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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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Upadhyyaya GK, Tewari S. Enhancing Surgical Outcomes: A Critical Review of Antibiotic Prophylaxis in Orthopedic Surgery. Cureus 2023; 15:e47828. [PMID: 38022210 PMCID: PMC10679787 DOI: 10.7759/cureus.47828] [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: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
The postoperative burden remains significant due to the possibility of prolonged hospitalization, escalated healthcare costs, and patient distress caused by postorthopedic surgical site infections (SSIs). Orthopedic surgery is likewise faced with a significant challenge posed by these conditions. A positive association has been observed between the presence of postorthopedic SSIs and heightened susceptibility to adverse health outcomes, along with elevated rates of morbidity and mortality. Systemic antibiotic prophylaxis (SAP) reduces the risk of acquiring an SSI. Closed fractures, open fractures, arthroplasty, and percutaneous fixation each possess distinct attributes that impact the data and antimicrobial therapy. When implementing SAP, it is crucial to strike a delicate equilibrium between maintaining effective antibiotic stewardship protocols and preventing the occurrence of SSIs. This practice effectively prevents both the incidence of negative consequences and the emergence of antibiotic resistance. The objective of this study was to examine the existing literature on the use of surgical antibiotic prophylaxis in orthopedic surgery and explore the potential consequences associated with the inappropriate administration of antibiotics.
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Affiliation(s)
- Gaurav K Upadhyyaya
- Department of Orthopedics, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Sachchidanand Tewari
- Department of Pharmacology, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
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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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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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An Automatic Method for Assessing Spiking of Tibial Tubercles Associated with Knee Osteoarthritis. Diagnostics (Basel) 2022; 12:diagnostics12112603. [PMID: 36359448 PMCID: PMC9689703 DOI: 10.3390/diagnostics12112603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022] Open
Abstract
Efficient and scalable early diagnostic methods for knee osteoarthritis are desired due to the disease’s prevalence. The current automatic methods for detecting osteoarthritis using plain radiographs struggle to identify the subjects with early-stage disease. Tibial spiking has been hypothesized as a feature of early knee osteoarthritis. Previous research has demonstrated an association between knee osteoarthritis and tibial spiking, but the connection to the early-stage disease has not been investigated. We study tibial spiking as a feature of early knee osteoarthritis. Additionally, we develop a deep learning based model for detecting tibial spiking from plain radiographs. We collected and graded 913 knee radiographs for tibial spiking. We conducted two experiments: experiments A and B. In experiment A, we compared the subjects with and without tibial spiking using Mann-Whitney U-test. Experiment B consisted of developing and validating an interpretative deep learning based method for predicting tibial spiking. The subjects with tibial spiking had more severe Kellgren-Lawrence grade, medial joint space narrowing, and osteophyte score in the lateral tibial compartment. The developed method achieved an accuracy of 0.869. We find tibial spiking a promising feature in knee osteoarthritis diagnosis. Furthermore, the detection can be automatized.
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PAMILO KJ, HAAPAKOSKI J, SOKKA-ISLER T, REMES V, PALONEVA J. Decreased burden of revision hip replacements despite substantial rise in prevalence: a register-based analysis in Finland. Acta Orthop 2022; 93:801-807. [PMID: 36222593 PMCID: PMC9555216 DOI: 10.2340/17453674.2022.4837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE While the incidence of THR operations has been established, little is known about the prevalence or the ratio of the annual number of revision THRs to the total number of THRs in the general population. By combining data from nationwide registers, we calculated the annual prevalence of THRs and the revision burden caused by THR survivors in Finland. PATIENTS AND METHODS All primary THRs performed between 1980 and 2020 were identified from the Finnish Arthroplasty Register (FAR). Patient deaths were extracted from the Finnish Digital and Population Data Services Agency and THR revisions and removals from the FAR and the Finnish Hospital Discharge Register. We analyzed annual THR prevalence by dividing the number of THRs by the population aged 40 or older and the revision burden factor (RBF) by dividing the annual number of revisions by the total number of primary and revision THRs in the population. The proportions of bilateral implants and patients with THRs performed more than 10 years earlier (older THRs) were identified. RESULTS THR prevalence in Finland increased rapidly, reaching 3.6% in 2020. Between 2010 and 2020, the number of THRs increased by 50% and the prevalence of THRs by 38%. In 2020, the proportion of bilateral THRs had risen to 29% and the proportion of patients with older THRs to 36%. The RBF decreased between 1996 and 2020 from 3.1% to 1.3% (age- and sex-adjusted proportion ratio PR 0.42 [95% CI 0.39-0.45]). INTERPRETATION Despite the decrease in the RBF, the rapidly increasing prevalence of THRs potentially increases the number of revisits and revisions and thus poses a challenge for healthcare in the future.
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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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