Total Knee Replacement Patients Research Articles

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.

New-onset Fibromyalgia After Total Knee Replacement in Patients With Osteoarthritis: A Propensity-score-matched Cohort Study in the United States.

The risk of new-onset fibromyalgia after total knee replacement (TKR) in osteoarthritis patients is not well-established. This study aimed to assess the risk of developing fibromyalgia post-TKR, considering potential variations across age and sex. Utilizing a multicenter retrospective cohort design and data from the TriNetX research network, electronic health records of osteoarthritis patients who underwent TKR and the same number of matched controls were analyzed. Propensity-score matching was performed by matching critical confounders. Hazard ratios were evaluated to assess fibromyalgia risk in the TKR cohort compared to non-TKR controls. The hazard ratio of future fibromyalgia for the TKR cohort was 2.08 (95% confidence interval=1.74-2.49) for 1 year after the index date, 1.81 (95% confidence interval=1.62-2.02) for 3 years, and 1.69 (95% confidence interval=1.54-1.86) for 5 years compared with non-TKR controls. The significant association remained in sensitivity models and stratification analyses in different age and sex subgroups. Clinicians should be vigilant about the potential for fibromyalgia development post-TKR and consider tailored interventions; our findings emphasize the need for further research to elucidate underlying mechanisms and identify modifiable risk factors.

Thyroid Diseases After Total Knee Replacement: A Multi-center, Propensity-score-matched Cohort Study.

Thyroid diseases are prevalent endocrine disorders that significantly affect overall health. Although the impact of pre-existing thyroid dysfunction on total knee replacement (TKR) outcomes has been studied, the potential for TKR to increase the risk of developing thyroid disorders remains unexplored. We examined electronic medical records from a large U.S. research network in the TriNetX research network. The study focused on patients with osteoarthritis, comparing those who had total knee replacement surgery (TKR) between 2005 and 2018 to a non-TKR group who did not have the surgery. Propensity score matching was employed to control for critical confounders. The hazard ratios (HRs) for the risk of thyroid diseases in TKR patients versus non-TKR controls were assessed. Post-matching, the TKR cohort demonstrated a significantly higher risk of developing thyroid diseases compared to the non-TKR cohort (unadjusted HR=1.218, 95%CI=1.169-1.269). This elevated risk persisted after adjusting for confounders (adjusted HR=1.126, 95%CI=1.061-1.196). Stratification analysis indicated that female TKR patients and those aged ≥65 years were at higher risk of developing thyroid diseases than their respective control groups. This study suggests a potential link between TKR and an increased risk of thyroid diseases, particularly among older adults and females. Potential mechanisms include inflammatory processes, surgical stress, autoimmune responses, and pharmacological effects. Healthcare providers should be vigilant in monitoring and managing thyroid dysfunction in TKR patients. Further research is necessary to elucidate the underlying mechanisms and develop preventive strategies.

Herpes Zoster Risk After Total Knee Replacement: a multicenter, propensity-score-matched cohort study in the United States.

Background: Total knee replacement (TKR) is a common surgical procedure for osteoarthritis (OA) patients. TKR may increase susceptibility to herpes zoster (HZ) by inducing immunosuppression, surgical stress, and nerve injury. However, limited data exist on the relationship between TKR and HZ. This study examined the risk of HZ over time among OA patients who underwent TKR and those who did not, using a large population-based cohort. Method: Utilizing the TriNetX research network, people with OA and underwent TKR were recruited as case group. After 1:1 propensity score matching, OA patients who never experienced TKR were included as control group. Covariates, including demographics, comorbidities, and laboratory data, were balanced using propensity score matching. A 5-year follow-up assessed the hazard ratio of incident HZ and related complications. Results: Compared to the control group, a significantly elevated risk of HZ was observed in the TKR cohort across 5-year follow-up period, with the hazard ratio of 1.223 (95% CI: 1.089-1.373). Zoster without complications presented 1.173-fold risk in TKR patients while comparing with non-TKR controls. However, most other secondary outcomes related to HZ complications-such as encephalitis, neurological involvement, ocular disease, and disseminated zoster-did not show a significant increase in risk. The risk of HZ was statistically significant for females and older adults in the TKR cohort than in the control cohort. Conclusions: OA patients who underwent TKR had an increased risk of HZ compared to those who did not receive the procedure, especially females and older adults. These findings highlight the need for HZ monitoring/prevention protocols and further research on mitigating viral reactivation after major joint surgery.

Ab. No. 133 Effect of 12-Week Neuromuscular Exercise Program on Hip, Knee, Ankle Joint Proprioception and Risk of Falls in Patients With Total Knee Replacement With and Without Type II Diabetes Mellitus

Introduction: The purpose is to study the effect of 12-week neuromuscular exercise program (NEP) on hip, knee and ankle joint proprioception (JP) and risk of falls in patients with total knee replacement (TKR) with and without type II diabetes mellitus (DM). Methods: Forty patients with TKR with DM (n=20) and without DM (n=20) between 45-80 years of age at moderate protection phase were included using convenient sampling. The study commenced after ethical approval from Institutional Ethics Committee. Outcome measures assessed at baseline and post 4-weeks of intervention were JP, muscle strength, range of motion and risk of falls. After the baseline assessment patients were taught the NEP. SPSS (version 24) Shapiro–Wilk test was used to analyse normality. Paired t-test was used for data which was normally distributed and Mann Whitney-U test was used for data which did not follow normal distribution. Effect size was used to compare the effect of NEP in both the groups. Results: Significant improvement was observed in JP angles of hip flexion, hip abduction and knee flexion after 4-weeks of NEP in patients with TKR without DM(p=0.00) and with DM (p< 0.05). Significant difference was found in risk of falls in patients with TKR with DM(p=0.00) and without DM(p=0.00). Conclusions: Significant improvement was reported in JP angles of hip flexion, hip abduction and knee flexion in both the groups, post intervention. Risk of falls reduced in both the groups, post intervention. There was no significant change in JP of hip, knee and ankle joint of the operated side when compared to non-operated side in patients with TKR with and without DM. Implications: NEP can be used in TKR patients with and without DM, and it can be used as a part of post-operative rehabilitation after TKR.

The Use of Robotic Devices in Knee Rehabilitation: A Literature Review

Introduction: Total Knee Replacement (TKR) surgery rehabilitation presents significant challenges, necessitating effective interventions to restore function and mobility. Robotic devices have emerged as promising tools for enhancing knee rehabilitation outcomes. Robotic-Assisted Rehabilitation (RAR) systems offer unique capabilities that may address some of the challenges associated with traditional methods, robotic devices can facilitate early mobilisation and functional training, potentially leading to faster recovery, improved joint function, and enhanced patient satisfaction. Aim: To provide a comprehensive overview of the current state of research on the use of robotic devices in knee rehabilitation. Materials and Methods: A thorough search of databases, including PubMed, Google Scholar, Science Direct, and Medical Literature Analysis and Retrieval System Online (MEDLINE) was conducted by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the terms “rehabilitation”, “robot”, and “total knee replacement”. This approach yielded 37 articles of which six full-text available articles, from 2014 and 2024 were included in the present review. Studies were selected based on predefined inclusion criteria. Pertinent reference lists were examined. Results: The review identified various types of robotic devices utilised in knee rehabilitation, including exoskeletons, robotic-assisted therapy systems, and rehabilitation platforms. Comparative effectiveness studies indicated potential benefits of robotic-assisted rehabilitation in improving range of motion, muscle strength, functional performance and patient satisfaction. Conclusion: It can be concluded that RAR may be an effective treatment in TKR patients. Future research should focus on personalised rehabilitation protocols, longitudinal outcomes assessment and innovative technologies to optimise patient care and rehabilitation efficacy in knee injuries and surgeries.

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 Effectiveness of 1 g Intravenous Tranexamic Acid in Reducing Blood Loss in Total Hip and Knee Replacement Surgeries: A Double-blind Controlled Study in a Regional Hospital

Abstract Background: Tranexamic acid (TXA) is one of the pharmacological drugs employed to reduce haemorrhage during total hip replacement (THR) and total knee replacement (TKR), but there is yet to be consensus on the doses and timing of administration during surgery. Aim: This is to assess the effectiveness of 1 g intravenous (IV) TXA compared to placebo for reducing blood loss in THR and TKR. Patients, Materials and Methods: This was a prospective randomised double-blind study conducted in our regional hospital between January 2016 and June 2017. THR and TKR patients were randomly allocated to placebo and TXA groups. Intraoperative blood loss (IBL), postoperative blood loss (PBL), total blood loss (TBL), haemoglobin (Hb) drop, duration of surgery, and transfusion rates were outcomes compared between the two groups. Results: The administration of 1000 mg (15 mg/kg) TXA significantly reduces IBL, PBL, and TBL by 30%, 31%, and 25.8%, respectively, when compared to placebo in patients who had THR. The mean IBL (187.7 ± 46.2 mL), PBL (334.4 ± 85.9 mL), and TBL (574.3 ± 102.1 mL) in the TXA group were significantly lower than those in the placebo group (344.3 ± 89.0 mL, 628.0 ± 197.4 mL, and 946.5 ± 152.3 mL) (P < 001), respectively, in TKR patients. There was a significant reduction in Hb drop in the TXA group when compared to the placebo group in both THR and TKR patients. The number of THR and TKR patients who received blood transfusions was significantly lower in the TXA group. Mean surgical time in the TXA group was reduced by 0.3 h during THR. However, there was no significant difference in the surgical time between TXA and placebo groups in TKR (P = 0.970). Conclusion: One gram of IV TXA is effective in reducing perioperative bleeding, Hb loss, and the need for blood transfusion requirements in THR and TKR.

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.