The Risk Factors of Postoperative Delirium after Total Knee Arthroplasty

2016 ◽  
Vol 30 (06) ◽  
pp. 600-605 ◽  
Author(s):  
Lih Wang ◽  
Sungsoo Kim ◽  
Kyungtaek Kim ◽  
Seunghyun Lee ◽  
Kyungho Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Start Time ◽  
Duration Of Hospital Stay ◽  
History Of ◽  
Total Knee ◽  
Underlying Diseases

AbstractWe investigated the results of delirium which developed after total knee arthroplasty (TKA) and the risk factors for delirium in the patients who are older than 65 years. From March 2008 to March 2012, we performed a retrospective study on 296 knees of 265 patients who were treated with TKA. They were divided into two groups: 216 patients without delirium and 49 patients diagnosed with delirium by psychiatry. We analyzed the risk factors into three categories: First, the preoperative factors including gender, age, body mass index (BMI), clinical and functional knee joint score (Knee Society Knee Score and Knee Society Function Score) and the number of underlying diseases and associations with each disease; Second, the operative factors including the anesthesia method, amount of blood loss, operating time, laboratory factors, and transfusion count; Third, the postoperative factors such as start time of walking and duration of hospital stay were analyzed. There were significant statistical difference between two groups just in age, history of dementia, cerebrovascular disease, difference of hemoglobin and albumin, start time of walking, and duration of hospital stay. The delirium after TKA delays the postoperative ambulation and extends the hospital stay, which causes functional and socioeconomic loss of patients. Therefore, the risk factors for delirium should be assessed and proper prevention and management should be conducted.

scholarly journals Reinfection Rate and Its Associated Factors after Two-Stage Revision for Infected Total Knee Arthroplasty

2021 ◽  
Author(s):  
Chang Hyun Nam ◽  
Su Chan Lee ◽  
Kyungwon Choi ◽  
Ji-Hoon Baek ◽  
Hye Sun Ahn
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Multivariable Logistic Regression Analysis ◽  
Two Stage ◽  
Reinfection Rate ◽  
Infected Total Knee Arthroplasty ◽  
History Of ◽  
Total Knee ◽  
History Of Cancer

Abstract Background: Two-stage revision is the gold standard for treatment of infected total knee arthroplasty. The purpose of our study was to evaluate the reinfection rate of two-stage revision and to analyze the factors affecting the prognosis of two-stage revision for infected total knee arthroplasty.Methods: One hundred seven cases of two-stage revision for infected total knee arthroplasty were reviewed retrospectively from March 2006 to November 2019. We evaluated possible risk factors between success and reinfection groups. Statistical analyses included multivariable logistic regression analysis to examine the relative contribution of risk factors to the success of two-stage revision. Results: There were 19 cases of reinfection (17.8%) after two-stage revision in our center. Between the success and reinfection groups, there was a significant difference in history of cancer (p=0.015). Also, multivariable logistic regression analysis of risk factors demonstrated history of cancer (HR 5.928, p=0.015). There were no statistically significant differences in reinfection relative to other risk factors. Conclusions: In subjects undergoing two-stage revision for infected total knee arthroplasty, history of cancer was a risk factor for reinfection, though no other significant differences between risk factors was shown for reinfection.Trial registration: Retrospectively registeredLevel of evidence: IV

scholarly journals COMPARISON OF EFFICACY OF TRANEXAMIC ACID 10 MG/KG AND 15 MG/KG IN REDUCING BLEEDING AND TRANSFUSIONS IN TOTAL KNEE ARTHROPLASTY

2019 ◽  
pp. 535-538
Author(s):  
HIMA R NAMBIAR ◽  
SHAILA S KAMATH
Keyword(s):  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
P Value ◽  
Duration Of Hospital Stay ◽  
Institutional Ethics ◽  
Number Of Patients ◽  
Total Knee ◽  
Group B

Objective: The objective of this study was to compare the efficacy of tranexamic acid 10 mg/kg and 15 mg/kg in reducing bleeding and transfusions in total knee arthroplasty. Methods: After approval from the Institutional Ethics Committee, KMC, Mangaluru, 88 patients fulfilling the inclusion criteria of this study undergoing total knee replacements were informed of the study details and consent was obtained for the same. They were randomized into two groups using computer-generated block randomization, i.e., Group A and Group B, and were administered tranexamic acid 10 mg/kg and 15 mg/kg intravenously, respectively. Intraoperatively, hemodynamic parameters were noted. Postoperatively, hemoglobin levels were assessed on days 1 and 3. Transfusions, thromboembolic complications, and duration of hospital stay were noted. Results: Of the 88 participants of the trial, 44 in Groups A and B each, there were no significant differences in the parameters observed in this study such as intraoperative hemodynamic changes, post-operative fall in hemoglobin on day 3, number of patients requiring transfusions, number of thromboembolic events, and duration of hospital stay. A significant p-value was observed in the fall in hemoglobin in the post-operative day 3 (p=0.043). Conclusion: About 15 mg/kg tranexamic acid proved to have a lesser fall in hemoglobin on day 3 postoperatively when compared to the 10 mg/kg group. However, the fall of hemoglobin on day 3 was statistically significant and warranted a blood transfusion in two patients in the 10 mg/kg group but did not prolong their hospital stay.

Venous Thromboembolic Events after Total Knee Arthroplasty: Which Patients Are at a High Risk?

2019 ◽  
Vol 33 (10) ◽  
pp. 947-957 ◽  
Author(s):  
Wen-Li Dai ◽  
Ze-Ming Lin ◽  
Zhan-Jun Shi ◽  
Jian Wang
Keyword(s):  
United States ◽  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
The United States ◽  
Inhospital Mortality ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Total Knee

AbstractVenous thromboembolism (VTE; deep venous thrombosis and pulmonary embolism) is a known complication following primary total knee arthroplasty (TKA). The aim of this study was to investigate the trends of the incidence of VTE after primary TKA and identify associated risk factors for the occurrence of VTEs in a large cohort of TKA patients. We performed a retrospective study in which the Nationwide Inpatient Sample (NIS) database was used to identify all patients who underwent primary TKA over a period of 13 consecutive years (between 2002 and 2014) in the United States. The occurrence of a symptomatic VTE was identified with the use of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes. A total of 1,460,901 primary TKA procedures were identified in the NIS from 2002 to 2014, and 12,944 of these patients were recorded as having 13,855 VTEs, consisting of 7,609 deep venous thromboses (0.52%) and 6,246 pulmonary emboli (0.43%). The overall VTE incidence in patients undergoing TKA in the United States from 2002 to 2014 was 0.89%. Patient-related risk factors for VTEs include an older age (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.31–1.59), black race (OR: 1.34; 95% CI: 1.25–1.44), and Medicare insurance (OR: 1.18; 95% CI: 1.13–1.22). Most of the comorbidities were associated with an increased risk of VTE following TKA. Particularly, cardiac arrhythmias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss increased the risk of VTE by more than twofold. After adjusting for confounders, VTE was associated with a longer hospital stay (2.81 ± 0.02 day), increased costs (US$14,212.16 ± US$255.64), and higher mortality rate (OR: 13.04; 95% CI: 11.08–15.35). This nationally representative study of inpatients in the United States identified several independent risk factors for VTE perioperatively in TKA patients and provided evidence that VTE patients after TKA are likely to have worse results than non-VTE patients with regard to the length of hospital stay, hospital costs, and inhospital mortality. This is a level III, prognostic study.

scholarly journals PERIARTICULAR REGIONAL ANALGESIA REDUCES PAIN AND HOSPITAL STAY AFTER TOTAL KNEE ARTHROPLASTY: A PROSPECTIVE, RANDOMIZED, AND DOUBLE-BLINDED CONTROLLED TRIAL

2020 ◽  
pp. 154-159
Author(s):  
PULIN BIHARI DAS ◽  
ANAND KUMAR SINGH ◽  
ARINDAM CHATTERJEE ◽  
ANURAG SINGH
Keyword(s):  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Local Infiltration ◽  
Periarticular Injection ◽  
Duration Of Hospital Stay ◽  
Post Operative Pain ◽  
Total Knee ◽  
Pain At Rest

Objective: There are multiple post-operative pain protocols for patients who undergo total knee arthroplasty (TKA). Post-operative analgesia with opioids or epidural analgesia has its side effect. We compared the duration of hospital stay, pain score, and range of motion of a control group who had no local infiltration with a group who had local infiltration analgesia following TKA. Methods: Randomization was done in 60 patients who underwent TKA in two groups, one who did not receive and the other who received a multimodal cocktail periarticular injection containing 30 ml of 0.5% bupivacaine, 1 ml of 30 mg ketorolac, 1 ml of 1 in 1000 adrenaline, 2 ml of 80 mg gentamycin, 5 ml of 750 mg cefuroxime, and rest 0.9% of normal saline. Visual analog score (VAS) for pain at rest was recorded and assessed preoperatively and postoperatively at 2, 6, 12, 24, 36 h, 2, 3, and 7 days and during an activity at 24 h, 36 h, 2, 3, and 7 days. Results: The patient who had received the local injection used very few analgesics over the first 24 h of surgery. Moreover, patients, where local infiltration was used, showed lower VAS for pain (at rest and during activity). They also showed higher VAS for patients’ satisfaction. Conclusion: Due to the reduced post-operative pain with periarticular injection analgesia, it was observed that the pain and duration of hospital stay were significantly reduced.

scholarly journals Higher body mass index is not a risk factor for in-hospital adverse outcomes following total knee arthroplasty

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880242 ◽  
Author(s):  
Usha Gurunathan ◽  
Aaron Pym ◽  
Cameron Anderson ◽  
Amanda Marshall ◽  
Sarah L Whitehouse ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Normal Weight ◽  
Cardiac Complications ◽  
Weight Category ◽  
Obese Class ◽  
Total Knee

Purpose: To investigate the association between body mass index (BMI) and perioperative complications until hospital discharge, following primary total knee arthroplasty (TKA). Methods: This retrospective study reviewed 1665 cases of elective primary unilateral TKA performed between 2006 and 2010, from a prospective secure electronic database. Types of complications, length of operating time, and duration of hospital stay were analyzed in both adjusted (for known confounders) and unadjusted analyses. A further matched analysis was also performed. Results: In terms of overall complications, there was no statistically significant difference between the BMI categories. When individual obesity category was considered, obese 2 had the lowest odds of developing complications, both with unadjusted (odds ratio (OR): 0.61, 95% confidence interval (CI) 0.41–0.91, p < 0.015) and adjusted regression analysis (OR: 0.65, 95% CI: 0.43–0.99, p = 0.044). Compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at 66% (OR: 0.34, 95% CI: 0.21–0.55) lower (unadjusted) odds of developing cardiac complications (overall p < 0.001). With the matched analysis, compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at a 60% (OR: 0.40, 95% CI: 0.23–0.68) lower (unadjusted) odds of developing cardiac complications (overall p = 0.004). Obese 3 patients had significantly higher operating time compared with other groups ( p < 0.001). Conclusion: This study did not find a significant association between BMI and increased overall in-hospital medical or surgical complications following primary TKA. Obesity significantly increased the length of operating time.

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