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Moisander AM, Pamilo K, Huopio J, Kautiainen H, Kuitunen A, Paloneva J. Risk stratification-based thromboprophylaxis does not affect mortality after fast-track hip and knee arthroplasty. Acta Anaesthesiol Scand 2024; 68:720-725. [PMID: 38531623 DOI: 10.1111/aas.14414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND PURPOSE Use of thromboprophylaxis effectively prevents pulmonary embolism (PE) and deaths after total hip and knee arthroplasty (THA and TKA). The optimum length of thromboprophylaxis is not known and has traditionally been based on the type of operation. Nowadays, a more individualized approach is preferred. This study analyzed if risk stratification-based planning of thromboprophylaxis has an association with the all-cause mortality after fast-track THA and TKA. PATIENTS AND METHODS We compared fast-track THAs and TKAs operated between 2015-2016 and 2020-2021. Between 2015 and 2016, all patients received a routine length of thromboprophylaxis. From 2020 onwards, thromboprophylaxis was planned by risk stratification, and patients at low risk for venous thromboembolism received thromboprophylaxis only during hospitalization. All causes of death within 90 days of surgery were identified and the incidence of mortality was calculated. Mortality rates between the two periods were then compared. RESULTS Between 2015 and 2016, 3192 arthroplasties were performed. A total of eight deaths occurred within 90 days of surgery, yielding an incidence of all-cause mortality of 0.3% (95% CI 0.1-0.5). Between 2020 and 2021, a total of 3713 arthroplasties were performed to patients who received risk stratification-based thromboprophylaxis. Thirteen of these patients died within 90 days of surgery, yielding an all-cause mortality incidence of 0.4% (95% CI 0.2-0.6). Cardiovascular diseases were the main cause of death during both study periods. None of the deaths were caused by PEs. INTERPRETATION Risk stratification-based thromboprophylaxis was not associated with increased all-cause mortality within 90 days of fast-track THA and TKA.
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Affiliation(s)
- Annette M Moisander
- Department of Anesthesia and Intensive Care, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Jukka Huopio
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, University of Eastern Finland, Kuopio, Finland
- Finland and Folkhälsan Research Center, Helsinki, Finland
| | - Anne Kuitunen
- Department of Intensive Care, Tampere University Hospital, Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä and University of Eastern Finland, Kuopio, Finland
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Nuevo M, Rodríguez-Rodríguez D, Jauregui R, Fabrellas N, Zabalegui A, Conti M, Prat-Fabregat S. Telerehabilitation following fast-track total knee arthroplasty is effective and safe: a randomized controlled trial with the ReHub® platform. Disabil Rehabil 2024; 46:2629-2639. [PMID: 37403684 DOI: 10.1080/09638288.2023.2228689] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE After a total knee arthroplasty (TKA), ensuring rehabilitation is continued at home is essential for a successful recovery. The aim of this randomized clinical trial (NCT04155957) was to demonstrate the safety and efficacy of an interactive telerehabilitation system (ReHub®) to guide and provide feedback during exercise in the postoperative period of a fast-track TKA program. METHODS Fifty-two patients who underwent TKA were randomized to intervention (N = 26) or control (N = 26). Upon discharge, they followed a 4-week plan of 5 daily exercises and up to 10 physiotherapy home visits. The intervention group performed exercises with ReHub® autonomously, control did not use any auxiliary device. Data were collected 1) on the day of discharge, 2) after 2 weeks and 3) after 4 weeks. RESULTS Telerehabilitation patients showed higher adherence to exercise (p = 0.002) and greater quadriceps strength (p = 0.028). No significant differences between groups were found in other outcomes. Only 1 adverse event was linked to ReHub®. Patients gave the platform high System Usability Scale scores (83/100). CONCLUSION Interactive telerehabilitation with ReHub® during a post-TKA exercise program is effective, safe, and well-received by patients. It provides real-time performance feedback and ensures communication. Quadriceps strength and adherence to the exercise plan are improved with ReHub®.
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Affiliation(s)
- Montse Nuevo
- Clinic Institute of Medical and Surgical Specialties (ICEMEQ), Hospital Clinic of Barcelona, Barcelona, Spain
- Nursing Sciences, Faculty of Health Science, University Jaume I, Castellón de la Plana, Spain
| | | | | | - Núria Fabrellas
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Adela Zabalegui
- Department of Research and Teaching in Nursing, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marco Conti
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Salvi Prat-Fabregat
- Clinic Institute of Medical and Surgical Specialties (ICEMEQ), Hospital Clinic of Barcelona, Barcelona, Spain
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Tapper V, Reito A, Pamilo K, Ylitalo A, Toom A, Paloneva J. Complications and secondary operations after non-operative and operative treatment of tibial plateau fractures: a population-based study of 562 patients with mean follow-up of 7 years. Arch Orthop Trauma Surg 2024; 144:269-280. [PMID: 37921992 DOI: 10.1007/s00402-023-05102-7] [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: 04/27/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION The incidence of tibial plateau fractures (TPF) is 1% of all fractures and increases with age. Whether non-operatively or operatively treated, complications (infection, malalignment, loss of reduction and delayed union or nonunion) and post-traumatic osteoarthritis are not uncommon, and the risk for complications has generally been assumed to rise with age. This study investigated all post-TPF complications and secondary surgery after non-operative and operative treatment. Secondary aims were to determine the incidence and epidemiology of TPF in the population of the Central Finland region. MATERIALS AND METHODS All patients over age 18 years with a TPF, including incidence, etiology, fracture type, and possible complications and reoperations, sustained during the period 1998-2019 were retrospectively identified from hospital records. RESULTS The annual mean incidence of TPF was 14.4/100,000, with older women at highest risk. The proportions of non-operative and operatively treated patients who had undergone at least one additional surgical operation were 6% and 26%, respectively. Age and female gender were identified as risk factors for complications and secondary operations. The risk peaked in patients aged 60-65 years, decreasing thereafter. Non-operative treatment showed low risk for both non-union and loss of reduction. CONCLUSIONS Older women were at the highest risk for TPF and for subsequent complications and secondary operations after TPF. Secondary operations after operatively treated TPF were not uncommon and patients aged 60-65 years were at highest risk. Given the low rates of complications and re-operations, non-operative treatment may be a safe option in cases of all minimally displaced TPF.
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Affiliation(s)
- Valtteri Tapper
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland.
| | - Aleksi Reito
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Antti Ylitalo
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Alar Toom
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Wellbeing Services County of Central Finland, Keskussairaalantie 19, 40620, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
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Cohen D, Greenberg A, Maliarov A, Seligman D, Backstein D. Long-term outcomes of the Nexgen © posterior stabilized knee: minimum 15 year follow-safe and effective. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2943-2949. [PMID: 36912950 PMCID: PMC10009351 DOI: 10.1007/s00590-023-03514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Studying long-term survivorship and functional outcomes for specific prostheses is critical for elucidating areas in need of design improvement. This study reports the long-term of the NexGen Posterior Stabilized (PS) Total Knee implant (TKA) (Zimmer Biomet, Warsaw IN) Performed by a single surgeon. METHODS Data from patients treated with the NexGen PS TKA between January 2003 and December 2005 with a minimal follow-up of 15 years was collected from a prospectively collected database. Survivorship rates and Oxford Knee Scores (OKS) were obtained for those patients available for follow-up. RESULTS Ninety-five patients met the inclusion criteria during the study period. OKS was available for 44 (46%) patients. Ten patients required revision surgery (10.52%). Implant-specific survivorship of all cases that were reviewed was 98%. Survivorship of implants in patients that we were able to reach, or deceased patients was 93%. The average Oxford Knee Score was 39.1 (14-48. SD ± 7.70) with 48 being the maximal score. CONCLUSION Despite some concerns about durability of this implant, good longevity and function was demonstrated. At a minimum of 15 years follow-up in this cohort. Given these results design features of this system should be considered for future generations of implants.
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Affiliation(s)
- Daniel Cohen
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Arieh Greenberg
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - Anton Maliarov
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Seligman
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
| | - David Backstein
- Granovsky Gluskin Orthopedic Division, Sinai Health System, University of Toronto, Toronto, ON Canada
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Le Stum M, Gicquel T, Dardenne G, Le Goff-Pronost M, Stindel E, Clavé A. Total knee arthroplasty in France: Male-driven rise in procedures in 2009-2019 and projections for 2050. Orthop Traumatol Surg Res 2023; 109:103463. [PMID: 36374765 DOI: 10.1016/j.otsr.2022.103463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of Total Knee Arthroplasty (TKA) procedures has been rising steadily for several decades in Europe and the USA. The increase varies in pace across countries, with a gradual climb in northern and central Europe, a slowing in the USA, and an exponential surge in the UK. In France, a 32.2% rise in the number of TKA and unicompartmental knee arthroplasty procedures was documented between 2012 and 2018. However, no study has focussed specifically on changes in both TKA procedures and the features of TKA patients. The objective of this study was to use the French national healthcare database to evaluate (1) increases in TKA procedures according to sex and age, (2) whether TKA is being performed at increasingly younger ages, (3) whether the comorbidity profile at TKA is changing, and (4) whether the TKA incidence rate will stabilise in the future, with a projection for 2050. HYPOTHESIS In France, the number of TKA procedures is rising in both males and females but the pace of the increases differs between sexes. MATERIAL AND METHOD This study used data collected in France in 2009-2019, separately for different age groups and for males and females, in the French national healthcare database (Système national des données de santé, SNDS) that collects information on all surgical procedures performed nationwide. Based on information about the TKA procedures, we determined (1) the TKA incidence rates with their time trends and (2) indirectly, the comorbidity profiles of the patients at TKA. Linear, Poisson, and logistic models were built to predict incidence rates in 2030, 2040, and 2050. RESULTS Between 2009 and 2019, the TKA incidence rate showed a steeper increase in males than in females (from 71.2 to 122.9 [+73%] vs. 124.2 to 181.0 [+46%], respectively). Although this increase was replicated in all age groups, it was sharper in patients younger than 65 years, in both males and females (from 20.9 to 37.9 [+82%] and 33.6 to 51.3 [+53%], respectively). During the study period, the number and proportion of patients increased in the group with mild comorbidities (from 40 093 to 67 430 TKAs, i.e., from 53.1% to 65.7% of all TKAs) but not in the other comorbidity groups. All projection models were validated. Nonetheless, the most likely scenario, provided by the logistic model, is a 33% rise by 2050 in both males and females (i.e., to 151 575 TKA procedures) with a plateau starting around 2030. CONCLUSION Although the increase in TKA procedures is more marked in males than in females, the trends are similar in both sexes, with a sharper rise in the group younger than 65 years and a shift toward patients with milder comorbidities. In the longer term, incidence rate trends follow logistic dynamics, with a plateau starting around 2030. To meet the increasing demand, a corresponding development in relevant healthcare resources must be planned. LEVEL OF EVIDENCE IV, descriptive epidemiological study.
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Affiliation(s)
- Mathieu Le Stum
- Institut national de la santé et de la recherche médicale (Inserm), laboratoire de traitement de l'information médicale (LATIM), UMR1101, 22, avenue Camille-Desmoulins, 29200 Brest, France.
| | - Thomas Gicquel
- Clinique mutualiste de la porte de l'Orient, 3, rue Robert-de-la-Croix, 56324 Lorient, France
| | - Guillaume Dardenne
- Centre hospitalo-universitaire de Brest, CHRU de Brest, LATIM, UMR 1101, 2, avenue Foch, 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
- Centre hospitalo-universitaire de Brest, CHRU de Brest, LATIM, UMR 1101, 2, avenue Foch, 29200 Brest, France; Université de Bretagne Occidentale, UBO, LATIM, UMR 1101, 22, avenue Camille-Desmoulins, 29200 Brest, France
| | - Arnaud Clavé
- Université de Bretagne Occidentale, UBO, LATIM, UMR 1101, 22, avenue Camille-Desmoulins, 29200 Brest, France; Service d'orthopédie, clinique Saint-George, 2, avenue de Rimiez, 06100 Nice, France
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Ponkilainen VT, Uimonen M, Sihvonen R, Partio N, Paloneva J, Mattila VM. Evaluation of the changes in incidence and patient age of knee arthroscopy along with changes in time between knee arthroscopy and arthroplasty between 1998 and 2018: a nationwide register study. Knee Surg Relat Res 2023; 35:19. [PMID: 37434234 DOI: 10.1186/s43019-023-00194-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Recent evidence has led to guidelines to refrain from recommending knee arthroscopy for patients with an osteoarthritis diagnosis. The aim of this study was to evaluate the latest changes in the incidence of arthroscopic surgery for degenerative knee disease, changes in the ages of those patients and the delay between knee arthroscopy and arthroplasty, in Finland between 1998 and 2018. METHOD The data for were collected from the Finnish National Hospital Discharge Register (NHDR). All knee arthroplasties and arthroscopies performed due to osteoarthritis, degenerative meniscal tears, and traumatic meniscal tears were included. Incidence rates (per 100,000 person-years) as well as the median age of patients were calculated. RESULTS The incidence of arthroscopy decreased 74% (413 to 106 per 100,000 person-years) and knee arthroplasty increased 179% (94 to 262 per 100,000 person-years) between 1998 and 2018. The incidence of all arthroscopies increased until 2006. Subsequently, the incidence of arthroscopy due to OA decreased by 91% and arthroscopic partial meniscectomy (APM) for degenerative meniscal tears decreased by 77% until 2018. The decrease of traumatic meniscal tears begun later, leading to decrease of 57% between 2011 and 2018. Conversely, the incidence of patients undergoing APM of traumatic meniscal tear increased 375%. The median age of patients who underwent knee arthroscopy decreased from 51 to 46 and from 71 to 69 in knee arthroplasty patients. CONCLUSIONS Increasing evidence that recommends refraining from knee arthroscopy in OA and degenerative meniscal tears has led to a dramatic decrease in the incidence of arthroscopies. Simultaneously, the median age of the patients who undergo these operations has continued to decrease.
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Affiliation(s)
- Ville T Ponkilainen
- Department of Surgery, Hospital Nova, Central Finland Healthcare District, Hoitajantie 3, 40620, Jyväskylä, Finland.
| | - Mikko Uimonen
- Department of Surgery, Hospital Nova, Central Finland Healthcare District, Hoitajantie 3, 40620, Jyväskylä, Finland
| | | | - Nikke Partio
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
| | - Juha Paloneva
- Department of Surgery, Hospital Nova, Central Finland Healthcare District, Hoitajantie 3, 40620, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- COXA Hospital for Joint Replacement, Biokatu 6, 33520, Tampere, Finland
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Keemu H, Alakylä KJ, Klén R, Panula VJ, Venäläinen MS, Haapakoski JJ, Eskelinen AP, Pamilo K, Kettunen JS, Puhto AP, Vasara AI, Elo LL, Mäkelä KT. Risk factors for revision due to prosthetic joint infection following total knee arthroplasty based on 62,087 knees in the Finnish Arthroplasty Register from 2014 to 2020. Acta Orthop 2023; 94:215-223. [PMID: 37140202 PMCID: PMC10158790 DOI: 10.2340/17453674.2023.12307] [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: 06/23/2022] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Periprosthetic joint infection (PJI) is the commonest reason for revision after total knee arthroplasty (TKA). We assessed the risk factors for revision due to PJI following TKA based on the Finnish Arthroplasty Register (FAR). PATIENTS AND METHODS We analyzed 62,087 primary condylar TKAs registered between June 2014 and February 2020 with revision for PJI as the endpoint. Cox proportional hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for the first PJI revision using 25 potential patient- and surgical-related risk factors as covariates. RESULTS 484 knees were revised for the first time during the first postoperative year because of PJI. The HRs for revision due to PJI in unadjusted analysis were 0.5 (0.4-0.6) for female sex, 0.7 (0.6-1.0) for BMI 25-29, and 1.6 (1.1-2.5) for BMI > 40 compared with BMI < 25, 4.0 (1.3-12) for preoperative fracture diagnosis compared with osteoarthritis, and 0.7 (0.5-0.9) for use of an antimicrobial incise drape. In adjusted analysis the HRs were 2.2 (1.4-3.5) for ASA class III-IV compared with class I, 1.7 (1.4-2.1) for intraoperative bleeding ≥ 100 mL, 1.4 (1.2-1.8) for use of a drain, 0.7 (0.5-1.0) for short duration of operation of 45-59 minutes, and 1.7 (1.3-2.3) for long operation duration > 120 min compared with 60-89 minutes, and 1.3 (1.0-1.8) for use of general anesthesia. CONCLUSION We found increased risk for revision due to PJI when no incise drape was used. The use of drainage also increased the risk. Specializing in performing TKA reduces operative time and thereby also the PJI rate.
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Affiliation(s)
- Hannes Keemu
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku.
| | - Kasperi J Alakylä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku
| | - Riku Klén
- Turku PET Centre, University of Turku and Turku University Hospital, Turku
| | - Valtteri J Panula
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku
| | - Mikko S Venäläinen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku; Department of Medical Physics, Turku University Hospital, Turku
| | | | - Antti P Eskelinen
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, University of Tampere, Tampere
| | - Konsta Pamilo
- Coxa Hospital for Joint Replacement and Faculty of Medicine and Health Technologies, University of Tampere, Tampere
| | - Jukka S Kettunen
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio
| | - Ari-Pekka Puhto
- OYS Centre for Musculoskeletal Surgery, Oulu University Hospital, Oulu
| | - Anna I Vasara
- Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Finland
| | - Laura L Elo
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku
| | - Keijo T Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku
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Mørup-Petersen A, Krogsgaard MR, Laursen M, Madsen F, Mongelard KBG, Rømer L, Winther-Jensen M, Odgaard A. Hospital variation in revision rates after primary knee arthroplasty was not explained by patient selection: baseline data from 1452 patients in the Danish prospective multicenter cohort study, SPARK. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07374-3. [PMID: 37083739 DOI: 10.1007/s00167-023-07374-3] [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: 10/25/2022] [Accepted: 02/27/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Revision rates following primary knee arthroplasty vary by country, region and hospital. The SPARK study was initiated to compare primary surgery across three Danish regions with consistently different revision rates. The present study investigated whether the variations were associated with differences in the primary patient selection. METHODS A prospective observational cohort study included patients scheduled Sep 2016 Dec 2017 for primary knee arthroplasty (total, medial/lateral unicompartmental or patellofemoral) at three high-volume hospitals, representing regions with 2-year cumulative revision rates of 1, 2 and 5%, respectively. Hospitals were compared with respects to patient demographics, preoperative patient-reported outcome measures, motivations for surgery, implant selection, radiological osteoarthritis and the regional incidence of primary surgery. Statistical tests (parametric and non-parametric) comprised all three hospitals. RESULTS Baseline data was provided by 1452 patients (89% of included patients, 56% of available patients). Patients in Copenhagen (Herlev-Gentofte Hospital, high-revision) were older (68.6 ± 9 years) than those in low-revision hospitals (Aarhus 66.6 ± 10 y. and Aalborg (Farsø) 67.3 ± 9 y., p = 0.002). In Aalborg, patients who had higher Body Mass Index (mean 30.2 kg/m2 versus 28.2 (Aarhus) and 28.7 kg/m2 (Copenhagen), p < 0.001), were more likely to be male (56% versus 45 and 43%, respectively, p = 0.002), and exhibited fewer anxiety and depression symptoms (EQ-5D-5L) (24% versus 34 and 38%, p = 0.01). The preoperative Oxford Knee Score (23.3 ± 7), UCLA Activity Scale (4.7 ± 2), range of motion (Copenhagen Knee ROM Scale) and patient motivations were comparable across hospitals but varied with implant type. Radiological classification ≥ 2 was observed in 94% (Kellgren-Lawrence) and 67% (Ahlbäck) and was more frequent in Aarhus (low-revision) (p ≤ 0.02), where unicompartmental implants were utilized most (49% versus 14 (Aalborg) and 23% (Copenhagen), p < 0.001). In the Capital Region (Copenhagen), the incidence of surgery was 15-28% higher (p < 0.001). CONCLUSION Patient-reported outcome measures prior to primary knee arthroplasty were comparable across hospitals with differing revision rates. While radiographic classifications and surgical incidence indicated higher thresholds for primary surgery in one low-revision hospital, most variations in patient and implant selection were contrary to well-known revision risk factors, suggesting that patient selection differences alone were unlikely to be responsible for the observed variation in revision rates across Danish hospitals. LEVEL OF EVIDENCE II, Prospective cohort study.
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Affiliation(s)
- Anne Mørup-Petersen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Michael Rindom Krogsgaard
- Department of Orthopaedic Surgery, Section for Sports Traumatology, Bispebjerg and Frederiksberg Hospital, Copenhagen, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - Mogens Laursen
- Department of Orthopaedic Surgery, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Lone Rømer
- Department of Radiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Matilde Winther-Jensen
- Center for Clinical Research and Prevention, Department of Data, Biostatistics and Pharmacoepidemiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, University of Copenhagen, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, København Ø, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Tiulpin A, Saarakkala S, Mathiessen A, Hammer HB, Furnes O, Nordsletten L, Englund M, Magnusson K. Predicting total knee arthroplasty from ultrasonography using machine learning. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100319. [DOI: 10.1016/j.ocarto.2022.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/15/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
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IRMOLA T, PONKILAINEN V, MÄKELÄ KT, ROBERTSSON O, W-DAHL A, FURNES O, FENSTAD AM, PEDERSEN AB, SCHRØDER HM, NIEMELÄINEN MJ, ESKELINEN A. Impact of Nordic Arthroplasty Register Association (NARA) collaboration on demographics, methods and revision rates in knee arthroplasty: a register-based study from NARA 2000-2017. Acta Orthop 2022; 93:866-873. [PMID: 36445098 PMCID: PMC9707384 DOI: 10.2340/17453674.2022.5256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE We have previously observed differences in treatment and outcome of knee arthroplasties in the Nordic countries. To evaluate the impact of Nordic collaboration in the last 15 years we aimed to compare patient demographics, methods, and revision rates in primary knee arthroplasties among the 4 Nordic countries. PATIENTS AND METHODS We included 535,051 primary knee arthroplasties reported 2000-2017 from the Nordic Arthroplasty Register Association (NARA) database. Kaplan-Meier analysis (KM) and restricted mean survival time (RMST) analysis were used to evaluate the cumulative revision rate (CRR) and RMST estimates with 95% confidence intervals (CI) and to compare countries in relation to risk of revision for any reason. RESULTS After 2010, the increase in incidence of knee arthroplasty plateaued in Sweden and Denmark but continued to increase in Finland and Norway. In 2017 the incidence was highest in Finland with 226 per 105 person-years, while it was less than 150 per 105 in the 3 other Nordic countries. In total knee arthroplasties performed for osteoarthritis (OA), overall CRR at 15 years for revision due to any reason was higher in Denmark (CRR 9.6%, 95% CI 9.2-10), Norway (CRR 9.1%, CI 8.7-9.5), and Finland (CRR 7.0%, CI 6.8-7.3) compared with Sweden (CRR 6.6%, CI 6.4-6.8). There were differences among the countries in use of implant brand and type, fixation, patellar component, and use of unicompartmental knee arthroplasty. INTERPRETATION We evinced a slowing growth of incidence of knee arthroplasties in the Nordic countries after 2010 with Finland having the highest incidence. We also noted substantial differences among the 4 Nordic countries, with Sweden having a lower risk of revision than the other countries. No impact of NARA could be demonstrated and CRR did not improve over time.
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Affiliation(s)
- Tero IRMOLA
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Ville PONKILAINEN
- Department of Orthopaedics and Traumatology, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Keijo T MÄKELÄ
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland,Department of Orthopaedics and Traumatology, Turku University Hospital, and University of Turku, Turku, Finland
| | - Otto ROBERTSSON
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Annette W-DAHL
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Ove FURNES
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anne M FENSTAD
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Alma B PEDERSEN
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark, and the Danish Knee Arthroplasty Registry
| | - Henrik M SCHRØDER
- Department of Orthopaedic Surgery, Naestved Hospital, Denmark, and the Danish Knee Arthroplasty Register
| | - Mika J NIEMELÄINEN
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
| | - Antti ESKELINEN
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland
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11
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Aartolahti E, Janhunen M, Katajapuu N, Paloneva J, Pamilo K, Oksanen A, Keemu H, Karvonen M, Luimula M, Korpelainen R, Jämsä T, Mäkelä K, Heinonen A. Effectiveness of Gamification in Knee Replacement Rehabilitation: Protocol for a Randomized Controlled Trial With a Qualitative Approach. JMIR Res Protoc 2022; 11:e38434. [PMID: 36441574 DOI: 10.2196/38434] [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: 04/19/2022] [Revised: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Exergames can provide encouraging exercise options. Currently, there is limited evidence regarding home-based exergaming in the postoperative phase of total knee replacement (TKR). OBJECTIVE This study aimed to investigate the effects of a 4-month postoperative home-based exergame intervention with an 8-month follow-up on physical function and symptoms among older persons undergoing TKR compared with home exercise using a standard protocol. In addition, a concurrent embedded design of a mixed methods study was used by including a qualitative component within a quantitative study of exergame effects. METHODS This was a dual-center, nonblinded, two-arm, parallel group randomized controlled trial with an embedded qualitative approach. This study aimed to recruit 100 patients who underwent their first unilateral TKR (aged 60-75 years). Participants were randomized to the exergame or standard home exercise arms. Participants followed a custom-made exergame program independently at their homes daily for 4 months. The primary outcomes at 4 months were function and pain related to the knee using the Oxford Knee Score questionnaire and mobility using the Timed Up and Go test. Other outcomes, in addition to physical function, symptoms, and disability, were game user experience, exercise adherence, physical activity, and satisfaction with the operated knee. Assessments were performed at the preoperative baseline and at 2, 4, and 12 months postoperatively. Exergame adherence was followed from game computers and using a structured diary. Self-reported standard exercise was followed for 4 months of intervention and physical activity was followed for 12 months using a structured diary. Qualitative data on patients' perspectives on rehabilitation and exergames were collected through laddering interviews at 4 and 12 months. RESULTS This study was funded in 2018. Data collection began in 2019 and was completed in January 2022. The COVID-19 pandemic caused an unavoidable situation in the study for recruitment, data collection, and statistical analysis. As of November 2020, a total of 52 participants had been enrolled in the study. Primary results are expected to be published by the end of 2022. CONCLUSIONS Our study provides new knowledge on the effects of postoperative exergame intervention among older patients with TKR. In addition, this study provides a new understanding of gamified postoperative rehabilitation, home exercise adherence, physical function, and physical activity among older adults undergoing TKR. TRIAL REGISTRATION ClinicalTrials.gov NCT03717727; https://clinicaltrials.gov/ct2/show/NCT03717727. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/38434.
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Affiliation(s)
- Eeva Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Katajapuu
- Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Healthcare District and University of Eastern Finland, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Airi Oksanen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko Karvonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr, Oulu, Finland.,Research Unit of Population Health, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Keijo Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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PAMILO KJ, HAAPAKOSKI J, SOKKA-ISLER T, REMES V, PALONEVA J. Rapid rise in prevalence of knee replacements and decrease in revision burden over past 3 decades in Finland: a register-based analysis. Acta Orthop 2022; 93:382-389. [PMID: 35383858 PMCID: PMC8985425 DOI: 10.2340/17453674.2022.2266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The prevalence of knee joint replacements (KJR) has been less investigated in situations where the increase in incidence is known. This study investigated the annual and population-based prevalence of KJR and the relationship between the prevalence of KJRs and the incidence of revision surgery. PATIENTS AND METHODS All KJRs performed between 1980 and 2020 were identified from the Finnish Arthroplasty Register (FAR). KJR revisions and removals were extracted from the FAR and hospital discharge registers and patient deaths from Finnish Digital and Population Data Services Agency. We analyzed the annual prevalence by dividing the number of KJR survivors by the population aged 40 or older. The revision burden factor (RBF) was determined by dividing the annual number of revisions by the number of primary and revision KJRs in the population. Proportions of bilateral implants and patients with older KJRs performed 10 or more years earlier were identified. RESULTS KJR prevalence in Finland increased by 298% between 2000 and 2020, reaching 4.0% in 2020. The proportion of patients with bilateral KJRs and those with older KJRs had increased to 37% and 34%, respectively, by 2020. The annual RBF decreased statistically significantly from 1.9% to 0.7% between 1996 and 2020 (proportion ratio, PR 0.37 [95% CI 0.33-0.42]) and was higher among males (PR 1.23 [CI 1.20-1.26]). INTERPRETATION Although the recent rapid increase in KJRs is abating and the RBF is diminishing, it is important to take the continuing increase in the prevalence of KJRs into account when assessing hospitals' future resources.
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Affiliation(s)
| | | | - Tuulikki SOKKA-ISLER
- Hospital Nova of Central Finland, Central Finland Health Care District, Jyväskylä,University of Eastern Finland, Kuopio
| | - Ville REMES
- SYNLAB Suomi, Helsinki,Jokilaakso Hospital, Jämsä, Finland
| | - Juha PALONEVA
- Hospital Nova of Central Finland, Central Finland Health Care District, Jyväskylä,University of Eastern Finland, Kuopio
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13
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LEWIS PL, W-DAHL A, ROBERTSSON O, LORIMER M, PRENTICE HA, GRAVES SE, PAXTON EW. The effect of patient and prosthesis factors on revision rates after total knee replacement using a multi-registry meta-analytic approach. Acta Orthop 2022; 93:284-293. [PMID: 35113168 PMCID: PMC8808477 DOI: 10.2340/17453674.2022.1997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Characteristics of patients receiving total knee arthroplasty (TKA) and prostheses used vary between regions and change with time. How these practice variations influence revision remains unclear. We combined registry data for better understanding of the impact of variation, which could potentially improve revision rates. PATIENTS AND METHODS We used data from 2003 to 2019 for primary TKA from arthroplasty registries of Sweden (SKAR), Australia (AOANJRR), and Kaiser Permanente (KPJRR). We included 1,072,924 TKA procedures for osteoarthritis. Factors studied included age, sex, ASA class, BMI category, prosthesis constraint, fixation, bearing mobility, patellar resurfacing, and polyethylene type. Cumulative percentage revision (CPR) was calculated using Kaplan-Meier estimates, and unadjusted Cox hazard ratios were used for comparisons. Random-effects generic inverse-variance meta-analytic methods were used to determine summary effects. RESULTS We found similarities in age and sex, but between-registry differences occurred in the other 7 factors studied. Patients from Sweden had lower BMI and ASA scores compared with other registries. Use of cement fixation was similar in the SKAR and KPJRR, but there were marked differences in patellar resurfacing and posterior stabilized component use. Meta-analysis results regarding survivorship favored patients aged ≥ 65 years and minimally stabilized components. There were inconsistent results with time for sex, fixation, and bearing mobility, and no differences for the patellar resurfacing or polyethylene type comparisons. INTERPRETATION Marked practice variation was found. Use of minimally stabilized and possibly also cemented and fixed bearing prostheses is supported.
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Affiliation(s)
- Peter L LEWIS
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, SA Australia,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Annette W-DAHL
- Swedish Knee Arthroplasty Register, Lund, Sweden,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Otto ROBERTSSON
- Swedish Knee Arthroplasty Register, Lund, Sweden,Lund University, Faculty of Medicine, Clinical Science Lund, Department of Orthopedics, Lund, Sweden
| | - Michelle LORIMER
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | | | - Stephen E GRAVES
- Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, SA Australia
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14
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Keast M, Hutchinson AF, Khaw D, McDonall J. Impact of Pain on Postoperative Recovery and Participation in Care Following Knee Arthroplasty Surgery: A Qualitative Descriptive Study. Pain Manag Nurs 2021; 23:541-547. [PMID: 34972657 DOI: 10.1016/j.pmn.2021.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/28/2021] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient participation in care is key to optimising postsurgical outcomes and the quality of acute care delivery. AIMS This study explored patient perceptions of the impact of pain on acute recovery following Total Knee Arthroplasty (TKA), and barriers and facilitators to participating in pain management. DESIGN An exploratory-descriptive qualitative study involving semi-structured interviews. SETTINGS A private-sector health service. PARTICIPANTS/SUBJECTS Participants were adults undergoing TKA allocated to the control ward of a cluster randomised controlled trial who received standard care. METHODS To allow adequate opportunity for participation in their care, interview and pain data were collected on postoperative Day 3. Acute pain was assessed using an 11-point Numerical Rating Scale (NRS). Interviews were analysed using combined qualitative thematic analysis and quantitative content analysis. RESULTS Overall, 120 patients, 69 females (50.4%) and 68 males, were interviewed (mean age = 66.8 years, stadard deviation [SD] = 8.5). Most reported severe (NRS 7-10), day 3 pain (n = 76, 63.3%). Two themes emerged from interviews: (1) participants' postoperative pain experience; and (2) participation in postoperative pain management was limited. Pain experience was characterised by variation in pain and its qualities, having uncontrolled pain and distress, and influence from preoperative expectations. Patient participation was characterized by reliance upon prior staff instruction, barriers from limited knowledge, inconsistent promotion of non-pharmacologic strategies, and suboptimal clinician-patient communication. Regular analgesia was identified to facilitate participation. CONCLUSIONS Despite the known benefits of patient participation in pain management, gaps remain in providing patients with the knowledge and opportunity to take an active role in their recovery. Interventions to overcome identified barriers need to be developed and evaluated.
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Affiliation(s)
- Mirella Keast
- Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia
| | - Anastasia F Hutchinson
- Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia; Deakin University Geelong, Centre for Quality and Patient Safety Research -Epworth Healthcare Partnership in the Institute for Health Transformation, Burwood, Australia
| | - Damien Khaw
- Deakin University Geelong, Centre for Quality and Patient Safety Research -Epworth Healthcare Partnership in the Institute for Health Transformation, Burwood, Australia
| | - Joanne McDonall
- Deakin University Geelong, School of Nursing and Midwifery, Burwood, Australia; Deakin University Geelong, Centre for Quality and Patient Safety Research -Epworth Healthcare Partnership in the Institute for Health Transformation, Burwood, Australia.
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15
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Liu WY, van der Steen MC, van Wensen RJA, van Kempen RWTM. Recovery patterns in patients undergoing revision surgery of the primary knee prosthesis. J Exp Orthop 2021; 8:117. [PMID: 34913109 PMCID: PMC8674388 DOI: 10.1186/s40634-021-00436-w] [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: 07/12/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose Despite good survival rates of revised knee prostheses, little is known about recovery trajectories within the first 12 months after surgery. This retrospective observational study explored recovery trajectories in terms of pain, function and quality of life in patients after revision knee arthroplasty over 12 months. Methods Eighty-eight revision knee arthroplasty patients rated changes in daily physical functioning using the anchor question (0: very much worsened; 7: very much improved). Patient reported outcome measures (PROMs) of pain (range 0–10), function (Oxford Knee Score) and quality of life (EQ-5D-3L) were assessed preoperatively, at 3 and 12 months postoperatively. Four recovery trajectories were identified using the anchor question at 3 and 12 months postoperatively: no improvement, late improvement, early improvement, and prolonged improvement. Repeated measures ANOVA was conducted with recovery trajectories as dependent variable and PROM assessments as independent variables. Results Sixty percent reported improvement in daily physical functioning at 12 months postoperatively. Age and reason for revision differed between groups. Pain, function and EQ-5D-3L differed between groups over time. Late and prolonged improvement groups improved on all PROMs at 12 months. The early improvement group did not report improvement in daily physical functioning at 12 months, while improvements in function and pain during activity were observed. Conclusions Different recovery trajectories seem to exist and mostly match PROMs scores over time. Not all patients may experience beneficial outcome of revision knee arthroplasty. These findings are of importance to provide appropriate information on possible recovery trajectories after revision knee arthroplasty to patients. Level of evidence III Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00436-w.
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Affiliation(s)
- W Y Liu
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands. .,Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, the Netherlands.
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands
| | - R J A van Wensen
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands
| | - R W T M van Kempen
- Department of Orthopaedic Surgery & Trauma, Catharina Hospital, P.O. box 1350, 5602 ZA, Eindhoven, the Netherlands
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16
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Iwamoto K, Yamazaki T, Sugamoto K, Tomita T. Comparison of in vivo kinematics of total knee arthroplasty between cruciate retaining and cruciate substituting insert. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 26:47-52. [PMID: 34722162 PMCID: PMC8521180 DOI: 10.1016/j.asmart.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022]
Abstract
Background The decision to choose cruciate retaining (CR) insert or cruciate substituting (CS) insert during total knee arthroplasty (TKA) remains a controversial issue. We hypothesized that there are different knee kinematics between CR and CS inserts and that a raised anterior lip design would offer a potential minimization of the paradoxical movement and provide joint stability. The objective of this study was to evaluate and compare kinematics of a CR and CS TKA of the same single-radius design. Methods We investigated the in vivo knee kinematics of 20 knees with a CR TKA (10 knees in the CR insert and 10 knees in the CS insert). Patients were examined during deep knee flexion using fluoroscopy and femorotibial motion was determined using a 2- to 3-dimensional registration technique, which used computer-assisted design models to reproduce the spatial positions of the femoral and tibial components. We evaluated the knee range of motion (ROM), femoral axial rotation relative to the tibial component, anteroposterior translation, and kinematic pathway of the nearest point of the medial and lateral femoral condyles on the tibial tray. Results The average ROM was 121.0 ± 17.3° in CR and 110.8 ± 12.4° in CS. The amount of femoral axial rotation was 7.2 ± 3.9° in CR, and 7.4 ± 2.7° in CS. No significant difference was observed in the amount of anterior translation between CR and CS. The CR and CS inserts had a similar kinematic pattern up to 100° flexion that was central pivot up to 70° flexion and then paradoxical anterior femoral movement until 100° flexion. Conclusion The present study demonstrated that there was no significant difference between the inserts in knee kinematics. These kinematic results suggested that the increased anterior lip could not control anterior movement in the CS insert.
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Affiliation(s)
- Keiji Iwamoto
- Department of Orthopedic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaharu Yamazaki
- Department of Information Systems, Saitama Institute of Technology, Fukaya, Saitama, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tetsuya Tomita
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Schelde AB, Petersen J, Jensen TB, Gromov K, Overgaard S, Olesen JB, Jimenez-Solem E. Thromboembolic and bleeding complications following primary total knee arthroplasty : a Danish nationwide cohort study. Bone Joint J 2021; 103-B:1571-1577. [PMID: 34587805 DOI: 10.1302/0301-620x.103b10.bjj-2021-0023.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS The aim of this study is to compare the effectiveness and safety of thromboprophylactic treatments in patients undergoing primary total knee arthroplasty (TKA). METHODS Using nationwide medical registries, we identified patients with a primary TKA performed in Denmark between 1 January 2013 and 31 December 2018 who received thromboprophylactic treatment. We examined the 90-day risk of venous thromboembolism (VTE), major bleeding, and all-cause mortality following surgery. We used a Cox regression model to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome, pairwise comparing treatment with dalteparin or dabigatran with rivaroxaban as the reference. The HRs were both computed using a multivariable and a propensity score matched analysis. RESULTS We identified 27,736 primary TKA patients who received thromboprophylactic treatment (rivaroxaban (n = 18,846); dalteparin (n = 5,767); dabigatran (n = 1,443); tinzaparin (n = 1,372); and enoxaparin (n = 308)). In the adjusted multivariable analysis and compared with rivaroxaban, treatment with dalteparin (HR 0.68 (95% CI 0.49 to 0.92)) or dabigatran (HR 0.31 (95% CI 0.13 to 0.70)) was associated with a decreased risk of VTE. No statistically significant differences were observed for major bleeding or all-cause mortality. The propensity score matched analysis yielded similar results. CONCLUSION Treatment with dalteparin or dabigatran was associated with a decreased 90-day risk of VTE following primary TKA surgery compared with treatment with rivaroxaban. Cite this article: Bone Joint J 2021;103-B(10):1571-1577.
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Affiliation(s)
- Astrid Blicher Schelde
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Janne Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Copenhagen Phase 4 Unit, Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Thomas Bo Jensen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark.,The Danish Hip Arthroplasty Register, Denmark
| | - Søren Overgaard
- The Danish Hip Arthroplasty Register, Denmark.,Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jonas Bjerring Olesen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Espen Jimenez-Solem
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Copenhagen Phase 4 Unit, Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Leppänen S, Niemeläinen M, Huhtala H, Eskelinen A. Mild knee osteoarthritis predicts dissatisfaction after total knee arthroplasty: a prospective study of 186 patients aged 65 years or less with 2-year follow-up. BMC Musculoskelet Disord 2021; 22:657. [PMID: 34353317 PMCID: PMC8344222 DOI: 10.1186/s12891-021-04543-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 07/08/2021] [Indexed: 02/08/2023] Open
Abstract
Background and aims The incidence of total knee arthroplasty (TKA) is increasing, especially among younger working-age patients. However, dissatisfaction rates in this population are higher than among older patients. The aim of this study was to assess the rates of dissatisfaction and persistent pain after TKA and to evaluate those factors that predict these outcomes. Material and methods In total, 186 patients undergoing unilateral TKA aged 65 years or less were enrolled into this prospective observational study with 2-year follow-up. To assess the outcome, the visual analogue scales regarding satisfaction and persistent pain at rest and during exercise were used. In addition, the association between patients´ demographics, radiographic severity of knee osteoarthritis (OA), patient-reported outcome measures (PROMs) and dissatisfaction and persistent pain were tested by univariate logistic regression analysis. Mild OA was defined as Kellgren-Lawrence (KL) grade 2 and severe OA as KL grade 3–4. Furthermore, multiple logistic regression analysis was also conducted to test statistically significant relations. Results After 2 years, 12 % (n = 23) of patients were dissatisfied with the outcome of TKA, 27 % (n = 50) reported persistent pain during exercise and 10 % (n = 18) at rest. Patients with mild knee OA were significantly more dissatisfied (28.6 %) than patients with more severe OA (8.7 %) (p = 0.003). Younger patients had an increased risk for both dissatisfaction and persistent pain. Apart from KOOS Quality of Life, poor preoperative KOOS subscores were also predictive for these outcomes. Conclusion Mild radiographic knee OA was the main predicting factor for dissatisfaction after TKA. Thus, performing TKA for such patients should be carefully considered. Furthermore, these patients should be informed about the increased risk for dissatisfaction and the same seems to apply to younger patients. Interestingly, when TKA is performed for patients with more severe knee OA, the satisfaction rates seem to be somewhat higher than those previously reported. Trial registration The study was retrospectively registered with ClinicalTrials.gov (registration number NCT03233620) on 28 July 2017.
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Affiliation(s)
- Sanni Leppänen
- Coxa Hospital for Joint Replacement, Tampere, Finland. .,Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.
| | - Mika Niemeläinen
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland.,Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland
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Daugberg L, Jakobsen T, Nielsen PT, Rasmussen M, El-Galaly A. A projection of primary knee replacement in Denmark from 2020 to 2050. Acta Orthop 2021; 92:448-451. [PMID: 33683167 PMCID: PMC8381887 DOI: 10.1080/17453674.2021.1894787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The incidence of knee replacements (KRs) has increased in the past decades. Previous studies have forecast a continuous and almost exponential rise in the use of KRs, but this rise must cease at some point. We estimated when and at what incidence the use of KRs will plateau in Denmark.Patients and methods - We retrieved 138,223 primary KRs conducted from 1997 to 2019 from the Danish Knee Arthroplasty Registry. Censuses from 1997 to 2019 as well as population projections from 2020 through 2050 were collected from Statistics Denmark. We applied logistic and Gompertz regression analysis to the data to estimate the future incidence until 2050 with root mean squared error (RMSE) as a quantitative measurement of the models' fit.Results - The Danish incidence of KRs from 1997 to 2009 increased by more than 300%, but has stalled since 2009. Logistic and Gompertz regression had an RMSE of 14 and 15 indicating that these models fitted the data well. Logistic and Gompertz regressions estimated that the maximum incidence will be reached in 2030 at 250 (95% prediction interval [PI]) 159-316) KRs per 105 or in 2035 at 260 (PI 182-336) KRs per 105, respectively.Interpretation - The Danish incidence of KRs seems set to plateau within the coming decades. Countries experiencing a current exponential rise at a lower incidence may benefit from this study's projection when forecasting their future demand for KRs.
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Affiliation(s)
- Louise Daugberg
- Department of Clinical Medicine, Aalborg University; ,Correspondence: LD:
| | - Thomas Jakobsen
- Department of Clinical Medicine, Aalborg University; ,Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark
| | | | - Mathias Rasmussen
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark
| | - Anders El-Galaly
- Interdisciplinary Orthopaedics, Aalborg University Hospital, Denmark
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20
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Barrett MC, Wilkinson FO, Blom AW, Whitehouse MR, Kunutsor SK. Incidence, temporal trends and potential risk factors for aseptic loosening following primary unicompartmental knee arthroplasty: A meta-analysis of 96,294 knees. Knee 2021; 31:28-38. [PMID: 34111799 DOI: 10.1016/j.knee.2021.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Aseptic loosening (AL) is among the major reasons for revision of failed primary unicompartmental knee arthroplasty (UKA). There is an ongoing temporal increase in the use of UKA with a resultant increase in the revision burden. We aimed to evaluate the incidence of, temporal trends and risk factors for AL. METHODS Longitudinal studies reporting the incidence of AL following primary UKA were sought from MEDLINE, Embase, Web of Science and Cochrane Library up to 6th April 2020. Incidence and relative risks (RR) (with 95% confidence intervals) were calculated. RESULTS We identified 62 studies for inclusion. Overall, 96,294 primary UKA procedures accounting for 1752 AL cases were included. AL incidence ranged from 0.00% to 22.70% over a 7.7 year weighted mean follow-up. The pooled random effects incidence (95% CI) was 1.77% (1.34-2.25) in the same follow-up period. The annual rate of AL was 0.10% (0.02-0.22). AL incidence increased with length of follow-up, but there was a temporal decrease from the 1970s onwards. Tibial loosening was more common than femoral component loosening: incidence (95% CI) of 1.63% (0.96-2.44) and 0.58% (0.20-1.09) respectively over a weighted follow-up of 6.6 years. Fixed bearing implant design and cemented fixation were both associated with increased AL risk, whereas robotic-assisted surgery was associated with decreased risk. CONCLUSION The overall incidence of AL following primary UKA is primarily driven by tibial component loosening and there is a temporal decline in rates. The use of mobile bearing, uncemented implants inserted with robotic assisted surgery may reduce the risk of AL.
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Affiliation(s)
- Matthew C Barrett
- Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, UK.
| | - Florence O Wilkinson
- Barts and The London School of Medicine and Dentistry, 4 Newark St, Whitechapel, London E1 2AT, UK
| | - Ashley W Blom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
| | - Michael R Whitehouse
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol BS10 5NB, UK
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21
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Hailer NP, Kuja-Halkola R, Brüggemann A, Pedersen NL, Michaëlsson K. Body Mass Index Differentially Moderates Heritability of Total Joint Replacement Due to Hip and Knee Osteoarthritis: A Cohort Study of 29,893 Swedish Twin Pairs. J Bone Joint Surg Am 2021; 103:1319-1327. [PMID: 33844661 DOI: 10.2106/jbjs.20.00946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteoarthritis and obesity are diseases with high prevalence, and they share common etiologies. We investigated the sex-specific genetic susceptibility to hip and knee osteoarthritis necessitating total joint replacement (TJR), and how body mass index (BMI) moderated the heritability of these osteoarthritis phenotypes. METHODS We linked 29,893 twin pairs with information on BMI in the Swedish Twin Registry with the Swedish National Patient Register to identify twins who underwent primary TJR of the hip or knee combined with a concomitant diagnosis of primary osteoarthritis of these joints. Structural equation modeling was used to calculate the heritability of hip and knee osteoarthritis treated with TJR, with estimates adjusted for the first available BMI, birth year, and sex. We also investigated how heritability varied with BMI treated as a continuous variable. RESULTS Similar heritability estimates for hip replacement (0.65 [95% confidence interval (CI), 0.59 to 0.70]) and knee replacement (0.57 [95% CI, 0.50 to 0.64]) were found. Heritability decreased with higher BMI in both sexes for hip replacement and in men for knee replacement. In contrast, heritability for knee replacement increased with higher BMI in women; the estimate was 0.37 (90% likelihood interval [LI], 0.25 to 0.49) for a BMI of 20 kg/m2 and 0.87 (90% LI, 0.68 to 0.94) for a BMI of 35 kg/m2. CONCLUSIONS In our population, heritability explained, on average, about half of the susceptibility to undergo primary TJR of the hip or knee with the indication of primary osteoarthritis, but it varied with BMI and sex. We demonstrated substantial heritability for knee replacement in obese women. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nils P Hailer
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anders Brüggemann
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karl Michaëlsson
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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22
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von Hintze J, Niemeläinen M, Sintonen H, Nieminen J, Eskelinen A. Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years. BMC Musculoskelet Disord 2021; 22:336. [PMID: 33827526 PMCID: PMC8028074 DOI: 10.1186/s12891-021-04205-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04205-9.
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Affiliation(s)
- Jake von Hintze
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland.
| | - Mika Niemeläinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jyrki Nieminen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland
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23
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Irmola T, Ponkilainen V, Mäkelä KT, Robertsson O, W-Dahl A, Furnes O, Fenstad AM, Pedersen AB, Schrøder HM, Eskelinen A, Niemeläinen MJ. Association between fixation type and revision risk in total knee arthroplasty patients aged 65 years and older: a cohort study of 265,877 patients from the Nordic Arthroplasty Register Association 2000-2016. Acta Orthop 2021; 92:91-96. [PMID: 33143501 PMCID: PMC7919873 DOI: 10.1080/17453674.2020.1837422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The population of the Nordic countries is aging and the number of elderly patients undergoing total knee arthroplasty (TKA) is also expected to increase. Reliable fixation methods are essential to avoid revisions. We compared the survival of different TKA fixation concepts with cemented fixation as the gold standard.Patients and methods - We used data from the Nordic Arthroplasty Register Association (NARA) database of 265,877 unconstrained TKAs performed for patients aged ≥ 65 years with primary knee osteoarthritis between 2000 and 2016. Kaplan-Meier (KM) survival analysis with 95% confidence intervals (CI) and the Cox multiple-regression model were used to compare the revision risk of the fixation methods.Results - Cemented fixation was used in 243,166 cases, uncemented in 8,000, hybrid (uncemented femur with cemented tibia) in 14,248, and inverse hybrid (cemented femur with uncemented tibia) fixation in 463 cases. The 10-year KM survivorship (95% CI) of cemented TKAs was 96% (96 - 97), uncemented 94% (94 - 95), hybrid 96% (96 - 96), and inverse hybrid 96% (94 - 99), respectively. Uncemented TKA was associated with increased risk of revision compared with the cemented TKA; the adjusted hazard ratio was 1.3 (95% CI 1.1 - 1.4).Interpretation - Cemented, hybrid, and inverse hybrid TKAs showed 10-year survival rates exceeding 95%. Uncemented fixation was associated with an increased risk of revision in comparison with cemented fixation. As both hybrid and inverse hybrid fixation were used in only a limited number of TKAs, indicating possibility of selection bias in their favor, cemented TKA still remains the gold standard, as it works reliably in the hands of many.
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Affiliation(s)
- Tero Irmola
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland; ,Correspondence:
| | - Ville Ponkilainen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Keijo T Mäkelä
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, and University of Turku, Turku, Finland;
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden. Department of Clinical Sciences, Orthopedics, Lund University, Sweden;
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden. Department of Clinical Sciences, Orthopedics, Lund University, Sweden;
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Bergen, Norway;
| | - Anne M Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital. Denmark and Danish Knee Arthroplasty Registry;
| | | | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Mika J Niemeläinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
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24
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Niemeläinen MJ, Mäkelä KT, Robertsson O, W-Dahl A, Furnes O, Fenstad AM, Pedersen AB, Schrøder HM, Reito A, Eskelinen A. The effect of fixation type on the survivorship of contemporary total knee arthroplasty in patients younger than 65 years of age: a register-based study of 115,177 knees in the Nordic Arthroplasty Register Association (NARA) 2000-2016. Acta Orthop 2020; 91:184-190. [PMID: 31928097 PMCID: PMC7144225 DOI: 10.1080/17453674.2019.1710373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Cemented fixation is regarded as the gold standard in total knee arthroplasty (TKA). Among working-age patients, there has been controversy regarding the optimal fixation method in TKA. To address this issue, we conducted a register-based study to assess the survivorship of cemented, uncemented, hybrid, and inverse hybrid TKAs in patients aged < 65 years.Patients and methods - We used the Nordic Arthroplasty Register Association data of 115,177 unconstrained TKAs performed for patients aged < 65 years with primary knee osteoarthritis over 2000-2016. Kaplan-Meier (KM) survival analysis with 95% confidence intervals (CI) and Cox multiple-regression model with adjustment for age, sex, and nation were used to compare fixation methods in relation to revision for any reason.Results - The 10-year KM survivorship of cemented TKAs was 93.6% (95% CI 93.4-93.8), uncemented 91.2% (CI 90.1-92.2), hybrid 93.0% (Cl 92.2-93.8), and inverse hybrid 96.0% (CI 94.1-98.1). In the Cox model, hybrid TKA showed decreased risk of revision after 6 years' follow-up compared with the reference group (cemented) (hazard ratio [HR] 0.5 [CI 0.4-0.8]), while uncemented TKAs showed increased risk of revision both < 1 year (HR 1.4 [1.1-1.7]) and > 6 years' (HR 1.3 [1.0-1.7]) follow-up compared to the reference.Interpretation - Both cemented and hybrid TKAs had 10-year survival rates exceeding 92->93% in patients aged < 65 years. Cemented TKA, however, was used in the vast majority (89%) of the operations in the current study. As it performs reliably in the hands of many, it still deserves the status of gold standard for TKA in working-age patients.
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Affiliation(s)
- Mika J Niemeläinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland; ,Correspondence:
| | - Keijo T Mäkelä
- Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland; ,Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland;
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden;;
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skane University Hospital, Lund, Sweden;; ,Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway;
| | - Anne M Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital. Denmark and Danish Knee Arthroplasty Registry;
| | | | - Aleksi Reito
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland;
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, University of Tampere, Tampere, Finland; ,Finnish Arthroplasty Register, National Institute for Health and Welfare, Helsinki, Finland;
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25
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Regional differences between the US, Scandinavia, and South Korea in patient demographics and patient-reported outcomes for primary total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140:93-108. [PMID: 31650229 DOI: 10.1007/s00402-019-03286-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Differences in total knee arthroplasty (TKA) patient demographics and clinical outcomes may exist between international regions, yet research is limited. The aim of this study was, therefore, to compare TKA patient demographics and patient-reported outcome measure (PROM) scores between the US, Scandinavia, and South Korea. MATERIALS AND METHODS A total of 398 TKA patients from three regions were assessed: 169 in Scandinavia (3 centers), 129 in the US (3 centers), and 100 patients in South Korea (2 centers). Regional variation in patient demographics was assessed using Kruskal-Wallis H tests. Regional variation in PROM scores from preoperative, 1-, 3- and 5-year visits was assessed using piecewise linear mixed effect models. The PROMs analyzed were a numerical rating scale for satisfaction and the Knee Osteoarthritis Outcome Score. RESULTS South Korean patients were the oldest (p < 0.001) and had the highest Charnley class (p < 0.001); US patients had the highest BMI (p < 0.001); Scandinavian patients had the lowest preoperative KL grade (p < 0.001). Scandinavian patients were associated with better preoperative and worse postoperative PROM scores. Scandinavian patients were also associated with moderately lower levels of satisfaction. These differences were lessened but remained significant after controlling for relevant demographic and surgical factors. CONCLUSIONS Regional differences were found in TKA patient demographics and PROMs between the US, Scandinavia, and South Korea. The regional differences in patient demographics support the need for more research and clear guidelines related to TKA appropriateness criteria. The better preoperative and worse postoperative Scandinavian PROM scores may have been related to their less severe KL grade but might also reflect cultural differences in how patients reflect on their health state when answering PROMs. Clinicians should be aware of these international differences in PROM scores when interpreting studies conducted in different international regions. Future studies should investigate TKA variation between more international regions and assess intraregional variation. LEVEL OF EVIDENCE Level III.
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26
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Hadi H, Rahbari A, Jabalameli M, Bagherifard A, Behrouzi A, Safi F, Rezaei Z, Azarnia Samarin G, Azimi A. Relationship between Femoral Intercondylar Notch Narrowing in Radiography and Anatomical and Histopathologic Integrity of Anterior Cruciate Ligament in Patients Undergoing Total Knee Replacement Surgery. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:523-530. [PMID: 31970257 PMCID: PMC6935521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/26/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND The presence of cruciate ligaments is very important for normal knee kinematics. Knee arthroplasty prostheses, in which these ligaments are maintained, have better kinematics. The aim of the present study was to investigate the association between femoral intercondylar notch (FIN) narrowing in radiography and clinical and histopathologic integrity of anterior cruciate ligament (ACL) in patients undergoing knee replacement surgery. METHODS FIN index was measured in tunnel view radiography of the knees of 102 candidates of knee replacement surgery. The anatomical status of ACL was also examined during total knee arthroplasty (TKA). ACL was removed and sent for histopathologic examination to assess its degeneration rate. The association between the FIN index and the clinical and histopathological health of ACL was investigated. RESULTS Among 102 patients with mean age of 69.73 ± 7.81 years , 39 patients (38.32%) had no or torn ACL, 31 patients (30.39%) had weak ACL, and 32 (31.37%) had normal ACL. There was a significant association between age and clinical status of ACL during surgery (P=0.017). There was a significant difference in FIN and ACL health status during surgery between the two groups with an index of more and less than 0.252 (P=0.019 and P=0.019, respectively). There was no significant difference in the mean total degeneration score (TDS) of ACL between the two groups with FIN more and less than 0.252 (P=0.816). CONCLUSION There was a significant difference between the age and FIN narrowing (less than 0.252) as well as ACL clinical status during surgery. FIN narrowing had no significant effect on the severity of ACL degeneration and there was no significant difference in the severity of degenerative histopathologic changes between healthy and attenuated ACLs. This indicates that if ACL exists, although apparently attenuated, it has the histologic characteristic of a healthy ligament.
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Affiliation(s)
- Hosseinali Hadi
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Ali Rahbari
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Mahmood Jabalameli
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Abolfazl Bagherifard
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Ahmadreza Behrouzi
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Fatemeh Safi
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Zahra Rezaei
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Gholamreza Azarnia Samarin
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
| | - Amir Azimi
- Orthopedic Department, Arak University of Medical Sciences, Arak, Iran
- Pathology Department, Arak University of Medical Sciences, Arak, iran
- Bone and Joint Reconstruction Research Center, Shafa Yahyaian Hospital, Iran university of Medical Science, Tehran, Iran
- Valiasr Hospital, Arak University of Medical Sciences, Arak, Iran
- Radiology Department, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
- Research performed at Bone and Joint Reconstruction Center, Vali-Asr Hospital, Arak University of Medical Science, Arak, Iran
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27
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Mäkelä KT, Furnes O, Hallan G, Fenstad AM, Rolfson O, Kärrholm J, Rogmark C, Pedersen AB, Robertsson O, W-Dahl A, Eskelinen A, Schrøder HM, Äärimaa V, Rasmussen JV, Salomonsson B, Hole R, Overgaard S. The benefits of collaboration: the Nordic Arthroplasty Register Association. EFORT Open Rev 2019; 4:391-400. [PMID: 31312523 PMCID: PMC6598612 DOI: 10.1302/2058-5241.4.180058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180058
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Affiliation(s)
- Keijo T Mäkelä
- Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register
| | - Ove Furnes
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Geir Hallan
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Anne Marie Fenstad
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Ola Rolfson
- Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register
| | - Johan Kärrholm
- Sahlgrenska University Hospital and University of Gothenburg, Sweden, and the Swedish Hip Arthroplasty Register
| | - Cecilia Rogmark
- Department of Orthopedics, Skåne University Hospital, Department of Clinical Sciences Malmö, Lund University, and the Swedish Hip Arthroplasty Register, Sweden
| | - Alma Becic Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark, and the Danish Hip Arthroplasty Register
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Department of Orthopedics, Skåne University Hospital, and Department of Clinical Sciences, Orthopedics, Lund University, Sweden
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland, and the Finnish Arthroplasty Register
| | - Henrik M Schrøder
- Department of Orthopaedic Surgery, Naestved Hospital, Denmark, and the Danish Knee Arthroplasty Register
| | - Ville Äärimaa
- Turku University Hospital and University of Turku, Finland, and the Finnish Arthroplasty Register
| | - Jeppe V Rasmussen
- Department of Orthopaedic Surgery, Herlev Hospital, University of Copenhagen, Denmark, and the Danish Shoulder Arthroplasty Register
| | - Björn Salomonsson
- Department of Orthopedics, Karolinska Institutet, Danderyds Sjukhus AB, Sweden, and the Swedish Shoulder Arthroplasty Register
| | - Randi Hole
- Haukeland University Hospital, Bergen, Norway, and the Norwegian Arthroplasty Register
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, and the Danish Hip Arthroplasty Register
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Mathijssen NMC, Verburg H, London NJ, Landsiedl M, Dominkus M. Patient reported outcomes and implant survivorship after Total knee arthroplasty with the persona knee implant system: two year follow up. BMC Musculoskelet Disord 2019; 20:97. [PMID: 30832636 PMCID: PMC6399845 DOI: 10.1186/s12891-019-2470-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background More personalized implant designs for total knee arthroplasty might optimize the clinical outcome after surgery. One of these personalized implant designs is the Persona knee implant system (Zimmer Biomet, Warsaw, Indiana, USA). The primary objective of this study was to determine patient reported outcomes and implant survivorship of the Persona Knee system used in primary total knee arthroplasty, up to two years after surgery. Methods From November 2013 to July 2016 consecutive patients undergoing primary total knee arthroplasty were enrolled in a prospective observational cohort study at three centers. Preoperatively, at 6 weeks, 6 months, 1 and 2 years after surgery, patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), the Knee Society Score (KSS, 2011, modified version) and the EQ-5D. Adverse Events were captured, assessed for relationship to device, and recorded in the study database. Furthermore, physical functioning was assessed by the orthopedic surgeon. Repeated measures analyses were performed on PROM scores. Kaplan Meier was used to calculate survivorship of the Persona Knee Implant System. Results A total of 146 total knee arthroplasties were performed. 61% (89/146) of the patients were female and mean age was 64.7 (± 6.9) years. Two years after surgery, one patient had a revision of the polyethylene insert because of a periprosthetic joint infection. Therefore, the Kaplan-Meier survival estimate at 2 years was 0.99 (0.95–1.00 95% CI). OKS increased from 22.1 (95% CI 20.9–23.3) to 41.8 (95% CI 40.6–43.1) two years after surgery. Furthermore, all other PROMs also increased from before surgery to 2 year postoperatively. Conclusion The Persona Knee implant is safe and effective and the clinical results up to two years after surgery are promising. PROMs results are very good; pain, function and quality of life all improved greatly after TKA. Further studies are needed to determine the long term clinical performance of the Persona prosthesis. Trial registration Clinicaltrials.gov (NCT02337244). Registered June 1st, 2015. Retrospectively registered.
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Affiliation(s)
- N M C Mathijssen
- , Department of Orthopedics, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625AD, Delft, The Netherlands.
| | - H Verburg
- , Department of Orthopedics, Reinier de Graaf Hospital, Reinier de Graafweg 5, 2625AD, Delft, The Netherlands
| | - N J London
- Department of Orthopaedics, Harrogate and District Foundation Trust, Park Rd, Harrogate, Lancaster, HG2 7SX, UK
| | - M Landsiedl
- , Department of Orthopedics, Orthopaedic Hospital Speising, Speisinger Str. 109, 1130, Vienna, Austria
| | - M Dominkus
- , Department of Orthopedics, Orthopaedic Hospital Speising, Speisinger Str. 109, 1130, Vienna, Austria.,Sigmund Freud Private University, Freudpl. 1, 1020, Vienna, Austria
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Sezgin EA, Robertsson O, W-Dahl A, Lidgren L. Nonagenarians qualify for total knee arthroplasty: a report on 329 patients from the Swedish Knee Arthroplasty Register 2000-2016. Acta Orthop 2019; 90:53-59. [PMID: 30334634 PMCID: PMC6366462 DOI: 10.1080/17453674.2018.1530173] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The nonagenarian (those aged 90 years and older) population is expected to double in the next 20 years. This demographic age quake may have a significant impact on the incidence of total knee arthroplasty (TKA), although current literature provides limited data. We examined death and revision rates, patient-reported outcomes (PROs) and bias on patient selection of nonagenarian patients operated on with TKA for osteoarthritis (OA) between 2000 and 2016. Patients and methods - The Swedish national knee arthroplasty register was used to identify 329 nonagenarians (mean age, 92 years). Each patient was followed-up until death or the end of 2017. PRO data of 22 of these patients were compared with 65- to 74-year-old patients operated in 2015, from the same register. Results - 5 patients (1.5%) died within 90 days and 23 (7%) patients died within 365 days after TKA. 8 patients (2.4%) developed knee complications that needed revision. For patients followed for 5 and 10 years, more than 50% and 10%, respectively, lived without being revised. The patients had statistically significant improvements in PROs, not significantly different from the younger SKAR cohort. However, the material is small and this statistical finding does not preclude that there may be clinically relevant differences. TKA incidence was different amongst the 21 counties in the country (range, 0-5.1/10,000). Interpretation - Our study suggests that nonagenarians with knee OA qualify for TKA, having similar outcomes to younger patients. The data presented may help surgeons and patients assessing the risks and outcome associated with the procedure.
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Affiliation(s)
- Erdem A Sezgin
- Gazi University, Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey;;
| | - Otto Robertsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
| | - Annette W-Dahl
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
| | - Lars Lidgren
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund, Sweden;; ,The Swedish Knee Arthroplasty Register, Lund, Sweden,Correspondence:
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Niemeläinen M, Moilanen T, Huhtala H, Eskelinen A. Outcome of knee arthroplasty in patients aged 65 years or less: a prospective study of 232 patients with 2-year follow-up. Scand J Surg 2018; 108:313-320. [PMID: 30522409 DOI: 10.1177/1457496918816918] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Previous studies have reported lower implant survival rates, residual pain, and higher patient dissatisfaction rates following knee arthroplasty in younger knee arthroplasty patients. We aimed to assess the real-world effectiveness of knee arthroplasty in a prospective non-selected cohort of patients aged 65 years or less with 2-year follow-up. MATERIAL AND METHODS In total, 250 patients (272 knees) aged 65 years or less were enrolled into this prospective cohort study. Patient-reported outcome measures were used to assess the outcome. RESULTS The mean Oxford Knee Score and all Knee Injury and Osteoarthritis Outcome Score subscales increased significantly (p < 0.001) from preoperative situation to the 2-year follow-up. Significant increase (p < 0.001) in physical activity was detected in High-Activity Arthroplasty Score and RAND-36 Physical Component Score (PCS). Pain was also significantly (p < 0.001) relieved during the follow-up. Total disappearance of pain was rare at 2 years. Patients with milder (Kellgren-Lawrence grade 2) osteoarthritis were less satisfied and reported poorer patient-reported outcome measure than those with advanced osteoarthritis (Kellgren-Lawrence grade 3-4). There was no difference in the outcome (any patient-reported outcome measure) between patients who underwent total knee arthroplasty and those who received unicondylar knee arthroplasty. CONCLUSION We found that measured with a wide set of patient-reported outcome measures, both total knee arthroplasty and unicondylar knee arthroplasty resulted in significant pain relief, as well as improvement in physical performance and quality of life in patients aged 65 years or less. Real-world effectiveness of these procedures seems to be excellent. 15% of patients still had residual symptoms and were dissatisfied with the outcome at 2 years after the operation.
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Affiliation(s)
- M Niemeläinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - T Moilanen
- Coxa Hospital for Joint Replacement, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - A Eskelinen
- Coxa Hospital for Joint Replacement, Tampere, Finland
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Price AJ, Alvand A, Troelsen A, Katz JN, Hooper G, Gray A, Carr A, Beard D. Knee replacement. Lancet 2018; 392:1672-1682. [PMID: 30496082 DOI: 10.1016/s0140-6736(18)32344-4] [Citation(s) in RCA: 377] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/19/2018] [Indexed: 12/13/2022]
Abstract
Knee replacement surgery is one of the most commonly done and cost-effective musculoskeletal surgical procedures. The numbers of cases done continue to grow worldwide, with substantial variation in utilisation rates across regions and countries. The main indication for surgery remains painful knee osteoarthritis with reduced function and quality of life. The threshold for intervention is not well defined, and is influenced by many factors including patient and surgeon preference. Most patients have a very good clinical outcome after knee replacement, but multiple studies have reported that 20% or more of patients do not. So despite excellent long-term survivorship, more work is required to enhance this procedure and development is rightly focused on increasing the proportion of patients who have successful pain relief after surgery. Changing implant design has historically been a target for improving outcome, but there is greater recognition that improvements can be achieved by better implantation methods, avoiding complications, and improving perioperative care for patients, such as enhanced recovery programmes. New technologies are likely to advance future knee replacement care further, but their introduction must be regulated and monitored with greater rigour to ensure patient safety.
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Affiliation(s)
- Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK.
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Jeffrey N Katz
- Department of Orthopedic Surgery and Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gary Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Nuffield Orthopaedic Centre, Oxford, UK
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Xie Z, Zhao Z, Yang X, Pei L, Luo H, Ni Q, Li B, Qi Y, Tie K, Magdalou J, Chen L, Wang H. Prenatal nicotine exposure intergenerationally programs imperfect articular cartilage via histone deacetylation through maternal lineage. Toxicol Appl Pharmacol 2018; 352:107-118. [DOI: 10.1016/j.taap.2018.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/15/2018] [Accepted: 03/14/2018] [Indexed: 02/07/2023]
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Harjula JNE, Paloneva J, Haapakoski J, Kukkonen J, Äärimaa V. Increasing incidence of primary shoulder arthroplasty in Finland - a nationwide registry study. BMC Musculoskelet Disord 2018; 19:245. [PMID: 30031390 PMCID: PMC6054850 DOI: 10.1186/s12891-018-2150-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background The incidence of shoulder arthroplasties is reportedly increasing and the types of arthroplasty are changing. The purpose of this study was to investigate the incidence of primary shoulder arthroplasty in Finland. Methods We analyzed nationwide data from the Finnish Arthroplasty Register (FAR) and the Finnish National Hospital Discharge Register (NHDR) during time period 2004–2015. The primary outcome variable was the incidence of shoulder arthroplasty per 100,000 person-years stratified by age, sex and year of surgery. The secondary outcome variables were surgical indication, arthroplasty type and prosthesis model. Results The number of primary shoulder arthroplasties was 7504 (women = 4878, men = 2625). The rate of operations increased from 6 to 15 per 100,000 person-years among men, and 11 to 26 per 100,000 person-years among women. The indication for arthroplasty was osteoarthritis in 56%, acute fracture in 21%, inflammatory arthritis in 13%, and rotator cuff arthropathy in 4% of the cases. Hemiarthroplasties accounted for 66%, total shoulder arthroplasties 8%, and reverse shoulder arthroplasties 12% of the cases, 14% of the cases was missing. During the 12-year study period the incidence of hemiarthroplasties decreased by 23% and the number of total shoulder and reverse shoulder arthroplasty increased by 500 and 4500%, respectively. Conclusions The incidence of primary shoulder arthroplasty has increased by 160% during the study period in Finland. The incidence of hemiarthroplasties decreased while total and reverse shoulder arthroplasties increased. Electronic supplementary material The online version of this article (10.1186/s12891-018-2150-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenni N E Harjula
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland.
| | - Juha Paloneva
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
| | | | - Juha Kukkonen
- Department of Surgery, Division of Orthopaedic and Trauma Surgery, Satakunta Central Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital, University of Turku, Turku, Finland
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Putman S, Argenson JN, Bonnevialle P, Ehlinger M, Vie P, Leclercq S, Bizot P, Lustig S, Parratte S, Ramdane N, Colmar M. Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients. Orthop Traumatol Surg Res 2018; 104:161-164. [PMID: 29292123 DOI: 10.1016/j.otsr.2017.11.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous surgical procedures raise technical challenges in performing total knee arthroplasty (TKA) and may affect TKA outcomes. Survival rates of TKA done after trauma or surgery to the knee have not been accurately determined in large populations. The objectives of this retrospective study in 263 patients with TKA after knee trauma or surgery and a follow-up of 10 years were to assess survival, functional outcomes, and the nature and frequency of complications. HYPOTHESIS Knee trauma or surgery before TKA increases the risk of complications and decreases implant survival. MATERIAL AND METHODS Two hundred and sixty-three patients (122 [47%] females and 141 [53%] males) underwent TKA between 2005 and 2009 at nine centres in France. Mean age at surgery was 61 years. The patients had knee osteoarthritis secondary to a fracture (n=66), osteotomy (n=131), or ligament injury (n=66). Mean time from trauma or surgery to TKA was 145 months (range, 72-219 months). RESULTS Major complications were infection (n=12, 4.5%), skin problems (n=8, 3%), and stiffness (n=8, 3%). Ten-year survival to implant exchange for any reason was 89%±2.8%. Flexion range increased by 2.5°±17° (p=0.02) to a mean of 110° (range, 30° to 140°); extension range increased by 4°±7° (p<0.001) to a mean of -1.19 (range, -20° to 0°). Of the 263 patients, 157 (60%) reported little or no pain at last follow-up. Mean postoperative hip-knee-ankle angle was 179°±3.2° (range, 171°-188°). CONCLUSION TKA performed after knee injury or surgery carries a risk of specific complications (infection, skin problems, and stiffness) and may have a lower survival rate compared to primary TKA. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- S Putman
- Département universitaire de chirurgie orthopédique et de traumatologie, hôpital Salengro, CHRU de Lille, rue Emile-laine, 59037 Lille, France.
| | - J-N Argenson
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - P Bonnevialle
- Département d'orthopédie et de traumatologie, hôpital P.P.-Riquet, place Baylac, 31052 Toulouse cedex, France
| | - M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - P Vie
- Clinique du Cèdre, 950, rue de la Haie, 76230 Bois-Guillaume, France
| | - S Leclercq
- CHP Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - P Bizot
- Service de chirurgie orthopédique et traumatologique, hôpital Lariboisière, université Paris Diderot, 3, rue Amboise-Paré, 75010 Paris, France
| | - S Lustig
- Département de chirurgie orthopédique, centre Albert-Trillat, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69004 Lyon, France
| | - S Parratte
- Département de chirurgie orthopédique, hôpital Sainte-Marguerite, hôpital universitaire de Marseille, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - N Ramdane
- EA 2694 - Santé publique : épidémiologie et qualité des soins, université de Lille, CHU de Lille, 59000 Lille, France
| | - M Colmar
- Hôpital privé des Côtes-d'Armor, 12, rue François-Jacob, 22198 Plerin, France
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- 56, rue Boissonade, 75014 Paris cedex, France
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Kiadaliri AA, Lohmander LS, Moradi-Lakeh M, Petersson IF, Englund M. High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990-2015. Acta Orthop 2018; 89:177-183. [PMID: 29160139 PMCID: PMC5901515 DOI: 10.1080/17453674.2017.1404791] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Osteoarthritis (OA) imposes a substantial burden on individuals and societies. We report on the burden of knee and hip OA in the Nordic region. Patients and methods - We used the findings from the 2015 Global Burden of Diseases Study to explore prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of OA in the 6 Nordic countries during 1990-2015 (population of about 27 million in 2015). Results - During 1990-2015, the number of prevalent OA cases increased by 43% to 1,507,587 (95% uncertainty interval [UI] 1,454,338-1,564,778) in the region. OA accounted for 1.3% (UI 1.0-1.7) of YLDs in 1990, increasing to 1.6% (UI 1.2-2.0) in 2015. Of 315 causes studied, OA was the 15th leading cause of YLDs, causing 52,661 (UI 34,056-77,499) YLDs in 2015; of these 23% were attributable to high body mass index. The highest relative importance of OA was reported for women aged 65-74 years (8th leading cause of YLDs in 2015). Among the top 30 leading causes of YLDs in the region, OA had the 5th greatest relative increase in total YLDs during 1990-2015. From 1990 to 2015, increase in age-standardized YLDs from OA in the region was slightly lower than increase at the global level (7.5% vs. 10.5%). OA was, however, responsible for a higher proportional burden of DALYs in the region compared with the global level. Interpretation - The OA burden is high and rising in the Nordic region. With population growth, aging, and the obesity epidemic, a substantial rise in the burden of OA is expected and should be addressed in health policies.
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Affiliation(s)
- Aliasghar A Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden,Correspondence:
| | - L Stefan Lohmander
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ingemar F Petersson
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden,Epidemiology and Register Centre South, Skåne University Hospital Lund, Lund, Sweden
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
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Kiadaliri AA, Rinaldi G, Lohmander LS, Petersson IF, Englund M. Temporal trend and regional disparity in osteoarthritis hospitalisations in Sweden 1998-2015. Scand J Public Health 2018; 47:53-60. [PMID: 29576011 DOI: 10.1177/1403494818766785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM This study investigated time trend and regional disparities in hospitalisations due to osteoarthritis (OA) among people aged ≥20 years in Sweden from 1998 through 2015. METHODS National and regional data on hospital admissions with a primary diagnosis of OA were collected from the National Patient Register. The absolute and relative regional disparities were assessed using the absolute weighted mean difference from overall mean and the index of disparity. We applied joinpoint regression for temporal trend analysis of hospitalisations and the Mann-Kendall trend test for disparity measures. Changes in number of OA hospitalisations between 1998-2000 and 2013-2015 were analysed using two counterfactual scenarios. RESULTS During 1998-2015, OA hospitalisations constituted 2.0% of all hospitalisations, with higher proportions among women (58.7%) and those aged 70-74 years (18.0%). The age-standardised rate of OA hospitalisation and its proportions from all and musculoskeletal disorders hospitalisations rose, on average, by >2.0% per year during the study period. OA hospitalisation rates rose statistically significantly in all age groups except for the youngest and oldest age groups. The proportion of hip OA from all OA hospitalisations declined, while the opposite was observed for knee OA. The relative regional disparities declined in men, and the absolute regional disparities rose among women over time. The population growth and ageing could explain only about one third of the observed increases in the absolute number of OA hospitalisations between 1998-2000 and 2013-2015. CONCLUSIONS OA hospitalisations have increased substantially, suggesting the need to improve OA prevention and primary-care management in Sweden.
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Affiliation(s)
- Aliasghar A Kiadaliri
- 1 Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden
| | | | - L Stefan Lohmander
- 1 Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden
| | - Ingemar F Petersson
- 1 Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden.,3 Skåne University Hospital, Sweden
| | - Martin Englund
- 1 Lund University, Faculty of Medicine, Department of Clinical Sciences-Lund, Orthopaedics, Clinical Epidemiology Unit, Sweden.,4 Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, USA
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Dagneaux L, Bourlez J, Degeorge B, Canovas F. Return to sport after total or unicompartmental knee arthroplasty: An informative guide for residents to patients. EFORT Open Rev 2017; 2:496-501. [PMID: 29387472 PMCID: PMC5765989 DOI: 10.1302/2058-5241.2.170037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Knee arthroplasty survival rate - either UKA or TKA - is currently 95%, greater than it was ten years ago, but has not been specifically evaluated in very active patients practicing sport at a high intensity.The terms and conditions of return to physical activities are decided by the surgeon, the rehabilitation or Sports Medicine doctor, who needs to make sure that postoperative rehabilitation has been conducted optimally. Specifically, range of movement must be complete, muscular strengthening has to be sufficient and balance must be recovered by proprioception. Only after this stage (i.e. three to six months after surgery) can physical activities be resumed.Return to sport must be gentle and progressive, with moderate activities limited to short sessions. Progressively the patient will be able to return to intermediate activities, provided that he/she possesses the adequate level of technique for the sport.This up-to-date review for young surgeons and residents aims to provide an informative guide for patients regarding sport following knee arthroplasty. Cite this article: EFORT Open Rev 2017;2:496-501. DOI: 10.1302/2058-5241.2.170037.
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