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

Inflammatory demyelinating polyneuropathy after total hip arthroplasty

Inflammatory demyelinating polyneuropathy is a rare but devastating condition. Guillain-Barré syndrome is the most common cause with acute inflammatory demyelinating polyneuropathy being the most common subtype that follows a monophasic course and does not recur. Chronic inflammatory demyelinating polyneuropathy occurs when symptoms persist for greater than 8 weeks. With many proposed etiologies, few reports have described acute inflammatory demyelinating polyneuropathy after total joint arthroplasty. To our knowledge, this is the first case report of chronic inflammatory demyelinating polyneuropathy developing after total hip arthroplasty that was further complicated by dislocation. Keywords: Guillain-Barré syndrome, Acute inflammatory demyelinating polyneuropathy, Chronic inflammatory demyelinating polyneuropathy, Inflammatory demyelinating polyneuropathy, Total hip arthroplasty, Dislocatio

Patient Perceptions and Interest in Robotic-Assisted Total Joint Arthroplasty

Background: Robotic-assisted total joint arthroplasty (rTJA) has growing interest among patients and surgeons. However, patient interest in and perceptions of rTJA have not been well explored. We sought to investigate the influence of patient demographics on interest in rTJA and patient perceptions regarding rTJA. Methods: Patients presenting for their initial adult reconstruction consultation received an optional anonymous survey prior to seeing the provider. Patient sociodemographic parameters were recorded. Additional questions assessed interest in and perceptions surrounding rTJA. Results were analyzed to determine whether patient factors correlated with survey responses. Results: A total of 360 patients participated. Analysis of responses revealed 77.8% of patients were interested in rTJA. Interest level positively correlated with patient age (Rs = 0.139, P = .010), education level (Rs = 0.168, P = .002), household income (Rs = 0.274, P < .001), and White race (F = 4.157, P = .016). At least 100 patients believed rTJA was easier and more accurate, but more expensive and had a significant learning curve for the surgeon. Over 100 patients believed robots were capable of independently performing most or all of the rTJA operation. Conclusions: Patient interest in rTJA varies between patients. Many patients have an incomplete understanding of rTJA, and orthopaedic surgeons should address patient perceptions during surgical consultation. Level of Evidence: IV, Cross-sectional study

Association of rapidly destructive osteoarthritis of the hip with intra-articular steroid injections

Background: To assess the relationship between rapidly destructive osteoarthritis (RDOA) of the hip and intra-articular steroid injections. Methods: Coding records from 2000 to 2013 were used to identify all subjects who had a fluoroscopy-guided intra-articular hip injection to treat pain associated with primary osteoarthritis. Radiographic measurements from preinjection and postinjection imaging were evaluated with Luquesne's classification of RDOA to determine diagnosis (greater than 50% joint space narrowing or greater than 2 mm of cartilage loss in 1 year with no other forms of destructive arthropathy). Demographic information, health characteristics, and number of injections were collected and analyzed as other potential explanatory variables. Patient outcome assessed by need for total hip arthroplasty (THA) after injection was also recorded. Results: One hundred twenty-nine injection events met the inclusion criteria in a total of 109 patients. From this sample, 23 cases of RDOA were confirmed representing a 21% incidence of RDOA. Twenty-one of the patients (91%) with RDOA had a THA at a median time of 10.2 months (interquartile range: 6.5-11.2) compared with 27 (31%) of those without RDOA at a median time of 24.9 months (interquartile range: 15.3-65.3). Older patients, patients with more severe osteoarthritis, and patients who identified themselves as white were more likely to have a diagnosis of RDOA (P = .008; P = .040; P = .009, respectively). Conclusions: The potential for RDOA and faster progression to THA raises questions about the use of intra-articular steroid injections for hip osteoarthritis and should be discussed with patients. Additional studies are needed to define a true relationship