Clinics in geriatric medicine
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The number of primary and revision total joint arthroplasty procedures is increasing exponentially with time. It is anticipated that there will be a huge expected demand for revision knee surgery over the next 2 decades. ⋯ Unless the surgeon accurately identifies the mode of failure, successful treatment becomes very unlikely; an increasing physical burden on the patient and financial burden on hospital trusts ensues. In comparison with primary joint arthroplasty, complication rates after revision surgery are significantly increased, and outcome is less assured.
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Clin. Geriatr. Med. · Aug 2012
ReviewHealth-related quality of life after total joint arthroplasty: a scoping review.
A scoping review was completed to summarize the change in health status after THA and TKA. Although a recent study has performed a systematic review of functional recovery after THA,(61) we reviewed a broad topic of HRQL changes after total joint arthroplasty. This scoping review was not restricted by study design; however, the majority of studies were prospective single group, observational studies so that change over time could be reported. ⋯ Because a number of HRQL measures are used to evaluate the outcomes after total joint arthroplasties, comparisons can be challenging. This review summarized published findings to help place the magnitude of change seen with total joint arthroplasty in perspective. Changes seen with HRQL are one aspect of evaluating outcomes from a patient perspective; however, recovery is a complex concept(64) that needs many clinical and research-oriented measures to evaluate the full spectrum of recovery.
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Clin. Geriatr. Med. · Aug 2012
ReviewMinimally invasive total hip and knee arthroplasty-implications for the elderly patient.
Overall, it can be concluded that because of the aging society, an increasing number of elderly people will be undergoing total joint arthroplasty. These elderly patients have an increased risk for serious complications after primary THA or TKA. However, the overall complication rates remain low. ⋯ MIS total joint arthroplasty aims at decreasing the surgical incision and minimizing damage to the underlying soft tissue to accelerate postoperative recovery and an earlier return to normal function. A critical look at the literature on MIS shows that the term minimally invasive is often used for a conventional total joint arthroplasty performed through a smaller skin incision. Research has shown promising results of using MIS in elderly patients; it seems that compared with younger patients, elderly patients benefit more from a minimally invasive approach.
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Patient satisfaction is an important outcome measurement in TKA/THA surgery. Patient satisfaction can be evaluated from 2 perspectives, determinants of satisfaction and components of satisfaction.(5) In total joint arthroplasty, improvements in satisfaction can be achieved by examining these perspectives. Patient satisfaction is one of the many PROMs used in orthopedic surgery and is an integral part of the growing sentiment to evaluate surgery from the patient's perspective as well as from the surgeon's. The importance of measuring outcomes from the patient perspective is integral to today's patient-centered models of care.
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Clin. Geriatr. Med. · Aug 2012
Pharmacologic pain management before and after total joint replacement of the hip and knee.
There are many effective treatment measures for OA of the hip or knee, with varying degrees of effectiveness. Nonoperative measures include patient education, physical therapy, activity modification, weight loss, and medications. Pharmacologic strategies include acetaminophen, NSAIDs, injections of cortisone or viscosupplementation, and, less commonly, tramadol or other pain relievers. ⋯ Over the past 20 years, multimodal pain management has been beneficial to the patient undergoing TJR surgery. Studies have shown this form of pain management decreases postoperative opioid consumption and the related adverse effects. Research is warranted in the areas of postoperative pain scores and patient satisfaction as institutional multimodal protocols continue to evolve.