Comparison of Area Deprivation Index, Socioeconomic Parameters, and Preoperative Demographics With Postoperative Emergency Department Visits After Total Knee Arthroplasty

BACKGROUND: This study aims to determine if socioeconomic (SE) parameters, primarily area deprivation index (ADI), relate to postoperative emergency department (ED) visits after total knee arthroplasty (TKA). METHODS: We retrospectively reviewed 2655 patients who underwent TKA in a health system of 4 hospitals. The primary outcome was an ED visit within 90 days, which was divided into those with and without readmission. SE parameters including ADI as well as preoperative demographics were analyzed. Univariable and multiple logistic regressions were performed determining risk of 90-day postoperative ED visits, as well as once in the ED, risks for readmission. RESULTS: 436 patients (16.4%) presented to the ED within 90 days. ADI was not a risk factor. The multiple logistic regression demonstrated men, Medicare or Medicaid, and preoperative ED visits were consistently risk factors for a postoperative ED visit with and without readmission. Preoperative anticoagulation was only a risk factor for ED visits with readmission. Among patients who visited the ED, if the patient was Caucasian, a lower BMI, or higher American Society of Anesthesiologists score, they were likely to be readmitted. CONCLUSION: The study demonstrated that the percentage of early ED returns after TKA was high and that ADI was not a predictor for 90-day postoperative ED visit. The only SE factor that may contribute to this phenomenon was insurance type. Once in the ED, race, preoperative ED visits, preoperative anticoagulation, BMI, gender, and preoperative American Society of Anesthesiologists score contributed to a risk of readmission. The study supports hospitals\u27 mission to provide equal access health care

Interactive effects and modeling of some processing parameters on milling, cooking, and sensory properties for Nigerian rice using a one-step ricemilling machine

This study investigates the interactive effects of processing parameters on the quality of milled rice using a one-step milling machine. Also, predictive models were generated using response surface methodology. The pro-cessing parameters were moisture content (10–14 % dry basis), shaft speed of rotation (600–900 rpm), andpolishing time (1–3 min). The quality parameters evaluated were milling (head rice yield, percentage broken rice,fine broken rice, and milled rice yield), cooking (optimum cooking time, kernel elongation ratio, and widthexpansion ratio), and sensory (flavor, aroma, appearance, texture, and overall acceptability) properties. The re-sults showed that the interactive effects of moisture content, shaft speed, and polishing time were significant (P<0.05) on percentage broken rice, milled rice yield,fine broken rice, optimum cooking time, kernel elongationratio, width expansion ratio, aroma, and appearance but was not significant on head rice yield,flavor, texture, andoverall acceptability. These results were similar to the regression models generated. In conclusion, the interactiveeffects of these processing parameters affect all the cooking properties but not all milling and sensory propertieswhile using a one-step milling machine

Effects of Preoperative Carbohydrate-rich Drinks on Immediate Postoperative Outcomes in Total Knee Arthroplasty: A Randomized Controlled Trial

BACKGROUND: This study investigates the effects of preoperative carbohydrate-rich drinks on postoperative outcomes after primary total knee arthroplasty. METHODS: We prospectively randomized 153 consecutive patients undergoing primary total knee arthroplasty at one institution. Patients were assigned to one of three groups: group A (50 patients) received a carbohydrate-rich drink; group B (51 patients) received a placebo drink; and group C (52 patients) did not receive a drink (control). All healthcare personnel and patients were blinded to group allocation. Controlling for demographics, we analyzed the rate of postoperative nausea and vomiting, length of stay, opiate consumption, pain scores, serum glucose, adverse events, and intraoperative and postoperative fluid intake. RESULTS: Demographics and comorbidities were similar among the groups. There were no significant differences in surgical interventions or experience. Surgical fluid intake and total blood loss were similar among the three groups (P = 0.47, P = 0.23). Furthermore, acute postoperative outcomes (ie, pain, episodes of nausea, and length of stay) were similar across all three groups. There were no significant differences in adverse events between the three groups (P = 0.13). There was a significant difference in one-time postoperative bolus between the three groups (P = 0.02), but after multivariate analysis, it did not demonstrate significance. None of the intervention group were readmitted, whereas 5.9% and 11.5% were readmitted in the placebo and control groups, respectively (P = 0.047). The chance of 90-day readmission was reduced in group A compared with group C (odds ratio, 0.08; 95% confidence interval, 0.01 to 0.72; P = 0.02). There were no differences in other postoperative outcome measurements. CONCLUSION: This randomized controlled trial demonstrated that preoperative carbohydrate loading does not improve immediate postoperative outcomes, such as nausea and vomiting; however, it demonstrated that consuming fluid preoperatively proved no increased risk of adverse outcomes and there was a trend toward decrease of one-time boluses postoperatively. CLINICAL TRIALS REGISTRY: NCT03380754

Return to Play and Performance in Golfers After Total Knee Arthroplasty: Does Component Type Matter?

BACKGROUND: Golf is a popular sport among patients undergoing total knee arthroplasty (TKA). The golf swing requires significant knee rotation, which may lead to changes in golfing ability postoperatively. The type of implant used may alter the swing mechanics or place different stresses on the knee. The purpose of this study was to evaluate golf performance and subjective stability after TKA and compare outcomes between cruciate-retaining (CR) and posterior-stabilized (PS) implants. HYPOTHESIS: Patients with CR implants will experience better stability during the golf swing compared to patients with PS implants. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Patients who underwent primary TKA were identified from the medical record and sent an electronic questionnaire focusing on return to play (RTP), performance, pain, and stability during the golf swing. Knee injury and Osteoarthritis Outcome Scores (KOOS) were collected before and at multiple time points after surgery. Patients were surveyed postoperatively and asked to evaluate overall performance, pain, and stability before and after surgery. Outcomes were compared based on implant type. RESULTS: Most patients (81.5%) were able to return to golf at an average of 5.3 ± 3.1 months from surgery. The average postoperative KOOS was 74.6 ± 12.5 in patients able to RTP compared with 64.4 ± 9.5 in those who were not ( CONCLUSION: Most patients can successfully return to golfing after TKA. Knee replacement offers patients reliable pain relief during the golf swing and fewer physical limitations during golf, with no detriment to performance. There is no difference in performance or subjective knee stability based on component type. CLINICAL RELEVANCE: Understanding associated outcomes of different TKA knee systems allows for unbiased and confident recommendations of either component to golfers receiving total knee replacement

Increased Accuracy in Templating for Total Knee Arthroplasty Using 3D Models Generated from Radiographs

Templating prior to total hip arthroplasty is a widely adopted practice that aims to improve operative efficiency and reduce clinical outliers. Predicting implant size before total knee arthroplasty (TKA), although less common, could increase operating room efficiency by reducing necessary equipment needed for the procedure. This study compared templating accuracy in TKA using two-dimensional (2D) digital radiographs to a novel imaging technology that generates a three-dimensional (3D) model from these 2D radiographs. Two hundred and two robotic-assisted primary TKA surgical cases using Persona Knee System (Zimmer Biomet, Warsaw, IN) were retrospectively analyzed. For all cases, 3D templating was completed preoperatively using a novel radiographic image acquisition protocol. Using the same radiographs, the knee was templated using a 2D digital templating program. All surgeons were blinded to the final implant sizes, and all templating was done independently. The accuracy of predictions within ± 1 from the final implant size was determined for the femoral and tibial components. The accuracy (within 1 size) of tibial size predictions was comparable between attending surgeons and residents (87 vs. 82%, p = 0.08), but attending surgeons more accurately predicted the femoral size (77 vs. 60%, p \u3c 0.05). The 2D to 3D imaging technology more accurately predicted both tibial and femoral sizes compared with the attending surgeons (99.5 vs. 87%, p \u3c 0.05; 84% vs. 77%, p \u3c 0.05). However, the imaging technology, attending surgeons, and residents were all more likely to overestimate femur size (p \u3c 0.05). Moreover, the 3D imaging technology predicted the exact tibial component size in 93.1% of cases, which was significantly greater compared with residents (40%, p \u3c 0.01) and attending surgeons (53%, p \u3c 0.01). The 2D to 3D imaging technology more accurately predicted tibial and femoral component sizes compared with 2D digital templating done by surgeons. All templating predictions were more accurate for the tibial implant size than for the femoral size. The increased accuracy of implant size predictions from this 3D templating technology has the potential to improve intraoperative efficiency and minimize costs and surgical time