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The Bone & Joint Journal Apr 2018Unicompartmental knee arthroplasty (UKA) has numerous advantages over total knee arthroplasty (TKA) and one disadvantage, the higher revision rate. The best way to... (Review)
Review
Unicompartmental knee arthroplasty (UKA) has numerous advantages over total knee arthroplasty (TKA) and one disadvantage, the higher revision rate. The best way to minimize the revision rate is for surgeons to use UKA for at least 20% of their knee arthroplasties. To achieve this, they need to learn and apply the appropriate indications and techniques. This would decrease the revision rate and increase the number of UKAs which were implanted, which would save money and patients would benefit from improved outcomes over their lifetime. Cite this article: Bone Joint J 2018;100-B:432-5.
Topics: Arthroplasty, Replacement, Knee; Hemiarthroplasty; Humans; Knee Prosthesis; Osteoarthritis, Knee; Patient Selection; Practice Patterns, Physicians'; Registries; Reoperation; Treatment Outcome; United Kingdom
PubMed: 29629577
DOI: 10.1302/0301-620X.100B4.BJJ-2017-0716.R1 -
Infectious Disease Clinics of North... Dec 2018Prosthetic joint infection occurs in a minority of arthroplasties performed; however, it brings a large burden to both the individual and society in terms of morbidity,... (Review)
Review
Prosthetic joint infection occurs in a minority of arthroplasties performed; however, it brings a large burden to both the individual and society in terms of morbidity, mortality, and health care expenditure. Although prevention of prosthetic joint infection is becoming more effective, the number of total arthroplasties in patients with increasing comorbidities continues to rise, and the total number of diagnosed and managed prosthetic joint infections is expected to rise accordingly. Management is complex and involves a multispecialty approach.
Topics: Arthroplasty; Bacterial Infections; Humans; Prosthesis-Related Infections
PubMed: 30241717
DOI: 10.1016/j.idc.2018.06.005 -
The Bone & Joint Journal Nov 2022Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there...
Periprosthetic joint infection (PJI) remains an extremely challenging complication. We have focused on this issue more over the last decade than previously, but there are still many unanswered questions. We now have a workable definition that everyone should align to, but we need to continue to focus on identifying the organisms involved. Surgical strategies are evolving and care is becoming more patient-centred. There are some good studies under way. There are, however, still numerous problems to resolve, and the challenge of PJI remains a major one for the orthopaedic community. This annotation provides some up-to-date thoughts about where we are, and the way forward. There is still scope for plenty of research in this area.Cite this article: 2022;104-B(11):1193-1195.
Topics: Humans; Prosthesis-Related Infections; Arthroplasty, Replacement, Hip; Synovial Fluid; Arthroplasty, Replacement, Knee; Biomarkers; Arthritis, Infectious; Sensitivity and Specificity
PubMed: 36317347
DOI: 10.1302/0301-620X.104B11.BJJ-2022-0944 -
BMC Musculoskeletal Disorders Jul 2022Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge... (Observational Study)
Observational Study
BACKGROUND
Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA.
METHODS
Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥ 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).
RESULTS
In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥ 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥ 12 weeks of postoperative PT (range Odds Ratios 0.97-0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01-1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations.
CONCLUSION
Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients' needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities.
TRIAL REGISTRATION
Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197 .
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Physical Therapy Modalities; Recovery of Function; Treatment Outcome
PubMed: 35831841
DOI: 10.1186/s12891-022-05429-z -
The Journal of Arthroplasty Jan 2023
Topics: Humans; Female; Arthroplasty, Replacement, Knee; Arthroplasty; Arthroplasty, Replacement, Hip
PubMed: 36494118
DOI: 10.1016/j.arth.2022.11.001 -
Orthopaedics & Traumatology, Surgery &... Feb 2022The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population,... (Review)
Review
The number of hip or knee arthroplasties, and internal fixations of the proximal and distal femur, is increasing in proportion to the growing and ageing population, whose life expectancy is lengthening. Thus, fractures of the femur between proximal and distal implants, although rare, are becoming more frequent. Women over the age of 70, with fragile bones and whose ends of the two implants are close to each other ("kissing implants") are particularly vulnerable to them. Reliable and reproducible fracture classifications exist when it comes to 2 prostheses, but they are less well established in the presence of one, or even two, non-prosthetic implants. Their treatment is difficult and must consider the possibility of fracture consolidation while ensuring or restoring the stability and role of the implants. Whether it is the main element of treatment or a complement to prosthesis revision, locked plating forms the basis of the treatment but it must be rigorous, considering that failures are mainly the result of technical errors. Other more invasive treatments (total femoral arthroplasty, cortical sleeves) are offered more rarely if consolidation appears compromised.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Bone Plates; Female; Femoral Fractures; Fracture Fixation, Internal; Humans; Periprosthetic Fractures; Reoperation; Treatment Outcome
PubMed: 34666198
DOI: 10.1016/j.otsr.2021.103117 -
The Orthopedic Clinics of North America Jan 2022The number of annual total joint arthroplasties (TJA) is increasing. Periprosthetic joint infections (PJI) occur when there is infection involving the prosthesis and... (Review)
Review
The number of annual total joint arthroplasties (TJA) is increasing. Periprosthetic joint infections (PJI) occur when there is infection involving the prosthesis and surrounding tissue, which has the potential to develop into sepsis if left untreated. Sepsis in patients who have undergone TJA is life threatening and requires urgent treatment. If sepsis is due to PJI, the focus should be on early intravenous antibiotics with aspiration as soon as possible to diagnose the infection. Patients who develop sepsis after surgery for PJI are particularly at high risk for mortality and need to be treated in the intensive care unit.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Prosthesis-Related Infections; Sepsis
PubMed: 34799018
DOI: 10.1016/j.ocl.2021.08.008 -
The Bone & Joint Journal Mar 2022
Topics: Arthroplasty, Replacement; Cognition; Humans; Life Expectancy; Outcome Assessment, Health Care
PubMed: 35227096
DOI: 10.1302/0301-620X.104B3.BJJ-2022-0115 -
The Knee Jan 2022Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of... (Observational Study)
Observational Study
BACKGROUND
Limited data exist on fast-track protocols in relation to revision knee arthroplasty. Hence, the aim of this study was to report length of stay (LOS), risk of LOS > 5 days and readmission ≤ 90 days after revision knee arthroplasty in centers with a well-established fast-track protocol in both primary and revision surgery.
METHODS
An observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Knee Arthroplasty Register. We included elective aseptic major component revision knee arthroplasties consecutively from 6 dedicated fast-track centers from 2010 to 2018.
RESULTS
1439 revision knee arthroplasties were analyzed, including 900 total revisions, 171 large partial revisions (revision of either femoral or tibia component) and 368 revisions of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA). Mean age was 65 years (SD 10.9) and 66% were females. Mean LOS was 3.7 days (SD 3.9) in the study period, but decreased to 2.4 days (SD 1.3) in 2018. Risk factors for LOS > 5 days was ≥ 1 previous revision, use of walking aid, BMI > 35, ages < 50, 70-79 and ≥ 80 years, whereas revision of UKA to TKA and large partial revision were negatively associated. The 90-day readmission and mortality risk was 9.1% and 0.5%. Cardiac disease and use of walking aid were associated with increased risk of readmission ≤ 90 days.
CONCLUSION
Elective aseptic major component revision knee arthroplasty using similar fast-track protocols as in primary TKA is safe with short and decreasing LOS.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cohort Studies; Elective Surgical Procedures; Female; Humans; Length of Stay; Reoperation
PubMed: 34894588
DOI: 10.1016/j.knee.2021.09.001 -
The Journal of Arthroplasty Nov 2022Joint arthroplasties are among the most commonly performed elective surgeries in the United States. Surgical outcomes are known to improve with volume but it is unclear...
BACKGROUND
Joint arthroplasties are among the most commonly performed elective surgeries in the United States. Surgical outcomes are known to improve with volume but it is unclear whether this has led to consolidation among elective surgeries. We examined trends in volumes per surgeon and hospital to assess whether the known volume-outcome relationship has led to consolidation in elective joint arthroplasty and to determine if there exist volume thresholds above which outcomes do not change.
METHODS
Among Medicare beneficiaries who underwent either total knee or total hip arthroplasty from 2009 through 2015, we described volume trends and used mixed-effect models to relate annual surgeon and hospital volumes with 30-day complications or mortality. We tested for optimal volume cut points at both the hospital and surgeon level.
RESULTS
Adjusted annual complication rates were inversely associated with volume for both procedures at both the surgeon level and hospital level, but there was minimal consolidation between 2009 and 2015. Complications no longer declined after volumes of each case exceeded 260 per year. The vast majority of cases (around 93% of hip and 88% of knee arthroplasties) were performed by surgeons operating at suboptimal volumes.
CONCLUSION
More than 2 decades after the volume-outcome relationship was established for joint arthroplasty, many cases continue to be performed by low-volume surgeons, with far more cases performed by surgeons operating at suboptimal volumes. Further improvement could be expected through consolidation at both the hospital and surgeon level, with a target of at least 260 cases per surgeon annually for each operation. Payers seem best-equipped to drive consolidation.
Topics: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Hospitals; Humans; Medicare; Postoperative Complications; United States
PubMed: 35568138
DOI: 10.1016/j.arth.2022.05.011