FOTO - Focus on Therapeutic Outcomes | Total Hip Arthroplasty Archives

High Risk Groups for Complication after Joint Replacement

Selena Horner — Tue, 12 Feb 2019 11:00:00 +0000

When it comes to predicting, models require far more variables than age and gender to accurately predict.

The ability to accurately predict incidences in health care is something many providers need. When I compare this abstract to what I know about predicting outcomes, there are similarities between models. The patient factor models that include very few patient factors have poor capability to actually predict.

It seems when it comes to predictive models thoughtful consideration about the various factors that may truly affect the outcome need to be included in the model. In this particular study use of corticosteroids was a component increasing predictive capability.

For the model in this study, what is helpful for you is to keep your eye on your patients who have had a replacement due to rheumatoid arthritis – probably because of the prescribed corticosteroids for the condition. At the same time, for anyone undergoing elective joint replacement surgery that has certain comorbidities, you will need to keep your eyes open for infection.

The abstract is included below for you to review.

Identification of high-risk groups for complication after arthroplasty: predictive value of patient’s related risk factors.

Castano-Betancourt MC¹, Fruschein Annichino R², de Azevedo E Souza Munhoz M², Gomes Machado E², Lipay MV², Marchi E².

Abstract

BACKGROUND:

Total joint arthroplasty (TJA) benefit patients with osteoarthritis (OA) and rheumatoid arthritis (RA). However, a specific approach to detect patients at higher risk of prosthetic joint infection (PJI) and mechanical complications is absent. The aim of this study is to identify groups at higher risk for infections and mechanical complications after TJA in patients with RA and OA based on their most significant predictors.

METHODS:

This is a hospital-based cohort study with 1150 recipients of TJA. Risk factors and comorbidities were assessed prior to the index surgery. Multivariate logistic and hazard regression were used to determine the relationship between risk factors and occurrence of complications after TJA. Odds ratios (OR), hazard ratios (HR), 95% confidence intervals (CI), and comparison between areas under the curve (AUC) using DeLong’s method are presented.

RESULTS:

Complications were more frequent in subjects with RA, use of corticosteroids, and previous comorbidities: respiratory disease, infections, diabetes, anemia, mental and musculoskeletal comorbidities than in subjects without these risk factors, and these factors were predictors of infections and mechanical complications (P < 0.05). A model including these factors was superior to a model with only type of joint disease (OA/RA) or age and gender to detect infections or mechanical complications after TJA (P < 0.05 for difference between models). Complication risk proportionally increased with the presence of two or more comorbidities (P < 0.001).

CONCLUSIONS:

There are two groups at higher risk for infections after TJA: patients with OA with at least two risk factors and patients with RA, who usually present at least one of the risk factors for infection.

J Orthop Surg Res. 2018 Dec 29;13(1):328. doi: 10.1186/s13018-018-1036-2.

The post High Risk Groups for Complication after Joint Replacement appeared first on FOTO Patient Outcomes.

Can a Smart Watch Help with Faster Recovery after a Joint Replacement

Selena Horner — Thu, 13 Dec 2018 11:00:00 +0000

Earlier this year I came upon a news story about Apple and how Apple is definitely taking steps to move into the health and medical world.

I am sure that many of us provide care to people who have had a joint replacement. I wish that our brains could accurately recall each of our patients.

I believe that the apps have a bit more importance than just pre and post-operative education and tracking. Research is pointing to the importance of being active far sooner than when osteoarthritis is seen. And then, even when someone has osteoarthritis, it is still important to be active. It seems research is indicating that the lack of physical activity may be playing a large role in occurrence rates. It seems to me there could be a way to somehow harness that research to pull into an app to help track, motivate and increase efforts to change behaviors before the situation reaches a need for a joint replacement.

As I read the news about the current study between Apple and Zimmer Biomet, I found it interesting that surgeons may play the main role with regard to who the patient will be able to communicate. As a physical therapist, as I think about the patients who don’t quite do as well, most may not have been zealous with stretching their joint and getting themselves back to life. I am not able to see the full app design via the link, so I hope there has been thought on how to capture that the patient is actually spending time focused on gaining full range of motion. The patients who don’t begin to walk distances or go up and down stairs in a normal manner are also at risk of not regaining full use of their new knee or hip. And for some individuals, targeted education, demonstration, exercises need to be provided to help the person get rid of their limp. I’m not quite sure how an app might be able to provide the individualized feedback to help the person perform quality movement patterns. Technically it isn’t unless it merges with a video platform that can see a patient move and qualify the movement pattern.

It seems that combining this wearable technology with the app being designed by Apple and Zimmer Biomet might have a bit more value. The ability to combine the majority of the patient needs into one package seems more helpful and ties everything together for the patient. Again, the biggest question: which patients need the technology to help them be successful.

I’m not sure the surgeon will really be the professional who truly cares or even wants to spend time thinking about the patient’s day to day activity level. It seems that a physical therapist would have more stake in not only analyzing the date, but also advising on activities. I am finding it more and more interesting to learn a patient’s perspective of doing a lot of walking. Some patients think “a lot” of walking is 1,000 steps. When I look at research to help me define activity levels based on steps: <5,000 steps is sedentary. So, yes, I can see a disconnect between “a lot of steps” and what is really necessary to have a person be considered physically active. I also think that as wearables become more commonly used with the majority of our patients, we have the opportunity to help educate on acceptable, healthy targets so the patient really is exceeding sedentary status.

Until next time,

~Selena

The post Can a Smart Watch Help with Faster Recovery after a Joint Replacement appeared first on FOTO Patient Outcomes.