Total Knee Joint Replacement Research Articles

Efficacy of Aspirin in Preventing Venous Thromboembolism in Total Knee and Hip Joint Replacement

Efficacy of Aspirin in Preventing Venous Thromboembolism in Total Knee and Hip Joint Replacement

Community-Level Social Vulnerability and Hip and Knee Joint Replacement Surgery Receipt Among Medicare Enrollees With Arthritis.

(1) Explore associations between county minority health social vulnerability index (MH-SVI) and total joint replacement (TJR), and (2) assess associations by individual-level race/ethnicity. An expanded understanding of relevant social determinants of health is essential to inform policies and practices that promote equitable access to hip and knee TJR. Retrospective cohort study of Medicare enrollees. Centers for Medicare and Medicaid Services claims data were linked with MH-SVI. Multivariable logistic regression models were used to evaluate the odds of TJR according to the MH-SVI quartile in which enrollees resided. A total of 10,471,413 traditional Medicare enrollees in 2018 aged 67 years or older with arthritis. The main outcome was enrollee primary TJR during hospitalization. The main exposure was the MH-SVI (composite and 6 themes) for the county of enrollee residence. Results were stratified by enrollee race/ethnicity. Asian American, Native Hawaiian, or Pacific Islander (AANHPI), Black or African American (Black), and Hispanic enrollees comparatively had 26%-41% lower odds of receiving TJR than White enrollees. Residing in counties within the highest quartile of composite and socioeconomic status vulnerability measures were associated with lower TJR overall and by race/ethnicity. Residing in counties with increased medical vulnerability for Black and White enrollees, housing type and transportation vulnerability for AANHPI and Hispanic enrollees, minority status and language theme for AANHPI enrollees, and household composition vulnerability for White enrollees were also associated with lower TJR. Higher levels of social vulnerability were associated with lower TJR. However, the association varied by individual race/ethnicity. Implementing multisectoral strategies is crucial for ensuring equitable access to care.

Advancement in biomedical implant materials-a mini review.

Metal alloys like stainless steel, titanium, and cobalt-chromium alloys are preferable for bio-implants due to their exceptional strength, tribological properties, and biocompatibility. However, long-term implantation of metal alloys can lead to inflammation, swelling, and itching because of ion leaching. To address this issue, polymers are increasingly being utilized in orthopedic applications, replacing metallic components such as bone fixation plates, screws, and scaffolds, as well as minimizing metal-on-metal contact in total hip and knee joint replacements. Ceramics, known for their hardness, thermal barrier, wear, and corrosion resistance, find extensive application in electrochemical, fuel, and biomedical industries. This review delves into a variety of biocompatible materials engineered to seamlessly integrate with the body, reducing adverse reactions like inflammation, toxicity, or immune responses. Additionally, this review examines the potential of various biomaterials including metals, polymers, and ceramics for implant applications. While metallic biomaterials remain indispensable, polymers and ceramics show promise as alternative options. However, surface-modified metallic materials offer a hybrid effect, combining the strengths of different constituents. The future of biomedical implant materials lies in advanced fabrication techniques and personalized designs, facilitating tailored solutions for complex medical needs.

Management of osteosarcoma by total knee joint replacement with ALT-free flap transfer: Case series

In the past, surgeries to treat osteosarcoma involved amputation, but now they have become more conservative with prosthesis replacement. To reduce the incidence of complications, it is essential to consider suitable and adequate soft tissue cover. Our patients underwent surgery to resect osteosarcoma of the upper and lower head of the tibia and femur, respectively and were given knee joint prostheses. We chose the anterolateral thigh flap (ALT) as the suitable material to cover the defect and the prosthesis. All flaps were used for the surgery, two of which were fasciocutaneous, and the other two were musculocutaneous. All flaps had good blood supply, and no complications were reported. Conservative surgery for osteosarcoma has become increasingly popular, particularly for bone or joint replacement. The free ALT flaps offer many advantages when reconstructing the soft tissue defect and covering the prosthesis. The lower donor site morbidity of ALT free-flap makes it a more favorable choice for reconstruction after joint replacement.

OUTCOMES OF REVISION TOTAL KNEE ARTHROPLASTY AFTER UNICOMPARTMENTAL KNEE ARTHROPLASTY AND PERIARTICULAR OSTEOTOMY

IntroductionThis study assessed outcomes of total knee joint replacements (TKJR) in patients who had undergone previous periarticular osteotomy compared with unicompartmental knee replacement (UKR). Establishing a difference in the results of total knee joint replacements following these operations may be an important consideration in the decision-making and patient counselling around osteotomy versus UKR for the management of single-compartment osteoarthritis.MethodUsing data from the New Zealand Joint Registry, we identified 1,895 total knee joint replacements with prior osteotomy and 1,391 with prior UKR. Revision rates and patient-reported outcomes, as measured by the Oxford Knee Score (OKS), between these two groups were compared. Adjusted hazard ratios were also calculated to compare the groups.ResultsThe revision rate for total knee joint replacement following osteotomy was significantly lower than TKJR following UKR (0.88 per 100 component years versus 1.38 per 100 component years, respectively). Adjusted hazard ratio calculations found that those with TKJR with prior UKR had more than double the risk of requiring revision than those with prior osteotomy. Additionally, there was a statistically significant difference in the mean adjusted OKS scores between the two groups, with improved outcomes in the group with prior osteotomy.ConclusionOur findings suggest that total knee joint replacement following periarticular osteotomy have a lower risk of revision and improved OKS when compared to those with prior UKR. Previous studies assessing New Zealand Joint Registry have not found a statistically significant difference between the two groups however, these results are no longer in keeping with more contemporary literature. Our study confirms the New Zealand population to be comparable with international studies with TKJR after osteotomy performing significantly better compared with prior UKR.

Regulation of cytokine and chemokine expression by histone lysine methyltransferase MLL1 in rheumatoid arthritis synovial fibroblasts

Histone lysine methylation is thought to play a role in the pathogenesis of rheumatoid arthritis (RA). We previously reported aberrant expression of the gene encoding mixed-lineage leukemia 1 (MLL1), which catalyzes methylation of histone H3 lysine 4 (H3K4), in RA synovial fibroblasts (SFs). The aim of this study was to elucidate the involvement of MLL1 in the activated phenotype of RASFs. SFs were isolated from synovial tissues obtained from patients with RA or osteoarthritis (OA) during total knee joint replacement. MLL1 mRNA and protein levels were determined after stimulation with tumor necrosis factor α (TNFα). We also examined changes in trimethylation of H3K4 (H3K4me3) levels in the promoters of RA-associated genes (matrix-degrading enzymes, cytokines, and chemokines) and the mRNA levels upon small interfering RNA-mediated depletion of MLL1 in RASFs. We then determined the levels of H3K4me3 and mRNAs following treatment with the WD repeat domain 5 (WDR5)/MLL1 inhibitor MM-102. H3K4me3 levels in the gene promoters were also compared between RASFs and OASFs. After TNFα stimulation, MLL1 mRNA and protein levels were higher in RASFs than OASFs. Silencing of MLL1 significantly reduced H3K4me3 levels in the promoters of several cytokine (interleukin-6 [IL-6], IL-15) and chemokine (C–C motif chemokine ligand 2 [CCL2], CCL5, C-X-C motif chemokine ligand 9 [CXCL9], CXCL10, CXCL11, and C-X3-C motif chemokine ligand 1 [CX3CL1]) genes in RASFs. Correspondingly, the mRNA levels of these genes were significantly decreased. MM-102 significantly reduced the promoter H3K4me3 and mRNA levels of the CCL5, CXCL9, CXCL10, and CXCL11 genes in RASFs. In addition, H3K4me3 levels in the promoters of the IL-6, IL-15, CCL2, CCL5, CXCL9, CXCL10, CXCL11, and CX3CL1 genes were significantly higher in RASFs than OASFs. Our findings suggest that MLL1 regulates the expression of particular cytokines and chemokines in RASFs and is associated with the pathogenesis of RA. These results could lead to new therapies for RA.

Essential amino acids in total knee and hip joint replacement: a narrative review

The increasing availability of total joint replacement especially for knee and hip joints has increased their rates substantially across the globe. It is associated with increased risk of sarcopenia with loss of muscle mass and strength in the postoperative period. The supplementation of proteins along with exercises have been mainframe strategy to improve the functional ability after total knee arthroplasty and total hip arthroplasty. However, supplementation of proteins necessitates effective proteolytic digestion and conversion to amino acids for exerting substantial effects. In overcoming this challenge, supplementation with essential amino acids can be an attractive approach In this article, we review the clinical evidence with use of essential amino acids in patients undergoing TKA and THA. In the nine studies included in the review, seven assessed EAAs in TKA and two in THA. In TKA studies, improvement in muscle mass, muscle strength and functional recovery has been significant over 6 weeks postoperatively in majority of the studies. Over long term (2 years), improved recovery of rectus femoris and quadriceps had been reported. In THA as well, significant improvement in hip function and stability has been reported. Thus, EAAs in addition to the existing rehabilitation program are helpful to improve sarcopenia and enhances the recovery to perform activities of daily living. We propose from current evidence that administration of EAAs 7 to 10 days prior to planned TKA or THA and continued for 14 to 20 days in the postoperative period along with rehabilitation program is optimal in enhancing the muscle strength and help in physical functional recovery. Current evidence indicates supplementation with EAAs should be a part of routine management protocol in patients undergoing TKA or THA.

NOVEL SOLUTION TO THE ARTHROPLASTY BACKLOG PROBLEM IN A TERTIARY ACADEMIC INSTITUTION

Hip and knee joint arthroplasty wait list has been getting outrageously long in South Africa with some tertiary hospital reporting more than 5 years of waiting time. This has been further compounded by covid 19 pandemic. There is plateau of ideas on how best to address the backlogs in high volume tertiary centers, with catchup list, out reach program, private partnership seeming unsustainable. We sought to look for sustainable solution to the problem and we looked not far but inside the system.MethodTriggered by the fire that engulfed part of the hospital, we found ourself refuged at the sister tertiary hospital with no access to theatre time. We visited districts hospitals within the cluster and discovered state of the art facility underutilized. We presented a plan to establish a satellite arthroplasty center which was greatly embraced by the management. We partnered with the trade to setup an arthroplasty service in this district hospital. Employed 3 retired nurses and 2 parttime anaesthetist all on yearly contract. We developed pathways for patient selection according to American Society of Anaesthesiologist(ASA).232 total joint arthroplasties were performed in 15-month, 33%Hips and 67%Knees. The average hospital stay was 2,3± 2days. We had 1 mortality(# NOF) and 2 cases of PJI treated successfully with debridement antibiotic and implant retention. We had 5 cases of intraoperative calcar femur fracture managed with cables and all stable at 6weeksand 3month. Over 76% of the cases were performed by fellows as the primary surgeons.Primary hip and knee total joint replacement can be safely performed in a district hospital. Employing motivated retired staff was key to the success of this project. Fellowship trainees performed most of the operations. We suggest that other academic hospitals with long waiting list can look at emulating this model within their district.

Epigenetic regulation of 15-lipoxygenase-1 expression in human chondrocytes by promoter methylation.

15-Lipoxygenase-1 (15-LOX-1) catalyzes the biosynthesis of many anti-inflammatory and immunomodulatory lipid mediators and was reported to have protective properties in several inflammatory conditions, including osteoarthritis (OA). This study was designed to evaluate the expression of 15-LOX-1 in cartilage from normal donors and patients with OA, and to determine whether it is regulated by DNA methylation. Cartilage samples were obtained at autopsy from normal knee joints and from OA-affected joints at the time of total knee joint replacement surgery. The expression of 15-LOX-1 was evaluated using real-time polymerase chain reaction (PCR). The role of DNA methylation in 15-LOX-1 expression was assessed using the DNA methyltransferase inhibitor 5-Aza-2'-desoxycytidine (5-Aza-dC). The effect of CpG methylation on 15-LOX-1 promoter activity was evaluated using a CpG-free luciferase vector. The DNA methylation status of the 15-LOX-1 promoter was determined by pyrosequencing. Expression of 15-LOX-1 was upregulated in OA compared to normal cartilage. Treatment with 5-Aza-dC increased 15-LOX-1 mRNA levels in chondrocytes, and in vitro methylation decreased 15-LOX-1 promoter activity. There was no difference in the methylation status of the 15-LOX-1 gene promoter between normal and OA cartilage. The expression level of 15-LOX-1 was elevated in OA cartilage, which may be part of a repair process. The upregulation of 15-LOX-1 in OA cartilage was not associated with the methylation status of its promoter, suggesting that other mechanisms are involved in its upregulation.

Does a consumer co-designed infographic increase knowledge of physical activity after total knee joint replacement? A randomised controlled trial.

To determine if a consumer co-designed infographic increased knowledge of physical activity and self-efficacy for exercise after total knee joint replacement surgery. Forty-four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were randomly allocated to an experimental or control group. The experimental group received a consumer co-designed infographic. All participants received usual care. Primary outcome measures were knowledge of physical activity and self-efficacy for exercise. Outcomes were administered at baseline, week 1 and week 6. Semi-structured interviews with experimental group participants explored the acceptability, implementation and efficacy of the infographic. There were no between-group differences for knowledge of physical activity at week 1 (MD -0.02units, 95% CI -0.9 to 0.9) or week 6 (MD 0.01units, 95% CI -0.9 to 0.9). Self-efficacy for exercise increased at week 1 (MD 14.2units, 95% CI 2.9-25.4) but was not sustained. Qualitative data showed that the infographic was embraced by some participants but not by others. A consumer co-designed infographic did not improve knowledge of physical activity but may have had a short-term positive effect on self-efficacy for exercise after knee joint replacement. Trial registration ACTRN12621000910808.

The knee joint deformities in rheumatoid arthritis patients

Knee joints injury in rheumatoid arthritis patients appear in 70 % cases. This is the most common cause of loss of work capacity, the ability to self-care. Patients become severely disabled, in that the disease is accompanied by deformations with the development of discordant positions of the lower limbs, which lead to a partial or complete loss of the function of support and walking, so this problem needs to be studied. Objective. To make an analysis of orthopedic treatment of secondary arthrosis of knee joints in RA patients, complicated by deformities depending on the age and gender of the patient, stage, duration of the disease and activity of the inflammatory process. Methods. In this work we have analyzed the orthopedic treatment of 66 RA patients with secondary arthrosis with axial deformities, who underwent 75 total endoprosthetics between 2013 and 2020. Anamnestic data, clinical, biomechanical and statistical research methods were used. The obtained data were evaluated using the scale of Joseph J., Kaufman E. E. Results. The analysis of the results of knee joint replacement was followed in the period from 6 months to 5 years. The results were carried out according to the 100-point scale Joseph J., Kaufman E. E. (1990). Thus, the analysis of the results of total knee arthroplasty in patients with RA according to the scale of Joseph J., Kaufman E. E. showed that good results were obtained in 46 (79.31 %) patients, satisfactory results in 11 (18.97 %) and unsatisfactory results obtained in 1 (1.72 %) patients. The reliable relationship of the level of joint deformation with the level of disease activity and with the scale of Joseph J., Kaufman E. E. was researched. Other indicators are not reliably correlated with the level of joint deformation. As a result of pairwise comparisons of groups with each other using the Duncan test, a significant increase in the degree of joint deformation was found in the group with activity 3 compared to the group with activity 1. The use of basic or complex therapy does not reliably affect the degree of joint deformation. Conclusions. Total knee joint replacement need patients with II stage of the 2nd phase of the disease and higher. In our opinion, this is the most optimal time for surgical treatment, which allows patients with RA to fully use the possibilities of an implanted endoprosthesis.

The Community Rehabilitation Assessment: patient and clinician-reported outcomes in ambulatory rehabilitation.

The interRAI Community Rehabilitation Assessment (CRA) is a comprehensive health assessment designed to collect essential health and function information for rehabilitation care planning, benchmarking, and evaluation of clinic and home-based programs. A portion of the CRA is completed through patient self-report. The objective of this study was to demonstrate how the CRA can be used to describe the baseline clinical characteristics of patients participating in ambulatory rehabilitation programs and measure change across numerous domains of function, health, and wellbeing over time. Cohort study. In total, 709 patients were assessed with the CRA across 25 ambulatory clinics in Ontario, Canada between January 1st, 2018, to December 31st, 2018. We examined sub-groups of patients receiving rehabilitation following stroke (n = 82) and hip or knee total joint replacement (n = 210). Frequency responses and means were compared between admission and discharge from the ambulatory rehabilitation programs. Measures of interest included self-reported difficulty in completing instrumental activities of daily living, locomotion, fear of falling, and pain. Significant improvement relative to at admission was detected for the overall cohort and both sub-samples on individual instrumental activities of daily living, stair difficulty, use of mobility aides, distance walked, fear of falling, and pain. The standardized and comparable information collected by the CRA is expected to provide clinicians, clinic, and health system administrators with essential health and function information that can be used for care planning, benchmarking, and evaluation.

Nursing Actions after Hip Total Joint Replacement Surgery

The joint replacement surgery is one of the greatest achievements of medicine these days. They are one of the most effective surgical interventions, performed recently, both in medical and economic terms [1].
 Every year in Lithuania as well as worldwide, the number of joint replacement surgeries is constantly increasing. This is influenced by the ageing population as well as the increasing number of people with chronic degenerative joint diseases [2].
 Despite the fact that hip, knee total joint replacement surgeries have become routine orthopedic surgeries, however, special care and nursing by medical employees are required during the postoperative period.
 The purpose of the research. To analyze nursing actions after the hip total joint replacement surgery. A quantitative survey has been performed by the questionnaire method; its participants were nurses, working in health care institutions of Utena City.
 The research revealed that the nurses shall assess the patient's general condition, his/her vital indicators, the wound, the drains and solve theproblems that have occurred.

The incidence of symptomatic venous thromboembolism following orthopaedic surgery at Bay of Plenty District Health Board.

To investigate the incidence of symptomatic venous thromboembolism (VTE) after orthopaedic surgery. We performed a retrospective cohort study investigating the incidence of symptomatic VTE within 90 days of orthopaedic surgery in the Bay of Plenty District Health Board (DHB). Risk factors and antithrombotic regimens were also reviewed. After 1,133 unilateral total hip joint replacements (THJRs), there were six VTEs (incidence 0.5%, 95% CI 0.2-1.1%), four deep vein thromboses (DVT) (0.4%, 0.1-0.9%) and three pulmonary emboli (PE) (0.3%, 0.1-0.8%). Following 898 unilateral total knee joint replacements (TKJRs), 18 patients developed VTEs (2.0%, 1.2-2.9%), five developed DVTs (0.6%, 0.2-1.3%) and 16 developed PEs (1.8%, 1.1-2.9%). There were five VTEs after 224 THJR revisions (2.2%, 1.0-5.1%), five VTEs after 110 TKJR revisions (4.5%, 2.0-10.2%) and 16 VTEs after 846 hip fracture surgeries (1.9%, 1.2-3.0%). VTE risk factors were ICU admission post operatively and having known coronary or cerebrovascular disease. Within 1 week of surgery, 38.5% (30/78) of VTEs were diagnosed and within 2 weeks 66.7% (52/78) were diagnosed. Aspirin was being taken by 44% (34/78) of VTE patients and 26% (19/78) were on more potent antithrombotics. VTE is a rare complication of orthopaedic surgery. The highest risk period is the initial 2 weeks after a procedure. VTE can develop despite pharmacological thromboprophylaxis.

FIVE- AND TEN-YEAR FOLLOW-UP OF UNICOMPARTMENTAL KNEE ARTHROPLASTIES IN OBESE PATIENTS

Due to shorter hospital stays and faster patient rehabilitation Unicompartmental Knee Replacements (UKR) are now considered more cost effective than Total Knee Joint Replacements (TKJR). Obesity however, has long been thought of as a relative contraindication to UKR due to an unproven theoretical concern of early loosening.This study is a retrospective review of patient reported outcome scores and revision rates of all UKR with recorded BMI performed by the Canterbury District Health Board (CDHB) from January 2011 and September 2021. Patient reported outcome scores were taken preoperatively, at 6 months, 1 year, 5 years and 10 years post operatively. These included WOMAC, Oxford, HAAS, UCLA, WHOQOL, normality, pain and patient satisfaction. 873 patients had functional scores recorded at 5 years and 164 patients had scores recorded at 10 years. Further sub-group analysis was performed based on patient BMI of <25, 25-30, 30-35 and >35. Revision data was available for 2377 UKRs performed in Christchurch during this period.Both obese (BMI >30) and non-obese (BMI <30) patients had significantly improved post-operative scores compared to preoperative. Pre-operatively obese patients had significantly lower functional scores except for pain and UCLA. All functional scores were lower in obese patients at 5 years but this did not meet minimum clinical difference. At 10 years, there was significantly lower HAAS, satisfaction and WOMAC scores for obese patients but no difference in Oxford, normality, WHOQOL, UCLA and pain scores. There was no significant difference in the improvement from pre-operative scores between obese and non-obese patients. All cause revision rate for obese patients at 10 years was 0.69 per 100 observed component years compared to 0.76 in non-obese. This was not statistically significant.Our study proves that UKR is an excellent option in obese patients with post-operative improvement in functional scores and 10 year survivorship equivalent to non-obese patients.

CEMENTED VERSUS UNCEMENTED KNEE JOINT ARTHROPLASTIES: FIVE-YEAR FOLLOW-UP COMPARING FUNCTIONAL OUTCOMES AND REVISION RATES

Our objective was to examine revision rates and patient reported outcome scores (PROMS) for cemented and uncemented primary total knee joint replacement (TKJR) at six months, one year and five years post-operatively. Patients and Methods: This matched cohort study involved secondary analyses of data collected as part of a large prospective observational study monitoring outcomes following knee replacement in Christchurch, New Zealand. Cemented and uncemented TKJR participants (n = 1526) were matched on age (± 5 years), sex and body mass index (BMI). From this larger sample, PROMS data, Oxford Knee Score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), out to five years post-operatively were analysed for a matched subset of participants (n = 252).The average age of participants was 67.9 years (SD 9.4, range 38-94). There were no differences between cemented and uncemented cohorts on the basis of age, sex, BMI or comorbidities, revision rates or PROMS outcomes. Cemented procedures had greater skin to skin times than uncemented procedures (p < 0.01). Unadjusted outcomes comparing risk for revision across the two participant cohorts did not significantly differ. Overall rates for revision were low (cemented 3.2% v uncemented 2.7%, p=0.70). Propensity adjusted associations between baseline characteristics (age, sex, BMI, comorbidity, baseline Oxford and baseline WOMAC scores) also revealed no differences in risk for revision at any post-operative timepoint.In this large multi-surgeon matched cohort study there were no significant differences in functional outcomes or revision rates, when outcomes following modern cemented and uncemented TKJR were compared out to 5-year follow up. Based on our findings, uncemented TKJR is predictable irrespective of patient's age, BMI or gender

3D BIOPRINTING OF ARTICULAR CARTILAGE FOR IN VIVO APPLICATION

3D printing and Bioprinting technologies are becoming increasingly popular in surgery to provide a solution for the regeneration of healthy tissues. The aim of our project is the regeneration of articular cartilage via bioprinting means, to manage isolated chondral defects.Chrondrogenic hydrogel (chondrogel: GelMa + TGF-b3 and BMP6) was prepared and sterilised in our lab following our standard protocols. Human adipose-derived mesenchymal stem cells were harvested from the infrapatellar fat pad of patients undergoing total knee joint replacements and incorporated in the hydrogel according to our published protocols. The chondrogenic properties of the chondrogel have been tested (histology, immunohistochemistry, PCR, immunofluorescence, gene analysis and 2nd harmonic generation microscopy) in vitro and in an ex-vivo model of human articular defect and compared with standard culture systems where the growth factors are added to the media at repeated intervals.The in-vitro analysis showed that the formation of hyaline cartilage pellet was comparable between the two strategies, with a similar metabolic activity of the cells. These results have been confirmed in the ex-vivo model: hyaline-like cartilage was observed within the chondral defect in both the chondrogel group and the control group after 28 days in culture.The use of bioprinting techniques in vivo requires the ability of stem cells to access growth factors directly in the environment they are in, as opposed to in vitro techniques where these factors are provided externally at recurrent intervals. This study showed the successful strategy of incorporating chondrogenic growth factors for the formation of hyaline-like cartilage in vitro and in an ex-vivo model of chondral loss.The incorporation of chondrogenic growth factors in a hydrogel is a possible strategy for articular cartilage regeneration.

Factors associated with persistent postsurgical pain after total knee or hip joint replacement: a systematic review and meta-analysis.

Studies have identified demographic, clinical, psychosocial, and perioperative variables associated with persistent pain after a variety of surgeries. This study aimed to perform a systematic review and meta-analysis of factors associated with persistent pain after total knee replacement (TKR) and total hip replacement (THR) surgeries. To meet the inclusion criteria, studies were required to assess variables before or at the time of surgery, include a persistent postsurgical pain (PPSP) outcome measure at least 2 months after a TKR or THR surgery, and include a statistical analysis of the effect of the risk factor(s) on the outcome measure. Outcomes from studies implementing univariate and multivariable statistical models were analyzed separately. Where possible, data from univariate analyses on the same factors were combined in a meta-analysis. Eighty-one studies involving 171,354 patients were included in the review. Because of the heterogeneity of assessment methods, only 44% of the studies allowed meaningful meta-analysis. In meta-analyses, state anxiety (but not trait anxiety) scores and higher depression scores on the Beck Depression Inventory were associated with an increased risk of PPSP after TKR. In the qualitative summary of multivariable analyses, higher preoperative pain scores were associated with PPSP after TKR or THR. This review systematically assessed factors associated with an increased risk of PPSP after TKR and THR and highlights current knowledge gaps that can be addressed by future research.

Wait time management strategies at centralized intake system for hip and knee replacement surgery: A need for a blended evidence-based and patient-centered approach

ObjectivesDelays in access to specialty care and elective hip and knee total joint replacement (TJR) surgery remain a major concern among patients with osteoarthritis (OA) in Canada. Centralized intake systems as a wait time management strategy in the face of resource constraints can increase access and patient flow through the system but are not standard practice. We examine how wait time management strategies for the assessment and triaging referrals in a centralized intake system can inform quality improvement initiatives. DesignWe developed a discrete-event simulation model using all referrals to the Edmonton Bone and Joint Centre centralized intake system from 2012 to 2016 for the base case model. We assessed the combined effect of three wait time management strategies: improved prioritization, improved sorting through screening, and increased conservative management. Outcomes were measured in terms of patient flow and wait times. ResultsThe screener sees more patient referrals (7094 compared to 6922), and the number of patients who proceed to surgery is reduced by 282 patients (4%) in the wait time management scenario compared to the base case model. Wait times from referral to surgery are reduced by 54 days for surgical patients. Furthermore, urgent surgical patients experienced lower wait times in all stages of care than non-urgent patients, with wait times from referral to surgery reduced by 86 days. ConclusionsTriaging processes addressing prioritization, screening and conservative management of non-surgical patients can improve patient flow and significantly reduce patient wait times in a centralized intake process for TJR.

Decrease in acute periprosthetic joint infections incidence with vancomycin-loaded calcium sulfate beads in patients with non-modifiable risk factors. A randomized clinical trial

ObjectivesThe influence of local antibiotic therapy in orthopedic surgery remains unclear. In this trial, we evaluated the incidence of periprosthetic joint infections (PJI), after local or intravenous (IV) antibiotic prophylaxis. The aim of this intervention was to compare the PJI incidence in a population with non-modifiable risk factors after local prophylaxis with vancomycin-loaded calcium sulfate beads versus a control group. MethodsA total of 83 subjects were evaluated, inclusion criteria included participants over 60 years of age, with at least one main risk factor for PJI who underwent total hip or knee joint replacement between June 2019 and May 2020. Cases were randomized, and the intervention group received local prophylactic antibiotic therapy with calcium sulfate beads impregnated with vancomycin; conventional IV prophylactic antibiotic therapy was administered for the control group. C-reactive protein (CRP) and erythrocyte sedimentation rate (ERS) serum biomarkers were analyzed on the day 5 and weeks 4, 8, and 12. When needed, the synovial fluid sample was obtained and cultured for the early acute PJI diagnosis. ResultsAcute PJI was found in 27 patients (67.5%) in the control group and 4 (9.3%) in the intervention group. The variable analysis identified that local prophylaxis with calcium sulfate beads reduces the incidence of acute knee or hip PJI in patients with non-modifiable risk factors compared to conventional prophylaxis (p < 0.0001) with a relative risk of 0.13 (CI:0.05–0.35). Length of hospital stay was also shorter in the intervention group at 4.6 days, compared to 15.25 days in the control group; p < 0.001. ConclusionsLocal antibiotic prophylaxis in patients with non-modifiable risk factors undergoing hip or knee replacement reduces the incidence of acute PJI compared to IV antibiotics. Clinical trialsNCT03976466 (clnicaltrials.gov) Level of evidenceII.