Perioperative blood loss leading to blood transfusion continues to be an issue for total knee arthroplasty (TKA) patients. The US Nationwide Inpatient Sample (NIS) was used to determine annual trends in allogenic blood transfusion rates, and effects of transfusion on in-hospital mortality, length of stay (LOS), costs, discharge disposition, and complications of primary TKA patients. TKA patients between 2000 and 2009 were included (n=4,544,999) and categorized as: (1) those who received a transfusion of allogenic blood, and (2) those who did not. Transfusion rates increased from 7.7% to 12.2%. For both transfused and not transfused groups, mortality rates and mean LOS declined, while total costs increased. Transfused patients were associated with adjusted odds ratios of in-hospital mortality (AOR 1.16; p = 0.184), 0.71 ± 0.01 days longer LOS (p < 0.0001), and incurred ($1,777 ± 36; p < 0.0001) higher total costs per admission.
A recent development to better recreate joint kinematics has been a change from a multiradius (MR) design to a single radius (SR) design. We analyzed 559 primary total knee arthroplasty (TKA) procedures which used either a SR (n?=?426 Triathlon?; Stryker Orthopaedics, Mahwah, NJ) or MR of curvature knee system (n?=?133 Duracon?; Stryker Orthopaedics, Mahwah, NJ) (79.3% follow-up; 705 total TKA procedures identified). Patients were administered a modification of the Knee Society score (KSS) (3.9 years average follow-up). The SR design showed improvements over the MR design in pain (p?=?0.021), stability (p?=?0.002), flexion (p?=?0.006), ability to completely straighten the knee (p?=?0.025), stair climbing (p?=?0.0001), walking (p?=?0.0001), use of assistive devices (p?=?0.0005), postoperative knee score (p?=?0.0005), and postoperative function (p?0.0001). Analysis of the change in KSS knee (p?=?0.002) and function scores (p?=?0.002) from preoperative visit to postoperative follow-up favored the SR design as well. These data support the use of SR implants and provide evidence of improved outcomes in terms of function, stability, and pain.
Background As the prevalence of and life expectancy after solid organ transplantation increases, some of these patients will require total hip arthroplasty (THA). Immunosuppressive therapy, metabolic disorders, and post-transplant medications may place transplant patients at higher risk of adverse events following surgery. The objective of this study was to compare inpatient complications, mortality, length of stay (LOS), and costs for THA patients with and without solid organ transplant history. Methods A retrospective cross-sectional analysis was conducted using 1998-2011 Nationwide Inpatient Sample. Primary THA patients were queried (n=3,175,456). After exclusions, remaining patients were assigned to transplant (n=7,558) or non-transplant groups (n=2,772,943). After propensity score matching, adjusted for patient and hospital characteristics, logistic regression and paired t-tests examined the effect of transplant history on outcomes. Results Between 1998 and 2011, THA volume among transplant patients grew approximately 48%. The overall prevalence of one or more complications following THA was greater in the transplant group than in the non-transplant group (32.0% vs. 22.1%; p<0.001). In-hospital mortality was minimal, with comparable rates (0.1%) in both groups (p=0.93). Unadjusted trends show that transplant patients have greater annual and overall mean LOS (4.47 days) and mean admission costs ($18,402) than non-transplant patients (3.73 days; $16,899; p<0.001). After propensity score matching, transplant history was associated with increased complication risk (odds ratio, 1.56;) after THA, longer hospital LOS (+0.64 days; p<0.001), and increased admission costs (+$887; p=0.005). Conclusions Transplant patients exhibited increased odds of inpatient complications, longer LOS, and greater admission costs after THA compared with non-transplant patients.
The activity demands of young patients undergoing total hip arthroplasty (THA) have not been clearly defined. University of California Los Angeles (UCLA) activity score, Hip disability and Osteoarthritis Outcome Score (HOOS), Short Form-12 version 2 (SF-12v2), and Functional Comorbidity Index (FCI) questionnaires were administered to 70 young patients who had undergone THA (young THA group; ie, ≤30 years old), 158 general patients who had undergone THA (general THA group; ie, ≥31 years old), and 106 young, comorbidity-matched patients who had not undergone arthroplasty and had no significant hip disease (nonarthroplasty group). Mean postoperative UCLA activity scores were similar among groups (young THA group, 6.5; general THA group, 6.4; nonarthroplasty group, 6.6) before and after adjustment for comorbidity, sex, and race (P=.62 and P=.47, respectively). Adjusted analyses also found a negative association between postoperative activity and increases in comorbidity and female sex (P<.001). Patients in the young THA group reported higher expectations of postoperative activity (7.7) than those in the general THA group (7.1; P=.02). Postoperative HOOS results showed greater hip symptoms (P=.003) and poorer hip-related quality of life (P<.001) in the young THA group. Patient groups had similar postoperative SF-12v2 physical health scores (P=.31), although mental health scores were significantly higher in the general THA group (P<.001). The interesting finding of lower postoperative expectations, greater hip-related quality of life, and better mental health scores in the general THA group may indicate a need for better management of expectations in young patients undergoing THA, including a discussion of realistic gains in activity and potential comorbidity-related restrictions.
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