Rate Of Total Knee Arthroplasty Research Articles

Long-Term Follow-Up of Cemented Fixed-Bearing Total Knee Arthroplasty in a Chinese Population: A Survival Analysis of More Than 10 Years

The aims of this study were to evaluate the long term clinical outcomes and survival rate of total knee arthroplasty (TKA) in Chinese population and the risk factors for failure. Between 1985 to 2001, 297 patients underwent primary TKAs with cemented fixed bearing platform in our center. Survival rate was 92.7% at 10 years, with reoperation of the implant as the endpoint, and 90.4% at 15 years. Main reasons for failure were infection and aseptic loosening. Clinical evaluation of 96 knees with HSS knee score showed the mean scores increased from 56.58 ± 11.05 preoperatively to 92.29 ± 10.95 postoperatively. RA patients had lower long-term survivorship compared with OA patients. Younger patients had better HSS scores. Patella strategy and posterior-cruciate-ligament (PCL) strategy had no effect on implant survivorship and clinical outcome. In conclusion, this was one of first studies showing valid long-term outcomes of primary TKA in Chinese.

Factors influencing regional variability in the rate of total knee arthroplasty

Background and purposeGeographic variations in knee arthroplasty have been detected through international surveys. We aim to investigate in this study the influence of aging index, health budget, and number of orthopedic surgeons in the regional variations of the primary and revision TKA rate in a single European country, Spain. Material and methodsInpatient database of knee arthroplasty procedures for years 1997 to 2010 was obtained from the Spanish Ministry of Health, including 393,714 primaries and 37,037 revisions, segregated for each of the 17 regional health services in Spain. Crude and adjusted rates (direct method with total Spanish population per year) were calculated and used as dependent variables. Aging index, regional health budget, and number of orthopedic surgeons per region were used as independent variables in a Kruskal–Wallis test and a negative binomial regression analysis model. Results and conclusionsWith a mean crude rate for Spain of 76 primary TKA and 7 revision surgeries per 105 population and year, the mean adjusted rate per region oscillated between 702 and 27 primary TKA and 87 and 3 revisions per 105. A model was adjusted confirming the influence of aging index, health budget, and number of surgeons, but regional variations remained partly unexplained by these factors.

Effectiveness of pre-operative physiotherapy-based programmes on outcomes following total knee arthroplasty: a systematic review and meta-analysis

Background: The rates of total knee arthroplasty (TKA) procedures have increased over the last 30 years. Prehabilitation has been advocated to enhance strength and functional capability in order to optimize post-operative rehabilitation.Objectives: A systematic review was conducted to determine the effectiveness of pre-operative physiotherapy-based interventions on outcomes following TKA.Methods: Searches of multiple databases of published (MEDLINE, EMBASE, CINAHL, AMED, the Cochrane library database and the PEDro database) and unpublished literature were conducted. All randomized and non-randomized controlled trials assessing pre-operative physiotherapy or exercise training were eligible. The PEDro scale was used to assess methodological quality.Results: Eleven trials including 656 participants were included. There were no statistically significant differences between groups for function as measured by the Western Ontario and McMaster Universities Osteoarthritis function scale, the SF-36 physical function scale, the Hospital for Special Surgery knee rating scale, pain scores, range of motion or length of stay (P>0·05). Of those studies reporting on objective measures of function, five out of eight studies reported no significant difference with the inclusion of pre-operative rehabilitation (P>0·05). Interventions based on neuromuscular electrical stimulation or proprioception in the intervention group demonstrated improvements in sit-to-stand and stair climbing/descending ability (P≤0·05) at 12 weeks after TKA.Conclusion: Pre-operative physiotherapy-based interventions can improve sit-to-stand, stair climbing/descending ability and standing balance post-TKA but do not have a significant effect on self-reported function, self-reported pain levels, range of motion or length of stay in the short-term. However, this should be viewed with caution, since the evidence-base presented with some major methodological limitations.

Declining use of synovectomy surgery for patients with rheumatoid arthritis in Japan

Several studies from different countries suggest that the rates of orthopaedic surgery have decreased for patients with rheumatoid arthritis (RA) in recent years. From the Rochester Epidemiology Project, there was...

Yearly Incidence of Unicompartmental Knee Arthroplasty in the United States

Our purpose was to estimate the incidence of unicompartmental knee arthroplasty in the United States. Three major implant manufacturers provided data over an 8-year period from 1998 to 2005. In addition, a database from 44 hospitals was used to derive national estimates for implants manufactured by all other companies. The incidence of unicompartmental knee arthroplasty ranged from 6570implants in 1998 to 44 990 in 2005. Unicompartmental knee arthroplasty increased at an average rate of 32.5% during the study period compared with a 9.4% average increase in rate of total knee arthroplasty over the same period. Although unicompartmental arthroplasty is growing at triple the rate of total knee arthroplasty in the United States, the data suggest that unicompartmental implants currently account for less than 8% of all knee arthroplasty procedures.

THE INFLUENCE OF INCOME AND RACE ON TOTAL KNEE ARTHROPLASTY IN THE UNITED STATES

Background: The associations among income, total knee arthroplasty, and underlying rates of knee osteoarthritis are not well understood. We studied whether high-income Medicare recipients are more likely to have a knee arthroplasty and less likely to suffer from knee osteoarthritis. Methods: Two data sources were used: (1) the 2000 United States Medicare claims data measuring the incidence of total knee arthroplasty by race, ethnicity, zip (postal) code income, and region (n = 27.5 million) and (2) the National Health and Nutrition Examination Survey (NHANES III) for individuals with an age of sixty years or more (n = 1926) with radiographic and clinical evidence of osteoarthritis. Logistic regression methods were used to adjust for covariates. Results: At the national level, age-adjusted rates of total knee arthroplasty in the high-income quintile were no higher than those in the low-income group (odds ratio, 0.98; 95% confidence interval, 0.96 to 1.00). Within regions, access to care was better for high-income groups (odds ratio, 1.19; 95% confidence interval, 1.17 to 1.22). Racial disparities in arthroplasty were significant (p < 0.001); the odds ratio was 0.36 (95% confidence interval, 0.34 to 0.38) for black men and 0.45 (95% confidence interval, 0.41 to 0.49) for Asian women. There was no evidence of an income gradient for most clinical and radiographic measures of arthritis. The exception was a significant negative association between income and pain on passive motion (p < 0.05). Conclusions: High-income Medicare enrollees are no less likely to have osteoarthritis than low-income enrollees but have somewhat better access to care. Racial disparities are more important than those that are attributable to socioeconomic status. Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

The Influence of Income and Race on Total Knee Arthroplasty in the United States

The associations among income, total knee arthroplasty, and underlying rates of knee osteoarthritis are not well understood. We studied whether high-income Medicare recipients are more likely to have a knee arthroplasty and less likely to suffer from knee osteoarthritis. Two data sources were used: (1) the 2000 United States Medicare claims data measuring the incidence of total knee arthroplasty by race, ethnicity, zip (postal) code income, and region (n = 27.5 million) and (2) the National Health and Nutrition Examination Survey (NHANES III) for individuals with an age of sixty years or more (n = 1926) with radiographic and clinical evidence of osteoarthritis. Logistic regression methods were used to adjust for covariates. At the national level, age-adjusted rates of total knee arthroplasty in the high-income quintile were no higher than those in the low-income group (odds ratio, 0.98; 95% confidence interval, 0.96 to 1.00). Within regions, access to care was better for high-income groups (odds ratio, 1.19; 95% confidence interval, 1.17 to 1.22). Racial disparities in arthroplasty were significant (p < 0.001); the odds ratio was 0.36 (95% confidence interval, 0.34 to 0.38) for black men and 0.45 (95% confidence interval, 0.41 to 0.49) for Asian women. There was no evidence of an income gradient for most clinical and radiographic measures of arthritis. The exception was a significant negative association between income and pain on passive motion (p < 0.05). High-income Medicare enrollees are no less likely to have osteoarthritis than low-income enrollees but have somewhat better access to care. Racial disparities are more important than those that are attributable to socioeconomic status.

Decreases in rates of hospitalizations for manifestations of severe rheumatoid arthritis, 1983-2001.

To determine whether the rates of hospitalization for 4 manifestations of severe rheumatoid arthritis (RA), which are used as indicators of long-term health outcomes, have changed from 1983 to 2001. Data on all patients with RA who were hospitalized with rheumatoid vasculitis or to undergo splenectomy for Felty's syndrome, cervical spine fusion for myelopathy, or total knee arthroplasty at hospitals in California were abstracted from a state hospitalization database. Changes in rates of hospitalization from 1983 to 2001 were examined in this serial cross-sectional study. Rates of hospitalization for rheumatoid vasculitis and splenectomy in Felty's syndrome decreased progressively over time. The risk of hospitalization for rheumatoid vasculitis was one-third lower in 1998-2001 than in 1983-1987. The risk of hospitalization for splenectomy in Felty's syndrome was 71% lower in 1998-2001 than in 1983-1987. There were no significant decreases in the rates of hospitalization for cervical spine surgery or total knee arthroplasty (primary and revision), although in 1998-2001 there was a reversal of the trend of increasing rates of total knee arthroplasty. The risk of hospitalization for primary total knee arthroplasty was significantly lower in 1998-2001 than in 1990-1993 (rate ratio 0.90, 95% confidence interval 0.86-0.95; P < 0.0001). Rates of hospitalization for rheumatoid vasculitis and splenectomy in Felty's syndrome have decreased over the past 19 years, and there has been a recent decrease in the rates of primary total knee arthroplasty in patients with RA. Although several factors may account for these decreases, these findings suggest that since the early 1980s, the long-term health outcomes of patients with RA have improved.

Efficacy of a single dose of cefazolin as a prophylactic antibiotic in primary arthroplasty

We analyzed the wound infection rate of 1,367 primary total hip and knee arthroplasties performed between 1991 and 1999. Two hundred and fifteen arthroplasties were performed with 3 doses (3 × 750 mg) of cefuroxime, and 1,152 arthroplasties were performed with a single preoperative dose (1 × 1 g) of cefazolin as antimicrobial prophylaxis. All wound infections that occurred within 2 years of the index surgery were analyzed. The deep wound infection rate of total hip arthroplasty was 1.1% (95% confidence interval [CI], 0%–3.3%) in the cefuroxime group and 1.1% (95% CI, 0%–2.2%) in the cefazolin group (Fisher’s exact test, P = 1.0). The deep wound infection rate of total knee arthroplasty in the cefuroxime group (1.6%; 95% CI, 0%–3.8%) was not significantly different from the cefazolin group (1.0%; 95% CI, 0.3%–1.7%) (Fisher’s exact test, P = .63). We concluded that a single dose (1 g) of cefazolin given at anesthetic induction offered similar protection to 3 doses (3 × 750 mg) of cefuroxime in preventing infection in primary total joint arthroplasty.