The Journal of arthroplasty
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Comparative Study
Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors.
It has been reported that pain-related outcomes after total knee arthroplasty (TKA) may vary with different analgesic techniques and with patient demographics. The purposes of this study were to compare local infiltration of regular bupivacaine (periarticular infiltration [PAI] group) vs liposomal bupivacaine (LBUP group) and to examine the effect of patient characteristics on postoperative pain after TKA. ⋯ This multivariate regression analysis study showed that in patients undergoing primary TKA, postoperative pain was lower in males, older patients, and those treated with LBUP. Awareness of these factors may assist in developing patient-specific multimodal postoperative pain and education protocols that reduce opioid reliance and related adverse events.
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Bundled payments are gaining popularity in arthroplasty as a tactic for encouraging providers and hospitals to work together to reduce costs. However, this payment model could potentially motivate providers to avoid unprofitable patients, limiting their access to care. Rigorous risk adjustment can prevent this adverse effect, but most current bundling models use limited, if any, risk-adjustment techniques. This study aims to identify and quantify the financial incentives that are likely to develop with total hip arthroplasty (THA) bundled payments that are not accompanied by comprehensive risk stratification. ⋯ If generalizable, our results suggest that Centers for Medicare and Medicaid Services bundled payments encompassing acute inpatient care should be adjusted upward by the aforementioned amounts (regression coefficients above) for advanced age, increasing BMI, cases performed for fractures, elevated ASA grade, and major complications (as defined by Medicare MCC modifiers). Furthermore, these figures likely underestimate costs in many bundling models which incorporate larger proportions of postdischarge care. Failure to adjust for factors affecting costs may create barriers to care for specific patient populations.
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Comparative Study
Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality.
The purpose of this study was to compare the complications and mortality between bilateral simultaneous total knee arthroplasty (BTKA-Simultaneous) and bilateral staged TKA (BTK-Staged) while adjusting for differences in patient, surgeon, and hospital characteristics. ⋯ There is a lack of evidence to support superiority of either BTKA-Simultaneous or BTKA-Staged.
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Function is often sacrificed for pain control after total knee arthroplasty. Motor-sparing blocks, including adductor canal block (ACB) and periarticular injection (PAI), have gained interest to address this compromise. Our study evaluates the anatomic feasibility, accuracy, and safety of intraoperative ACB as an adjunct to PAI by analyzing 3 different injection orientations and needle configurations. ⋯ Intraoperative ACB augmentation of PAI appears to be anatomically feasible and safe. There was decreased accuracy and increased risk of vascular puncture using a 3.5-inch spinal needle. A blunt 1.5-inch needle directed toward the distal AC had the highest accuracy while minimizing vascular injury.
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Randomized Controlled Trial Comparative Study
A Randomized Controlled Trial Comparing Adductor Canal Catheter and Intraarticular Catheter After Primary Total Knee Arthroplasty.
Multimodal analgesia, including peripheral nerve blocks, is recommended for postoperative pain relief after total knee arthroplasty (TKA). To date, no randomized controlled trial has compared the efficacy of adductor canal catheters (ACCs) and intraarticular catheters (IACs) in patients undergoing TKA. ⋯ ACC should be considered as part of a multimodal pain regimen after primary, unilateral TKA and provides a better option for pain control after discharge.