scholarly journals Informed Consent in Patients Undergoing Primary Hip and Knee Arthroplasty: What Do Patients Want to Know?

Cureus ◽  
2020 ◽  
Author(s):  
Nemandra A Sandiford ◽  
Maalee Mahendra ◽  
Lilanthi Wickramarachchi ◽  
Diane Back ◽  
Mohit Bansal
Keyword(s):  
Informed Consent ◽  
Knee Arthroplasty ◽  
Hip And Knee Arthroplasty

Venous thromboembolism complications in shoulder surgery: current concepts

2021 ◽  
pp. jisakos-2020-000538
Author(s):  
Michael R. Mancini ◽  
Matthew R. LeVasseur ◽  
Benjamin C. Hawthorne ◽  
Daniel E. Marrero ◽  
Augustus D. Mazzocca
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Informed Consent ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Shoulder Arthroplasty ◽  
Informed Consent Process ◽  
Shoulder Surgery ◽  
Mechanical Prophylaxis ◽  
Hip And Knee Arthroplasty

Venous thromboembolism (VTE) is a rare yet known complication of shoulder surgery. Concerning shoulder arthroplasty, reported rates of VTE range from 0.2% to 16%. Unlike many lower extremity procedures, particularly total hip and knee arthroplasty, chemical prophylactic guidelines for VTE in shoulder surgeries have not been established. Some argue that doing so is unnecessary. On the contrary, mechanical prophylaxis is nearly universally accepted in shoulder surgery, particularly for more lengthy procedures. With limited VTE incidence in shoulder surgery, treatment is anecdotally derived from the hip and knee arthroplasty literature. Recent studies have successfully identified risk factors for VTE related to the patient and to the surgery itself. Awareness of these risk factors by the surgeon and declaration of these factors to the patient should be discussed as part of the informed consent process. Further investigational studies and larger patient cohorts will be necessary to optimise VTE prevention in shoulder surgeries.

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

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

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 188
Author(s):  
Daniel C. Santana ◽  
Matthew J. Hadad ◽  
Ahmed Emara ◽  
Alison K. Klika ◽  
Wael Barsoum ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Perioperative Management ◽  
Recent Literature ◽  
Patient Specific ◽  
Antithrombotic Agents ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Post Operative Period ◽  
Number Of Patients ◽  
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.

Predictors of Successful Early Discharge for Total Hip and Knee Arthroplasty in Octogenarians

2021 ◽  
pp. 155633162110306
Author(s):  
Andrew B. Kay ◽  
Danielle Y. Ponzio ◽  
Courtney D. Bell ◽  
Fabio Orozco ◽  
Zachary D. Post ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Early Discharge ◽  
Readmission Rates ◽  
Patients Âgés ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
Student’S T ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: Decreased length of stay after total joint arthroplasty (TJA) is becoming a more common way to contain healthcare costs and increase patient satisfaction. There is little evidence to support “early” discharge in elderly patients. Purpose: We sought to identify preoperative factors that correlated with early discharge (by postoperative day [POD] 1) in comparison to late discharge (after POD2) in octogenarians after TJA. Methods: In a retrospective cohort study from a single institution, we identified 482 patients ages 80 to 89 who underwent primary TJA from January 2014 to December 2017; 319 had total knee arthroplasty (TKA) and 163 had total hip arthroplasty (THA). Data collected included preoperative knee range of motion (ROM), demographics, and comorbidities; 90-day readmission and mortality rates were also evaluated. P values for continuous data were calculated using student’s t test and for categorical data using χ2 testing. Results: Of octogenarian patients, 30.9% were discharged by POD1. Early discharge was associated with being male, married, and nonsmoking, as well as having an American Society of Anesthesiologists (ASA) score of 2, independent preoperative ambulation, and a postoperative caregiver. Type of procedure (TKA vs THA), body mass index, laterality, preoperative range of motion (ROM) for TKA, and single vs multilevel home did not affect the probability of early discharge. Discharge on POD1 was not associated with increased 90-day readmission rates. There were no deaths. Conclusion: Early discharge for octogenarians can be successfully implemented in a select subset of patients without increasing 90-day readmission or death rates. There are multiple factors that predict successful early discharge.

Tranexamic acid in patients with current or former cancer undergoing hip and knee arthroplasty

2021 ◽  
Author(s):  
Nathan H. Varady ◽  
Antonia F. Chen ◽  
Nicholas J. Drayer ◽  
John Ready ◽  
Santiago A. Lozano‐Calderon ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Hip And Knee Arthroplasty

scholarly journals Trends and developments in hip and knee arthroplasty technology

2021 ◽  
Vol 8 ◽  
pp. 205566832095204
Author(s):  
Martin Marsh ◽  
Simon Newman
Keyword(s):  
Knee Arthroplasty ◽  
Standard Of Care ◽  
Hip Resurfacing ◽  
Implant Survival ◽  
Dual Mobility ◽  
Joint Replacements ◽  
Robotic Assisted Surgery ◽  
Hip And Knee Arthroplasty ◽  
Hip Stems ◽  
Hip And Knee Surgery

The developments in hip and knee arthroplasty over recent years have aimed to improve outcomes, reduce complications and improve implant survival. This review describes some of the most interesting trends and developments in this important and fast-moving field. Notable developments have included ceramic hip resurfacing, mini hip stems, cementless knee replacement and the wider adoption of the dual mobility articulation for hip arthroplasty. Advances in additive manufacturing and the surface modification of joint replacements offer increasing options for more challenging arthroplasty cases. Robotic assisted surgery is one of the most interesting developments in hip and knee surgery. The recent growth in the use of this technology is providing data that will help determine whether this approach should become the standard of care for hip and knee arthroplasty in the future.

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