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Belt M, Robben B, Smolders JMH, Schreurs BW, Hannink G, Smulders K. A mapping review on preoperative prognostic factors and outcome measures of revision total knee arthroplasty. Bone Jt Open 2023; 4:338-356. [PMID: 37160269 PMCID: PMC10169239 DOI: 10.1302/2633-1462.45.bjo-2022-0157.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration. We performed a systematic literature search in MEDLINE, Embase, and Web of Science. The search string included multiple synonyms of the following keywords: "revision TKA", "outcome" and "prognostic factor". We searched for studies assessing the association between at least one prognostic factor and at least one outcome measure after rTKA surgery. Data on sample size, study design, prognostic factors, outcomes, and the direction of the association was extracted and included in an evidence map. After screening of 5,660 articles, we included 166 studies reporting prognostic factors for outcomes after rTKA, with a median sample size of 319 patients (30 to 303,867). Overall, 50% of the studies reported prospectively collected data, and 61% of the studies were performed in a single centre. In some studies, multiple associations were reported; 180 different prognostic factors were reported in these studies. The three most frequently studied prognostic factors were reason for revision (213 times), sex (125 times), and BMI (117 times). Studies focusing on functional scores and patient-reported outcome measures as prognostic factor for the outcome after surgery were limited (n = 42). The studies reported 154 different outcomes. The most commonly reported outcomes after rTKA were: re-revision (155 times), readmission (88 times), and reinfection (85 times). Only five studies included costs as outcome. Outcomes and prognostic factors that are routinely registered as part of clinical practice (e.g. BMI, sex, complications) or in (inter)national registries are studied frequently. Studies on prognostic factors, such as functional and sociodemographic status, and outcomes as healthcare costs, cognitive and mental function, and psychosocial impact are scarce, while they have been shown to be important for patients with osteoarthritis.
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Affiliation(s)
- Maartje Belt
- Research Department, Sint Maartenskliniek, Nijmegen, the Netherlands
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Bart Robben
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - José M H Smolders
- Department of Orthopedics, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - B W Schreurs
- Department of Orthopaedics, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Department of Operating Rooms, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Katrijn Smulders
- Research Department, Sint Maartenskliniek, Nijmegen, the Netherlands
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Song SJ, Park CH, Lee JW, Lee HW, Kim KI, Bae DK. Infection and Instability Increasing the Risk of Patella Baja and Pseudo-Patella Baja after Revision Total Knee Arthroplasty. Clin Orthop Surg 2023; 15:71-81. [PMID: 36778990 PMCID: PMC9880515 DOI: 10.4055/cios21154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/06/2022] Open
Abstract
Background Patella baja with patellar tendon shortening due to traumatic or ischemic injury is a widely known complication after primary total knee arthroplasty (TKA). Pseudo-patella baja may arise from the elevation of the joint line after excessive distal femoral resection. The maintenance of original patellar height is important in revision TKA because postoperative patella baja and pseudo-patella baja can cause inferior biomechanical and clinical results. We investigated the incidence and risk factors of patella baja and pseudo-patella baja after revision TKA. Methods We retrospectively reviewed data for 180 revision TKAs. Patella baja was defined as a truly low-lying patella with an Insall-Salvati ratio (ISR) of < 0.8 and a Blackburne-Peel ratio (BPR) of < 0.54. Pseudo-patella baja was defined as a relatively low-lying patella compared to the joint line within the normal range of ISR and with a BPR of < 0.54. Clinically, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and range of motion (ROM) were evaluated. Risk factors increasing the incidence of patella baja and pseudo-patella baja after revision TKA were evaluated using multiple regression analysis. Results Before revision TKA, 169 knees did not exhibit patella baja or pseudo-patella baja, while 9 knees showed patella baja and 2 knees exhibited pseudo-patella baja. At 2 years after revision TKAs, 25 knees (13.9%) showed patella baja and 23 knees (12.8%) exhibited pseudo-patella baja. Despite no differences in the postoperative WOMAC score between groups with and without patella baja and pseudo-patella baja, the postoperative ROM was significantly smaller in the group with patella baja (113.3°) or pseudo patella baja (110.5°) than in the normal group (122.0°). Infection as the cause of revision TKA increased the risk of patella baja (odds ratio, 10.958; p < 0.001), and instability increased the risk of pseudo-patella baja (odds ratio, 11.480; p < 0.001). Conclusions Infection and instability resulted in increases in the incidence of patella baja and pseudo-patella baja after revision TKA. Information about the risk factors of patella baja and pseudo-patella baja will help TKA surgeons plan the height of the patella after revision TKA and improve clinical outcomes.
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Affiliation(s)
- Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Cheol Hee Park
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jong Whan Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Kand Il Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Dae Kyung Bae
- Department of Orthopaedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, Finlayson H, George MD, Giles JT, Gilliland J, Klatt B, MacKenzie R, Michaud K, Miller A, Russell L, Sah A, Abdel MP, Johnson B, Mandl LA, Sculco P, Turgunbaev M, Turner AS, Yates A, Singh JA. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. J Arthroplasty 2022; 37:1676-1683. [PMID: 35732511 DOI: 10.1016/j.arth.2022.05.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To develop updated American College of Rheumatology/American Association of Hip and Knee Surgeons guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA). METHODS We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process. RESULTS This guideline updates the 2017 recommendations for perioperative use of disease-modifying antirheumatic therapy, including traditional disease-modifying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs, and glucocorticoids used for adults with rheumatic diseases, specifically for the treatment of patients with IA, including rheumatoid arthritis and spondyloarthritis, those with juvenile idiopathic arthritis, or those with SLE who are undergoing elective THA or TKA. It updates recommendations regarding when to continue, when to withhold, and when to restart these medications and the optimal perioperative dosing of glucocorticoids. CONCLUSION This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.
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Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
| | | | | | | | - David R Fernandez
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Heather Finlayson
- Multispecialty Physician Partners, LLC, Colorado Arthritis Associates, Lakewood, Colorado
| | | | | | - Jeremy Gilliland
- University of Utah and Veterans Affairs Medical Center, Salt Lake City
| | - Brian Klatt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronald MacKenzie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and Forward Databank, Wichita, Kansas
| | - Andy Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Linda Russell
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Sah Orthopaedic Associates, Institute for Joint Restoration, Freemont, California
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Peter Sculco
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, Finlayson H, George MD, Giles JT, Gilliland J, Klatt B, MacKenzie R, Michaud K, Miller A, Russell L, Sah A, Abdel MP, Johnson B, Mandl LA, Sculco P, Turgunbaev M, Turner AS, Yates A, Singh JA. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Rheumatol 2022; 74:1464-1473. [PMID: 35722708 DOI: 10.1002/art.42140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To develop updated guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA). METHODS We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process. RESULTS This guideline updates the 2017 recommendations for perioperative use of disease-modifying antirheumatic therapy, including traditional disease-modifying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs, and glucocorticoids used for adults with rheumatic diseases, specifically for the treatment of patients with IA, including rheumatoid arthritis and spondyloarthritis, those with juvenile idiopathic arthritis, or those with SLE who are undergoing elective THA or TKA. It updates recommendations regarding when to continue, when to withhold, and when to restart these medications and the optimal perioperative dosing of glucocorticoids. CONCLUSION This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.
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Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | | | | | - David R Fernandez
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Heather Finlayson
- Multispecialty Physician Partners, LLC, Colorado Arthritis Associates, Lakewood, Colorado
| | | | | | - Jeremy Gilliland
- University of Utah and Veterans Affairs Medical Center, Salt Lake City
| | - Brian Klatt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronald MacKenzie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and Forward Databank, Wichita, Kansas
| | - Andy Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Linda Russell
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Sah Orthopaedic Associates, Institute for Joint Restoration, Freemont, California
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Peter Sculco
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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Goodman SM, Springer BD, Chen AF, Davis M, Fernandez DR, Figgie M, Finlayson H, George MD, Giles JT, Gilliland J, Klatt B, MacKenzie R, Michaud K, Miller A, Russell L, Sah A, Abdel MP, Johnson B, Mandl LA, Sculco P, Turgunbaev M, Turner AS, Yates A, Singh JA. 2022 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty. Arthritis Care Res (Hoboken) 2022; 74:1399-1408. [PMID: 35718887 DOI: 10.1002/acr.24893] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/18/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop updated guidelines for the perioperative management of disease-modifying medications for patients with rheumatic diseases, specifically those with inflammatory arthritis (IA) and those with systemic lupus erythematosus (SLE), undergoing elective total hip arthroplasty (THA) or elective total knee arthroplasty (TKA). METHODS We convened a panel of rheumatologists, orthopedic surgeons, and infectious disease specialists, updated the systematic literature review, and included currently available medications for the clinically relevant population, intervention, comparator, and outcomes (PICO) questions. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence and the strength of recommendations using a group consensus process. RESULTS This guideline updates the 2017 recommendations for perioperative use of disease-modifying antirheumatic therapy, including traditional disease-modifying antirheumatic drugs, biologic agents, targeted synthetic small-molecule drugs, and glucocorticoids used for adults with rheumatic diseases, specifically for the treatment of patients with IA, including rheumatoid arthritis and spondyloarthritis, those with juvenile idiopathic arthritis, or those with SLE who are undergoing elective THA or TKA. It updates recommendations regarding when to continue, when to withhold, and when to restart these medications and the optimal perioperative dosing of glucocorticoids. CONCLUSION This updated guideline includes recently introduced immunosuppressive medications to help decision-making by clinicians and patients regarding perioperative disease-modifying medication management for patients with IA and SLE at the time of elective THA or TKA.
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Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | | | | | - David R Fernandez
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mark Figgie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Heather Finlayson
- Multispecialty Physician Partners, LLC, Colorado Arthritis Associates, Lakewood, Colorado
| | | | | | - Jeremy Gilliland
- University of Utah and Veterans Affairs Medical Center, Salt Lake City
| | - Brian Klatt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ronald MacKenzie
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, Nebraska, and Forward Databank, Wichita, Kansas
| | - Andy Miller
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Linda Russell
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Alexander Sah
- Sah Orthopaedic Associates, Institute for Joint Restoration, Freemont, California
| | | | | | - Lisa A Mandl
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Peter Sculco
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - Adolph Yates
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jasvinder A Singh
- University of Alabama at Birmingham and Veterans Affairs Medical Center, Birmingham, Alabama
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Matthews AH, Marks T, Evans JT, Toms AD, Evans JP. What is the patient experience following revision knee replacement: A systematic review and meta-analysis of the medium term patient reported outcomes. Knee 2022; 35:34-44. [PMID: 35193031 DOI: 10.1016/j.knee.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 02/02/2023]
Abstract
AIMS Revision knee replacement is an increasingly common procedure, however, information on patient-focused outcomes is limited. This systematic review and meta-analysis aimed to investigate the medium-term patient reported outcomes following a revision knee replacement. METHODS We performed a systematic review of MEDLINE and EMBASE (from inception to 1st March 2021) for articles reporting five year or greater patient reported outcome measures (PROMs) following revision knee replacement. A meta-analysis of PROMs data was undertaken using the Standardised Mean Difference (SMD). Quality of methodology was assessed using Wylde's non-summative four-point system. The study was registered with PROPSERO (CRD42021199289). RESULTS A total of 23 studies met the inclusion criteria containing 2414 patients at a mean minimum follow-up of 74 months (60-122). The reporting of PROMs were poorly standardised with several PROMs being used. The most commonly reported patient reported outcome was the Knee Society Score reported in 65% of studies (15/23). A meta-analysis of 629 eligible patients undergoing revision knee replacement revealed a significant improvement in pre-operative state with a SMD 2·05 95% CI 0.87, 3.23. CONCLUSION This systematic review has found a significant and sustained improvement in patient-reported outcomes following a revision knee arthroplasty beyond five years. We found a variation in the usage and administration of PROMs which hinders a clear synthesis of results. Furthermore, the PROMs have not been robustly tested for validity in the context of a revision knee replacement.
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Affiliation(s)
- Alexander H Matthews
- NIHR Academic Clinic Fellow, ST4 Trauma & Orthopaedic Registrar, Plymouth Hospitals NHS Foundation Trust & University of Exeter, United Kingdom.
| | - Thomas Marks
- Core Surgical Trainee, Plymouth Hospitals NHS Foundation Trust, United Kingdom
| | - Jonathan T Evans
- NIHR Academic Clinical Lecturer, ST8 Trauma & Orthopaedic Registrar, Royal Devon & Exeter Hospital & University of Bristol, United Kingdom
| | - Andrew D Toms
- Professor of Orthopaedic Surgery, Royal Devon & Exeter Hospital & University of Exeter, United Kingdom
| | - Jonathan P Evans
- NIHR Academic Clinical Lecturer, ST8 Trauma & Orthopaedic Registrar, Royal Devon & Exeter Hospital & University of Exeter, United Kingdom
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Kassel L, Hutton A, Zumach G, Rand J. Systematic review of perioperative use of immunosuppressive agents in patients undergoing bariatric surgery. Surg Obes Relat Dis 2019; 16:144-157. [PMID: 31735569 DOI: 10.1016/j.soard.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/14/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients who qualify for bariatric surgery are increasingly experiencing co-morbid conditions, which often require management through the use of immunosuppressive agents, such as corticosteroids, tumor necrosis factor-alpha inhibitors, or other immunomodulators, which may increase the risk of infection or wound healing complications. Perioperative management of these agents in bariatric surgery is challenging because of the lack of research in this patient population. With the use of immunosuppressive agents on the rise, the effects of these medications must be understood, both the risks posed in the perioperative period, and the benefit their sustained use may have for co-morbidity management. OBJECTIVES To describe the safety of immunosuppressive agents prior to bariatric surgery. SETTING United States of America. METHODS A systematic review was conducted to answer these questions about commonly encountered immunosuppressive agents. This review includes information from 37 studies to present recommendations and reasoning for the discontinuation and postoperative reinitiation of immunosuppressive agents including, tumor necrosis alpha factor-a inhibitors, methotrexate, and more. RESULTS Research addressing complications of these medications in patients undergoing bariatric surgery is sparse. Information from abdominal or general surgical complications may serve as a basis for conservative recommendations. Data specific to each agent or class are presented below. CONCLUSIONS The use of these agents may be critical for patients' chronic disease management, and the consequences of their impact should be considered by bariatric surgeons. While their immune system effects ultimately lead to disease management, each agent must be handled individually due to the varying effects and the potential for perioperative untoward effects.
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Affiliation(s)
- Lynn Kassel
- Drake University College of Pharmacy & Health Sciences, Des Moines, Iowa; MercyOne West Des Moines Hospital, West Des Moines, Iowa.
| | | | - Gregory Zumach
- Oregon State University College of Pharmacy, Oregon Health & Science University, Corvallis, Oregon; Good Samaritan Regional Medical Center, Corvallis, Oregon
| | - Joel Rand
- MercyOne West Des Moines Hospital, West Des Moines, Iowa; MercyOne Bariatric Surgery, West Des Moines, Iowa
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Park CH, Bae JK, Song SJ. Factors affecting the choice of constrained prostheses when performing revision total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2018; 43:1831-1840. [PMID: 30327936 DOI: 10.1007/s00264-018-4200-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The purposes of the present study were to assess the levels of prosthetic constraint chosen during revision total knee arthroplasty (TKA) and to identify factors influencing the choice of a constrained prosthesis. METHODS We retrospectively reviewed data on 274 revision TKAs. The mean follow-up period after revision TKA was 7.2 years. The femorotibial angle (FTA), joint line height (JLH), and Insall-Salvati ratio (ISR) were radiographically evaluated. Factors affecting the extent of constraint chosen were evaluated in terms of age, gender, body mass index, primary diagnosis, the cause of revision TKA, the Anderson Orthopedic Research Institute (AORI) classification, and changes in the JLH and ISR. RESULTS Totals of 247 (90.1%), 11 (4.0%), and 9 (3.4%) knees received posteriorly stabilized prostheses, constrained condylar knees, and rotating hinge prostheses, respectively. On multivariate analysis, the cause of revision TKA including loosening and instability and the changes in the JLH and ISR affected independently the choice of a constrained prosthesis. CONCLUSIONS The frequency of implantation of constrained prostheses was 7.4% in the present study. Consideration of various factors including the cause of revision TKA and changes in the JLH and ISR will aid the TKA surgeon in selecting prostheses with appropriate constraints when performing revision TKAs.
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Affiliation(s)
- Cheol Hee Park
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Jung Kwon Bae
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea
| | - Sang Jun Song
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul, 130-701, South Korea.
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Comparison of fixed-bearing and mobile-bearing total knee arthroplasty after high tibial osteotomy. INTERNATIONAL ORTHOPAEDICS 2017; 42:317-322. [PMID: 28667383 DOI: 10.1007/s00264-017-3540-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There is no information comparing the results of fixed-bearing total knee replacement and mobile-bearing total knee replacement in the same patients previously treated by high tibial osteotomy. The purpose was therefore to compare fixed-bearing and mobile-bearing total knee replacements in patients treated with previous high tibial osteotomy. METHODS We compared the results of 57 patients with osteoarthritis who had received a fixed-bearing prosthesis after high tibial osteotomy with the results of 41 matched patients who had received a rotating platform after high tibial osteotomy. The match was made for length of follow-up period. The mean follow-up was 17 years (range, 15-20 years). The patients were assessed clinically and radiographically. RESULTS The pre-operative knee scores had no statistically significant differences between the two groups. So was the case with the intra-operative releases, blood loss, thromboembolic complications and infection rates in either group. There was significant improvement in both groups of knees, and no significant difference was observed between the groups (i.e., fixed-bearing and mobile-bearing knees) for the mean Knee Society knee clinical score (95 and 92 points, respectively), or the Knee Society knee functional score (82 and 83 points, respectively) at the latest follow-up. However, the mean post-operative knee motion was higher for the fixed-bearing group (117° versus 110°). In the fixed-bearing group, one knee was revised because of periprosthetic fracture. In the rotating platform mobile-bearing group, one knee was revised because of aseptic loosening of the tibial component. The Kaplan-Meier survivorship for revision at ten years of follow-up was 95.2% for the fixed bearing prosthesis and 91.1% for the rotating platform mobile-bearing prosthesis. CONCLUSIONS Although we did manage to detect significant differences mainly in clinical and radiographic results between the two groups, we found no superiority or inferiority of the mobile-bearing total knee prosthesis over the fixed-bearing total knee prosthesis for patients previously operated by high tibial osteotomy.
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