The Journal of arthroplasty
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The postacute care strategies after total joint arthroplasty, including the use of postacute rehabilitation centers and home therapy services are associated with different costs. Providers in bundled payment programs are incentivized to use the most cost-effective strategies while maintaining quality and value for patients. ⋯ The postdischarge period is a significant part of a bundled payment episode. To manage a successful bundled payment program in total joint arthroplasty, significant efforts to coordinate care during this episode are needed for patients to receive quality care that meets their expectations.
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Several studies have suggested that malnutrition may be associated with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). However, strong evidence for this association is lacking. The purpose of the present study is to ask, Is the proportion of patients with hypoalbuminemia (a proxy for malnutrition) higher among patients with a septic indication for revision TJA than patients with an aseptic indication for revision TJA? Secondly, among patients undergoing revision TJA for an aseptic indication, is hypoalbuminemia predictive of subsequent early postoperative PJI? ⋯ These findings add to the growing body of evidence that malnutrition increases the risk of PJI after TJA. Future prospective studies should consider whether correcting malnutrition preoperatively reduces the risk of PJI after TJA.
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Randomized Controlled Trial Multicenter Study Comparative Study
Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial.
Tranexamic acid (TXA) reduces perioperative blood loss in total hip arthroplasty (THA). ⋯ IV and topical TXA are effective tools to reduce blood loss and transfusion costs in THA, and we recommend the IV form for ease of use.
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Variability in morphologic features of the human lower extremity within and across populations has been reported, but limb asymmetry within individuals is often overlooked. For example, in 19 studies of version of the lower extremity in the literature, 6 document asymmetry in the population, but none of these reports document asymmetry in an individual. The aim of this study was to identify the (a)symmetry and quantify variability in the tibiae and femora of matched pairs of limbs. More specifically, using a computed tomography scan database tool, we (1) identified (a)symmetry between paired left and right legs for angulation, version, and alignment features and (2) calculated the percentage of paired limbs with >1° of (a)symmetry for each evaluated parameter. ⋯ This study disproves the hypothesis that human limbs are absolutely symmetric, confirming instead that there is asymmetry in version between left and right paired limbs. Surgeons strive for symmetry in lower extremity reconstruction, and they often compare side to side in outcome studies, believing that normal limbs are absolutely symmetric when this is not necessarily true. These assumptions concerning lower extremity symmetry need to be reassessed.
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Large-diameter, monoblock acetabular components have been used for both hip resurfacing arthroplasty and metal-on-metal (MoM) total hip arthroplasty (THA). If revision is required, one solution is to retain the shell and use a dual-mobility bearing. ⋯ Retention of a well-fixed, monoblock MoM acetabular shell and mating it to a dual-mobility bearing in the setting of revision surgery seems to be a reasonable, low-morbidity option at short-term follow-up in appropriately positioned cups.