How Do Demographic, Surgical, Patient, and Cultural Factors Affect Pain Control After Unicompartmental Knee Arthroplasty? A Multivariable Regression Analysis

Predictors of Satisfactory Outcomes With Fixed-Bearing Lateral Unicompartmental Knee Arthroplasty: Up to 7-year Follow-Up

BACKGROUND

There is little literature available examining factors that may predict functional recovery after lateral unicompartmental knee arthroplasty (UKA). The purpose of this study was to report short to mid-term effectiveness and evaluate predictors of better outcome following lateral UKA.

METHODS

We retrospectively reviewed 248 patients (260 knees) who underwent lateral UKA from January 2013, with a mean 5-year follow-up. The primary outcome measures comprised the Hospital for Special Surgery (HSS) score and patient satisfaction. Multivariate regression analyses were implemented to investigate associations between these factors with a satisfactory outcome. Implant survival was estimated by Kaplan-Meier analysis.

RESULTS

Complete follow-up was available for 186 patients (198 knees). At last follow-up, the HSS scores were changed from 52.1 (range, 38-80) preoperatively to 85.6 (range, 61-98) (P < .001), The OKS improved from 22.8 (range, 16-32) preoperatively to 42.7 (range, 30-47) postoperatively (P < .01). The 5-year survival was 99.5%. The multivariate analysis showed that the following factors tended to obtain a satisfactory outcome: higher proportion of ASA class I (P < .001), diagnosis of primary OA (P = .007), postoperative limb alignment (P = .007), and higher preoperative HSS score (P = .019). Patients with valgus 9°-12° reported the highest HSS scores among different subgroups (P < .001).

CONCLUSION

Following lateral UKA, postoperative outcomes were satisfactory in patients with lower ASA scores, diagnosis with primary OA, higher preoperative HSS scores and those with postoperative valgus alignment. It is important to understand these correlations to help appropriate patient selection to obtain optimal function after lateral UKA.

Early post-operative opioid consumption: A comparison between medial unicompartmental, patellofemoral, and total knee arthroplasty

BACKGROUND

While there is emerging literature describing the use of narcotics for post-operative pain control following TKA, little data is available regarding narcotic use in partial knee replacements. The aim of this study is to compare the early post-operative narcotic requirements after medial compartmental arthroplasty (UKA) and patellofemoral arthroplasty (PFA) with that of TKA.

METHODS

In this retrospective chart review, we identified 37 patients who underwent PFA and 71 patients who underwent UKA. We identified a cohort of TKA patients who were matched to the unicompartmental group based on sex and age (n = 108). The primary outcome measure was self-reported use of opioids for pain management at the first post-operative clinic visit. Opioid use between groups was compared using Chi-square analysis.

RESULTS

The PFA group was younger (p < 0.001) and consisted of more females (p < 0.001) than the UKA group. The UKA cohort had more non-smoking patients (p = 0.044) compared to the PFA cohort. Self-reported opioid use at the first post-operative visit differed between the three groups of patients (p < 0.001). A greater proportion of both PFA (38% vs. 11%; p < 0.001) and TKA (41% vs. 11%; p = 0.01) patients reported opioid use when compared to UKA patients. No differences in opioid use existed between TKA and PFA groups (p = 0.61).

CONCLUSION

The prevalence of PFA patients who report opioid use at the first post-operative visit is similar to that for patients following TKA, suggesting that pain management protocols for this specific subset of partial knee arthroplasty patients should be structured similar to TKA patients and separate from UKA patients.

Ambulatory unicompartmental knee arthroplasty: Short outcome of 50 first cases

INTRODUCTION

The reduction in length of stay (LOS) in orthopedic surgery has been steady for several years. For the past 3 or 4 years in France, the trend toward outpatient surgery has been growing upwards, as it is a goal for hospital administration.

MATERIALS AND METHODS

This is a prospective, continuous, mono-centric, single operator study on 56 UKAs. Included were all UKAs carried out between January 2014 and December 2015, meeting the following criteria: voluntary patients, supportive family environment, absence of comorbidity (oral anticoagulants, diabetes, obesity), ASA score≤3. Preoperatively, patients received: Dexamethasone 2mg/10kg, Tranexamic acid 2g, Cefazolin 2g IV. All patients were operated on under general anesthesia with the same technique: Alpina^® (Zimmer-Biomet) uni-prosthesis without tourniquet. The arthrotomy was closed after a capsular injection of a solution of 150mg Ropivacaine+30mg Bi-Profenid^®. Patient discharge on the same day evening was authorized by both surgeon and anesthesiologist. Three criteria were quantified: number of patients seen before the date of the first consultation for the removal of stitches (around day 12), Visual Pain Scale (10 points scale) on the first 12 days, and the level of satisfaction at the one-month postoperative visit.

RESULTS

Six patients (11%) were not included in the ambulatory program during the initial consultation. Three patients were not able to be discharged on the same day evening due to nausea and therefore remained hospitalized for one night. Eighteen patients (38%) were reviewed before D10: 13 patients were reviewed between D1 and D4 for bleeding through the dressing and 5 for pain not controlled by level 1 and 2 analgesics. The Visual Pain Scale (VPS) reached level 6±2 by the 2nd day and then dropped to 1±1 by the 12th day. At 1 month, 85% of the patients were satisfied or very satisfied with their care. There were no general or localized complications.

DISCUSSION

Ambulatory UKA surgery is possible for most patients. The inclusion rate for ambulatory UKA was 88% for Berger RA in 2010, therefore very close to this study rate of 89%. Ambulatory care is not only a change in surgical and anesthetic practice but a totally new management process involving all medical and non-medical actors. Ambulatory UKA surgery is feasible and safe for most patients.

LEVEL OF EVIDENCE

IV, retrospective cohort study.