Patient-specific versus conventional instrumentation for total knee arthroplasty: peri-operative and cost differences.

The role of patient-specific instrumentation in total knee arthroplasty (TKA) is yet to be clearly defined. Current evidence evaluating peri-operative and cost differences against conventional TKA is unclear. We reviewed 356 TKAs between July 2008 and April 2013; 306 TKAs used patient-specific instrumentation while 50 had conventional instrumentation. The patient-specific instrumentation cohort averaged 20.4 min less surgical time (P < 0.01) and had a 42% decrease in operating room turnover time (P = 0.022). At our institution, the money saved through increased operating room efficiency offset the cost of the custom cutting blocks and pre-operative advanced imaging. Routine use of patient-specific TKA can be performed with less surgical time, no increase in peri-operative morbidity, and at no increased cost when compared to conventional TKA.

Lung ultrasonography derived B-line scores as predictors of left ventricular end-diastolic pressure and pulmonary artery wedge pressure.

BACKGROUND: Non-invasive assessment of elevated left ventricular end-diastolic pressure (LVEDP) and pulmonary artery wedge pressure (PAWP) in patients with heart diseases is challenging. Lung ultrasonography (LUS) is a promising modality for predicting LVEDP and PAWP. METHODS: Fifty-seven stable ambulatory patients who underwent right and left heart catheterization were included. Following the procedures, LUS was performed in twenty-eight ultrasonographic zones, and the correlation between five different LUS derived B-line scores with LVEDP and PAWP was examined. RESULTS: The B-line index correlated with LVEDP and PAWP, with coefficients of 0.45 (p = 0.006) and 0.30 (p = 0.03), respectively. B-line index showed an AUC of 0.76 for identifying LVEDP > 15 mmHg (p = 0.01) and an AUC of 0.73 for identifying PAWP > 15 mmHg (p = 0.008). Overall, scores performances were similar in predicting LVEDP or PAWP > 15 mmHg. A B-line index ≥ 28 was significantly associated with LVEDP > 15 mmHg (OR: 9.97) and PAWP > 15 mmHg (OR: 6.61), adjusted for age and indication for heart catheterization. CONCLUSIONS: LUS derived B-line scores are moderately correlated with PAWP and LVEDP in patients with heart diseases. A B-line index ≥ 28 can be used to predict elevated LVEDP and PAWP with high specificity.

Clinical predictors of psychological distress in patients presenting for evaluation of a spinal disorder.

BACKGROUND CONTEXT: Psychological distress has been shown to adversely affect the treatment outcomes of many spinal disorders. Most physicians do not routinely use psychological screening questionnaires. Additionally, physicians have not performed well when assessing patients for psychological distress while using clinical impression alone. PURPOSE: The purpose of our study was to evaluate the clinical factors that most accurately predict the presence of psychological distress in patients presenting for the evaluation of a spinal disorder. STUDY DESIGN: This is a retrospective study. PATIENT SAMPLE: Three hundred eighty-eight consecutive patients presented for an initial evaluation of a spinal disorder at a tertiary spine clinic. OUTCOME MEASURES: Oswestry disability index (ODI), visual analog scale (VAS), and distress risk assessment method (DRAM). METHODS: Three hundred eighty-eight consecutive patients presenting for the evaluation of a spinal disorder with a completed DRAM, ODI, and VAS were evaluated. The DRAM was used to classify the patients' level of psychological distress. Clinical variables such as history of depression, use of antidepressants, use of other psychotropic medications, history of surgery, and history of chronic pain syndromes along with ODI and VAS scores were used to develop a model to predict a patient's level of psychological distress. RESULTS: Our model was highly accurate (92%), sensitive (92%), and specific (95%) in predicting a patient's level of psychological distress. If patients' VAS is 4 or 5, their ODI is less than 45, and they are not on any psychotropic medications, they likely will fall into the normal group. Patients with a VAS greater than 7, currently taking antidepressants or other psychotropic medications, an ODI greater than 58, and a history of surgery are likely to fall into the higher distressed categories of distressed depressive or distressed somatic. CONCLUSIONS: A patient's clinical history, ODI, and VAS scores can predict their level of psychological distress. In general, patients with higher VAS pain scores, higher ODI scores (>58), and those taking an antidepressant or another psychotropic medication were likely to have high levels of psychological distress. The predictive clinical factors noted in this study are readily available to most physicians treating spinal disorders and may be helpful in improving their ability to detect patients with psychological distress, counseling them on realistic outcomes, and possibly improve their treatment outcomes.