Joint Replacement Center Research Articles

Periprosthetic hip infection: Current concepts and the Wrightington experience

Total hip arthroplasty (THA) is a highly successful operation performed worldwide in increasing numbers for a wide range of indications. There has been a corresponding rise in the incidence of periprosthetic joint infection of the hip (PJIH), which is a devastating complication.There is a significant variation in the definition, diagnosis and management of PJIH largely due to a lack of high-level evidence. The current standard of practice is largely based on cohort studies from high-volume centres, consensus publications amongst subject experts, and national guidance. This review describes our philosophy and practical approach of managing PJIH at a regional tertiary high-volume joint replacement centre.

Optimizing Interhospital Transfers in Orthopedics and Trauma Surgery: Challenges, Insights, and Proposals for Standardized Care in Germany.

Germany's high density of under-equipped hospitals and anticipated surge in orthopedic and trauma surgery-related diseases by 2030, combined with personnel shortages, are expected to increase patient transfers between hospitals, an issue that urgently needs standardized protocols. Despite some existing cooperative agreements, such as between joint-replacement centers or within the Trauma Network DGU®, these measures do not adequately address the full range of patient-transfer cases, including those due to a lack of specialization or staff shortages, resulting in delayed treatment and potential health risks. This study aims to dissect the intricacies of interhospital transfers in orthopedics and trauma surgery across Germany, focusing on understanding the underlying reasons for transfers, comparing the operational structures of small and large hospitals, and laying the groundwork for future standardized protocols to enhance patient care. A cross-sectional study was conducted in the form of an online survey via SoSci Survey, which was directed at orthopedic surgeons and trauma surgeons working in hospitals in Germany. The 22-question survey gathered information on participants' clinic roles, departmental details, transfer processes, frequent diagnoses, perceptions of transfer quality, and improvement areas. The survey was sent to orthopedic and trauma surgeons in Germany by the specialist society. The data were analyzed using descriptive and inferential statistics to ensure a comprehensive insight into interhospital transfer practices. The study involved 152 participants from various hospital ranks and located in different hospital sizes and types across rural and urban areas. A significant difference was observed between the care structures of basic/regular care and central/maximum care hospitals, especially regarding the available facilities and specialties. These findings suggest improvements such as better patient documentation, increased digital communication, optimized patient distribution, and standardization of transfer requests, among others. This study highlights the urgent need for improved protocols and resource allocation to eliminate inequalities in transfers between hospitals in orthopedics and trauma surgery in Germany.

Trends in the reasons for revision total knee arthroplasty

Introduction: As the number of annual total knee arthroplasty (TKA) procedures increases the number of revision surgeries will continue to increase. Several prior studies have identified various mechanisms of TKA failure and reported a number of reasons as the most common causes. The purpose of this review was to evaluate the causes of revision TKA at a single institution and to compare those reasons with previously published data in order to provide a current update on the topic. Methods: A retrospective review of all patients undergoing TKA revision by board-certified surgeons at a single institution between January 2, 2014 and October 16, 2020 was conducted. Statistical analysis was performed to identify trends among revision reasons and compare postoperative outcomes. Results: Of the 548 patients, 179 (32.7%) had an early revision and 369 (67.3%) had a late revision. The most common causes for early revision were infection (31.3%), loosening (27.4%), and instability (10.1%). The most common causes for late revision were loosening (29.5%), infection (22.2%), and polyethylene wear (20.3%). Postoperatively, there were no significant differences in OR time, length of stay, discharge status, 30-day readmission rates, or 30-day emergency department return rates between early and late revisions. Discussion: This study demonstrated the main causes for revision at a high-volume orthopedic joint replacement center. The most common reasons for revision were infection, loosening, instability, and polyethylene wear. This data in comparison to studies in the past suggests that the causes of revision are constantly evolving and need to be reassessed periodically in order to align focus on improvement.

Outcome of medial open wedge high tibial osteotomy and conversion knee arthroplasty in a local joint replacement centre

Background The primary purpose of this study is to evaluate the long-term survivorship of medial open wedge high tibial osteotomy. The secondary purpose is to review the clinical outcome and surgical challenges during conversion knee arthroplasty. Methodology The patients with medial open wedge high tibial osteotomy performed from 1995 to 2019 were reviewed. The survivorship, surgical particulars and clinical outcomes of the conversion arthroplasty were reviewed. Results There were 61 medial open wedge high tibial osteotomy performed from 1995 to 2019. The overall 10-year survival rate of medial open wedge high tibial osteotomy is 83.7%. In total, 22 medial open wedge high tibial osteotomy required conversion arthroplasty and none of them required revision in the study period. The patients who required conversion arthroplasty had higher mean posterior tibial slope than those who did not require it (14.5° vs 11.6°; p = 0.047). In total, 52.3% required quadriceps snip for exposure, 14.3% need a tibial stemmed component and 9.5% need a constrained total knee replacement. There was statistically significant improvement in Knee Society knee score, functional score, and range of motion after the conversion arthroplasty. Conclusion The 10-year survival rate of medial open wedge high tibial osteotomy is satisfactory. The patients who required conversion arthroplasty had higher mean posterior tibial slope. In conversion cases, with careful pre-operative planning, most of them can be converted to conventional total knee replacement. The range of movement and functional scores significantly improved after conversion arthroplasty. Also, patellar baja or not does not predict the need for quadriceps snip during conversion arthroplasty.

Revision rate of periprosthetic joint infection post total hip or knee arthroplasty of 34 hospitals in China between 2015 and 2017: a multi-center survey

Objective: To investigate the rate of periprosthetic joint infection (PJI) revision surgeries and clinical information of hip-/knee- PJI cases nationwide from 2015 to 2017 in China. Methods: An epidemiological investigation. A self-designed questionnaire and convenience sampling were used to survey 41 regional joint replacement centers nationwide from November 2018 to December 2019 in China. The PJI was diagnosed according to the Musculoskeletal Infection Association criteria. Data of PJI patients were obtained by searching the inpatient database of each hospital. Questionnaire entries were extracted from the clinical records by specialist. Then the differences in rate of PJI revision surgery between hip- and knee- PJI revision cases were calculated and compared. Results: Total of 36 hospitals (87.8%) nationwide reported data on 99 791 hip and knee arthroplasties performed from 2015 to 2017, with 946 revisions due to PJI (0.96%). The overall hip-PJI revision rate was 0.99% (481/48 574), and it was 0.97% (135/13 963), 0.97% (153/15 730) and 1.07% (193/17 881) in of 2015, 2016, 2017, respectively. The overall knee-PJI revision rate was 0.91% (465/51 271), and it was 0.90% (131/14 650), 0.88% (155/17 693) and 0.94% (179/18 982) in 2015, 2016, 2017, respectively. Heilongjiang (2.2%, 40/1 805), Fujian (2.2%, 45/2 017), Jiangsu (2.1%, 85/3 899), Gansu (2.1%, 29/1 377), Chongqing (1.8%, 64/3 523) reported relatively high revision rates. Conclusions: The overall PJI revision rate in 34 hospitals nationwide from 2015 to 2017 is 0.96%. The hip-PJI revision rate is slightly higher than that in the knee-PJI. There are differences in revision rates among hospitals in different regions.

Identified gamification opportunities for digital patient journey solution during an arthroplasty journey: secondary analysis of patients' interviews.

AimThe use of gameful design for supporting health‐related behaviours has been one of the major trends in health technology. An opportunity to increase engagement and motivation in a given health behaviour and the possibility of reaching improved outcomes through continued or consistent behaviour could be provided by gamification. This study aimed to identify gamification opportunities for digital patient journey solutions to increase patients' engagement and motivation for health‐related behaviour during an arthroplasty journey.DesignA secondary analysis.MethodSemistructured interviews were performed among 20 elective primary total hip and knee arthroplasty patients in a single joint‐replacement centre in Finland during autumn 2018. NVivo software was used for deductive content analysis. The study was conducted among 20 patients in a single joint replacement centre during 2018.ResultsSeveral opportunities for gamification were identified for digital patient journey solutions, which could be used in advanced care to increase patients' engagement and motivation for health‐related behaviour during the arthroplasty journey. These opportunities were identified related to five dimensions: accomplishment, challenge, guided, playfulness and social experience. Clear, scheduled, progressive and personalized goals with an activity tracking, real‐time timespan visualization and social networking with peers, support networks and healthcare providers could be provided. Opportunities for competition and immersion were not identified.

Defining Failure in Primary Total Joint Arthroplasty: The Minimal Clinically Important Difference for Worsening Score.

We define the value of the Minimal Clinically Important Difference for Worsening (MCID-W) for Patient-Reported Outcomes Measurement Information System Physical Function short form 10-a (PROMIS-PF-10a) score for primary total joint arthroplasty (TJA) of the hip and knee and describe the risk factors for patients scoring worse than the MCID-W. This retrospective study was performed using 3414 primary TJA patients. PROMIS-PF-10a scores were collected at the preoperatively and postoperatively, and patients were classified based on reaching Minimal Clinically Importance Difference for Improvement (MCID-I), MCID-W, or "no significant change" after TJA (scores betweex`n MCID-W and MCID-I). MCID-W and MCID-I values were determined by a distribution method. The association between numerous variables and scoring worse than the MCID-W of PROMIS-PF-10a was then evaluated through multiple logistic regression. A threshold for preoperative PROMIS-PF-10a score predicting decline past MCID-W was determined using the Youden index and receiver operating characteristic curve. The MCID-W for TJA was-1.89. Notably, increasing length of stay (odds ratio [OR] 1.073, 95% confidence interval [CI] 1.029-1.119, P < .001) and increasing preoperative PROMIS-PF-10a scores (OR 1.117, 95% CI 1.091-1.144, P < .001) were associated with increased likelihood of decline past the MCID-W of the PROMIS-PF-10a for TJA compared with patients who achieved the MCID-I. A community hospital with a dedicated joint replacement center was associated with a decreased risk for decline past the MCID-W (OR 0.601, 95% CI 0.402-0.899; P= .013). We described the MCID-W value (-1.89) for the PROMIS-PF-10a questionnaire for knee and hip TJA and associated patient- and hospital-level risk factors for failure after TJA. Healthcare funding initiatives should be directed toward modifiable factors associated with clinically significant worse outcomes after TJA.

Early Outcomes of Dual-Pivot Total Knee Replacement Compared to an Ultracongruent Design.

With a quest to optimize outcomes, there have been significant advancements in modern designs of total knee implants, attempting to mimic the natural knee motion and feel. One such new design reproducing the medial and lateral knee pivot is a dual-pivot (DP) knee. In the present study, we endeavored to compare the performance of the DP knee vis-a-vis an ultracongruent (UC) Knee design. This prospective cohort study was performed in a joint replacement center of a tertiary care military hospital. We enrolled 50 patients each in the DP knee group and the UC knee group and assessed knee flexion, patient-reported outcome (new Knee Society Score [nKSS]), patient performance (Delaware Osteoarthritis Profile Score), and function (Forgotten Joint Score [FJS]) at 2 years of follow-up. The nKSS was similar in the two groups. In the DP group, patients had significantly better improvement in the stair climb test (p = 0.026). In the UC group, timed up and go test was significantly better (p = 0.004). The gain in knee flexion was similar in the two groups: 26.3° ± 23.3° in the DP group and 27.5° ± 27.5° in the UC group (p = 0.930). Return to activity as judged by 2-year FJS was similar in both groups (p = 0.687). Our study showed that the DP knee design had similar knee function to the UC knee. The DP knee design had significantly better stair climbing ability, whereas getting up from chair was better in the UC knee design. With comparable patient-reported outcome and possible differences in patient performance in terms of day-to-day activities, any future trial should focus on comparing patient performance.

Les indications de prothèse de genou unicompartimentale médiale diminuent-elles avec l’âge ?

BackgroundThe effect of age on the percentage of primary knee replacements appropriate for unicompartmental replacement (UKR), defined as candidacy, is unknown. The aim was to determine the candidacy and outcome of UKR in different age groups. HypothesisAge is associated with candidacy for medial UKR. Patients and methodsThis cross-sectional study determined UKR candidacy from preoperative radiographs, including stress views, from 457 consecutive knee replacements (TKR or UKR) in a specialist joint replacement centre. Candidacy, estimated from radiographs and from usage, was determined for all knees and then stratified by age group <50, 50–60, 60–70, 70–80, and 80+. The outcome of UKR implanted in these groups was also assessed. To avoid overestimating, candidacy estimated by usage was used for the primary analysis. ResultsCandidacy decreased with age (OR 0.98, p=0.008) and was 61% (CI42-78), 52% (CI43-61), 43% (CI35-51), 41% (CI31-52), and 36% (CI22-52) respectively. Candidacy estimated by radiographs was slightly higher overall (49% compared to 46%) and in all age groups than candidacy estimated from usage. Neither functional outcome (p=0.47) nor implant survival (p=0.54) was affected by age. Overall, 80% achieved good/excellent Knee Society objective scores, and the five-year implant survival was 99%. DiscussionThere is a strong association of candidacy for UKR with age in that younger patients are more likely to be candidates (61% in those <50 and 36% in those 80+). Good outcomes can be expected in patients of all ages who are appropriate for UKR. Level of evidenceIV, Prognostic cross-sectional study.

Identified opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey: Secondary analysis of healthcare professionals' interviews.

To identify opportunities for gamification in the elective primary fast-track total hip and knee arthroplasty journey in order to support patients' health-related behaviour. Gamification provides an opportunity to increase engagement in a given health behaviour and, eventually, the possibility of reaching improved outcomes through continued or consistent behaviour. A secondary analysis. Semi-structured interviews were conducted with 20 healthcare professionals in a single joint-replacement centre in Finland during autumn 2018. NVivo software was used for deductive and inductive coding. The open codes were also calculated. The consolidated criteria for reporting qualitative research were followed. Gamification opportunities were identified related to six dimensions: accomplishment, challenge, competition, guided, playfulness and social experience. Based on the frequencies of the coded content, most opportunities for gamification can be identified in the context of personalised counselling, monitoring and social support. Several opportunities for gamification were identified and quantified. While various needs and limitations need to be considered when developing digital gamified solutions and more research into the effectiveness of such solutions will be required, the current study opens possible future avenues for exploring the use of gamification in lower limb joint replacement journey and other specialisms. This study provides an important insight into healthcare professionals' views of the current state of the total hip and knee arthroplasty journey and the potential for its development. In addition, it pinpoints the biggest opportunities for gamified services in the context of personalised counselling, monitoring and social support. Despite the focus of this secondary analysis being on the arthroplasty journey, the findings can also be generalised in other surgical journeys.

Candidacy for medial unicompartmental knee replacement declines with age

BackgroundThe effect of age on the percentage of primary knee replacements appropriate for unicompartmental replacement (UKR), defined as candidacy, is unknown. The aim was to determine the candidacy and outcome of UKR in different age groups. HypothesisAge is associated with candidacy for medial UKR. Patients and MethodsThis cross-sectional study determined UKR candidacy from preoperative radiographs, including stress views, from 457 consecutive knee replacements (TKR or UKR) in a specialist joint replacement centre. Candidacy, estimated from radiographs and from usage, was determined for all knees and then stratified by age group<50, 50–60, 60–70, 70–80, and 80+. The outcome of UKR implanted in these groups was also assessed. To avoid overestimating, candidacy estimated by usage was used for the primary analysis. ResultsCandidacy decreased with age (OR 0.98, p=0.008) and was 61% (CI 42–78), 52% (CI 43–61), 43% (CI 35–51), 41% (CI 31–52), and 36% (CI 22–52) respectively. Candidacy estimated by radiographs was slightly higher overall (49% compared to 46%) and in all age groups than candidacy estimated from usage. Neither functional outcome (p=0.47) nor implant survival (p=0.54) was affected by age. Overall 80% achieved good/excellent Knee Society objective scores, and the five-year implant survival was 99%. DiscussionThere is a strong association of candidacy for UKR with age in that younger patients are more likely to be candidates (61% in those<50 and 36% in those 80+). Good outcomes can be expected in patients of all ages who are appropriate for UKR. Level of evidenceIV, Prognostic cross-sectional study.

Patients' satisfaction and experiences during elective primary fast-track total hip and knee arthroplasty journey: A qualitative study.

To explore how satisfied patients are with the process of treatment and care and to identify the experiences that patients perceive during elective primary fast-track total hip and knee arthroplasty journey. Greater satisfaction with care has predicted better quality of recovery, and patient experience has been positively associated with patient safety and clinical effectiveness. However, a little is still known about how patients experience their treatment and care. A qualitative interview study. The study was conducted among 20 patients in a single joint replacement centre during 2018. Patient satisfaction was measured using a numerical rating scale. Patients' experiences were identified through qualitative semi-structured interviews which were analysed using an inductive content analysis method. The COREQ checklist was used (Supporting Information). The mean numerical rating scale score for overall satisfaction was 9.0 (SD 1.1) on a scale from 0-10. The patients' experiences were grouped under eight main categories that were derived from the qualitative data in the analysis: (a) patient selection, (b) meeting the Health Care Guarantee, (c) patient flow, (d) postdischarge care, (e) patient counselling, (f) transparency of the journey, (g) communication and (h) feedback. The findings suggest that patients are highly satisfied after an elective primary fast-track total hip and knee arthroplasty. However, closer analysis of the patients' experiences reveals challenges and suggestions on how they could be solved, often involving digital technologies. As the number of total joint arthroplasties grows, patients and their families need to take ever greater responsibility, for their own care from advance preparation to rehabilitation. The findings of the study can be used to organise work, improving patient-clinical communication, fostering engagement and improving patient centredness. In addition, the results pinpoint the issues on how the patient experience could be improved.

Variability of patient and surgical risk factors for infection in a single, urban, academic total joint replacement center

BackgroundWe describe surgeon-specific patient and procedure variability in a single center to determine how much variability exists between surgeons. MethodsData was analyzed from 2009 to 2013 at a single center. The total number of primary and revision hip and knee arthroplasty surgeries were quantified for each surgeon. ResultsSurgeon caseload varied significantly, with the largest differences observed in primary TKA caseload. The largest patient differences were in regards to percentage of patients with diabetes mellitus amongst primary TKA patients ConclusionSignificant differences in patient characteristics that could significantly impact outcomes after total joint arthroplasty were found amongst surgeons.

Healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey: A qualitative interview study.

To examine the lived experience of healthcare professionals providing care for patients with total hip and knee arthroplasty and to understand healthcare professionals' proposed eHealth needs in elective primary fast-track hip and knee arthroplasty journey. There is little evidence in nursing literature to indicate how to develop new eHealth services to support surgical care journeys. Evidence is particularly lacking regarding the development of eHealth solutions. This was a qualitative interview study. Semi-structured interviews were conducted with four surgeons, two anaesthesiologists, ten nurses and four physiotherapists in a single joint replacement centre during autumn 2018. The data were analysed using an inductive content analysis method. NVivo qualitative data analysis software was used. The COREQ checklist for qualitative studies was followed. Our research addressed the gap in evidence by focusing on the four main parts of the patient journey in the selected context. Analysis of the data revealed nine main categories for the proposed eHealth needs: eligibility criteria, referrals, meeting the Health Care Guarantee, patient flow, postdischarge care, patient counselling, communication, transparency of the journey and receiving feedback. In addition, the requirements and further development needs for eHealth solutions were generally identified. From the point of view of healthcare professionals, eHealth solutions have huge potential in supporting the elective primary fast-track hip and knee arthroplasty journey. However, it is important to acknowledge that these needs may be very different depending on the technological and organisational environment in question. More effective use of information and communication technologies is needed for organisational optimisation resulting in a streamlined pathway, better access to healthcare services, improved outcomes and an improved patient experience. These results can be used in the development of new eHealth solutions to support surgical care journeys and patient education.

Rapid Recovery After Total Joint Arthroplasty Using General Anesthesia

BackgroundMultiple papers have purported the superiority of spinal anesthesia used in total joint arthroplasty (TJA). However, there is a paucity of data available for modern general anesthesia (GA) regimens used at high-volume joint replacement centers. MethodsWe retrospectively reviewed a series of 1527 consecutive primary TJAs (644 total hip arthroplasties and 883 total knee arthroplasties) performed over a 3-year span at a single institution that uses a contemporary GA protocol and report on the length of stay, early recovery rates, perioperative complications, and readmissions. ResultsFrom the elective TJAs performed using a modern GA protocol, 96.3% (n = 1471) of patients discharged on postoperative day 1, and 97.2% (n = 1482) of subjects were able to participate with physical therapy on the day of surgery. Only 6 patients (0.4%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 2.4% (n = 36), while the reoperation rate was 1.3% (n = 20). DiscussionNeuraxial anesthesia for TJA is commonly preferred in high-volume institutions utilizing contemporary enhanced recovery pathways. Our data support the notion that the utilization of modern GA techniques that limit narcotics and certain inhalants can be successfully used in short-stay primary total joint arthroplasty. Level of EvidenceIV– Case series.

Total hip replacement surgery in Ethiopia

Background: Total hip replacement (THR) surgery has evolved over years to the point that it has been considered as "the operation of the century". For developed countries, arthroplasty is well established for the management of various joint disorders and has completely revolutionised the treatment of the arthritic hip. The story is different in developing nations. Expensive implant costs and lack of trained orthopaedic surgeons are the main constraints; poverty has caused African countries to remain behind from enjoying the benefits of this medical breakthrough. In this study, we report our first and largest series of 50 such surgeries performed at the CURE Hospital in Addis Ababa. We believe that this is the first consecutive case series from Ethiopia and wanted to share our experience.Methods: Prospectively, all consecutive patients that underwent THR at CURE Hospital from October 2009 to October 2013 were followed for over 3 years using clinical assessments and hip scores. The hip implant used was a Stryker Omnifit Uncemented HA-coated prosthesis. The Visual Analog Scale (VAS) for pain and the Modified Oxford Hip Score were used to assess outcomes. Variables recorded for each patient included sociodemographic information, diagnosis, comorbidity, surgical approach, duration of surgery, estimated blood loss, implant sizes for Ethiopian hips, complications, sequelae, hip scores, and final patient satisfaction. These were analysed using SPSS version 16. Patterns and learning points were observed.Results: Of the 50 consecutive THR patients, 26 were male. Mean age was 48 years (range 14-85). In 30 hips, the right side was operated on, and 2 were bilaterally treated. Primary osteoarthritis (OA) and avascular necrosis (AVN) were the leading diagnoses requiring THR. Previous partial hip replacement (PHR, hemiarthroplasty) was converted to THR in 6 patients. The commonest comorbidities were diabetes mellitus and hypertension. There were 4 hips that dislocated after THR and 1 needed revision surgery. There was 1 persistent infection, 1 case of deep vein thrombosis (DVT), and 1 death. Mean EBL was approximately 1 L and only 5 patients needed transfusion. The most common sizes for Ethiopian hips were a 28 mm+0 head, 52 mm acetabular shell, and 140 mm #8 stem. The VAS and Modified Oxford Hip scores both improved significantly, and the results were comparable with international standards.Conclusions: THR is a viable, safe, and effective option in Ethiopia. Appropriate staff training, careful patient selection, continuous supply chain of implants, and establishing a dedicated joint replacement centre will reliably sustain THR surgery.Keywords: THR; total hip arthroplasty; osteoarthritis; hip surgery; implants; arthritis; hip prosthesis

Popliteal artery thrombosis a TKA complication due to retractor: a report of two cases treated with endovascular reconstruction

Arterial thrombosis after total knee arthroplasty (TKA) is a rare but limb-threatening complication, and early diagnosis and intervention are critical. However, delayed diagnosis is not uncommon, even in high-volume joint replacement centers. Some studies have indicated that patients with preexisting vascular disease have an increased risk of vascular injury during TKA. Thus, we report two cases from our center, which were treated during a 4-month period, that developed acute popliteal artery thrombosis immediately after TKA, despite the absence of preoperative vascular abnormalities in the affected lower limbs. In both cases, absence of a foot pulse was detected in time to successfully manage the complication using endovascular stent deployment, rather than open surgery. After the second case, the complications were attributed to improper use of single-pronged retractors, which were applied to the posterior surface of the tibial plateau. No other cases with similar complications have occurred. Thus, these cases indicate that direct instrument-related blunt injury can cause popliteal arterial thrombosis after TKA, and that the thrombosis can be successfully treated using the endovascular approach.

A qualitative study of patient education needs for hip and knee replacement

BackgroundQuality health information is key to patient engagement, self-management and an enhanced healthcare experience. There is strong evidence to support involving patients and their families in the development and evaluation of health-related educational material. These factors were the impetus for our high volume joint replacement centre to undertake a qualitative study to elicit patient experiences to inform the development of effective strategies and education along the care continuum for hip and knee replacement.MethodsPurposively selected patients from postoperative follow-up clinics were recruited to participate in a focus group or telephone interview. We developed a semi-structured interview guide that addressed four specific aspects of the patient’s experience with educational material: pre-surgery, hospital stay, recovery period and future recommendations. The focus groups and interviews continued to the point of saturation and were audio-recorded and transcribed verbatim. Interview transcripts were coded and then inductively organized into larger categories using thematic analysis.ResultsSix focus groups and seven telephone interviews were conducted, totalling 32 participants. One of the key themes that emerged was a need for more education concerning pain management post-operatively; specifically, patients wanted more information on expected levels of pain, pain medication usage, management of side effects and guidelines for weaning off the medication. There was surprising variability in patients’ descriptions of their pre-surgery, surgery and recovery experiences. These corresponded to an equally diverse range of preferences for educational content, delivery and timing. Many patients reported using the web while others preferred traditional formats for information delivery. There was some interest in receiving education using mobile technology.ConclusionsOur findings validate the importance of multi-modal patient education tailored to individual preferences and experiences, which may differ according to such characteristics as gender and age. The gap in pain management information is a critical finding for healthcare providers working with patients undergoing joint replacement. Developing pain management education in different formats that addresses frequently asked questions will enhance patient engagement and, their overall experience and recovery.

Bilateral Sequential Total Knee Replacement Versus Unilateral Total Knee Replacement in a High Volume Hospital: 在大手術量醫院中雙側順序全膝關節置換術與單側全膝關節置換術的比較

Background/purposeBilateral simultaneous or sequential total knee replacement (TKR) is performed on a portion of patients but the benefits and risks remain controversial. MethodsA total of 89 sequential bilateral TKR (BTKR) patients were compared with 89 unilateral TKR (UTKR) patients in our total joint replacement centre from October 2011 to October 2014. The baseline parameters were matched and postoperative results were compared. ResultsThe BTKR group had a shorter length of stay per knee (4.8 days vs. 6.5 days) but with a higher total drain output, higher haemoglobin drop, higher transfusion rate, and more postoperative acute retention of urine. Both groups had similar major complication rates and no 90 days mortality. ConclusionBTKR is a safe surgery in selected patients performed in a high volume hospital with fast-track programme.

Predictive factors for length of hospital stay following primary total knee replacement in a total joint replacement centre in Hong Kong.

The demand for total knee replacement in Hong Kong places tremendous economic burden on our health care system. Shortening hospital stay reduces the associated cost. The aim of this study was to identify perioperative predictors of length of hospital stay following primary total knee replacement performed at a high-volume centre in Hong Kong. We retrospectively reviewed all primary total knee replacements performed at Yan Chai Hospital Total Joint Replacement Centre from October 2011 to October 2015. Perioperative factors that might influence length of stay were recorded. A total of 1622 patients were identified. The mean length of hospital stay was 6.8 days. Predictors of prolonged hospital stay following primary total knee replacement were advanced age; American Society of Anesthesiologists physical status class 3; bilateral total knee replacement; in-patient complications; and the need for blood transfusion, postoperative intensive care unit admission, and urinary catheterisation. Evaluating factors that can predict length of hospital stay is the starting point to improve our current practice in joint replacement surgery. Prediction of high-risk patients who will require a longer hospitalisation enables proactive discharge planning.