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Tan YCJ, Chen JYQ, Tay DKJ, Lo NN, Yeo SJ, Liow MHL. Patient Acceptable Symptom State Thresholds for the Knee Society Score, Oxford Knee Score, and 36-Item Short Form Survey Ten Years Following Unicompartmental Knee Arthroplasty. J Arthroplasty 2024; 39:1480-1486. [PMID: 38081552 DOI: 10.1016/j.arth.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The patient acceptable symptom state (PASS) refers to a cutoff value on any patient-reported outcome measures (PROMs) scale, beyond which patients consider themselves as having achieved an acceptable outcome. This study aimed to identify PASS thresholds for knee-specific and generic PROMs at 10 years post-unicompartmental knee arthroplasty (UKA). METHODS There were 269 patients who underwent UKA for medial osteoarthritis from 2004 to 2007 at a single institution and were surveyed preoperatively and 10 years postoperatively using the Knee Society Function Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), 36-Item Short Form Survey (SF-36) Mental Component Score (MCS), and SF-36 Physical Component Score (PCS). Treatment outcomes and expectations were assessed using an anchor question, and PASS attainment was determined using the Youden index on a receiver operating characteristic (ROC) curve. Also, a similar study that identified 2-year long-term PROM PASS thresholds for UKA was referenced and compared. RESULTS Overall, 91.1% reported acceptable outcomes. The area under the curve for ROCs of KSKS, OKS, and PCS were 0.80, 0.75, and 0.71, respectively. The area under the curve for ROCs of KSFS and MCS were both 0.64. The PASS thresholds were 67.5 for KSFS, 70.5 for KSKS, 39.5 for OKS, 44.6 for PCS, and 43.8 for MCS. Patients who achieved a PASS were at least 3 times more likely to have satisfactory outcomes. CONCLUSIONS To our knowledge, this is the first study that identified 10-year long-term PROM PASS thresholds for UKA. Accounting for our finding that a decade-long follow-up yielded lower PASS thresholds, time-specific UKA PROM PASS thresholds should be considered. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Y C Jeremy Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Y Q Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren K J Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - M H Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Strahl A, Delsmann MM, Simon A, Ries C, Rolvien T, Beil FT. A clinical risk score enables early prediction of dissatisfaction 1 year after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38796721 DOI: 10.1002/ksa.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE Dissatisfaction after total knee arthroplasty (TKA) is a prevalent and clinically relevant problem that affects approximately 10%-20% of patients. The aim of this study is to identify factors associated with dissatisfaction 1 year after TKA. METHODS A total of 236 patients undergoing TKA were included in this prospective cohort study. Demographic data, preoperative clinical parameters (e.g., axial alignment, osteoarthritis severity) and patient-reported outcome measures (PROMs) were collected preoperatively, at 1 month and 1 year after TKA, encompassing the Knee Society Score (KSS) and Knee injury and Osteoarthritis Outcome Score (KOOS). The primary outcome was dissatisfaction 1 year after TKA, defined as ≤20 points on the KSS satisfaction scale. A risk score based on multiple regression and area under the curve (AUC) analyses was calculated to predict dissatisfaction. RESULTS One year after TKA, 16% of the patients were dissatisfied. Dissatisfied patients were significantly younger (p = 0.023) and had a higher body mass index (BMI) (p = 0.007). No differences were observed in preoperative objective (p = 0.903) and functional KSS (p = 0.346), pain (p = 0.306), osteoarthritis severity (p = 0.358), axial knee alignment (p = 0.984) or psychological distress (p = 0.138). The likelihood of dissatisfaction at 1 year was 3.0, 4.0, 7.4, 4.3 and 2.8 times higher amongst patients aged <63.5 years, with a BMI > 30.1 kg/m2, a KOOSPain < 50%, a KSSFunction < 42 points and a KSSExpectation < 9 points (all at 1 month), respectively. Using these variables, a risk score with a maximum of 7 points was developed, demonstrating a high predictive value for dissatisfaction (AUC: 0.792 [95% confidence interval: 0.700-0.884], p < 0.001). CONCLUSION Dissatisfaction 1 year after TKA can be predicted by a weighted risk score that includes patient age, BMI, pain, subjective functionality and unmet expectation 1 month postoperatively. Using the risk score, early detection of dissatisfaction has the potential to enable targeted interventions and improve patients' quality of life. LEVEL OF EVIDENCE Level II, Prognostic study.
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Affiliation(s)
- André Strahl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian M Delsmann
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ries
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kaya C, Seyman CC, Kaya Y. Determination of the effect of preoperative knee joint function on postoperative quality of life in patients with total knee arthroplasty. J Orthop Res 2024. [PMID: 38734879 DOI: 10.1002/jor.25876] [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: 02/15/2024] [Revised: 04/03/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
Primary total knee arthroplasty (TKA) is one of the most successful procedures for end-stage knee osteoarthritis. To determine the effect of preoperative knee joint function on postoperative quality of life in patients undergoing primary TKA. This descriptive cross-sectional study was conducted with a total of 208 patients in the orthopedics and traumatology clinic. Data were gathered with a personal information form, the Oxford Knee Score (OKS), and the EQ-5D-5L Quality Of Life Scale in the preoperative period, at postoperative 6th week, and at postoperative 3rd month. The data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), correlation analysis, and simple linear regression analysis. The mean age of the patients was 65.65 ± 7.01 years. Most patients (86.1%) were women, and 51.4% underwent left TKA. OKS scores indicated poor knee function preoperatively and gradually increased at postoperative 6th week and 3rd month. Preoperative OKS was a significant predictor of postoperative knee joint function and quality of life. This study shows that preoperative knee joint function significantly affects postoperative knee joint function and quality of life. These results demonstrate the importance of the surgery timing and suggest that performing surgery earlier in functional decline may be associated with a better outcome.
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Affiliation(s)
- Cigdem Kaya
- Department of Surgical Nursing, Faculty of Health Sciences, Balıkesir University, Balıkesir, Turkey
| | - Cigdem Canbolat Seyman
- Department of Surgical Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Yılmaz Kaya
- Department of Orthopedics and Traumatology, Balıkesir State Hospital, Balıkesir, Turkey
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Abdioğlu AA, Peker G. Comparison of bilateral cementless total knee arthroplasty results between patients in different BMI groups. Arch Orthop Trauma Surg 2024; 144:2317-2326. [PMID: 38642162 DOI: 10.1007/s00402-024-05335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION The aim of this study was to compare the results of cementless bilateral total knee arthroplasty (TKA) between individuals in different obesity groups. MATERIALS AND METHODS This was a retrospective cohort study. Patients with a body mass index (BMI) greater than 25 who underwent bilateral TKA for gonarthrosis between 2014 and 2020 and completed a minimum follow-up of 24 months were included. Age, sex, height, weight, BMI, operation time, length of stay, patient satisfaction, knee scores and complications were compared. Patients with missing data, who were followed for less than 24 months or had postoperative fractures around the knee were excluded. RESULTS There was a significant difference between the groups in terms of operation time (Class III > overweight > Class II > Class I p < 0.001). There was a significant difference in complications between the groups (Class III > Class I > Class II > overweight p = 0.010). According to our pairwise comparison, complications were more common in the class III group than in the overweight group. Knee score (KS) and function score (FS) increased significantly after surgery in all groups (p < 0.001), with no difference in FS (p = 0.448). Knee score changes were greater in the overweight and class I groups (p < 0.001). There was a significant interaction between both KS and FS and person satisfaction (p < 0.001). CONCLUSION Cementless TKA improved KS and FS in all obesity groups, yielded high patient satisfaction. Although the incidence of complications was higher in the morbidly obese patients than in the overweight patients, the difference was not significant. Patients with morbid obesity should be informed about related risks before planning cementless TKA.
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Affiliation(s)
- Ahmet Atilla Abdioğlu
- Department of Orthopedics and Traumatology, Fatih State Hospital, Trabzon, 61100, Turkey.
| | - Gökhan Peker
- Department Of Orthopedics and Traumatology, University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
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Zhou Y, Patten L, Spelman T, Bunzli S, Choong PFM, Dowsey MM, Schilling C. Predictive Tool Use and Willingness for Surgery in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e240890. [PMID: 38457182 PMCID: PMC10924247 DOI: 10.1001/jamanetworkopen.2024.0890] [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] [Received: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
Importance Despite the increasing number of tools available to predict the outcomes of total knee arthroplasty (TKA), the effect of these predictive tools on patient decision-making remains uncertain. Objective To assess the effect of an online predictive tool on patient-reported willingness to undergo TKA. Design, Setting, and Participants This parallel, double-masked, 2-arm randomized clinical trial compared predictive tool use with treatment as usual (TAU). The study was conducted between June 30, 2022, and July 31, 2023. Participants were followed up for 6 months after enrollment. Participants were recruited from a major Australian private health insurance company and from the surgical waiting list for publicly funded TKA at a tertiary hospital. Eligible participants had unilateral knee osteoarthritis, were contemplating TKA, and had previously tried nonsurgical interventions, such as lifestyle modifications, physiotherapy, and pain medications. Intervention The intervention group was provided access to an online predictive tool at the beginning of the study. This tool offered information regarding the likelihood of improvement in quality of life if patients chose to undergo TKA. The predictions were based on the patient's age, sex, and baseline symptoms. Conversely, the control group received TAU without access to the predictive tool. Main Outcomes and Measures The primary outcome measure was the reduction in participants' willingness to undergo surgery at 6 months after tool use as measured by binomial logistic regression. Secondary outcome measures included participant treatment preference and the quality of their decision-making process as measured by the Knee Decision Quality Instrument. Results Of 211 randomized participants (mean [SD] age, 65.8 [8.3] years; 118 female [55.9%]), 105 were allocated to the predictive tool group and 106 to the TAU group. After adjusting for baseline differences in willingness for surgery, the predictive tool did not significantly reduce the primary outcome of willingness for surgery at 6 months (adjusted odds ratio, 0.85; 95% CI, 0.42-1.71; P = .64). Conclusions and Relevance Despite the absence of treatment effect on willingness for TKA, predictive tools might still enhance health outcomes of patients with knee osteoarthritis. Additional research is needed to optimize the design and implementation of predictive tools, address limitations, and fully understand their effect on the decision-making process in TKA. Trial Registration ANZCTR.org.au Identifier: ACTRN12622000072718.
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Affiliation(s)
- Yushy Zhou
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Lauren Patten
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Brisbane, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Peter F. M. Choong
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M. Dowsey
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Orthopaedic Surgery, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Chris Schilling
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Abdelhameed MA, Abdelnasser MK, Zaky BR, Bakr HM, Aziz M, Mahran M. Preoperative stiffness is the most important predictor of postoperative patient's satisfaction after total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3019-3024. [PMID: 36947311 PMCID: PMC10504170 DOI: 10.1007/s00590-023-03526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE To predict the most important preoperative factor affecting the patient satisfaction after total knee arthroplasty (TKA) in trial to improve patient counselling process. METHODS We retrospectively reviewed all patients who underwent primary TKA from January 1, 2018, to January 31, 2019, with minimum one-year follow-up for the previously collected patient-reported outcome measures (PROMs) as Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score for joint replacement (KOOS, JR) preoperative, 6 months and 12 months postoperative. RESULTS By using Oxford knee score at 12 months as dependent variable, we found a negative moderate spearman correlation between age and Oxford knee score at 12 months postoperative. Moderate negative spearman correlation was also found between Oxford knee score at 12 months postoperative and KOOS pain, stiffness and function scores at preoperative and 6 months postoperative, denoting higher satisfaction at 12 months with less perceived stiffness, pain and limited function at baseline and 6 months postoperative. A multivariate regression analysis was done using the oxford knee score at 12 months as dependent variable to detect the predictors of oxford knee score at 12 months postoperatively and showed that younger age and less perception of stiffness at baseline were significant predictors of higher Oxford knee score: higher satisfaction at 12 months postoperative. CONCLUSION Preoperative stiffness can predict the postoperative satisfaction score more than any other factor. We also address the importance of combining more than one PROM in assessing patients as OKS and KOOS, JR.
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Affiliation(s)
| | | | - Bishoy Raafat Zaky
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Hatem M. Bakr
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
| | - Mirette Aziz
- Public health department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Mahran
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut, Egypt
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Tay ML, Monk AP, Frampton CM, Hooper GJ, Young SW. The Strongest Oxford Knee Score Predictors of Subsequent Revision are 'Overall Pain,' 'Limping when Walking,' and 'Knee Giving Way'. J Arthroplasty 2023:S0883-5403(23)00218-8. [PMID: 36898485 DOI: 10.1016/j.arth.2023.03.001] [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: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The Oxford Knee Score (OKS) is used to measure knee arthroplasty outcomes, however, it is unclear which questions are more relevant. Our aims were to: 1) identify which OKS question(s) were the strongest predictors of subsequent revision and 2) compare predictive ability of the 'pain' and 'function' domains. PATIENTS AND METHODS All primary total (TKAs) and unicompartmental knee arthroplasties (UKAs) in the New Zealand Joint Registry between 1999 and 2019 with an OKS at six months (TKA n=27,708, UKA n=8,415), five years (TKA n=11,519, UKA n=3,365) or ten years (TKA n=6,311, UKA n=1,744) were included. Prediction models were assessed using logistic regressions and receiver operating characteristic analyses. RESULTS A reduced model with three questions ('overall pain,' 'limping when walking,' 'knee giving way') showed better diagnostic ability than full OKS for predicting UKA revision at six months (area under the curve (AUC): 0.80 vs. 0.78; P<0.01) and five years (0.81 vs. 0.77; P=0.02), and comparable diagnostic ability for predicting TKA revision at all timepoints (6 months, 0.77 vs. 0.76; 5 years, 0.78 vs. 0.75; 10 years, 0.76 vs. 0.73; all not significant (NS)), and UKA revision at 10 years (0.80 vs. 0.77; NS). The pain domain had better diagnostic ability for predicting subsequent revision for both procedures at five and ten years. CONCLUSION Questions on 'overall pain', 'limping when walking', and 'knee 'giving way' were the strongest predictors of subsequent revision. Attention to low scores from these questions during follow-up may allow for prompt identification of patients most at risk of revision.
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Affiliation(s)
- Mei Lin Tay
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private bag 92019, Auckland 1023, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Auckland 0620, New Zealand.
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Private Bag 92-024, Auckland, New Zealand; Auckland Bioengineering Institute, University of Auckland, Private Bag 93-503, Auckland 0620, New Zealand
| | - Chris M Frampton
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4545, Christchurch 8140, New Zealand
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, PO Box 4545, Christchurch 8140, New Zealand
| | - Simon W Young
- Department of Surgery, Faculty of Medical and Health Sciences (FMHS), University of Auckland, Private bag 92019, Auckland 1023, New Zealand; Department of Orthopaedic Surgery, North Shore Hospital, Private Bag 93-503, Auckland 0620, New Zealand
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Shichman I, Oakley CT, Thomas J, Fernandez-Madrid I, Meftah M, Schwarzkopf R. Comparison of traditional PS versus kinematically designs in primary total knee arthroplasty. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04763-8. [PMID: 36625899 DOI: 10.1007/s00402-023-04763-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Kinematically designed total knee arthroplasty (TKA) aims to restore normal kinematics by replicating the function of both cruciate ligaments. Traditional posterior-stabilized (PS) TKA designs, on the other hand, simplify knee kinematics and may improve TKA cost-effectiveness. The purpose of this study was to compare outcomes of patients who underwent primary TKA using either a traditional PS or kinematically designed TKA. METHODS This retrospective study examined all patients who underwent primary TKA using either a kinematically or a traditional PS designed TKA implant, with a minimum follow-up of 2 years. Patient demographics, complications, readmissions, revision rates and causes, range of motion (ROM) and patient reported outcomes (KOOS, JR) were compared between groups. Kaplan-Meier survivorship analysis was performed to estimate freedom from revision, and multivariate regression was performed to control for confounding variables. RESULTS A total of 396 TKAs [173 (43.7%) with a kinematic design, 223 (56.3%) with a traditional design] with a mean follow-up of 3.48 ± 1.51 years underwent analysis. Revision rates did not differ between groups (9.8% vs. 6.7%, p = 0.418). In Kaplan-Meier analysis at 2-year follow-up, freedom from all-cause revision (96.4% vs. 93.1%, p = 0.139) were similar between groups. The two cohorts had no significant difference in aseptic loosening at 2 years (99.6% vs. 97.1, p = 0.050) and at latest follow up (92.7% vs. 96.4%, p = 0.279). KOOS, JR scores and post-operative ROM were similar between groups. CONCLUSION This study demonstrated similar mid-term outcomes following the use of both a kinematically designed and a traditionally designed implant in primary TKA patients. LEVEL OF EVIDENCE Retrospective study-III.
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Affiliation(s)
- Ittai Shichman
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA.
| | - Christian T Oakley
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Jeremiah Thomas
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ivan Fernandez-Madrid
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, New York, NY, 10003, USA
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The Desired Oxford Knee Score Obtained Before Total Knee Arthroplasty is Predictive of the Postoperative Oxford Knee Score: A Prospective Study. J Arthroplasty 2023; 38:60-64. [PMID: 35940354 DOI: 10.1016/j.arth.2022.08.002] [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: 04/28/2022] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The relationship between patient expectations and patient-reported outcome measures (PROMs) after total knee arthroplasty (TKA) is not well understood. The purpose of the study was to test the influence of desired knee function on postoperative perceived knee function 1 year after TKA. METHODS A total of 102 patients undergoing primary TKA were available for data analyses. Preoperatively, patients completed the Oxford Knee Score (OKS) twice, one representing preoperative function (preoperative OKS); the second representing desired function after TKA (desired OKS). Western Ontario and McMaster Universities Arthritis Index (WOMAC), University of California, Los Angeles (UCLA) Activity score, Hospital for Special Surgery Knee Replacement Expectations Survey (HSS-KRES), Patient Health Questionnaire-9, and EuroQol-visual analogue scales were obtained preoperatively. One year after surgery, all surveys besides the UCLA activity score and HSS-KRES were repeated. The associations between postoperative OKS and WOMAC versus desired OKS and HSS-KRES were assessed using multivariable linear regression models, wherein linear regression coefficients represent the additive effect on the mean postoperative PROM. RESULTS The desired OKS was independently associated with the postoperative OKS (linear regression coefficient = 0.43; P = .011), that is, each point increase in desired OKS yielded a 0.43 increase in postoperative OKS. The preoperative OKS showed no association with postoperative PROMs. Desired OKS was correlated with postoperative WOMAC (coefficient = -0.67; P = .014). The HSS-KRES was not associated with the postoperative OKS (coefficient = -0.005; P = .965) or WOMAC (coefficient = 0.18; P = .288). CONCLUSION In TKA patients, higher preoperative desired function predict greater postoperative PROMs. Effects of preoperative expectations on outcomes are independent of patient demographics or preoperative function.
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Bersusky E, Arzac Ulla I, Loterzo LG, Ricciardi G, Zanotti G, Patiño JM. Puntajes IV. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2022. [DOI: 10.15417/issn.1852-7434.2022.87.5.1663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
El Comité Editorial quiere brindar a los lectores de la RAAOT una actualización de las escalas de uso corriente. El empleo de tablas y escalas es una práctica muy extendida en la ortopedia y traumatología. La medición y la cuantificación de los aspectos clínicos, funcionales y radiográficos se convirtieron en una herramienta imprescindible para la toma de decisiones en diferentes aspectos de la actividad asistencial. Llevamos a cabo una revisión de las escalas más utilizadas, definimos su uso e incluimos bibliografía original y actualizada.
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Heller S, Shemesh S, Rukinglaz O, Cohen N, Velkes S, Fein S. Efficacy of single-shot adductor canal block before Versus after primary total knee arthroplasty - Does timing make a difference? A randomized controlled trial. J Orthop Surg (Hong Kong) 2022; 30:10225536221132050. [PMID: 36189733 DOI: 10.1177/10225536221132050] [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] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is associated with severe postoperative pain. Multimodal analgesia, including peripheral nerve block, is recommended for post-operative pain relief. Administration of some pain medications prior to surgery has shown to be more effective than after the operation. This is a prospective, randomized controlled trial designed to compare the analgesic efficacy of the adductor canal block (ACB) performed immediately before or immediately after primary total knee arthroplasty (TKA). We hypothesized that ACB before the surgery will reduce postoperative pain and improve knee function. METHODS A total of 50 patients were enrolled and randomized into 2 groups, with 26 patients receiving a preoperative ACB and 24 receiving a postoperative ACB. RESULTS Treatment groups were similar in terms of gender (p = .83), age (p = 0.61) weight (p = .39) and ASA score. Average visual analogue scale (VAS) on arrival to the post-anesthesia care unit (PACU) were 4.9 ± 3.2 in the preoperative ACB versus 3.4 ± 2.8 for the postoperative ACB (p = .075). VAS scores at different time points as well as the mean, minimal and maximal reported VAS scores were not significantly different between the two groups. The cumulative quantities of Fentanyl administered by the anesthesia team was comparable between the groups. Similarly, the dosage of Morphine, Tramadol, Acetaminophen and Dipyrone showed only small variations. The Quality of Recovery Score, Knee Society Scores and knee range of motion did not differ between the groups. CONCLUSIONS Our findings demonstrate no significant differences in patient total narcotics consumption, pain scores and functional scores, between preoperative and postoperative ACB in patients undergoing TKA. TRIAL REGISTRATION The trial was registered at www.clinicaltrials.gov and was assigned the registration number NCT02908711. LEVEL OF EVIDENCE level I randomized controlled trial.
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Affiliation(s)
- Snir Heller
- Department of Orthopaedic Surgery, 36632Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shai Shemesh
- Department of Orthopaedic Surgery, 36632Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Oleg Rukinglaz
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Anesthesiology, Rabin Medical Center, Petach Tikva Israel
| | - Nir Cohen
- Department of Orthopaedic Surgery, 36632Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Steven Velkes
- Department of Orthopaedic Surgery, 36632Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Shai Fein
- Department of Anesthesiology, 511918Assuta Ashdod University Hospital, Israel.,Ben-Gurion University Joyce and Irving Goldman Medical School,Beer-Sheva, Israel
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Miralles-Muñoz FA, Gonzalez-Parreño S, Martinez-Mendez D, Gonzalez-Navarro B, Ruiz-Lozano M, Lizaur-Utrilla A, Alonso-Montero C. A validated outcome categorization of the knee society score for total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:1266-1272. [PMID: 33839804 DOI: 10.1007/s00167-021-06563-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine cutoff values for the Knee Society Scores (KSS) indicative of a categorical scale of medium-term outcomes. METHODS One hundred and fifty-five patients who underwent primary cruciate-retaining TKA with a patellar button for osteoarthritis at a single-centre were assessed prospectively by the KSS and short-form Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) simultaneously at the 3-year follow-up. A validated categorization of the WOMAC score was used as a standard. The area under the curve (AUC) of receiver-operating characteristic (ROC) was used to assess the discriminative analysis accuracy of the, and the Youden index estimated the optimal cutoff point. RESULTS For the KSS-knee score, the cutoff for an excellent outcome was 90.3 (AUC 0.75, 95% CI 0.71-0.78), 76.6 (AUC 76.6, 95% CI 0.70-076) for good, 64.8 (AUC 0.76, 95% CI 0.72-0.79) for fair, and < 64.8 (AUC 0.69, 95% CI 0.67-0.73) for poor. For the KSS-function score, the cutoff values were 85.2 (AUC 0.71, 95% CI 0.69-0.75), 73.1 (AUC 0.72, 95% CI, 0.70-0.76), 55.7 (AUC 0.70, 95% CI 0.71-0.74), and < 55.7 (AUC 0.68, 95% CI 0.66-0.72), respectively. CONCLUSION A KSS-knee score ≥ of 90 was considered an excellent outcome, 77 good, 65 fair, and < 65 poor. For the KSS-function, those values are 85, 73, 56 and < 56, respectively. The treatment outcome's judgement may be clearer for the surgeon concerning a particular patient when using cutoff values for the scoring system employed, such as those determined in the present study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Francisco A Miralles-Muñoz
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Santiago Gonzalez-Parreño
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Daniel Martinez-Mendez
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Blanca Gonzalez-Navarro
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Matias Ruiz-Lozano
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain.
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, N-332 km 87 s/n, 03550, San Juan de Alicante, Alicante, Spain.
| | - Carolina Alonso-Montero
- Department of Traumatology and Orthopaedics, Faculty of Medicine, Miguel Hernandez University, N-332 km 87 s/n, 03550, San Juan de Alicante, Alicante, Spain
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牛 鸣, 王 秋, 李 军, 王 同, 吴 旭, 蔡 经, 王 旭, 康 鹏. [Medial parapatellar soft tissue overlapping suture in total knee arthroplasty for severe osteoarthritis with permanent patellar dislocation: early and mid-term results]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:244-249. [PMID: 35365449 PMCID: PMC8983364 DOI: 10.12122/j.issn.1673-4254.2022.02.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the early and mid-term clinical results of medial parapatellar soft tissue overlapping suture in total knee arthroplasty for treatment of severe osteoarthritis combined with permanent patellar dislocation. METHODS We retrospectively analyzed the data of 12 patients (12 knees) diagnosed with severe knee osteoarthritis combined with permanent patellar dislocation undergoing total knee arthroplasty with medial parapatellar soft tissue overlapping suture. Knee Society Score (KSS), University of California Los Angeles (UCLA) activity-level rating, Visual Analog Scale (VAS) pain score, and knee range of motion of the patients were assessed before and 2 years after the surgery. Anteroposterior and lateral radiographs of the knee joint, full-length standing radiographs of the lower limbs and patellar axial radiographs were evaluated. RESULTS The mean Knee Society Score of the patients increased from 34.2±11.1 before surgery to 73.5±6.3 at two years after the surgery (P < 0.001). The UCLA activity-level rating increased from an average of 3.8 ± 0.8 before surgery to 5.8 ± 0.6 at two years postoperatively (P=0.003). The mean VAS pain score decreased from 42.8±6.0 before surgery to 20.1±3.7 (P < 0.001) and the range of motion of the knee joint increased from 74.6±8.9 degrees to 97.5±4.5 degrees at two years (P < 0.001). The radiographs showed no signs of subluxation or dislocation of the patella in all the patients. CONCLUSIONS Medial parapatellar soft tissue overlapping suture in total knee arthroplasty can achieve good early and mid-term clinical results for treatment of severe osteoarthritis combined with permanent patellar dislocation.
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Affiliation(s)
- 鸣 牛
- 张掖市甘州区人民医院骨科,甘肃 张掖 734000Department of Orthopedics, Ganzhou District People's Hospital, Zhangye 734000, China
| | - 秋入 王
- 四川大学华西医院骨科,四川 成都 610041Department of Orthopedics, Sichuan University West China Hospital, Chengdu 610041, China
| | - 军伟 李
- 张掖市甘州区人民医院骨科,甘肃 张掖 734000Department of Orthopedics, Ganzhou District People's Hospital, Zhangye 734000, China
| | - 同 王
- 张掖市甘州区人民医院骨科,甘肃 张掖 734000Department of Orthopedics, Ganzhou District People's Hospital, Zhangye 734000, China
| | - 旭年 吴
- 张掖市甘州区人民医院骨科,甘肃 张掖 734000Department of Orthopedics, Ganzhou District People's Hospital, Zhangye 734000, China
| | - 经纬 蔡
- 张掖市甘州区人民医院骨科,甘肃 张掖 734000Department of Orthopedics, Ganzhou District People's Hospital, Zhangye 734000, China
| | - 旭勃 王
- 张掖市甘州区人民医院骨科,甘肃 张掖 734000Department of Orthopedics, Ganzhou District People's Hospital, Zhangye 734000, China
| | - 鹏德 康
- 四川大学华西医院骨科,四川 成都 610041Department of Orthopedics, Sichuan University West China Hospital, Chengdu 610041, China
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Plachel F, Jung T, Bartek B, Rüttershoff K, Perka C, Gwinner C. The subjective knee value is a valid single-item survey to assess knee function in common knee disorders. Arch Orthop Trauma Surg 2022; 142:1723-1730. [PMID: 33523264 PMCID: PMC9296395 DOI: 10.1007/s00402-021-03794-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The patient's perspective plays a key role in judging the effect of knee disorders on physical function. We have introduced the Subjective Knee Value (SKV) to simplify the evaluation of individual's knee function by providing one simple question. The purpose of this prospective study was to validate the SKV with accepted multiple-item knee surveys across patients with orthopaedic knee disorders. MATERIALS AND METHODS Between January through March 2020, consecutive patients (n = 160; mean age 51 ± 18 years, range from 18 to 85 years, 54% women) attending the outpatient clinic for knee complaints caused by osteoarthritis (n = 69), meniscal lesion (n = 45), tear of the anterior cruciate ligament (n = 23) and focal chondral defect (n = 23) were invited to complete a knee-specific survey including the SKV along with the Knee Injury Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee subjective knee form (IKDC-S). The Pearson correlation coefficient was used to evaluate external validity between the SKV and each patient-reported outcome measure (PROM) separately. Furthermore, patient's compliance was assessed by comparing responding rates. RESULTS Overall, the SKV highly correlated with both the KOOS (R = 0.758, p < 0.05) and the IKDC-S (R = 0.802, p < 0.05). This was also demonstrated across all investigated diagnosis- and demographic-specific (gender, age) subgroups (range 0.509-0.936). No relevant floor/ceiling effects were noticed. The responding rate for the SKV (96%) was significantly higher when compared with those for the KOOS (81%) and the IKDC-S (83%) (p < 0.05). CONCLUSION At baseline, the SKV exhibits acceptable validity across all investigated knee-specific PROMs in a broad patient population with a wide array of knee disorders. The simplified survey format without compromising the precision to evaluate individual's knee function justifies implementation in daily clinical practice. LEVEL OF EVIDENCE II, cohort study (diagnosis).
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Affiliation(s)
- Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Tobias Jung
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Benjamin Bartek
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Katja Rüttershoff
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Clemens Gwinner
- Center for Musculoskeletal Surgery, Campus Mitte, Charité–Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Cemented versus uncemented hemiarthroplasty for the management of femoral neck fractures in the elderly: a meta-analysis and systematic review. Arch Orthop Trauma Surg 2021; 141:1043-1055. [PMID: 33423078 DOI: 10.1007/s00402-020-03737-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/19/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Hemiarthroplasty is commonly used to treat unstable femoral neck fractures in older patients. However, there is no consensus on the use of cement during hemiarthroplasty. Therefore, we performed a systematic review to focus on the outcomes of cemented and uncemented hemiarthroplasty for the treatment of femoral neck fractures in older patients. MATERIALS AND METHODS Pubmed, Cochrane Central Register of Controlled Trials, and Ovid were searched for studies related comparison of cemented versus uncemented hemiarthroplasty for unstable femoral neck fractures from inception to Jan 20, 2020. The quality of the included randomized controlled trials (RCTs) was assessed using the Cochrane Collaboration tool. The meta-analysis was performed using the RevMan 5.2 software. RESULTS Eleven RCTs were included in the meta-analysis. Cemented hemiarthroplasty was found to be superior to uncemented arthroplasty with respect to reoperation rate (RR 0.6, 95% CI 0.38-0.96, p = 0.03), complications related to prosthesis (RR 0.39, 95% CI 0.23-0.68, p = 0.0008), residual pain (RR 0.66, 95% CI 0.52-0.83, p = 0.0004), and operation time (MD 8.22, 95% CI 6.30-10.14, p < 0.00001). There were no significant between-group differences with respect to local and general complications, duration of hospital stay, hip function, and mortality. CONCLUSIONS This meta-analysis showed cemented hemiarthroplasty might be an optimum choice for treating unstable femoral neck fractures in older patients. However, the results of this meta-analysis should be interpreted cautiously owing to some limitations. Further studies are required to provide more robust evidence.
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Lei Y, Xie J, Huang Q, Huang W, Pei F. Is there a role of tranexamic acid in rheumatoid arthritis with total knee arthroplasty? Findings from a multicenter prospective cohort study in China. Arch Orthop Trauma Surg 2021; 141:489-496. [PMID: 33386441 DOI: 10.1007/s00402-020-03709-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/06/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) has proven to be effective in reducing the blood loss associated with total knee arthroplasty (TKA) in patients with osteoarthritis. However, there still exists a paucity of evidence regarding the effectiveness of intravenous TXA in patients with rheumatoid arthritis. The aim of this study was to explore the efficacy and safety of intravenous TXA on blood loss after TKA in Chinese patients with rheumatoid arthritis. MATERIALS AND METHODS A total of 405 patients with rheumatoid arthritis who had undergone TKA were categorized into two groups based on the protocol of TXA use. TXA group (n = 248): patients received 15 mg/kg TXA prior to operation. Control group (n = 157): patients received no TXA. The outcome measurements such as, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), transfusion, drainage, the timing of first ambulation, the length of stay (LOS), total hospitalization costs, the results of 12-Item Short Form Survey (SF-12), the incidence of thromboembolic events and other complications were recorded and compared. RESULTS The mean TBL, IBL, HBL, volume of transfusion and drainage were significantly lower in TXA group than in Control group. The rate of transfusion was significantly lower in TXA group than in Control group. There was a favorable effect in early ambulation for patients in TXA group, compared with patients in Control group. In addition, TXA group had shorter LOS, lower hospitalization costs and higher postoperative SF-12 score than Control group. The incidence of deep venous thrombosis and other complications did not differ between the two groups. CONCLUSION TXA can effectively diminish blood loss, reduce transfusion, shorten LOS and decrease hospitalization costs after TKA in Chinese patients with rheumatoid arthritis, without increasing the risk of complications.
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Affiliation(s)
- Yiting Lei
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.,Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China
| | - Jinwei Xie
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China
| | - Qiang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China.
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