A Missed Opportunity; The Impact of Hepatitis C Treatment Prior to Total Knee Arthroplasty on Postoperative Complications

Osteoarthritis and rheumatoid arthritis are the most ubiquitous joint disorders which cause tremendous loss of life quality and impose an economic burden on society. At present, the treatment options for these two diseases comprise non-operative and surgical treatments, amongst those total knee arthroplasties (TKA). Various studies have recognized smoking as a significant risk factor for postoperative complications. Therefore, the purpose of this study was to examine the impact of smoking on the incidence and postoperative complications after a total knee arthroplasty by a systematic review and meta-analysis. The research was performed using PUBMED, Cochrane Library and EMBASE, extracting data from thirteen suitable studies and incorporating 2,109,482 patients. Cohort studies evaluating the impact of smoking on TKA with sufficient data were included for the study, and cohort studies without a proper control group and complete data were excluded. A fixed-effects or random-effects model was used to measure the pooled risk ratio (RR) or hazard ratio (HR) with 95% confidence interval (CI). Compared to non-smokers, smokers had a significantly lower incidence of TKA (p<0.01). However, smokers had a higher incidence of total complications (p=0.01), surgical complications (p<0.01), pneumonia (p<0.01) and revision surgery (p=0.01). No significant difference in the risk of blood transfusion (p=0.42), deep vein thrombosis (p=0.31), pulmonary embolism (p=0.34), urinary tract infection (p=0.46) or mortality (p=0.39) was found between smokers and non-smokers. In conclusion, the study indicated that tobacco has two diametrically opposite effects on TKA patients: 1. Tobacco increases the incidence of surgical complications, pneumonia and revision after TKA; 2. It decreases the overall risk of being a candidate for TKA.

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Higher body mass index is associated with larger postoperative improvement in patient-reported outcomes following total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04512-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

K Giesinger ◽

JM Giesinger ◽

DF Hamilton ◽

J Rechsteiner ◽

A Ladurner

Keyword(s):

Body Mass Index ◽

Total Knee Arthroplasty ◽

Pain Relief ◽

Body Mass ◽

Knee Arthroplasty ◽

Normal Weight ◽

World Health ◽

Obese Patients ◽

Total Knee ◽

The Impact

Abstract Background Total knee arthroplasty is known to successfully alleviate pain and improve function in endstage knee osteoarthritis. However, there is some controversy with regard to the influence of obesity on clinical benefits after TKA. The aim of this study was to investigate the impact of body mass index (BMI) on improvement in pain, function and general health status following total knee arthroplasty (TKA). Methods A single-centre retrospective analysis of primary TKAs performed between 2006 and 2016 was performed. Data were collected preoperatively and 12-month postoperatively using WOMAC score and EQ-5D. Longitudinal score change was compared across the BMI categories identified by the World Health Organization. Results Data from 1565 patients [mean age 69.1, 62.2% women] were accessed. Weight distribution was: 21.2% BMI < 25.0 kg/m2, 36.9% BMI 25.0–29.9 kg/m2, 27.0% BMI 30.0–34.9 kg/m2, 10.2% BMI 35.0–39.9 kg/m2, and 4.6% BMI ≥ 40.0 kg/m2. All outcome measures improved between preoperative and 12-month follow-up (p < 0.001). In pairwise comparisons against normal weight patients, patients with class I-II obesity showed larger improvement on the WOMAC function and total score. For WOMAC pain improvements were larger for all three obesity classes. Conclusions Post-operative improvement in joint-specific outcomes was larger in obese patients compared to normal weight patients. These findings suggest that obese patients may have the greatest benefits from TKA with regard to function and pain relief one year post-op. Well balanced treatment decisions should fully account for both: Higher benefits in terms of pain relief and function as well as increased potential risks and complications. Trial registration This trial has been registered with the ethics committee of Eastern Switzerland (EKOS; Project-ID: EKOS 2020–00,879)

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The Impact of Gastric Bypass Surgery Compared to Total Knee Arthroplasty on Knee Symptoms

journal of Clinical & Experimental Orthopaedics ◽

10.4172/2471-8416.100058 ◽

2018 ◽

Vol 04 (02) ◽

Author(s):

Hafiz Kassam ◽

Allan Okrainec ◽

Timothy Jackson ◽

Michael G Zyweil ◽

Anthony V Perruccio ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Gastric Bypass ◽

Knee Arthroplasty ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Total Knee ◽

The Impact

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Bone ingrowth in total knee arthroplasty: The impact of HA-coatings and the relation with mechanical stability

Journal of Biomechanics ◽

10.1016/s0021-9290(98)80055-9 ◽

1998 ◽

Vol 31 ◽

pp. 26

Author(s):

L. Labey ◽

H. Van Campenhout ◽

J. Vander Sloten ◽

R. Van Audekercke ◽

G. Van der Perre ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Mechanical Stability ◽

Bone Ingrowth ◽

Total Knee ◽

The Impact

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When can total knee arthroplasty be safely performed following prior arthroscopy?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03859-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jin-Ning Ma ◽

Xiao-Lin Li ◽

Pan Liang ◽

Sheng-Li Yu

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Acl Injury ◽

Control Group ◽

Optimal Timing ◽

Complication Rates ◽

Increased Risk ◽

Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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Effect of Gait on Patellofemoral Mechanics

ASME 2008 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2008-192451 ◽

2008 ◽

Author(s):

Jeffrey E. Bischoff ◽

Justin S. Hertzler

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Clinical Studies ◽

Patellofemoral Joint ◽

Knee Kinematics ◽

Component Design ◽

Total Knee ◽

The Impact ◽

Reconstructed Knee

Computational modeling of the reconstructed knee is an important tool in designing components for maximum functionality and life. Utilization of boundary conditions consistent with in vivo gait loading in such models enables predictions of knee kinematics and polyethylene damage [1–4], which can then be used to optimize component design. Several recent clinical studies have focused on complications associated with the patellofemoral joint [5–6], highlighting the need to better understand the mechanics of this compartment of total knee arthroplasty (TKA). This study utilizes a computational model to characterize the impact of gait loading on the mechanics of the patella in TKA.

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Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

The Journal of Knee Surgery ◽

10.1055/s-0038-1676372 ◽

2019 ◽

Vol 33 (01) ◽

pp. 034-041 ◽

Cited By ~ 1

Author(s):

Theodore S. Wolfson ◽

David Novikov ◽

Kevin K. Chen ◽

Kelvin Y. Kim ◽

Afshin A. Anoushiravani ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Subgroup Analysis ◽

Blood Management ◽

Folate Supplementation ◽

Level Of Evidence ◽

Significant Difference ◽

Total Knee

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

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The impact of residual varus alignment following total knee arthroplasty on patient outcome scores in a constitutional varus population

The Knee ◽

10.1016/j.knee.2018.08.019 ◽

2018 ◽

Vol 25 (6) ◽

pp. 1278-1282 ◽

Cited By ~ 2

Author(s):

Brent A. Lanting ◽

Harley A. Williams ◽

Nicholas F. Matlovich ◽

Pieter-Jan. Vandekerckhove ◽

Matthew G. Teeter ◽

...

Keyword(s):

Patient Outcome ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Varus Alignment ◽

Outcome Scores ◽

Total Knee ◽

The Impact ◽

Constitutional Varus

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When can be safely performed total knee arthroplasty following prior arthroscopy?

10.21203/rs.3.rs-38843/v2 ◽

2020 ◽

Author(s):

Jin-Ning Ma ◽

Xiao-Lin Li ◽

Pan Liang ◽

Sheng-Li Yu

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Linear Regression Analysis ◽

Acl Injury ◽

Optimal Time ◽

Control Group ◽

Complication Rates ◽

Increased Risk ◽

Total Knee

Abstract Background The optimal time to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA; and 3) determine the timing of TKA following prior KA.Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum followup was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an end point. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA.Results The all-cause reoperation, revision and complication rates of KA group were significantly higher than those of control group (p<0.05). The survivorship of KA group and control group was 92.0% and 99.4% at the 2-year followup (p=0.002), respectively. Male (Hazards ratio [HR]=3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR=4.4) were associated with postoperative complications in the KA group. There was a non-liner relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months.Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within 9 months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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