Differences in mortality and complication rates following revision knee arthroplasty performed for urgent versus elective indications

2021 ◽  
Vol 103-B (10) ◽  
pp. 1578-1585 ◽  
Author(s):  
Simon G. F. Abram ◽  
Shiraz A. Sabah ◽  
Abtin Alvand ◽  
Andrew J. Price
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Revision Arthroplasty ◽  
Complication Rates ◽  
Serious Adverse Events ◽  
Revision Knee Arthroplasty ◽  
Primary Knee Arthroplasty ◽  
Subsequent Revision

Aims To compare rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications), and compare these with primary arthroplasty and re-revision arthroplasty. Methods Patients undergoing primary knee arthroplasty were identified in the national Hospital Episode Statistics (HES) between 1 April 1997 to 31 March 2017. Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes, including infection (undergoing surgery), pulmonary embolism, myocardial infarction, and stroke. Urgent indications for revision arthroplasty were defined as infection or fracture, and all other indications (e.g. loosening, instability, wear) were included in the elective indications cohort. Results A total of 939,021 primary knee arthroplasty procedures were included (939,021 patients), of which 40,854 underwent subsequent revision arthroplasty, and 9,100 underwent re-revision arthroplasty. Revision surgery for elective indications was associated with a 90-day rate of mortality of 0.44% (135/30,826; 95% confidence interval (CI) 0.37 to 0.52) which was comparable to primary knee arthroplasty (0.46%; 4,292/939,021; 95% CI 0.44 to 0.47). Revision arthroplasty for infection was associated with a much higher mortality of 2.04% (184/9037; 95% CI 1.75 to 2.35; odds ratio (OR) 3.54; 95% CI 2.81 to 4.46), as was revision for periprosthetic fracture at 5.25% (52/991; 95% CI 3.94 to 6.82; OR 6.23; 95% CI 4.39 to 8.85). Higher rates of pulmonary embolism, myocardial infarction, and stroke were also observed in the infection and fracture cohort. Conclusion Patients undergoing revision arthroplasty for urgent indications (infection or fracture) are at higher risk of mortality and serious adverse events in comparison to primary knee arthroplasty and revision arthroplasty for elective indications. These findings will be important for patient consent and shared decision-making and should inform service design for this patient cohort. Cite this article: Bone Joint J 2021;103-B(10):1578–1585.

Frequency of Myocardial Infarction, Pulmonary Embolism, Deep Venous Thrombosis, and Death following Primary Hip or Knee Arthroplasty

2002 ◽  
Vol 96 (5) ◽  
pp. 1140-1146 ◽  
Author(s):  
Margaret Wood ◽  
Carlos B. Mantilla ◽  
Terese T. Horlocker ◽  
Darrell R. Schroeder ◽  
Daniel J. Berry ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Adverse Events ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Total Hip ◽  
Diagnostic Certainty ◽  
Contemporary Practice

Background There is limited information about the frequency of perioperative complications after elective primary orthopedic total hip and knee arthroplasty in contemporary practice. The purpose of this study was to determine the frequency of clinically relevant myocardial infarction, pulmonary embolism, deep venous thrombosis, and death within 30 days after elective primary hip or knee arthroplasty treated according to contemporary perioperative management. Methods The authors examined the medical records of consecutive patients undergoing hip or knee arthroplasty at their institution in a 10-yr period. Prospectively collected databases were used to identify patients with the diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis, or death using strict validation criteria and diagnostic-certainty categories. Results A total of 10,244 patients underwent primary total hip or knee arthroplasty in the period of study. Of these, 224 patients had one or more adverse events (overall event rate: 2.2%; myocardial infarction: 0.4%; pulmonary embolism: 0.7%; deep venous thrombosis: 1.5%; death: 0.5%). Most adverse events (myocardial infarction, pulmonary embolism, and death) increased in frequency with older age, particularly for patients aged 70 yr or older. Myocardial infarction occurred more frequently in male patients. There were no differences in the overall event frequency between types of procedure. However, pulmonary embolism was highest in patients undergoing bilateral knee operations. Conclusions The overall frequency of serious complications within 30 days after primary total hip or knee arthroplasty with contemporary practice was 2.2%. Accurate knowledge of the perioperative risks associated with widely performed elective operations can be used to implement management strategies that may further improve patient outcomes and decrease cost.

Rotating Hinge Implants in Knee Arthroplasty

2019 ◽  
Vol 158 (04) ◽  
pp. 383-389
Author(s):  
Alexander Petershofer ◽  
Klemens Trieb
Keyword(s):  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Demographic Transition ◽  
Revision Arthroplasty ◽  
Implant Design ◽  
Knee Prostheses ◽  
Revision Knee Arthroplasty ◽  
Primary Knee Arthroplasty ◽  
Rotating Hinge ◽  
Rotating Hinge Knee

AbstractDue to demographic transition an increasing number of primary knee arthroplasty is expected. A consequence is a rise in frequency in revision knee arthroplasty. Rotating hinge prostheses are a development of former hinge prostheses, due to changes in implant design the outcome of modern rotating hinge implants clearly improved in comparison to former models. Interpretation of outcome in present literature is difficult due to the small number of cases and the heterogeneous indications. Nevertheless the use of rotating hinge knee prostheses in primary and revision arthroplasty is associated with good clinical outcomes, when indicated appropriately.

Comparison of Mortality and 30-Day Complication Rates for Patients Undergoing Fixation versus Revision Arthroplasty after Periprosthetic Fractures of the Hip and Knee

2018 ◽  
Vol 02 (01) ◽  
pp. 009-014
Author(s):  
Shalen Kouk ◽  
Benjamin Kester ◽  
Omar Behery ◽  
Jonathan Vigdorchik ◽  
Ran Schwarzkopf
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Adverse Events ◽  
Postoperative Complication ◽  
Knee Arthroplasty ◽  
Revision Arthroplasty ◽  
Periprosthetic Fractures ◽  
Complication Rates ◽  
Improvement Program ◽  
Significant Difference

AbstractPeriprosthetic fractures of the hip and knee are often associated with significant morbidity and mortality and may require operative fixation or revision arthroplasty to restore ambulation and functional status. There is scarce literature comparing patient profiles and operative complications between periprosthetic fractures of the hip/knee and the predisposing risk factors. The main study goal is to compare the postoperative complication rates and mortality between operative osteosynthesis fixation and revision arthroplasty while also evaluating the patient characteristics, intraoperative factors, and 30-day postoperative complications of periprosthetic total hip arthroplasty (THA) and total knee arthroplasty (TKA) fractures, as well as patient-related risk factors for serious adverse events. Patients who underwent surgery for periprosthetic fractures around a THA/TKA prosthesis were identified from the American College of Surgeons National Surgical Quality Improvement Program database between 2008 and 2015. Preoperative patient demographics and comorbidities, as well as operative factors and 30-day postoperative complications were compared between periprosthetic factures of the hip and those of the knee. A multivariable logistic regression analysis was used to identify patient risk factors for adverse events. Of 1,171 identified patients, patients with THA and TKA periprosthetic fractures had similar characteristics and were more likely female, with age over 70 years and a body mass index of > 25. Both groups had similar 30-day complication rates, with 9.8% of hip patients and 11.2% of knee patients having a postoperative complication. Mortality rate for THA periprosthetic fracture status postrevision or fixation was 3.6% and 3.3% for those with TKA periprosthetic fractures. There was no significant difference in 30-day mortality or postoperative complication rates in periprosthetic fractures treated with operative osteosynthesis fixation versus revision arthroplasty for THA and TKA. Patients with periprosthetic hip and knee arthroplasty fractures can be effectively managed with either operative osteosynthesis fixation or revision arthroplasty when properly indicated, with no significant difference in mortality, complication, or reoperation rates.

Revision knee arthroplasty with replacement of part of femoral diaphysis with the modular endosystem AMT in a patient with inhibitory hemophilia B

2020 ◽  
Author(s):  
Г.В. Мишин ◽  
В.Ю. Зоренко ◽  
Е.Е. Карпов ◽  
Н.В. Садыкова ◽  
М.С. Сампиев ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Hemophilia B ◽  
Femoral Diaphysis ◽  
Orthopedic Treatment ◽  
Complete Replacement ◽  
Revision Knee Arthroplasty ◽  
Leading Role ◽  
Primary Knee Arthroplasty ◽  
Considerable Length

Представлен случай использования модульной эндосистемы АМТ при ревизионном эндопротезировании коленного сустава у больного с ингибиторной формой гемофилии В. Эндопротезирование суставов у больных гемофилией занимает ведущую роль в оперативном ортопедическом лечении гемофилической артропатии. Хирургические вмешательства у пациентов с гемофилией связаны с высоким риском кровотечения и инфекции и проводятся на фоне заместительной гемостатической терапии. Выживаемость первичных эндопротезов коленного сустава у пациентов с гемофилией составляет около 80% при сроке наблюдения 10 лет. Тем не менее встречаются случаи, когда использование эпифизарных эндопротезов невозможно технически в связи с недостаточным массивом костной ткани. В таких случаях может потребоваться замещение дефекта костной ткани на значительном протяжении. Использование модульных эндопротезов позволяет частично или полностью замещать дефекты костей. В современной литературе описаны лишь единичные случаи использования модульных эндопротезов у больных гемофилией. Представлен клинический случай успешного применения модульного эндопротеза АМТ коленного сустава у больного с ингибиторной формой гемофилии В. The case is presented of modular endosystem AMT use in revision knee arthroplasty in a patient with an inhibitory form of hemophilia B. Arthroplasty in patients with hemophilia plays a leading role in the surgical orthopedic treatment of hemophilic arthropathy. Surgical treatment in patients with hemophilia is associated with a high risk of bleeding and infection, and is performed in conjunction with hemostatic therapy. The survival rate of primary knee arthroplasty in patients with hemophilia is about 80% with a follow-up period of 10 years. Nevertheless, there are cases when epiphyseal endoprostheses use is technically impossible, due to insufficient bone tissue. In these cases, it may be necessary to replace the bone defect over a considerable length. The use of modular endoprostheses allows partial or complete replacement of bone defects. Only a few cases of modular endoprostheses use in patients with hemophilia are described in the modern literature. The article presents a clinical case of successful application of a modular knee replacement AMT in a patient with an inhibitory form of hemophilia B.

Outcome of left atrial appendage occlusion in high-risk patients

Heart ◽  
2017 ◽  
Vol 104 (7) ◽  
pp. 594-599 ◽  
Author(s):  
Ahmed Masoud ◽  
Stefano Bartoletti ◽  
Timothy Fairbairn ◽  
Ayush Khurana ◽  
Periaswamy Velavan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Events ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
Complication Rates ◽  
Serious Adverse Events ◽  
Risk Patients

ObjectivePercutaneous left atrial appendage (LAA) occlusion can be an interventional alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation.MethodsWe delivered LAA occlusion therapy using a standardised approach to patient referral, multidisciplinary team assessment, implant criteria, imaging and follow-up. We analysed patient characteristics, efficacy and safety of the implant procedure, and 12-month outcomes.ResultsOf 143 referrals from October 2014 to December 2016, 83 patients (age 76±8years, 32.5% female, mean CHAD2S2-VASc score 4 ±1) were offered LAA occlusion. Eighty (95.3%) had previous major bleeding (intracranial in 59%). LAA occluder implantation with an Amulet device was successful in 82 (98.8%), with periprocedural major adverse events occurring in 5 (6.0%) patients (2 device embolisations including 1 death, 2 major bleeds). Cardiac imaging in 75 (94%) patients 2months following implant showed device-related thrombus in 1 case (1.3%) and minor (<5mm) device leaks in 13 (17.1%). Over a median 12-month follow-up, 3 (3.8%) ischaemic strokes, 2 (2.5%) haemorrhagic strokes and 5 (6.3%) major extracranial bleeds occurred. All-cause mortality was 10%, with most deaths (7, 87.5%) due to non-cardiovascular causes.ConclusionsLAA occlusion may be a reasonable option for stroke prevention inhigh-risk patients with atrial fibrillation ineligible for anticoagulation. However, procedural complication rates are not insignificant, and patients remain at risk of serious adverse events and death even after successful implant.

scholarly journals Thrombotic adverse events reported for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines: comparison of occurrence and clinical outcomes in the EudraVigilance database

2021 ◽  
Author(s):  
Mansour Tobaiqy ◽  
Katie MacLure ◽  
Hajer Elkout ◽  
Derek Stewart
Keyword(s):  
Pulmonary Embolism ◽  
Adverse Events ◽  
Clinical Outcomes ◽  
Blood Clot ◽  
Scientific Evidence ◽  
Fatal Outcome ◽  
Added Value ◽  
European Medicines Agency ◽  
Serious Adverse Events ◽  
Spontaneous Reports

SummaryBackgroundVaccination against COVID-19 is the cornerstone to control and mitigate the ongoing pandemic. Thrombotic adverse events linked to Moderna, Pfizer and the Oxford-AstraZeneca vaccine have been documented and described as extremely rare. While the Oxford-AstraZeneca vaccine has received much of the attention, the other vaccines should not go unchallenged. This study aimed to determine the frequency of reported thrombotic adverse events and clinical outcomes for these three COVID-19 vaccines, namely, Moderna, Pfizer and Oxford-AstraZenecaMethodsA retrospective descriptive analysis was conducted of spontaneous reports for Moderna, Pfizer and Oxford-AstraZeneca COVID-19 vaccines submitted to the EudraVigilance database in the period from 17 February to 14 June 2021.FindingsThere were 729,496 adverse events for the three vaccines, of which 3,420 were thrombotic, mainly Oxford-AstraZeneca (n=1,988, 58·1%) followed by Pfizer (n=1,096, 32·0%) and Moderna (n=336, 9·8%). As serious adverse events, there were 705 reports of pulmonary embolism for the three vaccines, of which 130 reports (18·4%) were for Moderna, 226 reports (32·1%) for Pfizer and 349 (49·5%) for Oxford-AstraZeneca vaccines. The occurrence of pulmonary embolism is significantly associated with a fatal outcome (P=<0·001). Sixty-three fatalities were recorded (63/3420, 1.8%), of which Moderna (n=6), Pfizer (n=25) and Oxford-AstraZeneca (n=32).InterpretationThrombotic adverse events reported for the three vaccines remains extremely rare with multiple causative factors reported elsewhere as precipitating these events. Practicing vigilance and proper clinical management for the affected vaccines, as well as continuing to report adverse events, are essential.FundingNo funding was sought for this study.Research in contextEvidence before this studyDuring the first quarter of 2021, several European countries suspended the use of the Oxford–AstraZeneca vaccine amid reports of blood clot events and the death of a vaccinated person. This was followed by several reports of fatalities related to pulmonary embolism and other thrombotic events including thrombocytopenia which has been referred to as vaccine-induced immune thrombotic thrombocytopenia (VITT). The European Medicines Agency on 18 March 2021 concluded that the Oxford– AstraZeneca vaccine was safe, effective and the benefits outweighed the risks.Added value of this studyThis study investigated the occurrence of thrombotic adverse events and their clinical outcomes of the three approved and most used COVID-19 vaccines namely Moderna, Pfizer and Oxford-AstraZeneca, using one of the largest spontaneous adverse events databases, namely EudraVigilance. Out of 729,496 adverse events reported for the three vaccines in the study period, only 3420 (0.47%) potential thrombotic adverse events were reported, the majority associated with Oxford-AstraZeneca (n=1,988, 58.1%).Implications of all the available evidenceMore than 4·89 billion doses of different COVID-19 vaccines have been administered across the globe.Despite thrombotic adverse events reported for the three vaccines in focus for this study - Moderna, Pfizer and Oxford-AstraZeneca - being extremely rare, so continuing to report adverse events is essential. On the basis of scientific evidence showing that benefit outweighs risk, people continue to be urged to accept the vaccination when offered.

scholarly journals Initial Clinical Experience with a New Complex-Shaped Detachable Platinum Coil System for the Treatment of Intracranial Cerebral Aneurysms

2006 ◽  
Vol 12 (2) ◽  
pp. 123-130 ◽  
Author(s):  
R.T. Higashida ◽  
C. Cognard ◽  
S. Bracard
Keyword(s):  
Adverse Events ◽  
Cerebral Aneurysms ◽  
Complication Rates ◽  
Open Label ◽  
Detachable Coil ◽  
Serious Adverse Events ◽  
Unruptured Aneurysms ◽  
Coil System ◽  
Aneurysm Occlusion ◽  
And Performance

Endovascular coil occlusion of cerebral aneurysms is increasing as a viable treatment for both ruptured and unruptured aneurysms. The purpose of this study was to evaluate the safety and performance of a newer generation of complex-shaped, geometrically conformable, platinum coils, the TRUFILL DCS Detachable Coil System. From September 2000 to December 2002, 112 patients with 116 aneurysms, either ruptured or unruptured, deemed by an attending neuro-in-terventionalist to be acceptable candidates for endovascular coil embolization, were recruited into an open-label, prospective, multi-center, international registry study from 23 centers in Europe. Information on relevant clinical characteristics, device and procedure performance, and angiographic occlusion data were collected for all patients. An Independent Medical Monitor collected and reviewed information on all device- and procedure-related complications resulting in serious adverse events. Angiographic evaluation immediately following treatment of 116 aneurysms showed a mean ± SD percent of aneurysm occlusion of 93.5% ± 14.2, with 90.2% of aneurysms occluded at least 90%. The desired occlusion was achieved in 94.9% of aneurysms. Success was defined as the ability to obtain ≥ 90% aneurysm occlusion. The proportion achieving greater than 90% occlusion was statistically equivalent (at least as good) to the 80% registry standard. Complication rates were 6.9% device-related and 2.6% procedure-related. Only two complications were categorized as serious adverse events. The TRUFILL DCS coil system provided good to excellent complete occlusion of the aneurysm at initial treatment, as compared to other published studies, and proved effective and safe to use in treating both ruptured and unruptured cerebral aneurysms.

Design, Construction, and Early Results of a Formal Local Revision Knee Arthroplasty Registry

2020 ◽  
Author(s):  
Aravinthan Visvanathan ◽  
Christopher Wilson ◽  
Emma Jackman ◽  
Geraldine Wong ◽  
Jegan Krishnan
Keyword(s):  
Knee Arthroplasty ◽  
Historical Data ◽  
Revision Arthroplasty ◽  
National Registry ◽  
Secondary Outcome ◽  
Local Health ◽  
National Data ◽  
Revision Knee Arthroplasty ◽  
Early Results ◽  
Arthroplasty Registry

AbstractNational registries for primary and revision knee arthroplasty in Australia, New Zealand, and Europe have been successful in ensuring quality control and providing information to drive crucial research. However, they face challenges in delivering the granularity of data useful at a local hospital level. Our aim was to address these challenges by designing and initiating a local revision knee arthroplasty registry and combining the data with national figures to better evaluate the types of revisions undertaken, and improve patient outcomes and care. All revision knee arthroplasty cases in our center were analyzed from April 2014 to December 2015 using our standardized diagnostic algorithm. Information such as reason and type of revision was collected. Results were compared with Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. Primary outcome was comparison against our center's historical data between January 1999 and December 2013 and secondary outcome was comparison against national data prior to and after our intervention. Between April 2014 and December 2015, our center performed 35 revision knee arthroplasties. When compared with our center's historical data, we observed lower rates of revision knee arthroplasties due to “pain” (14.2 vs. 36.7%) with corresponding lower rates of patella button only revision (8.6 vs. 39.2%). Compared with national data before our intervention, we had lower revision rates from infection (14.2 vs. 22.3%) and loosening/lysis (11.4 vs. 29.2%). We undertook more minor revisions (45.7 vs. 30.5%) and similar total revisions (25.7 vs. 25.3%). Similar trends were seen in comparison to national data after our intervention. Our study shows that a local registry can be designed and successfully implemented for revision knee arthroplasty surgery. Data can be easily compared with historic and current hospital and national registry data trends to assess quality and robustness of revision arthroplasty programs. Our early results suggest our center has succeeded in reducing incidences of major revisions, complications, and the risk of re-revision surgery. This will improve the quality of our service with a significant cost reduction for our local health care budget.

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