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1.
Emanuele Maiorano Bruno Dino Bodini Francesca Cavaiani Catia Pelosi Valerio Sansone 《The Knee》2017,24(1):116-120
Background
To identify variables influencing length of stay (LOS) and short-term functional outcome in patients undergoing total knee arthroplasty (TKA). A secondary aim was to verify the effect of the same variables on blood management and the rate of postoperative infection.Method
We retrospectively reviewed 353 patients, 258 females and 85 males, who underwent primary TKA in a single specialist orthopaedic centre. Anamnestic and anthropometric data and the Modified Barthel Index Score (MBI) at admission were recorded, and entered as covariates in four longitudinal regression models, separately carried out for female and male groups. The regression outcomes were LOS, MBI change, rate of infection and blood transfusion. Statistical significance was set at p < 0.05.Results
Mean LOS was 15.93 ± 4.97 days for females and 13.41 ± 3.63 days for males. Mean MBI improvement was statistically significant in both groups. 46.3% females and 29.4% males needed at least one blood transfusion, while infections complicated the hospitalization in 14.6% and 4.7% cases respectively. Among females, older age was predictive for a longer LOS and poorer post-operative MBI improvement. Lower MBI at admission was related to a longer LOS and to a higher risk of post-surgical infections in the female group, but to a better improvement of functional outcome in both groups. A higher rate of blood transfusion postoperatively was associated to lower pre-surgical haemoglobin levels and, for females, to older age and lower BMI.Conclusion
An accurate characterization of TKA candidates might help in reducing LOS and in achieving a better early functional outcome. 相似文献2.
Background
Unplanned hospital readmissions are indicators of the quality and performance of a health care system, but data on early readmission after primary total knee arthroplasty (TKA) in the Asian population are limited. The purpose of this study was to determine the causes, risk factors, and rate of unplanned readmission after primary TKA at a single institution in Korea.Methods
We analyzed all primary TKAs from 2004 to 2013 using the data from our institutional electronic database. A total of 4596 TKAs were performed on 3049 patients. All unplanned readmissions within 30 and 90 days of discharge were identified, categorized into arthroplasty-related, medical, and other orthopedic causes.Results
The overall unplanned readmission rate was 1.9% (n = 59) within 30 days and 3.3% (n = 101) within 90 days, and both the 30 and 90 day readmission rates remained stable over the entire study period. The majority of readmissions involved arthroplasty-related causes; the most common cause being wound problems, accounting for 22% (13/59) within 30 days and 24% (24/101) within 90 days. Age (P = 0.029) and hypertension (P = 0.021) were identified as risk factors for unplanned readmissions after TKA.Conclusion
This study demonstrates that unplanned readmissions after TKA are not infrequent in Korean patients and has identified wound complication as the most frequent cause of unplanned readmissions. Optimized care systems should be established to minimize unplanned readmissions, particularly for patients with high risk factors. 相似文献3.
Body mass index as a predictor of outcome in total knee replace: A systemic review and meta-analysis
Background
To conduct a meta-analysis with randomized controlled trials (RCTs) published in full text to demonstrate database to show the associations of perioperative, postoperative outcomes of normal and high body mass index (BMI) to provide the predictive diagnosis for clinic.Methods
Literature search was performed in PubMed, Embase, Web of Science and Cochrane Library for information from the earliest date of data collection to February.RCTs comparing the benefits and risks of normal BMI with those of high BMI in primary total knee arthroplasty (TKA) were included. Statistical heterogeneity was quantitatively evaluated by X2 test with the significance set P < 0.10 or I2 > 50%.Results
Seven RCTs consisting of 33,778 patients were included. (6065 normal BMI patient; 27,713 high BMI). The results showed that high BMI was related to a greater increase in operative time, post-operative range of motion (ROM), post-operative Knee Society and function scores (KSS), infection rate (P < 0.1). No differences in pulmonary embolism and perioperative mortality rates were found between normal and high body mass index patients with follow-up ≥ 5 years (P > 0.1).Conclusions
Compared with normal BMI patients, high BMI patients demonstrated an increased risk of perioperative and postoperative complications and clear difference about complications between normal and high BMI about TKA. 相似文献4.
Background
Superficial wound complications occur in up to 10% of total knee arthroplasty (TKA) procedures and have been associated with periprosthetic joint infection. The ideal material for TKA closure should offer: 1) fast intraoperative application, 2) minimal wound complications and 3) removable by patients without assistance. We evaluated a novel, non-invasive, removable skin closure system for TKA to determine its effect on wound complications.Methods
We prospectively evaluated 221 consecutive TKA patients who received skin closure using a non-invasive zipper-like system (‘Zip’; Zip 16 Surgical Skin Closure System; Zipline Medical). All procedures were performed by a single surgeon using the mini-midvastus approach. Patients received two weeks of rivaroxaban postoperatively. Demographics, comorbidities, in-hospital complications and six-week wound evaluation were recorded. Data was compared to a cohort of 1001 patients from the same surgeon who received staples for closure and coumadin for thromboprophylaxis.Results
Zip patients had a significantly higher BMI (p = 0.001), incidence of diabetes (p = 0.035) and smoking (p = 0.005). Zip patients removed dressings themselves and did not report problems with dressing care. Rate of readmission for wound-related complications was significantly lower in the Zip closure group (p = 0.045). Overall readmission rates were similar between groups.Conclusions
In our experience, the Zip 16 Surgical Skin Closure System is easy to apply, avoids home care and has produced fewer wound complications compared to staples. Results have been positive despite the study cohort having a higher number of diabetic patients and using an anticoagulant associated with a higher risk of wound complications. 相似文献5.
Kunal Dhurve Corey Scholes Sherif El-Tawil Aseem Shaikh Lai Kah Weng Kumbelin Levin Brett Fritsch David Parker Myles Coolican 《The Knee》2017,24(4):856-862
Background
The aims of this study were to identify the prevalence and causes of dissatisfaction in a cohort of private practice patients, and to compare the psychological characteristics of dissatisfied patients to matched, satisfied controls.Methods
Unilateral TKR patients were evaluated to identify those dissatisfied with their TKR. Dissatisfied and satisfied patients were matched in terms of age, gender, follow-up duration and body mass index (BMI). Psychological evaluation was performed using the Pain Catastrophizing Scale (PCS), Depression, Anxiety and Stress Scale (DASS) and the Multidimensional Health Locus of Control (MHLC) scale. The preoperative grade of osteoarthritis, prevalence of comorbidities, and postoperative functional outcomes, were also compared.Results
A cohort comprised 301 patients (response rate 71%), with 24 patients (eight percent) dissatisfied at a mean follow-up of 37 months (range eight to 74 months). Persistent pain was the most common reason for dissatisfaction (n = 10). Dissatisfied patients reported a significantly higher mean PCS score (P = 0.03), higher depression component of the DASS (P = 0.02) and lower internal locus of control (P = 0.02). The dissatisfied group exhibited reduced improvement (P < 0.05) in the Oxford Knee Score (OKS) and range of motion (ROM), as well as a lower preoperative grade of osteoarthritis compared to satisfied patients.Conclusions
Dissatisfied patients exhibit an altered psychological profile to matched satisfied controls. In addition, they have lesser improvements in the OKS and ROM. Thus, both physical as well as psychological factors contribute to dissatisfaction. Identification of these factors may help in planning focused interventions to address dissatisfaction. 相似文献6.
Manabu Kawata Yusuke Sasabuchi Hiroshi Inui Shuji Taketomi Hiroki Matsui Kiyohide Fushimi Hirotaka Chikuda Hideo Yasunaga Sakae Tanaka 《The Knee》2017,24(5):1198-1205
Background
Various nationwide studies have reported differing annual trends in utilization of knee arthroplasty and tibial osteotomy. Using the Diagnosis Procedure Combination database in Japan, the present series examined annual trends and demographics in total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and tibial osteotomy.Methods
All patients were identified who underwent TKA, UKA or tibial osteotomy for osteoarthritis, osteonecrosis or rheumatoid arthritis of the knee between July 2007 and March 2015.Results
A total of 170,433 cases of TKA, 13,209 cases of UKA and 8760 cases of tibial osteotomy were identified. The proportion of patients undergoing UKA rose from 4.0% in 2007 to 8.1% in 2014 (P < 0.001), and that of tibial osteotomy from 2.6% in 2007 to 5.5% in 2014 (P < 0.001); the proportion undergoing TKA fell from 93.4% in 2007 to 86.3% in 2014 (P < 0.001). Between 2007 and 2014 the proportions of patients with osteonecrosis who underwent UKA and tibial osteotomy increased from 34.7% and 11.6% to 38.6% and 16.2%, respectively (P = 0.001 for UKA and P = 0.004 for tibial osteotomy). The proportions of patients with osteonecrosis undergoing UKA or tibial osteotomy were significantly greater than those with other diagnoses (P < 0.001 for both).Conclusions
The popularity of UKA and tibial osteotomy in Japan increased during the period 2007–2014 at the expense of TKA. The proportions of UKA and tibial osteotomy in patients with osteonecrosis also increased, and were larger than those in patients with other causative diseases. 相似文献7.
Yoshinori Ishii Hideo Noguchi Junko Sato Hana Ishii Koji Todoroki Shin-ichi Toyabe 《The Knee》2017,24(5):1153-1159
Background
Proximal tibial bone mineral density (BMD) has been studied for its potential impact on subsidence and loosening of the tibial component after total knee arthroplasty (TKA). However, no known studies of proximal tibial BMD after TKA have evaluated the effect of major impact factors such as body weight (BW), muscle strength, and level of activity. We aim to determine whether factors such as level of activity, quadriceps strength, BW, gender, age, and prosthetic design affect proximal tibial BMD over the mid- to long-term following TKA.Methods
We evaluated 36 patients (72 knees) who were undergoing bilateral TKA performed by a single surgeon. Median follow up time was 115 months (range, 60–211 months) for a minimum of five years. We measured BMD in the proximal tibia and used a hand-held dynamometer to measure quadriceps isometric strength, recording the maximum value of three measurements for each patient.Results
Univariate analyses using Spearman's correlation coefficient for continuous variables revealed a weak negative correlation between age and BMD (r = ? 0.316, P = 0.007) and a moderate positive correlation between BW and BMD (r = 0.430, P < 0.001). However, no significant correlations were found between the other factors above and BMD for continuous and discrete variables. Based on multivariate analyses, only BW had a significant effect on BMD (β = 0.342, P = 0.003).Conclusions
BW is the most impact factor on the proximal tibial BMD after mid- to long-term follow up TKA. Therefore, the management of BW may contribute to prevention of decline of tibial BMD for TKA patients owing to aging. 相似文献8.
Background
Total knee arthroplasty (TKA) is a highly effective surgery, but is underutilized by some patient groups. This study determined factors associated with a person's expectations with respect to pain and walking function following a TKA procedure, should they elect to undergo a TKA.Methods
A total of 3542 people were studied with or at risk of knee osteoarthritis and enrolled in the community-based Osteoarthritis Initiative (OAI). Multivariable logistic regression analyses identified demographic, socioeconomic, osteoarthritis-related, joint replacement awareness, and psychological correlates as poor outcome expectations. Logistic regression determined if outcome expectation was associated with future knee arthroplasty utilization.Results
Approximately 25% of the sample expected a poor outcome. Several factors were associated with poor pain outcome expectation, with the most powerful being African American race (Odds Ratio (OR) = 2.11, 95% CI = 1.69, 2.64) and an interaction between clinical depression symptoms and pain catastrophizing (OR = 3.17, 95% CI = 2.26, 4.44 when both were coded ‘yes’). Whether a person had knee OA did not affect expectations. Pain outcome expectations were strongly associated with future TKA utilization (OR = 4.9, 95% CI = 2.2, 11.1).Conclusion
A variety of modifiable psychological factors impact people's expectations of the extent of pain and walking difficulty following a potential future TKA. Expectations strongly predict future TKA utilization. Given the high prevalence of knee osteoarthritis, mass media educational interventions for the population may assist in better aligning expectations with evidence-based knee arthroplasty outcomes and lead to more appropriate utilization of an effective procedure. 相似文献9.
Matthew T. Houdek Maurizio Scorianz Cody C. Wyles Robert T. Trousdale Franklin H. Sim Michael J. Taunton 《The Knee》2017,24(4):851-855
Background
Pigmented villonodular synovitis (PVNS) is a rare, benign proliferation of the synovium, commonly affecting the knee. Arthroplasty can successfully manage arthrosis in this population; however, outcome data is limited. The purpose of this study was to investigate the oncologic and functional outcome of patients undergoing total knee arthroplasty (TKA) in the setting of PVNS.Methods
48 patients were identified at our institution with histologically confirmed PVNS that subsequently received TKA. The cohort consisted of 28 females and 20 males with a mean age and body mass index of 61 years and 29.2 kg/m2. 37 patients had “active” disease, defined as diffuse in 40 patients and focal in eight. Mean follow-up was 14 years.Results
The 10-year disease free-survival was 88%. Recurrence occurred in 6 patients and was treated with synovectomy and revision arthroplasty (n = 4), local excision (n = 1) and transfemoral amputation (n = 1). 25 patients sustained at least 1 complication, most commonly decreased knee range of motion. Complications resulted in revision TKA in 10 patients (21%). There was no difference (P = 0.74) between mean pre- and postoperative ROM; however, there was a significant reduction in the number of patients with a flexion contracture > 15° (P = 0.03). The mean Knee Society score and functional score significantly improved following surgery (P < 0.001).Conclusions
This study indicates arthroplasty in the setting of PVNS improves patient function and reduces the presence of flexion contractures. Patients with a history of PVNS should be cautioned when undergoing arthroplasty on the elevated risk of subsequent procedures.Level of evidence
Level III. 相似文献10.
Background
There are unanswered questions about knee–ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee–ankle alignment after TKA.Methods
The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis.Results
The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (P < 0.05). The pre-operative malalignment of the knee was corrected (P < 0.05), and the ankle tilt angle was accordingly improved in the operative side after TKA (P < 0.05). In addition, TKA had little effect on knee–ankle alignment on the non-operative side (P > 0.05).Conclusion
These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA.Level of evidence
Level III. 相似文献11.
Chin Tat Lim Stuart B. Goodman James I. Huddleston Alex H.S. Harris Subhrojyoti Bhowmick William J. Maloney Derek F. Amanatullah 《The Knee》2017,24(5):1182-1186
Background
Smoking is associated with early postoperative complications, increased length of hospital stay, and an increased risk of revision after total knee arthroplasty (TKA). However, the effect of smoking on time to revision TKA is unknown.Methods
A total of 619 primary TKAs referred to an academic tertiary center for revision TKA were retrospectively stratified according to the patient smoking status. Smoking status was then analyzed for associations with time to revision TKA using a Chi square test. The association was also analyzed according to the indication for revision TKA.Results
Smokers (37/41, 90%) have an increased risk of earlier revision for any reason compared to non-smokers (274/357, 77%, p = 0.031). Smokers (37/41, 90%) have an increased risk of earlier revision for any reason compared to ex-smokers (168/221, 76%, p = 0.028). Subgroup analysis did not reveal a difference in indication for revision TKA (p > 0.05).Conclusions
Smokers are at increased risk of earlier revision TKA when compared to non-smokers and ex-smokers. The risk for ex-smokers was similar to that of non-smokers. Smoking appears to have an all-or-none effect on earlier revision TKA as patients who smoked more did not have higher risk of early revision TKA. These results highlight the need for clinicians to urge patients not to begin smoking and encourage smokers to quit smoking prior to primary TKA. 相似文献12.
Background
In total knee arthroplasty (TKA), the position of the patellar component can affect patellar tracking. However, the patellar component cannot always replicate the original high point of the patella because of anatomical variance. This study investigated whether altering the highest point of the patella can affect outcomes of primary TKA, especially in patients having a patella with a far-medialized median ridge.Methods
A retrospective review was performed for 177 knees (143 patients) treated with primary TKA between July 2011 and March 2014. Group 1 (34 knees) had the patellar component displaced over three millimeters from the median ridge, while Group 2 (143 knees) had the patellar component placed on the original median ridge position. The one-year follow-up outcomes were reviewed, including: patellar tilt angle, Knee Society Score, Feller Patellar Score, and modified Kujala Anterior Knee Pain Score.Results
Mean (± standard deviation) displacement of the patellar component in Group 1 was 3.97 ± 0.97 mm lateral to the original position of the median ridge, with a significant decrease in lateral patellar tilt angle (P < 0.001). Lateral patellar tilt showed a positive correlation with the medialization of the patellar component (P < 0.001, r = 0.401). Ability to rise from a chair was better in Group 1 (P = 0.025). There were no other between-group differences in other clinical outcomes.Conclusions
There should be no need for the patellar component to replicate the original highest point of the native patella in primary TKA. 相似文献13.
J. Ryan Martin Keith A. Fehring Chad D. Watts Daniel L. Levy Bryan D. Springer Raymond H. Kim 《The Knee》2017,24(4):863-868
Background
Semi-constrained, or varus–valgus constrained, implants are occasionally necessary to achieve stability in primary total knee arthroplasty (TKA). However, outcomes with these implants are largely unknown. Therefore, the primary goals of this study were to determine 1) can we identify preoperatively which patients might require a semi-constrained implant and 2) are there any clinical and or radiographic differences for those that require a semi-constrained implant?Methods
A multicenter retrospective study was performed to retrospectively review patients that had a Stryker Triathlon (Kalamazoo, MI) TKA with a Total Stabilized (TS) tibial insert (n = 75). This TS cohort was subsequently matched 1:1 based on age, gender, and BMI to a cohort of patients with the same primary TKA design with a PS insert (n = 75). Preoperative and postoperative radiographic and clinical data were compared between the two groups.Results
Preoperatively, the TS cohort had significantly greater varus (9.72 vs. 3.48; p = 0.0001) and valgus (14.1 vs. 7.57; p = 0.0001) deformity. Post-operatively, there were no statistically significant differences in revisions (p = 1), reoperations (p = 1), or complications (p = 1). Mean clinical and radiographic follow-ups were equivalent between groups (25.5 vs. 25.8 months, p = 0.8851).Conclusion
As suspected, use of a semi-constrained insert to achieve intraoperative coronal stability was most predicted by preoperative coronal deformity (either varus or valgus). Longer follow-up and larger patient cohorts are necessary to determine. 相似文献14.
Jodie A. McClelland Kate E. Webster Alankar A. Ramteke Julian A. Feller 《The Knee》2017,24(3):651-656
Background
Computer-assisted navigation in total knee arthroplasty (TKA) reduces variability and may improve accuracy in the postoperative static alignment. The effect of navigation on alignment and biomechanics during more dynamic movements has not been investigated.Methods
This study compared knee biomechanics during level walking of 121 participants: 39 with conventional TKA, 42 with computer-assisted navigation TKA and 40 unimpaired control participants.Results
Standing lower-limb alignment was significantly closer to ideal in participants with navigation TKA. During gait, when differences in walking speed were accounted for, participants with conventional TKA had less knee flexion during stance and swing than controls (P < 0.01), but there were no differences between participants with navigation TKA and controls for the same variables. Both groups of participants with TKA had lower knee adduction moments than controls (P < 0.01).Conclusions
In summary, there were fewer differences in the biomechanics of computer-assisted navigation TKA patients compared to controls than for patients with conventional TKA. Computer-assisted navigation TKA may restore biomechanics during walking that are closer to normal than conventional TKA. 相似文献15.
Charles Rivière Matthieu Ollivier Damien Girerd Jean Noël Argenson Sébastien Parratte 《The Knee》2017,24(3):627-633
Background
A principle of TKA is to achieve a neutral standing coronal alignment of the limb (HKA angle) to reduce risks of implant loosening, reduce polyethylene wear, and optimize patellar tracking. Several long-term studies have questioned this because the relationship between alignment and implant survivorship is weaker than previously reported. We hypothesize that standing HKA poorly predicts implant failure because it does not predict dynamic HKA, dynamic adduction moment, and loading of the knee during gait. Therefore, the aim of our study is to assess the relationship between the standing and the dynamic (gait activity) HKAs.Methods
A prospective study on a cohort of 35 patients treated with a posterior-stabilized TKA for primary osteoarthritis. Three months after surgery each patient had a long-leg radiograph and the limb was classified as neutrally aligned (17 patients), varus aligned (nine patients), or valgus aligned (four patients). Patients then performed a gait analysis for level walking.Results
Standing HKA has a moderate correlation with the peak dynamic varus (r = 0.318, p = 0.001) and the mean and peak adduction moments (r = 0.31 and r = ? 0.352 respectively). No significant correlation between standing HKA and the mean dynamic coronal alignment (r = 0.14, p = 0.449). No differences were found for dynamic frontal parameters (dynamic HKA and adduction moment) between patients defined as neutrally or varus aligned.Conclusions
The standing HKA after TKA was of little value to predict dynamic behaviour of the limb during gait, this may explain why standing coronal alignment after TKA may have limited influence on long-term implant fixation and wear. 相似文献16.
Background
Total knee arthroplasty (TKA) has been successful for many younger patients, but some experience residual symptoms or dissatisfaction. We performed this study to assess the relationship between radiographic disease severity and patient demographic features on patient reported TKA outcome scores.Methods
We compared 100 TKAs performed for 82 patients ≤ 55 years old with 100 gender-matched TKAs performed for 85 patients between 65 and 75 years old. These study cases represented 25% and 21%, respectively, of TKAs performed between January 2006 and June 2011. Radiographic disease severity was determined from preoperative weight bearing AP and lateral radiographs. Patient reported outcome instruments (SF-12, Knee Society function, and WOMAC) were assessed for all patients within six months before surgery and postoperatively at a mean of 20 months after TKA.Results
Although younger patients had less mean articular cartilage loss (p < 0.01), osteoarthritis severity (p < 0.01), and Kellgren–Lawrence grade (p = 0.05), they reported lower preoperative scores (p < 0.01) exceeding the MCID for SF-12 mental health (8.3 points), WOMAC pain (12.1 points), and WOMAC physical function (6.9 points). While substantial improvement was noted, WOMAC pain scores remained lower than those reported by older TKA patients (11.5 points, p < 0.05).Conclusion
Younger patients with less severe radiographic arthritis experience significant improvement with TKA, but outcome scores do not match those attained by older patients with more severe radiographic disease. 相似文献17.
Fernando Sanz-López César Berzosa Fidel Hita-Contreras Antonio Martínez-Amat 《The Knee》2017,24(3):570-579
Background
The analysis of structural changes in patellar tendon and muscle of healthy subjects in response to mechanical loads provides useful insight into the mechanism underlying overuse injuries.Methods
Changes produced in tendon and muscles structures after eccentric overload training and three consecutive running days were examined. Twenty healthy subjects were recruited and divided into two groups. One group (ECC) performed eccentric overload squat training (six weeks). After such training, the ECC group performed three running sessions on consecutive days, as did the control group (CONT). The structure of their patellar tendons and vastus lateralis muscles was quantified using ultrasound and Doppler imaging. Images were obtained before and after eccentric training for the ECC group and on every day of running performance for both groups.Results
After eccentric training, the ECC group experienced an increase in cross-sectional area (CSA) of patellar tendon (P = 0.012). After every day of running, the ECC group experienced a decrease in CSA (P = 0.027). In the CONT group, after one day of running a significant increase was observed in anteroposterior width of their patellar tendon (P = 0.028), as well as a decrease in pennation angle of vastus lateralis muscle (P = 0.028) within three days of running sessions.Conclusions
Eccentric overload training brought about changes in the patellar tendon consistent with an improvement in the quality of the tissue. The ECC group in our study showed a more normalised pattern than the CONT group in the running performance, in agreement with previous research.Level of evidence
Level 3, controlled trial. 相似文献18.
Background
Massive transfusion is the clinical scenario where the presumed adverse effects of stored blood are expected to be more evident because the whole patient's blood volume is replaced by stored blood.Objective
To analyse the association between age of transfused red blood cells (RBC) and survival in massively transfused patients.Methods
In this retrospective study, clinical and transfusion data of all consecutive patients massively transfused between 2008 and 2014 in a large, tertiary-care hospital were electronically extracted from the Transfusion Service database and the patients’ electronic medical records. Prognostic factors for in-hospital mortality were investigated by multivariate logistic regression.Results
A total of 689 consecutive patients were analysed (median age: 61 years; 65% males) and 272 died in-hospital. Projected mortality at 2, 30, and 90 days was 21%, 35% and 45%, respectively. The odds ratio (OR) for in-hospital mortality among patients who survived after the 2nd day increased with patient age (OR: 1.037, 95% CI: 1.021–1.054; per year P < 0.001), with the number of RBC unit transfused in the first 48 hours (OR: 1.060; 95% CI: 1.038–1.020 per unit; P < 0.001), and the percentage of such RBC stored for more than 28 days (1.010, 95% CI: 1.005–1.018 per percent point; P = 0.01).Conclusion
Mortality after massive transfusion was associated with a higher proportion of old RBCs transfused in the first 48 hours. Other factors associated with poor prognosis were older patient's age and larger volumes of transfused RBCs. 相似文献19.
Olivia Unwin Mohammed Hassaballa James Murray William Harries Andrew Porteous 《The Knee》2017,24(2):454-459
Background
MIS TKA has been shown to offer a reduced in-patient stay, but no clinical difference at two years. Whilst there may be a benefit from earlier discharge, we need to ensure that there are no detrimental effects in the medium and long-term following MIS-TKA. To report the mid-term result from a prospective randomised controlled trial (RCT) comparing MIS-TKA with standard approach for TKA.Methods
Using knee score questionnaires, we collected patient reported outcome measures (PROMs) regarding pain and function. Sixty-six patients (from an eligible cohort of 83 patients) completed the mid-term postal follow-up.Results
There was no significant difference between groups for change in score from pre-operative to final follow-up in all three PROMs. Mean MIS and standard group improvement was: AKSS 53 and 51 (p = 0.7644), OKS 15 and 16 (p = 0.2341) or WOMAC 15 and 15 (p = 0.9900) respectively. Both groups showed improvement in pain and function with no significant difference between groups. There was no difference between groups for revision due to malalignment at a mean six year follow-up.Conclusions
In addition to the early benefits regarding hospital stay and complications, we have found that at a mean of six years there was no increase in malalignment, pain or function with MIS techniques. 相似文献20.
Ron Batash Guy Rubin Alexander Lerner Hussein Shehade Nimrod Rozen David E. Rothem 《The Knee》2017,24(3):622-626