TKA Procedures Research Articles

The Epidemiology of Revision Total Knee Arthroplasty in the United States

Understanding the cause of failure and type of revision TKA procedure performed are essential in guiding research, implant design, and clinical decision making in TKA. The purpose of this study was to assess the most common mechanisms of failure and types of revision TKA procedures performed in the United States using newly implemented ICD-9-CM diagnosis and procedure codes related to revision TKA.

The Increasing Financial Burden of Knee Revision Surgery in the United States

The popularity of total knee arthroplasty combined with the aging US population indicates a dramatic increase in revision TKA procedures. Our objective was to project revision surgery costs in the United States, and to estimate the financial burden for hospitals historically under-reimbursed for these complex surgical procedures. Inflation adjusted charge data derived from a series of knee revision surgeries performed by a single surgeon practice (CJL) (n = 100) were applied to population projections of the number of revision surgeries expected for the Medicare population from 2005-2030. The average charge of TKA revision surgery was 73,696 dollars, (Cost was 36,848 dollars) with substantially higher costs for patients undergoing surgery because of deep joint infection, patients receiving a three component exchange, and patients receiving hinged or constrained condylar knee implants. The number of revision procedures is expected to increase from 37,544 in 2005 to 56,918 in 2030. Projected hospital costs for these procedures may exceed 2 billion dollars by 2030. The number of revision knee surgeries may increase by 66% in the next 25 years. Reimbursement rates will not cover hospital costs for this procedure despite recent increases in Medicare payments for revision arthroplasty. Economic analysis study, level III. See the Guidelines for Authors for a complete description of levels of evidence.

Update on hip and knee arthroplasty: Current state of evidence

Introduction Total hip (THA) and total knee (TKA) arthroplasties are cost-effective interventions for reducing pain, improving function, and enhancing the quality of life in patients with arthritis of the hip and knee (1,2). More than 193,000 THA and 381,000 TKA procedures are performed in the US each year (3), and future projections indicate that by the year 2030, more than 750,000 of these procedures will be performed per year (4). Therefore, it is imperative for health care professionals to practice evidence-based medicine by integrating the scientific literature with their clinical expertise and the patients’ preferences to select the most effective treatment interventions for enhancing patient recovery after joint replacement (5). In response to this need, the Association of Rheumatology Health Professionals, a division of the American College of Rheumatology, assembled a multidisciplinary group of experts from the US and Canada in a conference to review the current evidence on hip and knee arthroplasty. The purpose of the conference was to provide stateof-the-art information for health care professionals on the surgical procedures, preoperative interventions, biomechanical considerations, rehabilitation strategies, outcomes assessment, and health disparities related to THA and TKA. We present the findings from that conference, which synthesizes the available evidence in each area, identifies the gaps in knowledge, and provides suggestions for future research.

Effect of soft tissue tension on measurements of coronal laxity in mobile-bearing total knee arthroplasty

BackgroundThe purpose of this study was to determine the effect of intraoperative coronal laxity in total knee arthroplasty on the postoperative condition. MethodsWe conducted stress arthrometric studies using a Telos arthrometer on 40 knees in 36 patients. Both posterior cruciate ligament-retaining (PCLR) prostheses and posterior cruciate-sacrificing (PCLS) prostheses were placed in 20 knees respectively. All of the TKA procedures were judged clinically successful (Hospital for Special Surgery scores: PCLR 92±3 points, PCLS 91±4 points). Laxities were measured under spinal anesthesia (immediately postoperatively) and 6months postoperatively. ResultsPCLR prostheses had an average of 2.9°±1.8O and 3.0°±1.2O in abduction and 4.4°±2.8O and 3.6°±1.5O in adduction under anesthesia and the postoperative condition. PCLS prostheses had average laxities of 3.8°±1.4° and 3.5°±0.9° in abduction and 4.6°±3.8° and 4.0°±1.7° in adduction. There were no significant differences between them. ConclusionsThe findings suggest that surgeons should emphasize the achievement of suitable laxity under anesthesia to ensure the success of total knee arthroplasty.