Introduction

Tranexamic acid (TXA) has been shown to decrease hemoglobin loss and reduce the need for transfusions in primary hip and knee arthroplasty. Recently, authors have proven similar results in revision total knee arthroplasty (TKA). No previous paper has focused on the safety and efficacy of TXA for revision TKA for periprosthetic joint infection (PJI). The purpose of our study was to evaluate the safety and efficacy of topical TXA in revision TKA for PJI.

Introduction

Knee osteoarthritis is a leading cause of disability around the world. Traditionally, total knee arthroplasty (TKA) is the gold standard treatment; however, unicompartmental knee arthroplasty (UKA) has emerged as a less-invasive alternative to TKA. Patients with UKAs participate earlier with physical therapy (PT), have decreased complications, and faster discharges (1, 2). As UKA has evolved, so has computer navigation and robotic technology. The Robotic Assisted UKA combines the less invasive approach of the UKA with accurate and reproducible alignment offered by a robotic interface (3)(Figure1).

A key part of a patient's satisfaction is perioperative pain control. Femoral nerve blocks (FNB) are commonly performed to provide analgesia, though they cause quadriceps weakness which limits PT (4). An alternative is the adductor canal block (ACB) which provides analgesia while limiting quadriceps weakness (4). The adductor canal is an aponeurotic structure in the middle third of the thigh containing the femoral artery and vein, and several nerves innervating the knee joint including the saphenous nerve, nerve to the vastus medialis, medial femoral cutaneous nerve, posterior branch and occasionally the anterior branch of the obturator nerve (5).

In a multi-modal approach with Orthopedic Surgery, Regional Anesthesia, and PT departments, an early goal directed plan of care was developed to study ACB in UKA with a focus on analgesia effectiveness and PT compliance rates.

Introduction

Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. As the number of total hip and knee replacements has increased, the number of revision procedures has also increased. Revisions for infection require a greater amount of hospital and surgeon resources than noninfectious revisions. Our study compares the financial information for all two-stage revision surgeries performed at our tertiary referral center for hip or knee PJI over the last four years, separating them into two groups: referral versus self-originating cases.

Background

Hospitalists have assumed an evolving role in the care of postsurgical orthopaedic patients. Literature has provided evidence to suggest improved outcomes in postsurgical hip fracture patients managed by hospitalists in nonteaching hospitals. However, the full impact of a hospitalist co-management model has not been fully investigated with regard to elective joint arthroplasty patients in a multispecialty teaching facility. We hypothesized that a hospitalist co-management model in the setting of a teaching hospital would lead to an increase in unnecessary medical workups for joint arthroplasty patients.

Background:

Complications following hip and knee arthroplasty can occur in any given patient. However, specific risk factors such as increased age, history of coexistent disease, and increased body mass index have been found to increase the risk of complications after such procedures. Complications often require prolonged hospital admission periods and added hospital resources which ultimately results in increased costs per hospital stay. However, if patients are pre-operatively risk stratified, and followed post-operatively for specific high risk medical issues, many complications may be avoided. By using a hospital standardised peri-operative risk stratification process, the cost per hospital stay for hip and knee arthroplasty may decrease.

Introduction:

Deep infection after total joint arthroplasty is a devastating complication with reported incidence of 1–3% with projection to increase to 6.8% by 2030. The direct costs of revision surgery due to septic failure are estimated at over $55,000 per case. Antibiotic-Loaded Bone Cement (ALBC) has been proposed as a preventive measure to decrease post-operative infection rates. Its efficacy has been compared with plain bone cement (PBC) in multiple studies. There has been no study to our knowledge examining its efficacy in “high risk” patients. The purpose of this study is to compare infection rates in three cohorts of patients: (1) all patients receiving only PBC, (2) all patients receiving only ALBC, and (3) only “high risk” patients receiving ALBC.