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Calkins TE, Suleiman LI, Culvern C, Alazzawi S, Kazarian GS, Barrack RL, Haddad FS, Della Valle CJ. Hip resurfacing arthroplasty and total hip arthroplasty in the same patient: which do they prefer? Hip Int 2021; 31:328-334. [PMID: 31615288 DOI: 10.1177/1120700019882922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hip resurfacing arthroplasty (HRA) is an alternative to conventional total hip arthroplasty (THA) with potential advantages of preserving femoral bone stock and the ability to participate in higher impact activities. This study compares outcomes, satisfaction and preference in patients who underwent HRA in 1 hip and THA on the contralateral side. METHODS 62 Patients with an HRA in 1 hip and a contralateral THA were retrospectively identified at 3 centres, consisting of 38 males and 24 females with 53 patients (85.5%) undergoing HRA first. A survey regarding satisfaction and preference for each procedure and outcome scores were obtained. RESULTS Patients were younger (51.5 vs. 56.6 years, p = 0.002) and had longer follow-up on the HRA hip (11.0 vs. 6.0 years, p < 0.001). HRA was associated with larger increase in Harris Hip Score from preoperative to final follow-up (35.8 vs. 30.6, p = 0.035). 18 Patients (29.0%) preferred HRA, 19 (30.6%) preferred THA and 25 (40.3%) had no preference (p = 0.844). When asked what they would choose if they could only have 1 surgery again, 41 (66.1%, p < 0.001) picked HRA. Overall satisfaction (p = 0.504), willingness to live with their HRA versus THA for the rest of their life (p = 0.295) and recommendation to others (p = 0.097) were similar. CONCLUSIONS Although HRA is associated with risks related to metal-on-metal bearings, it showed greater increase in patient-reported outcomes and a small subjective preference amongst patients who have undergone both conventional and resurfacing arthroplasty.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.,Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennesse - Campbell Clinic Orthopaedics, Memphis, TN, USA
| | - Linda I Suleiman
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sulaiman Alazzawi
- Department of Orthopaedic Surgery, University College London Hospitals, London, UK
| | - Gregory S Kazarian
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Robert L Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Fares S Haddad
- Department of Orthopaedic Surgery, University College London Hospitals, London, UK
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Sershon RA, Fillingham YA, Abdel MP, Malkani AL, Schwarzkopf R, Padgett DE, Vail TP, Nam D, Nahhas C, Culvern C, Della Valle CJ. The Optimal Dosing Regimen for Tranexamic Acid in Revision Total Hip Arthroplasty: A Multicenter Randomized Clinical Trial. J Bone Joint Surg Am 2020; 102:1883-1890. [PMID: 33148955 DOI: 10.2106/jbjs.20.00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this multicenter, randomized trial was to determine the optimal dosing regimen of tranexamic acid (TXA) to minimize perioperative blood loss in revision total hip arthroplasty. METHODS Six centers prospectively randomized 175 patients to 1 of 4 regimens: (1) 1-g intravenous (IV) TXA prior to incision (the single-dose IV group), (2) 1-g IV TXA prior to incision followed by 1-g IV TXA after arthrotomy wound closure (the double-dose IV group), (3) a combination of 1-g IV TXA prior to incision and 1-g intraoperative topical TXA (the combined IV and topical group), or (4) 3 doses totaling 1,950-mg oral TXA (the multidose oral group). Randomization was based on revision subgroups to ensure equivalent group distribution. An a priori power analysis (α = 0.05; β = 0.80) determined that 40 patients per group were required to identify a >1-g/dL difference in postoperative hemoglobin reduction between groups. Per-protocol analysis involved an analysis of variance, Fisher exact tests, and two 1-sided t tests for equivalence. Demographic and surgical variables were equivalent between groups. RESULTS No significant differences were found between TXA regimens when evaluating reduction in hemoglobin (3.4 g/dL for the single-dose IV group, 3.6 g/dL for the double-dose IV group, 3.5 g/dL for the combined IV and topical group, and 3.4 g/dL for the multidose oral group; p = 0.95), calculated blood loss (p = 0.90), or transfusion rates (14% for the single-dose IV group, 18% for the double-dose IV group, 17% for the combined group, and 17% for the multidose oral group; p = 0.96). Equivalence testing revealed that all possible pairings were statistically equivalent, assuming a >1-g/dL difference in hemoglobin reduction as clinically relevant. There was 1 venous thromboembolism, with no differences found between groups (p = 1.00). CONCLUSIONS All 4 TXA groups tested had equivalent blood-sparing properties in the setting of revision total hip arthroplasty, with a single venous thromboembolism reported in this high-risk population. Based on the equivalence between groups, surgeons should utilize whichever of the 4 investigated regimens is best suited for their practice and hospital setting. Given the transfusion rate in revision total hip arthroplasty despite TXA utilization, further work is required in this area. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Robert A Sershon
- Department of Orthopedic Surgery, Anderson Orthopaedic Research Institute, Alexandria, Virginia
| | - Yale A Fillingham
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Arthur L Malkani
- Department of Orthopedic Surgery, University of Louisville, Louisville, Kentucky
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, New York University, New York, NY
| | - Douglas E Padgett
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Thomas P Vail
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California
| | - Denis Nam
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Cindy Nahhas
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Chris Culvern
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Dadrass F, Gusho C, Yang F, Culvern C, Bloom J, Fillingham Y, Colman M, Gitelis S, Blank A. A clinicopathologic examination of myxofibrosarcoma. Do surgical margins significantly affect local recurrence rates in this infiltrative sarcoma subtype? J Surg Oncol 2020; 123:489-496. [PMID: 33125727 DOI: 10.1002/jso.26277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Myxofibrosarcoma (MFS) is an aggressive soft tissue tumor with an unpredictable recurrence pattern. We sought to (a) determine whether margin status in MFS is correlated to rates of local recurrence (LR) and (b) identify demographic and treatment variables associated with disease-related outcomes in this population. METHODS This retrospective study identified 42 surgically treated patients with MFS over 10 years at a single institution. Patient demographics, tumor characteristics, intraoperative variables, and disease-related outcomes were recorded. RESULTS Thirty-three (83%) patients had negative surgical margins and seven (18%) had positive margins. Four of 32 patients (13%) with negative margins developed subsequent LR compared to six of seven (86%) patients with positive margins (p < .001). Three patients (75%) with metastatic disease were deceased at the end of the study, while five (15%) without metastasis were deceased (p = .024). CONCLUSIONS Positive margin procedures for MFS were associated with LR. However, negative surgical margins demonstrated a relatively high rate of LR compared to other soft tissue sarcoma subtypes. Furthermore, though MFS tends to locally recur and have a propensity for distant metastasis, patients are observed to have a higher probability of death from other causes.
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Affiliation(s)
- Farnaz Dadrass
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Charles Gusho
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Fan Yang
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Chris Culvern
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Julie Bloom
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Yale Fillingham
- Department of Orthopedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Matthew Colman
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Alan Blank
- Department of Orthopedic Surgery, Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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Calkins TE, Culvern C, Nam D, Gerlinger TL, Levine BR, Sporer SM, Della Valle CJ. Dilute Betadine Lavage Reduces the Risk of Acute Postoperative Periprosthetic Joint Infection in Aseptic Revision Total Knee and Hip Arthroplasty: A Randomized Controlled Trial. J Arthroplasty 2020; 35:538-543.e1. [PMID: 31575448 DOI: 10.1016/j.arth.2019.09.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this randomized, controlled trial is to determine whether dilute betadine lavage compared to normal saline lavage reduces the rate of acute postoperative periprosthetic joint infection (PJI) in aseptic revision total knee (TKA) and hip arthroplasty (THA). METHODS A total of 478 patients undergoing aseptic revision TKA and THA were randomized to receive a 3-minute dilute betadine lavage (0.35%) or normal saline lavage before surgical wound closure. Fifteen patients were excluded following randomization (3.1%) and six were lost to follow-up (1.3%), leaving 457 patients available for study. Of them, 234 patients (153 knees, 81 hips) received normal saline lavage and 223 (144 knees, 79 hips) received dilute betadine lavage. The primary outcome was PJI within 90 days of surgery with a secondary assessment of 90-day wound complications. A priori power analysis determined that 285 patients per group were needed to detect a reduction in the rate of PJI from 5% to 1% with 80% power and alpha of 0.05. RESULTS There were eight infections in the saline group and 1 in the betadine group (3.4% vs 0.4%, P = .038). There was no difference in wound complications between groups (1.3% vs 0%, P = .248). There were no differences in any baseline demographics or type of revision procedure between groups, suggesting appropriate randomization. CONCLUSION Dilute betadine lavage before surgical wound closure in aseptic revision TKA and THA appears to be a simple, safe, and effective measure to reduce the risk of acute postoperative PJI. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL; Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, TN
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Brett R Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Scott M Sporer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Nahhas CR, Yi PH, Culvern C, Cross MB, Akhavan S, Johnson SR, Nunley RM, Bozic KJ, Della Valle CJ. Patient Attitudes Toward Resident and Fellow Participation in Orthopedic Surgery. J Arthroplasty 2019; 34:1884-1888.e5. [PMID: 31133429 DOI: 10.1016/j.arth.2019.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Residents' and fellows' participation in orthopedic surgery is a potential source of anxiety and concern for patients. The purpose of this study was to determine patients' attitudes toward trainee involvement in orthopedic surgery, surgeons as educators, and disclosure of trainee involvement. METHODS Three hundred two consecutive patients with preoperative and postoperative appointments at three arthroplasty practices in academic medical centers were surveyed with an anonymous, self-administered questionnaire. The questionnaire was developed in consultation with an expert in survey design. RESULTS Two hundred thirty-four patients completed the questionnaire (response rate 77.5%). Respondents were 60.5% female, 79.6% white, 66.5% privately insured, and 82.8% had at least some college education. About 65.9% of the respondents felt that surgeons who teach are better surgeons. Nearly all felt residents and fellows should perform surgeries as part of their education (94.1% and 95.3%, respectively). However, 39.7% of the respondents were not satisfactory with a second-year resident assisting in their own surgery. Patients dissatisfied with their most recent orthopedic surgery were more likely to respond that they did not want residents helping with their surgery. Respondents agreed that resident or fellow involvement in surgery should be disclosed (92.2% and 90.1%, respectively). CONCLUSIONS Insured and educated patients in the United States overwhelmingly desire disclosure of trainee involvement in their surgery. To address the need for orthopedic training in the context of a patient population that is not fully comfortable with trainee involvement in their own surgery, an open discussion between patients and surgeons regarding trainees' roles may be the best course of action.
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Affiliation(s)
- Cindy R Nahhas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Paul H Yi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Michael B Cross
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sina Akhavan
- Department of Emergency Medicine, The University of Chicago, Chicago, IL
| | - Staci R Johnson
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Ryan M Nunley
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Calkins TE, Culvern C, Nahhas CR, Della Valle CJ, Gerlinger TL, Levine BR, Nam D. External Validity of a New Prediction Model for Patient Satisfaction After Total Knee Arthroplasty. J Arthroplasty 2019; 34:1677-1681. [PMID: 31056443 DOI: 10.1016/j.arth.2019.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The ability to identify patients at risk of dissatisfaction after total knee arthroplasty (TKA) remains elusive. This study's purpose was to determine the external validity of a recently published prediction model for patient satisfaction (PMPS) with the hypothesis that it would achieve similar predictive success in our study sample. METHODS A 10-question PMPS statistically derived from 5 patient-reported outcome questionnaires was tested for external validity in this prospective cohort investigation. The PMPS incorporates gender, age, stiffness, noise, and pain catastrophizing, with a score of 20 or greater predictive of satisfaction. As in the original study, to determine satisfaction the 2011 Knee Society Score (KSS) satisfaction subscale was collected at 3 months postoperatively. Two hundred seventy-four patients were administered the PMPS preoperatively, and 145 patients completed the KSS at 3 months postoperatively (53.0% response rate; 59% female; age, 64.9; body mass index, 32.5). A Bland-Altman analysis to assess agreement was performed. RESULTS One hundred thirty-three patients (91.7%) were satisfied and 12 (8.3%) were dissatisfied based on their postoperative KSS. The mean difference between the PMPS and KSS was 3.6 ± 8, but with a 95% prediction interval of -15.3 to 22.1 signifying almost no correlation. The PMPS did not predict any of the 12 dissatisfied patients postoperatively, and falsely predicted 5 patients to be dissatisfied of which 4 actually had a maximum postoperative KSS of 40. CONCLUSION A previously published, internally validated 10-question PMPS was unable to predict satisfaction after TKA in our external study sample. This study emphasizes the difficulty of developing a simple, but robust questionnaire that consistently predicts patient satisfaction after TKA.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Cindy R Nahhas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Brett R Levine
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Denis Nam
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Fillingham YA, Darrith B, Calkins TE, Abdel MP, Malkani AL, Schwarzkopf R, Padgett DE, Culvern C, Sershon RA, Bini S, Della Valle CJ. 2019 Mark Coventry Award: A multicentre randomized clinical trial of tranexamic acid in revision total knee arthroplasty: does the dosing regimen matter? Bone Joint J 2019; 101-B:10-16. [PMID: 31256650 DOI: 10.1302/0301-620x.101b7.bjj-2018-1451.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Tranexamic acid (TXA) is proven to reduce blood loss following total knee arthroplasty (TKA), but there are limited data on the impact of similar dosing regimens in revision TKA. The purpose of this multicentre randomized clinical trial was to determine the optimal regimen to maximize the blood-sparing properties of TXA in revision TKA. PATIENTS AND METHODS From six-centres, 233 revision TKAs were randomized to one of four regimens: 1 g of intravenous (IV) TXA given prior to the skin incision, a double-dose regimen of 1 g IV TXA given both prior to skin incision and at time of wound closure, a combination of 1 g IV TXA given prior to skin incision and 1 g of intraoperative topical TXA, or three doses of 1950 mg oral TXA given two hours preoperatively, six hours postoperatively, and on the morning of postoperative day one. Randomization was performed based on the type of revision procedure to ensure equivalent distribution among groups. Power analysis determined that 40 patients per group were necessary to identify a 1 g/dl difference in the reduction of haemoglobin postoperatively between groups with an alpha of 0.05 and power of 0.80. Per-protocol analysis involved regression analysis and two one-sided t-tests for equivalence. RESULTS In total, one patient withdrew, five did not undergo surgery, 16 were screening failures, and 25 did not receive the assigned treatment, leaving 186 patients for analysis. There was no significant difference in haemoglobin reduction among treatments (2.8 g/dl for single-dose IV TXA, 2.6 g/dl for double-dose IV TXA, 2.6 g/dl for combined IV/topical TXA, 2.9 g/dl for oral TXA; p = 0.38). Similarly, calculated blood loss (p = 0.65) and transfusion rates (p = 0.95) were not significantly different between groups. Equivalence testing assuming a 1 g/dl difference in haemoglobin change as clinically relevant showed that all possible pairings were statistically equivalent. CONCLUSION Despite the higher risk of blood loss in revision TKA, all TXA regimens tested had equivalent blood-sparing properties. Surgeons should consider using the lowest effective dose and least costly TXA regimen in revision TKA. Cite this article: Bone Joint J 2019;101-B(Supple 7):10-16.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - B Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - T E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University, New York, New York, USA
| | - D E Padgett
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - R A Sershon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - S Bini
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Calkins TE, Darrith B, Okroj KT, Drabchuk R, Culvern C, Della Valle CJ. Utilizing the Time Trade-Off, Standard Gamble, and Willingness to Pay Utility Measures to Evaluate Health-Related Quality of Life Prior to Knee or Hip Arthroplasty. J Arthroplasty 2019; 34:9-14. [PMID: 30245123 DOI: 10.1016/j.arth.2018.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Time trade-off, standard gamble, and willingness to pay assess the number of years, risk of death, and income a patient would give up for perfect health. These questions were used to evaluate the impact knee arthritis, hip arthritis, or failed total knee (TKA) or hip arthroplasty (THA) has on patients' health-related quality of life prior to surgery. METHODS Three hundred sixty patients including 176 undergoing primary TKA, 127 undergoing primary THA, 31 undergoing revision TKA, and 26 undergoing revision THA were assessed. Time trade-off and standard gamble were converted to utility scores with 1.0 suggesting perfect health and 0 suggesting preference for death rather than living in current state. Willingness to pay is the percentage of yearly income that a patient would pay for perfect health. RESULTS The mean time trade-off, standard gamble, and willingness to pay scores were 0.74, 0.83, and 0.32 without significant difference between procedures with the numbers available for study (P = .16, .31, and 0.41, respectively). Increasing body mass index was correlated with decreasing time trade-off scores (P = .014). CONCLUSION Patients scheduled for primary or revision THA and TKA would accept an average 17% risk of death, lose 2.6 years of an additional 10-year life expectancy, and pay 32% of their income for perfect health. The time trade-off (0.74) was similar to patients with history of acute myocardial infarction (0.74) or minor stroke (0.72) and worse than those with chronic hepatitis C (0.83) or human immunodeficiency virus/acquired immunodeficiency syndrome infection (0.86). These data highlight the high value that patients place on adult reconstructive procedures.
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Affiliation(s)
- Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Brian Darrith
- Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan
| | - Kamil T Okroj
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Roman Drabchuk
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Abstract
Aims Accurate placement of the acetabular component is essential in total hip arthroplasty (THA). The purpose of this study was to determine if the ability to achieve inclination of the acetabular component within the 'safe-zone' of 30° to 50° could be improved with the use of an inclinometer. Patients and Methods We reviewed 167 primary THAs performed by a single surgeon over a period of 14 months. Procedures were performed at two institutions: an inpatient hospital, where an inclinometer was used (inclinometer group); and an ambulatory centre, where an inclinometer was not used as it could not be adequately sterilized (control group). We excluded 47 patients with a body mass index (BMI) of > 40 kg/m2, age of > 68 years, or a surgical indication other than osteoarthritis whose treatment could not be undertaken in the ambulatory centre. There were thus 120 patients in the study, 68 in the inclinometer group and 52 in the control group. The inclination angles of the acetabular component were measured from de-identified plain radiographs by two blinded investigators who were not involved in the surgery. The effect of the use of the inclinometer on the inclination angle was determined using multivariate regression analysis. Results The mean inclination angle for the THAs in the inclinometer group was 42.9° (95% confidence interval (CI) 41.7° to 44.0°; range 29.0° to 63.8°) and 46.5° (95% CI 45.2° to 47.7°; range 32.8° to 63.2°) in the control group (p < 0.001). Regression analysis identified a 9.1% difference in inclination due to the use of an inclinometer (p < 0.001), and THAs performed without the inclinometer were three times more likely to result in inclination angles of > 50° (odds ratio (OR) 2.8, p = 0.036). The correlation coefficient for the interobserver reliability of the measurement of the two investigators was 0.95 (95% CI 0.93 to 0.97). Conclusion The use of a simple inclinometer resulted in a significant reduction in the number of outliers compared with a freehand technique. Cite this article: Bone Joint J 2018;100-B:862-6.
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Affiliation(s)
- B Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - J A Bell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Ililnois, USA
| | - C J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Fillingham YA, Darrith B, Lonner JH, Culvern C, Crizer M, Della Valle CJ. Formal Physical Therapy May Not Be Necessary After Unicompartmental Knee Arthroplasty: A Randomized Clinical Trial. J Arthroplasty 2018; 33:S93-S99.e3. [PMID: 29555497 DOI: 10.1016/j.arth.2018.02.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 01/23/2018] [Accepted: 02/11/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this randomized clinical trial was to compare formal outpatient physical therapy (PT) and unsupervised home exercises after unicompartmental knee arthroplasty (UKA). METHODS Fifty-two patients were randomized to 6 weeks of outpatient PT or an unsupervised home exercise program after UKA. The primary outcome was change in range of motion at 6 weeks with secondary outcomes including total arc of motion, Knee Society Score, Knee Injury and Osteoarthritis Outcome Score Jr, Lower Extremity Functional Scale, and Veterans Rands-12 score. RESULTS Twenty-five patients received outpatient PT, 22 patients the self-directed exercise program, while 3 patients deviated from the protocol, 1 patient withdrew, and 1 patient was lost to follow-up. There was no difference in the change of range of motion (P = .43) or total arc of motion at 6 weeks (P = .17) between the groups and likewise no significant differences were found in any of the secondary outcomes. Two patients who crossed over from the unsupervised home exercise program to formal outpatient PT within the first 2 weeks postoperatively required a manipulation under anesthesia. CONCLUSIONS Our results suggest self-directed exercises may be appropriate for most patients following UKA. However, there is a subset of patients who may benefit from formal PT.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Brian Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Jess H Lonner
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Chris Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Meredith Crizer
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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