Pain is the primary indication for both primary and revision total knee arthroplasty (TKA); however, most arthroplasty outcome measures do not take pain into account.
To document the prospective pain ...experience following TKA, with subjective pain-specific questionnaires to determine if comorbidities, preoperative pain or preoperative pain catastrophizing scores are predictive of long-term pain outcomes.
Fifty-five patients with a primary diagnosis of osteoarthritis of the knee, who were scheduled to undergo TKA, were asked to fill out the McGill Pain Questionnaire (MPQ) and the Pain Catastrophizing Scale (PCS) preoperatively and at three, 12 and 24 months follow-up. Comorbidities were extracted from the Queen Elizabeth II Health Sciences Centre health information system.
The overall response rate (return of completed questionnaires) was 84%. There was a significant decrease in the MPQ scores (P<0.05) postoperatively. PCS scores did not change over time. Receiver operating characteristic curves revealed the number of comorbidities per patient predicted the presence of pain postoperatively, as documented by the numerical rating subscale of the MPQ at 24 months (P<0.05). Receiver operating characteristic curves for preoperative PCS and rumination subscale scores predicted the presence of pain, as measured by the Pain Rating Index subscale of the MPQ at 24 months (P<0.05). Preoperative PCS scores and comorbidities were significantly higher in the persistent pain group (P<0.05).
The number of comorbidities predicted the presence of pain at 24 months follow-up and, for the first time, preoperative PCS scores were shown to predict chronic postoperative pain. This may enable the identification of knee arthroplasty patients at risk for persistent postoperative pain, thus allowing for efficient administration of preoperative interventions to improve arthroplasty outcomes.
Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) ...contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine if farther mobilization on POD0 led to shorter length of stay and to identify the predictors of farther mobilization and length of stay.
A retrospective chart review was undertaken using data for patients who had a primary TJA and mobilized on POD0. Patients were categorized into the following 4 mobilization groups: sat on the bedside (Sat), stood by the bed or walked in place (Stood), walked in the room (Room) and walked in the hall (Hall). The primary outcome was length of stay. Predictors of farther mobilization on POD0 and length of stay were identified using regression analyses.
The sample comprised 283 patients. The Hall group had significantly shorter length of stay than all other groups. There were sex differences across the mobilization groups. Simultaneous regression analysis showed that farther mobilization was predicted by younger age, male sex, lower body mass index, spinal anesthesia and fewer symptoms limiting mobilization. Hierarchical regression showed that shorter length of stay was predicted by male sex, lower body mass index, lower American Society of Anaesthesiologists physical status classification score, less pain/stiffness and farther mobilization on POD0.
Understanding the modifiable and nonmodifiable predictors of mobilization after TJA and length of stay can help identify patients more likely to mobilize farther on the day of surgery, which would contribute to better resource allocation and discharge planning. Focusing on symptom management could increase opportunities for farther mobilization on POD0 and thereby decrease length of stay.
Satisfaction with total knee arthroplasty (TKA) is correlated with the fulfillment of expectations. Good surgeon-patient communication impacts how expectations are formed and managed. The TKA ...communication checklist was developed to help surgeons better understand and manage patients’ postoperative expectations in order to increase satisfaction with TKA.
In this prospective cohort study, mean satisfaction scores of a standard of care communication group and a checklist intervention group were compared. The duration of postoperative follow-up appointments was also assessed to determine whether the checklist took significantly more time in practice.
Sixty patients received the checklist in TKA appointments with surgeons between 6 weeks and 6 months postoperatively and their satisfaction ratings were compared with 67 patients who had received the standard of care communication. The checklist group reported higher satisfaction on overall TKA satisfaction and expectations met (P = .02), care and concern shown by the surgeon (P = .01), surgeons’ communication ability (P = .01), and satisfaction with time spent in follow-ups (P < .001). Satisfaction with relief from pain and return to function was not significant (P = .06). More time was spent in the checklist groups’ follow-ups, with a mean difference of 1 minute, 51 seconds (P = .001).
The TKA communication checklist significantly improved patients’ satisfaction across multiple dimensions. This has practical significance because patient satisfaction is increasingly used as a key performance indicator for surgeons and healthcare institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the healthcare system overall.
Orthopedic surgical care, like all health care today, is in flux owing to an aging population and to chronic medical conditions leading to an increased number of people with illnesses that need to be ...managed over the lifespan. The result is an ongoing shift from curing acute illnesses to the management and care of chronic illness and conditions. Theoretical models that provide a useful and feasible vision for the future of health care and health care research are needed. This review discusses how the lifespan development model used in some disciplines within the behavioural sciences can be seen as an extension of the biopsychosocial model. We posit that the lifespan development model provides useful perspectives for both orthopedic care and research. We present key concepts and recommendations, and we discuss how the lifespan development model can contribute to new and evolving perspectives on orthopedic outcomes and to new directions for research. We also offer practical guidelines on how to implement the model in orthopedic practice.
Background
Total knee arthroplasty (TKA) is a well‐established surgical procedure with high rates of clinical success, yet up to 20% of patients are dissatisfied with their outcomes. Surgeon–patient ...communication is an important contributor to patient satisfaction, particularly in the area of setting or resetting postoperative expectations that are reasonable and achievable for individual patients.
Objective
The goal of the present research was to develop a communication checklist for surgeons to use with their patients, to enhance communication in order better to manage postoperative expectations and increase patient satisfaction with TKA.
Methods
Content analysis was used to identify a preliminary list of checklist items from audio‐recorded interviews of eight patients who were between 6 weeks and 6 months of their recovery from TKA. Patients identified eight issues for which more information was desired. The proportion of mentions for each topic was calculated, and chi‐square tests assessed the distribution and pattern of the categories mentioned across groups of patients.
Results
Certain topics were used significantly more often than others. Age and employment status, but not gender, affected which topics were mentioned more often. The final categories for the checklist included pain management, physiotherapy, medication and general outcome information.
Conclusion
An in‐depth analysis of patient experiences of recovering from TKA was the foundation of this research. The result was a checklist that creates a potential new avenue for increasing patient satisfaction by improving surgeon–patient communication. The research described here could extend to any other type of intervention in which understanding patient expectations and increasing patient satisfaction is the goal.
...at its heart, this is a story about how rampant official corruption in one former Soviet republic—Kazakhstan—is made possible by a fabulously well-paid global network of lawyers, bankers, ...ex-spooks, politicians, and public-relations executives, who are all too happy to launder reputations and money. What was most outrageous about dos Santos’s avarice, beyond the brazenness of her money grabs, was the global network of law firms, PR shops, and consulting companies falling over themselves to help her. To be certain, the United States, with its secretive limited-liability companies that Russian mobsters use to anonymously buy Manhattan apartments, does play a big role, especially as the book draws to a conclusion and the ties of the drama’s shady cast of characters to President Donald Trump come to light. The crooked Swiss bank that once employed Burgis’s main protagonist, the late Nigel Wilkins, benefited from a report it commissioned from BCG that showed it “how to find and serve clients including oligarchs and ‘federal and municipal functionaries, officers in the military, security organs etc.’ who are ‘highly dependent on a personal political network,’ and who demand ‘high confidentiality. . . . in order to prevent negative publicity and avoid pressure’” (p. 138).
Hospital admissions for trampoline-related injuries are a metric of injury severity. The literature shows hospital admissions are more likely to occur from trampoline park injuries rather than home ...trampoline injuries. The purpose of this study was to investigate the demographics, injury characteristics, patient experiences, and economic impact of home versus trampoline park injuries requiring admission to hospital before and after two indoor trampoline parks opened in the catchment area of a Level II trauma centre. A case series research design was used. All patients who were admitted to hospital following a trampoline injury were contacted. For those who consented, clinical data was recorded from patients' charts and electronic health records. A subset of participants consented to a telephone interview wherein patient narratives were collected on the mechanism of injury, recovery process, and impact of the injury. During the study period, 15 patients required 17 hospital admissions. Twelve consented to participate in the study. Nine of the 12 required an operative intervention. Eight of the 12 were trampoline park injuries. Anatomical location of the injuries, injury type and severity scores, hospital stay, and median age were similar. The economic impact of home trampoline and trampoline park injuries varied. Overall, there were more hospital admissions and more operative interventions for trampoline park injuries during the four-year study period. Seven participants who consented to be interviewed provided additional insights into the injury experience and long-term outcomes. This study contributes to the literature on trampoline-related injuries, focusing on hospital admissions, economic impact, and adds the important perspective of patients in evaluating the effect of these injuries.
Abstract The influence of dislocation on functional outcomes of primary total hip arthroplasty is unclear. The purpose of this study was to assess the effect of nonrecurrent dislocations treated with ...closed reduction after primary total hip arthroplasty on postoperative outcome in the short to medium term. Ninety-six patients were enrolled in this retrospective case-control study. There were 32 patients who had a postoperative dislocation. The control group consisted of 64 matched patients who did not dislocate. All patients had a minimum of 1-year follow-up. The 2 groups were compared using the SF-12, reduced WOMAC, and satisfaction questionnaire. There was no statistical difference between the 2 groups in subjective functional outcomes using the WOMAC or SF-12. However, there was a trend toward better quality of life scores in the control group, and they were more satisfied with their surgery compared with the dislocation group.
Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or ...total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge.
We performed a multicenter, double-blind, randomized, controlled trial involving patients who were undergoing total hip or knee arthroplasty. All the patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty or for 30 days after total hip arthroplasty. Patients were followed for 90 days for symptomatic venous thromboembolism (the primary effectiveness outcome) and bleeding complications, including major or clinically relevant nonmajor bleeding (the primary safety outcome).
A total of 3424 patients (1804 undergoing total hip arthroplasty and 1620 undergoing total knee arthroplasty) were enrolled in the trial. Venous thromboembolism occurred in 11 of 1707 patients (0.64%) in the aspirin group and in 12 of 1717 patients (0.70%) in the rivaroxaban group (difference, 0.06 percentage points; 95% confidence interval CI, -0.55 to 0.66; P<0.001 for noninferiority and P=0.84 for superiority). Major bleeding complications occurred in 8 patients (0.47%) in the aspirin group and in 5 (0.29%) in the rivaroxaban group (difference, 0.18 percentage points; 95% CI, -0.65 to 0.29; P=0.42). Clinically important bleeding occurred in 22 patients (1.29%) in the aspirin group and in 17 (0.99%) in the rivaroxaban group (difference, 0.30 percentage points; 95% CI, -1.07 to 0.47; P=0.43).
Among patients who received 5 days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. (Funded by the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT01720108 .).
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