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المؤلفون: Abella M; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Ong V; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Wong K; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.; Straub Medical Center, Bone and Joint Center, 888 South King Street Honolulu, Honolulu, HI, 96818, USA., Andrews SN; Straub Medical Center, Bone and Joint Center, 888 South King Street Honolulu, Honolulu, HI, 96818, USA.; Department of Surgery, University of Hawai'i, 1356 Lusitana Street, Honolulu, HI, 96813, USA., Nakasone CK; Straub Medical Center, Bone and Joint Center, 888 South King Street Honolulu, Honolulu, HI, 96818, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Jun; Vol. 144 (6), pp. 2789-2794. Date of Electronic Publication: 2024 May 28.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Knee*/methods , Patient Discharge*/statistics & numerical data, Humans ; Aged ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged, 80 and over ; Adult ; Time Factors ; Length of Stay/statistics & numerical data ; Ambulatory Surgical Procedures/statistics & numerical data ; Hospitals, Community

مستخلص: Background: Understanding the average time from surgery to discharge is important to successfully and strategically schedule cases planned for same day discharge (SDD) for total knee arthroplasty (TKA). The purpose of this study was to (1) evaluate the average time to discharge following unilateral TKA performed in a community hospital and (2) describe patient characteristics and peri-operative factors that may impact SDD.
Methods: This retrospective review included 75 patients having achieved SDD following unilateral TKA between March 2017 and September 2021 at a high-volume multi-specialty community hospital. Time to discharge was calculated from end of surgery, defined as completion of dressing application, to physical discharge from the hospital. Time surgery completed and association with time of discharge was also examined. Pearson's correlations were performed to evaluate the relationship between total time to discharge and patient demographics.
Results: The average age for all patients was 66.6 ± 10.9 years (Range: 38 to 86) and average BMI of 29.9 ± 5.6 kg/m ² (Range: 20.4 to 46.3). The average time to discharge was 5.8 ± 1.8 h (range: 2.2 to 10.5 h). Time to discharge was significantly longer for patients finishing surgery prior to noon (6.0 ± 1.8 h), than after noon (4.8 ± 1.4 h, p = 0.046). Total time to discharge was not correlated with age (r = 0.018, p = 0.881) or BMI (r=-0.158, p = 0.178), but was negatively correlated with surgical start time (r=-0.196, p = 0.094).
Conclusion: An average of six hours was required to achieve SDD following unilateral TKA performed in a community hospital. The time required for SDD was not found to be related to intrinsic patient factors but more likely due to extrinsic factors associated with time of scheduled surgery. To improve success of SDD, focus should be placed on the development of efficient discharge pathways rather than unchangeable intrinsic patient characteristics.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

المؤلفون: Weldon E; John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., Agonias K; John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., DeJesus J; John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., Weldon RH; University of Hawaii at Manoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, 96822, USA., Au DLMT; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA., Nakasone CK; John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 May; Vol. 144 (5), pp. 2365-2372. Date of Electronic Publication: 2024 Mar 21.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Hip*/methods , Hip Prosthesis*, Humans ; Retrospective Studies ; Male ; Female ; Middle Aged ; Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Prosthesis Design ; Adult ; Hip Joint/surgery ; Hip Joint/diagnostic imaging

مستخلص: Introduction: Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems.
Materials and Methods: This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1 year. Independent t-tests and Chi-squared analyses compared EO and SO groups.
Results: EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1 year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6 mm (76% vs. 82%; p = 0.193) and LLD < 6 mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively.
Conclusions: Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

المؤلفون: Thorne T; John A Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., Nishioka S; John A Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., Wong K; John A Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., Lawton DRY; John A Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA., Lim SY; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA., Nakasone CK; John A Burns School of Medicine, University of Hawai'i at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 May; Vol. 144 (5), pp. 1937-1944. Date of Electronic Publication: 2024 Mar 27.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Knee*/statistics & numerical data , Arthroplasty, Replacement, Hip*/statistics & numerical data , Healthcare Disparities*/statistics & numerical data , Healthcare Disparities*/ethnology, Humans ; Male ; Female ; Aged ; Retrospective Studies ; Middle Aged ; White People/statistics & numerical data ; Postoperative Complications/ethnology ; Postoperative Complications/epidemiology ; United States/epidemiology ; Native Hawaiian or Other Pacific Islander/statistics & numerical data ; Asian/statistics & numerical data

مستخلص: Background: Previous arthroplasty utilization research predominantly examined Black and White populations within the US. This is the first known study to examine utilization and complications in poorly studied minority racial groups such as Asians and Native Hawaiian/Pacific-Islanders (NHPI) as compared to Whites.
Results: Data from 3304 primary total hip and knee arthroplasty patients (2011 to 2019) were retrospectively collected, involving 1789 Asians (52.2%), 1164 Whites (34%) and 320 Native Hawaiians/Pacific Islanders (NHPI) (9.3%). The 2012 arthroplasty utilization rates for Asian, White, and NHPI increased by 32.5%, 11.2%, and 86.5%, respectively, by 2019. Compared to Asians, Whites more often underwent hip arthroplasty compared to knee arthroplasty (odds ratio (OR) 1.755; p < 0.001). Compared to Asians, Whites and NHPI more often received total knee compared to unicompartmental knee arthroplasty (White: OR 1.499; NHPI: OR 2.013; p < 0.001). White patients had longer hospitalizations (2.66 days) compared to Asians (2.19 days) (p = 0.005) following bilateral procedures. Medicare was the most common insurance for Asians (66.2%) and Whites (54.2%) while private insurance was most common for NHPI (49.4%). Compared to Asians, economic status was higher for Whites (White OR 0.695; p < 0.001) but lower for NHPI (OR 1.456; p < 0.001). After controlling for bilateral procedures, NHPI had a lower risk of transfusion compared to Asians (OR 0.478; p < 0.001) and Whites had increased risk of wound or systemic complications compared to Asians (OR 2.086; p = 0.045).
Conclusions: Despite NHPI demonstrating a significantly poorer health profile and lower socioeconomic status, contrary to previous literature involving minority racial groups, no significant overall differences in arthroplasty utilization rates or perioperative complications could be demonstrated amongst the racial groups examined.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

المؤلفون: Kop M; University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Kim N; University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Shimoda B; University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Unebasami E; University of Hawai'I, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Weldon RH; University of Hawai'i Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, 96822, USA., Nakasone CK; Straub Medical Center Bone and Joint Center, 888 South King Street, Honolulu, HI, 96814, USA. onohunter@icloud.com.; Department of Surgery, University of Hawai'i, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Apr; Vol. 144 (4), pp. 1565-1573. Date of Electronic Publication: 2024 Feb 22.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Hip* , Arthroplasty, Replacement, Knee* , Osteoarthritis, Hip*/diagnostic imaging , Osteoarthritis, Hip*/epidemiology , Osteoarthritis, Hip*/surgery , Osteoarthritis, Knee*/diagnostic imaging , Osteoarthritis, Knee*/epidemiology , Osteoarthritis, Knee*/surgery, Female ; Humans ; Male ; Knee Joint/surgery ; Native Hawaiian or Other Pacific Islander ; Prevalence ; White ; Asian

مستخلص: Background: It is estimated that one-third of patients presenting with unilateral joint pain have contralateral osteoarthritis (OA) at first presentation. Most studies have primarily examined White patient cohorts. The purpose of this study was to determine the prevalence of contralateral joint OA for patients presenting for unilateral total knee (TKA), unicompartmental knee (UKA) or total hip arthroplasty (THA) among Asian, Native Hawaiian/Pacific Islander and White patients.
Methods: Bilateral radiographic reports at initial presentation of 2,312 subjects who underwent unilateral arthroplasties (332 UKAs, 933 TKAs and 1,047 THAs) were reviewed. The presence of contralateral OA was recorded and compared by racial group and type of arthroplasty performed. Parametric statistical analyses were performed to determine differences between groups. Multivariable analyses were completed for each arthroplasty group to determine the influence on the presence of contralateral OA, presented as odds ratios and 95% confidence intervals.
Results: Contralateral joint OA was present in 86.7%, 90.4% and 70.4% of UKA, TKA and THA patients, respectively. Concurrent hip OA was present in 41.6% and 59.5% of UKA and TKA patients. No racial differences in the prevalence of contralateral knee OA were found for knee arthroplasty patients. White patients (74.6%) had a greater prevalence of contralateral hip OA compared to Asians (66.5%, p = 0.037) amongst THA recipients. Increased age and body mass index were significantly associated with the presence of contralateral knee OA. Increased age, being male and being White were significant contributors for the presence of contralateral hip OA.
Conclusion: The prevalence of contralateral joint OA and concurrent hip OA is high in all three racial groups. Due to the extensive prevalence of contralateral and concurrent knee and hip OA, bilateral radiographic evaluation should be considered for all patients presenting with unilateral hip or knee pain due to OA.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

المؤلفون: Tamate T; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.; Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA., Nishioka S; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Ry LD; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Weldon RH; Office of Public Health Studies, University of Hawaii at Manoa, 1960 East-West Road, Honolulu, HI, 96822, USA., N AS; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.; Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA., Nakasone CK; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Department of Surgery, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Apr; Vol. 144 (4), pp. 1773-1779. Date of Electronic Publication: 2023 Dec 22.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Hip*/methods , Osteoarthritis, Hip*/surgery, Humans ; Mental Health ; Treatment Outcome ; Retrospective Studies

مستخلص: Background: Poor mental health is difficult to recognize and as a result, its association with recovery from total joint arthroplasty is difficult to assess. The purpose of this study was to investigate the relationship between overall mental health scores and outcomes in the early postoperative period following unilateral total hip arthroplasty (THA).
Methods: This is a retrospective review of prospectively collected data involving 142 patients who underwent primary unilateral THA. Independent variables included patient demographics and preoperative Patient-Reported Outcomes Measurement Information System (PROMIS), Global Physical Health (GPH) and Global Mental Health (GMH) and Hip Disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) scores as well as diagnoses of depression or anxiety. Dependent variables included length of stay (LOS), disposition at discharge, narcotic consumption until discharge, 6-week postoperative GPH, GMH and HOOS JR scores and magnitude of change compared to preoperative scores. Preoperative GMH and postoperative outcomes were compared using Pearson correlation coefficient, independent t-tests, Pearson's Chi-Square test, and univariate logistic regression.
Results: Patients with preoperative GMH scores below the 25% quartile were less likely to be discharged home and resulted in lower GPH, GMH and HOOS JR scores at 6-week follow-up compared to patients with preoperative GMH scores in the top 25% quartile. However, patients with low preoperative GMH scores demonstrated a greater magnitude of improvement in both the GPH and GMH scores compared to patients in the top 25% quartile. There was no difference in opioid consumption or LOS between either groups. When comparing patients with and without depression/anxiety, no difference was seen in any of the outcomes measured.
Conclusion: Unilateral THA offers significant improvements in both physical and mental function to patients with hip osteoarthritis and poor mental health, though overall scores remain lower than in those with better mental health.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

المؤلفون: Hummel A; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Matsumoto M; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Shimoda B; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA., Au DLMT; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA., Andrews SN; Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA.; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA., Nakasone CK; Department of Surgery, John A Burns School of Medicine, University of Hawai'I, 1356 Lusitana Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.

المصدر: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2024 Jan; Vol. 144 (1), pp. 315-322. Date of Electronic Publication: 2023 Aug 26.

نوع المنشور: Journal Article

بيانات الدورية: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9011043 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1434-3916 (Electronic) Linking ISSN: 09368051 NLM ISO Abbreviation: Arch Orthop Trauma Surg Subsets: MEDLINE

مواضيع طبية MeSH: Arthroplasty, Replacement, Knee*/adverse effects , Arthroplasty, Replacement, Knee*/methods, Humans ; Male ; Female ; Length of Stay ; Hospitals, Community ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Patient Discharge ; Retrospective Studies

مستخلص: Introduction: The safety of single-stage bilateral total knee arthroplasty (SSBTKA) compared to unilateral total knee arthroplasty (TKA) remains controversial. The present study compares the 90-day postoperative complications encountered following SSBTKA and unilateral TKA in an unselected cohort of patients performed at a high-volume community hospital.
Materials and Methods: The perioperative electronic medical records of an unselected consecutive cohort of 1032 patients (1345 knees) having undergone unilateral or SSBTKA were reviewed. Ninety-day postoperative complications or need for additional procedures were compared between unilateral and SSBTKA groups.
Results: A total of 719 and 313 patients underwent unilateral and SSBTKA, respectively. There were no significant differences in age or BMI between groups. Patients undergoing SSBTKA were more likely to be male (p = 0.019), have longer lengths of stay (p < 0.001) and were less likely to discharge directly home (13.1%) compared to unilateral patients (80.9%) (p < 0.001). Patients undergoing SSBTKA were more likely to require a transfusion (14.7%) compared to unilateral patients (2.2%) (p < 0.001). Interestingly, mortality rate following unilateral TKA (1.7%) was significantly higher than SSBTKA (0.0%) (p = 0.013). There were no significant differences regarding other complications or need for additional procedures within 90 days following surgery.
Conclusion: SSBTKA did not result in greater complications when compared to unilateral TKA in this particular cohort. As expected, transfusion rates will likely be higher and there will be a greater need for acute inpatient care following surgery for SSBTKA patients.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)