The Journal of arthroplasty
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The incidence of total knee arthroplasty (TKA) is increasing, as are periprosthetic supracondylar femoral fractures. Treatment is complex and may involve the use of a retrograde intramedullary femoral nail, and it is essential to know the nail will fit through the femoral prosthesis in line with the intramedullary canal. ⋯ A comprehensive data set lists manufacturer, model, size, minimal intercondylar notch distance and position. This will be of practical use when planning the operative management of periprosthetic supracondylar femoral fractures.
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Comparative Study
Unicompartmental knee arthroplasty versus high tibial osteotomy: United States practice patterns for the surgical treatment of unicompartmental arthritis.
Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) produce satisfactory outcomes in the management of unicompartmental knee osteoarthritis (OA). The purpose of this study is to compare UKA and HTO practice patterns in a large US private payer insurance database. Utilization data for UKA and HTO were captured from the database between 2007 and 2011. ⋯ Utilization of UKA and HTO were inversely correlated (P = 0.001). UKA utilization is increasing, while HTO utilization is decreasing in the management of OA. More work is required to understand specific indications and outcomes.
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Comparative Study
Thirty-day readmission following total hip and knee arthroplasty - a preliminary single institution predictive model.
We sought to identify demographic or care process variables associated with increased 30-day readmission within the total hip and knee arthroplasty patient population. Using this information, we generated a model to predict 30-day readmission risk following total hip and knee arthroplasty procedures. ⋯ Specific comorbidities and patient demographic factors showed less significance. The predictive nomogram constructed for primary total joint readmission had a bootstrap-corrected concordance statistic of 0.76.
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The purpose of this study was to provide a cost-benefit analysis of topical tranexamic acid (TXA) in primary total hip and knee arthroplasty patients. A retrospective cohort of 591 consecutive patients, 311 experimental and 280 control, revealed a transfusion rate reduction from 17.5% to 5.5%, increased postoperative hemoglobin, and decreased delta hemoglobin without an increase in adverse events (all P < 0.001). ⋯ Hospital disposition to home compared to subacute nursing facility was also significantly increased by 9.3% (P < 0.02). We conclude that topical TXA reduces transfusion rate, increases home disposition, and reduces cost in primary hip and knee arthroplasty.
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The purpose of this study was to compare a novel liposomal bupivacaine to traditional peri-articular injection (PAI) in a multi-modal pain protocol for total knee arthroplasty (TKA). A retrospective cohort study compared 85 consecutive patients undergoing TKA with a traditional PAI of ropivacaine, epinephrine and morphine to 65 patients with a liposomal bupivacaine PAI. After the initial 24h, inpatient self-reported pain scores were higher in the liposomal bupivacaine group compared to the traditional PAI group (P = 0.04) and a smaller percentage (16.9%) of patients in the liposomal bupivacaine group rated their pain as "mild" compared to the traditional group (47.6%). Liposomal bupivacaine PAI provided inferior pain control compared to the less expensive traditional PAI in a multi-modal pain control program in patients undergoing TKA.