Assessing pain management in total joint arthroplasty using the Detroit interventional pain assessment scale-A prospective cohort study.

Background: Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, but postoperative pain has been poorly managed. The purpose of this study was to (1) assess how much narcotic medication was prescribed after TJA; (2) assess if patients were satisfied with their pain management; (3) compare these same data between total hip arthroplasty (THA)/total knee arthroplasty (TKA); (4) compare these same data between preoperative opioid users/opioid-naïve patients.

Methods: An IRB-approved prospective study was conducted at a US academic joint replacement practice.

Nutritional Considerations in Hip and Knee Arthroplasty: A Critical Analysis of Current Evidence.

» Initial screening for malnutrition can be initiated with a fibrinogen-albumin ratio threshold <11.7.» Protein supplementation to goal (1.

Hamstring Anterior Cruciate Ligament Autograft Contributes to a Delayed Symptomatic Cyclops Lesion: A Case Report.

Cyclops lesions are characterized as fibroid nodules with granulation tissue that looks similar to a cyclops eye during arthroscopy. These are rare postoperative complications following anterior cruciate ligament reconstruction (ACLR), presenting typically within six months of their reconstruction. This case report presents a 21-year-old male, three years following hamstring autograft ACLR, with a symptomatic cyclops lesion.

A Novel Digital Templating Method for Total Hip Arthroplasty in Patients With Unilateral Hip Arthrosis.

Background: Identification of the hip center of rotation (HCOR) before total hip arthroplasty (THA) is crucial for achieving optimal implant position and size, and for restoring native biomechanics around the hip joint. Current techniques for determining the HCOR in cases of abnormal hip anatomy are limited and unreliable. This study presents a novel technique using open-access software for preoperative THA templating for patients with significantly abnormal hip anatomy due to unilateral hip arthrosis.

Detroit Interventional Pain Assessment Scale: A Pain Score and Method for Measuring and Evaluating Post-Operative Pain Management-A Prospective Study.

: Orthopedic surgeons commonly prescribe opioids, surpassing all medical specialties. Our objective was to develop a pain management scale that captures medication use, patient-reported pain scores, and helps orthopedic surgeons evaluate their post-operative prescribing practice. : An IRB-approved prospective study followed 502 post-operative orthopedic surgery patients over a six-month period.

Predicting Factors for Blood Transfusion in Primary Total Knee Arthroplasty Using a Machine Learning Method.

Introduction: Acute blood loss anemia requiring allogeneic blood transfusion is still a postoperative complication of total knee arthroplasty (TKA). This study aimed to use machine learning models for the prediction of blood transfusion after primary TKA and to identify contributing factors.

Methods: A total of 2,093 patients who underwent primary TKA at our institution were evaluated using data extracted from the hospital quality improvement database to identify patient demographics and surgical variables that may be associated with blood transfusion.

Total Hip Arthroplasty in the Ultrayoung.

Background: Total hip arthroplasty (THA) procedures provide a surgical option for "ultrayoung" patients ≤30 years old with end-stage hip arthropathy. This has historically been coupled with concerns over early component failure and challenging surgical technique leading to increased risk of overall morbidity. The purpose of this study is to better elucidate the poorly defined indications and outcomes for THA in ultrayoung patients with end-stage hip disease.

Computer Vision and Machine Learning-Based Gait Pattern Recognition for Flat Fall Prediction.

Background: Gait recognition has been applied in the prediction of the probability of elderly flat ground fall, functional evaluation during rehabilitation, and the training of patients with lower extremity motor dysfunction. Gait distinguishing between seemingly similar kinematic patterns associated with different pathological entities is a challenge for the clinician. How to realize automatic identification and judgment of abnormal gait is a significant challenge in clinical practice.

Evaluation of Blood Loss in Conventional vs MAKOplasty Total Knee Arthroplasty.

Background: Primary total knee arthroplasty (TKA) has been historically associated with considerable blood loss. Allogenic transfusions, the standard of care for blood loss following TKA, carry inherent risks. With the expanding use of robotic technology in TKA, one theoretical advantage is decreased blood loss and postoperative blood transfusions requirements.

The risk of hospital readmission, revision, and intra- and postoperative complications between direct anterior versus posterior approaches in primary total hip arthroplasty: a stratified meta-analysis and a probability based cost projection.

Introduction: This study presents stratified meta-analysis and projected cost per case analysis of direct anterior approach (DAA) versus posterior approach (PA) in total hip arthroplasty (THA) to determine the best surgical approach and guarantee hip joint longevity.

Methods: Several online databases were searched for clinical trials comparing DAA and PA in primary THA. The stratified analysis was conducted to test for confounding and biases across the different types of included trials.

Differences in Immediate Postoperative Outcomes Between Robotic-Assisted TKA and Conventional TKA.

Background: Robotic-assisted total knee arthroplasty (TKA) is a growing technique in adult reconstruction. The variations between robotic-assisted and conventional TKA could lead to changes in immediate postoperative outcomes. We aimed to evaluate for differences in postoperative pain, discharge day, as well as post-hospital disposition (home vs subacute rehabilitation facility [SAR]) between robotic-assisted and conventional TKA.

The prevalence of posterolateral tibial baseplate overhang: An anatomical CT study.

Introduction: Total Knee Arthroplasty (TKA) is used in patients with osteoarthritis who have failed conservative management to reduce pain, improve functional outcomes and ultimately quality of life. However, less than optimal patient satisfaction has led to continued improvements in design and technology of TKA. One factor that can limit patient satisfaction is postero-lateral overhang of the tibial baseplate.

Assessing knee anatomy using Makoplasty software a case series of 99 knees.

Background: Role of MAKOplasty software in determining femoral neck version, distal-femoral resection angle, tibial axis difference, distal-femoral rotation, medial/lateral tibial slope, and tibial tubercle alignment has yet to be fully explored.

Methods: Preoperative CT scans and plain films of 99 patients were obtained for each patient according to predetermined MAKO-protocol by four observers. Reliability analyses (Cronbach's Alpha-test) was performed to determine agreement between raters for angle measures.

Clostridium difficile Colitis Following Revision Total Knee Arthroplasty: Incidence and Risk Factors.

Background: Clostridium difficile-associated diarrhea (CDAD) is associated with adverse events and financial liability. As institutions continue to adopt CDAD rates as a quality control metric, it is important to identify patients at risk before surgery, including revision total knee arthroplasty (rTKA). This study was conducted to (1) determine the incidence of CDAD within 30 days of rTKA and (2) identify perioperative risk factors for CDAD following rTKA.

Incidence, Causes, and Timing of 30-Day Readmission Following Total Knee Arthroplasty.

Background: It is important to study the incidence and causes of readmissions in order to understand why they occur and how to reduce them. This study looks at a national sample of patients following total knee arthroplasty (TKA) to identify incidences, trends, causes, and timing of 30-day readmissions.

Methods: Patients undergoing primary TKA from 2012 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program database were identified (n = 197,192).

Preoperative Functional Status Predicts Increased Morbidity Following Total Knee Arthroplasty.

Dependent functional status (DEP) has been associated with higher postoperative adverse events and mortality compared to patients with independent functional status (IND). However, the association between preoperative functional status and perioperative outcomes after primary TKA has not been well reported. Therefore, the purpose of this study was to evaluate this association.

Dependent Functional Status is a Risk Factor for Perioperative and Postoperative Complications After Total Hip Arthroplasty.

Background: As the population ages, the need for total hip arthroplasty (THA) will increase. However, this will be associated with an increase in comorbidities and a decrease in the ability to independently perform activities of daily living (ADLs). This study was designed to evaluate the impact preoperative functional status has on short-term outcomes after THA.

Improving Total Joint Replacement with Continuous Quality Improvement Methods and Tools.

Faced with increasing pressure to reduce costs, hospitals must find new ways to eliminate waste while simultaneously maintaining the highest quality of care. For any institution, these can types of changes can be complex and burdensome. This article outlines several methods that have been successful in reducing costs while maintaining high quality and highlights feasible methodologies that can help health care providers implement new quality improvement protocols.

Reimbursement Based on Value in Knee Surgery: What You Need to Know about the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015.

Health care cost is consuming a large portion of the nation's gross domestic product while placing added economic burdens on physicians and their patients. With total joint replacement being one of the early-targeted procedures in the evolving health care environment, knee surgeons will benefit from developing a critical knowledge on health care reforms and their financial implications. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents a cohesive movement toward value-based payment reform and contains several unchartered rulings that require detailed attention by knee surgeons.

Retrospective analysis of infection rate after early reoperation in total hip arthroplasty.

Background: Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the fate of these infected hips.

Questions/purposes: We therefore report the infection rate for patients undergoing THA who returned to the operating room within 90 days of his or her index procedure for any surgical intervention on the same hip.

Options for acetabular fixation surfaces.

Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial.