scholarly journals Incidence of Drug Abuse in Revision Total Knee Arthroplasty Population

2018 ◽  
Vol 31 (10) ◽  
pp. 928-933 ◽  
Author(s):  
Martin Roche ◽  
Tsun Law ◽  
Nipun Sodhi ◽  
Samuel Rosas ◽  
Jennifer Kurowicki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Drug Abuse ◽  
Knee Arthroplasty ◽  
Postoperative Pain Management ◽  
Revision Total Knee Arthroplasty ◽  
Alcohol Abusers ◽  
Patient Demographics ◽  
Increased Risk ◽  
Primary Tkas ◽  
Total Knee

AbstractSubstance abuse can have strong negative impacts on surgical outcomes. Therefore, this study assessed the effects of drug abuse in total knee arthroplasty (TKA) patients. Specifically, we identified revision TKA (RTKA): (1) incidence, (2) causes, (3) time to revision, and (4) patient demographics in patients with a history of drug abuse. The Medicare database within the PearlDiver Supercomputer (Warsaw, IN) was queried to identify 2,159,221 TKAs performed between 2005 and 2012. Drug abuse was subdivided into cocaine, cannabis, opioids, sedatives/hypnotics/anxiolytics (SHA), amphetamines, and alcohol abusers. The effect of drug use on the incidence and cause for RTKA, time to revision, as well as patient demographics were correlated using multivariate, analysis of variance, and regression analyses. There was a significant increase in the number of primary TKAs in cocaine (p = 0.011), cannabis (p < 0.001), opioid (p < 0.001), SHA (p < 0.001), amphetamine (p < 0.001), and alcohol (p < 0.001) users. Amphetamine users had the fastest mean time to revision (691 days, standard deviation: 679 days). At 30-, 90-day, and 6-month postoperative, cocaine had the highest proportion of patients requiring RTKA (7, 12, and 20%, respectively), and at 1-year alcohol abusers (38%, p < 0.001). Infection was the most common cause of revision in all drug abuse/dependent cohorts. Age distributions varied significantly by group for primary TKA (p < 0.001). Comorbidity status was similar in all RTKA patients as determined by comparison of the mean Charlson comorbidity index scores (p = 0.091). Based on these results, drug abuse patients are at increased risk for RTKA. These high-risk patients should, therefore, be appropriately risk stratified and receive comprehensive postoperative pain management.

3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 150-157
Author(s):  
Lucas A. Anderson ◽  
Matthew Christie ◽  
Brenna E. Blackburn ◽  
Chad Mahan ◽  
Christian Earl ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
Revision Total Knee Arthroplasty ◽  
Logistic Regression Models ◽  
Metaphyseal Fixation ◽  
Increased Risk ◽  
Primary Tkas ◽  
3D Printed ◽  
Total Knee

Aims Porous metaphyseal cones can be used for fixation in revision total knee arthroplasty (rTKA) and complex TKAs. This metaphyseal fixation has led to some surgeons using shorter cemented stems instead of diaphyseal engaging cementless stems with a potential benefit of ease of obtaining proper alignment without being beholden to the diaphysis. The purpose of this study was to evaluate short term clinical and radiographic outcomes of a series of TKA cases performed using 3D-printed metaphyseal cones. Methods A retrospective review of 86 rTKAs and nine complex primary TKAs, with an average age of 63.2 years (SD 8.2) and BMI of 34.0 kg/m2 (SD 8.7), in which metaphyseal cones were used for both femoral and tibial fixation were compared for their knee alignment based on the type of stem used. Overall, 22 knees had cementless stems on both sides, 52 had cemented stems on both sides, and 15 had mixed stems. Postoperative long-standing radiographs were evaluated for coronal and sagittal plane alignment. Adjusted logistic regression models were run to assess malalignment hip-knee-ankle (HKA) alignment beyond ± 3° and sagittal alignment of the tibial and femoral components ± 3° by stem type. Results No patients had a revision of a cone due to aseptic loosening; however, two had revision surgery due to infection. In all, 26 (27%) patients had HKA malalignment; nine (9.5%) patients had sagittal plane malalignment, five (5.6%) of the tibia, and four (10.8%) of the femur. After adjusting for age, sex, and BMI, there was a significantly increased risk for malalignment when a cone was used and both the femur and tibia had cementless compared to cemented stems (odds ratio 3.19, 95% confidence interval 1.01 to 10.05). Conclusion Porous 3D-printed cones provide excellent metaphyseal fixation. However, these central cones make the use of offset couplers difficult and may generate malalignment with cementless stems. We found 3.19-times higher odds of malalignment in our TKAs performed with metaphyseal cones and both femoral and tibial cementless stems. Cite this article: Bone Joint J 2021;103-B(6 Supple A):150–157.

Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 191-195
Author(s):  
Elizabeth B. Gausden ◽  
Matthew B. Shirley ◽  
Matthew P. Abdel ◽  
Rafael J. Sierra
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Significant Risk ◽  
Wound Dehiscence ◽  
Increased Risk ◽  
Primary Tkas ◽  
Traumatic Wound ◽  
Total Knee

Aims To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA). Methods From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed. Results Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component. Conclusion Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J 2021;103-B(6 Supple A):191–195.

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.

Periprosthetic Infection: Major Cause of Early Failure of Primary and Revision Total Knee Arthroplasty

2018 ◽  
Vol 32 (10) ◽  
pp. 941-946 ◽  
Author(s):  
Dimitrios S. Evangelopoulos ◽  
Sufian S. Ahmad ◽  
Anna M. Krismer ◽  
Christoph E. Albers ◽  
Sven Hoppe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Functional Score ◽  
Extension Deficit ◽  
Primary Tkas ◽  
Significant Difference ◽  
Flexion Extension ◽  
Cause Of Failure ◽  
Total Knee

AbstractRevision total knee arthroplasty (RTKA) represents an effective treatment for failed TKA, but with less favorable outcomes. Considering the technical complexity and economic burden of RTKA procedures, it is mandatory to investigate current mechanisms and predictors for RTKA failure. The objective of this study is to evaluate the survivorship and determine the predominant causes of failure of RTKA. A total of 146 patients undergoing RTKA between 2003 and 2013 were identified from the institutional database. Revision was defined as surgery in which the whole prostheses (inlay and both femoral and tibial components) required exchange. Median follow-up was 6.3 ± 2.7 years (range: 2.2–10). Patient demographics, year of primary implantation, reasons for revision surgery, implant type, pain, knee mobility, systemic or local postoperative complications, and treatment of the complications were recorded and evaluated. Infection was a major cause of failure followed by aseptic loosening, instability, pain, malalignment, and inlay wear. Following RTKA, Knee Society Score (KSS) (knee score and functional score) demonstrated a significant improvement (p < 0.05). No significant difference in flexion, extension deficit, and KSS was detected between aseptic and septic primary TKAs preoperatively and following first RTKA. Reinfection rate of the septic primary TKAs was 5%. Infection was the major cause of a second revision, reaching as high as 50% in all cases. The results of this study support that septic failure of a primary TKA is likely to occur within the first 2 years following implantation. Septic failure of primary TKA does not influence survival of the revision prosthesis.

scholarly journals Revision total knee arthroplasty versus primary total knee arthroplasty

2020 ◽  
Vol 1 (3) ◽  
pp. 29-34
Author(s):  
Paul Stirling ◽  
Scott D. Middleton ◽  
Ivan J. Brenkel ◽  
Phil J. Walmsley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Lateral Release ◽  
Matched Cohort ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Revision Tka

Introduction The primary aim of this study was to describe a baseline comparison of early knee-specific functional outcomes following revision total knee arthroplasty (TKA) using metaphyseal sleeves with a matched cohort of patients undergoing primary TKA. The secondary aim was to compare incidence of complications and length of stay (LOS) between the two groups. Methods Patients undergoing revision TKA for all diagnoses between 2009 and 2016 had patient-reported outcome measures (PROMs) collected prospectively. PROMs consisted of the American Knee Society Score (AKSS) and Short-Form 12 (SF-12). The study cohort was identified retrospectively and demographics were collected. The cohort was matched to a control group of patients undergoing primary TKA. Results Overall, 72 patients underwent revision TKA and were matched with 72 primary TKAs with a mean follow-up of 57 months (standard deviation (SD) 20 months). The only significant difference in postoperative PROMs was a worse AKSS pain score in the revision group (36 vs 44, p = 0.002); however, these patients still produced an improvement in the pain score. There was no significant difference in improvement of AKSS or SF-12 between the two groups. LOS (9.3 days vs 4.6 days) and operation time (1 hour 56 minutes vs 1 hour 7 minutes) were significantly higher in the revision group (p < 0.001). Patients undergoing revision were significantly more likely to require intraoperative lateral release and postoperative urinary catheterisation (p < 0.001). Conclusion This matched-cohort study provides results of revision TKA using modern techniques and implants and outlines what results patients can expect to achieve using primary TKA as a control. This should be useful to clinicians counselling patients for revision TKA.

Does Manipulation under Anesthesia Increase the Risk of Revision Total Knee Arthroplasty? A Matched Case Control Study

2017 ◽  
Vol 30 (07) ◽  
pp. 730-733 ◽  
Author(s):  
Todd Pierce ◽  
Kimona Issa ◽  
Anthony Festa ◽  
Anthony Scillia ◽  
Vincent McInerney ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Revision Total Knee Arthroplasty ◽  
Matched Cohort ◽  
Manipulation Under Anesthesia ◽  
Time Period ◽  
Increased Risk ◽  
Total Knee ◽  
Revision Tka

Manipulation under anesthesia (MUA) can help patients regain an adequate range of motion (ROM) following total knee arthroplasty (TKA). Although there are studies reporting that MUA can assist in improving ROM, there is a paucity of studies regarding whether requiring an MUA is associated with an increased risk of revision. The purpose of this study was to assess the: (1) incidence of revision TKA and (2) outcomes of those undergoing MUA and compare it with a matched cohort who did not require MUA. A prospectively collected database of two high-volume institutions was assessed for patients who required a single MUA following TKA between 2005 and 2011. We found a total of 138 knees with a mean 8.5-year follow-up post-MUA. We compared this with a matched cohort (1:1) who underwent TKA during this same time period but did not require an MUA. Incidence of revision surgery and clinical outcomes were compared between the two cohorts. Within the MUA cohort, nine knees underwent revision, which was similar to the matched cohort that had seven revisions (93 vs. 95%; p = 0.6). The mean KSS-functional (88 vs. 90 points; p = 0.15) and clinical scores (87 vs. 89 points; p = 0.1) were similar between the two cohorts. Undergoing an MUA was not associated with an increased risk of revision TKA. If patients require MUA, they may still achieve satisfactory outcomes. This information can be used in educating patients so they may be able to formulate their expectations following their MUA.

Greater Prevalence of Mental Health Conditions in Septic Revision Total Knee Arthroplasty: A Call to Action

2020 ◽  
Author(s):  
Hiba K. Anis ◽  
Jared A. Warren ◽  
Alison K. Klika ◽  
Suparna M. Navale ◽  
Guangjin Zhou ◽  
...  
Keyword(s):  
Mental Health ◽  
Total Knee Arthroplasty ◽  
Drug Abuse ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Health Conditions ◽  
Mental Health Conditions ◽  
Aseptic Revision ◽  
Total Knee ◽  
Septic Revision

AbstractThe purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) primary total knee arthroplasty (pTKA), (2) septic revision total knee arthroplasty (rTKA), and (3) aseptic revision total knee arthroplasty (TKA). The State Inpatient Databases were queried for all TKAs from 2005 to 2014 yielding 563,144 patients. Patients were separated into the following cohorts: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition and the following specific conditions were compared between the three cohorts: schizophrenia/delusion, bipolar disorder, depression/mood disorder, personality disorder, anxiety/somatic/dissociative disorder, eating disorders, attention deficit hyperactivity disorder /conduct/impulse control, alcohol abuse, and drug abuse. Throughout the study period, an increase in the prevalence of mental health conditions was observed in septic and aseptic revision patients. Overall, there was a significantly higher prevalence of mental health conditions in the septic revision cohort (22.7%) compared with the primary (17.8%, p < 0.001) and aseptic revision (20.0%, p < 0.001) cohorts. Specifically, septic revision TKA patients had a higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), drug abuse (p < 0.001), schizophrenia (p = 0.0007), and bipolar disorder (p < 0.001), compared with primary TKA patients. Additionally, there was a significantly higher prevalence of depression (p < 0.001), alcohol abuse (p < 0.001), and drug abuse (p < 0.001) among septic revision patients compared with aseptic revision patients. Mental health conditions were significantly higher among septic revision patients. Alcohol and drug abuse were approximately twice as prevalent in septic revision patients compared with primary and aseptic revision patients. These findings should serve as a call to action for mental health support for patients suffering from PJI.

scholarly journals Revision total knee arthroplasty versus primary total knee arthroplasty

2020 ◽  
Vol 1 (3) ◽  
pp. 29-34
Author(s):  
Paul Stirling ◽  
Scott D. Middleton ◽  
Ivan J. Brenkel ◽  
Phil J. Walmsley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Lateral Release ◽  
Matched Cohort ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Revision Tka

Introduction The primary aim of this study was to describe a baseline comparison of early knee-specific functional outcomes following revision total knee arthroplasty (TKA) using metaphyseal sleeves with a matched cohort of patients undergoing primary TKA. The secondary aim was to compare incidence of complications and length of stay (LOS) between the two groups. Methods Patients undergoing revision TKA for all diagnoses between 2009 and 2016 had patient-reported outcome measures (PROMs) collected prospectively. PROMs consisted of the American Knee Society Score (AKSS) and Short-Form 12 (SF-12). The study cohort was identified retrospectively and demographics were collected. The cohort was matched to a control group of patients undergoing primary TKA. Results Overall, 72 patients underwent revision TKA and were matched with 72 primary TKAs with a mean follow-up of 57 months (standard deviation (SD) 20 months). The only significant difference in postoperative PROMs was a worse AKSS pain score in the revision group (36 vs 44, p = 0.002); however, these patients still produced an improvement in the pain score. There was no significant difference in improvement of AKSS or SF-12 between the two groups. LOS (9.3 days vs 4.6 days) and operation time (1 hour 56 minutes vs 1 hour 7 minutes) were significantly higher in the revision group (p < 0.001). Patients undergoing revision were significantly more likely to require intraoperative lateral release and postoperative urinary catheterisation (p < 0.001). Conclusion This matched-cohort study provides results of revision TKA using modern techniques and implants and outlines what results patients can expect to achieve using primary TKA as a control. This should be useful to clinicians counselling patients for revision TKA.

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