BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many p...BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.展开更多
Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used thro...Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.展开更多
Background: Total joint arthroplasty is a commonly performed procedure for end-stage osteoarthritis. Preoperative anemia is a well-characterized and potentially modifiable risk factor for morbidity and mortality in no...Background: Total joint arthroplasty is a commonly performed procedure for end-stage osteoarthritis. Preoperative anemia is a well-characterized and potentially modifiable risk factor for morbidity and mortality in non-cardiac surgery. This retrospective cohort study identified the prevalence of anemia in our total joint arthroplasty population and investigated if there was an association with all-cause mortality. Study Design and Methods: Using an electronic medical record, we examined all patients who underwent a primary unilateral total joint arthroplasty at Dartmouth-Hitchcock Medical Center from January 1, 2011 through July 1, 2015. Preoperative anemia thresholds were defined according to the World Health Organization as 12 mg/dl for women and 13 mg/dl for men. Kaplan-Meier survival analyses were performed to examine the relationship between preoperative anemia and all-cause mortality. Cox proportional hazards were calculated for various models adjusting for potential confounders. Results: 439 of the 3247 patients (13.5%) that underwent total joint arthroplasty met the preoperative definition for anemia. 48 patients (1.48%) died during 6470 patient years of follow up, generating an incidence rate of 7.4 deaths per 1000 patient years. The crude hazard ratio for death in anemic patients was 3.42 (95% CI 1.89, 6.82). In multiple models adjusting for various health related confounders, preoperative anemia was associated with a roughly two-fold increase risk of death compared to non-anemic patients. Conclusion: Preoperative anemia is prevalent in our population and it is associated with increased postoperative mortality in total joint arthroplasty patients, even when adjustments are made for significant co-morbidities.展开更多
Objective:To explore the diagnostic value of serum Interleukin-6(IL-6)combined with synovial IL-6 and C-reactive protein for prosthesis joint infection(PJI)in patients after joint arthroplasty.Methods:A total of 253 p...Objective:To explore the diagnostic value of serum Interleukin-6(IL-6)combined with synovial IL-6 and C-reactive protein for prosthesis joint infection(PJI)in patients after joint arthroplasty.Methods:A total of 253 patients undergoing revision surgery after the first total hip and total knee arthroplasty in the Second Affiliated Hospital of Hainan Medical College from January 2018 to April 2020 were recruited as the study object.The patients were divided into the PJI group(n=85)and non-PJI group(n=168)according to whether there was PJI,and the baseline characteristics and the laboratory indexe were collected and compared between the two groups.the factors associated with PJI in patients after joint arthroplasty were analyzed by multivariate logistic regression model.And the diagnostic value of each marker for PJI in patients after joint arthroplasty was evaluated by Receiver Operating Characteristic(ROC)curve.Results:The incidence of PJI in this study was 33.6%.Compared with the non-PJI group,the patients in the PJI group had more diabetes mellitus and shorter prosthesis duration(P<0.05).The levels of serum C-reactive protein(CRP),serum interleukin-6(IL-6),synovial IL-6,synovial CRP,synovial leukocyte,synovial neutrophil and ESR in the PJI group were higher than those in non-PJI group,and the level of synovial lymphocyte was lower,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus(OR=1.706,95%CI:1.02~2.376,P=0.037),prosthesis duration(OR=0.781,95%CI:0.690~0.884,P<0.001),serum IL-6(OR=1.008,95%CI:1.004~1.012,P=0.046),synovial IL-6(OR=1.004,95%CI:1.002~1.006,P=0.011)and synovial CRP(OR=1.481,95%CI:1.010~2.170,P=0.044)were independently related to PJI in patients after joint arthroplasty.ROC curve analysis showed that the area under ROC curve(AUC)of serum IL-6 combined with synovial IL-6 and CRP for diagnose PJI in patients after joint arthroplasty was significantly greater than each marker(0.941 vs 0.760,Z=6.333,P<0.001;0.941 vs 0.743,Z=7.189,P<0.001;0.941 vs 0.785,Z=4.999,P=0.006).Conclusion:Serum IL-6,synovial IL-6 and CRP were independently related to PJI in patients after joint arthroplasty.They all had some diagnostic value,and serum IL-6 combined with synovial IL-6 and CRP had higher capability to diagnose PJI in patients after joint arthroplasty than each marker alone.展开更多
BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee a...BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee arthroplasty(TKA)procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa.The questionnaire consisted of four sections.The first section recorded baseline demographic data and medical co-morbidities,the length of time spent awaiting TJA,and the patients’desire to undergo elective surgery despite the COVID-19 pandemic.Section 2 and Section 3 assessed the patients’current physical and mental health,respectively,as a consequence of deferred surgical intervention.The last section established the patients’perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery.Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks.Thereafter,patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.RESULTS We included 185 patients(65.95%female;mean age:50.28 years)awaiting TJA for a mean of 26.42±30.1 mo.Overall,88.65%of patients wanted TJA despite the COVID-19 pandemic.Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting<1 year(P<0.000).Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities(P=0.013).After receiving education,the patients wanting TJA decreased to 54.05%.Patients who changed their opinion after education had less insight on the increased morbidity(P=0.046)and mortality(P=0.001)associated with COVID-19.Despite awaiting TJA for shorter period(24.7±20.38 mo),patients who continued to demand TJA had greater pain(P<0.000)and decreased function(P=0.043)since TJA postponement.CONCLUSION There is deterioration in health for patients,who have had elective procedures postponed during the COVID-19 pandemic.Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.展开更多
<span style="font-family:Verdana;">Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there...<span style="font-family:Verdana;">Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there are no guidelines for orthopaedic surgeons undertaking major primary and revision surgery in patients with high risk of venous thromboembolic events, who may present with complications directly linked to anticoagulant use. Hence the authors felt the need for this narrative review. They have tried to answer few questions that are commonly faced in clinical practice. Balanced anticoagulation is a difficult task to achieve. The potential consequences of over anticoagulation on the outcome of TJA and revision TJA are live changing and devastating. On the contrary falling short of adequate anticoagulation is fatal leading to recurrent thromboembolic events. Robust risk stratification tools and a multidisciplinary approach </span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> certainly the way forward. There is an urgent need for specialty specific guidelines for managing patient on anticoagulation undergoing TJA, and revision arthroplasty procedures</span><span style="font-family:Verdana;">.展开更多
Purpose: To evaluate personality characteris- tics’ impact upon outcome after silicone-based MP arthroplasty in RA patients. Methods: 40 RA patients who had undergone operations on their MP joints were investigated i...Purpose: To evaluate personality characteris- tics’ impact upon outcome after silicone-based MP arthroplasty in RA patients. Methods: 40 RA patients who had undergone operations on their MP joints were investigated in a one-year fol- low-up. Objective measurement to assess grip strength and active range of motion—Paper- pencil-tests to assess pain during activity and at rest performance, QoL, and personality. Results: Significant improvement was observed in func- tion and pain related scores except for the pain related VAS and in several QoL facets and do- mains. Patients who experienced improvement reported higher scores on the activities of daily living facet of the WHO QoL questionnaire. Those with lower pain showed more independ- ence. The variance of the QoL domain scores, other than social and physical domains, could substantially and meaningfully be explained by variance of objective measures combined with personality scores. Conclusions: Most RA pa- tients’ QoL can be improved by MP arthroplasty despite remaining substantial level of pain. NS and HA seem to play an important role in the adaptation process during the long term, chronic illness;whereas SD represents a tool of coping with the burden of pain and disability. Personal- ity characteristics are highly predictive for QoL suggesting their important mediating role be- tween experienced pain and disability and HR QoL.展开更多
BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg...BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.展开更多
BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including ...BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee arthroplasty.METHODS A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June 2018.Relevant randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were included.The effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial benefits.If possible,a meta-analysis was performed.In case of considerable heterogeneity among studies,a qualitative analysis was performed.RESULTS Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative analysis.The total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of females.The methodological quality of the included studies ranged from average to good.The ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular pathways.The analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported using Grading of Recommendation,Assessment,Development and Evaluation,presented moderate or high quality of evidence.CONCLUSION This study showed that implementation of ERP resulted in improved clinical and patient related outcomes compared to regular pathways in hip and knee arthroplasty,with a potential reduction of costs.展开更多
While advanced technology,increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty,prosthetic joint infection still remains one of the leading causes of inc...While advanced technology,increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty,prosthetic joint infection still remains one of the leading causes of increased healthcare costs,medical resources and societal burdens in orthopaedic care.Two stage arthroplasty revision remains the gold standard for treatment of prosthetic joint infection.Proponents of single stage revision arthroplasty for infection argue that it results in lower healthcare costs while improving patient reported functional outcomes and with equivalent success rates.Here we review the history of single stage revision arthroplasty,discuss the key principles,highlight the indications and contraindications,and review the reported outcomes with a focus on future developments of single stage revision arthroplasty for hip and knee periprosthetic joint infections.展开更多
Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a v...Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.展开更多
文摘BACKGROUND With the increasing incidence of total joint arthroplasty(TJA),there is a desire to reduce peri-operative complications and resource utilization.As degenerative conditions progress in multiple joints,many patients undergo multiple proce-dures.AIM To determine if both physicians and patients learn from the patient’s initial arth-roplasty,resulting in improved outcomes following the second procedure.METHODS The institutional database was retrospectively queried for primary total hip arth-roplasty(THA)and total knee arthroplasty(TKA).Patients with only unilateral THA or TKA,and patients undergoing same-day bilateral TJA,were excluded.Patient demographics,comorbidities,and implant sizes were collected at the time of each procedure and patients were stratified by first vs second surgery.Outcome metrics evaluated included operative time,length of stay(LOS),disposition,90-d readmissions and emergency department(ED)visits.RESULTS A total of 642 patients,including 364 undergoing staged bilateral TKA and 278 undergoing bilateral THA,were analyzed.There was no significant difference in demographics or comorbidities between the first and second procedure,which were separated by a mean of 285 d.For THA and TKA,LOS was significantly less for the second surgery,with 66%of patients having a shorter hospitalization(P<0.001).THA patients had significantly decreased operative time only when the same sized implant was utilized(P=0.025).The vast majority(93.3%)of patients were discharged to the same type of location following their second surgery.However,when a change in disposition was present from the first surgery,patients were significantly more likely to be discharged to home after the second procedure(P=0.033).There was no difference between procedures for post-operative readmissions(P=0.438)or ED visits(P=0.915).CONCLUSION After gaining valuable experience recovering from the initial surgery,a patient’s perioperative outcomes are improved for their second TJA.This may be the result of increased confidence and decreased anxiety,and it supports the theory that enhanced patient education pre-operatively may improve outcomes.For the surgical team,the second procedure of a staged THA is more efficient,although this finding did not hold for TKA.
文摘Surgical site infections(SSI)following total joint arthroplasty pose a significant concern for both providers and patients across the globe.Currently,administration of antimicrobial antibiotic prophylaxis is used throughout the world to reduce the incidence of SSI.However,the correct dosage and frequency of administration remains debatable.In this editorial,we emphasized the determination of the effect of administration of weight-adjusted antimicrobial antibiotic prophylaxis regime on the incidence of SSI and postoperative dosage reduction compared to the conventionally used regime during total joint arthroplasty.The results demonstrated similar efficacy between both regimes with respect to the incidence of SSI.In addition,weight-adjustment led to reduced postoperative dosage and has the potential to reduce chances of achieving lower therapeutic concentration,drug resistance,drug toxicity,and costs.
文摘Background: Total joint arthroplasty is a commonly performed procedure for end-stage osteoarthritis. Preoperative anemia is a well-characterized and potentially modifiable risk factor for morbidity and mortality in non-cardiac surgery. This retrospective cohort study identified the prevalence of anemia in our total joint arthroplasty population and investigated if there was an association with all-cause mortality. Study Design and Methods: Using an electronic medical record, we examined all patients who underwent a primary unilateral total joint arthroplasty at Dartmouth-Hitchcock Medical Center from January 1, 2011 through July 1, 2015. Preoperative anemia thresholds were defined according to the World Health Organization as 12 mg/dl for women and 13 mg/dl for men. Kaplan-Meier survival analyses were performed to examine the relationship between preoperative anemia and all-cause mortality. Cox proportional hazards were calculated for various models adjusting for potential confounders. Results: 439 of the 3247 patients (13.5%) that underwent total joint arthroplasty met the preoperative definition for anemia. 48 patients (1.48%) died during 6470 patient years of follow up, generating an incidence rate of 7.4 deaths per 1000 patient years. The crude hazard ratio for death in anemic patients was 3.42 (95% CI 1.89, 6.82). In multiple models adjusting for various health related confounders, preoperative anemia was associated with a roughly two-fold increase risk of death compared to non-anemic patients. Conclusion: Preoperative anemia is prevalent in our population and it is associated with increased postoperative mortality in total joint arthroplasty patients, even when adjustments are made for significant co-morbidities.
基金Natural science fund project of Hainan Province(No.819MS128)。
文摘Objective:To explore the diagnostic value of serum Interleukin-6(IL-6)combined with synovial IL-6 and C-reactive protein for prosthesis joint infection(PJI)in patients after joint arthroplasty.Methods:A total of 253 patients undergoing revision surgery after the first total hip and total knee arthroplasty in the Second Affiliated Hospital of Hainan Medical College from January 2018 to April 2020 were recruited as the study object.The patients were divided into the PJI group(n=85)and non-PJI group(n=168)according to whether there was PJI,and the baseline characteristics and the laboratory indexe were collected and compared between the two groups.the factors associated with PJI in patients after joint arthroplasty were analyzed by multivariate logistic regression model.And the diagnostic value of each marker for PJI in patients after joint arthroplasty was evaluated by Receiver Operating Characteristic(ROC)curve.Results:The incidence of PJI in this study was 33.6%.Compared with the non-PJI group,the patients in the PJI group had more diabetes mellitus and shorter prosthesis duration(P<0.05).The levels of serum C-reactive protein(CRP),serum interleukin-6(IL-6),synovial IL-6,synovial CRP,synovial leukocyte,synovial neutrophil and ESR in the PJI group were higher than those in non-PJI group,and the level of synovial lymphocyte was lower,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus(OR=1.706,95%CI:1.02~2.376,P=0.037),prosthesis duration(OR=0.781,95%CI:0.690~0.884,P<0.001),serum IL-6(OR=1.008,95%CI:1.004~1.012,P=0.046),synovial IL-6(OR=1.004,95%CI:1.002~1.006,P=0.011)and synovial CRP(OR=1.481,95%CI:1.010~2.170,P=0.044)were independently related to PJI in patients after joint arthroplasty.ROC curve analysis showed that the area under ROC curve(AUC)of serum IL-6 combined with synovial IL-6 and CRP for diagnose PJI in patients after joint arthroplasty was significantly greater than each marker(0.941 vs 0.760,Z=6.333,P<0.001;0.941 vs 0.743,Z=7.189,P<0.001;0.941 vs 0.785,Z=4.999,P=0.006).Conclusion:Serum IL-6,synovial IL-6 and CRP were independently related to PJI in patients after joint arthroplasty.They all had some diagnostic value,and serum IL-6 combined with synovial IL-6 and CRP had higher capability to diagnose PJI in patients after joint arthroplasty than each marker alone.
文摘BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee arthroplasty(TKA)procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa.The questionnaire consisted of four sections.The first section recorded baseline demographic data and medical co-morbidities,the length of time spent awaiting TJA,and the patients’desire to undergo elective surgery despite the COVID-19 pandemic.Section 2 and Section 3 assessed the patients’current physical and mental health,respectively,as a consequence of deferred surgical intervention.The last section established the patients’perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery.Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks.Thereafter,patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.RESULTS We included 185 patients(65.95%female;mean age:50.28 years)awaiting TJA for a mean of 26.42±30.1 mo.Overall,88.65%of patients wanted TJA despite the COVID-19 pandemic.Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting<1 year(P<0.000).Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities(P=0.013).After receiving education,the patients wanting TJA decreased to 54.05%.Patients who changed their opinion after education had less insight on the increased morbidity(P=0.046)and mortality(P=0.001)associated with COVID-19.Despite awaiting TJA for shorter period(24.7±20.38 mo),patients who continued to demand TJA had greater pain(P<0.000)and decreased function(P=0.043)since TJA postponement.CONCLUSION There is deterioration in health for patients,who have had elective procedures postponed during the COVID-19 pandemic.Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.
文摘<span style="font-family:Verdana;">Aggressive anticoagulation following total joint arthroplaty (TJA) is well known to increase the risk of both wound leakage and hematoma formation. Despite this there are no guidelines for orthopaedic surgeons undertaking major primary and revision surgery in patients with high risk of venous thromboembolic events, who may present with complications directly linked to anticoagulant use. Hence the authors felt the need for this narrative review. They have tried to answer few questions that are commonly faced in clinical practice. Balanced anticoagulation is a difficult task to achieve. The potential consequences of over anticoagulation on the outcome of TJA and revision TJA are live changing and devastating. On the contrary falling short of adequate anticoagulation is fatal leading to recurrent thromboembolic events. Robust risk stratification tools and a multidisciplinary approach </span><span style="font-family:Verdana;">are</span><span style="font-family:Verdana;"> certainly the way forward. There is an urgent need for specialty specific guidelines for managing patient on anticoagulation undergoing TJA, and revision arthroplasty procedures</span><span style="font-family:Verdana;">.
文摘Purpose: To evaluate personality characteris- tics’ impact upon outcome after silicone-based MP arthroplasty in RA patients. Methods: 40 RA patients who had undergone operations on their MP joints were investigated in a one-year fol- low-up. Objective measurement to assess grip strength and active range of motion—Paper- pencil-tests to assess pain during activity and at rest performance, QoL, and personality. Results: Significant improvement was observed in func- tion and pain related scores except for the pain related VAS and in several QoL facets and do- mains. Patients who experienced improvement reported higher scores on the activities of daily living facet of the WHO QoL questionnaire. Those with lower pain showed more independ- ence. The variance of the QoL domain scores, other than social and physical domains, could substantially and meaningfully be explained by variance of objective measures combined with personality scores. Conclusions: Most RA pa- tients’ QoL can be improved by MP arthroplasty despite remaining substantial level of pain. NS and HA seem to play an important role in the adaptation process during the long term, chronic illness;whereas SD represents a tool of coping with the burden of pain and disability. Personal- ity characteristics are highly predictive for QoL suggesting their important mediating role be- tween experienced pain and disability and HR QoL.
文摘BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.
文摘BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and innovation.AIM The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee arthroplasty.METHODS A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June 2018.Relevant randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were included.The effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial benefits.If possible,a meta-analysis was performed.In case of considerable heterogeneity among studies,a qualitative analysis was performed.RESULTS Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative analysis.The total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of females.The methodological quality of the included studies ranged from average to good.The ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular pathways.The analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported using Grading of Recommendation,Assessment,Development and Evaluation,presented moderate or high quality of evidence.CONCLUSION This study showed that implementation of ERP resulted in improved clinical and patient related outcomes compared to regular pathways in hip and knee arthroplasty,with a potential reduction of costs.
文摘While advanced technology,increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty,prosthetic joint infection still remains one of the leading causes of increased healthcare costs,medical resources and societal burdens in orthopaedic care.Two stage arthroplasty revision remains the gold standard for treatment of prosthetic joint infection.Proponents of single stage revision arthroplasty for infection argue that it results in lower healthcare costs while improving patient reported functional outcomes and with equivalent success rates.Here we review the history of single stage revision arthroplasty,discuss the key principles,highlight the indications and contraindications,and review the reported outcomes with a focus on future developments of single stage revision arthroplasty for hip and knee periprosthetic joint infections.
基金This was work supported by the National Center for Advancing Translational Sciences of the National Institutes of Health[UL1TR001086].
文摘Total knee arthroplasty is highly successful,in part due to range of motion(RoM)recovery.This is typically estimated goniometrically/visually by physical therapists(PTs)in the clinic,which is imprecise.Accordingly,a validated inertial measurement unit(IMU)method for capturing knee RoM was deployed assessing postoperative RoM both in and outside of the clinical setting.The study's objectives were to evaluate the feasibility of continuously capturing knee RoM pre-/post-op via IMUs,dividing data into PT/non-PT portions of each day,and comparing PT/non-PT metrics.We hypothesized IMU-based clinical knee RoM would differ from IMU-based knee RoM captured outside clinical settings.10 patients(3 M,69±13 years)completed informed consent documents following ethics board approval.A validated IMU method captured long duration(8–12 h/day,~50 days)knee RoM pre-/post-op.Post-op metrics were subdivided(PT versus non-PT).Clinical RoM and patient reported outcome measures were also captured.Compliance and clinical disruption were evaluated.ANOVA compared post-op PT and non-PT means and change scores.Maximum flexion during PT was less than outside PT.PT stance/swing RoM and activity level were greater than outside PT.No temporal variable differences were found PT versus non-PT.IMU RoM measurements capture richer information than clinical measures.Maximum PT flexion was likely less than non-PT due to the exercises completed(i.e.high passive RoM vs.low RoM gait).PT gait flexion likely exceed non-PT because of‘white coat effects’wherein patients are closely monitored clinically.This implies data captured clinically represents optimum performance whereas data captured non-clinically represents realistic performance.
