Identifying Reasons for Failed Same-Day Discharge Following Primary Total Hip Arthroplasty.

Background: As total hip arthroplasty (THA) gains popularity in ambulatory surgery centers, it is important to understand the causes of failed same-day discharge (SDD). The purpose of this study is to (1) identify reasons for an overnight stay among patients selected as candidates for SDD following THA and (2) determine what pre-operative factors are more common among patients who fail SDD.

Methods: This is a prospective cohort study of patients undergoing THA who were identified as candidates for SDD (<75 years, ambulate without walker, American Society of Anesthesiologists score 1-3, body mass index <40 kg/m, and agreed to SDD pre-operatively).

Calculating the Cost and Risk of Comorbidities in Total Joint Arthroplasty in the United States.

Background: With increased scrutiny regarding the cost and safety of health care delivery, there is increasing interest in judicious patient selection for total joint arthroplasty (TJA) procedures. It is unknown which comorbidities incur the greatest increase in risk to the patient and cost to the system after TJA. Therefore, this study sought to characterize the association of common preoperative comorbidities with both the risk for postoperative in-hospital complications and the total hospital cost in patients undergoing TJA.

International Rates of Patellar Resurfacing in Primary Total Knee Arthroplasty, 2004-2014.

Background: Patella resurfacing is performed in >80% of primary total knee arthroplasties (TKAs) in the United States, yet far fewer patellae are resurfaced internationally. Recent registry data have begun to question the long-held belief that patellar resurfacing yields lower revision rates. Multiple current meta-analyses have not shown a difference in patient satisfaction, anterior knee pain, or knee society scores based on patellar resurfacing.

Patient Perception of Value in Bundled Payments for Total Joint Arthroplasty.

Background: A central concern for providers in a bundled payment model is determining how the bundle is distributed. Prior studies have shown that current reimbursement rates are often not aligned with patients' values. While willingness-to-pay (WTP) surveys are perhaps useful in a fee-for-service arrangement to determine overall reimbursement, the percentage of payment distribution might be as or more important in a bundled payment model.

The Halo Effect: An Unintended Benefit of Care Pathways.

The objective of this study was to determine if implementation of a simplified care pathway for total knee arthroplasty (TKA) would affect outcomes of total hip arthroplasty (THA) patients in the same health care system. Data were collected from a total of 5,095 consecutive THA patients in the year before and 2 years after implementation of the care pathway for TKA patients. Postimplementation increases were observed in both early activity ( < 0.

Wear and loosening in total knee arthroplasty: a quick review.

Wear and osteolysis are common problems that often require revision surgery following total knee arthroplasty (TKA). Wear rates can be reduced through proper implant positioning and the use of modern, highly cross-linked polyethylene liners. More research is needed to identify medications that could prevent or treat the bone loss associated with osteolysis.

The Gown-glove Interface Is a Source of Contamination: A Comparative Study.

Background: The original Charnley-type negative-pressure body exhaust suit reduced infection rates in randomized trials of total joint arthroplasty (TJA) decades ago. However, modern positive-pressure surgical helmet systems have not shown similar benefit, and several recent studies have raised the question of whether these gowning systems result in increased wound contamination and infections. The gown-glove interface may be one source of particle contamination.

America's fertile frontier: how America surpassed Britain in the development and growth of plastic surgery during the interwar years of 1920-1940.

Most historians agree that modern plastic surgery was born out of the efforts of reconstructive surgeons in World War I (WW I). In a single British hospital, over 8000 wounded soldiers were treated for disfiguring facial wounds. These gruesome injuries provided surgeons with enough cases to make unprecedented advances in tissue reconstruction.