Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
1.
Front Public Health ; 10: 825408, 2022.
Article in English | MEDLINE | ID: covidwho-1776025

ABSTRACT

Objective: During total knee arthroplasty (TKA), tourniquet may negatively impact post-operative functional recovery. This study aimed at investigating the effects of tourniquet on pain and return to function. Methods: Pubmed, Embase, and Cochrane Library were comprehensively searched for randomized controlled trials (RCTs) published up to February 15th, 2020. Search terms included; total knee arthroplasty, tourniquet, and randomized controlled trial. RCTs evaluating the efficacies of tourniquet during and after operation were selected. Two reviewers independently extracted the data. Effect estimates with 95% CIs were pooled using the random-effects model. Dichotomous data were calculated as relative risks (RR) with 95% confidence intervals (CI). Mean differences (MD) with 95% CI were used to measure the impact of consecutive results. Primary outcomes were the range of motion (ROM) and visual analog scale (VAS) pain scores. Results: Thirty-three RCTs involving a total of 2,393 patients were included in this study. The mean age is 65.58 years old. Compared to no tourniquet group, the use of a tourniquet resulted in suppressed ROM on the 3rd post-operative day [MD, -4.67; (95% CI, -8.00 to -1.35)] and the 1st post-operative month [MD, -3.18; (95% CI, -5.92 to -0.44)]. Pain increased significantly when using tourniquets on the third day after surgery [MD, 0.39; (95% CI, -0.19 to 0.59)]. Moreover, tourniquets can reduce intra-operative blood loss [MD, -127.67; (95% CI, -186.83 to -68.50)], shorter operation time [MD, -3.73; (95% CI, -5.98 to -1.48)], lower transfusion rate [RR, 0.85; (95% CI, 0.73-1.00)], higher superficial wound infection rates RR, 2.43; [(5% CI, 1.04-5.67)] and higher all complication rates [RR, 1.98; (95% CI, 1.22-3.22)]. Conclusion: Moderate certainty evidence shows that the use of a tourniquet was associated with an increased risk of higher superficial wound infection rates and all complication rates. Therefore, the findings did not support the routine use of a tourniquet during TKA.


Subject(s)
Arthroplasty, Replacement, Knee , Pain, Postoperative , Tourniquets , Aged , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Humans , Pain, Postoperative/etiology , Randomized Controlled Trials as Topic , Range of Motion, Articular , Tourniquets/adverse effects
2.
J Arthroplasty ; 37(6S): S350-S354, 2022 06.
Article in English | MEDLINE | ID: covidwho-1748218

ABSTRACT

BACKGROUND: Since the COVID-19 pandemic of 2020, there has been a marked rise in the use of telemedicine to evaluate patients after total knee arthroplasty (TKA). The purpose of our study was to assess a novel stem with an embedded sensor that can remotely and objectively monitor a patient's mobility after TKA. METHODS: A single anatomically designed knee system was implanted in concert with an interconnected tibial stem extension containing 3D accelerometers, 3D gyroscopes, a power source, and a telemetry transmission capability in 3 cadaveric pelvis to toe specimens. The legs were moved by hand to preset tibial positions at full knee extension, midflexion, flexion, and back to midflexion and extension for a total of 16 trials across 6 knees. RESULTS: Sensor data were successfully transmitted with good quality of signal to an external base station. Good correlation to the range of motion of the tibia was found (mean error 0.1 degrees; root mean square error 3.8 degrees). The signal from the heel drop tests suggests the sensor could detect heel strike during activities of daily living in vivo and the potential for additional signal processing to analyze vibratory and motion patterns detected by the sensors. A frequency domain analysis of a properly cemented and poorly cemented implant during the heel drop test suggests a difference in accelerometer signal in these implant states. CONCLUSION: The results confirm signals generated from an embedded TKA sensor can transmit through bone and cement, providing accurate range of motion data and may be capable of detecting changes in prosthesis fixation remotely.


Subject(s)
Arthroplasty, Replacement, Knee , COVID-19 , Knee Prosthesis , Activities of Daily Living , Arthroplasty, Replacement, Knee/adverse effects , Biomechanical Phenomena , COVID-19/prevention & control , Cadaver , Feasibility Studies , Humans , Knee Joint/surgery , Monitoring, Physiologic , Pandemics , Range of Motion, Articular , Tibia/surgery
3.
BMJ Open ; 12(3): e060000, 2022 03 08.
Article in English | MEDLINE | ID: covidwho-1736074

ABSTRACT

INTRODUCTION: More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%-0.5% fatal PE, and over 1000 deaths. Antithrombotic prophylaxis is standard of care but evidence is limited and conflicting. We will compare effectiveness of three commonly used chemoprophylaxis agents to prevent all-cause mortality (ACM) and clinical venous thromboembolism (VTE) while avoiding bleeding complications. METHODS AND ANALYSIS: Pulmonary Embolism Prevention after HiP and KneE Replacement is a large randomised pragmatic comparative effectiveness trial with non-inferiority design and target enrolment of 20 000 patients comparing aspirin (81 mg two times a day), low-intensity warfarin (INR (International Normalized Ratio) target 1.7-2.2) and rivaroxaban (10 mg/day). The primary effectiveness outcome is aggregate of VTE and ACM, primary safety outcome is clinical bleeding complications, and patient-reported outcomes are determined at 1, 3 and 6 months. Primary data analysis is per protocol, as preferred for non-inferiority trials, with secondary analyses adherent to intention-to-treat principles. All non-fatal outcomes are captured from patient and clinical reports with independent blinded adjudication. Study design and oversight are by a multidisciplinary stakeholder team including a 10-patient advisory board. ETHICS AND DISSEMINATION: The Institutional Review Board of the Medical University of South Carolina provides central regulatory oversight. Patients aged 21 or older undergoing primary or revision hip or knee replacement are block randomised by site and procedure; those on chronic anticoagulation are excluded. Recruitment commenced at 30 North American centres in December 2016. Enrolment currently exceeds 13 500 patients, representing 33% of those eligible at participating sites, and is projected to conclude in July 2024; COVID-19 may force an extension. Results will inform antithrombotic choice by patients and other stakeholders for various risk cohorts, and will be disseminated through academic publications, meeting presentations and communications to advocacy groups and patient participants. TRIAL REGISTRATION: NCT02810704.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Pulmonary Embolism , Adult , Anticoagulants/therapeutic use , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , COVID-19 , Humans , Pulmonary Embolism/complications , Pulmonary Embolism/prevention & control , Randomized Controlled Trials as Topic , Young Adult
4.
J Arthroplasty ; 37(7S): S457-S464, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1693927

ABSTRACT

BACKGROUND: The impact of a postoperative diagnosis of COVID-19 in patients undergoing total joint arthroplasty (TJA) remains unknown. The objective of this study is to characterize the effect of COVID-19 infection following TJA on perioperative complication rates. METHODS: The Mariner database was queried for patients undergoing total hip and total knee arthroplasty from January 2018 to April 2020. TJA patients who were diagnosed with COVID-19 within 90 days postoperatively were matched in a 1:3 fashion based on age, gender, iron deficiency anemia, payer status, and Charlson Comorbidity Index with patients who were not diagnosed with COVID-19. Preoperative comorbidity profiles and complications within 3 months of surgery were compared. Statistical analysis included chi-squared tests and multivariate logistic regression with outcomes considered significant at P < .05. RESULTS: Of the 239 COVID-19 positive patients, 132 (55.2%) underwent total hip arthroplasty. On multivariate analysis, COVID-19 diagnosis was associated with increased odds of deep vein thrombosis (odds ratio [OR] 4.86, 95% confidence interval [CI] 2.10-11.81, P < .001), pulmonary embolism (OR 6.27, 95% CI 2.57-16.71, P < .001), and all complications (OR 3.36, 95% CI 2.47-4.59, P < .001). Incidence of deep vein thrombosis/pulmonary embolism was greater the closer in time the COVID-19 diagnosis was to the surgical procedure (10.24 times at 1 month, 7.87 times at 2 months, and 1.42 times at 3 months; P < .001). A similar relationship was observed with all complications. CONCLUSION: Postoperative COVID-19 infection is associated with higher rates of cardiopulmonary complications, thromboembolic disease, renal injury, and urinary tract infections in patients undergoing hip and knee arthroplasty. COVID-19 infection earlier in the postoperative period is associated with a higher risk of complications.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Pulmonary Embolism , Venous Thrombosis , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Humans , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Pulmonary Embolism/complications , Retrospective Studies , Risk Factors , Venous Thrombosis/etiology
5.
Hosp Pract (1995) ; 50(1): 68-74, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1625868

ABSTRACT

OBJECTIVES: The first known COVID-19 patient in the United States was reported on 1/20/2020. Since then, we noted increased thromboembolic events among our THA/TKA patients. Therefore, we sought to determine: (1) monthly incidences of pulmonary embolism (PE)/deep vein thrombosis (DVT) before and after January/2020 and (2) thromboembolic event rates for primary and revision patients. METHODS: We retrospectively obtained from our electronic-medical-records the total monthly number of patients (December/2018-March/2021) who underwent primary or revision THA/TKA, and among them, those who had PE/DVT during each month. Monthly rates of thromboembolic events were calculated and figures were created showing rates throughout time. The cutoff month to define before and after COVID-19 was January/2020. RESULTS: During the study period, 1.6% of patients (312/19068) had PE/DVT [PE (n = 102), DVT (n = 242), both (n = 32)]. Overall rate of PE/DVT before January/2020 was 1.2% (119/9545) and it was 2.0% (193/9523) after that month. Incidences of PE/DVT on April/June/July of 2020 were 3.4%, 3%, 3.4%, respectively. A major increase, when compared to 2019 (1.3%, 1%, 1%, respectively). An unusually high rate of PE was observed on April/2020 (3.4%), more than three times the one observed in any other month. After January/2020, there was an overall major increase of PE/DVT rates, but particularly among revision patients: 6% in five different months including 11.5% on November/2020. CONCLUSION: There was a major increase of thromboembolic events among THA/TKA patients during the COVID-19 pandemic, predominantly in revision patients. Patients need counseling about this increased risk. It remains uncertain whether more aggressive thromboprophylactic regimes should be followed.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Venous Thrombosis , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , COVID-19/epidemiology , Humans , Pandemics , Retrospective Studies , United States , Venous Thrombosis/epidemiology , Venous Thrombosis/etiology , Venous Thrombosis/prevention & control
6.
J Am Acad Orthop Surg ; 29(24): e1321-e1327, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1556078

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic resulted in the unprecedented widespread cancellation of scheduled elective primary total joint arthroplasty (TJA) in the United States. The impact of postponing scheduled total hip arthroplasty and total knee arthroplasty procedures on patients has not been well studied and may have physical, emotional, and financial consequences. METHODS: All patients whose elective primary TJA procedures at a tertiary academic medical center were postponed because of COVID-19 were surveyed. Seventy-four patients agreed to answer 13 questions concerning the physical, mental, and financial impact of surgery cancellation. Statistical analysis, including Pearson correlation coefficients, cross-tabulation analysis, and chi squares, was performed. RESULTS: 13.5% of patients strongly disagreed with the use of "elective" to describe their cancelled TJA surgery and 25.7% of patients reported substantial physical and/or mental deterioration due to postponement. Younger individuals experienced greater change in their symptoms (P = 0.034), anxiety about their pain (P = 0.010), and frustration/anger (P = 0.043). Poor quality of life, mood, and lower HOOS/KOOS Jr interval scores were correlated with greater financial strain, disagreement with the postponement, and disagreement with the use of "elective" to describe surgery. Disagreement with the use of "elective" to describe surgery was associated with greater financial strain (P = 0.013) and disagreement with the decision to postpone surgery (P = 0.008). In addition, greater financial strain was associated with disagreement with postponement (P = 0.014). CONCLUSION: The cancellation of elective TJA during the COVID-19 pandemic had a variety of consequences for patients. One in four patients reported experiencing substantial physical and/or emotional deterioration. Associations of poor quality of life and mood with greater financial strain and disagreement with the term "elective" were seen. These results help quantify the deleterious effects of cancelling elective surgery and identify at-risk patients should another postponement of surgery occur. LEVEL OF EVIDENCE: Level II-Prospective cohort study.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Elective Surgical Procedures , Humans , Pandemics , Prospective Studies , Quality of Life , SARS-CoV-2 , United States/epidemiology
7.
J Am Acad Orthop Surg ; 29(23): e1217-e1224, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1526957

ABSTRACT

INTRODUCTION: Although the pause in elective surgery was necessary to preserve healthcare resources at the height of the novel coronavirus disease 2019 (COVID-19) pandemic, recent data have highlighted the worsening pain, decline in physical activity, and increase in anxiety among cancelled total hip and knee arthroplasty patients. The purpose of this study was to evaluate the effectiveness of our staged reopening protocol and the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among elective arthroplasty patients. METHODS: We identified all elective hip and knee arthroplasty patients who underwent our universal COVID-19 testing protocol during our phased reopening between May 1, 2020, and July 21, 2020, at our institution. We recorded the SARS-CoV-2 test results of each patient along with their demographics, medical comorbidities, and symptoms at the time of testing. We followed each of these positive patients through their rescheduled cases and recorded any complications or potential SARS-CoV-2 healthcare exposures. RESULTS: Of the 2,329 patients, we identified five patients (0.21%) with a reverse transcription-polymerase chain reaction--confirmed SARS-CoV-2 positive test, none with symptoms. All patients were successfully rescheduled and underwent their elective arthroplasty procedure within 6 weeks of their original surgery date. None of these patients experienced a perioperative complication at the time of their rescheduled arthroplasty procedure. No orthopaedic surgeon or staff member caring for these patients reported a positive SARS-CoV-2 test. CONCLUSION: Our phased reopening protocol with universal preoperative virus testing was safe and identified a low incidence of SARS-CoV-2 among asymptomatic, elective arthroplasty patients at our institution. With uncertainty regarding the trajectory of the COVID-19 pandemic, we hope that this research can guide future policy decisions regarding elective surgery.


Subject(s)
Arthroplasty, Replacement, Knee , COVID-19 , Arthroplasty, Replacement, Knee/adverse effects , COVID-19 Testing , Elective Surgical Procedures , Humans , Incidence , Pandemics , SARS-CoV-2
8.
Knee ; 32: 97-102, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1469890

ABSTRACT

BACKGROUND: Postoperative radiographs are commonly ordered after primary total knee arthroplasty (TKA), however, there is limited data on how often these films change management over the entire postoperative time course, and what should prompt imaging to maximize clinical utility. METHODS: A retrospective cohort study was conducted of patients ≥ 18 years old who underwent a primary TKA at two level one trauma centers. Postoperative data were collected to determine the frequency of postoperative radiograph series, radiograph findings that did not suggest normal healing or alignment to radiologist and orthopedists, and changes in postoperative management. The total cost and radiation exposure values were calculated for all patient radiographs using estimates from previous literature. RESULTS: From the 1258 patients included, 3831 postoperative radiographs were taken (mean ± 95% confidence interval [CI]: 3.05 ± 0.11 radiographs per patient). Of these 3831 radiographs, 44 (1.1%) contained a positive radiographic finding. Only 13 (0.3% of radiographs) of these positive radiographic findings were positive orthopaedic findings, 11 of which led to changes in management. For all but 1 of these patients (10/11, 91%), these radiographs were taken during a non-routine postoperative visit. Routine postoperative radiographs that did not change management cost $1,008,480 and administered 22.92 mSV of radiation to patients within this study. CONCLUSION: Postoperative radiography obtained after primary TKA were of low clinical utility yet resulted in considerable healthcare costs and unnecessary radiation burden. Radiographs ordered during a non-routine visit, however, were a reliable indicator of when this imaging provided clinical utility.


Subject(s)
Arthroplasty, Replacement, Knee , Adolescent , Arthroplasty, Replacement, Knee/adverse effects , Cost-Benefit Analysis , Humans , Postoperative Period , Radiography , Retrospective Studies , Treatment Outcome
9.
Am J Health Syst Pharm ; 79(3): 147-164, 2022 01 24.
Article in English | MEDLINE | ID: covidwho-1429175

ABSTRACT

PURPOSE: To identify the proportion of patients with continued opioid use after total hip or knee arthroplasty. METHODS: This systematic review and meta-analysis searched Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and International Pharmaceutical Abstracts for articles published from January 1, 2009, to May 26, 2021. The search terms (opioid, postoperative, hospital discharge, total hip or knee arthroplasty, and treatment duration) were based on 5 key concepts. We included studies of adults who underwent total hip or knee arthroplasty, with at least 3 months postoperative follow-up. RESULTS: There were 30 studies included. Of these, 17 reported on outcomes of total hip arthroplasty and 19 reported on outcomes of total knee arthroplasty, with some reporting on outcomes of both procedures. In patients having total hip arthroplasty, rates of postoperative opioid use at various time points were as follows: at 3 months, 20% (95% CI, 13%-26%); at 6 months, 17% (95% CI, 12%-21%); at 9 months, 19% (95% CI, 13%-24%); and at 12 months, 16% (95% CI, 15%-16%). In patients who underwent total knee arthroplasty, rates of postoperative opioid use were as follows: at 3 months, 26% (95% CI, 19%-33%); at 6 months, 20% (95% CI, 17%-24%); at 9 months, 23% (95% CI, 17%-28%); and at 12 months, 21% (95% CI, 12%-29%). Opioid naïve patients were less likely to have continued postoperative opioid use than those who were opioid tolerant preoperatively. CONCLUSION: Over 1 in 5 patients continued opioid use for longer than 3 months after total hip or knee arthroplasty. Clinicians should be aware of this trajectory of opioid consumption after surgery.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Opioid-Related Disorders , Analgesics, Opioid/adverse effects , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Humans , Opioid-Related Disorders/drug therapy , Pain, Postoperative/drug therapy , Pain, Postoperative/epidemiology
10.
Ann R Coll Surg Engl ; 104(3): 165-173, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1331976

ABSTRACT

INTRODUCTION: We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature. METHODS: An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA. FINDINGS: Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%. CONCLUSION: We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.


Subject(s)
Ambulatory Surgical Procedures , Arthroplasty, Replacement, Knee , Aged , Ambulatory Surgical Procedures/adverse effects , Ambulatory Surgical Procedures/methods , Ambulatory Surgical Procedures/statistics & numerical data , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Arthroplasty, Replacement, Knee/statistics & numerical data , COVID-19 , Humans , Middle Aged , Patient Discharge/statistics & numerical data , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology
11.
Thromb Res ; 204: 40-51, 2021 08.
Article in English | MEDLINE | ID: covidwho-1275736

ABSTRACT

Heparin-induced thrombocytopenia (HIT) is characterized clinically by thrombocytopenia, hypercoagulability, and increased thrombosis risk, and serologically by platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies. Heparin-"induced" acknowledges that HIT is usually triggered by a proximate immunizing exposure to heparin. However, certain non-heparin medications (pentosan polysulfate, hypersulfated chondroitin sulfate, fondaparinux) can trigger "HIT". Further, naturally-occurring polyanions (bacterial lipopolysaccharide, DNA/RNA) can interact with PF4 to recapitulate HIT antigens. Indeed, immunologic presensitization to naturally-occurring polyanions could explain why HIT more closely resembles a secondary, rather than a primary, immune response. In 2008 it was first reported that a HIT-mimicking disorder can occur without any preceding exposure to heparin or polyanionic medications. Termed "spontaneous HIT syndrome", two subtypes are recognized: (a) surgical (post-orthopedic, especially post-total knee arthroplasty, and (b) medical (usually post-infectious). Recently, COVID-19 adenoviral vector vaccination has been associated with a thrombotic thrombocytopenic disorder associated with positive PF4-dependent enzyme-immunoassays and serum-induced platelet activation that is maximal when PF4 is added. Vaccine-induced immune thrombotic thrombocytopenia (VITT) features unusual thromboses (cerebral venous thrombosis, splanchnic vein thrombosis) similar to those seen in spontaneous HIT syndrome. The emerging concept is that classic HIT reflects platelet-activating anti-PF4/heparin antibodies whereas spontaneous HIT syndrome and other atypical "autoimmune HIT" presentations (delayed-onset HIT, persisting HIT, heparin "flush" HIT) reflect heparin-independent platelet-activating anti-PF4 antibodies-although the precise relationships between PF4 epitope targets and the clinical syndromes remain to be determined. Treatment of spontaneous HIT syndrome includes non-heparin anticoagulation (direct oral Xa inhibitors favored over direct thrombin inhibitors) and high-dose immunoglobulin.


Subject(s)
Arthroplasty, Replacement, Knee , COVID-19 , Thrombocytopenia , Thrombosis , Vaccines , Anticoagulants , Arthroplasty, Replacement, Knee/adverse effects , Heparin/adverse effects , Humans , Platelet Factor 4 , SARS-CoV-2 , Syndrome , Thrombocytopenia/chemically induced
14.
Medicine (Baltimore) ; 100(6): e24141, 2021 Feb 12.
Article in English | MEDLINE | ID: covidwho-1101918

ABSTRACT

BACKGROUND: The global neo-coronary pneumonia epidemic has increased the workload of healthcare institutions in various countries and directly affected the physical and psychological recovery of the vast majority of patients requiring hospitalization in China. We anticipate that post-total knee arthroplasty kinesiophobia may have an impact on patients' postoperative pain scores, knee function, and ability to care for themselves in daily life. The purpose of this study is to conduct a micro-video intervention via WeChat to verify the impact of this method on the rapid recovery of patients with kinesiophobia after total knee arthroplasty during neo-coronary pneumonia. METHODS: Using convenience sampling method, 78 patients with kinesiophobia after artificial total knee arthroplasty who met the exclusion criteria were selected and randomly grouped, with the control group receiving routine off-line instruction and the intervention group receiving micro-video intervention, and the changes in the relevant indexes of the two groups of patients at different time points on postoperative day 1, 3 and 7 were recorded and analyzed. RESULTS: There were no statistical differences in the scores of kinesiophobia, pain, knee flexion mobility (ROM) and ability to take care of daily life between the two groups on the first postoperative day (P > .05). On postoperative day 3 and 7, there were statistical differences in Tampa Scale for kinesiophobia, pain, activities of daily living scale score and ROM between the two groups (P < .01), and the first time of getting out of bed between the two groups (P < .05), and by repeated-measures ANOVA, there were statistically significant time points, groups and interaction effects of the outcome indicators between the 2 groups (P < .01), indicating that the intervention group reconstructed the patients' postoperative kinesiophobiaand hyperactivity. The level of pain awareness facilitates the patient's acquisition of the correct functional exercises to make them change their misbehavior. CONCLUSIONS: WeChat micro-video can reduce the fear of movement score and pain score in patients with kinesiophobia after unilateral total knee arthroplasty, shorten the first time out of bed, and improve their joint mobility and daily living ability. ETHICS: This study has passed the ethical review of the hospital where it was conducted and has been filed, Ethics Approval Number: 20181203-01.


Subject(s)
Arthroplasty, Replacement, Knee/psychology , COVID-19/psychology , Phobic Disorders/psychology , Pneumonia/epidemiology , Activities of Daily Living , Aged , Arthroplasty, Replacement, Knee/adverse effects , COVID-19/complications , COVID-19/diagnosis , COVID-19/virology , Case-Control Studies , China/epidemiology , Female , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Male , Middle Aged , Pain, Postoperative/diagnosis , Pain, Postoperative/psychology , Pneumonia/virology , Postoperative Period , Prospective Studies , Range of Motion, Articular , Recovery of Function , Rehabilitation/methods , Rehabilitation/psychology , SARS-CoV-2/genetics , Videoconferencing/instrumentation , Videoconferencing/statistics & numerical data
15.
J Am Acad Orthop Surg ; 29(23): e1217-e1224, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1067886

ABSTRACT

INTRODUCTION: Although the pause in elective surgery was necessary to preserve healthcare resources at the height of the novel coronavirus disease 2019 (COVID-19) pandemic, recent data have highlighted the worsening pain, decline in physical activity, and increase in anxiety among cancelled total hip and knee arthroplasty patients. The purpose of this study was to evaluate the effectiveness of our staged reopening protocol and the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among elective arthroplasty patients. METHODS: We identified all elective hip and knee arthroplasty patients who underwent our universal COVID-19 testing protocol during our phased reopening between May 1, 2020, and July 21, 2020, at our institution. We recorded the SARS-CoV-2 test results of each patient along with their demographics, medical comorbidities, and symptoms at the time of testing. We followed each of these positive patients through their rescheduled cases and recorded any complications or potential SARS-CoV-2 healthcare exposures. RESULTS: Of the 2,329 patients, we identified five patients (0.21%) with a reverse transcription-polymerase chain reaction--confirmed SARS-CoV-2 positive test, none with symptoms. All patients were successfully rescheduled and underwent their elective arthroplasty procedure within 6 weeks of their original surgery date. None of these patients experienced a perioperative complication at the time of their rescheduled arthroplasty procedure. No orthopaedic surgeon or staff member caring for these patients reported a positive SARS-CoV-2 test. CONCLUSION: Our phased reopening protocol with universal preoperative virus testing was safe and identified a low incidence of SARS-CoV-2 among asymptomatic, elective arthroplasty patients at our institution. With uncertainty regarding the trajectory of the COVID-19 pandemic, we hope that this research can guide future policy decisions regarding elective surgery.


Subject(s)
Arthroplasty, Replacement, Knee , COVID-19 , Arthroplasty, Replacement, Knee/adverse effects , COVID-19 Testing , Elective Surgical Procedures , Humans , Incidence , Pandemics , SARS-CoV-2
16.
Knee Surg Sports Traumatol Arthrosc ; 29(10): 3159-3163, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1023319

ABSTRACT

PURPOSE: During the COVID-19 pandemic there has been a massive reduction of arthroplasty services due to reallocation of hospital resources. The unique challenge for clinicians has been to define which arthroplasty patients most urgently require surgery. The present study aimed to investigate priority arthroplasty procedures during the pandemic and in the reinstatement period from the surgeon's perspective. MATERIAL AND METHODS: An online survey was conducted among members of the European Hip Society (EHS), European Knee Associates (EKA) and other invited orthopaedic arthroplasty surgeons (experts) from across the world. The survey consisted of 17 different arthroplasty procedures/indications of which participants were asked to choose and rank the most important 10. RESULTS: Four hundred and thirty-nine arthroplasty surgeons from 44 countries responded. The EHS and EKA had a 43% response rate of members. In weighted average points, the majority of respondents (67.5 points) ranked 'acute fractures requiring arthroplasty (Periprosthetic fractures, THA/hemi-arthroplasty for femoral neck fractures)' as priority indication number one, followed by 'first-stage explantations for acute PJI (periprosthetic joint infection)' in second place and priority indication (45.9 points) three as 'one-stage revision for acute PJI' (39.7 points). CONCLUSIONS: There was agreement that femoral neck fractures, periprosthetic fractures, and acute infections should be prioritised and cannot be postponed in the setting of the COVID-19 pandemic. As arthroplasty procedures are being resumed in most countries now, there has also been a relaxation of lockdown rules in most countries, which might cause a so-called second wave of the pandemic. Therefore, the results of the current study present a proposal by experts as to which operations should be prioritised in the setting of a second wave of the pandemic.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Communicable Disease Control , Humans , Pandemics , Reoperation , SARS-CoV-2 , Surveys and Questionnaires
17.
Clin Appl Thromb Hemost ; 26: 1076029620961450, 2020.
Article in English | MEDLINE | ID: covidwho-901722

ABSTRACT

Two of the more common potential complications after arthroplasty are venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), and excess bleeding. Appropriate chemoprophylaxis choices are essential to prevent some of these adverse events and from exacerbating others. Risk stratification to prescribe safe and effective medications in the prevention of postoperative VTE has shown benefit in this regard. The Department of Orthopaedic Surgery at Syosset Hospital/Northwell Health, which performs over 1200 arthroplasties annually, has validated and is using the 2013 version of the Caprini Risk Assessment Model (RAM) to stratify each patient for risk of postoperative VTE. This tool results in a culling of information, past and present, personal and familial, that provides a truly thorough evaluation of the patient's risk for postoperative VTE. The Caprini score then guides the medication choices for thromboprophylaxis. The Caprini score is only valuable if the data is properly collected, and we have learned numerous lessons after applying it for 18 months. Risk stratification requires practice and experience to achieve expertise in perioperative patient evaluation. Having access to pertinent patient information, while gaining proficiency in completing the Caprini RAM, is vital to its efficacy. Ongoing, real time analyses of patient outcomes, with subsequent change in process, is key to improving patient care.


Subject(s)
Arthroplasty, Replacement/adverse effects , Postoperative Complications/prevention & control , Risk Assessment/methods , Venous Thromboembolism/prevention & control , Aged , Arthroplasty, Replacement/methods , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Female , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , Male , Middle Aged , Postoperative Complications/etiology , Premedication , Venous Thromboembolism/etiology
18.
J Arthroplasty ; 36(1): 30-36, 2021 01.
Article in English | MEDLINE | ID: covidwho-688738

ABSTRACT

BACKGROUND: Advances in perioperative care have enabled early discharge and outpatient primary total joint arthroplasty (TJA). However, the safety of early discharge after revision TJA (rTJA) remains unknown and the COVID-19 pandemic will force decreased hospitalization. This study compared 90-day outcomes in patients undergoing aseptic rTJA discharged the same or next day (early) to those discharged 2 or 3 days postoperatively (later). METHODS: In total, 530 aseptic rTJAs performed at a single tertiary care referral center (December 5, 2011 to December 30, 2019) were identified. Early and later discharge patients were matched as closely as possible on procedure type, sex, American Society of Anesthesiologists physical status classification, age, and body mass index. All patients were optimized using modern perioperative protocols. The rate of 90-day emergency department (ED) visits and hospital admissions was compared between groups. RESULTS: In total, 183 early discharge rTJAs (54 hips, 129 knees) in 178 patients were matched to 183 later discharge rTJAs (71 hips, 112 knees) in 165 patients. Sixty-two percent of the sample was female, with an overall average age and body mass index of 63 ± 9.9 (range: 18-92) years and 32 ± 6.9 (range: 18-58) kg/m2. There was no statistical difference in 90-day ED visit rates between early (6/178, 3.4%) and later (11/165, 6.7%) discharge patients (P = .214). Ninety-day hospital admission rates for early (7/178, 3.9%) and later (4/165, 2.4%) discharges did not differ (P = .545). CONCLUSION: Using modern perioperative protocols with appropriate patient selection, early discharge following aseptic rTJA does not increase 90-day readmissions or ED visits. As hospital inpatient capacity remains limited due to COVID-19, select rTJA patients may safely discharge home the same or next day to preserve hospital beds and resources for more critical illness.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Adolescent , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Female , Humans , Middle Aged , Pandemics , Patient Discharge , Patient Readmission , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , SARS-CoV-2 , Young Adult
19.
J Knee Surg ; 35(4): 424-433, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-729017

ABSTRACT

Enhanced recovery after surgery (ERAS) represents a paradigm shift in perioperative care, aimed at achieving early recovery for surgical patients, reducing length of hospital stay, and complications. The purpose of this study was to provide an insight of the impact of the COVID-19 on ERAS protocols for knee arthroplasty patients in a tertiary hospital and potential strategy changes for postpandemic practice. We retrospectively reviewed all cases that underwent surgery utilizing ERAS protocols in the quarter prior to the pandemic (fourth quarter of 2019) and during the first quarter of 2020 when the pandemic started. A review of the literature on ERAS protocols for knee arthroplasty during the COVID-19 pandemic was also performed and discussed. A total of 199 knee arthroplasties were performed in fourth quarter of 2019 as compared with 76 in the first quarter of 2020 during the COVID-19 outbreak. Patients who underwent surgery in the first quarter of 2020 had shorter inpatient stays (3.8 vs. 4.5 days), larger percentage of discharges by postoperative day 5 (86.8 vs. 74.9%), and a larger proportion of patients discharged to their own homes (68 vs. 54%). The overall complication rate (1.3 vs. 3%) and readmission within 30 days (2.6 vs. 2%) was similar between both groups. ERAS protocols appear to reduce hospital lengths of stay for patients undergoing knee arthroplasty without increasing the risk of short-term complications and readmissions. The beneficial effects of ERAS appear to be amplified by and are synchronous with the requirements of operating in the era of a pandemic.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , COVID-19 , Enhanced Recovery After Surgery , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , COVID-19/epidemiology , Humans , Length of Stay , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL