Evaluating the Appropriateness of Podcasts to Improve the Knowledge and Awareness of Selected Health Topics Among Undergraduate General Nursing Students: Protocol for an International Feasibility Study.

BACKGROUND: Podcasts have proven to be a successful alternative source of educational material for students. Given the ability to listen to podcasts 24/7 and while on the go, this technology has the potential to provide informative and educational material to a large number of people at any given time. Podcasts are usually freely available on commonly used mobile devices, such as smartphones, laptops, and tablets. OBJECTIVE: This paper describes the impact of health-related podcasts as an intervention tool to support the knowledge and awareness of nursing students on a given topic. METHODS: Pre- and postpodcast questionnaires will gather data regarding the participants' knowledge and awareness of two topics-gestational diabetes and mental health. This intervention will be tested on general nursing undergraduate students. The total number of students (N=2395) from the participating universities are broken down as follows: (1) University College Cork (n=850) and the University of Galway (n=450) in Ireland, (2) Mzuzu University in Malawi (n=719), and (3) University of Fort Hare in South Africa (n=376). RESULTS: The study received ethical approval from the University College Cork Ethics Committee (2022-027A1). The approval obtained from University College Cork sufficed as ethics coverage for the University of Galway in Ireland. Ethics approval was also received from the Mzuzu University Research Ethics Committee (ID MZUNIREC/DOR/23/28) and the Inter-Faculty Research Ethics Committee of the University of Fort Hare (ID CIL002-21). Data collection is currently underway and will continue until the end of February 2024. The quantitative and qualitative data are expected to be analyzed in March 2024. CONCLUSIONS: Results from this study will allow for an investigation into the impact of podcasts in different settings: a high-income country (Ireland), an upper-middle-income country (South Africa), and a low-to-middle-income country (Malawi). The data gathered from this feasibility study will provide more clarity on the potential utility of podcasts as an intervention tool. We will gather data regarding listener demographics (eg, country of residence, age, gender, and year of study). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/50735.

Anterior capsulectomy versus repair in direct anterior total hip arthroplasty.

BACKGROUND: Utilization of the direct anterior approach for total hip arthroplasty (DAA THA) has increased over the last ten years. The preservation and repair of the anterior hip capsule has been recommended, while anterior capsulectomy has been described by others. In contrast, the higher risk of posterior dislocation using the posterior approach improved significantly after capsular repair. No studies to date have investigated outcome scores based on capsular repair versus capsulectomy for the DAA. METHODS: Patients randomized to anterior capsulectomy or anterior capsule repair. Patients were blinded to their randomization. Maximum hip flexion was measured both radiographically and clinically with a goniometer. Using a one-sided t test assuming equal variance with an effect size, Cohen's d, of 0.6 and an alpha of 0.05, 36 patients in each group (total 72 patients) needed for a minimum 80% power. RESULTS: Median goniometer measurements preoperatively were 95° for repair (IQR 85-100) and 91° for capsulectomy (IQR 82-97.5) (p = 0.52). Four-month and one-year goniometer measurements also had no significant difference, 110° (IQR 105-120) and 110° (IQR 105-120) for repair and 105° (IQR 96-116) and 109° (IQR 102-120) for capsulectomy (p = 0.38 and p = 0.26). Median change in flexion as measured by goniometer at 4 months and one year was 12 and 9 degrees for repair and 9.5 and 3 degrees for capsulectomy (p = 0.53 and p = 0.46). X-ray analysis showed no differences in pre-op, 4-month, and one-year flexion with median one-year flexion of 105.5° (IQR 96-109.5) for repair and 100° (IQR 93.5-112) for capsulectomy (p = 0.35). VAS scores were the same for both groups at all three time points. HOOS scores improved equally for both groups. There are no differences in surgeon randomization, age, or gender. CONCLUSIONS: Both capsular repair and capsulectomy used in direct anterior approach THA result in equal maximum clinical as well as radiographic hip flexion with no change in postoperative pain or HOOS scores.

Does Treatment at a Specialized Prosthetic Joint Infection Center Improve the Rate of Reimplantation.

BACKGROUND: Two-stage exchange arthroplasty is currently the preferred treatment method for periprosthetic joint infection (PJI). The effectiveness of this strategy in returning patients to premorbid function has recently been challenged. In a review of 18,535 PJI knee patients, 38% did not undergo reimplantation. In another review of 18,156 hip and knee PJI patients, 43% did not undergo reimplantation. These disturbing statistics led us to ask whether treatment at a specialized PJI center could improve the rate of reimplantation compared to the previously noted studies from large national administrative databases. METHODS: A retrospective review of our registry was performed to identify 390 patients who underwent a two-stage exchange after total knee arthroplasty and total hip arthroplasty who had a confirmed chronic bacterial PJI, defined by Musculoskeletal Infection Society criteria, from January 2010 through December 2019. Variables included number of joints resected, number reimplanted, and the number not reimplanted. RESULTS: Of the 390 patients undergoing 2-stage treatment, 386 of 390 (99%) were reimplanted and 4 of 390 (1%) were not reimplanted due to medical issues. CONCLUSION: We have shown that 2-stage treatment at a PJI center significantly improves the rate of reimplantation. A specialized PJI center with experienced revision surgeons doing high volume infection procedures complemented by infectious disease and medical consultants familiar with the special needs of PJI patients may be advantageous. A national network of such centers may have the ability to improve outcomes, standardize treatment protocols, and allow for collaborative research.

High Rate of Intramedullary Canal Culture Positivity in Total Knee Arthroplasty Resection for Prosthetic Joint Infection.

BACKGROUND: Periprosthetic infection is a devastating complication following total knee arthroplasty. A 2-stage protocol often includes an interim antibiotic spacer with intramedullary (IM) dowels. However, the necessity of IM dowels has recently been challenged. Specifically, the data supporting bacterial colonization of the IM canal are limited and controversial. The purpose of this study was to identify the rate of positive IM cultures during resection arthroplasty in periprosthetic knee infection. METHODS: A total of 66 IM diaphyseal cultures were taken during resection arthroplasty from 34 patients diagnosed with periprosthetic knee infection. These IM cultures were taken from the femoral and tibial canals using separate sterile instruments. All patients had infected primary total knee arthroplasty implants at the time of resection. RESULTS: Thirty one percent (n = 21) of IM canal cultures in this study were positive from either the tibial or the femoral diaphysis at the time of resection arthroplasty. There were 18 of 21 (86%) of the positive IM canal cultures with concordant intraoperative joint cultures where the IM cultures matched the intraarticular cultures. CONCLUSION: With a 31% positive IM canal culture rate, this study confirms the logic of using IM dowels with an antibiotic spacer to treat periprosthetic knee infection. Since the failure of a 2-stage reimplantation is catastrophic, any attempt to provide additional local antibiotic delivery seems warranted. Since nearly one-third of our patients had positive IM cultures, this simple addition to an antibiotic spacer has the potential to improve 2-stage results. Claims supporting the elimination of IM dowels during resection arthroplasty seem ill-advised.

Efficacy evaluation of novel organic iron complexes in laying hens: effects on laying performance, egg quality, egg iron content, and blood biochemical parameters.

OBJECTIVE: This study was conducted to determine the optimal dose of novel iron amino acid complexes (Fe-Lys-Glu) by measuring laying performance, egg quality, egg iron (Fe) concentrations, and blood biochemical parameters in laying hens. METHODS: A total of 1,260 18-week-old healthy Beijing White laying hens were randomly divided into 7 groups with 12 replicates of 15 birds each. After a 2-wk acclimation to the basal diet, hens were fed diets supplemented with 0 (negative control, the analyzed innate iron content was 75.06 mg/kg), 15, 30, 45, 60, and 75 mg Fe/kg as Fe-Lys-Glu or 45 mg Fe/kg from FeSO4 (positive control) for 24 wk. RESULTS: Results showed that compared with the negative and positive control groups, dietary supplementation with 30 to 75 mg Fe/kg from Fe-Lys-Glu significantly (linear and quadratic, p<0.05) increased the laying rate (LR) and average daily egg weight (ADEW); hens administered 45 to 75 mg Fe/kg as Fe-Lys-Glu showed a remarkable (linear, p<0.05) decrease in feed conversion ratio. There were no significant differences among all groups in egg quality. The iron concentrations in egg yolk and serum were elevated by increasing Fe-Lys-Glu levels, and the highest iron content was found in 75 mg Fe/kg group. In addition, hens fed 45 mg Fe/kg from Fe-Lys-Glu had (linear and quadratic, p<0.05) higher yolk Fe contents than that with the same dosage of FeSO4 supplementation. The red blood cell (RBC) count and hemoglobin content (linear and quadratic, p<0.05) increased obviously in the groups fed with 30 to 75 mg Fe/kg as Fe-Lys-Glu in comparison with the control group. Fe-Lys-Glu supplementation also (linear and quadratic, p<0.05) enhanced the activity of copper/zinc-superoxide dismutase (Cu/Zn-SOD) in serum, as a result, the serum malonaldehyde content (linear and quadratic, p<0.05) decreased in hens received 60 to 75 mg Fe/kg as Fe-Lys-Glu. CONCLUSION: Supplementation Fe-Lys-Glu in laying hens could substitute for FeSO4 and the optimal additive levels of Fe-Lys-Glu are 45 mg Fe/kg in layers diets based on the quadratic regression analysis of LR, ADEW, RBC, and Cu/Zn-SOD.

Genotoxicity evaluation of magnesium salts of isobutyrate and 2-methylbutyrate.

Results of genotoxicity studies for magnesium salts of isobutyrate and 2-methylbutyrate, two candidate ingredients for inclusion in animal feed, are described in this manuscript. Both substances were tested for mutagenicity in a bacterial reverse mutation assay and clastogenicity/aneugenicity in an in vitro micronucleus study in human lymphocytes, conducted according to Organisation for Economic Co-operation and Development (OECD) Guidelines. The substances were tested up to the limits of solubility in the tests. The results showed that that magnesium salts of isobutyrate and 2-methylbutyrate are not mutagenic, clastogenic or aneugenic. The tests were valid, as the negative and positive controls produced expected responses.

Results of debridement, antibiotics, and implant retention for periprosthetic knee joint infection supplemented with the use of intraosseous antibiotics.

AIMS: Debridement, antibiotics, and implant retention (DAIR) remains one option for the treatment of acute periprosthetic joint infection (PJI) despite imperfect success rates. Intraosseous (IO) administration of vancomycin results in significantly increased local bone and tissue concentrations compared to systemic antibiotics alone. The purpose of this study was to evaluate if the addition of a single dose of IO regional antibiotics to our protocol at the time of DAIR would improve outcomes. METHODS: A retrospective case series of 35 PJI TKA patients, with a median age of 67 years (interquartile range (IQR) 61 to 75), who underwent DAIR combined with IO vancomycin (500 mg), was performed with minimum 12 months' follow-up. A total of 26 patients with primary implants were treated for acute perioperative or acute haematogenous infections. Additionally, nine patients were treated for chronic infections with components that were considered unresectable. Primary outcome was defined by no reoperations for infection, nor clinical signs or symptoms of PJI. RESULTS: Mean follow-up for acute infection was 16.5 months (12.1 to 24.2) and 15.8 months (12 to 24.8) for chronic infections with unresectable components. Overall non-recurrence rates for acute infection was 92.3% (24/26) but only 44.4% (4/9) for chronic infections with unresectable components. The majority of patients remained on suppressive oral antibiotics. Musculoskeletal Infection Society (MSIS) host grade was a significant indicator of failure (p < 0.001). CONCLUSION: The addition of IO vancomycin at the time of DAIR was shown to be safe with improved results compared to current literature using standard DAIR without IO antibiotic administration. Use of this technique in chronic infections should be applied with caution. While these results are encouraging, this technique requires longer follow-up before widespread adoption. Cite this article: Bone Joint J 2021;103-B(6 Supple A):185-190.

One-stage Treatment of Prosthetic Joint Infection.

Management of prosthetic joint infection in hip and knee arthroplasty patients is traditionally undertaken with a two-stage treatment protocol. However, this strategy carries high morbidity and cost, yet a substantial portion of patients sustain reinfection. One-stage treatment protocols have been popularized in Europe and other parts of the world but remain infrequently performed in the United States, despite equivocal efficacy with two-stage treatment based on currently available data. Herein, we describe a current one-stage treatment protocol used as part of a multicenter randomized clinical trial in the United States. Furthermore, a case example is presented of a patient with prosthetic joint infection of the hip, successfully treated with a one-stage protocol including details on revising the hip through a direct anterior approach with use of an anterior cortical window osteotomy for removal of a well-fixed femoral component. (Journal of Surgical Orthopaedic Advances 30(4):216-219, 2021).

No difference in patient compliance between full-strength versus low-dose aspirin for VTE prophylaxis following total hip and total knee replacement.

INTRODUCTION: The utilization of aspirin for VTE prophylaxis following TJA has increased due to updated clinical practice guidelines. Aspirin is the only approved VTE prophylaxis medication that does not require a prescription, but adherence and tolerance remain unknown. We hypothesized decreased patient compliance utilizing full-strength 325 mg aspirin twice daily following TJA when compared to low-dose 81 mg twice daily. We also investigated the reasons why patients may elect to stop the medication earlier than 28 days. METHODS: A consecutive series of patients undergoing primary total hip or knee arthroplasty utilizing 325 or 81 mg of EC aspirin twice daily for 4 weeks were surveyed to determine compliance with use and any adverse events related to the medication. Fisher's exact test was used to determine statistical significance. RESULTS: 404 patients were enrolled with 199 patients prescribed the 325 mg regimen. Fifty-two patients who were prescribed 325 mg missed a dose versus 51 patients who were prescribed 81 mg (p = 0.082). No significant difference in the frequency of missed doses (missing < 5 doses, 5-10 doses, > 10 doses) between the treatment regimens (p = 0.78, 0.39 and 0.83, respectively). Most commonly cited reason for stopping aspirin in both treatment groups was gastrointestinal issues (10.5% and 7%, respectively). DISCUSSION AND CONCLUSIONS: By surveying patients on their use of aspirin we find no difference in adherence between full-strength and low-dose treatment regimens. Additionally, we have a better understanding of the reasons for noncompliance as GI upset was a relatively common complaint with both doses.

Radiologist Overreads of Intraoperative Radiographs-Value or Waste?

BACKGROUND: All aspects of the arthroplasty pathway must be scrutinized to maximize value and eliminate unnecessary cost. Radiology providers' contracts with hospitals often call for readings of all radiographs. This policy has little effect on patient care when intraoperative radiographs are taken and used to make real-time decisions. In order to determine the value of radiologist overreads, we asked 3 questions: what was the delay between the time an intraoperative radiograph was taken and time the report was generated, were the overreads accurate, and what is the associated cost? METHODS: Two hundred hip and knee radiograph reports generated over 6 months during 391 cases were reviewed. The time the report was dictated was compared to the time taken and time of surgery completion. To determine accuracy, each overread was rated as accurate or inaccurate. The cost of the overread was determined by multiplying the number of radiographs times the radiology fee less the technical fee. RESULTS: Median delay between taking the radiograph and filing the report was 45 minutes (range, 0-9778 minutes). Only 31.5% were filed before completion of the procedure. And 18.0% (36/200) were considered inaccurate despite lenient criteria. The reading fee for hip radiographs was $52.00, and for knee radiographs was $38.00, representing a total cost of $10,182 in our select series. This cost projects to $43,614 annually at our facility. CONCLUSION: Radiology overreads of intraoperative radiographs have no effect on real-time decision-making. In the era of value-based care, payors should stop paying for overreads and reimburse providers who actually read the films intraoperatively.

Effects of High-Dose of Copper Amino Acid Complex on Laying Performance, Hematological and Biochemical Parameters, Organ Index, and Histopathology in Laying Hens.

The objective of the study was to evaluate the maximum tolerance limit of amino acid copper complex (Cu-Lys-Glu) for laying hens by measuring their laying performance, hematological and serum biochemical parameters, organ index, and histopathology. A total of 450 18-week-old Beijing White layers were randomly allocated to 5 groups (90 birds per group) with 6 replicates of 15 birds each. After a 2-week acclimation on a basal diet (analyzed copper content 8.63 mg/kg), the birds were fed diets supplemented with 0 (control), 15, 75, 150, and 300 mg Cu/kg as Cu-Lys-Glu for 10 weeks. Results showed that, compared with the control group, dietary supplementation with 15, 75, and 150 mg Cu/kg as Cu-Lys-Glu did not affect (P > 0.05) laying performance, whereas hens receiving with 300 mg Cu/kg significantly decreased (P < 0.001) the laying rate as compared with the control. No significant differences (P > 0.05) were observed among the hens receiving 0, 15, 75, and 150 mg Cu/kg as Cu-Lys-Glu in hematological and serum biochemical parameters, organ indexes, and histopathological changes. However, hens receiving 300 mg Cu/kg significantly increased (P < 0.05) the concentrations of mean corpuscular volume (MCV), albumin (ALB), total bilirubin (TBILI), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (UN), and creatinine (CRE), as well as caused severe microscopic histopathological changes in the liver and kidney. In conclusion, 150 mg Cu/kg as Cu-Lys-Glu is identified as no-side-effect supplementation level in laying hens after daily administration for 70 days.

Rate of radiographic hip OA in spine patients: utility of including femoral heads on plain film A/P lumbar radiographs.

The incidence of concomitant lumbar spine and hip pathology is common in referral patients to spine clinics. Differentiating between the two pathologies is a key component to the clinical practitioner's role. At our institution, it has become routine protocol to obtain radiographs including the femoroacetabular joints on the AP and lateral views of the lumbar spine as part of the initial workup. The purpose of this study was to determine the rates of radiographic hip pathology seen on lumbar spine imaging. We report just over 25% concomitant spine and hip pathology with 25% of patients requiring further management from a hip surgeon. The studied protocol will assist in the workup of spine patients to further differentiate the intricacies of hip- and spine-related pathology.

The Efficacy and Safety of Opioids in Total Joint Arthroplasty: Systematic Review and Direct Meta-Analysis.

BACKGROUND: Opioids are frequently used to treat pain after total joint arthroplasty (TJA). The purpose of this study was to evaluate the efficacy and safety of opioids in primary TJA to support the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and the American Society of Regional Anesthesia and Pain Management. METHODS: The MEDLINE, EMBASE, and Cochrane Central Register of controlled trials were searched for studies published before November 2018 on opioids in TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of opioids. RESULTS: Preoperative opioid use leads to increased opioid consumption and complications after TJA along with a higher risk of chronic opioid use and inferior patient-reported outcomes. Scheduled opioids administered preemptively, intraoperatively, or postoperatively reduce the need for additional opioids for breakthrough pain. Prescribing fewer opioid pills after discharge is associated with equivalent functional outcomes and decreased opioid consumption. Tramadol reduces postoperative opioid consumption but increases the risk of postoperative nausea, vomiting, dry mouth, and dizziness. CONCLUSION: Moderate evidence supports the use of opioids in TJA to reduce postoperative pain and opioid consumption. Opioids should be used cautiously as they may increase the risk of complications, such as respiratory depression and sedation, especially if combined with other central nervous system depressants or used in the elderly.

The Past, Present, and Future of Orthopedic Education: Lessons Learned From the COVID-19 Pandemic.

The COVID-19 global pandemic has upended nearly every medical discipline, dramatically impacted patient care and has had far-reaching effects on surgeon education. In many areas of the country, elective orthopedic surgery has completely stopped to ensure that resources are available for the critically ill and to minimize the spread of disease. COVID-19 is forcing many around the world to re-evaluate existing processes and organizations and adapt to carry out business, of which medicine and education are not immune. Most national and international orthopedic conferences, training programs, and workshops have been postponed or canceled, and we are now critically evaluating the delivery of education to our colleagues as well as residents and fellows. This article describes the evolution of orthopedic education and significant paradigm shifts necessary to continue to teach ourselves and the future leaders of our noble profession.

A Risk Assessment Tool Based on Orthopedic Psychosocial and Health Status Factors is Associated With Post-Acute Resources.

BACKGROUND: We implemented a risk assessment tool (RAT) used by clinical navigators to quantify pre-operative mobility, home safety, social/cognitive barriers, and patient health history. We sought to determine if this RAT is associated with the need for post-acute care (PAC) services defined as inpatient rehabilitation and skilled nursing facility, home health, and none (home) following total joint arthroplasty. METHODS: The study sample comprised of a total of 1438 primary TJA patients included in a bundled payment model. The RAT score, which ranges from 0 to 100, with higher scores representing healthier, more independent patents, was the key independent variable and post-acute service was the primary outcome variable. RESULTS: The median RAT score was 83 (interquartile range 78-87.5) for no PAC discharges compared to 74 (interquartile range 67-81) for inpatient PAC discharges (P < .0001). After adjusting for the effects of length of hospital stay, surgery type, and patient gender, there was 6× increased odds of inpatient PAC for higher risk patients compared to low risk patients. A RAT score of 74 predicts discharges without PAC 87% of the time. CONCLUSION: The RAT that is based on psychosocial, cognitive, environmental factors, and health status was significantly associated with the need for PAC services. The next step is to build and validate a real time, risk adjustment model to assist physicians and patients with planning post-discharge resources.

Peri-implant fracture after dual-plating knee arthrodesis for failed total knee arthroplasty: case series.

Knee arthrodesis is an option in the setting of failed total knee arthroplasty. Dual-plate fixation is a described technique to obtain knee fusion in this scenario. Literature on the complications of knee arthrodesis with dual-plate constructs is limited. We present 3 cases who underwent dual-plate knee arthrodesis complicated by peri-implant femur fracture.

One-Stage Periprosthetic Joint Infection Reimbursement-Is It Worth The Effort?

BACKGROUND: One-stage protocols for the management of periprosthetic infection take an extended period of time requiring two separate preps and sets of instruments to ensure optimal sterility. While intraoperative service time is one part of the reimbursement algorithm, reimbursement has lagged behind for single-stage treatment with respect to the time and resources necessary to perform these complex treatment regimens. If one-stage results are shown to be acceptable, but not reimbursed appropriately, surgeons will be discouraged from managing periprosthetic joint infection (PJI) in a one-stage fashion. METHODS: The reimbursement and operative time for 50 PJI procedures were compared with 250 primary total hips and 250 primary total knees by the same 4 surgeons. RESULTS: The average reimbursement for a one-stage knee procedure was $2,597.08, with an average intraoperative service time of 259 minutes ($601.60/h). The average reimbursement for a primary total knee was $2,435.00, with an average intraoperative service time of 100 minutes ($1,461/h). The average reimbursement for a one-stage hip procedure was $2,826.17, with an average intraoperative service time of 311 minutes ($545.24/h). The average reimbursement for a primary total hip was $2,754.71 with an average intraoperative service time of 104 minutes ($1,589.26/h). CONCLUSION: One-stage procedures for PJI are reimbursed at approximately 1/3 the hourly rate of a primary procedure, which may discourage surgeons from selecting this treatment alternative even if recent studies confirm efficacy. Payers should be encouraged to reimburse physicians commensurate with the intraoperative service time needed to perform a one-stage procedure as adoption will decrease morbidity and save the healthcare system financially.

Unintended Bundled Payments for Care Improvement Consequences After Removal of Total Knee Arthroplasty From Inpatient-Only List.

BACKGROUND: The Centers for Medicare and Medicaid Services beginning in 2013 introduced the Bundled Payments for Care Improvement (BPCI) initiative to test innovative payment and service delivery models. Early implementers of the BPCI program have shown decreased hospital length of stays, discharges to inpatient facilities, and readmission rates with overall cost savings. Removal of total knee arthroplasty from the Medicare inpatient-only list may potentially cause substantial changes in patients included in BPCI bundles in 2018. METHODS: The 2017 Centers for Medicare and Medicaid Services data were used to compare total expenditures of diagnosis-related groups 469 and 470. Medicare patients who underwent total knee arthroplasty between January 2017 and December 2017 were defined as group one (n = 1024) and expenditures were compared to group two patients (n = 631) that included only those patients staying greater than 24 hours. Postacute events within the 90-day episode including admission to an inpatient rehabilitation facility/skilled nursing facility (SNF), home health (HH), and readmissions were analyzed. Expenditures were converted to 2018 dollars using Consumer Price Index. Statistical analysis of expenditures was performed with Wilcoxon Tests. RESULTS: Median expenditures were $15,587 (interquartile range [IQR] $13,915-$17,684) for group 1 and $16,706 (IQR $15,333-$19,247) for group 2 (P < .001). Median postacute care spend was $3817 (IQR $2431-$5057) for group 1 and $4195 (IQR $3049-$6064) for group 2 patients (P < .001). Compared with group 1 patients, group 2 patients had a higher rate of SNF admissions (21% vs 13%), inpatient rehabilitation facility admissions (0.16% vs 0.1%), HH (72% vs 69%), and readmissions (5% vs 4%). CONCLUSION: Implications of the removal of total knee arthroplasty from the inpatient-only list could potentially remove up to 40% of patients from the BPCI program leading to substantially less savings on average $1100 per patient. Remaining bundle patients are also more likely to require HH and SNF after discharge.

Early complications of revision total knee arthroplasty in morbidly obese patients.

INTRODUCTION: Morbid obesity is a known risk factor for complications and failure following primary total knee arthroplasty. Complications following revision total knee arthroplasty (rTKA) in the morbidly obese (BMI > 40) have not been well described. A retrospective cohort study was designed to investigate the early complications of rTKA in morbidly obese patients. METHODS: Revision TKA procedures were performed between January 2009 and December 2012 at a single institution. Comparisons were made between patients with a normal BMI (18.5-25) and patients with morbid obesity (BMI > 40). RESULTS: Thirty-three of 141 morbidly obese patients (23.4%) had a complication compared to 10 of 96 patients with a BMI 18.5-25 (10.4%) (p = 0.011). Morbidly obese patients were younger (69.3 vs. 61.4 years, p < 0.0001), and their most frequent complication in comparison with patients with normal BMI was wound healing problems (p = 0.01). CONCLUSION: Morbidly obese patients are at a significantly increased rate of early complications following rTKA compared to a normal weight cohort, especially with regard to wound complications. The morbidly obese group was significantly younger at the time of rTKA. In addition, this study highlights the importance of risk stratification for morbidly obese patients undergoing rTKA.