Venous thromboembolism after total knee arthroplasty is associated with a worse functional outcome at one year

2021 ◽  
Vol 103-B (7) ◽  
pp. 1254-1260
Author(s):  
Lorenzo Calabro ◽  
Nick D. Clement ◽  
Deborah MacDonald ◽  
James T. Patton ◽  
Colin R. Howie ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Venous Thromboembolism ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Significant Independent Predictor ◽  
Total Knee ◽  
Five Dimension ◽  
One Year

Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee-specific functional outcome (Oxford Knee Score (OKS)) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed in 2,393 patients. Patient demographics, comorbidities, OKS, EuroQol five-dimension score (EQ-5D), and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and compared with those without. Results A total of 37 patients (1.5%) suffered a VTE and were significantly more likely to have associated comorbidities of stroke (p = 0.026), vascular disease (p = 0.026), and kidney disease (p = 0.026), but less likely to have diabetes (p = 0.046). In an unadjusted analysis, patients suffering a VTE had a significantly worse postoperative OKS (difference in mean (DIM) 4.8 (95% confidence interval (CI) 1.6 to 8.0); p = 0.004) and EQ-5D (DIM 0.146 (95% CI 0.059 to 0.233); p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent predictor associated with a worse postoperative OKS (DIM -5.4 (95% CI -8.4 to -2.4); p < 0.001), and EQ-5D score (DIM-0.169 (95% CI -0.251 to -0.087); p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89 (95% CI 0.35 to 2.07); p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had clinically significantly worse knee-specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):1254–1260.

scholarly journals Higher treatment effect after total knee arthroplasty is associated with higher patient satisfaction

2020 ◽  
Author(s):  
Jörg Lützner ◽  
Franziska Beyer ◽  
Klaus-Peter Günther ◽  
Jörg Huber
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Arthroplasty ◽  
Treatment Effect ◽  
Treatment Effects ◽  
Oxford Knee Score ◽  
Individual Treatment ◽  
Total Knee ◽  
The Mean ◽  
One Year

Abstract Purpose The aim of this study was to investigate what influence the treatment effect after total knee arthroplasty (TKA) had on patient satisfaction. Methods Prospective registry data of a University-based arthroplasty centre were used. 582 patients with unilateral bicondylar TKA were analyzed. Treatment effect (TE) was deduced from Oxford Knee Score (OKS) before and one year after surgery. Positive values correspond to improved symptoms (maximum 1.0 reflect no symptoms at all) and negative values correspond to deterioration of symptoms. Satisfaction on a visual-analogue scale from 0 to 10 and the willingness to undergo TKA surgery again was assessed one year after surgery. Results The mean OKS improved from 22.1 before to 36.7 one year after TKA. Treatment effects ranged from 1.0 to –0.62 with a mean TE of 0.56. Taking an individual treatment effect of 0.2 as a cut-off between responder and non-responder, a total of 85.8% would be classified as responder after TKA. The mean satisfaction score with the TKA was 8.1. There was a significant correlation between the individual treatment effect and satisfaction after TKA (p < 0.001). The majority of patients (84.5%) would undergo surgery again. Patients not willing to undergo surgery again or those uncertain about this had lower satisfaction scores, a lower treatment effect and were more often female compared to patients who would undergo surgery again. Conclusion Higher individual treatment effects resulted in higher patient satisfaction and willingness to undergo surgery again. However, some patients with a relatively low treatment effect were highly satisfied, which indicates the need for both information. Level of evidence II.

The preoperative Oxford Knee Score is an independent predictor of achieving a postoperative ceiling score after total knee arthroplasty

2020 ◽  
Vol 102-B (11) ◽  
pp. 1519-1526
Author(s):  
Nicholas D. Clement ◽  
Irrum Afzal ◽  
Charis Demetriou ◽  
David J. Deehan ◽  
Richard E. Field ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Independent Predictor ◽  
Characteristic Curve ◽  
Oxford Knee Score ◽  
Ceiling Effect ◽  
Knee Score ◽  
Total Knee ◽  
Five Dimension ◽  
One Year

Aims The primary aim of this study was to assess whether the postoperative Oxford Knee Score (OKS) demonstrated a ceiling effect at one and/or two years after total knee arthroplasty (TKA). The secondary aim was to identify preoperative independent predictors for patients that achieved a ceiling score after TKA. Methods A retrospective cohort of 5,857 patients undergoing a primary TKA were identified from an established arthroplasty database. Patient demographics, body mass index (BMI), OKS, and EuroQoL five-dimension (EQ-5D) general health scores were collected preoperatively and at one and two years postoperatively. Logistic regression analysis was used to identify independent preoperative predictors of patients achieving postoperative ceiling scores. Receiver operating characteristic curve was used to identify a preoperative OKS that predicted a postoperative ceiling score. Results The ceiling effect was 4.6% (n = 272) at one year which increased significantly (odds ratio (OR) 40.3, 95% confidence interval (CI) 30.4 to 53.3; p < 0.001) to 6.2% (n = 363) at two years, when defined as those with a maximal score of 48 points. However, when the ceiling effect was defined as an OKS of 44 points or more, this increased to 26.3% (n = 1,540) at one year and further to 29.8% (n = 1,748) at two years (OR 21.6, 95% CI 18.7 to 25.1; p < 0.001). A preoperative OKS of 23 or more and 22 or more were predictive of achieving a postoperative ceiling OKS at one and two years when defined as a maximal score or a score of 44 or more, respectively. Conclusion The postoperative OKS demonstrated a small ceiling effect when defined by a maximal score, but when defined by a postoperative OKS of 44 or more the ceiling effect was moderate and failed to meet standards. The preoperative OKS was an independent predictor of achieving a ceiling score. Cite this article: Bone Joint J 2020;102-B(11):1519–1526.

Revision Total Knee Arthroplasty Causes of failure, bone loss management and outcomes\

2018 ◽  
Vol 69 (8) ◽  
pp. 2222-2227
Author(s):  
George Viscopoleanu ◽  
Bogdan Sendrea ◽  
Emil Haritinian
Keyword(s):  
Total Knee Arthroplasty ◽  
Bone Loss ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Bone Defects ◽  
Knee Score ◽  
Cause Of Failure ◽  
Total Knee

The objectives of the current study were to identify the causes leading to revision knee arthroplasty, analyse implant choices and assess the short-term outcome. The current study is a retrospective on including a group of 33 patients operated between Jan 2013-Dec 2016 in a single institution. Data was collected from the Romanian National Arthroplasty Register. The cause for revision surgery was noted, as well as the type of implant used during the surgical procedure. The bony defect was classified according to the Anderson Orthopaedic Research Institute (AORI) Classification and the reconstruction method was analysed. Functional outcome was assessed using Oxford Knee Score preoperatively and at one year follow-up. Infection was the cause of failure in 18 cases, aseptic loosening in 11 cases, malposition of implants in 2 cases, instability in 1 case and periprosthetic fracture in 1 case. Revision implants were chosen based on joint stability and degree bone loss. The preferred implant was a condylar constrained knee type (20 cases), followed by a rotating hinge type (5 cases). An unconstrained implant was used in 2 cases. Six infected cases required an arthrodesis of the knee. Based on the AORI Classification, there were 10 type III defects, 14 type IIB, 8 type IIA and only one type I defect. Metal augments were preferred for reconstruction of bone defects. Bone graft was used in 8 cases. The mean Oxford Knee Score was 15 pre-op (12-20) and 38 post-op (32-45). Implant survival at final follow-up was 100%. The most common cause of failure of primary total knee arthroplasty is prosthetic joint infection. Bone defects can be addressed using metal augments or bone allograft. Postoperative functional outcome is improved irrespective of the type of implant used.

The rate and predictors of patient satisfaction after total knee arthroplasty are influenced by the focus of the question

2018 ◽  
Vol 100-B (6) ◽  
pp. 740-748 ◽  
Author(s):  
N. D. Clement ◽  
M. Bardgett ◽  
D. Weir ◽  
J. Holland ◽  
C. Gerrand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Patient Satisfaction ◽  
Back Pain ◽  
Pain Relief ◽  
Logistic Regression Analysis ◽  
Knee Arthroplasty ◽  
Total Knee ◽  
One Year

AimsThe primary aim of this study was to assess the rate of patient satisfaction one year after total knee arthroplasty (TKA) according to the focus of the question asked. The secondary aims were to identify independent predictors of patient satisfaction according to the focus of the question.Patients and MethodsA retrospective cohort of 2521 patients undergoing a primary unilateral TKA were identified from an established regional arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 12-Item Short-Form Health Survey (SF-12) scores were collected preoperatively and one year postoperatively. Patient satisfaction was assessed using four questions, which focused on overall outcome, activity, work, and pain. Logistic regression analysis was used to identify independent preoperative predictors of increased stiffness when adjusting for confounding variables.ResultsUsing patient satisfaction with the overall outcome (n = 2265, 89.8%) as the standard, there was no difference in the rate of satisfaction for pain relief (n = 2277, odds ratio (OR) 0.95, 95% confident intervals (CI) 0.79 to 1.14, p = 0.60), but patients were more likely to be dissatisfied with activities (79.3%, n = 2000/2521, OR 2.22, 95% CI 1.96 to 2.70, p < 0.001) and work (85.8%, n = 2163/2521, OR 1.47, 95% CI 1.23 to 1.75, p < 0.001). Logistic regression analysis identified different predictors of satisfaction for each of the focused satisfaction questions. Overall satisfaction was influenced by diabetes (p = 0.03), depression (p = 0.004), back pain (p < 0.001), and SF-12 physical (p = 0.008) and mental (p = 0.01) components. Satisfaction with activities was influenced by depression (p = 0.001), back pain (p < 0.001), WOMAC stiffness score (p = 0.03), and SF-12 physical (p < 0.001) and mental (p < 0.001) components. Satisfaction with work was influenced by depression (p = 0.007), back pain (p < 0.001), WOMAC function (p = 0.04) and stiffness (p = 0.05) scores, and SF-12 physical (p < 0.001) and mental (p < 0.001) components. Satisfaction with pain relief was influenced by diabetes (p < 0.001), back pain (p < 0.001), and SF-12 mental component (p = 0.04).ConclusionThe focus of the satisfaction question significantly influences the rate and the predictors of patient satisfaction after TKA. Cite this article: Bone Joint J 2018;100-B:740–8.

Three groups of dissatisfied patients exist after total knee arthroplasty: early, persistent, and late

2018 ◽  
Vol 100-B (2) ◽  
pp. 161-169 ◽  
Author(s):  
N. D. Clement ◽  
M. Bardgett ◽  
D. Weir ◽  
J. Holland ◽  
C. Gerrand ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Increased Risk ◽  
Total Knee ◽  
One Year

Aims The primary aim of this study was to assess whether patient satisfaction one year after total knee arthroplasty (TKA) changed with longer follow-up. The secondary aims were to identify predictors of satisfaction at one year, persistence of patient dissatisfaction, and late onset dissatisfaction in patients that were originally satisfied at one year. Patients and Methods A retrospective cohort consisting of 1369 patients undergoing a primary TKA for osteoarthritis that had not undergone revision were identified from an established arthroplasty database. Patient demographics, comorbidities, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and Short Form 12 (SF-12) questionnaire scores were collected preoperatively, and one and five years postoperatively. In addition, patient satisfaction was assessed at one and five years postoperatively. Logistic regression analysis was used to identify independent predictors of satisfaction at one and five years. Results The overall rate of satisfaction did not change from one (91.7%, n = 1255) to five (90.1%, n = 1234) years (p = 0.16). Approximately half (n = 53/114) of the patients who were dissatisfied at one year became satisfied with their TKA at five years, whereas 6% (n = 74/1255) of those who were satisfied at one year became dissatisfied at five years. At one year, patients with lung disease (p = 0.04), with depression (p = 0.001), with back pain (p <  0.001), undergoing unilateral TKA (p = 0.001), or with a worse preoperative WOMAC pain score (p = 0.04) were more likely to be dissatisfied. Patients with gastric ulceration (p = 0.04) and a worse WOMAC stiffness score (p = 0.047) were at increased risk of persistent dissatisfaction at five years. In contrast, a worse WOMAC pain score (p = 0.01) at one year was a predictor of dissatisfaction in previously satisfied patients at five years. Conclusion Three groups of dissatisfied patients exist after TKA: ‘early’ dissatisfaction at one year, ‘persistent’ dissatisfaction with longer follow-up, and ‘late’ dissatisfaction developing in previously satisfied patients at one year. All three groups have different independent predictors of satisfaction, and potentially addressing risk factors specific to these groups may improve patient outcome and their satisfaction. Cite this article: Bone Joint J 2018;100-B:161–9.

scholarly journals Clinical outcomes and patient satisfaction after total knee arthroplasty: a follow-up of the first 50 cases by a single surgeon

2019 ◽  
Vol 47 (4) ◽  
pp. 1667-1676 ◽  
Author(s):  
Jacob A. West ◽  
Travis Scudday ◽  
Scott Anderson ◽  
Nirav H. Amin
Keyword(s):  
Total Knee Arthroplasty ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Oxford Knee Score ◽  
Function Score ◽  
Total Knee ◽  
One Year ◽  
Postoperative Knee

Objective To examine the association between single-surgeon learning curve and clinical outcomes following total knee arthroplasty (TKA). Methods This prospective study included the first consecutive patients undergoing TKA conducted by the same surgeon using the JOURNEY II Bi-Cruciate Stabilized Knee System (Smith & Nephew, Andover, MA, USA). Patients were assessed preoperatively, and at three months and one year postoperatively using Oxford Knee Score (OKS), Knee Society Score (KSS) and Knee Function Score (KFS). Outcomes were statistically analysed using sequential patient cohorts. Results Fifty patients were grouped into five sequential cohorts of 10 patients each. All patients showed significant improvement in postoperative knee scores following TKA. There was a trend toward increased improvement in knee scores in the later patient cohorts, at the three-month and 1-year follow-up. Conclusions The single-surgeon learning curve for minimally invasive TKA had a small effect on knee satisfaction scores at 3 months and 1 year following surgery in the first 50 consecutive cases, and only minor complications were encountered. A larger trial is necessary to draw generalizable conclusions regarding patient outcomes during surgeon learning.

Contralateral knee pain reduces the rate of patient satisfaction but does not clinically impair the change in WOMAC score after total knee arthroplasty

2020 ◽  
Vol 102-B (1) ◽  
pp. 125-131 ◽  
Author(s):  
Nicholas D. Clement ◽  
David J. Weir ◽  
James Holland ◽  
David J. Deehan
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Meaningful Improvement ◽  
Contralateral Knee ◽  
Total Knee ◽  
Clinically Significant ◽  
One Year

Aims The primary aim of this study was to assess whether pain in the contralateral knee had a clinically significant influence on the outcome of total knee arthroplasty (TKA) according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Secondary aims were to: describe the prevalence of contralateral knee pain; identify if it clinically improves after TKA; and assess whether contralateral knee pain independently influences patient satisfaction with their TKA. Methods A retrospective cohort of 3,178 primary TKA patients were identified from an arthroplasty database. Patient characteristics, comorbidities, and WOMAC scores were collected preoperatively and one year postoperatively for the index knee. In addition, WOMAC pain scores were also collected for the contralateral knee. Overall patient satisfaction was assessed at one year. Preoperative contralateral knee pain was defined according to the WOMAC score: minimal (> 78 points), mild (59 to 78), moderate (44 to 58), and severe (< 44). Multivariate regression analysis was used to adjust for confounding. Results According to severity there were 1,425 patients (44.8%) with minimal, 710 (22.3%) with mild, 518 (16.3%) with moderate, and 525 (16.5%) with severe pain in the contralateral knee. Patients in the severe group had a greater clinically significant improvement in their functional WOMAC score (9.8 points; p < 0.001). Only patients in the moderate (22.9 points) and severe (37.8 points) groups had a clinically significant improvement in their contralateral knee pain (p < 0.001), but they were significantly less likely to be satisfied with their TKA (moderate: odds ratio (OR) 0.64, 95% confidence interval (CI) 0.4 to 0.92, p = 0.022; severe: OR 0.57, 95% CI 0.39 to 0.82, p = 0.002). Conclusion Contralateral knee pain did not impair improvement in the WOMAC score after TKA, and patients with the most severe contralateral knee pain had a clinically significantly greater improvement in their functional outcome. More than half the patients presenting for TKA had mild-to-severe contralateral knee pain, most of whom had a clinically meaningful improvement but were significantly less likely to be satisfied with their TKA. Cite this article: Bone Joint J. 2020;102-B(1):125–131

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