Concomitant Gluteal and Thigh Compartment Syndrome Following Atraumatic Injury.

Gluteal compartment syndrome is a rare diagnosis associated with pelvic trauma and subsequent surgical intervention. Herein, we discuss the case and management of gluteal and thigh compartment syndrome following prolonged immobilization secondary to alcohol. To our knowledge, we present the first case of concomitant gluteal and thigh compartment syndrome following atraumatic injury.

Shorter Time to Surgery Is Associated With Better Outcomes for Spondylolisthesis in the Workers' Compensation Population.

This study sought to determine the impact of time to surgery on clinical outcomes in patients with spondylolisthesis in the workers' compensation (WC) population. There is conflicting evidence regarding the effect of time to surgery on patients with spondylolisthesis. Patients receiving WC are known to have worse outcomes following spine surgery compared with the general population.

Infrapatellar Fat Pad Resection or Preservation during Total Knee Arthroplasty: A Systematic Review.

Considerations of how to improve postoperative outcomes for total knee arthroplasty (TKA) have included preservation of the infrapatellar fat pad (IPFP). Although the IPFP is commonly resected during TKA procedures, there is controversy regarding whether resection or preservation should be implemented, and how this influences outcomes. Therefore, the purpose of this systematic review was to evaluate how IPFP resection and preservation impacts postoperative flexion, pain, Insall-Salvati Ratio (ISR), Knee Society Score (KSS), patellar tendon length (PTL), and satisfaction in primary TKA.

Effects of a Total Knee Arthroplasty Care Pathway on Cost, Quality, and Patient Experience: Toward Measuring the Triple Aim.

Background: Care pathways are increasingly important as the shift toward value-based care continues; however, there is an inconsistent literature regarding their efficacy. The authors hypothesized that a total knee arthroplasty (TKA) care pathway, at a multihospital health system, would decrease cost, length of stay (LOS), discharges to inpatient facilities, postoperative complications at 90 days, and improve patient experience.

Methods: A historical control study with multivariable regression was used to determine the association of an evidence-based care pathway with episode of care cost, LOS, discharge disposition, 90-day postoperative complications, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

Effect of Antibiotic-Impregnated Bone Cement in Primary Total Knee Arthroplasty.

Background: The purpose of this study is to evaluate the effect of commercially available antibiotic-impregnated bone cement (AIBC) on (1) prosthetic joint infections (PJIs) and (2) surgical site infections (SSIs) after primary total knee arthroplasty (TKA).

Methods: A review of primary TKAs between 2014 and 2017 from an institutional database was conducted. This identified 12,541 cases which were separated into AIBC (n = 4337) and non-AIBC (8,164) cohorts.

Patients with a History of Treated Septic Arthritis are at High Risk of Periprosthetic Joint Infection after Total Joint Arthroplasty.

Background: In patients undergoing total joint arthroplasty (TJA), increasing attention has been directed recently toward identifying specific patient-related risk factors that may predispose patients to periprosthetic joint infection (PJI). Currently, it is unclear whether having a history of a treated native septic arthritis is a risk factor for PJI after TJA in the same joint. Previous studies have reported contradictory evidence and results varied between a substantially higher rates of PJIs to very low or no reported PJIs.

No Difference Between Low- and Regular-dose Aspirin for Venous Thromboembolism Prophylaxis After THA.

Background: Aspirin is established as an effective prophylaxis for venous thromboembolism (VTE) after THA; however, there is no consensus as to whether low- or regular-dose aspirin is more effective at preventing VTE.

Questions/purposes: (1) Is there a difference in the incidence of symptomatic VTE within 90 days of elective THA using low-dose aspirin compared with regular-dose aspirin? (2) Is there a difference in the risk of significant bleeding (gastrointestinal and wound bleeding) and mortality between low- and standard-dose aspirin within 90 days after surgery?

Methods: We retrospectively evaluated 7488 patients in our database who underwent THA between September 2012 and December 2016. A total of 3936 (53%) patients received aspirin alone for VTE prophylaxis after THA.

Arthroscopic irrigation and debridement is associated with favourable short-term outcomes vs. open management: an ACS-NSQIP database analysis.

Purpose: Septic arthritis of the knee is an orthopaedic emergency that is associated with marked morbidity and can potentially be life threatening. Surgical debridement can be performed either arthroscopically or via an arthrotomy. The aim of this study was to compare the 30-day complications and adverse outcomes between the two procedures.

Emergency Department Visits Within Thirty Days of Discharge After Primary Total Hip Arthroplasty: A Hidden Quality Measure.

Background: Thirty-day hospital readmissions following total hip arthroplasty (THA) have received increasing scrutiny by policy makers and hospitals. Emergency department (ED) visits may not necessarily result in an inpatient readmission but can be a measure of performance and can incur costs to the health system. The purpose of this study is to describe the following: (1) the frequency and subsequent disposition; (2) patient characteristics; (3) reasons; and (4) potential risk factors for ED visits that did not result in a readmission within 30 days of discharge after THA.

Same-Day Bilateral Total Knee Arthroplasty Candidacy Criteria Decrease Length of Stay and Facility Discharge.

Simultaneous bilateral total knee arthroplasty (SBTKA) may present a higher risk for postoperative complications than unilateral surgery. The authors retrospectively identified 561 patients who underwent SBTKA between 2013 and 2015. The cohort was stratified according to the following appropriateness of care criteria (AOCC): (1) age younger than 70 years; (2) absence of cardiac disease; (3) controlled diabetes; and (4) body mass index less than 30 kg/m.

Validation of a Novel Surgical Data Capturing System Following Total Hip Arthroplasty.

Background: The OrthoMiDaS (Orthopedic Minimal Data Set) Episode of Care (OME) database was developed in an effort to advance orthopedic outcome measurements on a national scale. This study was designed to evaluate if the OME data capture system would increase the quality of data collected in the context of primary and revision total hip arthroplasty (THA) compared to conventional operative notes.

Methods: This study includes data from the first 100 primary THAs and 100 revision THAs performed by 15 surgeons at a single institution from January through April 2016.

Overlapping Lower Extremity Total Joint Arthroplasty Does Not Increase the Risk of 90-Day Complications.

Although total hip arthroplasty and total knee arthroplasty commonly overlap, there are concerns about the safety and quality of this scenario. The objectives of this study were to (1) compare the operative time and the incidence of 90-day complications between overlapping and nonoverlapping total joint arthroplasties; and (2) evaluate the effect of the duration of overlap on operative time and the incidence of 90-day complications. A total of 9192 patients who underwent primary total hip arthroplasty or total knee arthroplasty at a large academic hospital from 2005 to 2014 were identified.

Cervicothoracic Pedicle Morphometry: Using an Osteological Collection to Characterize Trends in Pedicle Size.

Pedicle screws are a common treatment option for spinal instability. Despite their popularity, pedicle screws carry the risk of transpedicular violation with subsequent neural and vascular damage. This study measured the pedicle dimensions of 500 dry specimens in an osteological collection.

Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty.

Background: Chronic obstructive pulmonary disease (COPD) is a major global health issue and a leading cause of morbidity and mortality. Patients with COPD are at increased risk of complications following surgery. The purpose of this study is to evaluate the postoperative total knee arthroplasty (TKA) outcomes in these patients in comparison to a non-COPD matching cohort.

Low-Dose Aspirin Is Safe and Effective for Venous Thromboembolism Prophylaxis Following Total Knee Arthroplasty.

Background: Aspirin is an effective prophylaxis for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The optimal prophylactic aspirin dose has not been established. The study aims to compare 2 aspirin regimens with regard to the incidence of (1) symptomatic deep venous thrombosis (DVT), (2) pulmonary embolism (PE), (3) bleeding, and (4) mortality within 90 days after TKA.

High Efficiency Particulate Air Filters Do Not Affect Acute Infection Rates During Primary Total Joint Arthroplasty Using Forced Air Warmers.

Background: Studies have suggested that forced-air warmers (FAWs) increase contamination of the surgical site. In response, FAWs with high efficiency particulate air filters (FAW-HEPA) were introduced. This study compared infection rates following primary total joint arthroplasty (TJA) using FAW and FAW-HEPA.

What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

Due to the paucity of evidence, this study was conducted to evaluate: (1) unique characteristics of multiple sclerosis (MS) patients and (2) short-term clinical outcomes, of primary total knee arthroplasty (TKA) in patients with MS (MS-TKA) compared with matched non-MS patients. MS patients who underwent TKA were identified using the Nationwide Inpatient Sample (NIS) database. The study sample consisted of 10,884 patients with MS and 56,45,227 control cohort.

Implementation of a Total Hip Arthroplasty Care Pathway at a High-Volume Health System: Effect on Length of Stay, Discharge Disposition, and 90-Day Complications.

Background: Standardized care pathways are evidence-based algorithms for optimizing an episode of care. Despite the theoretical promise of care pathways, there is an inconsistent literature demonstrating improvements in patient care. The authors hypothesized that implementing a care pathway, across 11 hospitals, would decrease hospital length of stay (LOS), decrease postoperative complications at 90 days, and increase discharges to home.

Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Hip Arthroplasty.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Furthermore, COPD patients are at increased risk of complications following surgery. The purpose of this study was to evaluate the postoperative total hip arthroplasty (THA) outcomes of COPD patients.

Diagnostic Utility of Histological Analysis for Detecting Ongoing Infection During Two-Stage Revision Arthroplasty in Patients With Inflammatory Arthritis.

Background: Surgeons often rely on intra-operative histology (frozen sections [FS]) to determine the next step in surgical management during the second stage (re-implantation surgery) of 2-stage revision arthroplasty. The purpose of the study is to assess the accuracy of permanent sections (PS) and FS in the diagnosis of persistent infection during re-implantation in patients with an inflammatory arthritis.

Methods: From 2001 to 2016, 47 planned second-stage revision total hip arthroplasty and total knee arthroplasty in patients with inflammatory arthritis were identified.

Economic evaluation of different suture closure methods: barbed versus traditional interrupted sutures.

Healthcare systems are receiving increasing pressures from payers, such as the Centers for Medicare and Medicaid (CMS), to reduce the costs associated with procedures, and with the implementation of the Affordable Care Act, high costs are addressed through pay-for-performance programs. Thus, multiple areas of total knee arthroplasty (TKA) surgery are under scrutiny, including surgical times, material costs, and the costs of associated complications and readmissions. Suture type has been determined to be a factor that may influence closure times, as well as direct material costs.

The Role of Barbed Sutures in Wound Closure Following Knee and Hip Arthroplasty: A Review.

Lower extremity joint arthroplasty procedures often require a large incision to have an adequate exposure, which subsequently leads to lengthy wounds that may contribute to long closure, anesthesia, and overall operative times. The recently introduced knotless barbed suture may provide better outcomes, faster closure time, and decreased material utilization. Therefore, the aim of this study was to review the impact of barbed sutures on: (1) wound-related complications; (2) closure and operative time; (3) patient outcomes (range of motion and Knee Society Scores [KSS]); and (4) effects on cosmesis and patients' satisfaction.

Reduction of Particles in the Operating Room Using Ultraviolet Air Disinfection and Recirculation Units.

Background: Airborne bacteria are a major source for wound contamination during total joint arthroplasty. Crystalline ultraviolet C (C-UVC) filter units were designed to disinfect and recirculate air in the operating room (OR). This preliminary study assessed the particle reducing capacity of C-UVC units in a highly controlled OR setting.

Knee Position during Surgical Wound Closure in Total Knee Arthroplasty: A Review.

Study areas concerning maximizing knee range of motion (ROM) following total knee arthroplasty (TKA) have come under focus by surgeons. Among the perioperative factors that were identified to affect ROM after TKAs is knee position during surgical wound closure. Therefore, the aim of this study was to review the impact of knee position during TKA wound closure on: (1) postoperative ROM, (2) wound-related complications, (3) Knee Society Score (KSS), (4) postoperative pain, and (5) muscle strength and home functional recovery.