The Journal of arthroplasty
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Current indices fail to consistently predict risk for major adverse cardiac events after major total joint arthroplasty. ⋯ The current total joint arthroplasty Cardiac Risk Index score was the most economical in predicting postoperative cardiac complication after primary unilateral TKA and THA. The RCRI was not a significant predictor of perioperative cardiac events for TKA patients but performed similarly to the current model for THA.
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There has been much attention paid to the ability to optimize outcomes, limit complications, and reduce costs within the episode of care after total joint arthroplasty. Limiting the duration of postoperative hospitalization as well as reducing emergency department (ED) visits and readmissions are additional considerations in the paradigm of cost containment. Our purpose was to evaluate the safety of early hospital discharge after primary total knee arthroplasty (TKA) and to identify the diagnoses responsible for ED visits and readmissions in the postoperative period. ⋯ Among patients undergoing primary TKA, it is the health of the patient, and not their resultant LOS, that correlates to return events. The ED is overused for complaints that may otherwise be managed as effectively and more cost efficiently in outpatient settings. Cost containment must include unnecessary utilization of the ED.
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Data addressing risk factors predictive of mortality and reoperation after periprosthetic femur fractures (PPFxs) are lacking. This study examined survivorship and risk ratios for mortality and reoperation after surgical treatment for PPFx and associated clinical risk factors. ⋯ After PPFx, patients have a 24% risk of either death or reoperation at 1 year. Factors contributing to increased mortality are nonmodifiable. Risk of reoperation is minimized with greater span of fixation and performance of revision arthroplasty.
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Metabolic syndrome (MS), defined as obesity, hypertension, hyperglycemia, and dyslipidemia, is prevalent among patients undergoing total joint arthroplasty (TJA). MS has proven to promote a proinflammatory and prothrombotic state in patients. Venous thromboembolism is one of the major complications of TJA. The purpose of this retrospective study is to identify whether MS and its components increase the risk of deep vein thrombosis (DVT) after TJA. ⋯ MS was a significant risk factor for DVT after TJA. Strategies to minimize the adverse effect of MS should be considered for these patients.
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Randomized Controlled Trial Comparative Study
Comparison of Local Infiltration Analgesia With Femoral Nerve Block for Total Knee Arthroplasty: A Prospective, Randomized Clinical Trial.
Total knee arthroplasty (TKA) is usually associated with severe postoperative pain, which can prevent rehabilitation of patients' knee function and influence the satisfaction of surgery. Local infiltration analgesia (LIA) as a new method to managing postoperative pain has been applied in clinical practice recently. However, the safety and efficacy of LIA compared with femoral nerve block (FNB) in postoperative pain management of TKA still remains controversial. Thus, we conducted an original clinical trial to compare LIA and FNB. ⋯ Our research showed that no significant differences were observed between the 2 treatment groups. LIA could provide a similar analgesic effect to FNBs with a low incidence of complications.