The practice of overlapping surgery has been increasing in the delivery of orthopaedic care, aiming to provide efficient, high-quality care. However, there have been concerns about the safety of this practice. The purpose of this study is to examine safety and efficacy of a model of partially overlapping surgery that we termed “the swing room” in practice in primary hip and knee arthroplasty. A retrospective review of prospectively collected data using an administrative database was carried out on patients who underwent primary unilateral total hip and total knee arthroplasty from 2006 to 2017 at two sites of one academic center staffed by four arthroplasty surgeons. All revisions and bilateral primary procedures were excluded. Cases were stratified as overlapping or non-overlapping. Overlapping was defined when a surgeon had access to two operating rooms with two teams, and non-overlapping was defined as when a surgeon only had access to a single operating room on a particular day. Patient demographic characteristics, operating room time, procedure time, length of stay, Postoperative complications within 30 days of the procedure, unplanned hospital readmissions, unplanned reoperations, and emergency department visits were collected. The Fisher's exact Wilcoxon rank-sum test and logistic regression analysis were used for statistical analysis.Introduction
Methods
Fully constrained liners are used to treat recurrent dislocations or patients at high risk after total hip replacements. However, they can cause significant morbidities including recurrent dislocations, infections, aseptic loosening and fractures. We examine long term results of 111 patients with tripolar constrained components to assess their redislocation and failure rate. The purpose of this study was to assess survivorship, complications and functional outcomes at a minimum 10 years after the constrained tripolar liners used in our institute.Background
Questions/purposes
High complication rates and poor outcomes have been widely reported in patients undergoing revision of large head metal-on-metal arthroplasty. A previous study from our center showed high rates of dislocation, nerve injury, early cup loosening and pseudotumor recurrence. After noting these issues, we implemented the following changes in surgical protocol in all large head MOM revisions: 1. Use of highly porous shells in all cases 2. Use of largest femoral head possible 3. Low threshold for use of dual mobility and constrained liners when abductors affected or absent posterior capsule 4. Use of ceramic head with titanium sleeve in all cases 5. Partial resection of pseudotumor adjacent to sciatic and femoral nerves. The purpose of the present study is to compare the new surgical protocol above to our previously reported early complications in this group of patients We specifically looked at (1) complications including reoperations; (2) radiologic outcomes; and (3) functional outcomes. Complication rates after (Group 1), and before (Group 2) modified surgical protocol were compared using Chi-square test, assuming statistical significance p<0.05.Background
Questions/purposes
