scholarly journals The impact of chronic kidney disease on postoperative complications in patients undergoing revision total knee arthroplasty: A propensity matched analysis

2020 ◽  
Vol 11 (1) ◽  
pp. 147-153
Author(s):  
Danny Lee ◽  
Ryan Lee ◽  
David Strum ◽  
Jessica H. Heyer ◽  
Taylor Swansen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Kidney Disease ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee ◽  
The Impact

The Association of International Normalized Ratio with Postoperative Complications in Revision Total Knee Arthroplasty

2019 ◽  
Author(s):  
Jessica L. Churchill ◽  
Linsen T. Samuel ◽  
J. M. Karnuta ◽  
Alexander J. Acuña ◽  
Atul F. Kamath
Keyword(s):  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
International Normalized Ratio ◽  
Revision Total Knee Arthroplasty ◽  
Hospital Length Of Stay ◽  
Operating Characteristics ◽  
Improvement Program ◽  
Increased Risk ◽  
Total Knee

AbstractThe purpose of this study was to examine the relationship between elevated preoperative international normalized ratio (INR) and (1) mortality, (2) postoperative bleeding, and (3) other postoperative complications in a national cohort of patients who underwent revision total knee arthroplasty (rTKA). The American College of Surgeons National Surgical Quality Improvement Program was queried for rTKA procedures conducted between 2006 and 2017. Cohorts were based on INR ranges: <1, 1 < INR ≤ 1.25, 1.25 < INR ≤ 1.5, and >1.5. Univariate/multivariate statistics were calculated to analyze associations between INR value and designated covariates. These statistics were additionally applied to optimal cutoff values of INR calculated using a receiver operating characteristics curve. The final cohort consisted of 1,676 patients. Progressively higher INR values were associated with an increased risk of mortality within 30 days (p < 0.006), bleeding requiring transfusion (p < 0.001), sepsis (p < 0.001), return to the operating room (Odds Ratio [OR], p = 0.011), reintubation (p < 0.001), pneumonia (p < 0.001), failure to wean from mechanical ventilation ≤48 hours (p < 0.001), acute renal failure (p = 0.001), and hospital length of stay (LOS). Statistically significant associations were similarly seen when calculated optimal INR values were used. Optimal INR turn point was found to be associated with a significant increased risk of long LOS (optimal INR = 1.03, OR: 1.7, 95% confidence interval [CI]: 1.33–2.18; p < 0.001) and a significant decreased risk of bleeding requiring transfusion (INR = 1.005, OR: 0.732, 95% CI: 0.681–0.786; p < 0.001). High preoperative INR values were independently and significantly associated with an increased risk of multiple postoperative complications. Current guidelines for INR <1.5 should be reassessed for patients undergoing rTKA.

What Is the Impact of Smoking on Revision Total Knee Arthroplasty?

2018 ◽  
Vol 33 (7) ◽  
pp. S172-S176 ◽  
Author(s):  
Nicholas A. Bedard ◽  
S. Blake Dowdle ◽  
Brandon G. Wilkinson ◽  
Kyle R. Duchman ◽  
Yubo Gao ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Total Knee ◽  
The Impact

scholarly journals Impact of Smoking on the Incidence and Postoperative Complications of Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Cohort Studies

2021 ◽  
Author(s):  
Yuqi He ◽  
Mohamed Omar ◽  
Xiaoyuan Feng ◽  
Claudia Neunaber ◽  
Michael Jagodzinski
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Cohort Studies ◽  
Knee Arthroplasty ◽  
Surgical Complications ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Total Knee ◽  
The Impact

Osteoarthritis and rheumatoid arthritis are the most ubiquitous joint disorders which cause tremendous loss of life quality and impose an economic burden on society. At present, the treatment options for these two diseases comprise non-operative and surgical treatments, amongst those total knee arthroplasties (TKA). Various studies have recognized smoking as a significant risk factor for postoperative complications. Therefore, the purpose of this study was to examine the impact of smoking on the incidence and postoperative complications after a total knee arthroplasty by a systematic review and meta-analysis. The research was performed using PUBMED, Cochrane Library and EMBASE, extracting data from thirteen suitable studies and incorporating 2,109,482 patients. Cohort studies evaluating the impact of smoking on TKA with sufficient data were included for the study, and cohort studies without a proper control group and complete data were excluded. A fixed-effects or random-effects model was used to measure the pooled risk ratio (RR) or hazard ratio (HR) with 95% confidence interval (CI). Compared to non-smokers, smokers had a significantly lower incidence of TKA (p<0.01). However, smokers had a higher incidence of total complications (p=0.01), surgical complications (p<0.01), pneumonia (p<0.01) and revision surgery (p=0.01). No significant difference in the risk of blood transfusion (p=0.42), deep vein thrombosis (p=0.31), pulmonary embolism (p=0.34), urinary tract infection (p=0.46) or mortality (p=0.39) was found between smokers and non-smokers. In conclusion, the study indicated that tobacco has two diametrically opposite effects on TKA patients: 1. Tobacco increases the incidence of surgical complications, pneumonia and revision after TKA; 2. It decreases the overall risk of being a candidate for TKA.

scholarly journals Immersive virtual reality enables technical skill acquisition for scrub nurses in complex revision total knee arthroplasty

2021 ◽  
Author(s):  
Thomas C. Edwards ◽  
Arjun Patel ◽  
Bartosz Szyszka ◽  
Alexander W. Coombs ◽  
Alexander D. Liddle ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Virtual Reality ◽  
Knee Arthroplasty ◽  
Real World ◽  
Revision Total Knee Arthroplasty ◽  
Dominant Hand ◽  
Immersive Virtual Reality ◽  
The Real ◽  
Total Knee ◽  
The Impact

Abstract Introduction Immersive Virtual Reality (iVR) is a novel technology which can enhance surgical training in a virtual environment without supervision. However, it is untested for the training to select, assemble and deliver instrumentation in orthopaedic surgery—typically performed by scrub nurses. This study investigates the impact of an iVR curriculum on this facet of the technically demanding revision total knee arthroplasty. Materials and methods Ten scrub nurses completed training in four iVR sessions over a 4-week period. Initially, nurses completed a baseline real-world assessment, performing their role with real equipment in a simulated operation assessment. Each subsequent iVR session involved a guided mode, where the software taught participants the procedural choreography and assembly of instrumentation in a simulated operating room. In the latter three sessions, nurses also undertook an assessment in iVR. Outcome measures were related to procedural sequence, duration of surgery and efficiency of movement. Transfer of skills from iVR to the real world was assessed in a post-training simulated operation assessment. A pre- and post-training questionnaire assessed the participants knowledge, confidence and anxiety. Results Operative time reduced by an average of 47% across the 3 unguided sessions (mean 55.5 ± 17.6 min to 29.3 ± 12.1 min, p > 0.001). Assistive prompts reduced by 75% (34.1 ± 16.8 to 8.6 ± 8.8, p < 0.001), dominant hand motion by 28% (881.3 ± 178.5 m to 643.3 ± 119.8 m, p < 0.001) and head motion by 36% (459.9 ± 99.7 m to 292.6 ± 85.3 m, p < 0.001). Real-world skill improved from 11% prior to iVR training to 84% correct post-training. Participants reported increased confidence and reduced anxiety in scrubbing for rTKA procedures (p < 0.001). Conclusions For scrub nurses, unfamiliarity with complex surgical procedures or equipment is common. Immersive VR training improved their understanding, technical skills and efficiency. These iVR-learnt skills transferred into the real world.

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