Outpatient Total Hip Arthroplasty, Total Knee Arthroplasty, and Unicompartmental Knee Arthroplasty

Pollock, Michael; Somerville, Lyndsay; Firth, Andrew; Lanting, Brent A.

doi:10.2106/jbjs.rvw.16.00002

Cited by 196 publications

(81 citation statements)

References 29 publications

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“…Given the high satisfaction rate and low rate of revision following total joint arthroplasty utilizing contemporary surgical technique and improved biomaterials, protection of the post-operative surgical wound and related complications are of paramount importance. Given the emerging trends of abbreviated inpatient stay following TJA and the increasing percentage of total joint arthroplasty performed in the outpatient setting, the search for reliable chemical anticoagulation agents that reduce VTE events while minimizing post-operative bleeding and wound complications is of great interest [37]. Not all new agents have been able to achieve these objectives consistently; many have been associated with an increased incidence of wound leakage and increased length of stay after total joint replacement [26].…”

Section: Discussionmentioning

confidence: 99%

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

et al. 2020

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Hip and knee arthroplasty patients are at high risk of perioperative venous thromboembolic events (VTE). VTE has been well studied in this population and it is recommended that total joint arthroplasty recipients receive chemoprophylactic anticoagulation due to risk factors inherent to the surgical intervention. There are few concise resources for the orthopedic surgeon that summarize data regarding post-operative anticoagulation in the context of currently available therapeutic options and perioperative standards of practice. The periodic reexamination of literature is essential as conclusions drawn from studies predating perioperative protocols that include early mobilization and sequential compression devices as standards of practice in total joint arthroplasty are no longer generalizable to modern-day practice. We reviewed a large number of recently published research studies related to post-operative anticoagulation in total joint arthroplasty populations that received a high Level of Evidence grade. Current literature supports the use of oral aspirin regimens in place of more aggressive anticoagulants, particularly among low risk patients. Oral aspirin regimens appear to have the additional benefit of lower rates of bleeding and wound complications. Less consensus exists among high risk patients and more potent anticoagulants may be indicated. However, available evidence does not demonstrate clear superiority among current options, all of which may place patients at a higher risk of bleeding and wound complications. In this situation, chemoprophylactic selection should reflect specific patient needs and characteristics.

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Section: Discussionmentioning

confidence: 99%

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

et al. 2020

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“…Over the past decade, total hip and total knee arthroplasties (THA and TKA) have transitioned to an outpatient setting, meaning that patients are discharged from hospital on the same day as their procedure. 2 This was initially performed primarily in the US but is now being increasingly performed in Canada and Europe as well. 4…”

Section: Outpatient Arthroplastymentioning

confidence: 99%

“…Success of outpatient THA and TKA has been reported in several studies and is summarized by Pollock et al in a systematic review. 2 All studies discussed in the review were conducted in the US, except for one that investigated outpatient unicompartmental knee arthroplasty in Canada. The authors found the studies reported similar complication rates between outpatient and inpatient groups with significantly lower associated costs for the outpatient group.…”

Section: International Experiencementioning

confidence: 99%

“…Outpatient joint replacements (where the patient is discharged from hospital on the same day as surgery) have become popular in the United States. 2 In Canada the current median length of stay for hip and knee replacements is three days. 1 Some surgeons have started to implement outpatient procedures into their practice, but barriers to outpatient care pathways have stood in the way of widespread implementation.…”

Section: Introductionmentioning

confidence: 99%

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<p>Implementation of Outpatient Total Joint Arthroplasty in Canada: Where We are and Where We Need to Go</p>

Zomar

Sibbald

Bickford

et al. 2020

ORR

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Total joint arthroplasties (TJA) are successful procedures for the treatment of end-stage hip and knee arthritis. Length of stay in hospitals after these procedures has been steadily decreasing over time, with outpatient procedures (discharge on the same day as surgery) introduced in the US within the last 20 years. Reducing length of stay after TJA can provide cost savings. Centres in Canada have started to utilize outpatient TJA procedures, but we have identified some barriers that may have limited their implementation. We have summarized the current literature for outpatient TJA and discussed potential solutions for the current barriers.

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“…The use of an arti cial joint is therefore one of the standard surgeries in modern medicine today [1]. Several hundred thousand hip endoprostheses are implanted worldwide every year [2][3][4][5] with sharp increase in demand [5,6].…”

Section: Introductionmentioning

confidence: 99%

Investigation of Assembly Forces During Creation of Head-Neck Taper Junction Following Total Hip Arthroplasty: A Biomechanical Study

Wendler

Prietzel

Möbius

et al. 2020

Preprint

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BackgroundAll current total hip arthroplasty (THA) systems are modular in design. Only during the operation femoral head and stem get connected by a Morse taper junction. The junction is realized by hammer blows from the surgeon. Decisive for the junction strength is the maximum force acting once in direction of the neck axis, which depends both on the applied impulse and the damping of human soft tissues. This leads to large differences in assembly forces between the surgeons. The investigation of assembly forces of different surgeons under influence of soft tissue damping is subject of this study.MethodsFirst, a measuring system, consisting of a prosthesis and a hammer, was developed. Both components are equipped with a piezoelectric force sensor. Initially, in situ experiments on human cadavers were carried out using this system in order to determine the actual assembly forces and to characterize the damping properties of human soft tissue. In addition to these experiments, an in vitro model in form of an artificial femur (Sawbones Europe AB, Malmo, Sweden) with implanted measuring stem embedded in gelatine was developed. The gelatine mixture was chosen in such a way that damping properties of the model correspond to those in situ. A study with 31 surgeons was carried out on the in vitro model mentioned above, in which the assembly forces were determined.ResultsA model has been developed, that represents the physiological damping behaviour of human soft tissue. The assembly forces measured on in vitro model were on average 2037.2 N ± 724.9 N and ranged from 822.5 N to 3835.2 N. The comparison of the surgeons showed no significant differences regarding sex (p=0.09), work experience (p=0.71) and number of THAs per year (p=0.69).ConclusionsAll measured assembly forces were below 4 kN, which is recommended in the literature. This could lead to increased corrosion following fretting in the head-neck interface. In addition, there was a very wide range of assembly forces among the surgeons, although other influencing factors such as different implant sizes or materials were not taken into account. To ensure optimal assembly force, the impaction should be standardized, e.g. by an appropriate surgical instrument.

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Outpatient Total Hip Arthroplasty, Total Knee Arthroplasty, and Unicompartmental Knee Arthroplasty

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 196 publications

References 29 publications

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

<p>Implementation of Outpatient Total Joint Arthroplasty in Canada: Where We are and Where We Need to Go</p>

Investigation of Assembly Forces During Creation of Head-Neck Taper Junction Following Total Hip Arthroplasty: A Biomechanical Study

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