The Journal of arthroplasty
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Recently, the government has moved towards public reporting of 30-day readmission rates after elective primary total knee (TKA) and total hip arthroplasty (THA). We identified 11,814 and 8105 patients who underwent primary TKA and THA from the 2011 ACS NSQIP. Overall readmission rates within 30-days of surgery were 4.6% for TKA and 4.2% for THA. ⋯ In TKA, multivariate analysis identified age (P=0.002), male gender (P=0.03), cancer history (P=0.008), elevated BUN (P=0.002), a bleeding disorder (P<0.001) and high ASA class (P<0.001) as predictors of readmission. In THA, obesity (P=0.008), steroid use (P=0.037), a bleeding disorder (P=0.002), dependent functional status (P=0.022), and high ASA class (P<0.001) predicted readmission. Understanding characteristics associated with readmission will be essential for equitable patient risk stratification.
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Randomized Controlled Trial Comparative Study
Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty.
Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6 weeks, and 3, 6 and 12 months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. ⋯ DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6 weeks, and higher HOOS Symptoms scores at 3 months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases.
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Multicenter Study
Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study.
Many patients have an unfavourable pain outcome post total knee arthroplasty (TKA). This multi-centre prospective cohort study recorded weekly pain scores one week before TKA and 12 weeks post TKA. 96 patients were enrolled into the study. Patients kept a record of their weekly scores pre-operation and post-operation by using the visual acuity score. ⋯ Patients with a pre-operative pain scores ≤ 4 were identified as an at risk group for poor pain outcome. Female gender, age and anaesthetics type were not identified as risk factors for poor pain outcome. Pain trajectory analysis also identified general patterns of pain response post TKA.
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Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. ⋯ A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03).