scholarly journals Evolution and projection of knee arthroplasties from 2003 to 2030 in the state of São Paulo

2019 ◽  
Vol 65 (7) ◽  
pp. 1001-1006 ◽  
Author(s):  
Rogério Teixeira de Carvalho ◽  
Tiago Lobão Lopes ◽  
Marcelo Itiro Takano ◽  
Juliana Hoss Silva Lima ◽  
Lucas Simões Arrebola ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Sao Paulo ◽  
The State ◽  
São Paulo ◽  
Cross Sectional ◽  
Significant Difference ◽  
Total Knee

SUMMARY OBJECTIVE Analyze data regarding total knee arthroplasty (TKA) carried out by the Public Health System (SUS) in the state of São Paulo from 2003 to 2010 and determine the projections expected for 2030. METHODS A cross-sectional study (observational). We analyzed 10,952 patients who underwent primary total knee arthroplasty (PTKA) and revision total knee arthroplasty (RTKA) in the state of São Paulo between 2003 and 2010. The collection of data based on ICD-10 and HAA (Hospital Admission Authorization) were provided by the Tabnet and Sigtap software (Management System for the Table of Procedures, Medications, and OPM by SUS). The following variables were analyzed: gender, number of PTKAs and RTKAs, and their projections. The information collected formed a database developed in Excel® for Windows, and the statistical analysis was performed by the Stata® 11 SE and Minitab 16 software. RESULTS There was a significant difference in the prevalence of TKA between genders (p<0.0001); most of the patients were females (7,891; 72%). The projection for 2030 when compared with the first year of the series, 2003, indicates a growth of 428% for PTKA and 1,380% for RTKA, with a greater increase percentage of RTKA in males than in females (1,558% and 1,318%, respectively). CONCLUSION The proportions of the RTKA projection are much greater than those of PTKA by 2030, with a greater percentage of increase of RTKA in males than in females.

scholarly journals Prevalence of knee arthroplasty in the state of São Paulo between 2003 and 2010

2016 ◽  
Vol 134 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Rogério Teixeira de Carvalho ◽  
Jonny Chaves Lima Canté ◽  
Juliana Hoss Silva Lima ◽  
Luiz Alberto Barbosa Tavares ◽  
Marcelo Itiro Takano ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Sao Paulo ◽  
The State ◽  
Public Healthcare ◽  
Osteoarthritis Of The Knee ◽  
São Paulo ◽  
The Public ◽  
Total Knee

ABSTRACT CONTEXT AND OBJECTIVE: The volume of knee arthroplasty procedures has increased over the last decade. The aim of this study was to estimate the frequency of these procedures performed within the public healthcare system of the state of São Paulo between 2003 and 2010. DESIGN AND SETTING: Cross-sectional study conducted in the state of São Paulo by researchers at Hospital do Servidor Público do Estado de São Paulo. METHODS: A sample of 10,952 patients (7,891 females and 3,061 males) who underwent primary total knee arthroplasty (TKA) and revision of total knee arthroplasty (RTKA) in the state of São Paulo between 2003 and 2010 was evaluated. The patients were cataloged using the public healthcare service's TABNET software. All of the patients presented primary osteoarthritis of the knee. The variables of gender, number of primary TKA procedures and number of RTKA procedures were evaluated. RESULTS: A total of 10,952 TKA procedures were performed (annual average of 1369), of which 9,271 (85%) were TKA and 1,681 (15%), RTKA. Of the TKA procedures, 72% were carried out on females (P < 0.0001), while 70% of the RTKA procedures were on females (P < 0.0001). The average ratio of TKA to RTKA was 5.5:1 (P < 0.0001); the ratios in 2003 and 2010 were 9.0:1 and 4.4:1 (P < 0.0001), respectively. CONCLUSION: The number and frequency of TKA and RTKA procedures increased in the state of São Paulo between 2003 and 2010. This increase was relatively greater in RTKA than in TKA and was predominantly in female patients.

scholarly journals COMPARISON OF HEMOSTASIS WITH TRANEXAMIC ACID IN TOTAL KNEE ARTHROPLASTY

2021 ◽  
Vol 29 (4) ◽  
pp. 184-188
Author(s):  
OTÁVIO MONTOVANELLI MONTEIRO ◽  
RODRIGO TURRA PERRONE ◽  
FABRÍCIO NASCIMENTO ALMEIDA ◽  
CID PEREIRA DE MOURA JUNIOR ◽  
SAULO GOMES DE OLIVEIRA ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Statistical Significance ◽  
Primary Total Knee Arthroplasty ◽  
Joint Surface ◽  
Thromboembolic Events ◽  
Significant Difference ◽  
Total Knee ◽  
Group 3

ABSTRACT Objective: To compare the use of intravenous and topical tranexamic acid (TXA) in unilateral primary total knee arthroplasty (TKA) in relation to blood loss and complications inherent to the medication. Method: Three groups with 14 patients each were constituted, and all of them were operated using the same surgical technique. In Group 1, usual measures for bleeding control were performed. Group 2 patients received TXA topically on the joint surface. In Group 3, intravenous TXA was used. Hemoglobin (HB), hematocrit (HTC), platelets (PLAT), prothrombin time, activated partial thromboplastin time and volume of blood drained observed 24 hours after arthroplasty were compared to the values of tests found before surgery. Results: There was a decrease in the concentration of HB, HTC and PLAT in all groups in relation to the preoperative, however without significant difference. Group 3 had a lower mean volume of drained blood than the other groups, with statistical significance. No adverse effects or thromboembolic events were observed in the groups that received TXA. Conclusion: This study showed superiority in the use of intravenous TXA in decreasing the volume of bleeding, without increasing the risk of thromboembolic events. Level of Evidence I, High quality randomized trial with statistically significant difference or no statistically significant difference but narrow confidence intervals.

Extended Oral Antibiotics and Infection Prophylaxis after a Primary or Revision Total Knee Arthroplasty

2019 ◽  
Vol 33 (02) ◽  
pp. 111-118 ◽  
Author(s):  
Cierra S. Hong ◽  
Collin S. Black ◽  
Sean P. Ryan ◽  
Thorsten M. Seyler
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Infection Prophylaxis ◽  
Oral Antibiotics ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Total Knee

AbstractOne of the most common reasons for failure of primary total knee arthroplasty and need for revision surgery is periprosthetic infection. Antibiotics are one of the mainstays of treatment to address prosthetic joint infections, but the route of administration and timing of delivery to optimize patient outcomes are debated. This article reviews the use and attributes of commonly used oral antibiotics, especially extended or long-term utilization, as prophylaxis and treatment for prosthetic joint infections in a primary or revision total knee arthroplasty, which include debridement, antibiotics, and implant retention, one-stage and two-stage exchange arthroplasty.

Extramedullary Guide Alignment Is not Affected by Obesity in Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Jocelyn Compton ◽  
Jessell Owens ◽  
Jesse Otero ◽  
Nicolas Noiseux ◽  
Timothy Brown
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Tibial Component ◽  
Primary Total Knee Arthroplasty ◽  
Coronal Plane ◽  
Coronal Alignment ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Valgus Alignment

AbstractCoronal alignment of the tibial implant correlates with survivorship of total knee arthroplasty (TKA), especially in obese patients. The purpose of this study was to determine if obesity affects coronal plane alignment of the tibial component when utilizing standard extramedullary tibial guide instrumentation during primary TKA. A retrospective review from June 2017 to February 2018 identified 142 patients (162 primary TKAs). There were 88 patients (100 knees) with body mass index (BMI) < 35 kg/m2 and 54 patients (62 knees) with BMI ≥ 35.0 kg/m2. The cohorts did not differ in age (p = 0.37), gender (p = 0.61), or Charlson's comorbidity index (p = 0.54). Four independent reviewers measured the angle between the base of the tibial component and the mechanical axis of the tibia on the anteroposterior view of long-leg film at first postoperative clinic visit. Outliers were defined as patients with greater than 5 degrees of varus or valgus alignment (n = 0). Reoperations and complications were recorded to 90 days postoperatively. There was no significant difference in mean tibial coronal alignment between the two groups (control alignment 90.8 ± 1.2 degree versus obese alignment 90.8 ± 1.2 degree, p = 0.91). There was no difference in varus versus valgus alignment (p = 0.19). There was no difference in the number of outliers (two in each group, p = 0.73). There was no difference in rate of reoperation (p = 1.0) or complication (p = 0.51). Obesity did not affect coronal plane alignment of the tibial component when using an extramedullary guide during primary TKA in our population.

Low-Dose Aspirin is Safe and Effective for Venous Thromboembolism Prevention in Patients Undergoing Revision Total Knee Arthroplasty: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Alex Tang ◽  
Stephen G. Zak ◽  
Daniel Waren ◽  
Richard Iorio ◽  
James D. Slover ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Total Joint Replacement ◽  
Joint Infection ◽  
Revision Total Knee Arthroplasty ◽  
Bleeding Complications ◽  
Vte Prophylaxis ◽  
Significant Difference ◽  
Total Knee

AbstractVenous thromboembolism (VTE) events are rare, but serious complications of total joint replacement affect patients and health care systems due to the morbidity, mortality, and associated cost of its complications. There is currently no established universal standard of care for prophylaxis against VTE in patients undergoing revision total knee arthroplasty (rTKA). The aim of this study was to determine whether a protocol of 81-mg aspirin (ASA) bis in die (BID) is safe and/or sufficient in preventing VTE in patients undergoing rTKAs versus 325-mg ASA BID. In 2017, our institution adopted a new protocol for VTE prophylaxis for arthroplasty patients. Patients initially received 325-mg ASA BID for 1 month and then changed to a lower dose of 81-mg BID. A retrospective review from 2011 to 2019 was conducted identifying 1,438 consecutive rTKA patients and 90-day postoperative outcomes including VTE, gastrointestinal, and wound bleeding complications, acute periprosthetic joint infection, and mortality. In the 74 months prior to protocol implementation, 1,003 rTKAs were performed and nine VTE cases were diagnosed (0.90%). After 26 months of the protocol change, 435 rTKAs were performed with one VTE case identified (0.23%). There was no significant difference in rates or odds in postoperative pulmonary embolism (PE; p = 0.27), DVT (p = 0.35), and total VTE rates (p = 0.16) among patients using either protocol. There were also no differences in bleeding complications (p = 0.15) or infection rate (p = 0.36). No mortalities were observed. In the conclusion, 81-mg ASA BID is noninferior to 325-mg ASA BID in maintaining low rates of VTE and may be safe for use in patients undergoing rTKA.

Periprosthetic Infection: Major Cause of Early Failure of Primary and Revision Total Knee Arthroplasty

2018 ◽  
Vol 32 (10) ◽  
pp. 941-946 ◽  
Author(s):  
Dimitrios S. Evangelopoulos ◽  
Sufian S. Ahmad ◽  
Anna M. Krismer ◽  
Christoph E. Albers ◽  
Sven Hoppe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Functional Score ◽  
Extension Deficit ◽  
Primary Tkas ◽  
Significant Difference ◽  
Flexion Extension ◽  
Cause Of Failure ◽  
Total Knee

AbstractRevision total knee arthroplasty (RTKA) represents an effective treatment for failed TKA, but with less favorable outcomes. Considering the technical complexity and economic burden of RTKA procedures, it is mandatory to investigate current mechanisms and predictors for RTKA failure. The objective of this study is to evaluate the survivorship and determine the predominant causes of failure of RTKA. A total of 146 patients undergoing RTKA between 2003 and 2013 were identified from the institutional database. Revision was defined as surgery in which the whole prostheses (inlay and both femoral and tibial components) required exchange. Median follow-up was 6.3 ± 2.7 years (range: 2.2–10). Patient demographics, year of primary implantation, reasons for revision surgery, implant type, pain, knee mobility, systemic or local postoperative complications, and treatment of the complications were recorded and evaluated. Infection was a major cause of failure followed by aseptic loosening, instability, pain, malalignment, and inlay wear. Following RTKA, Knee Society Score (KSS) (knee score and functional score) demonstrated a significant improvement (p < 0.05). No significant difference in flexion, extension deficit, and KSS was detected between aseptic and septic primary TKAs preoperatively and following first RTKA. Reinfection rate of the septic primary TKAs was 5%. Infection was the major cause of a second revision, reaching as high as 50% in all cases. The results of this study support that septic failure of a primary TKA is likely to occur within the first 2 years following implantation. Septic failure of primary TKA does not influence survival of the revision prosthesis.

scholarly journals Management of periprosthetic fractures of knee arthroplasty with revision surgery

2020 ◽  
Author(s):  
Ahmad Kamal ◽  
Ren Jiang Dong ◽  
Rafiq Shah ◽  
Cao Li
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Primary Total Knee Arthroplasty ◽  
Primary Treatment ◽  
Revision Total Knee Arthroplasty ◽  
Periprosthetic Fractures ◽  
Successful Operation ◽  
Total Knee

Abstract Objective : As periprosthetic knee fractures are becoming common with the increase in incidence of primary and revision total knee arthroplasty, their management and treatment have become important. The current study aims to evaluate the revision knee arthroplasty carried out due to the failure of primary treatment of periprosthetic femoral fractures.Methods: The study was conducted from May 2012 to September 2019 at Orthopedics department of Xinjiang Medical University; out of 21 patients 11 were women and 10 men aged 44 to 80 (mean, 70.76±8.31) years who underwent revision surgery for periprosthetic fractures of 19 distal femur, 1 patellar, and 1 proximal tibial fracture. Nineteen cases had definite trauma history leading to periprosthetic fracture, and 2 cases had fracture during post-operative functional exercise. All patients had revision surgery with extended stems with either constrained or limited condylar knee prosthesis.Results : The duration of follow-up averaged 4.3 years. The Hospital for Special Surgery (HSS) knee score before fracture averaged 91 + 7.01 points (89 - 95 points) and 85.5 + 6.18 points (81 - 90 points) at the last follow-up. The average range of motion of knee joint before fracture was 115.7 [+7.6] (110 [~126]), and 101.3 [+9.8] (85 [~115]) at the last follow-up. There was no significant statistical difference. No complications such as infection, component loosening or nonunion. 2 patients had lower extremity vein thrombosis.Conclusion Revision surgery of the knee for the periprosthetic fractures with proper prosthetic selection can attain good outcomes after primary total knee arthroplasty. Reasonable and correct procedure is the main principle for a successful operation. The benefits and applicability of revision TKA is the reconstructive solution for the issues of prosthetic knee fractures, is highly recommended.

scholarly journals Revision total knee arthroplasty versus primary total knee arthroplasty

2020 ◽  
Vol 1 (3) ◽  
pp. 29-34
Author(s):  
Paul Stirling ◽  
Scott D. Middleton ◽  
Ivan J. Brenkel ◽  
Phil J. Walmsley
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
Revision Total Knee Arthroplasty ◽  
Lateral Release ◽  
Matched Cohort ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee ◽  
Revision Tka

Introduction The primary aim of this study was to describe a baseline comparison of early knee-specific functional outcomes following revision total knee arthroplasty (TKA) using metaphyseal sleeves with a matched cohort of patients undergoing primary TKA. The secondary aim was to compare incidence of complications and length of stay (LOS) between the two groups. Methods Patients undergoing revision TKA for all diagnoses between 2009 and 2016 had patient-reported outcome measures (PROMs) collected prospectively. PROMs consisted of the American Knee Society Score (AKSS) and Short-Form 12 (SF-12). The study cohort was identified retrospectively and demographics were collected. The cohort was matched to a control group of patients undergoing primary TKA. Results Overall, 72 patients underwent revision TKA and were matched with 72 primary TKAs with a mean follow-up of 57 months (standard deviation (SD) 20 months). The only significant difference in postoperative PROMs was a worse AKSS pain score in the revision group (36 vs 44, p = 0.002); however, these patients still produced an improvement in the pain score. There was no significant difference in improvement of AKSS or SF-12 between the two groups. LOS (9.3 days vs 4.6 days) and operation time (1 hour 56 minutes vs 1 hour 7 minutes) were significantly higher in the revision group (p < 0.001). Patients undergoing revision were significantly more likely to require intraoperative lateral release and postoperative urinary catheterisation (p < 0.001). Conclusion This matched-cohort study provides results of revision TKA using modern techniques and implants and outlines what results patients can expect to achieve using primary TKA as a control. This should be useful to clinicians counselling patients for revision TKA.

scholarly journals REPLACEMENT VERSUS NON-REPLACEMENT OF THE PATELLAR JOINT SURFACE IN TOTAL KNEE ARTHROPLASTY

2018 ◽  
Vol 26 (3) ◽  
pp. 175-178
Author(s):  
RAFAEL ALUISIO FENERICH HONORIO FERREIRA ◽  
LEONARDO BARROS MASCARENHAS ◽  
RODRIGO SALIM ◽  
ALINE MIRANDA FERREIRA ◽  
FABRÍCIO FOGAGNOLO ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Pain ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Womac Score ◽  
Reoperation Rate ◽  
Joint Surface ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Total Knee

ABSTRACT Objective This study addresses functional data, pain, and the reoperation rate in patients undergoing primary total knee arthroplasty (TKA) during which the patella was or was not replaced. Methods Fifty-three knees were included, 18 with the patella replaced and 35 with the patella not replaced. WOMAC and SF-12 scores and knee pain were analyzed preoperatively and 3, 6, and 12 months after TKA. The reoperation rate was also evaluated. Results Both groups presented significant improvement in WOMAC score and pain at all postoperative follow-up appointments. There was no significant difference between the groups in all evaluated variables. Two subjects in the group did not undergo patellar replacement due to complaints of anterior knee pain after arthroplasty. There was no difference between the groups in relation to the reoperation rate. Conclusion Patients receiving patellar replacement during TKA did exhibit significant differences in the rate of reoperation, function, or pain when compared to patients in which the patella was replaced. Level of Evidence III; Cohort study.

scholarly journals Skin Closure Tape and Surgical Staples in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Xiangli Luo ◽  
Wenhui Zhang ◽  
Peijing Yan ◽  
Zongru He ◽  
Yuping Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Small Sample ◽  
Cochrane Library ◽  
Skin Closure ◽  
Significant Difference ◽  
Total Knee

Background. Staples closure technology has been widely used in total knee arthroplasty (TKA) and achieved good results. In recent years, a new type of material called skin closure tape (SCT) has been applied to TKA which also showed good treatment results. However, since it is still not clear yet which one is better, this paper collects literatures for statistical analysis so as to provide evidence for the use of SCT in TKA. Methods. The comparative study on effects between SCT and staples is reviewed after the primary release of TKA in PubMed, the Cochrane library, and the EMBASE database up to March 2019. The two researchers independently screened the literature and evaluated the quality of the literature using bias risk tools. Results. A total of four studies (3330 knees) have been included in our meta-analysis. For the main point, the results show that the SCT can reduce readmission rates compared to staples (RR 0.68, 95% CI 0.49–0.95, P=0.03), with no significant difference in complications (RR 0.85, 95% CI 0.27–2.64, P=0.77). Secondly, the results suggest that although there is no significant difference in removal time between the two groups, the SCT can reduce pains, save time and costs, and have a better cosmetic effect. Conclusions. Our study indicates SCT as a closure method with fewer complications and faster speed compared with staples. Nevertheless, the cost and pain need to be further confirmed because of the small sample size included in this study.

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