The Journal of arthroplasty
-
The Centers for Medicare and Medicaid Services have solicited comments to consider removing total knee arthroplasty (TKA) from the Inpatient Only list, as it has done for unicompartmental knee arthroplasty (UKA). The purpose of this study is to determine whether Medicare-aged patients undergoing TKA had comparable outcomes to those undergoing UKA. ⋯ TKA procedure in the Medicare population is an independent risk factor for increased complications and LOS compared to UKA. Policymakers should use caution extrapolating UKA data to TKA patients and recognize the inherent disparities between the 2 procedures.
-
Observational Study
How Much Pain Is Significant? Defining the Minimal Clinically Important Difference for the Visual Analog Scale for Pain After Total Joint Arthroplasty.
The ability to detect changes in patient-perceived pain after total joint arthroplasty (TJA) is critical to manage postoperative pain. The minimal clinically important difference (MCID) for visual analog scale for pain (VAS-P) has not been investigated in this population. This study investigated the MCID for VAS-P in the TJA population. ⋯ In the postoperative TJA population, VAS-P MCID changes depend on the type of surgical intervention, and whether pain is improving or worsening. Statistically significant VAS-P, improving -18.6 mm and -22.6 mm for THA and TKA patients, respectively, sets a reasonable threshold to identify clinically meaningful pain intervention with high specificity.
-
Limited data describe risks and perioperative resource needs of total joint arthroplasty (TJA) in dialysis-dependent patients. ⋯ Dialysis-dependence is an independent risk factor for 30-day adverse events, ICU care, longer admission, and rehabilitation needs in TJA patients. Thirty days is not sufficient to detect infectious complications among these patients. These findings inform shared decision-making, perioperative resource planning, and risk adjustment under alternative reimbursement models.
-
The purpose of this study was to compare risks for revision and short-term complications after total joint arthroplasty (TJA) in matched cohorts of morbidly obese patients, receiving and not receiving prior bariatric surgery. ⋯ After accounting for relevant selection biases, bariatric surgery prior to TJA was associated with reduced co-morbidity burden at the time of TJA and with reduced post-TJA complications. However, bariatric surgery did not reduce the risk for revision surgery for either TKA or THA.