Hip Replacement Patients Research Articles

The Efficacy and Safety of Parecoxib Multimodal Preemptive Analgesia in Artificial Joint Replacement: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Postoperative pain after artificial joint replacement is intense and remains an unsolved problem. Some studies have shown that parecoxib can provide better analgesia in postoperative multimodal analgesia, however, doubts arise about whether its multimodal preemptive analgesia can reduce postoperative pain. The purpose of this systematic review and meta-analysis was to evaluate the impact of preoperative injection of parecoxib on postoperative pain in patients undergoing artificial joint replacement. Systematic review and meta-analysis. Embase, PubMed, Cochrane Library, CNKI, VIP, Wangfang databases were searched to identify relevant randomized controlled trials. The last search was in May 2022. Randomized controlled trials of efficacy and adverse reactions of intra-operative and postoperative injection of parecoxib in artificial joint replacement were collected. The primary outcome was postoperative visual analog scale scores and the secondary outcomes included cumulative postoperative opioid consumption and incidence of adverse reactions. Using the Cochrane systematic review method to screen the studies, evaluate the quality of the included studies, and extract feature information, RevMan 5.4 software performs a meta-analysis of the corresponding research indicators. In total, nine studies were involved in the meta-analysis with 667 patients. The trial and control group were given the same dose of parecoxib or placebo at the same time point before and after surgery. The results showed that compared with the control group, the trial group is associated with substantially reduced visual analog scale scores in 24, 48h at rest (P < 0.05), visual analog scale scores in 24, 48, 72h at movement (P < 0.05), dose of opioid need in trial group is notably lower than that in control group (P < 0.05), but shows no obvious effect on visual analog scale scores in 72h at rest, and adverse events (P > 0.05). The major limitation of this meta-analysis relates to some low-quality studies. Our results support parecoxib multimodal preemptive analgesia in reducing postoperative acute pain in hip and knee replacement patients, and reduces cumulative opioid consumption without increasing the risk of adverse drug events. Its multimodal preemptive analgesia is safe and effective in hip and knee replacement. CRD42022379672.

RWD139 The Use of Oxidized Zirconium Result in Fewer Readmission Rates in Hip Replacement Patients Due to Hip Fracture

The Comprehensive Care for Joint Replacement (CJR) Model from the Centers for Medicare and Medicaid Services and similar programs from other payers make hospitals and healthcare systems more responsible for better clinical and economical outcomes of total hip arthroplasty (THA) aimed at slowing Medicare spending growth. Oxidized Zirconium◊ (OxZr) implants have been shown in numerous registry and clinical studies to be clinically effective when used on elective THA. The objective of this study was to evaluate 30, 90 and 180- and one-year outcomes in hip replacement due to hip fracture for patients using OxZr implants compared to ceramic-on-polyethylene (CoP) implants.

Cobalt induces neurodegeneration through FTO-triggered autophagy impairment by targeting TSC1 in an m6A-YTHDF2-dependent manner

Cobalt is the most widely used heavy metal pollutant in medicine and industry. Excessive cobalt exposure can adversely affect human health. Neurodegenerative symptoms have been observed in cobalt-exposed populations; however, the underlying mechanisms remain largely unknown. In this study, we demonstrate that the N6-methyladenosine (m6A) demethylase fat mass and obesity-associated gene (FTO) mediates cobalt-induced neurodegeneration by impairing autophagic flux. Cobalt-induced neurodegeneration was exacerbated through FTO genetic knockdown or repression of demethylase activity, but was alleviated by FTO overexpression. Mechanistically, we showed that FTO regulates TSC1/2-mTOR signaling pathway by targeting TSC1 mRNA stability in an m6A-YTHDF2 manner, which resulted in autophagosome accumulation. Furthermore, FTO decreases lysosome-associated membrane protein-2 (LAMP2) to inhibit the integration of autophagosomes and lysosomes, leading to autophagic flux damage. In vivo experiments further identified that central nervous system (CNS)-Fto-specific knockout resulted in serious neurobehavioral and pathological damage as well as TSC1-related autophagy impairment in cobalt-exposed mice. Interestingly, FTO-regulated autophagy impairment has been confirmed in patients with hip replacement. Collectively, our results provide novel insights into m6A-modulated autophagy through FTO-YTHDF2 targeted TSC1 mRNA stability, revealing cobalt is a novel epigenetic hazard that induces neurodegeneration. These findings suggest the potential therapeutic targets for hip replacement in patients with neurodegenerative damage.

Efficacy of Direct Anterior Approach Versus Posterior Lateral Approach for Total Hip Replacement in Patients with Parkinson's Disease.

BACKGROUND The present study was performed to evaluate the efficacy of direct anterior approach (DAA) versus posterolateral approach (PLA) for total hip arthroplasty (THA) in patients with Parkinson's disease (PD). The aim of the study was to compare the speed of recovery of hip function and postoperative complications between the 2 approaches. MATERIAL AND METHODS The study included 285 Parkinson's patients who underwent THA; 209 eligible patients were recruited for analysis as per the inclusion criteria and assigned into DAA group (n=90) and PLA group (n=119) according to the surgical approach. Postoperative Harris Hip Score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Forgotten joint score (FJS) were collected to assess hip function. RESULTS The DAA had a statistically lower incidence of postoperative complications than the PLA, particularly the rate of postoperative dislocation. Perioperative outcomes showed a longer operative time in the DAA than in the PLA group and more intraoperative blood loss in the DAA than in the PLA group. At 3 months postoperatively, the HHS and WOMAC scores in the DAA group showed significantly higher scores compared to the PLA group versus the DAA group. However, these differences disappeared at 6 months postoperatively and the FJS in the DAA group had a statistically higher score compared to the PLA group. CONCLUSIONS In patients with Parkinson's disease complicated with hip disease, the DAA approach exhibited a lower rate of dislocation than the PLA approach and had faster recovery of hip function.

Mechanical energy fluctuation in lower limbs during walking in participants with and without total hip replacement.

Mechanical energy fluctuation of the segments of lower limbs during walking has not been fully investigated. It was hypothesized that the segments may work as a pendulum, i.e. the kinetic and potential energies exchanged out of phase. This study aimed to investigate energy changes and recovery during gait in hip replacement patients. The gait data for 12 participants with total hip replacement and 12 age-matched control was compared. The kinetic, potential and rotative energies for whole lower limb and thigh, calf and foot, were calculated. The effectiveness of a pendulum effect was analysed. Gait parameters (speeds and cadence) were calculated. The results showed that the thigh had significant effectiveness as a pendulum during gait with energy recovery coefficient of approximately 40% while the calf and foot were less like a pendulum during gait. In comparison, energy recoveries of lower limbs in the two groups were not significantly different. If the pelvis was considered as an approximate to the centre of mass, however, the control group had a higher energy recovery than total-hip-replacement group by roughly 10%. This study concluded that, unlike centre of mass energy recovery, the mechanical energy recovery mechanism in the lower limbs during walking is not affected after total hip replacement.

Microbiological profiles and antibiotic resistance of periprosthetic joint infection after hip replacement in patients with fracture or non-fracture: A comparative study.

Periprosthetic joint infection (PJI) is one of the worst complications following total joint arthroplasty (TJA). Unfortunately, effective prevention strategies to reduce the burden of PJI have not been fully determined in hip replacement patients with fracture and non-fracture. This study aimed to analyze and compare the demographic characteristics, microbiological profiles and antibiotic resistance of PJI after hip replacement between patients with fracture and non-fracture. We retrospectively analyzed the data of 132 patients who treated PJI. There were divided into two groups: non-fracture group (64 patients infected after hip replacement for fracture) and non-fracture group (68 patients infected after hip replacement for non-fracture). Microorganisms were obtained from the synovial fluid and infected necrotic tissue in the joint capsule, medullary cavity, or acetabulum in all patients, and microbiological profiles and antibiotic resistance were evaluated. Coagulase-negative staphylococci (CoNS) were the most common pathogenic microorganisms in all patients. Methicillin-resistant Staphylococcus (MRS) accounted for 25% in all pathogenic microbes. Staphylococci showed high drug resistance rates to clindamycin, levofloxacin, and all of the first- and second-generation cephalosporins. MRS isolates in non-fracture group had higher drug resistance rates to clindamycin and levofloxacin than than those in fracture group. Gram-negative bacilli (GNB) showed high drug resistance rates to Aztreonam, gentamicin and all of the third- and fourth-generation cephalosporins. Furthermore, GNB isolates in the non-fracture group showed higher resistance rates to gentamicin and all of the third- and fourth-generation cephalosporins. MRS isolates in the non-fracture group showed higher drug resistance rates to clindamycin and levofloxacin, and GNB isolates in non-fracture group showed higher drug resistance rates to gentamicin and all of the third- and fourth-generation cephalosporins.

Acetabular, Femoral, and Combined Anteversion in a Province in South Korea: Computed Tomography-Based Study.

The purpose of this study was to investigate the femoral, acetabular, and combined anteversion of the hip joint in South Koreans using computed tomography (CT). We measured anteversion using CT venograms taken from 2016 to 2020. Of the total 1,073 patients, 952 patients were included in the study except for those with pelvic fractures, previous femoral fractures, childhood hip joint disease, osteoarthritis, or hip dysplasia (lateral center-edge angle, < 20), foreigners, and hip and knee replacement patients. Measurements were taken twice by two orthopedic surgeons. The femoral anteversion in women was 10.64° ± 10.26° (≤ 49 years), 15.75° ± 9.40° (50-59 years), 10.81° ± 9.14° (60-69 years), 12.38° ± 8.55° (70-79 years), and 11.23° ± 8.44° (≥ 80 years). The femoral anteversion in men was 12.02° ± 11.38° (≤ 49 years), 10.62° ± 9.11° (50-59 years), 6.09° ± 9.95° (60-69 years), 6.57° ± 9.51° (70-79 years), and 5.53° ± 9.29° (≥ 80 years). The acetabular anteversion in women was 17.65° ± 6.58° (≤ 49 years), 19.24° ± 6.42° (50-59 years), 20.30° ± 6.25° (60-69 years), 22.38° ± 7.36° (70-79 years), and 23.34° ± 6.98° (≥ 80 years). The acetabular anteversion in men was 15.21° ± 8.14° (≤ 49 years), 17.68° ± 6.00° (50-59 years), 17.54° ± 5.93° (60-69 years), 18.68° ± 6.62° (70-79 years), and 18.19° ± 6.94° (≥ 80 years). The combined anteversion in women was 28.29° ± 14.30° (≤ 49 years), 34.99° ± 10.62° (50-59 years), 31.11° ± 11.52° (60-69 years), 34.76° ± 10.86° (70-79 years), and 34.57° ± 11.45° (≥ 80 years). The combined anteversion in men was 27.23° ± 15.11° (≤ 49 years), 28.30° ± 11.23° (50-59 years), 23.63° ± 11.77° (60-69 years), 25.25° ± 12.02° (70-79 years), and 23.72° ± 11.88° (≥ 80 years). Femoral anteversion tended to decrease with age in men and acetabular anteversion tended to increase in both men and women. Combined anteversion showed a tendency to increase slightly in women.

A 20 mg dose of dexamethasone does not reduce the proportion of joint replacement patients needing rescue analgesia: a matched cohort study.

Consistent pain control after total joint replacement (TJR) has not yet been reached in all patients managed with a multimodal analgesia regime. Questions remain on dosage and timing of analgesics. Glucocorticoids such as dexamethasone are considered most powerful in reducing the surgery-induced inflammatory response with most pain studies using a 6-12 mg dose. Reviews agree that additional glucocorticoids may provide more analgesia, but a dose-finding analysis is limited. The primary aim of this study was to determine if a high, single preoperative dose of dexamethasone resulted in a reduced need for rescue analgesics during the first 24 hours after TJR when compared to a standard 8 mg dose of dexamethasone. A cohort study in which 59 patients who received 20 mg dexamethasone intravenously just prior to incision were matched 1:1 to patients who received a standard 8 mg dose. Consecutive elective hip and knee replacement patients managed by one anaesthesiologist were included in the high dose group between June 2019 and March 2020. Patients were matched for arthroplasty type, gender, age, anaesthesia type and pre-operative pain. Patients with opioid use before surgery or with diabetes mellitus were excluded. Oxynorm rescues analgesics (number of times given and dosage) usage during hospitalization was retrieved from the electronic nursing files. There were no significant differences between groups in gender distribution, mean age and body mass index (BMI), in American Society of Anesthesiologists (ASA), type of arthroplasty, anaesthesia type and pre-operative pain score. In the 20 mg group 54 patients (91.5%) needed oxynorm during hospitalization versus 58 (98.3%) in the 8 mg group (P=0.09). High dose group patients received a median of 5 mg [interquartile range (IQR): 0] oxynorm versus 5 mg (IQR: 0) in the standard dose group (P=0.70). In this matched cohort study there was no difference in the proportion of patients needing rescue analgesics during hospitalization between the group of patients who preoperatively received 20 mg dexamethasone and the group of patients who received 8 mg. Future blinded randomized controlled trials are needed to further investigate the effect of different glucocorticoids dosages on pain after joint replacement surgery.

Efficacy of Ultrasound-Guided Quadratus Lumborum Block in Postoperative Analgesia of Total Hip Replacement

compromising early postoperative recovery. Previous studies have reported favorable results using anterior, posterior and lateral quadratus lumborum block for pain control during hip surgery. In this study, we evaluate the effectiveness of ultrasound-guided quadratus lumborum block in postoperative analgesia of total hip replacement. 200 patients who underwent total hip arthroplasty in our hospital between January 2020 and January 2021 were recruited and assigned via random number table method to receive either ultrasoundguided quadratus lumborum block (study group) or fascia iliaca block (observation group) for anesthesia. All patients were given self-administered intravenous analgesia postoperatively. Outcome measures included cumulative postoperative sufentanil use, resting pain, motor pain, postoperative hip mobility and incidence of nausea and vomiting. Ultrasound-guided quadratus lumborum block resulted in significantly less sufentanil use in patients at 24 h and 48 h postoperatively (52.14±5.11, 105.74±8.14) vs. fascia iliaca block (77.58±7.93, 150.18±10.58) (p<0.05). Patients in the study group showed lower visual analogue scale scores both at rest and at exercise than those in the observation group at 12, 24 and 48 h postoperatively (p<0.05). The study group had significantly greater maximum hip flexion and abduction mobility at 24 h and 48 h postoperatively than the observation group (p<0.05). Ultrasound-guided quadratus lumborum block was associated with a lower incidence of nausea and vomiting (7.00 %) vs. fascia iliaca block (39.00 %) (p<0.05). Ultrasoundguided quadratus lumborum block reduces the use of opioids in total hip replacement patients, significantly alleviates surgical pain, promotes early functional recovery and lowers the incidence of adverse effects.

PCR83 Investigation of Functional Outcomes at Hospital Discharge in Hip Replacement Patients in Different Health Care Sectors

PCR83 Investigation of Functional Outcomes at Hospital Discharge in Hip Replacement Patients in Different Health Care Sectors

PCR88 How Does the Quality of Life of Hip Replacement Patients Operated in State and Private Health Care Change in the Postoperative Period?

PCR88 How Does the Quality of Life of Hip Replacement Patients Operated in State and Private Health Care Change in the Postoperative Period?

Protocol for the examination and selection of potential living donors of bone tissue for the production of allografts

The responsible stage of choosing the source of bone allografts is the process of examination and selection of the donor, which includes moral and ethical, legal and medical aspects. The selection of potential donors should be carried out with the participation of a qualified doctor, with a thorough collection of anamnesis, social conditions and a general medical examination. Up to 48 % of all potential donors are rejected to collect bone in the pre-operative period; up to 22 % of the received tissues are not suitable for transplantation according to the results of further examinations. Purpose – to develop a protocol for the examination of potential living donors of bone tissue based on anamnestic, clinical, laboratory and instrumental examinations to ensure the selection of high-quality bone material for the production of bone grafts. Materials and methods. From 01.01.2016 to 01.12.2021, 640 patients for hip replacement were involved in the selection of bone tissue donors. The following selection steps were applied: obtaining informed consent, filling in a questionnaire about the possibility of donation, express-tests for infections and X-ray morphometric examination based on the results of radiography of the hip joints in direct projection. Results. Based on the results of the examination of potential donors, it was established that the number of patients who were excluded from further research due to refusal to donate was 3 %, due to contraindications according to the results of filling out the questionnaire – 15 %, according to X-ray morphometric criteria – 51 %, according to the results of laboratory examination – 2 %. Conclusions. A protocol of examination of bone tissue donors for the production of scaffolds has been developed. It was established that about 30 % of all examined potential donors are suitable for donation.

The effect of hospital choice and competition on inequalities in waiting times

We use a quasi difference-in-difference approach to examine whether the 2006 relaxation of constraints on patient choice of hospital in the English National Health Service (NHS) affected waiting times inequalities for three common elective treatments (coronary bypass, hip replacement and knee replacement) in hospitals which faced more potential competition (number of rivals) before the choice reform was introduced relative to those which faced less competition. After the 2006 choice reform hospitals which had more rivals before 2006 had longer waits for hip and knee replacement, with one additional rival increasing the median waiting time by 2.5% and 4.0%, and the 75th quantile waiting time by 4.2% and 7.1%. There was no effect on waiting times for coronary bypass patients up to the 75th quantile of the wait distribution. The choice reform and market structure had no effect on the standard deviation of waiting times within hospitals but did increase waiting time variation within small geographical areas. Older hip replacement patients had shorter waits pre-choice reform but the gradient disappeared after it and was not affected by market structure. Before the choice reform, more deprived patients had longer waits but post-reform there was no deprivation gradient in waiting times, and the reduction in the gradient was not affected by pre-reform market structure. Overall, the results suggest that the choice reform led to longer and more dispersed waiting times in more competitive areas but deprivation related inequity was smaller in the post-choice period.

Outcome analysis of bilateral total hip replacement in patients of avascular necrosis of femoral head

Avascular necrosis (AVN) of the femoral head is one of the common causes of painful hip in a young adult. Bilateral presentation is frequently seen and males are more commonly affected. Total hip replacement (THR) is one of the most successful surgical procedures for AVN. THR is a time tested surgery giving good outcome in terms of relieving pain, restoring function &amp; improving quality of life in patients of AVN. The purpose of the study was to analyse the outcome of bilateral THR &amp; comparing the outcome of one stage THR with Two stage THR. In this study, 40 patients with AVN of bilateral femoral head who were presented in the Department of Orthopaedics, Hamidia Hospital, Bhopal from April 2016 to April 2020 who fulfilled the inclusion criteria were included in the study. THR of all the patients was done on elective basis by senior surgeons of the department. All patients were followed up clinically and radiologically for a period of 6 months after the surgery. Any complications if present were also noted. This study concludes that in patients of AVN of bilateral femoral head, THR gives excellent functional outcome with early walking &amp; early return to work. As compared to Two stage bilateral THR, One stage bilateral THR has advantage of less blood loss, less need of parenteral analgesics &amp; antibiotics &amp; less hospital stay. However, there is no significant advantage in terms of functional outcome, walking capability &amp; return to work.

Antibiotic utilisation in primary and revision total hip replacement patients: A registry linkage cohort study of 106 253 patients using the Australian Orthopaedic Association National Joint Replacement Registry.

Infection is a major complication following joint replacement (JR) surgery. However, little data exist regarding antibiotic utilisation following primary JR and how use changes with subsequent revision surgery. This study aimed to examine variation in antibiotic utilisation rates before and after hip replacement surgery in those revised for infection, revised for other reasons and those without revision. This retrospective cohort analysis used linked data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Government Pharmaceutical Benefits Scheme. Patients were included if undergoing total hip replacement (THR) for osteoarthritis in private hospitals between 2002 and 2017. Three groups were examined: primary THR with no subsequent revision (n=102 577), primary THR with a subsequent revision for reasons other than periprosthetic joint infection (PJI) (n=3156) and primary THR with a subsequent revision for PJI (n=520). Monthly antibiotic utilisation rates and prevalence rate ratios (PRRs) with 95% confidence intervals (CIs) were calculated in the 2 years pre- and post-THR. Prior to primary THR antibiotic utilisation was 9%-10%. After primary THR, antibiotic utilisation rates were higher among patients revised for PJI (PRR 1.69, 95% CI 1.60-1.79) compared to non-revised patients, while the utilisation rate was lower in patients revised for reasons other than infection (PRR 0.96, 95% CI 0.93-0.98). For those revised for infection, antibiotic utilisation post-revision surgery was two times higher than those revised for other reasons (PRR 2.16, 95% CI 2.08-2.23). Utilisation of injectable antibiotics including, vancomycin, flucloxacillin and cephazolin was higher in those revised for PJI patients 0-2 weeks following surgery but not in those revised for other reasons compared to the non-revised group. Ongoing antibiotic utilisation after primary surgery may be an early signal of problems with the THR and should be a prompt for primary care physicians to refer patients to specialists for further appropriate investigations and management.

Radial head replacement using personalized 3D printed porous tantalum prosthesis

Fractures of the radial head account for 33% of elbow fractures. More and more studies have found that the radial head plays an important role in the normal function of the elbow joint, and many complications will occur after resection of the radial head. Accurate treatment of radial head fractures is crucially important. At this stage, commercialized radial head prosthesis of fixed size is commonly used in radial head replacement, but the mismatch of prosthesis and material problems have resulted in many complications. The three-dimensional (3D) printed porous tantalum has good biocompatibility, is conducive to bone ingrowth, has ideal elastic modulus, and can be prepared into a highly porous material that can be designed to match the radial head according to each patient's personalized anatomical structure. The purpose of this study was to investigate the elbow joint function, complications and prosthesis conditions after radial head replacement using 3D printed porous tantalum. Seven patients with comminuted fracture of radial head in our Center received radial head replacement using 3D printed porous tantalum. Patients were followed on the elbow joint function, range of motion (ROM), elbow radiographs, postoperative complications, and bone condition of tantalum metal. quality situation. Follow-up data showed that the patients had less postoperative pain, improved elbow function and ROM, and bone ingrowth in the tantalum prosthesis. The 3D printing porous tantalum can be applied to hip replacement, knee replacement, and other patients with irregular bone defects such as bone tumor, bone deformity, etc., which has the potential to realize personalized and precise treatment.

The association between frailty and mortality among lower limb arthroplasty patients: a systematic review and meta-analysis

BackgroundSome studies associate frailty and postoperative mortality in hip or knee replacement patients, and others have explored the relationship between the frailty index and changes in postoperative mortality in hip or knee replacement patients, but their findings are not consistent. This meta-analysis and systematic review aimed to pool the results of existing studies to explore whether frailty is an independent risk factor for postoperative mortality in patients with lower limb arthroplasty (including hip or knee arthroplasty).MethodsOn December 15, 2021, we searched the relevant articles from the PubMed, Embase, Medline (via Ovid), China National Knowledge Infrastructure (CNKI) and Wan Fang Med Online databases. We used the Newcastle–Ottawa Scale (NOS) to assess the quality of the articles that met the exclusion and inclusion criteria. R Studio was used to analyze the effect sizes (based on the random model integration) on the extracted data. Meanwhile, potential publication bias and sensibility analysis were performed.ResultsWe included seven studies, which included a total of 460,594 patients, for quantitative analysis. Overall, frailty increased the risk of mortality in lower limb arthroplasty patients compared to those without frailty, as measured by a pooled risk ratio (RR) of 2.46 (95% confidence interval [CI]: 1.81–3.33). Additionally, subgroup analysis based on population revealed that the pooled RRs for total knee arthroplasty (TKA) patients in three studies and total hip arthroplasty (THA) patients in four studies were 2.61 (95% CI: 2.26–3.02) and 3.18 (95% CI: 1.92–5.28), respectively, for TKA patients in three studies and THA patients in four studies. Additionally, these statistically significant positive associations persisted in subgroup analyses by study design, geographic region, and follow-up period.ConclusionFrailty is an independent risk factor for postoperative mortality in patients undergoing lower limb arthroplasty, according to our findings. This suggests that frailty may be a predictor of preoperative risk stratification for patients with such elective surgery and could alert doctors and nurses of early screening and medical care interventions in patients with such a need for surgery to reduce postoperative mortality in lower limb arthroplasty patients.

Same-Day Total Joint Discharges: A Collaborative Effort for Patient Safety

<h3>Background Information</h3> Previously, both knee and hip replacement patients had been admitted to the hospital for several days on average. Our orthopedic surgeons began booking them as same day discharges. In navigating this new plan of care, we identified a lack of knowledge of the PACU RN regarding discharge instructions for these patients. The required home discharge information included: antibiotics, anticoagulation therapy, home visits with nursing, and physical therapy. Coordinating these therapies, same day, was identified as a new process for the PACU RN. <h3>Objective of Project</h3> The objective and goal of this project was to ensure our patients have a safe discharge on post-op day zero with adequate preparation for medication management and the necessary services at home. <h3>Process of Implementation</h3> Our team identified the key stakeholders to accomplish our objective. These stakeholders included: Orthopedic surgery, Orthopedic Nurse Practitioner, Case Management, Physical Therapy, PACU management, and PACU staff members. Multiple meetings occurred between these multidisciplinary team members to discuss each member's expectations for a safe discharge, potential roadblocks, and solutions. Issues identified were Case Management coverage for PACU, proper lovenox teaching, and physical therapy evaluation equipment needed in the PACU. These issues were addressed and resolved. To assure that the complex criteria for discharge was met, the PACU RN's created a tool to assist with this process. This tool listed all the activities to be completed prior to discharge. <h3>Statement of Successful Practice</h3> The identification of proper discharge requirements and the creation of the "Orthopedic Same-Day Surgery Tip Sheet" streamlined the discharge process. This tip sheet provided guidance to RN's to ensure each patient was being sent home with the correct teaching and tools for a safe same-day discharge. During the post-operative phone call the patients confirmed that the discharge instructions were complete and the home visits were scheduled. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> The identification of a knowledge deficit led to a multidisciplinary group collaborating on best practices. The creation of a PACU "Tip Sheet" gave the RN's the necessary tool and knowledge to care for the same day discharged total joint patient. Our patients are going home with proper education and resources needed for a successful and safe recovery at home.

Latent variable mixture models to address heterogeneity in patient-reported outcome data.

The populations included in studies that investigate patient-reported outcome (PRO) measures of health or well-being, including health-related quality of life, are often heterogeneous with respect to their sociodemographic and health status characteristics. If the sources of heterogeneity are not observed or are not known a priori, latent variable mixture models (LVMMs) can be used to identify homogeneous sub-groups within the study population based on observed patterns of responses in PRO data. Our purpose is to review the characteristics of LVMMs and their applications for PRO data, and provide a demonstration of their use. We focus on mixture item response theory (IRT) models, which combine latent class analysis with the conventional IRT model to define the measurement model for one or more latent variables. In PRO studies, IRT models can be used to assess differential item functioning and response shift. An illustrative example is presented using clinical registry data for 1391 total hip replacement patients who provided responses for the physical component items of the 12-item Short Form Health Survey (SF-12). After assessing model fit and class discrimination statistics, a three-class model was selected. Model parameter estimates across classes were dissimilar for many of the items. Sex and self-reported presence of arthritis and back pain were associated with class membership. LVMMs represent a potentially useful tool to explore patterns of responses in PRO data. Opportunities for other applications of LVMMs to PRO data are discussed.

Impact of age, sex and surgery type on engagement with an online patient education and support platform developed for total hip and knee replacement patients.

Patients should be active participants in the management of their condition and provided with appropriate information throughout their care pathway. We piloted an online digital platform (ODP) to deliver patient education and support (PES) for patients undergoing total hip (THR) and knee replacements (TKR). The aim of this study is to analyse the demographics of patients using the ODP, determine how and when they accessed the ODP and how different sexes and age groups interacted with the ODP. Demographics and program library logs for patients registered to the ODP between 21st September 2017 and 28th May 2020 was obtained. Associations between age, sex, type of surgery and engagement were assessed using statistical comparisons. 1195 patients were registered on the ODP of which 832 (69.6%) accessed their carepacs. Patients accessed the content within their carepacs a mean of 29.1 times, spending a mean total time of 83 minutes. There was greater engagement for patients with a THR carepac (75.5%) compared to TKR (63.8%) (p<0.001). There were no differences in the proportion of patients that accessed the ODP or the total time spent on the platform dependent upon age (p = 0.34). Females accessed the platform more than males (p = 0.03). The use of a computer to access the ODP increased as age increased, whereas the use of a phone was favoured by the younger age groups (p<0.001). An ODP providing information to patients regarding their surgery is effective and demonstrates high levels of patient engagement. An online resource such as this does not discriminate against age or sex in terms of accessibility and can be useful for information provision.