scholarly journals Introduction of day case hip and knee replacement programme at an inpatient ward is safe and may expedite shortening of hospital stays of traditional arthroplasties

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gyorgy Lovasz ◽  
Attila Aros ◽  
Ferenc Toth ◽  
John Va Faye ◽  
Marco La Malfa
Keyword(s):  
Day Case ◽  
Urine Retention ◽  
Inpatient Ward ◽  
Same Day Discharge ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty ◽  
Orthopaedic Ward ◽  
Hospital Stays ◽  
Total Knee ◽  
Satisfaction Rates

Abstract Purpose We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward. Methods 200 patients underwent elective, unilateral primary day case total hip (THA, n = 94), total knee (TKA, n = 60) and unicondylar knee replacements (UKA, n = 46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n = 6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period. Results 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5%), urine retention (3%) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

scholarly journals Introduction of Day Case Hip and Knee Replacement Programme at an Inpatient Ward is Safe and May Expedite Shortening of Hospital Stays of Traditional Arthroplasties

2021 ◽  
Author(s):  
Gyorgy Lovasz ◽  
Attila Aros ◽  
Ferenc Toth ◽  
John Va Faye ◽  
Marco La Malfa
Keyword(s):  
Day Case ◽  
Urine Retention ◽  
Inpatient Ward ◽  
Same Day Discharge ◽  
Knee Replacements ◽  
Hip And Knee Arthroplasty ◽  
Orthopaedic Ward ◽  
Hospital Stays ◽  
Total Knee ◽  
Satisfaction Rates

Abstract Purpose: We investigated the safety of primary hip and knee replacements with same day discharge (SDD) and their effect on length of stay (LOS) of traditional inpatient arthroplasties at our elective orthopaedic ward.Methods: 200 patients underwent elective, unilateral primary day case total hip (THA, n=94), total knee (TKA, n=60) and unicondylar knee replacements (UKA, n=46). SDD rates, reasons for failure to discharge, readmission, complication and satisfaction rates were recorded at 6-week follow up. Changes in LOS of inpatient arthroplasties (n=6518) and rate of patients discharged with only one night stay treated at the same ward were tracked from 1 year prior to introduction of day case arthroplasty (DCA) program to the end of observation period.Results: 166 patients (83%) had SDD while 34 (17%) needed overnight stay. Main reasons for failure to discharge were lack of confidence (4%) fainting due to single vasovagal episode (3.5 %), urine retention (3 %) and late resolution of spinal anaesthesia (3%). 5 patients (3%) had readmission within 6 weeks, including 1 (0.6%) with a partial and treated pulmonary embolism. 163 patients were satisfied with SDD (98%). After launching the DCA program, average LOS of inpatients was reduced from 2.3 days to 1.8 days and rate of discharge with only 1-night stay increased from 12% to around 60%. Conclusion: Introduction of routine SDD hip and knee arthroplasty programme at an elective orthopaedic centre is safe and also may confer wider benefits leading to shorter inpatient hospital stays.

scholarly journals The Diagnostic Accuracy of Radionuclide Arthrography for Prosthetic Loosening in Hip and Knee Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Timothy H. French ◽  
Nicholas Russell ◽  
Anand Pillai
Keyword(s):  
Knee Arthroplasty ◽  
Predictive Value ◽  
Diagnostic Tools ◽  
Total Knee Replacements ◽  
Knee Replacements ◽  
Hip Replacements ◽  
Hip And Knee Arthroplasty ◽  
Prosthetic Loosening ◽  
Total Knee ◽  
Mean Time

Purpose of Study. Diagnosis of prosthetic loosening in hip and knee arthroplasty remains a challenge. Although there are a number of diagnostic tools, no single test or combination is 100% sensitive or specific. There has been a recent interest in the use of radionuclide arthrography (RNA) for detection of prosthetic loosening.Methods. A retrospective review of 45 consecutive RNA scans from 2005 to 2010 was conducted. RNA findings were compared with intraoperative findings at revision and/or serial radiographic examinations to confirm loosening. A component was considered loose if sequential radiographs demonstrated macromotion, gross subsidence, or progressive radiolucency.Results. There were 26 females and 17 males, with mean age at RNA of 71 years (range of 53–89 years) and mean time from index surgery, 6.4 years (range of 0.5–23 years). There were 23 total knee replacements (TKR) (19 primary and 4 revision) and 20 total hip replacements (THR) (11 primary and 9 revision). 15 patients underwent revision surgery following RNA. Strict inclusion criteria allowed 27 patients for further analysis. Sixteen RNA scans were suggestive of loosening, of which 14 were confirmed loose. Eleven scans were suggestive of a stable prosthesis, of which 10 were confirmed well fixed. RNA had a sensitivity of 93%, specificity of 83%, positive predictive value of 88%, and negative predictive value of 91%.Conclusion. Radionuclide arthrography should be considered a useful adjunct in the diagnosis of prosthetic loosening in the challenging patient.

scholarly journals Towards the understanding of lubrication mechanisms in total knee replacements – Part I: Experimental investigations

2021 ◽  
Vol 156 ◽  
pp. 106874 ◽  
Author(s):  
David Nečas ◽  
Martin Vrbka ◽  
Max Marian ◽  
Benedict Rothammer ◽  
Stephan Tremmel ◽  
...  
Keyword(s):  
Experimental Investigations ◽  
Total Knee Replacements ◽  
Knee Replacements ◽  
Total Knee ◽  
Lubrication Mechanisms

scholarly journals Amorphous Carbon Coatings for Total Knee Replacements—Part I: Deposition, Cytocompatibility, Chemical and Mechanical Properties

Polymers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 1952
Author(s):  
Benedict Rothammer ◽  
Kevin Neusser ◽  
Max Marian ◽  
Marcel Bartz ◽  
Sebastian Krauß ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Amorphous Carbon ◽  
Detailed Characterization ◽  
Carbon Coatings ◽  
Dlc Coatings ◽  
Total Knee Replacements ◽  
Knee Replacements ◽  
Total Knee ◽  
Amorphous Carbon Coatings

Diamond-like carbon (DLC) coatings have the potential to reduce implant wear and thus to contribute to avoiding premature failure and increase service life of total knee replacements (TKAs). This two-part study addresses the development of such coatings for ultrahigh molecular weight polyethylene (UHMWPE) tibial inlays as well as cobalt–chromium–molybdenum (CoCr) and titanium (Ti64) alloy femoral components. While a detailed characterization of the tribological behavior is the subject of part II, part I focusses on the deposition of pure (a‑C:H) and tungsten-doped hydrogen-containing amorphous carbon coatings (a‑C:H:W) and the detailed characterization of their chemical, cytological, mechanical and adhesion behavior. The coatings are fabricated by physical vapor deposition (PVD) and display typical DLC morphology and composition, as verified by focused ion beam scanning electron microscopy and Raman spectroscopy. Their roughness is higher than that of the plain substrates. Initial screening with contact angle and surface tension as well as in vitro testing by indirect and direct application indicate favorable cytocompatibility. The DLC coatings feature excellent mechanical properties with a substantial enhancement of indentation hardness and elastic modulus ratios. The adhesion of the coatings as determined in modified scratch tests can be considered as sufficient for the use in TKAs.

scholarly journals Fast-Track Programs in Total Hip and Knee Replacement at Swedish Hospitals—Influence on 2-Year Risk of Revision and Mortality

2021 ◽  
Vol 10 (8) ◽  
pp. 1680
Author(s):  
Urban Berg ◽  
Annette W-Dahl ◽  
Anna Nilsdotter ◽  
Emma Nauclér ◽  
Martin Sundberg ◽  
...  
Keyword(s):  
Fast Track ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Total Hip ◽  
Total Knee Replacements ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Hip And Knee Arthroplasty ◽  
Total Knee

Purpose: We aimed to study the influence of fast-track care programs in total hip and total knee replacements (THR and TKR) at Swedish hospitals on the risk of revision and mortality within 2 years after the operation. Methods: Data were collected from the Swedish Hip and Knee Arthroplasty Registers (SHAR and SKAR), including 67,913 THR and 59,268 TKR operations from 2011 to 2015 on patients with osteoarthritis. Operations from 2011 to 2015 Revision and mortality in the fast-track group were compared with non-fast-track using Kaplan–Meier survival analysis and Cox regression analysis with adjustments. Results: The hazard ratio (HR) for revision within 2 years after THR with fast-track was 1.19 (CI: 1.03–1.39), indicating increased risk, whereas no increased risk was found in TKR (HR 0.91; CI: 0.79–1.06). The risk of death within 2 years was estimated with a HR of 0.85 (CI: 0.74–0.97) for TKR and 0.96 (CI: 0.85–1.09) for THR in fast-track hospitals compared to non-fast-track. Conclusions: Fast-track programs at Swedish hospitals were associated with an increased risk of revision in THR but not in TKR, while we found the mortality to be lower (TKR) or similar (THR) as compared to non-fast track.

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