•Orthopaedic boots change the joint mechanics of gait.•Leg length discrepancy contributes to asymmetries when wearing an orthopaedic boot.•A heel lift reduces the knee joint asymmetries created by an ...orthopaedic boot.•Introducing a heel lift increased hip frontal plane asymmetry.•Hip mechanics were affected in all three planes by the Boot.
Orthopaedic walking boots are commonly prescribed following injury and surgery. The boot creates a leg length discrepancy which is thought to affect limb symmetry and gait mechanics. This study aimed to examine the effects of a corrective heel lift for the contralateral limb on the mechanics and symmetry of walking with an orthopaedic walking boot. Research question: Does a corrective heel lift reduce biomechanical alterations and asymmetries caused by an orthopaedic boot during gait?
Healthy males (n=17) walked with normal shoes (Shod), an orthopaedic boot (Boot), and a corrective heel lift on the contralateral limb to the boot (Lift). A 10-camera motion capture system (Vicon, 100Hz) and four force platforms (AMTI, 1000 Hz) recorded lower extremity biomechanics. Pairwise statistics tested for differences in hip and knee kinematics and kinetics, and a symmetry index quantified limb symmetry.
The Boot affected the sagittal and frontal plane hip mechanics and transverse plane knee mechanics (p<0.05), and increased the asymmetry compared to the Shod condition. The Lift improved the symmetry of some measures but increased the frontal plane hip asymmetry compared to the Boot. However, introducing the Lift did not change all kinematic variables affected by the boot.
The Lift reduced some of the asymmetries introduced by the Boot, but also introduced new asymmetry in the hip frontal plane motion. The leg length discrepancy caused by the boot is probably not the only cause of altered gait mechanics. Prescribing a heel lift to a patient with an orthopaedic walking boot should be based on the individual patient’s needs.
Abstract Objectives Periprosthetic fracture (PPF) is a rare but devastating complication of primary total hip arthroplasty. While PPF is associated with increased morbidity and mortality, early ...revision rate, and poor patient outcome, there is a paucity of data on patient and hospital-dependent risk factors. Using a large administrative database, we investigated epidemiology and the risk factors associated with perioperative PPF after primary total hip arthroplasty. Methods We performed a retrospective review of the National Inpatient Sample (NIS) records from 2006-20011 and identified 1,062 PPF out of 1,187,969 patients using ICD-9 code for periprosthetic fracture (996.44). We then analyzed sociodemographic characteristics, comorbidities, and hospital characteristics of our study population. Results The overall incidence of PPF in NIS database were 0.089% (8.9 per 10,000 THAs). Patient-dependent risk factors were: female (OR 1.93, 95% CI 1.67-2.22), low household income (OR 1.4, 95% CI 1.18-1.65), Medicaid (OR 1.89, 95% CI 1.39-2.57), and uninsured (OR 2.74, 95% CI 1.63-4.61). Patients with malnutrition and hemiparesis/hemiplegia were associated 10-fold and 6-fold risk of PPF. Non-teaching hospitals (OR 1.15, 95% CI 1.01-1.32), hospitals in Northeast (OR 1.29, 95% CI 1.04-1.59), rural hospitals (OR1.27, 95% CI 1.06-1.53) had higher incidence of PPF. Conclusion Our study demonstrates that the incidence of PPF was low in our study population, and greater awareness is needed when performing primary THAs in patients with risk factors identified in our study to prevent PPF.
Abstract Background Inpatient dislocation after total hip arthroplasty (THA) is considered a nonreimbursable “never event” by the Centers for Medicare and Medicaid Services. There is extensive ...evidence that technical procedural factors affect dislocation risk, but less is known about the influence of nontechnical factors. We evaluated inpatient dislocation trends after elective primary THA and identified patient and hospital characteristics associated with the occurrence of dislocation. Methods We used discharge records from the Nationwide Inpatient Sample (2002-2011). Temporal trends were assessed, and multivariable logistic regression modeling was used to identify factors associated with dislocation. Results The in-hospital dislocation rate increased from 0.025% in 2002 to 0.15% in 2011, despite a downward trend in length of stay ( P < .001). Patient characteristics associated with the occurrence of dislocation were black or Hispanic race/ethnicity, lower household income, and Medicaid insurance. Comorbidities associated with dislocation included hemiparesis/hemiplegia, drug use disorder, chronic renal failure, psychosis, and obesity. Dislocations were less likely to occur at teaching hospitals and in the South. Conclusion The in-hospital dislocation rate after elective primary THA is increasing, in spite of shorter stays and surgical advances over time. Given the sociodemographic disparities in dislocation risk documented herein, interventions to address social determinants of health might do as much or more to reduce the occurrence of dislocation than technical improvements.
Abstract Although ‘dual taper’ modular stems with interchangeable modular necks have the potential to optimize hip biomechanical parameters, there is increasing concern regarding the occurrence of ...adverse local tissue reactions from mechanically assisted crevice corrosion at the neck–stem taper junction. A systematic treatment approach (risk stratification algorithm) based on the currently available data is recommended to optimize patient management. While specialized tests such as metal ion analysis and MARS MRI are useful modalities in evaluating for adverse tissue reactions, over-reliance on any single investigative tool in the clinical decision-making process should be avoided. There should be a low threshold to perform a systematic evaluation of patients with dual taper stem total hip arthroplasty as early recognition and diagnosis will facilitate the initiation of appropriate treatment.
Mesenchymal stem/stromal cells (MSCs) have been carefully examined to have tremendous potential in regenerative medicine. With their immunomodulatory and regenerative properties, MSCs have numerous ...applications within the clinical sector. MSCs have the properties of multilineage differentiation, paracrine signaling, and can be isolated from various tissues, which makes them a key candidate for applications in numerous organ systems. To accentuate the importance of MSC therapy for a range of clinical indications, this review highlights MSC-specific studies on the musculoskeletal, nervous, cardiovascular, and immune systems where most trials are reported. Furthermore, an updated list of the different types of MSCs used in clinical trials, as well as the key characteristics of each type of MSCs are included. Many of the studies mentioned revolve around the properties of MSC, such as exosome usage and MSC co-cultures with other cell types. It is worth noting that MSC clinical usage is not limited to these four systems, and MSCs continue to be tested to repair, regenerate, or modulate other diseased or injured organ systems. This review provides an updated compilation of MSCs in clinical trials that paves the way for improvement in the field of MSC therapy.
Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in ...determining patient candidacy for TJA based on body mass index (BMI).
A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations.
For TJA procedures, 49.9% of surgeons had a BMI cutoff at 40, 24.5% at 45, and 8.3% at 50. At a BMI cutoff of 40, 23.8% of surgeons felt their patient volume would be adversely affected, whereas at a BMI cutoff of 35, 50% of surgeons felt their patient volume would be adversely affected. Surgeons were more likely to not perform total hip arthroplasty on patients with morbid obesity than total knee arthroplasty (P = .037). Significantly more academic surgeons did not have cutoffs for total hip arthroplasty (P = .003) or total knee arthroplasty (P < .001) compared with all other practice settings.
There are myriad factors that affect surgeon BMI thresholds for offering elective TJA including poor outcomes, hospital thresholds, financial considerations, and the well being of the patient. Further work should be performed to minimize the risks associated with TJA while providing the best possible care to patients with morbid obesity.
Shifts in demand, capacity, and site of service have impacted total hip arthroplasty (THA) volumes and revenues over the 2019-2021 time period. Moving THA off the inpatient-only (IPO) list and the ...COVID-19 pandemic has caused a shift in delivery away from inpatient services and a decrease in demand.
Medicare claims data were surveyed for the latest period available (April 1, 2020 to September 2020) and compared with a similar period in 2019 prior to THA removal from the IPO list and before the COVID-19 pandemic. Length of stay (LOS), admission status, site of service, discharge status, cost to CMS (Centers of Medicaid and Medicare Services), and racial disparities were analyzed.
From 2019 to 2020, changes in primary THA metrics occurred (overall change in total joint arthroplasty THA plus total knee arthroplasty metrics): CMS THA volume decreased from 78,691 to 65,360, −16% (−22%); THA performed as an outpatient increased from 0% to 51% (141%); THA performed as same-day discharge increased from 3% to 12%, 325% (221%); overall LOS decreased from 1.91 to 1.46, −23% (−11%); inpatient LOS increased from 1.92 to 2.05, 7% (16%); outpatient LOS increased from 0.92 to 0.93, 1% (−12%); discharge home increased from 82% to 91%, 12.8% (11%); and CMS spending decreased from $1,033 million to $751 million, −27% (−27%).
Medicare payments, LOS, discharge to facilities, and volume declined from 2019 to 2020 and were accelerated by IPO list changes and COVID-19 issues. Same-day discharge and hospital outpatient department cases also increased. THA metrics were not affected by race.
•The health literacy of THA/TKA patients did not differ from their caregivers.•Patients with low health literacy had lower expectations for walking after surgery.•Low health literacy may contribute ...to disparities in opting for hip/knee surgery.•Healthcare practices should use easy to read and understand patient materials.•Plain language best practices can improve the readability of health care materials.
This study assessed patients’ health literacy and expectations for total hip (THA) and total knee (TKA) replacement surgery, and compared health literacy levels of patients and their caregivers.
A convenience sample of 200 THA/TKA participants, patients and their caregivers, participated in this study.
Results demonstrated no statistical difference in health literacy between patients and their caregivers. However, patients with lower health literacy had significantly lower expectations for walking after surgery.
Practices should be aware that caregivers may not be any better equipped to consume and use complicated patient education materials than the patient they are assisting. Additionally, lower health literacy, rather than or in addition to race or social factors, may contribute to disparities in opting for THA/TKA because of lower expectations for walking after surgery.
Healthcare practices should develop patient educational materials that are easy for all patients and caregivers to understand, especially those with low health literacy. Additional patient education and counseling may help patients with low health literacy realistically align their expectations and mitigate barriers to consenting to surgery due to low expectations.
Patient Health Literacy and Diabetic Foot Amputations Hadden, Kristie; Martin, Robert; Prince, Latrina ...
The Journal of foot and ankle surgery,
September 2019, 2019-Sep, 2019-09-00, 20190901, Letnik:
58, Številka:
5
Journal Article
Recenzirano
Patient health literacy is associated with self-care and management of chronic diseases, including diabetes. Interventions that address health literacy and aim to improve clinical outcomes have been ...focused mostly in primary care. The purpose of this study was to explore the association between patient health literacy and diabetic foot amputations in a retrospective cohort analysis in a large orthopaedic practice at an academic medical center. Using data extraction from clinical records, orthopaedic patients who had a diabetic foot amputation or re-amputation in the last 2 years were compared with the general orthopaedic patient population, with patient health literacy screening results as the dependent variable. Results revealed a statistically significant difference in health literacy between the foot amputee group (N = 177) and the general orthopaedic patient group (N = 14,683) (p < .0001). Patients in the foot amputee group were 8.07 times more likely to have inadequate health literacy than patients in the general orthopaedic patient group. Because diabetic amputations are frequently associated with poorly controlled diabetes, these results provide a strong rationale to develop health literacy–based interventions that address diabetes self-management and foot exams in orthopaedic practices to improve clinical outcomes, including amputation prevention.
Articulating hip spacers for periprosthetic joint infection (PJI) offer numerous advantages over static spacers such as improved patient mobilization, hip functionality, and soft tissue tension. Our ...study aimed to determine complication rates of a functional articulating spacer using a constrained liner to determine the role of acetabular cementation mantle and bone loss on the need for second-stage surgery. A retrospective review of 103 patients was performed and demographic information, spacer components and longevity, spacer-related complications, reinfection rates, and grade of bone loss and acetabular cement mantle quality were determined. There was no significant difference in spacer-related complications or reinfection rate between PJI and native hip infections. 33 of 103 patients (32.0%) elected to retain their spacers. Between patients who retained their initial spacer and those who underwent reimplantation surgery, there was not a significant difference in cement mantle grade (p = 0.52) or degree of bone loss (p = 0.78). Functional articulating antibiotic spacers with cemented constrained acetabular liners demonstrate promising early results in the treatment of periprosthetic and native hip infections. The rate of dislocation events was low. Further efforts to improve cement fixation may help decrease the need for second-stage reimplantation surgery.
PDF
