Perioperative Management of Chronic Antithrombotic Agents in Elective Hip and Knee Arthroplasty

Total hip and knee arthroplasty are common major orthopedic operations being performed on an increasing number of patients. Many patients undergoing total joint arthroplasty (TJA) are on chronic antithrombotic agents due to other medical conditions, such as atrial fibrillation or acute coronary syndrome. Given the risk of bleeding associated with TJAs, as well as the risk of thromboembolic events in the post-operative period, the management of chronic antithrombotic agents perioperatively is critical to achieving successful outcomes in arthroplasty. In this review, we provide a concise overview of society guidelines regarding the perioperative management of chronic antithrombotic agents in the setting of elective TJAs and summarize the recent literature that may inform future guidelines. Ultimately, antithrombotic regimen management should be patient-specific, in consultation with cardiology, internal medicine, hematology, and other physicians who play an essential role in perioperative care.

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Predicting Perioperative Transfusion in Elective Hip and Knee Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000001709 ◽

2017 ◽

Vol 127 (2) ◽

pp. 317-325 ◽

Cited By ~ 11

Author(s):

Josephine To ◽

Romi Sinha ◽

Susan W. Kim ◽

Kathryn Robinson ◽

Brendon Kearney ◽

...

Keyword(s):

Logistic Regression ◽

Total Hip Arthroplasty ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Odds Ratio ◽

Patient Specific ◽

Data Set ◽

Total Hip ◽

Preoperative Hemoglobin ◽

Hip And Knee Arthroplasty

Abstract Background Preoperative anemia is a significant predictor of perioperative erythrocyte transfusion in elective arthroplasty patients. However, interactions with other patient and procedure characteristics predicting transfusion requirements have not been well studied. Methods Patients undergoing elective primary total hip arthroplasty or total knee arthroplasty at a tertiary hospital in Adelaide, South Australia, Australia, from January 2010 to June 2014 were used to identify preoperative predictors of perioperative transfusion. A logistic regression model was developed and externally validated with an independent data set from three other hospitals in Adelaide. Results Altogether, 737 adult patients in the derivation group and 653 patients in the validation group were included. Binary logistic regression modeling identified preoperative hemoglobin (odds ratio, 0.51; 95% CI, 0.43 to 0.59; P < 0.001 for each 1 g/dl increase), total hip arthroplasty (odds ratio, 3.56; 95% CI, 2.39 to 5.30; P < 0.001), and females 65 yr of age and older (odds ratio, 3.37; 95% CI, 1.88 to 6.04; P = 0.01) as predictors of transfusion in the derivation cohort. Conclusions Using a combination of patient-specific preoperative variables, this validated model can predict transfusion in patients undergoing elective hip and knee arthroplasty. The model may also help to identify patients whose need for transfusion may be decreased through preoperative hemoglobin optimization.

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Elective orthopaedic cancellations due to the COVID-19 pandemic: where are we now, and where are we heading?

Bone & Joint Open ◽

10.1302/2633-1462.22.bjo-2020-0161.r1 ◽

2021 ◽

Vol 2 (2) ◽

pp. 103-110 ◽

Cited By ~ 3

Author(s):

Sam Oussedik ◽

Sam MacIntyre ◽

Joanne Gray ◽

Peter McMeekin ◽

Nick D. Clement ◽

...

Keyword(s):

Knee Arthroplasty ◽

Financial Burden ◽

Waiting Lists ◽

Waiting List ◽

Joint Registry ◽

Unmet Demand ◽

Number Of Patients ◽

Recovery Strategies ◽

Hip And Knee Arthroplasty ◽

The Cost

Aims The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers. Methods A model of referral, waiting list, and eventual surgery was created and calibrated using historical data from NHS England (April 2017 to March 2020) and was used to investigate the possible consequences of unmet demand resulting from fewer patients entering the treatment pathway and recovery strategies. NJR data were used to estimate the deficit of hip and knee arthroplasty by August 2020 and NHS tariff costs were used to calculate the financial burden. Results By November 2020, the elective waiting list in England is predicted to be between 885,286 and 1,028,733. If reduced hospital capacity is factored into the model, returning to full capacity by November, the waiting list could be as large as 1.4 million. With a 30% increase in productivity, it would take 20 months if there was no hidden burden of unreferred patients, and 48 months if there was a hidden burden, to return to pre-COVID-19 waiting list numbers. By August 2020, the estimated deficits of hip and knee arthroplasties from NJR data were 18,298 (44.8%) and 16,567 (38.6%), respectively, compared to the same time period in 2019. The cost to clear this black log would be £198,811,335. Conclusion There will be up to 1.4 million patients on elective orthopaedic waiting lists in England by November 2020, approximate three-times the pre-COVID-19 average. There are various strategies for recovery to return to pre-COVID-19 waiting list numbers reliant on increasing capacity, but these have substantial cost implications. Cite this article: Bone Jt Open 2021;2(2):103–110.

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Creation and Evaluation of a Preoperative Education Website for Hip and Knee Replacement Patients—A Pilot Study

Medicina ◽

10.3390/medicina55020032 ◽

2019 ◽

Vol 55 (2) ◽

pp. 32 ◽

Cited By ~ 1

Author(s):

Amelia Dayucos ◽

Laverne French ◽

Arpad Kelemen ◽

Yulan Liang ◽

Cecilia Sik Lanyi

Keyword(s):

Pilot Study ◽

Knee Arthroplasty ◽

Online Survey ◽

Patient Specific ◽

Surgical Patient ◽

Nursing Time ◽

Preoperative Education ◽

Web Based ◽

Hip And Knee Arthroplasty ◽

Website Content

Background and Objectives: There is limited research on the question of whether web-based preoperative education can improve surgical patient outcomes. The purpose of this pilot study was to determine the usability, utility, and feasibility of a website created to increase engagement and improve the quality of the preoperative education that patients having hip and knee arthroplasty surgery receive. Materials and Methods: A website was created, and its appearance was designed with evidence-based “menu-driven” drop-downs to make the screen options age-appropriate to the patient population; the content was supported with video and PDFs of educational material, the same or similar to the usual education provided to patients. The patient-specific outcomes included qualitative data regarding patient knowledge, satisfaction, utilities, and usability. These objectives were assessed based on the perceived health website usability questionnaire online survey. Eighty patients who met inclusion criteria were recruited, ranging in age from 40 to 65 years old. Among them, 52.5% were female, 71.25% were scheduled for knee arthroplasty, and 28.75% hip arthroplasty. The patients were randomly assigned to the paper only or website education cohorts in a 50:50 ratio. However, only 19 from each cohort participated in the survey questionnaire. Results and Conclusions: We hypothesized that findings would show that patients receiving web-based education would feel more knowledgeable about their procedure, have less anxiety, and greater satisfaction with the addition of the website content; and that nurses would report that a website could conserve nursing time and resources. The study revealed no statistically significant differences between the cohorts, with an Alpha level set at 0.05. However, survey results showed that patients using the website rated self-perceived increase in knowledge, and their satisfaction in the time to find and review the information was higher than that of the paper-only cohort. The nursing survey revealed that website education improved workflow, efficiency, and patient education.

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An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

Medicina ◽

10.3390/medicina56090416 ◽

2020 ◽

Vol 56 (9) ◽

pp. 416 ◽

Cited By ~ 1

Author(s):

Daniel C. Santana ◽

Ahmed K. Emara ◽

Melissa N. Orr ◽

Alison K. Klika ◽

Carlos A. Higuera ◽

...

Keyword(s):

Venous Thromboembolism ◽

Knee Arthroplasty ◽

High Volume ◽

Optimal Choice ◽

Slight Reduction ◽

Vte Prophylaxis ◽

Prophylactic Agent ◽

Total Hip ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

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The effects of physiotherapy using proprioceptive neuromuscular facilitation techniques on the gait of patients after hip and knee arthroplasty: a case report

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0015.0632 ◽

2021 ◽

Vol 15 (SUPPLEMENT 2) ◽

pp. 1

Author(s):

Antonina Kaczorowska ◽

Jolanta Kaboth ◽

Ewelina Lepsy ◽

Agata Mroczek

Keyword(s):

Case Report ◽

Knee Arthroplasty ◽

Sagittal Plane ◽

Lower Limbs ◽

Timed Up And Go ◽

Number Of Patients ◽

Proprioceptive Neuromuscular Facilitation ◽

Test Assessment ◽

Hip And Knee Arthroplasty ◽

Tinetti Test

Background Gait disturbances are a major problem for patients after arthroplasty. After the surgery, walking speed, the rhythm of locomotion, and the length of the steps are significantly reduced. One of the therapeutic methods used in gait re-education is proprioceptive neuromuscular facilitation (PNF). Aim of the study This study aimed to evaluate the effects of physiotherapy using PNF techniques on the gait of patients after hip and knee arthroplasty. Case report A 60-year-old woman with advanced osteoarthritis that received bilateral hip and right knee arthroplasties was examined. Before and after the therapy, the following tests were performed: measurement of the range of motion (ROM) of hip and knees joints in the sagittal plane using a goniometer, assessment of the symmetry of the lower limbs loading using the two scales test, assessment of the risk of falls using the “Timed Up and Go” test, assessment of balance and gait using the Tinetti test, and assessment of pain intensity using the visual analogue scale (VAS). Rehabilitation was comprised of 15 PNF therapies, including scapular and pelvic PNF patterns. The stabilization of the upper and lower trunk, lifting, shifting of the body’s weight from one foot to another, gait cycle (the stance phase and the swing phase), walking forward, backward, and sideways, and walking up/down the stairs were also used. After the therapy, the flexion ROM in both hip and knees joints was improved. The lower limb symmetry index decreased from 1.167 to 1.121, and the sum of the points obtained in the Tinetti test increased from 22 to 26. Pain in the joints also decreased from 6 on the VAS scale to 4. However, the result obtained in the “Timed Up and Go” test after the therapy was increased by 0.5 s compared to before the therapy. Conclusions After hip and knee arthroplasties, physiotherapy using PNF techniques improved the gait and functional status of the patient. Continuation of this research using a larger number of patients is needed.

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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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New Oral Anticoagulants for Venous Thromboembolism Prophylaxis in Total Hip and Knee Arthroplasty: A Systematic Review and Network Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2021.775126 ◽

2022 ◽

Vol 12 ◽

Author(s):

Yi-hu Yi ◽

Song Gong ◽

Tian-lun Gong ◽

Ling-yun Zhou ◽

Can Hu ◽

...

Keyword(s):

Systematic Review ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Oral Anticoagulants ◽

Bleeding Risk ◽

Vte Prophylaxis ◽

Risk Of Bleeding ◽

Hip And Knee Arthroplasty ◽

The Individual

Background: There is controversy over whether use of new oral anticoagulants (NOACs) associates with increased hemorrhage risk compared with non-NOAC. Meanwhile, determining which NOAC to use remains unclear. We aimed to summarize the evidence about NOACs in venous thromboembolism (VTE) prevention for patients with total hip and knee arthroplasty (THA and TKA).Methods: We searched RCTs assessing NOACs for VTE prophylaxis in adults undergoing THA and TKA in Medline, Embase, and Cochrane up to May 2021. Primary outcomes were VTE [included deep vein thrombosis (DVT) and pulmonary embolism (PE)], major VTE, and major bleeding. The rank probabilities of each treatment were summarized by the surface under the cumulative ranking curve area (SUCRA).Results: 25 RCTs with 42,994 patients were included. Compared with non-NOAC, NOACs were associated with a decreased risk of VTE (RR 0.68; 95% CI 0.55–0.84) and major VTE (RR = 0.52; 95% CI 0.35–0.76). Additionally, rivaroxaban, apixaban, and edoxaban but not dabigatran and betrixaban, did confer a higher efficacy compared with non-NOAC. None of the individual NOACs increased the risk of bleeding, while apixaban and betrixaban were even associated with a decreased risk of bleeding. In the comparison of different NOACs, rivaroxaban was associated with the greatest benefits in VTE (SUCRA = 79.6), DVT (SUCRA = 88.8), and major VTE (SUCRA = 89.9) prevention. Furthermore, subgroup analysis confirmed that NOACs associated with a higher efficacy tendency in patients with follow-up duration <60 days than follow-up duration ≥60 days.Conclusion: Evidence suggests that NOACs exert more benefits on VTE prophylaxis, and none of the individual NOACs increased hemorrhage compared with non-NOAC. Among various NOACs, rivaroxaban is recommended in patients with lower bleeding risk, and apixaban is recommended in patients with higher bleeding risk.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021266890].

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Blood Conservation Strategies in Total Hip and Knee Arthroplasty

Reconstructive Review ◽

10.15438/rr.4.4.85 ◽

2015 ◽

Vol 4 (4) ◽

pp. 39-45 ◽

Cited By ~ 2

Author(s):

David Liu ◽

Michael Dan ◽

Natalie Adivi

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Knee Arthroplasty ◽

Conservation Strategies ◽

Patient Specific ◽

Allogenic Blood Transfusion ◽

Transfusion Rate ◽

Blood Conservation ◽

Total Hip ◽

Hip And Knee Arthroplasty

Peri-operative blood management is one of a number of components important for successful patient care in total joint arthroplasty and surgeons should be proactive in its application. The aims of blood conservation are to reduce the risks of blood transfusion whilst at the same time maximizing haemaglobin in the post-operative period, thereby leading to a positive effect on early and long term outcomes and costs. An individualized strategy based on patient specific risk factors, anticipated blood loss and co-morbidities is useful in achieving this aim. Multiple blood conservation strategies are available in the pre-operative, intra-operative and post-operative periods and can be utilised either individually or in combination. Recent literature has highlighted the importance of identifying and correcting pre-operative anaemia, salvaging peri-operative red cells and the use of tranexamic acid in reducing blood loss. Given total hip and knee arthroplasty is an elective procedure, a zero allogenic blood transfusion rate should be the aim and an achievable goal.

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Clinical and radiological outcomes in three-dimensional printing assisted revision total hip and knee arthroplasty: a systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02646-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Rui Zhang ◽

Jiajun Lin ◽

Fenyong Chen ◽

Wenge Liu ◽

Min Chen

Keyword(s):

3D Printing ◽

Clinical Outcomes ◽

Knee Arthroplasty ◽

Three Dimensional ◽

Cochrane Library ◽

Control Group ◽

Total Hip ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Abstract Background This study investigates whether three-dimensional (3D) printing-assisted revision total hip/knee arthroplasty could improve its clinical and radiological outcomes and assess the depth and breadth of research conducted on 3D printing-assisted revision total hip and knee arthroplasty. Methods A literature search was carried out on PubMed, Web of Science, EMBASE, and the Cochrane Library. Only studies that investigated 3D printing-assisted revision total hip and knee arthroplasty were included. The author, publication year, study design, number of patients, patients’ age, the time of follow-up, surgery category, Coleman score, clinical outcomes measured, clinical outcomes conclusion, radiological outcomes measured, and radiological outcomes conclusion were extracted and analyzed. Results Ten articles were included in our review. Three articles investigated the outcome of revision total knee arthroplasty, and seven investigated the outcome of revision total hip arthroplasty. Two papers compared a 3D printing group with a control group, and the other eight reported 3D printing treatment outcomes alone. Nine articles investigated the clinical outcomes of total hip/knee arthroplasty, and eight studied the radiological outcomes of total hip/knee arthroplasty. Conclusion 3D printing is being introduced in revision total hip and knee arthroplasty. Current literature suggests satisfactory clinical and radiological outcomes could be obtained with the assistance of 3D printing. Further long-term follow-up studies are required, particularly focusing on cost-benefit analysis, resource availability, and, importantly, the durability and biomechanics of customized prostheses using 3D printing compared to traditional techniques.

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