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
Demand for total hip arthroplasty (THA) continues to rise and as such there is a concurrent presumed increase in the incidence of periprosthetic femoral fractures. Several studies have previously demonstrated differences in fixation technique and biomechanical advantages of various cerclage constructs in fixation of femoral periprosthetic fractures. The purpose of this study is to determine the most effective combination of cerclage materials and technique in fixation of of periprosthetic fractures during cementless THA. Thirty fourth generation synthetic femora were tested in axial compression and torsion. Femurs were placed in a standardized mount and a press fit hip prosthesis was implanted by one senior surgeon. After broaching but prior to implant placement, a band saw was used to create a Vancouver B1 fracture below the level of the lesser trochanter. The implant was then placed in the femur. Four different cerclage constructs were then created using two of the following: 1) hose clamp, 2) metallic cable, 3) synthetic cable, 4) monofilament wire. All cables were placed using tensioning devices to standardize final cerclage tension. Additional constructs were created increasing the number of cerclage cables/wires to three and then four, evenly spaced across the implant. Axial compression and torsion were assessed to failure for all constructs using standard Instrom testing criteria. Cost analysis was performed for each construct.Introduction:
Methods:
Starting February 2012, our institution changed from enoxaparin (Lovenox) to the Factor Xa inhibitor, rivaroxaban (Xarelto) for venous thromboembolism prophylaxis after primary total hip (THA) and total knee arthroplasty (TKA). The purpose of our study was to compare rates of venous thromboembolism and rates of major bleeding between these two medications when used for venous thromboembolism prophylaxis after primary THA and TKA. A retrospective review was performed on 1795 patients who underwent THA or TKA at our institution between January 1, 2011 and December 31, 2012. Patients were excluded if they had a bilateral procedure, partial arthroplasty (hip hemiarthroplasty, unicompartmental knee arthroplasty), revision surgery, and cases designated as complex. Patients were excluded if they were on other anticoagulants (dabigatran, aspirin, clopidogrel, warfarin, heparin, fondaparinux), or if pre-operative creatinine was 1.2 or greater. After excluding these patients, there were 1089 patients included in the study. Chart review recorded demographics (age, gender), comorbidities (BMI, ASA, creatinine), surgery performed (primary THA or TKA), length of stay (LOS), venous thromboembolic events (deep venous thrombosis [DVT], pulmonary embolus [PE]), post-operative infections, and major bleeding events (stroke, post-operative bleeding requiring transfusion). Periprosthetic infection rates are also currently being reviewed. T-tests were used to compare continuous variables between treatment groups, and Chi-square tests were used to compare categorical variables between treatment groups (α = 0.05).Purpose:
Methods:
