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What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?
CONCLUSIONS: As lengths of hospital stay after TJA continue to decrease, our findings suggest that caution is in order because several acute and immediately life-threatening findings, including myocardial infarction and pulmonary embolism, might occur after discharge. Furthermore, the timing of surgical site infection and sepsis suggests that even the 30-day followup afforded by the ACS-NSQIP may not be sufficient to study the latest occurring adverse events. Additionally, both pulmonary embolism and deep vein thrombosis tend to occur earlier after TKA than THA, and this should guide clinical surveillance efforts in patien...
Source: Clinical Orthopaedics and Related Research - January 3, 2017 Category: Orthopaedics Authors: Bohl DD, Ondeck NT, Basques BA, Levine BR, Grauer JN Tags: Clin Orthop Relat Res Source Type: research

Medical Complications After Adult Spinal Deformity Surgery: Incidence, Risk Factors, and Clinical Impact
Conclusion. Risk factors for the development of postoperative medical complications after correction of ASD include smoking, hypertension, and duration of symptoms. Patients who have one or more of these risk factors should be identified and informed during informed consent of their increased risks. They should be optimized preoperatively, and followed closely during the postoperative period. Level of Evidence: 3
Source: Spine - November 12, 2016 Category: Orthopaedics Tags: Deformity Source Type: research

Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery.
CONCLUSIONS: The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and should focus on wound complications and fall risks in order to minimize readmissions. Further, quality-reporting metrics should account for the risk factors identified here, in order to prevent penalties against surgeons who take on complex patients. PMID: 27528853 [PubMed - in process]
Source: Iowa orthopaedic journal - August 19, 2016 Category: Orthopaedics Tags: Iowa Orthop J Source Type: research

Predictors of 30-day mortality following hip/pelvis fractures
Discussion Several preoperative patient risk factors and postoperative complications greatly increased the odds for patient mortality following 30-days after initial surgery. Orthopaedic surgeons can utilize these predictive risk factors to better improve patient care. Level of evidence Retrospective study. Level IV.
Source: Orthopaedics and Traumatology: Surgery and Research - August 3, 2016 Category: Orthopaedics Source Type: research

Intraoperative hypotensive resuscitation for patients undergoing laparotomy or thoracotomy for trauma: Early termination of a randomized prospective clinical trial
Conclusion: This study was unable to demonstrate that hypotensive resuscitation at a target MAP of 50 mm Hg could significantly improve 30-day mortality. Further study is necessary to fully realize the benefits of hypotensive resuscitation. LEVEL OF EVIDENCE: Therapeutic study, level II.
Source: The Journal of Trauma: Injury, Infection, and Critical Care - May 21, 2016 Category: Orthopaedics Tags: AAST 2015 Plenary Papers Source Type: research

Medial unicompartmental knee arthroplasty in the ACL-deficient knee
Abstract Symptomatic osteoarthritis (OA) of the knee develops often in association with anterior cruciate ligament (ACL) deficiency. Two distinct pathologies should be recognised while considering treatment options in patients with end-stage medial compartment OA and ACL deficiency. Patients with primary ACL deficiency (usually traumatic ACL rupture) can develop secondary OA (typically presenting with symptoms of instability and pain) and these patients are typically young and active. Patients with primary end stage medial compartment OA can develop secondary ACL deficiency (usually degenerate ACL rupture) and the...
Source: Journal of Orthopaedics and Traumatology - May 8, 2016 Category: Orthopaedics Source Type: research

Sleep disordered breathing in spinal cord injury: A systematic review.
CONCLUSION: Early formal sleep study in patients with acute complete tetraplegia is recommended. In patients with incomplete tetraplegia and with paraplegia, the incidence of sleep-disordered breathing is significantly higher than the general population. With the lack of correlation between symptoms and SDB, formal study would be reasonable. There is insufficient evidence in the literature on the impact of treatment on morbidity, mortality and quality of life outcomes. PMID: 27077573 [PubMed - as supplied by publisher]
Source: Journal of Spinal Cord Medicine - April 16, 2016 Category: Orthopaedics Tags: J Spinal Cord Med Source Type: research

Effect of Smoking on Joint Replacement Outcomes: Opportunities for Improvement Through Preoperative Smoking Cessation.
Authors: Wright E, Tzeng TH, Ginnetti M, El-Othmani MM, Saleh JK, Saleh J, Lane JM, Mihalko WM, Saleh KJ Abstract Because orthopaedic surgeons focus on identifying serious potential complications, such as heart attack, stroke, and deep vein thrombosis, during the preoperative assessment, correctable factors, such as smoking, may be overlooked. Chronic exposure to nicotine has been correlated with perioperative complications that lead to worse outcomes, including decreased patient satisfaction, longer hospitalization periods, and an increased rate of hospital readmission. It has been proven that smoking is a negativ...
Source: Instructional Course Lectures - April 7, 2016 Category: Orthopaedics Tags: Instr Course Lect Source Type: research

The predicted lifetime costs and health consequences of calcium and vitamin D supplementation for fracture prevention—the impact of cardiovascular effects
Conclusions We conclude that the magnitude of potential cardiovascular side effects is crucial for the effectiveness and cost-effectiveness of CaD supplementation in elderly women.
Source: Osteoporosis International - February 4, 2016 Category: Orthopaedics Source Type: research

The Effect of Tranexamic Acid on Blood Loss after Primary Unilateral Total Knee Arthroplasty. Prospective Single-Centre Study.
CONCLUSIONS Our study confirmed the efficacy and safety of tranexamic acid administration in relation to blood loss after total knee arthroplasty. In this indication, the administration is in accordance with the literature data. KEY WORDS: tranexamic acid, total knee arthroplasty, post-operative haemorrhage, haemoglobin. PMID: 26787182 [PubMed - in process]
Source: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca - January 22, 2016 Category: Orthopaedics Tags: Acta Chir Orthop Traumatol Cech Source Type: research

Abdominal aortic calcification: a reappraisal of epidemiological and pathophysiological data
In men and women, there is a significant association between the risk of cardiovascular event (myocardial infarction, stroke) and risk of major fragility fracture (hip, vertebra). Abdominal aortic calcification (AAC) can be assessed using semiquantitative scores on spine radiographs and spine scans obtained by DXA. Severe AAC is associated with higher risk of major cardiovascular event. Not only does severe AAC reflect poor cardiovascular health status, but also directly disturbs blood flow in the vascular system.
Source: Bone - December 10, 2015 Category: Orthopaedics Authors: Pawel Szulc Tags: Review Source Type: research

Post-traumatic thrombo-embolic complications in polytrauma patients
Conclusion TE complications were associated with longer ICU and hospital stay as well as a higher mortality. Overall, age and repeated operations were the most important risk factors for the development of TE events.
Source: International Orthopaedics - February 18, 2015 Category: Orthopaedics Source Type: research

Dedicated Orthopaedic Operating Rooms: Beneficial to Patients and Providers Alike
Objective: Dedicated orthopaedic operating rooms (DOORs) are increasingly popular solutions to reducing after-hours procedures, physician fatigue, and elective schedule disruptions. Although the benefits to surgeons are well understood, there are comparatively few studies that explore the effects of DOORs on patient care. We compared treatments and outcomes for all consecutive patients with femoral neck fractures, 4 years before and 4 years after implementation of a DOOR-based schedule. Design: Retrospective case–control study. Setting: Level 1 academic trauma center. Patients: A total of 111 consecutive trauma patients ...
Source: Journal of Orthopaedic Trauma - December 23, 2014 Category: Orthopaedics Tags: Original Article Source Type: research

Serum uric acid and cardiovascular risk: State of the art and perspectives
In this report, we review the inextricably link of serum uric acid to known cardiovascular risk factors, and we describe the possible mechanisms and potential causative role between serum uric acid and cardiovascular events in the general population, in subjects with cardiovascular risk factors and in those with pre-existing cardiovascular diseases. Limited information however is available concerning the impact of urate-lowering treatments on cardiovascular events, whereas only a positive therapeutic trial could give definite answers to the difficult problem of causality of uric acid in relation to cardiovascular risk. Thu...
Source: Joint Bone Spine - December 7, 2014 Category: Orthopaedics Source Type: research

New strategies for osteoporosis patients previously managed with strontium ranelate
The aim of this article is to describe potential alternatives to patients no longer eligible for management with strontium ranelate for osteoporosis according to the recommendations by the European Medicines Agency. A systematic search of Pubmed was done for papers on fracture efficacy of various treatments for osteoporosis, and potential harms especially in terms of cardiovascular events and stroke. The results showed that drugs more efficacious in terms of relative risk reduction of fractures than strontium ranelate were alendronate, risedronate, zoledronate, and denosumab. Raloxifene, as for strontium, may be associated...
Source: Therapeutic Advances in Musculoskeletal Disease - November 19, 2014 Category: Orthopaedics Authors: Vestergaard, P. Tags: Reviews Source Type: research

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