Outcomes Of Total Joint Arthroplasty Research Articles

Superficial mycosis, at the site or distant to the surgical site, appears to predispose patients to bacterial periprosthetic joint infections.

It is traditionally believed that presence of fungal infection in the nail or skin of patients is a risk factor for subsequent infection. The literature is devoid of any evidence to confirm or refute this belief. This study examined a possible relationship between the presence of superficial skin or nail mycoses and subsequent periprosthetic joint infection (PJI) in patients undergoing total joint arthroplasty (TJA). This is a single-centre, retrospective study of patients who underwent primary TJA between 2000 and 2018. 55 patients with superficial mycoses of skin or nail, at the time of arthroplasty were identified and a variable number matching with up to a 1:5 ratio was performed with 182 patients undergoing TJA who had no superficial mycosis. The groups were further divided into knee and hip TJA. The outcome of TJA in the cohorts was compared. Preoperative demographics were similar between the 2 groups. The incidence of PJI in patients undergoing TKA within a year was significantly higher in patients with superficial mycosis at 8.6% (3/35) compared to 0% (0/120) in patients without mycosis. However, all infections were caused by bacterial species and none were fungal. Multiple regression analysis demonstrated that the presence of superficial mycosis had a strong correlation with development of PJI postoperatively in our TKA cohort. Identification of fungal infection (mycosis) of skin and nail in patients awaiting TJA is important. These patients appear to have a higher risk for developing bacterial PJI than those without fungal infections. Further study is needed to determine if treatment of these patients prior to arthroplasty stands to reverse the high risk for PJI that these patients carry.

The Impact of Sars-CoV-2 Pandemic on Patient Selection, Length of Stay, and Short-Term Postoperative Outcomes in Elective Total Joint Arthroplasty.

Introduction: The purpose of this study is to examine how COVID-19 has impacted patient selection and short-term outcomes for total joint arthroplasty (TJA). Methods: Retrospective study of patients who underwent TJA between 1/1/2019-8/1/2020 at an urban multi-center institution. Baseline characteristics and short term outcomes were reviewed. Study groups were assigned by date of procedure. Results: 5448 patients (2871 total knee and 2677 total hip arthroplasties) met inclusion criteria with 652 TJA performed in post-COVID period. Patients undergoing TJA after COVID-19 were younger, had lower ASA scores, had increased operative times, decreased LOS, greater proportion of home discharges, and lower readmission and reoperation rates. Discussion: We observed significant differences in patient characteristics and short-term postoperative outcomes for patients undergoing TJA after the spread of COVID19.

Temporal Trends in Revision Total Hip and Knee Arthroplasty from 2008 to 2018: Gaps and Opportunities.

An overall assessment of how patient demographic characteristics and comorbidities are improving or worsening can allow better understanding of the value of revision total joint arthroplasty (TJA). Therefore, the purpose of this study was to identify patient demographic characteristics and comorbidities trends and episode-of-care outcome trends from 2008 to 2018 in patients undergoing revision TJA. The National Surgical Quality Improvement Program database was queried to identify patient demographic characteristics, comorbidities, and episode-of-care outcomes in patients undergoing revision TJA from 2008 to 2018 (n = 45,706). Pairwise t tests and pairwise chi-square tests were performed on consecutive years with Bonferroni correction. Trends were assessed using the 2-tailed Mann-Kendall test of the temporal trend. Among patients undergoing revision TJA, there was no clinically important difference, from 2008 to 2018, in age, body mass index (BMI), percentages with >40 kg/m2 BMI, diabetes (18.8% to 19%), chronic obstructive pulmonary disease (4.1% to 5.4%), congestive heart failure within 30 days (0% to 1%), or acute renal failure (0% to 0.2%). However, modifiable comorbidities including smoking status (14.7% to 12.0%; p = 0.01), hypertension (66% to 26.0%; p = 0.02), anemia (34.5% to 26.3%; p < 0.001), malnutrition (10.4% to 9.3%; p = 0.004), and overall morbidity or mortality probability have improved, with a decrease in the hospital length of stay and 30-day readmission and a significant increase in home discharge (p < 0.001 for all). Time-difference analysis demonstrated that the overall health status of patients undergoing revision TJA improved from 2008 to 2018. However, formal time-trend analysis demonstrated improvements to a lesser degree. The multidisciplinary effort to improve value-based metrics including patient comorbidity optimization and episode-of-care outcomes for primary TJA has been shown to potentially have an impact on revision TJA. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Outcomes of total joint arthroplasty in patients with depression: A systematic review

BackgroundDepression has been implicated as a poor predictor of outcomes after total joint arthroplasty (TJA) of the lower extremity in some studies. We aimed to determine whether depression as a comorbidity affects the TJA outcomes and whether pain reduction associated with successful TJA alters depressive symptoms. MethodsA search of PUBMED was performed using keywords “depression”, “arthroplasty”, “depressive disorder”, and “outcomes.” All English studies published over the last ten years were considered for inclusion. Quantitative and qualitative analysis was then performed on the data. ResultsThirty articles met inclusion criteria (16 retrospective, 14 prospective). Three showed that depressed patients were at higher risk for readmission. Two reported that depressed patients had higher likelihood of non-home discharge after TJA compared to non-depressed patients. Four noted that depressed patients incur higher hospitalization costs than non-depressed patients. Ten suggest depression is a predictor of poor patient-reported outcome measures, pain, and satisfaction after TJA. Five suggested the gains depressed patients experience in functional outcome scores after TJA are similar to gains experienced by patients without depression. Another eight suggested that TJA improves not only function and pain but also depressive symptoms in patients with depression. ConclusionThe results of this review show that depression increases the risk of persistent pain, dissatisfaction, and complications after TJA. Additionally, depressed patients may incur higher costs than non-depressed patients undergoing TJA and may have worse preoperative and postoperative patient reported outcome measures (PROMs). However, the gains in function that depressed patients experience after TJA are equivalent to gains experienced by non-depressed patients and depressed patients may experience improvement in their depressive symptoms after TJA. Patient selection for TJA is critical and counseling regarding increased risk for complications is crucial in depressed patients undergoing TJA.

Postoperative Outcomes Following Total Hip and Knee Arthroplasty in Patients with Pain Catastrophizing, Anxiety, or Depression

BackgroundThe relationship among pain catastrophizing, emotional disorders, and total joint arthroplasty (TJA) outcomes is an emerging area of study. The purpose of this study is to examine the association of these factors with 1-year postoperative pain and functional outcomes. MethodsA prospective cohort study of preoperative TJA patients using the Pain Catastrophizing Scale and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) was conducted. Postoperative outcomes included Visual Analog Scale (VAS) pain, Oxford, Harris Hip (HHS) and Knee Society (KSS) scores. Median regression was used to assess the pattern of relationship among preoperative clinically relevant catastrophizing (CRC) pain, abnormal HADS, and 1-year postoperative outcomes. ResultsWe recruited 463 TJA patients, all of which completed 1-year follow-up. At 1 year, CRC-rumination (adjusted median difference 1; 95% confidence interval [CI] 0.31-1.69, P = .005) and abnormal HADS-A (adjusted median difference 1; 95% CI 0.36-1.64, P = .002) were predictors of VAS pain, CRC magnification a predictor of HHS/KSS (adjusted median difference 1.3; 95% CI 5.23-0.11, P = .041), and abnormal HADS-A a predictor of Oxford (adjusted median difference 3.68; 95% CI 1.38-5.99, P = .002). CRC patients demonstrated inferior VAS pain (P = .001), Oxford (P < .0001), and HHS/KSS (P = .025). Abnormal HADS patients demonstrated inferior postoperative VAS (HADS-A, P = .025; HADS-D, P = .030) and Oxford (HADS-A, P = .001; HADS-D, P = .030). However, patients with CRC experienced significant improvement in VAS, Oxford, and HHS/KSS (P < .05) from preoperative to 1 year. Similarly, patients with abnormal HADS showed significant improvement in VAS pain and HHS/KSS (P < .05). ConclusionTJA patients who are anxious, depressed, or pain catastrophizing have inferior preoperative and postoperative pain and function. However, as compared to their preoperative status, clinically significant improvement can be expected following hip/knee arthroplasty.

Effects of Preoperative Antiplatelet Agents and Anticoagulants on Total Joint Arthroplasty Outcomes.

Background: Postoperative total joint arthroplasty complications place a tremendous burden on the health care system. The purpose of this study was to compare 30-day postoperative complication rates for surgeries in patients who received preoperative antiplatelet agents and/or anticoagulants to surgeries in a control group that did not receive antiplatelet agents and/or anticoagulants in the 90 days prior to undergoing a total joint arthroplasty.Methods: We retrospectively reviewed total hip or knee arthroplasties from November 2012 to March 2016. Surgeries were categorized into 4 groups depending on their preoperative antiplatelet and anticoagulant status. Complications between the groups were compared using chi-square analysis and Fisher exact test.Results: In this study, 1,726 arthroplasties in 1,544 patients were included. Superficial wound complications were the most common complication in all 4 groups (3.8% of surgeries), with no significant difference between the groups. A statistically significant difference was found in the number of prosthetic joint infections in the group of surgeries with no antiplatelets or anticoagulants compared to surgeries with both medications administered during the 90 days preoperatively (0.82% vs 5.13%, P=0.0003). No significant difference was found between the groups with regard to stroke, myocardial infarction, pulmonary embolism, or deep venous thrombosis.Conclusion: Surgeries for which both antiplatelets and anticoagulants were administered in the 90 days preoperatively had a statistically significantly higher rate of prosthetic joint infections compared to surgeries with neither medication administered preoperatively. Surgeons can use this information to better inform and risk-stratify patients prior to surgery.

Systematic review of single stage revision for prosthetic joint infection.

While advanced technology, increased medical knowledge and improved surgical technique has improved patient outcomes in total joint arthroplasty, prosthetic joint infection still remains one of the leading causes of increased healthcare costs, medical resources and societal burdens in orthopaedic care. Two stage arthroplasty revision remains the gold standard for treatment of prosthetic joint infection. Proponents of single stage revision arthroplasty for infection argue that it results in lower healthcare costs while improving patient reported functional outcomes and with equivalent success rates. Here we review the history of single stage revision arthroplasty, discuss the key principles, highlight the indications and contraindications, and review the reported outcomes with a focus on future developments of single stage revision arthroplasty for hip and knee periprosthetic joint infections.

Comparison of total joint arthroplasty outcomes between renal transplant patients and dialysis patients\u2014a meta-analysis and systematic review

ObjectivesEnd-stage renal disease (ESRD) patients are at an increased risk of needing total joint arthroplasty (TJA); however, both dialysis and renal transplantation might be potential predictors of adverse TJA outcomes. For dialysis patients, the high risk of blood-borne infection and impaired muscular skeletal function are threats to implants’ survival, while for renal transplant patients, immunosuppression therapy is also a concern. There is still no high-level evidence in the published literature that has determined the best timing of TJA for ESRD patients.MethodsA literature search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to November 2019) was performed to collect studies comparing TJA outcomes between renal transplant and dialysis patients. Two reviewers independently conducted literature screening and quality assessments with the Newcastle-Ottawa Scale (NOS). After the data were extracted, statistical analyses were performed.ResultsCompared with the dialysis group, a lower risk of mortality (RR = 0.56, Cl = [0.42, 0.73], P < 0.01, I2 = 49%) and revision (RR = 0.42, CI = [0.30, 0.59], P < 0.01, I2 = 43%) was detected in the renal transplant group. Different results of periprosthetic joint infection were shown in subgroups with different sample sizes. There was no significant difference in periprosthetic joint infection in the small-sample-size subgroup, while in the large-sample-size subgroup, renal transplant patients had significantly less risk (RR = 0.19, CI = [0.13, 0.23], P < 0.01, I2 = 0%). For dislocation, venous thromboembolic disease, and overall complications, there was no significant difference between the two groups.ConclusionTotal joint arthroplasty has better safety and outcomes in renal transplant patients than in dialysis patients. Therefore, delaying total joint arthroplasty in dialysis patients until renal transplantation has been performed would be a desirable option. The controversy among different studies might be partially accounted for that quite a few studies have a relatively small sample size to detect the difference between renal transplant patients and dialysis patients.

A Literature Review and Summary Recommendations of the Impact of Bariatric Surgery on Orthopedic Outcomes.

Many surgeons recommend weight loss in preparation for orthopedic procedures, yet the impact of surgically induced weight loss before orthopedic procedures is not clear. We undertook a literature review to assess the impact of bariatric surgery on the outcomes of total joint arthroplasty (TJA). We searched PubMed, Medline, Cochrane Library, and Google Scholar for studies (2010-2017) that evaluated the associations between obesity, bariatric surgery, and orthopedic surgery. Nine studies found that prior bariatric surgery decreased major and minor post-operative complications, operating room (OR) time, length of stay (LOS), risk of re-operation, and 90-day re-admissions after TJA. Two studies found that bariatric surgery patients had a higher reoperation rate for stiffness and infection as well as need for revision within 90days after TJA. One meta-analysis found no statistically significant differences in wound infections, revisions, or mortality irrespective of bariatric surgery status; and another meta-analysis showed reduced medical complications, LOS, and OR time. Our review highlights many gaps in our knowledge and the need for additional studies to define the impact of the bariatric-first approach on TJA outcomes. We propose a framework from lessons learned to raise awareness of medical and surgical options of weight management before elective orthopedic operations in patients with obesity.

Should Insulin-dependent Diabetic Patients Be Screened for Malnutrition Before Total Joint Arthroplasty? A Cohort at Risk

The association of malnutrition in the morbidly obese cohort has led to recommendations for preoperative screening before total joint arthroplasty (TJA). However, despite the connection between diabetes and poor nutrition, preoperative screening in the diabetic cohort has not been closely examined. This study compared malnutrition risk between diabetic patients and morbidly obese patients undergoing TJA and investigated the association of malnutrition on 30-day postoperative TJA outcomes in the diabetic cohort. The National Surgical Quality Improvement Program database was queried, and primary TJA patients were identified for inclusion. Patients were stratified by body mass index and diabetes, and outcomes were reported as two composite groups: complications and infections in the 30-day postoperative period. Univariate and multivariate regressions were used for the analysis. Patients with insulin-dependent diabetes mellitus (IDDM) were at a high risk of being malnourished in both the morbidly obese and nonmorbidly obese populations (frequencies of 11.9% and 9.9%, respectively). Patients with IDDM, but without morbid obesity, were 1.5x more often malnourished than morbidly obese patients without diabetes mellitus (9.9% versus 6.4%, respectively, P < 0.001). In a multivariate analysis among patients with co-occurring diabetes and malnutrition, patients with IDDM were at greatest risk for postoperative complications and infection (odds ratio 2.081 [1.652, 2.621]; P < 0.001 and odds ratio 1.894 [1.231, 2.913]; P = 0.004, respectively). Patients with IDDM are at high risk for malnutrition, and increased vigilance should be maintained in this cohort before TJA to optimize outcomes. Future studies should further investigate the utility of preoperative malnutrition screening in this cohort.

Impact of Smoking and Drinking on Complications After Revision Total Joint Arthroplasty: A Matched Cohort Analysis.

Smoking and drinking have been shown to impair postoperative outcomes in primary hip and knee total joint arthroplasty (TJA). This study aimed to evaluate the potential impact of smoking and drinking on complications after revision TJA. We retrospectively evaluated a total of 4,302 consecutive patients who underwent revision TJA. Patient demographics and complications were compared between four cohorts based on smoking and drinking status: (1) nonusers (nonsmokers and nondrinkers), (2) smokers, (3) drinkers, and (4) concurrent users. A total of 1,924 patients were matched using propensity score analysis: 808 nonusers (42.0%), 421 smokers (21.9%), 483 drinkers (25.0%), and 212 concurrent users (11.1%). When compared with nonusers, smokers, drinkers, and concurrent users (simultaneous smokers and drinkers) exhibited higher odds for both inhospital complications (odds ratios, smokers: 2.40, drinkers: 1.55, and concurrent users: 5.13, P < 0.01). Among the user cohorts, although smokers and drinkers showed similar rates of 90-day postdischarge complications (smokers: 14.95% and drinkers: 14.80%, P = 0.95), concurrent users demonstrated the highest significant odds for these complications (odds ratio, 1.64, P = 0.02). Our propensity-score-matched cohort study results demonstrate that although the smokers and drinkers groups shared similarly poor outcomes after discharge, concurrent users were found to have the worst outcomes compared with either single user group.

Analysis of Outcomes of Total Cementless Hip Joint Arthroplasty in the Treatment of Advanced Hip Osteoarthritis Following Childhood Perthes' Disease.

The aim of this study is to analyse the outcomes of total cementless hip joint arthroplasty in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. The study enrolled 56 patients (15 women and 41 men) who underwent a total of 61 hip joint arthroplasties for coxarthrosis following Perthes' disease. The mean age of the patients at surgery was 46.7 years (range 21-67 years). The mean follow-up period was 13.7 years. Pre-operative Merle d'Aubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.7 points. The outcomes were classified as excellent in 25 cases, good in 16, satisfactory in 16 and poor in 9 cases. Poor results were always related to loosening of the acetabular cup. Heterotopic ossification was noted in 7 cases. According to the Kaplan-Meier estimator, 10 years' survival probability was 85.24% for the whole implant and 100% for the stem. 1. Total cementless hip joint arthroplasty is an effective method in the treatment of advanced hip osteoarthritis following Perthes' disease in childhood. 2. With good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. Due to the patients' young age, there may be more cases of loosening over time, requiring regular long-term follow-up.

Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty

BackgroundRacial and ethnic disparities in access to hip and knee total joint arthroplasty (TJA) and postoperative outcomes have wide-reaching implications for patients and the health care system. The aim of this study is to evaluate the effect of ethnicity on clinical outcomes and complications following revision hip and knee TJA. MethodsA single-institution, retrospective analysis of a consecutive series of 4424 revision hip and knee TJA patients was evaluated. Student’s t-test and chi-squared analysis were used to identify significant differences in patient demographics and clinical outcomes between Caucasians and various ethnic minorities, including African Americans, Hispanics, and Asians. ResultsWhen compared with white patients, African American patients demonstrated a significantly higher BMI (P = .04), ASA score (P = .04), length of hospital stay (P = .06), and postoperative infection rates (P = .04). Hispanics demonstrated a significantly higher BMI (P = .04), when compared with white patients, alongside a significantly higher risk for postoperative infection (P < .01). African American demonstrated a significantly higher ASA score (P = .02; P = .03), when compared with Hispanics and Asians, alongside a significantly increased length of stay (P = .01) and higher risk for postoperative infection (P = .02). ConclusionThe study findings demonstrate an underutilization of revision TJA by ethnic minority groups, suggesting that disparities in access to orthopedic surgery increase from primary to revision surgery despite higher failure rates of minority ethnic groups reported after primary TJA surgery. In addition, inferior postoperative outcomes were associated with African Americans and Hispanics, when compared to white patients, with African Americans demonstrating the highest risk of postoperative complications.

Gender and Total Joint Arthroplasty: Variable Outcomes by Procedure Type.

BackgroundRecent reports on the influence of gender on the outcomes of total joint arthroplasty were limited by either lack of longitudinal data or absent stratification by total hip arthroplasty (THA) or total knee arthroplasty (TKA). As a result, there remains a lack of clarity on this topic.MethodsThe American College of Surgeons National Surgical Quality Improvement Program was queried for all primary, elective THAs and TKAs performed between 2011 and 2017. Differences in demographics, comorbidity profiles, operative time, hospital length of stay (LOS), and 30-day outcomes were compared between male and female patients. Multivariate analyses were performed separately for THA and TKA.ResultsA total of 418,885 patients were analyzed; 59.1% were females. Compared with males, females were likely to be older, have a higher body mass index, identify as nonwhite, and require preoperative functional assistance (P < .001). Females had lower rates of diabetes, hypertension, anemia, and kidney disease but a higher rate of chronic steroid use (P < .001). They were also likely to have shorter operative times for both THA and TKA (P < .001). After controlling for the aforementioned differences, female gender was an independent risk factor for readmission, reoperation, and wound infection after THA (P < .001). In contrast, male sex was an independent risk factor for readmission, reoperation, and overall complications after TKA (P < .001). Regardless of the procedure, females were 64%–82% more likely to require an LOS >2 days than males.DiscussionA variable effect of gender was observed on the post–total joint arthroplasty LOS and outcomes depending on the procedure type (THA or TKA). Differences attributed to gender should be accounted for in risk-stratification models. Future studies are also needed to elucidate the underlying causes of gender differences in joint arthroplasty.

Opioid Prescription Consumption Patterns After Total Joint Arthroplasty in Chronic Opioid Users Versus Opioid Naive Patients.

Background:Although chronic preoperative opioid use has been linked to inferior total joint arthroplasty outcomes, little research exists on postoperative prescribing patterns for opioid-naive orthopaedic patients versus chronic opioid users.Method:The New York State Prescription Monitoring Program database, which tracks controlled prescriptions dispensed in-state over the preceding 12 months, was retrospectively queried for 386 patients who underwent primary, elective total hip or knee arthroplasty at a high-volume, urban medical center from May through December 2017. Seventy-four patients were excluded because they did not return prescription monitoring program results, leaving 312 patients. Prescribers, medications, dates prescribed and filled, and quantity dispensed were recorded 3 months preoperatively through 12 months postoperatively. We defined chronic users as ≥2 opioid prescriptions filled in 3 preoperative months and opioid-naive as <2 filled. Opioid use was compared univariately using 2-tailed Student t-tests.Results:Chronic opioid users (n = 49; 15.7%) filled an average of 13,006.64 morphine equivalent doses per patient in the 12-month postoperative period, while opioid-naive users (n = 263; 84.3%) filled an average of 854.48 morphine equivalent doses per patient (P < 0.01). Opioid use in the chronic-user group was significantly higher in each 6-week postoperative interval (P < 0.01). These trends remained significant when stratified by procedure. For opioid-naive patients, 74% of opioid prescriptions were prescribed by our orthopaedic department. For chronic users, only 21% of opioid prescriptions originated from our department. Chronic users were found to cyclically fill opioid prescriptions every 3 to 4 weeks postoperatively as far out as 12 months and were significantly more likely to fill nonopioid controlled substance prescriptions both preoperatively and postoperatively (P < 0.01).Discussion:Chronic opioid users undergoing arthroplasty filled significantly more opioid prescriptions than opioid-naive patients. Chronic users obtained prescriptions from myriad sources, only a minority of which originated from our orthopaedic department. In the current opioid epidemic, vigilance regarding opioid prescribing is critical.

Chronic kidney disease impact on total joint arthroplasty outcomes: A National Inpatient Sample-based study.

In the United States, chronic kidney disease (CKD) affects roughly 11% of the population or 19.2 million people. As the prevalence of CKD and demand for total joint arthroplasty (TJA) continue to rise, it is critical to assess the impact of CKD on postoperative clinical and economic outcomes. Discharge data from 2006 to 2011 National Inpatient Sample were used for this study. A total of 851,150 TJA patients were divided into three cohorts: group 1 included no CKD, CKD stage I, and CKD stage II; group 2 included CKD stage III and stage IV; group 3 included CKD stage V. Inverse probability of treatment weighting/propensity score weighting was used to predict outcome variables as a function of age, sex, and Elixhauser comorbidities. Patients were compared against group I for in-hospital postoperative outcomes. Stage III/IV CKD patients undergoing primary TJA had higher odds of any complication (odds ratio (OR), 2.63; p < 0.0001), longer length of stay (LOS), and higher total charge (LOS, 4.34 vs. 3.48 days; total charge, US$56,003 vs. US$46,115; p < 0.0001) when compared to patients with no CKD/stage I or II. Similarly, stage V CKD patients undergoing primary TJA had higher odds of any complication (OR, 1.64; p < 0.0001), longer LOS, and higher total charges (LOS, 5.81 vs. 3.48 days; total charge, US$59,869 vs. US$46,115) than their counterparts with no CKD/stage I or II CKD. Our results indicate that stage III, IV, or V CKD, compared with those with no CKD, stage I or II patients are at a greater risk for postoperative complications and consume more resources following TJA.

Chronic Kidney Disease Impact on Total Joint Arthroplasty Outcomes: A National Inpatient Sample Based Study

INTRODUCTIONIn the United States, chronic kidney disease (CKD) affects roughly 11% of the population or 19.2 million people. As the prevalence of CKD and demand for total joint arthroplasty (TJA) continue to rise, it is critical to assess the impact of CKD on post‐operative clinical and economic outcomes.METHODSDischarge data from 2006–2011 National Inpatient Sample (NIS) was used for this study. A total of 851,150 TJA patients were divided into 3 cohorts: Group 1 included no CKD, CKD Stage I, and CKD Stage II; Group 2 included CKD Stage III and Stage IV; Group 3 included CKD Stage V. Inverse Probability of Treatment Weighting (IPTW)/Propensity Score Weighting was used to predict outcome variables as a function of age, sex, and Elixhauser comorbidities. Patients were compared against group I for in‐hospital postoperative outcomes.RESULTSStage III/IV CKD patients undergoing primary TJA had higher odds of any complication (odds ratio [OR], 2.63; P&lt;0.0001), longer length of stay, and higher total charge (length of stay [LOS], 4.34 vs 3.48 days; total charge, $56,003 vs $46,115; P&lt;0.0001) when compared to patients with no CKD/Stage I or II. Similarly, Stage V CKD patients undergoing primary TJA had higher odds of any complication (OR, 1.64, P&lt;0.0001), longer LOS, and higher total charges (LOS, 5.81 vs 3.48 days; total charge, $59,869 vs $46,115) than their counterparts with no CKD/Stage I or II CKD.DISCUSSIONOur results indicate that Stage III, IV, or V CKD, compared with those with no CKD, Stage I or II patients are at a greater risk for postoperative complications and consume more resources following TJA.

Clinical and radiological outcomes of total joint arthroplasty in patients with ochronotic arthropathy.

Alkaptonuria is a rare metabolic disorder, and only a few case reports of total joint arthroplasty (TJA) for ochronotic arthropathy are described in the literature. We aim to analyse the functional and radiological outcomes of TJA in patients with ochronotic arthropathy. We retrospectively collected the data of twenty-seven TJA in sixteen patients with ochronotic arthropathy from April 2007 to December 2017. We assessed the functional outcome through pre- and post-operative modified Harris hip score (HHS) and knee society score (KSS). The hip radiographs were analysed for migration and radiolucent zones, and the knee radiographs were assessed using knee society roentgenographic evaluation and scoring system. The mean follow-up was 39.4months (12-132months). Two patients died before the final follow-up. There was a statistically significant improvement in mean HHS from 17.8 preoperatively to 78 at the final follow-up (p < 0.001). Similarly, there was a significant improvement in mean KSS, following the surgery, from 27.2 preoperatively to 89.4 (p < 0.001). One patient developed deep infection, and another patient presented with aseptic loosening of the acetabular component after 7years. In the radiological evaluation at the final follow-up, signs of lysis or loosening were not noted in any of the other patients. End-stage arthritis in ochronotic arthropathy is not uncommon. These patients can have multiple joint involvements, and the need for multiple surgeries should be considered. TJA in ochronotic arthropathy leads to a significant improvement in the functional outcome compared with the preoperative disability.

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

BackgroundThis meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group).MethodsWe searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group).ResultsEighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group.ConclusionsPreoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.

Patient Expectations for Outcomes of Upper Extremity Total Joint Arthroplasty: A Systematic Review

Joint arthroplasty leads to a dramatic improvement in outcomes of pain, function, and satisfaction for many patients. Patient expectations have been increasingly linked to these treatment outcomes, with positive expectations being associated with better outcomes and greater patient satisfaction. However, the majority of the literature focuses on lower, not upper, limb extremities. The purpose of this study is to identify and summarize studies that determine the extent to which preoperative expectations are predictive of postoperative outcomes in patients undergoing any arthroplasty of joints in the upper extremities. A comprehensive systematic online literature search was performed in Embase, Medline, CINAHL, PsycINFO, Cochrane Library, and Web of Science. Articles addressing joint arthroplasty in the upper extremities that measured preoperative expectations affecting postoperative treatment outcomes (pain, function, and satisfaction), as well as their relationships, were included, with an end result of eight studies reviewed. The methodological quality of the included articles ranged 53%-89%. Studies differed substantially in definitions and measurements of patient expectations. Only two reported a correlation analysis between patient expectations and outcomes. SF-12 function (p = 0.01), VAS pain (p = 0.05), and ASES function (p = 0.05) showed significant correlations with preoperative patient expectations. Findings show that research on upper limb arthroplasty is limited, unlike lower limb results. Future studies should focus on using preoperative patient education to modify expectations and on creating a framework to standardize patient expectations for arthroplasty of upper limb extremities.