scholarly journals Successes and Failures of a Freedom™ Constrained Cup Used in a Major Salvage Procedure

2017 ◽  
Vol 7 (3) ◽  
Author(s):  
Thomas Donaldson ◽  
Ian Clarke
Keyword(s):  
Office Visit ◽  
Salvage Procedure ◽  
Office Visits ◽  
Wear Performance ◽  
Hip Impingement ◽  
Hip Motion ◽  
Backside Wear ◽  
Total Knee ◽  
Eccentric Ring

Background: This is a case report of a 36mm constrained cup (Freedom™, Biomet IN) that performed successfully for 7-years in a salvage case involving a total-femur implanted in a leg already short by 3-4 inches. The goal was to enhance hip motion and stability using a 36mm head instead of the usual 32mm size. Templating indications were for a 50mm cup (Freedom™; Arcom™ liner). The proximal femur inserted in 2008 incorporated the 36mm constrained THA and was anchored distally to bone using the Compress™ fixator. By 2012 the fixator loosened and was replaced by hinged total-knee arthroplasty (TKA). The THA was retained at revision and patient’s clinical follow-up was satisfactory for 4 years. As indicated by Martel radiographic method, the Arcom™ liner showed minimal wear over this period. Radiographs in Feb-2016 showed the cup’s constraint ring had rotated slightly but the patient had no symptoms. By Dec-2016, the patient had experienced three falls and also had heard a popping sound in her hip. At Dec-2016 office visit, radiographs indicated additional rotation of the constraint ring and CT scans showed an eccentric head position contacting the metal shell. At revision, 50% of the Arcom rim was ablated and the remainder present as a loose fragment. Following insertion of new Freedom liner and 36mm head, her follow-up appears satisfactory 10-months later. Her leg shortening remains but she walks to office visits using a cane and doesn’t need the cane at home.Methods: Retrieved Arcom liner and detached rim fragment were reconstructed, photographed, and then bi-valved for comparison to similarly prepared exemplar liners, one identical to our revision and one with a thicker wall. Details of liner sections were taken from photographs and reconstructed by computer graphics (Canvas Draw-3™). Wear performance over the first 7 years was assessed using the Martel x-ray method.Results: Inspection of retrieved liner showed a large oval depression in the ablated rim. The contra-rim featured the large Arcom fragment and the underlying liner wall was less than 1mm thick. Comparison to exemplar liners showed that the large fragment had separated along the lower edge of the constraint groove. Exemplars demonstrated a substantial rim buttress spanning 13mm, which had been ablated in our retrieval.Discussion and Conclusion: Although this was not a high-demand patient, the considerable hip-impingement forces in a flail limb likely levered the head repeatedly against the liner’s constrained rim. Neck impingement was clearly evident in the damaged liner. A subluxing femoral head would also thin the contra-wall, as would backside wear. We do not know if the eccentric ring image in Feb-2016 radiographs depicted failure. The liner may have escaped from the shell’s locking-ring and with activity, ablated the Arcom contours and led to rim fracture. It is also possible that the liner constraint was damaged when the patient fell, thereby allowing the liner to mobilize.

Bridging to survivorship in breast cancer: How BMI weighs in.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 32-32
Author(s):  
Janet L. Espirito ◽  
Brian Turnwald ◽  
Robyn K. Harrell ◽  
Debajyoti Bhowmik ◽  
Neelima Denduluri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Office Visit ◽  
Large Network ◽  
Office Visits ◽  
Complete Treatment ◽  
Impact On Survival ◽  
Planning Methods ◽  
Survivorship Care Planning

32 Background: Obesity and depression complicate survivorship in early stage breast cancer (BC) by having a direct impact on survival and morbidity among patients (pts) who complete treatment (tx). The prevalence of obesity after BC tx in the community and concordance with BC tx type is poorly described, but important as we characterize risks of tx and optimize goals for survivorship care planning. Methods: We queried the electronic health record (EHR), iKnowMed, from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 office visits and follow up through 11-2012 for our retrospective study. We excluded pts who developed metastatic disease or died. We stratified pts by chemotherapy (CT) utilization (yes/no), hormone receptor (HR) status, age, and documented body mass index (BMI) at first office visit and annually. We evaluated changes in BMI characteristics by tx cohort. Results: We identified 8,506 pts with a documented BMI at first office visit and 1, 2, and 3 years (yrs) thereafter. 4,369 (51% of the total) pts received adjuvant CT and 4,137 (49%) did not. 6,897 pts (81%) were HR positive. Baseline BMI between tx cohorts were similar, though the prevalence of overweight (31%) and overweight or obese (68%) is high. Percent change of BMI at 3 yrs varied significantly between T cohorts (p<0.01) with greater rise among the cohorts who received CT in comparison to those who did not. Pts receiving CT were 46% more likely to have a 5 point or more increase in BMI at 3 yrs compared to pts that did not receive CT (OR 1.46, CI[1.08-1.96]). A stronger association for BMI increase of at least 0.5 points at 3 yrs (OR 1.53, CI [1.4-1.7]) was also observed amongst pts who received CT compared to those that did not. HR positive pts were less likely than HR negative or unknown pts to increase their BMI by at least 0.5 points (OR 0.84, p<0.01), but there was no difference at detecting a difference of 5 points in BMI (OR 0.88, p=0.49). Conclusions: With 3 yrs of follow up, overweight and obese status is remarkably common among BC survivors in the community and appears to be more prevalent after CT tx. Determinants of obesity require further study and point to necessary intervention to improve the health of early stage BC pts.

scholarly journals Electronic health record note review in an outpatient specialty clinic: who is looking?

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Jimmy S Chen ◽  
Michelle R Hribar ◽  
Isaac H Goldstein ◽  
Adam Rule ◽  
Wei-Chun Lin ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Electronic Health Record ◽  
Clinical Care ◽  
Office Visit ◽  
Health Record ◽  
Office Visits ◽  
Health Records ◽  
Ancillary Staff ◽  
Electronic Health

Abstract Note entry and review in electronic health records (EHRs) are time-consuming. While some clinics have adopted team-based models of note entry, how these models have impacted note review is unknown in outpatient specialty clinics such as ophthalmology. We hypothesized that ophthalmologists and ancillary staff review very few notes. Using audit log data from 9775 follow-up office visits in an academic ophthalmology clinic, we found ophthalmologists reviewed a median of 1 note per visit (2.6 ± 5.3% of available notes), while ancillary staff reviewed a median of 2 notes per visit (4.1 ± 6.2% of available notes). While prior ophthalmic office visit notes were the most frequently reviewed note type, ophthalmologists and staff reviewed no such notes in 51% and 31% of visits, respectively. These results highlight the collaborative nature of note review and raise concerns about how cumbersome EHR designs affect efficient note review and the utility of prior notes in ophthalmic clinical care.

Fever in Pediatric Primary Care: Occurrence, Management, and Outcomes

PEDIATRICS ◽  
2000 ◽  
Vol 105 (Supplement_2) ◽  
pp. 260-266
Author(s):  
Jonathan A. Finkelstein ◽  
Cindy L. Christiansen ◽  
Richard Platt
Keyword(s):  
Primary Care ◽  
Laboratory Testing ◽  
Office Visit ◽  
Pediatric Primary Care ◽  
Care Practice ◽  
Meningococcal Sepsis ◽  
Office Visits ◽  
Health Maintenance ◽  
Entire Cohort

Objective. To describe the epidemiology, management, and outcomes of children with fever in pediatric primary care practice. Patients. A cohort of 20 585 children 3 to 36 months of age cared for in 11 pediatric offices of a health maintenance organization between 1991 and 1994. Methods. Using automated medical records we identified all office visits with temperatures ≥38°C for a random sample of 5000 children, and analyzed diagnoses conferred, laboratory tests performed, and antibiotics prescribed. We also determined the frequency of in-person and telephone follow-up after initial visits for fever. Finally, we reviewed hospital claims data for the entire cohort of 20 585 to identify cases of meningitis, meningococcal sepsis, and death from infection. Results. Among 3819 initial visits of an illness episode, 41% of children had no diagnosed bacterial or specific viral source. Of these, 13% with a temperature of 38°C to 39°C and 36% with a temperature of ≥39°C received laboratory testing. Almost half (43%) received some documented follow-up care in the subsequent 7 days. Among the 26 970 child-years of observation in the entire cohort, 15 children (56 per 100 000 child-years) were treated for bacterial meningitis or meningococcal sepsis. Five had an office visit for fever in the week before hospitalization, but only 1 had documented fever ≥39°C and received neither laboratory testing for occult bacteremia nor treatment with an antibiotic. Conclusion. The majority of febrile children in ambulatory settings were diagnosed with a bacterial infection and treated with an antibiotic. Of highly febrile children without a source, 36% received laboratory testing consistent with published expert recommendations, and short-term follow-up was common. Meningitis or death after an office visit for fever without a source was predictably rare. These data suggest that increased testing and/or treatment of febrile children beyond the rates observed here are unlikely to affect population rates of meningitis substantially.

scholarly journals  Treatment of an infected total knee replacement with two-stage arthrodesis in a dog: a case report

2012 ◽  
Vol 57 (No. 5) ◽  
pp. 258-262
Author(s):  
IS Kim ◽  
CS Kim ◽  
KC Lee ◽  
NS Kim ◽  
MS Kim ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Joint Space ◽  
Salvage Procedure ◽  
Intact Female ◽  
Two Stage ◽  
Total Knee Replacements ◽  
Knee Replacements ◽  
Total Knee

A three-year-old intact female Great Pyrenees underwent total knee replacement for the treatment of osteoarthritis. The dog contracted septic arthritis 10 weeks following the procedure. Treatments including implant subtraction, debridement of tissue, and insertion of bone cement with antibiotics into the joint space were completed in the joint cavity. A temporary external skeletal fixator was used to stabilise the joint for four weeks. A second attempt at total knee replacement failed due to severe muscle contracture and bone loss. Therefore, it was decided to perform arthrodesis as a salvage procedure. At the 17 month follow-up examination, the patient was able to use the limb while standing and at all gait speeds. Based on these findings, two-stage arthrodesis can be a viable salvage procedure for infected total knee replacements. &nbsp;

scholarly journals Comparing telehealth to traditional office visits for patient management in the COVID-19 pandemic: A cross-sectional study in a respiratory assessment clinic

2021 ◽  
pp. 1357633X2199019
Author(s):  
J Cole Phillips ◽  
Richard W Lord ◽  
Stephen W Davis ◽  
Amanda A Burton ◽  
Julienne K Kirk
Keyword(s):  
Emergency Department ◽  
Hospital Admission ◽  
Primary Outcome ◽  
Office Visit ◽  
Cross Sectional Study ◽  
Office Visits ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference

Introduction The aim of this study was to examine whether telehealth is as safe and effective as traditional office visits in assessing and treating patients with symptoms consistent with COVID-19. Methods In this retrospective cross-sectional study, the primary outcome was any 14-day related healthcare follow-up event(s). Secondary outcomes were the type of 14-day related follow-up event including hospital admission, emergency department visit, office visit, telehealth visit and/or multiple follow-up visits. Individual visit types were identified due to the significant difference between a hospital admission and an office visit. Logistic regressions were done using the predictors of visit type, age, gender and comorbidities and the primary outcome variable of a related follow-up visit and then by follow-up type: hospital admission, emergency department visit or office visit. Results Of 1305 visits, median age was 42.3 years and 65.8% were female. Traditional office visits accounted for 741 (56.8%) of initial visits, while 564 (43.2%) visits occurred via telehealth. One hundred and forty-six (25.9%) of the telehealth visits resulted in a 14-day related healthcare follow-up visit versus 161 (21.7%) of the office visits (adjusted odds ratio (OR) 1.22, 95% CI 0.94–1.58). Discussion There was no significant difference in related follow-ups of initial telehealth visits compared to initial office visits including no significant difference in hospital admission or emergency department visits. These findings suggest that based on follow up healthcare utilization, telehealth may be a safe and effective option in assessing and treating patients with respiratory symptoms as the COVID-19 pandemic continues.

48Remote monitoring of Heart Failure patients with a Multisensor ICD Algorithm: value of an alert-based follow-up strategy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
D Pecora ◽  
V Tavoletta ◽  
A Dello Russo ◽  
E De Ruvo ◽  
F Ammirati ◽  
...  
Keyword(s):  
Heart Failure ◽  
Office Visit ◽  
Signs And Symptoms ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Office Visits ◽  
Ventricular Ejection Fraction ◽  
Increased Risk ◽  
Remote Data

Abstract Background The HeartLogic algorithm measures and combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. The associated alert has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation, and the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of HF events. Purpose To report the results of a multicenter experience of remote HF management with HeartLogic algorithm and appraise the value of an alert-based follow-up strategy. Methods The HeartLogic feature was activated in 104 patients (76 male, 71 ± 10 years, left ventricular ejection fraction 29 ± 7%). All patients were followed according to a standardized protocol that included remote data reviews and patient phone contacts every month and at the time of HeartLogic alerts. In-office visits were performed every 6 months or when deemed necessary. Results During a median follow-up of 13[11-18] months, centers performed remote follow-up at the time of 1284 scheduled monthly transmissions (10.5 per pt-year) and 100 HeartLogic alerts (0.82 alerts/pt-year). The mean delay from alert to the next monthly remote data review was 14 ± 8 days. Overall, the patient time in the alert state (i.e. HeartLogic index above the threshold) was 14% of the total observation period. HF events requiring active clinical actions were detected at the time of 11 (0.9%) monthly remote data reviews and at 43 (43%, p &lt; 0.001) HeartLogic alerts. Moderate to severe symptoms of HF were reported during 2% of remote visits when the patient was out of HeartLogic alert condition and during 15% of remote visits performed in alert condition (p &lt; 0.001). Out of 100 alerts, 17 required an in-office visit and 5 a hospitalization to manage the clinical condition. Overall, 282 scheduled and 56 unscheduled in-office visits were performed during follow-up. Any HF sign (i.e. S3 gallop, rales, jugular venous distension, edema) was detected during 18% of in-office visits when the patient was out of HeartLogic alert condition and during 34% of visits performed in alert condition (p = 0.002). Conclusions HeartLogic alerts are frequently associated with relevant actionable HF events. Events are detected earlier and the volume of alert-driven remote follow-ups is limited when compared with a monthly remote follow-up scheme. The probability of detecting common signs and symptoms of HF at regular remote or in-office assessment is extremely low when the patient is out of HeartLogic alert state. These results support the adoption of an alert-based follow-up strategy.

Outcomes of Rotating-hinge Total Knee Arthroplasty Following Complex Primary and Revision Total Knee Arthroplasty

2021 ◽  
Author(s):  
Daniel Pfeufer ◽  
Jeremy Gililland ◽  
Priscila Monteiro ◽  
Marissa Stagg ◽  
Mike Anderson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Prosthesis ◽  
Revision Total Knee Arthroplasty ◽  
Salvage Procedure ◽  
Rotating Hinge ◽  
Total Knee ◽  
The Mean ◽  
Revision Tka

In complex primary and revision total knee arthroplasty (TKA), rotating-hinge TKA (RH-TKA) prostheses play an important role. Compared to early fixed-hinge knee designs, new implants that include rotating platforms and improved hinge constructs may offer improvements in both survival and clinical outcomes. We sought to evaluate early survival following complex primary and revision TKA with a rotating-hinge knee prosthesis. We retrospectively reviewed a consecutive series of patients (n=47, 48 knees) who underwent revision TKA using an RH-TKA system. The mean age was 73 years (range, 37 – 86). The mean body mass index was 29 (range, 16.3 – 45.9) and the median ASA score was 3 (IQR, 2 – 3). As mortality was high, we performed a Kaplan-Meier analysis to evaluate survival, with death as failure. The median follow-up was 2.5 years (range, 0.07 – 9.8). Revision-free survival was 97% at a median 2.5 years of follow-up. Overall mortality was 46% (17/37) and survival free from death was 69% (49% - 82%) at a median of 2.5 years. Most reoperations were due to infection (5/12), following by wound-related complications (2/12) and hematomas (2/12). A high postoperative complication rate and mortality are evident in TKA using a hinged knee prosthesis in complex revision TKA. If the indication and surgical technique are matched to the complexity of the case, this type of implant offers a feasible salvage procedure.

Bridging to survivorship in breast cancer: How BMI weighs in.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9605-9605
Author(s):  
Janet L. Espirito ◽  
Brian Turnwald ◽  
Robyn K. Harrell ◽  
Debajyoti Bhowmik ◽  
Neelima Denduluri ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Office Visit ◽  
Large Network ◽  
Office Visits ◽  
Complete Treatment ◽  
Impact On Survival ◽  
Planning Methods ◽  
Survivorship Care Planning

9605 Background: Obesity and depression complicate survivorship in early stage breast cancer (BC) by having a direct impact on survival and morbidity among patients (pts) who complete treatment (tx). The prevalence of obesity after BC tx in the community and concordance with BC tx type is poorly described, but important as we characterize risks of tx and optimize goals for survivorship care planning. Methods: We queried the electronic health record (EHR), iKnowMed, from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 office visits and follow up through 11-2012 for our retrospective study. We excluded pts who developed metastatic disease or died. We stratified pts by chemotherapy (CT) utilization (yes/no), hormone receptor (HR) status, age, and documented body mass index (BMI) at first office visit and annually. We evaluated changes in BMI characteristics by tx cohort. Results: We identified 8,506 pts with a documented BMI at first office visit and 1, 2, and 3 years (yrs) thereafter. 4369 (51% of the total) pts received adjuvant CT and 4137 (49%) did not. 6897 pts (81%) were HR positive. Baseline BMI between tx cohorts were similar, though the prevalence of overweight (31%) and overweight or obese (68%) is high. Percent change of BMI at 3 yrs varied significantly between T cohorts (p<0.01) with greater rise among the cohorts who received CT in comparison to those who did not. Pts receiving CT were 46% more likely to have a 5 point or more increase in BMI at 3 yrs compared to pts that did not receive CT (OR 1.46, CI[1.08-1.96]). A stronger association for BMI increase of at least 0.5 points at 3 yrs (OR 1.53, CI [1.4-1.7]) was also observed amongst pts who received CT compared to those that did not. HR positive pts were less likely than HR negative or unknown pts to increase their BMI by at least 0.5 points (OR 0.84, p<0.01), but there was no difference at detecting a difference of 5 points in BMI (OR 0.88, p=0.49). Conclusions: With 3 yrs of follow up, overweight and obese status is remarkably common among BC survivors in the community and appears to be more prevalent after CT tx. Determinants of obesity require further study and point to necessary intervention to improve the health of early stage BC pts.

Unplanned Office Visits Following Outpatient Hand Surgery

Hand ◽  
2021 ◽  
pp. 155894472110289
Author(s):  
Clay B. Townsend ◽  
Tyler W. Henry ◽  
Kevin F. Lutsky ◽  
Pedro K. Beredjiklian
Keyword(s):  
Soft Tissue ◽  
Carpal Tunnel Release ◽  
Office Visit ◽  
Hand Surgery ◽  
Office Visits ◽  
Persistent Symptoms ◽  
De Quervain ◽  
Release Group ◽  
Unplanned Visit

Background Returning to the office for an unplanned visit postoperatively can be burdensome to both the patient and provider. The purpose of this study was to quantify the rate of unplanned office visits after common soft tissue hand surgeries and assess the reasons for these unplanned visits. Methods Patients who underwent common soft tissue hand surgeries over a 6-month time period were queried from an electronic medical record database. Manual chart review was performed to record patient demographics, unplanned visits within 3 months postoperatively, and specific reasons for unplanned visits. A total of 1648 postoperative follow-up visits in 1224 patients were included in analysis. Results Within 3 months of surgery, 6.3% (103/1648) of postoperative visits were found to be unplanned. There was no difference in the rate of unplanned visits among the included surgeries ( P = .46). The most common reasons for an unplanned office visit overall were wound problems (34%), pain (23.3%), and stiffness (17.5%). The trigger finger release group had significantly more patients return to the office for stiffness ( P = .01), the De Quervain release group had significantly more patients return for pain ( P = .02), and the carpal tunnel release group had significantly more patients return for persistent symptoms ( P < .05). Conclusions Unplanned office visits represented about 1 of 16 postoperative visits. Orthopedic surgeons should be aware of the most common reasons for these visits and be prepared to address these problems promptly. Preoperative patient education on these potential problems may help decrease the frequency of unplanned follow-up visits.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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