Establishment of a Qualified Integrated Care System After Total Knee Arthroplasty as a Role of Regional Rheumatoid and Degenerative Arthritis Centers

Abstract Background: The geriatric population and advanced knee osteoarthritis are rapidly increasing in Korea, and the socioeconomic burden of total knee arthroplasty (TKA) is increasing. This study aimed to analyze the demographic, clinical and socioeconomic characteristics of patients who underwent TKA and to differentiate the factors affecting participation in inpatient-intensive rehabilitation programs after TKA in oo regional rheumatoid and degenerative arthritis centers established by the government.Methods: This retrospective cohort study included 845 patients (735 females; 72.0±5.8 years) diagnosed with primary osteoarthritis (OA) of the knee who underwent elective unilateral primary TKA between January 2013 and June 2016. Demographic, clinical and socioeconomic characteristics, including age, body mass index, obesity, length of stay, OA severity, underlying disease, education level, occupation, and location of residence, were reviewed. Patients were allocated to the TKA-only group (home discharge) and to the TKA+ rehab group (participation in post-TKA rehabilitation). The variables were analyzed and compared before and after the establishment of the center and according to participation in intensive rehabilitation.Results: They showed a predominance of females and geriatrics and a high prevalence of comorbidities and obesity. Additionally, the only factor differentiating participation in intensive rehabilitation was the location of residence.Conclusion: The regional rheumatoid and degenerative arthritis center was appropriate to meet the high need for participating in intensive rehabilitation after TKA and for the qualified integrated post-TKA care system. Policy support should ensure early rehabilitation and a qualified integrated care system and prepare for the increased burden of revision, and future longitudinal studies should be conducted to assess the long-term effect of the integrated post-TKA rehabilitation program on functional outcomes and patient survivorship free from revision.

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Establishment of Qualified Integrated Care System after Total Knee Arthroplasty as a Role of Regional Rheumatoid and Degenerative Arthritis Center

10.21203/rs.3.rs-176155/v1 ◽

2021 ◽

Author(s):

Eun Young Han ◽

Sang Rim Kim ◽

Sang Hee Im

Keyword(s):

Total Knee Arthroplasty ◽

Integrated Care ◽

Knee Arthroplasty ◽

Rehabilitation Program ◽

Policy Support ◽

Degenerative Arthritis ◽

Socioeconomic Characteristics ◽

Total Knee ◽

Intensive Rehabilitation ◽

Care System

Abstract Elderly population and advanced knee osteoarthritis are rapidly increasing in Korea and the socioeconomic burden of total knee arthroplasty (TKA). This study aimed to analyze the demographic, clinical and socioeconomic characteristics in patients who underwent TKA and to differentiate the factors affecting participation in inpatient- intensive rehabilitation program after TKA in oo regional rheumatoid and degenerative arthritis center established by government. This retrospective cohort study included 845 patients (735 females; 72.0 ± 5.8 years) diagnosed with primary osteoarthritis (OA) of the knee and who performed an elective unilateral primary TKA between January 2013 and June 2016. Demographic, clinical and socioeconomic characteristics including age, body mass index, obesity, length of stay, OA severity, underlying disease, education level, occupation, location of residence) were reviewed and Patients were allocated to TKA only group (home discharge) and to TKA + rehab group (participation in post-TKA rehabilitation). The variables were analyzed and compared before and after establishment of center and according to participation in intensive rehabilitation. They showed predominance of female and elderly and high prevalence of comorbidities and obesity. Also, the only factor differentiating participation in intensive rehabilitation was the location of residence. Therefore, the regional rheumatoid & degenerative arthritis center was appropriate to meet the high need for participating in intensive rehabilitation after TKA and for the qualified integrated post-TKA care system. The policy support should ensure early rehabilitation and qualified integrated care system and prepare for the increased burden of revision and the future longitudinal study should be conducted for long-term effect of the integrated post-TKA rehabilitation program on functional outcome and patients’ survivorship free from revision.

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Femoral Shaft Bowing Angle in The Coronal Plane Affects Distal Femoral Valgus Cutting Angle: A Radiographic Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00047 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0004

Author(s):

Prettysia Suvarly ◽

Nyoman Aditya Sindunata ◽

Rio Aditya ◽

Rusli Muljadi ◽

John Butarbutar

Keyword(s):

Total Knee Arthroplasty ◽

Linear Regression ◽

Knee Arthroplasty ◽

Femoral Shaft ◽

Coronal Plane ◽

Coronal Alignment ◽

Geriatric Population ◽

X Ray ◽

Cutting Angle ◽

Total Knee

Postoperative limb alignment is important for successful total knee arthroplasty (TKA). Femoral shaft bowing angle (FBA) in coronal plane may influence distal femoral valgus cutting angle (DFVCA) and 5±2º may not perpendicular to mechanical axis. Methods: Sixty-six lower extremity long film x-ray of osteoarthritic knees were collected and analyzed with IntstaRISPACS (digital radiography software). The correlation and linear regression between FBA and DFVCAwere measured using SPSS 24. Results: Our study shows a strong correlation between FBA and DFVCA. Lateral FBA tends to present with DFVCA outside 7º as shown in linear regression test, vice versa. Conclusion: Since DFVCA is influenced by FBA, we recommend preoperative femoral x-ray in all knee replacement candidates. References: Rezende FC, Carneiro M. Is it safe the empirical distal femoral resection angle of 5° to 6°of valgus in the Brazilian geriatric population? Rev Bras Orthop. 2013; 48(5): 421-6. Kim CW, Lee CR. Effects of femoral lateral bowing on coronal alignment and component position after total knee arthroplasty: a comparison of conventional and navigation-assisted surgery. Knee Surg Relat Res. 2018 Mar; 30(1): 64–73. Kim JM, Hong SH, Kim JM, Lee BS, Kim DE, Kim KA, Bin et al. Femoral shaft bowing in the carinal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):1936-42

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The economic impact of periprosthetic infection in total knee arthroplasty

Canadian Journal of Surgery ◽

10.1503/cjs.012519 ◽

2021 ◽

Vol 64 (2) ◽

Author(s):

Mina W. Morcos ◽

Paul Kooner ◽

Jackie Marsh ◽

James Howard ◽

Brent Lanting ◽

...

Keyword(s):

Health Care ◽

Total Knee Arthroplasty ◽

Economic Impact ◽

Health Care System ◽

Knee Arthroplasty ◽

Joint Infection ◽

Accurate Estimate ◽

Total Knee ◽

Revision Tka ◽

Care System

Background: Currently, the gold standard treatment for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is 2-stage revision, but few studies have looked at the economic impact of PJI on the health care system. The objective of this study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in TKA and to assess the economic impact of PJI after TKA compared to uncomplicated primary TKA. Methods: We identified consecutive patients in our institutional database who had undergone 2-stage revision TKA for PJI between 2010 and 2014 and matched them on age and body mass index with patients who had undergone uncomplicated primary TKA over the same period. We calculated all costs associated with the 2 procedures and compared mean costs, length of stay, clinical visits and readmission rates between the 2 groups. Results: There were 73 patients (mean age 68.8 [range 48–91] yr) in the revision TKA cohort and 73 patients (mean age 65.9 [range 50–86] yr) in the primary TKA cohort. Two-stage revision surgery was associated with a significantly longer hospital stay (mean 22.7 d v. 3.84 d, p <s; 0.001), more outpatient clinic visits (mean 8 v. 3, p < 0.001), more readmissions (29 v. 0, p < 0.001) and higher overall cost (mean $35 429.97 v. $6809.94, p < 0.001) than primary TKA. Conclusion: Treatment for PJI after TKA has an enormous economic impact on the health care system. Our data suggest a fivefold increase in expenditure in the management of this complication compared to uncomplicated primary TKA.

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