scholarly journals Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091817
Author(s):  
Nicholas M. Hernandez ◽  
Sean P. Ryan ◽  
Christine J. Wu ◽  
Zoe W. Hinton ◽  
Samuel S. Wellman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Bilateral Total Knee Arthroplasty ◽  
Skilled Nursing ◽  
Tertiary Referral Center ◽  
Bilateral Tkas ◽  
Total Knee ◽  
Ed Visits ◽  
Acute Care Facilities

Purpose: Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to compare patient outcomes at a single tertiary referral center. Methods: The institutional database was queried from March 2014 to December 2017 for primary TKA. Patients undergoing bilateral procedures were stratified by same-day versus staged; length of stay (LOS), disposition, 90-day emergency department (ED) visits, and 90-day readmissions were examined through univariable and multivariable analyses. Results: A total of 676 patients were evaluated (113 same-day and 563 staged bilateral TKA patients) with mean age 66.0 (8.5) at first surgery and 292.1 (241.6) days between staged procedures. Same-day bilateral TKA patients were younger ( p < 0.001), had lower body mass index (BMI) ( p = 0.010), and had lower American Society of Anesthesiologists (ASA) scores ( p = 0.030). They were more likely to have a prolonged LOS ( p < 0.001) and be discharged to skilled nursing facility or rehab facility ( p < 0.001). Total LOS for separate hospitalizations in staged procedures was greater than LOS for same-day bilateral TKAs ( p < 0.001). There was no difference in 90-day ED visits ( p = 0.623) or readmission ( p = 0.286). In a multivariable model controlling for age, BMI, and ASA score, same-day bilateral TKA was not significantly associated with ED visits or readmissions. Conclusions: Patients undergoing same-day bilateral TKAs were more likely to be discharged to post-acute care facilities, however they did not have increased 90-day readmissions.

Skilled Nursing Facility Placement Process After Total Hip and Total Knee Arthroplasty: Revised Rating System and Opportunities for Intervention

2019 ◽  
Vol 34 (6) ◽  
pp. 1066-1071 ◽  
Author(s):  
Daniel J. Snyder ◽  
Thomas R. Kroshus ◽  
Aakash Keswani ◽  
Kevin J. Bozic ◽  
Yale A. Fillingham ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Rating System ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Hip ◽  
Facility Placement ◽  
Total Knee

scholarly journals Simultaneous bilateral total knee arthroplasty

2022 ◽  
Vol 3 (1) ◽  
pp. 29-34
Author(s):  
Gerard A. Sheridan ◽  
Rotem Moshkovitz ◽  
Bassam A. Masri
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Bilateral Total Knee Arthroplasty ◽  
Bilateral Tkas ◽  
Patient Satisfaction Scores ◽  
Total Knee ◽  
Simultaneous Bilateral Tka

Aims Simultaneous bilateral total knee arthroplasty (TKA) has been used due to its financial advantages, overall resource usage, and convenience for the patient. The training model where a trainee performs the first TKA, followed by the trainer surgeon performing the second TKA, is a unique model to our institution. This study aims to analyze the functional and clinical outcomes of bilateral simultaneous TKA when performed by a trainee or a supervising surgeon, and also to assess these outcomes based on which side was done by the trainee or by the surgeon. Methods This was a retrospective cohort study of all simultaneous bilateral TKAs performed by a single surgeon in an academic institution between May 2003 and November 2017. Exclusion criteria were the use of partial knee arthroplasty procedures, staged bilateral procedures, and procedures not performed by the senior author on one side and the trainee on another. Primary clinical outcomes of interest included revision and re-revision. Primary functional outcomes included the Oxford Knee Score (OKS) and patient satisfaction scores. Results In total, 315 patients (630 knees) were included for analysis. Of these, functional scores were available for 189 patients (378 knees). There was a 1.9% (n = 12) all-cause revision rate for all knees. Overall, 12 knees in ten patients were revised, and both right and left knees were revised in two patients. The OKS and patient satisfaction scores were comparable for trainees and supervising surgeons. A majority of patients (88%, n = 166) were either highly likely (67%, n = 127) or likely (21%, n = 39) to recommend bilateral TKAs to a friend. Conclusion Simultaneous bilateral TKA can be used as an effective teaching model for trainees without any significant impact on patient clinical or functional outcomes. Excellent functional and clinical outcomes in both knees, regardless of whether the performing surgeon is a trainee or supervising surgeon, can be achieved with simultaneous bilateral TKA. Cite this article: Bone Jt Open 2022;3(1):29–34.

Comparison of Day Rehabilitation to Skilled Nursing Facility for the Rehabilitation for Total Knee Arthroplasty

2013 ◽  
Vol 92 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Bess Kathrins ◽  
Richard Kathrins ◽  
Robert Marsico ◽  
Michael Frank ◽  
Brenda Stevenson-Marshall ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Knee

scholarly journals Discharge to the skilled nursing facility: patient risk factors and perioperative outcomes after total knee arthroplasty

2019 ◽  
Vol 7 (4) ◽  
pp. 65-65 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Chukwuweike Gwam ◽  
Sergio M. Navarro ◽  
Heather S. Haeberle ◽  
Jaret M. Karnuta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Perioperative Outcomes ◽  
Nursing Facility ◽  
Patient Risk ◽  
Skilled Nursing ◽  
Total Knee

Total Knee Arthroplasty in Patients with Dementia

2020 ◽  
Author(s):  
Nicholas M. Hernandez ◽  
Daniel J. Cunningham ◽  
William A. Jiranek ◽  
Michael P. Bolognesi ◽  
Thorsten M. Seyler
Keyword(s):  
Emergency Department ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
National Database ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Total Knee

AbstractThere are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p  ≤  0.05). Two-year complications in patients with dementia undergoing TKA were increased risk of ED visitation and SNF disposition (p  ≤  0.05). Patients with dementia undergoing TKA are at an increased risk of resource utilization.

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

2018 ◽  
Vol 32 (01) ◽  
pp. 111-116 ◽  
Author(s):  
John Barrington ◽  
Ryan Hansen ◽  
Belinda Lovelace ◽  
Elaine Böing ◽  
Morad Chughtai ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Lengths Of Stay ◽  
Oral Group ◽  
Total Knee

AbstractPostoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophen. Specifically, this study evaluated: (1) the hospital lengths of stay (LOS) and (2) discharge dispositions. The Premier Database was used to review patients who underwent TKA from 2012 to 2015. A total of 134,216 TKA patients received oral acetaminophen, whereas 56,475 TKA patients received IV acetaminophen postoperatively. LOS were calculated as the number of days from the date of hospital admission to the date of discharge, and the discharge disposition was categorized as to home or to a skilled nursing facility (SNF). Compared with the oral group, the IV acetaminophen group had a 0.14 days shorter LOS (95% confidence interval [CI], –0.15 to –0.13; p < 0.001) and 22% higher chance of being discharged home (odds ratio [OR] = 1.22; 95% CI, 1.19–1.25; p < 0.001). Also, compared with the oral group, the IV group had a 13% lower chance of being discharged to a SNF (OR = 0.87; 95% CI, 0.85–0.90; p < 0.001). This study demonstrated that TKA patients who received IV acetaminophen were associated with a significantly shorter hospital LOS as well as being discharged home and fewer patients had to go to SNF. This may lead to a reduction in the total cost of health care, while, at the same time, decreasing the resource use in patients who undergo TKA.

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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