The Journal of arthroplasty
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Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are important markers in the evaluation and treatment of painful total knee arthroplasty (TKA). Elevation of both markers usually occurs with infected TKAs while a normal ESR and CRP usually point to aseptic causes for failure. The purpose of this study is to compare (1) rate of revision, (2) infection, and (3) reason for reoperation in a group of patients undergoing revision TKA with a single abnormality in either ESR or CRP in an otherwise negative conventional infection work-up compared to patients with normal preoperative ESR and CRP. ⋯ A single abnormality in either the ESR or CRP increased the likelihood of both infection and reoperation following revision TKA. Conventional methods and criteria for infection detection may not be sufficiently sensitive or specific in these cases. Further work-up with additional modalities may help increase the confidence of aseptic failure before revision TKA.
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Length of hospital stay is a quality metric in joint arthroplasty. Rapid recovery protocols have safely reduced the average length of hospitalization, but it is unclear whether there is a difference in complication and readmission rates between patients discharged the day of surgery or on postoperative day 1 (POD 1). We calculated 30-day complication and readmission after total knee arthroplasty (TKA), total hip arthroplasty (THA), and unicompartmental knee arthroplasty (UKA) based on day of discharge. We then analyzed the rapid recovery group by comparing those discharged the day of surgery and those discharged on POD 1. ⋯ Increased length of stay is associated with increased complication and readmission after joint arthroplasty for patients with a hospital stay of 3 or more days. However, in THA, there was an increased complication rate in patients discharged POD 0 as compared to POD 1. Efforts to improve patient selection are expected to reduce short-term complications after outpatient joint arthroplasty. Further research is needed to determine which patients can be discharged POD 0 without increased complication after THA.
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Discharge destination is an important factor to consider to maximize care coordination and manage patient expectations after total joint arthroplasty (TJA). It also has significant impact on the cost-effectiveness of these procedures given the significant cost of post-acute inpatient care. Therefore, understanding factors that impact discharge destination after TJA is critical. ⋯ Socioeconomic status and race/ethnicity are important factors related to discharge destination following TJA. Thoroughly understanding and addressing these factors may help increase the rates of discharge to home as opposed to institution.
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Review Meta Analysis
Aspirin as Thromboprophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Venous thromboembolism (VTE) comprises pulmonary embolism and deep vein thrombosis and is a complication of particular concern in lower limb arthroplasty. In recent years, aspirin has emerged as a potential alternative thromboprophylactic agent, particularly after its acceptance as a recommended agent by the American College of Chest Physicians. Aspirin is favorable due to its relative cost-effectiveness and convenience compared to novel oral anticoagulants and warfarin. However, its efficacy since its inclusion in the American College of Chest Physicians guidelines remains unclear. The present systematic review aimed to establish the efficacy of aspirin in preventing VTE in total hip and knee arthroplasty. ⋯ Aspirin, both alone and in multimodal approaches to thromboprophylaxis, confers a low rate of VTE, with a low risk of major bleeding complications. However, the evidence for its use is limited by the low quality of studies and variation in dose in dosing regimes. Future randomized controlled trials should investigate the efficacy of aspirin, as well as the ideal dosing protocol for its use in thromboprophylaxis in arthroplasty.
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Multimodal pain protocols have been proposed to achieve improved long-acting postoperative analgesia. Controlling postoperative pain after joint arthroplasty is especially important as it relates to patient satisfaction and outcomes. The purpose of this study was to compare the postoperative pain, time to ambulation, and overall narcotic usage between patients who received either a femoral nerve block with a periarticular bupivacaine injection or a periarticular bupivacaine and extended-release liposomal bupivacaine injection after primary total knee arthroplasty. ⋯ Liposomal bupivacaine resulted in a decrease need for breakthrough pain medication, improved pain scores at 12 hours, and an earlier time to ambulation compared to a combined femoral nerve block and periarticular bupivacaine injection.