A search of the institutional database was performed to identify all TKAs carried out from January 2010 to May 2020. A study of TKA procedures indicated that 2514 procedures occurred before 2014, with a significant increase to 5545 procedures recorded after 2014. Data regarding 90-day emergency department (ED) visits, readmissions, and returns to operating room (OR) were collected and analyzed. Patients' characteristics, including comorbidities, age, initial surgical consultation (consult), BMI, and sex, were used to create propensity score weights for matching. Our analysis encompassed three outcome comparisons: (1) pre-2014 patients with both consultation and surgical BMIs of 40 against post-2014 patients with a consultation BMI of 40 and a surgical BMI less than 40; (2) pre-2014 patients were contrasted against post-2014 patients with consultation and surgical BMI below 40; (3) post-2014 patients with a consultation BMI of 40 and surgical BMI below 40 were compared against those having both a consultation and surgical BMI of 40 in the post-2014 group.
Patients who underwent consultations and surgery prior to 2014, with a BMI of 40 or higher, experienced a significantly greater frequency of emergency department visits (125% versus 6%, P=.002). There were equivalent readmission and return-to-OR trends between patients who had a consult BMI of 40 and surgical BMI lower than 40 and post-2014 patient cohorts. Before 2014, patients who had both a consultation and a surgical BMI below 40 exhibited a markedly higher rate of readmission (88% compared to 6%, P < .0001). Compared to their post-2014 counterparts, emergency department visits and returns to the operating room display analogous trends. 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.
Prior to total joint arthroplasty, patient optimization is critical. The benefits of a preemptive BMI reduction approach before total knee arthroplasty may significantly reduce risk for morbidly obese patients. oncology (general) For each patient, a delicate ethical balance must be struck between the pathology's severity, the predicted post-operative recovery, and the potential complications.
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Fractures of polyethylene posts, though uncommon, are a documented potential consequence subsequent to the implementation of posterior-stabilized total knee arthroplasty (TKA). We assessed the polyethylene and patient attributes of 33 primary PS polyethylene components, each of which had undergone revision with fractured posts.
Our review from 2015 to 2022 revealed 33 revised PS inserts. Patient information collected included age at initial total knee arthroplasty (TKA), gender, BMI, length of implantation, and the patient's own descriptions of events connected to the post-fracture period. Implant details recorded encompassed the manufacturer, cross-linking type (highly cross-linked polyethylene [XLPE] or ultra-high molecular weight polyethylene [UHMWPE]), evaluation of wear based on subjective scoring of the articular surfaces, and scanning electron microscopy (SEM) analysis of fracture surfaces. Patients' average age at index surgery was 55 years, ranging from 35 to 69 years of age.
The UHMWPE group displayed a statistically significant increase in total surface damage scores (573) compared to the XLPE group (442), with a P-value of .003. Fracture initiation, as evidenced by SEM analysis, occurred at the rear edge of the post in 10 of 13 cases. 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.
Post-fracture PS analysis exposed a distinction between XLPE and UHMWPE implant behaviors. XLPE failures presented with less generalized surface damage, following a lower loading index, and characterized by a more brittle fracture morphology, as evident in SEM observations.
Comparative post-fracture analysis of PS implants in XLPE and UHMWPE revealed distinct characteristics. XLPE implants demonstrated localized damage after a briefer loss of integrity, and SEM imaging suggested a more brittle fracture mechanism.
Following total knee arthroplasty (TKA), knee instability commonly results in a degree of patient dissatisfaction. Varus-valgus (VV) angulation, anterior-posterior (AP) translation, and internal-external rotation (IER) are frequently observed components of instability, manifesting as abnormal laxity in multiple directions. No existing arthrometer offers an objective measure of knee laxity encompassing all three directional components. Crucial to this investigation was the confirmation of the novel multiplanar arthrometer's safety and its reliability assessment.
The arthrometer's functionality relied upon a precisely engineered five-degree-of-freedom instrumented linkage. Two separate tests, conducted by two examiners, were administered on the legs of 20 patients who had undergone TKA (average age 65 years, age range 53-75; 9 males, 11 females). Nine patients were examined at 3 months and eleven at 1 year after the operation. Each subject's replaced knee was subjected to AP forces spanning from -10 to 30 Newtons, with concomitant VV moments of 3 Newton-meters and IER moments of 25 Newton-meters. The testing procedure involved employing a visual analog scale to assess the severity and location of knee pain experienced. Intraexaminer and interexaminer reliability were assessed using intraclass correlation coefficients.
The testing phase was successfully concluded by every subject. Participants' reported pain levels during testing had an average of 0.7 on a scale of 10, varying from 0 to 2.5. The intraexaminer reliability for all loading directions and examiners was greater than 0.77. In the VV, IER, and AP directions, the interexaminer reliability, with accompanying 95% confidence intervals, was observed to be 0.85 (0.66-0.94), 0.67 (0.35-0.85), and 0.54 (0.16-0.79), respectively.
Post-TKA, the novel arthrometer allowed for the safe evaluation of AP, VV, and IER laxity in the subjects. Evaluation of the connection between knee laxity and patient-reported instability is possible with the aid of this device.
The new arthrometer allowed for a safe measurement of AP, VV, and IER laxities in individuals who had received total knee replacement surgery (TKA). This device has the potential to explore the connection between laxity and how patients perceive knee instability.
A grave consequence of knee and hip arthroplasty is the development of periprosthetic joint infection (PJI). local antibiotics The historical record suggests a significant role for gram-positive bacteria in the causation of these infections, but the study of how the microbial makeup of PJIs changes over time is comparatively underdeveloped. This study's focus was to explore the rates and alterations in the pathogens causing prosthetic joint infections (PJI) over three decades.
A retrospective, multi-institutional study examined knee or hip prosthetic joint infections (PJIs) in patients from 1990 through 2020. Go 6983 mouse The selection criteria included patients with a confirmed causative organism, and those with insufficient sensitivity in the cultural data were excluded from the sample. A study identified 731 cases of eligible joint infections in 715 patients. 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.
There was a noteworthy and statistically significant positive linear trend in the incidence of methicillin-resistant Staphylococcus aureus over time, with a p-value of .0088. A statistically significant negative linear relationship was found between time and the incidence of coagulase-negative staphylococci, marked by a p-value of .0018. There was no demonstrable statistical link between the organism and the affected joint (knee/hip).
Prosthetic joint infections (PJI) caused by methicillin-resistant Staphylococcus aureus are increasing in frequency, while those caused by coagulase-negative staphylococci are decreasing, mirroring the growing global problem of antibiotic resistance. Discerning these patterns could help in the prevention and management of PJI by restructuring perioperative methods, modifying prophylactic and empirical antibiotic strategies, or exploring alternative therapies.
The increasing prevalence of methicillin-resistant Staphylococcus aureus prosthetic joint infections (PJI) is juxtaposed against the diminishing incidence of coagulase-negative staphylococci PJIs, a trend that mirrors the global upsurge in antibiotic resistance. Recognizing these patterns can aid in the prevention and management of PJI, potentially through adjustments to perioperative procedures, alterations to prophylactic/empirical antibiotic regimens, or shifts to alternative therapeutic approaches.
Regrettably, a substantial number of total hip arthroplasty (THA) procedures do not achieve the desired results for the patients. We set out to compare patient-reported outcome measures (PROMs) for three different total hip arthroplasty (THA) approaches, investigating the interplay of sex and body mass index (BMI) on these PROMs over a 10-year observation period.
Data from 906 patients undergoing primary THA (535 women, average BMI 307 [range 15 to 58]; 371 men, average BMI 312 [range 17 to 56]) at a single institution between 2009 and 2020, using anterior (AA), lateral (LA), or posterior approaches, were evaluated via the Oxford Hip Score (OHS). PROMs were obtained prior to the operation and repeatedly at 6 weeks, 6 months, and at 1, 2, 5, and 10 years post-surgery.
The three approaches each yielded substantial postoperative OHS improvements. Men displayed substantially higher OHS than women, a statistically significant outcome (P < .01).