Introduction
Elective orthopedic care, including in-person office visits and physical therapy (PT), was halted on March 16, 2020, at a large, urban hospital at the onset of the local COVID-19 surge. Post-discharge care was provided predominantly through a virtual format. The purpose of this study was to assess the impact of postoperative care disruptions on early total knee arthroplasty (TKA) outcomes, specifically 90-day complications, 120-day rate of manipulation under anesthesia (MUA) and 1-year patient-reported outcome measures (PROMs).
Materials and methods
Institutional records were queried to identify 624 patients who underwent primary, unilateral TKA for osteoarthritis and who were discharged home between 1/1/20 and 3/15/20. These patients were compared to 558 controls discharged between 1/1/19 and 3/15/2019. Cohort demographics and in-hospital characteristics were equivalent apart from inpatient morphine milligram equivalent (MME) consumption. Patient-reported access to PT (
p
< 0.001) and post-discharge care (
p
< 0.001) were worse among study patients. Study patients were prescribed fewer post-discharge PT sessions (19.8 vs. 23.5;
p
< 0.001) and utilized telehealth more frequently (
p
< 0.001). Mann–Whitney
U
,
T
, Fisher’s Exact, and chi-squared tests were used to compare outcomes.
Results
Ninety-day CMS complications were lower among study patients (3.5% vs. 5.9%;
p
= 0.05). Rates of MUA were similar between groups. Study patients reported similar PROMs and marginally inferior VR-12 mental and LEAS functional outcomes at 1 year.
Conclusion
Disruptions to elective orthopedic care in March 2020 seemed to have had no major consequences on clinical outcomes for TKA patients. Our findings question the usefulness of pre-pandemic post-discharge protocols, which may over-emphasize in-person visits and PT.
Background: The population of nonagenarians undergoing total joint arthroplasty (TJA) of the hip or knee is expected to increase, but this population may be reluctant to consider elective surgery because of their advanced age. Purpose: We sought to compare TJA outcomes between nonagenarians and octogenarians with an exact 10-year age difference. Methods: We performed a retrospective chart review, including 129 nonagenarians who underwent primary unilateral TJA for osteoarthritis in a 4-year period at a single institution and who were matched with 381 octogenarians based on sex, body mass index, Charlson Comorbidity Index, replaced joint (hip or knee), and a 10-year age difference. Ninety-day outcomes included Centers for Medicare and Medicaid Services (CMS) defined complications, unscheduled outpatient clinic visits, emergency room (ER) visits, and readmissions. No patients were lost to follow-up. Results: Nonagenarians and octogenarians had comparable rates of CMS complications (10% vs 6.3%, respectively), but nonagenarians had higher rates of CMS mechanical complications (6.2% vs 1.6%). There was 1 death in each group. Nonagenarians had longer hospital stays than octogenarians (4.1 vs 3.0 days, respectively), and a greater risk of in-hospital events and complications (60.5% vs 37.3%, respectively). The groups showed similar rates of unscheduled outpatient visits (14.7% vs 13.9%, respectively), ER visits (12.4 vs 6.6%, respectively), and readmissions (6.2% vs 7.1%, respectively). Conclusions: This retrospective study found higher rates of in-hospital complications in nonagenarians than in matched octogenarians following elective TJA, although the 2 groups showed similar rates of postdischarge complications. Further research in a larger cohort is needed.
Background and purpose: Elective total hip replacement (THR) was halted in our institution during the COVID-19 surge in March 2020. Afterwards, elective THR volume increased with emphasis on fast-track protocols, early discharge, and post-discharge virtual care. We compare early outcomes during this “return-to-normal period” with those of a matched pre-pandemic cohort.Patients and methods: We identified 757 patients undergoing THR from June to August 2020, who were matched 1:1 with a control cohort from June to August 2019. Length of stay (LOS) for the study cohort was lower than the control cohort (31 vs. 45 hours; p < 0.001). The time to first postoperative physical therapy (PT) was shorter in the study cohort (370 vs. 425 minutes; p < 0.001). More patients were discharged home in the study cohort (99% vs. 94%; p < 0.001). Study patients utilized telehealth office and rehabilitation services 14 times more frequently (39% vs. 2.8%; p < 0.001). Outcomes included post-discharge 90-day unscheduled office visits, emergency room (ER) visits, complications, readmissions, and PROMs (HOOS JR, and VR-12 mental/physical). Mann–Whitney U and chi-square tests were used for group comparisons.Results: Rates of 90-day unscheduled outpatient visits (5.0% vs. 7.3%), ER visits (5.0% vs. 4.8%), hospital readmissions (4.0% vs. 2.8%), complications (0.04% vs. 0.03%), and 3-month PROMs were similar between cohorts. There was no 90-day mortality.Interpretation: A reduction in LOS and increased telehealth use for office and rehabilitation visits did not adversely influence 90-day clinical outcomes and PROMs. Our findings lend further support for the utilization of fast-track arthroplasty with augmentation of postoperative care delivery using telemedicine.
Metal-on-polyethylene (MoP) total hip arthroplasty (THA) prostheses are known to release metal debris. Basic science studies suggest that metal implants induce a proinflammatory response that ultimately chemoattracts leukocytes including macrophages and neutrophils to the surgical site. This raises concern of higher risk of infection with these prostheses through the "trojan horse" mechanism by which neutrophils and macrophages transport intracellular pathogens from a remote site. This study compared the infection occurrence between MoP and ceramic-on-polyethylene (CoP) implants to determine if a higher infection rate in MoP is present. We reviewed a consecutive series of 6052 CoP and 4550 MoP primary THA patients from 2015 to 2019. The occurrence of periprosthetic joint infection at 2 years was defined according to the 2018 ICM definition. Statistical analysis consisted of descriptive statistics, univariate analysis, and regression modeling. When compared to CoP, MoP patients were older, included more females, had a higher body mass index, and more commonly affected by comorbidities according to Elixhauser's score. Total revisions were higher in the MoP group (3.19% vs.2.41%) The absolute incidence of PJI was higher in MoP (2.40% vs. 1.64%). When we adjusted for confounding factors, MoP was found independently associated with a higher PJI risk. Despite MoP and CoP both being widely used for primary THA, we found a higher incidence of PJI in MoP patients. The association remained significant when controlled for possible confounders. We hypothesize that leukocyte recruitment to these implants may play a role and should be further investigated.
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