The Journal of arthroplasty
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The American Society of Anesthesiologists physical status classification 4 (ASA PS 4) comprises patients with "severe systemic disease that is a constant threat to life." The purpose of this study is to conduct a retrospective analysis to report the rate of complications in the ASA PS 4 patients who undergo elective total joint arthroplasty (TJA). In addition, we report whether neuraxial anesthesia is associated with improved outcomes compared to general anesthesia in these patients. ⋯ The elevated risks for ASA PS 4 patients undergoing TJA may be too high to justify surgery. Neuraxial anesthesia is a reasonable alternative to general anesthesia if pursuing TJA in patients with a very high comorbidity burden.
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Knee arthrodesis (KA) and above-knee amputation (AKA) have been used for salvage of failed total knee arthroplasty (TKA) after periprosthetic joint infection (PJI). However, few studies have assessed the outcomes of KA after TKA PJI, as it remains an uncommon procedure. We investigated rates of AKA, control of infection, and ambulatory status after KA for TKA PJI treatment. ⋯ Level IV-case series.
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The aim of this study is to investigate which anesthetic technique is superior on 30-day outcomes after primary total knee arthroplasty (TKA) in United States veteran patients. To our knowledge, this is the first account from the Veterans Health Administration comparing the effects of different anesthesia modalities in patients undergoing TKA. ⋯ Veteran patients undergoing TKA under neuraxial anesthesia had reduced postoperative complications and decreased hospitalization stay compared to patients undergoing general anesthesia.
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The role of inpatient rehabilitation after total knee arthroplasty (TKA) remains uncertain, with evidence suggesting no better functional outcomes for those who discharge to rehabilitation to those who discharge home. The aim of this study is to develop and implement a pre-operative predictive tool, ARISE (Arthroplasty Rehabilitation Initial Screening Evaluation), that incorporated psychological, functional, and socio-demographic factors to determine discharge destination. ⋯ Pre-operative patient beliefs regarding rehabilitation and future home support are highly predictive of discharge destination after primary TKA. Pre-operative patient-reported functional status and demographic variables, with the exception of increasing age, were not shown to be predictive. Predicting those that are most likely to discharge to rehabilitation allows for early, targeted interventions to optimize resources and increase likelihood of home discharge.