The Journal of arthroplasty
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In-hospital falls (IFs) increase morbidity, cost, and may result in litigation. We analyzed the Nationwide Inpatient Sample to quantify the incidence of IFs in patients who underwent hip and knee arthroplasty and to define trends, patient's demographics, risk factors, complications, and hospital cost. Patients operated on between 1998 and 2007 were identified and grouped depending on the presence of a diagnosis of IF. ⋯ Patients having IF had a longer hospital stay and were less likely to be discharged to their primary residence. In-hospital mortality, complications, and cost were higher in patients sustaining IF. Given the associated morbidity, mortality, and increased cost, resources should be allocated to minimize the risk of IF in this population.
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An operative note is a vital component of a patient's medical-legal record, permitting the surgical team to safely administer perioperative care. Despite this critical function, operative note contents are neither standardized nor regulated; this is especially concerning in orthopedic surgery. ⋯ Surgeons performing primary THA must be cognizant to record detailed implant characteristics to ensure that if necessary, the revision surgeon will have all pertinent information to optimally treat the patient. Our survey of operative notes reveals the dismal nature of component documentation during primary THA; implementation of a standardized procedure-specific operative note guideline may minimize incomplete dictations and drive surgeons to include all pertinent information.
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The effect of patellar replacement technique on patellofemoral complications and anterior knee pain.
Routine patella replacement with total knee arthroplasty has not been universally adopted because of associated patellofemoral complications such as anterior knee pain (AKP). In the proposed technique, the articular surface of the lateral facet of the patella is excised to the depth of the subchondral bone, and the medial facet is then cut parallel to the anterior surface. ⋯ Anterior knee pain was present in 11% of cases, and no cases were severe or disabling. There were no correlations between AKP, range of motion, patellar size and shape, and any of the radiographic parameters.
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The outcomes of 18 primary or revision total hip (THA) and knee arthroplasties (TKA) in 9 patients with cardiac transplants were reviewed. Primary total joint arthroplasties were performed for osteonecrosis (5 hips) or osteoarthritis (5 hips, 4 knees). There were no infections in any of these patients. ⋯ No reoperations were required in this group. Overall, patients with heart transplantations on immunosuppression had generally good pain relief after THA and TKA. There were no infections in this small cohort; however, there were many complications.
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Comparative Study
A comparison of patellar vascularity between the medial parapatellar and subvastus approaches in total knee arthroplasty.
A complication of total knee arthroplasty is patellar avascular necrosis. Surgical approaches for total knee arthroplasty include the medial parapatellar approach (MPa) and, less commonly, the subvastus approach (SVa). ⋯ Results indicated no significant difference between groups on imaging (P = .935), the components of the bone vascularity scale, or anterior knee pain (P > .999). The SVa appears to offer no benefit over the MPa in terms of patellar vascularity or anterior knee pain.