Morbid Obesity in Revision Total Knee Arthroplasty: A Significant Risk Factor for Re-Operation

Aims The aim of this study was to measure the effect of hospital case volume on the survival of revision total knee arthroplasty (RTKA). Methods This is a retrospective analysis of Scottish Arthroplasty Project data, a nationwide audit which prospectively collects data on all arthroplasty procedures performed in Scotland. The primary outcome was RTKA survival at ten years. The primary explanatory variable was the effect of hospital case volume per year on RTKA survival. Kaplan-Meier survival curves were plotted with 95% confidence intervals (CIs) to determine the lifespan of RTKA. Multivariate Cox proportional hazards were used to estimate relative revision risks over time. Hazard ratios (HRs) were reported with 95% CI, and p-value < 0.05 was considered statistically significant. Results From 1998 to 2019, 8,301 patients (8,894 knees) underwent RTKA surgery in Scotland (median age at RTKA 70 years (interquartile range (IQR) 63 to 76); median follow-up 6.2 years (IQR 3.0 to 10.2). In all, 4,764 (53.6%) were female, and 781 (8.8%) were treated for infection. Of these 8,894 knees, 957 (10.8%) underwent a second revision procedure. Male sex, younger age at index revision, and positive infection status were associated with need for re-revision. The ten-year survival estimate for RTKA was 87.3% (95% CI 86.5 to 88.1). Adjusting for sex, age, surgeon volume, and indication for revision, high hospital case volume was significantly associated with lower risk of re-revision (HR 0.78 (95% CI 0.64 to 0.94, p < 0.001)). The risk of re-revision steadily declined in centres performing > 20 cases per year; risk reduction was 16% with > 20 cases; 22% with > 30 cases; and 28% with > 40 cases. The lowest level of risk was associated with the highest volume centres. Conclusion The majority of RTKA in Scotland survive up to ten years. Increasing yearly hospital case volume above 20 cases is independently associated with a significant risk reduction of re-revision. Development of high-volume tertiary centres may lead to an improvement in the overall survival of RTKA. Cite this article: Bone Joint J 2021;103-B(4):602–609.

Download Full-text

Blood loss in primary total knee arthroplasty—body temperature is not a significant risk factor—a prospective, consecutive, observational cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-015-0241-5 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 8

Author(s):

Michael Dan ◽

Sara Martinez Martos ◽

Elaine Beller ◽

Peter Jones ◽

Ray Randle ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Cohort Study ◽

Significant Risk ◽

Primary Total Knee Arthroplasty ◽

Significant Risk Factor ◽

Observational Cohort Study ◽

Observational Cohort ◽

Total Knee ◽

Primary Total Knee

Download Full-text

Changes in opioid discharge prescriptions after primary total hip and total knee arthroplasty affect opioid refill rates and morphine milligram equivalents

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2392.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 103-110

Author(s):

Brian P. Chalmers ◽

Juliana Special Lebowitz ◽

Yu-Fen Chiu ◽

Amethia D. Joseph ◽

Douglas E. Padgett ◽

...

Keyword(s):

Risk Factor ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Significant Risk ◽

Significant Risk Factor ◽

Post Discharge ◽

The Usa ◽

Total Knee ◽

Discharge Prescription ◽

Arthroplasty Procedure

Aims Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions. Methods We retrospectively reviewed 19,428 patients undergoing a primary THA or TKA between 1 February 2016 and 31 December 2019. Two reductions in the number of opioid tablets prescribed at discharge were implemented over this time; as such, we analyzed three periods (P1, P2, and P3) with different routine discharge MME (750, 520, and 320 MMEs, respectively). We investigated 90-day refill rates, refill MMEs, and whether discharge MMEs were associated with represcribing in a multivariate model. Results A discharge prescription of < 400 MMEs was not a risk factor for opioid represcribing in the entire population (p = 0.772) or in opioid-naïve patients alone (p = 0.272). Procedure type was the most significant risk factor for narcotic represcribing, with unilateral TKA (hazard ratio (HR) = 5.62), bilateral TKA (HR = 6.32), and bilateral unicompartmental knee arthroplasty (UKA) (HR = 5.29) (all p < 0.001) being the highest risk for refills. For these three procedures, there was approximately a 5% to 6% increase in refills from P1 to P3 (p < 0.001); however, there was no significant increase in refill rates after any hip arthroplasty procedures. Total MMEs prescribed were significantly reduced from P1 to P3 (p < 0.001), leading to the equivalent of nearly 500,000 fewer oxycodone 5 mg tablets prescribed. Conclusion Decreasing opioids prescribed at discharge led to a statistically significant reduction in total MMEs prescribed. While the represcribing rate did not increase for any hip arthroplasty procedure, the overall refill rates increased by about 5% for most knee arthroplasty procedures. As such, we are now probably prescribing an appropriate amount of opioids at discharge for knee arthroplasty procedure, but further reductions may be possible for hip arthroplasty procedures. Cite this article: Bone Joint J 2021;103-B(7 Supple B):103–110.

Download Full-text

Low Albumin Is a Risk Factor for Complications after Revision Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0036-1584575 ◽

2016 ◽

Vol 30 (03) ◽

pp. 269-275 ◽

Cited By ~ 4

Author(s):

Charles Nelson ◽

Nabil Elkassabany ◽

Zhenggang Guo ◽

Jiabin Liu ◽

Atul Kamath

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Total Knee

Download Full-text

Central Sensitization Is a Risk Factor for Persistent Postoperative Pain and Dissatisfaction in Patients Undergoing Revision Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2019.03.042 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1740-1748 ◽

Cited By ~ 3

Author(s):

Man S. Kim ◽

In J. Koh ◽

Sueen Sohn ◽

Byung M. Kang ◽

Dong H. Kwak ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Central Sensitization ◽

Revision Total Knee Arthroplasty ◽

Total Knee ◽

Persistent Postoperative Pain

Download Full-text

Corrigendum to “Preoperative opioid use is a risk factor for complication and increased healthcare utilization following revision total knee arthroplasty” [The Knee 27 (2020) 1121–1127]

The Knee ◽

10.1016/j.knee.2020.11.015 ◽

2020 ◽

Author(s):

Jacob M. Wilson ◽

Kevin X. Farley ◽

Thomas L. Bradbury ◽

Greg A. Erens ◽

George N. Guild

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Healthcare Utilization ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Opioid Use ◽

Total Knee

Download Full-text

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.

Download Full-text