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Lan R, Stiles ER, Ward SA, Lajam CM, Bosco JA. Patients With Moderate to Severe Liver Cirrhosis Have Significantly Higher Short-Term Complication Rates Following Total Knee Arthroplasty: A Retrospective Cohort Study. J Arthroplasty 2024; 39:1736-1740. [PMID: 38280615 DOI: 10.1016/j.arth.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Liver cirrhosis is associated with increased perioperative morbidity. Our study used the Model for End-Stage Liver Disease (MELD) score to assess the impact of cirrhosis severity on postoperative outcomes following total knee arthroplasty (TKA). METHODS A retrospective review identified 59 patients with liver cirrhosis who underwent primary TKA at a large, urban, academic center from January 2013 to August 2022. Cirrhosis was categorized as mild (MELD < 10; n = 47) or moderate-severe (MELD ≥ 10; n = 12). Modified Clavien-Dindo classification was used to grade complications, where grade 2+ denoted significant intervention. Hospital length of stay, nonhome discharge, and mortality were collected. A 1:1 propensity matching was used to control for demographics and selected comorbidities. RESULTS Moderate-severe cirrhosis was associated with significantly higher rates of intrahospital overall (58.33 versus 16.67%, P = .036) complications, 30-day overall complications (75 versus 33.33%, P = .042), and 90-day overall complications (75 versus 33.33%, P = .042) when compared to matched mild cirrhosis patients. Compared to matched noncirrhotic controls, mild cirrhosis patients had no significant increase in complication rate or other outcomes (P > .05). CONCLUSIONS Patients with moderate-severe liver cirrhosis are at risk of short-term complications following primary TKA. Patients with mild cirrhosis have comparable outcomes to matched noncirrhotic patients. Surgeons can use MELD score prior to scheduling TKA to determine which patients require optimization or higher levels of perioperative care.
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Affiliation(s)
- Rae Lan
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Elizabeth R Stiles
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Spencer A Ward
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Claudette M Lajam
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Dragosloveanu S, Petre MA, Cretu B, Mihailescu AA, Cergan R, Scheau C. Etiology of Total Knee Arthroplasty Revisions: A Two-Decade Institutional Perspective. Cureus 2024; 16:e55263. [PMID: 38425332 PMCID: PMC10904024 DOI: 10.7759/cureus.55263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Total knee arthroplasty (TKA) implant survival time is determined by various patient and implant-related factors and varies significantly in recent worldwide reports. In our study, we have included 247 TKA revisions in 203 patients performed in our hospital over the last 20 years. Multiple etiologies of revisions were identified and classified into 10 categories. Time to failure was analyzed with regard to etiology, patient demographics, and other relevant data. The overall average time to revision was 44.08 months (95% confidence interval (CI) between 33.34 and 49.82 months). Age at primary implant was negatively correlated with time to revision (hazard ratio (HR) = 1.0521 and 95% CI of HR = 1.0359 to 1.0685) and female patients showed a 1.59 times higher risk of implant failure than males. Periprosthetic joint infection was the cause of 46.56% (n=115) of revisions (out of which 12.55% (n=31) were early infections, diagnosed within the first three months), while aseptic loosening was found in 31.98% (n=79) of cases. Infection correlated with a shorter time to revision compared to aseptic loosening (p<0.05). These findings emphasize the need to intensify efforts to deliver the best patient care, select the best antibiotic regimen, and improve surgical techniques to decrease the incidence of infectious complications.
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Affiliation(s)
- Serban Dragosloveanu
- Department of Orthopaedics and Traumatology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Mihnea-Alexandru Petre
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Bogdan Cretu
- Department of Orthopaedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Alexandra Ana Mihailescu
- Department of Anesthesiology and Critical Care, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Romica Cergan
- Department of Anatomy, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology, and Osteoarticular Tuberculosis, Bucharest, ROU
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Menotti F, Scutera S, Coppola B, Longo F, Mandras N, Cavallo L, Comini S, Sparti R, Fiume E, Cuffini AM, Banche G, Palmero P, Allizond V. Tuning of Silver Content on the Antibacterial and Biological Properties of Poly(ɛ-caprolactone)/Biphasic Calcium Phosphate 3D-Scaffolds for Bone Tissue Engineering. Polymers (Basel) 2023; 15:3618. [PMID: 37688244 PMCID: PMC10489712 DOI: 10.3390/polym15173618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
There is a growing interest in tissue engineering, in which biomaterials play a pivotal role in promoting bone regeneration. Furthermore, smart functionalization can provide biomaterials with the additional role of preventing orthopedic infections. Due to the growing microbial resistance to antimicrobials used to treat those infections, metal ions, such as silver, thanks to their known wide range of bactericidal properties, are believed to be promising additives in developing antibacterial biomaterials. In this work, novel poly(ε-caprolactone) (PCL)-based 3D scaffolds have been designed and developed, where the polymer matrix was modified with both silver (Ag), to supply antibacterial behavior, and calcium phosphates (biphasic calcium phosphate, BCP) particles to impart bioactive/bioresorbable properties. The microstructural analysis showed that constructs were characterized by square-shaped macropores, in line with the morphology and size of the templating salts used as pore formers. Degradation tests demonstrated the important role of calcium phosphates in improving PCL hydrophilicity, leading to a higher degradation degree for BCP/PCL composites compared to the neat polymer after 18 days of soaking. The appearance of an inhibition halo around the silver-functionalized PCL scaffolds for assayed microorganisms and a significant (p < 0.05) decrease in both adherent and planktonic bacteria demonstrate the Ag+ release from the 3D constructs. Furthermore, the PCL scaffolds enriched with the lowest silver percentages did not hamper the viability and proliferation of Saos-2 cells. A synergic combination of antimicrobial, osteoproliferative and biodegradable features provided to 3D scaffolds the required potential for bone tissue engineering, beside anti-microbial properties for reduction in prosthetic joints infections.
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Affiliation(s)
- Francesca Menotti
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Sara Scutera
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Bartolomeo Coppola
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Turin, Italy; (B.C.); (P.P.)
| | - Fabio Longo
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Narcisa Mandras
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Lorenza Cavallo
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Sara Comini
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Rosaria Sparti
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Elisa Fiume
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Turin, Italy; (B.C.); (P.P.)
| | - Anna Maria Cuffini
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Giuliana Banche
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
| | - Paola Palmero
- Department of Applied Science and Technology, Politecnico di Torino, 10129 Turin, Italy; (B.C.); (P.P.)
| | - Valeria Allizond
- Department of Public Health and Pediatrics, University of Torino, 10126 Turin, Italy; (F.M.); (S.S.); (F.L.); (N.M.); (L.C.); (R.S.); (A.M.C.); (V.A.)
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