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Martin JR, Coronado R, Wilson JM, Polkowski GG, Shinar AA, Bruehl S. Central Sensitization: The Missing Link Between Psychological Distress and Poor Outcome Following Primary Total Knee Arthroplasty. J Arthroplasty 2024; 39:1201-1206. [PMID: 38128626 PMCID: PMC11032226 DOI: 10.1016/j.arth.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND While preoperative psychological distress is known to predict risk for worse total knee arthroplasty (TKA) outcomes, distress may be too broad and nonspecific a predictor in isolation. We tested whether there are distinct preoperative TKA patient types based jointly on psychological status and measures of altered pain processing that predict adverse clinical outcomes. METHODS In 112 TKA patients, we preoperatively assessed psychological status (depression, anxiety, and catastrophizing) and altered pain processing via a simple quantitative sensory testing protocol capturing peripheral and central pain sensitization. Outcomes (pain, function, opioid use) were prospectively evaluated at 6 weeks and 6 months after TKA. Cluster analyses were used to empirically identify TKA patient subgroups. RESULTS There were 3 distinct preoperative TKA patient subgroups identified from the cluster analysis. A low-risk (LR) group was characterized by low psychological distress and low peripheral and central sensitization. In addition, 2 subgroups with similarly elevated preoperative psychological distress were identified, differing by pain processing alterations observed: high-risk centralized pain and high-risk peripheral pain. Relative to LR patients, high-risk centralized pain patients displayed significantly worse function and greater opioid use at 6 months after TKA (P values <.05). The LR and high-risk peripheral pain patient subgroups had similar 6-month outcomes (P values >.05). CONCLUSIONS Among patients who have psychological comorbidity, only patients who have central sensitization were at elevated risk for poor functional outcomes and increased opioid use. Central sensitization may be the missing link between psychological comorbidity and poor TKA clinical outcomes. Preoperative testing for central sensitization may have clinical utility for improving risk stratification in TKA patients who have psychosocial risk factors.
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Affiliation(s)
- J. Ryan Martin
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Rogelio Coronado
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Jacob M. Wilson
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Gregory G. Polkowski
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Andrew A. Shinar
- Vanderbilt University Medical Center, Department of Orthopedics, 1211 Medical Center Dr, Nashville, TN 37232
| | - Stephen Bruehl
- Vanderbilt University Medical Center, Department of Anesthesia, 1211 Medical Center Dr, Nashville, TN 37232
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Mika AP, Mulvey HE, Engstrom SM, Polkowski GG, Martin JR, Wilson JM. Can ChatGPT Answer Patient Questions Regarding Total Knee Arthroplasty? J Knee Surg 2024. [PMID: 38442904 DOI: 10.1055/s-0044-1782233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
The internet has introduced many resources frequently accessed by patients prior to orthopaedic visits. Recently, Chat Generative Pre-Trained Transformer, an artificial intelligence-based chat application, has become publicly and freely available. The interface uses deep learning technology to mimic human interaction and provide convincing answers to questions posed by users. With its rapidly expanding usership, it is reasonable to assume that patients will soon use this technology for preoperative education. Therefore, we sought to determine the accuracy of answers to frequently asked questions (FAQs) pertaining to total knee arthroplasty (TKA).Ten FAQs were posed to the chatbot during a single online interaction with no follow-up questions or repetition. All 10 FAQs were analyzed for accuracy using an evidence-based approach. Answers were then rated as "excellent response not requiring clarification," "satisfactory requiring minimal clarification," satisfactory requiring moderate clarification," or "unsatisfactory requiring substantial clarification."Of the 10 answers given by the chatbot, none received an "unsatisfactory" rating with the majority either requiring minimal (5) or moderate (4) clarification. While many answers required nuanced clarification, overall, answers tended to be unbiased and evidence-based, even when presented with controversial subjects.The chatbot does an excellent job of providing basic, evidence-based answers to patient FAQs prior to TKA. These data were presented in a manner that will be easily comprehendible by most patients and may serve as a useful clinical adjunct in the future.
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Affiliation(s)
- Aleksander P Mika
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hillary E Mulvey
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen M Engstrom
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory G Polkowski
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J Ryan Martin
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob M Wilson
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
BACKGROUND The contemporary patient has access to numerous resources on common orthopaedic procedures before ever presenting for a clinical evaluation. Recently, artificial intelligence (AI)-driven chatbots have become mainstream, allowing patients to engage with interfaces that supply convincing, human-like responses to prompts. ChatGPT (OpenAI), a recently developed AI-based chat technology, is one such application that has garnered rapid growth in popularity. Given the likelihood that patients may soon call on this technology for preoperative education, we sought to determine whether ChatGPT could appropriately answer frequently asked questions regarding total hip arthroplasty (THA). METHODS Ten frequently asked questions regarding total hip arthroplasty were posed to the chatbot during a conversation thread, with no follow-up questions or repetition. Each response was analyzed for accuracy with use of an evidence-based approach. Responses were rated as "excellent response not requiring clarification," "satisfactory requiring minimal clarification," "satisfactory requiring moderate clarification," or "unsatisfactory requiring substantial clarification." RESULTS Of the responses given by the chatbot, only 1 received an "unsatisfactory" rating; 2 did not require any correction, and the majority required either minimal (4 of 10) or moderate (3 of 10) clarification. Although several responses required nuanced clarification, the chatbot's responses were generally unbiased and evidence-based, even for controversial topics. CONCLUSIONS The chatbot effectively provided evidence-based responses to questions commonly asked by patients prior to THA. The chatbot presented information in a way that most patients would be able to understand. This resource may serve as a valuable clinical tool for patient education and understanding prior to orthopaedic consultation in the future.
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Affiliation(s)
- Aleksander P Mika
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Larach DB, Kertai MD, Billings FT, Anderson SB, Polkowski GG, Shinar AA, Milne GL, Mishra P, Bruehl S. Preoperative Predictors of Prolonged Opioid Use in the 6 Months After Total Knee Arthroplasty. Clin J Pain 2023; 39:516-523. [PMID: 37440337 PMCID: PMC10529895 DOI: 10.1097/ajp.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Prolonged postoperative opioid use increases the risk for new postsurgical opioid use disorder. We evaluated preoperative phenotypic factors predicting prolonged postoperative opioid use. METHODS We performed a secondary analysis of a prospective observational cohort (n=108) undergoing total knee arthroplasty (TKA) for osteoarthritis with 6-week and 6-month follow-up. Current opioid use and psychosocial, pain, and opioid-related characteristics were assessed at preoperative baseline. Primary outcomes were days/week of opioid use at follow-up. RESULTS At 6 weeks, preoperative opioid use and greater cumulative opioid exposure, depression, catastrophizing, anxiety, pain interference, sleep disturbance, and central sensitization were significantly associated with more days/week of opioid use after controlling for contemporaneous pain intensity. Prior euphoric response to opioids were also significant predictors at 6 months. All 6-week predictors except anxiety remained significant after controlling for preoperative opioid use; at 6 months, cumulative opioid exposure, catastrophizing, pain interference, and sleep disturbance remained significant after this adjustment ( P <0.05). In multivariable models, a psychosocial factor reflecting negative affect, sleep, and pain accurately predicted 6-week opioid use (area under the curve=0.84). A combined model incorporating psychosocial factor scores, opioid-related factor scores, and preoperative opioid use showed near-perfect predictive accuracy at 6 months (area under the curve=0.97). DISCUSSION Overall, preoperative psychosocial, pain-related, and opioid-related phenotypic characteristics predicted prolonged opioid use after total knee arthroplasty.
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Affiliation(s)
- Daniel B. Larach
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Miklos D. Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frederic T. Billings
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara B. Anderson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory G. Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew A. Shinar
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ginger L. Milne
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Puneet Mishra
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Tarabichi S, Chen AF, Higuera CA, Parvizi J, Polkowski GG. 2022 American Association of Hip and Knee Surgeons Symposium: Periprosthetic Joint Infection. J Arthroplasty 2023:S0883-5403(23)00065-7. [PMID: 36738863 DOI: 10.1016/j.arth.2023.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/06/2023] Open
Abstract
Periprosthetic joint infection (PJI) is the leading cause of failure in patients undergoing total joint arthroplasty. This article is a brief summary of a symposium on PJI that was presented at the annual AAHKS meeting. It will provide an overview of current technqiues in the prevention, diagnosis, and management of PJI. It will also highlight emerging technologies in this setting.
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Affiliation(s)
- Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carlos A Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Gregory G Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Cox ZC, Engstrom SM, Shinar AA, Polkowski GG, Mason JB, Martin JR. Is cement mantle thickness a primary cause of aseptic tibial loosening following primary total knee arthroplasty? Knee 2023; 40:305-312. [PMID: 36592499 DOI: 10.1016/j.knee.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/27/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Aseptic tibial loosening following primary total knee replacement is one of the leading causes of long-term failure. Cement mantle thickness has been implicated as a source of aseptic tibial loosening. Therefore, the following study was designed to determine (1) what is the cement mantle thickness in patients that develop aseptic tibial loosening, and (2) is there a difference in cement mantle thickness based on the interface of failure? METHOD This retrospective cohort included 216 patients revised for aseptic tibial loosening. Patient demographics, operative data, and clinical outcomes were recorded. A preoperative radiographic assessment was performed to determine the interface of failure and the thickness of the cement mantle using the Knee Society Radiographic Evaluation System zones. RESULTS The average patient age was 65 years and body mass index was 33.7 kg/m2. 203 patients demonstrated radiographic failure at the implant-cement interface and 13 patients demonstrated failure at the cement-bone interface. The average cement mantle thickness of each radiographic zone for the entire cohort on the AP and lateral views was 4.4 and 4.5 mm, respectively. The average cement mantle thickness of patients that developed failure at the implant-cement interface was significantly greater than patients that failed at the cement-bone interface in each radiographic zone (p < 0.001). CONCLUSIONS Patients that develop implant loosening at the cement-bone interface were noted to have a significantly decreased cement mantle compared to patients that failed at the implant-cement interface. Methods for decreasing tibial implant loosening should likely focus on improving the fixation at the implant-cement interface.
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Affiliation(s)
- Zach C Cox
- OrthoCarolina Hip and Knee Center, Charlotte, NC, 250 N Caswell Rd Suit 200A, Charlotte, NC 28207, USA
| | - Stephen M Engstrom
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA
| | - Andrew A Shinar
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA
| | - Gregory G Polkowski
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA
| | - J Bohannon Mason
- OrthoCarolina Hip and Knee Center, Charlotte, NC, 250 N Caswell Rd Suit 200A, Charlotte, NC 28207, USA
| | - J Ryan Martin
- Vanderbilt University Medical Center, 1215 21st Ave S Suite 4200, Nashville, TN 37232, USA.
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Martin JR, Archibeck MJ, Gililland JM, Anderson LA, Polkowski GG, Schwarzkopf R, Seyler TM, Pelt CE. Trends in Total Knee Arthroplasty Cementing Technique Among Arthroplasty Surgeons-A Survey of the American Association of Hip and Knee Surgeons Members. J Arthroplasty 2022:S0883-5403(22)01109-3. [PMID: 36596429 DOI: 10.1016/j.arth.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Aseptic loosening persists as one of the leading causes of failure following cemented primary total knee arthroplasty (TKA). Cement technique may impact implant fixation. We hypothesized that there is variability in TKA cement technique among arthroplasty surgeons. METHODS A 28-question survey regarding variables in surgeons' preferred TKA cementation technique was distributed to 2,791 current American Association of Hip and Knee Surgeons (AAHKS) members with a response rate of 30.8% (903 respondents). Patterns of responses were analyzed by grouping respondents by their answers to certain questions including cementing technique, tibial cement location, and femoral cement location. RESULTS A total of 73.5% reported performing at least 7 of 8 of the highest consensus techniques, including vacuum mixing (79.9%), using two bags (76.1%), tibial implant first (95.2%), single-stage cementing (96.9%), compression of the implants in extension (91.7%), and use of a tourniquet (84.3%). Medium and high viscosity cement was most commonly used (37.9 and 37.8%, respectively). Finger pressurization was most common (76.1%) compared to a gun (29.8%). There were 26.5% of respondents performing 6 or fewer of the most common majority techniques and seemed to perform other less common techniques (eg, use of a single bag of cement, trialing or closure prior to cement curing, and heating to accelerate cement curing). Cement was most commonly applied to the entire bone and implant surface on both the tibia (46.4%) and femur (47.7%), leaving much variation in the remaining cement application location responses. DISCUSSION There appears to be variability in cemented TKA technique among arthroplasty surgeons. There were 26.5% of respondents performing less of the majority techniques and also performed other additional low-response rate techniques. Further studies that look at the impacts of variation in techniques on outcomes may be warranted. Our study demonstrates the need for defining best practices for cement technique given the substantial variability identified.
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Affiliation(s)
- J Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jeremy M Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Lucas A Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Gregory G Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Thorsten M Seyler
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Christopher E Pelt
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Dilbone ES, Moore-Lotridge SN, Gabbard M, Schultz JD, Rees AB, Martin JR, Polkowski GG. Location of Initial Closed Reduction Attempt Significantly Increases Cost and Length of Stay in Total Hip Arthroplasty. Arthroplast Today 2022; 15:102-107. [PMID: 35509290 PMCID: PMC9058571 DOI: 10.1016/j.artd.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 01/05/2023] Open
Abstract
Background Prosthetic hip dislocation remains one of the most frequent complications following total hip replacement. Dislocations are predominantly managed by a closed reduction in the emergency department (ED) or the operating room (OR). This study aimed to evaluate how the location of an initial closed reduction attempt impacts a patient's course of care including length of stay (LOS) and cost of care. Material and methods A retrospective chart review was performed on all patients presenting to a single ED with a unilateral prosthetic hip dislocation from 2009 to 2019. A total of 108 patients were identified. Data collected included patient demographics, ED/hospital course, and hospital charges. Results Seventy-four patients (69%) had initial reduction attempted in the ED (65/74, 88% were successful), while 34 patients (31%) went directly to OR (100% successful with closed reduction). Failed closed reduction in ED or direct to OR resulted in a greater LOS and rate of placement to a skilled nursing facility following discharge. Median hospital charges for successful ED reduction were $6,837, while failed ED closed reduction or direct to OR resulted in median charges of $27,317 and $20,481, respectively. Conclusion Many patients successfully underwent closed reduction in the ED, and there was no difference in complications, independent of where the reduction was first performed. Patients undergoing reduction in the OR had greater LOS and cost of care, independent of whether a reduction attempt was performed and failed in the ED, than those successfully reduced in the ED.
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Affiliation(s)
- Eric S. Dilbone
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephanie N. Moore-Lotridge
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Bone Biology, Vanderbilt University, Nashville, TN, USA
| | - Michael Gabbard
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Andrew B. Rees
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J. Ryan Martin
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gregory G. Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Moore HG, Schneble CA, Kahan JB, Polkowski GG, Rubin LE, Grauer JN. Total Joint Arthroplasty in Patients With Achondroplasia: Comparison of 90-Day Adverse Events and 5-Year Implant Survival. Arthroplast Today 2021; 11:151-156. [PMID: 34584919 PMCID: PMC8452593 DOI: 10.1016/j.artd.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Achondroplasia is the most common skeletal dysplasia, and total joint arthroplasty of the hip and/or knee in this patient population may present unique challenges. Methods All patients undergoing primary total hip or total knee arthroplasty (THA or TKA) for osteoarthritis in the 2010-2019 PearlDiver Mariner administrative database with least 90 days of postoperative follow-up were identified. Those with achondroplasia were matched 1:10 to patients without achondroplasia based on age, sex, and medical comorbidities. Ninety-day adverse events were assessed and compared using multivariate logistic regression. Five-year implant survival was determined and compared with Kaplan-Meier implant survival curves. Significance was set at P < .05. Results For THA, 150 patients with achondroplasia were matched to 1484 patients without and had significantly higher 90 days odds of surgical site infection (odds ratio [OR] = 3.49, P = .005) and readmission (OR = 2.35, P = .016). For TKA, 285 patients with achondroplasia were matched to 2828 without and had higher odds of aggregated any adverse event (OR = 1.52, P = .006) and transfusion (OR = 2.31, P < .001). Rates of the other studied adverse events were not significant for either set of the analyses. At 5 years, implant survival for those with and without achondroplasia was not different for those undergoing THA (P = .321) or TKA (P = .910). Conclusions The present study represents the largest cohort of patients with achondroplasia undergoing total joint arthroplasty to date. Although several short-term adverse events had greater odds for those with achondroplasia, 5-year survival was not different for those with or without achondroplasia after THA or TKA, supporting confidence in longer term implant success.
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Affiliation(s)
| | | | - Joseph B. Kahan
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Gregory G. Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lee E. Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
- Corresponding author. Department of Orthopaedics and Rehabilitation Yale School of Medicine 47 College Street, New Haven, CT 06511 Tel: 203-737-7463.
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Amaro E, Moore-Lotridge SN, Wessinger B, Benvenuti MA, An TJ, Oelsner WK, Polkowski GG, Schoenecker JG. Albumin and the fibrinogen-to-albumin ratio: Biomarkers for the acute phase response following total knee arthroplasty. PLoS One 2021; 16:e0247070. [PMID: 33592030 PMCID: PMC7886137 DOI: 10.1371/journal.pone.0247070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/29/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Complications following total knee arthroplasty (TKA) lead to patient morbidity and cost. While acute phase reactants, such as c-reactive protein (CRP) and fibrinogen, have been used to predict complications following TKA, the extent and duration of changes in albumin levels following TKA are unknown. It is hypothesized that like CRP and fibrinogen, albumin, and the fibrinogen/albumin ratio (FAR) represent useful measures of the acute phase response (APR) following TKA. The purpose of this study was to describe the longitudinal course of albumin and FAR in healthy patients following TKA, relative to established biomarkers, and examine if the variance in albumin or FAR correlates with patient comorbidities. METHODS This retrospective cohort study of patients undergoing TKA at a tertiary medical center. CRP, fibrinogen, and albumin values were collected pre- and post-operatively. An age-adjusted Charlson comorbidity index (CCI) was utilized as a measure of patient comorbidity status. RESULTS The median preoperative albumin value was 4.3 g/dL, which dropped to 3.6 g/dL on postoperative day 1 following TKA. The albumin value returned to 93% of the baseline by postoperative week 2. The course of albumin inversely mirrored the course of CRP (r = -0.41). Median preoperative FAR was 0.087 g/L, which rose to 0.130 g/L by postoperative week 2 and returned to baseline by postoperative week 6. While preoperative FAR strongly correlated with postoperative week 2 values (r = 0.74), there was a weak positive correlation between age-adjusted CCI and pre-operative FAR (r = 0.24) in patients undergoing primary TKA. CONCLUSION Albumin levels follow a predictable postoperative decline that inversely correlates with CRP in healthy patients following TKA. Given the low cost and abundance of laboratories offering albumin levels, direct albumin levels and/or albumin ratios such as FAR may be underutilized biomarkers for monitoring the APR following TKA.
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Affiliation(s)
- Emilie Amaro
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Stephanie N. Moore-Lotridge
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Bronson Wessinger
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Michael A. Benvenuti
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Thomas J. An
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - William K. Oelsner
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Gregory G. Polkowski
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jonathan G. Schoenecker
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
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Kuhn AW, Lynch JR, Ahlers CG, Polkowski GG. Spinal Anesthetic Type and Independent Risk Factors for Postoperative Urinary Retention Following Total Joint Arthroplasty. J Surg Orthop Adv 2020; 29:225-229. [PMID: 33416482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While risk factors for postoperative urinary retention (POUR) after total joint arthroplasty (TJA) have been identified, its association with type of spinal anesthetic has not yet been thoroughly investigated. Patients undergoing primary TJA between 2013-2018 were reviewed. From August 2013 to March 2016 bupivacaine was primarily given and from March 2016 through August 2018, most, although not all, received mepivacaine. Patient demographics as well as intraoperative data were recorded. One-thousand and fifty-four patients were included. POUR rates were not significantly different between groups (5.5% vs 6.1%, p = 0.675). Those who received mepivacaine had a significantly shorter length of stay (LOS) (1 vs. 2 days, p < 0.001). However, spinal anesthetic type was not significantly associated with either POUR or LOS after controlling for between-group differences. Older age (odds ratio [OR] 1.024 [95% confidence interval {CI}:1.000-1.049]; p = 0.049) and a history of benign prostatic hyperplasia or urinary incontinence/retention (OR 2.155 [95% CI:1.114-4.168]; p = 0.023) were confirmed as independent risk factors for POUR. (Journal of Surgical Orthopaedic Advances 29(4):225-229, 2020).
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Affiliation(s)
- Andrew W Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Jonathan R Lynch
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Gregory G Polkowski
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee
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Brekke AC, Amaro EJ, Posey SL, Engstrom SM, Polkowski GG, Schoenecker JG. Do Corticosteroids Attenuate the Peri-Operative Acute Phase Response After Total Knee Arthroplasty? J Arthroplasty 2019; 34:27-35. [PMID: 30268443 DOI: 10.1016/j.arth.2018.08.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Following tissue injury, the acute phase response (APR) functions to survive and then repair injured tissue. An exuberant APR, which can be evoked by total knee arthroplasty (TKA), results in a hyper-inflammatory state, leading to pain, nausea, venous thromboembolism, or potentially life-threatening complications. Here, we observed the effects of peri-operative dexamethasone on the APR following TKA by trending C-reactive protein (CRP, mg/L) and fibrinogen (mg/dL). We hypothesize that the anti-inflammatory effects of dexamethasone can attenuate the APR after TKA and will be associated with decreased post-operative pain and nausea. METHODS A retrospective case-control study was performed on 188 unilateral TKA procedures. The patients were divided into a group receiving dexamethasone (10 mg intra-operatively and on post-operative day [POD] 1) and a group receiving no corticosteroids. Post-operative CRP, fibrinogen, morphine equivalents, and anti-emetic doses were recorded. RESULTS Compared to the non-steroid group, patients receiving dexamethasone yielded a significantly decreased CRP on POD0 (5.5 vs 8.3), POD1 (11.8 vs 22.0), and POD2 (85.5 vs 148.9). A significant decrease in fibrinogen in patients receiving dexamethasone was seen on POD2 (460.0 vs 530.2). There was an increase in fibrinogen within the dexamethasone cohort at the 2-week visit (535.4 vs 488.9). Post-operative morphine equivalents administered were significantly decreased in patients receiving dexamethasone, but no difference in anti-emetic use was appreciated. CONCLUSION These data support the hypothesis that the APR following TKA can be attenuated pharmacologically by corticosteroids. Further studies are needed to determine whether the attenuation of the APR with the use of corticosteroids prevents complications following TKA.
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Affiliation(s)
- Adam C Brekke
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Emilie J Amaro
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Samuel L Posey
- School of Medicine, Vanderbilt University, Nashville, TN
| | - Stephen M Engstrom
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Gregory G Polkowski
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan G Schoenecker
- Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN; Department of Pathology Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN; Department of Pharmacology, Vanderbilt University, Nashville, TN
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Oelsner WK, Engstrom SM, Benvenuti MA, An, AB TJ, Jacobson RA, Polkowski GG, Schoenecker JG. Characterizing the Acute Phase Response in Healthy Patients Following Total Joint Arthroplasty: Predictable and Consistent. J Arthroplasty 2017; 32:309-314. [PMID: 27554779 PMCID: PMC7252910 DOI: 10.1016/j.arth.2016.06.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/04/2016] [Accepted: 06/13/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND During surgery, trauma to musculoskeletal tissue induces a systemic reaction known as the acute phase response (APR). When excessive or prolonged, the APR has been implicated as an underlying cause of surgical complications. The purpose of this study was to determine the typical APR following total joint arthroplasty in a healthy population defined by the Charlson Comorbidity Index (CCI). METHODS This retrospective study identified 180 healthy patients (CCI < 2) who underwent total joint arthroplasty by a single surgeon for primary osteoarthritis from 2013 to 2015. Serial measurements of C-reactive protein (CRP) and fibrinogen were obtained preoperative, perioperative, and at 2 and 6 weeks postoperative. RESULTS Postoperative CRP peaked during the inpatient period and returned to baseline by 2 weeks. Fibrinogen peaked after CRP and returned to baseline by 6 weeks. Elevated preoperative CRP correlated with a more robust postoperative APR for both total hip arthroplasty and total knee arthroplasty, suggesting that a patient's preoperative inflammatory state correlates with the magnitude of the postoperative APR. CONCLUSION Measurement of preoperative acute phase reactants may provide an objective means to predict a patient's risk of postoperative dysregulation of the APR and complications.
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Affiliation(s)
- William K. Oelsner
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee,College of Medicine, The Medical University of South Carolina, Charleston, South Carolina
| | - Stephen M. Engstrom
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | - Gregory G. Polkowski
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G. Schoenecker
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee,Reprint requests: Jonathan G. Schoenecker, MD, PhD, Vanderbilt University, 4202 Doctors’ Office Tower, 2200 Children’s Way, Nashville, TN 37232-9565
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Polkowski GG. Supplement to Proceedings-the 2015 AAHKS Annual Meeting. J Arthroplasty 2016; 31:1-2. [PMID: 27460299 DOI: 10.1016/j.arth.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Lieberman JR, Polkowski GG, Della Valle CJ. Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons. J Arthroplasty 2016; 31:3-6. [PMID: 27236744 DOI: 10.1016/j.arth.2016.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 04/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A survey was conducted at the 2015 annual meeting of the American Association of Hip and Knee Surgeons (AAHKS) to determine current practice management patterns among AAHKS members. METHODS A survey was conducted by the session moderator during the annual AAHKS meeting using an audience response system. A series of practice management issues were reviewed with AAHKS members. The survey contained multiple choice and yes and no questions. The audience responses were collected in a central database and then immediately displayed for the audience to review. RESULTS The survey responses provided interesting data on a variety of topics including: surgeon demographics, surgical activity, practice status, use of physician extenders, sources of ancillary income, the use of electronic medical records and surgeon satisfaction. Interestingly, 51% of AAHKS members remain in private practice and fee for service remains the most common form of compensation (48%). The vast majority of AAHKS members do not perform hip arthroscopy (86%) or hip preservation procedures (87%). CONCLUSION Valuable information regarding practice patterns of AAHKS members was obtained from this survey. Future surveys will need to focus on 3 areas of activity: surgeon involvement in bundled payment programs frequency of submission of patient data to a joint registry and the frequency of outpatient total joint arthroplasty.
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Affiliation(s)
- Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | | | - Craig J Della Valle
- Department of Othopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Polkowski GG, Duncan ST, Bloemke AD, Schoenecker PL, Clohisy JC. Screening for deep vein thrombosis after periacetabular osteotomy in adult patients: is it necessary? Clin Orthop Relat Res 2014; 472:2500-5. [PMID: 24733447 PMCID: PMC4079874 DOI: 10.1007/s11999-014-3614-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/27/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The periacetabular osteotomy has become a common procedure for treating symptomatic acetabular dysplasia. Like other major hip procedures, there is concern regarding the risk of associated venous thromboembolic disease. Nevertheless, there is limited information regarding the need for screening, and optimal prophylactic measures have not been established. QUESTIONS/PURPOSES We sought to determine the frequency of thromboembolic events (deep vein thrombosis [DVT] and symptomatic pulmonary embolism [PE]) associated with the periacetabular osteotomy in in patients receiving aspirin and mechanical compression prophylaxis. METHODS We performed a retrospective review of 134 adult patients (149 hips) treated with the periacetabular osteotomy during an 8-year period. During this period, 136 (91%) of the hips treated with a periacetabular osteotomy were screened within 1 week for DVT, whereas 13 (9%) could not be evaluated for various reasons. The mean age of the patients at the time of surgery was 30 years (range, 18-60 years), and no patients were lost to followup during the 4 to 6 months after surgery. The same thromboembolic prophylactic regimen was used for all patients. This consisted of 325 mg aspirin twice a day and compression stockings for 6 weeks and lower extremity pneumatic compression devices while hospitalized. Screening bilateral lower extremity ultrasonography was performed within 1 week (mean, 4 days) of the procedure to detect asymptomatic DVTs. RESULTS Of the 134 patients, two patients (two hips) with negative postoperative screening ultrasounds presented at 14 and 38 days postoperatively with clinical symptoms of DVT. Repeat ultrasound confirmed this diagnosis in both cases. There were no symptoms of PE. Screening venous ultrasonography did not identify any DVTs during the early postoperative period before discharge. These two patients were treated with 3 to 6 months of warfarin anticoagulation. Neither patient had persistent symptoms related to the DVT. CONCLUSIONS These data indicate that the risk of symptomatic DVT associated with periacetabular osteotomy is low (1%) with use of aspirin and mechanical compression prophylaxis. Furthermore, routine postoperative screening did not detect any patients with an asymptomatic DVT. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Stephen T. Duncan
- />Department of Orthopaedic Surgery, University of Kentucky School of Medicine, 125 E. Maxwell Street, Suite 021, Lexington, KY 40508 USA
| | | | | | - John C. Clohisy
- />Washington University School of Medicine, St Louis, MO USA
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Abstract
There is no consensus with respect to the best procedures to preserve the knee joint in patients with osteonecrosis of the knee. We performed a systematic review of the literature between 1999 and 2012. Only 10 of 1057 studies met our inclusion criteria. Core decompression prevented additional surgical treatment in pre-collapse knees with a failure rate of 10.4% (7 of 67 knees). Autogenous and osteochondral grafts decreased the need for additional surgery in both pre-collapse (0%, 20 of 20) and post-collapse knees (10.5%, 8 of 76 knees). Although these results are quite promising multi-center randomized trials are needed to identify the optimal procedures to treat this disease.
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Affiliation(s)
- Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, University of Southern California, Los Angeles, California
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Lieberman JR, Pensak MJ, Kelleher MS, Leger RR, Polkowski GG. Disclosure of financial conflicts of interest: an evaluation of orthopaedic surgery patients' understanding. Clin Orthop Relat Res 2013; 471:472-7. [PMID: 22948521 PMCID: PMC3549175 DOI: 10.1007/s11999-012-2525-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Industry and orthopaedic surgeons often partner to develop new technology, which can lead to orthopaedic surgeons having financial conflicts of interest (FCOI). It is essential these FCOI be conveyed clearly to patients. It is unclear, however, whether and to what degree patients understand the ramifications of physician FCOI. QUESTIONS/PURPOSES We evaluated (1) patients' concerns regarding their surgeon having FCOI or the presence of institutional FCOI, (2) the effect of surgeon FCOI on patients' willingness to have surgery, and (3) patients' understanding of FCOI. METHODS We asked 101 patients (66% female) receiving total joint arthroplasty from the orthopaedic practices of two surgeons at an academic health center to complete a descriptive, correlational designed survey at their 6-week followup appointment. The data collected included patient demographics, knowledge of FCOI, and the influence of FCOI on patient attitudes toward surgery and their surgeon. RESULTS A minority of patients (13%) reported discussing FCOI with prior physicians and only 55% agreed or strongly agreed a surgeon should disclose FCOI. Only 15% of patients believed such conflicts would make them less likely to have their surgeon operate on them. Level of education was weakly correlated (Spearman's rho = 0.29) with patient understanding of FCOI. CONCLUSIONS Overall, patients had a poor understanding of FCOI. Both level of education and previous discussions of FCOI predicted better understanding. This study emphasizes communication of FCOI with patients needs to be enhanced.
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Affiliation(s)
- Jay R. Lieberman
- />Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Michael J. Pensak
- />Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Michael S. Kelleher
- />Department of Internal Medicine, Hospital of Saint Raphael, New Haven, CT USA
| | - Robin R. Leger
- />Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Gregory G. Polkowski
- />Department of Orthopaedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030 USA
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Abstract
BACKGROUND There is growing evidence to suggest many patients experience pain and dissatisfaction after TKA. The relationship between preoperative osteoarthritis (OA) severity and postoperative pain and dissatisfaction after TKA has not been established. QUESTIONS/PURPOSES We explored the relationship between early-grade preoperative OA with pain and dissatisfaction after TKA by (1) determining the incidence of early-grade preoperative OA in painful TKAs with no other identifiable abnormality; and (2) comparing this incidence with the incidence of early-grade OA in three other cohorts of patients undergoing TKA. METHODS We evaluated all (n = 49) painful TKAs in a 1-year period that had no evidence of loosening, instability, malalignment, infection, or extensor mechanism dysfunction and classified the degree of preoperative OA according to the scale of Kellgren and Lawrence. For comparison, we identified three other cohorts of TKAs from the same center and classified their preoperative grade of OA: Group B (n = 100) was a consecutive series of primary TKAs performed for OA during the same year; Group C (n = 80) were asymptomatic TKAs from 1 to 4 years postoperatively; and Group D (n = 80) were TKAs with some degree of pain at 1 to 4 years postoperatively. RESULTS Patients in Group A had a higher incidence of early-grade OA is preoperatively (49%) compared with any of the comparison groups: Group B, 5%; Group C, 6%; and Group D, 10%. CONCLUSIONS A high percentage of patients referred for unexplained pain after TKA had early-grade osteoarthritis preoperatively. Patients undergoing TKA for less than Grade 3 or 4 OA should be informed that they may be at higher risk for persistent pain and dissatisfaction.
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Affiliation(s)
- Gregory G. Polkowski
- />Department of Orthopedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT USA
| | - Erin L. Ruh
- />Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110 USA
| | - Toby N. Barrack
- />Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110 USA
| | - Ryan M. Nunley
- />Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110 USA
| | - Robert L. Barrack
- />Department of Orthopaedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St Louis, MO 63110 USA
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Abstract
BACKGROUND Avoiding complications after hip arthroplasty with hard-on-hard bearings, especially metal-on-metal, correlates with the position of the acetabular component. Supine imaging with conventional radiography has traditionally been utilized to assess component inclination (abduction), as well as anteversion, after THA and surface replacement arthroplasty (SRA). However, most adverse events with hard bearings (excessive wear and squeaking) have occurred with loading. Standing imaging, therefore, should provide more appropriate measurements. QUESTIONS/PURPOSES We determined whether standing changed standard measurements of acetabular component position using a novel biplanar imaging system compared to traditional supine imaging. METHODS We performed simultaneous biplanar standing imaging of the lower extremity with a novel imaging system using low radiation collimated beam on 46 patients who underwent THA (23) or SRA (23). Patients who had previously undergone THA had standard CT scans performed. For patients who underwent SRA, we compared acetabular inclination in the supine versus double-limb and single-limb standing. RESULTS Standing anteversion differed from supine anteversion by greater than 5° for 12 of 23 patients who underwent THA (range, 5°-16°). For patients who underwent SRA, 13 of 23 patients exhibited a difference of greater than 3° in inclination between supine and double-limb standing images, and six of 23 patients exhibited a difference of greater than 3° in inclination between supine and single-limb standing images. CONCLUSIONS Standing changed the acetabular inclination and version in a substantial percentage of patients undergoing hip arthroplasty.
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Affiliation(s)
- Gregory G. Polkowski
- Department of Orthopedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT USA
| | - Ryan M. Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
| | - Erin L. Ruh
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
| | - Brandon M. Williams
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
| | - Robert L. Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
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Crosby SN, Polkowski GG, Schwartz HS, Shinar AA, Holt GE. Metal-backed versus all-polyethylene tibias in megaprostheses of the distal femur. J Arthroplasty 2011; 26:451-7. [PMID: 20334995 DOI: 10.1016/j.arth.2010.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 01/05/2010] [Indexed: 02/01/2023] Open
Abstract
In megaprostheses, the tibial component is rarely a source of failure. The evolution of these implants has followed standard arthroplasty trends moving from majority use of all-polyethylene tibias (APT) to high volume use of metal-backed tibial (MBT) components. We report the results of 72 endoprostheses using either MBT (n = 42) or APT (n = 30) implanted between 1994 and 2006. Failures of the implant related to the tibial component were isolated, and 5-year survival of the tibial implant of the MBT cohort was 94%, and for the APT cohort, 87% (P = .39). The difference in tibial component failures between the 2 groups was not statistically significant (Pearson χ(2) = 0.1535, P = .6952). Revision rates for the entire implant and infection rates were not significantly different between the 2 groups.
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Affiliation(s)
- Samuel N Crosby
- Department of Orthopaedic Surgery, Vanderbilt UniversityMedical Center, Nashville, TN, USA
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