Management of von Willebrand disease in patients undergoing total hip and knee arthroplasty

Von Willebrand disease is the commonest bleeding disorder encountered in the medical and surgical field. As a result of the repetitive bleeding into the joints many patients suffer from arthropathy that can cause a significant amount of pain and functional limitation. Total joint arthroplasty is being utilised as the last resort in managing these patients; however, the presence of von Willebrand disease raises a number of dilemmas. In this review, we look at the effects of von Willebrand disease on joints and the perioperative management of von Willebrand disease patients undergoing total joint arthroplasty.

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The impact of enhanced recovery after surgery on total joint arthroplasty: A protocol for systematic review and meta-analysis (Preprint)

10.2196/preprints.25581 ◽

2020 ◽

Author(s):

Siddharth Rele ◽

Cade Shadbolt ◽

Chris Schilling ◽

Nicholas F Taylor ◽

Michelle M Dowsey ◽

...

Keyword(s):

Systematic Review ◽

Health Service ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Meta Analysis ◽

Joint Arthroplasty ◽

Total Hip ◽

Hip And Knee Arthroplasty

BACKGROUND The number of total joint arthroplasty being performed is increasing worldwide. To match this increasing demand, there has been focus on hastening patients’ recovery of function. This effort has culminated in formulation of enhanced recovery for surgery (ERAS) strategies. However, with evolving ERAS programs and new recommendations, a review of current evidence is required to provide clinicians with up-to-date information about its effect on outcomes for total joint arthroplasty. OBJECTIVE This study outlines the protocol for a systematic review and meta-analysis that aims to assess the utility of enhanced recovery after surgery programs on patient, health services and economic outcomes for primary, elective total hip and knee arthroplasty. METHODS A systematic search will be conducted in Medline (OVID), EMCARE (OVID), Web of Science, CINAHL, National Health Service Economic Evaluations Database and the Cochrane Library. Analytical, observational and experimental designs will be included in this systematic review. Only studies including patients undergoing primary, total knee and hip arthroplasty comparing ERAS programs with conventional surgery and postoperative care will be included. Data related to patient outcomes, health service outcomes, safety and economic evaluation will be extracted. RESULTS The search terms have been finalized, and the final primary database search will be completed in November 2020. The results of this systematic review will be disseminated in a peer-reviewed journal. CONCLUSIONS This protocol will guide a systematic review assessing outcomes associated with ERAS surgery in primary, total hip and knee arthroplasty CLINICALTRIAL Open Science Framework. Doi: 10.17605/OSF.IO/Y4BHS

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Comprehensive Operative Note Templates for Primary and Revision Total Hip and Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001610010725 ◽

2016 ◽

Vol 10 (1) ◽

pp. 725-731 ◽

Cited By ~ 1

Author(s):

Ali J. Electricwala ◽

Derek F. Amanatullah ◽

Rapeepat I. Narkbunnam ◽

James I. Huddleston ◽

William J. Maloney ◽

...

Keyword(s):

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Revision Thas ◽

Total Hip ◽

Operative Note ◽

Hip And Knee Arthroplasty ◽

Operative Notes ◽

Revision Total Joint Arthroplasty ◽

Revision Tkas

Background: Adequate preoperative planning is the first and most crucial step in the successful completion of a revision total joint arthroplasty. The purpose of this study was to evaluate the availability, adequacy and accuracy of operative notes of primary surgeries in patients requiring subsequent revision and to construct comprehensive templates of minimum necessary information required in the operative notes to further simplify re-operations, if they should become necessary. Methods: The operative notes of 144 patients (80 revision THA’s and 64 revision TKA’s) who underwent revision total joint arthroplasty at Stanford Hospital and Clinics in the year 2013 were reviewed. We assessed the availability of operative notes and implant stickers prior to revision total joint arthroplasty. The availability of implant details within the operative notes was assessed against the available surgical stickers for adequacy and accuracy. Statistical comparisons were made using the Fischer-exact test and a P-value of less than 0.05 was considered statistically significant. Results: The primary operative note was available in 68 of 144 revisions (47%), 39 of 80 revision THAs (49%) and 29 of 66 revision TKAs (44%, p = 0.619). Primary implant stickers were available in 46 of 144 revisions (32%), 26 of 80 revision THAs (32%) and 20 of 66 revision TKAs (30%, p = 0.859). Utilizing the operative notes and implant stickers combined identified accurate primary implant details in only 40 of the 80 revision THAs (50%) and 34 of all 66 revision TKAs (52%, p = 0.870). Conclusion: Operative notes are often unavailable or fail to provide the necessary information required which makes planning and execution of revision hip and knee athroplasty difficult. This emphasizes the need for enhancing the quality of operative notes and records of patient information. Based on this information, we provide comprehensive operative note templates for primary and revision total hip and knee arthroplasty.

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Ceforanide vs. Cephalothin Concentrations in Total Joint Arthroplasty

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808301700910 ◽

1983 ◽

Vol 17 (9) ◽

pp. 645-648 ◽

Cited By ~ 3

Author(s):

William J. Cady ◽

Bradley G. Wulf ◽

Michael T. O'Neil ◽

Dwight W. Burney ◽

William R. Hamsa

Keyword(s):

Total Knee Arthroplasty ◽

Synovial Fluid ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Plasma Concentrations ◽

Prophylactic Antibiotic ◽

Joint Arthroplasty ◽

Total Hip ◽

Orthopedic Procedure ◽

Total Knee

Total joint arthroplasty is a common orthopedic procedure and requires prophylactic antibiotic coverage to prevent infections in the operated joint. The antibiotics routinely used for prophylaxis are the cephalosporins. This study compared bone, synovial fluid, and plasma concentrations of ceforanide with cephalothin concentrations in 30 patients undergoing elective total hip or total knee arthroplasty. Ceforanide provided significantly higher plasma concentrations for 61–110 minutes postdose than did cephalothin (p < 0.025 and p < 0.005). No difference was noted between the two antibiotics for the bone concentrations in the total hip arthroplasty group; however, cephalothin concentrated to a greater degree in the bone of patients undergoing total knee arthroplasty (p < 0.05). Cephalothin achieved higher concentrations in the synovial fluid than did ceforanide (p < 0.05). Both antibiotics were well tolerated and no postoperative infections were noted in either group.

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Predictors for readmission following primary total hip and total knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499020959160 ◽

2020 ◽

Vol 28 (3) ◽

pp. 230949902095916

Author(s):

Ong-art Phruetthiphat ◽

Jesse E Otero ◽

Biagio Zampogna ◽

Sebastiano Vasta ◽

Yubo Gao ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Multivariate Regression ◽

The United States ◽

Joint Arthroplasty ◽

Hospital Length Of Stay ◽

Common Cause ◽

Total Hip ◽

Total Knee

Background: Readmission following total joint arthroplasty has become a closely watched metric for many hospitals in the United States due to financial penalties imposed by Centers for Medicare and Medicaid Services. The purpose of this study was to identify both preoperative and postoperative reasons for readmission within 30 days following primary total hip and total knee arthroplasty (TKA). Methods: Retrospective data were collected for patients who underwent elective primary total hip arthroplasty (THA; CPT code 27130) and TKA (27447) from 2008 to 2013 at our institution. The sample was separated into readmitted and nonreadmitted cohorts. Demography, comorbidities, Charlson comorbidity index (CCI), operative parameters, readmission rates, and causes of readmission were compared between the groups using univariate and multivariate regression analysis. Results: There were 42 (3.4%) and 28 (2.2%) readmissions within 30 days for THA and TKA, respectively. The most common cause of readmission within 30 days following total joint arthroplasty was infection. Trauma was the second most common reason for readmission of a THA while wound dehiscence was the second most common cause for readmission following TKA. With univariate regression, there were multiple associated factors for readmission among THA and TKA patients, including body mass index, metabolic equivalent (MET), and CCI. Multivariate regression revealed that hospital length of stay was significantly associated with 30-day readmission after THA and TKA. Conclusion: Patient comorbidities and preoperative functional capacity significantly affect 30-day readmission rate following total joint arthroplasty. Adjustments for these parameters should be considered and we recommend the use of CCI and METs in risk adjustment models that use 30-day readmission as a marker for quality of patient care. Level of Evidence: Level III/Retrospective cohort study

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Functional outcomes after total joint arthroplasty are related to the severity of Parkinson’s disease: a mid-term follow-up

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1447-8 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 4

Author(s):

Xiao Rong ◽

Suraj Dahal ◽

Ze-yu Luo ◽

Kai Zhou ◽

Shun-Yu Yao ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Total Hip Arthroplasty ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Total Joint Arthroplasty ◽

Functional Outcomes ◽

Joint Arthroplasty ◽

Total Hip ◽

Total Knee

Abstract Background Performing total joint arthroplasty (TJA) in Parkinson’s disease (PD) patients may encounter a higher complication rate or worse functional outcomes compared with common patients. The relationship between PD and clinical outcomes after TJA is not fully understood. Methods Retrospectively, we used manual charts to investigate the clinical outcomes in 41 patients including 24 total hip arthroplasty (THA) patients (28 hips) and 18 total knee arthroplasty (TKA) patients (22 knees) with a diagnosis of PD from 2009 to 2016. The stage of PD was confirmed by Hoehn and Yahr scale. Prosthesis survivorship was estimated with revision for any reason as the endpoint. Result All the clinical outcomes improved significantly (p < 0.05). Subgroup analysis revealed worse functional outcomes in mid- or end-stage PD patients. Sixteen short-term mild to moderate complications were noted. Two revisions were conducted for hip periprosthetic osteolysis and postoperative knee pain. The prosthesis survivorship at 60 months for TJA, total hip arthroplasty (THA), or total knee arthroplasty (TKA) was 91.6%, 94.1%, and 87.5%, respectively. Conclusion Patients with PD who underwent TJA would result in excellent pain relief and gain of function. However, patients at late-stage PD may suffer from functional loss. The effectiveness of TJA in patients with severe PD remains a concern. Physician should help delay the progression of PD which may optimize and stabilize the functional outcomes of TJA.

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Who Should Not Undergo Short Stay Hip and Knee Arthroplasty? Risk Factors Associated With Major Medical Complications Following Primary Total Joint Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.01.056 ◽

2015 ◽

Vol 30 (9) ◽

pp. 1-4 ◽

Cited By ~ 72

Author(s):

P. Maxwell Courtney ◽

Joshua C. Rozell ◽

Christopher M. Melnic ◽

Gwo-Chin Lee

Keyword(s):

Risk Factors ◽

Knee Arthroplasty ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Medical Complications ◽

Short Stay ◽

Factors Associated ◽

Hip And Knee Arthroplasty

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Patient Satisfaction After Lower Extremity Total Joint Arthroplasty: An Analysis of Medical Comorbidities and Patient Demographics

Journal of Patient Experience ◽

10.1177/23743735211018089 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110180

Author(s):

Nicholas Frane ◽

Erik J Stapleton ◽

Brandon Petrone ◽

Aaron Atlas ◽

Larry Lutsky ◽

...

Keyword(s):

Patient Satisfaction ◽

Knee Arthroplasty ◽

Joint Arthroplasty ◽

Patient Specific ◽

Total Hip ◽

Hip And Knee Arthroplasty ◽

Total Knee ◽

Specific Factors ◽

Hip Arthroplasties ◽

Hcahps Survey

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has received increased attention to determine which demographics may influence patient satisfaction after Total Hip and Knee Arthroplasty. The purpose of this study was to evaluate the various effects that patient-specific factors, medical comorbidities, and demographics had on patient satisfaction. Two thousand and ninety-two patients underwent lower extremity total joint arthroplasty at our institution between 2014 and 2018. Nine hundred twenty-three of these patients responded to their HCAHPS survey (44%). Most patients (609, 66%) underwent primary total knee arthroplasty followed by 244 (26.4%) total hip arthroplasties, 35 (3.8%) revision total knee arthroplasties, 28 (3.0%) bilateral total knee arthroplasties, and 7 (0.8%) revision total hip arthroplasties. Increasing age and length of stay were associated with a decrease in patient satisfaction whereas patients who were married reported higher satisfaction. Patients discharged to a rehabilitation facility had a 12% decrease in top-box response rate compared to those discharged home. Contrary to our hypothesis, specific procedure type and the presence of comorbidities failed to predict patient satisfaction. The results of this study shed light on the intricate relationship between patient satisfaction and patient-specific factors. Furthermore, health care workers can counsel patients on expected satisfaction when considering total hip and knee arthroplasty.

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