scholarly journals Total knee arthroplasty reduces the risk of mortality in osteoarthritis patients up to 12 years: A Korean national cohort longitudinal follow-up study

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090258
Author(s):  
Hyo Geun Choi ◽  
Bong Cheol Kwon ◽  
Joong Il Kim ◽  
Joon Kyu Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Mortality Rate ◽  
Knee Arthroplasty ◽  
Causes Of Death ◽  
Age Groups ◽  
Mortality Rates ◽  
Control Group ◽  
Circulatory Disease ◽  
Total Knee

Introduction: Mortality rates and causes of death after total knee arthroplasty (TKA) are of great interest to surgeons. However, there is a shortage of studies regarding those of the Asian population. The aim of this study was to compare the mortality rate and causes of death in patients after TKA to the general population. Methods: National sample cohort data from the Korean Health Insurance Review and Assessment Service were used. In this study, 1:4 matched patients after TKA (TKA group: 5072) and general participants (control group: 20,288) were selected as subjects. Their average follow-up duration was 57.2 months ranging from a year up to 12 years. The matches were processed for age, gender, income, region of residence, and past medical history. Mortality rates and causes of death were compared between groups. Regarding the mortality rates, we also performed subgroup analyses according to age. Results: Adjusted hazard ratio (HR) of the TKA group for mortality rate was less than 1 with significance (adjusted HR = 0.61 (95% confidence interval = 0.54–0.70, p < 0.001)). The ratios were less than 1 for both age groups (<70 and ≥70 years), respectively; however, for patients under 70, they were insignificant. Among the 11 major causes of death, the circulatory disease showed the most significantly reduced mortality rate for the TKA group compared to the control group. The neoplasm was the only other cause with a significantly reduced mortality rate for the TKA group. Conclusion: The mortality rate in the TKA group was significantly lower than in the control group up to 12 years after the surgery in Korea. Among the major causes of death, circulatory disease and neoplasm showed a significant reduction in the mortality rate of the TKA group compared with the control group.

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

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.

Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients

2021 ◽  
Author(s):  
Kevin Zhai ◽  
Melissa Orr ◽  
Daniel Grits ◽  
Ahmed K. Emara ◽  
Christopher A. Rothfusz ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Mortality Rate ◽  
Knee Arthroplasty ◽  
Preoperative Diagnosis ◽  
Mortality Rates ◽  
Male Gender ◽  
Improvement Program ◽  
Patient Demographics ◽  
Comorbidity Burden ◽  
Total Knee

AbstractDespite its rarity, the risk of mortality following primary elective total knee arthroplasty (TKA) is a critical component of surgical decision-making and patient counseling. The purpose of our study was to (1) determine the overall 30-day mortality rate for unilateral primary elective TKA patients, (2) determine the 30-day mortality rates when stratified by age, comorbidities, and preoperative diagnosis, and (3) identify the distribution of (i) patient demographics, (ii) baseline comorbidities, and (iii) preoperative diagnoses between mortality and mortality-free cohorts. A total of 326,157 patients underwent primary elective TKA (2011–2018) were identified through retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into 30-day mortality (n = 320) and mortality-free (n = 325,837) cohorts. Patient demographics, preoperative comorbidities, and preoperative diagnoses were compared. Age group, American Society of Anesthesiology (ASA) score, and modified Charlson Comorbidity Index (CCI) scores were normalized per 1000 and stratified by preoperative diagnosis. The overall mortality rate was 0.098%. Older age (p < 0.001) and male gender (p < 0.001) were associated with increased mortality. There was no association between mortality and race (p = 0.346) or body mass index (BMI) class (p = 0.722). All reported comorbidities except smoking status were significantly greater in the mortality cohort (p < 0.05). For ASA scores of I, II, III, and IV, the number of deaths per 1,000 were 0.16, 0.47, 1.4, and 4.4, respectively. For CCI scores of 0, 1, 2, 3, 4, and 6, mortality rates per 1,000 were 0.76, 2.1, 7.0, 11, 29, and 7.6, respectively. Mortality rates for a preoperative diagnosis of osteoarthritis (OA) versus non-OA were, respectively, 0.096% and 0.19% (p < 0.001). Increased age, male gender, increased comorbidity burden, and non-OA preoperative diagnoses are associated with higher rates of 30-day postoperative mortality. There were no significant associations between BMI or race and 30-day mortality. These findings aid in identifying of higher-risk patients, who can then receive appropriate counseling or preoperative interventions to reduce the risk of perioperative mortality.

scholarly journals Pigmented villonodular synovitis does not influence the outcomes following cruciate-retaining total knee arthroplasty: a case-control study with minimum five year follow-up

2020 ◽  
Author(s):  
Wei Lin ◽  
Yike Dai ◽  
Jinghui Niu ◽  
Guangmin Yang ◽  
Ming Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Knee Society Score ◽  
Pigmented Villonodular Synovitis ◽  
Control Group ◽  
Villonodular Synovitis ◽  
Cruciate Retaining ◽  
Total Knee ◽  
Pigmented Villonodular

Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up outcomes of cruciate-retaining (CR) TKA in patients with PVNS.Methods: From January 2012 to December 2014, a retrospective study was conducted in 17 patients with PVNS who underwent CR TKA as PVNS group. During this period, we also selected 68 patients with osteoarthritis who underwent CR TKA (control group) for comparison. The two groups matched in a 1:4 ratio based on age, sex, body mass index and follow-up time. The range of motion, Knee Society Score, revision rate, disease recurrence, wound complications and the survivorship curve of Kaplan-Meier implant were assessed between the two groups.Results: All patients were followed up at least five years. There were no difference in range of motion, and Knee Society Score between the two groups before surgery and at last follow-up after surgery (p > 0.05). In the PVNS group, no patients with the recurrence of PVNS were found at the last follow-up, one patient underwent revision surgery due to periprosthetic fracture, and three patients had stiffness one year after surgery (17.6% vs 1.5%, p = 0.005; ROM:16°- 81°), but no revision was needed. At seven years, the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54).Conclusions: This study demonstrated that the function of patients with PVNS who underwent CR TKA had been significantly improved, and the survival rate of implants in these patients were similar to the patients with OA. Consequently, the patients with PVNS who underwent CR TKA might be an achievable option. However, these patients should pay more attention to the occurrence of postoperative stiffness complication.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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&lt;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.</p><p class="abstract"><strong>Conclusions:</strong> There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.</p><p> </p>

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

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.

scholarly journals Pigmented Villonodular Synovitis does not Influence the Outcome Following Cruciate-retaining Total Knee Arthroplasty: A Case- Control Study with Middle-term Follow-up Minimum 5-Year Follow-up

2020 ◽  
Author(s):  
Wei Lin ◽  
Yike Dai ◽  
Jinghui Niu ◽  
Guangmin Yang ◽  
Ming Li ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Pigmented Villonodular Synovitis ◽  
Control Group ◽  
Villonodular Synovitis ◽  
Middle Term ◽  
Cruciate Retaining ◽  
Total Knee ◽  
Pigmented Villonodular

Abstract Background: Pigmented villonodular synovitis (PVNS) is a rare synovial disease with benign hyperplasia, which has been successfully treated with total knee arthroplasty (TKA). The purpose of this study was to investigate the middle-term follow-up results of cruciate-retaining (CR) total knee arthroplasty (TKA) in PVNS patients.Methods: 17 patients with PVNS were treated with CR TKA between 2012 and 2014. 68 patients with osteoarthritis (OA) who received CR TKA as control group. The two groups matched in a 4:1 ratio based on age,gender, body mass index (BMI) and follow-up time. In the two groups, the range of motion (ROM), Knee Society Score (KSS), revision rate, disease recurrence, complications and the survivorship curve of Kaplan-Meier implant were compared. Results: All patients were followed up at least 7 years. At the last follow-up, no patients with recurrence of PVNS were found. There was no difference in KSS between the two groups, and no patients experienced infection and death. In the PVNS group, 3 patients had stiffness complications but did not need revision. 1 patient underwent revision surgery due to periprosthetic fracture. At 7 years,the implant survivorship was 90.0% in the PVNS group and 96.6% in the control group (p = 0.54).Conclusions: This study demonstrates that the function of PVNS patients who received CR TKA has been significantly improved. The survival rate of implants in PVNS patients is similar to that of OA patients. Consequently, PVNS patients who treated with CR TKA may be an achievable option. However, patients with PVNS should pay more attention to the occurrence of postoperative stiffness complications.

scholarly journals Using Tibia Proximal Cut Autograft in Advanced Varus Knee Deformity in Total Knee Arthroplasty; Outcomes Compared to the Control Group

2018 ◽  
Vol 12 (1) ◽  
pp. 405-410
Author(s):  
Aydin Arslan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Varus Deformity ◽  
Womac Score ◽  
Control Group ◽  
Varus Knee ◽  
Knee Deformity ◽  
Total Knee ◽  
Reconstruction Group

Background:The purpose of this study was to compare the outcomes of Total Knee Arthroplasty (TKA) performed for advanced varus knee deformity, which is performed by using tibia proximal cut bone for the reconstruction of the tibia proximal medial bone defects, with a control group consisting of TKAs which did not need reconstruction.Methods:Patients in the present study underwent total knee arthroplasty between 2009 and 2015. 12 patients with advanced varus deformity who had undergone reconstruction with tibia proximal cut autograft and 15 patients who were randomly selected from patients who did not need reconstruction, were compared clinically and radiographically.Results:The mean follow-up period of the patients was found to be 73.1 ± 19.7 (36-108) months in the reconstruction group and 73.2 ± 12.3 (39-107) months in the control group. (p> 0.05) In both groups, significant improvement was observed postoperatively. In both groups, there was no evidence of loosening the required revision. WOMAC score was 32.4 ± 13.3 (8-64) in the reconstruction group and 28.9 ± 17.2 (6-70) in the control group at the last control visit. There was no difference between the groups when comparing the WOMAC scores at the last control visit. In the reconstruction group, the Hip-Knee-Ankle (HKA) angle was 26.1 ± 4.9 ° varus preoperatively and 1.3 ± 2.3 ° valgus postoperatively; and in the control group 10.1 ± 2.1 ° varus preoperatively and 2.7 ± 3.4 ° valgus postoperatively. (p> 0.05)Conclusion:In the present study, clinical and radiographic results of total knee arthroplasty patients, who suffered from advanced knee varus deformity and whose proximal tibia medial defects were reconstructed by using tibial proximal cut autograft, have been found to be successful when compared to the control group.

scholarly journals App-based rehabilitation program after total knee arthroplasty: a randomized controlled trial

2021 ◽  
Author(s):  
Henrik C. Bäcker ◽  
Chia H. Wu ◽  
Matthias R. G. Schulz ◽  
Thomas Sanjay Weber-Spickschen ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Randomized Control Trial ◽  
Control Group ◽  
Prospective Randomized Control Trial ◽  
Long Term Study ◽  
Total Knee ◽  
Randomized Control

Abstract Introduction New app-based programs for postoperative rehabilitation have been developed, but no long-term study has been published to date. Thus, a prospective randomized control trial with 2-year follow-up was performed to evaluate the effectiveness of app-based rehabilitation (GenuSport) compared to a control group after total knee arthroplasty (TKA). Methods Between April and October 2016, 60 patients were enrolled in the study. Twenty-five patients were lost to follow-up, leaving 35 patients undergoing TKA for inclusion. In this group, twenty patients received app-based exercise program and 15 were randomized to the control group. The mean age was 64.37 ± 9.32 years with a mean follow-up of 23.51 ± 1.63 months. Patients in the app group underwent an app-based knee training starting on the day of surgery; whereas, patients in the control group underwent regular physiotherapy. Functional outcome scores using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS) and VAS of pain were analyzed. Results In the short term, significant differences between the app group and control group in time of 10-m walk (19.66 ± 7.80 vs. 27.08 ± 15.46 s; p = 0.029), VAS pain at rest and activity (2.65 ± 0.82 vs. 3.57 ± 1.58, respectively 4.03 ± 1.26 vs. 5.05 ± 1.21; p < 0.05) were observed. In the long term, a variety of different tendencies was found, highest in KSS Function with 76.32 ± 16.49 (app group) vs. 67.67 ± 16.57 (control group) (p = 0.130). Additionally, patients in the app group required less painkillers (10.0% vs. 26.7%) and more likely to participate in sports (65.0% vs. 53.3%). Conclusions An app-based knee trainer is a promising tool in improving functional outcomes such as KSS function score and VAS after TKA. Level of evidence Level II, prospective randomized control trial.

scholarly journals Study of factors affecting range of motion after total knee arthroplasty in Indian patients

2021 ◽  
Vol 9 (2) ◽  
pp. 56-63
Author(s):  
Ravindra GR ◽  
Kulkarni M ◽  
Patil S
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Age Groups ◽  
Important Indicator ◽  
Factors Affecting ◽  
Total Knee Replacements ◽  
Knee Replacements ◽  
Total Knee

Background: Range of motion is an important indicator of the success of total knee arthroplasty. To our knowledge there are no studies assessing the factors affecting the range of motion after total knee arthroplasty on Indian population which prompted us to undertake this study. Method: The present prospective study for all those patients with advanced arthritis of knee satisfying inclusion criteria, between August 2009 to June 2011. A total of 430 total knee replacements were done among 327 patients during this period out of which 354 primary total knee replacements among 254 patients were included in the study. Follow ups were done at 3 months, 6 months, one year and 2 years following procedure. Result: The average age was 63.8 years with a range of 50 – 80 years. 66.1% of the patients were female and 33.9% were male. The preoperative diagnosis was osteoarthritis in 81.1% of patients and 18.9% had rheumatoid arthritis. All poly implant was used in 83.1% of patients and in 16.9% of patients metal backed was used. The posterior tibial slope had no correlation with the postoperative range of motion at all the points of follow up. The preoperative range of motion had a statistical correlation with the postoperative range of motion at all the points of follow up and in all the age groups, p <0.0001. Conclusion: A more keen watch has to be kept in all young female patients with early onset of arthritis and mange them aggressively with conservative therapy.

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