Midterm Follow Up For Knee Replacement: How Well Do We Follow Our Patients?

The lost to follow up rate specifically for five year post surgical UKAs is significantly higher for this population subset than the most recent published average as seen in a meta analysis review (Callahan et al. 1995). Follow up visits allow for proper assessment of complications such as wear and osteolysis which need early intervention to improve long-term outcomes and reduce the overall cost of care (Bhandari et al. 2012). Eleven patients, 27.5% of those that were lost to follow up, were without a correct or working phone number, which presents a significant barrier to care. Maintaining updated patient contact information and educating patients about the importance of intermittent follow up may aid in compliance. Further research is required to better characterize patients with poor follow up rates so that systematic surveillance methods can be developed to improve the quality of care

Retrospective Review of Intra-Articular Hip Steroid Injections and Their Association with Rapidly-Progressive Osteoarthritis

Based on strict inclusion criteria, 109 patients were eligible for analysis in this study. Of these patients, 23 developed RPOA—representing an incidence of 21%. The characteristics of patients who went on to develop RPOA in this study were: worse initial Kellgren-Lawrence grade and older age. Future studies of larger sample size that also include outcomes of patients who did not receive intra-articular injections will be needed to establish a causal relationship between these injections and RPOA

Management of Fragility Hip Fractures: Our Institutional Experience

Introduction: Approximately 320 000 fragility hip fractures are sustained in the United States annually, resulting in substantial morbidity and mortality as well as significant economic burden on the health-care system. Nevertheless, a majority of these patients are not screened and do not receive treatment for osteoporosis. The objective of this study was to evaluate rates of osteoporosis screening and treatment in our institution and compare them to those reported in the literature. Methods: This was a retrospective cohort study of 191 patients ages 50 and older who sustained osteoporotic hip fractures. Primary outcome measures were percentage of patients who (1) underwent bone health laboratory workup during admission, (2) were started on vitamin D, calcium, and/or a bisphosphonate, (3) received bone mineral density testing, and (4) followed up with a primary care doctor or endocrinologist. Secondary outcomes measures were (1) whether gender, race, or age influenced our primary outcomes and (2) whether obtaining in-hospital laboratory workup led to increased rates of further screening and treatment. Results: Fifty-six (29.3%) patients received full laboratory workup, 48 (25.1%) were prescribed vitamin D and calcium, 11 (5.7%) were prescribed a bisphosphonate, 13 (6.8%) underwent bone mineral density testing, and 41 (21.5%) followed up with primary care or endocrinology. Discussion: Women were more likely to be treated with vitamin D and calcium. Outcomes were similar regardless of race. Younger patients were more likely to undergo laboratory testing, bisphosphonate therapy, and bone mineral density testing. Initiating workup during admission did not lead to increased rates of outpatient treatment. Conclusion: Despite nationwide efforts to improve, rates of osteoporosis screening and treatment following hip fracture are suboptimal. Rates at our institution are similar to those reported in previous studies. There were disparities between gender and age groups. Future studies are needed to evaluate whether more recently implemented policies lead to better osteoporosis screening and management

Post-operative Weight Gain After Total Knee Arthroplasty: Prevalence and Its Possible Attenuation Using Intraoperative Sensors

As the proportion of adults with obesity continues to climb, so too does the need for total knee arthroplasty. Unfortunately, total knee replacement patients often experience post-operative weight gain, despite improved joint function. The purposes of this study were: 1) To execute a literature meta-analysis in order quantify the changes in body mass that are typically observed following TKA, and 2) Evaluate data from a prospective, multicenter study to assess any trends towards weight loss in a group of “balanced”, sensor-assisted TKA patients. The literature review found that average proportion of patients who had weight gain after TKA is 47% to 66%. In literature, the average post-operative weight gain was 9.5 lbs. (1.6 kg/m2 BMI increase), up to 14 lbs. (2.3 kg/m2). In the multicenter study, only 30.4% of patients and 36.9% of patients exhibited weight gain at 6 months and 1 year, respectively. At the 1-year interval, this indicates an 11% decrease from reported averages (p=0.049), up to 29% as reported by the NIH (p<0.001). The average weight gain in the multicenter patient group was 4.3 lbs. (0.72 kg/m2 BMI increase) at 6 months, and 3.5 lbs. (0.58 kg/m2) at 1 year, both of which are non-clinically meaningful. The average weight loss of those in the non-gaining group was 7.8 lbs. (1.3 kg/m2) at 6 months and 9.6 lbs. (1.6 kg/m2) at 1 year. Both of these values are clinically meaningful. This evaluation demonstrates that weight gain after TKA is prevalent, but ensuring soft-tissue balance (via technologies such as intraoperative sensing) may help mitigate this expected increase in body mass