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1.
Hernández-Vaquero D Fernández-Carreira JM Pérez-Hernández D Fernández-Lombardía J García-Sandoval MA 《The Journal of arthroplasty》2006,21(3):358-361
The goal of this study was to compare the results of the total knee arthroplasty (TKA) in 2 study groups only differing by age. We have analyzed 218 TKA cases (138 women and 80 men) with at least 2 years follow-up. Mean age was 70 years (SD, 7.38 years; range, 43 to 98 years). An age cutoff point at 75 years defined the 2 study groups: 167 cases younger than 75 years and 51 older. Results were evaluated using the Hospital for Special Surgery Score. Mean score was raised from 53.43 (SD, 9.186) preoperatively to 85.57 (SD, 10.763) in 2 years follow-up (P < .001). The final score did not show significant differences between both groups (86.11 for the younger group and 83.8 for the older group). Differences in pain on walking, pain at rest, walk, range of motion, climbing stairs, transfer, muscle strength, or instability were not found between the patients younger and older than 75 years. We did not find any differences in TKA, functional score, or pain between the 2 studied groups. 相似文献
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Lyons MC MacDonald SJ Somerville LE Naudie DD McCalden RW 《Clinical orthopaedics and related research》2012,470(1):84-90
Background
TKA and unicompartmental knee arthroplasty (UKA) are both utilized to treat unicompartmental knee arthrosis. While some surgeons assume UKA provides better function than TKA, this assumption is based on greater final outcome scores rather than on change in scores and many patients with UKA have higher preoperative scores. 相似文献3.
Stephen M. Petis Brent A. Lanting Edward M. Vasarhelyi Douglas D.R. Naudie Fiona E. Ralley James L. Howard 《The Journal of arthroplasty》2017,32(9):2688-2693
Background
Several treatment modalities exist for the treatment of perioperative anemia. We determined the effect of oral iron supplementation on preoperative anemia, and the use of blood-conserving interventions before total hip arthroplasty (THA) and total knee arthroplasty (TKA).Methods
A total of 3435 total joint arthroplasties (1461 THAs and 1974 TKAs) were analyzed during 2 phases of a blood conservation program. The first phase used erythropoietin alfa (EPO) or intravenous (IV) iron for patients at risk for perioperative anemia. The second phase included these interventions, as well as preoperative iron supplementation. The effect on preoperative hemoglobin (Hb) and serum ferritin, as well as EPO and IV iron utilization, was determined.Results
Oral iron therapy increased preoperative Hb level by 6 g/L (P < .001) and 7 g/L (P < .001) in the hip and knee cohorts, respectively. Serum ferritin level rose by 80 μg/L (P < .001) and 52 μg/L (P < .001) in the hip and knee cohorts, respectively. The number of patients with an Hb level <130 g/L was significantly reduced (P < .001 for both cohorts), as were patients with serum ferritin levels <35 μg/L (P = .002 for hip and P < .001 for knee cohorts). Utilization of EPO reduced from 16% to 6% (P < .001) and 18% to 6% (P < .001) in the hip and knee cohorts, respectively. Utilization of IV iron reduced from 4% to 2% (P = .05) and 5% to 2% (P < .001) in the hip and knee cohorts, respectively.Conclusion
Oral iron therapy reduced the burden of perioperative anemia and reduced utilization of other blood-conserving therapies before THA and TKA. Future research should delineate the cost-effectiveness of oral iron therapy. 相似文献4.
Arthrodesis is a widely accepted treatment for failed total knee arthroplasty when further revision is contraindicated. In this study, we retrospectively review the pre-operative characteristics, operation techniques, treatment plans, and eventual outcomes in 42 consecutive patients (43 knees) who underwent knee arthrodesis at a single institution. Femorotibial fusion was achieved in 30 cases (75.0%). No cases of implant failure were recorded. Post-operative complications occurred in 20 cases (46.5%). Repeat arthrodesis was performed in 4 cases, and 2 patients eventually required above-the-knee amputation. Comparing the cases with successful vs. unsuccessful outcomes, there was a significant difference in days until hospital discharge following arthrodesis (P = .026), mean erythrocyte sedimentation rate prior to arthrodesis (P = .012), and the proportion of patients with post-operative wound complications (P = .021). 相似文献
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《The Journal of arthroplasty》2020,35(3):870-876
BackgroundCementless total knee arthroplasty has been developed to decrease the incidence of failure in younger and more active patients. However, failures are still more common in cementless versus cemented components. It is hypothesized that this is triggered by incomplete bone-tray contact. The present study compares the final contact area of a cementless tray as a function of the initial osteotomy flatness.MethodsEight surgeons prepared 14 cadaveric knees for cementless total knee replacement using standard instrumentation. The topography of each osteotomy was captured with a laser scanner; 3-dimensional computer models of the surfaces were generated. After scanning each tibia, the surgeons implanted cementless tibial trays using a manual impactor. Each tibia was then dissected, embedded in mounting resin, and sectioned. The sectioned blocks were observed under stereomicroscopy to identify points of bone-tray contact which were incorporated into the 3-dimensional models. Maps were then generated illustrating depicting contacting and noncontacting areas.ResultsThe mean initial flatness of all specimens was 1.1 ± 0.35 mm. After impaction, 79.4% ± 0.3% of the surface had established bony contact. Of the noncontacting areas, 17.6% were within 0.3 mm of the tray. Only 2.6% of the surface was at distances reported to impede ingrowth. Noncontacting areas were typically located centrally. A trend in decreasing percent contact area with increased flatness tolerance was observed (R2 = 0.605).Conclusion(1) There is an inverse correlation between the flatness of the tibial osteotomy and the percentage of the bony surface in contact with underside of the tibial tray. (2) Almost all tray-tibia contact is generated during implantation through flattening of elevated features on the tibial surface. (3) Gaps between the tray and the tibia are consistently located in the central regions of the osteotomy proximal to the medullary canal. 相似文献
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R. Pagoti S. O’Brien J. Blaney E. Doran D. Beverland 《Journal of Clinical Orthopaedics and Trauma》2018,9(4):295-299
Background
Reduced flexion following knee arthroplasty (TKA) may compromise patient’s function and outcome. The timing of manipulation under anaesthesia (MUA) has been controversial. We present our experience in a high volume practice and analyse the impact of timing.Methods
All TKA patients requiring MUA from February 1996 to June 2015 under the care of a single surgeon were analysed. MUA was offered to patients who had ≤ 75° of flexion post-op, providing that they had 30° more flexion preoperatively. To address the impact of timing from primary surgery to MUA on flexion gain we looked at 3 groups: Group I ≤ 90 days, Group II 91-180 days and Group III > 180 days.Results
Sixty two out of 7,423 (0.84%) underwent MUA. The MUA patients were significantly younger than the overall TKA cohort 61.2 vs 70.5 years (p = < 0.01). The median duration between arthroplasty and MUA was 3.9 months (IQR 3.4, Range 1.6-72.5 months). Overall flexion gained at 6-12 Weeks and 1 year post MUA showed significant improvements of 20.9° (p = <0.01) and 25° respectively (p = < 0.01). The flexion gain in group I (≤ 90 days) was significantly better than group III ( > 180 days) both at 6 weeks and 1 year following MUA but not better than group II (90-180 days).Conclusions
MUA is an effective treatment for reduced flexion following TKA and should be the first line of management after failed physiotherapy. It can still have benefit beyond 6 months but the gains become less effective with time. 相似文献9.
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《The Journal of arthroplasty》2021,36(12):3950-3958
BackgroundThe International Classification of Diseases-10 (ICD-10) came into effect in October 2015. The new procedural codes (ICD-10-PCS) were designed to specify granular aspects of the procedure, including laterality and revised components. This specificity could improve data collection in institutional databases, large registries, and administrative claims data. Given these possible applications, this study’s purpose was to assess the accuracy of ICD-10-PCS coding for revision total knee arthroplasty (rTKA).MethodsThis multicenter retrospective analysis utilized the rTKA databases at four academic medical centers for all aseptic rTKAs between October 1, 2015 and July 3, 2019. Operative reports were reviewed to determine laterality and revised components (tibial, femoral, liner, and patellar component), which were then compared with the ICD-10-PCS codes associated with the billing records. Proper coding required both component removal and replacement codes. The correct series of removal and replacement codes was determined using the American Joint Replacement Registry’s guidelines.ResultsIn total, 1906 rTKAs were examined, and 98.0% had at least one proper ICD-10-PCS code, indicating an rTKA had occurred. Coding for components replaced was correct in 76.3% of cases. When examining both removal and replacement codes, accuracy dropped to 57.0%.ConclusionNearly 25% of rTKA procedures were incorrectly coded for replaced components, and over 40% were incorrectly coded for removed and replaced components. ICD-10-PCS codes can accurately identify that an rTKA has occurred; however, the inaccuracy in identifying which specific components were revised should prompt further evaluation of the coding process before utilizing ICD-10-PCS codes to report granular rTKA data.Level of EvidenceIII, retrospective observational analysis. 相似文献
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Edwin Theosmy Michael Yayac Chad A. Krueger P. Maxwell Courtney 《The Journal of arthroplasty》2021,36(1):42-46
BackgroundIn 2018, the Centers for Medicare and Medicaid Services removed total knee arthroplasty (TKA) from the inpatient-only list, resulting in payment through the Outpatient Prospective Payment System with an average $3157 reduction. The purpose of this study is to determine if the reimbursement is justified by comparing the difference in facility costs between inpatient and outpatient TKAs.MethodsWe identified 4496 consecutive primary TKA procedures performed at 2 hospitals from 2015 to 2019. Itemized facility costs were calculated using a time-driven activity-based costing algorithm. Outpatient procedures were defined as those with a length of stay of less than 2 midnights (3851, 86%). Patient demographics, comorbidities, and itemized costs were compared between groups. A multivariate regression analysis was performed to determine the independent effect of outpatient status on true facility costs.ResultsOutpatient TKA patients had lower mean postoperative personnel costs ($1809 vs $947, P < .001), supply costs ($4347 vs $4229, P < .001), and overall total facility costs ($7371 vs $6937, P < .001) than inpatient TKA patients. Controlling for a younger patient cohort with fewer medical comorbidities, outpatient status was associated with a reduction in total facility costs of $972 (95% confidence interval $883-$1060, P < .001) compared to inpatient TKA.ConclusionOutpatient TKA costs hospitals nearly $1000 per patient less than inpatient TKA, yet the average difference in Medicare reimbursement for an outpatient procedure is $3157 less per patient. Centers for Medicare and Medicaid Services should reconsider the Outpatient Prospective Payment System classification of TKA to better incentivize surgeons to perform TKA as a lower cost outpatient procedure when safe and appropriate. 相似文献
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Reza M. Tabatabaee Mohammad R. Rasouli Mitchell G. Maltenfort Robert Fuino Camilo Restrepo Ali Oliashirazi 《The Journal of arthroplasty》2018,33(4):1076-1081
Background
Image-based and imageless computer-assisted total knee arthroplasty (CATKA) has become increasingly popular. This study aims to compare outcomes, including perioperative complications and transfusion rate, between CATKA and conventional total knee arthroplasty (TKA), as well as between image-based and imageless CATKA.Methods
Using the 9th revision of the International Classification of Diseases codes, we queried the Nationwide Inpatient Sample database from 2005 to 2011 to identify unilateral conventional TKA, image-based, and imageless CATKAs as well as in-hospital complications and transfusion rates.Results
A total of 787,809 conventional TKAs and 13,246 CATKAs (1055 image-based and 12,191 imageless) were identified. The rate of CATKA increased 23.13% per year from 2005 to 2011. Transfusion rates in conventional TKA and CATKA cases were 11.73% and 8.20% respectively (P < .001) and 6.92% in image-based vs 8.27% in imageless (P = .023). Perioperative complications occurred in 4.50%, 3.47%, and 3.41% of cases after conventional, imageless, and imaged-based CATKAs, respectively. Using multivariate analysis, perioperative complications were significantly higher in conventional TKA compared to CATKA (odds ratio = 1.17, 95% confidence interval 1.03-1.33, P = .01). There was no significant difference between imageless and image-based CATKA (P = .34). Length of hospital stay and hospital charges were not significantly different between groups (P > .05).Conclusion
CATKA has low complication rates and may improve patient outcomes after TKA. CATKA, especially the image-based technique, may reduce in-hospital complications and transfusion without increasing hospital charges and length of hospital stay significantly. Large prospective studies with long follow-up are required to verify potential benefits of CATKA. 相似文献14.
《The Journal of arthroplasty》2020,35(2):557-562
BackgroundThe available evidence on pseudo-patella baja (PPB) is limited. The purpose of this study is to investigate prospectively the occurrence of PPB after primary total knee arthroplasty and its clinical consequences in a large series of patients with a minimum follow-up of 2 years. PPB was defined as a patella distally displaced in relationship to the femoral trochlea with absence of patellar tendon shortening (Grelsamer RP. J Arthroplasty 2002;17:66-69) due to elevation of the joint line.MethodsThis study is a prospective case series of 354 patients with a mean age of 71.7 (range 52-87) years. Clinical evaluation was performed by the Knee Society Scores (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short-Form 12-item (SF12), and range of motion. Patellar height was assessed by the Insall-Salvati and Blackburne-Peel ratios.ResultsThe mean follow-up was 3.6 (range 2.0-6.6) years. Postoperatively, 286 (80.7%) patients had a normal patellar height, 17 (4.8%) had true patella baja (TPB), and 51 (14.4%) had PPB. There were no significant differences between the 3 groups in mean KSS-function (P = .107), range of motion (P = .408), WOMAC-pain (P = .095), WOMAC-stiffness (P = .279), or SF12-mental (P = .363). Between normal and PPB groups, there were no significant differences in mean KSS-knee (P = .903), WOMAC-function (P = .294), or SF12-physical (P = .940). However, the TPB group had significantly lower mean KSS-knee (P = .031), WOMAC-function (P = .018), and SF12-physical (P = .005) as compared with either 2 other groups.ConclusionPPB was a relatively common finding, but no significant differences in terms of clinical outcomes were found as compared to patients with postoperative normal patellar height. TPB was infrequent, but these patients had significantly worse clinical outcomes than those with PPB or normal patellar height. 相似文献
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Bruni D Iacono F Raspugli G Zaffagnini S Marcacci M 《Clinical orthopaedics and related research》2012,470(5):1442-1451
Background
The literature suggests survivorship of unicompartmental knee arthroplasties (UKAs) for spontaneous osteonecrosis of the knee ranges from 93% to 97% at 10 to 12 years. However, these data arise from small series (23 to 33 patients), jeopardizing meaningful conclusions. 相似文献17.
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We reviewed the results of 78 revision total knee arthroplasties using a rotating-hinge device, performed from 1993 through 2002. The average follow-up was 7.83 years. Only patients requiring revision arthroplasty due to aseptic loosening were included. Reasons for revision were malalignment with or without polyethylene wear (47), instability (24), extensor mechanism failure (3), and periprosthetic fracture (4). The mean preoperative scores according to the American Knee Society rating scale was 37.5 points for knee score and 32.8 points for function score. Postoperatively, the knee score improved to 85.7 points and the function score improved to 61.4 points. Nineteen patients had complications related to the design prostheses (mostly minor complications). Fifty-seven patients (73%) had excellent results, with a range of motion of 104 degrees in flexion and complete extension. For extreme circumstances, such as gross instability of the medial collateral ligament, massive bone loss, comminuted fracture, and chronic dysfunction of the extensor mechanism, there is a place for hinged revision implant surgery with good clinical results and quality of life. 相似文献
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Are There Prognostic Factors for One-Year Outcome After Total Knee Arthroplasty? A Systematic Review
Karen E.M. Harmelink Adelgunde V.C.M. Zeegers Wim Hullegie Thomas J. Hoogeboom Maria W.G. Nijhuis-van der Sanden J. Bart Staal 《The Journal of arthroplasty》2017,32(12):3840-3853.e1
Background
Preoperative factors predicting outcome for pain, physical function and quality of life after total knee arthroplasty (TKA) have not been clearly identified.Methods
Embase and MEDLINE were searched for relevant studies. A study was considered for inclusion if the study aimed to identify preoperative prognostic factors for pain, physical function, and/or quality of life after a follow-up period of at least 1 year; included at least 200 adults suffering from osteoarthritis and undergoing TKA; and analyzed data using multivariable modeling. The quality of the evidence per prognostic factor was determined using the Grading of Recommendations, Assessment, Development and Evaluation framework for prognosis studies.Results
A total of 18 studies were included. There is very low-quality evidence that preoperative more pain, presence of social support, absence of anxiety, and presence of more radiographic damage are prognostic factors for lower pain levels after TKA. There is very low-quality evidence that low preoperative physical function, less comorbidity, absence of anxiety, presence of social support, higher income, normal body mass index, and more radiographic damage are prognostic factors for better physical function. There is very low-quality evidence that female sex and less comorbidity are prognostic factors for better quality of life.Conclusion
Only very low-quality evidence was found for a number of prognostic factors of long-term outcome after TKA. More studies that seek to generate understanding of the underlying process for the prognosis of outcome in TKA are needed to understand and test prognostic pathways, and it might be more valuable to look at recovery curves rather than at recovery points.Systematic review registration number: CRD42015026814. 相似文献20.
Chloe E.H. Scott Matilda F.R. Powell-Bowns Deborah J. MacDonald Philip M. Simpson Frazer A. Wade 《The Journal of arthroplasty》2018,33(7):2203-2209