Incidence of Anterior Knee Pain and Functional Difficulty in a Prospectively Recruited Cohort Following Total Knee Arthroplasty With Selective Patellar Resurfacing.

BACKGROUND: The influence of patellar resurfacing on anterior knee pain, stair climbing, and functional activity outcomes following total knee arthroplasty (TKA) are incompletely understood. This study examined the influence of patellar resurfacing on patient-reported outcome measures (PROMs) relating to anterior knee pain and function. METHODS: The Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR.) patient PROMs were collected preoperatively and at 12 months follow-up for 950 TKAs performed over 5 years. Indications for patellar resurfacing included Grade IV patello-femoral (PFJ) changes or mechanical PFJ findings during patellar trialing. Patellar resurfacing was performed on 393 (41%) of the 950 TKAs performed. Multivariable binomial logistic regressions were performed, using KOOS, JR. questions assessing pain during stair climbing, standing upright, and function during rising from sitting as surrogates for anterior knee pain. Independent regression models were performed for each of the targeted KOOS, JR. questions, with adjustment for age at surgery, sex, and baseline pain and function. RESULTS: No association was observed between 12-month postoperative anterior knee pain or function with patellar resurfacing (P = .17, .97). Patients who had moderate or greater preoperative pain on stairs had an increased likelihood of postoperative pain and functional difficulty (odds ratio 2.3, P = .013), while males were 42% less likely to report postoperative anterior knee pain (odds ratio 0.58, P = .002). CONCLUSION: Selective patellar resurfacing based on PFJ degeneration and mechanical PFJ symptoms produces similar improvement in PROMs for resurfaced and unresurfaced knees.

What Role Does Patello-Femoral Joint Degeneration Have on Pain and Function After Unicompartmental Knee Arthroplasty? A Prospective Observational Cohort Study.

BACKGROUND: Influences on anterior knee pain, stair climbing limitations, and function such as rising from sitting are poorly understood in unicompartmental knee arthroplasty (UKA). Original indications for UKA excluded patients who had patello-femoral disease, while more recent studies have expanded the indications to include these patients. This study examined the influence of the patello-femoral joint degeneration on patient-reported outcome measures relating to anterior knee pain and function after UKA. METHODS: Between October 2017 and August 2021, Knee Injury and Osteoarthritis Outcome Score of Joint Replacement (KOOS, JR) patient-reported outcome measures were collected preoperatively and at 12 months of follow-up for 678 medial UKAs. Patello-femoral joint status was visually graded intraoperatively. Radiographic or intraoperative medial patellar facet and trochlear patello-femoral arthritis and preoperative anterior knee pain were not considered contraindications for UKA, while grade IV lateral patello-femoral arthritis was considered a contraindication for UKA. Multivariable ordinal logistic regressions were performed, using the KOOS, JR questionnaire assessing pain during stair climbing, standing upright, and function during rising from sitting. Independent regressions were performed for each targeted KOOS, JR question, with adjustments for age at surgery, sex, and baseline pain and function scores. RESULTS: No association was observed between 12-month postoperative anterior knee pain (P = .575) and function (P = .854) with patellar osteoarthritis grading after UKA. When comparing fixed and mobile-bearing UKA designs, no association was observed between bearing type and pain (P = .663) or functional outcomes (P = .758). CONCLUSION: Pain and function improved significantly following medial UKA and was independent of medial patellar and trochlear degenerative status.

Outpatient-Focused Joint Arthroplasty Is the Future: The Midwest Center for Joint Replacement Experience.

BACKGROUND: Perhaps, the most significant developments in joint arthroplasty in the past decade have been in the area of multimodal perioperative management reducing pain, nausea, and length of stay leading to outpatient arthroplasty. METHODS: Over a 2-year period, we performed 1230 arthroplasty cases including partial knee, total hip, total knee, and selected revision cases. RESULTS: Patient satisfaction ranged from 98% to 100% great/good. Ninety-eight percent of patients were discharged the same day. There were no readmissions for pain control and an overall readmission rate of 2%. CONCLUSION: The outpatient program centers on the patient needs, family engagement, essentials of home recovery, preoperative education, efficient surgery, and a surgeon-controlled environment with a highly standardized care. This is a distinct shift in today's health-care environment, which has seen the expansion of regulatory demands; focus on Electronic Health Record, and distractions from real discussions of demonstrated value creation. The future is bright for both ambulatory surgery center and hospital development of successful outpatient joint arthroplasty program for patients and surgeons alike.

Anxiety and Depression Associated With Burden in Caregivers of Patients With Brain Metastases.

PURPOSE/OBJECTIVES: To describe and examine the relationship between caregiver burden and the affective disorders anxiety and depression in caregivers of patients with brain metastases.
. DESIGN: Cross-sectional, descriptive, correlational.
. SETTING: Moores Cancer Center at the University of California, San Diego. 
. SAMPLE: 56 family caregivers of patients with brain metastases from solid tumors at other primary sites.
. METHODS: Self-administered survey.
. MAIN RESEARCH VARIABLES: Caregiver burden, anxiety, and depression.
. FINDINGS: With the exception of caregiver esteem, no statistically significant relationships were noted between impact on schedule, a dimension of caregiver burden, and screening positive for affective disorders.
. CONCLUSIONS: Findings from this study support previous reports indicating that the odds of having anxiety and depressive symptoms are greater in family caregivers who report higher levels of caregiver burden.
. IMPLICATIONS FOR NURSING: The identification and management of caregiver burden are important considerations for a comprehensive cancer care program. Addressing the needs of the cancer caregiver, who is at heightened risk for various psychological, physical, financial, and social problems, is increasingly vital.

Cobalt to Chromium Ratio is Not a Key Marker for Adverse Local Tissue Reaction (ALTR) in Metal on Metal Hips.

The diagnosis of adverse local tissue reaction (ALTR) after metal-on-metal total hip arthroplasty (MoMTHA) presents a significant challenge. No single biomarker is specific for ALTR. The purpose of this study was to determine if the ratio of cobalt to chromium ions is useful for diagnosing ALTR in MoMTHA. In 89 bearing-related revision THAs, preoperative cobalt and chromium ion levels were compared to an intraoperative soft tissue damage grading scale. The average cobalt to chromium ratio was 2.96 (0-20). There was no correlation between the tissue scale and the cobalt to chromium ratio (R=0.095; P=0.41). Many variables affecting ion production/excretion mitigate the use of the ion ratio. The cobalt to chromium ratio is not a predictive biomarker for ALTR in MoMTHA.