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1.
Environ Sci Pollut Res Int ; 30(2): 3942-3952, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35962163

RESUMO

A solar collector is a simple and cheap device that converts solar radiation into valuable heat energy. The thermal performance of the solar collectors can be enhanced significantly with the suspension of nanoparticles in the base fluid. A novel design for a solar-assisted water heater (SWH) is proposed in the current study, and the effect of nanofluid has been investigated on the thermal efficiency of the SWH. The use of nanofluid is one of the prominent methods in comparison to other techniques for improving the performance of solar collectors. Therefore, the base working fluid, i.e., water is mixed with the alumina nanoparticles of average particle size of 30 nm, and they are assumed to be spherical. The flow and thermal characteristics of nanofluid through the solar water heater are simulated numerically with the help of the Eulerian-Eulerian two-phase model using the finite volume method (FVM). The commercial package ANSYS Fluent, is used for modeling the problem under transient conditions with a pressure-based solver. In comparison to a conventional flat plate collector, the proposed solar water heater consists of a corrugated absorber-plate and the effect of the radius of curvature has been investigated on the heat transfer and collector efficiency. With the proposed design, the heat transfer area available with the riser tubes increases remarkably and it leads to a 43% and 14% increase in heat transfer augmentation and collector efficiency, in comparison to the conventional solar water heater.


Assuntos
Calefação , Energia Solar , Água , Luz Solar , Simulação por Computador
2.
J Arthroplasty ; 37(6S): S211-S215, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35256233

RESUMO

BACKGROUND: The use of surgical navigation has been shown to reduce revision rates after total knee arthroplasty (TKA) in patients <65 years of age. It is unknown if this benefit extends to older patients. We hypothesized that the use of surgical navigation would reduce rates of all-cause revision in patients of all ages. METHODS: In this cohort study, we queried the Truven MarketScan all-payer database to identify patients who underwent TKA from 2007 to 2015. Current Procedural Terminology codes were used to create 2 groups based on whether intraoperative navigation was used. Demographics, comorbidities, complications, and revision rates were determined. International Classification of Diseases codes were used to determine reasons for revision. RESULTS: The conventional TKA cohort included 312,173 patients. The navigation cohort included 20,881 patients. There were not any clinically significant differences in demographics between the cohorts. All-cause revision rates were lower in the navigation cohort at 1 year (0.4% vs 0.5%, P = .04), 2 years (0.7% vs 0.9%, P = .003), and 5 years (0.9% vs 1.3%, P < .001) of follow-up. Revisions for mechanical loosening were more common in the conventional cohort (30.8% vs 21.9%, P = .009). Rates of revision for other causes, including infection, did not differ between groups, with the numbers available. CONCLUSION: The use of surgical navigation yielded a 30.7% reduction in the all-cause revision rate at 5-year follow-up compared to conventional TKA. This benefit increased as follow-up duration increased. Increased usage of this inexpensive technology, from the current 6.3% in this US cohort, may reduce healthcare costs. LEVEL OF EVIDENCE: III.


Assuntos
Artroplastia do Joelho , Cirurgia Assistida por Computador , Artroplastia do Joelho/efeitos adversos , Estudos de Coortes , Computadores , Bases de Dados Factuais , Humanos , Reoperação , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento
3.
J Arthroplasty ; 37(6): 1143-1145, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35219818

RESUMO

BACKGROUND: Hydroxyapatite (HA) coatings were introduced to improve uncemented implant osteointegration and to prevent loosening and osteolysis. However, data regarding these implants have been inconsistent. We studied the effect of HA coating of femoral stems and acetabular cups on component revision after primary total hip arthroplasty (THA) in the veteran population. METHODS: We identified patients who underwent uncemented primary THA at any Veterans Health Administration (VHA) hospital from 2000 to 2017 and who had implants that were available as either HA-coated or non-HA-coated models. The endpoint was removal of the component of interest for any reason. For each individual stem and shell, unadjusted and adjusted (for age and body mass index) Cox proportional hazards models were used to estimate hazard ratios for the risk of explantation between HA-coated and non-HA-coated implants of the same type. RESULTS: A total of 262 HA-coated cups, 4580 non-HA-coated cups, 4767 HA-coated stems, and 9397 non-HA-coated stems were available for analysis. The mean follow-up time was 9.01 years (43,627 total implant-years) for cups and 7.13 years (101,004 total implant-years) for stems. One of the two shells reviewed had significantly lower survivorship and an elevated hazard ratio for explantation with HA coating. Among the five implant pairs of stems, and the other shell, implant survival and hazard ratios for explantation were not affected by HA coating. CONCLUSION: HA coating did not improve THA implant survival in our veteran population. Although HA-coated versions of hip implants tend to be more costly than their noncoated counterparts, these results do not support their general use.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Veteranos , Artroplastia de Quadril/métodos , Materiais Revestidos Biocompatíveis , Durapatita , Humanos , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Reoperação
4.
Environ Sci Pollut Res Int ; 28(38): 52702-52723, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34462854

RESUMO

The outbreak of COVID-19 pandemic has created havoc all across the globe causing exponential casualties and tremendous health and economic loss. With increasing COVID-19 cases, the amount of biomedical waste has increased manifolds making more people vulnerable to the pandemic. The developing and underdeveloped countries are already facing the challenges of waste management, and the waste generated during the pandemic scenario has added to the already existing challenges. The improper waste management practices need to be corrected; otherwise, the world will be facing a new disaster that could be termed as 'waste disaster'. The increase in COVID-19-associated waste (CAW) quantity and their availability in the environment will result in their easy approach to other organisms, which will possibly increase the potential risk of food chain contamination. Some of the countries have already started to make backup plans and are struggling to overcome the 'waste disaster'. In light of the limited knowledge available on the mutational properties and possible hosts of this newly emerged COVID-19, there is a great demand to have an efficient strategy to prevent the environment from further contamination in India. The necessity of the prevailing time is to create a more efficient, automatic, mechanized, and well-modified waste management system for handling the present situation and delaying the projected waste disaster in the near future in the era of COVID-19. The article aims to address the issues that originated from waste discharges, their potential sources along with possible sustainable solutions.


Assuntos
COVID-19 , Gerenciamento de Resíduos , Países em Desenvolvimento , Humanos , Pandemias , SARS-CoV-2
5.
PLoS One ; 16(7): e0255061, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34310629

RESUMO

Arthroplasty procedures are commonly performed and contribute to healthcare expenditures seen in the United States. Surgical team members may make selections among implants and materials without always knowing their relative cost. The current study reports on a survey aimed to investigate the perceptions of an academic group about the relative cost and value of commonly used operating room implants and materials related to joint arthroplasty cases using 10 matched pairs of items. Of the 124 persons eligible to take the survey, 102 responded (response rate of 82.3%) including attendings, fellows, residents, physician assistants (PAs), advanced practice registered nurses (APRNs) and registered nurses (RNs). On average for the ten pairs of items, the more expensive items were correctly selected by 90.2+/-13.9% (mean+/- standard deviation) of respondents with a range from 54.9% to 100%. Of note, the cost differences were significantly overestimated for 8/10 item pairs. The majority of respondents perceived the more expensive item as the item with the higher clinical value for 9/10 item pairs. Most arthroplasty attendings (91.3%) indicated willingness to use the less expensive item of two similar items. Nonetheless, 17.9% of fellows, residents, PAs, APRNs and RNs indicated that they would not feel comfortable suggesting using the less expensive item. Although attending arthroplasty surgeons stated a desire to consider costs, a knowledge deficit with regards to identifying the extent of cost differences was identified, and a significant portion of the surgical support team reported being hesitant to suggest less expensive options.


Assuntos
Percepção , Próteses e Implantes/economia , Artroplastia , Cimentos Ósseos/economia , Gastos em Saúde , Humanos , Enfermeiras e Enfermeiros/psicologia , Assistentes Médicos/psicologia , Cirurgiões/psicologia , Inquéritos e Questionários
6.
Foot Ankle Orthop ; 6(1): 2473011420981901, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35097423

RESUMO

BACKGROUND: Autogenous cancellous bone graft and bone marrow aspirate are commonly used in lower extremity fusion procedures to enhance fusion potential, and frequently in revision situations where bone loss and osteolysis may be a feature. The tibial metaphysis is a common donor site for bone graft, with the procedure typically performed using a curette or trephine to harvest the cancellous bone. Some limitations of this technique include suboptimal harvest of the marrow portion in particular, incomplete graft harvest, and loss of graft material during the harvest process. We describe a novel vacuum-assisted bone harvesting device to acquire cancellous bone and marrow from the proximal tibia. METHODS: This is a retrospective study of a single surgeon's consecutive patients who underwent foot and ankle arthrodesis procedures using proximal tibia autograft obtained using a vacuum-assisted bone harvesting device. Descriptive statistics were used to summarize patient and operative characteristics and outcomes. We identified 9 patients with a mean age of 51 years, 4 of whom were female. RESULTS: On average, the skin incision was slightly more than 2 cm, and 27 mL of solid graft and 16 mL of liquid phase aspirate were collected. At 6 weeks after the procedure, there was minimal to no pain at the donor site, and we did not observe any fractures or other complications. CONCLUSIONS: We report the use of a novel vacuum-assisted curette device to harvest bone graft from the proximal tibial metaphysis for use in foot and ankle fusions. This device has been reliable and efficient in clinical practice. LEVEL OF EVIDENCE: Level IV, retrospective case series.

7.
Cureus ; 12(3): e7394, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32337121

RESUMO

A major complication after total hip arthroplasty (THA) is infection, which can have devastating clinical and financial results. Silver-impregnated dry dressings, such as Aquacel dressings, and incisional negative pressure dressings (Prevena) have been developed to reduce the rates of surgical site infections (SSIs) after surgery. We retrospectively reviewed the medical records of 235 patients who underwent primary posterior approach THA at our institution during a three-year period. Patients were grouped based on surgical dressing. Rates of SSI were recorded, as well as the effects of factors including age, sex, body mass index, and medical comorbidities. In the high-risk subgroup, defined as BMI > 30 and ASA > 3, the infection rate was 2.97% in the Aquacel group, compared to 1.20% in the Prevena group. This difference did not reach statistical significance. There was a statistically significant impact on readmissions rate (p = 0.028) and reoperation (p = 0.001). The findings of this study suggest that negative pressure dressings in carefully selected patients may help to reduce reoperations and readmissions in this subgroup.

8.
Orthopedics ; 42(6): e539-e544, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505014

RESUMO

With the aging of the US population, total hip arthroplasty (THA) is becoming an increasingly common procedure. A major concern after THA is reducing infection rates, as infections can cause devastating complications. Improved sterile technique, standardized infection control protocols, and novel dressings have been used to reduce postoperative surgical site infections (SSIs). The use of either silver-impregnated dry dressings or easily applied incisional negative pressure dressings is aimed at reducing the rates of SSIs after primary anterior THA. The authors retrospectively reviewed the medical records of 275 patients who underwent anterior THA at their institution during a 1-year period. Patients were separated into groups based on their surgical dressing. Rates of SSI were documented, and the effects of various factors, including age, sex, body mass index, and comorbidities, were compared between the 2 cohorts. The authors also analyzed high-risk patients to determine whether easily applied incisional negative pressure dressings reduced infections. The use of easily applied incisional negative pressure dressings after primary anterior THA did not have a statistically significant impact on SSI rate (P=.42). There was also no difference in SSI, readmission, or reoperation in the high-risk group. The goal of using an incisional negative pressure wound therapy device is to help further decrease the risk of SSI. This study's findings suggest that the SSI rate in this group did not differ from that in the standard dressing group, such that the prophylactic use of a negative pressure wound therapy device is not indicated for either standard or high-risk patients undergoing primary anterior approach THA. [Orthopedics. 2019; 42(6):e539-e544.].


Assuntos
Artroplastia de Quadril/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores Etários , Idoso , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Infecção da Ferida Cirúrgica/etiologia
9.
Arthroplast Today ; 5(2): 176-180, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31286040

RESUMO

Osteogenesis imperfecta is a genetic disease resulting in abnormal collagen formation, with multiple clinical manifestations. Advancements in medical and surgical treatments have prolonged the life expectancy of these patients in recent decades. As a result, orthopedic surgeons are likely to be faced with the challenge of performing arthroplasty in these patients on a more frequent basis. Here, we describe a patient with osteogenesis imperfecta and subsequent severe osteoarthritis prompting primary total knee arthroplasty. This rare case presents an opportunity to explore special considerations unique to this patient population, including comorbid bone defects, the need for using extramedullary guides, careful alignment of prostheses to accommodate abnormalities in limb axes, and equipment utilization.

10.
J Orthop Traumatol ; 20(1): 15, 2019 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904970

RESUMO

The radial head plays a critical role in the stability of the elbow joint and its range of motion. Injuries may occur across a spectrum of severity, ranging from low energy non-displaced fractures to high energy comminuted fractures. Multiple classification systems exist to help characterize radial head fractures and their associated injuries, as well as to guide treatment strategies. Depending on the type of fracture, non-operative management may be possible if early range of motion is initiated. Other options include open reduction and internal fixation or excision followed by arthroplasty. A lateral approach is typically used for adequate surgical exposure. Controversy still remains regarding operative management of more severe fractures, but studies have shown good outcomes after radial head replacement for these fractures. We will review the current treatments available for radial head fractures, highlighting gaps in knowledge, as well as providing recommendations for the care of these injuries.Level of evidence: Level V.


Assuntos
Articulação do Cotovelo/fisiopatologia , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Fraturas Cominutivas/fisiopatologia , Humanos , Fraturas do Rádio/fisiopatologia , Resultado do Tratamento , Lesões no Cotovelo
11.
J Arthroplasty ; 34(2): 235-241, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30391051

RESUMO

BACKGROUND: Reduced hospital stay programs for total knee arthroplasty (TKA) are being implemented in order to increase patient satisfaction and reduce healthcare costs. Although elderly patients are often included in these pathways, there have been limited data on whether older patients can safely be discharged within a day after TKA. The purpose of this study is to compare perioperative complications following primary TKA with ≤1 day in the hospital in patients aged ≥80 compared to <80 years old in the National Surgical Quality Improvement Program database. METHODS: Patients who underwent primary TKA with hospital length of stay ≤1 day were identified in the 2005-2016 National Surgical Quality Improvement Program database. These patients were separated into 2 age groups: <80 and ≥80 years old. Preoperative and procedural characteristics were compared. Multivariate regressions were used to compare risk for perioperative adverse events and readmission. Independent risk factors for serious adverse events following such TKAs were identified. RESULTS: In total, 17,191 (<80 year olds) and 1005 (≥80 year olds) cases were identified. Of these patients, 1750 cases were discharged the same day. Multivariate analysis revealed only higher risk for 30-day readmission and nonhome discharge in ≥80 compared to <80 year olds. Notably, the octogenarians had a significantly higher rate of nonsurgical site-related readmissions. Independent risk factors for serious adverse events include only American Society of Anesthesiologists score ≥3 and not patient age. CONCLUSION: These data suggest that, although octogenarians can safely be discharged in ≤1 day, greater postdischarge care may be warranted to reduce the rate of nonsurgical site-related readmissions.


Assuntos
Artroplastia do Joelho/efeitos adversos , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Fatores de Risco , Estados Unidos/epidemiologia
12.
Knee Surg Sports Traumatol Arthrosc ; 27(3): 850-853, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30206655

RESUMO

Insertion of bone graft to fill metaphyseal defects and supply subchondral support when fixing Schatzker type II and III tibial plateau fractures can be difficult and tedious. Accurately directing the placement of bone graft through a small entry portal and against gravity can be challenging. Using a modified 3-mL syringe and bone tamps with application of the Seldinger technique can make this tedious task simple and more accurate.Level of evidence V.


Assuntos
Transplante Ósseo/métodos , Fixação Interna de Fraturas/métodos , Fraturas da Tíbia/cirurgia , Humanos , Masculino , Fraturas da Tíbia/diagnóstico por imagem , Adulto Jovem
13.
J Am Acad Orthop Surg ; 27(4): 145-154, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30252789

RESUMO

INTRODUCTION: There has been a lack of studies investigating the perioperative course of total shoulder arthroplasty (TSA) performed in the increasingly octogenarian (≥80 years old) population in a large sample size. The purpose of this study was to compare perioperative complications between primary TSA performed in octogenarians and that performed in younger populations (<70 and 70 to 79 years old) from the National Surgical Quality Improvement Program database. METHODS: Patients who underwent primary TSA between January 2005 and December 2015 were identified from the National Surgical Quality Improvement Program database and stratified into three age groups: <70, 70 to 79, and ≥80 years old. Patient characteristics and comorbidities were compared between the three groups. Propensity score-matched comparisons were then performed for length of hospital stay, 30-day perioperative complications, and readmissions. Risk factors and reasons for readmission in the octogenarians were characterized. RESULTS: This study included 3,007 patients who were <70 years old, 2,155 patients who were 70 to 79 years old, and 900 octogenarian patients. Statistical analysis was carried out after matching for propensity score. While no significant differences in perioperative complications were observed between the octogenarians and 70- to 79-year-olds, significantly higher rates of readmission (4.2% versus 1.7%; P = 0.002), pneumonia (1.1% versus 0.0%; P = 0.002), and urinary tract infection (1.8% versus 0.2%; P = 0.001) were found in the octogenarians compared with <70-year-olds. In addition, the octogenarians also had a slightly longer length of hospital stay compared with the younger populations (0.6 days longer than <70-year-olds and 0.4 days longer than 70- to 79-year-olds; both P < 0.001). CONCLUSION: These data suggest that primary TSA can safely be considered for octogenarians with only mildly increased morbidities. However, greater preoperative optimization or post-discharge care for octogenarians may be warranted to reduce the rates of readmission.


Assuntos
Artroplastia do Ombro/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos , Assistência Perioperatória , Pneumonia/epidemiologia , Pontuação de Propensão , Fatores de Risco , Resultado do Tratamento , Infecções Urinárias/epidemiologia
14.
Spine (Phila Pa 1976) ; 44(8): 543-549, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30247374

RESUMO

STUDY DESIGN: Retrospective study of prospectively collected data. OBJECTIVE: To determine the incidence, timing, risk factors, and clinical implications of postoperative hematoma requiring reoperation after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA: Postoperative hematomas requiring reoperation are rare but potentially catastrophic complications after ACDF. However, there has been a lack of large cohort studies investigating these complications in the ACDF population despite increasing outpatient procedure volume. METHODS: Patients who underwent ACDF in the 2012 to 2016 National Surgical Quality Improvement Program database were identified. The primary outcome was an occurrence of hematoma requiring reoperation within 30 days postoperatively. Risk factors for this outcome were identified using multivariate regression. Postoperative length of stay, subsequent complications, and mortality were compared between patients who did and did not develop a hematoma requiring reoperation. RESULTS: A total of 37,261 ACDF patients were identified, of which 148 (0.40%) developed a hematoma requiring reoperation (95% confidence interval [CI], 0.33%-0.46%). Of the cases that developed this complication, 37% occurred after discharge. Risk factors for the development of hematoma requiring reoperation were multilevel procedures (most notably ≥3 levels, relative risk [RR] = 3.14, 95% CI = 1.86-5.32, P < 0.001), preoperative international normalized ratio >1.2 (RR = 2.85, 95% CI = 1.42-5.71, P = 0.006), lower BMI (notably body mass index ≤24, RR = 2.11, 95% CI = 1.21-3.67, P = 0.008), American Society of Anesthesiologists classification ≥3 (RR = 2.07, 95% CI = 1.47-2.91, P < 0.001), preoperative anemia (RR = 1.71, 95% CI = 1.12-2.63, P = 0.027), and male sex (RR = 1.67, 95% CI = 1.18-2.37, P = 0.004). In addition, patients who developed a hematoma requiring reoperation before discharge had a longer length of stay. Further, those who developed a hematoma requiring reoperation were at higher risk for subsequent ventilator requirement, deep wound infection, pneumonia, and reintubation. CONCLUSION: Postoperative hematoma requiring reoperation occurred in approximately 1 in 250 patients after ACDF. High-risk patients should be closely monitored through the perioperative period. LEVEL OF EVIDENCE: 3.


Assuntos
Discotomia/efeitos adversos , Hematoma/epidemiologia , Hematoma/cirurgia , Reoperação/estatística & dados numéricos , Fusão Vertebral/efeitos adversos , Adolescente , Adulto , Idoso , Vértebras Cervicais , Discotomia/métodos , Feminino , Hematoma/etiologia , Humanos , Incidência , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fusão Vertebral/métodos , Infecção da Ferida Cirúrgica/epidemiologia , Estados Unidos , Adulto Jovem
15.
Spine (Phila Pa 1976) ; 44(9): E530-E538, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30247372

RESUMO

STUDY DESIGN: A retrospective cohort comparison study. OBJECTIVE: The aim of this study was to investigate the perioperative adverse event profile of cervical total disc replacement (CTDR) performed as an outpatient relative to inpatient procedure. SUMMARY OF BACKGROUND DATA: Recent reimbursement changes and a push for safe reductions in hospital stay have resulted in increased interest in performing CTDRs in the outpatient setting. However, there has been a paucity of studies investigating the safety of outpatient CTDR procedures, despite increasing frequency. METHODS: Patients who underwent single-level CTDR were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Outpatient versus inpatient procedure status was defined by length of stay, with outpatient being less than 1 day. Patient baseline characteristics and comorbidities were compared between the two groups. Propensity score matched comparisons were then performed for 30-day perioperative complications and readmissions between the two cohorts. In addition, perioperative outcomes of outpatient single-level CTDR versus matched outpatient single-level anterior cervical discectomy and fusion (ACDF) cases were compared. RESULTS: In total, 373 outpatient and 1612 inpatient single-level CTDR procedures were identified. After propensity score matching was performed to control for potential confounders, statistical analysis revealed no significant difference in perioperative complications between outpatient versus matched inpatient CTDR. Notably, the rate of readmissions was not different between the two groups. In addition, there was no difference in rates of perioperative adverse events between outpatient single-level CTDR versus matched outpatient single-level ACDF. CONCLUSION: The perioperative outcomes evaluated in the current study support the conclusion that, for appropriately selected patients, single-level CTDR can be safely performed in the outpatient setting without increased rates of 30-day perioperative complications or readmissions compared with inpatient CTDR or outpatient single-level ACDF. LEVEL OF EVIDENCE: 3.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Vértebras Cervicais/cirurgia , Substituição Total de Disco/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Segurança do Paciente , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos , Substituição Total de Disco/métodos , Substituição Total de Disco/estatística & dados numéricos
16.
Arthroplast Today ; 4(3): 359-362, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30186922

RESUMO

BACKGROUND: Arthrofibrosis after total knee arthroplasty (TKA) is a common complication, potentially occurring in up to 25% of patients, and may be treated during the early recovery period by manipulation under anesthesia (MUA). The majority of preoperative factors that predispose patients to postoperative stiffness are patient specific and not modifiable. The United States Veteran Affairs is a particularly challenging group given a higher baseline rate of medical comorbidities and opioid dependence than the general population. Patient education about postoperative expectations and complications has been shown to improve outcomes in certain orthopedic procedures. This retrospective study aims to determine if preoperative counseling for veterans undergoing primary TKA reduces the rate of postoperative stiffness, and consequently MUA, in this subset of patients. METHODS: We evaluated the medical records of 244 veterans at a single veteran affairs hospital who underwent 278 TKAs during a 6-year period under one surgeon. Patients were separated into groups based on attendance in the preoperative counseling session. Effects of various factors, including age, sex, body mass index, preoperative knee range of motion, and history of previous knee surgery, were compared between these 2 cohorts. RESULTS: Attendance in the preoperative course did not have a statistically significant impact on the rate of manipulation (odds ratio [OR], 1.07). Female gender and prior manipulation had an increased OR of knee manipulation, whereas age > 65 years had a decreased OR that did not reach significance. CONCLUSIONS: Our results show that preoperative counseling did not have a benefit in terms of postoperative MUA rates in veterans. Preoperative education may be helpful for setting appropriate expectations of pain, recovery, and function after total joint arthroplasty and may be useful in an online or video format in small practices in which cost may be prohibitive. Further studies are needed to determine whether they provide any benefit in postoperative arthrofibrosis rates.

17.
Case Rep Orthop ; 2018: 9706065, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30013805

RESUMO

Laparoscopic cholecystectomy is a surgical treatment for acute cholecystitis or symptomatic cholelithiasis. One potential complication, the spillage of gallstones into the peritoneal cavity, can form a nidus for infection and may be associated with hepatic, retroperitoneal, thoracic, and abdominal wall abscesses. We report a case of a patient presenting with a right iliopsoas abscess and an infected right hip prosthesis status postlaparoscopic cholecystectomy. A CT demonstrated that the acetabular shell was overmedialized and perforated through the medial wall. The patient was taken to the operating room for explantation of components. A collection of gallstones was identified deep to the acetabulum during the explantation. The case highlights the importance of avoiding overmedialization of the acetabular component, which can provide a direct route for infection into the hip joint.

18.
Bull Hosp Jt Dis (2013) ; 76(2): 100-104, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29799368

RESUMO

Fusion and rigid instrumentation have been the mainstay for the surgical treatment of degenerative diseases of the spine for many years. Dynamic stabilization provides a theoretical advantage of decreased biomechanical stress on adjacent spinal segments and decreased fatigue failure of implants. Artificial discs provide an alternative treatment and have been well-studied in the literature. Another technology that is currently used in Europe but rarely in the USA is flexible rods attached to pedicle screws instead of rigid rods or bone fusion. We performed a literature review of the current systems of flexible rod stabilization, while also considering range of motion, loading characteristics, and infection rates.


Assuntos
Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral , Animais , Fenômenos Biomecânicos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Doenças da Coluna Vertebral/diagnóstico por imagem , Doenças da Coluna Vertebral/fisiopatologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Resultado do Tratamento
19.
Front Biosci (Schol Ed) ; 10(2): 350-371, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29772563

RESUMO

The future supply of energy to meet growing energy demand of rapidly exapanding populations is based on wide energy resources, particularly the renewable ones. Among all resources, lignocellulosic biomasses such as agriculture, forest, and agro-industrial residues are the most abundant and easily available bioresource for biorefineries to provide fuels, chemicals, and materials. However, pretreatment of biomass is required to overcome the physical and chemical barriers that exist in the lignin-carbohydrate composite and pretreatment facilitate the entry of biocatalysts for the conversion of biomass into fermentable sugars and other by-products. Therefore, pretreatment of the biomass is necessary prerequisite for efficient hydrolysis of lignocelluloses into different type of fermentable sugars. The physiochemical, biochemical and biological pretreatment methods are considered as most promising technologies for the biomass hydrolysis and are discussed in this review article. We also discussed the recent advancements and modern trends in pretreatment methods of lignocelluloses conversion into ethanol with special focus on fermentation methods.


Assuntos
Biomassa , Etanol/química , Fermentação , Lignina/química , Amônia/química , Biocombustíveis , Biotecnologia , Carboidratos/química , Enzimas/química , Hidrólise , Íons
20.
J Arthroplasty ; 33(1): 178-184, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28844628

RESUMO

BACKGROUND: The number of octogenarians undergoing revision total knee arthroplasty (TKA) is increasing. However, there has been a lack of studies investigating the perioperative course and safety of revision TKA performed in this potentially vulnerable population in a large patient population. The purpose of this study is to compare complications following revision TKA between octogenarians and 2 younger patient populations (<70 and 70-79 year olds). METHODS: Patients who underwent revision TKA were identified in the 2005-2015 National Surgical Quality Improvement Program database and stratified into 3 age groups: <70, 70-79, and ≥80 years. Baseline preoperative and intraoperative characteristics were compared between the 3 groups. Propensity score matched comparisons were then performed for 30-day perioperative complications, length of hospital stay, and readmissions. RESULTS: This study included 6523 (<70 years), 2509 (70-79 years), and 957 octogenarian patients who underwent revision TKA. After propensity matching, statistical analysis revealed only higher rates of blood transfusion and slightly longer length of stay in octogenarians compared to <70 year olds. Similarly, octogenarians had only higher rates of blood transfusion and slightly longer length of stay compared to 70-79 year olds. Notably, there were no differences in mortality or readmission between octogenarians compared to younger populations. CONCLUSION: These data suggest that revision TKA can safely be considered for octogenarians with the observation of higher rates of blood transfusion and slightly longer length of stay compared to younger populations. Octogenarian patients need not be discouraged from revision TKA solely based on their advanced age.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Melhoria de Qualidade , Estados Unidos/epidemiologia
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