The Journal of arthroplasty
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The aim of the present study was to investigate potential predictive factors of an unfavorable outcome in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange. ⋯ A favorable outcome in patients with PJI undergoing 2-stage procedure was associated with an infection sustained by Gram-positive bacteria, absence of known comorbidities, and administration of oral therapy. Therefore, failure rate can be reduced with appropriate treatment choices.
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Debridement-antibiotics-and-implant-retention (DAIR) may be considered a suitable surgical option in periprosthetic joint infections (PJIs) with soundly fixed prostheses, despite chronicity. This study aims to define the long-term outcome following DAIR in hip PJI. ⋯ DAIR is, therefore, a valuable option in the treatment of hip PJI, especially in the early postoperative period (≤6 weeks), with good outcomes. However, DAIR is associated with increased morbidity; further surgery may be necessary and instability may occur. Where possible, exchange of modular implants should be undertaken.
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In recent years, bundled payment reimbursement models have been used to address the unsustainable rising cost of healthcare. Centers for Medicare and Medicaid Services initiatives, such as Bundled Payment for Care Improvement Program, have already demonstrated their ability to create financial and performance accountability in the public sector. ⋯ Bundled payment strategies provide incentives for physicians and healthcare professionals to eliminate unnecessary services and reduce costs. This article discusses our experience at a private institution with transitioning to a bundled payment program, while identifying the challenges and strategies associated with a successful implementation.
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Randomized Controlled Trial
Effect of Periarticular Morphine Injection for Total Knee Arthroplasty: A Randomized, Double-Blind Trial.
The periarticular multimodal cocktail injection including morphine is currently commonly used to treat postoperative pain after total knee arthroplasty (TKA). Despite its analgesic effect, it is frequently reported to cause nausea and vomiting, which are adverse effects of opioids. This study aimed to assess the efficacy of morphine as a component of a multimodal cocktail injection for providing postoperative analgesia and alleviating swelling in patients who underwent TKA. ⋯ The results of this study suggested that addition of morphine to the multimodal cocktail injection is not effective for relieving postoperative pain, alleviating swelling, or improving range of motion, and results in nausea and vomiting.
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Prior studies comparing unicompartmental knee arthroplasty (UKA) with total knee arthroplasty (TKA) in the elderly are limited by heterogeneity in arthritic disease patterns and patient selection. We report the results of UKA and TKA in patients 75 years and older with isolated medial compartmental arthritis, with special emphasis on immediate postoperative recovery, complications, reoperation rates, and implant survivorship at midterm follow-up. ⋯ Due to its less invasive nature, patients older than 75 undergoing UKA demonstrated faster initial recovery when compared to TKA, while maintaining comparable complications and midterm survivorship. UKA should be offered as an option in the elderly patient who fits the selection criteria for UKA.