Arthroplasty today
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Accurate sizing is critical for the overall success of a total knee arthroplasty (TKA). This study's primary purpose was to investigate the ability to predict the tibial and femoral component size in a single implant system from patient demographics and anthropometric data. A secondary goal was to compare the predicted tibial and femoral component sizes from our statistical model with a previously validated electronic application used to predict the implant size. ⋯ Our novel templating model may improve operative efficiency for a single TKA system. Our findings have a high concordance with a widely available electronic application used to predict implant sizes for a variety of TKA systems.
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The impact of femoral nerve blocks (FNBs) during primary total knee arthroplasty (TKA) on clinical outcomes and pain management remains unclear. The present research investigates the impact that continuous and single-shot FNBs during TKA have on postoperative opioid claims and short-term clinical outcomes. ⋯ FNBs during TKA place patients at a significantly higher risk of falls, readmissions, and systemic complications in the short term. The risk of readmission and systemic complications was higher for continuous FNBs. More patients without FNBs filed opioid claims postoperatively than patients who received FNBs.
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Over 1 million total joint arthroplasties (TJAs) are performed every year in the United States, creating Medicare cost concerns for policy makers. The purpose of this study is to evaluate recent trends in Medicare utilization and reimbursements to hospitals/surgeons for TJAs between 2012 and 2017. ⋯ Despite increasing TJA volume and utilization, surgeon reimbursements have continued to decline, whereas hospital payments and hospital charges have increased significantly more than surgeon charges. Cost containment efforts will need to address other expenditures such as hospital costs and implant costs to better align financial risks and incentives for TJA surgeons.
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Variables considered by hip and knee arthroplasty fellowship program directors (PDs) to select fellowship candidates are not well known. ⋯ According to hip and knee arthroplasty fellowship PDs, the interview, letters of recommendation, and personal connections to the applicant and/or letter writers are the most important factors considered in selecting arthroplasty fellowship candidates.
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Case Reports
Late Onset Metallosis after Revision Total Knee Arthroplasty with Metal-Backed Patellar Component In Situ.
We describe a small case series with severe metallosis after revision total knee arthroplasty (TKA) due to metal-backed patellar component failure. Metallosis is a rare complication after TKA, which may cause systemic and local symptoms. ⋯ Based on these cases, we recommend performing regular checkups in case of a metal-backed patellar component to detect metallosis in an early stage, to prevent extensive revision surgery. Moreover, we recommend applying a low threshold to revise a metal-backed patellar component because of the severe consequences of metallosis that might occur.