Pelkowski, Jessica N.

Introduction: Golf is a widely played recreational sport, but degenerative osteoarthritis in older adults can limit participation and performance. This study prospectively evaluates recreational golfers’ performance metrics of play, and clinical outcomes before and after total knee arthroplasty (TKA). Methods: A prospective cohort of 10 recreational golfers undergoing primary TKA were assessed at a professional golf performance center preoperatively and at 3 months, and 1-year postoperatively. The mean age was 72 years, 90% were men, and 50% underwent TKA on the lead leg. . Participants averaged 67 rounds in the year prior to surgery, maintained a handicap index (HCP) of 18. Golf performance metrics (driver and 7-iron), force-plate biomechanics, return-to-play timing, quality of play, and Knee Injury and Osteoarthritis Outcome Score, Junior (KOOS-JR) were analyzed using descriptive statistics. Results: At 1-year postoperatively, the mean changes in driver and 7-iron swing speed (+1.3 and -1.5 miles per hour (mph), respectively, 95% CI: -5, 4.7), ball speed (+3.5 and -2.6 mph, 95% CI: -12.9, 12.3), carry distance (-0.8 and +6.2 yards, 95% CI: -17.7, 17.1), maximum torque (+43 and +85 pounds per foot (lbs/ft), 95% CI: -30, 259), and vertical force (+93 and +119 lbs/ft, 95% CI: -175, 412). All patients returned to full golf rounds playing a mean 8 (SD: +5.7) and 44 (SD: +29.7) rounds by 3- and 12-months, respectively, with no change in HCP (P = 0.9). The KOOS-JR significantly improved (57 to 80, P = 0.01). Conclusion: Recreational golfers safely returned to play after TKA with no significant changes in swing performance or handicap, while patient-reported outcomes improved. These findings suggest TKA enables resumption of golf without compromising performance.

Introduction: Optimal patient outcomes after orthopaedic surgery rely on cooperative efforts of patients as well as performance of the care team. The purpose of this project was to design and implement a preoperative education class for patients to meet patient expectations, reduce anxiety regarding surgery, and reduce postoperative phone calls. Methods: This study implemented cross-sectional questionnaires and chart reviews for patients in an orthopaedic group in Florida. Enrollment in a preoperative education class was optional for all patients undergoing partial or total primary or revision knee or hip arthroplasty. There were two groups of participants (n1=50, n2=50). The joint education group completed the class and provided feedback, while the comparison group elected not to take the class. Postoperative phone calls from both groups were compared. Variables included gender, diagnosis of depression and/or anxiety, and availability of a support group. Results: The average numbers of phone calls to the office were 2.84 and 5.67 between surgery and the first postoperative visit (x̄=25.18 days and x̄=20.12 days) in the joint education group and the comparison group, respectively. Statistical analysis revealed P=0.011. Ninety percent of participants reported reduction in anxiety regarding surgery regardless of diagnosis of anxiety or depression. Conclusions: The preoperative education class resulted in alleviation of surgery-related anxiety. The number of patient phone calls to the office were fewer in the joint education group compared with the comparison group, which suggested better understanding about anticipated postoperative experience. The class provided benefits for patients, healthcare providers, and the clinic. Level of Evidence: Level III.

Polypharmacy is common, especially among older patients. Polypharmacy can lead to adverse patient outcomes and increased healthcare costs. After elective hip or knee arthroplasty, several new medications are prescribed, which can contribute to polypharmacy, although these medications are necessary in the postoperative period. Although some instances of polypharmacy may be appropriate, many are not. Nurse practitioners play a vital role in identifying and preventing inappropriate polypharmacy in the postoperative period and can develop individualized therapy plans for each patient to provide safe medication use in patients. This would be beneficial in the orthopaedic surgery postoperative period because of the introduction of several new medications.