Impact of Anesthetic Choice on Time to Discharge for Same-Day Discharge Joints.

Background: As total joint arthroplasty programs continue to move towards same-day discharge (SDD), time to discharge is an increasingly important performance indicator. The primary objective of this study was to determine the impact of the choice of anesthetic on the time to discharge after SDD primary hip and knee arthroplasty.

Methods: A retrospective chart review was conducted within our SDD arthroplasty program, with 261 patients identified for analysis.

Midterm Outcomes in Lateral Unicompartment Knee Replacement: The Effect of Patient Age and Bearing Choice.

Isolated lateral compartment knee osteoarthritis (OA) affects between 7 and 10% of patients with knee OA. Although lateral unicompartmental knee arthroplasty (UKA) is an accepted treatment to manage this condition, it is performed relatively infrequently. The aim of this study was to evaluate the mid-term survivorship, radiographic outcomes, and patient-reported outcome measures (PROMs).

Evaluation of Safety and Medium-Term Functional Outcomes of a Medial Fixed-Bearing Unicompartmental Knee Arthroplasty with Ultra-Highly Cross-Linked Polyethylene.

The primary objective of this study was to evaluate the in vivo safety of a unicompartmental knee arthroplasty design with sequentially annealed cross-linked polyethylene by evaluating reoperation rate, in particular those related to excessive polyethylene wear or breakage. The secondary objective was to examine functional outcomes via standardized questionnaires. This was a 5-year institutional review board-approved prospective single-surgeon case series of the first 152 consecutive patients with symptomatic medial unicompartmental osteoarthritis implanted with a partial knee replacement between May 2010 and December 2014.

Mid-Term Evaluation of the Unicompartmental Knee Arthroplasty in Patients with BMI of 40 or Greater.

Limited evidence is available on mid-term follow-up for patients with body mass index (BMI) ≥ 40 receiving a unicompartmental knee arthroplasty (UKA). The primary objective of this study was to investigate survival of the UKA in patients with BMI ≥ 40. Secondary objectives were to assess functional and patient reported outcome measures (PROMs).

The Clinical Outcome of Patellofemoral Arthroplasty vs Total Knee Arthroplasty in Patients Younger Than 55 Years.

Background: Patellofemoral osteoarthritis affects 10% of patients older than 40 years and is commonly treated by patellofemoral joint arthroplasty (PFA) or a total knee arthroplasty (TKA). PFA is a more conservative approach with documented faster recovery. No study to date has compared both approaches with respect to patient-reported outcome measures in patients younger than 60 years.

Defining growth potential and barriers to same day discharge total knee arthroplasty.

Background: Outpatient arthroplasty programs are becoming well established. Adverse event rates have been demonstrated to be no worse than inpatient arthroplasty in the literature for selected patients. The purpose of this study was to determine our rate of outpatient total knee arthroplasty (TKA), examine justification for exclusions, and estimate the proportion of TKAs that can occur safely on an outpatient basis.

Quality of Recovery, Postdischarge Hospital Utilization, and 2-Year Functional Outcomes After an Outpatient Total Knee Arthroplasty Program.

Background: Outpatient total knee arthroplasty (TKA) has been made possible with advances in perioperative care and standardized clinical inpatient pathways. While many studies report on benefits of outpatient programs, none explore patient-reported outcome measures. As such, our goals were to compare the short-term quality of recovery; highlight postdischarge hospital resources utilization; and report on 2-year functional outcomes scores.

Evaluation of a Patient Decision Aid for Unicompartmental or Total Knee Arthroplasty for Medial Knee Osteoarthritis.

Background: Many patients with isolated medial compartment osteoarthritis are candidates for either unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). A novel patient decision aid (PDA) was developed to educate patients on both interventions and prepare them for making the decision with their surgeon. The study objective was to evaluate the acceptability and usefulness of a PDA for informing and helping patients reach a surgical preference without increasing decisional conflict.

Assessing functional recovery shortly after knee or hip arthroplasty: a comparison of the clinimetric properties of four tools.

Background: Following hip or knee arthroplasty, it is clinically warranted to get patients functional as quickly as possible. However, valid tools to assess function shortly after knee or hip arthroplasty are lacking. The objective was to compare the clinimetric properties of four instruments to assess function shortly after arthroplasty.

The effect of medial release of the distal patellar tendon insertion on lateral patella translation and residual insertion strength: a cadaveric study.

Patellar tendon avulsion is a risk with difficult exposure in a stiff knee, patella baja or previous tibial osteotomy. We sought to define a safe amount of release of the patellar tendon insertion for such cases. Eleven pairs of fresh frozen cadaveric lower limb specimens were acquired and randomized to either intact or partial release of the distal tibial insertion.

Validity of a short-term quality of life questionnaire in patients undergoing joint replacement: the Quality of Recovery-40.

One hundred thirty-two patients undergoing total hip or knee arthroplasty were evaluated before and after surgery with the Quality of Recovery-40 (QoR-40) and the Short Form 12 (SF-12) questionnaires seven times over a 4-month period, with the objective of comparing their psychometric properties. Physical dimensions of the QoR-40 and SF-12 were not related in the days after surgery but moderately related over the first month. Only the change in score for the physical independence dimension of the QoR-40 exceeded measurement error.

Unicompartmental knee arthroplasties revised to total knee arthroplasties compared with primary total knee arthroplasties.

We studied the technical operative features and the subjective outcomes of 63 patients requiring a revision to a total knee arthroplasty (TKA) for failed Oxford medial unicompartmental knee arthroplasty. We compared this revision study group to a contemporary control cohort of 126 patients who underwent primary TKAs. The 2 groups from the same institution had a minimum follow-up of 2 years and were retrospectively matched 1:2 for age, sex, body mass index, and follow-up time.

Outpatient unicompartment knee arthroplasty with indwelling femoral nerve catheter.

Contemporary multimodal anesthesia regimens allow the performance of unicompartment knee arthroplasty (UKA) on an outpatient basis. Our initial pilot experience is presented using a continuous femoral nerve block as an adjunct for 24 patients classified as American Society of Anesthesiology class 1 (14 men, 10 women; median age, 56 years; range, 46-72 years). After minimally invasive UKA, patients documented their pain and oral medication use while at home for the first 5 days.

Impact of a surgical screening clinic for patients with knee osteoarthritis: a descriptive study.

Objective: To evaluate a surgical screening clinic for patients with knee osteoarthritis (OA) referred for total knee arthroplasty (TKA) and explore management before referral.

Design: Descriptive study using retrospective chart review.

Setting: Large Canadian teaching hospital.

Intercondylar fibrotic lesion after retrograde intramedullary nailing of a femoral shaft fracture: a case report and review of the literature.

Retrograde intramedullary nailing is a largely successful technique for the treatment of femoral shaft fractures, although reports of knee pain after this procedure are not uncommon. Here we describe the case of a patient who developed a polyp-like fibrotic lesion of the intercondylar notch nearly 2 years after retrograde intramedullary nailing of a femoral shaft fracture as discovered by arthroscopic evaluation. This lesion caused pain and compromised our patient's function; however, both of these measures were subjectively improved after the debridement of the lesion.

Decision support needs of patients choosing between unicompartmental and total knee arthroplasty for advanced medial compartment osteoarthritis of the knee.

Patients with isolated medial knee osteoarthritis are often candidates for both unicompartmental knee arthroplasty and total knee arthroplasty and must choose between these 2 options. We interviewed 20 such patients to describe their decision support needs and 14 knee arthroplasty surgeons to describe their requirements in supporting patients' decision making. Patients and surgeons both desired active patient participation in the decision.

Accuracy of administrative coding in identifying hip and knee primary replacements and revisions.

Rationale, Aims And Objectives: Hospital discharge notes can be used to identify rates of revisions in hip and knee arthroplasty surgeries if such administrative codes are accurate. In order to trust the data taken from the hospital discharge abstracts it is important to assess their reliability. The purpose of this study is to evaluate the accuracy of the administrative coding used in measuring revision rates for total hip and knee arthroplasty.

Initial experience with the oxford unicompartmental knee arthroplasty.

Our initial experience with mobile bearing medial compartment unicompartmental arthroplasty (UKA) is presented to highlight lessons that have been learned to avoid short-term failures. Consecutive cases of the Oxford medial UKA performed between February 2001 and April 2006 were reviewed to derive those cases that were revised to total knee arthroplasty (TKA). There were 545 patients available with mean age and body mass index of 65.

Major complications associated with femoral nerve catheters for knee arthroplasty: a word of caution.

One thousand one hundred ninety patients underwent knee arthroplasty between January 2004 and July 1, 2007, and received an indwelling continuous infusion femoral catheter for postoperative ropivicaine pump infusion. Catheters were placed using electrical stimulation guidance. For the initial 469 patients (group 1), the continuous infusion ran for 2 to 3 days.

Fibrin sealants from fresh or fresh/frozen plasma as scaffolds for in vitro articular cartilage regeneration.

Our objective was to evaluate human CryoSeal fibrin glue derived from single units of plasma as scaffolds for articular cartilage tissue engineering. Human articular chondrocytes were encapsulated into genipin cross-linked fibrin glue derived from individual units of fresh or frozen plasma using the CryoSeal fibrin sealant (FS) system. The constructs were cultured for up to 7 weeks in vitro under low (5%) or normal (21%) oxygen.

Open wedge high tibial osteotomy: a roentgenographic comparison of a horizontal and an oblique osteotomy on patellar height and sagittal tibial slope.

Background: In patients with unicompartmental medial knee arthritis, medial opening wedge high tibial osteotomy is used to shift the mechanical weightbearing line laterally to reduce pain and improve function. There have been concerns that opening wedge high tibial osteotomy is associated with a reduction of patellar height and increase in the sagittal posterior tibial slope, both of which can adversely affect the final result.

Hypothesis: A more distal oblique osteotomy at the level of insertion of the patellar tendon should decrease these effects when compared with a horizontal osteotomy made proximal to the patellar tendon insertion.

Functional outcome after proximal humeral fractures treated with hemiarthroplasty.

Objective: To evaluate functional outcome after hemiarthroplasty for displaced proximal humeral fractures and to review whether prosthesis type, intraoperative technique or previous ipsilateral shoulder surgery could affect the outcome.

Methods: We reviewed the medical records and radiographs of patients who had undergone hemiarthroplasty for proximal humeral fractures between 1992 and 2000. We identified 45 patients, 39 with acute fractures and 6 with fracture-related complications.