Modifiable Risk Factors in Total Joint Arthroplasty

Abstract Background Persons living with HIV (PLHIV) now have dramatically improved life-expectancy with age-related morbidities requiring total joint arthroplasties. We present here an institutional review of PLHIV who underwent total joint arthroplasty and prosthesis-related adverse outcomes at one year. Methods This was a retrospective chart review in a large academic medical center. Inclusion criteria were adult PLHIV undergoing total joint arthroplasty between 2013 and 2017. Arthroplasty-related adverse outcomes within the first-year post-surgery were recorded. Patients were identified using ICD-10 codes and classified as having a PJI using Infectious Diseases Society of America (IDSA) criteria. Results A total of 40 patients met the criteria. The median age was 59 years and 53% of patients were male. The median CD4 count and RNA viral load were 587 (range 94–1920) cells/mm3 and 0 (range 0—189,000) copies/mL, respectively. The most common procedure was hip replacement (55%) and the most common indication for arthroplasty was avascular necrosis (43%). Adverse outcomes including PJI, dislocation, prosthesis loosening, seroma and chronic pain were identified in 28% of patients. PJI occurred in two patients and both required surgical revision. Modifiable risk factors present in both patients were active smoking, history of substance use disorder, chronic pulmonary disease, depression and hepatitis C antibody positivity. Both patients had CD4 counts >600 cells/mm3. Both were on atazanavir containing antiretroviral regimens. Neither patient was screened for MRSA carriage. Causal organisms were MRSA and MSSA respectively and each patient received 6 weeks of antimicrobial therapy. Conclusion This study supports that when medically optimized, PLHIV have favorable outcomes. The two patients who developed PJI had multiple non-HIV modifiable risk factors predisposing them to PJI. In one case, the patient’s isolated organism was MRSA, for which the patient did not receive appropriate pre-operative antimicrobial prophylaxis. This highlights the importance of routine screening for appropriate pre-operative prophylaxis in patients undergoing joint arthroplasty, independent of HIV status. Disclosures All authors: No reported disclosures.

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The Development of a Surgical Readiness Interview Tool for Patients to Improve Conversation on Modifiable Risk Factors Prior to Total Joint Arthroplasty

10.21203/rs.3.rs-48889/v1 ◽

2020 ◽

Author(s):

Kristen I Barton ◽

Christopher E Hewison ◽

Ania Kania-Richmond

Keyword(s):

Risk Factors ◽

Primary Care ◽

Conservative Management ◽

Total Joint Arthroplasty ◽

Qualitative Interviews ◽

Joint Arthroplasty ◽

Care Physician ◽

Qualitative Inquiry ◽

Modifiable Risk Factors ◽

Study Participants

Abstract Background: Total joint arthroplasty (TJA) surgery is conducted forsevere hip and knee osteoarthritis (OA). However, a significant numberof patients referred to orthopedic surgeons with hip and knee OA are not appropriate surgical candidates.Further, many are sent back to their primary care physician because they had not yet exhausted non-surgical options, which suggests the importance surgeons place on exhausting conservative management before proceeding with TJA.The objective of this qualitative inquiry was to 1) explore patients’ perspectives of a surgical readiness interview tool and its potential utility in the management process for patients with OA, and 2) gain input from study participants to further refine the tool and ensure that it is reflective of the patients’ needs and perspectives. Methods: We used a diverse convenience sampling strategy to recruit TJA patients from the hip and knee arthroplasty clinics in Calgary, Alberta. Semi-structured qualitative interviews were conducted using a cognitive interviewing approach in order to elicit information regarding clarity and relevance of the interview tool. All interviews were digitally recorded and transcribed verbatim. Through an iterative process, a coding framework was developed and then applied in the analysis of all interviews. Results: Nine interviews were conducted (n=3 males and n=6), all of whom had a TJA within the previous 12 months. Participants found the questions in the interview tool to be clear and relevant, and nothing listed was unexpected. All participants expressed that they felt comfortable discussing the content of the interview tool with their doctors. The main themes that emerged from the interviews include 1) the need for clarifications, 2) patient-oriented changes, and 3) expectation management. While gaining insight from study participants, the qualitative inquiry confirmed utility of the tool improve the conversation about surgical readiness and utilizing conservative management prior to TJA. Conclusions: Overall, participants were positive about the interview tool and felt that it would lead to better care provision. We recommend the use of the interview tool in primary care settings to support the conversation on modifiable risk factors and non-surgical management strategies for OA prior to TJA.

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Falls and fear of falling in older adults with total joint arthroplasty: a scoping review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2954-9 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Serena Kuangyi Chen ◽

Don Voaklander ◽

Danielle Perry ◽

C. Allyson Jones

Keyword(s):

Risk Factors ◽

Older Adults ◽

Scoping Review ◽

Total Joint Arthroplasty ◽

Fear Of Falling ◽

Joint Arthroplasty ◽

Modifiable Risk Factors ◽

Inclusion Criteria ◽

Increased Risk ◽

Risk Factors For Falls

Abstract Background Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. Methods Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. Results Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. Conclusions An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.

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Inheritable Risk Factors for Venous Thromboembolism in Patients Undergoing Lower Extremity Total Joint Arthroplasty

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2013010092 ◽

2013 ◽

Vol 23 (4) ◽

pp. 293-300

Author(s):

D. Alex Stroh ◽

Kimona Issa ◽

Samik Banerjee ◽

Jesse Allert ◽

Eiman Shafa ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Lower Extremity ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty

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Corrigendum to ‘Predictive Risk Factors for 30-day Readmissions Following Primary Total Joint Arthroplasty and Modification of Patient Management’. [The Journal of Arthroplasty 29/10 (2014) 1938–1942]

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.05.054 ◽

2016 ◽

Vol 31 (2) ◽

pp. 559

Author(s):

Samantha Tayne ◽

Christian A. Merrill ◽

Eric L. Smith ◽

William C. Mackey

Keyword(s):

Risk Factors ◽

Total Joint Arthroplasty ◽

Patient Management ◽

Joint Arthroplasty ◽

Predictive Risk

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Incidence of and Risk Factors for 30-Day Readmission Following Elective Primary Total Joint Arthroplasty: Analysis From the ACS-NSQIP

The Journal of Arthroplasty ◽

10.1016/j.arth.2013.06.032 ◽

2013 ◽

Vol 28 (9) ◽

pp. 1499-1504 ◽

Cited By ~ 150

Author(s):

Andrew J. Pugely ◽

John J. Callaghan ◽

Christopher T. Martin ◽

Peter Cram ◽

Yubo Gao

Keyword(s):

Risk Factors ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Acs Nsqip

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The Incidence And Risk Factors of Serum Hypokalemia After Primary Total Joint Arthroplasty

10.21203/rs.3.rs-1029175/v1 ◽

2021 ◽

Author(s):

Pin Pan ◽

Zitao Zhang ◽

Xiaofeng Zhang ◽

Qing Jiang ◽

Zhihong Xu

Keyword(s):

Risk Factors ◽

Red Blood Cells ◽

Knee Replacement ◽

Serum Potassium ◽

Total Joint Arthroplasty ◽

Blood Cells ◽

Potassium Level ◽

Serum Potassium Level ◽

Joint Arthroplasty ◽

Regular Monitoring

Abstract Background: Regular monitoring of serum potassium after total joint arthroplasty (TJA) is a routine examination, which can detect abnormal serum potassium and reduce adverse events timely caused by postoperative hypokalemia. In this study, we aimed to investigate the incidence and risk factors of hypokalemia after primary total hip and knee replacement.Methods: This study included patients who underwent unilateral total knee or hip arthroplasty in our department from April 2017 to March 2018. The serum potassium level before and after operation was collected and retrospectively analyzed. The differences in age, BMI and other factors between hypokalemia patients and non-hypokalemia patients at different time points after surgery were compared, and then the risk factors of postoperative hypokalemia were analyzed based on multiple logistic regression.Results: The total incidence of postoperative hypokalemia was 53.1%, while the respective rate on the first, third and fifth postoperative day was 12.5%, 40.7% and 9.6%. The serum potassium level on the first, third and fifth postoperative day was 3.84±0.32mmol/l, 3.59±0.34mmol/l and 3.80±0.32mmol/l, while among which, the level on the third day was the lowest (p=0.015). The independent risk factors for hypokalemia after total hip and knee replacement were the level of preoperative serum potassium (p=0.011), preoperative red blood cells (p=0.027), and a history of diabetes (p=0.007).Conclusion: Regular monitoring of serum potassium should be performed after TJA due to hypokalemia was a very common complication. We need to pay more attention to patients’ preoperative potassium and red blood cells, especially patients with diabetes.

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