Grevekeating5557

Background Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department. Material and methods This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recoofessor P K Surendran Memorial Education Foundation.Objectives We explored how experience of arthrography affects treatment preferences for Legg-Calvé-Perthes disease (LCPD) patients. We also examined changes in surgical procedure preferences after examining arthrography images. In addition, we analysed the effect of experience with arthrography on treatment and surgical modality preferences. Methods A case-based questionnaire was completed by 26 participants. Information on age, symptoms, hip range of motion (ROM), and extremity length differences were provided for eight LCPD cases. Based on these data and roentgenography images of the cases, the respondents were questioned regarding diagnostic, treatment, and surgical preferences. A slide was shown of arthrography images of each case and the same questions were asked to determine any changes in treatment preferences. The participants were divided into arthrography-experienced (Group 1, n = 16) and -inexperienced (Group 2, n = 10) groups to determine differences in treatment preferences in association with ex surgical modality for LCPD. However, no study has explored changes in treatment preferences after viewing arthrography images. This study explored such changes in choices regarding the diagnostic method and treatment modality. Our study showed that experience with arthrography decreased the preference for additional diagnostic tests (p  less then  0.001). Experience of arthrography increased the preference for surgery, though not significantly (p = 0.193). © 2020 Published by Elsevier B.V. on behalf of Professor P K Surendran Memorial Education Foundation.Background While adequate pain relief is central to patient recovery and satisfaction, opioid use is associated with side effects, adverse drug events and opioid use disorder and therefore is under increased scrutiny. Enhanced surgical recovery protocols include multimodal pain management as a key process, but the impact of opioid dose as an independent variable has not been examined. Methods Retrospective analysis of 51,824 hip and knee arthroplasty encounters in a large healthcare system. Results Overall, patients receiving treatment with lower doses of opiates had shorter median length of stay (p  less then  0.001); this earlier discharge had no negative consequences on readmission rates. In particular, patients discharged on day 1 received a lower median morphine milligram equivalent (MME) per day than those who were not discharged (32.5 [IQR 19.0-50.0] versus 45.0 [26.7-71.2], respectively, p  less then  0.001). The probability of discharge on day 1 was 41.2% and 19.6% for those patients on lower versus higher MME/day, respectively. Similarly, there was a reduction in odds of readmission of 15.2% (95% CI 5.8-23.6%) for patients on lower doses of MME/day. Conclusion Lower MME/day following joint arthroplasty is linked to the probability of discharge on both days 1 and 2 post-surgery as well as reduced odds of readmission. These findings persisted even when adjusting for all other factors, including participation in the enhanced surgical recovery program, the use of a multi-modal analgesic regimen, the presence of complications, patient demographics, and other baseline characteristics. Efforts to reduce opioid use in the peri- and immediate post-operative period, regardless of the mechanism, demonstrated a significant effect on patient outcomes. © 2020 Professor P K Surendran Memorial Education Foundation. Sodium acrylate clinical trial Published by Elsevier B.V. All rights reserved.Introduction Mid-level constraint (MLC) in Total Knee Arthroplasty (TKA) offer surgeons the opportunity to obtain a well-balanced varus-valgus balance in the setting of slight ligament imbalance. As such, we sought to evaluate patient reported outcome measures (PROMs), alignment correction, and rate of revision between the MLC group and a cohort of posterior stabilized (PS) knees in a cohort of patients with preoperative degenerative arthritis. Materials/methods We performed a retrospective review of 57 MLC knees and 96 PS knees from a single manufacturer that were implanted by a single surgeon. We found the average age (68.91 vs. 68.40, p = 0.72), average BMI (30.88 vs. 29.14, p = 0.10), and gender breakdown (2532 vs. 2869, p = 0.08) to be comparable between the two cohorts. The latest follow-up was 4.0 years in the MLC group and 3.8 years in the PS group, p = 0.26. Results The two cohorts inherently resulted in significantly different preoperative deformities (MCL knees average varus deformity 13.75°, avera8% MLC vs. 9.40% PS, p = 0.38). Conclusion/discussion This study demonstrated that the use of MLC in TKA allows surgeons to correct preoperative deformities with equal or improved functional outcomes compared to PS knees. In general, we recommend that surgeons try to balance the knee and use the least amount of constraint possible but should consider MLC when needed and use such implants if they are unable to balance the varus-valgus gap. © 2020 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.