For the increasing number of working-age patients undergoing total hip or total knee arthroplasty (THA/TKA), return to work (RTW) after surgery is crucial. We investigated the association between occupational class and time to RTW after THA or TKA. Data from the prospective multicentre Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study were used. Questionnaires were completed preoperatively and six and 12 months postoperatively. Time to RTW was defined as days from surgery until RTW (full or partial). Occupational class was preoperatively assessed and categorized into four categories according to the International Standard Classification of Occupations 2008 (blue-/white-collar, high-/low-skilled). Cox regression analyses were conducted separately for THA and TKA patients. Low-skilled blue-collar work was used as the reference category.Aims
Methods
The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation. Between January 2000 and March 2019, 21,469 primary and revision arthroplasties (10,011 THAs; 11,458 TKAs), which were undertaken in 15,504 patients at a single academic medical centre, were identified from a 27-county linked electronic medical record (EMR) system. Depressive and anxiety disorders were identified by diagnoses in the EMR or by using a natural language processing program with subsequent validation from review of the medical records. Patients with mental health diagnoses other than anxiety or depression were excluded.Aims
Methods
The primary aim was to assess change in health-related quality of life (HRQoL) of patients as they waited from six to 12 months for a total hip (THA) or total or partial knee arthroplasty (KA). Secondary aims were to assess change in joint-specific function, mental health, quality of sleep, number living in a state worse than death (WTD), wellbeing, and patient satisfaction with their healthcare. This prospective study included 142 patients awaiting a THA (mean age 66.7 years (SD 11.4); 71 female) and 214 patients awaiting KA (mean age 69.7 years (SD 8.7); 117 female). Patients completed questionnaires (EuroQol five-dimension health questionnaire (EQ-5D), Oxford Hip and Knee Scores (OHS/OKS), Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Score (HADS), University of California, Los Angeles Activity Scale, wellbeing assessment, and satisfaction with their healthcare) at six and 12 months while awaiting surgery.Aims
Methods
The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from waiting lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five-dimension questionnaire (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood Clinical Frailty Scale (CFS), and 36-Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ-5D of less than zero.Aims
Methods
The primary aim was to assess whether preoperative health-related quality of life (HRQoL) was associated with postoperative mortality following total hip arthroplasty (THA) and knee arthroplasty (KA). Secondary aims were to assess whether patient demographics/comorbidities and/or joint-specific function were associated with postoperative mortality. Patients undergoing THA (n = 717) and KA (n = 742) during a one-year period were identified retrospectively from an arthroplasty register. Patient demographics, comorbidities, Oxford score, and EuroQol five-dimension (EQ-5D) were recorded preoperatively. Patients were followed up for a minimum of seven years and their mortality status was obtained. Cox regression analysis was used to adjust for confounding.Aims
Methods
The aims were to assess whether preoperative joint-specific function (JSF) and health-related quality of life (HRQoL) were associated with level of clinical frailty in patients waiting for a primary total hip arthroplasty (THA) or knee arthroplasty (KA). Patients waiting for a THA (n = 100) or KA (n = 100) for more than six months were prospectively recruited from the study centre. Overall,162 patients responded to the questionnaire (81 THA; 81 KA). Patient demographics, Oxford score, EuroQol five-dimension (EQ-5D) score, EuroQol visual analogue score (EQ-VAS), Rockwood Clinical Frailty Score (CFS), and time spent on the waiting list were collected.Aims
Methods
The National Health Service produces over 500,000 tonnes of waste and 25 mega tonnes of CO2 annually. Operating room waste is segregated into different streams which are recycled, disposed of in landfill sites, or undergo costly and energy-intensive incineration processes. By assessing the quantity and recyclability of waste from primary hip and knee arthroplasty cases, we aim to identify strategies to reduce the carbon footprint of arthroplasty surgery. Data was collected prospectively at a tertiary orthopaedic hospital, in the theatres of six arthroplasty surgeons between April – July 2022. Fifteen primary total hip arthroplasty (THA) and 16 primary total knee arthroplasty (TKA) cases were included; revision and complex primary cases were excluded. Waste was categorised into non-hazardous waste, hazardous waste, recycling, sharps, and linens. Each waste category was weighed. Items disposed as non-hazardous waste were catalogued for a sample of 10 TKA and 10 THA cases. Recyclability of items was determined from packaging. Average total waste generated for THA and TKA were 14.46kg and 17.16kg respectively, with TKA generating significantly greater waste (p < 0.05). On average only 5.4% of waste was recycled in TKA and just 2.9% in THA cases. The mean recycled waste was significantly greater in TKA cases compared to THA, 0.93kg and 0.42kg respectively (p < 0.05). Hazardous waste represented the largest proportion of the waste streams for both TKA (69.2%) and THA (73.4%). On average TKA generated a significantly greater amount (11.87kg) compared to THA (10.61kg), p < 0.05. Non-hazardous waste made up 15.1% and 11.3% of total waste for TKA and THA respectively. In the non-hazardous waste, only two items (scrub brush packaging and sterile towel packaging) were identified as recyclable based on packaging. We estimate that annually
Aims. The aim of this meta-analysis was to determine the pooled incidence of postoperative urinary retention (POUR) following
Malnutrition is considered a risk factor for postoperative complications in
Immigrated Canadians make up approximately 20% of the total population in Canada, and 30% of the population in Ontario. Despite universal health coverage and an equal prevalence of severe arthritis in immigrants relative to non-immigrants, the former may be underrepresented amongst arthroplasty recipients secondary to challenges navigating the healthcare system. The primary aim of this study was to determine if utilization of arthroplasty differs between immigrant populations and persons born in Canada. The secondary aim was to determine differences in outcomes following
Abstract. Introduction. Frailty is associated with poorer outcomes after joint replacement. Targeting frailty pre-operatively via protein supplementation and exercise has the potential to improve outcomes after joint replacement. Before conducting a randomised controlled trial (RCT), a feasibility study is necessary to address key uncertainties and explore how to optimise trial design. Methodology. Joint PREP is a feasibility study for a multicentre, two-arm, parallel group, pragmatic, RCT to evaluate the clinical and cost-effectiveness of prehabilitation for frail patients undergoing
Aims. Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the effectiveness of communication is only partially determined by the surgeon, and understanding how non-surgeon personnel affect intraoperative communication is critical for the development of safe and cost-effective staffing guidelines. Operative efficiency is also dependent on high-functioning teams and can offer a proxy for effective communication in highly standardized procedures like primary
Venous thromboembolism (VTE) is a serious complication after
Background. In surgeon controlled bundled payment and service models, the goal is to reduce cost but preserve quality. The surgeon not only takes on risk for the surgery, but all costs during 90 days after the procedure. If savings are achieved over a previous target price, the surgeon can receive a monetary bonus. The surgeon is placed in a position to optimize the patients preoperatively to minimize expensive postoperative readmissions in a high risk population. Traditionally, surgeons request that primary care providers medically clear the patient for surgery with cardiology consultation at their discretion, and without dictating specific testing. Our participation in the Bundled Payments for Care Improvement (BPCI) program for
Aims. While internet search engines have been the primary information source for patients’ questions, artificial intelligence large language models like ChatGPT are trending towards becoming the new primary source. The purpose of this study was to determine if ChatGPT can answer patient questions about
Introduction. The purpose of the study was to determine access to and, ability to use telemedicine technology in an adult hip and knee reconstruction patient population and we seek to understand these patients' perceived benefits, risks and preferences of telemedicine. Methods. We performed a cross-sectional telephone administered survey on patients scheduled to undergo primary THA and TKA by one of six surgeons at a single academic institution between March 23 and June 2, 2020. Results. 163 patients were contacted and 113 (69.3%) completed the survey. Of the patients that completed surveys, 88% of patients reported using the internet with 94% reporting owning a device capable of videoconferencing. 78% of patients had participated in a video call in the past year and 37% having done a video visit with their physician. When asked for their preferred method for a physician visit, 80% ranked in-person as their first choice, followed by 18% preferring a video visit. Perceived benefits of telemedicine visits included reduced travel to appointments (87% agree or strongly agree) and reduced cost of attending appointments (63% agree or strongly agree). However, patients were concerned that they would not establish the same patient-physician connection (51% agree or strongly agree) and would not receive the same level of care (33% agree or strongly agree) through telemedicine visits versus in person visits. Conclusion. The majority of
Background. The Bundled Payments for Care Improvement (BPCI) was developed by the US Center for Medicare and Medicaid (CMS) to evaluate a payment and service delivery model to reduce cost but preserve quality. 90 day postoperative expenditures are reconciled against a target price, allowing for a monetary bonus to the provider if savings were achieved. The surgeon is placed in a position to optimize the patients preoperatively to minimize expensive postoperative cardiovascular readmissions in a high risk population. Traditionally, surgeons request that primary care providers medically clear the patient for surgery with or without additional cardiology consultation, without dictating specific testing. Typical screening includes an EKG, occasionally an echocardiogram and nuclear stress test, and rarely a cardiac catheterization. Our participation in the BPCI program for
Patients undergoing
Introduction. Patients undergoing TJA have higher rates of anxiety and/or depression than the general population and higher costs of care. These preoperative diagnoses lead to higher levels of postoperative dissatisfaction and depression patients alone have higher readmission rates. There is significant crossover between anxiety and depressive disorders, and many patients are classed as combined. Our goal was to evaluate readmission rates of patients undergoing
Introduction. It is thought that socioeconomic status and cultural upbringing influence the patient based outcomes of total joint arthroplasty. Previous studies have shown that patients in a lower socioeconomic class had surgery at an earlier age, increased comorbidities, increased severity of symptoms at presentation, and less satisfaction with the outcome. The purpose of this study was to compare the 1) reasons for undergoing total joint replacement and 2) satisfaction with the outcome among patients in different cultures and socioeconomic categories. We hypothesized that the overall reasons for undergoing surgery would be similar among all groups. Method. Patients undergoing
The New Zealand Joint Registry (NZJR) was established in 1999. However, ethnicity data was not recorded by prioritisation in line with Ministry of Health (MoH) recommendations. Recently, cross-referencing with MoH updated ethnicity data for all 326,150 entries in the NZJR database. The objective of this national level, population study was to identify any ethnic disparities in access and outcome for Māori for primary
Aims. The purpose of this study was to assess early physical function
after
Elevated plasma levels of D-dimer have been found to be a useful screening tool in the diagnosis of deep venous thrombosis (DVT) in the general population. In the post operative setting however their role is less clear. The majority of NHS trusts use D-dimer as a prerequisite test prior to radiological imaging to diagnose DVT. Aims and method: This study evaluates the effectiveness of D-dimer as a screening tool for DVT in the postoperative period following
Introduction. Recent advances in algorithms developed with passively collected sensor data from smart phones and watches demonstrate new, objective, metrics with the capacity to show qualitative gait characteristics. The purpose of this feasibility study was to assess the recovery of gait quality following primary
Introduction: The purpose of this study was to utilise data from the Canadian Joint Replacement Registry (CJRR) to determine trends in the 43,000
The proportion of very elderly people within the general population is steadily increasing. These people, who often have coexisting medical problems and a limited life expectancy, may pose a dilemma for Orthopaedic Surgeons when referred for elective Orthopaedic procedures. The purpose of this study is to review the outcome of primary hip and knee arthroplasty in patients aged 90, and over, who are registered with the Trent Regional Arthroplasty Database. Between 1990 and 2000, prospective data was collected on patients aged 90, and over, undergoing primary
Two of the major complications of
Antibiotic-impregnated polymethylmethacrylate beads, which are used to deliver antibiotic directly to infected sites in the musculoskeletal system has been evaluated most widely. The disadvantages include reduced biocompatibility with bone, short duration of drug release, very low release rate and thermal damage to the antibiotics. For solving this problem, we developed the antibiotic-impregnated calcium hydroxyapatite ceramic implant (HA) as a new drug delivery system. This study is to evaluate the clinical results of the antibiotic-impregnated HA used for the treatment of infected
Aims. There is uncertainty regarding the optimal means of thromboprophylaxis
following
Aim: Inability to lose weight is often attributed to restriction of mobility due to painful arthritic joints. We hypothesise that removing the pain by total hip replacement or knee replacement will improve patients exercise tolerance thereby helping them lose weight. Method: A prospective study of obese patients (BMI >
30) undergoing consecutive primary
Aims: To determine the effect of a simple, user-friendly algorithm developed as a guidance for reducing the need for allogeneic blood transfusions in
We aimed to measure cerebral microemboli load during
Aim. Alpha-defensin was recently introduced as a new biomarker having a very high accuracy to rule out periprosthetic joint infection (PJI). A new rapid lateral flow version of the Alpha-defensin test was developed and introduced to detect high levels of Alpha-defensin in synovial fluid quickly and with ease. We conducted a single-centre prospective clinical study to compare the results of the Alpha-defensin rapid test* against the conventional diagnostics according to MSIS criteria. Method. A total of 223 consecutive patients with painful
We studied the changes in plasma viscosity and C-reactive protein to establish normal values after
The aim was to perform a cost-utility analysis of total joint replacement in the current environment. Arthritis is a disabling condition that leads to long-term deterioration in quality of life. Total joint replacement, despite being one of the greatest advances in medicine in the modern era, has come under recent scrutiny. The National Health Service (NHS) has competing demands and resource allocation is challenging in times of economic restraint. Patients undergoing
Introduction. Perioperative dexamethasone has been shown to effectively reduce post-operative nausea and vomiting and aide in analgesia after total joint arthroplasty (TJA), however systemic glucocorticoid therapy is carries the theoretical risk of increased susceptibility to prosthetic joint infection (PJI), increased white blood cell (WBC) counts, and increased blood glucose levels. The purpose of this study is to determine the effect of dexamethasone on PJI, WBC count, and blood glucose levels in diabetic and non-diabetic patients undergoing TJA. Methods. A retrospective chart review of all patients receiving primary total joint (hip or knee) arthroplasty between January 1, 2013 and December 31, 2015 (n = 1818) was conducted. The patients were divided into two main cohorts: those receiving dexamethasone (n = 1426) and those not receiving dexamethasone (n = 392); these groups were further subdivided into diabetic (n = 428 dexamethasone; n = 129 no dexamethasone) and non-diabetic patients (n = 998 dexamethasone, n = 263 no dexamethasone). The primary outcome was PJI; secondary measures included in (WBC) count, glucose levels, and days to infection. Statistics were carried out using chi-squared or ANOVA tests. Results. Of the 1818 joints, 1.05% (19) developed PJI; there was no significant difference between the dexamethasone and no dexamethasone groups (p = 0.1023): 12 (0.84%) in the dexamethasone group and 7 (1.79%) in the no-dexamethasone group. Additionally there was no significant effect on the increase in WBC count (p = 0.1784) or on the increase in blood glucose (p = 0.3120). Further subdividing the patients, there was a significantly higher rate of infection in those who received dexamethasone with diabetes (2.1%) compared to those without diabetes (0.30%) (p = 0.0016). Further, diabetics who received dexamethasone had a significantly greater elevation in blood glucose (p < 0.0001) compared to non-diabetics, but no significant change in WBC count (p = 0.6993). Conclusion. Perioperative intravenous dexamethasone had no statistically significant effect on the overall rate of prosthetic joint infections in primary
The purpose of this study was to establish a model to predict the future need for
Introduction. Rivaroxaban has been recommended for routine use as a thromboprophylactic agent in patients undergoing lower limb arthroplasty. Trials supporting its use have not fully evaluated the risks of wound complications related to rivaroxaban. Method. A retrospective cohort analysis of 1558 consecutive patients who underwent
The Hospital (Trust) guidelines generally recommend 40mg of Low molecular weight heparin (LMWH) twice daily (BD) for all patients over 100kg for those undergoing
We undertook a prospective controlled clinical trial of 109 patients to determine whether postoperative blood salvage in patients undergoing
This study aimed to evaluate the month-to-month prevalence of antibiotic dispensation in the 12 months before and after total knee arthroplasty (TKA) and total hip arthroplasty (THA) and to identify factors associated with antibiotic dispensation in the month immediately following the surgical procedure. In total, 4,115 THAs and TKAs performed between April 2013 and June 2019 from a state-wide arthroplasty referral centre were analysed. A cross-sectional study used data from an institutional arthroplasty registry, which was linked probabilistically to administrative dispensing data from the Australian Pharmaceutical Benefits Scheme. Multivariable logistic regression was carried out to identify patient and surgical risk factors for oral antibiotic dispensation. Oral antibiotics were dispensed in 18.3% of patients following primary TKA and 12.0% of patients following THA in the 30 days following discharge. During the year after discharge, 66.7% of TKA patients and 58.2% of THA patients were dispensed an antibiotic at some point. Patients with poor preoperative health status were more likely to have antibiotics dispensed in the month following THA or TKA. Older age, undergoing TKA rather than THA, obesity, inflammatory arthritis, and experiencing an in-hospital wound-related or other infectious complications were associated with increased antibiotic dispensation in the 30 days following discharge. A high rate of antibiotic dispensation in the 30 days following THA and TKA has been observed. Although resource constraints may limit routine wound review for all patients by a surgeon, a select cohort may benefit from timely specialist review postoperatively. Several risk factors identified in this study may aid in identifying appropriate candidates for such changes to follow-up care.
Orthopaedic surgery accounts for about 10% of red cell transfusions used in hospital. In view of the recognized risks and decreasing availability of donor blood, every effort should be made to minimize inappropriate transfusions. Methods: Data was collected on the number of patients prescribed blood transfusion after primary
Introduction: Several studies have established a relationship between the preoperative haemoglobin level and the need for postoperative blood transfusion. The aim of this study was to identify clinical factors associated with the need for perioperative blood transfusion in non-anaemic patients undergoing hip or knee arthroplasty. Methods: We prospectively evaluated 162 consecutive patients who underwent
Background. The optimal strategy for postoperative deep venous thrombosis (DVT) prophylaxis remains among the most controversial topics in hip and knee arthroplasty. Warfarin, the most commonly used chemical anticoagulant, initially causes transient hypercoagulability; however the optimal timing of treatment with respect to surgery remains unclear. Our purpose was to evaluate the effects of pre- versus postoperative initiation of warfarin therapy with a primary endpoint of perioperative change in hemoglobin (pre- minus post-operative level), with secondary endpoints of postoperative International Normalized Ratio (INR), drain output, and bleeding/thrombotic events. Methods. A quasi-experimental study design was employed, under which patients were assigned to begin taking warfarin the night prior to surgery or the night following surgery based on day of the week seen in clinic. An a priori power analysis was conducted in order to ensure appropriate enrollment to detect a 0.5 g/dL difference in perioperative change in hemoglobin between groups, given an alpha level of 0.05 and beta of 0.80. Based on the results, the study included all primary, elective
We conducted a multicentre cohort study of 228 patients with osteoarthritis followed up after
The aim of this study was to determine the effectiveness of home-based prehabilitation on pre- and postoperative outcomes in participants awaiting total knee (TKA) and hip arthroplasty (THA). A systematic review with meta-analysis of randomized controlled trials (RCTs) of prehabilitation interventions for TKA and THA. MEDLINE, CINAHL, ProQuest, PubMed, Cochrane Library, and Google Scholar databases were searched from inception to October 2022. Evidence was assessed by the PEDro scale and the Cochrane risk-of-bias (ROB2) tool.Aims
Methods
Hypothesis. Pre-specified pooling of data from the four phase III RECORD studies was conducted to determine whether rivaroxaban significantly reduced the less-frequent clinical endpoint of symptomatic venous thromboembolism (VTE) and all-cause mortality after
Many psychological factors have been associated with function after joint replacement. Personality is a stable pattern of responses to external conditions and stimuli. The aim of this study was to investigate the relationship between personality, joint function, and general physical in patients undergoing
After
Blood transfusion requirement after primary total hip replacements (THR) and total knee replacements (TKR) was found to be related to increased post-operative complications rate and length of hospital stay. Pre-operative haemoglobin level remains the single most important factor determining the requirement for post-operative blood transfusion. We carried out a local retrospective audit of 977 THRs and TKRs in 2019. Pre-operative and pre-transfusion haemoglobin levels for transfused group of patients were recorded.Abstract
Background
Methods