacement Model, developed by Centers for Medicare and Medicaid Services, aims to improve the quality of joint replacement. Metrics including emergency room visit rates after primary total knee and total hip arthroplasty (TKA and THA) are of particular interest. The purpose of this study is to determine if preoperative emergency department (ED) visits are predictive of postoperative ED visits among patients undergoing elective THA or TKA. METHODS: In a retrospective analysis of 6996 patients who underwent elective primary arthroplasty (2453 hips, 4543 knees), we identified all patients who had an ED visit from up to 1 year prior to their surgical date to 90 days after. We assessed if preoperative visit frequency or temporality is predictive of a return to the ED visit within 90 days. RESULTS: TKA and THA patients with a single preoperative ED visit had an odds ratio of 1.9 and 2.0, respectively, of returning to the emergency room postoperatively (P < .001). Increasing preoperative visit frequency correlated with increasing odds ratios (1.9-16.7, P < .001). The proximity of the most recent preoperative visit prior to surgery had a positive trend toward a larger effect, but did not clearly demonstrate a dose-dependent effect. CONCLUSION: Presentation to the ED is common prior to total joint arthroplasty and is predictive of a postoperative visit within 90 days. Increasing preoperative visit frequency further increases a patient's risk of a postoperative visit within 90 days.

Cutibacteriumacnes Septic Arthritis of the Nonoperated Knee: A Case Report.

Cutibacterium (Propionibacterium) acnes , a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes , however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of C. acnes septic arthritis.