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Acta Orthopaedica Jul 2022
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Postoperative Period
PubMed: 35848732
DOI: 10.2340/17453674.2022.3977 -
Bulletin of the Hospital For Joint... 2014Patellofemoral arthroplasty has been described as an appropriate treatment for isolated patellofemoral arthritis. With the aging population and the increasing number of... (Review)
Review
Patellofemoral arthroplasty has been described as an appropriate treatment for isolated patellofemoral arthritis. With the aging population and the increasing number of total joint arthroplasties, both patients and surgeons are on the lookout for alternatives to total joint arthroplasty. With appropriate patient selection, well-designed implants, and precise surgical technique, the outcomes of patellofemoral arthroplasty can be excellent. The main indication for patellofemoral arthroplasty is isolated patellofemoral arthritis.
Topics: Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Humans; Knee Prosthesis; Patellofemoral Joint; Patient Selection; Postoperative Complications; Prosthesis Design; Recovery of Function; Risk Factors; Treatment Outcome
PubMed: 25150332
DOI: No ID Found -
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 -
Orthopadie (Heidelberg, Germany) Feb 2023With the increasing number of primary arthroplasties, revisions of anatomical prostheses are becoming increasingly important. The most common reasons for revision are... (Review)
Review
With the increasing number of primary arthroplasties, revisions of anatomical prostheses are becoming increasingly important. The most common reasons for revision are glenoid loosening, including protrusion, rotator cuff insufficiency, including instability, and early/late infection. The reconstruction of glenoid defects can be done with an autograft or allograft. Depending on the size and situation, it is carried out in one or two stages. The stemless humeral head replacement and the short-stem prostheses that have been used more frequently in recent years have significantly simplified humeral revision. Platform systems take a different approach with the option of conversion without major interventions on the glenoid or revision stem. Intraoperative complications mainly occur on the humeral side. Postoperative complications include dislocation, component loosening, and infection. Revision of anatomical to reverse arthroplasty shows better clinical outcomes and lower complication rates than anatomical revision.
Topics: Humans; Arthroplasty, Replacement; Arthroplasty, Replacement, Shoulder; Humeral Head; Postoperative Complications; Shoulder Joint; Arthroscopy; Reoperation
PubMed: 36658348
DOI: 10.1007/s00132-022-04337-3 -
Acta Orthopaedica Et Traumatologica... Sep 2018Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. However, to the best of our... (Review)
Review
PURPOSE
Bibliometrics is increasingly used to assess the quantity and quality of scientific research output in many research fields worldwide. However, to the best of our knowledge, no studies have documented the main characteristics of arthroplasty publications from different countries. This study aimed to evaluate the worldwide research productivity and status of Turkey in the field of arthroplasty using bibliometric methods and to provide an insight into the arthroplasty research for surgeons and researchers.
METHODS
The Web of Science database was searched to identify arthroplasty articles published between 2006 and 2016. The contributions of countries were evaluated based on publication count, citation average, h-index and publication rate in the top 10 ranked journals. Each countries publication output was adjusted according to population size.
RESULTS
A total of 26.167 articles were identified. World arthroplasty publications were increased significantly over time (p < .005). The United States was the most productive country with 9007 articles (34,4% of total) followed by England with 2939 articles (11,4 of total) and Germany with 1881 articles (7,1% of total). According to average citations per item, Scotland was in the first place followed by Denmark and Sweden, whereas in the first place according to publication output adjusted by population size was Switzerland followed by Denmark and Scotland. The United States was also in the first place according to h-index and publication rate in the top 10 ranked journals. Founding average was 28,8% (7539 of 26164) for the arthroplasty articles that were analyzed in the study.
CONCLUSION
There is a rapid increase in the number of articles in arthroplasty research from 2006 to 2016. The United States was the most productive country as measured by total publications in the arthroplasty field. However, some small European countries with high in-come have higher quality of articles and better productivity when adjusted for population. Gross domestic product (GDP) per capita and research foundation had positive affect on arthroplasty publications, both qualitatively and quantitatively.
Topics: Arthroplasty; Bibliometrics; Biomedical Research; Humans; Turkey
PubMed: 29980409
DOI: 10.1016/j.aott.2018.06.002 -
Arthroplasty implant registries over the past five decades: Development, current, and future impact.Journal of Orthopaedic Research :... Sep 2018Local, regional, and national registries have played an important role in the development of hip and knee arthroplasty and the treatment of patients with various... (Review)
Review
Local, regional, and national registries have played an important role in the development of hip and knee arthroplasty and the treatment of patients with various maladies of these joints. Four arthroplasty registries stand out as leading forces behind the drive to popularize the use of registries and pursue the concept of evidence based medicine. The Mayo registry, started by Mark Coventry, is recognized as the oldest continuing registry for arthroplasty. The Harris Registry at Massachusetts General Hospital, along with the Mayo Registry, has greatly contributed to the advancement of arthroplasty surgery and have served an important role of identifying poorly performing implants and techniques in the United States. The Swedish Knee Arthroplasty Registry is the oldest national registry dedicated to joint arthroplasty and along with the Swedish Hip Arthroplasty Registry have established the infrastructure, analysis and reporting mechanisms, and leadership that has enabled other countries to subsequently develop national registries around the world. As more countries have adopted the concept of national registries, a new area of research is possible by pooling the resources of large registries as is now occurring with the Nordic countries. Several international organizations have been formed to promote future collaboration and develop international standards. The process of globalization of registries is a result of continued efforts over the past 50 years in improving and disseminating the knowledge gained from the early registries. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2319-2330, 2018.
Topics: Arthroplasty, Replacement, Elbow; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Arthroplasty, Replacement, Shoulder; Data Collection; Elbow Prosthesis; Evidence-Based Medicine; Hip Prosthesis; Humans; International Cooperation; Knee Prosthesis; Orthopedics; Prosthesis Design; Prosthesis Failure; Registries; Shoulder Prosthesis; Societies, Medical; Sweden; United States
PubMed: 29663575
DOI: 10.1002/jor.24014 -
Anesthesiology Jul 2021With increasing use of tranexamic acid in total hip and knee arthroplasties, safety concerns remain. Using national claims data, this study examined tranexamic acid use...
BACKGROUND
With increasing use of tranexamic acid in total hip and knee arthroplasties, safety concerns remain. Using national claims data, this study examined tranexamic acid use in patients with preexisting comorbidities. The hypothesis was that tranexamic acid use is not associated with increased complication risk in hip and knee arthroplasty patients with comorbidities.
METHODS
Among 765,011 total hip/knee arthroplasties (2013 to 2016, Premier Healthcare claims), tranexamic acid use was assessed in three high-risk groups: group I with patients with a history of venous thromboembolism, myocardial infarction, seizures, or ischemic stroke/transient ischemic attack (n = 27,890); group II with renal disease (n = 44,608); and group III with atrial fibrillation (n = 45,952). The coprimary outcomes were blood transfusion and new-onset "composite complications" (venous thromboembolism, myocardial infarction, seizures, and ischemic stroke/transient ischemic attack). Associations between tranexamic acid use and outcomes were measured separately by high-risk group. The odds ratios and Bonferroni-adjusted 99.9% CIs are reported.
RESULTS
Overall, 404,974 patients (52.9%) received tranexamic acid, with similar frequencies across high-risk groups I (13,004 of 27,890 [46.6%]), II (22,424 of 44,608 [50.3%]), and III (22,379 of 45,952 [48.7%]). Tranexamic acid use was associated with decreased odds of blood transfusion in high-risk groups I (721 of 13,004 [5.5%] vs. 2,293 of 14,886 [15.4%]; odds ratio, 0.307; 99.9% CI, 0.258 to 0.366), group II (2,045 of 22,424 [9.1%] vs. 5,159 of 22,184 [23.3%]; odds ratio, 0.315; 99.9% CI, 0.263 to 0.378), and group III (1,325 of 22,379 [5.9%] vs. 3,773 of 23,573 [16.0%]; odds ratio, 0.321; 99.9% CI, 0.266 to 0.389); all adjusted comparisons P < 0.001. No increased odds of composite complications were observed in high-risk group I (129 of 13,004 [1.0%] vs. 239 of 14,886 [1.6%]; odds ratio, 0.89, 99.9% CI, 0.49 to 1.59), group II (238 of 22,424 [1.1%] vs. 369 of 22,184 [1.7%]; odds ratio, 0.98; 99.9% CI, 0.58 to 1.67), and group III (187 of 22,379 [0.8%] vs. 290 of 23,573 [1.2%]; odds ratio, 0.93; 99.9% CI, 0.54 to 1.61); all adjusted comparisons P > 0.999.
CONCLUSIONS
Although effective in reducing blood transfusions, tranexamic acid is not associated with increased complications, irrespective of patient high-risk status at baseline.
Topics: Animals; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Transfusion; Humans; Risk; Tranexamic Acid
PubMed: 33857300
DOI: 10.1097/ALN.0000000000003772 -
Annals of Physical and Rehabilitation... Jun 2016There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the... (Review)
Review
There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures.
Topics: Adult; Arthrodesis; Arthroplasty; Humans; Osteoarthritis; Osteotomy; Patient Selection
PubMed: 27185463
DOI: 10.1016/j.rehab.2016.04.003 -
JAMA Surgery Jun 2023Surgical team communication is a critical component of operative efficiency. The factors underlying optimal communication, including team turnover, role composition, and...
IMPORTANCE
Surgical team communication is a critical component of operative efficiency. The factors underlying optimal communication, including team turnover, role composition, and mutual familiarity, remain underinvestigated in the operating room.
OBJECTIVE
To assess staff turnover, trainee involvement, and surgeon staff preferences in terms of intraoperative efficiency.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective analysis of staff characteristics and operating times for all total joint arthroplasties was performed at a tertiary academic medical center by 5 surgeons from January 1 to December 31, 2018. Data were analyzed from May 1, 2021, to February 18, 2022. The study included cases with primary total hip arthroplasties (THAs) and primary total knee arthroplasties (TKAs) comprising all primary total joint arthroplasties performed over the 1-year study interval.
EXPOSURES
Intraoperative turnover among nonsurgical staff, presence of trainees, and presence of surgeon-preferred staff.
MAIN OUTCOMES AND MEASURES
Incision time, procedure time, and room time for each surgery. Multivariable regression analyses between operative duration, presence of surgeon-preferred staff, and turnover among nonsurgical personnel were conducted.
RESULTS
A total of 641 cases, including 279 THAs (51% female; median age, 64 [IQR, 56.3-71.5] years) and 362 TKAs (66% [238] female; median age, 68 [IQR, 61.1-74.1] years) were considered. Turnover among circulating nurses was associated with a significant increase in operative duration in both THAs and TKAs, with estimated differences of 19.6 minutes (SE, 3.5; P < .001) of room time in THAs and 14.0 minutes (SE, 3.1; P < .001) of room time in TKAs. The presence of a preferred anesthesiologist or surgical technician was associated with significant decreases of 26.5 minutes (SE, 8.8; P = .003) of procedure time and 12.6 minutes (SE, 4.0; P = .002) of room time, respectively, in TKAs. The presence of a surgeon-preferred vendor was associated with a significant increase in operative duration in both THAs (26.3 minutes; SE, 7.3; P < .001) and TKAs (29.6 minutes; SE, 9.6; P = .002).
CONCLUSIONS AND RELEVANCE
This study found that turnover among operative staff is associated with procedural inefficiency. In contrast, the presence of surgeon-preferred staff may facilitate intraoperative efficiency. Administrative or technologic support of perioperative communication and team continuity may help improve operative efficiency.
Topics: Humans; Female; Middle Aged; Aged; Male; Arthroplasty, Replacement, Knee; Retrospective Studies; Arthroplasty, Replacement, Hip; Surgeons; Operating Rooms
PubMed: 36947044
DOI: 10.1001/jamasurg.2023.0168 -
The Bone & Joint Journal Oct 2015There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence,... (Comparative Study)
Comparative Study Review
There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence, different people draw different conclusions and as a result, there is great variability in the usage of UKA. The revision rate of UKA is much higher than TKA and so some surgeons conclude that UKA should not be performed. Other surgeons believe that the main reason for the high revision rate is that UKA is easy to revise and, therefore, the threshold for revision is low. They also believe that UKA has many advantages over TKA such as a faster recovery, lower morbidity and mortality and better function. They therefore conclude that UKA should be undertaken whenever appropriate. The solution to this argument is to minimise the revision rate of UKA, thereby addressing the main disadvantage of UKA. The evidence suggests that this will be achieved if surgeons use UKA for at least 20% of their knee arthroplasties and use implants that are appropriate for these broad indications.
Topics: Arthroplasty, Replacement, Knee; Attitude of Health Personnel; Hemiarthroplasty; Humans; Knee Prosthesis; Osteoarthritis, Knee; Registries; Reoperation; Treatment Outcome
PubMed: 26430080
DOI: 10.1302/0301-620X.97B10.36542