Total Joint Arthroplasty at a Tertiary Military Medical Center in Hawai'i: Does Travel Distance Influence Short Term Complications?

As the health care delivery system in the United States changes, there has been an increase in the presence of specialized medical centers, translating into increased travel distance for patients. Tripler Army Medical Center in Honolulu, Hawai'i serves a unique population of local patients and those traveling from neighboring Hawaiian Islands and from across the Pacific Basin and Asia. Previous studies have examined the role of distance traveled, but no study has looked at patients routinely flying in the immediate postoperative period. The purpose of this study is to investigate if increased travel distance is associated with a higher probability of complications after a total joint arthroplasty (TJA). A retrospective review of all patients receiving TJA at a single medical institution was performed. After meeting the inclusion criteria, 126 consecutive patients were reviewed for 30-day complications. Sixty-four patients were local (from O'ahu, Hawai'i), and 13 from neighboring Hawaiian Islands, while 49 were international. There were no significant differences in complications between the groups. Length of stay was not affected by distance. A significant risk factor for short-term complications was having a higher score based on the American Society of Anesthesiologists Physical Status Classification System (ASA), ASA 3 vs ASA 1&2 (14% vs 1%, P = .015). There were no findings in our population to support inferior outcomes in patients traveling from the outer Pacific Basin during their initial postoperative course compared to the local population. No patient sustained a short-term complication after a patient returned to their island or country of origin. The results of this study will help to guide clinical decision making and effective resource management for patients seeking TJA traveling from a significant distance.

Posterior Malleolus Arthroscopic Reduction and Internal Fixation Technique.

Adequate reduction of posterior malleolar fractures leads to better outcomes. Arthroscopic reduction and internal fixation presents an opportunity for excellent reduction with a minimally invasive approach. Herein, we present a technique with some discussion on outcomes.