Total Replacement Arthroplasty Research Articles

Treatment of intractable septic ankle arthritis with a continuous closed irrigation system.

The study aimed to evaluate the efficacy of a continuous closed irrigation system (CCIS) after open debridement for patients with intractable septic ankle arthritis. The retrospective study analyzed the intractable septic arthritis of 12 (6 males, 6 females; mean age: 64.1±14.7 years; range, 33 to 80 years) patients managed by CCIS between July 2015 and July 2020. All patients had previously undergone operations to treat septic ankle arthritis without resolution of the infection. After open debridement, the CCIS was usually equipped with two outflow tubes and one inflow tube. Saline inflow was about 1 L per day. The mean follow-up period was 30.8±14.9 (range, 15 to 70) months. The CCIS was maintained for a mean of 5.1±2.1 (range, 3 to 7) days. The mean number of operations the patients had previously undergone was 2.83±1.5 (range, 1 to 6). For 11 (91.6%) out of 12 patients, infection did not recur after one-time CCIS, and laboratory test results remained normal. Six patients had previously undergone total ankle replacement arthroplasty. These patients underwent antibiotics-mixed cement arthroplasty after CCIS. For five of six with infected total ankle replacement arthroplasty, infection did not recur after CCIS. However, one patient without the removal of both implants experienced recurrence at the same site after four postoperative months. In the reoperation, after the removal of both implants and the application of antibiotics-mixed cement arthroplasty, the infection was cleared. Use of CCIS after open debridement for intractable septic ankle arthritis is a good treatment option since it is relatively simple and safe, with good results.

Does Perioperative use of Bisphosphonate Affect Implant Revision Rate of Total Ankle Arthroplasty?

Category: Ankle Arthritis; Other Introduction/Purpose: It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. Therefore, the purpose of this study was 1) to investigate whether there is a relationship between the use of BP and the revision rate of TAR, and (2) to determine the effect of BP medication period on the revision rate of TAR. Our hypothesis was that the use of BP would lower the revision rate of TAR. Methods: We reviewed National Health Insurance Service data based on national health insurance service claim data and health care utilization, health screening, socio-demographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP non-users, while 909 patients were BP users. The revision rate according to BP medication and co-morbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. Results: The revision rate of TAR was 7.9% for BP users and 9.5% for BP non-users, which showed no significant difference (p=0.251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 (p=0.017), while other co-morbidities such as diabetes had no effect on revision rate of TAR. Conclusion: We found that the perioperative BP use do not reduce the revision rate of TAR. Co-morbidities except hypertension did not affect the revision rate of TAR. More research regarding various factor affecting revision of TAR could be warranted.

Does Perioperative Use of Bisphosphonate Affect the Implant Revision Rate of Total Ankle Arthroplasty?

It is unknown whether perioperative bisphosphonate (BP) use reduces revision rates in total ankle replacement arthroplasty (TAR) although its effect has been demonstrated to be effective in reducing revision rates in total knee or hip replacement arthroplasty. We reviewed National Health Insurance Service data based on national health insurance service claims data and health care utilization, health screening, sociodemographic variables, medication history, operation codes, and mortality data for 50 million Koreans. From 2002 to 2014, 6391 of 7300 patients who underwent TAR were BP nonusers, whereas 909 patients were BP users. The revision rate according to BP medication and comorbidities was investigated. The Kaplan-Meier estimate and extended Cox proportional hazard model were also used. The revision rate of TAR was 7.9% for BP users and 9.5% for BP nonusers, which showed no significant difference (P = .251). Implant survival over time decreased constantly. Adjusted hazard ratio for hypertension was 1.242 (P = .017), whereas other comorbidities such as diabetes had no effect on the revision rate of TAR. We found that the perioperative BP use did not reduce the revision rate of TAR. Comorbidities (except hypertension) did not affect the revision rate of TAR. More research regarding various factors affecting the revision of TAR could be warranted. Level III, retrospective cohort study.

Dynamic finite element analyses to compare the influences of customised total talar replacement and total ankle arthroplasty on foot biomechanics during gait.

Objective, Total talar replacement (TTR) using a customised talus prosthesis is an emerging surgical alternative to conventional total ankle arthroplasty (TAA) for treating ankle problems. Upon satisfying clinical reports in the literature, this study explored the advantages of TTR in restoring foot biomechanics during walking compared with TAA through computational simulations.Methods, A dynamic finite element foot model was built from the MRIs of a healthy participant and modified into two implanted counterparts (TTR and TAA) by incorporating the corresponding prosthetic components into the ankle joint. Twenty bony parts, thirty-nine ligament/tendon units, nine muscle contractors, and bulk soft tissue were included in the intact foot model. The TTR prosthesis was reconstructed from the mirror image data of the participant's contralateral talus and the TAA prosthesis was modelled by reproducing the Scandinavian ankle replacement procedure in the model assembly. The model was meshed with explicit deformable elements and validated against existing experimental studies that have assessed specific walking scenarios. Simulations were performed using the boundary conditions (time-variant matrix of muscle forces, segment orientation, and ground reaction forces) derived from motion capture analyses and musculoskeletal modelling of the participant's walking gait. Outcome variables, including foot kinematics, joint loading, and plantar pressure were reported and compared among the three model conditions.ResultsLinear regression indicated a better agreement between the TTR model and intact foot model in plots of joint motions and foot segment movements during walking (R2 ​= ​0.721–0.993) than between the TAA and intact foot (R2 ​= ​0.623–0.990). TAA reduced talocrural excursion by 21.36%–31.92% and increased (MTP) dorsiflexion by 3.03%. Compared with the intact foot, TTR and TAA increased the midtarsal joint contact force by 17.92% and 10.73% respectively. The proximal-to-distal force transmission within the midfoot was shifted to the lateral column in TTR (94.52% or 210.54 ​N higher) while concentrated on the medial column in TAA (41.58% or 27.55 ​N higher). The TTR produced a plantar pressure map similar to that of the intact foot. TAA caused the plantar pressure centre to drift medially and increased the peak forefoot pressure by 7.36% in the late stance.ConclusionThe TTR better reproduced the foot joint motions, segment movements, and plantar pressure map of an intact foot during walking. TAA reduced ankle mobility while increasing movement of the adjacent joints and forefoot plantar pressure. Both implant methods changed force transmission within the midfoot during gait progression.The translational potential of this article Our work is one of the few to report foot segment movements and the internal loading status of implanted ankles during a dynamic locomotion task. These outcomes partially support the conjecture that TTR is a prospective surgical alternative for pathological ankles from a biomechanical perspective. This study paves the way for further clinical investigations and systematic statistics to confirm the effects of TTR on functional joint recovery.

A Review Of Distraction Arthroplasty Vs Ankle Arthrodesis Vs Ankle Replacement

Recent developments in surgical techniques have led to new methods to treat ankle arthritis and perhaps produce a better effect on joint function and gait improvement. The indications for total ankle replacement, ankle fusion, or distraction arthroplasty in the management of ankle arthritis are controversial. The aim of this study is to evaluate different approaches with an overview of the literature. Core tip: Ankle arthritis is a common debilitating chronic disease that is not only present in the geriatric population, but also younger populations. The main method to treat end stage arthritis is ankle fusion. Ankle replacement is currently improving in popularity. Both treatment options manage end stage arthritis. It is important to consider the role of distraction arthroplasty in the context of these two other well accepted treatments. Here we examine the literature from 1941 to 2020 considering our own experience and the growing role regenerative techniques and biologics.

A Modified Technique for Applying Closed Incision Negative Pressure Therapy Dressing Following Total Joint Arthroplasty.

Postoperative incisional management subsequent to total joint replacement arthroplasty is of importance to the orthopedic surgical team. The application of closed incision negative pressure therapy (ciNPT) to surgical incisions following replacement arthroplasty has demonstrated positive outcomes in orthopedics. This paper describes a technique involving the postoperative application of ciNPT over closed incisions originating from joint arthroplasty to facilitate a reduction in the incidence of surgical site complications (SSCs). To address any potential challenges that may be associated with ciNPT application and removal, the ciNPT dressing was applied to the knee incision with approximately 15 degrees of flexion utilizing the total knee bump to allow the knee to rest with flexion at that angle. For posterior hip replacements or revisions, the readily adjustable ciNPT dressing was enlisted for use to cover curvilinear incisions. The adhesive drape over the foam ciNPT dressing would be blocked to ensure that drain placement, if used, would not be incorporated with the hydrocolloid portion of the dressing. In order to properly apply the dressing, it was imperative that the hydrocolloid portion was not subject to any buckling. The dressing was walked over the foam ciNPT dressing to ensure that there was an absence of tension on the dressing. The manufacturer’s instructions support dressing use for a maximum of seven days with continuous subatmospheric pressure (-125 mmHg) applied to the closed incision. Applying the adhesive ciNPT drape over the ciNPT foam dressing with a minimal amount of tension is integral to attaining positive outcomes using ciNPT. Employing ciNPT may reduce the risk of delayed incisional healing and SSCs, which may alleviate providers from extra postoperative global visits.

Everyday Physical Activity and Sedentary Behavior After Total Joint Arthroplasty: Do Patients and Partners Develop an Active Lifestyle?

BackgroundOsteoarthritis (OA) is a frequent cause of pain and disability, affecting half of the world’s population aged 65 years or older. Due to experienced pain and limitations, OA patients generally spend most of their waking hours sedentary and fail to adhere to physical activity (PA) recommendations. As a result of living together with OA patients, their partners might adopt a sedentary lifestyle. This study investigates the change in habitual PA and sedentary behavior (SB) in patients and their partners one year after the patients’ total joint replacement (arthroplasty) and inpatient rehabilitation.MethodsThis is a follow-up of a prospective cohort study including 24 older couples (69.3±7.8 years, gender ratio 11:13) consisting of OA patients (17 hip OA, 7 knee OA) and their partners. The participants’ habitual PA and SB were assessed by means of synchronous accelerometry (16h per day, 4–7 days) and additional self-report.ResultsAlthough the partners (~6300 steps per day) were significantly more active than the patients (~4800 steps per day) before arthroplasty, their lifestyle was still classified “low active”. Irrespective of the method used, the PA and SB parameters of patients and partners were significantly correlated before arthroplasty (accelerometry: r≥0.333, p≤0.001; self-report: r≥0.569, p≤0.004). Following the patients’ arthroplasty, no improvement in PA or SB was observed either in the patients or their partners. A detailed evaluation of accelerometric data on hourly basis revealed no change in behavior for both groups. Furthermore, their everyday activities remained correlated (accelerometry: r≥0.418, p≤0.001; questionnaire: r≥0.554, p≤0.005).ConclusionOne year post-arthroplasty and inpatient rehabilitation neither the OA patients nor their partners had changed their PA or SB. Their everyday physical activity was still strongly intertwined. Further research is needed to determine why behavior change does not occur even though the prerequisites are in place.

Revision Total Elbow Replacement Arthroplasty with an Allograft-Prosthesis Composite: Case Series and Technical Points

Purpose: The purpose of this study was to report the results of revision total elbow replacement arthroplasty (TERA) with an allograft-prosthesis composite (APC). Methods: We retrospectively reviewed 6 patients with an average age of 75 years who had undergone revision TERA with an APC for periprosthetic fracture or loosening of the component. The mean follow-up period was 13 months. We assessed serial radiographs for bone union and evaluated the outcomes in terms of pain visual analogue scale (VAS), the Mayo Elbow Performance Score (MEPS), range of motion, and complications. Results: The APC was used for the humerus in 5 patients and for the ulna in 1 patient. The clinical bone union was achieved at average 9 months after surgery. The mean pain VAS score improved from 6.8 to 1.7, the mean elbow joint range of motion increased from 95° to 129° and the MEPS score improved from 40 to 79 at the last follow-up. There were no major complications such as infection, nonunion, malunion, limitation of motion or refracture. One patient experienced transient radial nerve palsy and another patient a prominent edge of the humeral allobone that needed a trimming surgery later.Conclusion: Revision TERA with an APC provides good functional outcomes and can be recommended as one of the options for failed total elbow arthroplasty.

Aluminium Nanoparticles Released by Joint Implants ‐ Quartz Crystal Microbalance with Dissipation Analysis

IntroductionThe rising popularity of joint prosthetics such as total knee arthroplasty, total disc replacement or total hip arthroplasty has woken serious concern of toxicity of the nanoparticles (NPs) released by the prostheses because of corrosion and wear. The NPs are known to influence blood components, but their impact on platelets has not been yet analyzed. In this study we aimed to assess the effect of Al2O3 (Al) NPs on thrombocytes in vitro with the use of novel quartz crystal microbalance with dissipation (QCM‐D) methodology.MethodsThe several NPs (Al2O3 5nm, Al2O3 10nm, Al2O3 20nm, Al2O3 30nm, Al2O3 50nm and Al2O3 80nm) were tested for their ability to induce platelet activation and aggregation with use of flow cytometry, light transmission aggregometry and QCM‐D. The results of the latter test were confirmed with optical microscopy and transmission electron microscopy.ResultsSignificant changes in dissipation (D) and frequency (F) were noted in platelet‐rich‐plasma incubated with all assessed NPs (concentration of 5, 2.5, 1, 0.5 μg/mL), in comparison to controls under flow. All tested NPs, except for the largest (80 nm) ones, induced a significant rise of both F and D, revealing thrombocyte aggregation even at the lowest tested concentration (0.5 μg/mL). Optical microscopy revealed platelet aggregation also for 80 nm NPs. In contrast, transmission electron microscopy of 80 nm NPs showed lack of platelet aggregation, however, the NPs caused formation of several platelets clumps similar to aggregates.ConclusionOur study provides evidence that Al NPs influence thrombocytes function in vitro. Moreover, different mechanism depending on the size of NPs has been noted. Smaller Al NPs induce platelet aggregation, whereas large particles penetrate the platelets, damaging them and releasing Ca2+ stores. It is not certain if the latter causes thrombosis in vivo. We believe that future in vivo studies might indicate safe aluminium level for patients with Al‐containing ceramic prostheses as well as establish which concentration would be optimal for revision surgery.

Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty

Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty

라이프케어를 위한 관절 치환술 환자의 의료이용에 관한 연구

라이프케어를 위한 관절 치환술 환자의 의료이용에 관한 연구

Total elbow replacement - patient selection and perspectives.

Total joint replacements for elbow arthritis were developed in the late 1960s at the same time as total joint replacements for knee joint arthritis. Since then, there has been a continuing annual increase in the number of patients treated with total knee joint replacement for arthritis, in line with replacement arthroplasty of the other major limb joints, but in contrast to total elbow joint replacement which is falling, since reaching a peak in the 1990s. Which raises the question, why? Continuing controversy about implant design, the relatively high reported complication rates associated with total elbow replacement (TER) and the difficulties encountered in revision surgery are identified as reasons together with changes in the patient population currently treated with TER. The purpose of this review is to explore the reasons for this in the context of the patient population requiring implant surgery for elbow arthritis and our current perspective of elbow pathology requiring treatment. This is not a systematic review of the whole of the literature concerning total elbow joint replacement arthroplasty but is drawn largely from the supporting literature that reflects my own clinical experience and illustrated with teaching materials I have commissioned together with radiographs and intraoperative photographs of patients I have treated.

The differential algorithm for the prescription of the stabilizing training to the patients following replacement arthroplasty of the lower extremities

The biological feedback-based stability (balance) training is used for the rehabilitation of the patients following replacement arthroplasty of the lower extremities with the purpose of restoration of their postural balance. The objective of the present study was to develop a differential algorithm for the prescription of the stability training to the patients after they had undergone the endoprosthetic replacement of the joints of the lower extremities. The study included 48 patients presenting with the following nosological forms: hip arthrosis with total replacement arthroplasty and gonarthrosis with total replacement arthroplasty. All the patients underwent the biofeedback-based stability training with the use of the dynamic balance Pro-Kin system ('Technobody', Italy) using the 'Skiing' No. 10 computer game during 20 minutes every day. The clinical and instrumental methods were employed for the purpose. The rehabilitation subgroups of the patients who had undergone the were distinguished for the first time based on the identification of the main risk factors. It was shown that the main factors having the most pronounced influence on the recovery of postural balance under the conditions of stability training with biological feedback include the age, the time after surgery, the results of evaluation using the Spielberger-Hanin anxiety scale and the Bek depression scale, the level of co-morbidity, the risk of falling estimated from the Morse-Fall scale, and the results of the digit-symbol test based on the Wegsler intelligence scale. The distinguishing between rehabilitation subgroups allowed to develop the differentiated algorithm for the prescription of the stability training with biological feedback for the purpose of restoration of the patients' postural balance following total replacement arthroplasty of the lower extremities.

Analysis of medical service use of knee osteoarthritis and knee meniscal and ligament injuries in Korea: a cross-sectional study of national patient sample data

BackgroundOsteoarthritis (OA) and meniscal and ligament injuries of the knee are the two most common knee disorders in Korea. The aim of this study was to analyze the demographic characteristics, medical service use and related costs for these disorders, and the results are expected to help inform practitioners, researchers, and policy-makers.MethodsThe present study aimed to evaluate incidence and patient characteristics, and to assess current medical service use, usual care, and medical expenses of knee disorders by analyzing 2014 national patient sample data from the Korean Health Insurance Review and Assessment Service. Data was extracted using 3% stratified sampling from all Korea national health insurance claims submitted in 2014, and analyzed. Usual care for M17 knee osteoarthritis and S83 knee meniscal and ligament injury codes of the International Classification of Diseases, 10th revision (ICD-10) were determined by investigating total number of patients, sociodemographic characteristics, days in care, number of visits, and expenses.ResultsKnee OA showed the highest incidence in females aged ≥60 years, whereas meniscal and ligament injuries of the knee were most prevalent among patients aged <20 years and young adults. Total inpatient care expenses exceeded the cost of ambulatory care for both disorders. Ambulatory care was mainly provided at primary care clinics, with 90% of these visits made to orthopedic specialists. Medical expenses for knee OA and meniscal and ligament injuries were largely due to procedures/surgeries and injections, and procedures/surgeries and hospitalizations, respectively. Total replacement arthroplasty was the most commonly performed surgery for knee OA, while meniscectomy and cruciate ligament reconstruction were the most often performed surgeries for meniscal and ligament injuries. Intra-articular injection rates were 55% in knee OA patients and 3% in meniscal and ligament injury patients. Aceclofenac, diclofenac, and tramadol were the most frequently prescribed analgesics.ConclusionsThe current findings may be used as basic data for establishing medical policies and can benefit researchers and clinicians in recognizing trends and patterns of treatment for knee disorders.

Diagnosis of Deltoid Ligament Contracture in Varus Ankle Osteoarthritis

Category: Ankle Arthritis Introduction/Purpose: In total ankle replacement arthroplasty, ligament balancing is important to obtain a stable ankle joint and to prevent edge loading which would lead to asymmetric accelerated polyethylene wear and component loosening. Deltoid ligament release is recognized as an essential step in surgical technique for correcting varus instability. However, necessity of deltoid ligament release in every ankles with varus deformity is suspected recently because varus deformity could be corrected without deltoid ligament release in several ankles. The aims of this study were to assess the prevalence of deltoid ligament contracture and to identify the radiographic parameters that could predict the deltoid ligament contracture in ankle osteoarthritis which needs total ankle arthroplasty. Deltoid ligament contracture was determined when valgus stress radiograph showed talar tilt ≥ 0.5° and medial clear space ≤ 4 mm in this study. Methods: The plain weight-bearing radiograph and the valgus stress radiograph of 118 ankles (103 patients) with osteoarthritis were retrospectively evaluated. The 118 ankles were comprised 68 ankles of asymmetric varus-osteoarthritis(OA) group which showed medial joint space obliteration and tibiotalar angle ≥ 10°, 37 ankles of end-stage neutral-OA group which showed overall superior joint space obliteration and tibiotalar angle ≤ 10° and 13 ankles with end-stage varus-OA group which showed overall superior joint space obliteration and tibiotalar angle ≥ 10°. Various radiographic parameters of plain weight-bearing anteroposterior radiograph – talar tilt, distance from medial malleolus to talar dome (MM-T distance), talus center migration – were investigated. The individual associations between the deltoid ligament contracture and these radiographic parameters and the most important radiographic parameter were determined using logistic regression analysis. The optimal threshold of the most important radiographic parameters for predicting deltoid ligament contracture was determined with use of receiver operating characteristic curve analysis. Results: Thirty-seven ankles in the asymmetric varus-OA group (54%) had deltoid ligament contracture, while one ankle of the end-stage neutral-OA group (2.7%) and one ankle of the end-stage varus-OA group (7.7%) had deltoid ligament contracture. Among the 118 ankles, the talar tilt (Exp(B): 1.239, P=0.000) and the MM-T distance (Exp(B): 1.141, P=0.016) were significantly associated with the deltoid ligament contracture in the univariate logistic regression analysis. And only the talar tilt (Exp(B): 1.251, P=0.000) was significantly associated with the deltoid ligament contracture between the two significant radiographic parameters in the multivariate logistic regression analysis. The optimal threshold for predicting deltoid ligament contracture was 8.9° of the talar tilt, with a sensitivity of 76.9% and a specificity of 77.2%. Conclusion: This study showed that half of varus ankle osteoarthritis and most of end-stage ankle osteoarthritis did not have deltoid ligament contracture and the talar tilt could predict the deltoid ligament contracture. During total ankle arthroplasty, clinicians should determine deltoid ligament contracture before deltoid ligament release by using the talar tilt, because there may be a risk of valgus instability when deltoid ligament was released in ankles without deltoid ligament contracture.

Proximal Femur Bone Density Decreases up to 5 Years After Total Hip Arthroplasty in Young, Active Patients

BackgroundThe number of young, active patients undergoing hip arthroplasty continues to increase. The purpose of this study was to evaluate femoral bone density over a 5-year period after hip arthroplasty in young, active patients. MethodsA total of 96 patients (103 hips) with a presymptomatic University of California at Los Angeles (UCLA) score ≥6 who had a total hip arthroplasty (THA; 45 hips) or surface replacement arthroplasty (SRA; 58 hips) were prospectively enrolled. UCLA and Harris Hip Scores were collected preoperatively and postoperatively, and dual energy X-ray absorptiometry scans were performed at 6 weeks, 6 months, 1 year, 2 years, and 5 years postoperatively. Bone density was analyzed for 7 traditional Gruen zones in both groups and 6 femoral neck zones in the SRA group. Bone density ratios were calculated for change in bone density compared with baseline. ResultsNo differences were present in the preoperative or postoperative UCLA or Harris Hip Scores between the SRA and THA cohorts (P = .07-.7). In the THA group, bone density never returned to baseline during the 5-year period in Gruen zones 1 (91.2% of baseline), 2 (94.8%), 6 (97.3%), and 7 (89.2%). There were no decreases in bone mineral density ratio for the femoral Gruen zones in the SRA group at any interval. Femoral neck bone density after SRA increased on the lateral, tension side up to 5 years postoperatively (P < .0001). ConclusionYoung, active patients undergoing THA with cementless femoral fixation demonstrate reductions in bone density in the proximal femur in Gruen zones 1, 2, and 7 over time.

슬관절과 고관절 전치환술 환자의 수혈에 영향을 미치는 병원특성 요인 분석

저출산 고령화로 헌혈인구는 감소하고, 노년층의 혈액사용량은 증가할 것으로 예상되어 혈액부족과 수혈의 안정성 문제가 대두되고 있다. 이에 본 연구에서는 만성 퇴행성관절염인 슬관절과 고관절 전치환술 환자의 수혈에 영향을 주는 요인을 분석하고자 하였다. 이를 위해 건강보험심사평가원의 2011년 환자표본자료 중 입원환자 5,370명을 대상으로 하였으며, SPSS 20 프로그램을 이용하여 로지스틱 회귀분석을 실시하였다. 독립변수로 사용된 변수는 병원특성과 환자특성으로 병원특성은 의료기관 종류, 설립구분, 기관소재지와 가동병상수를, 환자특성으로는 성, 연령, 중증도, 전신마취유무, 주 진단, 빈혈유무와 의료보험종류로 구분하였다. 분석결과, 슬관절전치환술 환자의 수혈에 유의한 영향을 미치는 변수로는 의료기관 종류, 기관소재지, 성, 연령, 중증도, 주 진단, 빈혈유무였으며, 고관절전치환술 환자의 수혈에 유의한 영향을 주는 변수로는 의료기관 종류, 기관소재지, 성, 연령, 중증도, 전신마취유무, 빈혈유무였다. 수혈현황과 영향요인을 분석한 본 연구는 비용 효과적이며, 양질의 의료를 위한 기초자료로 활용될 수 있을 것으로 기대한다. The problems related with blood supply shortage and the stability of blood transfusion are on the rise, as it is expected that the blood doners will decrease but the blood use amount for aged population will increase, owing to low birth and aged population increase. The purpose of this study is to analyze the hospital characteristics which affect patients receiving and non-receiving blood transfusion for the knee and hip total replacement arthroplasty. Data were collected from Health Insurance Review and Assessment Service's 2011 sample data, and 5,370 inpatients were abstracted from them. Logistic regression analysis was performed, using SPSS 20. Independent variables used are hospital characteristics variables and patient characteristics variables. Hospital characteristics variables are hospital type, ownership, residence and the number of usable beds, and patient characteristics variables are gender, age, severity, type of anesthesia, main diagnosis, whether or not of anemia and insurance class. At the result of this study, it was found that hospital type, region, gender, age, severity, main diagnosis and whether or not of anemia were the factors that mostly affected the blood transfusion for knee arthroplasty. And hospital type, residence, gender, age, severity, type of anesthesia and whether of not of anemia were the factors that mostly affected the blood transfusion for hip arthroplasty. In addition to that, it is expected that this research which analyzed the present state of blood transfusion and its influence factors are cost effective, and would make a good use of preliminary data for good quality of medical service.

Pain, opioids, and confusion after arthroplasty in older adults.

Postoperative confusion is a common complication in older adults, particularly after total joint replacement (arthroplasty). Confusion after surgery can result in slower mobility progression, longer hospital stay, and increased patient distress. Postoperative pain has been shown to be a risk factor related to confusion; however, there is limited evidence regarding pain level, medication use, and confusion development in postoperative arthroplasty patients. To evaluate development of postoperative confusion and the current practice of pain management for older adult patients with hip or knee arthroplasty. Two-month retrospective chart review of medical records at a large, Midwestern, private hospital. Pain assessments were performed on a regular basis using self-report 11-point Numeric Rating Scale (0-10). Opioid use was scored using an equianalgesic conversion chart. Ninety-eight patients met inclusion criteria and 97 received treatment with opioids during the first 48 hours postoperatively. No patients received opioid agents that are contraindicated in older adults. Thirty-three patients had evidence in the medical record of confusion during the first 48 hours postoperatively. Lower equianalgesic dose was significant for increased age and increased confusion on postoperative day 1 (POD 1) and POD 2. Patients with higher equianalgesic scores were less likely to meet benchmark pain scores less than 5 on POD 0, POD 1, and POD 2. Patients receiving lower amounts of opioids in the first 48 hours after surgery were more likely to be confused on POD 1(p = .023) and POD 2 (p = .049).

Accuracy of Acetabular Component Position in Hip Arthroplasty

Acetabular component malposition is linked to higher bearing surface wear and component instability. Outcomes following total hip arthroplasty and surface replacement arthroplasty depend on multiple surgeon and patient-dependent factors. The purpose of this study was to examine the frequency in which acetabular components are placed within a predetermined target range. We evaluated postoperative anteroposterior pelvic radiographs for every consecutive primary total hip arthroplasty and surface replacement arthroplasty completed from 2004 to 2009 at a single institution. Acetabular component abduction and anteversion angles were determined using Martell Hip Analysis Suite software. We defined target ranges for abduction and anteversion for both total hip arthroplasty (30° to 55° and 5° to 35°, respectively) and surface replacement arthroplasty (30° to 50° and 5° to 25°, respectively). Surgeon and patient-related factors were analyzed for risk associated with placing the acetabular component outside the target range. Of the 1549 total hip arthroplasties, 1435 components (93%) met our abduction target, 1472 (95%) met our anteversion target, and 1363 (88%) simultaneously met both targets. Of the 263 surface replacement arthroplasties, 233 components (89%) met our abduction target, 247 (94%) met our anteversion target, and 220 (84%) simultaneously met both targets. When previously published target ranges of abduction (30° to 45°) and anteversion (5° to 25°) angles were used, only 665 total hip replacements (43%) met the abduction target, 1325 (86%) met the anteversion target, and 584 (38%) simultaneously met both targets. Of the surface replacement arthroplasties, 181 (69%) met the abduction target, 247 (94%) met the anteversion target, and 172 (65%) simultaneously met both targets. Low-volume surgeons were 2.16 times more likely to miss target component position compared with high-volume surgeons (p = 0.002). The odds of missing the target increased by ≥ 0.2 for every 5 kg/m2 increase in body mass index. Minimally invasive approaches, diagnosis, years of surgical experience, femoral head size, and age of the patient did not affect component position. Increased odds of component malposition were found with lower-volume surgeons and higher body mass index. No other variables had a significant effect on component placement. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Comparison of Sagittal Subluxation in Two Different Three-Component Total Ankle Replacement Systems

Malalignment following total ankle arthroplasty (TAA) has been reported in 4% to 45% of patients. However, all reports to date have been related to coronal deformity. This study compared sagittal malalignment between the Mobility and Hintegra total ankle systems and assessed the positional stability of the implant components over time. The study included 50 cases each of total ankle replacement arthroplasty with the Hintegra and Mobility total ankle systems performed between May 2008 and June 2010. The Mobility group included 24 men and 25 women, and the mean age was 60.3 years (range, 50.7-70.0 years). The Hintegra group included 25 men and 25 women, and the mean age was 59.8 years (range, 50.8-68.7 years). The 2 groups did not differ in terms of gender (P = .76) or age (P = .77). Three independent observers with different levels of training evaluated the radiographs and performed the measurements independently. Each observer evaluated the radiographs twice at a 6-week interval to determine the intraobserver reliability, and the anteroposterior offset ratio was evaluated. The anteroposterior offset ratio intra- and interobserver reliabilities all showed good or excellent levels of agreement in the Hintegra total ankle system and the Mobility total ankle system. With respect to the stability of sagittal translation of the talus, the Mobility system (0.08 ± 0.07 immediately, 0.0 ± 0.07 at 6 weeks postoperatively, and 0.01 ± 0.07 at 1 year postoperatively) was better than the Hintegra system (0.20 ± 0.08 immediately, 0.18 ± 0.11 at 6 weeks postoperatively, and 0.15 ± 0.10 at 1 year postoperatively) (P < .0001). The Mobility system had less sagittal malalignment of the talus than the Hintegra system. Consequently, when treating ankles in patients with osteoarthritis using the Hintegra system, one must pay careful attention to sagittal malalignment during surgery. Level III, retrospective comparative series.