scholarly journals The effect of smoking on outcomes following primary total hip and knee arthroplasty: a population-based cohort study of 117,024 patients

2019 ◽  
Vol 90 (6) ◽  
pp. 559-567 ◽  
Author(s):  
Gulraj S Matharu ◽  
Sofia Mouchti ◽  
Sarah Twigg ◽  
Antonella Delmestri ◽  
David W Murray ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Arthroplasty ◽  
Population Based ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

scholarly journals Protocol for a prospective cohort study of assessing postoperative cognitive changes after total hip and knee arthroplasty in the Greater Toronto area

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024259
Author(s):  
Stephen Choi ◽  
Sinziana Avramescu ◽  
Beverley A Orser ◽  
Shelly Au
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Knee Arthroplasty ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Postoperative Cognitive Dysfunction ◽  
Cognitive Changes ◽  
Total Hip ◽  
Postoperative Cognitive Decline ◽  
Hip And Knee Arthroplasty

IntroductionCognitive changes after anaesthesia and surgery, such as delirium and postoperative cognitive dysfunction (POCD), are common and lead to poor outcomes and increased healthcare costs. While several interventions for delirium exist, there are no effective treatment strategies for POCD. Understanding the risks and contributing factors may offer clinicians unique opportunities to better identify and develop preventative interventions for those at higher risk. Elderly patients undergoing orthopaedic surgery are at high risk of developing postoperative delirium (PD) and POCD. The incidence of POCD has not been rigorously studied in the total hip and knee arthroplasty (THA/TKA) population. Therefore, we have designed a prospective, observational cohort study to assess POCD in patients undergoing THA/TKA, both increasingly common procedures. The incidence of PD and POCD in a high volume, tertiary care arthroplasty centre will be determined and associated risk factors will be identified.Methods and analysisCognitive function will be tested with a computer-based cognitive assessment tool [CogState Brief Battery], preoperatively at baseline and postoperatively while in hospital at (<3 days), 6 weeks and 4.5 months. The primary outcome is the incidence of postoperative cognitive decline at 4.5 months. Logistic regression analysis is planned to test the association of POCD with several potential risk factors. In addition, delirium will be assessed preoperatively and postoperatively in the hospital using the Confusion Assessment Method (3D-CAM).Ethics and disseminationThe protocol for this prospective observational study was approved by the Sunnybrook Health Sciences Centre Research Ethics Board (REB#: 040–2017). Recruitment commenced in May 2017 and will continue until 2019. The results will be disseminated in a peer-reviewed journal and in scientific meetings.Trial registration numberNCT03147937.

Early Discharge After Total Hip and Knee Arthroplasty—An Observational Cohort Study Evaluating Safety in 330,000 Patients

2020 ◽  
Vol 35 (12) ◽  
pp. 3482-3487.e3
Author(s):  
Raman Mundi ◽  
Daniel E. Axelrod ◽  
Borna T. Najafabadi ◽  
Basma Chamas ◽  
Harman Chaudhry ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Arthroplasty ◽  
Early Discharge ◽  
Observational Cohort Study ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
Observational Cohort

scholarly journals Days alive and out of hospital after fast-track total hip and knee arthroplasty: an observational cohort study in 16 137 patients

2019 ◽  
Vol 123 (5) ◽  
pp. 671-678 ◽  
Author(s):  
Christoffer C. Jørgensen ◽  
Pelle B. Petersen ◽  
Henrik Kehlet ◽  
Frank Madsen ◽  
Torben B. Hansen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Knee Arthroplasty ◽  
Fast Track ◽  
Observational Cohort Study ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
Observational Cohort

scholarly journals Exploring variation in patient access of post-discharge physiotherapy following total hip and knee arthroplasty under a choice based system in the UK: an observational cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e021614 ◽  
Author(s):  
David F Hamilton ◽  
Fanny C Loth ◽  
Deborah J MacDonald ◽  
Gary J MacFarlane ◽  
David J Beard ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Post Discharge ◽  
Total Hip ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty ◽  
Total Knee ◽  
The Uk

ObjectivesTo assess a targeted ‘therapy as required’ model of post-discharge outpatient physiotherapy provision. Specifically, we investigated what proportion of patients accessed post-discharge physiotherapy following total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether accessing therapy was associated with post-arthroplasty patient reported outcomes and whether it was possible to predict which patients would access post-discharge physiotherapy from pre-operative data.DesignProspective, observational, longitudinal cohort study.SettingSingle National Health Service orthopaedic teaching hospital in the UK.Participants1395 patients undergoing total hip arthroplasty and 1374 patients undergoing total knee arthroplasty.Primary and secondary outcome measuresSelf-reported access of post-discharge physiotherapy, the Oxford Hip or Knee Score, EuroQol 5-dimension questionnaire and post-operative surgical episode satisfaction metric.Results662 (48.2%) patients with TKA and 493 (35.3%) patients with THA accessed additional post-discharge physiotherapy. Patient-reported outcomes (p<0.001) and surgical episode satisfaction (p=0.001) in both THA and TKA were higher in patients that did not participate in post-discharge physiotherapy. Regression models using pre-operative symptom burden and demographic data predicted post-discharge therapy access with an accuracy of only 17% greater than chance in patients with THA and 7% greater than chance in patients with TKA.ConclusionsIn a choice-based service model of ‘therapy as required’ following hip and knee arthroplasty only a third of THA and half of TKA patients accessed post-discharge therapy. Patients who did not access physiotherapy reported greater post-operative outcomes. This variation in the need for post-discharge physiotherapy suggests that targeting of rehabilitation may be a cost-effective model, however it was not possible to reliably predict which patients would access post-discharge physiotherapy from pre-operative data.

Safety of In-Hospital Only Thromboprophylaxis after Fast-Track Total Hip and Knee Arthroplasty: A Prospective Follow-Up Study in 17,582 Procedures

2018 ◽  
Vol 118 (12) ◽  
pp. 2152-2161 ◽  
Author(s):  
Pelle Petersen ◽  
Henrik Kehlet ◽  
Christoffer Jørgensen ◽  
Keyword(s):  
Cohort Study ◽  
Knee Arthroplasty ◽  
Fast Track ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Co Morbidity ◽  
National Patient ◽  
Hip And Knee Arthroplasty ◽  
Associated Risk Factors

AbstractMost international guidelines recommend pharmacological thromboprophylaxis after total hip and knee arthroplasty (THA/TKA) for 10 to 35 days. However, a recent cohort study on fast-track THA and TKA questioned the need for prolonged thromboprophylaxis when length of stay (LOS) is ≤ 5 days. We aimed at re-investigating the incidence of venous thromboembolism (VTE) in fast-track THA and TKA with in-hospital only thromboprophylaxis when LOS was ≤ 5 days. Prospective cohort study from 1 December 2011 to 30 October 2015 on elective unilateral THA/TKA with in-hospital only thromboprophylaxis if LOS was ≤ 5 days. Prospective information on co-morbidity and complete 90-day follow-up through the Danish National Patient Registry and medical records. Patients with pre-operative use of anticoagulants were excluded. In per protocol analysis, 17,582 (95.5%) had LOS of ≤ 5 days (median, 2 [interquartile range, 2–3]) and in-hospital thromboprophylaxis only. Incidence of symptomatic VTE was 0.40%, consisting of 28 (0.16%) pulmonary embolisms (PEs), 38 (0.22%) deep vein thrombosis (DVT) and 4 (0.02%) combined DVT and PE. Two PEs (0.01%) were fatal. VTE-associated risk factors with in-hospital only thromboprophylaxis were age > 85 years, odds ratio (OR) of 3.74 (95% confidence interval: 1.15–12.14, p = 0.028), body mass index (BMI) of 35 to 40, OR of 2.55 (1.02–6.35, p = 0.045) and BMI > 40, OR of 3.28 (1.02–10.56, p = 0.046). In conclusion, 90-day incidence of VTE after fast-track THA and TKA with in-hospital thromboprophylaxis only was 0.40%. Prolonged thromboprophylaxis may be reserved for LOS > 5 days or specific high-risk patients, but requires further studies regarding optimal type and duration of thromboprophylaxis.

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