Behaviour and Feedback of Patients with Gonarthrosis or Coxarthrosis Receiving Teletherapeutic Treatment - A Qualitative Video AnEine qualitative Videoanalysealysis

Background As a result of the corona pandemic, the implementation of physiotherapy as teletherapy was initially permitted for a limited period of time and subsequently approved for an unlimited period of time. Patients with gonarthrosis and coxarthrosis can be a target group.Aim To explore the behavior and feedback of patients with gonarthrosis and coxarthrosis, including patients who have had endoprosthetic treatment, during teletherapeutic treatments using screencasts.Method Patients with gonarthrosis or coxarthrosis, possibly after endoprosthetic treatment, received 6 treatment sessions including 5 by teletherapy. Participants completed the Musculoskeletal and Joint Health Questionnaire (MSK-HQ) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The first and last treatment sessions were videotaped and thereafter transcribed. Coding of the text passages was deductively content-analytic.Results 5 patients were included (2 m, 3w;56 to 78 years;3 gonarthrosis, 2 coxarthrosis;of those 2 with endoprosthesis). The behavior and patients' perspectives were assigned to the main categories of person-related factors, treatment characteristics, point of view or environment-related factors, each with 2-5 subcategories. The evaluation showed a thoroughly positive attitude towards teletherapy. This despite initial doubts and lack of knowledge about the method. Factors such as framework conditions, technology, personal motivation and compliance, as well as the relationship between patient and therapist, were found to influence the patients' attitude towards this method. A mixed therapy design consisting of teletherapy and conventional methods received a preferred resonance. For all participants, a clinically relevant improvement of the WOMAC was observed (7-47 points;improvement MSK-HQ 1-13 points).Conclusion The behavior of the participants shows that a sound planned teletherapy can be well implemented in practice. The description of the patient perspective provides researchers and practitioners with information that can be used for the further development of teletherapeutic treatment concepts for patients with gonarthrosis or coxarthrosis as well as for patients with musculoskeletal complaints in general.

Impact of the COVID-19 pandemic on early clinical outcome after total knee arthroplasty: a retrospective comparative analysis.

INTRODUCTION: To help combat the SARS-CoV-2 (COVID-19) pandemic, elective inpatient procedures have been reduced. The authors hypothesized that a nationwide lockdown would negatively affect the postoperative outcome after total knee arthroplasty (TKA) due to reduced physiotherapy as well as restrictions in external facilities of physiotherapy and rehabilitation. MATERIALS AND METHODS: We conducted a retrospective, comparative study including 41 patients who had undergone primary TKA during the first lockdown of the COVID-19 pandemic from March 2020 to April 2020 and a comparable control group consisting of 47 patients with a minimum follow-up of 6 months before the COVID-19 pandemic from 2019. Relevant end points were the visual analogue scale (VAS) for pain, Knee Society Function Score (KSS), Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion (ROM). RESULTS: The lockdown group had a significantly worse outcome compared to the control group 6 months after TKA regarding WOMAC (p = 0.001), KSS (p < 0.001), OKS (p < 0.001), and length of hospital stay (p < 0.001). We found no statistically significant difference between the groups in ROM (p = 0.132), KSFS (p = 0.933), VAS at rest (p = 0.9.22), and exercise (p = 0.304). CONCLUSION: The COVID-19 pandemic negatively affected early clinical outcome parameters of elective primary TKA at 6 months of follow-up due to restrictions in postoperative care. We believe that standardized protocols for physiotherapy will improve clinical outcomes for TKA in the event of future lockdowns and underline the importance of appropriate postoperative care during this pandemic.

Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates.

BACKGROUND: This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19. METHODS: A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not. Differences between groups were assessed using univariate and multivariate analyses. Overall, 712 COVID-19 patients were matched to 4,272 controls (average time to diagnosis: 128-117 days [range, 0-351]). RESULTS: Of patients diagnosed <90 days postoperatively, 32.5%-33.6% required COVID-19-driven readmission. Discharge to a skilled nursing facility (adjusted odds ratio [aOR] 1.72, P = .003) or acute rehabilitation unit (aOR 4.93, P < .001) and Black race (aOR 2.28, P < .001) were associated with readmission after TKA. Similar results were associated with THA. COVID-19 patients were at increased risk of pulmonary embolism (aOR 4.09, P = .001) after TKA and also periprosthetic joint infection (aOR 4.65, P < .001) and sepsis (aOR 11.11, P < .001) after THA. The mortality rate was 3.51% in COVID-19 patients and 7.94% in readmitted COVID-19 patients compared to 0.09% in controls, representing a 38.7 OR and 91.8 OR of death, respectively. Similar results were observed for TKA and THA separately. CONCLUSION: Patients who contracted COVID-19 following TJA were at greater risk of numerous complications, including death. These patients represent a high-risk cohort who may require more aggressive medical interventions. Given the potential limitations presently, prospectively collected data may be warranted to validate these findings.

Higher Complication Rate in COVID-19 Recovered Patients Undergoing Primary Total Joint Arthroplasty.

BACKGROUND: There is limited data reviewing complication risks associated with total joint arthroplasty (TJA) after recovering from COVID-19. This study evaluated complications within 90 days of TJA in patients who had a COVID-19 diagnosis at varying intervals prior to surgery versus a non-COVID-19 cohort. METHODS: A large national database was used to identify patients diagnosed with COVID-19 in the six months prior to total hip arthroplasty (THA) or total knee arthroplasty. The incidence of complications within 90 days of surgery was recorded and compared to a COVID-19 negative control group matched 1:3 for age range in 5-year intervals, Charlson Comorbidity Index, and sex. There were 7,780 patients included in the study; 5,840 (75.1%) never diagnosed with COVID-19, 1,390 (17.9%) who had a COVID-19 diagnosis 0 to 3 months prior to surgery, and 550 (7.1%) who had a COVID-19 diagnosis 3 to 6 months prior to surgery. RESULTS: When compared to their COVID negative controls, patients who had a COVID-19 diagnosis 0 to 3 months prior to surgery had significantly higher rates of readmission (14.0 versus 11.1%, P = .001), pneumonia (2.2 versus 0.7%, P < .001), deep vein thrombosis (DVT) (3.3 versus 1.9%, P = .001), kidney failure (2.4 versus 1.4%, P = .006), and acute respiratory distress syndrome (1.4 versus 0.7%, P = .01). Patients who had a COVID-19 diagnosis 3 to 6 months prior to surgery had significantly higher rates of pneumonia (2.0 versus 0.7%, P = .002) and DVT (3.6 versus 1.9%, P = .005) when compared to their COVID negative controls. CONCLUSION: Patients diagnosed with COVID-19 within three months prior to TJA have an increased risk of 90-day postoperative complications. Risk for pneumonia and DVT remains elevated even when surgery was performed as far as 3 to 6 months after COVID-19 diagnosis.

Epidemiology And Treatment Of Pain Associated With Osteoarthritis Of The Knee In Germany: A Retrospective Health Claims Data Analysis

Purpose: Osteoarthritis of the knee (knee OA) is the most prevalent form of OA, frequently leading to significant pain and an overall reduction in quality of life. The available options for managing pain, associated with knee OA, are well documented. They include various oral analgesic medications (for example, NASIDs and opioids), intraarticular agents, notably, hyaluronic acid and corticosteroids, and where pharmacological and lifestyle options have been exhausted, orthopedic surgery, including total knee replacement (TKR). The treatment option(s) a patient may receive, in which order and at what time point, post-diagnosis may vary significantly between healthcare centers. The current study focuses specifically on knee OA in Germany, aiming to determine the epidemiology, patient characteristics and treatment schemes for the management of pain associated with knee OA. Method(s): A non-interventional, retrospective health claims data analysis was performed with an anonymized, age- and sex-representative sample of the Institute for Applied Health Research Berlin GmbH (InGef) database. The database that was used for this study includes approximately 4.8 million persons from approx. 60 statutory health insurances (SHI). Patients >=18 years of age were analyzed cross-sectionally for each year 2015-2020. Using ICD-10 and ATC codes, newly diagnosed patients in 2015 were also analyzed longitudinally until end of 2020. Result(s): The average period prevalence of knee OA was 7.34%, with a slight increase during the years 2015-2020. Incidence ranged from 1.71% of patients in 2015 to 1.46% of patients in 2020. Females and patients aged >=66 years had both a higher prevalence and incidence proportion compared to males and younger persons. Approximately 62% of newly diagnosed patients in 2015 received medical treatment during follow-up, most of whom were prescribed non-opioid analgesics;WHO I category (96.84%), followed by WHO II (2.45%) and WHO III (0.71%), as first line treatment. This analysis could not account for the use of any over the counter medications, or medicines prescribed in hospital, prior to, or after diagnosis. As many as 16.58% of newly diagnosed patients had surgery within 5 years. Knee replacement was the most common type of surgery with rising prevalence. The number of patients in whom surgery was performed decreased slightly from 5,38% to 4,03% during the study years considered (Figure 1);the decrease in 2020 may, in-part, be a reflection of the COVID-19 pandemic and the knock-on impact on healthcare systems. Of the 8,318 surgical patients, 2,101 patients (25.26%) had no record of having received any prescription pharmacological treatment prior to first surgery. The median time from first diagnosis until surgery in newly diagnosed patients was 346 days for any surgery, and 564 days for knee replacement. [Formula presented] Conclusion(s): With a stable incidence and a growing population, the number of patients with knee OA in Germany is slowly rising. In parallel, there is an slight decrease in total knee surgeries occurring each year with an increasing proportion of TKRs. Time until first surgery, in general, and TKR in newly diagnosed patients is relatively short, compared to other countries, with some patients having no record of having received any prescription medication prior to first surgery. Other treatment options such as opioids and intraarticular agents, appear to play a relatively minor role, in newly diagnosed patients, in current practice in Germany.Copyright © 2023

A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study.

PURPOSE: Modern multimodal analgesia has been shown to significantly reduce opioid use following total knee arthroplasty (TKA). This study was conducted to determine if changing TKA discharge opioid prescriptions from automatic to upon request resulted in more opioid free recoveries without compromising pain control. METHODS: Between December 2019 and August 2021, an orthopedic surgeon performed 144 primary unilateral TKAs; patients received the same multimodal analgesia protocol except for postoperative opioid prescribing. The first consecutively-treated cohort automatically received an opioid prescription following discharge (automatic group) and the second cohort received opioid prescriptions only upon request (upon request group). Opioid prescription data were derived from a prescription monitoring program and patient-reported outcomes (PROs) were collected preoperatively and at 2 and 12 weeks postoperatively. RESULTS: A higher percentage of the upon request group was opioid free 3 months after TKA compared with the automatic group (55.6% vs 4.3%, p < 0.0001) without compromising pain or function. Among opioid-naïve patients, 72% in the upon request group were opioid free after TKA compared with 5.4% in the automatic group. Opioid prescribing was not significantly reduced among opioid-experienced patients regardless of the pain protocol. CONCLUSION: Requiring patients to request opioid prescriptions following TKA resulted in a higher rate of opioid free TKA, especially among opioid-naïve patients, without increasing pain compared with offering all patients an initial opioid prescription. LEVEL OF EVIDENCE: Level III.

Patients With Previous COVID-19 Infection Can Safely Undergo Primary Total Joint Arthroplasty.

BACKGROUND: The COVID-19 virus is believed to increase the risk of diffusing intravascular coagulation. Total joint arthroplasty (TJA) is one of the most common elective surgeries and is also associated with a temporarily increased risk of venous thromboembolism (VTE). However, the influence of a history of COVID-19 infection on perioperative outcomes following TJA remains unknown. Therefore, this study sought to determine what effect a history of COVID-19 infection had on outcomes following primary TJA. METHODS: A retrospective case-control study using the national database was performed to identify all patients who had a history of COVID-19 and had undergone TJA, between 2019 and 2020. Patients who had a history of both were 1:1 matched to those who did not have a history of COVID-19, and 90-day outcomes were compared. A total of 661 TKA and 635 THA patients who had a history of COVID-19 were 1:1 matched to controls. There were no differences in demographics and comorbidities between the propensity-matched pairs in both TKAs and THAs studied. Previous COVID-19 diagnosis was noted in 28.3% of patients 5 days within TJA and in 78.6%, 90 days before TJA. RESULTS: Patients who had a previous diagnosis of COVID-19 had a higher risk of pneumonia during the postoperative period for both THA and TKA (6.9% versus 3.5%, P < .001 and 2.27% versus 1.21%, P = .04, respectively). Mean lengths of stay were also greater for those with a previous COVID-19 infection in both cohorts (TKA: 3.12 versus 2.57, P = .027, THA: 4.52 versus 3.62, P < .001). Other postoperative outcomes were similar between the 2 groups. CONCLUSION: COVID-19 infection history does not appear to increase the risk of VTE following primary TJA, but appears to increase the risk of pneumonia in addition to lengths of stay postoperatively. Individual risk factors should be discussed with patients, to set reasonable expectations regarding perioperative outcomes.

An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: A Retrospective Cohort Analysis.

Background: The coronavirus disease 2019 (COVID-19) pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip and total knee arthroplasty. Methods: This retrospective study split patients into cohorts: TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following the resumption of elective surgeries (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index, American Society of Anesthesiologists score, and pertinent comorbidities were analyzed, and length of stay, 30-day emergency department (ED) visit rates, readmissions, and reoperations were compared. Results: A total of 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (interquartile range 63-76), and the post-COVID group had a median age of 68 years (interquartile range 61-75) (P = .024). SDD increased from 0.1% to 28.9% (P < .001), and length of stay decreased from 1.3 days to 0.89 days (P < .001). There was no change in 30-day ED visits, readmissions, or reoperations (P = .817, P = .470, and P = .643, respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age (P < .001, odds ratio [OR] = 0.94), body mass index (P = .006, OR = 0.95), male sex (P < .001, OR = 1.83), and history of tobacco use (P < .001, OR = 1.87). Conclusions: At our institution, the COVID-19 pandemic accelerated the utilization of SDD pathways without increasing ED visits, readmissions, or reoperations.

A UNIQUE CASE: ACUTE EOSINOPHILIC PNEUMONIA SECONDARY TO DAPTOMYCIN: A COVID-19 PNEUMONIA MIMIC

SESSION TITLE: Drug-Induced Lung Injury Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) is an atypical cause of acute hypoxic respiratory failure in adults, however if not identified can prove to be fatal. It can all be a COVID19 mimic during the pandemic. AEP has several causes, such as inhalational drugs, infections and various pharmaceuticals. Often, patients will have an acute respiratory syndrome for less than one-month, pulmonary infiltrates on chest computed tomography (CT) or radiography (CXR), in addition to bronchoalveolar lavage (BAL) with more than 25% of eosinophils. CASE PRESENTATION: A 79 y/o man underwent an elective total knee replacement complicated by acute lower limb ischemia from an occluded bypass graft. He developed methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) joint and soft tissue infection of the lower extremity. He was prescribed a 6-week course of Daptomycin. He presented about 3 weeks into treatment with shortness of breath. He was initially diagnosed with acute on chronic congestive heart failure (CHF) exacerbation and COVID negative. He was initially treated with diuretics. He developed acute renal failure requiring dialysis and acute hypoxic respiratory failure requiring intubation. CXR revealed bilateral lung infiltrates with BAL having 80% eosinophils, eosinophilia and urinalysis positive for eosinophils. Daptomycin was discontinued and he was started on systemic steroids for a two-week course. He was successfully extubated 5 days after diagnosis of AEP and was subsequently discharged to a rehabilitation facility on lifelong Doxycycline for MRSA prosthetic joint infection prophylaxis. DISCUSSION: AEP related to Daptomycin was first reported in 2007, in a patient that developed the condition after receiving treatment for endocarditis. Daptomycin caused an inflammatory reaction within the lungs, due to an accumulation of the drug within the pulmonary surfactant. Our case report patient met all components for AEP diagnosis, in addition to symptom onset being approximately 3 weeks into treatment. The ultimate treatment for AEP is to stop the reversible cause, if identifiable, along with glucocorticoids and symptomatic support. Prognosis for patients with AEP is excellent when diagnosis is prompt, and usually infiltrates are resolved within 1 month without long term adverse pulmonary effects. Our patient was discharged to an acute rehab facility without supplemental oxygen therapy and continues to improve from functional standpoint. This case a definite cause of AEP from Daptomycin presented as COVID19 pneumonia mimic. It highlights the importance of rapid diagnosis to prevent morbidity and mortality. CONCLUSIONS: The differential in a patient with acute hypoxic respiratory failure is numerous, especially during the COVID19 pandemic. During these challenging times, it is important to think of atypical causes, such as AEP to improve the patient's clinical status. Reference #1: Allen JN, Pacht ER, Gadek JE, Davis WB. Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure. N Engl J Med. 1989;321:569-574 Reference #2: Hayes Jr. D, Anstead MI, Kuhn RJ. Eosinophilic pneumonia induced by daptomycin. J Infect. 2007;54(4):e211-213. Reference #3: Rachid M, Ahmad K, Saunders-Kurban M, Fatima A, Shah A, Nahhas A. Daptomycin-Induced Acute Eosinophilic Pneumonia: Late Onset and Quick Recovery. Case Reports in Pulmonology. 2017. DISCLOSURES: No relevant relationships by Moses Bachan No relevant relationships by Zinobia Khan No relevant relationships by Kaitlyn Mehern

Teletherapy - Rehabilitation Options after Total Knee Arthroplasty Critical Appraised Topic (CAT)

To meet the future demand for physiotherapy in the face of a growing number of patients after arthroplasty, health service providers need a solution for the provision of appropriate therapy. One potential option could be teletherapy, which is becoming increasingly important due to the pandemic situation surrounding SARS-COV-2. Remote options can enable therapy for people who cannot visit a practice for different reasons. They also have the potential to realize cost savings. This review aimed to clarify whether remote physiotherapy in patients after knee arthroplasty was comparable to conventional physiotherapy. A literature review, carried out across the Cochrane, Europe PMC and PubMed databases for the period from January 1 to May 4, 2021, identified 4 suitable RCTs. All of the 4 RCTs demonstrated that remote therapy has a positive impact on function in patients after total arthroplasty of the knee and is not inferior to conventional physiotherapy. Results were clinically significant. Accordingly, teletherapy can be considered as an alternative. However, some of the trials were viewed critically due to methodological weaknesses. Consequently, this review cannot give a definite recommendation. Further studies are required to get clear results and issue a strong clinical recommendation for patients after total knee arthroplasty.

THE QUALITY of REPORTING in RANDOMIZED CONTROLLED TRIALS of STRENGTHENING EXERCISES in TOTAL KNEE ARTHROPLASTY

Background: End-stage knee osteoarthritis (KOA) is a signifcant health issue worldwide resulting in severe pain and disability. Total knee arthroplasty (TKA) leads to signifcant improvements in pain and the performance of functional activities such as walking for patients with end-stage KOA. Although TKA reduces pain and improves perceived function, patients continue to exhibit reduced muscle strength, voluntary muscle activation, and functional performance even years after surgery (1). In addition, quarantine, and related social restrictions due to the current Covid-19 pandemic may have affected the recovery of patients undergoing TKA due to limited access to exercise, physiotherapy, face-to-face follow-up, and medical services (2).Limited recovery after TKA will require intensive rehabilitation programs in the future. Strengthening exercises(SE) are the most effective intervention for improving muscle strength and functionality and have been recommended in the guidelines for KOA management and in clinical reviews for TKA rehabilitation (3). Randomized controlled trials (RCTs) are the gold standard for assessing the effects of health care interventions. However, RCTs may yield misleading results if they lack methodological rigors(4). RCTs provide the highest quality clinical evidence in the selection of the SE method to be applied (5). However, there are no studies examining the quality of RCTs related to SE in patients with TKA. Objectives: The aim of this study was to assess the reporting quality of RCTs of SE in patients with TKA. Methods: RCTs published between 2002 and 2021 were sourced from clinical trial registers, PubMed, and the Cochrane Reviews. RCTs were included if they involved SE in patients who underwent TKA. Analysis was carried out with two assessment tools: PEDro scale and 9-items from CONSORT(6). In addition, we have identifed some key methodological elements and examined their relationship to their methodological quality. Results: We found 35 RCTs that included SE in individuals with TKA. The mean PEDro score was 6.40 ± 1, 73. The most common defcient PEDro Items were: Blinding of all therapists who administered the therapy (14,2 %: 5/35 trials), allocation was concealed (31,4 %;11/35 trials), blinding of all subjects (31,4 %: 11/35 trials). The most common defcient CONSORT Criteria were: Statistical adjustment for multiple primary outcomes (40 %;14/35 trials), funding sources (40 %;14/35 trials) and identifcation as a randomized trial in the title (62,85%;22/35 trials). Of the key methodological factors we identifed, only exercise duration (weeks) was associated with PEDro score (R2 =.169, p<0.01). Conclusion: Our results show that the quality of reporting in the literature on RCTs of SE in patients with TKA is insufficient. In order to increase muscle strength after TKA, the lack of face-to-face programs due to COVID-19 should be eliminated with telerehabilitation methods, video conferencing platforms and virtual reality applications, and high-quality RCTs should be planned where these programs are examined.

THE QUALITY of REPORTING in RANDOMIZED CONTROLLED TRIALS of BALANCE EXERCISES in TOTAL KNEE ARTHROPLASTY

Background: Total knee arthroplasty (TKA) is used to treat patients with endstage osteoarthritis who experience pain and struggle to perform activities of daily living owing to having degenerative knee joints. Although TKA can improve the quality of life of patients, some may experience a decrease in their propri-oception and the ability to balance after surgery (1). Decreased balance ability makes it difficult to undertake daily life activities in patients after TKA, impairs walking capacity and increases the risk of falling (2). Almost all studies which investigate the risk of falling conclude that physical activity(PA) are effective methods in order to maintain an intact balance control and prevent falls(4). Today, however, measures aimed at controlling COVID-19 include quarantines that lead to PA restrictions (5). In these days when PA cannot be increased due to quarantines, the most effective way to prevent falls in TKA patients may be to apply balance exercises (3). The 'gold standard' in clinical trials are randomized controlled trials(RCTs) in which healthcare professionals make decisions about the safety and efficacy of treatments. However, poorly designed and reported RCTs can give misleading results. Methodological quality (MQ) assessment of clinical trials is important because it can prevent erroneous results in clinical practice and improve the quality of medical care. (6) Although RCTs provide the highest quality clinical evidence selection of balance exercises(BE) to be applied, there is no study in the literature investigating the MQ of RCTs of BE in TKA patients. Objectives: The aim was to investigate assess the reporting MQ of RCTs of BE in patients with TKA. Methods: We analyzed 17 published full-text reports of RCTs using BE in patients who underwent TKA. RCTs were sourced from PubMed, the Cochrane Reviews and PEDro Database. The PEDro scale and the 9-item CONSORT (7) were used to evaluate the MQ of the studies. Results: The mean PEDro score was 6,64 ± 1,57. Classifcation of RCTs according to total PEDro score revealed that 1 study was classifed as excellent, 13 studies as good, and 3 as fair. The least fulflled criteria in the PEDro scale were: Blinding of all therapists who administered the therapy (1[5.88%]), allocation was concealed (5[29.4%]) and blinding of all subjects (7[41.17%]). The adherence of the reports to CONSORT items ranged from 41.17 % to 100%. The most underreported CONSORT items were: funding sources (7[41.17%]), statistical adjustment for multiple primary outcomes (8[47.05%]), and number of primary outcomes (8[47.05%]). Conclusion: Our fndings show that the quality of reporting for RCTs of BE in TKA patients is not high quality. Since it is not possible to improve balance with PA today, when there are quarantine due to COVID-19, patients should be encouraged to participate in BE programs with telerehabilitation, home-based or web-based exercises, and high quality RCTs should be planned in these programs.

Short-Stay Arthroplasty is Not Associated With Increased Risk of 90-Day Hospital Returns.

BACKGROUND: With the removal of total hip arthroplasty (THA) and total knee arthroplasty (TKA) from the inpatient-only list, medical centers are faced with challenging transitions to outpatient surgery. We investigated if short-stay arthroplasty, defined as length of stay (LOS) <24 hours, would influence 90-day readmissions and emergency department (ED) visits at a tertiary referral center. METHODS: The institutional database was retrospectively queried for primary TKAs and THAs from July 2015 to January 2018, resulting in 2,217 patients (1,361 TKA and 856 THA). Patient demographics, including age, gender, body mass index, and American Society of Anesthesiologists score were collected. LOS, disposition, cost of care, 90-day ED visits, and readmissions were identified through the institutional database using electronic medical record data. Univariable and multivariable models were used to evaluate rates of 90-day readmissions and ED visits based on LOS <24 hours vs ≥24 hours. RESULTS: LOS <24 h was associated with significant decreases in 90-day ED visits (P = .003) and readmissions (P = .002). After controlling for potential confounding variables with a multivariable model, a significant decrease in ED visits (P = .034) remained in the THA cohort alone. Within TKA and THA cohorts, LOS <24 h was associated with lower costs (P < .001). Eighteen percent of patients with ≥24 h LOS were discharged to skilled nursing or rehabilitation facilities. CONCLUSION: In this cohort, LOS <24 hours was associated with decreased 90-day readmissions, ED visits, and costs. With the goal of minimizing costs and maintaining patient safety while efficiently using resources, outpatient and short-stay arthroplasty are valuable, feasible options in tertiary academic centers.

Influence of vitamin D levels on outcomes and nosocomial COVID-19 infection in patients undergoing total knee arthroplasty- a cohort study.

Purpose: This study aimed to audit the effects of vitamin D3 on the early functional outcomes, the incidence of nosocomial COVID-19 infection and complications in patients undergoing elective Total Knee Arthroplasty (TKA). Methods: This was a retrospective study involving patients undergoing primary unilateral TKA between January 2020 to May 2021 operated by a single surgeon using a single implant. Participants were divided into two cohorts, Deficient-vitamin D3 level <20 ng/ml and Sufficient-vitamin D3 level ≥20 ng/ml. Assessment for Knee Society Score and Oxford Knee Score (OKS) was done preoperatively and one year after TKA. Nosocomial COVID-19 infection rate, 30-day re-admissions and complications were noted during the study. Results: 235 patients were divided into 2 cohorts matched by age, gender and ASA grades. 74 patients belonged to the deficient group and 161 belonged to the sufficient group. The mean preoperative scores in the sufficient group were higher than the deficient group (OKS = 15.74 vs 12.95; KSS = 88.91vs 85.62). Similarly, the one-year postoperative scores in the sufficient group were significantly higher (OKS = 36.54 vs 35.16; KSS = 164.01 vs 161.22). A linear correlation was present between preoperative score (r = 0.273) & post-operative scores (r = 0.141) with serum vitamin D3 levels. Vitamin D3 deficient individuals had higher nosocomial COVID-19 infection rate (10.81% vs 4.96%,p = 0.16). The incidence of complications like DVT, embolism, stroke, infection and fracture were not statistically different in the two groups. Conclusion: Vitamin D positively influences the outcomes of TKA and protects against nosocomial COVID-19 infection in patients undergoing elective TKA.

Is it time to resume elective knee arthroplasty surgery? A multidisciplinary experience in a Sardinian center during the SARS-CoV-2 pandemic.

Background: Starting in January 2020, the SARS-CoV-2 pandemic caused changes in the nation's health systems. The hospital's reorganization led to a near-total stop of non-urgent, elective surgeries across all specialties, including hip and knee arthroplasty. However, in May 2020, a gradual elective surgery restarting was possible. Considering the risk of COVID-19 infections, the European Knee Associates suggest the need to implement specific protocols for a safe return to orthopaedic elective surgery. Methods: A retrospective analysis regarding all patients who underwent primary knee arthroplasty (TKA) between March 1st and October 1st, 2020 using an institutional database was performed. The study time was divided into 2 periods: Pandemic (from March 2020 to May 2020), Post Pandemic (from June 2020 to October 2020). A specific protocol was designed to safeguard the health of patients and healthcare workers during the SARS-CoV-2 pandemic. Results: A total of 147 patients underwent total knee replacement surgery in the analyzed period. The mean surgical time was 77.6 (+/-18.9). The intraoperative mean blood loss was 54 (+/-28) ml. The mean hospital stay was 3-4 days. Among the treated patients no case of COVID-19 infection was observed. Conclusion: The use of our protocol, developed ad hoc for the management of elective orthopedic patients, allowed the restart of elective orthopedic surgery in a safe and reproducible way with an average increase of 374% on surgical activity between the pandemic and post-pandemic periods without record cases of contagion among the treated patients.

Local Anesthetic Systemic Toxicity After Local Infiltration Analgesia Following a Total Knee Arthroplasty.

Multimodal analgesia is nowadays a recognized method to reduce postoperative pain. Infiltration of the surgical site with local anesthetic is one of the methods widely used for its effectiveness and its lower risk of toxicity, particularly in orthopedic surgery. We present here a case of local anesthetic systemic toxicity (LAST) that occurred on two different occasions to the same patient after total knee replacement surgeries. The clinical presentation of the syndrome was not typical for this 74-year-old patient who presented with respiratory distress associated with impaired consciousness. After the elimination of the most common diagnoses, it was finally the administration of Intralipid that followed with clinical improvement.

Italian Translation, Adaptation, and Validation of the Novel Satisfaction Measure Assessment after Primary Total Joint Arthroplasty: The Goodman Score Questionnaire.

Patient satisfaction after total joint arthroplasties (TJA) represents a key element for the evaluation of surgery success in relation to subjects' needs and expectations. The assessment tools are applied inconsistently throughout the literature, and thus, it is difficult to compare results among different studies. Goodman et al. proposed a standardized questionnaire with strong psychometric properties for the assessment of satisfaction. The present study aims to translate, adapt, and validate the Goodman questionnaire for the Italian population. After translation and back translation, the questionnaire was administrated to 50 patients. Internal consistency, test-retest reliability, floor and ceiling effects, and construct validity were evaluated (correlation with KOOS/HOOS, SF-12 PCS/MCS, EQ-5D). Responsiveness was evaluated with respect to SF-12 PCS improvements. The Italian version of the Goodman score questionnaire demonstrated psychometric properties similar to those of the original version. The translated questionnaire showed good internal consistency (Cronbach's alpha = 0.836) and test-retest reliability (ICC: 0.507). Moderate/strong correlations were observed between the Italian version of the Goodman score and other scores. The score significantly discriminated patients who improved from those who did not improve in SF-12 PCS after treatment. This study provides an adapted and validated Italian version of the Goodman score questionnaire, with psychometric properties similar to those of its original counterpart.

Comparison of total joint arthroplasty care patterns prior to the Covid-19 pandemic and after resumption of elective surgery during the Covid-19 Outbreak: A retrospective, large urban academic center study.

BACKGROUND: After the suspension of elective surgeries was lifted in June 2020 in New York State, challenges remained regarding coordination of total joint arthroplasty (TJA) cases. Using the experience from a high-volume health system in New York City, we aimed to describe patterns of care after resumption of elective TJA. METHODS: We retrospectively assessed 7,699 TJAs performed before and during the COVID-19 pandemic. Perioperative characteristics and clinical outcomes were compared between TJAs based on time period of performance: 1) pre-pandemic (PP, June 8th-December 8th, 2019), 2) initial period post-resumption of elective surgeries (IR, June 8th-September 8th, 2020), and 3) later period post-resumption (LR, September 9th-December 8th, 2020). RESULTS: LOS > 2 days (83%, 67%, 70% for PP, IR, LR periods respectively) and discharge rates to post-acute care (PAC) facilities were lower during the pandemic periods (ORIR vs. PP: 0.48, 95% CI: 0.40-0.59, p < 0.001; ORLR vs. PP: 0.63, 95% CI: 0.53-0.75, p < 0.001). Compared to the pre-pandemic period, the risk for 30-day readmission was lower during the IR period (OR: 0.62, 95% CI: 0.40-0.98, p = 0.041) and similar during the LR period (OR: 0.96, 95% CI: 0.65-1.41, p = 0.832). CONCLUSIONS: Despite decreased LOS and discharge to PAC for TJAs performed during the pandemic, 30-day readmissions did not increase. Given the increased costs and lack of superior functional outcomes associated with discharge to PAC, these findings suggest that discharge to PAC facilities need not return to pre-pandemic levels.

A Retrospective Analysis of Effect of COVID-19 on Revision Total Knee and Hip Arthroplasty

Background: The SARS-CoV-2 (Covid-19) has significantly impacted the health of the people around the globe. Primary Total Hip arthroplasty (THA) and Total Knee arthroplasty (TKA) were significantly affected in the pandemic time. The canceled surgeries of THA and TKA were rescheduled as majority of the beds in the hospitals were occupied by COVID patients. Due to this, patients for such surgery accumulated and many patients faced serious health issues. In addition to THA and TKA, Covid-19 pandemic also significantly impacted Total Joint arthroplasty (TJA) volume. According to analysis, the annual volume of the TKA and THA for 2020 was around 128,000 and 66,000 respectively. Aim: To analyze the effect of COVID-19 on revision total knee and hip arthroplasty. Methods: For the study, the data was collected from the institutional registry for TJA and pending revisions for the TKA and THA patients. Approximately 465 inpatient beds between April 2019 and March 2020 considered for the study. Procedures were conducted for 12 months prior to the initial shutdown of elective surgery (April 19 – March 20). The percentage changes for urgent revisions for TJA were compared focusing on pre and post-Covid TKA and THA. Results: Two groups were defined as pre-Covid patients (n = 190) and post-Covid patients (n= 160). The mean age of the patient in pre-Covid group was 75.3 years (SD = 1.01) and post-Covid group was 68.9 years (SD = 11.52). For TKA revision, in pre-covid group, 33.3% of the patients had Aseptic loosening and 22.2% had Periprosthetic joint infection, and 16.6% required Urgent revision. On the other hand, in post-Covid group, 33.3% of the patients had Aseptic loosening and 21.2% had Periprosthetic joint infection, and 18.1% required Urgent revision. Post-Covid cases of THA were also increased as out of 94 patients, 15.9% required Urgent revision. There was no significant difference between the groups for TKA revision (p>0.05). Similarly, apart from Aseptic loosening (p<0.05), there was no significant difference between the groups for THA revision (p>0.05). Conclusion: It has been carried out that revision of TKA and THA decreased in health care system during Covid-19 pandemic compared to pre-Covid. The numbers of urgent cases were increased in both groups such as the numbers of urgent cases for THA were 15.9% and TKA was 18.1% post-Covid and these are creating the backlog for the care professionals to provide the better treatment and recovery of the patients.