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Hoellwarth JS, Haidary A, Tetsworth K, Oomatia A, Al Muderis M. Transfemoral Osseointegration in Association With Total Hip Replacement: Observational Cohort Study of Patients With Follow-Up Exceeding 2 Years. Arthroplast Today 2024; 28:101463. [PMID: 39100422 PMCID: PMC11295706 DOI: 10.1016/j.artd.2024.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/17/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Some amputees with transfemoral osseointegration (TFOI) have ipsilateral hip arthritis which can be addressed with total hip arthroplasty (THA). This study reported the medium-term outcomes of THA in association with TFOI (THA + TFOI). Methods Retrospective review was performed for eight patients with THA + TFOI performed at least 2 years prior. Primary outcomes include complications prompting surgical intervention. Secondary outcomes include changes in mobility (K-level, 6-minute walk test [6MWT], timed up and go) and patient-reported measures (hip pain, daily prosthesis wear hours, Questionnaire for Persons with a Transfemoral Amputation, and Short Form 36 [SF36]). Results One patient died after 11 months (cancer); he was included to maximally report complications but excluded from mobility and reported outcomes. Three patients required subsequent surgeries: Two had skin refashioning, and the other underwent hip debridement of the replaced joint with subsequent removal of the TFOI. No perioperative complications, fractures, or arthroplasty explantations occurred. All patients reported complete hip pain relief. Of 6 patients reporting prosthesis wear time, 2 (33%) wore their prosthetic leg at least 4 hours daily before, vs all (100%) who did afterward (P = .061). K-levels improved in all responding patients. All 5 wheelchair-bound patients achieved and maintained ambulation. The Questionnaire for Persons with a Transfemoral Amputation and Short Form 36 did not significantly change. Conclusions THA + TFOI does not appear to pose an inevitable risk for prosthetic hip infection and may improve mobility and enhance quality of life (QOL) for transfemoral amputees with concurrent arthritic hip pain who are dissatisfied with their outcome following traditional socket prosthesis rehabilitation.
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Affiliation(s)
- Jason Shih Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, New York, NY, USA
| | - Amanullah Haidary
- Western Sydney University School of Medicine, Campbelltown, New South Wales, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Atiya Oomatia
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Munjed Al Muderis
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, 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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Li M, Zhang Y, Shao Z, Zhu H. Robotic-assisted total knee arthroplasty results in decreased incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty. J Orthop Surg (Hong Kong) 2024; 32:10225536241241122. [PMID: 38518261 DOI: 10.1177/10225536241241122] [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] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVE Periprosthetic fracture (PPF) is an uncommon but devastating complication after total knee arthroplasty (TKA). Anterior femoral notching (AFN) is one of a perioperative risk factor for PPF. The main purpose of this study was to compare between the rates of anterior femoral notching (AFN) and supracondylar periprosthetic femoral fracture (sPPF) of manual TKA and robotic arm-assisted TKA (RATKA). Meanwhile, blood loss, transfusion rates, inflammatory responses, complications, early clinical and radiological outcomes were also assessed. METHODS This retrospective study included 330 patients (133 RATKA and 197 manual TKA). Differences in risks of inflammatory, blood loss, complications (periprosthetic fracture and periprosthetic joint infection), pre-operative and post-operative distal lateral femoral angle (LDFA), distal femoral width (DFW), prosthesis-distal femoral width (PDFW) ratio, AFN, femoral component flexion angle (FCFA), peri-operative and post-operative functional outcomes between the RATKA and manual TKA groups were compared. RESULTS The operation time and postoperative CRP level in the RATKA group was significantly longer and higher than that in the manual TKA group (p < .001). However, there was no significant difference in postoperative WBC level (p = .217), hemoglobin loss (p = .362), postoperative drainage (p = .836), and periprosthetic fracture (p = 1.000). There was no significant difference in LDFA (p > .05), DFW(p = .834), PDFW ratio (p = .089) and FCFA (p = .315) between the two groups, but the rate of AFN in the RATKA group was significantly lower than that in the manual TKA group (p < .05). There was no significant difference in ROM between the two groups on POD3, POD 90 and 1 year (p < .05), but the FJS-12 score in the RATKA group was higher than that in the manual TKA group on 1 year (p = .001). CONCLUSION Robotic-assisted total knee arthroplasty can decrease the incidence of anterior femoral notching compared to posterior referenced instrumented total knee arthroplasty.
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Affiliation(s)
- MingYang Li
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - YongTao Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - ZhenShuai Shao
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - HaoXiang Zhu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Holzer LA, Borotschnig L, Holzer G. Evaluation of FRAX in patients with periprosthetic fractures following primary total hip and knee arthroplasty. Sci Rep 2023; 13:7145. [PMID: 37130875 PMCID: PMC10154289 DOI: 10.1038/s41598-023-34230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 04/26/2023] [Indexed: 05/04/2023] Open
Abstract
The fracture risk assessment tool (FRAX) is a tool which calculates an individual 10-year fracture risk based on epidemiological data in patients with a risk of osteporosis. The aim of this study was to evaluate the value of FRAX to estimate the risk of postoperative periprosthetic fractures (PPF) in patients following with total hip and knee arthroplasty. 167 patients (137 periprosthetic fractures in total hip arthroplasty and 30 periprosthetic fractures in total knee arthroplasty) were included in this study. Patients' data was retrieved retrospectively. In each patient the 10-year probability of a major osteoporotic fracture (MOF) and an osteoporotic hip fracture (HF) was calculated using FRAX. According to the NOGG guideline 57% of total hip arthroplasty (THA) patients and 43.3% of total knee arthroplasty (TKA) patients were in need of osteoporosis treatment, whereas only 8% and 7% received an adequate one respectively. 56% of the patients with PPF after THA and 57% of the patients with PPF after TKA reported about a previous fracture. Significant associations between the 10-year probability of a MOF and HF calculated by FRAX and PPF in THA and TKA were seen. The results of the present study show that FRAX might have the potential to estimate the PPF in patients following THA and TKA. FRAX should be calculated before and after THA or TKA in order to assess the risk and counsel patients. The data show a clear undertreatment of patients with PPF in respect to osteoporosis.
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedic Surgery, AUVA Trauma Center Klagenfurt, Waidmannsdorferstraße 35, 9020, Klagenfurt am Wörthersee, Austria.
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, Perth, Australia.
- Perth Orthopaedic and Sports Medicine Centre, Perth, Australia.
| | - Lisa Borotschnig
- Department of Orthopaedic Surgery, AUVA Trauma Center Klagenfurt, Waidmannsdorferstraße 35, 9020, Klagenfurt am Wörthersee, Austria
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Gerold Holzer
- Department of Orthopedics and Traumatology, Medical University of Vienna, Vienna, Austria
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Pornrattanamaneewong C, Sitthitheerarut A, Ruangsomboon P, Chareancholvanich K, Narkbunnam R. Risk factors of early periprosthetic femoral fracture after total knee arthroplasty. BMC Musculoskelet Disord 2021; 22:1009. [PMID: 34856975 PMCID: PMC8641153 DOI: 10.1186/s12891-021-04875-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Periprosthetic femoral fracture (PFF) is a serious complication after total knee arthroplasty (TKA). However, the risk factors of PFF in the early postoperative setting are not well documented. This study determines the risk factors of early PFF after primary TKA. Methods This study recruited 24 patients who had early PFF within postoperative 3 months and 96 control patients. Demographic data (age, gender, weight, height, body mass index, Deyo-Charlson comorbidity index, diagnosis, operated side, underlying diseases and history of steroid usage intraoperative outcomes), intraoperative outcomes (operative time, surgical approach, type and brand of the prosthesis), and radiographic outcomes (distal femoral width; DFW, prosthesis-distal femoral width ratio; PDFW ratio, anatomical lateral distal femoral angle; LDFA, the change of LDFA, femoral component flexion angle; FCFA and anterior femoral notching; AFN) were recorded and compared between groups. Details of PFF, including fracture pattern, preoperative deformity, and time to PFF were also documented. Results In univariate analysis, the PFF group had significantly older, right side injury, rheumatoid, dyslipidemia, Parkinson patients than the control group (p < 0.05). No cruciate-retaining design was used in PFF group (p = 0.004). Differences between the prosthetic brand used were found in this study (p = 0.049). For radiographic outcomes, PFF group had significantly lower DFW but higher PDFW ratio and postoperative LDFA than the control group (p < 0.05). While the change of LDFA, FCFA and AFN were similar between groups. The fracture patterns were medial condylar (45.8%), lateral condylar (25.0%) and supracondylar fracture (29.2%). The mean overall time to PFF was 37.2 ± 20.6 days (range 8–87 days). Preoperative deformity was significantly different among the three patterns (p < 0.05). When performed multivariate analysis using the logistic regression model, age was only an independent risk factor for early PFF. The cut-off point of age was > = 75 years, with a sensitivity of 75.0% and specificity of 78.1%. Conclusion This study determined that age was the independent risk factors for early PFF. However, further well-controlled studies with a larger sample size were needed to address this issue.
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Affiliation(s)
- Chaturong Pornrattanamaneewong
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | | | - Pakpoom Ruangsomboon
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Keerati Chareancholvanich
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Rapeepat Narkbunnam
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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6
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Allen MK, Parrish JM, Vakharia R, Kaplan JRM, Vulcano E, Roche MW, Aiyer AA. The Influence of Opioid Use Disorder on Open Reduction and Internal Fixation Following Ankle Fracture. Foot Ankle Spec 2021; 14:232-237. [PMID: 32270705 DOI: 10.1177/1938640020914715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ankle fractures are common and may require open reduction and internal fixation (ORIF). Literature is scarce evaluating the associations of opioid use disorder (OUD) with ORIF postoperative outcomes. This study investigates whether OUD patients have increased (1) costs of care, (2) emergency room visits, and (3) readmission rates. METHODS ORIF patients with a 90-day history of OUD were identified using an administrative claims database. OUD patients were matched (1:4) to controls by age, sex, and medical comorbidities. The Welch t-test determined the significance of cost of care. Logistic regression yielded odds ratios (ORs) for emergency room visits and 90-day readmission rates. RESULTS A total of 2183 patients underwent ORIF (n = 485 with OUD vs n = 1698 without OUD). OUD patients incurred significantly higher costs of care compared with controls ($5921.59 vs $5128.22, P < .0001). OUD patients had a higher incidence and odds of emergency room visits compared with controls (3.50% vs 0.64%; OR = 5.57, 95% CI = 2.59-11.97, P < .0001). The 90-day readmission rates were not significantly different between patients with and without OUD (8.65% vs 7.30%; OR = 1.20, 95% CI = 0.83-1.73, P = .320). CONCLUSION OUD patients have greater costs of care and odds of emergency room visits within 90 days following ORIF.Levels of Evidence: Level III: Retrospective cohort study.
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Affiliation(s)
- Megan K Allen
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - James M Parrish
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
| | - Rushabh Vakharia
- Holy Cross Hospital, Orthopedic Research Institute, Ft Lauderdale, Florida
| | | | | | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Ft Lauderdale, Florida
| | - Amiethab A Aiyer
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida
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Stamiris D, Gkekas NK, Asteriadis K, Stamiris S, Anagnostis P, Poultsides L, Sarris I, Potoupnis M, Kenanidis E, Tsiridis E. Anterior femoral notching ≥ 3 mm is associated with increased risk for supracondylar periprosthetic femoral fracture after total knee arthroplasty: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:383-393. [PMID: 33900452 DOI: 10.1007/s00590-021-02989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Anterior femoral notching (AFN) may be associated with a higher risk for supracondylar periprosthetic fracture (sPPF) after total knee arthroplasty (TKA), although studies have yielded inconclusive results. We aimed to systematically investigate and meta-analyze the best available evidence regarding the association between AFN and the risk of sPPF after TKA. METHODS A comprehensive search of PubMed, Scopus, Mendeley, Google Scholar and Cochrane databases was performed, from conception to February 29, 2020. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). I2-index was employed for heterogeneity. Newcastle-Ottawa scale was implemented for quality assessment of the included studies. RESULTS Nine studies fulfilled the eligibility criteria, including a total of 3264 patients subjected to TKA. Among them, there were 150 patients who sustained a sPPF. Overall, patients exposed to AFN (AFN group) demonstrated an increased risk for sPPF compared to those not exposed (control group) (OR 3.91, 95% CI 1.22-12.58, p = 0.02; I2 68.52%). Subgroup analysis based on AFN depth with a cut-off value of 3 mm further clarified this association. Patients with AFN ≥ 3mm were at higher risk for sPPF compared to patients with AFN < 3 mm and control group (OR 4.85, 95% CI 2.08-11.33, p = 0.00; I2 0.0%). On the contrary, fracture risk was not significant for patients with AFN < 3 mm compared to the control group (OR 5.0, 95% CI 0.44-56.82, p = 0.19; I2 42.99%). CONCLUSION Patients, exposed to AFN ≥ 3 mm in depth, are at higher risk for sustaining a sPPF.
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Affiliation(s)
- Dimitrios Stamiris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece. .,Department of Orthopedics, 424 General Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece. .,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Nifon K Gkekas
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Asteriadis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Stamiris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Department of Orthopedics, 424 General Military Hospital of Thessaloniki, 56429, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Anagnostis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.,Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lazaros Poultsides
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Sarris
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Potoupnis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road west 56403 Nea Efkarpia, Thessaloniki, Greece.,Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Redondo-Trasobares B, Torres-Campos A, Calvo-Tapies J, Gran-Ubeira N, Blanco-Rubio N, Albareda-Albareda J. Risk factors of periprosthetic femoral fracture after total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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9
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Risk factors of periprosthetic femoral fracture after total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:258-264. [PMID: 32381394 DOI: 10.1016/j.recot.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 02/19/2020] [Accepted: 03/01/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Periprosthetic fractures after primary knee arthroplasty has great importance in our environment due to the increase in their incidence and to the challenge they pose to the surgeon. Multiple factors have been associated with its production. The objective of the study was to identify the risk factors that could influence the appearance of these fractures, which of them are all modifiable and generate a probability prediction model based on these factors. MATERIAL AND METHODS Analytical, observational, retrospective, unpaired study of 38 cases of periprosthetic femoral knee fractures and 80 controls with knee prostheses. In total, 118 patients, 83 women and 35 men with a mean age of 72.49 years were included in the study. Sociodemographic data, medical history and drug consumption were collected, as well as those related to surgery. A univariate and bivariate analysis of the fracture determining factors was performed, using a logistic regression model to avoid confusion bias. RESULTS Of all the factors studied according to the logistic regression model, it was obtained that female sex (OR = 7.6), dementia (OR = 5), motor/parkinson's alteration (OR = 19.3) and femoral overcut Previous (OR = 8.6) were factors associated with the increased risk of this type of fractures. CONCLUSIONS This work allows us to conclude that there are risk factors such as female sex, dementia and parkinson's that increase the probability of periprosthetic fracture that are inherent to the patient and are not modifiable. However, there is any other totally modifiable that can be avoided by being demanding and thorough in the surgical technique, such as the anterior femoral overcut.
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10
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Does Femoral Notching During Total Knee Arthroplasty Influence Periprosthetic Fracture. A Prospective Study. J Arthroplasty 2019; 34:1244-1249. [PMID: 30904365 DOI: 10.1016/j.arth.2019.02.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/03/2019] [Accepted: 02/18/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Notching of the anterior femoral cortex during total knee arthroplasty (TKA) has been attributed to cause supracondylar fractures of the femur. Anatomic variations in the femur bone in different races make notching inevitable when standard designs of prostheses are used. The objective of this study is to determine the prevalence of notching when a PFC Sigma knee was used in an Indian population sample using the anterior referencing system and to assess the frequency of femoral shaft fractures in these cases. METHODS This is a single-center, prospective study. All patients undergoing TKA were recruited and followed up for a minimum of 2 years. All patients had a PFC Sigma knee (DePuy Synthes), and the anterior referencing system was used for implantation. The Knee Society Score was used for outcome scoring and the Gujarathi's schema for the grading of notching. Radiological outcomes were evaluated by an independent observer. Linear regression analysis assessed the effect of notching on range of motion and final score. RESULTS Of the 200 cases, 21% had varying degrees of notching. Grade I was seen in 13%, grade II in 6.5%, grade III in 1%, and grade IV in 0.5% in this series. There was no supracondylar fracture in 2 years. Notching had no bearing on the range of movement or outcome scores. CONCLUSION Although notching is best avoided, this study has shown no correlation between notching and supracondylar fracture of the femur following TKA. It does not appear to have any bearing on the range of movement or final outcome scores.
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Vakharia RM, Cohen-Levy WB, Vakharia AM, Donnally CJ, Law TY, Roche MW. Sleep Apnea Increases Ninety-Day Complications and Cost Following Primary Total Joint Arthroplasty. J Arthroplasty 2019; 34:959-964.e1. [PMID: 30814026 DOI: 10.1016/j.arth.2018.12.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sleep apnea (SA) negatively affects bone mineralization, cognition, and immunity. There is paucity in the literature regarding the impact of SA on total joint arthroplasty (TJA). The purpose of this study is to compare complications in patients with and without SA undergoing either total knee (TKA) or total hip arthroplasty (THA). METHODS A retrospective review from 2005 to 2014 was conducted using the Medicare Standard Analytical Files. Patients with and without SA on the day of the primary TJA were queried using the International Classification of Diseases, ninth revision codes. Patients were matched by age, gender, Charlson Comorbidity Index), and body mass index. Patients were followed for 2 years after their surgery. Ninety-day medical complications, complications related to implant, readmission rates, length of stay, and 1-year mortality were quantified and compared. Logistic regression was used to calculate odds ratios (OR) with their respective 95% confidence interval and P values. RESULTS After the random matching process there were 529,240 patients (female = 271,656, male = 252,106, unknown = 5478) with (TKA = 189,968, THA = 74,652) and without (TKA = 189,968, THA = 74,652) SA who underwent primary TJA between 2005 and 2014. Patients with SA had greater odds of developing medical complications following TKA (OR 3.71) or THA (OR 2.48). CONCLUSION The study illustrates an increased risk of developing postoperative complications in patients with SA following primary TJA. Surgeons should educate patients on these adverse effects and encourage the use of continuous positive airway pressure which has been shown to mitigate many postoperative complications.
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Affiliation(s)
| | - Wayne B Cohen-Levy
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL
| | | | - Chester J Donnally
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL
| | - Tsun Yee Law
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
| | - Martin W Roche
- Holy Cross Hospital, Orthopedic Research Institute, Fort Lauderdale, FL
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Vakharia RM, Sabeh KG, Vakharia AM, Damodar DM, Law TY, Roche MW. Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty. World J Orthop 2019; 10:137-144. [PMID: 30918797 PMCID: PMC6428996 DOI: 10.5312/wjo.v10.i3.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/13/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The influence of opioid use disorder on implant related complications, infection and readmission rates, and total global episode-of-care costs following primary total knee arthroplasty (TKA) is limited.
AIM To examine whether opioid abuse in patients undergoing primary TKA.
METHODS A retrospective analysis of the Medicare dataset, using the PearlDiver database, from 2005-2014 comparing outcomes in patients with opioid abusers (OUD) to non-opioid abusers (NOU) undergoing primary TKA was performed. Patient outcomes were analyzed including implant complications, readmission rates, and day-of-surgery and 90-d cost. Statistical analysis was performed with R (University of Auckland, New Zealand) calculating odds-ratio (OR) along with their respective 95% confidence interval (95%CI) and P-values.
RESULTS The OUD group was at greater odds of having implant related complications overall (20.84% vs 11.25%; OR: 2.07; 95%CI: 1.93-2.23; P < 0.001). Revision (OR: 2.07; 95%CI: 1.11-3.84; P < 0.001), infection (OR: 1.92; 95%CI: 1.72–2.18; P < 0.001), periprosthetic fractures (OR: 1.83; 95%CI: 1.16-4.79; P < 0.001), and 90-d readmission rates (OR: 1.47, 95%CI: 1.35-1.61, P < 0.001) were also significantly increased. OUD patients also incurred in higher day-of-surgery and total global 90-d episode-of-care costs compared to NOU.
CONCLUSION Patients with OUD show an increased risk of complications compared to the non-opioid users group. Appropriate recognition, pre-surgical optimization, and patient education are essential to mitigate these complications and improve patient outcome.
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Affiliation(s)
- Rushabh M Vakharia
- Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
| | - Karim G Sabeh
- Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Ajit M Vakharia
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Dhanur M Damodar
- Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL 33135, United States
| | - Tsun Yee Law
- Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
| | - Martin W Roche
- Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
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Lee SR, Shrestha K, Staggers J, Li P, Naranje SM, Shah A. Impact of time to surgery from injury on postoperative infection and deep vein thrombosis in periprosthetic knee fractures. Chin J Traumatol 2018; 21:329-332. [PMID: 30583982 PMCID: PMC6354129 DOI: 10.1016/j.cjtee.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/20/2018] [Accepted: 04/28/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Periprosthetic fracture (PPF) is a serious complication that occurs in 0.3%-2.5% of all total knee arthroplasties used to treat end-stage arthritis. To our knowledge, there are no studies in the literature that evaluate the association between time to surgery after PPF and early postoperative infections or deep vein thrombosis (DVT). This study tests our hypothesis that delayed time to surgery increases rates of postoperative infection and DVT after PPF surgery. METHODS Our study cohort included patients undergoing PPF surgery in the American College of Surgeons National Surgical Quality Improvement Program database (2006-2015). The patients were dichotomized based on time to surgery: group 1 with time ≤2 days and group 2 with time >2 days. A 2-by-2 contingency table and Fisher's exact test were used to evaluate the association between complications and time to surgery groups, and multivariate logistic regression was used to adjust for demographics and known risk factors. RESULTS A total of 263 patients (80% females) with a mean age of 73.9 ± 12.0 years were identified receiving PPF surgery, among which 216 patients were in group 1 and 47 patients in group 2. Complications in group 1 included 3 (1.4%) superficial infections (SI), 1 (0.5%) organ space infection (OSI), 1 (0.5%) wound dehiscence (WD), and 4 (1.9%) deep vein thrombosis (DVT); while complications in group 2 included 1 (2.1%) SI, 1 (2.1%) OSI, 1 (2.1%) DVT, and no WD. No significant difference was detected in postoperative complications between the two groups. However, patients in group 2 were more likely (p = 0.0013) to receive blood transfusions (57.5%) than those in group 1 (32.4%). CONCLUSION Our study indicates patients with delayed time to surgery have higher chance to receive blood transfusions, but no significant difference in postoperative complications (SI, OSI, WD, or DVT) between the two groups.
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Affiliation(s)
- Sung Ro Lee
- University of Alabama at Birmingham, 1313 13th Street South, Suite 226, Birmingham, AL, 35205, United States
| | - Kevin Shrestha
- University of Alabama at Birmingham, 1313 13th Street South, Suite 226, Birmingham, AL, 35205, United States
| | - Jackson Staggers
- University of Alabama at Birmingham, 1313 13th Street South, Suite 226, Birmingham, AL, 35205, United States
| | - Peng Li
- University of Alabama at Birmingham, 1313 13th Street South, Suite 226, Birmingham, AL, 35205, United States
| | - Sameer M Naranje
- University of Alabama at Birmingham, 1313 13th Street South, Suite 226, Birmingham, AL, 35205, United States.
| | - Ashish Shah
- University of Alabama at Birmingham, 1313 13th Street South, Suite 226, Birmingham, AL, 35205, United States
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Vakharia RM, Donnally CJ, Rush AJ, Vakharia AM, Berglund DD, Shah NV, Wang MY. Comparison of implant survivability in primary 1- to 2-level lumbar fusion amongst opioid abusers and non-opioid abusers. JOURNAL OF SPINE SURGERY 2018; 4:568-574. [PMID: 30547120 DOI: 10.21037/jss.2018.07.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Primary lumbar fusion (LF) is a treatment option for degenerative disc disease. The literature is limited regarding postoperative complications in opioid abusers undergoing LF. The purpose of this study was to compare 2-year short term implant-related complications, infection rates, 90-day readmission rates, in-hospital length of stay, and cost of care amongst opioid abusers (OAS) and non-opioid abusers (NAS) undergoing primary 1- to 2-level primary lumbar fusion (1-2LF). Methods A retrospective review was performed using the Medicare Standard Analytical Files from an administrative database. Patients undergoing LF were queried using the International Classification of Disease, ninth revision (ICD-9) procedure codes 81.04-81.08. Patients who underwent 1-2LF were filtered using ICD-9 procedure code 81.62. Inclusion criteria for the study group consisted of patients undergoing primary 1-2LF with a diagnosis of opioid abuse and dependency 90-day prior to the procedure. NAS undergoing 1-2LF served as controls. Patients in the study group were matched to controls according to age, gender, and Charlson-Comorbidity Index (CCI). Two mutually exclusive cohorts were formed and outcome measures analyzed and compared were implant complications, infection rates, 90-day readmission rates, LOS, and cost of care. Results After the matching process 13,342 patients were identified with equal cohort distribution. OAS had higher odds implant related complications (OR: 2.78, P<0.001) such as prosthetic joint dislocation (OR: 3.83, P<0.001), requiring revision (OR: 2.89, P<0.001), pseudarthrosis (OR: 2.50, P<0.001), and spine related infections (OR: 1.58, P<0.001) compared to NAS. OAS had higher 90-day readmission rates, (OR: 1.29, P<0.001), higher hospital costs ($143,057.38 vs. $121,450.45, P<0.001), and greater in-hospital LOS (P<0.001). Conclusions OAS are susceptible to complications following primary 1-2LF. Appropriate patient counseling regarding the effects of opioids on lumbar fusion should be given priority to maximize patient outcomes. Future studies should investigate the impact of pre-operative opioid abuse versus post-operative opioid use.
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Affiliation(s)
- Rushabh M Vakharia
- Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, FL, USA
| | - Chester J Donnally
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | - Augustus J Rush
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL, USA
| | | | - Derek D Berglund
- Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, FL, USA
| | - Neil V Shah
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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