Social determinants of health (SDOH) may contribute markedly to the total cost of care (COC) for patients undergoing elective total knee arthroplasty (TKA). This study investigated the association between demographics, health status, and SDOH on lengths of stay (LOS) and 30-day COC. Patients who underwent TKA between January 2018 and December 2019 were identified. Those who had complete SDOH data were utilized, leaving 234 patients. Data elements were drawn from the Chesapeake Regional Information System, the Center for Disease Control social vulnerability index (SVI), the Food Access Research Atlas (FARA). The SVI identifies areas vulnerable to catastrophic events, with 4 themed scores including: (1) socioeconomic status; (2) household composition and disability; (3) minority status and language; and (4) housing and transportation. Food deserts were defined as neighborhoods located 1 or 10 miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine an association with LOS and cost, after controlling for demographics.Introduction
Methods
Revision total knee arthroplasty (rTKA) is a complex procedure with increased risk of blood loss and transfusions. The Musculoskeletal Infection Society has included D-dimer as a serology marker for peri-prosthetic infection. The study's intent is to understand the impact of preoperative D-dimer levels on blood loss and venous thromboembolism in revision TKA. Following IRB approval, rTKA performed by a single surgeon between January 1, 2017 and December 31, 2019 were reviewed. Inclusion criteria consisted of pre-operative D-Dimer, cemented revision TKA of one or both components under tourniquet control. 89 patients met the criteria including 37 males (41.6%) and 52 females (58.4%). Mean ages were 65 for males and 67 for females. The data revealed 54 patients (61%) had an elevated D-dimer (group 1) and 35 patients (39%) had a normal D-dimer (group 2). Sex stratification showed 21 males (57.8%) and 33 females (63.5%) with elevated D-dimer. TXA protocol included 2 grams intravenous (82 patients) or 2 grams intra-articular application (7 patients). Post-operative anticoagulation included Lovenox 40mg daily for 2 weeks followed by aspirin 325 twice daily for 4 weeks. Pre-operative and post-operative hemoglobin, transfusion rates and post-operative VTE within 90 days of surgery were recorded.Background
Methods
As the number of total knee arthroplasties (TKA) being performed continues to increase, the number of potential failures requiring revision surgery would also be expected to increase. This study analyzed the trends in revision TKA (rTKA) from 2009 to 2016. The Nationwide Inpatient Sample (NIS) database was used to identify all rTKA by International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. The diagnoses leading to revision, revision costs, patient and hospital characteristics, and major inpatient complications were compared between 2009 and 2016. Multivariate logistic regression analyses were used to calculate odds ratios (OR) for complications.Background
Methods
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 total joint arthroplasty population, portals may also offer online physical therapy, allowing TJA patients to reach functional goals while reducing costs. Although technology may offer the potential of an enhanced recovery experience, disparities may exist between the comfort level of use and communication preferences of different patient populations. Our study aimed to analyze the utilization of an internet based patient portal, and quantify the impact of usage on patient reported outcome measures. 4,458 patients who underwent TJA across 8 major academic centers within one healthcare system were analyzed. Patients who scheduled surgery were registered for the online portal by the surgical coordinator. Upon registration, patients opt-in by signing a license agreement, and data is collected on their utilization of the portal including logins, exercise and educational videos watched, messages sent and PROs completed. Age was compared to utilization, opt-in rates, total videos watched, and messages sent. Two separate patient cohorts were identified to distinguish between active and non-active users. Anyone who opted-in and viewed over 5 preoperative videos or had at least 5 preoperative logins were considered active users. Patients’ postoperative KOOS-JR and HOOS-JR score improvements from baseline were compared between the active vs. non-active groups.Introduction
Methods
At a time when many surgeons are reluctant to perform a unilateral TKA in the obese patient, little is written on the safety and efficacy of bilateral simultaneous TKA in this same patient population. While these potential benefits are attractive to patients, surgeons may be hesitant to perform bilateral TKA due to the greater physical demand placed on the patient, and a potential increase in postoperative complication. The primary aim of this study was to analyze the impact of obesity on clinical outcomes and complication rates of patients undergoing bilateral TKA under one anesthetic. The clinical outcomes of 133 patients (266 knees) who underwent bilateral TKA between 2013 and 2016 were reviewed. The procedures were performed by three separate surgeons across three major academic institutions. ASA scores, tourniquet time, operative time, blood loss, length of stay, readmission, and postoperative complications were compared between different BMI categories of less than 30 kg/ m2, 30–34.99 kg/ m2, 35–39.99 kg/ m2and above 40 kg/ m2Introduction
Materials and Methods
Previously, fluoroscopy has been used to determine the in vivo kinematics during gait, step-up maneuvers and flexion to nine tydegrees. Recently, TKAs have been designed for deep flexion maneuvers. Therefore, the objective of this study is to determine the in vivo kinematics for subjects implanted with either a fixed or mobile bearing deep flexion TKA from full extension to maximum knee flexion Three-dimensional femorotibial contact positions for thirty-nine subjects, implanted by two surgeons, were evaluated using fluoroscopy into deep flexion. Nineteen subjects had a fixed bearing PS deep flexion TKA and 20 subjects were implanted with a mobile bearing deep flexion TKA. Both TKA designs have similar design features, including condylar geometries. Seventeen of nineteen subjects implanted with a fixed bearing deep flexion TKA experienced posterior femoral rollback, while all 20subjects having a mobile bearing deep flexion TKA experienced poster iorfemoral rollback. On average, subjects experienced -5.1 and -8.1 mm of posterior femoral rollback, for the fixed and mobile bearing TKA, respectively. The maximum amount of posterior femoral rollback was -11.8 and -12.4 mm for subjects having a fixed and mobile bearing TKA, respectively. On average, subjects experienced 6.5 and 5.4 degrees of normal axial rotation for a fixed and mobile bearing TKA, respectively. The average amount of weight-bearing range of motion was 116 and 125 degrees for a fixed and mobile bearing TKA, respectively. Also, subjects having both TKA types evaluated in this study experienced excellent patellofemoral kinematics This is the first study to evaluate femorotibial and patellofemoral knee kinematics into deep flexion for a fixed and mobile bearing TKA, designed for deep flex-ion activities. Both groups in this study experienced, on average and subject-to-subject comparison, excellent kinematic patterns. Also, both TKA types evaluated in this study achieved excellent weight-bearing range-of-motion, supporting the design goal for these TKA.
Few controversies in total knee arthroplasty have persisted for as long as the debate over the appropriate role of the posterior cruciate ligament. Excellent long-term results have been obtained with a posterior cruciate substituting design in which the tibial post and femoral cam function as a mechanical PCL. The constraint created by conforming surfaces and the spine-cam mechanism has not lead to increased loosening or polyethylene wear. Important new information in the area of biomechanics, histology, gait analysis, kinematics and clinical results have strengthened the belief that a posterior cruciate substituting design is the implant of choice for most primary and revision total knee arthroplasties.
