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Hampp E, Shi S, Scholl L, Taylor KB, Marchand KB, Kahan ME, Chen Z, Marchand RC, Mont MA. The Association of Patient and Procedural Factors on Improved Outcomes: A Cluster Analysis on 853 Total Knee Arthroplasty Patients. J Knee Surg 2023; 36:1386-1390. [PMID: 36564042 DOI: 10.1055/s-0042-1758773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many studies involving robotic-assisted total knee arthroplasty (RATKA) have demonstrated superiority regarding soft tissue balance and consistency with alignment target achievement. However, studies investigating whether RATKA is associated with improved patient outcomes regarding physical function and pain are also important. Therefore, we performed a cluster analysis and examined factors that contributed to differences in patient-reported outcome measures (PROMs). Specifically, we analyzed: (1) reduced WOMAC (rWOMAC) scores regarding pain and function; (2) usage of RATKA; (3) common patient comorbidities; as well as (4) patient demographic factors. The rWOMAC score is an abbreviated PROM that includes pain and physical function domains. This study analyzed 853 patients (95 conventional and 758 robotic-assisted) who had completed preoperative, 6-month, and 1-year postoperative rWOMAC surveys. Two clusters were constructed using rWOMAC pain and function scores at 1 year. Cluster 1 included 753 patients who had better outcomes at 1 year (mean rWOMAC pain = 0.9, mean rWOMAC function = 1.4), and cluster 2 included 100 patients who had worse outcomes at 1 year (mean rWOMAC pain = 7.7, mean rWOMAC function = 10.4). The clusters were compared to determine (1) how scores improved and (2) what patient characteristics were significantly different between clusters. Cluster 1 demonstrated greater improvement from preoperative to 6 months or 1 year (p = 0.0013 for pain preoperative to 6 months, p< 0.0001 for other measures) and 6 months to 1 year (p< 0.0001). Comparisons demonstrated that cluster 1 had older patients (67 vs. 65 years, p = 0.0479) who had lower body mass index or BMIs (31.8 vs. 33.9 kg/m2, p = 0.0042) and no significant differences in sex (p = 0.7849). Cluster 1 also had a significantly higher percentage of RATKA patients (90 vs. 79%, p< 0.001). Cluster analyses provided differentiating factors which were associated with improved postoperative rWOMAC pain and function scores at 1 year. Patients undergoing robotic-assisted TKA were associated with better rWOMAC pain and function scores from preoperative to 6 months and 1 year.
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Affiliation(s)
- Emily Hampp
- Division of Joint Replacement, Stryker, Mahwah, New Jersey
| | - Sarah Shi
- Division of Joint Replacement, Stryker, Mahwah, New Jersey
| | - Laura Scholl
- Division of Joint Replacement, Stryker, Mahwah, New Jersey
| | - Kelly B Taylor
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
| | - Kevin B Marchand
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
| | - Michael E Kahan
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Robert C Marchand
- Department of Orthopaedic Surgery, Ortho Rhode Island, Wakefield, Rhode Island
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Nace J, Chen Z, Bains SS, Kahan ME, Gilson GA, Mont MA, Delanois RE. 1.5-Stage Versus 2-Stage Exchange Total Hip Arthroplasty for Chronic Periprosthetic Joint Infections: A Comparison of Survivorships, Reinfections, and Patient-Reported Outcomes. J Arthroplasty 2023; 38:S235-S241. [PMID: 36878441 DOI: 10.1016/j.arth.2023.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Management of periprosthetic joint infection after total hip arthroplasty (THA) has traditionally consisted of a 2-stage approach. However, 1.5-stage exchange has garnered recent interest. We compared 1.5-stage to 2-stage exchange recipients. Specifically, we assessed (1) infection-free survivorship and risk factors for reinfection; (2) 2-year surgical/medical outcomes (eg, reoperations, readmissions); (3) Hip Disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS-JR); and (4) radiographic outcomes (ie, progressive radiolucent lines, subsidences, and failures). METHODS We reviewed a consecutive series of 1.5-stage or planned 2-stage THAs. A total of 123 hips were included (1.5-stage: n = 54; 2-stage: n = 69) with mean clinical follow-up of 2.5 years (up to 8 years). Bivariate analyses assessed incidences of medical and surgical outcomes. Additionally, HOOS-JR scores and radiographs were evaluated. RESULTS The 1.5-stage exchange had 11% greater infection-free survivorship at final follow-up compared to 2 stages (94% versus 83%, P = .048). Morbid obesity was the only independent risk factor demonstrating increased reinfection among both cohorts. No differences in surgical/medical outcomes were observed between groups (P = .730). HOOS-JR scores improved markedly for both cohorts (1.5-stage difference = 44.3, 2-stage difference = 32.5; P < .001). A total of 82% of 1.5-stage patients did not demonstrate progressive femoral or acetabular radiolucencies, while 94% of 2-stage recipients did not have femoral radiolucencies and 90% did not have acetabular radiolucencies. CONCLUSION The 1.5-stage exchange appeared to be an acceptable treatment alternative for periprosthetic joint infections after THAs with noninferior infection eradication. Therefore, this procedure should be considered by joint surgeons for treatment of periprosthetic hip infections.
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Affiliation(s)
- James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael E Kahan
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Gregory A Gilson
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Sax OC, Angerett NR, Remily EA, Kahan ME, Delanois RE, Mont MA, Nace J. The Doctor of Osteopathic Medicine: The Affiliation to Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:e9. [PMID: 35980037 DOI: 10.2106/jbjs.22.00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Kahan ME, Chen Z, Angerett NR, Sax OC, Bains SS, Assayag MJ, Delanois RE, Nace J. Unicompartmental Knee Arthroplasty Has Lower Infection, Conversion, and Complication Rates Compared to High Tibial Osteotomy. J Knee Surg 2022; 35:1518-1523. [PMID: 36538939 DOI: 10.1055/s-0042-1757597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Isolated medial knee osteoarthritis can be surgically treated with either unicompartmental knee arthroplasty (UKA) or high tibial osteotomy (HTO). Proponents of UKA suggest superior survivorship, while HTO offers theoretically improved alignment and joint preservation delaying total knee arthroplasty (TKA). Therefore, we compared complications in a large population of patients undergoing UKAs or HTOs. We specifically assessed 90 days, 1 year, and 2 years: (1) periprosthetic joint infection (PJI) rates, (2) conversion to TKA rates, as well as (3) complication rates. METHODS A review of an administrative claims database was used to identify patients undergoing primary UKA (n = 13,674) or HTO (n = 1,096) from January 1, 2010 to December 31, 2019. Complication rates at 90 days, 1 year, and 2 years were compared between groups using unadjusted odds ratios (ORs) with 95% confidence intervals. Subsequently, multivariate logistic regressions were performed for PJI and conversion to TKA rates. RESULTS At all time points, patients who underwent UKA were associated with lower rates of infection compared with those who underwent HTOs (all OR ≤ 0.51, all p ≤ 0.010). After 1 year, patients who received UKAs were found to have lower risk of requiring a conversion to a TKA versus those who received HTOs (all OR ≤ 0.55, all p < 0.001). Complications such as dislocations, periprosthetic fractures, and surgical site infections were found at lower odds in UKA compared with HTO patients. CONCLUSION This study provides large-scale analyses demonstrating that UKA is associated with lower infection rates and fewer conversions to TKA compared with patients who have undergone HTO. Dislocations, periprosthetic fractures, and surgical site infections were also found to be lower among UKA patients. However, with careful patient selection, good results and preservation of the native knee are achieved with HTOs. Therefore, UKA versus HTO may be an important discussion to have with patients in an effort to lower the incidence of postoperative infections and complications.
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Affiliation(s)
- Michael E Kahan
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nathan R Angerett
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Oliver C Sax
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael J Assayag
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.,LifeBridge Health, Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- LifeBridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Kahan ME, Drumm JE, Chen Z, Malkani AL, Mont MA, Delanois RE, Nace J. Early Experience With New Femoral and Tibial Cones in Revision Total Knee Arthroplasty: A Case Series. Surg Technol Int 2022; 41:sti41/1621. [PMID: 36450147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Highly porous metaphyseal cones have proven useful in revision total knee arthroplasty in providing surgeons with improved metaphyseal fixation when large contained and uncontained bony defects are encountered. In this case series, we demonstrate three patients who received the latest generation of metaphyseal cones. Specifically, these cases will highlight this new system description and its operative techniques as well as the indications for metaphyseal cone use with various real-world applications. These newer-generation porous-coated cones are excellent options for large bone defects in the absence of infection, providing adequate metaphyseal fixation without constraining final implant positioning.
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Affiliation(s)
- Michael E Kahan
- 1Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Joshua E Drumm
- Providence Orthopedics and Sports Medicine, Spokane, Washington
| | - Zhongming Chen
- 1Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Arthur L Malkani
- Department of Orthopedics, University of Louisville, Louisville, Kentucky
| | - Michael A Mont
- 1Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | | | - James Nace
- 1Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Angerett NR, Yevtukh A, Ferguson CM, Kahan ME, Ali M, Hallock RH. Improving Postoperative Acute Kidney Injury Rates Following Primary Total Joint Arthroplasty. J Arthroplasty 2022; 37:S1004-S1009. [PMID: 34952163 DOI: 10.1016/j.arth.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Perioperative hip and knee arthroplasty complications remain a significant clinical and financial burden. Our institution has shifted to developing protocols to decrease these perioperative complications. This study focuses on acute kidney injury (AKI) rate status post primary total joint arthroplasty (TJA). Current literature demonstrates a 2%-15% incidence of AKI following TJA. However, there is a paucity of published literature on protocols that have effectively reduced AKI rates following TJA. The purpose of this study is to evaluate the effect that our institutionally developed perioperative renal protocol had on the postoperative AKI rates. METHODS A retrospective cohort study was performed. Patient demographics, baseline creatinine, and postoperative creatinine values during the patient's hospitalization were collected and analyzed. The preintervention cohort data contained all patients at our institution who underwent a primary TJA from November 1, 2016 to January 1, 2018. The postintervention cohort included all primary TJA patients from July 1, 2018 to February 2, 2020. AKI was defined using the AKI Network classification system comparing baseline and postoperative creatinine values. A multivariate analysis was performed to determine the statistical significance of our results. RESULTS Before intervention 1013 patients underwent a primary TJA with 68 patients developing an AKI postoperatively. After intervention 2169 patients underwent primary TJA with 90 patients developing an AKI (6.71% vs 4.15%; P = .0015, odds ratio = 0.59, 95% confidence interval = 0.42-0.82). CONCLUSION This study demonstrated that implementation of a perioperative renal protocol can significantly reduce AKI rates. A reduction in AKI rates following TJA will result in improved outcomes and secondarily decrease the financial impact of postoperative complications seen following TJA.
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Affiliation(s)
- Nathan R Angerett
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Rubin Institute for Advanced Orthopedics, Center for Joint Preservation & Replacement, Sinai Hospital of Baltimore, Baltimore, MD; Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD
| | | | | | - Michael E Kahan
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Rubin Institute for Advanced Orthopedics, Center for Joint Preservation & Replacement, Sinai Hospital of Baltimore, Baltimore, MD; Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Muzaffar Ali
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA
| | - Richard H Hallock
- Department of Orthopaedic Surgery, UPMC Harrisburg, Harrisburg, PA; Orthopedic Institute of Pennsylvania, Camp Hill, PA
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Angerett NR, Chen Z, Kromka JJ, Muzio AE, Kahan ME, Ingari JV, Maurer RJ. Rare septic arthritis of the wrist and carpus primary osteoarticular manifestation of Mycobacterium tuberculosis: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221102004. [PMID: 35619746 PMCID: PMC9127846 DOI: 10.1177/2050313x221102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
Mycobacterium tuberculosis is one of the oldest and most studied infections, yet it remains one of the most common causes of infection-related death worldwide. The majority concern pulmonary tuberculosis. Therefore, extrapulmonary cases are rare and are often neglected in the differential diagnosis, especially in chronic musculoskeletal complaints. Nevertheless, osteoarticular manifestation of tuberculosis can cause disabling destruction of bone, cartilage, and surrounding soft tissues which may be exacerbated by a delay in diagnosis. This case report documents a case of primary osteoarticular tuberculosis causing septic arthritis of the wrist and carpus. In our case, the patient had no pulmonary burden of tuberculosis, which further delayed diagnosis and lead to irreversible damage to the wrist as well as carpus. This case illustrates the need to consider this diagnosis in at risk populations in order to prevent a delay in diagnosis and treatment.
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Affiliation(s)
- Nathan R Angerett
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - Zhongming Chen
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Joseph J Kromka
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anna E Muzio
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
| | - Michael E Kahan
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
- Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD, USA
| | - John V Ingari
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Robert J Maurer
- Department of Orthopaedic Surgery, UPMC Pinnacle, Harrisburg, PA, USA
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