Total knee arthroplasty is very successful although the clinical assessment and rated outcome does not always match the patients reported satisfaction. One reason for patient dissatisfaction is less than desired range of motion. Poor postoperative motion inhibits many functional activities and may create a perception of dysfunction. Early in the postoperative period when patients are having trouble regaining motion (usually 6–8 weeks), manipulation under anesthesia can be used to advance range of motion by manually lysing adhesions. Comorbidities have been used as predictors for outcome in total knee arthroplasty in population health studies. Likewise, predicting which patients are most susceptible to early postoperative stiffness/manipulation would be valuable for patient education and to predict outcome. Prospectively collected data was retrieved from the hospital's MARCQI database (Michigan Arthroplasty Collaborative Quality Initiative) for the years 2014–2018. There were 3098 primary total knees performed during the study period and 139 manipulations (4.44%). The registry specifically abstracts patients’ preoperative comorbidities, operative data, and 90-day postoperative complications.Introduction
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Total knee prostheses are continually being redesigned to improve performance, longevity and closer mimic kinematics of the native knee. Despite continued improvements, all knee implants even those with proven design features, have failures. We identified a cohort of patients with isolated tibial component failures that occurred in a popular and successful knee system. Our purpose was to (1) characterize the observed radiographic failure pattern; (2) investigate the biologic response that may contribute to the failure; and (3) to determine if the failure mechanism was of a biological or a mechanical nature. Twenty-one knees from 19 patients met the inclusion criteria of having isolated tibial component failure in a commonly used knee implant system. Radiographs from the primary and revision knee surgery were analyzed for implant positioning and failure pattern, respectively. Inflammatory biomarkers IL-1β, IL-6 and TNF-α were available in 16/21 knees and peripheral CD14+/16+ monocytes were measured in 10 of the above mentioned 16 knee revisions. Additionally, white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were measured to rule out infection as the cause of the cytokine upregulation.Background
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Alternative payment models, such as bundled payments, aim to control rising costs for total knee (TKA) and total hip arthroplasty (THA). Without risk adjustment for patients who may utilize more resources, concerns exist about patient selection and access to care. The purpose of this study was to determine whether lower socioeconomic status (SES) was associated with increased resource utilization following TKA and THA. Using the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database, we reviewed a consecutive series of 4,168 primary TKA and THA patients over a 3-year period. We defined lowest SES based upon the median household income of the patient's ZIP code. An Introduction
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Few studies have been reported focusing on developing implant surface nanofiber (NF) coating to prevent infection and enhance osseointegration by local drug release. In this study, coaxial doxycycline (Doxy)-doped polycaprolactone/polyvinyl alcohol (PCL/PVA) NFs were directly deposited on the titanium (Ti) implant surface during electrospinning. The bonding strength of Doxy-doped NF coating on Ti implants was confirmed by a stand single-pass scratch test. The improved implant osseointegration by PCL/PVA NF coatings in vivo was confirmed by scanning electron microscopy, histomorphometry and micro computed tomography at 2, 4 and 8 weeks after implantation. The bone contact surface (%) changes of NF coating group (80%) is significantly higher than that of no NF group (< 5%, p<0.05). Finally, we demonstrated that Doxy-doped NF coating effectively inhibited bacterial infection and enhanced osseointegration in an infected (
The ability to identify those at risk for longer inpatient stay helps providers with postoperative planning and patient expectations. Decreasing length of stay in the future will be determined by appropriate patient selection, risk stratification, and pre-operative patient optimization. The purpose of this study was to identify factors that place patients at risk for extended postoperative lengths of stay. The prospective study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty (THA) patients. Patient comorbidities were prospectively identified and the length of stay for each patient was tracked following a primary arthroplasty. Statistical analysis was performed to correlate which comorbidities were associated with longer inpatient stays.Background
Methods
A pulmonary embolus (PE) occurs frequently in medical patients and acutely in post surgical total joint patients. While the two groups seem vastly different, there has never been an analysis of the location, number of emboli a patient has and size of the emboli in post-operative total joint arthroplasty patients compared to general medical patients. Studies have looked at the size of PEs relative to symptomatic patients; recent data have suggested the timeline of PE development is usually within the first few days after total knee arthroplasty (TKA) or total hip arthroplasty (THA). We conducted a retrospective chart review at Providence Hospital from 2006 to 2011 of all THA and TKA patients who had a post-operative PE diagnosis and looked at their medical comorbidities, sex, age, procedure, post-operative day of PE, and size/location of PE using a novel pulmonary mapping tree database based on location of the PE on spiral computed tomography (CT). The same data, except for post-operative day, was collected for the medical population with a PE diagnosis. Size was defined based on level of blockage with small emboli occurring at different points within a lobe, medium being at the level of lobe, and large being either a saddle embolus or at the right or left pulmonary artery. Inclusion criteria for orthopaedic patients included THA or TKA performed prior to PE, PE within 1 month of surgery and CT confirming diagnosis of a PE. Medical patients meeting criteria had to have an admitting diagnosis of PE with CT confirmation of the PE. Exclusion criteria included V/Q scan alone to diagnose the PE.Introduction:
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