The Journal of arthroplasty
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The purpose of the present study was to identify factors that predict reinfusion following intraoperative blood salvage (IOBS). We retrospectively identified 298 patients who underwent aseptic revision total hip arthroplasty at our institution between February 2005 and January 2007. ⋯ Exchange of both the femoral and acetabular components, use of a trochanteric osteotomy, increased body mass index, and advanced age were associated with reinfusion. Based on these results, surgeons may consider using IOBS on patients with these preoperative characteristics.
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Head-neck adapters in total hip arthroplasty (THA) promise the reconstruction of optimal femoral offset and leg length in revision THA while retaining stable implants. Radiological parameters after adapter implantation in THA revision were determined in 37 cases. Significant reduction of leg length discrepancy and improvement of femoral offset (P < 0.001) were found. ⋯ Clinical scores were rather poor (median Harris hip score 54, WOMAC score 41) due to age and comorbidities, postoperative dislocation occurred in 3 cases. Only one stable femoral stem had to be revised due to recurrent postoperative dislocation. In conclusion, a head-neck adapter can be a valuable tool in certain cases of revision THA with acceptable dislocation rates while allowing the retention of stable implants.
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An effort to prevent PJI has led to the development of antimicrobial dressings that support wound healing. We sought to determine whether Aquacel Surgical dressing independently reduces the rate of acute PJI following TJA. ⋯ Multivariate analysis revealed that use of Aquacel dressing was an independent risk factor for reduction of PJI (odds ratio of 0.165, 95% confidence interval: 0.051-0.533). Aquacel Surgical dressing significantly reduces the incidence of acute PJI.
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The Patient Protection and Affordable Care Act (PPACA) is expected to increase health care availability through Medicaid expansion. The objective of this study was to evaluate potential effects of the PPACA by examining access to total hip arthroplasty in Southern California. 39 orthopaedic surgeons were called to schedule a hip arthroplasty. ⋯ This study showed that in Southern California, patients with income-based insurances are limited in the number of surgeons from whom they can receive care. Thus, although the PPACA will increase the number of insured patients, it may not similarly increase access to providers.
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The Centers for Medicare and Medicaid Services has proposed bundling of payments for acute care episodes for certain procedures, including total joint arthroplasty. The purpose of this study is to quantify the readmission burden of TJA as a function of readmission rate and reimbursement for the bundled payment. ⋯ For each group, we determined 30-day readmission rates and direct costs of each readmission. The hospital cost margins for Medicare TJAs are small and any decrease in these margins can potentially make performing these procedures economically unfeasible potentially decreasing Medicare patient access.