Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

AbstractDespite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

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When can total knee arthroplasty be safely performed following prior arthroscopy?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03859-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jin-Ning Ma ◽

Xiao-Lin Li ◽

Pan Liang ◽

Sheng-Li Yu

Keyword(s):

Total Knee Arthroplasty ◽

Postoperative Complications ◽

Knee Arthroplasty ◽

Acl Injury ◽

Control Group ◽

Optimal Timing ◽

Complication Rates ◽

Increased Risk ◽

Total Knee

Abstract Background The optimal timing to perform a total knee arthroplasty (TKA) after knee arthroscopy (KA) was controversial in the literature. We aimed to 1) explore the effect of prior KA on the subsequent TKA; 2) identify who were not suitable for TKA in patients with prior KA, and 3) determine the timing of TKA following prior KA. Methods We retrospectively reviewed 87 TKAs with prior KA and 174 controls using propensity score matching in our institution. The minimum follow-up was 2 years. Postoperative clinical outcomes were compared between groups. Kaplan-Meier curves were created with reoperation as an endpoint. Multivariate Cox proportional hazards regressions were performed to identify risk factors of severe complications in the KA group. The two-piecewise linear regression analysis was performed to examine the optimal timing of TKA following prior KA. Results The all-cause reoperation, revision, and complication rates of the KA group were significantly higher than those of the control group (p < 0.05). The survivorship of the KA group and control group was 92.0 and 99.4% at the 2-year follow-up (p = 0.002), respectively. Male (Hazards ratio [HR] = 3.2) and prior KA for anterior cruciate ligament (ACL) injury (HR = 4.4) were associated with postoperative complications in the KA group. There was a non-linear relationship between time from prior KA to TKA and postoperative complications with the turning point at 9.4 months. Conclusion Prior KA is associated with worse outcomes following subsequent TKA, especially male patients and those with prior KA for ACL injury. There is an increased risk of postoperative complications when TKA is performed within nine months of KA. Surgeons should keep these findings in mind when treating patients who are scheduled to undergo TKA with prior KA.

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Prospective randomized trial of standard versus highly crosslinked tibial polyethylene in primary posterior-stabilized total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b7.bjj-2018-1126.r2 ◽

2019 ◽

Vol 101-B (7_Supple_C) ◽

pp. 33-39 ◽

Cited By ~ 3

Author(s):

P. F. Lachiewicz ◽

J. A. O’Dell

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Study ◽

Posterior Stabilized ◽

Function Score ◽

Score Change ◽

Osteolytic Lesions ◽

Significant Difference ◽

Total Knee

Aims There is insufficient evidence to recommend the use of alternative polyethylene bearings in modular, fixed-bearing total knee arthroplasty (TKA). The purpose of this study was to compare standard polyethylene (SP) and highly crosslinked polyethylene (XLP) tibial liners in posterior-stabilized TKA, with osteolysis as the primary outcome and clinical results and the rate of re-operation as the secondary outcomes. Patients and Methods This is a single-surgeon, prospective randomized study involving one design of modular posterior-stabilized TKA. An analysis of 122 TKAs with an SP compression moulded liner and 123 with an XLP liner was performed, with a mean follow-up of six years (2 to 11). Patients were evaluated clinically using the Knee Society score, Lower Extremity Activity Score (LEAS), and the presence of an effusion, and standard radiographs were assessed for radiolucent lines and osteolytic lesions. Results Osteolysis was present in four TKAs (3.3%) in the SP group, and no knees in the XLP group (p = 0.06). There were no significant differences between the Knee Society total score, change in total score, knee function score, change in function score, LEAS, and change in LEAS in the two groups. There was a significant difference in the presence of an effusion (10/122 with SP liners, 1/123 with XLP liners; p = 0.02). There was no significant difference in the rate of re-operation between the two groups (p = 0.36). There were no complications related to the XLP liner. Conclusion At this length of follow-up, there were no advantages and no complications related to the use of this XLP tibial liner. The presence of effusion and small osteolytic lesions was more frequent with SP than XLP liners, but of unknown clinical significance. Cite this article: Bone Joint J 2019;101-B(7 Supple C):33–39

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NAVIGATED TOTAL KNEE ARTHROPLASTY FOR OSTEOARTHRITIS WITH EXTRA-ARTICULAR DEFORMITY

Acta Ortopédica Brasileira ◽

10.1590/1413-785220182603178367 ◽

2018 ◽

Vol 26 (3) ◽

pp. 170-174 ◽

Cited By ~ 1

Author(s):

IZUMI TANI ◽

NAOKI NAKANO ◽

KOJI TAKAYAMA ◽

KAZUNARI ISHIDA ◽

RYOSUKE KURODA ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Case Series ◽

Computer Assisted ◽

Level Of Evidence ◽

Assisted Navigation ◽

Radiographic Outcomes ◽

Navigation Group ◽

Significant Difference ◽

Total Knee

ABSTRACT Objective It is difficult to achieve proper alignment after total knee arthroplasty (TKA) in patients with extra-articular deformity (EAD) because of altered anatomical axis and distorted landmarks. As of this writing, only case series have been reported with regard to the usefulness of computer-assisted navigation systems for TKA with EAD. This study therefore compared outcomes in TKA with EAD, with and without navigation. Methods Fourteen osteoarthritis patients with EAD due to previous fracture malunion or operations were assessed. Seven TKAs were performed with navigation (navigation group) and another 7 were performed without navigation (manual group). Clinical and radiographic outcomes were compared before and two years after surgery. Results The mean postoperative Knee Society function score was significantly higher in the navigation group. No significant difference was found in postoperative range of motion and Knee Society knee score. The rate of outliers in radiographic outcomes tended to be lower in the navigation group. Conclusion Better clinical outcomes were achieved in cases in which navigation was used. Computer-assisted navigation is useful in TKA for patients with EAD. Level of Evidence III; Case control study.

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Should We Resect Hoffa's Fat Pad during Total Knee Replacement?

The Journal of Knee Surgery ◽

10.1055/s-0037-1598039 ◽

2017 ◽

Vol 30 (09) ◽

pp. 894-897 ◽

Cited By ~ 3

Author(s):

Alun Yewlett ◽

Ryan Trickett ◽

Mark Forster ◽

Adel Ghandour ◽

Hannah Sellars

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Fat Pad ◽

Hoffa’S Fat Pad ◽

Significant Difference ◽

Total Knee ◽

The Mean ◽

The Difference ◽

The One

AbstractResection of Hoffa's fat pad during total knee arthroplasty is sometimes performed to improve access and view. Opponents of this technique argue that sacrificing the fat pad potentially compromises blood supply to the patellar tendon and it can subsequently shorten. Our objective was to identify any difference in the Insall-Salvati ratio of knees undergoing total knee arthroplasty between a cohort that had Hoffa's fat pad preserved and the one that had Hoffa's fat pad completely excised. The total knee arthroplasties by two surgeons at our institution were reviewed over a 3-year period. Surgeon A routinely preserves the fat pad and surgeon B routinely excises the fat pad. Radiographs preoperatively, immediately postoperatively, and at a minimum of 1-year follow up were analyzed for the Insall-Salvati ratio. A total of 161 knees were reviewed, 65 in the preserved group and 96 in the excised group with a mean age of 67 and 70 years, respectively. The mean preoperative Insall-Salvati ratio for the preserved group was 1.12 (±0.145) and excised group 1.16 (±0.168) (p = 0.094). The mean immediate postoperative Insall-Salvati ratio for the preserved group was 1.10 (±0.154) and for excised group 1.18 (±0.194). The difference in Insall-Salvati ratio from preoperative to the immediate postoperative period in the preserved group compared with the excised group demonstrated a significant difference (p = 0.010). However, the change of Insall-Salvati ratio at 1 year did not significantly differ between the groups (p = 0.059). There does not appear to be any difference in the Insall-Salvati ratios of both groups at 1 year's follow up; therefore, this study radiologically at least supports the use of either technique.

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Quadriceps Tendon Rupture Following Total Knee Arthroplasty

The Open Orthopaedics Journal ◽

10.2174/1874325001913010250 ◽

2019 ◽

Vol 13 (1) ◽

pp. 250-254

Author(s):

Steven T. Heer ◽

James O'Dowd ◽

Rebecca R. Butler ◽

David O. Dewitt ◽

Gaurav Khanna ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Rare Complication ◽

Quadriceps Tendon ◽

Quadriceps Tendon Rupture ◽

Significant Difference ◽

Total Knee ◽

Suture Anchor Repair ◽

Extensor Lag

Introduction: Rupture of a Quadriceps Tendon (QT) following a Total Knee Arthroplasty (TKA) is a rare complication. The purpose of this study was to report outcomes and complications of QT repair following TKA. Methods: From a cohort of 437 QT repairs, 19 individuals were identified who had previously undergone a TKA on the ipsilateral leg. Data was collected on individuals with a minimum follow up of 3 months post QT repair (n=16), including Knee Society Scores, pre and post-operative lag, and pre and post-operative range of motion. Results: 13 patients were treated with End-to-End (EE) repairs and 6 were treated with transosseous or suture anchor repair (ATO). In the ATO group, there was no difference in pre (68.0 ± 22.5) and post KSS (82 ± 9.16) (p=0.231), but in the EE group, there was a significant improvement in KSS (pre=67.8 ± 13.1, post=86 ± 16.75, p=0.0027). There was significant difference in post-operative extension lag between ATO (26.0 ± 12.6) vs. EE (4.0 ± 2.74) (p=0.0083). Four out of six ATO patients had extension lag ≥10 degree extensor lag (66.7%) compared to 2 out of 13 (15.4%) patients in the EE group. Compared to EE, ATO repair had an 8.00 times odds of re-tear (95% CI: 0.53,120.6; p=0.133) and 2.75 times greater risk of infection (95% CI: 0.284, 26.61; p=0.382). Conclusion: Patients who underwent EE repair had better functional improvements compared to the ATO group and smaller extension lag.

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Patelloplasty with and without circumpatellar denervation in reducing anterior knee pain in primary total knee arthroplasty: a comparative prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200046 ◽

2020 ◽

Vol 6 (2) ◽

pp. 270

Author(s):

Sandeep Kumar Kanugula ◽

Mallesh Rathod ◽

Venugopal S. M.

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Intervention Group ◽

Control Group ◽

Significant Difference ◽

Total Knee ◽

Anterior Knee

Background: Anterior knee pain (AKP) following total knee arthroplasty (TKA) is one of the complication which cause dissatisfaction in patients. Incidence estimated to be 4-49%. The aim of our study is to know the efficacy of patelloplasty with circumpatellar denervation with diathermy in reducing AKP in primary TKA.Methods: A total of 130 unilateral TKAs’ are divided into 2 groups. Group I (control) includes 65 patients in which only patelloplasty was done. Group II (intervention) includes 65 patients in which both patelloplasty and circumpatellar denervation with diathermy was done and analysed. Mean follow up period was 18 months. Patients were assessed both preoperatively and postoperatively at final follow up.Results: The overall incidence of AKP at follow up (18 months) was 16.9%, with 7.7% in the intervention group and 26.1% in the control group (p<0.05). Western Ontario and McMaster Universities osteoarthritis index scores were significantly better in intervention group when compared to control group (28.71±3.948 vs 31.40±3.860). Better results were also found in knee society scores for intervention group compared to control group (166.57±7.941 vs 161.23±11.219); Feller patellar score of intervention group was significantly better when compared to control group (23.28±2.546 vs 20.69±3.729); the range of knee flexion was similar in both the groups (94.62±12.6 vs 93.54±10.7). In terms of pain referred by the patient at 72 hrs postoperatively, there was statistically significant difference observed according to visual analogue scale.Conclusions: There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.

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Meniscus Graft Augmentation for a Midsubstance Tear of the Medial Collateral Ligament during Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1715115 ◽

2020 ◽

Author(s):

Changjiao Sun ◽

Wei Rong ◽

Ruiyong Du ◽

Sha Wu ◽

Pu Liu ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Medial Collateral Ligament ◽

Control Group ◽

Collateral Ligament ◽

Impaired Wound Healing ◽

Primary Tkas ◽

Significant Difference ◽

Total Knee

AbstractsMultiple surgical techniques exist to repair iatrogenic medial collateral ligament (MCL) injury during total knee arthroplasty (TKA). The objective of the study is to confirm the clinical effectiveness of meniscus transfer for treatment of iatrogenic MCL midsubstance transection in which remaining MCL is of poor quality, and there is a persistent gap between both ligament ends during TKA. From January 2015 to November 2019, we treated 11 patients with MCL injuries of 882 primary TKAs by meniscus transfer. Another 24 primary TKAs were recruited as a control group. The two groups of patients were comparable for age, gender, body mass index (BMI), Knee Society scoring (KSS), knee function score (KFS), and type of prosthesis comparison without significant difference (p > 0.05). We reviewed the patient's stability, as well as objective measures such as KSS and KFS scores, physical examinations, and radiographs. No patient of either group reported impaired wound healing, joint instability on physical examination, pain, radiographic changes, signs of loosening, and other complications. At the final follow-up, there was no significant difference in terms of KSS (p = 0.780) and KFS (p = 0.612) between the injury group and control group at last follow-up. X-ray image review showed no prosthesis loosening or subsidence for both groups. Based on these results, we are cautiously optimistic that midsubstance transections in which the quality of remaining tendon is weak, there is suspicion of stretching, or there is a persistent gap between both ligament ends that can be reconstructed with meniscus autograft transfer augmentation and an unconstrained implant.

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Revision total knee arthroplasty longer term outcome and comparison between infection and aseptic loosening at mean follow-up of 10 years

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720971839 ◽

2020 ◽

pp. 221049172097183

Author(s):

TST Tse ◽

SHK Hui ◽

CY To ◽

MK Wong ◽

WL Tsang

Keyword(s):

Total Knee Arthroplasty ◽

Aseptic Loosening ◽

Knee Arthroplasty ◽

Revision Arthroplasty ◽

Term Outcome ◽

Revision Knee Arthroplasty ◽

Significant Difference ◽

Total Knee ◽

Arthroplasty Revision

Background: Although the majority of total knee arthroplasty cases have good outcome and survival, some arthroplasty eventually required revision. While early outcomes of revision knee arthroplasty are well reported, there is relatively fewer literatures reporting on the longer term outcome of revision knee arthroplasty. This study aims to review the outcome of revision knee arthroplasty for a longer term, and also make comparison between the two common indications for revision arthroplasty of infection and aseptic loosening. Methods: This study reviews all total knee arthroplasty revision performed at a single center over a 11 year period. Of the 48 cases found, 35 cases not lost to follow-up had a mean follow-up duration of 10.6 years (SD 2.9) for aseptic loosening, and 10.1 years (SD 2.6) for infection. Data of initial arthroplasty, revision arthroplasty, demographics, follow-up outcome were obtained, analyzed and compared. Results: Revision arthroplasty due to infection had more cases that required use of varus/valgus constraints (p ∼ 0.008) and extensile surgical exposure of quadriceps snip (p ∼ 0.005) compared to aseptic loosening. The survival at 10 years for this study is 91% overall (aseptic loosening 93.3%, infection 89.3%). Infection cases had significant initial improvement for range of motion (p ∼ 0.001) and use of walking aid (p ∼ 0.04) at post-operation 1 year, but no significant differences between the infection and aseptic loosening cases at 5 years and 10 years follow-up. Comparison between the two groups on other factors including initial arthroplasty, operative details, demographics, post-operative details and X-rays showed no statistically significant difference.

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A comparison of thrombosis in total knee arthroplasty with and without a tourniquet: a meta-analysis of randomized controlled trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02366-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jia Xie ◽

Hao Yu ◽

Fangyuan Wang ◽

Juehua Jing ◽

Jun Li

Keyword(s):

Clinical Trials ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Level Of Evidence ◽

Significant Difference ◽

Duration Of Surgery ◽

Total Knee

Abstract Background Tourniquets are widely used in total knee arthroplasty (TKA), but the issue of their safety remains controversial. Previous studies have focused on TKA blood loss, duration of surgery, and hemostatic drugs. The purpose of this meta-analysis was to analyze the effect of tourniquet use on postoperative deep venous thrombosis (DVT). Methods PubMed, SCOPUS, Web of Science, Embase, and the Cochrane Library were searched for randomized clinical trials published before April 17, 2020, that compared the effect of tourniquet use on postoperative DVT, knee circumference, D-dimers, and pain measured using the visual analog scale (VAS). Results Fourteen clinical trials that included 1321 unique participants were included in the meta-analysis. Among the total, 721 and 600 participants were randomized to the tourniquet and non-tourniquet groups, respectively. The incidence of postoperative thrombosis in the tourniquet group was significantly higher than in the non-tourniquet group (RR 2.30, 95% CI 1.51–3.49, P < 0.0001, I2 = 0%). On the 1st, 3rd, and 5th to 21st days, and 3 to 6 weeks after surgery, the knee circumference difference of the tourniquet group was significantly larger than that of the non-tourniquet group (P < 0.05). However, 4 to 6 months after the surgery, no significant difference in knee circumference was found between the two groups (MD 0.14, 95% CI −0.02–0.31, P = 0.09, I2 = 0%). The VAS score of the tourniquet group was higher than the non-tourniquet group on the 3rd and 5th days after surgery (P < 0.05). However, this difference was not significant (MD 0.31, 95% CI −0.05–0.66, P = 0.09, I2 = 89%). Conclusion Results of this meta-analysis indicate that tourniquet application could increase the incidence of postoperative DVT and aggravate postoperative pain and swelling in the short term. Level of evidence Level III

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Fixed-bearing vs mobile-bearing prostheses for total knee arthroplasty after approximately 10 years of follow-up: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02560-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Dongsheng Hao ◽

Junjie Wang

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Cruciate Ligament ◽

Mobile Bearing ◽

Complication Rates ◽

Fixed Bearing ◽

Significant Difference ◽

Total Knee ◽

Bearing Design

Abstract Background The benefits and risks of fixed-bearing and mobile-bearing designs for total knee arthroplasty (TKA) were compared, and long-term functional, clinical and radiological outcomes were analysed. Methods A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane Central databases was conducted to identify randomized controlled trials (RCTs) comparing fixed-bearing and mobile-bearing designs with no less than 9 years of follow-up. Primary outcome measures were Knee Society Scores (KSSs), range of motion (ROM) in knee joint values, complication rates and revision rates. The final search was performed on 23 April 2021. Results Six RCTs were included. A total of 451 patients with 612 knees met the inclusion criteria. The mobile-bearing design, in contrast to the fixed-bearing design, can clearly increase the KSFSs, especially with posterior cruciate retention. There was no significant difference in the KSKSs, ROM values, revision rates or complication rates between the two bearing design groups. Conclusion After approximately 10 years of follow-up, the mobile-bearing design has advantages in KSFSs over the fixed-bearing design. The mobile-bearing design may also have advantages in the revision rates over the fixed-bearing design when the posterior cruciate ligament is substituted. There may be no clear difference in KSKSs, ROM values or complication rates between these two designs.

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