Bone up your program: certification process for the total knee replacement and total hip replacement center

Knee and hip osteoarthritis, combined with the increased aging population, obesity, and other health-related risk factors, has led to a great need for joint replacement procedures. Joint replacement programs have been developed within hospitals to meet this demand. Joint replacement programs have been designed to provide an efficient and structured delivery of care. Facilities can demonstrate, to those seeking care, their quality programs by applying for and obtaining certification. Joint replacement certifications can guide facilities in providing a solid structure of improved care, quality, and superior outcomes. This article describes the steps that a community hospital took to attain the Blue Distinction Centers for Knee and Hip Replacement as well as The Joint Commission Disease-Specific Care Certification in Total Knee Replacement and Total Hip Replacement.     

Indications for hip and knee replacement in Sweden

Objectives The aim of this paper was to compare selected indication parameters for patients scheduled for hip and knee replacement at orthopaedic units in Sweden. Methods Swedish orthopaedic clinics performing joint replacement were invited to enrol in the study. The study time was set to 2 years (from June 2006 to June 2008). The study subjects were patients undergoing hip or knee replacement for osteoarthritis (OA). For data collection, we used a Swedish priority criteria tool based on a translation from a form used in Canada with minor changes. The reliability and validity of the Swedish tool were investigated, with good reproducibility. The questionnaires (one for the doctor and one for the patient) were completed during decision making for surgery. Results Eleven hospitals enrolled in the study. In total, 2961 patients were included during the study period. Among these, 1662 were hip replacement patients and 1299 were knee replacement patients. The vast majority of patients undergoing hip or knee replacement had findings indicating severe OA, both clinically and radiologically according to the clinical priority tool. Statistically significant self‐reported problems with pain at rest, walking and impaired activities of daily living were also observed. There were statistically significant differences in reported indications between the hospitals, both for hip OA patients and for knee OA patients. Conclusions A clinical priority criteria tool is a useful means of following changes in indications for certain procedures. It could also contribute to explaining differences in case mix when evaluating clinical outcome and patient satisfaction.     

Patient empowerment after total hip and knee replacement

PURPOSE: This research was designed to gain an enhanced understanding of empowerment within in-home care relationships after hospital discharge of elderly patients who had undergone total hip or total knee replacement. METHOD: An interpretive phenomenology method was used. SAMPLE: Nine participants were interviewed on audiotape, guided by a semistructured interview guide. Five themes emerged centering on a strong desire to maintain independence. Overall, participants experienced disempowered relationships with professional in-home care providers and a more equitable empowered relationship with nonprofessional care providers. CONCLUSION: Disempowered relationships with professional personnel were not identified as a dissatisfier to most participants. Rather, patients expressed deference to the traditional expert model of healthcare. Further investigation is needed to understand the effect of empowerment on client satisfaction and clinical outcomes.     

Preparing patients for hip and knee replacement surgery

This article considers the pre-operative physical, psychological and social factors that affect the outcomes of patients undergoing total hip and total knee replacement surgery. The implications for patient assessment before surgery are discussed and suggestions made about how interventions can be tailored so that patients' needs are met.     

人工髋关节和膝关节置换术的护理进展

主要从术前健康状况综合评价及健康教育、术后早期并发症护理、术后康复方面，综述了人工髋关节、膝关节置换术的护理进展。     

Nursing management issues in hip and knee replacement surgery

Total hip replacement (THR) and total knee replacement (TKR) are carried out for the relief of pain in hip or knee joints usually caused by osteoarthritis. Such replacements last for 10-15 years and therefore many nurses will care for patients with a THR/TKR even if that is not the primary reason for the patient seeking care. The different types of THR/TKR and how patients can be prepared for surgery are discussed. The major long-term complications of loosening or dislocation of the components of the THR/TKR and of infection are explored and the presenting symptoms are highlighted. The article is intended to be useful not only for orthopaedic nurses but also for nurses generally.     

Total joint replacement of the hip and knee.

Total hip and knee replacements are among the most common orthopedic surgical procedures performed on patients with arthritis. The procedures are highly successful in appropriately selected patients. The authors approach total joint replacement from a medical perspective, emphasizing indications, contraindications, preoperative evaluation, clinical outcome, and potential complications.     

同侧髋、膝关节同时置换术后康复

目的:探讨同侧髋膝关节同时置换术的康复方法。方法:对1992年—1999年间收治的30例43侧严重风湿病下肢同侧髋膝关节同时置换术患者进行术后康复治疗,针对这些严重的风湿病患者制订一系列康复措施,并针对同侧髋膝关节同时置换术后的病例特点进行康复。结果:术前术后对比,髋关节术后总活动度平均提高93.7°,髋关节Harris评分较术前提高45分。膝关节活动度平均较术前提高44°,HSS平均较术前提高46.5分。全部患者经过平均5.2年的随访。随访期内,1例1膝患者复发屈膝挛缩,1例1膝出院后家庭康复时不慎摔倒致左股骨干骨折,经手术治疗后骨折愈合。其余患者均对患肢功能主观评价满意,术后疼痛症状明显缓解,出院时所有患者的不扶拐行走距离均超过100m。结论:同侧髋膝关节同时置换术患者的康复应在术前详细制订康复计划,针对病人不同情况采取不同的康复措施,严格遵守循序渐进、因人而异、随时调整的原则。     

人工髋关节和膝关节置换术的护理进展

主要从术前健康状况综合评价及健康教育、术后早期并发症护理、术后康复方面,综述了人工髋关节、膝关节置换术的护理进展.     

Assessing the outcomes of total knee replacement

Abstract: The past few years have seen a growth of interest in outcome measurement in a variety of settings including audit, health care management and commissioning – besides the traditional applications in research work. This paper reports on a study of the outcomes of total knee replacement in an acute hospital where the outcomes were studied as part of an audit process. The outcome measures used included clinical and symptomatic measures as well as generic health status scales. The initial study in one hospital was expanded to include a number of others in the same region and a comparative database of outcomes developed. Examples of the results are shown. The technical measures using knee scores and general health status measure show significant improvement from pre-operatively to 3 months later. This improvement was maintained up to the 1-year follow-up on both measures. Although the information systems for collecting and measuring outcomes has been successful, the ability of such measures to lead to behavioural change has been limited. The problems in using outcome measures are discussed in particular in the context of an audit within hospitals, and for purchasing agencies.     

Incidence rates for thromboembolic,bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Summary. Background: Data on clinical outcomes of patients in the general population undergoing knee replacement or hip replacement surgery are sparse. Objectives: To conduct an observational study using insurance claims data to assess the incidence of selected clinical events following knee replacement or hip replacement surgery in the USA. Patients/Methods: A total of 97 469 knee replacement patients and a total of 45 203 hip replacement patients were included during the period 2004–2008; the median age was 64 years, and 63% of knee replacement patients and 55% of hip replacement patients were women. Results: During a median follow‐up of 70–71 days, the incidence rates in knee replacement patients and hip replacement patients were, respectively: ischemic stroke, 15 and 19 per 1000 person‐years; acute coronary syndrome (ACS), 15 and 18 per 1000 person‐years; bleeding events, 46 and 47 per 1000 person‐years; venous thromboembolism (VTE), 64 and 45 per 1000 person‐years; and hepatic events, one and one per 1000 person‐years. Approximately 45% of knee replacement and hip replacement patients had no claims for outpatient anticoagulant therapy within 1 week after discharge from hospital. Conclusions: Ischemic events such as stroke, ACS and VTE are important adverse events following knee replacement and hip replacement surgery. The results reported here can help in making challenging decisions regarding the clinical management of risks attributable to bleeding events and clotting events.     

A team to ensure sensitive continuing care. Setting up a symptom control/support team.

The stress and responsibility associated with palliative care is demanding for patients and healthcare professionals. A symptom control/support team can act as a resource for all involved, offering advice on symptom control, counselling, education and bereavement follow-up.     

全髋置换对膝关节运动状态的影响(英文)

背景:处在不同运动状态的人体下肢关节系统,其力学特性和关节变形量具有较大的差别.全髋置换是目前解决髋关节严重疾病的最终方法.明确置换前后人体下肢系统,特别是膝关节对置换的响应对于患者的康复训练具有积极意义.目的:通过对健康者和行全髋置换后19个月的患者,在相同的测试环境和测试方法下进行数据采集,对比分析髋关节置换对膝关节在运动中关节变形量的影响.方法:采用NDI公司的动态捕捉系统对行全髋术后19个月的患者进行测量,同时与患者身体状况相似的健康志愿者采用相同的测量仪器和测量方法进行实验.测量内容包括步长,步频,关节转角和关节位移曲线,并根据测量数据计算各关节的速度和加速度.结果与结论:由于髋关节置换对患者的自然关节状态进行了破坏,虽然置换后的步态没有太大的差别,但是通过实验数据可以发现,膝关节的变化量比正常状态下要大,说明人体自身进行了调节,通过增大膝关节的负荷,增加变形量来弥补由于髋关节手术所带来的损伤.     

Patient-perceived functional outcomes associated with elective hip and knee arthroplasties

The purpose of this study was to determine the effect elective hip and knee arthroplasties had on functional activities of daily living and if the background variables of age, gender, and surgery location can be used to predict functional outcome after these types of surgeries. Data were collected from 43 subjects, 6 to 35 months after they had elective hip or knee arthroplasties. The subjects responded to a mail survey that defined before surgery and after recovery functioning in relation to 22 activities of daily living representing personal care, housework-yard work, and recreation-social activities. Approximately 65% of the subjects reported no change in their ability to perform the 22 surveyed activities. Psychosocial variables appeared to be significant determinants of function. When the selected background data were compared with surgery results, women performed significantly better than men (p less than .05), but age and surgery location were not significant variables affecting outcome.     

The hip and knee replacement operation: an extensive life event

Scand J Caring Sci; 2010; 24; 663–670
The hip and knee replacement operation: an extensive life event Background: A total hip replacement and a total knee replacement have shown to effectively reduce pain and disability in patients with osteoarthritis of the hip and knee joint despite associated risks. Even though the intervention primarily concerns older people with additional health problems, the patients stand on their feet the day after the operation and are discharged a few days later. Previous research indicates that reflections about life are related to the operation. Aim: The aim of this study was to illuminate the meaning of reflections related to hip and knee replacement surgery. Method: A phenomenological hermeneutical approach with a longitudinal design was chosen in order to study the participants’ experiences of the hip and knee replacement intervention across the entire perioperative period. Findings: Four themes emerged from the structural analysis; choosing the challenge, past memories connect to the current situation, moving from happiness to ordinary everyday life and moving from despair towards reluctant acceptance of unexpected bad conditions for everyday life. There was inner negotiations about having surgery or not, and existential anxiety that reminded people that life cannot be taken for granted. Conclusion: Our findings indicate the operation was seen as an extensive life event including reflections about life and death and about hope and fear. Previous bad experiences of care seemed to influence the way patients dealt with fear and hope. Fear had to be overcome by inner negotiations about undergoing surgery or not. Relief was expressed about surviving the actual operation, but soon after fears arose about how to manage on the actual road to recovery. Hope for a good life grew either stronger or weaker, depending on the progress following the operation. The outcome eventually generated a transition from happiness to ordinary everyday life, or a transition from despair towards reluctant acceptance of unfulfilled expectations.     

Antibiotic use after cefuroxime prophylaxis in hip and knee joint replacement

The amount of additional antibiotics measured by defined daily dose (DDD) methods after 2651 hip and 362 knee replacements was assessed after prophylaxis with one or three doses (1502/1511 patients) of cefuroxime. No differences were observed between the two regimens with respect to total amount, type, indication, and duration of additional antibiotics. The incidence of joint sepsis did not differ significantly between the two trial arms, but the sample was too small for definite conclusions. There were 11.4 DDD/100 bed days of additional antibiotics used in 21% of patients after hip replacement and 15.7 DDD/100 bed days in 31% after knee replacement. For wound problems, 3.8 and 6.9 DDD/100 bed days were given in the hip- and knee-replacement groups. For distant infection, 6.5 DDD/100 bed days was administered in both groups. Duration of therapy varied only in relation to indication. Prescribed were penicillins (43% to 50%), sulfonamides (18%), cephalosporins (10% to 16%), and nitrofurantoin (8% to 13%); drug use was related to the type of infection.     

Investigation of anterior knee pain after total hip replacement: a pilot study

Background and Purpose. There is no previous research to determine if total hip replacement can lead to anterior knee pain. The idea for the present study came from clinical observation of anterior knee pain (AKP) after total hip replacement, and the objective was to investigate anterior knee pain after total hip replacement. Method. The study used a prospective single‐system design with a convenience sample. Six men and seven women were assessed before and at six weeks after total hip replacement for the presence and degree of AKP, using a step‐down test combined with a visual analogue scale (VAS). Measurements were also taken of leg length, hip and knee motion, thigh circumference and hamstring length using previously validated tests. Results. Eight of thirteen subjects had AKP at six weeks post‐operation. Active knee flexion was reduced post‐operation (p < 0.0007), and proximal, mid‐ and distal thigh circumferences were increased (p < 0.0001). Eleven of 13 subjects demonstrated leg lengthening (p < 0.0001), and 10/11 subjects demonstrated a reduction in passive knee flexion (p < 0.002). All biomechanical data were correlated against the VAS. Although none were statistically significant, both decreased active and passive knee flexion, and increased thigh circumference exhibited the greatest trend with the VAS. Conclusions. The results of the present study cannot be compared to other studies, as there are no previous studies on AKP after total hip replacement. Current outcome measures for total hip replacement do not measure for AKP, although it may potentially hinder full functional recovery. Orthopaedic surgeons and physiotherapists need to be aware if this is a possible complication of total hip replacement, and hence further research is required to test external validity. Copyright © 2006 John Wiley & Sons, Ltd.