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Related Concept Videos

Development of the Limb Synovial Joints01:07

Development of the Limb Synovial Joints

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Joints form during embryonic development in conjunction with the formation and growth of the associated bones. The embryonic tissue that gives rise to all bones, cartilage, and connective tissues of the body is called mesenchyme.
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Knee Joint01:23

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The knee joint is the most complicated joint in the body. It consists of three articulations– two tibiofemoral and one patellofemoral. As is characteristic of synovial joints, the knee joint has a thin articular capsule that partially surrounds this joint cavity. Additionally, several ligaments, muscles, and cartilaginous structures support the movement of the knee.
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Ankle Joint01:10

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The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...
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Smoking cessation prior to elective total joint arthroplasty results in sustained abstinence postoperatively.

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Related Experiment Video

Updated: Jun 28, 2025

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
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Subsequent total joint arthroplasty: Are we learning from the first stage?

Christine Jiang Wu1, Colin Penrose2, Sean Patrick Ryan3

  • 1Department of Orthopaedic Surgery, Duke University Hospital, Durham, NC 27710, United States. christine.j.wu@duke.edu.

World Journal of Orthopedics
|April 10, 2024
PubMed
Summary

Patients experience improved outcomes for their second total joint arthroplasty (TJA) due to learning from the initial surgery. Surgical teams find staged total hip arthroplasty (THA) more efficient, but this efficiency was not observed for total knee arthroplasty (TKA).

Keywords:
Asynchronous total joint arthroplastyContralateral total joint arthroplastyPerioperative outcomesStaged total joint arthroplastySubsequent total joint arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Patient Outcomes Research
  • Health Services Research

Background:

  • Rising incidence of total joint arthroplasty (TJA) necessitates strategies to minimize peri-operative complications and resource use.
  • Patients with multi-joint degenerative conditions often require staged, bilateral procedures.

Purpose of the Study:

  • To evaluate if patient and physician learning from an initial arthroplasty procedure leads to improved outcomes in a subsequent surgery.
  • To identify specific areas of outcome improvement in staged bilateral TJA.

Main Methods:

  • Retrospective query of an institutional database for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
  • Exclusion of unilateral and same-day bilateral TJA cases.
  • Stratification of patients by first vs. second surgery, collecting demographics, comorbidities, and implant sizes.
  • Evaluation of operative time, length of stay (LOS), disposition, 90-day readmissions, and emergency department (ED) visits.

Main Results:

  • Analysis of 642 patients (364 TKA, 278 THA) revealed no significant demographic or comorbidity differences between staged procedures.
  • Second TJA surgeries showed significantly shorter length of stay (LOS) (P < 0.001).
  • Total hip arthroplasty (THA) operative time decreased when the same implant size was used (P = 0.025); no significant difference in readmissions or ED visits.
  • Patients were more likely to be discharged home after the second procedure if their disposition changed (P = 0.033).

Conclusions:

  • Patients demonstrate improved peri-operative outcomes for their second TJA, potentially due to increased confidence and reduced anxiety.
  • Enhanced pre-operative patient education may further improve outcomes.
  • Staged THA procedures are more efficient for the surgical team, though this efficiency was not observed for TKA.