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Leal J, Holland CT, Easley ME, Nunley JA, Ryan SP, Bolognesi MP, Wellman SS, Jiranek WA. Comparison of PROMIS scores after total hip and total ankle arthroplasty : a propensity score-matched study. Bone Jt Open 2025; 6:1-13. [PMID: 40306699 PMCID: PMC11688126 DOI: 10.1302/2633-1462.65.bjo-2024-0200.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025] Open
Abstract
Aims This study evaluated joint-specific and generic patient-reported outcome measures (PROMs) after total hip arthroplasty (THA) and total ankle arthroplasty (TAA) in matched cohorts, while evaluating implant survivorship and 90-day hospital use. Methods Primary THA and TAA patients from 1 January 2015 to 1 January 2023 with minimum one-year follow-up were retrospectively reviewed. After applying exclusion criteria, 2,092 THAs and 478 TAAs were analyzed. Demographics, pre- and postoperative PROMs, revision surgeries, emergency department visits, and readmissions were collected. THA and TAA patients were then propensity score matched at a 2:1 ratio for age, sex, race, BMI, American Society of Anesthesiologists classification, and comorbidities, resulting in a final cohort of 844 THAs and 455 TAAs for comparison. Results Median preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference (PI) scores between THA and TAA were calculated (66.0 (IQR 62.0 to 70.0) vs 65.0 (IQR 62.0 to 70.0); p = 0.276), and both showed improvement at six weeks. However, THA patients exhibited lower median PROMIS PI scores at one year (53.0 vs 54.0; p = 0.009), as well as a greater median decrease in PROMIS PI from preoperative to one year (-13.0 (IQR -20.0 to -8.0) vs -12.0 (IQR -18.0 to -7.0); p = 0.023). Median preoperative PROMIS physical function (PF) was worse in THA patients (36.0 (IQR 32.0 to 40.0) vs 37.0 (IQR 33.0 to 40.0); p = 0.031), but showed greater median improvement compared to TAA patients at both six weeks (7.0 (IQR 3.0 to 12.0) vs 3.0 (IQR -2.0 to 9.0); p < 0.001) and one year (11.0 (IQR 6.0 to 17.0) vs 8.0 (IQR 4.5 to 13.0); p < 0.001). Preoperative PROMIS depression scores were similar and improved similarly in both groups. Joint-specific PROMs improved in both cohorts. Conclusion Patients undergoing THA or TAA experienced improvements in joint-specific PROMs postoperatively which translated to improved generic PROMs across both joints. Generic PROMs can be a useful tool to compare outcomes in THA and TAA. Results suggest that higher functional scores may be achieved sooner in THA.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | | | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - James A Nunley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Sean P Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Leal J, Kugelman DN, Ward SA, Wixted CM, Lajam CM, Schwarzkopf R, Seyler TM. Total hip arthroplasty was found to be safe in Jehovah's Witness patients: a multi-centered matched study. Arch Orthop Trauma Surg 2024; 145:103. [PMID: 39738842 DOI: 10.1007/s00402-024-05740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 12/17/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND Jehovah's Witness patients refuse blood transfusion because of their religious beliefs making total hip arthroplasty (THA) challenging. This study aims to determine the safety of THA in Jehovah's Witness patients using standard perioperative protocols as well as evaluate the effectiveness of tranexamic acid (TXA) in controlling blood loss. METHODS Databases from two tertiary academic centers were queried from 2003 to 2021 to identify THA patients. Demographics, pre- and postoperative hemoglobin (hgb) and hematocrit (hct) lab values, use of TXA intraoperatively, 90-day postoperative hospital utilization, and need for subsequent revision were extracted. Patients who identified as Jehovah's Witness were then compared to a 3:1 propensity score matched cohort of non-Jehovah's Witness patients. Linear regression analysis assessed the effect of intraoperative TXA on change in hgb from pre- to post-THA and logistic regression was used to assess risk of reaching hgb levels < 8.0 g/dL. RESULTS A total of 207 non-Jehovah's Witness patients and 69 Jehovah's Witness patients who underwent THA were analyzed. Both groups were found to have similar preoperative hgb and hct as well as postoperative hgb, hct, and hgb shift. Of the Jehovah's Witness patients 3 (6.4%) patients reached a hgb < 8.0 g/dL. Additionally, a higher proportion of Jehovah's Witness patients receive intraoperative TXA (55 [79.7%]) compared to non-Jehovah's Witness patients (127 [61.4%]) (p = 0.01; SMD = 0.41). Logistic regression analysis found that Jehovah's Witness did not have greater odds of reaching a hgb < 8.0 g/dL (OR = 1.03 [0.95, 1.10]; p = 0.49) and that patient who received intraoperative TXA had decreased odds of reaching a hgb < 8.0 (OR = 0.87 [0.80, 0.95]; p = 0.001). Multivariate linear regression found that intraoperative TXA was also associated with a smaller decrease in hgb from pre- to post-THA (β = 0.69 [0.16, 1.22]; p = 0.01). Overall, Jehovah's Witness patients had excellent revision-free (97% [93%, 100%]) and infection-free (99% [96%, 100%]) survival at 7 years. CONCLUSION Although Jehovah's Witness patients refuse transfusion, THA can be performed safely in these patients with excellent implant survivorship by optimizing preoperative hgb levels and utilizing intraoperative TXA. LEVEL OF EVIDENCE Level III Evidence.
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Affiliation(s)
| | - David N Kugelman
- Duke University Health System, Durham, USA
- New York University Langone Medical Center, New York, USA
| | - Spencer A Ward
- New York University Langone Medical Center, New York, USA
| | - Colleen M Wixted
- Duke University Health System, Durham, USA
- New York University Langone Medical Center, New York, USA
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Butarbutar JCP, Ivander G, Riantho A, Fidiasrianto K, Edward J, Tasya E. Greater Trochanter Tip as an Anatomical Reference to Minimize Leg Length Discrepancy following Hip Arthroplasty. Hip Pelvis 2024; 36:302-309. [PMID: 39620571 PMCID: PMC11638752 DOI: 10.5371/hp.2024.36.4.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/28/2024] [Accepted: 04/29/2024] [Indexed: 12/15/2024] Open
Abstract
Purpose The objective of the current study is to introduce a proposed method and evaluate its efficacy using the greater trochanter (GT) tip rather than the lesser trochanter (LT) as an anatomical landmark to reduce leg length discrepancy (LLD) during performance of hip arthroplasty. Materials and Methods Thirty-two patients who underwent hip arthroplasty were divided according to the GT group (n=17) and the LT control group (n=11); four patients were excluded. LLD was determined by assessing the vertical lengths parallel to the line connecting the lower margin of the teardrop to the most prominent part of the LT on a standing anteroposterior pelvic X-ray taken 30 days after the procedure. The mean and median LLD of the two groups were compared. Analysis of planning for femoral stem depth insertion and postoperative results was also performed. Results No significant differences in characteristics including age, sex, or body mass index were observed between the two groups. However, the type of arthroplasty differed significantly between groups (P=0.016). The mean postoperative LLD was significantly smaller in the GT group compared with the control group (P=0.004). The results of linear regression of femoral stem depth showed a significant association between intraoperative planning and postoperative measurement (t=2.705, r2=0.672, P=0.016). Conclusion Preoperative measurement in determining femoral stem depth insertion using the GT tip as an anatomical reference can effectively minimize LLD in patients who underwent hip arthroplasty.
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Affiliation(s)
- John Christian Parsaoran Butarbutar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Gian Ivander
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Albert Riantho
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Kevin Fidiasrianto
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Joshua Edward
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
| | - Earlene Tasya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia
- Department of Orthopaedics and Traumatology, Siloam Hospitals Lippo Village, Tangerang, Indonesia
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Tan IEH, Chok AY, Zhao Y, Chen Y, Koo CH, Aw J, Soh MHT, Foo CH, Ang KA, Tan EJKW, Tan AHC, Au MKH. Acute hospital-community hospital care bundle for elderly orthopedic surgery patients: A propensity score-matched economic analysis. World J Orthop 2023; 14:231-239. [PMID: 37155510 PMCID: PMC10122775 DOI: 10.5312/wjo.v14.i4.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/18/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND While Singapore attains good health outcomes, Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals. An Acute Hospital-Community Hospital (AH-CH) care bundle has been developed to assist patients in postoperative rehabilitation. The core concept is to transfer patients out of AHs when clinically recommended and into CHs, where they can receive more beneficial dedicated care to aid in their recovery, while freeing up bed capacities in AHs.
AIM To analyze the AH length of stay (LOS), costs, and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.
METHODS A total of 862 1:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital (SGH) before (2017-2018) and after (2019-2021) the care bundle intervention period was analyzed. Outcome measures were AH LOS, CH LOS, hospitalization metrics, postoperative 30-d mortality, and modified Barthel Index (MBI) scores. The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.
RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention, the age distribution, sex, American Society of Anesthesiologists classification, Charlson Comorbidity Index, and surgical approach were comparable between both groups. Patients transferred to CHs after the surgery had a shorter median AH LOS (7 d vs 9 d, P < 0.001). The mean total AH inpatient cost per patient was 14.9% less for the elderly group transferred to CHs (S$24497.3 vs S$28772.8, P < 0.001). The overall AH U-turn rates for elderly patients within the care bundle were low, with a 0% mortality rate following orthopedic surgery. When elderly patients were discharged from CHs, their MBI scores increased significantly (50.9 vs 71.9, P < 0.001).
CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH. Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery. Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.
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Affiliation(s)
- Ivan En-Howe Tan
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yun Zhao
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Yonghui Chen
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
| | - Chee Hoe Koo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
| | - Junjie Aw
- Post-Acute and Continuing Care, Family Medicine, Outram Community Hospital, Singapore 168582, Singapore
| | | | - Chek Hun Foo
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
| | - Kwok Ann Ang
- Finance, Singapore General Hospital, Singapore 169608, Singapore
| | | | - Andrew Hwee Chye Tan
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Marianne Kit Har Au
- Group Finance, Singapore Health Services, Singapore 168582, Singapore
- Singhealth Community Hospital, Singapore 168582, Singapore
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Farrow L, McLoughlin J, Gaba S, Ashcroft GP. Future demand for primary hip and knee arthroplasty in Scotland. Musculoskeletal Care 2022. [PMID: 36250556 DOI: 10.1002/msc.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The rising prevalence of osteoarthritis, associated with an ageing population, is expected to deliver increasing demand for arthroplasty services in the future. Understanding the scale of potential change is essential to ensure adequate provision of services and prevent prolonged waiting times that can cause patient harm. METHODS We set out to provide projections of future primary knee and hip arthroplasty out to 2038 utilising historical trend data (2008-2018) from the Scottish Arthroplasty Project. All analyses were performed using the Holt's exponential smoothing projection method with the forecast package in R statistics. Results were adjusted for projected future population estimates provided by National Records of Scotland. Independent age group predictions were also performed. RESULTS The predicted rise of primary hip arthroplasty for all ages is from 120/100k/year in 2018 to 152/100k/year in 2038, a 28% increase. The predicted rise of primary knee arthroplasty for all ages is from 164/100k/year in 2018 to 220/100k/year in 2038, a 34% increase. Based on a static 3-day length of stay average this would see 4280 and 7392 additional patient bed days required for primary hip and knee arthroplasty patients respectively per annum. The associated additional cost is anticipated to be approximately £26 million. CONCLUSIONS Anticipated future demand for arthroplasty will require significant additional resource and funding to prevent deterioration in quality of care and an increase in patient wait times, additional to that already required to clear the COVID-19 backlog. Understanding presented projections of changes to arthroplasty demand is key to future service delivery.
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Affiliation(s)
- Luke Farrow
- University of Aberdeen, Aberdeen, UK.,Woodend Hospital, Aberdeen, UK
| | - John McLoughlin
- University of Aberdeen, Aberdeen, UK.,Woodend Hospital, Aberdeen, UK
| | | | - George P Ashcroft
- University of Aberdeen, Aberdeen, UK.,Woodend Hospital, Aberdeen, UK
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Danaei B, McPhee J. Model-Based Acetabular Cup Orientation Optimization Based On Minimizing the Risk of Edge-Loading and Implant Impingement Following Total Hip Arthroplasty. J Biomech Eng 2022; 144:1141865. [PMID: 35748611 DOI: 10.1115/1.4054866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 11/08/2022]
Abstract
In this paper, a computationally-efficient model-based method for determining patient-specific optimal acetabular cup alignment for total hip arthroplasty (THA) is presented. The proposed algorithm minimizes the risk of implant impingement and edge-loading, which are reported as the major causes of hip dislocation following THA. First, by using motion capture data recorded from the patient performing different daily activities, the hip contact force and the relative orientation of the femur and pelvis are calculated by a musculoskeletal model. Then, by defining two quantitative indices i.e., angular impingement distance and angular edge-loading distance, the risk of impingement and edge-loading are assessed for a wide range of cup alignments. And finally, three optimization criteria are introduced to estimate the optimal cup alignment with a tradeoff between the risk of impingement and edge-loading. The results show that patient-specific characteristics such as pelvic tilt could significantly change the optimal cup alignment, especially the value of cup anteversion. Therefore, in some cases, the well-known Lewinnek safe zone may not be optimal, or even safe. Unlike other dynamic model-based methods, in this work, the need for force plate measurements is eliminated by estimating the ground reaction forces and moments, which makes this method more practical and cost-efficient. Furthermore, the low computational complexity due to analytical formulas makes this method suitable for both preoperative and intra-operative planning.
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Affiliation(s)
- Behzad Danaei
- Motion Research Group, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - John McPhee
- Motion Research Group, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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Kuehling T, Schilling P, Bernstein A, Mayr HO, Serr A, Wittmer A, Bohner M, Seidenstuecker M. A human bone infection organ model for biomaterial research. Acta Biomater 2022; 144:230-241. [PMID: 35304323 DOI: 10.1016/j.actbio.2022.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023]
Abstract
The aim of this work was to establish an organ model for staphylococcal infection of human bone samples and to investigate the influence and efficacy of a microporous β-tricalcium phosphate ceramic (β-TCP, RMS Foundation) loaded with hydrogels (alginate, alginate-di-aldehyde (ADA)-gelatin) and clindamycin on infected human bone tissue over a period of 28 days. For this purpose, human tibia plateaus, collected during total knee replacement surgery, were used as a source of bone material. Samples were infected with S. aureus ATCC29213 and treated with differently loaded β-TCP composites (alginate +/- clindamycin, ADA-gelatin +/- clindamycin, unloaded). The loading of the composites was carried out by means of a flow chamber. The infection was observed for 28 days, quantifying bacteria in the medium and the osseus material on day 1, 7, 14, 21 and 28. All samples were histologically processed for bone vitality evaluation. Bone infection could be consistently performed within the organ model. In addition, a strong reduction in bacterial counts was recorded in the groups treated with ADA-gelatin + clindamycin and alginate + clindamycin, while the bacterial count in the control groups remained constant. No significant differences between groups could be observed in the number of lacunae filled with osteocytes suggesting no differences in bone vitality among groups. In an ex-vivo human bone infection model, over a period of 28 days bacterial growth could be reduced by treatment with ADA-Gel + CLI and ALG + CLI -releasing β-TCP composites. This could be relevant for its clinical use. Further work will be necessary to improve the loading of β-TCP and the bone infection organ model itself. STATEMENT OF SIGNIFICANCE: The common treatment of bone infections is debridement and systemic administration of antibiotics. In some cases, antibiotic-containing carriers are already used, but these must be removed again. Our work is intended to show another treatment option. The scaffold we have developed, made of a calcium phosphate ceramic and a hydrogel as the active substance carrier, can, in addition to releasing the active substance, also assume a load-bearing function of the bone and is biodegradable. In addition, the model we developed can also be used for the analysis and treatment of bone infections other than those of the musculoskeletal system. More importantly, it can also serve as a substitute for previously used animal experiments.
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Metallic versus Non-Metallic Cerclage Cables System in Periprosthetic Hip Fracture Treatment: Single-Institution Experience at a Minimum 1-Year Follow-Up. J Clin Med 2022; 11:jcm11061608. [PMID: 35329933 PMCID: PMC8949985 DOI: 10.3390/jcm11061608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023] Open
Abstract
Metallic cerclage cables are reliable and cost-effective internal fixation devices, which are largely used in surgical practice for the treatment of periprosthetic fractures. Nevertheless, complications connected with their use have been described in the literature, including the following: third-body generation, failure and consequent migration, fraying, allergies, and injury to the surgical team. The development of new materials offers alternatives to traditional metallic cables. This study compares the outcomes between two groups of patients affected by periprosthetic hip fractures, treated with titanium cables or with ultra-high-molecular-weight polyethylene (UHMWPe) iso-elastic cables. Our retrospective study aims to compare the clinical and radiological outcomes of titanium cables and UHMWPe iso-elastic cables, isolated or associated with dedicated plates, for the surgical treatment of periprosthetic fractures with stable implants. Two groups of 30 (group A-metallic cables) and 24 (group B-UHMWPe iso-elastic cables) patients have been surgically treated in our institution for hip periprosthetic fractures, between September 2017 and June 2020. The mean age of the patients was 81 years in group A and 80 years in group B. In our study, we included fractures classified as B1 or C, according to the Vancouver postoperative fractures classification; the patients were evaluated retrospectively at 1 year postoperatively, regarding the following: surgery time, blood loss, partial weight-bearing time, radiographical healing time, Harris hip score, and postoperative complications. Comparable outcomes were observed in patients from both groups. Group A showed a higher complication rate compared to group B, at 1 year postoperatively. Non-metallic nylon fiber and ultra-high-molecular-weight polyethylene (UHMWPe) cerclage cables could represent a reliable fixation device, ensuring comparable healing and complication rates with traditional titanium cerclage cables.
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Dust P, Corban J, Sampalis J, Antoniou J, Bergeron SG. Patient Functional Status as an Indication for Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2022; 37:390-397. [PMID: 34538682 DOI: 10.1016/j.arth.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The number of total hip arthroplasties performed per year is increasing for reasons not fully explained by a growing and aging population. The purpose of this study was to determine the role of patient functional status as an indication for surgery and determine if patients are undergoing surgery at a better functional status than in the past. METHODS A systematic review and meta-analysis of the MEDLINE, EMBASE, and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Functional status was assessed using the 36-Item Short-Form Health Survey's Physical Component Summary score. Only primary procedures were included; revisions were excluded. Articles were screened by 2 independent reviewers with conflicts resolved with a third reviewer. Meta-regression analysis was performed to determine the effect of time, patient age, and gender. Subgroup analysis was performed to compare geographic regions. RESULTS A total of 1504 articles were identified. Data from 172 groups representing 18,644 patients recruited from 1990 to 2013 and identified from 107 articles were included. The mean preoperative Physical Component Summary score was 31.2 (95% confidence interval 30.5-31.9) with a 95% prediction interval of 22.6-39.8. The variance across studies was statistically significant (P = .000) with 97.25% true variance. Year of enrollment, age, and the percentage of females were not found to have any significant effect. There were no differences between countries. CONCLUSION Patients are undergoing total hip arthroplasty at a similar preoperative physical functional status as in the past. Patient age, gender, and location do not influence the functional status at which patients are indicated for surgery.
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Affiliation(s)
- Peter Dust
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada; Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
| | - Jason Corban
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada
| | - John Sampalis
- Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
| | - John Antoniou
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada; Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
| | - Stephane G Bergeron
- Jewish General Hospital, Department of Orthopaedic Surgery, McGill University, Montréal, Québec, Canada; Department of Experimental Surgery, McGill University, JSS Medical Research, Montréal, Québec, Canada
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10
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Chagas JBM, Andrez TN, Costa LAV, Paião ID, Lenza M, Ferreti M. Preoperative Home Care Can Be One of the Factors Affecting the Length of Hospital Stay in Patients Undergoing Total Hip Arthroplasty. Indian J Orthop 2021; 56:473-478. [PMID: 35251512 PMCID: PMC8854545 DOI: 10.1007/s43465-021-00554-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/19/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the importance of home nursing care on the functional outcome, quality of life, and length of stay of patients who underwent total hip arthroplasty. METHODS This was a retrospective cross-sectional study including patients who underwent surgery from February 2011 to December 2016. Patients were analyzed in two groups: with home care (received nursing care) and without home care. The analyzed outcomes were quality of life, functional outcome, and length of hospital stay. Total follow-up with questionnaires was 24 months. RESULTS A total of 244 patients (143 with home care and 101 without home care) were analyzed. No significant differences were found regarding the mean age (p = 0.125), gender distribution (p = 0.449) and BMI (p = 0.548) between the two groups. There was also no significant difference regarding functional outcome (p = 0.107) and quality of life (p = 0.848), measured by validated tools. However, the median of length of hospital stays in the home care group was lower in 1 day compared to without home care group (p < 0.001). CONCLUSION The home nursing care did not influence the functional outcome or quality of life of the patients, but there was a decrease in the length of hospital stay in the group that received preoperative nursing care.
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Affiliation(s)
- Júlia B. M. Chagas
- grid.413562.70000 0001 0385 1941Department of Orthopedics, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Sao Paulo, 05652-900 Brazil
| | - Tássio N. Andrez
- grid.413562.70000 0001 0385 1941Department of Orthopedics, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Sao Paulo, 05652-900 Brazil
| | - Lauro A. V. Costa
- grid.413562.70000 0001 0385 1941Department of Orthopedics, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Sao Paulo, 05652-900 Brazil
| | - Isabela D. Paião
- grid.413562.70000 0001 0385 1941Department of Orthopedics, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Sao Paulo, 05652-900 Brazil
| | - Mario Lenza
- grid.413562.70000 0001 0385 1941Department of Orthopedics, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Sao Paulo, 05652-900 Brazil
| | - Mario Ferreti
- grid.413562.70000 0001 0385 1941Department of Orthopedics, Hospital Israelita Albert Einstein, Avenida Albert Einstein, 627/701, Sao Paulo, 05652-900 Brazil
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Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:342. [PMID: 34049552 PMCID: PMC8161970 DOI: 10.1186/s13018-021-02493-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/23/2021] [Indexed: 11/28/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is an accepted, effective treatment to restore function, relieve pain, and improve the quality of life in patients with advanced osteoarthritis. One complication of this major surgery is impaired sleep quality. This study examines the quality of sleep in patients undergoing TKA before and after their operation. Methods All relevant records were obtained using a systematic search in three online databases: PubMed, Scopus, and Cochrane library. Out of the 177 records retrieved, only eight matched the inclusion criteria. Due to the lack of sufficient data, only four studies entered the meta-analysis. Values reported for sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) were extracted from patient records before and after surgery. A random-effect model was used to analyze the data. Results The results of the meta-analysis show a significant difference in the improvement of sleep quality after surgery at two time points of 4–6 weeks after surgery from the preoperative baseline (SMD − 0.16; 95% CI − 1.05 to 0.74; P = 0.0) and 3–6 months after surgery from the preoperative baseline (SMD − 0.92; 95% CI − 1.61 to − 0.24; P = 0.0). Conclusions The results show that TKA generally improves the patients’ sleep quality. Although some studies reported disrupted sleep quality in periods close to the surgery (especially in the early days after surgery), all studies have reported improved sleep quality in the late postoperative intervals.
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12
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Parkes RJ, Ayeko O, Brunton L, Griffiths-Jones W, Ungvari Z, Goss H. Revolutionising rapid recovery: a quality improvement project in hip and knee replacement. BMJ Open Qual 2021; 10:bmjoq-2020-001249. [PMID: 33879494 PMCID: PMC8061820 DOI: 10.1136/bmjoq-2020-001249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 04/03/2021] [Indexed: 12/25/2022] Open
Abstract
With increasing bed pressures and an ageing population, there is a need to increase throughput and reduce the bed burden of joint replacements. These issues were recognised in North Devon and an enhanced recovery pathway was established. Enhanced recovery, which aims to optimise the patient journey and shorten the inpatient admission, was first adopted for hip and knee replacements in North Devon District hospital in 2011. The Rapid Recovery Group, comprised a multidisciplinary team involved in the perioperative patient pathway, formed in the third financial quarter of 2018/2019 (Q3). The group was tasked with the optimisation of the pathway for patients requiring hip and knee replacement from referral to 12 months postoperation. Representatives from the group visited a similar sized hospital with successful outcomes from their pathway in order to compare and then construct a new pathway based on observed practices. Multiple interventions were instigated, alongside continuous data collection, forming a combination of simultaneous and sequential Plan Do Study Act cycles. Interventions involved intraoperative local anaesthetic injection protocols, use of Taurus frames together with nurse-led mobilisation and trials of simplified drug charts. Information collected included type of surgery, length of stay, who mobilised patients and when. Mean length of stay in total hip and knee replacement has dropped from 3.6 to 2.4 days and 3.6 to 2.0 days respectively, comparing mean for the fiscal year 2018/2019 to 2019/2020, putting the hospital in the top 10 trusts in the country. With multiple changes occurring simultaneously, the impact of individual elements is difficult to isolate but the overall impact of the interventions is evident. A drastic improvement in the length of stay has been seen and the collaborative multidisciplinary approach has been pivotal to success.
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Affiliation(s)
| | - Olusegun Ayeko
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
| | - Luke Brunton
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
| | | | - Zsolt Ungvari
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
| | - Henry Goss
- Trauma & Orthopaedics, North Devon District Hospital, Barnstaple, UK
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13
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Impact of a bundle on surgical site infections after hip arthroplasty: A cohort study in Italy (2012–2019). Int J Surg 2020; 82:8-13. [DOI: 10.1016/j.ijsu.2020.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
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14
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Tulp ADM, Kruse FM, Stadhouders NW, Jeurissen PPT. Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands - A Study of 5 Elective Surgeries. Int J Health Policy Manag 2020; 9:380-389. [PMID: 32610739 PMCID: PMC7557426 DOI: 10.15171/ijhpm.2019.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system in the Netherlands, by focusing on differences in healthcare quality and price. Methods: The cross-sectional study combined publicly available quality data, list prices and insurer contracts for 2017. Clinical outcomes of 5 elective surgeries (total hip and knee replacement, anterior cruciate ligament (ACL), cataract and carpal tunnel surgeries) were compared using zero-or-one inflated beta-regressions, corrected for underlying structural factors (ie, volume of care, process and structure indicators, and chain affiliation). Furthermore, price differences between ITCs and GHs were examined using ordinary least squares regressions. Lastly, we analysed quality of care in relation to the number of insurance contracts of the 4 largest Dutch insurance companies using ordered logistic regressions. Results: Quality differences between ITCs and GHs were found to be inconsistent across procedures. No facility type performed better overall. There were no differences exhibited in the list prices between ITCs and GHs. No consistent relationship was found between the underlying factors and quality or price, in different procedures and time. We found no indication for selective contracting based on quality within the ITC sector. Conclusions: This study found no evidence that ITCs outperform GHs on quality or price. This evidence does not support the focus factory theory. The substantial practice variation in quality of care may justify more evidence-based contracting within the market for elective surgery.
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Affiliation(s)
| | | | | | - Patrick P T Jeurissen
- IQ healthcare, Radboud University and Medical Center, Nijmegen, The Netherlands.,Ministry of Health, Welfare and Sport, The Hague, The Netherlands
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15
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Wu ZY, Zhang H, Yang YY, Yang FQ. An online dual-enzyme co-immobilized microreactor based on capillary electrophoresis for enzyme kinetics assays and screening of dual-target inhibitors against thrombin and factor Xa. J Chromatogr A 2020; 1619:460948. [PMID: 32059867 DOI: 10.1016/j.chroma.2020.460948] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/27/2019] [Accepted: 02/04/2020] [Indexed: 12/18/2022]
Abstract
In this study, an online capillary electrophoresis (CE) based dual-enzyme (thrombin and factor Xa) co-immobilized microreactor (THR-FXa IMER) was constructed for studying enzyme kinetics and screening dual-target inhibitors against THR and FXa with the aid of the polydopamine/graphene oxide (PDA/GO) coating. Based on the developed THR-FXa IMER, the Michaelis-Menten constants (Km) of THR and FXa were calculated to be 187.26 and 48.80 μM, respectively. The inhibition constants (Ki) for two known inhibitors, argatroban and rivaroxaban, on THR and FXa were determined to be 14.73 and 0.41 nM, respectively. In addition, after 30 consecutive runs, the enzymes' activity was remained 98% of the initial immobilized activity for both THR and FXa, which shows that the constructed IMER has good stability and repeatability. Finally, the developed method was successfully applied to screen dual-target inhibitors against THR and FXa from 30 small molecular compounds. Among them, 10 compounds such as salvianolic acid C and epigallocatechin gallate (EGCG) have dual-enzyme inhibitory activity, and 2 compounds named saikosaponin A and oleuropein have single THR inhibitory activity, 5 compounds such as rosemary acid and salvianolic acid B have single FXa inhibitory activity. Finally, the molecular interactions between enzyme and potential inhibitors were further verified via the molecular docking, and a new compound with a theoretically good coagulation inhibition effect was designed by the scaffold hopping study. In summary, the developed THR-FXa IMER is a reliable method for screening THR and/or FXa inhibitors.
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Affiliation(s)
- Zhao-Yu Wu
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing 401331, PR China
| | - Hao Zhang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing 401331, PR China
| | - Yi-Yao Yang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing 401331, PR China
| | - Feng-Qing Yang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing 401331, PR China.
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16
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Pinilla-Gracia C, Mateo-Agudo J, Herrera A, Muñoz M. On the relevance of preoperative haemoglobin optimisation within a Patient Blood Management programme for elective hip arthroplasty surgery. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:182-190. [PMID: 32281924 PMCID: PMC7250692 DOI: 10.2450/2020.0057-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/30/2020] [Indexed: 04/11/2023]
Abstract
BACKGROUND Preoperative anaemia is highly prevalent among patients scheduled for total hip arthroplasty (THA), and is the main risk factor for perioperative red blood cell transfusion (RBCT). This retrospective cohort study aimed at assessing whether preoperative haemoglobin (Hb) optimisation reduced RBCT rates and improved outcome in this patient population. MATERIALS AND METHODS All patients entered a Patient Blood Management (PBM) programme consisting of in-hospital erythropoiesis stimulation, tranexamic acid administration, and a restrictive RBCT policy. Data from preoperatively anaemic patients (Hb <13 g/dL) who underwent THA, before (2015-2016, control group, n=75) or after (2017-2018, study group, n=70) the incorporation of a preoperative Hb optimisation protocol (Ferric carboxymaltose IV, 1,000 mg ± epoetin-α, 40,000 IU; administered 4 weeks prior to surgery) to the PBM programme underwent a comparative analysis. RESULTS Haemoglobin concentrations at preoperative assessment were similar (12.1±0.7 g/dL vs 12.2±0.7 g/dL, for study and control groups, respectively; p=0.129). At hospital admission, significantly higher Hb were observed in the study group (13.4±0.8 g/dL vs 12.2±0.7 g/dL, respectively; p=0.001), with anaemia being corrected in 79% of cases. Compared to the control group, reduced perioperative RBCT rate (4% vs 24%, respectively; p=0.001), shorter length of hospital stay (6 [range 5-7] days vs 7 [5-8 days], respectively; p=0.002), and increased proportion of patients being discharged directly to their home (74% vs 47%, respectively; p=0.01) were observed in the study group. No treatment-related side-effects were witnessed. DISCUSSION Within a PBM programme for THA, preoperative Hb optimisation was efficacious at correcting anaemia and minimising RBCT requirements, thus contributing to an improvement in postoperative outcomes.
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Affiliation(s)
- Cristian Pinilla-Gracia
- Department of Orthopaedic Surgery and Traumatology, “Miguel Servet” University Hospital, Zaragoza, Spain
| | - Jesús Mateo-Agudo
- Department of Orthopaedic Surgery and Traumatology, “Miguel Servet” University Hospital, Zaragoza, Spain
| | - Antonio Herrera
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Aragón’s Health Research Institute, Zaragoza, Spain
| | - Manuel Muñoz
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
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17
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Yang YY, Wu ZY, Zhang H, Yin SJ, Xia FB, Zhang Q, Wan JB, Gao JL, Yang FQ. LC-MS-based multivariate statistical analysis for the screening of potential thrombin/factor Xa inhibitors from Radix Salvia Miltiorrhiza. Chin Med 2020; 15:38. [PMID: 32351617 PMCID: PMC7183602 DOI: 10.1186/s13020-020-00320-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/20/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The dry root and rhizome of Salvia miltiorrhiza Bunge, or Danshen, is a well-known traditional Chinese medicine with anticoagulant activity. Taking into account that thrombin (THR) and factor Xa (FXa) play crucial roles in the coagulation cascade, it is reasonable and meaningful to screening THR and/or FXa inhibitors from Danshen. METHODS Four extracts [butanol (BA), ethyl acetate (EA) and remained extract (RE) from 75% ethanol extract, and water extract (WE)] of Danshen were prepared, and their THR/FXa inhibitory activities were assessed in vitro. Then, the active EA extract was further separated by silica-gel column chromatography (SC), and its fractions (SC1-SC5) were analyzed by LC-MS. The principal component analysis (PCA) and orthogonal partial least squares discriminate analysis (OPLS-DA) were employed for predicting the specific marker compounds. The chemical structures of targeted compounds were identified by LC-MS/MS and their interactions with THR/FXa were analyzed by the molecular docking analysis. RESULTS Danshen EA extract showed strong activity against THR and FXa, and its fractions (SC1-SC5) exhibited obvious difference in inhibitory activity against these two enzymes. Furthermore, four marker compounds with potential THR/FXa inhibitory activity were screened by PCA and OPLS-DA, and were identified as cryptotanshinone, tanshinone I, dihydrotanshinone I and tanshinone IIA. The molecular docking study showed that all these four tanshinones can interact with some key amino acid residues of the THR/FXa active cavities, such as HIS57 and SER195, which were considered to be promising candidates targeting THR and/or FXa with low binding energy (< - 7 kcal mol-1). CONCLUSIONS LC-MS combined with multivariate statistical analysis can effectively screen potential THR/FXa inhibitory components in Danshen.
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Affiliation(s)
- Yi-Yao Yang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing, 401331 People’s Republic of China
| | - Zhao-Yu Wu
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing, 401331 People’s Republic of China
| | - Hao Zhang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing, 401331 People’s Republic of China
| | - Shi-Jun Yin
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing, 401331 People’s Republic of China
| | - Fang-Bo Xia
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, People’s Republic of China
| | - Qian Zhang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing, 401331 People’s Republic of China
| | - Jian-Bo Wan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, People’s Republic of China
| | - Jian-Li Gao
- Academy of Chinese Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053 People’s Republic of China
| | - Feng-Qing Yang
- School of Chemistry and Chemical Engineering, Chongqing University, Chongqing, 401331 People’s Republic of China
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18
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Berg AJ, Hoyle A, Yates E, Chougle A, Mohan R. Cement-in-cement revision with the Exeter Short Revision Stem: A review of 50 consecutive hips. J Clin Orthop Trauma 2020; 11:47-55. [PMID: 32001984 PMCID: PMC6985006 DOI: 10.1016/j.jcot.2019.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022] Open
Abstract
Revision of a well-fixed cemented femoral stem is technically challenging. The Exeter Short Revision Stem (SRS) was developed to facilitate cement-in-cement revision mitigating some of these challenges. We present the short to mid-term results of 50 cement-in-cement revisions performed with this implant. A retrospective review of all cement-in-cement revision with the Exeter SRS, at our institution, over a seven-year period between 2007 and 2014 was conducted. Records were assessed for radiological and clinical component loosening at greater than 12 months follow-up and for revision and complications at all time points. An Oxford Hip Score (OHS) and Numeric Rating Scale (NRS) for groin and thigh pain at rest and initial mobilisation were obtained. 50 implants in 46 patients were identified. Radiographic and clinical follow-up was available for 42 and 38 implants respectively at greater than 12 months. Mean radiographic follow-up was 5.1 years and clinical 4.9 years. There was no radiographic or clinical evidence of loosening. 3 revisions were performed, one for each of recurrent dislocation, infection and stem breakage. Median OHS was 39 (IQR 12) and mean NRS for groin pain at rest and initial mobilisation was 1.7 and 1.7 respectively and NRS for thigh pain at rest and initial mobilisation was 1.3 and 1.6 respectively with mean follow-up of 6.9 years. The Exeter SRS provides a viable option for cement-in-cement stem revision, with low revision, complication and loosening rates and good patient reported outcomes at short to mid-term follow up.
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Affiliation(s)
- Andrew J. Berg
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Pennine Acute Hospitals NHS Foundation Trust, Delaunays Road, Manchester, M8 5RB, UK
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19
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Kruse FM, Groenewoud S, Atsma F, van der Galiën OP, Adang EMM, Jeurissen PPT. Do independent treatment centers offer more value than general hospitals? The case of cataract care. Health Serv Res 2019; 54:1357-1365. [PMID: 31429482 PMCID: PMC6863231 DOI: 10.1111/1475-6773.13201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify differences between independent treatment centers (ITCs) and general hospitals (GHs) regarding costs, quality of care, and efficiency. DATA SOURCES Anonymous claims data (2013-2015) were used. We also obtained quality indicators from a semipublic platform. STUDY DESIGN This study uses a comparative multilevel analysis, controlling for case mix, to evaluate the performance of ITCs and GHs for patients diagnosed with cataract. DATA COLLECTION Reimbursement claims were extracted from existing claims databases of the largest Dutch health insurer. Quality indicators were obtained by external agencies through a mixed-mode survey. PRINCIPAL FINDINGS There are no stark differences in complexity of cases for cataract care. ITCs seem to perform surgeries more frequently per care pathway, but conduct a lower number of health care activities per surgical claim. Total average costs are lower in ITCs compared with GHs, but when adjusted for case mix, the differences in costs are lower. The findings with the adjusted quality differences suggest that ITCs outperform GHs on patient satisfaction, but patients' outcomes are similar. CONCLUSION This finding supports the postulation-based on the focus factory theory-that ITCs can provide more value for cataract care than GHs.
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Affiliation(s)
- Florien M. Kruse
- Scientific Center for Quality of Healthcare (IQ healthcare)Radboud Institute for health SciencesNijmegenThe Netherlands
| | - Stef Groenewoud
- Scientific Center for Quality of Healthcare (IQ healthcare)Radboud Institute for health SciencesNijmegenThe Netherlands
| | - Femke Atsma
- Scientific Center for Quality of Healthcare (IQ healthcare)Radboud Institute for health SciencesNijmegenThe Netherlands
| | | | - Eddy M. M. Adang
- Department of Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Patrick P. T. Jeurissen
- Scientific Center for Quality of Healthcare (IQ healthcare)Radboud Institute for health SciencesNijmegenThe Netherlands
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20
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Metal Artifact Reduction for Orthopedic Prosthesis in Lower Extremity CT Venography: Evaluation of Image Quality and Vessel Conspicuity. Cardiovasc Intervent Radiol 2019; 42:1619-1626. [DOI: 10.1007/s00270-019-02326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/22/2019] [Accepted: 08/24/2019] [Indexed: 11/26/2022]
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Grant S, Blom AW, Whitehouse MR, Craddock I, Judge A, Tonkin EL, Gooberman-Hill R. Using home sensing technology to assess outcome and recovery after hip and knee replacement in the UK: the HEmiSPHERE study protocol. BMJ Open 2018; 8:e021862. [PMID: 30056388 PMCID: PMC6067391 DOI: 10.1136/bmjopen-2018-021862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/18/2018] [Accepted: 06/14/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Over 160 000 people with severe hip or knee pain caused by osteoarthritis undergo total hip (THR) or knee replacement (TKR) surgery each year in the UK within the National Health Service (NHS), and this number is expected to increase. Innovative approaches to evaluating surgical outcomes will be needed to respond to the increasing burden of joint replacement surgery. The Sensor Platform for Healthcare in a Residential Environment, Interdisciplinary Research Collaboration (SPHERE-IRC) have developed a system of sensors that can monitor the health-related behaviours of people living at home. The system includes sensors for the home environment (measuring temperature, humidity, room occupancy, water and electricity usage), a wristband body-worn activity monitor and silhouette (body outline) sensors. The aim of HEmiSPHERE (Hip and knEe study of a Sensor Platform of HEalthcare in a Residential Environment) is to (1) determine the accuracy and feasibility of the sensory data as it compares with conventional assessment of health outcomes after surgery using patient self-reported questionnaires, and (2) to explore how the SPHERE system is useful for everyday clinical decision-making. METHODS AND ANALYSIS A feasibility study recruiting and installing the SPHERE system in the homes of up to 30 NHS adult patients as they undergo a THR or TKR. Through a mixed-methods design, the SPHERE system will monitor and record continuous measurements of daily behaviour. Main outcomes will assess the relationships between environmental, behavioural and movement data and the parameters of interest from the standard clinical assessments measuring patient outcomes over time. Patient interviews and focus groups with consultant orthopaedic surgeons will provide in-depth understanding of the acceptability, feasibility and accuracy of the data. ETHICS AND DISSEMINATION We aim to disseminate the findings through regional talks and seminars, international conferences and peer-reviewed journals and social media.
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MESH Headings
- Accelerometry
- Aged
- Arthroplasty, Replacement, Hip/rehabilitation
- Arthroplasty, Replacement, Knee/rehabilitation
- Cost-Benefit Analysis
- Feasibility Studies
- Female
- Focus Groups
- Health Services Research
- Humans
- Male
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/rehabilitation
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/diagnosis
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/rehabilitation
- Osteoarthritis, Knee/surgery
- Patient Reported Outcome Measures
- Quality of Life
- Recovery of Function/physiology
- Surveys and Questionnaires
- Technology Assessment, Biomedical
- Treatment Outcome
- United Kingdom
- Wearable Electronic Devices
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Affiliation(s)
- Sabrina Grant
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A W Blom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Ian Craddock
- Department of Electrical and Electronic Engineering, Faculty of Engineering, University of Bristol, Bristol, UK
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Tonkin
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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22
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Carlton L, Maccio JR, Maccio JG, McGowan C. The application of mechanical diagnosis and therapy on hip osteoarthritis: A case report. Physiother Theory Pract 2018; 36:347-357. [PMID: 29924661 DOI: 10.1080/09593985.2018.1485194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The prevalence and cost of hip osteoarthritis (OA) is rising. Mechanical diagnosis and therapy (MDT) is an orthopedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movements. There has been no investigation of the association between MDT and patients diagnosed with hip OA. Case Description: This case report presents a 71-year-old female diagnosed with hip OA and matching the currently accepted clinical prediction rule (CPR) for symptomatic hip OA. The patient was classified and treated by a Diplomat of MDT and co-examiner using MDT. Outcomes: Short- and long-term (13 months) outcomes were excellent, demonstrating rapid abolishment of symptoms and improvement in function in 5 visits over 21 days. The patient demonstrated the ability to prevent and manage reoccurrence of symptoms independently; nevertheless, she received a total hip replacement which was not in accordance with current guidelines and recommendations. Conclusion: This case report raises questions about whether or not pathologies traditionally associated with the etiology of hip OA are actually at fault. Moreover, it raises questions about the utility of special tests and CPRs typically utilized to identify those structures. The case report provides preliminary evidence from one patient that MDT may be capable of providing effective short- and long-term outcomes in the management of hip OA.
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23
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Luciano ADP, Almeida TCDC, dos Santos Figueiredo FW, Schoueri JHM, de Abreu LC, Adami F. Study of the evolution and variability of nontraumatic orthopedic surgeries in Brazil-9 years of follow-up: A database study. Medicine (Baltimore) 2018; 97:e10703. [PMID: 29794745 PMCID: PMC6393143 DOI: 10.1097/md.0000000000010703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/19/2018] [Indexed: 11/27/2022] Open
Abstract
In Brazil, there are no epidemiological statistics that map nontraumatic orthopedic injuries, their rate of variability, distribution by specialty, fatality rate, and the economic impact that these lesions and their consequences can bring to the country. The objective of this study was to evaluate the rates of variability for skills, deaths, mortality, and the economic impact of nontraumatic orthopedic surgeries in Brazil from 2008 to 2016.This is a descriptive study conducted through the analysis of data relating to the indicators of hospital production regarding orthopedic procedures of the Department of Informatics of the Unified Health System (Departamento de Informática do Sistema Único de saúde-DATASUS) between 2008 and 2016. The level of significance was 5%.There was a predominance of hospitalizations for surgery of the lower limbs, which also resulted in the largest number of deaths. The surgical mortality rate recorded for the hip also needs to be considered. In general, there is a national increase in the number of orthopedic surgeries performed, accompanied by a concomitant increase in the number of deaths and mortality of the population exposed.We observed a growing demand for hospitalization with a consequent increase in lethality and deaths. We can conclude that between 2008 and 2016, the number of hospitalizations for elective nontraumatic orthopedic surgical procedures increased significantly, driven mainly by lower limb surgeries, along with the cost of the Unified Health System (Sistema Único de Saúde-SUS) for these surgeries.
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Affiliation(s)
| | | | | | | | - Luiz Carlos de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica. Faculdade de Medicina do ABC (ABC Medical School), Lauro Gomes Avenue Santo André/São Paulo, Brazil
| | - Fernando Adami
- Epidemiology and Data Analysis Laboratory, Faculdade de Medicina do ABC (ABC Medical School)
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Gagnier JJ, Huang H, Mullins M, Marinac-Dabić D, Ghambaryan A, Eloff B, Mirza F, Bayona M. Measurement Properties of Patient-Reported Outcome Measures Used in Patients Undergoing Total Hip Arthroplasty. JBJS Rev 2018; 6:e2. [DOI: 10.2106/jbjs.rvw.17.00038] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Development of post hip replacement comfort scale. Appl Nurs Res 2017; 38:169-174. [PMID: 29241512 DOI: 10.1016/j.apnr.2017.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/01/2017] [Accepted: 10/15/2017] [Indexed: 11/20/2022]
Abstract
AIM To develop and psychometrically test the Post Hip Replacement Comfort Scale (PHRCS). BACKGROUND Evaluation of the patient comfort after hip replacement surgery is highly important in order to increase the quality of patient care. The review of the relevant literature shows that a scale that specifically measures the patient comfort after hip replacement surgery is absent. DESIGN Methodological design was used. This study included the development of the scale and tested the psychometric properties of the scale. METHOD 180 patients who had been hip replacement surgery recruited from three education and research hospitals' orthopedic and trauma departments from January 2014 to December 2015. The study was conducted in three phases. In phase 1, scale items were developed based on the literature review and other comfort scales. In phase 2, the trial was applied with data collection forms. Phase 3 was conducted to evaluate the reliability and validity of the finalized inventory using item analysis. RESULTS The Cronbach's alpha coefficient value is 0.758. Test-retest results found positive and meaningful correlation between the scores of the scales, indicating the reliability of the scale. Scope, surface, criterion and construct validity analysis confirmed the validity of the scale. There were 26 items in the final scale. In our study, the average patient comfort score was 3.64±0.43 (from 1 to 5). CONCLUSION The PHRCS is recommended for evaluating patients' comfort after hip replacement surgery and examining the effects of nursing interventions on patients' comfort.
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Hoang A, Goodman SM, Navarro-Millán IY, Mandl LA, Figgie MP, Bostrom MP, Padgett DE, Sculco PK, McLawhorn AS, Singh JA. Patients and surgeons provide endorsement of core domains for total joint replacement clinical trials. Arthritis Res Ther 2017; 19:267. [PMID: 29208013 PMCID: PMC5718077 DOI: 10.1186/s13075-017-1476-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/16/2017] [Indexed: 01/06/2023] Open
Abstract
Background Our objective in this study was to examine whether stakeholders further endorse the core domain set proposed by the Outcome Measures in Rheumatology Trials (OMERACT) total joint replacement (TJR) working group. Methods We emailed a survey to 3810 hip/knee arthroplasty patients and 49 arthroplasty surgeons at a high-volume arthroplasty center to rate the importance of each core domain (i.e., pain, function, patient satisfaction, revision surgery, adverse events, and death) and two additional domains (i.e., cost and participation). Ratings were on a 1–9 scale, with 1–3 indicating limited or no importance for patients, 4–6 being important but not critical, and 7–9 being critical. We calculated median (IQR) values and compared ratings by sex, age, and participant type using the Wilcoxon rank-sum test. Results The questionnaire was completed by 1295 patients (34%) and 21 surgeons (43%). Patient nonresponders were similar to responders in age (≥55 years, 85.7% vs. 88.6%), sex (female, 57.5% vs. 57.3%), and joint procedure (total hip replacement, 56.9% vs. 63.2%). Overall, all core domains and one noncore domain (i.e., participation) were confirmed as “critical” by both stakeholder groups. Cost was rated as only “important” but not “critical” by surgeons. A completed consensus for all the core domains persisted even when we stratified by sex, age, arthritis type, and the affected joint (knee vs. hip). We received suggestions for additional critical domains from 217 patients and 5 surgeons, prompting the inclusion of 2 research agenda items. Conclusions Our study confirmed a consensus rating of the OMERACT TJR core domain set as critical for patients. This broad endorsement should encourage the identification of candidate outcome instruments to further develop a TJR core measurement set that can harmonize reporting in TJR clinical trials.
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Affiliation(s)
- Anh Hoang
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Susan M Goodman
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | | | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - Mark P Figgie
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mathias P Bostrom
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Douglas E Padgett
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Jasvinder A Singh
- Medicine Service, VA Medical Center, 510 20th Street South, Faculty Office Tower 805B, Birmingham, AL, USA. .,Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294-0022, USA. .,Division of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL, 35294-0022, USA. .,University of Alabama at Birmingham, Faculty Office Tower 805B, 510 20th Street South, Birmingham, AL, 35294, USA.
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Arden N, Altman D, Beard D, Carr A, Clarke N, Collins G, Cooper C, Culliford D, Delmestri A, Garden S, Griffin T, Javaid K, Judge A, Latham J, Mullee M, Murray D, Ogundimu E, Pinedo-Villanueva R, Price A, Prieto-Alhambra D, Raftery J. Lower limb arthroplasty: can we produce a tool to predict outcome and failure, and is it cost-effective? An epidemiological study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05120] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BackgroundAlthough hip and knee arthroplasties are considered to be common elective cost-effective operations, up to one-quarter of patients are not satisfied with the operation. A number of risk factors for implant failure are known, but little is known about the predictors of patient-reported outcomes.Objectives(1) Describe current and future needs for lower limb arthroplasties in the UK; (2) describe important risk factors for poor surgery outcomes and combine them to produce predictive tools (for hip and knee separately) for poor outcomes; (3) produce a Markov model to enable a detailed health economic analysis of hip/knee arthroplasty, and for implementing the predictive tool; and (4) test the practicality of the prediction tools in a pragmatic prospective cohort of lower limb arthroplasty.DesignThe programme was arranged into four work packages. The first three work packages used the data from large existing data sets such as Clinical Practice Research Datalink, Hospital Episode Statistics and the National Joint Registry. Work package 4 established a pragmatic cohort of lower limb arthroplasty to test the practicality of the predictive tools developed within the programme.ResultsThe estimated number of total knee replacements (TKRs) and total hip replacements (THRs) performed in the UK in 2015 was 85,019 and 72,418, respectively. Between 1991 and 2006, the estimated age-standardised rates (per 100,000 person-years) for a THR increased from 60.3 to 144.6 for women and from 35.8 to 88.6 for men. The rates for TKR increased from 42.5 to 138.7 for women and from 28.7 to 99.4 for men. The strongest predictors for poor outcomes were preoperative pain/function scores, deprivation, age, mental health score and radiographic variable pattern of joint space narrowing. We found a weak association between body mass index (BMI) and outcomes; however, increased BMI did increase the risk of revision surgery (a 5-kg/m2rise in BMI increased THR revision risk by 10.4% and TKR revision risk by 7.7%). We also confirmed that osteoarthritis (OA) severity and migration pattern of the hip predicted patient-reported outcome measures. The hip predictive tool that we developed performed well, with a correctedR2of 23.1% and had good calibration, with only slight overestimation of Oxford Hip Score in the lowest decile of outcome. The knee tool developed performed less well, with a correctedR2of 20.2%; however, it had good calibration. The analysis was restricted by the relatively limited number of variables available in the extant data sets, something that could be addressed in future studies. We found that the use of bisphosphonates reduced the risk of revision knee and hip surgery by 46%. Hormone replacement therapy reduced the risk by 38%, if used for at least 6 months postoperatively. We found that an increased risk of postoperative fracture was prevented by bisphosphonate use. This result, being observational in nature, will require confirmation in a randomised controlled trial. The Markov model distinguished between outcome categories following primary and revision procedures. The resulting outcome prediction tool for THR and TKR reduced the number and proportion of unsatisfactory outcomes after the operation, saving NHS resources in the process. The highest savings per quality-adjusted life-year (QALY) forgone were reported from the oldest patient subgroups (men and women aged ≥ 80 years), with a reported incremental cost-effectiveness ratio of around £1200 saved per QALY forgone for THRs. In the prospective cohort of arthroplasty, the performance of the knee model was modest (R2 = 0.14) and that of the hip model poor (R2 = 0.04). However, the addition of the radiographic OA variable improved the performance of the hip model (R2 = 0.125 vs. 0.110) and high-sensitivity C-reactive protein improved the performance of the knee model (R2 = 0.230 vs. 0.216). These data will ideally need replication in an external cohort of a similar design. The data are not necessarily applicable to other health systems or countries.ConclusionThe number of total hip and knee replacements will increase in the next decade. High BMI, although clinically insignificant, is associated with an increased risk of revision surgery and postoperative complications. Preoperative pain/function, the pattern of joint space narrowing, deprivation index and level of education were found to be the strongest predictors for THR. Bisphosphonates and hormone therapy proved to be beneficial for patients undergoing lower limb replacement. The addition of new predictors collected from the prospective cohort of arthroplasty slightly improved the performance of the predictive tools, suggesting that the potential improvements in both tools can be achieved using the plethora of extra variables from the validation cohort. Although currently it would not be cost-effective to implement the predictive tools in a health-care setting, we feel that the addition of extensive risk factors will improve the performances of the predictive tools as well as the Markov model, and will prove to be beneficial in terms of cost-effectiveness. Future analyses are under way and awaiting more promising provisional results.Future workFurther research should focus on defining and predicting the most important outcome to the patient.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Doug Altman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nicholas Clarke
- Developmental Origins of Health & Disease Division, University of Southampton, Southampton, UK
| | - Gary Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- Medical Research Council, Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - David Culliford
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stefanie Garden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tinatin Griffin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jeremy Latham
- Orthopaedic and Trauma Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Mullee
- Research & Development Support Unit, University of Southampton, Southampton, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Emmanuel Ogundimu
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - James Raftery
- Wessex Institute for Health Research and Development, University of Southampton, Southampton, UK
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Comparison of ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Hip Arthroplasty. J Arthroplasty 2016; 31:2795-2799.e1. [PMID: 27286909 DOI: 10.1016/j.arth.2016.05.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/16/2016] [Accepted: 05/03/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Use of antifibrinolytic agents in total hip arthroplasty (THA) is well supported; however, most studies used tranexamic acid (TXA), whereas few used ε-aminocaproic acid (EACA), a similar antifibrinolytic. This study compares the efficacy and cost per surgery of intraoperative infusion of EACA and TXA in reducing postoperative blood transfusion rates in THA. METHODS Retrospective chart review of 1799 primary unilateral THA cases from April 2012 through December 2014 at 5 hospitals within our health care network. RESULTS In our cohort, 711 received EACA, 445 received TXA, and 643 (control group) received no antifibrinolytic. Both antifibrinolytic groups had significantly fewer patients receiving red blood cell (RBC) transfusions when compared with control group (EACA 6.8% [P < .0001], TXA 9.7% [P < .0001] vs control group 24.7%). Average number of RBC units per patient were similar for EACA and TXA (0.11 units/patient and 0.15 units/patient, respectively), and both were significantly lower than the control group (0.48 units/patient, P < .0001). No significant difference was noted in mean RBC units per patient and percentage of patients transfused between EACA and TXA groups (P = .144, P = .074). Logistic regression showed no difference between EACA and TXA when adjusting for age, gender, higher severity of illness levels, admission hemoglobin, performing surgeon, and hospital. Medication acquisition cost for EACA averaged $2.70 per surgery compared with TXA at $39.58 per surgery. CONCLUSION Intraoperative antifibrinolytic use significantly decreases need for postoperative blood transfusions. At our institution, EACA is comparable to TXA in THA for reducing transfusion rates while at a lower cost per surgery.
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In pursuit of empirically supported assessment for use in medical settings. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Smith TO, Jepson P, Beswick A, Sands G, Drummond A, Davis ET, Sackley CM, Cochrane Musculoskeletal Group. Assistive devices, hip precautions, environmental modifications and training to prevent dislocation and improve function after hip arthroplasty. Cochrane Database Syst Rev 2016; 7:CD010815. [PMID: 27374001 PMCID: PMC6458012 DOI: 10.1002/14651858.cd010815.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most common orthopaedic operations performed worldwide. Painful osteoarthritis of the hip is the primary indication for THA. Following THA, people have conventionally been provided with equipment, such as raised toilet seats and chairs, and educated to avoid activities that could cause the hip joint to be in a position of flexion over 90 degrees, or adduction or rotation past the midline. These aspects of occupational therapy have been advocated to reduce the risks of prosthesis dislocation. However, the appropriateness of these recommendations has been questioned. OBJECTIVES To assess the effects of provision of assistive devices, education on hip precautions, environmental modifications and training in activities of daily living (ADL) and extended ADL (EADL) for people undergoing THA. SEARCH METHODS We searched MEDLINE (1946 to April 2016), EMBASE (1947 to April 2016), the Cochrane Library including CENTRAL (Issue 4 of 12, 2016), Database of Reviews of Effects (DARE), Health Technology Assessment (HTA), Economic Evaluations Database (EED), CINAHL, PEDro and CIRRIE from inception to April 2016. In addition we checked Controlled Clinical Trials, Clinicaltrials.gov, the National Institutes of Health Trial Registry, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and the OpenGrey database from inception to April 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs that evaluated the effectiveness of the provision of assistive devices, education on hip precautions, environmental modifications, or training in ADL and EADL for people undergoing THA. The main outcomes of interest were pain, function, health-related quality of life (HRQOL), global assessment of treatment success, reoperation rate, hip dislocation and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recognised by Cochrane. We conducted a systematic literature search using several databases and contacted corresponding authors, appraised the evidence using the Cochrane risk of bias tool, analysed the data using a narrative analysis approach (as it was not possible to conduct a meta-analysis due to heterogeneity in interventions), and interpreted all outcomes using the GRADE approach. MAIN RESULTS We included three trials with a total of 492 participants who had received 530 THA. The evidence presented with a high risk of performance, detection and reporting bias.One study (81 participants) compared outcomes for participants randomised to the provision of hip precautions, equipment and functional restrictions versus no provision of hip precautions, equipment or functional restrictions. Due to the quality of evidence being very low, we are uncertain if the provision of hip precautions, equipment and functional restrictions improved function measured using the Harris Hip Score at 12 month follow-up, or health-related quality of life (HRQOL) measured by the Short Form-12 at four week follow-up, compared to not providing this. There were no incidences of hip dislocation or adverse events in either group during the initial 12 postoperative months. The study did not measure pain score, global assessment of treatment success or total adverse events.One study (265 participants; 303 THAs) evaluated the provision of hip precautions with versus without the prescription of postoperative equipment and restrictions to functional activities. Due to the quality of evidence being very low, we are uncertain if perceived satisfaction in the rate of recovery differed in people who were not prescribed postoperative equipment and restrictions (135/151 satisfied) compared to those prescribed equipment and restrictions (113/152) (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.75 to 0.93; 265 participants, one trial; number needed to treat for an additional beneficial outcome (NNTB) = 7). Due to the low quality evidence, we are uncertain if the incidence of hip dislocation differed between participants provided with hip precautions with (1/152) compared to without providing equipment or restrictions post-THA (0/151) (RR 2.98, 95% CI 0.12 to 72.59). The study did not measure pain, function, HRQOL, re-operation rates or total adverse events.One study (146 participants) investigated the provision of an enhanced postoperative education and rehabilitation service on hospital discharge to promote functional ADL versus a conventional rehabilitation intervention in the community. This study was of very low quality evidence. We were uncertain if the provision of enhanced postoperative education and rehabilitation improved function at six months follow-up, when assessed using the Objective and Subjective Functional Capability Index (146 participants, one trial; P > 0.05; no numerical results provided) compared to conventional rehabilitation. The study did not measure pain score, HRQOL, global assessment of treatment success, hip dislocation, re-operation rate or total adverse events. AUTHORS' CONCLUSIONS Very low quality evidence is available from single trials, thus we are uncertain if hip precautions with or without the addition of equipment and functional restrictions are effective in preventing dislocation and improving outcomes after THA. There is also insufficient evidence to support or refute the adoption of a postoperative community rehabilitation programme consisting of functional reintegration and education compared to conventional rehabilitation strategies based on functional outcomes.Further high-quality trials are warranted to assess the outcomes of different occupational therapy interventions both in the short and longer-term for those who undergo THA. An assessment of the impact of such interventions on pain and restriction on personal ADL, EADL and instrumental ADL is needed, and also of functional integration-type interventions rather than just hip precautions, equipment and restrictions.
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Affiliation(s)
- Toby O Smith
- University of East AngliaFaculty of Medicine and Health SciencesQueen's BuildingNorwichNorfolkUKNR4 7TJ
| | - Paul Jepson
- University of BirminghamSchool of Sport, Exercise & Rehabilitation SciencesEdgbastonBirminghamUKB15 2TT
| | - Andrew Beswick
- University of BristolMusculoskeletal Research UnitAvon Orthopaedic CentreSouthmead HospitalBristolUKBS10 5NB
| | - Gina Sands
- University of NottinghamCLAHRC East Midlands, School of MedicineInstitute of Mental HealthUniversity of Nottingham Innovation Park, Jubilee CampusNottinghamNottinghamshireUKNG7 2TU
| | - Avril Drummond
- University of NottinghamFaculty of Medicine and Health SciencesQMC CampusNottinghamNG7 2HAUK
| | - Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation TrustBristol Road SoutBirminghamUKB312AP
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Guerrero-Ludueña RE, Comas M, Espallargues M, Coll M, Pons M, Sabatés S, Allepuz A, Castells X. Predicting the Burden of Revision Knee Arthroplasty: Simulation of a 20-Year Horizon. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:680-687. [PMID: 27565286 DOI: 10.1016/j.jval.2016.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 02/19/2016] [Accepted: 02/28/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To estimate future utilization scenarios for knee arthroplasty (KA) revision in the Spanish National Health System in the short- and long-term and their impact on primary KA utilization. METHODS A discrete-event simulation model was built to represent KA utilization for 20 years (2012-2031) in the Spanish National Health System. Data on KA utilization from 1997 to 2011 were obtained from the minimum data set. Three scenarios of future utilization of primary KA (1, fixed number since 2011; 2, fixed age- and sex-adjusted rates since 2011; and 3, projection using a linear regression model) were combined with two prosthesis survival functions (W [worse survival], from a study including primary KA from 1995 to 2000; and B [better survival], from the Catalan Registry of Arthroplasty, including primary KA from 2005 to 2013). The simulation results were analyzed in the short-term (2015) and the long-term (2030). RESULTS Variations in the number of revisions depended on both the primary utilization rate and the survival function applied, ranging from increases of 8.3% to 31.6% in the short- term and from 38.3% to 176.9% in the long-term, corresponding to scenarios 1-B and 3-W, respectively. The prediction of increases in overall surgeries ranged from 0.1% to 22.3% in the short-term and from 3.7% to 98.2% in the long-term. CONCLUSIONS Projections of the burden of KA provide a quantitative basis for future policy decisions on the concentration of high-complexity procedures, the number of orthopedic surgeons required to perform these procedures, and the resources needed.
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Affiliation(s)
- Richard E Guerrero-Ludueña
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Mercè Comas
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Health Services Research on Chronic Patients Network (Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC]), Barcelona, Spain.
| | - Mireia Espallargues
- Health Services Research on Chronic Patients Network (Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC]), Barcelona, Spain; Agency for Health Quality and Assessment of Catalonia (Agència de Qualitat i Avaluació Sanitàries de Catalunya [AQuAS]), Barcelona, Spain
| | - Moisès Coll
- Traumatology and Orthopaedic Surgery Department, Hospital de Mataró, Mataró, Spain
| | - Miquel Pons
- Traumatology and Orthopaedic Surgery Department, Hospital de Sant Rafael, Barcelona, Spain
| | - Santiago Sabatés
- Traumatology and Orthopaedic Surgery Department, Hospital Mútua de Terrassa, Terrassa, Spain
| | - Alejandro Allepuz
- Agency for Health Quality and Assessment of Catalonia (Agència de Qualitat i Avaluació Sanitàries de Catalunya [AQuAS]), Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Health Services Research on Chronic Patients Network (Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC]), Barcelona, Spain
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32
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The effect of isotonic saline on the strength of bone cement during the polymerisation period. Hip Int 2016; 21:238-42. [PMID: 21484740 DOI: 10.5301/hip.2011.6517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2011] [Indexed: 02/04/2023]
Abstract
It is common practice to irrigate the wound in hip and knee replacement surgery during the working and setting phases of cement polymerisation. We sought to establish whether the addition of normal saline during the various stages of polymerisation would affect bone cement strength. Cement specimens were moulded to the dimensions defined in ISO 5833: 2002 and tested in an electro-mechanical test machine with a calibrated 50 kN load cell at a compression rate of 24 mm/min. The results suggest that the compressive strength of bone cement is not affected by the presence of saline following the initiation of polymerisation. However, saline added to the mix prior to the initiation of polymerisation increased its porosity and significantly decreased its strength. This may explain why vacuum mixing is important as it removes water vapour.
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Ben Lulu O, Rubin G, Krasnyansky S, Elbaz A, Segal G, Rozen N. Measuring the Femoral Head Size--An Additional Real-Time Intraoperative Monitoring Tool for the Accuracy of the Preoperative Process and Implant Selection. J Arthroplasty 2015; 30:2201-3. [PMID: 26117069 DOI: 10.1016/j.arth.2015.05.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/17/2015] [Accepted: 05/25/2015] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to examine the correlation between the implanted cup's outer diameter and the actual femoral head diameter removed during surgery. Seventy-five patients with primary total hip arthroplasty were evaluated. The difference between the implanted cup diameter and the femoral head diameter was calculated for each patient. The mean±SD actual femoral head diameter that was removed and measured during surgery was 48.5±3.7 mm. The mean±SD cementless implanted cup outer diameter was 51.8±3.5 mm. A high correlation was found between the implanted cup diameter and the actual femoral head diameter (r=0.923). A cut-off point of 4mm of the measured femoral head diameter should be considered as an additional monitoring indicator.
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Affiliation(s)
- Oren Ben Lulu
- Department of Orthopedic Surgery, HaEmek Medical Center, Afula, Israel
| | - Guy Rubin
- Department of Orthopedic Surgery, HaEmek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
| | | | - Avi Elbaz
- AposTherapy Research Group, Herzliya, Israel
| | - Ganit Segal
- AposTherapy Research Group, Herzliya, Israel
| | - Nimrod Rozen
- Department of Orthopedic Surgery, HaEmek Medical Center, Afula, Israel; Faculty of Medicine, Technion, Haifa, Israel
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Pengas IP, Khan WS, Bennett CA, Rankin KS. Impact of Weekend Physiotherapy Service on the Cost Effectiveness of Elective Orthopaedic Hip and Knee Arthroplasty. Open Orthop J 2015; 9:515-9. [PMID: 26587071 PMCID: PMC4645972 DOI: 10.2174/1874325001509010515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/31/2015] [Accepted: 06/01/2015] [Indexed: 12/03/2022] Open
Abstract
We performed a prospective correlational study to evaluate the efficiency and cost effectiveness of weekend
physiotherapy in accelerating rehabilitation, reducing hospital stay as well as hospital costs for joint arthroplasty patients
in a busy Scottish district general hospital. Patients that underwent elective hip (470) and knee (321) arthroplasty were
analysed over a 12 month period. A four month period with weekend physiotherapy provision was arranged to ascertain
its effectiveness on the length of stay and the achievement of set physiotherapy milestones. Data collected included length
of stay and progression in a defined set of physiotherapy milestones. The relationship between time to discharge,
mobilisation with sticks, straight leg raise, 90º knee flexion and cost effectiveness of service were used to determine the
correlation, and analysis of the interactions of these factors separately. Our Outcome data demonstrate a statistical
significance for the time to mobilisation with two sticks for hip (p=0.0030) and knee (p= 0.0037) arthroplasty patients.
There was a trend towards earlier discharge times for all patients receiving weekend physiotherapy, but this was not
statistically significant. We conclude that the provision of a continuous programme of weekend physiotherapy for all
arthroplasty patients has the potential benefit of a quicker rehabilitation that would results in a cost saving.
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Affiliation(s)
- I P Pengas
- Department of Orthopaedics, Perth Royal Infirmary, Perth, Scotland PH1 1NX, UK
| | - W S Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London HA7 4LP, UK
| | - C A Bennett
- Department of Physiotherapy, Perth Royal Infirmary, Perth, Scotland PH1 1NX, UK
| | - K S Rankin
- Department of Orthopaedics, Perth Royal Infirmary, Perth, Scotland PH1 1NX, UK
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Culliford D, Maskell J, Judge A, Cooper C, Prieto-Alhambra D, Arden NK. Future projections of total hip and knee arthroplasty in the UK: results from the UK Clinical Practice Research Datalink. Osteoarthritis Cartilage 2015; 23:594-600. [PMID: 25579802 DOI: 10.1016/j.joca.2014.12.022] [Citation(s) in RCA: 353] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 11/13/2014] [Accepted: 12/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the future rate of primary total hip (THR) or knee (TKR) replacement in the UK to 2035 allowing for changes in population demographics and obesity. DESIGN Using age/gender/body mass index (BMI)-specific incidence rates from a population-based cohort study of 50,000 THR and 45,609 TKR patients from the UK Clinical Practice Research Datalink (CPRD) between 1991 and 2010, we projected future numbers of THR and TKR using two models: a static, estimated rate from 2010 applied to population growth forecasts to 2035, and a log-linear rate extrapolation over the same period. Both scenarios used population forecast data from the UK Office for National Statistics (ONS). RESULTS Assuming rates of THR and TKR for 2010, and given projected population changes in age, gender and BMI, the number of THRs and TKRs performed in the UK in 2035 is estimated to be, respectively: 95,877 and 118,666. By comparison, an exponential extrapolation of historical rates using a log-linear model produces much higher estimates of THR and TKR counts in 2035 at 439,097 and 1,219,362 respectively. Projected counts were higher for women than men. Assuming a changing (rather than fixed) future BMI distribution increases TKRs by 2035 but not THRs. CONCLUSIONS Using historical rates and population forecasts we have projected the number of THR/TKR operations in the UK up to 2035. This study will inform policymakers requiring estimates of future demand for surgery. Incorporating future forecasts for BMI into projections of joint replacement may be more relevant for TKR rather than THR.
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Affiliation(s)
- D Culliford
- Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - J Maskell
- Public Health Sciences and Medical Statistics, Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - A Judge
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, SO16 6YB, UK
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, SO16 6YB, UK
| | - D Prieto-Alhambra
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, SO16 6YB, UK; GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Spain
| | - N K Arden
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, SO16 6YB, UK.
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Singh JA, Dohm M, Sprowson AP, Wall PD, Richards BL, Gossec L, Hawker GA, Riddle DL, Buchbinder R. Outcome Domains and Measures in Total Joint Replacement Clinical Trials: Can We Harmonize Them? An OMERACT Collaborative Initiative. J Rheumatol 2015; 42:2496-502. [DOI: 10.3899/jrheum.141201] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective.To develop a plan for harmonizing outcomes for people undergoing total joint replacement (TJR), to achieve consensus regarding TJR outcome research.Methods.The TJR working group met during the 2014 Outcome Measures in Rheumatology (OMERACT) 12 meeting in Budapest, Hungary. Multiple conference calls preceded the face-to-face meeting. Brief presentations were made during a 1.5-h meeting, which included an overview of published systematic reviews of TJR trials and the results of a recent systematic review of TJR clinical trial outcome domains and measures. This was followed by discussion of potential core set areas/domains for TJR clinical trials (as per OMERACT Filter 2.0) as well as the challenges associated with the measurement of these domains.Results.Working group participants discussed which TJR clinical trial outcome domains/areas map to the inner versus outer core for core domain set. Several challenges were identified with TJR outcomes including how to best measure function after TJR, elucidating the source of the pre- and post-TJR joint pain being measured, joint-specific versus generic quality of life instruments and the importance of patient satisfaction and revision surgery as outcomes. A preliminary core domain set for TJR clinical trials was proposed and included pain, function, patient satisfaction, revision, adverse events, and death. This core domain set will be further vetted with a broader audience.Conclusion.An international effort with active collaboration with the orthopedic community to standardize key outcome domains and measures is under way with the TJR working group. This effort will be further developed with new collaborations.
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Balck F, Lippmann M, Jeszenszky C, Günther KP, Kirschner S. The influence of optimism on functionality after total hip replacement surgery. J Health Psychol 2015; 21:1758-67. [PMID: 25609405 DOI: 10.1177/1359105314566256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery.
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Affiliation(s)
- Friedrich Balck
- Medical Psychology and Medical Sociology, University Hospital Dresden, Germany
| | - Maike Lippmann
- Medical Psychology and Medical Sociology, University Hospital Dresden, Germany
| | - Csilla Jeszenszky
- Medical Psychology and Medical Sociology, University Hospital Dresden, Germany
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Primary and revision THA using a stemless metaphyseal-loading implant above distorted proximal femoral anatomy. Hip Int 2014; 23:40-5. [PMID: 23250719 DOI: 10.5301/hip.2012.10425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 02/04/2023]
Abstract
Total hip arthroplasty is well established as a successful treatment for end stage arthritis, with a wide variety of components currently available. Using traditional stemmed implants in patients with a distorted proximal femur can be technically challenging with an increased risk of complications. We present seven patients with distorted proximal femoral anatomy or failed hip arthroplasty in whom a short, metaphyseal loading implant was utilised. At minimum two-year follow-up there have been no complications with all stems stable and well fixed radiologically. Average improvement in Oxford Hip Score is 32. We suggest that a short, metaphyseal loading prosthesis can be considered in cases where a conventional stemmed implant may not be suitable due to challenging proximal femoral anatomy.
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Elings J, Hoogeboom TJ, van der Sluis G, van Meeteren NLU. What preoperative patient-related factors predict inpatient recovery of physical functioning and length of stay after total hip arthroplasty? A systematic review. Clin Rehabil 2014; 29:477-92. [DOI: 10.1177/0269215514545349] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/05/2014] [Indexed: 02/03/2023]
Abstract
Objective: To identify the preoperative patient-related characteristics predicting inpatient recovery of functioning and/or length of hospital stay after elective primary total hip arthroplasty. Design: A search was conducted of the electronic databases MEDLINE, EMBASE and CINAHL from inception through April 2014. Observational studies were selected for systematic review if they identified clinically relevant preoperative prognostic factors and reported an association between inpatient recovery of physical functioning and/or length of hospital stay. Study participants were adults undergoing an elective primary total hip arthroplasty. Results: Fourteen studies were included, a total of 199,410 individual total hip arthroplasty procedures. Two studies investigated inpatient recovery of physical functioning, no strong level of evidence was found for a relationship between functional recovery and any of the preoperative predictors. Twelve studies investigated the length of hospital stay and reported 19 preoperative prognostic factors. A strong level of evidence suggested that higher scores on the American Society of Anaesthesiologists assessment (OR 3.34 to 6.22, +0.20 days), increased number of comorbidities (RR of 1.10, +0.59 to 1.61 days), presence of heart disease, (RR of 1.59, +0.26 days), and presence of lung disease (RR of 1.30, +0.34 days) were associated with longer lengths of hospital stay following total hip arthroplasty. Conclusion: For the prediction of inpatient recovery of physical functioning no factors with a strong level of evidence were found. For length of stay there was a strong level of evidence for the American Society of Anaesthesiologists score, number of comorbidities, and presence of heart or lung disease.
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Affiliation(s)
- J Elings
- Department of Physical Therapy, Diakonessenhuis Hospital, Utrecht, the Netherlands
- Department of Epidemiology, Maastricht University Medical Centre, the Netherlands
| | - TJ Hoogeboom
- Department of Epidemiology, Maastricht University Medical Centre, the Netherlands
- Centre for Care Technology Research (CCTR), Maastricht, the Netherlands
| | - G van der Sluis
- Department of Epidemiology, Maastricht University Medical Centre, the Netherlands
- Department of Physical Therapy, Nij Smellinghe, Drachten, the Netherlands
| | - NLU van Meeteren
- Department of Epidemiology, Maastricht University Medical Centre, the Netherlands
- Centre for Care Technology Research (CCTR), Maastricht, the Netherlands
- TNO Healthy Living, Leiden, the Netherlands
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Starks I, Wainwright TW, Lewis J, Lloyd J, Middleton RG. Older patients have the most to gain from orthopaedic enhanced recovery programmes. Age Ageing 2014; 43:642-8. [PMID: 24627354 DOI: 10.1093/ageing/afu014] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Between August 2007 and May 2009, 2128 consecutive patients underwent either primary hip or knee joint replacement surgery at our institute on an enhanced recovery pathway. We aimed to investigate the potential benefits of this pathway in patients over the age of 85 years. METHODS Data extracted from Hospital Episode Statistics were analysed. This data are prospectively collected and independently collated. RESULTS In all patients median length of stay was reduced when compared with both our own data before the introduction of the pathway (6 to 4 days) and national averages over the same time period for both hip and knee replacements (5 to 4 days). Difference in length of stay was most pronounced in the group of patients aged 85 years and over (9 to 5 days for total hip replacement and 8 to 5 days for total knee replacement). Nearly all patients were discharged directly home (97.4%). Readmission rates were over 45% lower in patients aged 85 and over when compared with national averages (5.2 vs. 9.4%). CONCLUSIONS This is the first series in the literature to assess the role of enhanced recovery pathways in the very elderly. This study not only shows that successful fast track rehabilitation can be achieved in the very elderly population undergoing elective joint replacement surgery, but that it is this cohort of vulnerable patients who have the most to gain from such multidisciplinary recovery programmes.
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Affiliation(s)
- Ian Starks
- Orthopaedic Department, Wrexham Maelor Hospital, Wrexham, UK
| | - Thomas W Wainwright
- Orthopaedic Department, The Royal Bournemouth Hospital, Bournemouth, UK Centre of Postgraduate Medicine, Research and Education, The School of Health and Social Care, Bournemouth University, Bournemouth, UK
| | - Jenny Lewis
- Lead Research Analyst at Dr Foster Intelligence London, UK
| | - John Lloyd
- Orthopaedic Department, The Royal Bournemouth Hospital, Bournemouth, UK
| | - Robert G Middleton
- Orthopaedic Department, The Royal Bournemouth Hospital, Bournemouth, UK Centre of Postgraduate Medicine, Research and Education, The School of Health and Social Care, Bournemouth University, Bournemouth, UK
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Abstract
In this systematic review, our aim was to explore whether or not patients are able to return to athletic activity following lower limb joint replacement. We also investigated any evidence as to whether participation in athletic activity post-joint replacement increases complications and reduces implant survival. A PubMed, Embase and Sports Discus search was performed using the MeSH terms ‘Sport’, ‘Athletic’, ‘Athlete’, ‘Physical’, ‘Activity’, ‘Arthroplasty’, ‘Total Hip Replacement’, ‘Hip Resurfacing’, ‘Total Knee Replacement’, ‘Unicompartmental Knee Replacement’ and ‘Unicondylar Knee Replacement’. From this search, duplications were excluded, the remaining abstracts were reviewed and any unrelated to the search terms were excluded. The remaining abstracts had their full papers reviewed. Following joint replacement, participation in sporting activity is common principally determined by pre-operative patient activity levels, BMI and patient age. The type of joint replaced is of less significance. Total time spent performing activity does not change but tends to be at a lower intensity. There is little evidence in the literature of an association between high activity levels and early implant failure. Cite this article: Bone Joint J 2014;96-B:923–7.
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Affiliation(s)
- S. S. Jassim
- University College London Hospital, 235
Euston Road, London, NW1
2BU, UK
| | - S. L. Douglas
- University College London Hospital, 235
Euston Road, London, NW1
2BU, UK
| | - F. S. Haddad
- University College London Hospital, 235
Euston Road, London, NW1
2BU, UK
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Herrero-Sánchez MD, García-Iñigo MDC, Nuño-Beato-Redondo BS, Fernández-de-las-Peñas C, Alburquerque-Sendín F. Association between ongoing pain intensity, health-related quality of life, disability and quality of sleep in elderly people with total knee arthroplasty. CIENCIA & SAUDE COLETIVA 2014; 19:1881-8. [DOI: 10.1590/1413-81232014196.04632013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 04/28/2013] [Indexed: 01/02/2023] Open
Abstract
The scope of this paper was to study the relationship between pain intensity, health-related quality of life, disability, sleep quality and demographic data in elderly people with total knee arthroplasty (TKA). 24 subjects who had been subjected to TKA the previous month (4 females; 66 ± 9years) and 21 comparable controls (8 male; 70 ± 9years) participated in the study. Intensity of pain, and highest and lowest pain intensity experienced in the preceding week were collected. The Western Ontario and McMaster Universities index function, quality of life (Medical Outcomes Study Short Form 36), and Pittsburgh Sleep Quality Index were assessed. Age, gender, weight, height, body mass index were also collected. Individuals with TKA presented worse physical function (P < 0.01), social role (P = 0.01), physical performance (P < 0.01), pain (P = 0.04), disability (P = 0.04) and sleep quality (P = 0.03) than the controls. Higher intensity of pain was associated with lower physical function, social role, mental health, vitality and general health, and with higher disability and sleep quality. Disability and sleep quality were negatively associated with several quality of life domains. The associations between the intensity of pain, disability, quality of life and sleep reveal the multidimensional experience of TKA.
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Yoon PW, Lee YK, Ahn J, Jang EJ, Kim Y, Kwak HS, Yoon KS, Kim HJ, Yoo JJ. Epidemiology of hip replacements in Korea from 2007 to 2011. J Korean Med Sci 2014; 29:852-8. [PMID: 24932089 PMCID: PMC4055821 DOI: 10.3346/jkms.2014.29.6.852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/10/2014] [Indexed: 11/20/2022] Open
Abstract
We analyzed national data collected by the Health Insurance Review and Assessment Service in Korea from 2007 to 2011; 1) to document procedural numbers and procedural rate of bipolar hemiarthroplasty (BH), primary and revision total hip arthroplasties (THAs), 2) to stratify the prevalence of each procedure by age, gender, and hospital type, and quantified, 3) to estimate the revision burden and evaluate whether the burden is changed over time. Our final study population included 60,230 BHs, 40,760 primary THAs, and 10,341 revision THAs. From 2007 to 2011, both the number and the rate of BHs, primary THAs increased steadily, whereas there was no significant change in revision THAs. Over the 5 yr, the rate of BHs and primary THAs per 100,000 persons significantly increased by 33.2% and 21.4%, respectively. The number of revision THAs was consistent over time. The overall annual revision burden for THA decreased from 22.1% in 2007 to 18.9% in 2011. In contrast to western data, there were no changes in the number and rate of revision THAs, and the rates of primary and revision THAs were higher for men than those for women. Although 5 yr is a short time to determine a change in the revision burden, there have been significant decreases in some age groups.
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Affiliation(s)
- Pil Whan Yoon
- Department of Orthopedic Surgery, Asan Medical Center, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeonghoon Ahn
- Office of Health Services Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Eun Jin Jang
- Office of Health Services Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of Information Statistics, Andong National University, Andong, Korea
| | - Yunjung Kim
- Office of Health Services Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Hong Suk Kwak
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Joong Kim
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Seoul National University, Seoul, Korea
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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Chang CH, Chang Y, Chen DW, Ueng SWN, Lee MS. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty. Clin Orthop Relat Res 2014; 472:1552-7. [PMID: 24385043 PMCID: PMC3971210 DOI: 10.1007/s11999-013-3446-0] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/20/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Systemic tranexamic acid can decrease blood loss and rates of transfusion in patients undergoing total hip arthroplasty (THA). However, the efficacy of topical tranexamic acid in THA has only recently been characterized in a small number of studies. QUESTIONS/PURPOSES The purpose of this study was to compare (1) the greatest hemoglobin decrease after surgery; (2) transfusion rates; and (3) symptomatic thromboembolic events among patients undergoing THA who did and did not receive topical tranexamic acid. METHODS We retrospectively compared 135 patients (154 THAs) who received 10 mL 5% tranexamic acid added in a topical cocktail solution during surgery between January 2009 and July 2011 with 211 patients (234 THAs) who received only the topical cocktail solution (analgesic and antibiotic agent) between January 2005 and December 2008. Contraindications for the use of tranexamic acid included a documented history of a venous thromboembolic event, an allergy to tranexamic acid, thrombophilia, or a high risk of venous thromboembolism based on the guidelines of the American Academy of Orthopaedic Surgeons; the 135 patients who received it during that period represented 99.4% of the patients undergoing THA during that time. We compared changes in Hb, transfusion rates, estimated blood loss, surgical results, and complications between the groups. The transfusion threshold was the same, when the Hb values were < 10 g/dL. Patients were screened for thromboembolic disease if symptoms or signs appeared. RESULTS Hb decreased less in the tranexamic acid group (1.87 ± 1.10 g/dL) than in the control group (2.2 ± 1.36 g/dL; p = 0.01) on the first postoperative day. The frequency of transfusion was lower in patients receiving tranexamic acid (17% as compared with 35% in the control group; p < 0.001). There was only one nonfatal pulmonary embolism in the control group during the study period. CONCLUSIONS Use of topical tranexamic acid in patients undergoing THA reduces postoperative bleeding and decreases blood transfusion rates. No increase in major complications was identified in patients managed with topical tranexamic acid. This retrospective study confirms the results of a smaller randomized trial on the same topic by another group. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chih-Hsiang Chang
- />Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan , />College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuhan Chang
- />Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan , />College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Dave W. Chen
- />Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan , />College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Steve W. N. Ueng
- />Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan , />College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mel S. Lee
- />Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsin Street, Kweishan, Taoyuan, Taiwan , />College of Medicine, Chang Gung University, Taoyuan, Taiwan , />Department of Orthopaedic Surgery, Chia-Yi Chang Gung Memorial Hospital, 6, W. Sec., Jiapu Road, Puzi, Chiayi, Taiwan
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Jordan M, Hofmann UK, Grünwald J, Meyer M, Sachsenmaier S, Wülker N, Kluba T, Ipach I. Influence of left- and right-side total hip arthroplasty on the ability to perform an emergency stop while driving a car. Arch Phys Med Rehabil 2014; 95:1702-9. [PMID: 24685390 DOI: 10.1016/j.apmr.2014.03.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/11/2014] [Accepted: 03/11/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To show the possible effect of left- and right-side total hip arthroplasty (THA) on the ability to perform an emergency stop when driving a car. DESIGN Inception cohort. SETTING A driving simulator using an actual car cabin, specifically developed for the experiment, was used for testing driving ability. PARTICIPANTS Patients (N=40; 20 left-side THA/20 right-side THA) were tested preoperatively and in increments of 8 days and 6, 12, and 52 weeks after surgery. INTERVENTIONS Left- and right-side THA. MAIN OUTCOME MEASURES Reaction time, movement time, total brake response time (TBRT), and maximum brake force. RESULTS Eight days postoperatively, measurements on driving performance indicated a slight worsening for all outcome parameters in patients after left-side THA and considerably more worsening in patients after right-side THA. For both patient groups, significant improvements in outcome measures were noted during the 1-year follow-up. Brake force declined significantly in patients with left-side THA (P=.012) and in patients after right-side THA (P<.001). A total of 35% of the patients with right-side THA and 15% with left-side THA could not meet the 600 ms TBRT threshold 6 weeks postoperatively. CONCLUSIONS Most patients who underwent right-side THA reached their preoperative baseline 6 weeks after surgery. Most of the patients with left-side THA showed no TBRT limitations 8 days postoperatively. Because of the patients' highly individual rehabilitation course and considering the possible consequences of the premature resumption of driving a motor vehicle, individual examination and recommendation are necessary.
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Affiliation(s)
- Maurice Jordan
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Julia Grünwald
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Morten Meyer
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Saskia Sachsenmaier
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Nikolaus Wülker
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Torsten Kluba
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Ingmar Ipach
- Department of Orthopedic Surgery, University Hospital of Tuebingen, Tuebingen, Germany; Department of Orthopedic Surgery, Hospital of Ingolstadt, Ingolstadt, Germany.
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Total hip replacement: a systematic review and meta-analysis on mid-term quality of life. Osteoarthritis Cartilage 2014; 22:389-406. [PMID: 24389057 DOI: 10.1016/j.joca.2013.12.006] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Total hip replacement (THR) is one of the most successful and frequently performed operations worldwide. Health-related quality of life (HRQOL) is a key outcome measure of surgery. We investigated mid-term HRQOL after THR in patients with osteoarthritis (OA). DESIGN A systematic review of clinical studies published after January 2000 was performed using strict eligibility criteria. Quality appraisal and data tabulation were performed using pre-determined forms. Data were synthesised by narrative review and random-effects meta-analysis using standardised response means. Tau(2) and I(2) values and Funnel plots were analysed. RESULTS 20 studies were included. Mid-term post-operative HRQOL is superior compared to pre-operative status on qualitative and quantitative analysis. Pooled response means of total Harris Hip Score (HHS) (P < 0.00001) and combined pain (P = 0.00001) and physical function (P < 0.00001) domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and HHS improved markedly up to 7 years. Medical Outcomes Survey Short Form 36 shows physical functioning (PF) (P < 0.00001), bodily pain (BP) (P < 0.00001), role physical (P = 0.001), role emotional (P = 0.04), and social functioning (SF) (P = 0.03) were improved up to 7 years. General health (GH) (P = 0.29), mental health (MH) (P = 0.43), and vitality (P = 0.17) was similar. HRQOL is at least as good as reference populations in the first few years and subsequently plateaus or declines. Patient satisfaction and functional status was favourable. There was significant heterogeneity amongst all studies, but publication bias was low in pooled analysis. CONCLUSION THR confers significant mid-term HRQOL benefits across a broad range of health domains. Further studies based on consistent guidelines provided in this review are required.
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Assmann G, Kasch R, Hofer A, Schulz AP, Kayser R, Lahm A, Merk H, Flessa S. An economic analysis of aseptic revision hip arthroplasty: calculation of partial hospital costs in relation to reimbursement. Arch Orthop Trauma Surg 2014; 134:413-20. [PMID: 24477287 DOI: 10.1007/s00402-014-1920-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Aseptic loosening is one of the most common intermediate and long-term complications after total hip replacement (THR). These complications cause suffering and require expensive revision surgery. Little concrete data on direct costs are available from the hospital's, moreover operating department's perspective. We here provide a detailed analysis of the costs of THR revision and relate them to reimbursement underlying the German diagnosis-related groups (DRG) system. MATERIALS AND METHODS Major cost parameters were identified using for orientation the cost matrix of the German Institute for Hospital Reimbursement (InEK GmbH). We then retrospectively analysed the major direct costs of aseptic revision THR in terms of contribution margins I and II. The analysis included a total of 114 patients who underwent aseptic revision from 1 January 2009 to 31 March 2012. Data were retrieved from the hospital information system and patient records. All costs of surgery, diagnostic tests, and other treatments were calculated as purchase prices in EUR. The comparative analysis of direct costs and reimbursements was done for DRG I46A and I46B from the hospital's, especially treating department's rather than the society or healthcare insurance's perspective. RESULTS The average direct cost incurred by the hospital for a THR revision was <euro>4,380.0. The largest share was accounted for surgical costs (62.7 % of total). Implant and staff costs were identified as the most important factors that can be influenced. The proportion of the daily contribution margin that was left to cover the hospital's indirect cost decreased with the relative cost weight of the DRG to which a patient was assigned. CONCLUSION Our study for the first time provides a detailed analysis of the major direct case costs of THR revision for aseptic loosening from the provider's perspective. Our findings suggest that these revision operations could be performed cost-beneficially by the operating unit. From an economic perspective, cases with higher cost weights are more favorable for a hospital. These results need to be confirmed in multicenter studies.
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Affiliation(s)
- G Assmann
- Department of Health Care Management, Faculty of Law and Economics, Ernst-Moritz-Arndt-University, Friedrich-Loeffler-Straße 70, 17487, Greifswald, Germany,
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Kirkwood G, Pollock AM, Howie C, Wild S. NHS Scotland reduces the postcode lottery for hip arthroplasty: an ecological study of the impact of waiting time initiatives. J R Soc Med 2014; 107:237-245. [PMID: 24566936 DOI: 10.1177/0141076814523950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Following the election of the Labour government in 1997, policies were developed in England to reduce waiting times for NHS treatment with commitments to reduce health inequalities. Similar policies were adopted in Scotland but with less emphasis on the use of the private sector to deliver NHS treatments than in England. This study uses routinely collected NHS Scotland data to analyse geographical and socioeconomic inequalities in elective hip arthroplasty treatment before and after the introduction of the waiting time initiatives in Scotland in 2003. DESIGN Ecological study design. SETTING Scotland. PARTICIPANTS NHS-funded patients receiving elective hip arthroplasty delivered by the NHS and private hospitals between 1 April 1998 and 31 March 2008. MAIN OUTCOME MEASURES Directly standardised treatment rates and incidence rate ratios calculated using Poisson regression. RESULTS There was a 42% increase in NHS-funded hip arthroplasties carried out in Scotland from 4095 in 2002-2003 (1 April 2002-31 March 2003) to 5829 in 2007-2008. There is evidence of a statistically significant reduction in geographical inequality (likelihood ratio test p < 0.001) but no evidence of any statistically significant change in socioeconomic inequality (p = 0.108), comparing the 5 years after 1 April 2003 with the 5 years before 1 April 2003. The number of NHS-funded hip arthroplasties undertaken privately rose from 1.1% in 2002-2003 to 2.9% in 2007-2008, whereas the NHS Golden Jubilee National Hospital increased its share from 3.3% to 10.6% over the same period. CONCLUSIONS The reduction in geographical inequality, or 'postcode lottery', in hip arthroplasty treatment in Scotland may be due to increased NHS capacity, in particular the development of the NHS Golden Jubilee National Hospital in Clydebank, Greater Glasgow as a dedicated centre to reduce surgery waiting times.
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Affiliation(s)
- Graham Kirkwood
- Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 2AB, UK
| | - Allyson M Pollock
- Centre for Primary Care and Public Health, Queen Mary, University of London, London E1 2AB, UK
| | - Colin Howie
- Lothian University Hospitals NHS Trust, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Sarah Wild
- Centre for Population Health Sciences, University of Edinburgh, Medical School, Edinburgh EH8 9AG, UK
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Lenza M, Ferraz SDB, Viola DCM, Garcia Filho RJ, Cendoroglo Neto M, Ferretti M. Epidemiology of total hip and knee replacement: a cross-sectional study. EINSTEIN-SAO PAULO 2014; 11:197-202. [PMID: 23843061 PMCID: PMC4872894 DOI: 10.1590/s1679-45082013000200011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 01/31/2013] [Indexed: 01/21/2023] Open
Abstract
Objective: To describe the epidemiologic characteristics and adverse events of patients submitted to total hip and total knee replacement. Methods: A cross-sectional study retrospectively assessing medical chart data of all total hip and total knee replacements performed at a private hospital, between January 2007 and December 2010 Patients submitted to total hip and total knee replacement, with consent of surgeons were included. Incomplete records and/or missing data of the hospital database were excluded. The categorical variables analyzed were age, gender, type of arthroplasty (primary or secondary), type of procedure, duration of surgery, use of drains, risk of infection, compliance to protocol for prevention of deep venous thrombosis and embolism pulmonary, and compliance to the protocol for prevention of infection. The outcomes assessed were adverse events after surgery. Results: A total of 510 patients were included; in that, 166 admissions for knee replacements (92 male) and 344 admissions for hip replacements (176 female). The mean age of patients was 71 years (range 31-99 years). Adverse events were reported in 76 patients (14.9%); there was no correlation between assessed variables and number of complications. Conclusion: The results showed no individual factors favoring complications in patients submitted to total hip and total knee replacement; hence, surgeons should consider prophylaxis to avoid complications.
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