Where Do Knee Revisions for Infection, Fracture, and Other Revisions Get Treated?
ABSTRACT Complicated knee revision procedures require specific expertise that may not be available across the healthcare network. Teaching hospitals appear to perform more knee revisions overall than urban or rural hospitals. We examined the location of care and payer status for all knee revisions including complex revisions (infection, periprosthetic fracture). Although only 39.7% of all primary total knee cases were performed in teaching hospitals, over half of all knee revisions were performed in teaching hospitals. Knee revision procedures, including treatment of periprosthetic infections and fractures are performed more often in teaching hospitals than in urban and rural settings combined. Reimbursement that does not match the cost of care for complex revision and infection cases may have a disproportionate impact on teaching hospitals.
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ABSTRACT: A national database was used to evaluate the risk for manipulation under anesthesia (MUA) after total knee arthroplasty (TKA), the association of demographics and comorbidities with needing MUA, and the risk of revision TKA after MUA. Of the 141,016 patients who underwent TKA, 4.3% required MUA within 6months. Age under 50years (OR: 2.79, P<0.0001), age 50-65years (OR: 2.03, P<0.0001), and female gender (OR: 1.12, P<0.0001) were all associated with increased rates of MUA. In patients under age 65years, smoking (OR: 1.47, P<0.0001) was associated with an increased rate of MUA. Patients who require MUA within 6months after TKA have a significantly increased risk of early revision TKA (OR: 2.43, P<0.0001). Copyright © 2015. Published by Elsevier Inc.The Journal of Arthroplasty 06/2015; DOI:10.1016/j.arth.2015.01.061 · 2.37 Impact Factor
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ABSTRACT: Periprosthetic joint infection is a hot topic for investigation because it represents a challenging clinical problem with considerable burden for patients, institutions, and health systems. Despite our substantial knowledge, many details in prevention, pathophysiology, diagnosis, and treatment of infectious complications following total knee arthroplasty remain to be controversial with the available evidence being insufficient and at times conflictive. This manuscript is an attempt to approach the most recently published literature regarding the aforementioned details and aims to provide the reader with an updated perspective in the management of periprosthetic joint infection of the knee.Current Reviews in Musculoskeletal Medicine 04/2014; DOI:10.1007/s12178-014-9217-z