The Journal of arthroplasty
-
Randomized Controlled Trial
Opioid-Sparing Analgesia and Enhanced Recovery After Total Knee Arthroplasty Using Combined Triple Nerve Blocks With Local Infiltration Analgesia.
Peripheral nerve block and local infiltration analgesia (LIA) have an increasing role as part of multimodal analgesia for enhanced recovery after total knee arthroplasty (TKA). We hypothesized that the combination of obturator nerve block (ONB) and tibial nerve block (TNB) would reduce pain and opioid consumption more than ONB or TNB alone when combined with continuous adductor canal block and LIA. ⋯ The combination of triple nerve block was superior to double nerve block in improving analgesia and functional outcomes in the immediate postoperative period after total knee arthroplasty, when combined with LIA.
-
Maryland is the only state utilizing the Global Budget Revenue (GBR) model to reduce costs. The purpose of this study is to evaluate whether the GBR payment model effectively reduced the following: (1) costs of inpatient hospital stays; (2) post-acute care costs; (3) lengths of stay (LOS); (4) readmission rates; and (5) discharge disposition in patients who underwent primary total hip and knee arthroplasty (THA and TKA). ⋯ The Maryland healthcare model may be associated with a reduction in inpatient and post-acute care costs. Furthermore, implementation of GBR may result in reductions in LOS and readmission rates.
-
Left common iliac vein (LCIV) compression by the right or left common iliac artery (RCIA, LCIA) is known to cause venous thromboembolism (VTE), but the extent to which occult LCIV compression synergizes with lower extremity orthopedic surgery is unknown. We hypothesize that occult LCIV compression is associated with increased VTE risk following total hip or knee arthroplasty (THA, TKA). ⋯ Compression of the LCIV significantly increases odds of developing postoperative VTE following THA. This effect may suggest a new method of stratifying VTE risk in the orthopedic population to reduce VTE-associated morbidity and mortality.
-
Comparative Study
Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications.
Although some prior work supports the safety of same-day arthroplasty performed in a hospital, concerns remain when these procedures are performed in a free-standing ambulatory surgery center. The purpose of this study is to compare 90-day complication rates between matched cohorts that underwent inpatient vs outpatient arthroplasty at an ambulatory surgery center. ⋯ This study suggests that arthroplasty procedures can be performed safely in an ambulatory surgery center among appropriately selected patients without an increased risk of complications.