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Olsen AA, Junge JM, Booth G, Abraham VM, Balazs GC, Goldman AH. A Lack of Generalizability-Total Knee Demographics in the Active Duty Population. Mil Med 2024; 189:e1161-e1165. [PMID: 37966515 DOI: 10.1093/milmed/usad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Age and sex are known demographic risk factors for requiring revision surgery following primary total knee arthroplasty (TKA). Military service members are a unique population with barriers to long-term follow up after surgery. This study aims to compare demographic data between active duty military personnel and a nationwide sample to identify differences that may impact clinical and economic outcomes. METHODS A retrospective observational analysis was performed using the Military Health System Data Repository (MDR) and the National Surgical Quality Improvement Program (NSQIP). Databases were queried for patients undergoing primary TKA between January 1, 2015 and December 31, 2020. The MDR was queried for demographic data including age, sex, duty status, facility type, geographic region, history of prior military deployment, history of deployment-related health condition, branch of military service, and military rank. National Surgical Quality Improvement Program was queried for age and sex. Median age between populations was compared with the Mann-Whitney U test, and gender was compared with a chi-squared test. RESULTS During the study period, 2,094 primary TKA patients were identified from the MDR, and 357,865 TKA patients were identified from the NSQIP database. Military TKA patients were 79.4% male with a median age of 49.0, and NSQIP TKA patients were 38.9% were male, with a median age of 67. Military TKA patients were significantly more likely to be male (P < .001) and younger (P < .001). CONCLUSION Patients undergoing TKA in the military are younger and more likely to be male compared to national trends. Current evidence suggests these factors may place them at a significant revision risk in the future. The application of quality metrics based on nationwide demographics may not be applicable to military members within the Military Health System.
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Affiliation(s)
- Aaron A Olsen
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| | - Joshua M Junge
- Department of Anesthesia, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Greg Booth
- Department of Anesthesia, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Vivek M Abraham
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| | - George C Balazs
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
| | - Ashton H Goldman
- Department of Orthopaedic Surgery, Bone and Joint Sports Medicine Institute, Portsmouth, VA 23708, USA
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Fary C, Cholewa J, Ren AN, Abshagen S, Anderson MB, Tripuraneni K. Multicenter, prospective cohort study: immediate postoperative gains in active range of motion following robotic-assisted total knee replacement compared to a propensity-matched control using manual instrumentation. ARTHROPLASTY 2023; 5:62. [PMID: 38044446 PMCID: PMC10694935 DOI: 10.1186/s42836-023-00216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/27/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Range of motion (ROM) following total knee replacement (TKR) has been associated with patient satisfaction and knee function, and is also an early indicator of a successful procedure. Robotic-assisted TKR (raTKR) is considered to reproduce more precise resections, and, as a result, may be associated with improved early patient satisfaction compared to manual TKR (mTKR). The purpose of this study was to evaluate the early postoperative active ROM (aROM) between raTKR and mTKR. METHODS A total of 216 mTKR patients were propensity-matched, in terms of age, gender, comorbidities, and BMI, to 216 raTKR cases. Intraoperative and immediate postoperative adverse events were collected. Knee flexion and extension aROM were measured preoperatively and at one- and three months after operation. RESULTS Changes in flexion aROM were significantly greater in raTKR vs. mTKR at one- (6.9°, 95% CI: 3.5, 10.4°) and three months (4.9°, 95% CI: 2.1, 7.7°). Flexion aROM was greater at three postoperative months compared to preoperative aROM only in the raTKR group, and raTKR patients had higher odds of achieving ≥ 90° of flexion at one month after operation (OR: 2.15, 95% CI: 1.16, 3.99). There were no significant differences between groups in intraoperative (P > 0.999) or postoperative adverse events. CONCLUSIONS Compared with mTKR, raTKR resulted in less loss of aROM immediately after operation and a faster recovery of aROM within three months after operation. TRIAL REGISTRATION Clinicaltrials.gov (NCT# 03737149).
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Affiliation(s)
- Camdon Fary
- Epworth Foundation, Richmond, VIC, 3121, Australia
- Department of Orthopaedics, Western Hospital, Melbourne, 3011, Australia
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Nin DZ, Chen YW, Talmo CT, Hollenbeck BL, Niu R, Chang DC, Smith EL, Mattingly D. Arthroscopic Procedures Are Performed in 5% of Patients With Knee Osteoarthritis 1 Year Preceding Total Knee Arthroplasty and Are Associated With Increased Stiffness and Increased Costs. Arthrosc Sports Med Rehabil 2023; 5:100776. [PMID: 38155763 PMCID: PMC10753171 DOI: 10.1016/j.asmr.2023.100776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/15/2023] [Indexed: 12/30/2023] Open
Abstract
Purpose To describe the different types of arthroscopic procedures that patients undergo in the year prior to total knee arthroplasty (TKA), reveal the cost associated with these procedures, and understand the relationship between preoperative arthroscopy and clinical outcomes after TKA. Methods An observational cohort study was conducted using the IBM Watson Health MarketScan databases. Patients with knee osteoarthritis who underwent unilateral isolated primary TKA between January 1, 2018, and September 30, 2019, were included. Knee arthroscopic procedures performed in the 1-year period before a primary TKA was identified. The primary outcomes of interest were cost of these procedures and the risk of 90-day postoperative complications. Results In total, 2,904 patients, representing 5.2% of the analyzed cohort, underwent arthroscopic procedures in the year prior to TKA. The most common procedure and diagnosis were meniscectomy and meniscal tear, respectively, with procedures performed an average of 7.2 ± 3.0 months before TKA. Average per patient costs were $9,716 ± $5,500 in the highest payment quartile vs $1,789 ± 636 in the lowest payment quartile. Patients with a history of arthroscopy were more likely to develop postoperative stiffness (P = .001), while no difference was found in the risk of 90-day periprosthetic joint infection (PJI). Conclusions Of the patients, 5.2% underwent knee arthroscopy in the year prior to TKA. While no association was seen with PJI risk, the costs associated with these procedures are high and may increase the overall cost of management of knee osteoarthritis. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Darren Z. Nin
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Carl T. Talmo
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Brian L. Hollenbeck
- Division of Infectious Diseases, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Ruijia Niu
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - David C. Chang
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Eric L. Smith
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - David Mattingly
- Department of Orthopedic Surgery, New England Baptist Hospital, Boston, Massachusetts, U.S.A
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Andreani L, Ipponi E, Falcinelli F, Barderi S, Vannucci L, Campo FR, D’Arienzo A, Parchi PD. Distal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-Operative Rehabilitation Protocol. Healthcare (Basel) 2023; 11:2984. [PMID: 37998476 PMCID: PMC10671754 DOI: 10.3390/healthcare11222984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Megaprostheses are the most used reconstructive approach for patients who have undergone massive resection of their distal femurs due to bone tumors. Although the literature about their outcomes has flourished in recent decades, to date, a consensus on rehabilitative treatment is yet to be established. In this study, we report on our experience with our latest standardized rehabilitation program, evaluating our results in a mid-to-long-term scenario. MATERIALS AND METHODS We evaluated the functional results of all our oncologic patients treated between 2016 and 2022 who could follow our standardized post-operative rehabilitative approach, consisting of progressive knee mobilization and early weight-bearing. RESULTS Sixteen cases were included in our study. The average duration of the patients' hospitalization was 12.2 days. A standing position was reached on average 4.1 days after surgery, while assisted walking was started 4.5 days after surgery. After a mean post-operative follow-up of 46.7 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggest that the sooner patients could achieve a standing position (R = -0.609; p = 0.012) and start walking (R = -0.623; p = 0.010), the better their final functional outcomes regarding their MSTS scores. CONCLUSIONS Rehabilitation should be considered a pivotal factor in decreeing the success of distal femur megaprosthetic implants in long-surviving oncologic patients. Correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximizing the post-operative functional outcomes of these patients.
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Affiliation(s)
- Lorenzo Andreani
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Edoardo Ipponi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Federico Falcinelli
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Sara Barderi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Lorenzo Vannucci
- Department of Rehabilitation and Physical Therapy, University of Pisa, 56126 Pisa, Italy;
| | - Francesco Rosario Campo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Antonio D’Arienzo
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
| | - Paolo Domenico Parchi
- Department of Orthopedics and Trauma Surgery, University of Pisa, 56126 Pisa, Italy; (L.A.); (F.F.); (S.B.); (F.R.C.); (A.D.); (P.D.P.)
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