Developing a Pathway for High-value, Patient-centered Total Joint Arthroplasty

Citters, Aricca D. Van; Fahlman, Cheryl; Goldmann, Donald A.; Lieberman, Jay R.; Koenig, Karl; DiGioia, Anthony M.; O’Donnell, Beth; Martin, James Kirby; Federico, Frank; Bankowitz, Richard; Nelson, Eugene C.; Bozic, Kevin J.

doi:10.1007/s11999-013-3398-4

Cited by 61 publications

(52 citation statements)

References 3 publications

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“…If elective THA was arranged for patients with severe abnormalities, preoperative optimization should be started as early as when they are still waiting for hospitalization, or the surgery could be postponed until they have improved their situation. On the other hand, a general medical checklist should be introduced into our clinical practice to record patients' preoperative abnormal laboratory tests, risk factors, coexisting comorbidities, and other important information, which would be helpful for preoperative optimization and improvement of the perioperative care pathway [29,30].…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

Zhu

Xiao

et al. 2020

The Journal of Arthroplasty

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Background: Recently, the practice of ordering routine postoperative laboratory tests in primary total hip arthroplasty (THA) has been challenged. This study aimed to evaluate the utility of routine postoperative laboratory tests after primary elective THA in an Asian population and identify the risk factors associated with abnormal postoperative laboratory testerelated intervention. Methods: We retrospectively reviewed 395 consecutive patients who underwent primary elective THA at a single tertiary academic center. Patient clinical information and laboratory test results were collected for analysis. Results: A total of 349 (88.4%) patients had abnormal postoperative laboratory test results; most patients had anemia and hypoalbuminemia. Twenty-seven (6.8%) patients received clinical intervention. Of the 307 (77.7%) patients with postoperative anemia, 7 patients received blood transfusion. Factors associated with transfusion were female gender, low body mass index, long operation time, and low preoperative hemoglobin levels. Of the 149 (37.7%) patients with postoperative hypoalbuminemia, 16 received albumin supplementation. Factors associated with albumin supplementation were female gender, long operation time, and low preoperative albumin levels. Although 36 patients had abnormal postoperative creatinine, only 1 patient required specialist consultation. For electrolyte abnormalities, hyponatremia was noted; however, no patient received sodium supplementation. Moreover, 14 patients developed hypokalemia, of which 6 required potassium supplementation; 163 patients had hypocalcemia, of which 2 received calcium supplementation. Conclusion: Routine laboratory tests after primary elective THA are unnecessary for most of the patients in modern clinical practice. However, for those with identified risk factors, postoperative laboratory tests still should be performed.

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Section: Implications For Clinical Practicementioning

confidence: 99%

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

Zhu

Xiao

et al. 2020

The Journal of Arthroplasty

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“…Although patient characteristics may explain the high incidence rates of abnormal postoperative laboratory tests and clinical intervention, the perioperative clinical pathway and physiological processes associated with hip fracture (e.g., the acute inflammatory stress, catabolic states) may also account for some of the high incidences [18,35,36]. The clinical pathway for THA differs between non-hip patients and hip fracture patients and can vary among institutions, which may lead to diverse results.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting

Liu

et al. 2020

J Orthop Traumatol

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Background Recent studies suggest that routine postoperative laboratory tests are not necessary after primary elective total hip arthroplasty (THA). This study aims to evaluate the utility of routine postoperative laboratory tests in patients undergoing THA for hip fracture in a semi-urgent clinical setting. Materials and methods This retrospective study included 213 consecutive patients who underwent primary unilateral THA for hip fractures. Patient demographics, clinical information, and laboratory tests were obtained from the electronic medical record system. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory test-related interventions. Results A total of 207 patients (97.18%) had abnormal postoperative laboratory results, which were mainly due to anemia (190/213, 89.20%) and hypoalbuminemia (154/213, 72.30%). Overall, 54 patients (25.35%) underwent a clinical intervention, 18 patients received blood transfusion, and 42 patients received albumin supplementation. Factors associated with blood transfusion were long operative time and low preoperative hemoglobin levels. Factors associated with albumin supplementation were long operative time and low preoperative albumin levels. Of the 33 patients with abnormal postoperative creatinine levels, 7 patients underwent a clinical intervention. For electrolyte abnormalities, sodium supplementation was not given for hyponatremia, three patients received potassium supplementation, and one patient received calcium supplementation. Conclusions This study demonstrated a high incidence of abnormal postoperative laboratory tests and a significant clinical intervention rate in patients who underwent THA for hip fracture in a semi-urgent clinical setting, which indicates that routine laboratory tests after THA for hip fracture are still necessary for patients with certain risk factors. Level of Evidence Level III. Trial registration Clinical trial registry number ChiCTR1900020690.

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“…Severe hip joint diseases, such as osteoporotic fracture, aseptic necrosis of the femoral head, osteoarthritis, end-stage rheumatic arthritis, and other arthritic diseases, often require total hip arthroplasty to alleviate pain, increase the range of motion, and improve the patient's quality of life (Van Citters et al, 2014). Even though great efforts have been expended in ameliorating the efficacy of THA, peri-prosthetic osteolysis (PPO) and subsequent aseptic loosening after long-term use of artificial joints remain to be the principle cause of arthroplasty failure (Abu-Amer et al, 2007;Patel et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Magnoflorine Suppresses MAPK and NF-κB Signaling to Prevent Inflammatory Osteolysis Induced by Titanium Particles In Vivo and Osteoclastogenesis via RANKL In Vitro

et al. 2020

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Wear particles that detach from the surface of prostheses induce excessive activation of osteoclast and immoderate release of inflammatory cytokines that lead to peri-implant osteolysis and aseptic loosening. In this work, we investigated whether magnoflorine, a quaternary aporphine alkaloid extracted from the Chinese herb Magnolia or Aristolochia, could effectively inhibit inflammatory calvarial osteolysis caused by titanium particles in mouse models, inflammatory response as well as osteoclastogenesis in vitro mediated via receptor activator of NF-kB ligand (RANKL). Micro-computed tomography and histological examination of mice treated with magnoflorine revealed fewer resorption pits, less osteoclasts formation and inflammatory cytokine expression. Moreover, in vitro differentiation of osteoclasts and bone resorption as well as titanium particle-induced inflammatory response were dose-dependently inhibited by magnoflorine. These were accompanied by reduced transcription of osteoclast-specific genes encoding tartrateresistant acid phosphatase (TRAP), V-ATPase d2, c-Fos, cathepsin K, nuclear factor of activated T cells (NFAT) c1, and calcitonin receptor (CTR). Further research on mechanism showed that the inhibition of phosphorylation of TAK1 and subsequent activation of MAPK and NF-kB signaling pathways were found to mediate the suppressive effects of magnoflorine. Collectively, these results suggested that magnoflorine treatment could effectively prevent peri-implant osteolysis due to wear debris as well as other diseases caused by chronic inflammation and excessive osteoclast activation.Commercial pure Ti particles (Alfa Aesar, Haverhill, MA, USA) were <20 µm in diameter. They were baked for 8 h at 180°C and then washed in 75% ethanol for 48 h for endotoxin removal before resuspension in sterile phosphate-buffered saline (PBS) at 0.3 g/ml and storage at 4°C. Ti particles were confirmed to be free of endotoxins via a Limulus amebocyte lysate assay.

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Developing a Pathway for High-value, Patient-centered Total Joint Arthroplasty

Abstract: Level V, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Cited by 61 publications

References 3 publications

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

The necessity of routine postoperative laboratory tests after total hip arthroplasty for hip fracture in a semi-urgent clinical setting

Magnoflorine Suppresses MAPK and NF-κB Signaling to Prevent Inflammatory Osteolysis Induced by Titanium Particles In Vivo and Osteoclastogenesis via RANKL In Vitro

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