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Faig‐Martí J, Martínez‐Catasús A. Over a decade of experience in total knee arthroplasty with a multiradius design and fixed bearing at a single centre: Data from the Catalan Arthroplasty Registry. J Exp Orthop 2024; 11:e12076. [PMID: 38957226 PMCID: PMC11217669 DOI: 10.1002/jeo2.12076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Arthroplasty registers can provide feedback information on the results of arthroplasties performed by a certain institution or surgeon. The use of real-world data to achieve real-world evidence can help evaluate the performance of the implants used and help counsel our patients. The main objective of our study was to determine the survivorship of the total knee implant we are currently using. Methods A retrospective cohort study of patients who received a total knee arthroplasty from January 2009 to December 2020 in our hospital was conducted, using data from the Catalan arthroplasty registry and the Catalan health service database. Demographic and surgical data were analysed using the Kaplan-Meier method, log-rank test and Cox proportional hazards models with the R Project software (p < 0.05). Results A total of 1336 total knee arthroplasties were included in the study, of which 992 were women. The causes for revision included aseptic loosening (17), infection (29), instability (13), patellar implantation (13), arthrofibrosis (5) and quadriceps tendon rupture (1).The cumulative risk for revision at 5 years using the Kaplan-Meier method was 6.0% and at 10 years 6.5%. Considering gender, this risk was 7.0% and 7.5% at 5 and 10 years, respectively, in women and 3.3% in men, both at 5 and 10 years (p = 0.009). A higher risk for revision in women was seen, which is considered statistically significant (p = 0.012). Conclusion Our survivorship results are comparable to those published in the literature, but with a higher revision risk in women that is only statistically significant for the whole group of reoperations and for patellar implantation, but not for the rest of the diagnoses. Level of Evidence Level IV.
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Affiliation(s)
- Jordi Faig‐Martí
- Orthopaedics DepartmentHospital Sant RafaelBarcelonaCataloniaSpain
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Zhao JL, Jin X, Huang HT, Yang WY, Li JH, Luo MH, Liu J, Pan JK. Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series. World J Clin Cases 2024; 12:1560-1568. [PMID: 38576738 PMCID: PMC10989437 DOI: 10.12998/wjcc.v12.i9.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Unicompartmental knee arthroplasty (UKA) has great advantages in the treatment of unicompartmental knee osteoarthritis, but its revision rate is higher than that of total knee arthroplasty. AIM To summarize and analyse the causes of revision after UKA. METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized. We analysed the clinical symptoms, medical histories, laboratory test results, imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA. RESULTS A total of 13 patients, including 3 males and 10 females, underwent revision surgery after UKA. The average age of the included patients was 67.62 years. The prosthesis was used for 3 d to 72 months. The main reasons for revision after UKA were improper suturing of the surgical opening (1 patient), osteophytes (2 patients), intra-articular loose bodies (2 patients), tibial prosthesis loosening (2 patients), rheumatoid arthritis (1 patient), gasket dislocation (3 patients), anterior cruciate ligament injury (1 patient), and medial collateral ligament injury with residual bone cement (1 patient). CONCLUSION The causes of primary revision after UKA were gasket dislocation, osteophytes, intra-articular loose bodies and tibial prosthesis loosening. Avoidance of these factors may greatly reduce the rate of revision after UKA, improve patient satisfaction and reduce medical burden.
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Affiliation(s)
- Jin-Long Zhao
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Xiao Jin
- Department of Chinese Medicine, The First Affiliated Hospital, Jinan University, Guangzhou 510630, Guangdong Province, China
| | - He-Tao Huang
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangdong Academy of Traditional Chinese Medicine, Guangzhou 510405, Guangdong Province, China
| | - Wei-Yi Yang
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China
| | - Jia-Hui Li
- The Affiliated TCM Hospital, Guangzhou Medical University, Guangzhou 510405, Guangdong Province, China
| | - Ming-Hui Luo
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou 510405, Guangdong Province, China
| | - Jian-Ke Pan
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, Guangdong Province, China
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Ge J, Hernigou P, Guo W, Zhang N, Liu C, Zhang Q. Minimally invasive small incision surgical technique for unicompartmental knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:2717-2725. [PMID: 37542540 DOI: 10.1007/s00264-023-05908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE It is always a challenge for orthopaedic surgeons to minimise surgical incisions while ensuring excellent surgical results. We propose the minimally invasive small incision (MISI) technique and an extramedullary positioning technique in the unicompartmental knee arthroplasty (UKA) surgery. This study aimed to clarify the early postoperative clinical outcomes and component alignment between MISI and conventional minimally invasive surgical (MIS) techniques. METHODS We prospectively enrolled 60 patients who underwent MISI-UKA and 60 patients who underwent MIS-UKA as controls. Clinical parameters include the time of straight leg raising, postoperative walking time with walker assistance, hospital stay, Numerical Rating Scale (NRS) pain score and Knee Society Score (KSS). The postoperative components and lower extremity alignment were compared between the two groups with radiographic image measurement. RESULTS The MISI group obtained a smaller incision during knee extension (P < 0.001) but a longer tourniquet usage time than the MIS group. The MISI group lost less blood (P < 0.001). The MISI group achieved straight leg raising and walking with aid earlier after surgery, with a shorter hospital stay than the MIS group (P < 0.001). Range of motion (ROM), NRS and KSS scores revealed no significant difference between the two groups in six months postoperative follow-up (P > 0.05). Radiographic measurement results between the two groups revealed no statistical difference (P > 0.05) CONCLUSION: The MISI-UKA could achieve faster earlier recovery after surgery and shorter hospital stays without compromising the principles of proper prosthesis position and limb alignment compared with the conventional MIS-UKA.
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Affiliation(s)
- Juncheng Ge
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France.
| | - Wanshou Guo
- Department of Orthopaedic Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
| | - Nianfei Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Changquan Liu
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
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Lima HA, Moazzam Z, Woldesenbet S, Alaimo L, Endo Y, Munir MM, Shaikh CF, Resende V, Pawlik TM. Persistence of Poverty and its Impact on Surgical Care and Postoperative Outcomes. Ann Surg 2023; 278:347-356. [PMID: 37317875 DOI: 10.1097/sla.0000000000005953] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE We sought to characterize the association between prolonged county-level poverty with postoperative outcomes. BACKGROUND The impact of long-standing poverty on surgical outcomes remains ill-defined. METHODS Patients who underwent lung resection, colectomy, coronary artery bypass graft, or lower extremity joint replacement were identified from Medicare Standard Analytical Files Database (2015-2017) and merged with data from the American Community Survey and the United States Department of Agriculture. Patients were categorized according to the duration of high poverty status from 1980 to 2015 [ie, never high poverty (NHP), persistent poverty (PP)]. Logistic regression was used to characterize the association between the duration of poverty and postoperative outcomes. Principal component and generalized structural equation modeling were used to assess the effect of mediators in the achievement of Textbook Outcomes (TO). RESULTS Overall, 335,595 patients underwent lung resection (10.1%), colectomy (29.4%), coronary artery bypass graft (36.4%), or lower extremity joint replacement (24.2%). While 80.3% of patients lived in NHP, 4.4% resided in PP counties. Compared with NHP, patients residing in PP were at increased risk of serious postoperative complications [odds ratio (OR)=1.10, 95% CI: 1.05-1.15], 30-day readmission (OR=1.09, 95% CI: 1.01-1.16), 30-day mortality (OR=1.08, 95% CI: 1.00-1.17), and higher expenditures (mean difference, $1010.0, 95% CI: 643.7-1376.4) (all P <0.05). Notably, PP was associated with lower odds of achieving TO (OR=0.93, 95% CI: 0.90-0.97, P <0.001); 65% of this effect was mediated by other social determinant factors. Minority patients were less likely to achieve TO (OR=0.81, 95% CI: 0.79-0.84, P <0.001), and the disparity persisted across all poverty categories. CONCLUSIONS County-level poverty duration was associated with adverse postoperative outcomes and higher expenditures. These effects were mediated by various socioeconomic factors and were most pronounced among minority patients.
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Affiliation(s)
- Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Muhammad M Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
| | - Vivian Resende
- Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
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Gap balance difference of unicompartmental knee arthroplasty between hanging leg and supine leg position: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:745-753. [PMID: 36629852 DOI: 10.1007/s00264-022-05680-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE Gap balance is critical in Oxford unicompartmental knee arthroplasty (OUKA) surgery; the effect of lower limb positioning on gap balance judgements has not been reported. There are two mean operative positions for OUKA patients, the hanging leg (HL) and the supine leg (SL) position. This study aimed to investigate the gap balance achieved by current UKA surgical techniques by using a force sensor, to compare the differences in gap balance between the two different positions, and to test whether the difference in gap balance leads to different outcomes in terms of component alignment and early post-operative clinical outcomes. METHODS This prospective study included 97 knees (76 patients), who underwent OUKA from June 1, 2020, to July 31, 2021, of which 67 knees underwent UKA in the supine leg position and the other 30 in the hanging leg position. When the operator was satisfied with the gap balance, the contact forces between the trial and the spacer block were measured at 90° of knee flexion (flexion gap) and 20° of knee flexion (extension gap) using a pre-developed matrix flexible force sensor. X-rays were reviewed three to five days after surgery. Knee Society Scores (KSS) were obtained at the six month follow-up. RESULTS Compared to the HL group, the contact force at the flexion gap was higher in the SL group: 55.15N (SD 43.36N) vs. 34.25N (SD 27.56N) (p < 0.05), whereas in the extension gap, there was no significant difference, 90.19 N (SD 43.36N) in the SL group and 86.72N (SD 43.08N) in the HL group (ns.). The contact force was greater in the extension gap than in the flexion gap in both groups (p < 0.01). The gap balance difference in the HL group was 52.46N (SD 31.33N), which was greater than that of the SL group at 35.03N (SD 19.50N) (p < 0.05). There were no significant differences in component alignment or lower limb mechanical alignment between the two groups. There was no significant difference in pre-operative and post-operative KSS between the two groups, while post-operative KSS was significantly higher in both groups compared to the pre-operative period. CONCLUSION The intra-operative contact forces between the flexion and extension gaps differed in the two groups; the hanging leg position appeared to produce a greater difference in the judgement of gap balance than the supine leg position, but this difference did not adversely affect the alignment of the component or the early post-operative clinical outcome.
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Goodell PB, Johansen PM, Bartels DW, Sherman SL, Amanatullah DF. Comparing Unicompartmental Knee Arthroplasty and High Tibial Osteotomy for Isolated Medial Compartment Knee Osteoarthritis. JBJS Rev 2023; 11:01874474-202303000-00004. [PMID: 36930742 DOI: 10.2106/jbjs.rvw.22.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
» Both unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) allow for compartment-specific intervention on an arthritic knee joint that preserves bone stock and native soft tissue compared to a total knee arthroplasty (TKA). Both operations give a more natural feeling with native proprioception compared with a TKA. » HTO is better suited in patients who are younger (<55 years-of-age), have a body mass index (BMI) <30 kg/m2, high activity requirements, mechanical malalignment, asymmetric varus, isolated anterior cruciate ligament insufficiency, need for multiplanar correction, and a preference for joint preserving interventions. Recent data suggest that age (>55 years-of-age) should not solely contraindicate a HTO. » UKA may be chosen in patients who are older (>55 years-of-age), low activity requirements, have a BMI <40 kg/m2, severe osteoarthritis with significant joint space narrowing, acceptable coronal alignment, symmetric varus, and patient preference for arthroplasty.
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Affiliation(s)
- Parker B Goodell
- Department of Orthopaedic Surgery, University of California San Francisco, Fresno, California
| | - Phillip M Johansen
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Douglas W Bartels
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
| | - Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University, Palo Alto, California
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Hospital volume-outcome relationship in total knee arthroplasty: a systematic review and dose-response meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2862-2877. [PMID: 34494124 PMCID: PMC9309153 DOI: 10.1007/s00167-021-06692-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE This systematic review and dose-response meta-analysis aimed to investigate the relationship between hospital volume and outcomes for total knee arthroplasty (TKA). METHODS MEDLINE, Embase, CENTRAL and CINAHL were searched up to February 2020 for randomised controlled trials and cohort studies that reported TKA performed in hospitals with at least two different volumes and any associated patient-relevant outcomes. The adjusted effect estimates (odds ratios, OR) were pooled using a random-effects, linear dose-response meta-analysis. Heterogeneity was quantified using the I2-statistic. ROBINS-I and the GRADE approach were used to assess the risk of bias and the confidence in the cumulative evidence, respectively. RESULTS A total of 68 cohort studies with data from 1985 to 2018 were included. The risk of bias for all outcomes ranged from moderate to critical. Higher hospital volume may be associated with a lower rate of early revision ≤ 12 months (narrative synthesis of k = 7 studies, n = 301,378 patients) and is likely associated with lower mortality ≤ 3 months (OR = 0.91 per additional 50 TKAs/year, 95% confidence interval [0.87-0.95], k = 9, n = 2,638,996, I2 = 51%) and readmissions ≤ 3 months (OR = 0.98 [0.97-0.99], k = 3, n = 830,381, I2 = 44%). Hospital volume may not be associated with the rates of deep infections within 1-4 years, late revision (1-10 years) or adverse events ≤ 3 months. The confidence in the cumulative evidence was moderate for mortality and readmission rates; low for early revision rates; and very low for deep infection, late revision and adverse event rates. CONCLUSION An inverse volume-outcome relationship probably exists for some TKA outcomes, including mortality and readmissions, and may exist for early revisions. Small reductions in unfavourable outcomes may be clinically relevant at the population level, supporting centralisation of TKA to high-volume hospitals. LEVEL OF EVIDENCE III. REGISTRATION NUMBER The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42019131209 available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131209 ).
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Wu LP, Mayr HO, Zhang X, Huang YQ, Chen YZ, Li YM. Knee Scores of Patients with Non-Lateral Compartmental Knee Osteoarthritis Undergoing Mobile, Fixed-Bearing Unicompartmental Knee and Total Knee Arthroplasties: A Randomized Controlled Trial. Orthop Surg 2021; 14:73-87. [PMID: 34870364 PMCID: PMC8755879 DOI: 10.1111/os.13111] [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: 11/10/2020] [Revised: 04/21/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate knee scores and clinical efficacies of patients with non‐lateral unicompartmental knee osteoarthritis (OA) who randomly underwent mobile‐bearing (MB) unicompartmental knee arthroplasty (UKA), fixed‐bearing (FB) UKA, and total knee arthroplasty (TKA). Methods From September 2015 to February 2017, a prospective, randomized, parallel, single‐center trial of 180 patients (78 males and 102 females; 63.3 ± 6.9 years) with non‐lateral compartmental knee OA was performed in the first author‐affiliated hospital. The patients were randomly divided into three groups (each group included 60 patients) and received medial cemented Oxford phase 3 MB UKA, medial cemented Link FB UKA, or cemented DePuy Sigma PFC TKA, respectively. A similar perioperative management and fast‐track surgery program was carried out for all patients. The knee scores at 3‐year follow‐up after operation and clinical efficacies of these three groups of patients were recorded, investigated, and compared. Results Primarily, compared to the TKA group, the UKA groups (MB UKA and FB UKA) had shorter operative time (median 63.2 < 67.1 min), less bleeding (8.6 < 30.0 mL), earlier resumption of walking without crutches (3.0 < 8.0 days) and walking up and down the stairs (5.0 < 10.0 days) (P < 0.001), higher FJS scores (78.0 > 74.5) (P = 0.007), better results in all knee scores (except VAS and KSS function scores) (P < 0.05), and a larger maximum flexion angle of the knee at the 3‐year follow‐up (123.0° > 96.0°) (P = 0.001). Secondarily, compared to the TKA group, the MB UKA group showed better results in the Western Ontario and McMaster Universities index (WOMAC) stiffness (83.6 > 79.6), WOMAC total (86.3 > 83.2), Oxford knee score (OKS) (20.0 < 23.0), Forgotten Joint Score (FJS) (78.5 > 74.5), and a larger maximum flexion angle of the knee (123.0 > 96.0) (P < 0.05). Moreover, the FB UKA group showed higher Hospital for Special Surgery Knee Score (HSS) (91.0 > 88.5), WOMAC stiffness (84.3 > 79.6), WOMAC function (85.2 > 81.7), WOMAC total scores (87.6 > 83.2), and a larger maximum flexion angle of the knee (119.0° > 96.0°) than the TKA group (P < 0.05). Overall, there was no significant difference in all knee scores and maximum flexion angles of the knee for the MB UKA and FB UKA groups (P > 0.05). There was one case with original bearing dislocation in MB UKA group. One patient with displacement of the femoral component caused by a fall injury, and another patient, who lost his life in a car accident, were involved in the FB UKA group. There was an infection case and an intermuscular vein thrombosis case in TKA group. Conclusion UKA showed more advantages than TKA; however, there was no significant difference between the MB UKA and FB UKA groups for treatment of non‐lateral compartmental knee OA.
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Affiliation(s)
- Li-Ping Wu
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Hermann O Mayr
- Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Xing Zhang
- Clinical Experimental Center, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yuan-Qiao Huang
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yuan-Zhuang Chen
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yu-Ming Li
- Department of Orthopedic Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
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Randsborg PH, Chen AC. How much is enough? Finding the minimum annual surgical volume threshold for total knee replacement. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2021; 3:e000092. [PMID: 35051249 PMCID: PMC8647569 DOI: 10.1136/bmjsit-2021-000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Per-Henrik Randsborg
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
- Dept. of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Akershus, Norway
| | - Amanda C Chen
- Department of Health Policy and Research, Weill Cornell Medical College, New York, New York, USA
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Goh GS, Zeng GJ, Chen JY, Lo NN, Yeo SJ, Liow MHL. Preoperative Flexion Contracture Does Not Compromise the Outcomes and Survivorship of Medial Fixed Bearing Unicompartmental Knee Arthroplasty. J Arthroplasty 2021; 36:3406-3412. [PMID: 34090691 DOI: 10.1016/j.arth.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the expanding indications for unicompartmental knee arthroplasty (UKA), the classic indication that limits flexion contracture to <5° in fixed bearing UKA excludes most patients with arthritic knees and has not been challenged in modern literature. This study compared the clinical outcomes between patients with severe flexion contracture and controls undergoing UKA. METHODS Eighty seven medial fixed bearing UKAs performed in patients with severe (≥15°) flexion contracture were matched 1:1 with 87 controls without flexion or recurvatum deformity (-5°<extension<5°) using propensity scores to control for age, sex, BMI, Charlson comorbidity index, ASA class, and baseline patient-reported outcome measures (PROMs). Perioperative outcomes were recorded. Range of motion, Knee Society Score, Oxford Knee Score, SF-36, and patient satisfaction were assessed at 6 months and 2 years. Survivorship was recorded at mean 11.5 ± 3.2 years. RESULTS Preoperative knee extension in the control and contracture groups was 0.9° ± 1.9° and 18.0° ± 3.5° (P < .001), respectively, whereas flexion was 122.8° ± 27.9° and 120.6° ± 13.6° (P = .502). The contracture group had poorer Knee Society functional (P = .023) and SF-36 physical score (P = .010) at 6 months. However, there was no difference in PROMs at 2 years. A similar proportion achieved the minimal clinically important difference for each PROM and was satisfied with surgery. Range of motion remained poorer in the contracture group and a higher percentage had residual contractures (P < .001). Ten-year survivorship was 94% and 97% in the control and contracture groups, respectively (P = .145). CONCLUSION Although patients with severe flexion contractures had a poorer range of motion and postoperatively, these patients attained comparable PROMs, satisfaction rates, and mid-term survivorship after UKA. LEVEL OF EVIDENCE III, therapeutic study.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Gerald J Zeng
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Jerry Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital
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Sun X, Hernigou P, Zhang Q, Zhang N, Wang W, Chen Y, Guo W. Sensor and machine learning-based assessment of gap balancing in cadaveric unicompartmental knee arthroplasty surgical training. INTERNATIONAL ORTHOPAEDICS 2021; 45:2843-2849. [PMID: 34351461 DOI: 10.1007/s00264-021-05176-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to assess the difference between flexion and extension contact forces-gap balance-after Oxford mobile-bearing medial unicompartmental knee arthroplasty (UKA) performed by surgeons with varying levels of experience. METHODS Surgeons in a training programme performed UKAs on fresh frozen cadaveric specimens (n = 60). Contact force in the medial compartment of the knee was measured after UKA during extension and flexion using a force sensor, and values were clustered using an unsupervised machine learning (k-means algorithm). Univariate analysis was performed with general linear regression models to identify the explanatory variable. RESULTS The level of experience was predictive of gap balance; surgeons were clustered into beginner, mid-level and experienced groups. Experienced surgeons' mean difference between flexion and extension contact force was 83 N, which was significantly lower (p < 0.05) than that achieved by mid-level (215 N) or beginner (346 N) surgeons. CONCLUSION We found that the lowest mean difference between flexion and extension contact force after UKA was 83 N, which was achieved by surgeons with the most experience; this value can be considered the optimal value. Beginner and mid-level surgeons achieved values that were significantly lower. This study also demonstrates that machine learning can be used in combination with sensor technology for improving gap balancing judgement in UKA.
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Affiliation(s)
- Xiaowei Sun
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Philippe Hernigou
- Department of Orthopaedic Surgery, University Paris East (UPEC), Hôpital Henri Mondor, Creteil, France
| | - Qidong Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Nianfei Zhang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yang Chen
- Department of Computer Science and Technology, Tsinghua University, Beijing, China
| | - Wanshou Guo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.
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Randsborg PH, Aae TF, Bukholm IRK, Fenstad AM, Furnes O, Jakobsen RB. Compensation claims after knee arthroplasty surgery in Norway 2008-2018. Acta Orthop 2021; 92:189-193. [PMID: 33439091 PMCID: PMC8158226 DOI: 10.1080/17453674.2020.1871187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Orthopedic surgery is one of the specialties with most compensation claims. We assessed the claims following knee arthroplasty surgery reported to the Norwegian System of Patient Injury Compensation (NPE) in light of institutional procedure volume.Patients and methods - We collected data from NPE and the Norwegian Arthroplasty Register (NAR) for the study period (2008-2018). Age, sex, type of claim, and reason for compensation were collected from NPE, while the number of arthroplasty surgeries was collected from NAR. The treating hospitals were grouped by quartiles according to annual procedure volume. The effect of hospital volume on the likelihood of an accepted claim was estimated.Results - NAR received 64,241 reports of arthroplasty procedures, of which 572 (0.9%) patients filed a claim for treatment injury. 55% of the claims were accepted, representing 0.5% of all knee arthroplasties. The most common reason for accepted claim was a hospital-acquired infection, in 28% of the patients, followed by misplaced implant (26%) and aseptic loosening (13%). The hospitals with the lowest annual volume (57 or fewer arthroplasties per year, first quarter) had a statistically significantly larger fraction of granted claims per procedures compared with other institutions.Interpretation - The overall risk of ending up with compensation due to treatment error following knee arthroplasty was 0.5%. The risk of accepted claim was greater for patients operated in the lowest volume hospitals.
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Affiliation(s)
- Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway; ,Sports Medicine Institute, Hospital for Special Surgery, New York, USA; ,Correspondence:
| | - Tommy Frøseth Aae
- Department of Orthopedic Surgery, Health Møre and Romsdal HF, Kristiansund Hospital, Kristiansund, Norway;
| | | | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Ove Furnes
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; ,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway; ,Department of Health Management and Health Economics, Medical Faculty, University of Oslo, Oslo, Norway;
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Component breakage after total knee arthroplasty: a narrative review. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Influence of Hospital Volume of Procedures by Year on the Risk of Revision of Total Hip and Knee Arthroplasties: A Propensity Score-Matched Cohort Study. J Clin Med 2019; 8:jcm8050670. [PMID: 31086009 PMCID: PMC6572453 DOI: 10.3390/jcm8050670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022] Open
Abstract
The volume of total hip (THA) and knee arthroplasties (TKA) performed in a hospital per year could be an influential factor on the revision of these procedures. The aims of this study were: To obtain comparable cohorts in higher- and lower-volume hospitals; and to assess the association between the hospital volume and the incidence of revision. Data from patients undergoing THA and TKA caused by osteoarthritis and recorded in the Catalan Arthroplasty Register (RACat) between January 2005 and December 2016 were used. The main explanatory variable was hospital volume by year (higher/lower). The cut-off point was fixed, based on previous research, at 50 THA and 125 TKA procedures/year. To obtain comparable populations, a propensity-score matching method (1:1) was used. Patient characteristics prior to and after matching were compared. To assess differences by volume, subhazard ratios (SHRs) from competing risks models were obtained. After matching, 13,772 THA and 36,316 TKA patients remained in the study. Prior to matching, in both joints, significant differences in all confounders were observed between volume groups. After matching, none of them remained significant. Both in THA and TKA, a higher risk of revision in higher-volume hospitals was observed (THA SHR: 1.25, 95%CI: 1.02–1.53; and TKA SHR: 1.29, 95%CI: 1.16–1.44). Unlike other contexts, currently in Catalonia, higher-volume hospitals have a greater risk of revision than lower-volume hospitals. Further research could be valuable to define context-dependent measures to reduce the incidence of revision.
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