scholarly journals Variable effects of obesity on access to total hip and knee arthroplasty

2021 ◽  
Vol 64 (1) ◽  
pp. E84-E90
Author(s):  
Glen Richardson ◽  
Chris Dusik ◽  
Lynn Lethbridge ◽  
Michael Dunbar
Keyword(s):  
Nova Scotia ◽  
Total Joint Arthroplasty ◽  
Wait Time ◽  
Preoperative Assessment ◽  
Study Data ◽  
Joint Arthroplasty ◽  
Wait Times ◽  
Weight Class ◽  
Data Set ◽  
Total Hip

Background: Obesity is an important comorbidity affecting outcomes after total joint arthroplasty. Consequently, surgeons may delay care of obese patients to first address obesity through different care pathways. The effect of obesity on patient wait times for total joint arthroplasty has not been explored. The purpose of this study was to evaluate the effect of obesity on access to total hip (THA) and knee (TKA) arthroplasty. Methods: The study data set was constructed from the Nova Scotia Health Authority’s Horizon Patient Folder system and the Patient Access Registry Nova Scotia. Wait time was measured as days between the decision to treat and date of surgery. Body mass index (BMI) was calculated from a preoperative assessment, and patients were grouped into BMI categories. Multivariate log-linear regression was used to test for statistical differences, controlling for confounding factors. Results: We observed longer wait times for TKA with increasing BMI weight class. Patients with BMIs greater than 50 had 34% longer waits than reference weight patients. However, THA recipients showed no statistical difference in wait times across weight categories. Furthermore, there was variability among surgeons in the wait times experienced by patients. Conclusion: The finding of longer wait times for TKAs, but not THAs, among patients who were obese was unexpected. This shows the variable wait times for THA and TKA that patients who are obese can experience with different surgeons. It is important to understand the variability in wait times so that efforts to standardize the patient experience can be accomplished.

scholarly journals Simplifying Thromboprophylaxis Could Improve Outcomes in Orthopaedic Surgery

Thrombosis ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-5
Author(s):  
Richard J. Friedman
Keyword(s):  
Venous Thromboembolism ◽  
Potential Barrier ◽  
Total Joint Arthroplasty ◽  
Orthopaedic Surgery ◽  
Joint Arthroplasty ◽  
Knee Surgery ◽  
Bleeding Complications ◽  
Conservative Approach ◽  
Total Hip

Venous thromboembolism is a serious complication after total hip or knee surgery, and there is a well-established clinical need for thromboprophylaxis. However, in a large number of cases adequate administration of thromboprophylaxis does not seem to occur after total joint arthroplasty. A major challenge in the management of thromboprophylaxis is to balance the benefits of treatment with the risks, including bleeding complications. Another potential barrier to the optimal use of thromboprophylaxis could be the inconvenience of currently available agents. Many surgeons therefore adopt a conservative approach towards thromboprophylaxis. Simplifying therapy with more convenient, efficacious, and safe anticoagulants could change attitudes to anticoagulant use and improve adherence to thromboprophylactic guidelines.

Ceforanide vs. Cephalothin Concentrations in Total Joint Arthroplasty

1983 ◽  
Vol 17 (9) ◽  
pp. 645-648 ◽  
Author(s):  
William J. Cady ◽  
Bradley G. Wulf ◽  
Michael T. O'Neil ◽  
Dwight W. Burney ◽  
William R. Hamsa
Keyword(s):  
Total Knee Arthroplasty ◽  
Synovial Fluid ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Plasma Concentrations ◽  
Prophylactic Antibiotic ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
Orthopedic Procedure ◽  
Total Knee

Total joint arthroplasty is a common orthopedic procedure and requires prophylactic antibiotic coverage to prevent infections in the operated joint. The antibiotics routinely used for prophylaxis are the cephalosporins. This study compared bone, synovial fluid, and plasma concentrations of ceforanide with cephalothin concentrations in 30 patients undergoing elective total hip or total knee arthroplasty. Ceforanide provided significantly higher plasma concentrations for 61–110 minutes postdose than did cephalothin (p < 0.025 and p < 0.005). No difference was noted between the two antibiotics for the bone concentrations in the total hip arthroplasty group; however, cephalothin concentrated to a greater degree in the bone of patients undergoing total knee arthroplasty (p < 0.05). Cephalothin achieved higher concentrations in the synovial fluid than did ceforanide (p < 0.05). Both antibiotics were well tolerated and no postoperative infections were noted in either group.

scholarly journals Minimalno-inciziona totalna artroplastika kuka

2006 ◽  
Vol 53 (4) ◽  
pp. 53-56 ◽  
Author(s):  
Z.Lj. Bascarevic ◽  
B.B. Radojevic ◽  
S.S. Timotijevic ◽  
V.D. Bascarevic ◽  
G.Z. Trajkovic ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hip Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Orthopedic Surgery ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
The World ◽  
The Future ◽  
First Results

"Minimally-invasive" total joint arthroplasty have been widely introduced to the orthopedic community several years ago. The concept has received a great attention and has been greeted variably with enthusiasm, concern, and skepticism. Numerous meetings, scientific exhibits, symposia and congresses has been taking place all around the world. Whether this represents the future of orthopedic surgery or just a fad, the term "minimally-invasive" or "minimally- incision" are yet to be clear and establish. Our intention is to present 72 of first 100 cases of total hip arthroplasty performed by "minimally-incision" surgery. In our opinion first results are positive and we intend to continue with this kind of surgery.

scholarly journals Predictors for readmission following primary total hip and total knee arthroplasty

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095916
Author(s):  
Ong-art Phruetthiphat ◽  
Jesse E Otero ◽  
Biagio Zampogna ◽  
Sebastiano Vasta ◽  
Yubo Gao ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Multivariate Regression ◽  
The United States ◽  
Joint Arthroplasty ◽  
Hospital Length Of Stay ◽  
Common Cause ◽  
Total Hip ◽  
Total Knee

Background: Readmission following total joint arthroplasty has become a closely watched metric for many hospitals in the United States due to financial penalties imposed by Centers for Medicare and Medicaid Services. The purpose of this study was to identify both preoperative and postoperative reasons for readmission within 30 days following primary total hip and total knee arthroplasty (TKA). Methods: Retrospective data were collected for patients who underwent elective primary total hip arthroplasty (THA; CPT code 27130) and TKA (27447) from 2008 to 2013 at our institution. The sample was separated into readmitted and nonreadmitted cohorts. Demography, comorbidities, Charlson comorbidity index (CCI), operative parameters, readmission rates, and causes of readmission were compared between the groups using univariate and multivariate regression analysis. Results: There were 42 (3.4%) and 28 (2.2%) readmissions within 30 days for THA and TKA, respectively. The most common cause of readmission within 30 days following total joint arthroplasty was infection. Trauma was the second most common reason for readmission of a THA while wound dehiscence was the second most common cause for readmission following TKA. With univariate regression, there were multiple associated factors for readmission among THA and TKA patients, including body mass index, metabolic equivalent (MET), and CCI. Multivariate regression revealed that hospital length of stay was significantly associated with 30-day readmission after THA and TKA. Conclusion: Patient comorbidities and preoperative functional capacity significantly affect 30-day readmission rate following total joint arthroplasty. Adjustments for these parameters should be considered and we recommend the use of CCI and METs in risk adjustment models that use 30-day readmission as a marker for quality of patient care. Level of Evidence: Level III/Retrospective cohort study

scholarly journals Measurement of surgical wait times in a universal health care system

2008 ◽  
Vol 2 (6) ◽  
pp. 597 ◽  
Author(s):  
Jun Kawakami ◽  
Wilma M. Hopman ◽  
Rachael Smith-Tryon ◽  
D. Robert Siemens
Keyword(s):  
Health Care ◽  
Multivariate Analysis ◽  
Real Time ◽  
Access To Health Care ◽  
A Priori ◽  
Wait Time ◽  
Administrative Databases ◽  
Wait Times ◽  
Data Set ◽  
Care Indicator

Introduction: Reported increases in surgical wait times for cancer have intensified the focus on this quality of health care indicator and have created a very public, concerted effort by providers to decrease wait times for cancer surgeryin Ontario. Delays in access to health care are multifactorial and their measurement from existing administrative databases can lack pertinent detail. The purpose of our study was to use a real-time surgery-booking software program to examine surgical wait times at a single centre.Methods: The real-time wait list management system Axcess.Rx has been used exclusively by the department of urology at the Kingston General Hospital to book all nonemergency surgery for 4 years. We reviewed the length of time from the decision to perform surgery to the actual date of surgery for patients in our group urological practice. Variables thought to be potentially important in predicting wait time were also collected, including the surgeon’s assessment of urgency, the type of procedure (i.e., diagnostic, minor cancer, major cancer, minor benign, major benign), age and sex of the patient, inpatient versus outpatient status and year of surgery. Analysis was planned a priori to determine factors that affected wait time by using multivariate analysis to analyze variables that were significant in univariate analysis.Results: There were 960 operations for cancer and 1654 for benign conditions performed during the evaluation period. The overall mean wait time was 36 days for cancer and 47 days for benign conditions, respectively. The mean wait time for cancer surgery reached a nadir in 2004 at 29.9 days and subsequently increased every year, reaching 56 days in 2007. In comparison, benign surgery reached a nadir wait time of 33.7 days in 2004 and in 2007 reached 74 days at our institution. Multivariate analysis revealed that the year of surgery was still a significant predictor of wait time. Urgency score, type of procedure and inpatient versus outpatient status were also predictive of wait time.Conclusion: The application of a prospectively collected data set is an effective and important tool to measure and subsequently examine surgical wait times. This tool has been essential to the accurate assessment of the effect of resource allocation on wait times for priority and nonpriority surgical programs within a discipline. Such tools are necessary to more fully assess and follow wait times at an institution or across a region.

One-Stage Bilateral Total Joint Arthroplasty: a Prospective, Comparative Study of Total Hip and Total Knee Replacement

Orthopedics ◽  
2008 ◽  
Vol 31 (2) ◽  
pp. 1-8 ◽  
Author(s):  
E. Louis Peak ◽  
William J. Hozack ◽  
Peter F. Sharkey ◽  
Javad Parvizi ◽  
Richard H. Rothman
Keyword(s):  
Total Knee Replacement ◽  
Comparative Study ◽  
Knee Replacement ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
One Stage ◽  
Prospective Comparative Study ◽  
Total Knee

scholarly journals Letter to the Editor: How Accurate Are the Surgical Risk Preoperative Assessment System (SURPAS) Universal Calculators in Total Joint Arthroplasty?

2020 ◽  
Vol 478 (8) ◽  
pp. 1946-1947 ◽  
Author(s):  
William G. Henderson ◽  
Robert A. Meguid ◽  
Karl E. Hammermeister ◽  
Kathryn L. Colborn ◽  
Paul D. Rozeboom ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Preoperative Assessment ◽  
Joint Arthroplasty ◽  
Assessment System ◽  
Surgical Risk ◽  
Letter To The Editor

scholarly journals Functional outcomes after total joint arthroplasty are related to the severity of Parkinson’s disease: a mid-term follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiao Rong ◽  
Suraj Dahal ◽  
Ze-yu Luo ◽  
Kai Zhou ◽  
Shun-Yu Yao ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Functional Outcomes ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
Total Knee

Abstract Background Performing total joint arthroplasty (TJA) in Parkinson’s disease (PD) patients may encounter a higher complication rate or worse functional outcomes compared with common patients. The relationship between PD and clinical outcomes after TJA is not fully understood. Methods Retrospectively, we used manual charts to investigate the clinical outcomes in 41 patients including 24 total hip arthroplasty (THA) patients (28 hips) and 18 total knee arthroplasty (TKA) patients (22 knees) with a diagnosis of PD from 2009 to 2016. The stage of PD was confirmed by Hoehn and Yahr scale. Prosthesis survivorship was estimated with revision for any reason as the endpoint. Result All the clinical outcomes improved significantly (p < 0.05). Subgroup analysis revealed worse functional outcomes in mid- or end-stage PD patients. Sixteen short-term mild to moderate complications were noted. Two revisions were conducted for hip periprosthetic osteolysis and postoperative knee pain. The prosthesis survivorship at 60 months for TJA, total hip arthroplasty (THA), or total knee arthroplasty (TKA) was 91.6%, 94.1%, and 87.5%, respectively. Conclusion Patients with PD who underwent TJA would result in excellent pain relief and gain of function. However, patients at late-stage PD may suffer from functional loss. The effectiveness of TJA in patients with severe PD remains a concern. Physician should help delay the progression of PD which may optimize and stabilize the functional outcomes of TJA.

Sign in / Sign up

Export Citation Format

Share Document