Cervical spine degenerative disease is an independent risk factor for increased revision rate following total knee arthroplasty

Abstract Background: Sarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the incidence and characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified sarcopenia as an independent risk factor for postoperative TKA complications.Methods: A retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018–2021. Patients were categorized into non-sarcopenia (n = 417) and sarcopenia (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m2; females, < 5.7 kg/m2). Three postoperative complications were analyzed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors.Results: The incidence of sarcopenia in primary TKA was 7.7% (35/452). The sarcopenia group had a lower preoperative hemoglobin (12.18±1.20 vs. 13.04±1.73 g/dL, p=0.004) and total protein (6.73±0.42 vs. 7.06±0.44 mg/dL, p=0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenia group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57–45.5, p=0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633–0.96) and SMI cut-off of 5.6 kg/m2.Conclusions: Sarcopenia determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia. Orthopedic surgeons should be aware of this, as it could influence the decision-making process or treatment plan of patients with sarcopenia undergoing primary TKA.Level of evidence: III, retrospective cohort study

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Association of Lumbar Degenerative Disease and Revision Rate following Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1701651 ◽

2020 ◽

Author(s):

Michael-Alexander Malahias ◽

Alex Gu ◽

Shawn S. Richardson ◽

Ivan De Martino ◽

David J. Mayman ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Multivariate Analysis ◽

Knee Arthroplasty ◽

Revision Surgery ◽

Revision Rate ◽

Lumbar Fusion ◽

Degenerative Disease ◽

Lumbar Degenerative Disease ◽

Increased Risk ◽

Total Knee

AbstractRecently, 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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Surgical Case Order is an Independent Risk Factor for Postoperative Infection in Primary Total Knee Arthroplasty

10.21203/rs.3.rs-751166/v1 ◽

2021 ◽

Author(s):

Dengying Wu ◽

Chao Jia ◽

Hongwei Lu ◽

Shuoyi Zhou ◽

Zheng wu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Knee Arthroplasty ◽

Independent Risk Factor ◽

Operative Time ◽

Operating Time ◽

Significant Risk ◽

Surgical Case ◽

Operative Outcomes ◽

Total Knee

Abstract Background: Total knee arthroplasty is regarded as the most effective treatment for severe knee joint problems. Surgery case order influences operative outcomes according to previous studies. This study aims to evaluate the effect of surgical case order on operative outcomes for TKA.Methods: A retrospective study was conducted on 4,267 TKAs performed by three surgeons at our hospital from February 2008 to February 2018. Variables, such as surgical time, loss of blood, and hospitalization stay, were also recorded and analysed. Logistic regression was used to analyse every variable as a potential risk for a surgical site infection.Results: Of the 4267 cases in this cohort, 1531 TKAs were classified as first-round cases, 1194 TKAs were second-round cases, 913 TKAs were third-round cases, 490 TKAs were fourth-round cases, and 139 were fifth-round or later cases. The mean operating time was shorter in intermediate cases (P< 0.01). Perioperative adverse events were increased in later surgical cases (P< 0.01). Later case order (OR= 1.29 [95% CI: 1.17–1.56], P<0.01) was a significant risk factor for severe arthroplasty complications. The operative time and length of stay were increased for cases performed later in the day. However, blood loss is not statistically associated with case order. Conclusions: Surgical case order is an independent risk factor for surgical infection. Significantly increased operative time and longer LOS were noted for third-round or later TKA cases. Our results identify potentially modifiable risk factors contributing to infection rates in TKA, and cases operated on later in the day in the same room were more likely to have a higher infection risk.

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Lymphedema: A Significant Risk Factor for Infection and Implant Failure After Total Knee Arthroplasty

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-20-00005 ◽

2020 ◽

Vol 28 (23) ◽

pp. 996-1002 ◽

Cited By ~ 1

Author(s):

Joshua M. Kolz ◽

William G. Rainer ◽

Cody C. Wyles ◽

Matthew T. Houdek ◽

Kevin I. Perry ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Knee Arthroplasty ◽

Significant Risk ◽

Significant Risk Factor ◽

Implant Failure ◽

Total Knee

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Abnormal Coagulation as a Risk Factor for Post-Operative Complications Following Primary and Revision Total Hip and Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2021.04.024 ◽

2021 ◽

Author(s):

Joyce J. Chung ◽

Martine Dolan ◽

Michael J. Patetta ◽

Justin T. DesLaurier ◽

Nickolas Boroda ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Knee Arthroplasty ◽

Total Hip ◽

Operative Complications ◽

Total Knee ◽

Post Operative Complications

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High usage of medial unicompartmental knee arthroplasty negatively influences total knee arthroplasty revision rate

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06650-4 ◽

2021 ◽

Author(s):

Antonio Klasan ◽

Mei Lin Tay ◽

Chris Frampton ◽

Simon William Young

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Revision Rate ◽

Oxford Knee Score ◽

High Volume ◽

Unicompartmental Knee ◽

Patient Reported ◽

Medial Unicompartmental Knee Arthroplasty ◽

Total Knee

Abstract Purpose Surgeons with higher medial unicompartmental knee arthroplasty (UKA) usage have lower UKA revision rates. However, an increase in UKA usage may cause a decrease of total knee arthroplasty (TKA) usage. The purpose of this study was to investigate the influence of UKA usage on revision rates and patient-reported outcomes (PROMs) of UKA, TKA, and combined UKA + TKA results. Methods Using the New Zealand Registry Database, surgeons were divided into six groups based on their medial UKA usage: < 1%, 1–5%, 5–10%, 10–20%, 20–30% and > 30%. A comparison of UKA, TKA and UKA + TKA revision rates and PROMs using the Oxford Knee Score (OKS) was performed. Results A total of 91,895 knee arthroplasties were identified, of which 8,271 were UKA (9.0%). Surgeons with higher UKA usage had lower UKA revision rates, but higher TKA revision rates. The lowest TKA and combined UKA + TKA revision rates were observed for surgeons performing 1–5% UKA, compared to the highest TKA and UKA + TKA revision rates which were seen for surgeons using > 30% UKA (p < 0.001 TKA; p < 0.001 UKA + TKA). No clinically important differences in UKA + TKA OKS scores were seen between UKA usage groups at 6 months, 5 years, or 10 years. Conclusion Surgeons with higher medial UKA usage have lower UKA revision rates; however, this comes at the cost of a higher combined UKA + TKA revision rate that is proportionate to the UKA usage. There was no difference in TKA + UKA OKS scores between UKA usage groups. A small increase in TKA revision rate was observed for high-volume UKA users (> 30%), when compared to other UKA usage clusters. A significant decrease in UKA revision rate observed in high-volume UKA surgeons offsets the slight increase in TKA revision rate, suggesting that UKA should be performed by specialist UKA surgeons. Level of evidence III, Retrospective therapeutic study.

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