Obesity is associated with worse outcomes following total knee/hip arthroplasty (TKA/TKA). This study aimed to determine the feasibility of a dietitian-led low-inflammatory weight-loss program for people with obesity awaiting arthroplasty. Quasi-experimental pilot study enrolled people with obesity waitlisted for primary TKA/THA into ‘usual care’ (UC) or weight-loss (low-inflammatory diet) program (Diet). Recruitment occurred between July 2019 and February 2020 at Fairfield and Campbelltown Hospitals. Assessments at baseline, pre-surgery, time of surgery and 90-days following surgery included anthropometric measurements, patient-reported outcomes, serum biomarkers and 90-day postoperative complication rate. 97 people consented to the study (UC, n=47, mean age 67, BMI 37, TKA 79%; Diet, n=50, mean age 66, BMI 36, TKA 72%). Baseline characteristics indicated gross joint impairments and poor compliance with a low-inflammatory diet. Study feasibility criteria included recruitment rate (52%), proportion of diet patients that improved compliance to low-inflammatory diet by ≥10% (57%) and had ≥60% attendance of dietitian consultations (72%), proportion of patients who undertook serum biomarkers (55%). By presurgery assessments, the diet group had more patients who cancelled their surgery due to symptom improvement (4 vs 0), reduced waist-circumference measurements, increased compliance with the Low-Inflammatory diet and preservation of physical activity parameters. More usual care participants experienced at least one postoperative complication to 90-days (59% vs 47%) and were discharged to inpatient rehabilitation (21% vs 11%). There was no difference in weight change, physical function, and patient-reported outcome measures from pre-surgery to 90-days post-surgery, and length of hospital stay. Using pre-determined feasibility criteria, conducting a definitive trial is not feasible. However, intervention audit demonstrated high intervention fidelity. Pilot data suggest our program may promote weight loss but the clinical effects for most are modest. Further research utilising a stronger intervention may be required to assess the effectiveness of a pre-arthroplasty weight-loss intervention

Introduction. Provision of prehabilitation prior to total knee arthroplasty (TKA) through a digital mobile application is a novel concept. The primary aim of our research is to determine whether provision of prehabilitation through a mobile digital application impacts length of stay (LOS), requirement for inpatient rehabilitation and hospital-associated costs after TKA. Our study hypothesis is that a mobile digital application provides a low resource, cost effective method of delivering prehabilitation prior to TKA. Methods. An observational, retrospective analysis was performed on a consecutive case series of 64 patients who underwent TKA by a single surgeon over a 21-month period. Pre operative Knee Osteoarthritis Outcome Score (KOOS) Patient Reported Outcome Measures (PROMs) were collected on all patients. The first group of patients (control) did not undergo prehabilitation, the subsequent group of patients (experimental) were offered prehabilitation through a mobile application called PhysiTrack. The experimental group were provided with progressive quadriceps and hamstring strengthening exercises, and calf and hamstring stretches. Exercises were automatically progressed after 2 weeks unless the patient requested otherwise or a physiotherapist clinically intervened. The non-compliance rate was 33% (n=11), after removing these patients from the analysis, 22 patients remained and these were age matched to 22 patients from the control group. Aside from the access to prehabilitation, all patients underwent TKA using identical surgical technique and peri-operative care regime. Length of stay data for inpatient care and rehabilitation were captured for all patients. Cost was calculated using the inpatient and rehabilitation costs provided by the hospital. Results. 44 patients were included in our final analysis. Pre operative KOOS were collected for all of the experimental group and 18 (81%) of control group. These subscores were not statistically different (p>0.05) reflecting pre operative equivalence. The average inpatient length of stay was statistically different, being 5.04 days for the control group and 4.31 days for the experimental group (p=0.01). The decision for ongoing inpatient rehabilitation (after the immediate post-operative inpatient period) was not statistically different between the groups (chi-quared p=0.07). Rehabilitation length of stay was 9.12 days in the experimental and 10.85 days in the control group (p = 0.25). The remaining outcomes were statistically significant with total length of stay 11.95 days in the control and 7.63 days in the experimental group (p=0.01) and the total cost of the hospital stay $6362.55AUD for the control and $4145.17AUD for the experimental group (p=0.01). This represents an average saving $2217.38 per patient who participated in prehabiliation prior to surgery. Conclusions. Our research shows a significant cost saving with this intervention, as measured by reduction in total length of stay in patients undergoing prehabilitation using PhysiTrack. To our knowledge, this is the first study that analyses the impact of a mobile application providing prehabilitation prior to TKA. Further work is required to determine the effect in a larger, randomised cohort of patients. Future studies should also be directed towards assessing the utility of digital prehabilitation on a per patient basis prior to total knee arthroplasty

Purpose. To update recent findings about the relationship between obesity and post-operative outcome including acetabular cup positioning, complications, readmissions and revision rates, and also inpatient rehabilitation outcome following total hip arthroplasty. Methods. A literature review was done using standard keyword search. Articles were scrutinized by the investigators to ensure relevancy to the purpose of this review. Summary of the review. As the number of all obese(body mass index(BMI) >30) are rising, the development of hip osteoarthritis and the need for total hip arthroplasty(THA) increased. Recent studies found that high BMI was the most significant risk factor contributed to acetabular cup malpositioning following THA. Obesity was found to be a predicting factor for 30-day readmission due to complications include wound infections and thromboembolism after THA. A meta-analysis had shown increased rates of aseptic loosening, dislocation and infection in obese patients thus resulted in higher revision rates compared to nonobese patients but the increase was not found to be statistically significant. Obese patients can make functional improvements during inpatient rehabilitation but at slow progress and higher cost. Conclusion. Based on the current literature, obesity may have a negative impact on the outcome of THA. It appeared that as BMI increases, obesity was related with the risk of postoperative complications, and affected outcomes after total hip arthroplasty. Therefore, this needs to be informed to every patient prior to considering total hip arthroplasty

BACKGROUND. This study aims to identify recent trends in discharge disposition following bilateral total knee arthroplasty (TKA) as well as factors that predispose patients to enter inpatient rehabilitation facilities (IRF) or skilled nursing facilities (SNF) versus home-rehabilitation (HR). The goal was to identify risk factors that predispose prolonged hospital stays and identify changes in management over time that may be responsible for decreased length of stay (LOS) and a HR program. METHODS. A retrospective cohort study design was used to collect and analyze clinical and demographic data for 404 consecutive bilateral primary total knee arthroplasty (TKA) procedures. Patients who underwent elective primary bilateral total knee arthroplasty from 2011 to 2016 were identified from hospital records at a single institution. Clinical and demographic data including sex, age, and disposition were analyzed. RESULTS. 404 bilateral TKAs were performed by 17 surgeons at a single institution from 2011 to 2016. The average age for bilateral TKA was 63y (31.4–86.6) and 59% were females (239/404). From 2011 to 2016, an increase of 61% (10% to 71%) was noted with regards to home discharge (22.035, <0.001), as well as an increase in the ratio of males being discharged home vs IRF/SNF (1.04 vs 2.4; 2.304, 0.008). Univariate analysis for factors associated with home discharge showed significance for age <60y (3.781, <0.001), age >70 (0.118, 0.001), the use of TXA (3.52, <0.001), type of implant (6.055, <0.001), low postoperative Hg (0.333, <0.001), and yearly trend (Pearson: 0.322, <0.001). Factors associated with prolonged LOS included age <60y (0.641, 0.029), age >70 (1.723, 0.032), active cancer (0.256, 0.027), low postoperative Hg (1.674, 0.020), and postoperative transfusion (1.667, 0.015). Multivariate regression for factors associated with a home discharge showed aggregate significance for BMI <25 (0.886, 0.024), use of TXA (1.139, <0.001), type of implant (1.310, 0.008), age <60 (0.956, 0.004), and age >70 (−1.627, 0.036). Multivariate logistic regression for factors associated with a prolonged LOS showed aggregate significance for active cancer (−1.654, 0.015), postoperative transfusion (0.485, 0.023), and age >70 (0.600, 0.024). CONCLUSION. There has been a significant trend towards postoperative home-rehabilitation programs rather than inpatient rehabilitation following bilateral total knee arthroplasty. There has also been a trend towards an increasing age for those undergoing bilateral total knee arthroplasty. Factors predisposing patients towards non-home discharge disposition include increased age and female gender. The increased use of both TXA and patient specific implants has led to a decrease in operative time and postoperative transfusion rates, and thus a decrease in the overall length of inpatient hospital stay

Objectives. The goal of this study was to describe and evaluate the implementation of a tailored care pathway as an alternative to a standard joint care protocol in the postoperative in-hospital rehabilitation after total knee replacement (TKR) on clinically relevant outcome parameters. Methods. We monitored an orthopaedic department regarding postoperative rehabilitation after TKR on several outcome parameters throughout a period of 32 months, whilst introducing a new care pathway after 17 months. Outcome parameters were monitored and comprised: Time to get functionally recovered (in days), length of stay (in days) and destination of discharge. Key-differences between the joint care protocol and the new tailored pathway were: 1. determination of individual short term rehabilitation goals on the basis of a preoperative clinical prediction rule and postoperative monitoring of functional recovery, 2. Enhancement of expertise of and collaboration between health care professionals and 3. implementation of fast track rehabilitation. We compared the patients operated after implementation of the tailored care pathway with those who were treated according to the joint care protocol. Regression analysis was used to estimate differences between the two groups of patients while correcting for baseline differences in risk profile between the groups. Results. Introduction of the tailored care pathway decreased the length of stay on average from 5.2 days to 4.2 days, (p< 0.01). In addition, there was a 7% non-statistically significant reduction in the number of patients who required inpatient rehabilitation after hospital discharge. Conclusion. Introduction of the tailored care pathway reduced the mean length of stay by one day, whilst patient safety and satisfaction remained unaltered