Wearable activity sensors and early pain after total joint arthroplasty.

A prospective observational cohort of 20 primary total hip arthroplasty (n = 12) and total knee arthroplasty (n = 8) patients (mean age: 63 ± 6 years) was passively monitored with a consumer-level wearable activity sensor before and 6 weeks after surgery. Patients were clustered by minimal change or decreased activity using sensor data. Decreased postoperative activity was associated with greater pain reduction (-5.5 vs -2.0, P = .03). All patients surpassed minimal clinical benefit thresholds of total joint arthroplasty (TJA) (Hip Disability and Osteoarthritis Score Junior 30.5 vs 20.8, P = .23; Knee Injury and Osteoarthritis Outcome Score Junior 23.3 vs 18.2, P = .77) within 6 weeks. Patients who objectively "take it easy" after TJA may experience less pain with no difference in early subjective outcome. Remote, passive analysis of outpatient wearable sensor data may permit real-time detection of early problems after TJA

Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty

Background: Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery. Objectives: We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA). Patients and Methods: Patients (n = 203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006 - 12. Patients evaluated in the APC had surgery in 2006 - 8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥ 10% and ≥ 8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (\u3e 5 days) were recorded. Results: Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c \u3c 10%, but not those with HbA1c \u3c 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P \u3c 0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥ 10% required prolonged LOS versus those without DM (P \u3c 0.001 and P = 0.0404, respectively). Conclusions: APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA

An Exploratory Study of Primary Care Physician Decision Making Regarding Total Joint Arthroplasty

BACKGROUND: For patients to experience the benefits of total joint arthroplasty (TJA), primary care physicians (PCPs) ought to know when to refer a patient for TJA and/or optimize nonsurgical treatment options for osteoarthritis (OA). OBJECTIVE: To evaluate the ability of physicians to make clinical treatment decisions. DESIGN AND PARTICIPANTS: A survey, using ten clinical vignettes, of PCPs in Indiana. MEASUREMENTS: A test score (range 0 to 10) was computed based on the number of correct answers consistent with published explicit appropriateness criteria for TJA. We also collected demographic characteristics and physicians’ perceived success rate of TJA in terms of pain relief and functional improvement. RESULTS: There were 149 PCPs (response rate = 61%) who participated. The mean test score was 6.5 ± 1.5. Only 17% correctly identified the published success rate of TJA (i.e., ≥90%). In multivariate analysis, the only physician-related variables associated with test score were ethnicity, board status, and perceived success rate of TJA. Physicians who were white (P = .001), board-certified (P = .04), and perceived a higher success rate of TJA (P = .004) had higher test scores. CONCLUSIONS: PCP knowledge with respect to guideline-concordant care for OA could be improved, specifically in deciding when to consider TJA versus optimizing nonsurgical options. Moreover, the perception of the success rate of TJA may influence a clinician’s decision making

Effects of Anaerobic Fatigue on the Tuck Jump Assessment Performance in Female Collegiate Club Athletes

Purpose: To determine the impact of a fatigue trial on the scores and number of jumps in a Tuck Jump Assessment (TJA) in female collegiate club athletes. The TJA is a 10-second plyometric jumping assessment used to replicate sport and identify lower extremity landing patterns. Scores from the TJA are summed together and those who score a 6 or higher are suggested for intervention training. Methods: Sixteen female club athletes (age: 20.9+1.9 years, weight: 59.13+7.72kg, height: 64.56+2.63cm) completed the TJA twice, once before performing a Wingate protocol and then again after. A dependent sample t-test was performed to determine any statistical differences between the TJA scores and the number of jumps, pre-Wingate and post-Wingate. Results: There was a statistically significant difference between scores for the TJA pre-Wingate (5.8+2.1) and post-Wingate (7.7+1.4) (PConclusions:The Wingate protocol had an impact on both the number of flaws and number of jumps, suggesting that athlete fatigue caused by completion of the Wingate protocol contributed to the increased number of errors in the TJA. The most common flaws were “pause between jumps” and “feet do not land in the same footprint”. A statistically significant difference between the number of jumps pre- to post-Wingate TJA was also found. There were a greater number of jumps in the post-Wingate TJA than pre-Wingate. Due to the increased scores in the post-Wingate condition, having athletes complete a fatiguing protocol prior to the TJA may provide for more sports-like levels of exhaustion. Recreating similar conditions athletes are sustaining during their sport could give a more accurate representation of the TJA, thereby making it a more clinically relevant and viable tool to use

Patient Perceptions Regarding Outpatient Hip and Knee Arthroplasties

Background There has been increasing interest in outpatient total joint arthroplasty (TJA) in the orthopedic community, but how patients feel about outpatient TJA is unknown. The purpose of this study was to understand patient perspectives on hip and knee replacements performed in an outpatient setting. Methods We surveyed 110 consecutive patients scheduled for primary TJA in an academic suburban arthroplasty practice regarding their knowledge and perceptions of outpatient TJA. Questionnaires were administered during preoperative clinic visits before discussion of surgery location, length of stay, and before preoperative joint replacement education. Results Fifty-seven percent of respondents were female, and 42.7% were aged 65 years or older. Very few patients expected same-day discharge (n = 3) or a one night stay in the hospital (n = 17). Fifty-four percent of patients were expected to stay in the hospital two or more nights. Only 54.5% of patients were aware that outpatient TJA is an option, with 55.3% of men and 31.7% of women reporting that they were comfortable with outpatient TJA (P = .030). In contrast, 61% and 72.8% believed that faster recovery and decreased likelihood of infection are likely advantages of outpatient TJA. Interestingly, 51.9% felt ambulatory surgery centers are as safe as hospitals, and 62.6% believed that home is the best place to recovery from TJA. Conclusion These observations suggest that there is need for patient education regarding outpatient TJA. As outpatient procedures become more common, it is essential that patients understand the ambulatory surgery process, the benefits and risks of same day discharge, and their role in a successful outpatient experience

The effect of malnutrition on patients undergoing elective joint arthroplasty.

Malnutrition has been linked to serious complications in patients undergoing elective total joint arthroplasty (TJA). This study prospectively evaluated 2,161 patients undergoing elective TJA for malnutrition as defined by either an abnormal serum albumin or transferrin. The overall incidence of malnutrition was 8.5% (184 of 2,161) and the rate of overall complications in the malnourished group was 12% as compared to 2.9% in patients with normal parameters (P55years-old undergoing TJA and is associated with a significant increase in post-operative complications

Implementation of outpatient total joint arthroplasty in canada: Where we are and where we need to go

© 2020 Zomar et al. Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for the current barriers

Comparison of Drop Jump and Tuck Jump Knee Joint Kinematics in Elite Male Youth Soccer Players: Implications for Injury Risk Screening

Context: Despite the popularity of jump-landing tasks being used to identify injury risk factors, minimal data currently exist examining differences in knee kinematics during commonly used bilateral jumping tasks. This is especially the case for rebounding-based protocols involving young athletes. Objective: The purpose of this study was to compare the frontal plane projection angle (FPPA) during the drop vertical jump (DVJ) and tuck jump assessment (TJA) in a cohort of elite male youth soccer players of varying maturity status. Methods: A total of 57 male youth soccer players from an English championship soccer club participated in the study. Participants performed three trials of the DVJ and TJA, during which movement was recorded with two-dimensional video cameras. FPPA for both right (FPPA-r) and left (FPPA-l) legs, with values <180º indicative of medial knee displacement. Results: On a whole-group level, FPPA-r (172.7 ± 7.4 º versus 177.2 ± 11.7 º; p < 0.05; ES = 0.46) and FPPA-l (173.4 ± 7.3 º versus 179.2 ± 11.0 º; p < 0.05; ES = 0.62) was significantly greater for both limbs in the TJA compared to the DVJ; however, these differences were less consistent when grouped by maturity status. FPPA-r during the TJA was significantly and moderately greater in the circa-PHV group compared to the post-PHV cohorts (169.4 ± 6.4 º versus 175.3 ± 7.8 º; p < 0.05; ES = 0.49). Whole group data showed moderate relationships for FPPA-r and FPPA-l between the TJA and DVJ; however, stronger relationships were shown in circa and post-PHV players compared to the pre-PHV cohort. Conclusions: Considering that the TJA exposed players to a larger FPPA and was sensitive to between-group differences in FPPA-r, the TJA could be viewed as a more suitable screen for identifying FPPA in young male soccer players

A prospective analysis of glove perforation in primary and revision total hip and total knee arthroplasty.

Literature in regard to glove perforation rates in revision total joint arthroplasty (TJA) is scarce. Our purpose was to determine the incidence of perforation in revision TJA. Gloves from all scrubbed personnel were tested based on the American Society for Testing and Materials. A total of 3863 gloves were collected from 58 primary and 36 revision arthroplasty cases. Surgeons had a 3.7% outer-glove perforation rate in primary TJA compared with 8.9% in revision TJA. When both gloves were perforated, the outer-glove perforation was recognized intraoperatively 100% of the time, and the inner-glove perforation was noted only 19% of the time. The surgeon has the highest rate of glove perforation. Outer-glove perforations should prompt careful inspection of the inner glove

Obesity & Hypertension are Determinants of Poor Hemodynamic Control during Total Joint Arthroplasty: A Retrospective Review

Background: Proper blood pressure control during surgical procedures such as total joint arthroplasty (TJA) is considered critical to good outcome. There is poor understanding of the pre-operative risk factors for poor intra-operative hemodynamic control. The purpose of this study is to identify risk factors for poor hemodynamic control during TJA. Methods: We performed a retrospective cohort analysis of 118 patients receiving TJA in the Dominican Republic. We collected patient demographic and comorbidity data. We developed an a priori definition for poor hemodynamic control: 1) Mean arterial pressure (MAP) 135% of preoperative MAP. We performed bivariate and multivariate analyses to identify risk factors for poor hemodynamic control during TJA. Results: Hypertension was relatively common in our study population (76 of 118 patients). Average preoperative mean arterial pressure was 109.0 (corresponding to an average SBP of 149 and DBP of 89). Forty-nine (41.5%) patients had intraoperative blood pressure readings consistent with poor hemodynamic control. Based on multi-variable analysis preoperative hypertension of any type (RR 2.9; 95% CI 1.3-6.3) and an increase in BMI (RR 1.2 per 5 unit increase; 95% CI 1.0-1.5) were significant risk factors for poor hemodynamic control. Conclusions: Preoperative hypertension and being overweight/obese increase the likelihood of poor blood pressure control during TJA. Hypertensive and/or obese patients warrant further attention and medical optimization prior to TJA. More work is required to elucidate the relationship between these risk factors and overall outcome