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Poursalehian M, Zafarmandi S, Razzaghof M, Mortazavi SMJ. The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg 2024; 144:947-966. [PMID: 37831198 DOI: 10.1007/s00402-023-05087-3] [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: 05/18/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION The management of well-fixed femoral stems in revision total hip arthroplasty (rTHA) remains a subject of debate, with concerns over potential complications arising from stem retention. This study aimed to investigate the re-revision rates due to aseptic loosening of the stem, overall re-revision rates, dislocation rates, and factors influencing these outcomes in rTHA with a retained well-fixed femoral stem. MATERIALS AND METHODS A systematic search was conducted across several databases including PubMed, EMBASE, and CENTRAL to identify pertinent publications from their inception through 2023. We specifically focused on studies that reported outcomes of rTHA with retained well-fixed femoral stems. The study designs incorporated in our research encompassed both cohort studies and case series studies. Thirty-five studies involving isolated acetabular revision and retaining the stem were included, representing a total of 3497 patients. Data extraction was tailored to the study questions. Meta-analyses, meta-regression, and subgroup analyses were conducted to evaluate the outcomes and their relationship with various factors. Pooled results, meta-regression, and subgroup analyses were performed using random-effects models. To assess and reduce bias, we employed Egger's test and the trim and fill method. RESULTS The meta-analysis included 3497 patients with a mean follow-up of 9.28 years. The 10-year risk of re-revision after retaining femoral stem using highly cross-linked polyethylene was 1.7% (95% CI 1.1%-2.3%; I2: 60%) for stem aseptic loosening and 8.8% (95% CI 6.2%-11.4%; I2: 78%) overall re-revision. Dislocation risk was 5.7% (95% CI 4.1-7.0%; I2: 61%). Ceramic heads showed lower stem failure risk than metal heads in long-term follow-ups (P < 0.001). The posterolateral approach in revision surgery resulted in better long-term outcomes compared to the direct lateral approach (P < 0.001). Follow-up duration, timeline of study, Harris Hip Score, type of stem fixation, femoral head material, BMI, age, stem age, and surgical approach were evaluated as influential factors on these outcomes. CONCLUSION The re-revision rate due to aseptic loosening of the retained stem during rTHA was found to be significantly low, supporting the idea of retaining well-fixed stems during rTHA. The overall re-revision and dislocation rates also presented comparable or better outcomes to prior studies. A range of factors, including the use of highly cross-linked polyethylene and ceramic femoral heads, was found to influence these outcomes. LEVEL OF EVIDENCE IV. PROSPERO REGISTRATION NUMBER CRD42022351157.
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Affiliation(s)
- Mohammad Poursalehian
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Zafarmandi
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Razzaghof
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Orthopedic Surgery Department, Imam Khomeini Hospital Complex, End of Keshavarz Blvd, Tehran, 1419733141, Iran.
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran.
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Jianlu T, Feng L, Wentao C, Hammouda HIM, Ismailova MS, Shabanova ZA, Efendieva AS. [Total knee replacement in different age groups]. Khirurgiia (Mosk) 2024:45-50. [PMID: 38888018 DOI: 10.17116/hirurgia202406145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To evaluate the efficacy and quality of life in long-term period (1 year) after total knee replacement in various age groups. MATERIAL AND METHODS We studied 134 patients after unilateral primary total knee replacement. The KOOS and SF-36 questionnaires were used to assess the therapeutic effect (functionality and symptoms) and quality of life in patients with knee osteoarthritis. RESULTS At baseline, group I (young patients) had low KOOS pain scores (39.42±16.42), function scores (50.18±19.16) and QoL scores (18.2±15.9) compared to other age groups. A year after surgery, group I (<55 years) had significantly lower KOOS scores of pain, function and quality of life compared to group III (>65 years). Multiple regression analysis showed that age was a significant predictor of pain, but not a function after a year. CONCLUSION Total knee replacement gives a noticeable improvement in pain, functionality and quality of life in all age groups. However, there are significant age-related differences in preoperative assessment of pain, quality of life and mental health, as well as in final indicators of postoperative pain and quality of life. Indeed, young patients (<50 years) report more intense pain and worse quality of life. These data may be used in clinical practice to improve decision-making and patient expectations before total knee replacement.
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Affiliation(s)
- T Jianlu
- Volgograd State Medical University, Volgograd, Russia
| | - L Feng
- The Third People's Hospital of Xiao Shan Hangzhou, Hangzhou, China
| | - C Wentao
- Shunyi District Hospital, Beijing, China
| | | | - M S Ismailova
- Dagestan State Medical University, Makhachkala, Russia
| | - Z A Shabanova
- Dagestan State Medical University, Makhachkala, Russia
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Hampp E, Shi S, Scholl L, Taylor KB, Marchand KB, Kahan ME, Chen Z, Marchand RC, Mont MA. The Association of Patient and Procedural Factors on Improved Outcomes: A Cluster Analysis on 853 Total Knee Arthroplasty Patients. J Knee Surg 2023; 36:1386-1390. [PMID: 36564042 DOI: 10.1055/s-0042-1758773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many studies involving robotic-assisted total knee arthroplasty (RATKA) have demonstrated superiority regarding soft tissue balance and consistency with alignment target achievement. However, studies investigating whether RATKA is associated with improved patient outcomes regarding physical function and pain are also important. Therefore, we performed a cluster analysis and examined factors that contributed to differences in patient-reported outcome measures (PROMs). Specifically, we analyzed: (1) reduced WOMAC (rWOMAC) scores regarding pain and function; (2) usage of RATKA; (3) common patient comorbidities; as well as (4) patient demographic factors. The rWOMAC score is an abbreviated PROM that includes pain and physical function domains. This study analyzed 853 patients (95 conventional and 758 robotic-assisted) who had completed preoperative, 6-month, and 1-year postoperative rWOMAC surveys. Two clusters were constructed using rWOMAC pain and function scores at 1 year. Cluster 1 included 753 patients who had better outcomes at 1 year (mean rWOMAC pain = 0.9, mean rWOMAC function = 1.4), and cluster 2 included 100 patients who had worse outcomes at 1 year (mean rWOMAC pain = 7.7, mean rWOMAC function = 10.4). The clusters were compared to determine (1) how scores improved and (2) what patient characteristics were significantly different between clusters. Cluster 1 demonstrated greater improvement from preoperative to 6 months or 1 year (p = 0.0013 for pain preoperative to 6 months, p< 0.0001 for other measures) and 6 months to 1 year (p< 0.0001). Comparisons demonstrated that cluster 1 had older patients (67 vs. 65 years, p = 0.0479) who had lower body mass index or BMIs (31.8 vs. 33.9 kg/m2, p = 0.0042) and no significant differences in sex (p = 0.7849). Cluster 1 also had a significantly higher percentage of RATKA patients (90 vs. 79%, p< 0.001). Cluster analyses provided differentiating factors which were associated with improved postoperative rWOMAC pain and function scores at 1 year. Patients undergoing robotic-assisted TKA were associated with better rWOMAC pain and function scores from preoperative to 6 months and 1 year.
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Affiliation(s)
- Emily Hampp
- Division of Joint Replacement, Stryker, Mahwah, New Jersey
| | - Sarah Shi
- Division of Joint Replacement, Stryker, Mahwah, New Jersey
| | - Laura Scholl
- Division of Joint Replacement, Stryker, Mahwah, New Jersey
| | - Kelly B Taylor
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
| | - Kevin B Marchand
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
| | - Michael E Kahan
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Robert C Marchand
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Langenberger B, Steinbeck V, Schöner L, Busse R, Pross C, Kuklinski D. Exploring treatment effect heterogeneity of a PROMs alert intervention in knee and hip arthroplasty patients: A causal forest application. Comput Biol Med 2023; 163:107118. [PMID: 37392619 DOI: 10.1016/j.compbiomed.2023.107118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
Patient reported outcome measures (PROMs) experience an uptake in use for hip (HA) and knee arthroplasty (KA) patients. As they may be used for patient monitoring interventions, it remains unclear whether their use in HA/KA patients is effective, and which patient groups benefit the most. Nonetheless, knowledge about treatment effect heterogeneity is crucial for decision makers to target interventions towards specific subgroups that benefit to a greater extend. Therefore, we evaluate the treatment effect heterogeneity of a remote PROM monitoring intervention that includes ∼8000 HA/KA patients from a randomized controlled trial conducted in nine German hospitals. The study setting gave us the unique opportunity to apply a causal forest, a recently developed machine learning method, to explore treatment effect heterogeneity of the intervention. We found that among both HA and KA patients, the intervention was especially effective for patients that were female, >65 years of age, had a blood pressure disease, were not working, reported no backpain and were adherent. When transferring the study design into standard care, policy makers should make use of the knowledge obtained in this study and allocate the treatment towards subgroups for which the treatment is especially effective.
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Ayers DC, Yousef M, Yang W, Zheng H. Age-Related Differences in Pain, Function, and Quality of Life Following Primary Total Knee Arthroplasty: Results from a FORCE-TJR Cohort. J Arthroplasty 2023:S0883-5403(23)00350-9. [PMID: 37121490 DOI: 10.1016/j.arth.2023.04.005] [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: 11/28/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION The impact of age on patient outcomes after total knee arthroplasty (TKA) remains controversial. Age has shown no effect on outcome in some studies, while others have reported better or worse outcome in younger patients. The aims of this study were to determine the differences in pain, function, and quality of life reported one-year after TKA across different age groups. METHODS A prospective, multi-center cohort of 11,602 unilateral primary TKA patients was evaluated. Demographic data, comorbid conditions, and patient-reported outcome measures (PROMs) including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS JR, and Short-Form health survey (12-item) were collected pre- and at one-year postoperatively. Descriptive statistics were generated, stratified by age [< 55 years (younger adult), 55 to 64 years (older adult), 65 to 74 years (early elder), and ≥ 75 years (late elder)], and differences in pain, function, and quality of life among the four age groups were evaluated using Chi-square and Kruskal-Wallis tests. Multivariate regression models with 95% confidence interval (CI) were performed to determine if age was predictive for KOOS pain and function scores. RESULTS Prior to surgery, younger patients (< 55 years) reported worse KOOS pain (39), function (50), and quality of life (18) scores with poor mental health score (47) than other older patient groups. The mean pre-op score differences across the age groups in the KOOS total score (9.37), KOOS pain (11.61), KOOS-12 pain (10.14), and KOOS/KOOS-12 QoL (12.60) reached the calculated minimal clinically important difference (MCID). At one-year after TKA, younger patients (< 55 years) reported lower KOOS pain, function, and quality of life scores when compared to older patients (≥ 75 years). The differences in one-year postop scores among the 4 age groups (ranging from 4.0 to 12.2) reached the MCID for pain (10.4) and quality of life (12.2). Younger patients (< 55 years) achieved higher baseline to one-year pain (36.8 points), function (30.3 points), and quality of life (40.7 points) score changes when compared to older patients ≥ 75 years. Although statistically significant, the differences in score changes among the age groups were clinically irrelevant. The multivariate regression analyses showed that age was a significant predictor for pain, but not for function at one year where KOOS pain score was predicted to be higher (less pain) (β =6.17; 95% CI (4.12- 8.22) (P<0.001) in older patients (≥ 75 years) when compared to younger patients (< 55 years). CONCLUSION A TKA provides a dramatic improvement in pain, function, and quality of life in all age groups. However, there are age-related clinically significant differences in pre-operative pain, quality of life, and mental health and in final post-operative pain and quality of life scores with younger patients (< 55 years) reporting more pain, less quality of life, and worse pre-operative mental health. The PROM data presented here can be used clinically to improve shared decision making and patient expectations prior to TKA.
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Affiliation(s)
- David C Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Mohamed Yousef
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA; Department of Orthopaedic Surgery, Sohag University, Sohag, Egypt
| | - Wenyun Yang
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Hua Zheng
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Sinclair ST, Klika AK, Jin Y, Higuera CA, Piuzzi NS. The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA. J Bone Joint Surg Am 2022; 104:2016-2025. [PMID: 36047698 DOI: 10.2106/jbjs.21.01339] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies involving total knee arthroplasty (TKA) have focused on patient-related factors as drivers of outcomes. Although some studies have investigated surgeon and/or surgery-level factors (i.e., approach, volume), the measure of variance in postoperative outcomes across surgeons following TKA has not been determined. The aim of the current study was to evaluate the relationship between the surgeon and 1-year patient-reported outcome measures, the length of stay, the discharge disposition, and 90-day readmission after TKA, as well as the differences in these variables among surgeons. METHODS Data were prospectively collected for 5,429 patients who underwent TKA at a large health-care system with 36 surgeons between 2016 and 2018. Likelihood ratio tests were performed to investigate the relationship between surgeon and the 1-year Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain subscale, KOOS-Physical Function Shortform (KOOS-PS), KOOS for Joint Replacement (KOOS-JR), patient acceptable symptom state (PASS), length of stay, discharge disposition, and 90-day readmission. The minimal clinically important difference (MCID) was used to assess meaningful outcomes. Variable importance was determined by the Akaike information criterion (AIC) increase, using ordinal and binary-response mixed-effect models. RESULTS There was a significant association between surgeon and KOOS-Pain (p < 0.001), KOOS-PS (p = 0.001), KOOS-JR (p < 0.001), PASS (p = 0.024), length of stay (p < 0.001), discharge disposition (p < 0.001), and 90-day readmission (p < 0.001). When modeling 1-year KOOS-Pain (AIC increase, 15.6), KOOS-PS (AIC increase, 6.8), KOOS-JR (AIC increase, 13.5), PASS (AIC increase, 1.9), length of stay, and discharge disposition, the surgeon variable contributed more to the 1-year outcome than some patient-level factors (e.g., body mass index, Charlson Comorbidity Index). The difference between the highest and lowest median probabilities of attaining the same value for the KOOS-Pain (11.2%), KOOS-PS (9.4%), KOOS-JR (11.8%), PASS (5.9%), length of stay (46.6%), discharge disposition (22.8%), and readmission (13.1%) indicated surgeon-level variability. CONCLUSIONS Surgeon-related factors may be stronger contributors to the 1-year patient-reported outcome measures and length of stay than patient characteristics emphasized in the literature. Current findings have suggested variability in patient-reported outcome measures, length of stay, discharge location, and 90-day readmission among surgeons. Surgeon variability should be considered when model-fitting in the setting of TKA. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- SaTia T Sinclair
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.,Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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Lee SS, Seo MK, Kim IS, Moon YW. Comparison of Survival Rate and Outcomes Between Conventional and Navigation-Assisted Primary Total Knee Arthroplasty in Severe Varus Knees: A Minimum 10-Year Follow-Up. J Arthroplasty 2022; 37:2164-2170. [PMID: 35618215 DOI: 10.1016/j.arth.2022.05.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to compare the long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA in patients with preoperative severe varus deformity. METHODS From January 2005 to December 2011, 152 TKAs and 62 TKAs with preoperative hip-knee-ankle (HKA) angles more than 15° were enrolled in the CON-TKA and NAV-TKA group with 135.7 months follow-up. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (HKA, α, β, γ, and δ angles), and survivorship were compared between the groups. RESULTS The mean value of radiographic outcomes was not statistically different; however, outliers of the HKA angle were significantly higher in the CON-TKA group (18.4% versus 8.1%, P = .04). However, long-term clinical outcomes were similar between both groups. The cumulative survival rate was 96.1% in the CON-TKA group and 96.8% in the NAV-TKA group, with no difference between the groups (P = .962). CONCLUSION NAV-TKA showed fewer outliers in the HKA angle for severe preoperative varus deformity compared with CON-TKA. The long-term clinical outcomes and survival rates were similar between the 2 techniques. A survival rate of more than 96% was observed in both groups. STUDY DESIGN Level III, retrospective comparative study.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, South Korea
| | - Min Kyu Seo
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Il Su Kim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Clement ND, Smith KM, Baron YJ, McColm H, Deehan DJ, Holland J. Increasing age does not influence hip-specific functional outcome or health-related quality of life following total hip arthroplasty. Bone Jt Open 2022; 3:692-700. [DOI: 10.1302/2633-1462.39.bjo-2022-0085.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of our study was to assess the influence of age on hip-specific outcome following total hip arthroplasty (THA). Secondary aims were to assess health-related quality of life (HRQoL) and level of activity according to age. Methods A prospective cohort study was conducted. All patients were fitted with an Exeter stem with a 32 mm head on highly cross-linked polyethylene (X3RimFit) cemented acetabulum. Patients were recruited into three age groups: < 65 years, 65 to 74 years, and ≥ 75 years, and assessed preoperatively and at three, 12, 24, and 60 months postoperatively. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and Hip disability and Osteoarthritis Outcome Score (HOOS), were used to assess hip-specific outcome. EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 36-Item Short Form Survey (SF-36) scores were used to assess HRQoL. The Lower Extremity Activity Scale (LEAS) and Timed Up and Go (TUG) were used to assess level of activity. Results There were no significant (p > 0.05) differences in the WOMAC scores, HSS, HOOS, or EQ-5D-5L at any postoperative timepoint between the age groups. Patients aged ≥ 75 years had significantly lower physical function (p ≤ 0.010) and physical role (p ≤ 0.047) SF-36 scores at 12, 24, and 60 months, but were equal to that expect of an age-matched population. No differences according to age were observed for the other six domains of the SF-36 (p > 0.060). The ≥ 75 years group had a lower LEAS (p < 0.001) and longer TUG test times (p ≤ 0.032) compared to the < 65 years group, but older age groups had significant (p < 0.001) improvement relative to their preoperative baseline measures. Conclusion Age did not influence postoperative hip-specific outcome or HRQoL (according to the EQ-5D) following THA. Despite a significant improvement, older patients had lower postoperative activity levels compared to younger patients, but this may be reflective of the overall physical effect of ageing. Cite this article: Bone Jt Open 2022;3(9):692–700.
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Affiliation(s)
- Nick D. Clement
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Karen M. Smith
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - Y. J. Baron
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - Heidi McColm
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - David J. Deehan
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
| | - James Holland
- Department of Orthopaedics, The Freeman Hospital, Newcastle, UK
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Kurapatti M, Patel V, Arraut J, Oakley C, Rozell JC, Schwarzkopf R. Primary total hip arthroplasty in patients older than 90 years of age - a retrospective matched cohort study. Hip Int 2022:11207000221082251. [PMID: 35259975 DOI: 10.1177/11207000221082251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Advanced age is considered a major risk factor for postoperative complications in total hip arthroplasty (THA). Consequently, older patients undergoing THA may require more detailed pre-procedural examinations and more healthcare resources postoperatively than younger patients. The purpose of this study was to compare discharge parameters and complication rates of THA in patients ⩾90 years old to those <90 years old. METHODS A retrospective review of 14,824 THA patients from 2011 to 2021 at a high-volume, urban academic centre was conducted. Patients ⩾90 years old were propensity-matched to a control group of patients aged <90 years old. Patient demographics, surgical time, hospital length of stay (LOS), discharge disposition, and 90-day revision, readmission, and mortality rates were collected. Demographic differences and outcomes were assessed using chi-square and independent sample t-tests. RESULTS After propensity matching, the average age in the younger cohort (YC, n = 54) was 75.81 ± 7.89, and 91.61 ± 1.73 for the older cohort (OC, n = 54). The OC had a longer LOS than the YC (mean 3.90 vs. 3.06 days; p = 0.031). Discharge disposition significantly differed (p = 0.007); older patients were more likely to be discharged to skilled nursing facilities (33.3% vs. 14.8%) or acute rehabilitation centres (14.8% vs. 3.7%) and less likely to be discharged to prior place of residence (home self-managed/home with services, 51.9% vs. 79.6%). There was no significant difference in surgical time (93.87 ± 29.75 vs. 96.09 ± 26.31 min; p = 0.682), 90-day revision rate (3.7% vs. 0%; p = 0.153), 90-day readmission rate (9.4% vs. 3.7%; p = 0.543), and 90-day mortality rate (1.9% vs. 1.9%; p = 1.000). CONCLUSIONS Although THA patients over 90 years of age had a longer LOS and differing discharge disposition, these patients had similar complications compared to their younger counterparts. Thus, our study supports similar efficacy of THA in patients 90 years and older relative to younger THA candidates.
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Affiliation(s)
| | | | - Jerry Arraut
- NYU Langone Orthopedic Center, New York, NY, USA
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Prentice HA, Chan PH, Royse KE, Hinman AD, Reddy NC, Paxton EW. Revision Risk in a Cohort of US Patients Younger Than 55 Undergoing Primary Elective Total Hip Arthroplasty. J Arthroplasty 2022; 37:303-311. [PMID: 34718107 DOI: 10.1016/j.arth.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/11/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND As indications for elective total hip arthroplasty (THA) expand to younger patients, we sought to (1) compare revision risk following primary elective THA in patients <55 years at the time of their THA to patients aged ≥65 years and (2) identify specific risk factors for revision in patients <55 years. METHODS A Kaiser Permanente's total joint replacement registry was used to conduct a cohort study including primary elective THA patients aged ≥18 (2001-2018). In total, 11,671 patients <55 years and 53,106 patients ≥65 years were included. Multiple Cox regression was used to evaluate cause-specific revision risk, including septic revision, aseptic loosening, instability, and periprosthetic fracture. Stepwise Cox regression was used to identify patient and surgical factors associated with cause-specific revision in patients <55 years. RESULTS Patients <55 years had a higher risk of septic revision (hazard ratio [HR] = 1.30, 95% confidence interval [CI] = 1.02-1.66), aseptic loosening (HR = 2.60, 95% CI = 1.99-3.40), and instability (HR = 1.35, 95% CI = 1.09-1.68), but a lower risk of revision for periprosthetic fracture (HR = 0.36, 95% CI = 0.22-0.59) compared to patients aged ≥65 years. In the <55 age group, risk factors for septic revision included higher body mass index, drug abuse, and liver disease. Hypertension, anterior approach, and ceramic-on-ceramic were associated with aseptic loosening. White race, American Society of Anesthesiologists classification ≥3, smoker, paralysis, posterior approach, ceramic-on-ceramic, and smaller head diameter were associated with instability. CONCLUSION Identified risk factors varied depending on the cause for revision. Although septic revisions were related to patient characteristics, more modifiable factors, such as implant or surgical approach, were associated with revision due to aseptic loosening and instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | - Kathryn E Royse
- Surgical Outcomes & Analysis, Kaiser Permanente, San Diego, CA
| | - Adrian D Hinman
- Department of Orthopaedics, The Permanente Medical Group, San Leandro, CA
| | - Nithin C Reddy
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA
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11
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Gazendam AM, Patel M, Ekhtiari S, Bali K, Wood TJ. Are Functional Outcomes of a Total Hip Arthroplasty Predictive of a Contralateral Total Hip Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2022; 37:298-302. [PMID: 34627955 DOI: 10.1016/j.arth.2021.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Current literature suggests that 8%-35% of patients undergoing total hip arthroplasty (THA) undergo a subsequent contralateral THA. This study aims to determine if functional outcomes after primary THA predict outcomes in the subsequent primary THA of the contralateral side. METHODS A retrospective cohort of patients undergoing staged bilateral primary THA was reviewed. The Oxford Hip Score (OHS) was utilized as the functional outcome measurement tool and was assessed preoperatively and at one year postoperatively. The minimal clinically important difference (MCID) was assessed. Based on the first-side THA one-year outcomes, the odds of maintaining an MCID, or not, for the second-side THA were determined. RESULTS The study cohort consisted of 551 patients and 1102 primary THAs. The average postoperative OHSs were similar after the first and second THA. Patients achieving the MCID with the first-side surgery were 2.6 times (95% confidence interval 1.0 to 6.64, P = .04) more likely to achieve the MCID for the second-side surgery than patients failing to reach the MCID for their first-side surgery. After the first THA, 29 (5.3%) patients failed to reach the predefined MCID for the OHS compared with 54 (9.8%) patients undergoing their second THA (odds ratio: 1.96 [95% confidence interval: 1.23 to 3.1], χ2 = 8.14, P = .005). CONCLUSIONS Functional outcomes after the first THA are predictive of functional outcomes of the second THA. Patients are more likely to achieve a clinically significant improvement after their first THA related to higher preoperative OHSs before the second THA.
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Affiliation(s)
- Aaron M Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mansi Patel
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kamal Bali
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Thomas J Wood
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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12
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Schatz C, Klein N, Marx A, Buschner P. Preoperative predictors of health-related quality of life changes (EQ-5D and EQ VAS) after total hip and knee replacement: a systematic review. BMC Musculoskelet Disord 2022; 23:58. [PMID: 35039045 PMCID: PMC8764845 DOI: 10.1186/s12891-021-04981-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcomes are of ever-increasing importance in medical decision-making. The EQ-5D is one of the generic instruments measuring health-related quality of life (HRQoL) in arthroplasty. This review aimed to identify possible predictors of HRQoL changes for patients undergoing total knee replacements (TKR) or total hip replacements (THR). METHODS A systematic literature review according to the PRISMA guidelines was conducted, searching several databases. Preoperative to postoperative HRQoL changes were evaluated in patients undergoing THR or TKR, using the EQ-5D visual analog scale (VAS) or the preference-based EQ-5D Index were evaluated. Articles were considered with prospectively or retrospectively collected data, as well as registry data, each with statistical analyses of patient-related factors. RESULTS Eight hundred eighty-two articles were found, of which 21 studies met the inclusion criteria. Predictors were distinguished in alterable and non-alterable ones. The EQ-5D Index indicated a tendency towards beneficial improvements for patients with a high body mass index (BMI) (> 40) and no significant results for the VAS. Additionally, one study found that patient education and preoperative physiotherapy appeared to enhance HRQoL. Some evidence indicated that male gender was negatively associated with changes in the VAS and the EQ-5D Index, but one study reported the opposite. Changes in VAS and EQ-5D Index were lower for older patients, whereas a higher educational level seemed to be advantageous. A high Charnley class led to deteriorating changes in VAS, although a high Kellgren Lawrence classification was positively associated with the EQ-5D Index, in a limited number of studies. For all results, clinical relevance was calculated differently and mainly reported as uncertain or small. CONCLUSIONS The literature on this topic was weak and offers only limited guidance. Results for alterable predictors, such as the BMI, indicated valuable improvements for highly obese patients. Further, high-quality research is required to support medical decision-making. LEVEL OF EVIDENCE Level IV, according to the OCEBM Levels of Evidence Working Group.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany.
| | - Nina Klein
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Antonia Marx
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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13
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Fang Y, Shang X. Comparison of Ceramic-on-Ceramic vs. Ceramic-on-Polyethylene for Primary Total Hip Arthroplasty: A Meta-Analysis of 15 Randomized Trials. Front Surg 2021; 8:751121. [PMID: 34977138 PMCID: PMC8716688 DOI: 10.3389/fsurg.2021.751121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: This meta-analysis aimed to compare ceramic-on-ceramic (COC) components and ceramic-on-polyethylene (COP) components during total hip arthroplasty (THA). Settings: A meta-analysis of randomized controlled trials (RCTs) comparing COC and COP during primary THA was conducted. Electronic searches were current to March 2021. Participants: Trials were included for meta-analysis if they compared at least the bearing surfaces of COC and COP for patients undergoing primary THA and if they reported the outcomes of THA after a certain period of follow-up and only RCTs in English were included. Primary and Secondary Outcome Measures: The primary endpoints consist of audible noise, prosthesis fracture, and revision. Secondary endpoints include dislocation, deep infection, osteolysis, and prosthesis loosening. Extracted data were statistically analyzed with the Stata11.0. Results: A total of 15 RCTs containing 2,702 patients (2,813 hips) were included in this study. The audible noise [odds ratio (OR) = 5.919; 95% CI: 2.043, 17.146; p ≤ 0.001] and prosthesis fracture (OR = 35.768; 95% CI: 8.957, 142.836; p = 0.001) were significantly higher in the COC group. Hip function, revision rate, dislocation rate, deep infection rate, osteolysis rate, and prosthesis loosening rate were comparable between these two groups, while the wear rate was higher in the COP group. Conclusion: This study indicated comparable outcomes of COC and COP bearing surfaces in primary THA; high-quality RCTs with a long-term follow-up are still urgently needed to provide more evidence on the optimal bearing surfaces in primary THA.
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Affiliation(s)
- Yan Fang
- Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobin Shang
- Department of Orthopaedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wagner M, Schönthaler H, Endstrasser F, Neururer S, Leitner H, Brunner A. Survivorship of Ceramic-on-Ceramic Total Hip Arthroplasty With Metal-Backed Acetabular Liners at 10 Years. J Arthroplasty 2021; 36:3507-3512. [PMID: 34176691 DOI: 10.1016/j.arth.2021.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/22/2021] [Accepted: 05/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Ceramic-on-ceramic bearings are becoming increasingly popular in primary total hip arthroplasty (THA). To enhance ceramic-on-ceramic liner exchange in case of revision surgery, metal-backed liner systems have been proposed. Little is known about the clinical performance of these implants. The purpose of this study is to evaluate a metal-backed liner implant system for primary THA. METHODS A total of 422 patients (with 468 consecutive THAs) were followed over a mean period of 10 years. All arthroplasties were performed with a cementless stem, a press-fit cup, and a metal-backed liner system. Surgical and clinical data, complications, and revisions were analyzed. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before surgery and at 1 and 10 years after surgery were compared. RESULTS The overall 10-year implant survival rate was 93.8%. The survival rate was 97.0% for heads and liners, 97.5% for stem, and 99.3% for acetabular cup. The most common reason for revision was ceramic breakage (2.4%) of the third-generation (BIOLOX forte) acetabular liner. Mean WOMAC score improved significantly from 50.1 before surgery to 13.2 at 1 year after surgery. There was no difference in WOMAC scores between surgical approach and type of bearing at 1 and 10 years after surgery. CONCLUSION THA using cementless stem, press-fit cup, and metal-backed liner system provides satisfactory long-term outcomes, with revision rate comparable to that with other systems available in the market. The metal-backed liner system has low risk of mal-seating. Third-generation ceramic liners should be avoided as they seem to be more prone to breakage.
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Affiliation(s)
- Moritz Wagner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Hannes Schönthaler
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Franz Endstrasser
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
| | - Sabrina Neururer
- Department of Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria
| | - Hermann Leitner
- Department of Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Tyrol, Austria
| | - Alexander Brunner
- Department of Orthopaedics and Traumatology, Bezirkskrankenhaus St. Johann in Tirol, St. Johann in Tirol, Tyrol, Austria
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Marques CJ, Bohlen K, Lampe F. Participation in a Preoperative Patient Education Session Is a Significant Predictor of Better WOMAC Total Index Score and Higher EQ-5D-5L Health Status Index 1 Year After Total Knee and Hip Arthroplasties: A Retrospective Observational Study. Am J Phys Med Rehabil 2021; 100:972-977. [PMID: 33443861 DOI: 10.1097/phm.0000000000001689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate whether patient-specific factors, preoperative patient-reported outcome measures, and participation in a preoperative patient education session significantly predict 1-yr Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) health status index of patients who underwent total hip or knee arthroplasties within an enhanced rehabilitation program. DESIGN This is a retrospective observational cohort study. The inclusion criteria were met by 676 (373 total hip arthroplasties and 303 total knee arthroplasties) patients. Two multiple regression models were carried out to estimate the contributions of nine potential predictors. RESULTS Younger age (P = 0.006), higher preoperative EQ-5D-5L index (P = 0.004), lower patient clinical complexity level (P = 0.001), lower preoperative WOMAC total score (P < 0.001), preoperative patient education session (P = 0.004), and submitting for total hip arthroplasty (P < 0.001) were significant predictors of better 1-yr WOMAC total score. Higher preoperative EQ-5D-5L index (P < 0.001), lower patient clinical complexity level classification (P < 0.001), lower preoperative WOMAC total score (P = 0.009), preoperative patient education session (P = 0.04), and submitting for total hip arthroplasty (P = 0.01) were significant predictors of higher 1-yr EQ-5D-5L health status index. CONCLUSIONS Better baseline patient-reported outcome measure scores, less comorbidities, younger age, submitting for total hip arthroplasty, and attending a preoperative patient education session were significant predictors of better WOMAC total scores and higher EQ-5D-5L health status index 1 yr after total hip or total knee arthroplasties.
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Affiliation(s)
- Carlos J Marques
- From the Science Office of the Orthopaedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Hamburg, Germany (CJM); Orthopaedic and Joint Replacement Department, Schoen Clinic Hamburg Eilbek, Academic Hospital of the University of Hamburg, Hamburg, Germany (KB, FL); and Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany (FL)
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Götz JS, Benditz A, Reinhard J, Schindler M, Zeman F, Grifka J, Greimel F, Leiss F. Influence of Anxiety/Depression, Age, Gender and ASA on 1-Year Follow-Up Outcomes Following Total Hip and Knee Arthroplasty in 5447 Patients. J Clin Med 2021; 10:jcm10143095. [PMID: 34300261 PMCID: PMC8305027 DOI: 10.3390/jcm10143095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: There are many factors influencing the outcome after total joint arthroplasty (TJA). In particular, patient-related factors such as age, gender, ASA (American Society of Anesthesiologists), or preoperative anxiety/depression have become increasingly important. The aim of this study was to examine the association of these parameters with 1-year postoperative outcomes after total knee and total hip arthroplasty (TKA, THA). Methods: A retrospective cohort of 5447 TJA patients was evaluated by pre- and postoperative analysis of EQ-5D, EQ-VAS and WOMAC Score. Furthermore, major focus was put on the association between age, gender, ASA, preoperative anxiety/depression and outcome parameters. Results: 53.3% (2903/5447) of all patients were identified with anxiety/depression at time of surgery. In the analysis, patients without anxiety/depression showed statistically significantly (p < 0.05) better EQ-5D, EQ-VAS and WOMAC scores. In addition, patients with ASA 2 or 3 and age over 70 years showed statistically significantly (p < 0.01) worse EQ-5D and WOMAC scores. Gender did not influence the postoperative EQ-5D and WOMAC results, but men had significantly better EQ-VAS scores than women in this study. Conclusion: Preoperative anxiety/depression symptoms show worse clinical outcomes 1 year postoperatively after TJA. Other outcome-influencing factors are higher age and ASA 2 or 3. In the future, such patients should be identified, and as far as applicable, a treatment of anxiety/depression or comorbidities should be implemented preoperatively of the surgical procedure to improve clinical outcomes.
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Affiliation(s)
- Julia Sabrina Götz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Achim Benditz
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Jan Reinhard
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Melanie Schindler
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
| | - Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
- Correspondence:
| | - Franziska Leiss
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077 Bad Abbach, Germany; (J.S.G.); (A.B.); (J.R.); (M.S.); (J.G.); (F.L.)
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17
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Mahure SA, Teo GM, Long WJ. Differences in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores for a Single Surgeon Comparing Two Institutions: An Unfair Reimbursement Metric. J Arthroplasty 2021; 36:403-411. [PMID: 33039193 DOI: 10.1016/j.arth.2020.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Emphasis on value-based purchasing links physician financial remuneration to patient-derived outcome scores. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys aim to provide a uniform comparison tool. Of the 22 different survey questions, only 3 (13.6%) focus on experience related to doctors. We sought to determine how HCAHPS scores differ for a single surgeon performing more than 500 total joint arthroplasties annually, divided almost equally between two centers. METHODS HCAHPS data from 2015 to 2018 for a single, fellowship-trained arthroplasty surgeon were collected from two different hospitals. More than 200 cases were performed at each center with the same staff. One center is a large metropolitan academic-teaching hospital, and the other is a suburban private hospital. The purpose of the study was to determine if differences existed regarding HCHAPS scores between the two institutions. RESULTS A significant difference was found between institutions regarding questions pertaining to "hospital environment," "admission process," and "hospital staff concern for pain," with more patients responding favorably in Institution Two than Institution One. CONCLUSION Patient perceptions and ratings of overall experience differ significantly between hospitals even when surgery is performed by a single surgeon. These results lend credence to the fact that surgeons should not be unduly penalized for the hospital in which they operate, and financial remuneration involving HCAHPS scores must be approached with caution. This unfair system could potentially drive surgeons to perform the majority of their cases in the hospital system with higher scores in the nonphysician related domains as this would affect overall patient satisfaction, and thus, financial compensation.
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Affiliation(s)
- Siddharth A Mahure
- University Langone Orthopaedic HospitalDepartment of Orthopaedic Surgery, New York, NY; Department of Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, NY
| | - Greg M Teo
- Insall Scott Kelly Institute, New York, NY
| | - William J Long
- Department of Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, NY; Insall Scott Kelly Institute, New York, NY
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Cai D, Yan H, Liu J, Chen S, Jiang L, Wang X, Qin J. Ergosterol limits osteoarthritis development and progression through activation of Nrf2 signaling. Exp Ther Med 2021; 21:194. [PMID: 33488803 PMCID: PMC7812583 DOI: 10.3892/etm.2021.9627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/04/2020] [Indexed: 11/06/2022] Open
Abstract
Osteoarthritis (OA) is a common joint disorder characterized by progressive articular cartilage degeneration and destruction and results in gradual disability among middle-aged and elderly patients. Our previous study demonstrated that depletion of nuclear factor erythroid 2-related factor 2 (Nrf2) exacerbated cartilage erosion in an OA model and that activation of the Nrf2 pathway could counter this process. As a downstream target of Nrf2, heme oxygenase (HO) degrades heme to free iron, biliverdin and carbon monoxide (CO), which protects against oxidative stress. Ergosterol (ER), which is extracted from fungi, is a newly discovered Nrf2 activator and displayed efficacy against myocardial injury. The present study aimed to investigate the potential protective effects of ER against cartilage damage during OA. Primary mouse chondrocytes were treated with ER for in vitro assays. Furthermore, mice that underwent destabilization of the medial meniscus surgery were orally administered with ER. Western blotting suggested that ER increased protein expression of Nrf2 and HO-1 in primary chondrocytes and articular cartilage from knee joints. Cartilage damage in knee joints was significantly reduced by ER treatment. Western blotting and PCR analysis confirmed that ER could also suppress the expression of MMP-9 and MMP-13 in vivo and in vitro. The present findings suggested that ER effectively alleviated cartilage degradation and that activation of the Nrf2-heme oxygenase 1 pathway may play a role in ER-mediated cartilage protection against OA.
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Affiliation(s)
- Dawei Cai
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Huyong Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Nanhua University, Hengyang, Hunan 421000, P.R. China
| | - Jun Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Sichun Chen
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Longhai Jiang
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
| | - Xiaoxu Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Nanhua University, Hengyang, Hunan 421000, P.R. China
| | - Jian Qin
- Department of Orthopaedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing, Jiangsu 211100, P.R. China
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Min L, Chen C, Yan Y, Jiang S, Linyi Y, Xiaoxuan B, Liwei Z, Dongmei C. Comparison of Combined Lumbosacral Plexus and T12 Paravertebral Nerve Blocks With General Anesthesia in Older Adults Undergoing Primary Total Hip Arthroplasty: A Retrospective, Propensity Score-Matched Cohort Study. Geriatr Orthop Surg Rehabil 2020; 11:2151459320976531. [PMID: 33282449 PMCID: PMC7691895 DOI: 10.1177/2151459320976531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Total Hip Arthroplasty(THA) is a surgical treatment for hip disease. A large
amount of evidence has been reported on comparing outcomes of
neuraxial(spinal or epidural) anesthesia and general anesthesia. However, it
is unclear whether nerve blocks(NB) as main anesthesia technique compared
with general anesthesia(GA) for THA could reduce perioperative
complications. We conducted a retrospective evaluation of NB and GA, using a
propensity score-matched analysis(PSMA). Methods: A total of 902 patients older than 60 years old with hip disease undergoing
primary THA received combined lumbosacral plexus and T12
paravertebral nerve blocks (n = 143) or GA (n = 759) at our institution from
2012 to 2018.Binary logistic regression was used for comparison of the
primary outcomes(the incidence of delirium) and the secondary outcomes(the
percentage of postoperative hemoglobin(>10g/dl), transfusion(>2
units), major cardiac events(MACE), postoperative pulmonary complications
(PPC) and 30-day mortality) in the matched cohorts.Statistical analysis was
performed using SPSS v 23.0. Results: Both cohorts were balanced in all included parameters after PSMA. The
incidence of delirium was lower (OR 0.233,95% CI 0.064-0.845, p = 0.030) in
NB group in matched cohorts. In the unmatched and matched cohorts, the
percentage of Hb(>10g/dl) was higher in GA group but the incidence of
transfusion(>2 units) was higher in NB group. No difference was found in
the incidence of 30-day mortality in the unmatched and matched cohorts. In
the unmatched cohorts, the incidence of PPC was higher and LOS was longer in
NB cohort, but no difference was observed in the matched cohorts. Conclusion: In patients older than 60 years old receiving primary THA, NB could be
associated with a lower incidence of delirium.
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Affiliation(s)
- Li Min
- Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Chen Chen
- Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Yuan Yan
- Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Shen Jiang
- Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Yang Linyi
- Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Bu Xiaoxuan
- Department of Anesthesiology, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Zhang Liwei
- Department of Infection Control Management, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
| | - Cao Dongmei
- Hospital Medical Records Statistics Office, The Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, People's Republic of China
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Maney AJ, Frampton CM, Young SW. Age and Prosthetic Design as Risk Factors for Secondary Patella Resurfacing. J Arthroplasty 2020; 35:1563-1568. [PMID: 32037214 DOI: 10.1016/j.arth.2020.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/19/2019] [Accepted: 01/09/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Selectively resurfacing the patella based on a patient's risk of secondary patella resurfacing (SPR) may be the optimal strategy for primary total knee arthroplasty (TKA). However, exactly which factors increase the risk of SPR is unknown. Utilizing New Zealand Joint Registry data, we investigated the following: (1) What patient and surgical factors are more prevalent among TKA patients who received SPR compared to those who did not? and (2) What is the difference in Oxford Knee Scores (OKS) between those who receive SPR and those who do not? METHODS Prevalence of various patient and surgical factors was compared between 197 non-resurfaced TKAs that proceeded to SPR and 31,399 that did not. Multivariate analysis was used to determine the odds ratio for each factor that differed between groups. Six-month postoperative OKS for each group was utilized for comparison. RESULTS Posterior-stabilized designs had an odds ratio of 1.86 (95% confidence interval [CI] 1.31-2.66; P = .001) when compared to cruciate-retaining designs. When compared to age less than 55, age >75 and age 65-74 had odds ratios of 0.27 (95% CI 0.16-0.46; P < .001) and 0.44 (95% CI 0.28-0.69; P < .001) respectively. Six-month OKS was lower among those who received SPR (37.27 vs 27.26; P < .001). CONCLUSION Younger age, posterior-stabilized design, and a low 6-month OKS were associated with SPR.
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Affiliation(s)
- Alistair J Maney
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Simon W Young
- Department of Orthopaedic Surgery, North Shore Hospital, Auckland, New Zealand
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