Rate Of Total Knee Arthroplasty Research Articles

What are the age-related factors linked to aseptic revisions in constrained and unconstrained TKA as well as UKA? A register-based study from the German arthroplasty registry (EPRD)

PurposeThe implantation rate of total knee arthroplasties (TKA) is continuously growing. Aseptic problems are a major cause of revision. The aim of the following study was to determinate the incidence of aseptic revisions in primary knee arthroplasty as well as aseptic revision rates and influencing factors according to the patients’ age and type of procedure.MethodsData collection was performed using the German Arthroplasty Registry. Influencing factors were analyzed according to the patients’ age and type of procedure. Risk factors were calculated using multiple Log-rank test with the Holm’s method. Incidence and comparison of aseptic revisions according to the patients’ age and type of procedure were analyzed using Kaplan-Meier-estimates. Cox regression was applied to calculate the hazard ratio.ResultsOverall, 300,998 knee arthroplasties with 254,144 (84.4%) unconstrained TKA, 9,993 (3.3%) constrained TKA and 36,861 (12.3%) unicondylar knee arthroplasties (UKA) were analyzed. Patients younger than 65 years suffered a significantly higher aseptic revision rate than older patients (p < 0.0001). After one year, a revision rate of 1.1% was recorded for patients 65–74 years, 1.6% for patients under 65 years, and 1.3% for patients beyond 74 years. After seven years, patients younger than 65 years sustained in 5.0%, patients 65–74 years in 2.9% and patients beyond 74 years in 2.4% revision. In unconstrained TKA, an increased Elixhauser-score (HR = 1,75; HR = 1,54; HR = 1,7; p < 0,001) was a risk factor regardless the age. A TKA volume of 101–250 regardless the age (HR = 0,66; HR = 0,69; HR = 0,79) and > 250 under 75 years (< 65: HR = 0,72; 65–74: HR = 0,78; p = 0,001) were protective for aseptic revision. In UKA, male gender (HR = 0,81; HR = 0,72; HR = 0,57; p < 0,001), a UKA volume ≥ 51 for patients under 75 years (< 65: HR = 0,62; 65–74: HR = 0,59; p = 0,003) as well as cemented UKA for patients younger than 75 years (< 65: HR = 0,37; 65–74: HR = 0,37; p < 0,001) were detected as preventive factors.ConclusionA significant increased rate of aseptic revisions was reported for patients younger than 65 years compared to older patients. An increased Elixhauser score was a risk factor, whereas male and a high volume of performed UKA or TKA could be identified as preventive factors.Level of evidenceIII, cohort study.

Unicondylar knee arthroplasty demonstrating a significant increased risk for aseptic revisions compared to unconstrained and constrained total knee arthroplasty: An analysis of aseptic revisions after unicondylar and primary total knee arthroplasty of the German Arthroplasty Registry.

Due to ageing population, the implantation rate of total knee arthroplasties (TKAs) is continuously growing. Aseptic revisions in primary knee arthroplasty are a major cause of revision. The aim of the following study was to determinate the incidence and reasons of aseptic revisions in constrained and unconstrained TKA, as well as in unicondylar knee arthroplasties (UKAs). Data collection was performed using the German Arthroplasty Registry. Reasons for aseptic revisions were calculated. Incidence and comparison of aseptic revisions were analysed using Kaplan-Meier estimates. A multiple χ2 test with Holm's method was used to detect group differences in ligament ruptures. Overall, 300,998 cases of knee arthroplasty with 254,144 (84.4%) unconstrained TKA, 9993 (3.3%) constrained TKA and 36,861 (12.3%) UKA were analysed. Aseptic revision rate in UKA was significantly increased compared to unconstrained and constrained TKA (p < 0.0001). In constrained TKA, a 2.0% revision rate for aseptic reasons were reported after 1 year, while in unconstrained TKA 1.1% and in UKA, 2.7% of revisions were identified. After 7 years in constrained TKA 3.3%, in unconstrained TKA 2.8%, and in UKA 7.8% sustained aseptic revision. Ligament instability was the leading cause of aseptic revision accounting for 13.7% in unconstrained TKA. In constrained TKA, 2.8% resulted in a revision due to ligament instability. In the UKA, the most frequent cause of revisions was tibial loosening, accounting for 14.6% of cases, while progression of osteoarthritis accounted for 7.9% of revisions. Ligament instability was observed in 14.1% of males compared to 15.9% of females in unconstrained TKA and in 4.6% in both genders in UKA. In patients with UKA, aseptic revision rates are significantly higher compared to unconstrained and constrained TKA. Ligament instability was the leading cause of aseptic revision in unconstrained TKA. In UKA, the most frequent cause of revisions was tibial loosening, while progression of osteoarthritis was the second most frequent cause of revisions. Comparable levels of ligament instability were observed in both sexes. Level III, cohort study.

Previous anterior cruciate ligament reconstruction influences the complication rate of total knee arthroplasty: a systematic review and meta-analysis

Purpose The results of total knee arthroplasty (TKA) following anterior cruciate ligament (ACL) reconstruction are still under-investigated. The purpose of this research is to investigate the differences between TKA after ACL reconstruction and TKA for primary osteoarthritis through a review and meta-analysis of the literature. Methods Case–control and cohort studies reporting outcomes of TKA following ACL reconstruction were considered eligible for inclusion. The primary endpoint was to systematically review and meta-analyze the reported complications of TKA following ACL reconstruction. The outcomes have been compared with a group of patients who underwent TKA for primary knee osteoarthritis (OA) with any previous ACL surgery. Secondary endpoints were to assess and compare technical difficulties and results including the operative time, the use of revision components, the request for intraoperative release or additional procedures, the revision rate, and the clinical outcomes. Results Seven studies were included involving 1645 participants, 619 of whom underwent TKA in previous ACL reconstruction and 1026 TKA for primary OA with no previous ACL reconstruction. Meta-analysis showed that TKA in previous ACL reconstruction had a significantly higher complication rate (OR = 2.15, P &lt; 0.001), longer operative times (mean differences (MD): 11.19 min; P &lt; 0.001) and increased use of revision components (OR = 2.16; P &lt; 0.001) when compared to the control group without differences of infection, and revision rate. Conclusions TKA in a previous ACL reconstruction has a significantly higher complication rate, longer operative times, and a higher need for revision components and intraoperative soft tissue releases in comparison to TKA for primary OA without previous ACL reconstruction.

No differences in mid-term survival and clinical outcome between CT- and MRI-based patient-specific instrumentation for total knee arthroplasty, a randomized controlled trial.

The purpose of this prospective randomized controlled trial was to compare the clinical outcome and the survival rate of total knee arthroplasty between CT- and MRI-based patient-specific instrumentation 5 years after initial surgery. At a mean follow-up of 5.8years (SD 0.3), 98 patients (64% women, loss to follow-up 28%) were included in this analysis. To assess the differences in clinical outcome, patients fulfilled PROMs preoperatively and at each follow-up moment. At final follow-up, the Forgotten Joint Score was adjusted. At final follow-up, no new patients underwent revision surgery in both groups. Regarding the clinical outcome, no statistically significant difference between the groups was found. The Forgotten Joint Score was only performed at final follow-up and showed no significant difference between both groups. At mid-term follow-up, survival rates between CT- and MRI-based patient-specific instrumentation did not show a significant difference. Regarding clinical outcome, only the EQ-5D-VAS (p < 0.040) showed a statistically significant difference over time, in favor of the MRI-group. Level I.

Assessing the Mortality Rate After Primary Total Knee Arthroplasty: An Observational Study to Inform Future Economic Analysis

BackgroundPrevious research has focused on the perioperative or short-term (<1 year) mortality rate of total knee arthroplasty (TKA), leaving the long-term (>1 year) mortality rate unresolved. In this study, we calculated the mortality rate up to 15 years after primary TKA. MethodsData from the New Zealand Joint Registry from April 1998 to December 2021 were analyzed. Patients aged 45 years or older who underwent TKA for osteoarthritis were included. Mortality data were linked with national records from births, deaths, and marriages. To determine the expected mortality rates in the general population, age-sex-specific life tables from statistics New Zealand were used. Mortality rate was presented as standardized mortality ratios (SMRs) – a comparison of relative mortality rate between the TKA and general populations. In total, 98,156 patients with a median follow-up of 7.25 years (range, 0.00 to 23.74) were included. ResultsOver the entire follow-up period, 22,938 patients (23.4%) had died. The overall SMR for the TKA cohort was 1.08 (95% confidence interval (CI): 1.06 to 1.09), suggesting that TKA patients have an 8% higher mortality rate compared to the general population. However, a reduction in short-term mortality rate was observed for TKA patients up to 5 years post TKA (SMR 5 years post TKA; 0.59 95% CI: 0.57 to 0.60]). On the contrary, a significantly increased long-term mortality rate was observed in TKA patients with greater than 11 years of follow-up, particularly in men over the age of 75 years (SMR 11 to 15 years post TKA for males ≥ 75 years; 3.13 [95% CI: 2.95 to 3.31]). ConclusionThe results suggest a reduction in short-term mortality rate for patients who undergo primary TKA. However, there is an increased long-term mortality rate particularly in men over the age of 75 years. Importantly, the mortality rates observed in this study cannot be causally attributed to TKA alone.

Comment on: The Effect of Intra-articular Hyaluronic Acid Injections and Payer Coverage on Total Knee Arthroplasty Procedures: Evidence From Large US Claims Database.

Comment on: The Effect of Intra-articular Hyaluronic Acid Injections and Payer Coverage on Total Knee Arthroplasty Procedures: Evidence From Large US Claims Database.

Comparison of survival rates between total knee arthroplasty after a previous anterior cruciate ligament reconstruction and primary total knee arthroplasty via propensity score matching.

Although the survival rate of total knee arthroplasty (TKA) in patients treated with anterior cruciate ligament reconstruction (ACLR) is not as favorable as that in patients treated with primary TKA without ligament reconstruction, the exact survival rates and complications associated with these procedures are still controversial. Therefore, the purpose of the current study was to compare the revision rates of TKA in patients with knee osteoarthritis (OA) with a previous ACLR and those of patients with primary TKA with no history of knee surgery by using propensity score matching analysis. A list of patients who underwent TKA from January 1, 2008 to May 31, 2019 was obtained from the Korean National Health Insurance database. Among these, 460 patients underwent TKA in a knee with a previous ACLR and 569,766 patients who underwent primary TKA due to degenerative OA. We performed propensity scoring matching to compare the revision rates including septic revision due to prosthetic joint infection after TKA and perioperative complication rates within 90days after revision TKA between the two groups. Matched patients were assigned to one of the two groups (group A: 2,201 patients who underwent TKA due to primary OA, group B: 448 patients who underwent TKA in a knee with a previous ACLR) based on the propensity score. The total number of revisions per 1000 person-years was significantly higher in group B than in group A (10.16 vs 4.66, respectively). Group B showed a higher risk of revision than group A at 10years post-TKA (hazard ratio: 2.49, 95% confidence interval: 1.30-4.77). However, group B showed a similar risk of septic revision as group A (p = 0.44). Perioperative complications within 90days after TKA showed no significant differences between the groups. Surgeons should be aware of the relatively higher revision rate of TKA in patients who had previously undergone an ACLR compared to that in patients who underwent primary TKA.

Automated Detection of Surgical Implants on Plain Knee Radiographs Using a Deep Learning Algorithm.

Background and Objectives: The number of patients who undergo multiple operations on a knee is increasing. The objective of this study was to develop a deep learning algorithm that could detect 17 different surgical implants on plain knee radiographs. Materials and Methods: An internal dataset consisted of 5206 plain knee antero-posterior X-rays from a single, tertiary institute for model development. An external set contained 238 X-rays from another tertiary institute. A total of 17 different types of implants including total knee arthroplasty, unicompartmental knee arthroplasty, plate, and screw were labeled. The internal dataset was approximately split into a train set, a validation set, and an internal test set at a ratio of 7:1:2. You Only look Once (YOLO) was selected as the detection network. Model performances with the validation set, internal test set, and external test set were compared. Results: Total accuracy, total sensitivity, total specificity value of the validation set, internal test set, and external test set were (0.978, 0.768, 0.999), (0.953, 0.810, 0.990), and (0.956, 0.493, 0.975), respectively. Means ± standard deviations (SDs) of diagonal components of confusion matrix for these three subsets were 0.858 ± 0.242, 0.852 ± 0.182, and 0.576 ± 0.312, respectively. True positive rate of total knee arthroplasty, the most dominant class of the dataset, was higher than 0.99 with internal subsets and 0.96 with an external test set. Conclusion: Implant identification on plain knee radiographs could be automated using a deep learning technique. The detection algorithm dealt with overlapping cases while maintaining high accuracy on total knee arthroplasty. This could be applied in future research that analyzes X-ray images with deep learning, which would help prompt decision-making in clinics.

Perioperative management of patient with late rheumatoid arthritis and post-bone tuberculosis with genu contracture undergoing tenotomy

Background: Rheumatoid arthritis (RA) is an autoimmune and inflammatory disease that potentially attacks all parts of the human body. Despite the use of disease-modifying anti-rheumatic drugs (DMARDs), the rate of total knee arthroplasty (TKA) remains high. Critical complications such as infection, dislocation, and readmission following TKA are also reportedly high and therefore, appropriate management during perioperative period is critical. We reported the perioperative management of a patient with late RA and genu contracture underwent tenotomy. Case Presentation: A 22-year-old male was referred to Dr. Soetomo General Hospital with a chief complaint of pain in the right and left groin. He also complained of immobilization and stiffness in both knees. He had been diagnosed with bone tuberculosis in 2014 and underwent a total knee replacement of both knees in 2015 due to stiffness and inability to walk. Radiography examination indicated erosion and loss of joint spaces in the joints of the hip, fingers, and toes. Laboratory investigation showed positive anti-mutated citrullinated vimentin (anti-MCV), confirming RA. The patient underwent tenotomy surgery and was treated with methylprednisolone 4 mg peroral daily, chloroquine 250 mg peroral daily, and natrium diclofenac peroral to reduce pain. Tenotomy was performed. Considering the disease activity, conventional DMARDs (chloroquine 250 mg peroral and low dose steroid, methylprednisolone 1x4mg peroral) were prescribed. Conclusion: The case highlights the complexity of perioperative management of late RA and genu contracture underwent tenotomy that required multiple disciplines. Therefore, interdisciplinary collaborative team is critical to be able to achieve optimal results of the patient.

Factors contributing to 1-year dissatisfaction after total knee arthroplasty: a nomogram prediction model

BackgroundIdentifying risk factors and early intervention are critical for improving the satisfaction rate of total knee arthroplasty (TKA). Our study aimed to identify patient-specific variables and establish a nomogram model to predict dissatisfaction at 1 year after TKA.MethodsThis prospective cohort study involved 208 consecutive primary TKA patients with end-stage arthritis who completed self-reported measures preoperatively and at 1 year postoperatively. All participants were randomized into a training cohort (n = 154) and validation cohort (n = 54). Multiple regression models with preoperative and postoperative factors were used to establish the nomogram model for dissatisfaction at 1 year postoperatively. The least absolute shrinkage and selection operator method was used to screen the suitable and effective risk factors (demographic variables, preoperative variables, surgical variable, and postoperative variables) collected. These variables were compared between the satisfied and dissatisfied groups in the training cohort. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis were used to validate the discrimination, calibration, and clinical usefulness of the model. Results were evaluated by internal validation of the validation cohort.ResultsThe overall satisfaction rate 1 year after TKA was 77.8%. The nomogram prediction model included the following risk factors: gender; primary diagnosis; postoperative residual pain; poor postoperative range of motion; wound healing; and the rate of change in the degree of coronal lower limb alignment (hip–knee–ankle angle, HKA).The ROC curves of the training and validation cohorts were 0.9206 (95% confidence interval [CI], 0.8785–0.9627) and 0.9662 (0.9231, 1.0000) (95% CI, 0.9231, 1.0000), respectively. The Hosmer–Lemeshow test showed good calibration of the nomogram (training cohort, p = 0.218; validation cohort, p = 0.103).ConclusionThis study developed a prediction nomogram model based on partially modifiable risk factors for predicting dissatisfaction 1 year after TKA. This model demonstrated good discriminative capacity for identifying those at greatest risk for dissatisfaction and may help surgeons and patients identify and evaluate the risk factors for dissatisfaction and optimize TKA outcomes.

Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study

BackgroundKnee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors.MethodsThis multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity.ResultsThe majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related “positive” psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain.ConclusionsThis study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.

CRITERIA FOR PATIENT APPROPRIATENESS FOR PRIMARY, ELECTIVE TOTAL KNEE ARTHROPLASTY FOR KNEE OSTEOARTHRITIS

Purpose: Despite rising rates of total knee arthroplasty (TKA) for knee osteoarthritis (OA), no tools exist to guide patient and surgeon decision-making regarding TKA. In prior research, we identified that knee OA patients and arthroplasty surgeons considered TKA need, psychological readiness/willingness, health status, and expectations of TKA important in assessing patient appropriateness for TKA. Using reliable and valid patient-report questionnaires to assess these constructs, we conducted a prospective cohort study, which confirmed the association of these measures with surgeons’ recommendations for TKA and TKA outcomes.

Orthopedic disease burden in adult patients with symptomatic lumbar scoliosis: results from a prospective multicenter study.

Although the health impact of adult symptomatic lumbar scoliosis (ASLS) is substantial, these patients often have other orthopedic problems that have not been previously quantified. The objective of this study was to assess disease burden of other orthopedic conditions in patients with ASLS based on a retrospective review of a prospective multicenter cohort. The ASLS-1 study is an NIH-sponsored prospective multicenter study designed to assess operative versus nonoperative treatment for ASLS. Patients were 40-80 years old with ASLS, defined as a lumbar coronal Cobb angle ≥ 30° and Oswestry Disability Index ≥ 20, or Scoliosis Research Society-22 questionnaire score ≤ 4.0 in pain, function, and/or self-image domains. Nonthoracolumbar orthopedic events, defined as fractures and other orthopedic conditions receiving surgical treatment, were assessed from enrollment to the 4-year follow-up. Two hundred eighty-six patients (mean age 60.3 years, 90% women) were enrolled, with 173 operative and 113 nonoperative patients, and 81% with 4-year follow-up data. At a mean (± SD) follow-up of 3.8 ± 0.9 years, 104 nonthoracolumbar orthopedic events were reported, affecting 69 patients (24.1%). The most common events were arthroplasty (n = 38), fracture (n = 25), joint ligament/cartilage repair (n = 13), and cervical decompression/fusion (n = 7). Based on the final adjusted model, patients with a nonthoracolumbar orthopedic event were older (HR 1.44 per decade, 95% CI 1.07-1.94), more likely to have a history of tobacco use (HR 1.63, 95% CI 1.00-2.66), and had worse baseline leg pain scores (HR 1.10, 95% CI 1.01-1.19). Patients with ASLS have high orthopedic disease burden, with almost 25% having a fracture or nonthoracolumbar orthopedic condition requiring surgical treatment during the mean 3.8 years following enrollment. Comparisons with previous studies suggest that the rate of total knee arthroplasty was considerably greater and the rates of total hip arthroplasty were at least as high in the ASLS-1 cohort compared with the similarly aged general US population. These conditions may further impact health-related quality of life and outcomes assessments of both nonoperative and operative treatment approaches in patients with ASLS.

Knee biomechanics and contralateral knee osteoarthritis progression after total knee arthroplasty

BackgroundDespite the success rate of Total Knee Arthroplasty (TKA), many patients undergo contralateral TKA. It is possible that altered gait mechanics after unilateral TKA play a role in the progression of contralateral OA progression. Research questionThe purpose of this study was to identify biomechanical predictors of radiographic OA progression in the contralateral (non-surgical) knee after unilateral (primary/initial) TKA. In addition, this study quantified for patients who had contralateral OA progression. MethodsBiomechanical outcomes were collected 6–24 months after unilateral primary TKA and were used to predict changes in contralateral OA severity at follow-up. Participants were divided into “Progressor” and “Non-Progressor” groups based on changes in Kellgren-Lawrence (KL) OA grade and Joint Space Width (JSW) between baseline and follow-up testing sessions. Biomechanical factors during walking were peak knee adduction moment, knee flexion/extension excursions, knee angle at initial foot contact, and peak knee flexion/extension. Multiple independent t-tests were used to examine the magnitude of differences in biomechanical variables between the groups. Logistic regression was used to examine the association between the biomechanical predictors and change in KL scores and JSW. ResultsThe mean time between surgery and follow-up x-rays was 8.8 (2.4) years. Of 40 participants, 62.5–78% had contralateral radiographic knee OA progression by follow-up. There were no significant differences in the biomechanical variables between groups. For the regression analysis, none of the biomechanical variables were found to be predictors for contralateral OA progression. SignificanceAlthough abnormal biomechanics are known risk factors for primary knee OA, it is possible that the mechanisms that result in OA progression of the contralateral limb are different than primary knee OA progression. Future work should evaluate other objective measures of OA progression and determine if cumulative measures of joint loading are related to OA worsening.

Osteoarthritis Care and Risk of Total Knee Arthroplasty Among Medicare Beneficiaries: A Population-Based Study of Regional Covariation.

To examine health care utilization among patients with knee osteoarthritis (OA) and assess whether utilization differs among residents of regions with high and low rates of total knee arthroplasty (TKA). This was a retrospective cohort study of US Medicare beneficiaries with knee OA enrolled from 2005 to 2010. Health care utilization data for knee complaints, including rates of physician visits, physical therapy, knee injections, and arthroscopy, were abstracted from claims files until time of TKA or the end of the study in 2015. Utilization was compared among beneficiaries who lived in regions with high or low rates of TKA. Among 988,570 beneficiaries with knee OA, 327,499 (33.1%) underwent TKA during follow-up (median 5.6 years). Higher frequency of visits for knee complaints was associated with increased risk of TKA, whereas physical therapy, specialist care, and intraarticular treatments were associated with lower risk of TKA. Frequency of TKA varied from 26.4% in the lowest regional TKA rate quintile to 42.1% in the highest regional TKA rate quintile. Rates of physician visits, physical therapy, specialist care, and treatment with intraarticular injections varied inversely with regional TKA rate quintile. For example, 32.5% of beneficiaries in the lowest region quintile and 23.6% in the highest region quintile underwent physical therapy. Across all quintiles, physical therapy was associated with lower TKA rates. Dedicated nonsurgical OA care was infrequently used to treat elderly Americans with knee OA. Nonsurgical care was more common in regions with low TKA rates, suggesting reciprocal emphasis on medical treatment compared to surgical treatment across regions.

Short-term outcomes of periprosthetic compared to native distal femur fractures, a national database study.

Distal femur fractures (DFFx) are highly morbid injuries with a complication rate comparable to hip fractures. Rising rates of total knee arthroplasty (TKA) have led to increasing rates of periprosthetic DFFx (pDFFx). We sought to determine how pDFFx complication rates differed from native DFFx (nDFFx). The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was used to identify patients who sustained pDFFx or nDFFx between 2012 and 2018. Patients were further stratified by operative treatment: open reduction internal fixation (ORIF) or distal femur replacement (DFR). Multivariate logistic regression was used to compare 30-day complication rates between pDFFx versus nDFFx and, among pDFFx patients, ORIF versus DFR or revision TKA (rTKA). 563 patients with pDFFx and 2259 patients with nDFFx were identified between 2012 and 2018. pDFFx patients had significantly lower rates of ORIF than nDFFx patients (36.4 vs 95.4%, p < 0.001). On multivariate analysis, pDFFx were associated with a higher rate of surgical site complications (OR 2.48, p = 0.009) compared to nDFFx. There were no differences in mortality, reoperations, major complications, rate of blood transfusion, venous thromboembolism and disposition. In patients with pDFFx, patients undergoing DFR/rTKA were more likely to be discharged home versus a rehab facility, compared to those undergoing ORIF (OR 2.62, p < 0.001). In this first large registry study comparing pDFFx and nDFFx, we find similar outcomes between these groups in the first 30days after surgery. Patients with pDFFx did have higher rates of surgical site complications, including infection and dehiscence. In pDFFx patients, those undergoing DFR were more likely to return home post-operatively.

Opposing Trends in Total Knee and Hip Arthroplasties for Patients With Rheumatoid Arthritis vs. the General Population-A 14-Year Retrospective Study in Taiwan.

Objective: To determine the trend of incidence rate of total knee arthroplasty (TKA), total hip arthroplasty (THA), and TKA or THA (major joint arthroplasty, MJA) among rheumatoid arthritis (RA) population and compared them with general population (GP) in Taiwan.Methods: Incidence rates and trends of TKA, THA, and MJA were determined over a 14-year period (2000–2013) among RA patients and compared them with GP. RA of patients was diagnosed based on the ACR 1987 criteria and extracted from GP. Subanalyses of incidences of TKA, THA, and MJA by year, 10-year age group, and gender were further conducted for demographic analysis. Patient profiles were extracted from the National Health Insurance Research Database (NHIRD) for interrupted time-series analysis and cohort studies.Results: Patients enrolled were 168,457 receiving TKA, 64,543 receiving THA, and 228,191 receiving MJA surgery. Incidences of TKA, THA, and MJA in RA patients were significantly lower by 49.0, 41.5, and 41.0% compared with concomitantly rises in GP by 131.0, 25.1, and 90.0% among the GP during the study period. The dominant age population for TKA, THA, and MJA were those aged 70–79 years in both GP and RA groups.Conclusions: We found an opposing trend in incidence of TKA, THA, and MJA between RA patients and the GP. The possible influence of pharmacological treatment is implicated for the lower incidence rates of TKA, THA, and MJA surgeries among RA patients.

Comparative Raman study on the molecular structure and IN VIVO wear of poly(methyl methacrylate)-based devices used as temporary knee prostheses: Effect of the antibiotic

The infection rate of total knee arthroplasty is still high, in spite of the high success of this surgical procedure. The use of an antibiotic-loaded temporary spacer made of poly(methyl methacrylate) (PMMA) has been proposed to treat infected knee arthroplasties.This study was aimed at comparatively investigating, on a molecular scale, two types of spacers from the same manufacturer (Spacer K and Vancogenx-space knee, Tecres, Italy), which differ for the added antibiotic (gentamicin sulphate in Spacer K and gentamicin sulphate + vancomycin hydrochloride in Vancogenx). Raman spectroscopy was used to gain more insights into the possible effects of the antibiotic on the spacer composition and polymer structure both in the new components and after in vivo use. Vancogenx was found to contain a lower residual MMA content than Spacer K (about 0.15% versus 0.4%). The former contained a higher amount of isotactic stereosequences than the latter, while the syndiotactic content (the prevailing component) was not significantly different in the two prostheses. The presence of vancomycin hydrochloride influenced not only the degree of polymerization and PMMA tacticity and crystallinity, but in turn also the wear behavior. Actually, Spacer K retrievals were found more affected by in vivo implantation than Vancogenx-space knee ones, revealing slight variations in polymer tacticity and crystallinity and relative radiopacifier content, besides release of MMA and additives of polymerization. However, these changes did not appear worrisome, due to the temporary nature of the prosthesis. In view of these results, the addition of vancomycin hydrochloride could offer an advantage, in spite of the higher costs requested and the potential risks of its unselective use.

Racial Disparities in the Use of Surgical Procedures in the US

The largest US federal action plan to date for reducing racial disparities in health care was implemented in 2011 and continues today. It is not known whether this program, along with other initiatives, is associated with a decrease in racial disparities in the use of major surgical procedures in the US. To analyze whether national initiatives are associated with improvement in racial disparities between White and Black patients in the use of surgical procedures in the US. In this case-control study, the national rates of use for 9 major surgical procedures previously shown to have racial disparities in rates of performance between White and Black adult patients (including angioplasty, spinal fusion, carotid endarterectomy, appendectomy, colorectal resection, coronary artery bypass grafting, total hip arthroplasty, total knee arthroplasty, and heart valve replacement) were analyzed from January 1, 2012, through December 31, 2017. Data analysis was conducted from May 1 to June 30, 2020. Population- and sex-adjusted procedural rates during the study period were examined and standardized based on all-payer insurance status. Racial changes were further analyzed by US census division and hospital teaching status for 4 selected procedures: coronary artery bypass grafting, carotid endarterectomy, total hip arthroplasty, and heart valve replacement. Population- and race-adjusted procedural rates by year, US census division, hospital teaching status, and insurance status. This study included national inpatient data from 2012 to 2017. In 2012, the national incidence rate of all 9 major surgical procedures was higher in White than in Black individuals. For example, the incidence rate of total knee arthroplasty in 2012 for White males was 184.8 per 100 000 persons and for Black males was 79.8 per 100 000 persons. By 2017, these racial disparities persisted for all 9 procedures analyzed. For example, the incidence rate of total knee arthroplasty in 2017 for White males was 220.5 per 100 000 persons and for Black males was 95.6 per 100 000 persons. Although the disparity gap between White and Black patients narrowed for angioplasty (-20.1 per 100 000 persons in males, -4.2 per 100 000 persons in females), spinal fusion (-7.7 per 100 000 persons in males, -15.0 per 100 000 persons in females), carotid endarterectomy (-4.3 per 100 000 persons in males, -4.6 per 100 000 persons in females), appendectomy (-12.3 per 100 000 persons in males, -12.2 per 100 000 persons in females), and colorectal resection (-9.0 per 100 000 persons in males, -12.7 per 100 000 persons in females), the disparity remained constant for coronary artery bypass grafting and widened for 3 procedures, total hip arthroplasty (11.6 per 100 000 persons in males, 20.8 per 100 000 in females), total knee arthroplasty (19.9 per 100 000 persons in males, 12.0 per 100 000 persons in females), and heart valve replacement(12.4 per 100 000 persons in males, 9.2 per 100 000 persons in females). In 2017, racial differences persisted in all US census divisions and in both urban teaching and urban nonteaching hospitals. When rates were adjusted based on insurance status, Black patients with Medicare, Medicaid, and private insurance underwent lower rates of all procedures analyzed compared with White patients. For example, rate of spinal fusion in Black patients was 70.2% of the rate in White patients with Medicare, 56.5% to that of White patients with Medicaid, and 61.2% to that of White patients with private insurance. Results of this study suggest that despite national initiatives, racial disparities have persisted for all analyzed procedures and worsened for one-third of the analyzed procedures. These disparities were evident regardless of US census division, hospital teaching status, or insurance status. Renewed initiatives to help diminish racial disparities and improve health care equality are warranted.

Embedded sensing package for temporary bone cement spacers in infected total knee arthroplasty

The re-infection rate of total knee arthroplasty (TKA) after two stage revision (15%) remains high as it can be challenging to determine whether the infection has been fully cleared between the first and second stage procedures. Temporary embedded sensor systems could be a potential solution to indicate whether the infection has been cleared. In this study a telemetric sensor system to integrate with a bone cement spacer and measure knee joint temperature was designed and evaluated. The sensor package precision, accuracy, hysteresis, and thermal equilibrium were empirically determined. Cadaveric testing was performed with the sensor package implanted inside the femoral notch alongside a pre-formed femoral and tibial bone cement spacer. The limb was tested though 30,000 cycles at 0.5 Hz under a 500 N load. Accuracy and precision of the sensing package were found to be ±0.24 °C and 0.09 °C respectively with negligible hysteresis. Thermal insulation caused by the implant itself was found to produce a thermal time constant of 263 ± 5 s, resulting in a 17 min rise time. Memory capacity enabled data logging every 20 s for a 6 week period before necessitating data transfer. Bluetooth was suitable for data transmission while the package was implanted. Following cyclic loading of the cadaveric specimen, imaging and debridement revealed no issues related to mechanical integrity of the bone cement spacer or encapsulated sensor package. While additional validation is required before use in patients, the concept of temporary embedded sensing technology to aid management of infection treatments is promising.