Force plates may be used for dynamic analyses of endoprostheses explantation procedures

2019 ◽  
Vol 64 (2) ◽  
pp. 243-245
Author(s):  
Hendrik Kohlhof ◽  
Sebastian Köhring ◽  
Dieter Christian Wirtz ◽  
Hartmut Witte
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Measurement Methods ◽  
Objective Data ◽  
Technical Base ◽  
Demographic Aging ◽  
Dynamic Analyses ◽  
Hip And Knee Arthroplasty ◽  
Hip Arthroplasties ◽  
Tools And Methods

Abstract The number of hip and knee arthroplasty replacement surgeries is increasing steadily. In combination with demographic aging and the number of periprosthetic complications, this development has lead to the phenomenon where the need for revision surgery is rising. The problem is, that, while implantation procedures of hip arthroplasties are more or less standardized, explantation is a non-standardized task for experienced specialists, due to the unpredictability of the adequate loosening method. The surgeon often only gets to decide on which tools and methods may be applied to detach the prosthesis, only after getting access to the operation site. The time taken to detach the prosthesis is hardly predictable and mainly depends on the surgeons’ skills. To gain objective data on the mechanics of explantation, new measurement methods are required. One technical base for studies on revision procedures are standard force plates, available in biomechanics laboratories.

scholarly journals Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

2015 ◽  
Vol 36 (12) ◽  
pp. 1431-1436 ◽  
Author(s):  
Kristen V. Dicks ◽  
Arthur W. Baker ◽  
Michael J. Durkin ◽  
Deverick J. Anderson ◽  
Rebekah W. Moehring ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Regression Models ◽  
Site Infection ◽  
Operative Duration ◽  
Binomial Regression ◽  
Hip And Knee Arthroplasty ◽  
American Society ◽  
Hip Arthroplasties ◽  
First Time

OBJECTIVETo determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties.DESIGNRetrospective cohort studySETTINGA total of 43 community hospitals located in the southeastern United States.PATIENTSAdults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012.METHODSLog-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age.RESULTSA total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P<.01). Short operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P=.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P<.01).CONCLUSIONSShort operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis.Infect. Control Hosp. Epidemiol. 2015;36(12):1431–1436

scholarly journals Patient Satisfaction After Lower Extremity Total Joint Arthroplasty: An Analysis of Medical Comorbidities and Patient Demographics

2021 ◽  
Vol 8 ◽  
pp. 237437352110180
Author(s):  
Nicholas Frane ◽  
Erik J Stapleton ◽  
Brandon Petrone ◽  
Aaron Atlas ◽  
Larry Lutsky ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Joint Arthroplasty ◽  
Patient Specific ◽  
Total Hip ◽  
Hip And Knee Arthroplasty ◽  
Total Knee ◽  
Specific Factors ◽  
Hip Arthroplasties ◽  
Hcahps Survey

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has received increased attention to determine which demographics may influence patient satisfaction after Total Hip and Knee Arthroplasty. The purpose of this study was to evaluate the various effects that patient-specific factors, medical comorbidities, and demographics had on patient satisfaction. Two thousand and ninety-two patients underwent lower extremity total joint arthroplasty at our institution between 2014 and 2018. Nine hundred twenty-three of these patients responded to their HCAHPS survey (44%). Most patients (609, 66%) underwent primary total knee arthroplasty followed by 244 (26.4%) total hip arthroplasties, 35 (3.8%) revision total knee arthroplasties, 28 (3.0%) bilateral total knee arthroplasties, and 7 (0.8%) revision total hip arthroplasties. Increasing age and length of stay were associated with a decrease in patient satisfaction whereas patients who were married reported higher satisfaction. Patients discharged to a rehabilitation facility had a 12% decrease in top-box response rate compared to those discharged home. Contrary to our hypothesis, specific procedure type and the presence of comorbidities failed to predict patient satisfaction. The results of this study shed light on the intricate relationship between patient satisfaction and patient-specific factors. Furthermore, health care workers can counsel patients on expected satisfaction when considering total hip and knee arthroplasty.

scholarly journals Towards UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): protocol for an evaluation of the requirements for arthroplasty follow-up, and the production of consensus-based recommendations

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e031351
Author(s):  
Carolyn J Czoski Murray ◽  
Sarah R Kingsbury ◽  
Nigel K Arden ◽  
Jenny Hewison ◽  
Andrew Judge ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Data Sets ◽  
Ageing Population ◽  
Follow Up Care ◽  
Hip And Knee Arthroplasty ◽  
The Uk ◽  
Joint Prostheses

IntroductionHip and knee arthroplasties have revolutionised the management of degenerative joint diseases and, due to an ageing population, are becoming increasingly common. Follow-up of joint prostheses is to identify problems in symptomatic or asymptomatic patients due to infection, osteolysis, bone loss or potential periprosthetic fracture, enabling timely intervention to prevent catastrophic failure at a later date. Early revision is usually more straight-forward surgically and less traumatic for the patient. However, routine long-term follow-up is costly and requires considerable clinical time. Therefore, some centres in the UK have curtailed this aspect of primary hip and knee arthroplasty services, doing so without an evidence base that such disinvestment is clinically or cost-effective.MethodsGiven the timeline from joint replacement to revision, conducting a randomised controlled trial (RCT) to determine potential consequences of disinvestment in hip and knee arthroplasty follow-up is not feasible. Furthermore, the low revision rates of modern prostheses, less than 10% at 10 years, would necessitate thousands of patients to adequately power such a study. The huge variation in follow-up practice across the UK also limits the generalisability of an RCT. This study will therefore use a mixed-methods approach to examine the requirements for arthroplasty follow-up and produce evidence-based and consensus-based recommendations as to how, when and on whom follow-up should be conducted. Four interconnected work packages will be completed: (1) a systematic literature review; (2a) analysis of routinely collected National Health Service data from five national data sets to understand when and which patients present for revision surgery; (2b) prospective data regarding how patients currently present for revision surgery; (3) economic modelling to simulate long-term costs and quality-adjusted life years associated with different follow-up care models and (4) a Delphi-consensus process, involving all stakeholders, to develop a policy document which includes a stratification algorithm to determine appropriate follow-up care for an individual patient.Ethics and DisseminationFavourable ethical opinion has been obtained for WP2a (RO-HES) (220520) and WP2B (220316) from the National Research Ethics Committee. Following advice from the Confidentiality Advisory Group (17/CAG/0122), data controllers for the data sets used in WP2a (RO-HES) – NHS Digital and The Phoenix Partnership – confirmed that Section 251 support was not required as no identifiable data was flowing into or out of these parties. Application for approval of WP2a (RO-HES) from the Independent Group Advising on the Release of Data (IGARD) at NHS Digital is in progress (DARS-NIC-147997). Section 251 support (17/CAG/0030) and NHS Digital approval (DARS-NIC-172121-G0Z1H-v0.11) have been obtained for WP2a (NJR-HES-PROMS). ISAC (11_050MnA2R2) approval has been obtained for WP2a (CPRD-HES).

scholarly journals Surgical Technique of a Cement-On-Cement Removal System for Hip and Knee Arthroplasty Revision Surgery

2021 ◽  
Vol 9 ◽  
pp. 112-117
Author(s):  
Miguel Tovar-Bazaga ◽  
David Sáez-Martínez ◽  
Álvaro Auñón ◽  
Felipe López-Oliva ◽  
Belén Pardos-Mayo ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Hip And Knee Arthroplasty ◽  
Cement Removal ◽  
Arthroplasty Revision ◽  
Removal System

Surgical site infection rate is higher following hip and knee arthroplasty when cefazolin is underdosed

2020 ◽  
Vol 77 (6) ◽  
pp. 434-440 ◽  
Author(s):  
Arthur J Morris ◽  
Sally A Roberts ◽  
Nikki Grae ◽  
Chris M Frampton
Keyword(s):  
Surgical Site Infection ◽  
Knee Arthroplasty ◽  
Multivariable Analysis ◽  
Outcome Data ◽  
Risk Scores ◽  
Site Infection ◽  
Hip And Knee Arthroplasty ◽  
Improvement Programme ◽  
Hip Arthroplasties ◽  
Higher Doses

Abstract Purpose While many guidelines recommend higher doses of cefazolin for patients with higher body weights, there are scant outcome data showing the benefit of higher doses. Surgical site infection (SSI) rates by dose of cefazolin used for surgical prophylaxis after hip or knee arthroplasty were analyzed. Methods Analysis of patient data entered into New Zealand’s national, prospective, surveillance and quality improvement SSI Improvement Programme database for the period July 2013 through December 2017 was conducted. The US Centers for Disease Control and Prevention’s National Healthcare Safety Network SSI definitions were used, and patients were followed for 90 days after surgery. Underdosing was defined as use of 1 g of cefazolin in patients weighing 80 kg or more or a cefazolin dose of &lt;3 g in those weighing 120 kg or more. Results There were 38,288 procedures where cefazolin was used for prophylaxis; patient body weight was known for all these procedures. Of the 1,840 patients who received 1 g of cefazolin, 676 (37%) weighed 80 kg or more. Of the 2,011 patients weighing 120 kg or more, 1,464 (73%) were underdosed. After multivariable analysis, male gender, higher total surgical risk scores, performance of revision and hip arthroplasties, and cefazolin underdosing were associated with higher SSI rates. For the 2,106 underdosed patients, the odds ratio for SSI was 2.19 (95% confidence interval, 1.61-2.99; P &lt; 0.0001). The number of higher-weight patients needed to treat to prevent 1 SSI was 83, with an estimated cost of &lt;NZ$500 to prevent 1 infection costing an estimated NZ$40,000. Conclusion Patients undergoing hip or knee arthroplasty and with weights of ≥80 kg and those with weights of ≥120 kg should receive cefazolin doses of 2 g and ≥3 g, respectively, for SSI prophylaxis. The question of whether a dose of ≥4 g is needed in patients weighing 120 kg or more or who are above a given body mass index threshold (eg, &gt;35 kg/m2 or &gt;40 kg/m2) remains unanswered.

scholarly journals Virtual arthroplasty follow-up: five-year data from a district general hospital

2020 ◽  
Vol 102 (3) ◽  
pp. 220-224 ◽  
Author(s):  
R Fisher ◽  
V Hamilton ◽  
S Reader ◽  
F Khatun ◽  
M Porteous
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Oxford Knee Score ◽  
District General Hospital ◽  
Assessment Process ◽  
X Rays ◽  
X Ray ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Introduction Follow-up after hip and knee arthroplasty is advocated to identify asymptomatic loosening and improve patient satisfaction. There are, however, financial and time implications associated with regular clinic appointments. Assessment through virtual means has been suggested as an alternative. Materials and methods At the West Suffolk Hospital, following arthroplasty surgery of the lower limb, patients are followed-up via a questionnaire at one and five years postoperatively, then subsequently at five-yearly intervals. Patients are recalled based on the outcome of these assessments. Using a locally compiled data base we identified all patients reviewed between 2011 and 2015 using this virtual assessment process and examined their outcomes. Results During the five years of follow-up, 5,380 patients were eligible for assessment. Compliance varied from 77% follow up for hips and 83% for knees. Ten patients were recalled following total hip replacement, eight for x-ray changes and one for a poor satisfaction score. Five went on to undergo revision surgery. Some 56 recalls to clinic following knee arthroplasty were seen; 42 due to a poor Oxford Knee Score, 6 with associated x-ray abnormalities and 6 isolated abnormal x-rays. Five subsequently underwent revision surgery; 30 (54%) were discharged after initial review and 18 (32%) were referred to different subspecialties. As a result of the virtual review process, 4,219 clinic appointments were avoided, with no documented admissions as a result of a missed complication from virtual review. Discussion A virtual arthroplasty clinic significantly reduces the number of patients attending regular follow-up clinics, without compromising safe practice.

scholarly journals 1526 Primary Hip and Knee Arthroplasty Documentation: Do Our Operation Notes Follow New GIRFT/BOA Guidelines? A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Whitham ◽  
J O'Callaghan ◽  
M Flintoft-Burt ◽  
V Shah
Keyword(s):  
Knee Arthroplasty ◽  
Best Practice ◽  
Range Of Movement ◽  
Essential Information ◽  
Best Practice Guidelines ◽  
Hip And Knee Arthroplasty ◽  
Data Points ◽  
Operation Note ◽  
Knee And Hip Arthroplasty ◽  
Hip Arthroplasties

Abstract Aim Operation notes provide essential information about the techniques and implants used in surgery. Accurate documentation is important to improve patient outcomes and reduce rising litigation costs within the NHS. The aim of this audit was to assess compliance to recent guidance for hip and knee arthroplasty documentation, issued by the Getting It Right First Time (GIRFT) programme in 2019. Method Data was collected retrospectively from operation notes of all primary total/unicompartmental knee and hip arthroplasties during August 2019 and again in October 2019 at a DGH. Documentation was audited against data items from the GIRFT knee and hip arthroplasty ‘best practice’ guidelines. Interventions between timeframes included clinician education and a discussion of the guidelines between local surgeons. Results In audit rounds 1 and 2 twenty-six and 34 patients had THRs and 23 and 28 had knee arthroplasties respectively. 100% compliance was seen in 5/23 THR criteria and 9/27 knee criteria. Average compliance for knee documentation rose from 71% to 74% but no improvement was seen for THR (68% vs 64%). Those with least improvement related to assessment of range of movement and vascular status at the end of surgery. Conclusions Although compliance was good against the majority of data points there was minimal change following a local education intervention. The development and use of fully compliant departmental operation note templates would provide further clarity about steps performed and surgeon rationale should patient care later be scrutinised. The template would also act as an invaluable educational tool for trainees reflecting on the case.

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