Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

2020 ◽  
Author(s):  
Shih-Hao Chen ◽  
Jen-Yuh Chen ◽  
Tze-Hong Wong ◽  
Frederick Buechel ◽  
Meng-Huang Wu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Management ◽  
Major Complication ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Pain Visual Analog Scale ◽  
Total Knee ◽  
American Society ◽  
American Society Of Anesthesiologists

AbstractSimultaneous bilateral total knee arthroplasty (SBTKA) increases the rates of procedure-related complications and mortality compared with unilateral TKA. There are no well-defined guidelines for selecting patients to avoid mortality and proposing an upgrade treatment to decrease complication rates. This study aimed to evaluate whether optimal perioperative management could improve the safety of SBTKA. From 2005 to 2017, 1,166 cases of SBTKA were identified from 14,209 TKA procedures. We retrospectively examined the SBTKA patients' demographics, comorbidity profiles, procedure-related complications, and perioperative management during two time periods. Optimal perioperative workup for managing SBTKA significantly decreased the incidences of major complication from 6.2 to 2.4% (p = 0.001) and minor complications from 28.9 to 21.5% (p = 0.004) during period I and period II, respectively. The efficiency of less tourniquet use along with intraarticular tranexamic acid injection was demonstrated by the decreases of hemoglobin (Hb) change in the first 2 days after surgery (p = 0.005) and blood transfusion requirement (p = 0.035) during the SBTKA. Furthermore, the less tourniquet use group had less thigh pain (visual analog scale decreased from 6.0 to 4.2, p = 0.003), shorter duration of hospital stay (decreased from 7.8 to 7.1, p < 0.001), and lower coagulation time (decrease from 3.5 to 2.9, p < 0.001) than the routine tourniquet use group. Patient's screening must be performed carefully for cardiopulmonary compromise in patients aged >80 years and with an American Society of Anesthesiologists score of 3. Additionally, hospitalists should consider developing methods for the eligibility, testing, and perioperative monitoring of patients who undergo SBTKA with the aim of avoiding complications and improving outcomes.

Clinical and Functional Outcomes of Total Knee Arthroplasty in Sarcopenia: A Case–Control Retrospective Cohort Study

2021 ◽  
Author(s):  
Zili He ◽  
Jie Cai ◽  
Xingyu Wang ◽  
Di Lu
Keyword(s):  
Total Knee Arthroplasty ◽  
Health Status ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Multivariate Logistic Regression Analysis ◽  
Control Group ◽  
Complication Rates ◽  
Patient Reported ◽  
Outcome Scores ◽  
Total Knee

Abstract Background The aim of the study was to investigate the relationship between sarcopenia and both clinical and functional outcome scores following total knee arthroplasty (TKA) performed for patients over 65 years of age. Methods We assessed patient demographics, preoperative health status, postoperative Knee Society Clinical (KSS-C) and Function (KSS-F) subscores, and perioperative complications for 180 patients with sarcopenia and 345 comparatively healthy patients at a mean of 12.0 months after surgery. Multivariate logistic regression analysis was performed to define whether sarcopenia was an independent risk factor for lower KSS-F and KSS-C subscores and peroperative complication rates. Patients with sarcopenia had lower mean body mass index, preoperative albumin, and preoperative hemoglobin levels (p < 0.01). Results Compared with the healthy control group, patients with sarcopenia had lower KSS-C (83.0 vs. 88.2, p < 0.01) and KSS-F (79.2 vs. 86.1, p < 0.01) subscores and increased postoperative complication rates (14.1% vs. 4.1%, p < 0.01). Conclusion Patients with sarcopenia present with generally poorer preoperative health and this appears to be associated with lower patient-reported clinical and functional outcome scores. Complication rates were higher among patients with sarcopenia who were still determined to have adequate health status to support TKA. Most complications were limited and could be managed with supportive treatment.

scholarly journals Relative Clinical Outcomes Comparing Manual and Robotic-Assisted Total Knee Arthroplasty at Minimum 1-Year Follow-up

2021 ◽  
pp. 155633162110285
Author(s):  
Joseph Mitchell ◽  
Jesse Wang ◽  
Brett Bukowski ◽  
Justin Greiner ◽  
Brianna Wolford ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Complication Rates ◽  
Readmission Rates ◽  
Robotic Assisted ◽  
Primary Tkas ◽  
Patient Reported ◽  
Total Knee

Background: Total knee arthroplasty (TKA) demonstrates excellent durability using jig-based manual techniques (manual TKA [mTKA]), but significant rates of dissatisfaction remain. Modifications of mTKA techniques and TKA implant designs to improve outcomes have had minimal success. Studies comparing relative outcomes of mTKA and robotic-assisted TKA (raTKA) are limited. Purpose: This study sought to compare outcomes of mTKA and raTKA in patients at a single institution. Methods: We retrospectively reviewed all primary TKAs performed by 1 surgeon from 2015 to 2017. In all, 139 consecutive mTKAs (2015–2016) and 148 consecutive raTKAs (2016–2017) were included. No cases were excluded. Patient demographics, complications, readmission rates, and clinical and patient-reported outcomes were compared at a minimum of 1-year follow-up. A post hoc student t test and Pearson χ2 test were used for continuous and categorical data. Results: We found that mTKA patients compared with raTKA patients required significantly longer length of stay (LOS) (1.73 vs 1.18 days, respectively), greater morphine milligram equivalents consumption (89.6 vs 65.2, respectively), and increased physical therapy (PT) visits (13.0 vs 11.0, respectively) with increased 30-day readmission rates (4.3 vs 0.7%, respectively) that approached significance. Knee Injury and Osteoarthritis Outcome Score for Joint Replacement and the University of California at Los Angeles activity score did not differ significantly comparing raTKA with mTKA patients at 1 year. There were no differences in complication rates. Conclusion: Significant early clinical benefits were noted with raTKA, including lower opioid requirements, shorter LOS, and fewer PT visits when compared with mTKA. A reduction in 30-day readmission rates was noted with raTKA that was not significant. Excellent clinical results with similar patient-reported outcomes were noted in both groups at 1-year follow-up. Further prospective investigations at longer follow-up intervals comparing these techniques are warranted.

Identifying an Ideal Time Frame for Staged Bilateral Total Knee Arthroplasty to Maximize Functional Outcome

2016 ◽  
Vol 30 (07) ◽  
pp. 682-686 ◽  
Author(s):  
Jerry Chen ◽  
Wu Lee ◽  
Hwei Chong ◽  
Hee Pang ◽  
Darren Tay ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Time Frame ◽  
Complication Rates ◽  
Readmission Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Sf 36 ◽  
Significant Difference ◽  
Total Knee

Compared with staged bilateral total knee arthroplasty (TKA), simultaneous bilateral TKA carries a higher risk of cardiac complications, pulmonary complications, and mortality, especially in patients with preexisting cardiopulmonary disease or advanced age. However, the period of time between staged TKAs that would eliminate these increased risks has yet to be determined. The purpose of this study is to evaluate complication rates and functional outcome in patients who underwent staged bilateral TKA and to determine an optimal time frame for the second knee. The authors retrospectively reviewed 306 patients who underwent staged bilateral TKA between 2002 and 2013. Patients were grouped into 31 to 90, 91 to 180, 181 to 270, and 271 to 365 days interval, where complication and 90-day readmission rates for the second TKA were identified. Patients were also assessed preoperatively and 2 years postoperatively using the Oxford knee score (OKS) and Short-Form (SF)-36. There was no significant difference in complication and 90-day readmission rates between the various groups. The functional outcome of the knees scored 2 years postoperatively using OKS and SF-36 showed comparable results across all four groups. Thus, the authors could not identify an ideal time frame for performing the second TKA with the objective of maximizing functional outcome.

Patient Selection in Outpatient and Short-Stay Total Knee Arthroplasty

2014 ◽  
Vol 23 (01) ◽  
pp. 2-8 ◽  
Author(s):  
Scott Lovald ◽  
Kevin Ong ◽  
Edmund Lau ◽  
Girish Joshi ◽  
Steven Kurtz ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Short Stay ◽  
Total Knee

scholarly journals Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jake von Hintze ◽  
Mika Niemeläinen ◽  
Harri Sintonen ◽  
Jyrki Nieminen ◽  
Antti Eskelinen
Keyword(s):  
Quality Of Life ◽  
Total Knee Arthroplasty ◽  
Survival Rate ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Abstract Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA.

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