During the pandemic of COVID-19, some patients with COVID-19 may need emergency surgeries. As spine surgeons, it is our responsibility to ensure appropriate treatment to the patients with COVID-19 and spinal diseases. A protocol for spinal surgery and related management on patients with COVID-19 has been reviewed. Patient preparation for emergency surgeries, indications, and contraindications of emergency surgeries, operating room preparation, infection control precautions and personal protective equipments (PPE), anesthesia management, intraoperative procedures, postoperative management, medical waste disposal, and surveillance of healthcare workers were reviewed. It should be safe for surgeons with PPE of protection level 2 to perform spinal surgeries on patients with COVID-19. Standardized and careful surgical procedures should be necessary to reduce the exposure to COVID-19.

Introduction

Fracture around the knee can lead to posttraumatic osteoarthritis (PTOA) of the knee. Malunion, malalignment, intra-articular osseous defects, retained internal fixation devices, and compromised soft tissues may affect the outcome of total knee replacement (TKR). On average, the posttraumatic patient subsets were 10.4 years younger than those for primary knee OA. Recently, there were several studies reporting the outcome of THA for posttraumatic OA hip. However, no current literature defines the comparative functional outcome between PTOA and primary OA knee.

The purpose of our study was to compare the midterm outcomes of patients undergoing TKR following periarticular knee fractures/ligamentous injuries versus primary osteoarthritis (PO) of the knee.

Background

Readmission following any total joint arthroplasty has become a closely watched metric for many hospitals in the United States because financial penalties imposed by CMS for excessive readmissions occurring within thirty days of discharge has occurred since 2015. The purpose of this study was to identify both preoperative comorbidities associated with and postoperative reasons for readmission within thirty days following primary total joint arthroplasty in the lower extremity.

Background

Readmission following any total joint arthroplasty has become a closely watched metric for many hospitals in the United States because financial penalties imposed by CMS for excessive readmissions occurring within thirty days of discharge will be forthcoming in 2015. The purpose of this study was to identify both preoperative comorbidities associated with and postoperative reasons for readmission within thirty days following primary total joint arthroplasty in the lower extremity.

The first 101 posterior cruciate retaining modular tibial components of a single design performed by a single surgeon in 75 patients were evaluated at a minimum 20-year follow-up. All components were fixed with cement. These patients had been prospectively followed at five-year intervals and evaluated clinically using Knee Society ratings and documenting any need for reoperation. Serial radiographs were evaluated for radiolucencies, osteolysis or component migration until the time of patient death or at minimum 20-year follow-up.

At minimum 20-year follow-up, five knees (5%) had required a revision operation. All revisions occurred greater than 10 years following the index procedures. Benefits of modularity (i.e. retention of the tibial tray) were utilized in three of five cases in this closely followed cohort. Survivorship from any revision was 90.8% at 20 years. For the 16 living patients with 22 knees, the average Knee Society Clinical and Functional scores were 91 and 59, respectively, and the average range of motion was 115 degrees.

When considering gamma irradiated in air polyethylene and a first generation locking mechanism were utilized, these results encourage the authors to continue to use modular tibial trays.