Chronic Kidney Disease Is an Independent Risk Factor for Transfusion, Cardiovascular Complication, and Thirty-Day Readmission in Minimally Invasive 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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Minimally Invasive Surgery Is Not a Risk Factor of Early Total Knee Arthroplasty Failure

Seminars in Arthroplasty ◽

10.1053/j.sart.2009.12.016 ◽

2010 ◽

Vol 21 (2) ◽

pp. 92-96 ◽

Cited By ~ 1

Author(s):

Adolph V. Lombardi ◽

Keith R. Berend ◽

Joanne B. Adams

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Knee Arthroplasty ◽

Invasive Surgery ◽

Total Knee ◽

Arthroplasty Failure

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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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