Knee Arthroplasty For Osteoarthritis Research Articles

Perioperative Analgesic Interventions for Reduction of Persistent Postsurgical Pain After Total Hip and Knee Arthroplasty: A Systematic Review and Meta-analysis.

High pain levels immediately after surgery have been associated with persistent postsurgical pain. Still, it is uncertain if analgesic treatment of immediate postsurgical pain prevents the development of persistent postsurgical pain. We searched MEDLINE, CENTRAL, and Embase up to September 12, 2023, for randomized controlled trials investigating perioperative analgesic interventions and with reported pain levels 3 to 24 months after total hip or knee arthroplasty in patients with osteoarthritis. The primary outcome was pain score 3 to 24 months after surgery, assessed at rest and during movement separately. Two authors independently screened, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 tool. We conducted meta-analyses and tested their robustness with trial sequential analyses and worst-best and best-worst case analyses. We included 49 trials with 68 intervention arms. All but 4 trials were at high risk of bias for the primary outcome. Moreover, the included trials were heterogeneous in terms of exclusion criteria, baseline pain severity, and which cointerventions the participants were offered. For pain at rest, no interventions demonstrated a statistically significant difference between intervention and control. For pain during movement, perioperative treatment with duloxetine (7 trials with 641 participants) reduced pain scores at 3 to 24 months after surgery (mean difference -4.9 mm [95% confidence interval {CI}, -6.5 to -3.4] on the 0-100 visual analog scale) compared to placebo. This difference was lower than our predefined threshold for clinical importance of 10 mm. We found no perioperative analgesic interventions that reduced pain 3 to 24 months after total hip or knee arthroplasty for osteoarthritis. The literature on perioperative analgesia focused little on potential long-term effects. We encourage the assessment of long-term pain outcomes.

The efficacy of aspirin versus low-molecular-weight heparin for venous thromboembolism prophylaxis after knee and hip arthroplasty: A systematic review and meta-analysis of randomized controlled trials.

The purpose of this study was to assess the efficacy of aspirin versus low-molecular-weight heparin (LMWH) in preventing venous thromboembolism (VTE) following hip and knee arthroplasty. PubMed/Medline, Embase, Cochrane Library and Google Scholar databases were searched from inception till June 2024 for original trials investigating the outcomes of aspirin versus LMWH in hip and knee arthroplasty. The primary outcome was VTE. Secondary outcomes included minor and major bleeding events, and postoperative mortality within 90 days. This review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized controlled trials with 12,134 participants were included. The mean ages for the aspirin and LMWH cohorts were 66.6 (57.6-69.0) years and 66.8 (57.9-68.9) years, respectively. There was no statistically significant difference in the overall risk of VTE between the aspirin and the LMWH cohorts (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.48-1.89; p: 0.877). A subanalysis based on the specific VTE entity (pulmonary embolism [PE] or deep venous thrombosis) showed a significantly higher PE risk for patients receiving aspirin than the LMWH cohort (OR: 1.79; 95% CI: 1.11-2.89; p: 0.017). There was no difference in minor (OR: 0.64; 95% CI: 0.40-1.04; p: 0.072) and major bleeding (OR: 0.77; 95% CI: 0.40-1.47; p: 0.424) episodes across both groups. Furthermore, subanalysis among the total knee arthroplasty group showed that the aspirin cohort was significantly more likely to suffer VTEs than their LMWH counterparts (OR: 1.55; 95% CI: 1.21-1.98; p < 0.001). This study demonstrated a significantly higher risk of PE among patients receiving aspirin compared to LMWH following hip or knee arthroplasty for osteoarthritis. Aspirin was associated with a significantly higher overall VTE risk among patients undergoing knee arthroplasty, in particular. This might suggest the inferiority of aspirin compared to LMWH in preventing VTE following such procedures. Level I.

A pilot multicentre randomised clinical trial to determine the effect of a pharmacist-partnered opioid tapering intervention before total hip or knee arthroplasty.

Opioid analgesic use before total hip or knee arthroplasty has been associated with worse postoperative outcomes. This pilot study aimed to examine the feasibility of a telehealth-based pharmacist-partnered opioid tapering intervention before elective primary hip or knee arthroplasty and its potential effectiveness compared with usual care. This study was conducted at seven hospitals in New South Wales, Australia. Eligible patients were those aged ≥ 18 years, scheduled to undergo primary hip or knee arthroplasty for osteoarthritis and taking opioid analgesics pre-operatively. The intervention group participated in an opioid tapering telehealth service, a partnership between a pharmacist and general practitioner, for 3 months pre-operatively up to the day of surgery, while the control group received usual care. The primary outcomes of the study were to investigate the feasibility of the intervention (i.e. adherence to treatment) and potential effectiveness in decreasing baseline daily opioid dose by > 50% before surgery. Between December 2021 and June 2023, 70 patients were recruited and assigned randomly to the intervention group (n = 35) or control group (n = 35). Baseline characteristics were similar between groups. Thirty patients in each group completed their allocated treatment. All patients allocated to the intervention group completed at least one appointment with a pharmacist, with the median (IQR [range]) being 2 (1-4 [1-6]) appointments. The number of patients who successfully decreased their baseline daily opioid dose by ≥ 50% before surgery was 27/30 in the intervention group compared with 5/30 in the usual care group (p < 0.001). The findings of this pilot study support the feasibility of a telehealth-delivered, pharmacist-partnered opioid tapering service for patients scheduled for primary hip or knee arthroplasty. A broader multicentre study to examine the effectiveness of this intervention on clinical outcomes is warranted.

Functional and Radiological Outcomes of Total Knee Arthroplasty in Osteoarthritis with Varus Deformity of Knee: A Prospective Study

Introduction: Total knee replacement (TKR) is the most commonly performed orthopedic surgical procedure for treating severe arthritis of the knee joint either due to osteoarthritis or due to inflammatory arthropathy. There was cartilage damage in either the medial or patella femoral joint/lateral compartment. Severe pain through deformity develops, subsequently necessitating a total joint replacement. This study assessed the Functional and radiological outcomes of total knee arthroplasty in osteoarthritis with varus deformity of the knee. Materials and Methods: From February 2021 to July 2022, all patients with osteoarthritis with varus deformity of knee were subjected to total knee arthroplasty after obtaining approval from the Institutional Ethics Committee were required to enroll patients. Results: The age of the patients in our study was 63.58 years ranging from 52 to 79 years. In 72.09% of the patients were females while the remaining 27.91% were females. In our study, 45% of the patients were overweight while the remaining 59.48% were overweight. In our study, 55.81% of the patients get their left knee operated first while the remaining 44.19% of the patients get their right knee operated first. In 25.58% patella resurfacing was done. The p-value was found to be significant between the pre- and post-oper knee society scores. In our study, 5 patients had complications out of which 4.65% of the patients had superficial wound infection, 4.65% of them patient had anterior knee pain and 2.33% had popliteal artery thromboembolism. Conclusion: Total knee arthroplasty is a relatively safe procedure. Treatment with total knee arthroplasty resulted in greater pain relief and functional improvement after 6 months. It improves the functional ability of the patient and the ability of the patient to get back to pre-disease state, which is to have a pain-free mobile joint, There was a significant association between the knee clinical score and knee functional score at six months follow-up.

Annual incidence and assessment of risk factors for early-onset deep surgical site infection following primary total knee arthroplasty in osteoarthritis.

This study aims to determine difference in annual rate of early-onset (≤ 90 days) deep surgical site infection (SSI) following primary total knee arthroplasty (TKA) for osteoarthritis, and to identify risk factors that may be associated with infection. This is a retrospective population-based cohort study using prospectively collected patient-level data between 1 January 2013 and 1 March 2020. The diagnosis of deep SSI was defined as per the Centers for Disease Control/National Healthcare Safety Network criteria. The Mann-Kendall Trend test was used to detect monotonic trends in annual rates of early-onset deep SSI over time. Multiple logistic regression was used to analyze the effect of different patient, surgical, and healthcare setting factors on the risk of developing a deep SSI within 90 days from surgery for patients with complete data. We also report 90-day mortality. A total of 39,038 patients underwent primary TKA for osteoarthritis during the study period. Of these, 275 patients developed a deep SSI within 90 days of surgery, representing a cumulative incidence of 0.7%. The annual infection rate did not significantly decrease over the seven-year study period (p = 0.162). Overall, 13,885 (35.5%) cases were excluded from the risk analysis due to missing data. Risk factors associated with early-onset deep SSI included male sex, American Society of Anesthesiologists grade ≥ 3, blood transfusion, acute length of stay, and surgeon volume < 30 TKAs/year. Early-onset deep SSI was not associated with increased 90-day mortality. This study establishes a reliable baseline infection rate for early-onset deep SSI after TKA for osteoarthritis using robust Infection Prevention and Control surveillance data, and identifies several potentially modifiable risk factors.

Clinical and functional outcome of total knee arthroplasty in osteoarthritic patients at a tertiary care center in Kerala: a prospective study

Background: Osteoarthritis affects the knee joint more frequently than any other joint. Osteoarthritis is a chronic joint disease that affects the older age group, women more frequently, and is associated in 90% of cases with a varus deformity of the knee. The following study was conducted to evaluate the functional outcome of total knee arthroplasty in osteoarthritis using the knee society score.Methods: The study was conducted in patients treated for osteoarthritis of the knee joint at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala during the period from December 2019 to March 2022. Thirty patients diagnosed with osteoarthritis of the knee joint were taken into the study, all were undergone total knee arthroplasty. Patients were followed up at 4 weeks, 12 weeks, and 24 weeks.Results: The sample consisted of thirty osteoarthritic patients with 8 males and 22 were females. The patients' ages ranged from 45-75 years. Among these 30 patients, 14 involved the right side, and 16 involved the left knee joint. The mean pre-operative knee clinical score was 36.93 which was improved to post-operative 84.70 following total knee arthroplasty. The mean pre-operative knee functional score was 16.83 which was improved to post-operative 71.17 following total knee arthroplasty. The outcome was rated as per knee society score. We got excellent results in 25 cases (83%), good in 3 (10%), and fair in 2 patients (7%) according to knee clinical score whereas 8 excellent (27%), 16 good (53%), 5 fair (17%) and 1 poor (3%) results were found according to knee functional score.Conclusions: Total knee arthroplasty shows drastic improvement in the functional ability of the patient and the ability of the patient to get back to a pre-disease state, which is mainly because of pain-free joint movements, reflected by the improvement in the post-operative knee clinical score and knee functional score.

Estimating incidence rates of periprosthetic joint infection after hip and knee arthroplasty for osteoarthritis using linked registry and administrative health data.

The aim of this study was to estimate the 90-day periprosthetic joint infection (PJI) rates following total knee arthroplasty (TKA) and total hip arthroplasty (THA) for osteoarthritis (OA). This was a data linkage study using the New South Wales (NSW) Admitted Patient Data Collection (APDC) and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), which collect data from all public and private hospitals in NSW, Australia. Patients who underwent a TKA or THA for OA between 1 January 2002 and 31 December 2017 were included. The main outcome measures were 90-day incidence rates of hospital readmission for: revision arthroplasty for PJI as recorded in the AOANJRR; conservative definition of PJI, defined by T84.5, the PJI diagnosis code in the APDC; and extended definition of PJI, defined by the presence of either T84.5, or combinations of diagnosis and procedure code groups derived from recursive binary partitioning in the APDC. The mean 90-day revision rate for infection was 0.1% (0.1% to 0.2%) for TKA and 0.3% (0.1% to 0.5%) for THA. The mean 90-day PJI rates defined by T84.5 were 1.3% (1.1% to 1.7%) for TKA and 1.1% (0.8% to 1.3%) for THA. The mean 90-day PJI rates using the extended definition were 1.9% (1.5% to 2.2%) and 1.5% (1.3% to 1.7%) following TKA and THA, respectively. When reporting the revision arthroplasty for infection, the AOANJRR substantially underestimates the rate of PJI at 90 days. Using combinations of infection codes and PJI-related surgical procedure codes in linked hospital administrative databases could be an alternative way to monitor PJI rates.Cite this article: Bone Joint J2022;104-B(9):1060-1066.

Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty

There remains a lack of randomized trials investigating aspirin monotherapy for symptomatic venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) or total knee arthroplasty (TKA). To determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE after THA or TKA. Cluster-randomized, crossover, registry-nested trial across 31 hospitals in Australia. Clusters were hospitals performing greater than 250 THA or TKA procedures annually. Patients (aged ≥18 years) undergoing hip or knee arthroplasty procedures were enrolled at each hospital. Patients receiving preoperative anticoagulation or who had a medical contraindication to either study drug were excluded. A total of 9711 eligible patients were enrolled (5675 in the aspirin group and 4036 in the enoxaparin group) between April 20, 2019, and December 18, 2020. Final follow-up occurred on August 14, 2021. Hospitals were randomized to administer aspirin (100 mg/d) or enoxaparin (40 mg/d) for 35 days after THA and for 14 days after TKA. Crossover occurred after the patient enrollment target had been met for the first group. All 31 hospitals were initially randomized and 16 crossed over prior to trial cessation. The primary outcome was symptomatic VTE within 90 days, including pulmonary embolism and deep venous thrombosis (DVT) (above or below the knee). The noninferiority margin was 1%. Six secondary outcomes are reported, including death and major bleeding within 90 days. Analyses were performed by randomization group. Enrollment was stopped after an interim analysis determined the stopping rule was met, with 9711 patients (median age, 68 years; 56.8% female) of the prespecified 15 562 enrolled (62%). Of these, 9203 (95%) completed the trial. Within 90 days of surgery, symptomatic VTE occurred in 256 patients, including pulmonary embolism (79 cases), above-knee DVT (18 cases), and below-knee DVT (174 cases). The symptomatic VTE rate in the aspirin group was 3.45% and in the enoxaparin group was 1.82% (estimated difference, 1.97%; 95% CI, 0.54%-3.41%). This failed to meet the criterion for noninferiority for aspirin and was significantly superior for enoxaparin (P = .007). Of 6 secondary outcomes, none were significantly better in the enoxaparin group compared with the aspirin group. Among patients undergoing hip or knee arthroplasty for osteoarthritis, aspirin compared with enoxaparin resulted in a significantly higher rate of symptomatic VTE within 90 days, defined as below- or above-knee DVT or pulmonary embolism. These findings may be informed by a cost-effectiveness analysis. ANZCTR Identifier: ACTRN12618001879257.

Perioperative prevention of persistent pain after total hip and knee arthroplasty-Protocol for two systematic reviews.

BackgroundBetween 9% and 20% of patients experience moderate to severe persistent postoperative pain after total hip or knee arthroplasty. Severe immediate postoperative pain limits rehabilitation and is associated with the development of persistent postoperative pain. Therefore, perioperative analgesic and physiotherapeutic interventions are of interest to reduce persistent pain. In two systematic reviews with identical methodology, we aim to investigate the effects of (a) perioperative analgesic interventions and (b) physiotherapeutic interventions in reducing persistent pain after total hip and knee arthroplasty.MethodsWe will include randomised and cluster‐randomised controlled trials on perioperative analgesic and physiotherapeutic interventions for patients undergoing elective total hip or knee arthroplasty for osteoarthritis. After contact with the authors, trials without pain data 3–24 months postoperatively will be excluded. Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and reference lists will be searched for eligible trials. Two authors will independently screen, extract data and assess the risk of bias. The primary outcome is pain scores 3–24 months postoperatively. Meta‐analyses will be performed for interventions with two or more trials. We will conduct trial sequential analyses and assign Grading of Recommendations, Assessment, Development and Evaluation (GRADE) ratings.ConclusionNo previous review on reduction of persistent postoperative pain has included non‐pharmacological or invasive analgesic techniques. These two reviews with identical methodology will summarise the evidence of analgesic and physiotherapeutic perioperative interventions to prevent persistent pain.PROSPERO registrationCRD42021284175.

187 Pooled Waiting Lists for Primary Hip and Knee Arthroplasty: Are the Outcomes Inferior to a Named Consultant List?

Abstract Aim A pooled waiting list model is where patients are treated in turn by the first available surgeon and works to use existing resources more efficiently to better match demand. Aim is to compare quantitative data of patients on the pooled list and named-consultant’ list and to determine the superiority of either list based on favourable outcomes. Method This single centre, retrospective study compared outcomes of primary elective hip and knee arthroplasty for osteoarthritis in patients from pooled and ‘named-consultant’ waiting lists over a 1-year period. The study period was before the corona virus pandemic. 371 total knee replacements (TKR) and 373 total hip replacements (THR) were included. Baseline characteristics were compared between patients from pooled and named-consultant lists. Results In the pooled TKR group, a significantly higher proportion of patients were older with higher BMI and ASA grade (p = 0.027, p = 0.479, p&amp;lt;0.001 respectively). There was no difference in baseline characteristics in the THR cohort. Waiting time to surgery was less in the pooled TKR group (mean = 4.17months) with no significant difference in mortality, revision and infection rates, length of stay, operative blood loss, DVT/PE rate, proportion requiring pain team referral and the number with unsatisfactory range of motion at follow-up. There was no significant difference in any outcomes between two groups in the THR cohort. Conclusions Pooled lists can therefore be an excellent tool in primary THR/TKR to efficiently utilize all available resources (surgeons and theatre time) without compromising on patient outcomes and prompting use in all UK arthroplasty centres.

Results of Primary Total Knee Arthroplasty in Osteoarthritis with Varus Thrust Knee and Severe Varus Deformity

Results of Primary Total Knee Arthroplasty in Osteoarthritis with Varus Thrust Knee and Severe Varus Deformity

CRISTAL (a cluster-randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study): statistical analysis plan

BackgroundThis a priori statistical analysis plan describes the analysis for CRISTAL.MethodsCRISTAL (cluster-randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study) aims to determine whether aspirin is non-inferior to low molecular weight heparin (LMWH) in preventing symptomatic venous thromboembolism (VTE) following hip arthroplasty (HA) or knee arthroplasty (KA). The study is nested within the Australian Orthopaedic Association National Joint Replacement Registry. The trial was commenced in April 2019 and after an unplanned interim analysis, recruitment was stopped (December 2020), as the stopping rule was met for the primary outcome.The clusters comprised hospitals performing > 250 HA and/or KA procedures per annum, whereby all adults (> 18 years) undergoing HA or KA were recruited. Each hospital was randomised to commence with aspirin, orally, 85–150 mg daily or LMWH (enoxaparin), 40 mg, subcutaneously, daily within 24 h postoperatively, for 35 days after HA and 14 days after KA. Crossover was planned once the registration target was met for the first arm.The primary end point is symptomatic VTE within 90 days. Secondary outcomes include readmission, reoperation, major bleeding and death within 90 days, and reoperation and patient-reported pain, function and health status at 6 months.The main analyses will focus on the primary and secondary outcomes for patients undergoing elective primary total HA and KA for osteoarthritis. The analysis will use an intention-to-treat approach with cluster summary methods to compare treatment arms. As the trial stopped early, analyses will account for incomplete cluster crossover and unequal cluster sizes.ConclusionsThis paper provides a detailed statistical analysis plan for CRISTAL.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12618001879257. Registered on 19/11/2018.

Estimation of Expenditure and Challenges Related to Rehabilitation After Knee Arthroplasty: A Hospital-Based Cross-Sectional Study.

Expenditure for rehabilitation following knee arthroplasty for osteoarthritis- and rehabilitation-related challenges following discharge to home after surgery is not available in the Indian context. To estimate cost of rehabilitation and document challenges in following rehabilitation advices, from a patient perspective. We conducted a hospital-based cross-sectional study of patients visiting the orthopedic department at a tertiary care public-funded hospital in New Delhi and included those who recently (less than 4months) underwent primary knee arthroplasty for osteoarthritis. A trained physiotherapist not involved in clinical care collected information on expenditures incurred after discharge from hospital, patient's ability to recall the advices given by the physician and challenges they experienced using a semi-structured questionnaire. We report median costs by category of direct and indirect cost and used linear regression to explore determinants of cost. We interviewed 82 consecutive patients (mean age 60.8years and 68% females) with median time since surgery of 28days. More than half (52%) sought some support for physiotherapy. The median cost of rehabilitation was INR 18,395 (Interquartile-range 11,325-27,775). Direct medical cost contributed to 74% of total cost (32% fee for services, 21% medications and lab investigations, 21% assistive devices). Twenty percent higher costs were incurred among those undergoing bilateral knee surgery after adjusting for age, sex, income, and type of physiotherapy support sought. Challenges were related to recall of advices, not understanding the recovery process and pain management. About half patients undergoing knee arthroplasty seek support for rehabilitation after discharge to home contributing to a major portion of expenses incurred during rehabilitation. Cost-effective support mechanism for home-based rehabilitation is required for improving patient rehabilitation experiences. The online version contains supplementary material available at 10.1007/s43465-021-00405-6.

Acute postoperative pain after total hip and knee arthroplasty for osteoarthritis does not affect pain in the first year after surgery

Purpose: Although total hip and knee arthroplasties (THA/TKA) are successful in most patients with end-stage osteoarthritis (OA), still 7-23% of the THA patients and 10-34% of the TKA patients report unfavorable outcomes like pain. Other medical fields have identified acute postoperative pain as a risk factor for long-term postoperative pain. However, the majority of THA and TKA patients experienced preoperative pain for years compared to the patients included in these previous studies. Therefore, we investigated if acute postoperative pain following total hip or knee arthroplasty (THA, TKA) in osteoarthritis (OA) patients was associated with pain levels 1-year after surgery and whether acute pain modifies postoperative pain over time.

Improved Sexual Function After Total Hip and Knee Arthroplasty for Osteoarthritis.

Osteoarthritis of the hip and knee is known to affect sexual activity. For patients with osteoarthritis, pain during sexual activity can lead to decreased quality of life and other associated health issues. The authors designed a prospective study to evaluate the effect of total hip arthroplasty and total knee arthroplasty on the psychosocial and physical aspects of sexuality pre- and postoperatively. Between April 2009 and December 2011, patients received questionnaires in the mail preoperatively. They were asked to return the preoperative questionnaire before surgery and the postoperative questionnaire 6 months after surgery. Data were analyzed to evaluate the psychosocial and physical aspects of sexuality and participants' subjective assessment of their appearance. Preoperatively, 91% and 67% of patients reported psychosocial and physical issues, respectively. After the arthroplasty procedure, 84% (P<.001) and 47% (P<.001) of patients reported improvement psychosocially and physically, respectively. Of the patients, 16% reported that arthroplasty adversely affected sexual function, with their predominant fear being joint damage (63%). A greater number of women and patients undergoing hip procedures reported improvement in sexual activity after surgery compared with men (P=.02) and patients undergoing knee procedures (P=.002). Both hip and knee osteoarthritis and arthroplasty had a significant effect on overall sexual function-psychosocially, physically, and in terms of patients' assessment of their external appearance-with higher rates of improvement seen after hip arthroplasty. Because of the effect of osteoarthritis and arthroplasty on sexual function, this topic should be addressed both pre- and postoperatively. [Orthopedics. 2021;44(2):111-116.].

Mortality after hip or knee arthroplasty for osteoarthritis in Chile: A survival analysis.

The purpose of this study is to determine if patients with osteoarthritis that undergo hip or knee arthroplasty jeopardize their life expectancy in Chile. A survival analysis study was designed and approved by our institutional ethics review board. Patients were included if they underwent surgery for hip or knee osteoarthritis and were 50 years or older at the time of surgery. Patients were excluded if arthroplasty was performed for fracture, hemophilia arthropathy, or tumor. A multiparametric Weibull regression was estimated, and the hazard ratio was reported. For internal validity, a bootstrap of 200 repetitions was performed. A total of 4 094 arthroplasties were included. The Kaplan-Meier curve estimates a higher survival than the general population up to 12 years, after which the median survival is less than the general population. The bootstrap multiparametric Weibull regression estimated a hazard ratio of 1.53 (95% confidence interval: 1.27 to 1.84) for women, 1.09 (1.08 to 1.10) for every year older, and 1.29 (1.07 to 1.53) for hip arthroplasty patients. Mortality after hip and knee arthroplasty in Chile follows a bimodal behavior similar to reports from the United States and Europe. At first, mortality is lower than the general population but worsens after 12 to 15 years of surgery.

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis.

AimsTo develop and validate patient-centred algorithms that estimate individual risk of death over the first year after elective joint arthroplasty surgery for osteoarthritis.MethodsA total of 763,213 hip and knee joint arthroplasty episodes recorded in the National Joint Registry for England and Wales (NJR) and 105,407 episodes from the Norwegian Arthroplasty Register were used to model individual mortality risk over the first year after surgery using flexible parametric survival regression.ResultsThe one-year mortality rates in the NJR were 10.8 and 8.9 per 1,000 patient-years after hip and knee arthroplasty, respectively. The Norwegian mortality rates were 9.1 and 6.0 per 1,000 patient-years, respectively. The strongest predictors of death in the final models were age, sex, body mass index, and American Society of Anesthesiologists grade. Exposure variables related to the intervention, with the exception of knee arthroplasty type, did not add discrimination over patient factors alone. Discrimination was good in both cohorts, with c-indices above 0.76 for the hip and above 0.70 for the knee. Time-dependent Brier scores indicated appropriate estimation of the mortality rate (≤ 0.01, all models).ConclusionSimple demographic and clinical information may be used to calculate an individualized estimation for one-year mortality risk after hip or knee arthroplasty (https://jointcalc.shef.ac.uk). These models may be used to provide patients with an estimate of the risk of mortality after joint arthroplasty.Cite this article: Bone Joint Res 2020;9(11):808–820.

Changes in gait parameters during rehabilitation after total knee arthroplasty

Knee arthroplasty (KAP) is a cost-effective and reliable treatment for knee osteoarthritis with the predicted increase in demand. Clinical assessment systems for the effectiveness of rehabilitation do not fully reflect the recovery process, but the evaluation of biomechanical gait parameters is most objective. Objective: to study of the changes in the biomechanical gait parameters after KAP for osteoarthritis. Subjects and methods . A total of 54 patients (31 women and 23 men; mean age, 63.86+1.69 years) were examined an average of 3.94+1.40 months after KAP at the Ivanovo Regional Hospital for War Veterans. A control group consisted of 49 people (28 women and 21 men; mean age, 34.6+8.8 years). Walking performance was studied three times: at admission, one and two weeks after the end of a cycle. Gait parameters were recorded using a Stedis feedback walking simulator (OOO “Neurosoft”, Ivanovo, Russia) in the Assessment package (Registration certificate No. РЗН 2018/7458 dated 08.07.2018). The results were processed using the standard biomedical statistical methods at a significance level of 5%. Results and discussion . In the early recovery period, the patients’ walking after KAP was characterized by decreased speed, by the symptoms of unloading, and by a slight lower extremity functional asymmetry. The revealed phenomena were suggestive of both positive changes in the recovery process as a whole and the normalization of the temporal pattern of a step cycle. It was established that walking speed and the double support period of gait were not restored 3 months after KAP. The main biomechanical changes were non-specific and were associated with reduced walking speed. It was suggested that physical therapy should be aimed mainly at increasing the stride length when controlling dynamic loads. The criterion for the effectiveness of rehabilitation was to reduce asymmetry when walking.

Methods for Improving Quadriceps Femoris Strength after Total Knee Arthroplasty

Research background. The recovery of quadriceps femoris muscle strength after total knee arthroplasty is suboptimal. Quadriceps weakness is associated with decreased gait speed, balance, stair–climbing and chair rise ability, as well as increased risk for falls. Scientifc data about the impact of physiotherapy methods for quadriceps strength is ambiguous. The goal of research was to review and analyse studies evaluating effectiveness of physiotherapy for quadriceps femoris strength after total knee arthroplasty. Methods. Fourteen full articles in English, published in 2006–2016, were selected and analysed; the articles met the following criteria: randomised controlled trials were reviewed if they assessed quadriceps strength, and compared two or more physiotherapy methods after primary total knee arthroplasty for osteoarthritis. Results. In total 1011 people after total knee arthroplasty participated in the analysed studies. The impact of progressive strength training, aquatic physical therapy, and resistance exercises using vibration plate, neuromuscular electrical stimulation, preoperative physiotherapy, traditional physiotherapy and telerehabilitation were assessed. It has been specifed that quadriceps strength significantly increases and functional status improves using various physiotherapy methods, but the most effcient methods are unclear, the data of the studies are ambiguous. Conclusions. Various physiotherapy methods are used for the improvement of the quadriceps muscle strength after total knee arthroplasty: preoperative physiotherapy, resistance exercises, aquatic physiotherapy, whole body vibration, neuromuscular electrical stimulation. Telerehabilitation is as effective as traditional rehabilitation in patients after total knee arthroplasty. There is a lack of scientific research that would deny or confrm the advantages of less frequently used physiotherapy methods against traditional physiotherapy, as well as the recommendations of their use after total knee arthroplasty.Keywords: total knee arthroplasty, physiotherapy, quadriceps femoris, muscle strength.

Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors

BackgroundTotal knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively.Material and methodsThree hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors.ResultsTotal blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban.ConclusionsPosterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.