James A. Browne

Primary Total Knee Arthroplasty in Super-obese Patients: Dramatically Higher Postoperative Complication Rates Even Compared to Revision Surgery

This study utilized a national database to evaluate 90 day postoperative complication rates after total knee arthroplasty (TKA) in super obese (BMI > 50 kg/m(2)) patients (n = 7666) compared to non-obese patients (n = 1,212,793), obese patients (n = 291,914), morbidly obese patients (n = 169,308) and revision TKA patients (n = 28,812). Super obese patients had significantly higher rates of local and systemic complications compared to all other BMI groups as well as those undergoing revision TKA with higher rates of venous thromboembolism (VTE), infection, and medical complications. Super obesity is associated with dramatically increased rates of postoperative complications after TKA compared to non-obese, obese, and morbidly obese patients as well as those undergoing revision TKA.

Morbid obesity in total shoulder arthroplasty: risk, outcomes, and cost analysis

BACKGROUNDnA rate of obesity in the US population and the rate of total shoulder arthroplasty (TSA) has increased over the past decade. Little information exists concerning the number of morbidly obese patients undergoing TSA or how these patients compare with their non-obese counterparts. The goal of this study was to determine whether morbidly obese patients exhibit greater rates of postoperative in-hospital complications, mortality, or utilization of resources.nnnMETHODSnWe used the Nationwide Inpatient Sample to analyze 31,924 patients undergoing TSA between 1998 and 2008. Multivariate analysis with logistic regression modeling was used to compare patients based on body mass index for various outcomes.nnnRESULTSnAmong morbidly obese patients, predictors of death included age (odds ratio, 1.06; 95% confidence interval, 1.01-1.11) and Deyo score. A comparison of hospital costs among patients showed that increased patient body mass index led to increased hospital charges independent of physician charges (

Patient age is a factor in early outcomes after shoulder arthroplasty.

38,103.88 in morbidly obese patients vs

Obesity, Morbid Obesity and their Related Medical Comorbidities are Associated with Increased Complications and Revision Rates after Unicompartmental Knee Arthroplasty

33,521.66 in non-obese patients, P = .0001). An increased length of stay was observed in morbidly obese patients (2.84 days vs 2.52 days in obese patients and 2.56 days in non-obese patients, P = .003). Respiratory dysfunction occurred more commonly in morbidly obese patients than in non-obese patients (1.2% vs 0.7%; odds ratio, 1.61; P < .01).nnnCONCLUSIONSnObese patients tend to have longer hospital stays, an increased risk of postoperative respiratory complications, and higher costs. Although there was a trend toward an increased early postoperative mortality rate, obesity was not associated with an increased incidence of most complications. These findings should be supplemented with further research to assist patient counseling and risk adjustment for obese patients undergoing TSA.

Does Timing of Previous Intra-Articular Steroid Injection Affect the Post-Operative Rate of Infection in Total Knee Arthroplasty?

BACKGROUNDnElderly and young patients alike are undergoing shoulder replacement at increased rates. In an era of outcomes reporting, risk adjustment, and cost containment, identifying patients likely to have adverse events is increasingly important. Our objective was to determine whether patient age is independently associated with postoperative in-hospital complications or increased hospital charges after shoulder arthroplasty.nnnMETHODSnWe used the Nationwide Inpatient Sample to analyze 58,790 patients undergoing total shoulder arthroplasty or hemiarthroplasty between 2000 and 2008. Multivariate analysis with logistic regression modeling was used to compare groups. Our objective was to determine whether age had an independent impact on the likelihood of postoperative in-hospital complications, mortality rate, length of stay, or charges after shoulder arthroplasty.nnnRESULTSnPatients aged 80 years or older had an increased in-hospital mortality rate (0.5%) compared with patients aged 50 to 79xa0years (0.1%) and patients aged younger than 50xa0years (0.1%). Predictors of death included female gender, total shoulder arthroplasty versus hemiarthroplasty, and Deyo score. Increased age was associated with slightly increased hospital charges. Length of stay was longer in patients aged 80 years or older compared with younger patients. After shoulder arthroplasty, postoperative anemia occurred more often in patients aged 80 years or older. Other postoperative complications including pulmonary embolism, infection, and cardiac complications were similar among groups.nnnCONCLUSIONnOlder patients tend to have longer hospital stays, an increased incidence of postoperative anemia, and slightly higher charges after shoulder arthroplasty. Advanced age is not associated with an increased incidence of pulmonary embolism, infection, and cardiac complications. Further research is warranted to explain the relationship between age and early postoperative outcomes.

Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications.

Recent studies have demonstrated clinical success in expanding the indications for unicompartmental knee arthroplasty (UKA) to patients with increased body mass index (BMI). This study utilized national databases to identify 15,770 unique patients who underwent UKA between 2005 and 2011. 18.7% of patients undergoing a UKA were obese or morbidly obese. Univariate analysis demonstrated that obesity and morbid obesity were associated with significantly higher complication rates within 90 days postoperatively compared to non-obese patients. The overall short-term revision rate in obese and morbidly obese patients undergoing UKA was almost twice as high as the revision rate in non-obese patients. Obese and morbidly obese patients being considered for UKA should be counseled preoperatively regarding their increased risk of postoperative complications and revision surgery.

The Timing of Total Hip Arthroplasty After Intraarticular Hip Injection Affects Postoperative Infection Risk

Intra-articular steroid injections are widely used for symptomatic relief of knee osteoarthritis. This study used a national database to determine if there is an association between preoperative intra-articular knee injection at various time intervals prior to ipsilateral TKA and infection. The incidence of infection within 3 months (2.6%, OR 2.0 [1.6-2.5], P < 0.0001) and 6 months (3.41%, OR 1.5 [1.2-1.8], P < 0.0001) after TKA within 3 months of knee injection was significantly higher than our control cohort. There was no significant difference in patients who underwent TKA more than 3 months after injection. Ipsilateral knee injection within three months prior to TKA is associated with a significant increase in infection.

Obstructive sleep apnea as a risk factor after shoulder arthroplasty

This study used a national database to compare 90-day postoperative complication rates between three groups of patients who underwent total knee arthroplasty (TKA): (1) non-obese patients (n=66,523), (2) morbidly obese patients who did not have bariatric surgery (n=11,294) and (3) morbidly obese patients who underwent bariatric surgery prior to TKA (n=219). Morbidly obese patients who underwent bariatric surgery prior to TKA had reduced rates of major (OR 0.45, P=0.001) and minor (OR 0.61, P=0.01) complications compared to morbidly obese patients who did not have bariatric surgery. Bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not to the same level as non-obese patients.

Superobesity (body mass index >50 kg/m2) and complications after total shoulder arthroplasty: an incremental effect of increasing body mass index

BACKGROUNDnThe data regarding any association between preoperative intraarticular steroid injection and risk ofperiprosthetic joint infection (PJI) after total hip arthroplasty (THA) are conflicting. The goal of the present study is to evaluate the association of preoperative intraarticular hip injection before THA on the incidence of postoperative PJI.nnnMETHODSnA national database was queried for patients who underwent THA and those patients who underwent prior ipsilateral hip injection. Three cohorts were created: THA within 3 months of ipsilateral hip injection (n = 829), THA between 3 and 6 months after ipsilateral hip injection (n= 1379), and THA between 6 and 12months after ipsilateral hip injection (n=1160). A control group of THAwithout prior injectionwas created for comparison purposes (n=31,229). The rate of postoperative infectionwas compared between injection cohorts and controls.nnnRESULTSnThe incidence of infection after THA at 3 months (2.41%; odds ratio, 1.9; P = .004) and 6 months (3.74%; odds ratio, 1.5; P < .019) was significantly higher in the patients who underwent hip injection within 3months before THA comparedwith controls. Therewas no significant difference in infection rates in patients who underwent THA between 3 and 6months or 6 and 12months after ipsilateral hip injection compared with controls.nnnCONCLUSIONSnThe present study demonstrates a significant increase in PJI in patients who underwent intraarticular hip injection within 3 months before THA. This association was not noted when THA was more than 3 months after injection.

Manipulation Under Anesthesia After Total Knee Arthroplasty is Associated with An Increased Incidence of Subsequent Revision Surgery.

BACKGROUNDnObstructive sleep apnea (OSA) has been identified as an important risk factor in perioperative orthopaedic surgery outcomes despite limited evidence. Screening systems are being instituted in increasing frequency to prevent morbidity and mortality. Our objective was to determine if patients with OSA have a higher likelihood of postoperative in-hospital complications, length of stay, or increased costs after shoulder arthroplasty.nnnMETHODSnWe utilized the Nationwide Inpatient Sample (NIS) to analyze 22988 patients undergoing TSA or hemiarthroplasty. Of these patients, 1983 (5.9%) were diagnosed with OSA. Multivariate analysis with logistic regression modeling was used to compare patients with and without OSA for various outcomes.nnnRESULTSnPatients with obstructive sleep apnea had overall similar in-hospital mortality and complications including PE compared with those without OSA. OSA was not associated with increased postoperative charges (