The Canadian Cardiovascular Society (CCS) recommends performing daily troponin testing on postoperative days 0 through 3 for noncardiac surgical patients to decrease the mortality rate due to myocardial injury. Indications for testing include:
->65 yo -45-64 yo with significant cardiovascular disease -a Revised Cardiac Risk Index score (RCRI) > 1 Troponin elevation > 30 ng/L is termed “myocardial injury after noncardiac surgery” (MINS). The study objective was to determine the prognostic relevance of applying CCS recommendations. 669 patients undergoing THA were included in the study. Based on the CCS recommendation there were 4 patient Groups depending on whether or not they met the MINS screening protocol criteria and whether or not it was applied:
-A - met & applied (n=181) -B - met & not applied (n=248) -C – not met & applied (n=10) -D – not met & not applied (n=230) 307 (45.8%) males and 363 (54.2%) females with an average age of 67.8 years were included. Group A- 24% incidence (43 patients) of troponin rise & 5% incidence (9 patients) of cardiac complications. Group B- 0.4% incidence (1 patient) of cardiac complications. Groups A + B – representing all patients who should have had the MINS screening protocol applied according to the CCS recommendations − 10 (2.3%) patients developed cardiac complication and one (0.2%) patient death MINS screening protocol group (A & C) LOS was 4.0 days compared to 1.4 days for those not screened (p-value: <0.001). Applying the CCS MINS screening protocol to elective THA patients added no benefit in predicting/preventing postoperative cardiac events but was associated with a significant increase in LOS. Following current CCS recommendations without more specifications and clinical evidence is unwarranted.
Total hip arthroplasty (THA) is an effective surgery for the treatment of advanced osteoarthritis but increasing numbers of these procedures are having a significant impact on healthcare budgets. One route to mitigate the increasing costs is outpatient THA, discharging patients on the same day as their surgery. The purpose of this study was to determine the cost of outpatient THA compared to standard overnight stay in hospital. This was a prospective-randomized controlled trial for patients undergoing primary THA through a direct anterior approach. Participants were randomized to be discharged on the same day as surgery, as outpatients, or on day one post-surgery, as inpatients, using a Zelen consent model. Adverse events were assessed, and participants completed self-reported cost questionnaires at two-, six- and 12-weeks post-surgery, and the WOMAC preoperatively and at 12-weeks post-surgery. We performed a cost analysis from health care payer (HCP) and societal perspectives.Introduction
Methods
Trunnion wear has been reported as a cause for failure of modern total hip replacement implants. While there are several reports on the prevalence of trunnion corrosion with specific stem designs, little is known about the prevalence of this problem across other femoral stem designs. The purpose of this study is to review three commonly used uncemented femoral stems and to correlate any established risk factors with rates of revision. We reviewed all patients followed prospectively over a 15-year period (March 2000 to September 2015) who underwent total hip arthroplasty with one of three modern uncemented femoral stem designs. All of the stems were made of titanium (Ti6Al4V alloy) with a 12/14 taper design. We included only metal (cobalt chromium) on highly cross-linked polyethylene articulations. We evaluated age, gender, body mass index (BMI), femoral head size, head length, neck angle and offset as potential risk factors for all cause revision and revision excluding infection by univariate analysis. We performed a logistic regression analysis with odds ratios (OR) for each parameter for both all cause revision as well as with infection excluded. We used a p value of <0.05 as a level of significance.Introduction
Methods
The purpose of this study is to estimate the cost-effectiveness of performing total hip arthroplasty (THA) versus nonoperative management (NM) in non-obese (BMI 18.5–24.9), overweight (25–29.9), obese (30–34.9), severely-obese (35–39.9), morbidly-obese (40–49.9), and super-obese (50+) patients. We constructed a state-transition Markov model to compare the cost-utility of THA and NM in the six above-mentioned BMI groups over a 15-year time period. Model parameters for transition probability (i.e. risk of revision, re-revision, death), utility, and costs (inflation adjusted to 2017 US dollars) were estimated from the literature. Direct medical costs of managing hip arthritis were accounted in the model. Indirect societal costs were not included. A 3% annual discount rate was used for costs and utilities. The primary outcome was the incremental cost-effectiveness ratio (ICER) of THA versus NM. One-way and Monte Carlo probabilistic sensitivity analysis of the model parameters were performed to determine the robustness of the model.Introduction
Methods
Early functional recovery following total hip arthroplasty (THA) has the potential to increase patient satisfaction and reduce resource utilization. The direct anterior approach (DA) has been shown to provide earlier recovery compared to the direct lateral (DL) approach based on functional tests and outcome scores. There are limited studies that objectively evaluate functional recovery comparing the two approaches in the early post-operative period. Activity trackers have emerged as a valid tool to objectively quantify physical activity levels and potentially better assess functional status compared to commonly reported functional questionnaires. The purpose of this study is to measure physical activity levels in patients undergoing THA with the DA approach and compare these to THA with the direct lateral approach in the immediate postoperative period. In a tertiary academic center we prospectively enrolled patients with primary OA that were eligible for a primary THA undergoing either the DA or the DL approach using the same prosthesis. Patients with comorbidities precluding them from ambulation, diagnoses of AVN or RA or undergoing bilateral THA were excluded. The number of steps walked per day were measured using wristband activity tracking technology for one week preoperatively, the first 2 weeks postoperatively and for 1 week leading up to their 6-week follow-up appointment. The University of California, Los Angeles (UCLA) activity score was also collected at the same two time points. Demographics were analyzed with descriptive statistics. A non-parametric Mann Whitney U test was used to determine whether a difference in physical activity levels exist between the DA and DL approach groups in the first 2 weeks and 6 weeks postoperatively.Introduction
Methods
