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1.
Orthop Clin North Am ; 51(2): 235-239, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138861

RESUMO

To determine if orthopedic surgeons are more efficient than nonsurgical providers at care of operative injuries in walk-in clinics, patients in a walk-in clinic for evaluation of acute injury who subsequently had surgical treatment of isolated distal radial fracture were compared based on whether the initial visit was with a surgical or nonsurgical provider. Initial evaluation in a walk-in orthopedic clinic setting versus a conventional hand surgeon's clinic was associated with longer delay between initial evaluation and surgical treatment, but this difference may not be significant. Evaluation by a nonsurgical provider was not associated with increased duration to definitive treatment.


Assuntos
Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Instituições de Assistência Ambulatorial , Feminino , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/terapia , Tempo para o Tratamento , Adulto Jovem
2.
Instr Course Lect ; 69: 575-582, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017752

RESUMO

Shoulder arthroplasty has traditionally been viewed as an inpatient procedure because of the inherent medical comorbidities associated with an aging population and the need for postoperative pain control. Recent studies have shown that in appropriately selected patients, shoulder arthroplasty procedures can be safely done as outpatient procedures and can deliver economic value in today's cost-conscious health care environment. Several factors help ensure a successful surgical outcome, including cooperation from the ambulatory anesthesia service, proper patient selection, and perioperative pain control. Postoperatively, provider availability is vital to complete a seamless patient experience. With appropriate algorithms and care plans in place, outpatient shoulder arthroplasty can be a safe and cost-efficient procedure. The advances pioneered by outpatient shoulder arthroplasty will also serve to benefit inpatient shoulder arthroplasty patients via improved pain control, perioperative education, and potentially decreased length of stay.


Assuntos
Artroplastia do Ombro , Idoso , Procedimentos Cirúrgicos Ambulatórios , Artroplastia , Humanos , Tempo de Internação , Pacientes Ambulatoriais , Seleção de Pacientes
3.
J Shoulder Elbow Surg ; 29(2): 244-251, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31427230

RESUMO

BACKGROUND: The purpose of this study was to determine the influence of current and former tobacco use on minimum 2-year clinical and radiographic outcomes after reverse total shoulder arthroplasty (RTSA). METHODS: Review of primary RTSA patient data identified 186 patients with at least 2 years of follow-up. Patients were classified as nonsmokers (76 patients), former smokers (89 patients), or current smokers (21 patients). Assessment included preoperative and postoperative visual analog scale pain scores, American Shoulder and Elbow Surgeons scores, strength, range of motion, complications, revisions, and narcotic use. Radiographs were analyzed for signs of loosening or mechanical failure. RESULTS: Overall mean age of the patients was 70 (48-87) years, and mean follow-up was 2.6 (2.0-5.7) years. Smokers (62.1 years) were significantly younger than nonsmokers (70.7 years) and former smokers (70.8 years; P = .00002). All patients had significant improvements in pain, American Shoulder and Elbow Surgeons score, strength, and forward flexion range of motion; however, smokers had higher visual analog scale pain scores (mean, 2.5) than nonsmokers (mean, 1.8) or former smokers (mean, 1.0; P = .014). Otherwise, no differences were found regarding any of the postoperative parameters (P > .05). CONCLUSIONS: Aside from increased patient-reported pain, current tobacco use does not appear to negatively affect outcomes after primary RTSA. The RTSA design obviates the need for a functioning rotator cuff, possibly mitigating tobacco's negative effects previously demonstrated in rotator cuff repair and anatomic total shoulder arthroplasty. Former users obtained outcomes similar to those of nonusers, suggesting that tobacco use is a modifiable risk factor to achieve optimal pain relief after RTSA.

4.
Orthop Clin North Am ; 51(1): 1-5, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739873

RESUMO

Using an age- and comorbidity-matched cohort, we compared patients who underwent unicompartmental knee arthroplasty in an ambulatory surgery center with those who underwent the procedure in a traditional hospital inpatient setting. Postoperatively, the ambulatory surgery center cohort had fewer major complications than the inpatient cohort. No ambulatory surgery center patients required acute hospital admission and none had major complications. Four major complications occurred in the inpatient cohort. There was no difference in complication rates. Our results suggest that outpatient unicompartmental knee arthroplasty in a freestanding ambulatory surgery center is a safe and reasonable alternative to the traditional inpatient hospital setting.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Artroplastia do Joelho/economia , Análise Custo-Benefício/métodos , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/estatística & dados numéricos , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-31834035

RESUMO

INTRODUCTION: Bundling of services, typically into a 90-day episode of care, is intended to facilitate cost reduction. The purpose of this study was to determine the impact of a private insurance bundling program on the costs of outpatient total shoulder arthroplasty (TSA) at a freestanding ambulatory surgery center. METHODS: A cost minimization analysis was done of patients who had anatomic TSA by a single surgeon at a single freestanding ambulatory surgery center, including line-by-line comparisons of demographic and comorbidity factors for all patients treated within the 90-day episode of care. RESULTS: Seventy-six primary anatomic TSAs were included, 39 in the bundled group and 37 outside of the program. The bundled group was on average older (58 years) than the unbundled group (54 years, P = 0.021), but the groups were otherwise similar in demographics. The average total implant charges were significantly less for the bundled group ($24,822.43 versus $28,405.51, P = 0.014). Average total surgery supply charges and anesthesia supply charges were similar (P > 0.05). Mean total outpatient surgical day charges (implants, surgical, and anesthesia equipment) were significantly less for the bundled group ($29,782.43 versus $33,238.68, P = 0.022), as were average operating room staffing costs ($135.37 versus $162.55, P = 0.015). During the 90-day postoperative period, charges were similar. CONCLUSIONS: Primary anatomic TSA using a bundled care program in an outpatient setting coincides with markedly lower charges. The primary driver of this reduction is implant pricing, which is negotiated as part of the bundle. Surgeons must carefully analyze their unique practices in the changing economic health care environment when creating an outpatient TSA and/or bundling program. LEVEL OF EVIDENCE: Level III economic analysis.

6.
J Am Acad Orthop Surg ; 27(5): 177-182, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30192247

RESUMO

INTRODUCTION: Our purpose was to determine whether the chronic use of preoperative narcotics adversely affected clinical and/or radiographic outcomes. METHODS: Seventy-three patients (79 shoulders) with primary total shoulder arthroplasty for osteoarthritis were evaluated clinically and radiographically at preoperative visits and postoperatively at a minimum follow-up of 2 years: 26 patients (28 shoulders) taking chronic narcotic pain medication for at least 3 months before surgery and 47 patients (51 shoulders) who were not taking narcotics preoperatively. RESULTS: Postoperatively, significant differences were noted between the narcotic and nonnarcotic groups regarding American Shoulder and Elbow Surgeons scores and visual analog scale scores, as well as forward elevation, external rotation, and all strength measurements (P < 0.01). The nonnarcotic group had markedly higher American Shoulder and Elbow Surgeons scores, better overall range of motion and strength, and markedly lower visual analog scale scores than the narcotic group. CONCLUSION: Chronic preoperative narcotic use seems to be a notable indicator of poor outcomes of anatomic total shoulder arthroplasty for glenohumeral osteoarthritis.


Assuntos
Analgésicos Opioides/efeitos adversos , Artroplastia do Ombro , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Período Pré-Operatório , Amplitude de Movimento Articular , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
7.
J Shoulder Elbow Surg ; 28(1): 65-70, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30100176

RESUMO

BACKGROUND: Outpatient total shoulder arthroplasty (TSA) is increasing in frequency, but the selection of patients who are appropriate outpatient joint candidates remains challenging. We propose an algorithm for selecting outpatient TSA candidates, with validation by a cohort of patients from an ambulatory surgery center (ASC). METHODS: We identified 61 patients who had primary anatomic and reverse TSA. The selection algorithm, which stratifies patients referable to their age and cardiopulmonary comorbidities, was used to choose patients for outpatient surgery. Complications, including cardiopulmonary, thromboembolic, and postoperative wound problems, were recorded. RESULTS: All 61 patients were discharged from the ASC on the day of surgery. There were no cardiopulmonary events requiring intervention or hospital admission. One patient (2%) required a secondary operation, 3 patients (5%) experienced acute surgical complications, 3 patients (5%) had transient postoperative nausea, and 4 patients (7%) had additional complications within the 90-day episode of care. CONCLUSIONS: This study is the first to propose a patient selection method for outpatient TSA. Using this algorithm for patient selection produced a low rate of perioperative complications and no hospital admissions. We suggest this algorithm provides an evidence-based method for the standardization of outpatient TSA candidate selection.


Assuntos
Algoritmos , Procedimentos Cirúrgicos Ambulatórios , Artroplastia do Ombro , Seleção de Pacientes , Adulto , Idoso , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade
8.
J Shoulder Elbow Surg ; 27(12): 2257-2261, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30340926

RESUMO

BACKGROUND: Postoperative pain control, short-term and long-term narcotic consumption, complication rates, and costs of indwelling interscalene catheter (ISC) were compared with a liposomal bupivacaine (LBC) mixture in patients undergoing primary total elbow arthroplasty. METHODS: Forty-four consecutive patients were identified, the first 28 with an ISC and the later 16 with intraoperative LBC injection that also included ketorolac and 0.5% bupivacaine. Medical records were reviewed for visual analog scale scores for pain, oral morphine equivalent (OME) use, complications, and facility charges. RESULTS: Average visual analog scale scores at 24 hours, 2 weeks, 6 weeks, and 12 weeks were not significantly different. Mean OME use was significantly greater in the LBC group at 24 hours but less at 12 weeks, although this difference was not statistically significant. Twelve anesthetic-related complications occurred in the ISC group (1 major and 11 minor); 10 patients (36%) had at least 1 complication. The major complication was respiratory failure requiring emergent tracheostomy. Minor complications included leaking pump/catheters, catheters inadvertently pulled out early, global hand paresthesias, forearm paresthesias, and pain at the catheter site. There were no anesthetic-related complications in the LBC group. The average charge for the LBC mixture was $327.10; charges for ISC, including equipment and anesthesia fees, were $1472.42. CONCLUSIONS: An LBC mixture provides similar pain relief with fewer complications at a lower cost than indwelling ISC after total elbow arthroplasty. Although the OME use in the LBC group was almost double that of the ISC group at 24 hours, there was no difference at later time points.


Assuntos
Analgésicos não Entorpecentes/administração & dosagem , Anestésicos Locais/administração & dosagem , Artroplastia de Substituição do Cotovelo , Bupivacaína/administração & dosagem , Cetorolaco/administração & dosagem , Idoso , Analgésicos não Entorpecentes/efeitos adversos , Analgésicos não Entorpecentes/economia , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/efeitos adversos , Anestésicos Locais/economia , Bupivacaína/efeitos adversos , Bupivacaína/economia , Cateteres de Demora , Combinação de Medicamentos , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Injeções , Cetorolaco/efeitos adversos , Cetorolaco/economia , Masculino , Morfina/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Escala Visual Analógica
9.
J Shoulder Elbow Surg ; 27(8): 1462-1467, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29526600

RESUMO

BACKGROUND: To determine the effectiveness of hybrid glenoid components in reducing the frequency of glenoid component loosening, we evaluated clinical and radiographic outcomes at a minimum 5-year follow-up in 45 shoulders that underwent total shoulder arthroplasty (TSA) using a system with a central porous titanium post to augment the cemented peripheral pegs. METHODS: Function and pain were evaluated with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment score, visual analog scale, active shoulder range of motion, and strength. Postoperative radiographs were analyzed for radiolucent lines, progressive loosening, and at-risk signs. RESULTS: The mean American Shoulder and Elbow Surgeons score improved from 40.4 to 83.7 (P < .0001) and the mean visual analog scale from 5.9 to 0.8 (P < .0001). Forward elevation improved from 113° to 151° (P < .001), internal rotation from 49° to 60° (P = .035), and mean external rotation from 36° to 50° (P = .0006). Radiographs showed glenoid component radiolucency in 29 shoulders. Radiolucencies were confined to the area under the glenoid faceplate in 6 and were only around the central post in 13. Nine TSAs (20%) demonstrated 2 or more columns of involvement but were not judged to be at-risk. One implant (2.2%) had glenoid component failure and was revised to a hemiarthroplasty. CONCLUSION: Anatomic TSA using a hybrid glenoid component with a central porous titanium post demonstrated a low rate of mechanical failure and a rate of radiolucent lines comparable to reports of all polyethylene implants. Further evaluations are needed to demonstrate the long-term durability of these implants and to determine the significance and fate of the radiolucent lines, particularly relative to the central post.


Assuntos
Artroplastia do Ombro/instrumentação , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Prótese de Ombro , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Osteoartrite/cirurgia , Desenho de Prótese , Amplitude de Movimento Articular , Titânio , Escala Visual Analógica
10.
Artigo em Inglês | MEDLINE | ID: mdl-29494716

RESUMO

Reconstructing proximal humeral bone loss in the setting of shoulder arthroplasty can be a daunting task. Proposed techniques include long-stemmed humeral components, allograft-prosthesis composites (APCs), and modular endoprosthetic reconstruction. While unsupported long-stemmed components are at high risk for component loosening, APC reconstruction techniques have been reported with success. However, graft resorption and eventual failure are significant concerns. Modular endoprosthetic systems allow bone deficiencies to be reconstructed with metal, which may allow for a more durable reconstruction.


Assuntos
Artroplastia do Ombro/métodos , Transplante Ósseo , Úmero/patologia , Osseointegração/fisiologia , Ombro/cirurgia , Humanos , Úmero/cirurgia , Resultado do Tratamento
11.
Int Orthop ; 42(4): 733-740, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29299652

RESUMO

PURPOSE: This study aimed to identify patient and treatment factors that predict a favourable response to intra-articular hyaluronic acid (HA) treatment to better guide patient and treatment selection. METHODS: This prospective, observational study evaluated patients with mild-to-moderate (Kellgren-Lawrence grades 1-3) primary knee osteoarthritis treated between March 2013 and May 2016. Patient function and pain scores were assessed by the Western Ontario and McMaster Universities Arthritis Index/Knee Injury and Osteoarthritis Outcome Score (WOMAC/KOOS) and visual analogue scale (VAS) surveys, with response to treatment defined according to the Osteoarthritis Research Society International (OARSI) 2004 criteria. Surveys were completed at each injection and three months post-treatment. Patients were followed an average of 27 months. RESULTS: Of 102 patients, 57% had a positive response. Those at least twice as likely to respond were patients with grades 1-2 osteoarthritis or a positive response to the first injection and those who were ≥60 years. Gender, race, body mass index (BMI), smoking status, HA brand, and initial VAS and WOMAC/KOOS scores were not significant predictors of success. Mean time to arthroplasty following injection series was 11 months (30% of nonresponders, 12% of responders). The VAS strongly correlated with KOOS pain scores and successful outcomes. CONCLUSION: Patients with mild-to-moderate osteoarthritis (grades 1-2) and those responding positively to the first injection were twice as likely to respond positively to the injection series, as were patients ≥60 years. Patients who did not respond positively were more likely to proceed to arthroplasty. The VAS appears to be a reliable method of defining and monitoring treatment success. Judicious patient selection and counseling may improve outcomes associated with intra-articular HA injections.


Assuntos
Ácido Hialurônico/administração & dosagem , Osteoartrite do Joelho/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intra-Articulares , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Dor/tratamento farmacológico , Dor/etiologia , Medição da Dor , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento
12.
J Shoulder Elbow Surg ; 27(1): 23-28, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28747276

RESUMO

BACKGROUND: In the current health care environment, it is becoming increasingly important to recognize risks factors that may affect a patient's postoperative outcome. To determine the potential impact of tobacco as a risk factor, we evaluated postoperative pain, narcotic use, length of stay, reoperations, and complications in the global 90-day episode of care for patients undergoing anatomic total shoulder arthroplasty (TSA) who were current tobacco users, former users, or nonusers. METHODS: Database search identified 163 patients with primary anatomic TSA done for glenohumeral arthritis; these were divided into 3 groups: current tobacco users (28), nonusers (88), and former users (47). All surgeries were done with the same technique and implants. RESULTS: Patients in the current tobacco use group had significantly higher visual analog scale scores preoperatively and at 12 weeks postoperatively than nonusers and former users. Mean improvement in visual analog scale scores was significantly less in current tobacco users. Cumulative oral morphine equivalent use at 12 weeks was significantly higher in current tobacco users than in nonusers and former users. The average oral morphine equivalent per day was also significantly higher in the current tobacco users than in nonusers and former users. There were no significant differences in length of stay or complications. CONCLUSIONS: Although length of stay, complication rates, hospital readmissions, and reoperation rates were not significantly different, tobacco users reported increased postoperative pain and narcotic use in the global period after TSA. Former tobacco users were found to have a postoperative course similar to that of nonusers, suggesting that discontinuation of tobacco use can improve a patient's episode of care performance after TSA.


Assuntos
Analgésicos Opioides/uso terapêutico , Artroplastia do Ombro , Dor Pós-Operatória/etiologia , Uso de Tabaco , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite/cirurgia , Artroplastia do Ombro/efeitos adversos , Cuidado Periódico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reoperação , Estudos Retrospectivos , Fatores de Risco , Articulação do Ombro/cirurgia , Uso de Tabaco/efeitos adversos , Resultado do Tratamento
13.
Orthop Clin North Am ; 49(1): 73-79, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29145988

RESUMO

Health care policy makers have placed increased attention on the cost of health care making outpatient joint arthroplasty an attractive alternative to routine hospital admission. Recent studies have shown outpatient shoulder arthroplasty is a safe and cost-effective alternative to inpatient shoulder arthroplasty. Proper patient selection, patient education, effective pain management strategies, and attention to intraoperative blood loss are keys in the success of outpatient shoulder arthroplasty.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Artroplastia , Articulação do Ombro/cirurgia , Análise Custo-Benefício , Humanos , Seleção de Pacientes , Assistência Perioperatória
14.
J Arthroplasty ; 33(1): 46-50, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28927566

RESUMO

BACKGROUND: We proposed to determine the complication and hospital admission rates for patients with total hip arthroplasty (THA) done by a single surgeon in a stand-alone ambulatory surgical center with same-day discharge. Given the recent emphasis on bundled payments for a 90-day episode of care, this same time frame after surgery was chosen to determine patient outcomes. METHODS: The records of patients with THAs done through a direct anterior approach by a single surgeon at 2 separate ambulatory surgery centers were reviewed. To analyze the learning curve for outpatient THA, the procedures were arbitrarily divided into 2 groups depending on when they were done: early in our experience or later. Complications were recorded, as were hospital admissions and surgical interventions, length of surgery and blood loss, and time spent at the outpatient facility. RESULTS: Over a 3-year period, 145 outpatient THAs were done in 125 patients; 73 were considered to be initial procedures, and 72 were considered to be later procedures. Only one of the 145 procedures (0.7%) required transfer from the outpatient facility to the hospital for a blood transfusion. No other direct admissions to the hospital or transfers to the emergency department from the surgery center were necessary. Surgical interventions were required after 3 (2%) of the 145 arthroplasties in the global period (90 days). CONCLUSION: This study demonstrated that same-day discharge to home following THA can be safely done without increased complications, readmissions, reoperations, or emergency room visits.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Artroplastia de Quadril/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Artroplastia de Quadril/estatística & dados numéricos , Transfusão de Sangue , Hospitalização , Humanos , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Alta do Paciente , Complicações Pós-Operatórias/etiologia , Reoperação , Tennessee/epidemiologia
15.
J Arthroplasty ; 32(11): 3557-3562, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28390888

RESUMO

BACKGROUND: The efficacy and costs of indwelling interscalene catheter (ISC) and liposomal bupivacaine (LBC), with and without adjunctive medications, in patients with primary shoulder arthroplasty are a source of current debate. METHODS: In 214 arthroplasties, 156 patients had ISC and 58 had LBC injections that were mixed with morphine, ketorolac, and 0.5% bupivacaine with epinephrine. Charts were reviewed for visual analog scale pain scores, oral morphine equivalent (OME) usage, major complications, and costs. RESULTS: Visual analog scale scores were not significantly different at 24 hours or at 2, 6, and 12 weeks. Average OME consumption at 24 hours was significantly more with LBC, but was not significantly different at 12 weeks. Relative risk of a major complication was nearly 4 times higher with ISC than with LBC. The average cost for the LBC mixture was $289.04, and for ISC, including equipment and anesthesia fees, was $1559.42. CONCLUSION: The intraoperative LBC mixture provided equivalent pain relief with significantly fewer major complications and at markedly lower cost than ISC. LBC required almost twice as much OME to attain the same level of pain relief at 24 hours, but there was no significant difference in the cumulative amount of outpatient narcotic use.


Assuntos
Anestésicos Locais/administração & dosagem , Artroplastia do Ombro/efeitos adversos , Bupivacaína/administração & dosagem , Cateteres de Demora/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Anestésicos Locais/economia , Bupivacaína/economia , Cateterismo , Cateteres de Demora/economia , Epinefrina/administração & dosagem , Feminino , Humanos , Cetorolaco/administração & dosagem , Tempo de Internação , Lipossomos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Manejo da Dor , Medição da Dor , Dor Pós-Operatória/etiologia , Estudos Retrospectivos , Ombro
16.
J Shoulder Elbow Surg ; 26(5): 786-791, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27765502

RESUMO

BACKGROUND: Glenoid component positioning in revision shoulder arthroplasty is difficult because of distorted anatomic landmarks and scarring in and around the glenoid vault. This study compared glenoid component version in revision total shoulder arthroplasty (TSA) and reverse TSA (RTSA) using traditional instrumentation vs. a generic glenoid targeting guide. METHODS: Radiographs of 50 shoulders undergoing revision arthroplasty were reviewed by an independent reviewer. Twenty-one components were placed using traditional instrumentation and 29 with a generic targeting guide. Glenoid component version was measured on axillary lateral radiographs, and absolute deviation from anatomic version was calculated. RESULTS: The average deviation in version from anatomic was 8° (range, 0°-21°) with the traditional technique and 5° (range, 0°-18°) with the targeting guide (P = .03). In revision to TSA, the average deviation was 10° with the traditional technique and 3° with the targeting guide (P = .01). There was no significant difference in revision to RTSA (average deviation was 8° with traditional technique and 6° with the targeting guide). Glenoid components in obese patients (body mass index >30 kg/m2) had less deviation (5°) with the targeting guide technique than with the traditional technique (9°, P = .04). No significant differences were found between techniques in glenoids with more than 15° of preoperative retroversion, TSA conversion to RSTA, or arthroplasty after proximal humeral fixation. CONCLUSIONS: For revision arthroplasty, glenoid components placed with the generic targeting guide were significantly more accurate in version than with traditional instrumentation, particularly with revision to anatomic TSA. The targeting guide was useful in obese patients.


Assuntos
Artroplastia do Ombro/instrumentação , Ajuste de Prótese/instrumentação , Articulação do Ombro/cirurgia , Idoso , Pontos de Referência Anatômicos , Artroplastia do Ombro/métodos , Feminino , Hemiartroplastia/instrumentação , Hemiartroplastia/métodos , Humanos , Masculino , Reoperação , Articulação do Ombro/diagnóstico por imagem , Prótese de Ombro
17.
J Shoulder Elbow Surg ; 26(2): 204-208, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27592373

RESUMO

BACKGROUND: Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. METHODS: Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P < .05 were considered statistically significant. RESULTS: No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. CONCLUSIONS: Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Artroplastia do Ombro , Hospitalização , Artropatias/cirurgia , Articulação do Ombro , Adulto , Idoso , Transfusão de Sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
18.
J Shoulder Elbow Surg ; 26(1): 140-143, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27727050

RESUMO

BACKGROUND: Two popular systems for classifying rheumatoid arthritis affecting the elbow are the Larsen and Sharp schemes. To our knowledge, no study has investigated the reliability of these 2 systems. We compared the intraobserver and interobserver agreement of the 2 systems to determine whether one is more reliable than the other. METHODS: The radiographs of 45 patients diagnosed with rheumatoid arthritis affecting the elbow were evaluated. Anteroposterior and lateral radiographs were deidentified and distributed to 6 evaluators (4 fellowship-trained upper extremity surgeons and 2 orthopedic trainees). Each evaluator graded all 45 radiographs according to the Larsen and Sharp scoring methods on 2 occasions, at least 2 weeks apart. RESULTS: Overall intraobserver reliability was 0.93 (95% confidence interval [CI], 0.90-0.95) for the Larsen system and 0.92 (95% CI, 0.86-0.96) for the Sharp classification, both indicating substantial agreement. Overall interobserver reliability was 0.70 (95% CI, 0.60-0.80) for the Larsen classification and 0.68 (95% CI, 0.54-0.81) for the Sharp system, both indicating good agreement. There were no significant differences in the intraobserver or interobserver reliability of the systems overall and no significant differences in reliability between attending surgeons and trainees for either classification system. CONCLUSION: The Larsen and Sharp systems both show substantial intraobserver reliability and good interobserver agreement for the radiographic classification of rheumatoid arthritis affecting the elbow. Differences in training level did not result in substantial variances in reliability for either system. We conclude that both systems can be reliably used to evaluate rheumatoid arthritis of the elbow by observers of varying training levels.


Assuntos
Artrite Reumatoide/classificação , Articulação do Cotovelo , Artrite Reumatoide/diagnóstico por imagem , Humanos , Variações Dependentes do Observador , Radiografia , Reprodutibilidade dos Testes
19.
Iowa Orthop J ; 36: 31-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27528832

RESUMO

BACKGROUND: Prospective orthopedic residency applicants commonly use one of three databases to identify potential programs: Accreditation Council of Graduate Medical Education (ACGME), American Medical Association (FREIDA), or Orthogate. org. In addition, institutional websites are typically the primary source of information once programs are identified. We sought to evaluate the databases and websites used by prospective orthopedic surgery applicants for content and accessibility. We hypothesized that information would be more available in comparison to previous studies but would still fail to provide complete, up to date program information for the prospective applicant. METHODS: Three online databases were queried in December 2014 to compile a list of orthopedic residency programs in the United States. This combined list was used as a basis for evaluating individual institution websites. Previously described criteria were used to evaluate the availability of information contained within orthopedic surgery residency websites. RESULTS: At the time of online review, 157 programs were identified. Depending on the database in question, up to 33% of programs either did not provide a link or listed a non-functioning link. Among the variety of evaluated criteria, inclusion of the information varied between 12% and 97% for the individual program websites. CONCLUSIONS: Online databases are useful in listing programs, but individual program details and direct functional links are lacking. Most program websites contain varying degrees of desired information; however, not all programs maintain websites which consistently provide information to satisfy the evaluated criteria in this study. Improved online accessibility and availability of information for residency programs would increase their visibility and utility for prospective applicants.


Assuntos
Internet , Internato e Residência , Ortopedia/educação , Bases de Dados Factuais , Humanos , Estados Unidos
20.
J Shoulder Elbow Surg ; 25(9): 1418-24, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27038566

RESUMO

BACKGROUND: Younger patients who have undergone reverse total shoulder arthroplasty (RTSA) are believed to have higher activity levels that place higher stresses across the prosthesis, increasing the risk of failure, but there is little information to support or refute this supposition. The purposes of this study were to define the patient-reported activity levels of patients younger than 65 years and older than 65 years who underwent RTSA and to evaluate any differences between the groups. METHODS: Forty-six patients who underwent primary RTSA answered a questionnaire regarding their activity levels. Data were categorized and tabulated according to pain, range of motion, strength, and activity level (low, medium, and high demand). Statistical analyses were performed using the Fisher exact test, χ(2) test, and independent t test. Differences with P < .05 were considered statistically significant. RESULTS: Seventeen patients younger than 65 years (mean age, 57.7 years) and 29 patients older than 65 years (mean age, 75.2 years) were included. No significant differences were found for range of motion, strength, or number of activities; 47% of younger patients and 44% of older patients reported high-demand activities (P = .64); 24% of younger patients and 37% of older patients reported medium-demand use (P = .30). Patients younger than 65 years were more likely to require narcotic pain medication (P = .03) and to have disability (P = .0001). CONCLUSION: These data provide initial evidence that commonly held concerns about higher activity levels among younger patients placing excessive demands on the RTSA prosthesis may not be as important as currently thought. Rather, patients seem to self-regulate their activities to minimize pain and maximize essential functions after surgery.


Assuntos
Atividades Cotidianas , Artroplastia do Ombro/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Escala Visual Analógica , Adulto Jovem
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