Publications by authors named "J Wolfstadt"

22 Publications

Outcomes of distal femoral arthroplasty after periprosthetic fractures : minimum 2-year follow-up.

Acta Orthop Belg 2021 Mar;87(1):111-116

Purpose: distal femoral periprosthetic fracture (DFPPF) is a serious complication following total knee arthroplasty (TKA). Recently, treatment of DFPPF with distal femoral arthroplasty (DFA) has gained popularity because of its posited benefits for both patients and the medical system. Short-term follow-up trials investigating DFA have demonstrated acceptable results with regards to function, pain relief and lower postoperative complications than ORIF in elderly patients. The purpose of the current study was to evaluate a consecutive series of DFPPF treated with DFA, with a minimum 2- year follow-up.

Methods: We performed a retrospective study asses- sing the outcomes of distal femoral arthroplasty (DFA) for patients diagnosed with DFPPF.

Results: Twenty patients were identified. The mean age of patients was 76.3 (SD, 9.41), the average time from the fracture to revision surgery was 6.7 days (SD, 11.35), The average operative time was 93.5 minutes (SD,16.6). The average follow-up time was 50.15 months (SD, 20.87). During this time, two patients (10%) had complications. One patient experienced a knee dislocation and the second patient had recurrent periprosthetic infections. At final follow up, the mean knee society score was 86.25 (SD, 9.44), the mean Forgotten joint score was 62.16(SD, 23.45) and 93.7 percent of patients were ambulatory.

Conclusion: DFA following DFPPF is associated with high success rates and provides patients with the opportunity for return of function in a safe and reliable manner.
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March 2021

Very Distal Femoral Periprosthetic Fractures: Replacement versus Fixation, a Systematic Review.

J Orthop Trauma 2021 Mar 16. Epub 2021 Mar 16.

Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada Division of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.

Objectives: To synthesize all-cause reoperations and complications data, as well as secondary clinical and functional outcomes, following the management of very distal femur periprosthetic fractures (vDFPFs) in a geriatric patient population with either a distal femoral locking plate (DFLP) or with distal femoral replacement (DFR).

Data Sources: MEDLINE, Embase and Web of Science, were searched for English-language articles from inception to March 16, 2020 in accordance to PRISMA guidelines.

Study Selection: Studies reporting the management of vDFPFs in adults over the age of 65 with either a DFLP or DFR were included. To ensure this review solely focused on very distal femoral periprosthetic fractures, only fractures of the following classifications were included: (1) Lewis and Rorabeck Type II or III, (2) Su and Associates' Classification of Supracondylar Fractures of the Distal Femur Type III, (3) Backstein et al. Type F2, and/or (4) Kim et al. Type II or III.

Data Extraction: Three reviewers independently extracted data from the included studies. Study validity was assessed using the methodological index for non-randomized studies (MINORS), a quality assessment tool for non-randomized controlled studies in surgery.

Data Synthesis: Twenty-five studies with 649 vDFPFs were included for analysis. There were 440 knees in the DFLP group (mean age range: 65.9 to 88.3 years) and 209 knees in the DFR group (mean age range: 71.0 to 84.8 years). Due to the literature's heterogeneity, the data was qualitatively synthesized.Conclusions: vDFPFs in the elderly treated with DFR underwent fewer reoperations relative to DFLP (0% to 45% vs. 0% to 77%, respectively). Time to weightbearing was observably shorter in DFR studies relative to DFLP studies. Functional outcomes and postoperative range of motion indicated a trend for DFLP knees to outperform DFR knees. Future research should include prospective studies and cost-effectiveness evaluations to better understand the utility of DFR for these fractures.

Level Of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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March 2021

Developing a business case for a regional anesthesia block room: up with efficiency, down with costs.

Reg Anesth Pain Med 2021 May 12. Epub 2021 May 12.

Anesthesiology and Pain Medicine, Sinai Health, Toronto, Ontario, Canada

Background: Regional anesthesia techniques offer many benefits for total joint arthroplasty (TJA) patients. However, they require personnel and equipment resources, as well as valuable operating room (OR) time. A block room offers a dedicated environment to perform regional anesthesia procedures while potentially offsetting costs.

Methods: The goal of this prospective quality improvement study was to develop a business case for implementation of a regional anesthesia block room and to demonstrate the cost-effectiveness of this program in decreasing OR time for TJA. All elective TJA patients presenting between January 2019 and March 2020 were included in our analysis.

Results: Our detailed business plan was approved by the hospital leadership. 561 patients in the preintervention group and 432 in the postintervention group were included for data analysis. Mean total OR time per surgical case decreased from 166 to 143 min for a difference of 23 min (95% CI 17 to 29). Similarly, anesthesia controlled OR time decreased from 46 min to 26 min for a difference of 20 min (95% CI 17 to 22). The block room resulted in an additional primary TJA case per daily OR list. The percentage of TJA patients receiving a peripheral nerve block increased from 63.1% to 87.0% (p<0.001). No safety events or block room associated OR delays were observed.

Conclusion: Implementing a regional anesthesia block room required a comprehensive business plan for securing the necessary resources to support the program. The regional anesthesia block room is a cost-effective method to improve patient care and OR efficiency.
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May 2021

Reducing Acute Hospitalization Length of Stay After Total Knee Arthroplasty: A Quality Improvement Study.

J Arthroplasty 2021 03 8;36(3):837-844. Epub 2020 Oct 8.

Granovsky Gluskin Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Background: The introduction of bundled funding for total knee arthroplasty (TKA) has motivated hospitals to improve quality of care while minimizing costs. The aim of our quality improvement project is to reduce the acute hospitalization length of stay to less than 2 days and decrease the percentage of TKA patients discharged to inpatient rehabilitation using an enhanced recovery after surgery bundle.

Methods: This study used a before-and-after design. The pre-intervention period was January to December 2017 and the post-intervention period was January 2018 to August 2019. A root cause analysis was performed by a multidisciplinary team to identify barriers for rapid recovery and discharge. Four new interventions were chosen as part of an improvement bundle based on existing local practices, literature review, and feasibility analysis: (1) perioperative peripheral nerve block; (2) prophylactic antiemetic medication; (3) avoidance of routine preoperative urinary catheterization; and (4) preoperative patient education.

Results: The pre-intervention and post-intervention groups included 232 and 383 patients, respectively. Mean length of stay decreased from 2.82 to 2.13 days (P < .001). The need for inpatient rehabilitation decreased from 20.2% to 10.7% (P = .002). Mean 24-hour oral morphine consumption decreased from 60 to 38 mg (P < .001). The percentage of patients experiencing moderate-to-severe pain and postoperative nausea and vomiting within the first 24 hours decreased by 25% and 15%, respectively (P < .001). Thirty-day emergency department visits following discharge decreased from 12.9% to 7.3% (P = .030).

Conclusion: Significant improvements in the recovery of patients after TKA were achieved by performing a root cause analysis and implementing a multidisciplinary, patient-centered enhanced recovery after surgery bundle.

Level Of Evidence: Level III.
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March 2021