Trends in Operative Time and Short-Term Outcomes After Conventional and Navigated Total Knee Arthroplasty

AbstractDespite the wide utilization of total knee arthroplasty (TKA), it can be technically challenging to perform in patients who have concomitant bone loss, ligamentous laxity, or high-grade deformity, whether in a revision situation or due to a primary pathology. Therefore, hinged knee prostheses have been developed to provide more stable fixation in these situations. The purpose of this study was to compare the short-term peri- and postoperative outcomes of patients undergoing primary TKA with and without hinged prosthesis. Specifically, we compared (1) mean operative times, (2) lengths of stay (LOS), (3) 30-day readmissions, and (4) complications. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify hinged TKAs and 99 procedures were included. They were matched in a 1:3 ratio to primary TKAs without a hinged prosthesis using propensity score matching. Operative time, LOS, discharge disposition, 30-day readmissions, and complications were compared. Adjusted odds ratios (OR) were also calculated. The operative time was significantly higher in hinged cohort compared with the nonhinged cohort (mean difference [MD] = 22 minutes; range, 10–34 minutes, p < 0.001). There were no significant differences between hinged and nonhinged TKAs with respect to LOS (MD= 0.61 days, range, –0.07–1.30 days, p = 0.080), discharge disposition (OR = 1.09, 95% confidence interval [CI], 0.66–1.84), readmissions (OR = 2.67, 95% CI, 0.84–8.24), and any complications (OR = 1.13, 95% CI, 0.55–2.19). Not surprisingly, primary TKAs with hinged prostheses had increased operative times, but had similar LOS, discharge dispositions, and 30-day rates of readmission and complications when compared with TKAs without a hinged prosthesis. One potential contributing factor to the increased operating time is that patients who receive a hinged implant tend to present with more severe deformities. It is reassuring to know that early outcomes were similar between both cohorts (although we await longer follow-up studies), and that hinged implants can be considered in these difficult to treat patients.

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Poor short-term outcomes after computer-assisted rotating-platform total knee arthroplasty with a deep-trochlear-groove femoral component: Analysis of 19 patients

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2012.07.010 ◽

2013 ◽

Vol 99 (2) ◽

pp. 183-190

Author(s):

A. Akakpo ◽

G. Dereudre ◽

N. Fouilleron ◽

G. Pasquier ◽

H. Migaud

Keyword(s):

Total Knee Arthroplasty ◽

Femoral Component ◽

Knee Arthroplasty ◽

Component Analysis ◽

Computer Assisted ◽

Trochlear Groove ◽

Short Term ◽

Rotating Platform ◽

Total Knee

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Re: Short-term outcomes of local infiltration anaesthetic in total knee arthroplasty: a randomized controlled double-blinded controlled trial

ANZ Journal of Surgery ◽

10.1111/ans.13677 ◽

2016 ◽

Vol 86 (10) ◽

pp. 845-846 ◽

Cited By ~ 1

Author(s):

Lawrence Kohan ◽

Dennis Kerr

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Controlled Trial ◽

Short Term ◽

Local Infiltration ◽

Randomized Controlled ◽

Total Knee ◽

Double Blinded

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Patient-specific instrumentation improved axial alignment of the femoral component, operative time and perioperative blood loss after total knee arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-018-5256-0 ◽

2018 ◽

Vol 27 (4) ◽

pp. 1083-1095 ◽

Cited By ~ 13

Author(s):

Song Gong ◽

Weihua Xu ◽

Ruoyu Wang ◽

Zijian Wang ◽

Bo Wang ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Femoral Component ◽

Knee Arthroplasty ◽

Operative Time ◽

Patient Specific ◽

Axial Alignment ◽

Perioperative Blood Loss ◽

Patient Specific Instrumentation ◽

Total Knee

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Is Operative Time a Predictor for Post-Operative Infection in Primary Total Knee Arthroplasty?

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.11.022 ◽

2019 ◽

Vol 34 (7) ◽

pp. S331-S336 ◽

Cited By ~ 19

Author(s):

Hiba K. Anis ◽

Nipun Sodhi ◽

Alison K. Klika ◽

Michael A. Mont ◽

Wael K. Barsoum ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Operative Time ◽

Primary Total Knee Arthroplasty ◽

Total Knee ◽

Primary Total Knee

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Short Term Analgesic Effects of Intraoperative Periarticular Injection in Total Knee Arthroplasty

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2008.43.5.625 ◽

2008 ◽

Vol 43 (5) ◽

pp. 625

Author(s):

Eun-Kyoo Song ◽

Jong-Keun Seon ◽

Sang-Jin Park ◽

Young-Jin Kim ◽

Dam-Seon Lee ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Short Term ◽

Periarticular Injection ◽

Analgesic Effects ◽

Total Knee

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Slight femoral under-correction versus neutral alignment in total knee arthroplasty with preoperative varus knees: a comparative study

Arthroplasty ◽

10.1186/s42836-021-00105-4 ◽

2022 ◽

Vol 4 (1) ◽

Author(s):

Kai Lei ◽

Li-Ming Liu ◽

Peng-Fei Yang ◽

Ran Xiong ◽

De-Jie Fu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Operative Time ◽

Length Of Hospital Stay ◽

Clinical Results ◽

Patient Reported Outcome Measures ◽

Tourniquet Time ◽

Patient Reported ◽

Total Knee ◽

Neutral Alignment

Abstract Background This study aimed to compare the short-term clinical results of slight femoral under-correction with neutral alignment in patients with preoperative varus knees who underwent total knee arthroplasty. Methods The medical records and imaging data were retrospectively collected from patients who had undergone total knee arthroplasty in our hospital from January 2016 to June 2019. All patients had varus knees preoperatively. Upon 1:1 propensity score matching, 256 patients (256 knees) were chosen and divided into a neutral alignment group (n=128) and an under-correction group (n=128). The patients in the neutral group were treated with the neutral alignment. In the under-correction group, the femoral mechanical axis had a 2° under-correction. The operative time, tourniquet time and the length of hospital stay in the two groups were recorded. The postoperative hip-knee-ankle angle, frontal femoral component angle and frontal tibial component angle were measured. Patient-reported outcome measures were also compared. Results The operative time, tourniquet time and the length of hospital stay in the under-correction group were significantly shorter than the neutral alignment group (P<0.05). At the 2-year follow-up, the under-correction group had a larger varus alignment (P<0.05) and a larger frontal femoral component angle (P<0.05), and the frontal tibial component angles of the two groups were comparable. Compared with the neutral alignment group, the slight femoral under-correction group had significantly better patient-reported outcome measures scores (P<0.05). Conclusion For varus knees treated with total knee arthroplasty, alignment with a slight femoral under-correction has advantages over the neutral alignment in terms of the shorter operative time and better short-term clinical results. Level of evidence III

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Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

BMC Anesthesiology ◽

10.1186/s12871-021-01442-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mark C. Kendall ◽

Alexander D. Cohen ◽

Stephanie Principe-Marrero ◽

Peter Sidhom ◽

Patricia Apruzzese ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Adverse Events ◽

General Anesthesia ◽

Knee Arthroplasty ◽

Anesthetic Management ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Short Term ◽

Knee Replacements ◽

Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

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