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Mozella ADP, Cobra HADAB, Minamoto STN, Salim R, Leal AC. Causes of Revision of Total Knee Arthroplasties in a Tertiary Hospital in Brazil. Rev Bras Ortop 2024; 59:e696-e701. [PMID: 39649045 PMCID: PMC11624922 DOI: 10.1055/s-0042-1757304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/17/2022] [Indexed: 12/10/2024] Open
Abstract
Objective To identify the causes of revision of total knee arthroplasty in a referral center in Brazil. Methods This is a case series, with 80 patients undergoing revision surgery for total knee arthroplasty (RTKA) at a referral center for knee surgery, between August 2019 and November 2021, with a mean age of 69.6 years. Of these patients, 60.23% were female and 39.77% were male. The average body mass index (BMI) was 30.23 kg/m 2 . The causes of TKA failure were defined as: periprosthetic infection according to the 2018 International Consensus Meeting criteria, ligament instability, range of motion limitation, periprosthetic fracture, malalignment, aseptic loosening, pain due to non-replacement of the patellar cartilage, polyethylene wear, fracture of implants, insufficiency of the extensor mechanism. Results Periprosthetic joint infection (PJI) was the main cause of revision total knee arthroplasty (TKA), corresponding to 47.73% of cases. Aseptic loosening of one or more components represented the second most frequent reason for TKA failure, accounting for 35.23% of revisions. Range of motion limitation represented the third most frequent cause, accounting for 5.68% of surgeries. Instability was the fourth most frequent reason for RTKA, occurring in 4.55% of patients. The other causes of revision were: periprosthetic fracture (3.41%), failure due to rupture of the extensor mechanism (2.27%), and pain attributed to non-replacement of the patellar cartilage (1.14%). Conclusions Periprosthetic joint infection was the most frequent cause of TKA revision in our series. Other reasons for TKA failures were, in descending order: aseptic loosening, limited range of motion, and instability.
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Affiliation(s)
- Alan de Paula Mozella
- Departamento de Ortopedia e Traumatologia, Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.
| | - Hugo Alexandre de Araújo Barros Cobra
- Departamento de Ortopedia e Traumatologia, Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.
| | - Sandra Tie Nishibe Minamoto
- Departamento de Ortopedia e Traumatologia, Centro de Cirurgia do Joelho, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.
| | - Rodrigo Salim
- Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), São Paulo, SP, Brasil.
| | - Ana Carolina Leal
- Divisão de Ensino e Pesquisa, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil.
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Manzetti M, Digennaro V, Di Martino A, Bordini B, Benvenuti L, Ferri R, Cecchin D, Faldini C. Survivorship of total knee arthroplasty in poliomyelitis patients: long-term results from the R.I.P.O. registry and single-institution retrospective study. Arch Orthop Trauma Surg 2024; 144:3641-3648. [PMID: 39069565 PMCID: PMC11417051 DOI: 10.1007/s00402-024-05426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/26/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION The survival of total knee arthroplasty (TKA) in patients with poliomyelitis remains a debated topic due to the high recurrence of postoperative genu recurvatum. This study aims to report the long-term survival of TKA in patients with poliomyelitis, using data from the Italian Register of Prosthetic Implantology. MATERIALS AND METHODS A registry-based population study was conducted, utilizing data from the Emilia Romagna orthopedic arthroplasty implants registry (RIPO - Registro Implantologia Protesica Ortopedica). The cohort consisted of 71 patients with poliomyelitis-related arthritis who underwent TKA. The study assessed and analyzed demographic data, implant type, fixation method, insert type, and level of constraint. Additionally, variations in preoperative and postoperative both clinical and functional Knee Society Scores (KSS) were collected. RESULTS Eight implants required revision surgery (16%), and three patients died (6.1%), resulting in a 10-year survival rate of 86.6% and a 15-year survival rate of 53.9%. Aseptic loosening was the primary cause of revision, accounting for 37.5% of failures, followed by insert wear (25%). No statistically significant correlation was found between the level of constraint and implant survival (p=0.0887, log-rank). Both the clinical and functional KSS improved postoperatively. CONCLUSION TKA is a viable alternative to knee arthrodesis and, in properly selected patients, might represent the first-choice treatment for articular degeneration due to its high survivorship. Despite the complexity of these cases, TKA can effectively alleviate articular pain, instability, and angular deviation, thereby preserving knee functionality.
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Affiliation(s)
- Marco Manzetti
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
| | - V Digennaro
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - A Di Martino
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - B Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, Bologna, 40136, Italy
| | - L Benvenuti
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - R Ferri
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - D Cecchin
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - C Faldini
- IRCCS - Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Sun Y, Liu J, Jiang W, Gao C, Qiao Y, Qin Y, Wang J. Epidemiology and Risk Factors for Revision Total Knee Arthroplasty in Chinese Patients: A Retrospective Study in Changchun, Jilin Province, China. Med Sci Monit 2024; 30:e943681. [PMID: 38881074 PMCID: PMC11191654 DOI: 10.12659/msm.943681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/24/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Over the past decades, total knee arthroplasty (TKA) in China has increased substantially. Owing to a lack of a joint registry, there is restricted information concerning the epidemiology of TKA failures in China. We aimed to (1) investigate the etiology of TKA failures in a cohort of Chinese patients and (2) determine the related demographic and anthropometric risk factors in Jilin, China, to have a look at the actual situation. MATERIAL AND METHODS A total of 1927 primary and 109 revision TKAs performed between April 2014 and May 2022 were analyzed in this retrospective study. Patient demographics and anthropometric measures, the interval from primary TKA to revision procedures, and the mechanisms for primary TKA failure were evaluated. A chi-square test, unpaired t test, and multivariate logistic regression were used to investigate the relationships between different factors and TKA failures. RESULTS The leading failure mechanism was infection (53.3%), followed by aseptic loosening (21.5%), stiffness (15.0%), instability (3.7%), malposition (2.8%), periprosthetic fractures (2.8%), and extensor mechanism disruption (0.9%). Infection (59.7%) was the main reason for early revision. Aseptic loosening (43.3%) was the leading cause of late revision. The male ratio in infection patients was higher (35.1% vs 20.6%). The smoking rate in patients with revision and infection was higher (18.9%, 23.9% vs 7%) than in primary patients. There was no difference in BMI between groups. CONCLUSIONS The leading cause of revision TKA in Jilin, China, was infection, followed by aseptic loosening and stiffness. Sex and smoking history were associated with TKA failures in this region.
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Affiliation(s)
- Yang Sun
- Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Jichao Liu
- Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Weibo Jiang
- Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Chao Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, PR China
| | - Yichun Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, PR China
| | - Yanguo Qin
- Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Jincheng Wang
- Orthopedic Medical Center, The Second Hospital of Jilin University, Changchun, Jilin, PR China
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Dragosloveanu S, Petre MA, Cretu B, Mihailescu AA, Cergan R, Scheau C. Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective. Cureus 2024; 16:e55263. [PMID: 38425332 PMCID: PMC10904024 DOI: 10.7759/cureus.55263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.
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Affiliation(s)
- Serban Dragosloveanu
- Department of Orthopaedics and Traumatology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Mihnea-Alexandru Petre
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Bogdan Cretu
- Department of Orthopaedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Alexandra Ana Mihailescu
- Department of Anesthesiology and Critical Care, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Romica Cergan
- Department of Anatomy, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
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Kim SE, Ro DH, Lee MC, Cholewa JM. Early- to Mid-Term Review of a Prospective, Multi-Center, International, Outcomes Study of an Anatomically Designed Implant with Posterior-Stabilized Bearing in Total Knee Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2105. [PMID: 38138207 PMCID: PMC10744842 DOI: 10.3390/medicina59122105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: National joint registries report higher total knee arthroplasty (TKA) revision rates in posterior-stabilized (PS) systems compared to non-posterior-stabilized designs. The purpose of this study was to investigate the implant survivorship and clinical outcomes of an anatomic implant with a PS bearing. Materials and Methods: An early- to mid-term follow-up of a prospective, multi-center, non-controlled outcomes study of patients who received primary TKA between November 2014 and June 2017 was performed. A total of 800 cases using PS bearings that were implanted in 664 patients were monitored post-operatively for their implant survivorship and adverse events for up to five years. The Knee Society Knee and Function scores, patient satisfaction, the five-dimensional European Quality of Life questionnaire, and range of motion (ROM) were evaluated pre-operatively and post-operatively at six weeks, six months, one year, two years, three years, and five years. Results: The mean follow-up period was 3.7 ± 1.3 years, and the three-year implant survival rate was 99.3% (95% CI: 98.4%, 99.7%) with five revisions during the five-year follow-up. Patient satisfaction was 96.1% at six weeks and increased to 99.3% at one year. All patient-reported outcome measures significantly (p < 0.0001) increased up to the one-year follow-up and then remained stable up to the five-year follow-up. Conclusions: This study supports the excellent survivorship and patient-reported outcomes of the Persona® Knee system using cemented, fixed bearing, posterior-stabilized components with minimal complications at early- to mid-term follow-up in an international Asian population. Ongoing observations are being performed to investigate the mid- to long-term survivorship and clinical outcomes associated with this knee system.
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Affiliation(s)
- Sung Eun Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jon Gno-Gu, Seoul 03080, Republic of Korea; (S.E.K.); (M.C.L.)
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jon Gno-Gu, Seoul 03080, Republic of Korea; (S.E.K.); (M.C.L.)
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-Ro, Jon Gno-Gu, Seoul 03080, Republic of Korea; (S.E.K.); (M.C.L.)
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Perez B, Koressel J, Cohen JS, Kirchner GJ, Kerbel YE, Lee GC. Why and What Happens to Patients Younger Than 60 Years Who Need Revision Total Knee Arthroplasty? J Arthroplasty 2023; 38:2404-2409. [PMID: 37196731 DOI: 10.1016/j.arth.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND With the increasing number of young patients undergoing primary total knee arthroplasty (TKA), there will be an increase in the number of patients who require revision. While the results of TKA in younger patients are well known, there is little information regarding to the outcomes of revision TKA in this population. The purpose of this study was to evaluate the clinical outcomes in patients <60 years of age undergoing aseptic revision TKA. METHODS We retrospectively reviewed 433 patients undergoing aseptic revision TKA between 2008 and 2019. There were 189 patients <60 years compared to a group of 244 patients >60 years undergoing revision TKA for aseptic failures in terms of implant survivorships, complications, and clinical outcomes. Patients were followed for a mean of 48 months (range, 24 to 149). RESULTS A total of 28 (14.8%) patients less than 60 years of age required repeat revision compared to 25 (10.2%) 60 years or older (odds ratio (OR) 1.94, 95% confidence interval (CI) 0.73-5.22, P = .187). There were no differences regarding postprocedural Patient-Reported Outcomes Measurement Information System (PROMIS) physical health scores (72.3 ± 13.7 versus 72.0 ± 12.0, P = .66) and PROMIS mental health scores (66.6 ± 17.4 versus 65.8. ± 14.7, P = .72), at an average of 32.9 and 30.7 months, respectively. Postoperative infection occurred in 3 (1.6%) patients <60 years of age, while 12 (4.9%) postoperative infections occurred in patients 60 years or older (OR 0.75, 95% CI 0.06-10.2, P = .83). CONCLUSION There were no statistically significant differences in clinical outcomes between patients <60 versus > 60 years of age undergoing aseptic revision TKA.
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Affiliation(s)
- Brian Perez
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph Koressel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan S Cohen
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory J Kirchner
- Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Yehuda E Kerbel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gwo-Chin Lee
- Hospital for Special Surgery, New York, New York
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Yuste I, Luciano FC, Anaya BJ, Sanz-Ruiz P, Ribed-Sánchez A, González-Burgos E, Serrano DR. Engineering 3D-Printed Advanced Healthcare Materials for Periprosthetic Joint Infections. Antibiotics (Basel) 2023; 12:1229. [PMID: 37627649 PMCID: PMC10451995 DOI: 10.3390/antibiotics12081229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
The use of additive manufacturing or 3D printing in biomedicine has experienced fast growth in the last few years, becoming a promising tool in pharmaceutical development and manufacturing, especially in parenteral formulations and implantable drug delivery systems (IDDSs). Periprosthetic joint infections (PJIs) are a common complication in arthroplasties, with a prevalence of over 4%. There is still no treatment that fully covers the need for preventing and treating biofilm formation. However, 3D printing plays a major role in the development of novel therapies for PJIs. This review will provide a deep understanding of the different approaches based on 3D-printing techniques for the current management and prophylaxis of PJIs. The two main strategies are focused on IDDSs that are loaded or coated with antimicrobials, commonly in combination with bone regeneration agents and 3D-printed orthopedic implants with modified surfaces and antimicrobial properties. The wide variety of printing methods and materials have allowed for the manufacture of IDDSs that are perfectly adjusted to patients' physiognomy, with different drug release profiles, geometries, and inner and outer architectures, and are fully individualized, targeting specific pathogens. Although these novel treatments are demonstrating promising results, in vivo studies and clinical trials are required for their translation from the bench to the market.
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Affiliation(s)
- Iván Yuste
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
| | - Francis C. Luciano
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
| | - Brayan J. Anaya
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
| | - Pablo Sanz-Ruiz
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, 28029 Madrid, Spain;
- Department of Surgery, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Almudena Ribed-Sánchez
- Hospital Pharmacy Unit, Hospital General Universitario Gregorio Marañón, 28029 Madrid, Spain;
| | - Elena González-Burgos
- Department of Pharmacology, Pharmacognosy and Botany, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
| | - Dolores R. Serrano
- Pharmaceutics and Food Technology Department, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain; (I.Y.); (F.C.L.); (B.J.A.); (D.R.S.)
- Instituto Universitario de Farmacia Industrial, Faculty of Pharmacy, Universidad Complutense de Madrid (UCM), 28040 Madrid, Spain
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Central Sensitization Is Associated with Inferior Patient-Reported Outcomes and Increased Osteotomy Site Pain in Patients Undergoing Medial Opening-Wedge High Tibial Osteotomy. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121752. [PMID: 36556954 PMCID: PMC9783071 DOI: 10.3390/medicina58121752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Studies have shown that centrally sensitized patients have worse clinical outcomes following total knee arthroplasty (TKA) than non-centrally sensitized patients. It is unclear whether central sensitization (CS) affects patient-reported outcomes (PROs) and/or level of osteotomy site pain in patients undergoing medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether CS is associated with PROs and osteotomy site pain following MOWHTO. Materials and Methods: A retrospective evaluation was conducted on 140 patients with varus knee osteoarthritis (OA) who were treated with MOWHTO and monitored for two years. Before surgery, the Central Sensitization Inventory (CSI) was used to assess CS status, and a CSI of 40 or higher was considered indicative of CS. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and pain visual analogue scale (VAS) were used to assess PROs. The minimal clinically important difference (MCID) for the WOMAC was set as 4.2 for the pain subscore, 1.9 for the stiffness subscore, 10.1 for the function subscore, and 16.1 for the total based on the results of a previous study. The WOMAC score, pain VAS score of the osteotomy site, and the achievement rates of WOMAC MCID were compared between the CS and non-CS groups. Results: Thirty-seven patients were assigned to the CS group, whereas 84 were assigned to the non-CS group. Before surgery, the CS group showed a higher WOMAC score than the non-CS group (58.7 vs. 49.4, p < 0.05). While there was a statistically significant improvement in WOMAC subscores (pain, stiffness, function, and total) for both groups at two years after surgery (all p < 0.05), the CS group had a higher WOMAC score than the non-CS group (37.1 vs. 21.8, p < 0.05). The CS group showed significantly inferior results in pre- and postoperative changes of WOMAC subscores (pain, function, and total) relative to the non-CS group (all p < 0.05). In addition, pain at the osteotomy site was more severe in the CS group than in the non-CS group at two years after surgery (4.8 vs. 2.2, p < 0.05). Patients with CS had worse MCID achievement rates across the board for WOMAC pain, function, and total scores (all p < 0.05) compared to the non-CS group. Conclusions: Centrally sensitized patients following MOWHTO had worse PROs and more severe osteotomy site pain compared to non-centrally sensitized patients. Furthermore, the WOMAC MCID achievement rate of patients with CS was lower than that of patients without CS. Therefore, appropriate preoperative counseling and perioperative pain management are necessary for patients with CS undergoing MOWHTO. Level of Evidence: Level III, case-control study.
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Supreeth S, Yukata K, Suetomi Y, Yamazaki K, Sakai T, Fujii H. Optimal intraoperative medial joint gap in extension to prevent flexion contracture following total knee arthroplasty using modified gap balancing technique. J Clin Orthop Trauma 2022; 33:101992. [PMID: 36089993 PMCID: PMC9450135 DOI: 10.1016/j.jcot.2022.101992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary aim to identify the ideal medial joint gap in extension needed to prevent post-operative flexion contracture following total knee arthroplasty (TKA) in varus osteoarthritic knees by the modified gap balancing technique. A secondary aim was to analyze multiple factors that influence knee extension in TKA by modified gap balancing. METHODS This is a prospective cohort study of 150 patients diagnosed with osteoarthritic varus knee who underwent TKA using the modified gap balancing technique. Operative and clinical records were assessed to determine factors including age, BMI (Body mass index), pre-operative extension angle and the medial extension laxity. Patients were followed for 6-months post-operatively and reviewed for knee extension angle. RESULTS Six months final follow-up information was available for 148 patients with an average age of 75.5 years. Pre-operative knee extension and BMI were significantly associated with post-operative knee extension. Post-operative flexion contracture of ≧ 100 was not seen in any of 34 patients with a medial extension laxity ≧ 0 mm who had no pre-existing flexion contracture, and in 1/9 (11.1%) patients with a medial extension laxity ≧ 1 mm who had pre-existing flexion contracture. CONCLUSIONS Pre-operative extension angle and BMI significantly influence the post-operative knee extension angle in TKA using the modified gap balancing technique. A medial extension laxity of at least 1 mm is ideally needed to prevent post-operative flexion contracture in patients with a pre-existing contracture ≧ 100. LEVEL OF EVIDENCE Level II; Prospective cohort study.
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Affiliation(s)
- Sam Supreeth
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Kiminori Yukata
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Yutaka Suetomi
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Kazuhizo Yamazaki
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Hiroshi Fujii
- Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, Ogori Daiichi General Hospital, 839-1 Ogori-shimogo, Yamaguchi, 754-0002, Japan
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UCPUNAR H, CAMURCU Y, BUYUK AF, AYDIN A, TAS SK, SAHIN V. Comparison of Contemporary Surgical Indications for Revision Total Knee Arthroplasty between 2005-2011 and 2012-2017 in a Referral Center. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:32-37. [PMID: 35291248 PMCID: PMC8889433 DOI: 10.22038/abjs.2021.47457.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/03/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Different causative factors for revision total knee arthroplasty (TKA) surgeries are elucidated in the arthroplasty registry data of different countries and the patient records at tertiary care centers. We aimed to determine the changes in the causes for revision TKAs before and after 2011 (The year that the Musculoskeletal Infection Society proposed a new definition for periprosthetic joint infection) and the changes in the demographics of patients who underwent revision TKAs during the same time intervals. METHODS Patients who underwent revision TKAs between 2004 and 2017 were evaluated. A total of 291 patients operated before (period 1, n = 139) and after (period 2, n = 152) 2011 were included, while 53 patients with inconclusive diagnoses were excluded. The demographic data of patients and the causes for revision TKAs were collected and compared between the two periods. RESULTS Infection was the most common cause of revision TKAs during periods 1 (58%) and 2 (48%). Aseptic loosening (46%) and infection (37%) were the 2 most common causes for late revisions during period 2. Aseptic loosening almost doubled during period 2 compared with that in period 1. Age, sex, and body mass index distribution in patients were similar across both the periods. CONCLUSION Although the incidence of aseptic loosening has significantly increased since 2011, infection is still the most common cause for revision knee arthroplasty surgery.
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Affiliation(s)
- Hanifi UCPUNAR
- Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Yalkin CAMURCU
- Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Abdul Fettah BUYUK
- Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Abdurrahman AYDIN
- Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Suleyman Kasim TAS
- Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
| | - Vedat SAHIN
- Department of Orthopedics and Traumatology, Erzincan University Faculty of Medicine, Erzincan, Turkey
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11
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Na BR, Kwak WK, Lee NH, Song EK, Seon JK. Trend Shift in the Cause of Revision Total Knee Arthroplasty over 17 Years. Clin Orthop Surg 2022; 15:219-226. [PMID: 37008971 PMCID: PMC10060782 DOI: 10.4055/cios21106] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/24/2021] [Accepted: 12/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background The number of revision total knee arthroplasty (TKA) has been increasing. Although many studies have analyzed the causes of revision TKA in Western countries, a limited number of studies have analyzed changes in causes of or trends in revision TKA in Asia. This study analyzed and determined the frequency and causes of failures after TKA in our hospital. We also analyzed the differences and trends over the past 17 years. Methods A total of 296 revision TKAs performed in a single institution from 2003 to 2019 were analyzed. During the 17-year study period, patients who had undergone primary TKA between 2003 and 2011 were classified into a past group, while those who had undergone primary TKA from 2012 to 2019 were classified into a recent group. A revision performed within 2 years after primary TKA was defined as early revision. Further, differences in causes of revision TKA according to the interval from primary TKA to revision TKA were determined. The causes of revision TKA were analyzed through a comprehensive analysis of patients' medical records. Results Overall, infection was the most common cause of failure (151/296 cases, 51.0%). Compared to the past group, the recent group had a relatively higher proportion of patients undergoing revision TKA for mechanical loosening (past group, 19.1% vs. recent group, 31.9%) and instability (11.2% vs. 13.5%) and a relatively lower proportion of patients undergoing revision TKA for infection (56.2% vs. 48.8%), polyethylene (PE) wear (9.0% vs. 2.9%), osteolysis (2.2% vs. 1.9%), and malalignment (2.2% vs. 1.0%). On comparison according to the interval from primary TKA to revision TKA, the rate of infection relatively decreased, whereas the rate of mechanical loosening and instability relatively increased in the late revision TKA compared to the early revision TKA. Conclusions Infection and aseptic loosening were the most common reasons of revision TKA in both past and recent groups. Compared to the past, revision TKA due to PE wear has decreased significantly and revision TKA due to mechanical loosening has relatively increased recently. Orthopedic surgeons need to be aware of recent trends in mechanisms of failure and should try to recognize and address the probable causes in TKA.
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Affiliation(s)
- Bo-Ram Na
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Woo-Kyoung Kwak
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Nam-Hun Lee
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Eun-Kyoo Song
- Department of Orthopedic Surgery, Segyero Hospital, Gwangju, Korea
| | - Jong-Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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12
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Cooper AM, Connolly K, Penna S, Parvizi J. Evaluation and Management of a Painful Knee After Total Knee Arthroplasty. Orthopedics 2021; 44:341-352. [PMID: 34618636 DOI: 10.3928/01477447-20211001-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pain after total knee arthroplasty (TKA) is not infrequent and may be indicative of a broad spectrum of prosthesis-related, intra-articular, or extra-articular pathologies. To diagnose and treat the underlying cause of a painful TKA, systematic evaluation of the patient is critical to ensure that they are managed appropriately and expeditiously. This evidence-based review presents current concepts regarding the pathophysiology, etiology, and diagnosis of painful TKA and our recommended approach for management. [Orthopedics. 2021;44(6):341-352.].
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13
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Gkiatas I, Xiang W, Nocon AA, Youssef MP, Tarity TD, Sculco PK. Heterotopic Ossification Negatively Influences Range of Motion After Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:2907-2912. [PMID: 33840538 DOI: 10.1016/j.arth.2021.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of heterotopic ossification (HO) after total knee arthroplasty (TKA) varies and is of unclear clinical significance. This study aimed to identify the incidence of HO in patients undergoing revision TKA for either stiffness or aseptic loosening/instability and determine if the presence of HO is associated with inferior absolute range of motion (ROM) and ROM gains. METHODS Eighty-seven patients were prospectively enrolled and separated into 2 cohorts to evaluate ROM after revision TKA (2017-2019). Group 1 (N = 40) patients were revised for stiffness, while group 2 (N = 47) patients were revised for either aseptic loosening or instability. Goniometer-measured ROM values were obtained preoperatively and at 6 weeks, 6 months, and 1 year postoperatively. Statistical analysis included a Fisher's exact test to assess for an association between preoperative HO and final ROM at 1 year after revision TKA. RESULTS HO was identified on preoperative radiographs in 17 patients (20%). There was a significantly higher rate of preoperative HO in patients revised for stiffness compared to patients revised for instability or loosening (30% vs 11%; P = .03). Five cases of HO qualitatively identified as most clinically severe were associated with lower ROM at each time point compared to the remainder of HO cases in this study cohort (P < .02). CONCLUSION The presence of HO is greater in patients undergoing revision TKA for stiffness. Additionally, HO severity appears to have a major effect on preoperative and postoperative ROM trajectory. This information should help guide patient expectations and highlight the need for a comprehensive, standardized classification system for HO.
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Affiliation(s)
- Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - William Xiang
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Allina A Nocon
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Mark P Youssef
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - T David Tarity
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
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14
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Malahias MA, Gu A, Richardson SS, De Martino I, Mayman DJ, Sculco TP, Sculco PK. Association of Lumbar Degenerative Disease and Revision Rate following Total Knee Arthroplasty. J Knee Surg 2021; 34:1126-1132. [PMID: 32074655 DOI: 10.1055/s-0040-1701651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Recently, a variety of studies have analyzed the potential correlation between lumbar degenerative disease (LDD) and inferior clinical outcomes after total hip arthroplasty. However, there has been limited data concerning the role of LDD as a risk factor for failure after total knee arthroplasty (TKA). The aim of our study was to determine: (1) what is the association of LDDs with TKA failure (all-cause revision) within 2 years of index arthroplasty and (2) if patients with LDD and lumbar fusion are at increased risk of TKA revision within 2 years compared with LDD patients without fusion. Data were collected from the Humana insurance database using the PearlDiver database from 2007 to 2017. To assess aim 1, patients were stratified into two groups based on a prior history of LDD (International Classification of Diseases [ICD]-9 or -10 diagnostic codes). To analyze aim 2, patients within the LDD cohort were stratified based on the presence of lumbar fusion (lumbar fusion Current Procedural Terminology code). All-cause revision rate was 3.4% among LDD patients versus 2.4% of patients with non-LDD (p < 0.001) at 2 years. Following multivariate analysis, LDD patients were at increased risk of all-cause revision surgery at 2 years (odds ratio [OR]: 1.361; 95% confidence interval [CI]: 1.238-1.498; p < 0.001) as well as aseptic loosening (OR: 1.533; 95% CI: 1.328-1.768; p < 0.001), periprosthetic joint infection (OR: 1.245; 95% CI: 1.129-1.373; p < 0.001), and periprosthetic fracture (OR: 1.521; 95% CI: 1.229-1.884; p < 0.001). Among LDD patients, patients who have a lumbar fusion had an all-cause revision rate of 5.0%, compared with 3.2% among LDD with no lumbar fusion patients at 2 years (p = 0.021). Following multivariate analysis, lumbar fusion patients were at increased risk of all-cause revision surgery (OR: 1.402; 95% CI: 1.362-1.445; p = 0.028), aseptic loosening (OR: 1.432; 95% CI: 1.376-1.489; p = 0.042), and periprosthetic fracture (OR: 1.302; 95% CI: 1.218-1.392; p = 0.037). Based on these findings, TKA candidates with preoperative LDD should be counseled that TKA outcome may be impaired by the coexistence of lumbar spine degenerative disease. This is Level III therapeutic study.
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Affiliation(s)
- Michael-Alexander Malahias
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Alex Gu
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Shawn S Richardson
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Ivan De Martino
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Thomas P Sculco
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
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Christopher ZK, McQuivey KS, Deckey DG, Haglin J, Spangehl MJ, Bingham JS. Acute or chronic periprosthetic joint infection? Using the ESR ∕ CRP ratio to aid in determining the acuity of periprosthetic joint infections. J Bone Jt Infect 2021; 6:229-234. [PMID: 34159047 PMCID: PMC8209584 DOI: 10.5194/jbji-6-229-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/31/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction: The gold standard for determining the duration of periprosthetic joint infection (PJI) is a thorough history. Currently, there are no well-defined objective criteria to determine the duration of PJI, and little evidence exists regarding the ratio between ESR (mm/h) and CRP (mg/L) in joint arthroplasty. This study suggests the ESR / CRP ratio will help differentiate acute from chronic PJI. Methods: Retrospective review of patients with PJI was performed. Inclusion criteria: patients > 18 years old who underwent surgical revision for PJI and had documented ESR and CRP values. Subjects were divided into two groups: PJI for greater (chronic) or less than (acute) 4 weeks and the ESR / CRP ratio was compared between them. Receiver-operating characteristic (ROC) curves were evaluated to determine the utility of the ESR / CRP ratio in characterizing the duration of PJI. Results: 147 patients were included in the study (81 acute and 66 chronic). The mean ESR / CRP ratio in acute patients was 0.48 compared to 2.87 in chronic patients ( p < 0.001 ). The ESR / CRP ROC curve demonstrated an excellent area under the curve (AUC) of 0.899. The ideal cutoff value was 0.96 for ESR / CRP to predict a chronic ( > 0.96 ) vs. acute ( < 0.96 ) PJI. The sensitivity at this value was 0.74 (95 % CI 0.62-0.83) and the specificity was 0.90 (95 % CI 0.81-0.94). Conclusions: The ESR / CRP ratio may help determine the duration of PJI in uncertain cases. This metric may give arthroplasty surgeons more confidence in defining the duration of the PJI and therefore aid in treatment selection.
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Affiliation(s)
| | - Kade S McQuivey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - David G Deckey
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Jack Haglin
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mark J Spangehl
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Joshua S Bingham
- Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
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16
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Röhner E, Heinecke M, Matziolis G. Diagnostic algorithm in aseptic TKA failure - What is evidence-based? J Orthop 2021; 24:248-253. [PMID: 33854292 PMCID: PMC8039505 DOI: 10.1016/j.jor.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. Röhner
- Corresponding author. Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | | | - G. Matziolis
- Orthopaedic Department of the Waldkliniken Eisenberg, University Hospital Jena, 07607, Eisenberg, Germany
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17
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Mathis DT, Hirschmann MT. Why do knees after total knee arthroplasty fail in different parts of the world? J Orthop 2021; 23:52-59. [PMID: 33456216 PMCID: PMC7797486 DOI: 10.1016/j.jor.2020.12.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE The aim of this narrative review was to provide an overview of failure modes after total knee arthroplasty in different parts of the world based on data from worldwide representative studies and National Joint Registries. METHODS A review of the available literature was performed using the keyword terms "total knee arthroplasty", "revision", "failure", "reasons", "causes", "complications", "epidemiology", "etiology"; "assessment", "painful knee", "registry" and "national" in several combinations. The following databases were assessed: Pubmed (https://pubmed.ncbi.nlm.nih.gov), Cochrane Reviews (https://www.cochrane.org), Google Scholar (https://scholar.google.com). In addition, registry data were obtained directly from national registry archives. Due to the heterogeneity of available data it was decided to present the review in a narrative manner. RESULTS Current literature report that infection has become the primary acute cause of TKA failure, while aseptic loosening and instability remain the overall most frequent reasons for revisions. Based on national registries certain tendencies can be deducted. The predominant overall failure mode of aseptic loosening is particularly found in Japan, United Kingdom, New Zealand and Switzerland. Leading early TKA failure mode represents infection with percentages of 20-30% in Sweden, Australia, New Zealand, Japan and the United States. Higher numbers could only be found in clinical studies on the Asian continent such as Korea (38%), China (53%), Iran (44%) and India (87%). CONCLUSION Although there are regional differences in TKA failure modes, TKA fails worldwide especially due to infections and aseptic loosening. It is important to diagnose these in good time and reliably using appropriate, standardized diagnostics in order to recommend the best possible therapy to the patient.
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Affiliation(s)
- Dominic T. Mathis
- University of Basel, CH-4051, Basel, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
| | - Michael T. Hirschmann
- University of Basel, CH-4051, Basel, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), CH-4101, Bruderholz, Switzerland
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18
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Reasons for failure in primary total knee arthroplasty - An analysis of prospectively collected registry data. J Orthop 2020; 23:60-66. [PMID: 33456217 DOI: 10.1016/j.jor.2020.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
Objective The aim of this study was to determine the causes leading to a first revision of primary total knee arthroplasty (TKA) in a specialized knee centre and compare the results with previously published data. Methods Prospectively collected data of a consecutive number of 195 patients after primary TKA and who underwent first revision surgery after completing the diagnostic algorithm for persistent knee pain were included. Data was prospectively collected from a specialized knee centre in which the patients presented between 2015 and 2020 and retrospectively analysed. Indications for revision surgery were categorized using all available information from patients' records. Patients were divided into early (up to two years) and late revision (more than two years). Results Overall mean time from index to revision surgery was 3.6 years. 49% of knee revisions occurred in the first two years, 51% after two years. 86% of the patients were referred to the knee centre from other surgeons. The most frequent reason for revision was instability, followed by patellofemoral problems, extensor mechanism insufficiency and malalignment. The most frequently performed revision was complete removal and re-implantation of a semi constrained implant design (52.5%) followed by revision using a full constrained implant design (16%). Secondary patella-resurfacing as part of complete revision was carried out in 71.5% of the cases. The majority of the patients showed concurrent reasons for TKA failure with significant correlations amongst another. Furthermore, correlations were identified between indications for revision surgery and revision implant designs. Conclusion In a specialized knee centre the most common indications for the first TKA revision were instability and patellofemoral and/or extensor mechanism insufficiency followed by malalignment. In most patients there was not only one failure mode, but a combination of many. It is important to establish a standardized diagnostic algorithm to facilitate comprehensive and efficient diagnostics and the optimal treatment.
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Tang H, Li H, Zhang S, Wang Y, Qu X, Yue B. Postoperative Complications Causing Readmission in 30 Days after Total Knee Arthroplasty: A Retrospective Nested Case-Control Study of Risk Factors Based on Propensity Score Matching. J Knee Surg 2020; 33:1100-1108. [PMID: 31357222 DOI: 10.1055/s-0039-1692630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We performed this study to identify independent risk factors for life-threatening postoperative complications causing 30-day readmissions after total knee arthroplasty (TKA). Improved understanding of these risks may improve efficiency and safety of treatment. We performed a retrospective, nested case-control study using an open-access database of 2,622 patients who underwent primary TKA at a tertiary academic medical center in Singapore between January 2013 and June 2014. Patients were grouped according to the incidence of complications. Multivariate logistic analysis was performed to identify predictive factors for TKA complications. The incidence of postoperative complications was 1.72%. Compared with cases performed with an operative time < 70 minutes, increased operative time was associated with a higher risk of complications. Case duration > 90 minutes was associated with an increased risk (adjusted odds ratio [aOR] = 4.57, p = 0.001; case duration ≥ 111 minutes, aOR = 4.64, p = 0.04; and case duration between 91 and 110 minutes, aOR = 3.20, p = 0.03). The correlation between operative time and complications was nonlinear. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) was an independent risk factor for increased complication rate (aOR = 11.59, p = 0.02). Operative duration has been identified as an independent risk factor for complications after TKA. As it remains a modifiable factor to which doctors are interested in bringing quality improvement, the risk of postoperative complications will be reduced by minimizing the operative duration.
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Affiliation(s)
- Haozheng Tang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People's Republic of China
| | - Hui Li
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People's Republic of China
| | - Shutao Zhang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People's Republic of China
| | - You Wang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People's Republic of China
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People's Republic of China
| | - Bing Yue
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People's Republic of China
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20
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Malahias MA, Jang SJ, Gu A, Richardson SS, Chen AZ, Rao RD, Sculco PK. Cervical spine degenerative disease is an independent risk factor for increased revision rate following total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:511-516. [PMID: 33026564 DOI: 10.1007/s00590-020-02799-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The relationship between cervical degenerative pathology and total knee arthroplasty (TKA) revision rates is not well understood. The aim of the study was to determine whether cervical spine degenerative diseases have a role in complications following TKA within 2 years. METHODS Data were collected from the Humana insurance database using the PearlDiver Patient Records Database from 2007-2017. Patients who had a primary TKA were identified using Current Procedural Terminology (CPT) code 27,447, and patients with degenerative cervical disease were identified using CPT and International Classification of Diseases (ICD) codes. Data on patients' demographics, comorbidities and postoperative complications were recorded and analyzed with univariate and multivariate analysis with significance set at p < 0.05. A Kaplan-Meier analysis was conducted to estimate the 1- and 2-year rates of survival free from revision. RESULTS A total of 81,873 patients were included in this study. Following multivariate analysis, cervical spine degenerative disease patients were at increased risk of all-cause revision surgery following 1 year (OR: 1.342 95% CI: 1.149-1.569; p < 0.001) and 2 year (OR: 1.338; 95% CI: 1.184-1.512; p < 0.001). At 2 years, patients with cervical spine degenerative disease had a survival rate of 97.7%, while the survival rate was 99.2% among the non-cervical degenerative cohort. CONCLUSIONS Based on these results, patients with cervical spine degenerative pathology should be counseled that their spinal pathology may impair outcomes following TKA.
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Affiliation(s)
- Michael-Alexander Malahias
- Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Seong J Jang
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Alex Gu
- Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.,Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Shawn S Richardson
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Aaron Z Chen
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Raj D Rao
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
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Lee HJ, Kim SH, Park YB. Selective medial release using multiple needle puncturing with a spacer block in situ for correcting severe varus deformity during total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:1523-1531. [PMID: 32519075 DOI: 10.1007/s00402-020-03510-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/31/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We aimed to establish a selective and sequential medial release technique using multiple needle puncturing (MNP) with a spacer block in situ in severe varus deformity during total knee arthroplasty (TKA) and to investigate its efficacy and safety. MATERIALS AND METHODS A total of 128 patients with a varus angle >15° were included. Patients were classified according to the tightness of extension and flexion (group 1, no tightness; group 2, extension; group 3, flexion; group 4, extension and flexion). When medial tightness was found on extension, the posterior clearing procedure, including release of the posterior capsule, posterior oblique ligament, and semimembranosus, was performed sequentially. When medial tightness was found on flexion, MNP using an 18-gauge needle with a spacer block in situ was performed at the anterior portion of the superficial MCL (aMCL). Clinical and radiological evaluations including stress radiographs were performed. RESULTS Among 128 knees, 110 required medial release (posterior clearing procedure only in 44 [34.3%], MNP with a spacer block in situ at aMCL only in 38 [29.7%], posterior clearing procedure and MNP in 28 [21.9%]). The mediolateral gap imbalances on extension and/or flexion were significantly improved (p < 0.001 in all). There were no significant differences in clinical radiological outcomes among groups. Over-release, iatrogenic transection, and postoperative laxity on the stress radiographs were not observed. CONCLUSION The selective and sequential technique using posterior clearing and/or MNP with a spacer block in situ can be a reliable option for managing medial tightness in severe varus deformity during primary TKA.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, 21 Bonghyeon-ro, Jinjeop-eup, Namyangju-si, 12013, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
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Mell SP, Wimmer MA, Lundberg HJ. Sensitivity of total knee replacement wear to variability in motion and load input: A parametric finite element analysis study. J Orthop Res 2020; 38:1538-1549. [PMID: 32458460 PMCID: PMC9595431 DOI: 10.1002/jor.24755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/30/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
Polyethylene wear remains a contributor to long term failure in total knee replacements (TKRs). Advances in materials have improved polyethylene wear rates, therefore further wear reductions require a better understanding of patient-specific factors that lead to wear. Variability of gait within patients is considerable and could lead to significant variability in wear rates that cannot be predicted by standard testing methods. An in-silico study was performed to investigate the influence of gait variability on TKR polyethylene wear. Nine characteristic peaks within the load and motion profiles used for TKR wear testing were varied 75% to 125% from baseline (ISO-14243-3:2014) to generate 310 unique waveforms. Wear was calculated for 1-million cycles using a finite element TKR wear model. From the results, a surrogate model was developed using multiple linear regression, and used to predict how wear changes due to dispersion of motion and force peaks within a) ±5%, the maximum allowable input tolerance of ISO, and b) ±25%, more reflective of patient gait inter-variability. The range of wear within the ±5% tolerance was 0.65 mm3 /million cycles and was 3.24 mm3 /million cycles within the ±25% variability more in line with the dispersion observed within patients. Although no one kinematic or kinetic peak dominated variability in TKR volumetric wear, variability within flexion/extension peaks were the largest contributor to wear rate variability. Interaction between the peaks of different waveforms was also important. This study, and future studies incorporating patient-specific data, could help to explain the connection between patient-specific gait factors and wear rates.
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Song SJ, Lee HW, Bae DK, Park CH. High Incidence of Tibial Component Loosening After Total Knee Arthroplasty Using Ceramic Titanium-Nitride-Coated Mobile Bearing Prosthesis in Moderate to Severe Varus Deformity: A Matched-Pair Study Between Ceramic-Coated Mobile Bearing and Fixed Bearing Prostheses. J Arthroplasty 2020; 35:1003-1008. [PMID: 31859013 DOI: 10.1016/j.arth.2019.11.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We compared the incidence of aseptic component loosening and subsequent revision, and the survival rate between ceramic titanium-nitride-coated mobile bearing (MB) and fixed bearing total knee arthroplasties (TKAs) performed in patients with moderate to severe varus deformities. METHODS In total, 200 TKAs using advanced coated system posterior stabilized prostheses in varus deformity of mechanical axis >8° between 2012 and 2016 were retrospectively reviewed. One hundred MB (ceramic-m group) and 100 fixed bearing (ceramic-f group) prostheses were included. The matches were made according to preoperative demographics, range of motion, and severity of deformity. The mean follow-up period was not different (ceramic-m vs ceramic-f = 4.8 vs 5.1 years; P = .104). The incidence of revision TKA due to aseptic component loosening and the survival rate (failure: revision due to aseptic loosening) was investigated. RESULTS The incidence of revision TKA due to aseptic component loosening was 7 (7%) in the ceramic-m group and 1 (1%) in the ceramic-f group (P = .032). All cases of aseptic loosening occurred at the tibial component. The overall survival rate was 91.3% in the ceramic-m group and 98.9% in the ceramic-f group (P = .025). CONCLUSION Considering the higher revision incidence and lower survival rate due to tibial component loosening, caution should be taken in tibial component fixation when using advanced coated system MB prosthesis in moderate to severe varus deformity. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, South Korea
| | - Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
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Oliver G, Jaldin L, Camprubí E, Cortés G. Observational Study of Total Knee Arthroplasty in Aseptic Revision Surgery: Clinical Results. Orthop Surg 2020; 12:177-183. [PMID: 31916370 PMCID: PMC7031607 DOI: 10.1111/os.12593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 11/12/2019] [Accepted: 11/19/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To review the long-term clinical results after revision surgery and the relationship between the different clinical variables involved with a failed total knee arthroplasty (TKA) and its evolution to provide a better understanding of the current treatment methods. METHODS The present study involved 89 subjects with a failed knee arthroplasty that ended up requiring revision surgery and component replacement between 2011 and 2015. The study included patients with pain remaining after TKA and indication from the knee unit surgeon to review the implant, without presenting with thromboembolic or neurological changes that could bias the results. The demographic data, surgical information, type of implant, and causes of failure were analyzed. The patients subjected to replacement surgery were specifically asked to fill out clinical and satisfaction questionnaires (Lysholm and KOOS). The mean follow-up was 5.6 years (range, 3-11 years) and the analysis was divided into early revision (<5 years) and late revision (>5 years). The R statistical package version 3.2.5 for Windows was used, with significance less than 0.05 Cohort observational study. RESULTS The results indicated that implant revisions accounted for 5.57% of total primary implants, with a mean survival of 6 years for primary prosthesis failure. The mean revision surgery result on the Lysholm knee scoring scale was 68.73 out of 100 points. A better score was obtained for revisions undertaken on TKA with over 5 years' survival and there were no significant differences in terms of the type of implant used. The causes of TKA failure were aseptic loosening (77.38%), instability (9.52%), and painful prosthesis (13.10%). The results were statistically significant when isolated revisions were performed on one component. Rating worse on most of the questionnaire subscales. CONCLUSION The clinical results were better in primary implant replacements with at least 5 years' survival. The replacement of only one of the components (tibial or femoral) provided worse clinical results than total replacement.
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Affiliation(s)
- Gabriel Oliver
- Orthopaedics Department, Head of Knee Unit, Barcelona, Spain
| | - Luis Jaldin
- Orthopaedics Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Eric Camprubí
- Orthopaedics Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Guillermo Cortés
- Orthopaedics Department, Hospital Universitario de Bellvitge, Barcelona, Spain
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25
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Lange JK, DiSegna ST, Yang W, Li W, Franklin PD. Using Cluster Analysis to Identify Patient Factors Linked to Differential Functional Gains After Total Knee Arthroplasty. J Arthroplasty 2020; 35:121-126.e6. [PMID: 31530461 DOI: 10.1016/j.arth.2019.08.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/28/2019] [Accepted: 08/15/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The basis of poor outcomes following total knee arthroplasty (TKA) is multifactorial. Previous research aimed at predicting outcome following TKA focuses largely on outcomes measured between two specific time points (pre-to post-TKA). Analysis of outcomes measured over multiple time points (trajectory) may expose relationships between patients' characteristics and longitudinal outcome patterns that may otherwise remain obscured. METHODS The current study analyzed Short Form 36 Physical Component Score (PCS) trajectories of 656 patients composed of 3 time points over a 1-year period. Clusters were constructed utilizing MultiExperiment Viewer hierarchical clustering algorithm. Statistical significance of these clusters was assessed using MeV's built-in bootstrapping method. Patient characteristics of the resulting statistically conserved clusters were summarized and compared using Wilcoxon rank-sum test or chi-squared test as appropriate. RESULTS Two distinct clusters of outcome trajectory were identified. Cluster 1 included 550 patients (84%) who demonstrated persistent PCS improvement at 6 and 12 months. Cluster 2 included 106 patients (16%) who demonstrated decline in PCS at 6 months followed by improvement at 12 months. Cluster 1 achieved earlier success, greater absolute mental and physical health scores as compared to Cluster 2 (P < .05), and demonstrated higher baseline mental health scores, lower baseline PCS, and a significantly higher proportion of non-Hispanic Whites (P ≤ .05). CONCLUSION Cluster analysis identified distinct functional outcome trajectories following TKA. Specific differentiating patient factors were associated with differing trajectories. Future studies should focus on this method's ability to inform predictive models regarding patient outcomes.
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Affiliation(s)
- Jeffrey K Lange
- Department of Orthopaedics, Brigham and Women's Hospital, Boston, MA; Department of Orthopaedics, University of Massachusetts Medical School, Worcester, MA
| | - Steven T DiSegna
- Department of Orthopaedics, University of Massachusetts Medical School, Worcester, MA
| | - Wenyun Yang
- Department of Orthopaedics, University of Massachusetts Medical School, Worcester, MA
| | - Wenjun Li
- Department of Orthopaedics, University of Massachusetts Medical School, Worcester, MA
| | - Patricia D Franklin
- Department of Orthopaedics, University of Massachusetts Medical School, Worcester, MA; Department of Medical Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
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Demcoe AR, Bohm ER, Hedden DR, Burnell CD, Turgeon TR. Does oxidized zirconium make a difference? Midterm cohort survivorship of symmetric posterior condyle posterior-stabilized total knee arthroplasty. Can J Surg 2019; 62:118-122. [PMID: 30907992 DOI: 10.1503/cjs.007518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background A novel symmetric posterior condylar design and option of a femoral component with an outer zirconium oxide layer were introduced to a successful asymmetric condylar total knee arthroplasty system in 2005. Given the paucity of information on this modified design, we performed a study to determine its early to midterm survivorship and performance. Methods Patients who received the Genesis II Symmetric Posterior Condyle or Legion Primary total knee (cobalt–chromium [CoCr] or oxidized zirconium–niobium [OxZr]) (Smith & Nephew) implanted at the study centre between March 2007 and
December 2013 were enrolled into a prospective database. We retrospectively reviewed the database and performed survival analysis using Kaplan–Meier techniques. Results There were 2178 patients (1359 women [62.4%]; mean age 64.6 yr; mean body mass index 35.0) with 2815 knee replacements available for analysis. Survival rates were 98.2% (95% confidence interval [CI] 97.6%–98.7%) for failure for any reason at 2 years and 96.8% (95% CI 96.0%–97.7%) at 5 years. Age (hazard ratio [HR] 0.97, 95% CI 0.94–0.997) and female sex (HR 0.45, 95% CI 0.27–0.75) were protective, whereas body mass index (HR 1.02, 95% CI 0.99–1.05) and OxZr implant (HR 1.11, 95% CI 0.57–2.18) did not influence survivorship. Oxford Knee Score values improved from a mean of 40.2 to 21.8 by 2 years (p < 0.001), with no difference between the CoCr and OxZr groups. Conclusion The symmetric posterior condylar posterior-stabilized knee offers excellent midterm survivorship. Implant bearing surface did not have an influence on survivorship to 5 years, and, thus, use of OxZr implants may not be justified.
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Affiliation(s)
- A. Ross Demcoe
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - Eric R. Bohm
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - David R. Hedden
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - Colin D. Burnell
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
| | - Thomas R. Turgeon
- From Kelowna Orthopedics, Kelowna, BC (Demcoe); and the Concordia Hip and Knee Institute, Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Bohm, Hedden, Burnell, Turgeon)
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Yoon JR, Ko SN, Jung KY, Lee Y, Park JO, Shin YS. Risk of Revision Following Total Knee Arthroplasty or High Tibial Osteotomy: A Nationwide Propensity-Score-Matched Study. J Bone Joint Surg Am 2019; 101:771-778. [PMID: 31045664 DOI: 10.2106/jbjs.18.00980] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND High tibial osteotomy (HTO) is often performed to postpone or avoid the need for subsequent total knee arthroplasty (TKA). We designed the present study to investigate the incidence rate and risk factors for subsequent revision in patients treated with HTO compared with those managed with TKA. METHODS In this retrospective nationwide cohort study, we reviewed the South Korean National Health Insurance claims database from January 1, 2009, to August 31, 2017. We evaluated patients ≥41 years old who had undergone TKA or HTO as the primary surgical procedure without a history of having undergone either procedure during the preceding 2 years. By including only new interventions without such prior surgery, we could eliminate the influence of previous TKA and HTO treatments. Multivariable logistic regression models were used to compare the risk of revision between the groups after propensity score matching with inverse probability of treatment weighting (IPTW). Revision was defined as conversion to revision TKA after primary TKA and conversion to TKA after HTO. RESULTS After applying the IPTW, a total of 436,538 patients with TKA and 452,724 patients with HTO were identified. The risk of revision during the entire study period was higher for patients with HTO than for patients with TKA (adjusted hazard ratio [HR], 2.47). The Kaplan-Meier 8-year survival was 97.8% in the TKA group and 91.5% in the HTO group. Compared with patients with TKA, patients with HTO had an increased risk of revision in cases of advanced age (HR of 1.85 for patients who were ≥61 to 69 years old and HR of 4.17 for those who were ≥70 years old), female sex (HR, 2.90), recipients of Medical Aid program benefits (HR, 4.77), the presence of hyperlipidemia (HR, 3.70), the presence of diabetes (HR, 4.86), and the presence of osteoporosis (HR, 3.53). However, younger patients with HTO (≤60 years old) had a lower risk of subsequent revision (HR, 0.64). CONCLUSIONS The risk of revision was higher for patients with HTO than for patients with TKA. The risk factors for subsequent revision in patients with HTO in our cohort of patients were advanced age (>60 years), female sex, receipt of Medical Aid, and the presence of comorbidities, such as diabetes, osteoporosis, and hyperlipidemia. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jung-Ro Yoon
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Seung-Nam Ko
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Kwang-Young Jung
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Young Lee
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Jae-Ok Park
- Department of Orthopedic Surgery (J.-R.Y. and S.-N.K.) and Medical Library (K.-Y.J., Y.L., and J.-O.P.), Veterans Health Service Medical Center, Seoul, South Korea
| | - Young-Soo Shin
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, South Korea
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Bottle A, Parikh S, Aylin P, Loeffler M. Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective. PLoS One 2019; 14:e0214855. [PMID: 30964880 PMCID: PMC6456180 DOI: 10.1371/journal.pone.0214855] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/21/2019] [Indexed: 12/30/2022] Open
Abstract
Aims To identify predictors of early revision (within 3 years of the index operation) for hip and knee replacement (HR, KR) from both surgeon and population perspectives. Patients and methods Hierarchical logistic regression on national administrative data for England for index procedures between April 2009 and March 2014. Results There were 315,273 index HR procedures and 374,530 index KR procedures for analysis. Three-year revision rates were 2.1% for HR and 2.2% for KR. The highest odds ratios for HR were for 3+ previous emergency admissions, drug abuse, Parkinson’s disease, resurfacing and ages under 60; for KR these were patellofemoral or partial joint replacement, 3+ previous emergency admissions, paralysis and ages under 60. Smaller effects were found for other comorbidities such as obesity (HR) and diabetes (KR). From a population perspective, the only population attributable fractions over 5% were for male gender, uncemented total hip replacements and partial knee or patellofemoral replacements. Conclusions Meeting the rising demand for revision surgery is a challenge for healthcare leaders and policymakers. Our findings suggest optimising patients pre-operatively and improving patient selection for primary arthroplasty may reduce the burden of early revision of arthroplasty. Our study gives useful information on the additional risks of various comorbidities and procedures, which enables a more informed consent process. Clinical relevance Surgeons should make patients with certain risk factors such as age and procedure type aware of their higher revision risk as part of shared decision-making.
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Affiliation(s)
- Alex Bottle
- Dr Foster Unit at Imperial College London, Department of Primary Care and Public Health, School of Public Health, London, United Kingdom
- * E-mail:
| | - Sunny Parikh
- Colchester General Hospital, Colchester, United Kingdom
| | - Paul Aylin
- Dr Foster Unit at Imperial College London, Department of Primary Care and Public Health, School of Public Health, London, United Kingdom
| | - Mark Loeffler
- Colchester General Hospital, Colchester, United Kingdom
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Suitability of Metal Block Augmentation for Large Uncontained Bone Defect in Revision Total Knee Arthroplasty (TKA). J Clin Med 2019; 8:jcm8030384. [PMID: 30893934 PMCID: PMC6462980 DOI: 10.3390/jcm8030384] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
This study was performed to determine whether metal block augmentation is suitable for large uncontained bone defect via evaluations of differences in biomechanical characteristics among the configurations of metal block augmentations for medium or large uncontained bone defects in revision total knee arthroplasty (TKA). Three-dimensional finite element (FE) models of the proximal tibia with revision TKA were developed and analyzed considering the configurations of the metal block augmentations for medium and large uncontained bone defects. To identify differences in biomechanical characteristics according to the configurations of metal block augmentations, the stress transfer, strain distribution, and peak von Mises stresses (PVMSs) were assessed. Large and medium uncontained bone defects had similar ranges of strain below the critical bone-damage strain for the metal block augmentations, but the strain distribution characteristics differed in response to the metal block-augmentation configurations. PVMSs exceeding the yield strength of the bone cement for the single metal block-augmentation configurations were, on average, 1.4 times higher than those for double metal block-augmentation configurations for both medium and large uncontained bone defects. These findings suggest that metal block augmentation may be suitable for large uncontained bone defects (≤20 mm), compared with the results obtained for metal block augmentation used in medium uncontained bone defects (≤10 mm). If possible, double metal block augmentation is recommended for both medium and large uncontained bone defects rather than single metal block augmentation. It is also recommended that the metal block augmentation should be customized to meet the contact characteristics with the cortical bone, thereby ensuring better stress transfer and reducing the risk of the bone resorption due to stress shielding and bone-cement failure.
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30
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Jorgensen NB, McAuliffe M, Orschulok T, Lorimer MF, de Steiger R. Major Aseptic Revision Following Total Knee Replacement: A Study of 478,081 Total Knee Replacements from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2019; 101:302-310. [PMID: 30801369 DOI: 10.2106/jbjs.17.01528] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Major revision is associated with less satisfactory outcomes, substantial complications, and added cost. Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) were analyzed to identify factors associated with major aseptic revision (MAR) of primary total knee replacement (TKR). METHODS The cumulative percent major aseptic revision rate following all primary TKRs performed in Australia from September 1, 1999, to December 31, 2015, was assessed. Kaplan-Meier estimates of survivorship were utilized to describe the time to first revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age and sex, were utilized to compare revision rates. RESULTS There were 5,973 MARs recorded from the total cohort of 478,081 primary TKRs. The cumulative percent MAR at 15 years was 3.0% (95% confidence interval [CI], 2.8% to 3.2%). Fixed bearings had a significantly lower rate of MAR at 15 years: 2.7% (95% CI, 2.4% to 2.9%) compared with 4.1% (95% CI, 3.8% to 4.5%) for mobile bearings (HR, 1.77 [95% CI, 1.68 to 1.86]; p < 0.001). Age had a significant effect on MAR rates, with a cumulative percent revision at 15 years for patients <55 years old of 7.8% (95% CI, 6.5% to 9.2%) compared with 1.0% for those ≥75 years old (95% CI, 0.8% to 1.1%; p < 0.001). Minimally stabilized TKR had a lower rate of MAR compared with posterior-stabilized TKR after 2 years (HR, 0.83 [95% CI, 0.77 to 0.90]; p < 0.001). Cementless fixation had a higher rate of revision than cemented or hybrid fixation. There was a higher rate of MAR with non-navigated compared with computer navigated TKR (HR, 1.32 [95% CI, 1.21 to 1.44], p < 0.001). The tibial component was revised more commonly than the femoral component. CONCLUSIONS Younger age, posterior stabilization, cementless fixation, a mobile bearing, and non-navigation were risk factors for higher rates of MAR following TKR. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicholas B Jorgensen
- Department of Orthopaedics, Ipswich General Hospital, Ipswich, Queensland, Australia
| | - Michael McAuliffe
- Department of Orthopaedics, Ipswich General Hospital, Ipswich, Queensland, Australia.,St Andrews Hospital, Ipswich, Queensland, Australia
| | - Thomas Orschulok
- Department of Orthopaedics, Ipswich General Hospital, Ipswich, Queensland, Australia
| | - Michelle F Lorimer
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Victoria, Australia.,Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
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Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, Jung H, In Y. Predictive factors for satisfaction after contemporary unicompartmental knee arthroplasty and high tibial osteotomy in isolated medial femorotibial osteoarthritis. Orthop Traumatol Surg Res 2019; 105:77-83. [PMID: 30509622 DOI: 10.1016/j.otsr.2018.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 09/28/2018] [Accepted: 11/13/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Both high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are viable treatment options for early osteoarthritis (OA). Although a substantial proportion of the patient selection criteria for HTO and UKA are now shared, the factors related to satisfaction following each procedure remain unclear. HYPOTHESIS We hypothesized that patient factors associated with satisfaction following contemporary HTO and UKA would be different. MATERIAL AND METHODS We retrospectively reviewed the records of consecutively enrolled medial opening-wedge HTOs (n=123) and Oxford mobile-bearing UKAs (n=118) with satisfactory postoperative alignment. Preoperative demographics, physical activity levels, varus deformity status, and degree of OA were recorded. Postoperative radiographs, frequency of combined procedures and patient-reported outcomes (PROs) including pain, Western Ontario and McMaster Universities Osteoarthritis Index score, and patient satisfaction were assessed. RESULTS Severe OA (p<0.01) was associated with an increased risk of dissatisfaction following HTO, whereas young age (p<0.01) and severe varus deformity (p=0.045) were related to dissatisfaction after UKA. In addition, patient satisfaction following UKA was higher than that following HTO in individuals with highly physically demanding activity. All UKA PROs were superior to those of the HTO group, except pain level. CONCLUSION Despite the shared patient selection criteria for contemporary HTO and UKA, severe OA was associated with dissatisfaction following HTO, whereas young age and varus deformity were associated with dissatisfaction following UKA. Age, varus deformity and OA severity should be considered when deciding whether to perform HTO or UKA. TYPE OF STUDY AND LEVEL OF PROOF Retrospective cohort study, Level III.
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Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, 02559 Seoul, Republic of Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Sueen Sohn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Kwang Yun Song
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Nam Yong Choi
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea
| | - Hoyoung Jung
- Department of Orthopaedic Surgery, St. Paul's Hospital, 02559 Seoul, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, 06591 Seoul, Republic of Korea.
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Functional outcome of two-stage reimplantation in patients with periprosthetic joint infection after primary total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 43:2503-2509. [PMID: 30652221 DOI: 10.1007/s00264-019-04296-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Two-stage reimplantation in patients with chronic periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) with the use of either articulating or static antibiotic-loaded spacers during the first step is considered to be the golden standard in orthopaedics. THE AIM OF THE STUDY The aim of the study was to evaluate the correlation of spacer type with the infection elimination rate as well as functional outcomes after two-staged revision TKA in patients with PJI. MATERIALS AND METHODS The cohort comprised 161 patients who were treated for PJI after TKA during a period from January 2007 to December 2015. After the exclusion of patients with severe bone defects (AORI 2B or 3), 104 were left for the analysis: 72 patients with articulating and 32 with static spacers. The overall patient mean age was 62 years old (95% CI, 30-84): 73 for females, 31 for males. The outcomes were evaluated after three, six and 12 months using the American Knee Society Score (KSS) and EQ-5D. Only 92 patients were available for observation: 25 with static and 67 with articulating spacers. RESULTS One year after the surgery, patients with articulating spacers demonstrated significantly higher mean KSS and function scores in comparison to patients with static spacers (90.4, 77.3 and 78.5, 67.8, respectively (p < 0.05)). The range of motion was also significantly better in patients with articulating spacers: 104.9° in comparison to 93.9° (р < 0.0001). The final EQ-5D score was comparable in both groups (0.82, 73.1 in articulating and 0.82, 72.6 in static spacers). CONCLUSION The two-stage revision TKA for PJI using articulating spacers in comparison to the static ones provides better infection eradication rate as well as functional outcomes and improved quality of life.
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Koh IJ, Kim MS, Sohn S, Song KY, Choi NY, In Y. Duloxetine Reduces Pain and Improves Quality of Recovery Following Total Knee Arthroplasty in Centrally Sensitized Patients: A Prospective, Randomized Controlled Study. J Bone Joint Surg Am 2019; 101:64-73. [PMID: 30601417 DOI: 10.2106/jbjs.18.00347] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Unexplained postoperative pain is one of the most feared complications of total knee arthroplasty (TKA). A persistent noxious peripheral stimulus, such as the pain of chronic knee osteoarthritis, can cause central sensitization in which the central nervous system becomes hyperexcitable, resulting in hypersensitivity to both noxious and non-noxious stimuli. Patients with central sensitization may be more susceptible to unexplained pain after TKA. Duloxetine, a selective serotonin norepinephrine reuptake inhibitor (SNRI), can ameliorate the pain associated with central sensitization, and we aimed to determine whether it could reduce postoperative pain and improve quality of recovery after TKA in patients with central sensitization. METHODS Patients undergoing TKA were screened for central sensitization preoperatively with use of the Central Sensitization Inventory (CSI). Among 464 patients with primary osteoarthritis who were scheduled for primary unilateral TKA, 80 were identified as being centrally sensitized and were included in the study. Forty patients were randomly assigned to the duloxetine group (30 mg 1 day before surgery and for 6 weeks after surgery), and 40 were randomized to the control group (no duloxetine). Pain and quality of recovery were assessed with use of the Brief Pain Inventory (BPI), the Short Form-36 (SF-36), the Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP), and the Hamilton Depression Scale. The prevalence of adverse medication effects was also noted. RESULTS The patients in the duloxetine group had better performance across pain metrics during the initial 2 to 12-week postoperative period (p < 0.05). The duloxetine group also had a superior quality of recovery 2 weeks after TKA, as indicated by emotional and physical functioning (all p < 0.05). There was no difference between groups in the prevalence of adverse events. CONCLUSIONS A substantial number of patients are centrally sensitized before TKA. Surgeons should consider selective incorporation of duloxetine into the multimodal postoperative analgesic protocol, according to the severity of central sensitization, to minimize the possibility of persistent pain following TKA. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- In Jun Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, South Korea.,Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Man Soo Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Sueen Sohn
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Kwang Yun Song
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Nam Yong Choi
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, South Korea
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Lee SA, Kang SB, Yoon C, Chang CB, Chang MJ, Seo JG. Temporal Value of C-Reactive Protein and Erythrocyte Sedimentation Rate after Total Knee Arthroplasty in Patients with Elevated Preoperative C-Reactive Protein: A Matched-Pair Analysis. Indian J Orthop 2019; 53:437-441. [PMID: 31080284 PMCID: PMC6501634 DOI: 10.4103/ortho.ijortho_96_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to determine whether temporal values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after total knee arthroplasty (TKA) differ between patients with and without elevated preoperative CRP. We hypothesized that temporal pattern of CRP and ESR change would differ between the two groups. MATERIALS AND METHODS This retrospective study included 30 TKAs with a diagnosis of osteoarthritis with elevated preoperative CRP (>1 mg/dl) without clinical signs and symptoms of infection before surgery (elevated CRP group). Patients without elevated preoperative CRP were matched in a 1:10 fashion according to age, sex, number of comorbidities and whether TKA was unilateral or bilateral (nonelevated CRP group). The temporal values of CRP and ESR after TKA were compared between the two groups until 2 months after surgery. RESULTS The mean peak values of CRP and ESR after surgery were similar between the two groups in both unilateral and bilateral TKAs. In the unilateral TKA, mean values of CRP and ESR and the proportions of the knees with normal CRP and ESR at 2 months after surgery were similar in the two groups. However, in the bilateral TKA, mean values of CRP and ESR were higher and the proportions of the knees with normal CRP and ESR at 2 months after surgery were lower in the elevated CRP group compared to the nonelevated CRP group. CONCLUSIONS When performing TKA in patients with elevated preoperative CRP, the fact that the levels of CRP and ESR may not be normalized until 2 months after surgery should be considered during followup.
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Affiliation(s)
- Seung Ah Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Kyung Hee University, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea,Address for correspondence: Prof. Seung-Baik Kang, Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, 5 Gil 20, Boramae-Road, Dongjak-Gu, Seoul 07061, South Korea. E-mail:
| | - Chan Yoon
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Moon Jong Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Jai Gon Seo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
BACKGROUND There has been a gradual increase in the revision TKA (RTKA) workload due to expanding indications of total knee arthroplasty (TKA), coupled with improving patient longevity. Western countries are already looking at their data on RTKA to plan for the future heath care needs of these patients. Limited data is available on RTKA from developing countries. Our study attempts to fill this gap in knowledge. MATERIALS AND METHODS We prospectively documented details of all RTKA performed at our centre for a period of six years (2011-16). We recorded the volume, causes and time to failure from index surgery of all RTKA and further recorded microbiological pattern in septic failures. We looked at the proportion of each cause of failure and time from index surgery. RESULTS Of the 5068 TKA procedures performed from January 2011 to December 2016, 201 (4%) were first-time revisions. The predominant cause of revisions was prosthetic infection (61%) followed by aseptic loosening (18%) and instability (7%). In the early, mid term, and late-failure groups, prosthetic infection remained the main cause of failure. In 47% of the septic revisions, the offending organisms could be identified and of those identified most (67%) were Gram-negative. CONCLUSION The volume of first-time RTKA procedures (4%) at our center remained low compared with that of the Western countries. In Western countries, the incidence of late aseptic failures was higher than that of early-septic failures, whereas in our study, revisions were more commonly performed in the early-failure group (48%) and most failures were due to prosthetic infection (61%).
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Affiliation(s)
- Vikas Kulshrestha
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India
| | - Barun Datta
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India,Address for correspondence: Dr. Barun Datta, Joint Replacement Centre, Army Hospital Research and Referral, Delhi Cantt, New Delhi - 110 010, India. E-mail:
| | - Gaurav Mittal
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India
| | - Santhosh Kumar
- Joint Replacement Centre, Army Hospital Research and Referral, New Delhi, India
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Significant increase of pathogen detection rate by dry arthroscopic biopsies at suspected low-grade infection following total knee arthroplasty: a prospective observational study. Arch Orthop Trauma Surg 2018; 138:1583-1590. [PMID: 30182141 DOI: 10.1007/s00402-018-3032-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The differentiation between stiff-knee and low-grade periprosthetic joint infection (PJI) is the current diagnostic challenge in total knee (TKA) revision arthroplasty. The aim of this study was to investigate the additional value of dry biopsies, compared to wet biopsies, in patients presenting with knee stiffness following primary TKA. MATERIALS AND METHODS Single center, prospective observational study. Consecutive patients with joint stiffness of unknown origin following primary TKA were enrolled. Patient assessment followed the diagnostic standard algorithm. During diagnostic arthroscopy, synovial fluid (synovial WBC, PMN%) and five dry biopsies (dry) were collected. Then fluid was infused and another five microbiology (wet) and five histological biopsies gathered, all from identical locations. The primary outcome parameter was the difference between the pathogens in wet and dry biopsies. RESULTS 71 patients (61% females, 67 ± 10 years) were eligible. Preoperative blood serology mean CRP (0.7 ± 1.5 mg/dl; p = 0.852), WBC (6.6 ± 1.7 G/l; p = 0.056), and synovial fluid mean WBC (1639 ± 2111; p = 0.602), PMN% (38 ± 28; p = 0.738) did not differ between patients with negative, positive wet or dry biopsies. The histology was in 11% positive (p = 0.058). In 32% at least one pathogen was detected, 48% from wet, 44% from dry biopsies. An inhomogeneous distribution was found. Cutibacterium acnes (100%) was solely found in wet, Micrococcus luteus (75%), Staphylococcus capitis (67%), and Micrococcus lylae (100%) were predominantly found in dry biopsies. Additional dry biopsies increased the pathogen detection rate by 49%. CONCLUSION The addition of dry biopsies to the current standard diagnostic algorithm for PJI increased the pathogen detection rate by 49%.
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Roche M, Law TY, Sultan AA, Umpierrez E, Khlopas A, Rosas S, Kurowicki J, Wang K, Mont MA. Racial Disparities in Revision Total Knee Arthroplasty: Analysis of 125,901 Patients in National US Private Payer Database. J Racial Ethn Health Disparities 2018; 6:101-109. [DOI: 10.1007/s40615-018-0504-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/05/2018] [Accepted: 05/31/2018] [Indexed: 02/04/2023]
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Duan G, Liu C, Lin W, Shao J, Fu K, Niu Y, Wang F. Different Factors Conduct Anterior Knee Pain Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2018; 33:1962-1971.e3. [PMID: 29398258 DOI: 10.1016/j.arth.2017.12.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A systematic review and meta-analysis was performed to investigate the risks associated with anterior knee pain (AKP) following primary total knee arthroplasty (TKA). METHODS A computerized search was performed of the following databases: MEDLINE, Embase, and Cochrane Central (published prior to July 2017). A total of 37 studies, which included 1641 cases of AKP and 168,090 TKAs, were included in the meta-analysis. RESULTS A subgroup analysis revealed that compared with those without the following medical conditions, patients who had an infrapatellar fat pad excision and more than 12 months of follow-up (odds ratio [OR] 12.58, 95% confidence interval [CI] 3.245-48.781) were more likely to have AKP after TKA. Circumpatellar electrocautery (>12 months: OR 0.50, 95% CI 0.326-0.760; ≤12 months: OR 0.59, 95% CI 0.408-0.867) and patellar resurfacing (OR 0.25, 95% CI 0.131-0.485) may decrease the risk of AKP. Other factors, including the prosthesis bearing type (mobile bearing or fixed bearing) and the approach (midvastus compared with the medial parapatellar approach), were not significant risk factors for AKP. CONCLUSION The use of strategies such as patellar denervation and patellar resurfacing in primary TKA is recommended because they are safe and result in good clinical outcomes in preventing AKP. Caution should be taken when using an infrapatellar fat pad excision, because there is an increased risk of AKP at long-term follow-up (>12 months). Future studies should investigate these different strategies to confirm the underlying mechanisms and help prevent the occurrence of AKP after TKA. The timing of AKP onset remains unclear and requires further research.
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Affiliation(s)
- Guman Duan
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Chang Liu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Weiwei Lin
- Department of Neurosurgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jiashen Shao
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Kunpeng Fu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yingzhen Niu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
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Lum ZC, Shieh AK, Dorr LD. Why total knees fail-A modern perspective review. World J Orthop 2018; 9:60-64. [PMID: 29686970 PMCID: PMC5908984 DOI: 10.5312/wjo.v9.i4.60] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/06/2018] [Accepted: 04/01/2018] [Indexed: 02/06/2023] Open
Abstract
Historically, the most common mechanism of total knee arthroplasty (TKA) failures included aseptic loosening, instability and malalignment. As polyethylene production improved, modes of failure from polyethylene wear and subsequent osteolysis became less prevalent. Newer longitudinal studies report that infection has become the primary acute cause of failure with loosening and instability remaining as the overall greatest reasons for revision. Clinical database and worldwide national registries confirm these reports. With an increasing amount of TKA operations performed in the United States, and with focus on value-based healthcare, it is imperative to understand why total knees fail.
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Affiliation(s)
- Zachary C Lum
- Department of Orthopaedic Surgery, Davis Medical Center, University of California, Sacramento, CA 95817, United States
| | - Alvin K Shieh
- Department of Orthopaedic Surgery, Davis Medical Center, University of California, Sacramento, CA 95817, United States
| | - Lawrence D Dorr
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, United States
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Van den Wyngaert T, Palli SR, Imhoff RJ, Hirschmann MT. Cost-Effectiveness of Bone SPECT/CT in Painful Total Knee Arthroplasty. J Nucl Med 2018; 59:1742-1750. [DOI: 10.2967/jnumed.117.205567] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/15/2018] [Indexed: 12/15/2022] Open
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Koh IJ, Han SB, In Y, Oh KJ, Lee DH, Kim TK. The Leukocyte Esterase Strip Test has Practical Value for Diagnosing Periprosthetic Joint Infection After Total Knee Arthroplasty: A Multicenter Study. J Arthroplasty 2017; 32:3519-3523. [PMID: 28823593 DOI: 10.1016/j.arth.2017.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Leukocyte esterase (LE) was recently reported to be an accurate marker for diagnosing periprosthetic joint infection (PJI) as defined by the Musculoskeletal Infection Society (MSIS) criteria. However, the diagnostic value of the LE test for PJI after total knee arthroplasty (TKA), the reliability of the subjective visual interpretation of the LE test, and the correlation between the LE test results and the current MSIS criteria remain unclear. METHODS This study prospectively enrolled 60 patients undergoing revision TKA for either PJI or aseptic failure. Serological marker, synovial fluid, and histological analyses were performed in all cases. The PJI group comprised 38 cases that met the MSIS criteria and the other 22 cases formed the aseptic group. All the LE tests were interpreted using both visual judgment and automated colorimetric reader. RESULTS When "++" results were considered to indicate a positive PJI, the sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy were 84, 100, 100, 79, and 90%, respectively. The visual interpretation agreed with the automated colorimetric reader in 90% of cases (Cronbach α = 0.894). The grade of the LE test was strongly correlated with the synovial white blood cell count (ρ = 0.695) and polymorphonuclear leukocyte percentage (ρ = 0.638) and moderately correlated with the serum C-reactive protein and erythrocyte sedimentation rate. CONCLUSION The LE test has high diagnostic value for diagnosing PJI after TKA. Subjective visual interpretation of the LE test was reliable and valid for the current battery of PJI diagnostic tests according to the MSIS criteria.
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Affiliation(s)
- In J Koh
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung B Han
- Department of Orthopaedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Kwang J Oh
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Dae H Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae K Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea; Department of Orthopaedics, Seoul National University College of Medicine, Seoul, Korea
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Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:2622-2631. [PMID: 26590562 DOI: 10.1007/s00167-015-3878-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/10/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Historically poor results of survivorship and functional outcomes of patellofemoral arthroplasty (PFA) have been reported in the setting of isolated patellofemoral osteoarthritis. More recently, however, fairly good results of PFA were reported, but the current status of PFA outcomes is unknown. Therefore, a systematic review was performed to assess overall PFA survivorship and functional outcomes. METHODS A search was performed using PubMed, Embase and Cochrane systems, and the registries were searched. Twenty-three cohort studies and one registry reported survivorship using Kaplan-Meier curve, while 51 cohort studies reported functional outcomes of PFA. RESULTS Twelve studies were level II studies, while 45 studies were level III or IV studies. Heterogeneity was mainly seen in type of prosthesis and year the cohort started. Nine hundred revisions in 9619 PFAs were reported yielding 5-, 10-, 15- and 20-year PFA survivorships of 91.7, 83.3, 74.9 and 66.6 %, respectively, and an annual revision rate of 2.18. Functional outcomes were reported in 2587 PFAs with an overall score of 82.2 % of the maximum score. KSS and Knee Function Score were 87.5 and 81.6 %, respectively. CONCLUSION This systematic review showed that fairly good results of PFA survivorship and functional outcomes were reported at short- and midterm follow-up in the setting of isolated patellofemoral osteoarthritis. Heterogeneity existed mainly in prosthesis design and year the cohort started. CLINICAL RELEVANCE These results provide a clear overview of the current status of PFA in the setting of isolated patellofemoral osteoarthritis. LEVEL OF EVIDENCE IV.
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Liu D, He C, Liu Z, Xu W. Gentamicin coating of nanotubular anodized titanium implant reduces implant-related osteomyelitis and enhances bone biocompatibility in rabbits. Int J Nanomedicine 2017; 12:5461-5471. [PMID: 28814863 PMCID: PMC5546782 DOI: 10.2147/ijn.s137137] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Titanium and titanium alloy are widely used as orthopedic implants for their favorable mechanical properties and satisfactory biocompatibility. The aim of the present study was to investigate the antibacterial effect and bone cell biocompatibility of a novel implant made with nanotubular anodized titanium coated with gentamicin (NTATi-G) through in vivo study in rabbits. The animals were divided into four groups, each receiving different kinds of implants, that is, NTATi-G, titanium coated with gentamicin (Ti-G), nanotubular anodized titanium uncoated with gentamicin (NTATi) and titanium uncoated with gentamicin (Ti). The results showed that NTATi-G implant prevented implant-related osteomyelitis and enhanced bone biocompatibility in vivo. Moreover, the body temperature of rabbits in NTATi-G and Ti-G groups was lower than those in Ti groups, while the weight of rabbits in NTATi-G and Ti-G groups was heavier than those in NTATi and Ti groups, respectively. White blood cell counts in NTATi-G group were lower than NTATi and Ti groups. Features of myelitis were observed by X-ray films in the NTATi and Ti groups, but not in the NTATi-G and Ti-G groups. The radiographic scores, which assessed pathology and histopathology in bone tissues, were significantly lower in the NTATi-G and Ti-G groups than those in the NTATi and Ti groups, respectively (P<0.05). Meanwhile, explants and bone tissue culture demonstrated significantly less bacterial growth in the NTATi-G and Ti-G groups than in the NTATi and Ti groups, respectively (P<0.01). The bone volume in NTATi-G group was greater than Ti-G group, and little bone formation was seen in NTATi and Ti groups.
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Affiliation(s)
- Denghui Liu
- Department of Orthopedics, the 113 Military Hospital, Ningbo
| | - Chongru He
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, People's Republic of China
| | - Zhongtang Liu
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, People's Republic of China
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, People's Republic of China
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Kim MS, Koh IJ, Choi YJ, Pak KH, In Y. Collagen Augmentation Improves the Quality of Cartilage Repair After Microfracture in Patients Undergoing High Tibial Osteotomy: A Randomized Controlled Trial. Am J Sports Med 2017; 45:1845-1855. [PMID: 28282221 DOI: 10.1177/0363546517691942] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The quality of cartilage repair after marrow stimulation is unpredictable. To overcome the shortcomings of the microfracture technique, various augmentation techniques have been developed. However, their efficacies remain unclear. HYPOTHESIS The quality of cartilage repair and clinical outcomes would be superior in patients undergoing high tibial osteotomy (HTO) with microfracture and collagen augmentation compared to those undergoing HTO with microfracture alone without collagen augmentation for the treatment of medial compartment osteoarthritis (OA) of the knee. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Twenty-eight patients undergoing HTO were randomized into 2 groups: microfracture alone (group 1, n = 14) or microfracture with collagen augmentation (group 2, n = 14). At 1 year postoperatively, second-look arthroscopic surgery and biopsy of repaired cartilage were performed at the time of HTO plate removal. Biopsy specimens were graded using the International Cartilage Repair Society Visual Assessment Scale II (ICRS II). In addition, imaging outcomes in terms of the magnetic resonance observation of cartilage repair tissue (MOCART) score were assessed based on magnetic resonance imaging (MRI). Finally, clinical outcomes in terms of the visual analog scale (VAS) for pain score, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and Tegner activity scale score were evaluated. RESULTS The mean ICRS II score in group 2 was significantly higher than that in group 1 (1053.2 vs 885.4, respectively; P = .002). Group 2 showed greater improvement in tissue morphology, cell morphology, surface architecture, middle/deep zone assessment, and overall assessment compared with group 1 ( P < .050 for all comparisons). Imaging outcomes based on the MOCART score were superior in group 2 compared to those in group 1 on MRI at 1 year postoperatively (64.6 vs 45.4, respectively; P = .001). The degree of defect repair was better in group 2 than in group 1 ( P = .040). Clinical outcomes in terms of the VAS for pain score, KOOS, IKDC score, and Tegner activity scale score were improved in both groups without between-group differences ( P > .100 for all comparisons). CONCLUSION The quality of cartilage repair after microfracture with collagen augmentation was superior to that after microfracture alone in patients undergoing HTO. Clinical results after 1 year did not reflect this difference in tissue repair. Therefore, a longer follow-up of the cohort is needed to answer this question.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Jun Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hyung Pak
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Koh HJ, Koh IJ, Kim MS, Choi KY, Jo HU, In Y. Does Patient Perception Differ Following Adductor Canal Block and Femoral Nerve Block in Total Knee Arthroplasty? A Simultaneous Bilateral Randomized Study. J Arthroplasty 2017; 32:1856-1861. [PMID: 28215966 DOI: 10.1016/j.arth.2017.01.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/31/2016] [Accepted: 01/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Femoral nerve block (FNB) has been used as part of the multimodal analgesia after total knee arthroplasty (TKA), but leads to weakness in the quadriceps muscles. Recently, adductor canal block (ACB) was reported to provide effective pain relief while sparing the strength of the quadriceps. This simultaneous bilateral randomized study investigated whether patients perceived differences between ACB and the FNB after same-day bilateral TKA. METHODS We performed a prospective simultaneous bilateral randomized study in 50 patients scheduled to undergo same-day bilateral TKA. One knee was randomly assigned to ACB and the other knee was assigned to FNB. All ACB and FNB were performed using ultrasound-guided single-shot procedures. These 2 groups were compared for pain visual analogue scale, straight leg raising ability and knee extension while sitting, and motor grade. At postoperative week 1, the peak torque for the quadriceps muscle was measured in both knees with an isokinetic dynamometer. RESULTS There were no differences in pain levels between ACB and FNB during the entire study period. During the first 48 h after TKA, more of the knees that received ACB could perform straight leg raising and knee extension with greater quadriceps strength compared with FNB. However, no group differences in quadriceps functional recovery were found after postoperative 48 h and isometric quadriceps strength at postoperative 1 week. CONCLUSION This simultaneous bilateral randomized study demonstrates that patients did not perceive differences in pain level, but experienced substantial differences in quadriceps strength recovery between knees during the first 48 h (Identifier: NCT02513082).
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Affiliation(s)
- Hyun J Koh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Seoul, Korea; Department of Anesthesia and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In J Koh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Man S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Keun Y Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Hyeon U Jo
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abdel MP, Ledford CK, Kobic A, Taunton MJ, Hanssen AD. Contemporary failure aetiologies of the primary, posterior-stabilised total knee arthroplasty. Bone Joint J 2017; 99-B:647-652. [DOI: 10.1302/0301-620x.99b5.bjj-2016-0617.r3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 02/24/2017] [Indexed: 11/05/2022]
Abstract
Aims The number of revision total knee arthroplasties (TKA) that are performed is expected to increase. However, previous reports of the causes of failure after TKA are limited in that they report the causes at specific institutions, which are often dependent on referral patterns. Our aim was to report the most common indications for re-operations and revisions in a large series of posterior-stabilised TKAs undertaken at a single institution, excluding referrals from elsewhere, which may bias the causes of failure. Patients and Methods A total of 5098 TKAs which were undertaken between 2000 and 2012 were included in the study. Re-operations, revisions with modular component exchange, and revisions with non-modular component replacement or removal were identified from the medical records. The mean follow-up was five years (two to 12). Results The Kaplan-Meier ten-year survival without a re-operation, modular component revision and non-modular component revision was 95.7%, 99.3% and 95.3%, respectively. The most common indications for a re-operation were: post-operative stiffness (58%), delayed wound healing (21%), and patellar clunk (11%). The indications for isolated modular component revision were acute periprosthetic joint infection (PJI) (64%) and instability (36%). The most common indications for non-modular component revision were chronic PJI (52%), aseptic loosening (17%), periprosthetic fracture (10%), and instability (10%). Conclusion Post-operative stiffness remains the most common indication for re-operation after TKA. Infection is the most common indication for modular and non-modular component revision. Aseptic loosening was not an uncommon cause of failure, however, it was much less common than in national registry and non-registry data. Focusing on posterior-stabilised TKAs initially performed at our institution allowed for an accurate assessment of the causes of failure in a contemporary specialty practice. Cite this article: Bone Joint J 2017;99-B:647–52.
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Affiliation(s)
- M. P. Abdel
- Mayo Clinic, 200
First Street SW, Rochester, MN
55905, USA
| | - C. K. Ledford
- Kentucky University Medical Center, 3901
Rainbow Boulevard, Kansas City, KS
66160, USA
| | - A. Kobic
- Mayo Clinic, 200
First Street SW, Rochester, MN
55905, USA
| | - M. J. Taunton
- Mayo Clinic, 200
First Street SW, Rochester, MN
55905, USA
| | - A. D. Hanssen
- Mayo Clinic, 200
First Street SW, Rochester, MN
55905, USA
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Choi NY, In Y, Bae JH, Do JH, Chung SJ, Koh IJ. Are Midterm Patient-Reported Outcome Measures Between Rotating-Platform Mobile-Bearing Prosthesis and Medial-Pivot Prosthesis Different? A Minimum of 5-Year Follow-Up Study. J Arthroplasty 2017; 32:824-829. [PMID: 27667531 DOI: 10.1016/j.arth.2016.08.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 07/23/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Both rotating-platform (RP) mobile-bearing and medial-pivot (MP) fixed-bearing prostheses allow axial femorotibial rotation using a highly conforming polyethylene insert. However, limited comparative data are available between the 2 designs. This study was performed to compare the midterm clinical outcomes and patient-reported outcome measures (PROMs) of RP and MP prostheses. METHODS We retrospectively reviewed the records of 52 total knee arthroplasties using RP mobile-bearing prosthesis and 49 total knee arthroplasties using MP fixed prosthesis with a minimum follow-up period of 5 years. Clinical and radiological outcomes, failure rates, and PROMs, including the Western Ontario and McMaster Universities Osteoarthritis Index score and satisfaction, were compared. RESULTS There was no difference in clinical or radiographic outcomes (P > .1 for all comparisons), with the exception of the larger flexion contracture (FC) in the MP group (0.3° in RP vs 2.3° in MP, P < .01). No failure in either group was recorded during the study period. PROMs were comparable (P > .1 in all comparisons), with the exception of higher satisfactions in the RP group while performing light household duties (P < .01) and leisure or recreational activities (P = .014) in patients without FC. CONCLUSION The midterm clinical results with both the RP mobile-bearing and MP fixed-bearing prostheses were satisfactory. Although both prostheses provided comparable PROMs, patients with an RP prosthesis were more satisfied than those with an MP prosthesis for highly demanding activities that are strongly associated with the presence of postoperative FC.
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Affiliation(s)
- Nam Y Choi
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jae-Ho Bae
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea
| | - Jung-Hoon Do
- Department of Orthopaedic Surgery, St. Paul's Hospital, Seoul, Korea
| | - Seung J Chung
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In J Koh
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea; Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, Seoul, Korea
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Vertullo CJ, Lewis PL, Graves S, Kelly L, Lorimer M, Myers P. Twelve-Year Outcomes of an Oxinium Total Knee Replacement Compared with the Same Cobalt-Chromium Design: An Analysis of 17,577 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2017; 99:275-283. [PMID: 28196029 DOI: 10.2106/jbjs.16.00092] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Oxidized zirconium (Oxinium) was introduced as an alternative bearing surface to cobalt-chromium (CoCr) in an attempt to reduce polyethylene wear and decrease aseptic mechanical failure of total knee replacements. While noncomparative reports have been described as promising, we were aware of no short or long-term clinical studies showing the superiority of Oxinium on polyethylene as a bearing surface. Using data from a comprehensive national joint replacement registry, we compared the long-term outcomes after cruciate-retaining total knee arthroplasty (TKA) with an Oxinium femoral component and those with the same prosthetic design but with a CoCr femoral component. METHODS The cohorts consisted of 17,577 cemented Genesis-II cruciate-retaining total knee replacements using non-cross-linked polyethylene, which included 11,608 with CoCr femoral components and 5,969 with Oxinium femoral components. The cumulative percent revision and hazard ratio (HR) for revision risk were estimated for the cemented Genesis-II Oxinium and CoCr cruciate-retaining TKAs performed in Australia from September 1, 1999, to December 31, 2013. In addition, the revision diagnoses and the effects of age and patellar resurfacing were examined. RESULTS No difference in the HR for revision risk was found between the Oxinium and CoCr cohorts for any age category for all causes of revision (HR = 0.92 [95% confidence interval (CI), 0.92 to 1.29]; p = 0.329), loosening or lysis, or aseptic causes, except for loosening or lysis in the group of patients who were ≥75 years old (p = 0.033). In these patients, TKA with Oxinium femoral components had a higher rate of revision. Younger patients preferentially received Oxinium femoral components. The revision risk was not affected by patellar resurfacing or nonresurfacing. At 12 years, the cumulative percent revision was 4.8% (95% CI, 4.2% to 5.4%) for the CoCr Genesis-II prosthesis compared with 7.7% (95% CI, 6.2% to 9.5%) for the Oxinium Genesis-II prosthesis. CONCLUSIONS In this cohort study involving the same prosthetic design, Oxinium femoral components did not reduce revision rates for all causes, loosening or lysis, or when infection as a cause of revision was removed compared with the same CoCr femoral component across all age groups including patients who were <55 years old. The cumulative percent revision was greater for the Oxinium components than for the CoCr components. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher J Vertullo
- 1Knee Research Australia, Gold Coast, Queensland, Australia 2Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia 3Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia 4Brisbane Orthopaedic & Sports Medicine Centre, Brisbane, Queensland, Australia
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The Utility of Postoperative Radiographs 2 Years After Primary Total Knee Arthroplasty. J Arthroplasty 2017; 32:106-109. [PMID: 27554780 DOI: 10.1016/j.arth.2016.06.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Radiographs are routinely used to evaluate patients postoperatively after total knee arthroplasty, but no evidence-based guidelines exist regarding their use. The purpose of this study is to quantify the use of radiographs within 2 years of primary total knee arthroplasty by one surgeon and to determine if routine studies in asymptomatic patients altered patient management. METHODS Patients undergoing consecutive primary total knee arthroplasties between 2008 and 2010 were identified. Patients undergoing revision or additional simultaneous procedures or those with less than 6 months of radiographic follow-up were excluded. Operative and clinic notes, radiographs, and radiology reports were reviewed. RESULTS A total of 263 patients were identified; each patient had an average of 13.5 ± 3.8 individual radiographs obtained in 6.5 ± 1.7 series. Twelve radiographic series were noted to have abnormal findings by either the attending surgeon or by radiology report. Three of these patients underwent reoperation directly related to the findings; 2 for deep infections and 1 for extensor mechanism disruption. All 3 patients had reported abnormal symptoms when their films were obtained. The remaining 9 abnormal radiographic findings included focal lucencies or osteolysis, asymmetric spacer wear, a healing stress fracture, an inferior patellar avulsion fracture, and heterotopic ossification. No patient had symptoms attributable to these findings when the radiographs were obtained, and in no case was the management altered based on these finding. CONCLUSION This study suggests that the observed frequency of routine postoperative radiographs in asymptomatic patients may not be necessary in the first 2 years after primary total knee arthroplasty.
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Hardcastle JM, So DH, Lee GC. The Fate of Revision Total Knee Arthroplasty With Preoperative Abnormalities in Either Sedimentation Rate or C-Reactive Protein. J Arthroplasty 2016; 31:2831-2834. [PMID: 27498389 DOI: 10.1016/j.arth.2016.05.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 05/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are important markers in the evaluation and treatment of painful total knee arthroplasty (TKA). Elevation of both markers usually occurs with infected TKAs while a normal ESR and CRP usually point to aseptic causes for failure. The purpose of this study is to compare (1) rate of revision, (2) infection, and (3) reason for reoperation in a group of patients undergoing revision TKA with a single abnormality in either ESR or CRP in an otherwise negative conventional infection work-up compared to patients with normal preoperative ESR and CRP. METHODS We retrospectively reviewed 791 consecutive revision TKAs performed at our institution between years 2004 and 2011. Following exclusion for infection, periprosthetic fracture, prior revision TKA, positive cultures, incomplete records, and patients with less than 24-month follow-up, a total of 228 aseptic revisions (89 knees with 1 abnormal serologic marker) were available for final analysis. No patients met the current established criteria for infection. All knees underwent revision TKA using antibiotic-impregnated cement. The 2 groups were compared in terms of overall survivorship, infection rate, and rate and causes of subsequent aseptic revision. RESULTS The average follow-up was 60 months (24-110). There were no significant differences between the 2 groups in terms of age, sex, American Society of Anesthesiologists class, and Charlson comorbidity index. A preoperative abnormality of either ESR or CRP significantly increased the risk for reoperation for all reasons (odds ratio [OR], 3.2; P = .0028), infection (OR, 4.0; P = .034), and revision for aseptic loosening (OR, 3.69; P = .044). There were no differences in reoperations for any other reason. The average time to revision in the study group was 28.3 months compared to 40.0 months in the control group (P = .213). CONCLUSION A single abnormality in either the ESR or CRP increased the likelihood of both infection and reoperation following revision TKA. Conventional methods and criteria for infection detection may not be sufficiently sensitive or specific in these cases. Further work-up with additional modalities may help increase the confidence of aseptic failure before revision TKA.
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Affiliation(s)
- John M Hardcastle
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David H So
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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