Aims. Nonagenarians (aged 90 to 99 years) have experienced the fastest percent decile population growth in the USA recently, with a consequent increase in the prevalence of nonagenarians living with joint arthroplasties. As such, the number of revision total hip arthroplasties (THAs) and
A substantial fraction of patients undergoing knee arthroplasty (KA) or hip arthroplasty (HA) do not achieve an improvement as high as the minimal clinically important difference (MCID), i.e. do not achieve a meaningful improvement. Using three patient-reported outcome measures (PROMs), our aim was: 1) to assess machine learning (ML), the simple pre-surgery PROM score, and logistic-regression (LR)-derived performance in their prediction of whether patients undergoing HA or KA achieve an improvement as high or higher than a calculated MCID; and 2) to test whether ML is able to outperform LR or pre-surgery PROM scores in predictive performance. MCIDs were derived using the change difference method in a sample of 1,843 HA and 1,546 KA patients. An artificial neural network, a gradient boosting machine, least absolute shrinkage and selection operator (LASSO) regression, ridge regression, elastic net, random forest, LR, and pre-surgery PROM scores were applied to predict MCID for the following PROMs: EuroQol five-dimension, five-level questionnaire (EQ-5D-5L), EQ visual analogue scale (EQ-VAS), Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS), and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS).Aims
Methods
While preoperative bloodwork is routinely ordered, its value in determining which patients are at risk of postoperative readmission following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is unclear. The objective of this study was to determine which routinely ordered preoperative blood markers have the strongest association with acute hospital readmission for patients undergoing elective TKA and THA. Two population-based retrospective cohorts were assembled for all adult primary elective TKA (n = 137,969) and THA (n = 78,532) patients between 2011 to 2018 across 678 North American hospitals using the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) registry. Six routinely ordered preoperative blood markers - albumin, haematocrit, platelet count, white blood cell count (WBC), estimated glomerular filtration rate (eGFR), and sodium level - were queried. The association between preoperative blood marker values and all-cause readmission within 30 days of surgery was compared using univariable analysis and multivariable logistic regression adjusted for relevant patient and treatment factors.Aims
Methods
The enhanced recovery after surgery (ERAS) concept in arthroplasty surgery has led to a reduction in postoperative length of stay in recent years. Patients with prolonged length of stay (PLOS) add to the burden of a strained NHS. Our aim was to identify the main reasons. A PLOS was arbitrarily defined as an inpatient hospital stay of four days or longer from admission date. A total of 2,000 consecutive arthroplasty patients between September 2017 and July 2018 were reviewed. Of these, 1,878 patients were included after exclusion criteria were applied. Notes for 524 PLOS patients were audited to determine predominant reasons for PLOS.Introduction
Methods
The aim of this study was to determine the prevalence and characteristics of C-reactive protein (CRP)-negative prosthetic joint infection (PJI) and evaluate the influence of the type of infecting organism on the CRP level. A retrospective analysis of all PJIs affecting the hip or knee that were diagnosed in our institution between March 2013 and December 2016 was performed. A total of 215 patients were included. Their mean age was 71 years (Aims
Patients and Methods
Valgus knee deformity can present a number of
unique surgical challenges for the total knee arthroplasty (TKA)
surgeon. Understanding the typical patterns of bone and soft-tissue pathology
in the valgus arthritic knee is critical for appropriate surgical
planning. This review aims to provide the knee arthroplasty surgeon
with an understanding of surgical management strategies for the
treatment of valgus knee arthritis. Lateral femoral and tibial deficiencies, contracted lateral soft
tissues, attenuated medial soft tissues, and multiplanar deformities
may all be present in the valgus arthritic knee. A number of classifications
have been reported in order to guide surgical management, and a variety
of surgical strategies have been described with satisfactory clinical
results. Depending on the severity of the deformity, a variety of
TKA implant designs may be appropriate for use. Regardless of an operating surgeon’s preferred surgical strategy,
adherence to a step-wise approach to deformity correction is advised. Cite this article:
There is evidence that high levels of physical
activity following arthroplasty of the hip or knee can lead to early revision.
However, the term ‘highly active’ is not well defined. A validated ankle accelerometer was used to quantify activity
in 13 patients, who had undergone a total of 20 arthroplasties of
the lower limbs and who had active lifestyles. The assessments were
taken at a mean of 8.7 years post-operatively (1.8 to 15.8). The mean gait cycles per day was 8273 (5964 to 12 557), which
extrapolates to 3.0 million cycles per year (cpy) (2.2 to 4.6).
The mean percentage of time spent in high activity mode was 4.3%,
or about one hour per day. The mean percentage of cycles in high
activity was 40%. Based on these data, we propose the following definitions of
high activity: >
3 million cpy; one hour per day in high activity
mode; 40% of cycles in high activity mode. Extrapolating the sample of activity over the time since operation,
the mean cycles per arthroplasty was 25.2 million, with a maximum
of 44.1 million. No joint has been revised, or shows evidence of
impending failure. Cite this article:
