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Kim MS, Choi KY, Cho RK, Jang HJ, Kwak DH, Yang SC, Oh ST, In Y. The collagen-augmented chondrogenesis technique demonstrates superior cartilage repair compared to microfracture for cartilage defects of the knee joint, regardless of age. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39369430 DOI: 10.1002/ksa.12500] [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: 01/25/2024] [Revised: 09/13/2024] [Accepted: 09/23/2024] [Indexed: 10/08/2024]
Abstract
PURPOSE This study investigated whether age affects clinical outcomes and cartilage repair quality in patients who underwent collagen-augmented chondrogenesis. METHODS The study included patients who underwent either the collagen-augmented chondrogenesis technique or microfracture for cartilage defects of the knee joint of International Cartilage Repair Society grade 3 or 4. Patients were categorised according to an age threshold of 50 years and the treatment method, whether collagen-augmented chondrogenesis technique or microfracture. Group 1 comprised 31 patients aged 50 years or older who received the collagen-augmented chondrogenesis technique, Group 2 consisted of 32 patients under the age of 50 years who received the collagen-augmented chondrogenesis technique and Group 3 included 243 patients aged 50 years or older who received microfracture. Clinical outcomes were assessed using the walking visual analogue scale (VAS) for pain and the Western Ontario McMaster University Osteoarthritis Index scale score (WOMAC) two years after surgery. For patients with magnetic resonance imaging results 1 year postoperatively (Group 1: 30 patients; Group 2: 31 patients; and Group 3: 31 patients), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) assessment was used to evaluate repaired cartilage lesions. RESULTS There were no significant differences in the VAS and WOMAC scores between the three groups 2 years after surgery (all n.s.). The MOCART score in patients who underwent MRI at 1 year postoperatively showed significant differences in the degree of defect repair, integration with the border zone, surface of the repaired tissue, adhesion and total score among the three groups (all p < 0.05). Post hoc analysis revealed no difference in the total MOCART scores between Groups 1 and 2. However, Groups 1 and 2 had significantly higher MOCART scores than Group 3 1 year after surgery (all p < 0.05). CONCLUSION The collagen-augmented chondrogenesis technique group showed improved quality of cartilage repair compared to the microfracture group, regardless of patient age. Compared with simple microfracture treatment, there were no differences in clinical outcomes between the patient groups, related to age. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Keun Young Choi
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ryu Kyoung Cho
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk Jin Jang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Ho Kwak
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Cheol Yang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Taek Oh
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hartono F, Ananditya T, Augustinus Y, Hendra, Gabriel N. Metaphyseal trauma of the lower extremities in major orthopedic surgery as an independent risk factor for deep vein thrombosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2797-2803. [PMID: 38780793 PMCID: PMC11291529 DOI: 10.1007/s00590-024-03960-4] [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: 11/24/2023] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Major orthopedic surgeries of the lower extremities, which heavily injure the metaphyseal region, are strongly associated with the risk of developing deep vein thrombosis (DVT). This study aims to investigate the role of metaphyseal trauma as an independent risk factor for DVT. METHODS Patients undergoing major orthopedic surgery of the hip and knee had their existing DVT risk factors recorded. Metaphyseal trauma was defined by the extent of bone injury during these surgeries. The samples were categorized into three surgery groups: total arthroplasty group (TA), hemiarthroplasty group (HA), and the open reduction internal fixation group (ORIF). Logistic regression test between significant existing risk factors and surgery groups determines the independent association between risk factors and DVT. RESULT The study found a 24.8% incidence of asymptomatic DVT in patients undergoing major orthopedic surgeries, with the highest prevalence (37.2%) in TA, which had the largest extent of metaphyseal trauma and the least existing DVT risk factors. TA showed 6.2 OR and 95% CI (p = 0.036) compared to the other existing risk factor in relation to DVT incidence. CONCLUSION Metaphyseal bone trauma in the hip and knee major orthopedic surgery is an independent risk factor for deep vein thrombosis.
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Affiliation(s)
- Franky Hartono
- Orthopaedic and Traumatology Department, Siloam Hospitals Kebon Jeruk, Jl. Perjuangan No.8, RT.14/RW.10, Kb. Jeruk, Kec. Kb. Jeruk, West Jakarta, Daerah Khusus, Ibukota, Jakarta, 11530, Indonesia
- Orthopaedic and Traumatology Department, Pantai Indah Kapuk Hospital, Jakarta, Indonesia
| | - Tessi Ananditya
- Orthopaedic and Traumatology Department, Siloam Hospitals Kebon Jeruk, Jl. Perjuangan No.8, RT.14/RW.10, Kb. Jeruk, Kec. Kb. Jeruk, West Jakarta, Daerah Khusus, Ibukota, Jakarta, 11530, Indonesia.
| | - Yohanes Augustinus
- Orthopaedic and Traumatology Department, Pantai Indah Kapuk Hospital, Jakarta, Indonesia
| | - Hendra
- Orthopaedic and Traumatology Department, Siloam Hospitals Kebon Jeruk, Jl. Perjuangan No.8, RT.14/RW.10, Kb. Jeruk, Kec. Kb. Jeruk, West Jakarta, Daerah Khusus, Ibukota, Jakarta, 11530, Indonesia
| | - Nicholas Gabriel
- Orthopaedic and Traumatology Department, Pantai Indah Kapuk Hospital, Jakarta, Indonesia
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Li J, Zhang H, Yu X, Jia G, Liu S, Liu G. Epidemiology and prognostic factors for new-onset deep venous thrombosis after unicompartmental knee arthroplasty: a retrospective study. BMC Musculoskelet Disord 2024; 25:205. [PMID: 38454388 PMCID: PMC10918878 DOI: 10.1186/s12891-024-07327-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/01/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Patients who underwent knee joint arthroplasty were at risk of venous thromboembolic events (VTEs), however, less studies were conducted to demonstrate the epidemiology and risk factors of deep venous thrombosis (DVT) following unicompartmental knee arthroplasty (UKA). Objective of this study was to explore the incidence and prognostic factors of DVT after UKA. METHODS Patients who underwent primary UKA from December 2018 to June 2022 were recruited in this study. Demographic characteristics, operation related variables and laboratory index were extracted and analyzed. Receiver operating characteristic analysis was performed to detect the optimum cut-off value for variables of interest. Univariate and multivariate logistic analysis were performed to identify risk factors of DVT. RESULTS 351 UKAs with a mean age of 65.4 ± 7.1 years were reviewed. After 12.9 ± 11.2 months follow-up, 35 DVTs were confirmed which indicating an incidence of 9.9%. The results showed that occupation (agricultural laborer) (P = 0.008), disease duration > 8.5 years (P = 0.035), operation time > 169 min (P = 0.003), intraoperative blood loss > 102 ml (P < 0.001), BMI > 26.8 kg/m 2 (P = 0.001), preoperative D-dimer > 0.29 mg/L (P = 0.001), prothrombin time < 10.7 s (P = 0.033) and INR < 0.98 (P = 0.032) between DVT and Non-DVT group were significantly different. Multivariate logistic regression analysis showed intraoperative blood loss > 102 ml (OR, 3.707; P, 0.001), BMI > 26.8 kg/m 2 (OR, 4.664; P, 0.004) and D-dimer > 0.29 mg/L (OR, 2.882; P, 0.009) were independent risk factors of DVT after UKA. CONCLUSION The incidence of DVT in the present study was 9.9%, extensive intraoperative blood loss, advanced BMI and high level of D-dimer would increase the risk of lower extremity thrombosis by 2-4 times.
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Affiliation(s)
- Jia Li
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang, 050031, Hebei, P.R. China
| | - Haijing Zhang
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang, 050031, Hebei, P.R. China
| | - Xiaoguang Yu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang, 050031, Hebei, P.R. China
| | - Guoxing Jia
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang, 050031, Hebei, P.R. China
| | - Sen Liu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang, 050031, Hebei, P.R. China
| | - Guobin Liu
- Department of Orthopedic Surgery, The First Hospital of Hebei Medical University, NO. 89 Donggang Road, Shijiazhuang, 050031, Hebei, P.R. China.
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An J, Han L, Ma X, Chang Y, Zhang C. Influence of diabetes on the risk of deep vein thrombosis of patients after total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2024; 19:164. [PMID: 38439085 PMCID: PMC10910741 DOI: 10.1186/s13018-024-04624-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/11/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Previous studies evaluating the influence of diabetes on the risk of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) showed inconsistent results. The aim of the study was to systematically evaluate the association between diabetes and DVT after TKA in a meta-analysis. METHODS An extensive search was conducted in PubMed, Embase, and Web of Science to identify relevant cohort studies. Random-effects models were employed to pool the results after taking account of the potential influence of heterogeneity. RESULTS Thirteen cohort studies involving 546,156 patients receiving TKA were included, with 71,110 (13.0%) diabetic patients before surgery and 1479 (2.1%) patients diagnosed as DVT after surgery. Overall, diabetes was associated with an increased risk of DVT after TKA (risk ratio [RR]: 1.43, 95% confidence interval [CI]: 1.12-1.84, p = 0.004; I2 = 44%). Sensitivity analysis limited to studies with chemoprophylaxis (RR: 1.96, 95% CI: 1.50-2.54), and studies with multivariate analysis (RR: 1.54, 95% CI: 1.12-2.11) showed consistent results. Subgroup analysis showed that diabetes was associated with higher risk of postoperative DVT in Asian countries (RR: 1.93, 95% CI: 1.49-2.52, p < 0.001; I2 = 1%) but not in Western countries (RR: 1.07, 95% CI: 0.86-1.34, p = 0.52; I2 = 0%; p for subgroup difference < 0.001). CONCLUSION Diabetes may be a risk factor for DVT after TKA, even with the chemoprophylaxis of anticoagulants. The association between diabetes and DVT after TKA may be more remarkable in patients from Asian countries.
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Affiliation(s)
- Jingzhi An
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, China
| | - Li Han
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, China
| | - Xiaojuan Ma
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, China
- Graduate School, Hebei Medical University, Shijiazhuang, 050017, China
| | - Yanyan Chang
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, China
| | - Cuixin Zhang
- Department of Clinical Pharmacy, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, China.
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Okewunmi JO, Ren R, Zubizarreta N, Kodali H, Poeran J, Hayden BL, Chen DD, Moucha CS. Prior COVID-19 and Venous Thromboembolism Risk in Total Joint Arthroplasty in Patients Over 65 Years of Age. J Arthroplasty 2024; 39:819-824.e1. [PMID: 37757982 DOI: 10.1016/j.arth.2023.09.026] [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: 01/28/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has been associated with increased risks of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). However, there is limited literature investigating prothrombotic states and complications after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We investigated (1) trends in VTE, PE, and DVT rates post-THA and TKA from 2016 to 2019 compared to 2020 to 2021 and (2) associations between prior COVID-19 diagnosis and VTE, PE, and DVT. METHODS A national dataset was queried for elective THA and TKA cases from 2016 to 2021. We first assessed trends in 90-day VTE prevalence between 2016 to 2019 and 2020 to 2021. Second, we investigated associations between previous COVID-19 and 90-day VTE with regression models. RESULTS From 2016 to 2021, a total of 2,422,051 cases had an annual decreasing VTE prevalence from 2.2 to 1.9% (THA) and 2.5 to 2.2% (TKA). This was evident for both PE and DVT (all trend tests P < .001). After adjusting for covariates (including vaccination status), prior COVID-19 was associated with significantly increased odds of developing VTE in TKA patients (odds ratio 1.2, 95% confidence interval 1.1 to 1.4, P = .007), but not DVT or PE (P > .05). There were no significant associations between prior COVID-19 and VTE, DVT, or PE after THA (P > .05). CONCLUSIONS Our study suggests that a previous diagnosis of COVID-19 is associated with increased odds of VTE, but not DVT or PE, in TKA patients. Ongoing data monitoring is needed given our effect estimates, emerging COVID-19 variants, and evolving vaccination rates.
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Affiliation(s)
- Jeffrey O Okewunmi
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Renee Ren
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hanish Kodali
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Darwin D Chen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Kim MS, Kim JJ, Kang KH, Lee JH, In Y. Central Sensitization and Neuropathic Pain Cumulatively Affect Patients Reporting Inferior Outcomes Following Total Knee Arthroplasty. J Bone Joint Surg Am 2024; 106:102-109. [PMID: 37943951 DOI: 10.2106/jbjs.23.00399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
UPDATE This article was updated on November 17, 2023, because of previous errors, which were discovered after the preliminary version of the article was posted online. On page 102, the text that had read "In a post hoc analysis of the preoperative results, Group 1 showed significantly inferior WOMAC pain, function, and total scores compared with Group 4 (p < 0.05 for all). Groups 2 and 3 showed worse preoperative WOMAC pain, function, and total subscores compared with Group 4 (p < 0.05 for all). These results remained the same at 2 years after surgery." now reads "In a post hoc analysis of the preoperative results, Groups 1, 2, and 3 showed significantly inferior WOMAC pain, function, and total scores compared with Group 4 (p < 0.05 for all). At 2 years postoperatively, Group 1 showed inferior WOMAC pain, function, and total scores compared with the other groups (p < 0.05 for all). Also, Groups 2 and 3 had worse WOMAC pain, function and total scores compared with Group 4 (p < 0.05 for all)." Also, on page 106, the title of Table IV, which had previously read "Inter-Group Comparison of Preoperative Scores (Post Hoc Analysis)" now reads "Inter-Group Comparison of Postoperative Scores (Post Hoc Analysis)."
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee HJ, Park KK, Park YB, Choi SW, Kim BO, Kim SH. Accuracy of Advanced Active Robot for Total Knee Arthroplasty: A Cadaveric Study. J Knee Surg 2024; 37:135-141. [PMID: 36638805 DOI: 10.1055/s-0042-1760391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Although the accuracy of other types of robotic systems for total knee arthroplasty (TKA) has been assessed in cadaveric studies, no investigations have been performed to evaluate this newly advanced active robotic system. Therefore, the authors aimed to analyze the accuracy of bone resection in terms of thickness and alignment in a cadaveric study. Three cadaveric specimens (six knees) and an active robotic system (CUVIS Joint, CUREXO) were used in the study. Three surgeons with different experiences in robotic TKAs performed this cadaveric study using the same robotic protocol with two different implant designs. The thickness and angle of bone resection planes obtained from the optical tracking system and the difference between resection planes and the planning data were assessed to determine accuracy. With respect to the overall resection accuracy compared to the plan, the cutting depth accuracy was within 1.0 mm mean of root mean square (RMS), and the resection angle accuracy in terms of sagittal, coronal, and axial planes was within 1.0 degree mean RMS. In contrast, no significant differences were observed between the planned and measured values in terms of the resection angles and cutting thickness. The hip-knee-ankle angle at postoperative evaluation was 0.7 degrees ± 0.7 degrees (RMS 1.0 degrees). This in vivo study suggests that the use of this newly advanced active robotic system for TKA demonstrates a high degree of accuracy in terms of resection thickness and alignment. This finding supports the clinical application of this advanced robotic system. LEVEL OF EVIDENCE: Cadaveric study, Level V.
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Affiliation(s)
- Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Gyeonggi-do, South Korea
| | - Sung Wook Choi
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Bong-Oh Kim
- R & D center, Curexo Inc., Seoul, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
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Kim MS, Cho RK, Yang SC, Hur JH, In Y. Machine Learning for Detecting Total Knee Arthroplasty Implant Loosening on Plain Radiographs. Bioengineering (Basel) 2023; 10:632. [PMID: 37370563 DOI: 10.3390/bioengineering10060632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: The purpose of this study was to investigate whether the loosening of total knee arthroplasty (TKA) implants could be detected accurately on plain radiographs using a deep convolution neural network (CNN). (2) Methods: We analyzed data for 100 patients who underwent revision TKA due to prosthetic loosening at a single institution from 2012 to 2020. We extracted 100 patients who underwent primary TKA without loosening through a propensity score, matching for age, gender, body mass index, operation side, and American Society of Anesthesiologists class. Transfer learning was used to prepare a detection model using a pre-trained Visual Geometry Group (VGG) 19. For transfer learning, two methods were used. First, the fully connected layer was removed, and a new fully connected layer was added to construct a new model. The convolutional layer was frozen without training, and only the fully connected layer was trained (transfer learning model 1). Second, a new model was constructed by adding a fully connected layer and varying the range of freezing for the convolutional layer (transfer learning model 2). (3) Results: The transfer learning model 1 gradually increased in accuracy and ultimately reached 87.5%. After processing through the confusion matrix, the sensitivity was 90% and the specificity was 100%. Transfer learning model 2, which was trained on the convolutional layer, gradually increased in accuracy and ultimately reached 97.5%, which represented a better improvement than for model 1. Processing through the confusion matrix affirmed that the sensitivity was 100% and the specificity was 97.5%. (4) Conclusions: The CNN algorithm, through transfer learning, shows high accuracy for detecting the loosening of TKA implants on plain radiographs.
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Affiliation(s)
- Man-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Ryu-Kyoung Cho
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Sung-Cheol Yang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Jae-Hyeong Hur
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Wu ML, Wang XR, Zhang WD, Zhang JM, Lu YY, Chai YN, Qin CZ. Efficacy and safety of salvianolate and enoxaparin in the prevention of perioperative deep venous thrombosis in gastrointestinal surgery. Pacing Clin Electrophysiol 2023; 46:425-431. [PMID: 36959770 DOI: 10.1111/pace.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/18/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE In this study, the efficacy and safety of salvianolate were compared with enoxaparin in the prevention of perioperative deep vein thrombosis in gastrointestinal surgery. METHODS From October 2017 to September 2019, 563 patients who underwent gastrointestinal surgery were collected. Based on the inclusion and exclusion criteria, 119 patients were divided into two groups: enoxaparin group (n = 65) and salvianolate group (n = 54). Comparisons were made regarding the outcomes: prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), D-dimer level (D-D), platelet count (PLT), hematokrit (HCT), and incidence of deep vein thrombosis (DVT). RESULTS The main outcomes showed no significance between enoxaparin group and salvianolate group (p > .05). The incidence of DVT in salvianolate group was 1.85%, significantly lower than that in enoxaparin group (12.3%) (p < .05). No serious adverse reactions occurred in the two groups during treatment. CONCLUSION Compared with enoxaparin, salvianolate has an advantage in the prevention of perioperative thrombosis in gastrointestinal surgery with a lower incidence of DVT.
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Affiliation(s)
- Meng-Lin Wu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
| | - Xin-Ru Wang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
| | - Wen-da Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
| | - Jing-Min Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
| | - Yao-Yao Lu
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
| | - Yu-Na Chai
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
| | - Chong-Zhen Qin
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan Provincial Key Laboratory of Precision Clinical Pharmacy, Zhengzhou, China
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Kim MS, Kim JJ, Kang KH, Lee JH, In Y. Detection of Prosthetic Loosening in Hip and Knee Arthroplasty Using Machine Learning: A Systematic Review and Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040782. [PMID: 37109740 PMCID: PMC10141023 DOI: 10.3390/medicina59040782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/02/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
Background: prosthetic loosening after hip and knee arthroplasty is one of the most common causes of joint arthroplasty failure and revision surgery. Diagnosis of prosthetic loosening is a difficult problem and, in many cases, loosening is not clearly diagnosed until accurately confirmed during surgery. The purpose of this study is to conduct a systematic review and meta-analysis to demonstrate the analysis and performance of machine learning in diagnosing prosthetic loosening after total hip arthroplasty (THA) and total knee arthroplasty (TKA). Materials and Methods: three comprehensive databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies that evaluated the detection accuracy of loosening around arthroplasty implants using machine learning. Data extraction, risk of bias assessment, and meta-analysis were performed. Results: five studies were included in the meta-analysis. All studies were retrospective studies. In total, data from 2013 patients with 3236 images were assessed; these data involved 2442 cases (75.5%) with THAs and 794 cases (24.5%) with TKAs. The most common and best-performing machine learning algorithm was DenseNet. In one study, a novel stacking approach using a random forest showed similar performance to DenseNet. The pooled sensitivity across studies was 0.92 (95% CI 0.84-0.97), the pooled specificity was 0.95 (95% CI 0.93-0.96), and the pooled diagnostic odds ratio was 194.09 (95% CI 61.60-611.57). The I2 statistics for sensitivity and specificity were 96% and 62%, respectively, showing that there was significant heterogeneity. The summary receiver operating characteristics curve indicated the sensitivity and specificity, as did the prediction regions, with an AUC of 0.9853. Conclusions: the performance of machine learning using plain radiography showed promising results with good accuracy, sensitivity, and specificity in the detection of loosening around THAs and TKAs. Machine learning can be incorporated into prosthetic loosening screening programs.
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Affiliation(s)
- Man-Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Jae-Jung Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Ki-Ho Kang
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Jeong-Han Lee
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea
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Hwang D, Han HS, Lee MC, Ro DH. Low muscle mass is an independent risk factor for postoperative blood transfusion in total knee arthroplasty: a retrospective, propensity score-matched cohort study. BMC Geriatr 2022; 22:218. [PMID: 35296255 PMCID: PMC8928693 DOI: 10.1186/s12877-022-02903-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
Background Sarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified low muscle mass as an independent risk factor for postoperative TKA complications. Methods A retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018–2021. Patients were categorized into normal (n = 417) and sarcopenic (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m2; females, < 5.7 kg/m2). Three postoperative complications were analysed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors. Results The proportion of sarcopenic patients in primary TKA was 7.7% (35/452). The sarcopenic group had a lower preoperative haemoglobin (12.18 ± 1.20 vs. 13.04 ± 1.73 g/dL, p = 0.004) and total protein (6.73 ± 0.42 vs. 7.06 ± 0.44 mg/dL, p = 0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenic group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57–45.5, p = 0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633–0.96) and SMI cut-off of 5.6 kg/m2. Conclusions Low muscle mass determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia that may influence the orthopaedic decision-making process or treatment planning in patients with sarcopenia undergoing primary TKA. Level of evidence III, retrospective cohort study. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02903-0.
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Affiliation(s)
- Doohyun Hwang
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea
| | - Du Hyun Ro
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, Republic of Korea. .,Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea. .,CONNECTEVE Co., Ltd., 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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