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%).
Aims. The outcomes of total knee arthroplasty (TKA) depend on many factors. The impact of implant design on patient-reported outcomes is unknown. Our goal was to evaluate the patient-reported outcomes and satisfaction after primary TKA in patients with osteoarthritis undergoing primary TKA using five different brands of posterior-stabilized implant. Patients and Methods. Using our institutional registry, we identified 4135 patients who underwent TKA using one of the five most common brands of implant. These included Biomet Vanguard (Zimmer Biomet, Warsaw, Indiana) in 211 patients, DePuy/Johnson & Johnson Sigma (DePuy Synthes, Raynham, Massachusetts) in 222, Exactech Optetrak Logic (Exactech, Gainesville, Florida) in 1508, Smith & Nephew Genesis II (Smith & Nephew, London, United Kingdom) in 1415, and Zimmer NexGen (Zimmer Biomet) in 779 patients. Patients were evaluated preoperatively using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS), and 12-Item Short-Form Health Survey questionnaire (SF-12).
Background. Advanced technologies, like robotics, provide enhanced precision for implanting total knee arthroplasty (TKA) components; however, optimal component position and limb alignment remain unknown. This study purpose was to identify the ideal target sagittal component position and coronal limb alignment that produce optimal clinical outcomes. Methods. A retrospective review of 1,091 consecutive TKAs was performed. All TKAs were PCL retaining or sacrificing with anterior lipped (49.4%) or conforming bearings (50.6%) performed with modern perioperative protocols. Posterior tibial slope, femoral flexion, and tibiofemoral limb alignment were measured with a standardized protocols. Patients were grouped by the ‘how often does your knee feel normal?’ outcome score at latest follow-up. Machine learning algorithms were used to identify optimal alignment zones which predicted improved outcomes scores. Results. Mean age and BMI were 66 years and 34 kg/m. 2. with 67% female.
Introduction. Previous studies have demonstrated that higher volume hospitals have better outcomes following revision total knee arthroplasty (rTKA), in current literature there are no reports investigating the effect of surgeon volume. The purpose of this study is to investigate if patients of high-volume revision surgeons have better outcomes following rTKA as compared to patients of low volume surgeons. Methods. This retrospective observational analysis examined the rTKA database at a large urban academic medical center for aseptic, unilateral rTKA between January 2016 and March 2019 with at least 1-year of follow-up. Surgeon operative volume during the same time period was evaluated. Surgeons who performed at least 18 aseptic rTKA per year were considered high volume (HV), whereas surgeons who performed fewer than 18 aseptic rTKA per year were considered low volume (LV).
Aims. The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. Methods. We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data.
Introduction. Identifying knee osteoarthritis patient phenotypes is relevant to assessing treatment efficacy. Biomechanical variability has not been applied to phenotyping, yet features may be related to outcomes of total knee arthroplasty (TKA), an inherently mechanical surgery. This study aimed to i) identify biomechanical phenotypes among TKA candidates based on demographic and gait mechanic similarities, and ii) compare objective gait improvements between phenotypes post-TKA. Methods. TKA patients underwent 3D gait analysis one-week pre (n=134) and one-year post-TKA (n=105). Principal component analysis was applied to frontal and sagittal knee angle and moment gait waveforms, extracting major patterns of variability.
Medial unicompartmental knee arthroplasty (mUKA) is an advised treatment for anteromedial knee osteoarthritis. While long-term survival after mUKA is well described, reported incidences of short-term surgical complications vary and the effect of surgical usage on complications is less established. We aimed to describe the overall occurrence and treatment of surgical complications within 90 days of mUKA, as well as occurrence in high-usage centres compared to low-usage centres. mUKAs performed in eight fast-track centres from February 2010 to June 2018 were included from the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Database. All readmissions within 90 days of surgery underwent chart review and readmissions related to the surgical wound or the prosthesis were recorded. Centres were categorized as high-usage centres when using mUKA in ≥ 20% of annual knee arthroplasties. The occurrence of complications between high- and low-usage centres were compared using Fisher’s exact test.Aims
Methods
Introduction. Low serum Vitamin D (VitD) levels are often found in patients being investigated for Total Knee Arthroplasty (TKA). VitD deficiency is associated with poor pre/post-operative functional scores and higher rate of complications. Studies report VitD as an important modifiable risk factor to improve outcomes post TKA. Aim. Aim of our study was 1) To examine the trajectory of VitD in TKA patients over 2 weeks, which included VitD sufficient and deficient patients who were supplemented orally or intramuscularly (IM) for comparision. 2) To compare early (2weeks) functional recovery in VitD sufficient and deficient patients. Material & Methods. We prospectively enrolled patients undergoing primary TKA by a single surgeon. Based on preoperative VitD levels (25OH VitD ≥30 being sufficient or <30 ng/mL being deficient) and means of supplementation(none, IM or Oral Injection Arachitol, Cholecalciferol IP 6,00,000 IU), we formed three groups: Group A (VitD sufficient, no supplementation); Group B (VitD deficient, IM supplementation); and Group C (VitD deficient, Oral supplementation). Study was approved by ethics committee. All patients gave informed consent and underwent TKA by same surgeon with uniform intra/post-operative protocols. VitD deficiency was supplemented orally/IM on the morning of surgery based on their randomization sequence. VitD levels (ng/mL) and outcome parameters of Flexion (degrees) and Timed up-and-go (TUG) test in seconds were assessed preoperatively and postoperatively on Day 3 and 14. 60 patients (20 per group) were enrolled.
Introduction. Hip and knee replacements are being performed at increasing rates and currently account for one of the largest procedure expenditures in the Medicare budget. Outcomes of total knee replacement (TKR) depend on surgeon, patient and implant factors. The impact that the specific implants might have on patient-reported outcomes is unknown. The primary purpose of this study was to evaluate the patient-reported functional outcomes and satisfaction after primary total knee arthroplasty in patients with osteoarthritis who underwent TKR using five different brands of posterior-stabilized implants. Specifically, the aim was to evaluate for any difference in patient-reported outcomes based on implant brand used. The hypothesis was that there would be no difference in functional outcome that could be attributed to the implant used in primary TKR. Methods. Using our institution's total joint arthroplasty registry, we identified 4,135 patients who underwent total knee replacement (TKR) using one of the five most common implant brands used at our institution. These included Biomet Vanguard (N=211 patients), Depuy/Johnson&Johnson Sigma (N=221), Exactech OptetrakLogic (N=1,507), Smith & Nephew Genesis II (N=1,414), and Zimmer NexGen (N=779). Only posterior-stabilized primary TKRs in patients with osteoarthritis were included. Patients were evaluated preoperatively using the Knee Osteoarthritis Outcomes Score (KOOS), Lower Extremity Activity Scale (LEAS), and Short Form-12 (SF-12).
Introduction. New implants for total knee arthroplasty (TKA) are frequently introduced with the promise of improved performance. Infrequently there is accompanying data to document relative performance. The goal of this study was to evaluate the outcomes of an implant widely used for decades (Existing TKA), compared to a new implant (New TKA) from the same manufacturer. Methods. From October 2011-March 2015, 19 sites prospectively enrolled and implanted 752 Subjects with Existing TKA. Between November 2012 and May 2015, 23 sites (18 sites had enrolled Existing TKAs), implanted 1131 Subjects with the New TKA.
The aim of this study was to describe and compare joint-specific and generic health-related quality of life outcomes of the first versus second knee in patients undergoing staged bilateral total knee arthroplasty (BTKA) for osteoarthritis. This retrospective cohort study used Australian national arthroplasty registry data from January 2013 to January 2021 to identify participants who underwent elective staged BTKA with six to 24 months between procedures. The primary outcome was Oxford Knee Score (OKS) at six months postoperatively for the first TKA compared to the second TKA, adjusted for age and sex. Secondary outcomes compared six-month EuroQol five-dimension five-level (EQ-5D-5L) domain scores, EQ-5D index scores, and the EQ visual analogue scale (EQ-VAS) between knees at six months postoperatively.Aims
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To identify variables independently associated with same-day discharge (SDD) of patients following revision total knee arthroplasty (rTKA) and to develop machine learning algorithms to predict suitable candidates for outpatient rTKA. Data were obtained from the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) database from the years 2018 to 2020. Patients with elective, unilateral rTKA procedures and a total hospital length of stay between zero and four days were included. Demographic, preoperative, and intraoperative variables were analyzed. A multivariable logistic regression (MLR) model and various machine learning techniques were compared using area under the curve (AUC), calibration, and decision curve analysis. Important and significant variables were identified from the models.Aims
Methods
The diagnosis of periprosthetic joint infection (PJI) can be challenging as the symptoms are similar to other conditions, and the markers used for diagnosis have limited sensitivity and specificity. Recent research has suggested using blood cell ratios, such as platelet-to-volume ratio (PVR) and platelet-to-lymphocyte ratio (PLR), to improve diagnostic accuracy. The aim of the study was to further validate the effectiveness of PVR and PLR in diagnosing PJI. A retrospective review was conducted to assess the accuracy of different marker combinations for diagnosing chronic PJI. A total of 573 patients were included in the study, of which 124 knees and 122 hips had a diagnosis of chronic PJI. Complete blood count and synovial fluid analysis were collected. Recently published blood cell ratio cut-off points were applied to receiver operating characteristic curves for all markers and combinations. The area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values were calculated.Aims
Methods
The mid-term results of kinematic alignment (KA) for total knee arthroplasty (TKA) using image derived instrumentation (IDI) have not been reported in detail, and questions remain regarding ligamentous stability and revisions. This paper aims to address the following: 1) what is the distribution of alignment of KA TKAs using IDI; 2) is a TKA alignment category associated with increased risk of failure or poor patient outcomes; 3) does extending limb alignment lead to changes in soft-tissue laxity; and 4) what is the five-year survivorship and outcomes of KA TKA using IDI? A prospective, multicentre, trial enrolled 100 patients undergoing KA TKA using IDI, with follow-up to five years. Alignment measures were conducted pre- and postoperatively to assess constitutional alignment and final implant position. Patient-reported outcome measures (PROMs) of pain and function were also included. The Australian Orthopaedic Association National Joint Arthroplasty Registry was used to assess survivorship.Aims
Methods
Despite recent literature questioning their use, vancomycin and clindamycin often substitute cefazolin as the preoperative antibiotic prophylaxis in primary total knee arthroplasty (TKA), especially in the setting of documented allergy to penicillin. Topical povidone-iodine lavage and vancomycin powder (VIP) are adjuncts that may further broaden antimicrobial coverage, and have shown some promise in recent investigations. The purpose of this study, therefore, is to compare the risk of acute periprosthetic joint infection (PJI) in primary TKA patients who received cefazolin and VIP to those who received a non-cephalosporin alternative and VIP. This was a retrospective cohort study of 11,550 primary TKAs performed at an orthopaedic hospital between 2013 and 2019. The primary outcome was PJI occurring within 90 days of surgery. Patients were stratified into two groups (cefazolin vs non-cephalosporin) based on their preoperative antibiotic. All patients also received the VIP protocol at wound closure. Bivariate and multiple logistic regression analyses were performed to control for potential confounders and identify the odds ratio of PJI.Aims
Methods
Total knee arthroplasty (TKA) is a common and safe orthopaedic procedure. Zimmer Biomet's NexGen is the second most popular brand of implant used in the UK. The primary cause of revision after the first year is aseptic loosening. We present our experience of using this implant, with significant concerns around its performance with regards early aseptic loosening of the tibial component. A retrospective, single-surgeon review was carried out of all of the NexGen Legacy Posterior Stabilized (LPS) TKAs performed in this institute. The specific model used for the index procedures was the NexGen Complete Knee System (Legacy Knee-Posterior Stabilized LPS-Flex Articular Surface, LPS-Flex Femoral Component Option, and Stemmed Nonaugmentable Tibial Component Option).Aims
Methods
The aims of this study were to investigate the ability to kneel after total knee arthroplasty (TKA) without patellar resurfacing, and its effect on patient-reported outcome measures (PROMs). Secondary aims included identifying which kneeling positions were most important to patients, and the influence of radiological parameters on the ability to kneel before and after TKA. This prospective longitudinal study involved 209 patients who underwent single radius cruciate-retaining TKA without patellar resurfacing. Preoperative EuroQol five-dimension questionnaire (EQ-5D), Oxford Knee Score (OKS), and the ability to achieve four kneeling positions were assessed including a single leg kneel, a double leg kneel, a high-flexion kneel, and a praying position. The severity of radiological osteoarthritis (OA) was graded and the pattern of OA was recorded intraoperatively. The flexion of the femoral component, posterior condylar offset, and anterior femoral offset were measured radiologically. At two to four years postoperatively, 151 patients with a mean age of 70.0 years (SD 9.44) were included. Their mean BMI was 30.4 kg/m2 (SD 5.36) and 60 were male (40%). They completed EQ-5D, OKS, and Kujala scores, assessments of the ability to kneel, and a visual analogue scale for anterior knee pain and satisfaction.Aims
Methods
The aim of this study was to screen the entire genome for genetic markers associated with risk for anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injury. Genome-wide association (GWA) analyses were performed using data from the Kaiser Permanente Research Board (KPRB) and the UK Biobank. ACL and PCL injury cases were identified based on electronic health records from KPRB and the UK Biobank. GWA analyses from both cohorts were tested for ACL and PCL injury using a logistic regression model adjusting for sex, height, weight, age at enrolment, and race/ethnicity using allele counts for single nucleotide polymorphisms (SNPs). The data from the two GWA studies were combined in a meta-analysis. Candidate genes previously reported to show an association with ACL injury in athletes were also tested for association from the meta-analysis data from the KPRB and the UK Biobank GWA studies.Aims
Methods
Debate remains whether the patella should be resurfaced during total knee replacement (TKR). For non-resurfaced TKRs, we estimated what the revision rate would have been if the patella had been resurfaced, and examined the risk of re-revision following secondary patellar resurfacing. A retrospective observational study of the National Joint Registry (NJR) was performed. All primary TKRs for osteoarthritis alone performed between 1 April 2003 and 31 December 2016 were eligible (n = 842,072). Patellar resurfacing during TKR was performed in 36% (n = 305,844). The primary outcome was all-cause revision surgery. Secondary outcomes were the number of excess all-cause revisions associated with using TKRs without (versus with) patellar resurfacing, and the risk of re-revision after secondary patellar resurfacing.Aims
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Our purpose was to describe an unusual series of 21 patients with fungal osteomyelitis after an anterior cruciate ligament reconstruction (ACL-R). We present a case-series of consecutive patients treated at our institution due to a severe fungal osteomyelitis after an arthroscopic ACL-R from November 2005 to March 2015. Patients were referred to our institution from different areas of our country. We evaluated the amount of bone resection required, type of final reconstructive procedure performed, and Musculoskeletal Tumor Society (MSTS) functional score.Aims
Methods