The Journal of arthroplasty
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Comparative Study
Comparison of Outpatient vs Inpatient Total Knee Arthroplasty: An ACS-NSQIP Analysis.
There has been a recent surge of interest in performing primary total knee arthroplasty (TKA) in the outpatient setting to reduce cost and increase patient satisfaction. Detailed information on the safety of outpatient TKA in large sample sizes is scarce. ⋯ Based on the perioperative outcome measures studied here, outpatient TKA can be appropriately considered in select patients based on rates of overall perioperative adverse events and readmissions. However, higher surveillance of these patients postdischarge may be warranted.
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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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Little is known about the relationship between chronic kidney disease (CKD) and minimally invasive total knee arthroplasty (MIS-TKA). We hypothesized that CKD was an independent risk factor for postoperative complications and increased blood transfusion in patients following MIS-TKA. ⋯ Based on our data, CKD is an independent risk factor for blood transfusion, cardiovascular complication, and 30-day readmission in patients undergoing MIS-TKA.
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Comparative Study
Differences in Patient-Reported Outcomes Between Unicompartmental and Total Knee Arthroplasties: A Propensity Score-Matched Analysis.
The purpose of this study was to compare the patient-reported outcomes regarding joint awareness, function, and satisfaction after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). ⋯ Patients who underwent UKA had higher FJS, HFKS, and satisfaction rate when compared with patients who underwent TKA, indicating that UKA facilitated less knee awareness and better function and satisfaction than TKA.
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Appropriate balancing of the patellofemoral joint (PFJ) using a lateral release can help to prevent patellar instability in total knee arthroplasty (TKA). Contemporary total knee implant designs are characterized by enhanced trochlear geometry more similar to native knee anatomy to minimize instability and reduce utilization of a lateral release. ⋯ We found that older knee implants were associated with higher use of lateral release, with successive designs the need for lateral release to balance the PFJ decreased. Continued design improvements to match the native knee anatomy may further improve the stability of the PFJ in future designs.