Is there a Threshold Preoperative WOMAC Score That Predicts Patient Satisfaction after Total Knee Arthroplasty?

Kashin-Beck Disease: A Risk Factor for Sarcopenia and Its Interaction with Selenium

OBJECTIVES

We aimed to explore the possible effects of Kashin-Beck disease (KBD) on the risk of sarcopenia and its possible interaction in the association between the risk of sarcopenia and element concentration.

METHODS

This cross-sectional study was conducted among individuals 18-75 years old in Qamdo, a KBD-endemic area. All individuals received physical and radiological examinations before recruitment. Patients with KBD were enrolled in the KBD group based on a diagnosis of national criteria WS/T 207-2010. Healthy individuals without KBD were enrolled in the non-KBD group. Participants with a history of element supplements, other severe musculoskeletal diseases, or organ dysfunctions were excluded. We adopted WOMAC scores for the assessment of musculoskeletal conditions and SARC-F scores for the risk of sarcopenia. Patients with SARC-F ≥ 4 were at risk of sarcopenia. Serum element concentrations were analyzed by inductively coupled plasma mass spectrometry. Dose-relationship effects of clinical scores and element concentrations on the risk of sarcopenia were determined in correlation analysis. Risk factors were identified using univariate and multivariate regression. Statistical analysis was conducted using R software.

RESULTS

A total of 65 patients with KBD and 38 participants without KBD were enrolled in the analysis. After propensity score matching, population characteristics were comparable in the two groups, and the incidence of SARC-F ≥ 4 was determined to be higher in the KBD group (p = 0.002). The WOMAC scores were correlated with SARC-F scores in the KBD group (p < 0.001) and non-KBD (p < 0.001) group, respectively. Further analysis proved that KBD was the independent risk factor for the risk of sarcopenia (p = 0.014). Moreover, high Selenium concentrations were associated with a low risk of sarcopenia in the non-KBD group (p = 0.047), while this association was not observed in the KBD group (p = 0.239).

CONCLUSIONS

KBD as an independent risk factor increased the risk of sarcopenia for patients. Although high Se concentration was associated with a low risk of sarcopenia in participants without KBD, this association was not observed in those with KBD.

Aetiology of patient dissatisfaction following primary total knee arthroplasty in the era of robotic-assisted technology

Aims

Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction.

Methods

This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups.

Results

Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023). Multivariate analysis revealed preoperative opioid use (p = 0.012), prior ACL reconstruction (p = 0.038), male sex (p = 0.006), and preoperative psychotropic medication use (p = 0.001) as independent predictive factors of patient dissatisfaction.

Conclusion

The use of RA-TKA demonstrated a high rate of patient satisfaction (629 of 674, 93.3%). Demographics for patients not satisfied following RA-TKA included: male sex, chronic opioid use, chronic psychotropic medication use, and prior ACL reconstruction. Patients in these groups should be identified preoperatively and educated on realistic expectations given their comorbid conditions.

The Relationship between Western Ontario and McMaster Universities Osteoarthritis Index Score and Satisfaction after Total Knee Arthroplasty Changes Over Time

This study aimed to determine whether there was a relationship between preoperative patient-reported outcome measures (PROMs) and satisfaction after total knee arthroplasty (TKA), and whether there was a relationship between the amount of improvement in PROM or final PROM and satisfaction and whether that relationship differed 1 and 2 years after TKA. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and satisfaction of 267 limbs who underwent TKA were analyzed. Logistic regression analysis was performed to determine whether there was a relationship between preoperative WOMAC or improvement in WOMAC or final WOMAC and satisfaction at 1 and 2 years after TKA. Pearson and Filon's z test was performed to determine whether there was a difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. There was no significant relationship between preoperative WOMAC and satisfaction. A higher improvement in WOMAC total score and better final WOMAC total scores at 1 and 2 years after TKA were related to greater satisfaction. At 1 year after TKA, there was no significant difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC. However, 2 years after TKA, the final WOMAC function and total score were more related to satisfaction than the amount of improvement in WOMAC function and total score. In the early postoperative period, there was no difference in evaluating satisfaction between the amount of improvement in WOMAC and final WOMAC, whereas over time, the final WOMAC was more related to satisfaction.

The development of machine learning algorithms that can predict patients satisfaction using baseline characteristics, and preoperative and operative factors of total knee arthroplasty

BACKGROUND

Patient satisfaction following primary total knee arthroplasty (TKA) is a crucial part to evaluate the success of the procedure. The purpose of this study was to develop to predict patient satisfaction following TKA.

METHODS

Satisfaction outcome data after 435 consecutive conventional TKAs performed between August 2020 and December 2021 were retrospectively collected. The total 26 input data were collected. The most favorable algorithm was first found using logistic regression (LR) and machine learning (ML) algorithms. To evaluate the predictive performance of the models, both area under curve (AUC) and F1-score were used as the primary metrics. The shapley additive explanations (SHAP) feature explanation in XGBoost and LR analysis were performed to interpret the model.

RESULTS

The performance of extreme gradient boosting classifier (XGBoost) was only higher than that of conventional LR in AUC (0.782 vs. 0.689). Comparing the F-1 score, only XGBoost showed better performance than LR (0.857 vs. 0.800). The most predictive feature in XGBoost was Short Form-36 physical and mental component summary scores (SF-36 MCS), followed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, Bone mineral density (BMD). In the LR analysis, lumbar spine disease, WOMAC pain, and BMD were statistically significant.

CONCLUSION

XGboost showed the best performance and was superior to conventional LR in the prediction of patient satisfaction after TKA. The SF-36 MCS was the most important feature in the ML model. WOMAC pain and BMD were meaningful variables and demonstrated a linear relationship with satisfaction in both the LR and ML models.

LEVEL OF EVIDENCE

Retrospective cohort study; Level of evidence 3.

Disease burden of and expectations from surgery in patients prior to total knee arthroplasty: Results of the prospective FInGK study

BACKGROUND

Disease burden in patients prior to total knee arthroplasty (TKA) varies widely between studies and countries. We aimed to characterize individuals undergoing TKA and examine their expectations from the surgery, focusing on variations in disease burden.

METHODS

Consecutive patients undergoing primary TKA in a German university hospital were recruited. A questionnaire including information on disease burden, preoperative expectations from surgery, health care utilization, demography, and socioeconomics was collected one day prior to surgery and linked to data from medical records. Patients were categorized into disease burden quartiles using the Western Ontario and McMaster Universities Osteoarthritis Index' (WOMAC) total score. Subsequently, study population's characteristics and expectations from surgery were analyzed stratified by disease burden.

RESULTS

A total of 196 patients were included (41 % male; mean age: 68.2 years). The median WOMAC was 52.0 (IQR: 41.0-58.0). Patients in Q1 were more often males (Q1: 63 % vs Q4: 29 %) and had a shorter duration of complaints with the impaired knee. They were also less restricted in social participation, reported less often signs of depression, and were less often treated with physiotherapy (Q1: 27 % vs Q4: 54 %). Furthermore, expectations from surgery were highest in patients with a low disease burden.

CONCLUSION

We found large variations in disease burden with a considerable number of patients undergoing TKA whose functional capacity is still maintained and for which guideline-recommended conservative treatment options are not fully exhausted. Further research on this subgroup as well as establishing an international consensus on specific thresholds for TKA indication are needed.

Good mid- to long-term results of the cemented oxford phase 3 unicompartmental knee arthroplasty in a non-designer centre

PURPOSE

Unicompartmental knee arthroplasty (UKA) provides patients with an alternative treatment to TKA in isolated medial compartment osteoarthritis providing better functional outcomes and faster recovery in the short term. Our aim was to quantify revision rates, predictors of revision, mortality rate and functionality of the Oxford Phase 3 UKA in a non-designer institution.

METHODS

This was a retrospective review of prospectively collected regional registry data. All Oxford Phase 3 UKAs performed for medial tibio-femoral osteoarthritis of the knee joint were included from a single academic institution between the period of January 1st 2006 and December 30th 2009. Kaplan-Meier survivorship curves adjusting for loss to follow-up and deceased patients were generated. Primary outcome variables included all-cause and aseptic revision. Secondary outcome variables included functional outcome scores. Patients were reviewed at 6 months, 2 years, 5 years, 10 years and 15 years.

RESULTS

A total of 64 cemented Oxford phase 3 UKAs were performed between January 2006 and November 2009. Fifteen-year follow-up data were available for 51 patients, of these 12 required revision. Survival rates, adjusting for patients that were either lost to follow-up or deceased, were 87.5% at 5 years, 81.4% at 10 years and 76.4% at 15 years. The overall aseptic revision rate at the time of review was 18.75% (n = 12). The only significant predictor of postoperative WOMAC score at 15 years was the preoperative WOMAC score (p = 0.03).

CONCLUSION

The Oxford Phase 3 UKA for medial tibio-femoral arthritis has promising outcomes at 15-year follow-up with a survival rate of 76.4% in a non-designer centre.

LEVEL OF EVIDENCE

III.

Excellent survival and outcomes with fixed-bearing medial UKA in young patients (≤ 60 years) at minimum 10-year follow-up

PURPOSE

To evaluate whether long-term (10-year minimum) patient outcomes and survival of fixed-bearing medial unicompartmental knee arthroplasty (UKA) in patients aged  ≤ 60 years were favorable despite non-conventional age criteria.

METHODS

The authors reviewed the records of 91 consecutive medial UKAs performed in patients aged ≤ 60 by a single surgeon. All patients received the same fixed-bearing M/G Unicompartmental Knee System. Patients records were updated, noting complications or revisions, and Oxford Knee Scores and overall satisfaction collected. If deceased, the general practitioner or next of kin provided data.

RESULTS

Of the initial 91 knees, 10 were revised, 6 were deceased, and 1 was lost to follow-up. The final cohort of 74 knees was aged 54.3 ± 4.3 years (range 41.8-60.6) at index surgery. Using revision of any component as endpoint, the present series had a KM survival of 92.9% (CI 84.8-96.7%) at 10 years, and 87.8% (CI 78.4-93.2%) at 15 years, and a single non-fatal DVT was reported. At final follow-up of 15 ± 1.3 years (range 11-18), OKS (available for all 74 knees) was 38.4 ± 8.4 (range 18-48). Overall patients were pleased or very pleased with 72 of the knees (97%).

CONCLUSION

Fixed-bearing medial UKA yields favorable results in the treatment of single compartment osteoarthritis of the knee in patients ≤ 60 years. The present study demonstrates low complication rates, good-to-excellent long-term patient outcomes, and satisfactory implant survival for this age group considering the advantages of UKA.

LEVEL OF EVIDENCE

Level IV, retrospective cohort study.