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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 518 - 518
1 Dec 2013
Saleh A Gad B Higuera C Klika A Iannotti J Barsoum W
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Background:

Acetabular component malpositioning in total hip arthroplasty increases the risk of dislocations, impingement, and long-term component wear. The purpose of this Sawbones study was to define the efficacy of a novel acetabular imprinting device (AID) with 3D preoperative planning in accurately placing the acetabular component.

Methods:

Four surgeons performed the study on osteoarthritic and dysplastic Sawbone models using 3 different methods for placing the acetabular component (total n = 24). The 3 methods included (1) standard preoperative planning and instrumentation (i.e., standard method), (2) 3D computed tomographic (CT) scan planning and standard instrumentation (i.e., 3D planning method), and (3) 3D CT scan planning combined with an acetabular imprinting device (i.e., AID method). In the AID method, 3D planning software was used to virtually place the acetabular component at 40° of inclination and 22° of anteversion and create a parallel guide pin trajectory. A patient-specific surrogate bone model with a built-in guide pin trajectory was then manufactured as a stereoltihography device (Fig. 1A). The surgeon molded bone cement into the acetabulum imprinting the acetabular features while maintaining the guide pin trajectory (Fig. 1B). Afterward, the AID was removed from the surrogate bone model and placed onto the Sawbone, ensuring a secure fit (Fig. 1C). A guide pin was drilled into the Sawbone along the prescribed trajectory. With the guide pin in place, the surgeon could ream the acetabulum and impact the acetabular component using the guide pin as a visual aid (Fig. 1D). Postoperatively, a CT scan was used to define and compare the actual implant location with the preoperative plan. Statistical analysis was performed as 3 group comparisons using the chi-squared test for categorical data and analysis of variance (ANOVA) for continuous measurements.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 12 - 12
1 Mar 2010
Klika A Barsoum WK Gad B Styron J Green K Bershadsky B Pifer M
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Purpose: The current health care climate encourages an early discharge directly home. Efforts to increase efficiency and decrease length of stay require accurate pre-planning of patient discharge following total joint arthroplasty (TJA). The purpose of this study was to develop and evaluate an easily administered form to preoperatively predict patient discharge disposition following TJA.

Method: A form was generated by a multidisciplinary group of clinicians which identified a set of preoperative factors relevant to patient discharge including age, gender, body mass index, comorbidities, preoperative ambulatory status, projected postoperative weight bearing, home environment and location, and caregiver assistance. Data were collected from a retrospective review of 516 medical charts for patients that had undergone primary total knee arthroplasty (TKA) (n=103), revision TKA (n=104), bilateral TKA (n=102), primary total hip arthroplasty (THA) (n=106), and revision THA (n=101). A stepwise multinomial logistic regression model was used to identify predictors of discharge to a skilled nursing facility (SNF), rehabilitation facility, or home, using SPSS version 11.5 statistical software (SPSS Inc., Chicago, IL).

Results: Patients were more likely to be discharged to either a SNF or rehabilitation facility if they underwent bilateral TKA (p< 0.001); were female (p< 0.001), have their heart disease monitored (p=0.003); or are older (p< 0.001). Patients are more likely to be discharged home if preoperatively they are capable of independent ambulation in the community (p=0.014). Patients discharged to either a SNF or rehabilitation facility were not significantly different except patients undergoing bilateral TKA were more likely to be discharged to a rehabilitation facility (p< 0.001).

Conclusion: We identified factors associated with discharge to a SNF, rehabilitation facility, or home following elective joint replacement surgery. With further validation, this model may be a useful tool for preoperatively predicting a patient’s discharge disposition, which is valuable to the hospital, clinicians, patients, and families in efficiently preparing for postoperative care.