Abstract. Introduction. Minimum clinically important differences (MCIDs) are critical to understanding changes in patient-reported outcome measure (PROM) scores after
Abstract. INTRODUCTION. 10% of patients with knee osteoarthritis (OA) have disease confined to the patellofemoral joint (PFJ). The main surgical options are total knee replacement (TKR) and PFJ replacement (PFJR). PFJR has advantages over TKR, including being less invasive, bone preserving, allowing faster recovery and better function and more ‘straight forward’ revision surgery. We aim to compare the clinical results of revised PFJR with primary TKR taking into consideration the survival length of the PFJR. METHODOLOGY. Twenty-five patients (21 female) were retrospectively identified from our arthroplasty database who had undergone revision from PFJR to TKR (2006–2019). These patients were then matched with regards to their age at their primary procedure, sex and
Aims. The aim of this study was to observe the implications of withholding
Background. Early mobilization after
Introduction. Unexpected cancellation of scheduled
Introduction. Morbid obesity (BMI>40) is a significant risk factor for complications following
Introduction. Pulmonary embolism (PE) complicates up to 1% of
Introduction. Patient reported outcome measures (PROMs) are increasingly used as quality benchmarks in
Introduction. Patients who undergo
Introduction. In recent years, online patient portals have been developed to offer the potential of an enhanced recovery experience. By offering videos, communication tools and patient-reported outcomes collection, online portals encourage patient's engagement in their care. In the
Introduction. There is little published evidence regarding cannabis or cannabinoid use among orthopedic patients, yet there is increasing public attention on its possible role in treating various medical conditions including pain. California passed legislation legalizing cannabis for medical treatment in 2003 and recreational use in 2018. All patients undergoing
Obesity is an epidemic across both the developed
and developing nations that is possibly the most important current
public health factor affecting the morbidity and mortality of the global
population. Obese patients have the potential to pose several challenges
for arthroplasty surgeons from the standpoint of the influence obesity
has on osteoarthritic symptoms, their peri-operative medical management,
the increased intra-operative technical demands on the surgeon,
the intra- and post-operative complications, the long term outcomes
of total hip and knee arthroplasty. Also, there is no consensus
on the role the arthroplasty surgeon should have in facilitating
weight loss for these patients, nor whether obesity should affect
the access to arthroplasty procedures.
Bundled Payments (BP) were a revolutionary new experiment for CMS that tested whether risk sharing for an episode of care would improve quality and reduce costs. The initial success of BP accelerated their growth as evidence by the launch of both mandatory and commercial bundles. Success in BP is dependent on the target price and the opportunity to reduce avoidable costs during the episode of care. There is concern that the aggressive target pricing methodology in the new model (BPCI-Advanced) penalizes high performing groups that already achieved low episode costs through prior experience and investment in BP. We hypothesize that this methodology incorporates unsustainable downward trends on target prices to a point beyond reasonableness for efficient groups to reduce additional costs and will lead to a large percentage of groups opting out of BPCI-A in favor of a return to fee for service (FFS) reimbursement. Using CMS data, we compared the target price factors for hospitals that participated in both BPCI classic (2013 –2018) and BPCI Advanced (beginning 10/2018), referred to as “legacy hospitals”, with hospitals that only participated in BPCI Advanced (beginning 10/2018). With the rebasing of BPCI-A target prices in Jan 2020 and the opportunity for participants to drop out of individual episode types or the program all together, we compared the retention of episode types that hospitals initially enrolled at the onset of BPCI-A with the current enrollment in 2020. Locally, we analyzed the BPCI-A target price factors across hospitals for a large orthopaedic practice that participated in BPCI Classic and the impact it had on the financial incentive/disincentive to remain in the lower extremity joint replacement episode type in 2020.Introduction
Methods
Satisfactory primary wound healing following
total joint replacement is essential. Wound healing problems can
have devastating consequences for patients. Assessment of their healing
capacity is useful in predicting complications. Local factors that
influence wound healing include multiple previous incisions, extensive
scarring, lymphoedema, and poor vascular perfusion. Systemic factors
include diabetes mellitus, inflammatory arthropathy, renal or liver
disease, immune compromise, corticosteroid therapy, smoking, and
poor nutrition. Modifications in the surgical technique are necessary
in selected cases to minimise potential wound complications. Prompt
and systematic intervention is necessary to address any wound healing
problems to reduce the risks of infection and other potential complications. Cite this article:
Abstract. Introduction.
Aims. The purpose of this study was to compare outcomes of combined
Introduction. Mechanical or corrosive failure of total knee arthroplasties (TKAs) is difficult to diagnose with current laboratory and radiographic analyses. As such, the goal of this study was to determine the mean blood concentration of cobalt, chromium, and titanium in a series of revision TKAs with mechanical implant failure and evaluate whether they facilitated identification of the underlying TKA failure mechanism. Methods. Serum cobalt, chromium, and titanium levels and synovial fluid characteristics were evaluated in 12 patients (13 aseptic revision TKAs) who underwent revision TKA between 2000 and 2020 at a single academic institution for mechanical implant failure or corrosion. Seventy-five percent were re-revisions of previously revised TKAs. Mean time to revision was 6 years. Modular metallic junctions were present in 100%. Twenty-five percent did not have another in situ
Background. The evaluation and management of outcomes risk has become an essential element of a modern
Introduction. Vancomycin is a commonly used antibiotic for prophylaxis in
Introduction. Periprosthetic joint infection (PJI) is a devastating complication after