The Journal of arthroplasty
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Periprosthetic femoral fractures are associated with high failure rates and mortality, particularly within one postoperative year. However, mid-term results related to this issue are lacking. Thus, we performed a retrospective follow-up evaluation. ⋯ Between one year and up to 7.3 postoperative years, only one surgical revision was necessary, and the mortality rate also decreased. No significant factors related to surgical revisions were detected. However, the initial hip fracture, older age, higher ASA score and dementia were associated with a higher mortality rate.
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The purpose of this study was to undertake a meta-analysis to evaluate whether patients really gain outcome benefits when using the high-flex (HF) prostheses in total knee arthroplasty (TKA) compared with standard (STD) implants. Only randomized controlled trials were included in this meta-analysis. ⋯ We found no statistically significant difference between the two designs in terms of ROM, knee scores (KSS, HSS, WOMAC, and SF-36), patients' satisfaction and complications. Hence there is currently no evidence to confirm that the use of high-flex prostheses in short-term is superior to the standard prostheses after total knee arthroplasty.
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Rapid recovery after total joint arthroplasty requires patients to get ahead and stay ahead or the four impediments to early rehabilitation and discharge: volume depletion, blood loss, pain, and nausea. Adequate volume resuscitation starts before entering the operating room and focuses on intravenous fluids rather than red blood cell transfusion. Tranexamic acid limits blood loss and reduces the need for most other blood management systems. ⋯ A short-acting spinal with a peri-articular local anesthetic injection is reliable, reproducible, and safe. Patients at risk for post-operative nausea are treated with anti-emetic medications and perioperative dexamethasone. These interventions reflect a transition from the sick-patient model to the well-patient model and make rapid recovery joint arthroplasty a reality in 2015.
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As health care reform continues to evolve, there will need to be an emphasis on generating value, quality improvement, and cost control. In 2011, the Centers for Medicare and Medicaid Services (CMS) initiated a new Bundled Payment for Care Improvement initiative. Early results from this CMS bundled payment initiative at an urban, tertiary, academic medical center demonstrate decreased length of stay and increased discharge to home, with decreasing readmission rates, which can result in cost-savings without compromise of the quality of care. Changes in care coordination, clinical care pathways, and evidence-based protocols are the key to improving the quality metrics and cost effectiveness within the implementation of the bundled payment for care initiative, thus bringing increased value to our total joint arthroplasty patients.