Same Day Discharge After Total Joint Arthroplasty The Future May Be Now.

Total joint arthroplasty has traditionally been performed as an inpatient procedure to mitigate the risks of perioperative complications, limited mobility, and pain control issues. Reducing readmissions and complications is increasingly important with the push toward outcomes based reimbursement. Nonetheless, there is a definite trend toward not only shortening postoperative length of stay but also toward considering a same day discharge arthroplasty model in appropriately selected patients. In this review, we outline the literature evidence regarding same day discharge in total joint arthroplasty and discuss our own institutional guidelines for appropriate patient selection as well as contraindications.

The Role and Timing of Treatment Strategies During Two-Stage Revision for Periprosthetic Joint Infections.

INTRODUCTION: Prosthetic joint infection continues to be a source of significant morbidity to patients and an economic burden to society as a whole. Two-stage revision is the current gold standard for treatment of periprosthetic joint infection in North America. Despite this, much discussion persists about treatment strategies surrounding the interim of the two-stage revision and treatment beyond reimplantation. The aim of this review is to answer some of these questions, specifically: are C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) helpful prior to reimplantation, is aspiration helpful, what is the role and timing for systemic antibiotics, and is there a role for oral suppression following second-stage reimplantation? METHODS: A literature review was completed in an attempt to address unanswered questions associated with two-stage reimplantation. Investigators' recommendations and current practices are described. RESULTS: ESR and CRP are less reliable in the interim of a two-stage revision than for diagnosis of infection in a primary total joint arthroplasty. There is inconclusive evidence regarding the utility of joint aspiration in two-stage revisions. Additionally, no evidence has been developed for length of IV antibiotic treatment after second-stage reimplantation, and in a few studies, oral antibiotic suppression has shown some benefit in reducing reinfection rates. CONCLUSION: The question of optimum treatment strategies has yet to be answered: attempts are underway to obtain suitable data with multi-center studies and large patient populations. Periprosthetic joint infection is a serious and life altering complication and with continued research we can further clarify treatment strategies.

The utility of bicruciate-retaining total knee arthroplasty.

BACKGROUND: We describe the features of modern and historical bicruciate-retaining (BCR) total knee arthroplasty (TKA) implants compared with other TKA implant designs, reviewing kinematics, proprioception, operative technique, and clinical results. METHODS: We performed a review based on PubMed, Embase, CINAHL Plus, and Cochrane databases from January 1990 to April 2016 using combinations of the following keywords: "bicruciate-retaining arthroplasty," "bicruciate-retaining total knee arthroplasty," "bicruciate-retaining TKA," "kinematics," "knee kinematics," and "TKA kinematics." RESULTS: Four studies have supported the notion that preservation of both cruciate ligaments in TKA preserves more "normal" knee kinematics. BCR implants provide greater proprioceptive performance when compared with posterior cruciate-retaining (CR) TKA implants. However, the operative implantation is more challenging with BCR TKAs, requiring the surgeon to take additional precautions. Overall, there did not seem to be a significant difference in short-term clinical outcomes between the BCR and CR implants. CONCLUSIONS: The utility of BCR TKA is still debatable. The literature has not shown clear indications and guidelines for the value and use of this implant. Although kinematics have been shown to mirror the native knee more closely, the clinical outcomes of BCR vs CR TKAs do not differ significantly. Moreover, additional care must be taken when inserting a BCR implant. The anterior cruciate ligament exploration and preservation is more challenging and certain preparation and precautions must take place. Overall, we have not found that BCR implants are significantly superior to CR implants with regards to short term clinical outcomes despite the BCR TKA having improved kinematics and proprioception.

Revision Total Hip Arthroplasty-Reducing Hospital Cost Through Fixed Implant Pricing.

BACKGROUND: A large component of the cost of revision total hip arthroplasty (THA) is the cost of the implants. We examined the pricing of revision THA implants to determine the possible savings of different pricing models. METHODS: From our institutional database, all revision THAs done from 9/1/2013 to 8/31/2014 were identified. The cost of the implants was analyzed as a percentage of the total cost of the hospitalization and compared to direct to hospital and fixed implant pricing models. RESULTS: Of 153 revision THAs analyzed, the cost of implants amounted to 36% of the total hospital cost. The direct to hospital cost and fixed implant pricing models would reduce the cost of an all-component revision to $4395 (saving $8962 per case) and $5000 (saving $8357 per case). CONCLUSION: Both fixed implant pricing and the direct to hospital pricing models would result in a decrease in revision implant costs.