scholarly journals Predictors for readmission following primary total hip and total knee arthroplasty

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

Ceforanide vs. Cephalothin Concentrations in Total Joint Arthroplasty

1983 ◽  
Vol 17 (9) ◽  
pp. 645-648 ◽  
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.

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

2019 ◽  
Vol 14 (1) ◽  
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.

The Impact of Diabetes on Perioperative Patient Outcomes after Total Hip and Total Knee Arthroplasty in the United States

2008 ◽  
Vol 23 (2) ◽  
pp. 322-323
Author(s):  
Michael P. Bolognesi ◽  
Milford H. Marchant, Jr. ◽  
Nicholas A. Viens ◽  
Chad Cook ◽  
Ricardo Pietrobon ◽  
...  
Keyword(s):  
United States ◽  
Total Knee Arthroplasty ◽  
Patient Outcomes ◽  
Knee Arthroplasty ◽  
The United States ◽  
Total Hip ◽  
Total Knee ◽  
The Impact

scholarly journals Medical management of patients with inflammatory arthritis undergoing total hip arthroplasty and total knee arthroplasty

2019 ◽  
Vol 2 (2) ◽  
pp. 102-107
Author(s):  
Ioana Creţu ◽  
Mihai Bojincă ◽  
Mihaela Milicescu ◽  
Teodora Şerban ◽  
Bogdan Creţu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Lupus Erythematosus ◽  
Inflammatory Arthritis ◽  
Joint Arthroplasty ◽  
Antirheumatic Drugs ◽  
Total Hip ◽  
Total Knee

AbstractTotal joint arthroplasty (TJA) including total hip arthroplasty (THA) and total knee arthroplasty (TKA) are performed for patients with primary osteoarthritis (OA). Also, there are patients who undergo TJA for management of inflammatory arthritis (IA), including patients with rheumatoid arthritis (RA), Spondyloarthritis (SPA) including ankylosing spondylitis (AS) and psoriatic arthritis (PSA) and systemic lupus erythematosus (SLE).The purpose of this review was to evaluate the current knowledge about the risk of complications after TJA in patients with IA and perioperative management of antirheumatic drugs.THA and TKA are orthopedic surgeries that help patients with arthritis restore function, mobility and reduce pain. Patients with inflammatory arthritis have systemic disorders that cause a high rate of complications associated with the surgery.Patients with inflammatory arthritis, including RA, SPA, and SLE who need TJA have a higher risk of developing complications compared to patients with OA.Information about cardiovascular risk factors and other comorbidities is important to better control and reduce the risk of postoperative complications.AbbreviationsTJA = total joint arthroplasty, THA = total hip arthroplasty, TKA = total knee arthroplasty, OA = osteoarthritis, SPA = spondyloarthritis, IA = inflammatory arthritis, RA = rheumatoid arthritis, AS = ankylosing spondylitis, PSA = psoriatic arthritis, SLE = systemic lupus erythematosus, DMARDs = Disease-modifying antirheumatic drugs, PJI = prosthetic joint infection, VTE = venous thromboembolism, HCQ = hydroxychloroquine, SSZ = sulfasalazine, TNF = tumor necrosis factor, GS = corticosteroids.

scholarly journals Do psychiatric disorders affect patient reported outcomes and clinical outcomes post total hip and knee arthroplasty?

2021 ◽  
Vol 9 ◽  
pp. 205031212110122
Author(s):  
Sahil Kooner ◽  
Jeremy Kubik ◽  
Saboura Mahdavi ◽  
Sophie (Ghashang) Piroozfar ◽  
Hoa Khong ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Arthroplasty ◽  
Control Groups ◽  
Total Hip ◽  
Total Knee

Introduction: The purpose of this study is to evaluate the role of major psychiatric illness on patient outcomes after total joint arthroplasty. Methods: Patients with a diagnosis of a major psychiatric disorder undergoing total joint arthroplasty were retrospectively matched one-to-one with a cohort without such a diagnosis. Major psychiatric disorder in the registry was identified by diagnosis of anxiety, mood, or a psychotic disorder. Primary outcome of interest included perioperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included EuroQol-5D, adverse events, length of stay, 30-day readmission, and discharge destination. Results: Total number of patients were 1828. The total hip arthroplasty (37.80 ± 17.91, p = 0.023) and the total knee arthroplasty psychiatric group (43.38 ± 18.41, p = 0.050) had significantly lower pre-operative WOMAC scores. At 3 months, the total hip arthroplasty (76.74 ± 16.94, p = 0.036) and total knee arthroplasty psychiatric group (71.09 ± 18.64, p < 0.01) again had significantly lower 3-month post-operative WOMAC score compared to the control groups. However, outcomes at 1 year were difficult to interpret, as patients with major psychiatric conditions had an extremely high loss to follow-up. Compared to the control groups, the total hip arthroplasty and total knee arthroplasty psychiatric group had an increased length of stay by 1.43 days (p < 0.01) and 0.77 days, respectively (p = 0.05). Similarly, the psychiatric groups were discharged directly home less often (total hip arthroplasty 86.9%, p = 0.024 and total knee arthroplasty 87.6%, p = 0.022) than the control groups. Conclusion: Patients with the diagnosis of a major psychiatric illness have an increased length of stay and are more likely to require a rehabilitation facility, compared to the control groups. Arguably, of utmost importance, there is a very high rate of loss to follow-up within the psychiatric groups. As such, we recommend these patients should be treated for their diagnosis prior to total joint arthroplasty. Furthermore, importance of clinical follow-up should be emphasized carefully.

scholarly journals Total Knee Arthroplasty In Patients With Parkinson's Disease- A Critical Analysis of Available Evidence

2017 ◽  
Vol 11 (1) ◽  
pp. 1087-1093 ◽  
Author(s):  
Munis Ashraf ◽  
Sruthi Priyavadhana ◽  
Senthil Nathan Sambandam ◽  
Varatharaj Mounasamy ◽  
Om Prakash Sharma
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Total Knee Arthroplasty ◽  
Parkinson Disease ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Total Knee

Background: In this era of modern medicine, there is an increase in life expectancy and thereby an ageing population. Among this group one of the most common neurological disorder is Parkinson disease and one of the most common operation done in elderly population is a total joint arthroplasty. But total joint arthroplasty in Parkinson disease is a relatively uncommon entity. There is sparse literature available with regards to total knee arthroplasty (TKA) in Parkinson disease. This review focusses on the necessity, complications and previous experiences on TKA in PD based on the literature available. Method: The review was conducted after a series of advanced search in the following medical databases; Pub med, Biomed central, Cochrane and Google scholar for articles related to total knee replacement in patients with Parkinson’s disease. The following keywords were used; Total knee arthroplasty, Parkinson’s disease, Hoehn and Yahr, Flexion Contracture. Results: The review indicates that the functional outcome is comparable to that of controls in immediate post-operative phase, one year and three-year phase, but the long term functional outcome seems to deteriorate significantly. Conclusion: Total knee arthroplasty can serve as an effective tool in alleviating pain in short term as well as long term periods, whereas the functional outcome seems to deteriorate post operatively on a long-term basis. Nevertheless, TKA in PD is a challenging situation, thereby necessitating a holistic approach with the efforts from various specialists needed at each stage to ensure a successful operation.

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