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Askari A, Mohammadpour M, Jabalameli M, Naeimipoor N, Goodarzy B, Jafari B, Rashidi H, Mousazadeh F, Rajei M, Khazanchin A, Bahardoust M, Hassanzadeh M. Predictors of health-related quality of life after total knee arthroplasty: a case-control study. Sci Rep 2024; 14:14176. [PMID: 38898136 PMCID: PMC11187171 DOI: 10.1038/s41598-024-65042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 06/17/2024] [Indexed: 06/21/2024] Open
Abstract
Total knee arthroplasty (TKA) improves patients' Health-related quality of life (HRQoL) compared to before surgery. However, based on our knowledge, the improvement in HRQoL after TKA, which depends on various factors, has yet to be investigated compared to healthy people. This study aimed to evaluate the HRQoL of patients compared to healthy people and the factors affecting the HRQoL after TKA. In this matched case-control study (1002 participants), HRQoL in 501 patients who underwent TKA between 2015 and 2022 at Shafa Yahyainan Hospital affiliated with Iran University of Medical Sciences were compared with 501 healthy controls. HRQoL was evaluated in two parts (before compared to 12 months after TKA and 12 months after TKA compared to the healthy population). The 36-item short-form health survey (SF-36) was used to evaluate HRQoL 12 months after surgery. The influencing factors on HRQoL were evaluated by multivariate logistic regression analysis. No significant difference was observed in the demographic characteristics of the participants in the two groups. The mean overall SF-36 score, 12 months after surgery, significantly improved compared to before surgery (64.21 ± 22.2 vs. 37.55 ± 15.13, p:0.001). The mean total score of SF-36 was statistically similar between the case and control groups (64.21 ± 22.2 VS 72.53 ± 25.3). The multivariate analysis showed that sex, BMI, number of comorbidities, postoperative compliance, and complications were significantly related to the decrease in patients' HRQoL (P < 0.001).TKA can improve the HRQoL except for two subscales of happiness/vitality and physical performance, similar to the healthy population. Female gender, obesity and overweight, comorbidity, bilateral TKA, non-adherence to postoperative physiotherapy, and complications were associated with decreased HRQoL.
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Affiliation(s)
- Alireza Askari
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadpour
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Taleghani Educational Hospital, Abadan University of Medical Sciences, Abadan, Iran
| | - Mahmoud Jabalameli
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Naeimipoor
- Department of Psychology, Neyshabur Branch, Azad University, Neyshabur, Iran
| | - Babak Goodarzy
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnam Jafari
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Heeva Rashidi
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mousazadeh
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maziar Rajei
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Khazanchin
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mansour Bahardoust
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Hassanzadeh
- Department of Orthopedic Surgery, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Tian R, Duan X, Xing F, Zhao Y, Liu C, Li H, Kong N, Cao R, Guan H, Li Y, Li X, Zhang J, Wang K, Yang P, Wang C. Computed tomography radiomics in predicting patient satisfaction after robotic-assisted total knee arthroplasty. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03192-1. [PMID: 38836956 DOI: 10.1007/s11548-024-03192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE After robotic-assisted total knee arthroplasty (RA-TKA) surgery, some patients still experience joint discomfort. We aimed to establish an effective machine learning model that integrates radiomic features extracted from computed tomography (CT) scans and relevant clinical information to predict patient satisfaction three months postoperatively following RA-TKA. MATERIALS AND METHODS After careful selection, data from 142 patients were randomly divided into a training set (n = 99) and a test set (n = 43), approximately in a 7:3 ratio. A total of 1329 radiomic features were extracted from the regions of interest delineated in CT scans. The features were standardized using normalization algorithms, and the least absolute shrinkage and selection operator regression model was employed to select radiomic features with ICC > 0.75 and P < 0.05, generating the Rad-score as feature markers. Univariate and multivariate logistic regression was then used to screen clinical information (age, body mass index, operation time, gender, surgical side, comorbidities, preoperative KSS score, preoperative range of motion (ROM), preoperative and postoperative HKA angle, preoperative and postoperative VAS score) as potential predictive factors. The satisfaction scale ≥ 20 indicates patient satisfaction. Finally, three prediction models were established, focusing on radiomic features, clinical features, and their fusion. Model performance was evaluated using Receiver Operating Characteristic curves and decision curve analysis. RESULTS In the training set, the area under the curve (AUC) of the clinical model was 0.793 (95% CI 0.681-0.906), the radiomic model was 0.854 (95% CI 0.743-0.964), and the combined radiomic-clinical model was 0.899 (95% CI 0.804-0.995). In the test set, the AUC of the clinical model was 0.908 (95% CI 0.814-1.000), the radiomic model was 0.709 (95% CI 0.541-0.878), and the combined radiomic-clinical model was 0.928 (95% CI 0.842-1.000). The AUC of the radiomic-clinical model was significantly higher than the other two models. The decision curve analysis indicated its clinical application value. CONCLUSION We developed a radiomic-based nomogram model using CT imaging to predict the satisfaction of RA-TKA patients at 3 months postoperatively. This model integrated clinical and radiomic features and demonstrated good predictive performance and excellent clinical application potential.
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Affiliation(s)
- Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xudong Duan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fangze Xing
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiwei Zhao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - ChengYan Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Heng Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ning Kong
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ruomu Cao
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huanshuai Guan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yiyang Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xinghua Li
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiewen Zhang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Chunsheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Cance N, Batailler C, Shatrov J, Canetti R, Servien E, Lustig S. Tibial Tubercle Osteotomy in Revision Total Knee Arthroplasty for Periprosthetic Infection: Indications and Outcomes. J Bone Joint Surg Am 2023; 105:1768-1776. [PMID: 37437007 DOI: 10.2106/jbjs.23.00256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Adequate exposure is essential in revision total knee arthroplasty (RTKA). Tibial tubercle osteotomy (TTO) enhances exposure, but its use is controversial in the setting of periprosthetic infection. The purposes of this study were to determine (1) the rates of complications and revisions due to TTO during RTKA in the setting of a periprosthetic infection, (2) the rate of septic failure, and (3) functional outcomes at a minimum 2-year follow-up. METHODS A single-center retrospective study from 2010 to 2020 was performed. The cases of a total of 68 patients who received a TTO during RTKA in the setting of periprosthetic infection with a minimum follow-up of 2 years (mean, 53.3 months; range, 24 to 117 months) were analyzed. Complications and revisions due to TTO were reported. The functional outcomes were assessed using the Knee Society Score (KSS) and range of motion. RESULTS Seven knees (10.3%) had complications secondary to the TTO (3 had fracture-displacement of the TTO; 2, nonunion; 1, delayed union; and 1, wound dehiscence). The mean time to union (and standard deviation) was 3.8 ± 3.2 months (range, 1.5 to 24 months). Two knees (2.9%) underwent a TTO-related revision (1 had wound debridement, and 1 had tibial tubercle osteosynthesis). Eighteen knees (26.5%) had recurrence of infection requiring revision: 17 were managed with debridement, antibiotics, and implant retention (DAIR), and 1 had 2-stage RTKA. Flexion improved after surgery (from a mean of 70° to a mean of 86°; p = 0.009), as did the KSS knee (46.6 to 79; p < 0.001) and function (35.3 to 71.5; p < 0.001) subscores. Overall, 42.6% of infected knees managed with RTKA with the TTO procedure were considered successful without any complication at the last follow-up. Only 2 knees (2.9%) required revision related to the TTO. CONCLUSIONS TTO in RTKA involving periprosthetic infection is an effective surgical exposure aid and has excellent rates of union (97.1%) despite the presence of infection. However, the risk of failure because of persistent or recurrent infection remains high in the first 2 years following RTKA for infection. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nicolas Cance
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Cécile Batailler
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Université Lyon, Villeurbanne, France
| | - Jobe Shatrov
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- Hornsby and Ku-Ring-Gai Hospital, Sydney, New South Wales, Australia
- Sydney Orthopaedic Research Institute, Sydney, New South Wales, Australia
| | - Robin Canetti
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
| | - Elvire Servien
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- EA 7424 - Interuniversity Laboratory of Human Movement Science, Université Claude Bernard Lyon 1, Lyon, France
| | - Sébastien Lustig
- Orthopedic Surgery Department, Croix-Rousse Hospital, Lyon, France
- IFSTTAR, LBMC UMR_T9406, Université Claude Bernard Lyon 1, Université Lyon, Villeurbanne, France
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Duan X, Zhao Y, Zhang J, Kong N, Cao R, Guan H, Li Y, Wang K, Yang P, Tian R. Prediction of early functional outcomes in patients after robotic-assisted total knee arthroplasty: a nomogram prediction model. Int J Surg 2023; 109:3107-3116. [PMID: 37352526 PMCID: PMC10583907 DOI: 10.1097/js9.0000000000000563] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Robotic-assisted total knee arthroplasty (RA-TKA) is becoming more and more popular as a treatment option for advanced knee diseases due to its potential to reduce operator-induced errors. However, the development of accurate prediction models for postoperative outcomes is challenging. This study aimed to develop a nomogram model to predict the likelihood of achieving a beneficial functional outcome. The beneficial outcome is defined as a postoperative improvement of the functional Knee Society Score (fKSS) of more than 10 points, 3 months after RA-TKA by early collection and analysis of possible predictors. METHODS This is a retrospective study on 171 patients who underwent unilateral RA-TKA at our hospital. The collected data included demographic information, preoperative imaging data, surgical data, and preoperative and postoperative scale scores. Participants were randomly divided into a training set ( N =120) and a test set ( N =51). Univariate and multivariate logistic regression analyses were employed to screen for relevant factors. Variance inflation factor was used to investigate for variable collinearity. The accuracy and stability of the models were evaluated using calibration curves with the Hosmer-Lemeshow goodness-of-fit test, consistency index and receiver operating characteristic curves. RESULTS Predictors of the nomogram included preoperative hip-knee-ankle angle deviation, preoperative 10-cm Visual Analogue Scale score, preoperative fKSS score and preoperative range of motion. Collinearity analysis with demonstrated no collinearity among the variables. The consistency index values for the training and test sets were 0.908 and 0.902, respectively. Finally, the area under the receiver operating characteristic curve was 0.908 (95% CI 0.846-0.971) in the training set and 0.902 (95% CI 0.806-0.998) in the test set. CONCLUSION A nomogram model was designed hereby aiming to predict the functional outcome 3 months after RA-TKA in patients. Rigorous validation showed that the model is robust and reliable. The identified key predictors include preoperative hip-knee-ankle angle deviation, preoperative visual analogue scale score, preoperative fKSS score, and preoperative range of motion. These findings have major implications for improving therapeutic interventions and informing clinical decision-making in patients undergoing RA-TKA.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Ohyama Y, Iwamura T, Hoshino T, Miyata K. Prognostic models of quality of life after total knee replacement: A systematic review. Physiother Theory Pract 2023:1-12. [PMID: 37162481 DOI: 10.1080/09593985.2023.2211716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To systematically review and critically appraise prognostic models for quality of life (QOL) in patients with total knee replacement (TKA). METHODS Subjects were TKA recipients recruited from inpatient postoperative settings. Searches were made on June 2022 and updated on April 2023. Databases included PubMed.gov, CINAHL, The Cochrane Library, Web of Science. Two authors performed all review stages independently. Risk of bias assessments on participants, predictors, outcomes and analysis methods followed the Prediction study Risk Of Bias ASsessment Tool (PROBAST). RESULTS After screening 2204 studies, 9 were eligible for inclusion. Twelve prognostic models were reported, of which 10 models were developed from data without validation and 2 were both developed and validated. The most frequently applied predictor was the pre-TKA QOL score. Discriminatory measures were reported for 9 (75.0%) models with areas under the curve values of 0.66-0.95. All models showed a high risk of bias, mostly due to limitations in statistical methods and outcome assessments. CONCLUSION Several prognostic models have been developed for QOL in patients with TKA, but all models show a high risk of bias and are unreliable in clinical practice. Future, prognostic models overcoming the risk of bias identified in this study are needed.
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Affiliation(s)
- Yuki Ohyama
- Department of Rehabilitation, Hidaka Rehabilitation Hospital, Takasaki, Japan
| | - Taiki Iwamura
- Department of Rehabilitation, Azumabashi Orthopedics, Tokyo, Japan
| | - Taichi Hoshino
- Department of Rehabilitation, Gunma Chuo Hospital, Maebashi, Gunma, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Science, Ibaraki, Japan
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Belt M, Robben B, Smolders JMH, Schreurs BW, Hannink G, Smulders K. A mapping review on preoperative prognostic factors and outcome measures of revision total knee arthroplasty. Bone Jt Open 2023; 4:338-356. [PMID: 37160269 PMCID: PMC10169239 DOI: 10.1302/2633-1462.45.bjo-2022-0157.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration. We performed a systematic literature search in MEDLINE, Embase, and Web of Science. The search string included multiple synonyms of the following keywords: "revision TKA", "outcome" and "prognostic factor". We searched for studies assessing the association between at least one prognostic factor and at least one outcome measure after rTKA surgery. Data on sample size, study design, prognostic factors, outcomes, and the direction of the association was extracted and included in an evidence map. After screening of 5,660 articles, we included 166 studies reporting prognostic factors for outcomes after rTKA, with a median sample size of 319 patients (30 to 303,867). Overall, 50% of the studies reported prospectively collected data, and 61% of the studies were performed in a single centre. In some studies, multiple associations were reported; 180 different prognostic factors were reported in these studies. The three most frequently studied prognostic factors were reason for revision (213 times), sex (125 times), and BMI (117 times). Studies focusing on functional scores and patient-reported outcome measures as prognostic factor for the outcome after surgery were limited (n = 42). The studies reported 154 different outcomes. The most commonly reported outcomes after rTKA were: re-revision (155 times), readmission (88 times), and reinfection (85 times). Only five studies included costs as outcome. Outcomes and prognostic factors that are routinely registered as part of clinical practice (e.g. BMI, sex, complications) or in (inter)national registries are studied frequently. Studies on prognostic factors, such as functional and sociodemographic status, and outcomes as healthcare costs, cognitive and mental function, and psychosocial impact are scarce, while they have been shown to be important for patients with osteoarthritis.
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Affiliation(s)
- Maartje Belt
- Research Department, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Bart Robben
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - José M H Smolders
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - B W Schreurs
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Katrijn Smulders
- Research Department, Sint Maartenskliniek, Nijmegen, the Netherlands
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Similar outcomes to primary total knee arthroplasty achievable for aseptic revision using the same primary posterior-stabilised prosthesis at a mean follow-up of 49 months. Knee Surg Sports Traumatol Arthrosc 2022; 30:2854-2861. [PMID: 34476561 DOI: 10.1007/s00167-021-06716-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of the study was to compare clinical and radiological outcomes between primary and aseptic revision TKAs using the same posterior-stabilised (PS) prosthesis. The authors hypothesised similar outcomes between both groups for selected patients. METHODS This retrospective, case-control study assessed 36 patients who underwent aseptic revision TKA compared to a match group of 72 primary TKA. Both groups had the same PS design implant (ANATOMIC®, Amplitude, Valence, France). The International Knee Society (IKS) score, radiological outcomes (postoperative alignment, patellar tilt and radiolucent lines), re-intervention and revision rate were compared between the two groups with a minimum follow-up of 3 years. RESULTS The final study cohort included 29 patients and 63 patients respectively in the revision and primary group, with a mean follow-up of 49.1 months (range 36.1-69). Postoperatively, there was no significant difference in IKS scores between the two groups [169.8 for the revision group and 179.6 for the primary group (p = 0.09)]. No statistical difference was observed for post-operative satisfaction 86.2% versus 92.1% (p = 0.46). Between the two groups, there was no difference in mean radiological assessment, including radiolucent lines (p = 0.7). There was no significant difference for overall implant survivorship 96.5% versus 100% (p = 0.13) at 36 months. CONCLUSION Similar clinical, radiological and survivorship outcomes were found between rTKA and primary TKA groups using the same PS level of constraint in patients undergoing revision surgery for aseptic indications at 3-year follow-up. Use of PS implants in rTKA for the correct indication suggests this to be a safe approach at least in the medium term. LEVEL OF EVIDENCE IV, retrospective case-control study.
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Revision for coronal malalignment will improve functional outcome up to 5 years postoperatively. Knee Surg Sports Traumatol Arthrosc 2022; 30:2731-2737. [PMID: 34028565 DOI: 10.1007/s00167-021-06616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Revision of a total knee arthroplasty (TKA) for the diagnosis of malalignment is widely performed. However, very little is known about the functional outcome in revision TKA surgery for malalignment. The aim of this study was to assess the functional outcome and to identify factors influencing the functional outcome of patients who have had a revision of a TKA for the diagnosis of malalignment at 5 years follow-up. METHODS All patients with a revision of a TKA for malalignment as the primary reason were selected from a prospective database. The diagnosis of symptomatic malalignment was made by the surgeon and quantified by radiologic examination. Functional outcome was scored by the functional score of the Knee Society Clinical Rating System (fKSS) at 0, 12, 24 and 60 months. Multiple imputation for missing data and multivariable analysis were performed to identify factors influencing functional outcome. RESULTS After selection, 105 patients (age: 65.1 ± 9.1 years, gender M:F 30:75) were eligible for outcome analysis. Functional outcome significantly improved from the preoperative (fKSS: 44.1 ± 22.0) to 5 years postoperative (64.7 ± 24.0, p < 0.001) time frames. Higher degree of coronal deviation, younger age and lower preoperative KSS were found to be strongest positive influencing factors for the change in fKSS. CONCLUSION Revision of TKA for malalignment appears to be an effective treatment to improve functional outcome up to 5 years postoperatively. Higher degree of coronal deviation, younger age and lower preoperative KSS are the strongest contributing factors for functional improvement. LEVEL OF EVIDENCE Level III; Therapeutic prospective cohort study.
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Defining the minimal clinically important difference for the knee society score following revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:2744-2752. [PMID: 34117505 DOI: 10.1007/s00167-021-06628-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND No previous study has evaluated the MCID for revision total knee arthroplasty (TKA). This study aimed to identify the MCID for the Knee Society Score (KSS), for revision TKA. METHODS Prospectively collected data from 270 patients who underwent revision TKA at a single institution was analysed. Clinical assessment was performed preoperatively, at 6 months and 2 years using Knee Society Function Score (KSFS) and Knee (KSKS) Scores, and Oxford Knee Score (OKS). MCID was evaluated with a three-pronged methodology, using (1) anchor-based method with linear regression, (2) anchor-based method with receiver operating characteristic (ROC) and area under curve (AUC), (3) distribution-based method with standard deviation (SD). The anchors used were improvement in OKS ≥ 5, patient satisfaction, and implant survivorship following revision TKA. RESULTS The cohort comprised 70% females, with mean age of 69.0 years, that underwent unilateral revision TKA. The MCID determined by anchor-based linear regression method using OKS was 6.3 for KSFS, and 6.6 for KSKS. The MCID determined by anchor-based ROC was between 15 and 20 for KSFS (AUC: satisfaction = 71.8%, survivorship = 61.4%) and between 33 and 34 for KSKS (AUC: satisfaction = 76.3%, survivorship = 67.1%). The MCID determined by distribution-based method of 0.5 SD was 11.7 for KSFS and 11.9 for KSKS. CONCLUSION The MCID of 6.3 points for KSFS, and 6.6 points for KSKS, is a useful benchmark for future studies looking to compare revision against primary TKA outcomes. Clinically, the MCID between 15 and 20 for KSFS and between 33 and 34 for KSKS is a powerful tool for discriminating patients with successful outcomes after revision TKA. Implant survivorship is an objective and naturally dichotomous outcome measure that complements the subjective measure of patient satisfaction, which future MCID studies could consider utilizing as anchors in ROC. LEVEL OF EVIDENCE II.
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VAN Nuffel M, Vandenneucker H, Kellens S, Rumes N, Degreef I. The Impact of Dupuytren Disease on Recovery of Motion at the Knee after Total Knee Arthroplasty. J Hand Surg Asian Pac Vol 2022; 27:320-325. [PMID: 35404210 DOI: 10.1142/s242483552250028x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Arthrofibrosis is a complication of total knee arthroplasty (TKA) that can lead to poor outcome. Idiopathic arthrofibrosis and Dupuytren disease (DD) have similar histological appearance. The aim of this study is to determine the influence of DD on the recovery of motion after TKAy. Methods: Patients older than 50 who underwent a TKA for primary osteoarthritis were examined 1 year later for the presence of DD. They were divided into two groups based on the presence or absence of DD. The groups were compared to each other with regard to arc of motion (AOM) of the operated knee at 6 weeks and 1 year; the need for additional measures to improve the AOM, and the effect of obesity [body mass index (BMI) > 30]. Results: The study included 61 patients of which 25 (41%) had DD. There was no difference in AOM at 6 weeks or 1 year between the two groups. Patients in the DD group required a greater number of additional measures to improve AOM. Also, non-obese patients (BMI < 30) in the DD group had lower AOM at 1 year. Conclusions: Patients in the DD group needed additional physiotherapy or manipulation under anaesthesia (MUA) to achieve the same AOM. This might indicate a possible connection between DD and post-operative stiffness of the knee. Identifying patients with DD in the pre-operative period may help recognise patients who may have difficulty in regaining AOM after TKA. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Maarten VAN Nuffel
- Department of Medical Sciences, KU Leuven-University of Leuven, Leuven, Belgium; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Vandenneucker
- Department of Medical Sciences, KU Leuven-University of Leuven, Leuven, Belgium; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sebastiaan Kellens
- Department of Medical Sciences, KU Leuven-University of Leuven, Leuven, Belgium; Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Nanou Rumes
- Department of Medical Sciences, KU Leuven-University of Leuven, Leuven, Belgium; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ilse Degreef
- Department of Medical Sciences, KU Leuven-University of Leuven, Leuven, Belgium; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
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11
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Liu WY, van der Steen MC, van Wensen RJA, van Kempen RWTM. Recovery patterns in patients undergoing revision surgery of the primary knee prosthesis. J Exp Orthop 2021; 8:117. [PMID: 34913109 PMCID: PMC8674388 DOI: 10.1186/s40634-021-00436-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Despite good survival rates of revised knee prostheses, little is known about recovery trajectories within the first 12 months after surgery. This retrospective observational study explored recovery trajectories in terms of pain, function and quality of life in patients after revision knee arthroplasty over 12 months. Methods Eighty-eight revision knee arthroplasty patients rated changes in daily physical functioning using the anchor question (0: very much worsened; 7: very much improved). Patient reported outcome measures (PROMs) of pain (range 0–10), function (Oxford Knee Score) and quality of life (EQ-5D-3L) were assessed preoperatively, at 3 and 12 months postoperatively. Four recovery trajectories were identified using the anchor question at 3 and 12 months postoperatively: no improvement, late improvement, early improvement, and prolonged improvement. Repeated measures ANOVA was conducted with recovery trajectories as dependent variable and PROM assessments as independent variables. Results Sixty percent reported improvement in daily physical functioning at 12 months postoperatively. Age and reason for revision differed between groups. Pain, function and EQ-5D-3L differed between groups over time. Late and prolonged improvement groups improved on all PROMs at 12 months. The early improvement group did not report improvement in daily physical functioning at 12 months, while improvements in function and pain during activity were observed. Conclusions Different recovery trajectories seem to exist and mostly match PROMs scores over time. Not all patients may experience beneficial outcome of revision knee arthroplasty. These findings are of importance to provide appropriate information on possible recovery trajectories after revision knee arthroplasty to patients. Level of evidence III Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00436-w.
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Affiliation(s)
- W Y Liu
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands. .,Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands.
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands
| | - R J A van Wensen
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands
| | - R W T M van Kempen
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands
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12
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Akkaya M, Simsek ME, Akcaalan S, Caglar C, Gursoy S, Citak M. Validity of the Novel Radiological Classification System of the Distal Femur. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021. [PMID: 34879417 DOI: 10.1055/a-1685-0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Aseptic loosening (AL) is among the most important causes of failure after total knee arthroplasty (TKA). However, while there are numerous underlying causes of AL, the morphometry of the distal femur and intramedullary canal has not been sufficiently demonstrated. This study aimed to show the interobserver and intraobserver reliability and validity of the Citak classification, which has been recently defined according to the morphometry of the distal femur and provides a risk factor definition for AL. MATERIALS AND METHODS A total of 200 patients whose standardized anteroposterior (AP) and lateral images of the knee joint were obtained between October 2019 and April 2020 were retrospectively evaluated in this study. Patients with a history of extra-articular deformity and knee surgery were excluded from the study. For AL, morphologies of the distal femur were identified by two observers using the new radiological classification system of the distal femur. Mean pairwise Cronbach's alpha coefficient was used to assess the intra- and interobserver agreement of the classification. RESULTS There was excellent interobserver agreement for the 20 cm proximal and 2 cm proximal to the lateral joint line (PLJL) and adductor tubercle (PAD), respectively. The mean Cronbach's alpha coefficient was 0.96 (range 0.764-0.944) for the PAD and 0.98 (range 0.734-0.929) for the PLJL. There was also an excellent intraobserver agreement, with 93% average pairwise percent agreement for the index group and 95.5% average pairwise percent agreement for the anatomical classification group. CONCLUSIONS The level of inter- and intraobserver agreement for the morphology of the distal femur was excellent in the new radiological classification system, which was shown to be beneficial in the planning of revision knee arthroplasty for AL. However, there is a need for further studies in order to make a correlation of the classification with specific intraoperative findings.
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Affiliation(s)
- Mustafa Akkaya
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany.,Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Mehmet Emin Simsek
- Department of Orthopaedics and Traumatology, Lokman Hekim Universitesi, Ankara, Turkey
| | - Serhat Akcaalan
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ceyhun Caglar
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Cankaya, Turkey
| | - Safa Gursoy
- Department of Orthopaedics and Traumatology, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Mustafa Citak
- Department of Orthopaedic Surgery, HELIOS ENDO-Klinik Hamburg, Hamburg, Germany
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13
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Sun H, Zheng K, Zhang W, Li N, Zhang L, Zhou J, Xu Y, Li R. [Early effectiveness of computer navigation-assisted total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1273-1280. [PMID: 34651480 DOI: 10.7507/1002-1892.202102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To estimate the early effectivenss of computer navigation-assisted total knee arthroplasty (TKA) by comparing with traditional TKA. Methods The clinical data of 89 patients (100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients (50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients (50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery (HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score (FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery (SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), and sagittal tibial component angle (sTCA) were measured and calculated the difference between the above index and the target value (deviation); and the joint line convergence angle (JLCA) was also measured. Results The operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group ( P<0.05); the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant ( P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation ( P<0.05); HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group ( P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation ( P>0.05); the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years ( t=-2.226, P=0.029), but there was no significant difference in SPPB ( t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group ( t=-7.392, P=0.000); among them, the HKA deviations of 50 knees (100%) in the navigation group and 36 knees (72%) in the control group were less than 3°, showing significant difference between the two groups ( χ 2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA, sFCA, and sTCA in the navigation group were smaller than those in the control group ( P<0.05). Conclusion Compared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.
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Affiliation(s)
- Houyi Sun
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Kai Zheng
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Weicheng Zhang
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Ning Li
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Lianfang Zhang
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Jun Zhou
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Yaozeng Xu
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Rongqun Li
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
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14
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Roof MA, Sharan M, Merkow D, Feng JE, Long WJ, Schwarzkopf RS. High-volume revision surgeons have better outcomes following revision total knee arthroplasty. Bone Joint J 2021; 103-B:131-136. [PMID: 34053278 DOI: 10.1302/0301-620x.103b6.bjj-2020-2287.r1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS It has previously been shown that higher-volume hospitals have better outcomes following revision total knee arthroplasty (rTKA). We were unable to identify any studies which investigated the effect of surgeon volume on the outcome of rTKA. We sought to investigate whether patients of high-volume (HV) rTKA surgeons have better outcomes following this procedure compared with those of low-volume (LV) surgeons. METHODS This retrospective study involved patients who underwent aseptic unilateral rTKA between January 2016 and March 2019, using the database of a large urban academic medical centre. Surgeons who performed ≥ 19 aseptic rTKAs per year during the study period were considered HV and those who performed < 19 per year were considered LV. Demographic characteristics, surgical factors, and postoperative outcomes were compared between the two groups. RESULTS A total of 308 rTKAs were identified, 132 performed by HV surgeons and 176 by 22 LV surgeons. The LV group had a significantly greater proportion of non-smokers (59.8% vs 49.2%; p = 0.029). For all types of revision, HV surgeons had significantly shorter mean operating times by 17.75 minutes (p = 0.007). For the 169 full revisions (85 HV, 84 LV), HV surgeons had significantly shorter operating times (131.12 (SD 33.78) vs 171.65 (SD 49.88) minutes; p < 0.001), significantly lower re-revision rates (7.1% vs 19.0%; p = 0.023) and significantly fewer re-revisions (0.07 (SD 0.26) vs 0.29 (SD 0.74); p = 0.017). CONCLUSION Patients of HV rTKA surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centres of excellence to offer patients the best possible outcomes following rTKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):131-136.
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Affiliation(s)
- Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Mohamad Sharan
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - David Merkow
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - James E Feng
- Department of Orthopaedic Surgery, Beaumont Hospital, Royal Oak, Royal Oak, Michigan, USA
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Ran S Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
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15
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Terradas-Monllor M, Navarro-Fernández G, Ruiz MA, Beltran-Alacreu H, Fernández-Carnero J, Salinas-Chesa J, Ochandorena-Acha M. Postoperative Psychosocial Factors in Health Functioning and Health-Related Quality of Life After Knee Arthroplasty: A 6-Month Follow up Prospective Observational Study. PAIN MEDICINE 2021; 22:1905-1915. [PMID: 33538821 DOI: 10.1093/pm/pnab025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Knee arthroplasty (KA) is an effective and cost-effective treatment for end-stage knee osteoarthritis. Despite high surgical success rates, as many as 25% of patients report compromised postoperative functioning, persistent pain, and reduced quality of life. The purpose of this study was to assess the predictive value of psychological factors in health functioning and quality of life, during a 6-month period after KA. DESIGN A prospective observational study. SETTING Surgery at two hospitals and follow-up was carried out through the domiciliary rehabilitation service. SUBJECTS In total, 89 patients (age 70.27 ± 7.99 years) met the inclusion criteria. METHOD A test battery composed of Health functioning associated with osteoarthritis (WOMAC), Health-related quality of life (EQ-5D-5L), Anxiety and Depression (HADS), Pain attitudes (SOPA-B), Pain catastrophizing (PCS), and Fear of Movement (TSK-11) was assessed at 1 week, and 1, 3, and 6 months after surgery. A mixed effects linear model was used to estimate the effect of time and covariates. An exploratory factor analysis was used to identify the number of dimensions underlying the group of psychological measurements. RESULTS In WOMAC model, anxiety level (F = 120.8), PCS (F = 103.9), depression level (F = 93.6) and pain score (F = 72.8) were the most influential variables. Regarding EQ-5D-5L model, anxiety level (F = 98.5), PCS (F = 79.8), depression level (F = 78.3) and pain score (F = 45) were the most influential variables. Pain score and the psychosocial variables of PCS, TSK, HADS-A, HADS-D, SOPA-B Emotion, SOPA-B Harm and SOPA-B Disability loaded in one single dimension. CONCLUSIONS Postoperative acute pain and psychosocial factors of pain catastrophizing, anxiety, depression, and pain attitudes might influence health functioning and quality of life during KA rehabilitation. Such factors could be gathered into one single dimension defined as pain-related psychologic distress.
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Affiliation(s)
- Marc Terradas-Monllor
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, Vic, Spain.,Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Institut de Rehabilitació i Terapèutica Biofísica (IRITEB), Badalona, Spain.,Programa de Doctorat en Medicina i Recerca Translacional, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Gonzalo Navarro-Fernández
- Physiotherapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid Madrid, Spain
| | - Miguel A Ruiz
- Faculty of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Hector Beltran-Alacreu
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.,Unit of Physiotherapy, Hospital La Paz Institute for Health Research, IdiPAZ, Madrid, Spain.,Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, Madrid, Spain
| | | | - Mirari Ochandorena-Acha
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia, Vic, Spain.,Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Center for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
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16
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Trabecular Metal Cones Combined With Short Cemented Stem Allow Favorable Outcomes in Aseptic Revision Total Knee Arthroplasty. J Arthroplasty 2021; 36:657-663. [PMID: 32978026 DOI: 10.1016/j.arth.2020.08.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the functional outcomes and implant survivorship at a minimum of 5 years of follow-up of several reconstruction techniques with or without metaphyseal cone and stems of variable length. METHODS A retrospective comparative matched analysis was performed from 2 prospectively collected databases. Only patients who underwent revision total knee arthroplasty procedures for aseptic causes using a single design of rotating hinge knee with a minimum of 5 years of follow-up were analyzed. Patients were separated into 3 groups: trabecular metal (TM) cones + short cemented stems (TM + short stem [SS]), TM cones + long uncemented stems (TM + long stem [LS]), and no cone (NC) + long uncemented stems (NC + LS). A matching process based on age (±5 years) was realized. RESULTS About 99 patients were included; 33 in the TM + SS group, 33 in the TM + LS group, and 33 in the NC + LS group. The mean time of follow-up was 9.3 years. A significant difference of the improvement of subscale pain, symptom, activities of daily living, quality of life of the Knee Injury and Osteoarthritis Outcome score and knee, function of the Knee Society Score was observed in favor of TM + SS group compared with the 2 other groups. At 8 years of survivorship, the components free of revision for any cause were 90.9% for the TM + SS group, 84.9% for the TM + LS group, and 90.6% for the NC + LS group. CONCLUSION The use of a short cemented tibial stem combined with a TM cone in revision total knee arthroplasty offers identical survival rate with better functional outcome compared with the use of a long uncemented stem associated with TM cones or metallic augments at a minimum of 5 years of follow-up.
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17
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Preoperative vitamin D level does not affect the short-term functional outcome after total knee arthroplasty in elderly women. Knee Surg Relat Res 2020; 32:30. [PMID: 32660608 PMCID: PMC7291554 DOI: 10.1186/s43019-020-00050-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to evaluate the effect of vitamin D levels on the functional outcome of elderly women who underwent total knee arthroplasty (TKA). Methods Seven hundred and four patients (1013 knees) who underwent primary TKA were included in our retrospective study. Preoperative vitamin D levels were measured and the relationship analyzed between these and age, weight, height, body mass index, and bone mineral density. Two hundred and twenty patients (220 knees) who received unilateral TKA and were followed up for more than 1 year after operation were divided into two groups: Group 1, serum 25-hydroxyvitamin D3 (25(OH)D3) level < 20 ng/ml; and Group 2, 25(OH)D3 level ≥ 20 ng/ml. Both groups were evaluated for the relationship between vitamin D levels and postoperative Visual Analogue Scale (VAS) score, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) score. Results The number of vitamin D-deficient patients (< 20 ng/ml of serum 25(OH)D3 level) was 556 (79.0%). In the correlation analysis, the vitamin D level was negatively correlated with weight only (p = 0.033). No significant differences were observed between the groups in terms of postoperative VAS score, KSKS, KSFS, and WOMAC score. Conclusions Vitamin D deficiency was highly prevalent in patients who underwent TKA. Vitamin D levels negatively correlated with weight. Low vitamin D level was not a risk factor for unsatisfactory TKA outcome in elderly women.
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