Kyle Kesler, T. Brown, J. R. Martin, B. Springer, Jesse E. Otero
Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions. This testing adds cost and may not be necessary in most patients. This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database. Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion. Results: Overall, 28664 patients who underwent THA patients were identified. Within this group, 6.1% (n=1737) had a post-operative transfusion. Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p 70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion. Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA.
{"title":"Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty","authors":"Kyle Kesler, T. Brown, J. R. Martin, B. Springer, Jesse E. Otero","doi":"10.15438/rr.9.1.226","DOIUrl":"https://doi.org/10.15438/rr.9.1.226","url":null,"abstract":"Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions. This testing adds cost and may not be necessary in most patients. This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database. Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion. Results: Overall, 28664 patients who underwent THA patients were identified. Within this group, 6.1% (n=1737) had a post-operative transfusion. Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p 70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion. Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45607304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Adverse reactions to metal debris with catastrophic failures have been seen with a number of metal on metal (MoM) total hip designs. Understanding survivorship and factors associated with failure will allow for more targeted surveillance of those patients at highest risk for failure. The purpose of this study was to assess the mid to long term survivorship and specific factors associated with failure for a large cohort of a single modular MoM design.Methods: Consecutive patients treated with a modular metal on metal bearing with a five to fourteen year follow-up were included. Clinical outcome scores and radiographic data were prospectively collected. Failure was defined as revision of either component for any reason during the study period. Multiple implant, surgical, and patient factors were analyzed for associations with elevated ion levels or revision due to adverse reactions to metal debris.Results: The average age at the time of surgery for the 253 patients included in the study was 55. There were 28 revisions (7.5%), eight due to metallosis (2%). Survivorship was 89% at 12.6 years with revision for any reason as the end point. Survivorship was 93% when limited to revision for ALTR as the end point. Time in situ was the only variable that was statistically associated with an increased risk of failure due to ALTR (p<0.0001)Conclusion: In this large series of a single design modular metal-metal total hip we found relatively low rates of revision due to adverse reactions to metal debris. The only variable associated with a statistically significant risk of ALTR was time in situ. Therefore, long-term surveillance is necessary in patients with a MoM THA.
{"title":"Long-Term Screening is Necessary in Patients with Metal on Metal Total Hip Arthroplasty","authors":"J. R. Martin, S. Odum, W. Griffin","doi":"10.15438/rr.9.1.225","DOIUrl":"https://doi.org/10.15438/rr.9.1.225","url":null,"abstract":"Introduction: Adverse reactions to metal debris with catastrophic failures have been seen with a number of metal on metal (MoM) total hip designs. Understanding survivorship and factors associated with failure will allow for more targeted surveillance of those patients at highest risk for failure. The purpose of this study was to assess the mid to long term survivorship and specific factors associated with failure for a large cohort of a single modular MoM design.Methods: Consecutive patients treated with a modular metal on metal bearing with a five to fourteen year follow-up were included. Clinical outcome scores and radiographic data were prospectively collected. Failure was defined as revision of either component for any reason during the study period. Multiple implant, surgical, and patient factors were analyzed for associations with elevated ion levels or revision due to adverse reactions to metal debris.Results: The average age at the time of surgery for the 253 patients included in the study was 55. There were 28 revisions (7.5%), eight due to metallosis (2%). Survivorship was 89% at 12.6 years with revision for any reason as the end point. Survivorship was 93% when limited to revision for ALTR as the end point. Time in situ was the only variable that was statistically associated with an increased risk of failure due to ALTR (p<0.0001)Conclusion: In this large series of a single design modular metal-metal total hip we found relatively low rates of revision due to adverse reactions to metal debris. The only variable associated with a statistically significant risk of ALTR was time in situ. Therefore, long-term surveillance is necessary in patients with a MoM THA.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42441417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Venet, A. Tesson, Francois Le Cour Grandmaison, N. Fraquet, D. Brazil, T. Mctighe
Background: Total hip arthroplasty (THA) is one of the most effective orthopedic procedures, providing consistently high success rates across all population segments as measured by pain relief, improved function, and patient satisfaction. However clinical outcomes have been less favorable in young active patients, that lead to the re-development of metal on metal hip resurfacing (HR), with the most successful being the Birmingham Hip Replacement (BHR) introduced in 1997. Evolving complications due to increased metal ion debris has lead to a great reduction of use for all metal on metal (MOM) HR designs, leading many surgeons and patients to look for an alternative surgical selection. This search has focused on the development and use of short stems for THA. One such style of short stems is curved neck preserving designs. This paper will review our French experience with one of those designs.Materials and Methods: This is a retrospective review of four surgeons series of a short curved tissue sparing cementless femoral implant (TSI™ Hip Stem, Signature Orthopaedics) for THA. The femoral component was used with two different cementless acetabular styles (Mathys RM Pressfit, and Zimmer Biomet Allofit®). Results on the cups will not be revived in this paper. 150 TSI™ Stems by four surgeons at the same institution utilizing the posterior surgical approach since September 2016. 40% women, average age 66 years with extremes of 27 to 78 years. 10 cases of dysplastic hips, 6 cases of aseptic osteonecrosis, 1 fracture, 1 rheumatoid coxitis, and the rest primary coxathosis, with 7 patients operated on both hips at the same time. 23.3 % have been Dorr type A canal shape.Results: There has been no aseptic loosing, three femoral components have been explanted due to postoperative infection. There was one intra-operative femoral distal fracture in a Dorr type A bone profile during stem insertion. One posterior dislocation; there has been two patients with thigh pain with pathological bone scan, and one with low back pain and no leg length discrepancies greater than plus or minus 5 mm.Conclusion: This short curved tissue sparing implant has demonstrated excellent initial short-term results, with excellent implant stability, excellent medial calcar bone remodeling with one dislocated stem, two thigh pain and one patient with low back pain. One distal intra-operative fracture in a Dorr type A bone. This has now been addressed with the use of distal sizing gauges and the use of flexible reamers to open the distal canal prior to stem insertion. Removal of the infected stems demonstrated implant stability with early bone attachment in the proximal porous surface. The high neck resection allows for ease of revision and conversion implanting a new primary conventional length cementless stem design.There is a short but definitive learning curve in fitting the implant to the femoral neck versus the standard metaphyseal and diaphyseal conventional style stems.
{"title":"Techniques of Insertion and Early Clinical Impressions with a Short Curved Tissue Sparing Implant for Total Hip Arthroplasty (The French Experience)","authors":"G. Venet, A. Tesson, Francois Le Cour Grandmaison, N. Fraquet, D. Brazil, T. Mctighe","doi":"10.15438/RR.9.1.224","DOIUrl":"https://doi.org/10.15438/RR.9.1.224","url":null,"abstract":"Background: Total hip arthroplasty (THA) is one of the most effective orthopedic procedures, providing consistently high success rates across all population segments as measured by pain relief, improved function, and patient satisfaction. However clinical outcomes have been less favorable in young active patients, that lead to the re-development of metal on metal hip resurfacing (HR), with the most successful being the Birmingham Hip Replacement (BHR) introduced in 1997. Evolving complications due to increased metal ion debris has lead to a great reduction of use for all metal on metal (MOM) HR designs, leading many surgeons and patients to look for an alternative surgical selection. This search has focused on the development and use of short stems for THA. One such style of short stems is curved neck preserving designs. This paper will review our French experience with one of those designs.Materials and Methods: This is a retrospective review of four surgeons series of a short curved tissue sparing cementless femoral implant (TSI™ Hip Stem, Signature Orthopaedics) for THA. The femoral component was used with two different cementless acetabular styles (Mathys RM Pressfit, and Zimmer Biomet Allofit®). Results on the cups will not be revived in this paper. 150 TSI™ Stems by four surgeons at the same institution utilizing the posterior surgical approach since September 2016. 40% women, average age 66 years with extremes of 27 to 78 years. 10 cases of dysplastic hips, 6 cases of aseptic osteonecrosis, 1 fracture, 1 rheumatoid coxitis, and the rest primary coxathosis, with 7 patients operated on both hips at the same time. 23.3 % have been Dorr type A canal shape.Results: There has been no aseptic loosing, three femoral components have been explanted due to postoperative infection. There was one intra-operative femoral distal fracture in a Dorr type A bone profile during stem insertion. One posterior dislocation; there has been two patients with thigh pain with pathological bone scan, and one with low back pain and no leg length discrepancies greater than plus or minus 5 mm.Conclusion: This short curved tissue sparing implant has demonstrated excellent initial short-term results, with excellent implant stability, excellent medial calcar bone remodeling with one dislocated stem, two thigh pain and one patient with low back pain. One distal intra-operative fracture in a Dorr type A bone. This has now been addressed with the use of distal sizing gauges and the use of flexible reamers to open the distal canal prior to stem insertion. Removal of the infected stems demonstrated implant stability with early bone attachment in the proximal porous surface. The high neck resection allows for ease of revision and conversion implanting a new primary conventional length cementless stem design.There is a short but definitive learning curve in fitting the implant to the femoral neck versus the standard metaphyseal and diaphyseal conventional style stems.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41615715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sridhar M. Durbhakula, Vinay Durbhakula, Navin S. Durbhakula
BACKGROUND: Studying and reporting the continuous, prospective outcomes of a post-surgical orthopaedic population without loss to follow-up at various standard landmarks over time is rarely achieved in total knee arthroplasty (TKA) literature. Small case series populations reported at an early follow-up time is common, and usually not beyond any initial publication for further reporting. The purpose of this study was to advance the knowledge base of the performance of Freedom Knee system through the continuous monitoring of a previously reported early series TKA patient population.METHODS: A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of five-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender.RESULTS: There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. One patient required tibial component and polyethylene insert revision following a motor vehicle accident resulting in a proximal tibial fracture and component loosening. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 6.9 years). In addition, there was an average significant increase in change of HSS score (p<0.001) and ROM (P<0.001) when compared to pre-operative baseline but no significant difference in HSS or ROM between the two and five-year outcome results.CONCLUSIONS: The design characteristic for component sizing and functional expectations were re-confirmed in the reported Western population cohort series, and observed optimum safety, performance and efficacy through five-years. Further continued study efforts of this primary TKA system is warranted across multiple surgeons and all ethnic cultures.
{"title":"Restoration of Femoral Condylar Anatomy for Achieving Optimum Functional Expectations: Continuation of an Earlier Study At 5-Year Minimum Follow-Up","authors":"Sridhar M. Durbhakula, Vinay Durbhakula, Navin S. Durbhakula","doi":"10.15438/RR.9.1.222","DOIUrl":"https://doi.org/10.15438/RR.9.1.222","url":null,"abstract":"BACKGROUND: Studying and reporting the continuous, prospective outcomes of a post-surgical orthopaedic population without loss to follow-up at various standard landmarks over time is rarely achieved in total knee arthroplasty (TKA) literature. Small case series populations reported at an early follow-up time is common, and usually not beyond any initial publication for further reporting. The purpose of this study was to advance the knowledge base of the performance of Freedom Knee system through the continuous monitoring of a previously reported early series TKA patient population.METHODS: A prospective, continuous series of 176 primary posterior stabilized (PS) TKAs were performed in 172 patients by a single surgeon. Femoral component size distribution was assessed and all patients were followed for a minimum of five-years post-operatively. Total Hospital for Special Surgery (HSS) scores and range of motion (ROM) was assessed for the entire cohort and by gender.RESULTS: There were no patients lost to follow-up. Two patients required incision and drainage for superficial wound infection of the indicated knees. One patient required tibial component and polyethylene insert revision following a motor vehicle accident resulting in a proximal tibial fracture and component loosening. There was no radiographic evidence of component failure. As expected, femoral component size frequency use was skewed by gender with the larger sizes in males. There were no pre- or post-operative clinical or functional differences by gender and at the recent follow-up (avg. 6.9 years). In addition, there was an average significant increase in change of HSS score (p<0.001) and ROM (P<0.001) when compared to pre-operative baseline but no significant difference in HSS or ROM between the two and five-year outcome results.CONCLUSIONS: The design characteristic for component sizing and functional expectations were re-confirmed in the reported Western population cohort series, and observed optimum safety, performance and efficacy through five-years. Further continued study efforts of this primary TKA system is warranted across multiple surgeons and all ethnic cultures.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44160915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recently our Journal was criticized for allowing a co-author to submit and publish a technical paper when said surgeon is involved in a litigation matter. “I am very surprised indeed that you do not consider being a defendant in legal action concerning the very practice being defended in an article amounts to a conflict of interest.” This made me think it might be an appropriate time to revisit this issue. First I think it is important to understand some of the history regarding disclosure and conflict of interest.
{"title":"What is Considered a Conflict of Interest or What to Disclose in Lectures and Publications?","authors":"T. Mctighe","doi":"10.15438/RR.9.1.221","DOIUrl":"https://doi.org/10.15438/RR.9.1.221","url":null,"abstract":"Recently our Journal was criticized for allowing a co-author to submit and publish a technical paper when said surgeon is involved in a litigation matter. “I am very surprised indeed that you do not consider being a defendant in legal action concerning the very practice being defended in an article amounts to a conflict of interest.” This made me think it might be an appropriate time to revisit this issue. First I think it is important to understand some of the history regarding disclosure and conflict of interest.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42561396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction“Fast-Track” protocols have been introduced in TKA with the intention to increase health care savings while maintaining or improving patient outcomes. The influence of the implant design in a “Fast-Track” setting has not been described yet. The primary goal of this study was to compare a customized implant with standard off-the-shelf (OTS) devices when utilizing a “Fast-Track” protocolMethodsSixty-two (62) patients were prospectively enrolled at a single center and implanted with either a customized or a standard off-the-shelf implant resulting in thirty (30) patients being treated with an OTS design and thirty-two (32) with the customized design. The same institutional fast-track protocol was utilized on all patients and included pre-, intra-, and postoperative medical treatment. We assessed total length of stay (LOS), discharge destination and range of motion at 6-8 weeks post-op and at an average of 16 months post-op follow-up to compare the OTS implant with the customized device. Implant survivorship was assessed at a minimum of 25 months post-op.ResultsUsing the fast track protocol we were able to decrease overall LOS to 2.1 days versus 3.6 days prior to introduction of the protocol. The use of the customized implant further reduced LOS significantly to 1.6 days. Significantly higher number of patients who got implanted with the customized device (66%) were discharged within 24 hours than in the OTS group (30%). Patients treated with the customized implant were found to be discharged home more often than patients treated with the OTS implants (97% vs. 80%) and achieved higher range of motion both at 6-8 weeks (114° vs. 101°) and at an average of 16 months (122° vs. 114°) than patients who got treated with the OTS device. At an average follow-up of 28 months, there was 1 implant revision in the customized group (due to tibial fracture resulting from patient fall). For the OTS group there was 1 implant revision (late infection) and 1 poly swap (due to instability).DiscussionBased on our analysis we observed a positive influence of the customized device on patient outcomes and hospital metrics and we therefore conclude that the implant choice is an important factor for TKA in a “fast-track” setting.
{"title":"Does Implant Design Affect Hospital Metrics and Patient Outcomes? TKA Utilizing a “Fast-Track” Protocol","authors":"R. Buch, L. Schroeder, Rylie Buch, R. Eberle","doi":"10.15438/RR.9.1.203","DOIUrl":"https://doi.org/10.15438/RR.9.1.203","url":null,"abstract":"Introduction“Fast-Track” protocols have been introduced in TKA with the intention to increase health care savings while maintaining or improving patient outcomes. The influence of the implant design in a “Fast-Track” setting has not been described yet. The primary goal of this study was to compare a customized implant with standard off-the-shelf (OTS) devices when utilizing a “Fast-Track” protocolMethodsSixty-two (62) patients were prospectively enrolled at a single center and implanted with either a customized or a standard off-the-shelf implant resulting in thirty (30) patients being treated with an OTS design and thirty-two (32) with the customized design. The same institutional fast-track protocol was utilized on all patients and included pre-, intra-, and postoperative medical treatment. We assessed total length of stay (LOS), discharge destination and range of motion at 6-8 weeks post-op and at an average of 16 months post-op follow-up to compare the OTS implant with the customized device. Implant survivorship was assessed at a minimum of 25 months post-op.ResultsUsing the fast track protocol we were able to decrease overall LOS to 2.1 days versus 3.6 days prior to introduction of the protocol. The use of the customized implant further reduced LOS significantly to 1.6 days. Significantly higher number of patients who got implanted with the customized device (66%) were discharged within 24 hours than in the OTS group (30%). Patients treated with the customized implant were found to be discharged home more often than patients treated with the OTS implants (97% vs. 80%) and achieved higher range of motion both at 6-8 weeks (114° vs. 101°) and at an average of 16 months (122° vs. 114°) than patients who got treated with the OTS device. At an average follow-up of 28 months, there was 1 implant revision in the customized group (due to tibial fracture resulting from patient fall). For the OTS group there was 1 implant revision (late infection) and 1 poly swap (due to instability).DiscussionBased on our analysis we observed a positive influence of the customized device on patient outcomes and hospital metrics and we therefore conclude that the implant choice is an important factor for TKA in a “fast-track” setting.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44006798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. R. Martin, Jesse E. Otero, B. Springer, W. Griffin
Introduction: Metal on Metal (MoM) total hip arthroplasty (THA) has been largely abandoned in the United States secondary to high failure rates. Many of the failures are attributed to adverse local tissue reactions (ALTR). Therefore, patients that have a MoM THA are routinely screened by checking serum metal ion levels every two years, as was recommended by the FDA. However, there is limited data on the costs of current screening protocols. Materials and Methods: 318 consecutive patients who underwent a MoM THA at a single institution were retrospectively enrolled. The average follow-up was 8.2 years. Clinical data, metal ion levels, revision and reoperation rates were prospectively collected. The costs of clinical screening for this patient population was calculated and compared to the cost of an annual screening protocol. Results: 12 patients had either an elevated Co or Cr level (>4.5 ppb). Eight patients were revised secondary to ALTR. The total cost of screening during the study was $612,250. Additionally, if annual screening had been performed, total screening costs would be approximately $1,719,200. Discussion: Eight patients in the following study were revised secondary to ALTR with a total cost of screening of $612,500. These costs are substantially less than the cost of annual screening ($1,719,200). Due to the considerable costs of screening asymptomatic MoM THA patients, we recommend both optimizing the frequency of screening and evaluating the specific risk of the implant being screened.
{"title":"Can We Improve Screening Costs in Asymptomatic Metal on Metal Total Hip Arthroplasties?","authors":"J. R. Martin, Jesse E. Otero, B. Springer, W. Griffin","doi":"10.15438/RR.9.1.214","DOIUrl":"https://doi.org/10.15438/RR.9.1.214","url":null,"abstract":"Introduction: \u0000Metal on Metal (MoM) total hip arthroplasty (THA) has been largely abandoned in the United States secondary to high failure rates. Many of the failures are attributed to adverse local tissue reactions (ALTR). Therefore, patients that have a MoM THA are routinely screened by checking serum metal ion levels every two years, as was recommended by the FDA. However, there is limited data on the costs of current screening protocols. \u0000Materials and Methods: \u0000318 consecutive patients who underwent a MoM THA at a single institution were retrospectively enrolled. The average follow-up was 8.2 years. Clinical data, metal ion levels, revision and reoperation rates were prospectively collected. The costs of clinical screening for this patient population was calculated and compared to the cost of an annual screening protocol. \u0000Results: \u000012 patients had either an elevated Co or Cr level (>4.5 ppb). Eight patients were revised secondary to ALTR. The total cost of screening during the study was $612,250. Additionally, if annual screening had been performed, total screening costs would be approximately $1,719,200. \u0000Discussion: \u0000Eight patients in the following study were revised secondary to ALTR with a total cost of screening of $612,500. These costs are substantially less than the cost of annual screening ($1,719,200). Due to the considerable costs of screening asymptomatic MoM THA patients, we recommend both optimizing the frequency of screening and evaluating the specific risk of the implant being screened. ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48447423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Cohen-Rosenblum, M. Crutcher, J. Gui, W. Novicoff, Stephen J. Nelson, J. Browne
Background: Perioperative administration of intravenous antibiotics is a routine part of total knee arthroplasty. Antibiotic selection is a matter of controversy, and the potential risks and benefits associated with each antibiotic selection need to be considered. The objective of this study is to examine the effects of routine dual antibiotic prophylaxis with both cefazolin and vancomycin on infection and renal failure after primary total knee arthroplasty (TKA) compared with cefazolin alone.Methods: We performed a retrospective review of primary TKA patients for two years before and two years after routine dual antibiotic prophylaxis was implemented at our institution. 1502 patients were included (567 cefazolin-only and 935 dual prophylaxis). Results: 2 patients (0.4%) in the cefazolin-only group had a deep surgical site infection, compared with 13 patients (1.4%) in the dual prophylaxis group (p=0.06). 46 patients (8.1%) in the cefazolin-only group had postoperative renal failure, compared with 36 patients (3.9%) in the dual prophylaxis group (p=0.0006).Discussion and Conclusion: Our results did not support the routine use of vancomycin in primary total joint arthroplasty to decrease periprosthetic joint infection. However, we also did not see any clear harm due to renal failure in the routine use of dual antibiotic prophylaxis.
{"title":"Dual Antibiotic Therapy with Vancomycin and Cefazolin for Surgical Prophylaxis in Total Knee Arthroplasty","authors":"A. Cohen-Rosenblum, M. Crutcher, J. Gui, W. Novicoff, Stephen J. Nelson, J. Browne","doi":"10.15438/RR.8.2.212","DOIUrl":"https://doi.org/10.15438/RR.8.2.212","url":null,"abstract":"Background: Perioperative administration of intravenous antibiotics is a routine part of total knee arthroplasty. Antibiotic selection is a matter of controversy, and the potential risks and benefits associated with each antibiotic selection need to be considered. The objective of this study is to examine the effects of routine dual antibiotic prophylaxis with both cefazolin and vancomycin on infection and renal failure after primary total knee arthroplasty (TKA) compared with cefazolin alone.Methods: We performed a retrospective review of primary TKA patients for two years before and two years after routine dual antibiotic prophylaxis was implemented at our institution. 1502 patients were included (567 cefazolin-only and 935 dual prophylaxis). Results: 2 patients (0.4%) in the cefazolin-only group had a deep surgical site infection, compared with 13 patients (1.4%) in the dual prophylaxis group (p=0.06). 46 patients (8.1%) in the cefazolin-only group had postoperative renal failure, compared with 36 patients (3.9%) in the dual prophylaxis group (p=0.0006).Discussion and Conclusion: Our results did not support the routine use of vancomycin in primary total joint arthroplasty to decrease periprosthetic joint infection. However, we also did not see any clear harm due to renal failure in the routine use of dual antibiotic prophylaxis. ","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41391459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Up to 20% of total knee arthroplasty (TKA) patients are not satisfied with their outcome, and coronal alignment is considered an important variable in attaining a well-functioning TKA. Neutral mechanical alignment is not necessarily the anatomic norm and has led some surgeons to advocate a shift in defining and attaining the optimal coronal component alignment. Our aim was to review the different coronal alignment paradigms of TKA and summarize the historical and contemporary outcomes of different alignment techniques.Methods: A systematic review was performed in March 2017 via PubMed using the search terms: coronal alignment, kinematic alignment, and total knee replacement using Boolean “and” in-between terms. Relevant results were then reviewed, analyzed and summarized Conclusions: Early clinical outcomes of kinematically aligned TKAs are promising, but long-term clinical results are unknown. Clinical, laboratory, and retrieval studies suggest that mechanical varus in TKA, especially involving the tibial component, may result in earlier failure. Kinematic alignment with boundaries may be an optimal strategy for patients with pre-operative constitutional varus or congenital tibia vara.
{"title":"Coronal Alignment in TKA: Traditional Principles Versus New Concepts","authors":"T. Parisi, J. Jennings, D. Dennis","doi":"10.15438/rr.8.2.213","DOIUrl":"https://doi.org/10.15438/rr.8.2.213","url":null,"abstract":"Background: Up to 20% of total knee arthroplasty (TKA) patients are not satisfied with their outcome, and coronal alignment is considered an important variable in attaining a well-functioning TKA. Neutral mechanical alignment is not necessarily the anatomic norm and has led some surgeons to advocate a shift in defining and attaining the optimal coronal component alignment. Our aim was to review the different coronal alignment paradigms of TKA and summarize the historical and contemporary outcomes of different alignment techniques.Methods: A systematic review was performed in March 2017 via PubMed using the search terms: coronal alignment, kinematic alignment, and total knee replacement using Boolean “and” in-between terms. Relevant results were then reviewed, analyzed and summarized Conclusions: Early clinical outcomes of kinematically aligned TKAs are promising, but long-term clinical results are unknown. Clinical, laboratory, and retrieval studies suggest that mechanical varus in TKA, especially involving the tibial component, may result in earlier failure. Kinematic alignment with boundaries may be an optimal strategy for patients with pre-operative constitutional varus or congenital tibia vara.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46353924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. R. Martin, Jesse E. Otero, W. B. Beaver, B. Springer, W. Griffin
Introduction: There has been recent enthusiasm for the use of modular stemmed tibial components in obese (BMI ≥35kg/m2) patients undergoing primary total knee arthroplasty (TKA). This has been mainly driven by studies demonstrating statistically significant increases in the rates of aseptic tibial loosening (ATL) in this patient population. However, to our knowledge, no study has specifically evaluated the cost effectiveness of this current recommendation.Methods: The following study was performed utilizing previously obtained data on the incidence of ATL in obese patients undergoing primary TKA. This data was then utilized to create a cost calculator that can evaluate the price point at which the use of a stemmed tibial component in all obese patients would be less than or equal to the costs of revision surgery if a stemmed implant was not utilized.Results: Utilizing historical data with a revision rate of 4% for aseptic loosening of the tibia on obese patients, a cost calculator was developed. The cost calculator requires the input of expected or known incidence of ATL utilizing a stem extension and the expected or known costs of revision for ATL.Conclusion: The following cost calculator quickly determines a price point at which the use of a tibial stem offsets the costs of revision surgery. While this study may not provide an exact cost-effectiveness of modular stem fixation due to model limitations, it will hopefully initiate the discussion for providing more cost-effective individualized care for this patient population.
{"title":"Is Utilizing a Modular Stemmed Tibial Component in Obese Patients Undergoing Primary Total Knee Replacement Cost-Effective?","authors":"J. R. Martin, Jesse E. Otero, W. B. Beaver, B. Springer, W. Griffin","doi":"10.15438/RR.8.2.215","DOIUrl":"https://doi.org/10.15438/RR.8.2.215","url":null,"abstract":"Introduction: There has been recent enthusiasm for the use of modular stemmed tibial components in obese (BMI ≥35kg/m2) patients undergoing primary total knee arthroplasty (TKA). This has been mainly driven by studies demonstrating statistically significant increases in the rates of aseptic tibial loosening (ATL) in this patient population. However, to our knowledge, no study has specifically evaluated the cost effectiveness of this current recommendation.Methods: The following study was performed utilizing previously obtained data on the incidence of ATL in obese patients undergoing primary TKA. This data was then utilized to create a cost calculator that can evaluate the price point at which the use of a stemmed tibial component in all obese patients would be less than or equal to the costs of revision surgery if a stemmed implant was not utilized.Results: Utilizing historical data with a revision rate of 4% for aseptic loosening of the tibia on obese patients, a cost calculator was developed. The cost calculator requires the input of expected or known incidence of ATL utilizing a stem extension and the expected or known costs of revision for ATL.Conclusion: The following cost calculator quickly determines a price point at which the use of a tibial stem offsets the costs of revision surgery. While this study may not provide an exact cost-effectiveness of modular stem fixation due to model limitations, it will hopefully initiate the discussion for providing more cost-effective individualized care for this patient population.","PeriodicalId":20884,"journal":{"name":"Reconstructive Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44557464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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