The Journal of arthroplasty
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The effect of obesity on the outcomes of total joint arthroplasties is an ongoing concern. As obesity becomes more endemic, new categories emerge, such as the "super-obese." We conducted a retrospective study to determine the difference in outcomes among the super-obese. When categorized according to body mass index (BMI), the overall rate of complications was higher for patients with BMI of 45 or higher. ⋯ Length of stay was increased by 13.8% for each 5-U increase in BMI above 45. There is a significant increased risk for complications in the super-obese population, and this continues to increase with BMI increases above 45. These data are important when counseling super-obese patients and should be accounted for in reporting quality outcome measures in this population.
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With improving patient outcome after joint arthroplasty, new assessment tools with increased discriminatory power especially in well-performing patients are desirable. The goal of the present study was to develop and validate a new score ("Forgotten Joint Score," or FJS) introducing a new aspect of patient-reported outcome: the patient's ability to forget the artificial joint in everyday life. After a pilot study, the FJS was validated and showed high internal consistency (Cronbach α = .95). ⋯ Known-group comparisons proved the FJS to be highly discriminative in a validation sample of 243 patients. The FJS not only reflects differences between "good" and "bad" but also between "good," "very good," and "excellent" outcomes. This concise score is appealing for its more adequate measurement range and because it measures the new, promising concept of the "forgotten joint."
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Case Reports
Incarceration of a dislocated mobile bearing to the popliteal fossa after unicompartmental knee arthroplasty.
The mobile meniscal bearing of unicompartmental knee arthroplasty is completely free moving, and dislocation of this bearing is a major concern for all mobile-bearing designs. Most dislocations are located in the intracapsular area; however, posterior dislocation of the polyethylene bearing to an extra-articular area of the knee after unicompartmental arthroplasty has not been previously reported. During a revision surgery, separate incision was necessary to remove a dislocated meniscal bearing in the popliteal fossa. The authors present a case of incarceration of a dislocated mobile bearing to the popliteal fossa after unicompartmental knee arthroplasty that was missed during initial diagnosis.
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Randomized Controlled Trial
To use or not to use continuous passive motion post-total knee arthroplasty presenting functional assessment results in early recovery.
Continuous passive motion (CPM), though of doubtful value, is yet routinely practiced post-total knee arthroplasty (TKA). We prospectively distributed 84 patients with TKA to 1 of the 3 standard rehabilitation regimes: no-CPM, 1-day-CPM, and 3-day-CPM. ⋯ We concluded that CPM gives no benefit in immediate functional recovery post-TKA, and in fact, the postoperative knee swelling persisted longer. We have since then discontinued its use in our patients without any untoward effect.