The Journal of arthroplasty
-
Comparative Study
Discharge to Inpatient Rehab Does Not Result in Improved Functional Outcomes Following Primary Total Knee Arthroplasty.
Monitored rehabilitation has long been considered an essential part of the recovery process in total knee arthroplasty (TKA). However, the optimal setting for rehabilitation remains uncertain. We sought to determine whether inpatient rehabilitation settings result in improved functional and patient-reported outcomes after primary TKA. ⋯ Inpatient rehabilitation settings did not result in lower complications at 6 months or improved functional or patient-reported outcomes at 2 years compared to discharge directly to home when patients are propensity matched for age, living situation, comorbidities, baseline functional status, and insurance status. This finding has important cost implications and calls into question whether the healthcare system should allow otherwise healthy patients to use inpatient rehabilitation services postoperatively after primary TKA.
-
Intrathecal morphine (ITM) combined with bupivacaine spinal anesthesia can improve postoperative pain, but has potential side effects of postoperative nausea/vomiting (PONV) and pruritus. With the use of multimodal analgesia and regional anesthetic techniques, postoperative pain control has improved significantly to a point where ITM may be avoided in total joint arthroplasty (TJA). ⋯ ITM was associated with improved POD 0 pain scores and less initial oral/intravenous opioid consumption, which likely contributes to the subsequent improved mobilization and lower rates of PONV. In the setting of a modern regional anesthesia and multimodal analgesia recovery plan for TJA, ITM can still be considered for its benefits.
-
The objective of the study was to assess the accessibility and content of accredited adult reconstruction hip and knee fellowship program websites. ⋯ AAHKS provides a reasonable method of identifying programs. Yet, most programs can readily be identified using a Google search (76.9%). Although most fellowship program websites contained program details, there is still paucity of information for fellowship candidates.