Effect of Total Hip Arthroplasty on Ipsilateral Lower Limb Alignment and Knee Joint Space Width: Minimum 5-Year Follow-up.

BACKGROUND: This study aimed to 1) assess the effect of total hip arthroplasty (THA) on coronal limb alignment, namely, the hip-knee-ankle angle (HKA), 2) identify factors that determine changes in the HKA, and 3) determine whether alignment changes influence the knee joint space width. METHODS: We retrospectively evaluated 266 limbs of patients who underwent THA. Three types of prostheses with neck shaft angles (NSAs) of 132°, 135°, and 138° were used. Several radiographic parameters were measured in the preoperative and final radiographs (at least 5 years after THA). A paired t-test was used to confirm the effect of THA on HKA change. Multiple regression analysis was performed to identify radiographic parameters related to HKA changes following THA and changes in knee joint space width. Subgroup analyses were performed to reveal the effect of NSA change on the HKA change, and the proportion of total knee arthroplasty usage and changes in radiographic parameters between maintained joint space and narrowed joint space groups were compared. RESULTS: The preoperative mean HKA was 1.4° varus and increased to 2.7° varus after THA. This change was related to changes in the NSA, lateral distal femoral angle, and femoral bowing angle. In particular, in the group with a decrease in NSA of > 5°, the preoperative mean HKA was largely changed from 1.4° varus to 4.6° varus after THA. The prostheses with NSA of 132° and 135° also led to greater varus HKA changes than those with an NSA of 138°. Narrowing of the medial knee joint space was related to changes in the varus direction of the HKA, decrease in NSA, increase in femoral offset. CONCLUSION: A large reduction in NSA can lead to considerable varus limb alignment after THA, which can have adverse effects on the medial compartment of the ipsilateral knee.

Delayed normalization of C-Reactive protein and erythrocyte sedimentation rate was not associated with inferior clinical outcomes after total knee arthroplasty.

BACKGROUND: The purpose of this study aimed to identify the proportion of patients with delayed normalization of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) after TKA, to determine postoperative thresholds predictive of prolonged elevation. Further, we aimed to determine if the clinical outcomes of patients with prolonged elevation were inferior to those without prolonged elevation. METHODS: The records of 211 unilateral and 320 bilateral TKA were reviewed. Patients were divided into the normal and elevation group based on CRP and ESR levels at 6 weeks and 3 months. The temporal pattern of CRP and ESR change in both groups was compared, and thresholds predictive of elevation at 6 weeks and 3 months were identified. Further, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and Tegner activity scale of both groups at 6 months, 1 year, and 2 years after TKA were compared. RESULTS: The proportion of patients with elevated CRP and ESR at 6 weeks and 3 months was CRP: 24.2%, 10%, ESR: 51.6%, 29.9% in unilateral and CRP: 31.5%, 10.6%, ESR: 58.1%, 42.7% in bilateral TKA. The thresholds for elevation at 6 weeks and 3 months were 9.5 mg/dL, 11.4 mg/dL (CRP at 6 weeks) and 81.5 mm/h, 74.5 mm/h (ESR at 3 months). There was no difference in the WOMAC score and Tegner activity scale between both groups. CONCLUSIONS: CRP and ESR are often elevated for a prolonged period even in the absence of infection after TKA. Such cases show distinct temporal patterns, which are predictable, and do not appear to have a significant effect on clinical outcome.

Effects of Intravenous Dexamethasone on Glycemic Control in Patients With Type 2 Diabetes Mellitus After Total Knee Arthroplasty.

BACKGROUND: We sought to determine whether administrations of intravenous (IV) dexamethasone jeopardize blood glycemic control, increase rates of postoperative complications, and diabetic medication change after TKA. METHODS: This retrospective study included 427 patients with DM who underwent TKA. Patients were divided into two groups according to the use of IV dexamethasone (Dexa and No Dexa). For the Dexa, IV dexamethasone (5mg) was administered twice (surgery day, postoperative day 1). Blood glucose level until postoperative day 5, whether the mean blood glucose level was ≥200 mg/dL or not, the rate of a diabetic medication change, and postoperative complications (surgical site infection, delayed wound healing) were analyzed. RESULTS: The adverse effects of IV dexamethasone on glycemic control were limited to the day of injection. The mean blood glucose level was 168.8 mg/dL and 204.4 mg/dL on operation day and 193.0 mg/dL and 210.5 mg/dL on postoperative day 1 in the No Dexa and the Dexa, respectively. High preoperative glycated hemoglobin (HbA1c) levels, but not IV dexamethasone administration, increased the risk of postoperative blood glucose level ≥200 mg/dL (odds ratio [OR], 2.810) and diabetic medication change (OR, 3.635, P < .001). A preoperative HbA1c level of >7.05% was associated with the risk of diabetic medication change. There was increase of postoperative complications (OR, 0.693, P = .552). CONCLUSIONS: IV dexamethasone have transient effects on increasing the blood glucose level after TKA in patients with DM. However, patients with a preoperative HbA1c level of ≥7.05% may need to change their diabetic medication after TKA, regardless of IV dexamethasone administration.

Effect of severity and cause of preoperative anemia on the transfusion rate after total knee arthroplasty.

This study aimed to (1) evaluate the preoperative Hb cut-off value for transfusion after unilateral and bilateral staged (1 week apart) TKAs, respectively, and (2) determine whether cause of preoperative anemia can affect transfusion rate after TKA. A total of 951 patients who underwent TKA (unilateral: 605, bilateral staged: 346) from 2016 to 2019 were reviewed retrospectively. Patient demographics, comorbidities, preoperative Hb level, surgery types, and cause of anemia were evaluated as possible risk factors. The cut-off values for preoperative Hb level to reduce transfusion after TKA were evaluated in each surgery type. Preoperative Hb level, surgery type, and cardiac disease were identified as the risk factors for transfusion after TKA, and preoperative Hb levels of 11.8 (AUC 0.88) and 12.8 (AUC 0.76) were the cut-off values for transfusion after unilateral and staged bilateral TKAs, respectively. Although transfusion rate was higher in anemia with iron deficiency (ID) group than anemia without ID group, preoperative Hb level was also lower in anemia with ID group than anemia without ID group. Single use of preoperative Hb level with different cut-offs depending on the surgery types can be useful indicator for preoperative optimization regardless of cause of anemia.

Subchondral Bone Condition and Intraoperative Grading of Cartilage Degeneration Underneath Patella Unrelated to the Clinical Outcome after TKA with Unresurfaced Patella.

The degree of cartilage degeneration assessed intraoperatively may not be sufficient as a criterion for patellar resurfacing in total knee arthroplasty (TKA). However, single-photon emission tomography/computed tomography (SPECT/CT) is useful for detecting osteoarthritic involvement deeper in the subchondral bone. The purpose of the study was to determine whether SPECT/CT reflected the cartilage lesion underneath the patella in patients with end-stage osteoarthritis (OA) and whether clinical outcomes after TKA without patellar resurfacing differed according to the severity of patellofemoral (PF) OA determined by visual assessment and SPECT/CT findings. This study included 206 knees which underwent TKA. The degree of cartilage degeneration was graded intraoperatively according to the International Cartilage Repair Society grading system. Subjects were classified into low and high uptake groups according to the degree of bone tracer uptake (BTU) on SPECT/CT in the PF joint. The Feller's patella score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed preoperatively and postoperative 1 and 2 years. The increased BTU in the PF joint was associated with more severe degenerative cartilage changes underneath the patella (p < 0.001). The risk for the presence of denudated cartilage was greater in the high uptake group (odds ratio = 5.89). There was no association between clinical outcomes and visual grading of patellar cartilage degeneration or the degree of BTU on SPECT/CT. The visual assessment of the degree of cartilage degeneration underneath the patella and preoperative SPECT/CT evaluation of the PF joint were not predictive of clinical outcome after TKA with unresurfaced patella.

Metabolic syndrome, not menopause, is a risk factor for hypertension in peri-menopausal women.

BACKGROUND: It has been long debated whether menopause itself is a risk factor for hypertension in peri-menopausal women. We aimed to assess the association between menopause and hypertension, and whether metabolic syndrome (MetS) has an influence on its effect. METHODS: Data for 1502 women aged 42 to 53 from the Korean Genome and Epidemiology Study (KoGES) database were retrospectively analyzed. The KoGES database consists of 10,038 participants, of which 52.6% (5275) were female. Subjects were followed up for 4 years, and compared according to menopausal status. Additionally, 1216 non-hypertensive subjects were separately analyzed to assess whether a change in menopausal status was associated with development of hypertension. RESULTS: The prevalence of hypertension, diabetes, and MetS for menopausal and non-menopausal subjects at baseline was 24.4% vs. 16.7%, 5.8% vs. 2.9%, and 25.4% vs. 16.6%, respectively (p < 0.01 for all comparisons). Among non-hypertensive subjects at baseline, prevalence of hypertension at 4-year follow-up was 9.4%, 19.7%, and 13.1% for non-menopausal, those who became menopause during follow-up, and those who were menopause at baseline, respectively. Development of hypertension was positively correlated with MetS (HR 3.90, 95% CI 2.51-6.07) and increased BMI (HR 1.09, 95% CI 1.03-1.16), while association with menopause was not significant. CONCLUSIONS: Menopause is closely associated with increased incidence of hypertension, but the increase may not be attributable to menopause itself but to increased prevalence of MetS.