Clinical Outcomes Following Revision Total Knee Arthroplasty: Minimum 2-Year Follow-up

BACKGROUD: The longer-term outcomes of revision total knee arthroplasty are not well described in the current literature. Managing patient expectations of revision total knee arthroplasty can be challenging for orthopedic surgeons due to a paucity of data to guide decision-making. We present outcomes of revision total knee arthroplasty performed by a single surgeon over a 12-year period from 2004 through 2015. METHODS: A retrospective review of hospital and private medical records demonstrated 202 revision total knee arthroplasties performed by the senior author in 178 patients from 2004 through 2015. Of these, 153 patients were available for assessment. Patients were contacted and invited to participate in a structured telephone interview to assess Oxford Knee Score (OKS) and patient satisfaction. All patients received the PFC (Depuy) prosthesis at a single institution and were followed up for minimum 2 years postoperatively at the time of review. Retrospective chart review was used to obtain other data for analysis including patient demographics, preoperative and postoperative range of motion (ROM), and intraoperative details. RESULTS: This cohort demonstrated a 93.5% survival rate and an 85% satisfaction rate at a mean of 6.5 years postoperatively. Mean ROM improved from 100° (range, 5°–145°) to 112° (range, 35°–135°) (p < 0.001). The mean OKS was 39.25 (range, 14–48). The factors associated with improved postoperative outcomes included male gender, fewer previous revision total knee arthroplasty procedures, increased preoperative ROM, and receiving a less constrained implant. CONCLUSIONS: This study provides a comprehensive description of outcomes following revision total knee arthroplasty in a large patient cohort with a long follow-up. Although revision total knee arthroplasty is a challenging and complex aspect of arthroplasty surgery, high patient satisfaction and good functional outcomes can be achieved for the majority of patients

A Reliable Surgical Approach to Revision Total Knee Arthroplasty

BACKGROUD: The surgical exposure obtained in revision total knee arthroplasty should facilitate the utilisation of instrumentation and implants, including adjuncts such as stemmed prostheses, bone allograft, and artificial augments. We have previously identified within this cohort of revision total knee arthroplasty patients a high satisfaction rate of 93.5% at a mean 6.5 years of follow-up and a high level of postoperative function. We, therefore, seek to describe in detail the operative technique and perioperative care and report the early postoperative complications. METHODS: We report on the surgical approach, closure technique, and postoperative care used by the senior author for revision total knee arthroplasty procedures. The patient demographics, intraoperative details, and postoperative outcomes are also reported. We aim to provide a clear description of the intraoperative technique and postoperative outcome, facilitating adoption or comparison with other surgeons or techniques. Patient inclusion criteria were revision total knee arthroplasty performed by the senior author using the PFC (Depuy) prosthesis at John Flynn Private Hospital with a minimum of 2-year postoperative follow-up. A retrospective chart review was combined with a structured telephone assessment questionnaire to assess outcomes. RESULTS: A total of 202 revision total knee arthroplasties were available for follow-up in 185 patients. The mean 1-year postoperative range of motion was 110°. Key features of surgical approach include incision planning, soft-tissue plane development, parapatellar scar debridement, safe removal of implants, management of bone defects, and closure technique. The overall 90-day complication rate was 9%, including 4.4% requiring manipulation under anaesthesia and 3% superficial surgical site infections (1 patient requiring intravenous antibiotics). CONCLUSIONS: We suggest that the described technique is reproducible and reliable. It rarely requires modification and facilitates successful postoperative outcomes with a low complication rate. The adoption of this surgical technique allows surgeons to approach complex knee arthroplasty with confidence in the appropriate exposure of anatomy, facilitating subsequent steps in their arthroplasty procedures

Blood loss in primary total knee arthroplasty-body temperature is not a significant risk factor-a prospective, consecutive, observational cohort study

BACKGROUND: Hypothermia related to anaesthesia and operating theatre environment is associated with increased blood loss in a number of surgical disciplines, including total hip arthroplasty. The influence of patient temperature on blood loss in total knee arthroplasty (TKA) has not been previously studied. METHODS: We recorded patient axillary temperature in the peri-operative period, up to 24 h post-operatively, and analysed the effect on transfusion rate and blood loss from a consecutive cohort of 101 patients undergoing primary TKA. RESULTS: No relationship between peri-operative patient temperature and blood loss was found within the recorded patient temperature range of 34.7–37.8 °C. Multivariable analysis found increasing age, surgical technique, type of anaesthesia and the use of anti-platelet and anticoagulant medications as significant factors affecting blood loss following TKA. CONCLUSION: Patient temperature within a clinically observed range does not have a significant impact on blood loss in primary TKA patients. As long as patient temperature is maintained within a reasonable range during the intra-operative and post-operative periods, strategies other than rigid temperature control above 36.5 °C may be more effective in reducing blood loss following TKA

Year-round West Nile Virus Activity, Gulf Coast Region, Texas and Louisiana

West Nile virus (WNV) was detected in 11 dead birds and two mosquito pools collected in east Texas and southern Louisiana during surveillance studies in the winter of 2003 to 2004. These findings suggest that WNV is active throughout the year in this region of the United States

ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis

Severe symptomatic osteoarthritis in young and active patients with pre-existing deficiency of the anterior cruciate ligament and severe functionally instability is a difficult subgroup to manage. There is considerable debate regarding management of young patients with isolated unicompartment osteoarthritis and concomitant ACL deficiency. A retrospective analysis of was done in 9 patients with symptomatic osteoarthritis with ACL deficiencies and functional instability that were treated with unicompartment knee arthroplasty and ACL reconstruction between April 2002 and June 2005. The average arc of flexion was 119° (range 85° to 135°) preoperatively and 125° (range 105° to 140°). There were no signs of instability during the follow up of patients. No patients in this group were reoperated. In this small series we have shown that instability can be corrected and pain relieved by this combined procedure

Assessment of patient satisfaction following revision total knee arthroplasty

Background:Patient satisfaction is becoming an increasingly important measure of healthcare quality. Satisfaction following RTKA is poorly described within the literature, resulting in difficulty for clinicians to manage patient expectations and obtain informed consent. Methods:We investigated postoperative satisfaction of RTKA patients by a single surgeon, using a single prosthesis, at a single institution. Patient satisfaction was assessed using structured telephone assessment questionnaires and review of orthopaedic/hospital records. The effect of patient and surgical characteristics on satisfaction was assessed using correlation coefficients and binary logistic regression in SPSS. Results:Two hundred and two RTKAs were performed in 178 patients between 2004 and 2015 inclusive. One hundred and twenty-four patients (143 RTKAs) were contactable to complete satisfaction assessment. Eighty-five percent of patients were satisfied and would have the RTKA again, 8% were unsure, 7% would not. Mean reported satisfaction on a numerical scale (1–10) was 8.17 (range 1–10), with 74% of patients scoring 8 or above, and 35% of patients scoring 10. The Mahomed Satisfaction Scale outcomes demonstrated a mean score of 87.7. High positive correlation was found between assessment tools. Logistic regression analysis identified factors contributing to satisfaction included ROM, OKS, BMI, and surgical time. Conclusion:This cohort demonstrated high patient satisfaction rate following RTKA, utilizing simple and reliable outcome measurement tools. We found a high positive correlation between methods of assessment, and moderate positive correlation between satisfaction and functional outcomes. These results contribute to the understanding of satisfaction in RTKA patients, which may assist in informing patients of expected post-operative outcomes.</p

Consideraciones éticas en la gestión enfermera: una revisión actual.

Introducción: Las decisiones de gestión configuran una parte importante del contexto organizativo para la prestación de cuidados. En la literatura científica se encuentran evidencias del impacto del contexto organizativo y de la pericia de los profesionales en los resultados. Puesto que el contexto organizativo está influido por las decisiones de gestión y la toma de decisiones está directamente relacionada con el nivel de competencia de cada profesional, es de esperar que en la práctica existan múltiples visiones sobre una misma situación, que precipiten dilemas éticos en los que la enfermera gestora deberá actuar. Objetivo: Presentar una revisión reflexiva sobre los aspectos éticos de actualidad en la gestión enfermera como herramienta esencial en el desarrollo de pericia para la toma de decisiones. Método: Revisión interpretativa y discusión de la literatura científica actual sobre las cuestiones ético-morales en el ámbito de la gestión asistencial y directiva enfermera: conflictos de valores, dilemas éticos, competencia ética, sufrimiento moral, redes relacionales, whistleblowing y comportamientos negativos. Resultados y conclusiones: Gestionar el equilibrio entre los valores y las prioridades, en el marco del cumplimiento de los principios empresariales de eficiencia, efectividad y productividad puede chocar con los valores profesionales de respeto a la dignidad, equidad, beneficencia, calidad y seguridad, por lo que se requieren enfermeras gestoras con un grado elevado de competencia ética, capaces de abordar la emergencia de los dilemas que surgen en la práctica. Los directivos de las empresas sanitarias no deberían obviar la promoción de redes relacionales positivas y las políticas de gestión de los comportamientos negativos y abordar las cuestiones relacionadas con la cultura del silencio