scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

scholarly journals Intraarticular Botulinum Toxin A for Refractory Painful Total Knee Arthroplasty: A Randomized Controlled Trial

2010 ◽  
Vol 37 (11) ◽  
pp. 2377-2386 ◽  
Author(s):  
JASVINDER A. SINGH ◽  
MAREN L. MAHOWALD ◽  
SIAMAK NOORBALOOCHI
Keyword(s):  
Total Knee Arthroplasty ◽  
Botulinum Toxin ◽  
Pain Relief ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Global Assessment ◽  
Physician Global Assessment ◽  
Short Term ◽  
Pain Subscale ◽  
Total Knee

Objective.To assess short-term efficacy of single intraarticular botulinum toxin (IA-BoNT/A) injection in patients with chronically painful total knee arthroplasty (TKA) in a randomized, placebo-controlled, triple-blind study.Methods.Patients with chronic TKA pain (pain > 6 on 0–10 scale and > 6 months post-TKA) evaluated in and referred from orthopedic surgery clinics were recruited. The primary outcome, proportion of patients with clinically meaningful decrease of at least 2 points on 0–10 visual analog scale (VAS) for pain, was compared between treatment groups at 2 months using comparison of proportions test and for all efficacy timepoints (2, 3, and 4 months) using generalized estimating equations (GEE). Secondary outcomes of global assessment, function, and quality of life were compared using GEE, duration of pain relief by t-test, and adverse events by chi-square test.Results.In total, 54 patients with 60 painful TKA were randomized, with main analyses restricted to one TKA per patient (49 TKA in 49 patients). Mean age was 67 years, 84% were men, and mean duration of TKA pain was 4.5 years. A significantly greater proportion of patients (71%) in the IA-BoNT/A group compared to IA-placebo (35%) achieved clinically meaningful reduction in VAS pain at 2 months (p = 0.028) and at all efficacy timepoints (p = 0.019). Duration of meaningful pain relief was significantly greater after IA-BoNT/A, 39.6 days (SD 50.4) compared to IA-placebo, 15.7 days (SD 22.6; p = 0.045). Statistically significantly better scores were seen in IA-BoNT/A vs IA-placebo for all efficacy timepoints for the following outcomes: “very much improved” on physician global assessment of change (p = 0.003); Western Ontario McMaster Osteoarthritis Index physical function (p = 0.026), stiffness (p = 0.004), and total scores (p = 0.024); and Short-Form 36 pain subscale score (p = 0.049). Number of total and serious adverse events was similar between groups, with no patients in either group with new objective motor or sensory deficits during followup.Conclusion.In this single-center randomized trial, single IA-BoNT/A injection provided clinically meaningful short-term improvements in pain, global assessment, and function in patients with chronic painful TKA. A multicenter trial is needed to confirm these findings.

Differences in Short-Term Complications Between Spinal and General Anesthesia for Primary Total Knee Arthroplasty

2013 ◽  
Vol 95 (3) ◽  
pp. 193-199 ◽  
Author(s):  
Andrew J Pugely ◽  
Christopher T Martin ◽  
Yubo Gao ◽  
Sergio Mendoza-Lattes ◽  
John J Callaghan
Keyword(s):  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Short Term ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

Short Term Analgesic Effects of Intraoperative Periarticular Injection in Total Knee Arthroplasty

2008 ◽  
Vol 43 (5) ◽  
pp. 625
Author(s):  
Eun-Kyoo Song ◽  
Jong-Keun Seon ◽  
Sang-Jin Park ◽  
Young-Jin Kim ◽  
Dam-Seon Lee ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Term ◽  
Periarticular Injection ◽  
Analgesic Effects ◽  
Total Knee

scholarly journals Cemented Total Knee Arthroplasty- A Short Term Clinical, Functional Assessment and Outcome Analysis

2020 ◽  
Vol 9 (03) ◽  
pp. 138-141
Author(s):  
Meenakshi Sundaram Kandasamy ◽  
Kandaswamy Ganesh Shankar Kandaswamy ◽  
Sathish Kumar Rajaram ◽  
Vijayan Gopala Krishna Kurup
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Assessment ◽  
Outcome Analysis ◽  
Short Term ◽  
Total Knee

scholarly journals Short Term Follow-up Study of Kinemax Total Knee Arthroplasty in the Rheumatoid Arthritic Knee.

1992 ◽  
Vol 41 (1) ◽  
pp. 304-309
Author(s):  
Go Maeda ◽  
Masakazu Kondo ◽  
Norio Shinohara ◽  
Koichiro Yokoyama ◽  
Koji Najima ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Short Term ◽  
Follow Up Study ◽  
Rheumatoid Arthritic ◽  
Total Knee ◽  
Arthritic Knee

What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

2018 ◽  
Vol 32 (02) ◽  
pp. 165-170 ◽  
Author(s):  
Jared Newman ◽  
Assem Sultan ◽  
Anton Khlopas ◽  
Nipun Sodhi ◽  
Mhamad Faour ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Primary Total Knee Arthroplasty ◽  
Care Facility ◽  
Medical Complication ◽  
Short Term ◽  
Total Knee ◽  
Multiple Sclerosis Patients

Due to the paucity of evidence, this study was conducted to evaluate: (1) unique characteristics of multiple sclerosis (MS) patients and (2) short-term clinical outcomes, of primary total knee arthroplasty (TKA) in patients with MS (MS-TKA) compared with matched non-MS patients. MS patients who underwent TKA were identified using the Nationwide Inpatient Sample (NIS) database. The study sample consisted of 10,884 patients with MS and 56,45,227 control cohort. Various patient factors were compared. To control for potential confounders, with the use of propensity scores, MS-TKA patients were matched (1:3) to non-MS-TKA patients and regression analyses were performed to compare perioperative complications, length of stay (LOS), and discharge dispositions. Patients with MS were younger, more likely to be females, on corticosteroids, and more likely to have muscle spasms and gait abnormalities. Annual frequency of TKAs in MS patients increased from 1.16/1,000 TKAs in 2002 to 2.48/1,000 TKAs in 2013 (p < 0.001). Compared with the matched cohort, MS patients had significantly greater odds for any medical complication (odds ratio [OR] = 1.26; 95% confidence interval [CI], 1.11–1.44), longer mean LOS (mean difference: 0.15; 95% CI, 0.09–0.22), and had a greater chance of being discharged to a care facility (OR = 2.17; 95% CI, 1.96–2.40). In this study, we identified specific characteristics of patients with MS who had TKA and analyzed and compared their short-term TKA outcomes to non-MS patients. It was demonstrated that more patients with MS are undergoing TKA, and these patients were at a higher risk of perioperative complications, had longer LOS, and were more likely to be discharged to a sub-acute or inpatient facility. Orthopaedic surgeons should be cognizant of the increased risks and provide proper counseling to MS patients who are candidates for TKA.

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