The Journal of arthroplasty
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Due to the potential reduction of morbidity and mortality, unicompartmental knee arthroplasty (UKA) may represent an interesting solution for older patients with unicompartmental arthritis. It was our hypothesis that UKA can represent an alternative to total knee arthroplasty (TKA) for patients older than 75. We, thus, aimed to compare in those patients (1) functional results, (2) rates of forgotten joint, and (3) survivorships of UKA vs TKA. ⋯ The results of our study showed that UKA provide higher function and better forgotten joint scores with similar survivorship, compared to TKA, for patients older than 75.
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Comparative Study
Biomechanical Effects of Different Varus and Valgus Alignments in Medial Unicompartmental Knee Arthroplasty.
Medial unicompartmental tibial components are not always positioned following neutral mechanical alignment and a tibial varus alignment of 3° has been suggested based on several clinical follow-up studies. However, no biomechanical justification is currently available to confirm the suitability of different alignment positions. ⋯ Neutral mechanical or 3° of varus alignment present similar biomechanical outputs in the bone, collateral ligament strain, and on the polyethylene insert. A 6° varus alignment or changes in valgus alignment were always associated with more detrimental effects.
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The relationship between pain catastrophizing and emotional disorders including anxiety and depression in osteoarthritic patients undergoing total joint arthroplasty (TJA) is an emerging area of study. The purpose of this study was to examine the association of these factors with preoperative patient characteristics. ⋯ The most important predictor of catastrophizing, anxiety and/or depression in TJA patients is preoperative pain and poor subjective function. At-risk patients include those with increased pain and generally good clinical function, as well as younger women with significant comorbidities. Such patients should be identified and targeted psychological therapy implemented preoperatively to optimize coping strategies and adaptive behavior to mitigate potential for inferior TJA outcomes including pain and patient dissatisfaction.
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Length of hospital stay is a quality metric in joint arthroplasty. Rapid recovery protocols have safely reduced the average length of hospitalization, but it is unclear whether there is a difference in complication and readmission rates between patients discharged the day of surgery or on postoperative day 1 (POD 1). We calculated 30-day complication and readmission after total knee arthroplasty (TKA), total hip arthroplasty (THA), and unicompartmental knee arthroplasty (UKA) based on day of discharge. We then analyzed the rapid recovery group by comparing those discharged the day of surgery and those discharged on POD 1. ⋯ Increased length of stay is associated with increased complication and readmission after joint arthroplasty for patients with a hospital stay of 3 or more days. However, in THA, there was an increased complication rate in patients discharged POD 0 as compared to POD 1. Efforts to improve patient selection are expected to reduce short-term complications after outpatient joint arthroplasty. Further research is needed to determine which patients can be discharged POD 0 without increased complication after THA.
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Discharge destination is an important factor to consider to maximize care coordination and manage patient expectations after total joint arthroplasty (TJA). It also has significant impact on the cost-effectiveness of these procedures given the significant cost of post-acute inpatient care. Therefore, understanding factors that impact discharge destination after TJA is critical. ⋯ Socioeconomic status and race/ethnicity are important factors related to discharge destination following TJA. Thoroughly understanding and addressing these factors may help increase the rates of discharge to home as opposed to institution.