The Journal of arthroplasty
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Severe preoperative leg length discrepancy (LLD) can lead to poor preoperative functional status in patients with extensive osteonecrosis of the femoral head (ONFH). This study aimed to assess the effect of preoperative LLD on functional outcomes and patient satisfaction post-total hip arthroplasty (THA) in ONFH patients. ⋯ Patients with severe LLD experienced similar improvement at 3 months after THA as those with mild LLD in terms of the HHS and OHS but showed greater improvement at 12 months postoperatively than patients with mild LLD.
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Hip arthroplasty is increasingly performed as a treatment for femoral neck fractures (FNFs). However, these cases have higher complication rates than elective total hip arthroplasties (THAs). The Center for Medicare and Medicaid Services has created the Comprehensive Care for Joint Replacement model to increase the value of patient care. This model risk stratifies FNF patients in an attempt to appropriately allocate resources, but the formula has not been disclosed. The goal of this study was to ascertain if patients with FNFs have different readmission rates compared to patients undergoing elective THA so that the resource utilization can be assessed. ⋯ Results suggest that patients who undergo an arthroplasty following urgent or emergent FNFs have inferior outcomes to those receiving an arthroplasty for a diagnosis of arthritis. Fracture patients should either be risk stratified to allow appropriate resource allocation or be excluded from alternative payment initiatives such as Comprehensive Care for Joint Replacement.
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Comparative Study Observational Study
Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty.
Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA. ⋯ Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery.
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Comparative Study
Biomechanical Effects of Different Varus and Valgus Alignments in Medial Unicompartmental Knee Arthroplasty.
Medial unicompartmental tibial components are not always positioned following neutral mechanical alignment and a tibial varus alignment of 3° has been suggested based on several clinical follow-up studies. However, no biomechanical justification is currently available to confirm the suitability of different alignment positions. ⋯ Neutral mechanical or 3° of varus alignment present similar biomechanical outputs in the bone, collateral ligament strain, and on the polyethylene insert. A 6° varus alignment or changes in valgus alignment were always associated with more detrimental effects.
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The relationship between pain catastrophizing and emotional disorders including anxiety and depression in osteoarthritic patients undergoing total joint arthroplasty (TJA) is an emerging area of study. The purpose of this study was to examine the association of these factors with preoperative patient characteristics. ⋯ The most important predictor of catastrophizing, anxiety and/or depression in TJA patients is preoperative pain and poor subjective function. At-risk patients include those with increased pain and generally good clinical function, as well as younger women with significant comorbidities. Such patients should be identified and targeted psychological therapy implemented preoperatively to optimize coping strategies and adaptive behavior to mitigate potential for inferior TJA outcomes including pain and patient dissatisfaction.