scholarly journals Impact of Preoperative Opioid Use on Patient-Reported Outcomes after Revision Total Knee Arthroplasty: A Propensity Matched Analysis

2021 ◽  
Author(s):  
Eitan Ingall ◽  
Christian Klemt ◽  
Christopher M. Melnic ◽  
Wayne B. Cohen-Levy ◽  
Venkatsaiakhil Tirumala ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Opioid Use ◽  
Absolute Increase ◽  
Patient Reported ◽  
Total Knee ◽  
Opioid Users ◽  
Revision Tka

AbstractThis is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre- and postoperative PROMs was identified. Due to differences in baseline characteristics, 99 opioid users were matched to 198 nonusers using the nearest-neighbor propensity score matching. Pre- and postoperative knee disability and osteoarthritis outcome score physical function (KOOS-PS), patient reported outcomes measurement information system short form (PROMIS SF) physical, PROMIS SF mental, and physical SF 10A scores were evaluated. Opioid use was identified by the medication reconciliation on the day of surgery. Propensity score–matched opioid users had significantly lower preoperative PROMs than the nonuser for KOOS-PS (45.2 vs. 53.8, p < 0.01), PROMIS SF physical (37.2 vs. 42.5, p < 0.01), PROMIS SF mental (44.2 vs. 51.3, p < 0.01), and physical SF 10A (34.1 vs. 36.8, p < 0.01). Postoperatively, opioid-users demonstrated significantly lower scores across all PROMs: KOOS-PS (59.2 vs. 67.2, p < 0.001), PROMIS SF physical (43.2 vs. 52.4, p < 0.001), PROMIS SF mental (47.5 vs. 58.9, p < 0.001), and physical SF 10A (40.5 vs. 49.4, p < 0.001). Propensity score–matched opioid-users demonstrated a significantly smaller absolute increase in scores for PROMIS SF Physical (p = 0.03) and Physical SF 10A (p < 0.01), as well as an increased hospital length of stay (p = 0.04). Patients who are actively taking opioids at the time of revision TKA report significantly lower preoperative and postoperative outcome scores. These patients are more likely to have longer hospital stays. The apparent negative effect on patient reported outcomes after revision TKA provides clinically useful data for surgeons in engaging patients in a preoperative counseling regarding narcotic use prior to revision TKA to optimize outcomes.

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.

scholarly journals Correction to: Robotic‑arm assisted total knee arthroplasty is associated with improved accuracy and patient reported outcomes: a systematic review and meta‑analysis

2021 ◽  
Author(s):  
Junren Zhang ◽  
Wofhatwa Solomon Ndou ◽  
Nathan Ng ◽  
Paul Gaston ◽  
Philip M. Simpson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Meta Analysis ◽  
Robotic Arm ◽  
Patient Reported ◽  
Total Knee ◽  
Improved Accuracy

A correction to this paper has been published: https://doi.org/10.1007/s00167-021-06522-x

No differences in patient-reported outcomes between medial pivot insert and symmetrical insert in total knee arthroplasty: A randomized analysis

The Knee ◽  
2018 ◽  
Vol 25 (6) ◽  
pp. 1254-1261 ◽  
Author(s):  
Kohei Nishitani ◽  
Moritoshi Furu ◽  
Shinichiro Nakamura ◽  
Shinichi Kuriyama ◽  
Masahiro Ishikawa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Patient Reported ◽  
Medial Pivot ◽  
Total Knee

scholarly journals Bicompartmental Knee Arthroplasty (BKA) in comparison to unicompartmental (UKA), Patellofemoral (PFA) ans total knee arthroplasty (TKA) – Early Clinical Results

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Johannes Holz ◽  
Stefan Schneider ◽  
Ansgar Ilg ◽  
Rene Kaiser
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Patient Reported Outcomes ◽  
Clinical Results ◽  
Single Center ◽  
Patient Reported ◽  
Total Knee ◽  
Bicompartmental Arthroplasty

Aims and Objectives: The purpose was to evaluate the clinical outcomes of patients with knee osteoarthritis treated with bicompartmental arthroplasty (BKA) in comparison to unicompartmental (UKA), patellofemoral (PFA) and total knee arthroplasty (TKA) in a single center. Materials and Methods: This is a prospective study analyzing a consecutive series of 396 patients from two surgeons in a single center. In 191 men and 205 women either partial or total knee replacement were performed. Their mean age at surgery was 63±6,85 years and mean BMI 29,55±5,00 kg/m2. In 238 patients UKA, in 125 TKA, in 21 PFA and in 11 patients BKA was performed. Implants were cemented and made of cobalt chrome in partial knee and zirconium oxide in total knee replacement. Demographics and patient reported outcomes (VAS, KOOS, Oxford Knee Score (OKS)) were collected preoperatively and 3,6 and 12 months postoperatively. A total of 202 patients have thus far completed the 12 months follow-up time point. Results: All mean KOOS and OKS scores improved significantly 1 year after surgery (p<0.05). Mean preoperative aggregated KOOS improved from 49,0±14,1 to 74,3±17,8 in UKA, from 44,1±12,9 to 67,5±9,4 in PFA, from 46,1±15,1 to 71,0±14,8 in TKA and from 45,7±13,8 to 72,6±9,7 in BKA (p<0.05). Mean preoperative aggregated OKS improved from 25,1±7,6) to 38,5±9,7 in UKA, from 23,0±7,6 to 36,8±3,8 in PFA, from 23,4±8,2 to 37,3±8,1 in TKA and from 22,9±9,6 to 37,0±1,5 in BKA (p<0.05). The mean pain level (VAS)decreased from pre-treatment to 12 months after surgery in UKA from 5,5 to 1,6, in PFA from 6,1 to 2,5, in TKA from 6,0 to 1,9 and in BKA from 6,6 to 2,6. One patient (0.4%) underwent revision (at 3 month for inlay dislocation). Conclusion: This study shows excellent early clinical results of patients treated with unicompartmental, bicompartmental and total knee arthroplasty. Adherence to strict indications lead to a significant improvement of patient reported outcomes and a low revision rate one year postoperatively. The reported results for BKA are comparable to those of patients treated with unicompartmental arthroplasty. We conclude that bicompartmental arthroplasty is a safe and reliable surgery for patients with bicompartmental osteoarthritis.

Preoperative Chronic Opioid Use and Its Effects on Total Knee Arthroplasty Outcomes

2019 ◽  
Vol 33 (03) ◽  
pp. 306-313 ◽  
Author(s):  
Kelvin Kim ◽  
Kevin Chen ◽  
Afshin A. Anoushiravani ◽  
Mackenzie Roof ◽  
William J. Long ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Postoperative Period ◽  
Management Strategies ◽  
Opioid Use ◽  
Use Patterns ◽  
Usage Patterns ◽  
Total Knee ◽  
Chronic Opioid Use ◽  
Opioid Users

AbstractUnsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared in this study—preoperative chronic opioid users and nonchronic opioid users. Opioid usage patterns and quality metrics were collected and analyzed over a 3-month preoperative and a 6-month postoperative period. Fifty-four (16.0%) preoperative chronic opioid users were identified out of the total 338 patients included in the study. Preoperative chronic opioid users experienced significantly longer LOS (2.9 vs 2.6 days; p = 0.026). Patients who remained persistent chronic users throughout the preoperative and postoperative stages demonstrated a significantly longer LOS (3.4 days vs 2.5 days; p = 0.017) compared with those who were no longer chronically using opioids by the 6 months postoperative period. By the 6 months postoperative time point, preoperative chronic users were consuming eight times the morphine-equivalents (mg/day) compared with nonchronic users (p < 0.001). Preoperative chronic opioid use was associated with substantially higher usage patterns throughout the postoperative stages. Such opioid use patterns were associated with longer LOS. Given that perioperative chronic opioid use has shown to negatively impact TKA outcomes, future studies refining current perioperative management strategies are warranted. This is a Level II, prognostic study.

Sign in / Sign up

Export Citation Format

Share Document