Editorial: Current Concepts in Arthroplasty

The Open Orthopaedics Journal 03/2011; 5(1):78-9. DOI: 10.2174/1874325001105010078
Source: PubMed
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Available from: Jasvinder A Singh, Sep 30, 2015
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    ABSTRACT: Understanding the cause of failure and type of revision total knee arthroplasty (TKA) procedures performed in the United States is essential in guiding research, implant design, and clinical decision making in TKA. We assessed the causes of failure and specific types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA data from the Nationwide Inpatient Sample (NIS) database. Clinical, demographic, and economic data were reviewed and analyzed from 60,355 revision TKA procedures performed in the United States between October 1, 2005 and December 31, 2006. The most common causes of revision TKA were infection (25.2%) and implant loosening (16.1%), and the most common type of revision TKA procedure reported was all component revision (35.2%). Revision TKA procedures were most commonly performed in large, urban, nonteaching hospitals in Medicare patients ages 65 to 74. The average length of hospital stay (LOS) for all revision TKA procedures was 5.1 days, and the average total charges were $49,360. However, average LOS, average charges, and procedure frequencies varied considerably by census region, hospital type, and procedure performed. Level of Evidence: Level II, economic and decision analysis. See Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 07/2009; 468(1):45-51. DOI:10.1007/s11999-009-0945-0 · 2.77 Impact Factor
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    ABSTRACT: In patients who underwent revision TKA from 1993 to 2005 and responded to follow-up questionnaires 2 or 5 years postrevision TKA, we studied whether body mass index (BMI), comorbidity (measured by validated Deyo-Charlson index), sex, and age predict activity limitation 2 and 5 years after revision TKA. Overall moderate-severe activity limitation was defined as 2 or more activities (walking, stairs, rising chair) with moderate-severe limitation. Multivariable logistic regressions also adjusted for income, diagnosis, and distance from medical center and American Society of Anesthesiologists physical status score. The prevalence of overall moderate-severe activity limitation was high: 46.5% (677/1456) at 2 years and 50.5% (420/832) at 5 years postrevision TKA. At both 2 and 5 years of follow-up, BMI of 40 or higher, higher Deyo-Charlson score, female sex, and age greater than 80 years, each significantly predicted higher odds of moderate-severe overall activity limitation.
    The Journal of arthroplasty 10/2010; 25(7):1091-5, 1095.e1-4. DOI:10.1016/j.arth.2009.07.020 · 2.67 Impact Factor
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    ABSTRACT: Little is known about factors that might predict functional outcome following revision hip arthroplasty. The purpose of this study was to identify predictors of pain and physical function at two years following revision total hip arthroplasty and to evaluate whether the time that the patient waited for the surgery and whether the patient had complications were significant predictors of outcome. One hundred and twenty-six patients (126 hips) were entered prospectively into the study when their name was placed on the waiting list for surgery. Baseline measures included demographic factors, comorbidities, and the responses to the Short Form-36 (SF-36) and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaires. Follow-up was carried out at six-month intervals while the patient was waiting for the surgery; within one week prior to the surgery; and at six, twelve, and twenty-four months after the surgery. Patient age and gender, the preoperative WOMAC pain and function scores, the physical and mental component scores of the SF-36, comorbidities, the number of revisions, bilateral joint replacement, and the severity of the revision were evaluated as possible predictors of ultimate pain and function as measured with the WOMAC instrument. The mean age of the patients was 68.6 years. Improvement in WOMAC pain and function scores plateaued at six months. The mean pain score (and standard deviation) improved from 9.4 +/- 4.1 points preoperatively to 3.9 +/- 3.9 points at six months postoperatively, and the mean function score improved from 35.4 +/- 14.1 to 19.1 +/- 13.2 points. Preoperative pain (p = 0.002) and comorbidity (p = 0.02) were significant predictors of pain at two years. There was a trend toward preoperative function predicting function at twenty-four months (p = 0.07). There was no significant deterioration in the WOMAC pain or function score while the patients waited for surgery. Twenty-eight patients had complications. When the time that the patient waited for the surgery and complications were added to the models, only complications were found to be predictive of outcome (p = 0.04 for pain and p = 0.05 for function). Four patients required repeat revision during the follow-up period. Patients with better preoperative pain scores and fewer comorbidities have better outcomes following revision total hip arthroplasty. Although the time that the patient waited for the revision was not predictive of the ultimate WOMAC pain and function scores, we believe that performing revision arthroplasty before the patient has substantial functional compromise potentially improves the outcome.
    The Journal of Bone and Joint Surgery 05/2006; 88(4):685-91. DOI:10.2106/JBJS.E.00150 · 5.28 Impact Factor
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