The Journal of arthroplasty
-
Total knee arthroplasty (TKA) is the second most common surgery performed in Canada. Understanding and improving quality metrics associated with such high-volume procedures is of utmost importance to maximize value within the healthcare system, which is a balance between cost and quality. Although rates and predictors of hospital readmission and emergency department (ED) visits following TKA have previously been described in privatized healthcare settings, few studies have evaluated trends in length of stay (LOS), hospital readmissions, and ED visits following TKA in a universal single-payer system. ⋯ We identified a significant increase in ED visits following TKA in Ontario between 2003 and 2016, with no corresponding increase in hospital readmissions despite a significant temporal trend toward shorter LOS. Predictors of ED visits and readmissions were similar, including male gender, lower income, higher comorbidities, and lacking a PCP visit postoperatively. Increased rates of ED visits following TKA in Ontario represent a quality problem, as they are associated with increased cost to the public healthcare system without any substantial benefit. Interventions aimed at redirecting patients from the ED for minor postoperative concerns should be investigated, as this is likely to improve care by reducing costs, improving efficiency, and enhancing patient experience.
-
The etiopathogenesis of developmental dysplasia of the hip (DDH) has not been clarified. This systematic review evaluated current literature concerning all known chromosomes, loci, genes, and their polymorphisms that have been associated or not with the prevalence and severity of DDH. ⋯ DDH is a complex disorder with environmental and genetic causes. However, no firm correlation between genotype and DDH phenotype currently exists. Systematic genome evaluation in studies with larger sample size, better methodological quality, and assessment of DDH patients is necessary to clarify the DDH heredity. The role of next-generation sequencing techniques is promising.
-
Review Meta Analysis
Survivorship and Clinical Outcomes of Custom Triflange Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review.
Several studies have evaluated the survivorship and clinical outcomes of custom triflange acetabular component (CTAC) usage in complex acetabular revision; however, there remains no consensus on the overall performance of this custom implant design. We therefore performed a systematic review of the literature in order to examine survivorship and complication rate of CTAC usage. ⋯ Based on the current data, CTACs have a high complication rate but remain an efficacious treatment option in complex acetabular reconstructions. When dealing with patients with significant acetabular bone loss for revision total hip arthroplasty, surgeons should continue to consider CTACs as a viable option but educate patients as to the increased risk of postoperative complications and reoperations.
-
Review Meta Analysis
Survivorship and Clinical Outcomes of Custom Triflange Acetabular Components in Revision Total Hip Arthroplasty: A Systematic Review.
Several studies have evaluated the survivorship and clinical outcomes of custom triflange acetabular component (CTAC) usage in complex acetabular revision; however, there remains no consensus on the overall performance of this custom implant design. We therefore performed a systematic review of the literature in order to examine survivorship and complication rate of CTAC usage. ⋯ Based on the current data, CTACs have a high complication rate but remain an efficacious treatment option in complex acetabular reconstructions. When dealing with patients with significant acetabular bone loss for revision total hip arthroplasty, surgeons should continue to consider CTACs as a viable option but educate patients as to the increased risk of postoperative complications and reoperations.
-
Total knee arthroplasty (TKA) yields substantial improvements in quality of life for patients with severe osteoarthritis. Previous research has shown that TKA outcomes are inferior in patients with certain demographic and clinical factors. Length of stay (LOS) following TKA is a major component of costs incurred by healthcare providers. It is hypothesized that patient-related factors may influence LOS following TKA. The purpose of this systematic review and meta-analysis is to investigate these factors. ⋯ IV, systematic review, and meta-analysis of level III and IV evidence.