Keywords international normalized ratio...

international normalized ratio AND arthroplasty
Claudia R Brick, Catherine J Bacon, Matthew J Brick
BACKGROUND: Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis...
August 2020: American Journal of Sports Medicine
Rohil Malpani, Ryan P Mclynn, Patawut Bovonratwet, Paul S Bagi, Alp Yurter, Michael R Mercier, Lee E Rubin, Jonathan N Grauer
Current literature suggests a correlation between preoperative coagulopathies and postsurgical adverse events (AEs). However, this correlation has not been specifically assessed in the total hip arthroplasty (THA) and the total knee arthroplasty (TKA) populations. Patients who underwent primary THA and TKA with coagulopathy data were identified from the 2011-2015 American College of Surgeons National Surgical Quality Improvement Program database. Coagulopathies studied were low platelets, high partial thromboplastin time (PTT), high international normalized ratio (INR), and other hematological conditions...
July 1, 2020: Orthopedics
Alejandro Gonzalez Della Valle, Kate A Shanaghan, Joseph Nguyen, Jiabin Liu, Stavros Memtsoudis, Nigel E Sharrock, Eduardo A Salvati
AIMS: We studied the safety and efficacy of multimodal thromboprophylaxis in patients with a history of venous thromboembolism (VTE) who undergo total hip arthroplasty (THA) within the first 120 postoperative days, and the mortality during the first year. Multimodal prophylaxis includes discontinuation of procoagulant medications, VTE risk stratification, regional anaesthesia, an intravenous bolus of unfractionated heparin prior to femoral preparation, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient's risk of VTE...
July 2020: Bone & Joint Journal
Menachem M Meller, Stuart Goodman, Mark H Gonzalez, Edmund Lau
Patients with morbid obesity, defined as body mass index of greater than 40 kg/m2 , are being referred for weight loss and bariatric surgery before being accepted for a total knee arthroplasty (TKA). Previous studies have identified the risks associated with doing a TKA in an individual with an increased body mass index. We now present data identifying the same risks in individuals who have undergone bariatric surgery before submitting to TKA. Questions/Purposes: (1) Has the bariatric surgery improved the risk profile for the subsequent TKA? (2) Does the type of bariatric procedure matter? Method: A retrospective cohort study was conducted of patients who underwent bariatric surgery followed by TKA using Medicare hospital claims data...
December 2019: Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
Abiram Bala, David V Ivanov, James I Huddleston, Stuart B Goodman, William J Maloney, Derek F Amanatullah
BACKGROUND: Malnutrition is a known risk factor for complications and adverse outcomes after elective total joint arthroplasty (TJA), but little is known about the burden this risk factor places on the healthcare system. The purpose of this study was to evaluate the 90-day impact of malnutrition on medical and surgical complications and understand the increase in global reimbursements associated with TJA in malnourished patients. METHODS: We queried a combined private-payer and Medicare database from 2007 to 2016 for TJA using International Classification of Diseases, 9th revision and Current Procedural Terminology codes...
November 27, 2019: Journal of Arthroplasty
Jessica L Churchill, Linsen T Samuel, J M Karnuta, Alexander J Acuña, Atul F Kamath
The purpose of this study was to examine the relationship between elevated preoperative international normalized ratio (INR) and (1) mortality, (2) postoperative bleeding, and (3) other postoperative complications in a national cohort of patients who underwent revision total knee arthroplasty (rTKA). The American College of Surgeons National Surgical Quality Improvement Program was queried for rTKA procedures conducted between 2006 and 2017. Cohorts were based on INR ranges: <1, 1 < INR ≤ 1.25, 1...
November 7, 2019: Journal of Knee Surgery
Sarah E Rudasill, Jiabin Liu, Atul F Kamath
BACKGROUND: Efforts to identify preoperative risk factors for primary total hip arthroplasty have amplified with its increasing incidence. The international normalized ratio (INR) is 1 measure that may influence postoperative outcomes. This study of a national database assessed whether there exists an association between preoperative INR and postoperative bleeding and mortality among patients who underwent primary total hip arthroplasty. METHODS: We retrospectively analyzed 17,567 adult patients who underwent primary total hip arthroplasty in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) between 2005 and 2016...
January 2, 2020: Journal of Bone and Joint Surgery. American Volume
Ding-Quan Pan, Ling-Li Chen, Biao Sun, Zhe Yu, Jian-Bin Ge, Mei-Fen Miao
OBJECTIVE: To explore clinical efficacy and safety of application of tranexamic acid for two times combined with postoperative hip and knee on flexion position for reducing blood loss during total knee arthroplasty. METHODS: From January 2015 to January 2018, 90 patients with knee osteoarthritis underwent unilateral total knee arthroplasty, including 33 males and 57 females, aged from 61 to 85 years old with an average of(72.3±6.9) years old. The patients were randomly divided into three groups according to random number table, 30 patients in each group...
August 25, 2019: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Brian F Gage, Anne R Bass, Hannah Lin, Scott C Woller, Scott M Stevens, Noor Al-Hammadi, Jeffrey L Anderson, Juan Li, Tomás Rodriguez, J Philip Miller, Gwendolyn A McMillin, Robert C Pendleton, Amir K Jaffer, Cristi R King, Brandi Whipple, Rhonda Porche-Sorbet, Lynnae Napoli, Kerri Merritt, Anna M Thompson, Gina Hyun, Wesley Hollomon, Robert L Barrack, Ryan M Nunley, Gerard Moskowitz, Victor Dávila-Román, Charles S Eby
Importance: The optimal international normalized ratio (INR) to prevent venous thromboembolism (VTE) in warfarin-treated patients with recent arthroplasty is unknown. Objective: To determine the safety and efficacy of a target INR of 1.8 vs 2.5 for VTE prophylaxis after orthopedic surgery. Design, Setting, and Participants: The randomized Genetic Informatics Trial (GIFT) of Warfarin to Prevent Deep Vein Thrombosis enrolled 1650 patients aged 65 years or older initiating warfarin for elective hip or knee arthroplasty at 6 US medical centers...
September 3, 2019: JAMA: the Journal of the American Medical Association
Karan Goswami, Timothy L Tan, Alexander J Rondon, Noam Shohat, Michael Yayac, Patrick K Schlitt, P Maxwell Courtney
BACKGROUND: Aspirin has been shown to be a safe and cost-effective thromboprophylaxis agent with equivalent preventive efficacy to warfarin and fewer side-effects. However, animal studies have suggested delayed bone healing with aspirin and other inhibitors of prostaglandin synthesis. The impact of aspirin on aseptic loosening following cementless total hip arthroplasty (THA) has yet to be explored. Our aim was to determine if patients receiving aspirin for thromboprophylaxis had higher rates of aseptic loosening vs patients receiving warfarin after THA...
July 15, 2019: Journal of Arthroplasty
Myung Seo Kim, Jong Dae Kim, Kyung Han Ro, Jong Jun Park, Yong Girl Rhee
BACKGROUND: Few studies have investigated the amount of blood loss during reverse total shoulder arthroplasty (RTSA). The purpose of this study was to investigate blood loss in patients who underwent RTSA for massive irreparable rotator cuff tear (MIRCT) using the hemoglobin (Hb) balance method and total Hemovac amount and to identify predictors of blood transfusion in these patients. METHODS: We retrospectively reviewed 121 patients who underwent RTSA for MIRCT...
April 10, 2019: Journal of Shoulder and Elbow Surgery
Sarah E Rudasill, Jiabin Liu, Atul F Kamath
BACKGROUND: Consensus guidelines recommend use of the international normalized ratio (INR) to predict the risk of perioperative bleeding in orthopaedic surgery. However, current recommendations for targeting an INR of <1.5 are based on studies across all surgical disciplines. This study examined the impact of the INR on perioperative bleeding, mortality, postoperative infections, length of hospital stay (LOS), and readmissions following primary total knee arthroplasty (TKA). METHODS: We retrospectively reviewed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for adult patients who underwent primary TKA from 2010 to 2016...
March 20, 2019: Journal of Bone and Joint Surgery. American Volume
Shun-Dong Li, Rong-Min Xu, Chao Xu, Pei-Jian Tong, Han-Xiao Ye
OBJECTIVE: To compare computer measurement semi automatic quantitative detection software system with ultra thin layer pathological section to confirm the avascular necrosis percentage of the femoral head, and provide reference for clinical treatment options. METHODS: From June 2012 to December 2013, the X-ray and MRI of 24 patients(24 hips on unilateral) were reviewed, who had avascular necrosis of the femoral head at late stage (stage III and IV) according to the ARCO international staging system, and performed by total hip arthroplasty...
February 25, 2019: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Noam Shohat, Andrew Fleischman, Majd Tarabichi, Timothy L Tan, Javad Parvizi
BACKGROUND: Although morbid obesity is considered a modifiable risk factor for periprosthetic joint infection (PJI), there is no consensus regarding an appropriate threshold for body mass index (BMI) above which a high risk for infection may outweigh the benefits of surgery. QUESTIONS/PURPOSES: (1) Is there a BMI cutoff threshold that is associated with increased risk for PJI? (2) Is the risk of PJI increased in higher obesity classes? METHODS: A retrospective study was conducted of all primary THAs and TKAs performed at one institution between 2006 and 2015...
October 2018: Clinical Orthopaedics and related Research
Shangyi Hui, Liyuan Tao, Feroze Mahmood, Derong Xu, Zhinan Ren, Xin Chen, Lin Sheng, Qianyu Zhuang, Shugang Li, Yuguang Huang
BACKGROUND: Tranexamic acid (TXA) has been routinely delivered in multisegmental spinal decompression and bone graft fusion surgeries with satisfactory outcomes in minimizing gross blood loss and transfusion demands. However, concerns remain that intravenously delivered TXA (ivTXA) may increase risks of postoperative convulsive seizures and systemic thrombogenicity. Topical use of TXA (tTXA), being more targeted to the surgical bleeding site while minimizing patient systemic exposure to ivTXA, has been successfully applied to attenuate blood losses and transfusion requirements in hip and knee arthroplasty...
February 12, 2019: Trials
John C Hagedorn, James M Bardes, Creed L Paris, Ronald W Lindsey
Evaluation of coagulation is vital in the care of the orthopaedic patients, particularly in the subspecialties of trauma, spine, arthroplasty, and revision surgery resulting from blood loss and coagulopathies. Although conventional tests (prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet count, and fibrinogen) are most commonly used, others like thromboelastography (TEG) are also available to the orthopaedic surgeons. TEG is a blood test developed in the 1950s, which provides a snapshot of a patient's coagulation profile by evaluating clot formation and lysis...
July 15, 2019: Journal of the American Academy of Orthopaedic Surgeons
Martin Roche, Tsun Yee Law, Jennifer Kurowicki, Nipun Sodhi, Samuel Rosas, Leah Elson, Spencer Summers, Karim Sabeh, Michael A Mont
Nutritional status has become increasingly important in optimizing surgical outcomes and preventing postoperative infection and wound complications. However, currently, there is a paucity in the orthopaedics literature investigating the relationship between nutritional status and wound complications following total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine the prevalence of (1) postoperative infections, (2) wound complications, (3) concomitant infection with wound (CoIW) complication, and (4) infection followed by wound complication by using (1) albumin, (2) prealbumin, and (3) transferrin levels as indicators of nutritional status...
November 2018: Journal of Knee Surgery
Chi Xu, Heng Guo, Pengfei Qu, Jun Fu, Feng-Chih Kuo, Ji-Ying Chen
Background: The purpose of this study was to evaluate the prevalence of preoperatively elevated serum inflammatory markers and to determine its association with periprosthetic joint infection (PJI) in patients with osteoarthritis (OA) undergoing total knee arthroplasty (TKA). Methods: From January 2010 to May 2014, we retrospectively reviewed 3,376 consecutive patients who were scheduled for unilateral TKA due to OA. Patients with inflammatory arthritis, posttraumatic arthritis, previous knee surgery, simultaneous surgery or arthroplasty, and comorbidity with autoimmune disease, hepatitis, renal disease, respiratory tract infections, urinary tract infection, and malignancy were excluded...
2018: Therapeutics and Clinical Risk Management
Joshua S Bingham, Christopher G Salib, Kyle Labban, Zachary Morrison, Mark J Spangehl
Background: Periprosthetic joint infections (PJIs) are devastating complications. Excessive anticoagulation with warfarin is an independent risk factor for PJIs. The use of a dedicated anticoagulation clinic to improve warfarin management has not been proven. Methods: Between 2006 and 2014, we identified 92 patients who were placed on postoperative warfarin, and later developed PJI. These patients were compared to 313 patients who underwent total joint arthroplasty placed on warfarin without developing PJI...
September 2018: Arthroplasty Today
Rahul Goel, Patrick Buckley, Emily Sterbis, Javad Parvizi
BACKGROUND: Two-stage exchange arthroplasty is the preferred treatment for chronic periprosthetic joint infection following total hip arthroplasty (THA). These patients are at high risk of substantial blood loss and perioperative blood transfusion. Our study aimed at determining risk factors for blood transfusion during a 2-stage exchange for infected THA. METHODS: Medical records of 297 patients with infected THA who underwent 2-stage exchange arthroplasty from 1997 to 2016 were reviewed...
November 2018: Journal of Arthroplasty
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