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Maturitas Nov 2018Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However,... (Review)
Review
Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Femoral Fractures; Humans; Incidence; Periprosthetic Fractures; Risk Factors
PubMed: 30314554
DOI: 10.1016/j.maturitas.2018.08.010 -
Acta Bio-medica : Atenei Parmensis Jun 2017Total knee arthroplasty is a successful operation that significantly improves patient's quality of life. However, studies demonstrated as only 82% to 89% of patients are... (Review)
Review
Total knee arthroplasty is a successful operation that significantly improves patient's quality of life. However, studies demonstrated as only 82% to 89% of patients are satisfied with their surgery, being the other disappointed with regard to their expectations. Two to 5.7% of total knee arthroplasties (TKAs) require revision within 5 years. Both complex primary cases and revision TKA often necessitate for a higher degree of constrain than cruciate retaining or postero-stabilized implant design. In the 1970s varus-valgus constrained (VVC) or semi-constrained implants have been developed by Insall and associates from the PS design, which provide varus-valgus stability preserving a fair amount of host bone. VVC TKAs allows for a small amount of movement in the coronal, antero-posterior and axial planes. In this paper, the authors give an overview of the indications, outcomes and technique for varus-valgus constrained implants, both in the setting of primary and revision knee arthroplasty.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Patient Selection; Prosthesis Design; Reoperation
PubMed: 28657572
DOI: 10.23750/abm.v88i2-S.6521 -
The Bone & Joint Journal Aug 2019There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology...
AIMS
There has been a recent resurgence in interest in combined partial knee arthroplasty (PKA) as an alternative to total knee arthroplasty (TKA). The varied terminology used to describe these procedures leads to confusion and ambiguity in communication between surgeons, allied health professionals, and patients. A standardized classification system is required for patient safety, accurate clinical record-keeping, clear communication, correct coding for appropriate remuneration, and joint registry data collection.
MATERIALS AND METHODS
An advanced PubMed search was conducted, using medical subject headings (MeSH) to identify terms and abbreviations used to describe knee arthroplasty procedures. The search related to TKA, unicompartmental (UKA), patellofemoral (PFA), and combined PKA procedures. Surveys were conducted of orthopaedic surgeons, trainees, and biomechanical engineers, who were asked which of the descriptive terms and abbreviations identified from the literature search they found most intuitive and appropriate to describe each procedure. The results were used to determine a popular consensus.
RESULTS
Survey participants preferred "bi-unicondylar arthroplasty" (Bi-UKA) to describe ipsilateral medial and lateral unicompartmental arthroplasty; "medial bi-compartmental arthroplasty" (BCA-M) to describe ipsilateral medial unicompartmental arthroplasty with patellofemoral arthroplasty; "lateral bi-compartmental arthroplasty" (BCA-L) to describe ipsilateral lateral unicompartmental arthroplasty with patellofemoral arthroplasty; and tri-compartmental arthroplasty (TCA) to describe ipsilateral patellofemoral and medial and lateral unicompartmental arthroplasties. "Combined partial knee arthroplasty" (CPKA) was the favoured umbrella term.
CONCLUSION
We recommend bi-unicondylar arthroplasty (Bi-UKA), medial bicompartmental arthroplasty (BCA-M), lateral bicompartmental arthroplasty (BCA-L), and tricompartmental arthroplasty (TCA) as the preferred terms to classify CPKA procedures. Cite this article: 2019;101-B:922-928.
Topics: Arthroplasty, Replacement, Knee; Bibliometrics; Hemiarthroplasty; Humans; Knee Prosthesis; Osteoarthritis, Knee; Terminology as Topic
PubMed: 31362558
DOI: 10.1302/0301-620X.101B8.BJJ-2019-0125.R1 -
Journal of Orthopaedic Science :... Sep 2021Precise knowledge of the prevalence and trends of arthroplasty can facilitate the design of medical plans for efficient treatments. The National Database of Health...
BACKGROUND
Precise knowledge of the prevalence and trends of arthroplasty can facilitate the design of medical plans for efficient treatments. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan provides statistics about the annual number of arthroplasties (knee, hip, shoulder, finger, elbow, and foot/ankle) through health insurance claim numbers for these surgeries. The purpose of this study was to document the annual arthroplasty numbers between 2014 and 2017 in Japan and to analyze their four-year trends, gender differences, age distributions, and regional differences as revealed by the complete survey.
METHODS
Numbers of arthroplasty surgeries were extracted from the NDB Open Data Japan for 2014-2017. For "knee", "hip", "shoulder", "finger", "elbow", and "foot/ankle" arthroplasties, we showed the annual arthroplasty numbers, annual arthroplasty numbers by age group, annual arthroplasty numbers in individual prefectures, and annual arthroplasty numbers per 100,000 population in individual prefectures.
RESULTS
The annual arthroplasty numbers in 2017 were 146,189 for all joints, 82,304 for knees, 59,029 for hips, 2454 for shoulders, 1551 for fingers, 536 for elbows, and 291 for feet/ankles. For the four years up to 2017, the rate of alteration in the number of arthroplasties was +14% for total arthroplasties, +9% for knees, +21% for hip joints, +97% for shoulders, + 8% for fingers, -10% for elbows, and +25% for feet/ankles. The proportion of females was 70-90% and the peak age was between the late 60s and late 70s for all joints. Variations in arthroplasty numbers per population by prefecture appeared to be small for knees and hips and large for other joints.
CONCLUSIONS
We revealed the annual total number of arthroplasties for each joint in Japan using the NDB Open Data Japan for the first time.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Hip Joint; Humans; Japan; Knee Joint
PubMed: 32933832
DOI: 10.1016/j.jos.2020.07.022 -
Australian Journal of General Practice Nov 2020Osteoarthritis of the hip and knee is a common cause of pain and reduced mobility. Arthroplasty reliably improves quality of life for most patients when non-operative...
BACKGROUND
Osteoarthritis of the hip and knee is a common cause of pain and reduced mobility. Arthroplasty reliably improves quality of life for most patients when non-operative measures have failed. However, hip and knee arthroplasties are major operations that carry significant risks, including the need for revision surgery.
OBJECTIVE
The purpose of this article is to discuss pre-operative patient optimisation prior to arthroplasty to minimise risks and maximise recovery.
DISCUSSION
Recent literature has identified a number of modifiable factors that increase the risk of post-operative complications following arthroplasty. These include obesity, diabetes, tobacco use, opioid use, anaemia, malnutrition, poor dentition and vitamin D deficiency. Addressing these factors prior to arthroplasty may reduce the risk of adverse outcomes. Pre-operative education and exercise, termed prehabilitation, has an important role in optimising patient outcomes following hip and knee arthroplasty. Participation in a prehabilitation program prior to arthroplasty is recommended.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Australia; Diabetes Complications; Humans; Malnutrition; Obesity; Preoperative Care; Risk Management
PubMed: 33123714
DOI: 10.31128/AJGP-05-20-5436 -
Acta Bio-medica : Atenei Parmensis Jun 2023The number of shoulder arthroplasties has increased tremendously over the last twenty years, creating a proportional increase in complications rates and revision.... (Review)
Review
The number of shoulder arthroplasties has increased tremendously over the last twenty years, creating a proportional increase in complications rates and revision. Shoulder arthroplasty surgeon should have a clear understanding of the reasons for failure based on the specific index procedure that was performed. The main challenge includes the need for component removal and managing glenoid and humeral bone defects. This manuscript aims to outline the most common indications for revision surgery and treatment options based on a careful and detailed review of the available literature. This paper should help the surgeon in patient evaluation and selection of the optimal procedure for an individual patient.
Topics: Humans; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Arthroplasty, Replacement; Humerus; Reoperation; Treatment Outcome
PubMed: 37366190
DOI: 10.23750/abm.v94iS2.13730 -
The Bone & Joint Journal Feb 2021Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the...
AIMS
Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the effectiveness of communication is only partially determined by the surgeon, and understanding how non-surgeon personnel affect intraoperative communication is critical for the development of safe and cost-effective staffing guidelines. Operative efficiency is also dependent on high-functioning teams and can offer a proxy for effective communication in highly standardized procedures like primary total hip and knee arthroplasty. We aimed to evaluate how the composition and dynamics of surgical teams impact operative efficiency during arthroplasty.
METHODS
We performed a retrospective review of staff characteristics and operating times for 112 surgeries (70 primary total hip arthroplasties (THAs) and 42 primary total knee arthroplasties (TKAs)) conducted by a single surgeon over a one-year period. Each surgery was evaluated in terms of operative duration, presence of surgeon-preferred staff, and turnover of trainees, nurses, and other non-surgical personnel, controlling cases for body mass index, presence of osteoarthritis, and American Society of Anesthesiologists (ASA) score.
RESULTS
Turnover among specific types of operating room staff, including the anaesthesiologist (p = 0.011), circulating nurse (p = 0.027), and scrub nurse (p = 0.006), was significantly associated with increased operative duration. Furthermore, the presence of medical students and nursing students were associated with improved intraoperative efficiency in TKA (p = 0.048) and THA (p = 0.015), respectively. The presence of surgical fellows (p > 0.05), vendor representatives (p > 0.05), and physician assistants (p > 0.05) had no effect on intraoperative efficiency. Finally, the presence of the surgeon's 'preferred' staff did not significantly shorten operative duration, except in the case of residents (p = 0.043).
CONCLUSION
Our findings suggest that active management of surgical team turnover and composition may provide a means of improving intraoperative efficiency during THA and TKA. Cite this article: 2021;103-B(2):347-352.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Efficiency, Organizational; Humans; Interprofessional Relations; Operative Time; Patient Care Team; Personnel Turnover; Retrospective Studies
PubMed: 33517742
DOI: 10.1302/0301-620X.103B2.BJJ-2020-0170.R2 -
CMAJ : Canadian Medical Association... Mar 2016
Topics: Antibiotic Prophylaxis; Arthroplasty; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Postoperative Care; Surgical Wound Infection
PubMed: 26438015
DOI: 10.1503/cmaj.150429 -
The Journal of the American Academy of... Apr 2023Thrombocytopenia is an abnormally low level of blood platelets (less than 150,000/mL) resulting in an increased risk for bleeding. Typically, patients with platelet...
BACKGROUND
Thrombocytopenia is an abnormally low level of blood platelets (less than 150,000/mL) resulting in an increased risk for bleeding. Typically, patients with platelet levels below 50,000/mL should delay arthroplasty or be transfused with platelets before surgery. However, existing studies are mixed regarding the effects of more moderate thrombocytopenia in terms of total knee and hip arthroplasty outcomes.
METHODS
This level III retrospective chart review examined the effects of different severities of preoperative thrombocytopenia on length of hospitalization, readmission, and transfusion rates in 5,617 primary total knee and hip arthroplasties at one tertiary academic medical center. Preoperative platelet levels were sectioned into clinically relevant groups and compared with clinical outcomes using univariable and multivariable models.
RESULTS
On univariate analysis, having platelet levels of <100,000/mL and 100 to 149,000/mL was associated with a longer length of stay. However, after controlling individual demographics, there was no association between platelet levels and length of stay, nor with 30-day readmission. Finally, on univariate analysis, patients with platelet levels of <100,000/mL and 100 to 149,000/mL were more likely to have a blood transfusion, which remained true for those with <100,000/mL after controlling for individual demographics.
CONCLUSIONS
Total hip and total knee arthroplasty are safe in patients with varying platelet levels and not associated with increased length of stay or 30-day readmission. However, patients with more severe thrombocytopenia are more likely to receive red blood cell transfusions than patients with milder thrombocytopenia.
Topics: Humans; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Retrospective Studies; Thrombocytopenia; Anemia; Length of Stay
PubMed: 36749882
DOI: 10.5435/JAAOS-D-22-00834 -
Journal of Orthopaedic Surgery and... Oct 2022Total hip arthroplasties (THA) are cost-effective interventions for patients with osteoarthritis refractory to physical therapy or medical management. Most individuals...
BACKGROUND
Total hip arthroplasties (THA) are cost-effective interventions for patients with osteoarthritis refractory to physical therapy or medical management. Most individuals report positive surgical outcomes with reduction in pain and improved joint function. Multiple recent studies demonstrated the influence of patient mental health on surgical success. We sought to determine the relationship between patient preoperative psychological factors and postoperative THA outcomes, specifically pain and function.
METHODS
PubMed, EMBASE and Cochrane Reviews databases were queried using terms "(mental OR psychological OR psychiatric) AND (function OR trait OR state OR predictor OR health) AND (outcome OR success OR recovery OR response) AND total joint arthroplasty)." A total of 21 of 1,286 studies fulfilled inclusion criteria and were included in the review. All studies were analyzed using GRADE and Risk of Bias criteria.
RESULTS
Overall, compared to cohorts with a normal psychological status, patients with higher objective measures of preoperative depression and anxiety reported increased postoperative pain, decreased functionality and greater complications following THA. Additionally, participants with lower self-efficacy or somatization were found to have worse functional outcomes.
CONCLUSIONS
Preoperative depression, anxiety and somatization may negatively impact patient reported postoperative pain, functionality and complications following THA. Surgeons should consider preoperative psychological status when counseling patients regarding expected surgical outcomes.
Topics: Arthroplasty, Replacement, Hip; Humans; Osteoarthritis; Pain, Postoperative; Treatment Outcome
PubMed: 36253795
DOI: 10.1186/s13018-022-03355-3