Total Knee Arthroplasty Within Six Months After Knee Arthroscopy Is Associated With Increased Postoperative Complications

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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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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Incidence and predictors of total knee arthroplasty following knee arthroscopy

Journal of Orthopaedics ◽

10.1016/j.jor.2017.11.006 ◽

2018 ◽

Vol 15 (1) ◽

pp. 32-35

Author(s):

Tristan Camus ◽

Jiho Han ◽

Feroz Osmani ◽

Norman Scott ◽

William J. Long

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Arthroscopy ◽

Total Knee

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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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Total Knee Arthroplasty following Knee Arthroscopy in Patients over 50

The Journal of Knee Surgery ◽

10.1055/s-0041-1740391 ◽

2021 ◽

Author(s):

J. Stewart Buck ◽

Susan M. Odum ◽

Jonathan K. Salava ◽

David M. Macknet ◽

Thomas K. Fehring ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Knee Arthroscopy ◽

Administrative Database ◽

Univariable Analysis ◽

Digital Radiographs ◽

Multivariable Regression ◽

Total Knee ◽

Arthroscopic Knee ◽

And Control

AbstractThe purpose of this study was to evaluate the conversion rate of knee arthroscopy to ipsilateral total knee arthroplasty (TKA) within 2 years in patients aged 50 or older at the time of arthroscopy. The administrative database from a large, physician-owned orthopaedic practice (>100 surgeons) was queried to identify patients over the age of 50 who had undergone arthroscopic knee surgery between January 1, 2006 and January 2, 2015. The subset of patients who converted to TKA within 2 years after knee arthroscopy was identified and matched by age and sex to a control population that did not convert to TKA. Rates of conversion to TKA were calculated. Prearthroscopic digital radiographs were reviewed and Kellgren–Lawrence (KL) grades were compared among case and control populations. Univariable analyses and multivariable regression analysis were performed. Eight hundred seven of 16,061 (5.02%) patients aged 50 or older were converted to TKA within 2 years following ipsilateral knee arthroscopy. In univariable analysis, the rate of conversion to TKA in patients aged between 50 and 54 was 2.94%, compared with 4.44% in patients aged between 55 and 64, and 8.32% in patients 65 or older (p < 0.0001). Female sex was associated with a higher rate of conversion to TKA in univariable analysis (5.93 vs. 4.02% in males, p < 0.0001). KL grades were higher among patients who converted to TKA compared with those who did not (p < 0.0001). In a multivariable regression model controlling for age, sex, and KL grade, only increased KL grade was associated with increased odds of conversion to TKA. In the appropriately selected older patient, the risk of conversion to TKA within 2 years of knee arthroscopy is low (∼5%). Patients with KL grade 2 or higher at the time of arthroscopy should be counseled on the increased odds of early conversion to TKA.

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