TKA Patients Research Articles

Does In-Hospital Opioid Use Affect Opioid Consumption After Total Joint Arthroplasty?

Preoperative opioid use strongly correlates with greater postoperative opioid use and complications following total joint arthroplasty (TJA). However, there is a lack of information regarding the effect of opioid consumption during the hospital stay and within the operating room on postoperative opioid use. We retrospectively reviewed 369 consecutive patients undergoing primary TJA at an academic center over a 9-month period. Ninety-day preoperative and postoperative opioid prescriptions were obtained from the state's drug monitoring database. In-hospital opioid consumption data was obtained from the preoperative unit, operating room, postanesthesia care unit (PACU), and hospital floor. Multivariate analysis was utilized to compare patients' total in-hospital opioid consumption with their preoperative and postoperative use, along with opioid use throughout the hospitalization. Total in-hospital opioid consumption was independently associated with postoperative opioid use (rs= 0.17, P= .0010). Opioids consumed on the hospital floor correlated with opioid use in the preoperative unit (rs= 0.11, P= .0338) and PACU (rs= 0.15, P= .0032). Increased preoperative opioid consumption was the greatest risk factor for excessive postoperative use (rs= 0.44, P < .0001). A greater proportion of patients <65 years of age were high posthospital opioid consumers (P= .0146) and significantly more TKA patients were in the higher use groups (P= .0006). In-hospital opioid use is independently associated with preoperative and postoperative consumption. Preoperative opioid use remains the greatest risk factor for increased opioid consumption after TJA. Multimodal approaches to decrease reliance on opioids for pain control during hospitalization may offer hope to further decrease postoperative usage. III.

Significant Reduction in Short-Term Complications Following Unicompartmental Versus Total Knee Arthroplasty: A Propensity Score Matched Analysis

BackgroundTotal knee arthroplasty (TKA) is a gold standard surgical treatment for end-stage arthritis and unicompartmental knee arthroplasty (UKA) is an alternative for localized disease in appropriate patients. Both have been shown to have equivalent complications in the short-term period. We aimed to explore the differences in 30-day complication rates between UKA and TKA using recent data. MethodsCurrent Procedural Terminology codes identified patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent primary TKA or UKA from 2014 to 2018. Propensity score matching addressed demographic differences. Rate of any adverse event (AAE) and complications were compared. ResultsWe identified 279,852 patients with 270,786 and 9,066 undergoing TKA and UKA. No significant difference was observed in baseline demographics after matching. The AAE rate differed significantly between TKA (5.07%) and UKA (2.38%) cohorts (P < .001). TKA group experienced more wound dehiscence, cerebrovascular accident, postoperative blood transfusion, deep vein thrombosis, and requirement for postoperative intubation. Rate of extended length of stay differed between the TKA (11.35%) and UKA (4.89%) cohorts (P < .001). Accounting for all other variables, preoperative corticosteroid use, bleeding disorder, and chronic obstructive pulmonary disease increased the risk for AAE for both groups. Increasing American Society of Anesthesiologists class also increased the odds for complication proportionally with increasing age and operative time. ConclusionContrary to previous data, we found a significantly higher 30-day complication rate in TKA patients. TKA patients had a higher likelihood of having an extended length of stay. Multivariable analysis identified preoperative steroid use, bleeding disorder, and chronic obstructive pulmonary disease as risk factors for developing adverse events for both groups. Level of EvidenceLevel III.

Relationships Between Body Mass Index, Allogeneic Transfusion, and Surgical Site Infection After Knee and Hip Arthroplasty Surgery.

Increased body mass index (BMI) is considered as an important factor that affects the need for total knee and hip arthroplasty (TKA/THA) and the rate of perioperative complications. Previous investigations have not fully established the relationship of BMI and perioperative transfusion with surgical site infection (SSI) or the relationship of BMI and perioperative transfusion after TKA or THA. The National Surgical Quality Improvement Program database was used to perform a retrospective cohort study involving 333,223 TKA and 41,157 THA cases between 2011 and 2018. Multivariable regression assessed the associations of BMI (5 standard categories) and transfusion with SSI. Odds ratio (OR) of SSI was calculated relative to a normal BMI (18.5-24.9 kg/m 2 ) after adjustment of potential confounding factors. Perioperative transfusion decreased significantly over time for both TKA and THA; however, SSI rates remained steady at just under 1% for TKA and 3% for THA. In TKA, a higher OR for SSI was associated only with a BMI of 40+ (OR, 1.86; 95% confidence interval [CI], 1.60-2.18) compared to a referent BMI. In THA, increased ORs of SSI were seen for all BMI levels above normal and were highest for a BMI 40+ (OR, 3.08; 95% CI, 2.47-3.83). In TKA, ORs of transfusion decreased with increasing BMI and were lowest for a BMI 40+ (OR, 0.51; 95% CI, 0.47-0.54). In THA, ORs of transfusion began to increase slightly in overweight patients, reaching an OR of 1.36 (95% CI, 1.21-1.54) for a BMI 40+. SSI incidence remained unchanged despite continuous reductions in blood transfusion in TKA and THA patients over 8 years. In TKA, ORs for SSI increased, but ORs for transfusion decreased with increasing BMI above normal. Conversely, in THA, ORs for SSI and transfusion both increased for a BMI 40+, but only OR for transfusion increased in underweight patients. These findings suggest the importance of controlling obesity in reducing SSI following TKA and THA.

Medicare/Medicaid Insurance Status Is Associated With Reduced Lower Bilateral Knee Arthroplasty Utilization and Higher Complication Rates.

Whether to undergo bilateral total knee arthroplasty (BTKA) depends on patient and surgeon preferences. We used the National Inpatient Sample to compare temporal trends in BTKA utilization and in-hospital complication rates among TKA patients ≥50 with Medicare/Medicaid versus private insurance from 2007 to 2016. We used multivariable logistic regression to assess the association between insurance type and trends in utilization and complication rates adjusting for individual-, hospital-, and community-level covariates, using unilateral TKA (UTKA) for reference. Discharge weights were used for nationwide estimates. About 132,400 (49.5%) Medicare/Medicaid patients and 135,046 (50.5%) privately insured patients underwent BTKA. Among UTKA patients, 62.7% had Medicare/Medicaid, and 37.3% had private insurance. Over the study period, BTKA utilization rate decreased from 7.18% to 5.63% among privately insured patients and from 4.59% to 3.13% among Medicaid/Medicare patients (P trend difference <0.0001). In multivariable analysis, Medicare/Medicaid patients were less likely to receive BTKA than privately insured patients. Although Medicare/Medicaid patients were more likely to develop in-hospital complications after UTKA (adjusted odds ratio, 1.06; 95% confidence interval, 1.002 to 1.12; P = 0.04), this relationship was not statistically significant for BTKAs. In this nationwide sample of TKA patients, BTKA utilization rate was higher in privately insured patients compared with Medicare/Medicaid patients. Furthermore, privately insured patients had lower in-hospital complication rates than Medicare/Medicaid patients.

A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

BackgroundWhile technology-assisted total knee arthroplasty (TA-TKA) improves implant positioning, whether it confers improved clinical outcomes remains inconclusive. We sought to examine national TA-TKA utilization trends and to compare outcomes between TA-TKA and unassisted TKA (U-TKA).MethodsPatients who underwent primary, elective TKA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Demographic, perioperative, and 30-day outcomes were collected. Patients were stratified on the basis of whether they underwent TA-TKA, which included computer navigation and robotics, or U-TKA. The proportion of patients undergoing TKA using TA-TKA was calculated. One-to-one propensity-score matching paired patients undergoing TA-TKA or U-TKA. Independent samples t-tests and Mann–Whitney U tests were used to compare continuous variables, and chi-squared tests were used to compare categorical variables.ResultsOf the 402,284 TKA patients, 10,429 (2.6%) cases were performed using TA-TKA. Comparing the unmatched TA-TKA and U-TKA groups, race (p < 0.001), smoking status (p = 0.050), baseline functional status (p < 0.001), and body mass index (BMI) (p < 0.001) significantly differed. Propensity-score matching yielded 8633 TA-TKA and U-TKA pairs. The TA-TKA cohort had shorter hospital length of stay (LOS) (2.7 ± 2.5 versus 2.8 ± 1.9 days, p = 0.017) but similar operative times (92.4 ± 33.4 versus 92.6 ± 39.8 min, p = 0.670). Compared with the U-TKA group, the TA-TKA group had lower major complication (7.6% versus 9.4%, p < 0.001) and transfusion (3.9% versus 5.1%, p < 0.001) rates and higher rates of discharge to home (73.9% versus 70.4%, p < 0.001). Reoperation and readmission rates did not significantly differ between groups.ConclusionsTA-TKA utilization remains low among orthopedic surgeons. Compared with U-TKA, TA-TKA yielded improved perioperative and 30-day outcomes. Nonetheless, surgeons must consider the benefits and drawbacks of TA-TKA when determining the proper surgical technique and technology for each patient.Level III evidenceRetrospective cohort study.

Transfusion Avoidance in Severely Anemic Total Hip and Total Knee Arthroplasty Patients: An Analysis of Risk.

BackgroundAllogenic blood transfusions increase the risk of multiple complications. We evaluated the influence of restricting transfusions in adults with osteoarthritis that underwent total hip or knee arthroplasty (THA/TKA) with severe postoperative anemia.Material and methodsPatients that underwent THA/TKA for osteoarthritis with postoperative hemoglobin (Hb) ≤ 8 g/dl were retrospectively identified. We evaluated characteristics and adverse postoperative outcomes of patients not transfused and compared them to those of patients who received postoperative transfusion. Adverse outcomes were 90-day readmission, reoperation, infection, and falls, as well as inpatient cardiovascular events and deaths.ResultsOne thousand eighty-seven patients meeting inclusion criteria underwent THA and TKA. The 399 patients (36.7%) who did not undergo transfuion were younger (67.4 vs 69.5 years, P = .008), healthier (American Society of Anesthesiologist ≤ 2: 64.2% vs 56%, P = .006), comprised a lower proportion of cardiovascular disease patients (13.8% vs 24.7%, P < .001), a lower proportion of patients with Medicare/Medicare Managed Care (57.2% vs 65.5%, P = .05), received tranexamic acid more frequently (66.4% vs 52.9%, P < .01), had a shorter procedure time (92.7 vs 103.1, P < .01), a lower postoperative drop in Hb (4.0 vs 4.2 g/dl, P = .022), a later drop in Hb (2.6 vs 2.2 days, P = .003), and a shorter length of stay (3.5 vs 4.8, P < .01). TKA patients underwent transfusion more frequently than THA patients (67.5% vs 59%, P = .004). There were no postoperative deaths. Adverse events were similar between the 2 groups.ConclusionFindings suggest that younger and healthier patients that have lower Hb later during their hospital stay need not undergo transfusion solely based on Hb levels. Routine transfusion triggers can be avoided even in more anemic patients.

Not all Total Hip and Knee Arthroplasties Are the Same: What Are the Implications in Large Database Studies?

BackgroundThe use of claims databases for research after total hip and knee arthroplasty (THA, TKA) has increased exponentially. These studies rely on accurate coding, and inadvertent inclusion of patients with nonroutine indications may influence results. The purpose of this study was to evaluate the complexity of THA and TKA captured by CPT code and determine if complication rates vary based on the indication. MethodsThe NSQIP database was queried using CPT codes 21730 and 27447 to identify patients undergoing THA and TKA from 2018 to 2019. The surgical indication was classified based on the ICD-10 diagnosis code as routine primary, complex primary, inflammatory, fracture, oncologic, revision, infection, or indeterminant. Patient factors and 30-day complications, readmission, reoperation, and wound complications were compared. ResultsA total of 86,009 THA patients had 703 ICD-10 diagnosis codes and 91.4% were routine primary indications. Complication rates were: routine primary 7.4%, complex primary 11.3%, inflammatory 12.5%, fracture 23.9%, oncologic 32.4%, revision 26.9%, infection 38.7%, and indeterminant 10.3% (P < .0001). 137,500 TKA patients had 552 ICD-10 diagnosis codes and 96.1% were routine primary cases. Complication rates were: routine primary 5.9%, complex primary 8.0%, inflammatory 7.2%, fracture 38.9%, oncologic 32.7%, revision 13.3%, infection 37.7%, and indeterminant 9.6% (P < .0001). Routine primary arthroplasty had significantly lower rates of reoperation, readmission, and wound complications. ConclusionUsing CPT code alone captures 10% of THA and 4% of TKA patients with procedures for nonroutine primary indications. It is essential to recognize identification of patients simply by CPT code has the potential to inadvertently introduce bias, and surgeons should critically assess methods used to define the study populations.

The effect of tourniquet application on the morphology and function of quadriceps in patients undergoing total knee arthroplasty: study protocol for a single-blind randomized controlled trial

BackgroundTourniquet is currently widely used in total knee arthroplasty to reduce intraoperative blood loss. The academic view of tourniquet application in TKA is now in dispute. Some scholars argue that tourniquet may cause quadriceps injury and bring extra side effects, so they oppose the application of tourniquet. Others find that tourniquet application has no significant adverse impact on TKA patients. Regarding its advantages in reducing intraoperative blood loss, they advocate the regular application of tourniquet in TKA. Quadriceps injury is considered the main cause of tourniquet side effects. There are now many high-quality trials about tourniquet application in TKA but few of them concentrate on quadriceps morphology and function.MethodsA prospective, single-blind, randomized controlled trial will be adopted. The target sample is 130. Patients who meet the eligibility criteria will be randomly allocated to the tourniquet group and non-tourniquet group. The primary outcome is quadriceps thickness evaluated by ultrasound test. Secondary outcomes include quadriceps stiffness, rehabilitation outcomes, operation time, intraoperative and postoperative blood loss, blood transfusion rate, thigh circumference, VAS score, opioid consumption, d-dimer and C-reactive protein level in the serum, knee function score, postoperative satisfaction score, and complications.DiscussionThis proposed study will contribute to improve evidence of tourniquet application in total knee arthroplasty. This will be a high-quality single-blind randomized controlled trial with a sufficient sample size and strict study design. It will investigate the effects of tourniquet application especially on the morphology and function of quadriceps in patients undergoing total knee arthroplasty and offer advice for tourniquet application in clinical practice.Trial registrationChinese Clinical Trial Registry ChiCTR2000035097. Registered on 31 July 2020

Incidence and effectiveness of manipulation under anaesthesia for stiffness following primary total knee arthroplasty.

There are various modalities of cor- rection of stiffness following total knee arthro-plasty. Manipulation under anaesthesia (MUA) is generally indicated for people who fail to achieve their pre operative range of motion at 12 weeks. The purpose of this study was to determine: (1) the effect of MUA on Flexion arc (2) the influence of timing of MUA from index procedure and of diabetes mellitus on final flexion achieved. We retrospectively evaluated patients who underwent manipulation following total knee arthroplasty at our institution between January 2016 to December 2018. For the purpose of analysis, we have divided the patients into two groups. Those who underwent manipulation within 12 weeks and later than 12 weeks. We have also compared the effect of MUA between diabetic and non-diabetic patients. All were operated with posterior stabilised (PS) prosthesis by a single senior arthroplasty surgeon. The final flexion achieved during their last clinical follow-up were recorded and compared with the pre MUA flexion. The incidence of MUA after TKA at our institute during this period is about 1.14 %. There was a significant statistical difference between the pre and post manipulation flexion, with p value <0.01. There was no significant statistical difference between those who were manipulated before 12 weeks and after 12 weeks in improving the Flexion of the operated knees. We have found that both the diabetic and non diabetic group had comparable flexion after the manipulation in our study. Manipulation after anaesthesia is a safe first intervention to improve post operative stiffness and gain additional range of motion following TKA in patients who develop stiffness. It can be done even after 12 weeks of surgery with reasonably good gain in range of motion.

Acute pain after total hip and knee arthroplasty does not affect chronic pain during the first postoperative year: observational cohort study of 389 patients

Chronic pain is frequently reported after total hip and knee arthroplasties (THA/TKA) in osteoarthritis (OA) patients. We investigated if severity of acute postoperative pain following THA/TKA in OA patients was associated with pain during the first postoperative year. From an observational study, OA patients scheduled for primary THA/TKA (June 2012–December 2017) were included from two hospitals in the Netherlands. Acute postoperative pain scores were collected within 72 h postoperatively and categorized as no/mild (NRS ≤ 4) or moderate/severe (NRS > 4). Pain was assessed preoperatively, 3, 6 and 12 months postoperatively using the HOOS/KOOS subscale pain. With Multilevel Mixed-effects-analyses, we estimated associations between acute and chronic pain until one year postoperative, adjusted for confounders and including an interaction term (Time*Acute pain). 193 THA and 196 TKA patients were included, 29% of THA and 51% of TKA patients reported moderate/severe pain acutely after surgery. In the THA group, the difference in pain at 3 months between the no/mild and moderate/severe groups, was approximately six points, in favor of the no/mild group (95% CI [−12.4 to 0.9]) this difference became smaller over time. In the TKA group we found similar differences, with approximately four points (95% CI [−9.6 to 1.3]) difference between the no/mild and moderate/severe group at 6 months, this difference attenuated at 12 months. No association between severity of acute postoperative pain and pain during the first postoperative year was found. These findings suggest that measures to limit acute postoperative pain will likely not impact development of chronic pain.

Preoperative Colonization With Staphylococcus Aureus in THA Is Associated With Increased Length of Stay.

Preoperative Colonization With Staphylococcus Aureus in THA Is Associated With Increased Length of Stay.

Satisfaction and Health-Related Quality of Life Following Hip and Knee Arthroplasty Surgeries in Indian Patients: A Cross-Sectional Study.

Recently, the patient-reported outcome measures (PROMs) have been considered as the most important assessment tool for surgical outcome evaluation in arthroplasty. However, no study from the Indian subcontinent has evaluated the PROM in the total hip (THA) and knee (TKA) arthroplasties. This cross-sectional study evaluated the health-related quality of life (HRQoL) of 1244 North Indian patients following primary THA and TKA who had at least one-year follow-up. This study included 617 patients with 664 THA and 627 patients with 1152 TKA. The patients were asked to answer the EQ-5D-5L questionnaires and EQ-VAS in their own languages. The EQ-5D-5L values were used to derive level frequency scores (LFS) with validated Indian norms of EuroQoL. Ninety percent of THA and 82% of TKA patients rated excellent HRQoL using EQ-VAS. The regression analysis revealed age, gender, etiology and brand of prosthesis had a significant impact on EQ-5D-5L following THA. However, gender and simultaneous bilateral surgery were found to be important predictors of outcome in TKA. The mean value of LFS for THA was 0.95 ± 0.12 and TKA was 0.88 + 0.24 (p < 0.001). However, There was no difference in LFS between THA and TKA when only elderly patients (> 60years) were considered (p = 0.168). THA patients reported better HRQoL than TKA in the Indian subcontinent. One of the factors for a better outcome in hip arthroplasty was the relatively younger age of the patients. Patients above 60years of age reported similar levels of statisfactior in both THA and TKA. The online version contains supplementary material available at 10.1007/s43465-021-00589-x.

Machine learning algorithms predict within one size of the final implant ultimately used in total knee arthroplasty with good-to-excellent accuracy.

To develop a novel machine learning algorithm capable of predicting TKA implant sizes using a large, multicenter database. A consecutive series of primary TKA patients from two independent large academic and three community medical centers between 2012 and 2020 was identified. The primary outcomes were final tibial and femoral implant sizes obtained from an automated inventory system. Five machine learning algorithms were trained using six routinely collected preoperative features (age, sex, height, weight, and body mass index). Algorithms were validated on an independent set of patients and evaluated through accuracy, mean absolute error (MAE), and root mean-squared error (RMSE). A total of 11,777 patients were included. The support vector machine (SVM) algorithm had the best performance for femoral component size(MAE = 0.73, RMSE = 1.06) with accuracies of 42.2%, 88.3%, and 97.6% for predicting exact size, ± one size, and ± two sizes, respectively. The elastic-net penalized linear regression (ENPLR) algorithm had the best performance for tibial component size (MAE 0.70, RMSE = 1.03) with accuracies of 43.8%, 90.0%, and 97.7% for predicting exact size, ± one size, and ± two sizes, respectively. Machine learning algorithms demonstrated good-to-excellent accuracy for predicting within one size of the final tibial and femoral components used for TKA. Patient height and sex were the most important factors for predicting femoral and tibial component size, respectively. External validation of these algorithms is imperative prior to use in clinical settings. Case-control, III.

Investigation of the Relationship Between Hip and Knee Osteoarthritis and Disordered Spinal and Pelvic Morphology.

IntroductionA critical question is the causal relationship between hip or knee osteoarthritis (OA) and disordered spinal and pelvic morphology. The aim of this study is to examine this correlation. Therefore, we studied the effect of total hip or knee arthroplasty (THA/TKA) on truncal parameters to determine the causal relationship between these two situations.Materials and methodsThis is a prospective study of the effect of THA or TKA in patients with hip or knee OA on truncal morphological parameters. Patients with one-sided hip or knee OA who chose to undergo THA or TKA were enrolled and surveyed. A control group (CG) was also surveyed for comparison with the patients. The patients were preoperatively examined for truncal parameters using the Diers Formetric four-D analysis system (surface topography technique) to calculate several truncal parameters in all planes at four months and 12 months postoperatively. Measurable examinations were performed using the Statistical Package for the Social Sciences (SPSS) version 17.00 (SPSS Inc., Chicago), and statistical significance was set at a p-value of <0.05.ResultsThe study examined 34 patients who underwent THA, including 19 women and 15 men with a mean age of 67.62 ± 8.28 years. The study also examined 45 patients who underwent TKA, including 34 women and 11 men, with a mean age of 72.42 ± 7.0 years. These patients were also compared with a CG that consisted of 25 normal individuals, including 12 women and 13 men, with a mean age of 69.28 ± 10.11 years.The results of this study from four months after THA revealed that the lordotic angle, trunk torsion, pelvic inclination, pelvic obliquity, and pelvis rotation were improved to normal levels. At 12 months after THA, only the pelvic obliquity was improved to normal levels. At four months after TKA the lordotic angle, pelvic inclination, and pelvic obliquity were improved to normal levels. However, the fleche cervicale and vertebral rotation were worse. At 12 months after TKA, only the pelvic obliquity was improved to normal levels.ConclusionsTHA and TKA to correct hip and knee OA do not correct the disordered morphology of the trunk in the long term. Thus, hip or knee OA does not seem to be responsible for disordered trunk morphology. However, it cannot be ruled out whether the disturbed morphology is responsible for the appearance of the hip and knee OA.

Comparison of locomotive improvement effect in TKA patients and HTO patients

Comparison of locomotive improvement effect in TKA patients and HTO patients

Machine learning using preoperative patient factors can predict duration of surgery and length of stay for total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) is one of the most resource-intensive, high-volume surgical procedures. Two drivers of the cost of TKAs are duration of surgery (DOS) and postoperative inpatient length of stay (LOS). The ability to predict TKA DOS and LOS has substantial implications for hospital finances, scheduling, and resource allocation. The goal of this study was to predict DOS and LOS for elective unilateral TKAs using machine learning models (MLMs) based on preoperative factors. MethodsThe American College of Surgeons (ACS) National Surgical and Quality Improvement (NSQIP) database was queried for unilateral TKAs from 2014 to 2019. The dataset was split into training, validation, and testing based on year. Models (linear, tree-based, and multilayer perceptron (MLP)) were fitted to the training set in scikit-learn and PyTorch, with hyperparameters tuned on the validation set. The models were trained to minimize the mean squared error (MSE). Models with the best performance on the validation set were evaluated on the testing set according to 1) MSE, 2) buffer accuracy, and 3) classification accuracy, with results compared to a mean regressor. ResultsA total of 302,300 patients were included in this study. During validation, the PyTorch MLPs had the best MSEs for DOS (0.918) and LOS (0.715). During testing, the PyTorch MLPs similarly performed best based on MSEs for DOS (0.896) and LOS (0.690). While the scikit-learn MLP yielded the best 30-minute buffer accuracy for DOS (78.8%), the PyTorch MLP provided the best 1-day buffer accuracy for LOS (75.2%). Nearly all the ML models were more accurate than the mean regressors for both DOS and LOS. ConclusionConventional and deep learning models performed better than mean regressors for predicting DOS and LOS of unilateral elective TKA patients based on preoperative factors. Future work should include operational factors to improve overall predictions.

Opioid over-prescription after total joint arthroplasty: Findings from patient reported opioid consumption journals

We sought to determine postoperative opioid consumption for opioid-naïve patients undergoing total knee and hip arthroplasty (THA and TKA) procedures via an observational cohort study, consisting of 55 patients who underwent either primary unilateral TKA (n = 28) or THA (n = 27). Patients were provided with a journal to track daily consumption of pain medicine. Patients were prescribed an average of 67 opioid pills post-operatively; however, they consumed an average of 31 pills (214 morphine equivalent doses - MED). TKA patients received (p = 0.01) and consumed (p = 0.005) higher amounts of opioids. On average, patients ceased opioid usage at 14 days post-operatively.

Knee replacement surgery is more precise with

Robotic assisted total knee arthroplasty is one the recent advance to improve its outcome especially to address the issue of precision. Longetivity of TKA primarily depends on proper implant alignment. The Aim of this study is to compare the precision of robotic assisted TKA with the ideally planned mechanical parameters in TKA. A total of 50 robotic assisted TKA patients were included retrospectively in the study. Patient’s post operative mechanical femorotibial angle (mFTA), Lateral distal femoral angle (LDFA), medial proximal tibial angle (mPTA) in AP radiogram.and anterior femoral offset ratio, posterior condylar offset ratio, femoral component flexion, posterior tibial slope in lateral radiograms were evaluated with ideal values for specific parameter. Number of outliers were counted separately with values beyond 3 of malalignment. The mean postoperative FTA, LDFA, mPTA recorded is 0.15 ±0.70, 89.78±0.79, 89.80±0.86 respectively. The mean postoperative posterior tibial slope, femoral flexion is 3.03±0.35, 3.14±0.60 respectively. All the parameters when compared with planned ideal values (i.e. mFTA= 0, mPTA=90, LDFA=90, Posterior tibial slope=3, femoral component flexion=3) did not show significant difference. Study shows promising results with near normal execution of planned TKA. Robotic assisted TKA can be a game changer and a handy tool to improve the alignment of mechanical axis in TKAs.

Altered biomechanics in bilateral total knee replacement patients during stair negotiation

BackgroundMany total knee replacement (TKR) patients need to have a contralateral knee replacement. Biomechanical differences between first and second replaced limbs of bilateral TKR have not been examined during stair negotiation. Additionally, it is unknown whether hip and ankle biomechanics of bilateral patients are altered. We examined hip, knee, and ankle biomechanics of first and second replaced limbs bilateral patients, as well as replaced and non-replaced limbs of unilateral patients, during stair ascent and descent. MethodsEleven bilateral TKR patients (70.09 ± 5.41 years, 1.71 ± 0.08 m, 91.78 ± 13.00 kg) and 15 unilateral TKR patients (64.93 ± 5.11 years, 1.75 ± 0.09 m, 89.18 ± 17.55 kg) were recruited. Patients performed three to five trials of stair ascent and descent. The second step, during ascent, was the step of interest when analyzing each limb. A 2 × 2 (limb × group) analysis of variance was performed to determine differences between limbs and groups. ResultsDuring ascent, bilateral patients exhibited decreased peak loading-response knee extension (KEM) and push-off plantarflexion moments. Unilateral replaced limb KEM was lower than non-replaced limbs. During descent, bilateral patients descended the staircase significantly slower, had lower peak loading-response vertical ground reaction force and KEM, and push-off KEM. Bilateral patients had higher peak loading-response hip extension and push-off plantarflexion moments, and increased knee adduction ROM, compared with unilateral TKA patients. ConclusionsBilateral patients exhibited similar hip, knee, and ankle joint moments between first and second replaced limbs. Substantial differences in hip, knee, and ankle biomechanics during stair negotiation in bilateral patients compared with unilateral patients may indicate a more complex adaptation strategy present in these patients.

Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty.

We sought to determine whether administrations of intravenous (IV) dexamethasone jeopardize blood glycemic control, increase rates of postoperative complications, and diabetic medication change after TKA. This retrospective study included 427 patients with DM who underwent TKA. Patients were divided into two groups according to the use of IV dexamethasone (Dexa and No Dexa). For the Dexa, IV dexamethasone (5mg) was administered twice (surgery day, postoperative day 1). Blood glucose level until postoperative day 5, whether the mean blood glucose level was ≥200 mg/dL or not, the rate of a diabetic medication change, and postoperative complications (surgical site infection, delayed wound healing) were analyzed. The adverse effects of IV dexamethasone on glycemic control were limited to the day of injection. The mean blood glucose level was 168.8 mg/dL and 204.4 mg/dL on operation day and 193.0 mg/dL and 210.5 mg/dL on postoperative day 1 in the No Dexa and the Dexa, respectively. High preoperative glycated hemoglobin (HbA1c) levels, but not IV dexamethasone administration, increased the risk of postoperative blood glucose level ≥200 mg/dL (odds ratio [OR], 2.810) and diabetic medication change (OR, 3.635, P < .001). A preoperative HbA1c level of >7.05% was associated with the risk of diabetic medication change. There was increase of postoperative complications (OR, 0.693, P= .552). IV dexamethasone have transient effects on increasing the blood glucose level after TKA in patients with DM. However, patients with a preoperative HbA1c level of ≥7.05% may need to change their diabetic medication after TKA, regardless of IV dexamethasone administration.