Using an institutional database, we selected all instances of TKAs occurring between January 2010 and May 2020. In the examined dataset, 2514 TKA procedures were identified as pre-2014, with a much higher count of 5545 TKA procedures subsequently recorded after 2014. Data regarding 90-day emergency department (ED) visits, readmissions, and returns to operating room (OR) were collected and analyzed. Propensity score matching was applied to patients, accounting for comorbidities, age, initial surgical consultation (consult), BMI, and sex. Three comparisons of outcomes were made: (1) pre-2014 patients who underwent consultation and surgery with a BMI of 40 were compared to post-2014 patients with a consultation BMI of 40 and a surgical BMI less than 40; (2) pre-2014 patients were compared to post-2014 patients who had a consultation and surgical BMI below 40; (3) post-2014 patients with a consultation BMI of 40 and a surgical BMI less than 40 were contrasted with post-2014 patients who had a consultation BMI of 40 and a surgical BMI of 40.
A notable increase in emergency department visits was observed among pre-2014 patients who had a consultation and surgical procedure with a BMI of 40 or higher (125% versus 6%, P=.002). The rate of readmissions and returns to the operating room for patients with a consult BMI of 40 and a surgical BMI below 40 was comparable to those seen after 2014. Among patients consulted before 2014, those with a surgical BMI below 40 had a significantly higher readmission rate (88% versus 6%, P < .0001). In comparison to their post-2014 counterparts, similar trends are observed in emergency department visits and returns to the operating room. Following consultation in 2014 and later, patients having a BMI of 40 during consultation and a subsequent surgical BMI lower than 40 showed fewer emergency department visits (58% versus 106%) yet similar readmission and return to operating room rates as compared to patients with a consultation and surgical BMI of 40.
A crucial aspect of total joint arthroplasty is the optimization of the patient's condition beforehand. Prioritization of BMI reduction strategies before total knee arthroplasty appears to significantly lessen the risks for morbidly obese patients. click here For each patient, we must navigate the ethical considerations surrounding the pathology, expected surgical improvement, and all possible risks of complications.
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Although a rare side effect, fracturing of the polyethylene post can occur after a posterior-stabilized (PS) total knee arthroplasty (TKA). Analysis encompassed the polyethylene and patient-related attributes of 33 primary PS polyethylene components that underwent revision using fractured posts.
Thirty-three PS inserts were identified; revisions were made between 2015 and 2022. Age at index TKA, sex, BMI, length of implantation (LOI), and patient-reported details regarding events surrounding the post-fracture period were among the patient characteristics collected. Manufacturer, cross-linking specifics (high cross-linking polyethylene [XLPE] or ultra-high molecular weight polyethylene [UHMWPE]), subjective assessments of articular surface wear, and scanning electron microscopy (SEM) of fracture surfaces were all recorded implant characteristics. Mean age at the time of index surgery stood at 55 years, spanning a range from 35 to 69 years.
A statistically significant difference (P = .003) was found in total surface damage scores between the UHMWPE group (score 573) and the XLPE group (score 442). In 10 of 13 examined cases, SEM analysis revealed fracture initiation at the posterior edge of the post. Fractured UHMWPE surfaces displayed a higher density of tufted, irregularly shaped clamshell features, while XLPE surfaces showcased a more precise clamshell pattern and a diamond design in the area of the final fracture.
The post-fracture PS traits of XLPE and UHMWPE implants diverged. XLPE implant failures demonstrated less widespread surface damage, happening sooner after load initiation, and exhibited a more fragile fracture appearance, as determined by scanning electron microscope analysis.
The post-fracture characteristics of PS in XLPE and UHMWPE implants differed. XLPE fractures manifested less surface damage, following a shorter loss-of-integrity time, and SEM indicated a more brittle failure pattern.
The presence of knee instability is a primary source of complaint following total knee arthroplasty (TKA). Unstable conditions may exhibit unusual flexibility in various planes, encompassing varus-valgus (VV) angulation, anterior-posterior (AP) translation, and internal-external rotation (IER). Objective quantification of knee laxity in all three directions remains unachieved by any current arthrometer technology. The researchers intended to verify the safety and establish the trustworthiness of a new multiplanar arthrometer within this study.
The arthrometer featured an instrumented linkage with a five-degree-of-freedom design. Two examiners each performed two tests on the operative leg of each of 20 patients (mean age 65 years, age range 53-75, 9 males, 11 females) who had undergone total knee arthroplasty (TKA). Nine patients were assessed at three months postoperatively; eleven at one year. Subject-specific replaced knees were exposed to AP forces ranging from -10 to 30 Newtons, simultaneously experiencing VV moments of 3 Newton-meters and IER moments of 25 Newton-meters. Using a visual analog scale, the researchers assessed the degree and placement of knee pain observed during the testing. The intraclass correlation coefficients served to characterize the intraexaminer and interexaminer reliabilities.
The testing phase was successfully concluded by every subject. The average pain score recorded during the testing phase was 0.7, out of a potential 10-point scale, with scores ranging from 0 to 2.5. Every examiner and every loading direction showed intraexaminer reliability above 0.77. Reliability across examiners, with 95% confidence intervals, was 0.85 (0.66 to 0.94) for the VV, 0.67 (0.35 to 0.85) for the IER, and 0.54 (0.16 to 0.79) for the AP directions.
Subjects who had received TKA benefited from the safe application of the novel arthrometer for evaluating AP, VV, and IER laxities. This device enables researchers to investigate the interplay between knee laxity and patients' experiences of instability in their knees.
In post-TKA subjects, the novel arthrometer enabled safe evaluation of anterior-posterior, varus-valgus, and internal-external rotation ligament laxities. The device can be used for a study into the correlation between laxity and patients' feelings of instability in their knees.
Periprosthetic joint infection (PJI) is a deeply troubling complication that frequently emerges post-knee and hip arthroplasty. Rodent bioassays Previous research has highlighted the frequent involvement of gram-positive bacteria in such infections, yet the dynamic nature of microbial communities within PJIs has been understudied. Through this study, the incidence and shifts in the pathogens causing prosthetic joint infections (PJI) over three decades were analyzed.
Patients with knee or hip prosthetic joint infections (PJI) from 1990 to 2020 were examined in this multi-institutional, retrospective study. Shoulder infection The selection criteria included patients with a confirmed causative organism, and those with insufficient sensitivity in the cultural data were excluded from the sample. In the pool of 715 patients, 731 joint infections were deemed eligible. Categorizing organisms by genus and species, the study period was analyzed in five-year intervals. Microbial profile linear trends over time were examined through the use of Cochran-Armitage trend tests, where a P-value of less than 0.05 was indicative of statistical significance.
A noteworthy linear increase, statistically significant, in the occurrence of methicillin-resistant Staphylococcus aureus was observed across the timeframe (P = .0088). The incidence of coagulase-negative staphylococci demonstrated a statistically significant, negative, linear decrease over time, as evidenced by a p-value of .0018. The organism exhibited no statistically significant impact on the affected joint (knee/hip).
The increasing prevalence of methicillin-resistant Staphylococcus aureus prosthetic joint infections (PJI) is in stark contrast to the declining frequency of coagulase-negative staphylococci PJIs, which aligns with the broader global issue of antibiotic resistance. Identifying these tendencies could contribute to preventing and treating PJI by modifying surgical protocols during the operative period, adjusting antimicrobial prophylaxis and empiric treatments, or adopting novel therapeutic pathways.
There is a marked increase in cases of methicillin-resistant Staphylococcus aureus prosthetic joint infection (PJI), conversely, coagulase-negative staphylococci PJI is trending downward, a pattern consistent with the growing global antibiotic resistance. The establishment of these developing patterns can be valuable in the prevention and care of PJI by adjusting surgical processes, modifying prophylactic/empirical antimicrobial approaches, or transitioning to alternative therapeutic treatments.
Unfortunately, a noteworthy group of individuals undergoing total hip arthroplasty (THA) report outcomes that are less than satisfactory. We endeavored to contrast the patient-reported outcome measures (PROMs) associated with three principal THA strategies, and analyze how sex and body mass index (BMI) affected these PROMs longitudinally over a ten-year duration.
Employing the Oxford Hip Score (OHS), a single institution reviewed 906 patients (535 women, average BMI 307 [range 15 to 58]; 371 men, average BMI 312 [range 17 to 56]) who underwent primary total hip arthroplasty (THA) via anterior (AA), lateral (LA), or posterior approaches from 2009 to 2020. PROMs were collected before surgical procedures and were routinely evaluated at 6 weeks, 6 months, and 1, 2, 5, and 10 years after the surgical interventions.
All three approaches demonstrated a considerable enhancement in postoperative OHS. A statistically significant disparity in OHS was observed between men and women, with men exhibiting considerably higher levels (P < .01).