Surgical management of acetabular fractures in older patients remains controversial. The purpose of this study is to compare outcomes of primary THA with outcomes after THA for acute acetabular fractures (aTHA) as well as outcomes following delayed THA (dTHA) following prior acetabular fracture. We analyzed data from a large, national administrative claims database containing diagnostic, procedural, and demographic records from over 157 million patients. We identified all patients undergoing primary total hip arthroplasty THA continuously enrolled in the database at least 2 years prior and after the index procedure. Patients with an initial diagnostic code for acetabular fracture occurring the same day as the THA were classified as acute acetabular fractures. Patients with an initial acetabular fracture diagnostic code occurring at least 6 months before THA were classified as chronic acetabular fractures. The comparator group was patients undergoing THA with no history of acetabular fracture. There were 426,734 patients undergoing primary THA, 235 patients undergoing aTHA and 1,255 patients undergoing dTHA. Patients with an aTHA had higher complication rates, including revisions (9.8% vs 5.6%,), dislocations (8.9% vs 6.4%), and periprosthetic fracture (5.1% vs 2.3%) compared to dTHA. After adjusting for age, sex, region, and comorbidities, receiving an aTHA increased the odds of revision (OR = 3.65 [95% CI: 2.30–5.49]), dislocation (OR = 4.09 [95% CI: 2.53–6.27]), and periprosthetic fracture (OR = 4.29 [95% CI: 2.26–7.36]) compared to primary THA. Receiving a dTHA significantly increased the odds of revision (adjusted OR = 1.80 [95% CI: 1.40–2.27]), dislocation (adjusted OR = 2.50 [95% CI: 1.97–3.13]), and periprosthetic fracture (adjusted OR = 1.99 [95% CI: 1.34–2.83]) compared to primary THA. Patients undergoing aTHA in the treatment of an acetabular fracture have significantly increased rates of revision, periprosthetic fracture, and dislocation compared to dTHA and primary THA.
It has been shown that the preoperative modification of risk factors associated with obesity may reduce complications after total knee arthroplasty (TKA). However, the optimal method of doing so remains unclear. The aim of this study was to investigate whether a preoperative Risk Stratification Tool (RST) devised in our institution could reduce unexpected intensive care unit (ICU) transfers and 90-day emergency department (ED) visits, readmissions, and reoperations after TKA in obese patients. We retrospectively reviewed 1,614 consecutive patients undergoing primary unilateral TKA. Their mean age was 65.1 years (17.9 to 87.7) and the mean BMI was 34.2 kg/m2 (SD 7.7). All patients underwent perioperative optimization and monitoring using the RST, which is a validated calculation tool that provides a recommendation for postoperative ICU care or increased nursing support. Patients were divided into three groups: non-obese (BMI < 30 kg/m2, n = 512); obese (BMI 30 kg/m2 to 39.9 kg/m2, n = 748); and morbidly obese (BMI > 40 kg/m2, n = 354). Logistic regression analysis was used to evaluate the outcomes among the groups adjusted for age, sex, smoking, and diabetes.Aims
Methods
Previous research has indicated that preoperative modification of risk factors associated with obesity may reduce complications after TKA. However, the optimal method is still debated. This study aims to investigate whether a preoperative Risk Stratification Tool (RST) devised by our institution to optimize obese patients can reduce unexpected ICU transfers, and 90-day ED visits, readmissions, and reoperations. We retrospectively reviewed 1,724 consecutive risk stratified patients undergoing primary unilateral TKA. The mean age was 64.8 years and average body mass index (BMI) was 34.2 kg/m2. All patients underwent preoperative optimization using the RST. We first compared our primary variables of interest between obese (BMI>30, n=1,189) and non-obese patients (n=535). Patients were then divided into 3 groups (I-non-obese, II-obese (30–39.9 kg/m2) and III-morbidly obese ((>40 kg/m2)) and logistic regression was used to evaluate outcomes among the groups adjusted for age, sex, smoking history and diabetes.Introduction
Methods
The long-term survival of modern ceramic-ceramic bearings in young active patients with osteonecrosis undergoing total hip arthroplasty (THA) is unknown. A previously published study of this series at 5-year follow-up demonstrated an extremely high activity level. The purpose of this study is to examine whether this very high activity level is associated with ceramic-on-ceramic THA failure at long-term follow-up. This is a retrospective review of a single-surgeon at an academic medical center between years 2003–2010. Inclusion criteria were consecutive series of ceramic-on-ceramic articulations in patients younger than 50 with a diagnosis of osteonecrosis. Median follow-up was 12.4 years (range 10–17). Data was collected via mail, telephone, and e-mail surveys. Exclusion criteria included deceased prior to follow-up. Preoperative and postoperative Western Ontario and McMaster University Arthritis Index (WOMAC) and University of California at Los Angeles Activity scores (UCLA) were collected. Student t-tests were used as appropriate.Introduction
Methods
Rates of readmission and reoperation following primary total knee arthroplasty (TKA) are under scrutiny due to new payment models, which penalize these negative outcomes. Some risk factors are more modifiable than others, and some conditions considered modifiable such as obesity may not be as modifiable in the setting of advanced arthritis as many propose. We sought to determine whether controlling for hypoalbuminaemia would mitigate the effect that prior authors had identified in patients with obesity. We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the period of January 2008 to December 2016 to evaluate the rates of reoperation and readmission within 30 days following primary TKA. Multivariate logistic regression modelling controlled for preoperative albumin, age, sex, and comorbidity status.Aims
Methods
The obesity epidemic is a growing problem and must be considered with the projected increased demand for total hip arthroplasty (THA). Previous studies have reported increased complication rates after THA in the obese population, which has led to hesitation in offering surgery to this population. Moreover, some insurers are denying coverage for morbidly obese patients. While many consider obesity a “modifiable” risk factor, very few patients with advanced osteoarthritis have successfully lost substantial weight. The experience of centers that utilize systematic preoperative risk stratification tools and standardized postoperative total joint pathways may be underrepresented in prior studies. The aim of this study is to describe one surgeon's experience performing THA in morbidly and super-obese patient populations using an institutional preoperative Risk Stratification Tool (RST) and total joints pathway. We conducted a retrospective review of patients undergoing primary THA between May 2014 and December 2017 performed by a single surgeon at a tertiary care referral center. All patients were assessed preoperatively using an institutional RST and had a minimum of 90-day postoperative follow up. Patients were stratified by body mass index (BMI, kg/m2): non-obese (BMI < 30), obese (30–34), severely obese (35–39), morbidly obese (40–44), and super-obese (≥ 45). Primary outcomes were inpatient and 90-day complications. Continuous and binary parameters were analyzed by Kruskal-Wallis and Fisher exact tests. Logistic regression was additionally utilized to evaluate outcomes by BMI cohort.Introduction
Methods
Rates of readmission and reoperation following primary total knee arthroplasty (TKA) are under scrutiny due to new payment models, which penalize these negative outcomes. Many prior studies have demonstrated the risk of perioperative complications among patients with obesity. However, an elevated complication rate among patients with poor nutrition, as measured by hypoalbuminemia, has also been reported. We sought to determine whether controlling for hypoalbuminemia would mitigate the effect that prior authors had identified in patients with obesity. In addition, we hoped to identify an albumin threshold above which risk of readmission and reoperation would be minimized. We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the period of 2008–2016 to evaluate the rates of perioperative complications among primary TKA patients by obesity category and albumin level. Patients were divided into groups according to World Health Organization obesity category and continuous as well as dichotomous albumin level. The primary outcomes were readmission and reoperation within 30 days of surgery. Patients without BMI or albumin data were excluded, as were patients undergoing surgery for the treatment of fracture or bone tumor. Univariate logistic regression compared predictive value of body mass index and albumin on incidence of these outcomes, using the normal weight and albumin > 3.5 g/dL groups as controls. Multivariate logistic regression modeling controlled for age, gender, and comorbidity status. Receiver operator curves (ROC) were generated to determine if an albumin threshold could be determined, above which risk for these complications would be minimized.Introduction
Materials and Methods
Adductor canal block (ACB) has emerged as an alternative to femoral nerve block (FNB) for analgesia after total knee arthroplasty (TKA). The optimal duration of maintenance of the ACB is still questionable. The purpose of this study was to compare the analgesic benefits and physiotherapy (PT) outcomes of single-shot ACB to two different regimens of infusion of the continuous ACB, 24-hour and 48-hour infusion. This was a prospective, randomized, unblinded study. A total of 159 American Society of Anesthesiologists (ASA) physical status I to III patients scheduled for primary TKA were randomized to one of three study groups. Three patients did not complete the study, leaving 156 patients for final analysis. Group A (n = 53) was the single-shot group (16 female patients and 37 male patients with a mean age of 63.9 years (Aims
Patients and Methods
