Serious complications are uncommon following treatment of patellar fractures with a modified tension-band technique, with use of either Kirschner wires or cannulated screws. In both groups the rate of fixation failure was low, as was the rate of postoperative infection. Symptomatic implants, the most common complication observed, were twice as frequent in patients treated with Kirschner wires.

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Background Risk stratification is critical in patients with cirrhosis undergoing THAs and TKAs, as they may be more likely to have serious medical and surgical complications. As opposed to the Child-Pugh scoring system, which has limited use for orthopaedic surgeons inexperienced in assessing ascites and hepatic encephalopathy, the Model for End-stage Liver Disease (MELD) is an easily calculated, validated scoring system for severity of liver disease based on common laboratory values; however, its usefulness for predicting complications after elective arthroplasty has not been studied. Questions/purposes The purposes of this study were to determine the differences between patients with cirrhosis and control subjects in (1) hospital length of stay, discharge disposition, and readmission within 90 days; (2) early postoperative (90 days) medical complications potentially related to liver disease; (3) surgical complications within 90 days and any time after the procedure; (4) mortality rates after THA and TKA; and in addition, (5) to use the MELD score as a predictor for risk of complications and mortality. Methods Institutional database query software used coding data identified 115 patients with liver cirrhosis before having THAs or TKAs from 2000 to 2012 and 115 control subjects without cirrhosis matched by age, sex, procedure, and year of surgery. Early postoperative and longer-term medical and surgical complications were compared. Regression analysis was used to determine a MELD score that predicted greater risk of complications. Results Compared with matched control subjects, patients with cirrhosis had prolonged length of stay and higher rates of discharge to nursing facilities, readmission in 90 days, and urinary tract infections (p \ 0.01), renal failure (p = 0.03), blood transfusions (p \ 0.01), gastrointestinal hemorrhage (p = 0.04), dislocations (p = 0.01), infections (p = 0.02), and revisions (p = 0.04) within 90 days.One-year (p = 0.01) and longer-term (p = 0.0002) mortality rates were greater in patients with cirrhosis. A MELD score of 10 or greater predicted a three times increased likelihood (odds ratio [OR]) of any complication (95% CI, 1.28-7.00; p = 0.01) and 4.1 times Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research. Informed consent was deemed unnecessary by our institutional review board.

Background:The purpose of the current study was to evaluate the usage of prehabilitation on a telehealth platform prior to total knee arthroplasty (TKA) and its impact on short-term outcomes. Specifically, the study examined whether patients participating in a prehabilitation program impacted length of stay (LOS) and discharge disposition.Methods: A total of 476 consecutive patients who underwent TKA at three institutions were included. The average age of the 476 patients was 65.1 years (range, 35 and 93 years). There was a total of 114 patients who utilized the novel prehabilitation program that provided exercises, nutritional advice, education regarding home safety and reducing medical risks, and pain management skills prior to surgery. A group of 362 patients who did not utilize the program formed the control cohort. The outcomes evaluated were LOS and discharge disposition to home, home with health aide (HHA), or skilled nursing facility (SNF). Results:The average LOS in the prehabilitation group was significantly shorter than in the control group (2.0 vs. 2.7 days, P<0.001). Additionally, prehabilitation patients had more favorable discharge disposition status in comparison to the control group. In the prehabilitation patients, 77.2% went home without assistance, compared to 42.8% in the control group (P<0.001). Also, significantly fewer patients in the prehabilitation group were discharged to a SNF when compared to the control group (1.8% vs. 21.8%, P<0.0001).Conclusions: Prehabilitation preceding TKA in the current study showed early benefits in LOS and discharge disposition. This study will help expand the current literature and educate orthopaedic surgeons on a novel technology. To truly appreciate the role of telerehabilitation in the setting of TKA, further investigation is needed to investigate long-term outcomes, cost analysis, and patient and clinician satisfaction.