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  • 1
    Online Resource
    Online Resource
    The Potential Effects of Imposing a Body Mass Index Threshold on Patient-Reported Outcomes After Total Knee Arthroplasty
    Elsevier BV ; 2021
    In:  The Journal of Arthroplasty Vol. 36, No. 7 ( 2021-07), p. S198-S208
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 36, No. 7 ( 2021-07), p. S198-S208
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2020.08.060
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 2
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    Online Resource
    Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes
    SAGE Publications ; 2019
    In:  Geriatric Orthopaedic Surgery & Rehabilitation Vol. 10 ( 2019-01-01), p. 215145931987685-
    Details
    In: Geriatric Orthopaedic Surgery & Rehabilitation, SAGE Publications, Vol. 10 ( 2019-01-01), p. 215145931987685-
    Abstract: Displaced femoral neck fractures in the elderly individuals may be treated with total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the short-term medical outcomes are related to these surgical options. The purpose of this study was to compare early postoperative outcomes in THA patients to those of HHA patients. Methods: In this study, we compared 30-day mortality, likelihood of still being in the hospital at 30 days, postoperative major and minor complications, discharge disposition, reoperation and readmission, length of stay, days from admission to surgery, and operative time between THA and HHA. Using the American College of Surgeons National Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from 2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and 2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate regression models were created. Results: The THA patients ≥65 years old were at reduced risk for mortality ( P = .029) and still being in the hospital at 30 days ( P = .017). The THA patients were at an increased risk for minor complications ( P = .011) and longer operative times ( P 〈 .001). However, THA patients were more likely to have a home discharge ( P 〈 .001). Discussion: Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality risk, were more likely to be discharged home, and had less likelihood of being in the hospital at 30 days. This is the first study to explore short-term outcomes in patients ≥65 and has direct implications for alternate payment and merit-based payment models. Conclusion: As hip fracture treatment has come under scrutiny with respect to alternate payment models and merit-based incentive payments, this analysis of short-term outcomes warrants consideration when evaluating treatment pathways.
    Type of Medium: Online Resource
    ISSN: 2151-4593 , 2151-4593
    URL: Article
    DOI: 10.1177/2151459319876854
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2589094-3
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  • 3
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    Online Resource
    Tall-Statured Patients Have Similar Outcomes to Normal Height Patients after Primary Total Hip Arthroplasty
    Georg Thieme Verlag KG ; 2020
    In:  The Journal of Hip Surgery Vol. 04, No. 02 ( 2020-06), p. 060-065
    Details
    In: The Journal of Hip Surgery, Georg Thieme Verlag KG, Vol. 04, No. 02 ( 2020-06), p. 060-065
    Abstract: Total hip arthroplasty (THA) has been proven to be a safe and efficacious operation; however, there is a paucity of literature on outcomes in patients in the 99th percentile for height. The objectives of this study were to identify differences in (1) implant selection, (2) operative times, (3) intraoperative and postoperative complications, (4) 90-day readmission, (5) all cause reoperation rates, and (6) hospital length of stay (LOS), in tall-statured patients compared with a matched control cohort. An electronic research request was used to identify 12,850 patients who underwent THA from January 2012 to December 2016 with minimum 1-year follow-up at a single health care system for retrospective chart review. Patients were identified in the 99th percentile for height (193 cm for males and 177 cm for females) and then matched to controls based on gender, race, age, body mass index, and Charlson comorbidity index. A total of 260 THA patients (2%) were identified in the 99th percentile for height. The tall-statured patients were then matched to 248 patients of normal stature. The exclusion criteria was met by 172 tall-statured patients and 165 normal-statured patients. Final analysis comprised of 86 tall-statured patients (100 THA) and 83 matched normal-statured patients (92 THA). Baseline demographics information and the outcomes of interest were then compared. The mean height of the female patients in the tall cohort was 181.01 ± 2.51 cm compared with 166.6 ± 6.98 cm for the control group (p  〈  0.001), while it was 195.25 ± 4.03 cm for male patients in the tall cohort and 174.11 ± 4.63 cm for the control cohort (p  〈  0.001). Tall-statured patients had larger acetabular cups (p  〈  0.001) and femoral head (p = 0.046) components. There were no differences in reoperation (p = 0.282), 90-day readmissions (p = 0.862), intraoperative fractures (p = 0.228), postoperative complications (p = 0.678), operative times (p = 0.890), and LOS (p = 0.099) between the tall-statured and normal-statured patients. Patients that are in the 99th percentile for height have similar outcomes to patients that are of normal height. The level of evidence of this study is level 3.
    Type of Medium: Online Resource
    ISSN: 2472-8446 , 2472-8454
    URL: Article
    DOI: 10.1055/s-0040-1712519
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 4
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    Online Resource
    ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty
    Georg Thieme Verlag KG ; 2020
    In:  The Journal of Hip Surgery Vol. 4, No. 04 ( 2020-12), p. 187-192
    Details
    In: The Journal of Hip Surgery, Georg Thieme Verlag KG, Vol. 4, No. 04 ( 2020-12), p. 187-192
    Abstract: Diagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p  〈  0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p  〈  0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.
    Type of Medium: Online Resource
    ISSN: 2472-8446 , 2472-8454
    URL: Article
    DOI: 10.1055/s-0040-1719115
    Language: English
    Publisher: Georg Thieme Verlag KG
    Publication Date: 2020
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  • 5
    Online Resource
    Online Resource
    Have Venous Thromboembolism Rates Decreased in Total Hip and Knee Arthroplasty?
    Elsevier BV ; 2020
    In:  The Journal of Arthroplasty Vol. 35, No. 1 ( 2020-01), p. 259-264
    Details
    In: The Journal of Arthroplasty, Elsevier BV, Vol. 35, No. 1 ( 2020-01), p. 259-264
    Type of Medium: Online Resource
    ISSN: 0883-5403
    URL: Article
    DOI: 10.1016/j.arth.2019.08.049
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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  • 6
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    Online Resource
    Incidence and Characteristics of Osteoarticular Infections in Patients With Infective Endocarditis
    SLACK, Inc. ; 2020
    In:  Orthopedics Vol. 43, No. 1 ( 2020-01), p. 24-29
    Details
    In: Orthopedics, SLACK, Inc., Vol. 43, No. 1 ( 2020-01), p. 24-29
    Abstract: Osteoarticular infections (OAIs) in the setting of infective endocarditis (IE) are uncommon. Although morbidity and mortality have been widely studied, details of the characteristics of patients with concurrent IE and OAI are limited. Therefore, the purpose of this study was to determine the (1) incidence, (2) mortality, (3) clinical features, and (4) microbiological profiles of OAIs in the setting of IE. A retrospective review was conducted of 1280 IE cases at a large academic institution between 2009 and 2015. Patients were categorized according to the following OAI types: spondylodiskitis, large joint septic arthritis, other site infections, or multiple affected joints. Inpatient mortality rates, clinical findings, and microbiological characteristics were compared between OAI types. Overall, the incidence of OAI among IE patients was 6.8% (n=87). The in-hospital mortality rate was 9.2% (n=8) and was not significantly associated with OAI type ( P =.801). Eighteen patients had multiple affected joints resulting in a total of 114 infected sites. Of these, 39% (n=44) were spondylodiskitis, 29% (n=33) were large joint septic arthritis, and 32% (n=37) were infections of smaller joints. Back pain was most common among patients with spondylodiskitis ( P 〈 .001), whereas fever and general fatigue were most common with septic arthritis ( P 〈 .001). Of the available bone/ joint cultures, 69% were positive. Overall, Staphylococcus aureus was the most common IE pathogen in patients with both IE and OAI (63%). Clinicians should maintain a high suspicion for OAI in patients with IE caused by Staphylococcus aureus , particularly spondylodiskitis among those presenting with back pain. [ Orthopedics 2020; 43(1):24–29.]
    Type of Medium: Online Resource
    ISSN: 0147-7447 , 1938-2367
    URL: Article
    DOI: 10.3928/01477447-20191031-02
    Language: English
    Publisher: SLACK, Inc.
    Publication Date: 2020
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