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arthroplasty

Joint replacement with a prosthesis. Indications: - arthritis - osteonecrosis Epidemiology: - 2% of Americans Laboratory: - HgbA1c of <= 7.0% may not be achievable in many patients [5] Complications: - prosthesis infection - risk factors: - obesity > diabetes; when both present, risk is higher[3] - bacteriuria, but antibiotics not helpful* [6] - glucocorticoids associated with excess risk of postoperative infection [7] * risk not diminished by antibiotics & organisms isolated from infected joint never the same as organism isolated from preoperative urine [6] Notes: - bisphosphonate use is associated with a lower rate of revision after hip arthroplasty & knee arthroplasty & longer implant survival [2]

Specific

acetabuloplasty arthroplasty, shoulder arthroplasty, wrist hemiarthroplasty hip resurfacing total hip arthroplasty/replacement (THA, THR) total knee arthroplasty (TKA, TKR) vertebral arthroplasty

General

orthopedic surgery

References

  1. Genova A. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Prieto-Alhambra D et al. Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: Population based retrospective cohort study. BMJ 2011 Dec 6; 343:d7222 PMID: 22147909
  3. Jamsen E et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: A single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am 2012 Jul 18; 94:e1011 PMID: 22810408
  4. Marchione M Study: 2 percent of Americans have new hips, knees. Yahoo News. March 11, 2014 https://news.yahoo.com/study-2-percent-americans-hips-knees-051704182.html NEJM Journal Watch, March 12, 2014 Massachusetts Medical Society http://www.jwatch.org
  5. Giori NJ et al. Many diabetic total joint arthroplasty candidates are unable to achieve a preoperative hemoglobin A1c goal of 7% or less. J Bone Joint Surg Am 2014 Mar 19; 96:500. PMID: 24647507
  6. Sousa R et al. Is asymptomatic bacteriuria a risk factor for prosthetic joint infection? Clin Infect Dis 2014 Jul 1; 59:41. PMID: 24723280 http://cid.oxfordjournals.org/content/59/1/41 - Duncan RA. Prosthetic joint replacement: Should orthopedists check urine because it's there? Clin Infect Dis 2014 Jul 1; 59:48 PMID: 24723277 http://cid.oxfordjournals.org/content/59/1/48
  7. George MD et al. Risk of biologics and glucocorticoids in patients with rheumatoid arthritis undergoing arthroplasty: A cohort study. Ann Intern Med 2019 May 21; PMID: 31108503 - Ravi B, Hawker G. Elucidating the risks and benefits of withholding biologics to optimize surgical outcomes. Ann Intern Med 2019 May 21; PMID: 31108501
  8. Menon N, Turcotte J, Stone A et al. Outpatient, home-based physical therapy promotes decreased length of stay and post-acute resource utilization after total joint arthroplasty. J Arthroplasty. 2020;35(8):1968-1972 https://www.arthroplastyjournal.org/article/S0883-5403(20)30279-5/fulltext
  9. American Joint Replacement Registry http://www.aaos-annualmeeting-presskit.org/2014/daily_schedule/downloads/ajrr.pdf