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Axenhus M, Magnéli M. The COVID-19 pandemic caused gender-specific declines in knee surgery rates in Sweden from 2020 to 2021. J Exp Orthop 2024; 11:e70030. [PMID: 39364300 PMCID: PMC11447367 DOI: 10.1002/jeo2.70030] [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: 06/03/2024] [Revised: 07/05/2024] [Accepted: 07/24/2024] [Indexed: 10/05/2024] Open
Abstract
Purpose Changes in knee surgery incidence are important factors for stakeholders and healthcare providers. The aim of this study was to examine trends and patterns in knee surgeries in Sweden from 2010 to 2022. The study focuses on gender-specific and overall rates of knee surgeries. Methods The analysis is based on a data set sourced from national healthcare records. The data was stratified based on surgical rates and categorized by gender, year and the specific knee arthroplasty technique used. We tracked year-to-year changes in surgical rates to identify overarching patterns. We used Poisson regression to predict future trends. Comparisons were made between various surgical subcategories, such as those with and without cement in knee arthroplasty surgeries. Results In 2010, the rate of knee surgeries per 100,000 person-years was 518.7 for males and 448.0 for females. These rates exhibited fluctuations over time, reaching their lowest point in 2020, attributed to the pandemic's disruption of elective procedures, with 386.4 surgeries per 100,000 males and 386.3 surgeries per 100,000 females. A resurgence was observed in 2022. The rates of primary knee arthroplasty increased, with a male rate of 106.2 and a female rate of 150.7 surgeries per 100,000 inhabitants in 2010, rising to 126.8 for males and 166.2 for females in 2022. Conclusion This comprehensive nationwide open-source data analysis of knee surgeries in Sweden shows that the COVID-19 pandemic significantly impacted knee surgery rates in Sweden, causing a notable decline in 2020, followed by a resurgence in 2022. Furthermore, while men had higher surgery rates than women, they experienced a larger decline in the incidence of knee surgeries compared to women. Understanding these trends is crucial for stakeholders and healthcare providers to improve resource allocation, address gender disparities, and maintain the resilience of surgical services in the face of disruptions. Level of Evidence Level III.
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Affiliation(s)
- Michael Axenhus
- Department of Orthopaedic Surgery Danderyd Hospital Stockholm Sweden
- Department of Clinical Sciences, Danderyd Hospital Karolinska Institutet Stockholm Sweden
| | - Martin Magnéli
- Department of Orthopaedic Surgery Danderyd Hospital Stockholm Sweden
- Department of Clinical Sciences, Danderyd Hospital Karolinska Institutet Stockholm Sweden
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Le Stum M, Le Goff-Pronost M, Stindel E. Knee arthroplasty: an international systemic review of epidemiological trends. Orthop Traumatol Surg Res 2024:104006. [PMID: 39341338 DOI: 10.1016/j.otsr.2024.104006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 07/17/2024] [Accepted: 08/21/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND In response to various socio-economic factors and technological advancements, knee arthroplasty procedures have steadily increased. To date, epidemiological analyses have been conducted on a single-country basis. The aims of this article are: (1) to identify arthroplasty databases by country, (2) to verify the international comparability of coding, (3) to study retrospective epidemiological trends, and (4) to analyze projections by country. The hypothesis is that countries will follow similar trends, though with varying time lags. MATERIALS AND METHODS A literature review from 2005 to 2023 was conducted following PRISMA recommendations on PubMed, Web of Science, and Cochrane, using the keywords: "Knee + Arthroplasty + Trends + Replacement + Epidemiology." Only articles featuring national analyses, based on references recognized by healthcare systems, were included. RESULTS Forty-eight articles, representing 16 countries, were selected. Europe was the most represented (47% of occurrences), followed by the USA (22%), Asia (20%), Oceania (8%), and Chile (2%). The data came from national databases or representative extrapolated samples. Extraction methods used precise national codes or specific definitions. Growth rates in volume and incidence were positive but varied between countries, with distinct dynamics and different phases of growth. Females had higher volumes and incidence rates (sex ratio 2/3), but growth was faster in males. Future forecasts, based on regression models (Poisson, linear, or logistic), predicted an increase in volumes of between +30% by 2030 and +805% by 2050. CONCLUSION The analysis of census systems revealed growth in knee arthroplasties in all countries, but with varying intensities depending on the period. These multifactorial disparities appeared to follow a similar pattern, staggered over time based on the countries' economic development. LEVEL OF EVIDENCE IV; epidemiological review.
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Affiliation(s)
- Mathieu Le Stum
- Université de Brest, UBO, INSERM, Laboratoire de Traitement de l'Information Médicale (LATIM), UMR1101, 22 Avenue Camille Desmoulins, 29200 Brest, France.
| | - Myriam Le Goff-Pronost
- Institut Mines-Telecom, IMT Atlantique, LATIM - INSERM UMR 1101, M@rsouin, 655 Avenue du Technopôle, 29280 Plouzane, France
| | - Eric Stindel
- Université de Brest, UBO, INSERM, Laboratoire de Traitement de l'Information Médicale (LATIM), UMR1101, 22 Avenue Camille Desmoulins, 29200 Brest, France; Centre Hospitalo-Universitaire de Brest, CHRU Brest, LATIM, UMR 1101, 2 Avenue Foch, 29200 Brest, France
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Afshar AM, Sharma SK, Hamidi SH, Marznaki ZH, Mudgal SK, Kamyari N, Khalilizad M. Comparison of Dexamethasone at Three Doses Administered Postoperatively for Improving Pain Control and Sleep Quality in Patients Who Underwent Total Knee Arthroplasty: A Triple Blind Randomized Controlled Trial. J Arthroplasty 2024:S0883-5403(24)00943-4. [PMID: 39284389 DOI: 10.1016/j.arth.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/31/2024] [Accepted: 09/10/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Dexamethasone has been shown to alleviate pain, yet the optimal dosing and safety profiles remain unclear. This study aimed to evaluate the analgesic efficacy and impact on sleep quality of three different doses of intravenous dexamethasone in patients undergoing total knee arthroplasty (TKA). METHODS In this randomized, triple-blind, clinical trial, we assessed the analgesic effects of three doses of intravenous dexamethasone (four, eight, and 16 mg) in adult patients who underwent TKA. Pain was measured using the visual analog scale at one, 12, 24, and 48 hours postoperatively, and sleep quality was assessed two weeks postsurgery. RESULTS A total of 90 participants were enrolled in the study, with 30 participants in each dosing group. The mean visual analog scale scores at 12, 24, and 48 hours postoperatively showed significant improvement from baseline in all groups. Notably, the 16 mg and eight mg dexamethasone groups demonstrated significantly greater pain reduction compared to the four mg group (P < 0.05). Additionally, sleep quality significantly improved in the 16 mg and eight mg groups (P < 0.05). CONCLUSIONS Dexamethasone at doses of four, eight, and 16 mg effectively reduces pain and enhances sleep quality in patients undergoing TKA, with the 16 mg dose showing the most pronounced effects at 12, 24, and 48 hours postoperatively.
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Affiliation(s)
- Amir M Afshar
- Resident of Orthopaedic, Department of Orthopaedic and Trauma Surgery, Babol University of Medical Sciences, Babol, Iran
| | - Suresh K Sharma
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, India
| | - Seyed Hosseini Hamidi
- Department of Anesthesiology and Critical Care, Babol University of Medical Sciences, Babol, Iran
| | | | - Shiv K Mudgal
- College of Nursing, All India Institute of Medical Sciences, Deoghar, India
| | - Naser Kamyari
- Department of Biostatistics and Epidemiology, School of Health, Abadan University of Medical Sciences, Abadan, Iran
| | - Majid Khalilizad
- Department of Orthopaedic and Trauma Surgery, Shahid Beheshti Hospital and Mobility Impairment Research Centre, Babol University of Medical Sciences, Babol, Iran
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Park JG, Sim J, Han SB. Association between intra-articular hyaluronic acid injections in delaying total knee arthroplasty and safety evaluation in primary knee osteoarthritis: analysis based on Health Insurance Review and Assessment Service (HIRA) claim database in Republic of Korea. BMC Musculoskelet Disord 2024; 25:706. [PMID: 39232733 PMCID: PMC11373335 DOI: 10.1186/s12891-024-07698-2] [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: 12/19/2023] [Accepted: 07/16/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND The prevalence of knee osteoarthritis (KOA), a progressive degenerative disease, is gradually increasing, and it is a progressive degenerative disease. In patients with mild-to-moderate KOA, intra-articular hyaluronic acid (IA-HA) has been shown to be an effective non-operative treatment option that can provide significant pain relief and symptom improvement by increasing intra-articular viscoelasticity. This study aimed to evaluate the efficacy of IA-HA injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database. METHODS For this retrospective cohort study, the study population included patients aged ≥ 50 years with a first diagnosis of KOA between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Republic of Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration. RESULTS In all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60-0.62) than non-IA-HA group after adjusting for covariates, which included age, sex, medical history, number of hospital beds, and CS injection. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53-0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents (multiple injection regimen 7.0% vs. single injection regimen 3.6%) and concurrent IA-CS use (concurrent IA-CS use 13.9% vs. IA-HA only 6.7%) were associated with higher infection risk. CONCLUSION IA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings could suggest the use of IA-HA as an effective non-operative intervention option for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use could play a role in delaying the time to TKA and reducing complications.
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Affiliation(s)
- Jun-Gu Park
- Department of Orthopaedic Surgery, College of Medicine, Anam Hospital, Korea University, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Juho Sim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, College of Medicine, Anam Hospital, Korea University, 73, Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea.
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Park YB, Kim M, Nam HC, Jeon JW, Ha CW. Total knee arthroplasty and periprosthetic distal femoral fracture: looking beyond the osteoporosis to previous osteoporotic fracture. Osteoporos Int 2024; 35:1469-1475. [PMID: 38801524 DOI: 10.1007/s00198-024-07138-w] [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: 09/24/2023] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
Osteoporosis increases the risk of periprosthetic distal femoral fractures after TKA, especially in patients with a history of osteoporotic fractures. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized by the patients following primary TKA. PURPOSE Osteoporosis is a risk factor for fractures, including those of the hip, vertebrae, and distal radius; however, the association between osteoporosis and periprosthetic fractures after total knee arthroplasty (TKA) has not been much investigated. Therefore, we aimed to investigate the association of the presence of systemic osteoporosis with periprosthetic fractures after TKA. METHODS This study included 34 patients with periprosthetic fractures following primary TKA and 106 controls matched for age and sex. Bone mineral density was evaluated at the femoral neck, total hip, and lumbar spine using dual X-ray absorptiometry. Medical records were reviewed for age; sex; body mass index; smoking; rheumatoid arthritis, endocrine diseases, and cardiovascular diseases; history of glucocorticoid use; medication for osteoporosis; and history of previous osteoporotic fracture. In addition, anterior femoral notching after TKA was evaluated. Univariable and multivariable logistic regression analysis were used to determine factors associated with periprosthetic fracture. RESULTS The prevalence of osteoporosis in the fracture group was higher than that in the control group (61.8% vs. 40.6%, p=0.045). The rate of medication for osteoporosis was significantly low in the fracture group (47.6 % vs 76.7%, p=0.026). History of previous osteoporotic fracture (odds ratio [OR], 9.1; p=0.015) and osteoporosis (OR, 3.6; p=0.013) were significant risk factors for periprosthetic fractures after TKA. Medication for osteoporosis could decrease the risk of periprosthetic fracture (OR 0.3; p=0.020). CONCLUSION Osteoporosis is a major risk factor for periprosthetic distal femoral fractures after TKA. Therefore, careful assessment and proper treatment of osteoporosis need and the importance of taking osteoporotic medication needs to be recognized to the patients following primary TKA, especially in patients with a history of osteoporotic fracture. LEVEL OF EVIDENCE Prognostic study, level III.
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Affiliation(s)
- Y-B Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea.
| | - M Kim
- Department of Orthopedic Surgery, Keunhim Hospital, 246, Sincheon-daero, Busanjin-gu, Busan, 47192, Republic of Korea
| | - H-C Nam
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, 110, Deokan-ro, Gwangmyeong-si, Gyeonggi-do, 14353, Republic of Korea
| | - J-W Jeon
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea
| | - C-W Ha
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
- Ha's Orthopedic Hospital, 518, Gangnam-daero, Gangnam-gu, Seoul, Republic of Korea
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Mulpur P, Jayakumar T, Yakkanti RR, Apte A, Hippalgaonkar K, Annapareddy A, Masilamani ABS, Reddy AVG. Efficacy of Intrawound Vancomycin in Prevention of Periprosthetic Joint Infection After Primary Total Knee Arthroplasty: A Prospective Double-Blinded Randomized Control Trial. J Arthroplasty 2024; 39:1569-1576. [PMID: 38749600 DOI: 10.1016/j.arth.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a devastating complication. Intrawound vancomycin powder has been shown to reduce infection rates in spine surgery, but its role in arthroplasty remains controversial. This prospective randomized control trial aimed to evaluate the efficacy of intrawound vancomycin in preventing PJI after primary TKA. METHODS A total of 1,022 patients were randomized to the study group (n = 507, who received 2 grams intrawound vancomycin powder before arthrotomy closure) or to the control group (n = 515, no local vancomycin) with a minimum follow-up of 12-months. The primary outcome was the incidence of PJI or surgical site infection (SSI). Secondary outcomes included associated minor complications such as stitch abscess, persistent wound drainage, and delayed stitch removal. Other parameters evaluated include reoperation rates and incidences of nephrotoxicity. RESULTS The overall infection rate in 1,022 patients was 0.66%. There was no significant difference in PJI rate in the study group (N = 1; 0.2%) versus the control group (N = 3; 0.58%), P = .264. Reoperation rates in the study group (N = 4; 0.78%) and control (N = 5; 0.97%), and SSI rates in the study (N = 1; 0.2%) and control groups (N = 2; 0.38%) were comparable. The Vancomycin cohort, however, demonstrated a significantly higher number of minor wound complications (n = 67; 13.2%) compared to the control group (n = 39; 7.56%, P < .05). Subgroup analysis showed diabetics in the study group to also have a higher incidence of minor wound complications (24 [14.1%] versus 10 [6.2%]; P < 05]. Multivariate analyses found that vancomycin use (odds ratio = 1.64) and smoking (odds ratio = 1.85) were associated with an increased risk of developing minor wound complications. No cases of nephrotoxicity were reported. CONCLUSIONS Intrawound vancomycin powder does not appear to reduce PJI/SSI rate in primary total knee arthroplasties, including high-risk groups. Although safe from a renal perspective, intrawound vancomycin was associated with an increase in postoperative aseptic wound complications. Intrawound vancomycin may not be effective in reducing the rate of PJI in primary TKA.
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Affiliation(s)
- Praharsha Mulpur
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Tarun Jayakumar
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Ramakanth R Yakkanti
- Division of Arthroplasty, Rothman Orthopedics at Advent Health, Orlando, Florida
| | - Aditya Apte
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - Adarsh Annapareddy
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - A V Gurava Reddy
- Sunshine Bone and Joint Insitute, KIMS-Sunshine Hospitals, Hyderabad, India
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Kim CH, Park YB, Baek SH. Clinical and Radiological Outcomes of Computer-Assisted Navigation in Primary Total Knee Arthroplasty for Patients with Extra-articular Deformity: Systematic Review and Meta-Analysis. Clin Orthop Surg 2024; 16:430-440. [PMID: 38827763 PMCID: PMC11130617 DOI: 10.4055/cios23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 06/05/2024] Open
Abstract
Background Computer-assisted navigation surgery (CAS) during primary total knee arthroplasty (TKA) may help improve outcomes for patients with extra-articular deformity (EAD); however, this has not been extensively studied. Therefore, we aimed to investigate the clinical and radiological outcomes following primary TKA using CAS in patients with EAD. Methods We searched Medline, Embase, and the Cochrane Library up to March 3, 2023 for studies investigating surgical outcomes of using the navigation system for TKA to treat patients with EAD. From 14 studies, 539 knees with EAD that underwent navigation TKA were enrolled. We investigated the knee range of motion (ROM), outcome scores at final follow-up (Knee Society Score [KSS] and Knee Functional Score [KFS]), and pre- and postoperative mechanical hip-knee-ankle (mHKA) angle using lower extremity scanogram. The meta-analysis was based on the single-arm method, and all data were pooled using a random-effects model. Results Following our meta-analyses, the mean knee ROM changed from 87.0° (95% confidence interval [CI], 75.9°-98.1°) preoperatively to 109.4° (95% CI, 97.9°-120.8°) postoperatively. The adjusted KSS was 93.45 points (95% CI, 88.36-98.54 points), and the adjusted KFS was 91.57 points (95% CI, 86.80-96.33 points) in knees with EAD that underwent CAS-TKA. As a radiological outcome, the mHKA angle changed from 169.53° (95% CI, 166.90°-172.16°) preoperatively to 178.81° (95% CI, 178.31°-179.30°) postoperatively. Conclusions CAS-TKA yielded positive clinical results and demonstrated a satisfactory alignment of the lower limb's mechanical axis. CAS-TKA showed promise for primary TKA procedures, demonstrating favorable clinical and radiological outcomes even in complex cases involving EAD.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Suk Ho Baek
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
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Kim S, Won SJ, Lee NK, Chang CB. Life Expectancy of Patients Undergoing Total Knee Arthroplasty: Comparison With General Population. J Korean Med Sci 2024; 39:e106. [PMID: 38529576 DOI: 10.3346/jkms.2024.39.e106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aimed to analyze the life expectancy and cause of death in osteoarthritis (OA) patients who underwent total knee arthroplasty (TKA) and to identify risk factors that affect long-term mortality rate after TKA. METHODS Among 601 patients, who underwent primary TKA due to OA by a single surgeon from July 2005 to December 2011, we identified patients who died after the operation using data obtained from the National Statistical Office of Korea. We calculated 5-, 10-, and 15-year survival rates of the patients and age-specific standardized mortality ratios (SMRs) compared to general population of South Korea according to the causes of death. We also identified risk factors for death. RESULTS The 5-year, 10-year, and 15-year survival rates were 94%, 84%, and 75%, respectively. The overall age-specific SMR of the TKA cohort was lower than that of the general population (0.69; P < 0.001). Cause-specific SMRs for circulatory diseases, neoplasms, and digestive diseases after TKA were significantly lower than those of the general population (0.65, 0.58, and 0.16, respectively; all P < 0.05). Male gender, older age, lower body mass index (BMI), anemia, and higher Charlson comorbidity index (CCI) were significant factors associated with higher mortality after TKA. CONCLUSION TKA is a worthwhile surgery that can improve life expectancy, especially from diseases of the circulatory system, neoplasms, and digestive system, in patients with OA compared to the general population. However, careful follow-up is needed for patients with male gender, older age, lower BMI, anemia, and higher CCI, as these factors may increase long-term mortality risk after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sanghyo Kim
- Department of Orthopaedic Surgery, Busan Mirae Hospital, Busan, Korea
| | - Samuel Jaeyoon Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Na-Kyoung Lee
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Lee SS, Chang MJ, Cho JH, Oh J, Moon YW. No differences in long-term clinical outcomes and survival rate of navigation-assisted versus conventional primary mobile-bearing total knee arthroplasty: A minimum 10-year follow-up. Knee Surg Sports Traumatol Arthrosc 2024; 32:445-453. [PMID: 38270291 DOI: 10.1002/ksa.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
PURPOSE This study aimed to compare long-term clinical and radiographic outcomes and survival rates between navigation-assisted (NAV) total knee arthroplasty (TKA) and conventional (CON) TKA using a mobile-bearing insert. METHODS From May 2008 to December 2009, 45 and 63 mobile-bearing TKA patients were enroled in the CON- and NAV-TKA groups with 146.8 months follow-up, respectively. Clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index and Knee Society Scores), radiographic outcomes (hip-knee-ankle [HKA], lateral distal femoral, medial proximal tibial, γ, and δ angles), and survivorship were compared between both groups. RESULTS The number of HKA angle outliers (more than 3 degrees or less than -3 degree) was significantly lower in the NAV-TKA group (24.4% vs. 9.5%, p = 0.036) than in the CON-TKA group. However, long-term clinical outcomes were similar between both groups. The cumulative survival rate (best-case scenario) was 98.3% in the CON-TKA group and 97.5% in the NAV-TKA group, with no significant difference between the groups (p = 0.883). CONCLUSION Long-term clinical outcomes and survival rates were similar between the two groups despite fewer outliers of postoperative lower-limb alignment in the NAV-TKA group. Excellent survival rates were observed in both groups using mobile-bearing inserts. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Sung-Sahn Lee
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, South Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Ho Cho
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, South Korea
| | - Juyong Oh
- 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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Shon OJ, Kim GB, Jo SH. Sex Differences in Sarcopenia in Patients Undergoing Total Knee Arthroplasty for Advanced Knee Osteoarthritis. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:226. [PMID: 38399514 PMCID: PMC10889927 DOI: 10.3390/medicina60020226] [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: 01/09/2024] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The purpose of this study was to compare sex differences in the incidence of sarcopenia, demographic characteristics, and preoperative sarcopenic parameters in patients undergoing TKA for advanced knee osteoarthritis (OA). Moreover, we sought to compare patient-reported outcome measures (PROMs) and the predisposing factors after TKA in patients with sarcopenia by sex through subgroup analysis. Materials and Methods: From May 2020 to September 2022, a total of 892 patients who were evaluable for sarcopenia before primary TKA were enrolled. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were assessed according to the presence or absence of sarcopenia. After a two-to-one matched-pair analysis for subgroup analysis, 21 knees in men were matched with a corresponding number of knees in women (42), resulting in a total of 63 knees. PROMs were investigated using the Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, and the Short Form-12 physical and mental component summary scores. Moreover, the postoperative complications and predisposing factors for male sarcopenia were investigated. Results: The prevalence of sarcopenia was 10.9% (97/892), and the prevalence was higher in men (19.6%, 21/107) than in women (9.7%, 76/785). In subgroup analyses, male patients had significantly inferior PROMs up to 12 months after index surgery. Moreover, there was no significant difference in the systemic complications between the two groups. Multivariate binary logistic regression analysis indicated that alcohol consumption, smoking, and higher modified Charlson Comorbidity Index (mCCI) were predisposing factors for male patients with sarcopenia. The prevalence of sarcopenia was higher in male patients undergoing primary TKA. Conclusions: When compared with the propensity-matched female group, male patients had inferior PROMs up to 12 months postoperatively. Alcohol consumption, current smoker status, and higher mCCI were predisposing factors for sarcopenia in male patients with advanced knee OA.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea;
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea;
| | - Gi Beom Kim
- Department of Orthopedic Surgery, College of Medicine, Yeungnam University, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea;
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea;
| | - Seong Hyeon Jo
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea;
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Kim SG, Kim HP, Bae JH. Clinical Outcomes and Complications of 2-Stage Septic Versus Aseptic Revision Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2024; 106:158-168. [PMID: 37943574 DOI: 10.2106/jbjs.23.00519] [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: 11/10/2023]
Abstract
BACKGROUND Although several studies have compared the clinical outcomes of septic and aseptic revision total knee arthroplasty (TKA), their results have been controversial. Therefore, this study aimed to compare clinical outcomes and complications of septic and aseptic revision TKA through a systematic review and meta-analysis. METHODS The PubMed (MEDLINE) and Embase databases were searched for studies evaluating the clinical outcomes and complications of 2-stage septic revision and aseptic revision TKAs. A systematic review of clinical outcomes (Knee Society Knee and Function Scores and range of motion) and complications (reoperation, infection, and failure rates) was conducted. RESULTS Thirteen studies were included in the systematic review. The mean MINORS (Methodological Index for NOn-Randomized Studies) score of the included studies was 20.5 (range, 18 to 22). The meta-analysis revealed higher reoperation (risk ratio [RR], 1.98; 95% confidence interval [CI], 1.50 to 2.62; p < 0.00001), infection (RR, 4.08; 95% CI, 2.94 to 5.64; p < 0.00001), and failure rates (RR, 2.88; 95% CI, 1.38 to 6.03; p = 0.005) in septic revision TKAs than in aseptic revision TKAs. Moreover, septic revision TKAs showed lower Knee Society Knee Scores compared with aseptic TKAs (mean difference [MD], -6.86; 95% CI, -11.80 to -1.92; p = 0.006). However, the Knee Society Function Score (MD, -1.84; 95% CI, -7.84 to 3.80; p = 0.52) and range of motion (MD, -6.96°; 95% CI, -16.23° to 2.31°; p = 0.14) were not significantly different between septic and aseptic revision TKAs. CONCLUSIONS Despite the heterogeneity of prosthesis designs and surgical protocols used in septic and aseptic revision TKAs, the results of this systematic review suggest that 2-stage septic revision TKAs have poorer clinical outcomes and higher complication rates than aseptic revision TKAs do. LEVEL OF EVIDENCE Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sang-Gyun Kim
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Hwa Pyung Kim
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Republic of Korea
| | - Ji Hoon Bae
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
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Shim GY, Kim EH, Lee SJ, Chang CB, Lee YS, Lee JI, Hwang JH, Lim JY. Postoperative rehabilitation using a digital healthcare system in patients with total knee arthroplasty: a randomized controlled trial. Arch Orthop Trauma Surg 2023; 143:6361-6370. [PMID: 37129691 DOI: 10.1007/s00402-023-04894-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Digital healthcare systems based on augmented reality (AR) show promise for postoperative rehabilitation. We compared the effectiveness of AR-based rehabilitation and conventional rehabilitation after total knee arthroplasty (TKA). MATERIALS AND METHODS We randomly allocated 56 participants to digital healthcare rehabilitation group (DR group) and conventional rehabilitation group (CR group). Participants in the CR group performed brochure-based home exercises for 12 weeks, whereas those in the DR group performed AR-based home exercises that showed each motion on a monitor and provided real-time feedback. The primary outcome was change in 4-m gait speed. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, health-related quality of life [assessed by the EuroQoL 5-Dimension 5-Level (EQ5D5L) questionnaire], pain [measured using a numeric rating scale (NRS)], Berg Balance Scale (BBS), range of motion (ROM), and muscle strength. Outcomes were measured at baseline (T0) and 3 (T1), 12 (T2), and 24 (T3) weeks after randomization. RESULTS There was no significant difference in baseline characteristics of participants between two groups, except age and body mass index. No group difference was observed in 4-m gait speed (0.37 ± 0.19 and 0.42 ± 0.28 for the DR and CR groups, respectively; p = 0.438). The generalized estimating equation model revealed no significant group by time interaction regarding for 4-m gait speed, WOMAC, EQ5D5L, NRS, BBS, ROM, and muscle strength score. All outcomes were significantly improved in both groups (p < 0.001). CONCLUSION The use of a digital healthcare system based on AR improved the functional outcomes, pain, and quality of life of patients after TKA. AR-based rehabilitation may be useful treatment as an alternative to conventional rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov (identifier: NCT04513353). Registered on August 9, 2020. http://clinicaltrials.gov/ct2/show/NCT04513353 .
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Affiliation(s)
- Ga Yang Shim
- Department of Physical and Rehabilitation Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Eun Hye Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea
| | - Seong Joo Lee
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-Gu, Seoul, Republic of Korea.
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-Ro 173 Bundang-Gu, Seongnam, Gyeonggi, Republic of Korea.
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Wan D, Wang R, Wei J, Zan Q, Shang L, Ma J, Yao S, Xu C. Mapping knowledge landscapes and emerging trends of robotic-assisted knee arthroplasty: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e35076. [PMID: 37746959 PMCID: PMC10519459 DOI: 10.1097/md.0000000000035076] [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: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
The robotic-assisted knee arthroplasty has gained increasing attention in the research field. To date, no comprehensive bibliometric analysis has been carried out on this topic. The present study aimed to introduce the research status and hotspots and explore the field of robotic-assisted knee arthroplasty from a bibliometric perspective. The Web of Science Core Collection database was utilized to retrieve articles and reviews on robotic-assisted knee arthroplasty published between 1993 and 2023. CiteSpace, VOSviewer, Scimago Graphica, Pajek, and a bibliometric online analysis platform (http://bibliometric.com/) were employed to analyze the regions, institutions, journals, authors, and keywords, aiming to predict the latest trends in research related to robotic-assisted knee arthroplasty. This study encompasses 697 records. The annual publication count pertaining to robotic-assisted knee arthroplasty demonstrates consistent growth. The United States leads with the highest number of studies (298), trailed by the United Kingdom (110) and France (49). The Hospital for Special Surgery emerges as the most prolific institution, while Professor Mont, Michael A holds significant author influence. The Journal of Arthroplasty reigns supreme in this field, boasting the highest publication and citation figures. Funding sources predominantly include Stryker (34), Smith Nephew (19), and the National Natural Science Foundation of China (17). Noteworthy research themes within robotic-assisted knee arthroplasty encompass patient satisfaction, kinematic alignment, and clinical benefits. The landscape of robotic-assisted knee arthroplasty research is thriving. Anticipated trajectories of research will be geared toward refining the precision of robotic technology and enhancing clinical outcomes within the realm of robotic-assisted knee arthroplasty.
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Affiliation(s)
- Dongping Wan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi Province, China
| | - Rui Wang
- The First Clinical Medical College, Shaanxi University of Chinese Medicine, Xi’an, Shaanxi Province, China
| | - Jie Wei
- State Key Laboratory of Cancer Biology, Department of Pathology, The First Affiliated Hospital of Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Qiang Zan
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Lei Shang
- Department of Health Statistics, Faculty of Preventive Medicine, the Air Force Military Medical University, Xi’an, Shaanxi Province, China
| | - Jianbing Ma
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Shuxin Yao
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Chao Xu
- Department of Knee Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
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Pacheco-Brousseau L, Poitras S, Charette M, Amor SB, Desmeules F, Stacey D. Exploring appropriateness criteria for informing the total knee arthroplasty decision-making process: An interpretive descriptive study. J Eval Clin Pract 2023; 29:942-954. [PMID: 37410789 DOI: 10.1111/jep.13893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
RATIONAL The Hawker appropriateness criteria for total knee arthroplasty (TKA) are: osteoarthritis symptoms impacting quality of life, evidence of osteoarthritis, trial of conservative treatments, patient's realistic expectations, patient/surgeon agree benefits outweigh risks, and readiness for surgery. Little is known about the barriers and facilitators of using the Hawker et al. appropriateness criteria for TKA in clinical practice. AIMS AND OBJECTIVES Explore the barriers and facilitators to using appropriateness criteria for TKA in making decisions for adults with knee osteoarthritis. METHODS Interpretive descriptive qualitative study at an academic hospital. Purposive sampling aimed to recruit: (1) healthcare team members at all levels influencing care delivery, and (2) adults with TKA assessed at the hospital clinic. Semi-structured interviews asked about the barriers/facilitators to using the Hawker appropriateness criteria. Data analysis consisted of inductive thematic analysis with themes mapped to the Consolidated Framework for Implementation Research domains. RESULTS Nine healthcare professionals and 14 adults with TKA participated and identified common barriers to using the Hawker appropriateness criteria: (a) intervention characteristics domain: difficulty to assess criteria, patients expecting healthcare professionals to decide, limited accessibility to conservative treatments; (b) individuals characteristics domain: no need to change current TKA process, clinical judgement limited to OA severity/age, implicit assessment of subjective criteria; (c) inner setting domain: TKA information received after decision made; and (d) outer setting domain: no timely access to TKA. A facilitator of use was evidence/buy-in fosters programme changes. CONCLUSION Barriers to using the criteria relevant to clinical practice and the healthcare system were identified while only one facilitator was revealed. Interventions tailored to these barriers are needed to support the use of the Hawker appropriateness criteria in TKA decision-making.
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Affiliation(s)
- Lissa Pacheco-Brousseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Marylène Charette
- Population Health, Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Ben Amor
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Montréal, Quebec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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15
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Shon OJ, Cho SJ, Kim GB. Long locking plate combined with locking attachment plate in patients with periprosthetic femoral fracture around ipsilateral stem after total knee arthroplasty. BMC Musculoskelet Disord 2023; 24:594. [PMID: 37475013 PMCID: PMC10357702 DOI: 10.1186/s12891-023-06726-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The purpose of this study was to introduce the surgical technique using long locking plate and locking attachment plate (LAP) in patient with periprosthetic femoral fracture around ipsilateral stem after total knee arthroplasty (TKA). Moreover, we sought to investigate the outcomes of this fixation technique and to propose a new subtype in the existing classification of periprosthetic femoral fractures. METHODS From January 2013 to January 2022, thirty-four consecutive periprosthetic femoral fractures around ipsilateral stem following TKA with minimum 1-year follow-up were enrolled in this study. Most cases were fixed with long-locking plate and LAP using the MIPO technique. For subgroup analysis, we classified patients with stemmed hip implant (group H) and stemmed knee implant (group K). Bone union, American Knee Society Score (AKSS) scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the Western Ontario and McMaster Universities Osteoarthritis Index for pain and function, and range of motion were investigated. RESULTS The number of group H and K were 24 patients (70.6%) and 10 patients (29.4%), respectively. The mean age at operation was 71.5 years (range, 65‒85 years), and the mean follow-up period was 27.5 months (range, 12‒72 months). Bone union was confirmed radiographically in all patients, and the mean union time was 4.9 months (range, 3.5‒6 months). There were no significant differences in radiographic and clinical outcomes between the groups. CONCLUSIONS Long-locking plate combined with LAP showed favorable radiographic and clinical outcomes in patients with periprosthetic femoral fracture around ipsilateral stem after TKA. LEVEL OF EVIDENCE Level IV, Retrospective Case Series.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea
| | - Seung Jae Cho
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea.
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-Ro Nam-Gu, Daegu, 42415, Republic of Korea.
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Shon OJ, Kim GB, Cho SJ. Does Sarcopenia Accompanying End-Stage Knee Osteoarthritis Affect the Outcomes following Total Knee Arthroplasty? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1078. [PMID: 37374280 DOI: 10.3390/medicina59061078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: This study aimed to investigate the prevalence of sarcopenia in patients undergoing total knee arthroplasty (TKA) for advanced knee osteoarthritis (OA), and to assess whether sarcopenia accompanying OA affects patient-reported outcome measures (PROMs) after TKA. We evaluated which predisposing factors could influence the development of sarcopenia in patients with advanced knee OA. Material and Methods: A total of 445 patients whose body composition, muscle strength, and physical performance could be measured before primary TKA were enrolled. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Patients were categorized into sarcopenia (S, n = 42) and non-sarcopenia groups (NS, n = 403). PROMs were investigated using the Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index. Additionally, postoperative complications and predisposing factors for sarcopenia were evaluated. Results: The incidence of sarcopenia in the entire sample was 9.4%; the prevalence was higher in men (15.4%) than in women (8.7%), and significantly increased with advancing age (p < 0.001). At the six-month follow-up, PROMs in group S were significantly inferior to those in group NS, except for the pain score; however, at the 12-month follow-up, no significant difference was observed between the groups. Multivariate logistic regression indicated that age, body mass index (BMI), and a higher modified Charlson Comorbidity Index (mCCI) were predisposing factors for sarcopenia. Conclusions: A higher prevalence of sarcopenia was observed in men with progressive knee OA. Up to six months after primary TKA, PROMs in group S were inferior to those in group NS, except for the pain score; however, no significant difference was observed between the groups at 12 months. Age, BMI, and higher mCCI were predisposing factors for sarcopenia in patients with OA.
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Affiliation(s)
- Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Gi Beom Kim
- Department of Orthopedic Surgery, Yeungnam University College of Medicine, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
| | - Seung Jae Cho
- Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu 42415, Republic of Korea
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Lee S, Choi Y, Lee J, Lee H, Yoon J, Chang C. Valgus Arthritic Knee Responds Better to Conservative Treatment than the Varus Arthritic Knee. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040779. [PMID: 37109737 PMCID: PMC10146304 DOI: 10.3390/medicina59040779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Clinically, it is beneficial to determine the knee osteoarthritis (OA) subtype that responds well to conservative treatments. Therefore, this study aimed to determine the differences between varus and valgus arthritic knees in the response to conservative treatment. We hypothesized that valgus arthritic knees would respond better to conservative treatment than varus arthritic knees. Materials and Methods: Medical records of 834 patients who received knee OA treatment were retrospectively reviewed. Patients with Kellgren-Lawrence grades III and IV were divided into two groups according to knee alignment (varus arthritic knee, hip-knee-ankle angle [HKA] > 0° or valgus arthritic knee, HKA < 0°). The Kaplan-Meier curve with total knee arthroplasty (TKA) as an endpoint was used to compare the survival probability between varus and valgus arthritic knees at one, two, three, four, and five years after the first visit. A receiver operating characteristic (ROC) curve was used to compare the HKA thresholds for TKA between varus and valgus arthritic knees. Results: Valgus arthritic knees responded better to conservative treatment than varus arthritic knees. With TKA as an endpoint, the survival probabilities for varus and valgus arthritic knees were 24.2% and 61.4%, respectively, at the 5-year follow-up (p < 0.001). The thresholds of HKA for varus and valgus arthritic knees for TKA were 4.9° and -8.1°, respectively (varus: area under the ROC curve [AUC] = 0.704, 95% confidence interval [CI] 0.666-0.741, p < 0.001, sensitivity = 0.870, specificity = 0.524; valgus: AUC = 0.753, 95% CI 0.693-0.807, p < 0.001, sensitivity = 0.753, specificity = 0.786). Conclusions: Conservative treatment is more effective for valgus than for varus arthritic knees. This should be considered when explaining the prognosis of conservative treatment for knees with varus and valgus arthritis.
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Affiliation(s)
- SeungHoon Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - YunSeong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - JaeHyuk Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - HeeDong Lee
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - JungRo Yoon
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Republic of Korea
| | - ChongBum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnamsi 13620, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Long H, Xie D, Zeng C, Wang H, Lei G, Yang T. Burden and Characteristics of Revision Total Knee Arthroplasty in China: a National Study Based on Hospitalized Cases. J Arthroplasty 2023:S0883-5403(23)00183-3. [PMID: 36849014 DOI: 10.1016/j.arth.2023.02.052] [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] [Received: 10/06/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND National epidemiological data in China are absent for revision total knee arthroplasty (TKA). This study aimed to investigate the burden and characteristics of revision TKA in China. METHODS We reviewed 4,503 revision TKA cases registered in the Hospital Quality Monitoring System in China between 2013 and 2018 using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Revision burden was determined by the ratio of the number of revision procedures to the total number of TKA procedures. Demographic characteristics, hospital characteristics, and hospitalization charges were identified. RESULTS The revision TKA cases accounted for 2.4% of all TKA cases. The revision burden showed an increasing trend from 2013 to 2018 (2.3 to 2.5%) (P for trend = 0.034). Gradual increases in revision TKA were observed in patients aged > 60 years. The most common causes for revision TKA were infection (33.0%) and mechanical failure (19.5%). More than 70% of the patients were hospitalized in provincial hospitals. A total of 17.6% patients were hospitalized in a hospital outside the province of their residence. The hospitalization charges continued to increase between 2013 and 2015 and remained roughly stable over the next three years. CONCLUSIONS This study provided epidemiological data for revision TKA in China based on a national database. There was a growing trend of revision burden during the study period. The focalized nature of operations in a few higher volume regions was observed and many patients had to travel to obtain their revision procedure.
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Affiliation(s)
- Huizhong Long
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China; China Standard Medical Information Research Center, Shenzhen, Guangdong, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tuo Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Lee S, Kim MK, Ahn E, Jung Y. Comparison of general and regional anesthesia on short-term complications in patients undergoing total knee arthroplasty: A retrospective study using national health insurance service-national sample cohort. Medicine (Baltimore) 2023; 102:e33032. [PMID: 36827051 PMCID: PMC11309672 DOI: 10.1097/md.0000000000033032] [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: 11/06/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
This retrospective study compared the mortality and short-term complications according to the choice of general anesthesia or regional anesthesia in patients who underwent a total knee arthroplasty (TKA). We searched the Korean National Health Insurance Service National Sample Cohort database to analyze data from patients who received a TKA between January 2002 and December 2015. Before comparing the general and the regional anesthesia groups, the bias was reduced by propensity score matching. After matching, the mortality and complications occurring within 30 days after a TKA were compared between the 2 groups. In the database, 6491 primary TKA cases were identified. Nine hundred forty-three patients (14.5%) had a TKA performed under general anesthesia, and 5548 (85.5%) had a TKA performed under regional anesthesia. After propensity score matching, the data of 1886 patients were analyzed, with 943 patients in each group. There was no significant difference in mortality (0.32% vs 0.00%), transfusion rate (84.52% vs 84.73%, P = .8989), and length of hospital stay (50 vs 53, P = .5391) between the general and regional anesthesia groups. Most of the complications were not significantly different, but the major complications, including myocardial infarction (1.70% vs 0.64%, P = .0414) and acute renal failure (0.85% vs 0.11%, P = .0391), were higher in the general anesthesia group than in the regional anesthesia group. Also, admission to the intensive care unit (8.48% vs 2.33%, P < .0001) and total cost (₩8067, 400 vs ₩7487, 940, P = .0002) were higher in the general anesthesia group than in the regional anesthesia group. Our study found that regional anesthesia for TKA is associated with a decrease in major complications, including myocardial infarction and acute renal failure, and medical costs.
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Affiliation(s)
- SeungYoung Lee
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Seoul, South Korea
| | - Min Kyoung Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong hospital, Gyeonggi-do, Republic of Korea
| | - EunJin Ahn
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong hospital, Gyeonggi-do, Republic of Korea
| | - YongHun Jung
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong hospital, Gyeonggi-do, Republic of Korea
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20
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Comparison of survival rates between total knee arthroplasty after a previous anterior cruciate ligament reconstruction and primary total knee arthroplasty via propensity score matching. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04773-6. [PMID: 36656350 DOI: 10.1007/s00402-023-04773-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Although the survival rate of total knee arthroplasty (TKA) in patients treated with anterior cruciate ligament reconstruction (ACLR) is not as favorable as that in patients treated with primary TKA without ligament reconstruction, the exact survival rates and complications associated with these procedures are still controversial. Therefore, the purpose of the current study was to compare the revision rates of TKA in patients with knee osteoarthritis (OA) with a previous ACLR and those of patients with primary TKA with no history of knee surgery by using propensity score matching analysis. MATERIALS AND METHODS A list of patients who underwent TKA from January 1, 2008 to May 31, 2019 was obtained from the Korean National Health Insurance database. Among these, 460 patients underwent TKA in a knee with a previous ACLR and 569,766 patients who underwent primary TKA due to degenerative OA. We performed propensity scoring matching to compare the revision rates including septic revision due to prosthetic joint infection after TKA and perioperative complication rates within 90 days after revision TKA between the two groups. RESULTS Matched patients were assigned to one of the two groups (group A: 2,201 patients who underwent TKA due to primary OA, group B: 448 patients who underwent TKA in a knee with a previous ACLR) based on the propensity score. The total number of revisions per 1000 person-years was significantly higher in group B than in group A (10.16 vs 4.66, respectively). Group B showed a higher risk of revision than group A at 10 years post-TKA (hazard ratio: 2.49, 95% confidence interval: 1.30-4.77). However, group B showed a similar risk of septic revision as group A (p = 0.44). Perioperative complications within 90 days after TKA showed no significant differences between the groups. CONCLUSIONS Surgeons should be aware of the relatively higher revision rate of TKA in patients who had previously undergone an ACLR compared to that in patients who underwent primary TKA.
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Han EY, Kim SR, Cho KH, Im SH. Establishment of a qualified integrated care system after total knee arthroplasty as a role of regional rheumatoid and degenerative arthritis centers. BMC Geriatr 2022; 22:606. [PMID: 35864452 PMCID: PMC9306030 DOI: 10.1186/s12877-022-03277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The geriatric population and advanced knee osteoarthritis are rapidly increasing in Korea, and the socioeconomic burden of total knee arthroplasty (TKA) is increasing. This study aimed to analyze the demographic, clinical and socioeconomic characteristics of patients who underwent TKA and to differentiate the factors affecting participation in inpatient-intensive rehabilitation programs after TKA in the Jeju regional rheumatoid and degenerative arthritis center established by the government. METHODS This retrospective cohort study included 845 patients (735 females; 72.0 ± 5.8 years) diagnosed with primary osteoarthritis (OA) of the knee who underwent elective unilateral primary TKA between January 2013 and June 2016. Demographic, clinical, and socioeconomic characteristics, including age, body mass index, obesity, length of stay, OA severity, underlying disease, education level, occupation, and location of residence were reviewed. Patients were allocated to the TKA-only group (home discharge) and to the TKA + rehab group (participation in post-TKA rehabilitation). The variables were analyzed and compared before and after the establishment of the center and according to participation in intensive rehabilitation. RESULTS Patients who underwent TKA were mostly female, in the 60 s, and had a high prevalence of comorbidities and obesity. After the rehabilitation center's establishment, the intensive post-TKA participation increased profoundly from 3% to 59.2%. Participants after the center establishment had lower mean BMI and a higher proportion of K-L grade 4 compared to those before the center establishment. The location of residence was the only factor differentiating the participation in the intensive rehabilitation. CONCLUSION The regional rheumatoid and degenerative arthritis center was appropriate to satisfy the high unmet need for participating in the intensive rehabilitation after TKA and to execute the qualified integrated post-TKA care system. Policy support should ensure the early rehabilitation and a qualified integrated care system and prepare for the increased burden of revision. Future longitudinal studies should be conducted to assess the long-term effect of the integrated post-TKA rehabilitation program on functional outcomes and patient survivorship free from revision.
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Affiliation(s)
- Eun Young Han
- Department of Rehabilitation Medicine, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University College of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Sang Rim Kim
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Jeju National University College of Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Kye Hee Cho
- Department of Rehabilitation Medicine, CHA Ilsan Medical Center, CHA University, Goyang, Republic of Korea.
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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22
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Lee BC, Moon CW, Choi WS, Kim YM, Joo YB, Lee DG, Lee SJ, Choi ES, Ji JH, Suh DW, Cho KH. Clinical evaluation of usefulness and effectiveness of sitting type continuous passive motion machines in patients with total knee arthroplasty: a study protocol for a single-blinded randomized controlled trial. BMC Musculoskelet Disord 2022; 23:565. [PMID: 35689278 PMCID: PMC9188049 DOI: 10.1186/s12891-022-05507-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is an important management strategy for patients with knee osteoarthritis (OA) refractory to conservative management. Postoperative range of motion (ROM) exercise is important to recover patients’ activities of daily living. Continuous passive motion (CPM) is a machine that provides passive ROM exercises of the knee joint in a pre-defined arc of motion. The short- and long-term effects of CPM exercise are controversial. We hypothesized that the inconsistent results of the CPM exercise are due to poor fitting of CPM machines and measurement errors. This study aims to present a protocol for investigating a new type of CPM machine that could be applied in a sitting position in comparison with the conventional type of CPM machine for patients with unilateral TKAs. Methods This study presents the protocol of a prospective, multicenter, single-blinded, three-armed randomized controlled trial (RCT). One hundred and twenty-six patients receiving unilateral TKAs will be recruited at the physical medicine and rehabilitation clinics of two urban tertiary medical hospitals. The patients were randomly divided into three groups with a 1:1:1 allocation. The intervention group will receive two weeks of post-operative rehabilitation using a new type of CPM machine. The control group will receive 2 weeks of post-operative rehabilitation using conventional CPM machines. The third group will receive post-operative rehabilitation with both types of CPM machines. The primary outcome will be the change in the passive ROM of the affected knee joint from baseline to 2 weeks after baseline assessment. The secondary outcomes will be pain and functional measurements, and will include patient-reported outcomes and performance tests surveyed at multiple time points up to 3 months after TKA. Discussion This is the first RCT to investigate the effect of a new type of CPM machine. The results of this RCT will determine whether the position of the patients during CPM exercise is important in post-operative rehabilitation protocols after TKAs and will provide evidence for the development of proper rehabilitation guidelines after TKAs. Trial registration Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, https://cris.nih.go.kr/cris/search/detailSearch.do/21750 Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05507-2.
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Affiliation(s)
- Byung Chan Lee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea
| | - Chang Won Moon
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea.,Department of Biomedical Institute, Chungnam National University, Daejeon, Korea
| | - Woo Sung Choi
- Department of Biomedical Institute, Chungnam National University, Daejeon, Korea
| | - Young Mo Kim
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yong Bum Joo
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Da Gyo Lee
- Catholic University of Korea Industry Academic Cooperation Foundation. The Catholic University of Korea, Seoul, Korea
| | - Sook Joung Lee
- Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Seok Choi
- Department of Rehabilitation Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Whan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Korea. .,Department of Biomedical Institute, Chungnam National University, Daejeon, Korea.
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23
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Baek JH, Lee SC, Ryu S, Ahn HS, Nam CH. Usefulness of Trabecular Metal Cones in Revision Total Knee Arthroplasty in a Korean Population: A Case Series. Orthop Res Rev 2022; 14:199-206. [PMID: 35707697 PMCID: PMC9191581 DOI: 10.2147/orr.s365377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/31/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to assess the medium-term results of trabecular metal cones for the reconstruction of large bone defects in revision TKA. Methods Thirteen patients who had undergone revision TKA using trabecular metal cones for femoral and/or tibial large bone defects were identified. We included patients who had a minimum of three years follow-up in the study. We evaluated their functional outcomes, implant survivorship, radiological findings, and complications. Results At a mean follow-up of 6.9 years (range of 3.5–9.4 years), all trabecular metal cones and implants were well fixed and did not exhibit any radiographic evidence of migration or loosening. At the final follow-up, the mean Knee Society knee scores had improved from 37.2 to 78.1 (p < 0.05), and function scores had improved from 35.5 to 77.5 points (p < 0.05). One intraoperative fracture in the distal femur occurred in an 85-year-old woman during impaction of a single trabecular metal cone. The fracture was successfully affixed to the femoral cone and bone three months postoperatively. Conclusion The present study of trabecular metal cones demonstrates excellent clinical outcomes and survivorship in revision TKA during medium-term follow-up periods. However, longer-term follow-up studies are needed to further investigate these implants in revision TKA. Additionally, the necessity of metal cones in revision procedures should be carefully considered depending on patient needs and economic capabilities.
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Affiliation(s)
- Ji-Hoon Baek
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Su Chan Lee
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Suengryol Ryu
- Department of Orthopaedic Surgery, Himnaera Hospital, Busan, Republic of Korea
| | - Hye Sun Ahn
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
| | - Chang Hyun Nam
- Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Republic of Korea
- Correspondence: Chang Hyun Nam, Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, 120, Sinmok-ro, Yangcheon-gu, Seoul, 07999, Republic of Korea, Tel +82-2-3219-9229, Fax +82-2-2061-8605, Email
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Banios K, Raoulis V, Fyllos A, Chytas D, Mitrousias V, Zibis A. Anterior and Posterior Cruciate Ligaments Mechanoreceptors: A Review of Basic Science. Diagnostics (Basel) 2022; 12:diagnostics12020331. [PMID: 35204424 PMCID: PMC8870829 DOI: 10.3390/diagnostics12020331] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Proprioception is a specialized sensory modality encompassing the movement of the joint and its position in space, and it involves the conversion of mechanical deformation of tissues into neural signals. Mechanoreceptors are specialized nerve structures able to transmit mechanical deformation through electrical signals to dorsal root ganglion sensory neurons and are abundant in the muscles, tendons and ligaments of the knee joint. They are believed to play an important role in knee proprioception and dynamic knee stability. Proprioception should always be taken into consideration for successful reconstruction of the cruciate-deficient knee and for pain and function management in the arthritic knee. Advances in histological methods of detection are numerous and continue to highlight the presence and role of mechanoreceptors after ligament reconstruction, depending on choice of graft. In this review, we present the current knowledge of anterior and posterior cruciate ligaments and grafts mechanoreceptors, and their role in proprioception of knee joint, focusing on each type of mechanoreceptors.
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Affiliation(s)
- Konstantinos Banios
- Department of Orthopedic Surgery, General Hospital of Karditsa, Peripheral Road Karditsa-Kastania, 43100 Karditsa, Greece;
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
| | - Vasileios Raoulis
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
| | - Apostolos Fyllos
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
| | - Dimitrios Chytas
- Department of Physiotherapy, University of Peloponnese, 20 Plateon Street, 23100 Sparta, Greece;
| | - Vasileios Mitrousias
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
- Department of Orthopedic Surgery, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece
| | - Aristeidis Zibis
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
- Correspondence:
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25
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Park JS, Lee HJ, Jo YH, Lee MK, Lee BG. Surgical Trends of Shoulder Arthroplasty: Nationwide Epidemiologic Study in South Korea. Clin Orthop Surg 2022; 15:290-299. [PMID: 37008973 PMCID: PMC10060777 DOI: 10.4055/cios22163] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background The aim of this study was to determine the nationwide shoulder arthroplasty trends in South Korea based on an analysis of nationwide data acquired from the Korean Health Insurance Review and Assessment Service (HIRA). Methods We analyzed a nationwide database acquired from the HIRA that covered 2008 to 2017. International Classification of Diseases, 10th Revision (ICD-10) codes and procedure codes were used to identify patients who underwent shoulder arthroplasty, including total shoulder arthroplasty (TSA), hemiarthroplasty (HA), and revision shoulder arthroplasty. Results From 2008 to 2017, a total of 19,831 shoulder arthroplasties were performed; there were 16,162 TSAs and 3,669 hemiarthroplasties. During the 10-year study period, there was an exponential increase in the incidence of TSA (from 513 cases in 2008 to 3,583 cases in 2017), while the number of hemiarthroplasties remained steady. The most common diagnoses for TSA were rotator cuff tears (6,304 cases, 39.0%) and osteoarthritis (6,589 cases, 40.8%) for all 9 years. Osteoarthritis was the most common reason for TSA during the first 3 years (2008-2010), but rotator cuff tears ultimately surpassed osteoarthritis during the last 3 years (2015-2017). HA was performed to treat proximal humerus fracture (1,770 cases, 48.2%) and osteoarthritis (774 cases, 21.1%). In terms of hospital types, the rate of TSA in hospitals with 30-100 inpatient beds increased from 21.83% to 46.27%, while the rates of the other types of surgery decreased. A total of 430 revision surgeries were performed during the study period, and infection (152 cases, 35.3%) was the most common reason for revision surgery. Conclusions Overall, the total count and incidence of TSA, unlike HA, increased rapidly between 2008 and 2017 in South Korea. Moreover, at the end of the study period, nearly half of the TSAs were performed in small hospitals (30 to 100 beds). Rotator cuff tears were the leading cause of TSA at the end of the study period. These findings revealed an explosive increase in reverse TSA surgery.
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Affiliation(s)
- Jin Sik Park
- Department of Orthopaedic Surgery, Hanyang University Medical Center, Seoul, Korea
| | - Hee Jae Lee
- Department of Orthopaedic Surgery, Hanyang University Medical Center, Seoul, Korea
| | - Young-Hoon Jo
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Myoung Keun Lee
- Department of Orthopaedic Surgery, Hanyang University Medical Center, Seoul, Korea
| | - Bong Gun Lee
- Department of Orthopaedic Surgery, Hanyang University Medical Center, Seoul, Korea
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26
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The reasons for and mortality of patients unable to receive reimplantation after resection arthroplasty for chronic hip periprosthetic infection. INTERNATIONAL ORTHOPAEDICS 2021; 46:465-472. [PMID: 34746981 DOI: 10.1007/s00264-021-05254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Two-stage exchange arthroplasty is a feasible treatment for chronic PJI (periprosthetic joint infection) of total hip arthroplasty (THA). However, there are large numbers of patients who are unable to ultimately receive reimplantation after resection arthroplasty owing to uncontrolled infection and multiple comorbidities. The purpose of the current study was to identify patient-related risk factors and reasons for being unable to undergo revision THA. METHODS Individuals undergoing resection arthroplasty for chronic PJI treatment from 2013 to 2020 at our institution were retrospectively reviewed. A variety of patient comorbidities, laboratory data, isolated pathogens, and follow-up status were collected for analysis. RESULTS A total of 84 patients (46 men and 38 women) with a 2.7 ± 2.1-year follow-up were analyzed. Thirty-eight (45.2%) patients eventually underwent revision THA, while the other 46 (54.8%) did not receive reimplantation during follow-up. The patients without receiving reimplantation had higher Charlson comorbidity index (CCI) score (3.1 ± 2.9 versus 1.2 ± 1.5; p = 0.001). Lower cumulative incidence of receiving reimplantation was observed in patients with chronic kidney disease (log-rank test, p = 0.019), anemia (p = 0.011), presence of initial fever (p = 0.030), and oxacillin-resistant strain infection (p = 0.030). The most common reasons for not receiving reimplantation were uncontrolled infection, unstable medical conditions, and death. The patients without reimplantation had a relatively higher mortality rate (log-rank test, p = 0.002). CONCLUSION Chronic hip PJI with poor medical conditions or oxacillin-resistant strain infection decreased the chance of undergoing revision surgery. These patients had unfavourable outcomes and a higher mortality rate after resection arthroplasty.
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Bravi M, Santacaterina F, Bressi F, Papalia R, Campi S, Sterzi S, Miccinilli S. Does Posterior Cruciate Ligament Retention or Sacrifice in Total Knee Replacement Affect Proprioception? A Systematic Review. J Clin Med 2021; 10:jcm10163470. [PMID: 34441765 PMCID: PMC8396862 DOI: 10.3390/jcm10163470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Proprioception is an important part of the somatosensory system involved in human motion control, which is fundamental for activities of daily living, exercise, and sport-specific gestures. When total knee arthroplasty (TKA) is performed, the posterior cruciate ligament (PCL) can be retained, replaced, or discarded. The PCL seems to be responsible for maintaining the integrity of the joint position sense (JPS) and joint kinesthesia. The aim of this review was to assess the effect of PCL on knee joint proprioception in total knee replacement. Methods: This systematic review was conducted within five electronic databases: PubMed, Scopus, Web of Science, Cochrane, and PEDro with no data limit from inception to May 2021. Results: In total 10 publications were evaluated. The analysis was divided by proprioception assessment method: direct assessment (JPS, kinesthesia) and indirect assessment (balance). Conclusions: The current evidence suggest that the retention of the PCL does not substantially improve the joint proprioception after TKA. Due to the high heterogeneity of the studies in terms of design, proprioception outcomes, evaluation methods, further studies are needed to confirm the conclusions. In addition, future research should focus on the possible correlation between joint proprioception and walking function.
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Affiliation(s)
- Marco Bravi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
- Correspondence:
| | - Fabio Santacaterina
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Federica Bressi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.P.); (S.C.)
| | - Stefano Campi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (R.P.); (S.C.)
| | - Silvia Sterzi
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
| | - Sandra Miccinilli
- Department of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200, 00128 Rome, Italy; (F.S.); (F.B.); (S.S.); (S.M.)
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Rupp M, Walter N, Lau E, Worlicek M, Kurtz SM, Alt V. Recent trends in revision knee arthroplasty in Germany. Sci Rep 2021; 11:15479. [PMID: 34326421 PMCID: PMC8322047 DOI: 10.1038/s41598-021-94988-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
We aimed to answer the following questions: (1) How did numbers of revision knee arthroplasty procedures develop in Germany over the last decade compared to primary TKA? (2) How high was the percentage of septic interventions in knee prosthesis revisions? (3) Which treatment strategy was chosen for surgical treatment of knee PJI? Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). In 2018, a total number 23,812 revision knee arthroplasties were performed in Germany, yielding an overall increase of 20.76% between 2008 and 2018. In comparison, primary TKA procedures increased by 23.8% from 152,551 performed procedures in 2008 to 188,866 procedures in 2018. Hence, 12.6% of knee arthroplasties required a revision in 2018. Septic interventions increased by 51.7% for all revisions. A trend towards higher numbers in younger patients was observed. Compared to 2008, 17.41% less DAIR procedures were performed, whereby single-stage and two- or multi-stage change increased by 38.76% and 42.76% in 2018, respectively. The increasing number of revision knee arthroplasty in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies to delay primary arthroplasty and avoid periprosthetic joint infection.
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Affiliation(s)
- Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | | | - Michael Worlicek
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | | | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Efficacy and safety of duloxetine for postoperative pain after total knee arthroplasty in centrally sensitized patients: study protocol for a randomized controlled trial. BMC Musculoskelet Disord 2021; 22:316. [PMID: 33785016 PMCID: PMC8008334 DOI: 10.1186/s12891-021-04168-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative residual knee pain after total knee arthroplasty (TKA) is a significant factor that contributes to patient dissatisfaction. Patients with preoperative central sensitization (CS) may be more susceptible to unexplained chronic pain after TKA, and duloxetine has been reported to be effective in post-TKA pain control in patients with CS. However, there remains limited evidence to support this off-label use in routine clinical practice. Hence, we designed this randomized, placebo-controlled, triple-blind clinical trial to evaluate the effects of preoperative screening and targeted duloxetine treatment of CS on postoperative residual pain compared with the care-as-usual control group. Methods This randomized controlled trial includes patients with knee osteoarthritis on a waiting list for primary unilateral TKA. Patients with preoperative CS will be randomly allocated to the perioperative duloxetine treatment group (duloxetine group) or the care-as-usual control group (placebo group). Patients in the duloxetine group will receive a half-dose of preemptive duloxetine (30 mg/day) for a week before surgery and a full-dose of duloxetine (60 mg/day) for six weeks after surgery. The primary outcome is the intensity of residual pain at six months after TKA, including the visual analogue scale, 11-point numeric rating scale, the sensory dimension of the brief pain inventory, and the pain subscale of the Knee injury and Osteoarthritis Outcome Score. The secondary outcome measures will include the pain and function related outcomes. All of the patients will be followed up at one, three, and six months after surgery. All adverse events will be recorded and immediately reported to the primary investigator and ethics committee to decide if the patient needs to drop out from the trial. Discussion This clinical trial will convey the latest evidence of the efficacy and safety of the application of duloxetine in postoperative pain control in CS patients who are scheduled for TKA. The study results will be disseminated at national and international conferences and published in peer-reviewed journals. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn) registration number: ChiCTR2000031674. Registered 07 April 2020.
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