An institutional database was interrogated to identify all TKAs carried out between January 2010 and May 2020. The study's findings indicated that 2514 TKA procedures were identified before 2014, in contrast to 5545 procedures performed subsequent to 2014. The outcomes of 90-day emergency department (ED) visits, readmissions, and returns-to-operating room (OR) procedures were determined. Matching patients via propensity scores was performed based on comorbidities, age, initial surgical consultation (consult), BMI, and sex. We investigated three outcome comparisons: (1) pre-2014 patients with a consultation and surgical BMI of 40 were compared with post-2014 patients with a consultation BMI of 40 and a surgical BMI less than 40; (2) pre-2014 patients were juxtaposed against post-2014 patients having a consultation and surgical BMI below 40; (3) post-2014 patients with a consultation BMI of 40 and a surgical BMI below 40 were compared with post-2014 patients with a consultation BMI of 40 and a surgical BMI of 40.
A notable increase in emergency department visits was observed among pre-2014 patients who had a consultation and surgical procedure with a BMI of 40 or higher (125% versus 6%, P=.002). Patients seen after 2014 who had a consult BMI of 40 and a surgical BMI less than 40 exhibited similar readmission and return-to-OR rates compared to other patient groups. Patients with a surgical BMI less than 40 and who consulted before 2014 demonstrated a considerably elevated rate of readmission (88% compared to 6%, P < .0001). A comparable rate of emergency department visits and returns to the operating room is observed, when assessed against their counterparts that experienced the post-2014 period. Patients who had a consultation BMI of 40 and a surgical BMI below 40 after 2014 had a lower number of emergency department visits (58% versus 106%) but experienced a similar rate of readmissions and returns to the operating room compared to those with both consultation and surgical BMIs at 40.
Total joint arthroplasty hinges on the prior optimization of the patient. Strategies for reducing BMI before total knee arthroplasty seem to bring substantial risk reduction advantages for patients with morbid obesity. click here In every case, a rigorous ethical evaluation of the patient's pathology, projected recovery after surgery, and the full scope of possible complications is essential.
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Although a rare side effect, fracturing of the polyethylene post can occur after a posterior-stabilized (PS) total knee arthroplasty (TKA). We assessed the polyethylene and patient attributes of 33 primary PS polyethylene components, each of which had undergone revision with fractured posts.
We have identified 33 PS inserts that underwent revisions between 2015 and 2022. Among the patient characteristics collected were the patient's age at index total knee arthroplasty (TKA), sex, BMI, length of implantation (LOI), and accounts from patients regarding the events surrounding the post-fracture period. Documented characteristics for the implants included the manufacturer, crosslinking features (distinguishing highly cross-linked polyethylene [XLPE] from ultra-high molecular weight polyethylene [UHMWPE]), assessment of wear from subjective scoring of the articular surfaces, and examination of fracture surfaces by scanning electron microscopy (SEM). Patients' average age at index surgery was 55 years, ranging from 35 to 69 years of age.
A statistically significant difference (P = .003) was found in total surface damage scores between the UHMWPE group (score 573) and the XLPE group (score 442). Ten out of thirteen SEM observations indicated fracture origination on the posterior portion of the post. UHMWPE fracture surfaces demonstrated more irregular, tufted clamshell patterns, distinctly different from the more precise clamshell markings and diamond patterns seen on XLPE posts, concentrated in the final fracture zone.
Comparing XLPE and UHMWPE implants, post-fracture PS characteristics differed. XLPE fractures involved less pervasive surface damage, occurred sooner in the loading sequence, and showcased a more brittle fracture profile, as assessed by SEM.
XLPE and UHMWPE implants exhibited differing characteristics following PS fracture. XLPE fractures presented less extensive surface damage, after a shorter period of loss of integrity, and SEM micrographs indicated a more brittle fracture pattern compared to UHMWPE.
Knee instability is a frequent cause of dissatisfaction for those who have had total knee arthroplasty (TKA). Varus-valgus (VV) angulation, anterior-posterior (AP) translation, and internal-external rotation (IER) are frequently observed components of instability, manifesting as abnormal laxity in multiple directions. An objective three-dimensional quantification of knee laxity is not possible using any existing arthrometer. The researchers intended to verify the safety and establish the trustworthiness of a new multiplanar arthrometer within this study.
An instrumented linkage, with five degrees of freedom, was an essential component of the arthrometer. Two examiners administered two tests each on the leg undergoing TKA procedures for 20 patients (mean age 65 years, range 53-75; 9 males, 11 females), with distinct groups of 9 and 11 patients evaluated at 3 months and 1 year post-surgery, respectively. The replaced knees of each subject experienced AP forces varying from -10 to 30 Newtons, coupled with VV moments of 3 Newton-meters and IER moments of 25 Newton-meters. Knee pain's severity and area during the testing were gauged by employing a visual analog scale. Intraclass correlation coefficients were employed to gauge intraexaminer and interexaminer reliabilities.
All subjects passed the testing procedure successfully and completely. The average pain score recorded during the testing phase was 0.7, out of a potential 10-point scale, with scores ranging from 0 to 2.5. Intraexaminer reliability, consistently above 0.77, was observed for all loading directions and examiners. The VV direction showed an interexaminer reliability of 0.85 (0.66-0.94) with a 95% confidence interval, while the IER direction showed 0.67 (0.35-0.85), and the AP direction showed 0.54 (0.16-0.79).
The novel arthrometer proved a secure method for assessing AP, VV, and IER laxities in patients who underwent TKA. Employing this device, researchers can study the link between knee laxity and patients' subjective experiences of instability.
The novel arthrometer enabled a safe assessment of anterior-posterior, varus-valgus, and internal-external rotation laxities in patients who had undergone TKA. Researchers can use this device to explore the link between knee laxity and patients' perceptions of instability.
A devastating consequence of knee and hip arthroplasty is periprosthetic joint infection, or PJI. avian immune response While gram-positive bacteria are commonly associated with these infections, existing studies on the changing microbial populations of PJIs over time are scant. A three-decade analysis of pathogen incidence and trends in prosthetic joint infection (PJI) was undertaken in this study.
This retrospective study, encompassing multiple institutions, investigated patients with knee or hip prosthetic joint infections (PJI) between 1990 and 2020. Bioaccessibility test Patients possessing a known causative agent were selected; those with inconclusive culture sensitivity data were excluded from the study. Among 715 identified patients, 731 joint infections met eligibility criteria. A five-year interval approach was used to assess the study period, which encompassed organisms categorized by their genus and species. Cochran-Armitage trend tests served to examine the existence of linear trends in microbial profiles longitudinally, with a P-value of under 0.05 defining statistical significance.
A statistically significant, positive, linear pattern emerged in the frequency of methicillin-resistant Staphylococcus aureus throughout the observed timeframe (P = .0088). A statistically significant negative linear relationship was found between time and the incidence of coagulase-negative staphylococci, marked by a p-value of .0018. There was no demonstrable statistical link between the organism and the affected joint (knee/hip).
While methicillin-resistant Staphylococcus aureus prosthetic joint infections (PJI) are on the rise, coagulase-negative staphylococci PJIs are declining, mirroring the global surge in antibiotic resistance. Identifying these tendencies could contribute to preventing and treating PJI by modifying surgical protocols during the operative period, adjusting antimicrobial prophylaxis and empiric treatments, or adopting novel therapeutic pathways.
The upward trend in methicillin-resistant Staphylococcus aureus PJI cases stands in contrast to the decreasing cases of coagulase-negative staphylococci PJI, reflecting the concurrent rise in antibiotic resistance globally. Characterizing these evolving trends is crucial in preventing and treating PJI, including modifying perioperative procedures, modifying prophylactic/empirical antimicrobial regimens, or exploring alternative therapeutic solutions.
Regrettably, a substantial number of total hip arthroplasty (THA) procedures do not achieve the desired results for the patients. We sought to compare patient-reported outcome measures (PROMs) across three primary total hip arthroplasty (THA) techniques, and assess the influence of sex and body mass index (BMI) on these PROMs over a decade.
A single institution examined 906 patients (535 females, mean BMI 307 [range 15–58]; 371 males, mean BMI 312 [range 17–56]) who received primary total hip arthroplasty (THA) utilizing either an anterior (AA), lateral (LA), or posterior approach between 2009 and 2020, using the Oxford Hip Score (OHS). PROMs were obtained prior to the operation and repeatedly at 6 weeks, 6 months, and at 1, 2, 5, and 10 years post-surgery.
Postoperative OHS improvement was significantly enhanced by all three approaches taken. The observed difference in OHS between genders was statistically significant, with men experiencing substantially higher levels than women (P < .01).