The Journal of arthroplasty
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The use of inpatient rehabilitation services after total joint arthroplasty (TJA) is an important driver of episode-of-care costs. We determined the utility of a new standardized instrument collected during the immediate postoperative period, the Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" Mobility score, in predicting discharge disposition after TJA and its accuracy in estimating prolonged hospital stay, readmissions, and emergency department (ED) visits. ⋯ The AM-PAC "6-Clicks" Mobility score is a valid, simple tool for predicting discharge disposition after TJA.
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The purpose of this study was to assess whether weaning of opioid use in the preoperative period improved total joint arthroplasty (TJA) outcomes. ⋯ Patients with a history of chronic opioid use who successfully decreased their use of opioids before surgery had substantially improved clinical outcomes that were comparable to patients who did not use opioids at all.
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Perioperative myocardial infarctions and cardiac complications are leading causes of mortality after noncardiac surgery. In an effort to improve patient safety, the Surgical Care Improvement Project (SCIP) implemented guidelines concerning administration of β-blockers therapy aimed to reduce cardiac complications. ⋯ After the implementation of SCIP guidelines, there was a greater than 50% reduction in mortality and a significant decrease in fatal postoperative stroke, heart failure, and cardiac arrest.
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Postoperative pain after total knee arthroplasty (TKA) poses a major challenge. It delays mobilization, increases opioid consumption and side effects, and lengthens hospitalization. This challenge multiplies when treating an opioid-dependent population. We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients. ⋯ LB was not found to be superior to standard PAI in opioid-dependent patients undergoing TKA. This patient population continues to present a challenge even with modern multimodal pain protocols.
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Comparative Study
Effect of Patellar Resurfacing on Patellofemoral Crepitus in Posterior-Stabilized Total Knee Arthroplasty.
Patellofemoral crepitus (PC) is a complication of total knee arthroplasty (TKA). Although patellar resurfacing (PR) directly influences the kinematics of the patellofemoral joint, the influence of PR on PC is unclear. The purpose of this study was to investigate the influence of PR on the incidence of PC. ⋯ PR may decrease the incidence of PC by increasing the patellar tilt and medial shift and positioning the patella more closely parallel to the femur. PR is recommended during TKA with this prosthesis.