Background:
Digital patient engagement platforms are designed to improve the efficacy of the perioperative surgical home, but the currently available solutions have shown low patient and provider adoption. The purpose of this study was to evaluate the effectiveness of a text-messaging (Short Message Service [SMS]) bot with respect to patient engagement following joint replacement procedures in a randomized clinical trial.
Methods:
One hundred and fifty-nine patients (83 patients in the control group and 76 patients in the intervention group) were enrolled in a randomized controlled trial comparing the effectiveness of an SMS bot (intervention group) with the traditional perioperative education process (control group) in patients undergoing primary total knee or hip arthroplasty. There were no significant differences in the demographic characteristics between the 2 groups. The primary outcome of time participating in home-based exercises and the secondary outcomes of knee range of motion, the use of narcotics, visual analog scale (VAS) mood score, telephone calls to the office, patient satisfaction, and visits to the emergency department were measured and were compared between the 2 groups. Continuous outcomes were analyzed using linear regression, and categorical outcomes were analyzed using the Pearson chi-square test.
Results:
Patients in the intervention group exercised for 8.6 minutes more per day: a mean time (and standard deviation) of 46.4 ± 17.4 minutes compared with 37.7 ± 16.3 minutes for the control group (p < 0.001). The intervention group had an improved mood (mean VAS, 7.5 ± 1.8 points compared with 6.5 ± 1.7 points for the control group; p < 0.001), stopped their narcotic medications 10 days sooner (mean time, 22.5 ± 13.4 days compared with 32.4 ± 11.8 days for the control group; p < 0.001), placed fewer telephone calls to the surgeon’s office (mean calls, 0.6 ± 0.8 compared with 2.6 ± 3.4 for the control group; p < 0.001), and had greater knee range of motion 3 weeks after the surgical procedure (mean flexion, 101.2° ± 11.2° compared with 93.8° ± 14.5° for the control group; p = 0.008), but had an equal range of motion at 6 weeks. There was a trend toward fewer visits to the emergency department in the intervention group, but this comparison lacked statistical power.
Conclusions:
An SMS bot can improve clinical outcomes and increase patient engagement in the early postoperative period in patients undergoing hip or knee arthroplasty.
Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Background: It is unclear whether posterior hip precautions after primary total hip arthroplasty (THA) reduce the incidence of early postoperative dislocation. Methods: We performed a prospective randomized study to evaluate the effect of hip precautions on incidence of early dislocation after primary THA using a posterior approach. Between January 2016 and April 2019, 587 patients (594 hips) were consented and randomized into restricted or unrestricted groups. No significant demographic or surgical differences existed between groups. The restricted group was instructed to refrain from hip flexion >90 , adduction across midline, and internal rotation for 6 weeks. 98.5% (585 of 594) of hips were available for minimum 6-week follow-up (291 restricted and 294 unrestricted). Power analysis showed that 579 hips per group are needed to demonstrate an increase in dislocation rate from 0.5% to 2.5% with 80% power. Results: At average follow-up of 15 weeks (range, 6-88), there were 5 dislocations (incidence, 0.85%). Three posterior dislocations occurred in the restricted group at a mean of 32 days (range, 17-47), and 2 posterior dislocations occurred in the unrestricted group at a mean of 112 days (range, 21-203), with no difference in dislocation rate between groups (1.03% vs 0.68%; odds ratio, 0.658; 95% confidence interval, 0.11-3.96; P ¼ .647). At 6 weeks, unrestricted patients endorsed less difficulty with activities of daily living, earlier return to driving, and more time spent side sleeping (P < .05). Conclusion: Preliminary analysis suggests that removal of hip precautions after primary THA using a posterior approach was not associated with early dislocation and facilitated return to daily functions. Investigation to appropriate power is warranted.
Background: Proposed benefits of modularity for femoral revisions in total hip arthroplasty (THA) include more precise biomechanical restoration and improved stability, but this has not been proven with use of a splined, tapered design. This study's purpose is to compare (1) complication rates, (2) functional outcomes, and (3) radiographic measures of subsidence, offset, and leg length discrepancy with the use of modular vs monoblock splined, tapered titanium stems in revision THA. Methods: We retrospectively reviewed 145 femoral revisions with minimum 2-year follow-up (mean, 5.12 years; range, 2-17.3 years). Patients receiving a modular (67) or monoblock (78) splined, tapered titanium stem for femoral revision were included. Results: There were no statistically significant differences in rates of reoperation (22.3% vs 17.9%; P ¼ .66), intraoperative fracture (9.0% vs 3.8%; P ¼ .30), postoperative fracture (3.0% vs 1.3%; P ¼ .47), dislocation (11.9% vs 5.1%; P ¼ .23), or aseptic loosening (4.5% vs 6.4%; P ¼ .73) between the modular and monoblock cohorts, respectively. There were similar results regarding subsidence >5 mm (10.4% vs 12.8%; P ¼ .22), LLD >1 cm (35.8% vs 38.5%; P ¼ .74), restoration of hip offset (À5.88 ± 10.1 mm vs À5.07 ± 12.1 mm; P ¼ .67), and Harris Hip Score (70.7 ± 17.9 vs 73.9 ± 19.7; P ¼ .36) between groups. Multivariate regression showed no differences in complications (P ¼ .44) or reoperations (P ¼ .20) between groups. Conclusion: Modular and monoblock splined, tapered titanium stems demonstrated comparable complication rates, functional outcomes, and radiographic parameters for femoral revisions. However, a limited number of patients with grade IIIB or IV femoral bone loss received a monoblock stem. Future investigations are required to determine whether modularity is beneficial for more complex femoral defects.
Introduction:
Infection is a challenging complication after total knee arthroplasty (TKA) that is often treatable. However, recurrent infection may require resection, amputation, or arthrodesis. The purpose of this study was to evaluate the results of antegrade nailing with an intramedullary rod for the treatment of a chronically infected TKA.
Methods:
This study was a retrospective review of a consecutive series of 18 patients with chronically infected TKA treated with arthrodesis using a long antegrade intramedullary nail. There were 11 women and 7 men with an average age of 65 years and average body mass index of 33.8 kg/m
2
. Patients had an average of 7.4 procedures before fusion, and mean follow-up was 50 months. One patient died in the early postoperative period, leaving 17 patients for evaluation. Fusion was defined radiographically as bony bridging of the joint surfaces visible on both anterior-posterior and lateral radiographs. Ambulatory ability, need for chronic antibiotic suppression, complications, and nail removal were recorded.
Results:
Sixteen of 17 patients (94%) underwent successful fusion. Ten of 17 patients (59%) continued to ambulate with 9 of these patients requiring an assist device and 7 of 17 patients (41%) predominantly used a wheelchair. Chronic antibiotic suppression was used in 13 of 17 patients (76%). Two patients required nail removal (one for pseudarthrosis and one for possible total hip arthroplasty) and overall 8 of 17 patients (47%) had a complication. Six of 18 patients (33%) died within 2 years of their fusion procedure.
Discussion:
Knee arthrodesis with an antegrade intramedullary nail is a viable treatment option for the chronically infected TKA. There was a high rate of successful fusion, along with a high rate of complications, mortality, and need for chronic antibiotic suppression.
Conclusion:
Knee arthrodesis with a long IMN is a suitable treatment method as salvage for a chronically infected TKA, but patients should be counseled on the high rate of postoperative complications, poor ambulatory rate, likely need for suppressive antibiotics, and high mortality rate.
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