THE POTENTIAL UTILISATION OF PARTIAL KNEE ARTHROPLASTY AND ASSESSMENT OF ACL STATUS IN END STAGE KNEE OSTEOARTHRITIS

Introduction: Up to 33% and 25% of patients with end-stage hip and knee osteoarthritis (OA) are considered frail by the Groningen Frailty Indicator (GFI). This study aims to assess whether frail patients have lower functional gains after arthroplasty and to assess GFI as a tool to discriminate between good and adverse change score. Materials and Methods: Patients with end-stage hip/knee OA scheduled for arthroplasty were recruited from the Longitudinal Leiden Orthopaedics Outcomes of Osteo-Arthritis Study. Functional outcome was measured as change score on the Hip Osteoarthritis Outcome Score/Knee Osteoarthritis Outcome Score (HOOS/KOOS), by subtracting preoperative score from 1-year postsurgery score and then dichotomized based on a cutoff of 20 points. For each HOOS/KOOS subscale, 3 models were estimated: GFI univariate (model 1), GFI and baseline score (model 2), and baseline score univariate (model 3). A receiver operating characteristic analysis was performed to assess the discriminative ability of each model. Results: Eight hundred five patients with end-stage hip OA (31.4% frail) and 640 patients with end-stage knee OA (25.4% frail) were included. Frail patients were older, had a higher body mass index, had more comorbidities, and lived more often alone. Persons considered frail by GFI had significant lower baseline score; however, except for “function in sports and recreation” and “quality of life,” change scores were similar in frail and nonfrail persons. The discriminatory value of GFI was negligible for all HOOS/KOOS subscales. Baseline score, however, was adequate to discriminate between total knee arthroplasty patients with more or less than twice the minimally clinically important difference on KOOS symptoms subscale (area under the curve = 0.802). Discussion/Conclusion: Although frail patients with OA have lower functioning scores at baseline, the change scores on HOOS/KOOS subscales are similar for both frail and nonfrail patients. Exploring other heath assessements may improve patient-specific outcome prediction.

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Serum polyunsaturated fatty acid (PUFAS) levels as a risk factor for the post-operative development of venous thromboembolism (VTE) in patients with end-stage knee osteoarthritis who receiving total knee arthroplasty (TKA)

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2016.01.941 ◽

2016 ◽

Vol 24 ◽

pp. S514 ◽

Cited By ~ 1

Author(s):

J. Shiozawa ◽

T. Miyazaki ◽

M. Nagayama ◽

H. Kaneko ◽

M. Hiki ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Risk Factor ◽

Fatty Acid ◽

Venous Thromboembolism ◽

Knee Osteoarthritis ◽

Polyunsaturated Fatty Acid ◽

Knee Arthroplasty ◽

Total Knee ◽

End Stage

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Early Economic Analysis of Robotic-Assisted Unicondylar Knee Arthroplasty May Be Cost Effective in Patients with End-Stage Osteoarthritis

The Journal of Knee Surgery ◽

10.1055/s-0040-1712088 ◽

2020 ◽

Cited By ~ 1

Author(s):

David Yeroushalmi ◽

James Feng ◽

Leo Nherera ◽

Paul Trueman ◽

Ran Schwarzkopf

Keyword(s):

Cost Effectiveness ◽

Markov Model ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Cost Effective ◽

The United States ◽

Unicondylar Knee Arthroplasty ◽

Robotic Assisted ◽

Single Compartment ◽

End Stage

AbstractUnicondylar knee arthroplasty (UKA), as an alternative to total knee arthroplasty (TKA), has been shown to be an effective option for patients with single-compartment end-stage knee osteoarthritis. Implant survival is contingent upon proper alignment, which has been improved with the advent of robotic-assisted surgery (r-UKA), but whether this outweighs the increased cost of the robotic-assist device has not been analyzed in the literature. The purpose of this study was to investigate the mid-term cost-effectiveness of r-UKA compared with UKA with traditional instrumentation (t-UKA) in the United States. A cost-effectiveness analysis using a four-state Markov model was performed using data from the 2018 National Joint Registry of England and Wales and a retrospective multicenter, cohort study on a cohort of 65-year-old patients having undergone r-UKA. The main outcome was cost per revision avoided and sensitivity analyses were conducted to evaluate the impact of using different model assumptions on the results. The Markov model illustrated that the benefit derived from r-UKA versus t-UKA was beneficial from a payer's perspective. The estimated incremental cost-effectiveness ratio (ICER) was $14,737 per revision avoided in a facility seeing 100 patients a year. Case volume was shown to be the primary variable affecting cost-effectiveness, with the value of r-UKA directly increasing with higher case volumes. Cost-effectiveness analyses demonstrated that the use of r-UKA is an effective alternative to t-UKA in patients with single-compartment knee osteoarthritis. While this study could benefit from longer follow-up clinical studies to illustrate the benefits of r-UKAs beyond the current 2 years time horizon, r-UKAs remained cost-effective, even after investigating several different assumptions.

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Contemporary knee arthroplasty: one fits all or time for diversity?

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-04042-4 ◽

2021 ◽

Author(s):

Johannes Beckmann ◽

Malin Kristin Meier ◽

Christian Benignus ◽

Andreas Hecker ◽

Emmanuel Thienpont

Keyword(s):

Personalized Medicine ◽

Knee Osteoarthritis ◽

Knee Replacement ◽

Knee Arthroplasty ◽

Treatment Options ◽

Patient Specific ◽

Partial Knee Arthroplasty ◽

Limited Series ◽

Total Knee ◽

The Individual

Abstract Introduction Total knee arthroplasty (TKA) has historically been the preferred solution for any type of knee osteoarthritis, independently of the number of compartments involved. In these days of patient-specific medicine, mono-compartmental disease could also be approached with a more individualized treatment, such as partial knee arthroplasty (PKA). Off-the-shelf (OTS) implants are often the compromise of averages and means of a limited series of anatomical parameters retrieved from patients and the pressure of cost control by limited inventory. Personalized medicine requires respect and interest for the individual shape and alignment of each patient. Materials and methods A Pubmed and Google Scholar search were performed with the following terms: “patient-specific knee” and “arthroplasty” and “custom implant” and “total knee replacement” and “partial knee replacement” and “patellofemoral knee replacement” and “bicompartmental knee replacement”. The full text of 90 articles was used to write this narrative review. Results Unicondylar, patellofemoral and bicompartmental knee arthroplasty are successful treatment options, which can be considered over TKA for their bone and ligament sparing character and the superior functional outcome that can be obtained with resurfacing procedures. For TKA, where compromises dominate our choices, especially in patients with individual variations of their personal anatomy outside of the standard, a customized implant could be a preferable solution. Conclusion TKA might not be the only solution for every patient with knee osteoarthritis, if personalized medicine wants to be offered. Patient-specific mono-compartmental resurfacing solutions, such as partial knee arthroplasty, can be part of the treatment options proposed by the expert surgeon. Customized implants and personalized alignment options have the potential to further improve clinical outcome by identifying the individual morphotype and respecting the diversity of the surgical population.

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