Prevalence of osteoporosis and osteopenia in elderly patients scheduled for total knee arthroplasty

Abstract Introduction Osteoporosis is a common comorbidity in elderly patients with osteoarthritis (OA) and may increase perioperative complications in orthopedic surgery (e.g., component migration, periprosthetic fractures). As there is no investigation of bone mineral density (BMD) in elderly patients prior to total knee arthroplasty (TKA) in Europe, we investigated this issue with a particular focus on a potential treatment gap. Materials and methods We assessed the BMD by dual-energy X-ray absorptiometry (DXA) in 109 consecutive elderly patients (age ≥ 70 years) scheduled for TKA. In addition to a detailed assessment of osteoporosis and osteopenia, the influence of clinical risk factors and radiological OA severity on BMD was evaluated using group comparisons and linear regression models. In addition, we analyzed differences in BMD between patients scheduled for TKA vs. total hip arthroplasty (THA). Results Of the included 109 patients, 19 patients (17.4%) were diagnosed with osteoporosis and 50 (45.9%) with osteopenia. In the osteoporotic patients, a clinically relevant underdiagnosis concomitant with a serious treatment gap was observed in 95.0% of the patients. Body mass index, OA grade, and glucocorticoid use were identified as independent factors associated with BMD. No differences in BMD were found between the patients scheduled for TKA vs. THA. Conclusions Considering the high prevalence of osteoporosis and osteopenia in elderly patients, DXA screening should be recommended for patients ≥ 70 years indicated for TKA.

Download Full-text

Changes in bone mineral density of the distal femur following uncemented total knee arthroplasty

The Journal of Arthroplasty ◽

10.1016/s0883-5403(06)80058-6 ◽

1995 ◽

Vol 10 (1) ◽

pp. 7-11 ◽

Cited By ~ 50

Author(s):

M PETERSEN ◽

C OLSEN ◽

J LAURITZEN ◽

B LUND

Keyword(s):

Bone Mineral Density ◽

Total Knee Arthroplasty ◽

Bone Mineral ◽

Knee Arthroplasty ◽

Distal Femur ◽

Mineral Density ◽

Total Knee

Download Full-text

The Effect of Pre-Operative Patient Controlled Analgesia Education on Elderly Patients with Total Knee Arthroplasty

Journal of Korean Biological Nursing Science ◽

10.7586/jkbns.2014.16.4.318 ◽

2014 ◽

Vol 16 (4) ◽

pp. 318-325 ◽

Cited By ~ 2

Author(s):

Joohee Shim ◽

Smi Choi-Kwon

Keyword(s):

Total Knee Arthroplasty ◽

Elderly Patients ◽

Knee Arthroplasty ◽

Patient Controlled Analgesia ◽

Total Knee

Download Full-text

What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

The Journal of Knee Surgery ◽

10.1055/s-0038-1636836 ◽

2018 ◽

Vol 32 (02) ◽

pp. 165-170 ◽

Cited By ~ 3

Author(s):

Jared Newman ◽

Assem Sultan ◽

Anton Khlopas ◽

Nipun Sodhi ◽

Mhamad Faour ◽

...

Keyword(s):

Multiple Sclerosis ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Perioperative Complications ◽

Primary Total Knee Arthroplasty ◽

Care Facility ◽

Medical Complication ◽

Short Term ◽

Total Knee ◽

Multiple Sclerosis Patients

Due to the paucity of evidence, this study was conducted to evaluate: (1) unique characteristics of multiple sclerosis (MS) patients and (2) short-term clinical outcomes, of primary total knee arthroplasty (TKA) in patients with MS (MS-TKA) compared with matched non-MS patients. MS patients who underwent TKA were identified using the Nationwide Inpatient Sample (NIS) database. The study sample consisted of 10,884 patients with MS and 56,45,227 control cohort. Various patient factors were compared. To control for potential confounders, with the use of propensity scores, MS-TKA patients were matched (1:3) to non-MS-TKA patients and regression analyses were performed to compare perioperative complications, length of stay (LOS), and discharge dispositions. Patients with MS were younger, more likely to be females, on corticosteroids, and more likely to have muscle spasms and gait abnormalities. Annual frequency of TKAs in MS patients increased from 1.16/1,000 TKAs in 2002 to 2.48/1,000 TKAs in 2013 (p < 0.001). Compared with the matched cohort, MS patients had significantly greater odds for any medical complication (odds ratio [OR] = 1.26; 95% confidence interval [CI], 1.11–1.44), longer mean LOS (mean difference: 0.15; 95% CI, 0.09–0.22), and had a greater chance of being discharged to a care facility (OR = 2.17; 95% CI, 1.96–2.40). In this study, we identified specific characteristics of patients with MS who had TKA and analyzed and compared their short-term TKA outcomes to non-MS patients. It was demonstrated that more patients with MS are undergoing TKA, and these patients were at a higher risk of perioperative complications, had longer LOS, and were more likely to be discharged to a sub-acute or inpatient facility. Orthopaedic surgeons should be cognizant of the increased risks and provide proper counseling to MS patients who are candidates for TKA.

Download Full-text

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

The Journal of Knee Surgery ◽

10.1055/s-0038-1651529 ◽

2018 ◽

Vol 32 (06) ◽

pp. 475-482 ◽

Cited By ~ 5

Author(s):

Karim G. Sabeh ◽

Samuel Rosas ◽

Leonard T. Buller ◽

Andrew A. Freiberg ◽

Cynthia L. Emory ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Perioperative Complications ◽

Primary Total Knee Arthroplasty ◽

Cost Of Care ◽

Chronic Obstructive ◽

Level Of Evidence ◽

Medical Comorbidities ◽

Total Knee ◽

The Impact

AbstractMedical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294–26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost.

Download Full-text