New research was presented at AAOS 2015, the annual meeting of the American Academy of Orthopaedic Surgeons, from March 24 to 28 in Las Vegas. The features below highlight some of the studies emerging from the conference.
TKA & THA Outcomes by Gender
The Particulars: There is limited evidence suggesting that outcomes following total knee arthroplasty (TKA) and total hip arthroplasty (THA) differ by gender. However, little is known about gender-related morbidity and mortality rates following these procedures. Most gender studies involving TKA and THA have focused more on procedural failure rather than morbidity and mortality.
Data Breakdown: Researchers reviewed patients who underwent first-time TKA or THA from 2002 to 2009 in a study. Women who underwent THA were significantly older than men, whereas no difference in age was observed by gender among TKA patients. Following surgery, men were:
♦ 15% more likely to visit the emergency department within 30 days.
♦ 60% more likely to have an acute myocardial infarction (AMI) within 4 months following THA.
♦ 70% more likely to have an AMI within 4 months following TKA.
♦ 50% more likely to require revision surgery within 2 years of total knee replacement (TKR).
♦ 25% more likely to be readmitted within 2 years of TKR.
♦ 70% more likely to experience an infection or need revision surgery within 2 years of TKR.
Take Home Pearls: Women appear to undergo a first total joint replacement at an older age than men. However, women appear to be less likely than men to experience complications or require revision surgery.
The Costs of Perioperative Delirium
The Particulars: Few studies have assessed the health resources that are used when managing patients with low-energy hip fractures who suffer from perioperative delirium. This is a patient population that is deemed to be at high risk for perioperative delirium.
Data Breakdown: Canadian researchers reviewed the records of hip fracture patients aged 65 to 103. Among these patients, 48% experienced perioperative delirium. Patients with perioperative delirium spent 7.4 days longer in the hospital, and costs were $8,282 higher for these patients when compared with those who did not develop delirium.
Take Home Pearls: Nearly half of patients who undergo hip fracture surgery appear to experience perioperative delirium. This adverse event appears to significantly increase hospital costs and length of stay.
Spinal Surgery Improves Sexual Function
The Particulars: Few studies have assessed the impact of chronic low back pain on sexual function. Research is also lacking on whether or not spinal surgery helps improve sexual function in this patient population.
Data Breakdown: For a study, patients with spinal spondylolisthesis or spinal stenosis were asked about sexual activity and grouped by those who underwent surgical treatment and those who did not. Nearly three-quarters of patients reported that sexual activity was relevant to their quality of life. Of these patients, 40% reported some level of pain relating to sex at baseline. However, patients who underwent surgical treatment were twice as likely to report no pain during sex at 1, 2, 3, and 4 years follow-up when compared with those who did not undergo an operation.
Take Home Pearls: Sexual activity and function appear to be important considerations for patients with degenerative spine conditions. Among this patient group, those who receive surgical treatment appear to be less likely to report pain with sex when compared with those who do not undergo surgery.
A Mobile Solution for Preoperative Planning
The Particulars: TraumaCad (Voyant Health, Brainlab) is a software solution that has been used to help orthopedic surgeons plan surgery for more than a decade. Recently, the FDA cleared for marketing a mobile app for TraumaCad. The app is intended to aid with preoperative orthopedic surgical planning and digital templating.
Data Breakdown: The TraumaCad mobile app is designed to make total hip arthroplasty preparation quick and easy. Features of the app include automatic hip replacement planning, automatic calibration, a comprehensive template library, and collaboration and inventory management. The mobile solution can be integrated with existing picture archiving and communication systems or as a stand-alone app. The app allows for digital templating to be accessed from any web browser or Apple iPad device.
Take Home Pearl: The TraumaCad app may benefit orthopedic surgeons during preoperative planning of patients undergoing total hip arthroplasty.
Driving After Total Hip Replacement
The Particulars: Patients undergoing hip replacement surgery are recommended to wait 6 to 8 weeks before driving, based on decade-old study findings. With recent advances in surgical treatment and care, it is unknown if this waiting period can be shortened safely for this surgical population.
Data Breakdown: Study investigators evaluated driving performance among patients who had undergone total hip arthroplasty between October 2013 and March 2014. All participants underwent brake reaction tests preoperatively and at 2, 4, and 6 weeks postoperatively. Within 2 weeks, 87% of patients reached their baseline braking time. The remaining 13% of study participants reached their baseline braking time by 4 weeks.
Take Home Pearls: Most patients who undergo total hip arthroplasty appear to be ready to drive again as early as 2 weeks after their surgery or sometimes by 4 weeks. More research is needed to validate the findings, but it is possible that the waiting period to drive may be shortened for those undergoing this procedure.