The Journal of arthroplasty
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We sought to characterize the typical recovery in physical function (PF) and pain interference (PI) after TKA using Patient-Reported Outcomes Measurement Information System (PROMIS) patient-reported outcome (PRO) measures. ⋯ The greatest magnitude of improvement in both PF and PI occurred within the first 3 months. After 6 months, patients might expect modest improvements in PF and mild reductions of PI. Patients and surgeons should use this information for setting expectations, planning for recovery, and improving care.
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Risk Adjustment Is Necessary in Medicare Bundled Payment Models for Total Hip and Knee Arthroplasty.
Concerns exist that high-risk patients in alternative payment models may face difficulties with access to care without proper risk adjustment. The purpose of this study is to identify the effect of medical and orthopedic specific risk factors on the cost of a 90-day episode of care following total hip (THA) and knee arthroplasty (TKA). ⋯ Certain comorbidities and orthopedic risk factors increase 90-day episode-of-care costs in the Medicare population. The current lack of proper risk stratification could be a powerful driver of decreased access to care for our most medically challenged members of society.
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Total knee arthroplasty volume is increasing significantly in the United States. Reducing hospital length of stay may represent the best method for accommodating expanding volume and reducing costs. We hypothesized that tailoring a clinical pathway to facilitate early ambulation would decrease costs and resource utilization. ⋯ The data demonstrate that tailored clinical pathways designed to facilitate early ambulation can reduce hospital length of stay, reduce opioid consumption, reduce antiemetic use, and improve pain control. The results establish that refined clinical pathways can assist in improving care while increasing value to patients, providers, and systems.
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The argument on the clinical effects between gap balancing (GB) and measured resection (MR) in total knee arthroplasty remains to be resolved. A systematic review and meta-analysis was performed to investigate which technique in total knee arthroplasty has better clinical effect. ⋯ We conclude that both techniques can result in equivalent results when done properly, and each surgeon must understand the strengths and weaknesses of each technique.
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There has been a debate regarding the outcomes of 2-stage revision total knee arthroplasty (TKA) when debridement, antibiotics, irrigation, and implant retention (DAIR) had been carried out previously. The purpose of this study is to evaluate the influence of prior failed DAIR (F-DAIR) on the outcomes of 2-stage revision TKA done for periprosthetic joint infection (PJI). ⋯ A failed prior DAIR results in higher failure rates, lower functional outcome, and increased risk of wound-related complications.