Corneal Abrasions in Total Joint Arthroplasty

Introduction Corneal abrasion (CA) is the most common ocular complication in patients undergoing nonocular surgery. Corneal abrasions can be caused by a variety of mechanisms, the most common being drying of the cornea due to reduced tear secretions, loss of eyelid reflex, and the loss of pain recognition during surgery. Though CA heals well with eye lubricants, it can result in significant ocular pain and some cases may go on to develop ocular complications. With the current switch to outpatient total joint replacement, CA could potentially lead to discharge delays. Materials and Methods We examined the results of a quality improvement project to reduce CA during general anesthesia to determine the rates of CA during hip and knee total joint replacement. We compared rates of CA for 6 months before and 6 months after the intervention. Results A total of 670 hip and knee arthroplasty procedures were performed during this period. Two events of CA occurred, one occurred before and one after the intervention to decrease eye injuries. Both incidences occurred during total hip arthroplasty (THA) procedures with the patient in the lateral decubitus position and recovered without long-term deficit. Discussion Surgeons and anesthesiologists alike should be cognizant of this avoidable complication and take precaution to protect the eyes during surgery, especially during THA when the patient is placed in the lateral decubitus position. Conclusion Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if same-day discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty. The lateral decubitus position and longer surgeries times are risk factors for CA.

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The effect of cup orientation on stability of trapeziometacarpal total joint arthroplasty: a biomechanical cadaver study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193419851775 ◽

2019 ◽

Vol 44 (7) ◽

pp. 708-713 ◽

Cited By ~ 3

Author(s):

Annelien Brauns ◽

Pieter Caekebeke ◽

Joris Duerinckx

Keyword(s):

Range Of Motion ◽

Joint Replacement ◽

Total Joint Arthroplasty ◽

Total Joint Replacement ◽

Articular Surface ◽

Three Dimensional ◽

Cadaver Study ◽

Joint Arthroplasty ◽

Joint Stability ◽

Prosthetic Joint

It has been suggested that the cup of a trapeziometacarpal total joint replacement should be positioned parallel with the proximal articular surface of the trapezium to align it with the centre of motion. This would diminish the chance of dislocation. The goal of this study was to test this idea biomechanically. A linked trapeziometacarpal prosthesis was implanted in seven cadaver hands and combined with three-dimensional printed trapezium cups in 17 different orientations. For every combination, stability of the prosthesis was assessed through its entire passive range of motion. Dorsal inclination of the cup relative to the proximal articular surface increased the risk of dislocation with thumb flexion and opposition. The risk of dislocation was also increased with lateral or medial inclination of the cup exceeding 20°. Our results demonstrate that cup orientation is an important factor in prosthetic joint stability. Cup placement parallel to the proximal articular surface is ideal.

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Decreasing the Incidence of Post-Operative Urinary Retention (POUR) and Incontinence with the Total Joint Replacement Patients after Spinal Anesthesia in the Post Anesthesia Care Unit (PACU): A Quality Improvement Project

Journal of PeriAnesthesia Nursing ◽

10.1016/j.jopan.2019.05.102 ◽

2019 ◽

Vol 34 (4) ◽

pp. e42-e43

Author(s):

Shannon M. Wishart

Keyword(s):

Quality Improvement ◽

Spinal Anesthesia ◽

Urinary Retention ◽

Joint Replacement ◽

Total Joint Replacement ◽

Quality Improvement Project ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Improvement Project

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Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2021-103189 ◽

2022 ◽

pp. rapm-2021-103189

Author(s):

Edward Yap ◽

Julia Wei ◽

Christopher Webb ◽

Kevin Ng ◽

Matthias Behrends

Keyword(s):

Cohort Study ◽

General Anesthesia ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Outpatient Surgery ◽

Joint Arthroplasty ◽

Neuraxial Anesthesia ◽

General Anesthesia Group ◽

Increased Risk ◽

Same Day Discharge

BackgroundNeuraxial anesthesia when compared with general anesthesia has shown to improve outcomes following lower extremity total joint arthroplasty. It is unclear whether these benefits are present in outpatient surgery given the selection of healthier patients.ObjectiveTo compare the effects of neuraxial versus general anesthesia on outcomes following ambulatory hip and knee arthroplasty.MethodsMulticentered retrospective cohort study in ambulatory hip or knee arthroplasty patients between January 2017 and December 2019. Primary endpoint examined 30-day major postoperative complications (mortality, myocardial infarction, deep venous thromboembolism, pulmonary embolism, stroke, and acute renal failure).ResultsOf 11 523 eligible patients identified, 10 003 received neuraxial anesthesia, while 1520 received general anesthesia. 30-day major complications did not differ between neuraxial anesthesia and general anesthesia groups (1.8% vs 2.3%; aOR=0.85, CI: 0.56 to 1.27, p=0.39). There was no difference in 30-day minor complications (surgical site infection, pneumonia, urinary tract infection; 3.3% vs 4.1%; aOR=0.83, CI: 0.62 to 1.14, p=0.23). The neuraxial group demonstrated reduced pain and analgesia requirements and had less postoperative nausea and vomiting (PONV). Median recovery room length of stay was shorter by 52 min in the general anesthesia group, but these patients were more likely to fail same day discharge (33% vs 23.4%; p<0.01).ConclusionAnesthesia type was not associated with an increased risk for complications. However, neuraxial anesthesia improved outcomes that predict readiness for discharge: patients had less pain, required less opioids, and had a lower incidence of PONV, thus improving the rate of same day discharge.Trial registration numberNCT04203732.

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Diffusion of Successful Same Day Discharge Practice for Total Joint Arthroplasty Patients to a Select Population of Mastectomy Patients

Journal of PeriAnesthesia Nursing ◽

10.1016/j.jopan.2021.06.048 ◽

2021 ◽

Vol 36 (4) ◽

pp. e15

Author(s):

Team Leaders: Charlene Salvi ◽

June Nichols

Keyword(s):

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Same Day Discharge

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Team Approach: Same-Day Discharge of Patients Undergoing Total Joint Arthroplasty

JBJS Reviews ◽

10.2106/jbjs.rvw.19.00176 ◽

2020 ◽

Vol 8 (6) ◽

pp. e0176-e0176

Author(s):

Alexander M. Crawford ◽

Antonia F. Chen ◽

Amirmehdi Sabeti ◽

Jean F. Jay ◽

Vivek M. Shah

Keyword(s):

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Team Approach ◽

Same Day Discharge

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Total Joint Prosthetic Arthroplasty of the Great Toe—A 12-Year Experience

Foot & Ankle ◽

10.1177/107110078400400506 ◽

1984 ◽

Vol 4 (5) ◽

pp. 249-261 ◽

Cited By ~ 34

Author(s):

Stanley L. Kampner

Keyword(s):

Rheumatoid Arthritis ◽

Total Joint Arthroplasty ◽

Total Joint Replacement ◽

Metatarsophalangeal Joint ◽

Joint Arthroplasty ◽

Surgical Reconstruction ◽

Prosthetic Replacement ◽

Great Toe ◽

Number Of Patients

This report describes the use of a double-stemmed flexible hinge silicone elastomer implant for use as a total joint replacement for the metatarsophalangeal joint of the great toe. Experience with this prosthesis has been since 1971 with 103 prostheses implanted in 71 patients with a minimum follow-up of 12 months and an average follow-up of 7.4 years. Of the 71 patients, 40 had osteoarthritis with 64 joints replaced, 22 had rheumatoid arthritis with 29 joints replaced, four patients were revised from a failed excisional hemiarthroplasty, three patients with four joints involved were revised from a failed silicone implant hemiarthroplasty, and two patients had a surgically arthrodesed metatarsophalangeal joint taken down and revised to a total joint arthroplasty. Of the total number of patients involved, eight were men, 63 were women, and the average age per joint was 56 years. The results were graded as excellent, good, fair, and poor on two bases: relief of pain and the cosmetic result. Overall results were good. On the basis of these results over a 12-year period, it was concluded that there is a place for total joint prosthetic replacement in the surgical reconstruction of the painful, destroyed metatarsophalangeal joint of the great toe.

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Outcomes of a Joint Replacement Surgical Home Model Clinical Pathway

BioMed Research International ◽

10.1155/2014/296302 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Avinash Chaurasia ◽

Leslie Garson ◽

Zeev L. Kain ◽

Ran Schwarzkopf

Keyword(s):

Length Of Stay ◽

Joint Replacement ◽

Total Joint Arthroplasty ◽

Clinical Pathway ◽

Perioperative Care ◽

Care Facility ◽

Minimum Cost ◽

Joint Arthroplasty ◽

Maximum Benefit ◽

Clinical Measurements

Optimizing perioperative care to provide maximum benefit at minimum cost may be best achieved using a perioperative clinical pathway (PCP). Using our joint replacement surgical home (JSH) model PCP, we examined length of stay (LOS) following total joint arthroplasty (TJA) to evaluate patient care optimization. We reviewed a spectrum of clinical measurements in 190 consecutive patients who underwent TJA. Patients who had surgery earlier in the week and who were earlier cases of the day had a significantly lower LOS than patients whose cases started both later in the week and later in the day. Patients discharged home had significantly lower LOS than those discharged to a secondary care facility. Patients who received regional versus general anesthesia had a significantly lower LOS. Scheduling patients discharged to home and who will likely receive regional anesthesia for the earliest morning slot and earlier in the week may help decrease overall LOS.

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A Literature-Based Resource for the Development of Outpatient Arthroplasty Patient Selection Criteria

Reconstructive Review ◽

10.15438/rr.11.1.280 ◽

2021 ◽

Vol 11 ◽

Author(s):

Joseph Gondusky ◽

Richard Pahapill ◽

Christian Coulson

Keyword(s):

Patient Selection ◽

Total Joint Arthroplasty ◽

Selection Criteria ◽

Outpatient Setting ◽

Joint Arthroplasty ◽

Same Day Discharge ◽

Patient Selection Criteria ◽

Patient Optimization ◽

Optimal Site

Total joint arthroplasty (TJA) is moving towards the outpatient setting. Teams must develop patient selection criteria to ensure appropriate candidates are treated at the optimal site of care. Protocols and recommendations have been developed to aid care teams in developing patient selection criteria, but these come from multiple disparate sources. We review the available literature on patient selection criteria and optimization in the outpatient TJA population, and synthesize this information into a workable format for care design. We hope to provide a resource to stakeholders that can be tailored to their unique outpatient facility. Keywords: Total joint arthroplasty, outpatient, same day discharge, selection criteria, patient optimization.

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