Total Knee Arthroplasty following Knee Arthroscopy in Patients over 50

2021 ◽  
Author(s):  
J. Stewart Buck ◽  
Susan M. Odum ◽  
Jonathan K. Salava ◽  
David M. Macknet ◽  
Thomas K. Fehring ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Arthroscopy ◽  
Administrative Database ◽  
Univariable Analysis ◽  
Digital Radiographs ◽  
Multivariable Regression ◽  
Total Knee ◽  
Arthroscopic Knee ◽  
And Control

AbstractThe purpose of this study was to evaluate the conversion rate of knee arthroscopy to ipsilateral total knee arthroplasty (TKA) within 2 years in patients aged 50 or older at the time of arthroscopy. The administrative database from a large, physician-owned orthopaedic practice (>100 surgeons) was queried to identify patients over the age of 50 who had undergone arthroscopic knee surgery between January 1, 2006 and January 2, 2015. The subset of patients who converted to TKA within 2 years after knee arthroscopy was identified and matched by age and sex to a control population that did not convert to TKA. Rates of conversion to TKA were calculated. Prearthroscopic digital radiographs were reviewed and Kellgren–Lawrence (KL) grades were compared among case and control populations. Univariable analyses and multivariable regression analysis were performed. Eight hundred seven of 16,061 (5.02%) patients aged 50 or older were converted to TKA within 2 years following ipsilateral knee arthroscopy. In univariable analysis, the rate of conversion to TKA in patients aged between 50 and 54 was 2.94%, compared with 4.44% in patients aged between 55 and 64, and 8.32% in patients 65 or older (p < 0.0001). Female sex was associated with a higher rate of conversion to TKA in univariable analysis (5.93 vs. 4.02% in males, p < 0.0001). KL grades were higher among patients who converted to TKA compared with those who did not (p < 0.0001). In a multivariable regression model controlling for age, sex, and KL grade, only increased KL grade was associated with increased odds of conversion to TKA. In the appropriately selected older patient, the risk of conversion to TKA within 2 years of knee arthroscopy is low (∼5%). Patients with KL grade 2 or higher at the time of arthroscopy should be counseled on the increased odds of early conversion to TKA.

scholarly journals Incidence and predictors of total knee arthroplasty following knee arthroscopy

2018 ◽  
Vol 15 (1) ◽  
pp. 32-35
Author(s):  
Tristan Camus ◽  
Jiho Han ◽  
Feroz Osmani ◽  
Norman Scott ◽  
William J. Long
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Arthroscopy ◽  
Total Knee

scholarly journals Prior knee arthroscopy effects on subsequent total knee arthroplasty

Medicine ◽  
2020 ◽  
Vol 99 (17) ◽  
pp. e19844
Author(s):  
Feng Hu ◽  
Xulin Chen ◽  
Yingjie Wu ◽  
Wei Liu
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Arthroscopy ◽  
Total Knee

Same-day and delayed hospital discharge are associated with worse outcomes following total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 70-76 ◽  
Author(s):  
L. L. Nowak ◽  
E. H. Schemitsch
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Matched Cohort ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Multivariable Regression ◽  
Total Knee

Aims To evaluate the influence of discharge timing on 30-day complications following total knee arthroplasty (TKA). Patients and Methods We identified patients aged 18 years or older who underwent TKA between 2005 and 2016 from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database. We propensity score-matched length-of-stay (LOS) groups using all relevant covariables. We used multivariable regression to determine if the rate of complications and re-admissions differed depending on LOS. Results Our matched cohort consisted of 76 246 TKA patients (mean age 67 years (sd 9)). Patients whose LOS was zero and four days had an increased risk of major complications by an odds ratio (OR) of 1.8 (95% confidence interval (CI) 1.0 to 3.2) and 1.5 (95% CI 1.2 to 1.7), respectively, compared with patients whose LOS was two days. Patients whose LOS was zero, three, and four days had an increased risk of minor complications (OR 1.8 (95% CI 1.3 to 2.7), 1.2 (95% CI 1.0 to 1.4), and 1.6 (95% CI 1.4 to 1.9), respectively), compared with patients whose LOS was two days. In addition, a LOS of three days increased the risk of re-admission by an OR of 1.2 (95% CI 1.0 to 1.3), and a LOS of four days increased the risk of re-admission by an OR of 1.5 (95% CI 1.3 to 1.6), compared with a LOS of two days. Conclusion Patients discharged on days one to two postoperatively following TKA appear to have reduced major and minor complications compared with discharge on the day of surgery, or on days three to four. Prospective clinical data are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B(7 Supple C):70–76

scholarly journals Thirty-Day Unplanned Readmission after Total Knee Arthroplasty at a Teaching Community Hospital: Rates, Reasons, and Risk Factors

2019 ◽  
Vol 33 (02) ◽  
pp. 206-212 ◽  
Author(s):  
Kalain K. Workman ◽  
Nathan Angerett ◽  
Ronald Lippe ◽  
Alex Shin ◽  
Scott King
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Community Hospital ◽  
Significant Risk ◽  
The United States ◽  
Administrative Database ◽  
Unplanned Readmission ◽  
Teaching Community ◽  
Total Knee

AbstractUnplanned readmission after total knee arthroplasty (TKA) has an increasing prevalence in the United States. Readmissions are now a metric for hospital quality of care, yet there are mixed results and variables associated with unplanned readmission. In this changing healthcare, it is critical for community healthcare institutions to identify risk factors for unplanned readmissions following TKA. Retrospective chart review and a hospital administrative database query to report causes, demographics, and medical comorbid risk factors result in 30-day readmission after undergoing primary TKA between 2011 and 2016 at a teaching community hospital. This study identified 7,482 primary TKA procedures of which 210 (2.8%) were unplanned readmissions. Gastrointestinal bleed (9.05%) and periprosthetic infection (8.10%) were the most common causes of readmission. Age 65 and older (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.21–2.21; p = 0.0012), male (OR, 1.37; 95% CI, 1.03–1.83; p = 0.0302), length of stay > 3 days (OR, 2.04; 95% CI, 1.45–2.86; p < 0.0001), and discharge to rehab (OR, 2.21; 95% CI, 1.49–3.26; p ≤ 0.0001) were correlated significantly with risk of 30-day readmission. Chronic airway disease (OR, 2.81; 95% CI, 1.54–5.14; p = 0.0008) and obesity (OR, 1.45; 95% CI, 1.006–2.10; p = 0.0463) were significant risk factors. Higher Charlson comorbidity index was not a predictor of time to readmission within 30 days after TKA.

scholarly journals Effects of Muscle Strengthening around the Hip on Pain, Physical Function, and Gait in Elderly Patients with Total Knee Arthroplasty: A Randomized Controlled Trial

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 489
Author(s):  
KwangSun Do ◽  
JongEun Yim
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Exercise Program ◽  
Step Test ◽  
Muscle Strengthening ◽  
Strengthening Exercise ◽  
Single Leg Stance ◽  
Total Knee ◽  
And Control

Background: Functional limitations may still remain even after a patient completes a traditional quadriceps-based rehabilitative program after total knee arthroplasty. Based on studies reporting that patients with knee osteoarthritis have muscle weakness around the hip joint after total knee arthroplasty, we investigated whether strengthening the hip muscles can reduce pain and improve the physical function and gait of patients who underwent total knee arthroplasty. Methods: Patients were randomly divided into three groups: hip, quadriceps, and control. The hip group (n = 19) completed an extensor, adductor, and external muscle strengthening exercise program. The quadriceps group (n = 20) completed a quadriceps strengthening exercise program. The control group (n = 16) completed an active range of motion exercises. Therapy was conducted thrice weekly for 12 weeks. Pain and function items from the Western Ontario and McMaster Universities Osteoarthritis Index, Alternate Step Test, Five Times Sit to Stand Test, and Single Leg Stance Test were performed to assess pain and physical function. In the gait analysis, stride, single-stance (%), double-stance (%), and gait speed were measured. Data were collected at baseline and at 4, 8, and 12 weeks after the intervention. Results: The hip group showed more significant improvements in pain and performance on the Alternate Step Test and Single Leg Stance Test than the quadriceps and control groups. In the gait analysis, the hip group showed the largest improvements in single stance and double stance. Conclusions: In conclusion, a 12-week hip muscle strengthening exercise program effectively improves the physical function and gait of patients who have undergone total knee arthroplasty.

Total Knee Arthroplasty in Patients With Prior Ipsilateral Hip Fusion: A Surgical Technique

2021 ◽  
pp. 155633162110392
Author(s):  
Carlos A. Encinas-Ullán ◽  
Primitivo Gómez-Cardero ◽  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Arthroscopy ◽  
Knee Instability ◽  
Posttraumatic Arthritis ◽  
Congenital Dislocation ◽  
Hip Arthrodesis ◽  
Rotating Hinge ◽  
Total Knee ◽  
Hip Fusion

Background: In patients with severe osteoarthritis of the knee with prior ipsilateral hip fusion who require total knee arthroplasty (TKA), a controversial issue is whether to first convert the hip fusion to a total hip arthroplasty (THA) or to perform TKA without reconstruction of the hip. Also, immobility of the ipsilateral, fused hip adds significant technical challenge because the usual positioning of the leg requires modification in order to gain access needed for the TKA. Technique: In such cases, we position the patient with the knee suspended, similar to how we perform knee arthroscopy. In our experience, the ipsilateral knee has significant deformity and is best addressed with a constrained, hinged TKA. Results: In 3 patients with severe knee osteoarthritis with prior ipsilateral hip fusion—a 72-year-old man and a 79-year-old woman with hip arthrodesis due to posttraumatic arthritis and an 81-year-old woman with hip arthrodesis due to congenital dislocation of the hip—rotating-hinge knee prostheses were implanted due to severe knee instability. All 3 patients had satisfactory results, without complications, after follow-up of 1 to 5 years. Conclusions: We obtained satisfactory results in the short and medium term without previously converting the hip arthrodesis to THA by positioning patients with the knee suspended, in a way similar to when knee arthroscopy is performed, and implanting rotating hinge TKAs due to severe preoperative knee instability.

ENDOGENOUS CORTISOL PRODUCTION IN RESPONSE TO KNEE ARTHROSCOPY AND TOTAL KNEE ARTHROPLASTY

2003 ◽  
Vol 85 (11) ◽  
pp. 2163-2167 ◽  
Author(s):  
SETH S. LEOPOLD ◽  
MICHAEL T. CASNELLIE ◽  
WINSTON J. WARME ◽  
PAUL J. DOUGHERTY ◽  
SUSAN T. WINGO ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Arthroscopy ◽  
Endogenous Cortisol ◽  
Total Knee

Cost Analysis of Medicare Patients with Varying Complexities Who Underwent Total Knee Arthroplasty

2019 ◽  
Author(s):  
Hiba K. Anis ◽  
Nipun Sodhi ◽  
Rushabh M. Vakharia ◽  
Giles R. Scuderi ◽  
Arthur L. Malkani ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Study Cohort ◽  
Control Cohort ◽  
Bundled Payments ◽  
Complex Patients ◽  
Episodes Of Care ◽  
Total Knee ◽  
Care Improvement ◽  
And Control

AbstractThe effort to reduce overall healthcare costs may affect more complex patients, as their pre- and postoperative care can be substantially involved. Therefore, the purpose of this study was to use a large nationwide insurance database to compare (1) costs, (2) reimbursements, and (3) net losses of 90-day episodes of care (EOC) for total knee arthroplasty (TKA) patients according to Elixhauser's comorbidity index (ECI) scores. All TKAs performed between 2005 and 2014 in the Medicare Standard Analytic Files were extracted from the database and stratified based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort and control cohort were matched based on age and sex, resulting in a total of 715,398 patients included for analysis. Total EOC costs, reimbursements, and total net losses (defined as total EOC costs minus total EOC reimbursements) were compared between the cohorts. Overall, total EOC costs increased with ECI. For example, compared with the matched ECI 1 cohorts, the total EOC costs for ECI 5 patients ($56,589.19 vs. $51,747.54) were significantly greater (p < 0.01). Although reimbursements increased with increasing ECI, so did net losses. The net losses for ECI 5 patients were greater than that for ECI 1 patients ($42,309.39 vs. $40,007.82). The bundled payments for care improvement (BPCI) and comprehensive care for joint replacement (CJR) are alternative payment models that might de-incentivize treatment of more complex patients. Our study found that despite increasing reimbursements, overall costs, and therefore net losses, were greater for more complex patients with higher ECI scores.

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