Why Do Patients Choose Skilled Nursing Facilities After Total Hip and Knee Arthroplasty?

BACKGROUND: Current research indicates that total joint arthroplasty patients who are discharged to skilled nursing facilities (SNFs) have higher complication rates as compared to home. Many factors like age, sex, race, Medicare status, and past medical history have been shown to influence discharge destination. The present study sought to gather patient-indicated reasons for SNF discharge and identify potentially modifiable factors influencing the decision. METHODS: Primary total joint arthroplasty patients were asked to complete surveys at their presurgical and 2-week postsurgical follow-up appointments. The surveys included home access and social support questions as well as patient-reported outcome measures: Patient-Reported Outcomes Measurement and Information System, Risk Assessment and Prediction Tool, Knee injury and Osteoarthritis Outcome Score for Joint Replacement, or Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement. RESULTS: Of 765 patients who met inclusion criteria, 3.9% were discharged to an SNF and these were more frequently post-THA, women, older, Black, and persons living alone. Regression analyses indicated that lower Risk Assessment and Prediction Tool score, higher age, no caregiver presence, and Black race were significantly associated with SNF discharge. Patients discharged to an SNF most commonly reported social concerns rather than medical or home access concerns as the main factor for SNF discharge. CONCLUSIONS: While age and sex are nonmodifiable factors, the availability of a caregiver and social support represents an important modifiable factor in regard to discharge destination. Dedicated attention during the preoperative planning period may help augment social support and avoid unnecessary discharges to SNFs.

Crash characteristics for classic/historic vehicles and comparisons to newer vehicles.

INTRODUCTION: Older vehicles, commonly referred to as "classic," "vintage," or "historic" vehicles (CVH), share the roadways with newer vehicles. Older vehicles lacking safety systems likely come with an increased risk of fatality, however there is no study examining the typical conditions for crashes involving CVH. METHOD: This study utilized information from crashes occurring in 2012 to 2019 to estimate fatal crash rates for vehicles grouped by model year deciles. Data from crashes documented in the National Highway Traffic Safety Administration's (NHTSA) FARS and GES/CRSS data sets were utilized to examine roadway, temporal, and crash types for passenger vehicles produced in 1970 or earlier (CVH). RESULTS: These data show CVH crashes are rare (<1% of crashes), but carry a relative risk of fatality from 6.70 (95th CI: 5.44-8.26) for impacts with other vehicles, which was the most common crash, to 9.53 (7.28-12.47) for rollovers. Most crashes occurred in dry weather, typically during summer, in rural areas, most frequently on two lane roads, and in areas with speed limits between 30 and 55 mph. Factors associated with fatality for occupants in CVH included alcohol use, lack of seat belt use, and older age. CONCLUSIONS AND PRACTICAL APPLICATIONS: Crashes involving a CVH are a rare event but have catastrophic consequences when they do occur. Regulations that limit driving to daylight hours may lower the risk of crash involvement, and safety messaging to promote belt use and sober driving may also help. Additionally, as new "smart" vehicles are developed, engineers should keep in mind that older vehicles remain on the roadway. New driving technologies will need to safely interact with these older, less safe vehicles.

Isolated tibial polyethylene insert exchange outcomes after total knee arthroplasty.

UNLABELLED: Total knee arthroplasty (TKA) using a modular design allows isolated tibial polyethylene insert exchange (ITPIE) as a treatment option for isolated polyethylene failure. We asked whether ITPIE in selected patients would provide high survivorship and identified factors predicting success or failure. We retrospectively reviewed 42 patients (42 knees) who underwent ITPIE for instability, stiffness, or aseptic effusions after TKA. All patients had well-aligned and well-fixed components documented by radiographs and intraoperative evaluation. We determined whether patients had been revised and evaluated unrevised patients using the Knee Society rating system. The minimum followup was 2 years (average, 5.6 years; range, 2-11 years). Twelve patients (29%) underwent subsequent revision of their ITPIE (58% survivorship at 11 years). Average time to revision was 3 years. Although mean Knee Society scores improved, nine of the 30 unrevised patients (30%) had persistent pain at followup. Time from index TKA to ITPIE was associated with outcome; ITPIE less than 3 years from index TKA was 3.8 times more likely to undergo rerevision than ITPIE more than 3 years from index TKA. ITPIE for failed TKA is associated with unpredictable outcomes. ITPIE, even with well-defined and narrow indications, should be undertaken with caution. The longer the initial components performed successfully before ITPIE, the greater the likelihood of success after ITPIE. LEVEL OF EVIDENCE: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.