Impact of Smoking on the Incidence and Postoperative Complications of Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Cohort Studies

Osteoarthritis and rheumatoid arthritis are the most ubiquitous joint disorders which cause tremendous loss of life quality and impose an economic burden on society. At present, the treatment options for these two diseases comprise non-operative and surgical treatments, amongst those total knee arthroplasties (TKA). Various studies have recognized smoking as a significant risk factor for postoperative complications. Therefore, the purpose of this study was to examine the impact of smoking on the incidence and postoperative complications after a total knee arthroplasty by a systematic review and meta-analysis. The research was performed using PUBMED, Cochrane Library and EMBASE, extracting data from thirteen suitable studies and incorporating 2,109,482 patients. Cohort studies evaluating the impact of smoking on TKA with sufficient data were included for the study, and cohort studies without a proper control group and complete data were excluded. A fixed-effects or random-effects model was used to measure the pooled risk ratio (RR) or hazard ratio (HR) with 95% confidence interval (CI). Compared to non-smokers, smokers had a significantly lower incidence of TKA (p<0.01). However, smokers had a higher incidence of total complications (p=0.01), surgical complications (p<0.01), pneumonia (p<0.01) and revision surgery (p=0.01). No significant difference in the risk of blood transfusion (p=0.42), deep vein thrombosis (p=0.31), pulmonary embolism (p=0.34), urinary tract infection (p=0.46) or mortality (p=0.39) was found between smokers and non-smokers. In conclusion, the study indicated that tobacco has two diametrically opposite effects on TKA patients: 1. Tobacco increases the incidence of surgical complications, pneumonia and revision after TKA; 2. It decreases the overall risk of being a candidate for TKA.

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Joint awareness after unicompartmental knee arthroplasty and total knee arthroplasty: a systematic review and meta-analysis of cohort studies

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06327-4 ◽

2020 ◽

Author(s):

Sujit Kumar Tripathy ◽

Paulson Varghese ◽

Anand Srinivasan ◽

Tarun Goyal ◽

Prabhudev Prasad Purudappa ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Cohort Studies ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Meta Analysis ◽

Unicompartmental Knee ◽

Total Knee

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Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty: a meta-analysis and systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02824-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jiahao Li ◽

Zijian Yan ◽

Yan Lv ◽

Yijin Li ◽

Pengcheng Ye ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Medial Collateral Ligament ◽

Meta Analysis ◽

Cochrane Library ◽

Collateral Ligament ◽

Postoperative Function ◽

Significant Difference ◽

Total Knee ◽

The Impact

Abstract Background As an uncommon but severe complication, medial collateral ligament (MCL) injury in total knee arthroplasty (TKA) may be significantly under-recognized. We aimed to determine whether MCL injury influences postoperative outcomes of patients undergoing TKA. Methods Two independent reviewers searched PubMed, Cochrane Library, and EMBASE from their inception to July 1, 2021. The main outcomes were postoperative function, and secondary outcomes included the incidences of revision and complications. Results A total of 403 articles yielded 15 studies eligible for inclusion with 10 studies used for meta-analysis. This study found that there was a statistically significant difference in postoperative functional scores, range of motion (ROM), complications, and revision rates, with adverse outcomes occurring more commonly in patients with MCL injury. Conclusions This meta-analysis highlights the complexity of MCL injury during TKA and shows the impact on postoperative function, joint mobility, complications, and revision. Surgeons need to prevent and put more emphasis on MCL injury during TKA.

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Predictors of chronic pain and level of physical function in total knee arthroplasty: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-037674 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037674

Author(s):

Unni Olsen ◽

Maren Falch Lindberg ◽

Eva Marie-Louise Denison ◽

Christopher James Rose ◽

Caryl Lynn Gay ◽

...

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Total Knee Arthroplasty ◽

Physical Function ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Cochrane Library ◽

Impaired Function ◽

Total Knee ◽

Prospective Longitudinal

IntroductionOne in five patients undergoing total knee arthroplasty (TKA) experience unchanged or worse pain and physical function 1 year after surgery. Identifying risk factors for unfavourable outcomes is necessary to develop tailored interventions to minimise risk. There is a need to review more current literature with updated methodology that addresses the limitations of earlier systematic reviews and meta-analyses. We present a Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols compliant protocol for a systematic review and meta-analysis of predictors of chronic pain and impaired function after TKA.Methods and analysisThis review will include prospective longitudinal observational studies, or randomised trials (including cluster and crossover designs) that report arm-wise predictors of chronic postsurgical pain or impaired physical function at 3 months, 6 months or 12 months. A comprehensive literature search of studies published between 2000 and 2019 will be performed in Medline, Embase, CINAHL, Cochrane Library and PEDro. Blinded assessment with consensus agreement will be applied for inclusion of studies, data extraction and assessment of bias risk (Quality in Prognosis Studies tool). The co-primary outcomes, pain and impaired function, at 12 months after TKA will be analysed separately. Estimates of association between each outcome and any preoperative or intraoperative factor that may predict chronic pain or impaired physical function will be extracted from the included studies, where possible. For randomised studies, results will only be extracted from TKA arms (or the first period of crossover trials). Estimates of association from the primary evidence will be synthesised narratively, and quantitatively using multivariate meta-analysis to provide ‘pooled’ estimates of association. Subgroup and sensitivity analyses will be performed. Certainty of evidence for each predictor will be derived from the Grading of Recommendations Assessment, Development and Evaluation framework.Ethics and disseminationNo ethical issues are associated with this project. The results from this review will be published in peer-reviewed journals and presented at international conferences.PROSPERO registration numberCRD42018079069.

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Clinical and Radiological Changes of Ankle in Knee Osteoarthritis With Varus After Total Knee Arthroplasty: A Systematic Review

Frontiers in Surgery ◽

10.3389/fsurg.2021.713055 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhiwei Feng ◽

Ming Ma ◽

Yaobin Wang ◽

Chenfei Yang ◽

Zhongcheng Liu ◽

...

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Osteoarthritis ◽

Ankle Joint ◽

Knee Arthroplasty ◽

Varus Deformity ◽

Cochrane Library ◽

Total Knee ◽

Radiological Changes ◽

The Impact

Background: Arthritis with severe varus deformity remains a challenge in total knee arthroplasty (TKA). Until recently, surgeons aimed at a neutral lower limb alignment when performing a TKA. However, the impact of TKA on the ankle joint has been ignored. Therefore, we conducted a systematic review to assess the clinical and radiological changes in the ankle joint after TKA on knees with severe varus deformity.Methods: A systematic search was conducted in four English (PubMed, Embase, Cochrane Library, and Web of Science) and four Chinese (CBM, VIP, CNKI, and Wan Fang Database) databases. Screening of literature and extraction of data were independently performed by two researchers. The modified methodological index for non-randomized studies (MINORS) was used to assess the quality.Results: A total of eight studies were eligible, namely, four prospective and four retrospective studies. TKA resulted in a negative clinical effect in the ankle joint in patients with ankle osteoarthritis. Seven studies reported changes in the mechanical tibiofemoral angle, and four studies reported radiological changes in the hindfoot. The mean score of the MINORS was 9.8 out of eight (9–11).Conclusion: As a result of the correction of the knee osteoarthritis with severe varus deformity following mechanically aligned TKA, the radiological malalignment of the ankle joint was improved. However, some patients experience increased ankle pain after undergoing TKA, especially, if there was a residual knee varus deformity, a stiff hindfoot with varus deformity, or ankle arthritis.

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A commentary on “The optimal dosage, route and timing of glucocorticoids administration for improving knee function, pain and inflammation in primary total knee arthroplasty: A systematic review and network meta-analysis of 34 randomized trials” [Int. J. Surg. 82 (2020 Oct) 182–191]

International Journal of Surgery ◽

10.1016/j.ijsu.2021.01.014 ◽

2021 ◽

Vol 87 ◽

pp. 105888

Author(s):

Shijie Lin ◽

Baojin Wu ◽

Yufei Li

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Trials ◽

Meta Analysis ◽

Primary Total Knee Arthroplasty ◽

Knee Function ◽

Optimal Dosage ◽

Total Knee ◽

Primary Total Knee

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The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060521998220 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199822

Author(s):

Youguang Zhuo ◽

Rongguo Yu ◽

Chunling Wu ◽

Yuting Huang ◽

Jie Ye ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Low Dose ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Postoperative Rehabilitation ◽

Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

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