Time from surgery end to discharge following total knee arthroplasty: implications for same day discharge.

Background: Understanding the average time from surgery to discharge is important to successfully and strategically schedule cases planned for same day discharge (SDD) for total knee arthroplasty (TKA). The purpose of this study was to (1) evaluate the average time to discharge following unilateral TKA performed in a community hospital and (2) describe patient characteristics and peri-operative factors that may impact SDD.

Methods: This retrospective review included 75 patients having achieved SDD following unilateral TKA between March 2017 and September 2021 at a high-volume multi-specialty community hospital.

Complications following single-stage bilateral total knee arthroplasty and unilateral procedures: experience of a high-volume community hospital.

Introduction: The safety of single-stage bilateral total knee arthroplasty (SSBTKA) compared to unilateral total knee arthroplasty (TKA) remains controversial. The present study compares the 90-day postoperative complications encountered following SSBTKA and unilateral TKA in an unselected cohort of patients performed at a high-volume community hospital.

Materials And Methods: The perioperative electronic medical records of an unselected consecutive cohort of 1032 patients (1345 knees) having undergone unilateral or SSBTKA were reviewed.

Preoperative Educational Classes in Elderly Patients May Not be Necessary Prior to Elective Joint Arthroplasty.

Preoperative arthroplasty classes decrease complications and readmissions, however, in-person classes are inconvenient for elderly patients with mobility limitations. This retrospective review included 232 patients (305 joints) with in-person preoperative educational classes (IPC) and 155 patients (192 joints) with telephone preoperative educational classes (TC). Compared to IPC, TC patients had a shorter length of stay (P<.

Higher intra-operative narcotic requirements and weakness with quadratus lumborum compared to paravertebral nerve block for total hip arthroplasty.

Background: This was a prospective single-blinded study comparing the peri-operative opioid consumption and motor weakness for patients undergoing total hip arthroplasty (THA) with either a Quadratus Lumborum Type 3 Nerve Block (QLB) or a Paravertebral Nerve Block (PVB).

Methods: A consecutive cohort of patients undergoing elective anterior approach (AA) THA by a single high-volume surgeon were randomly assigned an anesthesiologist by the charge anesthesiologist. One anesthesiologist performed all QLBs, and the other six anesthesiologists performed the PVBs.

COVID-19 had Limited Impact on Resumption of Elective Joint Arthroplasty and Ethnic Disparities.

In response to the COVID-19 pandemic, federal and state recommendations included the postponement of elective arthroplasties until adequate safety measures could be implemented. Following resumption of arthroplasties, exposure fears and financial concerns may have restricted access for some demographics. Therefore, the purpose of this study was to (1) investigate how the COVID-19 pandemic impacted the incidence of arthroplasty, both overall and by various demographics, and (2) evaluate if pre-operative patient-reported measures were different throughout the pandemic.

Can a community hospital successfully transition to outpatient total knee arthroplasty in unselected patients?

Background: The removal of total knee arthroplasty (TKA) from the Inpatient-Only list in 2018 created pressure on community hospitals to develop rapid discharge protocols (RAP) to increase outpatient discharge. The purpose of this study, therefore, was to compare the efficacy, safety and barriers in achieving outpatient discharge between the standard discharge protocol and newly developed RAP in unselected, unilateral TKA patients.

Methods: This retrospective chart review included 288 standard protocol patients and the first 289 RAP patients following unilateral TKA in a community hospital.

True "outpatient discharge" following single-stage bilateral unicompartmental knee arthroplasty may be unrealistic for most.

Background: Single-stage bilateral unicompartmental knee arthroplasty (BUKA) has shown post-operative function and cost benefits over staged bilateral procedures, without increased complications. A rapid discharge protocol at the current study site has reported outpatient discharge for the unilateral procedure exceeding 97%. However, the feasibility of outpatient discharge following BUKA remains unclear.

A smaller femoral stem is needed for asian females.

Background: Current femoral implants are manufactured based on Western anatomical structures and may be too large for smaller physiques, such as those of Asian females. This study reviewed the femoral stem size distribution used in a high-volume total hip arthroplasty (THA) practice and evaluated malalignment in patients receiving a size one implant.

Materials And Methods: A consecutive cohort of female patients self-reported as Asian (257 patients, 331 hips) or Caucasian (158 patients and 190 hips) were retrospectively evaluated.

Fixed 6° distal femoral cut consistently achieves neutral alignment for Asians, Caucasians, and Native Hawaiian/Pacific Islanders.

Background: Restoration of a neutral mechanical axis (MA) is important to the success of total knee arthroplasty (TKA). While known differences are present between Asians and Caucasians regarding native knee alignment, it is unknown whether such differences exist amongst Native Hawaiian/Other Pacific Islanders (NHPI) or if utilizing a fixed distal femoral cut of 6° can consistently achieve a neutral MA in these minority racial groups. This study examines the preoperative deformities presented by Asians, Caucasians, and NHPI, and the resulting knee alignment achieved following TKA when a fixed 6° distal femoral cut is targeted for all patients.

Reducing transfusion in hip arthroplasty: tranexemic acid diminishes influence of anesthesia administered.

Background: The risk of transfusion following total hip arthroplasty (THA) continues to be problematic. The best choice of anesthesia (spinal vs general) and impact of tranexamic acid (TXA) use in reducing transfusions following surgery remain unclear. Therefore, the purpose of this study was to compare rates of blood transfusion following THA via the anterior approach using three different anesthesia protocols with and without TXA.

Outcomes After Hip Labral Reconstruction Using Peroneus Longus Graft: A Novel Graft Experience.

Currently, there is no consensus on the ideal graft for hip labral reconstruction. The purpose of this study was to describe the surgical technique and report the short-term outcomes after hip labral reconstruction using a peroneal longus allograft. Eleven patients diagnosed with femoracetabular impingement and irreparable damage to the acetabular labrum underwent labral reconstruction with a peroneus longus allograft.

Tempering Expectations for Outpatient Total Knee Arthroplasty for Patients Over 70.

Background: Total knee arthroplasty (TKA) is now considered an outpatient procedure, yet advanced age impacts patients' ability to achieve outpatient discharge. Therefore, the purpose of this study is to determine the rate of successful outpatient discharge for TKA patients above 70 years of age and identify potential barriers to success.

Methods: This retrospective review included 352 unilateral TKA patients.

Does femoral stem choice influence fracture type or incidence for direct anterior approach total hip arthroplasty?

Introduction: Despite similar fracture rates, the incidence of intraoperative and post-operative fractures between standard (ST) length and short (SH) femoral stems remains unclear. Therefore, this study compared the incidence of intraoperative and early postoperative fractures between three ST and a single tapered-wedge SH femoral stem.

Materials And Methods: Data were retrospectively collected on 1113 patients (1306 hips) having undergone total hip arthroplasty, via the anterior approach on a fracture table, between 2014 and 2019.

Stepping toward outpatient total hip arthroplasty with a rapid discharge protocol.

With total hip arthroplasty no longer an inpatient only procedure, this study retrospectively evaluated the percentage of same day, outpatient (<24 h) and inpatient (>24 h) discharges between 543 standard discharge (SDP) and 372 rapid discharge (RDP) patients. Outpatient discharges increased from 31.9% with SDP to 87.

Osteoporosis treatment rates after hip fracture 2011-2019 in Hawaii: Undertreatment of men after hip fractures.

Objectives: To investigate trends of osteoporosis treatment rates, and factors affecting osteoporosis treatment after hip fracture admission within a single health care system in Hawaii.

Methods: A retrospective chart review was conducted of patients aged 50 years or older and hospitalized for hip fractures between January 1, 2011 and December 31, 2019 at Hawaii Pacific Health, a large health care system in Hawaii. We collected data on basic demographics and osteoporosis medication prescription from electronic medical records.

Does age increase perioperative complications for single-stage bilateral total hip arthroplasty?

The potential of post-operative complication may exclude elderly patients from undergoing single-staged bilateral total hip arthroplasty (SSBTHA). This study retrospective compared perioperative complications between SSBTHA patients <70 (N = 157) and ≥70 (N = 56) years of age. Patients ≥70 had significantly lower body mass index (p = 0.

Can obese patients undergo simultaneous bilateral total knee arthroplasty without an increased risk of perioperative complications?

Simultaneous bilateral total knee arthroplasty (simBTKA) remains controversial, especially in obese patients. Therefore, this retrospective study compared six month perioperative complications in 313 simBTKA patients. Comparison groups included 139 non-obese patients (BMI < 30), 61 obese patients (BMI = 30-35) and 48 severely obese patients (BMI > 35).

Similar infection rates in a new wound closure method following knee arthroplasty.

Surgical site infections, defined as acute wound infections requiring surgical intervention within 90 days post-surgery, were retrospectively compared between a novel, zipper-like closure method (ZM) and staples in 682 patients (904 knees) and 772 patients (971 knees), respectively. The incidence of deep infections was 0.6% for staples and 0.

Component positioning of the first 300 mobile bearing unicompartmental knee arthroplasties.

The Oxford® Partial Knee has excellent long-term survivorship but high surgical times indicate a learn curve. This retrospective review included a radiographic evaluation of component placement of the initial 300 procedures following conversion from fixed bearing implant use. The anteroposterior and sagittal femoral angles were considered inaccurate in 1.

Safety of Single-Stage Bilateral Direct Anterior Approach Total Hip Arthroplasty Performed in All Eligible Patients at a Honolulu Hospital.

Total hip arthroplasty (THA) is a commonly performed surgery, with candidates often requiring bilateral replacement. Simultaneous, single-stage bilateral THA offers several advantages and the direct anterior approach (DAA) for THA is well-suited for this procedure. In Hawai'i, single-stage bilateral DAA THA has yet to be adopted as a primary practice, and currently, there is limited research on patient outcomes following single-stage bilateral DAA THA in heterogeneous patient populations.