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Orthopaedic Surgery and Rehabilitation in the Aging Population

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Special Issue Information
Keywords
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A special issue of Geriatrics (ISSN 2308-3417). This special issue belongs to the section "Geriatric Rehabilitation".

Deadline for manuscript submissions: closed (30 April 2020) | Viewed by 37133

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Special Issue Editor

Dr. Eric L. Smith

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Guest Editor

Boston Medical Center, Department of Orthopaedic Surgery, Boston, MA, USA
Interests: total joint arthroplasty using customized implants; the use of constraint in total knee arthroplasty; establishment of a surgical home for total joint arthroplasty outpatients; total joint arthroplasty in vulnerable patient populations

Special Issue Information

Dear Colleagues,

The world’s population is aging, and, with aging, comes challenges for both the surgeon and the health care system to care for older patients. Orthopaedic patients seek an improvement in their quality of life and daily activities, and this Special Issue highlights some of the efforts aimed at optimizing care in an older population.

In this Special Issue, we explore optimal approaches and treatment of hip fractures and femoral neck fractures, specifically in elderly patients with an emphasis on function. The outcomes of both primary and revision total knee and total hip replacement are highlighted in this Special Issue with a focus on those patients over the age of 80. Perioperative care of elderly patients undergoing orthopaedic surgical procedures is highlighted, specifically postoperative pain management, anticoagulation, and physical therapy, all essential to optimizing outcomes.

Outcomes of surgical interventions in elderly patients are explored using both local and large national databases.

Dr. Eric L. Smith
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Femoral neck fracture
Primary and revision total knee arthroplasty in the elderly
Primary and revision total hip arthroplasty in the elderly
Postop pain management in orthopaedic surgery in elderly
The effect of physical therapy on orthopaedic surgery outcomes
Therapeutic prothrombin time for hip fracture patients
Surgical approaches of hemiarthroplasty
Large/national database analysis

Published Papers (6 papers)

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Research

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7 pages, 181 KiB

Open AccessArticle

Postoperative Complications of Hip Fractures Patients on Chronic Coumadin: A Comparison Based on Operative International Normalized Ratio

by Michael S. Kain, David Saper, Kyle Lybrand, Kasey-Jean Bramlett, Paul Tornetta III, Peter Althausen, John S. Garfi, Donald P. Willier III, Ruijia Niu and Andrew J. Marcantonio

Geriatrics 2020, 5(3), 43; https://doi.org/10.3390/geriatrics5030043 - 15 Jul 2020

Cited by 2 | Viewed by 2821

Abstract

In current clinical practice, orthopedic surgeons often delay the surgery intervention on geriatric hip fracture patients to optimize the international normalized ratio (INR), in order to decrease the risk of postoperative hematological complications. However, some evidence suggests that full reversal protocols may not be necessary, especially for patients with prior thromboembolic history. Our study aims to compare the surgical outcomes of patients with normal versus elevated INR values. We conducted a retrospective chart review on 217 patients who underwent surgeries on hip fractures at two academic trauma centers. We found that in our group (n = 124) of patients with an INR value of 1.5–3.0, there was only one reoperation for a hematoma, but there was a trend for more blood transfusions. There was no statistically significant difference in the odds of reoperation or overall complications. Nevertheless, there were significantly more events of postoperative anemia in this high INR patient group. Full article

(This article belongs to the Special Issue Orthopaedic Surgery and Rehabilitation in the Aging Population)

6 pages, 205 KiB

Open AccessArticle

Factors Determining Home versus Rehabilitation Discharge Following Primary Total Joint Arthroplasty for Patients Who Live Alone

by Christopher Fang, Sara J. Lim, David J. Tybor, Joseph Martin, Mary E. Pevear and Eric L. Smith

Geriatrics 2020, 5(1), 7; https://doi.org/10.3390/geriatrics5010007 - 12 Feb 2020

Cited by 10 | Viewed by 3873

Abstract

Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination. Full article

(This article belongs to the Special Issue Orthopaedic Surgery and Rehabilitation in the Aging Population)

7 pages, 198 KiB

Open AccessArticle

PT Achievement in Public Hospitals and Its Effect on Outcomes

by Jessica S. Morton, Alex Tang, Michael J. Moses, Dustin Hamilton, Neville Crick and Ran Schwarzkopf

Geriatrics 2019, 4(4), 58; https://doi.org/10.3390/geriatrics4040058 - 18 Oct 2019

Viewed by 4240

Abstract

The demand for TKA continues to rise within the United States, while increasing quality measures and cost containment became the basis of reimbursement for hospital systems. Length of stay is a major driver in the cost of TKA. Early mobilization with physical therapy has been shown to increase range of motion and decrease complications, but with mixed results in regards to length of stay. We postulate that initiating physical therapy on post-operative day zero will decrease length of stay in an urban public hospital. Retrospective chart review was performed at a large, urban, public academic medical center to identify patients who have had a primary TKA over the course of a 3-year period. Groups who underwent post-operative day zero therapy were compared with those who initiated physical therapy on post-operative day one. Length of stay was the primary outcome. Patient demographic characteristics and discharge disposition were also collected. There were 98 patients in the post-operative day-one physical therapy cohort and 58 in the post-operative day zero physical therapy group. Hospital length of stay was significantly decreased in the post-operative day zero physical therapy group. (p < 0.01) There was no difference in discharge disposition between the two groups. Full article

(This article belongs to the Special Issue Orthopaedic Surgery and Rehabilitation in the Aging Population)

12 pages, 223 KiB

Open AccessArticle

Comparing Inpatient Complication Rates between Octogenarians and Nonagenarians Following Primary and Revision Total Hip Arthroplasty in a Nationally Representative Sample 2010–2014

by Evan M Dugdale, David Tybor, Michael Kain and Eric L Smith

Geriatrics 2019, 4(4), 55; https://doi.org/10.3390/geriatrics4040055 - 1 Oct 2019

Cited by 15 | Viewed by 5713

Abstract

We compared inpatient postoperative complication rates between octogenarians and nonagenarians undergoing primary and revision total hip arthroplasty (THA). We used inpatient admission data from 2010–2014 from the Nationwide Inpatient Sample (NIS). We compared the rates at which nonagenarians and octogenarians developed each complication in the inpatient setting following both primary THA (PTHA) and revision THA (RTHA). A total of 40,944 inpatient admissions were included in our study which extrapolates to a national estimate of 199,793 patients. A total of 185,799 (93%) were octogenarians and 13,994 (7%) were nonagenarians. PTHA was performed on 155,669 (78%) and RTHA was performed on 44,124 (22%) of the patients. Nonagenarians undergoing PTHA required transfusions significantly more frequently (33.13% v. 24.0%, p < 0.001) and developed urinary tract infection (5.14% v. 3.92%, p = 0.012) and acute kidney injury (5.50% v. 3.57%, p < 0.001) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA required transfusions significantly more frequently (51.43% v. 41.46%, p < 0.001) and developed urinary tract infection (19.66% v. 11.73%, p < 0.001), acute kidney injury (13.8% v. 9.66%, p < 0.001), pulmonary embolism (1.24% v. 0.67%, p = 0.031), postoperative infection (1.89% v. 1.11%, p = 0.023), sepsis (3.59% v. 2.43%, p = 0.021) and other postoperative shock (1.76% v. 1.06%, p = 0.036) significantly more frequently than octogenarians. Nonagenarians undergoing RTHA also had a significantly higher inpatient mortality rate (3.28% v. 1.43%, p < 0.001) than octogenarians. Orthopedic surgeons and primary care providers can use these findings to help counsel both their octogenarian and nonagenarian patients preoperatively when considering THA. Our analysis can help these patients better understand expected inpatient complication rates and assist them in deciding whether to pursue surgical intervention when applicable. Full article

(This article belongs to the Special Issue Orthopaedic Surgery and Rehabilitation in the Aging Population)

Review

Jump to: Research

15 pages, 3507 KiB

Open AccessReview

Surgical Treatment of Femoral Neck Fractures: A Brief Review

by Ellen Lutnick, Jeansol Kang and David M. Freccero

Geriatrics 2020, 5(2), 22; https://doi.org/10.3390/geriatrics5020022 - 1 Apr 2020

Cited by 26 | Viewed by 15127

Abstract

Hip fracture is a cause for concern in the geriatric population. It is one of the leading causes of traumatic injury in this demographic and correlates to a higher risk of all-cause morbidity and mortality. The Garden classification of femoral neck fractures (FNF) dictates treatment via internal fixation or hip replacement, including hemiarthroplasty or total hip arthroplasty. This review summarizes existing literature that has explored the difference in outcomes between internal fixation, hemiarthroplasty, and total hip arthroplasty for nondisplaced and displaced FNF in the geriatric population, and more specifically highlights the risks and benefits of a cemented vs. uncemented approach to hemiarthroplasty. Full article

(This article belongs to the Special Issue Orthopaedic Surgery and Rehabilitation in the Aging Population)

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15 pages, 3070 KiB

Open AccessReview

Review of Therapeutic Options for the Prevention of VTE in Total Joint Arthroplasty

by Jordan Etscheidt, Amir Shahien, Monique Gainey, Daniel Kronenfeld, Ruijia Niu, David Freccero and Eric Smith

Geriatrics 2020, 5(1), 18; https://doi.org/10.3390/geriatrics5010018 - 18 Mar 2020

Cited by 5 | Viewed by 4841

Abstract

Hip and knee arthroplasty patients are at high risk of perioperative venous thromboembolic events (VTE). VTE has been well studied in this population and it is recommended that total joint arthroplasty recipients receive chemoprophylactic anticoagulation due to risk factors inherent to the surgical intervention. There are few concise resources for the orthopedic surgeon that summarize data regarding post-operative anticoagulation in the context of currently available therapeutic options and perioperative standards of practice. The periodic reexamination of literature is essential as conclusions drawn from studies predating perioperative protocols that include early mobilization and sequential compression devices as standards of practice in total joint arthroplasty are no longer generalizable to modern-day practice. We reviewed a large number of recently published research studies related to post-operative anticoagulation in total joint arthroplasty populations that received a high Level of Evidence grade. Current literature supports the use of oral aspirin regimens in place of more aggressive anticoagulants, particularly among low risk patients. Oral aspirin regimens appear to have the additional benefit of lower rates of bleeding and wound complications. Less consensus exists among high risk patients and more potent anticoagulants may be indicated. However, available evidence does not demonstrate clear superiority among current options, all of which may place patients at a higher risk of bleeding and wound complications. In this situation, chemoprophylactic selection should reflect specific patient needs and characteristics. Full article

(This article belongs to the Special Issue Orthopaedic Surgery and Rehabilitation in the Aging Population)

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