Partial Knee Arthroplasty Research Articles

Freestanding Ambulatory Surgery Centers and Patients Undergoing Outpatient Knee Arthroplasty

In 2018, Medicare removed total knee arthroplasty from the list of inpatient-only procedures, resulting in a new pool of patients eligible for outpatient total knee arthroplasty. How this change was associated with the characteristics of patients undergoing outpatient knee arthroplasty at hospital-owned surgery centers (HOSCs) vs freestanding ambulatory surgery centers (FASCs) is unknown. To describe the characteristics of patients undergoing outpatient, elective total and partial knee arthroplasty in 2017 and 2018 and to compare the cohorts receiving treatment at FASCs and HOSCs. This observational retrospective cohort study included 5657 patients having elective, outpatient partial and total knee arthroplasty in the Florida and Wisconsin State Ambulatory Surgery Databases in 2017 and 2018. Prior admissions were identified in the State Inpatient Database. Statistical analysis was performed from March to June 2022. Characteristics of patients undergoing surgery at a FASC vs a HOSC in 2017 and 2018 were compared. A total of 5657 patients (mean [SD] age, 64.2 [9.9] years; 2907 women [51.4%]) were included in the study. Outpatient knee arthroplasties increased from 1910 in 2017 to 3747 in 2018 and were associated with an increase in total knee arthroplasties (474 in 2017 vs 2065 in 2018). The influx of patients undergoing outpatient knee arthroplasty was associated with an amplification of differences between the patients treated at FASCs and the patients treated at HOSCs. Patients with private payer insurance seen at FASCs increased from 63.4% in 2017 (550 of 867) to 72.7% in 2018 (1272 of 1749) (P < .001), while the percentage of patients with private payer insurance seen at HOSCs increased, but to a lesser extent (41.6% [427 of 1027] in 2017 vs 46.4% [625 of 1346] in 2018; P < .001). In 2017, the percentages of White patients seen at FASCs and HOSCs were similar (85.0% [737 of 867] vs 88.2% [906 of 1027], respectively); in 2018, the percentage of White patients seen at FASCs had increased and was significantly different from the percentage of White patients seen at HOSCs (90.6% [1585 of 1749] vs 87.9% [1183 of 1346]; P = .01). Both types of facilities saw an increase from 2017 to 2018 in the percentage of patients from communities of low social vulnerability, but this increase was greater for FASCs (FASCs: 6.7% [58 of 867] in 2017 vs 33.9% [593 of 1749] in 2018; HOSCs: 7.6% [78 of 1027] in 2017 vs 21.2% [285 of 1346] in 2018). Finally, while FASCs and HOSCs had cared for a similar portion of patients with prior admissions in 2017 (7.8% [68 of 867] vs 9.4% [97 of 1027], respectively; P = .25), in 2018, FASCs cared for fewer patients with prior admissions than HOSCs (4.0% [70 of 1749] vs 8.1% [109 of 1346]; P < .001). This study suggests that the increase in the number of patients undergoing outpatient knee arthroplasty in 2018 corresponded to FASCs treating a greater share of patients who were White, covered by private payer insurance, and healthier. These findings raise a concern that as more operations transition to the outpatient setting, variability in access to FASCs may increase, leaving hospital-owned centers to bear a greater share of the burden of caring for more vulnerable patients with more severe illness.

Return to Work in Welder Underwent Total Knee Arthroplasty

Background: Osteoarthritis is the most common musculoskeletal disorders found and after reached severe stage, total knee arthroplasty (TKA) should be considered. Welders are group of workers whose work dominated by kneeling or squatting position in long period and sometimes carrying heavy weights. Return to work (RTW) process in welder underwent TKA was varied by duration and activity limited post operation.Aim: to know whether welder underwent TKA could return to his original work.Methods: Searching literature for the evidence-based has been conducted with a clinical question through “PICO” method. Then we continued the searching using electronic databases: “PubMed”, “Cochrane Library”, “EMBASE”, and “Scopus”. The keyword is “osteoarthritis”, “total knee arthroplasty”, and “return to work” with all the synonyms combined with Boolean Operator. The inclusion criteria were blue collar worker or welder population, underwent TKA at most for one year, and full text article. While we excluded study in white collar worker or office worker population, partial knee arthroplasty procedure, and population age &gt;65 years old.Results: From the three literatures obtained, we could learn about RTW duration in workers underwent TKA and what activities were limited after operation, and what the workers expectation after the procedure.Conclusion: Welder underwent TKA could return to work at least three months after the procedure was done, but modification in the workplace still need to be done.

Moonlight surgery: no influence of moon phase or Friday 13th on outcomes of total knee arthroplasty.

The purpose of the present study was to investigate associations between revision-free survival and functional scores of total knee arthroplasty (TKA) and moon phase on the day of surgery, as well as operations performed on a Friday 13th. The data of all patients that received TKA between 2003 and 2019 were extracted from the Tyrol arthroplasty registry. Patients that had undergone previous total or partial knee arthroplasty as well as patients that had missing pre- or post-operative WOMAC were excluded. Patients were allocated to one of the following four groups according to moon phase on the day of surgery: new, waxing, full and waning. Patients operated on a Friday 13th were also identified and compared to patients operated on any other days/dates. A total of 5923 patients met the inclusion criteria, with mean age of 69 ± 9years, and comprising 62% women. There were no significant differences in revision-free survival among the four moon phase groups (p = 0.479), and no significant differences in preoperative and postoperative total WOMAC (p = 0.260, p = 0.122), There were no significant differences in revision-free survival patients operated on Friday 13th vs. other days/dates (p = 0.440). The preoperative total WOMAC was significantly worse for patients operated on a Friday 13th (p = 0.013), which was observed in the pain (p = 0.032) and function (p = 0.010) subscales. There were no significant differences in postoperative total WOMAC at 1year follow-up (p = 0.122). Neither moon phase on the day of surgery nor Friday 13th were associated with revision-free survival or clinical scores of TKA. Patients operated on a Friday 13th had significantly worse preoperative total WOMAC but similar postoperative total WOMAC at 1-year follow-up. These findings could help reassure patients that TKA renders consistent outcomes regardless of the preoperative pain or function, and in spite of bad omens or moon phases.

Total and partial knee arthroplasty versus non-surgical interventions of the knee for moderate to severe osteoarthritis

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of TKA and PKA for people with moderate to severe knee osteoarthritis compared to placebo or sham (efficacy) and to non‐surgical interventions for the knee (comparative effectiveness).

Remote Monitoring using Wearable Technology after Knee Arthroplasty Using a Joint-Specific Wearable Device: A Prospective Cohort Study of 435 patients with 6 week follow up.

Introduction As wearable devices become more sophisticated, their application in monitoring the post-surgical recovery curve following Total Knee Arthroplasty (TKA) may be used to assist with rehabilitation and general care. While there is growing interest in this area, much of the research involves studies with small samples, non-pragmatic designs, and short monitoring periods. This study aims to characterize the progress and recovery kinetics of remote monitoring in the early post-TKA period, using many patients and across multiple surgeons and institutions. Methods Between June 2018 and June 2021, adult patients undergoing primary unilateral partial or total Knee Arthroplasty for end-stage knee osteoarthritis were preoperatively recruited to wear a remote monitoring system to track their recovery. Patients were provided with device education and knee specific surface sensors. The data collected by the sensors were transmitted to a smartphone application. Patients wore the surface sensors for a period as defined by their surgeon (2-, 4-, or 6-weeks duration). Primary measures were maximal daily flexion, minimal daily extension, and Total Daily Steps (TDS). Secondary outcomes were patient-reported pain scores. Results A total of 435 patients were recruited into the study. The primary outcomes of flexion and extension did not significantly differ from baseline, and TDS improved significantly from preoperative baseline to 6 weeks postoperative follow up. All metrics improved relative to surgical intervention relative to 6 weeks postoperative. Conclusions This study demonstrates that remote monitoring using knee specific surface sensors can capture the expected recovery kinetics following knee replacement surgery. The data provided, range of motion and total daily step counts can be used by providers to set expectations for recovery following intervention. Further work is required to compare surface sensor monitoring against standard post-surgical outcome measures to evaluate whether superior results may result from remote monitoring.

No difference in mobile and fixed bearing partial knee arthroplasty in octogenarians: a clinical trial

BackgroundA clinical trial comparing MB (mobile-bearing) versus FB (fixed-bearing) in medial partial knee arthroplasty (PKA) in octagenarians has been conducted. The focus of the present study was on PROMs, range of motion (ROM), implant positioning and implants survivorship. The hypothesis of the present study was that MB implants performed better than FB in PKA in octogenarians.MethodsThe first group received FB PKA-PPK®; the second received MB PKA-Oxford. Patients were not randomly allocated. The following PROMs were administered at T0 (pre-operatively), T1 (1 year after surgery), and T2 (3 years after surgery): visual analogue scale (VAS), Knee Society Score (KSS) and Oxford Knee Score (OKS). Data regarding the implant survivorship and ROM were also collected. Furthermore, the following radiographic parameters were measured: Femoral component varus/valgus; Tibial component varus/valgus; Anteroposterior slope.ResultsAt T0, 28 patients were included in the FB and 33 in the MB group. The surgical time was shorter in the FB group (p < 0.001). No difference between FB and MB in ROM, VAS, KSS, and OKS at each follow-up (p > 0.05). No difference was found in implant positioning (p > 0.05). At last follow-up, FB group reported three failures caused by aseptic loosening. Four failures were observed in the MB cohort: two for bearing dislocation and two for aseptic loosening. The Kaplan–Meier Curve found no differences in implant survivorship.ConclusionsAccording to the main findings of the present clinical trial, MB implants performed similar to FB in PKA in octogenarians. The FB group demonstrated shorted surgical time. No difference was found in patient reported outcome measures, ROM, implant positioning, and survivorship.Level of evidenceLevel II, prospective study.

Few Runners Return to Running after Total Joint Arthroplasty, While Others Initiate Running

Introduction: This study examines self-reported running practices in total joint arthroplasty (TJA) patients. Methods: This prospective, cross-sectional study of a multi-institutional database identified 4,462 primary total hip arthroplasty (THA) and total or partial knee arthroplasty (TKA/UKA) patients from June 2015 to June 2020. TJA patients completed an online survey capturing pre-TJA running experience and expectations, surgeon recommendations about return to running, postoperative characteristics, revision surgeries, and the Commitment to Exercise Scale and Brief Resilience Scale. Patient-reported follow-up reached 5 years. Logistic regression, the chi square test, and analysis of variance tests were used. Results: Five hundred forty-nine patients (12.2%) self-reported running preoperatively, and 65 patients (11.8%) returned to running after surgery. 67.2% were satisfied with their return to running. 40 patients (1.0%) who were not preoperative runners started running after TJA. Preoperative runners who returned to running had higher mean Brief Resilience Scale (3.9 ± 0.7) scores and the highest Commitment to Exercise Scale scores (46.5 ± 17.6, F[2,510] = 3.88, P = 0.02). Runners who returned to running had a 6.2% revision rate while those who did not run postoperatively had a 4.8% revision rate (P = 0.55). Surgeon recommendations included no return to running (29.5%), maintain low-impact activities (35.2%), return to preoperative levels (5.1%), and no recommendations (30.1%). Discussion: 12% of TJA preoperative runners returned to running, mostly within 1 year, and 67.2% were satisfied with their running ability.

Item response theory may account for unequal item weighting and individual-level measurement error in trials that use PROMs: a psychometric sensitivity analysis of the TOPKAT trial

ObjectivesTo apply item response theory as a framework for studying measurement error in superiority trials which use patient-reported outcome measures (PROMs). MethodsWe reanalyzed data from the The Total or Partial Knee Arthroplasty Trial, which compared the Oxford Knee Score (OKS) responses of patients undergoing partial or total knee replacement, using traditional sum-scoring, after accounting for OKS item characteristics with expected a posteriori (EAP) scoring, and after accounting for individual-level measurement error with plausible value imputation (PVI). We compared the marginalized mean scores of each group at baseline, 2 months, and yearly for 5 years. We used registry data to estimate the minimal important difference (MID) of OKS scores with sum-scoring and EAP scoring. ResultsWith sum-scoring, we found statistically significant differences in mean OKS score at 2 months (P = 0.030) and 1 year (P = 0.030). EAP scores produced slightly different results, with statistically significant differences at 1 year (P = 0.041) and 3 years (P = 0.043). With PVI, there were no statistically significant differences. ConclusionPsychometric sensitivity analyses can be readily performed for superiority trials using PROMs and may aid the interpretation of results.

ASSESSING PREOPERATIVE LOWER LIMB CORONAL ALIGNMENT IN THE SETTING OF KNEE ARTHROPLASTY: A COMPARISON OF WEIGHTBEARING HIP-KNEE-ANKLE RADIOGRAPHS WITH INTRAOPERATIVE ASSESSMENT USING CT-BASED NAVIGATION

Accurate evaluation of lower limb coronal alignment is essential for effective pre-operative planning of knee arthroplasty. Weightbearing hip-knee-ankle (HKA) radiographs are considered the gold standard. Mako SmartRobotics uses CT-based navigation to provide intra-operative data on lower limb coronal alignment during robotic assisted knee arthroplasty. This study aimed to compare the correlation between the two methods in assessing coronal plane alignment.Patients undergoing Mako partial (PKA) or total knee arthroplasty (TKA) were identified from our hospital database. The hospital PACS system was used to measure pre-operative coronal plane alignment on HKA radiographs. This data was correlated to the intraoperative deformity assessment during Mako PKA and TKA surgery.443 consecutive Mako knee arthroplasties were performed between November 2019 and December 2021. Weightbearing HKA radiographs were done in 56% of cases. Data for intraoperative coronal plane alignment was available for 414 patients. 378 knees were aligned in varus, and 36 in valgus. Mean varus deformity was 7.46° (SD 3.89) on HKA vs 7.13° (SD 3.56) on Mako intraoperative assessment, with a moderate correlation (R= 0.50, p&lt;0.0001). Intraoperative varus deformity of 0-4° correlated to HKA measured varus (within 3°) in 60% of cases, compared to 28% for 5-9°, 17% for 10-14°, and in no cases with &gt;15° deformity. Mean valgus deformity was 6.44° (SD 4.68) on HKA vs 4.75° (SD 3.79) for Mako, with poor correlation (R=0.18, p=0.38).In this series, the correlation between weightbearing HKA radiographs and intraoperative alignment assessment using Mako SmartRobotics appears to be poor, with greater deformities having poorer correlation.

Use of a Smartphone-Based Care Platform After Primary Partial and Total Knee Arthroplasty: 1-Year Follow-Up of a Prospective Randomized Controlled Trial

BackgroundThe rise in demand of knee arthroplasty has led the industry to develop methods to decrease costs of care, such as novel methods of delivering physiotherapy, including smartphone-based exercise educational platforms. The purpose of this study was to determine the noninferiority of one such system after primary knee arthroplasty as compared to traditional in-person physiotherapy. MethodsA prospective, multicenter randomized clinical trial was conducted comparing standard of care rehabilitation to a smartphone-based care platform after primary knee arthroplasty from January 2019 to February 2020. One-year patient outcomes, satisfaction scores, and utilizations of health care resources were analyzed. A total of 401 patients was available for analysis—241 in the control and 160 in the treatment group. ResultsThere were 194 (94.6%) patients in the control group who required 1 or more physiotherapy visits compared to only 97 (60.6%) patients in the treatment group (P < .001). Emergency department visits within 1 year occurred in 13 (5.4%) patients and 2 (1.3%) patients in the control and treatment groups, respectively (P = .03). The change in mean Knee Injury and Osteoarthritis Outcome Score for joint replacement scores at 1 year was similar between both the groups (32.1 ± 1 6.8 versus 30.1 ± 18.1, P = .32). ConclusionImplementation of this smartphone/smart watch care platform showed similar outcomes to traditional care models at 1 year postoperative. Traditional physiotherapy and emergency department visits occurred at much lower rates in this cohort, which could alleviate the need for health care dollars spent by reducing postoperative costs and enhancing communication across the health care system.

STEPPING BEYOND COUNTS, FEASIBILITY OF PASSIVELY COLLECTED QUALITATIVE GAIT METRICS USING A SMARTPHONE-BASED CARE MANAGEMENT PLATFORM FOLLOWING TOTAL JOINT ARTHROPLASTY

Advances in algorithms developed with sensor data from smart phones demonstrates the capacity to passively collect qualitative gait metrics. The purpose of this feasibility study was to assess the recovery of these metrics following joint reconstruction. A secondary data analysis of an ethics approved global, multicenter, prospective longitudinal study evaluating gait quality data before and after primary total knee arthroplasty (TKA, n=476), partial knee arthroplasty (PKA, n=139), and total hip arthroplasty (THA, n=395). A minimum 24 week follow-up was required (mean 45±12, range 24 - 78). Gait bouts and gait quality metrics (walking speed, step length, timing asymmetry, and double support percentage) were collected from a standardized smartphone operating system. Pre- and post-operative values were compared using paired-samples t-tests (p&lt;0.05).A total of 595 females and 415 males with a mean age of 61.9±9.3 years and mean BMI of 30.2±6.1 kg/m2 were reviewed. Walking speeds were lowest at post-operative week two (all, p&lt;.001). Speeds exceeded pre-operative means consistently by week 21 (p=0.015) for PKA, and week 13 (p=0.007) for THA. The average weekly step length was lowest in post-operative week two (all, p&lt;0.001). PKA and THA cases achieved pre-operative step lengths by week seven (p=0.064) and week 9 (p=0.081), respectively. The average weekly gait asymmetry peaked at week two post-operatively (all, p &lt;0.001). Return to pre-operative baseline asymmetry was achieved by week 11 (p=0.371) for TKA, week six (p=0.541) for PKA, and week eight (p=.886) for THA. Double limb support percentages peaked at week two (all, p&lt;0.001) and returned to pre-operative levels by week 24 (p=0.089) for TKA, week 12 (p=0.156) for PKA, and week 10 (p=0.143) for THA.Monitoring gait quality in real-world settings following joint reconstruction using smartphones is feasible, and may provide the advantage of removing the Hawthorne effect related to typical gait assessments and in-clinic observations.

Partial versus total knee arthroplasty for isolated antero-medial osteoarthritis – An analysis of PROMs and satisfaction

This study aimed to compare the patient-reported functional outcomes and patient satisfaction after medial Unicompartmental Knee Arthroplasty (UKA) versus Total Knee Arthroplasty (TKA), performed for anteromedial osteoarthritis (AMOA) of the knee in patients from an Indian population, at a minimum 3-year follow-up. This is a prospective matched cohort study (1:2 ratio). One hundred and one UKA cases were matched to 206 TKA cases by propensity score matching for age, body mass index (BMI), gender distribution, and the Charlson Comorbidity Index (CCI). The primary outcome (Oxford knee score, OKS) was assessed at a 3-year follow-up, along with secondary outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] Score, Forgotten Joint Score (FJS), Anterior Knee Pain (Kujala) score, patient satisfaction, and revision rate at the final follow-up). The UKA group was superior to the TKA group in patient-reported functional outcomes based on the OKS (p=0.004). Using the FJS score, UKA was more likely to be a forgotten joint compared to TKA (p<0.001). However, differences in the OKS and FJS did not meet the reported minimal clinically important difference (MCID) thresholds. Quality of life (EuroQol-5D VAS scale) was found to be significantly higher in the UKA group (p<0.001). Patients in the UKA group were more likely to be very satisfied (75.2%) versus the TKA group (62.1%, p=0.023). For AMOA, UKA was associated with improved patient satisfaction compared to TKA. Although patient-reported outcome measures were statistically in favour of UKA over TKA, the differences were not clinically significant. Multicenter and randomized studies comparing the two procedures are warranted. Level-II Therapeutic.

Reduced Early Revision Surgery and Medical Complications in Computer-assisted Knee Arthroplasty Compared With Non-computer-assisted Arthroplasty.

Computer assistance can help surgeons achieve mechanical accurate alignment, but the clinical effect of this technology in different arthroplasty types remains controversial because of conflicting functional outcomes, revision rates, and complication rates. The goal of this study was to compare 90-day medical complications and 1 and 2-year revision surgeries after computer-assisted patellofemoral arthroplasty, unicompartmental knee arthroplasty (CA-UKA), bicompartmental knee arthroplasty (CA-BKA), and total knee arthroplasty (CA-TKA) with non-computer-assisted procedures. A retrospective cohort analysis was conducted using the Mariner data set of the PearlDiver Patient Records Database from 2010 to 2018. Current Procedural Terminology codes were used to identify patients who underwent patellofemoral arthroplasty, unicompartmental knee arthroplasty, bicompartmental knee arthroplasty, and total knee arthroplasty with or without computer assistance for osteoarthritis. All included patients were followed up for 2 years. Univariate and multivariable analyses were conducted. On multivariable analysis, revision within 1 year was decreased in patients who underwent computer-assisted patellofemoral arthroplasty (odds ratio [OR]: 0.541, P = 0.031), CA-UKA (OR: 0.798, P = 0.019), and computer-assisted bicompartmental knee arthroplasty (OR: 0.186, P = 0.025) compared with the same surgeries without technology assistance. CA-TKA had decreased odds of revision for aseptic loosening at 2 years (OR: 0.789, P < 0.001). CA-UKA and CA-TKA had decreased risk of overall 90-day medical complications (OR: 0.838, P < 0.001; OR: 0.903, P < 0.001, respectively) and major complications (OR: 0.750, P = 0.004; OR: 0.822, P < 0.001, respectively). Complication rates and revision surgeries for all arthroplasty types were equivalent or more favorable when computer assistance was used during surgery. Our results quantify some early benefits to using computer assistance in total and partial knee arthroplasties.

Analysis of revision rates and complication rates among patients undergoing unicompartmental and bicompartmental knee Arthroplasties when compared to Total knee arthroplasty

BackgroundWith recent advances in partial knee arthroplasty, there is conflicting data regarding the outcomes and revision rates for bicompartmental knee arthroplasty (BKA) and unicompartamental knee arthroplasty (UKA) compared to total knee arthroplasty (TKA). This study uses national data to compare surgical and medical complications of UKA, BKA, and TKA to aid surgical decision-making. MethodsA retrospective cohort analysis was done using the Mariner dataset of the PearlDiver patient records database from 2010-2019. Current Procedural Terminology (CPT) codes were used to identify patients who underwent UKA, BKA, and TKA for a primary indication of osteoarthritis (OA). Univariate and multivariable analyses were performed to determine 1-year and 2-year revision, prosthetic joint infection (PJI), and loosening, 1-year manipulation under anesthesia (MUA), and 90-day postoperative medical complications. ResultsThe BKA cohort was found to have higher odds of one and two-year revision compared to UKA and TKA cohorts. Additionally, the UKA cohort had higher odds of one and two-year revision but lower odds of 1-year MUA than the TKA cohort. However, both the BKA and UKA cohorts had lower odds of any 90-day postoperative complications when compared to the TKA cohort. ConclusionsEven with modern implants and approaches, our study found that revision rates are highest for BKA followed by UKA and TKA at two years postoperatively. Notably, medical complications were much less common after all partial knee replacement types when compared to TKA. These findings may be used to guide patients in selecting the appropriate surgery to meet their goals and expectations.

Knee arthroplasty utilization trends from 2010 to 2019

BackgroundInterest in partial knee arthroplasty procedures including unicompartmental arthroplasty (UKA), patellofemoral arthroplasty (PFA), and bicompartmental knee arthroplasty (BKA) has increased due to their bone and ligament preservation compared to total knee arthroplasty (TKA). Implant designs, changing thoughts on appropriate indications for partial knee arthroplasty, and availability of navigation also impacted the field over the last decade. The aims of this study were to evaluate trends over the last decade in utilization of 1) partial and total knee arthroplasty; and 2) computer-assistance in knee arthroplasty. MethodsA retrospective cohort analysis was conducted using the PearlDiver database. Patients who underwent PFA, UKA, BKA, and TKA for an indication of osteoarthritis (OA) were identified using Current Procedural Terminology (CPT) codes. Trends analysis from 2010 to 2019 was conducted to compare utilization based on procedure type and computer-assistance. Statistical analysis was conducted using Compounded Annual Growth Rates (CAGR) and linear regression. ResultsFrom 2010 to 2019, there was a significant decrease in utilization of PFA (CAGR: −5.73 %; p = 0.011) and BKA (CAGR: −10.49 %; p = 0.013), but no significant difference in that of UKA (p = 0.224) and TKA (p = 0.421). There was a significant increase in the utilization of computer assistance for both UKA (CAGR: +19.81 %; p = 0.002) and TKA (CAGR: +3.90 %; p = 0.038), but there was no significant difference for computer-assisted PFA (p = 0.724) and BKA (p = 0.951). ConclusionsTKA is still the most common arthroplasty procedure for OA. Decreased utilization of PFA and BKA may be explained by reported failure and revision rates for PFA and BKA compared to TKA.

Critical Rehabilitation for Partial and Total Knee Arthroplasty: Guidelines and Objective Testing to Allow Return to Physical Function, and Recreational and Sports Activities.

Medicine & Science in Sports & Exercise 54(8):p 1400, August 2022. | DOI: 10.1249/01.mss.0000854448.09805.3f

Medium-term results after partial (unicompartmental) knee arthroplasty with a mobile platform

Background: Early gonarthrosis is characterized by involvement of one compartment of the knee joint, most commonly the medial tibio-femoral joint (AMOA). Surgical treatment includes debridement, chondroplasty, corrective osteotomy, unicondylar knee arthroplasty (UKA), or total joint replacement (TKE). Materials and results: The aim of the study is a retrospective analysis of the clinical results after UKA from a cohort of patients operated at the Clinic of Orthopedics and Traumatology, University Hospital "Queen Joanna - ISUL", Medical University Sofia. Patients in the cohort reported a excellent functional outcome, with the exception of two of the participants in the study. Conclusion: UKA is a suitable surgical alternative for teams that have experience with the technique. Careful consideration of the preoperative parameters of patients, as well as creating acceptable and realistic expectations about the postoperative results are crucial for a positive end result.

Paper 78: Integrating PROM Collection for Shoulder Surgical Patients through the Electronic Medical Record: A Low Cost and Effective Strategy for High Fidelity PROM Collection

Objectives:Patient Reported Outcome Measures (PROMs) are critical measures of quality of care and treatment outcomes; however, they are challenging to collect without significant financial and administrative investment. The purpose of this study was to evaluate the efficacy and cost of an automated PROM collection through the electronic medical record for shoulder surgery patients in a large, integrated healthcare system.Methods:An existing, electronic medical record (EMR) based, automated, PROM scheduling system was integrated into the surgical check-in workflow for all elective primary total hip, total knee, and partial knee arthroplasty patients from November 2020 through August 2021 at 3 high volume surgical sites in a large, integrated health system. Rates of completion for Patient Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Patient Reported Outcomes Measurement Information System Pain Interference (PROMIS-PI) and American Shoulder and Elbow Surgeons Shoulder (ASES) surveys were determined. No additional staff were hired to assist in PROM collection. In our institution, if the patient had an ambulatory appointment within 25 days prior to surgery, their PROM scores were marked complete and were not reassigned on the day of surgery (DOS). For all other patients, PROMs were assigned by the automated system on DOS.Results:A total of 325 patients with a mean age of 42 + 28 years were included in this study. The vast majority, 94% (306), were assigned surveys on their day of surgery as a result of the automated system. The other 6% (19) had PROM scores completed in the ambulatory setting as they had a pre-operative visit less than 25 days prior to surgery. For patients completing PROMS on their day of surgery, 87% (266/306) completed at least 1 of PROMIS-UE or ASES, while 82% (251/306) completed both. In total 88% (285/325) of patients completed at least 1 PROM on or within 25 days prior to surgery and 85% (277/325) completed both. This entire system cost $5180 to deploy.Conclusions:A native PROM scheduling and collection system was successfully implemented with a survey completion rate of 82% to 95% of patients. This system serves as an efficient, low-cost model for other surgical departments to leverage existing systems to collect day of surgery PROMs.

The Performance of Diagnostic Tests for Identifying Periprosthetic Joint Infection After Failed Partial Knee Arthroplasty

BackgroundIndications for unicompartmental knee arthroplasty (UKA) and patello-femoral arthroplasty are expanding. Despite the lower published infection rates for UKA and patello-femoral arthroplasty than total knee arthroplasty, periprosthetic joint infection (PJI) remains a devastating complication and diagnostic thresholds for commonly utilized tests have not been investigated recently. Thus, this study evaluated if diagnostic thresholds for PJI in patients who had a failed partial knee arthroplasty (PKA) align more closely with previously reported thresholds specific to UKA or the 2018 International Consensus Meeting on Musculoskeletal Infection. MethodsWe identified 109 knees in 100 patients that underwent PKA with eventual conversion to total knee arthroplasty within a single healthcare system from 2000 to 2021. Synovial fluid nucleated cell count and synovial polymorphonuclear percentage in addition to preoperative serum erythrocyte sedimentation rate, serum C-reactive protein, and serum white blood cell count were compared with Student’s t-tests between septic and aseptic cases. Receiver operating characteristic curves and Youden’s index were used to assess diagnostic performance and the optimal cutoff point of each test. ResultsSynovial nucleated cell count, synovial polymorphonuclear percentage, and serum C-reactive protein demonstrated excellent discrimination for diagnosing PJI with an area under the curve of 0.97 and lower cutoff values than the previously determined UKA specific criteria. Serum erythrocyte sedimentation rateESR demonstrated good ability with an area under the curve of 0.89. ConclusionSerum and synovial fluid diagnostic thresholds for PJI in PKAs align more closely with the thresholds established by the 2018 International Consensus Meeting as compared to previously proposed thresholds specific to UKA. Level of EvidenceLevel III, retrospective comparative study.

The role of routine laboratory tests after unilateral total knee arthroplasty

BackgroundRecent studies suggest that routine laboratory tests are not required within 1 day after partial knee arthroplasty. In this study, we evaluated the utility of routine postoperative laboratory tests after initial unilateral total knee arthroplasty (TKA) in an Asian population. In addition, we explored risk factors associated with abnormal test results.MethodsClinical data of patients who underwent original unilateral TKA between 2015 and 2020 were retrospectively analyzed. Patient characteristics and laboratory test results were recorded. Multivariate binary logistic regression analysis was performed to identify risk factors associated with 3 abnormal laboratory results.ResultsA total of 713 patients, who underwent relevant laboratory tests within 3 days of TKA surgery, were enrolled. Among them, 8.1%, 9.9%, and 3.4% patients with anemia, hypoalbuminemia, and abnormal serum potassium levels required clinical intervention after surgery. Binary logistic regression analysis revealed that preoperative hemoglobin levels, estimated blood loss, and age were independent risk factors of postoperative blood transfusion in TKA patients. On the other hand, preoperative albumin levels, intraoperative blood loss, and operation time were risk factors associated with postoperative albumin supplementation. In addition, lower body mass index (BMI) and preoperative hypokalemia were potential risk factors of postoperative potassium supplementation.ConclusionConsidering that more than 90% of abnormal postoperative laboratory tests do not require clinical intervention, we believe that routine laboratory tests after surgery have little significance in patients with primary unilateral TKA. However, postoperative laboratory testing is necessary for patients with established risk factors.