Total Knee Replacement Patients Research Articles

RESULTS OF ROBOTIC ASSISTED VS CONVENTIONAL TOTAL KNEE ARTHROPLASTY AT 1 YR FOLLOW UP

Background: Osteoarthritis (OA) of the knee is a prevalent condition among older individuals, causing significant discomfort and impairments in quality of life. Conventional total knee arthroplasty (COTKA) is a common treatment, but issues such as inadequate soft tissue balance and prosthesis misalignment can impact outcomes. Robotic-assisted total knee arthroplasty (RATKA) has emerged as a potential solution, offering enhanced precision in prosthesis placement. While observational studies suggest benefits, comprehensive reviews of randomized controlled trials (RCTs) are lacking. This study aims to fill this gap by evaluating the clinical, functional, and radiological outcomes of RATKA compared to COTKA in adult patients with primary knee OA. Methods: This prospective study was conducted at a specialized orthopedic center, involving patients diagnosed with symptomatic knee OA eligible for total knee replacement (TKR). Patients were allocated to either conventional TKR (Group A) or robotic-assisted TKR (Group B). Outcome measures included Visual Analog Scale (VAS) for pain, Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), patient satisfaction, and quality of life assessments. Radiological outcomes were assessed using standardized radiographs. Statistical analyses included descriptive statistics, group comparisons, and repeated measures analysis of variance (ANOVA). Results: Baseline characteristics showed similar distributions between Group A (n=30) and Group B (n=30). Clinical outcomes demonstrated significant improvements over time in both groups, with Group B consistently outperforming Group A across all measures. Notably, Group B exhibited lower pain scores (VAS), higher functional scores (KSS), lower disability scores (WOMAC), higher patient satisfaction, and better quality of life assessments. Radiological outcomes also favored Group B, with improved mechanical axis deviation and component positioning. Conclusion: Robotic-assisted TKR demonstrated superior clinical, functional, and radiological outcomes compared to conventional TKR in patients with knee OA. These findings support the growing body of evidence favoring the use of robotic technology in TKR procedures, particularly for optimizing implant placement and alignment. Future research should focus on cost-effectiveness and long-term outcomes to further inform clinical practice and enhance patient care.

Effect of core stability exercises on knee proprioception, function and quality of life in chronic total knee replacement patients

Background: Chronic osteoarthritis of knee joint leads to severe pain after weight bearing and prolonged activities .TKR is widely used as a successful and effective last-stage surgical treatment for relieving chronic knee pain and functional disability. This research aimed to study the effect of core stability exercises on knee proprioception, function and quality of life in chronic total knee replacement patients. Methods: Total 40 patients with chronic total knee replacement with age between 45-65 years were included. They were divided into two groups: Group-A (n=20) and Group-B (n=20). Both group received conventional treatment, in addition Group-B received core stability exercise. Patients were evaluated pre-intervention (0 week) and post-intervention (4 week) for proprioception (by universal goniometer), for function (LEFS) and for quality of life (SF-12). Statistical analysis was done using SPSS 20 version. Significance level was set at p<0.05. Results: Wilcoxon signed rank test was applied for within group comparison. There was statistically significant difference in mean of proprioception, function and SF-12 PCS in both groups during four week intervention period. Mann Whitney U test was applied for between group comparison. Significant difference was found between Group-A and Group-B in mean difference of proprioception, function. Conclusions: The concluded that the core stability exercise along with conventional treatment is more effective for improving knee proprioception, function and quality of life than alone conventional treatment in chronic total knee replacement patients.

Prevalence of anxiety among patients with a total knee replacement

Introduction and Aim: Knee pain mainly attributed to osteoarthritis in the elderly, significantly impacts daily life. Non-surgical options include analgesics and physical therapy, but Total Knee Replacement (TKR) is most effective for severe cases. While complications are generally minimal, infections and psychological distress may arise. Studies indicate improved mental well-being post-TKR due to pain relief. The aim is to determine the prevalence of anxiety among patients with Total Knee Replacement.
 
 Methods and Materials: 100 participants, aged 45-84, comprising both genders, were selected through convenient sampling. Informed consent was obtained, and assessments were conducted using the Hamilton Anxiety Rating Scale (HAM-A) over 8 weeks at SMCH. The researcher collected sociodemographic details, including name, age, height, weight, and comorbidities. The HAM-A, consisting of 14 items graded from 0 to 4, measured anxiety levels. Total scores ranged from 0-56, indicating mild to severe anxiety. The study aimed to understand anxiety prevalence among TKR patients, employing a comprehensive approach to gather and analyze data within a specified time.
 
 Results: The statistical analysis revealed among 100 patients with a total knee replacement, between the age of 45-84 years, the prevalence of anxiety is widespread.
 
 Conclusion: Post total knee replacement, widespread anxiety necessitates coordinated intervention from surgeons, physical therapists, and psychotherapists within hospital management to effectively address associated complications.

Effect of Intravenous Zoledronic Acid on Total Knee Replacement in Patients With Symptomatic Knee Osteoarthritis and Without Severe Joint Space Narrowing: A Prespecified Secondary Analysis of a Two-Year, Multicenter, Double-Blind, Placebo-Controlled Clinical Trial.

To determine the effect of zoledronic acid (ZA) on the risk of total knee replacement (TKR) in patients with symptomatic knee osteoarthritis and without severe joint space narrowing (JSN). We included 222 participants (mean age 62 years, 52% female) from the two-year Zoledronic Acid for Osteoarthritis Knee Pain trial (113 received 5 mg of ZA annually and 109 received placebo) conducted between November 2013 and October 2017. Primary TKR were identified until February 22, 2022. The effect of ZA on TKR risk was evaluated using Cox proportional hazard regression models. Because the treatment effect failed the proportional hazards assumption, a time-varying coefficients analysis for treatment was conducted by splitting the study into two periods (ie, within and after two years of randomization). Over a mean follow-up of seven years, 39% and 30% of participants had any TKR in the ZA and placebo groups, and 28% and 18% had TKR in the study knee, respectively. Use of ZA was associated with a higher risk of TKR in any knee (hazard ratio [HR] 4.2, 95% confidence interval [CI] 1.2-14.7) and showed a trend in the study knee (HR 6.8, 95%CI 0.9-53.9) during the trial. In the posttrial period, the risk of TKR was similar in the ZA and the placebo groups for any knee (HR 1.2, 95%CI 0.5-1.8) and the study knee (HR 1.4, 95%CI 0.5-2.2). These results suggest that ZA is not protective against TKR in patients with symptomatic knee osteoarthritis and without severe JSN.

Effects of Resistance Exercise with Pressure Biofeedback Unit on the Gait Ability and Knee Joint Function in Subject with Total Knee Replacement Patients

Effects of Resistance Exercise with Pressure Biofeedback Unit on the Gait Ability and Knee Joint Function in Subject with Total Knee Replacement Patients

Clinical Super-Resolution Computed Tomography of Bone Microstructure: Application in Musculoskeletal and Dental Imaging

PurposeClinical cone-beam computed tomography (CBCT) devices are limited to imaging features of half a millimeter in size and cannot quantify the tissue microstructure. We demonstrate a robust deep-learning method for enhancing clinical CT images, only requiring a limited set of easy-to-acquire training data.MethodsKnee tissue from five cadavers and six total knee replacement patients, and 14 teeth from eight patients were scanned using laboratory CT as training data for the developed super-resolution (SR) technique. The method was benchmarked against ex vivo test set, 52 osteochondral samples are imaged with clinical and laboratory CT. A quality assurance phantom was imaged with clinical CT to quantify the technical image quality. To visually assess the clinical image quality, musculoskeletal and maxillofacial CBCT studies were enhanced with SR and contrasted to interpolated images. A dental radiologist and surgeon reviewed the maxillofacial images.ResultsThe SR models predicted the bone morphological parameters on the ex vivo test set more accurately than conventional image processing. The phantom analysis confirmed higher spatial resolution on the SR images than interpolation, but image grayscales were modified. Musculoskeletal and maxillofacial CBCT images showed more details on SR than interpolation; however, artifacts were observed near the crown of the teeth. The readers assessed mediocre overall scores for both SR and interpolation. The source code and pretrained networks are publicly available.ConclusionModel training with laboratory modalities could push the resolution limit beyond state-of-the-art clinical musculoskeletal and dental CBCT. A larger maxillofacial training dataset is recommended for dental applications.

Advancing total knee replacement surgery Assessment with Wearable Sensors and AI: A Case Study

Background: India has a higher prevalence of about 20-24%.of people suffering from osteoarthiritis. Due tothe load effect, forces between two and three times body weight are transmitted across the knee joint during anormal stride, which accounts for the higher risk of OA.A Qualitative Analysis of Decision-Making for Total KneeReplacement in Patients with Osteoarthritis. A cutting-edge wearable sensor system called Fitknees deliversa complex arrangement of motion sensors that are carefully placed on the lower limb. These sensors outlinethorough kinematic data that include gait analysis, muscle strength, knee range of motion, and balance metrics.Objective: Utilizing individualised measurements, using wearable sensors and AI tool to assess preoperativeevaluations and postoperative rehabilitation programs.Results: camping between affected and unaffected side with the normative data provided by the AI.Conclusion:advancement in the medical technologies have made it easier for medial professionals to detect and early diagnosethe diseases. Plan a better treatment plan with the aid of artificial intelligence to achieve better results.

Comparative Analysis of Efficacy of Epidural Analgesia vs Intra-operative Cocktail for Post-operative Pain Management in Total Knee Replacement (TKR) Patients

Comparative Analysis of Efficacy of Epidural Analgesia vs Intra-operative Cocktail for Post-operative Pain Management in Total Knee Replacement (TKR) Patients

Comparative Study of Clinical and Radiological Outcomes of Conventional Total Knee Replacement (TKR) and Robotic-Assisted TKR in Patients with Bilateral Varus Deformity Knee OA within the Eastern Population

Background: Osteoarthritis (OA) of the knee, including bilateral varus deformity, presents unique challenges for treatment. This comparative study evaluates clinical and radiological outcomes of conventional total knee replacement (TKR) and robotic-assisted TKR in patients with bilateral varus deformity knee OA within the Eastern population. Methods: A prospective study was conducted on 84 bilateral varus deformity knee OA patients treated with two different surgical approaches: Group A (Conventional TKR) and Group B (Robotic-assisted TKR). Clinical outcomes, including pain relief, functional improvement, and patient satisfaction, were assessed using Visual Analog Scale (VAS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quality of life measures. Radiological outcomes, including alignment and component positioning, were evaluated. Statistical analyses compared outcomes between groups. Results: Both groups demonstrated significant improvements in clinical and radiological outcomes. Robotic-assisted TKR showed advantages with reduced pain (p < 0.001), superior knee function (p < 0.001), better pain relief and function (p < 0.001), higher patient satisfaction (p < 0.001), and improved quality of life (p < 0.001) compared to conventional TKR. Radiologically, robotic-assisted TKR exhibited superior alignment (p < 0.001) and component positioning (p < 0.001). Implant survivorship remained excellent in both groups, with no revisions reported. Conclusion: Robotic-assisted TKR offers significant benefits in pain relief, functional improvement, and radiological outcomes for patients with bilateral varus deformity knee OA within the Eastern population. While both approaches are effective, the advantages of robotic assistance should be considered in surgical decision-making. Further research is needed to assess cost-effectiveness and long-term outcomes.

Perioperative Intra-articular Infiltration of Tranexamic Acid and Ropivacaine Cocktail in Bilateral Total Knee Replacement

Objective: This study evaluated the efficacy and safety of perioperative intra-articular infiltration with a tranexamic acid and ropivacaine cocktail in patients undergoing bilateral total knee replacement (TKR). Methods: A randomized controlled trial was conducted involving 50 patients scheduled for elective bilateral TKR. Participants were randomly assigned to receive either intra-articular infiltration of a tranexamic acid and ropivacaine cocktail (intervention group) or standard care (control group). Outcome measures included postoperative blood loss, pain scores, range of motion, and adverse events. Results: Among the enrolled patients (n=50), the intervention group demonstrated reduced postoperative blood loss, evidenced by higher hemoglobin levels and lower drain output than the control group. Additionally, the intervention group exhibited consistently lower pain scores at various postoperative time points and greater improvements in range of motion. Conclusion: Intra-articular infiltration with a tranexamic acid and ropivacaine cocktail in bilateral TKR patients showed promising outcomes, including reduced blood loss, improved pain control, and enhanced range of motion. These findings suggest the potential of this adjunctive therapy in optimizing perioperative care for patients undergoing bilateral TKR. However, further research with larger sample sizes is warranted to validate these preliminary results and establish this intervention’s long-term efficacy and safety.

Physical activity and health-related quality of life of patients with chronic knee pain after total knee replacement: Analysis of the PEP-TALK trial

BackgroundChronic pain is a major challenge for some people after total knee replacement (TKR). The changing impact of this complication during the first post-operative year remains unclear. This analysis aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after TKR for patients with and without post-operative chronic knee pain. MethodsWe conducted a secondary analysis of data from a randomised controlled trial (PEP-TALK), which tested the effectiveness of a behaviour change physiotherapy intervention compared with usual rehabilitation after TKR. Mean UCLA Activity Score and EQ-5D-5L for participants with and without chronic knee pain (14 points or lower in the Oxford Knee Score Pain Subscale (OKS-PS) at six months post-TKR) were compared at six and 12 months post-TKR. ResultsData from 83 participants were analysed. For those with chronic knee pain, UCLA Activity Score remained unchanged between baseline to six months (mean: 3.8 to 3.8), decreasing at 12 months (3.0). Those without post-operative chronic knee pain reported improved physical activity from baseline to six months (4.0 vs 4.9), plateauing at 12 months (4.9). Participants with chronic knee pain reported lower baseline HRQoL (0.28 vs 0.48). Both groups improved health utility over one year. Of those without chronic pain at six months, 8.5% returned to chronic pain by 12 months. ConclusionsMonitoring clinical outcomes after six months may be indicated for those at risk of chronic pain post-TKR. Further, sufficiently powered analyses are warranted to increase the generalisability of this exploratory analyses’ results.

The difference in leg lengths following total knee replacement for patients with severe osteoarthritic deformity

PurposeIncreased height after total knee replacement surgery (TKR) may offer patients higher satisfaction as well as the quality of life. Therefore, in this paper, we aim to document the changes in leg length after TKR in patients with severe bilateral deformities.MethodsThe data of 61 patients were collected from the Egyptian Community Arthroplasty Register; of them, 21 patients had unilateral TKR while 40 had bilateral simultaneous TKR. The patterns of changes in height of 101 osteoarthritic knees were followed up for 1 year after having TKR. All patients had standing leg X-rays, before and after surgery, to document the length of the femur and tibia before and after TKR. Correlations were assessed using the two-sample t-test.ResultsThe sample was mostly females (56/61, 91.8%). The distribution of the operated side was nearly equal (right knee was 47/101, 46.5%). The overall average leg length difference was 5.4 (SD = 2.3); for the unilateral group, the average was 4.6 (SD = 2.6); and for the bilateral group, the average was 5.6 (SD = 2.3), p = 0.119. We found that leg length may differ according to the varus deformity angle (p < 0.001) as well as fixed flexion deformity (p < 0.001).ConclusionsLeg length increased significantly 1 year after TKR. However, there is not enough evidence to suggest that the bilateral group had a greater height increase when compared to the unilateral group.

Infiltration Between Popliteal Artery and Capsule of the Knee Combined with Adductor Canal Block as Analgesic Adjuvant During and Postoperative in Total Knee Replacement Surgery

Background: Infiltration between the popliteal artery and capsule of the knee (iPACK) is one method that has been proposed in recent years as a potential alternative to peripheral nerve block as analgesia in total knee replacement (TKR) procedures. This study presents anesthetic management using spinal anesthesia combined with iPACK and adductor canal block (ACB) in patients with grade IV osteoarthritis who underwent TKR of the right knee.&#x0D; Case presentation: A woman, a housewife aged 50 years, was planning to undergo TKR surgery. The patient came with complaints of pain in the right knee 1 year before entering the hospital. The patient was given supplemental oxygen with a nasal cannula at 3 liters per minute. Prior to spinal anesthesia, the patient was given fentanyl 25 mcg iv, ketamine 10 mg iv, and midazolam 1.5 mg IV as premedication. The patient was positioned on the right side, and a 27G Quincke needle was inserted at the level of L3-L4 and given bupivacaine heavy 0.5% 7.5 mg, then lateralized for 15 minutes. After lateralization, the patient was positioned supine and used ultrasound to direct ACB action with a regimen of ropivacaine 0.25% + dexamethasone 5 mg a volume of 20 ml, then iPACK was performed with a regimen of Ropivacaine 0.375% + dexamethasone 5 mg a volume of 20 ml. After surgery, the patient is treated in the recovery room for 1 hour until bromage score is 0. The patient received the PCA Morphine analgesic demand only 1 mg/mL, 1 mg per dose, max 5 mg over 4 hours, lockout interval 6 minutes; Paracetamol 500 mg every 6 hours PO; Ibuprofen 400 mg every 8 hours PO.&#x0D; Conclusion: TKR patients who were given analgesia using the ACB peripheral nerve block technique combined with iPACK experienced a decrease in pain levels and lower use of postoperative morphine so that patient mobilization was faster and reduced the patient's length of stay.

Does early or late discharge after total knee replacement affect the burden and stress of caregivers?

BackgroundSince patients may experience difficulties in their daily activities after total knee replacement surgery, the role of the caregiver is important in supporting the daily needs of the patients. Caregivers are involved in the day-to-day care activities of the patient during the recovery process, managing their symptoms and providing support. All these factors can affect the burden and stress of caregivers. MethodsIt was aimed to compare the caregiver burden and stress of caregivers of total knee replacement patients who were discharged on the same day of surgery and at a later point. Data were collected from 140 caregivers by using the Bakas Caregiving Outcomes Scale, Zarit Caregiving Burden Scale, and Stress Coping Styles Scale. ResultsThere was no significant difference between on the same day of surgery discharge and later discharge in terms of care burden and stress of caregivers (p > 0.05). While the burden of care was mild to moderate (22.15 ± 13.76) on the same day of surgery discharge group, the burden of care in the later discharge group was very low (19.03 ± 13.65). ConclusionIn order to reduce the care burden and stress levels of caregivers, it is important that nurses determine the problems related to caregiving and provide the necessary support.

Physiotherapy rehabilitation in severe damaged osteoarthritis knee following surgically treated bilateral total knee replacement – A case study

This 62-year-old female patient case study describes physiotherapy rehabilitation exercises of stage 4 osteoarthritis in the post-operative phase. The patient has pain, symptoms, decreased adl activities and decreased quality of life (study measures completely done by Koos scale). Following surgical managed total knee replacement patient gets better with her symptomatically level and this study tells the importance of replacing knee joint in time as suggested by an orthopaedic surgeon, else there would be a marked functional outcome limitation of the patient. It also emphasis on the importance of physiotherapy and maintaining the operative knee joint in long term care.

Comparison of All-Polyethylene Tibial Versus Metal-Backed Tibial Component in Total Knee Replacement Surgery

Introduction: Total knee replacement (TKR) is the most successful procedure in Orthopedics. The selection of an ideal implant relies on better survivorship, restoration of functional activities and cost-effectiveness. This study compared the effectiveness of all-polyethylene (AP) versus metal-backed tibial (MTB) implant in TKR patients in terms of objective and subjective patient related outcomes. Objectives: To compare the effectiveness of all-polyethylene tibial implants versus metal-backed tibial implants in total knee replacement patients in terms of improvement in the American Knee Society Score (AKSS). Methodology: It was a nonrandomized controlled trial done in the Orthopaedic Department of the Sharif Medical City Hospital, Lahore, after approval by the institutional ethical committee. Fifty patients of grade IV knee joint osteoarthritis for greater than six months were included by nonprobability convenient sampling technique. The patients were allocated equally into standard treatment and intervention groups; patients underwent TKR with MTB implants in the standard group and AP implants in the intervention group after taking informed written consent. The AKSS score was calculated pre-operatively, 3 months and 6 months after surgery by the team member not involved in surgical planning. Results: A statistically significant improvement was observed in pre-operative to post-operative knee scores (p-value = 0.004) and functional scores (p-value = 0.001) with TKR. When the means of knee scores were compared between AP and MTB implants, there was no significant difference between the two groups between pre-operative and post-operative knee scores and functional scores. Practical implication Conclusion: There is no significant difference in knee score between the all-polyethylene and metal-backed implants regarding pain and functional status. All-polyethylene implants are a better substitute for MTB implants due to their cost-effectiveness, particularly in countries with financial constraints. The most practical implication of the current study is health economics. In a developing country with a low per capita income, expensive implants can be swapped with low cost implants to bring the cost of the procedure down. Keywords: All-polyethylene tibial, Metal-backed tibial, Total knee replacement, American Knee Society Score, AKSS.

Long-term survivorship and results in lower limb arthroplasty: a registry-based comparison study

IntroductionPopularity of joint replacement surgery due to ever aging population surges the demand for a proper national joint registry. Our Chinese University of Hong Kong – Prince of Wales Hospital (CUHK-PWH) joint registry has passed the 30th year. The aims of this study are 1) summarize our territory-wide joint registry which has passed the 30th year since establishment and 2) compare our statistics with other major joint registries.MethodsPart 1 was to review the CUHK-PWH registry. Demographic characteristics of our patients who underwent knee and hip replacements had been summarized. Part 2 was a series of comparisons with registries from Sweden, UK, Australia and New Zealand.ResultsCUHK-PWH registry captured 2889 primary total knee replacements (TKR) (110 (3.81%) revision) and 879 primary total hip replacements (THR) (107 (12.17%) revision). Median Surgery time of TKR was shorter than THR. Clinical outcome scores were much improved after surgery in both. Uncemented of hybrid in TKR were most popular in Australia (33.4%) and 40% in Sweden and UK. More than half of TKR and THR patients showed the highest percentage with ASA grade 2. New Zealand reflected the best cumulative percentage survival 20 years after surgery of 92.2%, 76.0%, 84.2% survivorship 20 years after TKR, unicompartmental knee replacement (UKR) and Hip.ConclusionA worldwide accepted patient-reported outcome measure (PROM) is recommended to develop to make comparisons among registries and studies feasible. Completeness of registry data is important and useful to improve surgical performance through data comparisons from different regions. Funding from government on sustaining registries is reflected. Registries from Asian countries have yet to be grown and reported.

Patient-Reported Outcomes following Total Knee Replacement in Patients Aged 65 Years and Over-A Systematic Review.

A previous systematic review showed positive patient-reported outcomes following total knee replacement (TKR) in patients aged < 65 years. However, the question remains as to whether these results are replicated for older individuals. This systematic review evaluated the patient-reported outcomes following TKR in individuals aged ≥ 65 years. A systematic search of Ovid MEDLINE, EMBASE, and Cochrane library were performed to identify studies examining disease-specific or health-related quality of life outcomes following TKR. Qualitative evidence synthesis was performed. Eighteen studies with low (n = 1), moderate (n = 6), or serious (n = 11) overall risk of bias were included, with evidence syntheses derived from 20,826 patients. Four studies reported on pain scales, showing improvement of pain from 6 months to 10 years postoperatively. Nine studies examined functional outcomes, showing significant improvements from 6 months to 10 years after TKR. Improvement in health-related quality of life was evident in six studies over 6 months to 2 years. All four studies examining satisfaction reported overall satisfaction with TKR results. TKR results in reduced pain, improved function, and increased quality of life for individuals aged ≥ 65 years. The improvement in patient-reported outcomes needs to be utilised in conjunction with physician expertise to determine what would comprise clinically significant differences.

Clinical Frailty Scale is a better predictor for adverse post-operative complications and functional outcomes than Modified Frailty Index and Charlson Comorbidity Index after total knee arthroplasty.

Studies have demonstrated correlations between frailty and comorbidity scores with adverse outcomes in total knee replacement (TKR). However, there is a lack of consensus on the most suitable pre-operative assessment tool. This study aims to compare Clinical Frailty Scale (CFS), Modified Frailty Index (MFI), and Charlson Comorbidity Index (CCI) in predicting adverse post-operative complications and functional outcomes following a unilateral TKR. In total, 811 unilateral TKR patients from a tertiary hospital were identified. Pre-operative variables were age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) class, CFS, MFI, and CCI. Binary logistic regression analysis was performed to ascertain odd ratios of pre-operative variables on adverse post-operative complications (length of stay < LOS >, complications, ICU/HD admission, discharge location, 30-day readmission, 2-year reoperation). Multiple linear regression analyses were used to estimate the standardized effects of pre-operative variables on the Knee Society Functional Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and 36-Item Short Form Survey (SF-36). CFS is a strong predictor for LOS (OR 1.876, p < 0.001), complications (OR 1.83-4.97, p < 0.05), discharge location (OR 1.84, p < 0.001), and 2-year reoperation rate (OR 1.98, p < .001). ASA and MFI were predictors for ICU/HD admission (OR:4.04, p = 0.002; OR 1.58, p = 0.022, respectively). None of the scores was predictive for 30-day readmission. A higher CFS was associated with a worse outcome for 6-month KSS, 2-year KSS, 6-month OKS, 2-year OKS, and 6-month SF-36. CFS is a superior predictor for post-operative complications and functional outcomes than MFI and CCI in unilateral TKR patients. This suggests the importance of assessing pre-operative functional status when planning for TKR. Diagnostic, II.

Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity.

Class III obesity (body mass index >40 kg/m2 ) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the cost-effectiveness of Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR. Using the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long-term clinical benefits, costs, and cost-effectiveness of weight-loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight-loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality-adjusted life expectancy (QALE), and incremental cost-effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty. LSG increased QALE by 1.64 quality-adjusted life-years (QALYs) and lifetime medical costs by $17,347 compared to no intervention, leading to an ICER of $10,600/QALY. RYGB increased QALE by 0.22 and costs by $4,607 beyond LSG, resulting in an ICER of $20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost-effective in 67% of iterations at a willingness-to-pay threshold of $50,000/QALY. For patients with class III obesity considering TKR, RYGB provides good value while immediate TKR without weight loss is not economically efficient.