scholarly journals Total Joint Arthroplasty Cost Savings With a Rapid Recovery Protocol in a Military Medical Center

2012 ◽  
Vol 177 (1) ◽  
pp. 64-69 ◽  
Author(s):  
David M. Doman ◽  
Tad L. Gerlinger
2020 ◽  
Vol 4 (5) ◽  
pp. e20.00034 ◽  
Author(s):  
Surabhi Bhatt ◽  
Kristina Davis ◽  
David W. Manning ◽  
Cynthia Barnard ◽  
Terrance D. Peabody ◽  
...  

2019 ◽  
Vol 25 ◽  
pp. 107602961982811 ◽  
Author(s):  
Chase Thorson ◽  
Kevin Galicia ◽  
Andrew Burleson ◽  
Olivia Bouchard ◽  
Debra Hoppensteadt ◽  
...  

Osteoarthritis, a degenerative disease of the joints, is the most common form of arthritis in the knee. Total joint arthoplasty is a commonly used treatment for joint degeneration and osteoarthritis, and due to these factors, TJA for hip and knee joints is projected to grow by 137% and 601% between 2005 and 2030. Matrix metalloproteases are enzymes found in the extracellular matrix that cleave matrix components. Normally MMPs are downregulated in tissues by Tissue Inhibitors of Metalloproteases, or TIMPs. The relative concentration of TIMPs also may denote some of the activity of the MMPs found in serum. Lubricin (proteoglycan 4) is a molecule found in the synovial fluid that protects joints by dissipating strain energy during locomotion. Lubricin synovial fluid concentration is also diminished in many patients with osteoarthritis, but not all. Given the importance of these three sets of molecules, our lab investigated the correlation between circulating lubricin, MMP levels and TIMPs levels. Blood plasma samples were obtained from de-identified subjects undergoing total joint arthroplasty at Loyola University Medical Center and the University of Utah. Normal blood plasma from pooled healthy individuals served as a control. We analyzed biomarker levels in plasma using ELISA. Our data show that MMP-1 and 9 were increased in TJA patients compared to normal controls, while MMP-2 and 13 were decreased. We also found decreased lubricin and tissue factor in surgical patients relative to controls. These data support the idea that lubricin is vital in protecting the synovial joint and that MMPs play a complex role in the destruction of the joint.


2020 ◽  
Vol 35 (4) ◽  
pp. 950-954 ◽  
Author(s):  
Justin J. Turcotte ◽  
Andrea H. Stone ◽  
Ruby J. Gilmor ◽  
Josephine W. Formica ◽  
Paul J. King

2020 ◽  
Vol 35 (5) ◽  
pp. 1445-1446
Author(s):  
Jeffrey B. Stambough ◽  
G. Barnes Bloom ◽  
Paul K. Edwards ◽  
Gregory R. Mehaffey ◽  
C. Lowry Barnes ◽  
...  

2021 ◽  
pp. 155633162199868
Author(s):  
Justin Turcotte ◽  
Nandakumar Menon ◽  
Jeanne Angeles ◽  
Amina Zaidi ◽  
Paul King ◽  
...  

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures that are expected to continue increasing in demand. Although they are proven to be safe and effective, emergency room (ER) visits or hospital readmissions within 90 days after these procedures account for more than one-third of the total cost of postacute care. Purpose: We sought to identify changes in reasons for 90-day ER visits and readmissions after total joint arthroplasty (TJA) during a 5-year period over which rapid recovery protocols evolved. Methods: We conducted a retrospective cohort study comparing 1980 patients who had undergone TJA from July 2017 to June 2018 with a previously published cohort of 7466 patients who had undergone TJA from July 2013 to June 2017. All procedures were performed at a single institution. Changes in the proportion of patients returning for medical and surgical reasons were compared using univariate analysis. Results: For patients discharged home, the 2017–2018 cohort showed a significant reduction in the proportion of ER visits due to pain and swelling and wound infection and an increase in visits for medical reasons. This cohort had a higher proportion of readmissions for medical reasons. In patients discharged to a skilled nursing facility (SNF), similar reasons for ER visits were observed across time periods, and a decrease in the proportion of readmissions for wound infections was observed in the 2017–2018 cohort. Falls and nausea, vomiting, or diarrhea increased significantly to account for 9.5% of readmissions each in 2017–2018. Conclusion: The results of a comparison of 2 cohorts demonstrate the heterogeneous and dynamic nature of unplanned return-to-hospital events and the importance of patient support throughout the surgical episode. As we strive toward minimizing ER visits and readmissions after TJA, rapid recovery protocols must continue to evolve to address the complexity of this patient population.


2021 ◽  
Vol 17 (1) ◽  
pp. 51-58
Author(s):  
Eric N. Windsor ◽  
Abhinav K. Sharma ◽  
Ioannis Gkiatas ◽  
Ameer M. Elbuluk ◽  
Peter K. Sculco ◽  
...  

With the increase in technological advances over the years, telehealth services in orthopedic surgery have gained in popularity, yet adoption among surgeons has been slow. With the onset of the COVID-19 pandemic, however, orthopedic surgery practices nationwide have accelerated adaptation to telemedicine. Telehealth can be effectively applied to total joint arthroplasty, with the ability to perform preoperative consultations, postoperative follow-up, and telerehabilitation in a virtual, remote manner with similar outcomes to in-person visits. New technologies that have emerged, such as virtual goniometers, wearable sensors, and app-based patient questionnaires, have improved clinicians’ ability to conduct telehealth visits. Benefits of using telehealth include high patient satisfaction, cost-savings, increased access to care, and more efficiency. Notably, some challenges still exist, including widespread accessibility and adaptation of new technologies, inability to conduct an in-person orthopedic physical examination, and regulatory barriers, such as insurance reimbursement, increased medicolegal risk, and privacy and confidentiality concerns. Despite these hurdles, telehealth is here to stay and can be successfully incorporated in any total joint arthroplasty practice with the appropriate adjustments.


2020 ◽  
Vol 35 (9) ◽  
pp. 2307-2317.e1
Author(s):  
Sara J. Hyland ◽  
Brian J. Kramer ◽  
Robert A. Fada ◽  
Michelle M. Lucki

2017 ◽  
Vol 31 (09) ◽  
pp. 815-821 ◽  
Author(s):  
Blake Peterson ◽  
Samuel Thompson ◽  
James Cook ◽  
Ajay Aggarwal ◽  
John Martino

AbstractDemand for total hip (THA) and knee arthroplasties (TKA) is expected to rise sharply by 2030. Increasing demand in conjunction with financial pressure requires the use of cost-effective total joint arthroplasty (TJA) strategies. This study examined the effects that day of week and surgery location [academic (AH) versus orthopaedic-specific (OsH) hospital] have on length of stay (LOS) and cost for primary TJA patients in one multihospital university-based medical center. An Institutional Review Board-approved database of adult patients undergoing primary THA or TKA from June 2013 to December 2014 was constructed. Surgery location, day of procedure, age, American Society of Anesthesiologists (ASA) classification, LOS, and cost were recorded for each patient. Data were compared for significant differences using analysis of variance, t-Test or rank sum and for strength of correlations using Pearson's or Spearman's tests. A total of 1,291 patients met inclusion criteria. OsH showed significantly lower cost and shorter LOS than AH. Wednesday surgeries had significantly higher cost and longer LOS than all other days. Friday surgeries had significantly lower cost and shorter LOS than other days. ASA 3 and 4 were associated with the highest cost and longest LOS. LOS had a moderately strong direct correlation to cost. ASA did not have a strong correlation with LOS or cost. Data separated for THA and TKA showed similar results. At our institution, OsH provides more consistent and lower LOS and cost across all ASA classes. Wednesday and Thursday surgeries have increased LOS and cost than other days, which may be due to weekend discharge difficulties (average LOS is 3.0 days).


2017 ◽  
Vol 13 (3) ◽  
pp. 267-270 ◽  
Author(s):  
Allyson Alfonso ◽  
Lorraine Hutzler ◽  
Bill Robb ◽  
Chad Beste ◽  
André Blom ◽  
...  

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